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N1 Final Exam Study Guide(1)
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N1 Final Exam NotesQuiz 1
1. In meeting the safety needs of the adolescent client, it would be most important for the nurse
to focus her teaching on:
A. Smoking
B. Sports injury
C. Alcohol abuse
D. Drivers education
2. When implementing the use of restraints on a hospitalized client the nurse should.
a. Restrain all confused clients so they do not sustain a fall injury
b. Tie restraint to bottom of the side rail so the client can’t reach
c. Ensure that the primary care provider renews orders every 24 hours
d. Release and provide skin assessment once every shift
3. A client on the hospital unit has fallen. Place the nursing interventions in order of priority:
A. Identify all witnesses
B. Call the physician
C. Assess and provide urgent care
D. Notify the charge nurse
E. Fill out the incident report
Correct order: C, D, B, A, E
4. A nurse observes smoke coming from under the door of the staff lounge. Which is the priority
action?
a. Extinguish
b. Pull alarm
c. Evacuate the patient
d. Close all open doors on the unit
5 A nurse manager is renewing guidelines to prevent injury with staff nurses. Which of the
following should the nurse manager include in the teaching? (Select all that apply)
A. Request assistance when repositioning a client
B. Avoid a twisting, jerking movement
C. Keep the knees slightly lower
D. Use smooth movements
E. Take a break from negative movements every 2-3 hours to flex and stretch joints and
muscles
Quiz 2
1. The physical assessment technology used during the musculoskeletal assessment
include:
1. Palpation, interview, and auscultation
2. Inspection, palpation, and range of motion
3. Observation, palpation, and auscultation
4. Interview, percussion, and palpation
2) A 50-year-old woman had a surgical repair of a fracture of her right tibia 2 days ago. She has
been using crutches for ambulation and must remain non-weight bearing on her right leg but
must learn to use the steps leading into her house. The nurse should instruct the woman to
,N1 Final Exam Notes
- Lead with the left leg when going up the steps, and lead with the right leg when going
down the steps
3) A client is newly diagnosed with osteoarthritis of her knees and she has told the nurse that
the healthcare provider prescribed acetaminophen and ibuprofen for pain. Client says she can
not afford prescription. The nurse's best response would be.
a. Dr. Cho thinks your pain is only minimal and the cheap medications are a good way to
keep you out of the office.
b. Dr. Cho knows that these medications will help your pain and they are relatively
inexpensive and available over the counter at your local grocery store or pharmacy
c. I’ll call the social worker
d. Dr. Cho knows that these medications are covered by your insurance and you shouldn’t
be worried
4) In assessing a client who has been immobilized because of illness, the nurse would most
likely document the client’s muscles as which of the following?
- Atrophied
5) A nurse is performing health screenings of client’s as a health fair. Which of the following
clients are at risk for osteoporosis? (Select all that apply)
- A 40-year-old client who takes prednisone for asthma
- A 45-year-old client who takes Dilantin for seizures
- A 65-year-old client who has a sedentary lifestyle
- A 70-year-old client who has smoked for 50 years
CLASS NOTED 04-16-18
Osteomalacia—softening of bone---Paget’s disease: affects skull, vertebrae..painful (Tx PAIN)—
Osteomyelitis: infection of bone, long term ABT, PICC/CENTRAL 6ks to months, painful—
Tumors: malignant: primary: 10-30 age secondary: metastatic: occurs in older adults,
metastasized; Osteosarcoma=death—Osteoporosis: most common in postmenopausal women, Ca
loss, reduction of weight bearing activities, decreased estrogen level, loss of bone density; silent
disease; bone mineral density test; 65 yrs and older; first sign in fx back, wrist, hip; vertebrae
become compact (lose ht); supplements (Fosamax, Boniva)-review Fosamax; may develop
kyphosis, COPD,--fibromyalgia: nerve pain, pain stiffness in lower back, chest, exacerbation and
remissions; lack of sleep stress, not eating right, arthritis, worsen with increased activity, hot and
cold weather, diff altitudes, migraine common symptom, bright light, noise; prevent: restful night
sleep, limit stress, eat well, TX with anti inflammatory, Elavil, Cymbalta, gabapentin, lyrica---
Gout deposits in joints, uric acid—primary error in purine levels, common in men—secondary
excessive uric acid in blood any age, medications: diuretics, renal insufficiency, crash diet,
chemo drugs—Allopurinol: acute, maintenance, and for kidney stones—exacerbation of gout:
Colchicine—low purine diet: red & organ meat, shellfish, alcohol, gravies, strong cheeses (pg
331)---Osteoarthritis: DJD-obesity, wear and tear, aging; usually single joint; weight bearing
joints; NSAIDS, lidocaine patches—rheumatoid arthritis: bilateral joints—arthroplasty joint
surgery—arthroscopy: look at joint—Pg 308—osteoarthritis: Mobic or Celebrex—RA: synovial,
autoimmune, exacerbation, upper extremities, bilateral or symmetrical, immunosuppressants,
methotrexate, steroids, stiffness in joints, weak, assistive device to eat, ADLs; exacerbation and
,N1 Final Exam Notes
remission—Lyme disease: trick, pain, bullseye rash, flu like symptoms (doxycycline early)—
dyspnea, dizziness, palpitations, bell's palsy, dysrhythmias (abt at least 30 days-late)
EXAM notes
Sentinel event = loss of life or limb
Look alike/Sound alike medications (Use TallMan lettering)
Sharp end (Active error) direct patient care - pt fell and didn’t do a fall assessment. Amputated
wrong leg, no bed alarm.
Blunt end (Latent error)… documented on the wrong pt
SBAR: one nurse to another, facility, collaboration.
Least invasive to most invasive: Family member to remain with the client, bed alarm, nurses
station, *make sure they have their call bell*,
OD at the home - Call poison control
RACE: rescue, alarm, contain, extinguish. PASS: pull, aim, sweep, spray.
Joint commissions: voice concerns, advocate for themselves.
Just culture/Culture of safety: Done with communication and root-cause analysis
Home safety - alarms (Carbon dioxide and fire), monitors, cabinet locks
Car seat: middle back rear facing till age 2 (Booster seat in middle of back seat, stay in the back
seat until age 13 and must wear seat belt)
Food poisoning - hand hygiene, proper handling, eating out safety, proper storage, store raw food
at the very bottom.
Immunocompromised caution with raw foods and unpasteurized milk
Elderly adult: clutter, rugs, cords, anything that can catch on fire, pets.
Calcium and Phosphorus normal levels (Need to know) Calcium - 8.5-10.5mg/dL, Phosphorus -
2.7-4.5 mg/dL
Know difference between RA and Osteoporosis
Celebrex, mobic, allopurinol, coltrazine (Know these meds)
Medications that increase risk for falls: Narcotics, Diuretics, Anti-anxiety, Anti-psychotics
Preventing falls in adults - Keep active *Basic Nursing Book Chapter 23 (safety)*
Most at risk for age group pg 653 (basic nursing safety chapter)
Most at risk for suffocation: Newborns and infants
Most at risk for accidental injury, drowning, and poisoning: Toddlers
Most at risk for SI and HI: Adolescents
Most at risk for falls, burns, pedestrian and motor vehicle accidents(crashes): Older
Adults
Most at risk for motor vehicle accidents (crashes): Middle Adults
Padding, helmet, knee pads, cord near crib, falling dressers.
Calcium and Vitamin D for healthy bones.
Know low purine diet (Foods you should not eat with Gout)
Alcohol
Fish
Cured meats
90% of hip fractures happen due to falls
Client at the hospital is risk for falls, you should
Clear clutter
Teach to use call bell
, N1 Final Exam Notes
Illuminate pathway
Move them closer to the nurses station
Have someone stay with them
Encourage regular exercise (Weight bearing)
Proper footwear (Non-skid socks)
Assess for LOC, risk for falls/injury
Client at home is risk for falls, you should teach
Client to know surroundings (placement of furniture)
Remove throw rugs
Rails (bars) in the restroom
Shower chair (seat in shower)
Raise toilet seat
Electrical cords behind furniture
Proper lighting
Proper shoes
Bed in lowest position
Clear pathways (remove all clutter)
Client needs restraints, what should you do:
Obtain an order
Chart every hr
Remove restraints every hour (assess skin, circulation, repositioning (aid can do))
Offer food, water, bathroom
Must use quick release knot and two finger space
The Rights of Medication:
Patient
Medication
Dose
Route
Time
Documentation
Education
Assessment
Evaluation
Refusal
Expiration date
Reason response
Complete components of an order:
Generic name
Brand name (When applicable)
Metric dose (Strength)
Frequency
Duration
Route
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