Health Assessment Final Exam (Study Guide Questions
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Invbassessingvbavbclientvbforvbkidneyvbtenderness,vbwherevbwouldvbyouvbbegin?
vb-vbcorrectvbanswer✔ ✔ Costovetebral
Avbnursevbworkingvbinvbavbhospitalvbincludesvbabdominalvbassessmentvbasvbpar
tvbofvbpatientvbassessment.vbInvbwhichvbpatientsvbwouldvbavbnursevbexpectvbtovbf
indvbdecreasedvborvbabsentvbbowelvbsoundsvbaftervblisteningvbforvb5vbminutes?vb
-vbcorrectvbanswer✔ ✔
Avbpatientvbdiagnosedvbwithvbperitonitis.vbAvbpatientvbwhovbisvbonvbprolonge
dvbbedrest.vbAvbpatientvbwhovbhasvbparalyticvbileusvbcausedvbbyvbsurgery.
Thevbnursevbisvbassessingvbthevbabdomenvbofvbavbpatientvbwhovbisvbexperiencin
gvbfrequentvbboutsvbofvbdiarrhea.vbThevbnursevbfirstvbobservesvbthevbcontourvbof
vbthevbabdomen,vbnotingvbanyvbmasses,vbscars,vborvbareasvbofvbdistention.vbWha
tvbactionvbwouldvbthevbnursevbperformvbnext?vb-vbcorrectvbanswer✔ ✔
InspectvbandvbAuscultatevbthevbabdomenvbusingvbanvborderlyvbclockwisevbap
proachvbinvballvbabdominalvbquadrants.
Ifvbthevbclientsvbumbilicusvbisvbenlargedvbandvbtovbthevbleft,vbwhatvbisvbthisvbindi
cativevbof?vb-vbcorrectvbanswer✔ ✔ Umbilicalvbhernia
Whatvbquadrantvbisvbthevbpancreasvblocated?vb-vbcorrectvbanswer✔ ✔
LLQ,vbDeepvbinvbuppervbabdomenvbandvbcannotvbbevbpalpated.
,Whatvbquadrantvbisvbthevbsigmoidvbcolonvblocated?vb-vbcorrectvbanswer✔ ✔
Leftvblowervbquadrant
Whatvbquadrantvbdoesvbthevbcolonvboriginate?vb-vbcorrectvbanswer✔ ✔
Rightvblowervbquadrant
Wherevbwouldvbyouvbpalpatevbthevbadultsvbappendix?vb-vbcorrectvbanswer✔
✔ RightvbLowervbQuadrantvb(RLQ)
Whatvbdovbyouvbobservevbwhenvbassessingvbavbclientsvbgait?vb-
vbcorrectvbanswer✔ ✔
thevbpersonvbrisesvbfromvbavbchair,vbwalksvb10vbfeet,vbturns,vbwalksvbbackvbtovb
thevbchair,vbandvbsitsvbdown.vbFactorsvbtovbnotevbarevbsittingvbbalance,vbtransfer
ringvbfromvbsittingvbtovbstandingvb(e.g.,vbdoesvbthevbpersonvbneedvbtovbpushvboffv
bthevbarmrestvbtovbrise),vbpacevbandvbstabilityvbofvbwalking,vbabilityvbtovbturnvbwi
thoutvbstaggering,vbandvbsittingvbbackvbdownvbinvbthevbchair.
Thevbsequencevbofvbtechniquesvbusedvbduringvbanvbexaminationvbofvbthevbabdo
menvbare?vb-vbcorrectvbanswer✔ ✔
Inspect,vbauscultate,vbpercussion,vbpalpate.
Describevbhyperactivevbbowelvbsounds...vb-vbcorrectvbanswer✔ ✔
Highvbpitched
, Auscultationvbthevbabdomenvbisvbbegunvbinvbthevbrightvblowervbquadrantvb(RL
Q)vbbecause?vb-vbcorrectvbanswer✔ ✔
Bowelvbsoundsvbarevbalwaysvbnormalyvbpresentvbhere.
Bruitvb-vbcorrectvbanswer✔ ✔
Blowingvbandvbswishing;vbAbnormalvbsoundvbheardvbthroughvbavbstethosco
pe.
Mastitisvb-vbcorrectvbanswer✔ ✔ Inflammationvbofvbthevbbreast.
Ligamentsvb-vbcorrectvbanswer✔ ✔ -
avbshortvbbandvbofvbtough,vbflexible,vbfibrousvbconnectivevbtissuevbthatvbconnec
tsvbtwovbbonesvborvbcartilagesvborvbholdsvbtogethervbavbjoint.
-avbmembranousvbfoldvbthatvbsupportsvbanvborganvbandvbkeepsvbitvbinvbposition.
Atrophicvbvaginitisvb-vbcorrectvbanswer✔ ✔
S:vbPostmenopausalvbvaginalvbitching,vbdryness,vbburningvbsensation,vbdys
pareunia,vbmucoidvbdischargevb(mayvbbevbfleckedvbwithvbblood),vbpostcoitalvb
bleeding.vbSymptomsvboccurvbgraduallyvbduevbtovbthinningvbofvbepithelialvblay
ers.
O:vbPale,vbdryvbmucosavbwithvbabradedvbareasvbthatvbbleedvbeasily,vbdecreasedv
brugae;vbmayvbhavevbbloodyvbdischarge.vbDecreasevbinvbusualvbshinyvbvaginalvb
secretions.vbVaginavbmayvbbevbshortenedvbandvbnarrowed;vbcervixvbmayvbbevbl
vb vb vb vb vb vb
)
Invbassessingvbavbclientvbforvbkidneyvbtenderness,vbwherevbwouldvbyouvbbegin?
vb-vbcorrectvbanswer✔ ✔ Costovetebral
Avbnursevbworkingvbinvbavbhospitalvbincludesvbabdominalvbassessmentvbasvbpar
tvbofvbpatientvbassessment.vbInvbwhichvbpatientsvbwouldvbavbnursevbexpectvbtovbf
indvbdecreasedvborvbabsentvbbowelvbsoundsvbaftervblisteningvbforvb5vbminutes?vb
-vbcorrectvbanswer✔ ✔
Avbpatientvbdiagnosedvbwithvbperitonitis.vbAvbpatientvbwhovbisvbonvbprolonge
dvbbedrest.vbAvbpatientvbwhovbhasvbparalyticvbileusvbcausedvbbyvbsurgery.
Thevbnursevbisvbassessingvbthevbabdomenvbofvbavbpatientvbwhovbisvbexperiencin
gvbfrequentvbboutsvbofvbdiarrhea.vbThevbnursevbfirstvbobservesvbthevbcontourvbof
vbthevbabdomen,vbnotingvbanyvbmasses,vbscars,vborvbareasvbofvbdistention.vbWha
tvbactionvbwouldvbthevbnursevbperformvbnext?vb-vbcorrectvbanswer✔ ✔
InspectvbandvbAuscultatevbthevbabdomenvbusingvbanvborderlyvbclockwisevbap
proachvbinvballvbabdominalvbquadrants.
Ifvbthevbclientsvbumbilicusvbisvbenlargedvbandvbtovbthevbleft,vbwhatvbisvbthisvbindi
cativevbof?vb-vbcorrectvbanswer✔ ✔ Umbilicalvbhernia
Whatvbquadrantvbisvbthevbpancreasvblocated?vb-vbcorrectvbanswer✔ ✔
LLQ,vbDeepvbinvbuppervbabdomenvbandvbcannotvbbevbpalpated.
,Whatvbquadrantvbisvbthevbsigmoidvbcolonvblocated?vb-vbcorrectvbanswer✔ ✔
Leftvblowervbquadrant
Whatvbquadrantvbdoesvbthevbcolonvboriginate?vb-vbcorrectvbanswer✔ ✔
Rightvblowervbquadrant
Wherevbwouldvbyouvbpalpatevbthevbadultsvbappendix?vb-vbcorrectvbanswer✔
✔ RightvbLowervbQuadrantvb(RLQ)
Whatvbdovbyouvbobservevbwhenvbassessingvbavbclientsvbgait?vb-
vbcorrectvbanswer✔ ✔
thevbpersonvbrisesvbfromvbavbchair,vbwalksvb10vbfeet,vbturns,vbwalksvbbackvbtovb
thevbchair,vbandvbsitsvbdown.vbFactorsvbtovbnotevbarevbsittingvbbalance,vbtransfer
ringvbfromvbsittingvbtovbstandingvb(e.g.,vbdoesvbthevbpersonvbneedvbtovbpushvboffv
bthevbarmrestvbtovbrise),vbpacevbandvbstabilityvbofvbwalking,vbabilityvbtovbturnvbwi
thoutvbstaggering,vbandvbsittingvbbackvbdownvbinvbthevbchair.
Thevbsequencevbofvbtechniquesvbusedvbduringvbanvbexaminationvbofvbthevbabdo
menvbare?vb-vbcorrectvbanswer✔ ✔
Inspect,vbauscultate,vbpercussion,vbpalpate.
Describevbhyperactivevbbowelvbsounds...vb-vbcorrectvbanswer✔ ✔
Highvbpitched
, Auscultationvbthevbabdomenvbisvbbegunvbinvbthevbrightvblowervbquadrantvb(RL
Q)vbbecause?vb-vbcorrectvbanswer✔ ✔
Bowelvbsoundsvbarevbalwaysvbnormalyvbpresentvbhere.
Bruitvb-vbcorrectvbanswer✔ ✔
Blowingvbandvbswishing;vbAbnormalvbsoundvbheardvbthroughvbavbstethosco
pe.
Mastitisvb-vbcorrectvbanswer✔ ✔ Inflammationvbofvbthevbbreast.
Ligamentsvb-vbcorrectvbanswer✔ ✔ -
avbshortvbbandvbofvbtough,vbflexible,vbfibrousvbconnectivevbtissuevbthatvbconnec
tsvbtwovbbonesvborvbcartilagesvborvbholdsvbtogethervbavbjoint.
-avbmembranousvbfoldvbthatvbsupportsvbanvborganvbandvbkeepsvbitvbinvbposition.
Atrophicvbvaginitisvb-vbcorrectvbanswer✔ ✔
S:vbPostmenopausalvbvaginalvbitching,vbdryness,vbburningvbsensation,vbdys
pareunia,vbmucoidvbdischargevb(mayvbbevbfleckedvbwithvbblood),vbpostcoitalvb
bleeding.vbSymptomsvboccurvbgraduallyvbduevbtovbthinningvbofvbepithelialvblay
ers.
O:vbPale,vbdryvbmucosavbwithvbabradedvbareasvbthatvbbleedvbeasily,vbdecreasedv
brugae;vbmayvbhavevbbloodyvbdischarge.vbDecreasevbinvbusualvbshinyvbvaginalvb
secretions.vbVaginavbmayvbbevbshortenedvbandvbnarrowed;vbcervixvbmayvbbevbl
