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215 Final
215 Final
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1
What conditions may cause sensory impairments and skin breakdown in patients?
Diabetes and peripheral vascular disease
Infections such as the flu
Exposure to loud noises
lack of sleep or fatigue
2
What is the recommended starting flow rate for a nasal cannula when initiating supplemental oxygen?
2 L/min
1 L/min
4 L/min
6 L/min
3
What are some of the symptoms of hypoxia?
Cyanosis, tachypnea, low spO2, tachycardia
Flushing, bradypnea, low spO2, tachycardia
Pale skin, bradypnea, high spO2, bradycardia
Jaundice, hyperventilation, high spO2, bradycardia
4
During which stage of sleep do most dreams occur?
None of the above
Both NREM and REM stages
Non-REM (NREM) stage
REM stage
5
What are some safety considerations to keep in mind when assisting patients with mobility?
Having a patient hold onto an IV pole for stability
Using a gait/transfer belt for patients who need assistance with ambulation
Holding a patient under the arms while ambulating
Encouraging patients to wear socks while ambulating
6
What is the purpose of continuing frequent turning/repositioning and assessment of skin in hospice care patients?
To improve respiratory function
To prevent falls and injuries
sleep and relaxation
Comfort, maintain skin integrity, & prevent further pain r/t skin breakdown
7
What nursing interventions are recommended for hospice care patients with inadequate pain management?
Increase nonpharmacological interventions
Refer patient to physical therapy
Discontinue pain medication regimen
Contact provider to obtain appropriate orders for pain meds
8
What is one of the biggest factors that increase fall risk?
Confusion
Weakness
Impaired vision
Dizziness
9
What should you do before using a cane?
Check the rubber tip
Lean over or onto the cane
Use the cane on the weak side of the body
Skip using the cane if you feel strong enough
10
Which of the following is a primary goal of palliative care?
To provide supportive care for family members
To reduce the patient's pain and discomfort
To cure the patient's illness
To provide psychological counseling to the patient
11
What is the purpose of the logrolling technique?
To move the patient from one bed to another
To reposition the patient to prevent pressure ulcers
To help the patient walk
To ensure the patient's spine is in one straight line while being moved
12
Which of the following is a strategy to promote consistent, high-quality sleep?
Drinking caffeine late in the day or before bedtime
Encouraging calming activities and relaxation techniques before bedtime
Using bed for activities such as reading or watching TV
Exercising right before bedtime
13
Which of the following tasks cannot be delegated to Unlicensed Assistive Personnel (UAPs) by a Registered Nurse (RN)?
Administering medications
Anything that requires assessment of the patient
Collecting vital signs and blood glucose checks.
Providing comfort measures that do not require assessment.
14
Nasal Cannula goes up to 6L and is the first choice for supplemental oxygen
False
True
15
What is the definition of denial and bargaining in the context of grief?
Denial: trying to make bargain or plea/ Bargaining: refusing to accept
Denial: accepting the situation and moving on / Bargaining: feeling angry
Denial: feeling numb / Bargaining: feeling overwhelmed and hopeless
Denial refusing to accept situation /Bargaining trying to make bargain/plea
16
Which of the following is not a manifestation of chronic stress?
Increased immune response
Fatigue/lack of energy
Memory difficulties
Headaches
17
Most functions decrease during the dying process.
True
False
18
What are some of the goals that a patient with pneumonia should meet before being discharged from the hospital?
Need for oxygen
SpO2 stabilized at 90% on room air
Ability to cough and breathe deeply
Lungs clear to auscultation with crackles or adventitious sounds
19
What are some considerations for assessing sensory impairments in patients?
Avoid assessing for sensory impairments if the patient is elderly
Use simple, direct questions and a compassionate, nonthreatening approach
Use complex and indirect questions to assess for sensory impairments
Sensory impairments do not pose a safety risk for patients
20
What final stage of the General Adaptation Syndrome experienced after prolonged stress w ineffective coping mechanisms?
Exhaustion
Resistance
Alarm
Adaptation
21
What mnemonic can be used to assess pain in patients?
ABCDE
FAST
MOAN
OLDCARTS
22
Which of the following can help prevent constipation?
Drinking less water
Regular exercise & increase intake of water & fiber
Avoiding fruits and vegetables
Eating a diet high in fat
23
Which oxygen delivery device is used for severe hypoxia and respiratory distress?
Simple face mask
Venturi mask
Nasal cannula
Non-rebreather mask
24
What is the best way to support patients' spiritual needs in hospice care?
Encouraging spiritual practices if comforting to the patient
None of the above
Assuming spiritual needs and preferences without asking the patient
Providing verbal comfort, active listening, or therapeutic touch
25
Which of the following statements is true regarding therapeutic support for family or loved ones after a PT's death?
All cultures perform postmortem care in the same way
Allow family members to help w postmortem care may aid in grieving process
Family members should not be allowed to help with postmortem care
Postmortem care should be performed only by healthcare professionals
26
What are the signs that an infection has become systemic?
Rapid heartbeat and difficulty breathing
High fever, tachycardia, and lymphadenopathy
Vomiting and diarrhea
Mild erythema, tenderness, and swelling
27
What is the recommended frequency for flushing nasogastric or enteral feeding tubes?
Every 4-6 Hours with 30-45 mL of water and check placement
Every 2-3 Hours with 30-45 mL of water and check placement
Every 8-12 hours with 30-45 mL of water and check placement
Every Hour with 30-45 mL of water and check placement
28
What size of the induration (swelling) at the injection site indicates a positive result for a tuberculin skin test?
> 5mm
> 15mm
> 20mm
> 10mm
29
nursing considerations: encourage safe mobility as much & as early as possible to prevent complications of immobility
True
False
30
What does the Nurse Practice Act (NPA) guide in terms of delegation for RNs and LPNs working in a particular state?
Additional certification is needed to delegate tasks to nursing assistants.
The number of patients a nurse can delegate tasks to.
The official scope of practice for RNs and LPNs in the state
The qualifications required to become an RN or LPN in that state.
31
Why is addressing spiritual needs important in hospice care?
It is a legal requirement
It helps patients recover faster
It is not necessary in hospice care
it is beneficial for the patient's overall well-being
32
How should patients store their home oxygen tanks?
In a portable oxygen holder
In a closet
On the kitchen counter
Under the bed
33
How should the height of a walker be adjusted for a patient?
So the elbows are bent 90 degrees
So the arms are straight
It doesn't matter
So the elbows are bent 30 degrees & walker height adjusted to height of pt
34
What are the five stages of grief?
Anger, bargaining, denial, acceptance, depression
Denial, anger, bargaining, depression, acceptance
Acceptance, anger, bargaining, depression, denial
Denial, bargaining, depression, acceptance, anger
35
What the right of PT to make their own decisions even if healthcare providers do not understand/agree with them called?
Beneficence
Non-maleficence
Autonomy
Veracity
36
Which of the following statements is NOT true regarding postmortem care?
Personal belongings should be sent with the body to the morgue
Pads should not be applied to the wrists and ankles during postmortem care
The body should not be cleansed after death
Tubes & drains should be left in body unless an autopsy is being performed
37
Which of the following is a manifestation of chronic stress?
Increased immune response
Reduced risk of hypertension and stroke
Constipation
Improved memory
38
What are some recommended guidelines for providing oral care to patients?
Hold a patient's mouth open during oral care
If patient is unconscious, turn onto side & lower head of bed
Raise head of the bed all the way up to prevent aspiration during oral care
Lower the head of the bed to prevent aspiration during oral care
Oral care is necessary for every patient
Only provide oral care to patients who request it
39
Which of the following tasks can be appropriately delegated to Unlicensed Assistive Personnel (UAPs)?
Assisting with patient assessments and care planning.
Collecting vital signs and blood glucose checks.
Comfort measures that do not require assessment
Repositioning/turning patients
Providing education on medication management.
Administering medication to patients.
40
What are some of the signs of sleep deprivation?
Increased energy
Increased appetite
Drowsiness during the daytime
Inability to fall asleep at night
41
What is the last sense to go during the dying process?
Taste
Smell
Touch
Hearing
42
What are the recommended transmission precautions for droplet transmission of infections?
Wear a surgical mask and gloves
Use any equipment in the patient's room
Wear a gown and gloves
Wear an N95 mask and gloves
43
What are some realistic stress/anxiety reduction strategies that can be used in a hospital setting?
Overworking
Watching TV for hours
Guided imagery and relaxation
Loud music
44
What are some considerations for foot and nail care in patients with diabetes and peripheral vascular disease?
Do not require foot & nail care
Are at increased risk of injury due to decreased sensation and circulation
Are at increased risk of injury due to increased sensation and circulation
not necessary for patients with diabetes and peripheral vascular disease
45
What are the recommended transmission precautions for preventing infection?
Always don gloves when entering room & remove gloves before leaving room
Place an N95 mask on patients with droplet or airborne precautions
Remove gloves when entering the room
Place a surgical mask on PT w droplet/airborne precautions during transport
46
What are some expected symptoms of grief?
Increased appetite
Improved sleep patterns
Headaches
Nausea
Improved concentration
Sleep pattern changes like insomnia
47
How many nursing staff members are usually required to assist in logrolling technique?
one
Four
Three
two
48
Goal for hospice patients is to manage their pain and keep them comfortable as long as possible
True
False
49
OLDCARTS stands for: O-Onset L-Location D-Duration C-Characteristics A-Aggravating R-Radiation T-Timing S-Severity
False
True
50
What can be done to reduce fall risk in patients with urinary frequency or diarrhea?
Monitor the PT closely to prevent attempts to get up without assistance
Encourage the patient to stay in bed
None of the above
Provide a bedpan for the patient to use
51
What are the signs of imminent death?
Dry mucous membranes & congestion in airways due to mucus buildup
Decreased level of consciousness & hallucinations
Muscle weakness/relaxation & incontinence
Decreased circulation: mottled skin, cold extremities, decreased BP & HR
Periods of apnea
Decreased urinary output
52
What is the primary ethical consideration for nurses when providing care to patients?
Providing care that is based on the nurse's personal biases and prejudices.
Providing patient-centered care that assesses the patient's goals
Prioritizing the nurse's personal beliefs and values in care decisions.
Facilitates their needs and wishes.
Providing care that is convenient for the healthcare provider.
Encourage patient to make decisions about plan of care
53
Types of nonverbal communication?
Jumping up & down
Sitting up in correct posture
comfortably communicating with you
Slumped posture & lack of eye contact may indicate low self-esteem
54
What are some examples of adaptive coping strategies for stress and anxiety reduction?
Skipping meals and restricting food intake
Overworking
Alcohol/drug use
Exercise, balanced diet, meditation, etc
55
Which of the following statements is true regarding palliative care?
Palliative care is only provided to patients with a terminal illness.
Palliative care is typically used for acute, short-term medical conditions.
Palliative care is appropriate at any stage of life.
Palliative care is only appropriate for patients approaching death.
56
What are some nonpharmacological techniques that can be used to provide comfort to patients?
Using cold or heat therapy directly on the skin
Encouraging patients to avoid any type of therapy
Administering medications such as opioids
Using techniques such as distraction, massage, cold/heat therapy, and humor
57
What is an example of therapeutic communication that can be used during patient assessment?
Asking open-ended Q'S to urge the PT to share more details about their symp
Asking close-ended questions to get specific answers from the patient.
Asking "why" questions to gain more information about the pt's symptoms
Asking leading questions to steer the patient towards a particular response
58
What are the signs of localized inflammation that may indicate an expected/normal immune response?
Vomiting and diarrhea
Mild erythema, tenderness, and swelling
High fever, chills, and fatigue
Rapid heartbeat and difficulty breathing
59
Which of the following statements is true regarding providing therapeutic support for family/loved ones after PT death?
Family should not be allowed to spend time with the body privately
Family should be allowed to spend time with the body privately
Providing therapeutic support to family is not important after a PTs death.
Expressing condolences to family should be delayed until after the funeral
60
What are some signs that an individual who is grieving may be experiencing depression?
Disheveled/unkempt appearance or home, crying, etc.
Increased appetite and interest in food
Improved physical appearance and hygiene
Increased social activity and engagement with others
61
Which of the following is a recommended tip for therapeutic communication?
Ask closed-ended questions
Use "why" questions frequently ]
Ask open-ended questions
Avoid open-ended questions
62
How do an individual's perceptions and beliefs about health and illness impact healthcare decisions?
Patients' perceptions & beliefs have a minor impact on healthcare decisions
Patients' perceptions and beliefs heavily impact healthcare decisions.
Patients' perceptions and beliefs have no impact on healthcare decisions
PT perceptions & beliefs only impact healthcare decisions
63
What are the recommended transmission precautions for airborne transmission of infections?
Use any equipment in the patient's room
Wear a surgical mask and gloves
Wear an N95 mask and gloves
Wear a gown and gloves
64
Who has the right to dignified end-of-life care?
Only patients who can afford it
Only patients with certain religious beliefs
ALL patients, no matter who they are or what they have done
Only patients with terminal illnesses
65
Which of the following is an example of a maladaptive coping mechanism?
Alcohol/drug use , overworking, etc
Meditation
Balanced diet
Exercise
66
What should be assessed if a patient is taking multiple prescription and over-the-counter medications?
The patient's age
The patient's height and weight
The patient's knowledge about drug interactions
The patient's occupation
67
What is the goal/purpose of palliative care?
To improve comfort and quality of life
To cure the patient's illness
To provide ongoing support to the patient's family
To coordinate hospitalization for the patient
68
Although mobility & hygiene are important, forcing PTs to ambulate or shower if they are in pain is not compassionate
True
False
69
What is a recommended approach to hygiene care for patients?
speak with the patients family and try to set up a hygaine care plan
force patient to do their hygeine
Determine the most appropriate hygiene plan for each patient
Nag the patient to do their hygeine so they can be clean
70
what should be done for postmortem care?
Apply ID tag to body and bag
Cleanse body
Body should be transported down to morgue with gown on in supine position
Apply pads on wrists & ankles and tie them together using gauze
Keep dentures inside mouth
Remove all tubes/drains unless autopsy being performed by medical examiner
71
What is cultural competence in healthcare?
PT conform to the healthcare provider's cultural values and practices.
Providing the same standard of care to all PT regardless of their culture
Being mindful and respectful of cultural values and practices
Encouraging patients to abandon their cultural values and practices.
72
When using a cane, on which side of the body should it be held?
It doesn't matter
The weak side of the body
In the middle of the body
The strong side of the body
73
What is the risk associated with a mechanical soft (soft, chopped) diet?
Increased risk of diarrhea
Increased risk of constipation
Increased risk of choking
Increased risk of dehydration
74
Which of the following symptoms is not associated with a urinary tract infection (UTI)?
Urinary urgency
Dysuria
Urinary frequency
Genital discharge
75
What is one way to prevent respiratory illness in COPD patients?
Encourage them to get pneumococcal vaccine
Encourage them to exercise vigorously every day
Advise them to avoid wearing masks or face coverings
Recommend they avoid taking prescribed medications
76
What are the recommended transmission precautions for contact transmission of infections?
Use any equipment in the patient's room
Use dedicated equipment that stays in patient's room when possible
Wear a mask and gloves
Wear a gown and gloves
