NURS 6501N Advanced Pathophysiology | Exam Test Bank- 230 Q&A | Walden University
A 5-year-old child presents with nasal congestion and a headache. To assess
for sinus tenderness, you should palpate over the:
A. sphen
...
NURS 6501N Advanced Pathophysiology | Exam Test Bank- 230 Q&A | Walden University
A 5-year-old child presents with nasal congestion and a headache. To assess
for sinus tenderness, you should palpate over the:
A. sphenoid and frontal sinuses.
B. maxillary and frontal sinuses.
C. maxillary sinuses only.
D. sphenoid sinuses only.
Only the maxillary and the frontal sinuses are accessible
for physical examination; however, the young child does
not develop frontal sinuses until 7 to 8 years of age.
A 6-month-old who can hear well can be expected to:
A. exhibit the Moro reflex.
B. stop breathing in response to sudden noise.
C. turn his or her head toward the source of sound.
D. imitate simple words.
Six-month-old infants turn their head toward the source of sound; they
start babbling, but they begin imitating speech sounds closer to 10
months of age. The Moro reflex and cessation of breathing in
response to noise are lost by 3 months of age.
A 23-year-old man comes to the urgent care clinic with intense left flank and lower left
quadrant pain. One patient response to history of present illness questions that further
supports a tentative diagnosis of renal calculi is:
A. "My urine has been a bright yellow."
B. "I have had fever and chills for 2 days."
C. "I also have a headache and neck ache."
D. "My left testicle and shoulder hurt as well."
Renal calculi present with hematuria, intermittent flank
pain that radiates to the groin and genitals, and a positive
Kehr sign (pain radiating to the left shoulder).
A 29-year-old patient presents with a new complaint of productive cough with purulent
sputum. He also complains of right lower quadrant abdominal pain. You suspect
pneumonia in which lobe?
A. Right lower
B. Right upper
C. Left upper
D. Left lower
Right lower lobe pneumonia can stimulate the tenth
thoracic nerve, causing right lower quadrant pain
and simulating an abdominal process.
A 44-year-old male patient who complains of a cough has presented to the emergency
department. He admits to smoking 1 pack per day. During your inspection of his chest, the
most appropriate lighting source to highlight chest movement is:
A. bright tangential lighting.
B. daylight from a window.
C. flashlight in a dark room.
D. fluorescent ceiling lights.
Bright tangential light is best for
visualizing chest movements.
A 51-year-old woman calls with complaints of weight loss and constipation.
She reports enlarged hemorrhoids and rectal bleeding. You advise her to:
A. use topical over-the-counter hemorrhoid treatment for 1 week.
B. exercise and eat more fiber.
C. come to the laboratory for a stool guaiac test.
D. eat six small meals a day.
Blood in the stools is an abnormal finding that should never be
ignored, even if it can be explained by conditions other than
colon cancer. She should have her stool checked for blood
now as well as annually because she is older than 50 years.
After thorough inspection of the abdomen, the next assessment step is:
A. percussion.
B. palpation.
C. auscultation.
D. rectal examination.
Assessment of the abdomen begins with inspection followed by auscultation.
This break from the usual system examination sequence occurs because
palpation and percussion can alter the frequency as well as the intensity of
bowel sounds. Therefore, auscultation is done first.
The American Thoracic Society suggests replacing the term rales with:
A. wheezes.
B. crunches.
C. rhonchi.
D. crackles.
The American Thoracic Society has suggested that
the term rales be replaced with crackles to more
precisely describe the sound.
The anteroposterior diameter of the chest is normally approximately the same
as the transverse diameter in which age group?
A. Infants
B. School-age children
C. Adolescents
D. Young adults
The chest of infants is generally round with equal
dimensions of anteroposterior and transverse
diameters.
The apex of a 2-month-old baby's heart typically lies closest to the:
A. fourth left intercostal space.
B. midsternal area.
C. midthoracic spinal area.
D. sixth left intercostal space.
In infants and young children, the heart lies more horizontally in
the chest. The apex of the heart is located higher, sometimes
well out into the fourth left intercostal space.An apical PMI palpated beyond the fifth intercostal space may indicate:
A. decreased cardiac output.
B. obesity.
C. left ventricular hypertrophy.
D. hyperventilation.
An apical impulse that is more forceful and widely distributed,
fills systole, or is displaced laterally and downward may be
indicative of left ventricular hypertrophy. Obesity, large breasts,
and muscularity can obscure the visibility of the apical impulse.
The appendix is an extension of the:
A. stomach.
B. pancreas.
C. small intestine.
D. large intestine.
The appendix is a blind-ended tube connected to the cecum,
the site of the beginning of the large intestine, located in the
right lower quadrant of the abdomen. It develops
embryologically from the cecum.
As you take vital signs on Mr. Barrow, age 78, you note that his respirations are 40 per
minute. He has been resting, and his mucosa is pink. Concerning Mr. Barrow's respirations,
you would:
A. document his rate as normal.
B. do nothing because his color is pink.
C. note that his rate is below normal.
D. report that he has an above-average rate.
The normal adult respiratory rate is 12 to 20 breaths per minute,
and the ratio of breaths to heartbeats is 1:4. A respiratory rate
of 40 breaths per minute is not within the normal range and
should be documented as above average.
The auscultation of a triphasic friction rub in a patient with acute chest pain
should lead you to suspect:
A. congestive heart failure.
B. pericarditis.
C. endocarditis.
D. cardiac tamponade.
Chest pain is the usual initial symptom in acute pericarditis, which is the inflammation of the pericardium.
The key physical finding is the triphasic friction rub, which comprises ventricular systole, early diastolic
ventricular filling, and late diastolic atrial systole. It is heard just to the left of the sternum in the third and
fourth intercostal spaces and is characteristically scratchy. The auscultation of a triphasic friction rub in a
patient with acute chest pain should not lead you to suspect congestive heart failure, endocarditis, or
cardiac tamponade.
Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausageshaped mass is palpable in his right upper quadrant. Joe's lower quadrant feels empty, and a positive
Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe's
symptoms?
A. Intussusception
B. Kidney stones
C. Meconium ileus
D. Pyloric stenosis
Intussusception refers to the prolapse of one segment of the intestine into
another, causing intestinal obstruction. A sausage-shaped mass may be
palpated in the right or left upper quadrant, whereas the lower quadrant feels
empty (positive Dance sign); it commonly occurs between 3 and 12 months of
age.
Before performing an abdominal examination, the examiner should:
A. ascertain the patient's HIV status.
B. have the patient empty his or her bladder.
C. don double gloves.
D. completely disrobe the patient.
The patient should empty the bladder to ensure an
accurate examination of organs as well as to provide
comfort for the patient.
The bell of the stethoscope placed at the apex is more useful than the
diaphragm for hearing:
A. pericardial friction rub.
B. high-pitched murmurs.
C. presystolic gallops.
D. systolic ejection sounds.
Using the bell of the stethoscope at the apex is more useful for
hearing low-pitched presystolic gallops. The patient should lie
in the supine or left lateral recumbent position.
The best time to observe and count respirations is while:
A. the patient is answering questions.
B. weighing the patient.
C. palpating the pulse.
D. the patient is sleeping.
Counting respirations while you palpate the pulse does not make the patient
self-conscious, because the patient expects you to be counting the pulse.
Respiratory patterns change as the patient speaks. Attempting to count during
weighing would make the patient self-conscious and affect the respiratory rate.
Respiratory patterns change as the patient sleeps
Both pleural effusion and lobar
pneumonia are characterized by
___________ percussion.
ANS:
dullness heard on
Pleural effusion and lobar pneumonia are more dense than air, with an
expected finding of dullness on percussion. Tympany is expected over hollow
organs, such as the stomach; resonance and hyperresonance are heard over
air-filled areas.
Bradypnea may accompany:
A. a subconscious response to observation.
B. an excellent level of cardiovascular fitness.
C. ascites.
D. severe pain from a rib fracture.
Bradypnea, a respiratory rate slower than 12 breaths per minute,
may be seen with cardiorespiratory fitness. Tachypnea is seen
with a subconscious response to observation, with ascites, and
with severe pain from a rib fracture.Breath odors may clue the examiner to certain underlying metabolic
conditions. The odor of ammonia on the breath may signify:
A. uremia.
B. tuberculosis.
C. hepatic failure.
D. diabetic ketoacidosis.
An ammonia-like breath odor suggests uremia, a renal condition. A
cinnamon-like breath odor suggests tuberculosis. A breath odor
resembling musty fish or clover suggests hepatic failure. A sweet,
fruity breath odor suggests diabetic ketoacidosis.
Breath sounds normally heard over the trachea are called:
A. bronchovesicular.
B. amphoric.
C. bronchial.
D. vesicular.
The sounds highest in intensity and pitch are the
bronchial sounds, which are normally heard over the
trachea.
Bulging of an amber tympanic membrane without mobility is most often
associated with:
A. middle ear effusion.
B. healed tympanic membrane perforation.
C. impacted cerumen in the canal.
D. repeated and prolonged crying cycles.
An amber color, with bulging of the tympanic membrane
and without mobility or redness, most often indicates the
presence of fluid in the middle ear.
A cause for alarm during chest assessment of a newborn is:
A. crackles.
B. rhonchi.
C. gurgles from the gastrointestinal tract.
D. stridor.
Stridor is alarming at any age. Crackles and rhonchi at birth are due to
the presence of remaining fetal fluid and are not a cause for alarm.
Intermittent gurgles are bowel sounds transmitted through the thinwalled chest and are not a cause for alarm.
Changes in the clarity and volume of spoken sounds during auscultation of the
lungs can help you distinguish:
A. consolidation from airway constriction.
B. foreign body from purulent exudate.
C. pulmonary edema from pleurisy.
D. right from left tracheal deviation.
When chest auscultation results in decreased breath sounds or
wheezes, the examiner can use techniques that involve the spoken
word to distinguish adventitious breath sounds caused by
consolidation from those caused by narrowing of a patent lumen.
The characteristic barrel chest of the older adult is due to a combination of
factors, including:
A. skeletal changes of aging.
B. increased muscular expansion of the chest wall.
C. less fibrous alveoli.
D. increased vital capacity.
Skeletal changes associated with aging include an
emphasis of the dorsal curve of the thoracic spine
that contributes to a barrel chest.
Chest pain with an organic cause in a child is most likely the result of:
A. cardiac disease.
B. asthma.
C. esophageal reflux.
D. arthritis.
Unlike chest pain in adults, chest pain in children and
adolescents is seldom caused by a cardiac problem. More
likely, the case is related to trauma, exercise-induced asthma,
or cocaine use.
Closure of the ductus arteriosus usually occurs:
A. 24 to 48 hours after birth.
B. after 7 days of life.
C. between the second and third month.
D. during the toddler period.
Closure of the ductus arteriosus usually
occurs within 24 to 48 hours after birth.
The condition in which a patient's heart is either rotated or displaced to the
right or is situated as a mirror image of the expected position is called:
A. amyloidosis.
B. coarctation.
C. dextrocardia.
D. situs inversus.
Dextrocardia occurs when the heart is displaced or rotated to the right or is a complete
mirror image of the expected finding. Amyloidosis is a metabolic disorder marked by
amyloid deposits in organs and tissues. Coarctation is the compression of the walls of a
vessel such as an aortic coarctation. Situs inversus occurs when the heart and stomach are
displaced to the right and the liver is located to the left.
A condition that is likely to present with dizziness and syncope is:
A. bacterial endocarditis.
B. hypertension.
C. sick sinus syndrome.
D. pericarditis.
Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to
hypertension, arteriosclerotic heart disease, or rheumatic heart disease. SSS causes
arrhythmias with subsequent syncope, transient dizzy spells, lightheadedness, seizures,
palpitations, angina, or congestive heart failure (CHF). Bacterial endocarditis presents with
prolonged fever, signs of neurologic dysfunctions, and sudden onset of CHF. Chest pain is
an initial symptom in acute pericarditis along with a triphasic friction rub.Contraction of the gallbladder propels bile into the:
A. stomach.
B. duodenum.
C. jejunum.
D. large intestine.
With contraction of the gallbladder,
bile is excreted into the duodenum.
Contraction of the ventricles causes:
A. closure of the atrioventricular valves.
B. closure of the pulmonic and aortic valves.
C. opening of the auricular septa.
D. opening of the mitral and tricuspid valves.
When the ventricles contract the semilunar valves, the pulmonic and aortic valves open,
causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid
and mitral valves close, preventing backflow into the atria. When the atria contract, the
tricuspid and mitral valves open, allowing blood flow into the ventricles. When the
ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close,
preventing backflow into the ventricles.
Conversion of fat-soluble wastes to water-soluble material for renal excretion
is a function of the:
A. gallbladder.
B. kidney.
C. liver.
D. pancreas.
The liver is responsible for converting fat-soluble waste
to water-soluble materials so that the kidneys can excrete
them as well as convert ammonia to urea.
Costovertebral angle tenderness should be assessed whenever you suspect
the patient may have:
A. cholecystitis.
B. pancreatitis.
C. pyelonephritis.
D. ulcerative colitis.
Pyelonephritis is characterized by flank pain
and costovertebral angle tenderness.
The diaphragm of the stethoscope is better than the bell for auscultation of the
lungs because it:
A. amplifies all types of sounds.
B. filters extraneous sounds.
C. pinpoints focal sound areas.
D. transmits high-pitched sounds.
The diaphragm is the better source because it transmits the normally highpitched sounds of the lung, and it has a broader area from which to listen.
Unless specially modified, the stethoscope does not amplify sound, filter
extraneous sounds, or pinpoint focal sound areas.
Dullness to percussion in intercostal spaces suggests the presence of:
A. cor pulmonale.
B. empyema.
C. pneumonia.
D. sickle cell disease.
Resonance is the expected percussion tone over normal lung
tissue, which is accessible in the intercostal spaces. Dullness
indicates an area of consolidation, as is seen with pneumonia.
During a chest assessment, you note the patient's voice quality while auscultating the lung
fields. The voice sound is intensified, the voice has a nasal quality, and the e's sound like a's.
This is indicative of:
A. lung consolidation.
B. emphysema.
C. bronchial obstruction.
D. asthma.
Vocal resonance, as described, indicates lung
consolidation. Sounds are transmitted more clearly
through consolidation rather than air.
During the auscultation of heart tones, you are
uncertain whether the sound you hear is an S2 split.
You should ask the patient to inhale deeply while
listening at the _____ area.
ANS:
pulmonic
Splitting of S2 is greatest at the peak of inspiration and best
heard at the pulmonic site.
During what developmental stage are hoarseness, voice cracking, and a
persistent cough common findings in females?
A. Adolescence
B. Infancy
C. Menopause
D. Pregnancy
Laryngeal changes in pregnancy include hoarseness,
deepening or cracking of the voice, vocal changes,
and persistent cough.
An ear auricle with a low-set or unusual angle may indicate chromosomal
aberration or:
A. digestive disorders.
B. skeletal anomalies.
C. renal disorders.
D. heart defects.
An auricle with a low-set or unusual angle may
indicate chromosomal aberrations or renal disorders.The earliest sign of heart failure in an infant is frequently:
A. liver enlargement.
B. fluid in the lungs.
C. enlarged thyroid.
D. clubbing of the fingers.
If heart failure is suspected, note that the infant's liver may
enlarge before there is any suggestion of fluid in the lungs and
that the left lobe of the liver may be more distinctly enlarged
than the right.
Electrical activity recorded by the electrocardiogram (ECG) tracing that
denotes the spread of the stimulus through the atria is the:
A. P wave.
B. PR interval.
C. QRS complex.
D. ST segment.
The P wave represents the spread of a stimulus through the atria (atrial depolarization). The
PR interval is the time from the initial stimulation of the atria to the initial stimulation of the
ventricles, usually 0.12 to 0.20 second. The QRS complex is the spread of a stimulus
through the ventricles (ventricular depolarization), less than 0.10 second. The ST segment
and T wave are the return of stimulated ventricular muscle to a resting state (ventricular
repolarization).
The eruption of permanent teeth most commonly begins with:
A. upper central incisors.
B. upper canines.
C. lower central incisors.
D. lower canines.
The central incisors on the lower jaw usually erupt between 6 and 7
years of age as the first permanent teeth. Upper central incisors
appear at 7 to 8 years of age. Upper canines appear at 11 to 12 years
of age. Lower canines appear at 9 to 10 years of age.
The esophagus travels a route from:
A. behind the trachea through the mediastinal cavity.
B. lateral to the trachea through the diaphragm.
C. left of the trachea through the peritoneum.
D. the anterior trachea through the cardiac orifice.
The esophagus lies posteriorly to the trachea, descends
through the mediastinal cavity and through the diaphragm, and
enters the stomach. The esophagus connects the pharynx to
the stomach.
The examiner percusses for diaphragmatic excursion along the:
A. sternum.
B. midvertebral line.
C. midaxillary line.
D. scapular line.
The technique for diaphragmatic excursion is to percuss along
the scapular line after the patient inhales deeply and then mark
the site where resonance changes to dullness, representing the
diaphragm. The sequence is repeated with exhalation.
An example of a functional heart murmur is one that is caused by:
A. anemia.
B. ventricular septal defect.
C. atrial septal defect.
D. mitral valve prolapse.
A functional heart murmur is a harmless heart murmur made by a
healthy heart beating strongly. High-output demands that increase the
speed of blood flow can cause murmurs. Anemia, pregnancy, and
thyrotoxicosis can cause these functional heart murmurs.
An expected finding of chest palpation in the adult would be:
A. a costal angle of 100 degrees.
B. cracking over the sternal notch.
C. greater right chest expansion.
D. inflexibility of the xiphoid.
The sternum and xiphoid are relatively inflexible in adults. The
expected normal costal angle in the adult is 90 degrees. Cracking
over the sternal notch is not an expected finding of chest palpation in
the adult. Normally, the chest moves symmetrically in the adult.
Expected physical changes associated with older adults include:
A. shiny buccal mucosa.
B. shorter teeth.
C. wetter nasal mucosa.
D. bristly hairs in the vestibule.
With age, buccal mucosa becomes less shiny, teeth appear
longer due to gums receding, nasal mucosa are drier, and
more bristly hairs appear in the nose, especially in men.
Expected respiratory changes of normal aging include:
A. increased chest expansion.
B. more frequent use of respiratory muscles.
C. accentuated lumbar curve.
D. more prominent bony structures.
Marked bony prominences are seen in older adults because of loss of
subcutaneous tissue. Chest expansion is decreased in older adults.
Older adults show less use of respiratory muscles because of muscle
weakness. The lumbar curve is flattened in older adults.
Failure to pass a meconium stool in the first 24 hours after birth along with
abdominal distention are often the first signs of:
A. Meckel diverticulum.
B. cystic fibrosis.
C. biliary atresia.
D. hydramnios.
Meconium ileus is often the first manifestation of
cystic fibrosis or Hirschsprung disease.The family history of a patient with diarrhea and abdominal pain should include
inquiry about cystic fibrosis because it is:
A. a common genetic disorder.
B. one cause of malabsorption syndrome.
C. a curable condition with medical intervention.
D. the most frequent cause of diarrhea in general practice.
Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple
systems. In the gastrointestinal tract, it causes malabsorption syndrome
because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from
increased gas production are frequent complaints.
Fat deposits in the circulatory system of an older adult can lead to:
A. diffuse conduction disturbances.
B. exaggerated contractility.
C. heart failure.
D. thinning of the ventricles.
Atherosclerosis is a disease in which fat deposits
(cholesterol) accumulate in the walls of the arteries,
which can lead to heart failure or stroke.
Fetal gas exchange is mediated by the:
A. lungs.
B. heart.
C. amniotic fluid.
D. placenta.
The placenta is the source of fetal gas exchange; the
lungs contain no air and the alveoli are collapsed. It
is not mediated by the heart.
Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are
findings most associated with:
A. diverticulitis.
B. pancreatitis.
C. ruptured ovarian cyst.
D. splenic rupture.
Only diverticulitis has all of these
presenting symptoms.
The foramen ovale should close:
A. by 24 weeks of gestation.
B. within minutes of birth.
C. by 4 weeks of age.
D. By 12 months of age.
The decrease in pulmonary pressures within the first
minutes of life leads to closure of the foramen ovale.
For best results, otoscopic and oral examination in a child should be:
A. conducted at the beginning of the assessment.
B. done after inspection.
C. performed at the end of the examination.
D. performed before palpation.
Because young children often resist otoscopic and oral
examination, it may be wise to postpone these procedures until
the end, after you have gained some trust.
A grade I or II murmur, without radiation and of medium pitch, is a common
variation found in:
A. school-age children.
B. older women.
C. middle-age men.
D. older adults.
Many murmurs, particularly in children and adolescents and especially in young
athletes, have no apparent cause. These are usually grade I or II murmurs that
are usually midsystolic and without radiation; are medium pitched; and are
blowing, brief, and often accompanied by splitting of S2.
A grade IV mitral regurgitation murmur would:
A. be described as a diastolic murmur.
B. not be expected to have a thrill.
C. radiate to the axilla.
D. be heard best at the base.
A grade IV murmur would have a thrill; and a mitral
regurgitation murmur is best heard at the apex, is
holosystolic, and would radiate to the axilla.
The hair cells of Corti and membrane of Corti:
A. produce a waxy lubricant.
B. protect the ear from foreign particles.
C. stimulate the eighth cranial nerve.
D. transmit vibrations to the ossicles.
Vibrations from the tympanic membrane cause the delicate hair
cells of the organ of Corti to strike against the membrane of
Corti, stimulating impulses in the sensory endings of the
auditory division of the eighth cranial nerve.
A hairy tongue with yellowish brown to black elongated papillae on the
dorsum:
A. is indicative of oral cancer.
B. is sometimes seen following antibiotic therapy.
C. usually indicates vitamin deficiency.
D. usually indicates anemia.
Recent antibiotic use can turn the tongue yellow-brown to
black and make it appear hairy. Oral cancer involves lesions. A
smooth red tongue with a slick appearance may indicate a
niacin or vitamin B12 deficiency. Pallor usually indicates anemia.Hearing tends to decline after 50 years of age because of deterioration of:
A. hair cells of the organ of Corti.
B. the eustachian tube.
C. the helix.
D. cerumen.
Hearing declines after 50 years of age due to
degeneration of hair cells in the organ of Corti as
well as atrophy of the hair cells in the cochlea.
Heart position can vary depending on body habitus. In a short, stocky
individual, you would expect the heart to be located:
A. more to the right and hanging more vertically.
B. more to the left and lying more horizontally.
C. riding higher in the chest and pushed anteriorly.
D. hanging lower in the chest and riding more vertically.
The position of the heart varies depending on body build, configuration of the
chest, and level of the diaphragm. A tall, slender person's heart tends to hang
vertically and is positioned centrally. A stocky, short person's heart tends to lie
more to the left and more horizontally.
The heart sound that coincides with the
carotid pulse is ________.
ANS:
S1
S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse.
Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1
while you palpate the carotid pulse. S2 marks the start of diastole.
How is the sputum of a viral infection different from the sputum of a bacterial infection?
A. Sputum production is greater with viral conditions than with bacterial infections.
B. The sputum is odorous in viral conditions and nonodorous in bacterial infections.
C. The sputum is yellow, green, or rust colored in bacterial infections and mucoid in viral
infections.
D. The sputum is much thinner in bacterial infections than in viral infections.
The characteristic most likely to differentiate viral sputum from
bacterial sputum is the sputum's color. Viral infections typically
produce mucoid sputum, whereas bacterial infections produce
yellow, green, or rust-colored sputum.
If the apical impulse is more vigorous than expected, it is called a:
A. lift.
B. thrill.
C. bruit.
D. murmur.
If the apical impulse is more vigorous than expected, it is referred to as a lift or
heave. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A
murmur is an auscultated sound that is caused by turbulent blood flow into,
through, or out of the heart.
In adults, the length of the external
auditory canal is _____ cm.
ANS:
2.5
The external ear canal is approximately 2.5 cm long in adults.
In barrel chest, the ratio of
anteroposterior diameter to transverse
(lateral) diameter is _____.
ANS:
1.0
In a barrel chest, an increase in the chest anteroposterior diameter
leads to an increase in the thoracic ratio (anteroposterior to transverse
diameters) of 1.0, wherein the chest is as wide as it is thick.
Increased oxygen tension in the arterial blood of a newborn infant causes:
A. closure of the ductus arteriosus.
B. hyperinflation of the lungs.
C. passive respiratory movements.
D. reopening of the foramen ovale.
Increased oxygen tension in the arterial blood
usually stimulates contraction and closure of the
ductus arteriosus.
An increase in heart rate during inspiration, with a decrease in this rate during
expiration, is an expected finding in:
A. adults under stress.
B. 4-year-old children.
C. pregnant women.
D. premature infants.
Sinus arrhythmia is a physiologic event during childhood. The
heart rate of a child (4 years old) varies in a cyclic pattern,
usually faster on inspiration and slower on expiration.
An infant's auditory canal, compared with an adult's, is:
A. short, narrow, and straight.
B. short and curved upward.
C. long, narrow, and curved forward.
D. short and curved downward.
Compared with the adult's, the infant's auditory canal is
shorter and has an upward curve, which is the reason that
pulling the pinna down straightens the canal.Infants born weighing less than 1500 g are at higher risk for:
A. hepatitis A.
B. necrotizing enterocolitis.
C. urinary urgency.
D. pancreatitis.
Necrotizing enterocolitis is a gastrointestinal disease that
mostly affects premature infants; it involves infection and
inflammation that cause destruction of the bowel, and it
becomes more apparent after feedings.
In older adults, overflow fecal incontinence is commonly due to:
A. malabsorption.
B. parasitic diarrhea.
C. fecal impaction.
D. fistula formation.
Constipation with overflow occurs when the rectum
contains hard stool and soft feces above a leak
around the mass of stool.
Inspection of the abdomen should begin with the patient supine and the
examiner:
A. seated on the patient's right.
B. standing at the foot of the table.
C. standing at the patient's left.
D. walking around the table.
Being seated on the patient's right is the preferred initial
position because it allows tangential viewing of the abdomen
for improved assessment of abdominal contour.
Intense pain with movement of the pinna is most closely associated with:
A. otitis media with effusion.
B. otitis externa.
C. purulent otitis media.
D. bacterial otitis media.
Otitis externa (swimmer's ear) should be suspected
when pulling of the pinna reproduces ear pain.
In the adult, the apical impulse should be most visible when the patient is in
what position?
A. Supine
B. Upright
C. Lithotomy
D. Right lateral recumbent
In most adults, the apical impulse should be visible at about the midclavicular line in the
fifth left intercostal space, but it is easily obscured by obesity, large breasts, or muscularity.
The apical impulse may become visible only when the patient sits upright and the heart is
brought closer to the anterior wall. A visible and palpable impulse when the patient is
supine suggests an intensity that may be the result of a problem. In most adults, the apical
impulse will not be visible in the upright, lithotomy, or right lateral recumbent positions.
In the fetus, the right ventricle pumps blood through the:
A. left atrium.
B. ductus arteriosus.
C. lungs.
D. foramen ovale.
The right ventricle of a fetal heart pumps blood through the
patent ductus arteriosus rather than into the lungs, not through
the left atrium, lungs, or foramen ovale.
In the most effective percussion technique for the posterior lung fields, the
patient cooperates by:
A. folding the arms in front.
B. bending the head back.
C. standing and bending forward.
D. lying on the side and extending the top arm.
Having the patient sit with the head forward and the
arms folded in front moves the scapula laterally,
exposing more lung to percussion.
In the presence of otitis externa, tympanic membrane perforation, or
myringotomy tubes, you should:
A. avoid performing otoscopic examinations.
B. clean the inner ear with soap.
C. instill alcohol into the ear.
D. avoid instilling fluids.
Any ear irrigation should be avoided in the presence of otitis externa, a perforated
tympanic membrane, myringotomy tubes, or mastoid cavity. The presence of otitis externa,
tympanic membrane perforation, or myringotomy tubes is not a contraindication for
otoscopic examinations. You should not clean the inner ear with soap. Only the auricle can
be cleaned with soap. You should not instill alcohol into the ear.
In what age-group are the right and left ventricles equal in weight and muscle
mass?
A. Newborns
B. School-age children
C. Adolescents
D. Older adults
At the time of birth, the right and left ventricles are equal in weight and muscle mass because they both
pump blood into the systemic circulation. Within 24 to 48 hours, closure of the ductus arteriosus and the
interatrial foramen ovale causes pressure in the left atrium to increase. At this time, the right ventricles
demand changes as the pulmonary circulation develops, and the left ventricle assumes total responsibility
for providing systemic circulation. This results in an increase in the mass of the left ventricle. In older
adults, the left ventricle wall thickens and the valves become fibrotic and calcified. The right and left
ventricles are not equal in weight and muscle mass in school-age children, adolescents, or older adults.
In what position can the mediastinal crunch (Hamman sign) best be heard?
A. A supine position
B. Lying on the left side
C. Sitting completely upright
D. With the head elevated 30 degrees
Hamman sign occurs with mediastinal emphysema. The adventitious
breath sounds are synchronous with the heartbeat and are best heard
when the patient leans to the left or lies down on the left side (these
maneuvers bring the heart muscle closer to the chest wall).In which patient situation would you expect to assess tachypnea?
A. Patient who is depressed
B. Patient who abuses narcotics
C. Patient with metabolic acidosis
D. Patient with myasthenia gravis
In metabolic acidosis, the body compensates by increasing the
respiratory rate to blow off the excess carbon dioxide. A
patient who is depressed, abuses narcotics, or has myasthenia
gravis would have respiratory depression.
Laryngeal obstructions would elicit which breath sound?
A. Fremitus
B. Stridor
C. Rhonchi
D. Crepitus
Obstructions high in the respiratory tree (e.g.,
laryngeal obstructions) are characterized by stridor.
A lift along the left sternal border is most likely the result of:
A. aortic stenosis.
B. atrial septal defect.
C. pulmonary hypertension.
D. right ventricular hypertrophy.
A lift along the left sternal border may be caused by right ventricular
hypertrophy. A thrill indicates a disruption of the expected blood flow related
to a defect in the closure of one of the semilunar valves, which is seen in aortic
or pulmonic stenosis, pulmonary hypertension, or atrial septal defect.
Loud, harsh bronchovesicular breath sounds in young children are an indication
of:
A. the accumulation of fluid.
B. malignant tumors or solid masses.
C. normal, thin chest wall structures.
D. pus-filled abscesses and tumors.
The chest wall of a young child is usually thin and
therefore normally able to transmit loud, harsh, and more
bronchial breath sounds than are heard in adults.
The lung begins its gestational development from the:
A. gut.
B. placenta.
C. heart.
D. trachea.
At about 4 weeks' gestation, the lung is
a groove on the ventral wall of the gut.
The major function of the large intestine is:
A. water absorption.
B. food digestion.
C. carbohydrate absorption.
D. glucose storage.
The major function of the large intestine is the
absorption of water and excretion of solid waste
material in the form of stool.
The major heart sounds are normally created by:
A. valves opening.
B. valves closing.
C. the rapid movement of blood.
D. rubbing together of the cardiac walls.
At the beginning of systole, ventricular contraction raises the pressure in the ventricles and
forces the mitral and tricuspid valves closed, which produces the first heart sound S1
"lubb." When the pressure in the ventricles falls, when the ventricles are almost empty,
below that of the aorta and pulmonary artery, the aortic and pulmonic valves close,
producing the second heart sound S2 "dubb." Valve opening is usually a silent event.
The majority of nutrient absorption takes place in the:
A. stomach.
B. small intestine.
C. cecum.
D. transverse colon.
Most absorption takes place in the small intestine. Very little
absorption takes place in the stomach. The cecum and
transverse colon are part of the large intestine, and their major
function is water resorption
The major occupant of the retroperitoneal space is the:
A. kidneys.
B. lungs.
C. spleen.
D. bladder.
The kidneys occupy most of the retroperitoneal space, lying
behind the abdominal cavity, beside the abdominal aorta. The
lungs and bladder lie outside the peritoneum, but not in the
retroperitoneal area. The spleen is within the peritoneum.
The middle ear contains the:
A. cerumen and sebaceous glands.
B. umbo and malleus.
C. vestibule and cochlea.
D. pars tensa and semicircular canals.
The middle ear contains the ossicles—three small bones: the malleus (umbo is
part of the malleus), the incus, and the stapes. Cerumen and sebaceous glands
lie outside the middle ear. The vestibule and the cochlea lie in the inner ear. The
tympanic membrane separates the external ear from the middle ear and is
composed of the pars tensa, and the semicircular canals lie in the inner ear.The middle ear is normally filled with:
A. air.
B. blood.
C. serous fluid.
D. cerebrospinal fluid.
The middle ear normally is an air-filled
cavity in the temporal bone.
The middle lobe of the right lung is best auscultated in the:
A. anterior chest.
B. posterior chest.
C. axilla.
D. midclavicular line.
The sounds of the middle lobe of the right
lung are best heard in the right axilla.
The most common congenital anomaly of the gastrointestinal tract is:
A. biliary atresia.
B. pyloric stenosis.
C. intussusception.
D. Meckel diverticulum.
Meckel diverticulum is the most common
congenital anomaly of the gastrointestinal tract.
The most helpful finding in determining left-sided heart failure is:
A. dyspnea.
B. orthopnea.
C. jugular vein distention.
D. S3 heart sound.
Evidence-based research has shown that the most
helpful clinical examination finding supportive of
left-sided heart failure is jugular vein distention.
The most pronounced functional change of the gastrointestinal (GI) tract in
older adults is:
A. decreased hydrochloric acid production.
B. increased saliva secretion.
C. decreased bile absorption.
D. decreased motility.
Motility of the intestine is the most
pronounced GI change in older adults.
The most superior part of the stomach is the:
A. body.
B. fundus.
C. pylorus.
D. pyloric orifice.
The most superior aspect of the stomach is the
fundus, followed by the body, and then the most
distal part, the pylorus.
A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever
she fastens the child's diaper. Nephroblastoma is a likely diagnosis for this child when your
physical examination of the abdomen reveals a:
A. fixed mass palpated in the hypogastric area.
B. tender, midline abdominal mass.
C. olive-sized mass of the right upper quadrant.
D. nontender, slightly moveable, flank mass.
A Wilms tumor (nephroblastoma) is the most common intraabdominal tumor of childhood. It presents with hypertension,
fever, malaise, and a firm nontender mass deep within the flank
that is only slightly movable and is usually unilateral.
Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss. Which of the
following are changes in hearing that occur in the elderly? Select all that apply.
A. Results from cranial nerve VII
B. Progression is slow
C. Loss of high frequency
D. Bone conduction heard longer than air conduction
E. Sounds may be garbled and difficult to localize
F. Unable to hear in a crowded room
, E, F
Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of
ear drainage. When examining an infant's middle ear, the nurse should use one hand to
stabilize the otoscope against the head while using the other hand to:
A. pull the auricle down and back.
B. hold the speculum in the canal.
C. distract the infant.
D. stabilize the chest.
The nurse should use the other hand to pull the
auricle down and back in an effort to straighten the
upward curvature of the canal.
Mr. Curtis is a 44-year-old patient who has presented to the emergency department with
shortness of breath. During the history, the patient describes shortness of breath that gets
worse when he sits up. To document this, you will use the term:
A. platypnea.
B. orthopnea.
C. tachypnea.
D. bradypnea.
Dyspnea that increases in the upright posture is called
platypnea. Orthopnea is dyspnea that worsens when the
person lies down. Tachypnea is an increased respiratory rate.
Bradypnea is a decreased respiratory rate.Mr. Jones and his wife have brought in their infant daughter for a routine visit. A
holosystolic murmur in an infant that is best heard along the left sternal border, is in the
third to fifth intercostal spaces, and does not radiate to the neck is indicative of:
A. ventricular septal defect.
B. patent ductus arteriosus.
C. pulmonary stenosis.
D. dextrocardia.
Regurgitation through the ventricular septal defect results in a
holosystolic murmur that is best heard along the left sternal
border, is in the third to fifth intercostal spaces, and does not
radiate to the neck.
Mr. L. has cyanotic lips and nail beds. His lips are pursed, and he has nasal flaring. You
suspect he is having cardiac or pulmonary difficulty. What additional sign would support
this impression?
A. Callus formation on the heels
B. Clubbing of the fingers
C. Graying hair
D. Swollen toes and ankles
Clubbing of the fingers suggests
pulmonary or cardiac difficulty.
Mr. O., age 50, comes for his yearly health assessment, which is provided by his employer. During your
initial history-taking interview, Mr. O. mentions that he routinely engages in light exercise. At this time, you
should:
A. ask if he makes his own bed daily.
B. have the patient describe his exercise.
C. make a note that he walks each day.
D. record "light exercise" in the history.
When Mr. O. says he engages in light exercise, have him
describe his exercise. To qualify his use of the term "light," ask
him the type, length of time, frequency, and intensity of his
activities.
Mr. Robins is a 45-year-old man who presents to the emergency department with a
complaint of constipation. During auscultation, you note borborygmi sounds. This is
associated with:
A. gastroenteritis.
B. peritonitis.
C. satiety.
D. paralytic ileus.
Borborygmi are prolonged loud gurgles that occur with
gastroenteritis, early intestinal obstruction, or hunger. Peritonitis and
paralytic ileus result in hypoactive bowel sounds. Food satiety does
not stimulate growling sounds like hunger does.
Mrs. Donaldson is a 31-year-old patient who is pregnant. In providing Mrs. Donaldson with
health care information, you will explain she can expect to experience:
A. more nasal stuffiness.
B. a sensitive sense of smell.
C. drooling.
D. enhanced hearing.
Physiologic changes of pregnancy include nasal
stuffiness, decreased sense of smell, impaired
hearing, epistaxis, and a sense of fullness in the ears.
Mrs. James is 7 months pregnant and states that she has developed a problem with
constipation. She eats a well-balanced diet and is usually regular. You should explain that
constipation is common during pregnancy due to changes in the colorectal areas, such as:
A. decreased movement through the colon and increased water absorption from stool.
B. increased movement through the colon and increased salt taken from foods.
C. looser anal sphincter and fewer nutrients taken from foods.
D. tighter anal sphincter and less iron eliminated in the stool.
Constipation and flatus are more common during pregnancy because the
colon is displaced, peristalsis is decreased, and water absorption is increased.
Movement through the colon is decreased during pregnancy. The colon does
not absorb nutrients. A tighter sphincter tone is not related to pregnancy.
Mrs. Kinder is a 39-year-old patient who presents to the office with complaints of an earache. In
explaining to the patient about the function of her ears, which ear structure would you tell her is
responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning?
A. Eustachian tube
B. Inner ear
C. Pars flaccida
D. Triangular fossa
The eustachian tube is a cartilaginous and bony passageway
between the nasopharynx and the middle ear that opens
briefly to equalize the middle ear pressure with that of the
atmospheric pressure when swallowing, yawning, or sneezing.
Mrs. Little is a 44-year-old patient who presents to the office with abdominal pain and fever. During your
examination, you ask the patient to raise her head and shoulders while lying in a prone position. A midline
abdominal ridge rises. You chart this observation as a(n):
A. small inguinal hernia.
B. large epigastric hernia.
C. abdominal lipoma.
D. diastasis recti.
A diastasis recti occurs when abdominal contents bulge between two
abdominal muscles to form a midline ridge as the head is lifted. It has
little clinical significance and most often occurs in women who have
had repeated pregnancies and obese patients.
Mr. Spencer presents with the complaint of hearing loss. You specifically inquire about
current medications. Which medications, if listed, are likely to contribute to his hearing
loss?
A. Chlorothiazide
B. Acetaminophen
C. Salicylates
D. Cephalosporins
Ototoxic medications include aminoglycoside,
salicylates, furosemide, streptomycin, quinine,
ethacrynic acid, and cisplatin.
Mr. Sprat is a 21-year-old patient who complains of nasal congestion. He admits to using
recreational drugs. On examination, you have noted a septal perforation. Which of the
following recreational drugs is commonly associated with nasal septum perforation?
A. Heroin
B. Cocaine
C. PCP
D. Ecstasy
Long-term cocaine snorting causes ischemic
necrosis of the septal cartilage and leads to
perforation of the nasal septum.Mr. Williams, age 25, has recovered recently from an upper and lower respiratory infection. He describes
a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away.
Information concerning his chronic postnasal drip should be documented within which section of his
history?
A. Age-specific data
B. Past medical data
C. Past surgical data
D. Social history
Information concerning the patient's chronic
postnasal drip is part of the past medical history.
Ms. Rudman, age 74, has no known health problems or diseases. You are doing a preventive health care
history and examination. Which symptom is associated with intrathoracic infection?
A. Barrel chest
B. Cor pulmonale
C. Funnel chest
D. Malodorous breath
.
Intrathoracic infections may make the
breath malodorous
Ms. Sharpe is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On
auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. She
reports a recent severe sore throat. You suspect:
A. angina.
B. acute rheumatic fever.
C. cardiac amyloidosis.
D. aortic sclerosis.
Acute rheumatic fever is a systemic connective tissue disease that occurs after
a streptococcal pharyngitis or skin infection. It may result in serious cardiac
valvular involvement of the mitral or aortic valve. Often the valve becomes
stenotic and regurgitant. Prevention is adequate treatment of streptococcal
pharyngitis or skin infections.
A musical squeaking noise heard on auscultation of the lungs is called:
A. friction rub.
B. rales.
C. rhonchi.
D. wheezing.
Wheezing is a continuous, high-pitched musical
sound that can be heard on inspiration and
expiration.
Nancy Walker is a 16-year-old girl who presents to the clinic with complaints of severe, acute chest pain.
Her mother reports that, apart from occasional colds, Nancy is not prone to respiratory problems. What
potential risk factor is most important to assess with regard to Nancy's current problem?
A. Anorexia symptoms
B. Cocaine use
C. Last menses
D. Signs of rheumatic fever
Illegal drug use of cocaine is especially important to prioritize as a
social history question for all adolescents and adults who complain of
severe chest pain. Cocaine can lead to tachycardia, hypertension,
coronary arterial spasm with infarction, and pneumothorax.
Nasal symptoms that imply an allergic response include:
A. purulent nasal drainage.
B. bluish-gray turbinates.
C. small, atrophied nasal membranes.
D. firm consistency of turbinates.
Nasal symptoms that imply an allergic response include bluish
gray or pale pink nasal turbinates that are swollen and boggy
and a transverse crease at the junction between the cartilage
and the bone of the nose.
A newborn whose serum bilirubin is greater than 20 mg/100 mL has a risk of
later:
A. hearing loss.
B. sinusitis.
C. tooth decay.
D. meningitis.
Risk factors for hearing loss in infants include infection, irradiation, drug abuse,
and syphilis in the mother, as well as birth weight less that 1500 g, excessively
high bilirubin level, infections (e.g., bacterial meningitis and recurrent otitis
media), cleft palate, craniofacial abnormalities, ototoxic antibiotic use, head
trauma, and hypoxic episodes in infancy
Normal cardiac changes that occur during pregnancy include:
A. decreased cardiac output.
B. increased thickness and mass of the left ventricle.
C. decreased heart rate.
D. dilation of the ventricles.
The maternal blood volume increases by 40% to 50% due to an increase in plasma volume.
The heart works harder to accommodate the increased heart rate and stroke volume (both
equal cardiac output), thereby resulting in the increase in left ventricle wall thickness and
mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery.
As the uterus enlarges and the diaphragm moves upward, the heart is shifted horizontally
and there is a slight axis rotation.
Normal heart sounds are best heard:
A. directly over the semilunar and bicuspid heart valves.
B. over areas where blood flows after it passes through a valve.
C. near the carotid vessels.
D. over the central sternum.
Normal heart sounds are best heard in areas where
the blood flows after it passes through a valve in the
direction of blood flow.
Normal tympanic membrane color is:
A. amber.
B. chalky white.
C. green.
D. pearly gray.
The expected normal tympanic
membrane color is pearly gray.One major function of the liver is to:
A. secrete pepsin.
B. emulsify fats.
C. store glycogen.
D. absorb bile.
The liver plays a metabolic role; it converts glucose
to glycogen, stores it, and then converts glycogen
back to glucose as needed by the body.
The organ of Corti is a coiled structure located inside the:
A. cochlea in the inner ear.
B. pars flaccida in the tympanic membrane.
C. eustachian tube.
D. lateral aspect of the pinna.
The cochlea is a coiled structure within the inner
ear that contains the organ of Corti.
The "pacing" structure of the heart's electrical activity is the:
A. AV node.
B. bundle of His.
C. Purkinje fibers.
D. sinoatrial (SA) node.
An electrical impulse stimulates each myocardial
contraction, and this impulse originates in and is
paced by the SA node.
A palpable rushing vibration over the base of the heart at the second
intercostal space is called a:
A. heave.
B. lift.
C. thrill.
D. thrust.
A thrill is a fine, palpable, rushing vibration¯a palpable murmur. Cardiac thrills generally
indicate a disruption of the expected blood flow related to some defect in the closure of
one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary
hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A lift
is another term for a heave, which is a more vigorous apical impulse. A thrust is sudden,
forcible forward movement.
A patient presents to the emergency department after a motor vehicle accident. The
patient sustained blunt trauma to the abdomen and complains of pain in the upper left
quadrant that radiates to the left shoulder. What organ is most likely injured?
A. Gallbladder
B. Liver
C. Spleen
D. Stomach
Spleen laceration/rupture is always suspected with abdominal
injury because of the spleen's anatomic location. The patient's
presenting symptoms confirm this suspicion.
The patient tells you that she uses herbal and other alternative therapies to
maintain her health. This information is recorded in the:
A. past medical history.
B. chief complaint.
C. social history.
D. family history.
Patient data concerning the use of herbal or other remedies
and other complementary or alternative therapies are
recorded within the social history component of the history
and physical.
A patient you are seeing in the emergency department for chest pain is believed to be having a
myocardial infarction. During the health history interview of his family history, he relates that his father had
died of "heart trouble." The most important follow-up question you should pose is which of the following?
A. "Did your father have coronary bypass surgery?"
B. "Did your father's father have heart trouble also?"
C. "What were your father's usual dietary habits?"
D. "What age was your father at the time of his death?"
A family history of sudden death, particularly in
young and middle-aged relatives, significantly
increases one's chance of a similar occurrence.
Percussing at the right midclavicular line, below the umbilicus, and continuing
upward is the correct technique for locating the:
A. descending aorta.
B. lower liver border.
C. medial border of the spleen.
D. upper right kidney ridge.
Percussing along the right midclavicular line upward from
the umbilicus determines the lower border of the liver. A
liver border more than 2 to 3 cm signifies hepatomegaly.
Percussion of the abdomen begins with establishing:
A. liver dullness.
B. spleen dullness.
C. gastric bubble tympany.
D. overall dullness and tympany in all quadrants.
Percussion begins with a general establishment over
all quadrants for areas of dullness and tympany and
then proceeds to specific target organs.
Peristalsis of intestinal contents is under the control of:
A. cognitive processes.
B. gravity.
C. the autonomic nervous system.
D. the fluid content of the stomach.
The movement of food and digestive products is
regulated by the autonomic nervous system.Peritonitis produces bowel sounds that are:
A. hypoactive.
B. hyperactive.
C. high pitched.
D. absent.
Hypoactive bowel sounds occur with peritonitis and paralytic
ileus.
Placing the base of a vibrating tuning fork on the midline vertex of the patient's
head is a test for:
A. air conduction of sound.
B. bone versus air conduction.
C. lateralization of sound.
D. mallear auditory ability.
Placing the fork on the midline vertex of the patient's
head is the Weber test, a test for conductive hearing
loss that lateralizes to the affected ear.
Pleural pain differs from chest discomfort caused by other conditions in that it
is:
A. precipitated by coughing.
B. eased with deep breathing.
C. usually described as dull in nature.
D. related to time of day.
Pleural pain is precipitated by breathing and coughing
and is usually described as a sharp pain that is present
during respirations and absent during breath-holding.
A pregnant woman is expected to develop:
A. tachypnea and decreased tidal volume.
B. deep breathing but not more frequent breathing.
C. dyspnea and increased functional residual capacity.
D. bradypnea and increased tidal volume.
In a pregnant woman, the tidal volume and vital capacity
increase, the functional residual capacity decreases, and the
woman breathes more deeply but not more frequently.
Purkinje fibers are located in the:
A. sinoatrial node.
B. atrioventricular node.
C. myocardium.
D. aortic arch.
The Purkinje fibers are located in the
ventricular myocardium.
Respiratory effort usually exhibited by a patient with cerebral brain damage is
called:
A. Cheyne-Stokes respiration.
B. paroxysmal nocturnal dyspnea.
C. Kussmaul breathing.
D. Biot respiration.
Cheyne-Stokes respirations occur in children and older adults
during sleep, but otherwise occur in seriously ill patients,
particularly those with brain damage at the cerebral level.
The respiratory rate of a sleeping
newborn is expected to be _____ breaths
per minute.
ANS:
40 to 60
The expected respiratory rate for infants is 40 to 60
breaths per minute.
A serous membrane that lines the abdominal cavity and forms a protective
cover for many abdominal structures is the:
A. peritoneum.
B. mediastinum.
C. periosteum.
D. hilum.
The peritoneum is a serous membrane that lines the
abdominal cavity and serves as a protective cover.
Severe vertigo, tinnitus, and progressive hearing loss are characteristic of:
A. cholesteatoma.
B. Ménière disease.
C. otosclerosis.
D. cocaine abuse.
The classic triad of Ménière disease is vertigo,
tinnitus, and progressive hearing loss.
A smooth red tongue with a slick appearance may indicate:
A. niacin or vitamin B12 deficiency.
B. oral cancer.
C. recent use of antibiotics.
D. fungal infection.
A smooth red tongue with a slick appearance may indicate a niacin or vitamin
B12 deficiency. Oral cancer involves lesions; recent use of antibiotics can turn
the tongue yellow-brown to black and hairy; and fungal infections result in
slightly raised white, cream-colored, or yellow spots in the mouth.Speech with a monotonous tone and erratic volume may indicate:
A. otitis externa.
B. hearing loss.
C. serous otitis media.
D. sinusitis.
Speech with a monotonous tone and erratic
volume may indicate hearing loss.
A split second heart sound is:
A. abnormal.
B. greatest at the peak of inspiration.
C. heard best after forceful expiration.
D. supposed to disappear with deep inspiration.
Splitting of S2 is an expected event, because pressures are higher and
depolarization occurs earlier on the left side of the heart. Ejection times on the
right are longer, and the pulmonic valve closes a bit later than the aortic valve.
Splitting of S2 is greatest at the peak of inspiration. During expiration, the split
may disappear.
The spread of the impulse through the ventricles (ventricular depolarization) is
depicted on the ECG as the:
A. P wave.
B. QRS complex.
C. PR interval.
D. T wave.
The QRS complex is the spread of a stimulus through the ventricles and is
measured as less than 0.10 second. The P wave is the spread of a stimulus
through the atria. The PR interval is the time from the initial stimulation of the
atria to initiation of stimulation of the ventricles. The T wave is the return of
stimulated ventricular muscle to a resting state.
The structures that lie along the lateral
wall of the nasal cavity near the facial
cheek are the _____ sinuses.
ANS:
maxillary
The maxillary sinuses lie along the nasal cavity near the cheek; the ethmoid sinuses lie
behind the frontal sinuses near the superior portion of the nasal cavity; and the paranasal
sinuses are extensions of the nasal cavities within the skull.
Tactile fremitus is best felt:
A. along the costal margin and xiphoid process.
B. in the suprasternal notch along the clavicle.
C. parasternally at the second intercostal space.
D. posterolaterally beneath the scapula.
Fremitus is best palpated at the second intercostal
space, which also corresponds to the bifurcation of
the bronchi.
Thin-walled reservoirs of the heart are the:
A. atria.
B. pericardium.
C. sinuses.
D. ventricles.
The atria are small, thin-walled structures that act primarily as reservoirs for the blood
returning to the heart from the venous system. The pericardium is a double-walled
membranous fibroserous sac enclosing the heart and the bases of the great vessels. A
sinus is a dilated channel for venous blood. The ventricles are large, thick-walled chambers
that pump blood to the lungs and throughout the body. The ventricles are the primary
muscle mass of the heart.
A third heart sound is created by:
A. atrial contraction.
B. ventricular contraction.
C. diastolic filling.
D. regurgitation between the right and left ventricles.
Diastole is a relatively passive interval until ventricular filling is
almost complete. Diastole occurs when the ventricle is filling
with blood from the atria and the filling sometimes produces a
third heart sound, S3.
To accommodate the enlarging uterus of pregnancy, chest changes result in:
A. intercostal muscle atrophy.
B. lowering of the resting diaphragm.
C. a decrease in alveoli expansion.
D. an increase in the subcostal angle.
The subcostal angle progressively increases from
approximately 68.5 degrees to 103.5 degrees in later
pregnancy.
To approximate vocal frequencies, which tuning fork should be used to assess
hearing?
A. 100 to 300 Hz
B. 200 to 400 Hz
C. 500 to 1000 Hz
D. 1500 to 2000 Hz
Use of 500 to 1000 Hz approximates
vocal frequencies.
To assess for liver enlargement in the obese person, you should:
A. use the hook method.
B. have the patient lean over at the waist.
C. auscultate using the scratch technique.
D. attempt palpation during deep exhalation.
If the abdomen is obese or distended, or if the abdominal
muscles are tight, you should plan on auscultating the liver
using the scratch method to estimate the lower border of the
liver.To correctly document absent bowel sounds, one must listen continuously for:
A. 30 seconds.
B. 1 minute.
C. 3 minutes.
D. 5 minutes.
Absent bowel sounds are confirmed after listening
to each quadrant for 5 minutes.
To count the ribs and the intercostal spaces, you begin by palpating the
reference point of the:
A. distal point of the xiphoid.
B. manubriosternal junction.
C. suprasternal notch.
D. acromion process.
The angle of Louis, the junction of the manubrium and the
sternum, corresponds to the second rib, the reference
point for counting ribs and intercostal spaces.
To distinguish between a respiratory friction rub and a cardiac friction rub, ask
the patient to:
A. hold the breath.
B. lean forward.
C. say "ninety-nine" while you palpate the anterior chest.
D. identify the location of the pain.
A respiratory friction rub results when inflamed
pleura rub against each other during the respiratory
cycle; if the breath is held, the rub stops.
To distinguish crackles from rhonchi, you should auscultate the lungs:
A. before and after the patient coughs.
B. first at the lung base, then at the apex.
C. with the patient inhaling, then exhaling.
D. with the patient recumbent, then sitting.
To distinguish between crackles and rhonchi, ask the patient to
cough and auscultate again over the same area. Because they
reflect secretions in larger airways, rhonchi can clear with
coughing.
To estimate heart size by percussion, you should begin tapping at the:
A. anterior axillary line.
B. left sternal border.
C. midclavicular line.
D. midsternal line.
Estimating the size of the heart can be done by percussion. Begin
tapping at the anterior axillary line, moving medially along the
intercostal spaces toward the sternal border. The change from a
resonant to a dull note marks the cardiac border.
To hear diastolic heart sounds, you should ask patients to:
A. lie on their back.
B. lie on their left side.
C. lie on their right side.
D. sit up and lean forward.
Left lateral recumbent is the best position to hear the low-pitched filling sounds
in diastole with the bell of the stethoscope. Sitting up and leaning forward is
the best position in which to hear relatively high-pitched murmurs with the
diaphragm of the stethoscope. Right lateral recumbent position is the best
position for evaluating right rotated heart of dextrocardia.
To inspect the lateral borders of the tongue, you should:
A. ask the patient to extend the tongue outward.
B. insert the tongue blade obliquely against the tongue.
C. lift the tongue upward with gloved fingers.
D. pull the gauze-wrapped tongue to each side.
To inspect the lateral borders of the tongue, you
should wrap the tongue with a piece of gauze, then
pull the tongue to each side for inspection.
To perform the Rinne test, place the tuning fork on the:
A. top of the head.
B. mastoid bone.
C. forehead.
D. preauricular area.
The fork is initially placed against the mastoid bone
for the Rinne test, a test for sensorineural loss.
An umbilical assessment in the newborn that is of concern is:
A. a thick cord.
B. umbilical hernia.
C. one umbilical artery and two veins.
D. pulsations superior to the umbilicus.
Expect two arteries and one vein. A single umbilical artery indicates the
possibility of congenital anomalies. A thick cord suggests a well-nourished
fetus, an umbilical hernia will generally spontaneously close by 2 years, and
pulsations to the abdomen in the epigastric area are common.
Urinary incontinence that occurs from the
inability to hold urine once the stimulus to
urinate is perceived is called _____ incontinence.
ANS:
urge
Urge incontinence is the inability to delay urination once the
urge to void occurs.What part of the small intestine forms a C-shaped curve around the head of
the pancreas?
A. Duodenum
B. Ileum
C. Jejunum
D. Pylorus
The C-shaped curve around the head of the
pancreas is the duodenum, the first 12 inches of the
small intestine.
What term would you use to document a respiratory rate greater than 20
breaths per minute in an adult?
A. Dyspnea
B. Orthopnea
C. Platypnea
D. Tachypnea
Tachypnea is a respiratory rate greater than 20
breaths per minute. Dyspnea, orthopnea, and
platypnea describe respiratory effort, not rate.
When assessing abdominal pain in a college-age woman, one must include:
A. history of interstate travel.
B. food likes and dislikes.
C. age at completion of toilet training.
D. the first day of the last menstrual period.
Exploring abdominal pain complaints in a young woman can reveal multiple causes related
to the menstrual cycle including menstrual pain, ovulation discomfort, and abnormal
menses. Asking the patient to tell you the first day of her last menstrual period can help
discriminate among these factors. History of international travel and traveler's diarrhea can
relate to abdominal pain, but interstate travel usually does not. Food preferences and age
at completion of toilet training are not relevant.
When auscultating the abdomen, which finding would indicate collateral
circulation between the portal and systemic venous systems?
A. Arterial bruit
B. Gastric rumbling
C. Renal hyperresonance
D. Venous hum
Venous hum is associated with blood flow in venous collaterals
found in portal hypertension. Aortic bruit occurs during systole,
while a venous hum is a continuous sound and softer than a
bruit.
When auscultating the apex of the lung, you should listen at a point:
A. even with the second rib.
B. 4 cm above the first rib.
C. higher on the right side.
D. on the convex diaphragm surface.
The apex of the lung is 4 cm above the
first rib.
When conducting an adult otoscopic examination, you should:
A. position the patient's head leaning toward you.
B. grasp the handle of the otoscope as you would a baseball bat.
C. select the largest speculum that will fit in the canal.
D. ask the patient to keep his eyes closed.
When conducting an adult otoscopic examination, select the largest speculum that will
comfortably fit in the patient's ear. When you are conducting an adult otoscopic
examination, the patient's head should be positioned toward the opposite shoulder. Hold
the handle of the otoscope between the thumb and the index finger, supporting it on the
middle finger. There is no reason for the patient to keep the eyes shut.
When examining the abdomen, what is the order for examination techniques?
(Separate letters by a comma and space as follows: A, B, C, D.)
A. Inspection
B. Light palpation
C. Percussion
D. Auscultation
ANS:
A, D, C, B
Inspection is always used as the first technique in all cases of physical
examination, including the abdomen. In the abdomen the auscultation is
completed prior to percussion or palpation.
When hearing is evaluated, which cranial nerve is being tested?
A. III
B. IV
C. VIII
D. XII
Cranial nerve VIII, the vestibulocochlear
nerve, is associated with hearing.
When palpating the abdomen, you should note whether the liver is enlarged in
the:
A. left lower quadrant.
B. midepigastric region.
C. periumbilical area.
D. right upper quadrant.
The liver is located in the right upper
quadrant of the abdomen.
When palpating the aorta, a prominent lateral pulsation suggests:
A. aortic aneurysm.
B. normal pulsation.
C. renal artery fistula.
D. vena cava varicosity.
Anterior pulsations of the aorta are within normal
limits; lateral pulsations suggest an aortic aneurysm.When percussing a spleen, distorted sounds are most likely caused by:
A. colonic air.
B. distended bladder.
C. empty stomach.
D. solid mass.
Percussion of the spleen is more difficult because percussion
tones elicited may be due to other conditions. A full stomach
or feces in the intestines can mimic splenic dullness, and a dull
tone can be obscured by the louder tympany of colonic air.
When using the bimanual technique for palpating the abdomen, you should:
A. push down with the bottom hand, with the other hand atop.
B. push down with the top hand, with the other hand atop.
C. place the hands side by side and push equally.
D. place one hand anteriorly and the other hand posteriorly, squeezing the
hands together.
The bimanual technique uses one hand on top of the
other. Exert pressure with the top hand while
concentrating on sensation with the other hand.
When you ask the patient to identify
smells, you are assessing cranial nerve
_____.
ANS:
I
The first cranial nerve, the olfactory nerve, is tested when you
ask a patient to identify different smells.
Which abnormality is common during pregnancy?
A. Eruption of additional molars
B. Hypertrophy of the gums
C. Otitis externa
D. Otitis media
The gums of pregnant women may appear
reddened, swollen, and spongy, with the
hypertrophy resolving within 2 months of delivery.
Which bronchial structure(s) is(are) most susceptible to aspiration of foreign
bodies?
A. Left mainstem bronchus
B. Terminal bronchioles
C. Right mainstem bronchus
D. Respiratory bronchioles
The right mainstem bronchus has a more downward slope and
is less angled than the left bronchus. Therefore it is more likely
to be a site of aspiration and is a more likely site for
endotracheal tubes that are advanced too far.
Which cardiac structure is responsible for the heart's pumping action?
A. Pericardium
B. Epicardium
C. Myocardium
D. Endocardium
The myocardium is the thick muscular middle layer that is responsible for the pumping
action of the heart. The pericardium is the tough, double-walled, fibrous sac that protects
the heart. The epicardium is the thin outermost muscle layer that covers the heart and
extends onto the great vessels. The endocardium is the innermost layer that lines the
chambers of the heart and covers heart valves.
Which chest structure contains all the thoracic viscera except the lungs?
A. Manubrium
B. Mediastinum
C. Sternum
D. Xiphoid
The mediastinum, situated between the lungs, contains all
the thoracic viscera except the lungs. The sternum is
composed of the manubrium and xiphoid.
Which condition requires immediate emergency intervention?
A. Patient with pleuritic pain without dyspnea
B. Patient with fever and a productive cough
C. Patient with tachypnea but no chest retractions
D. Patient with absent breath sounds and dull percussion tones
A patient who experiences unexpected pleuritic pain without
prior respiratory distress or dyspnea most likely has developed
a pulmonary embolism, a condition with a high mortality rate.
Which dysrhythmia is a physiologic event during childhood?
A. First-degree AV block
B. Mobitz type II
C. Multifocal PVCs
D. Sinus arrhythmia
Sinus arrhythmia is a physiologic event during childhood. The
heart rate varies in a cyclic pattern, usually faster on inspiration
and slower on expiration. The heart rates of children react with
wider swings to stress, exercise, fever, or tension.
Which ECG change would not be expected as an age-related pattern?
A. First-degree block
B. Bundle branch block
C. Left ventricular hypertrophy
D. Ventricular fibrillation
Common ECG changes in older adults include first-degree
atrioventricular block, bundle branch blocks, ST-T wave abnormalities,
premature systole (atrial and ventricular), left anterior hemiblock, left
ventricular hypertrophy, and atrial fibrillation.Which ethnicity is associated with the highest rate of oral cancers?
A. Caucasian
B. Asian
C. Mexican American
D. African American
Risk factors for oral cancer include age older than 40 years, male gender,
African American ethnicity, excessive alcohol use, dental lesions, tobacco use,
occupational hazards (e.g., textile industry and leather manufacturing), and
systemic disease (e.g., pernicious or iron-deficiency anemia, HIV infection,
lichen planus, and previous malignancy).
Which finding suggests a minor structural variation?
A. Barrel chest
B. Clubbed fingers
C. Pectus carinatum
D. Chest wall retractions
Pectus carinatum (pigeon chest) is a minor structural variation.
Barrel chest, clubbing of the fingers, and chest wall retractions
result from compromised respirations.
Which of the following information belongs in the past medical history section
related to heart and blood vessel assessment?
A. Adolescent inguinal hernia
B. Childhood mumps
C. History of bee stings
D. Previous unexplained fever
Previous unexplained fever should be included in the past
medical history of a heart and blood vessel assessment. This
incidence may be related to acute rheumatic fever, with
potential heart valve damage.
Which of the following is an expected finding in newborns but a cause for
concern in adults?
A. Mottling of the thorax
B. Sternal retractions
C. Cough
D. Nasal flaring
Nasal flaring is common in infants, because children are obligate nose
breathers; however, it is a sign of distress in the adult. Other findings that would
be a concern in adults but not in infants are respiratory grunting and periodic
breathing. Mottling of the thorax and sternal retractions are a sign of distress in
all ages. Cough is rare in the newborn and would be considered a problem.
Which of the following is the most useful adjunct to the history of present
illness when assessing the quantity and degree of a patient's abdominal pain?
A. Appetite and recall of last meal
B. Family comments about the patient
C. Patient's previous medical record
D. Finding abdominal scars
Inquiring about hunger and eating patterns is an
important indicator. It is unlikely that hunger will
persist along with acute intra-abdominal infection.
Which of the following is true regarding the stomach?
A. It lies in the lower right quadrant of the abdomen.
B. It secretes gastric lipase that serves to digest protein.
C. Very little absorption takes place in the stomach.
D. The stomach produces most of the body's bile.
The stomach has a very small role in the absorption of nutrients. The
stomach lies across the upper abdomen, not in the lower right
quadrant. The stomach does secrete, but gastric lipase does not
digest protein. The stomach does not produce most of the body's bile.
Which of the following organs is part of the alimentary tract?
A. Pancreas
B. Stomach
C. Gallbladder
D. Liver
The term alimentary tract refers to the continuous
tract from the mouth to the esophagus, stomach,
small intestine, large intestine, and anus.
Which one of the following is a common symptom of cardiovascular disorders
in the older adult?
A. Fatigue
B. Joint pain
C. Poor night vision
D. Weight gain
Common symptoms of cardiovascular disorders in older adults
include confusion, dizziness, blackouts, syncope, palpitations,
coughs and wheezes, hemoptysis, shortness of breath, chest
pains or tightness, impotence, fatigue, and leg edema.
Which organs both have an excretion function and function as endocrine
glands?
A. Kidney and liver
B. Liver and gallbladder
C. Pancreas and kidney
D. Gallbladder and pancreas
The pancreas excretes pancreatic juices as well as producing insulin and glucagons; the kidneys excrete
urine and produce rennin and erythropoietin. Although the kidney excretes urine and functions as an
endocrine gland, the gallbladder is an excretory organ that is not considered an endocrine gland. The
liver and the gallbladder are excretory organs and are not considered endocrine glands. Although the
pancreas excretes pancreatic juices and produces insulin and glucagons, the gallbladder is an excretory
organ that is not considered an endocrine gland.
Which site of chest wall retractions indicates a more severe obstruction in the
asthmatic patient?
A. Lower chest
B. Along the anterior axillary line
C. Above the clavicles
D. At the nipple line
Asthma more commonly produces retractions of the lower
chest. The more severe the obstruction, the greater the
negative pressure produced in the chest during inspiration, and
retractions are manifested in the upper thorax.Which structure is located in the hypogastric region of the abdomen?
A. Bladder
B. Cecum
C. Gallbladder
D. Stomach
The hypogastric (pubic) area contains the
ileum, the bladder, and the pregnant uterus.
Which symptom is the most significant indicator of asthma and should be
identified in the health history?
A. Wheeze
B. Persistent cough
C. Coexistent skin conditions
D. Chest pain
All the symptoms listed are associated with asthma; however, a
persistent cough may be the only manifestation. A detailed
description of cough should be included in the health history
for any patient with a respiratory complaint.
Which two heart chambers are most anterior in the chest?
A. Both atria
B. Both ventricles
C. The right atrium and ventricle
D. The left atrium and ventricle
The most anterior surface of the heart is formed by the right
ventricle. The heart is turned ventrally on its axis, putting its
right side more forward. The left atrium is above the left
ventricle, forming the most posterior aspect of the heart.
Which two structures together form the primary muscle mass of the heart?
A. Right and left ventricles
B. Left ventricle and the aorta
C. Right and left atria
D. Left atrium and the pulmonary vein
The ventricles are large, thick-walled chambers that pump blood to the lungs and
throughout the body. The right and left ventricles together form the primary muscle mass
of the heart. The left ventricle pumps blood through the aortic valve into the aorta, which
provides blood to the rest of the body. The right and left atria pump blood through the
tricuspid and mitral valves to the ventricles. The pulmonary vein pumps oxygenated blood
from the lungs to the left atria.
Which type of apnea requires immediate action?
A. Primary apnea
B. Secondary apnea
C. Sleep apnea
D. Periodic apnea of the newborn
Secondary apnea is a grave condition, and unless resuscitative measures are
instituted immediately, breathing will not resume spontaneously. Primary apnea
is self-limiting. Sleep apnea should be evaluated but does not require
immediate action. Periodic apnea of the newborn is a normal condition.
Which variation may be an expected finding in the ear examination of a
newborn?
A. Diffuse light reflex
B. Purulent material in the ear canal
C. Redness and swelling of the mastoid process
D. Small perforations of the tympanic membrane
The newborn's tympanic membrane does not
become conical for several months; therefore the
light reflex appears diffuse.
While auscultating the lung fields, you note that the patient's voice sound is
intensified, the voice has a nasal quality, and e's sound like a's. This describes:
A. resonance.
B. bronchophony.
C. pectoriloquy.
D. egophony.
Egophony is marked by increased intensity of the
spoken voice, a nasal quality to the voice, and e's
that become stuffy, broad a's.
White, rounded, or oval ulcerations surrounded by a red halo and found on the
oral mucosa are:
A. Fordyce spots.
B. aphthous ulcers.
C. Stensen ducts.
D. leukoedema.
Aphthous ulcers are white, round, or oval lesions surrounded by a red halo and appear on
the buccal mucosa. Fordyce spots are ectopic sebaceous glands that appear on the
buccal mucosa and lips as numerous small, yellow-white, raised lesions. Stensen ducts are
parotid gland outlets and should appear as whitish yellow or whitish pink protrusions in
approximate alignment with the second upper molar. Leukoedema appears on the buccal
mucosa as a diffuse filmy grayish surface with white streaks, wrinkles, or milky alteration.
With consolidation in the lung tissue, the breath sounds are louder and easier
to hear, whereas healthy lung tissue produces softer sounds. This is because:
A. consolidation echoes in the chest.
B. consolidation is a poor conductor of sound.
C. air-filled lung sounds are from smaller spaces.
D. air-filled lung tissue is an insulator of sound
Air is a poor conductor of sound. More dense consolidation promotes louder
sounds and is a better conductor of sound. Consolidation is a better conductor
of sound than air is. Breath sounds are easier to hear when the lungs are
consolidated; the mass surrounding the tube of the respiratory tree promotes
sound transmission better than do air-filled alveoli.
You are completing a general physical examination on Mr. Rock, a 39-year-old man with
complaints of constipation. When examining a patient with tense abdominal musculature, a
helpful technique is to have the patient:
A. hold his or her breath.
B. sit upright.
C. flex his or her knees.
D. raise his or her head off the pillow.
To help relax the abdominal musculature, it is helpful to place a
small pillow under the patient's head and under slightly flexed
knees. The other techniques are not helpful because they
increase muscle flexion.You are conducting an examination of Mr. Curtis's heart and blood vessels and
auscultate a grade III murmur. The intensity of this murmur is:
A. barely discernible.
B. moderately loud.
C. loud with palpable thrill.
D. very loud without a stethoscope.
The intensity of a grade III murmur is described as moderately
loud. Barely discernible is a grade I murmur. Loud with a
palpable thrill is a grade IV murmur. Very loud without a
stethoscope is a grade VI murmur.
You are documenting a rash between the eighth and ninth ribs on the lateral
border. This intercostal space will be documented in terms of the:
A. rib immediately above it.
B. rib immediately below it.
C. number of centimeters it is positioned below the clavicle.
D. number of inches it is positioned below the clavicle.
The number of each intercostal space corresponds
to that of the rib immediately above it.
You are examining the abdomen of a 45-year-old female patient.
When percussing her urine-filled bladder, you will hear ____________
tones.
ull percussion
You are interviewing a parent whose child has fever, is pulling at her right ear, and is
irritable. You ask the parent about the child's appetite and find that the child has a
decreased appetite. This additional finding is more suggestive of:
A. acute otitis media.
B. otitis externa.
C. serous otitis media.
D. middle ear effusion.
Anorexia is an initial symptom of acute
otitis media.
You are listening to a patient's heart sounds in the aortic and pulmonic areas. The sound
becomes asynchronous during inspiration. The prevalent heart sound in this area is most
likely:
A. S1.
B. S2.
C. S3.
D. S4.
S2 marks the closure of the semilunar valves, which indicates
the end of systole, and is best heard in the aortic and pulmonic
areas. It is higher pitched and shorter than S1. S2 typically splits
during inspiration.
You are performing hearing screening tests. Who would be expected to find
difficulty in hearing the highest frequencies?
A. A 7 year old
B. An 18 year old
C. A 30 year old
D. A 50 year old
Sensorineural hearing loss begins after 50 years of
age, initially with losses of high-frequency sounds
and then progressing to tones of lower frequency.
You are performing Weber and Rinne hearing tests. For the Weber test, the sound
lateralized to the unaffected ear; for the Rinne test, air conduction-to-bone conduction
ratio was less than 2:1. You interpret these findings as suggestive of:
A. a defect in the inner ear.
B. a defect in the middle ear.
C. otitis externa.
D. impacted cerumen.
These results are consistent with a sensorineural hearing loss, a
defect in the inner ear. Otitis externa and impacted cerumen
are conditions of the external ear that can cause conductive
hearing problems.
You are using a pneumatic attachment on the otoscope while assessing tympanic
membrane movement. You gently squeeze the bulb but see no movement of the
membrane. Your next action should be to:
A. remove all cerumen from the canal.
B. change to a rubber speculum.
C. squeeze the bulb with more force.
D. insert the speculum to depth of 2 cm.
When using the pneumatic attachment, to see tympanic movement there
should be a seal around the speculum to block outside air. In this manner, the
normal tympanic membrane moves as a result of pressure changes from the
insufflator bulb. A soft rubber speculum is recommended to establish the seal.
Your older clinic patient is being seen today as a follow-up for a 2-day history of pneumonia. The patient
continues to have a productive cough, shortness of breath, and lethargy and has been spending most of
the day lying in bed. You should begin the chest examination by:
A. percussing all lung fields.
B. auscultating the lung bases.
C. determining tactile fremitus.
D. estimating diaphragmatic excursion.
Because the patient has consolidation and has been recumbent
and fatigued, the most appropriate first step is to listen to the
lung bases before the patient gets exhausted. The lung bases
are the most likely sites of adventitious sounds.
Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back
and left scapula with nausea and vomiting. Based on this history, your prioritized physical
examination should be to:
A. percuss for ascites.
B. assess for rebound tenderness.
C. inspect for ecchymosis of the flank.
D. auscultate for abdominal bruits.
Abdominal pain that radiates to the back could be caused by pancreatitis or a gastric
ulcer; gallbladder pain usually radiates to the right or left scapula but not to the back;
pancreatitis pain can radiate to the left shoulder or scapula; and nausea and vomiting most
often occur with gallbladder, pancreas, or appendix conditions. Pancreatitis is a differential
diagnosis for all the symptoms, so begin the examination by inspecting the flanks for Grey
Turner sign, an indication of pancreatitis.Your patient presents with symptoms that lead you to suspect acute appendicitis. Which
assessment finding is least likely to be associated with this condition?
A. Positive psoas sign
B. Positive McBurney sign
C. Consistent right lower quadrant (RLQ) pain
D. Rebound tenderness
A positive psoas sign, McBurney point pain, rebound
tenderness, and periumbilical pain that migrates to the RLQ are
signs of appendicitis. The absence of pain migration makes
appendicitis less likely.
Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and
symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic
lesions to the palms. These findings are consistent with the development of:
A. rheumatic fever.
B. cor pulmonale.
C. pericarditis.
D. endocarditis.
Endocarditis is a bacterial infection of the endothelial layer of the
heart. It should be suspected with at-risk patients (such as IV drug
abusers) who present with fever and sudden onset of congestive heart
symptoms. The lesions described are Janeway lesions.
Your trauma patient has no auscultated breath sounds in the right lung field. You can hear
adequate sounds on the left side. A likely cause of this abnormality could be that the
patient:
A. has a closed head injury.
B. has fluid in the pleural space.
C. is moaning and in severe pain.
D. is receiving high-flow oxygen.
Trauma to the chest can cause an exudative pleural
effusion or pneumothorax. In the affected areas, the
breath sounds are diminished to absent.
You would expect to document the presence of a pleural friction rub for a
patient being treated for:
A. pneumonia.
B. atelectasis.
C. pleurisy.
D. emphysema.
A pleural friction rub is caused by inflammation of
the pleural surfaces and would be expected to be
auscultated with pleurisy.
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