NSG 316 EXAM 1 QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

NSG 316 EXAM 1 QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 Describe the elements of a general survey - Answers -physical appearance (age, sex, consciousness, skin color, facial features, signs of distress) -body structure (stature, nutrition, symmetry, posture, position, build, deformities) -mobility (gait, involuntary movements) -behavior (expression, mood, speech, dress, hygiene) PBMB when should you begin observing - Answers the second you see the client health assessment - Answers collection of data about the patient's health state complete database - Answers full health history and physical examination (family practice) episodic database - Answers limited or short term problem concerns 1 problem or complex or system (urgent care) follow-up database - Answers status of pervious problem at regular scheduled intervals (doctors office) emergency database - Answers rapid collection of data (ER) comprehensive assessment - Answers health history and complete physical examination, usually conducted when a patient first enters a health care setting focused assessment - Answers assessment conducted to assess a specific problem; focuses on pertinent history and body regions subjective data - Answers what the person says about himself or herself during history taking objective data - Answers information that is seen, heard, felt, or smelled by an observer; signs first level priority - Answers Emergent, life threatening, and immediate (ABCs) second level priority - Answers Next in urgency, requiring attention so as to avoid further deterioration third level priority - Answers Important to patient's health but can be addressed after more urgent problems are addressed functional assessment components - Answers -basis for care planning, goal setting, and discharge planning -self care (ADLs) -self maintenance (IADLs) -physical mobility collecting subjective data for the ill person - Answers information about health problem obtaining an accurate and current health history - Answers -subjective data -biographical data (name,DOB,sex,race,ethnic origin) -source of history (themselves or family?) -reason for seeking care (signs/symptoms) -present health/illness (location, severity, timing, setting, relieving factors) -past health (childhood illness, hospitalizations, operations, immunizations, allergies, current meds) -family history -review of systems -functional assessment (ADLs, IADLs, AADLs) cultural competence - Answers An understanding of how a patient's cultural background shapes his beliefs, values, and expectations for therapy; established through knowing your own culture first inspection - Answers -begins when you first see the patient -first examine as a whole and then systems -good lighting, exposure, and instruments palpation - Answers -examine by touch -doctor does this, if nurses do this it will be light -fingertips (skin texture, swelling, pulsation, lumps) -fingers/thumb (position, shape, consistency of organ/mass) -dorsa of hand/fingers (temperature) -base of fingers (vibration) direct percussion - Answers striking hand directly contacts body wall indirect percussion - Answers using both hands, striking hand contacts stationary hand fixed on patient's skin Auscultation - Answers -listening to body sounds -bell (low-frequency sounds: extra heart sounds or murmurs) -diaphragm (high-frequency sounds: breaths, bowels, normal heart sounds) acute pain - Answers -short term -fast onset -predictable trajectory -goes away after injury heals incident acute pain - Answers happens with movement chronic pain - Answers -lasts 6 months or longer -slow onset -malignant -nonmalignant (arthritis, fibromyalgia, low back pain) -isn't associated with injury -BRADS (bracing, rubbing, appetite, decreased activity, sighing) breakthrough pain - Answers Occurs when patient has recurrence of pain before next scheduled dose of medication visceral pain - Answers large internal organs (dull, deep, squeezing, cramping) ex. appendicitis and cholecystitis somatic pain - Answers Pain that originates from skeletal muscles, ligaments, or joints. (aching, throbbing) cutaneous pain - Answers pain from skin surface and subcutaneous tissue (superficial, sharp, nausea, sweating, tachycardia, HTN) referred pain - Answers pain felt in a part of the body other than its actual source nociceptive pain - Answers -nerve fibers are stimulated -Triggered by events outside the nervous system from actual or potential tissue damage -transduction, transmission, perception, modulation (arthritis, mechanical back pain) neuropathic pain - Answers Does not adhere to the typical phases Due to a lesion or disease in the somatosensory nervous system Implies abnormal processing of the pain message from an injury to the nerve fibers Most difficult to assess, diagnose, and treat May evolve into chronic condition May be caused by diabetes, shingles, HIV, chemotherapy, stroke, MS, a tumor, etc. PQRST - Answers provocative/palliative, quality, region/radiation, severity, timing Identify changes that occur when a client's pain is poorly controlled. - Answers Cardiac changes: tachycardia, elevated BP, increased myocardial oxygen demand, increased cardiac input Pulmonary changes: hypoventilation, hypoxia, decreased cough, atelectasis GI changes: nausea, vomiting, ileus Renal changes: oliguria, urinary retention Musculoskeletal changes: spasm, joint stiffness Endocrine changes: increased adrenergic activity CNS changes: fear, anxiety, fatigue Immune changes: impaired cellular immunity, impaired wound healing Poorly controlled chronic pain: depression, isolation, limited mobility and function, confusion, family distress, diminished quality of life what information is important for the nurse to know when providing care for people from diverse backgrounds - Answers cultural competence which interventions will the nurse do to obtain objective data - Answers conduct physical exam, review lab reports, summon previous med records when would a nurse establish a complete database of a patient - Answers during initial home visit, in primary health setting, community health care setting ACE unit - Answers focuses on preventing functional decline in older adults during hospitalization TUG test - Answers timed up and go test; quantifies functional mobility; going outside alone safely, walking 10 ft, turn, walk back to chair and sit down, ADL - Answers activities of daily living; walking, dressing, using stairs, eating, feeding, grooming, toileting IADLs - Answers instrumental activities of daily living; shopping, meal cooking, cleaning, laundry, managing finances, counting, housekeeping, taking meds, using transportation Mini Mental State Exam - Answers Concentrates only on cognitive functioning, not on mood or thought processes Montreal Cognitive Assessment (MoCA) - Answers Mild cognitive dysfunction; Attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking calculations and orientation AADLs - Answers Advanced Activities of Daily Living; activities performed in the community- social or recreational, activities performed within the family Katz Index of ADL - Answers -Assessment for evaluation of activities of daily living -Focus: assessment of level of independence functioning and type of assistance required in six areas of ADL: 1) bathing 2) dressing 3) toileting 4) transferring 5) continence 6) feeding syncope - Answers loss of consciousness or fainting due to weakness complete skin assessment - Answers - scrutinize outer surface of skin -concentrate on underlying structures and inspect thoroughly -inspect feet, toenails, and between toes -check for color, temperature, moisture, texture, thickness, edema, mobility and turgor, vascularity or bruising, and lesions what causes true pallor (skin) - Answers could be due to blood loss or anemic; slowed circulation (immobility/inactivity, prolonged elevation) jaundice (skin) - Answers Yellowing - decreased liver function Where is jaundice first seen? - Answers In the sclera of the eye, and then the skin cyanotic (skin) - Answers blue- Not enough oxygen getting to red blood cells erythema (skin) - Answers red- indicates trauma, fever or infection; vasodilation what might multiple bruises at different stages of healing indicate - Answers physical abuse edema can indicate - Answers heart failure Scale to Grade Pitting Edema - Answers 1+ mild pitting, slight indentation, no perceptible swelling in the leg 2+ moderate pitting, indentation subsides rapidly 3+ deep pitting, indention remains for a short time, leg looks swollen 4+ very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted complete nail assessment - Answers shape and contour, consistency, color, capillary refill, profile sign (160 deg) ABCDE skin assessment - Answers A: asymmetry B: border C: color D: diameter E: elevation and enlargement excoriation - Answers Skin sore or abrasion produced by scratching or scraping lichenification - Answers excoriation and scaling; caused by prolonged intense scratching keloids - Answers Irregular masses of scar tissue protruding from the skin surface primary skin lesions - Answers Macules Papules Patches Plaques Nodules Wheals Tumors Urticaria (hives) Vesicles Cysts Bullas Pustules macule/patch - Answers Macule: color change, flat and circumscribed, less than 1cm Patch: macules larger than 1cm (freckles, petechiae, measles) Papule/Plaque - Answers Papule: elevated, circumscribed, less than 1cm (mole or wart) Plaque: several papules coming together (psoriasis) nodule/tumor - Answers Nodule: solid, round or oval elevated lesion 1 cm or more in diameter, extends deeper into dermis Tumor: larger than few cm, extends deep into dermis, benign or malignant wheal/urticaria - Answers small, round, raised area on the skin that may be accompanied by itching; usually seen in allergic reactions -urticaria is a lot of wheals -hives/mosquito bite vesicle/bulla - Answers Vesicle: A membrane bound sac that contains materials involved in transport of the cell; fluid filled up to 1cm (chickenpox, shingles)