Chapter 3 Exam Techniques

Question 1

According to the guidelines for Standard Precautions, the caregiver’s hands should be washed
a. only after touching body fluids with ungloved hands and between patient contacts.
b. only after touching blood products with ungloved hands and after caring for
infectious patients.
c. only after working with patients who are thought to be infectious.
d. after touching any body fluids or contaminated items, regardless of whether gloves
are worn.

Answer 1

ANS: D
Handwashing is to be done after removal of gloves, between patient contacts, and after
touching body fluids, regardless of whether gloves are used. The nurse should never touch
body fluids or blood products with ungloved hands. The nurse should use hand hygiene
regardless of a patient’s possible infection.

Question 2

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

Answer 2

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

Question 3

Which initial action, in a patient with autonomic dysreflexia, would aid in lowering blood
pressure?
a. Have the patient lie on the left side.
b. Assist the patient to remove any tight clothing.
c. Recheck the blood pressure after 5 minutes.
d. Perform an EKG.

Answer 3

ANS: B
Autonomic dysreflexia occurs as a result of dysregulation of the autonomic nervous system.
Cutaneous or visceral stimulation below the level of the spinal cord injury initiates afferent impulses that elicit reflex sympathetic nervous system activity. This response leads to diffuse
vasoconstriction, which causes a rise in blood pressure. Helping the patient remove any tight
clothing can help lower blood pressure.

Question 4

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.

Answer 4

ANS: D
Tangential lighting is used to cast shadows to observe contours and variations in body
surfaces best.

Question 5

You are caring for a nonambulatory 80-year-old male patient and he tells you, a 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 doctor 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.

Answer 5

ANS: A
Necessary exposure for direct observation, while adjusting for modesty, is warranted. The
complaint warrants validation before referral or delegation. Before you call the clinician, you
need to assess the patient. The assessment should not wait for another shift. Before treatment,
it is important to assess the complaint.

Question 6

You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand
is best for palpating vibration?
a. Dorsal surface
b. Finger pads
c. Fingertips
d. Ulnar surface

Answer 6

ANS: D
The ulnar surface of the hand and bases of the fingers can best feel vibratory sensations such
as thrills and fremitus. The dorsal surface of the hand is best for assessing temperature. The
finger pads and fingertips are best for palpating pulses.

Question 7

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

Answer 7

ANS: B
The dorsal surface, or back of the hand, is best for assessing warmth, or temperature. The
palmar surface, rather than the dorsal surface, is best for assessing crepitus. The palmar
surface, rather than the dorsal surface, is best for assessing texture. The ulnar surfaces of the
hand and fingers, rather than the dorsal surface, are best for assessing vibration.

Question 8

Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal
pain. You have completed the inspection of the abdomen. What is your next step in the
assessment process?
a. Light palpation
b. Deep palpation
c. Percussion
d. Auscultation

Answer 8

ANS: D
Auscultation precedes palpation or percussion of the abdomen because these techniques can
stimulate peristalsis, which may alter correct assessment of the abdominal sounds. Light
palpation, deep palpation, and percussion should not be completed until auscultation is
completed.

Question 9

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 muscle areas produces the loudest percussion tones.

Answer 9

ANS: B
Percussion sounds vary according to the tissue being percussed. Less dense tissue (such as
that over normal lungs) produces a loud tone, whereas more dense tissue (such as a muscle)
produces a softer tone. The more dense the medium, the softer is the percussion tone. The
more hollow the area, the louder is the percussion tone. Percussion tones over muscle are soft
and flat.

Question 10

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

Answer 10

ANS: C
A normal lung produces resonance percussion tones, whereas an empty stomach is expected
to produce tympany. Dullness indicates atelectasis of the lung. Hyperresonance over the lungs
indicates emphysema. Flatness occurs over muscle.

Question 11

During percussion, a dull tone is expected to be heard over
a. healthy lung tissue.
b. emphysemic lungs.
c. the liver.
d. most of the abdomen.

Answer 11

ANS: C
Dull tones are expected over denser areas such as the liver. Healthy lung tissue is resonant.
Emphysemic lungs are hyperresonant. Tympany is heard over most of the abdomen.

Question 12

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. Place the ulnar surface of the nondominant hand on the body surface, with the
fingers together.
d. Place the ulnar surface of the nondominant hand on the body surface, with the
fingers slightly spread apart.

Answer 12

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

Question 13

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

Answer 13

ANS: C
The downward snap of the striking fingers should originate from the wrist.

Question 14

Which technique is commonly used to elicit tenderness arising from the liver, gallbladder, or
kidneys?
a. Finger percussion
b. Palmar percussion
c. Fist percussion
d. Forearm percussion

Answer 14

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

Question 15

During auscultation, you can limit your perceptual field best by
a. asking patients to describe their symptoms.
b. closing your eyes.
c. performing auscultation before percussion.
d. using an aneroid manometer

Answer 15

ANS: B
By closing your eyes, your sense of hearing becomes more acute, and it increases your ability
to isolate sounds. Asking patients to describe their symptoms does not assist in the technique
of auscultation. The only time that auscultation occurs before percussion is in examination of
the abdomen. Using an aneroid manometer does not assist in the technique of auscultation.
During auscultation, the only equipment needed is the stethoscope.

Question 16

You are auscultating a patient’s chest. The sounds are not clear, and you are having difficulty
distinguishing between respirations and heartbeats. Which 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.

Answer 16

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. Anticipating the next sounds will not facilitate the
assessment. Listening to all sounds together will not facilitate the assessment. One of the most
difficult achievements in auscultation is learning to isolate sounds. Moving the stethoscope
clockwise will not facilitate the assessment.

Question 17

Auscultation should be carried out last, except when examining the
a. neck area.
b. heart.
c. lungs.
d. abdomen.

Answer 17

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

Question 18

Tympanic thermometers measure body temperature when a probe is placed
a. anterior to the ear.
b. posterior to the ear.
c. under the ear.
d. in the auditory canal.

Answer 18

ANS: D
Tympanic thermometer probes are placed at the external opening of the auditory canal.

Question 19

A scale used to assess patients’ weight should be calibrated
a. only by the manufacturer.
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.

Answer 19

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. The manufacturer
does not calibrate the scale after it is sold. A qualified technician does not calibrate the scale at
regularly scheduled intervals. Scales cannot be calibrated with the patient standing on the
scale.

Question 20

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

Answer 20

ANS: A
To ensure patient safety, the arm of the height-measuring attachment should be pulled up
before the patient steps on the scale, after the scale is balanced, and before weight is assessed.

Question 21

The infant should be placed in which position to have his or her height or length measured?
a. Vertically, with the examiner’s hands under the infant’s axillae
b. Supine on a measuring board
c. Prone on a measuring board
d. In the lateral position, with the toes against a measuring board

Answer 21

ANS: B
The infant should be placed supine on a measuring board to measure height or length.

Question 22

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. myopia.
d. strabismus.

Answer 22

ANS: C
Rotating the lens selector compensates for myopia (nearsightedness) or hyperopia
(farsightedness) in the examiner and patient.

Question 23

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

Answer 23

ANS: D
The pneumatic attachment on the otoscope produces a puff of air directed to the tympanic
membrane, resulting in its movement. The pneumatic attachment for the otoscope is not used
to evaluate ear canal patency, eardrum landmarks, or hearing acuity. Ear canal patency is
assessed by visually inspecting the ear. Hearing acuity is assessed by the whisper test.

Question 24

Mr. Walters, a 32-year-old patient, tells you that his ears are ―stopped up.‖ An objective
assessment of this complaint is achieved by using the
a. tuning fork.
b. reflex hammer.
c. otoscope with pneumatic attachment.
d. tympanometer.

Answer 24

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. The tuning fork
assesses vibration. The reflex hammer assesses tendon reflexes. The otoscope with pneumatic
attachment assesses tympanic membrane movement

Question 25

Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure
a. buzzing or tingling sensations.
b. buzzing from bone conduction.
c. hearing range of normal speech.
d. noise above the threshold level.

Answer 25

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

Question 26

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.

Answer 26

ANS: A
Deep tendon reflexes are measured by quickly and firmly tapping either end of the rubber
hammer on the stretched tendon and then observing muscle movement.

Question 27

A variant of the percussion hammer is the 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

Answer 27

ANS: A
The neurologic hammer unscrews at the handle to reveal a soft brush, and the knob on the
head unscrews to reveal an attached sharp needle.

Question 28

Transillumination functions on the principle that
a. air, fluid, and tissue transmit light differentially.
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.

Answer 28

ANS: A
Transillumination functions to differentiate between various media in a cavity. It can
distinguish among air, fluid, and tissue.

Question 29

Which of the following are the causes of hyperreflexia? (Select all that apply.)
a. Cold stirrups
b. Standard scale
c. Insertion of a speculum
d. Fever
e. Pressure during bimanual examination

Answer 29

ANS: A, C, E
Hyperreflexia is often caused by a cold, hard, examination table, cold stirrups, insertion or
manipulation of a speculum, or pressure during bimanual or rectal examinations.