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Jarvis Final Exam With 451 Practice
Questions Correctly Answered
Which of the following factors is most likely to affect the nutritional status of an 82-year-old person? 1.Increase in taste and smell 2.Living alone on a fixed income 3.Change in cardiovascular status 4.Increase in gastrointestinal motility and absorption - ✔ ✔ ANS: 2 Socioeconomic conditions frequently have the greatest effect on the nutritional status of the aging adult; these factors should be closely evaluated. Physical limitations, income, and social isolation are frequent problems and can obviously interfere with the acquisition of a balanced diet. When considering a nutritional assessment, the nurse is aware that the most common anthropometric measurements include: 1.height and weight. 2.leg circumference. 3.biceps skinfold thickness. 4.hip and waist measurement. - ✔ ✔ ANS: 1
The most commonly used anthropometric measures are height, weight, triceps skinfold thickness, elbow breadth, and arm and head circumferences. If a 29-year-old woman weighs 146 pounds and the nurse determines her ideal body weight to be 120 pounds, how would the nurse classify the woman's weight? 1.Obese 2.Mildly overweight 3.Suffering from malnutrition 4.Within appropriate range of ideal weight - ✔ ✔ ANS: 1 Obesity is defined as greater than 120% of ideal body weight. For this patient, 120% of her ideal body weight, 120 pounds, is 144 pounds. Her current weight of 146 pounds is greater than 120% of ideal body weight. To perform a triceps skinfold assessment, the examiner would do which of the following? 1.After pinching the skin and fat, apply the calipers vertically to the fat fold. 2.Gently pinch the skin and fat on the anterior aspect of the patient's arm and then apply calipers. 3.After applying the calipers, wait 3 seconds before taking a reading. Repeat the procedure three times.
Remember that accurate mid upper arm circumference and triceps skinfold measurements are difficult to obtain and interpret in older adults because of sagging skin, changes in fat distribution, and declining muscle mass. The nurse is concerned about the skeletal protein reserves of a patient who has been hospitalized frequently for chronic lung disease. Which of the following measurements would be necessary to include in the assessment? 1.Body mass index 2.Weight and height 3.Mid arm muscle area 4.Ideal body weight and frame size - ✔ ✔ ANS: 3 Mid arm muscle area is a good indicator of lean body mass and skeletal protein reserves. These reserves are important in growing children and are especially valuable in evaluating persons who may be malnourished because of chronic illness, multiple surgeries, or inadequate dietary intake. The equation for calculating mid arm muscle area includes mid upper arm circumference and mid-upper arm muscle circumference. Which of the following best describes the technique for measuring frame size? 1.With the patient standing, measure the distance from the top of the head to the back of the heel. 2.With the patient in a sitting position, measure the distance from the condyle of the humerus to the clavicle.
3.With the patient's right arm extended forward and the elbow extended, measure the distance from fingertips to the condyle of the humerus. 4.With the right arm extended forward and the elbow bent, use the calipers to measure the distance between the condyles of the humerus.
- ✔ ✔ ANS: 4 Instruct the person to extend the right arm forward, perpendicular to the body. Bend the elbow to a 90-degree angle with the palm of the hand turned laterally. Facing the person, place the calipers on the condyles of the humerus. Read the distance between the condyles. In teaching a patient how to determine total body fat at home, the nurse includes instructions to obtain measurements of: 1.height and weight. 2.frame size and weight. 3.waist and hip circumferences. 4.mid upper arm circumference and arm span. - ✔ ✔ ANS: 1
Abnormal characteristics of pigmented lesions are summarized in the mnemonic ABCD: asymmetry of pigmented lesion, border irregularity, color variation, and diameter greater than 6 mm. A patient comes to the clinic and states that he has noticed that his skin is redder than normal. The nurse understands this condition to be due to hyperemia and knows that it can be caused by:
3.Ashen, gray, or dull 4.Patchy areas of pallor - ✔ ✔ ANS: 3 Pallor in black-skinned people will appear ashen, gray, or dull. See Table 12-2. A patient has tingling sensations in her feet and has noticed that her tongue has become very red and painful. The nurse suspects that she has: 1.polycythemia. 2.pernicious anemia. 3.micronucleus anemia. 4.iron deficiency anemia. - ✔ ✔ ANS: 2 Pernicious anemia is indicated by neurologic deficits and a red, painful tongue along with a lemon yellow tint of the face and slightly yellow sclera. A 32-year-old female patient complains that she has noticed several small, slightly raised, bright red dots on her chest. On examination, the nurse expects that the spots are probably: 1.anascara. 2.scleroderma. 3.senile angiomas. 4.latent myeloma. - ✔ ✔ ANS: 3
Cherry (senile) angiomas are small, punctate, slightly raised bright red dots that commonly appear on the trunk in all adults over 30 years old. A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up appointment. On assessment of his skin, the nurse might expect to find the following: 1.anasarca. 2.scleroderma. 3.pedal erythema. 4.clubbing of the nails. - ✔ ✔ ANS: 4 Clubbing of the nails occurs with congenital, chronic, cyanotic heart disease and with emphysema and chronic bronchitis. A newborn infant has Down syndrome. During the skin assessment, the nurse notices a transient mottling in the trunk and extremities in response to the cooler examination room temperature. The infant's mother also notices the mottling and asks what it is. The nurse knows that this mottling is called:
2.carotenemia. 3.acrocyanosis. 4.cutis marmorata. - ✔ ✔ ANS: 4 Persistent or pronounced cutis marmorata occurs with Down syndrome or prematurity and is a transient mottling in the trunk and extremities in response to cooler room temperatures.
A 70-year-old woman who loves to garden has small, flat, brown macules over her arms and hands. She asks, "What causes these liver spots?" The nurse tells her: 1."They are signs of decreased hematocrit related to anemia." 2."They are due to destruction of melanin in your skin from exposure to the sun." 3."They are clusters of melanocytes that appear after extensive sun exposure." 4."They are areas of hyperpigmentation related to decreased perfusion and vasoconstriction." - ✔ ✔ ANS: 3 Liver spots, or senile lentigines, are clusters of melanocytes that appear on the forearms and dorsa of the hands after extensive sun exposure. The nurse notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding, the nurse would report this as a: 1.bulla. 2.wheal. 3.nodule. 4.papule. - ✔ ✔ ANS: 4 A papule is something one can feel, is solid, elevated, circumscribed, less than 1 cm diameter, and is due to superficial thickening in the epidermis.
The nurse just noted from a patient's medical record that the patient has a lesion that is confluent in nature. On examination, the nurse would expect to find: 1.lesions that run together. 2.annular lesions that have grown together. 3.lesions arranged in a line along a nerve route. 4.lesions that are grouped or clustered together. - ✔ ✔ ANS: Grouped lesions are clustered together. Polycyclic lesions are annular in nature. Zosteriform lesions are arranged along a nerve route. Confluent lesions run together. A patient has had a "terrible itch" for several months that he has been scratching continuously. On examination, the nurse might expect to find: 1.a keloid. 2.a fissure. 3.keratosis. 4.lichenification. - ✔ ✔ ANS: 4 Lichenification results from prolonged, intense scratching that eventually thickens the skin and produces tightly packed sets of papules. A physician has diagnosed a patient with purpura. After leaving the room, a nursing student asks the nurse what the physician saw that led to that diagnosis. The nurse should say:
The nurse notices that a patient has bluish-white, red-based spots in her mouth that are elevated about 1 mm to 3 mm. What other signs would the nurse expect to find in this patient? 1.A pink, papular rash on the face and neck 2.Pruritic vesicles over her trunk and neck 3.Hyperpigmentation on the chest, abdomen, and the back of the arms 4.A red-purple, maculopapular, blotchy rash behind the ears and on the face - ✔ ✔ ANS: 4 With measles (rubeola), the examiner would assess a red-purple, blotchy rash on the third or fourth day of illness that appears first behind the ears and spreads over the face and then over the neck, trunk, arms and legs. It looks coppery and does not blanch. Koplik's spots in the mouth would also be found. The nurse is assessing the skin of a patient who has AIDS and notices a widely disseminated, violet-colored tumor covering the skin and mucous membranes. The nurse would conclude that: 1.he is in the first stage of AIDS. 2.he is in the advanced stage of AIDS. 3.this person has been exposed to a viral infection. 4.these lesions indicate an advanced case of herpes zoster. - ✔ ✔ ANS: 2 In the advanced stage of AIDS, you may notice widely disseminated lesions involving the skin, mucous membranes, and visceral organs.
A 45-year-old farmer comes in for a skin evaluation and complains of hair loss on his head. He has noticed that his hair seems to be breaking off in patches and that he has some scaling on his head. The nurse would begin the examination suspecting: 1.tinea capitis. 2.tinea corporis. 3.toxic alopecia. 4.seborrheic dermatitis. - ✔ ✔ ANS: 1 Tinea capitis is rounded patchy hair loss on scale, leaving broken-off hairs, pustules, and scales on the skin. It is due to fungal infection. Lesions are fluorescent under a Wood's light. It is usually seen in children and farmers and is highly contagious. A mother brings her child in to the clinic for an examination of the scalp and hair. She states that the child has developed some places where there are irregularly shaped patches with broken-off, stub-like hair and she is worried that this could be some form of premature baldness. She tells the nurse that the child's hair is always kept very short. The nurse reassures her by telling her that it is: 1.folliculitis and that it can be treated with an antibiotic. 2.traumatic alopecia that can be treated with antifungal medications. 3.tinea capitis and that it is highly contagious and needs immediate attention. 4.trichotillomania and that her child probably has a habit of twirling her hair absent- mindedly. - ✔ ✔ ANS: 4
3.A local inflammation 4.Blockage of lymphatic drainage - ✔ ✔ ANS: 1 Bilateral edema or edema that is generalized over the entire body is caused by a central problem such as heart failure or kidney failure. Unilateral edema usually has a local or peripheral cause. A 40-year-old woman reports a change in mole size, accompanied by color changes, itching, burning, and bleeding over the past month. She has a dark complexion and has no family history of skin cancer, but she has had many blistering sunburns in the past. The nurse would would: 1.tell the patient to watch the lesion and report back in 2 months. 2.refer the patient because of the suspicion of melanoma on the basis of her symptoms. 3.ask additional questions regarding environmental irritants that may have caused this condition. 4.suspect that this is a compound nevus, which is very common in young to middle- aged adults. - ✔ ✔ ANS: 2 The ABCD danger signs of melanoma are asymmetry, border irregularity, color variation, and diameter. In addition, individuals may report a change in size, development of itching, burning, bleeding, or a new-pigmented lesion. Any of these signs raise suspicion of malignant melanoma and warrant referral. Which of the following assessment findings is most consistent with clubbing of the fingernails? 1.A nail base that is firm to palpation and slightly tender
2.Curved nails with a convex profile and ridges across the nail 3.A nail base that feels spongy with an angle of the nail base of 150 degrees 4.An angle of the nail base of 180 degrees or greater with a nail base that feels spongy - ✔ ✔ ANS: 4 The normal nail is firm at its base and has an angle of 160 degrees. In clubbing, the angle straightens to 180 degrees or greater and the nail base feels spongy. Jaundice is exhibited by a yellow skin color, indicating rising levels of bilirubin in the blood. Which of the following findings is indicative of true jaundice? 1.Yellow patches throughout the sclera 2.Yellow color of the sclera that extends up to the iris 3.Skin that appears yellow when examined under low light 4.Yellow deposits on the palms and soles of the feet where jaundice first appears - ✔ ✔ ANS: 2 The yellow sclera of jaundice extends up to the edge of the iris. Calluses on the palms and soles of the feet often look yellow but are not classified as jaundice. When assessing inflammation in a dark-skinned person, the nurse may need to: 1.assess the skin for cyanosis and swelling. 2.assess the oral mucosa for generalized erythema.
2.Basal cell carcinoma 3.Malignant melanoma 4.Squamous cell carcinoma - ✔ ✔ ANS: 2 Basal cell carcinoma usually starts as a skin-colored papule that develops rounded, pearly borders with a central red ulcer. It is the most common form of skin cancer, and it grows slowly. A father brings in his 2-month-old infant to the clinic because the infant has had diarrhea for the last 24 hours. He says that his baby has not been able to keep any formula down and that the diarrhea has been at least every 2 hours. The nurse suspects dehydration. Where should the nurse test skin mobility and turgor in this infant? 1.Over the sternum 2.Over the forehead 3.Over the forearms 4.Over the abdomen - ✔ ✔ ANS: 4 Test mobility and turgor over the abdomen in an infant. Poor turgor, or "tenting," indicates dehydration or malnutrition. A semiconscious woman is brought to the emergency department after she was found on the floor in her kitchen. Her face, nail beds, lips, and oral mucosa are a bright cherry-red color. The nurse suspects that this coloring is due to: 1.polycythemia. 2.carbon monoxide poisoning.
3.carotenemia. 4.uremia. - ✔ ✔ ANS: 2 A bright cherry-red coloring in the face, upper torso, nail beds, lips, and oral mucosa appears in cases of carbon monoxide poisoning. A patient has been admitted for severe iron deficiency anemia. The nurse can expect to see what finding in the patient's fingernails? 1.Splinter hemorrhages 2.Paronchyia 3.Koilonychia (spoon nails) 4.Beau's lines - ✔ ✔ ANS: 3 Koilonychia, or spoon nails, are thin, depressed nails with lateral edges tilted up, forming a concave profile. If all nails involved, they may be due to iron deficiency anemia. The nurse needs to be familiar with the various lesions that may be identified on assessment of the skin. Match each description given below with the appropriate term. 1.Tiny punctate hemorrhages, 1-3 mm, round and discrete, dark red, purple, or brown in color 2.A large patch of capillary bleeding into tissues 3.A hypertrophic scar 4.Elevated cavity containing free fluid, up to 1 cm. Clear serum flows if wall is ruptured.
