HEALTH ASSESSMENT FINAL EXAM
(STUDY GUIDE QUESTIONS)
Inooassessingooaooclientooforookidneyootenderness,oowhereoowouldooyouoobegin?oo-ooans--
Costovetebral
Aoonurseooworkingooinooaoohospitalooincludesooabdominalooassessmentooasoopartooofoopat
ientooassessment.ooInoowhichoopatientsoowouldooaoonurseooexpectootooofindoodecreasedoo
orooabsentooboweloosoundsooafteroolisteningooforoo5oominutes?oo-ooans--
Aoopatientoodiagnosedoowithooperitonitis.ooAoopatientoowhoooisooonooprolongedoobedrest.oo
Aoopatientoowhooohasooparalyticooileusoocausedoobyoosurgery.
Theoonurseooisooassessingootheooabdomenooofooaoopatientoowhoooisooexperiencingoofrequ
entooboutsooofoodiarrhea.ooTheoonurseoofirstooobservesootheoocontourooofootheooabdomen,
oonotingooanyoomasses,ooscars,ooorooareasooofoodistention.ooWhatooactionoowouldootheoon
urseooperformoonext?oo-ooans--
InspectooandooAuscultateootheooabdomenoousingooanooorderlyooclockwiseooapproachooino
oallooabdominalooquadrants.
Ifootheooclientsooumbilicusooisooenlargedooandootoootheooleft,oowhatooisoothisooindicativeooof
?oo-ooans--Umbilicaloohernia
Whatooquadrantooisootheoopancreasoolocated?oo-ooans--
LLQ,ooDeepooinooupperooabdomenooandoocannotoobeoopalpated.
Whatooquadrantooisootheoosigmoidoocolonoolocated?oo-ooans--Leftoolowerooquadrant
Whatooquadrantoodoesootheoocolonoooriginate?oo-ooans--Rightoolowerooquadrant
Whereoowouldooyouoopalpateootheooadultsooappendix?oo-ooans--
RightooLowerooQuadrantoo(RLQ)
Whatoodoooyouooobserveoowhenooassessingooaooclientsoogait?oo-ooans--
theoopersonoorisesoofromooaoochair,oowalksoo10oofeet,ooturns,oowalksoobackootoootheoochai
r,ooandoositsoodown.ooFactorsootooonoteooareoosittingoobalance,ootransferringoofromoositting
ootooostandingoo(e.g.,oodoesootheoopersonooneedootooopushoooffootheooarmrestootooorise),oo
paceooandoostabilityooofoowalking,ooabilityootoooturnoowithoutoostaggering,ooandoosittingoob
ackoodownooinootheoochair.
, Theoosequenceooofootechniquesoousedooduringooanooexaminationooofootheooabdomenooar
e?oo-ooans--Inspect,ooauscultate,oopercussion,oopalpate.
Describeoohyperactiveooboweloosounds...oo-ooans--Highoopitched
Auscultationootheooabdomenooisoobegunooinootheoorightoolowerooquadrantoo(RLQ)oobecau
se?oo-ooans--Boweloosoundsooareooalwaysoonormalyoopresentoohere.
Bruitoo-ooans--
Blowingooandooswishing;ooAbnormaloosoundooheardoothroughooaoostethoscope.
Mastitisoo-ooans--Inflammationooofootheoobreast.
Ligamentsoo-ooans---
aooshortoobandooofootough,ooflexible,oofibrousooconnectiveootissueoothatooconnectsootwooo
bonesoooroocartilagesooorooholdsootogetherooaoojoint.
-aoomembranousoofoldoothatoosupportsooanooorganooandookeepsooitooinooposition.
Atrophicoovaginitisoo-ooans--
S:ooPostmenopausaloovaginalooitching,oodryness,ooburningoosensation,oodyspareunia,oom
ucoidoodischargeoo(mayoobeoofleckedoowithooblood),oopostcoitaloobleeding.ooSymptomsoo
occuroograduallyoodueootooothinningooofooepithelialoolayers.
O:ooPale,oodryoomucosaoowithooabradedooareasoothatoobleedooeasily,oodecreasedoorugae;
oomayoohaveoobloodyoodischarge.ooDecreaseooinoousualooshinyoovaginaloosecretions.ooVa
ginaoomayoobeooshortenedooandoonarrowed;oocervixoomayoobeoolessooprotuberant.25ooEst
rogenoonormallyookeepsootissuesoothick,oomoist,oorugated,ooandooglycogenoorich;oosooolos
sooofooestrogenoocreatesoosignsooandooincreasesooriskooforootraumaooandooinfection.
Trichomoniasisoo-ooans--
S:ooPruritus,oowateryooandoooftenoomalodorousoovaginaloodischarge,oourinaryoofrequency,
ooterminaloodysuria,ooitching.ooSymptomsooareooworseooduringoomenstruationoowhenoothe
oopHooisoooptimalooforooorganism'soogrowth.
O:ooVulvaoomayoobeooerythematous.ooVaginaoodiffuselyoored;oogranular;oooccasionallyoow
ithoored,ooraisedoopapulesooandoopetechiaeoo("strawberry"ooappearance).ooFrothy,ooyello
w-green,oofoul-
smellingoodischarge.ooVaginaloopHoo>4.5.ooMicroscopicooexaminationooofoosalineoowetoo
mountoospecimenooshowsoocharacteristicooflagellatedoocells.
Syphilisoo-ooans---
Aoobacterialooinfectionoousuallyoospreadoobyoosexualoocontact.ooTheoodiseaseoostartsooaso
oaoopainlessoosoreoo—
ootypicallyooonooyouroogenitals,oorectumoooroomouth.ooItoospreadsoofromoopersonootooopers
onooviaooskinoooroomucousoomembraneoocontactoowithootheseoosores.
-
Afterootheooinitialooinfection,ootheoobacteriaoocanoolieoodormantooinooyouroobodyooforoodeca
desoobeforeoobecomingooactiveooagain.ooEarlyoostagesoocanoobeoocured,oosometimesoowi
(STUDY GUIDE QUESTIONS)
Inooassessingooaooclientooforookidneyootenderness,oowhereoowouldooyouoobegin?oo-ooans--
Costovetebral
Aoonurseooworkingooinooaoohospitalooincludesooabdominalooassessmentooasoopartooofoopat
ientooassessment.ooInoowhichoopatientsoowouldooaoonurseooexpectootooofindoodecreasedoo
orooabsentooboweloosoundsooafteroolisteningooforoo5oominutes?oo-ooans--
Aoopatientoodiagnosedoowithooperitonitis.ooAoopatientoowhoooisooonooprolongedoobedrest.oo
Aoopatientoowhooohasooparalyticooileusoocausedoobyoosurgery.
Theoonurseooisooassessingootheooabdomenooofooaoopatientoowhoooisooexperiencingoofrequ
entooboutsooofoodiarrhea.ooTheoonurseoofirstooobservesootheoocontourooofootheooabdomen,
oonotingooanyoomasses,ooscars,ooorooareasooofoodistention.ooWhatooactionoowouldootheoon
urseooperformoonext?oo-ooans--
InspectooandooAuscultateootheooabdomenoousingooanooorderlyooclockwiseooapproachooino
oallooabdominalooquadrants.
Ifootheooclientsooumbilicusooisooenlargedooandootoootheooleft,oowhatooisoothisooindicativeooof
?oo-ooans--Umbilicaloohernia
Whatooquadrantooisootheoopancreasoolocated?oo-ooans--
LLQ,ooDeepooinooupperooabdomenooandoocannotoobeoopalpated.
Whatooquadrantooisootheoosigmoidoocolonoolocated?oo-ooans--Leftoolowerooquadrant
Whatooquadrantoodoesootheoocolonoooriginate?oo-ooans--Rightoolowerooquadrant
Whereoowouldooyouoopalpateootheooadultsooappendix?oo-ooans--
RightooLowerooQuadrantoo(RLQ)
Whatoodoooyouooobserveoowhenooassessingooaooclientsoogait?oo-ooans--
theoopersonoorisesoofromooaoochair,oowalksoo10oofeet,ooturns,oowalksoobackootoootheoochai
r,ooandoositsoodown.ooFactorsootooonoteooareoosittingoobalance,ootransferringoofromoositting
ootooostandingoo(e.g.,oodoesootheoopersonooneedootooopushoooffootheooarmrestootooorise),oo
paceooandoostabilityooofoowalking,ooabilityootoooturnoowithoutoostaggering,ooandoosittingoob
ackoodownooinootheoochair.
, Theoosequenceooofootechniquesoousedooduringooanooexaminationooofootheooabdomenooar
e?oo-ooans--Inspect,ooauscultate,oopercussion,oopalpate.
Describeoohyperactiveooboweloosounds...oo-ooans--Highoopitched
Auscultationootheooabdomenooisoobegunooinootheoorightoolowerooquadrantoo(RLQ)oobecau
se?oo-ooans--Boweloosoundsooareooalwaysoonormalyoopresentoohere.
Bruitoo-ooans--
Blowingooandooswishing;ooAbnormaloosoundooheardoothroughooaoostethoscope.
Mastitisoo-ooans--Inflammationooofootheoobreast.
Ligamentsoo-ooans---
aooshortoobandooofootough,ooflexible,oofibrousooconnectiveootissueoothatooconnectsootwooo
bonesoooroocartilagesooorooholdsootogetherooaoojoint.
-aoomembranousoofoldoothatoosupportsooanooorganooandookeepsooitooinooposition.
Atrophicoovaginitisoo-ooans--
S:ooPostmenopausaloovaginalooitching,oodryness,ooburningoosensation,oodyspareunia,oom
ucoidoodischargeoo(mayoobeoofleckedoowithooblood),oopostcoitaloobleeding.ooSymptomsoo
occuroograduallyoodueootooothinningooofooepithelialoolayers.
O:ooPale,oodryoomucosaoowithooabradedooareasoothatoobleedooeasily,oodecreasedoorugae;
oomayoohaveoobloodyoodischarge.ooDecreaseooinoousualooshinyoovaginaloosecretions.ooVa
ginaoomayoobeooshortenedooandoonarrowed;oocervixoomayoobeoolessooprotuberant.25ooEst
rogenoonormallyookeepsootissuesoothick,oomoist,oorugated,ooandooglycogenoorich;oosooolos
sooofooestrogenoocreatesoosignsooandooincreasesooriskooforootraumaooandooinfection.
Trichomoniasisoo-ooans--
S:ooPruritus,oowateryooandoooftenoomalodorousoovaginaloodischarge,oourinaryoofrequency,
ooterminaloodysuria,ooitching.ooSymptomsooareooworseooduringoomenstruationoowhenoothe
oopHooisoooptimalooforooorganism'soogrowth.
O:ooVulvaoomayoobeooerythematous.ooVaginaoodiffuselyoored;oogranular;oooccasionallyoow
ithoored,ooraisedoopapulesooandoopetechiaeoo("strawberry"ooappearance).ooFrothy,ooyello
w-green,oofoul-
smellingoodischarge.ooVaginaloopHoo>4.5.ooMicroscopicooexaminationooofoosalineoowetoo
mountoospecimenooshowsoocharacteristicooflagellatedoocells.
Syphilisoo-ooans---
Aoobacterialooinfectionoousuallyoospreadoobyoosexualoocontact.ooTheoodiseaseoostartsooaso
oaoopainlessoosoreoo—
ootypicallyooonooyouroogenitals,oorectumoooroomouth.ooItoospreadsoofromoopersonootooopers
onooviaooskinoooroomucousoomembraneoocontactoowithootheseoosores.
-
Afterootheooinitialooinfection,ootheoobacteriaoocanoolieoodormantooinooyouroobodyooforoodeca
desoobeforeoobecomingooactiveooagain.ooEarlyoostagesoocanoobeoocured,oosometimesoowi