Exam (elaborations)
Med Surg Final Exam 1 - LPN GRADED A
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Med Surg Final Exam 1 - LPN Med Surg Final Exam 1 - LPN Med Surg Final Exam 1 - LPN
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Med Surg Final Exam 1 - LPNfourth degree burn - verified answer burn in which full thickness of the skin and underlying muscle
and bone is damaged
color varies
visible charred in deepest areas
extremity movement limited
insensate
respiratory issues in burn pts - verified answer watch for -
increasing restlessnes
coughing
hoarseness
rapid shallow respirations
stridor (high-pitched wheeze)
falling o2 levels
contractures in burn pt - verified answer always a concern, tighness of the muscles or ligaments
-proper positioning
-regular excercise
-must be excercise and stretched every day
Roles and functions of the LPN - verified answer - caretaker
- educator
- collaborator
- advocate
- leader and delegator
- promote health and prevent disease
- provide comfort measures
,- assist to make decisions
- manage client care
- act as a resource person
- use resources in a cost effective manner
-
5 rights of delegation - verified answer right task
right circumstance
right person
right direction/communication
right supervision/evaluation
QSEN 5 competences - verified answer - provide pt centered care
- collaborate
- Implement evidence based practice
- use quality improvement
- use informatics
Factors that influence critical thinking - verified answer attitude, communication skills, problem
solving
characteristics of a critical thinker - verified answer *maintains and open mind and questioning
attitude
*recognizes own biases and limitations
*separates relevant info form irrelevant
*identifies missing info
*considers all possibilities
*admits what they do not know
*reasons logically
*strives for excellence
*draws valid conclusions from evidence and data
*sets priorities and makes careful decisions
,*is flexible, creative, humble, honest, curious, and insightful
*admits what they do not know
clinical judgement - verified answer refers to the result (outcome) of critical thinking or clinical
reasoning; the conclusion, decision, or opinion a nurse makes
Data collection in the nursing process - verified answer - LPN may be asked to assist with initial
admission assessment which is the RN responsiblity
- LPN is responsible for ongoing assessment
- LPN systemically gather and review data
- determine whether there is a present life-threatening problem that needs addressing and act
appropriately
ADPIE - Diagnosis - LPN and medsurg - verified answer -LPN reports data collection findings to the RN
and assists in verifying, categorizing, and grouping the data in logical order
- the LPN also assist in analyzing the data to determine significant relationships among data, pt
needs, and problems
Planning (nursing process) - LPN and medsurg - verified answer SMART goals (Specific, Measurable,
Attainable, Realistic, Timely)
assist the RN in the developement of expected outcomes and interventions for a patients plan of
care
Implementation in the nursing process - verified answer provide planned nursing care to accomplish
expected outcomes of nursing
- distinguish with activities you need to carry out and which ones the pt must learn to do to gain
independence
Evaluation in the nursing process - verified answer compare actual outcomes of nursing care to
expected outcomes and assist with update the nursing care plan
Sources and information for the database - verified answer *admission form if applicable
, --- reason for admission, allergies, home medications, etc.
* If the pt has been hospitalized in the past
*medical diagnosis
*preliminary lab work
*imaging studies
*chief complaint
*level of pain
*last bowel movement
*problems with urination, eating, or difficulty sleeping
*secondary sources of info from family
Inspection - verified answer - facial expression
-posture
-grimaces
-movements
-hair, skin, nails
- oral mucus membranes and teeth
- clean
-evidence of a support system
congruent - verified answer match the feeling tone of what is said verbally
olfaction - smelling - verified answer -sweet fruity scent of acetone can indicate diabtetic acidosis
-the smell of newly mown clovers can be present with hepatic coma
- the smell of alcohol
------ smells like aftershave, mouthwash, vanilla, sterno, or other strong odors
-foul or metallic mouth usually means bad oral hygiene
focused assessment - verified answer -usually done daily at beginning of shift
- is directed to areas in which the pt is experiencing health problems
- based on identified problems, data from the report, and medical diagnosis
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