Podcast
Questions and Answers
What is the correct process to obtain a urine specimen for culture and sensitivity from a catheterized patient?
What is the correct process to obtain a urine specimen for culture and sensitivity from a catheterized patient?
- Disconnect the drainage bag, obtain a sterile syringe and draw the specimen from the drainage bag
- Clamp the catheter for 30 minutes, alcoholize the tube above the clamp site, obtain a sterile syringe and draw the specimen on the tube above the clamp
- Alcoholize the self sealing port, obtain a sterile syringe and draw the specimen on the self sealing port (correct)
- Disconnect the tube, obtain a sterile syringe and draw the specimen from the tube
Which option demonstrates an example of secondary prevention?
Which option demonstrates an example of secondary prevention?
- Screening patients for hypertension (correct)
- Immunizing infants with BCG
- Teaching the diabetic client on obtaining his blood sugar level using a glucometer
- Providing PPD on a construction site
Identify the abnormal condition in which a person must sit, stand, or use multiple pillows when lying down.
Identify the abnormal condition in which a person must sit, stand, or use multiple pillows when lying down.
- Eupnea
- Apnea
- Dyspnea
- Orthopnea (correct)
Which aspect should be prioritized when assigning care for geriatric patients?
Which aspect should be prioritized when assigning care for geriatric patients?
What is the highest priority component before conducting a physical examination?
What is the highest priority component before conducting a physical examination?
Legally, who owns the patient's chart?
Legally, who owns the patient's chart?
Which of the following is a form of primary prevention?
Which of the following is a form of primary prevention?
What is typically seen in the water seal bottle during inhalation of the patient?
What is typically seen in the water seal bottle during inhalation of the patient?
What is the appropriate position for draining the anterior and posterior apical segments of the lungs when performing percussion?
What is the appropriate position for draining the anterior and posterior apical segments of the lungs when performing percussion?
Which aspect should NOT be included when documenting the outcome of Richard's treatment?
Which aspect should NOT be included when documenting the outcome of Richard's treatment?
When assessing Richard for chest percussion or vibration, which factor would be least relevant?
When assessing Richard for chest percussion or vibration, which factor would be least relevant?
Which of the following is a special consideration when performing postural drainage and percussion?
Which of the following is a special consideration when performing postural drainage and percussion?
What distinguishes chest percussion from vibration?
What distinguishes chest percussion from vibration?
What is a primary reason for having Richard sit upright before treatment?
What is a primary reason for having Richard sit upright before treatment?
Which would be the least effective action in helping a client with excessive secretions?
Which would be the least effective action in helping a client with excessive secretions?
During the assessment of a client for percussion therapy, which observation is least relevant?
During the assessment of a client for percussion therapy, which observation is least relevant?
Which type of bath is recommended for a patient experiencing pruritus?
Which type of bath is recommended for a patient experiencing pruritus?
What type of burn is characterized by a whitish, leathery, and painless burned area on the skin?
What type of burn is characterized by a whitish, leathery, and painless burned area on the skin?
During the first 24 hours after a burn, which nursing measure should be prioritized?
During the first 24 hours after a burn, which nursing measure should be prioritized?
What is the priority nursing intervention during the acute phase of burn management?
What is the priority nursing intervention during the acute phase of burn management?
What is the most fatal electrolyte imbalance in burn clients during the emergent phase?
What is the most fatal electrolyte imbalance in burn clients during the emergent phase?
Which ECG change is associated with hypokalemia?
Which ECG change is associated with hypokalemia?
What is the preferred route for administering pain medications to burn patients?
What is the preferred route for administering pain medications to burn patients?
Which type of debridement uses proteolytic enzymes?
Which type of debridement uses proteolytic enzymes?
What role does a warm and caring nurse play in the context of a mentally ill person's positive response?
What role does a warm and caring nurse play in the context of a mentally ill person's positive response?
What is likely to be Camila's premorbid personality if her past history is reviewed?
What is likely to be Camila's premorbid personality if her past history is reviewed?
When receiving telephone orders, how long does a physician have to sign the order after it is documented?
When receiving telephone orders, how long does a physician have to sign the order after it is documented?
What is the most critical goal for a nurse to set with a family if a child is determined to be physically abused?
What is the most critical goal for a nurse to set with a family if a child is determined to be physically abused?
How is cocaine classified based on its effects on the central nervous system?
How is cocaine classified based on its effects on the central nervous system?
What should an 85-year-old widow focus on to complete the tasks of older adulthood successfully?
What should an 85-year-old widow focus on to complete the tasks of older adulthood successfully?
What is the concept called when a nurse understands their own values and feelings and how they impact others in a therapeutic relationship?
What is the concept called when a nurse understands their own values and feelings and how they impact others in a therapeutic relationship?
Which observation would indicate a decrease in the effectiveness of Bryant's traction for Graciela?
Which observation would indicate a decrease in the effectiveness of Bryant's traction for Graciela?
Which action is the highest priority regarding Rudy's external shunt?
Which action is the highest priority regarding Rudy's external shunt?
What dietary recommendation is appropriate for Rudy with acute renal failure?
What dietary recommendation is appropriate for Rudy with acute renal failure?
Which organism is the most common causative agent of Pyelonephritis in hospitalized patients due to prolonged catheterization?
Which organism is the most common causative agent of Pyelonephritis in hospitalized patients due to prolonged catheterization?
What should be instructed to increase the chance of passing renal stones for Fe?
What should be instructed to increase the chance of passing renal stones for Fe?
What does superficial partial thickness burns of the skin indicate in Sergio's condition?
What does superficial partial thickness burns of the skin indicate in Sergio's condition?
In the first 24 hours after Sergio's thermal injury, which electrolyte abnormalities should be assessed?
In the first 24 hours after Sergio's thermal injury, which electrolyte abnormalities should be assessed?
Which feeding method should the family adopt to minimize discomfort for Rudy?
Which feeding method should the family adopt to minimize discomfort for Rudy?
What is the best approach to avoid irritation in Rudy's condition?
What is the best approach to avoid irritation in Rudy's condition?
Flashcards
Ineffective airway clearance
Ineffective airway clearance
A nursing diagnosis related to difficulty clearing secretions from the lungs, increasing risk for infection.
Positioning for percussion
Positioning for percussion
Turning a patient to facilitate drainage and loosen secretions, alternating back and abdomen.
Chest percussion
Chest percussion
Using cupped hands to deliver rhythmic blows to the chest for loosening secretions.
Vibration therapy
Vibration therapy
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Urine specimen collection (sterile)
Urine specimen collection (sterile)
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Secondary prevention
Secondary prevention
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Primary prevention
Primary prevention
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Orthopnea
Orthopnea
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Geriatric care priority
Geriatric care priority
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Patient psychological preparation
Patient psychological preparation
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Patient chart ownership
Patient chart ownership
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A-V shunt care
A-V shunt care
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Acute renal failure diet
Acute renal failure diet
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Pyelonephritis cause
Pyelonephritis cause
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Superficial partial-thickness burn
Superficial partial-thickness burn
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Post-burn priority
Post-burn priority
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Burn electrolyte danger
Burn electrolyte danger
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Hypokalemia ECG sign
Hypokalemia ECG sign
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Burn pain management
Burn pain management
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Burn topical antimicrobial
Burn topical antimicrobial
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Hypertrophic burn scar
Hypertrophic burn scar
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Nurse role (mental health)
Nurse role (mental health)
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Telephonic orders
Telephonic orders
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Child abuse priority
Child abuse priority
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Cocaine classification
Cocaine classification
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Increased ICP signs
Increased ICP signs
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Study Notes
Airway Clearance and Nursing Interventions
- Richard has a nursing diagnosis of ineffective airway clearance due to excessive secretions and risk of infection.
- Appropriate positioning for percussion involves placing the client lying flat on his back and then on his abdomen.
- Documentation of treatment outcomes should exclude fluid intake measurements before and after the procedure.
- Key assessment focuses include respiratory rate, breath sounds, location of congestion, and ensuring client comfort regarding procedure tolerances.
- Special considerations for postural drainage involve checking the client's ability to tolerate various positions.
- Chest percussion involves delivering blows with cupped palms; vibration involves gentle shaking during exhalation.
Urine Specimen Collection and Community Health
- For urine specimen collection, it is correct to alcoholize the self-sealing port and draw from it using a sterile syringe.
- Secondary prevention includes activities like screening for hypertension.
- Primary prevention examples include immunizations.
Patient Assessments and Psychosocial Considerations
- Orthopnea describes a condition where a person must sit or use multiple pillows to breathe comfortably.
- Highest priority in geriatric care is ensuring client safety, especially for those at risk of falls.
- Before a physical examination, psychological preparation of the client holds the highest priority.
- Patient charts are legally owned by the hospital and controlled by healthcare professionals, not the patient.
Chronic Renal Failure and Dialysis Care
- For patients with an A-V shunt, the highest priority is to avoid taking BP or blood samples from the shunt arm.
- Diet therapy for acute renal failure should focus on low-protein, low-potassium, and low-sodium foods.
- E. coli is identified as the most common causative agent of pyelonephritis from catheterization.
Burn Care and Management
- Superficial partial thickness burns involve damage to the dermis but not deeper structures.
- Within the first 24 hours post-burn, focus on intake and output monitoring and strict aseptic technique.
- Post-burn, the priority nursing intervention during the acute phase is infection prevention.
- The most dangerous electrolyte imbalance in burn patients is hyperkalemia during the emergent phase.
- Hypokalemia is identifiable on an ECG by the presence of a U wave.
- Pain medications are best administered intravenously for burn patients.
- Topical antimicrobial frequently used in burn care includes silver sulfadiazine.
Therapeutic Relationships and Interventions
- Hypertrophic burn scars result from exaggerated contraction processes following burns.
- The role of the nurse includes being a counselor, especially for mental health patients requiring supportive relationships.
- Understanding the impact of personal values and beliefs on therapeutic relationships is crucial for effective care.
Additional Nursing Considerations
- Telephonic orders from physicians must be documented and signed within 24 hours to ensure legality.
- In cases of suspected child abuse, prioritizing a safe environment for the child and siblings is crucial.
- Cocaine is categorized as a stimulant, affecting both mental and physical states.
- In older adulthood, individuals are encouraged to reflect on their lives and feel satisfaction.
- Effective traction management includes ensuring that weights are appropriately positioned for treatment.
Monitoring Symptoms and Patient Safety
- Observations for increased intracranial pressure following potential head injuries include specific signs such as altered consciousness and headache.
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Description
This practice exam focuses on nursing concepts related to airway management and patient care. It includes scenarios like assessing lung sounds and developing care plans for effective clearance of secretions. Ideal for nursing students preparing for the NLE.
