Foundations of Nursing Final Exam

Question 1

What are the different types of grief?

Answer 1

Normal (Which is subjective): Complex emotional, cognitive, social, physical, behavioral and spiritual response to loss
Anticipatory: Unconscious process of letting go before any loss occurs
Disenfranchised: Marginal/unsupported grief
Complicated: Prolonged grief/Difficulty moving past loss

Question 2

What are the different types of complicated grief ?

Answer 2

Exaggerated: Intense and/or prolonged with no signs of healing
Delayed: Grief later than expected
Masked: Grief (emotionally, physically or both) that go unrecognized by the patient

Question 3

What are the Kubler-Ross 5 Stages of Grief?

Answer 3

Denial: Not accepting loss as protection
Anger: Resistance/Anger toward loss
Bargaining: Trying to prevent loss
Depression: Realizing the full weight of the loss
Acceptance: Able to find a way forward after loss and incorporates it into life

Question 4

What is the difference between palliative and hospice care?

Answer 4

Palliative: Can still be performed with curative treatment; focused on prevention, relief and symptom management
Hospice Cannot be performed with curative treatment; focused on quality of life, pain and symptom management

Question 5

Can nurses pronounce death?

Answer 5

Yes. It should be confirmed with at least one more provider.

Question 6

What are the different sleep cycles?

Answer 6

Circadian: Individual gets 8-9 hrs of sleep; characterized by sleep and hormone release (cortisol)
Infradian: Individual needs more than 8-9 hrs of sleep; often in teens
Ultradian: Frequent short cycles of sleep thorough 24 hrs

Question 7

What are the 4 Non-REM Stages of sleep?

Answer 7

Stage 1: Lightest level of sleep occurring in the first few minutes, easily aroused by sensory stimulation
Stage 2: Sound sleep within the first 10-20 min; progressive slowing and relaxation of the body
Stage 3: Initial deep lasting 15-30 min; the body is relaxed and difficult to arouse
Stage 4: Deepest sleep for 15-20 min where sleepwalking or enuresis (bed-wetting), difficult to arouse

Question 8

What is the REM Stage of sleep?

Answer 8

Stage 5: Dreaming occurs 90 minutes into sleep, the body is very difficult to arouse, fluctuating activity of body systems, lasts 20 min

Question 9

What are the sleep requirements for younger people?

Answer 9

Neonate: 16 hrs
3+ month Infants: 15 hrs
Toddlers (2 yrs): 12 hrs
Pre-schooler: 12 hrs

Question 10

What are the sleep requirements for older people?

Answer 10

School age: Varies
Adolescent: 8-9 hrs; usually get 7.5
Adult: 6-8.5 hrs
Older Adults: 6-8.5 hrs; usually napping throughout the day

Question 11

What are visual sensory deficits?

Answer 11

Presbyopia: Gradual decline of near sight
Cataract: Cloudy/opaque areas in lens causing glares and blurred vision
Dry Eyes: Too few tears causing itching and burning
Glaucoma: Slowly progressive intraocular pressure on the optic nerve causing peripheral vis. loss, halo effect, issues with vision in the dark
Diabetic Retinopathy: retinal blood vessel changes causing decreased vision
Macular Degeneration: Macula function loss which blurs reading material, distortion/loss of central vision, distortion of vertcial lines

Question 12

What are visual hearing deficits?

Answer 12

Presbycusis: Common progressive hearing loss in older adults
Cerumen Accumulation: Earwax build-up causing conduction deadness

Question 13

What are balance and taste sensory deficits?

Answer 13

Dizziness/Disequilibrium (Balance): Change in head position provokes vertigo/disequilibrium
Xerostomia (Taste): Decreased salivary production leading to thicker mucus/dry mouth

Question 14

What are neurological sensory deficits?

Answer 14

Peripheral Neuropathy: Numbness/tingling in different areas

Stroke: CVA caused by a clot, hemorrhage, or emboli

Question 15

What are the different purposes for gastric tubes?

Answer 15

Decompression: Removal of secretions and gas in GI tract (ex. Bowel obstruction)
Compression: Internal application of pressure by means of an inflated balloon (ex. Esophageal varices bleed)
Lavage: Irrigation of stomach (ex. Overdose of medication)
Enteral Feedings: Instillation of liquid nutritional supplements or feedings into the GI tract (ex. Any issue that does not allow patient to swallow properly)

Question 16

What are important care instructions for enteral feedings?

Answer 16

Head of Bed (HOB) stays at 30-45 degrees at all times and 1 hr after feedings
Measure gastric residuals q 4-6 hrs for continuous feelings
Flush enteral feeding tubes every 4 hrs w/ > 30 mL
Verify placement every 4-6 hrs using gastric contents
Start feedings slow and increase rate every 8-12 hrs if no signs of intolerance

Question 17

What are the different pH levels for gastric contents and what do they mean?

Answer 17

Gastric: 0-4
Jejunum: 6
Lung: 7

Question 18

What are forms of parenteral routes?

Answer 18

Subcutaneous (SQ), Intradermal (ID), Intramuscular (IM) and Intravenous (IV)

Question 19

What are forms of non-parenteral routes?

Answer 19

(Anything other than parenteral/injections)

Oral, Enteral, Topical, Nasal, Eye, Ear, Vaginal, Rectal and Inhalation

Question 20

Which medications CAN NOT be crushed?

Answer 20

Sustained-release, enteric-coated tablets, buccal or sublingual medications

Question 21

What is the best practice for using Metered-Dose Inhalers (MDI)?

Answer 21

Using spacers

Question 22

When administering bronchodilators and corticosteroids, which should go first?

Answer 22

Bronchodilators to maximize airway 5 minutes before steroids

Question 23

What are the 6 rights of medication administration?

Answer 23

1. Right Medication
2. Right Dose
3. Right Patient
4. Right Route
5. Right Time
6. Right Documentation

Question 24

How many mL is the average adult intaking and outputting?

Answer 24

2200-2700 mL

Question 25

What is the normal value for Na (Sodium) and what does it mainly affect?

Answer 25

135-145; affects the Central Nervous System (CNS)

Question 26

What are the symptoms of hypernatremia?

Answer 26

Extreme thirst, fever, confusion/agitation, coma, SEIZURES, dry/flushed skin, postural hypotension

Question 27

What are the symptoms of hyponatremia?

Answer 27

Decreased LOC, possible coma, SEIZURES, Nausea and Vomiting, Apprehension

Question 28

What is the normal value of K (Potassium) and what does it mainly affect?

Answer 28

3.5-5.0; mainly affects the cardiac system

Question 29

What are the symptoms of hypokalemia?

Answer 29

Fatigue, muscle weakness, nausea and vomiting, CARDIAC DYSRHYTHMIAS

Question 30

What are the symptoms of hyperkalemia?

Answer 30

Anxiety, ABDOMINAL CRAMPS, diarrhea, muscle weakness, CARDIAC DISRHYTHMIAS and CARDIAC ARREST

Question 31

What is the normal value for Ca (Calcium) and what does it mainly affect?

Answer 31

8.4-10.5; mainly affects neuro and bones

Question 32

What are the symptoms of hypocalcemia?

Answer 32

NUMBNESS AND TINGLING of fingers and mouth, HYPERACTIVE REFLEXES, muscle twitching, tetany, seizures, Laryngospasm, cardiac dysrhythmias

Question 33

What are the symptoms of hypercalcemia?

Answer 33

Anorexia, nausea and vomiting, constipation, Fatigue, DIMINISHED REFLEXES, changed LOC, cardiac dysrhythmias, POSSIBLE FLANK PAIN from renal calculi, PATHOLOGICAL FRACTURES

Question 34

What is the normal value for Magnesium (Mg) and what does it normally affect?

Answer 34

1.5-2.5; mainly affects neuro

Question 35

What are the symptoms of hypomagnesemia?

Answer 35

Basically hypocalcemia (HYPERACTIVE REFLEXES) with INSOMNIA

Question 36

What are the symptoms of hypermagnesemia?

Answer 36

Lethargy, HYPOACTIVE REFLEXES, bradycardia, hypotension, FLUSHING/SENSATION OF WARMTH, hypoventilation, MUSCLE PARALYSIS, cardiac dysrhythmias/arrest

Question 37

What is the degree, range of gauges, range of volume, and list of sites for intramuscular injections?

Answer 37

Degree: 90 
Range of Gauges: 18-25 (5/8-1 inch long)
Range of Volume: 1-3 mL
Sites: Ventrogluteal, Vastus Lateralis, Deltoid
USE Z-TRACK

Question 38

What is the degree, range of gauges, range of volume, and list of sites for subcutaneous injections?

Answer 38

Degree: 90 or 45
Range of Gauges: 25-30 (3/8-5/8 inch long)
Range of Volume: 1 mL or less
Sites: Outer posterior upper arm, Lower abdomen 2 inches away from the umbilicus

Question 39

What is the degree, range of gauges, range of volume, and list of sites for intradermal injections?

Answer 39

Degree: 5-15
Range of Gauges: 27-31 (1/2 inch long)
Range of Volume: less than 0.5 mL
Sites: Inner forearm, upper back

Question 40

What is the normal oxygen saturation (SaO2) range?

Answer 40

95-100%

Question 41

What are the low flow options for oxygen delivery?

Answer 41

Nasal Cannula: 24-44%, 1-6 L/min
Simple Face Mask: 35-50%, 5-8 L/min
Nonrebreather mask: 60-80%, 10-15 L/min

Question 42

What is the high flow option for oxygen delivery?

Answer 42

Venturi mask: 24-60%, 4-12 L/min

Question 43

How do you calculate pack years?

Answer 43

How many packs a day X How many years the patient has smoked

Question 44

What are the normal diagnostic values for a Complete Blood Count (CBC) including white blood cells, hemoglobin, hematocrit, and platelets?

Answer 44

White blood cells: 5,000-10,000 mm3
Hemoglobin (complete range): 12-18 g dL
Hematocrit (complete range): 37-52%
Platelets: 150,000-400,000 mm3

Question 45

What are the symptoms with high and low Complete Blood Count values?

Question 46

What are the normal diagnostic values for Coagulation Studies including Prothrombin Time (PT), International Normalized Ratio (INR), and Partial Thromboplastin (PTT)

Answer 46

PT: 11-12.5 sec.
INR: 0.76-1.27
PTT: 60-70 sec

Question 47

What are the symptoms with high and low “Coagulation Studies” values?