Multi Choice Exam MN502 Qs Flashcards
Urinary Retention is..?
The Inability to partially or Completely empty the bladder
The patient is an 86-year-old male who is incontinent at night. An appropriate alternative to catheterisation for this patient would be:
Applying a uridome at night. (Other names: External Catheter/Penis Sheath), applying incontinence pads, or administering Antidiuretic medication.
The mechanism of action of the oral laxative docusate sodium (coloxyl) is:
A stool softener, it works by increasing the amount of water the stool absorbs in the gut, making the stool softer and easier to pass. (anionic surfactant)
The nurse begins to suspect faecal impaction in a patient who has not passed a stool in 10 days when the patient:
- Abdominal pain
- liquid stool
- malaise (pain)
- persistent urge
- bleeding
- absent bowel sounds
- distended lower abdomen
- tenderness on palpation
- dull sound on percussion
- Passing gas
An elderly patient states that she is worried because she has not had a bowel movement each day. The nurse’s best response concerning defecation patterns for elderly people would be:
Not every adult has a daily bowel movement. A bowel movement only every 3 or
more days may be considered normal if it is not associated with pain, passage of
hard faeces or bloating. Peristaltic action decreases and oesophageal emptying
slows. Mucosa of gut change in absorption causing protein, vitamin and mineral
deficiencies. Older adults may have decreased tone of pelvic floor muscles and anal
sphincter. Because of slowing of nerve impulses, some are less aware of the need
to defecate and are likely to become constipated.
Ascites is defined as?
The accumulation of fluid in the peritoneal cavity causing abdominal swelling
What is a normal finding on palpation of the Abdomen?
No tenderness, No masses, No solid areas, symmetrical, and no distension.
When inspecting a client’s abdominal contour, the nurse observes the abdomen to be sunken with the lower edges of the ribs visible. The nurse describes and documents this as:
Gentle S-Shape or Scaphoid (Abdomen)
A nurse asks a patient to turn their palm down with the elbows straight. The specific joint movement the nurse is testing for is:
Pronation of the elbow. Testing the elbow joints range of movement.
A client who presents in the medical centre with lower limb pain following a motor vehicle accident requires a musculoskeletal assessment. When completing the assessment, the nurse should apply all of the following principles except:
Upper body assessment. (Shoulders, Elbows, Head, Wrists, Fingers? or Asking client to move the joint quickly whilst applying pressure
You are inspecting your client’s spinal symmetry and assessing their posture. You identify that the client has kyphosis. This is:
Excessive outward curvature of the thoracic spine, causing hunching of the back.
The nurse is examining the ROM of a client’s shoulder. Which of the following is a normal finding?
No crepitus, fluid build up, tenderness, swelling, bruising, scars and lesions. Patient can preform internal and external rotation at 90 degrees and preform active flexion/extension/abduct/adduct/and rotation bilaterally.
You are caring for Mr Smith who has been admitted following a mechanical fall. You are reviewing his nursing care plan. Which component of the care plan indicates that the patient’s problems have been appropriately described?
Nursing Diagnosis
When using a mobile hoist with a dependent patient, identify the correct rule:
- LITE assessment/how many to assist
- Assess what the patient is able to complete themselves
- Ensure clothing is correct: non slip footwear, free movement of clothes
- Consider PPE if necessary
The older person’s tendency to take smaller steps with feet close together will mostly likely result in:
Tripping and Falling (Hazards)
A person with a normal gait should demonstrate all of the below actions, except:
Uncoordinated movements, unsteady balance, dragging feet, legs bent inward, toes scraping the ground, waddling, limp
To ensure safe administration of medications the nurse must be aware of the seven rights of medication administration. These are the right:
-Time – Dose – Medication – Patient – Route – Documentation – Reason
What is the term given to an unexpected effect of a medication?
Adverse effects/Side Effects
A nurse administers medication to a patient. Who has the ultimate responsibility for the medication to be administered correctly?
The nurse
While the nurse is administering medication, the patient states, “This pill looks different to what I usually take.” What is the correct practice in this situation?
Address the patient by name = right person - Check the medication/double check the patient’s case notes to ensure correct medication Aka go through 7 rights again.
A nurse administering medications has many responsibilities including knowledge of pharmacodynamics. Pharmacodynamics is best described as:
What the drug does to the body aka the study of a drug’s molecular, biochemical, and physiologic effects or actions
