Nursing Process
Nurse's clinical judgment about the patient's response to actual or potential health conditions, formatted in a list.
What is Nursing Diagnosis?
Which pulse site is located on the inside of the elbow?
A. Temporal
B. Radial
C. Femoral
D. Brachial
What is Brachial?
This type of power is by virtue of position.
What is Explicit power?
This type of assessment is conducted to assess a specific problem.
What is a focused assessment?
This level of communication occurs between two or more people with the goal to exchange messages.
What is interpersonal communication?
The transfer of responsibility for the performance of an activity to another individual while retaining accountability for the outcome.
What is delegation?
This is known as decreased respiratory rate; occurs in some pathologic conditions.
What is bradypnea?
This type of Leadership style is non-directive and relinquishes power to the group.
What Laissez-faire?
Which physical assessment technique is used to assess temperature, turgor, texture, moisture, and shape?
A. Inspection
B. Percussion
C. Palpation
D. Auscultation
What is C? Palpation
This phase of the helping relationship is the longest and the nurse is in the role of teacher and counselor.
What is the working phase?
This stage is where the nurse formulates a plan of action.
What is the planning phase?
When taking a manual BP the sound we are assessing with the stethoscope is?
What is Korotkoff? (The first sound is systolic, the change or cessation in sound is diastolic)
This type of management structure includes senior managers generally making decisions with little input from the group.
What is centralized management?
The following questions are assessing what? What is today’s date? What day of the week is it? What season of the year is this? What was the last holiday?
What is the patient's level of awareness, specifically time?
Which activity generally occurs during the orientation phase of the helping relationship?
A. An agreement or contract about the relationship is established.
B. The nurse provides any assistance needed to achieve patient goals.
C. The nurse provides patient counseling and teaching.
D. The patient and nurse examine the goals of the helping relationship for indications of attainment.
What is A?- an agreement or contract about the relationship is established.
This takes place after the interventions to see if goals are met.
What is evaluation?
This is characterized by an increase above normal in both systolic and diastolic pressures.
What is primary or essential hypertension?
This conflict resolution strategy results in a win for one party at the expense of the other group. This win-lose confrontation can frustrate the loser, with a desire to "get even" in the future. This strategy may be used when one party has more knowledge of the situation or resistance is appropriate because of ethical concerns or unsafe patient care practices.
What is competing?
Name two purposes of documenting the physical assessment.
Identify actual and potential health problems
Make nursing diagnoses
Plan appropriate care
Evaluate patient's responses to treatment
This type of interviewing technique prevents the patient from giving a simple yes or no answer.
What is an open-ended question or comment?
What is, if used incorrectly, the patient might be misdiagnosed?
Name three instances when assessing VS would be appropriate.
On admission to any health care facility or institution
Based on the facility or institutional policy and procedures
Any time there is a change in the patient's condition Any time there is a loss of consciousness
Before and after any surgical or invasive diagnostic procedure
Before and after activity that may increase risk, such as ambulation after surgery
Before administering medications that affect cardiovascular and respiratory function
In this stage of Lewin's theory of change, the change is initiated after a careful process of planning.
What is the moving phase?
This quadrant of the abdomen contains the stomach, spleen, splenic flexure of the colon and the body of the pancreas.
What is the left upper quadrant?
This behavior is rude, disruptive, intimidating, and undesirable behavior directed at another person. It includes failing to act when action is warranted, such as refusing to assist a coworker or sharing important information about a patient's care.
What is incivility?