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

FUNDAMENTAL NURSING BULLETS - 6

1. After turning a patient, the nurse should document the position used, the time that the patient was turned, and the findings of skin assessment.

2. PERRLA is an abbreviation for normal pupil assessment findings: pupils equal, round, and reactive to light with accommodation.

3. When percussing a patient’s chest for postural drainage, the nurse’s hands should be cupped.

4. When measuring a patient’s pulse, the nurse should assess its rate, rhythm, quality, and strength.

5. Before transferring a patient from a bed to a wheelchair, the nurse should push the wheelchair footrests to the sides and lock its wheels.

6. When assessing respirations, the nurse should document their rate, rhythm, depth, and quality.

7. For a subcutaneous injection, the nurse should use a 5/8″ 25G needle.

8. The notation “AA & O × 3” indicates that the patient is awake, alert, and oriented to person (knows who he is), place (knows where he is), and time (knows the date and time).

9. Fluid intake includes all fluids taken by mouth, including foods that are liquid at room temperature, such as gelatin, custard, and ice cream; I.V. fluids; and fluids administered in feeding tubes. Fluid output includes urine, vomitus, and drainage (such as from a nasogastric tube or from a wound) as well as blood loss, diarrhea or feces, and perspiration.

10. After administering an intradermal injection, the nurse shouldn’t massage the area because massage can irritate the site and interfere with results.

11. When administering an intradermal injection, the nurse should hold the syringe almost flat against the patient’s skin (at about a 15-degree angle), with the Level up.

12. To obtain an accurate blood pressure, the nurse should inflate the manometer to 20 to 30 mm Hg above the disappearance of the radial pulse before releasing the cuff pressure.

13. The nurse should count an irregular pulse for 1 full minute.

14. A patient who is vomiting while lying down should be placed in a lateral position to prevent aspiration of vomitus.

15. Prophylaxis is disease prevention.

16. Body alignment is achieved when body parts are in proper relation to their natural position.

17. Trust is the foundation of a nurse-patient relationship.

18. Blood pressure is the force exerted by the circulating volume of blood on the arterial walls.

19. Malpractice is a professional’s wrongful conduct, improper discharge of duties, or failure to meet standards of care that causes harm to another.

20. As a general rule, nurses can’t refuse a patient care assignment; however, in most states, they may refuse to participate in abortions.

21. A nurse can be found negligent if a patient is injured because the nurse failed to perform a duty that a reasonable and prudent person would perform or because the nurse performed an act that a reasonable and prudent person wouldn’t perform.

22. States have enacted Good Samaritan laws to encourage professionals to provide medical assistance at the scene of an accident without fear of a lawsuit arising from the assistance. These laws don’t apply to care provided in a health care facility.

23. A physician should sign verbal and telephone orders within the time established by facility policy, usually 24 hours.

24. A competent adult has the right to refuse lifesaving medical treatment; however, the individual should be fully informed of the consequences of his refusal.

25. Although a patient’s health record, or chart, is the health care facility’s physical property, its contents belong to the patient.

26. Before a patient’s health record can be released to a third party, the patient or the patient’s legal guardian must give written consent.

27. Under the Controlled Substances Act, every dose of a controlled drug that’s dispensed by the pharmacy must be accounted for, whether the dose was administered to a patient or discarded accidentally.

28. A nurse can’t perform duties that violate a rule or regulation established by a state licensing board, even if they are authorized by a health care facility or physician.

29. To minimize interruptions during a patient interview, the nurse should select a private room, preferably one with a door that can be closed.

30. In categorizing nursing diagnoses, the nurse addresses life-threatening problems first, followed by potentially life-threatening concerns.

31. The major components of a nursing care plan are outcome criteria (patient goals) and nursing interventions.

32. Standing orders, or protocols, establish guidelines for treating a specific disease or set of symptoms.

33. In assessing a patient’s heart, the nurse normally finds the point of maximal impulse at the fifth intercostal space, near the apex.

34. The S1 heard on auscultation is caused by closure of the mitral and tricuspid valves.

35. To maintain package sterility, the nurse should open a wrapper’s top flap away from the body, open each side flap by touching only the outer part of the wrapper, and open the final flap by grasping the turned-down corner and pulling it toward the body.

36. The nurse shouldn’t dry a patient’s ear canal or remove wax with a cotton-tipped applicator because it may force cerumen against the tympanic membrane.

37. A patient’s identification bracelet should remain in place until the patient has been discharged from the health care facility and has left the premises.

38. The Controlled Substances Act designated five categories, or  schedules, that classify controlled drugs according to their abuse potential.
39. Schedule I drugs, such as heroin, have a high abuse potential and have no currently accepted medical use in the United States.

40. Schedule II drugs, such as morphine, opium, and meperidine (Demerol), have a high abuse potential, but currently have accepted medical uses. Their use may lead to physical or psychological dependence.

41. Schedule III drugs, such as paregoric and butabarbital (Butisol), have a lower abuse potential than Schedule I or II drugs. Abuse of Schedule III drugs may lead to moderate or low physical or psychological dependence, or both.

42. Schedule IV drugs, such as chloral hydrate, have a low abuse potential compared with Schedule III drugs.

43. Schedule V drugs, such as cough syrups that contain codeine, have the lowest abuse potential of the controlled substances.

44. Activities of daily living are actions that the patient must perform every day to provide self-care and to interact with society.

45. Testing of the six cardinal fields of gaze evaluates the function of all extraocular muscles and cranial nerves III, IV, and VI.

46. The six types of heart murmurs are graded from 1 to 6. A grade 6 heart murmur can be heard with the stethoscope slightly raised from the chest.

47. The most important goal to include in a care plan is the patient’s goal.

48. Fruits are high in fiber and low in protein, and should be omitted from a low-residue diet.

49. The nurse should use an objective scale to assess and quantify pain. Postoperative pain varies greatly among individuals.

50. Postmortem care includes cleaning and preparing the deceased patient for family viewing, arranging transportation to the morgue or funeral home, and determining the disposition of belongings.

FUNDAMENTAL NURSING BULLETS- 5

1. 1.        Before signing an informed consent form, the patient should know whether other treatment options are available and should understand what will occur during the preoperative, intraoperative, and postoperative phases; the risks involved; and the possible complications. The patient should also have a general idea of the time required from surgery to recovery. In addition, he should have an opportunity to ask questions.
   
   
   2.        A patient must sign a separate informed consent form for each procedure.
   
   
   3.        During percussion, the nurse uses quick, sharp tapping of the fingers or hands against body surfaces to produce sounds. This procedure is done to determine the size, shape, position, and density of underlying organs and tissues; elicit tenderness; or assess reflexes.
   
   
   4.        Ballottement is a form of light palpation involving gentle, repetitive bouncing of tissues against the hand and feeling their rebound.
   
   
   5.        A foot cradle keeps bed linen off the patient’s feet to prevent skin irritation and breakdown, especially in a patient who has peripheral vascular disease or neuropathy.
   
   
   6.        Gastric lavage is flushing of the stomach and removal of ingested substances through a nasogastric tube. It’s used to treat poisoning or drug overdose.
   
   
   7.        During the evaluation step of the nursing process, the nurse assesses the patient’s response to therapy.
   
   
   8.        Bruits commonly indicate life- or limb-threatening vascular disease.
   
   
   9.        O.U. means each eye. O.D. is the right eye, and O.S. is the left eye.
   
   
   10.      To remove a patient’s artificial eye, the nurse depresses the lower lid.
   
   
   11.      The nurse should use a warm saline solution to clean an artificial eye.
   
   
   12.      A thready pulse is very fine and scarcely perceptible.
   
   
   13.      Axillary temperature is usually 1° F  lower than oral temperature.
   
   
   14.      After suctioning a tracheostomy tube, the nurse must document the color, amount, consistency, and odor of secretions.
   
   
   15.      On a drug prescription, the abbreviation p.c. means that the drug should be administered after meals.
   
   
   16.      After bladder irrigation, the nurse should document the amount, color, and clarity of the urine and the presence of clots or sediment.
   
   
   17.      After bladder irrigation, the nurse should document the amount, color, and clarity of the urine and the presence of clots or sediment.
   
   
   18.      Gauge is the inside diameter of a needle: the smaller the gauge, the larger the diameter.
   19.      An adult normally has 32 permanent teeth.
   20.      . A patient indicates that he’s coming to terms with having a chronic disease when he says, “I’m never going to get any better.”
   21.       In an infant, the normal hemoglobin value is 12 g/dl.
   22.      The nitrogen balance estimates the difference between the intake and use of protein.
   23.      Most of the absorption of water occurs in the large intestine.
   24.      Most nutrients are absorbed in the small intestine.
   25.      When assessing a patient’s eating habits, the nurse should ask, “What have you eaten in the last 24 hours?”
   26.      A vegan diet should include an abundant supply of fiber.
   27.       A hypotonic enema softens the feces, distends the colon, and stimulates peristalsis.
   28.      First-morning urine provides the best sample to measure glucose, ketone, pH, and specific gravity values.
   29.      To induce sleep, the first step is to minimize environmental stimuli.
   30.      Before moving a patient, the nurse should assess the patient’s physical abilities and ability to understand instructions as well as the amount of strength required to move the patient.
   31.       To avoid shearing force injury, a patient who is completely immobile is lifted on a sheet.
   32.       To insert a catheter from the nose through the trachea for suction, the nurse should ask the patient to swallow.
   33.       Vitamin C is needed for collagen production.
   34.      Only the patient can describe his pain accurately.
   35.      Cutaneous stimulation creates the release of endorphins that block the transmission of pain stimuli.
   36.       Patient-controlled analgesia is a safe method to relieve acute pain caused by surgical incision, traumatic injury, labor and delivery, or cancer.
   37.      The patient who believes in a scientific, or biomedical, approach to health is likely to expect a drug, treatment, or surgery to cure illness.
   38.       Chronic illnesses occur in very young as well as middle-aged and very old people.
   39.      School health programs provide cost-effective health care for low-income families and those who have no health insurance.
   40.       Abandonment is premature termination of treatment without the patient’s permission and without appropriate relief of symptoms.
   41.       Milk and milk products, poultry, grains, and fish are good sources of phosphate.
   42.      The best way to prevent falls at night in an oriented, but restless, elderly patient is to raise the side rails.
   43.       Falls in the elderly are likely to be caused by poor vision.
   44.       Barriers to communication include language deficits, sensory deficits, cognitive impairments, structural deficits, and paralysis.
   45.       The three elements that are necessary for a fire are heat, oxygen, and combustible material.
   46.      Sebaceous glands lubricate the skin.
   47.       To check for petechiae in a dark-skinned patient, the nurse should assess the oral mucosa.
   48.      To put on a sterile glove, the nurse should pick up the first glove at the folded border and adjust the fingers when both gloves are on.
   49.        Endorphins are morphine-like substances that produce a feeling of well-being.
   50.      Pain tolerance is the maximum amount and duration of pain that an individual is willing to endure.
                                    

FUNDAMENTAL NURSING 4

                                                       BULLET QUESTIONS - 4

1.        In adults, the most convenient veins for venipuncture are the basilic and median cubital veins in the antecubital space.

2.        Two to three hours before beginning a tube feeding, the nurse should aspirate the patient’s stomach contents to verify that gastric emptying is adequate.

3.        People with type O blood are considered universal donors.

4.        People with type AB blood are considered universal recipients.

5.        Hertz (Hz) is the unit of measurement of sound frequency.

6.        Hearing protection is required when the sound intensity exceeds 84 dB. Double hearing protection is required if it exceeds 104 dB.

7.        Prothrombin, a clotting factor, is produced in the liver.

8.        If a patient is menstruating when a urine sample is collected, the nurse should note this on the laboratory request.

9.        During lumbar puncture, the nurse must note the initial intracranial pressure and the color of the cerebrospinal fluid.

10.     If a patient can’t cough to provide a sputum sample for culture, a heated aerosol treatment can be used to help to obtain a sample.

11.     If eye ointment and eyedrops must be instilled in the same eye, the eyedrops should be instilled first.

12.     When leaving an isolation room, the nurse should remove her gloves before her mask because fewer pathogens are on the mask.

13.     Skeletal traction, which is applied to a bone with wire pins or tongs, is the most effective means of traction.

14.     The total parenteral nutrition solution should be stored in a refrigerator and removed 30 to 60 minutes before use. Delivery of a chilled solution can cause pain, hypothermia, venous spasm, and venous constriction.

15.     Drugs aren’t routinely injected intramuscularly into edematous tissue because they may not be absorbed.

16.     When caring for a comatose patient, the nurse should explain each action to the patient in a normal voice.

17.     Dentures should be cleaned in a sink that’s lined with a washcloth.

18.     A patient should void within 8 hours after surgery.

19.     An EEG identifies normal and abnormal brain waves.

20.     Samples of feces for ova and parasite tests should be delivered to the laboratory without delay and without refrigeration.

21.     The autonomic nervous system regulates the cardiovascular and respiratory systems.

22.     When providing tracheostomy care, the nurse should insert the catheter gently into the tracheostomy tube. When withdrawing the catheter, the nurse should apply intermittent suction for no more than 15 seconds and use a slight twisting motion.

23.     A low-residue diet includes such foods as roasted chicken, rice, and pasta.

24.     A rectal tube shouldn’t be inserted for longer than 20 minutes because it can irritate the rectal mucosa and cause loss of sphincter control.

25.     A patient’s bed bath should proceed in this order: face, neck, arms, hands, chest, abdomen, back, legs, perineum.

26.     To prevent injury when lifting and moving a patient, the nurse should primarily use the upper leg muscles.

27.     Patient preparation for cholecystography includes ingestion of a contrast medium and a low-fat evening meal.

28.     While an occupied bed is being changed, the patient should be covered with a bath blanket to promote warmth and prevent exposure.

29.     Anticipatory grief is mourning that occurs for an extended time when the patient realizes that death is inevitable.

30.     The following foods can alter the color of the feces: beets (red), cocoa (dark red or brown), licorice (black), spinach (green), and meat protein (dark brown).

31.     When preparing for a skull X-ray, the patient should remove all jewelry and dentures.

32.     The fight-or-flight response is a sympathetic nervous system response.

33.     Bronchovesicular breath sounds in peripheral lung fields are abnormal and suggest pneumonia.

34.     Wheezing is an abnormal, high-pitched breath sound that’s accentuated on expiration.

35.     Wax or a foreign body in the ear should be flushed out gently by irrigation with warm saline solution.

36.     If a patient complains that his hearing aid is “not working,” the nurse should check the switch first to see if it’s turned on and then check the batteries.

37.     The nurse should grade hyperactive biceps and triceps reflexes as +4.

38.     If two eye medications are prescribed for twice-daily instillation, they should be administered 5 minutes apart.

39.     In a postoperative patient, forcing fluids helps prevent constipation.

40.     A nurse must provide care in accordance with standards of care established by the American Nurses Association, state regulations, and facility policy.

41.     The kilocalorie (kcal) is a unit of energy measurement that represents the amount of heat needed to raise the temperature of 1 kilogram of water 1° C.

42.     As nutrients move through the body, they undergo ingestion, digestion, absorption, transport, cell metabolism, and excretion.

43.     The body metabolizes alcohol at a fixed rate, regardless of serum concentration.

44.     In an alcoholic beverage, proof reflects the percentage of alcohol multiplied by 2. For example, a 100-proof beverage contains 50% alcohol.

45.     A living will is a witnessed document that states a patient’s desire for certain types of care and treatment. These decisions are based on the patient’s wishes and views on quality of life.

46.     The nurse should flush a peripheral heparin lock every 8 hours (if it wasn’t used during the previous 8 hours) and as needed with normal saline solution to maintain patency.

47.     Quality assurance is a method of determining whether nursing actions and practices meet established standards.

48.     The five rights of medication administration are the right patient, right drug, right dose, right route of administration, and right time.

49.     The evaluation phase of the nursing process is to determine whether nursing interventions have enabled the patient to meet the desired goals.

50.     Outside of the hospital setting, only the sublingual and translingual forms of nitroglycerin should be used to relieve acute anginal attacks.