Exam 2: NSG 316/ NSG316 (New 2024/ 2025 Update) Health Assessment | Guide with Qs and As | 100% Correct| Grade A (Verified Answers)-
... [Show More] GCU
QUESTION
assessing the nose
Answer:
-External nose: symmetric, midline, proportionate; if injured, palpate for pain
-Check patency of nostrils: occlude one nostril at a time to check air flow
-Test CN I for smell if needed
-Nasal cavity: inspect nasal mucosa, look for deviated septum (common and not significant unless obstructed airway)
-Palpate sinus areas: frontal (up/under eyebrows), maxillary (below cheekbones)
QUESTION
assessing the mouth
Answer:
-Lips: color, moisture, lesions; retract lips and look at inner surface
-Teeth: compare number of teeth with expected number for age; ask client to bite as if chewing to observe alignment of jaw
-Gums: check color, texture, swelling,
-Tongue: check color, surface, moisture; ask client to touch tongue to roof of mouth (should be smooth, glistening, and see veins; inspect for white patches, nodules, ulcerations, lesions (palpate for induration) which are all abnormal)
-Buccal mucosa: check color, Stensen's duct (opening of parotid salivary duct)
QUESTION
tonsils grading
Answer:
1+ visible
2+ halfway between tonsillar pillars and uvula
3+ touching uvula
4+ touching each other
QUESTION
assessing the throat/neck
Answer:
-head is centered/midline and accessory neck muscles are symmetrical, erect, still, ROM, look at trachea
-Assess ROM: perform slowly on elderly
-Lymph nodes: Palpate within the neck using a gentle circular motion of finger pads.
-Thyroid gland: posterior approach, anterior approach
If enlarged: auscultate for bruit and check area they drain for sources of the problem
Palpate the thyroid gland to ensure no swelling or lumps. Palpate lymph nodes within the neck (60-70 lymph nodes within the neck).
-Tonsils: color, surface peppered with indentations
Graded in size (1+ and 2+ is normal)
-Depress tongue to view posterior pharyngeal view
-Scan for color, exudate, lesions
-Test CN IX and X
-Test CN XII (note tremor, loss of movement, deviating to side)
-Notice breath odor
QUESTION
HEENMT assessment for the aging adult (head)
Answer:
-bones are more prominent; skin sags due to decreased elasticity; decreased subcutaneous fat; decreased moisture; lower face may look smaller if teeth have been lost; twisted/prominent temporal arteries; mild rhythmic tremor of head; senile tremors, head nodding and tongue protrusion
-Ask about any dizziness and neck pain and if it affects daily activities
QUESTION
presbyopia
Answer:
impaired vision as a result of aging (lens losing elasticity)
QUESTION
presbycusis
Answer:
age related hearing loss
QUESTION
cataracts
Answer:
lens opacity due to clumping of protein in lens
QUESTION
glaucoma [Show Less]
