Chapter 24: Putting it All Together

Question 1

Which is true regarding the relationship between the examiner and patient?
a. It is the examiner’s responsibility to help the patient understand that he or she is
qualified to make decisions regarding health care.
b. The patient must trust the examiner completely.
c. The examiner-patient relationship is enhanced by ignoring cultural issues.
d. The patient is a full partner with the examiner.

Answer 1

ANS: D
The patient is a full partner with the examiner. The examiner should keep the patient informed
and should develop a relationship to ensure trust. Cultural issues should be acknowledged, not
ignored. The examiner should keep the patient informed, but it is not the examiner’s
responsibility to help the patient understand that he or she is qualified to make healthcare
decisions. The examiner should develop a relationship to ensure trust, but it is not necessary
for the patient to trust the examiner completely.

Question 2

Which examiner behavior would help minimize your patient’s dissatisfaction?
a. Assume a busy and rushed attitude.
b. Convey your own feelings of discomfort.
c. Keep the patient waiting for more than 30 minutes.
d. Seek information about the patient’s problem.

Answer 2

ANS: D
When performing an examination, you are seeking information about the patient and the
problem that brings the patient to you. This process teaches you about the patient and teaches
the patient about your personal discipline, professional composure, and respect for others.

Question 3

An examiner might be able to help a patient who seems uncomfortable with close contact
during an examination by
a. acknowledging the discomfort.
b. backing away from the patient.
c. joking about the patient’s discomfort.
d. moving briskly to completion

Answer 3

ANS: A
Acknowledging the patient’s discomfort during the examination will help the patient feel
more relaxed. Your professional concern can be reassuring to the patient. You should explain
what you are doing to the patient before the assessment and what the patient will experience;
if not, you will run the risk of losing trust. The other choices would make the patient more
uneasy.

Question 4

When performing a history and physical assessment, the examiner should
a. change the sequence of observation with each interview.
b. develop a sequence of standard observations.
c. develop a preliminary diagnosis at the onset.
d. direct patient responses to fit the history sequence.

Answer 4

ANS: B
When performing a history and physical assessment, you should develop an approach that is
comfortable to you and ensures comfort for the patient. Part of the history can be obtained
while you are doing the physical examination.

Question 5

The examiner should develop a demeanor that is exemplified by which one of the following
behaviors?
a. Exhibits visible distaste about the condition.
b. Gives immediate reassurances to the patient.
c. Gives patient unsolicited advice.
d. Validates the patient’s justified concerns.

Answer 5

ANS: D
The examiner needs to learn a gentle and balanced demeanor. By showing concern for the
patient’s feelings, you gain the patient’s trust; giving unsolicited advice can cause the patient
to lose trust in the relationship.

Question 6

At your first meeting with a patient, it is usually best to say
a. ―Let’s get to the point.‖
b. ―I hope you will learn to trust me.‖
c. ―Let me tell you what I can do for you.‖
d. ―Tell me about yourself.‖

Answer 6

ANS: D
Take the time to ask open-ended questions to ensure that the patient has the opportunity to
report accurately. Too great an adherence to routine may prevent the true story from
emerging. The other statements are not open-ended, which would not allow the patient to
elaborate. In addition, they are not comforting statements and would make the patient feel
uncomfortable at the initial meeting.

Question 7

Which patient characteristic is most likely to limit patient reliability during history taking?
a. The patient’s measured IQ is above average.
b. The patient is alert and oriented to time and place.
c. The patient is depressed.
d. The patient speaks the same language as examiner.

Answer 7

ANS: C

Emotional constraints can limit a patient’s reliability as a historian. Language barriers,
cultural barriers, and an unresponsive or comatose patient can all affect a patient’s ability to
be a thorough historian. All the other options would not limit a patient’s reliability

Question 8

The reliability of health-related findings and observations is the responsibility of the
a. patient.
b. professional and medical assistants.
c. attending clinician.
d. professional and the patient.

Answer 8

ANS: D
It is the responsibility of the health professional and patient to present reliable findings and
observations. They work as a team.

Question 9

Which is most likely to enhance examiner reliability?
a. The examiner who seeks input from others.
b. The examiner is uncomfortable with his or her own skills.
c. The examiner believes that he or she must always be correct.
d. The examiner prejudges the patient and family.

Answer 9

ANS: A
As the examiner, you may not always be correct, but questioning yourself and seeking
confirmation from others when necessary will serve to assure your reliability. Showing that
you are uncomfortable with your skills can make the patient feel uncomfortable and see you
as unreliable. Believing that you must always be correct will not enhance your reliability as an
examiner. A person should never be prejudged, because this can interfere with the
examination and findings.

Question 10

Which statement accurately reflects the sensitivity and specificity of laboratory tests?
a. The gold standard test has 100% sensitivity and specificity.
b. Sensitivity and specificity are inversely correlated.
c. Sensitivity and specificity are directly correlated.
d. No test has 100% sensitivity and specificity.

Answer 10

ANS: D
No test has 100% sensitivity and specificity

Question 11

As you greet the patient, which examination technique is first implemented?
a. Auscultation
b. Inspection
c. Measurement
d. Palpation

Answer 11

ANS: B
Begin to inspect the patient as you greet him or her as you look for signs of distress or disease.
Inspect the appearance, gait, orientation, and difficulty in hearing or speech.

Question 12

Which data is not part of your general inspection?
a. Dress and habitus
b. Sinus tenderness
c. Gait
d. Facial expression

Answer 12

ANS: B
On meeting the patient, the facial expression, gait, dress, and habitus should be inspected.
Inspecting for sinus tenderness is performed afterward, if indicated.

Question 13

The sequence of the physical examination should be individualized to
a. minimize the number of times that the patient must change positions.
b. maximize the convenience of the examiner.
c. improve patient flow.
d. minimize the time that the patient is in the room

Answer 13

ANS: A
There is no one right way to put together the parts of the physical examination. The sequence
should be individualized to minimize the number of times the patient has to change positions
to conserve the patient’s energy.

Question 14

According to the usual examination procedure, you would first assist your patient to assume
which position?
a. Lithotomy
b. Prone
c. Sitting
d. Supine

Answer 14

ANS: C
On entering the examination room, you should assist the patient in the sitting position on the
examining table. In the sitting position, you can examine the patient’s anterior and posterior
upper trunk and head, which comprise most of the focused assessments.

Question 15

An ophthalmoscopic eye examination involves
a. lens inspection.
b. near vision evaluation.
c. sclera observation.
d. visual field assessment.

Answer 15

ANS: A
Ophthalmoscope eye examination involves testing the red reflex and inspecting the lens, disc,
cup margins, vessels, and retinal surface. The other assessments do not involve the use of the
ophthalmoscope

Question 16

Palpation of the epitrochlear nodes is part of the
a. examination of the upper extremities.
b. assessment of the chest and thorax.
c. palpation of the abdomen.
d. examination of the head and neck.

Answer 16

ANS: A
Palpation of the epitrochlear nodes is part of the examination of the upper extremities. To
palpate the epitrochlear nodes, support the elbow in one hand and palpate in the depression
above and posterior to the medial condyle of the humerus.

Question 17

Which are examined with the patient in a reclining 45-degree position?
a. Bilateral hips and popliteal angles
b. Facial bones and cranial nerves V and VII
c. Jugular venous pulsation and pressure
d. Oropharynx and thyroid gland placement

Answer 17

ANS: C
With the patient in a reclining 45-degree position, you can examine jugular venous pulsations
and measure jugular venous pressure. All the other choices can be examined with the patient
in a sitting position.

Question 18

Which patient position facilitates inspection of the chest and shoulders?
a. Sitting
b. Supine
c. Trendelenburg
d. Prone

Answer 18

ANS: A
With the patient in the sitting position, the examiner can inspect the chest and shoulders. The area being inspected is exposed for the examiner to do a thorough assessment. The other
positions are not used to assess the chest and shoulders.

Question 19

When assessing the abdomen, the examiner needs to expose the patient
a. from the waist down.
b. from the pubis to the epigastrium.
c. in entirety.
d. at no point during the examination.

Answer 19

ANS: B
While the patient is in the supine position, the examiner can assess the abdomen. Arrange
draping to expose the abdomen from the pubis to epigastrium, ensuring that the private areas
of the patient are covered.

Question 20

To inspect the abdominal muscles, ask the
a. supine patient to raise their head.
b. standing patient to bend forward.
c. prone patient to raise their lower legs.
d. standing patient to stand on tiptoes.

Answer 20

ANS: A
Asking the supine patient to raise his or her head will contract the rectus abdominis muscles,
which produces muscle prominence, making abdominal wall masses visible.

Question 21

Proprioception should be assessed while the patient is
a. prone.
b. supine.
c. seated.
d. standing.

Answer 21

ANS: D
The proprioception examination involves the Romberg test, heel to toe walking, standing on
one foot and then the other with the eyes closed, hopping in place, and deep knee bends. The
standing position is required to conduct these examinations.

Question 22

Examination of the patient in the lithotomy, or knee-chest, position includes
a. inspection for inguinal hernias.
b. palpation of anal sphincter tone.
c. percussion of pelvic structures.
d. stereognosis testing.

Answer 22

ANS: B
With the patient in the lithotomy position, the examiner can inspect the external and internal
female genitalia and perform a rectal examination to assess and palpate anal sphincter tone.
The other choices require the patient to be in the supine or standing position.

Question 23

Which portion of the physical examination is best done with the patient standing?
a. Spinal
b. Rectal
c. Neurologic
d. Musculoskeletal

Answer 23

ANS: A
With the patient in the standing position, the examiner can inspect and palpate the spine as the
patient bends over at the waist and can also test a patient’s range of motion.

Question 24

The greatest risk for potential health problems occurs in which age group?
a. Newborn
b. Toddler
c. School-age
d. Adolescence

Answer 24

ANS: A
Newborns have a greater risk for potential health problems than other age groups but also
have the potential for better health than the other age groups.

Question 25

A common method for estimating gestational age of a newborn is to assess
a. middle finger length.
b. creases on the sole of the foot.
c. umbilical placement.
d. visual acuity.

Answer 25

ANS: B
To determine gestational age, look at the soles of the feet. Before 36 weeks’ gestation, only
one or two transverse creases are present; by 40 weeks’ gestation, many creases are present on
the soles of the feet. Other clues to gestational age include a breast nodule less than 3 cm,
cartilage in the helix of the ear, descending of the scrotum and amount of rugae, and
extremities in flexed positions.

Question 26

To promote a child’s cooperation during your examination, your approach to the examination should be to
a. ask the parent to give the child a bottle during the examination.
b. sing songs with the child during the examination.
c. conduct the physical examination on the child while the parent is holding the child.
d. let the child play with examination room equipment to feel more comfortable

Answer 26

ANS: C
For children, the examination sequence depends on their cooperation for as long as possible.
To promote this, examine the child while the parent is holding the child, which maximizes
inspection and opportunities for physical examination.

Question 27

Which cannot be assessed in the crying infant?
a. Tactile fremitus
b. Respiratory rate
c. Lung excursion
d. Facial symmetry

Answer 27

ANS: B
Respirations cannot be counted in the crying infant. Tactile fremitus can be felt when the
infant is crying.

Question 28

The Ballard Gestational Age Test is completed within 36 hours of birth to
a. determine if the menstrual estimated age is correct.
b. determine if the newborn is premature.
c. determine an actual quantitative measure.
d. determine combined objective and subjective observations.

Answer 28

ANS: B
Because menstrual histories are inaccurate, the Ballard Gestational Age assessment tool
contains newborn characteristics that can determine prematurity.

Question 29

Mrs. Kia has brought her newborn infant in for a 2-week examination. The examination of the
newborn should begin with
a. inspection.
b. palpation.
c. vital signs.
d. auscultation.

Answer 29

ANS: A
The examination of a newborn should begin with inspection; skin color, flaccidity, tension,
gross deformities, or distortions of faces should be noted. All the other examination
techniques follow inspection.

Question 30

The best way to ease the apprehension of a 3-year-old child before a physical examination is
to
a. explain that you will be gentle
b. hand the child a picture book.
c. let the child hold the stethoscope while you listen.
d. tell the child that he or she will get a lollipop for good behavior.

Answer 30

ANS: C
The best way to ease the apprehension of a 3-year-old child before a physical examination is
to encourage the child to participate by helping you. Ask the child to hold the endpiece of the
stethoscope or to ―blow out‖ your flashlight.

Question 31

In crying infants, it is often difficult to
a. perform tactile fremitus assessments.
b. determine lung expansion.
c. auscultate heart sounds.
d. visualize the pharynx.

Answer 31

ANS: C
For the crying infant, lungs can be auscultated between consolable moments. While the infant
is crying, the examiner can assess the lustiness of cry, tactile fremitus, lung excursion, facial
symmetry, and appearance of the mouth and pharynx. Each time a breath is taken, heart tone
can be auscultated

Question 32

When you attempt to move a 10-month-old child from his mother’s lap to the examination
table, he screams loudly. Your best action is to
a. move the child to the examination table and proceed matter of factly with the
examination.
b. ask the mother to try to get the child to stop crying.
c. perform the examination while the child is in the mother’s lap.
d. defer the examination until another day.

Answer 32

ANS: C
The parent’s lap is a great examination table because it helps the child feel more at ease and is
also a good way to observe the nature of the parent-child relationship. All the other actions
would not comfort the patient or make the situation better.

Question 33

When conducting a geriatric assessment, keep in mind that basic activities of daily living
(ADL) include
a. bathing.
b. housekeeping.
c. medication compliance.
d. communication skills.

Answer 33

ANS: A
Basic ADL include bathing, dressing, toileting, ambulating, and feeding. All the other options
represent instrumental ADL.

Question 34

When examining a ―difficult‖ patient, it is best to allow which person in the examination
room?
a. The clinician
b. Patient’s small children
c. An interpreter
d. A chaperone

Answer 34

ANS: D
A chaperone for ―difficult‖ patients ensures the examination goes smoothly. The chaperone
may also assist with patient positioning.

Question 35

Functional assessment is most important during the examination of a(n)
a. adolescent.
b. infant.
c. older adult.
d. young adult.

Answer 35

ANS: C
Functional assessment is most important when examining the older adult. Initial observation
and interaction can provide a great deal of information about the individual’s independent
functional capacity. Attention should be given to self-care activities and instrumental
activities.

Question 36

Observation of the child playing in the playroom provides information about which two
systems?
a. Dermatologic and cardiovascular
b. Neurologic and musculoskeletal
c. Respiratory and ear, nose, and throat
d. Gastrointestinal and genitourinary

Answer 36

ANS: B
The child playing on the floor offers an opportunity to evaluate the musculoskeletal and
neurologic systems by noting the child’s coordination of activities, such as when throwing a
ball, drawing, coloring, walking, and jumping.

Question 37

Throughout the history and physical examination, the clinician should
a. concentrate on emotional issues.
b. follow an inflexible sequence.
c. evaluate the whole patient.
d. deal only with previously identified problems.

Answer 37

ANS: C
The clinician should evaluate the whole patient, including physical, emotional, and social
needs. Learning how to follow a disciplined course and be flexible will help the clinician
during the history and physical examination. The information obtained should be kept
organized to provide essential patient care.

Question 38

For a routine physical examination, which equipment is not necessary?
a. A penlight
b. A measuring tape
c. Examination gloves
d. A monofilament

Answer 38

ANS: D
A penlight, measuring tape, and examination gloves are needed for every routine examination;
a monofilament is not.

Question 39

The cranial nerves are usually assessed while the patient is in which position?
a. Standing
b. Supine
c. Sitting
d. Prone

Answer 39

ANS: C
While the patient is in the sitting position, you can assess all cranial nerve functions.

Question 40

Which action should the nurse take before auscultating bowel sounds in an 18-month-old
child?
a. Stand to the left of the child.
b. Palpate the abdomen.
c. Loosen the diaper.
d. Position the child prone

Answer 40

ANS: C
The diaper must be loosened so the nurse is able to place the stethoscope on the child’s skin
and not the diaper. Placing the stethoscope on the child’s diaper will interfere with the nurse’s
ability to hear the bowel sounds.

Question 41

Which position is most likely the most comfortable for a patient who is 6 months pregnant?
a. Side-lying
b. Lithotomy
c. Prone
d. Flexed-knee

Answer 41

ANS: A
Late in pregnancy, the patient may find it difficult to assume the lithotomy or supine position.
The nurse should position pillows so that the patient is in the side-lying position as much as
possible during the examination.

Question 42

What is the ―brown-bag approach‖ in regard to examining an older adult?
a. The patient’s stool sample is brought to the examination in a brown bag.
b. The patient’s medications are brought to the examination in a brown bag.
c. The patient’s change of clothes is brought to the examination in a brown bag.
d. The patient’s assistive device is brought to the examination in a brown bag.

Answer 42

ANS: B
Older adults are often asked to bring in all of their medications, prescription and
non-prescription, from all healthcare providers to their physical examination appointment.
This is referred to as the ―brown-bag approach

Question 43

Mrs. Jones is a 44-year-old patient who presents for a routine physical examination. The
patient is unable to shrug her shoulders against the examiner’s hands during the examination.
The cranial nerve involved with successful shoulder shrugging is CN .

Answer 43

ANS:
XI
Cranial nerve XI enables the patient to shrug her shoulders.

Question 44

Ms. Stein visits the nurse practitioner for an annual examination. The nurse practitioner tests
Ms. Stein’s tongue for movement and strength. The nurse practitioner is assessing CN
.

Answer 44

ANS:
XII
Cranial nerve XII enables the patient to demonstrate tongue movement and strength.