Vol. 3 Chapter 5 : Secondary Assessment Flashcards
Examination
Procedure for Taking Vital Signs
- Counts the patient’s respirations
- Assesses the pulse as an indicator of circulatory function
- Assesses blood pressure with a sphygmomanometer and stethoscope
- If blood pressure cannot be heard with a
stethoscope, uses an ultrasonic Doppler - Uses a battery-operated oral thermometer to
take the patient’s temperature
Examination
Proceedure
Examining the Head
- Palpates the cranium from front to back
- Inspects the mastoid process
- Palpates the facial bones
- Palpates the TMJ
Examination
Proceedure
Examining the Eyes
- Uses a visual acuity chart to test visual acuity
- Tests peripheral vision
- Inspects the external eye
- Tests the pupil’s reaction to light
- Tests for accommodation
- Moves finger in an H pattern to test patient’s extraocular muscles
- Checks the corneal reflex
- Visualizes the interior eye with an ophthalmoscope
Examination
Procedure
Examining the Ears
- Examines the external ear
- Presses on the mastoid process
- Inspects the ear canal for drainage
- Whispers into the patient’s ear
- Visualizes the inner ear canal and tympanic membrane
Examination
Procedure
Examining the Nose
- Palpates the external nose
- Inspects the internal nose with an otoscope
- Inspects the nose for nasal obstruction
- Palpates the frontal sinus
- Palpates the maxillary sinus
Examination
Procedure
Examining the Mouth
Examining the Mouth
- Palpates the lips
- Inspects the lips’ undersurfaces
- Examines the buccal mucosa
- Inspects the tongue using a gauze pad and a
gloved hand
- Inspects under the tongue
- Has the patient say “Aaahhh” while examining the soft palate and uvula,
Examination
Procedure
Examining the Neck
- Assesses the trachea for midline position
- Palpates the carotid arteries, one at a time
- Palpates the thyroid gland
- Palpates the lymph nodes
Examination
Procedure
Examining the Chest
- Palpates the posterior chest for excursion
- Palpates the posterior chest for tactile fremitus
- Percusses the posterior chest
- Auscultates the posterior chest
- Palpates the anterior chest for excursion
- Percusses the anterior chest
- Auscultates the anterior chest
Examination
Procedure
Examining the Abdomen
- Auscultates for renal bruits
- Palpates abdomen lightly
- Palpates abdomen deeply
- Tests for ascites
Examination
Procedure
Examining the Wrist and Hand
- Palpates the DIP and PIP joints
- Palpates the MCP joints
- Palpates the wrist
- Assesses wrist flexion and extension
- Assesses radial and ulnar deviation
- Tests for carpal tunnel syndrome
Examination
Procedure
Examining the Elbow
- Inspects the elbow
- Palpates the lateral and medial epicondyles
- Assesses elbow flexion and extension
- Assesses supination and pronation of the wrist
Examination
Procedure
Examining the Shoulder
- Palpates the shoulder using fingertips
- Assesses shoulder flexion and extension
- Assesses shoulder abduction and adduction
- Assesses internal and external shoulder rotation
Examination
Procedure
Examining the Foot and Ankle
- Palpates the ankle and foot
- Palpates the metatarsophalangeal joints
- Assesses dorsiflexion and plantar flexion
- Assesses inversion and eversion of the foot
- Tests flexion and extension of the toes
Examination
Procedure
Examining the Knee
- Palpates the knee
- Palpates the patella
- Tests the collateral ligaments of the knee
- Tests the cruciate ligaments of the knee
- Assesses knee flexion and extension
Examination
Procedure
Examining the Hip
- Palpates the hip
- Assesses hip flexion with the knee flexed
- Assesses external and internal rotation of the hip
- Assesses hip abduction and adduction
Assessing
Procedure
Assessing the Cardiovascular System
- Assesses the carotid pulse
- Auscultates for bruits
- Palpates for the point of maximal impulse (PMI)
- Percusses for the PMI
- Auscultates for heart sounds
Assessing
Procedure
Assessing the Peripheral Vascular System
- Palpates the radial artery
- Palpates the brachial artery
- Palpates and compares the femoral arteries
- Palpates the popliteal pulse
- Palpates the dorsalis pedis pulse
- Palpates the posterior tibial pulse.
- Palpates for edema
Assessing
Procedure
Assessing the Spine
- Palpates the spine
- Tests flexion and extension of the head and neck
- Tests rotation of the head and neck
- Assesses lateral bending of the head and neck
- Assesses flexion of the lower spine
- Assesses lateral bending of the lower spine
- Assesses spinal extension
- Assesses spinal rotation
Assessing
Procedure
Assessing the Cranial Nerves
- Tests the olfactory nerve by having the patient identify common odors
- Tests the oculomotor, trochlear, and abducens nerves by evaluating thepatient’s extraocular movements
- Tests motor function of the trigeminal nerve by palpating the temporal andmasseter muscles
- Tests sensory function of the trigeminal nerve with sharp and dull objects
- Tests the glossopharyngeal and vagus nerves with a tongue blad
- Tests the spinal accessory nerve by having the patient shrug his shouldersagainst resistance
Assessing
Procedure
Assessing the Motor System
- Assesses the elbow’s range of motion
- Tests the patient’s grip
- Tests arm strength
- Tests for pronator drift
- Tests for coordination with rapid alternating movements
- Tests coordination with point-to-point testing
- Assesses coordination with heel-to-shin testing
Testing & Reassessing
Procedure
Testing the Reflexes
- Tests the biceps reflex (cervical nerves C5 and C6)
- Tests the triceps reflex (cervical nerves C6, C7, and C8)
- Tests the brachioradialis reflex (cervical nerves C5 and C6)
- Tests the quadriceps reflex (lumbar nerves L2, L3, and L4)
- Tests the Achilles reflex (sacral nerves S1 and S2)
- Tests the plantar reflex (central nervous system)
- Tests the abdominal reflexes (thoracic nerves T8, T9, T10, T11, T12)
Testing & Reassessing
Procedure
Reassessment
- Reassesses the ABCs
- Takes all vital signs again
- Performs focused assessment again
- Evaluates effect of interventions
The process of informed observation is:
A .Palpation
B. Inspection
C. Percussion
D. Auscultation
B. Inspection
Which of the following is not a type of percussion:
A. Pointed
B. Blunt
C. Direct
D. Indirect
A. Pointed
It is best to examine which of the following patients
using the toe to head method?
A. 6-year-old child complaining of a sore throat
B.12-year-old female patient complaining of difficulty
breathing
C. 2-year-old child with a fractured arm
D. 9-month-old infant with a fever
D. 9-month-old infant with a fever
Voice changes that are caused by vocal cord
problems are known as:
A. Dysarthria
B. Aphasia
C. Dysphonia
D. Dysphasia
C. Dysphonia
The first physical exam finding you will often observe
with an emergency condition is a change in:
A. Blood pressure
B. Pulse rate
C. Respiratory rate
D. Mental status
D. Mental Status
___________ usually indicates an increase in
sympathetic nervous system stimulation as the body compensates foranother problem.
A. Shortness of breath
B. Bradycardia
C. Tachycardia
D. Chest pain
C. Tachycardia
The difference between the systolic and diastolic
pressures is known as:
A. Pulse pressure
B. Mean arterial pressure
C. Blood pressure differential
D. Mean systemic pressure
A. Pulse pressure
A positive orthostatic vital sign change means that
upon standing the patient’s pulse rate:
A. Decreased by 5 beats per minute
B. Decreased by 15 beats per minute
C. Increased by 5 beats per minute
D. Increased by15 beats per minute
D. Increased by15 beats per minute
A blood pressure cuff fits the patient correctly if it
covers:
A. One-third of the upper arm
B. Two-thirds of the upper arm
C. One-half of the upper arm
D. The entire upper arm
B. Two-thirds of the upper arm
Skin color should be assessed where the _________
is thinnest.
A. Epidermis
B. Dermis
C. Capillary bed
D. Papillary layer
A. Epidermis
An elevated, palpable area containing liquid or
viscous matter is called a/n:
A. Pustule
B. Bulla
C. Cyst
D. Fissure
C. Cyst
Clubbing of the fingernails occurs because of:
A. Transient hypoxia
B. Chronic hypoxia
C. Transient hypercapnia
D. Chronic hypercapnia
B. Chronic hypoxia
Which of the following cranial nerves does NOT
control eye movement?
A. Trigeminal nerve
B. Oculomotor nerve
C. Trochlear nerve
D. Abducens nerve
A.Trigeminal nerve
The ___________ is a coiled structure that transmits
sound to the acoustic nerve.
A. Malleus
C. Stapes
B. Concha
D. Cochlea
D. Cochlea
Battle’s sign is a common but late sign of:
A. A hemorrhagic stroke
B. Increased intracranial pressure
C. A basilar skull fracture
D. Mandibular fracture
C. A basilar skull fracture
An adult normally has _____ permanent teeth.
A. 24
B. 32
C. 28
D. 34
B. 32
To examine the postauricular lymph node, you
palpate:
A. At the base of the mandible under the chin
B. Along the underside of the jaw
C. On the tragus and “milk” anteriorly
D. On or under the mastoid process
D. On or under the mastoid process
Popping, nonmusical sounds heard during inspiration
are called:
A. Wheezes
B. Stridor
C. Rales
D.Rhonchi
C. Rales
The resistance in the vessels that the heart must
overcome to eject blood is called:
A. Preload
B. Afterload
C. Mean arterial pressure
D. Pulse pressure
B. Afterload
Tennis elbow is found by palpating the:
A. Capitulum
B. Trochlea
C. Lateral epicondyle
D. Medial epicondyle
D. Medial epicondyle
Memory can be divided into three grades: ____________,
___________, and __________.
Immediate, recent, remote
The force of blood against the arteries’ walls as the heart contracts and relaxes creates the patient’s ____________ ____________.
Blood pressure
The scalp has five layers of tissue that can be remembered by the acronym SCALP, which stands for: ____________, ____________,
_______________, _____________, and _____________.
Skin
Connective tissue
Aponeurosis
Loose tissue
Periosteum
When testing a patient’s visual acuity, you should place the patient 20 ______ from a visual acuity wall chart or hold a visual acuity card 14_______ from his face.
20 Feet
14 Inches
The inner ear cavity contains the _____________________, the
_______________ ______________, and the _______________.
Vestibule, semicircular canals, cochlea
When assessing your patient’s ear, you should pull the helix _____________ and __________, and press on the ______________ and
the _______________ _________________.
Upward,
outward,
tragus,
mastoid process
The salivary glands include the:
_________________ ___________, _________________ __________,
_______________ ____________, ___________________ _____________,
_________________ ______________, ________________ ____________.
Posterior auricular, occipital, superficial cervical, posterior cervical, supraclavicular, preauricular,
tonsillar, submental, submandibular,
deep cervical chain
When assessing a patient’s chest, you should auscultate for the
following adventitious breath sounds: ______________,
________________, ______________, ______________, ____________
__________.
Crackles, wheezes, rhonchi, stridor, pleural rubs
Vibrations felt on a patient’s chest wall when he speaks are called
_______________ _____________.
Tactile fremitus
______________ _____________ _________ are the squeaking
or grating sounds of the pleural linings rubbing together.
Pleural friction rubs
__________ is the amount of blood returned to the heart from the body.
Preload
During systole the ventricles contract and the __________ and
____________ valves close.
Tricuspid, mitral
When attempting to listen for the S2 heart sound, you place your
stethoscope at the _________ ___ ___ ________.
Base of the heart
A third heart sound, usually considered pathological in patientsover the age of 30, is sometimes called the ____________ ___________.
Ventricular gallop
The large intestine has three distinct sections, including the _________ ______, the _________ __________, and the______________ _____________.
Ascending colon, transverse colon, descending colon
The proximal attachment of a tendon to a bone is called the ________, and the distal attachment
is called the ______________.
Origin, insertion
The six type of joints are: __________ and ___________, ___________, _______________, ______________, ___________________,
and ____________.
Ball,
socket,
condyloid,
gliding,
hinge,
pivot,
saddle
C1 is comminly referred to as the ___________, and C2 is
commonly referred to as the ______________.
Atlas, axis
Areas of skin that are innervated by afferent fibers are known as
________________.
Dermatomes