Physical Examination: A Vitamin D Deficiency.

 

(Physical Examination: A Vitamin D Deficiency.)

Mr.Williams, a 62-year-old patient, presents for a physical examination. You suspect a vitamin D deficiency. Which of the following assessment findings might lead the examiner to suspect vitamin D deficiency?

Question

Question 1

Mr.Williams, a 62-year-old patient, presents for a physical examination. You suspect a vitamin D deficiency. Which of the following assessment findings might lead the examiner to suspect vitamin D deficiency?

a. Spinal curvature and bowed legs

b. Night blindness and dry eyes

c. Neuropathy and seizures

d. Nausea and insomnia

Question 2

A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that contains mostly:

a.fruit and vegetables.

b.lean meat and fish.

c.sandwiches and diet drinks.

d.pasta and chicken.

e.cereal and breads.

Question 3(Physical Examination: A Vitamin D Deficiency.)

In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for:

a. glycogen storage in the liver.
b. normal growth and development.
c. myocardial cell function.
d. building and maintaining tissues.

Question 4

Monitoring a patient’s waist-to-hip ratio provides data concerning:

a. daily caloric requirements.
b. lung capacity.
c. stomach cancer risk.
d. cardiovascular disease risk.

Question 5

Mr.Jones is a 45-year-old patient who presents for a physical examination. On examination, you note costochondral beading, an enlarged skull, and bowed legs and diagnose him with rickets. A deficiency of which fat-soluble micronutrient can result in rickets?

a. Vitamin A
b. Vitamin E
c. Vitamin D
d. Vitamin K

Question 6

A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she:

a. binges and vomits.
b. has regular menstrual periods.
c. has constipation frequently.
d. is cold intolerant.

Question 7(Physical Examination: A Vitamin D Deficiency.)

Mr.Miles is a 45-year-old man who is being evaluated for obesity. Advising Mr.Miles to reduce which macronutrient will produce the greatest calorie reduction per gram?

a. Carbohydrate
b. Protein
c. Fat
d. All provide the same number of calories per gram.

Question 8

Macronutrients are so named because they:

a. have high molecular weights.
b. form long chemical chains.
c. tend to increase waist measurements.
d. are required in large amounts.

Question 9

Bulging of an amber tympanic membrane without mobility is usually associated with:

a. middle ear effusion.
b. healed tympanic membrane perforation.
c. impacted cerumen in the canal.
d. repeated and prolonged crying cycles.

Question 10

An infant’s auditory canal, compared with an adult’s, is:

a. short, narrow, and straight.
b. short and curved upward.
c. long, narrow, and curved forward.
d. short and curved downward.

Question 11

An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or:

a. digestive disorders.
b. skeletal anomalies.
c. renal disorders.
d. heart defects.

Question 12

A 6-month-old who can hear well can be expected to:

a. exhibit the Moro reflex.
b. stop breathing in response to sudden noise.
c. turn his or her head toward the source of sound.
d. imitate simple words.

Question 13(Physical Examination: A Vitamin D Deficiency.)

A hairy tongue with yellowish brown to black elongated papillae on the dorsum:

a. is indicative of oral cancer.
b. is sometimes seen following antibiotic therapy.
c. usually indicates vitamin deficiency.
d. usually indicates anemia.

Question 14

A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness, you should palpate over the:

a. sphenoid and frontal sinuses.
b. maxillary and frontal sinuses.
c. maxillary sinuses only.
d. sphenoid sinuses only.

Question 15

A smooth red tongue with a slick appearance may indicate:

a. niacin or vitamin B12 deficiency.
b. oral cancer.
c. recent use of antibiotics.
d. fungal infection.

Question 16

A newborn whose serum bilirubin level is greater than 20 mg/100 mL has a risk of later:

a. hearing loss.
b. sinusitis.
c. tooth decay.
d. meningitis.

Question 17

A clinical syndrome of failing memory and impairment of other intellectual functions, usually related to obvious structural diseases of the brain, describes:

a. delirium.
b. dementia.
c. depression.
d. anxiety.

Question 18(Physical Examination: A Vitamin D Deficiency.)

Flight of ideas or loosening of associations is associated with:

a. aphasia.
b. dysphonia.
c. multiple sclerosis.
d. psychiatric disorders.

Question 19

An older adult is administered the Set Test and scores a 14. The nurse interprets this score as indicative of:

a. depression.
b. cognitive impairment.
c. delirium.
d. dementia.

Question 20

Assessing orientation to person, place, and time helps determine:

a. ability to understand analogies.
b. abstract reasoning.
c. attention span.
d. state of consciousness.

Question 21

Appropriateness of logic, sequence, cohesion, and relevance to topics are markers for the assessment of:

a. mood and feelings.
b. attention span.
c. thought process and content.
d. abstract reasoning.

Question 22

A 69-year-old truck driver presents with a sudden loss of the ability to understand spoken language. This indicates a lesion in the:

a. temporal lobe.
b. Broca area.
c. frontal cortex.
d. cerebellum.

Question 23

An aversion to touch or being held, along with delayed or absent language development, is characteristic of:

a. attention-deficit/hyperactivity disorder.
b. autism.
c. dementia.
d. mental retardation.

Question 24

Facial muscle or tongue weakness may result in:

a. aphasia.
b. impaired comprehension.
c. neologisms.
d. echolalia.

Question 25

Adolescents most likely to smoke, abuse substances, perform poorly in school, and be depressed are those who are:

a. from dual-income families.
b. from families that emphasize strong reli-gious beliefs.
c. from deprived socioeconomic groups.
d. unsupervised after school.

Question 26(Physical Examination: A Vitamin D Deficiency.)

An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native Americans, Asians, and Arabs is Western medicine’s attempts to:

a. use a holistic approach that views a par-ticular medical problem as part of a bigger picture.
b. determine a specific cause for every prob-lem in a precise way.
c. establish harmony between a person and the entire cosmos.
d. restore balance in an individual’s life.

Question 27

An image of any group that rejects its potential for originality or individuality is known as a(n):

a. acculturation.
b. norm.
c. stereotype.
d. ethnos.

Question 28

A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids eye contact and answers questions only by saying, “Yeah,” “No,”or “I guess so.” Which of the following is appropriate for the interviewer to say or ask?

a.“Why are you so depressed?”

b.“It’s hard for me to gather useful information because your answers are so short.”

c.“Are you uncomfortable talking with me?”

d.“Does your religion make it hard for you to answer my questions?”

Question 29

An example of a cold food is:

a. chocolate.

b. hard liquor.

c. oil.

d. onions.

e. a dairy product

Question 30

An example of a cold condition would be:

a. a fever.
b. a rash.
c. tuberculosis.
d. an ulcer.

Question 31

As the health care provider, you are informing a patient that he or she has a terminal illness. This discussion is most likely to be discouraged in which cultural group?

a. Navajo Native Americans
b. Dominant Americans
c. First-generation African descendants
d. First-generation European descendants

Question 32(Physical Examination: A Vitamin D Deficiency.)

A flat, nonpalpable lesion is described as a macule if the diameter is:

a. larger than 1 cm.
b. smaller than 1 cm.
c. 3 cm exactly.
d. too irregular to measure.

Question 33

A 17-year-old student complains of a “rash for 3 days.” You note pale, erythematous oval plaques over the trunk. They have fine scales and are arranged in a fernlike pattern, with parallel alignment. What is the nurse’s next action?

a. Teach infectious control measures.
b. Inquire about another recent skin lesion.
c. Inspect the palms and the soles.
d. Inform the patient that this will resolve within a week.

Question 34

A 5-year-old child presents with discrete vesicles on an erythematous base (dew drops on a rose petal appearance) that began near her scalp and are spreading to the trunk. The child has a low-grade fever and feels tired. What is the nurse’s next action?

a. Teach infectious control measures.
b. Inquire about other patterns of physical abuse.
c. Inspect the buccal mucosa for Koplik spots.
d. Inform the parent that this will resolve within a couple of days.

Question 35

Age spots are also called:

a. seborrheic keratoses.
b. solar lentigines.
c. cutaneous horns.
d. acrochordon.

Question 36

A single transverse line seen in the palm of a small child may imply:

a. Down syndrome.
b. Turner syndrome.
c. systemic sclerosis.
d. profound dehydration.

Question 37

A 29-year-old white woman appears jaundiced. Liver disease as a cause has been excluded. What history questions should the nurse ask?

a. Whether she had unprotected sex
b. Whether she has a history of diabetes mellitus
c. Whether she had unusual bleeding prob-lems
d. Whether she eats a lot of yellow and orange vegetables

Question 38

A slightly elevated brownish papule with indistinct borders is a typical characteristic of a(n) _____ nevus.

Compound

Question 39(Physical Examination: A Vitamin D Deficiency.)

A Dennie-Morgan fold is probably caused by:

a. birth trauma.
b. high fever.
c. excess adipose tissue.
d. chronic rubbing.

Question 40

A cause for alarm during chest assessment of a newborn is:

a. crackles.
b. rhonchi.
c. gurgles from the gastrointestinal tract.
d. stridor.

Question 41

A pregnant woman is expected to develop:

a. tachypnea and decreased tidal volume.
b. deep breathing but not more frequent breathing.
c. dyspnea and increased functional residual capacity.
d. bradypnea and increased tidal volume.

Question 42

A musical squeaking noise heard on auscultation of the lungs is called:

a. a friction rub.
b. rales.
c. rhonchi.
d. wheezing.

Question 43

A 44-year-old male patient who complains of a cough has presented to the emergency department. He admits to smoking one pack per day. During your inspection of his chest, the most appropriate lighting source to highlight chest movement is:

a. bright tangential lighting.

b. daylight from a window.

c. flashlight in a dark room.

d. fluorescent ceiling lights

Question 44

A 29-year-old patient presents with a new complaint of productive cough, with purulent sputum. He also complains of right lower quadrant abdominal pain.You suspect pneumonia in which lobe?

a. Right lower
b. Right upper
c. Left upper
d. Left lower

Question 45

Bone spicule pigmentation is a hallmark of:

a. chorioretinal pigmentosa.
b. cytomegalovirus infection.
c. lipemia retinalis.
d. retinitis pigmentosa.

Question 46(Physical Examination: A Vitamin D Deficiency.)

A pterygium is more common in people heavily exposed to:

a. high altitudes.
b. tuberculosis.
c. ultraviolet light.
d. cigarette smoke.

Question 47

A condition that typically develops by the age of 45 years is:

a. presbyopia.
b. hyperopia.
c. myopia.
d. astigmatism.

Question 48

An increased level of lysozyme in the tears will occur normally during which life stage?

a. Adolescence
b. Childhood
c. Infancy
d. Pregnancy

Question 49

Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the:

a. retina.
b. optic disc.
c. retinal vessels.
d. macula.

Question 50

Changes seen in proliferative diabetic retinopathy are the result of:

a. anoxic stimulation.
b. macular damage.
c. papilledema.
d. minute hemorrhages.

Question 51

A condition in which the eyelids do not completely meet to cover the globe is called:

a. glaucoma.
b. lagophthalmos.
c. exophthalmos.
d. hordeolum.

Question 52

An abnormal growth of conjunctiva extending over the cornea from the limbus is known as:

a. a cataract.
b. erythematous.
c. glaucoma.
d. a pterygium.

Question 53

A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She seems nervous as she speaks to you. An appropriate response is to:

a. continue to collect information regarding the chief complaint in an unhurried man-ner.
b. finish the interview as rapidly as possible.
c. ask the patient to take a deep breath and calm down.
d. ask the patient if she wants to wait until another day to talk to you.

Question 54(Physical Examination: A Vitamin D Deficiency.)

Constitutional symptoms in the ROS refer to:

a. height, weight, and body mass index.
b. fever, chills, fatigue, and malaise.
c. hearing loss, tinnitus, and diplopia.
d. rashes, skin turgor, and temperature.

Question 55

A tool used to screen adolescents for alcoholism is the:

a. CAGE.
b. CRAFFT.
c. PACES.
d. HITS.

Question 56

A guideline for history taking is for caregivers to:

a. ask direct questions before open-ended questions so that data move from simple to complex.
b. ask for a complete history at once so that data are not forgotten between meetings.
c. make notes sparingly so that the patient can be observed during the history taking.
d. write detailed information as stated by patients so that their priorities are reflect-ed.

Question 57

A pedigree diagram is drafted for the purpose of obtaining:

a. sexual orientation and history.
b. growth and developmental status.
c. genetic and familial health problems.
d. ethnic and cultural backgrounds.

Question 58

A brief statement of the reason the patient is seeking health care is called the:

a. medical history.
b. chief complaint.
c. assessment.
d. diagnosis.

Question 59

Behaviors that diffuse anxiety during the interview include:

a. avoiding wearing uniforms or laboratory coats.
b. providing forthright answers to questions.
c. providing all necessary information before the patient has to ask for it.
d. completing the interview as quickly as possible.

Question 60

After you ask a patient about her family history, she says, “Tell me about your family now.” Which response is generally most appropriate?

a. Ignore the patient’s comment and contin-ue with the interview.
b. Give a brief, undetailed answer.
c. Ask the patient why she needs to know.
d. Tell the patient that you do not discuss your family with patients.

Question 61

If only two blood pressure values are recorded, they are the _______________ sounds. blank(s) with correct word

first systolic and second diastolic

Question 62

A normal adult’s pulse pressure should range from _____ to _____ mm Hg.  Fill in the blank(s) with correct word

30; 40

Question 63

Body language that leads you to suspect that a person is in pain is:

a. talkative, verbose speech.
b. fretful hand movements.
c. focused, fixed eye stares.
d. marked salivation.

Question 64

During respiration, the internal intercostals:

a. increase the force of muscular contraction.
b. decrease the lateral diameter during expi-ration.
c. decrease the intrathoracic space.
d. increase elastic recoil during expiration.

Question 65

Hypertension in the adult is generally defined as pressure in excess of:

a. 120 mm Hg plus the patient’s age.
b. 140 mm Hg.
c. 160 mm Hg.
d. 200 mm Hg.

Question 66

If a sufficiently large cuff is unavailable to fit an obese arm, which technique may be used to assess blood pressure?

a. Wrap a standard cuff around the deltoid area and place the stethoscope over the radial artery.
b. Wrap a standard cuff around the forearm and place the stethoscope over the radial artery.
c. Wrap a standard cuff around the thigh and place the stethoscope on the dorsalis pedis.
d. Wrap a pediatric cuff around the ankle and place the stethoscope on the popliteal artery.

Question 67

In a syndrome in which regional pain extends beyond this specific peripheral nerve injury, you would notice which of the following: (Select all that apply.)

a. Allodynia
b. Sleep disturbance
c. Blood flow changes
d. Numbness
e. Edema

Question 68(Physical Examination: A Vitamin D Deficiency.)

A blood pressure cuff bladder should be long enough to:

a. cover 20% to 25% of the arm circumfe-rence.
b. cover 45% to 50% of the arm circumfe-rence.
c. cover 75% to 80% of the arm circumfe-rence.
d. completely encircle the arm.

Question 69

A variant of the percussion hammer is the neurologic hammer, which is equipped with which of the following?

a. Brush and needle
b. Tuning fork and cotton swab
c. Penlight and goniometer
d. Ruler and bell

Question 70

Auscultation should be carried out last, except when examining the:

a. neck area.
b. heart.
c. lungs.
d. abdomen.

Question 71

A rubber or plastic ring should be around the bell endpiece of a stethoscope to:

a. prevent the transmission of static electric-ity.
b. prevent cold metal from touching the pa-tient.
c. prevent the sharp edge of the stethoscope from damaging the patient’s skin.
d. ensure secure contact with the body sur-face.

Question 72

During percussion, a dull tone is expected to be heard over:

a. healthy lung tissue.
b. emphysemic lungs.
c. the liver.
d. most of the abdomen.

Question 73

According to the guidelines for Standard Precautions, the caregiver’s hands should be washed:

a. only after touching body fluids with un-gloved hands and between patient con-tacts.
b. only after touching blood products with ungloved hands and after caring for infec-tious patients.
c. only after working with patients who are thought to be infectious.
d. after touching any body fluids or conta-minated items, regardless of whether gloves are worn.

Question 74

During auscultation, you can limit your perceptual field best by:

a. asking patients to describe their symp-toms.
b. closing your eyes.
c. performing auscultation before percussion.
d. using an aneroid manometer.

Question 75

A patient in the emergency department has a concussion. You suspect the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient?

a. Grid
b. Red-free filter
c. Slit lamp
d. Small aperture

Question 76

A scale used to assess patients’ weight should be calibrated:

a. only by the manufacturer.
b. by a qualified technician at regularly scheduled intervals.
c. each time it is used.
d. when necessary, with the patient standing on the scale.

Question 77

At what age does peak height growth velocity occur in boys?

a. 10 years
b. 12 years
c. years
d. years

Question 78

An 11-year-old boy is brought in for an annual physical examination by his mother.You suspect _______________ when you measure his arm span at 65 inches and his height at 60 inches. Fill in the blank(s) with correct word

Marfan syndrome

Question 79

A pregnant woman of normal prepregnancy weight should be expected to gain how much weight per week during the second and third trimesters of pregnancy?

a. 1 pound
b. pounds
c. 2 pounds
d. pounds

Question 80

A prominent forehead, large nose, large jaw, and elongation of the facial bones and extremities are signs of:

a. infantile hydrocephalus.
b. acromegaly.
c. Cushing syndrome.
d. achondroplasia.

Question 81

A marker for nutritional status is the:

a. head circumference.
b. waist-to-hip ratio.
c. standing height.
d. triceps skinfold thickness.

Question 82

A woman with a normal prepregnancy body mass index (BMI) should gain approximately _____ pounds during pregnancy. Fill in the blank(s) with correct word

30

Question 83

After 50 years of age, stature:

a. becomes fixed.
b. begins a barely perceptible secondary in-crease.
c. increases at a rate of 0.5 cm/ year.
d. declines.

Question 84

A Mexican American mother brings her 12-year-old daughter to the clinic because this child is not maturing as quickly as her classmates. You examine the daughter and determine that her growth and physical findings are within normal limits. You should explain to the family that:

a. Mexican Americans may develop more slowly than other ethnic groups.
b. more tests should be conducted because the family appears so worried.
c. the daughter should drink more juices and eat more fruit.
d. there is a serious problem with the daugh-ter’s development.

Question 85(Physical Examination: A Vitamin D Deficiency.)

A 29-year-old woman presents to the urgent care center with a history of a severe headache of 2 hours’ duration. She describes it as bandlike and constricting.In interviewing the woman about her complaint, you would ask:

a. whether she has experienced increased tearfulness.
b. the date of her last menstrual period.
c. whether these headaches started in child-hood.
d. whether she is particularly stressed or overworked.

Question 86

An inconsequential finding on the head of an adult is a palpable:

a. embryonic remnant.
b. posterior fontanel.
c. sagittal suture ridge.
d. skull indentation.

Question 87

Closure of the anterior skull fontanel should occur by ______________.  Fill in the blank(s) with correct word

24 months of age

Question 88

During a head and neck assessment of a neonate, it is important to screen for:

a. the presence of torticollis.
b. signs and symptoms of cerebral palsy.
c. uneven movement of the eyes.
d. unilateral movement of the tongue.

Question 89

A stethoscope is used in a head and neck examination to assess:

a. intracranial fluid.
b. pulsating fontanels.
c. skull bone development.
d. thyroid vascular sounds.

Question 90

During a physical examination of a 30-year-old Chinese man, you notice a slight asymmetry of his face. The cranial nerve examination is normal. Your best action is to:

a. ask the patient if this characteristic runs in his family.
b. perform monofilament testing on the face.
c. consult with the physician regarding the laboratory tests needed.
d. record the finding in the patient’s chart.

Question 91

A bruit, or blowing sound, over the skull or temporal region of an adult indicates a:

a. degenerative change.
b. hyperthyroid storm.
c. skull fracture.
d. vascular anomaly.

Question 92

Coarse, dry, and brittle hair is associated with which metabolic disorder?

a. Hypothyroidism
b. Diabetes mellitus
c. Addison disease
d. Cushing syndrome

Question 93

A red streak that follows the course of the lymphatic collecting duct is a finding associated with:

a. Hodgkin disease.
b. lymphangitis.
c. lymphedema.
d. lymphoma.

Question 94

As adults age, their ability to resist infection is reduced because of the lymphatic nodes becoming more:

a. fibrotic.
b. mucoid.
c. porous.
d. profuse.

Question 95(Physical Examination: A Vitamin D Deficiency.)

Equipment for examining the lymphatic system includes a:

a. caliper.
b. centimeter ruler.
c. goniometer.
d. syringe and needle.

Question 96

Cells that line the lymph node sinuses perform the specific function of:

a. fat absorption.
b. fetal immunization.
c. hematopoiesis.
d. phagocytosis.

Question 97

An organ that is essential to the development of protective immune function in the infant but has little or no demonstrated function in the adult is the:

a. spleen.
b. liver.
c. thymus.
d. pancreas.

Question 98

A congenital defect in the immune system of a 2-week-old infant may be suspected if:

a. there are small femoral nodes palpable.
b. the umbilical cord has not yet dropped off.
c. the tonsils are visible.
d. the thymus is visible on a chest radio-graph.

Question 99

Hodgkin disease is most common in ______________________. Fill in the blank(s) with correct word

late adolescence and young adulthood

Question 100

Enlarged inguinal nodes are likely to be associated with:

a. genital herpes.
b. pelvic inflammatory disease.
c. uterine cancer.
d. testicular cancer.

 

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