Test Bank for Seidels Guide to Physical Examination 9th Edition By Ball

Test Bank for Seidels Guide to Physical Examination

9th Edition By Ball

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Chapter 10: Lymphatic System
Ball: Seidel’s Guide to Physical Examination, 9th Edition

MULTIPLE CHOICE

1. Which organ does not have lymphatic vessels?

a. Brain
b. Kidneys
c. Liver
d. Lungs
ANS: A
Lymphatic tissues are found abundantly throughout the body except in two places, the
placenta and the brain (central nervous system). Lymphatic tissues are found abundantly in
the kidneys, liver, and lungs.

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

2. Cells that line the lymph node sinuses perform the specific function of:
a. fat absorption.
b. fetal immunization.
c. hematopoiesis.
d. phagocytosis.
ANS: D
Lymph nodes defend against the invasion of microorganisms by phagocytosis.

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

3. Lymph flows faster in response to:

a. increased metabolic activity.
b. decreased blood volume.
c. decreased metabolic rate.
d. decreased permeability of the capillary walls.
ANS: A
Lymph flow increases with mounting capillary pressure, greater permeability of the
capillary walls, or increased metabolic rate.

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

4. An organ that is essential to the development of protective immune function in the infant
but has little or no demonstrated function in the adult is the:
a. spleen.
b. liver.
 c. thymus.
d. pancreas.
ANS: C
In the adult, the thymus atrophies and, in the older adult, is replaced by fat and connective
tissue.

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

5. Mr. Shea is a 45-year-old patient who presents to the office for multiple complaints. The
examination of the upper left quadrant of the abdominal cavity is essential to the
evaluation of the immune system because of the location of which organ?
a. Spleen
b. Liver
c. Stomach
d. Pancreas
ANS: A
The spleen is the largest of the lymphatic organs. It is located in the upper left portion of
the abdomen.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

6. Mrs. Farrel brings in her 6-year-old son with complaints of a sore throat and fever. As the
healthcare provider, you are concerned about his tonsils and adenoids. Enlarged tonsils
and adenoids may obstruct the:
a. thoracic duct.
b. esophagus.
c. nasopharyngeal passageway.
d. external auditory meatus.
ANS: C
The palatine tonsils are located on either side of the pharynx; the adenoids (pharyngeal
tonsils) are found on the posterior wall of the pharynx and superior to the soft palate. If
these structures become enlarged, they block the passage between the pharynx and nasal
cavity.

DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

7. Mrs. Sing is a 44-year-old patient who presents to the office with a complaint of enlarged
lymph nodes. When enlarged, which lymph nodes are most likely to be a sign of pathology
(e.g., malignancy)?
a. Occipital
b. Anterior cervical
c. Supraclavicular
d. Femoral
 ANS: C
Supraclavicular nodal enlargement is of special concern because it suggests a malignancy,
even in children; an enlarged supraclavicular lymph node may be the sentinel node of
Hodgkin disease.

DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

8. As adults age, their ability to resist infection is reduced because of the lymphatic nodes
becoming more:
a. fibrotic.
b. mucoid.
c. porous.
d. profuse.
ANS: A
Older adults’ lymph nodes diminish in both number and size and are replaced with more
fibrotic and fatty tissues.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

9. Equipment for examining the lymphatic system includes a:

a. caliper.
b. centimeter ruler.
c. goniometer.
d. syringe and needle.
ANS: B
The centimeter ruler and marking pencil are the only equipment needed for examination of
the lymphatic system. They are used to measure and outline the borders of the nodes.

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

10. Which nodes are most often associated with inflammation?

a. Shotty
b. Movable
c. Fixed
d. Tender
ANS: D
Tenderness is almost always indicative of inflammation. Shotty nodes (feel like the tip of
an eraser) that are fixed are of greater concern. Shotty, movable, or fixed nodes are not
usually associated with inflammation.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation
11. Which nodes are also called Virchow nodes?
a. Internal mammary
b. Anterior axillary
c. Deep cervical
d. Supraclavicular
ANS: D
The supraclavicular nodes are also referred to as Virchow nodes.

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

12. The harder and more discrete a node, the more likely that there is a(n):
a. innocent cause.
b. infection.
c. malignancy.
d. metabolic disease.
ANS: C
Tender nodes almost always indicate the presence of an infection, whereas a hard, discrete,
and nontender node is more likely to represent a malignancy.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

13. Which finding indicates that the examiner is assessing a blood vessel rather than a lymph
node?
a. A bruit
b. Inflammation
c. Tenderness
d. Redness
ANS: A
Pulsations and auscultation of bruits indicate a blood vessel and not a lymph node.

DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

14. When examining lymph nodes near a joint in the arm or leg, which of the following
maneuvers is likely to facilitate the examination?
a. Extension of the extremity
b. Circumduction of the extremity
c. Flexion of the extremity
d. Rotation of the extremity
ANS: C
Bending joint areas will ease taut tissues and allow for better accessibility to palpation.

DIF: Cognitive Level: Applying (Application) OBJ: Nursing

 process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

15. To palpate the inguinal nodes, you should have the patient:
a. bend over a table and cough.
b. lie supine with knees slightly flexed.
c. lie supine with legs extended.
d. stand and cough vigorously.
ANS: B
To palpate the inguinal nodes, you should have the patient lie supine and slightly flex her
or his knees.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

16. The most important clue to the diagnosis of immunodeficiency disease in a child is:
a. family history.
b. illness in siblings.
c. previous hospitalizations.
d. serious recurring infections.
ANS: D
Although family history, illness in siblings, and previous hospitalizations are helpful clues
to discover an immunodeficiency in a child, it is most important to review the occurrence
of serious, uncommon infections, such as Pneumocystis jirovecii, or other fungal
infections that do not respond as expected to therapy.

DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

17. A red streak that follows the course of the lymphatic collecting duct is a finding associated
with:
a. Hodgkin disease.
b. lymphangitis.
c. lymphedema.
d. lymphoma.
ANS: B
Lymphangitis—inflammation of the lymphatic vessels—is evident by a red streak that
follows the course of the inflamed lymphatic duct. Hodgkin disease and lymphoma refer to
malignancies manifested primarily by nodal enlargements; lymphedema is lymph swelling
that distinguishes itself from interstitial edema because it does not pit.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

18. Which disorder is characterized by a single node that is chronically enlarged and
nontender in a patient with no other symptoms?
 a. Retropharyngeal abscess
b. Streptococcal pharyngitis
c. Mononucleosis
d. Toxoplasmosis
ANS: D
Toxoplasmosis is characterized by a chronically enlarged, nontender, single node—usually
in the posterior cervical chain.

DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

19. Initial signs and symptoms of Epstein-Barr virus mononucleosis usually include:
a. pharyngitis, fever, and malaise.
b. bleeding gums and spontaneous nosebleeds.
c. headache, visual disturbance, and rash.
d. inguinal adenopathy and painful urination.
ANS: A
Presenting signs and symptoms of Epstein-Barr virus mononucleosis are pharyngitis,
fever, fatigue, malaise, often splenomegaly, and occasionally hepatomegaly and/or rash.

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

20. Tender nodes associated with cat scratch disease are usually found in which area?
a. Epitrochlear area
b. Popliteal area
c. Axilla
d. Inguinal area
ANS: C
Cat scratch disease usually results in enlargement of nodes in the head, neck, and axillae.
Although epitrochlear enlargement occurs most exclusively in cat scratch fever, its
occurrence is less common.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

21. Serum sickness is usually characterized first by the appearance of:

a. lymph node enlargement.
b. joint pain.
c. urticaria.
d. fever.
ANS: C
Urticaria is the first sign of serum sickness, followed by lymphadenopathy, joint pain,
fever, and facial edema.
Test Bank for Seidels Guide to Physical Examination 9th Edition By Ball

DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

MULTIPLE RESPONSE

1. Which condition stimulates lymph node enlargement? (Select all that apply.)
a. Graves disease
b. Lymphangioma
c. Esophageal reflux
d. Parotid swelling
ANS: A, B, D
Lymph node enlargement is stimulated by Graves disease, lymphangioma, and parotid
swelling.

DIF: Cognitive Level: Applying (Application) OBJ: Nursing

process—assessment
MSC: Physiologic Integrity: Physiologic Adaptation

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