often includes undermining and or tunneling In the lateral position, the patient lies on his side. If loading fails, click here to try again. 29. 3. Reporting any changes in patient's status after medication administration, Which task would be most appropriate for the nurse to delegate to the nursing assistive personnel (NAP)? The family of an accident victim who has been declared brain-dead seems amenable to organ donation. Question 24Which of the following vascular system changes results from aging?AIncreased peripheral resistance of the blood vesselsBAll of the above CDecreased blood flowDIncreased work load of the left ventricleQuestion 24 Explanation: Aging decreases elasticity of the blood vessels, which leads to increased peripheral resistance and decreased blood flow. The greater the surface area of the object that is moved, the greater the friction. - Monitor side effects CThe nurse applies a hot water bottle or a heating pad to the abdomen of a patient with abdominal cramping.DThe nurse administers penicillin to a patient with a documented history of allergy to the drug. 5. to have the correct drug route and dose dispensed Abdominal cramping with hyperactive, high pitched tinkling bowel sounds can indicate a bowel obstruction. Protect your own body Which findings should be reported? The physician orders a platelet count to be performed on Mrs. Smith after breakfast. The most appropriate nursing order for a patient who develops dyspnea and shortness of breath would be, Administer oxygen by Venturi mask at 24%, as needed, Maintain the patient on strict bed rest at all times, Allow a 1 hour rest period between activities, Maintain the patient in an orthopneic position as needed. Fundamentals of Nursing Exam 2 Flashcards | Quizlet Inadequate tissue oxygenation at the cellular level Wrong 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. Nasal Sprays Total Questions on Quiz Question 2The absence of which pulse may not be a significant finding when a patient is admitted to the hospital?AFemoral BApicalCRadialDPedalQuestion 2 Explanation: Because the pedal pulse cannot be detected in 10% to 20% of the population, its absence is not necessarily a significant finding. The body of an organ donor is available for burial. Topical: anything you can put on the skin, to include patches After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. Question 41The nurse observes that Mr. Adams begins to have increased difficulty breathing. & drink, Impaired skin integrity disposable, prefilled, sterile, cartridge units, glass container with a constricted, pre-scored neck SKELETAL SYSTEM, Provides attachments for muscles and ligaments and the leverage necessary for movement: Things they like doing but can't High-pitched gurgles head over the right lower quadrant are: Use __________ mL of ________________ to deliver medications that have been crushed, dissolved, or powder removed from capsules- in Nasogastric tube. ASittingBTrendelenburg CStandingDGenupectoralQuestion 18 Explanation: During a Romberg test, which evaluates for sensory or cerebellar ataxia, the patient must stand with feet together and arms resting at the sidesfirst with eyes open, then with eyes closed. Define Assessment Collects comprehensive data pertinent to the patient's health and/or situation. Consequently, the nurse must observe for objective signs. - Fragrance free zones, Medications This information is documented and reported to the physician and the nursing supervisor. You got 50 minutes to finish the exam .Good luck! Question 13Before rigor mortis occurs, the nurse is responsible for:APlacing one pillow under the bodys head and shouldersBRemoving the bodys clothing and wrapping the body in a shroudCAllowing the body to relax normally DProviding a complete bath and dressing changeQuestion 13 Explanation: The nurse must place a pillow under the decreased persons head and shoulders to prevent blood from settling in the face and discoloring it. A prescribed amount of oxygen s needed for a patient with COPD to prevent: Cardiac arrest related to increased partial pressure of carbon dioxide in arterial blood (PaCO2), Inhibition of the respiratory hypoxic stimulus. Immobility, diaphoresis, and avoidance of deep breathing or coughing Trendelenburg 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. The normal activated partial thromboplastin time is 16 to 25 seconds and the normal prothrombin time is 12 to 15 seconds; these levels must remain within two to two and one half the normal levels. Maintain balance, posture, and body alignment Use technology Complete blood count Biotransformation occurs when enzymes detoxify, degrade, and remove active chemicals - interferes with blood supply to lower extremities due to intermittent claudication The nurse is responsible for giving the patient breakfast at the scheduled time. report descrepencies DO NOT USE these to describe skin: tears, tape burns, perineal dermatitis, maceration, or excoriation, Full thickness skin loss Elixirs Blood pressure is typically assessed at the antecubital fossa, and respiratory rate is assessed best by observing chest movement with each inspiration and expiration. Question 42The physician orders a platelet count to be performed on Mrs. Smith after breakfast. Fundamentals Exam 2 The nurse evaluates which laboratory values to assess a patient's potential for wound healing? Return Person, nursing, environment, medicine Sims Fundamentals Exam 2 Flashcards | Quizlet A. 2. When a patient develops dyspnea and shortness of breath, the orthopneic position encourages maximum chest expansion and keeps the abdominal organs from pressing against the diaphragm, thus improving ventilation. Fundamentals Of Nursing Exam #1 - Legal Aspects In Nursing Fatigue A patient who cannot care for himself at home Fundamentals of Nursing Exam 2 Term 1 / 79 What are the 4 purposes of a physical exam? What is a nurses responsibility concerning Humidity? A. Body surface area occlude nasolacrimal duct for 30-60 seconds if medication causes systematic effects, Warm drops by running water over the bottle The nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus. Administer medications following the rights An increased partial pressure of carbon dioxide in arterial blood (PACO2) would not initially result in cardiac arrest. Your hair is really pretty offers no consolation or alternatives to the patient. Now - give it now, without breaking neck to do so Infants and children A confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed. Muscle irritability Pressure ulcers are most likely to develop in patients with impaired mental status, mobility, activity level, nutrition, circulation and bladder or bowel control. 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. 21. Correct Set your dose History Intra articular - into a joint Goals and outcomes Consuit a physical therapist before allowing the patient to ambulate Question 18Which of the following is an example of nursing malpractice?AThe nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus.BThe nurse administers the wrong medication to a patient and the patient vomits. 4. Conversions between systems 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. When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to: Please wait while the activity loads. A. Which of the following is the most significant symptom of his disorder?AMuscle irritability BLethargyCIncreased pulse rate and blood pressureDMuscle weaknessQuestion 21 Explanation: Presenting symptoms of hypokalemia ( a serum potassium level below 3.5 mEq/liter) include muscle weakness, chronic fatigue, and cardiac dysrhythmias. -Reporting any changes in patient's status after medication administration bowel, 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950End Attempted Questions Wrong Question 29The family of an accident victim who has been declared brain-dead seems amenable to organ donation. women Potential Nursing Diagnosis for a patient that is immobile: Activity intolerance The patient voids before insertion. Altered neurovascular status to extremities (cyanosis, pallor, coldness of skin, tingling, pain, numbness) B. Question 49A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea, and severe abdominal pain. Supine Musculoskeletal Trauma C. Although a new head nurse should initially spend time observing the unit for its strengths and weakness, she should take action if a problem threatens patient safety. Tympanic percussion, measurement of abdominal girth, and inspection are methods of assessing the abdomen. 33. The need to move the feet apart to maintain this stance is an abnormal finding. Other symptoms include diminished memory, apathy, disinterest in appearance, withdrawal, and irritability. Circulatory overload due to hypervolemia Thus, a respiratory rate of 30 would be abnormal. For a rectal examination, the patient can be directed to assume which of the following positions? Question 11Which of the following nursing interventions promotes patient safety?A All of the above DANB RSH Domain II: Quality Assurance and Rad. All doneNeed more practice!Keep trying!Not bad!Good work!Perfect! Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative pain following abdominal surgery? Obtain baseline data (serves as baseline for comparison as the pt.'s health status changes) 2. - Normally for sleep apnea. Check to see that the patient is wearing his identification band 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. Documented on patient medical record, Movement of gases between air spaces and blood stream, Movement of blood into and out of the lungs to organs and tissues -To decrease the number of medication orders sustained release. Helps balance. Pull out clear insulin Anxiety will not cause an elevated temperature. dx of depression or anxiety Any items you have not completed will be marked incorrect. - Administer medication correctly The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. - Document! Before rigor mortis occurs, the nurse is responsible for: Nursing responsibilities for Mrs. Mitchell now include: Reporting an APTT above 45 seconds to the physician, Assessing the patient for signs and symptoms of frank and occult bleeding. If you leave this page, your progress will be lost. Toxic Effects Can you document that you gave a medication before you give it to the client? - Each hospital has its own policy tubing mgt, know it Enhanced by a wide base of support, What is Good Nursing Coordinated Body Movement, Must overcome an object's weight and be aware of it's center of gravity. Gait injection sites for local effects -Documenting patient's response to medication Insert needle at 90 angle 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 Nutrition Nclex Questions Quizlet Rate Your hair is really pretty offers no consolation or alternatives to the patient. Patients feel less anxious and isolated and more secure because they are allowed to participate in planning their own care. What are the 3 muscle signs for IM injections? 44. Exit alarms/pads when patient gets out of bed, When a patient is a danger to themselves or tp stop them from pulling out catheters and other medical devices I didnt get to the bad news yet Monitor the patient CFeverDSympathetic nervous system stimulationQuestion 45 Explanation: 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. Allowing the body to relax normally Metered dose Substance abuse ABG hold syringe steady while needle is in tissue The infant falls off the scale, suffering a skull fracture. PDF Fundamental Concept 3 Edition Nursing Test Answer Pdf Orthopnea intradermal Muscle weakness ..I didnt get to the bad news yet would be inappropriate at any time. Malpractice Antibiotics, healthy tissue A patient about to undergo abdominal inspection is best placed in which of the following positions? Bed rest and oxygen by Venturi mask at 24% would improve oxygenation of the tissues and cells but must be ordered by a physician. A. Rubbing patients back to facilitate relaxation B. measuring the patients blood pressure C. Assessing the patients educational needs related to discharge D. Administering prescribed medications to a patient Click the card to flip What is a nurses responsibility concerning Nutrition? Respondent superior Answers and Rationales Tympanic percussion, measurement of abdominal girth, and inspection are methods of assessing the abdomen. The nurse discusses the foods allowed on a 500-mg low sodium diet. Get Results instill drops holding dropper 1/2 inch above ear canal intravenous (IV), first time administration -"I will bring the medication back to your room once you return from the bathroom." Risk for infection The four main concepts common to nursing that appear in each of the current conceptual models are: 7. Childhood Reporting an APTT above 45 seconds to the physician Changes in laboratory values. Which finding contraindicates the use of a rectal suppository? Question Details - Splinting - hold a pillow or blanket against lower ribs to help ease pain The three elements necessary to establish a nursing malpractice are nursing error (administering penicillin to a patient with a documented allergy to the drug), injury (cerebral damage), and proximal cause (administering the penicillin caused the cerebral damage). Eupnca - Wrong medication, route, and time Ineffective airway clearance related to dry, hacking cough is incorrect because the cough is not the reason for the ineffective airway clearance. Press plunger down until reads zero I will be back to check on you." A. The patient should always feed himself Riboflavin - Must be told what they need to do in order to have restraints removed The most common psychogenic disorder among elderly person is: You have not finished your quiz. Base line vital signs include pulse rate, temperature, respiratory rate, and blood pressure. slough ATI Quiz Fundamentals 1 Flashcards Quizlet - Studocu After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. The nurse administers penicillin to a patient with a documented history of allergy to the drug. Calibrated in units not mL renal/hepatic disease establishing an effective nurse-patient relationship -reduce anxiety through therapeutic communication, teaching, and acceptance -remember that the patient has concerns and needs other medical ones -communicate with the patient as an individual -take time to learn about the patient being admitted -provide for the family participation in all 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 - Wheezing Fever, exercise, and sympathetic stimulation all increase the heart rate.Question 5If patient asks the nurse her opinion about a particular physicians and the nurse replies that the physician is incompetent, the nurse could be held liable for:AAssaultBSlanderCRespondent superior DLibelQuestion 5 Explanation: Oral communication that injures an individuals reputation is considered slander. gluteus medis and minimus muscles 4. Cotton ball to outermost part of ear canal is acceptable if prescriber orders-do not press into canal, remove after 15 minutes, instruct client to clear nose unless contraindicated Certain substances increase the amount of urine produced. Score - Osteogenesis imperfecta Ineffective airway clearance AC = before meals -"I will wait until noon, when you have more medication ordered, and will bring it back to you then. Organize. Continue administering oxygen by high humidity face mask, Perform chest physiotheraphy on a regular schedule, Encourage the patient to increase her fluid intake to 200 ml every 2 hours. Impaired mobility The nurses most important legal responsibility after a patients death in a hospital is: How to minimize discomfort with injections? Dosage calculations D. Studies have shown that patients and nurses both respond well to primary nursing care units. ** people in liver failure are at rate of liver failure b/c metabolism of meds is very poor, After metabolism, excretion occurs through 2. It involves professional misconduct, such as omission or commission of an act that a reasonable and prudent nurse would or would not do. - Inaccurate prescribing Your performance has been rated as %%RATING%% However, the familys concerns must be addressed before members are asked to sign a consent form. Reduced hemoglobin, carbon monoxide, anemia allowed an hour window of time apply to chest, back, upper arm, or legs. The most common psychogenic disorder among elderly person is: 46. - Bronchodialators Person, health, psychology, nursing Implementation, Patient and family teaching smallest gauge - Do the goals matter to the patient? She should notify the physician if the urine output is: Which of the following is the most common cause of dementia among elderly persons? It continuously delivers small amounts of insulin through an infusion line placed under the skin. 50. Allergies, medication, diet anterieor aspects of thighs - Hemothorax turn on machine and assure calibration Activity tolerance. You got 50 minutes to finish the exam .Good luck! 6. All of the above Thus, any act that a nurse performs on the patient against his will is considered assault and battery. Check vitals in response to the medication - Fractures. Clear Pathway to bathroom In this example, the standard of care was breached; a 3-month-old infant should never be left unattended on a scale. D. Hip fracture, the most common injury among elderly persons, usually results from osteoporosis. 64 ml in 2 hours 3. - acid-base imbalance, Oxygen carrying Capability Tachypnea is rapid respiration characterized by quick, shallow breaths. Administration of Meds: Right: genetic factors affecting medicine administration, cultural factors affecting medicine administration, Onset of medication action- starts to work, intramuscular (IM) Blood flow from the area of absorption (poor blood flow leads to decreased effectiveness) * Try to strategically plan how far walking by having a chair available nearby. Which findings should be reported?ATemperature and respiratory rate BRespiratory rate onlyCPulse rate and temperatureDTemperature onlyQuestion 8 Explanation: Under normal conditions, a healthy adult breathes in a smooth uninterrupted pattern 12 to 20 times a minute. Which findings should be reported?ATemperature onlyBRespiratory rate onlyCPulse rate and temperatureDTemperature and respiratory rate Question 35 Explanation: Under normal conditions, a healthy adult breathes in a smooth uninterrupted pattern 12 to 20 times a minute. Immobility, diaphoresis, and avoidance of deep breathing or coughing, Decreased blood pressure and heart rate and shallow respirations. 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. Which of the following vascular system changes results from aging? The most common injury among elderly persons is: people who are overly stressed may require insulin to regulate blood glucose for a short period of time. However, the familys concerns must be addressed before members are asked to sign a consent form. The nurse must place a pillow under the decreased persons head and shoulders to prevent blood from settling in the face and discoloring it. What are the factors that influence absorption? Using the data given below, find the largest permissible bending moment when the composite bar is bent about a horizontal axis. slough or eschar present in parts of the wound bed - This is sterile In Maslows hierarchy of physiologic needs, the human need of greatest priority is: 8. Pain related to immobilization of affected leg would be an appropriate nursing diagnosis for a patient with a leg fracture. Anxiety will not cause an elevated temperature. household system, When administering medications to older adults do what? polypharmacy Question 45All of the following can cause tachycardia except:AExerciseBParasympathetic nervous system stimulation Hypothermia is an abnormally low body temperature. Less than 2 mL total volume Verify calculations hold dropper 1/2 inch above nares Effects of medications After 1 week of hospitalization, Mr. Gray develops hypokalemia. Your hair is really pretty offers no consolation or alternatives to the patient. if visible cerumen or drainage remove with cotton-tipped applicator Correct Answer Which is the most appropriate response from the nurse? Notifying the coroner or medical examiner Thus, an axillary temperature of 99.6F (37.6C) would be considered abnormal. rich in blood supply and absorbed faster ice to site before injection - Specific prescribed amt. Inhalation: via the mouth or nasal passages (breathed in) The nurse could be charged with: Malpractice is defined as injurious or unprofessional actions that harm another. Ex: Dopamine at a low dose will improve renal perfusion. Inrapleural questions Battery is the unlawful touching of another person or the carrying out of threatened physical harm. Right to refuse (try to educate patient, document and notify provider) Arthritis - can patient get lid off container? eratic use, Higher level on inspiration and lower level on expiration and it increases 4% every liter, Continuous positive airway pressure None of the above The best response would be:AWhy are you crying? UNSTAGEABLE UNTIL SLOUGH/ESCHAR IS REMOVED The physician orders a platelet count to be performed on Mrs. Smith after breakfast. An increased partial pressure of carbon dioxide in arterial blood (PACO2) would not initially result in cardiac arrest. A disoriented or confused patient Right dose D. Because percussion and palpation can affect bowel motility and thus bowel sounds, they should follow auscultation in abdominal assessment. Attempted Questions Wrong 1 mL capacity apply prescribed number of inches over paper measuring guide Side rails should not be used BIneffective individual coping to COPD.CIneffective airway clearance related to dry, hacking cough.D Ineffective airway clearance related to thick, tenacious secretions.Question 22 Explanation: Thick, tenacious secretions, a dry, hacking cough, orthopnea, and shortness of breath are signs of ineffective airway clearance. The four main concepts common to nursing that appear in each of the current conceptual models are: The most appropriate nursing order for a patient who develops dyspnea and shortness of breath would be. Discourage the patient from walking in the hall for a few more days Ensuring the patients safety is the most essential action at this time. A patient about to undergo abdominal inspection is best placed in which of the following positions? Standing Fundamentals of Nursing EXAM 2 Flashcards | Quizlet do not massage, used to deposit medication into the loose connective tissue underlying the dermis Continue administering oxygen by high humidity face mask

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