Vital Signs
Mobility/Immoblilty
Cranial Nerves
Skin Integrity
Physical Assessment
Professionalism
100

Another name for fever 

Pyrexia

100

Lateral movement of a body part away from the midline of the body.

Abduction

100

Function is sense of smell 

CNI Olfactory 

100

The first line of defense against microorganisms

Skin

100

Patient data that is measurable and directly observed

Objective Data

100

regulatory body having the authority to make and enforce rules and regulations concerning the nursing profession; detemines number of CEU's required for license renewal. 

State Board of Nursing

200

Normal range for pulse in adults 

60-100 beats per minute

200

 The state of being in a straight line.

Extension

200

responsible for pupillary response and accomodation

CN III Oculomotor

200

(dehydration)- the process of drying up.

Desiccation

200

Term for fullness or elasticity of the skin

Turgor

200

Most important law affecting your nursing practice; describes the “who,” “what,” “when,” “where,” “why,” and “how” of nursing practice.

Nurse Practice Act

300

Most common site to assess peripheral pulse in adults when taking vital signs

radial pulse

300

Backward bending of the hand or foot.

Dorsiflexion

300

Responsible for chewing and facial sensation; corneal reflex

CN V Trigeminal

300

In wound healting- the tissue that often appears as red, bumpy tissue that is described as “cobblestone-like” in appearance; forms the foundation for scar tissue development.

Granulation Tissue

300

Visual acuity is assessed using this tool

Snellen Chart

300

The process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area.

Certification

400

Grade for a normal, brisk pulse amplitude (strength)

+2

400

involves muscle shortening and active movement. Examples include carrying out ADLs, independently performing range-of-motion exercises, and swimming, walking, jogging, and bicycling.

Isotonic exercise

400

Tests for visual acuity and visual fields 

CN II Optic
400

Type of drainage composed primarily of the clear, watery portion of the blood

Serous

400

Acronym used for normal eye function

PERRLA

400

Type of intentional tort in which a threat or an attempt to make bodily contact with another person without that person’s consent.

Assault

500

Movement of air in and out of the lungs

ventilation

500

the maximum degree of movement of which a joint is normally capable)

Range of Motion

500

Sense of hearing

CN VIII Acoustic

500

known as the repair phase of wound healing

Proliferation phase

500

Breath sounds heard over the mainstem bronchus

Bronchovesicular

500

Spoken Defamation of Character

Slander

600

Normal range for respirations in an adult

12-20

600

semi-sitting position, calls for the head of the bed to be elevated 30 to 45 degrees.

semi-fowlers

600

Lateral movement of the eyes; side-to-side

CN VI abducens

600

Term for dead tissue in wounds; appears as slough—moist, yellow, stringy tissue—and eschar appears as dry, black, leathery tissue.

Necrosis

600

term for abnormal lung sounds 

adventitious

600

Willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property

Fraud

700

Increased respiratory rate; may occur in response to an increased metabolic rate

Tachypnea

700

the patient lies flat on the back with the head and shoulders slightly elevated with a pillow unless contraindicated

supine

700

Tested by raising eyebrows, smile, frown; taste on anterior 2/3 tongue

CN VII Facial

700

The partial or total separation of wound layers as a result of excessive stress on wounds that are not healed.

Dehiscence

700

Harsh, loud, high pitched sound that indicates obstruction of the airway

stridor

700

Defined as performing an act that a reasonably prudent person under similar circumstances would not do or, conversely, failing to perform an act that a reasonably prudent person under similar circumstances would do

Negligence

800

Maximum pressure when left ventricle contracts and pushes blood through aortic valve into the aorta

Systolic Pressure

800

True or False: The cane is held on the patient’s stronger side and is advanced one small stride ahead 

True

800

Swallow, gag reflex; taste on posterior 1/3 of tongue

CN IX Glossopharyngeal

800

Pressure injury stage with nonblanchable erythema of intact skin.

Stage I

800

first and second heart sounds "lub-dub"

S1S2

800

The four elements that MUST be established to prove that malpractice or negligence has occurred.

Duty, Breach, Causation, Damages

900

Lowest pressure when the heart rests between beats

Diastolic Pressure

900

True or False: when going down stairs-Move crutches and unaffected leg first, followed by the affected leg. 

False

900

Downward, inward eye movement

CN IV Trochlear

900

Type of drainage that consists of large numbers of red blood cells and looks like blood

Sanguineous 

900

Anatomical location of pulmonic valve

2nd ICS, left sternal border

900

The protection and support of another’s rights

Advocacy

1000

Results from an inadequate physiologic response to position changes

Orthostatic Hypotension

1000

an increased thoracic spinal curve; common in older adults

Kyphosis

1000

Movement of the tongue

CN XII Hypoglossal

1000

When the abdominal wound completely separates, with protrusion of viscera (internal organs) through the incisional area.

Evisceration

1000

Anatomical location of the mitral valve

5th ICS, midclavicular line

1000

Acting in accordance with an appropriate code of ethics and accepted standards of practice.

Integrity

1100

Factors that affect pulse oximetry reading- Name 3

Temperature of the extremity

Nail polish/artificial nails

Movement

Inflated BP cuff on same extremity

Perfusion

1100

Characterized by the displacement of a bone from a joint with tearing of ligaments, tendons, and capsules.

Dislocation

1100

Swallowing and speaking

CN X Vagus

1100

Pressure injury stage with full-thickness skin and tissue loss that may extend to the muscle, bone, tendon, or joint

Stage IV

1100

Amount of time to auscultate bowel sounds before documenting absent 

1 minute per quad, 5 min total

1100

value that is reflected in professional practice when the nurse works to assure equal treatment under the law and equal access to quality health care.

social justice

1200

S/S include headache, fatigue, Skin moist/sweating, increased pulse, temperature elevated but typically 102 or less. 

Heat exhaustion

1200

type of exercise that refers to sustained (often rhythmic) muscle movements that increase blood flow, heart rate, and metabolic demand for oxygen over time, promoting cardiovascular conditioning

Aerobic

1200

Movement of shoulder muscles

CN XI Accessory 

1200

Type of open drain that does not have a collection device

Penrose drain

1200

Percussion sound heard over normal lung

Resonance (hollow)

1200

Involves the transfer of responsibility for the performance of an activity to another person while retaining accountability for the outcome.

Delegation

1300

S/S include Anxiety, confusion, skin hot and dry, impaired sweating, increased pulse and respirations, hypotension; body temp 105 or greater

Heat stroke

1300

Weight bearing term for ability to remove a sheet of paper from beneath foot at all times

Touch down/Toe Touch

1300

Number of cranial nerves that are both sensory and Motor

Four; CN V, VII,IX,X

1300

Factors that affect pressure injury development/impaired skin integrity- List 4 

Aging skin

Chronic illnesses

Immobility

Malnutrition

Fecal and urinary incontinence

Altered level of consciousness

Spinal cord and brain injuries

Neuromuscular disorders

1300

Ration for T:AP Diameter

2:1

1300

5 Rights of Delegation

Right Task

Right Circumstance

Right Person

Right Direction/Communication

Right Supervision