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NCLEX: Fundamentals Of Nursing > Set 6 > Flashcards

Set 6 Flashcards

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1
Q

Short-term pain with a new or sudden onset; vital signs will be impacted

A

Acute pain (ex: appendicitis)

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2
Q

Pain that has persisted longer than 3 months that the body has learned to adapt to; may not impact vital signs

A

Chronic pain

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3
Q

Pain caused by injury to a tissue

A

Nociceptive pain

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4
Q

How do patients typically describe nociceptive pain?

A

Aching; throbbing

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5
Q

Pain caused by injury to the nerves

A

Neuropathic

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6
Q

How do patients typically describe neuropathic pain?

A

Burning, shooting, pins and needles

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7
Q

Pain with unknown origin

A

Idiopathic pain

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8
Q

T or F: the patient is the ONLY person who can administer analgesia via PCA

A

TRUE

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9
Q

The natural wake and sleep cycle of the human body

A

Circadian rhythm

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10
Q

Stage 1 through 3 of the circadian rhythm are going from _________ to _________ sleep

A

Light; deeper

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11
Q

A patients vitals signs are lowest during which stage of sleep?

A

Stage 3

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12
Q

How long after falling asleep do people enter REM?

A

90 mins

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13
Q

Characteristics of REM sleep

A
  • difficulty to waking (also stage 3)
  • vitals signs go up
  • vivid dreaming
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14
Q

Sleep disorder characterized by difficulty falling asleep, staying asleep, or both

A

Insomnia

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15
Q

Sleep disorder characterized by excessive daytime sleepiness and inadvertently falling asleep while awake

A

Narcolepsy

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16
Q

Sleep disorder characterized by a stop in breathing for a period of time during sleep

A

Sleep apnea

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17
Q

Sleep hygiene patient education

A
  • maintain regular sleep schedule
  • sleep in a cool, dark, and quiet environment
  • avoid afternoon naps
  • avoid alcohol and caffeine later in the day
  • exercise regularly, but NOT within 3 hours of bedtime
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18
Q

The physiological changes that happen during periods of stress

A

General Adaptation Syndrome (GAS)

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19
Q

Stages of GAS

A

Alarm, Resistance, Exhaustion

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20
Q

Fight or flight response of GAS (increased HR, BP, cortisol)

A

Alarm

21
Q

Phase of GAS in which body begins to get used to stress, vital signs, and hormones might normalize BUT may have poor concentration, irritability, and frustration

A

Resistance

22
Q

Phase of GAS in which the body cannot keep up with stress anymore and will have fatigue, depression, anxiety, and impaired immunity/disease

A

Exhaustion

23
Q

5 Stages of Grief

A

Denial, Anger, Bargaining, Depression, Acceptance

24
Q

A loss that an individual has not yet experienced, but is impending

A

Anticipatory grief

25
Q

Grief that an individual feels on average, usually for 6-12 months, that resolves and do not impair ability to function

A

Normal/uncomplicated grief

26
Q

Grief that persists for longer than one year and interferes with the ability to function

A

Complicated grief

27
Q

A loss or grief that is not publicly acknowledged (“suffering in silence”)

A

Disenfranchised grief (ex: miscarriage; death of extramarital lover)

28
Q

Care aimed at reducing/managing a patient’s pain or symptoms of a disease or illness ALONG with having curative treatment

A

Palliative care

29
Q

Goal of palliative care

A

Increased quality of life and decreasing suffering (can be for patients who are or are not terminally ill)

30
Q

Symptom management for life-limiting illness, typically for individuals who have a diagnosis of terminal illness with an estimation of less than 6 months to live

A

Hospice care

31
Q

T or F: patient’s in hospice care are all DNR status

A

FALSE; you do not have to be DNR in hospice

32
Q

Effects of immobility of the respiratory system

A

Decreased lung expansion and increased risk of atelectasis

33
Q

Effects of immobility on cardiovascular system

A

Increased risk of blood clots

34
Q

Effects of immobility on musculoskeletal system

A

Muscle atrophy and bone demineralization (increased risk for fractures)

35
Q

Effects of immobility on gastrointestinal system

A

Decreased GI motility (increased risk for constipation)

36
Q

Effects of immobility on renal system

A

Risk for kidney stones, UTIs

37
Q

Effects of immobility on integumentary system

A

Risk for pressure injuries

38
Q

Clotting of blood in a deep vein

A

Deep Vein Thrombosis (DVT)

39
Q

DVTs most commonly occur in the

A

Calf and thigh

40
Q

S/S of DVT

A

Erythema at site, edema, extreme pain at site

41
Q

Pain on leg affect by DVT inflicted by raising the toes to nose while standing

A

Positive Howman’s sign

42
Q

DVT patient education

A
  • elevated leg, but NO pillows beneath the knee
  • NEVER massage affected area (risk for dislodgement and PE)
  • warm, moist compresses for pain
43
Q

The nurse should alert the provider should a patient with a DVT develop

A

Sudden onset chest pain, SOB, decreased pulse ox, elevated HR (all signs of PE — MEDICAL EMERGENCY!)

44
Q

What are the three things that promote lung expansion and airflow in an immobile patient?

A

Coughing, deep breathing, incentive spirometry

45
Q

Compression stockings that help with blood return from the legs

A

TED hose

46
Q

Compression device that squeeze the leg every now and then to help move blood back from the legs

A

Sequential Compression Devices (SCDs)

47
Q

Pharmacological prevention of DVTs

A

Subq Lovenox (low molecular weight heparin)

48
Q

Nursing care to combat effects of immobility

A
  • reposition patient every two hours
  • encourage ROM
  • increase fiber and fluid

NCLEX: Fundamentals Of Nursing (14 decks)

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