Chapter 8 - Assessment Techniques and the Clinical Setting

Question 1

Deep palpation is used to..

Answer 1

identify abdominal contents

Question 2

At the end of the examination, the examiner should

Answer 2

review the findings with the patient

Question 3

When should the examiner use hand washing instead of an alcohol-based hand rub?

Answer 3

if the patient has an infection with Clostridium difficile

Question 4

What is the order of inspection?

Answer 4

inspection, palpation, percussion, and auscultation

Question 5

Palpation

Answer 5

applies your sense of touch to assess these factors: texture, temperature, moisture, organ location and size, as well as any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses, and presence of tenderness or pain.

Question 6

Palpation: Fingertips

Answer 6

Fingertips—best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps

Question 7

Palpation: A grasping action of the fingers and thumb

Answer 7

to detect the position, shape, and consistency of an organ or mass

Question 8

Palpation: The dorsa (backs) of hands and fingers

Answer 8

best for determining temperature because the skin here is thinner than on the palms

Question 9

Palpation: Base of fingers (metacarpophalangeal joints) or ulnar surface of the hand

Answer 9

best for vibration

Question 10

Percussion
What is the middle finger called that gets struck?
What is the striking finger called?

Answer 10

is tapping the person’s skin with short, sharp strokes to assess underlying structures.

The strokes yield a palpable vibration and a characteristic sound that depicts the location, size, and density of the underlying organ.

Middle Finger = pleximeter
striking finger = plexor

Question 11

Percussion has the following uses:

Answer 11

• Mapping out the location and size of an organ by exploring where the percussion note changes between the borders of an organ and its neighbors.
• Signaling the density (air, fluid, or solid) of a structure by a characteristic note.
• Detecting an abnormal mass if it is fairly superficial; the percussion vibrations penetrate about 5 cm deep—a deeper mass would give no change in percussion.

•Eliciting a deep tendon reflex using the percussion hammer. (Jarvis 116)
Jarvis, Carolyn. Physical Examination and Health Assessment, 6th Edition. Saunders, 2012. VitalBook file.

Question 12

Characteristics of Percussion Notes: Resonant

Answer 12

Over normal lung tissue

Question 13

Characteristics of Percussion Notes: Hyperresonant

Answer 13

Normal over child’s lung

Abnormal in the adult, over lungs with increased amount of air, as in emphysema

Question 14

Characteristics of Percussion Notes: Tympany

Answer 14

Over air-filled viscus (e.g., the stomach, the intestine)

Question 15

Characteristics of Percussion Notes: Dull

Answer 15

Relatively dense organ, as liver or spleen

Question 16

Characteristics of Percussion Notes: Flat

Answer 16

When no air is present, over thigh muscles, bone, or over tumor

Question 17

Stethoscope: Diaphragm

Answer 17

(most often used) flat edge is best for high-pitched sounds—breath, bowel, and normal heart sounds.

Question 18

Stethoscope: Bell

Answer 18

It is best for soft, low-pitched sounds such as extra heart sounds or murmurs. Hold it lightly against the person’s skin—just enough that it forms a perfect seal.

Question 19

tangential lighting

Answer 19

(directed at an angle), which will highlight pulsations and body contours better than perpendicular lighting

Question 20

goniometer

Answer 20

to measure joint range of motion

Question 21

Doppler sonometer

Answer 21

to augment pulse or blood pressure measurement

Question 22

fetoscope

Answer 22

for auscultating fetal heart tones

Question 23

pelvimeter

Answer 23

to measure pelvic width

Question 24

Always wash hands when…

Answer 24

patients are infected with spore-forming organisms (e.g., Clostridium difficile or Bacillus anthracis)