General 1
General 2
General 3
General 4
General 5
100

Before starting a health assessment on a client what would the nurse consider with the physical environment?

The room should be private, quiet, and warm with adequate lighting.

100

The nurse observes a bluish tint to a client's skin. What is the name of this?

Cyanosis

100

The nurse observes a reddish tint to a client's skin. What is the name of this?

Erythema

100

The nurse observes a pale tint to a client's skin. What is the name of this?

Pallor

100

Describe a pulse amplitude of 1+

Weak, thready, diminished pulse

200

Nurse, you've just auscultated for bowel sounds on your client and they are absent, what will you do next?

Listen for 5 minutes

200

What PPE (personal protective equipment) would the nurse use to assess the oral mucosa of a client's mouth?

Gloves

200

What would be a nursing focus for a patient with diarrhea?

Hydration

200

Naming Pain on a 0-10 scale is called what?

Severity

200

The nurse is assessing the past health history of a patient with COPD. What would be most relevant?

Smoking History

300

The nurse observes a yellowish tint to a client's skin. What is the name of this?

Jaundice

300

What equipment would a nurse choose to complete a hearing exam?

Tuning Fork
300

What is the sequence of physical assessment of the abdomen?

Inspection, Auscultation, Palpation, and then Percussion.

300

Name 4 unexpected findings when palpating the abdomen.

Large masses

Hardness 

Tenderness with guarding or rigidity 

Rebound tenderness

300

Nurse, you are assessing the ears of your client.  What equipment will you need?

Otoscope

400

Describe pulse amplitude of 4+

Bounding

400

What is addressed as part of the general survey? (8)

•Appearance

•Behavior

•Indicators of abuse/neglect/human trafficking

•Body structure

•Mobility

•Height/weight/BMI

•Vital signs

•Pain

400

Which nerve stimulates the muscles of the tongue.

Cranial Nerves IX glossopharyngeal and X vagus.

400
A nurse is assessing the upper and lower extremities of a client.  What is most important when assessing body parts?

Symmetry 

400

How would the nurse assess level of consciousness in their client?

Orientation to person, place, and time are among the essential components of LOC.

500

Name one unexpected finding of a client with COPD.

  • Tripod position needed to assist with breathing
  • Tachypnea after simple activity
  • Full use of the accessory respiratory muscles of the neck and shoulders
  • Barrel chest
  • Pursed-lips expiration (prolonged expiration)
  • Hoover sign (paradoxical retraction of the lower interspaces during inspiration)
  • Cyanosis
  • Asterixis due to severe hypercapnia
  • Enlarged, tender liver due to right-sided heart failure
  • Peripheral edema
  • Neck vein distention (especially during expiration)
500

Nurse, you are assessing Graphesthesia on your client. Describe what an unexpected finding would be for this assessment. 

If the patient cannot distinguish the number or letter, he or she may have a parietal lobe lesion.

500

Which Cranial Nerves identify taste?

CN VII & IX

500

Nurse, you are doing a screening for distant vision.  What equipment do you need?

Snellen Chart

500

The nurse completes a head-to-toe assessment to do what after analyzing data and identifying problems.

Develop a Plan of Care