The nurse is preparing to use the Glasgow Coma Scale to assess a ...

[khang]

The nurse is preparing to use the Glasgow Coma Scale to assess a client's level of consciousness in which areas?
 
  1. Eye response.
  2. Motor response.
  3. Verbal response.
  4. Orientation.
  5. Musculoskeletal response.

Question 2

The nurse is preparing to conduct an assessment of the heart. Where will the nurse place the stethoscope to auscultate heart sounds?
 
  1. Aortic region.
  2. Pulmonic region.
  3. Tricuspid valve region.
  4. Abdomen.
  5. Mitral valve region.

[yuyiding]

Answer to Question 1

Correct Answer: 1,2,3
Rationale 1: The Glasgow Coma Scale tests in three major areas: eye response, motor response, and verbal response.
Rationale 2: The Glasgow Coma Scale tests in three major areas: eye response, motor response, and verbal response.
Rationale 3: The Glasgow Coma Scale tests in three major areas: eye response, motor response, and verbal response.
Rationale 4: The Glasgow Coma Scale is not used to assess orientation.
Rationale 5: The Glasgow Coma Scale is not used to assess musculoskeletal response.

Answer to Question 2

Correct Answer: 1,2,3,5
Rationale 1: The nurse will auscultate heart sounds over the aortic region.
Rationale 2: The nurse will auscultate heart sounds over the pulmonic region.
Rationale 3: The nurse will auscultate heart sounds over the tricuspid valve region.
Rationale 4: The abdomen is not assessed during the assessment of the heart.
Rationale 5: The nurse will auscultate sounds over the mitral valve region.