NUR 2349 / NUR2349 Exam 2 Review (Latest 2021 / 2022): Professional Nursing I / PN 1 -, Study Guides, Projects, Research of Nursing

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NUR 2349 / NUR2349 Exam 2 Review

Professional Nursing I / PN 1

1. The most accurate information concerning a client’s pain comes from the nurse’s assessment or the client? Information from the client

Is objective or subjective data more important? Subjective

When objective and subjective data about a client’s pain are in conflict, which report should the nurse consider as the primary source? Pain is always subjective “subject says”.

2. When administering pain medication, is it the most appropriate to administer the minimum dose and reevaluate the client’s pain after 30 minutes or administer the highest pain medication dosage to ensure the client’s pain is relieved? If BP is slow, start low. If patient comes out of surgery and pain is an 8 pushing the max dose is at the nurses discretion.
3. What physiological changes can occur when a client is in acute pain?
   • BP, Resp Rate, Pulse
   • Dilated Pupils
   • Perspiration (Diaphoresis/sweating)
   • Pallor (pale skin)

How can a nurse assess a non-verbal client for pain? Wong Baker Face Scale, or non-verbal cues (grimacing, rolling on bed, fetal position).

What is the difference between pain quality and intensity? Quality = Type (sharp, dull, stabbing, numb) Intensity = How bad it hurts (scale of 1-10)

4. What are the signs of a client in chronic pain?
   • Lasts over 6 months
   • Persistent
   • Constant/recurrent
   • Produces negative changes in life (withdrawn, frail)
   • Body adapts (moves slowly to avoid movement of painful areas)
   • Needs reg assessment & diff approach to treatment
5. What is the gate control theory? Things other than medications can help relief pain (communication ie. Saying someone will be okay and rubbing their backs, therapy,

acupuncture)

6. Review hypertension stepped-care approach, food with elevated sodium levels, know which ethnic group tends to develop hypertension earlier in life. African Americans are higher risk, change in lifestyle & diet first, then diuretics (which eliminate water from the body by passing urine more frequently).
7. Review the difference between primary (essential) hypertension and secondary hypertension.
   • Primary Hypertension : More common, is the in BP due to unknown causes
   • Secondary Hypertension: Rarer, renal or endocrine disease process

that results in BP Which type is rarer? Secondary

8. What mm/hg is normal for blood pressure? 120/

What are palpitations? Heart is racing, pounding, fluttering, skipping a beat often, bothersome but rarely a sign of heart attack.

What is the “fifth” vital sign?

• Body temperature
• Pulse
• Respirations
• Blood Pressure
• Pain

9. Review the Joint Commissions standards related to pain management. Each client’s pain must be treated individually due to different interpretations of pain and different goals of pain relief.

Do previous experiences, cultures, age, poverty level, or educational level affect a client’s pain experience? (Which ones do not?) Education level & poverty level do not.

10. Do older clients fear being labeled as “complainers” and avoid requesting medications? They often live with the pain in fear of being labeled as a complainer or a bother, nurse should encourage to request pain relief when needed.

11. Know about the normal vital signs and morphine dosage range. Normal= 12 RR Below 8-10 they will get Narcan (reverses)

Be able to decide if a pain medication can be given based upon the client’s vital signs and physicians order. Always by Physicians order

Would breathing changes, such as Cheyne-Stokes pattern prevent you from administering the client’s pain medication if their vital signs are normal? Cheyne-Stokes-> increase, decrease, then temporary stop in breathing (ie. Sleep apnea) Probably not but monitor closely.

12. Are clients who are able to gain pain relief able to function normally and comfortably? Yes, don’t chase the pain.
13. When using the SBAR technique for telephone communication, information in the S (situation) should include the nurse’s name, the client name, the circumstances leading up to the call.

What does the BAR include?

• S: Situation (Nurses name, PT name, circumstances leading to event)
• B: Background
• A: Assessment
• R: Recommendation

Scenario 1: An RN on the Medical Floor has an order for a patient to receive an exam that requires IV contrast. The patient’s creatinine level is 2.9. The ordering physician needs to be called to clarify this order.

1. Situation: “Dr. Smith, this is Darlene on Med/Surg at OMH. I have an order for a PE study for Mr. Marino. His creatinine is elevated and I wanted to clarify the order with you.”
2. Background: “I see that Mr. Marino came into the ED with right-sided chest pain and difficulty breathing. The CT for rule-out PE was ordered.”
3. Assessment: “Mr. Marino’s creatinine level is 2.9, far above the allowable level for a rule-out PE study.”
4. Recommendation: “I think that the order

should be changed from a CT for rule-out PE to an order for a VQ scan.”

14. What are the definitions of inflammation and/or infection? Inflammation- Body attempting to rally (blood rushes to inflamed area).

Infection- Invader is stronger than the host. The infection overpowers the

body such as a “war”. How do inflammation and infection differ? What are the

signs of each? Inflammation- Nonspecific, in CRP (c-reactive protein), cellular response to tissue injury, redness, pain, swelling and pus, heat, loss of function NOT sensation.

Infection- WBC (white blood count)

15. What is RICE? How is this utilized within the first 72 hours of an injury, especially when pain and edema are present? (Soft tissue injuries mostly)
    • R: Rest
    • I: Ice (24-72 hours, controls Edema)
    • C: Compression
    • E: Elevation
16. Be able to name some common infections. MRSA, UTI, Syphilis
    • Bacterial (can be cured with antibiotics): Diarrhea, pneumonia, sinusitis, UTI, cellulitis, meningitis, gonorrhea, otitis media, & impetigo.
    • Viral (cannot be cured, but maintained): Influenza, Measles, common cold, Chicken Pox, Hep B, Genital Herpes, & HIV.
17. What is disinfection? Elimination of pathogens aka. germs (not sores) from inanimate objects with disinfectants & germicides.
18. What is sterilization? Total elimination of microorganisms from instruments and other supplies used. Ie. Surgery, sterile, kills the spores.
19. What is antiseptic technique? Disinfection

Which one is used to eliminate pathogens, except spores, from inanimate

objects? Disinfection Which one is used to prevent the transmission of

pathogens? Sterilization

20. What are some types of barrier protection? Gloves, gown, masks, face shields, shoe covers…

What is standard, contact, droplet, airborne, and neutropenic precautions?

• Contact: Used for infections, diseases, or germs that are spread by touching the patient or items in the room (MRSA, VRE, open wounds, RSV, diarrheal illnesses).
• Droplet: Used for diseases or germs that are spread in tiny droplets caused by coughing and sneezing (Pneumonia, Influenza, Whooping Cough, Bacterial Meningitis).
• Airborne: Used for diseases or very small germs that are spread through the air from one person to another (Tuberculosis, Measles, Chickenpox).
• Neutropenic: Wash hands often, bathe daily, brush teeth 2 times a day, do not share personal items with anyone. It is a condition that causes you to have low neutrophils (a type of WBC that helps your body fight infection and bacteria) in your blood.

What protective equipment is required for each?

• Standard: Hand hygiene & gloves.
• Contact: Hand hygiene, gown (used for contact patients), & gloves.
• Droplet: Hand hygiene, gown (used for contact patients), gloves, surgical mask within 3ft of patient.
• Airborne: Hand hygiene, gown, gloves, particulate respirator, & possibly a negative pressure room N-95.

21. Should clients always be taught to take all of their antibiotics as prescribed? Why is this important?

Yes, to make sure all of the bacteria is killed, and the infection doesn’t return.

22. What is a superinfection? A previously infected cell gets co-infected with a diff strain of the virus (or another virus) later in time. Ie. Fungal infection or CDiff

What causes a superinfection? Not cleaning the environment thoroughly or properly (germs will sit, collect, & mutate over time).

What is the most effective way to decrease the spread of infection? Disinfecting properly and often, & HAND HYGIENE.

23. What factors related to aging places older clients at risk for infections? Slower immune systems, skin integrity (get older, work slower)
24. Can nurses order specific pain medications for a client, or is ordering medications a physician’s job? The Physicians job
25. Know the difference between each link in the chain of infection (portal of exit, mode of transmission, portal of entry, host, agent, reservoir…)
    • Development of an infectious process: o Agent, host, & environment is required o Involves several essential elements
    • Differences between each link in the chain: o Agent: Entity capable of causing disease o Reservoir: Place where the agent survives (Ie. Humans, plants, animals, environment). o Portal of Exit: Route the agent leaves reservoir to transfer to a host. o Portal of Entry: Any break/opening in skin for agent to enter through (Ie. Mouth, anus, open wounds/cuts). o Susceptible Host: Any person who is at risk for an infection. o Compromised Host: Anyone at increased risk for infection (Ie. Someone elderly or a child, receives immune suppression treatment for cancer/illness, immune deficient). o Mode of Transmission: Means of transmission for agent to leave reservoir to exit and find new host. ▪ Direct/Contact: Touching, biting, kissing, sexual contact (within 3ft) -> sneezing, coughing, spitting, singing, talking. ▪ Indirect/Vehicle-borne: Intermediate means of transport, introduces agent to host

through portal of entry (handkerchiefs, toys, soiled clothes, utensils, surgical instruments). ▪ Indirect/Vector-borne: Animal, flying/crawling insect that serves as means of transport for agent. Injects salivary fluid during biting or depositing feces on skin.

26. When educating a client being discharged to home with a wound , is it more important for the client to be taught to wash their hands because of wearing gloves, wash their hands to prevent infection, keep their bed linens dry and clean, or to keep their dressings dry and clean? Wash their hands to prevent infection.
27. Review where you find each of the heart sounds. “What’s your address? 2245 Apt. M” S2 -> Aortic: located at 2nd^ intercostal space right of sternum. Pulmonic: located at 2nd^ intercostal space left of sternum. S1 -> Tricuspid: located at 4/5th^ intercostal space left of sternum. Mitral: located at 5th^ intercostal space midclavicular line.

What causes S1 and S2 heart sounds? S1: “lub”; 1 st^ heart sound, caused by closure of tricuspid & mitral; beginning of Systole. S2: “dub”; 2nd heart sound, caused by closure of aortic & pulmonic; beginning of Diastole.

What are some of the symptoms of cardiac disorders? Dyspnea (difficulty breathing), chest pain, fatigue, edema, syncope (lightheaded), palpitations.

How is cyanosis (not receiving oxygen) assessed? By observing the skin in earlobes, lips, mucous membranes, & finger and toenails.

28. What is a positive Homan’s sign? Pain

How is it assessed? Also called “dorsiflexion” sign test. A physical exam used to test for DVP (Deep Vein Thrombosis; clots in the leg).

Assessed in order: In supine position, knee of suspected leg of patient

should be flexed. What should the nurse do when a Homan’s sign test is

painful for the client? The examiner observes whether or not the patient reports pain in his calf or popliteal (behind knee).

29. Review the various cardiac enzymes, including troponin levels, CK, CK-MB, & myoglobin. Which level is more specific for cardiac injury? Troponin Levels (always low, if comes back positive = risk for heart attack or injuries)
30. Know the following labs and what these labs show: C-reactive protein, prealbumin, erythrocyte sedimentation rate, plasma viscosity, ferritin, &

Haptoglobin.

• C-reactive Protein: Evaluates vascular inflammation
• Prealbumin: Checks for signs of poor diet (malnutrition) quicker than albumin.
• Erythrocyte Sedimentation Rate (ESR): Indirectly measures the degree of inflammation present in the body. Measures rate of fall (sedimentation) of erythrocytes (RBCs) in a sample of blood.
• Plasma viscosity: Replaced by ESR (Erythrocyte Sedimentation Rate) blood test.
• Ferritin: Detects reason for anemia.
• Haptoglobin: Hemoglobin binding protein found within erythrocytes.

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31. Review the main goal for clients with hypertension (it is not related to sodium). Change in lifestyle- stop smoking, drinking, exercise more and lose weight.

Review the relationship between diuretics and hypertension. Diuretics “water pills” helps to remove extra fluid in the body being stored by blood clots creating hypertension.

Why are diuretics the first line of medications in treating hypertension after the first step program does not gain results. Because they only effect the kidneys, not the heart.

Review the various diuretics (loop, osmotic, potassium-sparing, thiazides) and names within each type of diuretics.

• Loop Diuretics: Removes excess fluid by causing the kidneys to produce more urine. These include furosemide (Lasix), ethacrynic acid (Edecrin), and torsemide (Demadex).
• Osmotic: To remove fluid from body tissues, reducing fluid in the brain. These include Mannitol, Glycerol, and Urea.
• Potassium Sparing: Blocks the action of aldosterone in the distal nephron, prevents promotion of sodium uptake in exchange for potassium secretion (caused by aldosterone), potassium is spared (not secreted), & sodium is secreted. Causes very little diuresis. These include Amiloride (Midamor), Spironolactone (Aldactone), Furosemide (Lasix), & Triamterene (Dyrenium).
• Thiazides: Drugs increase excretion of water, sodium, potassium, & chloride by blocking the reabsorption of sodium & chloride. These include Hydroclorothiazide (Esidrix, HydroDIURIL, Diazide), Metolazone (Zaroxolyn), & Indapamide (Lozol).

32. What is the purpose of multiple individuals and disciplines documenting in the same medical record? Continuity- reason, PT, nurse, DR all chart in the same location so they all see the same information.

□ EXTRAS

33. Use the PQRST method for assessment of pain.
    • P: Provoked
    • Q: Quality -R: Region

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-S: Severity -T: Timing

34. Don’t stop taking antibiotics.

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35. Only the patient can tell you about their pain (it is all subjective). Objective includes behavior (crying, screaming, guarding, rubbing of site, etc.)
36. Pain assessment must be recorded.
37. Nurses role:
    • Know whether to give analgesic and which one
    • Assess client’s response.
    • Report to physician when change is needed.
    • Teach family and client regarding use.
38. Demurral is 7x stronger than Morphine.