Exam 3 - advanced health assessment Questions & Answers; Updated A Plus Guide XI Spinal, Exams of Nursing

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Exam 3 - advanced health assessment Questions & Answers; Updated A Plus Guide XI Spinal Accessory - Ans>>>- shoulder movement - head rotation tests * head/neck rotation against resistance * shrug shoulder against resistance IX Glossopharyngeal - Ans>>>-sensations from throat, taste - swallowing * listen to voice quality, volume, characteristics, articulation of words X Vagus - Ans>>>- movement of palate, larynx + swallowing, gag reflex * Ask patient to say "ah" * Observe rising of soft palate/uvula * Observe swallow * Check gag reflex VIII Vestibulocochlear - Ans>>>- hearing, balance - test one ear at a time - whisper test - stand behind patient 1-2 feet away, whisper 2 syllable word, increase volume as necessary VII Facial - Ans>>>- taste - facial muscle movement - expressions - raise eyebrows - close eyes tight with resistance - frown, smile - show upper and lower teeth - puff out cheeks with resistance VI Abducens - Ans>>>- extraocular eye movements - assess directions of gaze - moves eyes laterally - can be normal in those under age 40 and trained athletes - brief mid diastolic impulse Mitral area - Ans>>>- Apical area - Apex of the heart - 5th left intercostal space at the midclavicular line All People Enjoy Time Magazine Tricuspid area - Ans>>>- 4th left intercostal space at the left sternal border All People Enjoy Time Magazine Erb's point - Ans>>>- 3rd left intercostal space at the medial left sternal border - can only be heard in the left lateral recumbent position Pulmonic area - Ans>>>- 2nd left intercostal space at the upper left sternal border Aortic area - Ans>>>- 2nd intercostal space at the upper right sternal border Left ventricle - Ans>>>- is the pumping chamber of the left side of the heart - generating 5 x the pressure vs the right - oxygenated blood -> through the aortic valve into the aorta -> throughout the body Left atrium - Ans>>>- collects the pulmonary venous return from the 4 main pulmonary veins - left atrium -> blood through the mitral valve -> into the left ventricle Right ventricle - Ans>>>- pumping chamber of the right side of the heart - pumps deoxygenated blood through -> pulmonic valve into the pulmonary artery - 2 main branches of pulmonary artery deliver pulmonary cardiac output to the lungs for oxygenation Right atrium - Ans>>>- receives systemic venous return from the inferior and superior vena cava - this blood is deoxygenated from its travels through the body - RA gets blood -> goes through the tricuspid valve -> directs into the right ventricle Heart - Ans>>>- right and left atria receive blood - right and left ventricles pump it out Peritonitis - Ans>>>signs - positive cough test: cough produces pain - guarding: voluntary contraction of abdomen wall - rigidity: involuntary reflex contraction - rebound tenderness: pain on withdrawal - percussion tenderness: percuss gently Rigidity makes 4 x more likely Abdomen Deep palpation abnormal - Ans>>>- Physiologic - pregnant uterus - Inflammatory - diverticulitis - Vascular - abdominal aortic aneurysm - Neoplastic - colon cancer - Obstructive - distended bladder or dilated loop of bowel Abdomen Deep palpation normal - Ans>>>- to identify abdominal masses -location -size - inferior vena cava obstruction: dilated veins - intraperitoneal hemorrhage: ecchymosis abdominal wall - intestinal obstruction: increased peristaltic waves - aortic aneurysm: increased pulsation Abdomen Inspection normal - Ans>>>- scar, old silver striae/stretch marks - small veins - symmetric contour - persitalsis may be visible in very thin people - pulsation of aorta is frequently visible in the epigastrium Split s2 - Ans>>>- commonly a normal event - heart beat at the top of the heart s1 - Ans>>>- the first heart sound - mitral and tricuspid valves close - heard best at APEX s2 - Ans>>>- the second heart sound - aortic and pulmonic valves close - heard best at TOP of the heart Chest pain personal history - Ans>>>- dyspnea, orthopnea - paroxysmal nocturnal dyspnea - cough - palpitations - fatigue - decreased appetite - skin changes: color change in hands or feet - skin changes: shiny shins with hair loss Congenital heart defect children - Ans>>>- tiring during play - squatting position - unexplained joint pain or fever Deep tendon reflexes - Ans>>>0 : absent 1+ : diminished 2+ : normal 3+ : more brisk than normal 4+ : hyperactive 5+ : clonus XII Hypogloassal - Ans>>>- tongue movement - inspect tongue - stick tongue out and note position: midline/deviation - move tongue side to side - check strength Epigastric hernia - Ans>>>- A small midline protrusion through a defect in the linea alba between the xiphoid and the umbilicus - Protrudes when patient raises head or shoulders Incisional hernia - Ans>>>- postoperative hernia caused by a weakness in the abdominal wall from the incision or postoperative complications -protrusion through an operative scar Umbilical hernia - Ans>>>- Protrusion through defective umbilical ring - most common in infants - In infants, usually closes spontaneously within 1-2 years Hernias - Ans>>>- have patient raise both head and shoulders off the table -> hernia will bulge - fever, chills, warmth, redness - joint pain, swelling, warm skin around the joint, trouble moving the joint, fever - only affects one joint usually - bacteria causes infection of the joint Anterior drawer test - Ans>>>- test ligamentous stability of the anterior cruciate ligament - ACL - patient lays supine with knee flexed, examiner pulls lower leg forward - sit on patient foot to stabilize and pull Lateral epicondylitis - Ans>>>- AKA tennis elbow - tenderness distal to the epicondyle McMurray test - Ans>>>- test for mensicus injury - medial and lateral - have patient lay supine, flex knee and hip; externally rotate leg while extending leg out - if you hear a "click" or a "pop" along the medial joint with valgus stress, then positive - a positive sign AND locking make it more likely Phalen's test - Ans>>>- test for carpal tunnel - median nerve compression - have patient press back of hands together to form right angles - numbness or tingling in the median nerve distribution within 60 seconds is positive Tinels' test - Ans>>>- test for carpal tunnel -tap lightly over the course of the medial nerve - aching and numbness in the median nerve distribution is a positive test CVA - Ans>>>- hemiparesis - hemipalegia - ataxia Babinski Test - Ans>>>- plantar reflex - stroke plantar surface of foot - positive test is dorsiflexion of the big toe and fanning of the other toes - may be normal in some infants until age 2 years Kernig Test - Ans>>>- sign of meningeal irritation - patient lays supine, flex patients hip and knee, and then straighten leg - back pain and resistance to extending is a positive test - if bilateral, more likely to be meningeal irritation Brudzinski Test - Ans>>>- sign of meningeal irritation - patient lays supine, lift patients head up ( flex neck ) and hip and knees will automatically flex = positive test Pronator drift test - Ans>>>- tests balance + upper extremity weakness - patient stands for 30 seconds with both arms straight forward, palms up, eyes closed - tap the arms briskly downward - arms should return normally - drift is pronation of one forearm Romberg Test - Ans>>>- patient stands with feet together, arms at side and eyes open and then close eyes for 30-60 seconds without support - ability to maintain upright posture - loses balance with eyes closed = positive test fractured bone - Ans>>>- point tenderness - ecchymosis - inflammation Thompson Test - Ans>>>- Achilles tendon rupture test - squeeze back of calf at the same time, toes will hyper flex - absence of toes flexing = positive test Grading muscle strength 0 - Ans>>>- no muscular contraction Osteoarthritis - Ans>>>- Heberdens nodes at the DIP joints - usually hard, painless - middle aged to elderly - bony overgrowth Rheumatoid arthritis - Ans>>>- asymmetric deformity in the PIP + MCP and wrist joints and ulnar deviation - MCP's are boggy or tender - bilateral swelling/tenderness for several weeks GOUT - Ans>>>- isolated swelling of big toe - red, hot, swollen - sudden onset, excessive food or alcohol intake Meniscus injury of the knee - Ans>>>- positive McMurray test - tear may displace meniscal tissue causing "locking" on full knee extension - A McMurray sign and "locking" make diagnosis more likely Straight leg raise - Ans>>>- tests lumbosacral radiculopathy - pain radiating into the ipsilateral leg (same leg) Herniated disc - Ans>>>- "listing" of the truck to one side - sciatic nerve tenderness (difficult to palpate in most patients) Carpal tunnel syndrome - Ans>>>- repetitive motion with wrists flexed (e.g. keyboard use or mail sorting) pregnancy, rheumatoid arthritis, diabetes or hypothyroid - positive thumb abduction test (have patient raise thumb against resistance) - diagrams that confirm sensory symptoms in the hand - and decreased sensation in the median nerve distribution - all of these double the likelihood Aortic stenosis - Ans>>>- a medium pitched harsh systolic murmur - best heard at the right upper border of the sternum Grade IV murmur - Ans>>>- first time a thrill is palpated Diastolic murmur Mitral stenosis - Ans>>>- "stiff" mitral valve causes turbulence in diastole when blood flows through it - whooping sound, decrescendo, low pitch rumble, opening snap - apex, 5th intercostal space MCL, after S2, diastolic Holosystolic murmur Mitral regurgitation - Ans>>>- pressure in left ventricle greater than left atrium - high pitched best heard at Apex, in left lateral position - starts with s1 continues until s2