Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ruben's Nursing 50A > Fundamentals: Chapter 30 > Flashcards

Fundamentals: Chapter 30 Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Mental Health flashcards Nursing Management of Care flashcards NCLEX-PN® flashcards NCLEX-RN® flashcards Nursing Fundamentals flashcards Nursing Pediatrics flashcards Nursing Safety & Infection flashcards Nursing Pharmacology flashcards Nursing Maternity flashcards Family Nurse Practitioner (FNP) flashcards
1
Q

What does a complete health assessment involve?

A

nursing history and behavioral and physical examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When should you perform a reassessment?

A

when a patient’s condition changes as it improves or worsens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two types of palpation used for a physical examination?

A

light and deep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What involves tapping the skin with the fingertips to vibrate underlying tissues and organs?

A

percussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What involves listening to sounds the body makes to detect variations from normal?

A

auscultation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is important to remember when assessing skin pallor on a dark-skinned patient?

A

normal brown skin appears to be yellow-brown and normal black skin appears to be ashen gray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the best site to assess for jaundice?

A

sclera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the term for red discoloration?

A

erythema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What refers to the character of the skin and how the deeper layers feel?

A

skin texture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is induration?

A

hardening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What refers to the elasticity of the skin?

A

turgor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the term for when pressure from an examiners fingers leave an indentation in the edematous area?

A

pitting edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the most common neoplasms in patients?

A

skin (cutaneous) malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common carcinoma in sun-exposed areas and frequently occurs with a history of sun-damaged skin?

A

Basal cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which carcinoma develops on the outer layers of sun-exposed skin?

A

Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which skin cancer develops from melanocytes and often begins as a mole?

A

malignant melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does ABCD stand for when assessing the skin for any type of carcinoma?

A

Asymmetry

Border irregularity

Color

Diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the two types of hair that cover the body?

A

soft, fine, vellus hair, which covers the body; and coarse, long, thick terminal hair, which is easily visible on the scalp, axillae, and pubic areas and in the beard on men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a change in angle between nail and nail base

A

clubbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are transverse depressions in nails indicating temporary disturbance of nail growth

A

Beau’s lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a concave curve in a nail?

A

Koilonychia (spoon nail)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are red or brown linear streaks in the nail bed?

A

splinter hemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is inflammation of the skin at the base of the nail?

A

Paronychia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does an examination of the head and neck include?

A

assessment of the head, eyes, ears, nose, mouth, pharynx, and neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What does an examination of the eyes include?

A

assessment of visual acuity, visual fields, extraocular movements, and external and internal eye structures

26
Q

What is an involuntary, rhythmical oscillation of the eyes

A

nystagmus

27
Q

What is responsible for tear production?

A

lacrimal gland

28
Q

What is a thin white ring along the margin of the iris? When is it uncommon?

A

arcus senilis

under 40 yrs old

29
Q

What does an observation of the pupils include?

A

size, shape, equality, accommodation, and reaction to light

30
Q

What do cloudy pupils indicate?

A

cataracts

31
Q

What do dilated pupils result from?

A

glaucoma, trauma, neuro disorders, eye medication, withdrawal from opioids

32
Q

What do constricted pupils indicate?

A

inflammation of the iris, drug use

33
Q

What does pinpoint pupils indicate?

A

opioid intoxication

34
Q

What can alter pupillary reaction?

A

changes in intracranial pressure, lesions along the nerve pathways, locally applied ophthalmic medications, and direct trauma to the eye

35
Q

What kind of nurse uses an ophthalmoscope to inspect the internal eye structures?

A

APRN

36
Q

What does an ear assessment involve?

A

the integrity of ear structures and hearing acuity

37
Q

How does a nurse assess the integrity of the nose and sinuses?

A

inspection and palpation

38
Q

What is the purpose of assessing the mouth and pharynx?

A

detect signs of overall health; determine oral hygiene needs; and determine therapies needed for patients with dehydration, restricted intake, oral trauma, or oral airway obstruction

39
Q

What does the assessment of the neck include?

A

assessing the neck muscles, lymph nodes of the head and neck, carotid arteries, jugular veins, thyroid gland, and trachea

40
Q

What does an abnormality of superficial lymph nodes sometimes reveal?

A

the presence of an infection or malignancy

41
Q

What are the vibrations in the chest wall created by sounds waves during speech called?

A

vocal or tactile fremitus

42
Q

What are the 3 normal breath sounds?

A

Vesicular

Bronchovesicular

Bronchial

43
Q

What are the 4 types of adventitious breath sounds?

A

crackles

rhonchi

wheezes

pleural friction rub

44
Q

What is the failure of the heart to beat at regular successive intervals called?

A

dysrhythmia

45
Q

What is caused by a premature rush of blood into a ventricle that is stiff or dilated as a result of heart failure and hypertension

A

ventricular gallop

46
Q

What are are sustained swishing or blowing sounds heard at the beginning, middle, or end of the systolic or diastolic phase

A

murmur

47
Q

What is a murmur that occurs between S1 and S2?

A

systolic murmur

48
Q

What is a murmur that occurs between S2 and the next S1?

A

diastolic murmur

49
Q

How do you assess for radiation when listening to the heart sounds?

A

listen over areas in addition to where it is heard best such as over the neck or back

50
Q

What is a continuous palpable sensation that resembles the purring of a cat?

A

thrill

51
Q

What is the term for vascular narrowing?

A

stenosis

52
Q

What is the blowing sound that is created by turbulence when blood passes through a narrowed section?

A

bruit

53
Q

What are the most accessible veins for examination?

A

internal and external jugular veins in the neck

54
Q

When does a nurse assess the lymphatic drainage of the lower extremities?

A

during examination of the vascular system or during the female or male genital examination

55
Q

How does a nurse assess the lymphatic drainage of the upper extremities?

A

gently palpate the epitrochlear nodes, located on the medial aspect of the arms near the antecubital fossa

56
Q

When is the best time for a breast self exam (BSE)?

A

the fourth through seventh day of the menstrual cycle or right after the menstrual cycle ends, when the breast is no longer swollen or tender from hormone elevations

57
Q

What does an abdominal assessment include?

A

assessment of structures of the lower gastrointestinal (GI) tract in addition to the liver, stomach, uterus, ovaries, kidneys, and bladder

58
Q

What is used for an objective measurement of consciousness?

A

Glasgow Coma Scale

59
Q

What are common pressure points?

A

Pinna, shoulder blades, elbows, sacrum and coccyx, knees, heels, toes

60
Q

What can cause increased GI motility?

A

Inflammation of the bowel, anxiety, diarrhea, bleeding, excessive ingestion of laxatives, and reaction of the intestines to certain foods

61
Q

What is the term for hyperactive GI sounds that are loud, “growling” sounds?

A

borborygmi

Ruben's Nursing 50A (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions