NSG 316 Exam 1/59 Complete
Questions & Answers
General Survey Components - -physical appearance, body structure,
mobility, behavior
-Health Assessment - -· Start with head-to-toe survey
· Health Hx and records
· Physical examination
· Interview
· Functional assessment
· Cultural and spiritual assessment
· Consultation
· Review of literature
-ADLs (activities of daily living) - -personal daily care tasks, including
bathing, skin, nail, and hair care, walking, eating and drinking, mouth care,
dressing, transferring, and toileting
-IADLs (instrumental activities of daily living) - -more complex activities.
Laundry, shopping for groceries, using a telephone, cooking, shopping,
housekeeping, finances, taking medications, preparing meals, fixing things
around the house, lawn care,
-AADLs (Advanced Activities of Daily Living)- - -social, family, and
community roles, occupation
-Functional Assessment - -an objective review of an individual's mobility,
transfer skills, and activities of daily living, including self-care, sphincter
control, mobility, locomotion, and communication
-Acculturation - -The adoption of cultural traits, such as language, by one
group under the influence of another.
-Acculturative stress - -stress resulting from the need to change and adapt
a person's ways to the majority culture
-Assimilation - -the social process of absorbing one cultural group into
harmony with another
-PQRSTU - -*PQRSTU* stands for *P*rovocative or palliative, *Q*uality or
quantity, *R*egion or radiation, *S*everity scale, *T*iming, and
*U*nderstanding the patient's perception of the problem.
, -Examples of internal factors - -liking others, empathy, ability to listen
-Examples of external factors - -ensure privacy, refuse interruptions,
physical environment
-Title VI of Civil Rights Act of 1964 - -Services cannot be denied to people of
limited English proficiency
-Inspection - -§ Close, careful, concentrated scrutiny of the whole and then
each body system
§ Begins when you first meet the person; always comes first
§ Requires good lighting, adequate expose, occasional instruments (scales,
calipers, sphygmomanometer, stethoscope, thermometer, penlight, reflex
hammer, tongue depressor, etc.)
-Palpation - -§ Nurses use light palpation only (physicians can do deep or
bimanual palpation; may cause injury)
· Detect surfaces characteristics
· Accustom a person to be touched
§ Different parts of hands for different factors:
· Fingertips: tactile discrimination (skin texture, swelling, pulsation,
determining the presence of lumps)
· Fingers and thumb: detection for position, shape, and consistency of an
organ or mass
· Dora (back) of hands and fingers: temperature (thinner than on palms)
· Base of fingers or ulnar surface of hand: vibration
-percussion - -· Direct: striking hand directly contacts body wall
· Indirect: striking hand contacts stationary hand fixed on person's skin (two
hands)
§ Mapping location and size of organs
§ Signaling density of a structure by a characteristic note
§ Detecting a superficial abnormal mass
§ Eliciting pain if underlying structure is inflamed
§ Eliciting deep tendon reflex using percussion hammer
-Auscultation - -§ Stethoscopes do not magnify sound but block out extra
sounds
· Clean between every patient
· Warm before putting on patient
· Diaphragm and bell
-4 stages of pain - -transduction , transmission, perception, modulation
-Senile purpura - -discoloration due to increasing capillary fragility