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VNSG 1423 EX2 || All Questions Answered Correctly.

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Protect patients from injury by assessing & controlling the bathwater temperature. correct answers Especially important for elderly &others patients with reduced sensation Locate the site for deltoid injection. correct answers 2-3 finger widths below the acromion process, axilla as lower lan...

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VNSG 1423 EX2 || All Questions Answered Correctly.
Protect patients from injury by assessing & controlling
the bathwater temperature. correct answers Especially important for elderly &others patients
with reduced sensation

Locate the site for deltoid injection. correct answers 2-3 finger widths below the acromion
process, axilla as lower landmark

Asepsis (making bed) III

rational to prevent skin breakdown and infection correct answers Wrinkles left in linen can pose
a potential in immobilized/debilitated(=weaken) patients.

Asepsis (making bed) IV

· never leave patient on soiled linen. correct answers => ð it contribute to physical issues
=> ð the psychological implications.

Locate the site for the Vastus Lateralis correct answers Greater trochanter, lateral femoral
condyle and administer in middle third.

Locate the site for the Rectus femoris correct answers Anterior superior iliac spine and the
patella with administration in the middle third.

Location of Ventrogluteal injection site. correct answers Greater trochanter,
first finger toward the anterior superior iliac spine and fingers pointed upward toward the iliac
crest.

Inches for rectal suppository in an adult correct answers 4 inches

Inches for rectal suppository in a child correct answers 2 inches

Length of time for patient to hold breath after inhaler. correct answers 10 seconds

Area in eye where pressure is applied for 30-60 seconds. correct answers Nasolacrimal duct

The purpose of applying pressure to the nasolacrimal duct. correct answers To prevent systemic
absorption of medication.

Contraindications to
rectal suppository. correct answers Rectal Bleeding,
prostate(전립선) perineal surgery,
fecal impaction,
rectal prolapse(직장탈)
low platelet count,

,lack of consent, diarrhea.

Example of
a systemic effect of a suppository. correct answers Anti-pyretic
as in Tylenol.

Example of
a local effect from a suppository. correct answers Dulcolax (bisacodyl)
for constipation.

Distance for a vaginal suppository. correct answers 3-4 inches

Distance for a vaginal cream correct answers 2-3 inches

Maximum amount for
an IM (intramuscular) injection. correct answers 3mL

Maximum amount for
an IM injection in the deltoid. correct answers in the DELTOID 1mL

Maximum amount for
a subcutaneous injection. correct answers SQ : 1mL

Degree of angle for IM injections. correct answers 90 degrees

Degree of angle for SQ injections for one inch. correct answers 45 degrees

Degree of angle for SQ injections for two inches or more. correct answers 90 degrees

Which subcutaneous injection site has the greatest absorption? correct answers Abdomen

Why is the dorsogluteal
no longer used? correct answers Risk of damage to the sciatic nerve.

Identify factors that increase the rate of absorption of a topical patch? correct answers Use of a
heating pad,
fever
open areas

Gauge range for subcutaneous injections. correct answers 25-28;
30 for insulin

Gauge range for IM injections. correct answers 20-23;
25 for smaller framed persons

Identify two (2) High Alert medication correct answers Insulin & Heparin

,Identify one (1) rapid-acting (fast-acting) insulin correct answers Novolog
Humalog

What is the onset of action for rapid (fast) acting insulins? correct answers 15 minutes

Name one (1) short-acting insulin. correct answers Regular

What is specific about Regular insulin? correct answers It is the only one that can be
administered IV.

Identify one (1) intermediate insulin. correct answers NPH

What is the onset of action for NPH insulin? correct answers 2-4 hours

What is the onset of action for a basal-acting insulin? correct answers 1-2 hours

Identify two (2) basal-acting insulins. correct answers Lantus

Levemir

What is a potential effect from oral inhalation of corticosteroid inhalers? correct answers
Development of
oral candida (thrush).

What is a potential complication from repeated site injection of insulin? correct answers
Lipodystrophy

Why is the umbilicus avoided? correct answers A highly vascular area.

What are the landmarks for insulin administration? correct answers Two (2) inches away from
the umbilicus,
above the level of the iliac crest
below the costal margins.

What are the landmarks for Lovenox administration? correct answers Two (2) inches away from
the umbilicus
above the level of the iliac crest.

Identify one (1) medication that cannot be crushed. correct answers ER (Extended release)

EC (enteric coated).

use a mild cleansing agent that minimizes friction.
@ especially over bony prominences. correct answers Avoid use of friction&force,
Avoid massaging.

, Therapeutic bath - sitz bath I
perineal & anal areas
Diaphoresis ( 발한) correct answers cleanses & reduces pain & inflammation

Therapeutic bath - sitz bath II
Diaphoresis ( 발한) correct answers Used for a patient
who has undergone rectal/ perineal surgery
childbirth
has local irritation from hemorrhoids(piles 치질), fissures(크게 갈라진 틈).

***neuropathy : disease or dysfunction of one or more peripheral nerves, typically causing
numbness or weakness correct answers peripheral neuropathy
(i.e.. Diabetic patients)
spinal cord injuries
(where there may be decreased sensation).

Patients who are unable to communicate discomfort. correct answers Use bath time as a time to
communicate with the patient and assess the patient's skin.

Perform a complete physical assessment of the integument during this (BATH) time. correct
answers Assist the patient through ROM during the bathing process.
=> Consider patient's activity tolerance.

Skin assessment:

*intact healthy skin is the body's primary defense. correct answers T - Texture (tugor)
W- Temperature
I - Integrity
C- Color
E- edem

The nails can be filed or cut across taking care
NOT to cut on the LATERAL sides correct answers - as this may predispose the patient to
develop ingrown nails.
- The nurse will clean beneath the nails to remove any debris.

For those patients with, a podiatrist will be the one to provide nail care. correct answers · DM
(diabetes)
· PVD (peripheral vesicular disease)
· long-term steroid therapy
·anticoagulation therapy,

In shaving a patient, it is important to know if the patient is taking
<Anticoagulant>
· Coumadin

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