Low-pitched, bubbling, moist sounds that may persist from early inspiration to early expiration; also described as softly separating Velcro.

Low-pitched, dry, grating sound; sound is much like crackles, only more superficial and occurring during both inspiration and expiration.

High-pitched, musical sounds heard primarily during expiration but may also be heard on inspiration.

Low-pitched snoring or moaning sounds heard primarily during expiration but may be heard throughout the respiratory cycle. These wheezes may clear with coughing.

Inhaled air suddenly opens the small deflated air passages that are coated and sticky with exudate.

Inhaled air comes into contact with secretions in the large bronchi and trachea.

Sound is the result of rubbing of two inflamed pleural surfaces.

Air passes through constricted passages (caused by swelling, secretions, or tumor).

Same as sibilant wheeze. The pitch of the wheeze cannot be correlated to the size of the passageway that generates it.

Occurring late in inspiration and associated with restrictive diseases such as pneumonia and congestive heart failure. Also, occurring early in inspiration are associated with obstructive disorders such as bronchitis, asthma, or emphysema.

May indicate pneumonia, pulmonary edema, and pulmonary fibrosis. “Velcro rales” of pulmonary fibrosis are heard louder and closer to stethoscope, usually do not change location, and are more common in clients with long-term COPD.

Pleuritis

are often heard in cases of acute asthma or chronic emphysema.

Are often heard in cases of bronchitis or single obstructions and snoring before an episode of sleep apnea. Stridor is a harsh honking wheeze with severe broncho laryngospasm, such as occurs with croup

Are paired mammary glands that lie over the muscles of the anterior chest wall, anterior to the pectoralis major and serratus anterior muscles. Depending on their size and shape, the breasts extend vertically from the second to the sixth rib and horizontally from the sternum to the midaxillary line

The upper outer quadrant, which extends into the axillary area, is referred to as the ______. Most breast tumors occur in this quadrant.

Are present in both male and female breasts. These structures drain lymph from the breasts to filter out microorganisms and return water and protein to the blood.

The ______, which is located in the center of the breast, contains the tiny openings of the lactiferous ducts through which milk passes.

The ______ surrounds the nipple (generally 1 to 2 cm radius) and contains elevated sebaceous glands (Montgomery glands) that secrete a protective lipid substance during lactation.

Hair follicles commonly appear around the?

The nipple and areola typically have darker pigment than the surrounding breast. Their color ranges from _____ to _____, depending on the person’s skin color.

The amount of pigmentation increases with pregnancy then decreases after _____. It does not, however, entirely return to its original coloration.

_______ or other breast tissue may appear along an area called the “milk line”. This milk line or ridge extends from each axilla to the groin area and appears during embryonic development. It gradually atrophies and disappears as the person grows and develops.

Female breasts consist of three types of tissue:

Constitutes the functional part of the breast, allowing for milk production. Arranged in 15 to 20 lobes that radiate in a circular fashion from the nipple. Each lobe contains several lobules in which the secreting alveoli (acini cells) are embedded in grapelike clusters.

______ from the alveoli converge into a single lactiferous duct that leaves each lobe and conveys milk to the nipple.

The slight enlargement in each duct before it reaches the nipple is called the?

The milk can be stored in the _____ (or ampullae) until stimulated to be released from the nipple.

The _____ provides support for the glandular tissue largely by way of bands called Cooper’s ligaments (suspensory ligaments). These ligaments run from the skin through the breast and attach to the deep fascia of the muscles of the anterior chest wall.

The third component of the breast. The glandular tissue is embedded in it. This subcutaneous and retromammary fat provides most of the substance to the breast and thus determines the size and shape of the breasts. The functional capability of the breast is not related to size but rather to the glandular tissue present.

Drain the anterior chest wall and breasts.

The posterior chest wall and part of the arms are drained by the _____.

Have the client disrobe and sit with arms hanging freely. Explain what you are observing to help ease client anxiety.

Be sure to note client’s overall skin tone when inspecting the breast skin. Note any lesions.

Observe visibility and pattern of breast veins.

Note the color, size, shape, and texture of the areolas of both breasts.

Ask the client to remain seated while performing several different maneuvers. Ask the client to raise her arms overhead; then press her hands against her hips. Next ask her to press her hands together. These actions contract the pectoral muscles.

Finally ask the client to lean forward from the waist. The nurse should support the client by the hands or forearms. This is a good position to use in women who have large, pendulous breasts.

These are irregular, firm, hard, not defined masses that may be fixed or mobile. They are not usually tender and usually occur after age 50.

These lesions are lobular, ovoid, or round. They are firm, well defined, seldom tender, and usually singular and mobile. They occur more commonly between puberty and menopause.

Also called fibrocystic breast disease, it is marked by round, elastic, defined, tender, and mobile cysts. The condition is most common from age 30 to menopause, after which it decreases.

A 23 year old female client asks the nurse, "Why do I need to examine my armpits when I do y monthly breast exam?" Which of the following would be an appropriate response for the nurse to make to this client?

The nurse is preparing to examine the breast of male client and plans to do which of following? Select all that apply:

1. Ask about a family history of testicular cancer.

2. Position the client in the supine position for palpation of the breast.

3. Palpate extensively in the tail of Spence area.

4. Position the client in the sitting position for inspection of the breast.

5. Palpate the lymph nodes and the axillary area.

The nurse is performing a breast examination. Which of the following reflect abnormal findings during the inspection phase of breast examination?

Characterized by lumps, pain or tenderness, and nipple discharge as a result of thickening of the breast tissue.

The sebaceous glands on the areola, which enlarge and produce a secretion that protects and lubricate the nipples.

During breast assessment, the nurse notes an inverted right nipple. The nurse knows that this is:

"Orange peel" appearance caused by edema from blocked lymphatic drainage in advanced cancer.

Benign temporary breast enlargement in one or both breast in males.

Which of the following positions accentuates the presence of dimpling during the inspection phase of breast assessment?

A 20 year old client with benign breast disease say she has increased breast pain and tenderness with menses. What should the nurse do in this situation?

The following conditions are to be inspected while assessing gait.

How many thoracic vertebrae are there in human body?

The function of ligaments is to:

A degenerative non inflammatory disease of joint is known as:

Stretching of tendon is known as:

A human skeletal system is composed of many total number of bones?

The outward curvature of the spine is termed as:

A newly hired nurse id asking the supervisor about the sprain. The best reply given by the supervisor is:

When inspecting and palpating the sternoclavicular joint, the following conditions are normal finding, EXCEPT:

The human vertebral column is composed of how many lumbar vertebrae?

Getting patient-oriented with self, place, and time is part of the assessment for:

A patient comes in the emergency department, the nurse check the reflexes by scratching the bottom of his/her foot, and her/his toes and reflect backward. This is an indication of:

Nurse Pat will assess the Lobes of the cerebral hemispheres and their functions of her client. What lobes directs the voluntary skeletal actions and also influences communications, emotions, intellect, reasoning ability, and behavior?

Types of cranial nerve that innervates tongue muscles, that promotes the movement of food and talking

Nurse Pat will get the subjective data of her client, basing on her neurologic assessment/examinations. Which of the following assessment should be documented?

The nurse on duty will assess the cranial nerve II which is the optic nerve. Which of the following the nurse will do or use?

Nurse Clara is assessing the CN III (oculomotor), CN VI (trochlear)and CN VI (abducens). She inspect margins of the eye lids of each eye. Her findings is, there is drooping of the eyelids which called:

The nurse will check the gag reflex of her client by touching the posterior pharynx with the tongue depressor. an absent of gag reflex is an indication of:

The nurse will perform the Romberg test to her 65 year old client by asking the client to stand erect with arm at side and feet together. The number one nursing responsibility of the nurse to observe is:

When you ask the client to hang the arm freely while you support it with non dominant hand, with the elbow flexed, and you use the flat side of the reflex hammer to tap the tendon above the olecranon process. What reflex you are eliciting?

In performing breast examinations, the nurse knows that examining the upper outer quadrant of the breasts is especially important. The reason for this is that the upper quadrant is?

A client asks the nurse, "Why do I need to examine my armpits when I do my monthly breast exam?" Which of the following would be an appropriate response for the nurse to make to this client?

The nurse is planning a focused breast/axilla interview and wants to include a general health question. Which of the following questions would fit this criteria?

A female client tells the nurse, "I know I should examine my breasts but I just don't." What should the nurse do with this information?

When doing breast self-examination, the female patient should report which findings to her physician?

This is due to increase vascular resistance, as occurs in elders, digoxin toxicity, cold weather and severe heart failure.

Is a physical finding with arterial pulse waveforms showing alternating strong and weak beats

It is important that the nurse be knowledgeable about cardiac output in order to:

Which part of the cardiovascular system is responsible in taking deoxygenated blood through the veins and sends it to the lungs for oxygenation?

Which heart sound can be heard most commonly in elderly and with hypertension?

The part of the GIT system responsible for the absorption of vitamins and minerals

The part of the accessory organ for digestion that is responsible for production and secretion of insulin that helps in utilization of glucose.

Which of the following principle is NOT part of the techniques used in assessing the GIT system/abdomen?

Arrange the following techniques in assessing the abdomen:

1- Inspection

2- Palpation

3- Auscultation

4- Percussion

The patient has vomited a coffee ground vomitus. This would suggest that the patient might be suffering from which of the following conditions?

The patient was diagnosed with an acute pancreatitis, which of the following signs and symptoms would you see upon the assessment of the abdomen?

The part of the accessory organ for digestion that is responsible for detoxifying the body from various substances which includes but not limited to drugs and hormones

The part of the GIT system responsible for the absorption of sodium and water

Generally, the sound hear during percussion of the abdomen brought about by a hallow organ is characterized by which of the following sound?

The nurse heard an abnormal sound and suspects that this is due to narrowing blood flow in the blood vessel. This sound can be documented as:

The patient has a black tarry stool during the time of diaper change. This sign would suggest that the patient might have which of the following conditions?

The patient was diagnosed with appendicitis, which of the following quadrant is the LAST point you will assess?

Performing breast self examination will help in which level of prevention?

A 58 year old client says to the nurse, "My saggy breasts embarrass me!" What can the nurse say to this client in response?

The nurse is volunteering at a community center to teach women about breast cancer. The nurse should include all when discussing risk factors except?

During the breast exam, the nurse palpates a series of lymph nodes. Why is this a part of the breast exam?

A client asks the nurse, "Why do I need to examine my armpits when I do my monthly breast exam?" Which of the following would be an appropriate response for the nurse to make to this client?

A 9 year old girl is in the clinic for a sport physical examination. After some initial shyness she finally asks, Am I normal? I don`t seem to need a bra yet, but I have some friends who do. What if I never get breasts? The nurses best response would be:

In performing breasts examinations, the nurse knows that examining the upper outer quadrant of the breast is especially important. The reason for this is that the upper quadrant is?

Which of the following is NOT part of your assessment if you are focusing on the cardiovascular system?

In checking for arterial insufficiency, the nurse would do which of the following test?

The patient reported an unpleasant awareness of her heartbeat even for a short distance walking. She characterized it by a pounding pulse that is very fast. The nurse would document this finding as:

Which heart sound is produced during the closure of the Aortic and Pulmonic Valves?

Which heart sound can be heard most commonly in elderly and with hypertension?

When caring for a patient who has intermittent claudication, the cardiac-vascular nurse advises the patient to:

Examination of a patient in a supine position reveals distended jugular veins from the base of the neck to the angle of the jaw. This finding indicates:

It is important that the nurse be knowledgeable about cardiac output in order to:

A patient has been diagnosed with Right-Sided Congestive Heart Failure, and is confused about return of deoxygenated blood from the tissue. To clarify the confusion, which chamber of the heart receives blood from systemic circulation?

This equipment can be used in patient`s having difficulty to palpate peripheral pulses

The nurse is performing a breast examination. Which of the following reflect abnormal findings during the inspection phase of breast examination?

The nurse is preparing to examine the breast of male client and plans to do which of the following? select all the apply:

1. ask about a family history of testicular cancer

2. position the client in the supine position for palpation of the breast

3. palpate extensively in the tail of spence area

4. position the client in the sitting position for inspection of the breast

5. palpate the lymph nodes and the axillary area

A 20 year old client with benign breast disease say she has increased breast pain and tenderness with menses. What should the nurse do in this situation?

Which of the following positions accentuates the presence of dimpling during the inspection phase of breast assessment?

Benign temporary breast enlargement in one or both breast in males

"Orange peel" appearance caused by edema from blocked lymphatic drainage in advanced cancer

During breast assessment, the nurse notes an inverted right nipple. The nurse knows that this is:

The sebaceous glands on the areola, which enlarge and produce a secretion that protects and lubricate the nipples.

Acceptance of responsibility for ethical and honest behavior toward others.

The ability to make your own decisions without being controlled by anyone else

Defined as kindness and charity, which requires action on the part of the nurse to benefit others.

Refers to the duty to protect privileged information and to share entrusted information responsibly.

Nurses must keep professional promises, such as providing high-quality, competent, safe, and efficient patient care. It also entails being supportive of patient decisions, encouraging patient autonomy, and advancing the profession.

Autonomous authorization by a competent, comprehending adult who authorizes a professional to involve the subject in research, initiate a medical plan for the patient, or both.

In nursing ethics implies that patients have a right to fair and impartial treatment. This means no matter what a patient's insurance status or financial resources may be, or what gender identification, age or ethnicity they are, they have the right to fairness in nursing decisions.

This means that nurses must do no harm intentionally. Nurses must provide a standard of care which avoiding risk or minimizing it, as it relates to medical competence.

The state or condition of being free from being observed or disturbed by other people.

The principle of _______, or truth telling, requires that healthcare providers be honest in their interactions with patients.

4 PRINCIPLES OF INFORMED CONSENT

5 CONDITIONS OF INFORMED CONSENT

Every person has a right to health and medical care corresponding to his state of health, without any discrimination and within the limits of the resources, manpower and competence available for health and medical care at the relevant time. The patient has the right to appropriate health and medical care of good quality.

The patient has a right to a clear, truthful and  substantial  explanation,  in  a  manner  and  language  understandable  to  the patient, of all proposed procedures, whether  diagnostic, preventive, curative, rehabilitative or therapeutic, wherein the person who will perform the said procedure shall provide  his  name  and credentials  to  the  patient,  possibilities  of  any  risk  of mortality or serious side effects, problems related to recuperation, and probability of success  and  reasonable  risks  involved:  Provided,   That  the  patient  will not  be subjected  to any procedure without his written informed consent

In emergency cases, when the patient is at imminent risk of physical injury, decline of death if treatment is withheld or postponed. In such cases, the physician can perform any diagnostic or treatment procedure as good practice of medicine dictates without such consent;

Informed consent is not needed when the health of the population is dependent on the adoption of a mass health program to control epidemic;

Informed Consent is not needed when the law makes it compulsory for everyone to submit a procedure;

When the patient is either a minor, or legally incompetent, in which case. a third-party consent Is required;

when disclosure of material information to patient will jeopardize the success of treatment, in which case, third party disclosure and consent shall be in order;

Informed Consent is not needed when the patient waives his right in writing.

Informed consent shall be obtained from a patient concerned if he is of legal age and of sound mind. In case the patient is incapable of giving consent and a third-party consent is required. The following persons, in the order of priority stated hereunder, may give consent:

If a patient is a minor, consent shall be obtained from his parents or legal guardian. If the parents or legal guardians refuse to give consent to a medical or surgical procedure necessary to save the life or limb of a minor or a patient incapable of giving consent, courts, upon the petition of the physician or any person interested in the welfare of the patient, in a summary proceeding, may issue an order giving consent.

The privacy of the patients must be assured at all stages of his treatment.

The patient has the right to be free from unwarranted public exposure, except when his mental or physical condition is in controversy and the appropriate court, in its discretion, order him to submit to a physical or mental examination by a physician;

The patient has the right to be free from unwarranted public exposure, except when the public health and safety so demand

The patient has the right to be free from unwarranted public exposure, except when the patient waives this right in writing

The patient has the right to demand that all information, communication and records pertaining to his care be treated as confidential. Any health care provider or practitioner involved in the treatment  of a patient and all those who have legitimate access to the patient's record is not authorized to divulge any information to a third party  who  has  no concern  with  the  care  and  welfare  of  the  patient  without  his consent

The patient has the right to demand that all information, communication and records pertaining to his care be treated as confidential. Any health care provider or practitioner involved in the treatment  of a patient and all those who have legitimate access to the patient's record is not authorized to divulge any information to a third party  who  has  no concern  with  the  care  and  welfare  of  the  patient  without  his consent, except:

Informing the spouse or the family to the first degree of the patient's medical condition may be allowed; Provided that the patient of legal age shall have the right to choose on whom to inform. In case the patient is not of legal age or is mentally incapacitated, such information shall be given to the parents or legal guardian.

In the course  of his/her  treatment  and  hospital care, the patient or his/her legal guardian has a right to be informed of the result of the evaluation  of the nature and extent of his/her disease,  any other additional  or further  contemplated   medical  treatment on surgical procedure or procedures, including any other additional medicines to be administered and their generic counterpart including the possible complications  and other pertinent facts, statistics or studies,  regarding  his/her  illness

The patient is free to choose the health care provider to serve him as well as the facility except when he is under the care of a service facility or when public health and safety so demands or when the patient expressly waives this right in writing. The patient has the right to discuss his condition with a consultant specialist, at the patient’s request and expense.  He also has the right to seek for a second opinion and subsequent opinions, if appropriate, from another health care provider/practitioner.

The patient has the right to avail himself/herself of any recommended diagnostic and treatment procedures.

Any person of legal age and of sound mind may make an advance written directive for physicians to administer terminal care when he/she suffers from the terminal phase of a terminal illness:  Provided That

The patient has the right to refuse medical treatment or procedures which may be contrary to his religious beliefs, subject to the limitations described in the preceding subsection: Provided, that such a right shall not be imposed by parents upon their children who have not reached the legal age in a life-threatening situation as determined by the attending physician or the medical director of the facility.

The patient is entitled to a summary of his medical history and condition. He has the right to view the contents of his medical records, except psychiatric notes and other incriminatory information obtained about third parties, with the attending physician explaining contents thereof. At his expense and upon discharge of the patient, he may obtain from the health care institution a reproduction of the same record whether or not he has fully settled his financial obligation with the physician or institution concerned.

The patient has the right to leave hospital or any other health care institution regardless of his physical   condition: Provided that

a) he/she is informed of the medical consequences of his/her decision

b) he/she releases those involved in his/her care from any obligation relative to the consequences of his decision;

c) his/her decision will not prejudice public health and safety.

No patient should be detained against his/her will in any health care institution on the sole basis of his failure to fully settle his financial obligations.  However, he/she shall only be allowed to leave the hospital provided appropriate arrangements have been made to settle the unpaid bills: Provided.  further, that unpaid bills of patients shall be considered as loss income by the hospital and health care provider/practitioner and shall be deducted from gross income as income loss only on that particular year.

The patient has the  right to be advised if the  health care provider  plans to  involve him in medical research, including but not limited  to  human  experimentation which may be performed only with the written informed consent of the patient

The patient has the right to communicate with relatives and other persons and to receive visitors subject to reasonable limits prescribed by the rules and regulations of the health care institution.

The patient has the right to express complaints and grievances about the care and services received without fear of discrimination or reprisal and to know about the disposition of such complaints. Such a system shall afford all parties concerned with the opportunity to settle amicably all grievances.

Every person has the right to be informed of his rights and obligations as a patient. It shall be the duty of health care institutions to inform of their rights as well as of the institution's rules and regulations that apply to the conduct of the patient while in the care of such institution.

Otherwise known as the Data Privacy Act is a law that seeks to protect all forms of information, be it private, personal, or sensitive. It is meant to cover both natural and juridical persons involved in the processing of personal information.

The patient has the right to considerate and respectful care

The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment and prognosis. Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and/or treatments, the crisis involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits.

The patient has the right to know the identity of physicians, nurses, and others involved in his/her care, as well as when those involved are students, residents, or trainees. The patient also has the right to know the immediate and long-term financial implications of treatment choices, in so far as they are known.

The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.

The patient has the right to have an advance directive (such as a living will, health care) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy.

Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices, ask if the patient has an advance directive, and include that information in patient records. The patient has the right to timely information about hospital policy that may limit its ability to implement fully a legally valid advance directive.

The patient has the right to every consideration of his privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patient’s privacy.

The patient has the right to expect that all communications and records pertaining to his/her care should be treated as confidential by the hospital, except in cases such as suspected public health hazards where reporting is permitted or required by law.

The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records.

The patient has the right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary except when restricted by law.

The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and /or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility.

The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient must also have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives to such a transfer.

The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or players that may influence the patient’s treatment and care.

The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting his care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide.

The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers available and realistic patient care options when hospital care is no longer appropriate.

The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital’s charges for services and available payment methods.

Intact perineal skin usually slightly

more pigmented than the skin of the

buttocks

Anal skin is normally more pigmented,

coarser, moister than perianal skin and

is usually hairless

rectal wall is smooth

& not tender.

The prostate land is about _cm in diameter,

firm, rubbery smooth and

mobile

RECTUM AND ANUS

Dorsal recumbent with

knees flexed or lithotomy

RECTUM AND ANUS

standing position while the client bends

over the examining table may also be

used