Foundations for Nursing Practicum I (NURS 1003)
Positioning when head of the bed is 30 degrees
Semi Fowler's
This organ pumps blood throughout the body and maintains circulation
During a physical assessment, this technique involves listening to sounds produced by the body, such as the heart, lungs, and abdomen.
Auscultation
What is a serious black box warning for people taking antidepressants?
Antidepressant use can increase the risk of suicide around the 2 week mark
This is the term for chest pain due to reduced blood flow to the heart.
Angina
The nursing intervention that helps prevent pressure ulcers and maintains skin integrity in immobile patients
Regular repositioning q2 hours
Primary structure (amino acid sequence)
During a health assessment, this type of data is gathered from the patient’s own statements about symptoms, feelings, and perceptions, rather than what the nurse observes.
subjective data
You observe your patient sitting in a corner talking to themself, what would be a good initial therapeutic response?
“are you hearing voices, what are they telling you?"
Bubbling in this chamber indicates an air leak in the chest tube system
Water seal chamber
29 y/o M post-op appendectomy x48 hours is fatigued and has scant purulent drainage from the surgical site.
Vitals: T: 37.7 C, HR: 104, RR: 20, BP: 120/80 mmHg
What may this patient be manifesting?
Fever
These cells in the pancreas secrete insulin and glucagon, regulating blood glucose levels.
Islets of Langerhans
A nurse auscultates crackles at the bases of the lungs of a patient with shortness of breath. This finding may indicate this condition...
fluid in the alveoli / pulmonary edema, possibly due to heart failure
What is the PHQ-9 Questionnaire utilized for?
It is used to screen for depression and measure/assess risk for suicide. It is also used to monitor treatment for depression.
The PHQ-9 Questionnaire cannot diagnose depression, it is not a tool for bipolar disorder, and will not assess physical health.
A patient has chest pain with ST-elevation on ECG. Which intervention takes priority?
What is prepare for emergent reperfusion therapy (PCI or thrombolytics)
During enteral feeding via a NG tube, this step ensures that the tube is correctly placed in the stomach and prevents aspiration.
What is checking tube placement by aspirating stomach contents and/or verifying pH?
This portion of the small intestine has the largest surface area for nutrient absorption due to villi and microvilli.
Jejunum
On inspection, a patient’s skin is yellowish in color, and sclera are icteric. What does this indicate?
jaundice, possibly indicating liver dysfunction
Yes. Naloxone is short acting. Naloxone will displace the opioid from the receptor then attach again causing respiratory depression.
Scenario: You have four new patients on your shift. Which do you see first?
Patient A: 65-year-old post-MI, chest pain rated 7/10, HR 110, BP 88/54.
Patient B: 50-year-old with pneumonia, oxygen saturation 90% on 2L O₂, stable vitals.
Patient C: 70-year-old with newly diagnosed DKA, blood glucose 26 mmol/L, alert, vomiting.
Patient D: 40-year-old post-op appendectomy, vitals stable, needs medication administration.
Patient A first (unstable cardiac status = highest acuity), then Patient C (DKA), then Patient B (respiratory issue but more stable), then Patient D.
This nursing action is critical when a patient on bed rest develops sudden shortness of breath, chest pain, and leg swelling, indicating a life-threatening complication.
HINT: you will assess for...
Assessing for and responding to signs of a possible pulmonary embolism/deep vein thrombosis
This part of the brainstem regulates autonomic functions like respiration, heart rate, and blood pressure, and contains nuclei for cranial nerves IX–XII.
medulla oblongata
Auscultation reveals a harsh, blowing sound over the carotid artery.
carotid bruit, possibly indicating arterial stenosis
What is the role of the psychiatric patient advocate office
Advocate on behalf of clients, advise clients and SDMs of their rights, and education.
A 62-year-old patient with stage 4 CKD, HF, and COPD is admitted with shortness of breath, edema, and crackles on auscultation. Vital signs: BP 95/60, HR 110, O₂ sat 88% on 2L. Labs: K⁺ 6.2 mmol/L, creatinine 450 µmol/L. ECG shows peaked T waves. The patient reports palpitations and mild confusion.
What is the nurse’s highest priority action?
A) Elevate the head of the bed to Semi Fowler's and increase oxygen flow rate
B) Administer IV furosemide to reduce fluid overload and pulmonary edema
C) Place on cardiac monitor and notify physician for emergent hyperkalemia management
D) Restrict potassium intake and record daily weights
Place on cardiac monitor and notify physician for emergent hyperkalemia management.WHY? Hyperkalemia with ECG changes is life-threatening; cardiac monitoring and rapid physician notification are urgent.
The most critical thing = peaked t waves = early sign of hyperkalemia. causes cellular disruptions which can lead to ventricular fibrillation. can be treated with calcium gluconate to stabilize the heart. or IV insulin and dextrose to drive K+ into cells