What is the nursing process? correct answers An ongoing systematic problem solving approach
What are the five steps of the nursing process? correct answers -Assessment
-Diagnosis
-Planning
-Implementation
-Evaluation
HIPPA correct answers -Health insurance portability and accountability act
-A law that restricts assess to patients medical records and information
Standard precautions correct answers -A set of precautions by the CDC
-In order to minimize the risk of catching and spreading infections
Universal precautions correct answers -The practice of avoiding contact with patients' bodily
fluids
-Nonporous articles such as medical gloves, goggles, and face shields
Recommended guidelines under universal precautions correct answers -Wearing gloves when
collecting or handling blood and body fluids contaminated with blood
-Wearing face shields when there is danger of blood splashing on mucous membranes
-Disposing all needles and sharp objects in puncture-resistant containers
Universal precautions should not be confused with _______ precautions which goes _______
universal precautions correct answers -Standard
-Beyond
,Standard precautions must be observed with _______ ________ at _______ ________,
regardless of their age, gender, diagnosis, or whether they are under isolation for a specific
disease correct answers -All patients
-All times
Standard precautions (3) correct answers -Wear gloves when touching blood, body fluids,
secretions, excretions, and contaminated items.
-Put on clean gloves just before touching a patient's mucous membranes and non-intact skin
-Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items,
whether or not gloves had been worn.
What is the most important measure for preventing the spread of pathogens? correct answers
Effective hand washing
First step in washing hands correct answers Wet your hands with WARM, running water and
apply liquid soap (dime size) or use clean bar soap
Second step in washing hands correct answers Rub your hands vigorously together for at lest 15
to 20 seconds
How high on the wrist should you scrub? correct answers 2 inches high
Step three of washing hands correct answers Rinse well
Step four of washing hands correct answers Dry your hands with a clean/disposable towel
Step five of washing hands correct answers Use a new, clean, dry towel to turn off the faucet
,Subjective data correct answers -Comes from what the client states
-Example: client states no past surgeries
Objective data correct answers -Comes from your own observations and medical records
-Example: 12 cm scar at on right knee
Methods of validation correct answers -Recheck
-Clarify
-Verify (verify with previous records or have another clinician check)
-Compare
What do you do once you have finished assessing? correct answers Fill in the holes of the
assessment and document
Culture correct answers The values, beliefs, and norms of a particular group that guides their
thinking, decisions, and actions
Values correct answers -Provide the foundation for beliefs, attitudes, and behaviors
-More difficult to assess than culture
Beliefs correct answers Opinions, knowledge, and faith concerning various aspects of the world
Customs correct answers -Learned behaviors
-Easily assessed by direct observation and questioning
Euro-American correct answers -Very time conscious
-Arm's length distance while communicating
-Speaks directly and maintains eye contact
, -Productive, prefer action over inaction
-Measure accomplishments by external standards
African-American correct answers -Time orientation is not strict
-Present oriented instead of future
-Avoids eye contact
-May use jargon or slang
-Self-Care and Folk Medicine very prevalent
-Attempts home remedies first
Latin-American (hispanic) correct answers -Very modest
-Time orientation not strict
-Don't like to be questioned
-Politeness is a sign of respect
-Tends to express emotions openly
-Tends to have a fatalistic outlook on life
-Illness is an imbalance between Hot and Cold
Asian-American correct answers -Privacy, No expression of emotions
-Unlikely to complain about problems
-Physical contact not acceptable
-Do not react well to painful diagnostic work-up
-Goal of therapy is to restore balance of Yin and Yang
Native American correct answers -Respect of the body
-Present oriented
-Respect for the elderly