NSG-300 EXAM 2 WITH CORRECT QUESTIONS AND ANSWERS STUDY GUIDE TEST BANK LATEST UPDATED VERSION 2026 GRADED A+

NSG-300 EXAM 2 WITH CORRECT QUESTIONS AND ANSWERS STUDY GUIDE TEST BANK LATEST UPDATED VERSION 2026 GRADED A+ A patient is admitted to the hospital with shortness of breath. As the nurse assesses this patient, the nurse is using the process of: - Answer ️data collection nursing health history - Answer ️biographical information reason for seeking health care health history spiritual health patient expectations present illness or health concerns family history psychosocial history review of systems documentation of findings The nursing process organizes your approach to delivering nursing care. To provide care to your patients, you will need to incorporate nursing process and: - Answer ️interview process characteristics of body fluids that influence body system function - Answer ️fluid amount (volume), concentration (osmolality), composition (electrolyte concentration), degree of acidity (pH) sensible fluid loss - Answer ️can be measured (includes fluid lost from defecation, urination, and wounds) insensible fluid loss - Answer ️Occurs daily through lungs and skin--cannot be measured for accurate output - Answer ️electrolyte intake and absorption, electrolyte distribution, and electrolyte output what secretes ADH - Answer ️pituitary gland concerning fluid gain - Answer ️2.2lbs A 22-year-old new mother is breastfeeding. You ask her if she is taking the correct quantities of nutrients. what reflects that she understands the dietary guidelines? - Answer ️I am making eating choices according to the recommended dietary allowances." basic metabolic rate - Answer ️Energy needed at rest to maintain life-sustaining activities for a specific amount of time Resting energy expenditure (REE) - Answer ️Amount of energy needed to consume over 24-hour period for the body to maintain internal working activities while at rest where is urine formed in the kidney - Answer ️nephron a health care provider may suspect that a patient is experiencing urinary retention when the patient has - Answer ️small amounts of urine voided two to three times per hour Credes method - Answer ️putting pressure on the suprapubic area and is used for the relief of urinary retention factors affecting bowel elimination - Answer ️age, diet/fluid intake, physical activity, psychological factors, personal habits, position during defecation, pregnancy, surgery/ anesthesia, meds/laxatives/ cathartics, dx tests heat therapy physiological response - Answer ️vasodilation reduced blood viscosity reduced muscle tension increased tissue metabolism increased capillary permeability cold therapy physiological response - Answer ️vasoconstriction local anethesia reduced cell metabolism increased blood viscosity decreased muscle tension hypokalemia - Answer ️-Bilateral muscle weakness that begins in quadriceps and may ascend to respiratory muscles, abdominal distention, decreased bowel sounds, constipation, dysrhythmias -serum K+level below 3.5 mEq/L hyperkalemia - Answer ️-Bilateral muscle weakness in quadriceps, transient abdominal cramps, diarrhea, dysrhythmias, cardiac arrest if severe -Serum K+level above 5 mEq/L hypocalcemia - Answer ️-Numbness and tingling of fingers, toes, and circumoral (around mouth) region, positive Chvostek's sign (contraction of facial muscles when facial nerve is tapped), hyperactive reflexes, muscle twitching and cramping; carpal and pedal spasms, tetany, seizures, laryngospasm, dysrhythmias -Total serum Ca2+level below 9.0 mg/dL hypercalcemia - Answer ️-Anorexia, nausea and vomiting, constipation, fatigue, diminished reflexes, lethargy, decreased level of consciousness, confusion, personality change, cardiac arrest if severe -Total serum Ca2+level above 10.5 mg/dL Hypomagnesemia - Answer ️-Positive Chvostek's sign, hyperactive deep tendon reflexes, muscle cramps and twitching, grimacing, dysphagia, tetany, seizures, insomnia, tachycardia, hypertension, dysrhythmias -Serum Mg2+level below 1.3 mEq/L Hypermagnesemia - Answer ️-Lethargy, hypoactive deep tendon reflexes, bradycardia, hypotension; acute elevation (flushing, warmth sensation); severe acute hypermagnesemia (dec rate and depth of respirations, dysrhythmias, cardiac arrest) -Serum Mg2+level above 2.1 mEq/L risk factors for fluid, electrolyte, and acid-base imbalances - Answer ️age environment: sodium rich diet (ECV excess), electrolyte poor diet, hot weather (clinical dehydration) GI output: diarrhea (ECV deficit, clinical dehydration, hypokalemia, metabolic acidosis), drainage, vomiting -Chronic diseases: cancer, COPD, cirrhosis, heart failure, oliguric renal disease -Trauma: burns, crash injuries, head injuries, hemorrhage -Therapies: diuretics/other meds, IV therapy, calcium products - Answer ️dairy products, green leafy vegetables, soy, nuts, fish (canned sardines and salmon with bones), fortified grains diet for patients with IBS - Answer ️dietary fiber, diet low in fat, avoid large meals, diet low in dairy and sorbitol foods, vitamins and iron supplements how to pack a wound - Answer ️1. Assess size, depth, and shape -Dressing needs to be flexible and in contact with the entire wound surface -Overpacking can cause pressure on the tissue in the wound bed -tx modality is a negative pressure wound therapy or vaccum assisted closure 2. Apply the correct dressing negative colors of poop - Answer ️bright red- bleed in lower GI tract dark red/black-bleed in upper GI tract green- diarrhea yellow-excess fat what places patients at risk for pressure ulcers/impaired skin integrity - Answer ️pressure intensity, pressure duration, tissue tolerance, impaired sensory perception, impaired mobility, alteration in LOC, shear, friction, moisture layers of the skin - Answer ️epidermis, dermis (collagen) body's defenses against infection - Answer ️normal flora, inflammatory response, immune response comprehensive wound assessment - Answer ️-ongoing assessment from time of injury, wound care, any condition changes, and on scheduled basis -Important to include cause of injury, history of wound, treatment, description, response to therapy -Braden scale: assesses risk for pressure/skin injury every shift Braden Scale - Answer ️assesses risk for developing pressure ulcers; includes patient's sensory perception, moisture, activity, mobility, nutrition, friction and shear; the lower the number the higher the risk 9= very high risk 10-12= high risk 13-14= moderate risk 15-18= mild risk 19-23= generally not at risk type 1 ulcers - Answer ️skin is intact but may be red or pink and warm to the touch; no blanching -for POC, there may be no noticeable blanching but skin color may vary type 2 ulcers - Answer ️partial-thickness loss of dermis; shallow broken skin; red-pink wound bed type 3 ulcers - Answer ️full-thickness tissue loss with visible fat (subcutaneous layer); pale-yellow color; may include slough but does not obstruct view of depth of injury type 4 ulcers - Answer ️full-thickness tissue loss with exposed bone, muscle, or tendon. possible tunneling and undermining unstageable pressure ulcer - Answer ️base of ulcer covered by slough and/or eschar in the wound bed so the depth is unknown; exudate; deep tissue injury - Answer ️Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. how should you clean a wound - Answer ️from least to most contaminated eschar - Answer ️black, brown or necrotic tissue in wound bed; needs to be removed before healing slough - Answer ️stringy pale-yellowish tissue that lays in the wound bed; needs to be removed before healing if a patient has slough, eschar, and infectious exudate which one would you be most concerned about - Answer ️infectious exudate factors influencing heat and cold tolerance - Answer ️Exposure time Exposed skin Temperature Age Perception of sensory stimuli assessment for pressure ulcers includes - Answer ️location, staging (depth), type and % of tissue in wound bed, wound dimensions (including tunneling), exudate description (if odor is present), and condition of surrounding skin