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Nursing Skills > Final exam > Flashcards

Final exam Flashcards

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1
Q

Define Abduction, Adduction, Flexion, Extension

A

Abduction: away from body
Adduction: towards the body
Flexion: contract
Extension: straigten

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2
Q

Who does the work in passive ROM and active ROM

A

Patient= active
nurse= passive

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3
Q

COAL: What side does the cane go one.

A

Cane Opposite Affected Leg
Cane goes on strong side

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4
Q

What foot do you step with when using a Walker

A

Wandering Willa’s Always Late
Walk With Affected Leg

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5
Q

Prone Position

A

face down ass up

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6
Q

Supine

A

Supine you’re on your spine
laying flat on your back, face up

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7
Q

Sims

A

Laying on side with your legs separated

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8
Q

Lateral

A

laying on side with legs together

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9
Q

Fowlers: high and semi

A

Semi: 45 HOB, up right position
High: 90 HOB up right position

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10
Q

Sterile Field Rules

A

1” margin, is unsterile
Sterile touches sterile

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11
Q

What safety measures are needed when getting a patient up to walk to the bathroom

A

Lower bed, non skid socks, gait belt

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12
Q

What is the process of log rolling? Who is it used for

A

Grab chuk under patient and roll to side, careful of head making sure it is being moved at the same time.
Used when patients have head or spine injury

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13
Q

Normal hourly urine output is?

A

40 mL

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14
Q

What interventions can the nurse implement to prevent constipation?

A

Ability, hydration, high fiber diet, proper positioning, privacy

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15
Q

What is normal infant vital signs ranges

A

T: same as adult (100 is fever)
R: 20-30
P: 80-140
BP: 70-100/ 60
O2: 90% >

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16
Q

if a bp cuff is too big, what does it do to the reading

A

increases blood pressure

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17
Q

skin breakdown can occur in as little as ___ hours

A

2

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18
Q

what 2 factors lead to skin breakdown

A

fiction and shear
moisture
pressure

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19
Q

what are the 5 p’s

A

pain
position
potty
pathways
personal belongings

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20
Q

How many tiers of isolation are there? What are they?

A

1: standard precautions
2: transmission based

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21
Q

What Braden score indicates risk for skin breakdown?

A

<9

22
Q

Does a high number or a low number indicate a fall risk on the Morse Fall Tool?

A

high

23
Q

Name 4 interventions to prevent a patient from falling

A

non- skid socks, lowering bed, bed rails, fall risk bracelet, gait belt, walker, bed alarm

24
Q

Name 3 never events

A

falls, distribution of wrong blood, foreign objects in body

25
Q

How do you wash the eyes

A

inner to outer

26
Q

1 tsp= ? mL

A

5

27
Q

10 kg= ? lb

A

22

28
Q

1 oz. = ? ml

A

30

29
Q

1 gm= ? mg

A

1,000

30
Q

54 g= ? kg

A

0.054

31
Q

1.8 mg= ? mcg

A

1,800

32
Q

5 L= ? ml

A

5,000

33
Q

510 mg= ? g

A

0.510

34
Q

1 tbsp= ? ml

A

15

35
Q

1 tbsp= ? tsp

A

3

36
Q

What are the 3 transmission based precautions?

A
  1. contact: gloves and gown
  2. Droplet: mask, gloves, glown
  3. airborne: full PPE
37
Q

What are some things to consider with Neutropenic Precautions?

A

no fresh flowers, no food that come from outside, or could have possible diseases, leave door closed.

38
Q

When is range of motion best performed?

A

with hygiene activities (ex. during a bed bath)

39
Q

With a cane what side should it be held on, and what foot should be stepped first?

A

Held on strong side
Cane, strong foot, weak foot

40
Q

With a walker, what should be the steps when walked

A

walker and weak leg first followed by strong leg

41
Q

What are the point of crutches?

A

to assist with eliminating weight bearing on the legs.

42
Q

What are some good body mechanics?

A

bed working height
wide base of support
squat to lift
push vs. lift
get help

43
Q

factors that affect mobility and activity

A

lifespan
nutrition
lifestyle
stress
disease

44
Q

Define transfer definitions:
Atrophy
hypertrophy
Flaccidity
Spasticity
Tremor
Paresis
Paresthesia

A

Atrophy: wasting muscle away
hypertrophy: enlargement
Flaccidity: soft or limb
Spasticity: abnormal increase in muscle tone
Tremor: shakes
Paresis: partial paralysis
Paresthesia: numbness or tingling

45
Q

Safety interventions for fall risk patients: equipment and actions

A

Equipment: low bed, floor mats, fall risk bracelet, slippers, gait belt, bed alarm
Actions: orientate patient, reduce clutter, toileting schedule, hourly checks

46
Q

What are every time actions when collecting specimen?

A

label clearly
utilize gloves and hand hygiene
utilize appropriate containers
transport in a specimen transport bag
be aware of the timing

47
Q

Do you need a full stool for stool specimen collection?

A

no, just grab a little
Also, use a toilet hat to collect patients stool.

48
Q

Things to know for a clean catch/midstream urine specimen

A

must use specific wiping packets before use (each wipe= 1 cloth) (females each side of labia front to back, then down the middle)
begin voiding, without stopping the stream insert the container and collect a sample, finish voiding

49
Q

Things to remember with foley UA

A

alcohol swab the specimen port before
clamp catheter tubing for 20-30 minutes
use sterile syringe 10-20 ml of urine
clean up with alcohol wipe again and UNCLAMP the catheter

50
Q

Timed urine samples

A

Specimen containers are refrigerated during collection in the soiled utility room refrigerator
if you miss any output, the collection and time must be restarted

Nursing Skills (16 decks)

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