Final Exam Practice-Transitions & Foundations

Which framework is used during a focused assessment for an acute illness?

In SBAR, what does the "R" stand for?

Which finding is considered an abnormal CV assessment of an infant that should be reported to the physician?

A nurse has conducted an Allen’s test on a patient and the result was 8 seconds. What should the nurse do next?

Which client outcome is an example of a physiologic outcome?

Information technology (IT) can be used to increase patient safety. The nurse uses IT in this way by:

For best practices on documentation, which statements are correct? Choose 3.

Assessment of the cranial nerves, the nurse asks the client to smile, frown, wrinkle forehead, and puff out the cheeks:

What is the est. max amount a pt can inspire after normal expiration? TV=490mL, IRV=3200mL, ERV=1200mL, RR=12/min.

What is the focus of a diagnostic statement for a collaborative problem?

A client has been diagnosed with PVD. Which area of the body should the nurse focus the assessment?

What is the pt's lung vital capacity (VC) if the following are: IRV=2900mL, TV=490mL, and ERV=1000mL? (ydk? look em up!)

What activity in charting will assist most in the avoidance of errors?

Identify the signs and symptoms of COPD. Select 3.

Which nursing action reflects evaluation?

A nurse is documenting client information using PIE charting. Which information would the nurse expect to document?

When auscultating a client’s abdomen, a nurse notes gurgling sounds. What does the nurse document this as?

Which are cognitive client outcomes? Select 3.

Student nurses ask the informatics nurse specialist, "What is a clinical information system?" She replies: (Select 4)

Nursing care and & client outcomes may be evaluated by use of a retrospective evaluation process. Example of this?

The nurse should utilize ISBARR (Introduction, Situation, Background, Assessment, Recommendation, Read Back) when?

A broad, research-based recommendation that may/may not have been tested in clinical practice.

Which of the following techniques should you use to assess cranial nerve III?

For best results, when should the nurse evaluate the pt's progress toward a goal of dressing oneself end of 6wk therapy?

A client is experiencing shortness of breath, lethargy, and cyanosis. These three cues provide organization or...

The nurse makes an appointment for a female client to get a mammogram. Which health prevention/promotion is this?

What nursing organization first legitimized the use of the nursing process?

What are the signs/symptoms of tuberculosis (TB)? Select 3.

The nurse is preparing to assess convergence of the client’s eyes. How should the nurse conduct this assessment?

According to HIPPA regulations, which of the following is a client right regarding the client’s medical record? Pick 3.

When assessing the abdomen, which assessment technique is used last?

A client had an ischemic stroke 5 days ago. Which 3 diagnoses would be justified in identifying and documenting?

Which statement about eupnea is correct?

The nursing student asks the RN why rationales are not written on the hospital care plan. The RN replies:

In older adults, decreased skin turgor, diffuse red spots and raised, dark areas on back of hands are abnormal findings.

What change in the body initiates the process of forceful expiration?

Which type of visualization format(s) would an informatics nurse specialist most likely use for client populations? SATA

Which statement is not true regarding a medication administration record (MAR)?

In an audit that has the goal of creating a quality improvement plan, which organization would a nurse admin report to?

Which outcome statements are in the cognitive realm? Select 3.

Which of the following abbreviations is on the list of the Joint Commission "do not use" abbreviations? Select 3.

Which of the following r/t respiratory health is an example of tertiary health promotion and illness prevention?

A nurse is giving a talk to a local community group on the importance of proper diet and regular exercise. This is:

What is the typical value of Tidal Volume (TV) for an adult at rest?

The pt is concerned about injury risk associated with falls. How would the RN know if the intervention was successful?

Which is true regarding the mucus lining the respiratory tract? Select 2.

Which of the following reflects the diagnosis phase?

Which individual is considered the first informatics nurse?

The nurse is collecting subjective data from a client. Which of the following are subjective data? Choose 2.

The nurse is collecting objective data from a client. Which of the following are objective data? Choose 2.

When using the SBAR hand-off, what are the correct uses of this process? Select 4.

Which inflammation of the upper respiratory tract does a healthcare provider treat as a medical emergency?

The registered nurse is providing an independent nursing intervention when: (select 3).

Standardized care plans, which target desired outcomes for certain illnesses, procedures, or conditions on a timeline.

For which assessments would you have the client lay in a prone position? Select 3.

Which action(s) should the nurse perform to limit casual access to the identity of clients? Select 3.

The nurse is assessing a patient’s cranial nerve III. What technique is best?

In which of the following cases should a progress note be written? Select 3.

Which action should the nurse take when client data indicate that the stated goals have not been achieved?

A nurse is documenting a client's VS, height, and weight in the EHR. She would identify these values as which component?

Besides identifying responses to potential/actual health problems, what is another purpose of the diagnosing process?

Intravenous fluids and blood are administered and the nurse monitors the pt's physiologic response. This is known as:

Computerized provider order entry (CPOE):

The nurse reads in a chart that a patient has a paronychia. What is the correct assessment technique for this condition?

Which actions should the nurse perform, as classic elements of evaluation when evaluating a plan of care? Choose 4.

What is the primary purpose of validation as a part of assessment?

When palpating a client's lower leg, you find a fluid-filled 1 cm mass. What do you document this as?

Which identifies the physiologic, psychological, sociologic, spiritual, and environmental factors of a client?

Which of the following would the nurse identify as an actual nursing diagnosis?

A nurse is formulating a nursing diagnosis for a client with a respiratory disease. Which of the following is correct?

What ensures continuity of care?

Which actions should the nurse perform during the planning step of the nursing process? Select 4.

Who is responsible for the term "nursing process" in 1955?

What is the ABCDE mnemonic for skin assessment?

When auscultating a client's lungs, you hear soft and low-pitched sounds, with longer inspiration than expiration.

An informatics nurse specialist wants to evaluate the optimization of clinical information. Nurse should focus on 4: