Excelsior

Question 1

What are the 2 overriding AOC’s for the CPNE?

Answer 1

Plan of Care

Safe patient Care

Question 2

20 minute checks are specific to which AOC’s?

Answer 2

Fluid Management

Oxygen Management

Question 3

During medication administration (IVP) how much volume of flush should be used?

Answer 3

Will be listed on the MAR by the CE

Question 4

How far should a catheter be inserted for male and female?

Answer 4

Male: 5-7 inches
Female: 2-3 inches

Question 5

How much leeway is allowed when calculating drip medications?

Answer 5

+/- 5 drops/min

Question 6

Basic steps of IV meds

Answer 6

Aspirate for blood
Pre-flush
Med
Post flush

Question 7

What action should be taken when clinical alarms go off?

Answer 7

Notify assigned nurse or CE

Question 8

What consideration should be made with kids in cribs?

Answer 8

1. Keep within reach when side rail is down
2. In visual sight when side rail is down.
3. Secured to seat/high chair when out of bed
4. Do not leave unattended when out of bed

Question 9

What are the 5 different contours of the abdomen?

Answer 9

Concave, flat, convex/round, distended

Question 10

List 4 adult comfort interventions

Answer 10

1. Relaxation techniques
2. Distraction techniques
3. Heat or cold
4. Positioning

Question 11

List 3 pediatric comfort interventions

Answer 11

1. Swaddle
2. Pacifier
3. Comfort object

Question 12

How is breastfeeding volume measured?

Answer 12

Time on each breast

Question 13

Only have the prescribed amount of flush in the flush. What should you do with the waste?

Answer 13

Ask the CE if you can dispose in the trash.

Question 14

Is aspiration needed for IM injection?

Answer 14

No. Current evidence shows that aspiration can cause injury to the tissue.

Question 15

How much leeway is allowed when checking a pulse?

Answer 15

+/-5 for 2years up

+/- 10 for less than 2 years

Question 16

How much allowance is given when assessing blood pressure?

Answer 16

+/- 6

Question 17

Can medications be given at any time during the PCS?

Answer 17

No, medications will have a specific assigned time. Medications must be administered within 30 minutes of the assigned time and documented immediately after.

Question 18

When giving insulin, should you massage the area first?

Answer 18

No - apply gentle pressure after injection

Question 19

What are the 6 areas of assessment for the Morse Fall Scale?

Answer 19

1. History of falls within 3 months?
2. Secondary diagnosis?
3. Ambulatory aid?
4. IV/Heparin lock?
5. Gait/Transferring?
6. Mental status (to own ability)

Question 20

6 rights of medication administration

Answer 20

Person
Place
Time
Drug
Dose
Documentation

Question 21

Which AOC’s do not require pt. teaching?

Answer 21

Abdominal Assessment
Neurological assessment
Vitals

Question 22

When should the MAR be filled out?

Answer 22

Immediately after giving meds

Question 23

Which AOC’s require “20 min. checks”

Answer 23

Fluid Management

Oxygen Management

Question 24

What side of pt. Should you be on for catheter insertion?

Answer 24

Right Handed = right side

Question 25

How should cleansing be performed for catheter insertion?

Answer 25

3-step

Far labia
Near labia
Middle

Question 26

Drop rate formula

Answer 26

(Volume/time) X dripset = drips/min

Question 27

List 5 interventions for Skin Management

Answer 27

Reposition
Clean skin
Incontinence care
Pillow (to float heels)
Apply protective products