NUR 195 exam 1,2&3 (weeks 5-6) questions with 100% correct answers 2024, Exams of Nursing

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NUR 195 exam 1,2&3 (weeks 5-6) questions with

100% correct answers 2024

5 rights of delegation

• Right task: Per policy, OBN law, stability of PT, training of STNA
• Right circumstance: Stable? Unstable? Do not delegate unstable
• Right person: Who is willing? Trained properly?
• Right supervision: Always follow up
• Right direction & communication: Must be specific (need weight by 9am) Nursing process A - Assessment: Always assess first D - Diagnose: LPNS don't diagnose P - Plan: LPN helps to gather information so the RN can plan I - Implementation: Put plan into action E - Evaluate: Evaluates the different outcomes, do we need a new plan What is leadership?
• Action of leading a group of people or organization Autocratic leadership
• Individual control over all decisions and little input from group members
• Dictator
• Emphasizes policies
• Task oriented Democratic leadership
• Leadership style that promotes the active participation of workers in making decisions Laissez-faire leadership
• Allows the group to function more or less on its own
• "LAZY"
• Gives away leadership to other
• Might ask for a volunteer
• Concerned w/ employee over policies/pts Situational leadership
• Leader who adopts different leadership styles dependent on the situation at hand and development of other team members Authentic leadership

• Self actualized individuals who are aware of their strengths, limitations, and their emotions Shared leadership
• Maximizing all of the human measures in an organization by empowering individuals and giving them the opportunity to take leadership in their areas of expertise In healthcare, who helps ensure quality health development of patient safety standards?
• Joint Commision Professional boundaries
• Avoid dual relationships, conflicts of interest, social media contacts
• Always take notes Delegation versus assignment
• Delegation: LPN can do it but asks you to do it extra tasks
• Assignment: routine care, activities, and procedures authorized in scope/job description (STNA toilets Pt) NPSG - national patient safety goals
• Id patient correctly: 2 identifiers
• Improve staff communication: get test results to the right ppl on time
• Use Medications safely: b4 procedure label meds properly, take extra care of individuals on blood thinners, record and pass along correct information
• Alarm safety: make improvements to ensure alarms on equip is heard and answered promptly
• Prevent infection: wash hands (WHO, CDC standard)
• Identify safety risks: reduce risk of suicide
• Surgery: right person, right place (mark on body), right surgery, pause for a Time-Out b4 surgery HIPPA (Health Insurance Portability and Accountability Act)
• National standards that protect sensitive patient information
• Without patient consent or knowledge S/S of seizures
• Change in LOC
• Involuntary movements
• Posturing
• Changes in perception, behaviors, or sensations Seizure interventions
• Padded side rails
• Low bed
• Fall matts
• Suctioning equipment at bedside

• Don't leave patient alone
• Environment should be low in stimuli
• After assess LOC
• Avoid alcohol
• Protect head
• Nothing in mouth
• Turn patient on side
• Know how long lasted & characteristics
• Antiseizure meds FAST F- Facial drooping A- Arm weakness S- Slurred speech T- Time to get tx (3hrs) ***NOT 911!!!!!! Hemorrhagic stroke DX test
• CT w/out contrast Ischemic Stroke DX test
• EEG Other tests:
• Angiogram
• Doppler
• MRI
• Ultrasound
• Cardiac imaging Stroke complications
• UTI (very common)
• Malnutrition (dysphagia)
• Musculoskeletal pain (contractures)
• DVT (immobile)
• Seizures (very common w/both types)
• Pressure ulcers (doubled risk if incontinent)
• Multiple residual effects (sense of loss=movement, independence, activities, role confusion, depression/anxiety) Stroke modifiable risk factors
• Cholesterol
• Obesity
• High BP/Hypertension
• Stress
• Alcoholism

• Sedentary lifestyle
• DM Type 2 Stroke non-modifiable risk factors
• Age
• Gender
• Ethnicity
• Family hx
• Heredity
• Previous TIA Stroke interventions
• Control hypertension
• Maintain proper body alignment in bed
• Position client to minimize edema, prevent contractures, and maintain skin integrity
• Perform ROM 4x/day
• Monitor bladder elimination
• Speech therapy/OT/PT consultation Hemorrhagic stroke tx
• Surgery: aneurysm clipping
• Carotid endarterectomy
• Hemicraniectomy
• Mannitol (osmotic diuretic) Ischemic stroke tx
• TPA (tissue plasminogen activator) w/in 3 hrs clot buster
• Heparin (anticoagulant) SQ/IV
• ASA (antiplatelet, antipyretic, NSAID) PO Labs for stroke pt on Heparin
• PT/PTT
• Platelets
• Hematocrit (thrombocytopenia)
• HGB
• INR (therapeutic 2-3) (normal 0.8-1.2) Post-op complications
• DVT
• Hemorrhage
• Infection
• Fever
• N/V
• Pain

Post-op teaching

• Early ambulation
• Incentive spirometer
• Deep breathing
• Splint before coughing DVT (deep vein thrombosis)
• Formation of blood clot in a deep vein of the body
• Occurring most commonly in the legs or thighs DVT s/s
• Pain
• Swelling
• Redness
• Vein hard to touch Glasgow Coma Scale (GCS)
• Eye
• Verbal
• Motor
• Comatose 8 and below DVT labs and diagnostic testing
• Duplex ultrasonography
• D-dimer DVT tx
• Low molecular wt Heparin therapy SQ every 12 hrs
• ASA for anti-platelet therapy
• Ambulate then Warfarin (Coumadin) PN SOP
• Data collection
• Focused assessment
• Participate in planning nursing care needs
• Implement care within SOP rather than legal, ethical, and educational parameters
• Implement teaching plan for common health problems and well-defined learning needs
• Provide direct basic care to assigned multiple clients in structured settings
• Assist in evaluation of client's responses and outcomes to therapeutic interventions
• Use a problem-solving approach as the basis for decision making in practice SBAR

• Situation
• Background
• Assessment
• Recommendation Pharmacologic pain management
• Corticosteroids
• Opioids
• NSAIDS
• Lidocaine
• Anti-inflammatories Non-pharmacological pain management
• Distraction
• Relaxation
• Imagery
• Breathing techniques
• Music
• Environmental modifications
• Heat or cold
• Repositioning
• Spiritual practices 5 keys to effective communication
• Be positive
• Be a listener
• Be an echo
• Be real
• Be a mirror (is often therapeutic) PASS
• Pull
• Aim
• Squeeze
• Sweep RACE
• Rescue
• Alarm
• Contain
• Extinguish/evacuate Aspiration pneumonia

• Can occur when a foreign substance, such as vomit, is inhaled into the lungs Aspiration pneumonia risk factors
• Stroke
• Dysphagia
• Smoking
• Immobile
• Immunocompromised
• Neuromuscular disorders Aspiration pneumonia labs
• ABG
• Blood culture
• Bronchoscopy
• CBC
• X-ray/ CT
• Sputum culture
• Swallow study Aspiration pneumonia (bacteria) medical management
• Examine lab values
• Deep breathing Q2h
• Use humidity 3L O
• Suction airway
• Auscultate lung sounds
• Monitor LOC
• Anti-infectives (Zosyn) DM type 1
• Total lack of insulin production
• Usually develops in childhood
• Pts require insulin replacement therapy DM type 2
• High blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production
• Diabetes of a form that develops especially in adults and most often obese individuals Types of insulin
• Rapid: Humalog, Aspart (Novolog)
• Short/regular: Humulin R, Novolin R
• Intermediate: NPH, Humulin-N, Novolin-N
• Long: Lantus, Levemir

DM type 1 tx

• Insulin injections (BS normal range: 70-100)
• Carb counting
• Eat carb snack before physical activity DM type 2 tx
• Moderate carb intake spaced evenly throughout the day
• Oral medications (Metformin, Glipizide)
• Insulin
• Lose weight DM type 2 oral meds
• Metformin (Glucophage)
• Glipizide (Glucotrol)
• Sulfonylureas
• Acarbose (Precose)
• Sitagliptin (Januvia) Hyperglycemia s/s
• Fruity odor to breath
• Headache
• N/V
• Abdominal pain
• Rapid pulse
• Polyuria
• Polyphagia
• Polydipsia Hypoglycemia s/s
• Palpitations
• Tachycardia
• Sweating
• Fatigue
• Hunger DKA s/s D - dehydration K - ketones in urine/blood, Kussmaul's, K+ A - acidosis, acetone breath, anorexia due to nausea What are the skills that are necessary to function successfully as a first-line manager?

• Building a strong base
• Supervises
• Example: charge nurse Behaviors of active listening
• Tell me more
• Avoiding judgement
• Eye contact
• Frequent nodding What are 5 core areas of knowledge and skills that are necessary for the practical/vocational charge nurse to be an effective leader?
• Motivate team to accomplish goals
• Set team goals
• Communicate assertively
• Build team of cooperative workers
• Manage stress effectively UAP can perform what duty for pt dx w/ DM?
• Record how much patient has eaten What should the nurse consider before delegating/assigning care?
• Condition of the pt (must be stable) Indicative of a active listener
• Always thinking not just hearing or seeing words
• Saying things like "Tell me more"
• Avoiding judgement
• Good eye contact
• Frequent nodding Aspiration pneumonia s/s
• Coughing
• Wheezing/crackles
• Increased respirations
• Increased temp/fever
• Increased WBC
• Decreased pulse ox Important information to give UAP during report
• Code status
• Vital parameters
• Can't take BP in mastectomy arm
• Shunts

• Graphs
• No rectal temperature
• Diet Maslow's hierarchy
• Psychological needs
• Safety
• Love and belonging
• Self esteem needs
• Self-actualization Low census on the unit. Charge nurse says one of you can go home early. How would the charge nurse respond if they were a Laissez Faire manager?
• She would ask for a volunteer LPN is orienting and teaching a new UAP about their role in the new nursing home. Which statement by the UAP indicates need for further teaching? "I should start mouth to mouth when I see a patient having difficulty breathing." Transformational leadership
• Teamwork A new nurse and you are observing staff behaviors, which observation demonstrates a positive working environment? Sit down in the lounge and talk Making more assignments for 2 UAP's and you want to ensure that they understand your expectations. To assure they understand your expectations, what should we do? Direct the UAP's to write down the instructions Tests for stroke patients
• CT scan w/out contrast
• Thrombolytics aka clot busters
• Up to 3 hours to give TPA
• Hemorrhagic stroke = no TPA
• D-dimer Stomatitis
• Inflammation of the mouth
• Chemo patients get it
• UAP can help with diet choices What can you delegate to the UAP for an 8 year old patient who has stomatitis and is on chemotherapy?

• Help client eat bland soft diet 2 employees with a long standing conflict
• Arrange a meeting with both and discuss the issue is You assigned a UAP to take vitals and weigh daily, what demonstrates your continued accountability?
• Conducting frequent assessments on patients condition Risks for stroke
• A-fib
• HTN
• Obesity
• Kidney disease
• DM
• Hyperlipidemia (high cholesterol) Decreasing risk factors for stroke
• Take medication (don't stop taking)
• Stop smoking
• Exercise
• Low sodium diet
• Low saturated fat diet
• SCDs Active stroke
• Call 911
• Vitals
• Call doctor
• Call family Metformin
• Damaging to the kidneys
• CT with dye hold med for 48 hours
• A1C below 7
• DM type 2 Glipizide
• Lowers blood sugar
• DM type 2 Furosemide
• Loop diuretic
• Pt lose potassium

• Lose weight
• Decrease blood pressure
• Decrease in swelling
• Increased urination Lisinopril (Prinivil)
• Ace inhibitor
• Antihypertensive
• Monitor BP before and after
• Prevents heart failure Enoxaparin (Lovenox)
• Anti-coagulant
• Monitor for increased heart rate
• Monitor for low BP
• Monitor for bleeding
• No DVT means it's working
• SQ Hydrochlorothiazide
• Diuretic
• Treats high BP
• Monitor for hypotension Simvastatin
• Statin
• Treats high cholesterol (lowers cholesterol)
• Monitor kidney and liver labs (Cr and BUN) Aspirin
• Antiplatelet
• Anti-inflammatory
• Antipyretic
• Pain Transferring patient
• Know family med hx
• All meds taken
• Pt refusing treatment
• Anticoagulants
• Pt smokes
• Alcohol abuse If patient is in pain and no med is due what interventions can LPN do?

• Backrub
• Distraction
• Prayer
• Repositioning
• Reassessing pain
• Comfort family
• Massage
• Music Diabetes foot care
• No bare feet Insulin
• Read sliding scale and check BS before eating
• Given SQ
• Insulin pen at room temp Improving staff communication
• Important results to the right person on time Thrombotic stroke is known as? What happens when someone has this stroke?
• Ischemic (most common)
• Clot in the arteries that block blood supply to the brain What is happening when a patient has an embolic stroke?
• Blood clot or plaque that develops elsewhere in the body and then travels to one of the blood vessels in the brain through the bloodstream What is happening when a patient has a hemorrhagic stroke?
• Rupture of an artery or bleed in the brain 85% of all strokes are
• Ischemic strokes 15% of strokes are
• Hemorrhagic What race has the highest mortality rates for strokes?
• African Americans Would we administer Lovenox to a patient who has just had a hemorrhagic stroke?
• No because has a brain bleed and blood will not clot

If a patient who recently had a stroke and has difficulty swallowing, can we delegate feeding this patient to a UAP? Why or why not

• No because pt is considered unstable Would we give Metformin to a patient with a 74 blood glucose level?
• No because it would drop BS more Aspirin should NOT be given to a patient with a post hemorrhagic stroke?
• True because is an antiplatelet Lisinopril would be given to a ______ patient?
• Hypertensive TPA is known as? When would we use it?
• Tissue plasminogen activator: it breaks down blood clots
• Use this for ischemic strokes only If we don't have an available TPA, what would we use instead?
• Anticoagulant such as Heparin or Coumadin If a patient receives a 3 or less on the glascow coma scale, what does this mean?
• It indicates the patient is unresponsive Subjective data
• Symptoms a pt tells you about that you cannot observe through your senses Objective data
• Information that is seen, heard, felt, or smelled by an observer Patients that a UAP is not allowed to care for? Unstable patient Patient from ER Patient in ICU to med-surg patient with chest pain patient who recently had a fall A patients family is at the bedside. The patient is complaining of still being in pain but the medication for pain they are currently on are not due until another few hours, the family is becoming unhappy, what are our interventions? Acknowledge family assure you doing your best do a pain assessment offer non-Pharma logical therapies reposition music backrub etc.

When there is a conflict between a UAP and a patient, what is our best course of action? Get the UAP out of the room Take care of patient and address needs Report incident to the management, DON & Charge nurse Do NOT tell them to go home tPA is for what kind of stroke Ischemic strokes ONLY sliding scale insulin

• Adjusted doses dependent upon individual blood glucose
• Usually done before eating and at bedtime
• Usually utilizes rapid or short-acting insulin You should never mix long acting insulin with? anything LPns can give insulin via what routes? Sub Q Never IV S/s for a patient with pneumonia? Elevated temperature coughing Low pulse OX Elevated WBC Increased RR Lisinopril is what kind of medication? Antihypertensive Lovenox (enoxaparin) is what type of medication? Anticogulant Hydroclorothiazide is what kind of medication thiazide diuretic, antihypertensive How do we know lovenox is working in a patient with a DVT? The patient no longer has a blood clot Glipizide (Glucotrol) îs what type of medication, and what does it do? Antidiabetic Has pancreas make more insulin

Mr. Edwards had a stroke and is now being discharged, what education would we give to prevent another from happening in the future? Smoking cessation being active Take BP medication if prescribed Limit fat and cholesterol intake low sodium diet If a patient who is either on metformin or Glyripenide and the doctor has a CT ordered that involves a contrast or a dye what must we do? Have the medication held 2-3 days before and resume 2-3 days after because it could cause kidney failure BUN levels 10 - 20 creatine levels 0.6-1. Potassium levels 3.5-5. Sodium levels 135 - 145 MONA for chest pain Morphine Oxygen Nitroglycerin Aspirin Aspirin is a Antiplatelet Enteric coating aspirin shouldn't be given to an infant, why? They can develop Reyes syndrome Diabetics must get an A1C every goal is 3 months and to keep it less than 7 months Stroke can affect left and right side of the brain at the same time? True or false True

Rapid insulin's include? How do we remember it? HumaLOG novaLOG Rapids logs rolling down the hill Onset: 15 min Peak:30 min - hour Short acting insulins? How do we remember Humalin R Novalin R ShoRt acting insulins have r Onset: 30min Peak:1-2 hours intermediate insulins are? How do we remember. NPH NOVALIN N iNtermediate have Ns Onset: 1-2 hours Peak 2-4 hours Long acting insulins are? How do we remember Lantus Levamir Long are L No peak Onset 2-4 hours TPA must be completed within? 3 hour window TIA stroke transient ischemic attack, mini stroke but should still be looked Aspirin falls into what 3 medication classes? Analgesic, antipyretic, NSAID & Anti platelet Lovenox (enoxaparin) is given? SUB Q What are examples of ACE inhibitors? (Think pril) Lisinopril Aptopril

Beta blocker medication examples? (Think lol) Atenolol Labetolol calcium channel blockers examples (think pine trees) Amlodipine Nifedipine Magnesium does what to the vascular walls? Opens "mellows" Calcium does what to the channels? Constricts the vascular walls Nursing interventions for a patient who had stroke? Monitor vital signs Encourage IS use i&O along with IV monitoring Head to toe assessment Educate on safety for discharge Assess skin break down Range of motions Monitor for daily labs Circulation checks

NUR 195 exam 2 questions with 100% correct

answers 2024

Kidney stone diet Increase fluid intake and protein AVOID chocolate and calcium, nuts, shellfish, wheat products, carbonated beverages Care coordination tier 1 Frail, elderly, terminal illness, dying, children w/ disabilities Care coordination tier 2 Mental health Care coordination tier 3 Everyone else medication reconciliation

• NPSG
• Every time a patient has a procedure/surgery, moves facility, unit or goes up the doctor will review current medications lasix, spironolactone
• Diuretics
• Lowers blood pressure Which patient would benefit the most from care coordination 87 year old who just had a CV resulting in dysphasia and right sided weakness right sided heart failure
• Jugular vein distention
• edema (starts in feet can radiate to sacrum)
• Ascites
• Nausea and vomiting
• Abdominal distention
• Enlarged liver
• Low appetite Left sided heart failure
• Dyspnea, SOB
• Crackles
• PINK FROTHY SPUTUM

• Pulse OX is dropping
• hypertrophy
• restless
• Cool/pale skin
• Restless
• Low urine output (oliguria) ramopril Ace inhibitor
• Hypertension
• Low dose-cardiac effect Amiodarone (Cordarone)
• Tachycardia, ventricular fibrillation
• Can damage the heart
• Can cause blue/grey color to the skin Common side effect: Hypotension National patient safety goals
• Suicide prevention
• Pass meds safely
• Prevent infection Preferred skin cleanser
• Chloraprep
• Chlorohexidine- chloraprep and alcohol mixed Digoxin (Lanoxin)
• Slows HR down and strengthens contraction
• PO, IV, IV push
• CHF
• Apical pulse below 60 BPM HOLD the medication Congestive heart failure intervention
• Fluid restriction
• Sodium restrictions Promethazine (Phenergan)
• motion sickness, N/V
• Sedation Common SE: Constipation, Urinary retention, dizziness, drowsiness Severe SE: Thrombocytopnea, neuroleptic malignant syndrome VESICANT

Cardiac bypass surger

• Surgen
• Dietician
• Cardiac rehab
• Cardiologist orthopedic surgeon Bone doctor Contact percautions Minimum gown and gloves Droplet Minimum of mask with face shield Airborne
• N95
• Private room
• Negative pressure High potassium Kayexalate- orally, rectally Urticaria, Pruritus Itching Dr order 1-2 pain pill q4hr. How do you determine which dose to give? If they have kidney/liver problems and are small give 1 pill If they are larger or 10/10 pain give 2 pills Endocrinologist Diabetes signs of hypoglycemia
• Shaky
• Confused
• Pass out
• Diaphoretic
• Grouchy
• Seizures can occur Signs of diabetes polyuria, polydipsia, polyphagia

Rapid acting insulin Lispro (Humalog) Aspart (Novolog) Give when tray is with the PT Heparin flush in the 100s unit/ml Heparin treatment in the 1000s unit/ml What would be included in report

• Important info that happened when PT was with us
• Family Hx
• They don't need to know visitors Clinical pathways interdisciplinary plan of care for a particular patient; care guidelines and outcomes are specified for each day of the patient's stay
• Evidence based pathway
• Helps DR hit all main points of treatments Chest pain/MI pathway
• IV lopressor (treats high BP)
• Heart cath Heparin antidote protamine sulfate Tylenol antidote Acetylcysteine (Mucomyst) Sense of impending doom Symptom that something serious is happening Labs for renal failure BUN and creatine ONLY Elevated BUN Dehydration Renal disease Often have high potassium level

Torodal (ketorolak) NSAID- IM Side effects:

• Clotting problems (stroke, MI)
• hard on kidneys What side effect would I be most concerned about? urolythiasis urinary stone nephrolithiasis condition of stones in the kidney Contribution to kidney stones
• Inactivity
• Frequent UTI
• Hypo/hyperparathyroidism
• Diet Carvedilol (Coreg) Beta-blocker
• Hypertension
• HF
• Lowers heart rate and blood pressure Side effects: impedance, raises blood sugar leapfrog group Organization that promotes healthcare safety by giving consumers the information they need to make better- Identify and purpose solutions. Designed to reduce medical errors Allopurinol (Zyloprim) Gout and kidney stones Reduces uric acids Common SE: N/V/D Tylenol
• Mild to moderate pain reducer
• antipyretic
• Antidote: mucomyst Acetylcysteine (Mucomyst)

• Cystic Fibrosis
• Help get kidneys in shape for contrast die** give before procedures
• Antidote for Tylenol S/S hyperglycemia
• Sweaty
• Hot
• Polyuria
• Polydipsia
• Polyphagia
• Fatigue over 140 hypoxia inadequate oxygen delivery to the lungs or body tissues from circulation, hemoglobin, or toxic substances hypoxemia decrease amount in oxygen in the blood a SaO2 of 90 indicates ______________ hypoxemia mild At SaO2 of 90%, PaO2 = and requires 60 mmHg immediate intervention with oxygen therapy effects of chronic hypoxia fatigue, drowsiness, inattentiveness, apathy, delayed reaction time chronic hypoxia s/s enlarged heart, clubbing, anorexia, constipation, decreased urinary output, decrease libido, weakness of extremity muscles, muscle pain acute hypoxia effects, s/s Restlessness, disorientation, confusion, impaired judgement, hyperventilation, air hunger, circulatory changes (tachycardia-bradycardia) Assessments for oxygenation

ABG

pulse ox (o2 sat) physical assessment findings Low flow oxygen delivery systems

• Nasal cannula (>4L/min use humidification)
• Simple face mask
• Partial rebreather mask
• Nonrebreather mask High flow oxygen delivery systems
• Venturi mask
• transtracheal catheter
• aerosol masks
• mechanical ventilators
• face tent A physician orders a patient to receive oxygen 3L/minute via nasal cannula. When calculating the fraction of inspired oxygen (FiO2) for this setting, which of the following would be correct? 28% 32% 36% 40% Calculate: ___ L x 4 + 20 = FiO2 or concentration of oxygen; each additional L of flow is + 4% Answer: B. 32% FiO2 is essentially the percent of oxygen being delivered by the oxygen-delivery system An order is received to place a patient on a Venturi mask of 40%. Which explanation best fits this oxygen delivery device? Different masks are used for each desired oxygen concentration. An air entrainment device blends the oxygen with room air. One set oxygen flow rate is used with this mask. With a venture, there is variable oxygen delivery. One set oxygen flow rate is used with this mask. Obstructive sleep apnea partial or complete upper airway obstruction during sleep with repeated periods of apnea, brief arousals resulting in a fragmented sleep. Which of the following clinical manifestations increase oxygen demand for a patient? Anemia Tachycardia