Primary Care: Art and Science of Advanced Practice Nursing - An
Interprofessional Approach 5th edition Dunphy Test Bank
Chapter 1. Primary Care in the Twenty-First Century: A Circle of Caring
1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on the
incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented
findings at a level of significance of <0.01. This indicates that
A) the control group and the experimental group were more than 99% similar.
B) the findings of the study have less than 1% chance of being attributable to chance.
C) the effects of the intervention were nearly zero.
D) the clinical significance of the findings was less than 1:100.
Feedback: The level of significance is the level at which the researcher believes that the study results
most likely represent a nonchance event. A level of significance of <0.01 indicates that there is less
than 1% probability that the result is due to chance.
2. A nurse has read a qualitative research study in order to understand the lived experience of parents
who have a neonatal loss. Which of the following questions should the nurse prioritize when
appraising the results of this study?
A) How well did the authors capture the personal experiences of these parents?
B) How well did the authors control for confounding variables that may have affected the findings?
C) Did the authors use statistical measures that were appropriate to the phenomenon in question?
D) Were the instruments that the researchers used statistically valid and reliable?
Feedback: Qualitative studies are judged on the basis of how well they capture and convey the
subjective experiences of individuals. Statistical measures and variables are not dimensions of a
3. A nurse has expressed skepticism to a colleague about the value of nursing research, claiming that
nursing research has little relevance to practice. How can the nurses colleague best defend the
importance of nursing research?
A) The existence of nursing research means that nurses are now able to access federal grant money,
something that didnt use to be the case.
B) Nursing research has allowed the development of masters and doctoral programs and has greatly
increased the credibility of the profession.
C) The growth of nursing research has caused nursing to be viewed as a true profession, rather than
simply as a trade or a skill.
D) The application of nursing research has the potential to improve nursing practice and patient
Feedback: The greatest value of nursing research lies in the potential to improve practice and,
ultimately, to improve patient outcomes. This supersedes the contributions of nursing research to
education programs, grant funding, or the public view of the profession.
4. Tracy is a nurse with a baccalaureate degree who works in the labor and delivery unit of a busy
urban hospital. She has noticed that many new mothers abandon breast-feeding their babies when
they experience early challenges and wonders what could be done to encourage more women to
continue breast-feeding. What role is Tracy most likely to play in a research project that tests an
intervention aimed at promoting breast-feeding?
A) Applying for grant funding for the research project
B) Posing the clinical problem to one or more nursing researchers
C) Planning the methodology of the research project
D) Carrying out the intervention and submitting the results for publication
Feedback: A major role for staff nurses is to identify questions or problems for research. Grant
applications, methodological planning, and publication submission are normally carried out by
nurses who have advanced degrees in nursing.
5. A patient signed the informed consent form for a drug trial that was explained to patient by a
research assistant. Later, the patient admitted to his nurse that he did not understand the research
assistants explanation or his own role in the study. How should this patients nurse respond to this
A) Explain the research process to the patient in greater detail.
B) Describe the details of a randomized controlled trial for the patient.
C) Inform the research assistant that the patients consent is likely invalid.
D) Explain to the patient that his written consent is now legally binding.
Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not
responsible for research consent. If patients who have agreed to participate exhibit ambivalence or
uncertainty about participating, do not try to convince them to participate. Ask the person from the
research team who is managing consents to speak with concerned patients about the study, even after
a patient has signed the consent forms.
6. A nurse leader is attempting to increase the awareness of evidence-based practice (EBP) among
the nurses on a unit. A nurse who is implementing EBP integrates which of the following? (Select all
A) Interdisciplinary consensus
B) Nursing tradition
C) Research studies
D) Patient preferences and values
E) Clinical expertise
Ans: C, D, E
Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problem-solving
approach to the delivery of healthcare that integrates the best evidence from studies and patient care
data with clinician expertise and patient preferences and values.
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow to
heal and which now poses a threat of osteomyelitis. The wound care nurse who has been working
with Mrs. Mayes applies evidence-based practice (EBP) whenever possible and has proposed the use
of maggot therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant
and adamantly opposes this treatment despite the sizable body of evidence supporting it. How should
the nurse reconcile Mrs. Mayes views with the principles of EBP?
A) The nurse should explain that reliable and valid research evidence overrides the patients opinion.
B) The nurse should explain the evidence to the patient in greater detail.
C) The nurse should integrate the patients preferences into the plan of care.
D) The nurse should involve the patients family members in the decision-making process.
Feedback: Patient preferences should be integrated into EBP and considered alongside research
evidence and the nurses clinical expertise; evidence does not trump the patients preferences. The
family should be involved, but this is not an explicit dimension of EBP. Similarly, explaining the
evidence in more detail is not a demonstration of EBP.
8. The administrators of a long-term care facility are considered the use of specialized, pressurereducing mattresses in order to reduce the incidence of pressure ulcers among residents. They have
sought input from the nurses on the unit, all of whom are aware of the need to implement the
principles of evidence-based practice (EBP) in this decision. Which of the following evidence
sources should the nurses prioritize?
A) A qualitative study that explores the experience of living with a pressure ulcer
B) A case study that describes the measures that nurses on a geriatric unit took to reduce pressure
ulcers among patients
C) Testimonials from experienced clinicians about the effectiveness of the mattress in question
D) A randomized controlled trial that compared the pressure-reducing mattress with standard
Feedback: The most reliable evidence is considered RCTs. Qualitative studies, case studies, and
expert opinion are low on the hierarchy of evidence.
9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their
attempt to ascertain the most efficient and effective way to communicate between nurses who are on
different units, a project that will consider many types of evidence. Which of the following
information sources should the administrators prioritize?
A) A systematic review about communication in nursing contexts
B) Nurses ideas about communication methods
C) The results of a chart review
D) The hospitals accreditation status
Feedback: Systematic reviews are assigned a high value in EBP. Reviews would be prioritized over
nurses ideas or a chart review, though both are potential considerations. The hospitals accreditation
status is not a relevant consideration.
10. A nurse has resolved to apply the evidence-based practice (EBP) process to the way that
admission assessments are conducted and documented on a unit. How should the nurse begin the
process of establishing EBP?
A) Gather evidence showing the shortcomings of current practices
B) Formulate a clear and concise question to be addressed
C) Elicit support from the nurses who are most often responsible for admissions
D) Search the literature for evidence that is potentially relevant to the practice need
Feedback: The first step in applying EBP is to ask a clear, focused question. This should precede a
search of the literature or the recruitment of participants. An assessment of the shortcomings of the
current system is not an explicit component of the EBP process.
11. Which of the following questions best exemplifies the PICOT format for asking evidence-based
A) What affect does parents alcohol use have on the alcohol use of their teenage children?
B) Among postsurgical patients, what role does meditation rather than benzodiazepines have on
anxiety levels during the 48 hours following surgery?
C) Among high school students, what is the effectiveness of a sexual health campaign undertaken
during the first 4 weeks of the fall semester as measured by incidence of new sexually transmitted
D) In children aged 68, is the effectiveness of a descriptive pain scale superior to a numeric rating
scale in the emergency room context?
Feedback: The correct answer includes a population (postsurgical patients), intervention
(meditation), comparison (benzodiazepines), outcome (anxiety levels), and a time frame (48 hours).
No other option contains each of the five elements of a PICOT question.
12. A nurse has made plans to implement the University of North Carolina (UNC) model of 5 As
during the process of applying evidence-based practice (EBP) to a practice problem. What is the
final step that the nurse will take in applying this model?
A) Analyze the results of the EBP process
B) Advocate for others to embrace the identified change
C) Adopt the changes identified in the review process
D) Assess the outcomes of the new practice
Feedback: The final step in the UNC rubric is to Assess the change using the quality improvement
process in place in the institution.
13. A nurse has been asked to make a presentation to a group of high school students on the subject
of sexual health. However, the nurse does not have a background in this practice area and requires
rapid access to evidence-based guidelines. Which of the following strategies is most likely to
provide the nurse with valid and reliable evidence in a time-efficient manner?
A) Search the Cochrane Library of Systematic Reviews
B) Google search terms such as sexual health teens and sexual education
C) Search Medline using PubMed and order relevant articles
D) Scan the most recent issues of nursing journals that address this area of practice
Feedback: For some problems, a systematic review may be available from a source such as the
Cochrane Library. Often this review is done by an expert panel providing excellent information on
which to base decisions. This approach is more likely to produce valid and reliable results than a
Google search and is more efficient than searching journal manually or ordering articles through
14. The nurses at a university hospital have been informed that a computerized record system will be
implemented over the next 12 months. The nurses should be aware that such as system presents
particular challenges in the area of
A) vulnerability to errors in charting and the inability to make changes.
B) patient privacy and confidentiality of records.
C) enforcing compliance with the system on the part of nurses.
D) ensuring compatibility with different computer operating systems.
Feedback: Concerns about privacy become magnified when information is available to many people
in many sites far removed from where the patient is located, a situation that exists when
computerized records are used. This is usually considered a more important concern than issues of
compliance, compatibility, or vulnerability to errors.
15. A nurse is nervous about the impeding introduction of computerized nursing care records at the
hospital because he does not consider himself to be technologically adept. How should this nurse
best respond to this situation?
A) Take courses in advanced practice nursing to build his knowledge.
B) Explore employment opportunities in settings that use written documentation systems.
C) Advocate for a delay in the introduction of the proposed system.
D) Seek out opportunities to learn the relevant knowledge and practice the necessary skills.
Feedback: A nurse who lacks technological knowledge or skills should seek out opportunities to
expand these. This is preferable to finding a job elsewhere, studying advanced practice nursing, or
attempting to delay the change.
Chapter 2. Caring and the Advanced Practice Nurse
1. A goal of community nursing is to provide primary prevention from disease. Which of the
following nursing actions reflect this goal?
A) A nurse creates a pamphlet discussing heart-healthy foods and distributes it in the neighborhood
B) A nurse starts an intravenous line on a dehydrated baby who has been brought to the emergency
C) A nurse performs range-of-motion exercises for a patient in traction.
D) A nurse repositions an elderly patient confined to a wheelchair to avoid the formation of pressure
Feedback: Primary prevention involves the efforts to prevent disease from ever occurring. Primary
prevention can be aimed at stopping the cause of disease. Generalized efforts to educate people
regarding healthy diets are aimed at this type of primary prevention. Tertiary prevention focuses on
preventing long-term disability and restoring functional capacity, as exemplified by repositioning an
immobile patient, rehydrating a patient, or assisting with exercises.
2. A nurse decides to pursue a career in community-based nursing. Which of the following
statements represents the environment in which the nurse will be working?
A) Community-based nursing is limited to work in public clinics, schools, and industry.
B) The key to community-based settings is that the nurse is in charge.
C) The nurse serves as an educator, guide, and resource person and determines the action taken by
D) Care in the community is cost-effective.
Feedback: Care in the community is cost-effective and often more acceptable to the client because it
causes less disruption in life. It takes place in a wide variety of settings and involves the nurse
entering into a collaborative relationship with clients.
3. The movement of a client from acute care to a long-term nursing care facility involves planning to
provide continuity of care. What is the term for this type of planning?
A) Discharge planning
B) Comprehensive planning
C) Ongoing planning
D) Transition planning
Feedback: Transitions are the movement of the patient from one care environment to another.
Transition planning refers to the planning process that takes place to assure that the patients wellbeing is maintained throughout the time of transition. Organizing this transition from one care
setting to another is not termed discharge planning, comprehensive planning, or ongoing planning.
4. A nurse is called into work to perform triage in the aftermath of an earthquake. Which of the
following are the expected responsibilities of this nurse?
A) Set up and monitor IV lines.
B) Prepare the emergency room for multiple victims.
C) Screen victims to prioritize treatment.
D) Check available blood products and assist with transfusions.
Feedback: Triage involves the initial screening of victims for the purpose of prioritizing treatment
and making the most effective and efficient use of both human and material resources. The other
noted tasks are within the scope of disaster nursing but are not triage activities.
5. A client asks a nurse for help in obtaining an alternative healthcare provider. Which of the
following is an accurate fact regarding alternative care that the nurse should share with this client?
A) Most alternative healthcare practitioners do not have education-based credentials to practice their
B) Alternative providers are not usually included in the federal HIPAA legislation that mandates
confidentiality in conventional healthcare settings.
C) The cost of alternative therapy is never covered by insurance carriers or healthcare plans.
D) It is easy to find accurate safety and efficacy data for alternative medicine on the Internet.
Feedback: Alternative providers are not normally included in the federal Health Insurance Portability
and Accountability Act of 1996 legislation that mandates confidentiality in conventional healthcare
settings. Alternative practitioners do not necessarily lack credentials. Accurate online information
can be difficult to find and costs for treatment may be covered by some insurance plans.
6. There is an increasing trend for nursing care to move from the hospital setting into the
community. Nurses who are to provide excellent care in a community setting should prioritize which
of the following?
A) Integrating culture and family into the planning and delivery of care
B) Becoming more assertive in client education and the planning of client care
C) Encouraging clients to limit their interactions with physicians
D) Teaching clients to replace biomedical interventions with complementary therapies
Feedback: The move to community care heightens the importance of family-centered, culturallycompetent nursing. Community nursing does not necessarily require that a nurse become more
assertive with client. It would be simplistic, and in most cases inappropriate, to guide clients to
replace biomedical interventions or avoid doctors.
7. In spite of the important role that hospitals play in American healthcare, there is growing
importance of community-based healthcare and community-based nursing. Which of the following
statements best conveys a central aspect of the philosophy of community care?
A) The client is in charge of his or her health and healthcare in the community.
B) Nurses maximize their scope of practice in noninstitutional settings.
C) Community settings allow for the greatest number and variety of treatment options.
D) The nurse becomes the key member of the healthcare team in a community setting.
Feedback: A central premise of community healthcare is the fact that patients/clients are in charge.
The move toward community care is not motivated by an increased role for nurses. There are a
greater number of treatment options in hospitals than in the community, but this fact does not negate
the importance of community care.
8. Mr. Hammond is a 70-year-old man with a diagnosis of type 1 diabetes who developed a diabetic
foot ulcer earlier this year. He has recently been discharged from the hospital and now requires
regular wound care. Karen is a community health nurse who provides wound care for Mr. Hammond
twice weekly. Which of Karens actions is most likely to empower Mr. Hammond?
A) Encourage Mr. Hammond to acknowledge his contribution to the development of his wound.
B) Provide information to Mr. Hammond that matches his expressed needs.
C) Encourage Mr. Hammond to involve members of his family in his care.
D) Delegate wound care to Mr. Hammond and reduce the frequency of her visits.
Feedback: Client empowerment is often fostered by assessing and meeting a clients need for
information. Encouraging an acknowledgement of the clients contribution to his or her current health
state is beneficial in many circumstances, but it less likely to make the client feel empowered.
Similarly, family involvement can be beneficial but does not directly foster empowerment.
Empowerment does not necessarily mean that the nurse does less and the client performs his or her
own care; delegation may not be appropriate.
9. An elderly female client who resides in the community tends to defer decisions regarding her care
to her eldest son. How should the community health nurse respond to the clients reluctance to make
A) Discuss this observation with the client and her son in an open manner and explore alternatives.
B) Organize care so that it takes place at times when the son is not present in the home.
C) Accommodate this aspect of the clients family dynamics when planning and carrying out care.
D) Teach the client assertiveness skills that she can apply in her interactions with her son.
Feedback: The nurse should respect the clients desire to organize her care in the way that she prefers.
It is not the responsibility of the nurse to reorganize or overcome this familys dynamics.
10. A client with a long-standing diagnosis of chronic obstructive pulmonary disease (COPD) has
been enrolled in a disease management program. Which of the following activities will be prioritized
in this program?
A) Providing comprehensive and evidence-based care of the clients COPD
B) Creating collaborative relationships between the client and the care team
C) Ensuring that the client qualifies for Medicare and Medicaid
D) Liaising between the client and his health maintenance organization (HMO)
Feedback: Disease management focuses on providing the best evidence-based care for an individual
with a specific chronic illness. This does not necessitate enrollment in an HMO, Medicare, or
Medicaid. Collaborative relationships facilitate effective disease management but this is a means to
the end of positive health outcomes rather than an end in itself.
11. One of the expressed goals of Healthy People 2020 is to achieve health equity and eliminate
disparities. What health indicator can most accurately gauge whether this goal is being achieved?
A) Environmental quality
B) Injury and violence
C) Mental health
D) Access to healthcare services
Feedback: Health equity is achieved when all Americans have equitable access to health services and
there a fewer disparities in health access and health outcomes. Environmental quality, mental health
and injury, and violence are important health indicators but these are less directly indicative of health
equity and the elimination of disparities.
12. Nurses have the potential to positively impact the health of communities. Which of the following
actions is most likely to improve the health of a community?
A) Publicizing the consequences of unhealthy lifestyles
B) Advocating politically for laws and policies that foster community health
C) Ensuring that nurses are practicing to the full extent of their scope of practice
D) Providing nursing care to individuals who are not patients or clients
Feedback: One important role of nurses in the promotion of healthy communities is as a supporter
and advocate for political measures that would improve the health of the community. Publicizing
negative health outcomes is appropriate in some contexts but this is likely less effective than
promoting broad change politically. It is not normally appropriate to provide nursing care for
individuals who are not patients or clients. Practicing to the full extent of ones scope of practice is
not likely to impact community health in a direct way.
13. A nurse who provides care in an acute medical unit is aware of the importance of thorough
discharge planning. The discharge planning process should begin
A) once the patient has stabilized and is assured of positive outcomes.
B) as soon as possible after the patient is admitted.
C) once the patient has received a discharge order from his or her primary care provider.
D) 48 to 72 hours before the projected date of discharge.
Feedback: If possible, discharge planning should begin immediately upon admission.
14. A hospital patient has discussed with the nurse her use of visualization, biofeedback, and
relaxation exercises in managing the chronic pain that results from her fibromyalgia. The nurse
should recognize this patients use of what category of complementary/alternative medicine (CAM)?
A) Biologically-based practices
B) Manipulative practices
C) Traditional indigenous medicine
D) Mind-body medicine
Feedback: Examples of mind-body medicine include relaxation exercises, hypnosis, meditation,
dance, prayer, visualization, and biofeedback. Biologically-based practices focus on food and dietary
supplements while indigenous medicine applies the collective health knowledge of a particular
culture. Manipulative practices involve the systematic application of touch.
15. A hospital patient who suffered a spinal cord injury has expressed an interest in exploring
complementary/alternative therapies. The nurse should encourage the patient to begin this process by
doing which of the following activities?
A) Asking practitioners of different therapies to provide lists of satisfied clients
B) Asking the patients primary care provider for permission to explore nonbiomedical treatments
C) Finding reliable evidence regarding the safety and effectiveness of therapies
D) Determining whether the patients health insurance would cover the cost of
Feedback: The first step for an individual interested in complementary/alternative therapies is to
assess the safety and effectiveness of the therapy in relationship to his or her own condition. This
must precede the identification of specific practitioners or making financial arrangements.
Communication with the care team is important, but the patient does not need to seek permission
before exploring treatment alternatives.
Chapter 3. Health Promotion
Identify the choice that best completes the statement or answers the question.
____ 1. Which of the following is a primary prevention measure for a 76-year-old man newly diagnosed
with a testosterone deficiency?
a. Calcium supplementation
b. Testicular self-examination
c. Bone density test
d. Digital rectal examination
____ 2. Which of the following is an example of secondary prevention in a 50-year-old woman?
a. Yearly mammogram
b. Low animal fat diet
c. Use of seat belt
d. Daily application of sunscreen
____ 3. Which of the following is an example of tertiary prevention in a patient with chronic renal failure?
a. Fluid restriction
b. Hemodialysis 4 days a week
c. High-protein diet
d. Maintenance of blood pressure at 120/80
____ 4. Immunizations are an example of which type of prevention?
Indicate whether the statement is true or false.
____ 1. Prevalence is the number of new cases of a particular disease.
____ 2. The number of cases of a particular disease for the past 5 years is an example of the incidence rate.
____ 3. “There are 1,185,000 cases of HIV/AIDS in the United States” is an example of the morbidity rate.
____ 4. Endemic is the term used when the presence of an event is constant.
____ 5. The “bird” flu of 2005 to 2006 is considered a sporadic outbreak.
____ 6. A pandemic affects many communities in a short period of time.
Chapter 3. Health Promotion
1. ANS: A PTS: 1
2. ANS: A PTS: 1
3. ANS: B PTS: 1
4. ANS: A PTS: 1
1. ANS: F PTS: 1
2. ANS: F PTS: 1
3. ANS: T PTS: 1
4. ANS: T PTS: 1
5. ANS: F PTS: 1
6. ANS: T PTS: 1
Chapter 4. The Art of Diagnosis and Treatment
1. An 85-year-old man has come in for a physical examination, and the nurse notices that he uses a
cane. When documenting general appearance, the nurse should document this information under the
section that covers:
c. Mood and affect.
d. Physical deformity.
Use of assistive devices would be documented under the mobility section. The other responses are
all other categories of the general appearance section of the health history.
2. The nurse is performing a vision examination. Which of these charts is most widely used for
The Snellen eye chart is most widely used for vision examinations. The other options are not tests
for vision examinations.
3. After the health history has been obtained and before beginning the physical examination, the
nurse should first ask the patient to:
a. Empty the bladder.
b. Completely disrobe.
c. Lie on the examination table.
d. Walk around the room.
Before beginning the examination, the nurse should ask the person to empty the bladder (save the
specimen if needed), disrobe except for underpants, put on a gown, and sit with the legs dangling off
side of the bed or table.
4. During a complete health assessment, how would the nurse test the patients hearing?
a. Observing how the patient participates in normal conversation
b. Using the whispered voice test
c. Using the Weber and Rinne tests
d. Testing with an audiometer
During the complete health assessment, the nurse should test hearing with the whispered voice test.
The other options are not correct.
5. A patient states, Whenever I open my mouth real wide, I feel this popping sensation in front of my
ears. To further examine this, the nurse would:
a. Place the stethoscope over the temporomandibular joint, and listen for bruits.
b. Place the hands over his ears, and ask him to open his mouth really wide.
c. Place one hand on his forehead and the other on his jaw, and ask him to try to
open his mouth.
d. Place a finger on his temporomandibular joint, and ask him to open and close his
The nurse should palpate the temporomandibular joint by placing his or her fingers over the joint as
the person opens and closes the mouth.
6. The nurse has just completed an examination of a patients extraocular muscles. When
documenting the findings, the nurse should document the assessment of which cranial nerves?
a. II, III, and VI
b. II, IV, and V
c. III, IV, and V
d. III, IV, and VI
Extraocular muscles are innervated by cranial nerves III, IV, and VI.
7. A patients uvula raises midline when she says ahh, and she has a positive gag reflex. The nurse
has just tested which cranial nerves?
a. IX and X
b. IX and XII
c. X and XII
d. XI and XII
Cranial nerves IX and X are being tested by having the patient say ahh, noting the mobility of the
uvula, and when assessing the patients gag reflex.
8. During an examination, the nurse notices that a patient is unable to stick out his tongue. Which
cranial nerve is involved with the successful performance of this action?
Cranial nerve XII enables the person to stick out his or her tongue.
9. A patient is unable to shrug her shoulders against the nurses resistant hands. What cranial nerve is
involved with successful shoulder shrugging?
Cranial nerve XI enables the patient to shrug her shoulders against resistance.
10. During an examination, a patient has just successfully completed the finger-to-nose and the
rapid-alternating-movements tests and is able to run each heel down the opposite shin. The nurse
will conclude that the patients __________ function is intact.
The nurse should test cerebellar function of the upper extremities by using the finger-to-nose test or
rapid-alternating-movements test. The nurse should test cerebellar function of the lower extremities
by asking the person to run each heel down the opposite shin.
11. When the nurse performs the confrontation test, the nurse has assessed:
a. Extraocular eye muscles (EOMs).
b. Pupils (pupils equal, round, reactive to light, and accommodation [PERRLA]).
c. Near vision.
d. Visual fields.
The confrontation test assesses visual fields. The other options are not tested with the confrontation
12. Which statement is true regarding the complete physical assessment?
a. The male genitalia should be examined in the supine position.
b. The patient should be in the sitting position for examination of the head and neck.
c. The vital signs, height, and weight should be obtained at the end of the
d. To promote consistency between patients, the examiner should not vary the order
of the assessment.
The head and neck should be examined in the sitting position to best palpate the thyroid and lymph
nodes. The male patient should stand during an examination of the genitalia. Vital signs are
measured early in the assessment. The sequence of the assessment may need to vary according to
different patient situations.
13. Which of these is included in an assessment of general appearance?
c. Skin color
d. Vital signs
General appearance includes items such as level of consciousness, skin color, nutritional status,
posture, mobility, facial expression, mood and affect, speech, hearing, and personal hygiene. Height,
weight, and vital signs are considered measurements.
14. The nurse should wear gloves for which of these examinations?
a. Measuring vital signs
b. Palpation of the sinuses
c. Palpation of the mouth and tongue
d. Inspection of the eye with an ophthalmoscope
Gloves should be worn when the examiner is exposed to the patients body fluids.
15. The nurse should use which location for eliciting deep tendon reflexes?
Deep tendon reflexes are elicited in the biceps, triceps, brachioradialis, patella, and Achilles heel.
16. During an inspection of a patients face, the nurse notices that the facial features are symmetric.
This finding indicates which cranial nerve is intact?
Cranial nerve VII is responsible for facial symmetry.
17. During inspection of the posterior chest, the nurse should assess for:
a. Symmetric expansion.
b. Symmetry of shoulders and muscles.
c. Tactile fremitus.
d. Diaphragmatic excursion.
During an inspection of the posterior chest, the nurse should inspect for symmetry of shoulders and
muscles, configuration of the thoracic cage, and skin characteristics. Symmetric expansion and
tactile fremitus are assessed with palpation; diaphragmatic excursion is assessed with percussion.
18. During an examination, the patient tells the nurse that she sometimes feels as if objects are
spinning around her. The nurse would document that she occasionally experiences:
Vertigo is the sensation of a person moving around in space (subjective) or of the person sensing
objects moving around him or her (objective) and is a result of a disturbance of equilibratory
19. A patient tells the nurse, Sometimes I wake up at night and I have real trouble breathing. I have
to sit up in bed to get a good breath. When documenting this information, the nurse would note:
b. Acute emphysema.
c. Paroxysmal nocturnal dyspnea.
d. Acute shortness of breath episode.
Paroxysmal nocturnal dyspnea occurs when the patient awakens from sleep with shortness of breath
and needs to be upright to achieve comfort
20. During the examination of a patient, the nurse notices that the patient has several small, flat
macules on the posterior portion of her thorax. These macules are less than 1 cm wide. Another
name for these macules is:
A macule is solely a lesion with color change, flat and circumscribed, less than 1 cm. Macules are
also known as freckles
21. During an examination, the nurse notices that a patients legs turn white when they are raised
above the patients head. The nurse should suspect:
b. Raynaud disease.
c. Chronic arterial insufficiency.
d. Chronic venous insufficiency.
Elevational pallor (striking) indicates arterial insufficiency
22. The nurse documents that a patient has coarse, thickened skin and brown discoloration over the
lower legs. Pulses are present. This finding is probably the result of:
b. Raynaud disease.
c. Chronic arterial insufficiency.
d. Chronic venous insufficiency.
Chronic venous insufficiency would exhibit firm brawny edema, coarse thickened skin, normal
pulses, and brown discoloration
23. The nurse notices that a patient has ulcerations on the tips of the toes and on the lateral aspect of
the ankles. This finding indicates:
b. Raynaud disease.
c. Arterial insufficiency.
d. Venous insufficiency.
Ulcerations on the tips of the toes and lateral aspect of the ankles are indicative of arterial
24. The nurse has just recorded a positive iliopsoas test on a patient who has abdominal pain. This
test is used to confirm a(n):
a. Inflamed liver.
b. Perforated spleen.
c. Perforated appendix.
d. Enlarged gallbladder.
An inflamed or perforated appendix irritates the iliopsoas muscle, producing pain in the RLQ.
25. The nurse will measure a patients near vision with which tool?
a. Snellen eye chart with letters
b. Snellen E chart
c. Jaeger card
The Jaeger card is used to measure near vision
26. If the nurse records the results to the Hirschberg test, the nurse has:
a. Tested the patellar reflex.
b. Assessed for appendicitis.
c. Tested the corneal light reflex.
d. Assessed for thrombophlebitis.
The Hirschberg test assesses the corneal light reflex
27. During the examination of a patients mouth, the nurse observes a nodular bony ridge down the
middle of the hard palate. The nurse would chart this finding as:
d. Torus palatinus.
A normal variation of the hard palate is a nodular bony ridge down the middle of the hard palate; this
variation is termed torus palatinus
28. During examination, the nurse finds that a patient is unable to distinguish objects placed in his
hand. The nurse would document:
29. After the examination of an infant, the nurse documents opisthotonos. The nurse recognizes that
this finding often occurs with:
a. Cerebral palsy.
b. Meningeal irritation.
c. Lower motor neuron lesion.
d. Upper motor neuron lesion.
Opisthotonos is a form of spasm in which the head is arched back, and a stiffness of the neck and an
extension of the arms and legs are observed. Opisthotonus occurs with meningeal or brainstem
30. After assessing a female patient, the nurse notices flesh-colored, soft, pointed, moist, papules in a
cauliflower-like patch around her introitus. This finding is most likely:
a. Urethral caruncle.
b. Syphilitic chancre.
c. Herpes simplex virus.
d. Human papillomavirus.
Human papillomavirus appears in a flesh-colored, soft, moist, cauliflower-like patch of papules
31. While recording in a patients medical record, the nurse notices that a patients Hematest results
are positive. This finding means that there is(are):
a. Crystals in his urine.
b. Parasites in his stool.
c. Occult blood in his stool.
d. Bacteria in his sputum.
32. While examining a 48-year-old patients eyes, the nurse notices that he had to move the handheld
vision screener farther away from his face. The nurse would suspect:
Presbyopia, the decrease in power of accommodation with aging, is suggested when the handheld
vision screener card is moved farther away.
Chapter 5. Evidence-Based Care
Identify the choice that best completes the statement or answers the question.
____ 1. Which of the following are parts of evidence-based practice?
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