BN4 The Nursing Process

Question 1

What term describes the act of listening for sounds within the body?

Answer 1

Auscultation

Question 2

What term describes information that you obtain through the use of the senses?

Answer 2

Cue

Question 3

What position is a patient in when lying on their back in the supine position, with the knee flexed, used for assessing the head, neck, anterior thorax, lungs, axillae, heart, abdomen and extremites?

Answer 3

Dorsal Recumbent

Question 4

What term describes judgement or interpretation based off cues?

Answer 4

Inference

Question 5

What is a technique used in physical examination to carefully and critically examine the body using the sense of sight?

Answer 5

Inspection

Question 6

What position is a patient in when lying supine with hips and knees flexed and the thighs abducted and rotated externally?

Answer 6

Lithotomy position

Question 7

What examination technique is being used when assessing texture, size, consistency and location of certain parts of the body with the hands?

Answer 7

Palpation

Question 8

What technique of physical exam consist of tapping the body with fingertips to evaluate the size, boarders and consistency of some internal organs and to discover the presence and evaluate the amount of fluid in a cavity of the body?

Answer 8

Percussion

Question 9

What term describes using the sense of small during a physical examination?

Answer 9

Olfaction

Question 10

What position is a patient in who is in a side lying position on either side, with the top leg flexed toward the abdomen?

Answer 10

Sim’s Position

Question 11

What occurs when the nursing process is done in order and with good communication?

Answer 11

Nursing care is organized and has a purpose, Nursing team members have the same goals for the patient, Patient feels safe and secure

Question 12

What are the five steps in the nursing process?

Answer 12

Assessment, nursing diagnosis, planning, implementation and evaluation

Question 13

What part of the nursing process is described by the deliberate and systematic collection of data to determine a patient’s current and past health status?

Answer 13

Assessment

Question 14

What term describes a clinical judgement about an individual, family or community response to actual and potential health problems and life processes?

Answer 14

Nursing diagnosis

Question 15

What is the difference between a nursing and a medical diagnosis?

Answer 15

Medical Dx describes a disease or condition, nursing Dx is formulated based on patients needs because of the medical Dx

Question 16

What is considered when developing a nursing Dx?

Answer 16

Physcial Needs
Emotional needs,
Social needs,
Spiritual needs

Question 17

In what part of the nursing process are diagnoses prioritized to meet the patients immediate needs?

Answer 17

Planning

Question 18

What part of the nursing process is performing or carrying out the nursing measures using interventions developed during planning?

Answer 18

Implementation

Question 19

What part of the nursing diagnosis would you determine whether the patient’s condition or well being has improved?

Answer 19

Evaluation

Question 20

What is a patient medial Hx used for?

Answer 20

Establish rapport, provide a focal point for the physical assessment, Aid in ordering appropriate tests, institute appropriate treatment

Question 21

What information should you obtain in the past medial Hx?

Answer 21

Allergies, Pertinent treatment, Hospitalizations, surgeries, Illnesses, risk factors, medications, alcohol or tobacco use, sleep hygiene, diet

Question 22

What does the examiner uses physical assessments for?

Answer 22

Gather baseline data regarding the patients health, Supplement, confirm, or refute previously gathered data, confirm and identify diagnosis, make clinical judgements about the patients health status, evaluate the physiological outcomes of care

Question 23

what are the basic guidelines when obtaining a medical Hx?

Answer 23

Maintain patient confidentiality, Prepare the environment, Conduct the interview

Question 24

What guideline for obtaining a medical hx are you following when you ask a patient “what brings you to see us today?”

Answer 24

Conduct the interview

Question 25

What information should you ask in environmental Hx?

Answer 25

Do you live alone? Do you have Transportation? What is your work environment?

Question 26

What questions should you ask when obtaining a psychosocial Hx?

Answer 26

Do you have a support system? How do you cope with stress?

Question 27

what piece of examination equipment assess automatic responses to a given stimulus?

Answer 27

Percussion/reflex hammer

Question 28

What can a mouth mirror be used for?

Answer 28

Reflects light, retracts tongue and tissue, protects oral mucosa from injury

Question 29

What can an Explorer be used for?

Answer 29

Detect breaks in the enamel, check severity of decay, locate popcorn husks, tooth pick fragments

Question 30

What dental instrument has a long blunt working end calibrated from one to ten mm and is used to check the periodontal pockets?

Answer 30

Peridontal probe

Question 31

What is a tweezer like instrument used to transport small items to and from the mouth?

Answer 31

Cotton Forceps

Question 32

What are the five basic skill involved in physical examination?

Answer 32

Inspection, palpation, percussion, auscultation, smell

Question 33

What part of the hands are best for feeling texture, moisture and shape?

Answer 33

Fingertips

Question 34

What part of the hands are best for feeling vibration?

Answer 34

Palmar

Question 35

What part of the hand is best for feeling temperature?

Answer 35

Back of the hand

Question 36

What should you allow your patient to do before examination?

Answer 36

allow them to relieve their bowel or bladder, provide collection cups if needed

Question 37

What can you do to help alleviate a patient’s anxiety about a physical exam?

Answer 37

Educate the patient on the procedures and the purpose of the examination. As you complete each body system give detailed explanation to the patient. convey open, receptive approach, allow and encourage questions