NURSING FINAL EXAM VERIFIED A+ study guide

NURSING FINAL EXAM R R




HowRcanRyouRes mateRaRclient'sR dalRvolume?R-
RTidalRvolumeRcanRbeRes matedRbyRobservingRtheRdepthRofRtheRclient'sRrespira ons.




WhatRisRtheRrangeRofRnormalRforRanRadult'sRrespiratoryRrate?R-
RARrateRofR12RtoR20RbreathsRperRminuteRisRnormalRforRadults




BesidesRtheRrate,RwhatRotherRcharacteris csRofRaRclient'sRrespira onsRshouldRyouRobserve?R-
RDepth,Rrhythm,Reffort,RbreathRsounds,RandRchestRmovementRshouldRbeRobservedRinRaddi onRtoRrate.




WhatRareRsomeRcommonRclinicalRsignsRassociatedRwithRpoorRoxygena on?R-
RPallorRorRcyanosisRofRtheRnails,Rlips,RorRskin;Rrestlessness;Rapprehension;Rconfusion;Rdizziness;Rfa gue;Rcha

ngesRinRpulseRandRbloodRpressure;RandRdecreasedRlevelRofRconsciousnessRareRassociatedRwithRpoorRoxygen
a on.



WhichRofRtheRKorotkoffRsoundsRwouldRyouRrecordRasRtheRsystolicRpressure?R-RFirst



WhichRofRtheRKorotkoffRsoundsRwouldRyouRrecordRasRtheRdiastolicRpressure?R-RFi h



ARnurseRisRausculta ngRaRBP.RHeRhearsRtheRfirstRsoundRatR170RmmRHg.RTheRsoundRdisappearsRimmediately.R
AtR150RmmRHg,RtheRsoundRappearsRagainRandRcon nuesRun lRthereRisRsilenceRatR80RmmRHg.RTheRpressures
RwereRtakenRinRtheRclient'sRrightRarmRwhileRtheRclientRwasRlyingRdown.


R



HowRshouldRtheRnurseRrecordRtheseRpressures?R-
RBPRRA,Rsupine,R170/80RwithRanRauscultatoryRgapRfromR170RtoR150




HowRdoRyouRexplainRwhatRhappened?R-
RAnRauscultatoryRgapRoccurred.RARgapRisRmostRcommonlyRheardRinRhypertensiveRclients,RwhoseRsystolicRblo

odRpressureRisRhigherRthanRtheRadultRnormalRlimitRofR140RmmRHg.



WhichRofRtheRfollowingRpa entsRhasRhypertension?ROneRwithRaRBPRof:

,150/80RonRtwoRseparateRoccasions

180/100RonRoneRoccasion

138/88RonRtwoRoccasionsR-R150/80RonRtwoRseparateRoccasions



WhichRofRtheRfollowingRclient(s)Rhas/haveRprimaryRhypertension?

ClientRA,RwhoRisRobeseRandRhasRaRhighRsodiumRintake

ClientRB,RwhoRisRinRrenalRfailure

ClientRC,RwhoRhasRhypertensionRinducedRbyRpregnancy

ClientRD,RwhoRhasRaRfamilyRhistoryRofRhypertensionR-RClientRD,RwhoRhasRaRfamilyRhistoryRofRhypertension



WhatRareRfiveRfunc onsRofRtheRskin?R-
RTheRskinRservesRfiveRfunc ons:Rprotec on,Rsensa on,RtemperatureRregula on,Rsecre on/excre on,RandRf

orma onRofRvitaminRD.



HowRdoesRtheRskinRhelpRregulateRbodyRtemperature?R-
RTheRskinRcontainsRsensoryRorgansRorRreceptorsRforRheatRandRcold.RTheRskinRregulatesRtemperatureRthroug

hRtheRprocessRofRdila ngRandRconstric ngRbloodRvesselsRandRac va ngRorRinac va ngRsweatRglands.RTheRs
weatRglandsRfoundRinRtheRaxillaeRandRexternalRgenitaliaRsecreteRfa yRacidsRandRproteinsRandRexcreteRpersp
ira on,RwhichRproducesRaRcoolingReffectRasRtheRmoistureRevaporatesRfromRtheRskin.



WhatRchangesRtakeRplaceRinRtheRskinRasRaRpersonRagesR-
RWithRage,RbothRlayersRofRtheRskinRbecomeRthinnerRandRmoreRfragile.RAsRcollagenRandRelas nRfibersRinRtheR

dermisRdeteriorate,RtheRskinRbecomesRwrinkled.RSebaceousRandRsweatRglandRac vityRdecreases,RcausingRt
heRskinRtoRbecomeRdry,Rscaly,RandRitchy,RandRtemperatureRregula onRinRhotRweatherRbecomesRmoreRdiffic
ult.RAsRtheRnumberRandRac vityRofRhairRfolliclesRandRpigmentRcellsR(melanocytes)Rdiminishes,RhairRbecome
sRthin,RturnsRgrayRorRwhite,RandRgrowsRmoreRslowly.RNailsRthickenRandRgrowthRdecreases.RTheseRchangesRi
ncreaseRtheRriskRforRskinRproblems.



TrueRorRfalse:RTheRprofessionalRnurseRisRresponsibleRforRmakingRassessments.R-RTrue



TrueRorRfalse:RAssis ngRwithRtheRbathRisRanRexcellentR meRtoRassessRtheRpa ent.R-RTrue

, ToRinspectRforRpallorRinRaRdark-
skinnedRperson,RwhichRareasRwouldRyouRassessRforRanRashenRgrayRorRyellowRcolor?R-RForRdark-
skinnedRpersons,RtheRconjunc vae,RbuccalRmucosa,Rtongue,Rlips,RnailRbeds,Rpalms,RandRsolesRshouldRbeRas
sessedRforRpallor.



WhatRisRtheRtermRthatRmeansR"aRbluishRcolorRofRtheRskin"?R-
RCyanosisRmeansRaRbluishRdiscolora onRofRtheRskin.




NameRtwoRcausesRofRerythema.R-RVasodila onRandRinflamma onRareRcausesRofRerythema.



WhereRcanRyouRbestRseeRjaundice?R-RTheRscleraRofRtheReyesRisRtheRbestRplaceRtoRseeRjaundice



TrueRorRfalse:RHealthyRnailsRareRusuallyRclean,Rsmooth,RandRconvexlyRcurvedR-RTrue



ListRatRleastRthreeRnailRchangesRthatRoccurRwithRaging.R-
RAsRaRpersonRages,RtheRnailsRthicken,RbecomeRridged,RandRmayRyellowRorRbecomeRconcaveRinRshape.




ListRatRleastRfourRthingsRyouRshouldRteachRclientsRaboutRself-careRofRtheirRnails.R-RAnswer:

ClientsRshouldRbeRtaughtRtheRfollowingRself-careRofRtheirRnails:

●RInspectRtheRnailsRdaily.

●RTrimRnailsRwithRaRnailRclipperR(peopleRwithRdiabetesRorRcirculatoryRproblemsRshouldRfileRonly,RasRcu ngR
posesRaRriskRforRinjuryRtoRtheR ssues).

●RFileRtheRnailsRstraightRacross,RroundingRtheRcornersRslightlyRtoRpreventRscratching;RdoRnotRcutRdeeplyRint
oRtheRlateralRcorners,RasRthisRmayRcauseRingrownRnails.

●RRemoveRhangnailsRbyRcarefullyRcu ngRthemRoff.

●RCleanRunderRtheRnailsRwithRanRorangewoodRs ckRorRotherRbluntRinstrument.

●RPushRbackRtheRcu clesRgently.

●RUseRaRmoisturizingRlo onRtoRso enRcu cles.

●RAvoidRbi ngRnails.

●RConsultRaRpodiatristRforRanyRingrownRtoenailsRorRotherRnailRproblems.

●RRecommendRtoRpa entsRwithRdiabetes,RcirculatoryRinsufficiency,RorRnailRproblemsRthatRtheyRseekRnailRca
reRfromRaRpodiatrist.