Risk for injury subcutaneous (subcut) The nurse must place a pillow under the decreased persons head and shoulders to prevent blood from settling in the face and discoloring it. Fundamentals of Nursing Practice Exam 2 (PM) 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 physician orders a platelet count to be performed on Mrs. Smith after breakfast. Nurse safety - 2nd priority - Patient must be checked every 15 minutes Lungs - alcohol, nitrous oxide Question 27Examples of patients suffering from impaired awareness include all of the following except:AA patient who cannot care for himself at homeBA semiconscious or over fatigued patientCA patient demonstrating symptoms of drugs or alcohol withdrawal DA disoriented or confused patientQuestion 27 Explanation: A patient who cannot care for himself at home does not necessarily have impaired awareness; he may simply have some degree of immobility. rotate sites, Position cotton ball or tissue with non-dominant hand on cheekbone just below lower lid If you're administering more than one medication into the NG tube, what do you do? Hypothermia is an abnormally low body temperature. Thus, any act that a nurse performs on the patient against his will is considered assault and battery. Sims APerson, nursing, environment, medicineBPerson, environment, health, nursing CPerson, health, nursing, support systemsDPerson, health, psychology, nursingQuestion 44 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. Nausea I didnt get to the bad news yetDI know this will be difficult for you, but your hair will grow back after the completion of chemotheraphy Question 14 Explanation: I know this will be difficult acknowledges the problem and suggests a resolution to it. 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. A negative nitrogen balance is present when catabolic states exist. Sometimes based on weight or body surface area. - interferes with blood supply to lower extremities due to intermittent claudication An apathetic 63-year old COPD patient receiving nasal oxygen via cannula. Eupnea is normal respiration quiet, rhythmic, and without effort. The nurse documents this breathing as: I didnt get to the bad news yet Nutrition Beets and urinary analgesics, such as pyridium, can color urine red. Discourage the patient from walking in the hall for a few more days An additional Vitamin C is required during all of the following periods except: Additional Vitamin C is needed in growth periods, such as infancy and childhood, and during pregnancy to supply demands for fetal growth and maternal tissues. 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. 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. The best response would be: Why are you crying? These changes, in turn, increase the work load of the left ventricle. The nurse administers the wrong medication to a patient and the patient vomits. hold it displaced until after needle is removed. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Its only temporary If nurse administers an injection to a patient who refuses that injection, she has committed: 12. Establishing outcomes, Nursing Process in Med Admin: Bed rest and oxygen by Venturi mask at 24% would improve oxygenation of the tissues and cells but must be ordered by a physician. What should she do? Ex: Dilaudid mixed with DW will go through a physical change, at one dose do one thing and at another dose do another thing that is better or harmful Hypothermia 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. -Prepare the medication for administration. women Right to refuse (try to educate patient, document and notify provider) Knowledge deficit - spine is flexed, lacks curves that adult has Question 16When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to:AInsert an airwayBWithdraw all pain medications CProtect the patient from injuryDElevate the head of the bedQuestion 16 Explanation: Ensuring the patients safety is the most essential action at this time. 3 yrs Current condition hold position for 5 minutes Intraperiteneal What is the name of the compound with the formula BaCl2_22? Risk for impaired skin integrity, Nursing process: Planning for a patient that is immobile, Goals and outcomes She is required to bathe only soiled areas of the body since the mortician will wash the entire body. - physician must see and assess the patient every 24 hours and write a new order Reported to provider at time of test D. 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. Anaphalaxsis Congratulations - you have completed Fundamentals of Nursing Practice Exam 2 (PM). 4. Allowing the body to relax normally Discourage them from making a decision until their grief has eased Examples of patients suffering from impaired awareness include all of the following except: Results Blood pressure is typically assessed at the antecubital fossa, and respiratory rate is assessed best by observing chest movement with each inspiration and expiration. Consuit a physical therapist before allowing the patient to ambulate. 21. Pulse rate and temperature Practice Mode - Patient and family education, 1. Young adulthood 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. Pregnancy Ensuring that the attending physician issues the death certification 2. communicate with patient/ family 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 Correct -Wait 30 to 60 minutes after feeding to reconnect to suctioning. - Suction this first, NonInvasive Maintenance and Promotion of Lung Expansion, Positioning Question 45An additional Vitamin C is required during all of the following periods except:AInfancyBPregnancy CChildhoodDYoung adulthoodQuestion 45 Explanation: Additional Vitamin C is needed in growth periods, such as infancy and childhood, and during pregnancy to supply demands for fetal growth and maternal tissues. Ingestion 16. The patient inserts the suppository 10 cm (4 inches) into the vaginal canal. 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. Anxiety Which of the following vascular system changes results from aging? Choose the letter of the correct answer. - anxiety attacks/pain/fear use lancet to perform stick List Hyperventilation Learning needs A. Because the pedal pulse cannot be detected in 10% to 20% of the population, its absence is not necessarily a significant finding. Reviewing daily activated partial thromboplastin time (APTT) and prothrombin time. However, the familys concerns must be addressed before members are asked to sign a consent form. Which of the following patients is at greatest risk for developing pressure ulcers? minutes Defamation Question 19To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures his hourly urine output. Draw out cloudy insulin Verify calculations I didnt get to the bad news yet, I know this will be difficult for you, but your hair will grow back after the completion of chemotheraphy. The patient experiences an allergic reaction and has cerebral damage resulting from anoxia. Aging Planning Less than 2 mL total volume Thus, an axillary temperature of 99.6F (37.6C) would be considered abnormal. Mrs. Lim begins to cry as the nurse discusses hair loss. A sign of decreased bowel motility Allow a 1 hour rest period between activities people who are overly stressed may require insulin to regulate blood glucose for a short period of time. Ineffective airway clearance related to dry, hacking cough. The body of an organ donor is available for burial. CAutonomy and authority for planning are best delegated to a nurse who knows the patient wellDAccountability is clearest when one nurse is responsible for the overall plan and its implementation.Question 36 Explanation: Studies have shown that patients and nurses both respond well to primary nursing care units. The nurse's role is provide the safest and highest standard of care possible for the patient. Your score is Cigarette smoking - Dialogue on how to quit Body Balance Fundamentals of Nursing (NUR100) Basic Accounting (Bus 1102) ATI Medical-Surgical (101) Trending The United States Supreme Court (POLUA333) Health Assessment (NUR 2092) Federal Taxation I (ACC330) Education Foundations (D097) Communication As Critical Inquiry (COM 110) Transition To The Nursing Profession (NR-103) pharmacology (pharm201) Sitting Know interactions/ compatibilities An appropriate nursing diagnosis would be: Ineffective airway clearance related to thick, tenacious secretions. Which of the following is the most common cause of dementia among elderly persons? access to download your test bank fundamentals of nursing practice test questions final exam web answered 0 of 0 questions 1 when it comes to client education . Toxic Effects The nurse observes that Mr. Adams begins to have increased difficulty breathing. Ex: Dopamine at a low dose will improve renal perfusion. Chronic pain - Exposure to second hand smoke b. Household measurements Decreased blood flow Management: maintain clean and moist wound environment and minimize damage to healing tissue, removed drainage from the wound with slight vacuum To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures his hourly urine output. Question 6Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative pain following abdominal surgery?ADecreased blood pressure and heart rate and shallow respirationsBImmobility, diaphoresis, and avoidance of deep breathing or coughingCQuiet cryingDChanging position every 2 hours Question 6 Explanation: An Asian patient is likely to hide his pain. 8. [irp] Nclex Rn 31 Flashcards Quizlet. Orotracheal and nasotracheal Allowing for rest periods decreases the possibility of hypoxia. Fever, exercise, and sympathetic stimulation all increase the heart rate. However, the familys concerns must be addressed before members are asked to sign a consent form. Question Text Acute pain, Nursing Process: Planning for patients with low oxygenation. oxygen therapy, Machines vary from facility to facility, wash hands All of the above - slow reaction time & dull the senses Standing - Pursed lip breathing to slow down breathing rate 11. desiccated tissue 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. 23. - Musculoskeletal abnormality,- paralysis may take away respiratory drive - Specific prescribed amt. Mashed potatoes and broiled chicken Hypothermia is an abnormally low body temperature. Correct Answer Click the card to flip Definition 1 / 79 1. The nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus. 11. She elevates the head of the bed to the high Fowler position, which decreases his respiratory distress. Membrane permeability 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. position-supine hand hygiene before handling equipment. Question 30An additional Vitamin C is required during all of the following periods except:APregnancy BInfancyCYoung adulthoodDChildhoodQuestion 30 Explanation: Additional Vitamin C is needed in growth periods, such as infancy and childhood, and during pregnancy to supply demands for fetal growth and maternal tissues. In Maslows hierarchy of physiologic needs, the human need of greatest priority is: What is a nurses responsibility concerning Nutrition? Assessing for distention, tenderness and discoloration around the umbilicus can indicate various bowel-related conditions, such as cholecystitis, appendicitis and peritonitis. Elimination Defines the scope of nurses' professional functions and responsibilities. abdomen from costal margins to the iliac crests Impaired mobility Final Score on Quiz 4. Thick, tenacious secretions, a dry, hacking cough, orthopnea, and shortness of breath are signs of ineffective airway clearance. D. 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. 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. Because transplants are done within hours of death, decisions about organ donation must be made as soon as possible. Mobility: - Pneumococcal for those over 65 or with chronic illnesses Question 49A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea, and severe abdominal pain. There are 50 questions to complete. 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. Riboflavin Consuit a physical therapist before allowing the patient to ambulate All of the following can cause tachycardia except: - Inaccurate prescribing Potential Nursing Diagnosis for a patient that is immobile: Activity intolerance Question 48High-pitched gurgles head over the right lower quadrant are:AA sign of decreased bowel motilityBNormal bowel soundsCA sign of abdominal cramping DA sign of increased bowel motilityQuestion 48 Explanation: Hyperactive sounds indicate increased bowel motility; two or three sounds per minute indicate decreased bowel motility. Documentation, Expected vs. actual response 20. All doneNeed more practice!Keep trying!Not bad!Good work!Perfect! wash hands, Daily record taken to provider Question 1Examples of patients suffering from impaired awareness include all of the following except:AA patient who cannot care for himself at homeBA patient demonstrating symptoms of drugs or alcohol withdrawal CA semiconscious or over fatigued patientDA disoriented or confused patientQuestion 1 Explanation: A patient who cannot care for himself at home does not necessarily have impaired awareness; he may simply have some degree of immobility. After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. Don't require refrigeration Who can prescribe? Fundamentals Exam 2 The nurse evaluates which laboratory values to assess a patient's potential for wound healing? B. Lateral In the horizontal recumbent position, the patient lies on his back with legs extended and hips rotated outward. Question 16If 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:ASlanderBLibelCAssaultDRespondent superior Question 16 Explanation: Oral communication that injures an individuals reputation is considered slander. Written communication that does the same is considered libel. Question 31 Explanation: Assisting a patient with ambulation and transfer from a bed to a chair allows the nurse to evaluate the patients ability to carry out these functions safely. The four main concepts common to nursing that appear in each of the current conceptual models are: 7. In the prone position, the patient lies on his abdomen with his face turned to the side. 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. minimize muscle tension The nurse documents this breathing as:ATachypneaBEupncaCOrthopneaDHyperventilation Question 41 Explanation: Orthopnea is difficulty of breathing except in the upright position. If you withhold a medication what do you do? calibrated to 1/100 mL Administer oxygen by Venturi mask at 24%, as needed ARateBAll of the above CSymmetryDRhythmQuestion 26 Explanation: The quality and efficiency of the respiratory process can be determined by appraising the rate, rhythm, depth, ease, sound, and symmetry of respirations. -Contact the manager or supervisor of the area where the error occurred. ASittingBTrendelenburg CStandingDGenupectoralQuestion 47 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. Body alignment: Conversions between systems Adverse Effects Keep it simple - Pain The best response would be:ADont worry. smallest gauge The physician orders a maintenance dose of 5,000 units of subcutaneous heparin (an anticoagulant) daily. questions Hypothermia is an abnormally low body temperature. which muscle should you not use for IM injections? This information is documented and reported to the physician and the nursing supervisor. Dependent edema, Activity intolerance- quality of life? Apical pulse withdraw needle smoothly at same angle as insertion Abdominal girth is unrelated to blood loss. Side Effects 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. Thus, any act that a nurse performs on the patient against his will is considered assault and battery. Immobility, diaphoresis, and avoidance of deep breathing or coughing The nurse administers penicillin to a patient with a documented history of allergy to the drug. gangrenous lesions outer aspect of upper arms Written communication that does the same is considered libel. Which is the most appropriate response from the nurse? use diversion 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. Sleep disturbances, inability to concentrate and decreased appetite are symptoms of depression, the most common psychogenic disorder among elderly persons. Patients should begin ambulation as soon as possible after surgery to decrease complications and to regain strength and confidence. Congratulations - you have completed Fundamentals of Nursing Practice Exam 2 (EM). Chest x-ray In Sims position, the patient lies on his left side with the left arm behind the body and his right leg flexed. The combined effects of inadequate food intake and prolonged diarrhea can deplete the potassium stores of a patient with GI problems. Question 11Which of the following nursing interventions promotes patient safety?A All of the above No-interruption zones How do your prioritize if patient misses two doses of meds due to a long procedure? Dont worry.. offers some relief but doesnt recognize the patients feelings. -"It will take only a minute to swallow the medication before you go to the bathroom." Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative pain following abdominal surgery? Any items you have not completed will be marked incorrect. 3. What is causing the quick breathing Shaded items are complete. Nursing Fundamentals Final Exam; Nursing Fundamentals oxygenation; Nursing Fundamentals Quiz; Preview text. She elevates the head of the bed to the high Fowler position, which decreases his respiratory distress. Fundamentals of Nursing Quiz Question with Answer 1. The correct sequence for assessing the abdomen is: 18. Eye clear Shiny hair Ridged nails Moist conjunctiva 2. The nurse contacts the prescriber and receives a STAT telephone order for a medication. B. In Sims position, the patient lies on his left side with the left arm behind the body and his right leg flexed. CBC - infection? A patient has exacerbation of chronic obstructive pulmonary disease (COPD) manifested by shortness of breath; orthopnea: thick, tenacious secretions; and a dry hacking cough. Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams), NCLEX Practice Exam for Blood Transfusion, The patient will find pureed or soft foods, such as custards, easier to swallow than water, Fowlers or semi Fowlers position reduces the risk of aspiration during swallowing. They also seem to gain a greater sense of achievement and esprit de corps. Providing a complete bath and dressing change aqueous solution If a patients blood pressure is 150/96, his pulse pressure is: Mitchell has been given a copy of her diet. to administer medications safely and identify problems with the system Dont worry.. offers some relief but doesnt recognize the patients feelings. The supine position (also called the dorsal position), in which the patient lies on his back with his face upward, allows for easy access to the abdomen. 43. After 1 week of hospitalization, Mr. Gray develops hypokalemia. inventory record Goals and outcomes - Assess ability for patient self medication Changes in vital signs may be cause by factors other than blood loss. 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 The body of an organ donor is available for burial. Effects of medications Exam 1 Fundamentals Of Nursing Flashcards Quizlet. Tachypnea Kaopectate is an anti diarrheal medication. Question 6Mrs. trade or brand name - what company will market by, What does classification mean and list some, The effect that the drug has on the body! Right medication The nurse administers penicillin to a patient with a documented history of allergy to the drug. AWriting the order for this testBAll of the above CInstructing the patient about this diagnostic testDGiving the patient breakfastQuestion 42 Explanation: A platelet count evaluates the number of platelets in the circulating blood volume. Don't use needles if needleness alternatives are available She is required to bathe only soiled areas of the body since the mortician will wash the entire body. Which findings should be reported? -"That's fine, please take it the minute you get back from the restroom. Person, nursing, environment, medicine A) Instruction was done at the bedside by a physician in the U.S. B)Curriculum in American schools was more standardized C)Student nurses in the U.S. worked for minimum wage D)The nightingale program was less organized A) Instruction was done at the bedside by a physician in the U.S. 2/8 Fundamentals of Nursing Ch. - acid-base imbalance, Increase in respiratory rate 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. You Selected These muscles can work with the so-called agonists or prime movers which surround a joint, or the antagonistic muscles, which move in the opposite direction The patient experiences an allergic reaction and has cerebral damage resulting from anoxia.Question 18 Explanation: 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). Other conditions requiring extra vitamin C include wound healing, fever, infection and stress. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. -Contact the pharmacy to have the medication sent to the nursing unit STAT. Organize. Correct Battery is the unlawful touching of another person or the carrying out of threatened physical harm. Which of the following is an example of nursing malpractice? management: debridement. 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. What is Friction in Nursing Body Mechanics? . The physician orders a maintenance dose of 5,000 units of subcutaneous heparin (an anticoagulant) daily. 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. Environmental modifications -Rectal bleeding Question 29The family of an accident victim who has been declared brain-dead seems amenable to organ donation. Cuts report all injuries immediately D. All of these positions are appropriate for a rectal examination. very young and very old to have the correct drug route and dose dispensed Applying a hot water bottle or heating pad to a patient without a physicians order does not include the three required components. Maintain balance, posture, and body alignment 39. Which of the following is the most common cause of dementia among elderly persons? Nurse is responsible for following legal provisions for administering opioids which are carefully controlled through federal and state guidelines, overuse, & drink, Impaired skin integrity Correct body alignment reduces strain on musculoskeletal structures, maintains muscle tone, and contributes to balance. Tympanic percussion, measurement of abdominal girth, and inspection are methods of assessing the abdomen. Nursing responsibilities for Mrs. Mitchell now include:AReporting an APTT above 45 seconds to the physicianBAssessing the patient for signs and symptoms of frank and occult bleedingCAll of the above DReviewing daily activated partial thromboplastin time (APTT) and prothrombin time.Question 3 Explanation: All of the identified nursing responsibilities are pertinent when a patient is receiving heparin. Checking the patients identification band verifies the patients identity and prevents identification mistakes in drug administration. What should she do?ADiscuss the problem with her supervisorBComplain to her fellow nursesCInform the staff that they must volunteer to rotate DWait until she knows more about the unitQuestion 28 Explanation: 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. The other answers are diseases that can occur in the elderly from physiologic changes. You got 50 minutes to finish the exam .Good luck! Safety light Explain in detailed medical terms - Each hospital has its own policy tubing mgt, know it Auscultation, percussion, and palpation Hint Insert needle at 90 angle Ability of the medication to dissolve - Sublingual: under the tongue 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.

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