NR 304 Week 7 ATI Worksheet Questions with Correct Answers latest 2021/2022

Questions: 1. Define subjective and objective data. Give three examples of each and state if the findings are documented in the history or physical examination findings. a. Subjective data: information given to you by the pt. i. pain, cramping, decreased sensation b. Objective: information that is gathered by examination and assessment i. Pallor, skin texture, capillary refill 2. List five actions a nurse should take when assessing a patient with a potentially critical hemodynamic state. Put your actions in priority order of 1-5. 1. LOC 2. RR 3. BP 4. HR 3. What does the priority setting ABC mean? How does the nurse use this mnemonic in patient assessment? If a patient has a slow or rapid respiratory rate, is airway the primary concern? a. Airway, breathing, circulation b. the nurse will assess by priority if the patient has any obstruction or abnormality with their airway, they will then assess if they can breathe or not, lastly assess if anything is wrong with their cardiovascular circulation. c. If the patient is having trouble breathing but is still breathing that may show something lodged in the airway. If nothing is seen then circulation could be the underlying problem. 4. What is HIPAA? Describe one situation when the nurse must adhere to HIPAA. a. Health Insurance Portability & Accountability Act i. Helps protect client’s medical records b. When over hearing a coworker talk about their pt. to another coworker 5. Describe the process of taking a pulse. What is a normal pulse? What are qualities of a normal pulse? What is the first action a nurse should take when the pulse is not as expected? a. Assess by palpating the surface using gentle pressure over the artery location chosen i. Normal qualities: 2+, equal in rhythm, rate, and strength, no signs of bruit or thrill b. The nurse should normally take a pulse for 30sec. and x2, if irregular or abnormal, retake the pulse for a full 1min/60sec., if irregular still take apical pulse for 1min/60se