Nursing Process/Role
These are the steps in the nursing process, listed in order
Assessment, diagnosis, planning, Implementation, Evaluation
This healthcare professional is responsible for assessing patients, administering medications, coordinating care plans, educating patients, and often acts as the primary communicator between doctors and patients.
What is a nurse
These factors would affect this type of vital sign, feet not flat on ground, patient slouched, legs crossed, arm not at heart level, patient not relaxed/quiet
What is blood pressure
This can be measured, palpable, assessed using the senses
What is objective data
These are caused by brain disease of known specific organic cause such as delirium, dementia, alcohol and drug intoxication, and withdrawal
What is organic disorders
If circulation is compromised, ____ or ____ may be present
What is lack of oxygen, paleness of skin (hypopigmentation)
Beginning nursing student or any nurse entering a situation for which there is no previous experience
What is a novice nurse
This is the respiration rate for bradypnea
What is <12bpm
Symptoms like this are: Temp 37.1 o C, Pulse=72, Resp = 22, BP = 112/64...
What is objective data
The systemic assessment of emotional and cognitive function
What is the mental status exam
During this stage in Maslow's hierarchy of needs, a nurse assigns the highest priority to a patient experiencing urinary incontinence due to a recent surgery
What is elimination
The Nurse is helping a patient express their treatment goals to the doctor or the social worker. This an example of what nursing role?
What is an advocate
Pyrexia begins at what temperature
What is normal 99.5 degrees F
Hearing a popping sound when the left knee is extended. The client saying that their left knee has been swollen and hot for the past 3 days
Reported left knee pain... Which is the subjective data
What is their knee swollen for 3 days and the left knee in pain
What is the 4 unrelated word test
The clinic nurse prepares to perform a focused assessment on a client who is complaining of symptoms of a cold, a cough, and lung congestion. Which should the nurse address first? What level of priority are the cold and cough symptoms?
What is long congestion and 2nd level priority
This is the use best-practice techniques including research evidence, clinical expertise, physical assessment, and patient preference
What is evidenced-based practice
A patient has intravenous fluids infusing in the right arm. When taking a blood pressure on this patient, what would the nurse do in this situation?
What is take the blood pressure on the left arm
Lung sounds are clear to auscultation, crackles in the left lower lobe, improved since last assessment, incentive spirometer and coughing with deep breathing completed, oxygen saturation 96%, BP 148/92, T 100.6 °F, complaining of being cold , HR 114 bpm, RR 24 per minute. This all objective data, true or false, if false why?
What is false, complaining of being cold is subjective
These four parts are assessed during a mental status assessment. It is the objective data collected during a mental status exam
What is ABCT (appearance, behavior, cognition, and thought process)
A nurse is working in a clinic that is located in a busy, inner-city neighborhood. Which client would the nurse address first to be in most need of an emergency assessment?
14-year-old girl who is crying because she thinks she is pregnant
45-year-old man with chest pain and diaphoresis
3-year-old child with fever, rash, and sore throat
20-year-old man with a 3-inch shallow laceration on his neck
What is the 45 year old man
This type of database is used in all settings, collected for short-term problems, and focuses on one body system or cue complex
What is problem-centered database
Volume of blood pumped into the arteries by the heart and equals the result of the stroke volume (SV) times the heart rate (HR) per min
What is cardiac output
The nurse who provides care at an ambulatory clinic is preparing to meet a client and perform a comprehensive health assessment. Which of the action should the nurse perform first?
What is validate the patient's identity using 2 identifiers (name and DOB)
This mental exam concentrates on cognitive function and memory. It tests a patient's level of orientation to time and place, ability to register and recall words, attention and calculation, and language skills. It detects dementia.
What is mini mental state exam (MMSE)