FINAL Flashcards
1
Q
What size of needle and at what angle should the student practical nurse use for a slightly obese patient who requires an intradermal injection?
A
27 gauge, ⅝ inch, 15 degrees
2
Q
What site should the student practical nurse use for an intradermal injection on an average size patient?
A
inner aspect of the forearm
3
Q
The physician orders 36 units of nph and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order.
- Inject air equal to nph dose into nph vial
- Invert regular insulin bottle and withdraw regular insulin dose
- Inject air equal to regular dose into regular dose
- Invert nph vial and withdraw nph dose
A
- Answer: 1324
4
Q
Following administration of a sc narcotic the student practical nurse lets the patient know that he will return in 30 mine. What is the purpose of this return?
A
monitor for drug effects
5
Q
The student practical nurse has prepared a narcotic to be administered through a sc catheter. However, some medication must be discarded. What is best practice?
A
the spn documents on the control inventory form
6
Q
Which site is not recommended for im injections?
A
dorsogluteal
7
Q
The student practical nurse has prepared a cognitive patients erd daily dose of im vitamin b12. Prior to administration, the patient states, i have never received an im injection, why are you giving it to me? How should the student respond
A
recheck patient name band and physician order
8
Q
The student practical nurse is to administer an im injection. Why should the z track method be utilized?
A
Decreases irritation and seals the medication into the muscle tissue
9
Q
Which type of oxygen delivery device provides the highest concentration of oxygen?
A
partial rebreather face mask
10
Q
Which of the following is a crucial assessment that the student practical nurse performs for a patient on a non rebreather mask?
A
the attached bag is inflated at all times
11
Q
When suctioning nasopharyngeal secretions, the student practical nurse does not apply suction for more than..
A
15 secs
12
Q
A patient is admitted with pneumonia. Which of the following assessment findings would indicate that the patient needs oropharyngeal suctioning?
A
decreased independent ability to cough and expectorate
13
Q
A patient has been newly diagnosed with emphysema. In discussing his condition with the nurse, which of his statements would indicate a need for further education?
A
if i get short of breath, i’ll turn up my oxygen levels as high as my tank goes
14
Q
A patient is admitted to the emergency department with suspected carbon monoxide poisoning. The son understands that the patient is at a risk for decreased oxygen carrying capacity of blood because carbon monoxide does which of the following:
A
forms a strong bond with hemoglobin
15
Q
The student practical nurse assesses a patient and finds her lying supine in bed. The patient tells the student practical nurse that she feels shortness of breath which should the student practical nurse do first?
A
raise the head of the bed to 45 degrees
16
Q
After having transurethral resection of the prostate (turp), mr. Locke returns to the unit with a three way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the patients catheter is occluded?
A
client reports bladder spasms and the urge to void
17
Q
Mr ford is a carrier of mrsa what precautions should the spn take to prevent spread of mrsa to other patients?
A
mr ford should be moved to a private room and placed on contact precautions
18
Q
The spn is assigned to care for a patient with a deep wound infection. Which action would result in the contamination of sterile gloves?
A
pulling bed linen over patient’s perineum for better draping
19
Q
When transferring. Sterile item to a sterile field, what is the best method used by the spn?
A
open package, and follow the 2.5 borders, remaining sterile
20
Q
What are the four characteristics of wouldnt drainage that must be assessed?
A
type, amount, odour, colour
21
Q
When providing discharge teaching to a patient with a healing abdominal incision which of the following is an appropriate teaching point
A
protect the site and dressing while showering and clean it
22
Q
A female patient with an indwelling urinary catheter is suspected of having a uti. What action does the spn take
A
clamp for 30 minutes and get a culture and sensitivity test
23
Q
The student practice nurse is caring for a patient who is on continuous bladder irrigation. What technique should be used
A
maintain aseptic technique
24
Q
After undergoing turp to treat benign prostate hypertrophy, a male patient returns to the room with continuous bladder irrigation. On the first day after surgery and reports bladder pain, what should the nurses intervention be?
A
assess the irrigation catheter for patency and drainage
25
The spn is caring for a patient on intermittent tube feeds of 350ml four times a day. How often should the spn assess tube placement?
before each feeding occurs, or at least once per shift if not being used
26
Patient is scheduled for feed at 2200 to subsidize nutritional intake from feeding tube, what position should patient be in?
high fowler's
27
A patient with type 1 diabetes has a blood sugar level of 17.2 at bedtime. An order for insulin existet. What should the student nurse do first?
administered insulin as ordered but see when it was administered if all 3 doses have been given you call the doctor
28
define Hypoxia
inadequate tissue oxygenation
29
define dyspnea
difficulty breathing
30
define Orthopnea
inability to breath except in the upright position
31
Oropharyngeal and nasopharyngeal suction is used when
when the patient can cough effectively but is not able to clear secretions
32
Orotracheal and nasotracheal suction is used when?
patient is unable to manage secretions
33
Tracheal suction is used with
an artificial airway
34
what does the Pulse Oximetry do
- A device that measures the oxygen saturation of arterial blood in a subject by utilizing a sensor attached typically to a finger, toe, or ear to determine the percentage of oxyhemoglobin in blood pulsating through a network of capillaries
35
what are 3 ways to maintain and promote lung expansion?
- Position, to help reduce pulmonary stasis, maintains ventilation, and oxygenation
- Incentive spirometry, encourages voluntary deep breathing
- Chest tubes, a catheter is placed through the thorax to remove air and fluids from the pleural space or to prevent air from re-entering or to re-establish intrapleural and intrapulmonary pressures
36
What is The most effective position for patients with cardiopulmonary disease
is the 45-degree semi-fowlers position.
37
what is the Oropharyngeal Airway
- is a medical device called an airway adjunct used to maintain or open a patient's airway. It does this by preventing the tongue from covering the epiglottis, which could prevent the person from breathing
38
What is a nasal cannula?
- A low-flow device used for oxygen delivery. this device consists of a lightweight tube which on one end splits into two prongs which are placed in the nostrils and from which a mixture of air and oxygen flows
39
Oxygen is delivered via the cannulas with a flow rate of? Flow rates greater than 4 L/min require what>
6 L/min.
| -Flow rate greater than 4 L/min, humidification is required.
40
What is an oxygen face mask?
| A simple face mask is used for? It fits loosely and delivers oxygen concentration at what %??
- An oxygen mask is a device used to administer oxygen, humidity, or heated humidity.
- The simple face mask is used for short-term oxygen therapy.
- O2 at 40-60% concentration (5-8L per minute)
41
The partial rebreather mask and non-rebreathing mask are low-flow devices with a reservoir bag. The partial rebreather mask provides and O2 concentration of? with a minimum flow rate of ?
The non-rebreather provides high concentration of O2 at?
- delivers O2 at 40-70% concentration with minimum 10L/min, reservoir bag allows ⅓ of exhaled air to be rebreathed with O2.
- non-rebreather = 60% - 80%, w/ min flow rate of 10 L/min
42
What is gerontology?
- the scientific study of old age, the process of aging, and the particular problems of old people.
43
What are SC specific assessments required?
- SC specifically - assess the patient for factors such as circulatory shock and reduced local tissue perfusion. Assess adequacy of pt’s adipose tissue
- Allergies
44
What angle do you inject for SC for skinny ppl and overweight?
```
skinny = 45 degrees
overweight = 90 degrees
```
45
what are the usual syringe and needle lengths for SC injections?
Syringe - (1-3 mL) needle - (25-27 gauge, 1-1.6cm)
46
When mixing from vial and ampule, which one do you prepare first?
prepare from vial first then ampule
47
Only regular (short-acting) insulin can be administered
Intravenously
48
Insulin: med check 1 inject air into clear or/and cloudy? draw up which one first?
clear (regular) and cloudy (NPH) , inject air in cloudy then clear, draw up the clear
49
Insulin: med check 2 Steps
clear, show instrurcter or nurse the syringe and vial, draw up the cloudy, label
50
Insulin: med check 3 steps
clear and cloudy combination
51
Rapid-acting and short-acting is clear or cloudy?
Clear
52
Intermediate-acting is clear or cloudy?
cloudy
53
long-acting is clear or cloudy?
clear
54
Premixed insulin - NPH clear or cloudy?
cloudy
55
Subcutaneous Butterflies - A device which provides access for subcutaneous medication administration and hypodermoclysis. It is used when?
-This is used when they have frequent subcutaneous injections as frequency of breaking the skin is reduced
56
When giving U-100 insulin, use what syringe and what gauge needles?
use U-100 insulin syringes with preattached 26- to 31- gauge needles
57
With SC butteflies, an additional how many mL of medication is required to prime tubing and injection cap? For when?
0.25 mL with FIRST dose
58
What is the preferred site for administering SC butterflies?
Abdomen
59
For IM injections, what is the safest site for adults and children older than 7 months. It’s deep and not close to any major blood vessels and nerves
Ventrogluteal
60
IM Injections - Patients with developed muscles can tolerate no more
3 mL
61
what syringe size if recommended for IM injections?
syringe - 2-3 mL
62
HOw many mL is recommended for less developed muscles for IM injection?
0.5 mL to 1 mL
63
What needle length and gauge and angle of injection is recommended for IM injections?
length - 1.3 cm - 7.5 cm
Gauge - 18 - 27
angle - 90 degrees
64
What are intradermal injections used for?
used for sensitivity tests, such as TB, allergy, and local anesthesia tests
65
When injection intradermal injections on the forearm, stretch the skin, with the needle almost against patients skin, insert slowly with bevel up at what angle until resistance is felt? then advance through the epidermis to approximately how many mm below the skin surface? If no resistance felt that means?
5 - 15 degree angle. Advance approx 3 mm. Needle tip can be seen though the skin.
- means the needle is too deep, remove and begin again
66
What is the z-track method?
The Z-track method is a type of IM injection technique used to prevent tracking (leakage) of the medication into the subcutaneous tissue (underneath the skin)
67
When injection SC butterflies, ensure bevel is? and yellow wing bubbles are toward? Inject at what angle?
- Ensure bevel is up and yellow wing bubbles are towards the patient (squeezing wings locks the bevel)
- Insert the SC 20-40 degree angle or as policy states **
68
SC butterflies remain insitu for up to how many days? infusion bags are good for?
up to 7 days, bags good for 24 hours
69
What are unexpected outcomes of injection administration ?
- Raised, reddened, or hard zone (induration) around intradermal test site – notify health care provider
- Hypertrophy of skin, resulting from repeated SC injections – Do not use this site in the future, instruct pt not use this site for 6 months
- Signs and symptoms of allergy or adverse effects – follow institutional policy/guidelines. Notify health care provider, add allergy info to med record
- Complaints of localized pain, numbness, tingling, or burning sensation at injection site, indicating possible injury to nerve or tissues
70
Reconstitution of meds: what is it?
Some drugs can be stored in a powder form because they become inactivated after a prolonged amount of time when mixed in a solution
71
Joanne Duffy's quality of care model "maintains
that quality nursing care is based on the use of best evidence and asserts that it is a nursing responsibility to gather and use such evidence in daily practice"
72
- The major purposes of the Quality- Caring Model are to
1) guide professional practice;
2) reaffirm and expose the hidden work of nursing;
3) describe the conceptual-theoretical-empirical link ages between quality of care and human caring; and
4) propose a research agenda that will provide evidence of the value of nursing
73
Imogene King's theory of goal attainment model "provides a
holistic appriach to the study of nursing phenomena as an open system and frees one's thinking from the parts-vs-whole delimma"
74
The theory of goal attainment is linked very closely to the nursing process and patient outcomes, with critical importance of concern for the pt using evidence-based practice. What are the concepts for the Theory of Goal Attainment?
```
self
perception
communication
interaction
transaction
role
growth and development
stress
time
personal space
```
75
The conceptual framework of the PN program emphasizes the relationship between...
patient/family, community and society.
| |Kings theory does the same.
76
sublingual route: Meds are placed where? Patient teachings?
medication is placed under the tongue
- teachings involve patients not to chew or swallow the medication or to drink anything until medication is completely dissolved, medication can be absorbed because under the tongue has a high blood supply, highly vascular
77
Buccal: medication is placed where? teachings?
placed against the mucous membranes of the cheek
- teachings involve to alternate cheeks with each subsequent dose to avoid irritation, teach patients not to chew or swallow the medication, and to not drink anything until medication is dissolved
78
What information should be gathered that can influence med adminstration via the oral route?
lab data, blood glucose, electrolytes, fluid restriction
79
Nursing considerations for nasal route meds?
- Each medication is to be administered separately
- Liquid suspension should be used when available
- Oral pills are crushed and mixed with a small amount of water
- Verify the amount of the time to hold a feeding with agency policy or a pharmacist
- Flush before, in between and after medications
80
Assessment Prior to Administration of nasal Tube
- Assess patient's need for enteral tube feeding such as NPO, functional gastrointestinal tract, inability to ingest sufficient nutrients
- Assess the patency of the nares, and have patient close each nostril alternately and breathe
- Examine the nares for skin breakdown and patency
- Assess the gag reflex by placing a tongue blade in the patient's mouth and touch the uvula
- Order
- Allergies
- Tube placement
- Patency
- Intake and outake
81
for nasal drops, instruct patient to clear or blow out the nose unless otherwise stated. Place pt in what position and to remain for how long? How often should you observe for side effects?
- Placed in supine position, and is to remain in supine for 5 minutes after administration
- Patient can not blow the nose for several minutes
- Observe for side effects 15-30 minutes after systemic reaction may occur
82
With nasal sprays, what position should the pt be in?inform the patient that during administration
- High fowler's or sitting position
- there might be burning to the mucosa or tickling sensation or have a choking sensation as this medication route can affect the throat
83
Steps of Safe Nasogastric, gastric or Feeding Tubes
- Raise the head of the bed into semi or high fowler's position
- Always check the tube placement using x ray
- Use liquid medications when possible, and know what oral tablets can be crushed down
- After verification of tube placement, flush it with 15mL-30mL of warm water
- And always flush between medication administration
- After medication administration flush with 30mL - 60mL
84
- What to assess prior to the administration of enteral tubing route medications?
Tube placement, risk for aspiration, pH of gastric residual should be 0-5.5 for proper tube placement, patency of tube (check by flushing the tube), skin integrity
- Each medication is given separately
- Liquid suspension is to be used when available
- Oral pills are crushed, and mixed with a small amount of water (15-30mL) always start with the lowest mL than work way up
85
Position for Ophthalmic (Eye) Route of Medication
- Supine position if possible or to sit back in a chair with the head slightly hyperextended
86
how long should you wait if the patient has more than 1 eye med for the same eye?
5 min
87
Administration for Eye Drops: instill med where? after instilling, ask pt to close eyes gently otherwise what happens?
When systemic effects occur with meds, what do you do?
- Instill the medication to the conjunctival sac
- Squirting or squeezing of the eyelids forces medication out of the site of administration
- When systemic effects occur with medications, apply gentle pressure, and clean the patients nasolacrimal duct doe 30-60 seconds, with a clean tissue
88
how do you administer Ointment or Topical Route into eye?
- Ask patient to look at the ceiling and apply a thin stream of ointment evenly along the inner edge of the lower eyelid on the conjunctive from the inner canthus to outer canthus
- Get patient to close the eye, while using a cotton ball, rub lightly in the circular motion if rubbing is not contradicted
89
What are nursing considerations for Otic (Ear) Medication Route?
- Instilled drops should be kept at room temperature and remain sterile
- Assess if the eardrum is ruptured and if the patient has drainage
- Never occlude the ear canal with a dropper or syringe
- Apply gentle pressure to the tragus after administration unless pain is stated, do this for around 3-4 times
- Position patient in side lying position, unless otherwise stated
90
how do you straighten the ear canal for children under 3 and adults? How long should pt remain in position?
- In children under 3 years of age, pull the auricle down and back
- In adults, pull the auricle upward and outward
- Patient is to remain in the position 2-3 minutes after administration
- Place the cotton ball into the outermost part of the ear if needed
91
how do you remove and dispose of patches
wearing clean gloves peel horizontally along the skin, fold adhesive side together and suppose into the sharps container
92
Vaginal Medication Route: Bladder is to be emptied prior to administration. What position should the patient be in and remain for how long?
- Place the patient in dorsal recumbent position, and is to lie in the position for at least 10 minutes for proper absorption
93
Rectal Medication Routes Can have local effects such as ? Position and length of time to remain?
promoting defecation or systemic effects such as reducing nausea.
- Position the patient into left lateral otherwise known as sims position to expose the anus and relax the external anal sphincter, the patient is to remain flat on on the side for 5 minutes to prevent expulsion of the suppository
94
Instilled drops should be at room temperature and stay sterile. Why?
Internal ear structures are very sensitive to temperature extremes. Failure to instill ear drops or irrigating fluid at room temperature may cause vertigo or nausea.
Sterile solutions and drops are used in case the eardrum is ruptured
95
Vaginal and rectal: With dominant hand: insert a suppository along the posterior wall of vaginal canal for the entire length of your finger (L) insert the applicator approx. ______ cm, then push the plunger to deposit medication (R)
5-7.5 cm
96
Rectal Instillations: Lubricate the rounded end then place the suppository past internal sphincter and against the rectal mucosa. Why?
- Otherwise it can be expelled before it can dissolve and be absorbed into the mucosa
97
What are metered dose inhalers (MDI)?
- Delivers a measured dose of medication with each push
- Either squeeze and breathe inhalers or inhalers that activated by the patient's breath
- Can be used with a spacer (allows particles of medication to slow down and break into smaller pieces which improves absorption)
98
what are Dry Powder Inhaler (PDI)?
- Hold dry, powdered medication which creates an aerosol when the patient inhales
- Patients do not need to coordinate puffs with inhalation
- Spacer is not needed
- And the medication can clump with humid climate
99
what should be assessed prior to administering inhaled medications?
- Assess the respiratory pattern
- Auscultate the patient's breath sounds
- Assess the patient's ability to hold, manipulate, and depress the canister, assess the strength of inhalation
- Assess the patient's readiness and ability to learn, assess the knowledge and understanding
100
Teaching points safely administer by MDI or DPI
- Shake the inhaler vigorously 5-6 times ( do not shake inhaler for DPI or breath-activaed MDI)
- Inhale slowly and deeply through the mouth for 3-5 seconds while depressing the canister
- Hold the breath for approximately 10 seconds after
- Rinse mouth after inhalation
101
how do you determine when the MDI or PDI is empty and needs to be replaced
Divide the capacity of the canister by the number of doses the patient takes per day
102
what is a pathogen
Capable of causing disease, infection can result from the entry and multiplication of a pathogen in the host
103
The potential for microorganisms to cause disease depends on
- Number
- Virulence
- Ability to enter and survive in the host
- Susceptibility
104
Medical Asepsis vs surgical asepsis
Medical Asepsis: Clean technique
- Procedures used to decrease and prevent the spread of microorganisms (hand hygiene, clean gloves, cleaning the environment)
- An area is considered CONTAMINATED if it contains or is suspected of containing pathogens
- Absence of most but not all microorganisms
Surgical Asepsis :Sterile technique
- Procedure that eliminates all microorganisms
- An area or object is considered CONTAMINATED if it is touched by any object that is not sterile, or any breaks in technique
- Governed by principles that help maintain sterility
