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Test your basic knowledge |
Nursing Fundamentals 3
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Study First
Subjects
:
health-sciences
,
nursing
Instructions:
Answer 50 questions in 15 minutes.
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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. A potential adverse rx of chemically restraining a confused patient would be
Med dx often involves problems with organ systems or disease and is the reason for admission to the hospital
Paradoxical reaction
Fluid volume deficit related to poor intake
Functional decline - cardiovascular distress - incontinence - pressure ulcers - aggitation - muscle atrohpy
2. All body system data is not necessary which type of assessment
Fast and deep respirations seen in patient's with acidosis
Focused
Med dx often involves problems with organ systems or disease and is the reason for admission to the hospital
Pt's underlying feelings
3. At What age do you begin to use logical thought process?
Nursing
Defining a baseline of cognitive function - any changes or deviations from norm.
Upper airways
School age childen
4. Side effects of putting confused pts in restraints include
Fluid volume deficit related to poor intake
Functional decline - cardiovascular distress - incontinence - pressure ulcers - aggitation - muscle atrohpy
Pain in legs assoc w walking
Decision assessment
5. The order of air flow into the lungs is
Nares - nasopharynx - trachea - bronchi - broncioles - alveoli
Hygeine - DOB - work hx
Snap - crackle - pops; velcro - bubble wrap
Have them do simple math problems
6. If patient reports pain of 3 on scale of 0-10 - What is the appropriate class of pain reliever?
Med dx often involves problems with organ systems or disease and is the reason for admission to the hospital
ADPIE - Assessment - Dx - Planning - Implentation and Evaluation
Non - opiod (ex: NSAID/acetominaphen)
Best heard over large airways due to secretions in lungs - sounds like gurgles - snorts
7. What is a definition of a delusion?
A false - fixed belief that cannot be corrected through reasoning.
Stroke volume x's heart rate
Clinical judement about a patient - family or community response to actual or potential health problems and life processes.
Secondary
8. Nursing interventions should be based on who's theory?
Confusion Assessment Method
Maslow
Ask - Believe - Choose - Deliver - Empower
Have them do simple math problems
9. The basis for a plan of care comes for which stage of the nursing process?
A systematic method for organizing and delivering effective and efficient goal centric nursing care based on problem solving principles.
Nursing dx
Fluid volume deficit related to poor intake
Knowing What to do/how to make a decision based upon available data.
10. ABG's would be an important lab value for What types of patient's?
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11. The path of blood from the heart to the lungs is
Medical
Sup/inferior vena cava - into the r/atrium - tricuspid - rt ventricle - pulmonary veins
Adolescence
The patient
12. What is pain?
A personal experience that does whatever the person in pain says it does
Trend assessment (shift report)
# of packs per day x # of years smoked
A systematic method for organizing and delivering effective and efficient goal centric nursing care based on problem solving principles.
13. Orthopnea is described as?
A false - fixed belief that cannot be corrected through reasoning.
Having to use more than one pillow when sleeping
Broncial (heard over trachea)
Communicate using hands and eyes.
14. When a patient has increased lymphocytes - this may indicate what?
Nurse
The process of storing - learning - retrieving - and using info.
Viral infection
Pain on inspiration and expiration; superficial squeaking or grating
15. What are the components of an assessment?
Data collection - data validation - data organization - data analysis - and data reporting/recording.
Clinical judement about a patient - family or community response to actual or potential health problems and life processes.
Pt's underlying feelings
Abstract thinking
16. Intermittent claudication is caused by?
Decreased arterial perfusion
The process of storing - learning - retrieving - and using info.
Hemoglobin
Broncial (heard over trachea)
17. At patient that state their shoes are tighter at the end of the day may be experiencing
The result is accurate patient dB
Edema
Having to use more than one pillow when sleeping
Adolescence
18. The path of blood from the lungs to the heart is
Approach from front - walk slow - stand to side - crouch low - offer hand - call by name - wait for response
Pulmonary artery - left atrium - mitral valve - left ventricle - aortic valve
Objective
Have them do simple math problems
19. What is the difference between a nursing dx and a med dx?
Disorganized thinking and altered LOC
Med dx often involves problems with organ systems or disease and is the reason for admission to the hospital
Ask - Believe - Choose - Deliver - Empower
Assess over all health status and identify the problem
20. If an abnormal finding is revealed during assessment - the nurse should
Double check equip and patient
Ask - Believe - Choose - Deliver - Empower
Adolescence
Immature immune system - structures close together lends to easy spreading from on area to another.
21. What do rhonchi sound like?
The patient
The result is accurate patient dB
Best heard over large airways due to secretions in lungs - sounds like gurgles - snorts
Adolescence
22. Once a medical dx has been made - who is accountable for the reporting s/s of complications?
Nurse
Best heard over large airways due to secretions in lungs - sounds like gurgles - snorts
Knowing What to do/how to make a decision based upon available data.
To simulate eating motions with the hands
23. When using restraints in a confused patient
Secondary
Hygeine - DOB - work hx
An 80 y/o patient that has emergency surgery
Risk of falls increases
24. One way to test a person's cognitive ability and abstract thinking ability would be to
School age childen
Level of stress - risk for violence - anxiety level - patient unmet needs
Have them do simple math problems
Secondary soureces (family - friends)
25. Where can you hear bronchovesicular breath sounds?
Bacterial infection
Wind (hypoxia/pneumonia) - water (UTI/dehydration) - wound (infection/sepsis) - walk (DVT - showering clots) and weird (new drugs)
Best heard over large airways due to secretions in lungs - sounds like gurgles - snorts
Anteriorly @ intercostal spaces 1 and 2. Posteriorly between the scapulae.
26. When noticing a patient with dementia has stopped eating - the RN's first response is?
Functional decline - cardiovascular distress - incontinence - pressure ulcers - aggitation - muscle atrohpy
To simulate eating motions with the hands
No
Pain
27. Ageusia is
Inattention and acute increase/decrease in cognitive function
Confusion Assessment Method
Loss of taste
Hemoglobin
28. What is a component of the cognitive part of critical thinking skills?
Nursing
Interventions for which the nurse is accountable
Decreased arterial perfusion
Knowing What to do/how to make a decision based upon available data.
29. Where can wheezes best be heard?
Assess over all health status and identify the problem
Upper airways
An 80 y/o patient that has emergency surgery
Pain on inspiration and expiration; superficial squeaking or grating
30. What are the ABCDE's of pain management?
EdFED- Q
Sup/inferior vena cava - into the r/atrium - tricuspid - rt ventricle - pulmonary veins
Ask - Believe - Choose - Deliver - Empower
Sensorineural (auditory or cortical nerve - or brain stem malfunction) - conductive (bones in middle ear) - mixed (damage to inner/middle/outer ear or auditory nerve)
31. The fifth vital sign is
Defining a baseline of cognitive function - any changes or deviations from norm.
Pain
Pt's underlying feelings
Implementation
32. In Which part of the nursing process will you find delegation?
Maslow
Implementation
Loss of taste
Objective
33. What are the steps of the nursing process?
Functional decline - cardiovascular distress - incontinence - pressure ulcers - aggitation - muscle atrohpy
Decreased sense of taste
Vesicular (peripheral lung areas)
ADPIE - Assessment - Dx - Planning - Implentation and Evaluation
34. The assessment that includes the patient's overhall health status
Initial assessment
Sensory motor (birth - 2 years) - Preoperational (2-7) - Concrete operational (7-11) - Formal operational (11- adult)
Pt's underlying feelings
Sensory motor
35. Data gathered via instrumention (pulse ox) is considered
Sensory motor (birth - 2 years) - Preoperational (2-7) - Concrete operational (7-11) - Formal operational (11- adult)
Objective
Hygeine - DOB - work hx
Broncial (heard over trachea)
36. What is the purpose of the nursing process?
Daily
Vesicular (peripheral lung areas)
Serves to expedite dx and tx of actual and potential health problems
Pain
37. 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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38. Data validation assures
Pt's underlying feelings
The result is accurate patient dB
Eye hygeine - accomodating factors - what was the level of decline - how long has it been
Defining a baseline of cognitive function - any changes or deviations from norm.
39. An example of a primary source is
Paradoxical reaction
The patient
Family - spouse - someone other than a healthcare worker - previous medical records.
Have them do simple math problems
40. What are the components of a mental status exam that are not part of a regular assessment?
8.4
Ongoing assessment
Clinical judement about a patient - family or community response to actual or potential health problems and life processes.
Long and s/t memory - attention - ability to calculate problems/abstract thinking - delusions/perceptual disturbances
41. What is cognition?
The process of storing - learning - retrieving - and using info.
Fluid volume deficit related to poor intake
Maslow
Vesicular (peripheral lung areas)
42. QUESTT is a tool for What type of an assessment?
Symptoms
Serves to expedite dx and tx of actual and potential health problems
Confusion Assessment Method
Pain
43. Are changes in vital signs a reliable indicator of chronic pain?
Nursing
Risk of falls increases
No
Pain on inspiration and expiration; superficial squeaking or grating
44. What is the nursing process?
Pt's with oxygenation and perfusion problems
Medical
A systematic method for organizing and delivering effective and efficient goal centric nursing care based on problem solving principles.
Having to use more than one pillow when sleeping
45. Blood passes through the heart valves In what order?
Sensory motor (birth - 2 years) - Preoperational (2-7) - Concrete operational (7-11) - Formal operational (11- adult)
Decreased sense of taste
Wandering
Tricuspid - mitral and the aortic
46. What is the cognitive difference between a preschooler and schoolage child?
Risk of falls increases
Communicate using hands and eyes.
Irregular respirations (fast/slow) often seen at end of life
Preschool is cause and effect - school age begins to use logical thought process.
47. A patient that is easily fatigued may have a HgB lab value of?
The process of storing - learning - retrieving - and using info.
Abstract thinking
Pain on inspiration and expiration; superficial squeaking or grating
8.4
48. Why are young children at greater risk for respiratory infection?
Ongoing assessment
Immature immune system - structures close together lends to easy spreading from on area to another.
EdFED- Q
Hygeine - DOB - work hx
49. Other factors that may indicate confusion using the CAM tool could be
Disorganized thinking and altered LOC
Hemoglobin
Sensorineural (auditory or cortical nerve - or brain stem malfunction) - conductive (bones in middle ear) - mixed (damage to inner/middle/outer ear or auditory nerve)
The result is accurate patient dB
50. What scale is used to determine eating and feeding issues in adults with confusion
EdFED- Q
Level of stress - risk for violence - anxiety level - patient unmet needs
Delerium has stimulus that is misinterpreted - whereas a halluciantion has no stimulus.
Viral infection
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