MIDTERM #1 Flashcards
1
Q
What is subjective data?
A
What the person says about themselves, their feelings, sensations, health history, verbal descriptions created by care giver, symptoms
2
Q
What is objective data?
A
What the health care provider observes during the assessment, what is measurable, seen and heard.
3
Q
What are the 5 parts of the nursing process
A
Assessment Nursing Diagnosis Planning Implementation Evaluation
4
Q
Explain “Assessment” in the nursing process
A
Collecting, organizing, validating, and documenting Data.
5
Q
Explain “Nursing Diagnosis” in the nursing process
A
Analyze data, Identify health problems risks and strengths, formulate diagnostic statements.
6
Q
Explain “Nursing Planning” in the nursing process
A
Prioritize problems and diagnoses, formulate goals, design health outcomes, identify nursing intervention
7
Q
Explain “Nursing Implementation” in the nursing process
A
Reassess the patient, determine the nurse’s need for assistance, implement nursing interventions, supervise delegated care, document nursing activities.
8
Q
Explain “Nursing Evaluation” in the nursing process
A
Collect data related to outcomes, complete data with outcomes, relate nursing actions to patient goals/outcomes, draw conclusions about problem status, continue to modify or end the patient’s care plan.
9
Q
Nursing Assessment
A
Collection of data about an individual health state
10
Q
Inspection
A
Concentrated/purposeful watching, always performed first
11
Q
Palpation
A
Assessment of texture, temperature, moisture, size, swelling vibration etc.
12
Q
What are your fingertips best at assessing?
A
Best for determining, texture, swelling, pulsation, and lumps.
13
Q
What are grasping action between fingers best for assessing?
A
Best for detecting the position, shape, and consistency of an organ or mass.
14
Q
What are the back of the hands best for assessing?
A
Temperature
15
Q
What are the base of fingers best for assessing?
A
Vibration
16
Q
What is percussion
A
Tapping the person skin and assessing the sound
17
Q
What is resonant?
A
medium in sound low pitch and hollow
18
Q
What is hyper resonant?
A
Very Loud in sound very deep, booming
19
Q
What is Tymphany?
A
Loud in sound, high pitch sounds musical like
20
Q
What is Dull?
A
Soft, high pitched muffled thud
21
Q
What is flat?
A
Very soft, high pitched instant stop of dull sound
22
Q
What is ausculation
A
Listening to sounds
23
Q
What is the bell for
A
Low sounds
24
Q
What is the diaphragm for?
A
For high sounds
25
What are signs?
An objective abnormality that you as the examiner detect on a physical examination, or report
26
What are Symptoms?
Subjective statements that patient feels from the disorder
27
Iliac is AKA?
Inguinal
28
Hypo-gastric is AKA?
Suprapubic
29
I fell off my bike 2 hours ago.
Subjective
30
Client is slumped over in the chair.
Objective
31
I took 2 Tylenol for my broken arm.
Subjective
32
BP 120/80 Respiratory Rate 12 Pulse 80
Objective
33
The client is 52 years old.
Objective
34
The client’s hair is brown.
Objective
35
My hair started falling out about a month ago.
Subjective
36
Bruising on left forearm that is purple and blue in color.
Objective
37
It feels like I have bugs crawling on my skin.
Subjective
38
The client’s room smells like alcohol.
Objective
39
The client is wearing clothes inappropriate for the weather.
Sign
40
The client’s temperature was 37 C.
Sign
41
The client stated he expected to have more pain than he is.
Symptom
42
“It is very hot in this room."
Symptom
43
The length of the client’s leg is 31 inches
Sign
44
“I feel like I am going to throw up.”
Symptom
45
The client stated that she has had this feeling before.
Symptom
46
Bowel Sounds present in all 4 abdominal quadrants.
Sign
47
The client stated her husband hit her in the head.
Symptom
48
The nurse heard the client crying.
Sign
49
What is the 60 second assessment
```
ABC’s
Tubes and Lines
Respiratory Equipment
Patient Safety Survey
Environmental Survey
Sensory
Additional Assessments
```
50
What is the 60 second assessment
```
ABC’s
Tubes and Lines
Respiratory Equipment
Patient Safety Survey
Environmental Survey
Sensory
Additional Assessments
```
51
2. You are teaching an adolescent girls’ group about safer sexual practices. This is an example of which level of disease prevention?
a. primary prevention
b. secondary prevention
c. tertiary prevention
d. disease screening
A
52
6. An example of a “looking upstream” approach would be:
a. starting up an early-childhood development program. b. ensuring that adolescents have access to sexually transmitted infection screening.
c. initiating a school lunch program.
d. providing foot care to diabetic seniors.
A
53
7. You are providing nutritional counselling to a diabetic woman living in a remote First Nations community. You advise her to include more fresh vegetables in her diet, but she tells you that vegetables are very expensive in the community and she can’t afford to buy them. This is an example of:
a. secondary prevention.
b. the Ottawa Charter for Health Promotion
c. tertiary prevention.
d. a social determinant of health.
D
54
Describe the 5 principles of culturally competent care?
Resist the practice of "othering"
Everyone has a unique cultural identity
There is as much diversity within culture as across them
There is a difference between self-identity and being identified
Beware the dangers of stereotyping
55
State the purpose of the complete health history.
The purpose of the complete health history is to collect subjective data. The history is combined with the objective data that are obtained from the
physical examination and laboratory studies, to form the database. The database is used to make a
judgement or diagnosis about the health status of a person.
56
List and define the critical characteristics used to explore each symptom the patient identifies
O – onset (When did the pain start?)
P – provocative/palliative (Does anything make it feel worse)
Q – quality of pain (What does it feel like?)
R – region of body/radiation (Where is located? is it going anywhere?)
S – severity (How would you rate the intensity?)
T - treatment/timing ( Have you done anything to help, is the pain constant or a cycle?)
U – understanding of the pain ( What does patient think this is?)
V – values (What is your acceptable level?)
57
1. When reading a medical record, you see the following notation: “Patient states, ‘I have had a cold for about a week, and now I am having difficulty breathing.’” This is an example of:
a. past history.
b. a review of systems.
c. a functional assessment.
d. a reason for seeking care.
D
58
You have reason to question the reliability of the information being provided by a patient. One way to verify the reliability within the context of the interview is to:
a. rephrase the same questions later in the interview.
b. review the patient’s previous medical records.
c. call the person identified as emergency contact to verify data provided.
d. provide the patient with a printed history to complete and then compare the data provided.
A
59
The statement “reason for seeking care” has replaced the “chief complaint.” This change is significant because: a. “chief complaint” is really a diagnostic statement.
b. the newer term allows another individual to supply the necessary information.
c. the newer term incorporates wellness needs.
d. “reason for seeking care” can incorporate the history of present illness.
C
60
During an initial interview, the examiner says, “Mrs. J., tell me what you do when your headaches occur.” With this question, the examiner is seeking information about: a. the patient’s perception of the problem.
b. aggravating or relieving factors.
c. the frequency of the problem.
d. the severity of the problem.
B
61
Which of the following is an appropriate recording of a patient’s reason for seeking health care?
a. angina pectoris, duration two hours
b. substernal pain radiating to left axilla, one hour duration
c. “grabbing” chest pain for two hours
d. pleurisy, two days’ duration
C
62
7. Select the best description of “review of systems” as part of the health history.
a. the evaluation of the past and present health state of each body system
b. a documentation of the problem as described by the patient
c. the recording of the objective findings of the practitioner
d. a statement that describes the overall health state of the patient
A
63
Which of the following is considered to be subjective?
a. temperature of 38.5°C
b. pulse rate of 96 beats/min
c. measured weight loss of 10 kg since the previous measurement
d. pain lasting two hours
D
64
Functional assessment measures how a person manages day-to-day activities. The impact of a disease on the daily activities of older adults is referred to as:
a. interpersonal relationship assessment.
b. instrumental activities of daily living.
c. reason for seeking care.
d. disease burden.
D
65
Functional assessment measures how a person manages day-to-day activities. The impact of a disease on the daily activities of older adults is referred to as:
a. interpersonal relationship assessment.
b. instrumental activities of daily living.
c. reason for seeking care.
d. disease burden.
D
66
Distinguish between direct percussion and indirect percussion
Direct percussion involves the striking hand directly contacting the body wall. Indirect percussion is
used more often, and uses both hands. A hand is placed over the area, the stationary hand, which
remains fixed, while the striking hand contacts the stationary hand to produce a sound.
67
Describe the environmental conditions to consider in preparing the examination setting.
Ensure that the examination room is warm, comfortable, quiet, private, and well lit. Be sure to have
all equipment available. Before starting any assessment, do an environmental scan to ensure the
environment is safe.
68
1. Various parts of the hands are used during palpation. The part of the hand used for the assessment of vibration is (are) the:
a. fingertips.
b. index finger and thumb in opposition.
c. dorsum of the hand.
d. ulnar surface of the hand.
D
69
2. When performing indirect percussion, the stationary finger is struck:
a. at the ulnar surface.
b. at the middle joint.
c. at the distal interphalangeal joint.
d. wherever it is in contact with the skin.
C
70
3. The best description of the pitch of a sound wave obtained by percussion is:
a. the intensity of the sound.
b. the number of vibrations per second.
c. the length of time the note lingers.
d. the overtones of the note.
B
71
4. The bell of the stethoscope:
a. is used for soft, low-pitched sounds.
b. is used for high-pitched sounds.
c. is held firmly against the skin.
d. magnifies sound.
A
72
6. At the conclusion of the examination, the examiner should:
a. document findings before leaving the examining room.
b. have findings confirmed by another practitioner.
c. relate objective findings to the subjective findings for accuracy.
d. summarize findings to the patient.
D
73
10. A nosocomial infection is one that is acquired:
a. in a hospital setting.
b. in a public facility.
c. by the fecal–oral route.
d. through airborne contaminants.
A
74
Symmetrical
Client's left side and right side looks the same
75
Alert
Awake, readily aroused, aware of stimuli & able to respond appropriately to that stimuli
76
Lethargic
not fully alert, look drowsy or inattentive; thinking seems slow or fuzzy; drift off to sleep but can be aroused when name called
77
Oriented
get a sense if the person if fully oriented to these 4 domains:
TIME - day of the week, date, year, season
PLACE – present location, name of city, where they live
PERSON – who the examiner is
SELF – what is their own name, age
78
Define Pallor
When client is pale in skin tone
79
Define Stupor (semicoma)
respond only to vigorous shake or painful stimulus; not really verbal but groans or mumbles
80
Coma
completely unconscious; no response to pain or any other stimulus
81
Hyper vs hypothermia
Hyperthermia: Very hot
Hypothermia: Very cold
82
Febrile / afebrile
Febrile: Fever
Aferbrile: No fever
83
Hyper vs hypotension
Hypertension: High BP
Hypotension: Low BP
84
Systolic blood pressure
The maximum pressure on the artery during left ventricular contraction
85
Diastolic blood pressure
The elastic recoil or resting pressure that the blood exerts during each contraction
86
Bradycardia
Slow heart reat
87
Tachycardia
Fast heart rate
88
Tachypnea
Slow breathing
89
What are the parts of a general survey?
```
Age
Sex
Level of Consciousness
Skin Colour
Facial Features
```
90
What is the normal temperature range of a person
35.8 - 37.3
91
What is a healthy person's heart rate
50 to 95 beats/min
92
What is a healthy person's respiration
10-20 breaths/min
93
What is a healthy person blood pressure
120/80
94
What is a healthy person's SP02
97-99%
95
Why are vitals signs important
They determine which treatment protocols to follow, provide critical information needed to make life-saving decisions, and confirm feedback on treatments performed.
96
Nociceptive Pain
Caused by tissue injury, well localized
97
Somatic
Superficial derived from skin surface or subcutaneous; or deep structures (i.e., tendon, bone)
98
Visceral
Arises from larger interior organs, often poorly localized, constant or intermittent (i.e. appendicitis)
99
Neuropathic Pain
Results from damage to nerve pathway/or directly from a lesion or a disease. Burning, shooting sensations; may be decreased pain sensation
100
Referred Pain
Originates in one location and is felt somewhere else
101
Acute Pain
Short term; self-limiting; goes away after injury heals
| Follows a predictable trajectory (i.e. after surgery)
102
Persistent (or chronic)
Present for 6 months or longer that the time expected for healing to occur
May be experienced differently by different clients
Malignant (related to cancer)
Non-malignant (i.e. arthritis)
103
What nervous system is pain detected in
Central nervous system
104
```
List the significant information considered in each of the four areas of a general survey:
physical appearance,
body structure,
mobility,
behaviour.
```
Physical appearance: age, sex, level of consciousness, skin colour, facial features
Body structure: stature, nutrition, symmetry, posture, position, body build, contour
Mobility: gait, range of motion
Behaviour: facial expression, mood and affect, speech, dress, personal hygiene
105
Describe the normal posture and body build.
Normal posture: The person stands comfortably erect, as appropriate for his or her age. Note
the normal “plumb line” that would cross through the anterior ear, shoulder, hip, patella, and ankle. The
toddler may have “toddler lordosis” because of a normally protuberant abdomen, and the aging person
may have kyphosis.
Body build, contour proportions are:
Arm span (fingertip to fingertip) equals height
Body length from crown to pubis roughly equals the length from pubis to sole
106
For Pounds to Kg what is the formula
| For Cm to inches what is the formla
Divide by 2.2 to get KG
| Divide by 30 for Feet
107
What changes in height and in weight distribution would you expect for an adult in his or her 70s and 80s?
In the older adult, body weight decreases as a result of muscle shrinkage. Subcutaneous fat is lost
from the face and periphery, and additional fat is deposited on the abdomen and hips. Height may also
decrease because of shortening of the spinal column secondary to thinning of the vertebral disks and
shortening of the individual vertebrae, as well as the postural changes of kyphosis, and slight flexion in the hip and knees
108
Factors that affect bp
BP taken when patient is moody, when arm is above or below heart, patient supports own are, deflating too quickly or slowly, halting and restarting, time of day, cardiac output, viscosity, elasticity, resistance, volume
109
Explain the significance of phase I, phase IV, and phase V Korotkoff’s sounds during blood pressure measurement.
Phase 1 Systolic
Phase 5 diastolic
Phase 4 Recorded on separate occasions
110
Describe the tympanic membrane thermometer, and compare its use to other forms of temperature measurement.
9. The tympanic membrane thermometer (TMT) senses the infrared emissions of the tympanic
membrane, which shares the same vascular supply that perfuses the hypothalamus (the internal carotid
artery). Compared with other forms of temperature measurement, the TMT is noninvasive,
nontraumatic, quick, and efficient. It is useful with toddlers, who need restraint if the rectal route is
used, and is also useful for preschoolers, who are unable to cooperate for an oral temperature and fear
the invasion of a rectal temperature. Conflicting evidence has led to a move away from the use of
tympanic thermometry in critical patients and has fallen out of favour in many acute hospital
environments.
111
Describe four qualities to consider when assessing the pulse.
(1) Rate
(2) Rhythm
(3) Force
(4) Elasticity
112
Define and describe the relationships among the terms pulse pressure, and mean arterial pressure
Pulse pressure is the difference between the systolic and diastolic and reflects the stroke volume, mean arterial pressure is pressure-forcing blood into the tissues, averaged over the cardiac cycle. Close to diastolic pressure plus one-third of pulse pressure
113
Note aspects of normal gait
Base is as wide as the shoulder width. Foot placement is accurate, walk is booth, coordinated, even and well balanced, symmetrical arm swing present
114
Stage 1 hypertensoin
| Stage 2 Hypertension
S more than 120 D more than 80
S more than 140 D more than 90
S: more than 160 D: more than 100
115
The four areas to consider during the general survey are:
a. ethnicity, sex, age, and socioeconomic status.
b. physical appearance, sex, ethnicity, and affect.
c. dress, affect, nonverbal behaviour, and mobility.
d. physical appearance, body structure, mobility, and behaviour.
D`
116
During the general survey part of the examination, gait is assessed. When walking, the base is usually:
a. varied, depending upon the height of the person.
b. equal to the length of the arm.
c. as wide as the shoulder width.
d. half of the height of the person
C
117
During the eighth and ninth decades of life, what changes occur in height and weight?
a. both increase
b. weight increases, height decreases
c. both decrease
d. both remain the same as during the 70s
C
118
During an initial home visit, the patient’s temperature is noted to be 36.3°C. This temperature: a. cannot be evaluated without a knowledge of the person’s age. b. is below normal. The person should be assessed for possible hypothermia. c. should be retaken by the rectal route because this best reflects core body temperature. d. should be reevaluated at the next visit before a decision is made.
A
119
Select the best description of an accurate assessment of a patient’s pulse.
a. count for 15 seconds if pulse is regular
b. begin counting with 0; count for 30 seconds
c. count for 30 seconds, and multiply by 2 for all cases
d. count for 1 full minute; begin counting with 0
B
120
After assessing the patient’s pulse, the practitioner determines the pulse force to be “normal.” This would be recorded as:
a. 31
b. 21
c. 11
d. 0
B
121
Select the best description of an accurate assessment of a patient’s respirations.
a. count for a full minute before taking the pulse
b. count for 15 seconds, and multiply by four
c. count after informing the patient where you are in the assessment process
d. count for 30 seconds following pulse assessment
D
122
Pulse pressure is:
a. the difference between the systolic and diastolic pressure.
b. a reflection of the viscosity of the blood.
c. another way to express the systolic pressure.
d. a measure of vasoconstriction.
A
123
Mean arterial pressure is:
a. the arithmetic average of systolic and diastolic pressures.
b. the driving force of blood during systole.
c. diastolic pressure plus one-third pulse pressure.
d. corresponding to phase III Korotkoff’s
C
124
Explain how acute and persistent pain differs in terms of nonverbal behaviours.
Acute pain nonverbal behaviours: guarding; grimacing; vocalizations, such as moaning, agitation,
restlessness, stillness, and diaphoresis, or changes in vital signs.
Persistent pain nonverbal behaviours: there will be more variability of behaviours with chronic pain
because the person adapts to it over time. Some examples include bracing, rubbing, diminished activity,
sighing, and change in appetite.
125
How would you assess for pain in an individual with dementia?
Use observations and chart with smiley faces
126
What would you say to a colleague who remarks that the individual with Alzheimer’s disease does not feel pain and therefore does not require an analgesic?
They can still feel pain so they need it. Alzheimer's isn't painful but it can cause pain.
127
While you are taking a history, the patient describes a burning, painful sensation that moves around his toes and bottoms of his feet. These symptoms are suggestive of:
a. nociceptive pain.
b. neuropathic pain.
B
128
The most reliable indicator of pain in the adult is:
a. degree of physical functioning.
b. nonverbal behaviours.
c. magnetic resonance imaging findings.
d. the patient’s self-report.
C
129
When a person presents with acute pain of the abdomen, following the initial examination, it is best to withhold analgesia until diagnostic testing is completed and a diagnosis is made.
a. true
b. false
B
130
A pain problem should be anticipated in a cognitively impaired older adult with a history of:
a. diabetes.
b. peripheral vascular disease.
c. chronic obstructive pulmonary disease (COPD).
d. Parkinson’s disease.
B
131
During the physical examination, your patient is diaphoretic and pale, and complains of pain directly over the left upper quadrant (LUQ) of the abdomen. This would be categorized as:
a. cutaneous pain.
b. somatic pain.
c. visceral pain.
d. psychogenic pain
C
132
For older adult postoperative patients, poorly controlled acute pain places them at higher risk for:
a. atelectasis.
b. increased myocardial oxygen demand.
c. impaired wound healing.
d. all of the above.
D
133
A 30-year-old female reports having persistent intense pain in her right arm related to trauma sustained from a car accident 5 months ago. She states that the slightest touch or clothing can exacerbate the pain. This report is suggestive of:
a. referred pain.
b. psychogenic pain.
c. complex regional pain syndrome.
d. cutaneous pain.
C
134
What does GU mean
Genitourinary
135
Dysuria
Painful or difficult urination, burning
136
Hematuria
Presence of blood in a person's urine
137
HPV
Common sexually transmitted disease that can lead o genital warts
138
TSE
Testicular self-examination
139
What stores sperm
Epididymis
140
Nocturia
Excessive peeing during the night
141
What are the efffects of prostate englargement
Trouble urinating
142
What are the objective data for a penis
Inspect and palpate the penis
Inspect and palpate the scrotum
Inspect and palpate for hernia
Palpate the inguinal lymph nodes
143
What happens to womens vagina when they age
```
Rapid decrease in hormones
Stages of menopause
Shrinkage of uterus and ovaries
More fragile vaginal surfaces
Physiological changes in sexual response cycle
Decreased natural lubrication
```
144
Vagina objective data
```
External genitalia—Inspection
Skin colour
Hair distribution
Labia majora
Any lesions
Clitoris
Labia minora
Urethral opening
Vaginal opening
Perineum
Anus
```
145
Comparison of Female and Male Genitourinary Anatomy
Urethra is 5x longer in males than in females
Divided into 3 segments in males but is only one short tube in females
Females are more prone to urinary tract infections
A common duct for the urinary and reproductive systems in males.
Two separate systems in females
146
What screening are older women reccomend to get
Cervical screening
147
Describe the function of the cremaster muscle
The cremaster muscle controls the size of the scrotum by responding to the temperature around the scrotal area. This action keeps the testes at a temperature 3°C below the abdominal temperature, which is the ideal temperature for producing sperm.
148
Identify the structures that provide transport of sperm
Sperm are transported along a series of ducts. First, the testis is capped by the epididymis, which is the main storage site for sperm. The lower part of the epididymis is continuous with a muscular duct, the vas deferens, which then approximates with other vessels to form the spermatic cord. The spermatic cord eventually joins the duct of the seminal vesicle to form the ejaculatory duct, which empties into the urethra.
149
Describe the significance of the inguinal canal and the femoral canal.
Knowledge of these anatomical areas in the groin is useful because they are potential sites for a hernia, which is a portion of bowel protruding through a weak area in the musculature.
150
Identify the normal bladder capacity, daily total volume of urine output, and the average bladder volume that typically initiates the urge to void.
Normal adult urine output is 1500 mL per day but varies with food and fluid intake, and normal bladder capacity ranges from 600 to 1000 mL. On average, 200 to 250 mL of urine in the bladder causes moderate distention and urge to urinate. (See p. 763, “Assessment of Urine Output.”)
151
During examination of the scrotum, a normal finding would be that:
a. the left testicle is firmer to palpation than the right.
b. the left testicle is larger than the right.
c. the left testicle hangs lower than the right.
d. the left testicle is more tender to palpation than the right.
C
152
A 64-year-old man has come for a health examination. A normal, age-related change in the scrotum would be:
a. testicular atrophy.
b. testicular hypertrophy.
c. pendulous scrotum.
d. increase in scrotal rugae
C
153
During palpation of the testes, the normal finding would be:
a. firm to hard, and rough.
b. nodular.
c. 2 to 3 cm long by 2 cm wide and firm.
d. firm, rubbery, and smooth.
D
154
A 20-year-old man has indicated that he does not perform testicular self-examination. One of the facts that should be shared with him is that testicular cancer, though rare, does occur most commonly in men aged:
a. under 15.
b. 15 to 49.
c. 50 to 65.
d. 65 and older
B
155
How sensitive to pressure are normal testes?
a. somewhat
b. not at all
c. left more sensitive than right.
d. only when inflammation is present
A
156
List the external structures of the female genitalia.
Vulva, mons pubis, labia majora, labia minora, frenulum, clitoris, vestibule, urethral meatus, paraurethral glands, vaginal orifice, hymen, vestibular glands
157
Outline the changes observed during the perimenopausal period.
During the perimenopausal period, decline in ovarian function causes irregular menses that gradually become farther apart and produce a lighter flow than usual. The ovaries stop producing progesterone and estrogen, causing the dramatic physical changes of menopause. The uterus shrinks in size, and the ovaries atrophy. The sacral ligaments relax, and pelvic musculature weakens, causing the uterus to droop. The cervix shrinks and looks paler with a thick, glistening epithelium. The vagina becomes shorter, narrower, and less elastic; the vaginal epithelium atrophies, becoming thinner, drier, and itchy. Externally, the mons pubis looks smaller as a result of atrophy of the fat pad. The labia and the clitoris gradually decrease in size, and pubic hair becomes thin and sparse.
158
Discuss infection control precautions taken during examination of female genitalia and procuring of specimens.
9. The examiner should first wash the hands and then put on gloves and protective clothing. The examiner will perform a visual inspection and palpation of the external genitalia, and then insert the speculum to examine the internal structures. Once the speculum examination is completed, cervical smears and culture specimens are obtained, and then the speculum is removed. The metal speculum should be placed in a basin for later sterilizing and disinfection; use of plastic types should be avoided. At this point, gloves should be discarded and the hands washed. With fresh gloves, the bimanual examination is performed, followed by the rectovaginal examination. Gloves should be changed again before the rectovaginal examination to prevent spreading any possible infection. When obtaining specimens, the nurse must be ensure that the sterile swabs and culture media are not contaminated.
159
1. Vaginal lubrication is provided during intercourse by: a. the labia minora.
b. sebaceous follicles.
c. Skene’s glands.
d. Bartholin’s glands.
D
160
During the examination of the genitalia of a 70-year-old woman, a normal finding would be:
a. hypertrophy of the mons pubis.
b. increase in vaginal secretions.
c. thin and sparse pubic hair.
d. bladder prolapse.
C
161
Which of the following is (are) normal, common finding(s) on inspection and palpation of the vulva and perineum?
a. labia majora that are wide apart
b. palpable Bartholin’s glands
c. clear, thin discharge from paraurethral glands
d. bulging at introitus during Valsalva manoeuvre
A
162
What is the name of all auscultation valves of the heart
Aortic, Pulmonary, Erb's point, tricuspid Mitral
163
Apical Pulse
Heard on the apex of the heart, Seen when patient rolls on their side, can be seen in children
164
What is S1 and S2
S1 is lub S2 is dub
S1 is the start of systole, caused by the closure of AV Valves
S2 closure of semilunar valves
165
What are bruits
They are vascular murmers that are generated by turbulent blood flow
166
What is a pulse deficit?
Weak contraction of the ventricles
167
What are the layers of the heart wall
Perocardium, Myocardium, Endocardium
168
What are the four changbers of the heart seperated byq
Valves
169
Right AV valve is AKA
Tricuspid
170
Left AV valve is AKa
Bicuspid/Mitralq
171
right semilunar valve is aka
Pulmonic Valve
172
Left semilunar valve is aka
Aortic Valve
173
In diastol ventricles are __________________ valves
| _______ __________ are ______ so the ventricles can fill with blood
Relaxd
Tricuspd
Bicuspid
Open
174
SYSTOLE
↑ pressure in _____(from blood) causes _____ & ____- valve closure
Ventricles _________, semilunar valves open & blood pumped to body or lungs
Ventricles
Tricuspid
Mitral
175
Preload
Preload = amount of blood in atria at the end of diastole
176
Afterload
Afterload = pressure the ventricles must contract against (resistance
