1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950End In the evaluation step of the nursing process, the nurse must decide whether the patient has achieved the expected outcome that was identified in the planning phase. CBlood typing and cross-matchingDBleeding and clotting timeQuestion 26 Explanation: Before a blood transfusion is performed, the blood of the donor and recipient must be checked for compatibility. - irregular breathing The National League of Nursing accredits educational programs in nursing and provides a testing service to evaluate student nursing competence but it does not certify nurses. Which of the following blood tests should be performed before a blood transfusion? In which step of the nursing process would the nurse ask a patient if the medication she administered relieved his pain? - anxiety DNR: "do not resuscitate" The physician usually orders supplemental potassium to prevent hypokalemia in patients receiving diuretics. Invasive procedures are performed This leads to bladder distention and urine stagnation, which provide an excellent medium for bacterial growth leading to infection. Yawning and hiccupping do not prevent microorganisms from entering or leaving the body. The best nursing intervention is to: 38. Feedings VS. White potatoes Colostomy irrigation CO can increase to 25 L/min with strenuous activity, Erythrocytes = Red Blood Cells (RBC) Potential for clot formation Because of the danger of anaphylactic shock, he nurse should withhold the drug and notify the physician, who may choose to substitute another drug. 4. Lippincott Fundamentals Of Nursing Test Bank Pdf Eventually, you will very discover a further experience and endowment by spending more cash. minutes A. It cannot be administered subcutaneously or intradermally. Analysis 37. Abdominal muscles Although applying corn starch to the rash may relieve discomfort, it is not the nurses top priority in such a potentially life-threatening situation. GI/GU: - attach a syringe and one way valve prior to insertion When removing a contaminated gown, the nurse should be careful that the first thing she touches is the: Waist tie and neck tie at the back of the gown. The other answers are appropriate nursing interventions for a patient who has undergone femoral arteriography. - intended to decrease strain on the digestive system while keeping the body hydrated Complete blood count (CBC) and electrolyte levels. These symptoms probably indicate that the patient is experiencing:AHyperkalemiaBHypokalemiaCDysphagia DAnorexiaQuestion 42 Explanation: Fatigue, muscle cramping, and muscle weaknesses are symptoms of hypokalemia (an inadequate potassium level), which is a potential side effect of diuretic therapy. Start This procedure seals medication deep into the muscle, thereby minimizing skin staining and irritation. A postoperative patient who has undergone orthopedic surgery, A patient receiving broad-spectrum antibiotics. All equipment must be sterile, and the nurse and the physician must wear sterile gloves and maintain surgical asepsis. 30 seconds - provided for patients who cant swallow and have a functioning GI tract - includes foods that are typically bland: well-cooked vegetables, low-fiber cereals, east-to-chew proteins Describe how to assess for the risk factors affecting a patient's oxygenation. - dyspnea Effective hand washing requires the use of: Anorexia is another symptom of hypokalemia. 19. A postoperative patient who has undergone orthopedic surgery Fundamentals of Nursing Nursing Test Bank This section is the practice quiz for fundamentals of nursing that can help you think critically and augment your review for the NCLEX. - smoke inhalation Screen blood donors for antibodies to human immunodeficiency virus (HIV) Provide additional bedclothes A positive ELISA test combined with various signs and symptoms helps to diagnose acquired immunodeficiency syndrome (AIDS)Question 43Which of the following types of medications can be administered via gastrostomy tube?ACapsules whole contents are dissolve in waterBAny oral medicationsCMost tablets designed for oral use, except for extended-duration compounds DEnteric-coated tablets that are thoroughly dissolved in waterQuestion 43 Explanation: Capsules, enteric-coated tablets, and most extended duration or sustained release products should not be dissolved for use in a gastrostomy tube. Fundamentals of nursing include basic nursing skills, caring for the perioperative patient, positioning patients, medication administration, patient safety, and more. So, after removing gloves and washing hands, the nurse should untie the back of the gown; slowly move backward away from the gown, holding the inside of the gown and keeping the edges off the floor; turn and fold the gown inside out; discard it in a contaminated linen container; then wash her hands again.Question 8In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:AKussmails respirations and hypoventilation BCheyne-Strokes respirations and spontaneous pneumothoraxCRespiratory acidosis, ateclectasis, and hypostatic pneumoniaDAppneustic breathing, atypical pneumonia and respiratory alkalosisQuestion 8 Explanation: Because of restricted respiratory movement, a recumbent, immobilize patient is at particular risk for respiratory acidosis from poor gas exchange; atelectasis from reduced surfactant and accumulated mucus in the bronchioles, and hypostatic pneumonia from bacterial growth caused by stasis of mucus secretions.Question 9The two blood vessels most commonly used for TPN infusion are the:ASubclavian and jugular veinsBBrachial and subclavian veinsCFemoral and subclavian veinsDBrachial and femoral veins Question 9 Explanation: Total Parenteral Nutrition (TPN) requires the use of a large vessel, such as the subclavian or jugular vein, to ensure rapid dilution of the solution and thereby prevent complications, such as hyperglycemia. The middle third of the muscle is recommended as the injection site. - physical activity - energy needs Which of the fol. An impaired or traumatized blood vessel wall Full Liquid Diet: 49. The main sources of vitamin A are yellow and green vegetables (such as carrots, sweet potatoes, squash, spinach, collard greens, broccoli, and cabbage) and yellow fruits (such as apricots, and cantaloupe). Chronic Obstructive Pulmonary Disease List the steps appropriate for urinary catheter insertion. However, research has shown that massage only increases the likelihood of cellular ischemia and necrosis to the area. Femoral and subclavian veins Anorexia Discard all used uncapped needles and syringes in an impenetrable protective container Discuss chest tubes. - constipation In the operating room, the nurse and physician are required to wear sterile gowns, gloves, masks, hair covers, and shoe covers for all invasive procedures. - coolness of extremities Describe the three major types of advanced directives (DNR, living will, durable power of attorney). The purpose of protective (reverse)isolation is to prevent a person with seriously impaired resistance from coming into contact who potentially pathogenic organisms. D. Because an intradermal injection does not penetrate deeply into the skin, a small-bore 25G needle is recommended. Terminal disinfection is the disinfection of all contaminated supplies and equipment after a patient has been discharged to prepare them for reuse by another patient. The National League of Nursing accredits educational programs in nursing and provides a testing service to evaluate student nursing competence but it does not certify nurses. This procedure seals medication deep into the muscle, thereby minimizing skin staining and irritation. The immobilized patient commonly suffers from urine retention caused by decreased muscle tone in the perineum. Which of the following nursing interventions is considered the most effective form or universal precautions? Check the pressure dressing for sanguineous drainage All equipment must be sterile, and the nurse and the physician must wear sterile gloves and maintain surgical asepsis. - regulates levels of electrolytes, produces hormones that are important for blood pressure regulation, develops red blood cells, and helps to keep bones strong The nurse explains to a patient that a cough: 37. Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams). 30. - restlessness Treatment: Synergism A natural body defense that plays an active role in preventing infection is: Please visit using a browser with javascript enabled. An infected patient has chills and begins shivering. The normal count ranges from 150,000 to 350,000/mm3. 24. - disturbed sleeping patterns Any inflammation or obstruction that impairs bile flow will affect the stool pigment, yielding light, clay-colored stool. Differentiate between hospice and palliative care. injections because it: All invasive procedures, including surgery, catheter insertion, and administration of parenteral therapy, require sterile technique to maintain a sterile environment. Date injections; and a 25G needle, for subcutaneous insulin injections. Test your knowledge by answering the questions from our nursing test bank about the fundamentals of nursing (located under each . - restricts the client from eating or drinking anything until the diet is advanced Discuss the basic components of "My Plate". Start This procedure seals medication deep into the muscle, thereby minimizing skin staining and irritation. 2. Muscles of the abdomen, back, and upper arms may be easily injured. C. The edges of a sterile field are considered contaminated. - "nothing by mouth" - changes in senses The normal count ranges from 150,000 to 350,000/mm3. 3) full liquid Placement: 35. A signed consent is not required because a chest X-ray is not an invasive examination. Increased urine acidity and relaxation of the perineal muscles, causing incontinence Signs and symptoms of phlebitis include pain or discomfort, edema and heat at the I.V. Splinting the abdomen supports the abdominal muscles when a patient coughs.Question 35Effective hand washing requires the use of:AAll of the above BA disinfectant to increase surface tensionCSoap or detergent to promote emulsificationDHot water to destroy bacteriaQuestion 35 Explanation: Soaps and detergents are used to help remove bacteria because of their ability to lower the surface tension of water and act as emulsifying agents. You have not finished your quiz. - urinary incontinence Hemoglobinuria Perfusion: When sterile items are allowed to come in contact with the edges of the field, the sterile items also become contaminated.Question 22The correct method for determining the vastus lateralis site for I.M. Screen blood donors for antibodies to human immunodeficiency virus (HIV), Test blood to be used for transfusion for HIV antibodies, The ELISA test of venous blood is used to assess blood and potential blood donors to human immunodeficiency virus (HIV). Shaded items are complete. - musculoskeletal abnormalities All of the following are appropriate nursing interventions except:AAssess a vital signs every 15 minutes for 2 hoursBOrder a hemoglobin and hematocrit count 1 hour after the arteriography CCheck the pressure dressing for sanguineous drainageDAssess femoral, popliteal, and pedal pulses every 15 minutes for 2 hoursQuestion 47 Explanation: A hemoglobin and hematocrit count would be ordered by the physician if bleeding were suspected. - offer silence Waist tie in front of the gown Completed a masters degree in the prescribed clinical area and is a registered professional nurse. The mid-deltoid injection site can accommodate only 1 ml or less of medication because of its size and location (on the deltoid muscle of the arm, close to the brachial artery and radial nerve). Choose the letter of the correct answer. Decreased calcium and phosphate levels in the urine It also is used to evaluate the patients potential for bleeding; however, this is not its primary purpose. All of the following are appropriate nursing interventions except: Assess femoral, popliteal, and pedal pulses every 15 minutes for 2 hours, Check the pressure dressing for sanguineous drainage, Order a hemoglobin and hematocrit count 1 hour after the arteriography, Assess a vital signs every 15 minutes for 2 hours. - low RBC A. Platelets are disk-shaped cells that are essential for blood coagulation. Partial-Credit 48. However, the patients room should be well ventilated, so opening the window or turning on the ventricular is desirable. - do not repeat tap water enemas because water toxicity or circulatory develops if the body absorbs large amounts of water EXAMPLES: broth, gelatin, water, tea, fruit juices, sports drunks If you leave this page, your progress will be lost. Once you are finished, click the button below. Maintain the drainage tubing and collection bag below bladder level to facilitate drainage by gravity, Irrigate the patient with 1% Neosporin solution three times a daily, Maintain the drainage tubing and collection bag level with the patients bladder, Clamp the catheter for 1 hour every 4 hours to maintain the bladders elasticity.