Seidel's

Question 1

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 1

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

Question 2

The nurse assesses the patient’s nails and finds transverse white bands that cover the nail except
for a narrow zone at the distal tip. Additional physical examination of this patient should include
a. palpation of the liver.
b. auscultation for carotid bruits.
c. inspection for jaundice.
d. fist percussion of the kidney.
e. chest percussion.

Answer 2

ANS: C
White banding of this nature describes Terry nails, which are usually associated with cirrhosis and hypoalbuminemia. Cirrhosis results in jaundice (icterus). The liver is scarred but not
generally enlarged; carotid bruits and lung and kidney involvement are not directly related.

Question 3

Which of the following groups has the greatest variation in pulse rate?

a. Toddlers
b. Premature infants
c. Neonates
d. Adolescents
e. Older adults

Answer 3

ANS: B
The pulses of the newborn are easily palpable. Rates close to 200 beats/min may occur in
neonates.

Question 4

Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more and
doesn’t hang around his friends, and recently his girlfriend broke up with him. Your most immediate
question is to ask Kyle

a. “Do you want to see a counselor today?”
b. “Is your father out of jail yet?”
c. “Are you taking any illegal drugs?”
d. “Have you made plans to harm yourself?”
e. “What sexual practices did you have with your girlfriend?”

Answer 4

ANS: D
If you sense that a patient is contemplating suicide, you should ask about suicidal ideation directly.

Question 5

J.M. 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
e. family

Answer 5

ANS: C
If the patient is well known or if you have been seeing the patient for the same problem over time, a
focused history is appropriate.

Question 6

Soft, painless, bluish papules in persons who are HIV-positive are most likely

a. Kaposi sarcoma (KS).
b. malignant melanoma.
c. molluscum contagiosum.
d. pityriasis rosea.
e. herpes zoster.

Answer 6

ANS: A
KS is the more common malignant skin lesion of HIV-infected persons. The lesions are soft,
painless, bluish-purple macules or papules.

Question 7

The perception of pain:

a. is the same across cultures.
b. does not apply to neonates.
c. is predictable with the same circumstances.

d. is affected by emotions and quality of sleep.
e. is not affected by age.

Answer 7

ANS: D
The perception of pain is variable and is affected by emotions, cultural background, sleep
deprivation, previous pain experience, and age. Perception of pain is different among cultures
and does apply to neonates.

Question 8

Which technique is used during the history taking and the physical examination process?

a. Auscultation
b. Instrumentation
c. Palpation
d. Percussion
e. Inspection

Answer 8

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

Question 9

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 9

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.

Question 10

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 10

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.

Question 11

Which is the most reliable indicator of a patient’s pain?

a. Facial grimacing
b. Grunting or groaning
c. Body movements
d. Reluctance to be moved
e. Patient’s report of the pain

Answer 11

ANS: E
The patient’s report of pain is the most reliable indicator of pain and should be believed even
when observed behaviors do not seem to correspond.

Question 12

Which of the following is not involved in increasing body temperature?

a. Pyrogens
b. Vasoconstriction
c. Shivering
d. Vasodilation
e. Prostaglandins

Answer 12

ANS: D
Body cooling occurs by vasodilation, which increases heat loss through the skin and evaporation
of perspiration.

Question 13

When examining the abdomen, which technique should be used first?

a. Inspection
b. Light palpation
c. Percussion
d. Auscultation
e. Direct palpation

Answer 13

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

Question 14

Nociceptors transmit pain impulses from the periphery along A-delta and C-polymodal fibers to the

a. posterior horn of the spinal cord.
b. hypothalamus.
c. cerebellum.
d. dorsal horn of the spinal cord.
e. pons.

Answer 14

ANS: D
Pain impulses travel from the site of injury to the dorsal horn of the spinal cord and then through
the ascending spinal tracts to the thalamus and cerebral cortex.

Question 15

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 15

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.

Question 16

The nurse assesses the nail base angle using the Schamroth technique. The normal expected examination finding is nail beds that are _____ at the bases.

a. flat
b. convex
c. concave
d. bowed
e. elevated

Answer 16

ANS: C
The normal nail base angle should be 160 degrees, which results in a concave nail base that
produces a diamond-shaped window with the Schamroth technique.

Question 17

Women with terminal hair growth in a male distribution pattern should receive further evaluation for a(n)

a. circulation condition.
b. gastrointestinal disorder.
c. inflammatory state.

d. nutritional deficit.
e. endocrine disorder.

Answer 17

ANS: E
Hirsutism in women (growth of terminal hair in a male distribution) can be a clinical sign of an
endocrine disorder. Hair loss can be associated with poor circulation, inflammation, or
nutritional deficits.

Question 18

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 18

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.

Question 19

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 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.

Question 20

The nurse assesses the blood pressure to be 140/62 mm Hg and records 78 as the

a. pulse pressure.
b. pulse deficit.
c. afterload pressure.
d. preload pressure.
e. stroke volume.

Answer 20

ANS: A
The formula is: Systolic pressure – diastolic pressure = pulse pressure. Pulse deficit occurs when
the number of pulse beats counted at the radial pulse is less than those counted at the same time
at the heart. Afterload and preload are not measured according to blood pressures. Stroke volume
cannot be determined from the blood pressure.

Question 21

Which examination technique should be used first?

a. Deep palpation
b. Inspection
c. Percussion
d. Auscultation
e. Light palpation

Answer 21

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

Question 22

Pain is difficult to assess in older adults because

a. their histories are usually unreliable.
b. sharp pain may be felt as a dull ache.
c. they tend to exaggerate symptoms.
d. their language skills decline.
e. drugs act more rapidly with age.

Answer 22

ANS: B
Pain is often an unreliable symptom in older adults because they lose pain perception and experience
pain in a different manner from those in other age groups.

Question 23

The value of the use of scales for patients to rate their pain intensity is that

a. the emotional responses are factored in.
b. correlation with others’ expectations is achieved.

c. the patient’s response to therapy can be documented.

d. subjective responses are eliminated.
e. the patient’s perception is minimized.

Answer 23

ANS: C
The use of scales permits the very important day to day documentation of the response to
therapy. Although the patient’s perception is the controlling variable, the patient is still giving a
subjective measurable response.

Question 24

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 concern 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.
e. ignore her, because anxiety rarely accompanies physical disorders.

Answer 24

ANS: A
With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor communicates caring to
the patient.

Question 25

The nurse inspects an annular lesion. What type of additional lighting source should be used for further assessment?

a. Florescent lighting
b. Wood’s lamp
c. Goose-neck lamp
d. Sunlight
e. Cobalt blue

Answer 25

ANS: B
Annular lesions are characteristic of tinea, which are fluorescing lesions that illuminate as
yellow-green under a Wood’s lamp.

Question 26

During history taking, a mother states that her son awoke in the middle of the night complaining of intense itching on his legs. Today your inspection reveals honey-colored exudate from the vesicular rash on his legs. Which condition is consistent with these findings?

a. Exanthem
b. Impetigo
c. Solar keratoses
d. Trichotillomania
e. Drug eruption

Answer 26

ANS: B
Impetigo causes intense pruritus, regional lymphadenopathy, and honey-colored exudative
crusting as the vesicles or bullae rupture and dry.

Question 27

2. To prevent personal appearance from becoming an obstacle in patient care, the health care professional should
   a. wear a uniform.
   b. always wear a white coat.
   c. avoid extremes in dress.
   d. avoid wearing any jewelry.
   e. avoid wearing white.

Answer 27

ANS: C
Sensible personal habits, along with avoidance of extremes in behavior and dress, contribute to
establishing a trusting relationship between the provider of care and the patient. Uniforms help
identify roles rather than relationships.

Question 28

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 28

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.

Question 29

Which of the following is considered an IADL but not an ADL?

a. Paying bills
b. Toileting
c. Walking around the house
d. Dressing oneself
e. Eating

Answer 29

ANS: A
Paying bills is an instrumental activity of daily living but not an activity of daily living.
PTS: 1 REF:

Question 30

Tangential lighting is best used for inspecting skin

a. color.
b. turgor.
c. exudates.
d. symmetry.
e. contour.

Answer 30

ANS: E
Tangential lighting, light shined laterally to the surface, is best for inspecting skin contours.

Question 31

During pregnancy, all of the following may be related to back pain except

a. lax pelvic ligaments.
b. weight gain.
c. hyperlordosis.
d. anterior tilt of the pelvis.
e. lower blood pressure.

Answer 31

ANS: E
Blood pressure commonly decreases beginning at about 8 weeks of gestation, gradually falling
until a low point is reached at midpregnancy, but this is unrelated to the back pain some women
experience during pregnancy.

Question 32

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 32

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.

Question 33

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 33

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.

Question 34

Café au lait patches are numbered with each assessment of infants and young children because
a. their numbers are expected to increase each year.

b. coalescent lesions are a more serious finding.
c. the presence of more than six patches suggests neurofibromatosis.
d. decreasing numbers are expected with growth.
e. a higher number correlates with the development of erythema toxicum.

Answer 34

ANS: C
The presence of more than six patches with diameters of more than 5 mm in children younger than 5 years of age suggests neurofibromatosis. Fewer than five patches are usually considered harmless.

Question 35

Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish

a. cutaneous tags from lentigines.
b. furuncles from folliculitis.
c. sebaceous hyperplasia from eczema.
d. seborrheic keratoses from actinic keratoses.

e. herpes zoster from varicella.

Answer 35

ANS: D
Actinic keratoses have malignant potential, and seborrheic keratoses do not. Because they can look similar, an experienced practitioner should make the determination.

Question 36

Painful vesicles are associated with

a. psoriasis.
b. pityriasis rosea.
c. paronychia.
d. herpes zoster.
e. rosacea.

Answer 36

ANS: D
Herpes zoster (shingles) produces painful itching or burning of the dermatome area. Psoriasis and pityriasis may itch. Paronychia infection and rosacea may be tender to touch and do not produce vesicles.

Question 37

Skin turgor checks are performed to determine

a. the temperature of the skin.
b. hydration status.
c. skin texture.
d. the extent of an ecchymosis.
e. skin moisture.

Answer 37

ANS: B
Skin will remain tented if the patient is dehydrated or will not tent if edema is present.

Question 38

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 38

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

Question 39

Which of the following make infants more susceptible to hypothermia?

a. Low body surface area for weight
b. Thicker skin
c. Limited ability to cope with cold stress
d. Higher pulse rate
e. Lower blood pressure

Answer 39

ANS: C
Infants are more susceptible to hypothermia because of their large ratio of body surface area to weight, thinner skin, and limited ability to cope with cold stress. Infants have a higher pulse rate and lower blood pressure than adults, but this is unrelated to hypothermia.

Question 40

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 40

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

Question 41

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 41

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

Question 42

Systolic hypertension in the adult is generally defined as pressure in excess of

a. 120 + the patient’s age.
b. 140.
c. 160.
d. 180.
e. 200.

Answer 42

ANS: B
Hypertension continues to be defined as a blood pressure consistently at 140/90 mm Hg or higher. The equation that systolic blood pressure should be less than 120 + the patient’s age is no longer the acceptable definition.

Question 43

Unusual white areas on the skin may be caused by:

a. adrenal disease.
b. polycythemia.
c. vitiligo.
d. Down syndrome.
e. lentigo.

Answer 43

ANS: C
The absence of melanin produces unpigmented white areas known as vitiligo.

Question 44

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. “You shouldn’t feel that way; look at all the good things in your life.”
c. “You can’t mean what you’re saying.”
d. “If you think about it, nothing is worth getting this upset about.”
e. “What in life is causing you such pain?”

Answer 44

ANS: E
Specific yet open-ended questions are best used when the patient has feelings of loss of self-worth and depression. The other responses hurry the patient and offer superficial assurance.

Question 45

Assessment of poor hygiene, healed fractures with deformity, or unexplained trauma in older adults indicates

a. sexual abuse.
b. physical neglect.
c. psychologic abuse.
d. violated rights.
e. financial abuse.

Answer 45

ANS: B
The question describes is the most common form of elder abuse—physical neglect.

Question 46

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 46

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

Question 47

Which pulse is most commonly used to assess heart rate?

a. Radial
b. Brachial
c. Dorsalis pedis
d. Posterior tibial
e. Popliteal

Answer 47

ANS: A

The radial pulse is most often used to assess the heart rate. With the pads of your second and third fingers, palpate the radial pulse on the flexor surface of the wrist laterally.

Question 48

A tool used to screen adolescents for alcoholism is the

a. CAGE questionnaire.
b. CRAFFT.
c. PACE Assessment Instrument.
d. HITS questionnaire.
e. Glasgow Coma Scale.

Answer 48

ANS: B
The CRAFFT tool is used to screen for alcoholism in adolescents.

Question 49

Transient mottling of the patient’s skin in a cool room is a common finding in

a. menopausal women.
b. newborn infants.
c. pregnant women.
d. sedentary adults.
e. older adults.

Answer 49

ANS: B
Cutis marmorata, a mottled appearance, is part of a newborn’s response to changes in temperature.

Question 50

Constitutional symptoms in the ROS refer to:

a. height, visual acuity, and body mass index.
b. fever, chills, fatigue, and malaise.
c. hearing loss, tinnitus, and diplopia.
d. rashes, skin turgor, and temperature.
e. joint stiffness, redness, and swelling.

Answer 50

ANS: B
General constitutional symptoms refer to fever, chills, malaise, fatigability, night sweats, sleep patterns, and weight (average, preferred, present, change).

Question 51

Information that is needed during the initial interview of a pregnant woman includes all of the following except

a. the gender that the woman hopes the baby will be.
b. her past medical history.
c. her health care practices.
d. the woman’s knowledge about pregnancy.
e. potential pregnancy risk factors.

Answer 51

ANS: A
The initial interview for the pregnant woman should include information of about her past history, assessment of health practices, identification of potential risk factors, and assessment of her knowledge because it affects the pregnancy.

Question 52

A brief statement of the reason the patient is seeking health care is called the

a. medical history.
b. chief concern
c. assessment.
d. diagnosis.
e. review of systems.

Answer 52

ANS: B
The chief concern is a brief statement of the reason the patient is seeking health care.

Question 53

Small, less than 0.5-cm in diameter, red-purple nonblanchable discolorations of the skin are

a. ecchymoses.
b. petechiae.
c. spider veins.
d. telangiectasias.
e. purpura.

Answer 53

ANS: B
Petechiae are red-purple, nonblanchable discolorations less than 0.5 cm diameter. They are frequently caused by intravascular defects or infections.

Question 54

Hypertension in a pregnant woman (blood pressure reading greater than or equal to 160 mm Hg systolic or 110 mm Hg diastolic) is one sign of

a. a normal pregnancy.
b. a nulliparous woman.
c. preeclampsia.
d. a multiparous woman.
e. Braxton Hicks contractions.

Answer 54

ANS: C
A gradual increase in blood pressure is common from the second to the third trimester. However, hyperten sion in this range may be a sign of preeclampsia. Braxton Hicks contractions are sporadic uterine contractions that start at around 6 weeks of pregnancy and are not associated with gestational hypertension or preeclampsia.

Question 55

You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should

a. never be interviewed alone because this may alienate the parent.
b. be mailed a questionnaire in advance to avoid the need for her to talk.
c. be given the opportunity to be interviewed without the parent at some point
d. be allowed to direct the flow of the interview.
e. be ignored while you address all questions to the parent.

Answer 55

ANS: C
An older child should be given the opportunity to give information directly. This enhances the probability that the child will follow your advice.

Question 56

The nurse blanches over a vascular lesion on a pregnant patient. The site blanches and refills evenly from the center outward. The nurse documents this lesion as

a. telangiectasia.
b. a spider angioma.
c. petechiae.
d. purpura.
e. ecchymosis.

Answer 56

ANS: B
Spider angiomas are dilated arterioles. A network of dilated capillaries radiates from the center arteriole, outward like a spider’s legs. Spider angiomas are often associated with high estrogen levels, as occur in pregnancy. Blanching over the center is followed by a rapid return of redness from the center outward. Whereas telangiectases refill erratically, petechiae, purpura, and ecchymoses do not blanch.

Question 57

Postural hypotension is defined as which of the following when the patient stands compared with

a sitting or supine reading?
a. Blood pressure drop of more than 20 mm Hg in systolic and 10 mm Hg drop in diastolic

b. Pulse rate decrease with a systolic pressure increase of at least 15 mm Hg
c. Diastolic pressure increase of more than 5 mm Hg and no pulse rate changes
d. Pulse rate decrease and diastolic pressure decrease of more than 5 mm Hg
e. Decrease in pulse pressure

Answer 57

ANS: A
Postural hypotension (orthostatic hypotension) represents a significant decrease in systolic pressure (greater than 20 mm Hg) and a 10–mm Hg drop in diastolic pressure as a patient changes from a sitting to a standing position. An increase in heart rate often occurs as well.

Question 58

Body temperature is regulated by the

a. thalamus.
b. hypothalamus.
c. medulla.
d. pons.
e. cerebellum.

Answer 58

ANS: B
Body temperature is regulated by the hypothalamus.

Question 59

A patient becomes restless during the history and says, “I don’t have time for all of this conversation. I’ve got to get back to work.” Your most appropriate response would be to

a. stop using open-ended questions and become more direct.
b. ask another open-ended question and insist on an answer.
c. ask questions about his anger and move closer to him.
d. acknowledge his anger and proceed with the history and examination.
e. ignore his displeasure and become more assertive about getting answers.

Answer 59

ANS: D
This is the only that resists the tendency for patient manipulation, pursues the information, and
confronts the patient’s anger.

Question 60

Which pulse is generally used to assess heart rate?

a. Radial
b. Brachial
c. Dorsalis pedis
d. Posterior tibial
e. Popliteal

Answer 60

ANS: A
The radial pulse is most often used to assess the heart rate. With the pads of your second and third fingers, palpate the radial pulse on the flexor surface of the wrist laterally.

Question 61

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 61

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.

Question 62

Age spots are also called

a. seborrheic keratoses.
b. senile lentigines.
c. cutaneous horns.
d. acrochordon.
e. cutaneous tags.

Answer 62

ANS: B
Senile lentigines are irregular, round, gray-brown lesions with a rough surface that occur in
sun-exposed areas and are referred to as age spots.

Question 63

Which of the following is an ABCD characteristic of malignant melanoma?

a. Asymmetric borders
b. Borders well demarcated
c. Color of lesion is uniform
d. Diameter less than 6 mm
e. Severe blistering or sunburns as a child

Answer 63

ANS: A
The ABCD melanoma mnemonic includes asymmetry, borders that are irregular, color that is not
the same all over, and diameter greater than 6 mm and growing. Severe blistering or sunburns as
a child is a risk factor and not part of the ABCD characteristics.

Question 64

The secretory activity of the sebaceous glands is stimulated by

a. body heat.
b. ambient temperature.
c. sex hormones.
d. dietary protein.
e. emotional stimuli.

Answer 64

ANS: C
The sebaceous glands, when stimulated by the sex hormones, become stimulated to produce a
lipid-rich substance that keeps the skin moist.

Question 65

Inspection to determine color variations of the skin is best conducted:

a. using an episcope.
b. under fluorescent lighting.
c. with illumination provided by daylight.
d. using a Wood’s lamp.
e. using a pen light.

Answer 65

ANS: C
Daylight provides the best illumination source for determining color variations of the skin.

Question 66

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. All information should be obtained from family members.

b. All information should be collected from past records 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.
e. The patient should be present during information collection but should not be addressed directly.

Answer 66

ANS: D
Patients with disabilities may not give an effective history, but they must be respected, and the
history must be obtained from them to the greatest extent possible. Family members may help
provide a more complete history but not at the exclusion of the patient.

Question 67

The type and brand of grooming products used are important to the health history of

a. adolescents.
b. everyone.
c. older adults.
d. persons with rashes.
e. children.

Answer 67

ANS: B
Knowledge of exposure to environmental chemicals is valid health history data for all age
groups.

Question 68

When you enter the examination room of a 3-year-old girl, you find her sitting on her father’s lap. She turns away from you when you greet her. Initially, your best response is to

a. screen the child for sexual abuse.
b. ask the child to be seated on the examination table so you can talk to her father.
c. explain to the child that you will not hurt her and that she will have to trust you.
d. ask the father to persuade the child to cooperate with you.
e. leave the child sitting in the father’s lap while you talk to the father.

Answer 68

ANS: E
Interaction with children must be modified according to age and in a manner that promotes trust.

Question 69

Fluorescing lesions are best distinguished using a(n)

a. incandescent lamp.
b. magnifying glass.
c. transilluminator.
d. Wood’s lamp.
e. halogen lamp.

Answer 69

ANS: D
Fluorescing lesions (e.g., some tinea lesions) show a characteristic yellow-green color under a
Wood’s lamp.

Question 70

Which cultural group has the lowest incidence of nevi?

a. Native Americans
b. African Americans
c. Mexican Americans
d. Asians
e. Eastern Europeans

Answer 70

ANS: B
Nevi are more common in persons who burn rather than tan; therefore, African Americans have
the lowest rates of nevi.

Question 71

Which structure is the site of new nail growth?

a. Cuticle
b. Paronychium

c. Eponychium
d. Nail bed
e. Matrix

Answer 71

ANS: E
The white, crescent-shaped area beyond the proximal nail fold (lunula) is the distal end of the
nail matrix, which is the site of new nail growth.

Question 72

A Dennie-Morgan fold is probably caused by

a. birth trauma.
b. high fever.
c. excess adipose tissue.
d. kidney disease.
e. chronic rubbing.

Answer 72

ANS: E
Persons with chronic atopic or allergic conditions tend to rub their eyes so much that it causes an
extra crease or pleat of skin below the eye, called the Dennie-Morgan fold.

Question 73

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 sex 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?”
e. “What sexually transmitted diseases have you had in the past?”

Answer 73

ANS: B
When approaching questioning about a sensitive area, it is recommended that the provider first ask
open-ended questions that explore the patient’s feelings about the issue.

Question 74

Which of the following is most closely related to damage or dysfunction of the central or peripheral nervous system?

a. Chronic pain
b. Neuropathic pain

c. Acute pain
d. Acute inflammation
e. Surgery

Answer 74

ANS: B
Neuropathic pain is long-term pain associated with damage or dysfunction of the central or peripheral nervous system (e.g., amputation, complex pain syndrome).

Question 75

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 75

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

Question 76

Which question would be considered a “leading question?”

a. “Please describe any associated symptoms with your headaches?”
b. “You don’t get headaches often, do you?”
c. “What activities affect the severity of your headaches?”
d. “What times of the day are your headaches the most severe?”
e. “What worries you most about your headache.”

Answer 76

ANS: B
This question would limit the information in the patient’s answer. The other choices allow the patient more discretion about the extent of an answer.

Question 77

Which decubitus ulcer stage indicates damage into the subcutaneous tissue?

a. Stage I
b. Stage II
c. Stage III
d. Stage IV
e. Stage V

Answer 77

ANS: C
Stage III describes damage through to the subcutaneous tissue. The staging of decubitus ulcers consists of only four stages.

Question 78

The difference in blood pressure readings between the right and left arms is considered normal up to _____ mm Hg.

a. 5
b. 10
c. 20

d. 25
e. 30

Answer 78

ANS: B
Blood pressure readings between the left and right arms may vary by as much as 10 mm Hg and tends to be higher in the right arm.

Question 79

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 79

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

Question 80

The skin repairs epidermal wounds by

a. exaggerating cell replacement.
b. excreting lactic acid.
c. producing vitamins.
d. providing a mechanical barrier.
e. increasing the vascularity of the epidermis.

Answer 80

ANS: A
The skin’s tissue cells have a rapid rate of turnover and constant renewal, thereby enabling the skin to repair damaged surfaces. The epidermis is avascular and depends on the underlying dermis for its nutrition.

Question 81

The most common inflammatory skin condition is

a. cutis marmorata.
b. eczematous dermatitis.
c. intradermal nevus.
d. pityriasis rosea.
e. psoriasis.

Answer 81

ANS: B
The most common inflammatory skin disorder is eczematous dermatitis. Cutis marmorata and nevi are not inflammatory conditions, pityriasis rosea is not as common as eczema, and psoriasis is a disease of keratin synthesis.

Question 82

A 17-year-old student complains of a “rash for 3 days.” You note pale, erythematous oval plaques over the trunk. They have fine scales and are arranged in a fernlike pattern with parallel alignment. What is the nurse’s next action?

a. Teach infectious control measures.
b. Inquire about another recent skin lesion.
c. Inspect the palms and the soles.
d. Inform the patient that this will resolve within 1 week.

e. Ask about sexual contacts.

Answer 82

ANS: B
The described rash is the typical presentation of pityriasis rosea. The rash is not infectious or contagious, does not involve the palms and soles, and usually lasts for several weeks. Pityriasis rosea begins with a sudden primary (herald) patch, with the generalized eruption to the trunk and extremities following 1 to 3 weeks later.

Question 83

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 83

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.

Question 84

Newborns are more vulnerable to hypothermia because of

a. the presence of coarse terminal hair.
b. desquamation of the stratum corneum.
c. their covering of vernix caseosa.
d. a poorly developed subcutaneous fat layer.
e. excessive secretion of eccrine sweat glands.

Answer 84

ANS: D
Newborns have a poorly developed subcutaneous fat layer and therefore have a reduced ability to generate heat and become insulated from the environment. The eccrine sweat glands do not begin to function until after the first month of life.

Question 85

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 85

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

Question 86

Cherry angiomas are a common finding in

a. adults older than 30 years.
b. newborns.
c. pregnant women.
d. sunbathers.
e. adolescents.

Answer 86

ANS: A
Cherry angiomas occur in virtually everyone older than 30 years and increase numerically with age.

Question 87

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 87

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.

Question 88

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 88

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

Question 89

Ms. T. is crying and states that her mother couldn’t possibly have a tumor. “No one else in the family has ever had cancer!” exclaims the daughter. The most appropriate response to Ms. T. would be

a. “Has anyone explained hospice care to your mother?”
b. “I’m so sorry that your mother was diagnosed with cancer.”
c. “Didn’t you know that all tumors are not cancerous?”
d. “Why do you think that your mother’s tumor is cancerous?”
e. “That is odd because cancer usually runs in families.”

Answer 89

ANS: D
This is the only answer that is a direct exploration of the daughter’s concern. The health care provider can explain and clarify the concerns of the daughter.

Question 90

A guideline for history taking is for caregivers to

a. ask direct questions before open-ended questions so that the data move from simple to complex.
b. use a previous diagnosis as a chief concern whenever possible.
c. make notes sparingly so that patients can be observed during the history taking.
d. write detailed information as stated by patients so their priorities are reflected.
e. ask for a complete history at once so that data are not forgotten between meetings.

Answer 90

ANS: C
During an interview, you should maintain eye contact with the patients, observing body language and proceeding from open-ended to direct questions.

Question 91

The nails of older adults grow slowly because of

a. decreased circulation.
b. dietary deficiencies.
c. fungal infections.
d. low hormone levels.
e. high estrogen levels.

Answer 91

ANS: A
Decreased circulation to the nails of older adults causes nail growth retardation.

Question 92

A 5-year-old child presents with discrete vesicles on an erythemic base (dew drops on a rose petal appearance) that began near her scalp and are spreading to the trunk. The child has a low-grade fever and feels tired. What is the nurse’s next action?

a. Ask about a family history of rashes.
b. Inquire about other patterns of physical abuse.

c. Inspect the buccal mucosa for Koplik spots.
d. Inform the parent that this will resolve within a couple of days.
e. Teach infectious control measures.

Answer 92

ANS: E
The description of this child’s complaint is a varicella rash, not physical abuse or rubeola. Chickenpox is a highly communicable disease and can be prevented by immunization. The period of communicability lasts from 1 or 2 days before the onset of the rash until all the vesicles have crusted over, which usually takes about 1 week.

Question 93

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 93

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.

Question 94

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 94

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 95

Skin lesions are transilluminated to determine

a. vascular from nonvascular lesions.
b. furuncles from folliculitis lesions.
c. fluid-filled lesions in solid cysts or masses.

d. herpes zoster from varicella.
e. macules from papules.

Answer 95

ANS: C
Transillumination is used to determine the presence of fluid in cysts and masses. Fluid-filled lesions transilluminate with a red glow, but solid masses do not transilluminate. This technique does not differentiate the other choices.

Question 96

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 96

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

Question 97

When are open-ended questions generally most useful?

a. During the physical examination
b. After several close-ended questions have been asked
c. While designing the genogram
d. During the review of systems
e. During the initial part of the interview

Answer 97

ANS: E
Asking open-ended questions at the beginning of an interview allows you to gather more information and establishes yourself as an empathic listener, which is the first step of effective communication. Interviewing for the purpose of conducting a genogram or review of systems requires more focused data that can be more easily gathered with direct questioning.

Question 98

Normal hormone-related changes of adolescence include

a. increased oil production.
b. the development of fine silky lanugo hair.
c. depletion of apocrine glands.
d. decreased sebaceous gland activity.
e. slowed hair growth.

Answer 98

ANS: A
During adolescence, the sebaceous glands increase sebum production, which causes the skin to have an oily appearance and predisposes the individual to acne.

Question 99

The most common cutaneous neoplasm is

a. basal cell carcinoma.
b. compound nevus.
c. seborrheic keratosis.
d. senile actinic keratosis.

e. malignant melanoma.

Answer 99

ANS: A
Basal cell carcinoma is the most common form of skin cancer. It occurs more frequently on sun-exposed parts of the body.

Question 100

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 100

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.

Question 101

Which of the following, if reported, belongs in the family history of a patient with a skin rash?

a. Father has chronic asthma.
b. Sister repeatedly uses a tanning booth.
c. Mother trims patient’s nails too short.
d. Sister had measles as a child.
e. Grandparent had chemical burn.

Answer 101

ANS: A
Asthma and many dermatologic findings have shared atopic (allergic) qualities.

Question 102

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 102

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.

Question 103

A 50-year-old man comes to the primary care clinic. He tells you he is worried because he has had severe chest pains for the past 2 weeks. Which initial history interview question is most appropriate?

a. “Can you describe the pain?”
b. “The pain doesn’t radiate to your arm, does it?”
c. “Have you been treated for anxiety before?”

d. “Does your father have heart disease?”
e. “Are the pains worse after you eat?”

Answer 103

ANS: A
Initially, an open-ended question is a more appropriate response. ”Can you describe the pain?” is an open-ended question that offers clues to the chief concern.

Question 104

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 104

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

Question 105

A blood pressure cuff bladder should be long enough to

a. cover 25% of the arm circumference.
b. cover 50% of the arm circumference.
c. cover 80% of the arm circumference.
d. completely encircle the arm.
e. wrap around the arm twice.

Answer 105

ANS: C
The cuff bladder should be twice the width of the bladder or about 80% of the limb circumference. The bladder should not completely encircle the limb.

Question 106

Blood pressure may increase during the process of aging caused by

a. increasing vagal tone.
b. decreasing cardiac output.
c. diminished tolerance to pain.
d. increasing stiffness of the blood vessels.
e. decreasing vascular resistance.

Answer 106

ANS: D
During the process of aging the systolic blood pressure often increases because of increasing stiffness of the blood vessels and increased vascular resistance. Increasing vagal tone may decrease the pulse rate.

Question 107

A survey of mobility and activities of daily living (ADLs) is part of a(n)

a. ethnic assessment.
b. functional assessment.

c. genetic examination.
d. social history.
e. sexual history.

Answer 107

ANS: B
A functional assessment is an assessment of a patient’s mobility, upper extremity movement, household management, activities of daily living, and instrumental activities of daily living.

Question 108

A normal adult’s pulse pressure should range from _____ mm Hg.

a. 10 to 20
b. 20 to 25
c. 30 to 40
d. 60 to 70
e. 80 to 100

Answer 108

ANS: C
An adult’s pulse pressure should range from 30 to 40 mm Hg and even as much as 50 mm Hg. Pulse pressure is the difference between the systolic and diastolic pressures.

Question 109

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 109

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

Question 110

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 110

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

Question 111

Brittle nails are typical findings in

a. adolescents.
b. infants.
c. pregnant women.
d. older adults.
e. children.

Answer 111

ANS: D
Older adults typically have decreased peripheral circulation to the nails, causing the nails characteristically to develop longitudinal ridges that are more brittle and susceptible to splitting into layers.

Question 112

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 112

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.

Question 113

Which of the following is a subjective measurement?

a. Temperature
b. Pulse
c. Blood pressure
d. Pain
e. Respirations

Answer 113

ANS: D
Pain is a subjective unpleasant symptom of many conditions and injuries. The pain experience and its characteristics and intensity are unique for each person.

Question 114

Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the

a. Miller Analogies Test.
b. PACE Assessment Instrument.
c. CAGE questionnaire.
d. Glasgow Coma Scale.
e. HITS questionnaire.

Answer 114

ANS: C
The CAGE questionnaire is a model for approaching a discussion of the use of alcohol.

Question 115

The adipose tissue in the hypodermis serves to

a. provide sensory input.
b. generate heat and insulate.
c. create tensile strength.
d. restrict water loss.
e. secrete collagen.

Answer 115

ANS: B
The hypodermis layer consists of adipose tissue that serves to generate heat and to provide insulation, shock absorption, and a reserve of calories.

Question 116

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 116

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.

Question 117

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 a direct question that refocuses the patient on the chief concern.
d. Tell the patient that you do not discuss your family with patients.
e. Ask the patient why she needs to know.

Answer 117

ANS: B
This response will satisfy the patient’s curiosity about yourself without invading your private life.

Question 118

The heart rate of a pregnant woman may increase to a level at term that is _____ higher than normal.

a. 5% to 10%
b. 10% to 30%
c. 40% to 60%

d. 60% to 80%
e. 80% to 100%

Answer 118

ANS: B
The heart rate of a pregnant woman gradually increases throughout pregnancy until it is 10% to 30% higher at term.

Question 119

During an interview, tears appear in the patient’s eyes, and his voice becomes shaky. Initially, you should

a. ask the patient what he is upset about.
b. offer a tissue and let him know it is all right to cry.
c. explain to the patient that you will be able to help him more if he can control his emotions.
d. keep the interview moving to distract the patient.
e. ask him if he would like some time alone.

Answer 119

ANS: D
When patients cry, it is best to allow the moment to pass at the patient’s pace. If you suspect a need to cry but the patient is suppressing it, give permission.

Question 120

Which action would best promote accurate translations as well as confidentiality when the caregiver does not speak the patient’s language?

a. Ask a person unfamiliar with the patient to translate.
b. Have a friend of the patient translate.
c. Ask simple leading questions that the patient may understand.
d. Use a neighbor as translator.
e. Involve the family with the translation.

Answer 120

ANS: A
When you do not speak the patient’s language, family members or friends may pose a communication barrier and may have issues of confidentiality; a stranger as an interpreter is less biased.

Question 121

A 29-year-old white woman appears jaundiced. A cause of liver disease has been excluded. What history questions should the nurse ask?

a. Whether she had unprotected sex
b. If she has a history of diabetes mellitus
c. Whether she has unusual bleeding problems

d. If she eats a lot of yellow and orange vegetables
e. If she has a family history of peripheral vascular disease

Answer 121

ANS: D
In the absence of liver disease, another cause of jaundice is increased carotene pigmentation. Diets high in carrots, sweet potatoes, and squash are high in carotene and can make the skin appear to be jaundiced.

Question 122

A pedigree diagram is drafted for the purpose of obtaining

a. sexual orientation and history.
b. growth and developmental status.
c. genetic and familial health problems.
d. ethnic and cultural backgrounds.
e. the past medical history.

Answer 122

ANS: C
Drafting a pedigree diagram, or genogram, is a method to determine consanguinity of health problems.

Question 123

If only two blood pressure values are recorded, they are the _____ sounds.

a. first systolic and first diastolic
b. first systolic and second diastolic
c. second systolic and first diastolic
d. second systolic and second diastolic
e. first and second diastolic.

Answer 123

ANS: B
Phase 1 (systolic sound) and phase 5 (second diastolic sound) would be recorded if only two blood pressure values were used.

Question 124

Pale, shiny skin of the lower extremities may reflect

a. excessive steroids.
b. a history of vigorous exercise.
c. peptic ulcer disease.
d. vasculitis.
e. systemic disease.

Answer 124

ANS: E
Pale, shiny skin of the lower extremities may reflect peripheral changes that occur with systemic disorders, such as diabetes mellitus and cardiovascular disease.

Question 125

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 125

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.

Question 126

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 concern.
b. family history.
c. personal and social history.
d. review of systems.
e. past medical history.

Answer 126

ANS: C
Habits are included within the personal and social history.

Question 127

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 127

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.

Question 128

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 128

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.

Question 129

Expected hair distribution changes in the older adults include

a. increased terminal hair follicles to the scalp.
b. more prominent axillary and pubic hair production.
c. increased terminal hair follicles to the tragus of men’s ears.
d. more prominent peripheral extremity hair production.
e. women possibly developing less coarse facial hair.

Answer 129

ANS: C
The transition from vellus to terminal hair pattern occurs in older men at the nares and the tragus.

Question 130

Periods of silence during the interview can serve important purposes, such as

a. allowing the clinician to catch up on documentation.
b. giving you a clue that you should speed up the interview.
c. providing time for reflection.
d. increasing the length of the visit.
e. promoting calm.

Answer 130

ANS: C
Silence is a useful tool during interviews for the purposes of reflection, summoning of courage, and displaying compassion. It is usually a clue for you to go slower and not to push too hard.

Question 131

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 131

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

Question 132

A flat, nonpalpable lesion is described as a macule if the diameter is

a. greater than 1 cm.
b. less than 1 cm.
c. greater than 2 cm.
d. too irregular to measure.
e. exactly 5 mm.

Answer 132

ANS: B
A macule by definition is a flat, circumscribed area that is less than 1 cm in diameter. An example of a macular rash is measles.

Question 133

A 5-year-old is complaining of nondescriptive “belly pain.” Your next action should be to ask him to

a. point a finger to the spot that hurts.
b. draw a circle around the area that hurts.
c. use a metaphor to describe the pain.
d. identify what makes the pain worse.
e. allow him to use a “pain-o-meter.”

Answer 133

ANS: A
Asking the child to point to the area of pain can help communicate a more precise location. The other choices are not appropriate for the age of the child.

Question 134

Pigmentary demarcation lines are

a. a precursor of skin cancer
b. more common on people with fair skin
c. commonly seen on the face
d. a normal variation
e. may decrease during pregnancy

Answer 134

ANS: D
Pigmentary demarcation lines are a normal variation. They mark the border between deeply pigmented skin and lighter pigmented skin. They are most commonly seen on the arms, legs, chest, and back and have been reported most often in black and Japanese populations. Accentuation of preexisting lines or appearance of new lines may occur during pregnancy They are not a precursor of skin cancer.

Question 135

Linea nigra is commonly found on the abdomens of

a. newborns.
b. infants and children.
c. adolescents.
d. pregnant women.
e. older adults.

Answer 135

ANS: D
Pregnant women commonly develop pigmentation of the abdomen from the symphysis pubis to the top of the fundus in the midline.

Question 136

Which patient position is useful for auscultating heart tones?

a. Lithotomy

b. Dorsal recumbent
c. Left lateral recumbent
d. Right Sims
e. Prone

Answer 136

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.

Question 137

A pain scale that is reliable and valid for children is the _____ scale.

a. pain-o-meter
b. pain-rating instrument
c. numeric pain intensity
d. Wong/Baker Faces Rating
e. descriptive pain intensity

Answer 137

ANS: D
The Wong/Baker Faces Rating Scale and the Oucher Scale are examples of pain scales that are reliable and valid for use with children.

Question 138

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 138

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.

Question 139

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 139

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.

Question 140

Your 85-year-old patient is complaining of right knee pain. She has a history of osteoarthritis for which she is given antiinflammatory medication. To assess her right knee pain, you should ask her if

a. the current pain is similar to previous pain.

b. the left knee hurts as well.
c. she took pain medication last night.
d. the pain gets better when she sits.
e. this is the worse pain she has ever had.

Answer 140

ANS: D
You should refrain from asking older patients to compare past with present symptoms because recollection may be uncertain. It is more appropriate to ask a present-tense evaluation question, simply stated, without the addition of multiple factors to consider.

Question 141

When you suspect that your 81-year-old patient has short-term memory loss because he cannot remember what he had for breakfast, you should

a. order a neurology consult.
b. stop all of his medications.
c. continue to press the patient for appropriate answers.
d. validate the concern with his family or caregivers.
e. dismiss the finding as a normal age-related change.

Answer 141

ANS: D

When older adults experience memory loss for recent events, consult other family members to clarify discrepancies or to fill in the gaps.

Question 142

Which of the following is a noncandidal fungal infection?

a. Pityriasis rosea
b. Psoriasis
c. Milia
d. Rosacea
e. Tinea corporis

Answer 142

ANS: E
Tinea corporis is the only listed fungal infection (noncandidal); the others are not fungal in origin.

Question 143

Sweat glands, hair, and nails are all formed from

a. basement membranes under cellular strata.
b. closely packed squamous cells.
c. invaginations of epidermis into dermis.
d. papillae that penetrate the epidermis.
e. evaginations of the hypodermis.

Answer 143

ANS: C
Skin appendages are formed embryonically when the epidermis invaginates into the dermis.

Question 144

Which nail change found on examination would be most alarming?

a. Dark bands seen in all fingernails of a dark-skinned person

b. A yellow discoloration of the great toe of an older adult
c. A single blue nail
d. Pits in both index fingernails of an adult
e. Longitudinal ridges in an older adult

Answer 144

ANS: C
Dark bands in a dark-skinned person are normal, yellow in the toe of an older adult can be a nail
disease or a chronic respiratory condition, and pits are related to psoriasis. Longitudinal ridges are a common expected variation. A single blue or black nail may indicate melanoma.

Question 145

When taking a history, you should

a. ask patients to give you any information they can recall about their 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.
e. start the interview with the social history.

Answer 145

ANS: C
To give structure to the present problem or chief concern, the provider should proceed in a
chronologic and sequential framework. Asking patients to give you any information they can recall
about their health and using a holistic and eclectic structure do not provide for structure. Starting the
interview with the patient’s family history and with the social history are incorrect because gathering data about the chief concern is the initial step.

Question 146

Mr. F. is speaking with you, the health care provider, about his respiratory problem. Mr. F. says,
“I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your
cough.” Mr. F. 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. “You may have a serious problem, and being confrontational will not help.”
d. “I’ll examine you and figure out the problem later.”
e. “I don’t know what’s wrong. You could have almost any disease.”

Answer 146

ANS: A
This is the only response aimed at focusing on the chief concern to gather more data and does not digress from the issue.

Question 147

Which technique is most likely to result in the patient’s understanding of questions?

a. Use phrases that are commonly used by other patients in the area.
b. Use the patient’s own terms if possible.
c. Use language that keeps the patient from being expansive in his or her answer.
d. Use proper medical and technical terminology.
e. Use the simplest language possible.

Answer 147

ANS: B
To ensure that your questions have been correctly understood, be clear and explicit while using the
patient’s idiom and level of understanding.

Question 148

You are conducting a preschool examination on a 5-year-old child. Which injury would most likely raise your suspicion that the child was being abused?

a. Recent bruising over both knees
b. A healed laceration under the chin
c. A bruise on the right shin with associated abrasion of tissue

d. Bruises in various stages of resolution over body soft tissues
e. A scab on the elbow

Answer 148

ANS: D
Toddlers and older children who bruise themselves accidentally are bruised over bony
prominences, such as the knees, elbows, chin, and shin. Bruises over soft tissues are more consistent with abuse.

Question 149

Body language that leads you to suspect the person is in pain is

a. talkative, verbose speech.
b. fretful hand movements.
c. focused, fixed eye stares.
d. marked salivation.
e. flushed, dry skin.

Answer 149

ANS: B
A person in pain may suddenly become quiet; have an inability to keep the hands still; and have lackluster eyes, pallor, diaphoresis, pupil dilation, and a dry mouth.

Question 150

Which of the following is not related to older adults underreporting pain?

a. They believe it is a normal part of aging.
b. They have a diminished perception of pain.

c. They do not want to be a nuisance.
d. They believe reporting pain will lead to expensive testing or hospitalization.
e. They are hesitant to take pain medications.

Answer 150

ANS: B
No evidence exists that shows that older adults have a diminished capacity to perceive pain.

Question 151

Direct questioning about intimate partner violence in the home should be

a. a routine component of history taking with female patients.
b. avoided for fear of offending the woman’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.
e. used only when bruises are found on physical examination.

Answer 151

ANS: A
The presence of intimate partner violence should be routinely queried, and the questioning should be direct for all female patients.

Question 152

When questioning a patient regarding alcohol intake, she tells you that she is “only a social drinker.” Which initial response is appropriate?

a. “I’m glad that you are a responsible drinker.”
b. “Many people who are really alcoholic say they are social drinkers.”
c. “What amount and what kind of alcohol do you drink in a week?”
d. “If you only drink socially, you won’t need to worry about always having a designated driver.”
e. “Do the other people in your household consume alcohol?”

Answer 152

ANS: C
This answer clarifies the patient’s own term without asking a leading question or being judgmental.

Question 153

During a history-taking session, Mr. B. appears to be avoiding certain questions. He keeps looking out the window. What should the caregiver do?

a. Ask direct questions and insist on a “yes” or “no” answer to each question.
b. Continue to ask questions until Mr. B. responds appropriately.
c. Let the patient know all relevant information should be revealed in one interview.
d. Stop the interview until the patient is ready to cooperate.
e. Make a note to pursue sensitive issues later in the interview.

Answer 153

ANS: D
When the patient dissembles, do not push too hard for an answer. Allow the interview to go on and come back to it later. Learning all that you may need to know about a patient may not happen in one interview.

Question 154

The characteristic that best differentiates psoriasis from other skin abnormalities is the

a. color of the scales.
b. formation of tiny papules.
c. general distribution over the body.
d. recurrence.
e. loss of hair.

Answer 154

ANS: A
Unlike other skin conditions, silvery papules and plaques characterize psoriasis.

Question 155

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 face to face with the patient.
d. ask questions containing double negatives.
e. dim the lights to decrease anxiety.

Answer 155

ANS: C
The health care provider should position himself- or herself so that the older patient can see his or her face. Shouting distorts vocalizations, dimming the lights impairs vision; a written interview may be necessary if all else fails. The provider’s language should be uncomplicated and free from double negatives.

Question 156

Tom is a 16-year-old young man with diabetes 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. Tendency to give too much information
c. Low peer support needs
d. Propensity for risk taking
e. High self-esteem

Answer 156

ANS: D
Adolescents tend to experiment with risky behaviors that lead to a high incidence of morbidity and mortality. Adolescents may be reluctant to provide information.

Question 157

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 157

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.

Question 158

If a sufficiently large cuff is unavailable to fit the arm of an obese person, which technique may be used to assess blood pressure?
a. Wrap a standard cuff around the deltoid area and place the stethoscope over the radial artery.

b. Wrap a standard cuff around the forearm and place the stethoscope over the radial artery.
c. Wrap a standard cuff around the thigh and place the stethoscope on the dorsalis pedis.
d. Wrap a pediatric cuff around the ankle and place the stethoscope on the popliteal artery.
e. Wrap a standard cuff around the forearm and place the stethoscope over the ulnar artery.

Answer 158

ANS: B

Another technique to use when assessing the blood pressure of an obese person and you only have a standard adult cuff is to wrap the cuff around the smaller forearm and place the stethoscope over the radial artery.

Question 159

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 159

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

Question 160

When communicating with older children and teenagers, you should be sensitive to their

a. parent’s needs.
b. natural urge to communicate.
c. need for verbal instructions.
d. typical reluctance to talk.
e. desire for adult companionship.

Answer 160

ANS: D
Adolescents are usually reluctant to talk; therefore, the provider should clearly communicate a respect for their confidentiality.

Question 161

A 4  3-cm, rough, elevated area of psoriasis is an example of a

a. plaque.
b. patch.
c. macule.
d. papule.

e. wheal.

Answer 161

ANS: A
A plaque by definition is an elevated, firm, rough lesion with a flat-topped surface larger than 1 cm in diameter. An example is psoriasis.

Question 162

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 162

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.

Question 163

Behaviors that diffuse anxiety during the interview include

a. trying to limit the patient to simple “yes” or “no” answers.
b. providing forthright answers to questions.
c. providing all necessary information before the patient has to ask for it.
d. completing the interview as quickly as possible.
e. avoiding the wearing of uniforms and laboratory coats.

Answer 163

ANS: B
To relieve anxiety, the health care professional should answer patient questions in a forthright manner, avoiding overload of information and without hurrying the conversation.

Question 164

A patient with trigeminal neuralgia would describe the pain as

a. throbbing and dull.
b. burning or shocklike.
c. tender and deep.
d. crushing and tearing.
e. pressure or squeezing.

Answer 164

ANS: B
Pain resulting from nerve tissue damage is described as having a burning, shocklike (electrical) quality.

Question 165

Risk factors for skin cancer include

a. an olive complexion.
b. repeated trauma or irritation to the skin.
c. a history of allergic reactions to sunscreen.
d. dark eyes and hair.
e. pigmented bands in the nails.

Answer 165

ANS: B
Fair-skinned persons with light-colored eyes and repeated trauma or skin irritation are at have higher risk factor for skin cancer development. Pigmented bands in the nails are an expected finding in dark-skinned individuals.

Question 166

During an interview, you have the impression that a patient may be considering suicide. Which action is essential?

a. Immediately begin proceedings for an involuntary commitment.
b. Ask whether the patient has considered self-harm.
c. Ask whether the patient would like to visit a psychiatrist.
d. Record the impression in the patient’s chart and refer the patient for hospitalization.
e. Avoid directly confronting the patient regarding your impression.

Answer 166

ANS: B
If you think the patient may be considering suicide, he or she probably is. Mentioning it gives permission to talk about it.

Question 167

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 167

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

Question 168

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 168

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.

Question 169

The fifth vital sign is

a. pain.
b. orientation.
c. waist-to-hip ratio.
d. body mass index (BMI).
e. weight.

Answer 169

ANS: A
Pain, the universal distress signal, is now recognized as the fifth vital sign.

Question 170

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 170

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.

Question 171

The most frequent cause of serious hypertension in children is

a. malnutrition.
b. liver failure.
c. renal disease.
d. rheumatic fever.
e. heart disease.

Answer 171

ANS: C
Do not make the diagnosis of hypertension based on one reading. If the systolic blood pressure is elevated and the diastolic is not, anxiety may be responsible. Most children with a diagnosis of hypertension have an identifiable cause, usually renal disease.

Question 172

A single transverse crease seen on the palm of a small child may imply
a. Down syndrome.

b. Turner syndrome.
c. systemic sclerosis.
d. profound dehydration.
e. neurofibromatosis.

Answer 172

ANS: A
A single transverse crease is seen on the palm of children with Down syndrome.

Question 173

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 173

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.