NUR 437 Midterm Exam Study Guide
Questions and Answers
What is the use of digital information and communication technologies such as
computer and mobile devices to access health care services remotely and manage
care? - Answer-Telehealth
What are some examples of Telehealth? - Answer-Mobile phone to upload food logs,
medications and blood sugar levels for nurse/provider review, text/email/phone
reminder when specific procedures of exams are needed, online patient portal
Drawbacks to Telehealth... - Answer-Treatment may not be coordinated with regular
doctor, essential information from medical history may not be considered
issues with complex medical issues, lacking an in-person evaluation, does not allow for
doctor-patient shared decision making
Goals of Telehealth - Answer-Make healthcare accessible for those in rural
communities, improve communication and coordination of care among health care team
members, provide support for self management of healthcare
Nursing assessment via Telehealth - Answer-Nurses can assess patient status, deliver
interventions, and evaluate outcomes of nursing care. Can be used for triaging patients,
monitoring, providing education, emotional support, and providing follow up care
What kind of assessment is SADPERSONS? - Answer-Suicide risk
What is assessed in SADPERSONS? - Answer-S: sex (male more at risk)
A: age (15-24, 45-54 for females, over the age of 75 for men
D: depression
P: prior history
E: ethanol use
R: rational thinking loss
S: support system loss
O: organized plan
N: no significant other
S: sickness
0-2 score on SADPERSONS - Answer-No real problem, watch client
3-4 score on SADPERSONS - Answer-Send home, check in frequently
5-6 score on SADPERSONS - Answer-Consider hospitalization
7-10 score on SADPERSONS - Answer-Definite hospitalization
,What does the CIWA scale assess for? - Answer-Alcohol withdrawal
What are the components of the CIWA scale? - Answer-N/V, tremors, paroxysmal
sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual
disturbances, headaches, orientation and clouding of sensorium
What is assessed in the mental status exam? - Answer-Appearance
Behavior
Orientation (person, time, place, situation)
Consciousness
Attention/concentration
Memory
Intellectual functioning
Comprehension
Judgment
Insight: significance of current situation
Thought process/organization: how is the prisons thinking
Though content: what is the person thinking
Perceptions
Mood: patient's description of predominant feeling state
Affect
Eye contact
Speech
Risk for suicide/harm to self
Risk for harm to others
What is assessed in the APGAR assessment and when is it done? - Answer-
Appearance (skin color)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respirations
1 and 5 min (the higher the score the better
What is assessed in the newborn assessment? - Answer-Skin color, head, necking
shoulders, eyes, ears, nose, mouth, heart and respiratory, abdomen, umbilical cord,
genitalia, extremities, reflexes, back, spine, anus
Where do the EKG leads go? - Answer-White on top right, green on bottom right, black
on top left, red on bottom left, brown in center (clouds above grass, earth in the middle,
smoke over fire)
What tests to see that the fetus produces characteristic heart rate patterns in response
to fetal movement, uterine contractions, or stimulations? - Answer-Non-stress test
, How is a woman positioned for a NST? - Answer-Woman is seated in a reclining chair
(slight lateral tilt to optimize uterine perfusion and prevent supine hypotension)
___________________ is used to detect uterine contractions or fetal movements -
Answer-Toco
_________________ NST shows accelerations and is a positive result - Answer-
Reactive
Two accelerations in a 20 minute period, each lasting at least 15 minutes and peaking
at least 15 beats/min above the baseline
What is the goal of FHM during the rest and second trimesters and the third trimester? -
Answer-First and second trimesters: detection of fetal anomalies
Goal of third trimester is to determine whether the intrauterine environment continues to
support the fetus
Normal FHR? - Answer-120-160
On a FHM tracing, each small box represents 10 seconds and a solid red line indicates:
- Answer-1 minute
The toco monitors contractions and goes where? - Answer-On top of the fundus, it has
a knob on it
The FHR goes where and does what? - Answer-Goes towards the bottom side of the
fundus below umbilicus to measure fetal HR
VEAL CHOP - Answer-V- Variable C- Cord Comphression
E- Early Decels H- Head Compression
A- Accelerations O - OK
L-Late Decels P - Placenta
What provides an earlier warning of fetal compromise than the NST and produces fewer
false positives? - Answer-Contraction stress test (CST)
For a contraction stress test, we are looking for a ________) result - Answer-We are
looking for a negative result! Positive result warrants hospital admission, suspicious
results warrant a retest the next day Negative CST: no late decelerations with
contractions Positive CST: repetitive late decelerations
When should care be prioritized? What is the best way to determine patient well being?
- Answer-After receiving report, assessment
Five F' of prioritizing: - Answer-Fatal: failure to do so could cause death or injury
Fundamental: essential to professional definition of the job
Questions and Answers
What is the use of digital information and communication technologies such as
computer and mobile devices to access health care services remotely and manage
care? - Answer-Telehealth
What are some examples of Telehealth? - Answer-Mobile phone to upload food logs,
medications and blood sugar levels for nurse/provider review, text/email/phone
reminder when specific procedures of exams are needed, online patient portal
Drawbacks to Telehealth... - Answer-Treatment may not be coordinated with regular
doctor, essential information from medical history may not be considered
issues with complex medical issues, lacking an in-person evaluation, does not allow for
doctor-patient shared decision making
Goals of Telehealth - Answer-Make healthcare accessible for those in rural
communities, improve communication and coordination of care among health care team
members, provide support for self management of healthcare
Nursing assessment via Telehealth - Answer-Nurses can assess patient status, deliver
interventions, and evaluate outcomes of nursing care. Can be used for triaging patients,
monitoring, providing education, emotional support, and providing follow up care
What kind of assessment is SADPERSONS? - Answer-Suicide risk
What is assessed in SADPERSONS? - Answer-S: sex (male more at risk)
A: age (15-24, 45-54 for females, over the age of 75 for men
D: depression
P: prior history
E: ethanol use
R: rational thinking loss
S: support system loss
O: organized plan
N: no significant other
S: sickness
0-2 score on SADPERSONS - Answer-No real problem, watch client
3-4 score on SADPERSONS - Answer-Send home, check in frequently
5-6 score on SADPERSONS - Answer-Consider hospitalization
7-10 score on SADPERSONS - Answer-Definite hospitalization
,What does the CIWA scale assess for? - Answer-Alcohol withdrawal
What are the components of the CIWA scale? - Answer-N/V, tremors, paroxysmal
sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual
disturbances, headaches, orientation and clouding of sensorium
What is assessed in the mental status exam? - Answer-Appearance
Behavior
Orientation (person, time, place, situation)
Consciousness
Attention/concentration
Memory
Intellectual functioning
Comprehension
Judgment
Insight: significance of current situation
Thought process/organization: how is the prisons thinking
Though content: what is the person thinking
Perceptions
Mood: patient's description of predominant feeling state
Affect
Eye contact
Speech
Risk for suicide/harm to self
Risk for harm to others
What is assessed in the APGAR assessment and when is it done? - Answer-
Appearance (skin color)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respirations
1 and 5 min (the higher the score the better
What is assessed in the newborn assessment? - Answer-Skin color, head, necking
shoulders, eyes, ears, nose, mouth, heart and respiratory, abdomen, umbilical cord,
genitalia, extremities, reflexes, back, spine, anus
Where do the EKG leads go? - Answer-White on top right, green on bottom right, black
on top left, red on bottom left, brown in center (clouds above grass, earth in the middle,
smoke over fire)
What tests to see that the fetus produces characteristic heart rate patterns in response
to fetal movement, uterine contractions, or stimulations? - Answer-Non-stress test
, How is a woman positioned for a NST? - Answer-Woman is seated in a reclining chair
(slight lateral tilt to optimize uterine perfusion and prevent supine hypotension)
___________________ is used to detect uterine contractions or fetal movements -
Answer-Toco
_________________ NST shows accelerations and is a positive result - Answer-
Reactive
Two accelerations in a 20 minute period, each lasting at least 15 minutes and peaking
at least 15 beats/min above the baseline
What is the goal of FHM during the rest and second trimesters and the third trimester? -
Answer-First and second trimesters: detection of fetal anomalies
Goal of third trimester is to determine whether the intrauterine environment continues to
support the fetus
Normal FHR? - Answer-120-160
On a FHM tracing, each small box represents 10 seconds and a solid red line indicates:
- Answer-1 minute
The toco monitors contractions and goes where? - Answer-On top of the fundus, it has
a knob on it
The FHR goes where and does what? - Answer-Goes towards the bottom side of the
fundus below umbilicus to measure fetal HR
VEAL CHOP - Answer-V- Variable C- Cord Comphression
E- Early Decels H- Head Compression
A- Accelerations O - OK
L-Late Decels P - Placenta
What provides an earlier warning of fetal compromise than the NST and produces fewer
false positives? - Answer-Contraction stress test (CST)
For a contraction stress test, we are looking for a ________) result - Answer-We are
looking for a negative result! Positive result warrants hospital admission, suspicious
results warrant a retest the next day Negative CST: no late decelerations with
contractions Positive CST: repetitive late decelerations
When should care be prioritized? What is the best way to determine patient well being?
- Answer-After receiving report, assessment
Five F' of prioritizing: - Answer-Fatal: failure to do so could cause death or injury
Fundamental: essential to professional definition of the job
