Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Foundations Exam 2
| Question | Answer |
|---|---|
| Normal vitals signs for newborn | Temperature: 35.9 - 36.9 C / 96.7 F - 98.5 F (axillary), Pulse: 70-190 Beats/Min, Respirations: 30-40 Breaths/Min, BP: 73/55 |
| Normal vitals signs for infant | Temperature: 37.1 - 38.1 C/ 98.7 F - 100.5 F (temporal), Pulse: 80-60 Beats/Min, Respirations: 20-40, BP: 85/37 |
| Normal vitals signs for Toddler | Temperature: 37.1 - 38.1 C/ 98.7 F - 100.5 F, (temporal), Pulse: 80-130 Beats/Min, Respirations: 25-32, BP: 89/46 |
| Normal vitals signs for Child | Temperature: 36.8 - 37.8C / 98.2 F - 100 F (tympanic), Pulse: 70-115, Respirations: 20-26, BP: 95/57 |
| Normal vitals signs for preteen | Temperature: 35.8C - 37.5C/ 96.4 F - 99.5 F (oral), Pulse: 65-110, Respirations: 18-26, BP: 102/61 |
| Normal vitals signs for Teen | Temperature: 35.8C - 37.5C/ 96.4 F - 99.5 F (oral), Pulse: 55-105, Respirations: 12-22, BP: 112/64 |
| Normal vitals signs for adult | Temperature: 35.8C - 37.5C/ 96.4 F - 99.5 F (oral), Pulse: 60-100, Respirations: 12-20, BP: 120/80 |
| Normal vitals signs for elderly. | Temperature: 35.8- 36.8 C/ 96.4 F - 98.3 F (oral), Pulse: 40-100, Respirations: 16-24, BP: 120/80 |
| How to assess a patient | Safety, Vital Signs, Mental Status, Psychosocial, Head, Eyes, ears, nose, Chest, Abdomen, Upper and lower extremities, Activity, Therapeutic devices. |
| What are the different types of assessments | Ongoing Partial (follow up), Comprehensive (complete and physical), Focused (specific), Functional (effects of health/illness, areas of improvement), Emergency (Rapid Focused) |
| Subjective | What client says |
| Objective | Changes in the patients body system |
| Review the phases of "nursing diagnosis" | Describes patient problems nurses can treat independently |
| What is the purpose of a care plan | The written guide that directs the efforts of the nursing team working with the patient to meet his or her health goals. |
| What is a psychomotor outcome | Patient's achievement of new skills. New Skill Demonstration. (Holding baby, diapering, dressing/feeding baby) |
| What method of documentation incorporates the care plan into the progress note | describe the client's responses to what has been done and revisions to the initial plan. |
| What does palpation assess | May sequentially be used during the assessment of each body part. Uses sense of touch. |
| Signs of heart failure | Occurs when the heart is unable to pump a sufficient blood supply, resulting in inadequate perfusion and oxygenation of tissues |
| Risk for fluid volume loss | A problem focused nursing diagnosis for a patient who has experienced vomiting diarrhea, and excessive diaphoresis for 3 days. |
| A patient returns from outside of the country can they be placed in a room with other patients | No |
| How to write out a goal short term or long term | SMART S-specific, M-measurable, A-Attainable, R-Realistic, T- Time bound |
| In infants the respiratory rate is more _________ than any other age. | Rapid |
| A nurse reassuring oneself a being prepared to speak in front of a peer group is using which of the following types of communication | Intrapersonal |
| Which activity generally occurs during the orientation phase of the helping relationship? | An agreement or contract about the relationship is established |
| SBAR | Situation, Background, Assessment, Recommendation |
| Teaching Acronym | T-Tune into the patient, E-Edit patient information, A-Act on every teaching moment, C-Clarify often, H-Honor the patient as partner in the education process |
| Three Learning Domains | Cognitive, psychomotor, affective |
| Cognitive | storing and recalling the new knowledge in the brain |
| Psychomotor | learning a physical skill |
| Affective | Changing attitudes, values and feelings |
| Which action is an example of cognitive learning? | A patient describes how to portion food to maintain within a prescribed calorie range. |
| Teach back method | Confirm patient knows information |
| Language deficits | Know about interpreters and how to use when language barrier |
| Fluid volume deficit | dehydration. We cannot expect patient to understand medical terminology. The reason your hypokalemic is because of your ileostomy leaking. Due to fluid deficit. |
| Key Points to Effective Communication | SATA on EXAM |
| Most adults' orientation to learning is that material should be useful immediately rather than at sometime in the future | TRUE |
| What would be the best teaching strategy to teach a patient how to care for an indwelling catheter | Demonstration |
| Key Points to Effective Communication | Be sincere and honest. Avoid too much detail and stick to the basics. Ask for questions. Be a cheerleader for the patient. Use simple vocabulary. Vary the tone of voice. Keep content clear. Listen and do not interrupt. |
| Know how to write short term and long term goal | ensure there is a date. |
| Types of Power | Explicit and Implied |
| Explicit | Power by virtue of position |
| Implied | Power due to other factors such as personality |
| A good example of explicit power is a class bully who gets his way by intimidating his classmates | FALSE |
| It is increasingly difficult for the nurse manager to be both a clinical and managerial expert. | TRUE |
| Leadership Styles | Autocratic, Democratic, Laissez-Faire, Quantum, Transactional |
| Which styles of leadership describes a nurse leader who assumes control over the decision and activities of the group | Autocratic leadership |
| Can an LPN assess a patient | No it is responsibility of RN |
| A client is brought to the emergency department in an unconscious condition. The wife hands over the previous Medical files and points out that the client had suddenly fallen unconscious trying to get out bed. What is the primary source of information | Client's wife |
| A patient is experiencing hypoxia. What nursing diagnose would be appropriate? | Anxiety |
| Older client who is to be discharged. The client prescribed the use of a liquid unit at home to continue with oxygen therapy. What should the nurse tell the client regarding the potential problems of using a liquid oxygen unit? | Liquid oxygen may leak during warm weather. The units outlet may become occluded because of frozen moisture. Portable liquid oxygen is more expensive. |
| Upon entering the client’s room at the beginning of a shift, and throughout the shift, the nurse assesses the client. The nurse considered the client’s plan of care and response to nursing interventions during the assessments. | Ongoing Partial Assessment |
| The nurse is performing an assessment on an infant. Which finding is considered an abnormal cardiovascular assessment that should be documented and reported to the physician? | decreased heart rate |
| A patient comes to a community health clinic with complaints of vaginal itching and discharge. She believes it is from having sex with her boyfriend. Which response should the nurse use during the health history to elicit information? | Tell me more about the sexual activity with your boyfriend |
| What would a nurse ensure before beginning a health assessment? | The room is private, quiet, warm and has adequate light |
| A nurse working in a clinic is planning to conduct vision screenings for a group of low-income women. What equipment would be needed to test vision? | Snellen chart |
| A nurse is performing a general survey of a client admitted to the hospital. Which of the following actions is an element of this procedure? | Taking Vital Signs |
| When inspecting the skin of a client, the nurse notes a bluish tinge to the skin. What condition would the nurse document? | Cyanosis |
| A nursing student uses evidence-based practice findings in the development of a care plan. This is an example of which type of nursing skill. | Cognitive |
| Based on an established plan of care, a nurse turns a client every two hours. What part of the nursing process if the nurse using? | Implementing |
| What is a systematic way to form and shape one’s thinking? | Critical Thinking |
| The nurse is using a systematic approach to the collection of assessment data. The nurse uses an assessment guide that uses a hierarchy of five life requirements universal to all persons. What model for organizing the assessment data is the nurse using? | Human Needs (Maslow) model |
| A nurse is reviewing the health history and physical assessment findings for a client who is having respiratory problems. Of the following data collected, what data from the health history would be a cue to a nursing diagnosis for this problem? | I get out of breath when I walk a few steps |
| The nurse develops long-term and short-term outcomes for a client admitted with asthma. Which of the following is an example of a long-term goal. | Client returns home verbalizing an understanding of contributing factors, medications, and ◦ signs and symptoms of an asthma attack. |
| A nurse writes the following nursing diagnosis for a client with Alzheimer’s disease. Disturbed Thought Processes related to Alzheimer’s disease as evidenced by incoherent language. Which part of this diagnosis is considered the problem statement? | Disturbed thought process |
| Of the following types of nursing diagnoses, which one is validated by the presence of major defining characteristics? | Actual nursing diagnosis |
| A client who has to undergo a parathyroidectomy is worried that he may have to wear a scarf around his neck after surgery. What nursing diagnosis should the nurse document in the care plan? | Disturbed body image related to the incision scar |
| The nursing process: systematic method that directs the nurse, with the patient’s participation, to accomplish the following: | "1) Assess the patient to determine the need for nursing care 2) Determine nursing diagnoses for actual and potential health problems 3) Identify expected outcomes and plan care. 4) Implement the care 5) Evaluate the results " |
| "Concept Mastery Alert: " | Assessment is the first step in the nursing process and always involves gathering data. Data can be obtained from the patient, family, or other sources as well as from the physical examination. |
| Concept Mapping: | an instructional strategy in which learners identify, graphically display in a diagram, or drawing, and identify relationships between core concepts |
| TLC) Total Lung Capacity: | the amount of air contained within the lungs at maximum inspiration |
Created by:
MSTVT