1014 Jarvis Review Questions

Skipped chapters 3-8

According to the biomedical model, a narrow definition of health is

• optimal functioning of mind, body, and spirit within the environment.

• the absence of disease.

• the response of the whole person to actual or potential problems.

• prevention of disease.

• the absence of disease.

What type of database is most appropriate when rapid collection of data is required and often performed concurrently with life-saving measures?

• Episodic

• Follow-up

• Emergency

• Complete

• Emergency

A medical diagnosis is used to identify and explain

• a person’s state of health.

• the response of the whole person to actual or potential health problems.

• a person’s culture.

• the cause of disease

• the cause of disease

Which of the following is considered an example of subjective data?

• Decreased range of motion

• Crepitation in the left knee joint

• Left knee has been swollen and hot for the past 3 days

• Arthritis

• Left knee has been swollen and hot for the past 3 days

What type of database is most appropriate for an individual who is admitted to a long-term care facility?

• Episodic

• Follow-up

• Emergency

• Complete

• Complete

Which of the following is considered an example of objective data?

• Alert and oriented

• Headache

• An earache

• A sore throat

• Alert and oriented

The nursing process is

• the process of analyzing health data and drawing conclusions to identify diagnoses.

• a systematic method of planning and providing patient care organized around series of phases that integrate evidence-informed practice and critical thinking.

• the approach to treatment that involves multiple disciplines.

• a process of continually examining how you view and respond to patients on the basis of your own assumptions, cultural and social orientations, and past experiences.

• a systematic method of planning and providing patient care organized around series of phases that integrate evidence-informed practice and critical thinking.

A nursing diagnosis is best described as

• a determination of the etiology of disease.

• a pattern of coping.

• an individual’s perception of health.

• a concise statement of actual or potential health concerns or level of wellness.

• a concise statement of actual or potential health concerns or level of wellness.

Social determinants of health are

• comprehensive social and political processes.

• secondary and primary preventions to change lifestyle and behaviour.

• socioenvironmental perspectives.

• social, economic, and political conditions.

• social, economic, and political conditions.

A patient admitted to the hospital with asthma has the following problems identified, on the basis of the admission health history and physical assessment results. Which problem is a first-level priority?

• Ineffective self-health management

• Risk for infection

• Impaired gas exchange

• Readiness for enhanced spiritual well-being

• Impaired gas exchange

The social determinants of health related to the socioeconomic environment should be a concern for

• a middle-income couple living in a supportive community.

• an executive with a strong family network.

• a university graduate employed with a company of good reputation.

• a homeless man living on the streets.

• a homeless man living on the streets.

Health promotion has signaled a shift in power from

• consumers of health care to their health care providers.

• health insurance companies to health care providers.

• health care agencies to consumers of health care.

• health care providers to consumers of health care.

• health care providers to consumers of health care.

Which of the following populations have a shorter life expectancy compared with the rest of Canadians?

• South Asian and Southeast Asian Canadians

• Indigenous peoples

• European Canadians

• African Canadians

• Indigenous peoples

Assessments can facilitate effective health promotion for specific patients when

• they are time constrained, are to the point, and use predetermined strategies.

• they are presumptive, involve minimal patient and family inputs, and consider preconceived notions of the patient.

• they are systematic and thorough, use a strength-based approach, consider developmental level, take into account the patient’s and family’s cultural and social contexts, and involve the patient in decision making to ensure that care is patient centred.

• they are comprehensive, depend on health care provider decision making, and have minimal consideration of socioeconomic determinants of health.

• they are systematic and thorough, use a strength-based approach, consider developmental level, take into account the patient’s and family’s cultural and social contexts, and involve the patient in decision making to ensure that care is patient centred.

Which of the following is an example of tertiary prevention?

• Prostate–specific antigen (PSA) blood test

• Preventing second-hand smoke exposure of a patient with chronic obstructive lung disease

• Immunization against infectious diseases

• Diet and exercise programs to prevent further heart attack or strokes

• Preventing second-hand smoke exposure of a patient with chronic obstructive lung disease

The social determinants of health include

• injury prevention, diet, exercise, sexual health, substance use, dental health, anticipatory guidance, and primary prevention of specific cancers.

• identifying depression, fall risk, visual acuity loss, problematic alcohol or substance use, and hearing loss.

• income and social status; social support networks; education and literacy; employment/working conditions; social environments; physical environments; personal health practices and coping skills; healthy child development; biology and genetic endowment; health services; gender; and culture.

• developmental tests, screening tests, immunizations, counselling, and health education.

• income and social status; social support networks; education and literacy; employment/working conditions; social environments; physical environments; personal health practices and coping skills; healthy child development; biology and genetic endowment; health services; gender; and culture.

What actions are outlined in the Ottawa Charter for Health Promotion to enable people to take control of and improve their health?

• Income, social status, social support networks, education, employment, and social environments

• Primary prevention, secondary prevention, and tertiary prevention

• Building healthy public policy, creating supportive environment, strengthening community actions, developing personal skills, reorienting health services, and enabling, mediating, and advocating

• Involving the population as a whole, taking action on the social determinants of health, combining diverse but complementary methods, seeking public participation are actions that are nurtured and enabled by health care providers

• Building healthy public policy, creating supportive environment, strengthening community actions, developing personal skills, reorienting health services, and enabling, mediating, and advocating

When health care providers are challenged to focus upstream, their primary goal is to

• focus on early detection of disease, before symptoms appear.

• analyze health data and draw conclusions to identify diagnoses.

• assess the root causes of health conditions that affect individuals.

• focus on preventing complications when a condition or disease is present or progressed.

• assess the root causes of health conditions that affect individuals.

Which of the following are examples of primary prevention activities? (Select all that apply.)

• Promoting the use of bicycle helmets by 12-year-old children

• Reminding a patient with congestive heart failure to carefully monitor his weight

• Organizing public influenza clinics

• Teaching an 8-year-old child with asthma how to use his inhaler correctly

• Providing nutrition classes to low-income families

• Scheduling a colonoscopy for a 55-year-old man with a family history of colorectal cancer

• Promoting the use of bicycle helmets by 12-year-old children

• Organizing public influenza clinics

• Providing nutrition classes to low-income families

The Population Health Promotional Model is (Select all that apply.)

• a multifaceted approach that includes the social determinants of health and is used in nursing health assessments.

• the predominant model of the Canadian health care system.

• a framework that can be used to influence health, social, and environmental policies.

• a model that emphasizes changing behaviours and lifestyle.

• a multifaceted approach that includes the social determinants of health and is used in nursing health assessments.

• a framework that can be used to influence health, social, and environmental policies.

To examine a toddler, the nurse should

• allow the child to sit on the parent’s lap.

• remove the child’s clothing at the beginning of the examination.

• ask the child to decide whether parents or siblings should be present.

• perform the assessment from head to toes.

• allow the child to sit on the parent’s lap.

Deep palpation is used to

• identify abdominal contents.

• evaluate surface characteristics.

• elicit deep tendon reflexes.

• determine the density of a structure.

• identify abdominal contents.

Amplitude is

• the intensity (soft or loud) of sound.

• the length of time the note lingers.

• the number of vibrations per second.

• the subjective difference in a sound’s distinctive overtones.

• the intensity (soft or loud) of sound.

The dorsa of the hands are used to determine

• vibration.

• temperature.

• an organ’s position.

• fine tactile discrimination.

• temperature.

Fine tactile discrimination is best achieved with the

• opposition of the fingers and the thumb.

• fingertips.

• back of the hands and fingers.

• base of the fingers.

• fingertips.

An examination of the fundus is an examination of the

• inner ear.

• pharynx.

• internal structures of the eye.

• nasal turbinates.

• internal structures of the eye.

Which of the following is considered when preparing to examine an older adult?

• Basing the pace of the examination on the patient’s needs and abilities

• Avoiding physical touch to offset making the older adult uncomfortable

• Being aware that loss will result in poor coping mechanisms

• That confusion is a normal, expected finding in an older adult

• Basing the pace of the examination on the patient’s needs and abilities

When performing percussion, the examiner

• strikes the flank area with the palm of the hand.

• strikes the stationary finger at the distal interphalangeal joint.

• strikes the stationary finger at the proximal interphalangeal joint.

• taps fingertips over bony processes.

• strikes the stationary finger at the distal interphalangeal joint.

At the end of the examination, the examiner should

• complete the documentation before leaving the examination room.

• have the findings confirmed by another provider.

• compare objective and subjective data for discrepancies.

• review the findings with the patient.

• review the findings with the patient.

When would the nurse use second-tier precautions in addition to routine practices?

• The patient is admitted with a leg fracture.

• The patient is admitted with a methicillin-resistant Staphylococcus aureus infection.

• The patient is a postpartum mother.

• The patient is admitted for heart surgery.

• The patient is admitted with a methicillin-resistant Staphylococcus aureus infection.

The general survey consists of four distinct areas. These areas include

• mental status, speech, behaviour, and mood and affect.

• gait, range of motion, mental status, and behaviour.

• physical appearance, body structure, mobility, and behaviour.

• level of consciousness, personal hygiene, mental status, and physical condition

• physical appearance, body structure, mobility, and behaviour.

A common error in blood pressure measurement includes

• taking the blood pressure in the arm positioned at the level of the heart.

• waiting less than 1 to 2 minutes before repeating the blood pressure reading on the same arm.

• deflating the cuff by about 2 mm Hg per heartbeat.

• using a blood pressure cuff whose bladder length is 80% of the arm circumference.

• waiting less than 1 to 2 minutes before repeating the blood pressure reading on the same arm.

Data collection for the general survey begins

• at the first encounter.

• at the beginning of the physical examination.

• while taking vital signs.

• during the mental status examination.

• at the first encounter.

The Doppler technique

• is used to assess the apical pulse.

• augments Korotkoff’s sounds during blood pressure measurement.

• provides an easy and accurate measure of the diastolic pressure.

• measures arterial oxygenation saturation.

• augments Korotkoff’s sounds during blood pressure measurement.

The tympanic membrane thermometer

• provides an accurate measurement of core body temperature.

• senses the infrared emissions of the cerebral cortex.

• is not used in unconscious patients.

• accurately measures temperature in 20 to 30 seconds.

• provides an accurate measurement of core body temperature.

Endogenous obesity is

• caused by inadequate secretion of cortisol by the adrenal glands.

• caused by excess adrenocorticotropic hormone (ACTH) production by the pituitary gland.

• characterized by evenly distributed excess body fat.

• a result of excessive secretion of growth hormone in adulthood.

• caused by excess adrenocorticotropic hormone (ACTH) production by the pituitary gland.

To perform an accurate assessment of respirations, the examiner should

• inform the person of the procedure and count for 1 minute.

• count for 15 seconds while keeping fingers on the pulse, and multiply by 4.

• count for 30 seconds after completing a pulse assessment, and multiply by 2.

• assess respirations for a full 2 minutes if an abnormality is suspected.

• count for 30 seconds after completing a pulse assessment, and multiply by 2.

Physical appearance includes statements that compare appearance with

• mood and affect.

• stated age.

• gait.

• nutrition.

• stated age.

An adult patient’s pulse is 46 beats per minute. The term used to describe this rate is

• tachycardia.

• bradycardia.

• weak and thready.

• sinus arrhythmia.

• bradycardia.

The nurse records that the patient’s pulse is 3+, or “full and bounding.” Which of the following could be the cause?

• Dehydration

• Shock

• Bleeding

• Anxiety

• Anxiety

Pain signals are carried to the central nervous system by way of

• perception.

• afferent fibres.

• modulation.

• referred pain

• afferent fibres.

Which of the following is the most reliable indicator for pain?

• Magnetic resonance imaging (MRI) results

• Patient’s self-report

• Tissue enzyme levels

• Blood drug levels

• Patient’s self-report

Which of the following is true regarding pain in children?

• Infants have the same capacity for pain as do adults.

• Preverbal infants do not remember pain.

• Children older than 2 years of age are able to accurately rate pain intensity.

• Children will exaggerate their descriptions of pain in the presence of a health care provider

• Infants have the same capacity for pain as do adults.

What occurs during transduction (the first phase of nociceptive pain)?

• Pain signals move from the site of origin to the spinal cord.

• The pain impulse moves from the spinal cord to the brain.

• The brain interprets the pain signal.

• Chemical mediators are neutralized, decreasing the perception of pain.

• Pain signals move from the site of origin to the spinal cord.

What type of pain is short and self-limiting, and dissipates after the injured tissue has healed?

• Chronic

• Persistent

• Acute

• Malignant

• Acute

Neuropathic pain implies an abnormal

• degree of pain interpretation.

• processing of the pain message.

• transmission of pain signals.

• modulation of pain signals.

• processing of the pain message.

What is the source of deep somatic pain?

• Skin and subcutaneous tissues

• Bones and joints

• Pancreas

• Intestine

• Bones and joints

Which of the following has been found to influence pain perception in women?

• Age

• Genetics

• Parity

• Weight

• Genetics

Specialized nerve endings that are designed to detect painful sensations are

• synapses.

• dorsal horns.

• nociceptors.

• C fibres.

• nociceptors.

An intubated sedated patient has a score of 7 on the Critical-Care Pain Observation Tool. The nurse should

• reassess the pain level in 3 to 4 hours.

• administer prescribed pain medication.

• confirm the pain level with vital signs.

• use only nonpharmacological pain relief interventions.

• administer prescribed pain medication.

Nutrition screening identifies individuals at nutritional risk by using the following parameters:

• Alertness, lethargy, obtundation, stupor, and coma

• Weight and height history, diet information, medical history, and routine laboratory data

• Inspection, palpation, percussion, and auscultation

• Occupation, socioeconomic status, religion, and sex

• Weight and height history, diet information, medical history, and routine laboratory data

Healthy weight and healthy diet promotion should include

• recommending fad diets or no-carbohydrate diets to achieve rapid weight loss.

• recommending intake of foods high in sodium and fats, and ensuring that intake exceeds expenditure of calories.

• recommending eating portions from all food groups, matching intake and expenditure of calories, including physical activity, and reflecting individuality.

• recommending limiting food intake to less than 1000 calories per day and increasing physical activity.

• recommending eating portions from all food groups, matching intake and expenditure of calories, including physical activity, and reflecting individuality.

The lack of accessibility for all people to nutritious, safe, personally acceptable, and culturally suitable foods, produced in an environmentally and socially appropriate manner, is known as

• isolation.

• low-income nutrition.

• food insecurity.

• high-income nutrition.

• food insecurity.

In adolescence, nutrient requirements

• increase.

• decrease.

• stabilize.

• fluctuate.

• increase.

What is included as objective data in a nutritional assessment to determine a patient’s nutritional status?

• General appearance, physical examination, and laboratory tests

• Immunizations and allergies

• Location, quality, quantity, timing, setting, aggravating and associated factors, and perception

• 24-hour diet recall

• General appearance, physical examination, and laboratory tests

In comparison to the general population people with diabetes are 20 times more likely to be hospitalized with

• cardiovascular disease.

• end-stage renal failure.

• nontraumatic lower limb amputation.

• metabolic syndrome.

• nontraumatic lower limb amputation.

A comprehensive nutritional assessment always includes

• anthropometric measures.

• a direct observation of feeding and eating processes.

• a work history.

• a comprehensive metabolic panel.

• anthropometric measures.

Obese persons with more fat in the upper body, especially the abdomen, have

• gastronomic obesity.

• gynoid obesity.

• anthropometric obesity.

• android obesity.

• android obesity.

The physiological changes associated with aging that affect nutritional status for the older person include (Select all that apply.)

• increased saliva production.

• poor dentition.

• diminished olfactory and taste sensitivity.

• increased gastro-intestinal absorption.

• poor dentition.

• diminished olfactory and taste sensitivity.

While the nurse is taking the health history, the patient complains of pruritus. What is a potential cause of this symptom?

• Excessive bruising

• Hyperpigmentation

• Diaphoresis

• Drug reactions

• Drug reactions

A flat macular hemorrhage is called a(n)

• purpura.

• ecchymosis.

• petechiae.

• hemangioma.

• purpura.

A nursing student has been assigned to teach grade 4 students about the importance of caring for their skin. Which of the following should be included while discussing the skin?

• The skin is the body’s second largest organ system.

• The skin is not part of regulating temperature.

• The skin is not waterproof.

• The skin is a first line of defense to protect you against microorganisms and injury.

• The skin is a first line of defense to protect you against microorganisms and injury.

Functions of the skin include

• production of vitamin C.

• temperature regulation.

• the production of new cells by melanocytes.

• the secretion of a drying substance called sebum.

• temperature regulation.

A 75-year-old hospitalized patient with limited mobility, activity, and nutrition scores a 7 on the Braden Risk Assessment Scale. What does this indicate?

• The patient is at risk for malignant melanoma.

• The patient has severe cognitive impairment.

• The patient is at very high risk for skin tears, skin breakdown, and/or the development of pressure sores.

• The patient has pain that is greater than moderate in severity.

• The patient is at very high risk for skin tears, skin breakdown, and/or the development of pressure sores.

Which of the following terms refers to a linear skin lesion that runs along a nerve route?

• Zosteriform

• Annular

• Polycyclic

• Shingles

• Zosteriform

The components of a nail examination include

• shape, contour, consistency, and colour.

• colour, texture, distribution, and lesions.

• clubbing, pitting, and grooving.

• colour, texture, temperature, and moisture.

• shape, contour, consistency, and colour.

To determine if a dark-skinned patient is pale, the nurse should assess the colour of the

• conjunctivae.

• ear lobes.

• elbows.

• skin in the antecubital space

• conjunctivae.

An example of a primary lesion is a(n)

• erosion.

• ulcer.

• urticaria.

• port-wine stain

• urticaria.

A scooped-out, shallow depression in the skin is called a(n)

• ulcer.

• excoriation.

• fissure.

• erosion.

• erosion.

Bleeding into the periosteum during birth is known as

• caput succedaneum.

• craniosynostosis.

• moulding.

• cephalhematoma

• cephalhematoma

Craniosynostosis is a severe deformity caused by

• premature closure of the sutures.

• increased intracranial pressure.

• a localized bone disease that softens, thickens, and deforms bone.

• excess growth hormone or a deficit in thyroid hormone.

• premature closure of the sutures.

Narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia are characteristic of

• Down’s syndrome.

• fetal alcohol syndrome.

• chronic childhood allergies.

• hydrocephalus.

• fetal alcohol syndrome.

Kyphosis of the spine is common with aging. To compensate, older adults will

• shift their centre of gravity.

• extend their heads and jaws forward.

• stiffen their gait.

• shuffle.

• extend their heads and jaws forward.

Which of the following statements related to aggravating symptoms or triggers of headaches is accurate?

• Alcohol consumption may precipitate the onset of cluster or migraine headaches.

• Certain foods, such as chocolate or cheese, may precipitate the onset of tension headaches.

• Premenstrual hormonal fluctuations may precipitate the onset of cluster headaches.

• Poor posture may trigger a migraine headache.

• Alcohol consumption may precipitate the onset of cluster or migraine headaches.

Most facial bones articulate at a suture. Which facial bone articulates at a joint?

• Nasal bone

• Mandible

• Zygomatic bone

• Maxilla

• Mandible

A severe deficiency of thyroid hormone leading to nonpitting edema, coarse facial features, dry skin, and dry coarse hair is known as

• Parkinson’s syndrome.

• Cushing’s syndrome.

• myxedema.

• Graves’ disease.

• myxedema.

Which of the following statements describing a headache would warrant an immediate referral?

• “This is the worst migraine of my life.”

• “This is the worst headache I’ve had since puberty.”

• “I have never had a headache like this before; it is so bad I can’t function.”

• “I have had daily headaches for years.”

• “I have never had a headache like this before; it is so bad I can’t function.”

Your patient has right-sided facial paralysis, and cannot wrinkle their forehead, raise their right eyebrow, close their right eye, whistle, or show their teeth on the right side. These findings indicate

• cerebral vascular accident (stroke).

• Bell’s palsy.

• Cushing’s syndrome.

• Parkinson’s syndrome.

• Bell’s palsy.

A patient is admitted to the emergency department after a motor vehicle accident. The trachea is deviated to the left side. This finding is characteristic of

• right pneumothorax.

• aortic arch aneurysm.

• right pleural adhesion.

• right-sided atelectasis.

• right pneumothorax.

The extraocular muscles consist of four straight or ________ muscles and two slanting or ______ muscles.

• palpebral; conjugate

• superior; inferior

• rectus; oblique

• rectilinear; diagonal

• rectus; oblique

The location in the brain where optic nerve fibres from the temporal fields of vision cross over is identified as the

• optic chiasm.

• fovea centralis.

• optic disc.

• choroid.

• optic chiasm.

Which of the following groups of individuals need to be tested for colour blindness (colour deficiency)?

• Males of Indigenous descent between ages 10 and 15 years

• Males of European descent between ages 4 and 8 years

• Females of Asian descent between ages 3 and 6 years

• Females of European descent between ages 4 and 8 years

• Males of European descent between ages 4 and 8 years

Which of the following statements is true in regard to the results obtained from use of the Snellen chart?

• The smaller the denominator, the poorer is the vision.

• The larger the denominator, the poorer is the vision.

• The larger the numerator, the better is the vision.

• The smaller the numerator, the poorer is the vision.

• The larger the denominator, the poorer is the vision.

The lens of the eye functions as a

• refracting medium.

• mediator of light.

• sensory facilitator.

• controller of intraocular pressure.

• refracting medium.

With aging the lower eyelid becomes loose, rolls outward and does not approximate to the eyeball. This condition is identified as

• entropion.

• chalazion.

• ectropion.

• blepharitis.

• ectropion.

The normal colour of the optic disc is

• red.

• creamy pink.

• creamy yellow-orange to pink.

• creamy red to yellow-orange.

• creamy yellow-orange to pink.

Which of the following is an expected response on the cover-uncover test?

• The covered eye moves into a relaxed position.

• The covered eye maintains its position when uncovered.

• The uncovered eye is unable to maintain its gaze on a fixed object.

• The covered eye jumps to re-establish fixation when it is uncovered.

• The covered eye maintains its position when uncovered.

Which of the following findings is associated with Horner’s syndrome?

• Bilateral miosis

• Bilateral mydriasis

• A unilateral, small, regular pupil that reacts to light and accommodation

• A unilateral dilated pupil with no reaction to light or accommodation

• A unilateral, small, regular pupil that reacts to light and accommodation

Decreased vision in the older adult may be caused by which of the following conditions?

• Macular degeneration

• Arcus senilis

• Fixation

• Presbyopia

• Macular degeneration

Binaural interaction at the level of the brain stem permits

• interpretation of sound.

• identification and location of the direction of the sound.

• amplification of sound.

• direction of sound toward the appropriate conduction pathway.

• identification and location of the direction of the sound.

Which of the following behaviours demonstrated by an individual may be indicative of hearing loss?

• Not looking at the examiner when being questioned

• Frequently asking to have the questions or statements repeated

• Talking in a high-pitched voice

• Speaking slowly with well-articulated consonants

• Frequently asking to have the questions or statements repeated

Which of the following is at risk of recurrent otitis media (OM)?

• An 18-month-old infant who lives with a smoker

• A 2-year-old child who has had two ear infections in the past 6 months

• A 6-month-old infant who has a sibling who had tubes inserted at age 3 years

• An 18-month-old infant who has had three episodes of ear infections in a 5-month period

• An 18-month-old infant who has had three episodes of ear infections in a 5-month period

The external structure of the ear is identified as the

• auricle.

• atrium.

• atrophy.

• aura.

• auricle.

The labyrinth of the inner ear is responsible for maintaining the body’s

• binaural interaction.

• air conduction.

• equilibrium.

• pressure equalization.

• equilibrium.

When an otoscope examination is performed on an older adult, the tympanic membrane may be

• pinker than that of a younger adult.

• thinner than that of a younger adult.

• whiter than that of a younger adult.

• more mobile than that of a younger adult.

• whiter than that of a younger adult.

Which of the following tests provides a precise quantitative measure of hearing?

• Tuning fork tests

• Romberg test

• Audiometer test

• Whispered voice test

• Audiometer test

The position of the tympanic membrane in the neonate is more ________________, making it more difficult to visualize with the otoscope.

• horizontal

• vertical

• perpendicular

• oblique

• horizontal

The tympanic membrane of a child with acute OM would be

• flat and slightly pulled in at the centre.

• intact and mobile.

• bulging, with a distinct red colour.

• shiny and translucent, with a pearly grey colour.

• bulging, with a distinct red colour.

If the tympanic membrane has white, dense areas, the examiner suspects

• perforation resulting from a ruptured tympanic membrane.

• scarring from recurrent ear infections.

• serous fluid from serous OM.

• a fungal infection.

• scarring from recurrent ear infections.

The nasal mucosa of an individual with rhinitis would be

• moist and pink.

• swollen, boggy, and grey.

• bright red and swollen.

• pale with bright red bleeding.

• bright red and swollen.