Caring, Communication, Diversity
Occurs between two or more people with a goal to exchange messages
Interpersonal Communication
Interpersonal: Between 2 or more people
Intrapersonal: Self-talk; communication within a person
This law protects patient privacy and keeps health information confidential.
HIPPA
The nurse is caring for five patients. Which patient should the nurse see FIRST?
A. A patient with COPD who has an O₂ saturation of 90% on a 2L nasal cannula and is resting comfortably.
B. A patient with diabetes reporting a blood glucose of 250 mg/dL before lunch.
C. A postoperative patient with a new onset of shortness of breath.
D. A patient with chronic heart failure who has 2+ bilateral lower extremity edema.
E. A patient requesting pain medication rated 6/10.
C
ABC, Maslow's
This autoimmune disease commonly causes symmetric joint pain and stiffness lasting longer than 30 minutes in the morning.
Rheumatoid Arthritis (RA)
Common S/SX:
• Symmetric joint pain and morning stiffness greater than 30 minutes
• Joint swelling, warmth, erythema, and lack of function
• Spongy or soft feeling in the joints
• Acute onset (symptoms start suddenly and quickly)
• Pain is bilateral and symmetric (e.g., both wrists or both hands)
• Hand and foot deformity is common
After a needlestick injury, this is the FIRST action the nurse should take.
Clean the area with soap and water
A BMI of 28.6 is considered:
Overweight
Less than 18.4 = Underweight
18.5-24.9 = Normal Weight
25-29.9 = Overweight
30-34.9 = Obese
Greater than 35 = Extremely Obese
This diet is used for patients with diabetes to control blood glucose levels.
Consistent carbohydrate diet
Focuses on carb intake each meal, and helps prevent blood sugar spikes and drops.
Earliest sign of hypoxia
Restlessness
A patient typically qualifies for hospice when their life expectancy is less than this amount of time.
6 months or less
These blood vessels carry deoxygenated blood back to the heart.
Veins
Veins carry deoxygenated blood back to the heart.
Arteries carry oxygenated blood AWAY from the heart to the rest of the body.
This outermost layer of skin provides a waterproof barrier and has no blood vessels.
Epidermis
Epidermis – protective waterproof barrier
Dermis – strength, elasticity, contains nerves/blood vessels
Subcutaneous – insulation, cushioning, anchors skin
A patient with excessive thirst, frequent urination, and blurred vision is most likely experiencing this condition
Hyperglycemia
This cancer treatment uses high-energy waves to destroy cancer cells and commonly causes localized skin changes such as redness and irritation.
Radiation therapy
Chemo: targets and kills cancer cells through the use of cytotoxic (kills or damages cells) chemical substances.
Radiation: Use of high-energy particles or high-energy waves to kill cancer cells.
A patient’s ECG shows peaked T waves. The nurse recognizes this as a sign of this electrolyte imbalance.
Hyperkalemia
Normal Range 3.5-5.0 MEQ/L
Functions: Balance fluid volume, Nerve transmission, HEART contractility, and muscle functioning
This type of incontinence occurs when a patient leaks urine with coughing, sneezing, or laughing.
Stress incontinence
The ability to understand and share in another person’s feelings and experiences while maintaining professional boundaries.
Empathy
✅ Empathy = Therapeutic
Understanding and sharing the patient’s feelings while staying professional. Patient-focused.
❌ Sympathy = Non-therapeutic
“I feel so bad for you. This is awful.” Nurse’s feelings and blurred boundaries.
A patient refusing treatment after education is an example of this ethical principle.
autonomy
This method uses technology to provide healthcare remotely, improving access for patients in rural or underserved areas.
Telehealth
This condition is characterized by periods of flares and remissions and can affect multiple organs.
Systemic Lupus Erythematosus (SLE)
S/Sx:
Butterfly rash across cheeks and nose
• Photosensitivity
• Fatigue
• Fever
• Joint pain, stiffness, and swelling
• Oral ulcers
• Raynaud’s phenomenon (narrowing of the small arteries in the fingers and toes, causing pallor, cyanosis, and redness in the extremities)
*Lupus can cause damage anywhere in the body and cause multiple complications, such as Nephritis, seizures, pericarditis, anemia, etc.
DAILY DOUBLE!!!
This organization creates the National Patient Safety Goals and updates them annually.
The Joint Commission
The joint commission is an organization that accredits healthcare facilities and sets patient safety standards
A 4-year-old enjoys leading games, exploring new activities, and taking on new tasks. When repeatedly discouraged, the child begins to feel bad about trying new things and stops participating. What Erikson's stage of development is the child in?
Initiative vs. guilt
Trust vs. Mistrust – Birth–1 year
Autonomy vs. Shame & Doubt – 1–3 years
Initiative vs. Guilt – 3–6 years
Industry vs. Inferiority – 6–12 years
Identity vs. Role Confusion – 12–18 years
Intimacy vs. Isolation – 18–40 years
Generativity vs. Stagnation – 40–65 years
Ego Integrity vs. Despair – 65+ years
This screening test checks for cervical cancer.
Pap smear
Typically begins at age 21 and is done every 3 years.
This process moves oxygen and CO₂ from high to low concentration.
Diffusion
The internal emotional response to loss.
Grief
A patient’s legs are cool, pale, and have diminished pulses. These findings are most consistent with this condition.
Peripheral arterial disease (PAD)
This wound complication occurs when a surgical incision partially or completely separates.
Dehiscence
Dehiscence–partial/complete separation of wound edges
Evisceration–protrusion of organs through the wound opening.
Stay with the patient & call for help
Cover the organs with sterile gauze soaked in normal saline
Position patient in low Fowler’s with knees bent
Do NOT try to push organs back in
Keep patient NPO
Monitor vital signs
This part of the brain acts like the body’s thermostat, triggering sweating when you’re too hot and shivering when you’re too cold.
Hypothalamus
These precautions are implemented for patients with low neutrophil counts and focus on preventing exposure to infection, including avoiding sick visitors, raw foods, and fresh flowers.
Neutropenic precautions
A patient presents with confusion, lethargy, N/V, muscle weakness, and seizures. The nurse suspects this electrolyte imbalance.
Hyponatremia
Normal Range 135-145 meq/l
Functions: Balances fluid volume and blood volume and regulates nerve impulses.
FUN FACT: Sodium and Potassium = Opposites
High NA = Low K
Low NA = High K
Positive Kernig’s and Brudzinski’s signs are most associated with this condition.
Meningitis
This tool is used to communicate critical patient information in a structured format.
I-SBAR-R
I- Introduction
“Hi, this is Audrey, the RN on IMC at Regional, calling about Mr. Smith in room 312.”
S- Situation
“He is reporting new onset chest pain that started 10 minutes ago.”
B-Background
“He was admitted for pneumonia yesterday and has a history of hypertension and high cholesterol.”
A-Assessment
“His pain is 8/10, BP is 168/94, HR 110, and he appears diaphoretic.”
R- Recommend
“I recommend we obtain a STAT EKG and troponin levels. Would you like to give any medications?”
R- Read Back
“Okay, I will obtain a STAT EKG, draw troponins, and administer nitroglycerin as ordered.”
Using the best current evidence with clinical expertise is called this.
evidence-based practice (EBP)
This level of Maslow’s Hierarchy is demonstrated when a patient states, “I feel isolated and miss my family since being in the hospital.”
Love and belonging
1. Physiological: O2, food, water
2. Safety: Shelter (housing), physical safety, financial security
3. Love and Belonging: Relationships, connection, support
4. Esteem: Self-worth, confidence, independence
5. Self-Actualization: Reaching full potential, personal growth
The priority action for a patient experiencing anaphylaxis is the administration of this medication.
Epinephrine
First-line treatment for anaphylaxis
Given IM in the lateral thigh (vastus lateralis). Can be given through clothing
Adult Dose = 0.3–0.5 mg IM
Works FAST
Give IMMEDIATELY at the first signs of anaphylaxis
👉 Can repeat every 5–15 minutes if needed
Seek emergency care AFTER use
⚠️ IV only in severe cases (hospital setting)
💉 Adult Dose (Cardiac Arrest)
👉 1 mg IV push
👉 Concentration: 1:10,000 (0.1 mg/mL)
👉 Give every 3–5 minutes
This type of nursing education prepares patients and families for expected developmental changes and potential risks.
Anticipatory guidance
This type of play occurs when toddlers play next to each other but do not interact.
Answer: Parallel play
Parallel play (Toddlers) = Playing next to other children but not interacting with them
Associative Play (Preschoolers) = Playing with other children and interacting, but without rules or structure
This abnormal lung sound is described as high-pitched, musical, and is commonly heard in patients with airway narrowing such as asthma or COPD.
Wheezing
Taylor's page 801
Wheeze: musical, high-pitched, air passing through narrowed airways, inspiration/expiration
Rhonchi: Snoring, low-pitched, inspiration/expiration, air passing through and around sections. Coughing may help clear the sound
Crackles: crackling, popping, low-high-pitched, inspiration/expiration, opening deflated small airways and alveoli, air passing through fluid in the airways
Stridor: Harsh, loud, high-pitched. Inspiration, narrowing of the upper airway, and possible presence of a foreign body in the airway
Friction Rub: rubbing or grating, inspiration/expiration, inflamed pleura(a thin, double-layered membrane that surrounds the lungs and lines the inside of the chest), rubbing against the chest wall.
A patient with asthma has severe dyspnea, cannot speak, has silent lungs, and is not responding to inhalers.
Status asthmaticus
Loss that occurs before the actual death, such as in hospice care.
Anticipatory loss
DAILY DOUBLE!!!
This is the normal percentage range of blood ejected from the left ventricle with each heartbeat.
55% to 70%
Ejection Fraction (EF): % of blood pumped out of the ventricle
Normal = 55-70%
HF: <40%
This phase of wound healing is when new tissue is built and granulation tissue forms.
Proliferation phase
Hemostasis–clotting stops bleeding, occurs immediately
Inflammatory–WBCs clean wound (red/swollen). Follows hemostasis and lasts about 2 to 3 days
Proliferation–new tissue/granulation forms. Lasts for several weeks
Maturation–collagen remodels/scar forms. Begins about 3 weeks after the injury, possibly continuing for months or years
DAILY DOUBLE!!!
This is the main source of body heat in the human body.
Metabolism
•The main source of body heat is metabolism – the process your body uses to make energy.
•When your body needs to make more heat (like when you’re cold), it speeds up metabolism.
This is the gold standard diagnostic test used to confirm the presence of cancer.
Biopsy
Name 2 Hypertonic, 2 Isotonic, and 2 Hypotonic IV solutions
Hypertonic
Isotonic
0.9% Normal Saline (NS)
Lactated Ringer’s (LR)
D5W (isotonic in bag, acts hypotonic in body)
Hypotonic =
Cells shrink
10% NS
5% NS
3% NS
Cells swell
0.45% NS (½ NS)
0.33% NS
0.225% NS
Name FOUR nursing interventions used during seizure precautions.
Place patient on their side
Do NOT put anything in the mouth
Pad side rails
Have suction at bedside
Keep bed in low position
Provide oxygen as needed
This concept focuses on ensuring that all individuals have a fair and just opportunity to achieve their highest level of health by addressing barriers like access, discrimination, and social determinants of health.
Health Equity
Heath equity- attainment of the highest level of health for all people
According to the Clinical Judgment Model (Taylor / NCJMM), name all SIX steps of the clinical judgment process in order.
1. Recognize Cues
Collect the data
“Patient has COPD, O₂ sat 88%, RR 28, using accessory muscles, reports shortness of breath.”
2. Analyze Cues
What does it mean?
“Findings indicate impaired gas exchange and possible COPD exacerbation.”
3. Prioritize Hypotheses
What is most important?
“Impaired oxygenation is the priority problem.”
4. Generate Solutions
What should be done?
“Provide oxygen, position patient upright, administer bronchodilators.”
5. Take Action
Do it (specific nursing action)
“Per MD order, apply 2L NC now and reassess oxygen saturation in 5–10 minutes."
6. Evaluate Outcomes
Did it work?
“O₂ saturation improved to 92%, patient reports decreased shortness of breath.”
DAILY DOUBLE!!!!
This role serves as the central point of contact, is clinically trained, and helps remove barriers to treatment.
Nurse navigator
This organism is the most common cause of osteomyelitis.
Staphylococcus aureus
Osteomyelitis:
Infection of the bone causes inflammation in the bone and surrounding structures.
Acute S/Sx
• Severe Pain
• Fever
• Swelling
• Erythema (Redness)
• Warmth
In the RACE fire safety protocol, what does each letter stand for?
R = Rescue
A = Alarm
C = Confine
E = Evacuate
Identify whether each of the following is primary, secondary, or tertiary prevention:
1. Vaccinations
2. Medications
3. Blood pressure screening
4. Rehabilitation after a stroke
5. Pap Smear
1. Vaccinations: Primary
2. Medications: Tertiary
3. Blood pressure screening: Secondary
4. Rehabilitation after a stroke: Tertiary
5. Pap Smear: Secondary
Define the following terms:
1. Tachypnea
2. Bradypnea
3. Apnea
4. Dyspnea
5. Orthopnea
1. Tachypnea: Increased RR, >24
2. Bradypnea: Decreased RR, <10
3. Apnea: Periods during which there is no breathing
4. Dyspnea: Difficult or labored breathing (shortness of breath)
5. Orthopnea: SOB when lying flat
This happens in the alveoli during pneumonia that impairs gas exchange.
The alveoli fill with fluid or pus
DAILY DOUBLE!!!
The Kübler-Ross stage characterized by sadness and withdrawal.
Depression
Kübler-Ross 5 stages:
1. Denial (refusal to accept reality)
2. Anger (frustration/blame)
3. Bargaining (trying to make deals)
4. Depression (sadness/withdrawal)
5. Acceptance (coming to terms)
In this disease, the heart walls become thick, stiff, and non-compliant. This can obstruct the aortic valve and cause SUDDEN DEATH.
Hypertrophic cardiomyopathy
Dilated: The chambers of the heart dilate, and the muscle walls become weak and thin.
Hypertrophic: The heart walls become thick, stiff, and non-compliant.
Restrictive: The heart muscle becomes stiff and hard like a rock
This stage of pressure injury is characterized by partial-thickness skin loss with exposed dermis and may appear as a blister or shallow open ulcer.
Stage 2
Stage 1–nonblanchable redness intact skin
Stage 2–partial thickness skin loss blister/shallow ulcer
Stage 3–full-thickness skin loss, no exposed bone
Stage 4–full thickness with exposed bone/tendon/muscle
This hormone allows glucose to enter cells and is deficient or ineffective in diabetes.
Insulin
Insulin is the key needed to allows glucose to enter the body’s cells
DAILY DOUBLE!!!
Name THREE manifestations of breast cancer.
Painless lump
Change in breast size or shape
Skin dimpling
Nipple retraction (inversion)
Nipple discharge (bloody/clear)
Redness or scaling of nipple/breast
Swelling of part or all of the breast
Enlarged axillary lymph nodes
DAILY DOUBLE!!!
A patient with hypocalcemia presents with positive Trousseau’s and Chvostek’s signs. Describe what these terms mean.
Calcium level: 8.5-10.5
Tap the cheek (facial nerve)
Positive: facial twitching
Inflate BP cuff on the arm
Positive: hand spasms
After a seizure, the patient may experience confusion, drowsiness, and fatigue. This phase is called this.
Postictal phase
During this phase, the nurse helps the patient explore problems, set goals, and implement interventions to improve health outcomes.
The Working Phase
Orientation phase: Getting to know the patient, building trust, and setting goals.
Working phase: Doing the work, addressing problems, implementing care, and progressing toward goals.
Termination phase: Ending the relationship, evaluating outcomes, and preparing for discharge.
A nurse is assessing factors that may impact a patient’s health outcomes beyond medical care. According to Taylor’s Fundamentals of Nursing, the nurse identifies several social determinants of health.
Name FIVE social determinants of health that could affect this patient’s health.
SDOH: The conditions in which people are born, grow, live, work, and age that affect their health outcomes. (Non-medical factors that influence a person’s health)
Economic stability: Income, employment, ability to afford food, housing, medications
Education: Literacy, education level, ability to understand health information
Health care access and quality: insurance, access to providers, quality of care
Neighborhood and built environment: Housing, safety, transportation, access to healthy food
Social and community context: support systems, relationships, discrimination, community engagement
Things that are NOT a SDOH: Medical dx, s/sx, labs, genetics, lifestyle choices like smoking.
The RN is caring for multiple patients. Name 3 tasks that cannot be delegated to an LPN or UAP and must be performed by the RN?
1. Initial patient assessment
Performing a full head-to-toe assessment on admission
2. Nursing diagnosis
Identifying: Impaired Gas Exchange
3. Care planning
Developing measurable goals, creating interventions, and determining priorities
4. Patient education/teaching
Teaching insulin administration, educating about discharge medications
5. Evaluation of patient outcomes
Determining if interventions worked, reassessing after medication
Don't delegate what you EAT
E= Evaluate
A = Assess
T= Teach
A patient on high-dose IV methylprednisolone (Solu-Medrol) at increased risk for this metabolic complication?
Hyperglycemia (It acts like cortisol, a stress hormone, which raises blood sugar)
Solu-Medrol is a corticosteroid (anti-inflammatory & immunosuppressant)
DAILY DOUBLE!!!!!!!!
Demo the following:
1. Abduction (arm)
2. Adduction (arm)
3. Circumduction (arm)
4. Flexion (arm)
5. Extension (arm)
6. Hyperextension (leg)
7. Dorsiflexion
8. Plantar flexion
1. Abduction: Move your arm away from your body
2. Adduction: Bring your arm back toward your body
3. Circumduction: Move your arm in a full circular motion (like making a big circle)
4. Flexion: Bend a joint (example: bend your elbow)
5. Extension: Straighten a joint (example: straighten your arm)
6. Hyperextension:
Extend a joint past the normal straight position (slightly backward)
7. Dorsiflexion: Pull your toes up toward your head
8. Plantar flexion: Point your toes down like pressing a gas pedal
At birth, infants receive these FOUR routine screenings. Name at least TWO.
Hearing screen
Newborn blood screen
Pulse oximetry
Bilirubin test
Using the mannequin in the classroom, locate and point to the exact sites where you would assess each of the following pulses:
Temporal
Carotid
Brachial
Radial
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis
Temporal → Side of forehead, in front of the ear
Carotid → Side of the neck (next to the trachea) ⚠️ one side only
Brachial → Inside of the upper arm (inside elbow)
Radial → Wrist on the thumb side
Femoral → Groin area
Popliteal → Behind the knee
Posterior Tibial → Inside of the ankle (behind the ankle bone)
Dorsalis Pedis (Pedal) → Top of the foot
Name the normal ABG values:
pH:
PaCO2:
HCO3
PaO2
pH: 7.35-7.45
PaCO2: 35-45
HCO3: 22-26
PaO2: 80-100
A patient who has bone cancer is most likely experiencing which of the following types of pain?
Somatic
Deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves.
Name 3 manifestations of right-sided HF.
Right = rest of the body
Left = lungs
Peripheral edema
Ascites (abnormal fluid buildup in the peritoneal cavity/ abdominal swelling)
JVD
Hepatomegaly (enlarged liver)
Anorexia
N/V
Generalized weakness
Weight gain
This condition affects central vision, making it difficult to read or recognize faces, while peripheral vision remains intact.
Macular degeneration
Macular degeneration–loss of central vision
Cataracts–cloudy lens blurry vision
Glaucoma–increased eye pressure damages optic nerve
The most common sign of the body’s systemic response to infection, injury, or inflammation.
Fever
Afebrile—without fever
Febrile—with fever
This mnemonic is used to assess suspicious skin lesions: ABCDE. What do these letters stand for?
A = Asymmetry (opposing sides do not match)
B = Border (edges are irregular and blurred)
C = Color (more than one color present)
D = Diameter (larger than 6mm)
E = Evolving (changing in size, shape, color, etc.)
This medication is administered IV to treat symptomatic hypocalcemia and stabilize cardiac membranes.
Calcium gluconate
Increases calcium levels
Give IV slowly (NEVER rapid push)
Continuous ECG monitoring (can cause Cardiac dysrhythmias)
These two lab values are used together to assess kidney function and increase when the kidneys are not filtering properly. What are they, and what are their normal ranges?
Creatinine and BUN
Creatinine–waste from muscle metabolism, normal 0.7–1.4 mg/dL
BUN–waste from protein breakdown, normal 7–18 mg/dL