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ADVANCED HEALTH TEST – FINAL EXAM, Exams of Nursing

ADVANCED HEALTH TEST – FINAL EXAM ADVANCED HEALTH TEST – FINAL EXAM

Typology: Exams

2024/2025

Available from 07/14/2025

Prof.Lorraine-Dixon
Prof.Lorraine-Dixon 🇬🇧

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ADVANCED HEALTH TEST – FINAL EXAM
COMPONENTS OF MENTAL STATUS EXAM INCLUDE: -
Solution A-B-C-T
APPEARANCE; posture, body movements, dress, grooming and
hygiene
BEHAVIOR; LOC, Facial expression, speech, mood and affect
COGNITION; address, phone#, etc. date?, attention span, recent and
remote memory, new learning
THOUGHT PROCESS; perceptions, should be logical and consistent
this person make sense?
how do people treat you?, do you feel you are being watched, followed
or controlled? have you heard your name when alone?
___________________ screens for Anxiety - Solution GAD- 7
questions to ask for depression or suicidal ideations: - Solution
Depression:
Over the past two weeks, have you fell down, depressed or hopeless?
Over the past 2 weeks, have you felt little interest or pleasure in doing
things?
Suicidal:
Have you ever felt so blue you thought of hurting yourself?
Do you have a plan to hurt yourself?
How would you do it?
***Must not ignore any talk of suicide***
When is a full mental status exam necessary? - Solution * Patients
whose initial screening suggests an anxiety disorder or depression
* Behavioral changes: such as memory loss, inappropriate social
interaction
* Brain lesions: trauma, tumor, cerebrovascular accident or stroke
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ADVANCED HEALTH TEST – FINAL EXAM

COMPONENTS OF MENTAL STATUS EXAM INCLUDE: -

Solution A-B-C-T APPEARANCE; posture, body movements, dress, grooming and hygiene BEHAVIOR; LOC, Facial expression, speech, mood and affect COGNITION; address, phone#, etc. date?, attention span, recent and remote memory, new learning THOUGHT PROCESS; perceptions, should be logical and consistent this person make sense? how do people treat you?, do you feel you are being watched, followed or controlled? have you heard your name when alone? ___________________ screens for Anxiety - Solution GAD- 7 questions to ask for depression or suicidal ideations: - Solution Depression: Over the past two weeks, have you fell down, depressed or hopeless? Over the past 2 weeks, have you felt little interest or pleasure in doing things? Suicidal: Have you ever felt so blue you thought of hurting yourself? Do you have a plan to hurt yourself? How would you do it? Must not ignore any talk of suicide When is a full mental status exam necessary? - Solution * Patients whose initial screening suggests an anxiety disorder or depression

  • Behavioral changes: such as memory loss, inappropriate social interaction
  • Brain lesions: trauma, tumor, cerebrovascular accident or stroke
  • Aphasia: impairment of language ability secondary to brain damage
  • Symptoms- of psychiatric mental illness especially with acute onset ________________ Screens for Alcoholism. - Solution CAGE: Score 2 or greater highly significant
  • Have you ever felt you should CUT down on your drinking?
  • Have people ANNOYED you by criticizing your drinking?
  • Have you ever felt bad or GUILTY about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (EYE OPENER) Things to Consider When Assessing Older Adults mental status include:
  • Solution Ask about chronic illness and how they are managing? Sensory impairments? Polypharmacy (med list again!) Social isolation Physiological issue
  • Delirium vs. Dementia
  • UTI
  • Sundowners Delirium VS Dementia VS Depression: Onset course duration consciousness attention psychomotor changes reversibility - Solution Delirium ** Dementia ** Depression: ========================================== O: Acute insidious Acute or insidious C: Fluctuating Progressive May be chronic D: Hrs to wks Mos to yrs Mos to yrs C: Altered Usually clear clear
  • Arms out with palms up
  • Shut eyes
  • If pt sways or looses balance = Positive Romberg's Risks Related to Undiagnosed Ear Disorders: - Solution - Poor language development
  • Delayed learning
  • Social isolation
  • Hearing loss
  • Risk for falls
  • Missed diagnoses of respiratory and oral infections Major symptoms of ear disease include: - Solution Hearing loss Vertigo Tinnitus Otorrhea Otalgia Itching Questions to ask if acute hearing loss occurs: - Solution - Is the hearing loss in one ear?
  • For how long have you been aware of the hearing loss?
  • Was the loss sudden?
  • Is there a family history of hearing loss?
  • What type of work do you do (or have you done)?
  • What types of hobbies do you have?
  • Have you noticed you can hear better when it's noisy?
  • What kind of medications are you currently taking?
  • Do you know if you have been given an antibiotic called streptomycin or gentamicin? Types and Causes of Hearing Loss: - Solution Conductive:
  • Poor transmission of sound waves through the external and/or middle ear
  • Tend to speak softer

Sensorineural

  • Diseases of the cochlea and/or poor conduction of sound-generated impulses along the eighth cranial nerve to the brain stem
  • Tend to speak louder Mixed
  • Combination of both conductive and sensorineural hearing loss in the same ear Questions to ask if acute vertigo occurs: - Solution - How long have you had this sensation?
  • Have you had repeated attacks?
  • How long does an attack last? Seconds? Minutes? Hours? Days?
  • Is the onset of an attack abrupt?
  • Was the sensation brought on by, or worsened by, changes in position?
  • Does the spinning sensation get worse during an attack?
  • Are there positions that make you feel better? During an attack have you had double vision? Loss of strength? Decreased hearing? A disturbance of gait? Nausea? Vomiting? Ringing in your ears?
  • What medications are you currently taking?
  • Do you know if you have been given an antibiotic called streptomycin or gentamicin? Tinnitus is defined as ___________________. - Solution Buzzing or ringing in the ears without environmental input Causes of Tinnitus can include: - Solution - Meniere's disease
  • Noise trauma
  • Ototoxic drugs
  • Otosclerosis
  • Infections and inflammations of middle and external ear structures and mastoid tissues.
  • Secondary (referred to the ear from other regions)
  • TMJ problems, dental and periodontal problems
  • Infections in the sinuses and nasopharyngeal areas
  • Lesions of the tongue
  • Cervical musculoskeletal problems
  • Neuralgias Itching in the Ear can be caused by _____________. - Solution - Yeast infection of ear
  • Systemic
    • Diabetes
    • Hepatitis
    • Lymphoma The presence of a tophi is __________________ and is defined as_________________________. - Solution - a highly specific but nonsensitive sign of gout.
  • Tophi are deposits of uric acid crystals. They appear as hard nodules in the helix or antihelix. Cauliflower ear is a ______________________. - Solution pinna that is gnarled as a result of repeated trauma. If discharge is present in the ear you should __________________. - Solution note its characteristics, such as color, consistency, and clarity. Test for Auditory Acuity include: - Solution - Whisper test
  • Finger rub test
  • Tuning Fork Tests 512-Hz fork ideal
    • Test the ability of the patients to hear pure tones
  • Weber Test
    • Tests for adequacy of bone conduction

Conductive loss - Lateralized to affected hear

Sensorineural - lateralized to unaffected ear Normal - no lateralization

  • Rinne Test
    • Tests for comparison of air conduction to bone conduction in each ear separately

AC in compared to BC AC > BC = Positive Rinne Questions to ask if obstruction in the nose is suspected: - Solution - Is the obstruction on one side?

  • Have you ever had an injury to your nose?
  • How long has the obstruction been present?
  • Do you have any allergies?
  • Does the obstruction worsen with stress?
  • Is there a history of nasal polyps?
  • Is the obstruction associated with other symptoms?
  • Is there a seasonal change in your symptoms?
    • Which season is worse? Types of dIscharge from nose include: - Solution - Thin and watery
  • Thick and purulent
  • Bloody
  • Foul smelling Sinus Disease Symptoms include: - Solution - Fever
  • Malaise
  • Cough
  • Nasal congestion
  • Maxillary toothache
  • Purulent nasal drainage
  • Headache
  • Decongestants ineffective
  • Pain worse when bending over

If there is an ulcer in the oral cavity, questions to ask should include: - Solution - Have you had a lesion like this before?

  • Are there multiple lesions?
  • How long have the lesions been present?
  • Are there lesions anywhere else on the body, such as in the vagina? Urethra? Anus?
  • Are the lesions painful?
  • Do you smoke?
  • How much?
  • Do you drink alcohol?
  • Do you have a history of venereal disease? If a patient snores or if suspected sleep apnea, questions you should include: - Solution - Have you been told you snore?
  • How often do you snore?
  • Does your snoring bother other people?
  • Have breathing pauses been noticed?
  • Are you tired after sleeping?
  • Are you tired during the daytime?
  • Have you ever fallen asleep while driving?
  • Do you have high blood pressure?
  • Is your BMI greater than 28?
  • Are you 50 years or older?
  • Are you a man with a neck circumference greater than 17 inches or a woman with a neck circumference greater than 16 inches?
  • During usual sleep, have you noticed or been told that you toss and turn frequently?
  • Have you noticed or been told that you kick or jerk your legs repeatedly?
  • During the time you are usually awake, how often do you become irresistibly sleepy or fall asleep in the following situations:
    • After a meal
    • Reading or watching TV
    • Sitting and talking to someone
  • At work
  • While a passenger in a vehicle
  • While driving a vehicle
  • About how many times per night do you wake up?
  • Do you have difficulty falling asleep at night?
  • How many hours do you sleep? Dysphonia is ______________________. - Solution hoarseness; the major symptom of laryngeal disease is a change in voice. Four Chambers of the Heart include: - Solution Upper two chambers: (right and left atria)
  • Thin-walled, low-pressure chambers
  • Receive blood from the venae cava and pulmonary arteries
  • Pump blood into the respective ventricle Lower two chambers (right and left ventricles)
  • Thick muscular-walled chambers
  • Pump blood from the atria to the lungs and throughout the body via the aorta
  • Animation of cardiac cycle: https://www.youtube.com/watch? v=SwxA3L55yqs Epicardium is ____________________. - Solution the thin, outmost protective layer of the heart. Myocardium is ____________________. - Solution - Thick muscular middle layer
  • Pumps blood through the heart Endocardium is ____________________. - Solution - Lines the inner cavities; covers the heart valves
  • Limits heart motion; provides a barrier to infection

S4 - "atrial gallop"

  • Ventricular hypertrophy
  • Myocardial ischemia
  • "Summation gallop" - all 4 heart sounds present simultaneously Most common murmurs - systolic vs diastolic: MS.ARD & MR.ASS = - Solution M S A R D Mitral Stenosis (5ICS-MCL but can radiate laterally) Aortic Regurg (Erb's point) Diastolic murmurs M R A S S Mitral Regurg (5ICS-MCL) Aortic Stenosis (2ICS-RSB & clavicle) Systolic murmurs Audible mid-systolic click is indicative of _________________. - Solution MVP (mitral valve prolapse) Erb's point auscultate especially for __________________. - Solution - opening snap of MVP
  • Aortic valve regurgitation
  • Patent VSD

How do you describe any murmurs heard in heart? - Solution - Timing in the cardiac cycle

  • Location
  • Radiation
  • Duration
  • Intensity
  • Pitch
  • Quality
  • Relationship to respiration
  • Relationship to body position WHAT ARE THE 6 LEVELS OF THE LEVINE SCALE FOR GRADING MURMURS? - Solution I/VI. The murmur can only be heard if one listens carefully for some time. II/VI. The murmur is faint but can be heard straightaway with a stethoscope. III/VI. The murmur is moderately loud and can be heard immediately but there is no palpable thrill (vibration that can be felt). IV/VI. The murmur is loud and accompanies a palpable thrill. V/VI. The murmur accompanies a palpable thrill and is loud enough to be heard with just a slight touch of a stethoscope's rim. VI/VI. The murmur accompanies a palpable thrill and is so loud that it can be heard before a stethoscope even makes contact with skin.
  • Xanthomata -Nails
  • Splinter hemorrhages
  • Lichstein's sign (beware false + or -)
  • Eyes *Arcus senilis *Xanthelasma *Hypertelorism
  • Mouth
    • Palatal petechiae
  • Neck
    • Webbing
  • Chest configuration
  • Extremities When inspecting the Skin, with suspected cardiovascular issues, you should assess for ___________. - Solution - Color- is cyanosis present? Does it appear central or peripheral? Is Pallor present?
  • Temp Xanthomata are __________. - Solution stony- hard, slightly yellowish masses that are commonly found on the extensor tendons of the fingers- indicative of extremely high serum cholesterol >450mg/dL Eruptive Xanthomata result from ______________. - Solution elevations in plasma triglyceride concentrations, >1500mg/dL When assessing the Nails, with suspected cardiovascular issues, you should assess for ___________. - Solution Splinter hemorrhages: visible, small reddish-brown lines in the nail bed. classically associated with infective endocarditis.
  • Lichstein's sign is ____________. - Solution (not reliable -beware false + or -):

Earlobe crease; is an oblique crease, often bilateral, seen frequently in patients older than 50 yrs with significant CHD Arcus senilis, if found in patients younger than 40 years old may be due to - Solution -hypercholesterolemia What does Arcus senilis look like? - Solution a whitish ring at the perimeter of the cornea. Xanthelasma is __________ and is due to possible _______________. - Solution - the presence of yellowish plaques on the eyelids.

  • hyperlipoproteinemia Hypertelorism is ___________ and is often associated with ____________. - Solution - widely set eyes
  • congenital heart problems such as mitral valve prolapse. When cardiovascular issues are suspected, a high-arched palate may be associated with ________________. - Solution congenital heart problems such as mitral valve prolapse. Palatal petechiae is often associated with ___________________. - Solution infective endocarditis. Webbing of neck, as seen in individuals with Turners syndrome and in patients with Noonan's syndrome, may be due to _______________. - Solution coarctation of the aorta. Pectus excavatum is ______________. - Solution caved in chest Pectus carinatum is _______________. - Solution pigeon breast Questions to assess during General Appearance assessment for cardiac patient should include: - Solution is the patient in acute distress? What
  • Chest X-ray
  • Hematologic studies
  • Cardiac catheterization What diagnostic test is for murmurs? - Solution Echocardiogram What are the main symptoms of pulmonary disease? - Solution - Cough
  • Sputum production
  • Hemoptysis
  • Dyspnea
  • Wheezing
  • Cyanosis
  • Chest Pain
  • Snoring What components of the physical assessment for pulmonary disease should you include? - Solution - Inspection (anterior and posterior)
    • Should include general assessment of patient's overall "attitude"
  • Distress
  • Posture
  • Chest configuration
  • Inspect hands for clubbing
  • Respiratory rate/pattern Barrel Chest is seen in patients with ________________. - Solution COPD The use of accessory muscles during breathing is indicative of __________________. - Solution respiratory distress Palpation of chest is used to assess _______________. - Solution - Areas of tenderness
  • Symmetry
  • Tactile fremitus

Increased tactile fremitus can be a result of ___________. - Solution - Pulmonary consolidation

  • Pneumonia
  • Pulmonary edema
  • Alveolar fibrosis
  • Alveolar tumor Decreased tactile fremitus can be a result of ___________. - Solution - Decreased tactile fremitus
  • Separation between lung and chest wall
  • Pleural effusion
  • Pneumothorax
  • Obesity
  • Atelectasis
  • Airway obstruction
  • Tumor or foreign body
  • Bronchopneumonia
  • Pulmonary hyperinflation
  • Emphysema (COPD) Tracheal Shifts toward side of what diseases? - Solution Atelectasis Lung cancer pulling on a bronchus Tracheal Shifts away from side of what diseases? - Solution Pneumothorax Large pleural effusion What does asymmetrical chest excursion indicate? - Solution Localized pulmonary disease may cause one side of the chest to move less than the opposite side. Name the Percussion notes in the lung and what they are indicative of. - Solution - Tympany

    Large pneumothorax

  • Hyperresonance