-
Which term best describes the science of nursing?
a. The skilled application of knowledge
b. The knowledge base for care
c. Hands-on care, such as giving a bath
d. Respect for each individual patient
The correct response is b.
The science of nursing is the knowledge base for care that is provided. In contrast, the skilled application of knowledge is the art of nursing.
-
Which nurse in history is credited with establishing nursing education?
a. Clara Barton
b. Lillian Wald
c. Lavinia Dock
d. Florence Nightingale
The correct response is d.
Florence Nightingale established nursing education.
-
What historic event in the 20th century led to an increased emphasis on nursing and broadened the role of nurses?
a. Religious reform
b. Crimean War
c. World War II
d. Vietnam War
The correct response is c.
During World War II, large numbers of women worked outside the home. There was an increased emphasis on education and a knowledge explosion in medicine and technology, broadening the roles of nurses.
-
You are teaching a class of junior-high students about the effects of smoking. This educational program will meet which of the aims of nursing?
a. Promoting health
b. Preventing illness
c. Restoring health
d. Facilitating coping with disability or death
The correct response is b.
Educational programs, such as the risks of smoking, can reduce the risk of illness and promote good health habits.
-
Which of the following nursing degrees prepares a nurse for advanced practice as a clinical specialist or nurse practitioner?
a. LPN
b. ADN
c. BSN
d. Master's degree
The correct response is d.
A master's degree prepares advanced practice nurses.
-
Which nursing organization was the first international organization of professional women?
a. ICN
b. ANA
c. NLN
d. NSNA
The correct response is a.
The ICN, founded in 1899, was the first international organization of professional women.
-
What is the purpose of the ANA's Scope and Standards of Practice?
a. To describe the ethical responsibility of nurses
b. To define the activities that are special and unique to nursing
c. To establish nursing as an independent and free-standing profession
d. To regulate the practice of nursing
The correct response is b.
The ANA's Scope and Standards of Practice define the activities of nurses that are specific and unique to nursing.
-
What type of authority regulates the practice of nursing?
a. International standards and codes
b. Federal guidelines and regulations
c. State nurse practice acts
d. Institutional policies
The correct response is c.
Nurse practice acts are established in each state to regulate the practice of nursing.
-
What is a 3 point gait?
The most common gait pattern when one extremity is involved.
Sequence is crutches and weak leg (if weight bearing is allowed)....then strong leg.
-
What is a 4 point gait?
Used when there is general lower extremity weakness or both legs are equally involved.
Sequence is right crutch, left foot, left crutch, right foot. Slowest.
-
What is a 2 point gait?
Progression of a 4pt gait.
Sequence is right crutch and left foot, then left crutch and right foot.
-
What is ROM?
Range of Motion
-
What is Isotonic exercise?
Cjange in length of muscle producing movement.
Examples: running, walking, swimming etc
-
What are Isokentic exercises?
Change in length of muscle producing movement with resistance.
Examples: knee or elbow rehab....like joint and muscles through ROM with a weight added.
-
What are Isometric exercises?
Increased muscle tension with little or no change in muscle length.
Examples: Tighten ab muscles, backward bending of hand or foot, pinch buttocks together.
-
What is abduction?
Movement of an extremity away from the midline of the body.
-
What is adduction?
Movement of an extremity toward the midline of the body.
-
What is dorsiflexion?
Flexion of the toes and foot upward.
-
What is plantar flexion?
Bending of the toes and foot downward.
-
What is supination?
Movement of a body part so front or ventral surfaces faces upward.
-
What is pronation?
Movement of a body part so front or ventral surface faces downward. Hand forearm.
-
What is extension?
Movement increasing the angle between two adjoining bones. Elbow, knee, fingers.
-
What is flexion?
Movement decreasing the angle between two adjoining bones; bending of a limb. Elbow, fingers, knee.
-
What is Hyperextension?
Movement of a body part beyond its normal resting extended position. Head.
-
What is eversion?
Turning of the body part away from the midline. Foot.
-
What is inversion?
Turning of the body part toward the midline. Foot.
-
What are nosocomial infections?
an infection acquired in a hospital
-
What is medical asepsis?
clean technique, refers to the practice of controlling and reducing the number of organisms in the environment.
-
What is ROJM?
Range of joint motions
-
What are chemical restraints?
a medication that accomplishes the physical or psychological limitations of the person's ability to manipulate the environment
-
What is ankylosis?
fixation or immobilization of a joint
-
What is atelectasis?
incomplete expansion or collapse of the lungs
-
What is Atrophy?
decrease in the size of a body structure
-
What is flaccidity?
decrease in muscle tone
-
What is flexion?
state of being bent
-
What is fowler's position?
semi-sitting position with the head of the bed raised 45 degrees to 60 degrees
-
What is osteoporosis?
condition characterized by loss of calcium from bone tissue
-
What is semi-fowler's position?
low, semi-sitting position with the head of the bed raised 15-30 degrees.
-
What is supination?
assumption of the supine position, such as lying on their back
-
What is the supine position?
patient lies flat on their back with their legs together (dorsal position)
-
What is the sims position?
patient is on their side with the top knee flexed sharply into the abdomen and lower knee less sharply flexed
-
What is Tonus?
normal, partially steady state of muscle contraction
-
What is febrile?
A person with a fever.
-
What is hyperprexia?
A person with a high fever, above 105.8
-
What are the physicial effects (symptoms) of fevers?
Patients with fever usually experience loss of appetite, headache, hot, dry skin, flushed face, thirst, and general malaise.
Young children or other people with high fevers may experience periods of delirium or seizures.
Observing for other potentially dangerous manifestations of a fever, such as dehydration, decreased urinary output, and rapid heart rate, is an important nursing assessment.
-
What is a remittent fever?
The body temperature fluctuates several degrees more than 2°C (3.6°F) above normal but does not reach normal between fluctuations.
-
What is an intermittent fever?
The body temperature alternates regularly between a period of fever and a period of normal or subnormal temperature.
-
What is a relapsing fever?
The body temperature returns to normal for at least a day, but then the fever recurs.
-
What many beats per minute determines if someone is tachycardic?
greater than 100 BPM
-
How many beats per minute determine if someone is bradycardic?
Less than 60, however, less than 50 is usually when the pt is symptomatic.
-
What is a NORMAL pulse AMPLITUDE?
3+
Pulsation is easily felt, takes moderate pressure to cause it to disappear.
-
What is a BOUNDING pulse AMPLITUDE?
4+
The pulsation is strong and does not disappear with moderate pressure.
-
What is a WEAK pulse AMPLITUDE?
2+
Stronger than a thready pulse; light pressure causes it to disappear
-
What is a THREADY pulse AMPLITUDE?
1+
is not easily felt, and slight pressure causes it to disappear.
-
What is a ABSENT pulse AMPLITUDE?
0
No pulsation is felt despite extreme pressure.
-
What is apnea?
Apnea refers to periods during which there is no breathing. If apnea lasts longer than 4 to 6 minutes, brain damage and death might occur.
-
What is dyspnea?
Dyspnea is difficult or labored breathing. A dyspneic patient usually has rapid, shallow respirations and appears anxious.
-
What is orthopnea?
Dyspneic people can often breathe more easily in an upright position, a condition known as orthopnea
-
What is the normal number of breaths/respirations per minute?
12–20 breaths/min
-
What is Cheyne-Stokes respirations?
Alternating periods of deep, rapid breathing followed by periods of apnea; regular
Caused by: Drug overdose, heart failure, increased intracranial pressure, renal failure
-
What are Biot's respirations?
Varying depth and rate of breathing, followed by periods of apnea; irregular
Caused by: Meningitis, severe brain damage
-
What is a normal blood pressure?
In regard to risk of heart disease, optimal is defined as less than 120/80 mm Hg.
-
What is hypertension?
High blood pressure
-
What is Circadian rhythm?
Normal fluctuations occur during the day. The blood pressure is usually lowest on arising in the morning. The blood pressure has been noted to rise as much as 5 to 10 mm Hg by late afternoon, and it gradually falls again during sleep.
-
What is Orthostatic hypotension (postural hypotension)?
Orthostatic hypotension (postural hypotension) is a low blood pressure associated with weakness or fainting when one rises to an erect position (either supine to sitting, supine to standing, or sitting to standing).
It is the result of peripheral vasodilation without a compensatory rise in cardiac output. Patients most at risk for postural hypotension are older adults, patients who have been on prolonged bed rest, and those who are dehydrated or have sustained a significant blood loss. Some drugs, such as meperidine hydrochloride (Demerol) cause hypotension.
Arising and moving about slowly, especially after a period of bed rest, might prevent orthostatic hypotension. When ambulating the postoperative patient, the nurse should first raise the head of the bed, then assist the client to a sitting position on the side of bed (often called “dangling”) for a few minutes to assess for dizziness or faintness, and then assist to a standing position. If the patient becomes dizzy or feels faint, he or she should be returned to bed and placed in a supine position, which restores blood flow to the brain.
-
An elevation of the body temperature above normal is labeled
a. Fever
b. Hypothermia
c. Hypertension
d. Afebrile
The correct response is a.
Fever is an elevation of body temperature.
Hypothermia (b) is low body temperature. Hypertension (c) is elevated blood pressure. Afebrile (d) means that there is no elevation of body temperature.
-
For which of the following patients would you use an oral thermometer?
a. 6-month-old infant
b. Patient receiving oxygen therapy by mask
c. 42-year-old healthy woman
d. Unconscious patient
The correct response is c.
Use of oral thermometers is contraindicated in infants (a), patients receiving oxygen therapy (b), and unconscious patients (d).
-
Insertion of a rectal thermometer may cause a potentially harmful condition. This condition is
a. An increase in heart rate
b. A decrease in heart rate
c. An involuntary loss of stool
d. An increase in respirations
The correct response is b.
Insertion of a rectal thermometer may stimulate the vagus nerve, which, in turn, would decrease heart rate. This may potentially be harmful for patients with cardiac problems.
-
While taking an adult patient's pulse, a student finds the rate to be 140 beats/min. What should the student do next?
a. Check the pulse again in 2 hours.
b. Check the blood pressure.
c. Record the information.
d. Report the rate.
The correct response is d.
A rate of 140 beats/min in an adult is an abnormal pulse and should be reported to the instructor or the nurse in charge of the patient.
-
A patient complains of severe abdominal pain. When assessing the vital signs, the nurse would not be surprised to find
a. An increase in the pulse rate
b. A decrease in body temperature
c. A decrease in blood pressure
d. An increase in body temperature
The correct response is a.
The pulse often increases when an individual is experiencing pain. Pain does not affect body temperature and may increase (not decrease) blood pressure.
-
What equipment is necessary to assess the apical pulse?
a. Sphygmomanometer
b. Electronic thermometer
c. Stethoscope
d. Doppler apparatus
The correct response is c.
The apical pulse can only be assessed by listening with a stethoscope.
-
The difference between the apical and radial pulse rates is called the
a. Pulse deficit
b. Pulse amplitude
c. Ventricular rhythm
d. Heart arrhythmia
The correct response is a.
The difference between the apical and radial pulse rate is called the pulse deficit. The other responses are names given to volume and rhythm of the pulse.
-
The normal respiratory rate in adults is considered to be
a. 1 to 6 breaths/min
b. 12 to 20 breaths/min
c. 60 to 80 breaths/min
d. 100 to 120 breaths/min
The correct response is b. The normal respiratory rate for adults is 12 to 20 breaths/min.
-
A patient is having dyspnea. What would the nurse do first?
a. Remove pillows from under the head
b. Elevate the head of the bed
c. Elevate the foot of the bed
d. Take the blood pressure
The correct response is b.
Dyspnea is difficult respirations. Elevating the head of the bed allows the abdominal organs to descend, giving the diaphragm greater room for expansion and facilitating lung expansion. Any other intervention would not facilitate respirations.
-
What does the blood pressure measure?
a. Flow of blood through the circulation
b. Force of blood against arterial walls
c. Force of blood against venous walls
d. Flow of blood through the heart
The correct response is b.
Blood pressure is the measurement of the force of blood against arterial walls. Other responses are incorrect in describing blood pressure.
-
With aging, blood pressure is often higher due to
a. Loss of muscle mass
b. Changes in exercise and diet
c. Decreased peripheral resistance
d. Decreased elasticity in arterial walls
The correct response is d.
With aging, elasticity in arterial walls is decreased, contributing to an elevated blood pressure reading. The other responses may contribute to changes in readings, but they are not the physiologic basis for blood pressure findings in the older adult.
-
A patient has a blood pressure reading of 130/90 mm Hg when visiting a clinic. The nurse would recommend
a. Follow-up measurements of blood pressure
b. Immediate treatment by a physician
c. Nothing, because the nurse considers this reading is due to anxiety
d. A change in diet and exercise
A.
A single blood pressure reading that is mildly elevated is not significant, but the measurement should be taken again over time to determine if hypertension is a problem. The nurse would recommend a return visit to the clinic for a recheck.
-
In recording a blood pressure of 120/80 mm Hg, the 120 represents the
a. Pulse rate
b. Diastolic pressure
c. Systolic pressure
d. Pulse deficit
C.
The systolic pressure is 120 mm Hg. The diastolic pressure is 80 mm HG. The other responses relate to pulse rather than blood pressure.
-
A patient has intravenous fluids infusing in the right arm. When taking a blood pressure on this patient, the nurse would
a. Take the blood pressure in the right arm
b. Take the blood pressure in the left arm
c. Use the smallest possible cuff
d. Report inability to take the blood pressure
The correct response is b.
The blood pressure should be taken in the arm opposite the one with the infusion. Blood pressure should not be taken in the arm with an intravenous infusion because the pressure of inflating the cuff may allow the artery to clot.
-
What is an Antipyretic?
agent that reduces fever
-
What are adventitious sounds?
Abnormal breath sounds heard over the lungs.
-
What is auscultation?
listening for sounds within the body
-
What is a bigeminal pulse?
Pulse rhythm in which every two pulsations is followed by a pause.
-
What is Cardiac Output?
volume of blood pumped from the left ventricle per minute
-
What is Crisis?
point at which body temperature drops rapidly to normal.
-
What is Eupnea?
Normal respirations.
-
What is hypotension?
Blood pressure below the lower limits of normal.
-
What is Friction Rub?
crackling sounds heard in the chest cavity, caused by inflamed pleura rubbing against the chest wall
-
What are Korotkoff sounds?
Series of sounds that correspond to changes in blood flow through an artery as pressure is released.
-
What is lysis?
gradual return of an elevated body temperature to normal
-
What is peripheral resistance?
Restraint to blood flow created by arterial walls in a partial state of contraction
-
What is polypnea?
Fast respiration rate; synonym for tachypnea.
-
What is Rales?
Abnormal lung sound described as crackling in nature.
-
What are the normal values for K?
3.5 - 5
-
What are the normal values for Na?
135 - 145
-
What are the normal values for Ca?
8.5 - 11
-
What are the normal pH values?
7.35 - 7.45
-
What are the normal SaO2 levels?
95 - 100
-
What is a normal pulse?
60 - 100 BPM
-
What are the factors affecting pulse?
Exercise, gender, drugs, hemmorrhage, postural change, pulmonary disease, temperature, environment
-
What are the normal number of respirations per minute in an adult?
14 - 22
-
What is the maximum (high normal) BP that is still considered normal?
140/90....120/80 is the "Classic" normal.
|
|
