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Nursing exam 1


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The nurse who is subservient to the doctor, following orders without questioning and providing physical care is an example of
What are some images of nurses through the decades?
angel of mercy, handmaiden, battle-ax, naughty nurse, military battlefield caregiver
who is seen as the start of the nursing profession?
florence nightingale
observing, comparing, contrasting and evaluating a client's condition is known as
clinical judgement
what is critical thinking?
collecting and analyzing information and considering the options for action
problem solving is:
considering an issue and attempting to find a solution
The ANA's definition of nursing is:
the diagnosis and treatment of human responses to actual and potential health problems
why do we need to define nursing?
to help the public understand nursing, to help students understand what is expected of them, to help explain the differences of nursing from medicine
Identify florence nightingale's 5 major contributions to nursing?
1. establish nursing as a distinct profession 2. introduce a broad-based liberal education for nurses 3. major reform in the delivery of care in hospitals 4. introductions of standards to control the spread of disease in hospitals 5. major reforms in health care for the military
to be considered a discipline, a profession must have a _________ that has theoretical and practical bounds
domain of knowledge
who can registered nurses delegated and supervise?
unlicensed assistive personnel and LPNs
In the US, the practice of nursing is regulated by:
state nurse practice acts
The purpose of nursing care is to achieve the goals of what 4 things?
health promotion, illness prevention, health restoration and end-of-life care
Patricia Brenner came up with 5 stages of nursing competence. What are they?
1. Novice 2. Advanced Beginner 3. Competence 4. Proficient 5. Expert
As a student nurse, what level are you?
As a graduate nurse, what level are you?
Advanced beginner
Someone who has been a nurse for several years is at the level of:
this goal focuses on the avoidance of disease
illness prevention
activities that foster a return to health for those already ill is:
health restoration
activities that foster the highest state of well-being of the recipient is
health promotion
what are the 3 programs to get into nursing?
diploma (3 yrs), associate's (2 yrs), or bachelor's (4 yrs)
what does a DNS degree do?
Doctorate of Nursing, it prepares for advanced clinical practice
What is a PhD in nursing?
research degree
Continuing education is:
maintaining current clinical knowledge
In-service education is:
offered at the work site
What is the international honor society for nursing?
Sigma Theta Tau International
What are the 6 essential features of nursing according to ANA?
1. relationship that facilitates health and healing 2. attention to human experiences and responses 3. integration of objective data w/knowledge gained 4. application of scientific knowledge 5. advancement of nursing knowledge 6. influence of policy to promote social justice
where are 5 places nurses work?
hospitals, extended care facilities, ambulatory care (outpatient), home care, community health
what are some forces outside nursing that influence nursing practice?
economy, consumers, direct-to-consumer marketing, legislation, women's movement, groups & unions
what are forces within health care that influence the nursing profession?
increased use of UAP, increased variety of work settings, increased use of alternative medicine, nurses' ability to influence healthcare policies, use of technology
males comprise what percent of the nursing profession?
what are morals
private, personal, or group standards of right and wrong
the study or right and wrong in situations involving morals and values is
sources of ethical problems for nurses can be:
informed consent, using technology, differing ethics throughout different cultures, patient advocacy
advocacy is:
communication and defense of the rights and interests of another
what is moral distress?
inability to carry out a moral decision
what is moral outrage?
the the belief that others are acing immorally
what is whistleblowing?
identifying an unethical or illegal situation and reporting it to an authority (ex: your coworker is drunk)
attitudes are your _______ toward something
autonomy is:
right to choose
nonmaleficence is:
do no harm
fidelity is:
keeping promises
veracity is:
duty to tell the truth
justice is:
obligation to be fair
what is consequentialism?
right or wrong is dependent on the consequences
utilitarianism is
the principle of utility - an act must result in the greatest good for the greatest amount of people (ex: having kids vaccinated against diphtheria)
deontology means something is right or wrong regardless of the
formal statements of a group's expectations and standards for professional behavior accepted by it's members is
a professional code of ethics
an ethical dilemma is
choosing between 2 bad choices
the system of ethical decision making is known as
what does the state board of nursing use to evaluate a nurse's ethical behavior?
nursing code of ethics
what is the MORAL model?
a decision making model 1. massage the dilemma 2. outline the options 3. resolve the dilemma 4. act by applying the chosen option 5. look back and evaluate
what is the ANA standards of care code?
1. practices with compassion and respect 2. primary commitment is the patient 3. promotes, advocates, strives for the health, safety and rights of the patient 4. responsible and accountable for individual nursing practice 5. nurse owes the same duties to self as to others 6. participates in establishing, maintaining, improving health care environment 7. nurse participates in advancing the profession 8. nurse collaborates with other professionals 9. nursing articulates nursing values to maintain integrity of the profession
what is an infection
when microorganisms capable of producing disease invade the body
what are the 6 links of infection?
infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host
what are the 2 possible infectious agents
pathogens and normal flora
a reservoir is
where pathogens live and multiply
can a reservoir be non-living?
yes - food, floors, equipment
what is a common portal of exit
bodily fluids, coughing, sneezing, diarrhea, wounds, tubes, IV lines
direct modes of transmission are
touching, kissing, sexual contact
indirect contact examples are
contact with a fomite (inanimate object like a toilet seat)
3 major modes of transmission
contact, droplet, airborne
what are common portals of entry?
eyes, nares, mouth, vagina, cuts, scrapes, wounds, IV sites, bites
a susceptible host is usually a person who
has an inadequate defense system
the 3 determining factors to a susceptible host are
virulence (how strong pathogen is), number of organisms, and the host's defenses
what are the 5 stages of infection?
1. incubation 2. prodromal 3. illness 4. decline 5. convalescence
during what stage is a person the most contagious?
incubation is the time period of:
infection to the manifestation of symptoms
the prodromal stage is:
the appearance of vague symptoms, ie "just not feeling right"
do all diseases have all 5 stages of infection?
NO - some do not have the prodromal stage
what stage can death occur at?
what stage of infection does tissue repair occur and a person returns to health?
this is the stage where pathogens begin to decline
decline stage
what is a local infection?
an infection that occurs in a limited region of the body (like a UTI)
what is a systemic infection?
spread via blood or lymph and affects many regions of the body
and example of a deadly systemic infection is
how is a systemic infection spread?
through blood or lymph
what is an acute infection
rapid onset with short duration (common cold)
what is a chronic infection
slow development with a long duration (diabetes)
what is a latent infection
infection is present but there are no symptoms (HIV/AIDS)
what is a nosocomial infection?
an infection acquired in a health care facility
what is an endogenous nosocomial infection?
when a person's normal flora multiply and cause infection as a result of their treatment
what are primary defenses?
anatomical features that limit pathogen entry
what are examples of primary defenses?
intact skin, mucous membranes, tears (lysozyme), normal flora in GI tract, normal flora in urinary tract
what are secondary defenses?
biochemical processes activated by chemicals released by pathogens
what are examples of secondary defenses
phagocytosis, complement cascade, inflammation, fever
what is phagocytosis?
when white blood cells engulf and destroy an invading organisms
neutrophils, monocytes and eosinophils are all examples of what
white blood cells
a monocyte can become a
what is the complement cascade
1. blood proteins (called complement) trigger chemicals that attack the cell membranes and cause them to rupture 2. complement signals basophils to release histamine and cause inflammation
what is inflammation?
when histamine causes the dilations and increased permeability of blood vessels to increase the flow of phagocytes, oxygen, and nutrients to an area that needs help
a fever will trigger what kind of immune response?
a tertiary response
why do we get fevers?
it increases our metabolism and makes our bodies too warm for pathogens to multiply
what are 2 types of tertiary defenses?
humoral immunity and cell-mediated immunity
b-cells are lymphocytes grown where?
in the bone
t-cells are lymphocytes grown where?
what is humoral immunity and how does it work?
and immune response directly against a pathogen 1. helpter t-cells stimulate b-cells to produce antibodies 2. antibodies attack antigens and destroy them
antibodies are also known as
immunoglobulins (Ig)
phagocytosis, neutralization, agglutination, and activation of complement and inflammation are methods of destruction in what type of immunity?
what happens during agglutination?
2 antigens get tied up and clumped together to make is easier to spot by a leukocyte
IgM is produced when?
when first introduced to the antigen
IgG is what?
the most common immunoglobulin; is involved in recognizing memory cells that remember the antigen
which antibody is responsible for allergic reactions?
IgA does what?
secreted by mucous around body openings and pushes things away
IgD forms on the surface of _____ to trap potential pathogens
what is cell-mediated immunity?
the t-cell response; acts to destroy body cells that have become infected
what are cytotoxic t-cells?
direct assault killer cells
why are memory t-cells formed?
to respond to the same illness if it strikes again
these t-cells are though to stop the immune response when the infection is contained
suppressor t-cells
what are some factors that increase your infection risk?
1. age 2. breaks in the skin 3. illness/injury, chronic disease 4. smoking, substance abuse 5. multiple sex partners 6. medications that inhibit/decrease immune response (ex: chemo, organ transplants) 7. nursing/medical procedures
what are some factors that support a host's defenses?
adequate nutrition, balanced hygiene, rest/exercise, reducing stress, immunization
what is medical asepsis?
the site you're cleaning; decreases the potential for spread of infections
asepsis is promoted by
maintaining a clean environment, washing your hands, following CDC guidelines
wash your hands for at least ______ in a nonsurgical setting
15 seconds
wash your hands for ______ in a surgical setting
2-6 minutes
what temperature water should you use to wash your hands?
warm, NOT hot
why is it important to dry your hands after washing them?
to make sure you don't leave an area where bacteria could grow
standard precautions do what?
protect health-care workers from exposure, decreases the transmission of pathogens, protects clients from pathogens
what are contact precautions?
pathogen spread by direct contact; you need private room, clean gown and gloves before entering the room, disposal of all items in the room
what are droplet precautions?
pathogen is spread via moist droplets like coughing, sneezing, touching; same precautions as contact, but you wear a mask and eye protection within 3 feet of the client
what are airborne precautions?
pathogen spread through air; ventilation systems, shaking sheets, sweeping - same as contact precautions, but with special mask (must be fitted)
what is reverse isolation?
used with immune-compromised clients, protects the client from organisms - private room, mask, sterile gown and gloves.
how do we implement surgical asepsis?
sterile environment, equipment, attire, gloves, field, technique, surgical hand scrub
what kind of infection is a top 20 health problem in the US
nosocomial infections
how much liquid soap should you use when washing your hands?
3-5 mL
how should you dry your hands?
blot them dry
when can you not use hand sanitizer?
when your hands are soiled
rub antiseptic solution until
your hands and fingers are dry
when wearing a gown, where should your gloves be?
OVER the cuff of the gown with no skin showing
when removing your gown, should your gloves be on or off?
ON when you untie your waist, but OFF when you untie your neck
what does RACE stand for?
Rescue the patient Activate the alarm Confine the fire Extinguish the fire
What are the top 3 causes of accidental death in the US?
1. motor vehicle accidents 2. poisoning 3. falls
who is at the greatest risk for suffocation?
ages 0-4
what are the top safety hazards for health care workers?
back injury, needlestick injury, radiation injury, workplace violence
who is the most at risk for falls?
infants and older adults
what are important measures to take for fall prevention?
perform fall risk assessment, place the call light within reach, orient the person to the surroundings, place a disoriented patient near the nurse's station, keep the bed in a lowered position, nonskid slippers
what do you need to restrain a patient?
a physician's order
if you see a person in trouble, what is the first thing you should do?
ask the person if they are "ok," don't assume they are not and start rescue treatments
what is the prone position?
lying face-down
what is the supine position?
on your back
what is the sims' position?
on your side with on leg up and bent at the knee
what should the temperature of the water be used to bathe a client in bed?
110-115 degrees
what position should an unconscious patient be in for the nurse to provide oral care?
on their side with their head lower than their stomach
why does the nurse use a different portion of the washcloth to cleanse a patient's eyes?
minimizes the spread of infection
what is the best position to give a patient a back rub?
how should you wash a patient?
clean to dirty principle
during a partial bath, where will the nurse wash?
only absolutely necessary areas
during a help bath, where will the nurse wash?
areas patient cannot reach
body mechanics says that to prevent injury, we should avoid
bending and twisting
what is erythema?
redness of the skin
what is pruritus?
what is maceration?
softening of the skin from prolonged moisture
what is excoriation?
loss of the superficial layers of the skin caused by digestive enzymes in feces
what is a pressure ulcer?
lesions caused by tissue compression and inadequate perfusion
where is the perineum?
area between the anus and the vulva/scrotum
what is tinea pedis?
athlete's foot
hyperplasia is
excessive growth of cells
stomatitis is
inflammation of the oral mucosa
glossititis is
inflammation of the tongue
cheilosis is
cracking/ulceration of the lips
pediculosis is
infestation of head lice
what angle is the fowler's position
45 degrees
what position would be 30 degree angle?
trendelenburg's position is
feet are higher than the head
when washing a patient, do you always have to have gloves on?
no - if you are going to be exposed to bodily fluids, it's a good idea. Must use when washing the perineal and rectal area
how should you trim the toenails?
straight across
vital signs in a hospital are usually taken every
4-8 hours
what is the normal range for an oral temperatue/
96.2-100.4 degrees, 35.7-38.6
what is the normal range for a rectal temperature?
97.2-101.4 degrees, 36.2-38.6 degrees
what is the ideal average oral and tympanic temperature?
98.6, 36.7-37
what is the idea average rectal temperature?
99.5 or 37.5
what is the idea average axillary temperature?
97.7 or 36.5
what is the normal pulse range?
60-100 bpm
what is the average pulse rate?
80 bpm
what is the normal respiration rate range?
12-20 per minute
what is the normal range for blood pressure?
100-120 systolic, 60-80 diastolic
what is the average blood pressure
vaso_____ will cause a lower temperature
vaso_____ with cause a higher temperature
what is conduction
transfer of heat from a warm surface to a cool surface via direct contact
what is convection
transfer of heat through currents of air or water
what is radiation
loss of heat through electromagnetic waves emitting from surfaces that are warmer than the surrounding air
the clinical name for a fever is
a fever of 105.8 or above is considered
what serves as your body's thermostat?
what is considered a fever?
100.4 or above (38)
what is piloerection?
hairs standing on ends
if you wanted to get a core temperature reading, how would you get it?
rectal or tympanic
what factors influence body temp?
developmental level, environmental temp, hormones, exercise, emotions and stress, circadian rhythm
advantages of glass thermometers are:
flexibility, accuracy, easily disinfected
how long will it take to get an accurate glass temp reading?
3-6 minutes
what site is considered the least accurate to take a temp?
the initial phase of a fever is called the
febrile episode (onset symptoms of fever)
the second phase of a fever is called the
course (fever is reached, we feel warm)
the final phase of a fever is called the
defervescence or crisis phase (body temp is reset to normal, so we get rid of water through sweating)
what is diaphoresis?
what is hypothermia?
when the core temperature drops below normal (96.8 or 36)
what is severe hypothermia?
below 82.4 or 28
dyspnea is
difficulty breathing
pulse rate less than 60 is
pulse is the "wave" when the ____ heart ventricle contracts and relaxes
systole is the
peak of the wave, the contraction of the heart
diastole is the
trough, resting phase of the heart, when the ventricle relaxes
stroke volume is the
quantity of blood forced out by each contraction of the left ventricle
the average stroke volume in a healthy adult is
70 mL
cardiac output is
the total quantity of blood pumped per minute
newborns have a higher/lower pulse rate
what are some factors that influence pulse?
age, sex, exercise, food, stress, disease, fever, blood loss, position changes, medications
your stethoscope contains
bell and diaphragm (high frequency sounds)
where is the most accurate area to take a pulse?
what are common pulse points?
apical, carotid, brachial, radial, femoral, popliteal, pedal
the term for pulse rape above 100 bpm is
what is the pulse deficit?
the difference between an apical and radial pulse
what is bilateral equality/symmetry?
pulse the same on both sides (like arms)
what is a peripheral pulse?
when you feel for the beat
how can you find the apex of the heart?
5th intercostal space at the midclavicular line
when the intervals between your heart beats vary enough to be noticeable, this is called
if a patient has a 0 on the pulse scale, what does that mean?
no pulse!
respiration is
the exchange of oxygen and carbon dioxide in the body
another word for pulmonary ventilation is
apnea is when
there are no respirations
the amount of air moving in and out with each breath is
tidal volume
when your blood pressure is greater than 120/80
you might get a false high blood pressure if
your cuff is too small
a patient who received an opioid analgesic will most likely show what vital sign changes?
decreased respiratory rate
how long should you wait to take a temperature after your patient has a drink?
15 minutes
bradypnea is
respirations less than 12
what is hypertension?
140/90 plus
when taking an oral temperature, where should the thermometer be?
posterior sublingual pocket
why is it important to establish a baseline for a patient?
important to know the baseline so we can understand future changes or if the person has odd vitals normally
inspiration is
drawing air into the lungs
expiration is
exhaling air from the lungs
what is orthopnea?
inability to breathe when horizontal
what is a stridor sound?
high pitched, piercing, usually heard during inhalation
what is a stertor sound?
labored breathing that produces a snoring sound
what is hyperventiliaton?
too much oxygen, not enough carbon dioxide
what is something you would do for someone who is hyperventilating?
breath into a bag to get more carbon dioxide
what is hypoventilation?
not enough oxygen and too much carbon dioxide
what is an ABG?
arterial blood gas
what does an ABG measure?
oxygen, carbon dioxide, blood pH
this is the noninvasive method to monitor respiratory status
pulse oximetry
pulse oximetry measures what?
the percentage of oxygen saturation (96-100% is good)
what are biot's respirations?
periods of respirations of equal depth, alternating with periods of apnea
what are cheyne-stokes respirations?
gradual increase in depth of respirations, then gradual decrease in depth, then apnea
what is intercostal retraction?
when you can see the tissues sinking around and between the ribs when someone is struggling to breath
hypoxia is
inadequate cellular oxygenation
what is blood pressure?
the pressure of the blood as it's forced against arterial walls during cardiac contraction
what is the systolic pressure?
the peak pressure exerted against the arterial walls and ventricles contract and eject the blood
what is diastolic pressure?
the minimum pressure exerted against arterial walls when the heart is at rest
what is blood pressure measured in
millimeters of mercury (mm Hg)
is it systolic/diastolic or diastolic/systolic?
what is pulse pressure?
the difference between the systolic and diastolic pressures
your pulse pressure should be no more than _____ of your ____ pressure
one third of your systolic pressure
if your heart rate is down, what is likely going to happen to your BP?
it will go down also
what are some factors that impact your BP?
age, gender, family history, lifestyle, smoking, alcohol, caffeine, body position, exercise, pain, race, obesity, meds, diseases
how would you get a BP through a direct method?
a catheter is inserted into an artery under sterile conditions and attached a tubing connected to an electronic monitoring system
what do you measure BP with?
the sounds you hear during a BP reading are
korotkoff's sounds
the first sound you hear as you deflate the BP cuff is the
systolic pressure
what is hypotension?
systolic blood pressure under 100
prehypertension is
where should the arm be when you take a BP?
at heart level
it is better to use a BP cuff that is too ____ rather than too _____
big better than too small
the width of the BP cuff should cover:
2/3 of the upper arm for an adult (whole arm for child)
what are orthostatic vital signs?
taking the pulse and BP with the patient supine, sitting, and standing
do patients in a coma feel pain?
yes - pain impulses are transmitted, but unconscious patients can't respond to it
what organ has the most nociceptors?
the skin
what is cutaneous or superficial pain?
arisis in the skin of subcutaneous tissue
pain stemming from an organ would be
visceral pain
what is somatic pain?
from the body, arises from ligaments, tendons, nerves, bones
what is radiating pain?
starts at the source but extends elsewhere
what is referred pain?
pain occurs in an area that is distant from original site
what is phantom pain
pain in an area that doesn't exist
what is psychogenic pain?
pain believed to arise from the mind
nociceptive pain is when
pain receptors are stimulated in response to something that is potentially damaging
what is neuropathic pain?
injury to a nerve causes pain, often chronic
what is intractable pain?
chronic and highly resistant to relief
what is transduction?
activation of nociceptors by stimuli (hot stove)
what is transmission?
conduction of pain message to the spinal cord (bump your knee)
the point at which the brain recognizes and defines a stimulus as pain is called
pain threshold
the duration or intensity of pain a person is willing to endure is
pain tolerance
hyperalgesia is
extreme sensitivity to pain
what factors influence pain?
emotions, developmental stage, sociocultural factors, cognitive and communication impairments
what is the visual analogue scale for pain?
line with "no pain" on one side and "worst pain imaginabe" on the other; the patient points to where they are
the simple descriptor scale for pain is what
a list of adjectives that describe different pain levels - mild, moderate, severe
What is the wong-baker face pain scale?
illustrations of faces that go from smiling to crying
why is cutaneous stimulation used for pain relief?
skin stimulation sends impulses along large sensory fibers with "close the gate" in the spinal cord, which diminishes pain perception
what is a TENS stimulation?
electrode pads directly applied to the painful area that stimulates sensory fibers
what is a PENS stimulation?
combines a TENS system but also has needle probes to stimulate peripheral nerves
NSAIDs stands for
non steroidal anti inflammatory drugs
what does HIPPA stand for?
health insurance privacy and portability act
what does the newborns' and mothers' health protection act do?
keeps mom and baby in the hospital for a certain amount of time
what's the difference between criminal and civil law?
criminal law is when the federal or state government prosecutes, civil law allows for resolution of dispute between private parties
what are source oriented records?
members of each discipline record their findings
what are problem-oriented records?
organized around the patient's problems
what is narrative charting?
data is set up in chronological format
what is SOAP charting?
subjective data, objective data, assessment and plan
what is PIE charting?
problem, intervention, evaluation
What is charting by exception?
uses preprinted flow sheets to document aspects of care
the form in a chart that serves as the patient care summery that summarizes the POC is called the
contract law is dealing with ______ between individuals
tort law is dealing with
duties and rights among individuals
what are quasi-intentional torts?
defamation (false communication to a third person), slander (oral defamation), libel (written defamation)
what are intentional torts?
assault and battery, false imprisonment, fraud, invasion of privacy
what is negligence?
failure to perform as a reasonable, prudent nurse would where no intent to harm is present
what is malpractice?
professional form of negligence
what 4 elements are necessary to collect damages in a malpractice case?
1. existence of a duty (you had a job) 2. breach of the duty 3. causation 4. damages
what are common malpractice claims?
failure to assess and diagnose, failure to plan, failure to implement plan of care, failure to evaluate
if you make a mistake on a chart, what should you do?
single line through the error, write "mistaken entry", date, time, and initials
when you take a telephone or verbal order, what should you do?
repeat back to the physician for clarification, make sure you know which physician you're talking to, know it the order will cause potential harm and must refuse orders that are inappropriate
what does CUBAN stand for?
confidential, uninterrupted, brief, accurate, named nurse
what happens during a change-of-shift report?
name, age, room #, physician, admitting diagnosis, treatments done/due, restrictions, plan of care, significant assessment, medications given/due
what happens during a transfer report?
nurse's name, facility, phone #, pt name, age, gender, diagnosis, physician, procedures/surgeries, vitals, tubes, I&O, skin status, reason for transfer, questions, name of nurse receiving report
to take a tympanic thermometer for an adult, you should do what with the ear
pull the pinna up and back (for a child, down and back)
what is intrapersonal communication?
conscious internal dialogue, self-talk
what is interpersonal communication?
communication between 2 or more people
what is group communication?
interaction between several people
what is the content of communication?
the subject matter, words, gestures, substance of the conversation
what is the process of communication?
the active part of communication
what are the 5 steps of the communication process?
1. message 2. sender 3. channel 4. receiver 5. feedback
what is the first phase of the therapeutic relationship?
pre-interaction; gathering information prior to meeting the client
what is stage 2 of the therapeutic communication relationship?
orientation phase; meet the client and establish rapport and trust
what is stage 3 of therapeutic relationship?
working phase; active part of the relationship
what is the last stage of therapeutic communication?
what is the generic name of a medicine?
assigned when the drug is first manufactured that is similar to the chemical name (ex: acetaminophin)
what is the brand/trade name of a med?
the copyrighted name given by manufacturer of a med (ex: tylenol, motrin, advil)
to have a prescription be legal, what must you have? (7 things)
client's name, medication name, dose, route frequency, amount to dispense, number of refills, physician signature
what is a controlled substance?
drugs that affect the mind or behavior that may be habit forming and have a high potential for abuse
what are common controlled substances?
opioids (narcotics), barbiturates, illegal drugs, sleeping pills, sedatives, hypnotics
what is a schedule 1 controlled substance?
not accepted for medical use; heroin, LSD, marijuana
what is a schedule 2 controlled substance?
amphetamines, codeine, dermerol, methadone, morphine, cocaine
what is a schedule 3 controlled substance?
acceptable for medical use but slightly less potential for abuse; oxycodone, darvon, some codeine
what is a schedule 4 controlled substance?
benzodiazepines, nonnarcotic analgesics
what are the 4 processes of pharmacokinetics?
1. absorption 2. distribution 3. metabolism 4. excretion
what is absorption?
from the time it enters your body until it reaches your blood
what is the distribution phase?
the time it takes for the drug to be into your circulation and arrives at the site of action
what is metabolism of a med?
inactivating and breaking down a medication
what is the first-pass effect?
lives transforms substances before it reaches the tissues (through liver, then goes through the blood)
what is the excretion phase?
movement of a drug from its site of metabolism back into circulation and transport to the site of exit from the body
where are the most common excretion sites?
kidneys, lungs, sweat glands, mammary glands, GI tract
what is a half-life?
amount of time the body needs to lower by half the drug's serum concentration
what is the onset of a medication?
amount of time needed after administration to produce the desired effect
what is the peak of medication?
amount of time needed for a drug to reach the highest concentration
what is the duration of a medication?
the span of time when drug level is high enough to produce the desired effects
what is a drug plateau?
sustained level of drug that is reached with successive dosage
what are primary drug effects?
things we want
what are secondary medication effects?
unintended, nontherapeutic, unplanned
what is an adverse effect?
unplanned effect that is potentially life threatening
what is polypharmacy?
too many drugs
what are some factors affecting drug actions?
genetic differences, gender, heigh and weight, diseases, reactions to environment
what is urticaria?
what is an allergic response?
antigen-antibody response to a medication
what is antiphylaxis?
life-threatening, bronchoconstriction, hypotension, very bad
what is an idiosyncractic response?
unexplained, unpredictable response; ex: medicine for drowsiness causes excitability
what is a synergistic drug?
one drug enhances the effect of another
what is an antagonistic effect?
one drug reduces or negates the effect of another drug
drug tolerance:
diminishing therapeutic effect over time
drug dependence is:
compulsive patterns of drug use, lifestyle centered around the drug
illicit drugs are
street drugs, illegal
What MUST you have for a legal medication order? (6)
1. date and time of order 2. medication name 3. dose of medication 4. route of administration 5. frequency of administration 6. signature of prescriber
what is a standing order?
medication should be given on a routine basis; ex: insulin
PRN stands for
pro re nata
what is the only thing that should keep you from a STAT order?
cardiac arrest
what are the 6 rights of medication administration?
right drug right dose right client right route, right time right documentation
what are 3 other rights of a patient?
right reason, right to know, right to refuse
When should you make the 3 med checks?
1. before you get it 2. after you get it 3. at the bedside
parenteral means
outside of the GI tract
what do you need to do before you give meds?
take vitals
what part of the needle should you never touch
the plunger because it goes into the sterile barrel
what angle should you give an IM injection?
what angle should you give a SQ injection with a 1/2 inch needle?
what angle should you give a SQ injection with a 1 inch needle?
what angle should you give an intradermal injection?
where is the ventrogluteal site?
side of butt/hip
where is the vastus lateralis?
femural area
where is the dorsogluteal site?
back/butt area
when do you aspirate during an injection?
how much medication should you give with an ID injection?
very small amount - about 0.1 mL
how is insulin injected?
SQ or IV
why should you add 0.2 mL of air to a heparin injection?
it helps push the medicine down deeper
how much fluid can you give in an IM injection?
3-4 mL in larger muscles, 0.5-1 mL in the average deltoid muscle
what is the site of choice for an IM injection?
where is the last place you should try to give an IM injection?
what is the nursing process?
systematic problem-solving process that guides all nursing actions
what are the phases of the nursing process? (6)
assessment, diagnosis, planning outcomes, planning interventions, implementation, evaluation
what is assessment?
gathering data so you can draw a conclusion about health status
what is diagnosis?
identify client's health needs based on review of assessment data to hypothesize about client's health status
what is the planning outcomes stage?
work with the client to decide goals for you care
what is the planning interventions stage?
develop a list of possible interventions based on knowledge and choose the most likely to achieve goals
what is the implementation stage?
action phase; carryout and delegate actions you previously planned
what is the evaluation phase?
the final phase; judge if your actions have successfully treated or prevented the client's health problems
what is primary data?
subjective and objective data obtained from the client
what is secondary data?
data obtained second hand
what is subjective data?
info told to the nurse by the client, family or community
what is objective data?
gathered through physical assessment or lab/diagnostic tests; things you see with your own eyes
what is an initial assessment?
completed when client first presents to the healthcare facility
what is the purpose of the nursing process?
to help the nurse provide goal-directed, client-centered care
a nursing diagnosis identifies what?
a patient's response
what is an ongoing assessment?
performed as needed at any time; vital signs, maybe monitors
what is a comprehensive assessment?
provides information from all levels; history, initial and ongoing assessment, physical exam
what is a focused assessment?
obtains data about an actual, potential, or possible problem that has been identified (ex: heart)
what is a special needs assessment?
a type of focused assessment such as nutrition or pain
what are some components of a health history?
biographical data, psychosocial profile, reason for seeking health care, current health status
what is the PQRST analysis?
for current health status assessment; p-precipitating factors q-quality/quantity r-region/radiation/related symptoms s-severity t-timing
what does a nursing diagnosis do?
treat the symptoms of a problem
collaborative problems are always a _____ problem
what is a possible nursing diagnosis?
you think there is/could be a problem, but don't have enough data to confirm
what is a syndrome diagnosis?
symptoms that occur due to another health event (ex: rape)
how should you prioritize the diagnosis?
according to maslow's hierarchy of needs
what are the components of a NANDA nursing diagnosis?
diagnostic label, definition and defining characteristics, related factors, risk factors
what is the 3-part statement for a nursing diagnosis?
problem r/t etiology AEB signs and symptoms
when do we start discharge planning?
upon admission
planned outcomes should be
realistic and measurable
what is a SMART outcome?
specific, measurable, acceptable, realistic, timely
what is a critical pathway?
outcome-based plans that sequence client care based on case type
what does a nursing order contain?
date, subject (always the nurse), action verb, times and limits, signature

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