Chapter 09 - General Survey, Measurements, Vital Signs

1.The general survey consists of four distinct areas. These areas include:
A. mental status, speech, behavior, and mood and affect.
B. gait, range of motion, mental status, and behavior.
C. physical appearance, body structure, mobility, and
behavior.
D. level of consciousness, personal hygiene, mental status, and
physical condition.
E. The general survey is a study of the whole person, covering
the general health state and any obvious physical characteristics. The four
areas of the general survey are physical appearance, body structure,
mobility, and behavior.
2.A common error in blood pressure measurement is:
A. taking the blood pressure in an arm that is at the level of the
heart.
B. waiting less than 1 to 2 minutes before repeating the
blood pressure reading on the same arm.
C. deflating the cuff about 2 mm Hg per heartbeat.
D. using a blood pressure cuff whose bladder length is 80% of
the arm circumference.
E. Waiting less than 1 to 2 minutes before repeating the blood
pressure reading on the same arm will result in a falsely high diastolic
pressure related to venous congestion in the forearm. The patients arm
should be positioned at the level of the heart when obtaining a blood
pressure measurement. The cuff should be deflated at a rate of 2 mm Hg
per heartbeat. The blood pressure cuff bladder length should be about 80%
of the arm circumference.
3.Data collection for the general survey begins:
A. at the first encounter.
B. at the beginning of the physical examination.
C. while taking vital signs.
D. during the mental status examination.
4.The Doppler technique:
A. is used to assess the apical pulse.
B. augments Korotkoff sounds during blood pressure
measurement.
C. provides an easy and accurate measurement of the diastolic
pressure.
D. measures arterial oxygenation saturation.
E. The Doppler technique may be used to locate peripheral
pulse sites and for blood pressure measurement to augment Korotkoff
sounds. A stethoscope is used to assess an apical pulse. The systolic blood

pressure is more easily identified with the Doppler technique than the
diastolic pressure. A pulse oximeter measures arterial oxygenation
saturation.
5.The tympanic membrane thermometer (TMT):
A. provides an accurate measurement of core body
temperature.
B. senses the infrared emissions of the cerebral cortex.
C. is not used in unconscious patients.
D. accurately measures temperature in 20 to 30 seconds.
E. The TMT accurately measures core body temperature. The
TMT senses the infrared emissions of the tympanic membrane; the
tympanic membrane shares the same vascular supply that perfuses the
hypothalamus. The TMT is used with unconscious patients or patients in the
emergency department, recovery areas, and labor and delivery units. The
temperature is displayed in 2 to 3 seconds.
6.Endogenous obesity is:
A. due to inadequate secretion of cortisol by the adrenal glands.
B. caused by excess adrenocorticotropin production by the
pituitary gland.
C. characterized by evenly distributed excess body fat.
D. a result of excessive secretion of growth hormone in
adulthood.
E. Endogenous obesity is caused by either the administration of
adrenocorticotropin or excessive production of adrenocorticotropin by the pituitary.
Adrenocorticotropin stimulates the adrenal cortex to secrete excess cortisol and
causes Cushing syndrome, which is characterized by weight gain and edema with
central trunk and cervical obesity. Excessive catabolism causes muscle wasting with
thin arms and legs. Body fat is evenly distributed in exogenous obesity because of
excessive caloric intake. Acromegaly is caused by an excessive secretion of growth
hormone in adulthood.

7.To perform an accurate assessment of respirations, the examiner should:

A. inform the person of the procedure and count for 1 minute.
B. count for 15 seconds while keeping fingers on the pulse and
then multiply by four.
C. count for 30 seconds after completing a pulse
assessment and multiply by two.
D. assess respirations for a full 2 minutes if an abnormality is
suspected.

E. Respirations should be counted for 30 seconds (if regular) and

multiplied by two. The respirations should be counted after the pulse assessment.
Patients have conscious control over respirations; the examiner should not mention
that respirations will be counted. Avoid counting respirations for 15 seconds because
the results can vary +4 or -4 with such a small number. Respirations should be
counted for 1 minute if abnormalities are suspected.
8.Physical appearance includes statements that compare appearance with:
A. mood and affect.
B. stated age.
C. gait.
D. Nutrition.
E. Physical appearance includes statements that compare
appearance with age, sex, level of consciousness, skin color, and facial
features. Behavior is compared with mood and affect. Mobility is compared
with gait. Body structure is compared with nutrition.
9.An adult patients pulse is 46 beats per minute. The term used to describe this rate
is:
A. tachycardia.
B. bradycardia.
C. weak and thready.
D. sinus arrhythmia.
E. A heart rate of less than 50 beats per minute in an adult is
bradycardia. A heart rate of greater than 90 beats per minute in an adult is
tachycardia. Weak and thready describes the force of the pulse reflecting a
decreased stroke volume. Sinus arrhythmia is a pulse that is irregular; the
heart rate varies with the respiratory cycle.

10.The nurse records that the patients pulse is 3+ or full and bounding. Which of the
following could be the cause?
A.
B.
C.
D.
E.

Dehydration
Shock
Bleeding
Anxiety
A full, bounding pulse (3+) reflects an increased stroke

volume, as with anxiety and exercise. A weak, thready pulse may reflect a
decreased stroke volume, as with dehydration. A weak, thready pulse may
reflect a decreased stroke volume, as with shock. A weak, thready pulse
reflects a decreased stroke volume, as with bleeding.

Chapter 10
1.Pain signals are carried to the central nervous system by way of:
A. perception.
B. afferent fibers.
C. modulation.
D. referred pain.
E. Nociceptors carry the pain signal to the central nervous
system by two primary sensory (or afferent) fibers. Perception indicates the
conscious awareness of a painful sensation. Modulation inhibits the pain
message producing an analgesic effect. Referred pain is pain felt at a
particular site that originates from another location.
2.Which of the following is the most reliable indicator for chronic pain?
A. Magnetic resonance imaging (MRI) results
B. Patient self-report
C. Tissue enzyme levels
D. Blood drug levels
3.Which of the following statements regarding cultural/racial differences in the
treatment of pain is true?

A. White individuals receive more analgesic therapy than

black or Hispanic individuals with similar symptoms.
B. Black and Hispanic individuals have been found to have a
higher pain tolerance than white individuals.
C. Pain modulation is more highly developed in black and
Hispanic individuals.
D. Neurotransmitters are more concentrated in white individuals
than in black and Hispanic individuals.
4.What occurs during transduction (the first phase of nociceptive pain)?
A. Pain signals move from the site of origin to the spinal
cord.
B. The pain impulse moves from the spinal cord to the brain.
C. The brain interprets the pain signal.
D. Chemical mediators are neutralized to decrease the
perception of pain.
E. Transduction is the first phase of nociceptive pain. During this
phase, injured tissue releases chemicals that propagate the pain message;
an action potential moves along an afferent fiber to the spinal cord. During
transmission (the second phase), the pain impulse moves from the level of
the spinal cord to the brain. The third phase is perception; the person has
conscious awareness of a painful sensation. In phase four, modulation, the
neurons from the brainstem release neurotransmitters that block the pain
impulse.
5.What type of pain is short and self-limiting and dissipates after the injury heals?
A. Chronic
B. Persistent
C. Acute
D. Breakthrough
E. Acute pain is short-term and self-limiting, often follows a
predictable trajectory, and dissipates after an injury heals. Chronic pain
lasts 6 months or longer; the pain persists after the predicted trajectory.
Persistent pain is another term for chronic pain. Breakthrough pain starts
again or escalates before the next scheduled analgesic dose.
6.Neuropathic pain implies an abnormal:
A. degree of pain interpretation.
B. processing of the pain message.
C. transmission of pain signals.
D. modulation of pain signals.
7.What is the source of deep somatic pain?
A. Skin and subcutaneous tissues
B. Bones and joints
C. Pancreas
D. Intestine
E. Deep somatic pain comes from the blood vessels, joints,
tendons, muscles, and bones. Cutaneous pain is derived from skin surface

and subcutaneous tissues. Visceral pain originates from the larger interior
organs such as the pancreas. Visceral pain originates from the larger
interior organs such as the intestine.
8.Which of the following has been found to influence pain sensitivity in women?
A. Age
B. Hormonal changes
C. Parity
D. Weight
9.Specialized nerve endings that are designed to detect painful sensations are:
A. synapses.
B. dorsal horns.
C. nociceptors.
D. C fibers.
E. Nociceptors are specialized nerve endings designed to detect
painful sensations from the periphery and transmit them to the central
nervous system. A synapse is a region (or small gap) where nerve impulses
are transmitted and received. The dorsal horn is a longitudinal subdivision
of gray matter in the dorsal part of each lateral half of the spinal cord that
receives terminals from some afferent fibers of the dorsal roots of the spinal
nerves. C fibers are one of two primary sensory or afferent fibers that are
unmyelinated and smaller; C fibers transmit the signal slowly.
10.An older adult patient with dementia has a pain rating of 5 on the Pain
Assessment in Advanced Dementia (PAINAD) scale. The nurse should:
A. reassess the pain level in 3 to 4 hours.
B. administer prescribed pain medication.
C. ask the patient to verify the pain rating.
D. use only nonpharmacologic pain relief interventions.
E. A patient with a pain score of 4 or greater on the PAINAD scale
should receive pain intervention. Patients with dementia can be given an analgesic
trial or option. The nurse should not wait an additional 3 to 4 hours for another pain
assessment. A patient with dementia may say no if asked about having pain even if
he or she is having pain. Words lose their meaning with dementia.
Nonpharmacologic pain relief interventions can be implemented with or without
prescribed pain medication.

Chapter 11 - Nutritional Assessment

1.Obesity in adults is defined as:
A. excess body fat placed predominately within
the hips and thighs.
B. excessive body fat leading to body weight 5%
above ideal.
C. a body mass index of 30 or greater.
D. Overnourished.
E. Obesity in adults is defined as a body mass
index of 30 or greater. Overweight in adults is defined as a body
mass index of 25 or greater. Obese persons with most of their fat in
the hips and thighs have gynoid obesity; android (upper body)
obesity places a person at higher risk for obesity-related diseases
and early mortality. Obesity is greater than 120% of the ideal body
weight. Overnutrition is caused by the consumption of nutrients,
especially calories, sodium, and fat, in excess of body needs
2.A patients complaints include bleeding gums, splinter hemorrhages
of the nails, and joint pain. These complaints are symptomatic of:
A. riboflavin deficiency.
B. vitamin C deficiency.
C. vitamin B12 deficiency.
D. iron deficiency.
E. Patients with vitamin C deficiency may have
the following clinical manifestations: petechiae or ecchymoses,
bleeding gums, joint pain, and splinter hemorrhages of the nails.
Patients with a riboflavin deficiency may have the following clinical
manifestations: nasolabial seborrhea, red conjunctivae, cheilosis,
angular stomatitis, and purplish-colored tongue. Patients with a
vitamin B12 deficiency may have the following clinical
manifestations: pale conjunctivae, disorientation, or irritability.
Patients with iron deficiencies may have the following clinical
manifestations: pale conjunctivae, angular stomatitis; pale tongue;
and brittle, ridged, or spoon shaped nails.
3.A patient reports consuming approximately 2000 calories per day.
For a healthy diet, the patient should:
A. eat at least 4 cups of fruits and 4 cups of
vegetables per day.

B. consume less than 100 mg per day of

cholesterol.
C. consume 6 ounces of whole-grain
products per day.
D. keep fat intake to 5% of total calories.
E. On a 2000-calorie-per-day diet, a person should
consume three servings (6-ounce equivalents) or more of whole grain
products per day and three servings of other enriched grain products. On a
2000-calorie-per-day diet, a person should consume 2 cups of fruit and 2
cups of vegetables per day. On a 2000- calorie-per-day diet, a person should
consume less than 300 mg per day of cholesterol. On a 2000-calorie-perday-diet, a person should keep total fat intake to 20% to 35% of total calories.
4.A dietary practice to restrict meat on certain days such as Ash
Wednesday and Fridays during Lent is an example of what type of nutritional
influence?
A. Ethnic
B. Economic
C. Religious
D. Cultural
5.Energy requirements for an aging adult decrease as a result of:
A. loss of energy.
B. eating habits.
C. loss of lean body mass.
D. decreasing body fat.
6.Nutritional status is best determined by:
A. serum albumin.
B. clinical manifestations.
C. triglycerides.
D. 24-hour diet recall.
7.Dietary guidelines suggest that overall fat consumption should be:
A. less than 300 mg per day.
B. between 10% and 20% of the total calorie
intake.
C. between 20% and 35% of the total calorie
intake.
D. mostly trans-fatty acid or saturated fat.
E. Total fat intake should be between 20% and
35% of calories, mostly from polyunsaturated or monounsaturated
fats. Consumption of cholesterol should be less than 300 mg per
day. Intake of saturated fat should be limited. Trans-fatty acid
consumption should be as low as possible.
8.For optimum health, infants and children up to 2 years of age
should receive whole milk. What component of whole milk is essential for neurologic
development?
A. Lactose
B. Pasteurized protein

C. Fortified vitamin D
D. Fat
9.A comprehensive nutritional assessment always includes:
A. anthropometric measures.
B. a direct observation of feeding and eating
processes.
C. a work history.
D. a comprehensive metabolic panel.
E. Anthropometric measures evaluate growth,
development, and body composition. Examples include height,
weight, waist circumference, derived weight measures (e.g., body
mass index, waist-to-hip ratio), and triceps skinfold thickness.
10.Obese persons with more fat in the upper body, especially the
abdomen, have:
A. gastronomic obesity.
B. gynoid obesity.
C. anthropometric obesity.
D. android obesity.
E. Obese persons with most of their fat in the
abdomen have android (upper body) obesity. A waist-to-hip ratio of
1.0 or greater in men or 0.8 or greater in women is indicative of
android obesity, which places a person at higher risk for obesityrelated diseases and early mortality.

Chapter 12 - Skin, Hair, and Nails

1.

Questions

1.When taking the health history, the patient complains of pruritus.

What is a common cause of this symptom?
A. Excessive bruising
B. Hyperpigmentation
C. Melasma
D. Drug reactions

E. Drug reactions can lead to pruritus or itching.

F. Excessive bruising can occur in response to a
traumatic event or a coagulation abnormality. It is associated with erythema,
not pruritus.
G. Hyperpigmentation is related to color changes.
H. Melasma (also known as chloasma or the mask of
pregnancy) is a facial skin discoloration related to hormones of pregnancy.
2.A flat macular hemorrhage is called a(n):
A. purpura.
B. ecchymosis.
C. petechiae.
D. Hemangioma.

E. Purpura is a flat, macular, red-to-purple hemorrhage

that is a confluent and extensive patch of petechiae and ecchymoses greater
than 3 mm.
F. An ecchymosis is a hemorrhage that is greater than 3
mm.
G. Petechiae are tiny punctate hemorrhages that are 1 to
3 mm; round and discrete; and dark red, purple, or brown caused by bleeding
from superficial capillaries.
H. Hemangiomas are vascular lesions caused by a
benign proliferation of blood vessels in the dermis.
3.A student nurse has been assigned to teach fourth graders about
hygiene. While preparing, the student nurse adds information about the sweat
glands. Which of the following should be included while discussing this topic?
A. There are two types of sweat glands: eccrine
glands and sebaceous glands.
B. The evaporation of sweat, a dilute saline
solution, increases body temperature.
C. Eccrine glands produce sweat and are mainly
located in the axillae, anogenital area, and navel.
D. Newborn infants do not sweat and use
compensatory mechanisms to control body temperature.

E. Newborn infants eccrine glands do not secrete sweat

in response to heat until the first few months of life; newborn temperature
regulation is ineffective.
F. There are two types of sweat glands: eccrine glands
and apocrine glands.
G. The evaporation of sweat reduces body temperature.
H. The apocrine glands produce a thick, milky secretion
and open into the hair follicles; they are located mainly in the axillae,
anogenital area, nipples, and navel.
4.Functions of the skin include:
A. production of vitamin C.
B. temperature regulation.
C. production of new cells by melanocytes.
D. secretion of a drying substance called
sebum.

E. Functions of the skin include protection, prevention of

penetration, perception (of touch, pain, temperature, and pressure),
temperature regulation, identification, communication, wound repair,
absorption and excretion, and production of vitamin D.
F. The skin produces vitamin D, not vitamin C.
G. The basal cell layer of the epidermis forms new skin
cells. Melanocytes produce melanin, which gives brown tones to the skin and
hair.
H. Sebum is produced by the sebaceous glands to
lubricate the skin and hair.
5.Risk factors that may lead to skin disease and breakdown include:
A. loss of protective cushioning of the dermal
skin layer.
B. decreased vascular fragility.
C. a lifetime of environmental trauma.
D. increased thickness of the skin.

E. Accumulating factors that place an aging person at

risk for skin disease and breakdown include thinning of the skin, decrease in
vascularity and nutrients, loss of protective cushioning of the subcutaneous
layer, a lifetime of environmental trauma to skin, social changes of aging, an
increasingly sedentary lifestyle, and the chance of immobility.

F. Aging results in the loss of protective cushioning of

the subcutaneous layer of the skin.
G. Aging results in decreased vascularity of the skin.
H. Aging results in thinning of the skin.
6.What term refers to a linear skin lesion that runs along a nerve
route?
A.
B.
C.
D.

Zosteriform
Annular
Dermatome
Shingles

E. Zosteriform describes a lesion that has a linear

arrangement along a nerve root.
F. Annular describes a lesion that is circular and begins
in the center and spreads to the periphery.
G. A dermatome is an area of skin that is mainly supplied
by a single spinal nerve.
H. Shingles (herpes zoster) are small grouped vesicles
that emerge along the route of a cutaneous sensory nerve, followed by
pustules, and then crusts; shingles is caused by the herpes zoster virus.
7.The components of a nail examination include:
A. contour, consistency, and color.
B. shape, surface, and circulation.
C. clubbing, pitting, and grooving.
D. texture, toughness, and translucency.

E. The nails should be assessed for shape and contour,

consistency, and color.
8.To determine if a dark-skinned patient is pale, the nurse should
assess the color of the:
A.
B.
C.
D.

conjunctivae.
earlobes.
palms of the hands.
skin in the antecubital space.

E. To detect pallor in a dark-skinned patient, the nurse

should assess an area with the least pigmentation, such as the conjunctivae
or mucous membranes.
9.An example of a primary lesion is a(n):
A. erosion.
B. ulcer.
C. urticaria.
D. port-wine stain.

E. Urticaria is a primary lesion; a primary lesion is one

that develops on previously unaltered skin.
F. Erosions are secondary lesions; a secondary lesion is
one that changes over time or changes because of a factor such as
scratching or infection.
G. Ulcers are secondary lesions; a secondary lesion is
one that changes over time or changes because of a factor such as
scratching or infection.
H. A port-wine stain is a vascular lesion.
10.A scooped-out, shallow depression in the skin is called a(n):
A. ulcer.
B. excoriation.
C. fissure.
D. Erosion.

E. An ulcer is a deeper depression extending into the

dermis.
F. An excoriation is a self-inflicted abrasion that is
superficial.
G. A fissure is a narrow opening of tissue or skin.
H. An erosion is a scooped-out, shallow depression in
the skin.

Questions Chapter 13
1.
Bleeding into the periosteum during birth is known as:
A. caput succedaneum.
B. craniosynostosis.
C. molding.
D. Cephalhematoma.
E. cephalhematoma is a subperiosteal hemorrhage resulting from birth
trauma.
F. A caput succedaneum is edematous swelling and ecchymosis of the
presenting part of the head caused by birth trauma.

G. Craniosynostosis is marked asymmetry that is due to a severe

deformity caused by premature closure of the sutures and resulting in a long, narrow
head.
H. Molding of the cranial bones during passage through the birth canal
makes the head asymmetric and ridges more prominent.
2.
Craniosynostosis is a severe deformity caused by:
A. premature closure of the sutures.
B. increased intracranial pressure.
C. a localized bone disease that softens, thickens, and deforms
bone.
D. excess growth hormone or a deficit in thyroid hormone.
E. Craniosynostosis is marked asymmetry that is due to a
severe deformity caused by premature closure of the sutures and resulting
in a long, narrow head.
F. Hydrocephalus (obstruction of drainage of cerebrospinal fluid)
results in excessive accumulation of cerebrospinal fluid, increasing
intracranial pressure, and enlargement of the head.
G.
Paget disease (osteitis deformans) is a localized bone
disease of unknown etiology that softens, thickens, and deforms bone.
H.Acromegaly results from excessive secretion of growth
hormone from the pituitary after puberty. Congenital hypothyroidism and
myxedema are caused by thyroid hormone deficiency.

3.Narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia are

characteristic of:
A. Down syndrome.
B. fetal alcohol syndrome.
C. chronic childhood allergies.
D. congenital hypothyroidism.
E. Facial characteristics of fetal alcohol syndrome include narrow
palpebral fissures, epicanthal folds, and midfacial hypoplasia.
F. Facial characteristics of Down syndrome include upslanting eyes with
inner epicanthal folds; flat nasal bridge; small, broad, flat nose; protruding thick
tongue; and ear dysplasia.
G. Facial characteristics of chronic allergies include exhausted face,
blue shadows below the eyes, double or single crease on the lower eyelids, central
facial pallor, open mouth breathing (malocclusion of the teeth and malformed jaw),
and a transverse line on the nose.
H. Facial characteristics of congenital hypothyroidism include low
hairline, hirsute forehead, swollen eyelids, narrow palpebral fissures, widely spaced

eyes, depressed nasal bridge, puffy face, thick tongue protruding through an open
mouth, and a dull expression.
4.
Kyphosis of the spine is common with aging. To compensate, older adults:
A. increase their center of gravity.
B. extend their heads and jaws forward.
C. stiffen their gait.
D. Shuffle.
E. An older adult may show an increased anterior cervical
(concave or inward) curve when the head and jaw are extended forward to
compensate for kyphosis of the spine.
5.
Which of the following statements related to aggravating symptoms or
triggers of headaches is true?
A. Alcohol consumption may precipitate the onset of
cluster or migraine headaches.
B. Certain foods such as chocolate or cheese may precipitate
the onset of tension headaches.
C. Premenstrual hormonal fluctuations may precipitate the
onset of cluster headaches.
D. Poor posture may trigger a migraine headache.
E. Aggravating symptoms or triggers for cluster headaches include
alcohol consumption, stress, or wind or heat exposure. Aggravating symptoms or
triggers for migraines include hormonal fluctuations, certain foods, letdown after
stress, changes in sleep pattern, sensory stimuli, and changes in weather or physical
activity.
F. Aggravating symptoms or triggers for tension headaches include
stress anxiety, depression, and poor posture.
6.Most facial bones articulate at a suture. Which facial bone articulates at a joint?
A. Nasal bone
B. Mandible
C. Zygomatic bone
D. Maxilla
E. The facial bones articulate at sutures (nasal bone, zygomatic
bone, and maxilla) except for the mandible. The mandible articulates at the
temporomandibular joint.
7.A severe deficiency of thyroid hormone leading to nonpitting edema, coarse facial
features, dry skin, and dry coarse hair is known as:
A. congenital hypothyroidism.
B. scleroderma.
C. myxedema.
D. Hashimoto thyroiditis.
E. Myxedema (hypothyroidism) is a deficiency of thyroid
hormone. If severe, the symptoms include nonpitting edema or myxedema;
a puffy edematous face, especially around the eyes (periorbital edema);
coarse facial features; dry skin; and dry coarse hair and eyebrows.

F. Congenital hypothyroidism is a thyroid deficiency that occurs

at an early age; characteristics include low hairline, hirsute forehead,
swollen eyelids, narrow palpebral fissures, widely spaced eyes, depressed
nasal bridge, puffy face, thick tongue protruding through an open mouth,
and a dull expression.
G.
Scleroderma is a rare connective tissue disease
characterized by chronic hardening and shrinking degenerative changes in
the skin blood vessels, synovium, and skeletal muscles.
H.Hashimoto thyroiditis is a condition with excess thyroid
hormone production; symptoms include goiter, nervousness, fatigue, weight
loss, muscle cramps, heat intolerance, tachycardia, shortness of breath,
excessive sweating, fine muscle tremor, thin silky hair and skin, infrequent
blinking, and a staring appearance.
8.
Which of the following statements describing a headache would warrant an
immediate referral?
A. This is the worst migraine of my life.
B. This is the worst headache Ive had since puberty.
C. I have never had a headache like this before; it is so
bad I cant function.
D. I have had daily headaches for years.
9.
What disease is characterized by a flat, expressionless, or masklike face; a
staring gaze; oily skin; and elevated eyebrows?
A. Acromegaly
B. Scleroderma
C. Cushing syndrome
D. Parkinson disease
E. Facial characteristics of Parkinson disease include a flat,
expressionless face that is masklike with elevated eyebrows, a staring
gaze, oily skin, and drooling.
F. Facial characteristics of acromegaly include an elongated
head, a massive face, a prominent nose and lower jaw, a heavy eyebrow
ridge, and coarse facial features.
G.
Facial characteristics of scleroderma include hard,
shiny skin on the forehead and cheeks; thin, pursed lips with radial
furrowing; absent skinfolds; muscle atrophy of the face and neck; and
absence of expression.
H.Facial characteristics of Cushing syndrome include a
plethoric, rounded, moonlike face; prominent jowls; red cheeks; and
hirsutism on the upper lip, lower cheeks, and chin.

10.A patient is admitted to the emergency department after a motor vehicle accident.
The trachea is deviated to the left side. This finding is characteristic of:
A. right pneumothorax.
B. aortic arch aneurysm.
C. right pleural adhesion.
D. right-sided atelectasis.
E. The trachea is normally midline; with a right pneumothorax,
the trachea is deviated to the unaffected side (left).
F. The trachea is pulled downward with systole of an aortic arch
aneurysm.
G.

With a large right-sided pleural adhesion, the trachea

is deviated to the affected side (right).

H.With a large right-sided atelectasis, the trachea is deviated to
the affected side (right).

Chapter 14 - Eyes

1.
The extraocular muscles consist of four straight or ________ muscles and
two slanting or ______ muscles.
A. palpebral; conjugate
B. superior; inferior
C. rectus; oblique
D. rectilinear; diagonal
E. The four straight, or rectus, muscles are the superior, inferior,
lateral, and medial rectus muscles. The two slanting, or oblique, muscles
are the superior and inferior muscles.
2.
A slight protrusion of the eyeballs may be noticed when examining individuals
who come from which ethnic/cultural group?
A. Asian
B. African American
C. Hispanic
D. American Indian
E. African Americans normally may have a slight protrusion of
the eyeball beyond the supraorbital ridge.
3.
The location in the brain where optic nerve fibers from the temporal fields of
vision cross over is identified as the:
A. optic chiasm.
B. fovea centralis.
C. optic disc.
D. Choroid.
E. At the optic chiasm, nasal fibers (from both temporal visual
fields) cross over.
F. The fovea centralis is the area of the retina that has the
sharpest and keenest vision.
G.
The optic disc is the area in which fibers from the
retina converge to form the optic nerve.
H.The choroid is the middle vascular layer of the eye; the
choroid has dark pigmentation to prevent light from reflecting internally and
is heavily vascularized to deliver blood to the retina.
4.
Which of the following groups of individuals need to be tested for the
presence of color blindness (deficiency)?
A. Black boys between the ages of 10 and 15 years
B. White boys between the ages of 4 and 8 years
C. Asian girls between the ages of 3 and 6 years
D. White girls between the ages of 4 and 8 years
5.
Which of the following statements regarding the results obtained from use of
the Snellen chart is true?
A. The smaller the denominator, the poorer the vision.
B. The larger the denominator, the poorer the vision.
C. The larger the numerator, the better the vision.

D. The smaller the numerator, the poorer the vision.

6.
The lens of the eye functions as a:
A. refracting medium.
B. mediator of light.
C. sensory facilitator.
D. controller of intraocular pressure.
E. The lens serves as a refracting medium, keeping a viewed object in
continual focus on the retina.
F. The muscle fibers of the iris function as the mediator of light.
G. The cornea is very sensitive to touch.
H. The intraocular pressure is determined by a balance between the
amount of aqueous humor produced and resistance to its outflow at the angle of the
anterior chamber.
7.
When inspecting the eyeballs of an African American individual, which of the
following might the examiner expect to observe?
A. A slight misalignment of the eyeballs
B. A slight yellow discoloration of the sclera
C. Small brown macules on the sclera
D. A slight amount of drainage around the lacrimal apparatus
8.
The normal color of the optic disc is:
A. red.
B. creamy pink.
C. creamy yellow-orange to pink.
D. creamy red to yellow-orange.
9.
Which of the following is an expected response on the cover test?
A. The covered eye moves into a relaxed position.
B. The covered eye maintains its position when uncovered.
C. The uncovered eye is unable to maintain its gaze on a fixed
object.
D. The covered eye jumps to reestablish fixation when it is
uncovered.
E. A normal response to the cover test is a steady fixed gaze.
F. If muscle weakness is present, the covered eye will drift into a
relaxed position.
G.

A normal response to the cover test is a steady fixed

gaze.
H.When the eye is uncovered, if it jumps to reestablish fixation,
eye muscle weakness exists.
10.
Which of the following findings is associated with Horner syndrome?
A. Bilateral miosis
B. Bilateral mydriasis
C. A unilateral small regular pupil that reacts to light and
accommodation

D. A unilateral dilated pupil with no reaction to light or

accommodation
E. Horner syndrome is caused by a lesion of the sympathetic
nerve. An individual with Horner syndrome has a unilateral small regular
pupil that reacts to light and accommodation. There is unilateral ptosis and
absence of sweat on the same side.
11.
Decreased vision in an elderly patient may be due to which of the following
conditions?
A. Macular degeneration
B. Retinoblastoma
C. Fixation
D. Presbyopia
E. Decreased vision in elderly patients is most commonly
caused by cataracts, glaucoma, or macular degeneration.
F. Retinoblastoma is a malignant tumor of the retina that usually
affects children younger than 6 years old.
G.
Fixation is a reflex direction of the eye toward an
object attracting a persons attention; fixation is impaired by drugs, alcohol,
fatigue, and inattention.
H.The lens in an older adult loses elasticity and becomes hard
and glasslike; this decreases the lens ability to change shape to
accommodate for near vision and is called presbyopia.

Chapter 15, Ears

1.Binaural interaction at the level of the brainstem permits:
A. interpretation of sound.
B. identification and location of the direction of the sound.
C. amplification of sound.
D. direction of sound toward the appropriate conduction
pathway.
2.
Which of the following behaviors demonstrated by an individual may be
indicative of hearing loss?
A. Not looking at the examiner when being questioned
B. Frequently asking for the question to be repeated
C. Talking in a high-pitched voice
D. Speaking slowly with well-articulated consonants
E. Hearing loss is indicated when a person frequently asks to
have statements repeated.
F. Hearing loss is indicated when a person lip reads or watches
faces and lips closely.
G.
Hearing loss is indicated when a person has a flat,
monotonous tone of voice.
H.Hearing loss is indicated when speech sounds are garbled,
vowel sounds are distorted, and the person uses an inappropriately loud
voice.
3.
Which of the following children is at risk of recurrent otitis media (OM)?
A. An 18-month-old infant who lives with a smoker
B. A 2-year-old child who has had two ear infections in the past
6 months
C. A 6-month-old infant who has a sibling who had tubes
inserted at 3 years of age
D. An 18-month-old infant who has had three episodes of
ear infections in a 5-month period
4.
The external structure of the ear is identified as the:
A. auricle.
B. atrium.
C. aureole.
D. Auriga.

E. The auricle or pinna is the external structure of the ear.

F. The atrium is the upper chamber of the heart.
5.
The labyrinth of the inner ear is responsible for maintaining the bodys:
A. binaural interaction.
B. air conduction.
C. equilibrium.
D. pressure equalization.
E. The labyrinth maintains the bodys equilibrium.
F. Binaural interaction is controlled by the brainstem and permits
locating the direction of a sound.
G.
The normal pathway of hearing is by air conduction.
H.The eustachian tube allows equalization of air pressure on
each side of the tympanic membrane.
6.
When an otoscopic examination is performed on an older adult patient, the
tympanic membrane may be:
A. pinker than that of a younger adult.
B. thinner than that of a younger adult.
C. whiter than that of a younger adult.
D. more mobile than that of a younger adult.
E. During otoscopy, the tympanic membrane of an older adult
may be whiter in color than that of a younger adult. The tympanic
membrane may also appear more opaque and dull.
F. A yellow-amber eardrum color occurs with otitis media with
effusion. A red color occurs with acute otitis media.
G.
The tympanic membrane of an older adult may be
thicker compared with that of a younger adult.
H.Hypomobility is an early sign of acute otitis media.
7.
Which of the following tests provides a precise quantitative measure of
hearing?
A. Tuning fork tests
B. Romberg test
C. Audiometer test
D. Whispered voice test
E. An audiometer gives a precise quantitative measure of
hearing by assessing the persons ability to hear sounds of varying
frequency.
F. The tuning fork tests (Weber and Rinne) are inaccurate and
should not be used for general screening.
G.
The Romberg test assesses the ability of the
vestibular apparatus in the inner ear to help maintain standing balance.
H.The whispered voice test is nonquantitative; this test
documents the presence of hearing loss but does not measure the degree
of loss.
8.

The position of the tympanic membrane in the neonate is more

________________, making it more difficult to visualize with the otoscope.
A. horizontal
B. vertical
C. perpendicular
D. Oblique
E. The position of the eardrum is more horizontal in the neonate,
making it more difficult to see completely and harder to differentiate from
the canal wall.
F. By 1 month of age, the eardrum is in the oblique position
similar to an older child, and examination is easier.
9.
The tympanic membrane of a child with acute otitis media would be:
A. flat and slightly pulled in at the center.
B. mobile and would flutter with the Valsalva maneuver.
C. bulging with a distinct red color.
D. shiny and translucent, with a pearly gray color.
E. The tympanic membrane would be bulging and red with acute
otitis media.
F. A normal tympanic membrane is flat and slightly pulled in at
the center.
G.

A normal tympanic membrane is mobile and flutters

with the Valsalva maneuver.

H.A normal tympanic membrane is shiny and translucent, with a
pearly gray color.
10.
If the tympanic membrane has white dense areas, the examiner suspects:
A. perforation from a ruptured membrane.
B. scarring from recurrent ear infections.
C. serous fluid from serous otitis media.
D. a fungal infection.
E. White dense areas indicate scarring on the tympanic membrane from
recurrent ear infections.
F. Dark oval areas indicate perforation from a ruptured tympanic
membrane.
G. Air or fluid levels or air bubbles indicate serous fluid from serous otitis
media.
H. Black or white dots indicate a fungal infection.

Chapter 16, Nose Mouth and Throat

1.
The nasal mucosa of an individual with rhinitis would be:
A. moist and pink.
B. swollen, boggy, and gray.
C. bright red and swollen.
D. pale with bright red bleeding.
E. The nasal mucosa is bright red and swollen with rhinitis.
F. Normally, the nasal mucosa is red with a smooth and moist
surface.
G.

The nasal mucosa is swollen, boggy, pale, and gray

with chronic allergies.

H.Bright red bleeding occurs with epistaxis (bleeding from the
nose).
2.
The examiner notices a fine tremor when the patient sticks out his or her
tongue. What disorder is consistent with this finding?
A. Hyperthyroidism
B. Diabetic ketoacidosis
C. Halitosis
D. Alcoholism
E. A fine tremor of the tongue occurs with hyperthyroidism.
F. A patient in diabetic ketoacidosis would have a sweet, fruity
breath odor.
G.
Halitosis is a term used to describe any breath odor.
H.A coarse tremor occurs with alcoholism.
3.
Which of the following questions would the examiner ask to determine
whether an individual has epistaxis?

A. Do you have any difficulty with swallowing?

B. Have you ever noticed any unusual lesions on the inside of
your mouth?
C. Do you experience nosebleeds?
D. Do you experience a runny nose frequently?
4.
On examination of the mouth of an American Indian, the examiner notices the
presence of a bifid uvula. How should this finding be interpreted?
A. This is an expected variation associated with this
individual.
B. This condition is frequently associated with cleft palate.
C. This may indicate the presence of oral cancer.
D. This is rare and indicates other congenital anomalies may be
present.
E. Bifid uvula is a condition in which the uvula is split either
completely or partially. This condition occurs in 18% of individuals in some
American Indian groups.
F. Bifid uvula may indicate a submucous cleft palate.
G.
Bifid uvula is not associated with oral cancer.
H.The incidence of bifid uvula is common in American Indians.
5.
An enlarged tongue (macroglossia) may accompany:
A. cleft palate.
B. hairy tongue.
C. Down syndrome.
D. fissured tongue.
E. Macroglossia occurs with Down syndrome; it also occurs with
cretinism, myxedema, and acromegaly. A transient swelling also occurs with
local infections.
6.
In addition to initiating digestion of food, saliva:
A. augments taste sensation.
B. protects the mucosa from caustic substances.
C. inhibits overgrowth of bacteria in the mouth.
D. cleans and protects the mucosa.
7.
One of the purposes of the paranasal sinuses is to:
A. lighten the weight of the skull bones.
B. warm and moisten the inspired air.
C. amplify sound.
D. augment the sensory sensation of smell.
E. The paranasal sinuses lighten the weight of the skull bones.
F. Nasal mucosa and nasal turbinates warm, humidify, and filter
the inhaled air.
G.
production.

The paranasal sinuses serve as resonators for sound

H.Olfactory receptors (responsible for the sensation of smell)

are located in the nasal cavity and septum and merge into the olfactory
nerve.
8.
The duct in the parotid gland that opens into the mouth opposite the second
molar is:
A. the Wharton duct.
B. the salivary duct.
C. the Stensen duct.
D. the sublingual duct.
E. The duct in the parotid gland is the Stensen duct; it runs
forward to open on the buccal mucosa opposite the second molar.
F. The Wharton duct (for the submandibular gland) runs up and forward
to the floor of the mouth and opens at either side of the frenulum.
G. The mouth contains three pairs of salivary glands, which are the
parotid gland, the submandibular gland, and the sublingual gland.
H. The sublingual gland lies within the floor of the mouth under the
tongue.
9.
Which of the following pairs of sinuses is absent at birth, is fairly well
developed between 7 and 8 years of age, and is fully developed after puberty?
A. Maxillary
B. Frontal
C. Sphenoid
D. Ethmoid
E. The frontal sinuses are absent at birth, are fairly well
developed between 7 and 8 years of age, and reach full size after puberty.
F. The maxillary sinuses are present at birth and reach full size
after all permanent teeth have erupted.
G.
The sphenoid sinuses are minute at birth and develop
after puberty.
H.The ethmoid sinuses are present at birth and grow rapidly
between 6 and 8 years of age and after puberty.
10.
What is the major cause of decreased saliva production in older adults?
A. Use of anticholinergic medications
B. Normal aging process
C. Decreased fluid intake
D. A diminished sense of taste and smell

Chapter 18 - Thorax and Lungs

1.

Increased tactile fremitus would be evident in an individual who has which of

the following conditions?
A. Emphysema
B. Pneumonia
C. Crepitus
D. Pneumothorax
E. Fremitus is a palpable vibration. Increased fremitus occurs
with compression or consolidation of lung tissue (e.g., lobar pneumonia).
F. Decreased fremitus occurs when anything obstructs
transmission of vibrations (e.g., obstructed bronchus, pleural effusion or
thickening, pneumothorax, or emphysema).
G.
Crepitus is a coarse crackling sensation palpable over
the skin surface. It occurs in subcutaneous emphysema when air escapes
from the lung and enters the subcutaneous tissue.
2.
A common clinical manifestation in a patient with chronic obstructive
pulmonary disease (COPD) is:
A. periodic breathing patterns.
B. pursed-lip breathing.
C. unequal chest expansion.
D. Hyperventilation.
E. patient with COPD may purse the lips in a whistling position.
By exhaling slowly and against a narrow opening, the pressure in the
bronchial tree remains positive, and fewer airways collapse.
F. Periodic breathing patterns are Cheyne-Stokes or Biot
respirations. Cheyne-Stokes respirations occur in heart failure, renal failure,
meningitis, drug overdose, and increased intracranial pressure; this type
also normally occurs in infants and older adults during sleep. Biot
respirations occur with head trauma, brain abscess, heat stroke, spinal
meningitis, and encephalitis.
G.
Unequal chest expansion occurs when part of the
lung is obstructed or collapsed, as with pneumonia, or with guarding to
avoid postoperative incisional pain or pleurisy pain.
H.Hyperventilation is a normal response to fever, fear, or
exercise; respiration rate also increases with respiratory insufficiency,
pneumonia, alkalosis, pleurisy, and lesions in the pons.
3.
Which of the following is not included in the definition of the thoracic cage?
A. Sternum
B. Ribs
C. Costochondral junction
D. Diaphragm
E. The thoracic cage comprises the sternum, ribs, vertebrae,
and diaphragm.
4.

Inspiration is primarily facilitated by which of the following muscles?

A. Diaphragm and rectus abdominis
B. Trapezius and sternomastoids
C. Internal intercostal and abdominis
D. Diaphragm and intercostal
5.
Which of the following voice sounds would be a normal finding?
A. The voice transmission is distinct and sounds close to the
ear.
B. The eeeee sound is clear and sounds like eeeee.
C. The whispered sound is transmitted clearly.
D. Whispered 1-2-3 is audible and distinct.
6.
The gradual loss of intra-alveolar septa and a decreased number of alveoli in
the lungs of elderly adults cause:
A. hyperventilation.
B. spontaneous atelectasis.
C. decreased surface area for gas exchange.
D. decreased dead space.
7.
The function of the trachea and bronchi is to:
A. transport gases between the environment and the lung
parenchyma.
B. condense inspired air for better gas exchange.
C. moisturize air for optimum respiration.
D. increase air turbulence and velocity for maximum gas
transport.
8.
Stridor is a high-pitched, inspiratory crowing sound commonly associated
with:
A. upper airway obstruction.
B. atelectasis.
C. congestive heart failure.
D. Pneumothorax.
E. Stridor is associated with upper airway obstruction from swollen,
inflamed tissues or a lodged foreign body.
9.
Percussion of the chest is:
A. a useful technique for identifying small lesions in lung tissue.
B. helpful only in identifying surface alterations of lung
tissue.
C. is not influenced by the overlying chest muscle and fat tissue.
D. normal if a dull note is elicited.
E. An abnormal finding must be 2 to 3 cm wide to yield an
abnormal percussion note.
F. Percussion detects only the outer 5 to 7 cm of tissue; it does
not penetrate to reveal any change in density deeper than that.

G.

Percussion findings (resonant notes) may be modified

by a muscular chest wall of an athlete or subcutaneous tissue of an obese

person.
H.Resonance is a low-pitched, clear, hollow sound that
predominates with percussion of healthy lung tissue.
10.
Which of the following pairs correctly expresses the relationship to the lobes
of the lungs and their anatomic position?
A. Upper lobeslateral chest
B. Upper lobesposterior chest
C. Lower lobesposterior chest
D. Lower lobesanterior chest
E. The posterior chest is almost all lower lobe.
F. The anterior chest contains mostly upper and middle lobe with very
little lower lobe.

11.
An increase in the transverse diameter of the chest cage in a pregnant
woman is due to a(n):
A. compensatory increase in respiratory parenchyma.
B. increase in estrogen.
C. increase in surfactant.
D. increase in tidal volume.
E. The increase in estrogen level during pregnancy relaxes the
chest cage ligaments. This allows an increase in the transverse diameter of
the chest cage by 2 cm, and the costal angle widens.

Chapter 19 - Heart and Neck Vessels

1.The first heart sound (S1) is produced by the:

A. closure of the semilunar valves.

B. closure of the AV valves.
C. opening of the semilunar valves.
D. opening of the AV valves.
E. S1 occurs with closure of the atrioventricular valves.
F. The second heart sound (S2) occurs with closure of the
semilunar valves.
G.

Normally opening of the semilunar valves is silent, but

in aortic or pulmonic stenosis, an ejection click may be heard. An ejection

click occurs early in systole at the start of ejection because it results from
opening of the semilunar valves.
H.A third heart sound (S3) can be heard when the ventricles are
resistant to filling during the early rapid filling phase. S3 is heard when the
AV valves open and atrial blood first pours into the ventricles.
2.
Which of the following guidelines may be used to identify which heart sound
is S1?
A. S1 is louder than S2 at the base of the heart.
B. S1 coincides with the A wave of the jugular venous pulse
wave.
C. S1 coincides with the carotid artery pulse.
D. S1 coincides with the Q wave of the QRS electrocardiogram
complex.
E. S1 coincides with the carotid artery pulse.
F. S1 is loudest at the apex of the heart.

G.

S1 coincides with the C wave of the jugular venous

pulse wave.
H.S1 coincides with the R wave (the upstroke of the QRS
complex).
3.
Which of the following cardiac alterations occurs during pregnancy?
A. An increase in cardiac output and blood pressure
B. An increase in cardiac volume and a decrease in blood
pressure
C. An increased heart rate and increased blood pressure
D. An increased stroke volume and decreased cardiac output
E. During pregnancy the blood volume increases by 30% to
40%; this creates an increase in stroke volume and cardiac output and an
increased pulse rate of 10 to 15 beats per minute. The arterial blood
pressure decreases in pregnancy as a result of peripheral vasodilation.
4.
Which of the following is an appropriate position to have the patient assume
when auscultating for extra heart sounds or murmurs?
A. Roll toward the left side
B. Roll toward the right side
C. Trendelenburg position
D. Recumbent position
E. After auscultation in the supine position, the nurse should
have the patient roll onto the left side; the examiner should listen at the
apex with the bell for the presence of any diastolic filling sounds (i.e., S 3 or
S4) or murmurs that may be heard only in this position. The examiner
should have the patient sit up and lean forward; the examiner should
auscultate at the base with the diaphragm for a soft, high-pitched, early
diastolic murmur of aortic or pulmonic regurgitation.
5.
The leaflets of the tricuspid and mitral valves are anchored by
__________________ to the _________________, which are embedded in the
ventricular floor.
A.
B.
C.
D.

endocardial ligaments; mediastinal muscles

atrioventricular tendons; pericardial bundles
chordae tendineae; papillary muscles
pericardial cords; ventricular sheaths

6.
The ability of the heart to contract independently of any signals or stimulation
is due to:
A.
B.
C.
D.
7.

depolarization.
automaticity.
conduction.
repolarization.

When auscultating the heart of a newborn within 24 hours after birth, the
examiner hears a continuous sound that mimics the sound of a machine. This finding
most likely indicates:
A. the presence of congenital heart disease.
B. a normal sound because of the thinner chest wall of the
newborn.
C. an expected sound caused by nonclosure of the ductus
arteriosus.
D. pathology only when accompanied by an increased heart
rate.The murmur of a patent ductus arteriosus is a continuous machinery
murmur, which disappears by 2 to 3 days.
8.
A bruit heard while auscultating the carotid artery of a 65-year-old patient is
caused by:
A. decreased velocity of blood flow through the carotid artery.
B. turbulent blood flow through the carotid artery.
C. rapid blood flow through the carotid artery.
D. increased viscosity of blood.
E. A carotid bruit is a blowing, swishing sound indicating blood
flow turbulence. A bruit indicates atherosclerotic narrowing of the vessel.
9.
The jugular venous pressure is an indirect reflection of the:
A. hearts efficiency as a pump.
B. cardiac cycle.
C. conduction effectiveness.
D. synchronization of mechanical activity.
E. Jugular venous pressure is a reflection of the hearts ability to pump
blood. If the pressure is elevated, heart failure is suspected.
10.
The semilunar valves separate the:
A. atria from the ventricles.
B. right atria from the left atria.
C. ventricles from the arteries.
D. atria from the veins.
E. The semilunar valves separate the ventricles from the
arteries. The atrioventricular valves separate the atria and ventricles.
F. The atrioventricular valves separate the atria and the
ventricles.
G.

The septum separates the right atria from the left

atria.
H.The vena cava are not separated by a valve from the right
atrium; the pulmonary veins are not separated by a valve from the left
atrium.