Fundamental skills eaq Flashcards
The following flashcards are going to be based off the NGN fundamental skills 1, under the eaq assignment, rationales and additional information based on what I think could be tested on for the quiz.
The first question on the NGN assignment was based off a patient who was having issues with their right radial pulse being weak and thready.
the question was asking what action would the nurse do for a client who had this issue.
the answer choices were
- assess all peripheral pulses
- asses and compare both radial pulses
- ask a second nurse to assess the client’s pulses
- assess for edema or other issues that may be restricting peripheral blood Flow
- observe for pallor/skin temperature differences distal to the weak pulse
can you tell me why we would not do these
administer IV fluid ?
assess client SPO2 on that hand?
withhold antihypertensive meds?
we can not give IV fluids without a providers order
we should not measures sp02 on that hand since it will not be accurate because of impaired circulation and instead should be assess on the opposite hand
once again, the patient may be on medications, but it is not the responsibility to withhold the medication, instead we must inform and notify the provider about the suggestion, and wait until appropriate orders
The following question on the NGN case study for fundamentals 1, talks about a patient who has a positive diagnosis for HIV.
what are some routes of how a patient with HIV can transmitted the disease?
based on the following choices (2)
- feces
- blood
- semen
- urine
- sweat
- tears
why not the other choices ?
just incase there is a question on the 10 question quiz on friday, just remember, HIV can be found in other bodily secretions like urine, sweat, saliva, sputum, emesis, but why is it less likely to be transmitted?
blood & semen
HIV is a virus that can be transmitted through blood, semen, and bloody bodily fluids.
because of the low viral count found in those body secretions
Question number 3 of the NGN is asking us what is normal signs of a newborn.
The following responses are correct.
- baby weight is 6lbs
- hands/feet are cyanosed
- head circumference is 33cm/13inches
could you explain to me why these 3 are normal ?
the following were not correct, could you tell me why for each ?
- flat abdomen
- corner of the mouth drops with crying
- copious watery discharge from eyes
- does not blink in the presence of light
- nipples spaced widely apart
the average weight of a newborn can be from 6-9 pounds (2700-400g)
the hands and feet of a newborn are typically cyanosed during the first 24 hours after birth
the average newborn head circumference Is between 3-35cm or 13-14inches
the responses to why they aren’t correct
newborns typically have a protuberant abdomen
the corner of the mouth dropping with crying is a sign of facial nerve paralysis that may have been caused during birth
copious watery discharge which progresses to purulent is a sign of chalmydia conjunctivitis and needs to be treated.
newborns exhibit a blinking reflect when light is directed towards their eye, meaning they should response
widely spaced nipples, along with lymphedema and excessive nuchal tissue is a sign of Turner syndrome
- meaning they should not have widely spaced nipples
The following question was asking how the nurse is to respond to an actively dying patient.
I want to make it clear that the response between a patient who has a DNR verses a patient who doesn’t is slightly different in the sense that you would not immediacy do hospice care.
based on the following choices, what would you select for an action that a nurse should do for a dying patient, and why. (4)
- admit the client in hospice care
- ensure the nurse talks to and not about the client
- perform aggressive laboratory tests
- keep the client undistributed for a long time
- try to set a comfortable environment in the room
- perform symptom management for the client
- encourage family to talk to the client
and why would you not do the other options that were not selected/correct. (3)
I know im gonna forget to mention it when im walking, so im writing this down here, when should patients be admitted into hospice care if death is expected?
( ofc after consent with the patient for hospice care )
2 option, during the dying process both healthcare staff and visitors should talk to and not about the client. Meaning you should discuss with the client as if they were perfectly fine instead of everything that is wrong.
4 option, it is the nurses job to provide comfort care by reassuring the client and family members present to aid with reducing the emotional anxiety that death brings.
6 option, a comfortable environmental such as a low lighting and soft music may aid with helping emotions
7 option, it is responsible for the nurse to help with any symptom management to aid with the clients quality of life, while they may be DNR, it does not mean you should immediacy do hospice care unless noted they are DNR, instead you will try to aid the patient with comfortable and lack of pain
8 option. the client should be able to talk to the family, and even be encouraged that the family talks to the client even while they are actively passing away
the other options, being option 1, it is not okay to immediataly place the client in hospice care if she or he is dying.
- instead hospice care is if death is expected within 6 months
option 3, we should not do aggressive labs when death is imminent.
option 5, the client should not be repositioned for comfort, and not lead undisturbed for a long period of time, meaning you should always be checking in and assessing the situation
remember, it is 6 months when death is expected
The following NGN question was about what are some things that increase the risk for an infection for a patient.
based on the following choices, select the ones that apply, and give a reason why they are correct in this case for an increase risk of infection. (4)
- surgical incision
- inactive lifestyle
- urinary catheter
- poor diet
- intravenous access
- antibiotic therapy
- diminished appetite
- vegetarain diet
why did we not select the other 4 options ?
surgical incision, urinary catheter and intravenous access are all portals of entry for microorganisms, meaning, we are opening up the body, either through cut or insertion, so that is opening up the risk for an infection
the reason why antibiotic therapy is on here is because some antibiotic and disturb the normal flora and cause a superinfection, think about how vancomycin is a common medication that cause c.diff as a symptom
inactive lifestyle, poor diet and diminished appetite could negativitly affect your general health but it does not increase the risk of infection
a vegetarian diet is also known to aid in reducing some types of infection even
The following NGN question discusses the a patient who is having the urge to use the bathroom however is not being able to urinate.
all his labs came back within normal limits, however the question of the NGN is expecting us to anticipate an order from the doctor.
this is the correct order,
the nurse anticipates the physical to order
- an intermittent catheter
to
- relieve urinary retention.
Effectiviness of care is evidenced by
- postvoid bladder scan of 35mL
why do you think these 3 options are correct?
what does urinary retention mean ?
what is urinary retention treatment?
what is an expected finding after treatment of urinary retention?
why would restricting fluids not be recommended would treating urinary retention ?
why would we not irrigate the bladder?
why would we not use tamsulosin ?
if you remember, the client does not have an infection because all of his labs came back normal, no bacterial, crystals and only 2 white blood cells. even if the client was dribbling, ( what sign does this mean typically in males? ), would it be a sign of infection after the catheter was removed and he started dribbling?
what are signs of stress incontience for a patient with urine problems?
we understand that the client does not have incontinence, so the client would not have effective care with decreased episodes of incontience.
the reason why is because this client is unable to expel the urine to begin with.
why would a palpable bladder be a bad sign for this patient, or more so a sign of this patient, meaning it is not effective sign?
lastly, why would an increase of creatinine from 0.9 to 1.4 be a bad thing instead of an effective sign for this patient with urinary retention?
the nurse would anticipate the physician to order an intermittent catheter to relieve the patients urinary retention and would be effective with the evidence of a bladders can of 35ml.
the reason why we know the patient has urinary retention is because of his distended bladder and how he can not empty it/frequency and urgency to go, even after the Catheter has been removed.
urinary retention is treated with an intermittent Catheter, and to know that its working effectively, a bladder scan would indicate less than 50ml or in this case, 35ml or less.
restricting fluids would not be recommended in treating urinary retention due to the fact that the body needs fluids in order to properly hydrated and make the kidneys work.
we would not irrigate the bladder because it will only add more fluid into this retention, causing the bladder to feel more worse.
tamsulosin is used for an enlarged prostate, not a urinary retention situation.
dribbling of the penis with urine, typically is a sign of an enlarged prostate, however, this client in this case started dribbling after the catheter was removed, meaning it was a normal sign to expect. rather than something he had going on prior.
involuntary loss of urine when increased abdominal or detrusor pressure occurs, such as loss of urine when sneezing or coughing.
we would not say the bladder being palpable is an effective sign because if we can feel a bladder, it means it has urine and is retaining inside the body.
if creatinine were to be increased, it would mean the care was super ineffective, likely causing the patient to have kidney damage or injury.
The following NGN question a bit confusing to discuss this it was a highlighted question problem, so instead we are going to talk about how we came to conclude with each answer choice.
background, client has a history of a-fib, hypertension and diabetes, came into the hospital having c-diff after treatment with antibiotics for a severe infection.
the following were the correct highlighted responses, that a nurse should follow up on, tell me why they were right.
tented skin turgor
im so thirsty all the time
urinating small amounts of dark amber urine
states sores on ankle that won’t heal
the following were not correct, meaning not highlighted but was given the option to be, tell me why they were not right.
heart tone irregular
temp of 99.2
pulse of 94 beats
blood pressure 144/84
skin turgor should be brisket, not tented.
a patient should not be thirsty all the time, instead should be adequately hydrated, but we know that this patient has c-diff, so we should try to keep that under control.
urine should be yellow, not dark amber
the last 3 responses, are all signs of complications from having c-diff and need to be watched and treated.
the sore on ankles that won’t heal is likely a worsening complication of having diabetes and needs to be looked at because of the possible wound infection.
heart tones irregular is typical for patients who have a-fib
temp being 99,2 is a high normal so within range
pulse is 94, being within range
and even if the blood pressure is 144/84, it is expected from a patient who has hypertension
the following NGN question was a direct follow from the last flashcards or question on the eaq, about the same patient with Cdiff. I want you to identify why each of these responses correlated to the actual diagnosis finding.
elevated blood pressure - hypertension
ankle sore that won’t heal - diabetes
intake 50ml and output 175ml of watery stool - c.diff
foul smelling diarrhea - c.diff
hyperactive bowel sounds - c.diff
really this is just based on common knowledge of symptoms associated with the actual diagnosis, so its important you understand what are normal findings between these three
also additional, diarrhea leads to increased peristalsis(moving poop through the intestine faster with diarrhea) , resulting in hyperactive bowel sounds.
another additional, ankle sore that won’t heal is typically due to diabetes causing a slow wound healing process, impaired immune response and increased glucose levels
the following question also applies to the last 2 flashcards with the patient of c.diff.
this time, the question Is asking us what is the client at risk for expericing with c.diff.
here are your choices, and you can only pick 2, and when you do, what were they and why did you pick them.
dehydration
urinary tract infection
rhabdomyolysis
intussusception
falls
volvulus
tell me why the other options are not it.
dehydration & falls
- the reason why is because the patient is losing so much fluid from all the diarrhea, causing a risk for dehydration.
- even showing the classic signs of dehydration of tented skin turgor, small dark amber urine, thirsty.
- the reason why fall is here is because the client is becoming so weak due to all the fluid loss, making falls a safety issue.
here are the reasons why the other options are not it
for urinary tract infection, even though the urine isn’t the right color, it is not from a UTI, its from the intestines/normal flora disturbance.
rnhabdomylosis is a cause form muscle injury to trauma, typically like car crashes, excessive exercise, alcohol or high temperatures.
even though the patient is cramping, intussusception is unlucky due to the presence of stool and client age, its usually found in children and leads to the lack of stool.
volvulus is a twisting of the intestine, that would result in constipation or bloody stools, and not explosive diarrhea like c.diff
the following question is still on the same c.diff patient, this time, which actions would the nurse include in the plan of care for the same patient.
select all that apply and then tell me why you did those choices. (5)
continue with contact precautions
wash hands with antiseptic gel
offer bland, low residue foods
reduce fluid intake
test stool for ova and parasites
institute fall precautions
suggest a fecal microbiota transplantation
monitor for sepsis
notify the physician
why would we not choose the rest. (4)
we want to continue with contact precautions because of the risk of spreading the infection across the hospital, so glove and gown down.
- remember c.diff is transmitted by direct and indirect contact
offer bland, low residue foods in order to not upset the stomach and flora more.
institute fall precautions because of the high amount of fluid loss causing dehydration and the patient stating that they feel weak.
monitor for sepsis because of the infection and it could spread more throughout the body
notify the physician about any changes whatsoever.
why we would not do the other options
the reason why we dont wash our hands with antiseptic gel is because it will not kill off c.diff, instead soap and water must be used.
fluid intake should be increased and not reduced because of the patient dehydration status from all the diarrhea.
stool would not need to be tested because parasites and ova were not indicative, meaning the patient didn’t go out the country and its been established already; the previous treatment from a medication/antibiotic
fecal microbiota transplant could be used, but its only ever used for chronic c.diff or if the treatment does not work. so this patient hasn’t even got to that level of extreme either
the following question is the same thing as the last,
the patient with c.diff
this is the answer
the nurse would first
- notify the physician
for
intravenous fluids
the reason is because what we are missing and we have to select what additional information we should include.
why would we not do physical therapy ?
why would we not give 400mg to the patient?
why would we not do colonoscopy?
why no emergency surgery?
why no telescoped bowel?
why no microbitoic transplanted ?
why not cooling blanket?
we would want to notify and ask for fluids because the patient is dehydrated and becoming weak.
no physical theory cause the weakness can cause more problems
patient is given 200mg of fidaxomicin not 400mg, so it would be bad.
no colosncopy or emergency surgery cause its not recommended or required
additional, the patient does not have a telescoped bowel, or intussuepction
the patient does not need a macrobiotic transplantation because they dont have chronic or emergency need
no need for cooling blanket because they do not have a fever
the last question is the same patient once again.
the following questions was asking to put these into categories of improved, no change or declined.
you tell me each one
and why they’re there.
brisk skin turgor - improved
crackles in left lower lung- declined
pulse 94 - no change
250ml yellow urine - improved
blood pressure 156/88 - declined
temparure 99.2 - no change
active bowel sounds - improved
skin improved from tented to brisk , meaning hydration is becoming better
crackles being in the left lower lung means that it was clear to now fluid filled, causing a problem -could be from the iv fluid being infused too quickly for the client
pulse was always at 94, so its stable and baseline
urine improved from small amount of dark amber urine to now 250ml yellow
blood pressure was at 144/84 and now has increased, meaning that there are problems with possible fluid being infused too fast
temperature has no change, so its baseline
active bowels is a good change because it was from hyperactive, this is likely changed positively due to the help of iv fluids resolving the dehydration
that is everything for the fundamentals eaq, the following flashcards if added, are going to be additional information I believed is needed
