NUR 3066- EXAM 1 STUDY GUIDE
WITH COMPLETE SOLUTIONS
Objective Data - ANSWER-what you as the health professional observe/sense (see,
hear, smell, feel...) by inspecting, percussing, palpating, and auscultating during the
physical examination
Components of the Mental Status examination - ANSWER-ABCT
Appearance: posture, dress, body movement
Behavior: LOC, facial express, mood
Cognition: orientation, attention span, memory
Thought process: thought content/process
Assessment Techniques - ANSWER-1. inspection- observe
2. palpation- sense of touch
3. percussion- tapping for audible vibrations
4. auscultation- listening to sounds (stethoscope)
Components of the General Survey - ANSWER-1. physical appearance
2. body structure
3. mobility
4. behavior
Range of Vitals - ANSWER-temperature: 96.4F to 99.1F
pulse: 50 to 95bpm
pulse rhythm: regular, even tempo
pulse force: 2+
respiration: 16 to 25 breaths per min
oxygen saturation: >95% room air
blood pressure: 120/80
BMI: 18.5 to 24.9
Orthostatic hypotension - ANSWER-refers to a drop in systolic pressure of ≥20 mm
Hg or diastolic pressure ≥10 mm Hg after changing to a standing position
Subjective Data - ANSWER-what the subject says about themselves or their
condition during the assessment process
Priority Setting - ANSWER-evolves over time with changes in priority setting
depending on the severity of the problem
First-level Priority - ANSWER-emergent, life-threatening, and immediate (ABCs:
Airway, Breathing, Circulation)
Second-level Priority - ANSWER-needs attention before it becomes a first level
(mental status change, acute pain, infection risk, abnormal labs, safety risks)
WITH COMPLETE SOLUTIONS
Objective Data - ANSWER-what you as the health professional observe/sense (see,
hear, smell, feel...) by inspecting, percussing, palpating, and auscultating during the
physical examination
Components of the Mental Status examination - ANSWER-ABCT
Appearance: posture, dress, body movement
Behavior: LOC, facial express, mood
Cognition: orientation, attention span, memory
Thought process: thought content/process
Assessment Techniques - ANSWER-1. inspection- observe
2. palpation- sense of touch
3. percussion- tapping for audible vibrations
4. auscultation- listening to sounds (stethoscope)
Components of the General Survey - ANSWER-1. physical appearance
2. body structure
3. mobility
4. behavior
Range of Vitals - ANSWER-temperature: 96.4F to 99.1F
pulse: 50 to 95bpm
pulse rhythm: regular, even tempo
pulse force: 2+
respiration: 16 to 25 breaths per min
oxygen saturation: >95% room air
blood pressure: 120/80
BMI: 18.5 to 24.9
Orthostatic hypotension - ANSWER-refers to a drop in systolic pressure of ≥20 mm
Hg or diastolic pressure ≥10 mm Hg after changing to a standing position
Subjective Data - ANSWER-what the subject says about themselves or their
condition during the assessment process
Priority Setting - ANSWER-evolves over time with changes in priority setting
depending on the severity of the problem
First-level Priority - ANSWER-emergent, life-threatening, and immediate (ABCs:
Airway, Breathing, Circulation)
Second-level Priority - ANSWER-needs attention before it becomes a first level
(mental status change, acute pain, infection risk, abnormal labs, safety risks)
