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203: Health Assessment > 203 Exam #2 > Flashcards

203 Exam #2 Flashcards

1
Q

Neurologic system:
- balance, coordination, & movement
- speech
- senses

A

Cerebellum

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2
Q

Neurologic system:
- sight

A

Occipital lobe

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3
Q

Neurologic system:
- interpretation of smells sound & language
- Wernicke’s area

A

Temporal lobe

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4
Q

Neurologic system:
- breathing
- heart rate
- cough
- sleep
- consciousness

A

Brain stem

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5
Q

Neurologic system:
- cardiac
- vasomotor
- respiratory
- digestion

A

Medulla oblongata

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6
Q

Neurologic system:
- respiratory function

A

Pons

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7
Q

Neurologic system:
- auditory & visual reflexes

A

Midbrain

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8
Q

Three vital parts of the brain stem

A

Medulla oblongata, pons, midbrain

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9
Q

Are the following examples of subjective or objective data regarding alterations in the neurologic system:
- pain
- nervousness
- dizziness
- nausea
- vertigo
- changes in vision
- parasthesia (numbness & tingling

A

Subjective

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10
Q

What is assessed to obtain objective data relating to alternations in the neurological system?

A

The 12 cranial nerves

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11
Q

What are the five pieces of data (some subjective, some objective) from the assessment of the neurological system used to identify risk factors, analyze findings, and plan intervention?

A

LOC
Orientation (x4)
Speech
Behavior
PERRLA

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12
Q

Which two diagnostic tests are ordered to:
- check for allergies
- check renal function

A

Computed tomography (CT)
and
Magnetic resonance imaging (MRI)

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13
Q

Which diagnostic test is ordered
to measure electrical activity in the brain?

A

Electroencephalogram (EEG)

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14
Q

Which diagnostic test is ordered to:
- assess risk of infection or hemorrhage
- look for signs of CSF

A

Lumbar puncture

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15
Q

When performing a lumbar puncture, what findings are considered “normal”?

A

Colorless/clear fluid

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16
Q

After performing a lumbar puncture, what position should the patient be in and for how long?

A

Flat on either stomach or back for eight hours

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17
Q

What does the American Stroke Association’s acronym “F.A.C.E.” stand for?

A

Face dropping
Arm weakness
Speech
Time

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18
Q

Define lethargy

A

Drowsiness

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19
Q

Define hypotonia

A

Decreased muscle tone

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20
Q

Define hypertoria

A

Increased muscle tone

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21
Q

Define rigidity

A

Muscles contract & tense

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22
Q

Define spasticity

A

Increased muscle tone

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23
Q

Define hemiparesis

A

Loss of muscle tone & strength on one side of the body

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24
Q

Define paraplegic

A

Paralysis of lower extremities

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25
Q

Define quadriplegic

A

Loss of sensory & motor function in both lower & upper extremities

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26
Q

What is the sclera & what is its function?

A

White structure that protects eye & maintains structure

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27
Q

What is the lens of the eye responsible for?

A

Refracting light

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28
Q

What are the two functions of the eyelid?

A

Protecting & lubricating the eye

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29
Q

What is the conjunctiva of the eye?

A

Thin membrane covering ye

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30
Q

What are the lacrimal glands?

A

Tear ducts

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31
Q

What is the auricle (pinna):

A

Outer, visible portion of the ear

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32
Q

What is the eustachian tube?

A
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33
Q

What is the cochlea?

A

Organ of hearing

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34
Q

What is the tympanic membrane?

A

Shiny, translucent eardrum

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35
Q

What are the nostrils lined with?

A

Mucous membrane

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36
Q

What are adenoids?

A

Lymphatic tissue part of immune system found in the nose

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37
Q

What are the salivary glands responsible for?

A

Secreting saliva to begin digestion

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38
Q

What are the two pieces of subjective data relating to alterations in the HEENT?

A

Tinnitus & vertigo

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39
Q

What four things are associated w/ vertigo?

A
  • dizziness
  • pain
  • headache
  • difficulty swallowing
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40
Q

What is the Snellen chart diagnostic test & how is it used?

A

Visual acuity, stand 20 ft. away w/ card covering one eye then read smallest line

41
Q

What is the Weber/Rinne diagnostic test?

A

Conduction test for hearing loss using a tuning fork

42
Q

When is the swallowing evaluation diagnostic test used?

A

When dysphasia (difficulty swallowing) is observed or reporter

43
Q

What is done after dysphasia is observed or reported aside from conducting a swallowing evaluation?

A

Referral to speech pathologist who will observe eating & drinking

44
Q

What is the modified barium swallow study diagnostic test?

A

X-ray that assesses swallowing by having patient drink barium sulfate

45
Q

Which 3 diagnostic tests require the nurse to check if the patient takes metformin?

A

CT, MRI, angiogram

46
Q

Why is it important to check if a patient takes metformin prior to conducting certain diagnostic tests?

A

If contrast is used on a patient who takes metformin, the kidneys may be damaged

47
Q

What is one way hearing impaired patients can practice health promotion & risk reduction?

A

Ensure there are working smoke detectors in the home

48
Q

Define tinnitus

A

Ringing in the ears

49
Q

Define vertigo

A

Feeling dizzy/surroundings are moving

50
Q

Define diplopia

A

Double vision

51
Q

Define nystagmus

A

Involuntary rhythmic movement of the eyes

52
Q

Define myopia

A

Nearsighted- far away objects are blurry

53
Q

Define hyperopia

A

Farsighted- close up objects are blurry

54
Q

Define presbyopia

A

Vision loss due to old age

55
Q

Legally blind

A

20/200

56
Q

Define conjunctivitis

A

Viral infection causing inflammation of the conjunctiva

57
Q

Define ptosis

A

Abnormal drooping of the eyelid

58
Q

What are the four main functions of the lymph system?

A
  • immunity spread of infection
  • production of WBC
  • fluid & protein balance
  • absorbs lipids during digestion
59
Q

What are the spleen’s two function in the lymph system?

A
  • filters & stores blood
  • produces WBC
60
Q

What is the largest organ in the lymph system?

A

Spleen

61
Q

What is the thymus’ function in the lymph system?

A

Matures a specific type of WBC that fight off foreign organisms

62
Q

What is bone marrow’s function in the lymph system?

A

Produce RBC, WBC, & platelets

63
Q

What are the tonsils & adenoids two main functions in the lymph system?

A
  • trap pathogens from food
  • serve as first line of defense against foreign invaders
64
Q

What is the appendix’s function in the lymph system?

A

Contain lymphoid tissue that can destroy bacteria prior to reaching intestinal wall during absorption

65
Q

What are the peyers patches in the lymph system?

A

Small masses of lymphatic in the mucous membrane that line the S.I.

66
Q

What are lymph nodes and what do they do?

A

Small oval shaped lymphatic glands, network of fibers & irregular channels that slow down lymph flow

67
Q

What happens as lymph fluid passes through nodes?

A

Fibers filter out bacteria, viruses, & cellular debris

68
Q

What four substances make up lymphoma?

A
  • proteins
  • water
  • impurities
  • waste products
69
Q

Lymph fluid seeps into tissue from ______, is stored in the _______ _______ and flows back into _______ _______

A

Circulation; lymphatic system; blood circulation

70
Q

How does lymph fluid move?

A

In one direction

71
Q

What are the four primary pieces of subjective data relating to alterations in the lymph system?

A
  • pain
  • tenderness
  • fatigue
  • feeling of fullness
72
Q

What is the proper way to assess the 10 neck & face lymph nodes?

A
  1. Patient sits up & slightly flexes neck
  2. Use index & middle finger pads to palpate in circular motions on both sides
73
Q

Assessing edema: grade 1+ pitting depth & duration

A

2 mm, disappears rapidly

74
Q

Assessing edema: grade 2+ pitting depth & duration

A

4 mm, disappears in 10-15 seconds

75
Q

Assessing edema: grade 3+ pitting depth & duration

A

6 mm, lasts more than a minute

76
Q

Assessing edema: grade 4+ pitting depth & duration

A

8 mm, last 2-3 minutes

77
Q

What are the characteristics of a “normal” lymph mode?

A
  • less than 1 cm.
  • moveable
  • not tender
78
Q

What are the characteristics of an “abnormal” lymph node?

A
  • anything over 1 cm
  • rubbery, rock hard
  • fixed
  • tender
79
Q

What are the two purposes of the following diagnostic test: lymph node biopsy

A
  • detects infection/cancer
  • checks for bleeding abnormalities
80
Q

The incision site must be monitored for signs of infection following which diagnostic test?

A

Lymph node biopsy

81
Q

What is the purpose of the following diagnostic test: angiogram

A

Diagnose vascular insufficiencies & blockages in lymphatic system

82
Q

Prior to conducting am angiogram diagnostic test, what two things does the nurse need to check regarding the patient?

A
  • does the patient have allergies?
  • does the patient have a bleeding disorder?
83
Q

Relating to an angiogram, nurse needs to check for changes in _____ _____ as well as changes in ______ & _______ of skin around incision

A

Peripheral pulse; color; temperature

84
Q

Following an angiogram, what position should the patient maintain and for how long? Why?

A

Supine position for 2-6 hrs, prevents stress un the puncture site

85
Q

What are the 6 risk factors for lymphedema?

A
  • family history of lymphedema
  • removal of lymph nodes
  • invasive surgery
  • radiation therapy
  • chemotherapy
  • morbid obesity
86
Q

Define lymphedema

A

Swelling/accumulation of fluid in lymphatic system

87
Q

Define leukocytosis

A

Elevation of WBC

88
Q

Define lymphadenopathy

A

Enlarged lymph nodes due to infection, inflammation, or cancer

89
Q

Define lymphoma

A

Cancer of lymphatic system (hodgkins/nonhodgkins)

90
Q

Define lymphocytosis

A

High concentration of fluid

91
Q

Neurologic system:
- emotions
- reasoning
- abstraction
- consentration
- information storage
- voluntary eye movement
- Broca’s area/motor control of speech

A

Frontal lobe

92
Q

Neurologic system:
- integrates sensory information

A

Parietal lobe

93
Q

Neurologic system:
- controls emotions
- reasoning
- abstraction & concentration
- storage & concentration
- voluntary eye movement
- Broca’s area: motor control speech

A

Frontal lobe

94
Q

Neurologic system:
- integrates sensory information

A

Parietal lobe

95
Q

What do the following test evaluate: TSH, T3, T4

A

Thyroid function

96
Q

Define nystagmus

A

Eyes involuntarily moving from side to side

97
Q

What are the 8 structures of the lymphatic system?

A
  • spleen
  • thymus
  • appendix
  • bone marrow
  • lymph nodes
  • tonsils
  • adenoids
  • peyer’s patch in S.I.
98
Q
A

203: Health Assessment (7 decks)

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