NU 301 Final Flashcards
What are the steps to processing an ethical dilemma?
- Ask if this is an ethical problem.
- Gather all relevant information.
- Identify the ethical elements in the problem and examine your values.
- Name the problem.
- Consider possible courses of action.
- Create an action plan and carry it out.
- Evaluate action plan.
What are some common negligent acts?
Medication errors
IV therapy errors
Falls
Failure to use aseptic technique
Failure to monitor a client’s condition
Failure to notify and MD of significant change.
What are some unintentional torts?
Negligence
Malpractice
What are some intentional torts?
Assault
Battery
False imprisonment
What are quasi-intentional torts?
Acts in which a person may not intend to cause harm to another but does
What is a living will?
Expresses wishes regarding medical treatment in the event the client becomes incapacitated and facing end-of-life
What is a durable power of attorney?
Client’s designated a healthcare proxy.
What are provider’s orders?
Patient’s are a full code unless the provider writes a DNR or AND order
What does the emergency medical treatment and active labor act dictate?
A patient who presents to an emergency department, must be treated.
What does HIPAA do?
Establishes patient rights regarding privacy of their health care information and records.
What does the patient protection and affordable care act do?
Consumer rights, and protections
Affordable health care coverage
Increased access to care
Quality of care that meets the needs of patients
What does the client self determination act dictate?
Competent adults have the right to refuse treatment, including the right to leave.
if client refuses treatment or procedure, client signs a document stating they understand the risk of refusing (nurse must inform of right to refuse but explain consequences) notify providers
AMA get form signed if possible.
What does the Health Information Technology Act dictate?
Nurses must ensure PHI is protected
What does Americans with Disabilites Act dictate?
Protects rights of people with physical or mental disabilities
What does the Mental Health Parity and Addiction Equity Act dictate?
Requires health insurance companies to provide coverage for mental health and substance use disorder treatment.
What a do nurse practice acts dictate?
State laws intended to protect citizens, make nurses accountable and assessment that care is consistent with best practice within the scope and standards of nursing.
Licensure
Enhanced nurse licensure compact
What do informed consent and health care acts dictate
An explanation of the procedure or treatment
Names and qualifications of people performing and assisting in the procedure
A description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort
Knows that he or she has the right to refuse the procedure/treatment
Knows that he or she may refuse the procedure/treatment
What are Good Samaritan Laws?
Limit liability and offer legal immunity if a nurse helps at the scene of an accident
What are public health laws?
Laws affect individuals, populations, and communities that are intended to improve the health of people
Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. although nurses agree to do no harm, this procedure may be the patient’s only treatment choice. This example describes the ethical principle of:
A. Autonomy
B. Fidelity
C. Justice
D. Nonmaleficence
D. Nonmaleficence.
A nurse is caring for a patient who states, “I just wanted to die.” For the nurse to comply with this request, the nurse should discuss:
A. Living wills,
B. Assisted suicide
C. passive euthanasia
D. Advanced directives
D advanced directives
What is the order of bathing a client?
Get equipment
- Start with eyes. Clean in to out using a washcloth. Use a new area to clean face, neck, ears, and behind ears.
- Expose chest and arms (towel under arms). Long strokes on arms. Also clean armpits, fingers, nails, and hands. Apply deodorant
- Wash chest to pelvic area. Apply new gown
- Expose legs and feet and wash (towel under legs). Avoid massaging the legs. Clean in between toes and toenails as well.
- Expose perineal area (towel under area). Clean inner thigh and work to perineal area. For men, clean in circular motion. For women, front to back. New area of cloth each wipe.
- Turn patient to side, wash back using long strokes.
- Wash buttocks from outside, working in to anus area.
What are the steps to oral care?
Gather equipment
- Assess client’s mouth
- Towel under chin
- Clean all areas of mouth with toothbrush (teeth, gums, tongue)
- Allow patient to rinse with water.
- Offer mouthwash for 30 seconds and spit
- Floss gently back and forth until all have teeth been cleaned
- If patient is unconscious or cannot tolerate a toothbrush they may can use a lemon glycerin swab or regular mouth swab to clean all areas of mouth.
- If patient is unconscious, you can turn them on their side, apply standard oral care, and use suction as needed.
What are the steps for denture care?
Keep dentures covered in water when they are not worn.
- Store in an enclosed, labeled cup with the cup placed on patient’s bedside.
- Have a towel under chin during removal so you do not drop them and cause damage
- Bruh them with toothpaste and put back in cup
How do you care for a client in restraints?
Assess skin integrity every 2 hours
- Offer fluids, food, and provide hygiene
- Monitor vitals
- Offer ROM exercises
- Pad bony prominences
- Remove and replace restraints frequently to ensure circulation
- Use quick release knots to bed fame- no side rails
- Verify restraints loose enough for two fingers to fit between device and client
- Never leave patient unattended
- Document properly
Name some client education methods
Teach back method
- Brochures or printed materials
- Videos
- Group meetings
- Visual aids like power points or models
- Audio aids like podcasts or recordings
- Written steps
- Kinesthetic Demonstrations
What is the normal heart rate range for an infant?
120-160
What is the normal heart rate range for a toddler?
90-140
What is the normal heart rate range for a preschooler?
80-110
What is the normal heart rate range for a school age child?
75-100
What is the normal heart rate range for an adolescent?
60-90
What is the normal heart rate range for an adult?
60-100
What are the normal respiration rate ranges for a newborn?
30-60
What is the normal respiration rate range for an infant (6 months)?
30-50
What are the normal respirations rate for a toddler (2 years)?
25-32
What are the normal respirations rate for a child?
20-30
What is the normal respiration rate for an adolescent?
16-20
What is the normal respiration rate for an adult?
12-20
What is the normal O2 sat range?
95-100%
How do you communicate with a client who has receptive aphasia?
Those with receptive aphasia may need visual or other aids to help them understand and put together the purpose of what you are telling them since they have trouble understanding.
How do you communicate with a client who has expressive aphasia, a laryngetcomy, or an endotracheal/tracheostomy tube?
may be able to communicate by writing on a notepad or typing out their questions and requests. If they cannot write, they may be able to communicate with sign language or symbols
How do you care for a client with visual impairements?
- Encourage the patient to discuss changes in visual acuity or eye/vision issues by asking focused questions
- Educate patients on age-related eye diseases and conditions, eye care services, and the importance of taking care of their eyes.
- Collaborate with the inter professional team to help improve access to eye care services
- Follow up with patients to reiterate important points and check on progress
- Provide written eye care instructions in type that uses large fonts and sharp contrast to improve readability.
- These patients use tone of voice and inflections to detect emotional tone. May also use Braille.
How do you care for clients with hearing impairments?
- Sign language
- Note pad and pen or typing
- Visual or kinesthetic aids for communication
- Keep in mind these patients may have balance issues if inner ear is affected
- Provide adequate time for communication
What are the 7 rights to medication administration?
Right patient, right drug, right dose, right route, right time, right documentation, right indication
What needle and syringe size is used for Intradermal injection?
25-27g; 1 mL syringe
What Needle and syringe size for Subcutaneous injection?
28-31g (insulin) or 25-27g (anything else); Insulin syringe or 1-3mL syring
What Needle and syringe size for Deltoid injection?
21-25g; 1-5 mL syringe (usually 3 mL)
Deltoit max injection is 2ml
What Needle and syringe size for Ventrogluteal injection?
20-25g; 1-5 mL syringe
What Needle and syringe size for Vastus Lateralis injection?
21-25g; 1-5 mL syringe
What is actual loss?
When a person can no longer feel, touch, hear, see, or know a person or object.
What is necessary loss (maturational loss)?
result of normal lifespan changes
What is situational loss?
Sudden unexpected change in life
What is percieved loss?
Defined by the person experiencing loss, unnoticed by others
- You are caring for a patient who is depressed because the only child has gone away to college. The nurse will assess this type of depression as:
A. actual loss.
B. perceived loss.
C. situational loss.
D. maturational loss.
D. maturational loss.
What is Normal (uncomplicated) grief?
Natural response to loss
What is anticipatory grief?
Experience before loss occurs
caregiver may detach too early n the dying process
What is disenfranchised grief?
experienced connection with a loss that is not socially supported or acknowledged by the usual rites or ceremonies
What is complicated (chronic, exaggerated, delayed, masked) grief?
response are dysfunctional, prolonged, or overwhelming
What are the emotional stages of dying?
denial, anger, bargaining, depression, acceptance
What is palliative care?
Focuses on the prevention, relief, and reduction of symptoms
Goal is to help achieve the best possible quality of life
What is hospice care?
Focuses on the care of terminally ill patients
Goal is to manage pain, provide comfort, ensure quality of life
Prioritize care according to patient wishes
What are myths related to hospice care?
Hospice is a place.
Hospice means the patient will die soon.
Hospice is only for cancer patients.
Hospice is only for the patient.
A patient has to have Medicare or Medicaid to afford hospice.
Hospice provides 24 hour care.
Patients have to change doctors with hospice.
Hospice is only available for a limited amount of time.
Once a patient accepts hospice they can not seek aggressive treatment for their illness.
Hospice means relinquishing hope.
What are the s/s of impending death 3 months prior to death?
withdrawal
decreased food intake
increased sleep
increased pain
What are the s/s of death 1-2 weeks prior?
disorientation,
respiratory changes,
increased perspiration,
erratic pulse,
decreased BP,
changes in skin color
what are the s/s of death 1-2 days to hours prior?
Earlier symptoms become more intense
Increased congestion (death rattle/apnea)
Decreased output
Restlessness
Glassy gaze
Mottling of skin
Decreased LOC
Surge of energy
What are some Nursing diagnoses relevant for patients experiencing grief, loss, or death?
Impaired family coping
Death anxiety
Pain (Acute or Chronic)
Dysfunctional Grief
Anticipatory Grief
As a first-year nursing student, you are assigned to care for a dying patient. To best prepare you for this assignment, you will want to:
A. complete a course on death and dying.
B. control your emotions about death and dying.
C. compare this experience to the death of a family member.
D. develop a personal understanding of your own feelings about grief and death.
D. develop a personal understanding of your own feelings about grief and death.
What is stress?
An actual or alleged hazard to the balance of homeostasis
Can impact the physical and mental well-being of patients
What is chronic stress?
Chronic stress occurs in stable conditions and results from stressful roles.
What is acute stress?
Time-limited events that threaten a person for a relatively brief period provoke acute stress.
What are situational stress factors?
Arise from job changes, illness, caregiver stress
What are maturational stress factors?
Vary with life stages
What are sociocultural stress factors?
Environmental, social, and cultural stressors perceived by children, adolescents, and adults
You are a nurse working in the college student health center. You receive a call that an athlete has just fallen and has been injured. You know that according to the general adaptation syndrome, the athlete will be exhibiting:
A. an increased appetite.
B. an increased heart rate.
C. a decrease in perspiration.
D. a decrease in respiratory rate.
B. an increased heart rate.
- A patient comes into the emergency department complaining of chest pain. When discussing possible reasons why the chest pain has occurred, the nurse learns that the patient is depressed because of the loss of a job. This type of crisis can be classified as:
A. maturational.
B. situational.
C. sociocultural.
D. posttraumatic.
B. situational.
What is Neuman systems model?
Uses systems approach
Based on the concepts of stress and reaction to stress
What is Roy’s adaptation model?
modifty external stimuli to allow adaptation to occur.
What is Pender’s health promotion model?
Focuses on promoting health and managing stress.
What is compassion fatigue?
A state of burnout and secondary traumatic stress
Caring for others who are suffering
Emotional exhaustion
Can overwhelm health care providers and cause physical, mental, and emotional health issues
What is second victim syndrome?
When a medical error occurs that inflicts significant harm on a patient and the patient’s family
How do you convert F to C?
C = (F-32)/1.8
How do you convert C to F?
(C x 1.8) + 32 = F
What are advance directives?
a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity.
What are the four different sites for injection?
subcutaneous
intradermal
intramuscular
intravaneous
What are airborne precautions?
Used for diseases spread through the air.
* Private, monitored negative pressure room
with door always closed.
* These diseases are spread by germs attached to tiny particles that remain
infective over time and distance.
* They are dispersed over long distances by air currents.
* Requires the use of special air handling and ventilation systems….requires a
N95 mask.
Ex: chicken pox, TB, measles, smallpox, COVID 19
15
What are droplet precautions?
Droplet precautions require the wearing of a surgical mask when
within 3 feet of the patient, proper hand hygiene, and some
dedicated-care equipment.
What is contact precautions?
Gown and gloves. Hand washing
Where are all the different temperature sites?
Mouth, rectum, tympanic membrane, temporal, axillary,
Where are all the pulse sites?
Temporal, carotid, apical, brachial, radial, femoral, popliteal, posterior tibialis, dorsalis pedis
You notice a teenager has an irregular pulse. What should you do?
A. Read the history and physical
B. Assess the apical pulse rate for 1 minute
C. Auscultate for strength and rate of pulse
D. Asking whether the patient feels palpitations or faintness of breath.
B. Assesss the apical pulse for 1 minute.
What are the normal sodium levels?
136-145
What are the normal potassium levels?
3.5-5.0
What are the normal chloride levels?
98-106
What are the normal magnesium levels?
1.3-2.1
What are the normal calcium levels?
9.0-10.5
What factors influence hygiene?
Social Practices, Body Image, Socioeconomic Status
What are values?
A belief held about something
What is autonomy?
The right to choose for yourself
What is beneficience?
To do good
What is nonmaleficience?
Do no harm
What is justice?
Fairness
What is fidelity?
To keep one’s promises
What are the 7 rights of medications administration?
Right patient, right drug, right dose, right route, right time, right documentation, right indication
What is urinary retention?
Accumulation of urine due to bladder being unable to empty
What is a UTI?
Infection of urinary tract due to catheterization or procedure
What is urinary incontinence?
Involuntary urine leakage
What color is normal urine?
straw
What does amber (dark) urine indicate?
dehydration
What does light straw colored urine indicate?
overhydration
What does red urine indicate?
Blood, injury
What does orange urine indicate?
medicine
What is normal urine’s odor like?
faint
What is abnormal urine’s odor like?
Strong (anything but faint)
What is the normal consistenty of urine?
Clear
What is abnormal consistency of urine?
cloudy or thick
How can we promote normal urinary elimination?
Maintain elimination habits
maintain adequate fluid intake
Promote complete bladder emptying
How can we prevent UTIs?
Hand hygiene
maintenance of a closed system
Avoid kinks in system
Keep drainage bag below level of bladder
Secure the catheter
routine perineal hygiene
What are some common urine studies performed?
Clean-catch
sterile UA
24 hour urine (discard first voiding)
What is polyuria?
Producing lots of urine
What is oliguria?
Producing little urine
What is anuria?
Producing no urine
What is dysuria?
difficulty/painful urination
What are the different routes of medication administration (not injections sites)
oral, topical, nasal, eye/ear instillation, vaginal instillation, rectal instillation,
What do you do when a medication error occurs?
- Assess the patient
- Report the incident
- FIle an incidence report
- Report near misses and incidents that cause no harm
What are the different scales to rate pain?
VIsual analogue scale
Numeric rating scale
simple descriptor scale
Wong-Baker faces scale
What angle is used for IM injections?
90 degrees
What angle is used for Subcutaneous injections?
45 or 90 degrees
What angle is used for intradermal injections?
15 degrees
What kind nutrition should you include for wound care?
Protein
Vitamin C
Zinc
Copper
What is a stage I pressure injury?
Non-bleachable red skin, intact
What is a stage 2 pressure injury?
Partial thickness loss with exposed dermis
What are stage 3 wounds?
Full thickness skin loss with adipose present slough and eschar may be present
What are stage 4 pressure injuries?
Full thickness skin loss with bone/muscle etc exposed. slough and eschar present
What is an unstageable wound?
Too much eschar/slough to determine.
What is normal BP for a newborn?
40
What is normal BP for a 1 month old?
85/54
What is normal BP for a 1 year old?
95/65
What is normal BP for a 6 year old?
105/65
What is normal BP for 10-13 year olds?
110/65
What is normal BP for 14-17 year olds?
119/75
What is normal BP for 18 and older?
120/80
What is an elavated BP?
120-129/80
What is Hypertension stage 1?
130-139/80-89
What is hypertension stage 2?
140/90
What is the average temperature range for an adult?
96.8-100.4 F
What is the average oral/tympanic temp range?
98.6 F
What is the average rectal temperature?
99.5 F
What is the average axillary temperature?
97.7 F
What should you do when you make a phone call to a provider for orders?
Document
T or F, verbal or telephone orders are okay to take all the time
False, they are discouraged except in emergent or urgent situations.
What does correct documentation look like in nursing?
Objective
Exact measurements
Clear notes
Chart immediately after task
legible, black ink, proper spelling.
Facts only, no opinions.
State what you saw e.i.
“I found Mr. Smith lying on the floor” not
“I think Mr. Smith fell”
T or F, you can erase or apply correction fluid when charting
False, you can only draw one straight line throught incorrect data.
T or F, you can chart care before you actually perform it
False, you cannot chart in advance
- As a first-year nursing student, you are assigned to care for a dying patient. To best prepare you for this assignment, you will want to:
A. complete a course on death and dying.
B. control your emotions about death and dying.
C. compare this experience to the death of a family member.
D. develop a personal understanding of your own feelings about grief and death
. develop a personal understanding of your own feelings about grief and death.
You notice a respiratory change in your immobilized postoperative patient. The change you note is most consistent with:
A. atelectasis.
B. hypertension.
C. orthostatic hypotension.
D. coagulation of blood.
A. atelectasis
What are some respiratory interventions for immobile patients?
TCDB
Prevention of atelectasis/pneumonia
Incentive spirometer
PO hydration
What are some metabolic interventions for immobile patients?
High protein , high calorie diet,
with Vitamin B and C.
May need enteral feedings.
Assess likes and dislikes.
May need to feed the patient.
What are some CV interventions for immobile patients?
TEDS
SCDS
Dangle legs prior to standing
Ambulate
Heparin, Lovenox
ROM exercises
What are some musculoskeletal interventions for immobile patients?
Assess for muscle atrophy
ROM exercises
Appropriate diet
What are some elimination interventions for immobile patients?
Be sure the patient is receiving the correct amount and type of fluid intake (IV and / or oral) .
Assess urine color and consistency daily.
Assess bowel sounds, abdominal distention, and bowel patterns for consistency and frequency .
What are some psychological interventions for immobile patients?
Allow for time to talk
Assess for behavior responses or changes
Withdraw
What do you do for immediate post operative recovery?
Hand-off communication
Conduct complete systems assessment
Once awake, expectorate the airway
Airway obstruction
Determine a patient’s status and eventual readiness for discharge from the PACU on the basis of vital sign stability
Postanesthesia recovery score (PARS)
What assessments are performed post-op?
Neurological functions
Skin integrity and condition of the wound
Metabolism
Genitourinary function
Gastrointestinal function
Mobility
Comfort and sleep
What type of continuing care is provided post-op?
Prepare for discharge
Provide patient education
Help patients adhere to exercise programs
Make referrals to home care as needed
When would you empty an ileostomy bag?
When it is 1/3rd to half way full
What do you irrigate an ostomy with?
warm water
What is the antidote for narcotics?
Narcan
When a smiling and cooperative patient complains of discomfort, nurses caring for this patient often harbor misconceptions about the patient’s pain. Which of the following is true?
A. Chronic pain is psychological in nature.
B. Patients are the best judges of their pain.
C. Regular use of narcotic analgesics leads to drug addiction.
D. Amount of pain is reflective of actual tissue damage
Patients are the best judges of their pain.
A patient has just undergone an appendectomy. When discussing with the patient several pain-relief interventions, the most appropriate recommendation would be:
A. adjunctive therapy.
B. nonopioids.
C. NSAIDs.
D. PCA pain management.
D. PCA pain management.
