Final Exam: NURS190 / NURS 190 (Latest 2026 / 2027 Update) Physical Assessment | Questions & Answers | Grade A | 100% Correct – WCU

Final Exam: NURS190 / NURS 190 (Latest 2026 / 2027 Update) Physical Assessment | Questions & Answers | Grade A | 100% Correct – WCU Q: Negligence Answer Failure to use such care as a reasonably prudent and careful person would under similar circumstances Q: Malpractice Answer Professional misconduct or unreasonable lack of skill Q: Privacy Answer The patient's right to protection against unreasonable and unwarranted interference with his or her solitude. Q: Confidentiality Answer The right to privacy of the health record. Q: Reporting Statutes Answer -ensures the safety or rights of specific classes of individuals -most states have reporting laws for suspected child and elder abuse and laws for reporting certain categories of diseases and injuries. -examples include: STD's, abuse of residents in nursing and convalescent homes, and suspected child abuse. -many states now have mandatory reporting of incompetent practice/practitioners Q: What are doctrines that minimize one's liability when acting in leading and managing roles in nursing practice settings? Answer -doctrine of respondeat superior: makes employers accountable for the negligence of their employees (the rationale is that the employee would not have been in a position to cause the wrongdoing unless hired by the employer) Q: Delegation Answer The transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome Q: 5 Rights of Delegation Answer 1. Task: Is the task appropriate and legal? 2. Circumstance: Is the delegation process appropriate to the environment/resources/equipment? 3. Person: Is the prospective delegatee a willing and able employee with expertise? 4. Direction/Communication: Do the delegator and delegatee understand a common work related language, and are there clear/concise instructions? 5. Supervision: Is it clear that the delegatee will provide feedback to the task, when appropriate? Is the delegator able to monitor and evaluate the patient appropriately? Q: Differentiate between assignments and tasks in the delegation process? Answer Assignment: Accepting the care within the scope of practice of the nurse Delegation/Task: When specific tasks are requested and be completed and overseen by the licensed person Q: Explain the different components of delegation? Answer Assessment and Planning: Select a nurse leader who has ability to make thorough assessment about the facility and who is in a position to develop appropriate staffing models for delegation while maintaining accountability for safe and person-centered care. The nurse must ensure that the laws and rules support their delegation and it's within their scope of practice. Implementation: The delegator allocates work to UNP's and gives them the responsibility to perform work. Evaluation: Allows for time to reflect on delegation decisions. It provides the nurse time to determine whether the delegation was successful and to identify the strengths and challenges related to the delegation decision. It allows us to build on the strengths, learn from the challenges, and implement quality measures to improve delegation decisions. Q: Understand the role of unlicensed personnel in the delivery of health care Answer UAPs provide direct care to patients related to personal hygiene, vital signs, feeding, ambulation, and toileting, and monitor patients' blood glucose and cognition. Q: Analyze the complexity and legal authority for delegation decisions for RNs Answer -Legal authority is the ability to delegate responsibility to complete a task or activity to a competent individual, however the nurse retains accountability for ensuring that the task is completed by the right person and that person is supervised appropriately. -A critical component of delegation is authority, and the delegated task must comply with the law and with the educational preparation of the individual. -Delegation is a complex process: the delegator is responsible for prudent action. If the task isn't performed within acceptable standards, the potential for nursing malpractice emerges. -Failure to delegate and supervise within acceptable standards may extend to direct corporate liability for the facility. -Even when another individual is providing care and not the nurse, the nurse is still responsible as the delegator Q: Analyze critical elements of an interview Answer -Go prepared with questions: this means that you learned about this organization and position ahead of time. Know their terms, so you can seek clarity about values and beliefs while using their words -Practice answering what you know they will ask: you can assume people will want to know the kind of person you are and what kind of work you see, strengths and what others would say bout you, experiences you've had that are like experiences needed for the position. They want to know you are a team player and how you'd resist peer pressure in doing what's right for patients. Assume that they want to know about any errors you've made and what you learned from them. -Select words carefully when you are emotional about an issue: consider words as carefully as you do the types of answers to provide -Evaluate the messages the interviewer is sending: use both verbal/nonverbal communication to receive the messages the interviewer is sending. Assume that the interviewer is on his or her best behavior, so be sure to "feel" how the interview is going. If you feel rushed, you may feel this way once you're an employee and are seeking help. Q: Describe professional development activities Answer -Academic progression: earning a graduate degree opens the door to numerous career opportunities. Think carefully about your goals, and choose a program based on your future career plans. -Certification: Certification signifies completion of requirements in a particular field beyond basic nursing educational preparation for licensure. Nurses earn this as a recognition of competence in one or more specialty areas. Obtaining certification may require testing, continuing education, and documented time in a specific practice area. -Continuing Education: This is a systematic professional learning experience designed to augment the knowledge, skill, and attitudes of nurses, thereby enriching the nurses' contributions to quality health care and their pursuit of professional career goals. This will increase your knowledge base, contribute to professional growth, provides professional networking opportunities, contributes to meeting certification and licensure requirements, and documents additional efforts in maintaining or developing clinical expertise. -Professional Associations: This demonstrates leadership and provides opportunities to meet other leaders, participate in policy formation, continue specialized education, and shape the future. Professional associations are groups of people who share a set of professional values and who decide to join their colleagues to effect change. Q: Identify the benefits of active involvement in professional organizations Answer -Networking and exposure to different opportunities within the nursing profession are two of the most valuable benefits of belonging to an organization. When nurses stop working due to family or educational priorities, organizational membership can help them stay connected to professional issues and colleagues through meetings and publications and smooth the transition back into practice. The organization can serve as a training ground through which nurses can build skills and gain leadership experiences. Members in nursing organizations can provide continuous support and advice when in ethical dilemmas and professional challenges. Members are nonbiased and safe, and may also help you to connect with experts in the field. Understand importance and difference between cover letter and resume. Answer Resume: Brief customized documents with examples focused on the qualifications tailored to the position that you seek. It provides details, and is presented in sentences or phrases to share the value of the information. Advertises skills and talents. (use verbs like produced, created, led) Cover Letter: Cover letters are used to emphasize your best strengths, provide an example about an ability, illustrate diversity of interests and abilities, and to add to info that is in the resume or CV. They serve several purposes, but the purpose is to reconfirm the position. Using it as a marketing device to achieve one of the purposes on the screen achieves greater results than are attained with a resume alone. Transactional Leadership Answer Employees understand that a superior leader makes decisions with little or no input from subordinates. A transactional leader is the historical "boss" image. It relies on the power of organizational position and formal authority to reward and punish performance. The focus of this type of leadership system is the accomplishment of a task, and it is the seen type in health-care organizations. Transactional leadership techniques and outcomes Leader Behaviors: Answer -contingent reward (quid pro quo) -punitive -management by exception (active)-monitors performance and takes action to correct -management by exception (passive)-intervenes only when problems exist Effect on Follower: -fulfills the contract or gets punished -does the work and gets paid -corrects errors in a reactive manner Organizational Outcomes: -work is supervised and completed according to the rules -deadlines are met -limited job satisfaction is evident -low to stable levels of commitment are typical Transformational Leadership Based on an inspiring vision that changes the framework of the organization for employees. It involves communication that connects with employees ideals in a way that causes emotional engagement. Transformational leaders can motivate employees by articulation of an inspirational vision; by encouragement of a novel, innovative thinking, and by individualized consideration of each employee. The goal is to transform people and organizations in a literal sense, to change them in mind and heart; enlarge vision, insight, and understanding; clarify purposes, make behavior congruent with beliefs, principles, or values; and bring about changes that are permanent. Transformational leadership techniques and outcomes Leader Behaviors: -charismatic -inspirational and motivational -intellectually stimulating -individualized consideration Effect on Follower: -a shared vision -increased self-worth -challenging and meaningful work -coaching and mentoring happens -a sense of being valued Organizational Outcomes: -increased loyalty -increased commitment -increased job satisfaction -increased morale -increased performance Analyze the decision making style of a nurse leader/manager -Paternalistic: Managers decide what is best for their team -Informative: Offers the staff the ability to make a decision after the information has been shared -Shared decision making: Decisions are made through an interactive, deliberate process where the staff may express and discuss options and preferences autonomy personal freedom and self-determination, the right to choose what will happen to oneself as well as the accountability for making individual choices beneficence the actions one takes should promote good; beneficence is the basic obligation to assist others nonmeleficence one should do no harm veracity concerns telling the truth and demands that the truth be told completely justice the principle of treating all persons equally and fairly paternalism allows one person to make partial decisions for another and is most frequently deemed to be a negative or undesirable principle. Paternalism, however, may be used to assist persons to make decisions when they do not have sufficient data or expertise. fidelity Keeping one's promises or commitments respect for others The highest ethical principle, respect for others acknowledges the right of individuals to make decisions and to live by those decisions. Analyze moral distress and implications for nurse managers. Moral distress: -Most often occurs when one is faced with situations in which two ethical principles compete, such as when the nurse is balancing the patient's autonomy issues with attempting to do what the nurse knows is in the patient's best interest. Implications: -When the nurse manager is balancing a direct care nurse's autonomy with what the nurse manager perceives to be a better solution to an ethical dilemma. -Constraints caused by financial pressures -Limited patient care resources -Disagreements among family members regarding patient interventions -Limitations imposed by primary healthcare providers -When actions nurses perform violate their personal beliefs Analyze the role of institution ethics committees Ethics committees provide structure and guidelines for potential problems, serve as open forums for discussion, and function as true patient advocates by placing the patient at the core of the committee discussions. Analyze decision making when legal and ethical situations overlap Nurse managers should ensure that nurses whose ethical values differ from court orders are given opportunities to voice their concerns and feelings, mechanisms for requesting reassignment, and time for quiet reflection. Examine the code of ethics for nurses from the nurse manager perspective -inform the public of the minimum standards acceptable for conduct by members of the discipline and assist the public in understanding a discipline's professional responsibilities -outline the major ethical considerations of the profession -provide to its members guidelines for professional practice -serve as a guide for the discipline's self-regulation Equal Employment Opportunity Laws Laws intended to decrease discrimination of minorities during employment. Occupational Safety and Health Act A federal law that establishes and promotes workplace safety standards for businesses. It requires isolation procedures, placarding areas containing ionizing radiation, proper grounding of electrical equipment, protective storage of flammable and combustible liquids, and the gloving of all personnel when handling bodily fluids. Family and Medical Leave Act of 1993 The act was written in an attempt to balance the demands of the workplace with the demands of the family, allowing employed individuals to take leaves for medical reasons, including the birth or adoption of children and the care of a spouse, child, or parent who ha serious health problems. It provides job security for unpaid leave while the employee is caring for a new infant or other family healthcare needs. (gender neutral) Employment-at-Will and Wrongful Discharge If the employer terminates the employee in violation of statute or contract, a claim for wrongful discharge can be brought. Collective Bargaining The joining together of employees for the purpose of increasing their ability to influence the employer and improve working conditions. Evaluate informed consent issues, including patients' rights in health literacy, from a nurse manager's perspective Health Literacy: Many nurses serve as a witness to the signing of informed consent docs; in this capacity they are attesting only to the voluntary nature of the patient's signature. No duty on the part of the nurse to insist that the patient repeat what has been said or what he/she remembers is present. If the pt has q's that alert the nurse to inadequacy of true comprehension on the pt's part or expresses uncertainty while signing the doc, the nurse has an obligation to inform the PCP and appropriate persons that informed consent has not been obtained. Evaluate informed consent issues, including patients' rights in research, from a nurse manager's perspective -Research: Whenever research is involved, the investigators muse disclose the research to the subject or the subject's representative and obtain informed consent. Federal guidelines have been developed that specify the procedures used to review research and the disclosures that must be made to ensure that valid informed consent is obtained. The federal government mandated the basic elements of info that must be included to meet the standards of informed consent. Selected Informed Consent Issues - Research issues are impacted by the federally enacted HIPAA laws. - Research issues vary in regard to de-identified information and protected health information. - Issues also arise in relationship to a patient's health literacy. Nurse Practice Act -single most important piece of legislation for nurses -defines the categories of nurses -sets educational and examination requirements -establishes a state board of nursing, which develops and implements rules and regulations What are the legal differences between licensed registered nurses and licensed practical (vocational) nurses An RN position is a higher-level nurse than an LVN/LPN. RNs may supervise LVNs/LPNs. While LVNs/LPNs provide basic patient care, RNs assess patient conditions, record patient medical symptoms and histories, administer medicine, perform and analyze diagnostic tests and create patient care plans. The LPN would assist the RN in medication administration (not including IV medications in most states), wound care, and activities of daily living (ADLs), while the RN worked on care plans, charting, updating physicians, and administering IV medications. Decision making model: normative or prescriptive approach Used when the situation is fairly routine. Agency policy, standard procedures, and analytical tools can be applied to situation that are structured and in which options and outcomes are known. Decision making model: descriptive or behavioral approach Used when the situation is subjective, non-routine, and unstructured, or if outcomes are unknown or unpredictable. More info must be gathered to address the situation effectively like creativity, experience, and group process are useful in dealing with the unknown. Decision making model: satisficing The decision maker selects an acceptable solution, one that may minimally meet the objective or standard for a decision. This allows for quick decisions and may be the most appropriate when lack of time is an issue. Decision making model: optimizing Used when the decision maker selects the option that is best, based on analysis of the pros and cons associated with each option. A better decision is more likely using this approach, although it takes longer to arrive at a decision Box 15.1 Decision-Making Formal Come up with options, advantages, disadvantages, and ranking. Complete implementation and evaluation plans Understand generational differenced leadership is challenged by -generation z has the highest level of technology usage of any prior generation (nurse managers must understand what motivates the different generations and use that knowledge to bring together teams to achieve departmental goals) -with the implementation of EHR's where generation y nurses may support learning needs of the baby boomers -baby boomers may provide education, encouragement, and mentorship as frontline staff gain confidence and learn new skills Generational Characteristics -Veterans: beliefs aligned with commitment, duty, and discipline -Baby Boomers: desire to improve the world -Generation X: value wisdom, learning, and information -Generation Y-Millenials: Optimistic, patient, and globally connected -Generation Z: highest level of technology usage Analyze the role of leadership in creating a satisfying working environment for nurses -Meant to ensure that care is provided in a safe, efficient manner -Elicit input from others and formulate a vision for the future Nurse Executive Provide leadership of everyone within the workplace. Helps create a shared vision of the preferred future and gathers data from the voices of staff to evoke change and growth Nurse Manager Ensures day to day elements of the workplace are done correctly. Employer selection, development, helping staff to reach their greatest potential. Inspire staff, developing direct care nurses and offering inclusion Direct Care Nurse Ensures environment of satisfaction for support staff. Creatively pose solutions to problems, capitalize on opportunities. Could include practice councils, team advocate, spokesperson Strategies for making the leadership opportunity positive for both the leader and the followers -lead by example -accept responsibility -share the rewards -have a clear vision -be willing to grow Refraction of the eye: emmatropia normal refractive condition of the eye Refraction of the eye: Myopia (nearsightedness) Light rays focus in front of retina You use a Rosenbaum chart to test this vision Refraction of the eye: hyperopia (farsightedness) Light rays focus behind the retina You use Snellen chart to test this vision Refraction of the eye: Presbyopia (age related far sightedness) light rays focus behind the retina Cranial Nerve II (two) Visual acuity (testing vision with snellen chart) Snellen Chart Position patient 20 feet from the chart Test one eye at a time, read left to right, top to bottom most line they can see If patient uses corrective lenses, first test with eyeglassess then without it Snellen Chart: Normal and Abnormal Findings 20/20 is normal vision 20/30 and up is abnormal 20/200 is legal blindness Cranial Nerve: III, IV, VI (3,4,6) Extraoccular movements (PERRLA) Hirschberg Test When shining light 12 inches from patient, reflection of light (which appears as a twinkle) should appear in the same spot on both pupils. A positive hirschberg sign is an abnormal finding Esotropia One eye moves inward Exotropia One eye turns outward Testing for Strabismus (cross eye) The cover/uncover test is what tests for strabismus. Cover one eye and observe the uncovered eye. It should be looking straight ahead. Then quickly uncover the covered eye and observe it to see if it moves. It should be looking straight ahead as well. Abnormal Eye Findings: Mydriasis pupils stay larger (dilated) with or without light shining in the eye Abnormal Eye Findings: Miosis pupils stay smaller (constricted) with or without light shining in the eye Abnormal Eye Findings: Strabismus (Esotropia) Eye moves inward Abnormal Eye Findings: Strabismus (Exotropia) Eye moves outward Abnormal Eye Findings: Ptosis Drooping of the eyelid Abnormal Eye Findings: Periorbital edema Swollen, puffy lids- occurs with infection, trauma, and systemic problems like kidney, heart failure, and allergy Abnormal Eye Findings: Exophthalmos Bulging eyes- can occur in one or both eyeballs (happens with hyperthyroidism/Grave's disease) Abnormal Eye Findings: Chalazion Firm, nontender nodule on the eyelid, arising from infection of the meibomian gland. Not painful unless inflammed. Abnormal Eye Findings: Hordeolum (aka stye) Staphylococcal infection of hair follicles on the margin of the lids. Affected eye is swollen, red, and painful. Also called a stye. Abnormal Eye Findings: Conjuctivitis (pink eye) Infection of the conjuctiva usually due to bacteria or virus but which may result from chemical exposure. Commonly called pink eye. Abnormal Eye Findings: Iritis Redness around iris and cornea, decreaed vision, deep aching pain, pupil is often irregular. Abnormal Eye Findings: Subconjuctival Hemorrhage Bleeding (big red patch) between sclear (white of the eye) and conjuctiva Abnormal Eye Findings: Hyphema Collection of blood in the anterior chamber of the eye caused by blunt trauma to the eye. Other causes can be eye surgery, blood vessel abnormalities, and medical problems like cancer. Abnormal Eye Findings: Acute glaucoma REQUIRES IMMEDIATE ITERVENTION. Sudden increase in intraocular pressure. Pupil is oval shaped and dilated; cornea appears cloudy with circumcorneal redness. Pain onset is sudden, accompanied by decrease in vision and halos around lights. Abnormal Eye Findings: Cataracts Opacity in lens, usually occurs with aging Abnormal Eye Findings: Pinguecula Yellow nodules that are thickened in areas of the bulbar conjuctiva due to prolonged exposure to sun, wind, and dust. Ear: Rinne Test Air conduction should be 2 times greater than bone conduction. (A comes before B) If bone conduction is greater than air conduction, then there is condutive hearing loss Ear: Weber Test Normal finding is sound heard equally in both ears. Place tool midline of the skull/top of the head Ear: Tympanic membrane normal finding Flat, gray, translucent with no scars Ear: Typmanic membrane abnormal finding Reddish/yellow: indicates infection of the middle ear Bulging Romberg Test Assessing balance Transillumination of sinuses if it does not glow, it may be inflamed, blocked with secretions and mucus. If it does glow, it's normal Tonsils Normal Finding 1+ is normal (tonsils behind tonsil pillars) Tonsils Abnormal findings 0: absent 2+: Tonsils extend to the edges of tonsil pillars 3+Tonsils extend beyond the edges of tonsil pillars, but not the midline 4+Tonsils extend to midline and may touch Ear Abnormalities: Otitis Media Infection of middle ear producing red, bulging ear drum, fever, and hearing loss. Otoscope examination reveals absent light reflex. Ear Abnormalities: Otitis externa (aka swimmers ear) Redness and swelling of auricle with drainage May have some itching, fever, enlarged lymph nodes Tympanic membrane is not affected Ear Abnormalities: perforation of tympanic membrane A rupturing of the eardrum due to trauma or infection. May be seen as a dark spot on the eardrum when checking with an otoscope. Ear Abnormalities: Tophi A sign of gout: Small, white nodules on the helix or antihelix of the ear that contain uric acid crystals and are a sign of gout. Nose Abnormalities: Nasal Polyps pale, round, firm nonpainful overgrowth of nasal mucosa usually caused by chronic allergic rhinitis Nose Abnormalities: Perforated septum A hole in the middle caused by chronic trauma, infection, or sniffing cocaine. Detected by shining penlight through the naris on the other side. Nose Abdnormalities: Rhinitis Nasal inflammation because of viral infection or allergy, accompanied by watery, copius discharge, sneezing, and congestion. Nose Abnormalities: Sinusitis Inflammation of sinuses because of upper respiratory tract infection. Causes facial pain and discharge. Fever, chills, frontal headache, dull, pulsating pain in cheeks or teeth may also beem seen/felt. Tongue Abnormalities: Black Hairy Tongue Assocated with antibiotic use. Overgrowth of fungus on papillae of the tongue Tongue Abnormalities: Oral Carcinoma Heavy smoking, chewing tobacco, and chronic heavy drinking can increase the risk. Commonly found in lower lip and base of tongue. Can indicate cancer if the sore or lesion does not heal in a few weeks. Tongue Abnormalities: Leukoplakia Associated with heavy smoking; the white patches CANNOT be scraped off. White thicking of the mucosa membrane or tongue. Precancerous condition. Lip Abnormalities: Cleft lip Separation or splitting of two sides of the upper lip. Can occur alone or with cleft palate Lip Abnormalities: Cleft palate An opening or separation in the roof of the mouth. May involve hard palate, soft palate, or both structures Gum Abnormalities: Gingival hyperplasia enlargement of the gums; frequently seen in pregnancy, leukemia, or prolonged use of phenytoin Gum Abnormalities: Gingivitis Inflammation of gums that can be caused by poor hygiene or vitamin C deficiency. If not treated, it can result in periodontal disease or tooth loss