Nursing 2000 Exam #2 Mark Klimek Cedarville University
Questions With Complete Solutions
Process of blood flow through the heart:
Vena cava-right atrium-tricuspid valve-right ventricle-pulmonic
valve-pulmonary artery-pulmonary capillary bed-pulmonary
vein-left atrium-mitral valve-left ventricle-aortic valve-aorta
ascites
fluid accumulating in peritoneal cavity
1 cm
depth of light palpation
light palpation
,with this type of palpations you feel in all 4 quadrants for lesions
superficial to abdominal musculature
lipomas
fatty tumors that make up 60 percent of lesions felt during light
palpation
30 percent
what percent of superficial lesions felt during light palpation are
lymph nodes?
deep palpation
this is palpation done in all four quadrants in which you look for
masses in the peritoneal cavity
one hand
how many hands are used for light palpation?
two hands, top, bottom
how many hands are used for deep palpation? and which hand is
doing the pushing? the feeling?
top down
how do you tend to lose cognitive function?
MSE
assesses cerebral cortex and usually used only as intake exam
MSQ
mental status questionnaire; have access to on any unit you work
on
,MMSE
mini mental status exam; top score of 30 is normal; anyone with
score of 21 or less has cognitive impairment
components of a MSE
level of consciousness, behavior and appearance, language,
memory, knowledge, abstract thinking
level of conciousness
same as state of awareness and tells how well they interact with
environment around them; you want comparative scale so you
use glasgow coma scale
glasgow coma scale (GCS)
total of fifteen points possible and objectively tells if patient is
improving/deteriorating ; scored in 3 areas eye, verbal, motor
best eye
on the GCS the max score is a 4; spontaneous eye opening is a
4; unresponsiveness is a 1
best verbal
on GCS the best score is a 5; speak spontaneously and audibly;
moan is a 1
best motor
on GCS this max score is a 6; which means they move
extremities appropriately and a 1 means they don;t move
behavior and appearance
, this is especially important for assessing nonverbal children
aphasia
inability to mediate and process language effectively; caused by
interruption in neural pathways
frontal/temporal lobes
these are the tow lobes needed for effective communication
sensory aphasia (afferent, receptive)
cannot understand and comprehend incoming language; its a
reception problem;can speak fluently; document as able to hear,
but responds nonsensible
pervasive sensory aphasia
don't understand written, spoken sing language, or symbols
temporal lobe
is sensory aphasia caused by a problem in which lobe?
motor aphasia (efferent, expressive)
this is the inability to formulate responses properly; sounds are
interpreted fine, but function is messed up;know that words are
wrong; use picture boards; benefit from language/speech therapy
frontal lobe
in which lobe does problems cause motor aphasia
pure motor aphasia
completely understand what is said but wrong words or
unintelligible sounds come out
Questions With Complete Solutions
Process of blood flow through the heart:
Vena cava-right atrium-tricuspid valve-right ventricle-pulmonic
valve-pulmonary artery-pulmonary capillary bed-pulmonary
vein-left atrium-mitral valve-left ventricle-aortic valve-aorta
ascites
fluid accumulating in peritoneal cavity
1 cm
depth of light palpation
light palpation
,with this type of palpations you feel in all 4 quadrants for lesions
superficial to abdominal musculature
lipomas
fatty tumors that make up 60 percent of lesions felt during light
palpation
30 percent
what percent of superficial lesions felt during light palpation are
lymph nodes?
deep palpation
this is palpation done in all four quadrants in which you look for
masses in the peritoneal cavity
one hand
how many hands are used for light palpation?
two hands, top, bottom
how many hands are used for deep palpation? and which hand is
doing the pushing? the feeling?
top down
how do you tend to lose cognitive function?
MSE
assesses cerebral cortex and usually used only as intake exam
MSQ
mental status questionnaire; have access to on any unit you work
on
,MMSE
mini mental status exam; top score of 30 is normal; anyone with
score of 21 or less has cognitive impairment
components of a MSE
level of consciousness, behavior and appearance, language,
memory, knowledge, abstract thinking
level of conciousness
same as state of awareness and tells how well they interact with
environment around them; you want comparative scale so you
use glasgow coma scale
glasgow coma scale (GCS)
total of fifteen points possible and objectively tells if patient is
improving/deteriorating ; scored in 3 areas eye, verbal, motor
best eye
on the GCS the max score is a 4; spontaneous eye opening is a
4; unresponsiveness is a 1
best verbal
on GCS the best score is a 5; speak spontaneously and audibly;
moan is a 1
best motor
on GCS this max score is a 6; which means they move
extremities appropriately and a 1 means they don;t move
behavior and appearance
, this is especially important for assessing nonverbal children
aphasia
inability to mediate and process language effectively; caused by
interruption in neural pathways
frontal/temporal lobes
these are the tow lobes needed for effective communication
sensory aphasia (afferent, receptive)
cannot understand and comprehend incoming language; its a
reception problem;can speak fluently; document as able to hear,
but responds nonsensible
pervasive sensory aphasia
don't understand written, spoken sing language, or symbols
temporal lobe
is sensory aphasia caused by a problem in which lobe?
motor aphasia (efferent, expressive)
this is the inability to formulate responses properly; sounds are
interpreted fine, but function is messed up;know that words are
wrong; use picture boards; benefit from language/speech therapy
frontal lobe
in which lobe does problems cause motor aphasia
pure motor aphasia
completely understand what is said but wrong words or
unintelligible sounds come out
