Chapter 09: General Survey and Measurement
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. The nurse is performing a general survey. Which action is a component of the general survey?
a.
Observing the patient’s body stature and nutritional status
b.
Interpreting the subjective information the patient has reported
c.
Measuring the patient’s temperature, pulse, respirations, and blood pressure
d.
Observing specific body systems while performing the physical assessment
2. Which of these guidelines should a nurse follow when measuring a patient’s weight?
a.
The patient is always weighed wearing only his or her undergarments.
b.
The type of scale does not matter, as long as the weights are similar from day to
day.
c.
The patient may leave on his or her jacket and shoes as long as these are
documented next to the weight.
d.
Attempts should be made to weigh the patient at approximately the same time of
day, if a sequence of weights is necessary.
3. When performing an examination, the nurse should consider a child’s physical growth to be
the best indicator of which aspect of health?
a.
General health
b.
Genetic makeup
c.
Nutritional status
d.
Activity and exercise patterns
4. A 1-month-old infant has a head measurement of 34 cm and has a chest circumference of 32
cm. Based on the interpretation of these findings, what action should the nurse take?
a.
Refer the infant to a physician for further evaluation.
b.
Consider these findings normal for a 1-month-old infant.
c.
Expect the chest circumference to be greater than the head circumference.
d.
Ask the parent to return in 2 weeks to re-evaluate the head and chest
circumferences.
5. The nurse is assessing an 80-year-old male patient. Which assessment findings would be
considered normal?
a.
Increase in body weight from his younger years
b.
Additional deposits of fat in the cheeks and forearms
c.
Presence of kyphosis and flexion in bilateral knees and hips
d.
Change in overall body proportion, including a longer trunk and shorter
extremities
6. The nurse is preparing to measure the length, weight, chest, and head circumference of a
6-month-old infant. Which measurement technique is correct?
a.
Measuring the infant’s length by using a tape measure
b.
Weighing the infant by placing him or her on an electronic standing scale
c.
Measuring the chest circumference at the nipple line with a tape measure
d.
Measuring the head circumference by wrapping the tape measure over the nose and
cheekbones
7. A 60-year-old male patient has been treated for pneumonia for the past 6 weeks. He is seen
today in the clinic for an “unexplained” weight loss of 10 pounds over the last 6 weeks.
Which is an appropriate rationale for this patient’s weight loss?
a.
Chronic diseases such as hypertension cause weight loss.
b.
Weight loss is probably the result of unhealthy eating habits.
c.
Unexplained weight loss often accompanies short-term illnesses.
d.
Weight loss is probably the result of a mental health dysfunction.
8. When assessing a 75-year-old patient who has asthma, the nurse notes that he assumes a
tripod position, leaning forward with arms braced on the chair. How should the nurse interpret
these findings?
a.
Assume that the patient is eager and interested in participating in the interview.
b.
Evaluate the patient for abdominal pain, which may be exacerbated in the sitting
position.
c.
Assume that the patient is having difficulty breathing and assist him to a supine
position.
d.
Recognize that a tripod position is often used when a patient is having respiratory
difficulties.
9. In a patient with acromegaly, which assessment finding will the nurse expect to find?
a.
Sternal deformity and hyperextensible joints
b.
Growth retardation and a delayed onset of puberty
c.
Overgrowth of bone in the face, head, hands, and feet
d.
Increased height and weight and delayed sexual development
10. The nurse is performing a general survey of a patient. Which finding is considered normal?
a.
Body mass index (BMI) of 20
b.
When standing, the patient’s base is narrow.
c.
The patient appears older than his stated age.
d.
Arm span (fingertip to fingertip) is greater than the height.
11. Which of these specific measurements is the best index of a child’s general health?
a.
Body mass index
b.
Height and weight
c.
Head circumference
d.
Chest circumference
12. The nurse is assessing an 8-year-old child whose growth rate measures below the third
percentile for a child his age. He appears significantly younger than his stated age and is
chubby with infantile facial features. Which condition does this child likely have?
a.
Acromegaly
b.
Marfan syndrome
c.
Hypopituitary dwarfism
d.
Achondroplastic dwarfism
13. During an examination, the nurse notices that a female patient has a round “moon” face,
central trunk obesity, and a cervical hump. Her skin is fragile with bruises. The nurse
determines that the patient likely has which condition?
a.
Gigantism
b.
Acromegaly
c.
Cushing syndrome
d.
Marfan syndrome