Pedi
An 8-year-old understands that pouring water into a taller glass does not change the amount of water.
Concrete Operational
Define Health Promotion and Give an Example
Health promotion is the process of helping individuals, families, and communities improve their health and well-being by encouraging healthy lifestyle choices, preventing disease, and increasing control over factors that influence health.
Examples:
A nurse administers 2mg of morphine IV to a patient. What is their priority assessment?
Level of consciousness and respiratory rate
A patient is experiencing panic level anxiety. What is the top concern and what communication techniques should the nurse implement?
Top Priority: Safety (Do not leave the patient)
Communication: Provide calm, brief, and direct communication
Name 3 findings of fluid volume excess.
Weight gain, edema, crackles, hypertension, bounding pulses, shortness of breath, orthopnea, jugular vein distention
A nurse is providing discharge education to a 68-year-old client who has been newly diagnosed with heart failure. What dietary changes should the nurse emphasize to help manage heart failure, and why are these changes important?
Reduce Sodium Intake - The client should reduce sodium (salt) intake to help prevent fluid retention, decrease edema, reduce the workload on the heart, and minimize symptoms such as shortness of breath.
A provider prescribes Vancomycin 1 gram in 250 mL of normal saline to infuse over 90 minutes. The nurse will administer the medication using IV tubing with a drop factor of 15 gtt/mL.
At what rate should the nurse regulate the IV tubing in drops per minute (gtt/min)? Round to the nearest whole number.
Volume x Drop Factor / Time
250x15/90 = 41.7
= 42 gtt/min
A provider orders 1,000 mL of Lactated Ringer's (LR) with 30 mEq of potassium chloride (KCl) to infuse for a client with hypokalemia. The pharmacy supplies KCl at a concentration of 10 mEq per 5 mL.
How many milliliters of KCl should the nurse add to the IV bag?
30/10 x 5 = 15mL
Desired/Have x Quantity
A 2-month-old infant is scheduled to receive routine immunizations at a well-child visit. The parents ask what they can do to help reduce their baby's pain and anxiety during the injections.
What education should the nurse provide to the parents? Include at least four evidence-based, nonpharmacologic interventions that can be used to comfort the infant during and after the immunizations.
A 72-year-old client with chronic kidney disease is alert, oriented, and fully understands the risks and benefits of dialysis. After discussing the treatment with the healthcare team, the client decides to decline dialysis and pursue comfort-focused care. The provider writes the order for dialysis anyway, stating it is "in the client's best interest." Which ethical principle has been violated?
Autonomy. The client is competent and has the legal and ethical right to make informed decisions about their own healthcare, including refusing treatment. Proceeding with dialysis against the client's wishes violates the principle of autonomy.
During shift report, the nurse learns that a 9-month-old infant has flu-like symptoms and tachypnea. What priority complication should the nurse anticipate, and what assessment findings would support this concern?
The infant is at greatest risk for dehydration due to increased insensible fluid losses from tachypnea, possible fever, decreased oral intake, and the limited fluid reserves and higher metabolic rate of infants. The nurse should monitor for decreased urine output, dry mucous membranes, sunken fontanel (if applicable), delayed capillary refill, poor skin turgor, irritability, and lethargy.
What are early signs of respiratory distress?
Tachypnea, Dyspnea, Restlessness, Nasal flaring, Decrease in O2 Saturation
What does a A1C indicate? What is an acceptable A1C level for a Diabetic patient?
A client suddenly reports crushing substernal chest pain rated 8/10 that radiates to the left arm. Vital signs are stable, and the nurse has already assessed the client. What priority medication should the nurse administer first to help relieve myocardial ischemia, assuming there are no contraindications?
Nitroglycerin 0.4mg SL every 5 minutes for a maximum of 3 doses
What are signs of a hemolytic transfusion reaction?
Fever, Chills, Shortness of Breath, Back Pain
What would your immediate nursing intervention be?
A nurse is preparing to hang a new bag of enteral feeding for a client receiving continuous tube feedings. According to current best practice, how often should the enteral feeding administration tubing be replaced?
Every 24 hours - Enteral feeding administration tubing used for continuous feedings should be changed every 24 hours to reduce the risk of bacterial contamination and infection.
What lab result can best ensure patient safety when preparing for a blood transfusion?
A crossmatch is a laboratory test performed before a blood transfusion to ensure that the donor's red blood cells are compatible with the recipient's blood. It is the final safety check before blood is administered and helps prevent a life-threatening hemolytic transfusion reaction.
A toddler child is in the clinic for a well-child visit. The parents ask which toys would best support their child's developmental stage. Name at least three age-appropriate toys or play activities you would recommend for a toddler.
Define Cognitive Therapy
Cognitive therapy is a form of psychotherapy that helps individuals identify, challenge, and replace inaccurate or negative thought patterns with more realistic and constructive thoughts. The goal is to improve emotional well-being and promote healthier behaviors by changing the way a person thinks about situations.
A patient with an NG tube to suction is at the highest risk for what electrolyte imbalance?
Hypokalemia - Gastric suction removes potassium-rich gastric secretions, increasing the risk for hypokalemia. Patients may also develop metabolic alkalosis due to the loss of hydrochloric acid from the stomach.
A client is sweaty, shaky, tachycardic, and confused. What diabetic condition are you concerned about and what are interventions used for treatment?
Hypoglycemia
Conscious Patient: Rule of 15. Give 15 grams of rapid carbohydrate, recheck glucose level in 15 minutes, repeat if <70, and offer complex carbs when stable.
Unconscious patient: IV D50 or Glucagon 1mg
A 9-year-old child is attending a birthday party at school. About 10 minutes after eating a cupcake, the child tells the school nurse, "My throat feels funny." Name 5 signs and symptoms of an anaphylactic reaction.
Itchy throat, Angioedema, Wheezing, Dyspnea, Urticaria, Hypotension
Nursing Priority: ABCs!
What skills or tasks can a RN delegate to an LPN?
An RN can delegate stable, predictable nursing tasks to a LPN including:
What injection site is best to administer an IM injection in a newborn?
Vastus lateralis
A 19-year-old client with a history of anorexia nervosa is admitted to the medical unit. The client has experienced significant weight loss, reports restricting food intake, and has a heart rate of 46 beats/min. What is the nurse's priority treatment or intervention for this client?
Correct fluid and electrolyte imbalances. The priority is to stabilize the client's physiological status by restoring fluid and electrolyte balance, monitoring cardiac function, and then beginning nutritional rehabilitation while watching closely for refeeding syndrome.
Name at least three conditions that can stimulate increased ADH release.
Hemorrhage, Dehydration, Hypovolemia, Hypotension, Increased serum osmolality (hypernatremia), Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Name 3 signs of a severe asthma attack.
Initial loud wheezes that become diminished or silent (silent chest), Tachypnea, Accessory Muscle Use, Nasal Flaring, Agitation, Restlessness, Hypoxia
What are the major risk factors for cardiovascular disease?
Age, Males, Family, Diabetes, Smoking, Obesity, Physical Inactivity, Metabolic Syndrome
A nurse is participating in an interdisciplinary meeting to develop a discharge plan for a client whose family members, physical therapist, social worker, and provider all have different recommendations. Which critical thinking characteristic is most important for the nurse to demonstrate, and why?
The nurse should demonstrate openness to various viewpoints. This critical thinking characteristic involves considering different perspectives, evaluating evidence objectively, and remaining willing to modify one's thinking based on new information. Being open to the input of the interdisciplinary team promotes collaborative decision-making and helps develop the most appropriate, patient-centered plan of care.
A nurse is caring for a client with a chest tube following a traumatic pneumothorax. At the beginning of the shift, the chest drainage collection chamber contains 150 mL of fluid. At the end of the shift, the chamber contains 510 mL. During the shift, the nurse instilled 20 mL of sterile saline into the chest tube twice to maintain tube patency as prescribed. How much actual drainage did the client have during the shift?
A hospitalized client says, "I've been waiting over an hour for someone to answer my call light." The nurse replies, "The unit has been extremely busy today, and everyone is working as quickly as they can."
What nontherapeutic communication technique is the nurse using?
Defending -Defending occurs when the nurse attempts to justify or protect the actions of others or the healthcare system instead of acknowledging the client's feelings. This can make the client feel unheard. A more therapeutic response would be:
A patient with dehydration, a patient with cerebral edema, and a patient with diabetic ketoacidosis (DKA) all require IV fluid therapy. Name one example of a hypotonic, isotonic, and hypertonic IV solution that may be prescribed.
Hypotonic: 0.45% Normal Saline
Isotonic: 0.9% Normal Saline, Lactated Ringer's
Hypertonic: D10W, D5NS
A patient arrives in the emergency department with an acute asthma exacerbation and is experiencing wheezing and bronchospasm. The provider orders a medication that rapidly relaxes the smooth muscles of the airways to improve airflow. What class of medication is being prescribed? Name one example.
A beta₂ agonist. Beta₂ agonists stimulate beta₂ receptors in the lungs, causing bronchodilation and relieving bronchospasm.
Examples:
Untreated essential hypertension increases the risk of what conditions? (name 3)
Myocardial infarction, Chronic Kidney Disease, Kidney Failure, Stroke, Retinopathy, Nephropathy, Neuropathy
What are the six links in the chain of infection? For each link, provide one example of a nursing intervention that can break the chain and reduce the spread of infection.
1. Infectious Agent: The microorganism that causes disease (e.g., bacteria, viruses, fungi, parasites). Administer prescribed antibiotics or antivirals, disinfect equipment, and sterilize instruments.
2. Reservoir: The place where the microorganism lives and multiplies (e.g., humans, animals, water, equipment). Clean and disinfect patient rooms and equipment, change soiled linens, and maintain proper environmental hygiene.
3. Portal of Exit: The path by which the organism leaves the reservoir (e.g., blood, respiratory secretions, urine, feces). Cover coughs and sneezes, apply dressings over draining wounds, and properly dispose of contaminated materials.
4. Mode of Transmission: How the organism spreads (contact, droplet, airborne, vehicle, vector). Perform proper hand hygiene, wear appropriate PPE, follow isolation precautions, and clean shared equipment between patients.
5. Portal of Entry: The route through which the organism enters a new host (e.g., broken skin, respiratory tract, urinary tract). Use aseptic technique for invasive procedures, maintain catheter care, and keep wounds clean and covered.
6. Susceptible Host: A person at risk for infection due to decreased immunity or other factors. Promote immunizations, encourage good nutrition, manage chronic diseases, and educate patients on infection prevention.
A patient comes is admitted for a GI virus with vomiting and diarrhea. What assessment indicates the most accurate fluid status?
Daily Weight