NU 325 Final Exam Questions And
Already Passed Answers.
medical dx - Answer only made by doctors
nursing dx - Answer used to evaluate the response of the whole person to actual or potential health
problems
nursing process - Answer - iterative process allowing practitioners to move back and forth while caring
for the needs of complex pts.
- Includes six phases: assessment, diagnosis, outcome identification, planning, implementation,
evaluation
"A Delicious Orange PIE" - Answer Assessment- collect data
Diagnosis- interpret data
Outcome identification- identify the expected outcomes
Planning
Implementation- doing what you planned
Evaluation- was the outcome we wanted achieved?
inspection phase - Answer concentrated watching. Checking for abnormalities before continuing.
Inspection begins the moment you first meet a person and develop a "general survey"
purpose of percussion - Answer - mapping out the location and size of an organ by exploring where the
percussion note changes b/n the borders of an organ and its neighbors
- signaling the density (air, fluid, or solid) of a structure by a characteristic note
- detecting an abnormal mass if its fairly superficial; the percussion vibrations penetrate a/b 5 cm deep---
a deeper mass would give no change in percussion
- eliciting a deep tendon reflex using the percussion hammer
,diaphragm - Answer used for high-pitched sounds → breath, bowel, and normal heart sounds. Hold the
diaphragm firmly a/g the person's skin, firm enough to leave a slight ring afterwards
bell - Answer used for soft,low-pitched sounds such as extra heart sounds or murmurs. Hold it lightly
a/g the person's skin, just enough that it forms a perfect seal
1st level priorities - Answer emergent, life threatening
airway, breathing, circulation, vital signs
2nd level priorities - Answer requires prompt intervention to forestall further deterioration
acute pain, mental status change, abnormal labs, risk of infection
3rd level priorities - Answer those that are important to the pt's health but can be addressed after
more urgent problems. Interventions to treat these problems are more long term, and the response to
treatment is expected to take more time
subjective data - Answer what the pt says, biased
objective data - Answer unbiased, what the pt cannot see, labs
how do you prioritize patient problems/diagnosis? - Answer airway → breathing → circulation →
perfusion
spirituality - Answer broader term focused on a connection to something larger than oneself and a
belief in transcendence
religion - Answer organized system of beliefs concerning the cause, nature, and purpose of the
universe, as well as the attendance of regular services
role of nurse with DM - Answer for neglect in the elderly and children, report your suspicions to the
proper authorities. No evidence is needed, when in doubt, REPORT
, BMI - Answer weight (lbs.) / height (in.) * 703
- normal = 18.5-24.9
- <18.8 → underweight
- want to be less than 25 > 30 = obese
negative effects on elderly nutritional status - Answer lack of taste, medications, teeth issues,
decreased GI motility, decrease visual acuity, decreased saliva production
how long would you monitor a heart rate if it is irregular - Answer 1 full minute
proper way to take a BP - Answer palpate pulse in radial artery,
Let air out 2-4 mmHg/second.
Listen for first and last sounds, Pt shouldn't cross legs, chew gum, drink caffeine, etc in the past 30
minutes or smoked in the past 5 minutes.
best indicator of pain - Answer pt report of pain, subjective data
systolic number (top #) - Answer indicates how much pressure your blood is exerting a/g your artery
walls when the heart beats
diastolic number (bottom #) - Answer indicates how much pressure your blood is exerting a/g your
artery walls while the heart is resting b/n beats
uvula - Answer rises on phonation, midline to soft palate, CN 9 (glossopharyngeal)
frenulum - Answer midline fold of tissue that connects the tongue to the floor of the mouth
strabismus - Answer a disorder in which the eyes don't look in the same direction at the same time;
"cross eyed"