Chapter 12

Question 1

what is the normal capillary refill?

Answer 1

less than 3

< 3 sec

Question 2

what is the first step in assessing musculoskeletal system?

Answer 2

inspection for symmetry and posture

Question 3

examples of objective data-

Answer 3

checking VS, measuring urine out put etc

Question 4

example of subjective data

Answer 4

client states or reports —–

Question 5

write a nursing diagnosis for a patient who is prone to have skin problems because of anorexia

Answer 5

Risk for impaired skin integrity R/T malnutrition

Question 6

what is the order for assessing bowel sounds

Answer 6

inspection
auscultate
palpation 
percussion 
I am pal pear
** auscultate before palpation

Question 7

what information is gathered during a health history

Answer 7

*hospitalization
*past illness
*surgeries
*vitamins
religious beliefs related to treatment plans
support systems

Question 8

radial pulse is assessed using which assessment technique

Answer 8

palpation

Question 9

what is an important function by he nurse prior to collecting health history

Answer 9

*it is important for the nurse to establish a rapport with the clientt

Question 10

what assessment technique would you use when checking for lung sounds-

Answer 10

auscultation

Question 11

explain 
AA0 X 1
AA0 X 2
AAO X 3
AAO X 4

Answer 11

AAO X 1 - person
AAO X 2 - person and place
AAO X 3 - person, place and time
AAO X 4 - person, place , time and purpose

Question 12

True or false? diabetes is an example of chronic disorder

Answer 12

true

Question 13

define risk factor?

Answer 13

an individuals vulnerability to developing a disease.

Question 14

what are the 4 categories of risk factors?

Answer 14

genetic
physiological
age
lifestyle

Question 15

a decrease in skin turgor is caused by

Answer 15

dehydration

Question 16

an increase in skin turgor is caused by

Answer 16

edema

Question 17

what are the classifications of bowel sounds and explain each

Answer 17

classified as: active, hyperactive, hypoactive, absent.

NORMAL- 4-32 active.
hypoactive - below 4 – constipation
hyperactive (borborygmi) over 32— diarrehea and hunger.
absent bowel sounds seen in - paralytic ileus , notify MD

Question 18

which assessment has priority for jaundice in a dark skinned person?

Answer 18

sclera of the eyes

Question 19

define jaundice-

Answer 19

yellowish appearance of the skin

Question 20

define erythema

Answer 20

redness of the skin

Question 21

define cyanosis

Answer 21

grayish blue tone

Question 22

define pallor

Answer 22

paleness, bases of color

Question 23

define diaphoresis-

Answer 23

excessive sweating

Question 24

an ange related curvature of the spine

Answer 24

kyphosis

Question 25

how do you describe crackles

Answer 25

wet, popping sounds

Question 26

what does the following snellen chart result mean?

Answer 26

20/40

bottom umber denotes what a normal eye sees
top number shows what an impaired eyes sees.