Week 1

Question 0

How is a nursing diagnosis structured?

Answer 0

Diagnosis…r/t…AEB…

Question 1

What are the steps of the nursing process?

Answer 1

Assessment, diagnosis, planning, intervention, evaluation.

Question 2

What is evidence-based practice?

Answer 2

EBP is basing clinical decisions and findings on research and evidence-based theories, physical examination and assessment, clinical expertise and patient values.

Question 3

Cultural competence:

Answer 3

Tailoring care based on the individual’s culture and their own beliefs. Respecting the individual’s values and culture.

Question 4

Cultural sensitivity:

Answer 4

Having a basic understanding of cultural differences and religions.

Question 5

Culturally appropriate:

Answer 5

Utilizing your understanding of culture to tailor care.

Question 6

What is culture?

Answer 6

There is no single definition, but broadly it includes language, beliefs, etiquette, laws, morals, entertainment, education, and sets of dynamically evolving shared traits.

Question 7

Heritage:

Answer 7

Heritage includes a person’s cultural, ethnic, religious and socialization experiences.

Question 8

Ethnicity vs. race:

Answer 8

Ethnicity is the region a person is from and is more closely linked to heritage, while race is genetic (how a person looks) and may not seem to fit within the individual’s ethnic group.

Question 9

Example of race vs. ethnic group:

Answer 9

Irish, English, welsh, German and Scandinavian are all ethnic groups that are considered to be part of the Caucasian race.

Question 10

Heritage consistency:

Answer 10

How much the patient’s lifestyle reflects his/her heritage (traditional v. Modern).

Question 11

Heritage assessment:

Answer 11

The process of identifying factors that may/do affect the individual’s heritage consistency.

Question 12

Autonomy:

Answer 12

The patient’s self determination.

Question 13

Beneficence:

Answer 13

Our need to do good for the patient.

Question 14

Nonmaleficence:

Answer 14

Our need to do no harm to the patient.

Question 15

Utilitarianism:

Answer 15

The appropriate use of resources for the greater good.

Question 16

Fairness and justice:

Answer 16

Our need to give equal treatment to all patients.

Question 17

Deontologic imperatives:

Answer 17

Care delivered according to traditions and cultural contexts.

Question 18

What are the five C’s of communication with patients:

Answer 18

Courtesy, comfort, connection, confirmation, confidentiality.

Question 19

Open-ended questions:

Answer 19

Allow the patient to decide how much or little is shared. They choose the answer.

Question 20

What is the purpose of a direct question?

Answer 20

Direct questions get needed specific answers.

Question 21

Leading questions:

Answer 21

Limit the patient’s answer and may keep them from giving you the truth because you have already implied the “correct answer”

Question 22

How do you ensure that patient understands you and you understand them?

Answer 22

Facilitate ~ get patient to say more
Reflect
Clarify
Empathize
Confront ~ disturbing behavior 
Interpret ~ very similar to reflecting

Question 23

What are some traps of interviewing?

Answer 23

Asking yes/no questions, leading questions, appearing rushed, closed off body language, extreme dress/appearance.

Question 24

What is the structure of a complete health history?

Answer 24

``` Biographical data Source of history Chief complaint Theory of present illness Pst medical history Family history Review of systems Functional assessment ```

Question 25

What is CAGE?

Answer 25

``` CAGE is an acronym for asking/determining whether an individual is an alcoholic. Cutting down Annoyance by criticism Guilty feelings Eye-openers ```

Question 26

What is a complete health history?

Answer 26

It covers everything since you we're and infant.

Question 27

What is an inventory health history?

Answer 27

It covers the process/progress of disease or condition, since last inventory, etc.

Question 28

What is a focused health history?

Answer 28

It focuses on just one issue (ie migraines).

Question 29

What is an interim health history?

Answer 29

It is an update (updates the files).

Question 30

PPQRST

Answer 30

``` Mnemonic to assess symptoms. Precipitating - what causes it Palliative Quality/ quantity Region/ radiation Severity Timing ```

Question 31

What is a general?

Answer 31

It is a family tree with illnesses/diseases of relatives and self.

Question 32

How/why are pertinent negatives used?

Answer 32

Normal is so subjective to interpretation. Pertinent negatives such as denies hx of chest pain is concrete and specific.

Question 33

What are standard universal precautions?

Answer 33

They are precautions used to prevent the spread of infection and they apply to all patients (hand washing, PPE).

Question 34

What is inspection?

Answer 34

It is the use of your eyes, ears and nose to assess symmetry, movement, gross abnormalities and ***signs of distress***.

Question 35

What is palpation?

Answer 35

It is the use of hands/touch for assessment.

Question 36

Light palpation:

Answer 36

Palpate < 1/2 inch | Used for surface characteristic assessment.

Question 37

Deep palpation:

Answer 37

Palpate > 1/2 inch deep | Used to assess organs, masses and tenderness

Question 38

Ballottement:

Answer 38

The type of palpation that requires two hands to assess partially free floating organs (I.e. kidneys).

Question 39

What is the dorsal aspect of the hand best used to assess?

Answer 39

Temperature

Question 40

What are the balls and ulnar surface of the hand best used to assess?

Answer 40

Vibration

Question 41

What are the fingertips/pads best used to assess?

Answer 41

Fine sensations

Question 42

What is percussion?

Answer 42

The use of fingers for pounding for assessment. Hyperextension of middle finger and tap with other middle finger.

Question 43

What is auscultation?

Answer 43

It is listening with (indirect) or without a stethoscope (direct).

Question 44

In what order do you assess the abdomen?

Answer 44

Look, listen, palpate, percuss.

Question 45

In what order do you assess any body region, except the abdomen?

Answer 45

Look, palpate, percuss, listen.

Question 46

True or false: 1) the diaphragm allows you to hear high pitch sounds 2) the bell allows you to hear low pitch sounds

Answer 46

1) true | 2) true

Question 47

Supine position:

Answer 47

Pt lying flat on back.

Question 48

Dorsal recumbent lithotomy position:

Answer 48

Pt on back with legs spread (for pelvic exam).

Question 49

Sims position:

Answer 49

Patient on back with one leg swung over.

Question 50

Prone position:

Answer 50

Pt lying on stomach.

Question 51

Left lateral recumbent position:

Answer 51

Pt lying on side like a board.

Question 52

Knee to chest position:

Answer 52

Pt sits in child's pose. Not often used on adults.

Question 53

What is the general survey and its compenents?

Answer 53

A general survey is the opening to a physical exam and has four general areas: General health state/overall physical appearance Body structure Mobility Behavior

Question 54

What anthropometric measurements should you obtain?

Answer 54

Standing height, weight, frame size (done with elbow), BMI calculation, waist circumference.

Question 55

BMI equations:

Answer 55

(Weight in pounds/height in inches^2)x703

Question 56

What are healthy BMI numbers?

Answer 56

18.5-24.9

Question 57

What circumference at the iliac crest is dangerous for women/men?

Answer 57

> 35" is risky for women | > 40" is risky for men

Question 58

How much of weight gain during pregnancy is from the fetus?

Answer 58

5-10 lb

Question 59

What percent of body weight is often lost in aging adults?

Answer 59

5%

Question 60

What is the 5th vital sign?

Answer 60

Pain

Question 61

What is the Wong/baker pain scale?

Answer 61

Five faces for children to identify pain.

Question 62

What is the oucher scale?

Answer 62

Ten point scale with pictures of children's faces. Available for all races.

Question 63

What is the CRIES assessment?

Answer 63

``` It is used to assess infant pain. Crying Requires oxygen Expression Sleepless ```

Question 64

How do you asses pain non-verbally?

Answer 64

Physiological and behavioral changes. Nausea, vomiting, tachycardia,etc Anxiety, fatigue, confusion, depression.

Question 65

SOAP notes:

Answer 65

``` Used to aid documentation. Subjective - symptoms Objective - signs Assessment - nursing diagnosis Plan - what you as the nurse can do (intervention) ```

Question 66

How is a pt introduction formatted (for documentation)?

Answer 66

Pt's initials, pt age, ethnicity, sex, general health status.

Question 67

In what order should VS be recorded?

Answer 67

Temp, pulse, respirations, BP

Question 68

Goals should be SMART:

Answer 68

``` Specific Measureable Attainable Realistic Time frame ```