NSG 3160 LATEST EXAM 2 COMPREHENSIVE QUESTIONS WITH 100% SOLUTIONS-GUARANTEED PASS, Exams of Nursing

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NSG 3160 LATEST EXAM 2

COMPREHENSIVE QUESTIONS

WITH 100% SOLUTIONS-

GUARANTEED PASS

Mental status is defined as A.) A pt's emotional & cognitive function B.) The pt's conscious, mood, and affect C.) General Intelligence D.) Pt's perception A.) A pt's emotional & cognitive function A mental disorder is best defined as A.) Presence of phobia B.) A lack of rational thought and abstract researching C.) Extreme behavior that is usually associated with stress D.) Remote memory from years ago may be impacted C.) Extreme behavior that is usually associated with stress The A, B, C, and T of the mental health assessment is A.) Attitude, behavior, cleanliness, talk/speech B.) Appearance, behavior, cognition, and thought C.) Airway, breathing, circulation D.) Ability, beliefs, culture, traditions B.) Appearance, behavior, cognition, and thought Which of the following best describes a pt's appearance? A.) Posture is erect and body movement is voluntary B.) Pt is oriented x C.) Pt is awake, alert, and aware and responds appropriately D.) GAD score > 3 A.) Posture is erect and body movement is voluntary One method a nurse can use to assess recent memory A.) Assess a pt's ability to complete a thought without wandering B.) Ask pt for a 24 hour diet recall C.) Ask about pt's first job D.) Perform 4 unrelated words test B.) Ask pt for a 24 hour diet recall Recent memory deficit can occur with delirium and dementia A.) True B.) False

B.) Responds only to persistent shaking or pain C.) Will wake with loud shouting or vigorous shake D.) No response to pain or any external stimuli C.) Will wake with loud shouting or vigorous shake Expressive aphasia is also known as A.) Broca aphasia B.) Global aphasia C.) Wernicke aphasia D.) Receptive aphasia A.) Broca aphasia Delirium is a chronic progressive loss of cognitive and intellectual functions A.) True B.) False B.) False Hypochondriasis means A.) Person believes they are God B.) Person feels "They are out to get me" C.) Morbid fear of their lack of health or a fear of having cancer D.) Irrational fear of an object C.) Morbid fear of their lack of health or a fear of having cancer Which substance displays signs of intoxication of reddened eyes, relaxation, suspicious A.) Cocaine B.) Nicotine C.) Cannabis D.) Opiates C.) Cannabis Which substance displays signs of intoxication of pinpoint pupils, decreased pulse, and BP A.) Cocaine B.) Nicotine C.) Cannabis D.) Opitaes D.) Opitaes Which substance displays signs of intoxication of pupillary dilation, chills, and nausea A.) Cocaine B.) Nicotine

C.) Cannabis D.) Opiates A.) Cocaine Which areas on the body are lymph nodes NOT easily palpated? A.) Head, neck, inguinal B.) Breast and neck C.) Axillae and arm D.) Popliteal and inguinal B.) Breast and neck The corneal light reflex is also called A.) Convergence test B.) Accomodation test C.) PEARRLA D.) Hirschberg test D.) Hirschberg test As people age, the skin begins to "sag" NOT due to A.) Reduced subcutaneous fat B.) Decreased moisturizer C.) Decreased elasticity D.) Decreased protein and fats in diet D.) Decreased protein and fats in diet With the older adult, nurses must remain aware of lingering effects if medications and drugs due to A.) Increased liver and kidney functioning B.) Decreased cardiac functioning C.) Decreased liver and kidney functioning D.) Decreased subcutaneous fat C.) Decreased liver and kidney functioning If the patellar joint is able to articulate, it is able to A.) Have range of motion B.) Become dislocated C.) Remain rigid D.) Withstand a higher BMI A.) Have range of motion

C.) Pearly gray Lymphatic drainage of the external ear flows to A.) Parotid, mastoid, superficial cervical B.) Submental submandibular C.) Postauricular, eustachian tube D.) Mastoid, preauricular, deep cervical chain A.) Parotid, mastoid, superficial cervical Which is NOT true of the middle ear? A.) It is a tiny air-filled cavity B.) Protected by the tympanic membrane C.) Contains 3 ossicles or 3 bones D.) Contains the cochlea D.) Contains the cochlea The sounds amplitude means A.) The pitch B.) The vibration C.) The loudness D.) The fibers C.) The loudness Normal pathway of hearing is A.) Air conduction B.) Water conduction C.) Bone conduction A.) Air conduction What causes presbycusis? A.) Nerve degeneration that occurs with aging B.) Too much cerumen in the ear canal C.) Bright light D.) The room is spinning A.) Nerve degeneration that occurs with aging While completing health hx, to evaluate pt's mental status, the nurse must observe A.) Appearance, behavior, cognition, thought process B.) Ask pt's family about coping skills

C.) The presence of phobias D.) Perform an IQ test A.) Appearance, behavior, cognition, thought process Older adults tend to report pain... A.) Is dull due to neuropathy B.) Describing it as walking on pins and needles C.) Infrequently D.) Heightened due to loss of fat C.) Infrequently What specialized nerve endings detect painful sensations in the peripheral system? A.) Noxious stimuli B.) Nociceptors C.) Modulation D.) Opioid receptors B.) Nociceptors Neuropathic pain is often due to... A.) Lesion or disease in somatosensory nervous system B.) Responding when touching a hot stove C.) Poorly controlled chronic nociceptive pain D.) Typically predictable A.) Lesion or disease in somatosensory nervous system The pain scale is used to measure the pain's... A.) Length B.) Quality C.) Location D.) Severity D.) Severity Which area are lymph rarely palpable? A.) Arms B.) Neck C.) Inguinal D.) Breast D.) Breast

B - Behavior ABC or T? Mood and Affect B - Behavior ABC or T? Body Movement A - Appearance ABC or T? Pupils A - Appearance ABC or T? Dress A - Appearance ABC or T? Posture A - Appearance ABC or T? Remote Memory C - Cognitive ABC or T? Screen for suicidal thoughts T - Thought process ABC or T? Thought content T - Thought process ABC or T? Grooming A - Appearance ABC or T? Hygiene A - Appearance ABC or T? Judgment C - Cognitive ABC or T?

Perception T - Thought Process ABC or T? Speech B - Behavior ABC or T? Recent Memory C - Cognitive ABC or T? Facial Expression B - Behavior ABC or T? Attention Span C - Cognitive ABC or T? Orientation C - Cognitive ABC or T? New learning C - Cognitive Which answer below does not describe a patch?

• Solely a color change
• Larger than 1 cm
• Pruritic
• Examples include mongolian spot, chloasma Pruritic Which of the following describes a papule?
• Something you can feel, smaller than 1 cm
• Something you can feel, larger than 1 cm
• Examples include psoriasis and mosquito bite - Soft nodule
• Something you can feel, smaller than 1 cm Which of the statements is true for a nodule?
• Flat, shallow, smaller than 1 cm
• Elevated, soft, smaller than 1 cm
• Solid, elevated, soft, larger than 1 cm - Solid, flat, shallow, larger than 1 cm
• Solid, elevated, soft, larger than 1 cm

Cocaine withdrawal Psychomotor agitation Heavy drinking for women 8 or more drinks per week Nicotine intoxication Alert, increased HR, nausea, vomiting, jittery feeling Heroin withdrawal dilated pupils, fever, insomnia, runny nose, sweating Cocaine intoxication Pupil dilation, chills, weight loss Cannabis withdrawal Mild, loss of appetite Nicotine withdrawal Vasodilation, headaches, anxiety, difficulty concentrating Heroin intoxication Pinpoint pupils, decreased BP, and respirations Alcohol withdrawal Tremor of hands, nausea, tachycardia, anxiety, insomnia Which lobe? Movement, problem solving, concentrating, thinking, behavior, mood, personality Frontal Lobe Which lobe? Hearing, language, memory Temporal lobe Which lobe? Sensations, language, perception, body awareness, attention Parietal lobe Which lobe? Vision, perception Occipital lobe Brain structure that controls posture, balance, and coordination of movement

Cerebellum Landmark to find the thyroid Cricoid cartilage Function of the parathyroid Calcium regulation Goiter Enlarged thyroid Pilar cyst (wen) Smooth, firm, fluctuant swelling on scalp, pressure of contents causes overlying skin to be shiny and taut; benign When is the parotid gland palpable? Mumps (causes rapid, painful parotid inflammation) Cushing's Syndrome Excessive cortisol, lots of fat, apple-shaped Graves' disease Hyperthyroidism, "look like they're going to the grave", thin Bell's Palsy One-sided facial paralysis (Treated w/steroids) Strabismus "Cross-eyed" There are various forms w/different names Anisocoria Unequal pupil size (opposite of PERRLA) Miosis Pupil constriction Mydriasis Pupil dilation Conjunctivitis Pink eye Subconjunctival hemorrhage

Cognition Orientation, attention span, recent & remote memory, new learning Thought process Thought content, perceptions, suicidal thoughts The nurse must first evaluate the patient's ____________ __ __________ to accurately assess their mental status The nurse must first evaluate the patient's LEVEL OF CONSCIOUSNESS to accurately assess their mental status Assessing orientation "What is today's date?" Assessing attention span Give a series of directions Recent memory 24-hr diet recall Remote learning "What was your first job?" New learning Four unrelated words test What does the 4 words test assess at 5 minutes? New learning What does the 4 words test assess at 10 and 30 minutes? Recent memory Typically the mental status assessment is observed or obtained ____________ the subjective and objective data collection Typically the mental status assessment is observed or obtained THROUGHOUT the subjective and objective data collection Pain intensity Pain severity Nociceptive pain Due to trauma, pain develops when function and intact nerve fibers in the periphery are stimulated (burns, injury, etc.)

Neuropathic pain Pain due to a lesion or disease in the somatosensory nervous system, abnormal processing of pain message from nerve damage (diabetes, shingles, sciatica) T/F Nociceptive pain can eventually become neuropathic pain True Conductive hearing loss due to some sort of blockage (cerumen, etc.) Sensory hearing loss Due to nerve damage to CN8 (guns, loud noises), this is a neuropathic loss A deviated septum may be common but is never __________________ A deviated septum may be common but is never NORMAL Normal color of the mouth Pink Normal color of nose Red When to suspect infection on tonsils White patches/blanket, pain, redness In the mouth, aging adults have a decrease in _________ ______________ In the mouth, aging adults have a decrease in SALIVARY SECRETION Why is it important that older adults experience decreased salivary production? Impacts their ability to taste, swallow, messes with their thirst mechanism (if they say they're thirsty, they're likely already pretty dehydrated) Tonsil grade 0 Not visible, surgically removed Tonsil grade 1+ Small tonsil Tonsil grade 2+ Normal, halfway Tonsil grade 3+ Enlarged, touching uvula

Dermis Keratin Tough fibrous protein that provides strength and waterproofing Melanin Responsible for skin color, variations How often is skin replaced? Every 4 weeks Eccrine glands Produce sweat, open directly onto skin surface Apocrine glands Produces sweat, open into hair follicle, in armpits, pubic area, scalp Sebaceous glands Produce lipid oil Which population has 20x higher risk of skin cancer Caucasians Black/African American patients have higher risk of Keloids, pigmentary disorders, pseudofoliculitis, melasma (pregnancy mask) Pallor in light skin Pale Pallor in dark skin Ashen gray Cyanosis in light skin Dusky blue Cyanosis in dark skin Dark and dull Erythema in light skin Redness, bright pink Erythema in dark skin Purplish tinge, may not see, palpate skin for warmth

Venous stasis in light skin Dusky rubor Venous stasis in dark skin Easily masked, hard to see Jaundice in light skin Yellow in sclera Jaundice in dark skin Yellow in hard and soft palate Petechiae 1-3 mm, round Purpura

3mm, round ABCDE skin assessment A - asymmetry B - border C - color D - diameter E - elevation, enlargement The nurse is assessing a patient who has been admitted for liver failure. What finding would the nurse expect? 1. Cyanosis

2. Flushing
3. Rubor
4. Jaundice
5. Jaundice Normal nail color Transluscent nail plate w/pink nail bed underneath The area for storing milk in the breast are

• Lactiferous sinuses
• Montgomery glands
• Alveoli
• Lobules Lactiferous sinuses What is the most common site of breast tumors?