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Nursing Foundations Lab > 106Lab Test Prep Exam 3 > Flashcards

106Lab Test Prep Exam 3 Flashcards

1
Q

What PPE is needed for contact precautions

A

gown and gloves

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2
Q

What PPE is needed for droplet precautions?

A

gown, gloves, surgical grade mask and face shield

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3
Q

What PPE is needed for airborne precautions?

A

gown, gloves and N95 mask

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4
Q

Give examples of illnesses requiring contact precautions

A

MRSA, CDIFF, lice, scabies

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4
Q

What PPE do visitors need to wear?

A

the same as nurse. gown and gloves only if providing direct care

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5
Q

Give examples of illnesses requiring droplet precautions

A

N meningitidis, mumps, pertussis, norovirus, vomiting, influenze, invasive Group A strepococcus

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6
Q

Give examples of illnesses requiring airborne precautions

A

Pulmonary tuberculosis, measles, chickenpox, disseminated Zoster, Corona Virus

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7
Q

What is the equipment needed for a nasal swab?

A

nasal swab, sterile water, nonsterile gloves, goggle and face mask, or face shield, addl PPE as indicated, biohazard bag, appropriate label for specimen

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8
Q

A nasal swab provides a sample of cells from the nostril that ________

A

can be cultured, which can aid in the detection of viruses and bacteria that cause respiratory infections, such as influenza, Covid-19, and RSV (respiratory syncytial virus)

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9
Q

A nasal swab can be part of the screening process to detect infection with _______

A

drug-resistant microorganisms such as MRSA and coronavirus

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10
Q

Pain may be classified according to its….

A

duration
localization/location
etiology

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11
Q

Acute pain

A

rapid in onset and varies in intensity from mild to severe - protective in nature - warns the person of tissue damage or organ disease and triggers autonomic responses such as increased heart rate, the fight-or-flight response, and increased blood pressure

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12
Q

Chronic pain

A

maladaptive pain that persists or is recurrent for more than 3 months

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13
Q

Chronic primary pain

A

the chronic pain itself is considered the disease - such as fibromyalgia or back pain

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14
Q

Cutaneous pain

A

superficial pain that usually involves the skin or subcutaneous tissue - paper cut

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15
Q

Visceral pain

A

splanchnic pain - poorly localized and originates in body organs in the thorax, cranium and abdomen

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16
Q

Somatic pain

A

diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves

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17
Q

Nociceptive pain

A

initiated by nociceptors that are activated by actual or threatened damage to nonneural tissue and is representative of the normal pain process

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17
Q

Referred pain

A

pain can originate in one part of the body but be perceived in an area distant from its point of origin

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18
Q

Nociceptors

A

the peripheral somatosensory nerve fibers that transduce and encode noxious stimuli

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19
Q

Neuropathic pain

A

pain caused by a lesion or disease of the peripheral or central somatosensory nervous system

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20
Q

Nociplastic pain

A

pain that is not classified as nociceptive or neuropathic in nature

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21
Q

What are the 3 levels of severity of pain?

A

Severe or excruciating
Moderate
Slight or mild

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21
Q

Intractable pain

A

pain that is resistant to therapy and persists despite a variety of interventions

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22
Phantom pain
phantom limb pain - receptors and nerves are clearly absent yet pain occurs as a real experience for the patient
23
Common responses to pain
Behavioral (voluntary) responses Physiologic (involuntary) responses Affective (psychological) responses
24
What are the 4 main qualities of pain?
sharp, dull, diffuse, shifting
25
Nurse's responsibility when assessing vital signs
ensure the accuracy of data, interpret vital sign findings, report abnormal findings, follow principles of delegation, validate abnormal findings and further assess the patient
25
What are the periodicities of pain?
continuous, intermittent, brief or transient
26
What are the respiratory signs of distress?
breathing rate, color changes, grunting, nose flaring, retractions, sweating, wheezing, body positions, Levine's sign, shortness of breath or unexplained wheezing, pain, weakness or lightheadedness, nausea or vomiting, papitations (heart racing, fluttering or skipping)
27
Normal temperature range
96.4-99.5 F / 35.8-37.5 C
28
Normal heart rate/pulse
60-100 bpm
29
Normal blood pressure
120/80
29
Normal respirations
12-20 breaths/min
30
Normal pulse oximetry / O2
95-100 %
31
Sites for measuring core temperatures
Tympanic and rectal Esophagus and pulmonary (invasive monitoring devices)
32
3 methods to assess pulse
Palpating the peripheral arteries Auscultating the apical pulse with a stethoscope Using a portable Doppler ultrasound
33
Sites for measuring surface body temperatures
Oral (sublingual) Axillary
34
What is the pattern of the pulsations and the pauses between them called?
pulse rhythm
35
What is the quality of the pulse called?
pulse amplitude
36
Common pulse sites
`Temporal, Carotid, Brachial, Radial, Ulnar, Femoral, Popliteal, Posterior tibial, Dorsalis pedis
37
Pulse Scale
0 - pulse is absent 1 - diminished 2 - normal 3 - full 4 - bounding/strong
37
What is the most reliable method to get pulse in children less than two years of age?
apical pulse
38
What is orthopnea?
breathing more easily in an upright position
39
What is tachypnea?
Rapid respirations
40
Blood pressure is measured in ___
mm of Hg
41
What is blood pressure?
The force of blood against the arterial walls
42
L + OPQRST
Location plus Onset Provacative/Palliative Quality Radiation Severity Timing
43
What are Karotkoff sounds?
The sounds the blood pressure makes using a stethoscope and sphygmomanometer
44
Pain assessment scale 0-10
0 - none 1-3 mild 4-6 moderate 7-10 severe
45
Radiating pain
radicular pain - starts in one place but travels to another, usually along the path of a nerve - sciatica
46
Referred pain
reflective pain - pain that is felt in a different part of the body than where the stimulus is actually coming from
47
Physical assessment techniques
Inspection, palpation, percussion, auscultation
48
Characteristics of sound
Pitch: low to high Loudness: soft to loud Quality: gurgling or swishing Duration: short, medium, or long
49
S1
first heart sound - closing of the mitral and tricuspid valves - clinically corresponds to the pulse
49
S2
second heart sound - closure of the semilunar (aortic and pulmonary) valves
50
A/O x4
Alert and Orientated to person, place, time, and situation
51
S4
fourth heart sound - atrial gallop - occurs just before s1 when the atria contract to force blood into the left ventricle
51
S3
third heart sound - ventricular gallop - occurs just after s2 when the mitral valve opens, allowing passive filling of the left ventricle
52
In what order do we examine the abdomen
inspect -- auscultate -- percuss -- palpate
53
bowel sound
absent - must listen for at least 5 minutes Hypoactive - one bower sound every 3-5 minutes Normoactive - Gurgles 5-30 times per minute Hyperactive - constant bowel sounds >30 sounds per minute
53
The sensation of pain and/or burning, stinging, or itching of the urethra or urethral meatus associated with urination
Dysuria
54
When auscilating the abdomen, where do you start?
Right Lower Quadrant (RLQ) and clockwise from there
55
Dorsiflexion and plantar flexion
Dorsiflexion - toe up towards sky plantar flexion - foot stretched out straight in line with leg
56
What are the two types of nasal swabs?
nasopharyngeal mid-turbinate

Nursing Foundations Lab (9 decks)

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