Blueprint for Success NUR 130 Exam 1
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,open-ended questions - Answers:open-ended questions (narrative response): gives the
pt discretion about the extent of his or her answers, and does not presuppose a specific
answer. they prompt pt to describe a situation in more than one or two words
What nursing interventions can be done for a patient with dehydration? -
Answers:maintaining intake of fluids prevents dehydration resulting from diaphoresis.
The patients increased metabolic rate requires an adequate nutritional intake, which
maybe provided through IV parenteral nutrition. Rest preserves energy for the healing
process
what ways to assess a patient for dehydration? - Answers:dehydration and edema
increase the rate of skin breakdown in a pt who is immobilized. Can assess the mouth
and check mucous membranes which dry easily, when checking skin turgor if it fails to
reassume its normal contour or shape.
Give examples of the type of patients who would likely be on fluid restriction -
Answers:Kidney disease, heart failure, hyponatremia, cardiopulmonary
interventions for hyperkalemia - Answers:administer IV calcium, obtain specimens for
serum potassium levels every 2 to 4 hours, ensure low-potassium diet
monitoring for hyperkalemia - Answers:serum potassium levels, I&O, signs and
symptoms of hyper and hypokalemia
monitoring for hypokalemia - Answers:monitor cardia, respirations, neuro, GI, urinary
I&O, renal status
interventions for hypokalemia - Answers:Oral/IV potassium supplements, monitor EKG
and ABGs
Foods high in potassium - Answers:fruits, potatoes, instant coffee, molasses, brazil nuts
foods low in potassium - Answers:applesauce
green beans
cabbage
lettuce
peppers
grapes
blueberries
cooked summer squash
cooked turnip greens
pineapple
raspberries
explain how to instruct a patient with diabetes about proper foot care - Answers:assess
skin for redness, abrasions, and open areas daily
, apply lotion to feet daily
clean between toes after bathing
discuss what should be included in the first step of a comprehensive physical
examination - Answers:Develop a plan of care.
The first action the nurse should take using the nursing process is to assess the client
and develop a plan of care. The nursing process follows the steps of assessment,
analysis, planning, implementation, and evaluation.
Explain accountability - Answers:means that you are responsible professionally and
legally for the type and quality of nursing care provided. You must remain current and
competent in nursing and scientific knowledge and technical skills.
Ex: You note that the patient has a fever and the surgical wound has a yellow-green
discharge. You collaborate with other health professionals to develop the best treatment
plan for this patient's surgical wound infection.
Explain responsibility - Answers:is the knowledge that you are accountable for your
decisions, actions, and critical thinking, when caring for patients you are responsible for
correctly performing nursing care activities on the basis of standards of practice
Ex: you do not take shortcuts (e.g., failing to identify a patient, preparing medication
doses for multiple patients at the same time) when administering medications.
discuss interventions for a patient having a seizure - Answers:have an oral airway,
oxygen and suction readily available, keep bed in low position with side rails up. stay
with pt to protect them injuring themselves, observe and time seizure activity
give examples of nursing interventions(autonomy) that do not require a health care
provider's order or prescription - Answers:you independently implement coughing and
deep-breathing exercises for a patient who recently had surgery
Explain the 'planning' step of the nursing process. Give an example - Answers:the nurse
priortizes the nursing dx and identifies goals with specific outcome identification
pt cholesterol levels and high bp so we can suggest pt to be on medication to help lower
these numbers and recommends he exercise at least twice a week
Explain the 'evaluation' step in the nursing process. Give an example. - Answers:during
the evaluation the nurse determines goal attainment , the effectiveness of interventions
and whether the plan of care should be discontinued, continued or revised
ex: give a patient a graph to write down points for their blood sugar levels every day for
a month to see the baseline and when its high/low, this may or may not work for
diabetes patients
what does immobility do to the endocrine system - Answers:disrupts normal metabolic
functioning, decreasing the metabolic rate, altering the metabolism of carbs, fats and
proteins, causing fluid, electrolyte and calcium imbalances, decrease in appetite in
creased BMR as a result of fever or wound healing