Instructions:

• Answer 50 questions in 15 minutes.
• If you are not ready to take this test, you can study here.
• 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. Nursing dx provides basis of
Toddler
No
Interventions for which the nurse is accountable
# of packs per day x # of years smoked


2. 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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3. What is responsible for transporting O2 in the blood
Hemoglobin
# of packs per day x # of years smoked
Secondary
Pain in legs assoc w walking


4. What is pain?
Sensory motor (birth - 2 years) - Preoperational (2-7) - Concrete operational (7-11) - Formal operational (11- adult)
Non - opiod (ex: NSAID/acetominaphen)
A personal experience that does whatever the person in pain says it does
Symptoms


5. Which patient would be most likely to experience sensory overload?
Decreased sense of taste
Best heard over large airways due to secretions in lungs - sounds like gurgles - snorts
Confusion Assessment Method
An 80 y/o patient that has emergency surgery


6. What is a component of the cognitive part of critical thinking skills?
Delerium has stimulus that is misinterpreted - whereas a halluciantion has no stimulus.
Trend assessment (shift report)
Medical
Knowing What to do/how to make a decision based upon available data.


7. Kussamaul respirations describe

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8. In Which part of the nursing process will you find delegation?
Pain
Vesicular (peripheral lung areas)
Implementation
Long and s/t memory - attention - ability to calculate problems/abstract thinking - delusions/perceptual disturbances


9. One way to test a person's cognitive ability and abstract thinking ability would be to
Surgically implanted device for deaf or hard or hearing - also called bionic ear.
Paradoxical reaction
School age childen
Have them do simple math problems


10. What is the correct approach when dealing with older adults?
Assess over all health status and identify the problem
Trauma or illness
Eye hygeine - accomodating factors - what was the level of decline - how long has it been
Approach from front - walk slow - stand to side - crouch low - offer hand - call by name - wait for response


11. Once a medical dx has been made - who is accountable for the reporting s/s of complications?
ID'ing status of exisiting problems and locating new issues
Nurse
Defining a baseline of cognitive function - any changes or deviations from norm.
Fast and deep respirations seen in patient's with acidosis


12. Types of hearing loss include
Eye hygeine - accomodating factors - what was the level of decline - how long has it been
Maslow
Sensorineural (auditory or cortical nerve - or brain stem malfunction) - conductive (bones in middle ear) - mixed (damage to inner/middle/outer ear or auditory nerve)
Stroke volume x's heart rate


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

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14. What is the difference between hallucination and delirium?
Having to use more than one pillow when sleeping
Pain in legs assoc w walking
Nursing
Delerium has stimulus that is misinterpreted - whereas a halluciantion has no stimulus.


15. All body system data is not necessary which type of assessment
EdFED- Q
The medication will not affect the patient's breathing.
Objective
Focused


16. The fifth vital sign is
Pain
A personal experience that does whatever the person in pain says it does
Surgically implanted device for deaf or hard or hearing - also called bionic ear.
Nursing


17. At patient that state their shoes are tighter at the end of the day may be experiencing
Edema
Interventions for which the nurse is accountable
Adolescence
Wandering


18. Intermittent claudication is caused by?
Decreased arterial perfusion
Nares - nasopharynx - trachea - bronchi - broncioles - alveoli
Irregular respirations (fast/slow) often seen at end of life
ID'ing status of exisiting problems and locating new issues


19. The purpose of an intitial assement serves to?
Assess over all health status and identify the problem
Hygeine - DOB - work hx
Sup/inferior vena cava - into the r/atrium - tricuspid - rt ventricle - pulmonary veins
Toddler


20. What are the steps of the nursing process?
Non - opiod (ex: NSAID/acetominaphen)
Secondary soureces (family - friends)
Snap - crackle - pops; velcro - bubble wrap
ADPIE - Assessment - Dx - Planning - Implentation and Evaluation


21. Examples of personal information
Initial assessment
Functional decline - cardiovascular distress - incontinence - pressure ulcers - aggitation - muscle atrohpy
Hygeine - DOB - work hx
An 80 y/o patient that has emergency surgery


22. 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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23. QUESTT is a tool for What type of an assessment?
Pain
Double check equip and patient
Knowing What to do/how to make a decision based upon available data.
Immature immune system - structures close together lends to easy spreading from on area to another.


24. What do rhonchi sound like?
Best heard over large airways due to secretions in lungs - sounds like gurgles - snorts
Hearing loss
Functional decline - cardiovascular distress - incontinence - pressure ulcers - aggitation - muscle atrohpy
Stroke volume x's heart rate


25. What is cognition?
The process of storing - learning - retrieving - and using info.
Adolescence
ID'ing status of exisiting problems and locating new issues
Assess over all health status and identify the problem


26. What is the purpose of the nursing process?
ADPIE - Assessment - Dx - Planning - Implentation and Evaluation
Pain on inspiration and expiration; superficial squeaking or grating
Serves to expedite dx and tx of actual and potential health problems
To ID the problem


27. What factors may indicate plural rub?
Symptoms
Pain on inspiration and expiration; superficial squeaking or grating
A systematic method for organizing and delivering effective and efficient goal centric nursing care based on problem solving principles.
Disorganized thinking and altered LOC


28. Ageusia is
Loss of taste
Communicate using hands and eyes.
Pain
Fast and deep respirations seen in patient's with acidosis


29. 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 -
Viral infection
# of packs per day x # of years smoked
Implementation


30. Diabetes is a _________ dx
Inattention and acute increase/decrease in cognitive function
Decision assessment
Pain
Medical


31. When speaking with a patient with moderate hearing loss the RN should
Communicate using hands and eyes.
ADPIE - Assessment - Dx - Planning - Implentation and Evaluation
Anteriorly @ intercostal spaces 1 and 2. Posteriorly between the scapulae.
Secondary


32. Describe the purpose of a mental status exam
Approach from front - walk slow - stand to side - crouch low - offer hand - call by name - wait for response
Loss of taste
Sup/inferior vena cava - into the r/atrium - tricuspid - rt ventricle - pulmonary veins
Defining a baseline of cognitive function - any changes or deviations from norm.


33. What scale is used to determine eating and feeding issues in adults with confusion
Pulmonary artery - left atrium - mitral valve - left ventricle - aortic valve
EdFED- Q
Confusion Assessment Method
Wind (hypoxia/pneumonia) - water (UTI/dehydration) - wound (infection/sepsis) - walk (DVT - showering clots) and weird (new drugs)


34. A patient that is easily fatigued may have a HgB lab value of?
8.4
Upper airways
Stroke volume x's heart rate
Double check equip and patient


35. Data validation assures
No
The result is accurate patient dB
The patient
Family - spouse - someone other than a healthcare worker - previous medical records.


36. The site where gas exchange occurs is
Capillaries
Pain
Have them do simple math problems
EdFED- Q


37. Are changes in vital signs a reliable indicator of chronic pain?
To simulate eating motions with the hands
Anteriorly @ intercostal spaces 1 and 2. Posteriorly between the scapulae.
Implementation
No


38. Ongoing assessments are useful in

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39. What is a chochlear implant?
Adolescence
Surgically implanted device for deaf or hard or hearing - also called bionic ear.
Hemoglobin
Trauma or illness


40. What is the cognitive difference between a preschooler and schoolage child?
Hearing loss
Nurse
Non - opiod (ex: NSAID/acetominaphen)
Preschool is cause and effect - school age begins to use logical thought process.


41. Name the 5 'W's' of assessing a change in LOC
Ongoing assessment
Immature immune system - structures close together lends to easy spreading from on area to another.
Wind (hypoxia/pneumonia) - water (UTI/dehydration) - wound (infection/sepsis) - walk (DVT - showering clots) and weird (new drugs)
Focused


42. What is a definition of a delusion?
Focused
Daily
Confusion Assessment Method
A false - fixed belief that cannot be corrected through reasoning.


43. A potential adverse rx of chemically restraining a confused patient would be
Risk of falls increases
Level of stress - risk for violence - anxiety level - patient unmet needs
Paradoxical reaction
The patient


44. Where can you hear bronchovesicular breath sounds?
Vesicular (peripheral lung areas)
Edema
Decreased arterial perfusion
Anteriorly @ intercostal spaces 1 and 2. Posteriorly between the scapulae.


45. Expiration sounds are heard longer than inspiration In What area?
Broncial (heard over trachea)
Focused
Fast and deep respirations seen in patient's with acidosis
Serves to expedite dx and tx of actual and potential health problems


46. Blood passes through the heart valves In what order?
Medical
Risk of falls increases
Trauma or illness
Tricuspid - mitral and the aortic


47. A nursing dx is best described as
Clinical judement about a patient - family or community response to actual or potential health problems and life processes.
To ID the problem
No
Trend assessment (shift report)


48. An example of a primary source is
Long and s/t memory - attention - ability to calculate problems/abstract thinking - delusions/perceptual disturbances
Snap - crackle - pops; velcro - bubble wrap
Tricuspid - mitral and the aortic
The patient


49. What is the difference between a nursing dx and a med dx?
Pt's underlying feelings
Wandering
Med dx often involves problems with organ systems or disease and is the reason for admission to the hospital
Secondary


50. Hypogeusis is
Nursing
Decreased sense of taste
Hygeine - DOB - work hx
Best heard over large airways due to secretions in lungs - sounds like gurgles - snorts