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NR 302 final review
2 causes of arterial insufficiency - . . ANSWER ✓✓ ischemia,
arteriosclerosis or decreased blood flow
a 65 year old man with emphysema and bronchitis has come to
the clinic for a follow up appointment, on assessment of his skin
, the nurse might expect to assess the following - . . ANSWER
✓✓ clubbing of the nail which may indicated COPD, and lack of
oxygen over time
a 67 year old patient states he recently began to have pain in his
left calf when climbing 10 stairs to his apartment, the pain is
relieved by sitting for about 2 minutes, then he is able to resume
his activities, the patient is most likely experiencing - . .
ANSWER ✓✓ arterial obstruction or claudication
a mother is at the clinic with her 2 year old son, "he wont go to
sleep at night and during the day he has several fits" I get so
upset when this happens, the nurses best verbal response would
be - . . ANSWER ✓✓ to clarify and get more information, fits?,
tell me what you mean by this
a mother presents with her son, who has been in a new day care
facility, on examination the nurse asses moist, think vesicles
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with an erythematous base around the nose and mouth, the
nurse suspects - . . ANSWER ✓✓ impetigo
a nurse is assessing a patient admitted with congestive heart
failure (CHF) for edema, the nurse assesses this in dependent
parts of the body, when applying pressure there is a dent in the
skin that last very long time, the nurse would document this as -
. . ANSWER ✓✓ 4+ pitting edema for 8 mm indentations
a nurse is performing a lung assessment on a patient diagnosed
with RLL pneumonia, the patient is asked to say "eee" and
through the stethoscope the nurse hears an "aaa" sound over the
RLL, what term would document the finding - . . ANSWER ✓✓
egophony
a patient with a long history of COPD is being assessed, the
nurse would be likely to inspect - . . ANSWER ✓✓ hypertrophied
neck muscles, anterior/posterior-to transverse diameter of 1:1
and tripod positioning
a patients reason for seeking care is shortness of breath, when
obtaining a health history, which of these questions by the nurse
would obtain the most helpful information - . . ANSWER ✓✓ will
you please describe the activities that cause you to be short of
breath
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accommodation - . . ANSWER ✓✓ distance to near where pupils
constrict, and eyes converge, part of PURRLA test
after completing an initial assessment on a pt, the nurse charts,
vital signs as temp of 100.1 oral, apical HR 98 irregular, RR 24
shallow, B/P 128/90, pulse ox of 90% on RA, what are you worried
about - . . ANSWER ✓✓ oxygenation, infection, activity
intolerance, capillary refill greater than 3 seconds
an adult patient with a history of allergies comes to the clinic
with complaints of wheezing and dyspnea, the assessment
reveals nasal flaring, use of accessory muscles and tachypnea,
the description is consistent with - . . ANSWER ✓✓ asthma
an example of objective data obtained during the physical
assessment includes - . . ANSWER ✓✓ audible and auscultated
inspiratory wheeze, 2x2 cm stage 1 pressure ulcer on right ankle,
crackles that clear with cough
apical impulse - . . ANSWER ✓✓ intercostal space, palpate for
impulse, auscultate for pulse, turn obese patients to the left side
arterial ulcer - . . ANSWER ✓✓ dry, coolness, pallor, elevational
pallor, dependent rubor, diminished pulses, systolic bruits, signs
of malnutrition, think, shiny skin, thick ridged nails, atrophy of
muscles, and distal gangrene
NR 302 final review
2 causes of arterial insufficiency - . . ANSWER ✓✓ ischemia,
arteriosclerosis or decreased blood flow
a 65 year old man with emphysema and bronchitis has come to
the clinic for a follow up appointment, on assessment of his skin
, the nurse might expect to assess the following - . . ANSWER
✓✓ clubbing of the nail which may indicated COPD, and lack of
oxygen over time
a 67 year old patient states he recently began to have pain in his
left calf when climbing 10 stairs to his apartment, the pain is
relieved by sitting for about 2 minutes, then he is able to resume
his activities, the patient is most likely experiencing - . .
ANSWER ✓✓ arterial obstruction or claudication
a mother is at the clinic with her 2 year old son, "he wont go to
sleep at night and during the day he has several fits" I get so
upset when this happens, the nurses best verbal response would
be - . . ANSWER ✓✓ to clarify and get more information, fits?,
tell me what you mean by this
a mother presents with her son, who has been in a new day care
facility, on examination the nurse asses moist, think vesicles
,2|Page
with an erythematous base around the nose and mouth, the
nurse suspects - . . ANSWER ✓✓ impetigo
a nurse is assessing a patient admitted with congestive heart
failure (CHF) for edema, the nurse assesses this in dependent
parts of the body, when applying pressure there is a dent in the
skin that last very long time, the nurse would document this as -
. . ANSWER ✓✓ 4+ pitting edema for 8 mm indentations
a nurse is performing a lung assessment on a patient diagnosed
with RLL pneumonia, the patient is asked to say "eee" and
through the stethoscope the nurse hears an "aaa" sound over the
RLL, what term would document the finding - . . ANSWER ✓✓
egophony
a patient with a long history of COPD is being assessed, the
nurse would be likely to inspect - . . ANSWER ✓✓ hypertrophied
neck muscles, anterior/posterior-to transverse diameter of 1:1
and tripod positioning
a patients reason for seeking care is shortness of breath, when
obtaining a health history, which of these questions by the nurse
would obtain the most helpful information - . . ANSWER ✓✓ will
you please describe the activities that cause you to be short of
breath
, 3|Page
accommodation - . . ANSWER ✓✓ distance to near where pupils
constrict, and eyes converge, part of PURRLA test
after completing an initial assessment on a pt, the nurse charts,
vital signs as temp of 100.1 oral, apical HR 98 irregular, RR 24
shallow, B/P 128/90, pulse ox of 90% on RA, what are you worried
about - . . ANSWER ✓✓ oxygenation, infection, activity
intolerance, capillary refill greater than 3 seconds
an adult patient with a history of allergies comes to the clinic
with complaints of wheezing and dyspnea, the assessment
reveals nasal flaring, use of accessory muscles and tachypnea,
the description is consistent with - . . ANSWER ✓✓ asthma
an example of objective data obtained during the physical
assessment includes - . . ANSWER ✓✓ audible and auscultated
inspiratory wheeze, 2x2 cm stage 1 pressure ulcer on right ankle,
crackles that clear with cough
apical impulse - . . ANSWER ✓✓ intercostal space, palpate for
impulse, auscultate for pulse, turn obese patients to the left side
arterial ulcer - . . ANSWER ✓✓ dry, coolness, pallor, elevational
pallor, dependent rubor, diminished pulses, systolic bruits, signs
of malnutrition, think, shiny skin, thick ridged nails, atrophy of
muscles, and distal gangrene
