Module 2 Kelsey Health Assessment Chapter 2 Practice Questions

Question 1

A 17-year-old client presents at the clinic with the following reason for seeking care: “I have been sick for three days. I feel sick to my stomach and have diarrhea.” Which of the following would be most appropriate to document as her reason for her visit/chief complaint?
a. Flulike symptoms
b. GI distress
c. “I feel sick to my stomach and have diarrhea.”
d. Possible pregnancy, needs further evaluation

Answer 1

c. “I feel sick to my stomach and have diarrhea.”

Reasoning: Use a brief statement in the patients own words

Question 2

Which of the following would be considered a subjective assessment finding to be placed in the S section of SOAP format charting?
a. motile trichomonads
b. mucopurulent discharge
c. Trichomoniasis vaginitis
d. Vaginal itching

Answer 2

d. Vaginal itching

Reasoning: Subjective is what the patient tells you

Question 3

Which of the following includes a pertinent negative that needs to be documented?
a. 16-year-old female who has never been sexually active: no history of STIs
b. 25-year-old female with abdominal pain: no nausea, vomiting, or diarrhea
c. 40-year-old female with depression; past history of suicidal attempt
d. 60-year-old female with stress incontinence; no breast mass or nipple discharge

Answer 3

b. 25-year-old female with abdominal pain: no nausea, vomiting, or diarrhea

Question 4

Appropriate information in the review of systems section of the health history would include:
a. alert, cooperative, well groomed.
b. had measles and chickenpox as a child.
c. occasional loss of urine with coughing.
d. walks 2 miles a day for exercise.

Answer 4

c. occasional loss of urine with coughing.

The review of systems is used to assess common symptoms for each major body system to avoid missing any potential or existing problems.

Question 5

Which of the following would most appropriately be documented in the A section of SOAP charting format?
a. CBC ordered
b. Client states that she would like to quit smoking
c. Medication instructions provided
d. Mucopurulent cervicitis

Answer 5

d. Mucopurulent cervicitis

Question 6

The bell of the stethoscope should be used when listening for:
a. bowel sounds
b. carotid bruits
c. lung sounds
d. S1 and S2 heart sounds

Answer 6

b. carotid bruits

The bell of the stethoscope is best for listening to low-pitched sounds such as those heard over large blood vessels.

Question 7

Evaluation of EOM movement includes:
a. ophthalmoscopic examination
b. PERRLA evaluation
c. the six cardinal fields of gaze
d. visual fields by confrontation

Answer 7

c. the six cardinal fields of gaze

EOM function is evaluated by assessing symmetry, lid lag, and nystagmus as the client holds her head still and follows your finger through the six cardinal fields of gaze.

Question 8

The adventitious lung sounds most commonly associated with asthma is:
a. crackles
b. pleural rub
c. rhonchi
d. wheezes

Answer 8

d. wheezes

Wheezes are high-pitched (sound like a squeak), continuous adventitious lung sounds that may be heard when air flows through constricted passageways that occur in conditions such as asthma.

Question 9

When auscultating lung sounds, the normal finding over most of the lung fields is:
a. bronchial
b. resonant
c. tympanic
d. vesicular

Answer 9

d. vesicular

The lung sound over most of the lung fields is vesicular, with inspiratory sounds lasting longer than expiratory sounds.

Question 10

Increased tactile fremitus would be an expected finding in a client with:
a. asthma
b. emphysema
c. lobar pneumonia
d. pleural effusion

Answer 10

c. lobar pneumonia

Tactile fremitus refers to the palpable transmission of vibrations through the bronchus to the chest wall when the client is speaking. There is increased transmission through consolidated tissue, as is found with lobar pneumonia.

Question 11

The sound heard over the cardiac area if the client has pericarditis is mostly likely to be a(n):
a. diastolic murmur
b. fixed split S2
c. friction rub
d. increased S4

Answer 11

c. friction rub

A pericardial friction rub may be heard over the cardiac area as a grating sound throughout the cardiac cycle when inflammation of the pericardium is present.

Question 12

Which of the following is an abnormal abdominal examination finding in an adult?
a. Abdominal aorta 2.5 cm in width
b. Liver border nonpalpable
c. Liver span 8cm at the right MCL
d. Splenic dullness at the left anterior axillary line

Answer 12

d. Splenic dullness at the left anterior axillary line

Splenic dullness may be percussed at the sixth to tenth ICS just posterior to the midaxillary line on the left side, with the client in the supine position. Splenic dullness at the anterior axillary line is indicative of an enlarged spleen.

Question 13

One of the cranial nerves for which you would test both motor and sensory function is:
a. CN II-optic nerve
b. CN V-trigeminal nerve
c. CN VI-abducens nerve
d. CN XI-spinal accessory nerve

Answer 13

b. CN V-trigeminal nerve

Reasoning: Nerves with both functions are CN V, CN VII, CN IC and CN X. Routinely, the only nerve where you test both is the CN V

Question 14

A client with a Hgb of 10.2 g/dL and RBC indices indicating both microcytosis and hypochromia most likely has:
a. folic acid deficiency
b. iron deficiency
c. severe dehydration
d. vitamin B12 deficiency

Answer 14

b. iron deficiency

RBC indices provide information about size, weight, and Hgb concentration of RBCs and are useful in classifying anemia when the individual has a low Hgb level. Iron-deficiency anemia is characterized by abnormally small (microcytic) and pale (hypochromic) RBCs.

Question 15

A client with an increased WBC count related to infectious hepatitis would most likely have an elevated level of:
a. basophils
b. eosinophils
c. lymphocytes
d. neutrophils

Answer 15

c. lymphocytes

Reasoning: lymphocytes and monocytes are increased with acute viral infections and chronic bacterial infections

Question 16

Expected thyroid function test findings with primary hypothyroidism include:
a. decreased TSH and decreased FT4
b. decreased TSH and increased FT4
c. increased TSH and decreased FT4
d. increased TSH and increased FT4

Answer 16

c. increased TSH and decreased FT4

Reasoning: Increased TSH is seen with primary hypothyroidism and thyroiditis. Decreased FT4 is seen with hypothyroidism.

Question 17

A pregnant client presents with a recent-onset rash. Which of the following laboratory results would be reassuring that this is not likely rubella?
a. HAI titer of 1:10 at her initial visit 1 month earlier
b. HAI titer of 1:128 at the current visit
c. Increased IgG antibody levels at the current visit
d. Increased IgM antibody levels at the current visit

Answer 17

a. HAI titer of 1:10 at her initial visit 1 month earlier

Reasoning: Titers of 1:10 or greater indicate immunity to rubella. High titers (1:64 or greater) may indicate current rubella infection

Question 18

A client who had HBV 6 months ago currently has no symptoms but has a positive test for HbsAg. This most likely indicates that she:
a. has immunity to future infection
b. has persistent active infection
c. is a chronic carrier of HBV
d. is in the early stage of reinfection

Answer 18

c. is a chronic carrier of HBV

Reasoning: HBsAg rises before onset of clinical symptoms, peaks during the first week of symptoms, and returns to normal by the time jaundice subsides. An individual is considered to be a carrier (remains infectious) is HBsAg persists.

Question 19

A false-negative TB PPD test may be the result of:
a. dormant infection
b. immunosuppression
c. intradermal injection
d. prior BCG vaccination

Answer 19

b. immunosuppression

Reasoning: False negative can result from incorrect admin or immunosuppression.

Question 20

A client with cholecystitis would most likely have a(n):
a. decreased alkaline phosphatase
b. decreased indirect bilirubin
c. increased albumin level
d. increased direct bilirubin

Answer 20

d. increased direct bilirubin

Reasoning: An elevated direct (conjugated) bilirubin level occurs with gallstones and obstruction of the extrahepatic duct

Question 21

Measuring waist circumference is most appropriate when the client’s BMI places her in which of the following categories?
a. Underweight
b. Normal Weight
c. Overweight
d. Extreme obesity

Answer 21

c. Overweight

Waist circumference provides measurement of abdominal fat as an independent prediction of risk for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease in individuals with BMI between 25 and 39.9 (overweight and obesity). Waist circumference has little added value in disease risk prediction in individuals with BMI of 40 or greater (extreme obesity).

Question 22

Which of the following lab values is not normally affected by pregnancy?
a. Cholesterol
b. MCV
c. T4
d. Triglycerides

Answer 22

b. MCV

T4 levels are affected by the amount of TBG, which is increased during pregnancy. The MCV is the average volume or size of a single RBC. Although the Hgb/Hct levels may be lower during pregnancy, the size of the RBCs should not change unless the woman has iron-deficiency anemia, thalassemia, vitamin B12 deficiency, or folic acid deficiency.

Question 23

A 65-year-old female has a bone densitometry test, with the results of T-score being -2.0. This indicates she has:
a. bone density that is greater than that of most women her age
b. bone density that is equal to that of a young normal adult
c. bone loss that is at the level for a diagnosis of osteopenia
d. bone loss that is at the level for a diagnosis of osteoporosis

Answer 23

c. bone loss that is at the level for a diagnosis of osteopenia

Reasoning: Osteopenia is defined as BMD between 1 and 2 SD below that of a young normal adult. This is a T-score of between –1 and –2.5.

Question 24

Appropriate management for a 45-year-old client who has no diabetes risk factors and no symptoms of diabetes with a fasting glucose of 130 mg/dL would include which of the following?
a. Inform client she has impaired glucose tolerance
b. Order HbA1c level
c. Repeat glucose testing on another day
d. Repeat glucose screening in 3 years

Answer 24

c. Repeat glucose testing on another day

A fasting glucose of 126 mg/dL or greater is diagnostic for diabetes. Repeat testing should be done on a subsequent day to confirm the diagnosis.

Question 25

A client who either has acute active HBV infection or who is a carrier would have a positive test for:
a. HBsAg
b. HBsAb
c. HBeAg
d. HBeAb

Answer 25

a. HBsAg

Question 26

Tests for cerebellar function include:
a. deep tendon reflex evaluation
b. short-term memory evaluation
c. discriminatory sensation tests
d. Romberg test for balance

Answer 26

d. Romberg test for balance

The cerebellum coordinates motor activity, maintains equilibrium, and helps to control posture.

Question 27

Which of the following statements is correct regarding autosomal recessive inheritance of genetic disorder?
a. Both parents are unaffected but are carriers of the mutated gene
b. Disorder tends to occur in every generation of the affected family
c. Male offspring are more likely to be affected than females
d. One parent has the genetic disorder with the mutated gene

Answer 27

a. Both parents are unaffected but are carriers of the mutated gene

In autosomal recessive inheritance of a genetic disorder, the affected individual has two mutated copies of the responsible gene in each cell. The affected individual usually has unaffected parents (carriers), each of whom carries a single copy of the mutated gene.

Question 28

Obtaining a Z-score on a bone mineral density test might be appropriate for evaluating:
a. A 40-year-old female with a nontraumatic hip fracture
b. a 46-year-old female with a strong family history of osteoporosis
c. a 60-year-old female who smokes cigarettes and has low body weight
d. a 70-year-old female with osteoporosis being treated with a bisphosphonate

Answer 28

a. A 40-year-old female with a nontraumatic hip fracture

A Z-score may be used to compare bone density in a premenopausal woman to an age-, gender-, and ethnicity-matched reference population to evaluate for secondary causes of osteoporosis.

Question 29

A client who was treated for primary syphilis one year ago now has the following test results: VDRL nonreactive and FTA-ABS positive. These findings indicate that the client most likely:
a. was not adequately treated for primary syphilis one year ago
b. has become reinfected since completion of treatment one year ago
c. has some other condition that is causing a false-positive FTA-ABS.
d. was treated adequately for syphilis and has not become reinfected

Answer 29

d. was treated adequately for syphilis and has not become reinfected

Nontreponemal tests (VDRL, RPR) usually become nonreactive with time after treatment. Treponemal tests (FAT-ABS, TPI) usually remain positive indefinitely after treatment.

Question 30

Which of the following heart sounds may be a normal finding in the third trimester of pregnancy?
a. Diastolic murmur
b. Fixed split S2
c. S3
d. S4

Answer 30

c. S3

Nontreponemal tests (VDRL, RPR) usually become nonreactive with time after treatment. Treponemal tests (FAT-ABS, TPI) usually remain positive indefinitely after treatment.

Question 31

Pelvic findings on examination of a 22-year-old nulliparous client are uterus 7 cm in length and ovaries 3 cm x 2 cm x 1 cm. These findings are consistent with:
a. an enlarged uterus and enlarged ovaries
b. a normal-size uterus and enlarged ovaries
c. an enlarged uterus and normal-size ovaries
d. a normal-size uterus and normal-size ovaries

Answer 31

d. a normal-size uterus and normal-size ovaries

Reasoning: Uterus is 5.5 to 8 cm long in nilliparous. Ovaries are 3cm x 2cm x1cm in reporoductive years

Question 32

A laboratory test finding of increased immature neutrophils (shift to the left) is consistent with a(n):
a. acute bacterial infection
b. acute viral infection
c. allergic reaction
d. chronic bacterial infection

Answer 32

a. acute bacterial infection

Reasoning: Increased immature neutrophil forms (“shift to the left”) are seen with ongoing acute bacterial infection

Question 33

An elderly woman has had gastroenteritis with vomiting and diarrhea for the past 3 days. Her mucous membranes appear dry, and she says she has not urinated yet today. Expected laboratory test findings related directly to her current condition might include:
a. decreased urine specific gravity
b. decreased hematocrit
c. increased blood glucose
d. increased blood urea nitrogen

Answer 33

d. increased blood urea nitrogen

Reason: BUN is an indirect measure of renal liver function. Increased levles may be seen with hypovolemia, dehydration, reuced cardiac function, GI bleeding, starvation, sepsis, and renal disease.

Question 34

The blood type in which an individual has no antigens on his or her RBCs is:
a. AB+
b. AB-
c. O+
d. O-

Answer 34

d. O-

Question 35

The heart sound heard best at the base of the heart is:
a. S1
b. S2
c. S3
d. S4

Answer 35

b. S2

The S2 heart sound is heard best at the base of the heart using the diaphragm of the stethoscope.

Question 36

A client who was sexually assaulted 3 weeks ago by an individual known to be HIV positive has a nonreactive rapid EIA test result using an oral mucosal transudate specimen. The most appropriate next step would be to:
a. advise the client to return or repeat testing in 3 months
b. repeat the rapid EIA test not using a blood sample
c. order an HIV-1 p24 antigen test
d. order a Western blot test to confirm the nonreactive EIA test reult

Answer 36

c. order an HIV-1 p24 antigen test

Reason: The HIV-1 p24 antigen test detects HIV-1 antigen as early as 2-6 weeks after infection; levels of this antigen decline once HIV antibodies develop. HIV antibodies are detectable in 95% of individuals within 6 months of infection. A combined HIV antibody and p24 antigen test is available.

Question 37

An abnormal finding on ophthalmoscopic examination would be:
a. arterioles smaller than veins
b. a yellow optic disc
c. presence of a red reflex
d. tapering of the veins

Answer 37

d. tapering of the veins

The normal retinal artery wall is transparent except for the column of blood going down the middle, so a vein crossing beneath the artery can be seen up to the column of blood on either side (arteriovenous crossing). When narrowing of the retinal artery occurs (as with hypertension), the arterial wall thickens and becomes less transparent. The vein crossing under the narrowed artery appears to taper down on either side of the artery.

Question 38

When examining the cervix of a 20-year-old client, you note that most of the cervix is pink, but there is small ring of dark-red tissue surrounding the os. This is most likely:
a. an endocervical polyp
b.due to cervical dysplasia
c. due to cervical infection
d. the squamocolumnar junction

Answer 38

d. the squamocolumnar junction

Reason: The squamocolumnar junction is the area where squamous epithelium (pink) and columnar epithelium (dark red) of the cervix meet. The junction may be inside the cervical os so that only squamous epithelium is visible, or a ring of columnar tissue may be visible to a varying extent around the os.

Question 39

The laboratory test that is done for definitive diagnosis of sickle cell disease is:
a. Hgb electrophoresis
b. peripheral blood smear
c. RBC indices
d. sickle cell preparation

Answer 39

a. Hgb electrophoresis

Reason: Sickle cell preparation is a screening test that checks for the presence of Hgb S and Hgb electrophoresis is the definitive test as it identifies Hgb type and quantity.

Question 40

A woman who is currently pregnant, has had two full-term deliveries, and has had one first-trimester abortion would be considered:
a. gravida 2 para 2
b. gravida 3 para 2
c. gravida 3 para 3
d. gravida 4 para 2

Answer 40

d. gravida 4 para 2

Question 41

The best position for palpating the axilla is with the woman:
a. lying down with her arm above the head on the side you are examining
b. lying down with her arm at her side on the side you are examining
c. sitting up with her arm raised above her head on the side you are examining
d. sitting up with her arm down on the side you are examining

Answer 41

d. sitting up with her arm down on the side you are examining

Question 42

Which of the following would be considered a positive PPD result?
a. General population: 5 mm induration
b. General population: 10 mm induration
c. Moderate-risk population: 5mm induration
d. High-risk population: 5 mm induration

Answer 42

d. High-risk population: 5 mm induration

In the individual considered to be high risk for tuberculosis, a PPD skin test resulting in a 5-mm or greater area of induration is a positive reaction.

Question 43

Abnormal findings on a urinalysis would include:
a. pH 5.0
b. specific gravity 1.5
c. WBC 3 per HPF
d. protein 4 mg/dL

Answer 43

b. specific gravity 1.5

Reason: Normal values- SG (1.005 to 1.030), pH (4.6-8), WBC (0-4 per HPF), and protein (0-8 mg/dL)

Question 44

Adding KOH to a wet mount slide before viewing it under the microscope is useful in the detection of:
a. Clue cells
b. pseudohyphae
c. trichomonads
d. WBCs

Answer 44

b. pseudohyphae

Reason: Adding KOH facilitates visualization of candida pseudohyphae and bids

Question 45

A 42-year-old female is concerned she may be pregnant because she is 12 days late for her period. The best initial pregnancy test to obtain is a:
a. qualitative sensitive urine hCG test
b. qualitative serum hCG test
c. quantitative sensitive urine hCG test
d. quantitative serum hCG test

Answer 45

a. qualitative sensitive urine hCG test

Reason: Sensitive urine hCG tests may detect pregnancy as early as 28 days from the last menstrual period. Cross-reactions with other hormones are not a problem. A qualitative (positive/negative) test is the appropriate pregnancy test choice.

Question 46

A client presents with no symptoms but is concerned because she had sexual intercourse 3 weeks ago with a new partner who has recently disclosed having a history of genital herpes. The client wants to know if there is a test that can be performed at this visit to see if she has been infected. Which of the following would be the best response?
a. A Pap test can be done at this time that will show if she has been infection
b. A blood test can be done at this visit to see if she has recently been infected
c. If she does not develop lesions in the next 4-8 weeks, she is not infected
d. She can have a blood test in 1-2 months to determine whether she has the herpes antibodies

Answer 46

d. She can have a blood test in 1-2 months to determine whether she has the herpes antibodies

Type-specific serologic tests detect HSV-1 and 2 antibodies but it may take 4-12 weeks for seroconversion to occur.

Question 47

The glands located posteriorly on each side of the vaginal orifice are the:
a. Bartholin’s glands
b. Bulbar glands
c. Nabothian glands
d. Skene’s glands

Answer 47

a. Bartholin’s glands

Question 48

Which of the following statements regarding gene mutations is correct?
a. All gene mutations occur at the time of conception
b. Germ cell mutations occur after conception
c. Germ cell mutations may occur as a result of exposure to radiation
d. Somatic mutations may occur at any time in a person’s life

Answer 48

d. Somatic mutations may occur at any time in a person’s life

Somatic mutations are acquired and occur after conception. A DNA copying mistake may occur during cell division or from exposure to ionizing radiation, chemicals, or viruses during gestation or later in life.

Question 49

The CDC-recommended diagnostic test for Trichomonas is:
a. culture
b. NAAT
c. vaginal fluid sialidase test
d. wet mount evaluation for motile trichomonads

Answer 49

b. NAAT

Question 50

Which of the following statements concerning testing for strep throat in an adult client with sore throat, fever, and tonsillar exudate is correct?
a. A positive rapid streptococcal antigen test indicates the need for antibiotic treatment
b. No testing is indicated, as these findings are indicative of a viral infection
c. Throat culture is recommended rather than a rapid streptococcal antigen test
d. Throat culture is indicated if a rapid streptococcal antigen test is negative

Answer 50

a. A positive rapid streptococcal antigen test indicates the need for antibiotic treatment

Reason: A positive rapid streptococcal antigen test indicates the presence of GABHS requiring antibiotic treatment. A negative test indicates that the infection is more likely viral. A culture is not needed to confirm a negative test.

Question 51

A premenopausal women with which of the following conditions would be most likely to have a low FSH and low estradiol level?
a. Adrenal tumor
b. Anorexia nervosa
c. Premature ovarian failure
d. Turner’s syndrome

Answer 51

b. Anorexia nervosa