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1

To keep alignment of knees and hips because when laying for long period of time knees turn out and patients looses the ability to sit up

Trochanter Roll

2

A patient has an indwelling urinary catheter. Why does an indwelling urinary catheter present a risk for urinary tract infection? (Select all that apply.)

-It allows migration of organisms into the bladder.

-The insertion procedure is not done under sterile conditions

-It obstructs the normal flushing action of urine flow.

-It keeps an incontinent patient's skin dry.

-The outer surface of the catheter is not considered sterile.

-It allows migration of organisms into the bladder.

It obstructs the normal flushing action of urine flow.

3

What is the normal respiratory range for toddler

: 25-32

4

Which of the following patients are at most risk for tachypnea? (Select all that apply.)

-Patient just admitted with four rib fractures

- Woman who is 9 months’ pregnant

- Adult who has consumed alcoholic beverages

- Adolescent waking from sleep

- Three-pack–per-day smoker with pneumonia

-Patient just admitted with four rib fractures

Woman who is 9 months’ pregnant

Three-pack–per-day smoker with pneumonia

5

What is the normal blood pressure range for adult

<120/80 B/P (mmHg)

6

An aspect of clinical decision making is knowing the patient. Which of the following is the most critical aspect of developing the ability to know the patient?

-Working in multiple health care settings

- Learning good communication skills Incorrect

- Spending time establishing relationships with patients

- Relying on evidence in practice

Spending time establishing relationships with patients

7

What 6 factors can influence temperature?

Age, exercise, hormonal levels, environment, Circadian rhythm, Temperature alterations

8

By using known criteria in conducting an assessment such as reviewing with a patient the typical characteristics of pain, a nurse is demonstrating which critical thinking attitude?

-Curiosity

- Adequacy

-Discipline

- Thinking independently

Discipline

9

You are caring for a patient who frequently tries to remove his intravenous catheter and feeding tube. You have an order from the health care provider to apply a wrist restraint. What is the correct order for applying a wrist restraint?

1. Be sure that patient is comfortable with arm in anatomic alignment.
2. Wrap wrist with soft part of restraint toward skin and secure snugly.
3. Identify patient using two identifiers.
4. Introduce self and ask patient about his feelings of being restrained.
5. Assess condition of skin where restraint will be placed.

-4, 3, 5, 1, 2

- 4, 3, 1, 5, 2

- 3, 4, 1, 5, 2

- 3, 4, 5, 1, 2

- 3, 4, 1, 5, 2

10

Killing or eliminating pathogen

Scrub (Surgical)

PPE Sterile handling

Sterile Asepsis

11

A patient presents in the clinic with dizziness and fatigue. The nursing assistant reports a slow but regular radial pulse of 44. What is your priority intervention?

- Request that the nursing assistant repeat the pulse check

- Call for a stat electrocardiogram (ECG)

- Assess the patient’s apical pulse and evidence of a pulse deficit

- Prepare to administer cardiac-stimulating medications

- Assess the patient’s apical pulse and evidence of a pulse deficit

12

If clinical signs and symptoms are not present, the illness is termed _________

asymptomatic.

13

the complete elimination or destruction of all microorganisms, including spores

Sterilization:

14

Drugs that increase pulse rate

Epinephrine

15

When should a nurse wear a mask? (Select all that apply).

-The patient’s dental hygiene is poor.

-The nurse is assisting with an aerosolizing respiratory procedure such as suctioning.

-The patient has acquired immunodeficiency syndrome (AIDS) and a congested cough.

-The patient is in droplet precautions.

-The nurse is assisting a health care provider in the insertion of a central line catheter.

-The nurse is assisting with an aerosolizing respiratory procedure such as suctioning.

-The patient is in droplet precautions.

The nurse is assisting a health care provider in the insertion of a central line catheter.

16

Two patient deaths have occurred on a medical unit in the last month. The staff notices that everyone feels pressured and team members are getting into more arguments. As a nurse on the unit, what will best help you manage this stress?

-Keep a journal

-Participate in a unit meeting to discuss feelings about the patient deaths

- Ask the nurse manager to assign you to less difficult patients

- Review the policy and procedure manual on proper care of patients after death

Participate in a unit meeting to discuss feelings about the patient deaths

17

3 levels of critical thinking starting with lowest to highest

basic

complex

commitment

18

Which of the following are physiological outcomes of immobility?
A. Increased metabolism
B. Reduced cardiac workload
C. Decreased lung expansion
D. Decreased oxygen demand

Decreased lung expansion

19

What is normal Pulse Oximetry Range?

95% to 100%

20

A continuous process characterized by open-mindedness, continual inquiry, and perseverance

critical thinking

21

A nurse has seen many cancer patients struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of:


-Creativity.

- Fairness.

- Clinical reasoning.

- Applying ethical criteria

Applying ethical criteria

22

What is your role as a nurse during a fire? (Select all that apply.)

- Help to evacuate patients

- Shut off medical gases

- Use a fire extinguisher

- Single carry patients out

- Direct ambulatory patients

- Help to evacuate patients

- Shut off medical gases

- Use a fire extinguisher

- Direct ambulatory patients

23

A patient has been newly admitted to a medicine unit with a history of diabetes and advanced heart failure. The nurse is assessing the patient's fall risks. Which of the following is the proper order of steps for the "Timed Get-up and Go Test" (TGUGT)?

1. Have patient rise from straight-back chair without using arms for support.
2. Begin timing.
3. Tell patient to walk 10 feet as quickly and safely as possible to a line you marked on the floor, turn around, walk back, and sit down.
4. Check time elapsed.
5. Look for unsteadiness in patient's gait.
6. Have patient return to chair and sit down without using arms for support.

- 3, 1, 2, 5, 6, 4

- 2, 1, 3, 5, 6, 4

- 1, 2, 3, 6, 5, 4

- 1, 2, 3, 5, 6, 4

3, 1, 2, 5, 6, 4

24

A patient is experiencing some problems with joint stability. The doctor has prescribed crutches for the patient to use while still being allowed to bear weight on both legs. Which of the following gaits should the patient be taught to use?

-Four-point

- Three-point

- Two-point

- Swing-through

-Four-point

25

Which type of personal protective equipment are staff required to wear when caring for a pediatric patient who is placed into airborne precautions for confirmed chicken pox/herpes zoster? (Select all that apply.)

-Disposable gown

-N 95 respirator mask

-Face shield or goggles

-Surgical mask

-Gloves


Disposable gown

N 95 respirator mask

Gloves

26

In immobility

GI distended abdomen, _____ bowel sounds, _____ frequency of elimination

Decreased

27

In immobility

GU dysuria, _________ urinary output, cloudy/concentrated urine

Decreased

28

The nursing assessment of an 80-year-old patient who demonstrates some confusion but no anxiety reveals that the patient is a fall risk because she continues to get out of bed without help despite frequent reminders. The initial nursing intervention to prevent falls for this patient is to:

Place a bed alarm device on the bed.

Place the patient in a belt restraint.

Provide one-on-one observation of the patient.

Apply wrist restraints.

Place a bed alarm device on the bed.

29

Any body action involving muscles and joints in natural directional movements

Range-of-Motion (ROM)

30

The_____ of a sterile field or container are considered to be contaminated.

edges