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NR 509 Final Exam Questions and answers
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NR 509 Final Exam10 minute geriatric screener - ✅✅ -1.vision a. difficulty driving/watching
TV/reading
-->snellen chart with corrective lenses (normal: <20/40)
2. hearing: audioscope at 40dB (1,000 and 2,000) (+= inability to hear
one in both or one ear)
3. leg mobility: Get up and Go test: rise, walk 10 ft, turn, walk back, sit
down (+= greater than 10 seconds)
4. urinary incontinence: Ask: a. lose urine and gotten wet in last year? b.
6 times? (+= yes to both)
5. nutrition/weight loss: a. lost 10 lbs in 6 mos? b. check weight (+=
<100lbs)
6. memory: three-item recall (+= unable to remember all 3 after 1 min)
7. depression: Ask: do you feel sad/depressed (+= yes)
8. physical disability (6 questions: 1. strenious activity? 2. Heavy work?
3. Shopping? 4. Go to places out of walking distance? 5. Bath/shower?
6. Dress?) (+= no to any)
Abdomen palpation - ✅✅ -gently palpate over 4 quadrants:
abnormal: involuntary rigidity=peritoneal inflammation
Deep palpation to feel for masses: physiologic (pregnancy),
inflammatory (diverticulitis), vascular (AAA), neoplastic (colon cancer), or
obstructive (distended bladder or dilated loop of bowel)
Abdomen percussion - ✅✅ ---Tympany dominates d/t gas
--Dull areas: fluid, feces, mass, enlarged organ
--Protuberant abdomen: note where tympany changes to dullness (solid
posterior structures)
--Percuss lower anterior chest above costal margins: normal= right
dullness over liver, left tympany over gastric air bubble and spelnic
flexure of colon.
Abdominal Auscultation - ✅✅ -1. Bowel sounds
2. Bruits: hepatic (Cirrhosis), Arterial with systolic and diastolic
component (occlusion of aorta or large artery (ex. epigastric--renal artery
stenosis/renovascular hypertension)
,3. Venous Hum: rare soft humming w/ sys/dias.= increase collateral circ
btwn portal and systemic systems (hepatic cirrhosis)
4. Friction Rub over liver or spleen: Rare grating sounds w/ respiratory
variation=inflammation (liver cancer, chlamydial/gonococcal
perihepatitis, liver bx, splenic infarct)
Abdominal insepction - ✅✅ -Abnormal:
purple striae: cushing syndrome
Dilated veins: portal HTN from cirrhosis or ICV obstruction
Ecchymosis: intraperitoneal or retroperitoneal hemorrhage
Protuberant abdomen: 1. Hernia (umbilica, incisional, epigastric, 2.
Diastasis Recti, 3. Lipoma, 4. Fat, 5. Gas, 6. Tumor, 7. Pregnancy, 8.
Ascites
Acrocyanosis - ✅✅ -Blue cast to hands and feet when exposed to cold.
Common for first few days into early infancy.
--should disappear within 8 hrs of birth or warming.
Acute Cholecystits - ✅✅-RUQ pain
Murphy Sign
Acute Pancreatitis Aggrevating Factors - ✅✅ -Lying supine; dyspnea if
pleural effusions from capillary leak syn-drome; selected medications,
high triglycerides may exacerbate
Acute Pancreatitis Associated Symptoms and Setting - ✅✅ -Nausea,
vomiting, abdominal dis-tention, fever; often recurrent; 80% with history
of alcohol abuse or gallstones
Acute Pancreatitis Location - ✅✅ -Epigastric, may radiate straight to
the back or other areas of the abdomen; 20% with severe sequelae of
organ failure
Acute Pancreatitis Process - ✅✅ -Intrapancreatic trypsinogen activation
to trypsin and other enzymes, result-ing in autodigestion and
inflammation of the pancreas
, Acute Pancreatitis Quality -✅✅-Usually steady
Acute Pancreatitis Relieving factors - ✅✅-Leaning forward with trunk
flexed
✅✅-Acute onset, persistent pain
Acute PancreatitisTiming -
Adult immunizations - ✅✅-Influenza: >50 yrs, disorders present,
immunosuppressed, nursing homes residents, household contacts of
children <5 yrs.
Pneumococcal: >65 yrs, adults 19-64 with immunosuppression or other
problems.
Tdap: All adults no previously immunized and every 10 years.
Zoster: >60 years (except with history of immunodeficiency)
Anxiety disorders - ✅✅ -excessive worry persisting over a 6 month
period suggests anxiety disorder.
--3 % prevalence
1. Panic disorder
2. OCD
3. PTSD
4. Social anxiety disorder
5. Phobias
Aorta abnormalities - ✅✅ -A periumbilical or upper abdominal mass
with expansile pulsations that is ≥3 cm in diameter suggests an AAA.
Sensitivity of palpation increases as AAAs enlarge.
Aorta assessment - ✅✅ -Press firmly deep in the epigastrium, slightly
to the left of the midline, and identify the aortic pulsations
Adults over age 50 years, assess the width of the aorta by pressing
deeply in the upper abdomen with one hand on each side of the aorta
(normally no more than 3cm wide).
Aphasia - ✅✅-Disorder in producing or understanding language.
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