Question 1

During a genitourinary examination of a 30-year-old man,the nurse identifies a small amount of a white,thick substance on the patient's uncircumcised glans penis.What is the nurse's next step?

Accepted Answer

A small amount of thick,white smegma sometimes collects under the foreskin of an uncircumcised male.Penile pain or swelling,genital lesions,and urethral discharge are signs and symptoms that may indicate STI.All men 15 years and older need to perform a male genital self-examination monthly.The nurse needs to assess a patient's sexual history and use of safe sex habits.Sexual history reveals risks for STI and human immunodeficiency virus (HIV)infection.

Question 2

A febrile preschool-aged child presents to the after-hours clinic.Varicella is diagnosed on the basis of the illness history and the presence of small,circumscribed skin lesions filled with serous fluid.The nurse documents the varicella lesions as which type of skin lesion?

Accepted Answer

Vesicles are circumscribed,elevated skin lesions filled with serous fluid that are smaller than 1 cm in diameter.Wheals are irregularly shaped,elevated areas of superficial localized edema that vary in size.They are common with bug bites and hives.Papules are palpable,circumscribed,solid elevations in the skin that are smaller than 1 cm in diameter.Pustules are elevations of skin similar to vesicles,but they are filled with pus.

Question 3

An older patient is being seen for a chronic entropion.The nurse realizes that entropion places the patient at risk for which of the following?

Accepted Answer

Entropion can cause the lashes of the lids to irritate the conjunctiva and cornea,and irritation can lead to infection.In ectropion,eyelid margins turn outward so that the lashes do not irritate the conjunctiva.Exophthalmos is a bulging of the eyes and usually indicates hyperthyroidism.Strabismus,or crossing of the eyes,results from neuromuscular injury or inherited abnormalities.

Question 4

During a routine pediatric history documentation and physical examination,the parents report that their child was a premature infant and was so small that he had to stay in the neonatal intensive care unit longer than usual.They state that the infant was yellow when born and that he developed an infection that required "every antibiotic under the sun" to cure him.Considering the neonatal history,the nurse determines that it is especially important to perform which focused examination?

Accepted Answer

Risk factors for hearing problems include low birth weight,nonbacterial intrauterine infection,and excessively high bilirubin levels.Hearing loss due to ototoxicity (injury to auditory nerves)can result from high maintenance doses of antibiotics.Cardiac,respiratory,and eye examinations are important assessments but are not relevant to this case.

Question 5

During a school physical examination,the nurse reviews the patient's current medical history,which is positive for asthma,eczema,and allergic rhinitis.Which physical finding should the nurse expect on nasal examination?

Accepted Answer

Pale nasal mucosa with clear mucoid discharge indicates allergic rhinitis.Polyps are tumour-like growths.Yellow discharge would be seen with infection.Habitual use of intranasal cocaine and opioids causes puffiness and increased vascularity of the nasal mucosa.

Question 6

For a weak patient with bilateral basilar pneumonia,which is the best position for a complete geriatric physical examination?

Accepted Answer

Supine position is the most normally relaxed position.It will not further compromise the patient's breathing.If the patient becomes short of breath easily,the head of the bed can be raised.This position would be easiest for a weak older person to get into for an examination.Lateral recumbent and prone positions cause respiratory difficulty for any patient with respiratory difficulties.Sims's position is used for assessment of the rectum and the vagina.

Question 7

During an annual gynecological examination,a college student discusses her upcoming college break at a tropical location.After the student receives an oral contraceptive prescription,the nurse identifies the importance of skin cancer prevention by discussing which evidence-informed prevention technique?

Accepted Answer

Oral contraceptives can make the skin more sensitive to the sun.For this reason,the patient should be educated about the need for sun protection with such techniques as the use of wide-brimmed hats,use of broad-spectrum sunscreen of SPF 15 or higher,not tanning during midday,and not using tanning beds.Broad-spectrum sunscreens should be applied 15 minutes before a person goes out into the sun and after swimming or perspiring.

Question 8

The patient is a 50-year-old African Canadian man who has come in for his routine annual physical examination.Which of the following preventive screenings does the nurse recommend?

Accepted Answer

Men need to have a digital rectal examination of the prostate every year beginning at 50 years of age.Ca-125 blood tests are indicated for women at high risk for ovarian cancer.Because this patient is a man,the cancer antigen 125 test is not needed.Patients older than 65 need to have complete eye examinations yearly.Colonoscopy every 10 years is recommended in patients 50 years of age and older.

Question 9

The nurse is urgently called to the gymnasium regarding an injured student.The student is crying in severe pain with a malformed fractured lower leg.What is the proper sequence for the nurse's initial assessment?

Accepted Answer

Inspection is the use of vision and hearing to distinguish normal from abnormal findings.Light palpation determines areas of tenderness and skin temperature,moisture,and texture.Deep palpation is used to examine the condition of organs,such as those in the abdomen;it must be done with caution and is done after light palpation.Auscultation is used to evaluate sound.

Question 10

A parent calls the school nurse with questions regarding the recent school vision screening.Snellen chart examination revealed 20/60 for both eyes in the child.Considering the visual acuity results,what does the nurse inform the parent?

Accepted Answer

Normal vision is 20/20.The larger the denominator,the poorer the patient's visual acuity.For example,a value of 20/60 means that the patient,when standing 20 feet away,can read a line that a person with normal vision can read from 60 feet away.Strabismus is a (congenital)condition in which both eyes do not focus on an object simultaneously: these eyes appear crossed.Acuity may not be affected.Presbyopia is impaired near vision that occurs in middle-aged and older persons and is caused by loss of elasticity of the lens.Cataracts develop slowly and progressively after age 35 or suddenly after trauma.

Question 11

A school nurse recognizes a belt buckle-shaped ecchymosis on a 7-year-old student.When privately asked about how the injury occurred,the student described falling on the playground.Upon suspecting abuse,the school nurse's best next action is which of the following?

Accepted Answer

Most provinces and territories mandate a report to a social service centre if nurses suspect abuse or neglect.When abuse is suspected,the nurse interviews the patient in private.Abuse of children,women,and older persons is a growing health problem.It is difficult to detect abuse because many victims do not complain or report that they are in an abusive situation.

Question 12

A teenaged female patient reports intermittent abdominal pain that has lasted 12 hours.No dysuria is present.During an abdominal assessment,what should the nurse do?

Accepted Answer

Black or tarry stools (melena)indicate gastrointestinal alteration.The nurse should caution patients about the dangers of excessive use of laxatives or enemas.The nurse should also determine whether the patient is pregnant and note her last menstrual period.Pregnancy causes changes in abdominal shape and contour.Painful areas should be assessed last to minimize discomfort and anxiety.

Question 13

On admission,a patient weighs 113.4 kg (250 pounds).The weight is recorded as 116.1 kg (256 pounds)on the second inpatient day.The nurse should evaluate the patient for

Accepted Answer

This patient has gained 2.7 kg (6 pounds)in a 24-hour period.A weight gain of 2.3 kg (5 pounds)or more in a day indicates fluid retention problems.A downward trend may indicate a reduction in nutritional reserves that may be caused by decreased intake such as anorexia or by fluid loss.

Question 14

Objective physical data describe air moving through small airways,auscultated over the lung's periphery.The expected inspiratory-to-expiratory phase of this normal vesicular breath sound is which of the following?

Accepted Answer

Vesicular breath sounds are normal breath sounds heard over the lung's periphery,caused by air moving through smaller airways;the inspiratory phase is three times longer than the expiratory phase.In bronchovesicular breath sounds,the inspiratory phase is equally as long as the expiratory phase.In bronchial breath sounds,the expiration phase is longer than the inspiration phase,at a 3:2 ratio.

Question 15

During a presentation about sexually transmitted infections to high school students,the nurse recommends the human papillomavirus (HPV)vaccine series to prevent which of the following?

Accepted Answer

HPV infection increases the risk for cervical cancer.HPV vaccine is recommended by the Public Health Agency of Canada for female patients aged 9 to 26 years.Vaginal discharge,painful or swollen perianal tissues,and genital lesions are signs and symptoms that may indicate a sexually transmitted infection.

Question 16

A nurse identifies Pediculosis humanus capitis.Considering the possible complications of treatment,the nurse knows to not use which of the following treatment products?

Accepted Answer

Products containing lindane,a toxic ingredient,often cause adverse reactions and neurotoxic effects.Patients who have head lice are instructed to shampoo thoroughly with pediculicide (shampoo available at drugstores)in cold water,comb thoroughly with a fine-toothed comb,and discard the comb.A dilute solution of vinegar and water helps loosen nits.

Question 17

A male student comes to the college health clinic.He hesitantly describes that his testis has a pea-sized hard lump.The nurse recognizes this as a potential sign of which of the following?

Accepted Answer

Irregular lumps of the testes may indicate testicular cancer.Testicular cancer is cancer that begins in the testicles.Testicular cancer is the most common form of cancer in men between the ages of 15 and 35 years.A hernia manifests with bulging in the scrotum.Sexually transmitted infections often manifest with genital lesions.Use of diuretics,sedatives,or antihypertensives can cause difficulty in achieving an erection or ejaculation but does not usually cause lumps.

Question 18

A nurse is a preceptor for a nurse who just graduated from nursing school.When caring for a patient,the new graduate nurse begins to explain to the patient the purpose of completing a physical assessment.Which of the following statements made by the new graduate nurse necessitates intervention by the preceptor?

Accepted Answer

Nursing assessment data are used to evaluate the effectiveness of all aspects of a patient's care,not just the patient's medical care.Assessment data help to evaluate the effectiveness of medications and to determine a patient's health care needs,including the need for patient education.Nurses also use assessment data to identify patients' psychosocial and cultural needs.

Question 19

The nurse is caring for a female victim of rape.To perform the proper evaluation,the nurse should place the patient in which of the following positions?

Accepted Answer

Lithotomy is the position for examination of female genitalia.The lithotomy position provides for the maximum exposure of genitalia and allows the insertion of a vaginal speculum.Sitting does not allow adequate access for speculum insertion and is better used to visualize upper body parts.Dorsal recumbent is used to examine the head and neck,anterior thorax and lungs,breasts,axillae,heart,and abdomen.Knee-chest provides maximal exposure of the rectal area but is embarrassing and uncomfortable.

Question 20

A head and neck physical examination is completed on a 50-year-old woman.All physical findings are normal except that she has fine,brittle hair.On the basis of the physical findings,which of the following laboratory tests would the nurse expect to be ordered?

Accepted Answer

Thyroid disease can make hair thin and brittle.Liver function testing is indicated for a patient who has jaundice.Lead levels and a CBC are not indicated for the finding of brittle hair.

Quiz 32: Health Assessment and Physical Examination