FUNDAMENTAL NURSING BULLETS - 7

1. The nurse should provide honest answers to the patient’s questions.

2. Milk shouldn’t be included in a clear liquid diet.

3. When caring for an infant, a child, or a confused patient, consistency in nursing personnel is paramount.

4. The hypothalamus secretes vasopressin and oxytocin, which are stored in the pituitary gland.

5. The three membranes that enclose the brain and spinal cord are the dura mater, pia mater, and arachnoid.

6. A nasogastric tube is used to remove fluid and gas from the small intestine preoperatively or postoperatively.

7. Psychologists, physical therapists, and chiropractors aren’t authorized to write prescriptions for drugs.

8. The area around a stoma is cleaned with mild soap and water.

9. Vegetables have a high fiber content.

10. The nurse should use a tuberculin syringe to administer a subcutaneous injection of less than 1 ml.

11. For adults, subcutaneous injections require a 25G 1″ needle; for infants, children, elderly, or very thin patients, they require a 25G to 27G ½” needle.

12. Before administering a drug, the nurse should identify the patient by checking the identification band and asking the patient to state his name.

13. To clean the skin before an injection, the nurse uses a sterile alcohol swab to wipe from the center of the site outward in a circular motion.

14. The nurse should inject heparin deep into subcutaneous tissue at a 90-degree angle (perpendicular to the skin) to prevent skin irritation.

15. If blood is aspirated into the syringe before an I.M. injection, the nurse should withdraw the needle, prepare another syringe, and repeat the procedure.

16. The nurse shouldn’t cut the patient’s hair without written consent from the patient or an appropriate relative.

17. If bleeding occurs after an injection, the nurse should apply pressure until the bleeding stops. If bruising occurs, the nurse should monitor the site for an enlarging hematoma.

18. When providing hair and scalp care, the nurse should begin combing at the end of the hair and work toward the head.

19. The frequency of patient hair care depends on the length and texture of the hair, the duration of hospitalization, and the patient’s condition.

20. Proper function of a hearing aid requires careful handling during insertion and removal, regular cleaning of the ear piece to prevent wax buildup, and prompt replacement of dead batteries.

21. The hearing aid that’s marked with a blue dot is for the left ear; the one with a red dot is for the right ear.

22. A hearing aid shouldn’t be exposed to heat or humidity and shouldn’t be immersed in water.

23. The nurse should instruct the patient to avoid using hair spray while wearing a hearing aid.

24. The five branches of pharmacology are pharmacokinetics, pharmacodynamics, pharmacotherapeutics, toxicology, and pharmacognosy. 25. The nurse should remove heel protectors every 8 hours to inspect the foot for signs of skin breakdown.

26. Heat is applied to promote vasodilation, which reduces pain caused by inflammation.

27. A sutured surgical incision is an example of healing by first intention (healing directly, without granulation).

28. Healing by secondary intention (healing by granulation) is closure of the wound when granulation tissue fills the defect and allows reepithelialization to occur, beginning at the wound edges and continuing to the center, until the entire wound is covered.

29. Keloid formation is an abnormality in healing that’s characterized by overgrowth of scar tissue at the wound site.

30. The nurse should administer procaine penicillin by deep I.M. injection in the upper outer portion of the buttocks in the adult or in the midlateral thigh in the child. The nurse shouldn’t massage the injection site.

31. An ascending colostomy drains fluid feces. A descending colostomy drains solid fecal matter.

32. A folded towel (scrotal bridge) can provide scrotal support for the patient with scrotal edema caused by vasectomy, epididymitis, or orchitis.

33. When giving an injection to a patient who has a bleeding disorder, the nurse should use a small-gauge needle and apply pressure to the site for 5 minutes after the injection.

34. Platelets are the smallest and most fragile formed element of the blood and are essential for coagulation.

35. To insert a nasogastric tube, the nurse instructs the patient to tilt the head back slightly and then inserts the tube. When the nurse feels the tube curving at the pharynx, the nurse should tell the patient to tilt the head forward to close the trachea and open the esophagus by swallowing. (Sips of water can facilitate this action.)

36. Families with loved ones in intensive care units report that their four most important needs are to have their questions answered honestly, to be assured that the best possible care is being provided, to know the patient’s prognosis, and to feel that there is hope of recovery.

37. Double-bind communication occurs when the verbal message contradicts the nonverbal message and the receiver is unsure of which message to respond to.

38. A nonjudgmental attitude displayed by a nurse shows that she neither approves nor disapproves of the patient.

39. Target symptoms are those that the patient finds most distressing.

40. A patient should be advised to take aspirin on an empty stomach, with a full glass of water, and should avoid acidic foods such as coffee, citrus fruits, and cola.

41. For every patient problem, there is a nursing diagnosis; for every nursing diagnosis, there is a goal; and for every goal, there are interventions designed to make the goal a reality. The keys to answering examination questions correctly are identifying the problem presented, formulating a goal for the problem, and selecting the intervention from the choices provided that will enable the patient to reach that goal.

42. Fidelity means loyalty and can be shown as a commitment to the profession of nursing and to the patient.

43. Administering an I.M. injection against the patient’s will and without legal authority is battery.

44. An example of a third-party payer is an insurance company.

45. The formula for calculating the drops per minute for an I.V. infusion is as follows: (volume to be infused × drip factor) ÷ time in minutes = drops/minute

46. On-call medication should be given within 5 minutes of the call.

47. Usually, the best method to determine a patient’s cultural or spiritual needs is to ask him.

48. An incident report or unusual occurrence report isn’t part of a patient’s record, but is an in-house document that’s used for the purpose of correcting the problem.

49. Critical pathways are a multidisciplinary guideline for patient care.

50. When prioritizing nursing diagnoses, the following hierarchy should be used: Problems associated with the airway, those concerning breathing, and those related to circulation