assessment
What should you assess for when taking vitals?
Blood pressure, temperature , respirations, pulse, oxygen saturation, and pain.
How do you diagnose an infection?
Warmth, redness, swelling, moist, pain, loss of function
What is your plan of care for a fall risk patient?
Floor mats, lower bed, call light within reach, keep them close to nurses station, keep personal belongings close?
Which religious/cultural group does not receive a blood transfusion?
Jehovah’s Witness
What’s the normal temperature range for an adult?
98.6 to 100.2 degrees
How do you assess a child’s pain?
Using the FLACC- Face scale
What are the signs and symptoms of COPD?
SOB, wheezing, coughing up mucus, chest pain
How do you prevent a patient from pressure injuries who are immobile.
Repositioning every 2 hours and use assistive devices
When administering a TB test, what should you implement for?
Bevel up, a bleb, 15 degrees, intradermal, monitor for infection or swelling for 3 days
What are the standard precautions for an airborne infection?
Negative pressure room, N95 mask, private room
How do you assess for a stroke?
FAST. Face, arms, speech, time.
How would you diagnose a UTI in a geriatric patient?
Confusion, pain in perineal area, frequent urination, and pain when urinating.
Why is your plan of care for a patient who has gout?
Drink 8 to 16 glasses of water, avoid foods that are high in purines, and do not take these drugs if breastfeeding.
How do you implement giving ear drops for a child.
Pull external ear down and back.
Where are the pulses located?
Temporal, carotid, apical, brachial, radial, femoral, axillary, popliteal artery, posterior tibial artery, and pedal dorsalis
What are you looking for in an eye assessment?
PERRLA
How to diagnose an IV infiltration?
Redness, swelling, warmth, tissue damage, slough, necrosis
What is your plan of care for a patient taking corticosteroids?
Obtain a drug history, assess for any signs of fever, drainage, foul smelling urine, and productive cough. Momitor patient closely after taking medication.
How do you properly administer eye drops with one infected eye?
Use two medication bottles and wait five minutes in between. Change gloves in between for infection control.
The nurse assess the client’s breath sounds. Which one requires immediate medical attention?
1) crackles
2) rhonchi
3)stridor
4) wheezes
3) stridor
When assessing you patient, what is the first action the nurse should prioritiz?
ABC’s
What is the percentage when diagnosing a burn on the trunk of the body?
9%
What is the plan of care for a patient who has seizures?
O2, Pad the side rails, avoid any chocking hazards, padded floor mats
Name and explain the nine rights.
1. Right patient
2. Right drug
3. Right dosage
4. Right route
5. Right time
6. Right documentation
7. Right refusal
8. Right response.
9. Right reason
What are the different masks types and their flow rates?
Nasal cannula 2-6 L/min
Simple masks 6-10 L/min
Venturi masks 2-15 L/min
Face tent at least 10 L/min
Non-rebreather mask 10-15 L/min
High-flow nasal prong therapy up to 60 L/min