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What assessments should you make of the lower extremities in an initial shift assessment?
- A. Pulse strength, edema, skin condition, range of motion
- B. Capillary refill, temperature, sensation, strength
- C. Color, pulses, edema, mobility
- D. All of the above
Correct Answer: D
Rationale: Lower extremity assessment includes pulse strength, edema, skin condition, range of motion, capillary refill, temperature, sensation, strength, color, and mobility.
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Which of the following would be the most accurate description of dorsal flexion assessment?
- A. Ask the patient to press his or her toes toward the foot of the bed, applying pressure against the palms of your hands so you can assess the strength and equality of the flexion between the two sides
- B. Ask the patient to pull his or her toes toward the head, pulling against the palms of your hands so you can assess the strength and equality of the flexion between the two sides
- C. Ask the patient to gently point his or her toes toward the foot of the bed so you can assess agility and coordination of the lower extremities
- D. Ask the patient to gently point his or her toes toward the head so you can assess the neuromuscular activity of his lower extremities
Correct Answer: B
Rationale: Dorsal flexion involves pulling the toes toward the head, assessed for strength and equality against resistance.
During assessment of your patient, you notice that the patient has numbness of the left side of her face. You would use the medical term to document this finding.
- A. Paresthesia
- B. Hypoesthesia
- C. Anesthesia
- D. Dysesthesia
Correct Answer: B
Rationale: Hypoesthesia is the medical term for reduced sensation or numbness in a specific area, such as the face.
If you hear a shrill, high-pitched, crowing sound coming from the room of a 3-year-old child who has croup, you recognize the ominous sign known as
- A. Crackles
- B. Rhonchi
- C. Wheezes
- D. Pleural friction rub
- E. Stridor
Correct Answer: E
Rationale: Stridor is a high-pitched, crowing sound associated with upper airway obstruction, common in croup.
Blood pressure can provide you with information regarding which of the following?
- A. Central nervous system
- B. Cardiovascular system
- C. Integumentary system
- D. Renal system
- E. Fluid status
- F. Infection
Correct Answer: B,D,E
Rationale: Blood pressure reflects cardiovascular function (B), renal function (D) through regulation of blood volume, and fluid status (E) as it affects vascular volume.
Percussion of a patient's abdomen and chest provides you with what information about the patient?
- A. Density of underlying structures
- B. Presence of fluid or air
- C. Organ size and position
- D. All of the above
Correct Answer: D
Rationale: Percussion reveals density, fluid, air, and organ size/position through sound differences (e.g., dullness, tympany).