Final

Question 1

1. What factors must the psychiatric nurse consider when evaluating the patient’s ability to mobilize?

Answer 1

Body alignment/posture
Gait
Activity tolerance
Motor strength/control
Level of assistance
Use of mobility aids
Baseline
Assess cooperation, behavior, current medical status, pain & comfort, and vital signs

Question 2

2. What is the difference between passive and active range of motion exercises?

Answer 2

Active: pt able to move all joints thru ROM unassisted
Passive: pt unable to move independently
Nurse moves joints thru ROM
(can be restricted or limited)

Question 3

4. What safety issues are present for the nurse and the patient when ambulating, positioning, and/or transferring patients?

Answer 3

When transferring and mobilizing clients:
Fall risks
Injury
Fatigue

Question 4

5. What are safety issues related to the use of hydraulic and ceiling lifts?

Answer 4

Proper use of equipment
Is it within your scope of practice?
Client safety/concern
Correct application

Question 5

6. What assistive devices can the psychiatric nurse utilize to make lifting, transferring, and moving patients safer and easier?

Answer 5

Transfer sheet
Transfer/gait belt
Equipment aids (wheelchair, walker, cane, etc)
Health care providers/caregivers
Mechanical lifts (not in scope of practice)
Slider board
`

Question 6

7. What is important to consider when repositioning a patient in bed? When would you reposition a patient in bed?

Answer 6

Risk factors: paralysis, impaired mobility, impaired circulation, age, sensation, LOC, condition of skin
Eating

Question 7

8. What is important to consider when transferring a patient to and from bed to chair/wheelchair/toilet?

Answer 7

Age, sensory-perception alteration, cognitive impairment (LOC), poly-pharmacology, urinary incontinence, ability to communicate, lack of safety awareness, environmental factors

Question 8

1. When should a psychiatric nurse assess a patient’s risk for falls? What are specific risk factors that increase a patient’s risk for falls?

Answer 8

-hx of previous falls
-gait disturbance
-balance/mobility issues
-postural hypotension
-meds
-urinary incontinence
-cognitive impairment
-communication
-safety awareness
-environ hazards
-age
-polypharmacy

Question 9

2. What nursing interventions would a psychiatric nurse implement to reduce the risk for falls?

Answer 9

Rapid assessment: BLS, VS, NVS, CWMS, injuries, LOC, BG level
Transfer to bed
Ongoing assessment: unwitnessed/head impact
Witnessed/no head impact
Management: hold anticoagulants/antiplatelets. Sedatives, narcotics
-clean and dress wounds, pain meds PRN
Communication, reporting + documentation
-contact MRP + family
-review care team
-PSLS and document per agency policy

Question 10

3. What nursing interventions would a psychiatric nurse implement if a patient had an unwitnessed? What nursing interventions would a psychiatric nurse implement if a patient had a witnessed fall?

Answer 10

Unwitnessed: always treat for head impact, monitor closely vitals more frequently
Witnessed: no head impact

Question 11

4. If a patient was going to fall, how would the psychiatric nurse safely lower the patient to the ground?

Answer 11

1. Move behind patient. Take on step back
2. Support patient’s waist/hip. Put your leg btwn patient’s legs
3. Slide pt down your leg lowering yourself at same time
4. Assess pt for injuries before moving them
5. Reassure pt and seek help
6. Document per agency policy

Question 12

1. How would you define the following routes of medication administration: oral, sublingual, buccal, parenteral, intradermal, subcutaneous, intramuscular, intravenous, topical, transdermal, inhalation, and intraocular?

Answer 12

Oral: given by mouth, swallowed by fluid. Easiest. Slower onset and more prolonged effects
Sublingual: absorbed under the tongue, not to be swallowed
Buccal: place solid medication in mouth against mucous membranes of cheeks
Parenteral: injecting medication into body tissues
Intradermal: into the dermis just under epidermis
Subcutaneous: injection into tissues just below dermis
Intramuscular: injection into muscle
Intravenous: injection into vein
Topical: applied to skin and to mucous membranes usually result in local effects
Transdermal: or patch, systemic effects. Disc adheres medical ointment onto skin
Inhalation: inhaled/administered through nose/mouth
Intraocular: Dropped into eyes or form similar to contact lens

Question 13

2. What are the seven essential components of a medication order?

Answer 13

1. Patients full name, patient number
2. Date and time the order is written
3. Medication name, generic or trade
4. Dose
5. Route of administration
6. Time and frequency of administration
7. Signature of prescriber

Question 14

3. What actions should the psychiatric nurse take if they are unable to read a medication order?

Answer 14

Clarify with prescriber
Document efforts made to contact prescriber
Discuss with other health care professionals
DO NOT GIVE if unable to clarify or if uncertain

Question 15

4. What assessments should the psychiatric nurse perform prior to medication preparation and administration?

Answer 15

Allergy, diet, patient’s medical hx, patient’s current condition, perceptual or coordination problems, medication data, attitude towards med use, knowledge and understanding of med therapy, learning needs

Question 16

5. Where can the psychiatric nurse find patient allergy information?

Answer 16

On the patient chart, or on patient hospital band

Question 17

1. What are the 3 medication checks? What are the rights of medication administration? What are two patient identifiers?

Answer 17

Read labels at least 3 times (comparing med administration record with label) before, during, and after administering the medication
Right medication, right dose, right patient, right route, right time and freq., right documentation, right reason,
right to refuse, right patient education, right evaluation*
Check med admin record against pt ID bracelet and ask pt to state his/her name

Question 18

7. What do you need to know about the medication that you are administering?

Answer 18

Reason client is receiving dose, drug class, drug action, contraindications, usual dosage range, side effects, special nursing considerations

Question 18

7. What do you need to know about the medication that you are administering?

Answer 18

Reason client is receiving dose, drug class, drug action, contraindications, usual dosage range, side effects, special nursing considerations

Question 19

8. What is the procedure for administering oral medications? How do you maintain aseptic technique while preparing and administering medications?

Answer 19

Check accuracy and completeness of each medication administration record against prescribers original med order (rights)
Assess for contraindications
Assess patients medical history, allergies, med history and diet history
Gather info from patients physical exam and lab data that may influence med admin
Assess pts knowledge regarding health and med use
Assess reference for fluids
Prepare meds
Administer meds
Evaluate response to meds at times that correlate w onset, peak and duration
Educate family members

Work on a clean surface, Hand hygiene before preparing meds, avoid touching meds with fingers

Question 20

9. What are the five essential components of a Medication Administration Record?

Answer 20

2 patient identifiers (name, hospital number, DOB)
Date
Allergies
RN/RPN/LPN signature
Med name, dose, frequency, and time

Question 21

10. What could constitute a medication error? What is the procedure for reporting and documenting medication errors?

Answer 21

Omission, incorrect time, incorrect drug, incorrect dose, incorrect route, incorrect patient, incorrect preparation
Any event that could cause or lead to a pt receiving inappropriate med therapy or failing to receive appropriate med therapy

Question 22

1. What are the conversions for grams, milligrams, and micrograms?

Answer 22

1 g = 1000 mg
1 mg = 1000 mcg
1 g = 100 0000 mcg

Question 23

2. What are the guidelines for decimal point placement in relation to medication calculations and orders?

Answer 23

No trailing zero (3.0), decimal point is overlooked resulting in 10-fold dose error
No lack of leading zero (.5) decimal point overlooked, resulting in 10-fold dose error

Question 24

3. What is the sequence for writing a medication order? What is the difference between generic and brand names for medications?

Answer 24

Name of drug, dosage, route, frequency
Generic: non-proprietary (lower case)
Brand: trade or proprietary name (capital or upper-case letter)

Question 25

4. What essential information is included on the drug label?

Answer 25

Trade and generic name, dosage strength (per individual dose), form (patch, mL), drug delivery system (SR), supply dosage (x measured units per some quantity 10 mg/mL), total volume or quantity (full quantity in package, # of tablets, total fluid in volume of bottle), administration route, directions for mixing or reconstituting, special instructions (refrigerate at all times), name of manufacturer, expiry date, lot or control number, drug identification number, natural product number, bar code symbols, unit or single dose labels, combination drugs, supply dosage expressed as a ratio or percentage, checking labels,

Question 26

5. What is the formula for calculating medication dosages?

Answer 26

Desired dose D/dose on hand H x quantity = amount

Question 27

6. What is meant by the term enteric coated tablets? What is meant by the term sustained release/controlled release/long acting?

Answer 27

Enteric coated: delayed release, protective barrier allows drug to

Sustained release: timed release, prolonged release intended to maintain therapeutic window for prolonged periods of time
Controlled: prolong action of the drugs and maintain drug levels within therapeutic window in an attempt to both avoid peaks in drug concentration and max therapeutic efficiency