102 Nursing Theory

Question 1

Crackles

Answer 1

Rice crispy sound, fine, short, high pitch, best on inspiration, air pushing through collapsed alveoli

Question 2

Ronchi

Answer 2

Continuous, Low pitch gurgle, air pushing through narrow passage sure to secretions/swelling/tumor

Question 3

Wheezes

Answer 3

Continuous, high pitch musical squeaks, best on expiration, air passing through constricted bronchus, may be relieved by coughing

Question 4

Stridor

Answer 4

High pitch sound in trachea/larynx, barking seal noise

Question 5

Decrease fremitus

Answer 5

Pneumothorax (air in pleural space)

Question 6

Increase fremitus

Answer 6

Pneumonia

Question 7

Bristol

Answer 7

Stool scale 1 to 7, normal is 4

Question 8

Braden

Answer 8

Pressure ulcer risk, 18 or less is high risk

Question 9

Morse

Answer 9

Fall risk scale, 50+ high risk
History, 2nd diagnosis, ambulatory aid, IV, gait, mental status

Question 10

Glascow

Answer 10

Coma scale. 15 is fine, 3 is min, under 8 intubate. Verbal, eyes, motor response

Question 11

Romberg

Answer 11

Balance test. Negative is good

Question 12

Nystagmus

Answer 12

Involuntary, rythmic shaking of the eye

Question 13

Nystagmus

Answer 13

Involuntary, rythmic shaking of the eye

Question 14

Ptosis

Answer 14

Dropping eyelid, cranial nerve 3 palsy

Question 15

Cranial nerve 1

Answer 15

Olfactory

Question 16

Cn 2

Answer 16

Optic

Question 17

Cn3,4,6

Answer 17

Eye movement

Question 18

Cn 5

Answer 18

Face sensation, chewing

Question 19

Cn 7

Answer 19

Facial expression, taste

Question 20

Cn 8

Answer 20

Hearing and balance

Question 21

Cn 9

Answer 21

Taste and swallow

Question 22

Cn 10

Answer 22

Vagus

Question 23

Cn 11

Answer 23

Move head and shoulders

Question 24

Cn 12

Answer 24

Move tongue

Question 25

Dorsal recumbent

Answer 25

Laying on back knees bent feet on floor

Question 26

Supine

Answer 26

Laying flat face up

Question 27

Sitting

Answer 27

Sitting

Question 28

Lithotomy

Answer 28

Ob position

Question 29

Sims

Answer 29

Lazy dog sex position

Question 30

Prone

Answer 30

Laying face down

Question 31

Semi fowler

Answer 31

Reclined sitting

Question 32

High fowler

Answer 32

Sitting upright

Question 33

Trendelenburg

Answer 33

Lady flat head lower than feet

Question 34

Reverse Trendelenburg

Answer 34

Lady flat head above feet