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Final Review for Fall 23 - Part 2
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Which of these is a result of immobility?
 
Bilateral elbow contractures
 
Muscle mass gain
 
Decreased cardiac workload
 
Orthostatic hypertension
The student nurse documents a patient’s pain assessment in the chart. Which of the following is a correct example of documentation?
 
Patient states pain is continuous, throbbing, and an 8/10
 
Patient's pain seems to be continuous and throbbing
 
Patient is sleeping so pain is a 0/10
 
It appears that the patient's pain is about an 8/10
Which of the 5 senses is most commonly affected in dementia patients
 
Smell
 
Hearing
 
Touch
 
Sight
Your patient has been diagnosed with a terminal illness, the patients family member mentions “I want to make the most of the time that I have left with him”. Which form of grief is the patients family member experiencing?
 
Anticipatory Grief
 
Complicated Grief
 
Disenfranchised Grief
 
Mourning
Which IV Fluid should you avoid in a patient with a head injury?
 
0.33% Normal Saline
 
Lactated Ringers
 
5% Dextrose in 0.9% Normal Saline
 
10% Dextrose in 0.45% Normal Saline
What should the nurse do while placing an NG tube if the patient starts to gag uncontrollably?
 
Stop the procedure
 
Have them turn their head to the left
 
Put them in a supine position
 
Ask them to drink the water faster
A young girl’s cat has died. When on the playground she states to her friends, “I can’t wait to get home and play with my cat.” What type of grief is she displaying?
 
Denial
 
Anticipatory
 
Disenfranchised
 
Mourning
What kind of pressure is created by the wound vac?
 
Negative Pressure
 
Positve Pressure
 
Atmospheric Pressure
 
None of the Above
A patient’s wife states, “I can’t imagine trying to plan a funeral for my husband.” What type of grief does this represent?
 
Anticpatory grief
 
Complicated grief
 
Exaggerated grief
 
Disenfranchised grief
Which is NOT benefit of a diet high in fiber?
 
Normalize calcium levels
 
Lower blood cholesterol levels
 
Aid in weight loss
 
Normalize bowel movements
Which patient should the nurse prioritize?
 
sudden shortness of breath
 
severe pain
 
a draining pressue ulcer
 
dementia
How often should you reposition a patient to prevent a pressure ulcer?
 
Every 2 hours
 
Every 12 hours
 
Every 4 hours
 
Every 30 minutes
A nurse is caring for a patient who has been diagnosed with dehydration. Which of the following interventions would be appropriate to promote hydration and maintain normal urine specific gravity?
 
Encourage the patient to drink fluids every hour while awake
 
Administer a diuretic medication to promote urine output.
 
Restrict fluid intake to prevent fluid overload.
 
Monitor patient’s urine output, but do not encourage fluids
True or False? Algor Mortis is the stiffening of mustles post death
False
Which of these is a result of immobility?
 
Bilateral elbow contractures
 
Muscle mass gain
 
Orthostatic hypertension
 
Decreased cardiac workload
The student nurse documents a patient’s pain assessment in the chart. Which of the following is a correct example of documentation?
 
Patient states pain is a continuous, throbbing, 8/10 Patient
 
Patient's pain seems to be continuous and throbbing
 
It appears that the patient's pain is about an 8/10
 
Patient is sleeping so pain is a 0/10
What kinds of incontinence happens during ativities that increase intraabdominal pressure
Stress incontinence
Is it ok to have a bit of sugar in urine?
No, if there is sugar in urine, it should be repeated, and a blood sugar ordered.
95% of nutrient absorption takes place in the small intestine - Fact or Fiction?
Fiction! 90% of digestion also takes place here - 10% in stomach & large intestine
When it is appropraite for the nurse to remove lines and tubes from a deceased patient?
When it has been determined that an autopsy will not be performed
Name 3 things that may cause stress incontinence?
Some answers are: weakened pelvic floor muscles, trauma, childbirth, aging, meds, obesity
Which type of complicated grief involves behaviors that are interfering with normal functioning, but the person grieving is not aware they are doing these to conceal grief.
Masked Grief
A newly admitted patient is in acute pain, has not been sleeping well lately, and is having difficulty breathing. How should the nurse prioritize these problems?
Breathing, Pain, Sleep
Why would a patient need to do this to their food/drink?
Aspiration precautions or dsyphagia
What is an occult blood test?
It tests for blood in stool that cannot be seen
Which of the 5 senses is mostly commonly affected in dementia patients?
Smell, which leads to decreased eating
What is labeled A? Is the blood oxygenated or deoxygenated?
Aorta, oxygenated
Think of respiratory alkalosis and tell us if the pH is high or low and the Co2 is high or low.
pH high and CO2 low
Beef, oysters, shrimp, scallops, spinach, beets, and greens are good sources of _____.
Iron
The nurse documents the periwound tissue as
Maceration
What dose the O in SOLER stand for?
Open Stance
What is stress incontinence?
involuntary loss of urine through an intact urethra due to sneezing, coughing, changing position
What vascular devices are considered to be a central line?
PICC, central venous catheter, port
What is referred pain?
Pain that is perceived in an area distant from it's point of origin
Where is gas exchanged in the human body?
Alveoli
What is the gold standard method for a the nurse confirm placement of an NG tube?
XRAY
A resident points at the water pitcher and asks if you could hand her the blanket, what is this an example of?
Expressive aphasia
It occurs due to external sphincter not opening for release of urine or blockage of urethra leading to increased urine volume and bladder distention
Urinary Retention
CO2 retention causes
Respiratory Acidosis
Blood pH normal levels
7.35 to 7.45
A substance that takes up H+ ions in solution
Base
Substance that releases H+ ions into a solution
Acid