503 Exam 1

1) Complete database 
2) Problem-focused database
3) Emergency database  
4) Follow-up database

1) Problem-focused diagnosis
2) Risk diagnosis
3) Health Promotion

When a patient is critically ill, it is appropriate to ask which question?
A) How are you feeling?
B) Does it hurt when I push here? 
C) How did this happen?
D) Explain your pain.

All the following are examples of communication enhancers except:
A) Empathy 
B) Silence
C) “Why” questions
D) Clarification
E) Confrontation

Name four techniques that enhance communication.

A patient was admitted to the hospital the previous day with intense angina and a suspected myocardial infarction. The patient has remained in the hospital with checks every two hours. Following the diagnosis, what type of database was utilized to collect information?
A) emergency database
B) problem-focused database
C) follow-up database
D) complete database

What are the eight symptom descriptors needed in an HPI?

PQRSTU

HPI

An adolescent tells you they do not want their parent in the exam room with them. You should:
A) Ask the parent to leave the exam room
B) Call the physician
C) Tell the patient it is their parent’s choice
D) Refuse to perform the exam without a parent present

Which of the following IS NOT a component of a health history?
A) biographic data
B) reason for seeking care
C) vital signs
D) environmental health
E) functional assessment
F) past medical history

When conducting an interview, you should begin with questions about:
A) Suicide/self harm
B) Questions to get to know the patient
C) Sexuality
D) Questions that may make the patient uncomfortable

What is the correct order to perform assessment techniques (with exception to the abdomen)?
A)  Inspection → Auscultation → Palpation → Percussion
B) Inspection → Percussion → Palpation →Auscultation
C) Inspection → Palpation → Percussion →  Auscultation
D) Palpation → Percussion → Auscultation → Inspection

The width of the blood pressure bladder should be ____ of the circumference of the arm and the length of the bladder should be ____ of the circumference of the arm. Please circle the correct answer.
A) 40%, 60%
B) 60%, 60%
C) 60%, 80%
D) 40%, 80%

You are taking the blood pressure of a patient and hear the first sound at 119 mmHg and the last sound at 79 mmHg. What does this mean ?
A) The systolic blood pressure is pre-hypertensive but the diastolic pressure is normotensive.
B) The patient is in the normal range for blood pressure.
C) The reading is in the pre-hypertensive range, and the patient may benefit from increasing exercise.
D) The patient is hypertensive and should be prescribed medication.

If the cuff is too small for the individual, he or she will have:
A) false high reading
B) false low reading
C)  an accurate blood pressure reading
D) an incorrect reading

Which of the following demonstrates orthostatic hypotension?
A) While changing from supine to standing, a patient’s systolic and diastolic BP drop 10 mmHg.
B) While changing from supine to standing, a patient’s systolic BP drops by 20 mmHg and pulse rises by 20 BPM.
C) While changing from supine to standing, a patient’s diastolic BP drops by 20 mmHg and the pulse drops by 20 BPM.
D) While changing from supine to standing, a patient’s systolic BP drops 20 mmHg.

orthostatic hypotension occurs when the patient is moving from supine to standing with 2 out of 3 of the following:
A) decrease in SBP by 10; decrease in DBP by 20; increase in pulse by 20
B) decrease in SBP by 20; decrease in DBP by 10; decrease in pulse by 20
C) decrease in SBP by 20, decrease in DBP by 10; increase in pulse by 10
D) decrease in SBP by 20; decrease in DBP by 10; increase in pulse by 20

Hypertension can lead to:
A) Heart disease
B) Stroke
C) Renal disease            
D) All of the above

What is the equation for mean arterial pressure?           
A) MAP = 2/3 (DP) + 1/3 (SP)
B) MAP = (2DP + SP)1/3
C) MAP = (2DP + SP)/3
D) All of the Above

Select the indirect type of relationship (direct or indirect) between the following physiologic factors and blood pressure:
A) Cardiac output
B) Viscosity
C)  Vascular resistance
D) Elasticity of arterial walls
E) Volume

normal range for hypotension:
A) less than 100/60
B) less than 90/60
C) less than 95/60
D) less than 95/65

range for Normotension:
A) less than 120/80, but greater than 100/60.  
B) less than 130/85, but greater than 100/65
C) lesser than 110/65, but greater than 100/60
D) none of the above

Prehypertension normal range is
A) 120-139/80-89
B) 119-139/79-89
C) 121-140/81-89
D) None of the Above

Stage 2 HTN normal range
A) greater than 140/90
B) greater than 160/100
C) 140-159/90-99
D) none of the above

Stage 1 HTN normal range 
A) 140-159/90-99
B) greater than 160/100
C) 120-139/80-89
D) none of the above

individual should have yearly blood pressure screenings according to JNC 7? (SELECT ALL THAT APPLY)
A) a Hispanic man who is 38 years old.
B) a mid 30 female who whose weight is appropriate for height.
C) an obese 18 year old male.
D) a 25 year African American who is on the USA bobsled team.
E) a 39 year old male with a blood pressure reading of 130/85.

All the following are parts of the general survey except:
A) Behavior
B) Body Structure
C) Mobility
D) Appearance
E) Vitals

A patient comes in for an annual exam and these are your assessment findings: BP 119/79, HR 65, RR 26, and temperature of 35.9 C (96.6 F). How do you interpret these findings?
A) The patient is normotensive, tachypneic, and afebrile with a normal heart rate.
B) The patient is normotensive, bradypneic, and febrile, with a normal heart rate.
C) The patient is pre-hypertensive, tachpneic, and afebrile with a normal heart rate.           
D) None of the above

tachypnea

bradypnea

oral temperature normal range
A) 95.9F - 98.6F
B) 97.3F - 100.1F
C) 96.4F - 99.1F
D) 95.4F - 98.1F

Which of these statements is true about rectal temp? 
A) normal range 97.3F - 100.1F
B) most accurate 
C) higher than oral by 0.7F - 1.0F 
D) invasive
E) all of the above

hypothermia is
A) <95F
B) < 95.4F
C) <94F
D) <94.5F

low-grade fever is
A) >98.1F
B) >100.1F
C) >99.1F
D) >99.5F

high-grade fever is
A) >104.5F
B) >101.5F
C) >100.1F
D) >101.1F

normal bpm for HR is
A) 50-95 bpm
B) 55-100 bpm
C) 60-95 bpm
D) 55-95 bpm

bradycardia is
A) <50 bmp
B) <60 bmp
C) <55 bmp
D) <65 bmp

tachycardia is 
A) >100 bpm
B) >95 bpm
C) >110bpm
D) >105 bpm

normal oxygen saturation is 
A) 98-100% (pulse oximeter)
B) 90-95% (pulse oximeter)
C) 95-99% (pulse oximeter)
D) 94-98% (pulse oximeter)

hypoxemia is
A) <90%
B) <95%
C) <94%
D) <89%

pain scale is
severe:  
moderate: 
mild:  
no pain:

febrile vs afebrile

Which of the following temperature readings would cause concern for further evaluation? SELECT ALL THAT APPLY.
A) Oral temperature reading of 35.8 C (96.4 F).
B) Axillary temperature reading of 37.8 C (100.1 F).
C) Oral temperature reading of 35.5 C (95.9 F). 
D) Rectal temperature reading of 37.8 C (100.1 F).
E) Axillary temperature reading of 35.5 C (95.9 F).

older adults usually have a lower temperature than other age-groups, TRUE OR FALSE?
A) True
B) False

Identify the correct placement of the stethoscope when evaluating the apical pulse rate:
A) 5th-6th intercostal space, right mid-clavicular line
B) 4-5th intercostal space, left mid-clavicular line           
C) 4-5th intercostal space, right mid-clavicular line
D) 4-5th intercostal space, left sternal border

You are taking the apical pulse rate of an individual and count 45 beats/min. What is the next correct action?
A) Find another person to check the rate
B) Take the peripheral pulse.
C) Record the rate as a normal finding
D) Wait for a minute and then recheck the apical pulse rate 

When you assess a peripheral pulse, what should you document?
A) Rate
B) Rhythm
C) Force
D) All of the above

When assessing a peripheral pulse, you can barely feel the pulsation. You will document this as:
A) +1- thready
B) +2- normal
C) 0- absent
D) +3- bounding

normal force for peripheral force
A) 0
B) +2
C) +3
D) +1

KEY MEMORY TEMPS
40 C = 
37 C =
35 C =

normals
BP
HR
T
RR
SpO₂
pain

Which of the following patients demonstrates an abnormal finding in their vital assessment?
A) a patient with a pulse of 55 BPM, respiratory rate of 18 RPM, and oral temperature of 35.8 C.
B) a patient with a BP of 96/65, pulse of 77 BPM, oral temperature of 37.5 C, and oxygen saturation of 95%.
C) a patient with a pulse of 95 BPM, respiratory rate of 12 RPM, and oral temperature of 37.3 C.
D) a patient with a BP of 100/70, pulse of 70 BPM, respiratory rate of 20 RPM, and oxygen saturation of 99%.

You are working in the ICU and notice that your patient is obtunded. What does this mean?
A) The patient is completely unconscious and will not respond to any stimuli or pain
B) The patient is asleep and responds (withdraws) only to persistent, vigorous shaking or pain
C) The patient sleeps most of the time and needs constant stimulation, such as loud noises, or vigorous shaking, to stay awake
D) The patient is arousable by name, but drifts off to sleep when not stimulated

alert
A) needs loud shout or vigorous shake, requires constant stimulation for even marginal cooperation
B)  transitional state between lethargy & stupor, sleeps most of the time, difficult to arouse
C)  not fully alert, drifts off to sleep when not stimulated, can be aroused by name when called
D)  awake, readily aroused
E)  completely unconscious, NO response to pain, & NO motor response

lethargic
A)  transitional state between lethargy & stupor, sleeps most of the time, difficult to arouse
B)  not fully alert, drifts off to sleep when not stimulated, can be aroused by name when called
C)  awake, readily aroused
D)  completely unconscious, NO response to pain, & NO motor response
E) needs loud shout or vigorous shake, requires constant stimulation for even marginal cooperation

obtunded
A)  not fully alert, drifts off to sleep when not stimulated, can be aroused by name when called
B) needs loud shout or vigorous shake, requires constant stimulation for even marginal cooperation
C)  awake, readily aroused
D)  completely unconscious, NO response to pain, & NO motor response
E)  transitional state between lethargy & stupor, sleeps most of the time, difficult to arouse

stupor
A)  completely unconscious, NO response to pain, & NO motor response
B)  transitional state between lethargy & stupor, sleeps most of the time, difficult to arouse
C)  awake, readily aroused
D)  not fully alert, drifts off to sleep when not stimulated, can be aroused by name when called
E) needs loud shout or vigorous shake, requires constant stimulation for even marginal cooperation

coma
A)  completely unconscious, NO response to pain, & NO motor response
B) needs loud shout or vigorous shake, requires constant stimulation for even marginal cooperation
C)  awake, readily aroused
D)  transitional state between lethargy & stupor, sleeps most of the time, difficult to arouse
E)  not fully alert, drifts off to sleep when not stimulated, can be aroused by name when called

orientation (x4)

LOC

In order to check if a patient can do new learning, the nurse would ask for:
A) their normal blood pressure
B) the patient to explain how to do the new skill
C) a 24 hour diet recall
D) 4 word recall test

Which of the following are components of a mini mental state exam? SELECT ALL THAT APPLY.
A) a four word recall performed at 5, 10, and 30 minutes
B) a series of 125 questions to assess for cognitive deficiencies
C) Having the patient count down from 100 by 7s
D) Performing a clock drawing including face numbers, minute hand, and hour handAssessing for orientation to place and time

Mental Status Exam
test for?
how?
normal/abnormals?

Mini Mental State Exam
test for?
how?
normal/abnormal?

Mini Cog
test for?
how?
normal/abnormal?

Glasgow Coma Scale
test for?
how?
abnormal/normal?

Denver II
test for?
how?

CRIES
test for?
how? 
normal/abnormal?

PAINAD
test for?
how? 
normal/abnormal?

You are working in an assisted living facility and overhear a resident saying, “Take this pill? The pill is blue. I feel blue…” You know that the patient’s thought process can be categorized as:
A) Flight of ideas
B) Circumlocution
C) Echolalia           
D) Confabulation

circumlocution
FXN
DEF
EX

confabulation
FXN
DEF
EX

echolalia
FXN
DEF
EX

blocking
FXN
DEF
EX

neologism
FXN
DEF
EX

circumstantiality
fxn
defn
ex

loosening associations
FXN
DEF
EX

word salad
FXN
DEF
EX

perserveration
FXN
DEF
EX

clanging
FXN
DEF
EX

flight of ideas
FXN
DEF
EX

In an adult older than 70 years, the nurse needs to consider all of the following for assessing mental status except:
A) the sensory status of the patient
B) the patient may have a delayed response time
C) the patient may only be able to remember 2 words out of 4 words after 5 minutes
D) remembering 3 out of 4 words after 5 minutes

You observe a nursing student using the Glasgow Coma Scale to evaluate a patient. The student concludes that the patient’s eye opening score is 5, verbal score is 4, and motor response score is 6. What is the most likely conclusion about this assessment?
A) There is not enough information to determine
B) The patient is alert and oriented           
C) The patient is likely lethargic
D) The student has performed an error in their documentation

What aspects of the apical pulse are assessed?
A) Rate
B) Rhythm
C) Regularity
D) All of the above

When is it necessary to perform a full mental status assessment?
A) Abnormality in affect or behavior
B) Anxiety disorder or depression
C) When family members are concerned about a person’s behaviors
D) The new presence of aphasia
E) All of the above

Which of the following correctly demonstrates a mini-cog test?
A) The patient is assessed for orientation, performs serial 7s, and copies a picture onto a sheet of paper.
B) The patient names two simple objects handed to them, counts backwards from 100 by sevens, and repeats a phrase stated by the examiner.
C) The patient learns three unrelated words, performs a clock drawing, and then repeats the three words.
D) The patient learns four unrelated words and is asked to repeat them at 5, 10, and 30-minute intervals.

A patient has sustained damage to their frontal lobe and presents to the clinic with difficulty speaking. They are having difficulty forming sentences and primarily speak with one or two word phrases. However, the patient appears to understand speech. The nurse suspects the patient likely has:
A) Expressive aphasia           
B) Receptive aphasia
C) Wernicke's aphasia
D) Global aphasia

Wernicke's Aphasia

Aphasia
expressive vs. receptive

nociceptive vs neuropathic

What occurs during the transmission stage of nociception?
A) a signal is sent back down the spinal cord to impede the pain impulse
B) The signal is moving up the spinal cord
C) The stimulus is converted to activate the nociceptors
D) Conscious sensation of noxious stimuli in the cerebral cortex

What is false about the pain assessment?
A) Pain can vary between individuals or within the same individual at different points in their life.
B) Although pain is subjective information, the nurse should document pain in the objective section of the chart.
C) Pain intervention should be considered if a patient scores a 4 on the PAINAD scale.
D) The Faces Pain Scale is a good alternative to the numeric pain scale for patients who have trouble with written language.
E) A 7/10 pain score on the numeric pain scale is documented under subjective information, within the HPI.

What characteristics are assessed using the CRIES Pain Measurement Scale? SELECT ALL THAT APPLY .
A) Crying
B) Increased HR or BP
C) Body language
D) Negative vocalization
E) Sleeplessness

A patient has been experiencing chronic pain. What is the most accurate statement about their pain tolerance.
A) It does not change due to exposure to constant pain.
B) It has likely increased due to exposure to constant pain.
C) It has likely decreased due to exposure to constant pain.
D) It varies because pain is experienced differently for all individuals.

Which of the following would NOT alter an individual’s perception of pain? SELECT ALL THAT APPLY.
A) Fatigue                              
B) Gender
C) Genetics
D) Past experience
E) Anxiety

________ pain tends to be well localized, whereas _________ pain tends to NOT be well localized.
A) somatic/visceral
B) visceral/somatic

What are some of the causes of neuropathic pain? SELECT ALL THAT APPLY.
A) Muscle or bone trauma       
B) Diabetes, herpes zoster, AIDS
C) Subcutaneous injury
D) Side effects of medications such as chemotherapy
E) Nerve impingement

Sympathetic responses are initiated in response to _________ pain while parasympathetic responses are initiated in response to __________.
A) low-moderate/severe-deep
B) severe-deep/low-moderate

What type of pain often presents with autonomic responses, such as vomiting, nausea, pallor, and diaphoresis?
A) Somatic pain
B) Visceral pain
C) Cutaneous pain
D) Referred pain
E) Acute pain

Which of the following is a correct description of perceptual dominance?
A) Chronic progressive nerve pain involving burning, swelling, and stiffness.
B) Pain that is felt at a particular site, but originates from another location.
C) Intense pain at one area may increase the threshold at another location.
D) Pain that begins or escalates before a next scheduled analgesic dose.

What sinuses are we able to examine?
A) Sphenoid and Ethmoid
B) Frontal and Ethmoid
C) Ethmoid and Maxillary
D) Maxillary and Frontal

How do you document that a patient’s tonsils are touching the uvula?
A) +4
B) +1
C) +3
D) +2
E) +5

circum pallor
A)  cracks around mouth caused by candidiasis
B)  white around mouth caused by cold or by hypoxia
C)  CO poisoning
D) blue caused by hypoxia

cyanosis
A) blue caused by hypoxia
B)  white around mouth caused by cold or by hypoxia
C)  cracks around mouth caused by candidiasis
D)  CO poisoning

cherry red lips
A)  CO poisoning
B)  cracks around mouth caused by candidiasis
C) blue caused by hypoxia
D)  white around mouth caused by cold or by hypoxia

cheilitis
A)  white around mouth caused by cold or by hypoxia
B)  cracks around mouth caused by candidiasis
C)  CO poisoning
D) blue caused by hypoxia

A nasal polyp is distinguished from the nasal turbinates by three of the following. Which reason is INCORRECT?
A) The polyp is highly vascular and is more erythematous
B) The polyp is gray in color
C) The polyp is mobile
D) The polyp is nontender

USPSTF low risk

USPSTF high risk

JNS7 normal BP & T for older adults