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Nursing Fundamentals 3

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. One way to test a person's cognitive ability and abstract thinking ability would be to
Have them do simple math problems
Assess over all health status and identify the problem
Serves to expedite dx and tx of actual and potential health problems
Nailpolish - skin color - too bright light - poor peripheral blood flow - patient is too cold - low HgB levels -

2. Sleep deprivation can effect
Learning - memory and adaptation to stress
Ask - Believe - Choose - Deliver - Empower
Sup/inferior vena cava - into the r/atrium - tricuspid - rt ventricle - pulmonary veins
EdFED- Q

3. When noticing a patient with dementia has stopped eating - the RN's first response is?
To simulate eating motions with the hands
Communicate using hands and eyes.
Implementation
Learning - memory and adaptation to stress

4. Diabetes is a _________ dx
Knowing What to do/how to make a decision based upon available data.
Medical
Sensory motor
Wind (hypoxia/pneumonia) - water (UTI/dehydration) - wound (infection/sepsis) - walk (DVT - showering clots) and weird (new drugs)

5. Acceptable sources of assessment data when evaluating a confused patient would be
Irregular respirations (fast/slow) often seen at end of life
Secondary soureces (family - friends)
Hygeine - DOB - work hx
A false - fixed belief that cannot be corrected through reasoning.

6. What is the difference between hallucination and delirium?
Capillaries
No
Objective
Delerium has stimulus that is misinterpreted - whereas a halluciantion has no stimulus.

7. If an abnormal finding is revealed during assessment - the nurse should
ID'ing status of exisiting problems and locating new issues
Double check equip and patient
Ongoing assessment
Having to use more than one pillow when sleeping

8. What does CAM stand for
Secondary soureces (family - friends)
Confusion Assessment Method
Focused
Risk of falls increases

9. Data validation assures
The result is accurate patient dB
Stroke volume x's heart rate
Broncial (heard over trachea)
Long and s/t memory - attention - ability to calculate problems/abstract thinking - delusions/perceptual disturbances

10. Why are young children at greater risk for respiratory infection?
Irregular respirations (fast/slow) often seen at end of life
Tricuspid - mitral and the aortic
Immature immune system - structures close together lends to easy spreading from on area to another.
EdFED- Q

11. Hypogeusis is
Non - opiod (ex: NSAID/acetominaphen)
Decreased sense of taste
Anteriorly @ intercostal spaces 1 and 2. Posteriorly between the scapulae.
The medication will not affect the patient's breathing.

12. At What age do you begin to use logical thought process?
Communicate using hands and eyes.
Ongoing assessment
Focused
School age childen

13. When performing an interview with a patient with vision loss - select the correct questions for obtaining an accurate vision history
Eye hygeine - accomodating factors - what was the level of decline - how long has it been
Focused
Wind (hypoxia/pneumonia) - water (UTI/dehydration) - wound (infection/sepsis) - walk (DVT - showering clots) and weird (new drugs)
Delerium has stimulus that is misinterpreted - whereas a halluciantion has no stimulus.

14. What are Piaget's stages of cognitive development
Snap - crackle - pops; velcro - bubble wrap
Sensory motor (birth - 2 years) - Preoperational (2-7) - Concrete operational (7-11) - Formal operational (11- adult)
Level of stress - risk for violence - anxiety level - patient unmet needs
Med dx often involves problems with organ systems or disease and is the reason for admission to the hospital

15. Examples of personal information
Hygeine - DOB - work hx
Vesicular (peripheral lung areas)
Sensory motor
Sensorineural (auditory or cortical nerve - or brain stem malfunction) - conductive (bones in middle ear) - mixed (damage to inner/middle/outer ear or auditory nerve)

16. An infant is in which Paiget stage?
The process of storing - learning - retrieving - and using info.
Sensory motor
Tricuspid - mitral and the aortic
Capillaries

17. What is the purpose of the nursing process?
Serves to expedite dx and tx of actual and potential health problems
Stroke volume x's heart rate
A personal experience that does whatever the person in pain says it does
ADPIE - Assessment - Dx - Planning - Implentation and Evaluation

18. Side effects of putting confused pts in restraints include
Pain on inspiration and expiration; superficial squeaking or grating
Fluid volume deficit related to poor intake
Sensory motor
Functional decline - cardiovascular distress - incontinence - pressure ulcers - aggitation - muscle atrohpy

19. Would a nursing dx be part of the primary or secondary dx?
Decreased sense of taste
Defining a baseline of cognitive function - any changes or deviations from norm.
Secondary
Fluid volume deficit related to poor intake

20. Intermittent claudication is caused by?
Fluid volume deficit related to poor intake
Decreased arterial perfusion
Surgically implanted device for deaf or hard or hearing - also called bionic ear.
Wind (hypoxia/pneumonia) - water (UTI/dehydration) - wound (infection/sepsis) - walk (DVT - showering clots) and weird (new drugs)

21. A patient that is easily fatigued may have a HgB lab value of?
EdFED- Q
A systematic method for organizing and delivering effective and efficient goal centric nursing care based on problem solving principles.
8.4
Non - opiod (ex: NSAID/acetominaphen)

22. Where can wheezes best be heard?
Knowing What to do/how to make a decision based upon available data.
Upper airways
Family - spouse - someone other than a healthcare worker - previous medical records.
Nurse

23. Factors that may reduce the efficacy of pulse oximetry include
Nailpolish - skin color - too bright light - poor peripheral blood flow - patient is too cold - low HgB levels -
Hemoglobin
Stroke volume x's heart rate
Family - spouse - someone other than a healthcare worker - previous medical records.

24. An ongoing assessment is performed
Medical
Snap - crackle - pops; velcro - bubble wrap
Data collection - data validation - data organization - data analysis - and data reporting/recording.
Daily

25. Describe the purpose of a mental status exam
Defining a baseline of cognitive function - any changes or deviations from norm.
Stroke volume x's heart rate
Communicate using hands and eyes.
Confusion Assessment Method

26. What factors may indicate plural rub?
Data collection - data validation - data organization - data analysis - and data reporting/recording.
Hearing loss
Ask - Believe - Choose - Deliver - Empower
Pain on inspiration and expiration; superficial squeaking or grating

27. The path of blood from the lungs to the heart is
Wandering
Abstract thinking
Pulmonary artery - left atrium - mitral valve - left ventricle - aortic valve
Trend assessment (shift report)

28. What is cognition?
A false - fixed belief that cannot be corrected through reasoning.
Communicate using hands and eyes.
Decision assessment
The process of storing - learning - retrieving - and using info.

29. Data from the last 24/48 hours that included patterns would be a part of
Trend assessment (shift report)
Edema
A systematic method for organizing and delivering effective and efficient goal centric nursing care based on problem solving principles.
Nursing

30. What are the components of an assessment?
EdFED- Q
Data collection - data validation - data organization - data analysis - and data reporting/recording.
Hearing loss
Symptoms

31. What is pain?
# of packs per day x # of years smoked
Learning - memory and adaptation to stress
A personal experience that does whatever the person in pain says it does
Anteriorly @ intercostal spaces 1 and 2. Posteriorly between the scapulae.

32. What is a chochlear implant?
Surgically implanted device for deaf or hard or hearing - also called bionic ear.
Paradoxical reaction
Double check equip and patient
Risk of falls increases

33. An example of a secondary source is
Symptoms
Family - spouse - someone other than a healthcare worker - previous medical records.
The medication will not affect the patient's breathing.
No

34. A patient failing to answer questions or displaying a reluctance to participate in group or family activities may be experiencing
Focused
Hearing loss
EdFED- Q
Risk of falls increases

35. QUESTT is a tool for What type of an assessment?
Loss of taste
Defining a baseline of cognitive function - any changes or deviations from norm.
Nursing dx
Pain

36. What is the cognitive difference between a preschooler and schoolage child?
Preschool is cause and effect - school age begins to use logical thought process.
A personal experience that does whatever the person in pain says it does
Ask - Believe - Choose - Deliver - Empower
Bacterial infection

37. Keeping patient's belongings - shoes - suitcases and street clothes - etc. out of view are helpful for preventing: wandering?
Wandering
Communicate using hands and eyes.
No
Nailpolish - skin color - too bright light - poor peripheral blood flow - patient is too cold - low HgB levels -

38. Data that is recorded for an immediate need (code blue or fall) would be included in
Decision assessment
Level of stress - risk for violence - anxiety level - patient unmet needs
Pt's underlying feelings
Pain in legs assoc w walking

39. When a patient has increased lymphocytes - this may indicate what?
Interventions for which the nurse is accountable
Daily
Viral infection
Risk of falls increases

40. What is the formula for cardiac output?

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41. What is the nursing process?
Ongoing assessment
Assess over all health status and identify the problem
Nursing dx
A systematic method for organizing and delivering effective and efficient goal centric nursing care based on problem solving principles.

42. What is the formula for determining pack years?
8.4
Preschool is cause and effect - school age begins to use logical thought process.
Edema
# of packs per day x # of years smoked

43. A nursing dx is best described as
Daily
Clinical judement about a patient - family or community response to actual or potential health problems and life processes.
Family - spouse - someone other than a healthcare worker - previous medical records.
Snap - crackle - pops; velcro - bubble wrap

44. When dealing with a confused patient - should the nurse acknowledge the patient's underlying feelings or the content of the delusion?

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45. Expiration sounds are heard longer than inspiration In What area?
ID'ing status of exisiting problems and locating new issues
Trauma or illness
Broncial (heard over trachea)
Hemoglobin

46. All body system data is not necessary which type of assessment
Assess over all health status and identify the problem
Having to use more than one pillow when sleeping
No
Focused

47. What are the steps of the nursing process?
Nailpolish - skin color - too bright light - poor peripheral blood flow - patient is too cold - low HgB levels -
Double check equip and patient
Irregular respirations (fast/slow) often seen at end of life
ADPIE - Assessment - Dx - Planning - Implentation and Evaluation

48. ABG's would be an important lab value for What types of patient's?

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49. Which patient would be most likely to experience sensory overload?
Viral infection
Snap - crackle - pops; velcro - bubble wrap
An 80 y/o patient that has emergency surgery
Level of stress - risk for violence - anxiety level - patient unmet needs

50. A patient that is dying is on morphine. The family is concerned the prs breathing will stop. What is the correct RN response?

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Nursing Fundamentals 3

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