NRSG 100 - Fundamentals of Nursing Questions with Complete Solutions
Functioning as an essential member of interprofessional healthcare team Correct Answer-works collaboratively to provide holistic care
Importance of standards of practice Correct Answer-- define and direct level of care nurses should give (and will tattle on those who don't) - should refuse to practice outside scope of practice - defined by each state, ANA, healthcare facilities policies and procedures
- uses evidence-based research to make sure techniques are current
The actions of developing a plan of care for a client (Planning, Assessing, Implementing, Evaluation) Correct Answer-Not a linear process - can be cycle or go step to step
- Assessment: gathering data about the patient and their health status to identify needs - collect/validate/organize/record data - initial, ongoing, comprehensive, special needs, focused
- Diagnosis: using critical thinking skills the nurse analyzes the assessment data to identify patterns in the data and draw conclusions about the client's health status (strengths, problems, factors contributing to the problems)
- Planning (Outcomes/Interventions): initial, ongoing, and discharge (needs to be started at initial assessment) - identify goals/outcomes and creates a care plan with realistic goals - Implementation: doing delegating, and documenting - tied into every stage (Delegation: RN = EATUN, LPN = RRR, UAP = VAPER) - Evaluation: planned, ongoing, systematic activity making judgements about client's progress to desired outcomes, effectiveness of care plan, quality of nursing care
Wheelchair, Walker, and Cafe Safety Correct Answer-- Wheelchair: lock the wheels, ensure foot pedals are put into the middle so the patient doesn't drag their feet on the floor
- Walker: height is inside of wrist: elbow flexed at 15-30: pick up the walker when advancing it: stand between the back legs of the walker. Move WEAK leg with walker
- Cane: STRONGER side holds cane: move cane 1st then weak side 2nd.
Go Up with Good and Down with Bad
ROM - type of movements Correct Answer-Active/passive: helps maintain joint mobility and muscle strength
- flexion/extension, adduction/abduction, supination/pronation, circumduction/rotation, inversion/eversion, dorsiflexion/plantarflexion
Positioning Correct Answer-- Goals = promotion and prevention
- Fowlers (respiratory distress/feeding): semi/high
- Supine (sleep/surgery/catheter insertion): on back (dorsal recumbent)
- Prone (unconscious/spinal procedure): on stomach
- Sims (enemas/rectal suppositories): on side with leg over body
- Trendelenburg (poor circulation/abdominal surgeries/raise BP): head angled down - Reverse Trendelenburg (GI Issues/reflux/abdominal surgeries): feet angled down
- Lateral (comfort/relieve pressure): on side
- Lithotomy (pelvic exam/hemorrhoids): sitrrups
- Orthopneic (epidural/SOB): 90 degrees over bedside table
Mobility Correct Answer-body movement: freedom and independence in
purposeful movement
- Factors Affecting: developmental stage, lifestyle, environmental, disease and abnormalities, poor posture, health status, age - Nursing goal: assist in preserving, maintaining, and restoring as much mobility and function as possible
Patient Safety (Factors, Restraints, Safety Hazards) Correct Answer-1st line of keeping the patient safe = communication
- Factors Affecting: developmental, lifestyle, cognition, sensor perceptual status, impaired communication, mobility status, physical and
emotional health, safety awareness
- Restraints (chemical/environmental/mechanical): restricts pt's freedom of movement: need to have prescription reassessed every day and need to be checked every 30 minutes
- Home = poisoning, CO2, burns, guns, fires, drowning
- Community = car accidents, pathogens, weather
- Healthcare Facility = culture, quality nurse
- Patient Safety Events: unexpected event or circumstance that occurred without injury to patient