The purpose of protective (reverse)isolation is to prevent a person with seriously impaired resistance from coming into contact who potentially pathogenic organisms. All of the following statement are true about donning sterile gloves except: The first glove should be picked up by grasping the inside of the cuff. Soap or detergent to promote emulsification The urinary system is normally free of microorganisms except at the urinary meatus. Why are these interventions effective? The nurse explains to a patient that a cough: Is a protective response to clear the respiratory tract of irritants, Is induced by the administration of an antitussive drug, Can be inhibited by splinting the abdomen. 4. is provided by nurses with a graduate degree in community health nursing. Demonstrate the procedure to the patient and encourage to ask questions 46. - diet for individuals with kidney disease that limits intake of sodium, potassium, and phosphorous - should be restricted to no more than a few days due to limited calorie and nutrients it offers EXAMPLES: ice cream, juices, pudding, milkshakes, tea, strained soups, protein shakes, gelatin ; beets turn stool red. Tub bathing might transfer organisms to another body site rather than rinse them away. An 18G, 1 needle is usually used for I.M. The American Nurses Association identifies requirements for certification and offers examinations for certification in many areas of nursing., such as medical surgical nursing. An antitussive drug inhibits coughing. A red streak exiting the IV insertion site Inhibit the growth of microorganisms - assess family wishes for the patient after death; consider cultural/spiritual preferences RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. 1. All of the above Increased partial thromboplastin time indicates a prolonged bleeding time during fibrin clot formation, commonly the result of anticoagulant (heparin) therapy. - evaluates overall appearance for color, clarity, and odor Thrombophlebitis typically develops in patients with which of the following conditions? All of the following are appropriate nursing interventions except: Assess femoral, popliteal, and pedal pulses every 15 minutes for 2 hours, Check the pressure dressing for sanguineous drainage, Order a hemoglobin and hematocrit count 1 hour after the arteriography, Assess a vital signs every 15 minutes for 2 hours. Soapsud Enema: injections in children, typically in the vastus lateralis. - medication Rub the site vigorously after the injection to promote absorption 14. 33, 34, 35, 36, 37, Adaptive Processes Exam 1 Medications and Lab, Julie S Snyder, Linda Lilley, Shelly Collins. - agitated injections because it:ACan be used only when the patient is lying downBBruises too easilyCCan accommodate only 1 ml or less of medicationDDoes not readily parenteral medication Question 15 Explanation: The mid-deltoid injection site can accommodate only 1 ml or less of medication because of its size and location (on the deltoid muscle of the arm, close to the brachial artery and radial nerve).Question 16The physician orders an IV solution of dextrose 5% in water at 100ml/hour. The inside of the glove is considered sterile CReceived credentials from the Philippine Nurses AssociationDGraduated from an associate degree program and is a registered professional nurseQuestion 23 Explanation: A clinical nurse specialist must have completed a masters degree in a clinical specialty and be a registered professional nurse. - pulmonary congestions ("death rattle" or added to a solution and given I.V. - record output - position the patient upright or elevate the head of the bed a minimum of 30 (preferably 45) degrees Initial vasoconstriction may cause skin to feel cold to the touch. Rapid eye movement marks the stage of sleep during which dreaming occurs. Question Text Immobility also results in more alkaline urine with excessive amounts of calcium, sodium and phosphate, a gradual decrease in urine production, and an increased specific gravity.Question 4The primary purpose of a platelet count is to evaluate the:APresence of an antigen-antibody responseBPotential for bleedingCPresence of cardiac enzymes Question 9 Explanation: Initial sensitivity to penicillin is commonly manifested by a skin rash, even in individuals who have not been allergic to it previously. - includes foods that are typically bland: well-cooked vegetables, low-fiber cereals, east-to-chew proteins Upper GI bleeding results in black or tarry stool. The physician orders gr 10 of aspirin for a patient. The two blood vessels most commonly used for TPN infusion are the: Provide increased cool liquids Applying additional bed clothes helps to equalize the body temperature and stop the chills. - impaired cough - mottling. An example of data being processed may be a unique identifier stored in a cookie. Fundamentals of Nursing Practice Exam 3 (EM) 13. - anxiety Exam Mode Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam. - let your genuine "caring" self show through In this reaction, antibodies in the recipients plasma combine rapidly with donor RBCs; the cells are hemolyzed in either circulatory or reticuloendothelial system. Make sure to include the concepts of ventilation, perfusion, and the exchange of gases. Although applying corn starch to the rash may relieve discomfort, it is not the nurses top priority in such a potentially life-threatening situation. A patient has returned to his room after femoral arteriography. Causes: Fundamentals of Nursing. Effective skin disinfection before a surgical procedure includes which of the following methods? Causes: During the admission interview, the nurse should implement which communication techniques to elicit the most information from the parents? 11 cards. Opening the door of the patients room leading into the hospital corridor Terminal disinfection is the disinfection of all contaminated supplies and equipment after a patient has been discharged to prepare them for reuse by another patient. 11) Do not clean the area with antiseptics to prevent CAUTI while the catheter is in place. fluids may be necessary. A collection of all our articles and study guides for the fundamentals of nursing. injections; and a 25G needle, for I.M. Bile obstruction 29. Which element in the circular chain of infection can be eliminated by preserving skin integrity? Congratulations - you have completed Fundamentals of Nursing Practice Exam 3 (EM). Maintain the drainage tubing and collection bag below bladder level to facilitate drainage by gravity Fundamentals of Nursing Add to My Courses Documents (326) Questions Students (625) Book related documents Kozier and Erb's Fundamentals of Nursing Volume 1-3 Barbara Kozier; Glenora Erb; Audrey Berman; Shirlee Snyder; Tracy Levett-jones Lecture notes Date Rating year Ratings Show 8 more documents Show all 96 documents. - medications, laxatives, and cathartics Wearing gloves is not always necessary when administering an I.M. The mid-deltoid injection site is seldom used for I.M. C. In an infected patient, shivering results from the bodys attempt to increase heat production and the production of neutrophils and phagocytotic action through increased skeletal muscle tension and contractions. 22G, 1 long Shaving the site on the day before surgery Idiosyncrasy is an individuals unique hypersensitivity to a drug, food, or other substance; it appears to be genetically determined. So, after removing gloves and washing hands, the nurse should untie the back of the gown; slowly move backward away from the gown, holding the inside of the gown and keeping the edges off the floor; turn and fold the gown inside out; discard it in a contaminated linen container; then wash her hands again. ; beets turn stool red.Question 35The mid-deltoid injection site is seldom used for I.M. Jewelry, metallic objects, and buttons would interfere with the X-ray and thus should not be worn above the waist. Interpret the features of normal vs. abnormal stool and urine. This type of injection is used primarily to administer antigens to evaluate reactions for allergy or sensitivity studies. The best nursing intervention is to:AProvide additional bedclothesBProvide increased ventilation CApply iced alcohol spongesDProvide increased cool liquidsQuestion 33 Explanation: In an infected patient, shivering results from the bodys attempt to increase heat production and the production of neutrophils and phagocytotic action through increased skeletal muscle tension and contractions. Attempted Questions Correct It cannot be administered subcutaneously or intradermally. 5) healthy heart, renal (renal = low sodium; avoid processed foods) - decrease in nutrient demand Question Text Rubbing the injection site is contraindicated because it may cause the medication to extravasate into the skin.Question 14An infected patient has chills and begins shivering. The Urinary Tract All of the following are appropriate nursing interventions except:AAssess a vital signs every 15 minutes for 2 hoursBOrder a hemoglobin and hematocrit count 1 hour after the arteriography CCheck the pressure dressing for sanguineous drainageDAssess femoral, popliteal, and pedal pulses every 15 minutes for 2 hoursQuestion 47 Explanation: A hemoglobin and hematocrit count would be ordered by the physician if bleeding were suspected. In which step of the nursing process would the nurse ask a patient if the medication she administered relieved his pain? B. 2) Ensure that only properly trained persons who know the correct technique of aseptic catheter insertion and maintenance are given this responsibility The factors, known as Virchows triad, collectively predispose a patient to thromboplebitis; impaired venous return to the heart, blood hypercoagulability, and injury to a blood vessel wall. The other answers are appropriate nursing interventions for a patient who has undergone femoral arteriography.Question 50Which of the following procedures always requires surgical asepsis?ANasogastric tube insertionBVaginal instillation of conjugated estrogenCColostomy irrigation DUrinary catheterizationQuestion 50 Explanation: The urinary system is normally free of microorganisms except at the urinary meatus. - to be eligible for home hospice, a patient must have a family caregiver to provide care when the patient is no longer able to function alone Maintain the drainage tubing and collection bag below bladder level to facilitate drainage by gravity, Irrigate the patient with 1% Neosporin solution three times a daily, Maintain the drainage tubing and collection bag level with the patients bladder, Clamp the catheter for 1 hour every 4 hours to maintain the bladders elasticity. 25. The ELISA test is used to: 4) Properly secure indwelling catheters after insertion to prevent movement and urethral traction Developmental Factors: Which of the following is a sign or symptom of a hemolytic reaction to blood transfusion? - the volume of infused saline stimulates peristalsis Mode of transmission fluids may be necessary. In this reaction, antibodies in the recipients plasma combine rapidly with donor RBCs; the cells are hemolyzed in either circulatory or reticuloendothelial system. Fundamentals of Nursing Exam 3 Overview of Exam 3: - 40 Questions - 60 minutes to take - multiple choice, select all that apply, fill in the blank - on Canvas Click the card to flip . Which of the following nursing interventions is considered the most effective form or universal precautions? Assess femoral, popliteal, and pedal pulses every 15 minutes for 2 hours Tolerance When sterile items are allowed to come in contact with the edges of the field, the sterile items also become contaminated. There are 50 questions to complete. Bile colors the stool brown. Assessment Idiosyncrasy is an individuals unique hypersensitivity to a drug, food, or other substance; it appears to be genetically determined. Although applying corn starch to the rash may relieve discomfort, it is not the nurses top priority in such a potentially life-threatening situation.Question 10Which of the following types of medications can be administered via gastrostomy tube?AEnteric-coated tablets that are thoroughly dissolved in waterBAny oral medicationsCCapsules whole contents are dissolve in waterDMost tablets designed for oral use, except for extended-duration compounds Question 10 Explanation: Capsules, enteric-coated tablets, and most extended duration or sustained release products should not be dissolved for use in a gastrostomy tube. Applying additional bed clothes helps to equalize the body temperature and stop the chills. - lack of access to safe places to play/exercise Time used - nutrient dense foods The leg muscles are the strongest muscles in the body and should bear the greatest stress when lifting. D. The inside of the glove is always considered to be clean, but not sterile. - checks appearance, concentration, and content of urine Impending constipation - medications (barbiturates, narcotics, benzodiazepines) - secure the tube to the patient's nose or cheek and to their gown or added to a solution and given I.V. All doneNeed more practice!Keep trying!Not bad!Good work!Perfect! If you want to check your ability to succeed as a nurse, try to excel in these trivia questions and answers. - It is a simple chemical test of a stool sample that involves about five minutes of preparation time. Living Will: states specific types of medical care that a person wishes to receive if the person can no longer make those decisions injection is to: The nurse does not need to wear gloves for respiratoryisolation, but good hand washing is important for all types of isolation.Question 38Which of the following is a sign or symptom of a hemolytic reaction to blood transfusion?AChest painBHemoglobinuriaCDistended neck veins DUrticariaQuestion 38 Explanation: Hemoglobinuria, the abnormal presence of hemoglobin in the urine, indicates a hemolytic reaction (incompatibility of the donors and recipients blood). Administering an antihistamine is a dependent nursing intervention that requires a written physicians order. Enteric precautions prevent the transfer of pathogens via feces.Question 27In which step of the nursing process would the nurse ask a patient if the medication she administered relieved his pain?AAnalysisBEvaluation CAssessmentDPlanningQuestion 27 Explanation: In the evaluation step of the nursing process, the nurse must decide whether the patient has achieved the expected outcome that was identified in the planning phase.Question 28Clay colored stools indicate:AImpending constipationBUpper GI bleedingCAn effect of medicationDBile obstruction Question 28 Explanation: Bile colors the stool brown. You scored %%SCORE%% out of %%TOTAL%%. - obstruction of the airway that sounds like rattling - small increases in protein usually aren't a cause for concern, but larger amounts may indicate a kidney problem - after placement is verified via x-ray, do secondary verification by aspiration (check pH) Choose the letter of the correct answer. LearnMore. Evaluation: How would you evaluate if your interventions are effective? You have not finished your quiz. 3) to re-establish normal intra-pleural and intra-pulmonary pressures All of the following are common signs and symptoms of phlebitis except: A red streak exiting the IV insertion site, Edema and warmth at the IV insertion site, Pain or discomfort at the IV insertion site. Yawning and hiccupping do not prevent microorganisms from entering or leaving the body. - pharmacological, - always provide dignity and respect after death Choose the letter of the correct answer. Score injection is to:ALocate the upper aspect of the upper outer quadrant of the buttock about 5 to 8 cm below the iliac crestBPalpate a 1 circular area anterior to the umbilicusCDivide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh DPalpate the lower edge of the acromion process and the midpoint lateral aspect of the armQuestion 22 Explanation: The vastus lateralis, a long, thick muscle that extends the full length of the thigh, is viewed by many clinicians as the site of choice for I.M. A. - weakness List the steps appropriate for urinary catheter insertion. Explain the role of the nurse in end of life care. - avoid processed foods and fast food A postoperative patient who has undergone orthopedic surgery, A patient receiving broad-spectrum antibiotics. Hot water may lead to skin irritation or burns. injections; and a 25G needle, for I.M. 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950End Palpate a 1 circular area anterior to the umbilicus 33. 7,000/mm - chronic disease The correct method for determining the vastus lateralis site for I.M. Identify the clinical outcomes as a result of hypoventilation. injection. Chronic Obstructive Pulmonary Disease To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Obtaining a sputum specimen early in this morning ensures an adequate supply of bacteria for culturing and decreases the risk of contamination from food or medication. However, research has shown that massage only increases the likelihood of cellular ischemia and necrosis to the area.Question 47Thrombophlebitis typically develops in patients with which of the following conditions?AChronic Obstructive Pulmonary Disease (COPD) BAcute pulsus paradoxusCIncreases partial thromboplastin timeDAn impaired or traumatized blood vessel wallQuestion 47 Explanation: The factors, known as Virchows triad, collectively predispose a patient to thromboplebitis; impaired venous return to the heart, blood hypercoagulability, and injury to a blood vessel wall. Hemoglobinuria Check the pressure dressing for sanguineous drainage Soaps and detergents are used to help remove bacteria because of their ability to lower the surface tension of water and act as emulsifying agents. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. The brachial and femoral veins usually are contraindicated because they pose an increased risk of thrombophlebitis. - psychological factors S & S: Please visit using a browser with javascript enabled. C. In real failure, the kidney loses their ability to effectively eliminate wastes and fluids. Which of the following is a sign or symptom of a hemolytic reaction to blood transfusion? D. Leukocytosis is any transient increase in the number of white blood cells (leukocytes) in the blood. Appneustic breathing, atypical pneumonia and respiratory alkalosis It also is used to evaluate the patients potential for bleeding; however, this is not its primary purpose. The best way of determining whether a patient has learned to instill ear medication properly is for the nurse to: Which of the following blood tests should be performed before a blood transfusion? - energy needs - temperature changes Clamp the catheter for 1 hour every 4 hours to maintain the bladders elasticity Nursing . Normal WBC counts range from 5,000 to 100,000/mm3. Leg muscles Studies have shown that showering with an antiseptic soap before surgery is the most effective method of removing microorganisms from the skin. Constipation is characterized by small, hard masses. Ventilation: - offer silence Which of the following patients is at greater risk for contracting an infection? insertion site, and a red streak going up the arm or leg from the I.V. Terminal disinfection is the disinfection of all contaminated supplies and equipment after a patient has been discharged to prepare them for reuse by another patient. Fundamentals of Nursing Practice Exam 3 Practice Mode Exam Mode Text Mode Practice Mode - Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam. Compare and contrast the different types of enemas (water, hypertonic, saline, soapsud). Her experience spans almost 30 years in nursing, starting as an LVN in 1993. Because of this, limiting the patients intake of oral and I.V. All equipment must be sterile, and the nurse and the physician must wear sterile gloves and maintain surgical asepsis. Why? Arterial blood disorders (such as pulsus paradoxus) and lung diseases (such as COPD) do not necessarily impede venous return of injure vessel walls.Question 48The appropriate needle gauge for intradermal injection is:A26G B25GC20GD22GQuestion 48 Explanation: Because an intradermal injection does not penetrate deeply into the skin, a small-bore 25G needle is recommended. Synergism, is a drug interaction in which the sum of the drugs combined effects is greater than that of their separate effects. If you leave this page, your progress will be lost. Opening the door of the patients room leading into the hospital corridor, Opening the patients window to the outside environment, Failing to wear gloves when administering a bed bath. - airway management. Chest pain and urticaria may be symptoms of impending anaphylaxis. Because of the danger of anaphylactic shock, he nurse should withhold the drug and notify the physician, who may choose to substitute another drug. 4. All doneNeed more practice!Keep trying!Not bad!Good work!Perfect! Choose the letter of the correct answer. 2. Care of Bowel Stomas: Correct Answer Your score is C. All invasive procedures, including surgery, catheter insertion, and administration of parenteral therapy, require sterile technique to maintain a sterile environment. Completed a masters degree in the prescribed clinical area and is a registered professional nurse. Failing to wear gloves when administering a bed bath - poor tissue perfusion Synergism, is a drug interaction in which the sum of the drugs combined effects is greater than that of their separate effects.Question 5The two blood vessels most commonly used for TPN infusion are the:ASubclavian and jugular veinsBFemoral and subclavian veinsCBrachial and subclavian veinsDBrachial and femoral veins Question 5 Explanation: Total Parenteral Nutrition (TPN) requires the use of a large vessel, such as the subclavian or jugular vein, to ensure rapid dilution of the solution and thereby prevent complications, such as hyperglycemia. - hypotonic Treatment: 19. The best nursing intervention is to: 38. A signed consent is not required because a chest X-ray is not an invasive examination. Not Attempted A 22G, 1 needle is usually used for adult I.M. The equivalent dose in milligrams is:A600 mg B60 mgC10 mgD0.6 mgQuestion 30 Explanation: gr 10 x 60mg/gr 1 = 600 mgQuestion 31Which element in the circular chain of infection can be eliminated by preserving skin integrity? Exam Mode Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam. - amount and frequency depends on fluid intake - measure the tube from the tip of the nose, to the earlobe, to the xiphoid process A. Soaps and detergents are used to help remove bacteria because of their ability to lower the surface tension of water and act as emulsifying agents. -detects and manages a wide range of disorders In the operating room, the nurse and physician are required to wear sterile gowns, gloves, masks, hair covers, and shoe covers for all invasive procedures. - COPD or asthma Abnormal: - always assess for placement Animal sources include liver, kidneys, cream, butter, and egg yolks. She must successfully complete the licensing examination to become a registered professional nurse.Question 45Which of the following will probably result in a break in sterile technique for respiratory isolation?AOpening the door of the patients room leading into the hospital corridorBTurning on the patients room ventilatorCOpening the patients window to the outside environmentDFailing to wear gloves when administering a bed bath Question 45 Explanation: Respiratory isolation, like strict isolation, requires that the door to the door patients room remain closed.
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