Health Assessment Exam 1 Flashcards
Which statement is true regarding the relationship of physical characteristics and culture?
a. Physical characteristics should be used to identify members of cultural groups.
b. There is a difference between distinguishing cultural characteristics and
distinguishing physical characteristics.
c. To be a member of a specific culture, an individual must have certain identifiable
physical characteristics.
d. Gender and race are the two essential physical characteristics used to identify
cultural groups.
There is a difference between distinguishing cultural characteristics and
distinguishing physical characteristics.
An image of any group that rejects its potential for originality or individuality is known as a(n)
a. acculturation
b. norm.
c. stereotype.
d. ethnos.
c. stereotype.
- Mr. L presents to the clinic with severe groin pain and a history of kidney stones. Mr. L’s son tells you that for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response?
a. ―With your father’s permission, we will examine the stone and request that it be
returned to him.‖
b. ―The stone must be sent to the lab for examination and therefore cannot be kept.‖
c. ―We cannot let him keep his stone because it violates our infection control policy.‖
d. ―We don’t know yet if your father has another kidney stone, so we must analyze
this one
a. ―With your father’s permission, we will examine the stone and request that it be
returned to him.
- The motivation of the healthcare professional to ―want to engage in the process of becoming culturally competent, not ―have to, is called
a. cultural knowledge.
b. cultural awareness.
c. cultural desire.
d. cultural skill.
c. cultural desire.
- Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem?
a. ―How often do you have medical examinations?‖
b. ―What is your age, race, and educational level?‖
c. ―What types of symptoms have you been having?‖
d. ―Why do you think you are having these symptoms?
d. ―Why do you think you are having these symptoms?
- The definition of ill or sick is based on a
a. stereotype.
b. cultural behavior.
c. belief system.
d. cultural attitude.
c. belief system.
- A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids eye contact and answers questions only by saying, ―Yeah,―No, or ―I guess so. Which of the following is appropriate for the interviewer to say or ask?
a. ―We will be able to communicate better if you look at me.‖
b. ―It’s hard for me to gather useful information because your answers are so short.‖
c. ―Are you uncomfortable talking with me?‖
d. ―Does your religion make it hard for you to answer my questions?
c. ―Are you uncomfortable talking with me?
- As you explain your patient’s condition to her husband, you notice that he is leaning toward you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to
a. tell him that you understand his need to be alone.
b. ask whether he has any questions.
c. ask whether he would prefer to speak to the clinician.
d. tell him that it is all right to be angry.
b. ask whether he has any questions.
- An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native Americans, Asians, and Middle Eastern groups is Western medicine’s attempts to
a. use a holistic approach that views a particular medical problem as part of a bigger
picture.
b. determine a specific cause for every problem in a precise way.
c. establish harmony between a person and the entire cosmos
d. restore balance in an individual’s life.
b. determine a specific cause for every problem in a precise way.
- The attitudes of the healthcare professional
a. are largely irrelevant to the success of relationships with the patient.
b. do not influence patient behavior.
c. are difficult for the patient to sense.
d. are culturally derived.
d. are culturally derived.
- Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care healthcare provider. Which of the following describes a physical, not a cultural, differentiator?
a. Race
b. Rite
c. Ritual
d. Norm
a. Race
- Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to
a. forego the examination for fear of violating cultural norms.
b. ask a colleague from the same geographic area if this examination is acceptable.
c. inform the patient of the reason for the examination and ask if it is acceptable to
him.
d. refer the patient to a provider more knowledgeable about cultural differences.
c. inform the patient of the reason for the examination and ask if it is acceptable to
him.
- Mr. Jones is a 45-year-old patient who presents to the office. A person’s definition of illness is likely to be most influenced by
a. race.
b. socioeconomic class.
c. enculturation.
d. age group.
c. enculturation.
- As the healthcare provider, you are informing a patient that he or she has a terminal illness. This discussion is most likely to be discouraged in which cultural group?
a. Navajo Native Americans
b. Dominant Americans
c. First-generation African descendants
d. First-generation European descendants
a. Navajo Native Americans
- Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group?
a. Native Americans
b. Hispanics
c. Chinese
d. Italians
c. Chinese
. An example of a cold condition is
a. a fever.
b. a rash.
c. tuberculosis.
d. an ulcer.
c. tuberculosis.
- Which variables can intrude on successful communication? (Select all that apply.)
a. Social class
b. Gender
c. Stereotype
d. Phenotype
e. Age
a. Social class
b. Gender
e. Age
- Campinha-Bacote’s Process of Cultural Competence Model includes which cultural constructs? (Select all that apply.)
a. Desire
b. Awareness
c. Thought processes
d. Skill
e. Language
a. Desire
b. Awareness
d. Skill
- Which question would be considered a ―leading question?
a. ―What do you think is causing your headaches?
b. ―You don’t get headaches often, do you?
c. ―On a scale of 1 to 10, how would you rate the severity of your headaches?
d. ―At what time of the day are your headaches the most severe?
b. ―You don’t get headaches often, do you?
- When are open-ended questions generally most useful?
a. During sensitive area part of the interview
b. After several closed-ended questions have been asked
c. While designing the genogram
d. During the review of systems
a. During sensitive area part of the interview
- Periods of silence during the interview can serve important purposes, such as
a. allowing the clinician to catch up on documentation.
b. promoting calm.
c. providing time for reflection.
d. increasing the length of the visit.
c. providing time for reflection.
- Mr. Franklin is speaking with you, the healthcare provider, about his respiratory problem. Mr. Franklin says, ―I’ve had this cough for 3 days, and it’s getting worse. You reply, ―Tell me more about your cough. Mr. Franklin states, ―I wish I could tell you more. That’s why I’m here. You tell me what’s wrong! Which caregiver response would be most appropriate for enhancing communication?
a. ―After 3 days, you’re tired of coughing. Have you had a fever?
b. ―I’d like to hear more about your experiences. Where were you born?
c. ―I don’t know what’s wrong. You could have almost any disease.
d. ―I’ll examine you and figure out later what the problem is.
a. ―After 3 days, you’re tired of coughing. Have you had a fever?
- After you ask a patient about her family history, she says, ―Tell me about your family now.‖ Which response is generally most appropriate?
a. Ignore the patient’s comment and continue with the interview.
b. Give a brief, undetailed answer.
c. Ask the patient why she needs to know.
d. Tell the patient that you do not discuss your family with patients.
b. Give a brief, undetailed answer.
- A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She seems nervous as she speaks to you. An appropriate response is to
a. continue to collect information regarding the chief complaint in an unhurried manner.
b. finish the interview as rapidly as possible.
c. ask the patient to take a deep breath and calm down.
d. ask the patient if she wants to wait until another day to talk to you.
a. continue to collect information regarding the chief complaint in an unhurried
manner.
- Ms. A states, ―My life is just too painful. It isn’t worth it.‖ She appears depressed. Which one of the following statements is the most appropriate caregiver response?
a. ―Try to think about the good things in life.
b. ―What in life is causing you pain?
c. ―You can’t mean what you’re saying.
d. ―If you think about it, nothing is worth getting this upset about.
b. ―What in life is causing you pain?
- You are collecting a history from a 16-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be
a. given the opportunity to be interviewed without the parent at some point during the
interview.
b. mailed a questionnaire in advance to avoid the need for them to talk.
c. ignored while you address all questions to the parent.
d. allowed to direct the flow of the interview.
a. given the opportunity to be interviewed without the parent at some point during the
interview.
- Information that is needed during the initial interview of a pregnant woman includes all the following except
a. the gender that the woman hopes the baby will be.
b. past medical history.
c. healthcare practices.
d. the woman’s remembering (knowledge) about pregnancy.
a. the gender that the woman hopes the baby will be.
- When interviewing older adults, the examiner should
a. speak extremely loudly, because most older adults have significant hearing
impairment.
b. provide a written questionnaire in place of an interview.
c. position himself or herself facing the patient.
d. dim the lights to decrease anxiety.
c. position himself or herself facing the patient.
- To what extent should the patient with a physical disability or emotional disorder be involved in providing health history information to the health professional?
a. The patient should be present during information collection but should not be
addressed directly.
b. All information should be collected from past records and family members while
the patient is in another room.
c. The patient should be involved only when you sense that he or she may feel
ignored.
d. The patient should be fully involved to the limit of his or her ability.
d. The patient should be fully involved to the limit of his or her ability.
- When taking a history, the nurse should
a. ask the patient to give you any information he or she can recall about his or her
health.
b. start the interview with the patient’s family history.
c. use a chronologic and sequential framework.
d. use a holistic and eclectic structure.
c. use a chronologic and sequential framework.
- When questioning the patient regarding his or her sexual history, which question should be asked initially?
a. ―Do you have any particular sexual likes or dislikes?
b. ―Do you have any worries or concerns regarding your sexual life?
c. ―How often do you have intercourse and with whom?
d. ―Do you have any reason to think you may have been exposed to a sexually
transmitted infection?
b. ―Do you have any worries or concerns regarding your sexual life?
- A guideline for history taking is for caregivers to
a. ask direct questions before open-ended questions so that data move from simple to complex.
b. ask for a complete history at once so that data are not forgotten between meetings.
c. make notes sparingly so that the patient can be observed during the history taking.
d. write detailed information as stated by patients so that their priorities are reflected.
c. make notes sparingly so that the patient can be observed during the history taking.
- Mr. D complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the
a. chief complaint.
b. past medical history.
c. personal and social history.
d. review of systems.
c. personal and social history.
- Direct questioning about domestic violence in the home should be
a. a routine component of history taking with all patients.
b. avoided for fear of offending the patient’s partner.
c. conducted only in cases in which there is a history of abuse.
d. used only when the patient is obviously being victimized.
a. a routine component of history taking with all patients.
- A tool used to screen adolescents for alcoholism is the
a. CAGE.
b. CRAFFT.
c. PACES.
d. HITS.
b. CRAFFT.
- Tom is a 16-year-old diabetic who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom’s health?
a. Attachment to parents
b. High self-esteem
c. Low peer support needs
d. Propensity for risk taking
d. Propensity for risk taking
- Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADL) is part of a(n)
a. ethnic assessment.
b. functional assessment.
c. genetic examination.
d. social history.
b. functional assessment.
- Constitutional symptoms in the ROS refer to
a. height, weight, and body mass index.
b. fever, chills, fatigue, and malaise.
c. hearing loss, tinnitus, and diplopia.
d. rashes, skin turgor, and temperature.
b. fever, chills, fatigue, and malaise.
- JM has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) _________ history.
a. complete
b. inventory
c. problem or focused
d. interim
c. problem or focused
- Which are appropriate for the interview setting with a patient? (Select all that apply.)
a. Playing music in the background
b. Ensuring comfort for all involved
c. Maintaining eye contact
d. Using a conversational tone
e. Keeping the door open
f. Removing physical barriers
b. Ensuring comfort for all involved
c. Maintaining eye contact
d. Using a conversational tone
f. Removing physical barriers
- 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.
d. after touching any body fluids or contaminated items, regardless of whether gloves
are worn.
- 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
b. The patient who has had multiple procedures or surgeries
- 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.
b. Assist the patient to remove any tight clothing.
- . 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.
d. variations in contour of the body surface.
- 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.
a. Drape the patient and observe the rectal area.
- 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
d. Ulnar surface
- The dorsal surface of the hand is most often used for the assessment of
a. crepitus.
b. temperature.
c. texture.
d. vibration.
b. temperature
- 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
d. Auscultation
- 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.
b. The less dense the medium, the louder the percussion tone.
- 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.
c. tympany over an empty stomach.
- 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.
c. the liver.
- 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.
b. Place the palmar surface of the nondominant hand on the body surface, with the
fingers slightly spread apart.
- During percussion, the downward snap of the striking fingers should originate from the
a. shoulder.
b. forearm.
c. wrist.
d. interphalangeal joint.
c. wrist.
- 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.
b. closing your eyes.
- 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.
b. Isolate each cycle segment.
- Auscultation should be carried out last, except when examining the
a. neck area
b. heart.
c. lungs.
d. abdomen
d. abdomen
- 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.
d. in the auditory canal.
- 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.
c. each time it is used.
- 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.
a. before the patient steps on the scale.
- 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
b. Supine on a measuring board
- 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.
c. myopia.
- The pneumatic attachment for the otoscope is used to evaluate
a. ear canal patency.
b. eardrum landmarks.
c. hearing acuity.
d. tympanic membrane movement.
d. tympanic membrane movement.
- 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.
d. tympanometer.
- 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.
c. hearing range of normal speech.
- 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
a. briskly tap the tendon with the rubber end of the hammer.
- 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
a. Brush and needle
- 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.
a. air, fluid, and tissue transmit light differentially.
- 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
a. Cold stirrups
c. Insertion of a speculum
e. Pressure during bimanual examination
- After the subjective and objective data have been prioritized, the next step is to
a. order laboratory tests.
b. formulate a problem list.
c. initiate appropriate referrals.
d. initiate therapy.
b. formulate a problem list.
- New findings of unknown causes are
a. problems to be noted on the problem list.
b. deferred for subsequent visits.
c. diagnosed before physical examination.
d. reserved for specialists.
a. problems to be noted on the problem list.
- Which is an accepted method of making a diagnosis?
a. Relying on intuition
b. Making maximal use of laboratory tests
c. Using first assumptions
d. Using algorithms
d. Using algorithms
- The adage that ―common problems occur commonly advises the practitioner to
a. always diagnose the patient’s problem in terms of what their practice usually sees.
b. refer any uncommon complaints to specialists as soon as possible.
c. not consider more than one diagnosis unless necessary.
d. examine uncommon problems critically before assuming that the issue is an unusual presentation of a common problem.
c. not consider more than one diagnosis unless necessary.
- The most important guide to sequencing actions should be
a. probability and utility.
b. assumption and intuition.
c. costs and risks of procedures.
d. reimbursement potential and patient acceptance.
a. probability and utility.
- Utilitarianism can be described as
a. balancing interests.
b. preventing harm.
c. choosing wisely.
d. doing good.
c. choosing wisely.
- Positive outcomes depend on the
a. number of laboratory tests ordered.
b. quality of decisions made.
c. use of pharmacologic modalities.
d. time saved by the use of ancillary personnel.
b. quality of decisions made.
- Self-analysis assists providers in giving proper context to
a. history and physical findings.
b. therapeutic options.
c. attitudes, values, and feelings.
d. differential diagnoses.
c. attitudes, values, and feelings.
- Medical decision making requires a balance between
a. trust and suspicion.
b. ethical and unethical behavior.
c. remembering and superstition.
d. mechanism and probabilism.
d. mechanism and probabilism.
- A valid history and physical examination can serve to
a. create higher healthcare costs.
b. limit the indiscriminate use of diagnostics.
c. threaten patient satisfaction.
d. increase the risk of liability.
b. limit the indiscriminate use of diagnostics.
- A specific test is one that has the ability to
a. correctly identify those who have the disease.
b. correctly identify those who do not have the disease.
c. be exclusively used to make a diagnosis.
d. exclude competing explanations for another test finding.
OBJ:Nursing process—diagnosis
b. correctly identify those who do not have the disease.
- Mr. Johnson actually has streptococcal pharyngitis; however, the throat culture is initially read as negative. This situation describes a test with a
a. low sensitivity.
b. high sensitivity.
c. high specificity.
d. low specificity.
a. low sensitivity.
- Which of the following is not a component of a management plan?
a. Presumptive diagnosis
b. Patient education
c. Diet modification
d. Physical therapy
a. Presumptive diagnosis
- When determining actions for the management plan, the practitioner should first address
a. problems in the order of their chronologic development.
b. the patient’s concern about a particular problem.
c. the patient’s social and economic circumstances.
d. the most urgent problem.
d. the most urgent problem.
- When utilizing a joint approach with the patient, which factors are likely to be considered? (Select all that apply.)
a. Consultations
b. Laboratory studies
c. Assistive technology
d. Patient education
e. Practitioner background
a. Consultations
b. Laboratory studies
c. Assistive technology
- Which part of the information contained in the patient’s record may be used in court?
a. Subjective information only
b. Objective information only
c. Diagnostic information only
d. All information
d. All information
- Ms. S reports that she is concerned about her loss of appetite. During the history, you learn that her last child recently moved out of her house to go to college. Rather than infer the cause of Ms. S’s loss of appetite, it would be better to
a. defer or omit her comments.
b. have her husband call you.
c. quote her concerns verbatim.
d. refer her for psychiatric treatment.
c. quote her concerns verbatim.
- Which is an effective adjunct to document the location of findings during the recording of the physical examination?
a. Relationship to anatomic landmarks
b. Computer graphics
c. Comparison with other patients of same gender and size
d. Comparison to previous examinations using light pen markings
a. Relationship to anatomic landmarks
- The position on a clock, topographic notations, and anatomic landmarks
a. are methods for recording locations of findings.
b. are used for noting disease progression.
c. are ways for recording laboratory study results.
d. should not be used in the legal record.
a. are methods for recording locations of findings.
- Regardless of the origin, discharge is described by noting
a. a grading scale of 0 to 4.
b. color and consistency.
c. demographic data and risk factors.
d. associated symptoms in alphabetic order.
b. color and consistency.
- Drawing of stick figures is most useful to
a. compare findings in extremities.
b. demonstrate radiation of pain.
c. indicate consistency of lymph nodes.
d. indicate mobility of masses.
a. compare findings in extremities.