EXAM 3 Flashcards by Vanessa Wences

What is the mnemonic for fire safety?

R: rescue and remove all patients in immediate danger
A: activate the alarm. Always do this before attempting to extinguish even a minor fire
C: confine the fire by closing doors and windows and turning off oxygen and electrical equipment
E: extinguish the fire with an appropriate extinguisher

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How do you use a fire extinguisher?

P: Pull pin
A: Aim at base of fire
S: Squeeze handles
S: Sweep from side to side to coat area evenly

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Who are at risk for falls?

elderly, visually impaired, generalized weakness, urinary freq, balance issues (cerebral palsy, injury, multiple sclerosis), cognitive dysfxal, side effects of meds like hypotension and drowsiness

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What is the term used to describe a sudden surge of electrical activity in the brain. it can occur at any time due to epilepsy, fever, or a variety of medical problems?

seizure

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What are the seizure precautions we should take when caring for a clients?

rescue equipment at bedside - oxygen, oral airway, suction, rail pads, saline lock for IV access
rapid intervention for airway patency
remove items that could cause harm and are not needed for treatment
do not put anything in their mouth during seizure
assist with ambulation
clear the area, protect head, don’t restrain
to do if a patient is having a seizure
stay with client, call for help
maintain airway patency and suction PRN
administer meds
note duration, sequence, and type of movement
after, determine mental status and measure O2 sat and vitals

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A nurse manager is reviewing with nurses on the unit the care of a client who has had a seizure. Which of the following statements by a nurse requires further instruction?
A. “i will place the client on his side.”
B. “i will go to the nurses’ station for assistance.”
C.“i will administer his medications.”
D.“i will prepare to insert an airway.”

*NEVER LEAVE THE PATIENT

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A nurse observes smoke coming from under the door of the staff’s lounge. Which of the following actions is the nurse’s priority? 
A. extinguish the fire.
B. activate the fire alarm.
C. Move clients who are nearby.
D. Close all open doors on the unit.

*RACE; R=RESCUE

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A nurse is caring for a client who has a history of falls. Which of the following actions is the nurse’s priority?
A. Complete a fall risk assessment.
B. educate the client and family about risks.
C. eliminate safety hazards from the client’s environment.
D. Make sure the client uses assistive aids in his possession.

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A charge nurse is assigning rooms for the clients to be admitted to the unit. Which of the following clients should the nurse assign to the room closest to the nurses’ station?
A. a middle adult who is postoperative following a laparoscopic cholecystectomy
B. a middle adult who requires telemetry for a possible myocardial infarction
C. a young adult who is postoperative following an open reduction internal fixation of the ankle
D. an older adult who is postoperative following a below‐the‐knee amputation

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A couple who is caring for their aging parents are concerned about factors that put them at risk for falls. Which factors are most likely to contribute to an increase in falls in the elderly? (Select all that apply.)

Inadequate lighting
Throw rugs
Multiple medications
Doorway thresholds
Cords covered by carpets
Staircases with handrails

1,2,3,4,5

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The nursing assessment of an 80-year-old patient who demonstrates some confusion but no anxiety reveals that the patient is a risk because she continues to get out of bed without help despite frequent reminders. The initial nursing intervention to prevent falls for this patient is to:

Place a bed alarm device on the bed.
Place the patient in a belt restraint.
Provide one-on-one observation of the patient.
Apply wrist restraints.

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The nurse is caring for a patient who is having a seizure. Which of the following measures will protect the patient and the nurse from injury? (Select all that apply.)

If patient is standing, attempt to get him or her back in bed.
With patient on floor, clear surrounding area of furniture or equipment.
If possible, keep patient lying supine.
Do not restrain patient; hold limbs loosely if they are flailing.
Never force apart a patient’s clenched teeth.

2,4,5

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What is your role as a nurse during a fire? (Select all that apply.)

Help to evacuate patients
Shut off medical gases
Use a fire extinguisher
Single carry patients out
Direct ambulatory patients

1,2,3,5

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What are the prevention measure to take for patients with risk for falls?

Complete a fall-risk assessment
accessible call light within reach
fall-alerts (sign, arm band, code)
provide regular elimination
orient clients to room and adequate lighting
bed in low position and locked
non skid footwear
keep room and floor clean
keep assistive devices nearby

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Intact skin with an area of persistent, non blanchable redness, typically over a bony prominence, which may feel warm or cool to touch. The tissue is swollen and congested, with possible discomfort at the site. With darker skin tones, the ulcer may appear blue or purple.

Stage I Pressure Ulcer

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Partial-thickness skin loss involving the epidermis and the dermis. The ulcer is visible and superficial and may appear as an abrasion, blister, or shallow cavity. Edema persists, and the ulcer may become infected, possibly with pain and scant drainage.

Stage II Pressure Ulcer

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Full-thickness tissue loss with damage to or necrosis of subcutaneous tissue.
The ulcer may reach, but not extend through the fascia below. The ulcer appears as a deep crater with or without undermining of adjacent tissue and without exposed muscle or bone. Drainage and infection are common

Stage III Pressure Ulcer

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Full-thickness tissue loss with destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. There may be sinus tracts, deep pockets of infection, tunneling, undermining, eschar (black scab-like material), or slough (tan, yellow, or green scab-like material).

Stage IV Pressure Ulcer

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Ulcers whose stages cannot be determined because eschar or slough obscures the wound.

Unstageable Pressure Ulcer

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A nurse is caring for a client who has been sitting in a chair for 1 hr. Which of the following complications is the greatest risk to the client?
A. decreased subcutaneous fat 
B. Muscle atrophy
C. Pressure ulcer
D. Fecal impaction

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A nurse is caring for a client who is postoperative. Which of the following interventions should the nurse take to reduce the risk of thrombus development? (Select all that apply.)
A. instruct the client not to perform the Valsalva maneuver.
B.apply elastic stockings.
C. Review laboratory values for total protein level.
D. Place pillows under the client’s knees and lower extremities.
E. assist the client to change position often.

B, E

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A nurse is planning care for a client who is on bed rest. Which of the following interventions should the nurse plan to implement??
A. Encourage the client to perform antiembolic exercises every 2 hr.
B. instruct the client to cough and deep breathe every 4 hr.
C. Restrict the client’s fluid intake.
D. Reposition the client every 4 hr.

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A nurse is evaluating teaching on a client who has a new prescription for a sequential compression device. Which of the following client statements should indicate to the nurse the client understands the teaching?
A. “this device will keep me from getting sores on my skin.”
B. “this thing will keep the blood pumping through my leg.”
C.“With this thing on, my leg muscles won’t get weak.”
D.“this device is going to keep my joints in good shape

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A nurse is instructing a client, who has an injury of the left lower extremity, about the use of a cane. Which of the following instructions should the nurse include? (Select all that apply.)
A. Hold the cane on the right side.
B. Keep two points of support on the floor.
C. Place the cane 38 cm (15 in) in front of the feet before advancing.
D. after advancing the cane, move the weaker leg forward.
E. advance the stronger leg so that it aligns evenly with the cane.

A, B, D

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``` A nurse educator is reviewing the wound healing process with a group of nurses. the nurse educator should include in the information which of the following alterations for wound healing by secondary intention? (select all that apply.) A. stage III pressure ulcer B. sutured surgical incision C. casted bone fracture D. laceration sealed with adhesive E. open burn area ```

A, E

A client who had abdominal surgery 24 hr ago suddenly reports a pulling sensation and pain in his surgical incision. The nurse checks the surgical wound and finds it separated with viscera protruding. Which of the following actions should the nurse take? (select all that apply.) A. cover the area with saline‐soaked sterile dressings. B. apply an abdominal binder snugly around the abdomen. C. use sterile gauze to apply gentle pressure to the exposed tissues. D. Position the client supine with his hips and knees bent. E. offer the client a warm beverage, such as herbal tea.

A, D

A nurse is caring for an older adult client who is at risk for developing pressure ulcers. Which of the following interventions should the nurse use to help maintain the integrity of the client’s skin? (select all that apply.) A. Keep the head of the bed elevated 30°. B. Massage the client’s bony prominences frequently. C. apply cornstarch liberally to the skin after bathing. D. Have the client sit on a gel cushion when in a chair. E. reposition the client at least every 3 hr while in bed.

A, D

When repositioning an immobile patient, the nurse notices redness over the hip bone. What is indicated when a reddened area blanches on fingertip touch? 1. A local skin infection requiring antibiotics 2. Sensitive skin that requires special bed linen 3. A stage III pressure ulcer needing the appropriate dressing 4. Blanching hyperemia, indicating the attempt by the body to overcome the ischemic episode

Name the three important dimensions to consistently measure to determine wound healing.

Width, Length, Depth

Complications of immobility

- Bed rest influences mobility→ therapeutic, but also harmful - It can cause muscular deconditioning - Disuse atrophy - Physiological problems such as calcium release - Psychological problems such as dependence - Social isolation

Goals/outcomes for pts with immobility problems

Promoting venous return

What is the most therapeutic type of moist heat?

Sitz baths

``` A nurse is caring for an adolescent client who is 2 days postoperative following an appendectomy and has type I diabetes mellitus. The client is tolerating a regular diet. He has ambulated successfully around the unit with assistance. He requests pain medication every 6 to 8 hr while reporting pain at a 2 on a scale of 0 to 10 after receiving the medication. His incision is approximated and free of redness, with scant serous drainage on the dressing. the nurse should recognize that the client has which of the following risk factors for impaired wound healing? (select all that apply.) A. extremes in age B. Impaired circulation C. Impaired/suppressed immune system D. Malnutrition E. Poor wound care ```

B, C

Which of the following are physiological outcomes of immobility? 1. Increased metabolism 2. Reduced cardiac workload 3. Decreased lung expansion 4. Decreased oxygen demand

When obtaining a wound culture to determine the presence of a wound infection, from where should the specimen be taken? 1. Necrotic tissue 2. Wound drainage 3. Wound circumference 4. Cleansed wound

After surgery the patient with a closed abdominal wound reports a sudden “pop” after coughing. When the nurse examines the surgical wound site, the sutures are open, and pieces of small bowel are noted at the bottom of the now-opened wound. Which are the priority nursing interventions? (Select all that apply.) 1. Notify the surgeon. 2. Allow the area to be exposed to air until all drainage has stopped. 3. Place several cold packs over the area, protecting the skin around the wound 4. Cover the area with sterile, saline-soaked towels immediately. 5. Cover the area with sterile gauze and apply an abdominal binder.

1, 4

What is the correct sequence of steps when performing wound irrigation to a large open wound? 1. Use slow, continuous pressure to irrigate wound. 2. Attach 19-gauge angiocatheter to syringe. 3. Fill syringe with irrigation fluid. 4. Place waterproof bag near bed. 5. Position angiocatheter over wound.

4, 3, 2, 5, 1

Which of the following is an indication for a binder to be placed around a surgical patient with a new abdominal wound? (Select all that apply.) 1. Collection of wound drainage 2. Providing support to abdominal tissues when coughing or walking 3. Reduction of abdominal swelling 4. Reduction of stress on the abdominal incision 5. Stimulation of peristalsis (return of bowel function) from direct pressure

2, 4

When is an application of a warm compress to an ankle muscle sprain indicated? (Select all that apply.) 1. To relieve edema 2. To reduce shivering 3. To improve blood flow to an injured part 4. To protect bony prominences from pressure ulcers 5. To immobilize area

1, 3

removal of devitalized tissue from a wound is called?

debridement

Which of the following are measures to reduce tissue damage from shear? (Select all that apply.) 1. Use a transfer device (e.g., transfer board) 2. Have head of bed elevated when transferring patient 3. Have head of bed flat when repositioning patient 4. Raise head of bed 60 degrees when patient positioned supine 5. Raise head of bed 30 degrees when patient positioned supine

1, 3, 5

What does the Braden Scale evaluate? 1. Skin integrity at bony prominences, including any wounds 2. Risk factors that place the patient at risk for skin breakdown 3. The amount of repositioning that the patient can tolerate 4. The factors that place the patient at risk for poor healing

On assessing your patient's sacral pressure ulcer, you note that the tissue over the sacrum is dark, hard, and adherent to the wound edge. What is the correct category/stage for this patient's pressure ulcer? 1. Category/stage II 2. Category/stage IV 3. Unstageable 4. Suspected deep-tissue damage

Which of the following describes a hydrocolloid dressing?

A dressing that forms a gel that interacts with the wound surface

A patient has been on bed rest for over 4 days. On assessment, the nurse identifies the following as a sign associated with immobility: 1. Decreased peristalsis 2. Decreased heart rate 3. Increased blood pressure 4. Increased urinary output

An older-adult patient has been bedridden for 2 weeks. Which of the following complaints by the patient indicates to the nurse that he or she is developing a complication of immobility? 1. Loss of appetite 2. Gum soreness 3. Difficulty swallowing 4. Left ankle joint stiffness

The effects of immobility on the cardiac system include which of the following? (Select all that apply.) 1. Thrombus formation 2. Increased cardiac workload 3. Weak peripheral pulses 4. Irregular heartbeat 5. Orthostatic hypotension

1, 2, 5

To prevent complications of immobility, what would be the most effective activity on the first postoperative day for a patient who has had abdominal surgery? 1. Turn, cough, and deep breathe every 30 minutes while awake 2. Ambulate patient to chair in the hall 3. Passive range of motion 4 times a day 4. Immobility is not a concern the first postoperative day

How do you calculate cardiac output?

stroke volume x heart rate

``` A nurse is collecting data from a client who is 5 days postoperative following abdominal surgery. The surgeon suspects an incisional wound infection and has prescribed antibiotic therapy for the nurse to initiate after collecting wound and blood specimens for culture and sensitivity. Which of the following findings should the nurse expect? (select all that apply.) A. Increase in incisional pain B. Fever and chills C. Reddened wound edges D. Increase in serosanguineous drainage E. Decrease in thirst ```

A, B, C

the process of moving gases into and out of the lungs

Ventilation

the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs

Perfusion

exchange of respiratory gases in the alveoli and capillaries

Diffusion

chemical produced in the lungs, maintains surface tension of alveoli to prevent collapse

surfactant

collapse alveoli = poor exchange of O2 and CO2

Atelectasis

moves blood to and from the alveolar capillary membrane for gas exchange

pulmonary circulation

An accumulation of blood and fluid in the pleural cavity, which usually occurs due to trauma. A rupture of small blood vessels caused by inflammatory processes such as TB or pneumonia can cause hemothorax. It produces counter pressure and prevents the lung from full expansion. Signs and symptoms consist of dyspnea, pain, or shock.

Hemothorax

Collection of air in the pleural space. This is caused by loss of negative intrapleural pressure which causes the lung to collapse. Secondary pneumothorax is caused by trauma (stab, gunshot, rib fractures). Primary pneumothorax (spontaneous) is a genetic condition in which an individual develops blisters (blebs) on the visceral pleura

Pneumothorax

Occurs when there’s decreased blood flow or an injury to the brainstem. This consists of an abnormal respiratory pattern with periods of apnea (this is the absence of respirations longer than 15 seconds) followed by deep breathing then shallow breathing

Cheyne Strokes

This consists of increased breathing rates and depth (greater than 35 breaths/min). This occurs during metabolic acidosis, in which the acidic pH stimulates an increase in rate.

Kussmaul Respiration

What are the three primary alterations of the respiratory system?

hypoventilation, hyperventilation and hypoxia.

What does ABC stand for?

airway, breathing, circulation

For CPR, it has been changed to CAB. What does it stand for?

chest compression airway, breathing

Upon the nursing process, when inspecting the patient with respiratory alterations, what will you find?

observations of the nails for clubbing. Clubbed nails often occurs in patients with prolonged oxygen deficiency, endocarditis and congenital defects, kussmaul respiratory, cheyne stokes respiration, apnea

Upon palpation on a patient with respiratory alterations, what will you find?

tenderness tactile fremitus, thrills, heaves, and the cardiac point of maximal impulse. Palpation of the extremities provides data about the peripheral circulation( presence and quality of peripheral pulses, skin temp, color, and capillary refill)

When you percuss for respiratory alterations, you....

Detects the presence of abnormal fluid or air in the lungs. Also determines diaphragmatic excursion.

When you auscultate for respiratory alterations, you...

Auscultation of lung sounds involves listening for movement of air throughout all lung fields, anterior, posterior, and lateral, adventitious, or abnormal, breath sounds occur with collapse of lung segment, fluid in lung segment, or narrowing or obstruction of an airway

What are the nursing diagnosis for patients with respiratory alterations?

``` Activity Intolerance Decreased Cardiac Output Fatigue Impaired Gas Exchange Impaired Verbal Communication Ineffective Airway Clearance Ineffective Breathing Pattern Risk For Aspiration ```

What are some goals and outcomes for patients with respiratory alterations?

Patients lungs are clear to auscultation Patient achieves bilateral lung expansion Patient coughs productively Pulse oximetry (SpO2) is maintained or improved

What are the steps to glucose monitoring?

Select site= Outer edge; Alternate site (earlobe, heel, palm,arm, thigh) Wrap site in warm, moist towel to enhance circulation Cleanse site with warm water and soap or antiseptic swab (not alcohol) and allow to dry Hold finger in a dependent position Pierce ski using sterile lancet and hold perpendicular to skin Wipe away first drop of blood Place drop of blood on test strip

involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse; this method to improve exercise tolerance in patients with COPD, patients were able to demonstrate increases in their exercise tolerance, breathing pattern, and arterial oxygen saturation

Pursed-lip breathing

useful for patients with pulmonary disease, postoperative patients, and women in labor to promote relaxation and provide pain control. The exercise improves efficiency of breathing by decreasing air trapping; this exercise is often used with the pursed lip breathing technique

Diaphragmatic breathing

What is the normal cardiac output?

4-6 L/min in a healthy adult at rest

``` A nurse is caring for a client who is receiving enteral tube feedings due to dysphagia. Which of the following bed positions should the nurse use for safe care of this client? A. supine B. semi‐Fowler’s C. semi‐prone D. Trendelenburg ```

A nurse is caring for a client who is sitting in a chair and asks to return to bed. Which of the following actions is the nurse’s priority at this time? A. obtain a walker for the client to use to transfer back to bed. B. call for additional staff to assist with the transfer. C. Use a transfer belt and assist the client back into bed. D. Determine the client’s ability to help with the transfer

A nurse is completing discharge instructions for a client who has COPD. The nurse should identify that the client understands the orthopneic position when she states that she will do which of the following when she has difficulty breathing at night? A. lie on her back with her head and shoulders on a pillow. B. lie flat on her stomach with her head to one side. C. sit on the side of her bed and rest her arms over pillows on top of her bedside table. D. lie on her side with her weight on her hip and shoulder with her arm flexed in front of her.

A nurse manager is reviewing guidelines for preventing injury with staff nurses. Which of the following instructions should the nurse manager include? (select all that apply.) A. request assistance when repositioning a client. B. Avoid twisting your spine or bending at the waist. C. Keep your knees slightly lower than your hips when sitting for long periods of time. D. Use smooth movements when lifting and moving clients. E. Take a break from repetitive movements every 2 to 3 hr to flex and stretch your joints and muscles.

A, B, D

A nurse educator is reviewing proper body mechanics during employee orientation. Which of the following statements should the nurse identify as an indication that an attendee understands the teaching? (select all that apply.) A. “my line of gravity should outside my base of support.” B. “The lower my center of gravity, the more stability I have.” C.“To broaden my base of support, i should spread my feet apart.” D.“When I lift an object, I should hold it as close to my body as possible.” E. “When pulling an object, i should move my front foot forward

B, C, D

A nurse is providing discharge instructions to a client who has a prescription for oxygen use at home. Which of the following information should the nurse include about home oxygen safety? (Select all that apply.) A. family members who smoke must be at least 10 ft from the client when oxygen is in use. B. Nail polish should not be used near a client who is receiving oxygen. C. a “No Smoking” sign should be placed on the front door. D. Cotton bedding and clothing should be replaced with items made from wool. E. a fire extinguisher should be readily available in the home.

B, C, E ** D. WOOL IS FLAMMABLE

``` A nurse educator is presenting a module on basic first aid for newly licensed home health nurses. The nurse educator evaluates the teaching as effective when the newly licensed nurse states the client who has heat stroke will have which of the following? a. Hypotension B. Bradycardia C. Clammy skin D. Bradypnea ```

A nurse educator is conducting a parenting class for new parents of infants. Which of the following statements made by a participant indicates understanding of the instructions? A. “I will set my water heater at 130° F.” B. “once my baby can sit up, he should be safe in the bathtub.” C.“I will place my baby on his stomach to sleep.” D.“once my infant starts to push up, I will remove the mobile from over the crib.”

A home health nurse is discussing the dangers of carbon monoxide poisoning with a client. Which of the following information should the nurse include in her counseling? A. Carbon monoxide has a distinct odor. B. Water heaters should be inspected every 5 years. C. The lungs are damaged from carbon monoxide inhalation. D. Carbon monoxide binds with hemoglobin in the body.

A home health nurse is discussing the dangers of food poisoning with a client. Which of the following information should the nurse include in her counseling? (Select all that apply.) A. Most food poisoning is caused by a virus. B. Immunocompromised individuals are at risk for complications from food poisoning C. Clients who are at high risk should eat or drink only pasteurized dairy products. D. Healthy individuals usually recover from the illness in a few weeks. E. Handling raw and fresh food separately can prevent food poisoning

B, C, E

A patient is admitted with the diagnosis of severe left-sided heart failure. What adventitious lung sounds are expected on auscultation? 1. Sonorous wheezes in the left lower lung 2. Rhonchi mid sternum 3. Crackles only in apex of lungs 4. Inspiratory crackles in lung bases

A nurse is reviewing a client’s medication history. The client has an admission blood glucose of 260 mg/dl and no documented history of diabetes mellitus. Which of the following types of medications should alert the nurse to the possibility that the client has developed an adverse effect of pharmacological therapy? (Select all that apply.) A. Diuretics B. corticosteroids C. oral anticoagulants D. opioid analgesics E. Antipsychotics

A, B, E

Given to clients whom are unable to provide their own hygiene management; This should be done to patients whom can tolerate

complete bed baths

Used when patients cannot tolerate a complete bed bath. Given to patients who need particular cleaning of odorous areas, or for patients who can perform part of the bath independently.

partial bed baths

these act as treatments for patients with skin diseases, or who need perineal care due to catheterization or stoma

therapeutic bed baths

How to provide foot care?

inspect the feet daily and pay specific attention to the area in between toes. Luke warm water is used followed by drying. Moisturizer can be applied to feet but not in between the toes. No otc products that contain alcohol should be used. Clean cotton socks should be changed daily, Comfortable shoes that do not restrict blood flow should be worn. No heat should be applied unless prescribed.

How to provide nail care?

Nails should be cut straight across | Nails can also be filed. Inspect nails for cracking, cyanosis, fungus, or clubbing.

Describe an aerobic culture

grows with air

Describe an anaerobic culture

grows without air

What phase represents the electrical conduction through both atria

P wave

What phase represents the impulse travel time from the SA node through the AV node, through the Bundle of His, and to the Purkinje fibers

PR interval

What phase indicates that the electrical impulse traveled through the ventricles; an increase in duration indicates a delay in conduction time through the ventricles

QRS complex

What phase represents the time needed for ventricular depolarization and repolarization; shortening occurs with digitalis therapy, hyperkalemia, and hypercalcemia.

QT interval

1, 2, 5

What is the proper position to use for an unresponsive patient during oral care to prevent aspiration? (Select all that apply.) 1. Prone position 2. Sims' position 3. Semi-Fowler's position with head to side 4. Trendelenburg position 5. Supine position

2, 3

The student nurse is teaching a family member the importance of foot care for his or her mother, who has diabetes. Which safety precautions are important for the family member to know to prevent infection? (Select all that apply.) 1. Cut nails frequently. 2. Assess skin for redness, abrasions, and open areas daily. 3. Soak feet in water at least 10 minutes before nail care. 4. Apply lotion to feet daily. 5. Clean between toes after bathing.

2, 4, 5