Ch 6 Verbal Responses

Question 1

The head looks normal

Answer 1

Normocephalic

Question 2

The head looks large

Answer 2

Macrocephalic

Question 3

The head looks small

Answer 3

Microcephalic

Question 4

eyes are normal

Answer 4

“Sclera white. Conjunctiva Clear.”

Question 5

After the light to eyes test

Answer 5

“Pupils equal, round, reactive to light directly and consensually”

Question 6

Nose is normal

Answer 6

No congestion or drainage

Question 7

mouth is normal

Answer 7

“mucous membrane moist and pink”. Note if it is pale, jaundice, dry

Question 8

Trachea is normal

Answer 8

“Trachea is Midline”

Question 9

Thorax

Answer 9

“normal AP (anterior/ Posterior) Diameter”

Question 10

normal lung sounds

Answer 10

“lung sounds clear and equal bilaterally”

Question 11

heart sounds normal, lub dub lub dub

Answer 11

“S1S2, regular, no murmurs or extra heart sounds”

Question 12

stomach sounds

Answer 12

Judge if they are present or are hypoactive or hyperactive

Question 13

Abdomen

Answer 13

“Abdomen flat, soft, non-tender. Normoacative bowel sounds.”

Question 14

Pulse grading? ( checking brachial and radial artery)

Answer 14

3+= "Full, bounding"
2+= "Normal" 
1+= "Weak, thready"
0=  Absent

Question 15

give them two fingers to squeeze

Answer 15

“Upper extremities strong”

Question 16

pinch skin on arm for elasticity

Answer 16

“skin warm and dry with good turgor”

Question 17

fingers are normal

Answer 17

“no clubbing or deformities. Nail beds pink with prompt capillary refill.”

Question 18

Perineum

Answer 18

ask about bowel movements and voiding. When’s the last time you used the restroom? Number 1 or number 2? Any pain? (you get the gist)

Question 19

Edema scale? Press on Tibia

Answer 19

Edema Scale
1+ Mild pitting; slight indentation; no perceptible swelling.
2+ Moderate pitting; indentation subsides rapidly.
3+ Deep pitting; indentation remains for a short time; leg looks swollen.
4+ Very deep pitting; indentation lasts a long time; leg very swollen.

Question 20

get foot to push, get foot to pull

Answer 20

“lower extremities strong”