Level 4 Final final
p. 1252-1253: Of Long-Term Care Facilities, Home Health, Physician's Office, Temporary Agencies, and Private Duty, know the following:
-good salary and right to refuse and a lot of opportunities -opportunity to advance to charge nurse and supervisor -more relaxed atmosphere, decreased patient load and usually a daytime schedule -learn skills not commonly acquired in a VN program, weekends off, and focus on prevention -totally independent, provide care in home, hospital or other facility, paid directly by patient
What is your obligation regarding HIPAA and how might you violate a patient's invasion of privacy (all that apply)
-health care -respect and dignity -privacy and confidentiality -safety -information
What must you complete to be eligible for a CLTC certified in long-term care
-home study certification program - It covers pharmacology, aging, pediatrics, and key topics that enhance nursing competence -successfully complete the certification examination, Eligibility requirements for certification are an LPN/LVN license plus 2000 hours of long-term care practice within the past 3 years.
What is one modern educational advancement program for LVNs entering an RN program
1-plus-1 program or a 2-plus-2 program Articulation: speak clearly, distinctly, and to the point; present yourself with clarity and effectiveness
Adverse Effect
Adverse effects are more severe symptoms or problems that arise because of the medication. An example is a patient who develops severe gastric bleeding from an ulcer caused by aspirin.
What framework is often used to establish priorities
Maslow's hierarchy of needs
objective data
Objective data are observable and measurable signs. One is able to record objective data. A camera records a rash, a skin lesion, or puffy eyes. A tape recorder gives evidence of crying or slurred speech. A thermometer records a temperature elevation. Other terms for objective data are signs and objective cues.
What nursing intervention should be done prior to ROM
Offer analgesic 30 minutes before ROM exercises (peak action of analgesic will occur as patient begins exercises).
AUDITORS
People appointed to examine patient charts and health records to assess the quality of care.
When should you administer an analgesic to an unconscious patient (look at box 16-3 on p. 408) (all that apply) PHYSIOLOGIC SIGNS
Pulse: increased rate Respirations: increased depth and frequency Blood pressure: increased systolic and diastolic Diaphoresis, pallor Dilated pupils Muscle tension (face, body) Nausea and vomiting (if pain is severe)
What should you do if asked to perform a skill you've never done
Standards of care coupled with the scope of nursing practice give direction to you as a practicing nurse, spelling out what you have the obligation to do, what you have permission to do, and what you are prohibited from doing for patients.In addition, special challenges face entry-level licensed nurses when they enter the workforce. It is your responsibility to seek additional instruction and supervision when faced with an unfamiliar practice or procedure. Remember that it is not possible for you to meet every single patient's needs.
endorsement
a statement of recognition of the license of a health practitioner in one state by another state; the applicant needs to meet the current state's licensing requirements
DIAGNOSIS-RELATED GROUPS (DRGS)
a system that classifies patients by age, diagnosis, and surgical procedure, using 300 different categories to predict the use of hospital resources, including length of stay
What is a nurse-prescribed intervention
actions that a nurse is legally able to order or begin independently
When and who should you report
behavior you witness that does not meet the established standards
Why use large muscle groups when lifting
capable of greater work without injury
"Sterilization" Know definition
kill all microorganisms, including spores
What vein is usually used for TPN
large central vein superior vena cava
reciprocity
means that an individual licensed in one state can automatically receive licensure in the other, even if the licensing requirements of the states differ
How does a nurse select a risk for nursing diagnosis or when can a nurse select a risk for nursing diagnosis
risk factors that contribute to increased vulnerability
Regardless of cause of immobility are permanent or temporary , what does the patient need
some type of exercise to prevent excessive muscle atrophy and joint contracture
How does a candidate know he or she has passed the NCLEX
the graduate is issued a license Pre-determined "pass" or not
What does a well-written patient-centered outcome consist of
• Uses the word patient or a part of the patient as the subject of the statement • Uses a measurable verb • Is specific for the patient and the patient's problem • Does not interfere with the medical plan of care • Is realistic for the patient and the patient's problem • Includes a time frame for patient reevaluation
What does a properly written nursing order consist of
•Date •Signature of nurse responsible for the care plan •Subject (who will be carrying out the activity) •Action verb •Qualifying details
When should you withhold a medication
(1) any part of the order is incorrect or unclear (2) the patient's condition would be made worse by the medication (3) the physician may not have had all the information needed about the patient when drug therapy was planned (4) there has been a change in the patient's condition and a question has arisen about whether the medication should be given
What are four common forms of inadequate documentation that lead to malpractice cases (all that apply)
(1) not charting the correct time when events occurred (2) failing to record verbal orders or failing to have it signed (3) charting actions in advance to save time (4) documenting incorrect data
What is a multidisciplinary plan that schedules clinical interventions over an anticipated time frame for high-risk, high-volume, high-cost types of cases (fill-in)
- clinical pathway Synonyms for clinical pathways are critical pathways, multidisciplinary action plans, action plans, and care maps.
What is the difference between aerobic and anaerobic bacterial infections
-Aerobic bacteria grow only in the presence of oxygen -Anaerobic bacteria grow only in the absence of oxygen.
What actions should you take to ambulate a patient who has left-sided weakness (all that apply)
-Walk to the side of patient, with one arm around patient's waist and one hand on belt. -Walk on the patient's weaker side so that you are able to give assistance if the patient starts to fall -Have patient support self by leaning on or holding your arm -Walk with your closest leg just behind the patient's knee -Walk with your knees and hips flexed. •Walk alongside bed or heavy furniture. •Use hand rail in hallway, if available. •Encourage patient to use furniture or rails for support.
The Church of Jesus Christ of Latter-Day Saints p. 169 What type of drink might the patient prefer
-beverages with no caffeine such as cola, coffee, and tea -no alcohol
How are bacterial infections transmitted from person to person (all that apply)
-direct contact -inhalation of droplet nuclei -indirect contact with articles contaminated with pathogen - ingestion of contaminated food and drink
What is a medical diagnosis (know the examples listed)
-identification of a disease or condition by a scientific evaluation of physical signs, symptoms, history, laboratory test, and procedures. congestive heart failure, pneumonia, diabetes mellitus, and hepatitis B.
In what direction should you always perform irrigation and why
-inner to the outer canthus -follows the normal directional flow of tears
What is negligence
-the commission of an act that a prudent person would not have done -the omission of a duty that a prudent person would have fulfilled -resulting in injury or harm to another person -proof is necessary that other prudent members of the same profession would ordinarily have acted differently under the same circumstances
Know the six rights
1The right drug 2The right time 3The right dose 4The right patient 5The right route 6The right documentation
p. 1260 "Medication Safety Alert: Precautions for Transcribing Orders" Know #s 9 and 10 (fill-in)
9. Make very certain that all orders have been carried out and recorded in the proper record. (Have a second nurse verify for accuracy until you gain experience.) 10. Check off each order on the physicians' order sheet and sign it with your name or initials.
Know the normal range for an infant's temperature
96° to 99.5°
Resume
A summary of educational and professional experiences, including activities and honors, to be used in seeking employment for biologic citations on professional meeting programs or related purposes; curriculum vitae Careful about length of time
PEER REVIEW
An appraisal by professional co-workers (of equal status) or the way an individual nurse conducts practice, education, or research.
What are the characteristics of a generic drug
Assigned name for a drug; not licensed and can be used by any manufacturer.
Know the generic/Trade name for Demerol, codeine, diazepam
Demerol - meperedine Codeine - codeine sulfate Valium - diazepam
Breach of contract
Failure on the part of the nurse or the employer to perform these duties
When does a breach of contract occur
Failure on the part of the nurse or the employer to perform these duties
What are the three reasons you should have a personal malpractice insurance policy over and above your employer's policy
First, if you or your employer are co-defendants and the court finds you liable and the cost of the settlement exceeds your employer's policy limits, it is possible that you will be required to pay the excess out of your own pocket. Second, it is possible for your employer's insurance company to sue you if they believe they incurred a loss because of your actions. Third, many employee policies are claim based rather than occurrence based. A claims-based policy covers claims made while the policy is in effect. If your employer discontinues this policy and a claim is made later (which often happens), you will not have coverage. An occurrence-based policy provides coverage if the incident occurs within the policy period, no matter when the claim arises. If the policy is allowed to lapse and a suit is filed for an incident that occurred during the policy period, coverage is in place.
What do you do if a therapy is ineffective at first
If a therapy is ineffective at first, encourage the patient to try it again before abandoning it
QUALITY ASSURANCE/ASSESSMENT/IMPROVEMENT
In health care, any evaluation of services provided and the results achieved as compared with accepted standards.
What is the difference between infection and inflammation
Infection is caused by an invasion of microorganisms, such as bacteria, viruses, fungi, or parasites, that produces tissue damage Inflammation is a protective response of body tissues to irritation, injury, or invasion by disease-producing organisms
What is a letter of application
Its objective is to introduce yourself, announce your interest in employment, briefly state your qualifications, and express your availability
What is another term for peripheral analgesic (fill-in)
NSAIDs such as tramadol (Ultram), ibuprofen (Motrin), naproxen (Naprosyn), ketorolac tromethamine (Toradol), and celecoxib (Celebrex) also work in the CNS, but their better-characterized actions are peripheral (AT THE SITE OF INJURY), where they are thought to exert analgesic effects through the inhibition of prostaglandin production. Prostaglandin is an inflammatory mediator, released when cells are damaged, that sensitizes nerves that carry information about pain. By inhibiting prostaglandin release, these drugs diminish transmission of pain stimuli.
Side Effect
Side effects are mild but annoying responses to medication. An example is nausea caused by an antibiotic or oral contraceptive.
Know difference between signs and symptoms (fill-in)
Signs are objective data as perceived by the examiner, in your case, what you see, hear, measure, or feel Symptoms are subjective indications of illness that the patient perceives
What is the best position to place the patient in (or have the patient assume) to auscultate lung sounds
Sitting upright provides full expansion of lungs
Why should you not maintain eye contact with a Korean patient (fill-in)
Some Asian cultures and American Indians relate eye contact to impoliteness or an invasion of privacy.
subjective data
Subjective data are the verbal statements provided by the patient. Statements about nausea and descriptions of pain, fatigue, and anxiety are examples of subjective data. Other terms for subjective data are symptoms and subjective cues.
NURSING NOTES
The form on the patient's chart on which nurses record their observations, care given, and the patient's responses.
TENS
Transcutaneous Electric Nerve Stimulation
What factors affect skin turgor
Turgor refers to the elasticity of the skin caused by the outward pressure of the cells and interstitial fluid. - Dehydration results in decreased skin turgor - Marked edema results in increased turgor
Endorsement/ reciprocity
a statement of recognition of the license of a health practitioner in one state by another state; the applicant needs to meet the current state's licensing requirements
What does standards of care mean
acts whose performance is required, permitted, or prohibited
What disease process might the patient have if he or she is unable to lie supine or must lean forward to breathe (fill-in)
acute or chronic respiratory disease signs of this distress
How is a nursing diagnosis written—what type of language or how might it be worded
adjective before the noun modified organization structure for the diagnostic labels that is called Taxonomy II
How long should you stay at your first job
at least 1 year
What is the correct order to perform a head-to-toe assessment
begin with a neurologic assessment, and then assess the skin, the hair, the head, and the neck, including eyes, ears, nose, and mouth. Examine the chest, the back, the arms, the abdomen, the perineal area, the legs, and the feet in that order.
What might the TENS unit interfere with
cardiac pacemaker device
How do you check to see that a medication order is correct
check the order you have (in a medication Kardex or drug system or on the computerized medication record) against the original order in the patient's chart.
What happens if you have strong moral obligations to something the patient desires (i.e. abortion)
communicate with the appropriate supervisor and explain your moral dilemma
What does a nurse practice act define and state
defines the title and the regulations governing the practice of nursing. The act delineates the legal scope of the practice of nursing within the geographic boundaries. Its provisions assist the nurse in staying within the legal scope of nursing practice in each state. Some states have separate governing boards for professional and practical or vocational nursing. The nurse practice act defines the regulations for practical nursing and includes requirements for an approved school of nursing. It also states the requirements for licensure and conditions for which a license may be revoked or suspended
How can you decrease environmental stimuli
dimming the lights and decreasing the noise level
Situational
directing, coaching, supporting, & delegating
What styles are incorporated into situational leadership
directing, coaching, supporting, and delegating
"Maslow's Model of Health and Illness" What is the premise of this model based on
essential human needs
"Autocratic Style" What might this style look like
firm, insistent, and dominating
What type of assessment is performed continuously throughout nurse-patient contact
focused assessment
Know what cue/data clustering is and the examples listed
grouping related cues together "Thirst; dry skin; dry oral mucous membranes; increased body temperature; and decreased urine output" is a cue cluster that identifies deficient fluid volume as a nursing diagnosis "Statements of inability to control symptoms of (specify problem), apathy, depression, and anxiety" is a cue cluster that potentially identifies the nursing diagnosis of powerlessness
Managers
handle the day-to-day operations to achieve a desired outcome. "hand"
What do many Latino men believe regarding pain and pain behaviors
men are supposed to endure pain without complaining and that alleviating it would be "unmanly" and demeaning in the eyes of their children.
Observant Jews (Orthodox Judaism and Some Conservative Groups) Who performs the circumcision
mohel
How do Folk health belief system classify illness or disease
natural or unnatural
What is the rule of thumb when lifting a patient (and know how to do the math)
never attempt to lift more than 35% of your own body weight
First nursing intervention after you realize a med error has occurred
nurse should immediately check the patient
What are values (fill-in)
personal beliefs about the worth of an object, an idea, a custom, or an attitude
What point do you move a joint to
point of resistance or pain
Why should older patients not be pulled across the bed (1st bullet)
potential to cause shearing or tearing of the skin
Why does the patient need to be mobile
predisposed to developing a wide variety of complications
What is the best way to avoid a lawsuit
provide compassionate, competent nursing care Carry your own insurance
Know vocabulary words in that section
pulse - rhythmic beating or vibrating movement tachycardia - pulse is faster than 100 beats per minute bradycardia - slower than 60 beats per minute dysrhythmia - irregularity in the normal rhythm of the heart
How should the patient interview be conducted
relaxed, unhurried manner in a quiet, private, well-lighted setting
"Vitamin B12" What group of people are at risk for deficit unless they supplement their diet
strict vegetarians, people over age 50, and individuals who have had stomach surgery intrinsic factor is missing, for example, after stomach excision or resection, pernicious anemia (a progressive macrocytic megaloblastic anemia, affecting mainly older people
What is a résumé
summary of educational and professional experiences, including activities and honors
What is the nursing process
systematic method by which nurses plan and provide care for patients
Leadership
the art of getting others to want to do something you are convinced has to be done. "to go"
Negligence
the commission of an act that a prudent person would not have done or the omission of a duty that a prudent person would have fulfilled, resulting in injury or harm to another person; proof is necessary that other prudent members of the same profession would ordinarily have acted differently under the same circumstances
What factors must you consider after medicating a patient (all that apply)
therapeutic effects and adverse effects
Why do you need a detailed and comprehensive report/assessment of signs and symptoms
to allow you to plan appropriate interventions
What is your legal duty regarding patient confidentiality
to protect information about a patient
"Narcotics Control Systems" What must you do if you accidently spill a medication
two nurses must sign the inventory report and describe the situation
Autocratic
very little trust>makes all decisions
What happens if you disagree with the DNR
you have the duty to follow the order
What is the relationship between nursing, patient, health and environment
• Nursing—encompasses the roles and actions of the nurse • Patient—the individual receiving the care • Health—the area along the wellness-illness continuum that the patient occupies • Environment—the setting for the nurse-patient interaction
