This scale is used to assess the level of consciousness in a patient following a brain injury.
Glasgow Coma Scale (GCS)
This cranial nerve is tested by asking the patient to shrug their shoulders and turn their head against resistance, assessing motor function in the upper traps and sternocleidomastoid.
cranial nerve XI (Accessory)
This organ is located in the upper left quadrant of the abdomen and is involved in filtering blood, storing red blood cells, and recycling iron.
spleen
The Phalen's test is performed to assess for this condition, characterized by tingling or numbness in the hand.
carpal tunnel syndrome
This maneuver involves the nurse asking the patient to move their fingers or toes away from the midline of their body.
abduction
When performing a neurological assessment, this test involves the patient closing their eyes and touching their finger to their nose, which helps assess coordination and cerebellar function.
finger-to-nose test
This cranial nerve is responsible for visual acuity and is tested using the Snellen chart.
cranial nerve II (Optic)
This term refers to the inability to pass gas or stool, often due to a blockage in the intestines, and can be diagnosed with an abdominal X-ray or CT scan.
bowel obstruction
The nurse asks the patient to place their chin to their chest, which is an example of testing _____ of the neck.
flexion
When performing a musculoskeletal assessment, this term refers to the movement of a body part in a circular motion, like rotating the shoulder.
circumduction
This term refers to the condition where a patient experiences paralysis or weakness on one side of the body due to brain damage, typically from a stroke.
hemiparesis or hemiplegia
To test the motor function of this cranial nerve, you ask the patient to smile, puff out their cheeks, and raise their eyebrows.
cranial nerve VII (Facial)
Pain in the upper right quadrant of the abdomen after eating a fatty meal may indicate this condition.
inflammation of the gallbladder (cholecystitis)
This condition involves the abnormal curvature of the spine and can lead to back pain, stiffness, and limited mobility.
scoliosis
An autoimmune condition that presents with symmetrical joint pain, heat, and swelling
rheumatoid arthritis
This cranial nerve controls the sense of smell and is tested by having the patient close their eyes and sniff a familiar aromatic substance.
cranial nerve I (Olfactory)
This cranial nerve controls the tongue’s movements and is assessed by asking the patient to stick out their tongue and move it side to side.
cranial nerve XII (Hypoglossal)
What would a nurse expect to hear during auscultation of normal bowel sounds?
intermittent, soft, gurgling sounds that occur 5 to 30 times per minute.
This degenerative joint disease commonly affects the knees, hips, and spine and is characterized by the breakdown of cartilage in the joints.
osteoarthritis
What is the significance of finding a pulsatile mass in the abdominal exam?
A pulsatile mass may indicate an abdominal aortic aneurysm (AAA). If detected, it should be evaluated immediately, as it can be life-threatening if it ruptures.
This cranial nerve is responsible for facial sensations and motor functions like chewing and is assessed by palpating the masseter muscle.
cranial nerve V (Trigeminal)
This type of seizure involves both sides of the brain and is characterized by loss of consciousness and rhythmic jerking movements.
generalized tonic-clonic seizure
A patient presents with sudden, severe abdominal pain in the lower right quadrant, nausea, and vomiting. What condition should the nurse suspect?
appendicitis
This bone disease, often seen in older adults, is characterized by low bone mass and increased risk of fractures.
osteoporosis
When would the nurse expect a patient to have hypoactive bowel sounds?
paralytic ileus, after abdominal surgery, constipation