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Nursing 209 Exam 1 ULL.
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Nursing 209 Exam 1 ULL.
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abnormal abstract thinking - ANS-cant explain a proverb or fable, doesn't see the pointor moral of the story
abnormal attention span - ANS-fidgets, doesn't listen and pay attention, incomplete
thoughts
abnormal auscultation of temporal artery - ANS-bruits, irregular pulse
abnormal behavior - ANS-uses drugs/alcohol to cope; negative attitude; can't function
due to depression; incongruent actions
Abnormal Chvostek's Sign - ANS-Contraction on forehead, eye, neck = 2
abnormal clarity/content - ANS-evasive, jumbled/confused thoughts, ideas run together
(flight of ideas) indecisive
abnormal dress - ANS-Clothes do not fit well; inappropriate for weather or occasion; not
worn properly; not buttoned properly
abnormal facial expressions - ANS-no expression, exaggerated expressions, not
appropriate to conversation or statements, facial asymmetry, drooping on one side
(patient could be unaware), dark circles under the eyes, blinking (anxiety), grimacing
(pain), puffy (could be bc of renal failure/cardiovascular problems)
abnormal facial muscle tone (palpate while pt has teeth clenched) - ANS--poor
turgor/rigidity
-decreased muscle tone
abnormal findings of hair - ANS--brittle and dry
-dull or no shine
-poor growth
-alopecia
-effects of hyper or hypothyroidism
abnormal gait - ANS-Staggers, shuffles, stumbles, watches feet, arms swing out of sync
abnormal hygiene - ANS-dirty/unshaven, body odors
Abnormal intellectual function - ANS-Alzheimer's- recalls 0-1 words from 3-4 word list.
difficulty with reading or math; can be causes by pain, anxiety, and/or depression
,Abnormal judgment - ANS-irrational, fearful, cant make simple decisions, doesn't
consider others, chooses the "wrong" way (stress, pain, drugs and anxiety can impair
this)
Abnormal Level of Consciousness - ANS-unaware of surroundings; doesn't know
who/where they are;
Abnormal lymph node characteristics - ANS-->1 cm
-confluent
-hard
-fix
-tender
abnormal memory - ANS-difficulty remembering short/long term events' Alzheimer's
patients remembering long term memories better than short term events; attempts to
cover memory loss
abnormal mood and affect - ANS-no observable expressions; depressed or anxiety;
rapidly changes from one mood to the next; inappropriate mood or expression for the
situation; facial expression does not match mood
abnormal motor/body movements - ANS-uncoordinated; jerky, tremors, tics; can't get
up; moves too fast or too slow; splints; asymmetric movement
Abnormal neck findings - ANS--asymmetry
-spasms
-rigidity
-torticollis
-deviated trachea
abnormal pain response - ANS-no withdrawal or movement
abnormal perception/insight - ANS-unable to follow directions, psychotic, doesn't follow
conversation, inappropriate affect, euphoric, delusional, paranoid
Abnormal Posture - ANS--Rigid/tense
-Shoulders slumped; looks deflated (e.g. depression)
-flexed arms (sign of Parkinson's)
, abnormal pupils - ANS-no reaction, dilated, constricted, sluggish reaction, asymmetric
abnormal scalp findings - ANS--sebaceous cysts
-masses
-nits/lice
-pain, ulcers, indentations, old scars
Abnormal Sensory Perception and complex coordination (ability to write name, draw a
circle) - ANS-trouble writing name (Alzheimer's); starts circle somewhere other than the
top and doesn't connect (shows readiness fro kindergarten)
abnormal similarities/differences - ANS-cant see how things are the same or different
(Alzheimer's)
abnormal speech - ANS-too high/low; monotoned; too high/low; stammers, stutters,
slurred, garbled
abnormal thyroid findings - ANS--asymmetry
-nodularity
-tenderness
-irregular consistency
-enlargement due to grave's disease
Abnormal Verbal Response (LOC) - ANS-Doesn't appear to hear; does not follow
commands
Abrasion - ANS-A wearing away or rubbing away by friction.
acetone - ANS-"fruity smell"; diabetic ketoacidosis
acid - ANS-odor of acid; peptic ulcer/acid reflux
acromegaly - ANS-large, elongated extremities, jaw, and forehead
Activity-Exercise Pattern - ANS-Describes patterns of exercise, activity, leisure, and
recreation; ability to perform activities of daily living
Acute lymph node infection - ANS-bilateral enlargement, warmth, tenderness, firmness,
and mobility
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