Questions

Question 1

How can Asprin affect a wound?

Answer 1

It can inhibit tensile strength of skin and prolong healing time.

Question 2

What is pain?

Answer 2

Pain is the conscious awareness or recognition of a nociceptive stimulus

Question 3

List the four types of pain

Answer 3

1. Acute pain
2. Chronic pain
3. Somatic pain
4. Neuropathic pain

Question 4

Falls and the consequences in the elderly population are becoming increasingly common. what interventions would you put in place to minimise the risk for an elderly patient in hospital?

Answer 4

The following interventions would be done:

• falls risk assessment and plan
• non slip socks
• mini mental exam
• call bell within reach
• aids and equipment nearby (e.g- glasses, walking aid, urinal, hearing aids)
• lower the bed to the ground
• supervised mobilisation
• PCA “guard”supervision” if confused
• medication review
• place patient near nurses station

Question 5

With regards to skin traction, explain why the traction force is applied over a wide area and why it is applied distal to the fracture?

Answer 5

Traction is applied over a wide area to evenly distribute pulling force. It is applied distal to maintain a pulling force on the ‘end” of the bone.

Question 6

List the integumentary conditions that are influenced by genetic factors

Answer 6

• Albinism
• eczema
• Hypohidrotic ectoderm all displagia
• incontinentia pigmenti
• neurofibromatosis elasticum
• psoriasis

Question 7

Why is documentation so important?

Answer 7

• to identify reason for admission, care already received and doctors orders
• to facilitate communication between all members of the multidisciplinary healthcare team
• to ensure other health professionals are well informed
• to ensure continuity of care of your patient
• to enable effective ongoing care of your patient

Question 8

Name 3 different types of oxygen delivery systems

Answer 8

• Face mask (Hudson mask)
• Venturi mask – for COPD patients
• Non rebreather mask – stops exhaled gas from returning
• Nasal prongs

Question 9

16. Nurses can prescribe and administer O2 to patients

Answer 9

• False, we cannot prescribe however we are able to administer oxygen in an emergency.

Question 10

Discuss the principles of good pain management in the care of acute pain.

Answer 10

• Pain is subjective- only the patient can describe it
• Working out any obstacles determine to combat
• Nurses have the responsibility to assess pain – pain scale , using the P,Q,R, S, T approach = provoking (what makes it better or worse),quality (what does it feel like), radiation (does your pain radiate), severity (pain intensity=1-10),time (when did it first start)
• Multimodal effect = using analgesic ladder to combat pain
• Non-pharmalogical comfort measures= music, TV, cold pack, heat pack

Question 11

When is consent required from a patient and who can consent for a patient?

Answer 11

Consent to treatment is the principal that a person must give their permission before they receive any type of medical treatment or examination. This must be done on the basis of a preliminary explanation either verbally or written. Consent should be from the patient or guardian if under age or those in which are acting on their behalf (power of attorney).
If unconscious consent is informed consent is surpassed in these situations.

Question 12

b) Explain the signs and symptoms of compartment syndrome

Answer 12

• Pain-persistent, progressive and out of proportion to the injury
• Pallor- the limbs may be pale
• Pulselessness- pulse absent or diminished
• Paraesthesia- nerves become ischaemic
• Paresis- feelings of weakness in limb or it’s extremities
Remember your 5 P’s

Question 13

Describe the features of a person who has decerebrate posturing.

Answer 13

The pt lies in rigid extension with arms internally rotated at the shoulders, elbows, knees and hips extended and fingers, ankles and toes flexed.

Question 14

Describe the features of a person who has decorticate posturing.

Answer 14

A unilateral or bilateral postural change, consisting of the upper extremities flexed and adducted and the lower extremities in rigid extension

Question 15

7. Describe the nursing care of a patient with a bowel obstruction. Where possible provide rationales for your interventions/actions.

Answer 15

• Pain & symptom management – provide medication if required
• Fluid balance monitoring
• Monitor for signs and symptoms of deterioration
• Administration of IV fluid, electrolytes and antibiotics
• Insertion of a nasogastric tube – nil by mouth
• Treatment of nausea and vomiting
• Radiograph or ultrasound required
• Prepare for surgery (if required

Question 16

Discuss the differences between ischemic and haemorrhagic stroke.

Answer 16

• Ischaemic stroke= sudden blockage or occlusion of cerebrovascular blood flow
• Haemorrhagic stroke= rupture of a blood vessel within the brain.

Question 17

The acronym RICE is used in nursing. Explain what this means and to whom you would apply it

Answer 17

RICE is used for the treatment of strains and sprains.
R-rest – prevent additions injury and promotes healing
I-ice-moist/dry cold applied intermittently for 20-30 min
C-compression- controls bleeding, reduces oedema and provides support for injured tissue
E-elevation- controls the swelling

Question 18

Describe the risk factors and the principles of prevention for the development of pressure ulcers.

Answer 18

• Surgery (THR, back injury) and bed bound for to long, immobile (quadriplegic)
• Turn or moving pt 2hrly
• Dry sheets
• Compression mattress
• Wedges, booties,
• Creams
• Brandon and Norton scale

Question 19

12. Describe the management and nursing care of a patient with a suspected CVA?

Answer 19

• They need to get a scan to determine type of CVA= ischaemic or Haemorrhagic stroke.
• ECG/CT scan
• find out as much information as possible / medical history
• Start an antithrombotics/anti platelets = aspirin, clopidogrel
• Monitor BP
• Medication management- antiarrthymics, antihypertensives
• Normal obs

Question 20

Discuss when a nasogastric tube may be required and the rationale for aspiration of the tube

Answer 20

A nasogastric tube may be required for:
• Short term administration of medications of feedings - infants
• To treat an obstruction
• To remove fluid and gas from the upper GI tract
The rationale for aspirating the tube is to be able to identify and confirm the position of the NGT and rule out the possibility of respiratory tract placement.

Question 21

Why is it important that the patient cease taking aspirin and NSAIDs prior to surgery?

Answer 21

• Can cause excessive bleeding as aspirin is a blood thinner

Question 22

Why is nutritional support an important consideration when caring for a patient with an ileostomy?

Answer 22

• Patients are at risk of malabsorption due to the inability to absorb nutrients from food prior to expulsion

Question 23

List 4 signs that someone may not be tolerating enteric feeding?

Answer 23

• Respiratory distress
• Nausea, vomiting, diarrhoea
• GORD
• Abdominal distention
• Blood sugars/ glucose fluctuations

Question 24

What is aspiration pneumonia? Why are stroke patients at increased risk? What can be done to reduce the risk of aspiration pneumonia?

Answer 24

• Aspiration pneumonia is an inflammation of the lungs and bronchial tubes caused by the inhalation of oropharyngeal or gastric content.
• Stroke patients are more at risk due to the attribution of dysphagia.
• To reduce risks of aspiration happening stroke patients should be made NPO till a swallow assessment has been performed. Enteral tube feeding may be required if the patient fails to meet their nutritional need orally. Modifying food and fluid textures to promote safe oral intake. Sitting the patient up and using modified equipment to help prevent complications from arising. pH measurement should be performed routinely. Measurement of exposed tube length and should be checked often especially after coughing or vomitting.

Question 25

List 3 indications for the insertion of a urinary catheter.

Answer 25

• Bypass an obstruction
• Allow irrigation of bladder
• Empty contents of the bladder

Question 26

Why is it not ideal for surgical drains to remain institu for extended periods?

Answer 26

• Has the potential to cause infection
• Can delay wound healing
• Can cause trauma to tissues

Question 27

Name 3 groups of individuals who may lack the capacity to act in a autonomus matter and whereby the clinician must seek consent from a legal guardian such as a parent, partner or trustee.

Answer 27

• Child – under the age
• Person with a diminished cognitive function – Alzheimer’s, dementia
• Unconscious or comatose person

Question 28

From a methodological perspective, provide 2 characteristics that differentiate Quantitative from qualitative study in nursing research

Answer 28

Quantitative research is big in research size and more objective based, using formulated facts and uncovering patterns while qualitative research is more subjective and smaller research size and is more based at gaining understanding on thoughts and opinions and uncovering trends

Question 29

What is Zollinger-Ellison disease, and why does it increase the risk of peptic ulcer?

Answer 29

• condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers

Question 30

What should be documented following insertion of a nasogastric tube?

Answer 30

• Document the initial measurements of the NGT to allow for comparison for future checking, as well as the position and pH level

Question 31

32. What are the indications for a fine bore nasogastric tube? What routine procedure cannot be undertaken with a fine bore tube?

Answer 31

• Long term use for those who unable to tolerate NG feeds

* Can’t be used for medications as it causes blockages

Question 32

Discuss the routine nursing care associated with enteric feeding.

Answer 32

• The position of the tube must be check prior to each feeding, medication administration, before putting anything down the tube or 4hrly.
• Checking the marker on the NGT
• pH testing should be performed
• ensure the taping is secure
• monitoring for any respiratory distress
• observations should be performed routinely
• assess the abdomen
• review bowel habits

Question 33

Describe the significance of coffee grind vomitus or nasogastric aspirate, and one nursing intervention.

Answer 33

• Coffee-grind vomit is a serious symptom that indicates bleeding in the upper GIT
• You would inform the physician immediately
• Nil by mouth

Question 34

Give 6 examples of when a nurse should check the position of a nasogastric by aspirating the contents of the gut and testing the pH of the aspirate

Answer 34

• Before a feed
• Before each medication
• Before putting anything down the tube
• 4 hourly if receiving continuous feeds
• start of shift
• Serious coughing

Question 35

Why is it important that the patient cease taking aspirin and NSAIDs prior to surgery?

Answer 35

• Can increase your chances of bleeding out

* Can have an adverse effect with the anaesthetics that will be used

Question 36

Name 3 different types of consent and where you would use these in practice

Answer 36

Verbal – asking to touch the patient and they verbally replying ‘Yes’.
Written – signing a declaration that they consent to a procedure.
Implied – where the client’s action or lack of action may clearly indicate their wishes. (ie- holding out their arm to have their BP checked

Question 37

What would the patient be displaying with a GCS of 3/15?

Answer 37

• Patient would be in a coma as they are not responding to verbal, motor or eye responses

Question 38

What would the patient be displaying with a GCS 15/15?

Answer 38

• Patient would have a normal appearance as they have ranked highly on all scales.