Skills Finals Review (Jeopardy, Expanded + More In-Depth) Flashcards
This action prevents drainage from the NG Tube from going into the esophagus and pharynx upon removal of the NG tube =
Pinching the tube
This is the gold standard for confirmation of NG Tube placement =
X-Ray
Name of the 1st anatomical landmark used when measuring NG Tube placement =
Tip of the Nose
Name of the 2nd anatomical landmark used when measuring NG Tube placement =
Ear Lobe
Name of the 3rd anatomical landmark used when measuring or NG Tube placement =
Xiphoid Process
What is the position used for placement of an NG Tube?
High Fowler’s
Having a pt hold their breath during NG Tube placement prevents-
Aspiration
The unintended administration of a vesicant drug or fluid into the subcutaneous tissue =
Extravasation
What should the change interval be for continuous IV fluids?
Every 96 hrs
Veins in this proximity to the body should be attempted first =
Distal / Distally
Blue Hub Angiocath =
22 G
Yellow Hub Angiocath =
24 G
Pink Hub Angiocath =
20 G
Green Hub Angiocath =
18 G
Grey Hub Angiocath =
16 G
Orange Hub Angiocath =
14 G
What fluid has an Osmolality that’s the same as bodily fluids?
Isotonic Solution
What fluid has an Osmolality that’s lower than bodily fluids?
Hypotonic Solution
What fluid has an Osmolality that’s higher than bodily fluids?
Hypertonic Solution
Assessment tool used to assess pressure ulcer risk =
Braden Scale
A high diet in this nutrient will aid in wound healing =
Protein
Acute wounds should be treated with what kind of dressings?
Hydrogels, Hydrocolloids, Alginates, Foams, Films
Chronic wounds should be treated with what kind of dressings?
Cellulose / Bacterial Cellulose, Collagen, Chitosan, Hyaluronic Acid, Fibrinogen / Fibrin, Polylysine
Define chronic wounds =
A wound that doesn’t heal in an orderly set of stages (is unpredictable) and lasts longer than 3 months
Brown / Black dead tissue attached to a wound =
Eschar Tissue
Thick, yellow, green, tan, or brown wound drainage =
Purulent Exudate
Clear, watery serum from a wound =
Serous Exudate
Bright red wound =
Sanguineous Exudate
Pale, red, watery wound =
Serosanguinous Exudate
Pus & Blood =
Purosanguinous Exudate
Intact, nonblancheable area of redness over a bony prominence =
Pressure Ulcer Stage 1
Partial-thickness skin loss which involves the epidermis layer and possibly the dermis layer of skin.
May be present as an abrasion, a blister, or a very shallow crater =
Pressure Ulcer Stage 2
Full-thickness skin loss involving subcutaneous tissue =
Pressure Ulcer Stage 3
Full-thickness skin loss involving muscle, bone, or other supporting structures such as tendons or joint capsules.
Undermining and sinus tracts may also be present =
Pressure Ulcer Stage 4
What’s the maximum amount of time spent with one pass of the suction catheter =
10 Seconds
Used to deliver high flow rates + High concentrations of oxygen =
Non-Rebreather Mask
Used for clients with chronic airflow limitations or for long term use. Most commonly used. Inexpensive. Doesn’t interfere with eating or talking =
Nasal Cannula
These are used in clients who are deteriorating who might require intubation =
Non-Rebreather Mask
What do Venturi masks provide?
High-Flow Oxygen (You can select the amount of oxygen desired)
What are the nursing interventions for a Croup Tent?
Make sure they know to not have any electrical toys in the tent.
May have to change the sheet often to keep the bed dry.
Used to treat obstructive sleep apnea, prevent endotracheal intubation, pulmonary edema, COPD, and Respiratory failure =
CPAP, BIPAP, ST
This holds the airway open allowing for patients with COPD longer to exhale CO2 if they are retaining CO2 =
BIPAP
Used to deliver aerosol Medications + Usually takes 15-20 mins =
Nebulizer
What are things that an Incentive Spirometer can solve?
Improve Pulmonary Ventilation
Loosen Secretions
Expand Collapsed Alveoli
Facilitate Respiratory Gas Exchange
Counteract the effects of Anesthesia or Hypoventilation
This type of Incentive Spirometer does not measure volume of air inhaled =
Flow Oriented
This type of Incentive Spirometer measures the volume of air inhaled =
Volume Oriented
This is when you use gravity to facilitate the removal of bronchial secretions =
Postural Drainage
When should coughing and deep breathing exercises be taught?
Chest surgery, COPD, or cystic fibrosis
Device used to prevent pneumonia in Post-Op pt’s =
Incentive Spirometer
Habit that should be avoided by anyone receiving oxygen therapy =
Smoking
What is the setting for wall suction when performing an endotracheal suction?
80-100 MMHG
The appearance of this structure may change in an infant depending on hydration status =
Anterior Fontanel
Skin variation characterized by hyperpigmentation in the buttocks region =
Mongolian Spots
Head circumference should be obtained until what age?
3 Years Old
What are the 2 pain scales used for children who are not yet able to verbalize pain?
FLACC Scale
Wong-Baker FACES Scale
What is the BMI?
A measurement of body fat determined by comparing height and weight
The donation of the pt’s own blood prior to a pt’s scheduled procedure =
Autologous Donation
Collecting the patient’s blood during surgery, filtering the blood, and then reinfusing the red cells back to the patient =
Blood Salvage
This occurs when a patient’s compatible family members and/or friends donate blood for their upcoming procedure =
Designated Donor
What’s the amount of time the nurse must remain with a pt after they start a blood transfusion?
15 Mins
This must be obtained prior to the administration of blood or blood products =
Informed Consent
Religious group that may refuse he transfusion of blood or blood products =
Jehovah’s Witnesses
Universal Donor =
O-
Universal Recipient =
AB+
What blood types can AB blood be donated to?
AB blood is only compatible for recipients who also have AB blood
Rh+ blood can’t be donated to recipients with Rh- blood. However, Rh- blood can be donated to Rh+ recipients.
True or false?
True
What are the 4 factors that must be assessed after placement of a splinting device or cast?
Color
Movement
Sensation
Pulse
