Health Assessment 302 Exam 2 Material

Helpfulness: +1
Set Details Share
created 5 years ago by Husky_Murse
792 views
updated 4 years ago by Husky_Murse
Grade levels:
College: Third year
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

Relaxation of ventricles; filling of atria; atrial contraction; filling of ventricles

Diastole

2

Ventricular contraction (AV valves close); ends with closure of semilunar valves

Systole

3

Mitral/tricuspid valves closing

S1

4

Pulmonic/aortic valves closing

S2

5

When do the coronary arteries receive oxygenated blood to feed itself?

Diastole

6

Difference between ischemia & infarct?

Ischemia is lack of blood flow; infarct is muscle death from that lack of blood flow

7

Amount of blood ejected by LV per beat

SV

8

How do you calculate CO?

HR x SV

9

What is pulse pressure?

SBP - DBP

10

What are 2 deep veins in the thigh region?

Great saphenous & femoral

11

What kind of veins are at risk of developing a thrombosis?

Deep veins (DVT) such as popliteal, anterior tibial, femoral, great saphenous, etc

12

Where is the epitrochlear node of the lymph system located?

Bilaterally inside above elbow

13

If you have a swollen epitrochlear node, or any lymph node, where will the problem be coming from?

Distal to blocked node/s

14

What regions host nodular clusters?

Axillary, inguinal, & cervical

15

Where do lymphatic capillaries receive their fluid from?

Interstitial tissue spaces & passively due to muscle contraction moving fluid into vessels

16

Why do fetuses have right to left shunting?

No need for full pulmonary perfusion due to receiving oxygenation from mother

17

When do the foramen ovale & ductus arteriosus close

Shortly after birth (<24 hrs)

18

What should you consider when assessing lymph nodes in children?

Nodes are larger in children; often palpable

Larger response w/infection

19

What assessment changes occur with a pregnant patient?

-Increased blood volume
-Increased HR
-Decreased BP
-Loud S3 (gallop)

20

What happens r/t pressure of the uterus on the inferior vena cava & iliac veins?

Edema & varicosities

21

What happens to BP in older adults?

SBP increases over time

22

What does the normal enlargement of calf veins in older adults place them at greater risk for?

DVT

23

What is the definition of orthostatic BP?

Within 3 minutes of going from lying to standing, a SBP drop of 20 or more or DBP drops by 10 or more

24

The pain caused by ischemia

Claudication

25

Outside of BP parameters, what other findings would indicate positive orthostatic VS?

Increase in HR of 20

26

How long do you lie down before taking first BP/Pulse with orthostatic VS?

5-10 minutes

27

How long do you wait after each position change?

1 minute

28

What happens with fluid volume as the body shifts from supine to upright position?

500mL - 1000mL shifts to lower body

29

What are the 2 causes of orthostatic hypotension?

-Reduced venous return = less circulatory volume
-Vasoconstriction in order to maintain same supply w/lower volume

30

Regarding normal vascular compensation, what's the normal expected shifting values associated w/HR & BP in orthostatics?

HR: Increase around 5-20
SBP: A drop less than or equal to 10
DBP: A rise of around 5

31

What parameters equate to orthostatic hypotension?

-SBP drop of at least 20
OR
-DBP drop of at least 10

-HR rise of at least 20
*Must be within 3 minutes of standing

32

How fast must the orthostatic recordings happen after the patient stands?

Within 3 minutes of standing

33

When auscultating the carotid (or other vessel) for bruit, what part of stethoscope do you use?

Bell

34

What position do you start the patient in for the neck exam?

Seated

35

What do jugular pulses greater than normal indicate?

Fluid overload

36

What is considered normal when auscultating the carotid arteries?

No sound = normal!

37

What is bruit?

Turbulent blood flow (swooshing)

38

What does bruit cause?

Aneurysm, stenosis

39

When assessing jugular veins, what position do you start with, and which one do you move to?

Seated, then supine

40

What does volume overload/increased venous pressure, revealed by JVD, cause?

-Portal HTN
-HF

41

What would be suspected if the apical pulse was lower than the 5th ICS & was lateral to MCL

Cardiomegaly (enlarged heart)

42

1. What part of stethoscope do you use to listen to normal heart sounds (S1/S2)?
2. What part for extra sounds (S3/S4)?

1. Diaphragm (high pitch)
2. Bell (low pitch)

43

What sound does S1 make, & what does it represent?

"Lub"; closure of AV valves

44

Where is S1 loudest?

Apex

45

What sound does S2 make, & what does it represent?

"Dub"; closure of aortic/pulmonic valves

46

Where is S2 loudest?

Base

47

1. When precordium is too "quiet", how should you position patient?

2. What does this do?

1. Place patient on L side

2. Brings apex to chest wall - easier to look, feel, & listen

48

What is S3?

"Kentucky" gallop

49

What is S4?

"Tennessee" gallop

50

May be a normal heart sound; disappears w/sitting; if pathologic, indicates early heart failure

S3 - "Kentucky" gallop

51

Generally not a normal heart sound; extra heart sound

S4 - "Tennessee" gallop

52

What are gallops a result of?

Ventricular filling or valve problems

53

When do S3/S4 occur?

-Both in diastole
-S3 early, S4 late

54

Identified when in the cardiac cycle they occur; caused by turbulent blood flow (valve regurgitation, stiffness)

Murmurs

55

What would a murmur occurring in systole be termed?

Systolic murmur

56

When assessing lymph nodes, what do you note?

-Size
-Mobility
-Texture
-Tenderness

57

When assessing legs, what would coolness or pallor indicate?

Arterial disease

58

What are the depths for 1+ through 4+ pitting edema?

1+ = 2mm
2+ = 4mm
3+ = 6mm
4+ = 8mm

59

This type of edema may be caused by lymphedema or hyperthyroidism

Non-pitting edema

60

With the exception of the femoral & popliteal pulses, how should you assess the patient’s various pulses?

Assess both sides at same time

61

What should you report when assessing a patient’s pulses?

Rhythm, symmetry, amplitude (rate is recorded in VS)

62

What are 2 ways to check for vascular insufficiency?

Manual compression test & color change with position change of legs

63

This disease process is usually associated with the femoral artery & its branches; produces thigh/calf symptoms

Peripheral Artery Disease (PAD)

64

What are some of the treatments for PAD?

-Assess risk factors (i.e. smoking)
-Meds (statins/anticoagulants)
-Stent
-Vessel bypass graft

65

What are some medications used to treat PAD?

Statins & anticoagulants

66

Arterial insufficiency can lead to ulcers developing where?

Toes or outside of ankle

67

Ulceration due to arterial insufficiency leads to ulcers that look like what? What does the surrounding skin look like?

Round ulcer, minimal drainage; surrounding area is shiny/hard/cold (diminished pulses)

68

Ulceration due to venous insufficiency leads to ulcers that look like what?

Irregularly shaped (not round), wet/oozing

69

Complication of ulcers r/t arterial insufficiency

Intermittent claudication

70

Complication of ulcers r/t venous insufficiency

Blood clots causing fluid to leak into tissue = ischemia

71

This variation of ulcer r/t insufficiency isn't caused by a lack of blood flow

Venous insufficiency ulcer

72

This variation of ulcer r/t insufficiency IS caused by a lack of blood flow

Arterial insufficiency ulcer

73

In PAD, the arteries that supply blood to the legs are narrowed, typically because of atherosclerosis, causing a cluster of pain symptoms referred to as this

Intermittent claudication

74

The examiner is palpating the apical pulse. What's the normal size of this impulse?

About 2cm

75

How do you differentiate a split S2 from S3 (Kentucky gallop)?

S3 is lower pitched & is heard at the apex

76

What's the best position to listen for a pericardial friction rub?

With diaphragm; patient sitting up, leaning forward, breath held in expiration

77

What's your first step in auscultating the heart?

Identify S1 & S2

78

Where will you hear a split S2 most clearly?

Pulmonic valve

79

Why should the bell of the stethoscope be pressed lightly against the skin?

So as to not act as a diaphragm

80

A murmur heard after S1 & before S2 is classified as this

Systolic (possibly benign); think of where in the cardiac cycle "after S1" occurs (during ventricular systole)

81

Where & how should you palpate the carotid artery during your assessment?

Medial to sternocleidomastoid, one side at a time

82

S1 coincides with what pulse?

Carotid pulse

83

S2 coincides with what wave on the ECG?

R wave

84

Inflammation of a vein associated with a clot

Thrombophlebitis

85

What are 2 causes of DVT?

-Immobility (stasis)
-Hypercoagulability (r/t pain, stress, Sx)

86

A process involving superficial vein enlargement due to incompetent valves; can be painful, but isn't associated with DVT

Varicose veins

87

2 treatments for varicose veins

-Elastic stockings
-Elevation

88

Is lymphedema considered venous or arterial?

Neither; lymphatic

89

What special circumstances affect patients who suffer from lymphedema (i.e. flying, saunas)

-Wear compression sleeve due to lower pressure in airplanes
-Avoid saunas r/t increased temp encouraging swelling

90

Assumption that able-bodied individuals are the norm & differences from full ability are "bad"; can include discrimination vs. disabled

Ableism

91

Any change in the work environment or in the way things are customarily done that enables an individual w/a disability to enjoy equal employment opportunities

Accommodation

92

What should you DO when working with blind/low-vision persons?

-Address directly & by name
-Offer assistance
-Use words like "look" & "see"

93

What should you NOT do when working with blind/low-vision persons?

-Grab their arm
-Pet guide dogs
-Move furniture
-Relocate objects w/out telling them

94

What does the American Foundation for the Blind suggest when interacting with the disabled?

"Interact w/the person, not the disability."

95

Blind persons are more sensitive to touch, thus perhaps better at acupressure

Toyohari

96

If a patient has damaged right sided vision in one or both eyes, where is the damage stemming from in the brain?

Right side

97

What are the refractive parts of the eye?

-Lens
-Aqueous humor
-Vitreous humor

98

What are the nerve receptors in the eye?

-Rods/cones
-Optic nerve (CN II), optic chiasm

99

What participates in the motor function of the eye?

-Extraocular muscles (CN III, IV, VI)
-Pupillary reflexes (CN III)

100

Which cranial nerve functions both with extraocular muscles & pupillary reflexes?

CN III

101

CN II

Optic nerve (sensory)

102

What does CN II control?

Vision (optic)

103

CN III

Oculomotor (motor)

104

CN IV

Trochlear (motor)

105

CN VI

Abducens (motor)

106

Cranial nerves III, IV, and VI work together to control what?

Extraocular muscles

107

Regarding the 3 cranial nerves that control the extraocular muscles, what would help you identify which nerve was affected were an issue to arise?

Location of muscle problem

108

What action does the Oculomotor (CN III) induce?

Moves eye upward or temporally

109

What action does the Trochlear (CN IV) induce?

Moves eye down or nasally

110

What action does the Abducens (CN VI) induce?

General eye movement

111

How does the flow of the eye exam go?

1. Subjective
2. Special procedures
3. Inspect/palpate external eye
4. Inspect internal structure (only red reflex)

112

Which reflex is both sensory & motor?

Pupillary reflex (CN III)

113

Testing sensory function for the eye includes what tests?

-Near/distant vision
-Peripheral vision (confrontation test)

114

What test assesses peripheral vision?

Confrontation test

115

Testing motor function for the eye includes what tests?

-Corneal light reflex
-Diagnostic positions test
-Cover test

116

If patient has corrective lenses, should the snellen test be performed with or without correction?

With correction

117

Snellen Test:

How many mistakes are allowed per line?

Up to 2

118

1. What's the first number in the Snellen Test?

2. What's the second?

1. Distance from chart

2. The distance from which a normal person could read the line

119

Abbreviation for right eye

OD

120

Abbreviation for left eye

OS

121

Abbreviation for both eyes

OU

122

Near-sightedness

Myopia

123

20/80 or worse in better eye; visually impaired

Myopia (near-sightedness)

124

Snellen score for legally blind determination

20/200 in better eye

125

Farsightedness

Hyperopia

126

Connects central command with body

Neck

127

What does the inspection part of the head/face/neck exam entail?

Observing movement of head, face, and eyes

128

When palpating the head & scalp, what do you assess bilaterally for strength & palpability?

Temporal artery (i.e. 2+ bilaterally)

129

What would an abnormal finding for testing ROM with the TMJ be?

Clicking/popping sound

130

Sound of bones clicking or rubbing together; can indicate fracture or misalignment

Crepitus

131

How do you palpate lymph nodes?

With pads of fingers, very light pressure, circular motion

132

What's a normal finding for palpating lymph nodes?

Nonpalpable

133

If lymph nodes are palpable, what's a good sign that they're likely NOT cancerous?

-Moveable (not fixed)
-Small (pea sized)
-Soft
-Tender

134

If lymph nodes are palpable, what's a potential sign of malignancy within them while palpating them?

-Fixed position
-Large
-Hard
-Non-tender

135

What are some functions of the nose?

-Mucus production
-Filters/warms/moistens air
-Resonance chamber for speech
-Houses olfactory receptors
-Sensory nerve endings (sneeze reflex, irritation from particles)

136

When does salivation start for infants?

At 3 months

137

What does the oral cavity contain?

-Lips
-Teeth (32)
-Gingiva
-Soft/hard palate
-Uvula
-Tongue
-Salivary ducts

138

What systems does the mouth belong to?

Digestive & respiratory

139

Location of the nasopharnyx

Behind soft palate

140

What are some common developmental subjective findings for children r/t the nose/mouth/throat?

-Sore throat
-Tonsillitis/adenoiditis
-Teeth erupting/changing to permanent
-Self care

141

What are some common developmental subjective findings for older adults r/t nose/mouth/throat?

-Changes in smell or taste
-Dry mouth
-Loss of teeth
-Dentures

142

What's the order for the exam that assesses nose/mouth/throat?

1. Inspect/palpate/percuss nose & sinuses, then...
2. Organize by region - outside to inside

143

When assessing the nose/mouth/throat, where you begin with inspection/palpation/percussion of nose & sinuses before moving to an organized regional assessment from outside to inside, how does this organization lay out?

1. Inspect & palpate lips & tongue
2. Inspect mouth & throat

144

When inspecting the internal nose, when would you not need to wear gloves?

When there's no discharge

145

What do you do prior to and immediately following inspection of the patient's internal nose?

Wash hands

146

Inflammation of the lips

Cheilitis

147

Cracking/fissures at corners of the mouth are called __1__ and r/t __2__ deficiency

1. Cheilosis
2. Vitamin B

148

What equipment is needed to exam oral cavity?

At least penlight & tongue depressor

149

The term referring to alignment of teeth when jaw is closed

Occlusion

150

Another term for tooth decay or cavities

Dental caries

151

Poor alignment of teeth when jaw is closed

Malocclusion

152

What tool will help when assessing the tongue?

Using gauze to hold tongue

153

Abnormality of the tongue where it is tied or anchored to the front, reducing mobility

Ankyloglossia

154

What are 2 abnormalities we may find when assessing the tongue?

1. Candidiasis
2. Anklyoglossia

155

Who is susceptible to candidiasis?

-Immunosuppressed patients (i.e. AIDS, steroids, chemo, transplants)
-Patients on ABX therapy

156

This tongue abnormality causes difficulty in speaking & feeding; often recognized by lactation specialists & is easily fixed with clipping of the frenulum

Ankyloglossia (tongue-tie)

157

Anatomical name for throat

Pharynx

158

Grade of tonsils when touching each other (kissing)

4

159

Grade of tonsils when touching uvula

3

160

Grade of tonsils when between tonsillar pillars & uvula

1-2

161

Grade of tonsils when they extend to arches (normal)

Visible

162

How could you state "normal" for the uvula?

Midline, rises with phonation

163

Term referring to the grinding of teeth

Bruxism

164

Know the locations of the cranial bones

card image
165

Meshed immovable joints uniting adjacent cranial bones

Sutures

166

Crowns head from ear to ear at union of frontal & parietal bones

Coronal suture

167

Separates head lengthwise between 2 parietal bones

Sagittal suture

168

Separates parietal bones crosswise from occipital bone

Lambdoid suture

169

Cervical vertebrae; "atlas"

C1

170

Cervical vertebrae; "axis"

C2

171

1. How many pairs of salivary glands are accessible to examination on the face?

2. Name/location?

1. 2

2. Parotid (in cheeks over mandible) & submandibular

172

Prominent "Adam's apple" in males

Thyroid cartilage

173

Lymph nodes located behind ear

Postauricular

174

Lymph nodes located in front of ear

Preauricular

175

Lymph nodes located at base of skull(just below ear level)

Occipital

176

Lymph nodes located just below ear lobe; under angle of mandible

Jugulodigastric

177

Lymph nodes located under lower jaw bone (mandible)

Submandibular

178

Lymph nodes located under chin

Submental

179

Lymph nodes overlying sternocleidomastoid muscle

Superficial cervical

180

Lymph nodes located in posterior triangle along edge of trapezius muscle

Posterior cervical

181

Lymph nodes located deep under sternocleidomastoid muscle

Deep cervical

182

When lymph nodes are abnormal, you should check for the area they drain, which would be where?

Proximal (upstream) to abnormal lymph node

183

This type of headache usually involves a family history

Migraine

184

With __1__, people lie down to feel better. With __2__ headaches, they need to move (even pace the floor) to feel better

1. Migraines
2. Cluster

185

Loss of consciousness before a fall may have this cause

Cardiac

186

Light-headed, swimming sensation, feeling of falling

Dizziness

187

True rotational spinning from neurological disease; can be either objective or subjective types

Vertigo

188

This phrase r/t a person feeling like the room is spinning

Objective vertigo

189

This phrase r/t the perception that a person is spinning

Subjective vertigo

190

Acute onset of neck stiffness w/headache & fever may indicate this

Meningeal inflammation

191

Where do you palpate the TMJ, and how?

In front of tragus; have person open mouth to feel for smooth motion

192

Enlargement of the lymph nodes (>1cm) from infection, allergy, or neoplasm

Lymphadenopathy

193

Edematous swelling & ecchymosis of the presenting part of head caused by birth trauma; gradually resolves during first few days of life & needs no treatment

Caput Succedaneum

194

Subperiosteal hemorrhage; result of birth trauma; blood reabsorbs over first few weeks of life & usually requires no treatment

Cephalhematoma

195

Resistance to neck flexion; indicative of meningeal irritation or meningitis

Nuchal rigidity

196

Excessive secretion of GH from pituitary after puberty creates enlarged skull & thickened cranial bones; head elongates with massive face & features

Acromegaly

197

Chronic enlargement of thyroid gland due to low iodine in diet (i.e. some regions of world where iodine levels in soil are low)

Goiter

198

Excessive secretion of ACTH & chronic steroid use; rounded, "moonlike" face

Cushing Syndrome

199

Deficiency of dopamine; immobility of face produces flat, expressionless, "masklike" facial appearance

Parkinson Syndrome

200

Non-pitting edema r/t hypothyroidism

Myxedema

201

Accompanies chronic wasting diseases such as cancer, dehydration, and starvation

Cachectic appearance

202

Rich vascular network in anterior part of septum; most common site of nosebleeds

Kiesselbach plexus

203

Why is nasal mucosa redder than oral mucosa?

Rich blood supply to warm inhaled air

204

3 parallel bony projections that increase surface area to warm inhaled air; superior, middle, & inferior

Turbinates

205

Location of frontal sinuses

Bilaterally superior to eyes

206

Location of maxillary sinuses

Bilaterally below eyes - each side of nose

207

Midline fold of tissue that connects tongue to floor of mouth

Frenulum

208

Children have 20 of these temporary teeth

Deciduous

209

Dry mouth; side effect of many drugs

Xerostomia

210

What facial bone articulates at a joint instead of a suture?

Mandible

211

Blood vessel that runs diagonally across sternocleidomastoid muscle

External jugular vein

212

The isthmus of the thyroid lies just below this cartilage

Cricoid

213

Highest bone in neck; even with chin

Hyoid

214

What might precipitate cluster headaches?

ETOH & daytime napping

215

Symptom that is least likely to indicate malignancy

Tenderness

216

Providing resistance while patient shrugs shoulders tests cranial nerve _____

XI

217

Upon examination, the fontanels should feel

firm, slightly concave, well defined

218

If thyroid gland is enlarged bilaterally, which maneuver is appropriate?

Listen for bruit over thyroid lobes

219

Characteristics of normal palpable lymph nodes in neck

Mobile, soft, nontender

220

Cephalhematoma is associated with this

Subperiosteal hemorrhage

221

What size are normal cervical lymph nodes?

< 1cm

222

This is usually linked to throbbing, unilateral pain with N/V, & photophobia

Migraine headache

223

Unilateral paralysis of half the face

Bell's Palsy

224

If you suspect an infant's head to be of abnormal size, what tool should you use to make sure?

Measuring tape

225

Most common site of nosebleeds

Kiesselbach plexus

226

What is the largest salivary gland, and where is it located?

Parotid gland - in cheeks in front of ear

227

A 70-year-old woman c/o dry mouth (xerostomia). The most frequent cause is

R/t medications she may be taking (side effect)

228

What's the best action to take if a deviated septum is noted upon assessment?

Document in record in event person needs to be suctioned

229

If tonsils were recorded at 3+, they would be

Touching the uvula

230

The opening of the adult's parotid gland (Stensen's duct) is opposite what?

Upper 2nd molar

231

What are 3 ways a nasal polyp may be distinguished from turbinates?

Polyp is...

-movable
-pale gray
-nontender

232

You notice small, round, white shiny papules on the hard palate & gums of a 2-month-old. What's the significance of this finding?

Normal - called Epstein pearls

233

When assessing the tongue, the examiner should

Palpate the U-shaped area under the tongue

234

Open space between the eyelids

Palpebral fissure

235

Corneal reflex mediated by these cranial nerves

V & VII

236

Retinal structures viewed through ophthalmoscope

Optic disc
Retinal vessels
Background
Macula

237

The thickening/yellowing of the lens, as a normal change in aging, is referred to as

Senile cataract

238

What is the cover test (eye) used to assess for?

Muscle weakness

239

When using ophthalmoscope with glasses, how would you approach left eye of patient?

Remove glasses and approach patient's left eye with your left eye

240

The six muscles that control eye movement are innervated by what cranial nerves?

III, IV, VI

241

CN that moves eye laterally outward (i.e. left eye moves to 3 o'clock position, or right eye to 9 o'clock position)

VI

242

CN that moves eye laterally inward and down (i.e. left eye moves to 7 o'clock position or right eye to 5 o'clock position)

IV

243

Besides eye movements to the 3/9 o'clock positions (CN VI) or 5/7 o'clock positions (IV), all other cardinal directions are controlled by what CN?

III

244

A patient has blurred peripheral vision. You suspect glaucoma, and test the visual fields. A person with normal vision would see your finger temporally at

90 degrees

245

Will you get bilateral pupillary constriction in a person who is blind in one eye?

Yes

246

When using the ophthalmoscope, an interruption of the red reflex occurs when

There's an opacity in the cornea or lens

247

What causes the red reflex?

Light reflecting from retina

248

Color of normal TM

Pearly gray

249

Type of hearing loss associated with gradual nerve degeneration

Sensorineural hearing loss

250

Parts of ear you should palpate before using otoscope

-Pinna
-Tragus
-Mastoid process

251

During an otoscopic exam of a child <3 yrs, how do you position the ear for visualization?

Pull pinna down

252

While viewing with an otoscope, you ask the person to hold their nose & swallow. You expect to see the eardrum do what during this maneuver?

Flutter

253

How do you pull ear to perform otoscopic exam on an adult?

Up & back

254

Congenital, painless nodule at the helix

Darwin's tubercle

255

How should patient's head be positioned when using an otoscope?

Tilted away from examiner

256

Location of hearing receptors

Cochlea

257

The sensation of vertigo is the result of what?

Pathology in the semicircular canals

258

Common cause of conductive hearing loss

Impacted cerumen

259

With acute purulent otitis media, how would the TM look?

Absent light reflex
Reddened/bulging drum

260

If the TM appears yellow in color, what do you suspect is in the middle ear?

Serum

261

If a person with a head injury has clear, watery drainage coming from the ear, what should you do?

Check drainage for glucose

262

At what phase during nociception does the patient become aware of a painful sensation?

Perception

263

A description of a burning, painful sensation that moves around toes & bottom of feet would be symptoms indicative of what type of pain?

Neuropathic

264

While examining your patient, he becomes pale & diaphoretic & c/o LUQ pain. This would be categorized as what type of pain?

Visceral pain

265

What difference is present with preterm infants r/t pain perception/tolerance?

More sensitive to painful stimuli

266

Most reliable indicator of pain in the adult

Patient's self-report

267

Best tool to assess pain of a 4-year-old with a broken arm

Wong-Baker scale

268

When a person presents with acute ABD pain, and after the initial examination, is it best to withhold pain meds until DX testing is complete & a diagnosis is made?

No!

269

Poorly controlled pain in geriatric post-op patients places them at greater risk for

Atelectasis
Increased myocardial O2 demand
Impaired wound healing

270

A 30-year-old female reports having persistent intense pain in her right arm r/t MVA x5 months ago. The slightest touch or clothing can exacerbate the pain. This is suggestive of

Complex Regional Pain I

271

Appropriate pain assessment tool for preterm & term neonates

CRIES

272

A pain problem should be anticipated in a cognitively impaired older adult with a HX of this type of vascular insufficiency

Peripheral vascular disease

273

Is pain in the aging adult considered to be part of the aging process?

No

274

Common physiologic change accompanying pain

Tachycardia

275

Function of venous system r/t increased blood volume

Blood & volume reservoir

276

Organs that aid the lymphatic system

Spleen
Tonsils
Thymus

277

Ms. T. has come for a prenatal visit. She c/o dependent edema, varicosities in the legs, & hemorrhoids. The best response to her is...

Normal pregnancy S/S caused by pressure of growing uterus on veins

278

A 3+ pulse would be described as

Increased, full

279

Inspection of a person's right hand reveals a red, swollen area. To further assess for infection, you would palpate what?

Epitrochlear node (elbow)

280

To screen for DVT, you would

Measure widest point with tape measure

281

When assessing for arterial deficit, a normal color return in the lower extremities after raising them would be?

10 seconds or less

282

Most characteristic sign of varicose veins

Dilated, tortuous superficial bluish vessels

283

Atrophic skin changes that occur with peripheral arterial insufficiency include

Thin, shiny skin with loss of hair

284

Muscular pain brought on by exercise

Intermittent claudication

285

Known risk factor for venous ulcer development

Obesity

286

A change typical of chronic venous insufficiency; term refers to non-pitting edema

Brawny edema

287

Loss of elasticity of the walls of blood vessels

Arteriosclerosis

288

Occurs in hands & feet r/t exposure to cold, vibration, & stress

Raynaud's phenomenon

289

Be familiar with inner structures of eye - except for scleral venous sinus & choroid (see opposite side for picture)

card image
290

Be familiar with outer structures of eye (see opposite side for picture)

card image
291

Nearsightedness

Myopia

292

Farsightedness

Hyperopia

293

Farsightedness due to age; gradual loss of your eyes' ability to focus on nearby objects. It's a natural, often annoying part of aging; usually becomes noticeable in your early to mid-40s and continues to worsen until around age 65.

Presbyopia

294

To test color vision, what 2 tests could you use?

Snellen (ID colors on chart)
Ishihara chart (dots/numbers)

295

Gross measure of peripheral vision; compares person's vision with your own

Confrontation Test

296

Leading cause of blindness; increased IOP; damage to optic nerve (CN II)

Glaucoma

297

2 methods used to assess cardinal fields of gaze

Spokes or H

298

When assessing for nystagmus, what should you do as you move your tool outward (as patient is following it with their eyes)?

Pause at lateral aspect and watch for fast, uncontrollable movements

299

Occurs w/disease of semicircular canals (ears), paretic eye muscle, multiple sclerosis, or brain lesions

Nystagmus

300

This test involves shining light at patient's eyes (midline), approx. 2 feet in front, while looking for a reflection of the light in the medial aspect of the bilateral pupils - reflection should be equal and towards nasal aspect

Corneal light reflex

301

Inward turning of the eye (strabismus)

Esotropia

302

Outward turning of the eyes (strabismus)

Exotropia

303

A finding of asymmetrical corneal light reflex, such as the light being reflected at 12 in the R eye but 3 in the L eye, is indicative of this

Strabismus (esotropia or exotropia)

304

Detects muscle weakness of the eyes

Cover-Uncover Test

305

If a patient has a stronger left eye and it is covered during the Cover-Uncover Test, what do you expect the right eye to do?

Drift toward left eye

306

Normal size of pupils in adults

3-5mm

307

PERLLA - Shining the light __1__ times per eye tests both the __2__ and __3__ reflexes

1. 2
2. Direct
3. Consensual

308

Accommodation occurs when the pupils _____ & _____

Constrict & converge

309

Type of reflex tested by Corneal Light Reflex

Motor reflex

310

Type of reflex tested by Confrontation Test

Sensory

311

Type of reflex tested by near/distant vision & color vision tests

Sensory

312

Type of reflex tested by Corneal Reflex

Mixed Sensory/Motor (CN V sensation of cornea; CN VII motor response)

313

What common thing could blunt the response to the corneal reflex?

Contact lenses

314

Nearsighted individuals have difficulty seeing things at this distance

Far away things

315

Farsighted individuals have difficulty seeing things at this distance

Up close things

316

Distance vision of this measure in a preschooler can be a cause for referral

20/50

317

How long does it take for a newborn to be able to focus?

About 2 weeks

318

Newborns can only focus on objects 8-10 inches away until what age?

3 months

319

What eye changes can occur during pregnancy?

Vision changes
Thickened cornea
Visual acuity (r/t hormones)

320

A white, grey, or blue opaque ring in the corneal margin r/t lipid deposition; no effect on vision

Arcus senilis

321

Leading cause of blindness; happens around 75-85 years of age

Macular degeneration

322

Know where the following external ear structures are located:

Helix, antihelix, lobule, mastoid process, tragus, external auditory meatus

card image

Mastoid process is behind ear on temporal bone

323

What does mastoid tenderness possibly indicate?

Middle ear infection

324

The cone of light is at __1__ in the right ear and __2__ in the left ear

1. 5 o'clock
2. 7 o'clock

325

Age-related hearing loss

Presbycusis

326

Drain fluid to prevent TM perforation

Tympanostomy tubes

327

If a boil (furuncle) forms on the cartilaginous part of the ear (most common), and occludes the meatus due to inflammation, what lymph node/s would become palpable & tender?

Preauricular

328

General hearing screening involving the use of 3 random letters and/or numbers, spoken lightly and at least 2 feet behind patient; patient occludes & rubs external auditory meatus of non-tested ear

Whisper Test

329

How does the examiner adequately prepare to whisper for the Whisper Test (hearing test)?

Full breath - exhale - whisper

330

Hearing loss r/t external or middle ear; caused by obstruction, impacted cerumen, or fluid in middle ear

Conductive hearing loss

331

What would the formation of spongy bone in the ears cause?

Deafness (particularly low tones)

Results in ankylosis (immobility) of the stapes

332

Hearing loss r/t deterioration of cochlea (organ of Corti) or damage to CN VIII

Sensorineural hearing loss

333

What can damage the cochlea (organ of Corti)?

Noise trauma
Ototoxicity

334

What is the sensory structure/organ of the inner ear?

Organ of Corti

335

8 symptom (pain) dimensions

PQRSTU + associated factors & setting

336

Nervous system transmission of the pain signal

Nociception

337

4 parts of nociceptive response, from beginning

1. Transduction (from injury site to spine)
2. Transmission (spine to brain)
3. Perception (conscious recognition)
4. Modulation (descending influence on pain signal)

338

Pain causes nervous system to become more efficient at transmitting pain; learns to relay pain impulse better

Wind-up

339

State of severe distress associated with events that threaten the intactness of the person

Suffering

340

Type of pain considered dull, aching, well-localized, nocturnal

Somatic (nociceptive) pain

341

Type of pain considered deep squeezing pressure, local tenderness & referred, poorly localized

Visceral (nociceptive) pain

342

Type of pain considered burning, stabbing, vice-like, electric shock-like, etc.

Neuropathic pain

343

Type of pain associated with post-op, bone metastases, arthritis, sports injury, or mechanical back pain

Somatic (nociceptive) pain

344

Type of pain associated with liver metastases, pancreatic cancer

Visceral (nociceptive) pain

345

Type of pain associated with stroke, herpes zoster, trigeminal neuralgia, complex regional pain syndrome

Neuropathic pain

346

Excessive sensitivity to pain

Hyperalgesia

347

Non-painful stimulus causes pain

Allodynia

348

Maximum pain that a person can endure

Pain tolerance

349

Medication approach for the different types of pain: acute, chronic, neuropathic, and cancer

Acute: NSAIDs, Opioids
Chronic: Tylenol (1st line), start w/non-opioid, then long-acting opioid
Neuropathic: Opioids don't work well (except methadone), use antidepressants, anticonvulsants
Cancer: If terminal, high dose opioids

350

What's the first line medication for chronic pain?

Acetaminophen

351

Looks like addiction, but patient wants medication because they are really in pain

Pseudoaddiction

352

Your patient’s right calf is cool, and the popliteal pulse is a weak 1+. There is no swelling. The patient reports calf pain upon walking. You find an ulcer on the outside of the ankle. Based on these findings, which of the following characteristics would be expected of this ulcer?
a. Irregular edges
b. Oozing, wet appearance
c. Edema in the calf
d. Round appearance

D - round appearance

353

While assessing an 80 year-old patient you notice some signs of dental caries. This finding is most likely related to what age-related physiological change?

a. Increased bruxism (teeth gnashing)
b. Shift from nasal breathing to mouth breathing
c. Decreased salivation
d. None of the above

C - decreased salivation

354

The nurse is testing a patient’s visual accommodation, which refers to which action?

a. Pupillary constriction when looking at a near object
b. Pupillary dilation when looking at a far object
c. Changes in peripheral vision in response to light
d. Involuntary blinking in the presence of bright light

A

355

To assess the function of the optic nerve (CN II) which equipment would be used?

a. Finger, to test the cardinal fields
b. Flashlight, to test corneal light reflexes
c. Snellen chart, to test visual acuity
d. Piece of cotton, to test corneal sensitivity

C - visual acuity & snellenhis

356

This happens late in diastole - just before S1; almost always a pathological issue

S4 - "Tennessee" gallop

Goes S4,S1...(normal pause)...S2

357

This happens early in diastole - just after S2; can be benign or normal, or it can be pathological

S3 - "Kentucky" gallop

Goes S1...(normal pause)...S2,S3

358

These types of murmurs are always pathological

Diastolic murmurs

359

These types of murmurs may or may not be of a pathological significance

Systolic murmurs