Sherpath Lesson 1 – Examination Techniques

Question 1 of 17

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To ensure accurate findings, what information would the nurse verify prior to beginning inspection?

• • A clock with a second hand is present in the room.A clock is not required for inspection of the patient.
• • The patient is completely covered with a drape at all times.Inspection requires exposing the part that is being assessed.
• • History-taking questions have been answered.Inspection can continue throughout the history-taking process and during the physical exam.
• Correct
  • Overhead lighting and a lamp are available.Adequate lighting (both direct and tangential) is needed to ensure accurate inspection findings.

Question 2 of 17

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Which condition is necessary for accurate inspection?

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  • Adequate time to complete examInspection should be careful and unhurried to ensure accurate findings.
• • Dark, calming room with an examination tableAdequate lighting is needed to ensure accurate inspection findings.
• • Patient is quiet and motionlessAccurate inspection can continue while the patient and nurse communicate and while the patient moves.
• • Examination room with sunny windowInspection requires adequate lighting, but this can be artificial lighting or natural lighting. A sunny window is not required.

Question 3 of 17

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What components are included in a general inspection of the patient?

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  • Overall color of skinInspecting the overall color of skin is part of the general inspection.
• Correct
  • Symmetry of bodyInspecting the symmetry of the body is part of the general inspection.
• • Color of scalpInspecting the color of the scalp is part of the systematic examination, not the general inspection.
• Correct
  • Obvious injuriesInspecting for obvious injuries is part of the general inspection.
• • Shape of thoraxInspecting the shape of the thorax is part of the systematic examination, not the general inspection.

Question 4 of 17

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Which part of the hand is used to palpate the patient’s abdomen?

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  • Finger padsFinger pads are best used for assessing texture, shape, and pulsations and are used for abdominal palpation.
• • Ball of handThe ball of the hand is best used for detecting vibrations and thrills and therefore are not used for abdominal palpation.
• • Back of handThe back of the hand is best used to assess temperature and moisture of the skin and therefore are not used for abdominal palpation.
• • Forefinger and thumbThe forefinger and thumb are best used to grasp tissue and palpate nodules and therefore are not used for abdominal palpation.

Question 5 of 17

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Which part of the hand is best used to assess for fremitus, or vibrations?

• • Finger padsFinger pads are best used for assessing texture, shape, and pulsations, not vibrations.
• Correct
  • Ball of handThe ball of the hand is best used for detecting vibrations and thrills.
• • Back of handThe back of the hand is best used to assess temperature and moisture of the skin, not vibrations.
• • Forefinger and thumbThe forefinger and thumb are best used to grasp tissue and palpate nodules, not to detect vibrations.

Question 6 of 17

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Which part of the hand would the nurse use to palpate pulsations?

• Correct
  • Finger padsFinger pads are best used for assessing texture, shape, and pulsations, not vibrations.
• • Ball of handThe ball of the hand is best used for detecting vibrations and thrills, not pulsations.
• • Back of handThe back of the hand is best used to assess temperature and moisture of the skin, not pulsations.
• • Forefinger and thumbThe forefinger and thumb are best used to grasp tissue and palpate nodules, not to detect pulsations.

Question 7 of 17

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During an abdominal assessment, palpation occurs after auscultation for what reason?

• • Palpation can cause the patient to experience pain.Although palpation could cause the patient pain, this is not the correct reason for auscultating the abdomen prior to palpating.
• • Auscultation always follows inspection.Except for the abdominal assessment, the normal progression of assessment is inspection, palpation, percussion, auscultation.
• Correct
  • Palpation may increase intestinal activity.Palpation of the abdomen prior to auscultation may increase intestinal activity, resulting in inaccurate auscultation findings.
• • Auscultation can be time-consuming.Auscultation may or may not be time-consuming; however, this does not determine the order of assessment for the abdomen.

Question 8 of 17

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Which tone would the nurse expect to hear when percussing over the stomach?

• Correct
  • TympanyTympany is heard over the stomach.
• • DullnessDullness is heard over dense organs, not the stomach.
• • ResonanceResonance is heard over the lungs, not the stomach.
• • FlatnessFlatness is heard over the bones or muscles, not the stomach.

Question 9 of 17

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Which tone would the nurse expect to hear when percussing over the lungs?

• • TympanyTympany is heard over the stomach, not the lungs.
• • DullnessDullness is heard over dense organs, not the lungs.
• Correct
  • ResonanceResonance is heard over the lungs.
• • FlatnessFlatness is heard over the bones or muscles, not the lungs.

Question 10 of 17

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Which tone would the nurse expect to hear when percussing over bone?

• • TympanyTympany is heard over the stomach, not bone.
• • DullnessDullness is heard over dense organs, not bone.
• • ResonanceResonance is heard over the lungs, not bone.
• Correct
  • FlatnessFlatness is heard over the bones or muscles.

Question 11 of 17

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What percussion tone would indicate air-filled (emphysematous) lungs?

• Correct
  • HyperresonanceHyperresonance is heard over hyperinflated (emphysematous) lungs.
• • DullnessDullness is heard over dense organs, not over emphysematous lungs.
• • ResonanceResonance is heard over healthy, not emphysematous, lungs.
• • FlatnessFlatness is heard over the bones or muscles, not over emphysematous lungs.

Question 12 of 17

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Which techniques are required to conduct accurate percussion?

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  • Downward snap the striking fingerA downward strike is required to percuss correctly.
• Correct
  • Tap sharply and rapidlyTapping sharply and rapidly is required to percuss correctly.
• • Slowly lift finger to damp soundThe finger should be lifted quickly to prevent dampening the sound.
• Correct
  • Use the tip of the finger to strikeThe fingertips, and not the finger pads, should be used to percuss.
• Correct
  • Have short fingernailsHaving short nails is a necessity for correct percussion.

Question 13 of 17

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Match the percussion technique with the expected findings.

• Flat sound on spine
• Resonance of lungs
• Tenderness of kidney

Question 14 of 17

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Place the steps for indirect percussion technique in order.

1. Expose patient’s skin by removing gown as needed.
2. Place middle finger of nondominant hand firmly on patient’s skin.
3. Keep the remaining fingers of the nondominant hand fanned out and off the surface of the skin.
4. Snap the wrist of the dominant hand downward.
5. With dominant hand, strike the middle finger of nondominant hand.

Correct indirect (mediate) percussion first involves exposing the patient’s skin as needed. Percussion must be performed on bare skin to elicit accurate findings. Next, the nurse should place the middle finger of the nondominant hand firmly on the patient’s skin. The nurse should keep the fingers of the nondominant hand fanned out to avoid dulling sounds. Finally, the nurse should snap the wrist of the dominant hand downward and then strike the middle finger of the nondominant hand to produce a tone.

Question 15 of 17

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Which auscultation techniques are correct for auscultating the heart and lungs?

• Correct
  • Isolate each sound and listen to it separatelyIsolating and listening to one sound at a time will ensure accurate auscultation findings.
• • Talk with the patient while auscultatingTalking with the patient prevents focus on the sound being heard.
• • Listen to the heart and lungs simultaneouslyListening to both sounds simultaneously prevents the nurse from distinguishing characteristics of each sound.
• Correct
  • Focus on the characteristics of each soundFocusing on the characteristics of each sound ensures accurate findings for auscultation of both the heart and the lungs.
• • Anticipate the patient’s next inhalationAnticipating the next sound heard can result in inaccurate findings and should be avoided.

Question 16 of 17

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Match the auscultation guidelines with correct rationale.

• Prevents distraction
• Avoids obscured sounds
• Important to identify characteristics
• Distinguishes between two sounds

Question 17 of 17

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What guidelines should the nurse follow to ensure that auscultation sounds are accurately heard?

• • Encourage the patient to ask questions during auscultationTalking with the patient prevents focus on the sound being heard by increasing environmental noise and increasing distractions.
• • Focus on counting the respiratory rate while auscultating the abdomenListening to one sound at a time will ensure accurate auscultation findings.
• Correct
  • Ensure that the stethoscope endpiece is firmly held against the skinThe stethoscope endpiece should be held firmly against the skin. Movements against a loosely held endpiece can create extra sounds.
• • Place the stethoscope over a sheet while auscultating a patient who is “cold”The stethoscope should be placed directly on the skin to avoid inaccurate findings. It is appropriate to warm the stethoscope using the hands prior to placing on a patient’s skin.