Sleep Disorders and Nursing Interventions, Exams of Nursing

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PNR Test Questions and Answers 2024

1. What aspects of the therapeutic nurse Client relationship is addressed in

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Ans

-

the article "lend an ear"?: Trust and

respect

2. What is one way a nurse violates the nurse client

relationship?:

wedon't listen.

Ans

Whe

n

3. What is the goal behind listening according to Broeder-morin and land?: -

Ans

-

Gain empathetic

understanding

Ans

4. How does a nurse show they are listening?: Eye contact,

arms

uncrossed,facial expression, touch, warmth

5. What are the client consequences of not being listened to according to the

Ans

article?: Depression, frustration, complaints about care , perceived

nurses as

beingrude, abrupt and not caring.

6. What happened in a recents coroners report when a client was not

listened

Ans

to?: A man died due to a med error because the client was not

listening when

he said it did not like the pills he received before and no double check

was made.

Ans

7. What does an electronic health record(EHR) do?:

Enhances

communicationamong healthcare providers and thus patient safety.

8. Nurses are legally and ethically to keep patient information confidential,

Ans

-

how long are records retained for?: Minimum of 10

years.

9. Communication between healthcare providers is important in client care.

What must the nurse do in order to ensure that communication is

adequate?- Ans

-

: provide accurate, detailed, objective, and timely

information.

10. SOAP: subjective, objective, assessment, plan
11. SOAPIE: subjective, objective, assessment, plan, intervention,

evaluation

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12. Focus charting (DAR): data, action, response
13. PIE: Problem, intervention, evaluation

14.A nurse has just admitted a patient with a medical diagnosis of heart

failure. When the admission paperwork is filled out, what does the nurse

need to record?: Objective data that are observed

15.Health documentation is an electronic format is an evolving process that

faces many challenges. Which of the following is one of these challenges?: -

Ensuring that documentation is accurate and precise.

16.What about the patient should be confidential?: All written, verbal

communi- cation, only people involved in care may have access to

records, can not be copied or duplicated, and clients can view their

health record often due with a person in authority so that questions

may be answered

17. 5 red flags that need to be advised in chart altering: 1. Don't add info

later without indicating you did so

18.Don't date the entry so it appears to have e been written at an

earlier time

19.Don't add inaccurate info

4. Don't destroy records
5. No writing in margins

18.When might a health care provider suspect a patient is experiencing

urinary retention?: The patient indicates pain in the suprapubic

region.

19. Is the rectum sterile?: No, you have to clean it.
20. Is the ostomy stertile?: No.

21.Patients with cardiovascular disease should be cautioned against strain-

ing while having a bowel movement. What does this help to avoid?:

Decreased venous return to the heart

22.To maintain normal elimination patterns in the hospitalized patient, the

nurse should encourage the patient to defecate 1 hour after meals for which

reason?: Mass colonic peristalsis occurs at this time.

23.A patient states that he has recently had a change in medications and

reports that his stools are now dry and hard, which makes them difficult to

eliminate. What condition is this type of bowel pattern consistent with?: Con-

stipation.

24.What side do patients turn on for rectal checks?: Patients always go on

their left side with there knees flexed and pad underneath.

25.Which type of urine specimen is obtained through catheterization?:

Cultur- al and sensitivity

26.What is the medical terminology used for microscopic amounts of blood

in stool?: Gastrointestinal hematochezia

27.A client with a long history of arthritis complains of sensitivity and

warmth in both knees. To determine the degree of limitation, what should the

nurse assess?: The clients RANGE OF MOTION

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28.When assessing a clients activity tolerance, the nurse must consider

which of the following?: The clients physiological, emotional, and

developmental factors

29.What is a complication of immobility and is worse in smokers called?: Hy-

postatic pneumonia

30. What refers to bone on bone: Crepitation
31. What can result in constipation?: Immobility

32.What can be reduced by performing activities more slowly and for a

shorter period?: Fatigue

33.The nurse notices an increased respiratory rate, decreased oxygen satura-

tion, and increased sputum in an immobilized postoperative Patient, the

noted change is consistent with which one of the following?:

Atelectasis(can't expand lungs)(collapse of lungs)

34.When the nurse is caring for a client on bed rest, what is the most appro-

priate nursing action?: Encourage hourly use of the incentive spirometer

35. infancy: 1/3 awake, 1/3 NON REM, 1/3 REM
36. old-age: 1/4 REM, 1/2 awake, 1/3 NON REM

37.Stage 1 NREM sleep: - lightest sleep, lasts for a few minutes, person is

drowsy and relaxed, easily aroused, aroused 2-5% of adult sleep time

38.Stage 2 NREM sleep: Sound sleep, 45-55% of adult sleep

time,relaxation progresses, arousal easy but needs more stimuli than

stage 1, body functions slower

39.Stage 3 NREM: Deepest sleep, 10% of adult sleep time, difficult to

arouse, muscles completely relaxed, may snore, lasts 15-30min

40.REM: Vivid, full colour dreaming(25% of adult sleep time) begins

about 90min- utes after sleep began, rapidly moving eyes, fluctuating,

heart rate, respiratory rate and BP. Loss of muscle tone, gastric

secretions increase, very difficult to arouse, INCREASED metabolism

41.During rounds on the night shift, the nurse notes that a client stops

breathing for 1-2 minutes several times during the shift. What is this

condition called?: Sleep apnea

42.A 4-year-old pediatric patient resists going to sleep. What action should

the nurse take in order to assist this client?: Maintain the clients home

sleep routine

43. A client suffers from a sleep pattern disturbance. What is the most

impor-

tant nursing intervention to promote adequate sleep?: Administer a sleep

aid 2 hours before bedtime

44.Sleep apnea is suspected if a person?: has loud snoring and wakes

up irritable and has difficulty staying awake during the day.

45. What's an effective nursing intervention to promote sleep?: Back

massage

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need additional safety teaching when they make which of the following state-

ments?: "A 3 year old can safely sit in the front seat of the car"

47. Adolescents are at a greater risk for injury from which of the following?: -

Substance abuse

Motor vehicle

accidents Suicide

48.A patient who is being prepared for discharge after a hospitalization for

frequent falls should have which of these interventions?: Have a home

assess- ment

49.You note that there is a doctors order for Mr. Jones to receive a

suppository due to a lack of bowel moment for the last three days. Which of

the following best explains the need to position Mr. Jones on his left lateral

side?: To facilitate the flow of solution into the sigmoid colon

50.Ms. Edwards states "Iam having a lot of burning and pain when I urinate."

Which medical terminology best describes the clients problem?: Dysuria

51.As a student nurse you understand a guaiac test is used to identify

in a stool specimen: Blood

52.You are ending your day shift and measuring the urinary output of a

client. Which of the following best describes an adequate amount of urinary

output?: 30-60 ml/hour

53.You are preparing to collect a specimen sample from Mr. Michael's leg

wound. Which of the following best describes the proper technique?:

Clean the wound according to policy and obtain a culture in a Z

formation

54.You are preparing for your nursing test and recall your teacher describe

the following characteristics of REM sleep:: Increased metabolism

55.Which of the following is a benefit of exercise?: Decreases body weight

and enhances well being and mental health

56.Mrs.Marie states she's having trouble with urine coming out and

producing urine, which medical terminology best describes the clients

problem?: Anuria

57.A child has an accident and wets the bed, what do we call this in medical

terminology?: Enuresis

58.As a student nurse, you understand a stool culture is used to identi-

fy in a stool specimen: Bacteria

59. What is considered to be a low urinary output and less than 400ml

called?-

: Oliguria

60.What is the condition called when a client is stressed, depressed, has

poor sleeping habits and an irregular sleep schedule?: Insomnia

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sudden attacks of sleep causing you to fall asleep at any moment?:

Narcolepsy

62.A patient complains of thirst and a headache, the patient appears

dehydrat- ed. Upon initial examination, the nurse finds that the patients skin

does not return to normal shape. With what is this finding consistent?: Poor

skin turgor

63.What do you need to assess when doing a integumentary skin assesss-

ment?: skin

hair

nail

s

64.what stage and what do we call this when a person has put too much

pressure on the skin, to much moisture, dragged in bed, unrelieved pressure,

emia in the blood, lots of blood to that area when I go to put my finger on the

ulcer it turns white, if it goes back to red, lots of blood flow going to that

area to heal: pressure ulcer stage 1

65.Why do pressure ulcers occur?: Blood is not able to flow to tissues

because of pressure and it became ischemic

66. ischemic: pertaining to the lack of blood supply to tissue

67.what is the medical terminology for redness of the skin due to increased

blood flow called?: hyperemia

68. what is the medical terminology for our skin turning white?: blanching

69.pressure duration: low pressure over a long time, or high pressure over

a short amount of time, pressure occurs quickly(1-2h)

70. tissue tolerance: ability of tissue to endure pressure

71.shearing force: combination of friction and pressure, force applied

when two surfaces slide against each other or in a twisting or rotting

motion, ur shearing the patient from the back if your dragging the

patient, picking up the patient is better.

72.risk factors for pressure injury development: age related skin changes,

immobility, obesity, excessive moisture/dryness, poor

nutrition/hydration, condition of soft tissue, medications

(corticosteroids), previous PI, microclimate and medical conditions

effecting blood flow (DM, PVD), pressure, friction, shear, moisture, nutri-

tion

73. level of consciousness: alert to person, place or time.

74.where do most pressure ulcers occur: occipital, scapula, elbow,

spinous process, ischium, malleolus, neck, head

75. what is epithelization?: healing by growth of tissues over wound

76.What is granulation?: new fibrous tissue formed during wound healing,

pinkish, healthy skin

77. necrosis of tissue: death of tissue
78. black tissue is called?: necrosis

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79. aging of skin is due to: less moisture, is dry and is the most at risk
80. assessing skin: hygiene,color, etc.
81. What is the medical terminology for yellowing of the skin and eyes

called?-

: jaundice

82.what is the medical terminology for bluish discolouration of the skin from

lack of oxygen called?: cyanosis

83.what do you check with people with cyanosis: lips, nails, hand, inside

mouth and oxygen saturation

84. pallor: pale skin from fear, stress, etc.
85. what do we call red in the face, extra blood flow, red pinkish, fever?:

flushed

86.what's the medical terminology for a widespread redness of the skin?:

ery- themic

87. effective skin is: smooth, thin, and moist

88.skin turgor: indicator of their fluid status, pinch the skin and if it goes

right back down its normal, if you pinch skin and Dosent go back down,

its a sign of dehydration

89.ineffective skin: pinching of skin, skin status if it stays up or not, you

should have the same temp throughout your body.

90.localized coolness: poor arterial blood flow to a limb, one part of

the body, coolness

91. Generalized coolness: hypothermia, all through out body
92. Hypothermia: low body temperature
93. diaphoresis: excessive sweating, may accompany chestpain, fever

or anxiety

94. effective skin: dry skin but not overly dry, effective color, warm,

dry, and intact

95. edema: swelling

96.Lesions: areas of tissue that have been pathologically altered by

injury, wound, or infection, assess color and elevation with light

97. Braden Scale: A tool for predicting pressure ulcer risk

98.risks for braden scale: sensory perception, moisture, activity, mobility,

nutrition, friction and shear, 9 or less is putting at high risk.

99.suspected deep tissue injury: Purple or maroon localized area of

discolored intact skin or blood-filled blister due to damage of

underlying soft tissue from pressure and/or shear.

100.stage 1 instant skin with nonblanchable redness: Dosent go white

and stays red, no hyperemia going on. beginning of pressure ulcer

101. hyperemia: increased blood flow

102.unstageable pressure ulcer: Full thickness tissue loss in which the

base of the ulcer is covered by slough (yellow, tan, gray, green or

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103.acute wound assessment: R-redness

E-edema

E-

ecchymosis

D-drainage

A-

Approximation

O-odour

104. Ecchymos

is:

bruising

105. approxima

tion: near

or close

estimate

106.Chronic wound assessment: Redness

edema

ecchymosis

drainage

epithiliaizati

on

wound

edges

odour

107.Drainage types: serous

serosanguineous

sanguineous

purulent

108.serous fluid: A clear, watery fluid secreted by the cells of a serous

membrane. yellow fluid

109.serosanguineous drainage: pale, red, watery: mixture of clear and red

fluid, pinkish

110. sanguineous drainage: bloody drainage (red)

111.A patient has a drainage that is green and pussy like, what do we call

this type of drainage?: purulent

112.A patient is losing lots of hair in the scalp, what do we call this in

medical terminology?: alopecia

113. what do we call scabbing in medical terminology?: eschar
114. nail bed color should be what color?: pink

115.what should the texture, nail angle, and capillary refill be?: convex,

160 degrees, less than 3 sec, if greater than it is slow circulation

116. bad nails are: concave(spoon nails)
117. early clubbing of nails is at an angle of: 180 degrees

118.acute pain: happening now, usually surgically, pain that is felt

suddenly from injury, disease, trauma, or surgery.

119.chronic pain: episode of pain that lasts for 6 months or longer;

may be intermittent or continuous

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120.impaired tissue integrity: Damage to mucous membrane, corneal,

integu- mentary, or subcutaneous tissues.

121. Wound management protocols: protect skin and prevent further

breakdown

122.name important factors in preventing skin breakdown?: 1. keep skin

clean and dry

123.ROM

124.wrinkle free bed

125.no sheering forces

126.proper nutrition

127.taking pressure off

123. name names for pressure sores: decubitus ulcer, wound ulcer, tissue

ulcer

124. decubitus ulcer: sore caused by lying down for long periods of time
125. a pressure risk assessment should be done: on admission and once a

week

126.Common sites for pressure ulcers: occiput, scapula, elbows, sacrum,

heels, ear, greater trochanter, knees, coccyx and etc.

127.what intervention can be carried out to improve circulation in clients

beds: ROM and repositioning every 2 hours

128.A patient complains of thirst and a headache, the patient appears dehy-

drated. Upon initial examination, the nurse finds that the patients skin does

not return to normal shape. With what is this finding consistent?: poor skin

turgor

129.interpersonal communication: one to one interaction between 2

people sender to receiver

130. intrapersonal communication: communication with oneself

131.Feedback Response: When the received message has been

decoded and understood, the receiver encodes thoughts and ideas

into a message and then transmits this message to the original

sender

132. serious conditions mean to clients that: death is near
133. Pacing: speak slowly so that the patient can understand you.
134. intonation: the tone of voice can communicate a variety of feelings

135.verbal communication, tone of voice, and body language: tone

of voice=38%

Verbal=7%

Body language=55%

136.nonverbal cues: Communication without words using techniques such

as eye contact, body language, gestures, and physical closeness. 55%

137.verbal cues: short, concise phrases that direct a performer's

attention to important environmental regulatory characteristics, or

that prompt the person to

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perform key movement pattern components of skills. 38%

138.personal appearance: way speakers dress, groom, and present

themselves physically

139.posture and gait: The way people sit, stand, and move is a form of

self-expres- sion.

Posture and gait reflect emotions, self-concept, and health status.

(Example: An erect posture and a quick, purposeful gait communicate

a sense of well-being and confidence.

A slumped posture and slow, shuffling gait may indicate depression

or fatigue. Leaning forward conveys attention.

Leaning backward in a more relaxed manner shows less interest or

indicates caution.)

[Nonverbal Communication]

140. intimate(0-45cm): changing a dressing; bathing a patient

141. personal(45cm-1m): sitting at bedside, talking to
142. public(4m and greater): speaking or teaching class

143.Zones of Touch: - social zone (permission not

needed) hands, arms, shoulders, back

-

consent zone (permission

needed) mouth, wrists, feet

-

vulnerable zone (special care

needed) face, neck, front of body

-

intimate zone (great sensitivity

needed) genitalia, rectum

144.what are facial expression, posture, gait, personal space and eye contact

all part of?: non verbal communication

145.interpersonal communication process:

trust respect

intimac

y

power

empat

hy

146.Why do nurses need to communication in a professional manner with

both patients and colleagues?: to evoke trustworthiness and

competence

147.gender: male / female: males use less

verbal females tend to disclose more info

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summarizing, silence, delaying responses, body language, posture

congruence, probing, staying on topic, empathy

149.open-ended questions: questions a person is to answer in his or her

own words

150. closed ended: yes or no

151.clarifying questions: ensuring that your understanding is accurate,

asking for more

152.validation of communication: The listener confirmed understanding

of the message, showing you were there

153.giving false assurance: -might give patients the impression that

things are going to turn out well even when knowing the chances are

not good

154.why is ineffective communication a problem that nurses need to be

aware of?: it may lead to adverse patient events

155. aphasia: loss of speech, impairment of language

156. receptive: open and responsive to ideas or suggestions

157.Non-therapeutic communication: asking personal questions, giving

personal opinions, changing the subject, automatic responses,

sympathy, asking for ex- planations, approval or disapproval, defensive

responses, passive or aggressive responses, and arguing.

158.Near Miss Incident: an incident that did not reach the patient(no harm

result- ed)

159.No Harm Incident: an incident that reached the patient, but no

discernible harm resulted

160.environmental factors of individuals safety: home,work, community,

health care setting

161. safety culture in organized practices: disclosing safety incidents to

clients

162.identifying safety risks inherent in the client population: falls

prevention, suicide assessment, pressure injury risks Braden scale

163.unintentional injuries are leading cause of death between 1 and 14 years

old: often relayed to normal growth and development, small children

curious and trusting of their environment/ do not perceive themselves

in danger

164. toddlers and preschoolers: attracted to water: greatest risk for

drowning

165.pressure ulcer risk assessment Braden scale: higher the score, lower

the risk of pressure ulcer development

166. what is the number 1 reported incident?: falls.
167. Code Green: evacuation

168.every time when giving meds, always check: 3 times the medication

before you give it and 2 patient identifiers before you give it

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170.effects of exercise on gastrointestinal: Increase appetite, increase

intestinal tone.

171.effects of exercise on urinary: blood flow to

kidneys effieiency in maintaining f & e balance

and excretion

172.metabolic effects of excersise: efficiency of metabolism and body

temp regulation

173. adolescence: the time period between the beginning of puberty

and adulthood

174.effects of excersise on psychological well being: increased energy,

sleep, positive health behaviours

175.hypostatic pneumonia: inflammation of the lung from stasis or

pooling of secretions, complication of immobility and is worse in

smokers

176.crepitation: the grating sound heard when the ends of a broken

bone move together

177.how can fatigue be reduced?: performing activities more slowly

and for shorter period

178.restorative care: Nursing care that is planned to promote residents

health and regain as much of their independence as possible

179.decreased metabolic rate, alters metabolism of: carbohydrates, fats,

pro- teins

180.musculoskeletal interventions: ROM- active or passive, 2-3 times

daily CPM therapy for orthopedic conditions

181.metabolic interventions: repair of injured tissue protein, calories

vitamin c to replace protein stores, vitamin b for skin integrity and

wound healing.

182.respiratory interventions: change position

q2h deep breathing and coughing

incentive spirometer

increase fluid

intake chest

physio consult

183.Gastrointestinal interventions: assess BS(bowel sounds), frequency

and consistency of BM(bowel movement) diet. rich in fluids, fruits,

vegetables, and fiber stool softeners, laxatives, and enemas as ordered

184. why are aboriginal blood pressures higher?: greater risk at cardiac

disease

185. how mnany hours of sleep is important for brain rest?: 8 hours
186. Stages of sleep: 1. Lightest Sleep (NREM) 2. Slightly Deeper Sleep

(NREM)

3. Deeper Sleep (NREM) 4. Delta Waves are omitted but there is not

much difference between this stage and stage 3 (NREM) 5. REM

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sleep deprivation

189.sleep apnea: a disorder in which the person stops breathing for brief

periods while asleep for at least 10 sec with no breathing

190.obstructive sleep apnea: muscles or structures of oral cavity or

throat relax during sleep, collapse of upper airway and breathing stop

10-30 sec

191.central apnea: occurs when the brain fails to stimulate breathing

muscles, causing brief pauses in breathing.

192.Narcolepsy: A sleep disorder characterized by uncontrollable sleep

attacks. The sufferer may lapse directly into REM sleep, often at

inopportune times.

193.Parasomnias: Abnormal behaviors such as nightmares or

sleepwalking that occur during sleep.

194. infants and toddlers need amount of sleep?: 12-14 hours per

day

195. school aged children need amount of sleep?: 9-10 hours
196. young adults need amount of sleep?: 6-81/2 hours

197. always give diuretics in morning and not at: night or early evening

198.Electronic Health Record (EHR): enhances communication among

health care providers and patient safety

199. records are retained for a minimum of: 10 years

200.what is one way a nurse violates the nurse client relationship?: when

we don't listen

201.how does a nurse show there listening?: eye contact, arms uncrossed,

facial expressions, touch, warmth

202.what are the client consequences of not being listened to according to

the article?: depression, frustration, complaints about care, erupt and

not caring

203.What happened in a recent corners report when a client was not listened

to?: a man died due to a med error because client was not listening

when he said it did not look like the pills he received before and no

double check was made

204. increased urination diet/fluid balance: caffeine and alcohol

205.physiological factors of urination?: age, muscle tone, activity, pain,

anxiety, and stress

206.Sociocultural factors of urination?: lifestyle, cultural, gender, and

religous practices

207.pathological conditions of urination: neurological disease, altered

mobility, renal disease

208.medications for urination: •Diuretics: prevent reabsorption of water

and cer- tain electrolytes in tubules

209. Urinary tract infections are more common in .:

women

210.urinary tract infection: common hospital acquired infection, common

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211.causes of urinary tract infections: not peeing after

sex bacteria

catheters

212. urinary incontinence: the inability to control the

voiding of urine

213. nocturia: excessive urination during the night
214. urinary retention: inability to empty the bladder
215. urostomy or ileal conduit: causes cancer, trauma
216. uremic syndrome: increase in nitrogenous wastes

in the blood

217. Olguria: low urine output
218. anuria: absence of urine
219. polyuria: frequent urination
220. dysuria: painful or difficult urination
221. hematuria: blood in the urine
222. prolapsed bladder or cystoceles: bladder falls into

the vagina

223.renal failure: loss of kidney function resulting in its inability to

remove waste products from the body and maintain electrolyte

balance

224. enuresis: bed wetting
225. Hesitency: delay in start of urinary stream when voiding
226. minimum amount of urine we want is?: 720mls/24 hours 30ml an

hour

227. color of urine: straw, amber, transparent
228. percussion of kidneys: flank tenderness, pain if kidneys infected or

inflamed

229. characteristics of urine: color, odor, turbidity, pH, specific

gravity,gluclose

230. Normal adult urine output: 1200-1500 mL/day, 50-60 mL/hour
231. clarity of urine: clearness, should be able to see thru
232. pH of urine: 4.6-8.0 (average 6.0)
233. what should not be in uterine: protein, glucose, blood and etc.
234. normal amount urination per day: 60-120ml per hour

235.Urostomy: a surgical procedure where users are brought through the

abdom- inal wall to carry urine out of there body

236. urine from a urostomy: often full of mucous which is effective and

normal

237.overflow urinary incontinence: a mechanical dysfunction resulting

from an over distended bladder.

238.stress urinary incontinence: leakage due to increased intra abdominal

pres- sure from coughing, laughing, etc.

239.urge urinary incontinence: the inability to hold urine once the urge

to void occurs.

240. residual urine: urine that remains in the bladder after urination-

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