1) General Survey

Question 1

When does the general survey begin?

Answer 1

• When the nurse first meets the patient
• Observing behavior, appearance, and mobility

Question 2

What is the general survey?

Answer 2

• The first step in physical examination
• Provides information about illness characteristics, hygiene, body image, emotional state, weight changes, developmental status

Question 3

What should the nurse do if abnormalities are noted in the general survey?

Answer 3

• Closely assess the affected body system later during physical examination

Question 4

What should be assessed when interacting with the patient?

Answer 4

• General appearance
• Behavior

Question 5

How do age and gender affect the examination?

Answer 5

• They affect the type of examination performed
• They affect the manner assessments are made
• Certain conditions are more likely based on gender/characteristics

Question 6

What signs of distress should be noted?

Answer 6

• Signs indicating pain (grimacing, splinting area)
• Signs of breathing difficulty (shortness of breath, retractions)
• Signs of anxiety (fidgeting, pacing)

Question 7

What should be observed about the patient’s body type?

Answer 7

• If they appear trim/muscular, obese, or excessively thin
• Body type reflects health level, age, and lifestyle

Question 8

How should normal standing and sitting posture be observed?

Answer 8

• Standing: upright, parallel hips/shoulders
• Sitting: some shoulder rounding
• Note if slumped, erect, or bent posture

Question 9

What should be noted about an older person’s posture?

Answer 9

• May have stooped, forward-bent posture
• Hips/knees flexed, arms bent raising arm level

Question 10

How should gait be observed?

Answer 10

• If ambulatory, observe walking into room/bedside
• Note if movements coordinated or uncoordinated
• Arms normally swing freely, head/face lead body

Question 11

What body movements should be observed?

Answer 11

• If movements purposeful
• Any tremors in extremities
• Any body parts immobile

Question 12

How should hygiene and grooming be assessed?

Answer 12

• Note cleanliness of hair, skin, nails
• If clothes are clean
• Amount/type of cosmetics used

Question 13

What factors affect the type of clothes a person wears?

Answer 13

• Culture
• Lifestyle
• Socioeconomic level
• Personal preference

Question 14

How should clothing appropriateness be assessed?

Answer 14

• Note if clothing is appropriate for temperature/weather conditions
• Depressed or cognitively impaired may not choose proper clothing
• Older persons tend to wear extra layers due to cold sensitivity

Question 15

What can cause an unpleasant body odor?

Answer 15

• Physical exercise
• Poor hygiene
• Certain disease states

Question 16

What is affect?

Answer 16

• A person’s feelings as they appear to others
• Expressed verbally and nonverbally

Question 17

How should mood be assessed?

Answer 17

• Note if verbal expressions match nonverbal behavior
• Observe if mood is appropriate for the situation
• Observe facial expressions while asking questions

Question 18

How should speech be assessed?

Answer 18

• Normal speech is understandable and moderately paced
• Associated with the person’s thoughts
• Note if abnormally rapid or slow
• Note tone and clarity of word inflection

Question 19

What are signs of possible violence/intimidation?

Answer 19

• Obvious physical injury or neglect
• Evidence of malnutrition
• Presence of bruising on extremities or trunk

Question 20

What should be assessed regarding potential abusers?

Answer 20

• Patient’s fear of spouse/partner/caregiver
• History of violence, alcoholism, drug abuse in partner/caregiver
• If partner/caregiver is unemployed, ill, or frustrated as caregiver

Question 21

What should be done if violence is suspected?

Answer 21

• Most provinces mandate reporting to social services
• Interview patient privately without suspected abuser
• Victims often don’t report abuse

Question 22

What safety precaution should be taken for victims of violence?

Answer 22

• The risk for further violence is high once reported or trying to leave
• Provide counseling options for these individuals

Question 23

What groups does substance use and misuse affect?

Answer 23

• It affects all socioeconomic groups
• A single clinic visit may not reveal the problem
• Several visits can reveal behaviors to confirm with history/exam

Question 24

How should patients with suspected substance misuse be approached?

Answer 24

• In a caring and non-judgmental way
• Issues involve emotional and lifestyle factors

Question 25

What are the CAGE questions to assess for substance misuse?

Answer 25

• Cut down: Need to cut down on drinking/drug use?
• Annoyed: People annoyed by criticizing your use?
• Guilty: Felt guilty about your use?
• Eye-opener: Used first thing in morning to steady nerves?

Question 26

What are physical indicators of child sexual abuse?

Answer 26

• Vaginal or penile discharge
• Blood on underclothing
• Pain, itching, or unusual odor in genital area
• Genital injuries
• Difficulty sitting or walking
• Pain while urinating; recurrent UTIs
• Foreign bodies in rectum, urethra, or vagina
• Sexually transmitted infections
• Pregnancy in a young adolescent

Question 27

What are behavioral indicators of child sexual abuse?

Answer 27

• Difficulty sleeping or eating
• Fear of certain people or places
• Play activities recreating the abuse
• Regressed behavior
• Sexual acting out
• Knowledge of explicit sexual matters
• Preoccupation with genitals
• Profound personality changes
• Declining school performance
• Poor peer relationships

Question 28

What are physical indicators of intimate partner violence?

Answer 28

• Injuries inconsistent with reported cause
• Multiple injuries to head, face, neck, breasts, abdomen, genitalia
• X-rays showing old and new fractures
• Abrasions, lacerations, bruises/welts
• Burns
• Human bites
• Attempted suicide

Question 29

What are behavioral indicators of intimate partner violence?

Answer 29

• Eating or sleeping disorders
• Anxiety
• Panic attacks
• Substance abuse following abuse
• Low self-esteem
• Depression
• Helplessness
• Guilt
• Forgetfulness
• Stress symptoms like headaches

Question 30

What are physical indicators of elder abuse?

Answer 30

• Injuries inconsistent with reported cause
• Hematomas
• Bruises at various stages
• Bruises from restraints
• Burns
• Fractures inconsistent with cause
• Dried blood
• Prolonged delay in treatment

Question 31

What are behavioral indicators of elder abuse?

Answer 31

• Dependent on caregiver
• Physically or cognitively impaired
• Combative
• Wandering
• Verbally aggressive
• Minimal social support

Question 32

What are red flags for suspecting substance use/misuse?

Answer 32

• Frequently missing appointments
• Frequently requesting work excuse notes
• Complaints of insomnia, “bad nerves,” or atypical pain
• Reporting lost prescriptions or requesting early refills
• Frequent emergency department visits
• Changing healthcare providers frequently
• History of medication bottles from multiple providers

Question 33

What medical histories suggest substance use/misuse?

Answer 33

• Gastrointestinal bleeds, ulcers, pancreatitis, cellulitis
• Frequent pulmonary infections
• Frequent STIs, complicated pregnancies, abortions, sexual dysfunction
• Chest pains, palpitations, admissions to rule out MI
• Activities placing patient at risk for HIV (multiple partners, rapes)

Question 34

What personal histories suggest substance use/misuse?

Answer 34

• Family history of addiction
• History of childhood abuse (sexual, physical, emotional)
• Social, financial or marital problems

Question 35

How can the CAGE questionnaire identify substance use disorder?

Answer 35

• If 2 or more CAGE questions are positive, strongly suspect substance use disorder
• Consider motivating patient to seek treatment