Health Assessment
These techniques (inspection, palpation, auscultation) are performed in order when assessing a patient, except:
Assessing the abdomen.
The nurse must begin each documented entry with:
Time and date.
What is a normal blood pressure for an adult patient?
120/80
Name one symptom of hypocalcemia.
numbness, tingles, seizures, spasms, muscle twitching, cramping,
Before giving a medication, the nurse should check the medication label to see that it has not what?
Expired
When assessing the neck, what items are we looking for?
Tracheal midline, no deviation, no jugular vein distension.
The nurse must end each document entry with:
Signature.
When counting a patient's respirations, the nurse should NOT?
Let the patient know they are counting breaths.
0.45% Normal saline is an example of what type of solution?
Hypotonic.
When should the nurse document giving a medication?
AFTER administration
The left arm may have a clot or a other circulatory issue.
The patient states, "I feel a little short of breath." This is an example of what type of data?
Subjective
Elderly patients typically have temperatures ______ compared to healthy adult patients.
Lower
bradycardia, lethargy, hypotension.
What angle is an IM injection given at?
90 degrees
The pulmonic valve is located where?
Left 2nd Intercostal space.
The nurse is documenting in the patient's chart when a mistake is made. What is the proper way to correct this?
Draw a single line through it, add time, date and signature.
Why is it important for the nurse to obtain the patient's temperature from the same site?
Different sites give different readings.
The nurse can expect which imbalance to occur in patient's experiencing diarrhea:
hypocalcemia, hypokalemia, hypomagnesemia, and metabolic acidosis.
The reduced function of which organ can lead to medication toxicity in older adults?
Kidney
Tricuspid and Mitral valves closing/Ventricles closing.
This type of documentation tells a story about the patient.
What is Narrative note?
The hypothalamus contains the control center for which vital sign?
Temperature
pH 7.33, CO2 - 87, HCO3 -25
Respiratory Acidosis.
What are the 7 rights of medication administration?
Right medication, dose, patient, route, time, documentation, indication