Chapter 03: Examination Techniques and Equipment

Question 1

Guidelines for Standard Precautions indicate that mask and eye protection or a face mask should be worn while performing a. suture removal. b. trachea care and suctioning. c. wet-to-dry dressing changes. d. patient bathing. e. tube feedings.

Answer 1

ANS: B Masks and eye protection or a face mask are indicated during procedures that are likely to generate splashes or sprays of body fluids, which include endotracheal secretions. REF: p. 31

Question 2

Standard Precautions apply to all patients a. with bloodborne infections. b. with infected, draining wounds. c. in intensive care units. d. receiving care in hospitals. e. believed to have an infectious disease.

Answer 2

ANS: D Although all of these statements are true, the best answer is patients receiving care in hospitals. Standard Precautions were developed with the intent of application to the care of all hospitalized patients; however, the standard has merit and should be applied to all cases of patient care regardless of the environment where care is delivered.

Question 3

According to the guidelines for Standard Precautions a. hand washing is not needed between tasks and procedures on the same patient. b. the caregiver’s hands should be washed only after touching blood products with ungloved hands and after caring for infectious patients. c. the caregiver’s hands should be washed only after working with patients who are thought to be infectious. d. the caregiver’s hands should be washed after touching any body fluids and contaminated items regardless of whether gloves are worn. e. the caregiver’s hands should be washed only after touching body fluids with ungloved hands and between patient contact.

Answer 3

ANS: D Hand washing should be done after removal of gloves, between patient contact, and after touching body fluids regardless of whether gloves are used. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross contamination of body parts. REF: p. 31

Question 4

Which patient is at the highest risk for the development of latex allergy? a. A new patient who has no chronic illness and has never been hospitalized b. A patient who has had multiple procedures or surgeries c. A patient who is allergic to eggs d. A patient who is allergic to contrast dye e. A patient who is a vegetarian

Answer 4

ANS: B A patient who has had multiple procedures or surgeries has a higher exposure rate to rubber gloves and to equipment and supplies that contain latex and therefore is at a higher risk for developing an allergic response. REF: p. 30

Question 5

One recommendation to prevent latex allergy is to a. wear latex gloves frequently to reduce sensitivity. b. forcefully snap off examination gloves to remove excess powder from the gloves. c. wash hands with mild soap after removing gloves and then dry the hands thoroughly. d. use well-powdered gloves with an increased protein content. e. use oil-based creams or lotions before donning gloves.

Answer 5

ANS: C The recommendations are to use nonlatex gloves for situations not likely to involve infectious materials, not to use oil-based creams or lotions, to wash hands with mild soap and dry thoroughly after removing gloves, and to use powder-free latex gloves with a reduced protein content. Forcefully snapping off latex gloves disperses latex molecules in the air, which can lead to the most severe reactions. REF: p. 32

Question 6

Which patient position is useful for auscultating heart tones? a. Lithotomy b. Dorsal recumbent c. Left lateral recumbent d. Right Sims e. Prone

Answer 6

ANS: C The left lateral recumbent position places the left ventricle closer to the chest wall and is recommended for hearing low-pitched sounds such as the third and fourth heart sounds. REF: p. 32

Question 7

Which technique is used during the history taking and the physical examination process? a. Auscultation b. Instrumentation c. Palpation d. Percussion e. Inspection

Answer 7

ANS: E Inspection is the technique used while gathering and validating data during the history taking and the actual hands-on physical examination. REF: p. 32

Question 8

Which examination technique should be used first? a. Deep palpation b. Inspection c. Percussion d. Auscultation e. Light palpation

Answer 8

ANS: B Inspection, the process of systematic observation, is the first technique used in an examination. REF: p. 32

Question 9

The use of secondary, tangential lighting is most helpful in the detection of a. variations in skin color. b. enlarged tonsils. c. foreign objects in the nose or ear. d. variations in contour of the body surface. e. variations in texture and mobility.

Answer 9

ANS: D Tangential lighting is used to cast shadows so as to best observe contours and variations in body surfaces. All the other choices are best observed with direct lighting that does not cast shadows. REF: p. 33

Question 10

A nonambulatory 80-year-old male patient tells the female nurse that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate? a. Drape the patient and observe the rectal area. b. Tell the patient that his physician will be notified of his problem. c. Tell the patient that you will ask the male nurse on the next shift to check on the problem. d. Give the patient an ice pack to apply to the area. e. Give the patient a specimen cup to collect the drainage.

Answer 10

ANS: A Necessary exposure for direct observation, while adjusting for modesty, is warranted. The complaint warrants validation before referring or delegating. REF: p. 33

Question 11

You are conducting a head to toe examination as part of a patient’s preventive health assessment. The room has adequate lighting, and you have access to both sides of the examining table. What position should you assume while conducting this examination? a. Behind the patient b. To the left side of the patient c. Seated in a chair in front of the patient d. To the right side of the patient e. Standing in front of the patient

Answer 11

ANS: D Although conventionally taught to approach an examination from the patient’s right side, it is not always practical. Therefore, it is important that the examiner develop the skills necessary to approach either side of the patient. REF: p. 33

Question 12

Which part of the examiner’s hand is best for palpating vibration? a. Dorsal surface b. The thumb c. Fingertips d. Ulnar surface and base of the fingers e. Finger pads

Answer 12

ANS: D The ulnar surface of the hand and the base of the fingers can best feel vibratory sensations such as thrills and fremitus. REF: p. 33

Question 13

The dorsal surface of the hand is most often used for the assessment of a. crepitus. b. thrills. c. texture. d. vibration. e. temperature.

Answer 13

ANS: E The dorsal surface, or back of the hand, can best feel for warmth. REF: p. 33

Question 14

When conducting the abdominal examination, after you inspect, you proceed next to a. percussion. b. deep palpation. c. the rectal examination. d. auscultation. e. light palpation.

Answer 14

ANS: D Auscultation precedes palpation or percussion of the abdomen because these techniques can stimulate peristalsis, which may alter the correct assessment of abdominal sounds. The rectal examination is performed at a point after a full abdominal examination is completed. REF: p. 35

Question 15

The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone? a. The more dense the medium, the louder the percussion tone. b. The less dense the medium, the louder the percussion tone. c. The more hollow the area percussed, the quieter the percussion tone. d. Percussion over bony areas produces the loudest percussion tones. e. Percussion tones are produced by the structure immediately beneath the skin.

Answer 15

ANS: B Percussion sounds vary according to the tissue being percussed. Whereas less dense tissue (e.g., over a normal lung) produces a loud tone, more dense tissue (e.g., a muscle) produces a softer tone. Percussion tones arise from vibrations 4 to 6 cm deep in the body tissue. REF: p. 34

Question 16

Expected normal percussion tones include a. dullness over the lungs. b. hyperresonance over the lungs. c. tympany over an empty stomach. d. flatness over an empty stomach. e. resonance over the liver.

Answer 16

ANS: C Whereas a normal lung produces resonance percussion tones, an empty stomach is expected to produce tympany. Dull percussion tones are heard over the liver. REF: p. 34

Question 17

When percussing, a dull tone is expected to be heard over a. most of the abdomen. b. emphysemic lungs. c. the liver. d. healthy lung tissue. e. an empty stomach.

Answer 17

ANS: C Dull tones are expected over more dense areas such as the liver. REF: p. 34

Question 18

When using mediate or indirect percussion, which technique is appropriate? a. Place the palmar surface of the nondominant hand on the body surface with the fingers held together. b. Place the palmar surface of the nondominant hand on the body surface with the fingers slightly spread apart. c. Mediate or indirect percussion involves striking the finger or hand directly against the body. d. Place the ulnar surface of the nondominant hand on the body surface with the fingers slightly spread apart. e. Place the ulnar surface of the nondominant hand on the body surface with the fingers together.

Answer 18

ANS: B The palmar surface of the nondominant (stationary) hand should rest against the body surface, with the fingers spread slightly. To improve eliciting correct tones, a helpful tip is to hyperextend the middle finger of the stationary hand and place the distal interphalangeal joint of the middle finger firmly against the body surface. This lifting of the fingertip avoids dampening the vibratory sounds. REF: p. 34

Question 19

During percussion, the downward snap of the striking fingers should originate from the a. wrist. b. forearm. c. shoulder. d. interphalangeal joint. e. elbow.

Answer 19

ANS: A The dominant hand’s middle finger strikes the stationary finger with a wrist motion and is lifted quickly off the striking surface. REF: p. 34

Question 20

Which technique is commonly used to elicit tenderness arising from the liver, gallbladder, or kidneys? a. Finger percussion b. Only indirect percussion techniques are ever used to elicit tenderness. c. Fist percussion d. Thumb percussion e. Palmer percussion

Answer 20

ANS: C Fist percussion is a direct percussion technique used to elicit tenderness over organs such as the liver, gallbladder, or kidneys. REF: p. 34

Question 21

During auscultation, you can limit your perceptual field best by a. asking patients to describe their symptoms. b. listening through the patient’s clothing. c. closing your eyes. d. performing palpation before percussion. e. turning out the lights in the examination room.

Answer 21

ANS: C By closing your eyes, your sense of hearing becomes more acute, increasing your ability to isolate sounds. REF: p. 35

Question 22

You are auscultating a patient’s chest. The sounds are not clear, and you are having difficulty distinguishing between respirations and heartbeats. What technique can you use to facilitate your assessment? a. Anticipate the next sounds. b. Isolate each cycle segment. c. Listen to all sounds together. d. Move the stethoscope clockwise. e. Ask the patient to whisper his or her name.

Answer 22

ANS: B If you are hearing everything at once, it is more difficult to distinguish different sounds. Try isolating each segment and listen to that segment intently; then move on to another segment. For example, listen only to breath sounds, then only to inspiratory breath sounds, and then only to expiratory breath sounds. REF: p. 35

Question 23

When examining the abdomen, which technique should be used first? a. Inspection b. Light palpation c. Percussion d. Auscultation e. Direct palpation

Answer 23

ANS: A Inspection is always used as the first technique in all physical examinations, including the abdomen. REF: p. 32

Question 24

Auscultation should be carried out last except when examining a. the neck area. b. the abdomen. c. the lungs. d. the heart. e. none of the above; auscultation is always carried out last in a proper physical examination.

Answer 24

ANS: B Auscultation is the last examination technique used for all areas except the abdomen. In this case, it is performed after inspection. REF: p. 35

Question 25

Which of the following statements is true regarding tympanic membrane temperature? a. It is taken by placing an infrared probe anterior to the ear. b. The probe is placed in the external auditory canal to occlude it. c. Temperatures taken with a tympanic thermometer never vary from those taken by the oral or rectal route. d. It is an accurate measurement of body temperature because the tympanic membrane shares its blood supply with the hypothalamus. e. It is taken by placing an infrared probe posterior to the ear.

Answer 25

ANS: D The tympanic membrane shares its blood supply with the hypothalamus and is therefore an accurate measurement of body temperature. Tympanic thermometer probes are gently placed at the external opening of the ear canal, but not in the canal, and they should not occlude the canal. REF: p. 39

Question 26

A scale used to assess a patient’s weight should be calibrated a. when the patient tells you the weight is not correct. b. by a qualified technician at regularly scheduled intervals. c. each time it is used. d. when necessary, with the patient standing on the scale. e. only by the manufacturer.

Answer 26

ANS: C Obtaining weight begins with a manual calibration of the scale before the patient stands on the scale. Electronic scales are automatically calibrated before each reading. REF: p. 37

Question 27

The height-measuring attachment of the standing platform scale should be pulled out a. before the patient steps on the scale. b. before the scale is balanced. c. after the patient steps on the scale. d. while the weight is being determined. e. only after the weight has been assessed.

Answer 27

ANS: A To ensure patient safety, the arm of the height measuring attachment should be pulled up before the patient steps on the scale. REF: p. 37

Question 28

An infant should be placed in which position to have his or her height or length measured? a. Vertical, with the examiner’s hands under the infant’s axilla b. Supine on a measuring board c. While being held by a parent d. In the lateral position with the toes against a measuring board e. Prone on a measuring board

Answer 28

ANS: B An infant should be placed supine on a measuring board to measure height or length. REF: p. 37

Question 29

The stethoscope’s diaphragm is most useful in the assessment of _____ sounds. a. high-pitched b. dull c. low-pitched d. rhythmic e. tympanic

Answer 29

ANS: A The diaphragm is best for hearing high-pitched sounds, such as breath sounds, bowel sounds, and normal heart tones. REF: p. 39

Question 30

Which of the following occurs when firm pressure is used to apply the stethoscope’s bell endpiece to the skin? a. It transmits low-pitched sounds. b. It functionally converts to a diaphragm endpiece. c. Assessment findings are more accurate. d. Most sounds are occluded. e. Abnormally low sounds are better transmitted.

Answer 30

ANS: B Applying firm pressure to the bell endpiece causes the skin to act as a diaphragm, obliterating the low-pitched sounds. REF: p. 39

Question 31

A rubber or plastic ring should be around the bell endpiece of a stethoscope to a. prevent the transmission of static electricity. b. avoid cold metal from touching the patient. c. prevent the sharp edge of the stethoscope from damaging the patient’s skin. d. allow firm pressure to be applied without discomfort. e. ensure secure contact with the body surface.

Answer 31

ANS: E The ring around the bell portion of the stethoscope functions to secure contact with body surfaces when placed lightly on the skin. REF: p. 40

Question 32

Which technique should be used to stabilize the stethoscope during auscultation? a. The tubing should be held lightly near the endpiece. b. The tubing should be held firmly near the endpiece. c. The endpiece should be held between the second and third fingers. d. The endpiece should be covered with the examiner’s flattened hand. e. The endpiece should be held with all the examiner’s fingers.

Answer 32

ANS: C To stabilize the stethoscope at the desired location, the endpiece should be held in place with the second and third fingers. REF: p. 40

Question 33

Weak pulses, fetal heart activity, and vessel patency are all best assessed with which type of stethoscope? a. Diaphragm end of an acoustic stethoscope b. Electronic c. Ultrasonic d. Magnetic e. Bell end of an acoustic stethoscope

Answer 33

ANS: C Only the ultrasonic stethoscope, the Doppler, can detect blood flow rather than amplify sounds, which is needed in assessing weak pulses, fetal heart activity, and vessel patency. REF: p. 41

Question 34

You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise and then counterclockwise to compensate for a. amblyopia. b. astigmatism. c. cataracts. d. strabismus. e. myopia.

Answer 34

ANS: E Rotating the lens selector compensates for myopia (nearsightedness) and hyperopia (farsightedness) in the examiner and the patient. REF: p. 42

Question 35

A patient in the emergency department has a concussion to the head. You suspect that the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient? a. Strabismoscope b. Red-free filter c. Slit lamp d. Small aperture e. Grid

Answer 35

ANS: B The red-free filter permits recognition of hemorrhages. The grid estimates the size of lesions, the slit lamp examines the anterior eye and assesses the elevation of lesions, and the small aperture is used with small pupils. The strabismoscope is used for detecting strabismus. REF: p. 42

Question 36

The Tumbling “E” vision acuity chart would most likely be used for _____ patients. a. older b. infant c. pregnant d. preschool e. color-blind adult

Answer 36

ANS: D The E chart is used for children 3 to 5 years of age and others who do not know the alphabet. The examinee is asked which way the “E” points. REF: p. 43

Question 37

Which type of speculum should be used to examine a patient’s tympanic membrane? a. The smallest speculum that will illuminate the ear b. The largest speculum that will fit comfortably in the ear c. The shortest speculum available d. Any speculum that will fit the otoscope head e. The longest speculum available

Answer 37

ANS: B To visualize the tympanic membrane adequately, the largest speculum that can comfortably fit in the car canal should be used. The other choices do not ensure greater visibility of the membrane and landmarks. REF: p. 45

Question 38

The pneumatic attachment for the otoscope is used to evaluate a. ear canal patency. b. eardrum landmarks. c. hearing acuity. d. tympanic membrane movement. e. tympanic membrane temperature.

Answer 38

ANS: D The pneumatic attachment on the otoscope produces a puff or air to the tympanic membrane, resulting in its movement. REF: p. 45

Question 39

The patient tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using a(n) a. nasal speculum. b. neurologic hammer. c. otoscope with pneumatic attachment. d. tympanometer. e. tuning fork.

Answer 39

ANS: D This patient is describing eustachian tube dysfunction. The tympanometer measures compliance of the middle ear as air pressures are varied. It is an objective means of assessing the function of the ossicular chain, eustachian tube, and tympanic membrane. REF: p. 45

Question 40

Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure a. vibratory sensations. b. hearing from bone conduction. c. hearing range of normal speech. d. noise above the threshold level. e. peripheral motor nerve damage.

Answer 40

ANS: C Normal speech has a range of 300 to 3000 Hz; therefore, a 500- to 1000-Hz fork is used most often because it can estimate hearing loss in the range of normal speech. REF: p. 46

Question 41

To perform a deep tendon reflex measurement, you should a. briskly tap the tendon with the rubber end of the hammer. b. place the hammer firmly on the tendon for 3 to 5 seconds. c. tap the silver end of the hammer on the tendon. d. use the needle implement to determine sensory perception. e. never use the pointed end to strike your finger placed over a tendon.

Answer 41

ANS: A Deep tendon reflexes are tested by quickly and firmly tapping either end of the rubber hammer on the stretched tendon and then observing muscle movement. The pointed end is particularly useful in small areas, such as on your finger placed over the patient’s biceps tendon. REF: p. 46

Question 42

A variant of the percussion hammer is a neurologic hammer, which is equipped with which of the following? a. Brush and needle b. Tuning fork and cotton swab c. Penlight and goniometer d. Ruler and bell e. Transilluminator

Answer 42

ANS: A A neurologic hammer unscrews at the handle to reveal a soft brush, and the knob on the head unscrews, to which a sharp needle is attached. REF: p. 46

Question 43

When monitoring serial measurements, such as head circumference or abdominal girth, which procedure is best to ensure that the tape measure is placed in the same position each time? a. Record the anatomic location for tape placement in the patient’s chart. b. Mark the borders of the tape at several intervals on the skin with a pen. c. Demonstrate proper tape placement to all members of the health care team. d. Ask the same person to perform the measurement each time. e. Ask the patient if the tape measure is on the same spot.

Answer 43

ANS: B The most effective procedure to ensure correct serial measurements is to mark the borders at several intervals so that with the next measurements, the tape is in the same location. REF: p. 47

Question 44

Transillumination functions on the principle that a. infrared radiation is easily detected. b. black light causes certain substances to fluoresce. c. converging and diverging light brings structures into focus. d. tangential light casts shadows that illuminate contours. e. air, fluid, and tissue transmit light differentially.

Answer 44

ANS: E Transillumination functions to differentiate between various media in a cavity. It can distinguish among air, fluid, and tissue. It consists of a strong light in the visible spectrum with a narrow beam. REF: p. 47

Question 45

When performing transillumination of a body cavity, the use of which of the following could be harmful to the patient? a. Penlight b. Performing the test in a darkened room c. Halogen bulb d. Otoscope light e. Flashlight

Answer 45

ANS: C A penlight, flashlight, or an otoscope light can safely be used; a halogen bulb can burn the skin. The test should be performed in a darkened room. REF: p. 47

Question 46

For a woman with a small vaginal opening, the examiner should use a _____ speculum. a. plastic Graves b. Pederson c. pediatric d. nasal e. metal Graves

Answer 46

ANS: B The Pederson speculum has blades that are as long as those of the Graves speculum, but are narrower and flatter and are therefore more comfortable for women with small vaginal openings. Pediatric or nasal speculums would be too small for adult use. Plastic speculums are similar in use to their metal counterparts. REF: p. 47

Question 47

You are performing a vaginal examination on a patient with a history of spina bifida. As you insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation? a. Replace the metal speculum with a plastic one. b. Put a blanket over the patient’s legs. c. Remove the speculum. d. Take her blood pressure. e. Raise her legs above her heart.

Answer 47

ANS: C This patient is experiencing symptoms of autonomic hyperreflexia. The first reaction should be for the examiner to remove the source of the stimulation. Cold tables, stirrups, insertion of a speculum, and pressure during pelvic examinations are examples of stimulations. REF: p. 37