WCU Nurs 190 Midterm Review
Assessment Techniques - answer Interview, history taking Privacy Quiet Ask open and
closed ended questions Ask about concern.... Do you smoking, do you wear glasses?
Four basic techniques for physical assessment? - answer inspect, auscultate, percuss,
palpate
Palpation - answer Using sense feeling- light, deep, temp
Stethoscope diaphragm - answer high pitch sounds
Stethoscope bell - answerlow pitched sounds
adult ear exam - answerpull ear up and back
Pressure Ulcers - answer-Stage 1: 1 layer affected; epidermis reddened
-Stage 2: 2 layer affected; open lesion
-Stage 3: 3 layers affected
-Stage 4: 4 layers affected, epidermis, dermis, subcutaneous,
muscle/bone
Grading of skin edema: push hard around bony prominences with
3 finger pads - answer0=no edema
1+=2mm
2+=4mm
3+=6mm
4+=8mm
signs of migraine - answerWith or without auras, n/v, photophobia, phonophobia, 4-6
hours
signs of cluster headache - answerOnset at night, last few minutes to hour, watery eyes,
runny nasal passage with congestion, insidious eye pain
Different types of equipment - answer-doppler: assess pulses when they cant be
palpated
-stadiometer: used to measure height of patient
breast assessment position - answerUpright, arm above head, hands against waist,
hands pressed together in front of waist, leaning forward
Diabetic Ketoacidosis (DKA) - answerhyperventilation from rapid deep breathing
, Check temp on what side of hand? - answerDorsal part is most sensitive
How to assess peripheral vision? - answerconfrontation test/ cover uncover test
Myopia - answernearsightedness
hyperopia - answerfarsightedness
Cranial Nerve 2 - answerOptic - vision
6 cardnial field of gaze - answerCN 3, 4, 6
cranial nerve 8 - answerVestibulocochlear (hearing and balance)
Age related hearing loss - answerpresbycusis
Age-related vision loss - answerpresbyopia
Old people cannot hear? - answerhigh pitched sounds
Old people cannot see? - answerUp close, need magnifying glass
bruit in carotid artery - answeris abnormal indicated cvd, turbulent blood flow, narrowing
S2 heart sound - answerclosure of aortic and pulmonic valves during diastole; best
heard at left 2nd/3rd ICS, DUB
S1 heart sound - answerclosure of AV valves (mitral and tricuspid) LUB
distole - answerRelaxation of the heart
Systole - answerContraction of the heart
S3 and S4 - answersoft sounds, blood flow into ventricles and atrial contraction
heart friction rub - answersound louder when pt leans forward or takes a deep breath,
Pericarditis is inflammation of the pericardium rubbing against heart
heart murmur - answerblowing sound or harsh whooshing, swishing, or rasping due to
disruption of blood flow; blood leaking back into left atrium
heart clicks and snaps - answerhigh-pitched heart sounds that can indicate structural
valve changes; Mitral Valve Prolapse
heart flow - answer1. Right Atrium
Assessment Techniques - answer Interview, history taking Privacy Quiet Ask open and
closed ended questions Ask about concern.... Do you smoking, do you wear glasses?
Four basic techniques for physical assessment? - answer inspect, auscultate, percuss,
palpate
Palpation - answer Using sense feeling- light, deep, temp
Stethoscope diaphragm - answer high pitch sounds
Stethoscope bell - answerlow pitched sounds
adult ear exam - answerpull ear up and back
Pressure Ulcers - answer-Stage 1: 1 layer affected; epidermis reddened
-Stage 2: 2 layer affected; open lesion
-Stage 3: 3 layers affected
-Stage 4: 4 layers affected, epidermis, dermis, subcutaneous,
muscle/bone
Grading of skin edema: push hard around bony prominences with
3 finger pads - answer0=no edema
1+=2mm
2+=4mm
3+=6mm
4+=8mm
signs of migraine - answerWith or without auras, n/v, photophobia, phonophobia, 4-6
hours
signs of cluster headache - answerOnset at night, last few minutes to hour, watery eyes,
runny nasal passage with congestion, insidious eye pain
Different types of equipment - answer-doppler: assess pulses when they cant be
palpated
-stadiometer: used to measure height of patient
breast assessment position - answerUpright, arm above head, hands against waist,
hands pressed together in front of waist, leaning forward
Diabetic Ketoacidosis (DKA) - answerhyperventilation from rapid deep breathing
, Check temp on what side of hand? - answerDorsal part is most sensitive
How to assess peripheral vision? - answerconfrontation test/ cover uncover test
Myopia - answernearsightedness
hyperopia - answerfarsightedness
Cranial Nerve 2 - answerOptic - vision
6 cardnial field of gaze - answerCN 3, 4, 6
cranial nerve 8 - answerVestibulocochlear (hearing and balance)
Age related hearing loss - answerpresbycusis
Age-related vision loss - answerpresbyopia
Old people cannot hear? - answerhigh pitched sounds
Old people cannot see? - answerUp close, need magnifying glass
bruit in carotid artery - answeris abnormal indicated cvd, turbulent blood flow, narrowing
S2 heart sound - answerclosure of aortic and pulmonic valves during diastole; best
heard at left 2nd/3rd ICS, DUB
S1 heart sound - answerclosure of AV valves (mitral and tricuspid) LUB
distole - answerRelaxation of the heart
Systole - answerContraction of the heart
S3 and S4 - answersoft sounds, blood flow into ventricles and atrial contraction
heart friction rub - answersound louder when pt leans forward or takes a deep breath,
Pericarditis is inflammation of the pericardium rubbing against heart
heart murmur - answerblowing sound or harsh whooshing, swishing, or rasping due to
disruption of blood flow; blood leaking back into left atrium
heart clicks and snaps - answerhigh-pitched heart sounds that can indicate structural
valve changes; Mitral Valve Prolapse
heart flow - answer1. Right Atrium
