Practice Questions for exam 1 NUR 155 with 100% correct answers

Pick the infectious disease process for contact precautions. MRSA C-Diff MRSA Methicillin-Resistant Staphylococcus Aureus; an infectious disease caused by a pathogen that is resistant to many antibiotics C. diff (Clostridium difficile) are passed in feces and spread to food, surfaces and objects when people who are infected don't wash their hands thoroughly Pick the infectious disease process for airborne precautions. Tuberculosis Rubeola Tuberculosis Rubeola measles Pick the infectious disease process for droplet precautions. Diphtheria Streptococcal pharyngitis Pneumonia Diphtheria an acute bacterial infection of the throat and upper respiratory tract Streptococcal pharyngitis Pneumonia inflammation of the lungs A vibrating sensation like the purring of a cat or water running through a hose thrill what is skin redness? erythema What is a blueish tinge of the skin called? cyanosis the junction b/w the body of the sternum and the manubrium Angle of Louis period in which the ventricles contract systole what is the act of striking the body surface to elicit sounds or vibrations? percussion what is the period in which the ventricles relaxes? diastole TRUE/FALSE inspection is the visual examination-that is, assessing by using the sense of sight. true TRUE/FALSE tympany is a musical or drum like sound produced from an air-filled stomach true ... is a sound created by turbulence of blood flow due to a narrowed arterial lumen. bruit ... the result of inadequate circulating blood or hemoglobin and reduction in tissue oxygenation pallor ... is the presence of excess interstitial fluid. edema a central pulse apical pulse a pulse located away from the heart peripheral pulses a blood pressure that falls when a patient sits or stands orthostatic hypotension ... are body temperature, pulse, respiration, blood pressure, oxygen saturation, and pain level vital signs ... is a core body temperature below limit of normal hypothermia when taking a blood pressure using a stethoscope, the RN identifies the series os sounds called Korotkoff's sounds when taking BP, if the bladder is to narrow, the BP reading will be ...? elevated a nurse reports that the client has dyspnea when ambulating. This would be called? shortness of breath what happens to the pulse when a client has an elevated temperature the pulse will increase the following lung sound is low pitched and can be cleared with a cough rhonchi or gurgles this heart sound is located at the 2nd intercostal space and lateral to the left sternal border pulmonic valve a normal blood pressure reading for an adult 120/80 which question is appropriate to ask a patient before assessing the temperature orally? have you had anything hot or cold to eat or drink in the past 15 minutes? having a client to stand on one foot with the eyes closed and repeat with other foot assesses the neurologic system bowel sounds auscultated about every 15 seconds in each of the four quadrants would be documented as normoactive the correct order to assess an abdomen in an abdominal assessment is inspect, auscultate, palpate the lung sounds located b/w the scapula posteriorly are the bronchovesicular when auscultating the bowel sounds, it is important to start with right lower quadrant what could be signs of infection in a surgical patient? fever, smell, redness of the area, swelling pus, pain, edema, warm to touch While reviewing care plan goals by the new nurse, the nurse manager will follow up with the new nurse on which goal. a) be able to ambulate 20 feet with walker by end of shift b) be able to understand insulin administration by discharge c) be able to ambulate 15 feet without dyspnea unassisted by discharge b) be able to understand insulin administration by discharge The nurse has received a client from the emergency department and a report was called by the primary nurse in the ED. What type of data collection is this? Secondary source of data A client that the nurse is caring for is grimacing and moaning. A nurse demonstrates clinical reasoning by assessing the client and obtaining vital signs The nurse realizes that nursing diagnosis should be put in order of priority. Which nursing diagnosis in of the highest priority according to Maslow? Ineffective breathing pattern Which nursing diagnosis will take priority in 99 % of the statements? a) Actual problem b) Risk for a problem a) Actual problem Which action by the nurse demonstrates critical thinking and creativity? Having a child blow up balloons to teach deep breathing exercises A nurse thinks elderly clients like music from the 1920's. The nurse always puts the TV on a music channel that plays this type of music for all of the elderly clients. Which technique of critical thinking is the nurse using? deductive reasoning A problem solving technique that relies on a nurses inner sense is called intuition