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Clinical Class 2 > Week 5 > Flashcards

Week 5 Flashcards

1
Q

When caring for a patient receiving oxygen by nasal cannula, which of the following is a priority to help maintain good skin integrity

A

Assessing the patients external ears, nares, and nasal mucosa for breakdown at least once per shift

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2
Q

When caring for a patient who is receiving oxygen by simply face mask, which action ensures that the rate of oxygen being delivered is appropriate

A

Assessing proper placement of the mask on the patients face

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3
Q

When caring for a patient for whom oxygen by nonrebreathing mask has been ordered, which action ensures appropriate oxygen delivery

A

Assessing that the reservoir bag stays inflated

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4
Q

When caring for a patient who is receiving supplemental oxygen by face tent, which action ensures that the oxygen is flowing

A

Ensuring that a mist is always present

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5
Q

What would the nurse do when receiving an order to increase the delivery rate of a patients oxygen per nasal cannula from 1 L/min to 3 L/min

A

Adjust the float ball on the flow meter to 3 L/min

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6
Q

A nurse is palpating the breast of a patient. Which of the following are important aspects of proper palpation of the breasts

A

Using finger pads to palpate, using a consistent pattern, making small circles at each part of the breast and gliding from place to place
(ALL of the above)

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7
Q

What is the most important information to document if a mass is palpated in the breast or axilla

A

Consistency, borders, motility, location, size, shape, tenderness, and retraction of the mass

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8
Q

What are the 5 dangers signs to watch for when assessing nipples

A

Discharge, depression, discolouration, dermatologic changes, and deviation

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9
Q

Which of following statements is the most complete description of the tall of Spence

A

Breast tissue that extends into the axilla is a common place to find breast lumps

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10
Q

Assessing the breasts, which of the following is considered normal

A

Long-standing, unchanged nevi

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11
Q

Which of the following methods is correct for examining the ear of an adult patient with an otoscope

A

Gently pull the auricle up and back

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12
Q

Which of the following methods is correct for examining the ear of a child under the age of 3 with an otoscope

A

Gently pull the auricle down and back

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13
Q

A nurse is inspecting the patients ears with an otoscope. Which of following findings would be considered abnormal

A

Preformation of the tympanic membrane

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14
Q

A whispered voice test includes which of the following

A

Having the patient wiggle a finger in the opposite ear and whispering while standing 30 to 6o cm from the patients ear

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15
Q

The rice and weber tests measure which of the following

A

air and bone conduction

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16
Q

When using the snellen chart, what does a vision evaluation of 20/50 mean

A

The patient can read at 20 feet what most people can read at 50 feet

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17
Q

What term refers to the constriction of the pupils when a patient focuses on an object held about 10 centimetres from the nose

A

Accommodation

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18
Q

What does full movement of the eyes in the six cardinal fields of gaze reflect

A

Proper functioning of the oculomotor, trochlear, and abducens nerves and the extra ocular muscles

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19
Q

When examining the eyes, which of the following is an expected finding

A

Equal pupils

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20
Q

Which of the following are risk factors for glaucoma

A

Age over 40, diabetes, high blood pressure (ALL of these choices)

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21
Q

Which of the following is the correct way to assess a patients nose for patency

A

Occlude one naris, and have the patient breath through the open naris

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22
Q

What is the correct way to palpate the frontal sinuses

A

Press the thumbs against the brow bones

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23
Q

The gag reflex should be

A

Tested with a tongue blade on each side of the oropharynx and present on both sides

24
Q

Which structures are included in a complete assessment of the mouth

A

Lips, mucosa, teeth, and gums
Tongue and floor of the mouth
Hard and soft palates
(All of these choices)

25
During vocalization, the soft plate
Raises symmetrically
26
In which position should the patient be placed in order to palpate the popliteal pulse
Have the patient lie prone with knees flexed
27
Hearing a bruit in an artery is a sign of which of the following conditions
an obstruction
28
What is a depression that is left after pressing a finger or thumb on swollen tissue called
Pitting edema
29
Normal capillary refill is less than 2 seconds and is assessed by
pressing on the nail bed until it blanches, and observing how quickly full colour returns
30
Normal capillary refill in an infant is
<1 sec
31
Which of the following indicates normal respiratory function
symmetrical chest expansion
32
When palpating the thorax, which of the following would be an abnormal finding
Tenderness, Pulsations, Masses (All of the above)
33
When percusissing the thorax, which of the following would be a normal finding
Resonance over the lung fields and dullness over the ribs, heart and diaphragm
34
Normal breath sounds include
vascular sounds
35
When auscultating the lungs, it is important to
compare each side bilaterally, note abnormal sounds, ask the patient to take slow, deep breaths (All of these choices)
36
Why might the collection of a sputum specimen be delayed up to 2 hours
The patient has just finishing eating lunch
37
Which criterion makes it appropriate for the nurse to delegate to the UCP the skill of collecting a sputum specimen
The patient can produce the specimen by coughing
38
What is the role of the UCP when a sputum specimen is collected by means of nasotracheal suctioning
Transporting the specimen to the lab
39
Which action would help to ensure that the results of a suctioned sputum specimen culture are reliable
Refrigerating the specimen until it can be taken to the lab
40
Which action by the nurse would most effectively reduce the patients risk for injury when collecting a sputum specimen by means of nasotracheal suctioning
Lubricating the catheter with sterile water
41
What would the nurse do first when preparing to begin oxygen therapy for a patient
Review the medical prescription for the delivery method and flow rate
42
When preparing the patients environment for safe oxygen therapy, which intervention is a priority to minimize the patients risk for injury
Inspect all electrical equipment in the patients room to ensure it is functioning correctly and properly grounded
43
When a patient is receiving oxygen at home, which instruction to the family would help them understand how to use the oxygen safety
Place a "no smokin" sign at the entrance of the house
44
What would a nurse do first when preparing to educate the patient about safe administration of oxygen therapy at home
Assess the patients readiness and physical ability to provide autonomous car e
45
Which statement by the patient would indicate that they understand the safe use of oxygen
"I'll alert the nurse immediately if I have any increased difficulty breathing"
46
Which of the following is a risk factor for decreased oxygen saturation level in a patient
Chest wall injury
47
What should the nurse teach an UCO about selecting the appropriate site for measuring a patients oxygen saturation levels
"Ive checked their capillary refill, and its acceptable in both their hands and feet"
48
The nurse measures a patients oxygen saturation level as being 83%. What would the nurse do first
Ask the patient whether they are having trouble breathing
49
The nurse is preparing to measure the oxygen saturation level of a patient who is overweigh. Which action would help ensure an adequate measurement
Use a disposable tape-on sensor
50
A patient is prescribed continuous oxygen saturation monitoring. The nurse would confirm that the alarms have been set to which limits
Low of 85% and high of 100%
51
Why is it important for the nurse to set the correct flow rate for a satinet to whom oxygen is prescribed
To provide the correct amount of oxygen to the patient
52
What would be the nurses priority to minimize a patients risk for injury during oxygen therapy
Observing the ten rights of medication administration
53
What can the nurse do to evaluate a patients response to contionous oxygen therapy delivery at 4 L/min by nasal cannula
Regularly meander and trend the patients pulse oximetry (SpO2) values
54
What should the nurse do when a patient is prescribed 4 L/min oxygen by nasal cannula
Ensure that humidification is present
55
What would the nurse monitor frequently to ensure that the prescribed amount of oxygen is being delivered to a patient
Oxygen flow meter setting

Clinical Class 2 (5 decks)

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