NUR 2092 HEALTH ASSESSMENT FINAL EXAM BRAND NEW Q&A INCLUDED OVER 130 QUESTIONS WITH 100% CORRECT ANSWERS

NUR 2092 HEALTH ASSESSMENT FINAL EXAM BRAND NEW Q&A INCLUDED OVER 130 QUESTIONS WITH 100% CORRECT ANSWERS NUR 2092 Health Assessment Final Exam • The nurse is preparing to conduct a health history. Explain this to the patient. Answer: The purpose of a health history is to provide a database of subjective information about the patient's past and current health history. You might say to the patient, "I will be asking you questions about your past and present health." This information will help the provider along with the physical exam (objective data) to develop a diagnosis or health status. • The nurse is evaluating the reliability of a patient's responses, which of these statements would be correct? The patient: Provided consistent information and therefore is reliable • A patient tells the nurse that she has had abdominal pain for the past week. What would be the nurse's best response? "Can you point to where it hurts?" • Describe a genogram. Graphic family tree that uses symbols to depict the gender, relationship, and age of immediate family. Usually 3 generations- parents, grandparents, siblings. Also highlight the health of close family members and more details such as communicable disease, environmental hazards (smoke), tobacco use, and alcohol use. Any additional information includes the family history. • The nurse is obtaining health history on an 87-year-old woman. Which of the following areas of questioning would be most useful at this time? Current health promotion activities. • A 90-year-old patient tells the nurse that he cannot remember the names of the medication he is taking or why he is taking them. An appropriate response from the nurse would be? Would you have a family member bring in your medications please? • The nurse is performing a functional assessment on an 82-year-old patient who recently had a stroke. Which of these questions would be most important to ask? "Are you able to dress yourself?" • A patient is describing his symptoms to the nurse. Which of these statements reflects a description of the setting of his symptoms? "This pain happens every time I sit down to use the computer." • During a physical examination, a 45-year-old woman states that she has had a crusty, itchy rash on her breast for approximately 2 weeks. In trying to find the cause of the rash, which questions would be important for the nurse to ask? Where did the rash first appear- on the nipple, areola, or the surrounding skin? When did you first notice this? • During an annual physical examination, a 43-year-old patient states that she does not perform monthly breast self-examinations (BSEs). She tells the nurse that she believes that mammograms "do a much better job than I ever could to find a lump." The nurse should explain to her that: Breast self-exams may detect lumps that appear between mammograms • List risk factors for breast cancer 1) History of breast cancer - family history—first-degree relative 2) Medications such as estrogen and progestin combined 3) Certain tumor suppressor genes called BRCA1 and BRCA2 (inherited mutation) 4) Age • During an examination of a woman, the nurse notices that her left breast is slightly larger than her right breast. Which of these statements is true about this finding? Asymmetry is not unusual, but the nurse should verify that this change is not new • During the physical examination, the nurse notices that a female patient has an inverted left nipple. Which statement regarding this is most accurate? Whether the inversion is a recent change should be determined. • The nurse is performing a breast examination. Which of these statements best describes the correct procedure to use when screening for nipple and skin retraction during a breast examination? Have the woman: Slowly lift her arms above her head, and note any retraction or lag in movement. • The nurse is palpating a female patient's breasts during an examination. Which of these positions is most likely to make significant lumps more distinct during breast palpation? Supine with the arms raised over the head • The nurse is conducting a class on BSE. Which of these statements indicates the proper BSE technique? The best time to perform a BSE is 4 to 7 days after the first day of the menstrual period. • The nurse is preparing to teach a woman about BSE. Which statement by the nurse is correct? "BSE on a monthly basis will help you become familiar with your own breasts and feel their normal variations." • A 55-year-old postmenopausal woman is being seen in the clinic for her annual examination. She is concerned about changes in her breasts that she has noticed over the past 5 years. She states that her breasts have decreased in size and that the elasticity has changed so that her breasts seem "flat and flabby." The nurse's best reply would be: The decrease in hormones after menopause causes atrophy of the glandular tissue in the breast and is a normal process of aging. • In performing a breast examination, the nurse knows that examining the upper outer quadrant of the breast is especially important. The reason why is... This is the location for most breast tumors. • In performing an assessment of a woman's elixir lymph system, the nurse should assess which of these nodes? Central, lateral, pectoral, and subscapular.  The breast has extensive lymphatic drainage, 75% of the drainage drains into the axillary nodes. There are groups of axillary nodes central, pectoral and subscapular. • A 65-year-old patient remarks that she just cannot believe that her breasts "sag so much". She states it must be from a lack of exercise. What explanation should the nurse offer her? After menopause: The glandular and fat tissue atrophies, causing breast size and elasticity to diminish, resulting in sagging (flat and gabby) breasts. • In examining a 70-year-old male patient, the nurse notices that he has bilateral gynecomastia. Which of the following describes the nurse's best course of action? Explain that this is the result of hormonal changes (testosterone) and recommend a visit to their provider. • During a breast health interview, a patient states that she has noticed pain in her left breast. The nurse's most appropriate response to this would be: To seek more specific information about the pain, such as:  When did you first notice it?  Is the pain localized or all over?  Is it painful to touch?  Is the pain in relation to your menstrual cycle?  Is the pain associated with activity or exercise? • A 43-year-old woman is at the clinic for a routine examination. She reports that she has had a breast lump in her right breast for years. Recently, it has begun to change in consistency and is becoming harder. She reports that 5 years ago her physician evaluated the lump and determined that it "was nothing to worry about." The examination validates the presence of a mass in the right upper outer quadrant at 1 o'clock, approximately 5 cm from the nipple. It is firm, mobile, and non-tender, with borders that are not well defined. The nurse replies: Because of the change in consistency of the lump, it should be further evaluated by the physician. • The nurse is discussing BSEs with a postmenopausal woman. The best time for postmenopausal women to perform BSEs is? On the same day every month. • During a discussion about BSEs with a 30-year-old woman, what statement by the nurse is most appropriate? Examine your breast shortly after your menstrual period each month. • Peau d' orange- Lymphatic obstruction causes edema, which thickens the skin and exaggerates the hair follicles; this creates a pigskin or orange peel look. Could be an indication of cancer. • Dullness- A high-pitched muffled thud sound obtained by percussing over relatively dense organs such as liver or spleen, distended bladder, mass of adipose tissue • Tympany- A high-pitchedmusical and drum like note obtained by percussing the surface of a large air-containing space, such as the abdomen • Resonance- A low-pitched, clear, hollow note obtained by percussing over normal lung tissue • Hyperresonance- A low-booming note obtained by percussing over the adult lungs that have increased air such as with a patient who has emphysema, present with distended abdomen • Which structure is located in the left lower quadrant of the abdomen? Sigmoid colon • Aneurysm- defect or sec formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defect (aortic aneurysm) • Dysphasia- Difficulty swallowing • Anorexia- Loss of appetite • Ascites abnormal accumulation of serous fluid within the peritoneal cavity, associated with heart failure, cirrhosis, cancer or portal hypertension • Bruit- blowing, swoishing sound her through a stethoscope when an artery is partially occluded • Hepatomegaly- abnormally enlarged liver • Paralytic ileus- complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction • Peritonitis- inflammation of the peritoneum • Nurse suspects a patient has a distended bladder. How should the nurse assess? Percuss and palpate the midline area above the suprapubic bone. • The nurse is aware that one change that may occur in the gastrointestinal system of an aging adult is: Decreased gastric acid secretion. • A patient has hypoactive bowel sounds. The nurse knows that a potential cause of hypoactive bowel sounds is: Peritonitis, • A 29-year-old woman tells the nurse that she has "excruciating pain" in her back. Which would be the nurse's appropriate response to the woman's statement? "How would you say the pain affects your ability to do your daily activities?" • A patient tells the nurse that he is allergic to penicillin. What would be the nurse's best response to this information? "Describe what happens (or the reaction) to you when you take Penicillin." • Stroke or Cerebrovascular Accident (CVA)- Blood flow is interrupted to a part of the brain, the most common type is an ischemic stroke (when a blood clot blocks a blood vessel in the brain) and less common is a hemorrhagic ( a blood vessel in the brain ruptures and causes bleeding). • Common symptoms of a stroke: • Weakness or numbness in the face, arms, or legs, especially when it is on one side of the body • Confusion, trouble speaking or understanding • Changes in vision such as blurry vision or partial complete loss of vision in one or both eyes • Trouble walking, dizziness, loss of balance, or coordination • Severe headache with no reason or explanation Paresis, Paraplegia, Quadriplegia, Hemiplegia • paresis--weakness of muscles rather than paralysis • paraplegia--symmetric paralysis of both lower extremities • quadriplegia--paralysis of all four extremities • hemiplegia--paralysis of one side of the body • Symptoms of Meningeal Inflammation- Sudden fever, stiff neck, severe headache different than normal, nausea and vomiting, seizures, sleepiness, sensitivity to light • The nurse notices that a patient's palpebral fissures are not symmetric. On examination, the nurse may find that damage has occurred to which cranial nerve (CN)? Cranial Nerve 7- Facial • A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The nurse suspects damage to CN and proceeds with the examination by . Cranial Nerve 11- Accessory; asking the patient to shrug her shoulders against resistance • A patient says that she has recently noticed a lump in the front of her neck below her "Adam's apple" that seems to be getting bigger. During the assessment, the finding that leads the nurse to suspect that this may not be a cancerous thyroid nodule is that the lump (nodule): Mobile and not hard 98. 4 areas of the body where lymph nodes are accessible: Head and neck, arms, inguinal area, and axillae 99. A patient, an 85-year-old woman, is complaining about the fact that the bones in her face have become more noticeable. What explanation should the nurse give her? More noticeable facial bones are probably due to a combination of factors related to aging, such as decreased elasticity, subcutaneous fat, and moisture in her skin. • A patient has come in for an examination and states, "I have this spot in front of my ear lobe on my cheek that seems to be getting bigger and is tender. What do you think it is?" The nurse notes swelling below the angle of the jaw and suspects that it could be an inflammation of his: Parotid gland • A patient's thyroid gland is enlarged, and the nurse is preparing to auscultate the thyroid gland for the presence of a bruit. A bruit is a sound that is heard best with the of the stethoscope. Soft, whooshing, pulsatile; bell • A patient visits the clinic because he has recently noticed that the left side of his mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse suspects that he has: CVA or stroke • During an examination of a female patient, the nurse notes lymphadenopathy and suspects an acute infection. Acutely infected lymph nodes would be: Firm but freely movable • The nurse has just completed a lymph node assessment on a 60- year-old healthy female patient. The nurse knows that most lymph nodes in healthy adults are normally: Nonpalpable • During an examination, the nurse knows that the best way to palpate the lymph nodes in the neck is described by which statement? Using gentle pressure, palpate with both hands to compare the two sides • Visual accommodation- Pupillary constriction when looking at a near object • A patient has a normal pupillary light reflex. The nurse recognizes that this reflex indicates that: Constriction of both pupils occurs in response to bright light • A patient's vision is recorded as 20/30 when the Snellen eye chart is used. The nurse interprets these results to indicate that: The patient can read at 20 feet what a person with normal vision can read at 30 feet. • A 60-year-old man is at the clinic for an eye examination. The nurse suspects that he has ptosis of one eye. How should the nurse check for this? Observe the distance between the palpebral fissures • A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. These findings suggest that she may have: Macular degeneration • If your patient presented with an eye injury resulting in an emergency situation, what symptoms would you expect to see that would prompt an emergency? Loss of vision • Sclera is china white, although Blacks occasionally have a gray- blue or muddy color to the sclera. Also in dark-skinned people you normally may see on the sclera. Small brown merciless (freckles) • Extraocular muscles- Cranial nerves 3, 4, and 6 • Chronic Open-Angle Glaucome, Macular Degeneration, Cataracts, Presbyopia- • Chronic Open-Angle Glaucoma--Increased intraocular pressure that leads to peripheral vision loss. • Macular Degeneration--Breakdown of cells in the Macula or the Retina that leads to loss of central vision-the area of clearest vision. • Cataracts--Lens opacity, resulting from a clumping of protein in the lens. • Presbyopia--Loss of lens elasticity decreasing the len's ability to change shape to accommodate for near vision. • During an assessment of a patient has had a head injury from a car accident, the nurse notices the following change: pupils were equal, but now the right pupil is fully dilated and nonreactive, left pupil is 4 mm and reacts to light. What does finding this suggest? Increase in the intracranial pressure • The nurse notes that the patient's teeth are stained yellow and asks the patient about tobacco use. The patient states that he chews one bag of tobacco every other day. What health promotion concepts should the nurse include in the teaching plan? Smokeless tobacco (SLT) contains cancer-producing chemicals, such as nitrosamines, that increase the risk of oral cancers (pharynx, larynx, and esophagus). Early signs of oral cancer should be discussed, as well as other effects of SLT use, such as gum recession, tooth discoloration, bad breath, nicotine dependence, and unhealthy eating habits. SLT is not a healthy alternative to smoking.  Using smokeless tobacco can be detrimental to a person's health. The two types of SLT most commonly used in the United States are chewing tobacco and snuff. The largest group of SLT users is American Indian/Alaskan Native children, but SLT use is also high among young white males.  Pain is an early sign of oral cancer • What is the purpose of the ciliated mucous membrane in the nose? Filters out dust and bacteria. • Salivary gland that is the largest and located in the cheek in front of the ear is the gland. Parotid • The nurse is assessing an 80-year-old patient. Which of these findings would be expected for this patient? Decreased ability to identify odors. • The nurse is taking a family history. Important diseases or problems about which the patient should be specifically asked include: Mental illness. • The review of systems provides the nurse with... Information regarding health promotion practices, the information helps to evaluate the past and present health state of each body system, to obtain any data that may have been omitted in the section about present illness, and to evaluate health promotion and teaching opportunities. • Which of these statements represents subjective data the nurse obtained from the patient regarding the patient's skin? Patient denies any color change. • The nurse is obtaining a history from a 30-year old male patient and is concerned about health promotion activities. Which of these questions would be appropriate to use to assess health promotion activities for this patient? "Do you perform testicular self-examinations?" • Functional Assessment-- What information would you ask if the patient's leg was in a cast? A functional assessment includes the activities of daily living and the person's ability to take care of their needs. This area will help to formulate a nursing diagnosis. This could be present to the patient in a standardized form and will include data on the lifestyle and type of living environment. (Page 57) self-esteem, activity/exercise, sleep/rest, nutrition/elimination, interpersonal relationships/resources, spiritual resources, coping and stress management, personal habits, environmental hazards, violence questions, and occupational health questions. If a patient had a cast on their leg, appropriate questions would include how they transfer to bed, another chair, bathing technique, coping with the situation, support during the situation. • Regarding the use of alcohol, a patient asks the nurse why the nurse needs to know. What is the reason why? Alcohol can interact with all medications and make some diseases worse. • The nurse is watching a new graduate nurse perform auscultation of a patient's abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen? "Auscultation prevents distortion of bowel sounds that might occur after percussion and palpation." • Abdominal borborygmi- Hyperactive bowel sounds • Percussion notes heard during the abdominal assessment may include: Tympany, hyperresonnance, and dullness. • Causes of Abdominal Distention- Obesity, Ascites, Air or Gas, Ovarian cyst, Pregnancy, Tumor • Before reporting silent bowel sounds, the nurse should listen for at least: 5 minutes • The nurse is preparing to examine a patient who has been complaining of right lower quadrant pain. Which technique is correct during the assessment? The nurse should: Examine the tender area first. • State the rationale for performing auscultation of the abdomen before palpation or percussion. Percussion and palpation may increase peristalsis, which gives a false interpretation of bowel sounds • Specific questions to ask a patient with abdominal pain for the past week Describe the pain, is it in one spot, or does it move around, have the patient point to the area, when did it start, how long have you had the pain, is it constant or does it come and go, does it occur before a meal or after meals, describe the pain is it a cramping, burning, dull, stabbing, or aching pain, are there any changes associated with meals does the pain become worse or better, what have you tried to relieve the pain, what makes the pain worse, is the pain associated with your menstrual cycle • Right Upper Quadrant Organs- Liver, Gallbladder, Duodenum, Head of Pancreas, Right Kidney and adrenal gland, Hepatic flexure of colon, Part of ascending and transverse colon • Left Upper Quadrant Organs- Stomach, spleen, left lobe of liver, Body of Pancreas, Left kidney and adrenal, splenic flexure of colon, part of transverse and descending colon • Right Lower Quadrant Organs- Cecum, Appendix, Right over and tube, Right ureter, Right spermatic cord • Left Lower Quadrant Organs- Part of descending colon, Sigmoid colon, Left ovary and tube, left ureter, left spermatic cord • Midline- Aorta, Uterus, Bladder • Specific questions you would ask a patient who is complaining of nausea and vomiting How often, how much come up, color, odor, bloody, pain associated, any diarrhea, fever, chills, what did you eat in the last 24 hours, where, is there anyone else in the family with the same symptoms? • Functional units of the musculoskeletal system- Joints • Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called: Ligaments • To jump rope, they should have to be capable of: Circumduction • Articulation of the mandible and temporal bone is: Temporomandibular joint • Palpation of the temporomandibular joint: Anterior to the tragus • An 85-year-old patient comments during his annual physical examination that he seems to be getting shorter as he ages. How would you explain this to the patient? With aging, the vertebral column shortens • The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women. An action to prevent or delay bone loss in this group would be? Perform physical activity, such as fast walking. • A patient states, "I can hear a crunching or grating sound when I kneel." She also states that "it is very difficult to get out of bed in the morning because of stiffness and pain in my joints." The nurse should assess for signs of what problem? Crepitation • A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasms. The nurse should suspect: Rotator cuff lesions • During an assessment of a 20-year-old patient with a 3-day history of nausea and vomiting, the nurse notices dry mucosa and deep vertical fissures in the tongue. These findings are reflective of: Dehydration • While performing an assessment of the mouth, the nurse notices that the patient has a 1-cm ulceration that is crusted with an elevated border and located on the outer third of the lower lip. What other information would be most important for the nurse to assess? When the patient first noticed the lesion • A 40-year-old patient who has just finished chemotherapy for breast cancer tells the nurse that she is concerned about her mouth. During the assessment the nurse finds areas of buccal mucosa that are raw and red with some bleeding, as well as other areas that have a white, cheesy coating. The nurse recognizes that this abnormality is: Candidiasis • The nurse is assessing a patient in the hospital who has received numerous antibiotics and notices that his tongue appears to be black and hairy. In response to his concern, what would the nurse say? Black, hairy tongue is a fungal infection caused by all the antibiotics you have received. • During an assessment, a patient mentions that "I just can't smell like I used to. I can barely smell the roses in my garden. Why is that?" For which possible causes of changes in the sense of smell will the nurse assess? Select all that apply. Cigarette smoking, chronic allergies and aging. • Functions of the middle ear: (1) Conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear. (2) Protects the inner ear by reducing the amplitude of loud sounds. (3) Its eustachian tube allows equalization of air pressure on each side of the tympanic membrane in order to prevent membrane rupture. • Pathway of hearing: The normal pathway of hearing is known as air conduction (AC) and is the most efficient. An alternate route of hearing is known as bone conduction (BC); here the bones of the skull vibrate and these vibrations are transmitted directly to the inner ear and to cranial nerve VIII • Hearing loss: • A conductive hearing loss involves a mechanical dysfunction of the external or middle ear and is considered a partial loss because the person is able to hear if the sound amplitude is increased enough to reach the nerve elements in the inner ear. Common causes are impacted cerumen, foreign bodies in the ear canal, perforated tympanic membrane, and otosclerosis. • A sensorineural (or perceptive) hearing loss indicates pathology of the inner ear, cranial nerve VIII, or the auditory areas of the brain. A simple increase in amplitude may not enable the person to hear. Common causes are ototoxic drugs and presbycusis, a gradual nerve degeneration that occurs with aging. • A mixed loss is a combination of both types of hearing loss in the same ear. • Cerumen: Purpose of cerumen is to protect and lubricate the ear. • Eustachian tube: Helps equalize are pressure on both sides of the tympanic membrane. • Air conduction: Normal pathway for hearing. • Ear examination of an 80-year-old patient; which findings would be normal? High-tone frequency loss • A 17-year-old student is a swimmer on her high school's swim team. She has had three bouts of otitis externa this season and wants to know what to do to prevent it. The nurse instructs her to: Use rubbing alcohol or 2% acetic acid teardrops after every swim • "Buzzing sound" in the ear Tinnitus • Changes in hearing that occur with aging: Progression of hearing loss is slow, the aging person may find it harder to hear consonants than vowels, sounds may be garbled and difficult to localize. • The anal canal: Is the outlet for the gastrointestinal tract. • Colonoscopy- a test that allows the physician to look at the inner lining of the large intestines, with a thin flexible tube • A 60-year-old man has just been told that he has benign prostatic hypertrophy (BPH). He is concerned about cancer. How should the nurse respond? What would you say? The enlargement of your prostate is caused by hormonal changes, and not cancer Symptoms may include: urinary frequency, urgency, hesitancy, straining to urinate, wear stream, intermittent stream, or sensation of not emptying • A 30-year-old woman is visiting the clinic because of "pain in my bottom when I have a bowel movement." The nurse should assess for which problem? Hemorrhoids • After completing an assessment of a 60-year-old man with a family history of colon cancer, the nurse discusses with him early detection measures for colon cancer. The nurse should mention the need for a(n): Colonoscopy every 10 years • What position should a woman be in for a rectal exam Left lateral decubitus • Pigmentation of anus is darker than the surrounding skin, the anal opening is closed, and a skin sac that is shiny and blue is noted. Pain with bowel movements and occasionally noted some spots of blood- Thrombosed hemorrhoid • Anal fistula, rectal prolapse, rectal polyp, rectal fissure- Anal fistula—An abnormal passage from inner anus or rectum out to the skin surrounding the anus. May occur from chronic GI inflammation, local abscess. The tract may drain serosanguineous or purulent drainage. Rectal prolapse—protrusion of the rectal mucous membrane through the anus Rectal polyp—protruding growth from the rectal mucous membrane Rectal fissure—longitudinal tear in the superficial mucosa at the anal margin Rectal Prolapse- Moist, red, doughnut shaped protrusion from the anus • A 62-year-old man is experiencing fever, chills, malaise, urinary frequency, and urgency. He also reports urethral discharge and a dull aching pain in the perineal and rectal area. These symptoms are most consistent with which condition? Prostatitis • During a health history of a patient who complains of chronic constipation, the patient asks the nurse about high-fiber foods. The nurse relates that an example of a high-fiber food would be: Broccoli • During a digital examination of the rectum, the nurse notices that the patient has hard feces in the rectum. The patient complains of feeling "full," has a distended abdomen, and states that she has not had a bowel movement "for several days." The nurse suspects which condition? Fecal impaction • During an examination, the nurse asks a patient to bend forward from the waist and notices that the patient has lateral tilting. When his leg is raised straight up, the patient complains of a pain going down his buttock into his leg. The nurse suspects: Herniated nucleus pulposus • Changes with an aging adult  After 40,  loss of bone matrix occurs more rapidly than new bone formation;  postural changes occur with decreased height the most noticeable; decreased height is due to shortening of the vertebral column;  may see kyphosis; a distribution of subcutaneous fat changes through life;  there is a tendency to gain weight;  loss of muscle mass;  may see a shuffling pattern when walking,  arms out to help balance;  broader base of support;  may hold hand rails and haul their body up with it;  may lead with favored leg;  may find the aging holding two hands on the rail • Osteoporosis- your bones are living tissue that are continually growing and changing. Each day old bone tissue dissolves and is replaced with new bone tissue. As we age, the opposite begins to occur. When this happens bone can become weak and more likely to break even with the slightest bump. The bones of the wrist, hip, and spine are most often affected. There is no cure but there is treatment • Steps to bone health and osteoporosis prevention- • Diet- milk products (low fat) with vitamin D, which is needed for absorption of calcium; Fish canned ones which are packed in their bones; Leafy green vegetables; Limit caffeine; • Exercise- weight bearing a regular program of at least 3 times a week. • Lifestyle- avoid smoking and excessive alcohol; seek help for depression • Supplements as directed by your provider • Rheumatoid Arthritis- Rheumatoid Arthritis is a chronic, systemic inflammatory disease of the joints and surrounding connective tissue. Inflammation of the synovial membrane leads to thickening; then to fibrosis, which limits movement; and finally leads to bony ankylosis. Symmetric and bilateral characterized by heat, redness, swelling, and painful motion of the affected joints; the patient may experience fatigue, weakness, anorexia, weight loss, low grade fever, and swollen glands • Osteoarthritis- (Degenerative Joint Disease) is a non-inflammatory localized, progressive disorder involving deterioration of articular cartilage and subchondral bone and formation of new bone (osteophytes) at joint surfaces. It occurs with aging nearly all adult age 60 or older have some signs of osteoarthritis. Asymmetrical involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. Affected joints have stiffness, swelling, bony protuberance, pain with motion, limitation with movement. • Adduction, Abduction, Flexion, Extension • Adduction - movement of a body part toward the body's midline • Abduction - movement of a body part away from the body's midline • Flexion- describes the movement that decreases the angle between a segment and its proximal segment • Extension- is the opposite of flexion, describing a straightening movement that increases the angle between body parts • The 2 parts of the nervous system are: Central and Peripheral • Personality and ability to understand, crying easily, and becoming angry are associated to which lobe of the brain? Frontal • A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in maintaining her balance. Which area of the brain that is related to these findings would concern the nurse? Cerebellum • A 70-year-old woman tells the nurse that every time she gets up in the morning or after she's been sitting, she gets "really dizzy" and feels like she is going to fall over. The nurse's best response would be: You need to get up slowly when you have been lying down or sitting. • During the taking of the health history, a patient tells the nurse that "it feels like the room is spinning around me." The nurse would document this finding as: Vertigo • When discussing seizures with a patient, the patient asks the nurse, "What is an aura?" How would you explain this to the patient? "Do you have any warning signs before the seizure occurs?" An aura is a subjective sensation that preceded a seizure; may be auditory, visual or motor. • When the nurse asks a 68-year-old patient to stand with his feet together and arms at his side with his eyes closed, he starts to sway and moves his feet farther apart. The nurse would document this finding as: Positive Romberg Sign. • During the taking of the health history of a 78-year-old man, his wife states that he occasionally has problems with short-term memory loss and confusion: "He can't even remember how to button his shirt." When assessing his sensory system, which action by the nurse is most appropriate? Before testing, the nurse would assess the patient's mental status and ability to follow directions. • During an assessment of a 32-year-old patient with a recent head injury, the nurse notices that the patient responds to pain by extending, adducting, and internally rotating his arms. His palms pronate, and his lower extremities extend with plantar flexion. Which statement concerning these findings is most accurate? This patient's response: It is very ominous sign and may indicate brainstem injury. • Syncope, Vertigo, Seizure, Tremors, Paralysis- Syncope -a sudden loss of strength, a temporary loss of consciousness (a faint) caused by a lack of cerebral blood flow Vertigo- is a rotational spinning caused by neurological disease in the vestibular apparatus of the ear or the vestibular nuclei in the brainstem Seizure- characterized by altered or loss of consciousness, involuntary muscle movements, and sensory disturbances Tremors-- an involuntary shaking Paralysis—decreased or loss of motor power caused by problem with motor nerve or muscle fibers • Questions to include in aiding adult health history- • Any dryness in the mouth? • Xerostomia (dry mouth ) is a side effect of many drugs: antidepressants, anticholinergics, antispasmodics, antihypertensives, antipsychotics, bronchodilators • Are you taking any medications? (prescribed and over the counter) • Can you chew all types of food? Have you lost any teeth? • Are you able to care for your teeth or dentures? • Self-care may be due to a physical disability (arthritis), vision loss, confusion, or depression • Have you noticed a change in your sense of taste or smell? • How would you control a nosebleed? Remain calm, sit up straight, lean your head forward, tilting your head back will cause you to swallow the blood. Pinch the nostrils together with your thumb and index finger for about 10 minutes. • The nurse is performing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale, gray, and swollen. What would be the most appropriate question to ask the patient? Are you aware of having any allergies?