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NSG 300 Health Assessment > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Which description would be characteristic of fibroadenoma?

A

Freely movable and feels firm and elastic

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2
Q

Which vitamin deficiency would possibly cause xerophthalmia?

A

Vitamin A

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3
Q

Which term describes the thin layer of endothelial tissue that lines the inner surface of the heart and valves?

A

Endocardium

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4
Q

Which nutritional deficiency would contribute to osteoporosis in older adult patients?

A

Vitamin D and Calcium

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5
Q

Which organ would be located in all four quadrants of the abdomen?

A

Small intestines

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6
Q

Which feature would be characteristic of the great saphenous vein?

A

Located inside the leg

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7
Q

For which reason would an adolescent patient diagnosed with an upper respiratory tract infection complain of abdominal pain?

A

Inflammation of the mesenteric lymph nodes

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8
Q

Intercostal spaces are numbered based on which structures?

A

Ribs present above the spaces

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9
Q

Which microorganism would cause athlete’s foot?

A

Tinea Pedis

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10
Q

Which nutrient deficiency would cause papillary atrophy in a patient?

A

Niacin

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11
Q

What term would be used to document the patient’s report of painful breasts?

A

Mastalgia

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12
Q

Which structure separates the thoracic cavity from the abdomen?

A

The Diaphragm

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13
Q

Which illicit drug would be most commonly used in the United States?

A

Cannabis

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14
Q

Which method for obtaining information about dietary intake is a patient who has listed all foods eaten in the past 24 hours?

A

Obtaining a 24-hour recall

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15
Q

Which asymmetry of a patient’s calf measurements would reflect moderate lymphedema?

A

4.0 cm

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16
Q

Which medication would be a safety measure for a patient who uses oral contraceptives and is at risk for deep vein thrombosis?

A

Clopidogrel (Plavix)

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17
Q

What type of injury would be caused by friction?

A

Rug Burn

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18
Q

Wich location would the Montgomery glands be found?

A

Areola

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19
Q

What type of abuse would the nurse suspect when finding burns and belt marks on the back of a child patient?

A

Physical

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20
Q

Which soft-lobulated gland would be located behind the stomach?

A

Pancreas

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21
Q

Which intervention would the nurse perform when collecting a history from an abused 7-year-old with a hand injury?

A

Use simple language

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22
Q

While assessing a patient with an infection of the forearm, for which reason would the nurse use one hand to shake the patient’s hand and keep the other hand near the patient’s elbow?

A

Assess for enlarged epitrochlear nodes

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23
Q

Which condition would be suspected in an infant with enlarged, warm, and tender cervical lymph nodes?

A

Respiratory infection

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24
Q

What finding would support the nurse’s suspicion of pulsus paradoxes in a patient diagnosed with acute asthma?

A

Blood pressure decreases 10 mm Hg during inspiration

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25
Q

The goblet cells of the lungs serve which purpose?

A

Entrap small particulate matter

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26
Q

Which site would be appropriate for palpation of the popliteal pulse?

A

Below the knee

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27
Q

The accumulation of lymph in the breasts and upper arms would be due to an obstruction of which lymph nodes?

A

Axillary

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28
Q

What value of HDL in a male patient would qualify as a biomarker for metabolic syndrome?

A

mg/dL

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29
Q

Which purpose would the Cooper ligaments in the breast serve?

A

Support Breast tissue

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30
Q

Which finding would indicate a normal value for the breath alcohol analysis test?

A

0.00

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31
Q

Which intervention would the nurse perform when screening patients for intimate partner violence?

A

Focus on Males and Females

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32
Q

What feature would be specific to the right kidney?

A

May be palpable

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33
Q

To determine the development of tolerance with using the Tolerance, Worry, Eye-Opener, Amnesia, Kut down (TWEAK) questionnaire, which minimum number of drinks would the patient consume?

A

3

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34
Q

Where is the central axillary node of the breast located?

A

Over the ribs and serratus anterior muscle

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35
Q

Which type of abuse would involve belittling and threatening?

A

Emotional

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36
Q

Which intervention would the nurse perform for a child who has been abused?

A

Inform the legal authorities

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37
Q

Which finding would the nurse relate to Cushing syndrome during an assessment?

A

Purple-blue striae

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38
Q

Which tool collects dietary information without providing any information on the quantity of food consumed?

A

Food Frequency questionnaire

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39
Q

What PT assessment would the nurse report as a normal skin finding?

A

smooth firm skin

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40
Q

Which cause would be associated with a carked visible peristalsis?

A

intestinal obstruction

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41
Q

What skin color would the nurse observe in a child being fed vitamin A supplements regularly?

A

Yellowish-Orange

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42
Q

Which description of hypercapnia is correct?

A

increased carbon dioxide in the blood

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43
Q

Which type of drinker would describe a male who consumes two drinks a day?

A

Moderate

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44
Q

What substance would be the most used and abused psychoactive drug in the United States?

A

Alcohol

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45
Q

Which parameter would the nurse assess to determine the “W” in the TWEAK questionnaire?

A

Worry

46
Q

Which condition would the nurse anticipate when auscultating diminished bowel sounds?

A

Peritonitis

47
Q

How many thoracic vertebrae are present in the human body

A

12

48
Q

Which part of the breast is called the tail of the Spence?

A

The superior lateral corner

49
Q

Which physiological condition is the most common nutritional concern in the United States?

A

Overnutrition

50
Q

Which medical condition would be a major cause of liver cirrhosis

A

Alcohol abuse

51
Q

during the chest assessment of a patient, which reference line would the nurse note on the posterior chest wall?

A

Midspinal

52
Q

Which initial intervention would the nurse perform to confirm the position of the patient’s feeding tube prior to using it for the first time?

A

obtain a chest x-ray

53
Q

For which type of abuse would the nurse be assessing when asking the following question from the Elder Abuse Suspicion Index (EASI): Have you been upset because someone talked to you in a way that made you feel ashamed or threatened?

A

psychological

54
Q

Which condition is associated with a triceps skinfold (TSF) of 10% above the standard?

A

Overnutrition

55
Q

Which location is the human heart found?

A

Between the second and the fifth intercostal spaces from the right edge of the sternum to the left midclavicular line.

56
Q

If properly treated, how long does it take to resolve a plugged duct in the breast?

A

Less than a day

57
Q

Which resource standard would the nurse use for an adult female patient who is hesitating to file an abuse complaint against their partner because of immigration status?

A

Violence Against Women Act

58
Q

What disorder would cause calcification of the arteries?

A

Diabetes mellitus

59
Q

What assessment tool would the nurse suggest the patient use to obtain a thorough history of food consumed?

A

Food Diary

60
Q

Which patient population is most likely to be affected by scoliosis?

A

Adolescents

61
Q

Which blood vessel drains the blood from the head and upper extremities?

A

Superior vena cava

62
Q

Which statement is true regarding the right lung?

A

It is shorter than the left lung

63
Q

Which would the nurse assess first in the patient during a regional cardiovascular assessment?

A

Pulse and Blood Pressure

64
Q

Which part of the lungs is assessed on the posterior chest?

A

All parts of the lower lobes

65
Q

Which finding would indicate possible vitamin C deficiency?

A

Bleeding gums

66
Q

About which condition would the nurse educate the patient wanting a tattoo?

A

Non-Tuberculous Mycobacterial Infection

67
Q

What describes the pericardium?

A

Tough, fibrous double walled sac surrounding the heart

68
Q

Which score would alert the nurse to intimate partner violence (IPV) when using the Hurt, Insult, Threaten, and Scream (HITS) screening tool?

A

11

69
Q

Which term would the nurse use to document a rug burn found on a child’s back?

A

Friction Abrasion

70
Q

Which finding is expected during a breast assessment of an older adult patient?

A

The breast decrease in size and elasticity

71
Q

In regards to the mnemonic ABCDEF, which aspect would be represented by the “D”?

A

Diameter

72
Q

Which description of semilunar valves is correct?

A

Lie between the ventricles and the arteries

73
Q

The patient answered yes to the questions about tolerance and eye-opener and no to worry, amnesio, and kut down. Which score would be recorded using the Tolerance, Worry, Eye-Opener, Amnesia, and Kut down (TWEAK) questionnaire?

A

3

74
Q

When a patient is devoid of melanin pigment in patchy areas of the skin on the face, neck, and, feet, and body folds, which condition would the nurse document?

A

Vitiligo

75
Q

which term would the nurse document to describe individual lesions that remain separate from each other?

A

Discrete

76
Q

Which assessment finding is related to erythema in a dark-skinned patient diagnosed with polycythemia?

A

Reddish lips

77
Q

Which type of primary lesion would be superficial in the epidermis more than 1 cm in diameter and rupture easily?

A

Bulla

78
Q

Which term would the nurse use to describe the white cheesy substance on the neonate’s body?

A

Vernix caseosa

79
Q

When a child diagnosed with impetigo presents with vesicles having an erythematous base, for which additional assessment finding wold the nurse monitor?

A

Thick, honey-colored crusts

80
Q

Which skin finding present in a newborn would alert the nurse to fetal distress?

A

Greenish-brown discoloration of the nails and cord

81
Q

When would the nurse begin to assess a newborn for physiologic jaundice?

A

Around the 4th day of life

82
Q

Which physiologic mechanism causes the first heart sound?

A

Closing of the mitral valve

83
Q

Which heart rate would be found in a 4 month old infant with bradycardia?

A

50 bpm

84
Q

Which heart sound occurs because of the closure of the semilunar valves?

A

S2 Second heart sound

85
Q

Which description of chordae tendineae is correct

A

Collagenous fibers that anchor the leaflets of the atrioventricular valves

86
Q

Which section of the electrocardioram (ECG) indicates atrial depolarization?

A

P wave

87
Q

How would the nurse document a loud heart murmur with a palpable thrill?

A

4/6

88
Q

Which possible cause would be associated with a scaphoid=shaped abdomen in a 4-year-old patient?

A

dehydration

89
Q

Which medium to low-pitch systolic sound would the nurse hear when auscultating between the xiphoid process and the umbilicus?

A

Bruits

90
Q

Which observation would the nurse associate with abdominal pain related to peritonitis?

A

absolute stillness

91
Q

Which specific abdominal assessment would the nurse perform to confirm rebound tenderness?

A

Blumberg sign

92
Q

Which condition would cause the stool to be gray in color?

A

Presence of hepatitis

93
Q

To determine the most frequent method of acquisition, which question would the nurse ask a patient who abuses pain relievers?

A

“Did you get these from a friend or relative?”

94
Q

Which initial score on the Clinical Institute Withdrawal Assessment (CIWA) would warrant the nurse measuring vital signs every hour for 8 hours?

A

greater than or equal to 8

95
Q

Which score on the Clinical Institue Withdrawal Assessment (CIWA) would cause the nurse to follow the prescribed scheduled medication for the treatment of alcohol withdrawal?

A

Equal to or greater than 15

96
Q

Which score on the Alcohol Use Disorders Identification Test (AUDIT) would alert the nurse to the possibility of hazardous alcohol consumption in an adolescent?

A

Equal to or greater than 4

97
Q

Which behavioral change would the nurse observe in a patient abusing benzodiazepines?

A

Sexual aggressiveness

98
Q

When using the Alcohol Use Disorders Identification Test-C (AUDIT-C) the nurse would assign a score of 2 to which category of alcohol abuse?

A

Low-risk drinking

99
Q

Which condition would be associated with sympathetic system stimulation because of alcohol intake?

A

Vasoconstriction

100
Q

For which drug intoxication would the nurse assess in a patient who has dilated pupils, act superior and continuously scans the surroundings for threats

A

Cocaine

101
Q

Which method would be appropriate when examining large, pendulous breasts?

A

Leaning forward while the nurse supports the forearms

102
Q

Which condition is commonly found in the tail of spence?

A

Breast Cancer

103
Q

Which structure drains more than 75% of the lymph from the breasts?

A

Ipsilateral axillary nodes

104
Q

Which finding would be identified as abnormal in a patient’s breast assessment?

A

Localized redness with heat

105
Q

Which finding would indicate signs of malnutrition for a patient who recently immigrated from a developing country?

A

Dental caries

106
Q

Which beverage would the nurse avoid providing a patient of Orthodox Judaism faith who received beed at lunch?

A

Milk

107
Q

Which nutrient would be increased in the diet of a patient who has dull dry sparse hair and eczema?

A

Linoleic acid

108
Q

Which nutrient deficiency would cause red conjunctivae in the patient?

A

Riboflavin (Vit B2)

109
Q

Decreased tactile fremitus is consistent with which diagnosis?

A

Pleural Effusion

110
Q

The nurse is aware that structures at which depth are able to be assessed with percussion?

A

5-7 cm

NSG 300 Health Assessment (7 decks)

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