Exam 1: NR410 Flashcards

1
Q

What is the mnemonic for jesuit values?

A

M-FM-CCU

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2
Q

What does the “M1” stand for in Jesuit Values

A

Magis= the more

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3
Q

What Does “F” stand for in Jesuit Values?

A

Finding God in all Things

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4
Q

What does “M2” stand for in Jesuit Values?

A

Men & Women for others in need

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5
Q

What Does “C1” stand for in Jesuit Values?

A

Cura Persona = Care for the person

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6
Q

What does “C2” stand for in Jesuit Values

A

Contemplatives in Action

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7
Q

What does “U” stand for in Jesuit Values?

A

unity of mind and heart

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8
Q

What is the primary purpose of hand hygiene?

A

to prevent or control the transmission of infection from any source.

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9
Q

When delegating patient care that requires nursing assistive personnel (NAP) to use personal protective equipment (PPE), it is necessary for the nurse to do what first?

A

Review the patient’s need for a specific isolation precaution

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10
Q

In which situation would it be appropriate for the nurse to use an antiseptic hand rub to perform hand hygiene?

A

The nurse’s hands are not visibly soiled.

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11
Q

What is the primary reason for performing perineal care on a male patient with incontinence?

A

To reduce the risk of skin breakdown in the patient’s genital and perineal area

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12
Q

A patient with difficulty breathing requests a back massage. In which position would the nurse instruct nursing assistive personnel (NAP) to place the patient during the massage?

A

Side-lying

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13
Q

As the nurse is preparing to provide perineal care to a female patient with limited mobility, the patient says, “I can do that myself.” Which action would be the priority?

A

Assess the patient’s ability to perform proper perineal care.

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14
Q

What temperature should the water be when bathing a patient?

A

Warm

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15
Q

The nurse is delegating a female patient’s perineal care to nursing assistive personnel (NAP). What instruction would the nurse give to ensure the NAP’s safety while performing this care?

A

wear clean gloves

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16
Q

The nurse is assisting a patient with a tub bath. After the patient has been safely positioned in the tub, he tells the nurse, “I’ll call you when I’m done.” What is the nurse’s best response?

A

check back in 5 min

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17
Q

The nurse is preparing to provide perineal care for a female patient who is on bed rest. Which patient position should the nurse use for this care?

A

dorsal recumbent

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18
Q

A patient is being given a bed bath. The nurse realizes that another washcloth is needed to complete the bath. What is one way in which the nurse can ensure the patient’s safety?

A

Make sure the call light is within reach

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19
Q

As the nurse is preparing to provide perineal care to a female patient with limited mobility, the patient says, “I can do that myself.” Which action would be the priority?

A

Assess the patient’s ability to perform proper perineal care.

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20
Q

The nurse observes the nursing assistive personnel (NAP) providing perineal care to a male patient. Which observation of care requires the nurse’s follow-up?

A

Reserving the cleansing of the tip of the penis as the final step in perineal care

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21
Q

A patient with left-sided muscle weakness is prescribed a bath every other day. Which precaution would help the nurse reduce this patient’s risk of falling?

A

Decline the patient’s request to add scented oil to the bathwater.

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22
Q

A male patient receiving perineal care tells the nurse “It has started to hurt a little down there.” What is the nurse’s best response?

A

“When did you start experiencing the pain?”

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23
Q

What will the nurse do right after placing a clean top sheet on the patient?

A

Remove the bath blanket

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24
Q

The nurse is directing nursing assistive personnel (NAP) to make an occupied bed. What will the nurse say to minimize the risk of disease transmission to staff and patient during the bed change?

A

“You’ll need to apply Standard Precautions during this task.”

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25
A nursing assistive personnel (NAP) has finished making a surgical bed for a patient in surgery. How would the nurse instruct the NAP to leave the bed to transfer the surgical patient safely?
Raise the height of the bed.
26
When making a surgical bed with no patient present, at which time is it unnecessary to perform hand hygiene?
After disposing of soiled linen that is not visibly soiled
27
Comparing the changes in vital signs as a person ages x3
1. Respiratory rate remains fairly stable throughout a person's life. 2. Blood pressure increases; heart rate and respiratory rate decline 3. Men have higher blood pressure than women until after menopause
28
What is your primary intervention
maintain, improve wellness, immunization, nutrition
29
Secondary intervention
diagnosis followed by prompt intervention
30
Tertiary Intervention
prevent complications, undue deterioration, & rehab
31
What does SMART stand for in the planning phase
Specific, Measurable, Attainable, Realistic, Timed
32
what is our bodies' secondary defense
phagocytosis, fever
33
what is our bodies' tertiary defense
b-cells, t-cells
34
What are examples of portal entry/exit
lines tubes, skin, mucous, respiratory tract, UTI, Reproductive tract, blood
35
Which is better to block portal exit or portal exit
Portal Exit, because blocking entry to others. Keeps it contained.
36
What are the 4 stages of infection
1. **Incubation** (no symptoms yet) 2. **Prodromal** (not feeling well) 3. **Illness** (stay away) 4. **Convalescence** (starting to feel better)
37
7 factors that influence hygiene and self care
1. psychosocial 2. personal pref 3. culture/religion (male, female) 4. Economic status 5. development 6. Knowledge 7. phys health
38
What are common types of baths
1. Assist- hard to reach areas 2. Partial- necessary areas (perineum) 3. Complete- head to toe
39
In a care plan what might you say for evaluation of ADLs?
how patient tolerated the procedure, give more.
40
When should you contact RRT (regional response team)
* if worriend about PT * abnormal RR, BP, HR * neuro * acute urinary
41
What are the standards for taking vitals at a hosptial
every 4-8 hours
42
Why do some elders become malnourished or dehydrated
staffing issues, not enought time
43
What are common causes in changes in temperature
1. fever 2. hyperexia \> 105.8 3. hyperthermia 4. hypothermia
44
1 degree celsius is equal to an increase in how many beats per min
10
45
Nursing Research
* examine phenomena important to nursing * a guide to making clinical decisions
46
Steps to EBP x6
1. Ask clinical question 2. Collect evidence 3. Critique evidence 4. integrate 5. evaluate 6. share outcomes
47
What percent of hospitalized patients are malnourished
40-50%
48
What are nursing diagnoses for nutrion
* inadequate intake * self-care deficit * fluid volume deficite * nutrition imbalances less/more than requirement
49
Restrictions for nutrition
* sodium * fat * calories * protein
50
What does BRAT stand for
* Banana * Rice * Apple sauce * Toast
51
What foods should be avoided for low residue diet?
* Fruits * Vegetables
52
What are the standards for taking vitals for home health
ea. visit
53
Why do some elders become malnourished or dehydrated
staffing issues, not enought time
54
What are common causes in changes in temperature
1. fever 2. hyperexia \> 105.8 3. hyperthermia 4. hypothermia
55
1 degree celsius is equal to an increase in how many beats per min
10
56
Kolvenbach
MEN and WOMEN FOR others. Respect no matter what background
57
Ignatius Tradition
value-centered choices. How we should live, Critical thinking Social responsibility
58
The main objected of the class x3
1) Service Learning 2) Didactus 3) Lab/Clinical
59
Gordon's Functional Health Pattern
Health history//ADL's
60
What are the 3 types of diagnosis
1) Actual 2) Risk for 3) wellness
61
PES stands for
Problem, Etiology, Signs & Symptoms
62
What is the ideal temp for most pathogens
68-109F or 20-43 C
63
What are the super bugs known in hospitals- or these you need to use soap and water
NORA virus, MRSA, C-Diff, VRE, TB
64
In what order do you put on your PPE
1. Gown 2. Mask 3. Glasses 4. Gloves
65
Ignatius Tradition
value-centered choices. How we should live, Critical thinking Social responsibility
66
What is enteral nutrition?
* nutrients through GI tract * "tube feeding" * know there is many diff types
67
Parenteral feeding means?
* short-term * central venous line
68
Ventilation means..
gas in and out of lungs
69
What do we look for in the respiratory rate
rhtymn, rate, depth, quality, effectiveness
70
eupnea means
normal breathing
71
apnea
means temp not breathing
72
Cheyne Stokes
irregular shallow breathing, period of panea. Death approaching..
73
Immobility and ADL can cause risk for
pressure ulcers,
74
-Emia pertains to
blood flow
75
What can poor dental care cause?
1. CV disease 2. diabetes 3. malnutrition 4. stroke 5. pneumonia
76
What can good oral care facilitate?
* improved appetite
77
UAP stands for
Unlicensed assisted personnel "CNA"
78
Why would the nurse instruct nursing assistive personnel (NAP) to hand the patient a mirror before trimming his moustache and beard?
To allow him to point out which areas he would like to have trimmed
79
A patient with diabetes remarks during foot care that she has been letting her skin air-dry after bathing at home because her doctor told her to use plenty of moisturizer on her hands and feet. What should the nurse teach the patient?
towel dry thoroughly
80
What will the nurse do when a gown change is needed for a patient who is receiving intravenous fluids delivered by a pump?
pause the infusion by pressing the sensor on the pump
81
What would the nurse instruct nursing assistive personnel (NAP) to report when performing denture care for a patient?
any cracks
82
What is the purpose of parting the patient’s hair into sections?
to make brushing and combing more effective
83
Is it okay to have a CNA assess pain on a patient?
NO
84
What will the nurse instruct nursing assistive personnel (NAP) to do when measuring a patient’s rectal temperature using an electronic thermometer?
The patient should be placed in the side-lying Sims’ position.
85
What is pulse deficit
The difference btwn apical pulse and radial pulse
86
What is the major health problem resulting from a pulse deficit?
decreased cardiac output
87
Which instruction might the nurse give to nursing assistive personnel (NAP) that is applicable only to tympanic temperature assessment?
Gently tug the pinna backward, up, and out before inserting the probe.
88
What does the systolic measurement represent?
The pressure exerted against the arterial wall.
89
What is the nurse’s priority action if a patient’s radial pulse has an irregular rhythm?
Assess the patient for a pulse deficit.
90
For which patient would the nurse instruct nursing assistive personnel (NAP) to weigh a patient with a bed scale?
patient who has heart failure & inability to bear weight
91
This is a patient's life experiences and patterns of living
Assessment
92
This is the basis for all nursing interventions and of which the nurse is accountable...
Nursing Diagnosis
93
What are the steps to formulate a nursing diagnosis? x3
1. identify the problem 2. diagnostic statement 3. validate
94
Thi is a pattern of related cues and describes the prblem or wellness response
diagnostic label
95
What words should be used when describing an intervention
action words, frequency, amount
96
All nursing interventions directed at solving patient's problems and meeting healthcare needs..
implementation
97
What types of transmission are transported via dust?
Airbone, Droplet
98
What are common types of airborne infections? x 3
1. Varicella 2. TB 3. Measles
99
What PPE do you need for MRS precautions?
full gown, mask, gloves, hand hygiene
100
What are common infections considered to be droplet
Mumps, Flu
101
Which type of precaution do you need to wear a fitted mask (N95)?
Airborne
102
Ignatian Pedagogy Conceptual Model
* Context * Experience * Action * Evaluation
103
What is service learning also, besides just a community service?
Academic Learning, purposeful civic learning
104
What are 3 components of evidence based practice?
1. decisions based on most current research evidence 2. clinical expertise 3. needs/wants of the patient
105
Professional nursing promotes…X4
1. Responsibility 2. Accountability 3. Confidentiality 4. Advocacy
106
What are the 4 components of NANDA
1)Planning 2)Outcome 3) Identity 4)Intervention
107
What does malaise mean & is this local or systemic?
Fatigue, systemic
108
What are the main purposes of hygiene care x 3
1) maintenance of personal hygiene 2)Protection 3)Improve circulation (blood clots, pressure ulcers)
109
Nurse's Role for ADL's x 4
1) assess self care abilities 2)provide assistance w self care/independence 3)promote 4)delegate
110
What should you inform the UAP of
* limitations * amt assistance needed * assisted devices * presence and care of tubes * observation to make during hygiene care
111
Other times to take vitals..
* admission * change in condition * symptms * pre-post *surgery* * pre-post *medication* (cv sys) * pre-post *nursing interventions*
112
this is necessary in the OR and is a hereditary response to anasthetic agents
malignant hyperthermia
113
What was early research focused on
education
114
What is the focus of research now?
patient care
115
Who says we need to do research as a means of improving health and welfare of people?
international council of nursing
116
Dyarthria
* **difficulty chewing** * signs- * pocketing food, slurred speech
117
Dysphagia
* difficulty swallowing * signs * coughing * Speech therapy
118
NPO stands for
* nothing by mouth * Nil Per Os
119
Diet after a procedure
* clear liquid * full liquid-milk shake * pureed * ground * mechanical soft-mashed potatoes * soft * regular
120
In a care plan, an intervention looks a lot like..
a to do list of procedures
121
Diagnosis
Valid influences, compare "clusters", identify related factors
122
Outcome
realistic, something that can be measured, TIME FRAME, unique to PT
123
Planning
establish priorities, refer back to outcomes, plan of care, interventions
124
Implementation
readiness, review interventions, collaborate team members, counseling, refer continuing care
125
What does PQRSTU Stand for
1) Provocative 2)Quality/Quantity 3)Region/Radiation 4) Severity 5) Timing 6)Understanding
126
When is surgical apses necessary?
* intentional perforation of the skin * body cavity, not exposed to outside
127
Name 5 types where patient needs surgical asepsis technique
1. Open Body Cavity 2. Catheter 3. Burns 4. Central Line
128
Clean technique
* removes majority of microorganisms, not everything * no autoclaving
129
How has the nursing field changed over time?
* NCLEX process * Education * Subj/Objective Data * Evidence Based * Research * diversity * responsibile for patient care + outcomes
130
What was the nurse's identity originally?
* only a female job * nursing for infants * meant to "nourish" * used to be spiritual *only* * physical *only* * now it is both
131
identifyi nursing actions that convey a negative image of nursing?
* abuse * neglect * sexual assault * understaffing * drug abuse
132
Steps to Removing PPE
1. Gloves 2. Eyewear 3. Ties on Gown 4. Gown 5. Mask
133
What is our bodies' primary defense
skin