NRSG 5480 Final Exam | Complete Solutions (Verified)

NRSG 5480 Final Exam | Complete Solutions (Verified) Which question would be considered a "leading question"? ○ "What do you think is causing your headaches." ○ "You don't get headaches often, do you?" ○ "On a scale of 1 to 10 how would you rate the severity of your headaches?" ○ "At what time of the day are your headaches the most severe?" When you are questioning a patient regarding alcohol intake, she tells you that she is "only a social drinker." Which initial response is appropriate? ○ "I'm glad that you are a responsible drinker." ○ "Do the other people in your household consume alcohol?" ○ "What amount and what kind of alcohol do you drink in a week?" ○ "If you only drink socially, you won't need to worry about always having a designated driver." You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be: ○ given the opportunity to be interviewed without the parent at some point during the interview. ○ mailed a questionnaire in advance to avoid the need for them to talk. ○ ignored while you address all the questions to the parent. ○ allowed to direct the flow of the interview. A brief statement of the reason the patient is seeking health care is called the: ○ medical history. ○ chief complaint. ○ assessment. ○ diagnosis. Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the: ○ chief complaint. ○ past medical history. ○ personal and social history. ○ review of systems. When you enter the examination room of a 3-year-old girl, you find her sitting on her father's lap. She turns away from you when you greet her. Initially, your best response is to: ○ leave the child sitting in the father's lap while you talk with the father. ○ ask the child to be seated on the examination table so that you can talk to her father. ○ explain to the child that you will not hurt her and that she will have to trust you. ○ ask the father to persuade the child to cooperate with you. When you suspect that your 81-year-old patient has short-term memory loss because he cannot remember what he had for breakfast, you should first: ○ order a neurology consult. ○ stop all of his medications. ○ validate the concern with his family or caregivers. ○ dismiss the findings as normal age-related change. A comprehensive exam includes all the elements of the health history and the complete physical examination. True OR False TRUE A comprehensive exam will include all aspects of the history and physical exam. A focused exam is one that addresses problems that are specific to urgent care concerns. Subjective information is...? ○ What the patient tells you. ○ All physical exam findings. ○ Laboratory findings. ○ Diagnostic test results. The components of the comprehensive health history include which of the following? Mark all that apply. ○ Review of systems ○ Chief complaints(s) ○ Present illness ○ Past History The last part of the history would be to: ○ Review with the patient questions about each body system ○ Complete the 24 hour diet recall ○ Add up the 24 hour calories for the patient ○ Tell them what their diagnosis is Feed Back: This is called a Review of systems and is subjective information about each system. A patient presents with the following complaint: "Since last week I have not feel right; now I have a headache and fell like I might throw up." Which of the following is the most appropriate documentation of the chief complaint? ○ Flu-like illness ○ GI distress ○ Nausea, Headache, not "feeling right" x 1 week ○ Nausea, headache Feedback: The chief complaint needs to be as specific as possible and include onset and duration. Several questions that would be important to ask during the Review of Systems for respiratory disorders would be: ○ Hobbies, Exercise Tolerance, Immunizations ○ Employment, Home Environment ○ Cough, sputum production, SOB ○ Nutritional status, Travel Feedback: The review of systems is subjective information about a specific body system and not about lifestyle, hobbies, or family history. Eliciting in chronological order the state of health before onset of present problem would be the: ○ Family history ○ Past medical history ○ Genetic background of client ○ The physical exam Feedback: The past medical history is what the patient provides about their health up to the current visit. Inspection should always be the last part of the physical exam. True OR False FALSE Inspection is the first part of the physical exam. Hyperressonance will be heard when percussing the lungs fields of a patient with emphysema. True OR False TRUE This occurs because of the trapped air in the patients lungs. During auscultation, the diaphragm is used to hear high pitched sounds. True OR False TRUE Diaphragm for high-pitched sounds. Bell for low-pitched sounds. Select the subjective information that you might obtain from review of system questions for the cardiovascular system. ○ Regular rate and rhythm ○ Denies chest pain ○ No lifts, heaves or thrills ○ Pulse rate 80 This is subjective information from the patient. Which assessment technique is used during both the history taking and the physical examination process? ○ Palpation ○ Inspection ○ Auscultation ○ Percussion Inspection is used at the beginning of the patient encounter to formulate the "general impression" of the patient. When interviewing older adults, the examiner should: ○ dim the lights to decrease anxiety. ○ provide a written questionnaire in place of an interview. ○ speak extremely loud, as most elders have significant hearing impairment. ○ position him/herself face-to-face with the patient. This will assist with making sure the patient can understand you if there are alterations in hearing ability or sight. To perform the Rinne test, place the tuning fork on the: ○ mastoid bone. ○ forehead. ○ preauricular area. ○ occiput. Feedback: The fork is initially placed against the mastoid bone for the Rinne test, a test for sensorineural loss. You observe pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for: ○ confrontation reaction. ○ accommodation. ○ pupillary light reflex. ○ nystagmus. Feedback: Testing for accommodation involves asking the patient to look at an object at a distance (pupils dilate) and then looking at another much closer (pupils constrict). The other choices do not test for accommodation. Hearing tends to deteriorate after 50 years of age because of: ○ degeneration of the hair cells of the organ of Corti. ○ increased pliability of the tympanic membrane. ○ more serous cerumen. ○ proliferation of the stria vascularis. Feedback: Hearing declines after 50 years of age due to degeneration of hair cells in the organ of Corti as well as atrophy of the hair cells in the cochlea. Normal tympanic membrane color is: ○ amber. ○ chalky white. ○ pearly gray. ○ red. A stethoscope is used in a head and neck examination to assess: ○ intracranial fluid. ○ pulsating fontanels. ○ skull bone development. ○ thyroid vascular sounds. Feedback: The skull is not routinely auscultated, the neck is auscultated using the bell of the stethoscope at the thyroid gland to screen for states of hypermetabolism that have increased with blood supply and produce bruits. The thyroid gland should: ○ be slightly left of midline. ○ have a clear vascular sound. ○ feel nodular. ○ move when the patient swallows. Feedback: It is a normal finding for the thyroid gland to move with swallowing; however, being off center may indicate nodular growth or enlargement. Vascular sounds indicate hypermetabolic states such as hyperthyroidism, and a tug with each heartbeat is a sign of an aortic aneurysm. The consistency of the thyroid should be firm but pliable, not nodular. Mr. C.'s visual acuity is 20/50. This means that he: ○ can see 50% of what the average person sees at 20 feet. ○ has perfect vision when tested at 50 feet. ○ can read letters while standing 20 feet from the chart that the average person could read at 50 feet. ○ can see 20% of the letters on the chart's 20/50 line. Feedback: Visual acuity is measured as a fraction in which the top number is the distance the patient is standing from the chart and the bottom number is the distance that an average person can stand and still read the line. Vision not correctable to better than 20/200 is considered legal blindness. The Rosenbaum card is used to measure: ○ distance perception. ○ near vision. ○ the ability to identify colors. ○ extraocular movements. Feedback: The Rosenbaum card is best used to measure nearsightedness because the patient holds the card a comfortable distance and reads from the card. Distance perception cannot be accurately measured with a card held close. Peripheral vision and extraocular movements are assessed by an examiner by hand movements, and color identification can be measured with color cards. Measurement of near vision should be tested: ○ in each eye separately. ○ with the head at a 45-degree angle. ○ with the confrontation test ○ with the use of primary colors. Feedback: Near vision is measured by the Rosenbaum card and should be tested in each eye separately holding the card in front at about 35 cm. Color identification is not measured by this test, and the Snellen chart tests visual acuity at 20 feet. The confrontation test is an imprecise way of testing peripheral vision. When there is an imbalance found with the corneal light test, you should then perform the _____ test. ○ confrontation ○ accommodation ○ cover-uncover ○ pupillary light reflex Feedback: If the corneal light reflex demonstrates an imbalance, the next test to perform is the cover-uncover test. The confrontation test measures peripheral vision, the pupillary light reflex and the accommodation test assesses pupillary reaction to light, and the visual acuity test measures vision, all of which will not help to further assess eye muscle imbalance. A 29-year-old white woman appears jaundiced. An etiology of liver disease has been excluded. What history questions should the nurse ask? ○ Whether she had unprotected sex. ○ Whether she has a history of diabetes melitus. ○ Whether she had unusual bleeding problems. ○ Whether she eats a lot of yellow and orange vegetables. What is jaundice? A jaundiced child has yellowish skin and sclera (the white part of the eyes). The most common cause of jaundice is hepatitis (a viral infection of the liver). What is carotenemia? Carotenemia is a harmless condition in which the skin turns a yellowish color from eating lots of certain foods. Unlike jaundice, the whites of the eyes remain white. This happens most often between 6 and 18 months of age. Your child's skin turns a yellow-orange color because of the pigment (carotene) found in yellow vegetables (squash, carrots, sweet potatoes), as well as some fruits (such as oranges, apricots, and peaches). Carotene is also found in green vegetables (for example green beans and peas). Breastfed babies can also develop carotenemia if their mother eats a lot of foods that are high in carotene. You do not need to have your child stop eating these foods unless you want to change your child's skin tone. After a return to a more normal diet, the carotenemia color will disappear in 3 or 4 weeks. Even without dietary change, the skin color will gradually return to normal by 2 or 3 years of age. A flat, nonpalpable lesion is described as a macule if the diameter is: ○ greater than 1 cm. ○ less than 1 cm. ○ 3 cm exactly. ○ too irregular to measure. Feedback: Macule: A flat, small (1 centimeter or less) lesion with color change. Seen in rubeola, rubella, scarlet fever, roseola infantum. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 3-cm, rough, elevated area of psoriasis. This is an example of a: ○ plaque. ○ patch. ○ macule. ○ papule. Feedback: PLAQUE. A plaque is a solid, raised, flat-topped lesion greater than 1 cm. in diameter. Painful vesicles are associated with: ○ psoriasis. ○ pityriasis rosea. ○ paronychia. ○ herpes zoster Which of the following is an "ABCD" characteristic of malignant melanoma? ○ Irregular borders ○ Borders well demarcated. ○ Color of lesion is uniform. ○ Diameter is less than 6 mm. The most common cutaneous neoplasm is: ○ basal cell carcinoma. ○ compound nevus. ○ seborrheic keratosis ○ senile actinic keratosis. As part of your health promotion education for a new patient, you explain that the risk factors for skin cancer include: ○ olive complexion. ○ repeated trauma or irritation to skin. ○ history of allergic reactions to sun screen. ○ dark eyes and hair. You are inspecting the lower extremities of a patient and have noted pale, shiny skin of the lower extremities. This may reflect: ○ systemic disease. ○ a history of vigorous exercise. ○ peptic ulcer disease. ○ mental retardation. Normal hormone-related changes of adolescence include: ○ increase oil production. ○ the development of fine silky lanugo hair. ○ depletion of apocrine glands. ○ decreased sebaceous gland activity. Feedback: the onset of adolescents is a common time for acne to develop. This is causes by the increased oil production. Unusual white areas on the skin may be due to: ○ adrenal disease ○ polycythemia ○ vitiligo ○ Down syndrome The characteristic barrel chest of the older adult is due to a combination of factors including: skeletal changes of aging. increased muscular expansion of the chest wall. increased vital capacity increased lung resiliency. Feedback: Skeletal changes associated with aging include an emphasis of the dorsal curve of the thoracic spine that contributes to a barrel chest. Tactile fremitus is best felt: along the costal margin and xiphoid process. parasternally at the second intercostal space. in the mid axillary lines. in the suprasternal notch along the clavicle. Feedback: Fremitus is best palpated at the second intercostal space, which also corresponds to the bifurcation of the bronchi. Which bronchial structure(s) is(are) most susceptible to aspiration of foreign bodies? Left mainstem bronchus Terminal bronchioles Right mainstem bronchus Respiratory bronchioles What term would you use to document a respiratory rate greater than 20 breaths per minute in an adult? Dyspnea Orthopnea Platypnea Tachyapnea Mr. L. has cyanotic lips and nail beds. His lips are pursed, and he has nasal flaring. You suspect he is having cardiac or pulmonary difficulty. What additional sign would support this impression? Callus formation on the heels Clubbing of the fingers Graying hair Swollen toes and ankles You would expect to document the presence of a pleural friction rub for a patient being treated for: pneumonia. atelectasis. tuberculosis. emphysema. Feedback: Pleural friction rub. ... They occur where the pleural layers are inflamed and have lost their lubrication. Pleural rubs are common in pneumonia, pulmonary embolism, and pleurisy (pleuritis). Because these sounds occur whenever the patient's chest wall moves, they appear on inspiration and expiration. Breath sounds normally auscultated over most of the lung fields are called: vesicular. bronchovesicular. bronchial. tubular. Feedback: The bronchial breath sounds over the trachea has a higher pitch, louder, inspiration and expiration are equal and there is a pause between inspiration and expiration. The vesicular breathing is heard over the thorax, lower pitched and softer than bronchial breathing. With consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas healthy lung tissue produces softer sounds. This is because: consolidation echoes in the chest. consolidation is a poor conductor of sound. air-filled lung sounds are from smaller spaces. air-filled lung tissue is an insulator of sound Feedback: A pulmonary consolidation is a region of (normally compressible) lung tissue that has filled with liquid, a condition marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung. Normal physiologic changes in the respiratory system of the geriatric client include an increased rigidity of rib cage and increase in anteroposterior (AP) diameter of the chest. True OR False TRUE Feedback: Changes to the bones and muscles of the chest and spine: Bones become thinner and change shape. This can change the shape of your ribcage. As a result, your ribcage cannot expand and contract as well during breathing. The muscle that supports your breathing, the diaphragm, becomes weakened. This weakness may prevent you from breathing enough air in or out. These changes in your bones and muscles may lower the oxygen level in your body. Also, less carbon dioxide may be removed from your body. Symptoms such as tiredness and shortness of breath can result. Changes to lung tissue: Muscles and other tissues that are near your airways may lose their ability to keep the airways completely open. This causes the airways to close easily. Aging also causes the air sacs to lose their shape and become baggy. These changes in lung tissue can allow air to get trapped in your lungs. Too little oxygen may enter your blood vessels and less carbon dioxide may be removed. This makes it hard to breathe. When is the correct procedure when percussing the chest? Percuss the entire right side of the anterior chest and move to the left side. Percuss systematically and symmetrically the anterior chest, moving from left to right side, then percuss the posterior chest. Percuss the posterior chest, then measure for diaphragmatic excursion on the anterior chest. Begin at the upper left side of the posterior chest and compare to the respective anterior side, moving from front to back. Feedback: Both the anterior and posterior chest should be percussed systematically and symmetrically, moving from left to right. Diaphragmatic excursion is usually only measured on the posterior chest. In which location would carotid bruits best be heard? Posterior cervical triangle Anterior margin of the sternocleidomastoid muscle At the angle of the mandible Over the aortic valve Feedback: Carotid artery bruits are best heard at the anterior margin of the sternocleidomastoid muscle. Mr. O., age 50, comes for his yearly health assessment, which is provided by his employer. During your initial history-taking interview, Mr. O. mentions that he routinely engages in light exercise. At this time, you should: ask if he makes his own bed daily. have the patient describe his exercise. make a note that he walks each day. record "light exercise" in the history. Feedback: When Mr. O. says he engages in light exercise, have him describe his exercise. To qualify his use of the term "light," ask him the type, length of time, frequency, and intensity of his activities. The amplitude of pulses is recorded on a(n): Likert scale of absent to bounding. numerical scale of 0 to 4. alphabetic scale of A to E. descriptive scale of mild, moderate, and severe. Feedback: The amplitude of pulses is recorded on a numeric scale of 0 to 4: 0 is absent, not palpable; 1 is diminished, barely palpable; 2 is expected finding; 3 is full, increased; and 4 is bounding.