NURS 6512, Week 6 Midterm Exam
QUESTIONS
1. Before performing an abdominal examination, the examiner should:
Answer: Have the patient empty their bladder
2. During an interview, tears appear in the patient’s eyes and his voice becomes shaky.
Initially, you should:
Answer: Keep the interview moving to distract the patient
3. Which of the following is the most accurate reflection of an individual’s food intake?
Answer: Food Diary
4. Percussing at the right midclavicular line, below the umbilicus, and continuing upward is
the correct technique for locating the:
Answer: Lower liver border
5. A fixed image of any group that rejects its potential for originality or individuality is
known as a:
Answer: Stereotype
6. Peritonitis produces bowel sounds that are
Answer: Decreased/Hypoactive
7. Brittle nails are typical findings in:
Answer: Older adults
8. Which of the following is an expected change in the assessment of the thyroid during
pregnancy?
Answer: A Bruit is auscultated d/t increased vascularity
9. You are planning to palpate the abdomen of your patient. Which part of the examiner's
hand is best for palpating vibration?
Answer: Ulnar Surface
10. A 5-year-old child presents with nasal congestion and a headache to assess for sinus
tenderness you should palpate over the:
Answer: Maxillary sinuses only
11. During physical examination of a 30-year-old Chinese man you notice a slight asymmetry
of his face. the cranial nerve examination is normal. Your best action is to
Answer: Ask the patient if this characteristic runs in his family
12. Unusual white areas on the skin may be due to
Answer: Vitiligo
13. You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens
selector clockwise, then counterclockwise to compensate for:
Answer: Myopia
14. Mrs. Webb is a 38-year old patient who has been changing her lifestyle to eat in a healthy
way and lose weight: during your health promotion education regarding her nutritional status,
you explain the function of dietary protein as:
Answer: Building and maintaining tissues
15. Mr. Akins is a 78-y/o 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. Improved ability to hear low-frequency sounds
B. No change in hearing ability
C. Loss of high frequency
D. Enhanced auditory processing speed
E. Sounds may be garbled, difficult to localize
F. Unable to hear in a crowded room
Answer: C. Loss of high frequency
E. Sounds may be garbled, difficult to localize
F. Unable to hear in a crowded room
16. The most superior part of the stomach is the
Answer: Fundus
17. Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B
vitamin is deficient in patients with pernicious anemia?
Answer: B12
18. A 51-y/o woman calls with complaints of weight loss and constipation. She reports
enlarged hemorrhoids and rectal bleeding. You advise her to:
Answer: Come to the laboratory for a stool guaiac test.
19. Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a
test for:
Answer: Lateralization of Sound
20. Which technique is most likely to result in the patients understanding of questions?
Answer: Use the patient's own terms if possible.
21. 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 the history?
Answer: Past medical data
22. Nasal symptoms that imply an allergic response include:
Answer: Bluish gray turbinates. ("Turbinates that appear bluish gray or pale pink with a
swollen, boggy consistency may indicate allergies"-Seidel p.243)
23. Mr. Franklin is speaking with you the health care provider, about his respiratory problem.
Mr. Franklin says, “I’ve had this cough for 3 days and it’s getting worse.” You reply, “Tell me
more about your cough.” Mr. Franklin states, “I wish I could tell you more, that’s why I am
here! You tell me what’s wrong.” Which caregiver response would be the most appropriate
for enhancing communication?
Answer: After 3 days, you're tired of coughing. Have you had a fever?"
24. When taking a history, you should:
Answer: Use a chronologic and sequential framework.
25. Which of the following formats would be used for visits that address problems not yet
identified in the problem-oriented medical record (POMR)?
Answer: Brief SOAP note
26. 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:
Answer: Pull the auricle down and back in an effort to straighten the upward curvature of the
canal
27. Which question would be considered a leading question?
Answer: You don't get headaches often, do you?"
28. Mr. Black is a 44y/o patient who presents to the clinic with complaints of neck pain that
he thinks is from his job involving computer data entry. As the examiner, you are checking
the range of motion in his neck and note the greatest degree of cervical mobility is at?
Answer: C 4 to C 5: C4 and C5 or C5 and C 6 provide the greatest horizontal mobility in
adults
29. The term denoting the caregiver’s need to do no harm to the patient is:
Answer: Deontologic imperatives.
30. A tool used to screen adolescents for alcoholism is the:
Answer: Craft
31. Under normal circumstances, how much water is lost daily by the body?
Answer: Under normal circumstances, approximately 2 to 2.5 liters of water is lost daily
32. You have just completed a skin assessment on Mr. Baker. During your assessment, you
have transilluminated a skin lesion. During the physical examination, you know that skin
lesions are transilluminated to distinguish:
Answer: Transillumination is used to determine the presence of fluid in cysts and masses.
Fluid-filled lesions will transilluminate with a red glow, and solid masses will not
transilluminate.
33. Mr. Mills is a 55/y/o patient who presents to the office for an initial visit for health
promotion. A survey of mobility and activities of activities of daily living is part of a(n):
Answer: Functional assessment.
34. Sweat glands, hair, and nails are all formed from?
Answer: Invagination of epidermis into dermis
35. A brief statement of the reason the patient is seeking health care is called the?
Answer: Chief concern
36. Which part of the information contained in the patient’s record may be used in court?
Answer: Anything that is entered into a patient’s record in paper or electronic form, is a legal
document and can be used
37. Which cranial nerves innervate the face?
Answer: 5 and 7
38. In counseling a client regarding nutrition education, you explain that linoleic acid, a
major fatty acid, is thought to be essential for?
Answer: Linoleic acid, found abundantly in milk and dairy fat, is required for normal growth
and development, it has been suggested that it can reduce body fat in overweight patient
39. When are open-ended questions generally most useful?
Answer: During the initial part of the interview
40. Knowledge of the culture or cultures represented by the patient should be used to?
Answer: Help make interview questions more pertinent
41. Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric
abdominal pain. You have completed the inspection of the abdomen. What is your next step
in the assessment process?
Answer: Auscultation
42. A guideline for history taking is for caregivers to?
Answer: Make notes sparingly so that patients can be observed during the history taking
43. Which type of speculum should be used to examine a patient’s tympanic membrane?
Answer: The largest speculum that will fit comfortably in ear
44. You are palpating a patient’s thyroid and find that its broadest dimension measures 4cm.
the right lobeis 25% larger than the left. These data would indicate?
Answer: The description is most likely a normal finding
45. Mr. L. presents to the clinic with severe groin pain and a history of kidney stones. Mr.
L.’s son tells you that, for religious reasons, his father wishes to keep any stone that is passed
into the urine filter that he has been using. What is your most appropriate response?
Answer: Healthcare provider should be willing to modify delivery and respectful of
wishes/culture background
46. Before performing an abdominal examination, the examiner should?
Answer: Have the patient empty his or her bladder
47. You are examining a pregnant patient and have noted a vascular lesion. When you
Blanche over the vascular lesion, the site blanches and refills evenly from the center outward.
The nurse documents this lesion as a?
Answer: Telangiectasia
48. As you explain your patient’s condition to her husband, you notice that he is leaning
toward you and pointedly blinking his eyes. Knowing that he is from England, your most
appropriate response to this behavior is to?
Answer: The English worry about being overheard and tend to speak in a modulated voice,
so when they lean toward you, they probably have a question
49. When palpating the abdomen, you should note whether the liver is enlarged in the?
Answer: The liver is located in the right upper quadrant of the abdomen
50. Expected normal percussion tones include?
Answer: Normal lings produce renaissance percussion tones
51. 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 ate concerned about violating a cultural
prohibition when you prepare to do his rectal examination. The best tactic would be to?
Answer: Inform the patient of the reason for the exam and ask if it is acceptable to him
52. Fluorescing lesions are best distinguished using a(n)?
Answer: Wood’s lamp
53. Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling
because she is a vegetarian. Deficiency of which of the following is a concern in the
vegetarian diet?
Answer: Proteins, calcium, iron, B12, and vitamin D
54. Underestimation of blood pressure will occur if the blood pressure cuff’s width covers?
Answer: Cuff that are too wide will underestimate blood pressure, which would happen with
a cuff that is more than one third of the upper arm
55. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin
rashes. You have noted a 4’3cm, rough, elevated area of psoriasis. This is an example of a?
Answer: Plaque
56. Penicillin is considered a?
Answer: Miracle drug for all the reasons except. It was not the first antibiotic.
57. Small, minute bruises are called?
Answer: Petechiae
58. After thorough inspection of the abdomen, the next assessment step is?
Answer: Auscultation
59. When you are questioning a patient regarding alcohol intake, she tells you that she is only
a social drinker. Which initial response is appropriate?
Answer: What amount and what kind of alcohol do you drink in a week?
60. Regardless of the origin, discharge is described by noting?
Answer: Color and consistency
61. Recommended carbohydrate content of total dietary intake (% total calories) is?
Answer: 50%
62. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure?
Answer: Hearing range of normal speech
63. Auscultation should be carried out last, except when examining the?
Answer: The abdomen
64. Mr. Kevin Marks is a new health care provider. What is the best method to develop
cultural competence?
Answer: Realize the cultural values are difficult to change and must be respected
65. Which of the following is an “ABCD” characteristic of malignant melanoma?
Answer: Asymmetric borders
66. Tracheal tug suggests the presence of a(n)?
Answer: Aortic aneurysm
67. Your patient presents with symptoms that lead you to suspect acute appendicitis. Which
assessment finding is least likely to be associated with this condition early in its course?
Answer: Consistent right lower quadrant pain
68. The review of systems is a component of the:
Answer: Personal and social history
69. Cherry angiomas are a common finding in:
Answer: Adults older than 30 years
70. Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the
skin is best conducted:
Answer: with illumination provided by daylight.
71. To correctly document absent bowel sounds, one must listen continuously for:
Answer: 5 minutes
72. The adult recommended dietary fat intake should be ____g/day.
Answer: 20 to 35
73. Mr. Jones is a 45-year-old patient who presents for a physical examination. On
examination, you note costochondral beading, enlarged skull, and bowed legs and diagnose
him with rickets. A deficiency of which fat-soluble micronutrient can result in rickets?
Answer: Vitamin D
74. A flat, non-palpable lesion is described as a macule if the diameter is:
Answer: Less than 1 cm
75. Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her
current weight. In your patient teaching with her, you explain the importance of
macronutrients. Which of the following is a macronutrient?
Answer: Fat
76. Which of the following organs is part of the alimentary tract?
Answer: continuous tract from the mouth to the esophagus, stomach, small intestine, large
intestine, and anus
77. Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical
examination to establish a new primary care health care provider. Which of the following
describes a physical, not a cultural, differentiator?
Answer: Race
78. To approximate vocal frequencies, which tuning fork should be used to assess hearing?
Answer: 500 to 1000 Hz
79. During percussion, a dull tone is expected to be heard over:
Answer: The liver
80. The attitudes of the health care professional:
Answer: Culturally derived/are largely irrelevant to the success of relationships with the
patient
81. When recording physical findings, which data are recorded first for all systems?
Answer: Inspection
82. Spasmodic muscular contractions of the head, face, or neck are called:
Answer: tics
83. Which of the following occurs when firm pressure is used to apply the stethoscope’s bell
end-piece to the skin?
Answer: It functionally converts to a diaphragm end-piece.
84. Differential diagnoses belong in the:
Answer: Assessment
85. Pigmented, raised, warty lesions over the face and trunk should be assessed by an
experienced practitioner who can distinguish:
Answer: seborrheic keratoses from actinic keratoses.
86. Mr. Walter’s, a 32-year-old patient, tells you that his ears are “stopped up.” An objective
assessment of this complaint is achieved by using the:
Answer: Tympan meter
87. Mrs. Leonard brings her newborn infant into the paediatrician’s office for a first wellbaby visit. As the health care provider, you teach her that newborns are more vulnerable to
hypothermia due to:
Answer: a poorly developed subcutaneous fat layer.
88. Tympanic thermometers measure body temperature when a probe is placed:
Answer: Eardrum (in the ear)
89. A serous membrane that lines the abdominal cavity and forms a protective cover for many
abdominal structures is the:
Answer: peritoneum
90. White, rounded, or oval ulcerations surrounded by a red halo and found on the oral
mucosa are:
Answer: aphthous ulcers (canker sores)
91. When assessing abdominal pain in a college-age woman, one must include:
Answer: the first day of the last menstrual period.
92. 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:
Answer: inspect for ecchymosis of the flank.
93. The infant should be placed in which position to have his or her height or length
measured?
Answer: Supine on a measuring board
94. 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?
Answer: "Why do you think you are having these symptoms?"
95. Which of the following is the most vital nutrient?
Answer: water
96. What finding is unique to the documentation of a physical examination of an infant?
Answer: Fontanel size
97. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for
problem drinking, you would use the:
Answer: Cage questionnaire
98. Mr. D. complains of a headache. During the history he mentions his use of alcohol and
illicit drugs. This information would most likely belong in the:
Answer: personal and social history
99. 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:
Answer: flex his or her knees
100. When communicating with older children and teenagers, you should be sensitive to
their:
Answer: typical reluctance to talk
101. Periods of silence during the interview can serve important purposes, such as:
Answer: Providing time for reflection.
Question 1
Mr. Franklin is speaking with you, the health care provider, about his respiratory problem.
Mr. Franklin says, "I've had this cough for 3 days, and it's getting worse." You reply, "Tell me
more about your cough." Mr. Franklin states, "I wish I could tell you more. That's why I'm
here. You tell me what's wrong!" Which caregiver response would be most appropriate for
enhancing communication?
Answer: The best response here would be: "I understand your frustration. Let's work
together to figure out what's causing this." This approach validates Mr. Franklin's feelings
and opens a collaborative dialogue.
Question 2
Before performing an abdominal examination, the examiner should:
Answer: Before performing an abdominal examination, the examiner should ensure that the
patient is in a comfortable position (usually supine) and that the abdomen is adequately
exposed while maintaining the patient’s modesty. Additionally, the examiner should warm
their hands to enhance comfort and relax the abdominal muscles.
Question 3
Periods of silence during the interview can serve important purposes, such as:
Answer: Periods of silence during an interview can serve important purposes, such as
allowing the patient time to think and reflect on their responses, which can lead to deeper
insights. They can also encourage the patient to share more by creating a space for them to
express thoughts or feelings they might otherwise withhold.
Question 4
Your patient presents with symptoms that lead you to suspect acute appendicitis. Which
assessment finding is least likely to be associated with this condition early in its course?
Answer: In the early stages of acute appendicitis, the assessment finding least likely to be
associated with the condition is elevated white blood cell count. While a mild leukocytosis
may develop as the condition progresses, it may not be present early on. Other findings, such
as abdominal pain (especially in the right lower quadrant), tenderness, and possibly nausea or
vomiting, are more characteristic of early appendicitis.
Question 5
To perform the Rinne test, place the tuning fork on the:
Answer: To perform the Rinne test, place the tuning fork on the patient's mastoid process
(the bone behind the ear) to test bone conduction. After the sound is no longer heard, move
the tuning fork to the front of the ear canal to test air conduction. This comparison helps
determine whether the patient has conductive or sensorineural hearing loss.
Question 6
As part of your health promotion education for a new patient, you explain that the risk factors
for skin cancer include:
Answer: Risk factors for skin cancer include excessive sun exposure, fair skin, family
history, and a weakened immune system. Additionally, previous skin cancer and increasing
age also elevate the risk.
Question 7
A brief statement of the reason the patient is seeking health care is called the:
Answer: A brief statement of the reason the patient is seeking health care is called the chief
complaint. This is typically a concise description of the primary issue or symptom that
prompted the patient to seek medical attention.
Question 8
When assessing abdominal pain in a college-age woman, one must include:
Answer: When assessing abdominal pain in a college-age woman, include her menstrual
history and sexual history to identify potential gynecological issues. Also, assess the pain
characteristics and any associated gastrointestinal symptoms.
Question 9
Peritonitis produces bowel sounds that are:
Answer: Peritonitis typically produces bowel sounds that are diminished or absent. In cases
of acute peritonitis, inflammation of the peritoneum often leads to decreased bowel activity,
resulting in less pronounced or no bowel sounds upon auscultation. This contrasts with
conditions like bowel obstruction, where bowel sounds may be increased.
Question 10
The most superior part of the stomach is the:
Answer: The most superior part of the stomach is the fundus. It is the rounded, upper portion
that sits above the level of the entrance of the esophagus and is typically filled with gas.
Question 11
To approximate vocal frequencies, which tuning fork should be used to assess hearing?
Answer: To approximate vocal frequencies, a 512 Hz tuning fork is commonly used to assess
hearing. This frequency closely matches the range of human speech and is effective for
testing both air and bone conduction during hearing assessments.
Question 12
Which of the following is the most vital nutrient?
Answer: The most vital nutrient is water. It is essential for numerous bodily functions,
including maintaining hydration, regulating temperature, transporting nutrients, and
facilitating metabolic processes. Without adequate water intake, the body cannot function
properly, making it crucial for overall health.
Question 13
Which of the following is an expected change in the assessment of the thyroid during
pregnancy?
Answer: An expected change in the assessment of the thyroid during pregnancy is an
increase in thyroid size. This enlargement is due to increased vascularity and hormonal
changes, including elevated levels of thyroid hormones (T3 and T4) to meet the metabolic
demands of both the mother and the developing fetus. Additionally, there may be changes in
thyroid function tests, with some women experiencing slight increases in thyroid hormone
levels.
Question 14
Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin
is best conducted:
Answer: Your inspection to determine color variations of the skin is best conducted in
natural light. This provides the best visibility to assess the true color of the skin and any
variations, such as redness, pallor, or jaundice, which can be more difficult to discern under
artificial lighting. Additionally, examining areas with less pigmentation, like the palms of the
hands or soles of the feet, can help in assessing color variations accurately.
Question 15
Peritonitis produces bowel sounds that are:
Answer: Peritonitis typically produces bowel sounds that are diminished or absent. This
occurs because inflammation of the peritoneum can lead to a decrease in bowel activity. In
contrast, conditions like bowel obstruction might result in increased or hyperactive bowel
sounds.
Question 16
Macronutrients are so named because they:
Answer: Macronutrients are so named because they are needed by the body in large
amounts. They include carbohydrates, proteins, and fats, and provide the energy necessary
for various bodily functions and overall growth. Their large quantity requirement
differentiates them from micronutrients, which are needed in smaller amounts, such as
vitamins and minerals.
Question 17
In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of
the tracheal cartilage is at the:
Answer: In examining the neck of a 34-year-old female patient, you note that the uppermost
ridge of the tracheal cartilage is at the level of the thyroid cartilage, specifically at the C4-C5
vertebrae level. This ridge is also known as the jugular notch or suprasternal notch, located
just above the sternum.
Question 18
Which of the following occurs when firm pressure is used to apply the stethoscope's bell endpiece to the skin?
Answer: When firm pressure is used to apply the stethoscope's bell end-piece to the skin, it
can convert the bell into a diaphragm-like function, leading to an increase in high-frequency
sounds. This means that while the bell is designed to capture low-frequency sounds, applying
pressure can make it more sensitive to higher-frequency sounds, which may affect the clarity
of the auscultation results.
Question 19
You have just completed a skin assessment on Mr. Baker. During your assessment, you have
transilluminated a skin lesion. During the physical examination, you know that skin lesions
are transilluminated to distinguish:
Answer: During a physical examination, skin lesions are transilluminated to distinguish
between solid masses and fluid-filled lesions. Transillumination can help identify whether a
lesion is cystic (fluid-filled) or solid by observing how light passes through the lesion; fluidfilled lesions typically allow light to pass through more easily, while solid lesions do not.
Question 20
The position on a clock, topographic notations, and anatomic landmarks:
Answer: The position on a clock, topographic notations, and anatomic landmarks are often
used in medical assessments and descriptions to provide clear communication about the
location of structures, lesions, or symptoms on the body.
For example, using a clock face analogy helps specify the location on the body (e.g., "a
lesion at 3 o'clock on the right breast"). Topographic notations help describe the relationship
between different anatomical structures. These methods enhance precision in clinical
documentation and facilitate effective communication among healthcare providers.
Question 21
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?
Answer: You would tell Mrs. Kinder that the Eustachian tube is responsible for equalizing
atmospheric pressure in the ears when swallowing, sneezing, or yawning. This tube connects
the middle ear to the back of the throat and helps maintain equal pressure on both sides of the
eardrum, which is important for proper hearing and ear function.
Question 22
Ms. Jones is a 31-year-old female patient who presents for a routine physical examination.
Which examination technique will be used first?
Answer: The first examination technique used during a routine physical examination is
inspection. This involves visually examining the patient for any signs of abnormalities, such
as changes in skin color, posture, or any visible signs of distress before proceeding to other
techniques like palpation, percussion, or auscultation.
Question 23
When recording physical findings, which data are recorded first for all systems?
Answer: When recording physical findings, the general survey data are recorded first for all
systems. This includes observations about the patient’s overall appearance, level of
consciousness, hygiene, posture, and any signs of distress. It sets the stage for more detailed
assessments of specific body systems.
Question 24
Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the
correct technique for locating the:
Answer: Percussing at the right midclavicular line, below the umbilicus, and continuing
upward is the correct technique for locating the liver. This technique helps to assess the size
and border of the liver by identifying the change from dullness (over the liver) to resonance
(over the lung or intestine) during percussion.
Question 25
Ms. G. is being seen for her routine physical examination. She is a college graduate and
president of a research firm. Although her exact salary is unknown, she has adequate health
insurance. Most of the above information is part of Ms. G.'s _____ history.
Answer: Most of the above information is part of Ms. G.'s social history. This section
includes details about her education, occupation, financial status (like insurance coverage),
and other lifestyle factors that may impact her health.
Question 26
You are planning to palpate the abdomen of your patient. Which part of the examiner's hand
is best for palpating vibration?
Answer: The best part of the examiner's hand for palpating vibration is the palmar surface
(or the pads) of the fingers. This area is sensitive and effective for detecting vibrations, such
as those felt during the assessment of fremitus or during palpation of certain abdominal
structures.
Question 27
Which of the following is an "ABCD" characteristic of malignant melanoma?
Answer: A: Asymmetry
B: Border irregularity
C: Color variation (multiple colors or uneven distribution)
D: Diameter greater than 6 mm (or any change in size)
Question 28
Mrs. Webb is a 38-year-old patient who has been changing her lifestyle to eat in a healthy
way and lose weight. During your health promotion education regarding her nutritional
status, you explain the function of dietary protein as:
Answer: During health promotion education regarding Mrs. Webb's nutritional status, you
would explain that the function of dietary protein is to build and repair tissues, including
muscles and organs, and to produce enzymes and hormones. Additionally, proteins play a
crucial role in maintaining immune function and can serve as an energy source when
carbohydrates are insufficient.
Question 29
George Michaels, a 22-year-old patient, tells the nurse that he is here today to "check his
allergies." He has been having "green nasal discharge" for the last 72 hours. How would the
nurse document his reason for seeking care?
Answer: The nurse would document George Michaels' reason for seeking care as follows:
"Patient presents with complaints of green nasal discharge for the past 72 hours, stating he is
here to check for allergies."
Question 30
Sweat glands, hair, and nails are all formed from:
Answer: Sweat glands, hair, and nails are all formed from epithelial tissue. Specifically, they
originate from the epidermis, which is the outermost layer of the skin. These structures are
part of the integumentary system and play various roles in protecting the body and regulating
temperature.
Question 31
Your patient returns for a blood pressure check 2 weeks after a visit during which you
performed a complete history and physical. This visit would be documented by creating a(n):
Answer: This visit would be documented by creating a follow-up note or progress note. This
type of documentation includes updates on the patient's condition, any changes since the last
visit, the results of the blood pressure check, and any further recommendations or plans for
ongoing care.
Question 32
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:
Answer: Based on the patient's symptoms, your prioritized physical examination should
focus on the abdominal exam, assessing for tenderness in the epigastric area and right upper
quadrant. Additionally, evaluate for signs of pancreatitis or gallbladder issues, such as
guarding or rebound tenderness.
Question 33
Expected normal percussion tones include:
Answer: Expected normal percussion tones include:
1. Resonance: Typically heard over normal lung tissue.
2. Tympany: Commonly found over the stomach and gas-filled intestines.
3. Dullness: Noted over solid organs like the liver or spleen.
These tones help in assessing the underlying structures and identifying any abnormalities.
Question 34
Recommended carbohydrate content of total dietary intake (% total calories) is ____ %.
Answer: The recommended carbohydrate content of total dietary intake is typically 45-65%
of total calories. This range supports adequate energy levels and nutritional balance in a
healthy diet.
Question 35
Underestimation of blood pressure will occur if the blood pressure cuff's width covers:
Answer: Underestimation of blood pressure will occur if the blood pressure cuff's width
covers less than 80% of the arm circumference. A cuff that is too narrow can result in falsely
low readings. It is important to use an appropriately sized cuff to ensure accurate blood
pressure measurements.
Question 36
Which technique is most likely to result in the patient's understanding of questions?
Answer: The technique most likely to result in the patient's understanding of questions is the
use of open-ended questions. This approach encourages patients to express themselves in
their own words, providing more context and clarity. Additionally, actively listening and
using teach-back methods—asking patients to repeat back what they understood—can further
enhance comprehension and ensure they grasp the information being communicated.
Question 37
Which question would be considered a leading question?
Answer: A leading question is one that suggests a particular answer or contains an
assumption. An example of a leading question would be:
"Don't you think you should try to lose some weight?"
This question implies that the respondent should believe that losing weight is necessary,
guiding them toward that answer rather than allowing them to express their own opinion
freely.
Question 38
Spasmodic muscular contractions of the head, face, or neck are called:
Answer: Spasmodic muscular contractions of the head, face, or neck are called tics. Tics can
involve sudden, repetitive movements or sounds and are often associated with conditions like
Tourette syndrome.
Question 39
Tangential lighting is best used for inspecting skin:
Answer: Tangential lighting is best used for inspecting skin lesions, textures, or
abnormalities. This technique involves directing light at a low angle across the surface of the
skin, which enhances shadows and highlights, making it easier to visualize subtle changes or
irregularities in the skin’s surface, such as moles, scars, or other skin conditions.
Question 40
Small, minute bruises are called:
Answer: Small, minute bruises are called petechiae. These are tiny, red or purple spots that
appear on the skin due to bleeding underneath the skin, often resulting from minor trauma,
certain medical conditions, or clotting disorders.
Question 41
When examining the skull of a 4-month-old baby, you should normally find:
Answer: When examining the skull of a 4-month-old baby, you should normally find that the
fontanelles (soft spots) are still present, particularly the anterior fontanelle, which is
typically open and may measure about 2 to 3 centimeters in diameter. The skull should feel
smooth and symmetric, and the sutures may be palpable but should not be widely separated
or overriding.
Question 42
Mr. L. presents to the clinic with severe groin pain and a history of kidney stones. Mr. L.'s
son tells you that, for religious reasons, his father wishes to keep any stone that is passed into
the urine filter that he has been using. What is your most appropriate response?
Answer: Your most appropriate response would be: "I understand that it's important to your
father to keep the stone for religious reasons. We can help ensure that any passed stone is
collected and preserved properly." This response acknowledges the patient's wishes while
also offering support in fulfilling them.
Question 43
What finding is unique to the documentation of a physical examination of an infant?
Answer: A unique finding in the documentation of a physical examination of an infant is the
presence of fontanelles. These soft spots on the skull are important indicators of cranial
development and can provide information about the infant's growth, hydration status, and
potential intracranial pressure. Additionally, noting the infant's reflexes, such as the Moro
reflex or rooting reflex, is also specific to infants and important for assessing neurological
function.
Question 44
The recommended minimum daily protein requirement for the normal adult is ______.
Answer: The recommended minimum daily protein requirement for the normal adult is about
46 grams for women and 56 grams for men. This is based on the Recommended Dietary
Allowance (RDA) of 0.8 grams of protein per kilogram of body weight for adults. Individual
needs may vary based on factors such as age, activity level, and health status.
Question 45
Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis
would be:
Answer: Based on a BMI of 33, Ms. Davis would be classified as having obesity. According
to the World Health Organization (WHO) classification, a BMI of 30 or higher indicates
obesity, which can increase the risk of various health conditions.
Question 46
As you explain your patient's condition to her husband, you notice that he is leaning toward
you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate
response to this behavior is to:
Answer: Knowing that he is from England, your most appropriate response to his behavior
would be to maintain eye contact and continue to engage with him in a respectful and open
manner. Leaning in may indicate interest or attentiveness, and the blinking might be a
cultural gesture. Responding positively by acknowledging his engagement and ensuring clear
communication can help facilitate understanding.
Question 47
Which of the following organs is part of the alimentary tract?
Answer: The organs that are part of the alimentary tract include the esophagus, stomach,
small intestine, large intestine, rectum, and anus. These structures form the digestive system
responsible for processing food and absorbing nutrients.
Question 48
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:
Answer: The best tactic would be to communicate openly with Mr. Abdul about the
examination. You can explain the necessity of the rectal examination in the context of his
abdominal pain, ensuring he understands the medical reasons for it. Additionally, ask for his
preferences and reassure him about privacy and respect during the examination. If he
expresses discomfort, consider alternative methods of assessment or involve a same-gender
clinician if appropriate. This approach shows cultural sensitivity and helps build trust.
Question 49
Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure:
Answer: Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to
measure hearing. Specifically, these frequencies are used in tests like the Rinne and Weber
tests to assess bone conduction and air conduction of sound, helping to determine the type of
hearing loss a patient may have.
Question 50
During an interview, tears appear in the patient's eyes and his voice becomes shaky. Initially,
you should:
Answer: Initially, you should pause and allow the patient to express their emotions. Give
them a moment to gather themselves, and offer a supportive presence. You might gently
acknowledge their feelings by saying something like, "It's okay to feel emotional; take your
time." This approach shows empathy and allows the patient to feel heard and understood,
which can foster trust and open communication.
Question 51
Tympanic thermometers measure body temperature when a probe is placed:
Answer: Tympanic thermometers measure body temperature when a probe is placed in the
ear canal (tympanic membrane). This method detects the infrared heat emitted from the
eardrum, providing a quick and accurate measurement of core body temperature.
Question 52
Under normal circumstances, how much water is lost daily by the body?
Answer: Under normal circumstances, the body loses about 2 to 3 liters of water daily. This
loss occurs through various means, including urine, sweat, respiration, and feces.
Maintaining adequate hydration is essential to replace this loss and support overall health.
Question 53
After thorough inspection of the abdomen, the next assessment step is:
Answer: After thorough inspection of the abdomen, the next assessment step is auscultation.
This involves listening to the bowel sounds using a stethoscope, which helps assess
gastrointestinal activity before proceeding to palpation and percussion. Auscultation should
be performed before palpation to avoid altering bowel sounds.
Question 54
Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin
rashes. You have noted a 4' 3-cm, rough, elevated area of psoriasis. This is an example of a:
Answer: This is an example of a plaque. In dermatology, a plaque is a raised, flat-topped
lesion that is typically greater than 1 cm in diameter. In the case of psoriasis, plaques are
often scaly and can vary in color, appearing red with silvery-white scales.
Question 55
Which cranial nerves innervate the face?
Answer: The cranial nerves that innervate the face are Cranial Nerve V (Trigeminal Nerve),
which provides sensory and motor functions, and Cranial Nerve VII (Facial Nerve), which
innervates the muscles of facial expression.
Question 56
Which technique is most likely to result in the patient's understanding of questions?
Answer: The technique most likely to result in the patient's understanding of questions is
using clear and simple language while also employing open-ended questions. This allows
patients to express their thoughts and feelings more freely, providing context and clarity.
Additionally, active listening and rephrasing questions can help ensure that the patient fully
comprehends what is being asked, fostering better communication and understanding.
Question 57
Which of the following is the most accurate reflection of an individual's food intake?
Answer: The most accurate reflection of an individual's food intake is typically obtained
through a 24-hour dietary recall. This method involves asking the individual to recount all
the foods and beverages consumed in the past 24 hours. It provides detailed information
about food choices and portion sizes, making it a reliable way to assess dietary habits. Other
methods, like food diaries or food frequency questionnaires, can also be used but may not
provide as immediate or specific an assessment.
Question 58
When assessing abdominal pain in a college-age woman, one must include:
Answer: When assessing abdominal pain in a college-age woman, one must include her
menstrual history and sexual history to identify potential gynecological issues, along with
evaluating the pain characteristics and any associated gastrointestinal symptoms.
Question 59
The infant should be placed in which position to have his or her height or length measured?
Answer: The infant should be placed in a supine position (lying on their back) to have their
length measured. A measuring board or length mat can be used, ensuring the infant's head is
positioned at the top and their feet are straightened at the bottom. This method provides an
accurate measurement of the infant's length.
Question 60
A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings
reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears
healthy otherwise. You should ask her if she:
Answer: You should ask her if she has been experiencing any issues with her eating habits or
has engaged in behaviors such as vomiting after meals. The combination of bradycardia,
tooth enamel erosion, and scars on her knuckles (likely from inducing vomiting) raises
concerns for bulimia nervosa or other eating disorders. It's important to explore her
relationship with food and any possible binge-purge cycles she may be experiencing.
Question 61
A 5-year-old child presents with nasal congestion and a headache. To assess for sinus
tenderness you should palpate over the:
Answer: To assess for sinus tenderness in a 5-year-old child, you should palpate over the
maxillary sinuses, located just below the cheekbones, and the frontal sinuses, located above
the eyebrows in the forehead area. Gentle pressure on these areas can help identify any
tenderness that may indicate sinusitis or other sinus-related issues.
Question 62
Coarse, dry, and brittle hair is associated with which metabolic disorder?
Answer: Coarse, dry, and brittle hair is often associated with hypothyroidism. In this
condition, the thyroid gland does not produce enough thyroid hormones, leading to various
symptoms, including changes in hair texture and quality. Other signs of hypothyroidism may
include fatigue, weight gain, and cold intolerance.
Question 63
A detailed description of the symptoms related to the chief complaint is presented in the:
Answer: A detailed description of the symptoms related to the chief complaint is presented in
the history of present illness (HPI). The HPI provides a comprehensive account of the
patient's symptoms, including their onset, duration, severity, location, and any associated
factors, helping to inform the clinical assessment and diagnosis.
Question 64
Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical
examination to establish a new primary care health care provider. Which of the following
describes a physical, not a cultural, differentiator?
Answer: A physical differentiator refers to a characteristic that is observable and related to
the body's structure or function. An example of a physical differentiator, in this context, could
be body mass index (BMI), blood pressure, or skin color.
In contrast, cultural differentiators may include beliefs, values, or practices that pertain to a
person's cultural background. If you have specific options in mind, please share them for a
more targeted response!
Question 65
You are using an ophthalmoscope to examine a patient's inner eye. You rotate the lens
selector clockwise, then counterclockwise to compensate for:
Answer: When using an ophthalmoscope and rotating the lens selector clockwise or
counterclockwise, you are compensating for refractive errors in the patient's vision. This
adjustment allows you to focus the view of the retina and other structures in the inner eye,
ensuring a clear examination. For instance, moving the lens selector to a plus (+) setting
helps focus on a myopic (nearsighted) patient, while a minus (−) setting is used for a
hyperopic (farsighted) patient.
Question 66
Tracheal tug suggests the presence of a(n):
Answer: Tracheal tug suggests the presence of a mediastinal mass or tracheal displacement.
This sign indicates that there may be increased negative pressure in the thoracic cavity, often
due to conditions such as a large tumor or other abnormalities in the mediastinum that can
pull the trachea downward during inspiration.
Question 67
Auscultation should be carried out last, except when examining the:
Answer: Auscultation should be carried out last, except when examining the abdomen. In the
case of an abdominal exam, auscultation is performed before palpation and percussion to
avoid altering bowel sounds, which may occur if the abdomen is manipulated first. This helps
provide an accurate assessment of gastrointestinal function.
Question 68
Unusual white areas on the skin may be due to:
Answer: Unusual white areas on the skin may be due to vitiligo, pityriasis alba, tinea
versicolor, or post-inflammatory hypopigmentation. These conditions can result from various
factors, including autoimmune processes, fungal infections, or skin irritation.
Question 69
A serous membrane that lines the abdominal cavity and forms a protective cover for many
abdominal structures is the:
Answer: The serous membrane that lines the abdominal cavity and forms a protective cover
for many abdominal structures is called the peritoneum. It consists of two layers: the parietal
peritoneum, which lines the abdominal wall, and the visceral peritoneum, which covers the
organs within the abdominal cavity. The peritoneum helps reduce friction between the organs
and provides a supportive framework.
Question 70
A blood pressure cuff bladder should be long enough to:
Answer: A blood pressure cuff bladder should be long enough to cover 80-100% of the
circumference of the arm. Ideally, it should encircle at least 80% of the arm's circumference
to ensure accurate readings. If the bladder is too short or too narrow, it can lead to falsely
high or low blood pressure measurements.
Question 71
Mr. Walters, a 32-year-old patient, tells you that his ears are "stopped up." An objective
assessment of this complaint is achieved by using the:
Answer: An objective assessment of Mr. Walters' complaint of "stopped up" ears can be
achieved by using the otoscope. This instrument allows you to visualize the ear canal and
tympanic membrane (eardrum) to check for blockages, such as earwax (cerumen), fluid, or
signs of infection. Additionally, you might consider using a tuning fork for hearing tests, but
the otoscope is essential for examining the ear directly.
Question 72
Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her
current weight. In your patient teaching with her, you explain the importance of
macronutrients. Which of the following is a macronutrient?
Answer: A macronutrient includes carbohydrates, proteins, and fats. These nutrients are
essential for providing energy, supporting growth and development, and maintaining overall
health. In your discussion with Mrs. Raymonds, you can explain how each macronutrient
plays a specific role in her diet and overall well-being.
Question 73
Knowledge of the culture or cultures represented by the patient should be used to:
Answer: Knowledge of the culture or cultures represented by the patient should be used to
enhance communication and understanding during healthcare interactions, ensuring that care
is respectful and tailored to the patient’s values, beliefs, and practices. This cultural
awareness can improve patient satisfaction and adherence to treatment plans.
Question 74
During percussion, a dull tone is expected to be heard over:
Answer: During percussion, a dull tone is expected to be heard over solid organs such as the
liver, spleen, or kidneys. Dullness indicates that the underlying tissue is denser than air,
which is typical for these organs. Dull tones can also be heard in areas where there is fluid,
such as in cases of pleural effusion.
Question 75
You are palpating a patient's thyroid and find that its broadest dimension measures 4 cm.
The right lobe is 25% larger than the left. These data would indicate:
Answer: If the right lobe of the thyroid is 25% larger than the left lobe, and the broadest
dimension measures 4 cm, this indicates asymmetry in the size of the thyroid lobes.
Specifically, you can calculate that the right lobe would measure approximately 2.5 cm,
while the left lobe measures about 2 cm.
While some degree of variation in thyroid lobe size can be normal, significant asymmetry
may raise concerns for potential thyroid disorders or nodular growths. Further evaluation,
including imaging or laboratory tests, may be warranted to assess thyroid function and
structure.
Question 76
The adult recommended dietary fat intake should be _____ g/day.
Answer: The adult recommended dietary fat intake should be approximately 70 to 100 grams
per day, which typically accounts for about 20% to 35% of total daily caloric intake.
However, individual needs may vary based on factors such as activity level, age, and overall
health. It's important to focus on healthy fats, such as those from avocados, nuts, seeds, and
fish, while limiting saturated and trans fats.
Question 77
Before performing an abdominal examination, the examiner should:
Answer: Before performing an abdominal examination, the examiner should ensure that the
patient is in a comfortable position (usually supine with the arms at the sides) and that the
environment is warm to promote relaxation. Additionally, the examiner should expose the
abdomen adequately while maintaining the patient's dignity, and ask the patient to empty
their bladder if necessary. Finally, it’s important to perform a general inspection of the
abdomen before proceeding with palpation, percussion, and auscultation.
Question 78
A college student comes to the student health center complaining of difficulty in
concentrating during class and while studying. The diet that would contribute to this problem
is one that consumes mostly:
Answer: The diet that would contribute to difficulty in concentrating is one that consumes
mostly highly processed foods, sugary snacks, and refined carbohydrates. Such a diet often
lacks essential nutrients like omega-3 fatty acids, vitamins, and minerals that are important
for brain health. Foods high in sugar can lead to fluctuations in blood sugar levels, which can
impact energy and concentration. A balanced diet rich in whole foods, including fruits,
vegetables, whole grains, lean proteins, and healthy fats, is more beneficial for cognitive
function and focus.
Question 79
A flat, nonpalpable lesion is described as a macule if the diameter is:
Answer: A flat, nonpalpable lesion is described as a macule if the diameter is less than 1
centimeter. If the flat lesion is 1 centimeter or larger, it is referred to as a patch. Macules are
typically characterized by a change in skin color without any elevation or depression.
Question 80
When are open-ended questions generally most useful?
Answer: Open-ended questions are generally most useful in initial patient interviews or
assessments, as they encourage the patient to share their thoughts and feelings in their own
words. They are also effective for exploring complex issues, allowing for a deeper
understanding of the patient’s experiences and concerns.
Question 81
When communicating with older children and teenagers, you should be sensitive to their:
Answer: When communicating with older children and teenagers, you should be sensitive to
their need for privacy and autonomy, as well as their desire to be treated with respect and as
individuals. It's important to foster an environment where they feel comfortable expressing
their thoughts and concerns.
Question 82
Pigmented, raised, warty lesions over the face and trunk should be assessed by an
experienced practitioner who can distinguish:
Answer: Pigmented, raised, warty lesions over the face and trunk should be assessed by an
experienced practitioner who can distinguish benign lesions, such as seborrheic keratosis or
dermatofibromas, from malignant lesions like melanoma or squamous cell carcinoma.
Accurate assessment is crucial for appropriate management and treatment.
Question 83
Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which
medication is frequently associated with weight gain?
Answer: Several medications are frequently associated with weight gain, but one common
class is antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like
paroxetine (Paxil). Additionally, certain antipsychotics (such as olanzapine and clozapine)
and corticosteroids (like prednisone) are also well-known for contributing to weight gain. It’s
important to review her medication history to identify any that may be linked to her weight
gain.
Question 84
The most common form of birth trauma of the scalp is:
Answer: The most common form of birth trauma of the scalp is caput succedaneum. This
condition is characterized by the accumulation of fluid (edema) in the soft tissues of the
baby's head, typically caused by pressure during delivery. It usually appears as a swelling
that crosses suture lines and is generally resolved within a few days without treatment.
Question 85
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:
Answer: 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 pull the auricle (outer ear) down
and back. This technique helps to straighten the ear canal in infants, allowing for better
visualization of the tympanic membrane (eardrum) and the middle ear structures.
Question 86
Mr. Black is a 44-year-old patient who presents to the clinic with complaints of neck pain
that he thinks is from his job involving computer data entry. As the examiner, you are
checking the range of motion in his neck and note the greatest degree of cervical mobility is
at:
Answer: The greatest degree of cervical mobility is at the C1-C2 level (the atlantoaxial
joint). This joint allows for significant rotation of the head, which is essential for activities
like turning the head side to side. While the cervical spine as a whole allows for flexion,
extension, lateral bending, and rotation, the C1-C2 joint provides the most mobility
specifically for rotation.
Question 87
Brittle nails are typical findings in:
Answer: Brittle nails are typical findings in hypothyroidism and can also be associated with
nutritional deficiencies, such as a lack of biotin or iron. Other conditions that may lead to
brittle nails include eczema, psoriasis, and certain systemic illnesses. Additionally, frequent
exposure to water and harsh chemicals can contribute to nail brittleness. If brittle nails are
observed, it's important to consider these underlying factors.
Question 88
White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa
are:
Answer: White, rounded, or oval ulcerations surrounded by a red halo and found on the oral
mucosa are known as apthous ulcers, commonly referred to as canker sores. These painful
lesions can occur due to various factors, including stress, nutritional deficiencies, and certain
medical conditions. They typically heal on their own within one to two weeks.
Question 89
Which type of speculum should be used to examine a patient's tympanic membrane?
Answer: A pneumatic otoscope is the type of speculum that should be used to examine a
patient's tympanic membrane. This instrument allows for visualization of the tympanic
membrane and also includes the ability to apply gentle pressure (pneumatic) to assess the
mobility of the eardrum, which can help in diagnosing conditions such as otitis media. The
otoscope should have a suitable speculum size that fits comfortably in the ear canal for
effective examination.
Question 90
The examiner's evaluation of a patient's mental status belongs in the:
Answer: The examiner's evaluation of a patient's mental status belongs in the neurological
examination section of the patient’s assessment. This evaluation typically includes
assessments of cognitive function, orientation, mood, thought processes, and any signs of
mental health conditions. It can also be documented in the review of systems or the history of
present illness if relevant to the patient's current complaints.
Question 91
Bulging of an amber tympanic membrane without mobility is most often associated with:
Answer: Bulging of an amber tympanic membrane without mobility is most often associated
with otitis media with effusion (OME), commonly referred to as fluid in the middle ear. This
condition occurs when fluid builds up behind the tympanic membrane, often due to allergies,
colds, or other respiratory infections. The amber color indicates the presence of fluid, and the
lack of mobility suggests that the tympanic membrane is under pressure from the
accumulated fluid.
Question 92
When you are questioning a patient regarding alcohol intake, she tells you that she is only a
social drinker. Which initial response is appropriate?
Answer: An appropriate initial response could be, "Can you tell me more about what a
'social drinker' means for you?" This open-ended question encourages the patient to elaborate
on her drinking habits, providing more context and allowing for a better understanding of her
alcohol consumption without making assumptions. It fosters a supportive dialogue and helps
to assess her alcohol intake more accurately.
Question 93
Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because
she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet?
Answer: In a vegetarian diet, a deficiency of vitamin B12 is a significant concern. Vitamin
B12 is primarily found in animal products, so vegetarians need to ensure they obtain it from
fortified foods or supplements. Other potential deficiencies in a vegetarian diet can include
iron, zinc, calcium, and omega-3 fatty acids, but vitamin B12 is particularly critical to monitor
due to its essential role in nerve function and the production of red blood cells.
Question 94
Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural
competence?
Answer: The best method for Mr. Kevin Marks to develop cultural competence is to engage
in ongoing education and training about diverse cultures, including their beliefs, practices,
and values related to health care. Additionally, actively seeking hands-on experience by
interacting with patients from different cultural backgrounds and reflecting on these
experiences can further enhance his understanding and skills in providing culturally
competent care.
Question 95
Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B
vitamin is deficient in patients with pernicious anemia?
Answer: Patients with pernicious anemia are deficient in vitamin B12. This deficiency
occurs due to the inability to absorb vitamin B12 from the gastrointestinal tract, often because
of a lack of intrinsic factor, a protein necessary for B12 absorption. Vitamin B12 is essential
for the production of red blood cells and proper neurological function.
Question 96
The term denoting the caregiver's need to do no harm to the patient is:
Answer: The term denoting the caregiver's need to do no harm to the patient is
nonmaleficence. This ethical principle emphasizes the obligation of healthcare providers to
avoid causing harm to patients, ensuring that their actions do not negatively affect the
patient's well-being.
Question 97
Penicillin is considered a
Answer: Penicillin is considered an antibiotic. It is a type of beta-lactam antibiotic that is
effective against certain types of bacteria. Penicillin works by inhibiting the synthesis of
bacterial cell walls, leading to the destruction of the bacteria. It is commonly used to treat
various infections, including strep throat, pneumonia, and skin infections.
Question 98
Mrs. Leonard brings her newborn infant into the paediatrician’s office for a first well baby
visit. As the health care provider, you teach her that newborns are more vulnerable to
hypothermia due to:
Answer: Newborns are more vulnerable to hypothermia due to their higher surface area-tovolume ratio, which increases heat loss, as well as their limited ability to generate heat
through shivering and their immature subcutaneous fat stores. Additionally, newborns have a
thinner layer of insulating fat and a lack of muscle mass to help maintain body temperature.
Question 99
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 (ADLs) is part of a(an):
Answer: A survey of mobility and activities of daily living (ADLs) is part of a functional
assessment. This assessment evaluates a patient's ability to perform basic daily tasks and
activities, which can provide important insights into their overall health, independence, and
potential needs for support or intervention. Functional assessments are often included in
initial visits for health promotion, especially in older adults, to identify areas where
assistance may be required and to develop appropriate care plans.
Question 100
Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal
pain. You have completed the inspection of the abdomen. What is your next step in the
assessment process?
Answer: After completing the inspection of the abdomen, the next step in the assessment
process is to auscultate the abdomen. This involves using a stethoscope to listen for bowel
sounds and any abnormal vascular sounds. Auscultation should be performed before
palpation and percussion to avoid altering the bowel sounds that may be present.
Another
Question 1
When completing this exam, did you comply with Walden University’s Code of Conduct
including the expectations for academic integrity?
Answer: It’s always important to adhere to academic integrity guidelines and codes of
conduct. If you have questions about those expectations, it’s a good idea to review the
university’s resources or speak with an advisor.
Question 2
When hearing is evaluated, which cranial nerve is being tested?
Answer: When hearing is evaluated, the cranial nerve being tested is the vestibulocochlear
nerve, also known as cranial nerve VIII. This nerve is responsible for both hearing and
balance.
Question 3
Bulging of an amber tympanic membrane without mobility is most often associated with:
Answer: Bulging of an amber tympanic membrane without mobility is most often associated
with otitis media with effusion (OME), also known as serous otitis media. This condition
typically occurs when fluid accumulates in the middle ear without signs of infection. The
tympanic membrane may appear amber due to the presence of fluid behind it.
Question 4
The examiner's evaluation of a patient's mental status belongs in the:
Answer: The examiner's evaluation of a patient's mental status typically belongs in the
neurological examination section of the clinical assessment. It may also be documented in
the mental status examination (MSE), which specifically addresses aspects such as
appearance, behavior, mood, thought processes, and cognition.
Question 5
Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B
vitamin is deficient in patients with pernicious anemia?
Answer: Pernicious anemia is primarily caused by a deficiency of vitamin B12. This
condition occurs due to an inability to absorb vitamin B12 from the gastrointestinal tract,
often linked to a lack of intrinsic factor, a protein essential for B12 absorption. Symptoms of
this deficiency can include fatigue, weakness, and neurological issues. Treatment typically
involves vitamin B12 supplementation, either through injections or high-dose oral
supplements. Regular monitoring is essential to ensure adequate levels are maintained.
Question 6
Which of the following organs is part of the alimentary tract?
Answer: The organs that are part of the alimentary tract include the esophagus, stomach,
small intestine, large intestine, rectum, and anus. These structures make up the digestive
system responsible for processing food and absorbing nutrients.
Question 7
Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal
pain. You have completed the inspection of the abdomen. What is your next step in the
assessment process?
Answer: After completing the inspection of the abdomen, the next step in the assessment
process is to perform palpation. This involves gently pressing on the abdominal area to assess
for tenderness, masses, or organ enlargement. Palpation can help identify specific areas of
pain, any abnormal findings, and provide further insight into the underlying cause of the
epigastric pain. After palpation, you may proceed with percussion and auscultation as well.
Question 8
Mrs. Tuber is a 36-year-old patient who comes into the health center with complaints that her
fingernails are not growing. Which structure is the site of new nail growth?
Answer: The site of new nail growth is the nail matrix. The nail matrix is located under the
base of the nail, beneath the cuticle, and is responsible for producing new cells that harden
and form the nail plate as they grow out. If there are issues with the nail matrix, it can affect
the growth and appearance of the nails.
Question 9
Mr. L. presents to the clinic with severe groin pain and a history of kidney stones. Mr. L.'s
son tells you that, for religious reasons, his father wishes to keep any stone that is passed into
the urine filter that he has been using. What is your most appropriate response?
Answer: Your most appropriate response would be: "I understand that keeping the stone is
important for your father. We can help ensure that any stone that passes can be collected and
preserved properly." This response acknowledges his wishes and offers support in facilitating
them.
Question 10
The most superior part of the stomach is the:
Answer: The most superior part of the stomach is the fundus. The fundus is the rounded,
upper portion of the stomach that lies above the level of the opening of the esophagus. It is
typically filled with gas and can be seen on imaging studies.
Question 11
Before performing an abdominal examination, the examiner should:
Answer: Before performing an abdominal examination, the examiner should ensure the
patient is in a comfortable position, typically supine, and that the abdomen is adequately
exposed while maintaining the patient's modesty. Additionally, the examiner should warm
their hands to enhance comfort and relax the abdominal muscles.
Question 12
You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the
examination room. When collecting history from older children or adolescents, they should
be:
Answer: When collecting history from older children or adolescents, they should be allowed
to speak for themselves and encouraged to express their thoughts and concerns directly,
while also ensuring that privacy is respected. It's also beneficial to have a portion of the
discussion with the patient alone, if appropriate, to foster openness and honesty.
Question 13
Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin
is best conducted:
Answer: The best way to inspect for color variations of the skin is in natural light. This
setting allows for the most accurate assessment of skin tones and any changes, such as
redness, pallor, cyanosis, or jaundice. If natural light is not available, a well-lit examination
room with good artificial lighting can also work, but it's essential to avoid harsh or dim
lighting that could obscure true skin color.
Question 14
The review of systems is a component of the:
Answer: The review of systems (ROS) is a component of the medical history taken during a
patient evaluation. It involves a systematic inquiry into different body systems to identify any
additional symptoms the patient may be experiencing, even if they are not the primary reason
for the visit. The ROS helps to gather comprehensive information that can aid in diagnosis
and management.
Question 15
Expected hair distribution changes in older adults include:
Answer: Expected hair distribution changes in older adults include thinning of scalp hair,
graying or whitening of hair due to decreased melanin production, and reduced body hair,
particularly on the limbs. Additionally, there may be increased facial hair in women and a
receding hairline or balding patterns in men.
Question 16
During percussion, a dull tone is expected to be heard over:
Answer: During percussion, a dull tone is expected to be heard over solid organs, such as the
liver and spleen. It may also be heard over areas of fluid accumulation, such as in cases of
ascites.
Question 17
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.
Answer: Changes in hearing that occur in the elderly include presbycusis, which involves a
decline in high-frequency hearing, and difficulty understanding speech, especially in noisy
environments. Additionally, many older adults may experience tinnitus or a decreased ability
to hear soft sounds.
Question 18
You are using an ophthalmoscope to examine a patient's inner eye. You rotate the lens
selector clockwise, then counterclockwise to compensate for:
Answer: You rotate the lens selector clockwise, then counterclockwise to compensate for the
refractive error of the patient's eyes. This adjustment helps focus the light on the retina for a
clearer view during the examination.
Question 19
Nuchal rigidity is most commonly associated with:
Answer: Nuchal rigidity is most commonly associated with meningitis, an inflammation of
the protective membranes covering the brain and spinal cord. It often presents with
symptoms such as neck stiffness, headache, and sensitivity to light. Nuchal rigidity can also
be seen in other conditions, such as subarachnoid hemorrhage or certain infections, but it is
most frequently linked to meningitis, especially in clinical settings.
Question 20
Tympanic thermometers measure body temperature when a probe is placed:
Answer: Tympanic thermometers measure body temperature when a probe is placed in the
ear canal, specifically in the tympanic membrane area. This method provides a quick and
generally accurate reading of core body temperature by detecting infrared heat emitted from
the eardrum. It's important to ensure proper placement in the ear for the most accurate results.
Question 21
During an interview, you have the impression that a patient may be considering suicide.
Answer: If you have the impression that a patient may be considering suicide, it's crucial to
take the situation seriously and respond appropriately. Here are the steps to follow:
Ensure Safety: Assess the immediate risk. Ask direct questions about suicidal thoughts, plans,
and means.
Another
Question 1
A tool used to screen adolescents for alcoholism is the:
Answer: A commonly used tool to screen adolescents for alcoholism is the CRAFT
screening tool (Car, Relax, Alone, Forget, Friends, Trouble). It is designed to identify
substance use and abuse in adolescents. The CRAFT includes questions about behavior and
experiences related to alcohol and drug use, making it a valuable resource for healthcare
providers in assessing potential substance use issues in this population.
Question 2
You are examining a pregnant patient and have noted a vascular lesion. When you blanche
over the vascular lesion, the site blanches and refills evenly from the center outward. The
nurse documents this lesion as a:
Answer: The lesion you are describing is consistent with a vascular birthmark known as a
hemangioma. Specifically, the characteristic blanching and refilling from the center outward
suggests it could be a capillary hemangioma. These lesions are composed of blood vessels
and are common in pregnancy, often referred to as "strawberry marks." They typically appear
bright red and may change over time but usually have a benign course.
Question 3
Which question would be considered a leading question?
Answer: A leading question is one that suggests a particular answer or contains information
that prompts the respondent toward a specific response. An example of a leading question
would be:
"Don't you think that taking medication will help improve your condition?"
This question implies that taking medication is the right choice and nudges the person to
agree, rather than allowing them to express their own thoughts or feelings freely. In contrast,
a neutral question would be, "What are your thoughts about taking medication for your
condition?"
Question 4
Your patient presents with symptoms that lead you to suspect acute appendicitis. Which
assessment finding is least likely to be associated with this condition early in its course?
Answer: The assessment finding least likely to be associated with acute appendicitis early in
its course is rebound tenderness. While rebound tenderness can develop as the condition
progresses, early signs typically include vague abdominal pain, particularly in the
periumbilical region, nausea, and loss of appetite, rather than specific rebound tenderness.
Question 5
Before performing an abdominal examination, the examiner should:
Answer: Before performing an abdominal examination, the examiner should ensure the
patient is comfortably positioned, usually supine, and that the abdomen is adequately
exposed while maintaining the patient's modesty. Additionally, the examiner should warm
their hands to promote relaxation of the abdominal muscles.
Question 6
Which of the following formats would be used for visits that address problems not yet
identified in the problem-oriented medical record (POMR)?
Answer: The format used for visits that address problems not yet identified in the problemoriented medical record (POMR) is the "SOAP" format, which stands for Subjective,
Objective, Assessment, and Plan. This format allows for a comprehensive approach to
document new concerns while organizing the information effectively.
Question 7
Which statement is true regarding the relationship of physical characteristics and culture?
Answer: A true statement regarding the relationship of physical characteristics and culture is
that physical characteristics, such as skin color, hair type, and facial features, can be
influenced by genetic factors and may vary widely among different ethnic groups. However,
these traits do not solely define cultural identity, as culture encompasses a broader range of
factors, including beliefs, practices, and social norms..
Question 8
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:
Answer: Based on the patient's symptoms of acute, intense sharp epigastric pain that radiates
to the back and left scapula, along with nausea and vomiting, your prioritized physical
examination should focus on the abdominal examination, specifically looking for signs of
pancreatitis or gallbladder-related issues. Key steps include:
Question 9
Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her
current weight. In your patient teaching with her, you explain the importance of
macronutrients. Which of the following is a macronutrient?
Answer: A macronutrient is one of the nutrients required in large amounts in the diet to
provide energy and support bodily functions. The primary macronutrients are:
1. Carbohydrates
2. Proteins
3. Fats
Among these, if you have specific options to choose from, I can help identify which one is a
macronutrient!
Question 10
Tangential lighting is best used for inspecting skin:
Answer: Tangential lighting is best used for inspecting skin lesions or abnormalities. This
technique involves shining light at an angle to the skin surface, which enhances the visibility
of contours, texture, and any subtle changes in color. It is particularly useful for identifying
conditions such as moles, rashes, or any other skin irregularities that might not be easily seen
under direct lighting.
Question 11
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:
Answer: The best tactic in this situation would be to communicate openly with Mr. Abdul
about the examination. Here’s how you can approach it:
Explain the Procedure: Clearly explain the reason for the rectal examination and its
importance in diagnosing his condition.
Question 12
When are open-ended questions generally most useful?
Answer: Open-ended questions are generally most useful in initial patient interviews and
assessments, as they encourage the patient to share their thoughts and experiences in detail.
They are also effective for exploring complex issues, allowing for a deeper understanding of
the patient's concerns and perspectives.
Question 13
Pigmented, raised, warty lesions over the face and trunk should be assessed by an
experienced practitioner who can distinguish:
Answer: Pigmented, raised, warty lesions over the face and trunk should be assessed by an
experienced practitioner who can distinguish between benign growths, such as seborrheic
keratosis, and potentially malignant lesions, such as melanoma or basal cell carcinoma.
Question 14
Regardless of the origin, discharge is described by noting:
Answer: Regardless of the origin, discharge is described by noting its color, consistency,
odor, and amount. These characteristics help in identifying the nature and potential cause of
the discharge.
Question 15
When assessing abdominal pain in a college-age woman, one must include:
Answer: When assessing abdominal pain in a college-age woman, include her menstrual
history and sexual history, as these can help identify potential gynecological issues.
Additionally, assess the characteristics of the pain and any associated gastrointestinal
symptoms.
Question 16
A detailed description of the symptoms related to the chief complaint is presented in the:
Answer: A detailed description of the symptoms related to the chief complaint is presented in
the history of present illness (HPI) section of the medical record. The HPI includes specific
information about the onset, duration, intensity, location, quality, and any associated factors
of the symptoms, as well as how they have progressed over time. This section is crucial for
understanding the context and significance of the chief complaint and helps guide further
evaluation and management.
Question 17
Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On
examination, you have noted a bruit heard over the thyroid. This is suggestive of:
Answer: A bruit heard over the thyroid gland is suggestive of increased vascularity, which
can occur in conditions such as hyperthyroidism, particularly in Graves' disease. The
increased blood flow to the thyroid can lead to this audible sound. It may also indicate other
thyroid conditions, such as a toxic adenoma or thyroiditis. Further evaluation, including
thyroid function tests and imaging, may be warranted to assess the underlying cause.
Question 18
Expected hair distribution changes in older adults include:
Answer: Expected hair distribution changes in older adults include thinning of scalp hair,
graying or whitening of hair, and decreased body hair on the limbs. Additionally, women may
experience increased facial hair, while men may have a receding hairline or balding patterns.
Question 19
To perform the Rinne test, place the tuning fork on the:
Answer: To perform the Rinne test, place the tuning fork on the mastoid process behind the
ear (this assesses bone conduction) and then, after the patient can no longer hear the sound,
move the tuning fork to just in front of the ear canal (this assesses air conduction). The Rinne
test compares air conduction to bone conduction to help determine the presence of hearing
loss. Normal results show that air conduction is better than bone conduction (AC > BC).
Question 20
Bulging of an amber tympanic membrane without mobility is most often associated with:
Answer: Bulging of an amber tympanic membrane without mobility is most often associated
with middle ear effusion, commonly seen in conditions such as otitis media with effusion
(OME). This condition occurs when fluid accumulates in the middle ear space, often without
infection, and can lead to hearing loss. The amber color indicates the presence of fluid behind
the tympanic membrane, which can cause it to bulge.
Another
Question 1
Which technique is commonly used to elicit tenderness arising from the liver, gallbladder, or
kidneys?
Answer: The fist percussion is a direct percussion technique used to elicit tenderness over
organs such as the liver, gallbladder, or kidneys.
Question 2
A rubber or plastic ring should be around the bell end-piece of a stethoscope to:
Answer: The ring around the bell portion of the stethoscope functions to secure contact with
body surfaces when placed lightly on the skin.
Question 3
In terms of cultural communication differences, Americans are more likely to _____ than are
other groups of patients.
Answer: In the United States, individuals are very direct in conversation and come to the
point quickly. They also tend to talk more loudly and to worry less about being overheard.
Question 4
For a woman with a small vaginal opening, the examiner should use a _____ speculum.
Answer: The Pederson speculum has blades that are as long as those of the Graves speculum
but are both narrower and flatter and therefore more comfortable for women with small
vaginal openings. Pediatric or nasal speculums would be too small for adult use. Plastic
speculums are similar in uses to the metal counterparts.
Question 5
During percussion, the downward snap of the striking fingers should originate from the:
Answer: The dominant hand s middle finger strikes the stationary finger with a wrist motion
and is lifted quickly off the striking surface.
Question 6
You are auscultating a patient s chest. The sounds are not clear, and you are having difficulty
distinguishing between respirations and heartbeats. What technique can you use to facilitate
your assessment?
Answer: 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, then only expiratory breath sounds.
Question 7
Expected normal percussion tones include:
Answer: A normal lung produces resonance percussion tones while an empty stomach is
expected to produce tympany. Dull percussion tones are heard over the liver.
Question 8
During auscultation, you can limit your perceptual field best by:
Answer: By closing your eyes, your sense of hearing becomes more acute and it increases
your ability to isolate sounds.
Question 9
Standard Precautions apply to all patients:
Answer: Although all of the statements are true, the best answer is 4.
Another
Question 1
Fluorescing lesions are best distinguished using a(n):
Answer: Fluorescing lesions are best distinguished using a Wood's lamp (or ultraviolet light).
This specialized light can help identify certain skin conditions by causing specific lesions to
fluoresce, allowing for better visualization and differentiation from surrounding tissues. It's
commonly used in dermatology to assess conditions like fungal infections, certain types of
pigment disorders, and other skin abnormalities.
Question 2
Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit
drugs. This information would most likely belong in the:
Answer: This information would most likely belong in the social history section of the
patient's medical record. The social history typically includes details about the patient's
lifestyle, including substance use such as alcohol and illicit drugs, as well as other relevant
factors like occupation, living situation, and social support. This information is important for
understanding potential contributing factors to the patient's headache and overall health.
Question 3
You are using an ophthalmoscope to examine a patient's inner eye. You rotate the lens
selector clockwise, then counterclockwise to compensate for:
Answer: You rotate the lens selector clockwise, then counterclockwise to compensate for the
refractive error of the patient's eyes. This adjustment ensures that the light is properly
focused on the retina for a clearer examination.
Question 4
Expected hair distribution changes in older adults include:
Answer: Expected hair distribution changes in older adults include thinning of scalp hair,
graying or whitening of hair due to decreased melanin production, and reduction of body
hair, particularly on the limbs. Additionally, some individuals may experience increased
facial hair in women and a receding hairline or balding patterns in men.
Question 5
Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On
examination, you have noted a bruit heard over the thyroid. This is suggestive of:
Answer: A bruit heard over the thyroid gland is suggestive of increased vascularity,
commonly associated with hyperthyroidism, particularly conditions such as Graves' disease.
This increased blood flow can create the audible sound of a bruit. It may also indicate other
thyroid issues, such as a toxic adenoma or thyroiditis. Further evaluation, including thyroid
function tests and possibly imaging, would be warranted to assess the underlying cause.
Question 6
George Michaels, a 22-year-old patient, tells the nurse that he is here today to "check his
allergies." He has been having "green nasal discharge" for the last 72 hours. How would the
nurse document his reason for seeking care?
Answer: The nurse would document George Michaels' reason for seeking care as: "Patient
presents with green nasal discharge for the past 72 hours, stating he is here to check for
allergies."
Question 7
Under normal circumstances, how much water is lost daily by the body?
Answer: Under normal circumstances, the body loses approximately 2 to 3 liters of water
daily through processes such as urination, sweating, respiration, and feces. This amount can
vary based on factors like activity level, climate, and overall health.
Question 8
Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing
correctly into adolescence. Which structures disproportionately enlarge in the male during
adolescence?
Answer: During adolescence, the structures that disproportionately enlarge in males include
the testes, penis, and muscle mass. Additionally, there is often an increase in shoulder width
and changes in body hair distribution.
Question 9
When assessing abdominal pain in a college-age woman, one must include:
Answer: When assessing abdominal pain in a college-age woman, one must include her
menstrual history, including the regularity and nature of her menstrual cycles, as well as any
history of sexual activity and potential pregnancy. This helps identify possible gynecological
issues that may be contributing to the pain.
Question 10
During an interview, you have the impression that a patient may be considering suicide.
Which action is essential?
Answer: If you have the impression that a patient may be considering suicide, it is essential
to directly ask the patient about their thoughts of self-harm or suicide. This open and nonjudgmental inquiry can provide them with an opportunity to express their feelings and allows
you to assess the risk and determine the appropriate interventions.
Question 11
Nuchal rigidity is most commonly associated with:
Answer: Nuchal rigidity is most commonly associated with meningitis, an inflammation of
the protective membranes covering the brain and spinal cord. It is characterized by neck
stiffness and is often accompanied by other symptoms such as headache, fever, and
sensitivity to light. Nuchal rigidity can also be observed in other conditions, such as
subarachnoid haemorrhage, but it is most frequently linked to meningitis, particularly
bacterial meningitis.
Question 12
Placing the base of a vibrating tuning fork on the midline vertex of the patient's head is a test
for:
Answer: Placing the base of a vibrating tuning fork on the midline vertex of the patient's
head is a test for bone conduction and is known as the Weber test. This test helps assess
hearing and can indicate whether there is a unilateral conductive or sensorineural hearing
loss. In the Weber test, the patient is asked where they hear the sound best—either in one ear
or equally in both ears. If the sound lateralizes to one side, it can suggest either a conductive
loss in that ear or a sensorineural loss in the opposite ear.
Question 13
In counseling a client regarding nutrition education, you explain that linoleic acid, a major
fatty acid, is thought to be essential for:
Answer: In counseling a client regarding nutrition education, you can explain that linoleic
acid, a major fatty acid, is thought to be essential for maintaining cell membrane integrity
and function, as well as playing a crucial role in the synthesis of eicosanoids, which are
signaling molecules involved in inflammatory responses and other physiological processes.
Linoleic acid is an omega-6 fatty acid, and since the body cannot synthesize it, it must be
obtained from the diet through sources such as vegetable oils, nuts, and seeds.
Question 14
Periods of silence during the interview can serve important purposes, such as:
Answer: Periods of silence during the interview can serve important purposes, such as
allowing the patient time to think and process their thoughts, and encouraging them to share
more information or feelings they may initially withhold. Silence can also help to create a
reflective atmosphere that fosters deeper communication.
Question 15
A 51-year-old woman calls with complaints of weight loss and constipation. She reports
enlarged hemorrhoids and rectal bleeding. You advise her to:
Answer: You advise her to schedule an appointment for a thorough evaluation to assess her
symptoms, particularly given the combination of weight loss, constipation, rectal bleeding,
and enlarged hemorrhoids. It's important to rule out any serious underlying conditions, such
as gastrointestinal issues or malignancies. Additionally, encourage her to increase her fluid
and fiber intake to help manage constipation.
Question 16
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?
Answer: You would tell Mrs. Kinder that the Eustachian tube is responsible for equalizing
atmospheric pressure in the ear. This tube connects the middle ear to the nasopharynx and
helps maintain balance between the pressure inside the middle ear and the external
environment, especially when swallowing, sneezing, or yawning. Proper function of the
Eustachian tube is important for ear health and comfort.
Question 17
Which of the following is the most accurate reflection of an individual's food intake?
Answer: The most accurate reflection of an individual's food intake is typically obtained
through a 24-hour dietary recall or a food diary where the individual records everything they
eat and drink over a specified period. This method allows for a detailed assessment of dietary
habits and nutrient intake.
Question 18
You are examining a pregnant patient and have noted a vascular lesion. When you blanche
over the vascular lesion, the site blanches and refills evenly from the center outward. The
nurse documents this lesion as a:
Answer: The nurse would document this lesion as a telangiectasia or vascular birthmark,
specifically describing it as a "strawberry hemangioma" or a "capillary malformation." The
characteristic of blanching and refilling evenly from the center outward indicates that it is
likely a type of vascular lesion that is common in pregnant patients, often resulting from
hormonal changes. These lesions are generally benign but should be monitored for any
changes.
NURS 6512
Midterm Exam Review (Weeks 1-6)
Building A Complete Health History
1. Communication techniques used to obtain a patient’s health history
o Courtesy
Knock before entering a room
Address (first time) the patient formerly, such as Miss, Ms., Mrs. Mr. –
can shake their hand(s)
Meet and acknowledge others in the room. Establish their role and degree
of participation
Learn their names
Ensure confidentiality
Give them your undivided attention – take some time – don’t rush out
Take minimal notes – use keywords. Observe and listen
Respect the need for modesty
Allow the patient time to change back into street clothes before resuming
conversation
o Comfort
Ensure everyone is comfortable (including yourself)
Maintain close, but comfortable proximity with patient
Maintain privacy. Pull curtains and shades as applicable
Ensure comfortable room temperature. Provide blanket if needed
Ensure good lighting
Ensure quiet surrounding
Pace interview. If necessary, prioritize and complete at another visit
o Connection
Look at patient, maintain good eye contact (if culture allows)
Watch your language (don’t use technical jargon & don’t patronize)
Don’t dominate the discussion (listen closely & allow patient to prioritize
issues)
Keep an open mind – don’t accept previous diagnosis as a chief complaint
Inquire if patient turned away from another provider to come to you
Take history and complete physical exam before looking at previous tests
Consider first what the patient has to say
Avoid leading or direct questions in the beginning
Use open-ended questions.
Let the specifics evolve
Avoid being judgmental
Respect silence – pauses can be productive
Be flexible
Assess the patient’s potential as a partner in their care
Seek clues to problems from patient’s verbal behavior and body language
(talking too fast or too little)
Look for hidden concerns underlying chief concern
Never trivialize any finding or clue
Problems can have multiple causes – do not leap to one cause too quickly
Define any concern completely: LOCATES, OLDCARTS
o Confirmation
Ask patient to summarize the discussion (should be a clear understanding)
Allow the possibility of more discussion with another open-ended
question (“Anything else you would like to bring up?”)
If there is a question that you cannot immediately answer – say so &
follow up later if possible
If you have made a mistake, make every effort to repair it.
Candor is important for the development of a trusting partnership.
Most patients respect it.
2. Recording and documenting patient information
o Illustrations – sometimes can be a better description
o POMR – problem oriented medical record
Comprehensive health history
Chronological order
HPI - OLDCARTS
Complete physical examination
Problem list
Assessment/plan
Baseline & problem directed labs/radiology
Progress notes
3. SOAP note documentation
o Subjective data
Told to you by patient
o Objective data
What you see
o Assessment
Interpretations/conclusion – rational
Diagnostic strategy
Present and anticipated problems
Ongoing and future care
o Plan
What you intend to do
Specific for each problem
Includes: diagnostics/therapeutics/patient education
4. Subjective vs objective information when documenting
o Subjective – information from the individual’s point of view (symptoms); may
include feelings, perceptions, and concerns
o Objective – observable and measurable information obtained through observation,
physical examination, and laboratory and diagnostic testing
5. Ethical decision making and beneficence
o Beneficence – promoting/doing good
Diversity and Health Assessments
6. Cultural awareness and diversity
o Culture – reflects the whole of human behavior, including ideas and attitudes;
ways of relating to one another; manners of speaking; and the material products of
physical effort, ingenuity, and imagination
o Physical characteristics – gender, race, phenotypic traits
o Minimize stereotyping and prejudice to achieve cultural competence
o Cultural competence – Knowledge of cultural encounters, desire, awareness,
knowledge, and skill
o For ethnic minorities, assess social context through inquiry of stressors, support
networks, sense of life control, and literacy
o Be sensitive to a patient’s heritage, sexual orientation, socioeconomic status,
ethnicity, and cultural background
7. Socioeconomic, spiritual, and lifestyle factors affecting diverse populations
o Disease is shaped by illness and illness is shaped by the totality of the patient’s
experience
o Definition of ill or sick is based on the patient’s belief system and is determined
by their enculturation
8. Functional assessments
o Beliefs and behaviors that will have an impact on patient assessment include:
Mode of communication – speech, body language, space
In the US, people talk more loudly while the English worry about
being overheard and are more modulated
In US – people are direct in conversation and prefer to avoid the
subject and to come to the point quickly while the Japanese do the
opposite, using indirection and talking around points, and
emphasizing attitudes and feelings
Silence allows those who are Native American to think and a
response should not be forced; allow for quiet time
Firm eye contact is evident in the Spanish and French while Asian
and Middle Eastern cultures believe it is a sign of disrespect.
Health beliefs and practices that may vary from your own
Naturalistic or holistic approach believes that external factors must
be kept in balance to remain well
Balance of hot and cold is a belief of Asians, Middle Eastern,
Hispanics, and Native Americans
Treat condition with the opposite to restore balance
Diet and nutritional practices
Orthodox Jewish will not take some medicines, particularly during
holiday period like Passover
Muslims must respect Halal
Chinese patient with HTN and salt-restricted diet may need to limit
MSG and soy sauce
Dietary supplements containing ephedra alkaloids mat increase
risk of stroke, whereas other herbal preparations interact with
prescribed medicines
The nature of relationships within a family
Be aware of the sequence of related behaviors because it may be
unrelated to the integrity of the family structure, gender, or
background
Parenting style of child-rearing practices like setting boundaries
and expectations may be culturally driven
Assessment Tools and Diagnostic Tests in Adults and Children
9. Growth, Development, and Measurements in children and adults
General
o Growth Hormone: stimulates the pituitary to release the growth hormone.
o Somatostatin inhibits the secretions of the growth hormone and thyroid
stimulating hormone.
o Growth hormone promotes growth, increase in organ size, regulates car, protein
and lipid metabolism.
o Thyroid hormone stimulates growth hormone secretion and production of insulin
like growth factor-plays an important role in bone formation and resorption.
o 70% of growth occurs during sleep.
o At 34 weeks gestation, 65% of the weight of the newborns brain is present.
o By 3 years old, most brain growth is complete.
o Lymphatic tissues: reach adult size at age 6, double at 10-12 years of age, then
decrease back to adult size during adolescence.
Infants and Children
o Legs are the fastest growing body part during childhood.
o Fat tissue increases slowly until 7 years old, then pre-pubertal fat spurt occurs
before the true growth spurt.
o In adolescence, 50% of the individual weight is gain, and skeletal mass and organ
sytm double in size.
o Sexual Maturation in girls: early 7, late 12
o Sexual Maturation in boys: early 9, late 14
Older adults
o Physical stature declines beginning at age 50.
o Age 60 and over will have a decrease in weight for height and BMI, and
approximately 5% body weight loss over several years.
o Older adults will see an increase in body fat, and skeletal muscle loss due to
decrease in exercise.
o May see a decrease in size and weight of organs such as liver, kidney, lung.
o In the last 15 years, there has been an increase in obese older adults.
Pregnant Adults
o Fetus accounts for 6-8 pounds of total weight gained, the other is due to an
increase in maternal tissues.
Fluid volume: 2-3 pounds
Blood volume: 3-4 pounds
Breast enlargement: 1-2 pounds
Uterine enlargement: 2 pounds
Amniotic fluid: 2 pounds
Maternal fat and protein stores: 4-6 pounds
o Weight gain slow during first trimester, rapid during second and third, fetal
growth accounts for most weight gained during third trimester
o Inadequate weight gain=increased risk for low birth weight infant
BMI
o Most common method used to assess nutritional status and total body fat.
Undernutrition: less than 18.5
Appropriate: 18.5-24.9
Overweight: 25-29.9
Obese: 30-39.9
Extreme obesity: 40 and higher
Infant Measurements
o Health baby length: 18-22 inches
o Weigh the baby to the nearest 10 g
o Average variations in birth weight (5lbs 8oz to 8lbs 13oz) =2500-4000g
o Infants double their birth weight by 4-5months and triple by 12 months
o Head circumference: measure nearest 0.5cm or ¼ inch; wrap tape around occipital
protuberance and the supraorbital prominence
o Normal newborn head circumference: 32.5-37.5 cm
o Chest circumference: used when problem is suspected; measure midway between
inspiration and expiration to the nearest 0.5cm or ¼ inch; wrap at nipple line; at
5mths-2 years the chest and head are close to same size, and after 2 years, the
chest exceeds the head circumference.
10. Nutritional assessment to include recommended water intake and energy requirements
o Assess the patient’s nutritional status including:
Recent growth, weight loss, weight gain
Chronic illnesses
Medication and supplement
Nutrition screen
Assessment of nutrition intake
o Water: most vital nutrient, body is approximately 55-65% water
Functions as: providing turgor, altering dissolved substances, transporting
dissolved nutrients and waste, maintaining stable temperature.
Approximately 2-2.5 liters are lost daily.
o Energy requirements: includes used at rest, energy used in physical activity, and
energy used as a result of thermogenesis. Affecting these are: age, gender, body
size, composition, genetics and physiologic state, disease and temperature.
11. Macronutrients vs Micronutrients
Macronutrients
o Includes: carbohydrates, protein and fat
Carbohydrate: main source of energy (4 calories/ gram)
Serve major functions in vital organs: liver, heart, central nervous
system
Recommended daily intake: 45-65% of total calories (130g =
adults)
Protein major functions: build and maintain tissue, regulate water and acid
base balance, precursor for enzymes, antibodies and hormones (4
calories/gram)
Recommended protein intake of diet 10-35% of total calories (46g
women, 56 g men)
Fat: memory storage, energy metabolism, absorption of fat-soluble
vitamins. (9 calories/gram)
Recommended fat intake of diet 20-35% of total calories
Micronutrients
o Vitamins, minerals, electrolytes
12. Significance of a food diary
o Provides a retrospective view of an individual’s eating habits and dietary intake,
recorded as it happened
o Collects relevant data that may aid in identifying problem areas
13. BMI measurements for normal, overweight, obesity, morbid obesity
o Normal – 18.5 to 24.9
o Overweight – 25 to 29.9
o Obesity – 30 to 39.9
o Morbid obesity – 40 and higher
14. Pernicious Anemia
o B12 deficiency is usually the result of impaired B12 uptake caused by lack of
intrinsic factor that is caused by a loss of parietal cells in the stomach lining.
o The loss of these cells can be caused by partial or full gastrectomy, Crohn’s
disease, autoimmune disorders such as DMI and immunocompromised disease
such as HIV.
o A smooth red tongue with a slick appearance may indicate NIACIN or Vitamin
B12 deficiency.
15. Examination techniques and equipment
o Inspection – used throughout physical exam and interview process
o Palpation – gathering information through touch
o Auscultation – carried out last except when examining kidney or abdomen. Used
to listen to sounds produced by the body
o Fist – use for indirect finger percussion by striking the middle finger of the
nondominant hand
o Deep abdominal palpation of the kidney used to assess tenderness over the
kidney.
o Ulnar surface of the hand used to palpate mass in the skin
o Dorsal surface of the hand – sensitive to vibration
o Percussion Tone expected
Stomach – tympanic
Sternum – flat
Liver – dull
Lung of a patient with pneumonia – dull
Abdomen with lung tumor – Dull
16. Diagnostic Assessment tools and tests to include tuning forks, BP monitoring, use of
stethoscope, otoscope, ophthalmoscope
o Weight scales and height measurement devices – always observe what patient is
wearing and calibrate the scale each time to ensure accuracy
o Thermometer – tympanic thermometers are best in children ages 2 months to 16
years; infrared axillary thermometers for neonates
o Stethoscope – for auscultation; three basic types are acoustic (most common),
magnetic, and electronic
o Sphygmomanometer – manual BP requires stethoscope and sphygmomanometer;
electronic sphygmomanometer also available (no stethoscope required) and works
by sensing vibrations and converting them into electric impulses
o Pulse oximeter – measures the percentage of hemoglobin saturated with oxygen
(oxyhemoglobin); adult/pediatric sites are finger, toes, pinna (top) or lobe of the
ear; infant sites are the foot, palm of the hand, big toe, or thumb
o Doppler – should be used when there is difficulty auscultating with regular
stethoscope; they are ultrasonic stethoscopes that detect blood flow; used to detect
systolic BPs, auscultate fetal heart activity, locate vessels, take weak pulses,
assess vessel patency, localize acute and chronic arterial occlusions, assess DVTs
and valvular incompetency, and assess testicular torsion and varicocele
o Portable ultrasound – ultrasound waves pass through fluids and soft tissue; helpful
in assessing fluid-filled organs (bladder) and soft organs (gallbladder and liver);
shows the structure and movement of organs, blood flow through vessels, and
abnormalities (cysts, tumors, and infections); aids in clinical procedures (pleural
effusions, abscesses, and biopsies)
o Fetal monitoring equipment – fetal heart rate determined by using fetoscope and
Leff scope, a stethoscope, or an electronic instrument that uses doppler
o Ophthalmoscope – enables visualization of the interior structures of the eye;
numbers on the instrument correspond to the magnification power
o PanOptic Ophthalmoscope – uses and optical design that allows a large field of
view
o StrabismoScope – used for detecting strabismus (eye misalignment) and can be
used as part of eye testing in children
o Photoscreening – used to detect amblyopia (lazy eye) and strabismus in children
through the use of camera or video to obtain images of pupillary reflexes and red
reflexes
o Visual acuity charts – Snellen Alphabet (screening exam of far vision for literate,
verbal, and English-speaking adults and school-aged children), Tumbling E
(nonalphabet version of Snellen chart; has the letter “E” facing in different
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
directions), HOTV (wall chart composed only of H’s, O’s, T’s, and V’s; child
must match the letter on the wall chart to the testing board), LEA Symbols
(consists of four optotypes – circle, square, apple, house – that blur equally and
child must match), and lastly Broken Wheel Cards (picture cards where child
must identify the cards with broken wheels on the car)
Near vision charts – can use a designed chart (Rosenbaum or Jaeger) or simply
newsprint
Amsler grid – used to test those at risk for macular degeneration
Otoscope – provides illumination for examining the external auditory canal and
tympanic membrane; can also be used for nasal examination
Tympanometer – simple and reliable way of assessing the functions of the
ossiscular chain, eustachian tube, and tympanic membrane
Nasal speculum – used with a penlight to visualize the lower and middle
turbinates of the nose
Tuning fork – used in screening tests for auditory function and for vibratory
sensation as part of the neuro exam
Percussion (reflex hammer) – used to test deep tendon reflexes
Neurologic hammer – variant of the reflex hammer; also used for testing deep
tendon reflexes
Tape measure – used for determining circumference, length, and diameter
Transilluminator – consists of a strong light source with a narrow beam; beam is
directed to a body cavity to determine media present in the cavity (fluid in the
sinuses or blood in the scrotum)
Vaginal speculum – two blades and a handle; three types (Graves, Pederson, and
Pediatric/Virginal)
Goniometer – used to determine the degree of joint flexion and extensions
Wood’s Lamp – contains a light source that aids in determining the presence of
fungi on skin lesions
Dermatoscope – a skin surface microscope that uses epiluminescence microscopy
(ELM) to illuminate and magnify a skin lesion to allow for a more detailed
inspection
Calipers for Skinfold Thickness – measure the thickness of subcutaneous tissue at
certain points of the body
Monofilament – designed to test for loss of protective sensation, particularly on
the plantar surface of the foot
Scoliometer – measures the degree of rotation of the spine to screen for scoliosis
Assessment of the Skin, Hair, and Nails
17. Skin lesion characteristics
o Skin lesion – general term that collectively describes any pathologic skin change
or occurrence
May be primary or secondary
o Lesions should be described according to characteristics, exudates, configuration,
and location and distribution
Macule – flat, circumscribed area that is a change in the color of the skin;
1 cm in
diameter (psoriasis, actinic keratoses)
Wheat – elevated, irregular-shaped area of cutaneous edema; solid,
transient, variable diameter (insect bites, urticaria, allergic reaction)
Nodule – elevated, firm, circumscribed lesion; deeper in dermis than a
papule; 1-2 cm in diameter (erythema nodosum, lipoma)
Tumor – elevated and solid lesion; may or may not be clearly demarcated;
deeper in dermis; >2 cm in diameter (neoplasms, benign tumor, lipoma)
Vesicle – elevated, circumscribed, superficial, not into dermis; filled with
serous fluid; 1 cm in diameter (blister)
Pustule – elevated, superficial lesion; similar to a vesicle but filled with
purulent fluid (impetigo, acne)
Cyst – elevated, circumscribed, encapsulated lesion; in dermis or
subcutaneous layer; filled with liquid or semisolid material (sebaceous
cyst, cystic acne)
Telangiectasia – fine, irregular, red line produced by capillary dilation
(rosacea)
Scale – heaped-up, keratinized cells; flaky skin; irregular; thick or thin;
dry or oily; variation in size (flaking of skin from dermatitis or drug
reaction; dry skin)
Lichenification – rough, thicken epidermis secondary to persistent
rubbing, itching, or skin irritation; often involves flexor surfaces of
extremity (chronic dermatitis)
Keloid – irregularly shaped, elevated, progressively enlarging scar; grows
beyond the boundaries of the wound; caused by excessive collagen
formation during healing (keloid formation following surgery)
Scar – thin to thick fibrous tissue that replaces normal skin following
injury or laceration to the dermis (heated wound or surgical incision)
Excoriation – loss of the epidermis; linear hollowed-out, crusted area
(abrasion or scratch, scabies)
Fissure – linear crack or break from the epidermis to the dermis; may be
moist or dry (athlete’s foot, cracks at the corner of mouth)
Erosion – loss of part of the epidermis; depressed, moist, glistening;
follows rupture of a vesicle or bulla (varicella, variola after rupture)
Ulcer – loss of epidermis and dermis; concave; varies in size (decubiti,
stasis ulcers)
Crust – dried serum, blood, or purulent exudates; slightly elevated; size
varies; brown, red, black, tan, or straw-colored (scab on abrasion, eczema)
Atrophy – thinning of skin surface and los of skin markings; skin
translucent and paper-like (striae, aged skin)
18. Documenting skin lesions using “ABCD” rule
o To document changes in moles
o A – asymmetry
o B – border
o C – color
o D – diameter
19. Anatomy and physiology of skin layers
o Epidermis
Outermost portion of skin
Two layers:
Stratum corneum – protects body against harmful environmental
substances & restricts water loss
o Closely packed, dead squamous cells that contain keratin –
form the protective barriers
Cellular stratum – where keratin cells are synthesized
o Stratum germinativum (deepest layer of cellular stratum) –
where keratin cells are formed; also contains melanocytes
o Stratum lucidum – present only in thicker skin (palms &
soles)
Avascular and depends on dermis for nutrition
o Dermis
Richly vascular connective tissue layer of skin that supports and separates
the epidermis from the cutaneous adipose tissue
Elastin, collagen, reticulum fibers, sensory nerve fibers, and autonomic
motor nerves
o Hypodermis
Subcutaneous layer that consists of loose connective tissue filled with fatty
cells
Generates heat & provides insulation, shock absorption, & a reserve of
calories
o Appendages
Epidermis invaginates into the dermis at various points to form
appendages:
Eccrine sweat glands, apocrine sweat glands, sebaceous glands,
hair, and nails
20. Abnormal nail findings in older adults
o Nail growth slows because of decreased peripheral circulation. The nails,
particularly the toenails, become thicker, brittle, hard and yellowish. They develop
longitudinal ridges and are prone to splitting into layers.
21. Psoriatic skin lesions
o Multifactorial origin with genetic component and immune regulation.
Characterized by increased epidermal cells turnover, increased number of
epidermal stem cells, and abnormal differentiation of keratin expression leading to
thickened skin with copious scale.
o May have puritis
o Well-circumscribed, dry silvery, scaling papules and plaques
o Lesions commonly occur in the back, buttocks, extensor surfaces of the
extremities, and the scalp.
o Can be associated with psoriatic arthritis in up to 30% of patients.
22. Vesicular skin characteristics
o Elevated, circumscribed, superficial, not into dermis
o Filled with serous fluid, less than 1cm in diameter – chicken pox, shingles
o Vesicle greater than 1cm is called a bullae – blister, pemphigus vulgaris
23. Normal vs abnormal hair distribution during aging
o Normal:
Adolescent – increase in hair oiliness; hair on the extremities darkens and
becomes coarser; pubic and axillary hair in both males and females
develops and assumes adult characteristics; males develop facial and chest
hair that varies in quantity and coarseness
Pregnant women – hair growth is altered during pregnancy due to
circulating hormones; the growing phase of their hair is lengthened, and
hair loss is decreased; 2-4 months after delivery increased hair shedding
occurs; regrowth of hair occurs 6-12 months
Older adults – hair turns gray or white as melanocytes cease functioning;
head, body, pubic, and axillary hair thins and becomes sparse and drier;
men may show an increase in coarse aural, nasal, and eyebrow hair;
women tend to develop coarse facial hair; symmetric balding (usually
frontal or occipital) often occurs in men
o Abnormal:
Bald spots in children and infants – typically ringworm of the scalp (tinea
capitis, alopecia areata, or trichotillomania (compulsive hair-pulling);
infants who sleep on their backs can develop areas of alopecia from
pressure of occiput
Alopecia areata – sudden, rapid, patchy loss of hair (usually from the scalp
or face); unknown cause
Scarring alopecia – replacement of hair follicles with scar tissue; causes
by skin disorders of the scalp or follicles that result in scarring
Traction alopecia – hair loss that is the result of prolonged, tightly pulled
hairstyles; follicle is not damaged, and the loss is reversible
Hirsutism – growth of terminal hair in women in the male distribution
pattern on the face, body, and pubic areas; caused by high androgen levels
or hair follicles that are more sensitive to normal androgen levels
24. Characteristics of hair distribution
o Like much of the hair on the human body, leg, arm, chest, and back hair begin as
vellus hair. As people age, the hair in these regions will often begin to grow
darker and more abundantly. This will typically happen during or after puberty
Men – abundant, coarser hair on the arms and back
Women – less drastic change in hair growth in arms and back but have
significant change in thickness of hairs
o Chest and Abdomen
Vellus hair grows on the chest and abdomen of both sexes at all stages of
development
Puberty to adulthood – males grow increasing amounts of terminal hair
over the chest and abdomen areas
Women can grow terminal hairs around areola
o Arms
Grows on forearms
Terminal arm hair – concentrated on the wrist end of the forearm,
extending over the hand
Males – much more intense than in females (especially with dark
hair)
Vellus arm hair – seen on elbow end of the forearm and ends on the lower
part of the upper arm
Women – looks hairy but it is softer and different compared to
men’s arm hair
o Feet
Visible hair on the top surfaces of feet and toes that begins with the onset
of puberty
More intense in adult and adolescent males than in females
o Legs
Appears at the onset of adulthood, with legs of men more often hairier
than those of women
o Pubic
Collection of coarse hair found in the pubic region, thighs, and abdomen
Thick pubic hair acts as a cushion during intercourse
The gential area of males and females are first inhabited by shorter, lighter
vellus hairs that are next to invisible and only begin to develop into darker,
thicker pubic hair at puberty
o Armpits
Underarm hair starts at the beginning of puberty and ends during the
teenage years
Thin fine hairs
o Facial
Grows around one’s face
Non-vellus facial hair will begin to grow around puberty
Men – facial hair begins to grow around the age of puberty,
although some men may not grow a moustache until they reach
late teens or not at all
Women – develop a few facial hairs under or around the chin,
along the sides of the face (in the area of sideburns), or on the
upper lip.
Assessment of Head, Neck, Eyes, Ears, Nose, and Throat
25. Cranial Nerves associated with the HEENT system
Nerve
Test
Abnormal Findings
Possible Causes
I: Olfactory
Identify familiar
Anosmia
Upper respiratory
odors
infection
(temporary); tobacco
or cocai neuse;
fracture of cribri
form plate or
ethmoid area; front
allobelesion; tumor
in olfatcory bulb or
tract
II: Opt
Visual acuity
Defection or absent
Congenital
central vision
blindness; refractive
error; acquire
division loss from
number diseases
(e.g., stroke,
diabetes); trauma
Visual Fields
Defect in peripheral
Congenital
vision, hemianopsia
blindness; refractive
error; acquire
division loss from
number diseases
(e.g., stroke,
diabetes); trauma
III: Oculomotor
Shine light in eye
Absent light reflex
Direct Inspection
Papilledema optical
Increased
trophy Retin
intracranial pressure;
allusions
glaucoma, diabetes
Dilated pupil ,
Paralysis in CN III
ptosis, eye turns out
from internal
and slightly down
carotid; tumor;
Inspection
Nerve
Test
Abnormal Findings
Possible Causes
inflammatory
lesions; uncal
herniation with
increased
intracranial pressure
Extraocular muscle
Failure to mov e eye
Ptosis from
movement
up, in, down
myasthenia gravis;
oculomotor nerve
palsy; Horner
syndrome
Shine light in eye
Absent light reflex
Blindness; drug
influence; increased
intracranial pressure;
CNS injury;
circulatory arrest;
CNS syphilis
IV: Trochlear
V: Trigeminal
Extraocular muscle
Failure to turn eye
Fracture of orbit;
movement
down or out
brainstem tumor
Superficial touch—
Absent touch and
Trauma; tumor;
three divisions
pain paresthesias
pressure from
aneurysm
inflammation;
sequelae of alcohol
injection for
trigeminal neuralgia
Corneal reflex
No blink
Trauma; tumor;
pressure from
aneurysm
inflammation;
sequelae of alcohol
Nerve
Test
Abnormal Findings
Possible Causes
injection for
trigeminal neuralgia
Clench teeth
Weakness of
Unilateral weakness
masseter or
with CN V lesion;
temporalis muscles
bilateral weakness
with UMN or LMN
disorder
VI: Abducens ocular
Extraocular muscle
ilure to move
Ain stem tumor or
muscle movement to
movement to right
laterally, diplopia on
trauma; fracture of
right and left
and left sides
lateral gaze
orbit
VII: Facial
Wrinkle forehead,
Absent or
Bell palsy(LMN
close eyes tightly
asymmetric facial
lesion) causes
movement
paralysis of entire
half of face
Smile, puff cheeks
Loss of taste
Identify tastes
UMN lesions
(stroke, tumor,
inflammatory) cause
paralysis of lower
half of face, leaving
forehead intact;
other LMN causes of
paralysis: swelling
from ear or
meningeal infections
VIII: Acoustic
Hearing acuity
Decrease or loss of
Inflammation;
hearing
occluded ear canal;
otosclerosis;
presbycusis; drug
toxicity; tumor
Nerve
Test
Abnormal Findings
Possible Causes
IX:
Gag reflex
See CNX
Phonates “ahh”
Uvula deviates to
mor; neck injury;
side
CN X lesion
Gag reflex
No gag reflex
Vocal cord weakness
Note voice quality
Hoarse or brassy Na
Soft palate weakness
salt wang Husky
Unilateral CNX
Glossopharyngeal
X: Vagus
lesion
Note swallowing
Dysphagia, fluids
Bilateral CNX lesion
regurgitate through
nose
XI: Spinal accessory
XI: Spinal accessory
XII: Hypoglossal
Turn head, shrug
Absent movement of Neck injury,
shoulders against
sternomastoid or
resistance
trapezius muscles
Turn head, shrug
Absent movement of Neck injury,
shoulders against
sternomastoid or
resistance
trapezius muscles
Protrude tongue
Deviates to side
LMN lesion
Wiggle tongue from
Slowed rate of
Bilateral UMN
side to side
movement
lesion
torticollis
torticollis
26. Normal assessment findings of an adolescent’s nose and throat (Same as Adult)
o Nasal mucosa should glisten and appear deep pink
o A film of clear discharge is often apparent on the nasal septum
Purulent drainage may indicate: respiratory infection, sinusitis, or foreign
body
o Hairs may be present in the vestibule.
o Turbinates are parallel curbed bony structures covered by vascular mucous
membrane that form the lateral walls of the nose and protrude into the nasal
cavity. They increase the nasal surface area to warm, humidify, and filter the air.
Inferior meatus drains the nasolacrimal duct, the medial meatus drains the
paranasal sinus, and the superior meatus drains the posterior ethmoid
sinus.
They are firm and the same color as the surrounding area.
Turbinates with bluish-gray or pale pink with a swollen, boggy
consistency may indicate allergies
Rounded, elongated masses projecting into the nasal cavity from the
boggy mucosa may be a polyp
o Nasal septum close to midline and fairly straight with the anterior septum thicker
than the posterior septum
Deviation may be indicated by the asymmetric size of the posterior nasal
cavities
o Sense of smell (CN1) tested with different odors.
o Sinuses: Only the maxillary and frontal sinuses are accessible for physical
examination
Frontal sinuses: use thumbs to press up under the bony brown on each side
of the nose. Press up under the zygomatic processes, use either thumbs or
index and middle fingers to palpate the maxillary sinuses: Expect no
tenderness or swelling over the soft tissue: if present there may indicate
infection or obstruction.
Use transillumination if swelling or tenderness present: Glow is expected,
opaque (no transillumination): secretions or never developed, dull
(reduced transillumination).
o Throat:
Tonsils are usually the same pink color of the pharynx and are expected to
fit in within the tonsillar pillars.
May have crypts where cellular debris and food particles collect
Reddened, hypertrophied, and covered with exudate, an infection may be
present.
Pharnyx posterior wall should be smooth, glistening, pink mucosa with
some small, irregular spots of lymphatic tissue and small blood vessels.
A red bulge adjacent to the tonsil and extending beyond the midline may
indicate a peritonsillar abscess.
A yellowish mucoid film in the pharynx is typical of postnasal drip
Gag response: touch the posterior wall of the pharynx- tests
glossopharyngeal and vagus nerve (CN IX and X)
27. Normal examination findings of an infant’s fontanelles
o The seven cranial bones are soft and separated by the sagittal, coronal, and
lambdoid sutures.
o The anterior and posterior fontanels are formed where the four cranial bones meet
and intersect.
o Ossification of the sutures begins after completion of brain growth at about 6
years of age and finished by adulthood.
o Posterior fontanel usually closes by 2 months, and the anterior fontanel closes by
12-15 months.
o Suture lines feel ridgelike until about 6 months of age, after which they are no
longer palpable.
o Anterior fontanel less than 6 months should not exceed 4-5 cm and should get
progressively smaller beyond that age until closing at 12-15 months.
o Palpate anterior fontanel for bulging or depressions: it should feel slightly
depressed, and some pulsation is expected. If the child is tense or crying the
fontanel may protrude above the bone level.
o A bulging fontanel with marked pulsations may indicate increased intracranial
pressure from a space-occupying mass or meningitis
28. Examination findings of a patient with hypothyroid and hyperthyroid
o To assess the thyroid gland:
Neck swelling, pain, difficulty or pain with swallowing, redness
Temperature intolerance, mood and energy changes
Changes in hair texture, skin or nails
Thyroid gland should move with swallowing
o Hypothyroid
Cold intolerance, puffiness and weight gain and swelling, coarse dry pale
skin, fatigue, decreased appetite, hair loss or brittle dry hair, decreased
sweating, hoarseness, goiter, bradycardia and hypotension (decrease SBP,
and increased DBP), myxedema, hyporeflexia, constipation
EVERYTHING IS SLOWED
o Hyperthyroid
Bulging eyes as if staring with eyelid lag, increased sweating, heat
intolerance, skin moist hot and smooth, hand tremors, weight loss with
increased appetite, increased heart rate or A fib, HTN (SBP with wide
pulse pressure, oligomenorrhea, diarrhea
Graves disease
EVERYTHING IS EXCELERATED
29. Techniques for examining the HEENT systems
o Palpate and inspect skull; note hair color, texture, and mount; look for lesions,
bumps, and trauma
o Palpate sinuses (frontal and maxillary) for tenderness
o Note symmetry of head, eyes, nose, and mouth
o Lymph node assessment – palpate and note pain
o Palpate thyroid gland, note size
o Listen to carotid arteries for bruits
o Note any drainage from the eyes or nose
o Note eye color and sclera color
30. Examination findings for a patient with sinus symptoms
o Frontal and maxillary sinus tenderness
o Headache
o Nasal mucosal erythema and edema
o Nasal polyps
o Nasal drainage or congestion (note color and consistency for infection, pus, thick
green or yellow drainage)
o Postnasal drip
o Deviated septum
o Blockage
o Conjunctiva color, redness
o Eye tearing
o Cough
o Fever (infection)
31. Appropriate tuning fork frequencies to approximate vocal frequencies
For vibratory sensation evaluation
o Lower frequency fork for vibratory sensation (should occur between 100 and 400
Hz)
For auditory evaluation
o Weber Test- compares hearing by bone conduction with that by air conduction.
Assesses unilateral hearing loss
Place tuning fork midline of patient’s head (ask if sound is heard
equally in both ears or is better in one)
o Rinne Test- distinguishes whether the patient hears better by air or bone
conduction
Rinne Positive when Air conduction heard longer than bone conduction by
2:1 ratio
Rinne Negative when bone conduction heard longer than air conduction in
affected ear
Place base of vibrating tuning fork against patient’s mastoid and
ask the patient to tell when the sound is no longer heard.
Then, quickly place the still vibrating tines 1-2cm from the
auditory canal and ask the patient to tell when the sound is no
longer heard.
Compare the number of seconds sound is heard by bone
conduction versus air conduction.
32. Examining the oral mucosa
Lips
o Mouth closed, inspect/palpate lip for symmetry, color, edema (angioedema or
infection), surface abnormalities.
Deep fissures of the at corners of mouth (cheilosis) may indicate
riboflavin deficiency or overclosure of mouth
Pallor could indicate anemia; cyanosis could be hypoxia.
Buccal Mucosa, Teeth, Gums
o Ask patient to smile to assess cranial nerve VII and to visualize any occlusions
(overbite, cross-bite, open bite) of teeth.
o Use tongue blade inspect buccal mucosa, gums, teeth (should be pinkish red,
smooth, and moist).
o Gingivae are expected to be coral pink in whites and may be hyperpigmented in
other races. Should not have any inflammation or swelling.
o Palpate gums for lesions, induration, thickening, or masses.
o Inspect and count teeth
Oral Cavity
o Inspect the dorsum of the tongue (note any swelling, color change, variation in
size, coating or ulcerations.
o The tongue should be red/pink, moist, and glistening
o Ask patient to touch tongue tip to palate to inspect the floor of the mouth and the
ventral surface of the tongue
o Palpate tongue for lumps, nodules, or ulceration.
o Tilt patient head back to inspect palate and uvula.
Oropharynx
o Inspect oropharynx using tongue blade observe tonsillar pillars, note size of
tonsils (if present), and the integrity of the retropharyngeal wall
33. Hearing loss findings when examining the elderly patient
o Age-related hearing loss Is associated with degeneration of hair cells in the organ
Corti, loss of cortical and organ of Corti neurons, degeneration of cochlear
conductive membrane, and decreased vascularity in the cochlea.
o Sensorineural hearing loss first occurs with high frequency sounds and interferes
with understanding of speech and localization of sound.
o Conductive hearing loss may result from excess deposition of bone cells along the
ossicle chain.
34. Examination techniques used to examine the trachea and thyroid
Physical exam:
o Inspection of neck
o Palpation of paratracheal area
o Palpation of lateral neck
o Pulse rate
o Looking for: exophthalmos, hoarseness of voice, distant mass
Examination techniques:
o Trachea: hyoid bone, thyroid cartilage (adams apple), cricoid cartilage
Inspect then Palpate trachea with thumb along each side
(sternocleidomastoid muscle on each side)
A tugging sensation, synchronous with the pulse is evidence of tracheal
tug sign (Cardarelli sign or Oliver sign) suggesting an aortic aneurysm
o Thyroid: extend neck, have the patient take a sip of water
*The estimation of thyroid size by lateral inspection is the most sensitive
test for determining the presence of a goiter
FRONT: place thumb over trachea 3 cm beneath thyroid cartilage, to
examine RIGTH lobe use left thumb and press trachea towards patients
left with your left thumb. Place first 3 fingers of your right hand in the
right thyroid bed- leave fingers still while the patient swallows. To
examine LEFT lobe, move your fingers o the reverse positions
BEHIND: 2 fingers on each sides of the trachea- swallow (feeling for
movement of the isthmus) displace trachea to left (with fingers from right
hand) with fingers from left hand palpate left lobe as patient swallows.
Assessment of the Abdomen and Gastrointestinal System
35. Organs involved in the alimentary tract
o The alimentary tract is 27 feet long and runs from the mouth to the anus
including:
Esophagus
Collapsible 10 inches long connecting the pharynx to the stomach
Stomach
Three sections: fundus, body, and pylorus
Secretes hydrochloric acid and digestive enzymes that break down
fats and proteins
Pepsin digests proteins
Gastric lipase emulsifies fat
Little absorption takes place here
Small intestines
21 feet long
Coiled in the abdominal cavity
First 12 inches’ duodenum forms a C shaped curve around the head
of the pancreas
Next 8 feet is the jejunum that gradually becomes larger and
thicker
Last 12 feet are the ileum
Ileocecal valve lies between the ileum and the large intestines to
prevent backflow
Nutrients are absorbed through the mucosa of the small intestines
Large intestines
Begins with the cecum, a blind pouch about 2-3 inches long that
hold ileal contents
Vermiform appendix extends from the cecum
Ascending colon extends from the cecum along the right posterior
abdominal wall- under surface of the liver
Transverse colon crosses the abdominal cavity toward the spleen
and down toward the splenic flexure
Descending colon runs along the left abdominal wall to the rim of
the pelvis turning medially and inferiorly
Sigmoid colon is the S-shaped that connects to the rectum
extending from the sigmoid to the pelvic floor through the anal
canal and terminates at the anus
o The alimentary tract functions to digest food; absorb nutrients, electrolytes, and
water; and excrete waste products
36. Correct assessment order for examining the abdomen
o Patient remains supine. Cover chest with the patient’s gown. Arrange draping to
expose the abdomen from the pubis to the epigastrium.
Inspect skin characteristics, contour, pulsations, and movement
Auscultate all quadrants for bowel sounds
Auscultate the aorta and renal, iliac, and femoral arteries for bruits or
venous hums
Percuss all quadrants for tones
Percuss liver borders and estimate span
Percuss left midaxillary line for splenic dullness
Lightly palpate all quadrants
Deeply palpate all quadrants
Palpate right costal margin for liver borders
Palpate left costal margin for spleen
Palpate laterally at the flanks or right and left kidneys
Palpate midline for aortic pulsation
Test abdominal reflexes
Have your patient raise their head as you inspect the abdominal muscles
37. Examination technique and findings of the liver
o General Info:
Located in the right upper quadrant, below the diaphragm and above the
gallbladder and right kidney
Heaviest organ of the body, weighs 3 lbs.
Made of 4 lobes, which contain lobules. Lobules are made of liver cells
which radiate around a central vein
Branches of the portal vein, hepatic artery, and bile duct penetrate deep
into the periphery of the lobules
The hepatic artery transports blood directly from the aorta to the liver. The
portal vein carries blood from the digestive tract and spleen to the liver.
Metabolizes carbs, fats, and proteins. Concerts glucose into glucagon and
stores for use.
The liver uses cholesterol to form bile salts
The liver also detoxifies
o Examination Technique:
Percuss for liver span by starting at the right midclavicular line over an
area of tympany. Always begin in an area of tympany and move to an area
of dullness. Percuss upward along the midclavicular line to determine
lower border of liver. Dullness is usually heard at the costal margin. Mark
the border with a pen.
A lower liver border that is more than 2-3 cm below the costal margin
may indicate organ enlargement or downward displacement of the
diaphragm due to emphysema or pulmonary disease.
For the upper border: begin percussion to the right of the midclavicular
line at an area of lung resonance around the third intercostal space.
Continue down until the percussion tone changes to dullness. This marks
the upper border, mark it with a pen. It is usually at the 5th intercostal
space, an upper border lower than this may indicate organ displacement or
liver atrophy. Dullness above the 5th intercostal space may indicate
upward displacement of the liver from abd fluid or mass.
Measure the distance between the marks to estimate the vertical span of
the liver, normal span is 6-12 cm. Greater span = liver enlargement; lesser
span = atrophy
Errors in percussion for liver span can be caused by dullness from a
pleural effusion. Gas in the colon can cause tympany and obscure the
dullness of the liver.
If enlargement is suspected additional percussion is needed. Percuss
upward and downward on the right midaxillary line, liver dullness is
detected at the 7th intercostal space.
To assess the descent of the liver, ask the pt. to take a deep breath and hold
it while you percuss upward from the abd at the right midclavicular line.
The area of the lower border should move 2-3 cm down. These maneuvers
assess later palpation of the liver.
Palpating the liver: place your left hand under the pt. at the 11th and 12th
ribs. Pressing upwards to elevate the liver toward the abdominal wall.
Place your right hand on the abd, fingers pointing towards the head and
extended so the tips of the fingers rest on the right midclavicular line
below the level of liver dullness. Have the pt. breathe regularly a few
times then take a deep breath. Feeling for the liver edge as the diaphragm
pushes it downwards towards your fingertips. Normally the liver is not
palpable but can sometimes be felt in thin persons. The liver edge should
feel firm, smooth, even, and nontender. Feel for nodules, tenderness and
irregularity. If the liver is palpable, repeat the assessment medially and
laterally to assess the entire border.
Alternate palpation: hook fingers over the right costal margin below the
margin of dullness and press in and up toward the costal margin, feeling
for the liver edge as they breathe.
Scratch Test: Useful if the abd is distended to assess liver border. Place
the diaphragm of the stethoscope over the liver and with the finger of the
other hand scratch the abd surface lightly, moving towards the liver
border, when you are over liver, the sound intensifies.
Direct percussion can also check for liver tenderness.
o Findings:
Hepatitis: Inflammatory process characterized by diffuse or patchy
hepatocellar necrosis
Patho: caused by viral infection, alcohol, drugs, or toxins
Subjective Data: Can be asymptomatic, other sx include: jaundice,
anorexia, abd pain, clay color stool, tea color urine, and fatigue.
Objective Data: abnormal liver function tests, jaundice and
hepatomegaly.
Cirrhosis: Diffuse hepatic process characterized by fibrosis and alteration
of normal liver architecture into structurally abnormal nodules
Patho: progression of liver disease that can take weeks or years.
S/S due to decreased liver function, decreased detoxification
capabilities, or portal hypertension. Commonly caused by hepatitis
C and alcohol liver disease
Subjective Data: may be asymptomatic, others jaundice, anorexia,
abd pain, clay color stool, tea colored urine, fatigue. Prominent
abdominal vasculature cutaneous spider angiomas, hematemesis,
full abd.
Objective Data: Initially liver is enlarged, as disease progresses
and liver scars, it cannot be palpated. Hepatic encephalopathy.
Portal hypertension and ascites. Muscle wasting and nutritional
deficiencies. Abnormal lab values.
Primary Hepatocellular Carcinoma:
Patho: usually s/t cirrhosis, 20-30 years after liver injury or disease
onset. 25% have no prior risk for cirrhosis. Death s/t tumor
progression with median survival 6 mos. Can metastasize to lungs,
portal vein, bone, and brain
Subjective Data: jaundice, anorexia, fatigue, abd fullness, clay
color stool, tea color urine.
Objective Data: Hepatomegaly with a hard-irregular liver border.
Liver nodules with tenderness.
Nonalcoholic Fatty Liver Disease (NAFLD): Spectrum of hepatic
disorders not associated with excessive alcohol intake including steatosis
to cirrhosis
Patho: hepatic cell inflammation and injury s/t triglyceride
accumulation in liver, genetics and environmental factors. Insulin
resistance important factor. Most common cause of liver disease in
US.
Subjective Data: upper right quadrant pain, fatigue, malaise,
jaundice, or asymptomatic
Objective Data: Abnormal liver function tests, increased BMI,
hepatomegaly, MRI and liver biopsy needed
38. Examination findings associated with appendicitis
o General Info:
Most common indication for emergency abdominal surgery
Accurate diagnosis made on history and physical exam can facilitate rapid
surgical intervention and prevent further injury.
Characterized by RLQ pain. Initial periumbilical pain that migrates to the
RLQ, pain before vomiting.
Rigidity, a positive psoas sign fever, and rebound tenderness on physical
exam are sx of appendicitis. Pain at McBurney’s point.
Children may present with vomiting, rebound tenderness, rectal
tenderness, and fever without the RLQ pain. Colic like symptoms
common.
Associated s/s: guarding, tenderness, +iliopsoas sign, + obturator sign,
RLQ skin hyperesthesia, anorexia, nausea, vomiting, low grade fever,
+Aaron, Rovsing, Markle and McBurney signs
o Tests:
Assess for rebound tenderness by holding your hand at a 90-degree angle
to the abd with the fingers extended, press gently and deeply into a region
remote from the area of abdominal discomfort and rapidly withdraw your
hand. Pain at the site of peritoneal inflammation as the structures return to
normal position indicates a positive test. This should be done at the end of
the examination because a positive response can cause pain that will
inhibit further examination.
Iliopsoas Muscle Test: for suspected appendicitis, which can cause
irritation at the lateral iliopsoas muscle
Ask pt. to lie supine, place hand over lower right thigh. Have pt.
raise right leg flexing at the hip while you push downward. Pain
with this technique is positive sign.
39. Examining McBurney’s sign
o Rebound Tenderness felt over McBurney’s Point in the lower right quadrant
suggests appendicitis and is a positive McBurney’s sign.
40. Assessment of abdominal pain in women
o Potential threats to life in women:
Ectopic pregnancy – typically presents with lower abdominal pain and
vaginal bleeding, late missed period, peritoneal irritation
Associated internal bleeding may show shoulder tip pain
Female abdominal pain must be investigated – ask for sexual &
menstrual history, conduct pelvic exam, & perform urine
pregnancy test. Anticipate the emergency of a RUPTURE.
Incomplete Miscarriage
Genital Tract Trauma
Pulmonary Embolism
Toxic Shock Syndrome
o Causes of abdominal pain in women:
Common: UTI, PID, Dysmenorrhea, Labor
Uncommon: Ectopic pregnancy, Appendicitis, Biliary Colic, Ovarian
Syndromes, Miscarriage
Rare: Ovarian Hyperstimulation Syndrome, Curtis Fitzhugh Syndrome,
Toxic Shock Syndrome
The menstrual history must be taken and pregnancy or its complications
o Cystitis – frequency and dysuria
R/o pelvic appendicitis (abdominal pain, dysuria, frequency, and protein,
blood, and WBC in UA)
o Pyelonephritis – urinary symptoms & groin pain, fever, and nausea, and vomiting
41. Landmarks for abdominal examination
o RUQ – Liver and Gallbladder, Pylorus, Duodenum. Head of Pancreas (HOP),
Right Adrenal Gland (RAG), Portion of Right Kidney (PORK), Hepatic Flexure
of Colon (HFC), Portions of Ascending and Transverse Colon (PAT-C)
o LUQ- Left Lobe of Liver (3L), Spleen, Stomach, Body of Pancreas (BOP), Left
Adrenal Gland (LAG), Portion of Left Kidney (POLK), Splenic flexure of Colon
(SFC), Portions of Ascending and Transverse Colon (PAT-C)
o RLQ – Lower Pole of Right Kidney (L-PoRK), Cecum and Appendix, Portion of
Ascending Colon (PAC), Bladder (if distended), Ovary and Salpinx, Uterus, Rt.
Spermatic Cord, Right ureter
o LLQ- Lower pole of Left Kidney (L-Polk), Sigmoid Colon, Portion of
Descending Colon, Bladder (if Distended), Ovary and Salpinx, Uterus (if
enlarged), Left Spermatic Cord, Left ureter
o Right Hypochondriac – Right Lobe of Liver, Gallbladder, Portion of Duodenum,
Hepatic Flexure of Colon, Portion of Rt. Kidney, Right Adrenal Gland
o Epigastric – Pylorus, Duodenum, Pancreas, Portion of Liver
o Left Hypochondriac- Stomach, Spleen, Tail of pancreas, Splenic flexure of
Colon, Upper Pole of Left Kidney, Left Adrenal Gland
o Right Lumbar – Ascending Colon, Lower Half of Right Kidney, Portion of
Duodenum and Jejunum
o Umbilical – Omentum, Mesentery, Lower Part of Duodenum, Jejunum, and Ileum
o Right Iliac – Cecum, Appendix, Lower end of Ileum, Right ureter, Right
Spermatic Cord, Right Ovary
o Hypogastric (Pubic) – Ileum, Bladder, Uterus
o Left Inguinal – Sigmoid Colon, Left Ureter, Left Spermatic Cord, Left Ovary
42. Characteristics of bowel sounds heard during auscultation
o Normal – Clicks and gurgle sounds heard irregularly from 5-35 minutes.
o Borborygmi -growling, loud prolonged gurgles.
Heard in gastroenteritis, early intestinal obstructions, or hunger
o High-Pitched tinkling sound – heard in early obstruction
o Decreased Bowel Sounds – heard in peritonitis and paralytic ileus
o Absent Bowel Sounds – no bowel sounds after 5 minutes of auscultation.
o Friction Rub – high-pitched, heard in auscultation with respiration
Indicates inflammation of the peritoneal surface of the organ from tumor,
infection, or infarct.
o Bruit- Harsh or musical intermittent auscultatory sound
Indicates blood flow turbulence and indicate vascular disease
o Use bell of the stethoscope in listening for the aortic, renal, iliac, and femoral
artery bruits. Also in epigastric region and umbilical region for “venous hum” –
soft, low pitched, and continuous which indicates increased collateral circulation
between portal and systemic venous systems.
