Nurs 230 - exam 1 Questions with complete solutions
The nursing process - definition Correct Answer-- Systematic method that directs the nurse and the patient - patient centered - outcome oriented
- shows what the patient should do to improve their health
The nursing process AND PIE Correct Answer-Assessing - collecting patient data (objective and subjective)
Nursing diagnosis - find out what are the patients current issues and then
what are possible issues we can have (problem, etiology (related to...) define characteristics (as evidence by...)
Planning - develop an individualized plan of care that identifies what the
goals are and interventions we need to do Implement - execute plan of care Evaluate - need to make sure plan of care is working
Maslow's heirarchy Correct Answer-physiologic, safety and security, love and belonging, self - esteem, self- actualization
Top three things you need to deal with Correct Answer-Airway
Breathing Circulation Planning Correct Answer-outcomes must be realistic, measurable and dated (time frame - could be short or long term)
Medical asepsis Correct Answer-- Clean technique - The use of practices to reduce the number, growth and spread of micro - organisms - hand hygiene, changing linens, clean floor, rooms, separate clean from dirty, linens - don't place on floor or shake
5 moments of hand hygiene Correct Answer-1. before touching a patient
2. before clean/ aseptic procedure
3. after body fluid exposure risk
4. after touching a patient
5. after touching patient surroundings
Hand hygiene Correct Answer-Soap and water - when hands visibally soiled, atleast 15 sec
Alcohol based - 3 - 5 ml
Surgical asepsis Correct Answer-- practice to eliminate all micro - organisms from an object or area - avoid coughing, sneezing, talking directly over, do not touch anything sterile without glove, one inch around border considered non- sterile Pathogens Correct Answer-- micro - organisms or microbes that cause infections - bacteria - gram (+/-), rods, spheres, aerobic or anaerobic - most common found infection - viruses - antibiotics not effective; use of antiviral for treatment - fungi - mold, yeast
- prions - protein particles - parasites
Chain of infection Correct Answer-Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host
Stages of infection Correct Answer-Incubation period - organisms growing and multiplying prodromal stage - person is most infectious, vague and nonspecific signs
of disease
Full stage of illness - presence of specific signs and symptoms
Convalescent period - recovery from the infection
Signs of infection Correct Answer-- temp above 98.6
- chills, increased pulse, respiratory rate - redness, edema, warmth, pain
- elevated WBC count - normal = 5,000 to 10,000/ mm3
- elevated erythrocyte sedimentation rate - presence of pathogen in urine, blood, sputum or draining cultures
The nursing process - definition Correct Answer-- Systematic method that directs the nurse and the patient - patient centered - outcome oriented
- shows what the patient should do to improve their health
The nursing process AND PIE Correct Answer-Assessing - collecting patient data (objective and subjective)
Nursing diagnosis - find out what are the patients current issues and then
what are possible issues we can have (problem, etiology (related to...) define characteristics (as evidence by...)
Planning - develop an individualized plan of care that identifies what the
goals are and interventions we need to do Implement - execute plan of care Evaluate - need to make sure plan of care is working
Maslow's heirarchy Correct Answer-physiologic, safety and security, love and belonging, self - esteem, self- actualization
Top three things you need to deal with Correct Answer-Airway
Breathing Circulation Planning Correct Answer-outcomes must be realistic, measurable and dated (time frame - could be short or long term)
Medical asepsis Correct Answer-- Clean technique - The use of practices to reduce the number, growth and spread of micro - organisms - hand hygiene, changing linens, clean floor, rooms, separate clean from dirty, linens - don't place on floor or shake
5 moments of hand hygiene Correct Answer-1. before touching a patient
2. before clean/ aseptic procedure
3. after body fluid exposure risk
4. after touching a patient
5. after touching patient surroundings
Hand hygiene Correct Answer-Soap and water - when hands visibally soiled, atleast 15 sec
Alcohol based - 3 - 5 ml
Surgical asepsis Correct Answer-- practice to eliminate all micro - organisms from an object or area - avoid coughing, sneezing, talking directly over, do not touch anything sterile without glove, one inch around border considered non- sterile Pathogens Correct Answer-- micro - organisms or microbes that cause infections - bacteria - gram (+/-), rods, spheres, aerobic or anaerobic - most common found infection - viruses - antibiotics not effective; use of antiviral for treatment - fungi - mold, yeast
- prions - protein particles - parasites
Chain of infection Correct Answer-Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host
Stages of infection Correct Answer-Incubation period - organisms growing and multiplying prodromal stage - person is most infectious, vague and nonspecific signs
of disease
Full stage of illness - presence of specific signs and symptoms
Convalescent period - recovery from the infection
Signs of infection Correct Answer-- temp above 98.6
- chills, increased pulse, respiratory rate - redness, edema, warmth, pain
- elevated WBC count - normal = 5,000 to 10,000/ mm3
- elevated erythrocyte sedimentation rate - presence of pathogen in urine, blood, sputum or draining cultures
