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Fundamentals One
Exam three review
| Question | Answer |
|---|---|
| Where is the best site for the nurse to obtain the infant's pulse? | The brachial or apical pulse |
| With a restless patient having a temperature of 102.2 F what is one of the first things the nurse should do? | Place the patient on oxygen because during a fever cellular metabolism increases and oxygen consumption rises. |
| Which artery is most appropriate for assessing the pulse of a small child? | Brachial or apical pulse |
| What mechanism transfers heat away by using air movement? | Convection |
| What mechanism transfers heat from one object to another with direct contact? | Conduction |
| What mechanism transfers heat from the surface of one object to the surface of another without direct contact? | Radiation |
| What mechanism transfers heat energy when a liquid is changed to a gas? | Evaporation |
| What do newborns wear to prevent heat loss? | A cap |
| What lab value might help determine the amount of blood viscosity? | The hematocrit or the percentage of red blood cells in the blood. |
| What medications can slow down the pulse rate? | Negative chronotropic drugs such as digitalis, beta-adrenergic and calcium channel blockers. |
| Rectal temperatures are usually (higher/lower) than oral temperatures? | Higher |
| Axillary temperatures are usually (higher/lower) than oral temperatures? | Lower |
| What is the single most important thing individuals can do to prevent the spread of infection? | Wash their hands. |
| What are the signs and symptoms of the inflammatory response? | Swelling, redness, heat, pain or tenderness and loss of function in the affected body part. |
| A spike in postoperative infections is categorized as what type of health care associated infection? | Exogenous infection |
| How does the posterior hypothalamus help control temperature? | Initiates heat conservation mechanisms such as vasoconstriction |
| What is the name for the situation when heat loss mechanisms are unable to keep pace with excess heat production resulting in an abnormal rise in body temperature? | Pyrexia |
| If the blood pressure is 140/60. What is the pulse pressure? | 80 |
| What happens in the ovulation phase? | During ovulation, greater amounts of progesterone enter the circulatory system and raise the body temperature to previous baseline levels or higher. |
| The incidence of hypertension is greater in which type of patients? | Diabetics, older adults and African Americans |
| What is the normal respiratory rate range for a newborn? | 30 to 60 breaths per minute |
| What is the acceptable respiratory rate range for an infant (6 months)? | 30 to 50 breaths per minute |
| What factors increase susceptibility of an individual to acquire an infection? | Age, nutritional status, presence of a chronic disease, trauma and smoking. |
| What is a normal defense mechanism against infection in the respiratory tract? | The cilia lining the upper airways of the lungs and normal mucous. |
| What effect might smoking have on the respiratory tract? | Smoking may alter the defense mechanism of the respiratory tract and increase the patient's potential for infection. |
| What is a fever? | An upward shift in the set point. |
| What is hyperthermia? | An elevated body temperature related to the body's inability to promote heat loss or reduce heat production. |
| What effect does smoking have on a patient's blood pressure? | Immediately increases BP and this increase can last for up to 15 minutes. |
| What effect does caffeine have on blood pressure? | Caffeine increases blood pressure for up to 3 hours. |
| What is the average body temperature of older adults? | 96.8 F (36C) Older adults have poor vasomotor control, reduced amounts of subcutaneous tissue and reduced metabolism. |
| What are the benefits of using a temporal artery thermometer? | A temporal artery thermometer provides very rapid measurement and reflects rapid changes in core temperature. |
| Can the skill of temperature measurement be delegated? | Yes, but the nurse is responsible for assessing changes in body temperature. |
| What are signs of systemic inflammation? | Fever, malaise, anorexia, nausea and vomiting. |
| What are signs of local inflammation? | Swelling, redness, heat, pain or tenderness and loss of function in the affected body part. |
| What is the function of the posterior hypothalamus? | If it senses that the body's temperature is lower than the set point, the body initiates heat conservation mechanisms. |
| What does the anterior hypothalamus do? | The anterior hypothalamus control heat loss by inducing sweating, vasodilation of blood vessels and inhibition of heat production. |
| What is cognitive learning? | Includes all intellectual behaviors and requires thinking. |
| What is affective learning? | Deals with expressions of feelings and acceptance of attitudes, opinions or values. Values clarification is an example. |
| What is psychomotor learning? | Involves acquiring skills that require the integration of mental and muscular activity such as the ability to walk or use an eating utensil. |
| What is motivation? | A force that acts on or within a person to cause the person to behave in a particular way. |
| What is an attentional set? | The mental state that allows the learner to focus on and comprehend a learning activity. |
| What is self efficacy? | Refers to a person's perceived ability to successfully complete a task. |
| How does intellectual growth move as a child matures? | From the concrete to the abstract |
| Define patient's behavior in the stage of denial or disbelief. | Avoids discussion of illness, withdraws from others, disregards physical restrictions; suppresses and distorts information given. |
| Define patient's behavior in the stage of anger. | Blames and complains and often directs anger toward nurse or others. |
| Define patient's behavior in the stage of bargaining. | Offers to live a better life in exchange for promise of better health. |
| Define patient's behavior in the stage of resolution. | Begins to express emotions openly, realizes that illness has created changes and begins to ask questions. |
| Define patient's behavior in the stage of acceptance. | Recognizes reality of condition, actively pursues information and strives for independence |
| What factors improve the education of an adult learner? | Assess what the patient currently knows, wants to know, and setting mutual goals. |
| What must the nurse assess before teaching a patient? | Determine information that is critical for the patient to learn.Ask questions that identify and define the patient's motivation. Determine the patient's physical and cognitive ability to learn. |
| Define health literacy. | The cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health. |
| What is the telling approach to teaching? | Use the telling approach when teaching limited information. There is no opportunity for feedback with this method. Example: preparing a patient for an emergent diagnostic procedure. |
| What is the participating approach to teaching? | The nurse and patient set objectives and become involved in the learning process together. |
| What is the entrusting approach to teaching? | Provides the patient the opportunity to manage self care. |
| What is the reinforcing approach to teaching? | Requires using a stimulus that increases the probability for a response. Feedback is a form of reinforcement. |
| How do you evaluate a patient's learning? | By observing performance of expected learning behaviors under desired conditions. |
| What teaching techniques promote effective learning in the older adult? | When information is paced slowly and presented in small amounts. |
| What is teaching? | An interactive process that promotes learning. |
| What is learning? | The purposeful acquisition of new knowledge, attitudes, behaviors and skills. |
| What controls body temperature? | The hypothalamus located between the cerebral hemispheres. |
| What is an acceptable temperature range? | 36 to 38 C (96.8 to 100.4 F) |
| What is diaphoresis? | Visible perspiration |
| Where is the core temperature measured? | Pulmonary artery, esophagus, urinary bladder and tympanic membrane. |
| What does a temporal artery measure? | Cutaneous blood flow |
| What is a reliable noninvasive measure of core temperature? | The temporal artery temperature |
| What is a fever? | An elevated body temperature |
| What is hyperthermia? | An elevated body temperature related to the inability of the body to promote heat loss or reduce heat production. |
| What is heat exhaustion? | Occurs when profuse diaphoresis results in excess water and electrolyte loss. |
| What is hypothermia? | Heat loss during prolonged exposure to cold overwhelms the ability of the body to produce heat. |
| What is stroke volume? | Approximately 60 to 70 mL of blood enters the aorta with each ventricular contraction. |
| What is cardiac output? | The volume of blood pumped by the heart during 1 minute, the product of stroke volume and heart rate of the ventricle. |
| What is tachycardia? | An abnormally elevated heart rate above 100 beats/minute in adults. |
| What is bradycardia? | A slow heart rate, below 60 beats/min in adults. |
| What is dysrhythmia? | An abnormal rhythm |
| What is the advantage of a digit probe to measure O2 saturation? | Are spring loaded and conform to various sizes |
| What is the advantage of an earlobe probe to measure O2 saturation? | Have greater accuracy at lower saturations and are least affected by peripheral vasoconstriction |
| What is systolic pressure? | The peak of maximum pressure in the aorta when ejection occurs. |
| What is diastolic pressure? | When the ventricles relax, the blood remaining in the arteries exerts minimum pressure |
| What is pulse pressure? | The difference between systolic and diastolic pressure |
| What does blood pressure reflect the interrelationship of? | Cardiac output, peripheral vascular resistance, blood volume, blood viscosity and artery elasticity. |
| If you detect an abnormal rate while palpating a peripheral pulse, what is the next step? | Assess the apical rate. |
| What is the pulse deficit? | The difference between the apical and radial pulse |
Created by:
judypilcher
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