HEALTH ASSESSMENT RLE

CFU ANSWERS AND RATIONALE (9-16)

Module 9
1. When providing patient education on hearing, patients should be reminded to utilize ear plugs
when they are what? (Select all that apply.)
a. At train stations c. At work
b. At the movies d. At concerts
Answer: A, C, and D
RATIONALE: As nurses, prevention is key, and patients should be reminded to utilize ear plugs
when exposed to loud
noises in their daily lives (e.g., lawnmowers, leaf blowers, chainsaws, concerts, train stations,
battlefields, and sirens) and
to limit exposure (iPod buds and cell phones).
2. Functionally, the most important range for hearing is the range of human speech. What is the
range of
human speech?
a. 300 Hz to 3000 Hz c. 200 Hz to 2000 Hz
b. 250 Hz to 2500 Hz d. 50 Hz to 15000 Hz
Answer: A
RATIONALE: When trying to distinguish between conductive and neurosensory hearing loss,
you need a quiet room and a tuning fork, preferably of 512 Hz or possibly 1024 Hz. These
frequencies fall within the range of human speech (300 Hz to 3000 Hz)—functionally the most
important range.
3. When assessing a patient, you note that the tonsils are touching the uvula. How would you
document the tonsils?
a. Tonsils are T4 c. Tonsils are T2
b. Tonsils are T3 d. Tonsils are T1
Answer: B
RATIONALE: Tonsils are graded based on size: T1: tonsils are visible; T2: tonsils are between
the tonsillar pillars and the
uvula; T3: tonsils are touching the uvula; T4: tonsils are touching each other.
4. What is the average age of significant hearing loss detected if the infant is not assessed prior
to leaving
the hospital at birth?
a. 18 months c. 14 months
b. 16 months d. 12 months
Answer: C
RATIONALE: Hearing screening should be completed before an infant leaves the hospital.
Without such programs, the average age of detection of significant hearing loss is approximately
14 months.
5. You are teaching a health class at the local high school. What would you teach the students
to use during oral sex to help reduce the transmission of STDs?
a. Oral barriers c. Dental dams
b. Dental prophylactic d. Oral condoms
Answer: C
RATIONALE: Use of dental dams during oral sex will act as a barrier to bodily fluids and help
reduce transmission of STDs such as herpes, genital warts, and HIV.
6. What structure in the inner ear senses the position and movements of the head and helps to
maintain
balance?
a. The labyrinth c. The umbo
b. The cochlea d. The ossicle
Answer: A
RATIONALE: The labyrinth within the inner ear senses the position and movements of the head
and helps to maintain balance.
7. An alternate pathway that bypasses the external and middle ear is called what?
a. Bone conduction c. Neuro conduction
b. Sensory conduction d. Air conduction
Answer: A
RATIONALE: An alternate pathway, known as bone conduction, bypasses the external and
middle ear and is used for testing purposes.
8. A patient presents at the clinic with a chief complaint of right ear pain. You note a rash in the
right ear canal. What should you know is a possible cause of these symptoms?
a. Acute ossiculo-mastitis c. Acute mastoiditis
b. Chronic otosclerosis d. Chronic otitis media
Answer: D
RATIONALE: Unusually soft wax, debris from inflammation or rash in the ear canal, or
discharge through a perforated
eardrum may be secondary to acute or chronic otitis media.
9. Your patient is complaining of nasal stuffiness. What drugs should you ask if she is taking?
(Select all that apply.)
a. Oral contraceptives d. Nicotine
b. Guaifenesin e. Guanethidine
c. Alcohol
Answer: A, C and E
RATIONALE: Inquire about drugs that might cause stuffiness: oral contraceptives, reserpine,
guanethidine, and alcohol.
10. What lines the cheeks?
a. Lingual mucosa c. Buccal mucosa
b. Alveolar mucosa d. Labial mucosa
Answer: C
RATIONALE: The buccal mucosa lines the cheeks.

Module 10
1. What is the best guide to make vertical locations on the chest?
a. Midclavicular line c. Angle of Henri
b. Sternal angle d. 5th intercostal space
Answer: B
RATIONALE: To make vertical locations, you must be able to count the ribs and interspaces.
The sternal angle, also termed the angle of Louis, is the best guide.
2. When assessing the posterior chest, what is a starting point for counting ribs and intercostal
spaces?
a. 6th rib c. 10th rib
b. 8th rib d. 12th rib
Answer: D
RATIONALE: Posteriorly, the 12th rib is another possible starting point for counting ribs and
intercostal spaces: it helps locate findings on the lower posterior chest and provides an option
when the anterior approach is unsatisfactory.
3. Which ribs are considered “floating ribs”?
a. 11th and 12th c. 9th and 10th
b. 10th and 11th d. 8th and 9th
Answer: A
RATIONALE: Note that the costal cartilages of the first seven ribs articulate with the sternum;
the cartilages of the 8th,9th, and 10th ribs articulate with the costal cartilages just above them.
The 11th and 12th ribs, the “floating ribs,” have no anterior attachments. The cartilaginous tip of
the 11th rib usually can be felt laterally, and the 12th rib may be felt
posteriorly. On palpation, costal cartilages and ribs feel identical.
4. When assessing posteriorly, where would the trachea bifurcate into its mainstem bronchi?
a. Sternal angle c. Suprasternal notch
b. T4 spinous process d. Midaxillary line
Answer: B
RATIONALE: The trachea bifurcates into its mainstem bronchi at the levels of the sternal angle
anteriorly and the T4 spinous process posteriorly.
5. Dyspnea, an uncomfortable awareness of breathing that is inappropriate to the level of
exertion, is what?
a. Audible breathing c. Air hunger
b. Painful breathing d. Prolonged inspiration
Answer: C
RATIONALE: Dyspnea is air hunger, a non painful but uncomfortable awareness of breathing
that is inappropriate to the level of exertion, commonly termed shortness of breath.
6. A 25-year-old male patient is brought to the emergency department by ambulance after being
involved in a motor vehicle accident. You find that he has decreased breath sounds over the left
lung fields. What might you suspect is the cause?
a. Pneumothorax c. Muscular weakness
b. COPD d. Pulmonary embolism
Answer: A
RATIONALE: Breath sounds may be decreased when air flow is decreased (as in obstructive
lung disease or muscular weakness) or when the transmission of sound is poor (as in pleural
effusion, pneumothorax, or COPD).
7. When assessing the breath sounds of a newly admitted patient, the nurse notes increased
transmission of
voice sounds over the right lung. What would this indicate to the nurse?
a. The lung is full of fluid c. The lung is overinflated
b. The lung has an embolus d. The lung has become airless
Answer: D
RATIONALE: Increased transmission of voice sounds suggests that air-filled lung has become
airless.
8. What replaces resonance when fluid or solid tissue replaces air-containing lung or occupies
the pluralspace?
a. Hyperresonance c. Tympany
b. Dullness d. Chief complaint
Answer: B
RATIONALE: Dullness replaces resonance when fluid or solid tissue replaces air-containing
lung or occupies the pleural
space.
9. What associated symptoms might a patient with a history of chronic bronchitis have? (Mark
all that apply.)
a. Orthopnea d. Recurrent respiratory infections
b. Chronic productive cough e. Wheezing
c. Paroxysmal nocturnal dyspnea
Answer: B, D, and E
RATIONALE: Associated symptoms of chronic bronchitis include chronic productive cough and
recurrent respiratory
infections; wheezing may also develop.
10. You are caring for an 80-year-old Hispanic woman who is 48 hours postop from the repair of
a fractured hip.
She has a sudden onset of dyspnea without pain. What disease process would you suspect?
a. Left ventricular failure c. Pulmonary embolism
b. Asthma d. Chronic lung disease
Answer: C
RATIONALE: Risk factors for pulmonary embolism include postpartum or postoperative periods,
prolonged bed rest, congestive heart failure, chronic lung disease, fractures of hip or leg, and
deep venous thrombosis (often not clinically apparent).

Module 11
1. What is located at the right and left 2nd intercostal spaces next to the sternum?
a. “Base of the heart” c. Pulmonary vein
b. Apex of the heart d. Aortic valve
Answer: A
RATIONALE: The right ventricle narrows as it rises to meet the pulmonary artery just below the
sternal angle. This is called the “base of the heart” and is located at the right and left 2nd
intercostal spaces next to the sternum.
2. When a patient is obese or has a thick chest wall, what is difficult to palpate?
a. Thrill c. Grade 4 murmur
b. Apical impulse d. Sternal angle
Answer: B
RATIONALE: Obesity or a thick chest wall makes palpation of the apical impulse difficult.
3. What is the normal peak pressure of the left ventricle?
a. 90 mm Hg c. 110 mm Hg
b. 100 mm Hg d. 120 mm Hg
Answer: D
RATIONALE: In the diagram below, pressure in the left ventricle rises from <5 mm Hg in its
resting state to a normal peak of 120 mm Hg.
4. A 78-year-old male Filipino patient is noted to have a pathologic change in ventricular
compliance. What information from the cardiac assessment would indicate this?
a. A split S2
b. A delayed S3
c. An n S3 gallop
d. A weak S4
Answer: C
RATIONALE: In older adults, an S3, sometimes termed “an S3 gallop,” usually indicates a
pathologic change in
ventricular compliance.
5. What are the components of S1? (Mark all that apply.)
a. An earlier aortic sound d. A later tricuspid sound
b. An earlier mitral sound e. An earlier tricuspid sound
c. A later pulmonic sound
Answer: B and D
RATIONALE: S1 also has two components, an earlier mitral and a later tricuspid sound.
6. Your patient asks you what the small P wave on her ECG indicates. What would you answer?
a. Atrial depolarization c. Atrial repolarization
b. Ventricular depolarization d. Ventricular repolarization
Answer: A
RATIONALE: The small P wave indicates atrial depolarization (duration up to 80 msec; PR
interval 120 to 200 msec).
7. What term is used to describe the degree of vascular resistance to ventricular contraction?
a. Contractile overload c. Preload
b. Afterload d. Volume overload
Answer: B
RATIONALE: Afterload refers to the degree of vascular resistance to ventricular contraction.
8. When, in the cardiac cycle, does blood pressure peak?
a. Preload c. Systole
b. Diastole d. Afterload
Answer: C
RATIONALE: Blood pressure in the arterial system varies during the cardiac cycle, peaking in
systole and falling to its
lowest trough in diastole.
9. Over a 24-hour period there is a striking variation in blood pressure levels. What can cause
these variations?
(Mark all that apply.)
a. Time of day d. Noise
b. Sugar ingestion e. Environmental temperature
c. Size of meals
Answer: A, D, and E
RATIONALE: Blood pressure levels fluctuate strikingly throughout any 24-hour period, varying
with physical activity;
emotional state; pain; noise; environmental temperature; use of coffee, tobacco, and other
drugs; and even time of day.
10. What do the oscillations in the internal jugular veins reflect?
a. Changing pressures within the right ventricle c. Changing pressures within the right ventricle
b. Changing pressures within the left atrium d. Changing pressures within the left atrium
Answer: D
RATIONALE: The oscillations that you see in the internal jugular veins, and often in the
externals, reflect changing pressures within the right atrium.

Module 12
1. What is the Virchow triad? (Mark all that apply.)
a. Arterial stasis d. High fat content in blood
b. Hypercoagulability e. Venous stasis
c. Vessel wall damage
Answer: b, c, and e
RATIONALE: The Virchow triad—venous stasis, hypercoagulability, and vessel wall damage—
sets the stage for the development of a DVT.
2. While assessing the legs of your patient you note that the legs and feet are cool to the touch.
What would you know is most often the cause of bilateral coolness?
a. Inadequate arterial circulation c. Anxiety
b. Embolism d. DVT
Answer: c
RATIONALE: Palpate the temperature of both legs and feet simultaneously with the backs of
your hands. Compare the temperature of the legs. Bilateral coolness is most often caused by a
cold environment or anxiety.
3. The nurse is assessing a patient with Raynaud disease. When assessing the wrist pulses,
what would the nurse expect to find?
a. Normal wrist pulses c. Bounding wrist pulses
b. Decreased wrist pulses d. Absent wrist pulses
Answer: a
RATIONALE: In Raynaud disease, wrist pulses are typically normal, but spasm of more distal
arteries causes episodes of sharply demarcated pallor of the fingers.
4. What is a long-term complication of peripheral vascular disease?
a. Decreased circulation c. Amputation
b. Thickened skin d. Loss of hair
Answer: c
RATIONALE: Diseases of the peripheral vascular system, peripheral arterial disease, venous
stasis, and thromboembolic disorders can severely affect the lifestyle and quality of life of
patients. Identifying modifiable risk factors and providing health pro- motion counselling can
prevent or delay long-term complications, such as decreased mobility and amputation.
5. The nurse is testing the valvular competency of the saphenous system. What test is she
performing on the
patient?
a. Trendelenburg test c. Allen Test
b. Ankle–brachial index test d. Venous occlusion test
Answer: a
RATIONALE: By the retrograde filling (Trendelenburg) test, you can assess the valvular
competency in both the communicating veins and the saphenous system.
6. Your patient has a difference between the highest and lowest systolic pressure of 12 mm Hg.
What does this indicate? (Mark all that apply.)
a. Obstructive airway disease d. Peripheral arterial disease
b. Pericardial tamponade e. Complex atheroma
c. Possible constrictive pericarditis
Answer: a, b, and c
RATIONALE: A difference between the highest and lowest systolic pressure of more than 10
mm Hg indicates a paradoxical pulse and suggests pericardial tamponade, possible constrictive
pericarditis, but most commonly obstructive airway disease.
7. What is a function of the lymph system?
a. Produce antibodies c. Drain lymph fluid from the vascular bed
b. Clean the blood d. Transport nutrients to the tissues
Answer: a
RATIONALE: The lymphatic system is an extensive vascular network that drains lymph fluid
from body tissues and
returns it to the venous circulation. In addition to its vascular functions, the lymphatic system
plays an important role in the body’s immune system. Cells within the lymph nodes engulf
cellular debris and bacteria and produce antibodies.
8. You are preparing a class presentation on edema. What mechanisms would you cite as
producing edema?
a. Arterial insufficiency d. Increased capillary blood pressure
b. Low plasma protein levels e. Hepatic disorders
c. Capillary leak syndrome
Answer: b, c, and d
RATIONALE: Four mechanisms produce edema:
1. increased capillary blood pressure (increased hydrostatic pressure), which may be caused by
venous
insufficiency or congestive heart failure;
2. increased capillary membrane permeability (capillary leak syndrome), caused by burns,
snake bites, angioedema,
or allergic reactions;
3. low plasma protein levels (creating low colloid osmotic pressure), caused by renal disorders;
and
4. Blockage or removal of lymphatic drainage, as seen in lymph node removal.
9. You are studying the peripheral vascular system so you would know that the vasa vasorum is
found where?
a. Inferior vena cava c. Venous intima
b. Superior vena cava d. Adventitia of the artery
Answer: d
RATIONALE: The outer layer of the artery is the adventitia, connective tissue containing nerve
fibers and the vasa vasorum.
10. The nursing instructor is discussing the great and small saphenous veins. What would the
instructor say connects these two veins?
a. Bridging veins c. Anastomotic veins
b. Communicating veins d. Insight
Answer: c
RATIONALE: Anastomotic veins connect the two saphenous veins that are readily visible when
dilated.

Module 13
1. What can cause bladder distention? (Mark all that apply.)
a. Medications d. Perineal fissure
b. Stroke e. Rectal abscess
c. Multiple sclerosis
Answer: A, B, and C
RATIONALE: Bladder distention results from outlet obstruction due to urethral stricture or
prostatic hyperplasia, and also from medications and neurologic disorders such as stroke or
multiple sclerosis.
2. You are assessing a patient for acute cholecystitis. What sign would you assess for?
a. Psoas sign c. Murphy sign
b. Obstipation sign d. Cutaneous hyperesthesia
Answer: C
RATIONALE: A sharp increase in tenderness with a sudden stop in inspiratory effort constitutes
a positive Murphy sign of acute cholecystitis. Hepatic tenderness may also increase with this
maneuver but is usually less well localized.
3. Your patient has epigastric pain that is poorly localized and radiates to the back. What would
be an important diagnosis to assess for?
a. Acute pancreatitis c. Acute cholecystitis
b. Biliary colic d. Acute diverticulitis
Answer: A
RATIONALE: With acute pancreatitis, epigastric pain may radiate to the back or other parts of
the abdomen; it may be poorly localized.
4. When assessing for appendicitis, what signs might you look for? (Mark all that apply.)
a. Murphy sign d. Rovsing sign
b. Psoas sign e. Cutaneous hyperesthesia
c. Obfuscator sign
Answer: B, D, and E
RATIONALE:
● Pain in the right lower quadrant during left-sided pressure suggests appendicitis (a positive
Rovsing sign). So does right lower quadrant pain on quick withdrawal (referred rebound
tenderness).
● Look for a psoas sign. Place your hand just above the patient’s right knee and ask the patient
to raise that thigh
against your hand. Alternatively, ask the patient to turn onto the left side. Then extend the
patient’s right leg at the
hip. Flex- ion of the leg at the hip makes the psoas muscle contract; extension stretches it.
● Increased abdominal pain on either maneuver constitutes a positive psoas sign, suggesting
irritation of the psoas
muscle by an inflamed appendix.
● Look for an obturator sign. Flex the patient’s right thigh at the hip, with the knee bent, and
rotate the leg internally
at the hip. This maneuver stretches the internal obturator muscle.
● Right hypogastric pain constitutes a positive obturator sign, suggesting irritation of the
obturator muscle by an
inflamed appendix.
● Test for cutaneous hyperesthesia. At a series of points down the abdominal wall, gently pick
up a fold of skin
between your thumb and index finger, without pinching it. This maneuver should not normally be
painful.
● Localized pain with this maneuver, in all or part of the right lower quadrant, may accompany
appendicitis.
5. Your patient describes her stool as soft, light yellow to grey, mushy, greasy, foul-smelling,
and usually floats in the toilet. What would you suspect is wrong with your patient?
a. Malabsorption syndrome c. Crohn disease
b. Lactose intolerance d. Ulcerative colitis
Answer: A
RATIONALE: Malabsorption syndrome is characterized by stool that is typically bulky, soft, light
yellow to grey, mushy,greasy or oily, sometimes frothy, and particularly foul-smelling, and it
usually floats in the toilet.
6. Your patient has a bladder disorder. Where would you expect the pain to be?
a. Upper abdomen c. Back
b. Suprapubic d. Perineal
Answer: B
RATIONALE: Bladder disorders may cause suprapubic pain.
7. Which type of incontinence is caused by bladder pressure exceeding urethral pressure?
a. Urge incontinence c. Stress incontinence
b. Functional incontinence d. Overflow incontinence
Answer: D
RATIONALE: Stress incontinence with increased intra-abdominal pressure suggests decreased
contractility of the urethral sphincter or poor support of bladder neck; urge incontinence, if
unable to hold the urine, suggests detrusor overactivity; overflow incontinence, when the
bladder cannot be emptied until bladder pressure exceeds urethral pressure, indicates anatomic
obstruction by prostatic hypertrophy or stricture, or neurogenic abnormalities.
8. You are admitting a patient who is in hypertensive crisis. The doctor’s notes indicate that
bruits that are both systolic and diastolic have been noted and renal artery stenosis is suspected
as the cause of the hypertension. Where would you auscultate the patient’s abdomen to hear
these bruits? (Mark all that apply.)
a. Right upper quadrant d. Epigastrium
b. Femoral arteries e. Costovertebral angles
c. Iliac arteries
Answer: A, D, and E
RATIONALE: If the patient has high blood pressure, listen in the epigastrium and in each upper
quad- rant for bruits. Later in the examination, when the patient sits up, listen also in the
costovertebral angles. A bruit in one of these areas that has both systolic and diastolic
components strongly suggests renal artery stenosis as the cause of hypertension.
9. A 55-year-old Filipino man presents at the clinic with a chief complaint of “indigestion.” The
patient tells the nurse, “It usually happens after I do things like mowing the lawn or doing other
yard work.” What should the nurse suspect?
a. Angina c. Aortic aneurysm
b. Ulcer disease d. Gallbladder disease
Answer: A
RATIONALE: Note that angina from inferior wall coronary artery disease may present as
“indigestion,” but is precipitated by exertion and relieved by rest.
10. Mrs Cherry Santos presents at the clinic with a chief complaint of pain in her upper
abdomen. On assessmentthe nurse notes that Mrs Santos has recurrent pain, more than two
times weekly, in her upper abdomen, and thatthis recurrent pain started 2 months ago. What
term should the nurse use for this type of pain?
a. Discomfort c. Dyspepsia
b. Dysphagia d. Odynophagia
Answer: C
RATIONALE: For more chronic symptoms, dyspepsia is defined as chronic or recurrent
discomfort or pain centered in the upper abdomen.

Module 14
1. The nursing student is learning to palpate the axillary nodes during a breast examination.
Which nodes is heor she most likely to palpate?
a. Central nodes c. Subscapular nodes
b. Pectoral nodes d. Lateral nodes
Answer: A
RATIONALE: Of the axillary lymph nodes, the central nodes are palpable most frequently.
2. The nursing instructor explains to the students that malignant cells from a breast cancer may
spread directly to what nodes?
a. Infraclavicular nodes c. Supraclavicular nodes
b. Lateral nodes d. Median nodes
Answer: A
RATIONALE: Malignant cells from a breast cancer may spread directly to the infraclavicular
nodes or into deep channels within the chest.
3. When examining a breast, what would you consider a common or concerning symptom?
(Mark all that apply.)
a. Rash c. Breast discomfort e. Edema
b. Bilateral green nipple discharge d. Rectangular shape
c. Breast discomfort
Answer: a, b, c, d, and e
RATIONALE: Common or concerning symptoms: breast lump or mass; breast pain or
discomfort; change in shape; nipple discharge; edema; dimpling; and rash.
4. What is an accurate description of scaling?
a. Small indents of the breast tissue c. Red, rough patch of skin
b. Thin flakes of keratinized epithelium d. Silvery patches of itchy skin
Answer: B
RATIONALE: Scaling consists of thin flakes of keratinized epithelium.
5. When is the best time for examination of the breast?
a. 3 to 5 days after the onset of menstruation c. 3 to 5 days before the onset of menstruation
b. 5 to 7 days after the onset of menstruation d. 5 to 7 days before the onset of menstruation
Answer: B
RATIONALE: The best time for examination is 5 to 7 days after the onset of menstruation.
6. Your patient is noted to have thickening of the skin and unusually prominent pores on her
right breast. What might you suspect?
a. Cyst c. Lymphatic obstruction
b. Inflammation d. Fibrocystic disease
Answer: C
RATIONALE: Thickening of the skin and unusually prominent pores may accompany lymphatic
obstruction.
7. You instruct your patient to lean forward so you can inspect the breasts. What might this
position reveal that is not visible in another position?
a. Retraction of the nipple and areola c. Asymmetry of the breast or nipple
b. Posttraumatic fat necrosis d. Mammary duct ectasia
Answer: C
RATIONALE: This position may reveal an asymmetry of the breast or nipple not otherwise
visible.
8. What pattern of palpation is currently the best validated technique for detecting breast
masses?
a. Circular pattern c. Wedge pattern
b. Supra to infra pattern d. Vertical strip pattern
Answer: D
RATIONALE: Although a circular or wedge pattern can be used, the vertical strip pattern is
currently the best validated technique for detecting breast masses.
9. When palpating a breast, what must you examine the breast tissue carefully for? (Mark all
that apply.)
a. Dimples c. Tenderness e. Rash
b. Nodules d. Consistency
Answer: b, c, and d
RATIONALE: Examine the breast tissue carefully for consistency of the tissues, tenderness,
and nodules.
10. You palpate a mobile mass that becomes fixed when your patient’s arm relaxes. What
would this tell you about the mass?
a. It is attached to the pectoral and scapular muscles c. It is attached to the scapular fascia
b. It is attached to the pectoral fascia. d. It is attached to the ribs and intercostal
muscles
Answer: D
RATIONALE: A mobile mass that becomes fixed when the arm relaxes is attached to the ribs
and inter- costal muscles; if fixed when the hand is pressed against the hip, it is attached to the
pectoral fascia.

Module 15
1. You are testing your patient for extension of the wrist and note weakness on the right side.
What central nervous system disease is indicated by your finding?
a. Fibromyalgia c. Gillian-Barré
b. Multiple sclerosis d. Lyme disease
Answer: b
RATIONALE: Weakness of extension is seen in peripheral nerve disease such as radial nerve
damage and in central nervous system disease producing hemiplegia, as in stroke or multiple
sclerosis.
2. How would you document normal muscle strength?
a. 1:1 c. 4+
b. 2 & 2 d. 5/5
Answer: D
RATIONALE: Scale for grading muscle strength: muscle strength is graded on a 0 to 5 scale:
0—No muscular contraction detected
1—A barely detectable flicker or trace of contraction
2—Active movement of the body part with gravity eliminated
3—Active movement against gravity
4—Active movement against gravity and some resistance
5—Active movement against full resistance with- out evident fatigue. This is normal muscle
strength.
3. When examining a patient’s musculoskeletal system, you find acute involvement of only one
joint. What would this suggest to you? (Mark all that apply.)
a. Gout c. Septic arthritis e. Rheumatoid arthritis
b. Duchenne muscular dystrophy d. Trauma
Answer: a, c, and d
RATIONALE: Acute involvement of only one joint suggests trauma, septic arthritis, or gout.
4. What is increased muscle tone in both directions that is not rate dependent?
a. Rigidity c. Atrophy
b. Spasticity d. Atony
Answer: a
RATIONALE: Rigidity is increased resistance throughout the range of movement and in both
directions (not rate dependent).
5. What are the principal muscles used in opening the mouth?
a. Temporalis c. External pterygoids
b. Masseter d. Internal pterygoids
Answer: c
RATIONALE: The principal muscles opening the mouth are the external pterygoids.
6. You are the school nurse in the local high school. You note that a 15-year-old girl carries her
left shoulder higher than her right shoulder. What would you assess this student for?
a. Torn rotator cuff c. Broken clavicle
b. Dislocated shoulder d. Scoliosis
Answer: d
RATIONALE: Scoliosis may cause elevation of one shoulder.
7. The pitcher of the high school baseball team, 16 years old, is brought to the clinic by his
mother with a complaint of pain in his right elbow. Where would you expect to locate his
tenderness?
a. Distal to the right lateral epicondyle c. Over the right olecranon process
b. Distal to the right medial epicondyle d. Proximal to the right olecranon bursa
Answer: b
RATIONALE: Tenderness is distal to the epicondyle in lateral epicondylitis (tennis elbow) and
less commonly in medial epicondylitis (pitcher’s or golfer’s elbow)
8. Birthmarks, port-wine stains, hairy patches, and lipomas often overlie what?
a. Bony defects c. Missing bursa
b. Muscular defects d. Malformed ligaments
Answer: a
RATIONALE: Birthmarks, port-wine stains, hairy patches, and lipomas often overlie bony
defects such as spina bifida.
9. A patient presents at the clinic with a history of cerebral palsy. When examining the patient
you note increased resistance that is rate dependent and increases with rapid movement. What
would you chart about this patient?
a. Patient has rigidity c. Patient has muscular atrophy
b. Patient demonstrates spasticity d. Patient demonstrates muscular atony
Answer: b
RATIONALE: Spasticity is increased resistance that worsens at the extremes of range.
Spasticity, seen in central corticospinal tract diseases, is rate dependent, increasing with rapid
movement.
10. You note that your patient has decreased muscle tone. You know that this can be caused by
what? (Mark all that apply.)
a. Brain stem injury d. Cerebellar disease
b. Cerebral disease e. Disease of the peripheral nervous system
c. Acute stages of spinal cord injury
Answer: c, d, and e
RATIONALE: Decreased resistance suggests disease of the peripheral nervous system,
cerebellar disease, or the acute stages of spinal cord injury.

Module 16
1. What percent of the population identified as drug abusers abuse marijuana?
a. 60% b. 50% c. 40% d.30%
Answer: a
RATIONALE: An estimated 3% of the population are dependent on or abuse illicit drugs; of
these cases, 60% involve marijuana.
2. The outcome and costs of care of what dis- eases improve when depression is treated?
(Mark all that apply.)
a. HIV/AIDS b. Dementia c. kidney disease d. Diabetes e. Liver disease
Answer: a, b, and d
RATIONALE: Depression frequently accompanies serious medical illnesses, including diabetes,
heart disease, cancer,stroke, dementia, and HIV/AIDS; outcomes and costs of care for these
illnesses improve when depression is treated.
3. When depression goes undiagnosed, what consequences occur eight times more frequently
than in the general population?
a. Polyhedonia b. Comorbidity c. Death Bankruptcy
Answer: c
RATIONALE: Failure to diagnose depression can have fatal consequences—suicide rates
among patients with major depression are eight times higher than in the general population.
4. Which patients are most at risk for depressive symptoms? (Mark all that apply.)
a. Married b. Divorced c. Females d.Males e. Chronically ill
Answer: b, c, and e
RATIONALE: Watch carefully for depressive symptoms, especially in patients who are young,
female, single, divorced or separated, seriously or chronically ill, or bereaved. Those with a prior
history or family history of depression are also at risk.
5. Nurses are urged to conduct what kind of mental health screenings?
a. General b. Targeted c. Focal d. Mini
Answer: b
RATIONALE: Currently, given the low incidence of suicide, nurses are urged to intensify
targeted rather than general screening.
6. Mr Lim complains of weakness that is made worse with repeated effort and improves with
rest. What would you suspect is wrong with Mr Lim?
a. Multiple sclerosis b. Lyme disease c. Myasthenia gravis d. Parkinson diseasE
Answer: c
RATIONALE: Weakness made worse with repeated effort and improved with rest suggests
myasthenia gravis.
7. A patient has a chief complaint of “My face feels funny.” When you assess the patient you
find isolated facial sensory loss to pain and no neurologic deficits in his extremities. What could
be the patient’s diagnosis?
a. Stroke b. Horner syndrome c. Bell palsy d. Trigeminal neuralgia
Answer: d
RATIONALE: Ask the patient to report whether it is “sharp” or “dull” and to compare sides.
Isolated facial sensory loss is seen in peripheral nerve disorders like trigeminal neuralgia.
8. You are assessing your patient’s coordination and you find that her movements are clumsy,
unsteady, and inappropriately varying in their speed, force, and direction. You note the patient
has dysmetria and he has?
a. Cerebellar disease b. Cerebral disease c. Brainstem disease d. Basal ganglia disease
Answer: a
RATIONALE: In cerebellar disease, movements are clumsy, unsteady, and inappropriately
varying in their speed, force, and direction. The finger may initially overshoot its mark, but finally
reaches it fairly well, termed dysmetria. An intention tremor may appear toward the end of the
movement.
9. You know that often the first sensation lost in a peripheral neuropathy is what?
a. Light touch b. Pain c. Vibration d. Temperature
Answer: c
RATIONALE: Vibration sense is often the first sensation to be lost in a peripheral neuropathy.
10. What important questions guide the approach to this challenging clinical area? (Mark all that
apply.)
a. Where does the lesion lie?
b. Is the central nervous system intact?
c. Is the mental status intact?
d. Is the peripheral nervous system intact?
e. Are right-sided and left-sided examination findings symmetric?
Answer: a, c, and e
RATIONALE: Let three important questions guide the approach to this challenging clinical area:
Is the mental status intact? Are right-sided and left-sided examination findings symmetric? and If
the findings are asymmetric or otherwise abnormal, does the lesion lie in the central nervous
system, consisting of the brain and spinal cord, or in the peripheral nervous system, consisting
of the 12 pairs of cranial nerves and the spinal and peripheral nerves?