NURSING 143 VERIFIED QUESTIONS
AND CORRECT ANSWERS
What are some general medication assessment best practices? -
CORRECT ANSWER- - Ensure MAR is accurate and complete
(patient's name, medication name, dosage, route, and time of
administration)
- Review pertinent information related to the medication including action,
purpose, normal dose and route, adverse effects, time of onset and peak
action, and nursing implications
- Assess for any contraindications to patient including being on NPO,
inability to swallow, nausea/vomiting, bowel inflammation, reduced
peristalsis, recent GI surgery, gastric suction, and decreased level of
consciousness
- Assess risk for aspiration and protect patient by assessing swallowing
ability
- Assess patient's medical, medication, diet history, and history of
allergies
- Review assessment findings and laboratory data that influence
medication administration such as vital signs and results of renal and
liver function
- Assess patient's need for medication education and guidance
- Assess patient's preference for fluids and determine if medications can
be given with fluids
What are some general steps to prevent medication errors? -
CORRECT ANSWER- - Always follow 10 rights of medication
administration
- Only prepare medications for one patient at a time
- Be sure to read labels at least 3 times
- Use at least 2 person-specific identifiers every time medication is
administered (name, DOB, health #)
,- Do not allow any interruptions while administering medication
- Double-check all calculations
- Do not interpret illegible handwriting
- Question abnormally large or small doses
- Document all medications as soon as they are given
What are the components of the nursing process? - CORRECT
ANSWER- ADPIE:
Assessment (collection of data)
Diagnosis (determine key issues)
Planning (formal plan)
Implementation (action)
Evaluation (response to interventions/next steps)
What is the Fundamentals of Care Framework? - CORRECT
ANSWER- - A trusting therapeutic relationship between care recipient
and care provider
- Integrating and meeting a persons' physical, psychosocial and
relational needs
- A context of care that is supportive of relationship development and
care integration
What are the 3 sources of health assessment data? - CORRECT
ANSWER- Primary: Client (best source of information if cognition is
unimpaired)
Secondary: Family members/significant others, health care team, client
chart/medical records
Tertiary: Scientific/medical literature, nurse's experience
Subjective Data - CORRECT ANSWER- Subjective Data: client's
verbal descriptions of their health concerns; obtained through health
history; the individual's own perception of their health; quoting is best
method of documenting; OPQRSTU (onset, provoke/palliate, quality,
region/radiation, severity, timing, understanding); a symptom
Objective Data - CORRECT ANSWER- Objective Data: observations
or measurements of a client's health status; gathered through technical
,measurements/observations by health care practitioner; vital signs, lab
tests, diagnostics; inspect, percuss, palpate, auscultation; a sign
List the 4 skills required for a physical examination - CORRECT
ANSWER- Inspection, Palpation, Percussion, Auscultation
Inspection - CORRECT ANSWER- The use of vision and hearing to
distinguish normal from abnormal findings (concentrated watching)
Palpation - CORRECT ANSWER- Involves the use of the hands to
touch body parts to make sensitive assessments (sense of touch)
Percussion - CORRECT ANSWER- Involves tapping the body with
the fingertips using short, sharp strokes to produce a vibration that
travels through body tissues; character of the sound determines the
location, size, and density of underlying structures to verify abnormalities
assessed by palpation and auscultation
Auscultation - CORRECT ANSWER- Involves listening to sounds the
body makes to detect variations from normal (most sounds will require
the aid of a stethoscope)
What are some of the key fundamentals in a head-to-toe examination?
- CORRECT ANSWER- - Head-to-toe approach includes all body
systems
- Begins by assessing the head and neck structures and progressing
methodically down the body
- Compare both sides of the body for symmetry
- If a patient is seriously ill, first assess the systems of the body more at
risk for abnormalities
- If a patient is fatigued, offer rest periods between assessments
- Perform painful procedures at the end of the examination
- Record assessments in specific terms on a physical assessment form
- Use common/accepted medical abbreviations
- Record quick notes during the examination to minimize time patient is
waiting
, Systematic Assessment Process - CORRECT ANSWER- A method
for collecting data on all body systems (integumentary, ocular, auditory,
respiratory, etc.)
Comprehensive Assessment Process - CORRECT ANSWER-
Includes identifying data, source of health history, reason for interview,
current state of health, developmental variables, psychological variables,
spiritual variables, sociocultural variables, physiological variables, history
of past illnesses/injuries, current medications, and a review of the body
systems
Examination Position and Preparation for Infants - CORRECT
ANSWER- Infants
- For very young, position supine on padded table
- If baby can sit, position on parent's lap
- Prepare examination 1-2 hours after baby has fed
- Maintain a warm environment
Examination Position and Preparation for Toddlers - CORRECT
ANSWER- Toddlers
- Sit on parent's lap
- Enlist parent for aid during invasive procedure
- Toddler can use security object (teddy bear/blanket) to ease anxiety
- Focus most of communication on parent to begin
Examination Position and Preparation for Preschool Age - CORRECT
ANSWER- Preschool Age
- Can be on parent's lap, or on exam table
- Verbal communication is helpful, but use simple terms
Examination Position and Preparation for School Age - CORRECT
ANSWER- School-Age
- Sitting on examination table
- Break ice with small talk
- Children should undress on their own
Examination Position and Preparation for Adolescents - CORRECT
ANSWER- Adolescent
AND CORRECT ANSWERS
What are some general medication assessment best practices? -
CORRECT ANSWER- - Ensure MAR is accurate and complete
(patient's name, medication name, dosage, route, and time of
administration)
- Review pertinent information related to the medication including action,
purpose, normal dose and route, adverse effects, time of onset and peak
action, and nursing implications
- Assess for any contraindications to patient including being on NPO,
inability to swallow, nausea/vomiting, bowel inflammation, reduced
peristalsis, recent GI surgery, gastric suction, and decreased level of
consciousness
- Assess risk for aspiration and protect patient by assessing swallowing
ability
- Assess patient's medical, medication, diet history, and history of
allergies
- Review assessment findings and laboratory data that influence
medication administration such as vital signs and results of renal and
liver function
- Assess patient's need for medication education and guidance
- Assess patient's preference for fluids and determine if medications can
be given with fluids
What are some general steps to prevent medication errors? -
CORRECT ANSWER- - Always follow 10 rights of medication
administration
- Only prepare medications for one patient at a time
- Be sure to read labels at least 3 times
- Use at least 2 person-specific identifiers every time medication is
administered (name, DOB, health #)
,- Do not allow any interruptions while administering medication
- Double-check all calculations
- Do not interpret illegible handwriting
- Question abnormally large or small doses
- Document all medications as soon as they are given
What are the components of the nursing process? - CORRECT
ANSWER- ADPIE:
Assessment (collection of data)
Diagnosis (determine key issues)
Planning (formal plan)
Implementation (action)
Evaluation (response to interventions/next steps)
What is the Fundamentals of Care Framework? - CORRECT
ANSWER- - A trusting therapeutic relationship between care recipient
and care provider
- Integrating and meeting a persons' physical, psychosocial and
relational needs
- A context of care that is supportive of relationship development and
care integration
What are the 3 sources of health assessment data? - CORRECT
ANSWER- Primary: Client (best source of information if cognition is
unimpaired)
Secondary: Family members/significant others, health care team, client
chart/medical records
Tertiary: Scientific/medical literature, nurse's experience
Subjective Data - CORRECT ANSWER- Subjective Data: client's
verbal descriptions of their health concerns; obtained through health
history; the individual's own perception of their health; quoting is best
method of documenting; OPQRSTU (onset, provoke/palliate, quality,
region/radiation, severity, timing, understanding); a symptom
Objective Data - CORRECT ANSWER- Objective Data: observations
or measurements of a client's health status; gathered through technical
,measurements/observations by health care practitioner; vital signs, lab
tests, diagnostics; inspect, percuss, palpate, auscultation; a sign
List the 4 skills required for a physical examination - CORRECT
ANSWER- Inspection, Palpation, Percussion, Auscultation
Inspection - CORRECT ANSWER- The use of vision and hearing to
distinguish normal from abnormal findings (concentrated watching)
Palpation - CORRECT ANSWER- Involves the use of the hands to
touch body parts to make sensitive assessments (sense of touch)
Percussion - CORRECT ANSWER- Involves tapping the body with
the fingertips using short, sharp strokes to produce a vibration that
travels through body tissues; character of the sound determines the
location, size, and density of underlying structures to verify abnormalities
assessed by palpation and auscultation
Auscultation - CORRECT ANSWER- Involves listening to sounds the
body makes to detect variations from normal (most sounds will require
the aid of a stethoscope)
What are some of the key fundamentals in a head-to-toe examination?
- CORRECT ANSWER- - Head-to-toe approach includes all body
systems
- Begins by assessing the head and neck structures and progressing
methodically down the body
- Compare both sides of the body for symmetry
- If a patient is seriously ill, first assess the systems of the body more at
risk for abnormalities
- If a patient is fatigued, offer rest periods between assessments
- Perform painful procedures at the end of the examination
- Record assessments in specific terms on a physical assessment form
- Use common/accepted medical abbreviations
- Record quick notes during the examination to minimize time patient is
waiting
, Systematic Assessment Process - CORRECT ANSWER- A method
for collecting data on all body systems (integumentary, ocular, auditory,
respiratory, etc.)
Comprehensive Assessment Process - CORRECT ANSWER-
Includes identifying data, source of health history, reason for interview,
current state of health, developmental variables, psychological variables,
spiritual variables, sociocultural variables, physiological variables, history
of past illnesses/injuries, current medications, and a review of the body
systems
Examination Position and Preparation for Infants - CORRECT
ANSWER- Infants
- For very young, position supine on padded table
- If baby can sit, position on parent's lap
- Prepare examination 1-2 hours after baby has fed
- Maintain a warm environment
Examination Position and Preparation for Toddlers - CORRECT
ANSWER- Toddlers
- Sit on parent's lap
- Enlist parent for aid during invasive procedure
- Toddler can use security object (teddy bear/blanket) to ease anxiety
- Focus most of communication on parent to begin
Examination Position and Preparation for Preschool Age - CORRECT
ANSWER- Preschool Age
- Can be on parent's lap, or on exam table
- Verbal communication is helpful, but use simple terms
Examination Position and Preparation for School Age - CORRECT
ANSWER- School-Age
- Sitting on examination table
- Break ice with small talk
- Children should undress on their own
Examination Position and Preparation for Adolescents - CORRECT
ANSWER- Adolescent
