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Seidel's Guide to Physical Examination 9th Edition Ball Test
Bank Chapter 01: The History and Interviewing
Process
Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE Which question would be considered a “leading question?” “What do you think is causing your headaches?” “You don’t get headaches often, do you?” “On a scale of 1 to 10, how would you rate the severity of your headaches?” “At what time of the day are your headaches the most severe?” ANS: B Stating to the patient that he or she does not get headaches would limit the information in the patient’s answer. Asking the patient what he or she thinks is causing the headaches is an open-ended question. Asking the patient how he or she would rate the severity of the headaches and asking what time of the day the headaches are the most severe are direct questions. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
- When are open-ended questions generally most useful? a. During sensitive area part of the interview b. After several closed-ended questions have been asked c. While designing the genogram d. During the review of systems
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Asking open-ended questions during the sensitive part of the interview allows you to gather more information and establishes you as an empathic listener, which is the first step of effective communication. Asking closed-ended questions may stifle the patient’s desire to discuss the history of the illness. Interviewing for the purpose of designing a genogram or conducting a review of systems requires more focused data than can be more easily gathered with direct questioning. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Periods of silence during the interview can serve important purposes, such as: allowing the clinician to catch up on documentation. promoting calm. providing time for reflection. increasing the length of the visit. ANS: C Silence is a useful tool during interviews for the purposes of reflection, summoning courage, and displaying compassion. This is not a time to document in the chart, but rather to focus on the patient. Periods of silence may cause anxiety rather than promote calm. The length of the visit is less important than getting critical information. ANS: A
With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will communicate caring to the patient. If you as a healthcare provider are hurried, the patient will be more anxious. The best way to assist an anxious patient is to not hurry and remain calm, because this will communicate caring to the patient. Asking the patient if she wants to wait until another day to talk to you delays the needed health care. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Ms. A states, “My life is just too painful. It isn’t worth it.” She appears depressed. Which one of the following statements is the most appropriate caregiver response? “Try to think about the good things in life.” “What in life is causing you such pain?” “You can’t mean what you’re saying.” “If you think about it, nothing is worth getting this upset about.” ANS: B Specific but open-ended questions are best used when the patient has feelings of loss of self- worth and depression. “Try to think about the good things in life,” “You can’t mean what you’re saying,” and “If you think about it, nothing is worth getting this upset about” are statements that will hurry the patient and offer only superficial assurance. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
- You are collecting a history from a 16-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be:
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given the opportunity to be interviewed without the parent at some point during the interview. mailed a questionnaire in advance to avoid the need for them to talk. ignored while you address all questions to the parent. allowed to direct the flow of the interview. ANS: A The adolescent should be given the opportunity to give information directly. This enhances the probability that the adolescent will follow your advice. Mailing a questionnaire in advance to avoid the need for her to talk does not assist the adolescent in learning to respond to answers regarding her health. The parent can help fill in gaps at the end. If she is ignored while you address all questions to the parent, the patient will feel as though she is just being discussed and is not part of the process for the health care. The healthcare provider should always direct the flow of the interview according to the patient’s responses. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Information that is needed during the initial interview of a pregnant woman includes all the following except : the gender that the woman hopes the baby will be. past medical history. healthcare practices.
the woman’s remembering (knowledge) about pregnancy. ANS: A The initial interview for the pregnant woman should include information about her past medical history, assessment of health practices, identification of potential risk factors, and assessment of remembering (knowledge) as it affects the pregnancy. The gender of the fetus is not as important as the information about her past medical history, healthcare practices, and the woman’s remembering (knowledge) about her pregnancy. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation When interviewing older adults, the examiner should: speak extremely loudly, because most older adults have significant hearing impairment. provide a written questionnaire in place of an interview. position himself or herself facing the patient. dim the lights to decrease anxiety. ANS: C The healthcare provider should position himself or herself so that the older patient can see his or her face. Shouting distorts speech, dimming the lights impairs vision, and a written interview may be necessary if all else fails. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
To what extent should the patientNURwithSINaGphysicalTB.COdisabilityM or emotional disorder
be involved in providing health history information to the health professional? The patient should be present during information collection but should not be addressed directly. All information should be collected from past records and family members while the patient is in another room. The patient should be involved only when you sense that he or she may feel ignored. The patient should be fully involved to the limit of his or her ability. ANS: D Patients who are disabled may not give an effective history, but they must be respected, and the history must be obtained from them to the greatest extent possible. Patients should be addressed directly and participate in the interview to the extent of their ability. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation When taking a history, the nurse should: ask the patient to give you any information he or she can recall about his or her health. start the interview with the patient’s family history. use a chronologic and sequential framework. use a holistic and eclectic structure.
personal and social history. review of systems. ANS: C Habits are included within the personal and social history. The chief complaint is the reason the patient is seeking health care. The past medical history is made up of the previous medical conditions that the patient has had. The review of systems is an overview of problems with other body systems. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Direct questioning about domestic violence in the home should be: a routine component of history taking with female patients. avoided for fear of offending the woman’s partner. conducted only in cases in which there is a history of abuse. used only when the patient is obviously being victimized. ANS: A The presence of domestic violence should be routinely queried, and the questioning should be direct for all female patients. Direct questioning about domestic violence in the home should not be avoided for fear of offending the woman’s partner, should be part of a routine examination, and should not be used only when the patient is obviously being victimized. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation A tool used to screen adolescentsNRforIalcoholismGB.Cis (^) Mthe: a. CAGE.U S N T^ O CRAFFT. PACES. HITS. ANS: B The CRAFFT tool is used to screen for alcoholism in adolescents. The CAGE test is used to screen for alcoholism in adults. PACES is used to screen adolescents for important issues in their life. HITS is the screen for domestic violence. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Tom is a 16-year-old diabetic who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom’s health? Attachment to parents High self-esteem Low peer support needs Propensity for risk taking ANS: D Adolescents tend to experiment with risky behaviors that can lead to a high incidence of morbidity and mortality.
DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADL) is part of a(n): ethnic assessment. functional assessment. genetic examination. social history. ANS: B A functional assessment is an assessment of a patient’s mobility, upper extremity movement, household management, ADL, and instrumental activities of daily living (IADL). DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Constitutional symptoms in the ROS refer to: height, weight, and body mass index. fever, chills, fatigue, and malaise. hearing loss, tinnitus, and diplopia. rashes, skin turgor, and temperature. ANS: B General constitutional symptoms refer to pain, fever, chills, malaise, fatigue, night sweats, sleep patterns, and weight (average, preferred, present, change).
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DIF: Cognitive Level: Understanding (Comprehension) USNT O OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation JM has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) _________ history. complete inventory problem or focused interim ANS: C If the patient is well known, or if you have been seeing the patient for the same problem over time, a focused history is appropriate. A complete history is only obtained during initial visits or during a complete history and physical examination (H&P). An inventory is related to but does not replace the complete history. It touches on the major points without going into detail. This is useful when the entire history taking will be completed in more than one session. An interim history is only obtained during a return of the patient after several months of absence. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE
Chapter 02: Cultural Competency
Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE Which statement is true regarding the relationship of physical characteristics and culture? Physical characteristics should be used to identify members of cultural groups. There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics. To be a member of a specific culture, an individual must have certain identifiable physical characteristics. Gender and race are the two essential physical characteristics used to identify cultural groups. ANS: B Physical characteristics are not used to identify cultural groups; there is a difference between the two, and they are considered separately. Physical characteristics should not be used to identify members of cultural groups. To be a member of a specific culture, an individual does not need to have certain identifiable physical characteristics. You should not confuse physical characteristics with cultural characteristics. Gender and race are physical characteristics, not cultural characteristics, and are not used to identify cultural groups. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
- An image of any group that rejects its potential for originality or individuality is known as a(n): N
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ANS: A We should be willing to modify the delivery of health care in a manner that is respectful and in keeping with the patient’s cultural background. “With your father’s permission, we will examine the stone and request that it be returned to him” is the most appropriate response. “The stone must be sent to the lab for examination and therefore cannot be kept” and “We don’t know yet if your father has another kidney stone, so we must analyze this one” do not support the patient’s request. “We cannot let him keep his stone because it violates our infection control policy” does not provide a reason that it would violate an infection control policy. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation The motivation of the healthcare professional to “want to” engage in the process of becoming culturally competent, not “have to,” is called: cultural knowledge. cultural awareness cultural desire cultural skill. ANS: C Cultural encounters are the continuous process of interacting with patients from culturally diverse backgrounds to validate, refine, or modify existing values, beliefs, and practices about a cultural group and to develop cultural desire, cultural awareness, cultural skill, and cultural knowledge. Cultural awareness is deliberate self-examination and in-depth exploration of one’s biases, stereotypes, prejudices, assumptions, and “-isms” that one holds about individuals and groups who areN^ differentRIGfromB.themCM.Cultural knowledge is the process of USNT O seeking and obtaining a sound educational base about culturally and ethnically diverse groups. Cultural skill is the ability to collect culturally relevant data regarding the patient’s presenting problem, as well as accurately performing a culturally based physical assessment in a culturally sensitive manner. Cultural desire is the motivation of the healthcare professional to want to engage in the process of becoming culturally competent, not have to. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem? “How often do you have medical examinations?” “What is your age, race, and educational level?” “What types of symptoms have you been having?” “Why do you think you are having these symptoms?” ANS: D “Why do you think you are having these symptoms?” is an open-ended question that avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged. The other questions do not explore the patient’s cultural beliefs about health problems.
restore balance in an individual’s life. ANS: B A more scientific approach to healthcare problem solving, in which a cause can be determined for every problem in a precise way, is a Western approach. Hispanics, Native Americans, Asians, and Arabs embrace a more holistic approach. Using a holistic approach, establishing harmony between a person and the entire cosmos, and restoring balance in an individual’s life would not be troublesome to many Hispanics, Native Americans, Asians, and Arabs. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation The attitudes of the healthcare professional: are largely irrelevant to the success of relationships with the patient. do not influence patient behavior. are difficult for the patient to sense. are culturally derived. ANS: D The attitudes of the healthcare provider are foundationally derived from his or her own culture; understanding this is relevant to the success of patient relationships. Attitudes of the healthcare professional are easily detected by others, and they influence patient behavior; they are not irrelevant to the success of relationships with the patient; they do influence patient behavior; and they are not difficult for the patient to sense. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation NURSINGTB.COM
- Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care healthcare provider. Which of the following describes a physical, not a cultural, differentiator? a. Race b. Rite c. Ritual d. Norm ANS: A Race is a physical, not a cultural, differentiator. Rite is a prescribed, formal, customary observance. Ritual is a stereotypic behavior regulating religious, social, and professional behaviors. A norm is a prescribed standard of allowable behavior within a group. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to: forego the examination for fear of violating cultural norms. ask a colleague from the same geographic area if this examination is acceptable. inform the patient of the reason for the examination and ask if it is acceptable to him. refer the patient to a provider more knowledgeable about cultural differences.
ANS: C Asking, if you are not sure, is far better than making a damaging mistake. Not completing the examination could cause the patient further harm. Asking a colleague from the same geographic area if this examination is acceptable may not be appropriate. Referring the patient to a provider more knowledgeable about cultural differences at this point is unnecessary. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Mr. Jones is a 45-year-old patient who presents to the office. A person’s definition of illness is likely to be most influenced by: race. socioeconomic class. enculturation. age group. ANS: C The definition of illness is determined in large part by the individual’s enculturation (the process whereby an individual assumes the traits and behaviors of a given culture). DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation As the healthcare provider, you are informing a patient that he or she has a terminal illness. This discussion is most likely to be discouraged in which cultural group? a. Navajo Native Americans b. Dominant Americans^ N R I G B.C M c. USNT O First-generation African descendants d. First-generation European descendants ANS: A The Navajo culture believes that thought and language have the power to shape reality; the desire to avoid discussing negative information is particularly strong in this culture. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group? Native Americans Hispanics Chinese Italians ANS: C The Chinese are most likely to use MSG and soy sauce in their diet. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation An example of a cold condition is:
Chapter 03: Examination Techniques and Equipment
Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE According to the guidelines for Standard Precautions, the caregiver’s hands should be washed: only after touching body fluids with ungloved hands and between patient contacts. only after touching blood products with ungloved hands and after caring for infectious patients. only after working with patients who are thought to be infectious. after touching any body fluids or contaminated items, regardless of whether gloves are worn. ANS: D Handwashing is to be done after removal of gloves, between patient contacts, and after touching body fluids, regardless of whether gloves are used. The nurse should never touch body fluids or blood products with ungloved hands. The nurse should use hand hygiene regardless of a patient’s possible infection. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
- Which patient is at the highest risk for developing latex allergy? a. The new patient who has no chronic illness and has never been hospitalized b. The patient who has had multiple procedures or surgeries c. The patient who is a vegetarian d. The patient who is allergic
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ANS: B The patient who has had multiple procedures or surgeries has a higher rate of exposure to rubber gloves and to equipment and supplies that contain latex and therefore is at a higher risk for developing an allergic response. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Which technique is used during both the history taking and the physical examination process? Auscultation Inspection Palpation Percussion ANS: B Inspection is the technique that is used while gathering and validating data during both the history taking and the actual hands-on physical examination. Auscultation, palpation, and percussion are not used during the history taking and physical examination processes. It is not possible to listen to the patient talking and use the stethoscope at the same time. The focus is on the patient’s response to your touch and what you are feeling; it is not possible to perform palpation and listen to the patient talking at the same time.
DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation The use of secondary, tangential lighting is most helpful in the detection of: variations in skin color. enlarged tonsils. foreign objects in the nose or ear. variations in contour of the body surface. ANS: D Tangential lighting is used to cast shadows to observe contours and variations in body surfaces best. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation You are caring for a nonambulatory 80-year-old male patient and he tells you, a female nurse, that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate? Drape the patient and observe the rectal area. Tell the patient that his doctor will be notified of his problem. Tell the patient that you will ask the male nurse on the next shift to check on the problem. Give the patient an ice pack to apply to the area. ANS: A Necessary exposure for direct observation, while adjusting for modesty, is warranted. The complaint
warrants validationNbeforeURSIreferralNGTBor.CdelegationOM. Before you call the
clinician, you need to assess the patient. The assessment should not wait for another shift. Before treatment, it is important to assess the complaint. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is best for palpating vibration? Dorsal surface Finger pads Fingertips Ulnar surface ANS: D The ulnar surface of the hand and bases of the fingers can best feel vibratory sensations such as thrills and fremitus. The dorsal surface of the hand is best for assessing temperature. The finger pads and fingertips are best for palpating pulses. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation The dorsal surface of the hand is most often used for the assessment of: crepitus. temperature.
ANS: C A normal lung produces resonance percussion tones, whereas an empty stomach is expected to produce tympany. Dullness indicates atelectasis of the lung. Hyperresonance over the lungs indicates emphysema. Flatness occurs over muscle. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation During percussion, a dull tone is expected to be heard over: healthy lung tissue. emphysemic lungs. the liver. most of the abdomen. ANS: C Dull tones are expected over denser areas such as the liver. Healthy lung tissue is resonant. Emphysemic lungs are hyperresonant. Tympany is heard over most of the abdomen. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation When using mediate or indirect percussion, which technique is appropriate? Place the palmar surface of the nondominant hand on the body surface, with the fingers held together. Place the palmar surface of the nondominant hand on the body surface, with the fingers slightly spread apart. Place the ulnar surface ofNtheRnondominantIGB.handCMon the body surface, with the fingers together. U S N T O Place the ulnar surface of the nondominant hand on the body surface, with the fingers slightly spread apart. ANS: B The palmar surface of the nondominant (stationary) hand should rest against the body surface, with the fingers spread slightly. A helpful tip to improve elicitation of correct tones is to hyperextend the middle finger of the stationary hand and place the distal interphalangeal joint firmly against the body surface. This lifting of the fingertip avoids dampening of the vibratory sounds. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation During percussion, the downward snap of the striking fingers should originate from the: shoulder. forearm. wrist. interphalangeal joint. ANS: C The downward snap of the striking fingers should originate from the wrist. DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Which technique is commonly used to elicit tenderness arising from the liver, gallbladder, or kidneys? Finger percussion Palmar percussion Fist percussion Forearm percussion ANS: C Fist percussion is a direct percussion technique used to elicit tenderness over organs such as the liver, gallbladder, or kidneys. DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation During auscultation, you can limit your perceptual field best by: asking patients to describe their symptoms. closing your eyes. performing auscultation before percussion. using an aneroid manometer. ANS: B By closing your eyes, your sense of hearing becomes more acute, and it increases your ability to isolate sounds. Asking patients to describe their symptoms does not assist in the technique of auscultation. The only time that auscultation occurs before percussion is in examination of the abdomen. Using an aneroid manometer does not assist in the technique of auscultation. During auscultation, the onlyNequipmentURSINGneededTB.CisOtheM stethoscope. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation You are auscultating a patient’s chest. The sounds are not clear, and you are having difficulty distinguishing between respirations and heartbeats. Which technique can you use to facilitate your assessment? Anticipate the next sounds. Isolate each cycle segment. Listen to all sounds together. Move the stethoscope clockwise. ANS: B If you are hearing everything at once, it is more difficult to distinguish different sounds. Try isolating each segment and listen to that segment intently; then move on to another segment. For example, listen only to breath sounds, then only to inspiratory breath sounds, and then only to expiratory breath sounds. Anticipating the next sounds will not facilitate the assessment. Listening to all sounds together will not facilitate the assessment. One of the most difficult achievements in auscultation is learning to isolate sounds. Moving the stethoscope clockwise will not facilitate the assessment. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
