Details of Test Bank For Seidel-s Guide to Physical Examination An Interprofessional Approach 10th EditionChapter 01: Cultural Competency MULTIPLE
... [Show More] CHOICE
1. 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.
ANS: B
Physical characteristics are not used to identify cultural groups; there is a difference between the two, and they are considered separately. Physical characteristics should not be used to identify members of cultural groups. To be a member of a specific culture, an individual does not need to have certain identifiable physical characteristics. You should not confuse physical characteristics with cultural characteristics. Gender and race are physical characteristics, not cultural characteristics, and are not used to identify cultural groups.
DIF:Cognitive Level: Understanding (Comprehension) OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
2. 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.
ANS: C
A fixed image of any group that rejects its potential for originality or individuality is the definition of stereotype. Acculturation is the process of adopting another culture’s behaviors. A norm is a standard of allowable behavior within a group. Ethnos implies the same race or nationality.
DIF:Cognitive Level: Remembering (Knowledge) OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
3. 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.
b. c. d.
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―With your father’s permission, we will examine the stone and request that it be returned to him.‖
―The stone must be sent to the lab for examination and therefore cannot be kept.‖ ―We cannot let him keep his stone because it violates our infection control policy.‖ ―We don’t know yet if your father has another kidney stone, so we must analyzethis one.‖
ANS: A
We should be willing to modify the delivery of health care in a manner that is respectful and
in keeping with the patient’s cultural background. ―With your father’s permission, we will
examine the stone and request that it be returned to him‖ is the most appropriate response.
―The stone must be sent to the lab for examination and therefore cannot be kept‖ and ―We
don’t know yet if your father has another kidney stone, so we must analyze this one‖ do not
support the patient’s request. ―We cannot let him keep his stone because it violates our
infection control policy‖ does not provide a reason that it would violate an infection control
policy.
DIF:Cognitive Level: Analyzing (Analysis)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
4. 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.
ANS: C
Cultural encounters are the continuous process of interacting with patients from culturally
diverse backgrounds to validate, refine, or modify existing values, beliefs, and practices about a
cultural group and to develop cultural desire, cultural awareness, cultural skill, and cultural
knowledge. Cultural awareness is deliberate self-examination and in-depth exploration of
one’s biases, stereotypes, prejudices, assumptions, and ―-isms‖ that one holds about individuals
and groups who are different from them. Cultural knowledge is the process of seeking and
obtaining a sound educational base about culturally and ethnically diverse groups. Cultural skill
is the ability to collect culturally relevant data regarding the patient’s presenting problem, as
well as accurately performing a culturally based physical assessment in a culturally sensitive
manner. Cultural desire is the motivation of the healthcare professional to want to engage in
the process of becoming culturally competent, not have to.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
5. 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.
c.
d.
―What is your age, race, and educational level?‖
―What types of symptoms have you been having?‖
―Why do you think you are having these symptoms?‖
ANS: D
―Why do you think you are having these symptoms?‖ is an open-ended question that avoids
stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to
2 | P a g ebe exchanged. The other questions do not explore the patient’s cultural beliefs about health
problems.
DIF:Cognitive Level: Analyzing (Analysis)
OBJ:Nursing process—assessment
6. The definition of ill or sick is based on a
a. stereotype.
b. cultural behavior.
c. belief system.
d. cultural attitude.
ANS: C
The definition of ill or sick is based on the individual’s belief system and is determined in
large part by his or her enculturation.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
7. 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.
c.
d.
―It’s hard for me to gather useful information because your answers are so short.‖
―Are you uncomfortable talking with me?‖
―Does your religion make it hard for you to answer my questions?‖
ANS: C
It is all right to ask if the patient is uncomfortable with any aspect of your person and to talk
about it; the other choices are less respectful.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
8. 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.
ANS: B
The English worry about being overheard and tend to speak in modulated voices so, when
they lean in toward you, they are probably poised to ask a question.
DIF:Cognitive Level: Analyzing (Analysis)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
9. An aspect of traditional Western medicine that may be troublesome to many Hispanics,
3 | P a g e
MSC: Physiologic Integrity: Physiologic AdaptationNative 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.
ANS: B
A more scientific approach to healthcare problem solving, in which a cause can be determined
for every problem in a precise way, is a Western approach. Hispanics, Native Americans,
Asians, and Arabs embrace a more holistic approach. Using a holistic approach, establishing
harmony between a person and the entire cosmos, and restoring balance in an individual’s life
would not be troublesome to many Hispanics, Native Americans, Asians, and Arabs.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
10. 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.
ANS: D
The attitudes of the healthcare provider are foundationally derived from his or her own
culture; understanding this is relevant to the success of patient relationships. Attitudes of the
healthcare professional are easily detected by others, and they influence patient behavior; they
are not irrelevant to the success of relationships with the patient; they do influence patient
behavior; and they are not difficult for the patient to sense.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
11. 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
ANS: A
Race is a physical, not a cultural, differentiator. Rite is a prescribed, formal, customary
observance. Ritual is a stereotypic behavior regulating religious, social, and professional
behaviors. A norm is a prescribed standard of allowable behavior within a group.
DIF:Cognitive Level: Remembering (Knowledge)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
4 | P a g e12. 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.
ANS: C
Asking, if you are not sure, is far better than making a damaging mistake. Not completing the
examination could cause the patient further harm. Asking a colleague from the same
geographic area if this examination is acceptable may not be appropriate. Referring the patient
to a provider more knowledgeable about cultural differences at this point is unnecessary.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
13. 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.
ANS: C
The definition of illness is determined in large part by the individual’s enculturation (the
process whereby an individual assumes the traits and behaviors of a given culture).
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
14. 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
ANS: A
The Navajo culture believes that thought and language have the power to shape reality; the
desire to avoid discussing negative information is particularly strong in this culture.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
15. 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
5 | P a g eb. Hispanics
c. Chinese
d. Italians
ANS: C
The Chinese are most likely to use MSG and soy sauce in their diet.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
16. An example of a cold condition is
a. a fever.
b. a rash.
c. tuberculosis.
d. an ulcer.
ANS: C
A cold condition in cultures with a holistic approach is tuberculosis.
DIF:Cognitive Level: Remembering (Knowledge)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
MULTIPLE RESPONSE
1. Which variables can intrude on successful communication? (Select all that apply.)
a. Social class
b. Gender
c. Stereotype
d. Phenotype
e. Age
ANS: A, B, E
Social class, age, and gender are variables that characterize everyone; they can intrude on
successful communication if there is no effort for mutual knowledge and understanding.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
2. 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
ANS: A, B, D
6 | P a g eCampinha-Bacote’s Process of Cultural Competence Model includes the cultural constructs
encounters, desires, awareness, knowledge, and skill.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 02: The History and Interviewing Process
MULTIPLE CHOICE
1. Which question would be considered a ―leading question?‖
a.
―What do you think is causing your headaches?‖
b.
c.
d.
―You don’t get headaches often, do you?‖
―On a scale of 1 to 10, how would you rate the severity of your headaches?‖
―At what time of the day are your headaches the most severe?‖
ANS: B
Stating to the patient that he or she does not get headaches would limit the information in
the patient’s answer. Asking the patient what he or she thinks is causing the headaches is an
open-ended question. Asking the patient how he or she would rate the severity of the
headaches and asking what time of the day the headaches are the most severe are direct
questions.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
2. 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
ANS: A
Asking open-ended questions during the sensitive part of the interview allows you to gather
more information and establishes you as an empathic listener, which is the first step of
effective communication. Asking closed-ended questions may stifle the patient’s desire to
discuss the history of the illness. Interviewing for the purpose of designing a genogram or
conducting a review of systems requires more focused data than can be more easily gathered
with direct questioning.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
3. 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.
7 | P a g eANS: C
Silence is a useful tool during interviews for the purposes of reflection, summoning courage,
and displaying compassion. This is not a time to document in the chart, but rather to focus on
the patient. Periods of silence may cause anxiety rather than promote calm. The length of the
visit is less important than getting critical information.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
4. 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.
c.
d.
―I’d like to hear more about your experiences. Where were you born?‖
―I don’t know what’s wrong. You could have almost any disease.‖
―I’ll examine you and figure out later what the problem is.‖
ANS: A
―After 3 days, you’re tired of coughing. Have you had a fever?‖ is the only response aimed at
focusing on the chief compliant to gather more data and does not digress from the issue.
DIF:Cognitive Level: Analyzing (Analysis)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
5. 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.
ANS: B
Giving a brief, undetailed answer will satisfy the patient’s curiosity about yourself without
invading your private life. Ignoring the patient’s comment, continuing with the interview, and
telling the patient that you do not discuss your family with patients will potentially anger or
frustrate her and keep her from sharing openly. Asking the patient why she needs to know will
distract from the real reason she is seeking care and instead move the interview conversation
away from the topics that should be discussed.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
6. 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.
8 | P a g eb. 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.
ANS: A
With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will communicate
caring to the patient. If you as a healthcare provider are hurried, the patient will be more
anxious. The best way to assist an anxious patient is to not hurry and remain calm, because
this will communicate caring to the patient. Asking the patient if she wants to wait until
another day to talk to you delays the needed health care.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
7. 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.
c.
d.
―What in life is causing you pain?‖
―You can’t mean what you’re saying.‖
―If you think about it, nothing is worth getting this upset about.‖
ANS: B
Specific but open-ended questions are best used when the patient has feelings of loss of
self-worth and depression. ―Try to think about the good things in life,‖ ―You can’t mean what
you’re saying,‖ and ―If you think about it, nothing is worth getting this upset about‖ are
statements that will hurry the patient and offer only superficial assurance.
DIF:Cognitive Level: Analyzing (Analysis)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
8. 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.
ANS: A
The adolescent should be given the opportunity to give information directly. This enhances the
probability that the adolescent will follow your advice. Mailing a questionnaire in advance to
avoid the need for her to talk does not assist the adolescent in learning to respond to answers
regarding her health. The parent can help fill in gaps at the end. If she is ignored while you
address all questions to the parent, the patient will feel as though she is just being discussed
and is not part of the process for the health care. The healthcare provider should always direct
the flow of the interview according to the patient’s responses.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
9 | P a g e9. 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.
ANS: A
The initial interview for the pregnant woman should include information about her past
medical history, assessment of health practices, identification of potential risk factors, and
assessment of remembering (knowledge) as it affects the pregnancy. The gender of the fetus is
not as important as the information about her past medical history, healthcare practices, and
the woman’s remembering (knowledge) about her pregnancy.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
10. 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.
ANS: C
The healthcare provider should position himself or herself so that the older patient can see
his or her face. Shouting distorts speech, dimming the lights impairs vision, and a written
interview may be necessary if all else fails.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
11. 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.
ANS: D
Patients who are disabled may not give an effective history, but they must be respected, and
the history must be obtained from them to the greatest extent possible. Patients should be
addressed directly and participate in the interview to the extent of their ability.
DIF:Cognitive Level: Understanding (Comprehension)
10 | P a g eOBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
12. 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.
ANS: C
To give structure to the present problem or chief complaint, the provider should proceed in a
chronologic and sequential framework. Asking patients to give any information they can
recall about their health and using a holistic and electric structure do not provide structure
to the history. Gathering the patient’s family history is only the first step.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
13. When questioning the patient regarding his or her sexual history, which question should be
asked initially?
a.
b.
c.
d.
―Do you have any particular sexual likes or dislikes?‖
―Do you have any worries or concerns regarding your sexual life?‖
―How often do you have intercourse and with whom?‖
―Do you have any reason to think you may have been exposed to a sexually
transmitted infection?‖
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. ―Do you
have any particular sexual likes or dislikes?‖ is not a question that should be asked in an
interview regarding sexual history. ―How often do you have intercourse and with whom?‖ and
―Do you have any reason to think you may have been exposed to a sexually transmitted
infection?‖ are not questions that should be asked initially in an interview regarding the
patient’s sexual history.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
14. 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.
ANS: C
During the interview, you should maintain eye contact with the patient, observing body
language and proceeding from open-ended to direct questions. Asking direct questions first
11 | P a g emay upset the patient. During the interview you should gather as much information as you
need for the current reason the patient is seeking health care. It is important to focus on
the patient. Brief notes can be charted, but you should maintain eye contact with the
patient, observing body language and proceeding from open-ended to direct questions.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
15. 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.
ANS: C
Habits are included within the personal and social history. The chief complaint is the reason
the patient is seeking health care. The past medical history is made up of the previous medical
conditions that the patient has had. The review of systems is an overview of problems with
other body systems.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
16. 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.
ANS: A
The presence of domestic violence should be routinely queried, and the questioning should be
direct for all patients. Direct questioning about domestic violence in the home should not be
avoided for fear of offending the patient’s partner, should be part of a routine examination,
and should not be used only when the patient is obviously being victimized.
DIF:Cognitive Level: Remembering (Knowledge)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
17. A tool used to screen adolescents for alcoholism is the
a. CAGE.
b. CRAFFT.
c. PACES.
d. HITS.
ANS: B
The CRAFFT tool is used to screen for alcoholism in adolescents. The CAGE test is used to
screen for alcoholism in adults. PACES is used to screen adolescents for important issues in
their life. HITS is the screen for domestic violence.
12 | P a g eDIF:Cognitive Level: Remembering (Knowledge)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
18. 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
ANS: D
Adolescents tend to experiment with risky behaviors that can lead to a high incidence of
morbidity and mortality.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
19. 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.
ANS: B
A functional assessment is an assessment of a patient’s mobility, upper extremity movement,
household management, ADL, and instrumental activities of daily living (IADL).
DIF:Cognitive Level: Remembering (Knowledge)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
20. 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.
ANS: B
General constitutional symptoms refer to pain, fever, chills, malaise, fatigue, night sweats,
sleep patterns, and weight (average, preferred, present, change).
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
21. 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
13 | P a g eb. inventory
c. problem or focused
d. interim
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. A complete history is only obtained during initial visits
or during a complete history and physical examination (H&P). An inventory is related to but
does not replace the complete history. It touches on the major points without going into detail.
This is useful when the entire history taking will be completed in more than one session. An
interim history is only obtained during a return of the patient after several months of absence.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
MULTIPLE RESPONSE
1. 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
ANS: B, C, D, F
The interview setting requires comfort for all involved, removal of physical barriers,
unobtrusive access to a clock, maintaining eye contact, and using a conversational tone.
Playing music in the background may be distracting and keeping the door open does not
provide for privacy.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
Chapter 03: Examination Techniques and Equipment
MULTIPLE CHOICE
1. According to the guidelines for Standard Precautions, the caregiver’s hands should be washed
a. only after touching body fluids with ungloved hands and between patient contacts.
b. only after touching blood products with ungloved hands and after caring for
infectious patients.
c. only after working with patients who are thought to be infectious.
d. after touching any body fluids or contaminated items, regardless of whether gloves
are worn.
14 | P a g eANS: D
Handwashing is to be done after removal of gloves, between patient contacts, and after
touching body fluids, regardless of whether gloves are used. The nurse should never touch
body fluids or blood products with ungloved hands. The nurse should use hand hygiene
regardless of a patient’s possible infection.
DIF:Cognitive Level: Remembering (Knowledge)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
2. Which patient is at the highest risk for developing latex allergy?
a. The new patient who has no chronic illness and has never been hospitalized
b. The patient who has had multiple procedures or surgeries
c. The patient who is a vegetarian
d. The patient who is allergic to contrast dye
ANS: B
The patient who has had multiple procedures or surgeries has a higher rate of exposure to
rubber gloves and to equipment and supplies that contain latex and therefore is at a higher
risk for developing an allergic response.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
3. Which initial action, in a patient with autonomic dysreflexia, would aid in lowering blood
pressure?
a. Have the patient lie on the left side.
b. Assist the patient to remove any tight clothing.
c. Recheck the blood pressure after 5 minutes.
d. Perform an EKG.
ANS: B
Autonomic dysreflexia occurs as a result of dysregulation of the autonomic nervous system.
Cutaneous or visceral stimulation below the level of the spinal cord injury initiates afferent
impulses that elicit reflex sympathetic nervous system activity. This response leads to diffuse
vasoconstriction, which causes a rise in blood pressure. Helping the patient remove any tight
clothing can help lower blood pressure.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—application
MSC: Physiologic Integrity: Physiologic Adaptation
4. The use of secondary, tangential lighting is most helpful in the detection of
a. variations in skin color.
b. enlarged tonsils.
c. foreign objects in the nose or ear.
d. variations in contour of the body surface.
ANS: D
Tangential lighting is used to cast shadows to observe contours and variations in body
surfaces best.
15 | P a g eDIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
5. You are caring for a nonambulatory 80-year-old male patient and he tells you, a female nurse,
that he feels like he is having drainage from his rectum. Which initial nursing action is
appropriate?
a. Drape the patient and observe the rectal area.
b. Tell the patient that his doctor will be notified of his problem.
c. Tell the patient that you will ask the male nurse on the next shift to check on the
problem.
d. Give the patient an ice pack to apply to the area.
ANS: A
Necessary exposure for direct observation, while adjusting for modesty, is warranted. The
complaint warrants validation before referral or delegation. Before you call the clinician, you
need to assess the patient. The assessment should not wait for another shift. Before
treatment, it is important to assess the complaint.
DIF:Cognitive Level: Applying (Application)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
6. You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand
is best for palpating vibration?
a. Dorsal surface
b. Finger pads
c. Fingertips
d. Ulnar surface
ANS: D
The ulnar surface of the hand and bases of the fingers can best feel vibratory sensations such
as thrills and fremitus. The dorsal surface of the hand is best for assessing temperature. The
finger pads and fingertips are best for palpating pulses.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
7. The dorsal surface of the hand is most often used for the assessment of
a. crepitus.
b. temperature.
c. texture.
d. vibration.
ANS: B
The dorsal surface, or back of the hand, is best for assessing warmth, or temperature. The
palmar surface, rather than the dorsal surface, is best for assessing crepitus. The palmar
surface, rather than the dorsal surface, is best for assessing texture. The ulnar surfaces of the
hand and fingers, rather than the dorsal surface, are best for assessing vibration.
DIF:Cognitive Level: Understanding (Comprehension)
16 | P a g eOBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
8. Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal
pain. You have completed the inspection of the abdomen. What is your next step in the
assessment process?
a. Light palpation
b. Deep palpation
c. Percussion
d. Auscultation
ANS: D
Auscultation precedes palpation or percussion of the abdomen because these techniques can
stimulate peristalsis, which may alter correct assessment of the abdominal sounds. Light
palpation, deep palpation, and percussion should not be completed until auscultation is
completed.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
9. The degree of percussion tone is determined by the density of the medium through which the
sound waves travel. Which statement is true regarding the relationship between density of the
medium and percussion tone?
a. The more dense the medium, the louder the percussion tone.
b. The less dense the medium, the louder the percussion tone.
c. The more hollow the area percussed, the quieter the percussion tone.
d. Percussion over muscle areas produces the loudest percussion tones.
ANS: B
Percussion sounds vary according to the tissue being percussed. Less dense tissue (such as
that over normal lungs) produces a loud tone, whereas more dense tissue (such as a muscle)
produces a softer tone. The more dense the medium, the softer is the percussion tone. The
more hollow the area, the louder is the percussion tone. Percussion tones over muscle are soft
and flat.
DIF:Cognitive Level: Understanding (Comprehension)
OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
10. Expected normal percussion tones include
a. dullness over the lungs.
b. hyperresonance over the lungs.
c. tympany over an empty stomach.
d. flatness over an empty stomach.
ANS: C
A normal lung produces resonance percussion tones, whereas an empty stomach is expected
to produce tympany. Dullness indicates atelectasis of the lung. Hyperresonance over the lungs
indicates emphysema. Flatness occurs over muscle.
17 | P a g eDIF:Cognitive Level: Understanding (Comprehension) OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
11. During percussion, a dull tone is expected to be heard over a. healthy lung tissue. b. emphysemic lungs. c. the liver. d. most of the abdomen.
ANS: C Dull tones are expected over denser areas such as the liver. Healthy lung tissue is resonant. Emphysemic lungs are hyperresonant. Tympany is heard over most of the abdomen.
DIF:Cognitive Level: Understanding (Comprehension) OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
12. When using mediate or indirect percussion, which technique is appropriate? a. Place the palmar surface of the nondominant hand on the body surface, with the fingers held together.
b. Place the palmar surface of the nondominant hand on the body surface, with the fingers slightly spread apart.
c. Place the ulnar surface of the nondominant hand on the body surface, with the fingers together.
d. Place the ulnar surface of the nondominant hand on the body surface, with the fingers slightly spread apart.
ANS: B The palmar surface of the nondominant (stationary) hand should rest against the body surface, with the fingers spread slightly. A helpful tip to improve elicitation of correct tones is to hyperextend the middle finger of the stationary hand and place the distal interphalangeal joint firmly against the body surface. This lifting of the fingertip avoids dampening of the vibratory sounds.
DIF:Cognitive Level: Understanding (Comprehension) OBJ:Nursing process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
13. During percussion, the downward snap of the striking fingers should originate from the a. shoulder. b. forearm. c. wrist. d. interphalangeal joint.
ANS: C The downward snap of the striking fingers should originate from the wrist. [Show Less]