nur 310 exam 1 Questions With Complete Solutions
+1= Correct Answer a weak, thready, diminished pulse
+2= Correct Answer a normal, brisk pulse
+3= Correct Answer an increased, strong pulse
+4= Correct Answer a bounding, full volume pulse
0= Correct Answer absent, impapable pulse
1. assessment Correct Answer gathers information through
interview, physical exam, and observation
subjective vs. objective data
1. idenify Correct Answer state team members name and title
1. infection control Correct Answer uses standard precautions
during physical assessment and should be implemented with all
clients
1. inspection Correct Answer start with a general survey from
head to toe then observe for symmetry, skin for bruises, wounds,
rashes, shape of chest, and inspect and observe affect and mood
of client
1. introduction/opening Correct Answer Begin the interview by
addressing the person using their surname and offering a
handshake, if appropriate. Then, introduce yourself, stating your
role within the agency, and provide the reason for the interview
,1. personal factors Correct Answer being self aware, nurse is
there for client and not to share personal stories or comparison.
maintain professionalism. do not impose your own values on
others.
1. physical privacy Correct Answer exam room should be
quiet, curtain pulled, make sure client is covered when not
getting inspected so client doesn't feel vulernable
be aware of religous, cultural, gender idenity, and personal
preferences when providing care
1. right task Correct Answer The task being delegated must be
within the job description of the delegatee. Expectations and
limitations of the task should also be clearly outlined in the
policies and procedures of the facility
2. diagnosis/analysis Correct Answer analyze data and develop
plan of care, identifying the actual and potential problems
2. hand hygiene Correct Answer CDC and WHO recommend
hand hygiene as the first line of defense to decrease nonsocimal
infections (hospital acquired)
no nail polish, long finger nails.
hand hygiene standards include washing for 15-30 sec and using
friction on both sides
done before/after all client contact, invasive procedures, removal
of gloves, and contact with client items or surfaces
,2. palpation Correct Answer touch to assess for findings as
texture, temperature, moisture, tenderness, and edema
begin with light palpation then deep
2. personal privacy Correct Answer identify client, could be
through asking, bracelet
identify the clients assigned sex at birth and gender identify
always adress client by their surname
2. right circumstance Correct Answer The nurse should ensure
that the client's condition is stable. The delegatee must also
communicate any changes in the client's condition.
2. situation Correct Answer provide the circumstates that have
required the communication to occur
2. therapeutic communication Correct Answer both verbal and
nonverbal. introduce yourself and state title, focus on the person
not the problem. do not disapprove of clients statements or
health practices
2. working phase Correct Answer asking a simple, open-ended
question and then allowing the person to proceed however they
wish. The workingphase is the data-gathering phase of the
interview, and often involves the nurse using therapeutic
communication techniques to collect client data using a
combination of open-ended and closed questions.
3. background Correct Answer provide the background data
regarding the client to assist to provider with familiarity
, 3. closing phase Correct Answer Simply thank
the client for their participation, answer any questions, and
summarize the collected
information. Avoid an abrupt or awkward closing, as this can
destroy rapport and
leave the client with a negative impression of the interaction.
3. mandated reporting Correct Answer if observe any type of
abuse, required by law to report it.
can involve a child, adult, dependent adult, older adult
document verbatim what client says and what you observe,
including lassertions, bruises, cuts, burns, stabs
3. Percussion Correct Answer vibrations are produced through
tapping of skin which help determine the density of the area
whether its fluid or air filled, or solid
3. planning Correct Answer nurse uses problem solving and
decision making skills to prioritize care
which fire is the strongest
first level priority
second level priority
third level priority
3. PPE Correct Answer includes goggles, gowns, masks, gloves
all serve as a purpose against infections
3. right person Correct Answer The delegatee must have the
ability and knowledge to perform the task.
