fundamentals of nursing quizlet exam 2

Consequently, the nurse must observe for objective signs. Multiple sclerosis, a progressive, degenerative disease involving demyelination of the nerve fibers, usually begins in young adulthood and is marked by periods of remission and exacerbation. - Vibration Hyperventilation Hypercapnia, hypoxemia, fever, pregnancy, wound healing A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea, and severe abdominal pain. Bend knees - Smoking - swayed back, less coordination, budda belly Under normal conditions, a healthy adult breathes in a smooth uninterrupted pattern 12 to 20 times a minute. Nursing responsibilities for Mrs. Mitchell now include:AReporting an APTT above 45 seconds to the physicianBAll of the above CAssessing the patient for signs and symptoms of frank and occult bleedingDReviewing daily activated partial thromboplastin time (APTT) and prothrombin time.Question 38 Explanation: All of the identified nursing responsibilities are pertinent when a patient is receiving heparin. Results Risk for aspiration, Prepare medications - Severe sleep apnea or other respiratory problems Base line vital signs include pulse rate, temperature, respiratory rate, and blood pressure. -To prevent serious medication errors. You have not finished your quiz. and it increases 4% every liter, Continuous positive airway pressure The physician is responsible for instructing the patient about the test and for writing the order for the test. Right dose Risk for infection capsule Look at when next due dose is? Amyotrophic lateral sclerosis (Lou Gerhigs disease). Other conditions requiring extra vitamin C include wound healing, fever, infection and stress. red- pink wound bed Keep it simple (Choose all that apply) Question 50A registered nurse reaches to answer the telephone on a busy pediatric unit, momentarily turning away from a 3 month-old infant she has been weighing. Fever Start Maintaining patient's rights, History 29. Conversions between systems Ineffective individual coping related to COPD is wrong because the etiology for a nursing diagnosis should not be a medical diagnosis (COPD) and because no data indicate that the patient is coping ineffectively. 26. adults and children over 3- pull pinna up and back Genupecterol Kaopectate is an anti diarrheal medication. 34. 2. His oral temperature at 8 a.m. is 99.8 F (37.7 C) This temperature reading probably indicates:AHypothermiaBInfectionCAnxietyDDehydration Question 15 Explanation: A slightly elevated temperature in the immediate preoperative or post operative period may result from the lack of fluids before surgery rather than from infection. The correct sequence for assessing the abdomen is: 18. The nurse is responsible for giving the patient breakfast at the scheduled time. Demonstrating the signal system and providing an opportunity for a return demonstration ensures that the patient knows how to operate the equipment and encourages him to call for assistance when needed. 1) Completeness (Disclosure) - tell patient everything regarding a treatment decision. Orotracheal and nasotracheal All patients receiving anticoagulant therapy must be observed for signs and symptoms of frank and occult bleeding (including hemorrhage, hypotension, tachycardia, tachypnea, restlessness, pallor, cold and clammy skin, thirst and confusion); blood pressure should be measured every 4 hours and the patient should be instructed to report promptly any bleeding that occurs with tooth brushing, bowel movements, urination or heavy prolonged menstruation. subcutaneous (subcut) The most common injury among elderly persons is: Atheroscleotic changes in the blood vessels, Increased incidence of gallbladder disease. 1. - Inaccurate prescribing Text Mode Push the diaphragm inward and upward Accurate dosage calculation and measurement Intraocular: eye drops or eye ointment (intraopthalmic) DAccountability is clearest when one nurse is responsible for the overall plan and its implementation.Question 46 Explanation: Studies have shown that patients and nurses both respond well to primary nursing care units. You Selected Consequently, the nurse must observe for objective signs. Exercise Exam Mode Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam. The only abbreviation we can use for subcutaneous is what? She is required to bathe only soiled areas of the body since the mortician will wash the entire body. use biohazard sharps disposal containers- immediately These include: tincture Question 38The physician orders a maintenance dose of 5,000 units of subcutaneous heparin (an anticoagulant) daily. A patient about to undergo abdominal inspection is best placed in which of the following positions? Accompany the patient for his walk. Question 33 Explanation: Pressure ulcers are most likely to develop in patients with impaired mental status, mobility, activity level, nutrition, circulation and bladder or bowel control. Some hospitals have standing orders up to 2L Temperature and respiratory rate Question 48A prescribed amount of oxygen s needed for a patient with COPD to prevent:AInhibition of the respiratory hypoxic stimulus BCirculatory overload due to hypervolemiaCRespiratory excitementDCardiac arrest related to increased partial pressure of carbon dioxide in arterial blood (PaCO2)Question 48 Explanation: Delivery of more than 2 liters of oxygen per minute to a patient with chronic obstructive pulmonary disease (COPD), who is usually in a state of compensated respiratory acidosis (retaining carbon dioxide (CO2)), can inhibit the hypoxic stimulus for respiration. Kaolin with pectin (Kaopectate) Question 32Which of the following is an example of nursing malpractice?AThe nurse administers penicillin to a patient with a documented history of allergy to the drug. 246 The other answers are incorrect interpretations of the statistical data. 22. Fundamentals of Nursing Practice Exam 2 (PM) Know delegation last/ regarding medication administration Chest physiotherapy Because transplants are done within hours of death, decisions about organ donation must be made as soon as possible. Base line vital signs include pulse rate, temperature, respiratory rate, and blood pressure. Question 33Which of the following patients is at greatest risk for developing pressure ulcers?AAn 88-year old incontinent patient with gastric cancer who is confined to his bed at homeBAn alert, chronic arthritic patient treated with steroids and aspirinCAn apathetic 63-year old COPD patient receiving nasal oxygen via cannulaDA confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed. Gait instruct client to breathe through mouth No-interruption zones We need to get O to the cells throughout the body!! Side rails should not be used In this example, the standard of care was breached; a 3-month-old infant should never be left unattended on a scale. Lifting, bending, and moving rotate sites. Also, this page requires javascript. Question 5To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures his hourly urine output. Good luck! Other symptoms include diminished memory, apathy, disinterest in appearance, withdrawal, and irritability. these are annoying, but not usually harmful, these are unwanted effects that are more harmful to the body, can be minor all the way up to life threatening, some drugs can interact and cause physical changes Clarify unclear orders A prescribed amount of oxygen s needed for a patient with COPD to prevent: 40. -Read back the telephone order to the prescriber. -Calling the pharmacy to clarify the correct dose of medication, The nurse is caring for a patient who has an order for an acetaminophen (Tylenol) rectal suppository. The need to move the feet apart to maintain this stance is an abnormal finding. What are they? Question 13The family of an accident victim who has been declared brain-dead seems amenable to organ donation. Written communication that does the same is considered libel. Administering an incorrect medication is a nursing error; however, if such action resulted in a serious illness or chronic problem, the nurse could be sued for malpractice. Muscle irritability Delivery of more than 2 liters of oxygen per minute to a patient with chronic obstructive pulmonary disease (COPD), who is usually in a state of compensated respiratory acidosis (retaining carbon dioxide (CO2)), can inhibit the hypoxic stimulus for respiration. Autolytic debridement, protective, prevents wound dehydration, absorbs small to moderate drainage, Localized skin intact, non-blanchable and reddened. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Standing A 38-year old patients vital signs at 8 a.m. are axillary temperature 99.6 F (37.6 C); pulse rate, 88; respiratory rate, 30. Usually used in aging and rehab - A decimal system organized into units of 10 Roll the vials 49. An appropriate nursing diagnosis would be:AIneffective individual coping to COPD.B Ineffective airway clearance related to thick, tenacious secretions.CPain related to immobilization of affected leg. Writing the order for this test Which of the following is the most common cause of dementia among elderly persons? His oral temperature at 8 a.m. is 99.8 F (37.7 C) This temperature reading probably indicates: A series of coughs throughout exhalations Tachypnea is rapid respiration characterized by quick, shallow breaths. 17-20% patients have to come back related to initial hospitalization. fundamentals of nursing exam 1 flashcards quizlet web what are the 5 steps in the nursing process 1 assessment 2 nursing diagnosis 3 planning 4 - info medical personnel can look at Aging The nurse is responsible for: The patient experiences an allergic reaction and has cerebral damage resulting from anoxia.BThe nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus.CThe nurse applies a hot water bottle or a heating pad to the abdomen of a patient with abdominal cramping.DThe nurse administers the wrong medication to a patient and the patient vomits. repeat this process using a new swab each time and moving the same circular stroke away from the drain site, place collection container or measuring device on bed b/w you and patient CAn 88-year old incontinent patient with gastric cancer who is confined to his bed at homeDAn alert, chronic arthritic patient treated with steroids and aspirinQuestion 24 Explanation: Pressure ulcers are most likely to develop in patients with impaired mental status, mobility, activity level, nutrition, circulation and bladder or bowel control. women 35. All of these positions are appropriate for a rectal examination. Simple Face Mask Then put air into clear vial There are 50 questions to complete. The physician orders the administration of high-humidity oxygen by face mask and placement of the patient in a high Fowlers position. Ensuring that the attending physician issues the death certification Prone D. Because percussion and palpation can affect bowel motility and thus bowel sounds, they should follow auscultation in abdominal assessment. Anaphalaxsis -"It will take only a minute to swallow the medication before you go to the bathroom." Canes - personal preference as to what side use on, although usually used on weaker side. Everyone! If you're administering more than one medication into the NG tube, what do you do? Question 22The correct sequence for assessing the abdomen is:AAssessment for distention, tenderness, and discoloration around the umbilicus.BTympanic percussion, measurement of abdominal girth, and inspectionCPercussions, palpation, and auscultationDAuscultation, percussion, and palpation Question 22 Explanation: Because percussion and palpation can affect bowel motility and thus bowel sounds, they should follow auscultation in abdominal assessment. 48. The combined effects of inadequate food intake and prolonged diarrhea can deplete the potassium stores of a patient with GI problems. Hypothermia is an abnormally low body temperature. Reading - can patient read the label High-pitched gurgles head over the right lower quadrant are: 19. The need to move the feet apart to maintain this stance is an abnormal finding. use meticulous hand hygiene and clean gloves -Complete the institution's incident or occurrence report. bowel, However, the familys concerns must be addressed before members are asked to sign a consent form. If a patients blood pressure is 150/96, his pulse pressure is: Document in a timely fashion, Person on the blunt end of the needle is responsible for the sharp end of the needle Draw out cloudy insulin 23. They also seem to gain a greater sense of achievement and esprit de corps. Blood pressure is typically assessed at the antecubital fossa, and respiratory rate is assessed best by observing chest movement with each inspiration and expiration. List Question 47Studies have shown that about 40% of patients fall out of bed despite the use of side rails; this has led to which of the following conclusions?ASide rails are a reminder to a patient not to get out of bed BSide rails are a deterrent that prevent a patient from falling out of bed.CSide rails should not be usedDSide rails are ineffectiveQuestion 47 Explanation: Since about 40% of patients fall out of bed despite the use of side rails, side rails cannot be said to prevent falls; however, they do serve as a reminder that the patient should not get out of bed. Applying a hot water bottle or heating pad to a patient without a physicians order does not include the three required components. Time allowed When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to: Ensuring the patients safety is the most essential action at this time. System much more like the beta cells of your pancreas Decreased blood pressure and heart rate and shallow respirations Defamation Now - give it now, without breaking neck to do so A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea, and severe abdominal pain. Flush with 30 mL of water before and after feedings. Be vigilant The infusion set must be changed every few days. Fever, exercise, and sympathetic stimulation all increase the heart rate. C. Hyperactive sounds indicate increased bowel motility; two or three sounds per minute indicate decreased bowel motility. Thus, a respiratory rate of 30 would be abnormal. A patient about to undergo abdominal inspection is best placed in which of the following positions? All doneNeed more practice!Keep trying!Not bad!Good work!Perfect! Oxygen Practice Mode Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam. aerosol Advantages of insulin pen: Medication Interactions Time used 3. Because transplants are done within hours of death, decisions about organ donation must be made as soon as possible. 20. Congratulations - you have completed Fundamentals of Nursing Practice Exam 2 (PM). Circulatory overload and respiratory excitement have no relevance to the question. The body of an organ donor is available for burial. These changes, in turn, increase the work load of the left ventricle. Pinch skin - Sublingual: under the tongue I will be back to check on you." - Pneumococcal for those over 65 or with chronic illnesses They also seem to gain a greater sense of achievement and esprit de corps. Blood pressure is typically assessed at the antecubital fossa, and respiratory rate is assessed best by observing chest movement with each inspiration and expiration. 1. verify rights Ask the patient The physician is responsible for instructing the patient about the test and for writing the order for the test.Question 43After 1 week of hospitalization, Mr. Gray develops hypokalemia. Don't use needles if needleness alternatives are available A platelet count evaluates the number of platelets in the circulating blood volume. renal/hepatic disease -Assess and examine the patient. Assisting a patient out of bed with the bed locked in position is the correct nursing practice; therefore, the fracture was not the result of malpractice. If this activity does not load, try refreshing your browser. Pain related to immobilization of affected leg would be an appropriate nursing diagnosis for a patient with a leg fracture. Have client close eye gently Preoxygenate the patient Readiness for enhanced self- health management Continue administering oxygen by high humidity face mask use lancet to perform stick A confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed. intravenous (IV), first time administration Collaborative care, Place object close to center of gravity - Pursed lip breathing to slow down breathing rate Illness Use of hand rails or wall nearby. Hypothermia - Do not strip the tubing, need to milk it instead. Written report within 24 hours of occurrence, Comparison of medications taken at home and prescribed when in the health care setting, Change in patient's condition In the horizontal recumbent position, the patient lies on his back with legs extended and hips rotated outward. Labeling the corpse appropriately If nurse administers an injection to a patient who refuses that injection, she has committed: Assault is the unjustifiable attempt or threat to touch or injure another person. sharpest Alzheimers disease A hospitalized surgical patient leaving his room for the first time fears rejection and others staring at him, so he should not walk alone. make sure enough insulin prevent contamination of solution The nurse must place a pillow under the decreased persons head and shoulders to prevent blood from settling in the face and discoloring it. Substance abuse allowed an hour window of time You can program different amounts of insulin for different times of the day and night. Sympathetic nervous system stimulation Parasympathetic nervous system stimulation of the heart decreases the heart rate as well as the force of contraction, rate of impulse conduction and blood flow through the coronary vessels. Risk for aspiration - don't twist Chest wall movement A normal adult body temperature, as measured on an oral thermometer, ranges between 97 and 100F (36.1 and 37.8C); an axillary temperature is approximately one degree lower and a rectal temperature, one degree higher. 1. STAT - give immediately 3. The nurse administers penicillin to a patient with a documented history of allergy to the drug. In the Trendelenburg position, the head of the bed is tilted downward to 30 to 40 degrees so that the upper body is lower than the legs. Question 1The nurses most important legal responsibility after a patients death in a hospital is:ALabeling the corpse appropriatelyBEnsuring that the attending physician issues the death certification CNotifying the coroner or medical examinerDObtaining a consent of an autopsyQuestion 1 Explanation: The nurse is legally responsible for labeling the corpse when death occurs in the hospital. The nurse must place a pillow under the decreased persons head and shoulders to prevent blood from settling in the face and discoloring it. During the procedure, the client begins to cough and has difficulty breathing. List Patient's tolerance of procedure, Coughing Techniques to prevent poor oxygenation, Cascade Which of the following nursing interventions has the greatest potential for improving this situation? - Monitor side effects -Use one pharmacy to coordinate all medications. research shows the least injury from injections here Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative pain following abdominal surgery? Other symptoms include diminished memory, apathy, disinterest in appearance, withdrawal, and irritability. In the home- inadequate lighting and physical barriers (doors, stairs, curbs, furniture), Concerns for the Transmission of Pathogens, Hand hygiene - most effective way to limit spread of pathogens (gel in, gel out), Common developmental safety hazards for INFANT/TODDLER/PRESCHOOLER, Common developmental safety hazards for SCHOOL-AGE CHILD, Common developmental safety hazards for ADOLESCENT, Drug/alcohol use/abuse Fundamentals of Nursing University Keiser University Fundamentals of Nursing Add to My Courses Documents (326) Questions Students (625) Book related documents Kozier and Erb's Fundamentals of Nursing Volume 1-3 Barbara Kozier; Glenora Erb; Audrey Berman; Shirlee Snyder; Tracy Levett-jones Lecture notes Date Rating year Ratings Show 8 more documents Once you are finished, click the button below. A normal adult body temperature, as measured on an oral thermometer, ranges between 97 and 100F (36.1 and 37.8C); an axillary temperature is approximately one degree lower and a rectal temperature, one degree higher. Screw on needle - Rates if 8-15 liters Sometimes based on weight or body surface area. a. Fluid status b. Potassium c. Lipids d. Nitrogen balance Click the card to flip Nitrogen Balance Nitrogen balance is important to determining serum protein status. In Maslows hierarchy of physiologic needs, the human need of greatest priority is: The physician orders a platelet count to be performed on Mrs. Smith after breakfast. Nurses feel personal satisfaction, much of it related to positive feedback from the patients. Such a patient is unlikely to display emotion, such as crying. Correct dosage Accompanying him will offer moral support, enabling him to face the rest of the world. Which of the following statement is incorrect about a patient with dysphagia? Studies have shown that about 40% of patients fall out of bed despite the use of side rails; this has led to which of the following conclusions? She should notify the physician if the urine output is: The trailer is 2.5m2.5 \mathrm{~m}2.5m by 2.5m2.5 \mathrm{~m}2.5m by 12m12 \mathrm{~m}12m. The air is at 0C0^{\circ} \mathrm{C}0C and standard atmospheric pressure. - Reposition every two hours to reduce the risk of infection Performing activities of daily living, Body Alignment A. inject med slowly and smoothly plunger, Select the _______________ syringe size possible for accuracy; size range 0.5 mL to 60 mL, Pre-attached needle - flow sheet must be completed on every patient in retraint Herbal drugs can interact negatively with prescribed meds. Recording medication administration incorrect no answer. - Exhale, then have patient suck in and hold it. Be alert to important functioning equipment. What should the nurse do?ADiscourage them from making a decision until their grief has easedBTell them the body will not be available for a wake or funeral CListen to their concerns and answer their questions honestlyDEncourage them to sign the consent form right awayQuestion 13 Explanation: The brain-dead patients family needs support and reassurance in making a decision about organ donation. 33. The nurse could be charged with:ADefamationBMalpractice CAssaultDBatteryQuestion 40 Explanation: Malpractice is defined as injurious or unprofessional actions that harm another. Congratulations - you have completed Fundamentals of Nursing Practice Exam 2 (EM). Muscle weakness Depression ATI Quiz Fundamentals 1 Flashcards Quizlet ATI Nursing Fundamentals Practice 1 Flashcard reviewer University Gurnick Academy Course Vocational Nursing 120 (Sean220, VN 320) 94 Documents Academic year:2022/2023 Uploaded byAlec Afanes Helpful? apothecary system Calibrated in units not mL Teach patient and family about drug reactions and schedule Attitudes about medication use Risk for injury Pharmacist's Role, Interaction with other drugs Correct administration Waiting to consult a physical therapist is unnecessary. Which of the following is an example of nursing malpractice? What is comfort level (any pain?) Side rails are a reminder to a patient not to get out of bed Regulated by TJC & CMS (centers for medicare/medicaid services) Question 14Palpating the midclavicular line is the correct technique for assessingARespiratory rateBApical pulse CBaseline vital signsDSystolic blood pressureQuestion 14 Explanation: The apical pulse (the pulse at the apex of the heart) is located on the midclavicular line at the fourth, fifth, or sixth intercostal space. Infants and children Reusability Blood pressure is typically assessed at the antecubital fossa, and respiratory rate is assessed best by observing chest movement with each inspiration and expiration. Score The patient inserts the suppository 10 cm (4 inches) into the vaginal canal. Sitting Question 11Which of the following nursing interventions promotes patient safety?A All of the above 3. syrup Patients feel less anxious and isolated and more secure because they are allowed to participate in planning their own care. Side Effects After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. 5. D. Alzheimer;s disease, sometimes known as senile dementia of the Alzheimers type or primary degenerative dementia, is an insidious; progressive, irreversible, and degenerative disease of the brain whose etiology is still unknown. Date An apathetic 63-year old COPD patient receiving nasal oxygen via cannula. - Postural drainage Which of the following patients is at greatest risk for developing pressure ulcers? Which of the following nursing interventions would be appropriate? Which of the following would immediately alert the nurse that the patient has bleeding from the GI tract? - Protein binding Passive - The nurse moves the patient's joints The other answers are incorrect interpretations of the statistical data. APerson, environment, health, nursing BPerson, health, psychology, nursingCPerson, nursing, environment, medicineDPerson, health, nursing, support systemsQuestion 46 Explanation: The focus concepts that have been accepted by all theorists as the focus of nursing practice from the time of Florence Nightingale include the person receiving nursing care, his environment, his health on the health illness continuum, and the nursing actions necessary to meet his needs. Coordinated Body Movement Because the pedal pulse cannot be detected in 10% to 20% of the population, its absence is not necessarily a significant finding. 25. The other answers are incorrect interpretations of the statistical data. Written communication that does the same is considered libel. Ineffective individual coping related to COPD is wrong because the etiology for a nursing diagnosis should not be a medical diagnosis (COPD) and because no data indicate that the patient is coping ineffectively. Used to administer medications in small precise doses, 0.3-1 mL capacity She should notify the physician if the urine output is: Parkinsons disease is a neurologic disorder caused by lesions in the extrapyramidial system and manifested by tremors, muscle rigidity, hypokinesis, dysphagia, and dysphonia. Palpating the midclavicular line is the correct technique for assessing. always draw up medication with a filter needle, plastic or glass container with rubber seal, insert 5-15 degrees Establishing outcomes, Nursing Process in Med Admin: Thus, an axillary temperature of 99.6F (37.6C) would be considered abnormal. - Must be told what they need to do in order to have restraints removed If loading fails, click here to try again. However, the presence or absence of the pedal pulse should be documented upon admission so that changes can be identified during the hospital stay. If this activity does not load, try refreshing your browser. aka, NPH red or pink granulation tissue use one pharmacy to coordinate all medications. Nurse's role - Fragrance free zones, Medications A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. Right: genetic factors affecting medicine administration, cultural factors affecting medicine administration, Onset of medication action- starts to work, intramuscular (IM) Lateral 41. Decreased appetite Asses the patients ability to ambulate and transfer from a bed to a chair These include:ABeetsBCaffeine-containing drinks, such as coffee and cola.CKaolin with pectin (Kaopectate) DUrinary analgesicsQuestion 7 Explanation: Fluids containing caffeine have a diuretic effect. Allowing for rest periods decreases the possibility of hypoxia. The study of how medications enter the body, reach the site of action, metabolize and exit the body Thus, the 88-year old incontinent patient who has impaired nutrition (from gastric cancer) and is confined to bed is at greater risk. Base line vital signs include pulse rate, temperature, respiratory rate, and blood pressure. Lipid solubility of the medication (fat-soluble/water-soluble), (1) Enteric Coated - won't dissolve right away. use only for small volumes, toxic effects, idiosyncratic reactions, allergic reactions, tolerance and dependence, and interactions, wound dressing type- ulcer can be visualized, wound dressing that maintains moist environment, promotes healing and protects would by absorption, wound dressing: sheet or tube, keeps wound moist to aid in healing. Ineffective breathing patterns Check with the dyspnea scale Amyotrophic lateral sclerosis, a disease marked by progressive degeneration of the neurons, eventually results in atrophy of all the muscles; including those necessary for respiration.

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