FUNDAMENTALS OF NURSING - NURSESLABS BULLETTED

 A blood pressure cuff that’s too narrow can cause a falsely elevated blood  A patient who can’t write his name to give consent for treatment must make an
pressure reading. X in the presence of two witnesses, such as a nurse, priest, or physician.
 When preparing a single injection for a patient who takes regular and neutral  The Z-track I.M. injection technique seals the drug deep into the muscle,
protein Hagedorn insulin, the nurse should draw the regular insulin into the thereby minimizing skin irritation and staining. It requires a needle that’s 1″
syringe first so that it does not contaminate the regular insulin. (2.5 cm) or longer.
 Rhonchi are the rumbling sounds heard on lung auscultation. They are more  In the event of fire, the acronym most often used is RACE. (R) Remove the
pronounced during expiration than during inspiration. patient. (A) Activate the alarm. (C) Attempt to contain the fire by closing the
 Gavage is forced feeding, usually through a gastric tube (a tube passed into the door. (E) Extinguish the fire if it can be done safely.
stomach through the mouth).  A registered nurse should assign a licensed vocational nurse or licensed
 According to Maslow’s hierarchy of needs, physiologic needs (air, water, food, practical nurse to perform bedside care, such as suctioning and drug
shelter, sex, activity, and comfort) have the highest priority. administration.
 The safest and surest way to verify a patient’s identity is to check the  If a patient can’t void, the first nursing action should be bladder palpation to
identification band on his wrist. assess for bladder distention.
 In the therapeutic environment, the patient’s safety is the primary concern.  The patient who uses a cane should carry it on the unaffected side and advance
 Fluid oscillation in the tubing of a chest drainage system indicates that the it at the same time as the affected extremity.
system is working properly.  To fit a supine patient for crutches, the nurse should measure from the axilla to
 The nurse should place a patient who has a Sengstaken-Blakemore tube in the sole and add 2″ (5 cm) to that measurement.
semi-Fowler position.  Assessment begins with the nurse’s first encounter with the patient and
 The nurse can elicit Trousseau’s sign by occluding the brachial or radial artery. continues throughout the patient’s stay. The nurse obtains assessment data
Hand and finger spasms that occur during occlusion indicate Trousseau’s sign through the health history, physical examination, and review of diagnostic
and suggest hypocalcemia. studies.
 For blood transfusion in an adult, the appropriate needle size is 16 to 20G.  The appropriate needle size for insulin injection is 25G and 5/8″ long.
 Intractable pain is pain that incapacitates a patient and can’t be relieved by  Residual urine is urine that remains in the bladder after voiding. The amount of
drugs. residual urine is normally 50 to 100 ml.
 In an emergency, consent for treatment can be obtained by fax, telephone, or  The five stages of the nursing process are assessment, nursing diagnosis,
other telegraphic means. planning, implementation, and evaluation.
 Decibel is the unit of measurement of sound.  Assessment is the stage of the nursing process in which the nurse continuously
 Informed consent is required for any invasive procedure. collects data to identify a patient’s actual and potential health needs.
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 Nursing diagnosis is the stage of the nursing process in which the nurse makes  Hand washing is the single best method of limiting the spread of
a clinical judgment about individual, family, or community responses to actual microorganisms. Once gloves are removed after routine contact with a patient,
or potential health problems or life processes. hands should be washed for 10 to 15 seconds.
 Planning is the stage of the nursing process in which the nurse assigns  To perform catheterization, the nurse should place a woman in the dorsal
priorities to nursing diagnoses, defines short-term and long-term goals and recumbent position.
expected outcomes, and establishes the nursing care plan.  A positive Homan’s sign may indicate thrombophlebitis.
 Implementation is the stage of the nursing process in which the nurse puts the  Electrolytes in a solution are measured in milliequivalents per liter (mEq/L). A
nursing care plan into action, delegates specific nursing interventions to milliequivalent is the number of milligrams per 100 milliliters of a solution.
members of the nursing team, and charts patient responses to nursing  Metabolism occurs in two phases: anabolism (the constructive phase) and
interventions. catabolism (the destructive phase).
 Evaluation is the stage of the nursing process in which the nurse compares  The basal metabolic rate is the amount of energy needed to maintain essential
objective and subjective data with the outcome criteria and, if needed, modifies body functions. It’s measured when the patient is awake and resting, hasn’t
the nursing care plan. eaten for 14 to 18 hours, and is in a comfortable, warm environment.
 Before administering any “as needed” pain medication, the nurse should ask  The basal metabolic rate is expressed in calories consumed per hour per
the patient to indicate the location of the pain. kilogram of body weight.
 Jehovah’s Witnesses believe that they shouldn’t receive blood components  Dietary fiber (roughage), which is derived from cellulose, supplies bulk,
donated by other people. maintains intestinal motility, and helps to establish regular bowel habits.
 To test visual acuity, the nurse should ask the patient to cover  Alcohol is metabolized primarily in the liver. Smaller amounts are metabolized
each eye separately and to read the eye chart with glasses and without, as by the kidneys and lungs.
appropriate.  Petechiae are tiny, round, purplish red spots that appear on the skin and
 When providing oral care for an unconscious patient, to minimize the risk mucous membranes as a result of intradermal or submucosal hemorrhage.
of aspiration, the nurse should position the patient on the side.  Purpura is a purple discoloration of the skin that’s caused by blood
 During assessment of distance vision, the patient should stand 20′ (6.1 m) from extravasation.
the chart.  According to the standard precautions recommended by the Centers for
 For a geriatric patient or one who is extremely ill, the ideal room temperature Disease Control and Prevention, the nurse shouldn’t recap needles after use.
is 66° to 76° F (18.8° to 24.4° C). Most needle sticks result from missed needle recapping.
 Normal room humidity is 30% to 60%.  The nurse administers a drug by I.V. push by using a needle and syringe to
deliver the dose directly into a vein, I.V. tubing, or a catheter.
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 When changing the ties on a tracheostomy tube, the nurse should leave the old  In a patient who has a cardiac disorder, measuring temperature rectally may
ties in place until the new ones are applied. stimulate a vagal response and lead to vasodilation and decreased cardiac
 A nurse should have assistance when changing the ties on a tracheostomy tube. output.
 A filter is always used for blood transfusions.  When recording pulse amplitude and rhythm, the nurse should use these
 A four-point (quad) cane is indicated when a patient needs more stability than descriptive measures: +3, bounding pulse (readily palpable and forceful); +2,
a regular cane can provide. normal pulse (easily palpable); +1, thready or weak pulse (difficult to detect);
 A good way to begin a patient interview is to ask, “What made you seek and 0, absent pulse (not detectable).
medical help?”  The intraoperative period begins when a patient is transferred to the operating
 When caring for any patient, the nurse should follow standard precautions for room bed and ends when the patient is admitted to the postanesthesia care unit.
handling blood and body fluids.  On the morning of surgery, the nurse should ensure that the informed consent
 Potassium (K+) is the most abundant cation in intracellular fluid. form has been signed; that the patient hasn’t taken anything by mouth since
 In the four-point, or alternating, gait, the patient first moves the right crutch midnight, has taken a shower with antimicrobial soap, has had mouth care
followed by the left foot and then the left crutch followed by the right foot. (without swallowing the water), has removed common jewelry, and has
 In the three-point gait, the patient moves two crutches and the affected leg received preoperative medication as prescribed; and that vital signs have been
simultaneously and then moves the unaffected leg. taken and recorded. Artificial limbs and other prostheses are usually removed.
 In the two-point gait, the patient moves the right leg and the left crutch  Comfort measures, such as positioning the patient, rubbing the patient’s back,
simultaneously and then moves the left leg and the right crutch simultaneously. and providing a restful environment, may decrease the patient’s need for
 The vitamin B complex, the water-soluble vitamins that are essential for analgesics or may enhance their effectiveness.
metabolism, include thiamine (B1), riboflavin (B2), niacin (B3), pyridoxine  A drug has three names: generic name, which is used in official publications;
(B6), and cyanocobalamin (B12). trade, or brand, name (such as Tylenol), which is selected by the drug
 When being weighed, an adult patient should be lightly dressed and shoeless. company; and chemical name, which describes the drug’s chemical
 Before taking an adult’s temperature orally, the nurse should ensure that the composition.
patient hasn’t smoked or consumed hot or cold substances in the previous 15  To avoid staining the teeth, the patient should take a liquid iron preparation
minutes. through a straw.
 The nurse shouldn’t take an adult’s temperature rectally if the patient has a  The nurse should use the Z-track method to administer an I.M. injection of iron
cardiac disorder, anal lesions, or bleeding hemorrhoids or has recently dextran (Imferon).
undergone rectal surgery.  An organism may enter the body through the nose, mouth, rectum, urinary or
reproductive tract, or skin.
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 In descending order, the levels of consciousness are alertness, lethargy, stupor, Place both arms well under the patient’s hips, and straighten the back while
light coma, and deep coma. moving the patient toward the edge of the bed.
 To turn a patient by logrolling, the nurse folds the patient’s arms across the  When being measured for crutches, a patient should wear shoes.
chest; extends the patient’s legs and inserts a pillow between them, if needed;  The nurse should attach a restraint to the part of the bed frame that moves with
places a draw sheet under the patient; and turns the patient by slowly and the head, not to the mattress or side rails.
gently pulling on the draw sheet.  The mist in a mist tent should never become so dense that it obscures clear
 The diaphragm of the stethoscope is used to hear high-pitched sounds, such as visualization of the patient’s respiratory pattern.
breath sounds.  To administer heparin subcutaneously, the nurse should follow these steps:
 A slight difference in blood pressure (5 to 10 mm Hg) between the right and Clean, but don’t rub, the site with alcohol. Stretch the skin taut or pick up a
the left arms is normal. well-defined skin fold. Hold the shaft of the needle in a dart position. Insert the
 The nurse should place the blood pressure cuff 1″ (2.5 cm) above the needle into the skin at a right (90-degree) angle. Firmly depress the plunger,
antecubital fossa. but don’t aspirate. Leave the needle in place for 10 seconds. Withdraw the
 When instilling ophthalmic ointments, the nurse should waste the first bead of needle gently at the angle of insertion. Apply pressure to the injection site with
ointment and then apply the ointment from the inner canthus to the outer an alcohol pad.
canthus.  For a sigmoidoscopy, the nurse should place the patient in the knee-chest
 The nurse should use a leg cuff to measure blood pressure in an obese patient. position or Sims’ position, depending on the physician’s preference.
 If a blood pressure cuff is applied too loosely, the reading will be falsely  Maslow’s hierarchy of needs must be met in the following order: physiologic
lowered. (oxygen, food, water, sex, rest, and comfort), safety and security, love and
 Ptosis is drooping of the eyelid. belonging, self-esteem and recognition, and self-actualization.
 A tilt table is useful for a patient with a spinal cord injury,  When caring for a patient who has a nasogastric tube, the nurse should apply a
orthostatic hypotension, or brain damage because it can move the patient water-soluble lubricant to the nostril to prevent soreness.
gradually from a horizontal to a vertical (upright) position.  During gastric lavage, a nasogastric tube is inserted, the stomach is flushed,
 To perform venipuncture with the least injury to the vessel, the nurse should and ingested substances are removed through the tube.
turn the bevel upward when the vessel’s lumen is larger than the needle and  In documenting drainage on a surgical dressing, the nurse should include the
turn it downward when the lumen is only slightly larger than the needle. size, color, and consistency of the drainage (for example, “10 mm of brown
 To move a patient to the edge of the bed for transfer, the nurse should follow mucoid drainage noted on dressing”).
these steps: Move the patient’s head and shoulders toward the edge of the bed.  To elicit Babinski’s reflex, the nurse strokes the sole of the patient’s foot with
Move the patient’s feet and legs to the edge of the bed (crescent position). a moderately sharp object, such as a thumbnail.
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 A positive Babinski’s reflex is shown by dorsiflexion of the great toe and  Skeletal traction, which is applied to a bone with wire pins or tongs, is the
fanning out of the other toes. most effective means of traction.
 When assessing a patient for bladder distention, the nurse should check the  The total parenteral nutrition solution should be stored in a refrigerator and
contour of the lower abdomen for a rounded mass above the symphysis pubis. removed 30 to 60 minutes before use. Delivery of a chilled solution can cause
 The best way to prevent pressure ulcers is to reposition the bedridden patient at pain, hypothermia, venous spasm, and venous constriction.
least every 2 hours.  Drugs aren’t routinely injected intramuscularly into edematous tissue because
 Antiembolism stockings decompress the superficial blood vessels, reducing they may not be absorbed.
the risk of thrombus formation.  When caring for a comatose patient, the nurse should explain each action to
 In adults, the most convenient veins for venipuncture are the basilic and the patient in a normal voice.
median cubital veins in the antecubital space.  Dentures should be cleaned in a sink that’s lined with a washcloth.
 Two to three hours before beginning a tube feeding, the nurse should aspirate  A patient should void within 8 hours after surgery.
the patient’s stomach contents to verify that gastric emptying is adequate.  An EEG identifies normal and abnormal brain waves.
 People with type O blood are considered universal donors.  Samples of feces for ova and parasite tests should be delivered to the
 People with type AB blood are considered universal recipients. laboratory without delay and without refrigeration.
 Hertz (Hz) is the unit of measurement of sound frequency.  The autonomic nervous system regulates the cardiovascular and respiratory
 Hearing protection is required when the sound intensity exceeds 84 dB. systems.
Double hearing protection is required if it exceeds 104 dB.  When providing tracheostomy care, the nurse should insert the catheter gently
 Prothrombin, a clotting factor, is produced in the liver. into the tracheostomy tube. When withdrawing the catheter, the nurse should
 If a patient is menstruating when a urine sample is collected, the nurse should apply intermittent suction for no more than 15 seconds and use a slight
note this on the laboratory request. twisting motion.
 During lumbar puncture, the nurse must note the initial intracranial pressure  A low-residue diet includes such foods as roasted chicken, rice, and pasta.
and the color of the cerebrospinal fluid.  A rectal tube shouldn’t be inserted for longer than 20 minutes because it can
 If a patient can’t cough to provide a sputum sample for culture, a heated irritate the rectal mucosa and cause loss of sphincter control.
aerosol treatment can be used to help to obtain a sample.  A patient’s bed bath should proceed in this order: face, neck, arms, hands,
 If eye ointment and eyedrops must be instilled in the same eye, the eyedrops chest, abdomen, back, legs, perineum.
should be instilled first.  To prevent injury when lifting and moving a patient, the nurse should
 When leaving an isolation room, the nurse should remove her gloves before primarily use the upper leg muscles.
her mask because fewer pathogens are on the mask.
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 Patient preparation for cholecystography includes ingestion of a contrast  As nutrients move through the body, they undergo ingestion, digestion,
medium and a low-fat evening meal. absorption, transport, cell metabolism, and excretion.
 While an occupied bed is being changed, the patient should be covered with a  The body metabolizes alcohol at a fixed rate, regardless of serum
bath blanket to promote warmth and prevent exposure. concentration.
 Anticipatory grief is mourning that occurs for an extended time when the  In an alcoholic beverage, proof reflects the percentage of alcohol multiplied by
patient realizes that death is inevitable. 2. For example, a 100-proof beverage contains 50% alcohol.
 The following foods can alter the color of the feces: beets (red), cocoa (dark  A living will is a witnessed document that states a patient’s desire for certain
red or brown), licorice (black), spinach (green), and meat protein (dark brown). types of care and treatment. These decisions are based on the patient’s wishes
 When preparing for a skull X-ray, the patient should remove all jewelry and and views on quality of life.
dentures.  The nurse should flush a peripheral heparin lock every 8 hours (if it wasn’t
 The fight-or-flight response is a sympathetic nervous system response. used during the previous 8 hours) and as needed with normal saline solution to
 Bronchovesicular breath sounds in peripheral lung fields are abnormal and maintain patency.
suggest pneumonia.  Quality assurance is a method of determining whether nursing actions and
 Wheezing is an abnormal, high-pitched breath sound that’s accentuated on practices meet established standards.
expiration.  The five rights of medication administration are the right patient, right drug,
 Wax or a foreign body in the ear should be flushed out gently by irrigation right dose, right route of administration, and right time.
with warm saline solution.  The evaluation phase of the nursing process is to determine whether nursing
 If a patient complains that his hearing aid is “not working,” the nurse should interventions have enabled the patient to meet the desired goals.
check the switch first to see if it’s turned on and then check the batteries.  Outside of the hospital setting, only the sublingual and translingual forms
 The nurse should grade hyperactive biceps and triceps reflexes as +4. of nitroglycerin should be used to relieve acute anginal attacks.
 If two eye medications are prescribed for twice-daily instillation, they should  The implementation phase of the nursing process involves recording the
be administered 5 minutes apart. patient’s response to the nursing plan, putting the nursing plan into action,
 In a postoperative patient, forcing fluids helps prevent constipation. delegating specific nursing interventions, and coordinating the patient’s
 A nurse must provide care in accordance with standards of care established by activities.
the American Nurses Association, state regulations, and facility policy.  The Patient’s Bill of Rights offers patients guidance and protection by stating
 The kilocalorie (kcal) is a unit of energy measurement that represents the the responsibilities of the hospital and its staff toward patients and their
amount of heat needed to raise the temperature of 1 kilogram of water 1° C. families during hospitalization.
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 To minimize omission and distortion of facts, the nurse should record  Major, unalterable risk factors for coronary artery disease include heredity,
information as soon as it’s gathered. sex, race, and age.
 When assessing a patient’s health history, the nurse should record the current  Inspection is the most frequently used assessment technique.
illness chronologically, beginning with the onset of the problem and  Family members of an elderly person in a long-term care facility should
continuing to the present. transfer some personal items (such as photographs, a favorite chair, and
 When assessing a patient’s health history, the nurse should record the current knickknacks) to the person’s room to provide a comfortable atmosphere.
illness chronologically, beginning with the onset of the problem and  Pulsus alternans is a regular pulse rhythm with alternating weak and strong
continuing to the present. beats. It occurs in ventricular enlargement because the stroke volume varies
 A nurse shouldn’t give false assurance to a patient. with each heartbeat.
 After receiving preoperative medication, a patient isn’t competent to sign an  The upper respiratory tract warms and humidifies inspired air and plays a role
informed consent form. in taste, smell, and mastication.
 When lifting a patient, a nurse uses the weight of her body instead of the  Signs of accessory muscle use include shoulder elevation, intercostal muscle
strength in her arms. retraction, and scalene and sternocleidomastoid muscle use during respiration.
 A nurse may clarify a physician’s explanation about an operation or a  When patients use axillary crutches, their palms should bear the brunt of the
procedure to a patient, but must refer questions about informed consent to the weight.
physician.  Activities of daily living include eating, bathing, dressing, grooming, toileting,
 When obtaining a health history from an acutely ill or agitated patient, the and interacting socially.
nurse should limit questions to those that provide necessary information.  Normal gait has two phases: the stance phase, in which the patient’s foot rests
 If a chest drainage system line is broken or interrupted, the nurse should clamp on the ground, and the swing phase, in which the patient’s foot moves forward.
the tube immediately.  The phases of mitosis are prophase, metaphase, anaphase, and telophase.
 The nurse shouldn’t use her thumb to take a patient’s pulse rate because the  The nurse should follow standard precautions in the routine care of all patients.
thumb has a pulse that may be confused with the patient’s pulse.  The nurse should use the bell of the stethoscope to listen for venous hums and
 An inspiration and an expiration count as one respiration. cardiac murmurs.
 Eupnea is normal respiration.  The nurse can assess a patient’s general knowledge by asking questions such
 During blood pressure measurement, the patient should rest the arm against a as “Who is the president of the United States?”
surface. Using muscle strength to hold up the arm may raise the blood  Cold packs are applied for the first 20 to 48 hours after an injury; then heat is
pressure. applied. During cold application, the pack is applied for 20 minutes and then
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removed for 10 to 15 minutes to prevent reflex dilation (rebound phenomenon)  A nursing diagnosis is a statement of a patient’s actual or potential health
and frostbite injury. problem that can be resolved, diminished, or otherwise changed by nursing
 The pons is located above the medulla and consists of white matter (sensory interventions.
and motor tracts) and gray matter (reflex centers).  During the assessment phase of the nursing process, the nurse collects and
 The autonomic nervous system controls the smooth muscles. analyzes three types of data: health history, physical examination, and
 A correctly written patient goal expresses the desired patient behavior, criteria laboratory and diagnostic test data.
for measurement, time frame for achievement, and conditions under which the  The patient’s health history consists primarily of subjective data, information
behavior will occur. It’s developed in collaboration with the patient. that’s supplied by the patient.
 Percussion causes five basic notes: tympany (loud intensity, as heard over a  The physical examination includes objective data obtained by inspection,
gastric air bubble or puffed out cheek), hyperresonance (very loud, as heard palpation, percussion, and auscultation.
over an emphysematous lung), resonance (loud, as heard over a normal lung),  When documenting patient care, the nurse should write legibly, use only
dullness (medium intensity, as heard over the liver or other solid organ), and standard abbreviations, and sign each entry. The nurse should never destroy or
flatness (soft, as heard over the thigh). attempt to obliterate documentation or leave vacant lines.
 The optic disk is yellowish pink and circular, with a distinct border.  Factors that affect body temperature include time of day, age, physical activity,
 A primary disability is caused by a pathologic process. A secondary disability phase of menstrual cycle, and pregnancy.
is caused by inactivity.  The most accessible and commonly used artery for measuring a patient’s pulse
 Nurses are commonly held liable for failing to keep an accurate count of rate is the radial artery. To take the pulse rate, the artery is compressed against
sponges and other devices during surgery. the radius.
 The best dietary sources of vitamin B6 are liver, kidney, pork, soybeans, corn,  In a resting adult, the normal pulse rate is 60 to 100 beats/minute. The rate is
and whole-grain cereals. slightly faster in women than in men and much faster in children than in adults.
 Iron-rich foods, such as organ meats, nuts, legumes, dried fruit, green leafy  Laboratory test results are an objective form of assessment data.
vegetables, eggs, and whole grains, commonly have a low water content.  The measurement systems most commonly used in clinical practice are the
 Collaboration is joint communication and decision making between nurses metric system, apothecaries’ system, and household system.
and physicians. It’s designed to meet patients’ needs by integrating the care  Before signing an informed consent form, the patient should know whether
regimens of both professions into one comprehensive approach. other treatment options are available and should understand what will occur
 Bradycardia is a heart rate of fewer than 60 beats/minute. during the preoperative, intraoperative, and postoperative phases; the risks
involved; and the possible complications. The patient should also have a
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general idea of the time required from surgery to recovery. In addition, he  After bladder irrigation, the nurse should document the amount, color, and
should have an opportunity to ask questions. clarity of the urine and the presence of clots or sediment.
 A patient must sign a separate informed consent form for each procedure.  Laws regarding patient self-determination vary from state to state. Therefore,
 During percussion, the nurse uses quick, sharp tapping of the fingers or hands the nurse must be familiar with the laws of the state in which she works.
against body surfaces to produce sounds. This procedure is done to determine  Gauge is the inside diameter of a needle: the smaller the gauge, the larger the
the size, shape, position, and density of underlying organs and tissues; elicit diameter.
tenderness; or assess reflexes.  An adult normally has 32 permanent teeth.
 Ballottement is a form of light palpation involving gentle, repetitive bouncing  After turning a patient, the nurse should document the position used, the time
that the patient was turned, and the findings of skin assessment.
of tissues against the hand and feeling their rebound.
 PERRLA is an abbreviation for normal pupil assessment findings: pupils
 A foot cradle keeps bed linen off the patient’s feet to prevent skin irritation and equal, round, and reactive to light with accommodation.
 When percussing a patient’s chest for postural drainage, the nurse’s hands
breakdown, especially in a patient who has peripheral vascular disease or
should be cupped.
neuropathy.  When measuring a patient’s pulse, the nurse should assess its rate, rhythm,
quality, and strength.
 Gastric lavage is flushing of the stomach and removal of ingested substances
 Before transferring a patient from a bed to a wheelchair, the nurse should push
through a nasogastric tube. It’s used to treat poisoning or drug overdose. the wheelchair footrests to the sides and lock its wheels.
 When assessing respirations, the nurse should document their rate, rhythm,
 During the evaluation step of the nursing process, the nurse assesses the
depth, and quality.
patient’s response to therapy.  For a subcutaneous injection, the nurse should use a 5/8″ to 1″ 25G needle.
 The notation “AA & O × 3” indicates that the patient is awake, alert, and
 Bruits commonly indicate life- or limb-threatening vascular disease.
oriented to person (knows who he is), place (knows where he is), and time
 O.U. means each eye. O.D. is the right eye, and O.S. is the left eye. (knows the date and time).
 To remove a patient’s artificial eye, the nurse depresses the lower lid.  Fluid intake includes all fluids taken by mouth, including foods that are liquid
at room temperature, such as gelatin, custard, and ice cream; I.V. fluids; and
 The nurse should use a warm saline solution to clean an artificial eye. fluids administered in feeding tubes. Fluid output includes urine, vomitus, and
 A thready pulse is very fine and scarcely perceptible. drainage (such as from a nasogastric tube or from a wound) as well as blood
loss, diarrhea or feces, and perspiration.
 Axillary temperature is usually 1° F lower than oral temperature.  After administering an intradermal injection, the nurse shouldn’t massage the
 After suctioning a tracheostomy tube, the nurse must document the color, area because massage can irritate the site and interfere with results.
 When administering an intradermal injection, the nurse should hold the syringe
amount, consistency, and odor of secretions. almost flat against the patient’s skin (at about a 15-degree angle), with the
 On a drug prescription, the abbreviation p.c. means that the drug should be bevel up.
 To obtain an accurate blood pressure, the nurse should inflate the manometer
administered after meals. to 20 to 30 mm Hg above the disappearance of the radial pulse before releasing
 After bladder irrigation, the nurse should document the amount, color, and the cuff pressure.
 The nurse should count an irregular pulse for 1 full minute.
clarity of the urine and the presence of clots or sediment.
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 A patient who is vomiting while lying down should be placed in a lateral  Standing orders, or protocols, establish guidelines for treating a specific
position to prevent aspiration of vomitus. disease or set of symptoms.
 Prophylaxis is disease prevention.  In assessing a patient’s heart, the nurse normally finds the point of maximal
 Body alignment is achieved when body parts are in proper relation to their impulse at the fifth intercostal space, near the apex.
natural position.  The S1 heard on auscultation is caused by closure of the mitral and tricuspid
 Trust is the foundation of a nurse-patient relationship. valves.
 Blood pressure is the force exerted by the circulating volume of blood on the  To maintain package sterility, the nurse should open a wrapper’s top flap away
arterial walls. from the body, open each side flap by touching only the outer part of the
 Malpractice is a professional’s wrongful conduct, improper discharge of duties, wrapper, and open the final flap by grasping the turned-down corner and
or failure to meet standards of care that causes harm to another. pulling it toward the body.
 As a general rule, nurses can’t refuse a patient care assignment; however, in  The nurse shouldn’t dry a patient’s ear canal or remove wax with a cotton-
most states, they may refuse to participate in abortions. tipped applicator because it may force cerumen against the tympanic
 A nurse can be found negligent if a patient is injured because the nurse failed membrane.
to perform a duty that a reasonable and prudent person would perform or  A patient’s identification bracelet should remain in place until the patient has
because the nurse performed an act that a reasonable and prudent person been discharged from the health care facility and has left the premises.
wouldn’t perform.  The Controlled Substances Act designated five categories, or schedules, that
 States have enacted Good Samaritan laws to encourage professionals to classify controlled drugs according to their abuse potential.
provide medical assistance at the scene of an accident without fear of a lawsuit 39. Schedule I drugs, such as heroin, have a high abuse potential and have no
arising from the assistance. These laws don’t apply to care provided in a health currently accepted medical use in the United States.
care facility.  Schedule II drugs, such as morphine, opium, and meperidine (Demerol), have a
 A physician should sign verbal and telephone orders within the time high abuse potential, but currently have accepted medical uses. Their use may
established by facility policy, usually 24 hours. lead to physical or psychological dependence.
 A competent adult has the right to refuse lifesaving medical treatment;  Schedule III drugs, such as paregoric and butabarbital (Butisol), have a lower
however, the individual should be fully informed of the consequences of his abuse potential than Schedule I or II drugs. Abuse of Schedule III drugs may
refusal. lead to moderate or low physical or psychological dependence, or both.
 Although a patient’s health record, or chart, is the health care facility’s  Schedule IV drugs, such as chloral hydrate, have a low abuse potential
physical property, its contents belong to the patient. compared with Schedule III drugs.
 Before a patient’s health record can be released to a third party, the patient or  Schedule V drugs, such as cough syrups that contain codeine, have the lowest
the patient’s legal guardian must give written consent. abuse potential of the controlled substances.
 Under the Controlled Substances Act, every dose of a controlled drug that’s  Activities of daily living are actions that the patient must perform every day to
dispensed by the pharmacy must be accounted for, whether the dose was provide self-care and to interact with society.
administered to a patient or discarded accidentally.  Testing of the six cardinal fields of gaze evaluates the function of all
 A nurse can’t perform duties that violate a rule or regulation established by a extraocular muscles and cranial nerves III, IV, and VI.
state licensing board, even if they are authorized by a health care facility or  The six types of heart murmurs are graded from 1 to 6. A grade 6 heart
physician. murmur can be heard with the stethoscope slightly raised from the chest.
 To minimize interruptions during a patient interview, the nurse should select a  The most important goal to include in a care plan is the patient’s goal.
private room, preferably one with a door that can be closed.  Fruits are high in fiber and low in protein, and should be omitted from a low-
 In categorizing nursing diagnoses, the nurse addresses life-threatening residue diet.
problems first, followed by potentially life-threatening concerns.  The nurse should use an objective scale to assess and quantify pain.
 The major components of a nursing care plan are outcome criteria (patient Postoperative pain varies greatly among individuals.
goals) and nursing interventions.
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 Postmortem care includes cleaning and preparing the deceased patient for  Proper function of a hearing aid requires careful handling during insertion and
family viewing, arranging transportation to the morgue or funeral home, and removal, regular cleaning of the ear piece to prevent wax buildup, and prompt
determining the disposition of belongings. replacement of dead batteries.
 The nurse should provide honest answers to the patient’s questions.  The hearing aid that’s marked with a blue dot is for the left ear; the one with a
 Milk shouldn’t be included in a clear liquid diet. red dot is for the right ear.
 When caring for an infant, a child, or a confused patient, consistency in nursing  A hearing aid shouldn’t be exposed to heat or humidity and shouldn’t be
personnel is paramount. immersed in water.
 The hypothalamus secretes vasopressin and oxytocin, which are stored in the  The nurse should instruct the patient to avoid using hair spray while wearing a
pituitary gland. hearing aid.
 The three membranes that enclose the brain and spinal cord are the dura mater,  The five branches of pharmacology are pharmacokinetics, pharmacodynamics,
pia mater, and arachnoid. pharmacotherapeutics, toxicology, and pharmacognosy.
 A nasogastric tube is used to remove fluid and gas from the small intestine 75. The nurse should remove heel protectors every 8 hours to inspect the foot
preoperatively or postoperatively. for signs of skin breakdown.
 Psychologists, physical therapists, and chiropractors aren’t authorized to write  Heat is applied to promote vasodilation, which reduces pain caused by
prescriptions for drugs. inflammation.
 The area around a stoma is cleaned with mild soap and water.  A sutured surgical incision is an example of healing by first intention (healing
 Vegetables have a high fiber content. directly, without granulation).
 Healing by secondary intention (healing by granulation) is closure of the
 ADVERTISEMENTS wound when granulation tissue fills the defect and allows reepithelialization to
 The nurse should use a tuberculin syringe to administer a subcutaneous occur, beginning at the wound edges and continuing to the center, until the
injection of less than 1 ml. entire wound is covered.
 For adults, subcutaneous injections require a 25G 5/8″ to 1″ needle; for infants, 79. Keloid formation is an abnormality in healing that’s characterized by
children, elderly, or very thin patients, they require a 25G to 27G ½” needle. overgrowth of scar tissue at the wound site.
 Before administering a drug, the nurse should identify the patient by checking  The nurse should administer procaine penicillin by deep I.M. injection in the
the identification band and asking the patient to state his name. upper outer portion of the buttocks in the adult or in the midlateral thigh in the
 To clean the skin before an injection, the nurse uses a sterile alcohol swab to child. The nurse shouldn’t massage the injection site.
wipe from the center of the site outward in a circular motion.  An ascending colostomy drains fluid feces. A descending colostomy drains
 The nurse should inject heparin deep into subcutaneous tissue at a 90-degree solid fecal matter.
angle (perpendicular to the skin) to prevent skin irritation.  A folded towel (scrotal bridge) can provide scrotal support for the patient with
 If blood is aspirated into the syringe before an I.M. injection, the nurse should scrotal edema caused by vasectomy, epididymitis, or orchitis.
withdraw the needle, prepare another syringe, and repeat the procedure.  When giving an injection to a patient who has a bleeding disorder, the nurse
 The nurse shouldn’t cut the patient’s hair without written consent from the should use a small-gauge needle and apply pressure to the site for 5 minutes
patient or an appropriate relative. after the injection.
 If bleeding occurs after an injection, the nurse should apply pressure until the  Platelets are the smallest and most fragile formed element of the blood and are
bleeding stops. If bruising occurs, the nurse should monitor the site for an essential for coagulation.
enlarging hematoma.  To insert a nasogastric tube, the nurse instructs the patient to tilt the head back
 When providing hair and scalp care, the nurse should begin combing at the end slightly and then inserts the tube. When the nurse feels the tube curving at the
of the hair and work toward the head. pharynx, the nurse should tell the patient to tilt the head forward to close
 The frequency of patient hair care depends on the length and texture of the the trachea and open the esophagus by swallowing. (Sips of water can facilitate
hair, the duration of hospitalization, and the patient’s condition. this action.)
 Families with loved ones in intensive care units report that their four most
important needs are to have their questions answered honestly, to be assured
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that the best possible care is being provided, to know the patient’s prognosis,  The most appropriate nursing diagnosis for an individual who doesn’t speak
and to feel that there is hope of recovery. English is Impaired verbal communication related to inability to speak
 Double-bind communication occurs when the verbal message contradicts the dominant language (English).
nonverbal message and the receiver is unsure of which message to respond to.  The family of a patient who has been diagnosed as hearing impaired should be
 A nonjudgmental attitude displayed by a nurse shows that she neither approves instructed to face the individual when they speak to him.
nor disapproves of the patient.  Before instilling medication into the ear of a patient who is up to age 3, the
 Target symptoms are those that the patient finds most distressing. nurse should pull the pinna down and back to straighten the eustachian tube.
 A patient should be advised to take aspirin on an empty stomach, with a full  To prevent injury to the cornea when administering eyedrops, the nurse should
glass of water, and should avoid acidic foods such as coffee, citrus fruits, and waste the first drop and instill the drug in the lower conjunctival sac.
cola.  After administering eye ointment, the nurse should twist the medication tube to
 For every patient problem, there is a nursing diagnosis; for every nursing detach the ointment.
diagnosis, there is a goal; and for every goal, there are interventions designed  When the nurse removes gloves and a mask, she should remove the gloves
to make the goal a reality. The keys to answering examination questions first. They are soiled and are likely to contain pathogens.
correctly are identifying the problem presented, formulating a goal for the  Crutches should be placed 6″ (15.2 cm) in front of the patient and 6″ to the side
problem, and selecting the intervention from the choices provided that will to form a tripod arrangement.
enable the patient to reach that goal.  Listening is the most effective communication technique.
 Fidelity means loyalty and can be shown as a commitment to the profession of  Before teaching any procedure to a patient, the nurse must assess the patient’s
nursing and to the patient. current knowledge and willingness to learn.
 Administering an I.M. injection against the patient’s will and without legal  Process recording is a method of evaluating one’s communication
authority is battery. effectiveness.
 An example of a third-party payer is an insurance company.  When feeding an elderly patient, the nurse should limit high-carbohydrate
 The formula for calculating the drops per minute for an I.V. infusion is as foods because of the risk of glucose intolerance.
follows: (volume to be infused × drip factor) ÷ time in minutes = drops/minute  When feeding an elderly patient, essential foods should be given first.
 On-call medication should be given within 5 minutes of the call.  Passive range of motion maintains joint mobility. Resistive exercises increase
 Usually, the best method to determine a patient’s cultural or spiritual needs is muscle mass.
to ask him.  Isometric exercises are performed on an extremity that’s in a cast.
 An incident report or unusual occurrence report isn’t part of a patient’s record,  A back rub is an example of the gate-control theory of pain.
but is an in-house document that’s used for the purpose of correcting the  Anything that’s located below the waist is considered unsterile; a sterile field
problem. becomes unsterile when it comes in contact with any unsterile item; a sterile
 Critical pathways are a multidisciplinary guideline for patient care. field must be monitored continuously; and a border of 1″ (2.5 cm) around a
 When prioritizing nursing diagnoses, the following hierarchy should be used: sterile field is considered unsterile.
Problems associated with the airway, those concerning breathing, and those  A “shift to the left” is evident when the number of immature cells (bands) in
related to circulation. the blood increases to fight an infection.
 The two nursing diagnoses that have the highest priority that the nurse can
assign are Ineffective airway clearance and Ineffective breathing pattern.  ADVERTISEMENTS
 A subjective sign that a sitz bath has been effective is the patient’s expression  A “shift to the right” is evident when the number of mature cells in the blood
of decreased pain or discomfort. increases, as seen in advanced liver disease and pernicious anemia.
 For the nursing diagnosis Deficient diversional activity to be valid, the patient  Before administering preoperative medication, the nurse should ensure that an
must state that he’s “bored,” that he has “nothing to do,” or words to that informed consent form has been signed and attached to the patient’s record.
effect.  A nurse should spend no more than 30 minutes per 8-hour shift providing care
to a patient who has a radiation implant.
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 A nurse shouldn’t be assigned to care for more than one patient who has a   Discrimination is preferential treatment of individuals of a particular group.
radiation implant. It’s usually discussed in a negative sense.
 Long-handled forceps and a lead-lined container should be available in the  Increased gastric motility interferes with the absorption of oral drugs.
room of a patient who has a radiation implant.  The three phases of the therapeutic relationship are orientation, working, and
 Usually, patients who have the same infection and are in strict isolation can termination.
share a room.  Patients often exhibit resistive and challenging behaviors in the orientation
 Diseases that require strict isolation include chickenpox, diphtheria, and viral phase of the therapeutic relationship.
hemorrhagic fevers such as Marburg disease.  Abdominal assessment is performed in the following order: inspection,
 For the patient who abides by Jewish custom, milk and meat shouldn’t be auscultation, percussion & palpation.
served at the same meal.  When measuring blood pressure in a neonate, the nurse should select a cuff
 Whether the patient can perform a procedure (psychomotor domain of that’s no less than one-half and no more than two-thirds the length of the
learning) is a better indicator of the effectiveness of patient teaching than extremity that’s used.
whether the patient can simply state the steps involved in the procedure  When administering a drug by Z-track, the nurse shouldn’t use the same needle
(cognitive domain of learning). that was used to draw the drug into the syringe because doing so
 According to Erik Erikson, developmental stages are trust versus mistrust could stain the skin.
(birth to 18 months), autonomy versus shame and doubt (18 months to age 3),  Sites for intradermal injection include the inner arm, the upper chest, and on
initiative versus guilt (ages 3 to 5), industry versus inferiority (ages 5 to 12), the back, under the scapula.
identity versus identity diffusion (ages 12 to 18), intimacy versus isolation  When evaluating whether an answer on an examination is correct, the nurse
(ages 18 to 25), generativity versus stagnation (ages 25 to 60), and ego should consider whether the action that’s described promotes autonomy
integrity versus despair (older than age 60). (independence), safety, self-esteem, and a sense of belonging.
 When communicating with a hearing impaired patient, the nurse should face  When answering a question on the NCLEX examination, the student should
him. consider the cue (the stimulus for a thought) and the inference (the thought) to
 An appropriate nursing intervention for the spouse of a patient who has a determine whether the inference is correct. When in doubt, the nurse should
serious incapacitating disease is to help him to mobilize a support system. select an answer that indicates the need for further information to eliminate
 Hyperpyrexia is extreme elevation in temperature above 106° F (41.1° C). ambiguity. For example, the patient complains of chest pain (the stimulus for
 Milk is high in sodium and low in iron. the thought) and the nurse infers that the patient is having cardiac pain (the
 When a patient expresses concern about a health-related issue, before thought). In this case, the nurse hasn’t confirmed whether the pain is cardiac. It
addressing the concern, the nurse should assess the patient’s level of would be more appropriate to make further assessments.
knowledge.   Veracity is truth and is an essential component of a therapeutic relationship
 The most effective way to reduce a fever is to administer an antipyretic, which between a health care provider and his patient.
lowers the temperature set point.  Beneficence is the duty to do no harm and the duty to do good. There’s an
 When a patient is ill, it’s essential for the members of his family to maintain obligation in patient care to do no harm and an equal obligation to assist the
communication about his health needs. patient.
 Ethnocentrism is the universal belief that one’s way of life is superior to others.  Nonmaleficence is the duty to do no harm.
 When a nurse is communicating with a patient through an interpreter, the nurse  Frye’s ABCDE cascade provides a framework for prioritizing care by
should speak to the patient and the interpreter. identifying the most important treatment concerns.
 In accordance with the “hot-cold” system used by some Mexicans, Puerto  A = Airway. This category includes everything that affects a patent airway,
Ricans, and other Hispanic and Latino groups, most foods, beverages, herbs, including a foreign object, fluid from an upper respiratory infection, and
and drugs are described as “cold.” edema from trauma or an allergic reaction.
 Prejudice is a hostile attitude toward individuals of a particular group.
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 B = Breathing. This category includes everything that affects the breathing Step 2: Identifying the problems and establishing goals
pattern, including hyperventilation or hypoventilation and abnormal breathing Step 3: Establishing a plan to meet the goals
patterns, such as Korsakoff’s, Biot’s, or Cheyne-Stokes respiration. Step 4: Identifying factors that facilitate or hinder attainment of the goals
 C = Circulation. This category includes everything that affects the circulation, Step 5: Implementing interventions
including fluid and electrolyte disturbances and disease processes that affect Step 6: Evaluating the effectiveness of the interventions
cardiac output.  A Hindu patient is likely to request a vegetarian diet.
 D = Disease processes. If the patient has no problem with the airway,  Pain threshold, or pain sensation, is the initial point at which a patient feels
breathing, or circulation, then the nurse should evaluate the disease processes, pain.
giving priority to the disease process that poses the greatest immediate risk.  The difference between acute pain and chronic pain is its duration.
For example, if a patient has terminal cancer and hypoglycemia, hypoglycemia  Referred pain is pain that’s felt at a site other than its origin.
is a more immediate concern.  Alleviating pain by performing a back massage is consistent with the gate
 E = Everything else. This category includes such issues as writing an incident control theory.
report and completing the patient chart. When evaluating needs, this category  Romberg’s test is a test for balance or gait.
is never the highest priority.  Pain seems more intense at night because the patient isn’t distracted by daily
 When answering a question on an NCLEX examination, the basic rule is activities.
“assess before action.” The student should evaluate each possible answer  Older patients commonly don’t report pain because of fear of treatment,
carefully. Usually, several answers reflect the implementation phase of nursing lifestyle changes, or dependency.
and one or two reflect the assessment phase. In this case, the best choice is an  No pork or pork products are allowed in a Muslim diet.
assessment response unless a specific course of action is clearly indicated.  Two goals of Healthy People 2010 are:
 Rule utilitarianism is known as the “greatest good for the greatest number of Help individuals of all ages to increase the quality of life and the number of
people” theory. years of optimal health
 Egalitarian theory emphasizes that equal access to goods and services must be Eliminate health disparities among different segments of the population.
provided to the less fortunate by an affluent society.  A community nurse is serving as a patient’s advocate if she tells a
 Active euthanasia is actively helping a person to die. malnourished patient to go to a meal program at a local park.
 Brain death is irreversible cessation of all brain function.  If a patient isn’t following his treatment plan, the nurse should first ask why.
 Passive euthanasia is stopping the therapy that’s sustaining life.  Falls are the leading cause of injury in elderly people.
 A third-party payer is an insurance company.  Primary prevention is true prevention. Examples are immunizations, weight
 Utilization review is performed to determine whether the care provided to a control, and smoking cessation.
patient was appropriate and cost-effective.  Secondary prevention is early detection. Examples include purified protein
169. A value cohort is a group of people who experienced an out-of-the- derivative (PPD), breast self-examination, testicular self-examination,
ordinary event that shaped their values. and chest X-ray.
 Voluntary euthanasia is actively helping a patient to die at the patient’s request.  Tertiary prevention is treatment to prevent long-term complications.
 Bananas, citrus fruits, and potatoes are good sources of potassium.  A patient indicates that he’s coming to terms with having a chronic disease
 Good sources of magnesium include fish, nuts, and grains. when he says, “I’m never going to get any better.”
 Beef, oysters, shrimp, scallops, spinach, beets, and greens are good sources of  On noticing religious artifacts and literature on a patient’s night stand, a
iron. culturally aware nurse would ask the patient the meaning of the items.
 Intrathecal injection is administering a drug through the spine.  A Mexican patient may request the intervention of a curandero, or faith healer,
 When a patient asks a question or makes a statement that’s emotionally who involves the family in healing the patient.
charged, the nurse should respond to the emotion behind the statement or  In an infant, the normal hemoglobin value is 12 g/dl.
question rather than to what’s being said or asked.  The nitrogen balance estimates the difference between the intake and use of
 The steps of the trajectory-nursing model are as follows: protein.
Step 1: Identifying the trajectory phase  Most of the absorption of water occurs in the large intestine.
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 Most nutrients are absorbed in the small intestine.  The patients’ bill of rights was introduced by the American Hospital
 When assessing a patient’s eating habits, the nurse should ask, “What have you Association.
eaten in the last 24 hours?”  Abandonment is premature termination of treatment without the patient’s
 A vegan diet should include an abundant supply of fiber. permission and without appropriate relief of symptoms.
 A hypotonic enema softens the feces, distends the colon, and  Values clarification is a process that individuals use to prioritize their personal
stimulates peristalsis. values.
 First-morning urine provides the best sample to measure glucose, ketone, pH,  Distributive justice is a principle that promotes equal treatment for all.
and specific gravity values.  Milk and milk products, poultry, grains, and fish are good sources of
 To induce sleep, the first step is to minimize environmental stimuli. phosphate.
 Before moving a patient, the nurse should assess the patient’s physical abilities  The best way to prevent falls at night in an oriented, but restless, elderly patient
and ability to understand instructions as well as the amount of strength is to raise the side rails.
required to move the patient.  By the end of the orientation phase, the patient should begin to trust the nurse.
 To lose 1 lb (0.5 kg) in 1 week, the patient must decrease his weekly intake by  Falls in the elderly are likely to be caused by poor vision.
3,500 calories (approximately 500 calories daily). To lose 2 lb (1 kg) in 1  Barriers to communication include language deficits, sensory deficits,
week, the patient must decrease his weekly caloric intake by 7,000 calories cognitive impairments, structural deficits, and paralysis.
(approximately 1,000 calories daily).  The three elements that are necessary for a fire are heat, oxygen, and
 To avoid shearing force injury, a patient who is completely immobile is lifted combustible material.
on a sheet.  Sebaceous glands lubricate the skin.
 To insert a catheter from the nose through the trachea for suction, the nurse  To check for petechiae in a dark-skinned patient, the nurse should assess the
should ask the patient to swallow. oral mucosa.
 Vitamin C is needed for collagen production.  To put on a sterile glove, the nurse should pick up the first glove at the folded
 Only the patient can describe his pain accurately. border and adjust the fingers when both gloves are on.
 Cutaneous stimulation creates the release of endorphins that block the  To increase patient comfort, the nurse should let the alcohol dry before giving
transmission of pain stimuli. an intramuscular injection.
 Patient-controlled analgesia is a safe method to relieve acute pain caused by  Treatment for a stage 1 ulcer on the heels includes heel protectors.
surgical incision, traumatic injury, labor and delivery, or cancer.  Seventh-Day Adventists are usually vegetarians.
 An Asian American or European American typically places distance between  Endorphins are morphine-like substances that produce a feeling of well-being.
himself and others when communicating.  Pain tolerance is the maximum amount and duration of pain that an individual
 The patient who believes in a scientific, or biomedical, approach to health is is willing to endure.
likely to expect a drug, treatment, or surgery to cure illness.
 Chronic illnesses occur in very young as well as middle-aged and very old
people.
 The trajectory framework for chronic illness states that preferences about daily
life activities affect treatment decisions.
 Exacerbations of chronic disease usually cause the patient to seek treatment
and may lead to hospitalization.
 School health programs provide cost-effective health care for low-income
families and those who have no health insurance.
 Collegiality is the promotion of collaboration, development, and
interdependence among members of a profession.
 A change agent is an individual who recognizes a need for change or is
selected to make a change within an established entity, such as a hospital.