Neurological
Reflex that causes the big toe to bend up and back and other toes to fan out when the sole of the foot is stimulated.
Joint action referring to moving a limb away from the body.
What is abduction?
Sonorous adventitious sound primarily heard over the larger bronchi.
What are rhonchi?
Inspect, auscultate, percuss, palpate
What is the correct order for assessment of the abdomen?
5th intercostal space at mid-clavicular line.
What is the apical impulse, mitral auscultation area, or PMI?
The client's tongue is midline and symmetrical when asked to stick her tongue out.
Auscultate using the bell of the stethoscope.
What are turbulent vascular sounds (ex. bruits, venous hums, cardiac murmurs)?
Ask client to say repeat a phrase, such as "99" when palpating the posterior thorax.
What is tactile fremitus?
Percussion sounds over the majority of the abdomen.
What is tympany?
2+
What is the normal amplitude for a pulse?
Normal response when testing this deep tendon reflex is plantar flexion.
Sideways curvature of the spine.
What is scoliosis?
Rubbing sound heard when auscultating the lung.
What is a pleural friction rub?
Loud, high-pitched sounds frequently heard early in a bowel obstuction.
What are hyperactive bowel sounds?
Heard over the pericardium with the diaphragm of the stethoscope.
What are S1 and S2 (or closing of the atrioventricular and semilunar valves)
Ask the client to smile, frown, and squeeze eyes closed.
1. Allow extra time for client to answer questions.
2. Speak at a lower pitch
3. Cluster actions together to allow for fewer position changes
What are modifications for performing an assessment on an older client?
What adventitous sound is auscultated when are is passing through narrowed bronchioles such as in asthma.
What are wheezes?
The amount of time the 4 quadrants of the abdomen is auscultated prior to identifying absent bowel sounds from an obstruction or a paralytic ileus.
What is 3 - 5 minutes?
Symptoms include pain at rest, lack of pulse, hairless area, and sores or wounds.
What is arterial insufficiency?
Purpose is to obtain a first impression of the client.
What is the general survey
Best method to determine severity of pain.
What is have client rate the pain on a 0 - 10 scale?
Sign of long-term COPD.
What is barrel chest or clubbing of the fingers.
Monthly exam performed day 7 - 10 of the menstrual cycle.
What is the self-exam of the breast?
Below 200 mg/dL.
What is a normal cholesterol level?