Foundations of nursing fundamentals week 3
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| show | The amount of blood injected into the arterial system with each heartbeat
Stroke volume is the volume of blood injected into the arterial system with each heartbeat (ventricles contract).
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| show | Clammy skin, thready pulse, confusion
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| show | *A noisy environment can cause a false low reading.”
*“If pressure is released too slowly, a false high reading is possible.”
*“Reinflating the cuff bladder before it has completely deflated can cause a false high measurement.”
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| Which factor would the nurse suspect is causing the blood pressure to fall when a patient who experienced a myocardial infarction (heart attack) is becoming cool and clammy? | show 🗑
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| Which action by the nurse when caring for a patient with a left mastectomy would cause the charge nurse to intervene? | show 🗑
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| Which interventions would the nurse implement to help an obese adult patient who smokes cigarettes successfully manage hypertension? | show 🗑
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| Which site would the nurse use to measure blood pressure when the patient’s upper body is severely burned? | show 🗑
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| Which adult patient’s blood pressure reading would the nurse realize is unexpected? | show 🗑
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| Which actions would the nurse take when manually measuring the patient’s brachial blood pressure? | show 🗑
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| Which patient cue would the nurse identify as relevant for blood pressure? | show 🗑
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| show | Overstimulation of angiotensin and aldosterone causes the blood pressure to increase.
Overstimulation of angiotensin and aldosterone causes the blood pressure to increase from neurohormonal dysfunction, leading to hypertension.
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| Which hypothesis would the nurse select for a patient with a blood pressure of 130/70 who when sitting up becomes dizzy and the blood pressure is 108/60? | show 🗑
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| show | Administer prescribed intravenous (IV) fluids. Administer prescribed oxygen. Position supine with legs elevated.
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| Which factor would the nurse consider is likely causing hypertension in an older adult female who is 5’4”, weighs 100 lbs (45.4 kg), drinks an occasional glass of red wine before bed, and limits salt in her diet? | show 🗑
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| Which finding would alert the nurse that a patient with a blood pressure of 80/40 is improving? | show 🗑
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| show | Patient will report a pain level of less than 3/10 within 45 minutes of receiving pain medication.
This is an appropriate patient outcome because it provides reasonable outcome criteria within a reasonable amount of time.
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| Which cues would a nurse closely monitor to determine a patient’s pain level who is intubated and can have nothing by mouth? | show 🗑
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| Which nonpharmacologic interventions would the nurse utilize to alleviate a patient’s immediate postoperative pain? | show 🗑
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| show | Closely monitor the patient’s vital signs, as well as level of agitation, irritation, and restlessness.
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| Which pain assessment tool would the nurse use when assessing a young school-age patient who has a broken arm after falling off the jungle gym? | show 🗑
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| Which patients would the nurse offer to massage the leg? | show 🗑
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| show | Acute Pain
Increasing abdominal pain postoperatively, elevated blood pressure, and pulse rate indicate Acute Pain.
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| show | On a scale of 0 to 10 with 10 being the worst pain in your life, how would you rate the pain?
This question determines severity by asking the patient to rank the pain.
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| show | emotional support, distraction, rubbing the painful area
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| show | Moderate
Moderate pain is ranked as 4 to 7.
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| Which question would be the most important for the nurse to ask when a postoperative patient says, “I’m hurting”? | show 🗑
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| Which response would the nurse make to a patient who says, “I can’t go to sleep”? | show 🗑
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| Which findings would alert the nurse the patient with an acute pain rating of 7/10 is declining? | show 🗑
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| show | each the patient about splinting.
Splinting (supporting the painful area with a pillow or blanket) will help decrease the pain when moving.
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| At which site would the nurse assess the patient’s apical pulse? | show 🗑
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| show | Offer noncaffeinated beverages., Administer fluid replacement.
, Monitor potassium and calcium levels.
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| Which action would the nurse take after obtaining a patient’s regular radial pulse rate of 45 in 30 seconds? | show 🗑
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| show | Pain, Fever, a drop in blood pressure
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| Which action would the nurse take to obtain a patient’s apical pulse? | show 🗑
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| Which short-term outcome would the nurse develop for a patient experiencing a decreased heart rate? | show 🗑
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| Which pulse site would the nurse check when an infant appears lifeless? | show 🗑
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| show | This test utilizes a portable device attached to the chest by electrodes.
A Holter monitor utilizes a portable device attached to the chest by electrodes. It measures and records the heart’s electrical activity continually.
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| show | Hypothermia, Beta blocker administration, ncreased intracranial pressure
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| Which cues would the nurse assess for in an adult patient with bradycardia? | show 🗑
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| Which finding would the nurse observe in an adult patient with Bradycardia who is improving? | show 🗑
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| show | elevate legs at rest, check peripheral pulses, balance periods of rest and exercise, assess heart sounds
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| Which actions would the nurse take for a patient with tachycardia and atrial fibrillation whose pulse continues to increase? | show 🗑
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| Which statement from the nurse indicates a correct interpretation of a higher temperature at 1830 when compared to the temperature at 1600? | show 🗑
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| show | One who was admitted to the hospital after experiencing a cerebrovascular accident (stroke)
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| Which cues would the nurse likely observe in a patient who has a temperature of 92°F (33.3°C)? | show 🗑
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| show | Touch the patient’s skin.
The nurse would touch the patient’s skin because heatstroke causes hot, dry skin (a key finding), whereas heat exhaustion causes hot, wet skin.
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| show | Administer prescribed warmed intravenous fluids, Apply several layers of warmed blankets., Wrap warm, dry towels around the patient’s head.
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| Which action by the nurse supports the hypothesis of Hypothermia when the patient presents with decreased respirations, cool skin, and low body temperature? | show 🗑
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| Which statement from the nurse indicates appropriate clinical judgment in choosing a temperature assessment site? | show 🗑
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| Which actions would the nurse take for a patient who has a fever? | show 🗑
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| show | Do not give the medication.”
The nurse would share this information because aspirin is not given to a 3-year-old with a viral infection; this can lead to Reye syndrome.
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| show | Patient’s temperature will be within the expected range until discharge.
Because the patient is afebrile (no fever or temperature alterations), the nurse would maintain the temperature level within expected ranges until discharge.
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| show | temp increase, urinary output increases,
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| show | temp increase, heart rate increase, dizziness
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| show | Pull the pinna up and back.
For patients 4 years to adult, the pinna is pulled up and back to straighten the ear canal for a tympanic reading.
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| Which action would the nurse take when the unlicensed assistive personnel (UAP) reports an adult patient has a 99.5°F (37.5°C) temperature? | show 🗑
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| Which instruction would the nurse share with a male patient who calls the clinic and tells the nurse that over a 24-hour period he has taken two extra strength acetaminophen tablets (1000 mg) every 4 hours for a fever? | show 🗑
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To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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Created by:
RachelKleinKatz1