D439 OA (OA Study Guide) Questions With
Correct Answers
What does ADPIE stand for?
| | | |
Assessment: gather all subjective/objective data
| | | |
Diagnosis: identify nursing problem (ex. Ineffective Breathing Pattern) -
| | | | | | | | |
use PES format, NANDA approved language
| | | | |
Planning: create SMART goals for your patient (specific, measurable,
| | | | | | | | |
attainable, realistic, timely), planning often includes "outcome
| | | | | | |
identification" - be clear on what success looks like for your patient!
| | | | | | | | | | |
Implementation: carry out the plan, nursing actions you take to achieve
| | | | | | | | | | |
goals (ex. administering medications, teaching breathing techniques,
| | | | | | |
repositioning patient) | |
Evaluation: Did the implementation meet goals? Better = document,
| | | | | | | | |
continue monitoring. Worse = start over at assessment.
| | | | | | | |
,What is PES format?
| | |
The PES format is a standardized structure used in nursing to write clear,
| | | | | | | | | | | |
accurate, and evidence-based problem-focused nursing diagnoses. It
| | | | | | | |
stands for Problem, Etiology, and Signs and Symptoms
| | | | | | |
What does SBAR stand for?
| | | |
Situation: identify yourself, the unit, patient (name + DOB), symptoms &
| | | | | | | | | |
severity
|
Background: date/time of admission, admitting diagnosis, relevant
| | | | | | |
history, lab & test results
| | | |
Assessment: suspected underlying cause or concern
| | | | |
Recommendation: How do you fix it? - clear & specific about urgency or | | | | | | | | | | | | |
request + expected time frame
| | | |
When is SBAR used?
| | |
,SBAR is used in communication when giving an update about a patient
| | | | | | | | | | | |
during: hand-offs, shift changes, when the pt. is first
| | | | | | | |
admitted/transferred.
|
What is the FIRST thing a nurse does?
| | | | | | |
Assess
What is the MOST important thing during assessment?
| | | | | | |
Gathering complete, accurate data before acting.
| | | | | |
What should a nurse do if a patient is breathing & not in immediate life-
| | | | | | | | | | | | | |
threatening status? |
Assess
, What 3 things take priority when there is an airway problem or an
| | | | | | | | | | | | |
immediate threat to life? | | |
ABCs - Airway, Breathing, Circulation
| | | |
Who should be notified 1st if the patient has a DNR and is declining?
| | | | | | | | | | | | |
physician
What is Maslow's Hierarchy of needs?
| | | | |
*always need to fulfill the step that comes 1st before moving to the next
| | | | | | | | | | | | |
one
|
Image: What is Maslow's Hierarchy of needs?
| | | | | |
What should be completed first regarding priority: ABCs or Maslow's
| | | | | | | | | |
Hierarchy
ALWAYS use ABCs first (Airway > Breathing > Circulation), then Maslow's
| | | | | | | | | | |
Hierarchy. |
*Airway beats everything. An SpO2 of 87% beats a pain rating of 9/10
| | | | | | | | | | | | |
every time.
| |
Correct Answers
What does ADPIE stand for?
| | | |
Assessment: gather all subjective/objective data
| | | |
Diagnosis: identify nursing problem (ex. Ineffective Breathing Pattern) -
| | | | | | | | |
use PES format, NANDA approved language
| | | | |
Planning: create SMART goals for your patient (specific, measurable,
| | | | | | | | |
attainable, realistic, timely), planning often includes "outcome
| | | | | | |
identification" - be clear on what success looks like for your patient!
| | | | | | | | | | |
Implementation: carry out the plan, nursing actions you take to achieve
| | | | | | | | | | |
goals (ex. administering medications, teaching breathing techniques,
| | | | | | |
repositioning patient) | |
Evaluation: Did the implementation meet goals? Better = document,
| | | | | | | | |
continue monitoring. Worse = start over at assessment.
| | | | | | | |
,What is PES format?
| | |
The PES format is a standardized structure used in nursing to write clear,
| | | | | | | | | | | |
accurate, and evidence-based problem-focused nursing diagnoses. It
| | | | | | | |
stands for Problem, Etiology, and Signs and Symptoms
| | | | | | |
What does SBAR stand for?
| | | |
Situation: identify yourself, the unit, patient (name + DOB), symptoms &
| | | | | | | | | |
severity
|
Background: date/time of admission, admitting diagnosis, relevant
| | | | | | |
history, lab & test results
| | | |
Assessment: suspected underlying cause or concern
| | | | |
Recommendation: How do you fix it? - clear & specific about urgency or | | | | | | | | | | | | |
request + expected time frame
| | | |
When is SBAR used?
| | |
,SBAR is used in communication when giving an update about a patient
| | | | | | | | | | | |
during: hand-offs, shift changes, when the pt. is first
| | | | | | | |
admitted/transferred.
|
What is the FIRST thing a nurse does?
| | | | | | |
Assess
What is the MOST important thing during assessment?
| | | | | | |
Gathering complete, accurate data before acting.
| | | | | |
What should a nurse do if a patient is breathing & not in immediate life-
| | | | | | | | | | | | | |
threatening status? |
Assess
, What 3 things take priority when there is an airway problem or an
| | | | | | | | | | | | |
immediate threat to life? | | |
ABCs - Airway, Breathing, Circulation
| | | |
Who should be notified 1st if the patient has a DNR and is declining?
| | | | | | | | | | | | |
physician
What is Maslow's Hierarchy of needs?
| | | | |
*always need to fulfill the step that comes 1st before moving to the next
| | | | | | | | | | | | |
one
|
Image: What is Maslow's Hierarchy of needs?
| | | | | |
What should be completed first regarding priority: ABCs or Maslow's
| | | | | | | | | |
Hierarchy
ALWAYS use ABCs first (Airway > Breathing > Circulation), then Maslow's
| | | | | | | | | | |
Hierarchy. |
*Airway beats everything. An SpO2 of 87% beats a pain rating of 9/10
| | | | | | | | | | | | |
every time.
| |
