exam 2 (NSG 241) Questions With Complete Solutions
What does the nurse need to know when performing a skin
assessment on the patient?
Factors affecting skin integrity
- wounds
- vascular disease
- diabetes
- malnutrition
- age
What does the nurse need to know about pressure ulcers and
preventing skin breakdown?
Turning and positioning
- Every 2 hours
Skin hygiene
- Maintains healthy skin
- Preserve normal skin pH
What is important for the nurse to know when irrigating a
wound?
- Location
- Size
- Presence of undermining or tunneling
- Drainage
- Conditions of wound edges and surrounding tissue
,When documenting and using EHRs, what is important for the
nurse to know?
• Confidentiality
oNurses have a professional and legal obligation to protect
patient information.
• Privacy
oControlling access to personal information
• Health Insurance Portability and Accountability Act (HIPAA)
oStandards for the protection of personal health information,
whether conveyed orally or recorded in any form or medium
Why is a hand-off report important?
oPassing patient-specific information from one caregiver to
another
oMay be oral, written, or recorded
oPromotes continuity of care
oProvides opportunity for collaborative problem solving
- Several sentinel events could occur because of incomplete
handoff reporting.
What legal considerations do nurses need to keep in mind when
providing care to patients?
• Nurses' notes are legal documents
• Medical records can be used as evidence in court
• Student entries are not admissible in the court of law
• Timely charting is recommended
• All entries include:
,- Date and Time
- Signature with credentials
- No blank spaces
- No blue ink
What does the nurse need to know when delegating tasks to
others?
When communicating during delegation, nurses must show
collegiality and respect for all members of the health care team
When nurses utilize evidence-based practice, what do they need
to know?
an integration of the best available research evidence and the
nurse's clinical expertise to make patient care decisions.
When nurses are providing education to patients, why is it
important to consider their health literacy?
Health literacy- The unique ability of a patient to understand and
integrate health-related knowledge
Why are the domains of learning important when providing
education to patients?
Cognitive domain
- Learning comprises knowledge and material that is
remembered
•Psychomotor domain
- learning incorporates physical movement and the use of motor
, skills into learning
• Affective domain
- Learning recognizes the emotional component of integrating
new knowledge
What is important for the nurse to know when documenting on
patients?
he nursing process: assessment, diagnosis, planning,
implementation, and evaluation.
What does the nurse need to know when using health models to
guide nursing practice?
The model focuses on three areas:
(1) individual characteristics and experiences;
(2) behavior-specific knowledge and affect;
(3) behavioral outcomes.
What does the nurse need to know regarding the health and
wellness of patients?
Health promotion - The process of enabling people to increase
control over, and to improve, their health
Wellness - The process of self-care achieved by making choices
leading to a healthy life
What does the nurse need to do when placing an NG tube?
- Provide a short-term feeding method for nutritional intake and
hydration
What does the nurse need to know when performing a skin
assessment on the patient?
Factors affecting skin integrity
- wounds
- vascular disease
- diabetes
- malnutrition
- age
What does the nurse need to know about pressure ulcers and
preventing skin breakdown?
Turning and positioning
- Every 2 hours
Skin hygiene
- Maintains healthy skin
- Preserve normal skin pH
What is important for the nurse to know when irrigating a
wound?
- Location
- Size
- Presence of undermining or tunneling
- Drainage
- Conditions of wound edges and surrounding tissue
,When documenting and using EHRs, what is important for the
nurse to know?
• Confidentiality
oNurses have a professional and legal obligation to protect
patient information.
• Privacy
oControlling access to personal information
• Health Insurance Portability and Accountability Act (HIPAA)
oStandards for the protection of personal health information,
whether conveyed orally or recorded in any form or medium
Why is a hand-off report important?
oPassing patient-specific information from one caregiver to
another
oMay be oral, written, or recorded
oPromotes continuity of care
oProvides opportunity for collaborative problem solving
- Several sentinel events could occur because of incomplete
handoff reporting.
What legal considerations do nurses need to keep in mind when
providing care to patients?
• Nurses' notes are legal documents
• Medical records can be used as evidence in court
• Student entries are not admissible in the court of law
• Timely charting is recommended
• All entries include:
,- Date and Time
- Signature with credentials
- No blank spaces
- No blue ink
What does the nurse need to know when delegating tasks to
others?
When communicating during delegation, nurses must show
collegiality and respect for all members of the health care team
When nurses utilize evidence-based practice, what do they need
to know?
an integration of the best available research evidence and the
nurse's clinical expertise to make patient care decisions.
When nurses are providing education to patients, why is it
important to consider their health literacy?
Health literacy- The unique ability of a patient to understand and
integrate health-related knowledge
Why are the domains of learning important when providing
education to patients?
Cognitive domain
- Learning comprises knowledge and material that is
remembered
•Psychomotor domain
- learning incorporates physical movement and the use of motor
, skills into learning
• Affective domain
- Learning recognizes the emotional component of integrating
new knowledge
What is important for the nurse to know when documenting on
patients?
he nursing process: assessment, diagnosis, planning,
implementation, and evaluation.
What does the nurse need to know when using health models to
guide nursing practice?
The model focuses on three areas:
(1) individual characteristics and experiences;
(2) behavior-specific knowledge and affect;
(3) behavioral outcomes.
What does the nurse need to know regarding the health and
wellness of patients?
Health promotion - The process of enabling people to increase
control over, and to improve, their health
Wellness - The process of self-care achieved by making choices
leading to a healthy life
What does the nurse need to do when placing an NG tube?
- Provide a short-term feeding method for nutritional intake and
hydration
