VOCN100 Final Exam 1
What type of data is considered subjective?
"My pain begins here and extends to here."
What information is not required by emergency department admissions for a patient who was brought in for treatment?
Mother's maiden name
Which system must be protected to minimize injury to the nurse and patient?
Musculoskeletal
The holiday Ramadan is practiced by members of what religion?
Muslim
Which is not a requirement for communication?
Narrator
Which is a byproduct of protein metabolism?
Nitrogen
Listening is a form of which type of communication?
Nonverbal
Which profession has the highest workers' compensation claims?
Nurses
In regard to personal space, which zone is considered an intimate zone?
0-18 inches
Which type of patient is prone to develop a pressure sore?
Chronic renal failure patient who requires assistance getting out of bed
Which is a form of nonverbal communication?
Eye contact
When cleansing this area, the nurse should use clear, clean water only.
Eyes
This law has been enacted in several states to protect health professionals from legal liability in the event of providing emergency first aid. This law is the:
Good Samaritan law.
Which is considered a noninvasive pain relief technique?
Guided imagery
How would you describe acute pain?
Intense and of short duration
Which process is the framework for the practice of nursing?
Nursing process
Which is a type of substance used for a medicated bath?
Oatmeal
Which falls within the LPN/LVN's roles and responsibilities?
Obtain and maintain current licensure and practice within the scope of practice
What national organization provides guidelines to protect health care workers in their environment?
Occupational Safety and Health Administration
Which organization requires that hospitals have an emergency plan for treating patients contaminated with radioactive substances?
Occupational Safety and Health Administration (OSHA)
Which is the slowest but safest route to administer medications?
Oral
Which route is considered the preferred route to manage chronic pain?
Oral
Dietary cholesterol is highest in which types of meat?
Organ
Which physiologic factor might hinder communication?
Pain
What is considered the fifth vital sign?
Pain assessment
Which stool specimen should be taken to the lab immediately after collection?
Parasites
What is the most common problem that nurses need to address to ensure the safety of their patients?
Percentage of falls in the facility
A sitz bath cleanses which area?
Perineal and rectal areas
What is the pharmacology phase in which the drug moves through the body and reaches the site for which it is intended?
Pharmacosynthetic phase
What are Maslow's five categories of basic human needs?
Physiologic, safety and security, love and belonging, self-esteem, and self-actualization
What should a nurse do with a patient's money and jewelry if a family member is not present?
Place them in the hospital safe.
Which type of physician should be consulted for a diabetic patient with thick, long, yellow toenails?
Podiatrist
If the nurse suspects an ingestion poisoning, whom should the nurse call?
Poison control center
What is lipping?
Pouring a small amount of a sterile solution that is discarded before pouring for a sterile procedure
Which is not a factor affecting personal hygiene?
Product preferences
What is one of the greatest challenges for nurses today?
Providing comfort
Which condition contraindicates a massage?
Pulmonary embolism
What is serous drainage?
Purulent drainage
Patients' charts are audited for which reasons?
Quality of care, peer review, and quality assurance
Which factor can affect the patient's response to medication?
Race
received?
Receptive aphasia
What are the four main benefits of reflexology?
Removes stress, enhances circulation, normalizes metabolism, and complements other healing
What does "RACE" stand for?
Rescue, Alarm, Confine, Extinguish
Which is an adventitious lung sound?
Rhonchi
Which is not one of the "six rights" of medication administration?
Right instruction
What does "SRD" stand for?
Safety Reminder Device
Florence Nightingale's plan focused on which concepts?
Sanitation, recordkeeping, hygiene, and nutrition
Which type of fats increases a person's cholesterol levels?
Saturated fats
The patient's recommended medication, based on the type of bacteria identified, is determined by what lab method?
Sensitivity
The use of a lift (draw) sheet prevents which type of injury to the patient?
Shearing
What is a monosaccharide?
Simple sugar
What actions by the nurse might ease a patient's anxiety?
The nurse is kind, empathetic, warm, and patient and treats the patient with respect.
Why is it important for the nurse to be able to assess lab values?
The nurse must inform the physician of abnormal labs.
Which is included in the Patient's Bill of Rights?
The patient has the right to refuse treatment and be informed of the medical consequences.
Why is an oral temperature not obtained in a comatose patient?
The patient is unable to assist with holding the thermometer.
What is informed consent?
The patient legally consents to an invasive procedure knowing all the risks and possible complications.
What needs to be removed from a fire extinguisher before it can be activated?
The pin
What does alternative therapy mean?
The primary treatment instead of conventional medicine
What are some safety considerations a nurse should contemplate when caring for an older adult?
Their visual acuity is not good, and their reflexes are slow.
What does complementary therapy mean?
Therapies used in addition to conventional treatments
What are essential nutrients?
They are nutrients that the body cannot make.
Home health care nurses spend 50% of their time documenting in the patient record. Why do they spend so much time charting?
They have to document precisely to receive reimbursement from Medicare and insurance.
How did World War I and World War II influence nursing?
They pressured states to mandate requirements for nurses.
How are health care-associated infections typically spread?
Through direct contact with health care personnel
Why should a hospital have a disaster plan?
To be prepared in times of an emergent community situation with the possibility of a large number of casualties
What does transcultural nursing mean?
Understanding various cultural practices and applying them to nursing care
When is the discharge planning process initiated?
Upon admission to the hospital
Which type of perineal care should be performed at least twice a day?
Urinary catheter care
How might a nurse communicate with a patient who is on a ventilator?
Utilizing a communication board
Which is a controlled substance?
Vicodin
Why is it important to obtain vital signs?
Vital signs may indicate problems.
When is the double bagging procedure utilized?
When it is impossible to keep the outer surface of a bag free from contamination
Fasting during which religious holiday is a practice of the Jewish faith?
Yom Kippur
A "possible" patient problem statement is utilized when:
a problem is feasible.
A dysrhythmia is a(n):
abnormal heart rate.
During the evaluation phase, the nurse should make one of three judgments regarding the desired outcome. These judgments regarding the outcome are:
achieved, not achieved, or partially achieved.
Nursing interventions are:
actions selected or prescribed by the nurse to achieve the desired patient outcome.
This legal document contains a patient's wishes regarding such matters as "do not resuscitate." This document is referred to as a(n) _________________________.
advance directive
A gauze dressing permits:
air to reach the wound.
The infection control nurse is explaining to certified nurse's aides that health care-associated infection means:
an acquired infection while in a medical facility within 12 hours after admission.
An incident report is a form required for:
any services rendered for quality assurance purposes.
The term supine indicates a position in which the patient is lying on the:
back.
The health care provider orders a medication to be administered by the buccal route. This route is:
between the cheek and teeth.
After 10 minutes of CPR, __________________ occurs.
brain death
A Kardex or Rand system is a:
card system that contains demographic information.
The nurse must assess neurovascular function, also called CMS assessment. CMS stands for:
circulation, movement, and sensation.
The assessment process is best described as one in which the nurse _________________.
collects information and analyzes data
The phrase holistic health care system indicates that this system's focus is on the ________.
comprehensive care of the patient
The term health means ___________.
condition of physical, mental, and social well-being, and absence of disease
Semi-Fowler's position is a position in which the head of the bed is:
elevated at a 30-degree angle.
Once _________ stores are full, further excess is converted to adipose tissue.
glycogen
Patient problem statements are ranked in order of priority of the patient's health and safety issues. Which problem statement would be the highest priority?
impaired breathing related to shortness of breath
Rest and activity are important to the healing process because they cause:
increased circulation and oxygenation of the wound, which promotes healing.
A patient is admitted to the surgery center for an endoscopic procedure. The nurse has a consent form for the endoscopic procedure that the patient is required to sign if he/she wishes to have the procedure. The patient states that the surgeon has discussed the procedure and the possible risks associated with the procedure. The nurse explains the procedure to the patient, along with the pre-procedure and postprocedure care. This type of consent is an _________________ consent.
informed
The patient states the doctor informed her that her cervical spine is out of alignment. This means the cervical spine:
is not in line with the thoracic vertebrae.
Apnea means:
lack of respirations.
A nurse-patient relationship is a __________ relationship.
legal
Why are staples used to adhere an incision? They are:
less expensive than sutures.
The nurse explains that a mode of transmission for a particular disease is a vector. The patient asks, "What is a vector?" She explains a vector is a(n):
living carrier.
A nurse is caring for a diabetic patient whose serum glucose level is 520 mg/dL prior to lunch. Insulin sliding scale coverage has been ordered by the health care provider with instructions to call her for any glucose level over 400 mg/dL. The nurse does not call the provider and goes to lunch. The patient develops ketoacidosis and is not stable. This nurse is liable for ___________.
malpractice
A care plan is a document that outlines the _____________.
methods used to meet the patient's needs by the health care team
Clinical pathways are a _____________ plan that schedules clinical interventions over an anticipated time frame.
multidisciplinary
Assertive communication is a form of communication in which the:
nurse takes into account the feelings and needs of the patient.
The section of the patient's chart that contains observations, care given, and patient's responses is:
nurse's notes.
Case management is the assignment of a health care provider to a patient so the care of that patient is overseen by one individual. This individual typically is a(n):
nurse.
Why should the nurse maintain a nonjudgmental attitude in obtaining a health history when admitting a patient to the hospital? So the nurse can:
obtain information regarding all therapies the patient is currently receiving.
A culture and sensitivity are ordered to determine the:
organism and what antibiotic is effective against the organism.
The term paraphrasing means restating a:
phrase in one's own terms to verify what was communicated.
PAS stands for:
practitioner-assisted suicide.
A chiropractic doctor cannot:
prescribe medicine.
The National Federation of Licensed Practical/Vocational Nurses' Code of Ethics was developed to:
provide knowledge for the LPN/LVN about the scope of practice.
When caring for an unresponsive patient, the nurse should:
provide loud, audible stimuli while caring for the patient.
The difference between criminal law and civil law is that criminal law's focus is __________ and civil law's focus is __________.
public offenses; a person's rights
When assessing respirations, the nurse should assess:
rate, depth, rhythm, and quality.
The primary purpose of a wet-to-dry dressing is to:
remove debris.
When caring for a patient with whom a nurse has a personal conflict, the nurse may _________.
request that the patient not be assigned to him/her
Some Asian and Native American cultures believe eye contact indicates:
rudeness.
considered:
secondary.
When obtaining information from a patient, the nurse inquires about signs and symptoms the patient has encountered. A rash would be considered a _____________.
sign
Components of the patient problem statement consist of:
signs and symptoms, cause, and defining characteristics.
The prone position is lying on one's:
stomach.
When performing a nursing physical assessment, the nurse's approach should include assessing:
the neurologic status, then the body in a head-to-toe approach, focusing on the body systems.
Before assisting a patient to ambulate to the bathroom, the nurse should first assess:
the patient's ability to assist with ambulation.
The purpose of the nurse's physical assessment of a patient is to determine:
the patient's state of health.
Chief complaint refers to:
the reason for seeking health care.
Empathy means:
understanding and sharing feelings another is experiencing.
What could cause a nosebleed (epistaxis)?
Hypertension
A patriarchal culture believes in which social structure?
The male of the household makes the decisions.
What part of the stethoscope is utilized to assess lung sounds?
Diaphragm
How much fluid should the patient consume during the postoperative period?
2000-2400 mL
What disciplines might be involved in the discharge planning process?
Dietitian, social worker, and home health care nurse
What is a telephone admission?
A phone conversation to obtain information prior to hospitalization and provide the patient with information prior to admission
What type of problem is a major concern for older adults? (Select all that apply.)
Driving, Hospitalizations, Accidental poisoning, Loneliness
What portion of a sterile drape is considered nonsterile?
1-inch border
What is a clinical pathway?
A plan in which many health care professionals schedule interventions to promote patient progress
1000 meters is equal to how many kilometers?
10 km
30 grams is equivalent to how many ounces?
2 oz
One grain equals how many milligrams?
60 mg
What room temperature is good for a patient's hospital room?
68° to 74° F
Hypothermia can result when an individual's body temperature falls below ______° F.
95
Which is a fat-soluble vitamin?
A
What is herbal therapy?
A derivative from the whole plant used to treat illness and maintain health.
What is transitional care?
A discharge planning approach in which the specialists assist with the discharge process and are available to the patient after discharge
What is the difference between a localized infection and a systemic infection?
A local infection is confined to a particular area of the body, and a systemic infection is throughout the body.
What does passive ROM mean?
A nurse or other person performs exercises to a patient's extremities.
What does primary intention mean?
A surgical wound
What does AMA mean?
Against medical advice
What is the difference between approved nursing programs and accredited nursing programs?
Approved programs meet minimum state requirements, whereas accredited programs are reviewed by a professional organization with higher standards than the state.
Which maneuver could be performed on a conscious adult who is choking?
Abdominal thrusts
What is the difference between acupressure and acupuncture?
Acupressure applies pressure to certain body points, whereas acupuncture applies a needle to these points.
Which of the following is on the second tier of the CDC's isolation guidelines?
Airborne, droplet, and contact precautions
What is animal-assisted therapy?
Animals utilized to assist patients reach their goals
When communicating, in what culture does silence indicate respect?
Asian
What is a discharge planner's role in the hospital environment?
Assist and coordinate the discharge planning needs of patients
Which is an ethical principle?
Autonomy
A person who is on a vegan diet lacks which vitamin?
B12
Pernicious anemia is a lack of which vitamin?
B12
Which blood pressure reading is most indicative of hypertension?
BP 140/90
Which physical areas of the body are appropriate for assessing skin turgor?
Back of the hand and sternum
What is ethnocentrism?
Believing a person's cultural practices and beliefs should be the standard
What is needed to assist in the digestion of fats?
Bile
During the initial step in the nursing health history, the nurse would verify which data gathered by the admitting office to verify accuracy?
Biographic data
Our Western culture believes in which type of health practice?
Biomedical medicine
What does occult mean when testing a stool specimen?
Blood that cannot be seen
Primitive people believed that a person became ill when an evil spirit entered the
Body
The heart and lungs have stopped functioning in which type of death?
Clinical death
What should the nurse assess and document regarding drainage?
Color, odor, consistency, and amount
What are some security issues regarding the computerized documentation system?
Confidentiality of information
What does infection control mean?
Control of infection within a facility
What is the difference between core temperature and surface temperature?
Core temperature indicates the temperature of deep tissues, and surface temperature indicates temperature of the skin.
Which is a physiologic sign of sleep deprivation?
Decreased reasoning and judgment
When assessing the abdomen, which is not an assessment that is performed by the nurse?
Deep palpation of masses
Which medication is considered an opioid?
Demerol
Which agency regulates long-term care facilities?
Department of Health
Why are computers considered a benefit to documentation?
Efficiency and legibility
What is medical asepsis?
Eliminating the growth and spread of pathogenic organisms utilizing clean technique
What factors can affect a person's temperature?
Environment
How often should a nurse inspect a postoperative surgical wound within the first 24 hours?
Every 2-4 hours
What is the benefit of imagery?
Evoke physical changes in the body
What nursing intervention is beneficial for a patient with epistaxis?
Extending the patient's head
Which skin integrity problem can occur when improperly lifting or pulling a patient up in bed?
Friction
Which culture views time as "elastic," indicating time is flexible?
Hispanic
Chinese-American health beliefs focus on which type of medicine?
Holistic
This bill was developed in 1972 by the American Hospital Association to promote the public's understanding of their rights and responsibilities in health care. What is this bill called?
Hospital Association Bill of Rights
What does universal carry mean?
How to remove a patient from the bed to the floor
What is the function of a 24-hour urine specimen?
Indicates renal function and urinary output
What type of pressure is applied to the artery located above the wound?
Indirect pressure
What is the nurse's responsibility after a specimen has been collected?
Label the specimen, ensure the delivery to the lab, and assess the results.
What type of sensitivity is often seen in the health care environment?
Latex allergies
Upon initial contact with a patient, which is needed to establish a therapeutic nurse-patient relationship?
Maintain eye contact, introduce yourself, allow questions, and maintain confidence and professionalism.
One of the following is not a basic rule for charting?
Mark through the error several times so it is not legible.
Which time of the day is best for obtaining a sputum specimen?
Morning
How is a medical assessment different from a nursing physical assessment?
The medical assessment is performed by a physician and focuses on the disease process and physical signs and symptoms. The nursing assessment is holistic in its approach, including signs and symptoms.
What precautions should the nurse take when obtaining a specimen?
Standard precautions
What tool does the nurse utilize to obtain an apical heart rate?
Stethoscope
Which medication is administered rectally?
Suppository
Which organization established standards for health care providers regarding pain assessment and management?
The Joint Commission
Which statement is a portion of the gate control theory?
The brain is unable to process pain while interpreting other stimuli.
How do herbs differ from pharmaceuticals?
The difference is herbs utilize the whole plant, whereas pharmaceuticals utilize only a portion of the plant.
What does dehiscence mean?
The layers of the wound have separated.