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NURS 312 Semester Review Flashcards | StudBud
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NURS 312 Semester Review
NURS 312 Semester Review
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1
The nurse is assessing the patient’s sclerae and notes a yellow tinge. What labs will the nurse check?
Potassium levels
BUN & creatinine (kidney function)
Liver function tests (LFTs)
WBCs
2
Subjective or objective data? The patient reports having diarrhea for 10 days.
Objective
Subjective
3
Which of the following vital signs is within normal limits (WNL)?
RR 24
HR 52
BP 110/72
T 101°F (38.3°C)
4
Costovertebral angle tenderness indicates what?
An inflamed lung
An inflamed kidney
An inflamed stomach
An inflamed gallbladder
5
In adults, what is a healthy range for systolic blood pressure?
< 90 mm Hg
120-140 mm Hg
90-120 mm Hg
> 140 mm Hg
6
Inspection
of the abdomen includes assessing for all of the following EXCEPT
bruising
scars
tenderness
contour
7
Tachypnea is?
Elevated heart rate.
Slow heart rate.
Slow respiratory rate.
Elevated respiratory rate.
8
In adults, what is a normal range for pulse?
12-20 beats per minute
60-100 beats per minute
40-60 beats per minute
100-120 beats per minute
9
This area is where the apical pulse is auscultated (and is the PMI):
Mitral Area
Erb's Point
Tricuspid area
Pulmonic Area
10
Solid viscera include which of the following organs?
stomach
liver
bladder
small intestine
11
What does PMI stand for?
Point of maximal impulse
Planned metered inhaler
Palpation measuring index
Too much information
12
In adults, what is a normal range for oxygen saturation?
95-100%
60-100%
12-20%
20-40%
13
In adults, what is a normal range for respiratory rate?
60-100 breaths per minute
12-20 breaths per minute
Under 120 breaths per minute
6-10 breaths per minute
14
What is the function of CN II?
smell
tongue movements
vision
hearing
15
Ptosis of the eye
reddened conjunctiva
lower lid drooping away
yellowish nodules on sclera
drooping eyelid
16
True or False: Delirium is reversible but dementia is not.
True
False
17
What does the C in SPICES stand for?
Chronic conditions
Confusion
Careful ambulation
Cold
18
What does the nurse anticipate during a physical assessment of a patient with a sudden onset of gout pain?
Warm, tender, and deformed wrists and finger joints bilaterally
Chronic lower back pain
Edema, warmth, and redness of a great toe
Tenderness with pronation and supination of the elbow
19
True or False: Memory loss is normal in older adults.
True
False
20
All of the following are
signs
except
:
Lungs clear to auscultation bilaterally
Patient reports pain of 7/10
Bilateral upper extremity strength of 5/5
Rash noted on abdomen
21
True or False: There are eight regions of the abdomen.
False
True
22
Which valve is located between the right atria and the right ventricle?
Tricuspid
Pulmonic
Mitral
Aortic
23
What is delirium?
A stage of Alzheimer’s
A long term issue in older adults
An acute stage of confusion
A drug inducted state
24
On the muscle strength rating scale, which score indicates normal?
0
2
4
5
25
What is a vesicular sound?
Abnormal breath sound heard in infants
Normal breath sound heard over trachea
Abnormal breath sound heard over the right middle lobe
Normal breath sound heard over most of the lung field
26
The RN is performing a mental status examination on a client with confusion.
This test assesses which of the following?
Cerebral function
Cerebellar function
Sensory function
Intellectual function
27
87% of strokes are ischemic and 13% are hemorrhagic.
False
True
28
A patient has an elevated BUN and creatinine. The nurse suspects the patient has:
Heart failure
Diabetes
Liver failure
Kidney failure
29
A patient's blood glucose is 285. The patient is:
Hyperglycemic
Hypoglycemic
Euglycemic (normal)
30
When a person suddenly becomes immobile, how long does it take to have a measurable decline in ROM?
One month
48 hours
4 days
One week
31
Your patient's CBC is as follows: WBC 7.2, Hgb 5.9, Hct 21, Plts 300. The patient is likely at risk for:
Sepsis
Bleeding
Falls
Infection
32
Subjective or objective? The patient's diarrhea is brown, watery, and malodorous.
Subjective
Objective
33
What are the movements of the elbow joints?
SATA
Flexion & extension
Lateral rotation
Supination & pronation
Abduction & adduction
34
How does a nurse assess plantar flexion of a patient's ankle?
Ask the patient to flex the toes up
Ask the patient to turn the sole of the foot inward toward the midline
Ask the patient to turn the sole of the foot away from the body
Ask the patient to point the toes down
35
All of the following test cerebellar function
except
:
Rapid alternating movements (RAM
Finger to finger test
Heel to shin test
Hand grip test
36
In adults, what is a normal range for diastolic blood pressure?
< 80 mm Hg
120-140 mm Hg
> 140 mm Hg
90-120 mm Hg
37
Which of the following is an unexpected finding (not within normal limits) of a peripheral vascular assessment?
Skin color uniform and appropriate for race bilaterally
Pulses present and equal bilaterally
Cyanosis or pallor, indicating decreased perfusion
Absence of jugular vein distention (JVD)
38
True or false: Ligaments connect bone to bone while tendons connect muscles to bone.
False
True
39
A patient's Morse Fall Score is 90. What is the patient's fall risk status?
High risk for falls
Moderate risk for falls
Low risk for falls
No risk for falls
40
The Glasgow Coma Scale measures patients according to what three categories of response?
Eye opening, verbal, and motor
Sensory, verbal, and cognition
Reflexes, verbal, and sensory
Eye opening, verbal, and auditory
41
The need to assume a more upright position to breathe comfortably is called
Paroxysmal Nocturnal Dyspnea
Nocturia
Dyspnea
Orthopnea
42
The RN is giving report to the another RN. Which vital signs would the nurse need to mention in the report?
SATA
RR 16
Systolic BPs in the 150s to 180s
T Max 98.6°F (37°C)
O2 sat 97% on room air
HR in the 110s
43
Which of the following tests are included in the CMP (comprehensive metabolic panel)?
Select all that apply.
Magnesium
Protein (total & albumin)
Phosphorous
Liver function tests (LFTs) x 4
44
The Lawton Scale Instrumental Activities of Daily Living (iADLs) include all of the following
except:
Ability to use a telephone
Sleeping
Shopping and food preparation
Housekeeping and laundry
45
We listen to the abdomen in this order: RLQ, RUQ, LUQ, & LLQ.
True
False
46
Which of the following are expected findings in a patient with COPD?
SATA
Barrel chest
Decreased diaphragmatic excursion
Oxygen saturation of 96%
Clubbed fingernails
47
How does a nurse assess the eversion of a patient's ankle?
Ask the patient to turn the sole of the foot away from the body
Ask the patient to turn the sole of the foot inward toward the midline
Ask the patient to point the toes down
Ask the patient to flex the toes up
48
Which of the following is an expected (normal) finding in a cardiac exam?
Extra heart sounds such as a murmur, S3, or S4
S1 and S2 heart sounds in a regular rate and rhythm
Reported chest pain, calf pain, or worsening shortness of breath
Symptomatic tachycardia at rest (HR>100 bpm)
49
Which example includes both objective and subjective data?
The client’s blood pressure is 132/68 and her heart rate is 88.
The client states he gets frequent headaches & takes aspirin for the pain.
The client’s cholesterol is elevated, and he states he likes fried food.
The client states she has trouble sleeping and that she drinks coffee daily
50
Clouding of the lens of the eye:
cataract
retinopathy
AMD
glaucoma
51
Which of the following signs is the earliest and most sensitive indicator of neurological status?
A change in pulse and blood pressue
A change in level of consciousness (LOC)
A change in reflexes
A change in motor function
52
True or False: Hypoactive bowel sounds are occur less than 5 times a minute and are also called ‘sluggish.’
True
False
53
The most serious side effect of abnormal potassium levels is:
Cardiac arrythmias
Numbness and tingling
Irritability
Muscle cramps
54
Your patient's CBC is as follows: WBC 18.2, Hgb 13, Hct 42, Plts 187. The nurse is concerned for:
Risk for bleeding
Anemia
Infection
Risk for infection
55
What is a bronchial sound?
Normal breath sound heard over the alveoli.
Normal breath sound heard over the trachea.
Abnormal breath sound heard in asthma attack.
Abnormal breath sound heard over the trachea.
56
True or False: We auscultate prior to palpation when assessing the abdomen.
False
True
57
Most commonly used visual acuity measure
PERRLA
Alphabetic Chart
Snellen Eye Chart
Finger to nose test
58
What is excursion?
A trip you take after graduation.
The expandability of the alveoli.
The measurement between the esophagus and the diaphragm.
The expandability of the chest.
59
Subjective data about the GI system include all of the following EXCEPT:
pain
nausea
BMI of 27
anorexia (lack of appetite)
60
The RN is giving report to the another RN. Which vital signs would the nurse need to mention in the report?
SATA
Systolic BPs in the 80s
HR in the 80s to 90s
O2 sat 95% on room air
T Max 99.9°F
RR 16
61
You ask the patient to smile, show teeth, close both eyes, puff cheeks, frown, and raise eyebrows. Which cranial nerve?
Accessory
Trigeminal
Vagus
Facial
62
Patient is drowsy but awakens, though not fully, to stimulation. Answers questions and follows commands, but slowly.
Lethargic
Stuporous
Alert
Comatose
63
Which tests are included in the BMP (basic metabolic panel)?
Select all that apply.
BUN & Creatinine
Magnesium & phosphorus
Chloride and bicarbonate (CO2)
Sodium & potassium
Glucose
Calcium
64
Which of the following vital signs is within defined limits (WDL)?
T 99°F (37.2°C)
RR 18
BP 168/88
P 110
65
Which organ is NOT in the RUQ?
Liver
Right kidney
Descending colon
Gallbladder
66
Moderate pitting edema with an indentation that takes about 5-6 seconds to rebound is graded:
2+
1+
4+
3+
67
Patient is on a dilaudid patient-controlled analgesia (PCA). Which vitals would the nurse report to the MD/NP/PA?
Last BP 118/82
O2 sat 92% on RA
T Max 98.2°F
RR 8
Last HR 78 bpm
68
An example of a hollow viscera is:
Spleen
Liver
Ovaries
Bladder
69
Which of the following is a normal capillary refill time?
Less than 3 seconds
Less than 5 seconds
More than 5 seconds
More than 3 seconds
70
A pt develops new confusion. Vitals are: T 101.2, BP 85/53, RR 32. Which orders does the nurse anticipate?
SATA.
NPO (nothing by mouth) diet order
IV fluids
IV antibiotics after blood cultures are drawn
IV antibiotics before blood cultures are drawn
Place Foley catheter
Lactate (lab)
71
The Katz Index of Activities of Daily Living (ADLs) include all of the following
except
:
Bathing and dressing
Continence
Toileting and transferring
Money and medication managment
72
Which of the following findings could trigger a nutritional consult with a dietician?
SATA
BMI of 24.5
cachectic appearance
patient reports having lost 25 pounds in the past 3 months without trying
Mini Nutritional Assessment (MNA) score of 7
73
The phase of the cardiac cycle when ventricles relax and fill with blood is called
Diastole
Systole
74
What is the motor function of CN V?
tongue movements
mastication
swallow
pupil response to light
75
A critical thinking process that professional nurses use to apply evidence-based nursing care
Standard of care
Clinical practice guideline
Nursing process
Independent nursing intervention
76
In adults, what is a normal range for temperature?
96.6-99.1ºF / 35.8-37.3 ºC
>100.4°F (38°C)
95.1°F to 97.1°F (35.1°C to 36.2°C)
99.2°F to 99.9°F (37.3°C to 37.7°C)
77
What is the best position to have a client in to visually inspect for jugular vein distention (JVD)?
30-45 degrees
Trendelenberg
Supine
90 degrees
78
A patient smoked 1/2 pack of cigarettes daily for 30 years but quit 10 years ago. Document the smoking history as:
15 pack-year
20 pack-year
10 pack-year
5 pack-year
79
What does CMST stand for?
Color, muscle strength, temperature
Curvature, movement, scoliosis, temperature
Color, movement, sensation, temperature
Cartilage, muscles, sinew, tendons
80
All of the following are common changes to the musculoskeletal system in older adults
except
:
Joint degeneration
Decreased proprioception
Increased bone density
Loss of muscle mass and strength
81
What is the SPICES assessment tool?
A guide for which spices are safe for older adults
A tool to learn about the mental health of older adults
A mnemonic for the top diseases in older adults
A tool to ask about the most common problems of the elderly
82
A patient's potassium is 2.8. What is this condition called?
Hypernatremia
Hypokalemia
Hyperkalemia
Hypocalcemia
83
To auscultate the tricuspid area, where would the nurse place the stethoscope?
Left sternal border, 4th intercostal space
Right sternal border, 2nd intercostal space
Left sternal border, 2nd intercostal space
Left sternal border, 5th intercostal space
84
Your patient's CBC is as follows: WBC 0.4, Hgb 5.9, Hct 21, Plts 300. The patient is at risk for:
SATA
Infection
Falls
Bleeding
Cardiac arrythmias
85
The RN is giving report to the another RN. Which vital lab results would the nurse need to mention in the report?
SATA
Potassium 2.8
Calcium 9.1
Bun 22
Glucose 238
Sodium 136
Creatinine 1.1
86
The nurse documents that the radial pulse is a +2. What does this mean?
The pulse is normal.
The pulse is full, increased.
The pulse is weak, barely palpable.
The pulse is bounding.
87
What are expected physiological changes in an older adult to the CV system?
SATA
Blood vessels narrow and lose elasticity
Valves become less efficient
Cardiac output decreases
Chest pain is common
88
Which of the following are possible causes of delirium?
SATA
Infection
Caffiene
Medications
Surgery
89
Which type of assessment do nurses typically perform on existing hospital patients during their shift?
Emergency assessments
Complete or comprehensive head-to-toe assessment
Abbreviated head-to-toe assessment
Focused assessment
90
True or False: Decreased elasticity of the skin is an expected finding in older adults.
False
True
91
Childhood diseases, adult diseases, accidents & injuries, etc. and prior surgeries, including any complications.
Review of systems
Social history
Family history
Past medical history/Past surgical history (PMH/PSH)
92
Which organ is NOT in the RLQ?
Right Ovary
Cecum
Appendix
Spleen
93
Which group of cervical nodes is palpable under the tip of the chin?
Parotid
Submaxillary
Submental
Tonsillar
94
Your patient was in a MVA and is now quadriplegic. You would expect his muscle strength in all extremities to be:
1
3
0
5
95
You document pain in the right calf, red streaks along the leg, and warmth & edema. What is the likely cause?
Arterial insufficiency
Deep vein thrombosis
Raynaud disease
Venous insufficiency
96
Hyperactive bowel sounds occur how often?
10 sounds a minute
5 sounds a minute
20 sounds a minute
greater than 30 sounds a minute
97
What consitutes a fever in medical terms?
> 100.4°F (38°C)
99.1°F to 99.9°F (37.3°C to 37.7°C)
< 104°F (40°C)
98.6°F (37°C)
98
Heart sound that has a thud-like quality and occurs directly before the S1 heart should be documented as:
S4
Pericardial friction rub
S3
Murmur
99
All internal organs in the abdomen are called viscera.
False
True
100
Patients' verbal descriptions of their health problems
Subjective data
Objective data
Assessment
Expected outcomes
