Exam 3

It is not unusual to find postauricular and occipital nodes in: children younger than 2 years of age. a. school-age children. b. adolescents. c. adults. d. older adults.

ANS: A Children younger than 2 years of age often have enlarged postauricular and occipital nodes.

To estimate heart size by percussion, you should begin tapping at the: a. apex. b. left sternal border. c. midclavicular line. d. midsternal line. e. anterior axillary line.

ANS: E Estimating the size of the heart can be done by percussion. Begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border. The change from a resonant to a dull note marks the cardiac border.

Initial signs and symptoms of Epstein-Barr virus mononucleosis most often include: a. pharyngitis, fever, and malaise. b. bleeding gums and spontaneous nosebleeds. c. headache, visual disturbance, and rash. d. inguinal adenopathy and painful urination. e. discrete labial and gingival ulcers and high-grade fever.

ANS: A Presenting symptoms of Epstein-Barr virus mononucleosis include pharyngitis, fever, fatigue, malaise, often splenomegaly, and occasionally hepatomegaly or rash.

The carotid pulse should coincide with which heart sound? a. S1 b. S2 c. S3 d. S4 e. S3-4

ANS: A S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1 while you palpate the carotid pulse. S2 marks the start of diastole. S3-4 is an abnormal summation gallop sound.

The abdomen should be auscultated for at least how many minutes before declaring hypoactive bowel sounds? a) One b) Two c) Three d) Four e) Five

e) Five

What condition is associated with striae that remain purplish? a. Cushing disease b. Diastasis recti c. Liver cirrhosis d. Recent pregnancy e. Intraabdominal bleeding

ANS: A Striae from pregnancy or obesity begin as a pink or purple color then turn silvery white; striae associated with Cushing disease stay purplish.

A bounding pulse in an infant may be associated with: a. patent ductus arteriosus. b. coarctation of the aorta. c. decreased cardiac output. d. peripheral vaso-occlusion. e. painful, swollen extremities.

ANS: A A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities or between femoral and radial pulses and absence of the femoral pulse suggests a coarctation of the aorta. Painful, swollen extremities are usually a sign of venous occlusion.

A healthy prostate protrudes into the rectal wall a distance of _______ cm. a. less than 1 b. 1 to 2 c. 2 to 3 d. 3 to 4 e. more than 4

ANS: A A healthy prostate should not protrude more than 1 cm into the rectum

The term claudication refers to: a. pain from muscle ischemia. b. lack of palpable pulsations. c. visible extremity changes of arterial occlusion. d. numbness and tingling in toes and fingers. e. constriction or narrowing of a vessel.

ANS: A Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping. It is brought on by sustained exercise and relieved by rest. Individuals with peripheral artery disease experience claudication because of a decrease in the amount of blood passing through the artery as a result of atherosclerosis, which cause the arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age.

In children, coarctation of the aorta should be suspected if you detect: a. a delay between the radial and femoral pulses. b. a simultaneous radial and femoral pulse. c. an absent femoral pulse on the left. d. bilateral absence of femoral pulses. e. equal blood pressure in the arms and legs.

ANS: A Coarctation of the aorta is a congeniItal stenosis or narrowing seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum. Ordinarily, the radial and femoral pulses are palpated simultaneously. When there is a delay or a palpable diminution of amplitude of the femoral pulse, coarctation must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion.

Mrs. G is 7 months' pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas, such as: a. decreased movement through the colon and increased water absorption from stool. b. increased movement through the colon and increased salt taken from foods. c. looser anal sphincter and less nutrients taken from foods. d. tighter anal sphincter and less iron eliminated in the stool. e. increased absorption of nutrients and water in the colon.

ANS: A Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. The colon does not absorb nutrients, and a tighter sphincter tone is not related to pregnancy.

Peritonitis often produces bowel sounds that are: a. decreased. b. increased. c. high pitched. d. absent. e. accentuated.

ANS: A Decreased bowel sounds occur with peritonitis and paralytic ileus.

All of the following are characteristics of the Frailty syndrome in older adults except: a. weight gain b. inability to climb one flight of stairs. c. inability to walk one block. d. most common in adults over age 70. e. linked to comorbid conditions.

ANS: A Frailty syndrome is characterized by signs and symptoms of being frail: weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss. It is linked to comorbid conditions and carries an elevated risk of catastrophic declines in health and function, including disability, hospitalization falls, fracture, and death It is most common in adults older than 70 years old and is increasingly common after age 80 years of age.

Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe's lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe's symptoms? a. Intussusception b. Kidney stones c. Meconium ileus d. Pyloric stenosis e. Necrotizing enterocolitis

ANS: A Intussusception refers to the prolapse of one segment of the intestine into another causing intestinal obstruction. Whereas a sausage-shaped mass may be palpated in the right or left upper quadrant, the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age.

A lower spinal cord lesion may be indicated by which finding? a. Lack of an "anal wink" b. Anorectal fissure c. Anal fistula d. Passage of meconium e. Small flaps of anal skin

ANS: A Lightly touching the anal opening of an infant should produce a contraction referred to as the "anal wink." A negative wink may indicate a lower spinal cord lesion.

Lymph flows faster in response to: a. massage. b. decreased blood volume. c. decreased metabolic rate. d. decreased permeability of the capillary walls. e. decreased capillary pressure.

ANS: A Lymph flow increases with mounting capillary pressure, greater permeability of the capillary walls, increased metabolic rate, and massage.

Which of the following organs does not have lymphatic vessels? a. Brain b. Kidneys c. Liver d. Lungs e. Appendix

ANS: A Lymphatic tissues are found abundantly throughout the body except in two places, the placenta and the brain (central nervous system).

A grade I or II murmur, without radiation and of medium pitch, is a common variation found in: a. school-age children. b. older women. c. middle-aged men. d. sedentary individuals. e. older adults

ANS: A Many murmurs, particularly in children, adolescents, and especially young athletes, have no apparent cause. These are generally grade I or II murmurs that are usually midsystolic and without radiation, are medium pitched, and are blowing, brief, and often accompanied by splitting of S2.

Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the: a. P wave. b. PR interval. c. QRS complex. d. ST segment. e. T wave.

ANS: A The P wave represents the spread of a stimulus through the atria (atrial depolarization). The PR interval is the time from the initial stimulation of the atria to the initial stimulation of the ventricles, usually 0.12 to 0.20 second. The QRS complex is the spread of a stimulus through the ventricles (ventricular depolarization), less than 0.10 second. The ST segment and T wave are the return of stimulated ventricular muscle to a resting state (ventricular repolarization).

If the apical impulse is more vigorous than expected to the chest wall, it is called: a. a lift. b. a thrill. c. a bruit. d. a murmur. e. crepitus.

ANS: A The apical impulse is more vigorous than expected; it is referred to as a heave or lift. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A murmur is an auscultated sound that is caused by turbulent blood flow into, through, or out of the heart. Crepitus is air in the subcutaneous tissue from respirations.

A common cause of dark green or black stool color during pregnancy is indicative of: a. consumption of iron preparations. b. consumption of vitamins. c. intestinal parasites. d. slow bleeding of hemorrhoids. e. slow intestinal bleeding.

ANS: A The daily use of iron replacement therapy, as expected during pregnancy, causes dark green or black stools.

Which structure is located in the hypogastric region of the abdomen? a. Bladder b. Cecum c. Gallbladder d. Stomach e. Liver

ANS: A The hypogastric (pubic) area contains the ileum, the bladder, and the pregnant uterus.

Factors associated with increased risk of prostate cancer include: a. African American descent. b. cigarette smoking. c. low-fat diet. d. alcoholism. e. obesity.

ANS: A The incidence rate of prostate cancer is more common in African Americans and in Caribbean patients of African ancestry; less common in Asian American and Hispanic/Latinos than in non-Hispanic whites.

The initial digital approach to the rectal examination should be: a. at a right angle to the anus. b. with direct horizontal pressure of fingertip. c. with the finger pad pressed against anal verge. d. during sphincter tightening. e. bidigital palpation with thumbs.

ANS: A The initial approach should be with the finger pad pressed against the perianal area at the anal junction. The sphincter will tighten and relax, and then the examination index finger should be flexed and inserted.

The adult internal rectal sphincter is controlled by the: a. autonomic nervous system. b. central nervous system. c. peripheral nervous system. d. lumbar spinal reflexes. e. sacral spinal reflexes.

ANS: A The internal ring of smooth muscle of the anal canal is under involuntary autonomic control.

The major function of the large intestine is: a. water absorption. b. food digestion. c. carbohydrate absorption. d. mucous absorption. e. glycogen breakdown

ANS: A The major function of the large intestine is the absorption of water and excretion of solid waste material in the form of stool. Mucous glands secrete large quantities of alkaline mucus.

To assess a patient's jugular veins, he or she should first be placed in which position? a. Supine b. Semi-Fowler c. Upright d. Left lateral recumbent e. Leaning forward

ANS: A To assess jugular veins, place the patient in supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the jugular vein pulsating becomes visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated.

Contraction of the ventricles causes: a. closure of the atrioventricular valves. b. closure of the pulmonic and aortic valves. c. opening of the mitral valve and closure of the tricuspid valve. d. opening of the mitral and tricuspid valves. e. opening of the auricular septa.

ANS: A When the ventricles contract, the semilunar, pulmonic, and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles.

Vascular changes expected in older adults include: a. loss of vessel elasticity. b. decreased peripheral resistance. c. decreased pulse pressure. d. constriction of the aorta and major bronchi. e. increased vasomotor tone.

ANS: A With age, the walls of the arteries become calcified, and they lose their elasticity and vasomotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resistance occurs, causing an increase in blood pressure.

An examiner can recognize a friction rub in the liver by a sound that is: a. clicking, gurgling, and irregular. b. high pitched and associated with respirations. c. loud, prolonged, and gurgling. d. soft, low-pitched, and continuous. e. low pitched, tinkling, and unrelated to respirations.

ANS: B An abdominal friction rub is rare and can be identified when high-pitched sounds are auscultated in association with respirations.

To make visualization of polyps in the anorectal area easier, you should: a. apply clear jelly around the anal orifice. b. ask the patient to bear down. c. ask the patient to relax the sphincter. d. rotate your finger inside the anal canal. e. have the patient contract the external sphincter.

ANS: B Asking the patient to perform a Valsalva maneuver will make fistulas, fissures, polyps, and hemorrhoids more visible.

During auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split. You should ask the patient to inhale deeply while listening at the ________ area. a. aortic b. pulmonic c. tricuspid d. mitral e. apex

ANS: B Splitting results from the failure of the mitral and tricuspid valves or the pulmonic and aortic valves to close simultaneously. Splitting of S1 is usually not heard because the closing of the tricuspid valve is too faint. Rarely, it may be audible in the tricuspid area on deep inspiration. Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site.

A venous hum heard over the internal jugular vein of a child: a. usually signifies untreatable illness. b. usually has no pathologic significance. c. usually requires surgical intervention. d. must be monitored until the child is grown. e. usually indicates dehydration.

ANS: B A venous hum is caused by the turbulence of blood flow in the internal jugular veins. A venous hum is common in children and usually has no pathologic significance. To detect a venous hum, auscultate over the right supraclavicular space at the medial end of the clavicle and along the anterior border of the sternocleidomastoid muscle. It is louder during diastole.

The major heart sounds are normally created by: a. valves opening. b. valves closing. c. the rapid movement of blood. d. rubbing together of the cardiac walls. e. pulmonic veins.

ANS: B At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1 "lubb." When the pressure in the ventricles falls, below that of the aorta and pulmonary artery, and when the ventricles are almost empty, the aortic and pulmonic valves close, producing the second heart sound S2 "dubb." Valve opening is usually a silent event.

A major risk factor for arterial embolic disease is: a. venous thrombosis. b. atrial fibrillation. c. hypotension. d. diuretic therapy. e. constrictive pericarditis.

ANS: B Atrial fibrillation results in a disturbance of blood flow through the atrium. Blood is not pumped out completely, so it may pool and clot. An embolus can travel throughout the arterial system, causing an occlusion of small arteries and leading to necrosis of the tissue.

Closure of the ductus arteriosus usually occurs: a. just before the initiation of labor. b. 24 to 48 hours after birth. c. after 7 days of life. d. between the second and third months of life. e. during the toddler stage.

ANS: B Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth.

The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it: a. only affects the GI tract. b. is one cause of malabsorption syndrome. c. is a curable condition with medical intervention. d. is the most frequent cause of diarrhea in general practice. e. is a common genetic disorder.

ANS: B Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are frequent concerns.

In differentiating between an occluded artery or vein, a differentiating sign (present in venous but not arterial occlusion) is: a. color change. b. edema. c. pain with walking. d. pain with palpation. e. paralysis.

ANS: B Deep vein thrombosis is suspected if swelling, pain, and tenderness occur over a vein. An occluded artery does not cause any swelling (edema). A positive Homan sign indicates venous thrombosis. Paralysis is a rare complication of arterial occlusion.

A split-second heart sound is: a. abnormal. b. greatest at the peak of inspiration. c. heard best after forceful expiration. d. supposed to disappear with deep inspiration. e. always accompanied by a thrill.

ANS: B Splitting of S2 is an expected event because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. It is never accompanied by a thrill.

Which of the following statements is most accurate in describing hepatic jugular reflux? a. It is an accurate indicator of heart failure. b. It is exaggerated in patients with right heart failure. c. It is normal when patients are sitting up straight. d. It should be absent in older patients with heart failure. e. It never elevates the jugular venous pressure (JVP) in patients without heart failure.

ANS: B Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. All patients will have elevation of the JVP with this maneuver, depending on the elevation of their head and their underlying venous pressure. Use your hand and apply firm pressure to the abdomen in the mid-epigastric region while the patient breathes regularly. Observe the neck for increased JVP followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and the release of the abdominal hand pressure.

If pitting edema is unilateral, you would suspect occlusion of a: a. lymphatic duct. b. major vein. c. surface capillary. d. superficial artery. e. deep artery.

ANS: B If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema.

A congenital defect in the immune system of a 2-week-old infant may be suspected if: a. there are small, palpable inguinal nodes. b. the umbilical cord has not yet dropped off. c. the tonsils are visible. d. the thymus is visible on a chest radiograph. e. the small postauricular nodes are palpable.

ANS: B In some infants, delayed separation of the umbilical cord has been associated with abnormal granulocyte function.

Transillumination is done during an examination of the lymphatic system to: a. detect lymphatic pulsation. b. distinguish nodes from cysts. c. evaluate nodal contours. d. observe erythematous lesions. e. distinguish blood vessels from nodes.

ANS: B Larger nodal masses should be transilluminated to determine whether the mass is a cyst, rather than a node. A cyst will transilluminate; a node will not.

The predominant formed elements of normal lymph fluid are: a. red blood cells. b. white blood cells. c. platelets. d. antigens. e. antibodies.

ANS: B Lymph fluid is mostly composed of variety .of lymphocytes, minimal red blood cells, no platelets, and some antigens and antibodies according to its immune function.

A red streak that follows the course of the lymphatic collecting duct is a finding associated with: a. Hodgkin lymphoma. b. lymphangitis. c. lymphedema. d. non-Hodgkin lymphoma. e. roseola infantum.

ANS: B Lymphangitis, inflammation of the lymphatic vessels, is evident by a red streak that follows the course of the inflamed lymphatic duct. Hodgkin lymphoma and non-Hodgkin lymphoma refer to malignancies manifested primarily by nodal enlargements; lymphedema is lymph swelling that distinguishes itself from interstitial edema because it does not pit. Roseola is a common early childhood viral illness that may present with occipital and postauricular adenopathy.

Failure to pass a meconium stool in the first 24 hours after birth along with abdominal distention is often the first sign of: a. Meckel diverticulum. b. cystic fibrosis. c. biliary atresia. d. hydramnios. e. Wilms tumor.

ANS: B Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease.

Infants born weighing less than 1500 g are at higher risk for: a. hepatitis A. b. necrotizing enterocolitis. c. urinary urgency. d. cystic fibrosis. e. pancreatitis.

ANS: B Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants; it involves infection and inflammation that causes destruction of the bowel, and it becomes more apparent after feedings. Low birth weight does not relate to the development of hepatitis A, urinary urgency, cystic fibrosis, or pancreatitis.

Normal heart sounds are best heard: a. directly over the semilunar and bicuspid heart valves. b. over areas where blood flows after it passes through a valve. c. near the carotid vessels. d. over the central sternum. e. over the ribs.

ANS: B Normal heart sounds are best heard in areas where blood flows after it passes through a valve in the direction of blood flow.

Prostate examination findings of a hard, irregular, painless nodule with obliteration of the median sulcus are signs of: a. benign prostatic hypertrophy. b. cancer of the prostate. c. longstanding prostatitis. d. swelling caused by aging. e. acute prostatitis.

ANS: B Obliteration of the median sulcus is consistent with organ enlargement; associated findings of a hard, irregular, and painless nodule are more likely a cancerous growth.

The posterior surface of the prostate can be located by palpation of the: a. posterior wall of the rectum. b. anterior wall of the rectum. c. lateral wall of the anus. d. lower abdomen and perineum. e. anal canal and perineum.

ANS: B Palpation of the rectal anterior wall facilitates posterior prostate location.

Visible intestinal peristalsis may indicate: a. normal digestion. b. intestinal obstruction. c. increased pulse pressure of aorta. d. aortic aneurysm. e. paralytic ileus.

ANS: B Peristalsis is not usually visible and when detected may indicate an intestinal obstruction.

You are listening to a patient's heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following? a. S1 b. S2 c. S3 d. S4 e. S3-4

ANS: B S2 marks the closure of the semilunar valves, which indicates the end of systole, and is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically splits during inspiration.

The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the: a. P wave. b. QRS complex. c. PR interval. d. T wave. e. U wave.

ANS: B The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to the initiation of stimulation of the ventricles. The T wave is the return of the stimulated ventricular muscle to a resting state. The U wave is a small deflection sometimes seen just after the T wave.

The appendix is an extension of the: a. ileum. b. cecum. c. ascending colon. d. transverse colon. e. descending colon.

ANS: B The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum.

To hear diastolic heart sounds, you should ask patients to: a. lie on their backs. b. lie on their left sides. c. lie on their right sides. d. sit up and lean forward. e. lie prone.

ANS: B The left lateral recumbent position is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. The right lateral recumbent position is the best position for evaluating a right rotated heart of dextrocardia.

The superior most part of the stomach is the: a. body. b. fundus. c. pylorus. d. cardiac orifice. e. pyloric orifice.

ANS: B The most superior aspect of the stomach is the fundus, followed by the body, and then the most distal part, the pylorus.

Heart position can vary depending on body habitus. In a short, stocky individual, you would expect the heart to be located: a. more to the right and hanging more vertically. b. more to the left and lying more horizontally. c. riding higher in the chest and pushed anteriorly. d. hanging lower in the chest and riding more vertically. e. more to the right and lying more horizontally.

ANS: B The position of the heart varies depending on body build, configuration of the chest, and level of the diaphragm. A tall, slender person's heart tends to hang vertically and is positioned centrally. A stocky, short person's heart tends to lie more to the left and more horizontally.

In males, which surface of the prostate gland is accessible by digital examination? a. Median lobe b. Posterior c. Superior d. Anterior e. Lateral

ANS: B The posterior surface of the prostate gland lies close to the anterior wall of the rectum and is palpable through digital recta examination.

To find the infection site associated with acute lymphangitis, the examiner should look to the inflammation. a. proximal b. distal c. contralateral d. anterior e. posterior

ANS: B The red streak of inflammation will follow the direction (proximal) of lymphatic flow, away from the periphery, and with the infection site distal to the streak.

In a fetus, the right ventricle pumps blood through the: a. left atrium. b. ductus arteriosus. c. lungs. d. foramen ovale. e. septum primum.

ANS: B The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs.

To palpate the inguinal nodes, you should have the patient: a. bend over a table and cough. b. lie supine, with the knees slightly flexed. c. lie supine, with the legs extended. d. stand with the back extended. e. lie prone, with the knees slightly flexed.

ANS: B To palpate the inguinal nodes, you should have the patient lying supine, with the knees slightly flexed.

Very light tan or gray stool may indicate: a. Hirschsprung disease. b. obstructive jaundice. c. lower gastrointestinal bleeding. d. polyposis. e. upper gastrointestinal bleeding.

ANS: B Very light tan or gray stools suggest obstructive jaundice.

The majority of nutrient absorption takes place in the: a. stomach. b. small intestine. c. cecum. d. transverse colon. e. descending colon.

ANS: B Very little absorption takes place in the stomach; most absorption takes place in the small intestine. The cecum and transverse colon are part of the large intestine, and its major function

Perianal abscesses, fissures, or pilonidal cysts will cause the patient to experience: a. bulging and wrinkling. b. constipation and pallor. c. urinary symptoms. d. tenderness and inflammation. e. diarrhea and redness.

ANS: D Pain, tenderness, and inflammation to the perianal area may be related to abscess, fistula or fissure, pilonidal cyst, or pruritus ani.

Conduction system impairment should be suspected if an irregular heartbeat is: a. galloping. b. paradoxical. c. patternless. d. weak. e. bounding.

ANS: C A patternless, unpredictable, irregular rate may indicate heart disease or conduction system impairment. A gallop is an abnormal regular heart rhythm with three sounds in each cycle resembling the gallop of a horse. Amplitude of the paradoxical pulse decreases on inspiration

A palpable rushing vibration over the base of the heart at the second intercostal space is called a: a. heave. b. lift. c. thrill. d. thrust. e. murmur.

ANS: C A thrill is a fine, palpable, rushing vibration, or a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A thrust is a movement forward suddenly and forcibly. A murmur is an auscultated sound caused by turbulent blood flow.

An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may indicate: a. decreased cardiac output. b. dextrocardia. c. left ventricular hypertrophy. d. hyperventilation. e. obesity.

ANS: C An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse. In dextrocardia, the PMI would be displaced to the right.

The characteristics of arterial pulses are directly affected by all of the following except: a. the volume of blood ejected. b. peripheral arterial resistance. c. venous valvular competence. d. blood viscosity. e. distensibility of aorta.

ANS: C Arterial pulses are affected by stroke volume (volume of blood ejected), distensibility of the aorta and large arteries, viscosity of the blood, and peripheral arteriolar resistance. Venous valvular competence contributes to the venous blood flow back to the heart.

After thorough inspection of the abdomen, the next assessment step is to: a. percuss. b. palpate nonpainful areas. c. auscultate. d. perform a rectal examination. e. palpate painful areas.

ANS: C Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence is because palpation and percussion can alter the frequency as well as the intensity of bowel sounds. Therefore, auscultation is done first.

A third heart sound is created by: a. atrial contraction. b. ventricular contraction. c. diastolic filling. d. regurgitation between the right and left ventricles. e. blood in the pericardium.

ANS: C Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria, and the filling sometimes produces a third heart sound S3.

The most helpful finding in determining left-sided heart failure is: a. dyspnea. b. orthopnea. c. jugular vein distention. d. an S4 heart sound. e. tachycardia.

ANS: C Evidence-based research has shown that the most helpful clinical examination finding supportive of left-sided heart failure is jugular vein distention. The other choices are not as reliable.

Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: a. spleen. b. kidney. c. liver. d. pancreas. e. gallbladder.

ANS: C The liver is responsible for converting fat-soluble waste to water-soluble materials so the kidneys can excrete them as well as convert ammonia to urea.

One major function of the liver is to: a. secrete pepsin. b. emulsify fats. c. store glycogen. d. absorb bile. e. produce insulin.

ANS: C The liver plays a metabolic role; it converts glucose to glycogen, stores it, and then converts glycogen back to glucose as needed by the body.

In pregnancy, blood pressure is lowest: a. at conception. b. during the first trimester. c. during the second trimester. d. during the third trimester. e. at the time of delivery.

ANS: C The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels.

Observation of hand veins can facilitate the assessment of: a. mitral valve competency. b. stoke volume. c. right heart pressure. d. pulse pressure. e. left heart pressure.

ANS: C Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand veins while the hand is at the patient's side. Then raise the hand until the veins collapse, and then use a ruler to measure the vertical distance between the midaxillary line (level of the heart) and the level of the collapsed hand veins.

Given the high certainty that screening results in reduced mortality, current recommendations include screening for colorectal cancer beginning at age 50 and continuing until age: a. 65. b. 70. c. 75. d. 80. e. 85.

ANS: C In 2016 the U.S. Preventive Services Task Force (USPSTF) updated its previous recommendations based on a review of the evidence assessing both benefits and harms of screening. Given the high certainty that screening results in reduced mortality, the USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. Screening for colorectal cancer in adults ages 76 to 85 years should be an individual one, taking into account the patient's overall health and prior screening history.

An organ that is essential to the development of protective immune function in infants but has little or no demonstrated function in adults is the: a. spleen. b. appendix. c. thymus. d. pancreas. e. liver.

ANS: C In adults, the thymus atrophies, and in older adults, it is replaced by fat and connective tissue.

Obstruction of the nasopharynx, pulmonary hypertension, and risk of sleep apnea may be associated with excessively enlarged: a. branchial cleft cysts. b. cystic hygromas. c. palatine tonsils. d. thyroglossal duct cysts. e. lymphangiomas.

ANS: C Palatine tonsil enlargement, grade 3+ to 4+, may obstruct the nasopharynx, which increases the risk of sleep apnea and, rarely, pulmonary hypertension. The other choices are congenital embryonic structures in the neck.

Pinworms and Candida may both cause: a. shrunken buttocks. b. hemorrhoids. c. perirectal irritation. d. perirectal protrusion. e. constipation.

ANS: C Pinworms and Candida both cause perirectal irritation and itch.

Costovertebral angle tenderness should be assessed whenever you suspect the patient may have: a. cholecystitis. b. pancreatitis. c. pyelonephritis. d. ulcerative colitis. e. intussusception.

ANS: C Pyelonephritis is characterized by flank pain and costovertebral angle tenderness.

The harder and more discrete a node, the more likely a(n): a. innocent cause. b. infection. c. malignancy. d. metabolic disease. e. drug reaction.

ANS: C Tender nodes almost always indicate the presence of an infection, but a hard, discrete, and nontender node is more likely to represent a malignancy.

Purkinje fibers are located in the: a. sinoatrial node. b. atrioventricular node. c. myocardium. d. aortic arch. e. pericardium.

ANS: C The Purkinje fibers are located in the ventricular myocardium.

Which landmark is the dividing line between the anterior and posterior cervical triangles? a. Clavicle b. Cervical spine c. Sternocleidomastoid muscle d. Sternum e. Hyoid bone

ANS: C The landmark dividing the anterior and posterior cervical triangles is the sternocleidomastoid muscle.

Lymph ducts merge into the venous system at the: a. portal vein. b. pulmonic vein. c. subclavian veins. d. vena cava. e. jugular veins.

ANS: C The large ducts of the lymphatics merge into the venous system at the left and right subclavian veins.

Peristalsis of intestinal contents is under the control of: a. cognitive processes. b. gravity. c. the autonomic nervous system. d. the fluid content of the stomach. e. cerebellum.

ANS: C The movement of food and digestive products is regulated by the autonomic nervous system.

A 45-year-old man relates a several-week history of severe intermittent abdominal burning sensations. He relates that the pain is relieved with small amounts of food. Before starting the physical examination, you review his laboratory work, anticipating a(n): a. elevated white blood cell count. b. decreased potassium level. c. positive Helicobacter pylori result. d. increased urine specific gravity. e. folate deficiency.

ANS: C The patient's presenting symptoms suggest peptic ulcer disease. The supporting laboratory finding is the presence of H. pylori.

Which of the following statements is true regarding the examination of peripheral arteries? a. The thumb should never be used to assess pulses. b. Palpate at least one pulse in each extremity, usually the most proximal one. c. The pulses are most readily felt over arteries that lie over bones. d. Extremity pulses do not normally generate waveforms. e. The pads of the fourth and fifth digits of the examiner's hands are the most sensitive.

ANS: C The pulses are best palpated over arteries that are close to the surface of the body and lie over bones. The arterial pulses with the digital pads of the second and third fingers. The thumb may also be used if vessels have a tendency to move or roll when palpated by the fingers. Palpate at least one pulse, the most distal pulse, in each extremity to determine the sufficiency of the arterial circulation. Arterial pulses have contour (waveform).

When examining a patient with tense abdominal musculature, a helpful technique is to have the patient: a. hold his or her breath b. sit upright. c. flex his or her knees. d. raise his or her head off the pillow. e. fully extend the legs.

ANS: C To help relax the abdominal musculature, it is helpful to place a small pillow under the patient's head and under slightly flexed knees. The other choices increase muscle flexion

Tarry black stool should make you suspect: a. internal hemorrhoids. b. rectal fistula. c. upper intestinal bleeding. d. prostatic cancer. e. lower intestinal bleeding.

ANS: C Upper intestinal tract bleeding results in tarry black stools.

Serum sickness is usually characterized first by the appearance of: a. diffuse lymph node enlargement. b. joint pain. c. urticaria. d. fever. e. a single enlarged posterior cervical node.

ANS: C Urticaria is the first reaction of serum sickness followed by lymphadenopathy, joint pain, fever, and facial edema.

The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing: a. the splitting of S2. b. high-pitched murmurs. c. presystolic gallops. d. systolic ejection sounds. e. pericardial friction rub.

ANS: C Using the bell of the stethoscope at the apex is more useful for low-pitched presystolic gallops. The patient should lie in the supine or left lateral recumbent position.

An umbilical assessment in the newborn that is of concern is: a. a thick cord. b. an umbilical hernia. c. one umbilical artery and two veins. d. pulsations superior to the umbilicus. e. visible nondistended superficial veins.

ANS: C What is expected is two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally spontaneously close by 2 years, and pulsations to the abdomen in the epigastric area are common. Nondistended superficial veins are usually visible in thin infants.

Which two heart structures are most anterior in the chest? a. Both atria b. Both ventricles c. The right atrium and ventricle d. The left atrium and ventricle e. Superior and inferior venae cavae

ANS: C The most anterior surface of the heart is formed by the right ventricle. The heart is turned ventrally on its axis, putting its right side more forward. The left atrium is above the left ventricle, forming the most posterior aspect of the heart. The superior and inferior venae cavae lie posteriorly.

A sound similar to a murmur that is heard over arteries is a: a. thrill. b. hum. c. friction rub. d. bruit. e. heave.

ANS: D A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system.

The most pronounced functional change of the gastrointestinal (GI) tract in older adults is: a. decreased hydrochloric acid production. b. increased motility. c. decreased bile absorption. d. decreased motility. e. increased saliva secretion.

ANS: D A decrease in motility of the gastrointestinal (GI) tract is the most pronounced GI change in older adults

You ask the patient to raise the head and shoulders while lying in a supine position. A midline abdominal ridge rises. You chart this observation as a(n): a. small inguinal hernia. b. large epigastric hernia. c. abdominal lipoma. d. diastasis recti. e. incisional hernia.

ANS: D A diastasis recti occurs when abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and most often occurs in repeated pregnancies and obesity.

A lift along the left sternal border is most likely the result of: a. aortic stenosis. b. atrial septal defect. c. pulmonary hypertension. d. right ventricular hypertrophy. e. left ventricular hypertrophy.

ANS: D A lift along the left sternal border may be caused by right ventricular hypertrophy. A thrill indicates a disruption of the expected blood flow related to a defect in the closure of one of the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or atrial septal defect.

To correctly document absent bowel sounds, one must listen continuously for: a. 30 seconds. b. 1 minute. c. 3 minutes. d. 5 minutes. e. 10 minutes.

ANS: D Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes.

The most important clue to the diagnosis of a child with an immunodeficiency disease is: a. family history. b. illness in siblings. c. previous hospitalizations. d. serious recurring infections. e. cervical adenitis.

ANS: D Although family history, illness in siblings, and previous hospitalizations are helpful clues to discover an immunodeficiency in a child, it is most important to review the occurrence of serious, uncommon infectionNs such as Pneumocystis jirovecii and other fungal infections that do not respond as expected to therapy.

You are examining Mr. S, a 79-year-old man with diabetes who is complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial insufficiency? a. Thick, calloused skin b. Ruddy, thin skin c. Warmer temperature of extremity in contrast to other body parts d. Thin atrophied skin e. Full superficial veins with rapid filling

ANS: D An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area. There may be collapsed superficial veins with delayed filling.

Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal. When is it likely that her closed anal passageway will be suspected by her healthcare providers? a. After she develops a scaphoid abdomen b. During her first feeding when she vomits c. When she bleeds from the rectum d. When she fails to pass meconium stool e. When the rectum prolapses

ANS: D Anal patency of the newborn is confirmed by passage of meconium stool.

Which risk factor is least likely to result in contracting HIV? a. Prostitution b. Hemophilia c. Intravenous drug use d. Working with AIDS patients e. Sexual contact with intravenous drug users

ANS: D As a work-related risk for HIV infection, providing health care is considered rare. Multiple and indiscriminate sexual contacts, hemophilia, and intravenous drug use carry higher rates of transmission of HIV.

Which ECG change would not be expected as an age-related pattern? a. First-degree block b. Bundle branch block c. Left ventricular hypertrophy d. Ventricular fibrillation e. Atrial fibrillation

ANS: D Common ECG changes in older adults include first-degree atrioventricular block, bundle branch blocks, ST-T wave abnormalities, premature systole (atrial and ventricular), left anterior hemiblock, left ventricular hypertrophy, and atrial fibrillation.

Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of: a. rheumatic fever. b. cor pulmonale. c. pericarditis. d. endocarditis. e. cardiac tamponade.

ANS: D Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected with at-risk patients (e.g., IV drug abusers) who present with fever and a sudden onset of congestive heart symptoms. The lesions described are Janeway lesions.

Palpation of a normal prostate in an older adult is likely to feel: a. cool. b. grainy. c. polypoid. d. rubbery. e. hard.

ANS: D Older men are more likely to experience prostate hypertrophy, which, when palpated, feels smooth, rubbery, and symmetric.

The most common causes of acute suppurative lymphadenitis are: a. HIV and herpes zoster. b. Haemophilus influenzae and adenovirus. c. herpes simplex type 1 and type 2. d. streptococcal and staphylococcal organisms. e. mumps.

ANS: D Group A beta-hemolytic streptococci and coagulase-positive staphylococci are the most common organisms responsible for suppurative (pus-forming) lymphadenitis. The other choices do not result in suppurative lymphadenitis.

Which of the following is a risk factor for anal cancer? a. White race b. Diet low in animal fats and proteins c. Physical inactivity d. Infection with high-risk type HPV e. Low body fat

ANS: D Infection with high-risk type human papillomavirus is considered a risk factor for anal cancer. The other answers are not.

When performing a rectal examination in a man, in which position is the patient generally placed? a. Lithotomy b. Prone c. Trendelenburg d. Left lateral e. Supine

ANS: D Male patients are usually positioned left lateral or standing with upper body flexed at the waist over the examination table, with the toes pointed together for increased exposure of the area.

The most common congenital anomaly of the gastrointestinal tract is: a. biliary atresia. b. meconium ileus. c. intussusception. d. Meckel diverticulum. e. pyloric stenosis.

ANS: D Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract.

Percussion of the abdomen begins with establishing: a. liver dullness. b. spleen dullness. c. gastric bubble tympany. d. overall dullness and tympany in all quadrants. e. bladder fullness.

ANS: D Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs.

Which of the following conditions is most commonly seen in adults with diabetes? a. Pinworms b. Pilonidal cysts c. Perianal fistula d. Pruritus ani e. Anorectal fissure

ANS: D Pruritus ani refers to chronic itching of the skin around the anus, which can be caused by fungal infections and is more common in diabetic patients. Pinworms are more common in children; the other conditions do not cause pruritus.

Which dysrhythmia is a physiologic event during childhood? a. First-degree AV block b. Mobitz type II c. Multifocal PVCs d. Sinus dysrhythmia e. Third-degree AV block

ANS: D Sinus dysrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension.

Normal supraclavicular lymph nodes are: a. clustered in a capsule. b. firm and discrete. c. less than 3 cm in diameter. d. not palpable. e. matted.

ANS: D Supraclavicular nodes, when palpated, are a concern; normally, they are not palpable.

Which nodes are most often associated with inflammation? a. Shotty b. Movable c. Fixed d. Tender e. Matted

ANS: D Tenderness is almost always indicative of inflammation.

Chest pain that is intensified or provoked by movement, particularly twisting, is long lasting, and is often associated with focal tenderness is most likely: a. cardiac. b. pleural. c. esophageal. d. musculoskeletal. e. psychoneurotic.

ANS: D The description given is a classic example of musculoskeletal chest pain.

Lymphoid tissue normally regresses to adult size by: a. 2 years of age. b. 5 years of age. c. 10 years of age. d. puberty. e. the early 20s.

ANS: D The extent of lymphoid tissue is abundant in infants, increases in childhood, and regresses to adult size at puberty.

Prostate-specific antigen (PSA) screening is controversial because: a. there are few false-negative results. b. PSA is produced by many other tissues. c. it is less sensitive than digital rectal examination. d. there are associated harms of false-positive test results. e. it detects prostate cancer only in its late stage.

ANS: D The persistent issue is whether the benefits of prostate cancer screening are large enough to outweigh the associated harms, which include false-positive screening test results, unnecessary biopsies, and overdiagnosis

Which nodes are also called Virchow nodes? a. Internal mammary b. Anterior axillary c. Deep cervical d. Supraclavicular e. Preauricular

ANS: D The supraclavicular nodes are also referred to as Virchow nodes.

Which disorder is characterized by a single node that is chronically enlarged and nontender in a patient with no other symptoms? a. Retropharyngeal abscess b. Streptococcal pharyngitis c. Mononucleosis d. Toxoplasmosis e. Herpes simplex

ANS: D Toxoplasmosis is displayed as a chronically enlarged, nontender, single node usually in the posterior cervical chain.

The "pacing" structure of the heart's electrical activity is the: a. atrioventricular (AV) node. a. bundle of His. b. Purkinje fibers. c. coronary sinus. d. sinoatrial (SA) node.

ANS: E An electrical impulse stimulates each myocardial contraction, and this impulse originates in and is paced by the SA node.

When examining lymph nodes near a joint in the arm or leg, which of the following maneuvers is likely to facilitate the examination? a. Extension of the extremity b. Circumduction of the extremity c. Abduction of the extremity d. Rotation of the extremity e. Flexion of the extremity

ANS: E Bending joint areas will ease taut tissues and allow for better accessibility to palpation.

Which arterial pulse is most useful in evaluating heart activity? a. Femoral b. Radial c. Temporal d. Brachial e. Carotid

ANS: E Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity.

In older adults, overflow fecal incontinence is commonly caused by: a. malabsorption. b. parasitic diarrhea. c. Meckel diverticulum. d. fistula formation. e. fecal impaction.

ANS: E Constipation with overflow occurs when the rectum contains hard stool and soft feces above leak around the mass of stool.

An expected anal or rectal finding late in pregnancy is the presence of: a. cysts. b. rectal prolapse. c. skin tags. d. polyps. e. hemorrhoids.

ANS: E Hemorrhoids are an expected variation late in pregnancy.

The earliest sign of heart failure in an infant is frequently: a. an apical impulse in the fourth intercostal space. b. moisture in the lungs. c. enlarged thyroid. d. clubbing of the fingers. e. liver enlargement.

ANS: E If heart failure is suspected, note that the infant's liver may enlarge before there is any suggestion of moisture in the lungs, and the left lobe of the liver may be more distinctly enlarged than the right. An apical impulse in the fourth intercostal space is a normal finding.

In an adult, the apical impulse should be most visible when the patient is in which position? a. Supine b. Leaning backward c. Lithotomy d. Right lateral recumbent e. Upright

ANS: E In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem.

Cells that line the lymph node sinuses perform the specific function of: a. fat absorption. b. fetal immunization. c. hematopoiesis. d. platelet production. e. phagocytosis.

ANS: E Lymph nodes defend against the invasion of microorganisms by phagocytosis.

Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings most associated with: a. peptic ulcer disease. b. pancreatitis. c. ruptured ovarian cyst. d. splenic rupture. e. diverticulitis.

ANS: E No choice other than diverticulitis has all of these presenting symptoms.

As adults age, their ability to resist infection decreases because of lymphatic nodes becoming more: a. hematopoietic. b. mucoid. c. porous. d. profuse. e. fibrotic.

ANS: E Older adults' lymph nodes diminish in both number and size and are replaced with more fibrotic and fatty tissues.

A 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? a. Positive psoas sign b. Positive McBurney sign c. History of periumbilical pain d. Rebound tenderness e. Obturator muscle test

ANS: E Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis. Conditions that cause irritation of the obturator muscle are late findings usually associated with a ruptured appendix or pelvic abscess.

When enlarged, which lymph nodes are most likely to be a sign of malignancy? a. Occipital b. Anterior cervical c. Posterior cervical d. Femoral e. Supraclavicular

ANS: E Supraclavicular nodal enlargement is of special concern because it suggests a malignancy even in children; it may be the sentinel node of Hodgkin lymphoma.

The level at which the jugular venous pulse is visible gives an indication of: a. mitral valve efficiency. b. aortic valve efficiency. c. stroke volume. d. left ventricular pressure. e. right atrial pressure.

ANS: E The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart.

Which abdominal organs also produce hormones and function as endocrine glands? a. Kidney and liver b. Liver and gallbladder c. Stomach and spleen d. Gallbladder and pancreas e. Pancreas and kidney

ANS: E The pancreas produces pancreatic juices as well as insulin and glucagon; the kidneys produce urine as well as the hormones rennin and erythropoietin.

When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? a. Arterial bruit b. Gastric rumbling c. Renal hyperresonance d. Borborygmi e. Venous hum

ANS: E Venous hum is associated with blood flow in venous collaterals found in portal hypertension. Aortic bruit occurs during systole, and a venous hum is a continuous sound and softer than a bruit. The other choices are not vascular sounds.

The nurse identifies which modifiable factors that reduce risk of coronary artery disease. a) High fiber diet b) Obesity c) High fiber diet d) Clotting disorder e) Hypercholesterolemia

a) High fiber diet

Which organ when percussed provides a dull, low-amplitude sound? a) Liver b) Small intestine c) Large intestine d) Stomach

a) Liver

To auscultate the aortic valve where would the nurse place the stethoscope on the client's chest? a) Right sternal border, 2nd intercostal space b) Left sternal border, 2nd intercostal space c) Left sternal border, 4th intercostal space d) Left sternal border, 5th intercostal space

a) Right sternal border, 2nd intercostal space

Hematemesis is the medical term that refers to vomitus with evidence of blood. Correct answer: a) True b) False

a) True

If an apical impulse is more vigorous than expected it is referred to as a lift. a) True b) False

a) True

The sequence of assessing the abdomen includes inspection, auscultation, percussion, and palpation. a) True b) False

a) True

When palpating the carotid pulses, the nurse should palpate both sides separately to avoid potential loss of consciousness that may occur if blood flow is decreased. a) True b) False

a) True

The medical term that is used to describe chest pain is: a) angina b) dyspepsia c) hypertension d) murmur

a) angina

Which anatomical location is concerning for possible malignancy if enlarged lymph nodes are palpated: a) supraclavicular region b) anterior cervical chain c) posterior cervical chain d) occipital area

a) supraclavicular region

How many clicks or gurgles are expected per minute in a client with normal bowel sounds? a) 1-5 b) 5-35 c) 20-37 d) 29-50

b) 5-35

All heart murmurs have a pathological cause. a) True b) False

b) False

Lymph nodes that are firm, nontender, and mobile are considered an abnormal finding. a) True b) False

b) False

The nurse can reliably confirm presence of blood in fecal material by visual inspection. a) True b) False

b) False

When percussing the stomach, which vibrational sound would the nurse expect to elicit? a) Dullness b) Tympany c) Hyper-resonance d) No sound

b) Tympany

A client with constipation would be expected to have what type of bowel sounds? a) normoactive b) hypoactive c) hyperactive

b) hypoactive

A heart rate of less than 60 beats per minute is called: a) normal sinus rhythm b) tachycardia c) bradycardia d) asystole

c) bradycardia

When performing deep palpation on a client's abdomen, the client reports pain when the clinician releases pressure in the right lower quadrant of the abdomen. This would be referred to as: a) Epigastric pain b) Psoas Sign c) Rovsing sign d) Rebound tenderness

d) Rebound tenderness

When palpating the left lower quadrant of the abdomen, the patient expresses pain on the right side. This is referred to as: a) peritoneal pain b) visceral pain c) neuropathic pain d) referred pain

d) referred pain

An organ that is essential for developing immune function in infants but has diminished function in adulthood is the: a) liver b) spleen c) gallbladder d) thymus

d) thymus