REGIS NU 650 Final Exam Study Guide: Physical Assessment and Clinical Examination, Exams of Nursing

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REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE

SOLUTION GUIDE FOR THE FINALS NEW SOLUTION

Order of Assessment - CORRECT ANSWER Inspection, Palpation, Percussion and Auscultation. EXCEPT with abdomen Comprehensive Health History - CORRECT ANSWER chief complaint, reason for visit, ROS, past medical and surgical history, social history and family history Pediatric Body measurements - CORRECT ANSWER length, height, weight, head circumference fro birth to 36 months Normal/Hypertension cut off - CORRECT ANSWER <130 normal 140+ hypertension Fontanel Closure - CORRECT ANSWER posterior 1-2 months, anterior 9mo-2years otoscope - CORRECT ANSWER adult-up and back, peds- down and back, using largest speculum that will fit comforably tympanic membrane - CORRECT ANSWER Cone of light R-5 l- EOM testing - CORRECT ANSWER CN III, IV, VI AP diameter of chest - CORRECT ANSWER 1:2 (AP less than transverse)

Hyperressonance (percussion) - CORRECT ANSWER trapped air crackles/rales - CORRECT ANSWER high pitched, discontinuous Wheezes - CORRECT ANSWER high-pitched whistling or squeaking sounds during inspiration or expiration Rhonchi - CORRECT ANSWER snoring, rumbling sounds heard upon auscultation of the chest during respiration-low pitched tactile fremitus - CORRECT ANSWER • INCREASED FREMITUS

• Means there is liquid or solid inside the lungs (consolidation such as with pneumonia)
• Remember Liquid or solid transmits vibrations better than air
• DECREASED FREMITUS Means air trapping such as with emphysema or bronchial obstruction. Bronchophony - CORRECT ANSWER the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue, clearer over disease Egophony - CORRECT ANSWER abnormal change in tone of voice that is heard when auscultating the lungs EE-->AA UE Arteries - CORRECT ANSWER radial-thumb side, ulnar pinky side Pulse grading - CORRECT ANSWER 0 absent 1+ weak 2+ normal 3+ increased

4+ bounding palpate bilaterally

be enlargement not normally felt on exam Blumberg Sign: Rebound Test - CORRECT ANSWER peritoneal inflammation, hurts more when release from palpation

shifting dullness - CORRECT ANSWER a sign of free peritoneal fluid wherein the dullness of percussion shifts, generally from one side to the other, as the patient is turned from side to side. Psoas sign - CORRECT ANSWER RLQ pain with extension of right thigh indicative of appendicitis Obturator sign - CORRECT ANSWER RLQ on internal rotation of right thigh indicative of appendicitis assessment of hernia - CORRECT ANSWER pt may report a lump. observe pt while lying and standing, hernia may disappear while lying. ask pt to strain or perform Valsalva maneuver and observe for bulging. absent bowel sounds may indicate strangulation. cardinal signs of Musculoskeletal disease - CORRECT ANSWER pain, erythema, swelling, increased warmth, deformity, loss of function Scoliosis - CORRECT ANSWER abnormal lateral curvature of the spine kyphosis - CORRECT ANSWER excessive outward curvature of the spine, causing hunching of the back. Knock-knee (genu valgum) - CORRECT ANSWER Legs curved inward so knees come together as person walks bow-legged - CORRECT ANSWER knees too far apart anatomic snuffbox - CORRECT ANSWER landmark depression on the radial aspect of the dorsal wrist; overlays the scaphoid bone

Drop Arm Test - CORRECT ANSWER identifies tear and/or full rupture of rotator cuff Allen test - CORRECT ANSWER determining the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of the other artery Phalen's sign - CORRECT ANSWER Tingling, numbness, or pain in the fingers within 60 seconds of performing Phalen's maneuver, a diagnostic test for carpal tunnel syndrome Tinel's sign - CORRECT ANSWER A distal tingling sensation on percussion of median nerve of the inner wrist; characteristic of carpal tunnel syndrome Drawer Test - knee - CORRECT ANSWER Patient supine, examiner flexes the hip and the knee of the patient's affected leg until the foot is flat on the table. Examiner sits on the foot of thepatient's afectedleg. Examinergrasps behindthe patient'sflexed knee and exerts a pushing and pulling pressure into the affected knee. +(1) Gapping > 6mm (tibia moves posterior) when the leg is pushed. +(2) same when the leg is pulled. INDIC: (1) Torn posterior cruciate ligament. (2) Torn anterior cruciate ligament. Confirmation Test: Lachman'sTest Lachman's Test - CORRECT ANSWER pivot shift test (ACL tear) Ballottment sign - CORRECT ANSWER medical sign which indicates increased fluid over the patella at the knee joint Straight Leg Raise Test - CORRECT ANSWER test often performed to determine

whether a patient with low back pain has an underlying herniated disk or sciatica Cerebrum vs cerebellum - CORRECT ANSWER cerebrum-mental status, cerebellum- balance gait

Denominator is always 5. Strength is only tested with "normal" movement

pronator drift test - CORRECT ANSWER Have pt stretch out arms with palms facing up and close eyes. Positive if one arm goes downward or drifts. Romberg test - CORRECT ANSWER assesses ability of vestibular apparatus in inner ear to help maintain standing balance Reflex grading scale - CORRECT ANSWER 0= no response, always abnormal 1+ = diminishes/depressed response, may or may not be normal 2+ = active normal response, normal 3+ = Brisk/exaggerated response, may or may not be normal 4+ = Very brisk/hyperactive: abnormal response, always abnormal Babinski reflex - CORRECT ANSWER in response to the sole of the foot being stroked, a baby's big toe moves upward or toward the top surface of the foot and the other toes fan out Position sense (proprioception) - CORRECT ANSWER Passively move the great toe up and down by grasping along the sides of the interphalangeal joint only a few mms. and ask patient which direction you are moving the toe Reduced perception (including falsely perceived motion) indicates large-fiber disease or DM Graphesthesia - CORRECT ANSWER ability to recognize writing on the skin purely by the sensation of touch Sterognosis test - CORRECT ANSWER identifying object with eyes closed Two point discrimination test - CORRECT ANSWER provides a measure of receptive field size for touch receptors. Moro reflex (startle reflex) - CORRECT ANSWER Sudden loud noise will cause

■ Absence on both sides: Rule out spinal cord or brain lesion. ■ Older infant: Persistence of Moro refl ex abnormal. Rule out brain pathology. rooting reflex - CORRECT ANSWER a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple, 3-4 months palmar grasp reflex - CORRECT ANSWER in response to stroking a baby's palm, the baby's hand will grasp. This reflex lasts a few months gone by 3-4 months Prostate screening - CORRECT ANSWER Yearly PSA blood test and digital rectal examination starting at age 50 or at age 45 if at high risk testicular self-examination - CORRECT ANSWER a self-help step in early detection of testicular cancer by detecting lumps, swelling, or changes in the skin of the scrotum, 1 x per month with warm water in shower breast self-examination - CORRECT ANSWER a self-care procedure for the early detection of breast cancer, raise arms for retraction or dimpling, best done 5-7 days after period Pap smear test - CORRECT ANSWER microscopic examination of stained cells removed from the vagina and cervix, in order form vag pool, cervical scrape, endocervical infant milestones - CORRECT ANSWER 2 months - holds up head 4 months - rolls from abdomen to back 7 months - sits alone 9 months - crawls 8 - 15 months - standing with support & walking neonate - palmer grasp reflex teething at 6 months

aortic stenosis murmur - CORRECT ANSWER second right intercostal, crescendo- decrescendo

mound) Stage 5-Adult pattern Tanner stage Boys - CORRECT ANSWER 1. Prepuberty II. enlargement of scrotum & testes

III. lengthening of penis IV. increase in size of penis V. Mature stage direct hernia - CORRECT ANSWER inguinal hernia does not extend into scrotum, external ring, most common men over 50 Indirect hernia - CORRECT ANSWER most common goes through internal inguinal ring, most common will touch finger tip, Will extend into scrotum Fibrocystic breast disease - CORRECT ANSWER benign, fluid filled cysts, tender to touch, vary in size with periods, caffeine may exacerbate -estrogen and progesterone dependent rope like Fibroadenoma - CORRECT ANSWER a round, firm, rubbery mass that arises from excess growth of glandular and connective tissue in the breast Cysts in breast - CORRECT ANSWER Squishy (can move and change in size during menstrual cycle) breast cancer - CORRECT ANSWER a carcinoma that develops from the cells of the breast and can spread to adjacent lymph nodes and other body sites, nodular, fixed, non mobile Cervical Motion Tenderness (CMT) - CORRECT ANSWER tenderness when moving the cerix (during bimanual exam) (PE GU) pain and temperature - CORRECT ANSWER spinothalamic tract position and vibration sense - CORRECT ANSWER posterior column