NURS 202 - Review Questions
What are the five steps in the nursing process? – answer ADPIE
1. Assessment
2. Nursing Diagnosis
3. Planning Intervention
4. Implementation of Intervention
5. Evaluation of Interventions Effects
What is the difference between a nursing and a medical assessment? - answer Medical
assessments treat disease.
Nursing assessments treat human responses to actual/potential health problems.
Name and describe the two types of assessment. - answer Focused: Problem-oriented.
Based on a specific patient concern.
Comprehensive: Initial assessment, head-to-toe. Health history and physical
examination.
What are the two types of data a nurse would want to obtain? Give an example of each.
- answerSubjective and Objective
1. Based on what the patient tells you, for example, "I experience headaches when I
wake up in the morning".
2. Based on your physical examination, for example, "8 cm length by 2 cm width incision
scar on LLQ of abdomen."
What are some things that you would observe in the general survey of a patient? -
answerPhysical Appearance
- Age
- Gender
- Level of consciousness
- Skin colour
- Facial features
Body Structure
- Stature
- Nutrition
- Symmetry
- Posture/Position
Mobility
,- Gait
- ROM
Behaviour
- Facial expression
- Speech
- Hygiene
When do you assess vital signs? - answer- When you first meet a patient
- According to orders (based on frequency)
- If there is a change in clinical condition
- After a procedure
- After medications that may affect VS
What are some factors that can influence vital signs? - answerTemperature
- Diurnal Cycle
- Menstrual Cycle
- Exercise
- Gender/Age
- Cold/Heat Exposure
- Surgery
- Infection
- Neurological Disease
Pulse
- Exercise
- Fever
- Medications
- Pain
- Fear/Anxiety
- Infection
- Dehydration
Respirations
- Age
- Exercise
- Anxiety
- Medications
- Respiratory Distress/Infection
- Head Injury
Blood Pressure
- Age/Gender/Race
- Diurnal Cycle
- Weight
- Exercise
, - Stress/Emotion
- Medications
- Blood Viscosity and Volume
- Vessel Wall Elasticity
What is the normal temperature range? - answer35.8 - 37.3 C
What are the different types of thermometers and considerations with each type? -
answerOrally
- Common and accurate
- Fast if electric
Axillary
- Done if uncooperative
- Can be 0.5C lower than oral
Tympanic
- Reads quickly
- Requires a special thermometer
Rectal
- Uncommon and uncomfortable
- Can be 0.5C higher than oral
How do you take a temperature if a patients had fluids or smoked? - answerAxillary
What is considered a normal heart rate for newborns? Children? Adults? - answer70-
190 bpm
70-110 bpm
60-100 bpm
What are four things to note when taking a radial pulse? - answer1. Rate
2. Rhythm: Regular vs Irregular
3. Elasticity
4. Force: Grade from 0-3
- 0 = absent
- 1+ = weak, thready
- 2+ = normal
- 3+ = full, bounding
Describe the two-step BP test. - answer1. Palpate the radial or brachial artery, inflate
the blood pressure cuff until the pulse is no longer felt
2. Continue to inflate 20-30 mmHg more.
What is a normal BP for an adult? What classifies someone as having hypertension? -
answerSystolic Pressure of 120 mmHg
What are the five steps in the nursing process? – answer ADPIE
1. Assessment
2. Nursing Diagnosis
3. Planning Intervention
4. Implementation of Intervention
5. Evaluation of Interventions Effects
What is the difference between a nursing and a medical assessment? - answer Medical
assessments treat disease.
Nursing assessments treat human responses to actual/potential health problems.
Name and describe the two types of assessment. - answer Focused: Problem-oriented.
Based on a specific patient concern.
Comprehensive: Initial assessment, head-to-toe. Health history and physical
examination.
What are the two types of data a nurse would want to obtain? Give an example of each.
- answerSubjective and Objective
1. Based on what the patient tells you, for example, "I experience headaches when I
wake up in the morning".
2. Based on your physical examination, for example, "8 cm length by 2 cm width incision
scar on LLQ of abdomen."
What are some things that you would observe in the general survey of a patient? -
answerPhysical Appearance
- Age
- Gender
- Level of consciousness
- Skin colour
- Facial features
Body Structure
- Stature
- Nutrition
- Symmetry
- Posture/Position
Mobility
,- Gait
- ROM
Behaviour
- Facial expression
- Speech
- Hygiene
When do you assess vital signs? - answer- When you first meet a patient
- According to orders (based on frequency)
- If there is a change in clinical condition
- After a procedure
- After medications that may affect VS
What are some factors that can influence vital signs? - answerTemperature
- Diurnal Cycle
- Menstrual Cycle
- Exercise
- Gender/Age
- Cold/Heat Exposure
- Surgery
- Infection
- Neurological Disease
Pulse
- Exercise
- Fever
- Medications
- Pain
- Fear/Anxiety
- Infection
- Dehydration
Respirations
- Age
- Exercise
- Anxiety
- Medications
- Respiratory Distress/Infection
- Head Injury
Blood Pressure
- Age/Gender/Race
- Diurnal Cycle
- Weight
- Exercise
, - Stress/Emotion
- Medications
- Blood Viscosity and Volume
- Vessel Wall Elasticity
What is the normal temperature range? - answer35.8 - 37.3 C
What are the different types of thermometers and considerations with each type? -
answerOrally
- Common and accurate
- Fast if electric
Axillary
- Done if uncooperative
- Can be 0.5C lower than oral
Tympanic
- Reads quickly
- Requires a special thermometer
Rectal
- Uncommon and uncomfortable
- Can be 0.5C higher than oral
How do you take a temperature if a patients had fluids or smoked? - answerAxillary
What is considered a normal heart rate for newborns? Children? Adults? - answer70-
190 bpm
70-110 bpm
60-100 bpm
What are four things to note when taking a radial pulse? - answer1. Rate
2. Rhythm: Regular vs Irregular
3. Elasticity
4. Force: Grade from 0-3
- 0 = absent
- 1+ = weak, thready
- 2+ = normal
- 3+ = full, bounding
Describe the two-step BP test. - answer1. Palpate the radial or brachial artery, inflate
the blood pressure cuff until the pulse is no longer felt
2. Continue to inflate 20-30 mmHg more.
What is a normal BP for an adult? What classifies someone as having hypertension? -
answerSystolic Pressure of 120 mmHg
