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NUR 258 (SDSU) FINAL EXAM 2025/2026 QUESTIONS AND ANSWERS GRADED A+ Direct vs. Indirect Percussion? Direct - Tapping against body surface - sinuses Indirect - Using a finger to tap another finger - listen to sounds for organ shape or fluid Bell vs. Diaphragm? Bell: Low-Pitched Sounds (hold lightly) Diaphragm: High-Pitched Sounds (hold firmly) When to do VS more frequently? Critical Situation After Surgery During Blood Transfusions
Typology: Exams
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Direct vs. Indirect Percussion?
Direct - Tapping against body surface - sinuses
Indirect - Using a finger to tap another finger - listen to sounds for organ shape or fluid
Bell vs. Diaphragm?
Bell: Low-Pitched Sounds (hold lightly)
Diaphragm: High-Pitched Sounds (hold firmly)
When to do VS more frequently?
Critical Situation
After Surgery
During Blood Transfusions
Normal Temperature?
What age is your temp not stable?
What does temp do when age increases?
When is your lowest temp?
96.4-99.1 (98.6)
-Newborn to adolescent is unstable
-Temp decreases as age increases
-Lowest temp from 1-4 am
Describe the types of temperature routes?
-Rectal
-Tympanic
-Axillary
-Core temperature, last resort, no rectal problems
-Good for children, question regarding accuracy
-Not accurate, must be help deep and tight to body
0=absent
2+=normal
3+ or 4+ = bounding
Influencing Factors of Respirations?
Stress and Exercise
Medications
Pain
Anxiety
What to know about respirations with pediatrics?
Count for full minute
10-15 s apnea
Sleeping is most accurate
Abdomen Movement when breathing
Normal ranges for respiration for adult and infant?
What is blood pressure?
What is systolic and diastolic?
Force the blood exerts against vessel walls
Systolic is top number
Diastolic is bottom number
Factors influencing blood pressure?
Blood flow
Medications
Normal Fluctuations
When do you not measure BP on an arm?
IV arm, dialysis access, mastectomy, arm or chest injury
Reduce Impact, Treat Infection and Education
Minimize impact of infection
Stages of Infection?
Incubation: Entrance to 1st symptoms
Prodromal: Nonspecific symptoms to more specific (capable of transmitting)
Illness: Specific Symptoms Evident
Convalescence: Acute Symptoms Disappear
Modes of Infection:
Droplet:
Airborne:
Vehicle:
Vector:
Droplet nuclei >5 microns (meningitis)
Droplet nuclei <5 microns; suspended >3 feet (Influenza, TB)
Contact or ingestion of contaminated items (Blood-Hepatitis)
Mechanical transfer (mosquito-west nile) (ticks-lyme)
What to wear for contact precautions?
Gloves, Masks, Gowns, Goggles
How many chronic illnesses do normal adults have?
3
What is medication reconciliation?
Process of comparing the patients meds listed in the patients record with the meds that the patient is currently taking
What is CAGE for alcohol?
Cut down
Annoyed you
Pneumonia, Asthma, Emphysema, Pleural Effusion
What are absent lung sounds?
What is it caused from?
Do not hear any movement
Fluid in intrapleural space (pleural effusion), Lung collapse (pneumothorax)
What are crackles (rales) lung sounds?
What is it caused from?
Fluid in smaller airways, does not clear with coughing
Congestive Heart Failure, COPD, Pneumonia
What are wheezes lung sounds?
What are they caused from?
Whistling or sighing sound, inflammation in airway
Asthma, COPD, Croup, RSV, Allergic Reaction
What are stridor lung sounds?
What are they caused from?
Medical Emergency, high-pitched brassy, heard on inspiration
More pronounced in children (Croup, Obstruction)
What are rhonchi lung sounds?
What are they caused from?
Coarse rumbling/rattling
Mucus in upper airway
High concentration (10-15L) (Reservoir: Inflate bag 1st to 2/3 and then should deflate 1/3 with each breath)
Used for infants
Infants or peds or confused patients
Cough and Deep Breath
Incentive Spirometry
2-3 deep coughs every 2-3 hours
5-10 times every 1-2 hours
ASSESSMENT OF SKIN, HAIR, and NAILS
Skin color types?
Pale:
Cyanotic:
Erythema:
Jaundice:
Mottling:
Lips, mucous membranes, inner eyelids
Purple, blue hue, ashen (lips and nailbeds)
Warm redness due to infection
Yellowing (sclera: yellow to iris) (Hard palate)
Blotchy/marbling of skin (yellow/purple) (death)
ASSESSMENT OF SKIN, HAIR, and NAILS
What are Beau's Lines?
Injury occurred at nail line under cuticle
ASSESSMENT OF SKIN, HAIR, and NAILS
What are Splinter Hemorrhages?
Tiny blood spots under nail
ASSESSMENT OF SKIN, HAIR, and NAILS
Skin lesions?
Macule:
Urticaria:
Papule:
Nodule:
Vesicle:
Cyst:
Flat
ASSESSMENT OF SKIN, HAIR, and NAILS
Where to do skin turgor?
Normally:
Elderly:
Infants:
Dorsal side of arm or anterior chest
Anterior Chest
Abdomen
ASSESSMENT OF SKIN, HAIR, and NAILS
Acute vs chronic wound?
<12 weeks for acute
12 weeks for chronic
ASSESSMENT OF SKIN, HAIR, and NAILS
How to measure a wound?
Length (12:00-6:00) Width (9:00-3:00) Depth (Q Tip)
ASSESSMENT OF SKIN, HAIR, and NAILS
Wound colors?
Red:
Pale Pink:
Purple:
Black or Brown:
White:
Infection
Anemia
Bruise
Bruise, gangrene: dead skin
After Band-Aid
ASSESSMENT OF SKIN, HAIR, and NAILS
Wound drainage?
Serous:
Sanguineous:
Serosanguineous:
Purulent:
Clear
Bruise: Different healing stages
ASSESSMENT OF SKIN, HAIR, and NAILS
What is gangrene?
Loss of perfusion and has an odor
Cardiac Risk Factors?
Smoking and vaping, sedentary lifestyle, obesity, high stress, sodium, cholesterol, high fat diet, uncontrolled diabetes or Htn
What is a bruit?
Turbulent blood flow - narrowing of an artery
(use bell to hear)
What does S1 and S2 mean?
S1 coincides with carotid pulse
S2 is closure of semilunar valves
Split S
Common in children and adolescents (aortic and pulmonic closing separate)
Click
Artificial valve (pig bones or metal) (mitral valve prolapse)
S3 (gallop)
Extra sound - extra fluid
CHF (know this, it was on a previous exam)
