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From Flashcardlet > NURSING II: TEST 1 > Flashcards

NURSING II: TEST 1 Flashcards

0
Q

Normal respiratory rate range for a NEWBORN infant:

A

30-60 breaths per minute

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1
Q

Pt requires routine temperature assessment, but is confused & easily agitated & has a history of seizures. Nurse’s best option/route to take his temperature:

a. orally
b. axillary
c. tympanically
d. rectally

A

c. tympanically - easily accessible, minimal repositioning, rapid measurement time, w/o disturbing the pt.

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2
Q

Normal respiratory rate range for an INFANT (6 months):

A

30-50 breaths per minute

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3
Q

Normal respiratory rate range for a TODDLER:

A

25-32 breaths per minute

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4
Q

Normal respiratory rate range for a CHILD:

A

20-30 breaths per minute

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5
Q

Normal respiratory rate range for an ADOLESCENT:

A

16-19 breaths per minute

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6
Q

Normal respiratory rate range for an ADULT:

A

12-20 breaths per minute

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7
Q

Physician’s order: “Lopressor (metoprolol) 50mg PO daily. Do not give if blood pressure is <100mm Hg systolic.” Pt BP is 92/66. The nurse (4):

A
  1. Hold the medication
  2. DOCUMENT blood pressure
  3. DOCUMENT intervention
  4. REPORT abnormal findings to charge nurse or health care provider
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8
Q

HPV

A

Human papillomavirus infection

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9
Q

The HPV vaccine is recommended by the American Cancer Society for (1)males/females aged (2) __.

A
  1. females

2. 9-26 years

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10
Q

HPV infection increases the person’s risk for

a. vaginal discharge
b. genital lesions
c. swollen perianal tissues
d. cervical cancer

A

d. cervical cancer

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11
Q

Signs and Symptoms that may indicate a sexually transmitted infection are (3):

A
  1. vaginal discharge
  2. painful or swollen perineal tissues
  3. genital lesions
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12
Q

Comprehensive abdominal examination would include, in proper order:

A
  1. Inspection
  2. Auscultation
  3. Palpation
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13
Q

A weight gain of 5 pounds or more in a day, indicates __ __ problems.

A

fluid retention

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14
Q

Proper term that describes yellow skin color

a. cyanosis
b. erythema
c. jaundice
d. exophthalmos

A

c. jaundice

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15
Q

Abnormal lung sounds

a. bronchial
b. vesicular
c. crackles
d. tracheal

A

c. crackles

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16
Q

Patient is complaining of intermittent abdominal pain. Subjective information from the patient would include:

a. condition of the skin
b. measurement of abdominal girth
c. auscultation of bowel sounds
d. frequency, color, consistency of bowel movement

A

b. frequency, color, consistency of bowel movement

all are descriptions of what the patient would report

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17
Q

A small amount of thick, white smegma under the uncircumcised penis is a(n) normal/abnormal finding.

A

normal

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18
Q

Signs and symptoms that may indicate STI (4):

A
  1. penile pain
  2. swelling
  3. genital lesions
  4. urethral discharge
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19
Q

True/False:

The color of a healthy mucous membranes is white.

A

False

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20
Q

The color of healthy mucous membranes is __.

A

pink.

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21
Q

Term used for whistling, squeaking sounds auscultated in the lungs

A

wheezes

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22
Q

Placing a tongue depressor on the posterior of the tongue tests the patient’s __ __.

A

gag reflex

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23
Q

Observing a patient while drinking, is a technique used to visualize an (1)_____. Normally, the (2)__ cannot be visualized.

A
  1. abnormally large thyroid gland

2. thyroid

24
Q

Patient Vital Signs:
T98.6, P84 and irregular, R18, BP138/84
What should be done at this time?

A

count apical pulse for 1 full minute (due to irregular pulse)

25
Q

Of the physiological changes in older adults listed, (1)which affects metabolism and medication clearance? A buildup of medication can cause (2)__ in older patients.

a. < cognitive function
b. delayed esophageal clearance
c. glomerular filtration of the kidneys
d. < gastric peristalsis

A
  1. choice “c”, glomerular filtration

2. toxicity

26
Q

If the nurse is apprehensive about a drug, dose, route, or reason for a medication, the nurse should ___.

A

first call the prescriber and CLARIFY.

27
Q

If a prescriber is unwilling to change a questionable order and does not justify the order in a reasonable and evidence-based manner, the nurse (may / may not) refuse to give the medication.

A

the nurse MAY REFUSE to give the medication, then notify her supervisor.

28
Q

Antihistamines block or prevent histamine from _____.

A

entering histamine receptor sites.

29
Q

Anticholinergic effects include ___.

A

dryness of mouth and throat.

30
Q

Choose the antihistamine:

a. Ampicillin
b. Tussin
c. Afrin
d. Benadryl

A

d. Benadryl

31
Q

An IV that is “tight”, puffy, swollen, and cool to the touch often indicates (1)__. The IV should be (2)__ __.

A
  1. infiltration

2. IMMEDIATELY REMOVED (it is not sufficient to only stop the fluids)!

32
Q

Antihistamines can cause (1)__ of the mouth. The nurse can (2)____.

A
  1. dryness

2. offer sips of water, ice chips, gum, hard candy

33
Q

A nasal decongestant works by __.

A

vasoconstriction

34
Q

__ nasal passages causes congestion.

A

Swollen

35
Q

Decongestants can be found OTC. This can lead to over-use and __ __.

A

rebound congestion.

36
Q

Choose the Decongestant from list below:

a. Zyrtec
b. Tylenol
c. Mucomyst
d. Sudafed

A

d. Sudafed

37
Q

Oral Decongestants: Adverse reactions

A
  1. tachycardia, high BP, arrhythmias
  2. nervousness, restlessness, insomnia
  3. blurred vision, nausea, vomiting
38
Q

Therapeutic theophylline levels range between ___ mcg/mL

a. 5-10
b. 0.5-2.0
c. 10-20
d. 3.5-5.5

A

c. 10-20 mcg/mL

39
Q

If both a corticosteroid and a bronchodilator inhalers are prescribed, which should be used first?

A

The bronchodilator (open up the bronchi, then decrease the inflammation of the airways)

40
Q

During a physical assessment, the nurse establishes a __ __ to which future data collected can be compared.

A

data base

41
Q

Assessment technique that involves listening to sounds the body makes to detect variations from normal.

A

auscultation

42
Q

Assessment technique that involves tapping the skin with fingertips to vibrate underlying tissues and organs.

A

Percussion

43
Q

Technique of physical assessment that occurs when interacting with a patient, watching for nonverbal expressions of emotional and mental status.

A

Inspection

44
Q

Technique that involves using the sense of touch (tactile sensation) to gather information

A

palpation

45
Q

How long should you listed for bowel sounds before stating that they are absent?

A

5 minutes

46
Q

Popping sounds heard on inspiration is classified as __.

A

crackles.

47
Q

A problem-oriented approach to data collection focuses on _____.

A

the patient’s current problem or presenting situation.

48
Q

If the patient’s vital signs have not been recorded, do not make assumptions. They must be recorded before administering (1)__ or (2)__ __ __ to another department.

A
  1. medications

2. transporting the patient

49
Q

The nurse reviews the current literature in the (1)__ phase of the nursing process to determine (2)__-__ __.

A
  1. implementation

2. evidence-based actions

50
Q

Orders for diagnostic and laboratory tests are in the __ section of the patient’s chart.

A

order

51
Q

_____ is a method of data collection utilized to establish a patient’s NURSING DATABASE.

a. current literature
b. physical examination
c. diagnostic and lab tests

A

b. physical examination

52
Q

Components of a nursing HEALTH HISTORY include

A
  1. physical exam findings
  2. patient expectations
  3. environmental history
  4. diagnostic data
53
Q

The difference between the systolic pressure and the diastolic pressure is the ___.

A

pulse pressure

54
Q

Therapeutic digoxin levels are between __ mg/mL.

a. 10-20
b. 0.5-2.0
c. 5-10
d. 3.5-5.5

A

b. 0.5-2.0

55
Q

This drug increases the production of respiratory secretions from the lower airways.

A

Expectorants

56
Q

Example of an expectorant

A

Tussin

57
Q

This drug reduces the viscosity of respiratory secretions by direct actions of the mucous.

A

Mucolytics

58
Q

Mucolytics is the antidote for ___.

A

acetaminophen (Tylenol)

From Flashcardlet (144 decks)

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