Midterm for PA 2 Health care questions with answers
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Course
NURS 190
Institution
NURS 190
. Pt with malignant melanoma; risk factors; what will the skin look like? ABCDE
ABCDE of Melanoma
Asymmetry
Border Irregularity
Color Variation
Diameter Greater than 6mm
Evolving Changes
Risk Factors
Sun sensitivity, difficulty tanning, hx of prolonged sun ex...
midterm for pa 2 health care questions with answers
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1. Pt with malignant melanoma; risk factors; what will the skin look like? ABCDE
ABCDE of Melanoma
Asymmetry
Border Irregularity
Color Variation
Diameter Greater than 6mm
Evolving Changes
Risk Factors
Sun sensitivity, difficulty tanning, hx of prolonged sun exposure, use of tanning booths, occupational
exposure to chemicals like tar and radiation
QUIZ QUESTION: Nevi this big and has color variation should be alerted for? – Malignant Melanoma
2. How to assess for central cyanosis?
Look at patient’s oral mucosa
QUIZ QUESTION: How to assess central cyanosis? – check the oral mucosa
3. Contact dermatitis
Inflammation of the skin due to an allergy to a substance that comes into contact with the skin
Redness, hives, vesicles or scales accompanied by intense itching
4. 3 Tineas; signs and symptom
Tinea Corporis – fungal infection of the body
Tinea Capitis – fungal infection of the scalp
Need to further assess the cause of pruritus of the scalp because this can be due to lice
Tinea Pedis – fungal infection of the feet (athlete’s foot)
5. COPD, configuration of chest
Barrel chest; AP:T diameter is equal
QUIZ QUESTION: Expected finding with patient with COPD?
Barrel chest
Kyphosis
Hollow Clavicle
Protruding Sternum angle of Louie
6. Scoliosis, kyphosis, lordosis, torticollis
Scoliosis – lateral curvature and rotation of the thoracic and lumbar spine (S back); most common in female
Kyphosis – exaggerated posterior curvature of the thoracic spine (hunchback); associated with aging.
Lordosis – exaggerated curvature of the lumbar spine (swayback); compensation for pregnancy, obesity, and
skeletal changes.
Torticollis – muscle spasm by spinal accessory nerve, causing lateral flexion contracture of neck muscle
7. Physiological changes in older adult for all the systems discussed
Skin, Hair, and Nails
Decreased elasticity, sebum production, perspiration, and melanin
Increased sensitivity to light
Nails become thicker, and more brittle
Head, Neck and Lymphatics
Loss of subcutaneous fat in the face
Decreased reproductive hormone
Hair change, tooth loss, limited ROM
Complaints of tired or weak feeling due to thyroid dysfunction
Eye
Decreased vision acuity
Presbyopia – age-related near vision difficulty
Cataract – thickened yellow lens; decreased lens clarity
Macular Degeneration – loss of central vision
Ears, Nose, Mouth and Throat
Loss of hearing frequency
Gradual hearing loss (presbycusis)
Chelitis (angular stomatitis)
Decreased sense of taste and smell, saliva production,
Receding gum, tooth loss
, Respiratory
Decreased respiratory efficiency, cough ability
Changes in breath depth
Increased RR, effect of infection
Breast and Axillae
Limited ROM for examinations
Modification of BSE
Changes in breast tissue composition
Gynecomastia in males
Increased breast cancer risk with aging
Cardiovascular
Loss of ventricular compliance and vascular rigidity
Conduction system loses automaticity
Peripheral Vascular
Increased BP
Decreased pulse with irregularities
Enlarged calf vessel
8. Different types of color – jaundice, pallor etc; What requires immediate intervention
Cyanosis – mottled blue color in skin (REQUIRES IMMEDIATE INTERVENTION)
Pallor – loss of skin color due to the absence of oxygen
Uremia – pale yellow tone due to urinary retention
Erythema – redness of the skin due to increase visibility of the oxyhemoglobin
Jaundice – yellow undertone due to increase bilirubin in the blood
QUIZ QUESTION: CYANOSIS is a priority because it indicates hypoxemia
9. How to assess jaundice, central cyanosis?
Look for discoloration with the patient’s oral mucosa, then conjunctiva next
10. How to assess temperature
Use the dorsal surface of the hand and feel for the temp
QUIZ QUESTION: If assessing for temperature, use the DORSAL surface of the hand
11. Sxs of infection; patient suspecting with infection
Older patient with pneumonia will present CONFUSION
QUIZ QUESTION: patient suspected of fungal infection? – have you taken antibiotics recently
12. Assessing for pain; expected findings with acute pain /chronic pain
Self-reported pain from patient is the most accurate assessment of pain
QUIZ QUESTION: Best way to assess for pain is SELF-REPORTED pain from patient
13. Cranial nerves I, II, III,IV, VI; how to assess the different cranial nerves?
CN I: Olfactory – smell
Assessment: have the patient close their eyes, obstruct one nare then make patient sniff a common
substance, and then do the other nare
Anosmia – inability to detect odor
Unilateral or bilateral anosmia
CN II: Optic – sight
Assessment: Snelling and Rosenbaum
Optic atrophy, papilledema, amblyopia, field defects
CN III: Oculomotor – eyelids and pupil
Direct Constriction – shine light directly to the pupil; failure of the pupil to constrict shows defect in the
direct pupillary response; defect in CN III
Consensual Constriction – simultaneous constriction of the pupil that is not illuminated.
6 Cardinal Fields of Gaze – evaluates the movement of the eyes
o Nystagmus – weakness of the extraocular muscles; repetitive uncontrolled eye movements
o Looking up and down without moving the head
Confrontational Test – tests peripheral vision by covering one eye together with patient; examiner moves
finger in peripheral field
ABNORMAL: can’t move eye upward, and downward
Diplopia, ptosis, dilated pupils, inability to focus on close objects
, CN IV: Trochlear – eyeball
ABNORMAL: can’t move eye down or nasally
Convergent strabismus, diplopia
CN VI: Abducens – eyeball
ABNORMAL: can’t move eye temporally
Diplopia, strabismus
QUIZ QUESTIONS:
Test for CN II (Optic Nerve) – Snellen and Rosenbaum
CN III (Oculomotor Nerve) – look up and down without moving the head
14. Assess for clubbing
Normal nails will form a diamond-shaped opening when put together; convex curve
have the dorsal surface of the fingers together
QUIZ QUESTION: How to assess for clubbing of fingers? – dorsal surface of fingers next to each other
15. Assessing for coordination? What tests? What is positive and negative Romberg’s
Romberg’s Test
Used to test for equilibrium
Have the patient stand with feet together and arms to the side, eyes open first then closed.
Mild swaying is a NEGATIVE Romberg
If patient is unable to maintain balance or needs to have feet further apart, then there may be a problem
with the vestibular apparatus (inner ear).
QUIZ QUESTION:
Minimal swaying during Romberg’s test – NEGATIVE FINDING
Swaying and feet apart – POSITIVE ROMBERG
16. Assess for weber or Rinne or whisper test? Normal and abnormal findings
Weber Test
Use of tuning fork;
Place activated tuning fork on top of head; sound should be heard equally (no lateralization)
Lateralization may be due to poor conduction (sound heard better in impaired ear) or nerve damage
(sound is referred to the better ear)
Rinne Test – use of tuning fork
Bone Conduction – tuning fork against the mastoid process
Air Conduction – tuning fork in front of the external meatus
Air conduction should be TWICE longer than Bone Conduction (AC 2x > BC)
Whisper Test
Whisper a phrase or sentence from a distance and have the patient repeat it; inability to repeat phrase
may indicate hearing loss; check for high frequency sounds
QUIZ QUESTIONS:
Rinne Test – air conduction is twice longer than the bone conduction
Hearing Test – whisper random phrases to the patient and make them repeat it
Rinne Test – air conduction of 32 and bone conduction of 15; still normal finding, slight
difference is okay.
17. Types of adventitious breath sounds and normal breath sounds
NORMAL BREATH SOUNDS
Tracheal – harsh, high pitched
Bronchial – loud, high pitched
Bronchovesicular – medium loudness, medium pitch
Vesicular – soft, low pitched
ADVENTITIOUS BREATH SOUNDS (ABNORMAL)
Fine Rales/Crackles – high pitched, short crackling
Coarse Rales/Crackles – loud, moist, low pitched bubbling
Wheezes – high pitched, continuous
Rhonchi – low pitched, continuous, snoring, rattling
Stridor – loud, high pitched, crowing heard without a stethoscope
Friction rub – low-pitched grating, rubbing
18. Patient with breast cancer, mastectomy with dissection with lymph nodes; precautions?
No BP on the affected arm
QUIZ QUESTION: What to tell nurse during assessment? – don’t take BP on the side of mastectomy
19. Assess for orthostatic hypotension
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