Professional Identity & Critical Thinking
Integrity, Accountability, Advocacy, Empathy, Cultural Sensitivity, Competence, Compassion, Patient-Centered Care, and Evidence-Based Practice are all elements of _____________
Professional Identity in nursing
The normal range for body temperature a _____ - ______ degrees Fahrenheit
96.8-100.4
The pulses in the lower extremities include __________, ____________, ___________, and ___________
Femoral, popliteal, posterior tibial, and dorsalis pedis
When the nurse palpates the lungs and asks the patient to say "ninety-nine," he/she is assessing __________
tactile fremitus
The acronym SBAR stands for ______________
Situation, Background, Assessment, Recommendation
This document is a set of state laws that regulate the practice of nursing to protect the public's health, safety, and welfare
Nurse Practice Act
When assessing a blood pressure, the first Korotkoff sound represents the ___________, and the last represents the ___________
systolic, diastolic
A swishing sound in an artery is called a _________, and a physical vibration over an artery is called a ____________
Bruit, thrill
The nurse should inspect the patient's abdomen in which order ________, ________, _________,
Inspect, Auscultate, Palpate
What types of tasks must be completed by an RN? (cannot be delegated to LPN) __________, __________, __________, ___________
Initial patient assessments, developing care plans, high-risk IV medications, administering blood products
When a nurse assesses situations, analyzes data, and considers what is most important in making safe patient-centered decision, he/she is demonstrating ___________________
Critical thinking
For young children and people unable to use the Numerical Rating Scale, the nurse can assess pain using the ____________
Wong-Baker Faces Pain Rating Scale
Expiratory wheezes
PERRLA stands for _________________
Pupils equal, round, reactive to light and accommodation
When documenting the strength of a pulse, one that feels normal or expected would be given a score of __________
2
When a nurse works closely with other healthcare professionals to make safe, patient-centered decisions, he/she is demonstrating _________________
Professional collaboration
In cases of severe infection and organ failure, the nurse expects which changes in vital signs (up or down):
Temp ______
Heart rate _______
Blood pressure ______
Respirations ________
Oxygen ________
Temp - up
Heart rate - up
Blood pressure - down
Respirations - up
Oxygen - down
"Less than 3 seconds" is a normal finding for which assessment _______________
capillary refill
A nurse is assessing a patient who just arrived to the ER from a nursing home. The patient is A&Ox1, confused to time, location, and events. What further information is most important for the nurse to obtain regarding the patient's mental status?
What is the patient's baseline?
The 5 rights of delegation are _______, ______, _______, _______, and _________
Task, Circumstances, Person, Directions, and Supervision
For each vital sign, list 2 common reasons a nurse might get an inaccurate reading:
Temperature: ________, ________
Blood pressure: _______, ________
O2 Saturation: ________, ________
Temp: Pt covered up or came from a hot environment, pt just took a cold drink of water
BP: cuff size too big or small, pt legs crossed
O2: reading before waveform established, placing probe in area without adequate circulation
Fifth, midclavicular
The 5 areas for listening to the heart are __________, _________, _________, _________, and __________
Aortic, pulmonic, Erb's point, tricuspid, and mitral
A swishing sound heard between S1 and S2 would be documented as a ____________
systolic murmur