NSG 500 EXAM 1 (From Blosser's Zoom Review)

Question 1

1. Interviewing skills: how to approach patients, start the process, and obtain information.

So what is the best interview technique when trying to get information from somebody? Open-ended questions. Give patient time to answer the questions. Give them time to tell their stories. Basically an open-ended interview technique.

If the patient says something to you that is confusing, ask them more specific questions. If when using that open-ended interview technique, and the patient mentions something, that is the time to ask more specific questions. Example: “How long exactly has it been going on?” “Has it been a day, a week, a month?”

Answer 1

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Question 2

2. Cultural sensitivity: Purpose, reason it is important, how culture may impact aspects of an exam of emotional health.

The definition of cultural sensitivity: Being aware and understanding of the different beliefs of different cultures, specifically those that are different from your own. Understanding that there are cultures and beliefs and values that are different from your own.

For example if you are attempting to give a child a flu vaccine and the parent does not want it, the first you do is to try to understand where they are coming from, why they do not want vaccination. Is it a cultural issue? Is it a misbelief they might have that you can do some education on? But, you have to question with sensitivity, and by making sure you understand where they’re coming from. So just ask more questions.

This could involve things like vaccines, blood transfusions and other blood products, also nutrition and diet, etc. All of these things could play into cultural beliefs. The first thing is understanding where they’re coming from and why they’re against something.

Also with cultural stuff, understanding that different cultures display different emotions; some cultures can be very stoic. You can’t really use body language or facial expressions to gauge what they’re feeling. So you might have to actually ask questions and inquire. Some cultures are prone to outbursts and have high emotions. Understand that that could be a culture/diversity issue.

Question 3

3. The steps for assessment: inspection, palpation, percussion, auscultation.

• You’re going to assess all the body systems in the same order and way except for the abdomen.
• For the abdomen: inspection, auscultation, palpation, percussion.

Question 4

On which part of the body can you feel vibrations most effectively? This is the ulnar side of the hands; this can be used on the back to check the lungs.

Question 5

Where do you have good fine discrimination feeling? Fingertips. Use your fingertips when checking for lymph nodes.

Question 6

What is the definition of resonant, and where would we use that terminology? Resonant means that you can hear it effectively and it’s going to be something that is air-filled. So when you’re listening to normal lungs they should sound resonant.

Where might you hear “dull?” Or feel dull? The liver. A solid organ. When percussing you may feel a dullness over the liver. Percussing over the lungs should be high-pitched and resonant.

Question 7

3. When are you inspecting?

You’re always inspecting, everywhere on the body. You’re always using your eyes and you’re always looking. Inspection is first in order but you are always inspecting regardless.

Question 8

3. What is the best technique for auscultation?

You want to make sure the environment is quiet and that the stethoscope is up against naked skin.

Question 9

3. When you are using your otoscope, when would you use a pneumatic tube?

You want to put air on the tympanic membrane, and you would do this in pediatrics. You’re putting a little bit or air in there and checking for bulging of the tympanic membrane. It’s because everything is smaller and harder to see in the ear of a child. You’re looking for pressure behind the tympanic membrane.

Question 10

3. What is the correct technique to perform an otoscopic exam for an adult?

How are you going to position the ear? Up and back.

Question 11

3. What is the correct technique to perform an otoscopic exam for a child?

How are you going to position the ear? Down and back.

Question 12

4. Equipment:

What is one piece of equipment that you are not going to use on a pediatric patient? (infant or toddler)

It’s the reflex hammer. You’re going to use your hand instead.

Question 13

4. Equipment:

What is the ophthalmoscope for?

It’s used for the eye, especially fundoscopic exam.

Question 14

4. Equipment:

The Wood’s lamp is used to look at the eye and different parts of the skin to find fungus, corneal abrasions.

Question 15

5. Indications of cognitive impairment (history or PE findings):

If you have an older adult that is showing signs of cognitive impairment (like a dementia dx), the first thing they are going to do is try to hide it, or make excuses, or downplay symptoms, or deny it. They may show some inappropriate emotions. May laugh when asked a difficult question. May divert the question to something else that is easier to answer. May get really angry and say they aren’t answering the question.

Question 16

6. Areas of the brain and their function.

• the parietal part deals with sensation
• the temporal deals with auditory and memory
• the frontal controls behavior and emotion, vocabulary, and speech
• cerebellar gives you sense of place, handwriting, fine motor control, drawing

Question 17

7. Main findings in acromegaly:

• acromegaly is a type of gigantism.

What specifically is going to be enlarged?

• hands, tongue, facial features

Question 18

7. What is Turner syndrome?

• A missing ‘X’ chromosome. Can only affect women. Only females can be diagnosed. So because of the missing X chromosome you will get a lack of sexual development, including under-developed ovaries. They are also very prone to heart defects.

Question 19

7. What is Cushing’s syndrome?

• A disease characterized by too much ACTH and cortisol.
• Overgrowth of hair, especially facial hair.
• Moon-shaped or rounded face
• buffalo hump
• hyperpigmentation in different areas

Question 20

7. What is precocious puberty?

• super early sexual development

Question 21

8. Exam findings indicative of nutritional deficiency, assessment of nutrition and protein status.

What are the symptoms of a vitamin B deficiency?

• fatigue, heart palpitations, sores in corner of your mouth, decreased energy, fatigue, SOB, some palpitations

Question 22

8. Exam findings indicative of nutritional deficiency, assessment of nutrition and protein status.

What are the symptoms of a vitamin E deficiency?

• affects muscle and nerve function

Question 23

8. Exam findings indicative of nutritional deficiency, assessment of nutrition and protein status.

What is the most common lab finding to diagnose a protein deficit? Albumin.

Question 24

9. Milestone developments (latest times). (walk, talk, use sentences)

At what age (and this is up to) would you expect to see walking? 18 months.

Question 25

9. Milestone developments (latest times). (walk, talk, use sentences)

At what age (and this is up to) would you expect to hear talking (1-2 words): 12 months

Question 26

9. Milestone developments (latest times). (walk, talk, use sentences)

At what age (and this is up to) would you expect to hear talking (full sentences): 36 months

Question 27

10. Differences between subjective and objective data.

self-explanatory.

If can’t see, hear, or feel then it’s subjective.

Question 28

11. Skin lesions

Macule - flat and small, like a freckle. An area of pigmentation that you cannot palpate

Question 29

11. Skin lesions

wheal - Redness, white and inflamed, raised, feels soft or kind of boggy to the touch. An example would be hives or an insect bite.

Urticaria would be multiple areas of these hives.

Question 30

11. Skin lesions

papule - The area will be raised, and you’ll be able to palpate it. It’s going to be circumscribed, so it’ll be something like a skin tag. Could be a scab, or pimple that’s not ready to pop.

An example would be molluscum.

Question 31

11. Skin lesions

pustule - Has pus in it. So an abscess, pimple, etc.

Question 32

11. Skin lesions

vesicle - raised area with fluid. That fluid is going to be serous.

An example would be a herpetic lesion.

Question 33

11. Skin lesions

impetigo - common staph or strep infection on the face. Usually kids will get it. They’ll get a bunch of red sores and require antibiotics to treat it.

Question 34

11. Skin lesions

When are you going to be concerned about a mass or lesion?

• irregular borders
• different colors
• change in size
• painfulness
• if it becomes immobile
• if it bleeds easily

Question 35

11. Skin lesions

Herpes - Herpetic lesions will give you the vesicular rash.

Question 36

12. What are normal changes in the skin of an older adult?

• loss of skin turgor
• thinning
• wrinkles
• skin tags
• severia keratosis (areas of severe pigmentation and dark brown spots; non-cancerous, benign)
• cherry angiomas (conglomeration of blood vessels right beneath the skin)

Question 37

11. Skin lesions

Basal cell carcinoma - going to be an open area with red patches.

Question 38

11. Skin lesions

Solar keratosis - s pre-malignancy or malignancy. Has scaly areas that are raised. These require a biopsy because they are pre-cancerous.

Question 39

11. Skin lesions

malignant melanoma - a mole that’s increased in size, changes color, has gotten darker, has gotten irregular.

Question 40

13. What to expect when palpating lymph nodes

How do you differentiate infection from malignancy?

• if hard, non-tender, doesn’t move, fixed: likely malignant
• Tender and mobile: infection or inflammation

Question 41

13. What to expect when palpating lymph nodes

You should not be able to palpate normal lymph nodes, and if you do they should feel elastic.

Question 42

13. Normal changes in the adult regarding their lymph

• fibrotic lymph nodes
• they’ll feel fatty

Fibrotic and fatty are the key words you’ll need to focus on.

Question 43

13. Areas you’ll be able to do a lymph node exam

• popliteal (fossa behind the knee)
• inguinal area
• the iliac
• mesoteric and splenic in abdominal exam (maybe)
• epitrochlear
• brachial
• supraclavicular
• cervical
• occipital
• pre-orricular

Question 44

13. What is one way to differentiate between a lymph and a cyst?

• illuminate it
• it may have surrounding redness as well
• may be fluctuant, feeling boggy

Question 45

14. What is the best way to palpate the thyroid?

• from standing behind them.
• have them swallow, and you should feel the thyroid elevate

Question 46

15. Hypothyroidism

What are some findings?

• weight gain
• hair loss
• everything slows down
• cold
• bradycardia
• constipated
• dry skin
• decreased metabolism

Question 47

15. Hyperthyroidism

What are some findings?

• weight loss
• bulging eyes (exopthalmus)
• tachycardia
• hot skin
• fast metabolism
• skinny and hungry

Question 48

16. History of findings suggestive of different types of headaches: migraine, tension, cluster

Migraine - typically associated with nausea and vomiting. Can be unilateral or bilateral. Described as a throbbing or pulsing sensation.

Tension headache - going to go across the frontal area. It’s going to be a squeezing or banding sensation.

Cluster headache - what you’re going to feel behind ONE eye. An area of intensity behind the eye, and it’s going to feel like a lot of pressure.

Question 49

17. How is pain assessed? What is the gold standard?

Gold standard: “pain is what the patient says it is.” (Not true, not always)

At what age can you reliably use a pain scale on a pediatric without observation?

• 3 years of age

Question 50

18. Overall changes in the older adult to differentiate normal from abnormal?

• fibrotic thyroid and skin changes are going to be normal findings

Question 51

19. Nutrition: What is a normal BMI? Overweight BMI? Obese BMI? Physical signs of nutrient deficiency?

• Normal BMI is 18-24
• Overweight BMI is 25-29
• Obese BMI is greater than 30

Question 52

20. What is physiologic jaundice of the newborn?

When is it normal and what does it indicate if abnormal?

• Normal is 2-3 days after birth. That would be considered physiologic.
• If it’s later than that, that would be a bad finding, and it’s usually going to indicate hemolysis.

Question 53

21. If you trans-illuminate the skull of an infant, what are you looking for?

• hydrocephalus

Question 54

22. What are normal/abnormal skin changes in pregnancy?

• linea negra: that fine line of hair that goes from the umbilicus down to the pubic-ranus(?)
• might have some itching
• they could develop some varicose veins and some spider veins
• you could see stretch marks or striae

Question 55

Where do the lymph nodes stop in the arm?

The trochlear area. elbow.

Question 56

How far down in the legs would you expect to feel for lymph nodes?

• the popliteal area behind the knee.