Ch 24 Putting it all together PDF

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Ch 24 Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Which of the following is true regarding the relationship between the examiner and the patient? a. It is the examiner’s responsibility to help the patient understand that he or she is qualified to make decisions regarding health care. b. The patient must trust the examiner completely. c. The examiner–patient relationship is enhanced by ignoring cultural issues. d. The patient is a full partner with the examiner. e. The examiner–patient relationship should never have priority over strict information gathering.

An examiner might be able to help a patient who seems uncomfortable with close contact during an examination by a. acknowledging the discomfort. b. backing away from the patient. c. joking about the patient’s discomfort. d. moving briskly to completion. e. deferring parts of the examination.

____

2.

____ a. b. c. d. e.

3.

At your first meeting with a patient, it is usually best to say “Let’s get to the point.” “I hope you will learn to trust me.” “Let me tell you what I can do for you.” “Tell me about yourself.” “What is the purpose of your visit today?”

4. Which one of the following patient characteristics is most likely to limit patient reliability during history taking? a. The patient’s measured IQ is above average. b. The patient is alert and oriented to time and place. c. The patient’s sensory deprivation d. The patient speaks the same language as examiner.

____

The patient appears emotionally stable.

e.

____

5.

Which of the following is most likely to enhance examiner

reliability? The examiner seeks confirmation from others when necessary. The examiner is uncomfortable with his or her own skills. The examiner believes he or she must always be correct. The examiner prejudges the patient and family. The examiners use of unselective technology.

a. b. c. d. e.

6. The reliability of health-related findings and observations is the responsibility of the a. patient. b. health care professionals. c. attending physician. d. patient and patient’s family. e. professional and the patient.

____

____ 7. Which of the following statements accurately reflects the sensitivity and specificity of laboratory tests? a. Sensitivity and specificity are not related. b. Sensitivity and specificity are inversely correlated. c. Sensitivity and specificity are directly correlated. d. No test has 100% sensitivity and specificity. e. The “gold standard” test has 100% sensitivity and specificity. 8. As you greet the patient, which examination technique is first implemented? a. Auscultation b. Inspection c. Measurements d. Palpation e. Percussion

____

____ a.

9.

Which of the following data are not part of your general inspection? Dress and habitus

Sinus tenderness Gait Facial expression Degree of relaxation

b. c. d. e. ____

10.

The sequence of the physical examination should be individualized

to minimize the number of times that the patient must change positions. maximize the convenience of the examiner. improve patient flow. minimize the time the patient is in the room. maximize patient movements to assess their mobility.

a. b. c. d. e.

According to the usual examination procedure, you would first assist your patient to assume which position? a. Lithotomy b. Prone c. Standing d. Supine e. Sitting

____

11.

____ a. b. c. d. e.

12.

An ophthalmoscopic eye examination involves lens inspection. near vision evaluation. sclera observation. visual field assessment. assessing extraocular eye muscles.

____ 13. The cranial nerves are usually assessed while the patient is in which position? a. Left lateral b. Supine c. Sitting d. Prone e. Standing ____ 14. Which of the following are examined with the patient in a reclining 45-degree position? a. Bilateral hips and popliteal angles b. Facial bones and cranial nerves V and VII c. Cardinal fields of gaze

Oropharynx and thyroid gland placement Jugular venous pulsation and pressure

d. e.

____

15.

Which patient position facilitates inspection of the chest and

shoulders? Sitting Supine Trendelenburg Prone Lithotomy

a. b. c. d. e. ____ a. b. c. d. e.

16.

When assessing the abdomen, one needs to expose the patient from the waist down. from the pubis to the epigastrium. from the clavicles to the hips. at no point during the examination. in the entirety.

____ a. b. c. d. e.

17.

To inspect the abdominal muscles, ask the supine patient to raise the head. standing patient to bend forward. prone patient to raise the lower legs. standing patient to stand on tiptoes. standing patient to lean backward.

____ a. b. c. d. e.

18.

Proprioception should be assessed while the patient is prone. supine. seated. standing. left lateral.

____

19.

Examination of the patient in the lithotomy, or knee–chest, position

includes a. b. c. d. e.

inspection for inguinal hernias. palpation of anal sphincter tone. percussion of pelvic structures. stereognosis testing. percussion of abdominal structures.

____ 20. Which portion of the physical examination is best done with the patient standing? a. Spinal b. Rectal c. Neck

Musculoskeletal Chest

d. e. ____

21.

The greatest risk for potential health problems occurs in which age

group? Newborn Toddler School age Adolescence Young adult

a. b. c. d. e. ____

22.

A common method of estimating gestational age of a newborn is to

assess middle finger length. creases on the sole of the foot. umbilical placement. visual acuity. creases on the palm of the hand.

a. b. c. d. e.

To promote your examination time with a cooperative child, your approach to the examination should be to a. ask the parent to give the child a bottle during the examination. b. sing songs with the child during the examination. c. conduct the physical examination on the child while the parent is holding the child. d. let the child play with examination room equipment to feel more comfortable. e. have the parent place the child in the prone position on the examination table. ____

23.

____

24.

When conveying “bad” or distasteful news to the patient and family,

it is best to avoid provision of any information until the entire family is assembled. provide minimal information permitted by the patient. be specific in all details. rely on medical jargon to minimize distress. let the patient inform the family.

a. b. c. d. e. ____

25.

The examination of a newborn should begin with

percussion. palpation. vital signs. auscultation. inspection.

a. b. c. d. e.

____ 26. The best way to ease the apprehension of a 3-year-old child before a physical examination is to a. explain that you will be gentle. b. have the parents leave the examination room. c. encourage child’s participation. d. tell the child he or she will get a lollipop for good behavior. e. hand the child a picture book. ____ a. b. c. d. e.

27.

In crying infants, it is often difficult to perform tactile fremitus assessments. determine lung expansion. auscultate heart sounds. visualize the pharynx. assess facial symmetry.

____ 28. When you attempt to move a 10-month-old child from his mother’s lap to the examination table, he screams loudly. Your best action is to a. move the child to the examination table and proceed matter-of-factly with the examination. b. perform the examination while the child is in the mother’s lap. c. ask the mother to get the child to stop crying. d. defer the examination until another day. e. have the mother place the child on the examination table. ____ 29. Observation of the child playing in the playroom provides information about which two systems? a. Dermatologic and cardiovascular b. Neurologic and musculoskeletal c. Respiratory and ear, nose, and throat d. Gastrointestinal and genitourinary e. Endocrine and hematopoietic 30. When conducting a geriatric assessment, basic activities of daily living (ADLs) include

____

bathing. housekeeping. medication compliance. communication skills. money management.

a. b. c. d. e. ____

31.

Functional assessment is most important during the examination of

a(n) adolescent. infant. older adult. young adult. toddler.

a. b. c. d. e. ____

32.

Throughout the history and physical examination, the clinician

should concentrate on emotional issues. follow an inflexible sequence. maintain a matter-of-fact demeanor. deal only with previously identified problems. evaluate the whole patient.

a. b. c. d. e. ____ a. b. c. d. e.

33.

Which of the following is not assessed in a newborn’s Apgar score? Color Heart rate Pupil reactivity Muscle tone Respirations

Ch 24 Answer Section MULTIPLE CHOICE 1.

ANS: D

The enduring message of sound communication is that you care and that the patient is your full partner. The relationship becomes well-established through the powerful therapeutic effect of really listening to what the patient says, careful exploration for hidden concerns, and explaining information without patronizing. PTS: 1 REF: p. 594 MSC: Organ System: General 2. ANS: A

TOP: Discipline: Behavioral Science

Acknowledging the patient’s discomfort during the examination will help the patient feel more relaxed. It may help to consistently provide an explanation of which part of the examination comes next and to be honest about the potential of

uncertainty, discomfort, or pain and how long it will last. PTS: 1 REF: p. 594 MSC: Organ System: General 3. ANS: D

TOP: Discipline: Behavioral Science

Take the time to ask open-ended questions to ensure that the patient has the opportunity to report accurately. Too great an adherence to routine may prevent the true story from emerging. The other choices are not open ended, which does not allow the patient to elaborate. They are not phrases that are comforting to the patient and would make the patient feel uncomfortable on the initial meeting. PTS: 1 REF: p. 594 MSC: Organ System: General 4. ANS: C

TOP: Discipline: Behavioral Science

A partial or total loss of any of the senses can limit a patient’s reliability as a historian. Emotional constraints, language barriers, cultural barriers, and an unresponsive or comatose patient can all affect a patient’s ability to be a thorough historian. All of the other options would not limit a patient’s reliability. PTS: 1 REF: p. 595 MSC: Organ System: General 5. ANS: A

TOP: Discipline: Behavioral Science

The examiner may not always be correct, but questioning yourself and seeking confirmation from others when necessary will serve to assure your reliability. A person should never be prejudged because this can interfere with your examination and findings. Showing that you are uncomfortable with your skills can make the patient feel uncomfortable and see you as unreliable. The use of unselective technology should not substitute for a well-honed history and physical examination. PTS: 1 REF: p. 596 MSC: Organ System: General 6. ANS: E

TOP: Discipline: Behavioral Science

It is the responsibility of the health professional and the patient to present reliable findings and observations. They work as a team. PTS: 1 REF: p. 595 MSC: Organ System: General 7. ANS: D

TOP: Discipline: Behavioral Science

No test has 100% sensitivity and specificity. PTS: 1 REF: p. 596 MSC: Organ System: General 8. ANS: B

TOP: Discipline: Biostatistics

Begin to inspect the patient as you greet him or her, as you look for signs of distress or disease. Inspect the patient’s appearance, gait, orientation, and difficulty in hearing or speech.

PTS: 1 REF: p. 597 MSC: Organ System: General 9. ANS: B

TOP: Discipline: Behavioral Science

Upon meeting the patient, his or her facial expression, gait, dress, and habitus should be inspected. Inspecting for sinus tenderness is performed afterward if indicated. PTS: 1 REF: p. 597 MSC: Organ System: General 10. ANS: A

TOP: Discipline: Behavioral Science

There is no one right way to put together the parts of the physical examination. The sequence should be individualized to minimize the number of times the patient has to change positions to conserve the patient’s energy. PTS: 1 REF: p. 596 MSC: Organ System: General 11. ANS: E

TOP: Discipline: Behavioral Science

Upon entering the examination room, you should assist the patient in the sitting position on the examining table. In the sitting position, you can examine the patient’s anterior and posterior upper trunk and head, which comprise the majority of focused assessments. PTS: 1 REF: p. 600 MSC: Organ System: General 12. ANS: A

TOP: Discipline: Behavioral Science

Ophthalmoscope eye examination involves testing the red reflex and inspecting the lens, disc, cup margins, vessels, and retinal surface. The other assessments do not involve the use of the ophthalmoscope. PTS: 1 REF: p. 598 MSC: Organ System: Nervous 13. ANS: C

TOP: Discipline: Neuroscience

While the patient is in the sitting position, you can assess all cranial nerve functions. PTS: 1 REF: p. 600 MSC: Organ System: Nervous 14. ANS: E

TOP: Discipline: Neuroscience

With the patient in a reclining 45-degree position, you can examine the jugular venous pulsations and measure jugular venous pressure. All of the other choices can be examined with the patient in a sitting position. PTS: 1 REF: p. 599 MSC: Organ System: Cardiovascular 15. ANS: A

TOP: Discipline: Physiology

With the patient in the sitting position, the examiner can inspect the chest and shoulders. The area being inspected is exposed for the examiner to do a thorough assessment. The other positions are not used to assess the chest and

shoulders. PTS: 1 REF: p. 598 MSC: Organ System: General 16. ANS: B

TOP: Discipline: Behavioral Science

While the patient is in the supine position, the examiner can assess the abdomen. Arrange draping to expose the abdomen from pubis to epigastrium, making sure to cover the private areas of the patient. All of the other options would not allow for a thorough inspection and examination or they would expose the patient inappropriately. PTS: 1 REF: p. 600 MSC: Organ System: General 17. ANS: A

TOP: Discipline: Behavioral Science

Asking the patient to raise the head will contract the rectus abdominis muscles, which produces muscle prominence, making abdominal wall masses visible. All of the other choices would not show the abdominal muscles contracting. PTS: 1 REF: p. 600 MSC: Organ System: Musculoskeletal 18. ANS: D

TOP: Discipline: Physiology

Proprioception examination involves the Romberg test, heel-to-toe walking, standing on one foot and then on the other with eyes closed, hopping in place, and deep knee bends. The standing position is required to conduct these examinations. PTS: 1 REF: p. 601 MSC: Organ System: Nervous 19. ANS: B

TOP: Discipline: Neuroscience

With the patient in the lithotomy position, the examiner can inspect the external and internal female genitalia and perform rectal examination to assess and palpate anal sphincter tone. The other answers require the patient to be in the supine or standing position. PTS: 1 REF: p. 602 MSC: Organ System: General 20. ANS: A

TOP: Discipline: Behavioral Science

With the patient in the standing position, the examiner can inspect and palpate the spine as the patient bends over at the waist and test the patient’s range of motion. PTS: 1 REF: p. 601 MSC: Organ System: Musculoskeletal 21. ANS: A

TOP: Discipline: Physiology

The newborn is at greater risk for potential health problems than other ages but also has the potential for better health than the other age groups. PTS: 1

REF: p. 602

TOP: Discipline: Biostatistics

MSC: Organ System: General 22. ANS: B

To determine gestational age, look at the soles of the feet. Before 36 weeks’ gestation, only one or two transverse creases are present; by 40 weeks’ gestation, many creases are present on the soles of the feet. Other clues to gestational age include breast nodule less than 3 cm, cartilage in the helix of the ear, descending of the scrotum and amount of rugae, and extremities in flexed positions. PTS: 1 REF: p. 602 MSC: Organ System: Reproductive 23. ANS: C

TOP: Discipline: Embryology

For children, the examination sequence depends on their cooperation for as long as possible. To promote this, examine the child while the parent is holding the child, while maximizing both inspection and opportunities for physical examination. PTS: 1 REF: p. 603 MSC: Organ System: General 24. ANS: C

TOP: Discipline: Behavioral Science

When conveying bad or distasteful news to the patient and family, arrange a setting that is quiet. Involve those who have had contact with the patient and those who the patient trusts. Be specific in all details and provide the information in a timely fashion adjusted to the needs of the patient and allow time for questions. Use jargon-free language that the patient can understand. Inform the patient as soon as possible. Involve family members and other essential persons to give the patient emotional and practical support. PTS: 1 REF: p. 609 MSC: Organ System: General 25. ANS: E

TOP: Discipline: Behavioral Science

The examination of a newborn should begin with inspection, noting skin color, flaccidity, tension, gross deformities, or distortions of facies. All of the other examination techniques follow inspection. PTS: 1 REF: p. 603 MSC: Organ System: Reproductive 26. ANS: C

TOP: Discipline: Physiology

The best way to ease the apprehension of a 3-year-old child before a physical examination is to encourage the child to participate by helping you. Ask the child to hold the end piece of the stethoscope or to “blow out” your flashlight. PTS: 1 REF: p. 606 MSC: Organ System: General 27. ANS: C

TOP: Discipline: Behavioral Science

For a crying infant, the lungs can be auscultated between consolable moments. While the infant is crying, the examiner can assess the lustiness of cry, tactile fremitus, lung excursion, facial symmetry, and appearance of the mouth and

pharynx. Between breaths, the heart tone can be auscultated. PTS: 1 REF: p. 603 MSC: Organ System: General 28. ANS: B

TOP: Discipline: Physiology

The parent’s lap is a great “examination table” because it helps the child feel more at ease and is a good way to observe the nature of the parent–child relationship. None of the other actions would comfort the patient or make the situation better. PTS: 1 REF: p. 603 MSC: Organ System: General 29. ANS: B

TOP: Discipline: Behavioral Science

A child playing on the floor offers an opportunity to evaluate both the musculoskeletal and neurologic systems by noting the child’s coordination of activities, such as when throwing a b...