Chapter 9 General Survey and Measurement

5. Which factors do you observe when assessing a patient's mobility? (Select all that apply.) A. Gait B. Body position C. Range of motion. D. Posture E. Stature

A. Gait C. Range of motion. When assessing a patient's mobility, you should observe gait and range of motion. Body position, posture, and stature are parameters of the assessment of body structure.

4. A 57-year-old male patient presents with complaints about feelings of depression. While conducting the general survey, you pay particular attention to the behavior assessment. In addition to facial expression, speech, speech pattern, and dress, which factors does this assessment include? A. Mood/affect and personal hygiene B. Presence of depression, and the number of hours spent in bed per day C. Memory and behaviors representative of dementia D. Personal hygiene and vocabulary

A. Mood/affect and personal hygiene The behavior assessment component of the general survey includes the parameters of mood/affect and personal hygiene as well as facial expression, speech, speech pattern, and dress.

15. When measuring a patient's waist circumference which procedural guidelines do you follow? A. Position the measuring tape at the iliac crest. B. Note the measure at the end of a deep exhalation. C. Hold the measuring tape tight enough to indent the skin. D. Obtain two measures and record their average.

A. Position the measuring tape at the iliac crest. To measure a patient's waist circumference, have the person stand and then palpate to locate the iliac crest which is the top of the hip bone. Place a measuring tape around the waist, parallel to the floor, at the level of the iliac crest. The tape should be snug but not pinch in the skin. Note the measurement at the end of a normal expiration.

12. When does the general survey begin? A. The moment you see the patient B. Once you have introduced yourself C. With the first question you ask the patient D. As the patient moves to the examining table

A. The moment you see the patient The general survey begins at the moment you first encounter the person. What leaves an immediate impression? Does the person stand promptly as his or her name is called and walk easily to meet you? Or does the person look sick, rising slowly or with effort, with shoulders slumped and eyes without luster or downcast? Is the hospitalized patient conversing with visitors, involved in reading or television, or lying perfectly still? Even as you introduce yourself and shake hands, you collect data. Does the person fully extend the arm, shake your hand firmly, make eye contact, or smile? Are the palms dry or wet and clammy? As you proceed through the health history, the measurements, and the vital signs, consider and make note of these four areas: physical appearance, body structure, mobility, and behavior.

6. As part of the general survey, the examiner compares the patient's appearance to which factor? A. Reported mood B .Stated age C. Documented occupation D. Recorded ethnicity

B .Stated age The general survey area of physical appearance includes statements that compare appearance to the patient's stated age. Appearance older than the biological age can indicate chronic disease or chronic alcoholism, among other factors.

1. Mr. Ward is a 58-year-old patient who presents with exogenous obesity. When discussing this problem with Mr. Ward, what information is appropriate to include? (Select all that apply.) A. Excessive catabolism is responsible for his weakness, thin arms and legs, and reduced height. B. This type of obesity is one in which body fat is evenly distributed. C. Muscle wasting is a primary characteristic of exogenous obesity. D. Exogenous obesity is due to caloric intake being greater than caloric expenditure. E. This type of obesity is accompanied by thin, fragile skin with purple abdominal striae, bruising, and acne.

B, D With exogenous obesity, body fat is the result of excessive caloric intake and is evenly distributed. Muscle strength is intact. Weakness, thinning extremities, muscle wasting, and reduced height are characteristics of endogenous obesity, as is a thin, fragile skin often with bruising and acne.

11. Mrs. Jones brings her son in for a follow-up well-child visit. As the health care provider, how often do you measure the head circumference? A. At birth and then during every well-child visit until 2 years of age B. At birth, at each well-child visit until 2 years of age, and then annually until 6 years of age C. At birth and then every 6 months until 2 years of age D. At birth and then annually until 6 years of age

B. At birth, at each well-child visit until 2 years of age, and then annually until 6 years of age Head circumference is measured at birth, at each well-child visit until 2 years of age, and then annually until 6 years of age. The measurement is plotted on a standardized growth chart and the patient's measurement is compared with that expected for age. The pattern of head growth is more significant than any single measurement figure.

7. Under which assessment category of the general survey are nutritional status, posture, position while seated, and the presence of a physical handicap or deformity documented? A. Physical appearance B. Body structure C. Mobility D. Behavior

B. Body structure Nutritional status, posture, position while seated, and the presence of a physical handicap or deformity are documented under body structure. Age, sex, level of consciousness, skin color, and facial features are documented under physical appearance. Gait and range of motion are documented under mobility. Facial expression, mood/affect, speech, speech pattern, dress, and personal hygiene are documented under behavior.

8. You assess a patient's gait as he walks from the waiting room to the exam room. In so doing, you keep in mind which fact about the base of support? A. Normally it is half the height of the person. B. Normally it is equal to shoulder width. C. Normally it is dependent on height. D. Normally it is proportionate to arm length.

B. Normally it is equal to shoulder width. Normally, when walking, the base is as wide as the shoulder width; foot placement is accurate; the walk is smooth, even, and well-balanced; and associated movements, such as symmetric arm swing, are present. The width of the base is not related to height nor is it proportionate to arm length.

9. Mrs. Bergen brings her 14-month-old son to the clinic for a follow-up well-child visit. Which technique should be your best choice for measuring his height? A. Use a tape measure while the infant is supine, measuring head to waist and then waist to toe. Incorrect B. Use a horizontal measuring board. C. Use a stadiometer. D. Measure arm span to estimate height.

B. Use a horizontal measuring board. Use of a horizontal measuring board is the best method to measure the height of older infants. Use of a tape measure is inaccurate. A stadiometer is used for children age 2 or 3 years. Although arm span (fingertip to fingertip) should equal height, it is not the recommended method of measurement.

3. An 18-month-old child is brought into the clinic for a health screening visit. To assess the height of the child: A. Use a tape measure B. Use of horizontal measuring board C. Have the child on the upright scale D. Measure arm span to estimate height

B. Use of horizontal measuring board

14. In reviewing a patient's record, you note that under mobility a problem with propulsion is identified. What would you observe for when you meet this patient? A. difficulty getting up from a sitting position B. difficulty stopping when walking C. jerky, staggering gait D. uncoordinated arm swing

B. difficulty stopping when walking Propulsion refers to difficulty stopping when walking. A propulsive gait is one in which a person's steps become faster and smaller creating the risk of falling over frontwards. It is characteristic of Parkinson's disease.

5. Which changes regarding height and weight occur during a person's 80s and 90s? A. Both increase B. Weight increase, and height decreases C. Both decrease D. Both remain the same as during the 70s

C. Both decrease

2. You are assessing a patient's gait. What do you expect to find? A. Gait is varied, depending on the height of the person. B. Gait is equal to the length of the arm. C. Gait is as wide as the shoulder width. D. Gait is half the height of the person.

C. Gait is as wide as the shoulder width.

2. Which assessment finding supports the conclusion that the patient has endogenous obesity? A. Body fat is evenly distributed. B. Patient reports a sedentary lifestyle and high caloric intake. C. Patient has marked central trunk and cervical fat. D. Muscle strength is normal.

C. Patient has marked central trunk and cervical fat. With endogenous obesity, body fat is the result of production of excess cortisol by the adrenal cortex in response to either administration of adrenocorticotropin (ACTH) or excessive production of ACTH by the pituitary gland. With endogenous obesity, there is marked central trunk and cervical fat, muscle wasting, weakness, thinning extremities, and reduced height. Also, the skin is thin and fragile and often marked with bruising and acne.

3. What are the four distinct, overriding categories of assessment that comprise the general survey? A. Personal hygiene, dress, speech, and mood/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

C. Physical appearance, body structure, mobility, and behavior The four distinct, overriding areas of assessment that comprise the general survey are physical appearance, body structure, mobility, and behavior. Parameters falling within the category of physical appearance are age, sex, level of consciousness, skin color, facial features, and overall appearance. Parameters in the category of body structure are stature, nutrition, symmetry, posture, position, body build, and obvious physical deformities. Parameters in the category of mobility are gait, range of motion, and absence of involuntary movement. Parameters in the category of behavior are facial expression, mood and affect, speech, speech pattern, dress, and personal hygiene.

13. Which word or phrase describes an expected characteristic of posture in a toddler? A. Plumb line B. Kyphotic C. Protruberant abdomen D. Malleable

C. Protruberant abdomen The standing toddler has a normally protruberant abdomen, which is sometimes termed "toddler lordosis". "Plumb line" refers to the straight posture of other age groups when standing comfortably. With good posture the straight plumb line passes through the anterior ear, shoulder, hip, patella, and ankle. The posture of some aging persons may be stooped as a result of kyphosis, which is an excessive convex curvature of the spine.

4. Which changes in head circumference measurements in relation to chest measurements will occur from infancy through early childhood? A. A newborn's head should be approximately 5 cm larger than the chest circumference, but by 2, they should be equal B. The chest grows at a faster rate than the cranium, but at age 1, the measurements will be the same, and after age 2, the chest should be approximately 5 cm larger. C. The newborn's head will be approximately 2 cm larger than the chest circumference, but between 6 months and 2 years, they will be about the same. D. The head and chest circumferences should be very similar, but between 6 months and 2 years, the chest size will increase and remain the way.

C. The newborn's head will be approximately 2 cm larger than the chest circumference, but between 6 months and 2 years, they will be about the same.

1. The 4 areas to consider during the general survey include: A. Ethnicity, gender, age, and socioeconomic status B. Physical appearance, gender, ethnicity, and affect C. Dress, affect, nonverbal behavior, and mobility D. Physical appearance, body structure, mobility, and behavior

D. Physical appearance, body structure, mobility, and behavior

10. The general survey for an infant or child consists of which assessment categories? A. Facial characteristics, mobility, body structure, behavior, maternal bonding B. Physical appearance, mobility, body contour, behavior, prenatal bonding C. Physical stature, parent nurturing, body contour, behavior, mobility D. Physical appearance, mobility, body structure, behavior, parental bonding

D. Physical appearance, mobility, body structure, behavior, parental bonding The five assessment categories comprising an infant's or child's general survey are physical appearance, mobility, body structure, behavior, and parental bonding.