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NURS 1300 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the Four (4) SKILLS performed for ASSESSMENT TECHNIQUES?

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
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2
Q

True or False: Palpitation always comes first during assessment techniques.

A

FALSE, INSPECTION always comes first.

  1. First individual as a whole is inspected
  2. Then each body system is inspected
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3
Q

What THREE (3) things does INSPECTION require?

A
  1. Good lighting
  2. Adequate exposure
  3. Occasional use of instruments
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4
Q

What NINE (9) things does PALPATION assess?

A
  1. Texture
  2. Temperature
  3. Moisture
  4. Organ location/size
  5. Swelling, vibration or pulsation
  6. Rigidity/spasticity
  7. Crepitation
  8. Lumps/masses
  9. Tenderness/pain
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5
Q

What are the FIVE (5) uses of PERCUSSION?

A
  1. Organ mapping
  2. Signaling density
  3. Detecting superficial abnormal mass
  4. Eliciting pain where inflamed
  5. Eliciting deep tendon reflex
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6
Q

What are the TWO (2) METHODS of PERCUSSION?

A
  1. Direct

2. Indirect

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7
Q

This ASSESSMENT TECHNIQUE is the close, careful SCRUTINY of individual and each body system.

A

Inspection

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8
Q

This ASSESSMENT TECHNIQUE applies the SENSE of touch to assess.

A

Palpation

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9
Q

This ASSESSMENT TECHNIQUE requires TAPPING a person’s SKIN with short, sharp strokes to assess underlying structures.

A

Percussion

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10
Q

This ASSESSMENT TECHNIQUE requires LISTENING to sounds produced by the body.

A

Auscultation

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11
Q

This METHOD of PERCUSSION is sometimes called IMMEDIATE, because the striking hand CONTACTS the body wall.

A

Direct

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12
Q

This METHOD of PERCUSSION is sometimes called MEDIATE because BOTH HANDS are used, where the striking hand CONTACTS STATIONARY HAND.

A

Indirect

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13
Q

True or False: most body sounds are very soft and must be channeled through a stethoscope.

A

TRUE

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14
Q

True or False: stethoscopes work by magnifying body sounds which make it easier to hear them.

A

FALSE, stethoscopes do not magnify body sounds but they do BLOCK OUT extraneous sounds.

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15
Q

This is a CRUNCHING SOUND that can be hear from the body.

A

Crepetation

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16
Q

This PART of the STETHOSCOPE uses LIGHT PRESSURE to auscultate LOW FREQUENCY sounds.

A

Bell

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17
Q

This PART of the STETHOSCOPE uses FIRM PRESSURE to auscultate HIGH FREQUENCY SOUNDS.

A

Diaphragm

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18
Q

What are the FIVE (5) major VITAL SIGNS?

A
  1. Temperature
  2. Pulse
  3. Respiration
  4. Blood pressure
  5. Pain
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19
Q

What is the RANGE for NORMAL body TEMPERATURE?

A
  1. 8- 37.3 degrees Celsius

96. 4- 99.1 degrees Fahrenheit

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20
Q

True or False: rectal temperatures are typically higher compared other routes.

A

TRUE, RECTAL temperatures are usually 0.4- 0.5 degrees Celsius (0.7- 1 degrees Fahrenheit) HIGHER.

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21
Q

What FOUR (4) things INFLUENCE normal TEMPERATURE?

A
  1. Exercise
  2. Age
  3. Diurnal Cycle (time of day)
  4. Menstruation
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22
Q

What are the FIVE (5) ROUTES for TEMPERATURE recording?

A
  1. Oral
  2. Axillary
  3. Rectal
  4. Tympanic Membrane
  5. Temporal Artery
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23
Q

Term used for the AMOUNT of BLOOD each heart beat pumps into the AORTA.

A

Stroke Volume

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24
Q

What is the average STROKE VOLUME for ADULTS?

A

70 ml

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25
Q

What FOUR (4) things does the GENERAL SURVEY assess?

A
  1. Physical Appearance
  2. Body Structure
  3. Mobility
  4. Behavior
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26
Q

What SIX (6) things are assessed in regards to PHYSICAL APPEARANCE?

A
  1. Age
  2. Sex
  3. Level of Consciousness
  4. Skin
  5. Facial Symmetry
  6. Signs of Acute Distress
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27
Q

What SEVEN (7) things are assessed in regards to BODY STRUCTURE.

A
  1. Stature
  2. Nutrition
  3. Symmetry
  4. Posture
  5. Position (comfortable)
  6. Body Build
  7. Physical Deformities
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28
Q

What THREE (3) things are assessed in regards to MOBILITY?

A
  1. Gait
  2. Range of Motion
  3. No Involuntary Movement
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29
Q

What FIVE (5) things are assessed in regards to BEHAVIOR?

A
  1. Facial Expression
  2. Mood/Affect
  3. Speech
  4. Dress
  5. Hygiene
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30
Q

This is the STRENGTH of the heart’s STROKE VOLUME.

A

Force

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31
Q

What are the scores of the THREE POINT SCALE for PULSE?

A

3+ full, bounding
2+ normal
1+ weak and thready
0 Absent

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32
Q

What are THREE (3) examples which could be the CAUSE of a FULL BOUNDING PULSE?

A
  1. Anxiety
  2. Exercise
  3. Abnormal Conditions
33
Q

What FOUR (4) things indicate NORMAL RESPIRATION?

A
  1. Relaxed
  2. Regular
  3. Automatic
  4. Silent
34
Q

This is the FORCE of BLOOD PUSHING against the side of its CONTAINER.

A

Blood Pressure

35
Q

This is the MAXIMUM PRESSURE felt on artery during LEFT VENTRICULAR CONTRACTION.

A

Systolic Pressure

36
Q

This is the ELASTIC RECOIL or RESTING PRESSURE that blood exerts constantly between each contraction.

A

Diastolic Pressure

37
Q

This is the DIFFERENCE between SYSTOLIC and DIASTOLIC pressure.

A

Pulse Pressure

38
Q

True or False: pulse pressure reflects stroke volume.

39
Q

This is the PRESSURE FORCING into TISSUES and averaged over cardiac cycle.

A

Mean Arterial Pressure (MAP)

40
Q

What is the RATIO of PULSE RATE?

41
Q

What is the AVERAGE BLOOD Pressure in YOUNG ADULTS?

42
Q

What SEVEN (7) factors might affect BLOOD PRESSURE?

A
  1. Age
  2. Gender
  3. Race
  4. Diurnal Rhythm
  5. Weight
  6. Emotions
  7. Stress
43
Q

What FIVE (5) factors DETERMINE LEVEL of BLOOD PRESSURE?

A
  1. Cardiac Output
  2. Peripheral Vascular Resistance
  3. Volume of Circulating Blood
  4. Viscosity
  5. Elasticity of Vessel Walls
44
Q

When measuring an ORTHOSTATIC BLOOD PRESSURE the patient’s POSITION is changed from ___________ to ___________.

A

Supine to Standing

45
Q

When an ORTHOSTATIC blood pressure is measured, a slight DECREASE in _____________ may occur.

A

Systolic pressure

46
Q

True or False: the decrease in systolic pressure seen when an orthostatic pressure is measured is about 17 mmhg.

A

FALSE, the slight decrease in systolic pressure seen when an orthostatic pressure is measured is LESS THAN 10.

47
Q

True or False: record blood pressure by using odd numbers.

A

FALSE, record blood pressure by using EVEN NUMBERS

48
Q

What SIX (6) things should be RECORDED along with taking ORTHOSTATIC VITALS?

A
  1. Position of patient
  2. Arm used
  3. Size of the BP Cuff
  4. Rate of Pulse
  5. Rhythm of Pulse
  6. Regularity of Pulse
49
Q

The WIDTH of the rubber bladder on an ANEROID SPHYGMOMANOMETER should equal ___% of the circumference of the person’s arm.

50
Q

The LENGTH of the rubber bladder on an ANEROID SPHYGMOMANOMETER should equal ___% of the circumference of the person’s arm.

51
Q

What THREE (3) things may be assessed during a GENERAL SURVEY of an AGING ADULT?

A
  1. Physical appearance
  2. Posture
  3. Gait
52
Q

This is ILL CURVATURE of the SPINE that may be seen in older adults.

53
Q

In regards to AGING ADULTS, weight ____________ during 80’s and 90’s.

54
Q

During 80’s and 90’s subcutaneous FAT is LOST from ______________ and ______________.

A

Face and Periphery

especially forearms

55
Q

During 80’s and 90’s subcutaneous FAT is DEPOSITED to ______________ and ______________.

A

Abdomen and Hips

56
Q

True or False: long bones do not shorten with age.

A

TRUE, long bones DO NOT SHORTEN with age

57
Q

CHANGES in AGING PERSON’S body TEMPERATURE regulatory mechanism leave them LESS LIKELY to have _________.

58
Q

CHANGES in AGING PERSON’S body TEMPERATURE regulatory mechanism leave them at GREATER RISK for _________.

A

Hypothermia

59
Q

True or False: temperature is a reliable index of an older person’s true state of health.

A

FALSE, temperature is LESS RELIABLE index of health for older people.

sweat gland activity is diminished

60
Q

How might the RADIAL ARTERY feel in an OLDER ADULT?

A
  1. Stiff
  2. Rigid
  3. Tortuous

does NOT imply disease

61
Q

True or False: a pulse is usually harder to find on an older adult.

A

FALSE, pulse is actually EASIER to palpate in aging adults.

rigid arterial wall needs faster upstroke

62
Q

In regards to RESPIRATION, AGING ADULTS experience DECREASED ____________ and _____________.

A
  1. Vital capacity

2. Inspiratory Reserve Volume

63
Q

True or False: the aorta and major arteries tend to harden with age.

64
Q

Because the AORTA is STIFFER in OLDER ADULTS, SYSTOLIC PRESSURE _____________.

A

Increases

leads to WIDENED PULSE PRESSURE

65
Q

What makes distinguishing NORMAL BP in AGED ADULTS from HYPERTENSION so difficult?

A

Systolic and Diastolic BP increase

66
Q

True or False: a pulse oximeter can be placed on the earlobe.

67
Q

An SpO2 level in a HEALTHY PERSON is usually ____% to ____%.

A

97% to 98%

68
Q

What are the THREE (3) INTERNAL FACTORS of COMMUNICATION.

A
  1. Liking people
  2. Empathy
  3. Ability to listen
69
Q

What are the SIX (6) EXTERNAL FACTORS of COMMUNICATION?

A
  1. Privacy
  2. Refuse Interruptions
  3. Physical Environment
  4. Dress
  5. Note taking
  6. Video/Tape recording
70
Q

What are the THREE (3) PHASES of an INTERVIEW?

A
  1. Introduction
  2. Working
  3. Termination
71
Q

When are OPEN ENDED QUESTIONS used during the interview process?

A
  1. Begin the interview
  2. Introduce new set of questions
  3. Patient introduces new topic
72
Q

When are CLOSED ENDED QUESTIONS used during the interview process?

A
  1. Fill in details a person may have left out
  2. When you need many specific facts
  3. To move along
73
Q

What EIGHT (8) topics are discussed when obtaining a HEALTH HISTORY?

A
  1. Biographical data
  2. Source of History
  3. Reason for Seeking care
  4. Present health/history of illness
  5. Past Health
  6. Family History
  7. Review of Systems
  8. Functional Assessment (ADLs)
74
Q

What NINE (9) things are obtained when gathering BIOGRAPHICAL DATA?

A
  1. Name
  2. Address/Phone
  3. Age & DOB
  4. Birthplace
  5. Sex
  6. Marital Status
  7. Race
  8. Ethnic Origin
  9. Occupation
75
Q

This is a SUBJECTIVE SENSATION a person feels from a disorder.

76
Q

This is an OBJECTIVE ABNORMALITY that can be detected on physical examination or laboratory reports.

77
Q

What EIGHT (8) things are gathered when obtaining PRESENT HEALTH or HISTORY of present ILLNESS?

A
  1. Location
  2. Character/Quality
  3. Quantity/Severity
  4. Timing
  5. Setting
  6. Aggravating/Relieving Factors
  7. Associated Factors
  8. Patient’s Perception
78
Q

What TEN (10) things are gathered for PAST health HISTORY?

A
  1. Childhood Illnesses
  2. Accidents/Injuries
  3. Serious/Chronic Illnesses
  4. Hospitalization S
  5. Operations
  6. Obstetric History
  7. Immunizations
  8. Last Exam
  9. Allergies
  10. Medications
79
Q

True or False: pain is always subjective.

NURS 1300 (1 decks)

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