CORE CONCEPTS EXAM 1 BLUEPRINT
QUESTIONS WITH VERIFIED ANSWERS
What is nursing process? - Answer-A way to guide your thinking as a nurse
What should we do for pain? - Answer-AND PIE
Assess:
-How bad is the pain, location of the pain
Nursing Diagnoses:
-Where is the pain the worst
Plan care:
-Set pain goals
Interventions:
-What can we do about it
Evaluate those interventions:
-What did we do? Did it work? Did their pain change? What can we do to make it
better?
Acute vs. Chronic pain - Answer-We assess them the same way: PQRST
Palpation/Provocation, Quality/Quantity, Region/Radiation, Severity, Timing
-How do we treat each?
Opioids mainly acute
NSAIDs mainly chronic
Tolerance, dependence, and addiction are all - Answer-very different
Addiction - Answer-psychological craving for medications you do not need; taking
medications for pain will not end up in addition if the pain is true.
Opioid naive - Answer-people with acute pain do not have much exposure to opioids
Opioid tolerant - Answer-people with chronic pain on opioids; takes a higher dose to
alleviate pain
Initial (Baseline) Assessment - Answer-Time: Performed within a specific time frame
after admission to healthcare agency
Purpose: To establish a complete baseline for problem identification, reference, and
future comparison
Example: Nursing admission assessment
Problem-Focused (for system-specific) Assessment - Answer-Time: Ongoing process
integrated with nursing care
Purpose: To determine the status of a specific problem identified in an earlier
assessment
, Example: Hourly assessment of client's fluid intake and urinary output in an intensive
care unit (ICU); Assessment of client's ability to perform self-care while assisting a client
to bathe
Emergency Assessment - Answer-Time: During any physiological or psychological crisis
Purpose: To identify life-threatening problems to identify new or overlooked problems
Example: Rapid assessment of open airway, breathing status, and circulation during
cardiac arrest; assessment of suicidal tendencies or potential violence
Ongoing Reassessment - Answer-Time: Minutes to months after initial assessment
Purpose: To compare the client's current status to baseline data previously obtained
Example: Reassessment of a client's functional health patterns in a home care or
outpatient setting, or shift assessments at an acute care setting
Physical Examination Order - Answer-Inspect, palpate, percuss, auscultate in that order
EXCEPT in the abdomen: inspect auscultate, palpate, percuss
Inspection - Answer-Begins with the first interaction and continues throughout the exam
using eyes, smell and hearing.
Size, shape color symmetry, and position.
Palpation - Answer-Using fingers to determine size, consistency, texture, temperature,
location and tenderness of an organ or body part.
Feel skin temperature with dorsal side of hand.
Use palmar surface and base of fingers for vibrations.
Fingerprints for pulsation, position, size, texture, and consistency
Percussion - Answer-Tapping patient's skin--produces sound.
Tympanic - hollow fluid-filled.
Auscultation - Answer-Stethoscope to examine bodily sounds
Diaphragm - high-pitched sounds (heart sounds, bowel sounds, lung sounds)
Bell - murmurs, low-pitched sounds
Temperature - Answer-36º to 38º C (98.6º - 100.4º F)
Avg. 37º C (98.6º F)
Respiration - Answer-Newborns: 30 - 60/min
School-age children: 20 - 30/min
Adults: 12 - 20/min
Blood Pressure - Answer-S: 120
D: 80
Pulse/Heart Rate - Answer-Infants: 120 - 160/min
12 to 14 year old children: 80 - 90/min
QUESTIONS WITH VERIFIED ANSWERS
What is nursing process? - Answer-A way to guide your thinking as a nurse
What should we do for pain? - Answer-AND PIE
Assess:
-How bad is the pain, location of the pain
Nursing Diagnoses:
-Where is the pain the worst
Plan care:
-Set pain goals
Interventions:
-What can we do about it
Evaluate those interventions:
-What did we do? Did it work? Did their pain change? What can we do to make it
better?
Acute vs. Chronic pain - Answer-We assess them the same way: PQRST
Palpation/Provocation, Quality/Quantity, Region/Radiation, Severity, Timing
-How do we treat each?
Opioids mainly acute
NSAIDs mainly chronic
Tolerance, dependence, and addiction are all - Answer-very different
Addiction - Answer-psychological craving for medications you do not need; taking
medications for pain will not end up in addition if the pain is true.
Opioid naive - Answer-people with acute pain do not have much exposure to opioids
Opioid tolerant - Answer-people with chronic pain on opioids; takes a higher dose to
alleviate pain
Initial (Baseline) Assessment - Answer-Time: Performed within a specific time frame
after admission to healthcare agency
Purpose: To establish a complete baseline for problem identification, reference, and
future comparison
Example: Nursing admission assessment
Problem-Focused (for system-specific) Assessment - Answer-Time: Ongoing process
integrated with nursing care
Purpose: To determine the status of a specific problem identified in an earlier
assessment
, Example: Hourly assessment of client's fluid intake and urinary output in an intensive
care unit (ICU); Assessment of client's ability to perform self-care while assisting a client
to bathe
Emergency Assessment - Answer-Time: During any physiological or psychological crisis
Purpose: To identify life-threatening problems to identify new or overlooked problems
Example: Rapid assessment of open airway, breathing status, and circulation during
cardiac arrest; assessment of suicidal tendencies or potential violence
Ongoing Reassessment - Answer-Time: Minutes to months after initial assessment
Purpose: To compare the client's current status to baseline data previously obtained
Example: Reassessment of a client's functional health patterns in a home care or
outpatient setting, or shift assessments at an acute care setting
Physical Examination Order - Answer-Inspect, palpate, percuss, auscultate in that order
EXCEPT in the abdomen: inspect auscultate, palpate, percuss
Inspection - Answer-Begins with the first interaction and continues throughout the exam
using eyes, smell and hearing.
Size, shape color symmetry, and position.
Palpation - Answer-Using fingers to determine size, consistency, texture, temperature,
location and tenderness of an organ or body part.
Feel skin temperature with dorsal side of hand.
Use palmar surface and base of fingers for vibrations.
Fingerprints for pulsation, position, size, texture, and consistency
Percussion - Answer-Tapping patient's skin--produces sound.
Tympanic - hollow fluid-filled.
Auscultation - Answer-Stethoscope to examine bodily sounds
Diaphragm - high-pitched sounds (heart sounds, bowel sounds, lung sounds)
Bell - murmurs, low-pitched sounds
Temperature - Answer-36º to 38º C (98.6º - 100.4º F)
Avg. 37º C (98.6º F)
Respiration - Answer-Newborns: 30 - 60/min
School-age children: 20 - 30/min
Adults: 12 - 20/min
Blood Pressure - Answer-S: 120
D: 80
Pulse/Heart Rate - Answer-Infants: 120 - 160/min
12 to 14 year old children: 80 - 90/min
