study guide final exam (brief)

1. Discuss the risk factors for complications of the patient undergoing surgery. (Ch. 50, pp. 1369-1375)
-age, nutrition, obesity, obstructive sleep apnea, immunocompromise, F&E imbalance, pregnancy, medical history, lifestyle choices, and socioeconomic factors

2. Discuss the signs and symptoms of the patient experiencing dyspnea. (Ch. 40, pg. 920)
-clinical sign of poor tissue perfusion marked by shortness of breath
*exaggerated respiratory effort, increased depth and RR, and activity intolerance

3. Discuss the nurse’s responsibility to safe medication administration. (Ch. 35, pg. 687)
-evaluate the effects of medications on health status
-teach patients about medications and side effects
-ensuring adherence with medication regimen
-evaluate client’s ability to self-administer

4. Discuss the responsibility of the nurse when a medication error has occurred. (Ch. 35, pg. 705)
-prepare written occurrence report or incident report to be filed within 24 hours
-feel comfortable and fear no repercussions; safety of the patient first

5. Discuss the nursing actions that will maintain dignity and respect to patients.
-good communication skills
-following through
-knowledgeable

6. Discuss the nursing interventions to promote communication with a patient with aphasia. (Ch. 24, Table 24-10)
-be patient and attentive
-ask simple questions, allowing time to answer
-encourage conversation
-do no speak loudly
-use communication aids and collaborate with speech therapists
-let patient know if you do not understand

7. Discuss the purpose of the implementation phase of the nursing process. (Ch. 19, pg. 279)
-achieve goals and expected outcomes to support or improve the patient’s health status

8. Discuss the purpose of open-ended questions when obtaining subjective data. Provide examples. (Ch. 16, pg. 239)
-technique leads to the patient actively describe their health status and strenghthen the nurse-client relationship
*tell me how you are feeling
*your discomfort affects your ability to get around in what way
*describe how your wife has been helping you
*give me an example of how you get relief from your pain at home

9. Discuss the nursing interventions to prevent vascular complications for an immobile patient. (Ch. 47, pg. 1247)
-mobilize the patient as soon as their physical condition allows for them to do so
-teach client to breathe out while repositioning themselves in bed
-lower extremity exercises, frequent fluids, and position changes

10. Differentiate between evaluation and assessment. (Ch. 20, pg. 291).
-evaluation is ongoing and whenever there is contact with the patient
-to compare the status before the assessment stage and after a nursing intervention to redirect nursing care if necessary

11. Explain autonomy. Provide examples. (Ch. 24, pg. 348 and Ch. 22, pg. 314)
-self-direction of nurses to make choices and accept outcomes of action like owning medication errors if they occur
-inclusion of patients in all aspects of care like signing consent forms before surgery

12. Discuss the nursing responsibilities for the patient while in the PACU. (Ch. 50, pg. 1394)
-focuses on monitoring and maintaining airway, respiratory, circulatory, and neurological status and on managing pain

13. Discuss strategies to ensure safe administration of medication. (Ch. 35, pp. 705-709)
-standards: right medication, right dose, right client, right route, right time, right documentation
-medical reconciliation: verify client’s current list of medications, clarify the list is accurate with as many people as necessary, reconcile discrepancies between new medication orders and current medications, and transmit updated and verified list to caregives and client

14. Discuss the assessment needed for the patient with fluid imbalance. (Ch. 41, pp. 978-984)
-age
-medical history including present medication
-lifestyle
-socioeconomic factors
-daily weights and I&Os

15. List the criteria for writing a correct outcome or goal. (Ch. 18, pg. 265-267)
-client centered and is specific and measureable reflecting wellness and independence
-realistic
-mutually set by nurse and patient

16. Discuss the criteria needed for writing an accurate nursing diagnosis. (Ch. 17, pg. 252)
-client centered problem based on validated objective and subjective data
-within nursing scope of practice
-includes diagnostic label, related factor (related to…), and etiology (as evidenced by…)

17. Discuss strategies that promote effective communication. (Ch. 24, pp. 348-355)
-use therapeutic communication techniques
-use active listening
-use professional communication
-provide comfortable and safe environment with favorable conditions

18. Discuss the role of the health care team when developing an initial plan of care. (Ch. 18, pp. 268-269)
-which interventions will be dependent nursing interventions
-communicate nursing care priorities to other health care professionals

19. Compare and contrast legal decision making and ethical and moral principles. (Ch. 22, pp. 314- and Ch. 23, pp. 328-332)
-legal decision making: advance directives, standards of care, informed consent, mental health parity act
-ethical and moral principles: autonomy, benefiecience, maleficience, justice and fidelity; code of ethics including advocacy, responsibility, accountability, and confidentiality

20. Discuss the nursing care of the patient with a urinary catheter. (Ch. 45, Table 45-3)
-prevent bacterial growth
-promote comfort, check for displacement
-assess purpose and need for catheter

21. Discuss the patient education needed for the patient scheduled for surgery. (Ch. 50, pp. 1379-1380, 1386)
-understand pre-op instructions and exercises
-state the time of surgery
-understand to post-op location and where family will be able to wait during and after surgery
-understand the post-op monitoring and therapy
-understand surgical procedures and post-op treatment
-understand post-op activity resumption
-understand pain-relief measures
-can openly express feelings about surgery

22. Discuss the nursing care of the patient who is confused. (Ch. 41, pp. 973-974)
-may be evidence of electrolyte imbalance
*monitor I&Os, daily weights, vital signs…
*per physician order: correct imbalance by administering diuretic or IV fluid electrolytes

23. Discuss the complications of general anesthesia. (Ch. 50, pg. 1392)
-side effects of anesthetic agents like cardiovascular depression or irritability, respiratory depression, and liver/kidney damage

24. Discuss the nursing interventions to prevent thrombophlebitis in the post-operative patient. (Ch. 50, pp. 1401-1403)
-leg exercises unless contraindicated
-apply stocking or devices to prevent circulatory stasis
-encourage ambulation as soon as possible after monitoring vital signs and safety measures
-reposition effectively
-anticoagulant drugs as ordered
-adequate hydration

25. Discuss the risk factors of the elderly patient undergoing surgery. (Ch. 50, Table 50-4)
-reduced cardiac function, skin integrity, respiratory function, renal function, metabolic function and sensory loss
-good vs. harm of patient going to surgery

26. Discuss the assessment needed for the patient with diarrhea. (Ch. 46, pp. 1185-1188)
-assess frequency, volume, and consistency
-inspect mouth and abdomen
-assess usual elimination patterns of patient

27. Discuss the nursing interventions for the patient with impaired skin integrity. (Ch. 48, pp. 1301-1305)
-maintain skin care, reposition to improve circulation and use devices if necessary to avoid further impairing skin integritry and educate the patient

28. Discuss causes of bradycardia. (Ch. 40, pp. 918-922)
-age, lifestyle choices, and socioeconomic factors may cause decreased elasticity of heart muscle, thicker and stiffer heart valves, and calcification of vessels

29. Discuss the assessment needed for the patient with the diagnosis of Activity Intolerance. (Ch. 47, pg. 1240)
-extent of ROM, ability to perform ADLs, varying degrees of pain perception/tolerance before and during activity

30. Discuss the signs and symptoms of severe hypoxia/hypoxemia. (Ch. 40, pg. 917)
-cyanosis, declined RR, low SpO2 as a result of respiratory fatigue

31. Discuss the nursing interventions needed to promote oxygenation of the post-operative patient. (Ch. 50, pg. 1401)
-breathing exercises: diaphragmatic breathing, coughing exercises, and incentive spirometer
-use respiratory devices when/if patient uses them at home or oxygen if ordered
-promote comfort: assist in turning and oral hygiene
-remove secretions

32. Discuss the preparation needed to safely transfer the patient to the operating room. (Ch. 50, pp. 1389-1391)
-use stretcher
-double checks for identification
-standards to prevent falls; rails up after medication administration
-void before surgery

33. Discuss the nursing interventions needed to promote ambulation. (Ch. 47, pp. 1246-1275)
-maintain circulation and muscle use to prevent ambulation complications
*ROM exercises, repositioning, breathing exercises, devices designed to improve circulation

34. Discuss the assessment needed for the patient who has been on bed rest and has an order to begin ambulation. (Ch. 47, pg. 1230-1237)
-assess mobility of the patient including range of motion, gait, exercise/activity tolerance, and body alignment
-ask or observe
-assess to protect patient safety: orthostatic hypotension

35. Discuss the purpose of bed rest. (Ch. 47, pg. 1225)
-reduce physical activity and oxygen needs of the body
-reduce pain
-allow ill or debilitated patients to rest
-allow exhausted patients uninterrupted rest

36. Discuss the correct procedure for administering a subcutaneous medication. (Ch. 35, pp. 744-750)
-use the rights of medication administration before giving injection and assess purpose and need for medication
*draw up syringe, cleanse proper injection site, pinch site and inject at 45-90 degree angle
*DO NOT RUB HEPARIN

37. Discuss the nursing care for the post-operative patient who had a nasogastric tube. (Ch. 50, 1404-1405)
-for decompression, not feeding, because stomach becomes paralyzed after surgery
-listen to BS, look BM, distension
-safely remove stomach contents to provide comfort for patient

38. Discuss the purpose of using an assistive device when moving patients. (Ch. 47, pg. 1224)
-reduce number of work-related injuries
-avoid unnecessary injury to nurse and patient

39. Discuss the correct procedure for suctioning a patient. (Ch. 40, pp. 934-941)
-suction to clear secretions a patient is unable to produce or clear

40. Discuss the physiological effects of prolonged bed rest. (Ch. 47, pg. 1239)
-poor circulation and muscle weakness
*slow wound healing, slowed or impaired GI/GU activity, activity intolerance, impaired respiration, lack of ROM, and muscle/fat loss

41. Discuss dependent nursing interventions for the patient experiencing nausea. (Ch. 41, pg. 975)
-may be evidence of fluid volume deficit or excess
*per physician order: diuretics, administering IV fluids, blood transfusions, laboratory tests…

42. Dosage and Calculations (Ch. 35, pp. 696- 698)
Can you calculate pills/tablets/injections?
-(dose ordered)/(dose on hand) x amount on hand = amount to administer
Can you calculate safe dosage ranges?
Can you safely administer medication (using the correct equipment)?

43. Can you utilize the nursing process given a specific case scenario?