Nursing 101 Final Exam Review 2022

60-100 - ANSWER Normal HR per minute. 96.8-99.5 - ANSWER Normal temperature in Fahrenheit. 12-20 - ANSWER Normal respirations per minute. 120/80 - ANSWER Normal BP. Pain - ANSWER 5th vital sign. Apical pulse - ANSWER Vital signs that should be checked prior to giving digoxin. Sacrament of the Sick - ANSWER For Roman Catholic's, what is important during severe illness or possible pending death? NREM - ANSWER Type of sleep accounting for 75-80% of sleep during the night. Grieving - ANSWER Normal emotional reaction to a loss. Same as RN - ANSWER Standard of care a nursing student is held to. Baptism - ANSWER Catholic's take part in this, and an infant born with a life threatening condition gets this as soon as possible. Vesicular - ANSWER Type of breath sounds heard in the periphery of the lungs. Clubbing of nails, barrel chest - ANSWER Two long term oxygenation issues that can be observed on inspection of the client. Orthopneic - ANSWER Position in which a client experiencing respiratory distress should be placed. Handwashing - ANSWER Most important infection control measure. Ineffective Breathing Pattern - ANSWER NANDA diagnosis in which inspiration and/or expiration does not provide adequate ventilation. Ineffective Airway Clearance - ANSWER NANDA diagnosis with the inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway. Ineffective Gas Exchange - ANSWER NANDA diagnosis with an excess or deficit in oxygenation and/or CO2 elimination at the alveolar-capillary membrane. FVD - ANSWER Decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone w/o change in Na level. FVE - ANSWER increased isotonic fluid retention. Physiological, Safety/Security, Love/Belonging, Self-esteem needs, Self actualization - ANSWER Maslow's Hierarchy of Needs. Stage 1 - ANSWER Which stage of pressure ulcer has non-blanchable redness? Stage 2 - ANSWER Which stage of pressure ulcer is a broken blister? Stage 3 - ANSWER Which stage of pressure ulcer is a small crater and has no tunneling? Down to subQ fat. Stage 4 - ANSWER Which stage of pressure ulcer is a crater deep to muscle and bone? 3 and 4 - ANSWER Which stages of pressure ulcer require debridement? increase, increase, increase - ANSWER Infection causes HR to do what, Temp to do what, and WBC to do what? (increase/decrease) Anger, depression, denial, bargaining, acceptance - ANSWER Kubler-Ross's stages of death and dying. Redness, Edema, Ecchymosis, Discharge, Approximation - ANSWER REEDA Sanguinous - ANSWER Type of discharge from a wound that consists of blood. Serosanguinous - ANSWER Type of discharge from a wound that consists of clear and blood. Purosanguinous - ANSWER Type of discharge from a wound that consists of pus and blood. Serous - ANSWER Type of discharge from a wound that consists of watery, clear portion of blood. Purulent - ANSWER Type of discharge from a wound that consists of pus that is yellow or green. Clean - ANSWER Type of wound that is uninfected with minimal inflammation and the resp, GI, genital, UT are not entered. Primarily closed wounds. Clean-contaminated - ANSWER Type of wound that is a surgical wound in which resp, GI, genital, and UT have been entered but there is no infection. Contaminated - ANSWER Type of wound that is open/fresh/accidental/surgical with inflammation present due to a break in sterile technique. Infected - ANSWER Type of wound that contains dead tissue with evidence of infection. Partial thickness - ANSWER Confined to skin (dermis and epidermis), heals by regeneration. Full thickness - ANSWER Requires connective tissue repair. Dehiscence - ANSWER partial or total rupturing of a sutured wound (occurs 4-5 days postop) Evisceration - ANSWER protrusion of something through incision (bend knees to decrease pull on incision). Inflammatory - ANSWER Phase of wound healing starting immediately after injury and lasting 3-6 days. Hemostasis and Phagocytosis occur in this phase. Proliferative - ANSWER Phase of wound healing extending from day 3-4 until day 31 postop. Collagen is synthesized, and granulation tissue is formed. Maturation - ANSWER Phase of wound healing starting on day 21 and extending 1-2 years after injury. Scar becomes stronger. Colace - ANSWER Good for heart patients to avoid straining during BM. Stimulant cathartic - ANSWER Fastest and most powerful medication for bowel movements, but also has a lot of side effects. Lactulose - ANSWER Osmotic (acts as enema, draws fluid in). Used if patient has liver issues. 3.5-5 Intracellular - ANSWER The normal levels of potassium and where most potassium is located. 135-145 Extracellular - ANSWER The normal levels of sodium and where most sodium is located. Sodium - ANSWER What regulates fluid in body. Acidosis - ANSWER Hypoventilation is a cause of (acidosis/alkalosis)? Acidosis - ANSWER Drug OD is a cause of (acidosis/alkalosis)? Acidosis - ANSWER COPD is a cause of (acidosis/alkalosis)? Acidosis - ANSWER Diabetic ketoacidosis is a cause of (acidosis/alkalosis)? Alkalosis - ANSWER Hyperventilation is a cause of (acidosis/alkalosis)? Alkalosis - ANSWER Fever is a cause of (acidosis/alkalosis)? Alkalosis - ANSWER High altitudes is a cause of (acidosis/alkalosis)? Alkalosis - ANSWER Overuse of antacids is a cause of (acidosis/alkalosis)? Alkalosis - ANSWER Hypokalemia is a S/S of (acidosis/alkalosis)? Acidosis - ANSWER Hyperkalemia is a S/S of (acidosis/alkalosis)? Neurological - ANSWER Low/High sodium affects which body system? Muscular - ANSWER Low/High potassium affects which body system? Hypernatremia - ANSWER S/S include thirst, dry membranes, fatigue, and decreased LOC. Hyponatremia - ANSWER S/S include nausea, abd pain/cramping, muscle twitching, seizure/coma, decreased appetite, vomiting, decreased urine osmolarity, and headache. Hyperkalemia - ANSWER S/S include dysrhythmia, muscle weakness, diarrhea, irregular pulse, numbness in extremities and cardiac arrest. Hypokalemia - ANSWER S/S include leg cramps, constipation, irregular pulse, alkalosis, nausea/vomiting, hypoactive bowel sounds. Bowel obstruction - ANSWER Antiemetics are contraindicated in patients with what? increase, decrease, increase, increase - ANSWER FVD does what to HR, BP, temp, and specific gravity (increase/decrease). Crackles - ANSWER FVE can cause what to be heard in the lungs? Sedative hypnotics - ANSWER class of drugs that depress the CNS, suppress dreams, and make you drowsy. They can cause dependence and withdrawal. Helps you relax/sleep. Benzodiazepine - ANSWER Includes Zanax, valium, diazazon. Do not combine with alcohol or grapefruit juice. They are anti-anxiety meds. Decreases respirations and causes constipation. Keloid - ANSWER Elevated, irregular, darkened area of excess scar tissue caused by excessive collagen formation during healing. cerebral death - ANSWER loss of cerebral/brain stem function. Orthodox Jews - ANSWER Religion that does not eat pork/shellfish, do not mix dairy and meat, and bury amputate body parts. Abdomen - ANSWER Where is insulin absorbed most quickly? Roman Catholic - ANSWER Religion that baptizes babies after birth even if they are sick or dead. Long-term coping - ANSWER Type of coping that is the best, most realistic type. Problem focused - ANSWER Type of coping in which person makes changes to improve situation. Jehovah's Witnesses - ANSWER Religion that does not believe in blood transfusions. Narcan - ANSWER Drug that reverses effects of morphine heart and lung death - ANSWER Type of death in which there is no apical pulse, respirations and absence of blood pressure. 30ml/hr - ANSWER Minimum per hour urine output. Pain diary - ANSWER Tool useful to manage chronic pain. Aspirin - ANSWER Common pain reliever that increases the risk of bleeding. Asian - ANSWER This culture does not like you to touch a child's head. Pallative - ANSWER Care that focuses on comfort. Rate, rhythm, depth, characteristics - ANSWER 4 observations of respirations. Hospice - ANSWER Support/care for dying. Nothing - ANSWER What happens to vital signs during chronic pain? Clean - ANSWER Type of gloves used to remove soiled bandages? cupping and coining - ANSWER Two traditional Asian practices. Debridement - ANSWER Reason for damp to damp dressing. Averting eyes - ANSWER Sign of modesty in Hispanic culture. Hypokalemia - ANSWER Diarrhea causes (hypernatremia, hyponatremia, hyperkalemia, hypokalemia)?