S.CH.25 QBank (+Rational)

acknowledging the discomfort. R:Acknowledging the patient's discomfort during the examination will help the patient feel more relaxed. It may help to consistently provide an explanation of which part of the examination comes next and to be honest about the potential of uncertainty, discomfort, or pain and how long it will last.

professional and the patient. R:It is the responsibility of the health professional and the patient to present reliable findings and observations. They work as a team.

No test has 100% sensitivity and specificity. R:No test has 100% sensitivity and specificity.

minimize the number of times that the patient must change positions. R:There is no one right way to put together the parts of the physical examination. The sequence should be individualized to minimize the number of times the patient has to change positions to conserve the patient's energy.

Sitting R:Upon entering the examination room, you should assist the patient in the sitting position on the examining table. In the sitting position, you can examine the patient's anterior and posterior upper trunk and head, which comprise the majority of focused assessments.

lens inspection. R: Ophthalmoscope eye examination involves testing the red reflex and inspecting the lens, disc, cup margins, vessels, and retinal surface. The other assessments do not involve the use of the ophthalmoscope.

Jugular venous pulsation and pressure R:With the patient in a reclining 45-degree position, you can examine the jugular venous pulsations and measure jugular venous pressure. All of the other choices can be examined with the patient in a sitting position.

supine patient to raise the head. R:Asking the patient to raise the head will contract the rectus abdominis muscles, which produces muscle prominence, making abdominal wall masses visible. All of the other choices would not show the abdominal muscles contracting.

standing. R:Proprioception examination involves the Romberg test, heel-to-toe walking, standing on one foot and then on the other with eyes closed, hopping in place, and deep knee bends. The standing position is required to conduct these examinations.

palpation of anal sphincter tone. R:With the patient in the lithotomy position, the examiner can inspect the external and internal female genitalia and perform rectal examination to assess and palpate anal sphincter tone. The other answers require the patient to be in the supine or standing position.

Spinal R:With the patient in the standing position, the examiner can inspect and palpate the spine as the patient bends over at the waist and test the patient's range of motion.

Newborn R:The newborn is at greater risk for potential health problems than other ages but also has the potential for better health than the other age groups.

conduct the physical examination on the child while the parent is holding the child. R:For children, the examination sequence depends on their cooperation for as long as possible. To promote this, examine the child while the parent is holding the child, while maximizing both inspection and opportunities for physical examination.

encourage child's participation. R:The best way to ease the apprehension of a 3-year-old child before a physical examination is to encourage the child to participate by helping you. Ask the child to hold the endpiece of the stethoscope or to "blow out" your flashlight.

auscultate heart sounds. R:For a crying infant, the lungs can be auscultated between consolable moments. While the infant is crying, the examiner can assess the lustiness of cry, tactile fremitus, lung excursion, facial symmetry, and appearance of the mouth and pharynx. Between breaths, the heart tone can be auscultated.

perform the examination while the child is in the mother's lap. R:The parent's lap is a great "examination table" because it helps the child feel more at ease and is a good way to observe the nature of the parent-child relationship. None of the other actions would comfort the patient or make the situation better.

Neurologic and musculoskeletal R:A child playing on the floor offers an opportunity to evaluate both the musculoskeletal and neurologic systems by noting the child's coordination of activities, such as when throwing a ball, drawing, coloring, walking, and jumping.

bathing. R:Basic ADL include bathing, dressing, toileting, ambulating, and feeding. All of the other choices represent instrumental ADL.

older adult. R:Functional assessment is most important when examining older adults. Initial observation and interaction can provide a great deal of information about the individual's independent functional capacity. Attention should be given to self-care activities and instrumental activities.

Pupil reactivity R:The Apgar score, taken at 1 and 5 minutes of age, provides insight to the baby's in utero, intrapartum, and immediate postnatal experience. A low score for several of the variables—color, heart rate, respirations, muscle tone, and reflex irritability—is evidence of difficulty.