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NUR |! 155 |! Exam |! 1 |! with |! accurate |!
detailed |! answers
critical |! thinking |! - |! Correct |! answer |! ✔intentional |! higher |! level |! reasoning; influenced |! by |! knowledge, |! experience, |! skills, |! attitudes, |! and |! interpersonal |! skills independence |! - |! Correct |! answer |! ✔thinking |! for |! self fair-mindedness |! - |! Correct |! answer |! ✔assess |! all |! viewpoints insight |! to |! egocentricity |! - |! Correct |! answer |! ✔biases intellectual |! humility |! - |! Correct |! answer |! ✔knowing |! limit |! of |! one's |! own |! knowledge integrity |! - |! Correct |! answer |! ✔apply |! same |! standards |! of |! proof |! to |! their |! own |! knowledge |! and |! beliefs |! as |! they |! apply |! to |! the |! knowledge |! and |! beliefs |! of |! others
perserverance |! - |! Correct |! answer |! ✔find |! effective |! solutions |! to |! the |! client |! and |! nursing |! problems confidence |! - |! Correct |! answer |! ✔leads |! to |! trustworthy |! conclusions curiosity |! - |! Correct |! answer |! ✔mind |! full |! of |! questions diagnostic |! reasoning |! - |! Correct |! answer |! ✔making |! sense |! of |! collected |! data; |! requires |! critical |! thinking; requires |! creation |! of |! diagnostic |! (working) |! hypothesis cues diagnostic |! (working) |! hypothesis data |! collection |! evaluate |! hypothesis |! - |! Correct |! answer |! ✔ 4 |! components |! of |! diagnostic |! reasoning critical |! analysis |! - |! Correct |! answer |! ✔the |! application |! of |! a |! set |! of |! questions |! to |! a |! particular |! situation |! or |! idea |! to |! determine |! essential |! information |! and |! ideas |! and |! discard |! unimportant |! information |! and |! ideas
identify |! health |! status |! and |! potential |! health |! care |! problems |! or |! needs |! and |! deliver |! intervention |! to |! meet |! needs subjective |! data |! - |! Correct |! answer |! ✔symptoms |! patient |! says |! (type |! of |! data?) objective |! data |! - |! Correct |! answer |! ✔signs |! nurse |! observes |! and |! measures |! (type |! of |! data?) primary |! source |! - |! Correct |! answer |! ✔information |! that |! comes |! from |! the |! patient |! (what |! type |! of |! source?) secondary |! source |! - |! Correct |! answer |! ✔information |! from |! the |! patient's |! family |! about |! the |! patient (what |! type |! of |! source?) nursing |! process- |! diagnosis |! - |! Correct |! answer |! ✔clinical |! judgement |! about |! actual |! or |! potential |! health |! problems; describe |! human |! response |! to |! a |! problem |! that |! requires |! nursing |! intervention; standardized |! statement |! about |! health |! of |! patient
actual |! diagnosis |! - |! Correct |! answer |! ✔patient |! problem |! that |! is |! present |! at |! the |! time |! of |! the |! nursing |! assessment |! (what |! type |! of |! diagnosis?) risk |! diagnosis |! - |! Correct |! answer |! ✔conditions |! that |! exist |! for |! problem |! to |! develop (what |! type |! of |! diagnosis?) health |! promotion |! diagnosis |! - |! Correct |! answer |! ✔relates |! to |! clients' |! preparedness |! to |! implement |! behaviors |! to |! improve |! their |! health |! condition (what |! type |! of |! diagnosis?) syndrome |! diagnosis |! - |! Correct |! answer |! ✔clinical |! judgement |! to |! describe |! a |! cluster |! of |! nursing |! diagnoses |! with |! similar |! interventions |! (what |! type |! of |! diagnosis?) medical |! diagnoses |! - |! Correct |! answer |! ✔clinical |! judgement |! by |! physician |! to |! identify |! specific |! disease, |! condition, |! or |! pathological |! state nursing |! diagnoses |! - |! Correct |! answer |! ✔clinical |! judgement |! identifying |! a |! client's |! response |! to |! a |! health |! state, |! problem, |! or |! condition
syndrome |! diagnosis |! - |! Correct |! answer |! ✔post |! trauma |! syndrome |! related |! to |! physical |! abuse, |! as |! evidenced |! by |! alienation, |! anger, |! anxiety, |! and |! depression |! (what |! type |! of |! nursing |! diagnosis?) problem etiology signs/symptoms |! - |! Correct |! answer |! ✔formulating |! diagnostic |! statements |! (3 |! part |! statements) unknown |! etiology |! - |! Correct |! answer |! ✔when |! cause |! is |! not |! known complex |! factors |! - |! Correct |! answer |! ✔when |! too |! many |! etiologic |! factors |! exist planning |! - |! Correct |! answer |! ✔phase |! of |! nursing |! process |! involving |! decision |! making |! and |! problem |! solving; create |! plan |! of |! action |! to |! improve |! the |! client's |! health |! status |! and/or |! better |! cope |! with |! their |! illness initial |! ongoing discharge |! - |! Correct |! answer |! ✔types |! of |! planning
initial |! planning |! - |! Correct |! answer |! ✔nurse |! performs |! admission |! assessment |! and |! develops |! initial |! comprehensive |! plan |! of |! care |! (what |! type |! of |! planning?) ongoing |! planning |! - |! Correct |! answer |! ✔determining |! whether |! the |! patient's |! health |! status |! has |! changed; |! set |! priorities |! for |! the |! patient's |! care |! during |! the |! shift; |! decide |! which |! problems |! to |! focus |! on |! during |! the |! shift; |! coordinate |! nurse |! activities |! so |! that |! more |! than |! one |! problem |! can |! be |! addressed |! at |! each |! client |! contact |! (what |! type |! of |! planning?) discharge |! planning |! - |! Correct |! answer |! ✔process |! of |! anticipating |! and |! planning |! for |! needs |! after |! discharge |! (what |! type |! of |! planning?) specific/directly |! related |! to |! diagnosis measurable attainable realistic/reasonable timed |! - |! Correct |! answer |! ✔SMART |! goals
culture, |! age, |! gender |! of |! patient |! and |! nurse |! - |! Correct |! answer |! ✔what |! influences |! comfortability |! in |! patient? dorsal |! recumbent |! - |! Correct |! answer |! ✔A |! back-lying |! position |! with |! knees |! flexed |! and |! hips |! externally |! rotated; |! small |! pillow |! under |! the |! head; |! soles |! of |! feet |! on |! the |! surface supine |! - |! Correct |! answer |! ✔back |! lying |! position |! with |! legs |! extended sitting |! - |! Correct |! answer |! ✔A |! seated |! position, |! back |! unsupported |! and |! legs |! hanging |! freely lithotomy |! - |! Correct |! answer |! ✔back |! lying |! position |! with |! feet |! supported |! in |! stirrups; |! hips |! should |! be |! in |! line |! with |! the |! edge |! of |! the |! table sims' |! - |! Correct |! answer |! ✔Side-lying |! position |! with |! lowermost |! arm |! behind |! the |! body, |! uppermost |! leg |! flexed |! at |! hip |! and |! knee, |! upper |! arm |! flexed |! at |! shoulder |! and |! elbow prone |! - |! Correct |! answer |! ✔lying |! on |! the |! abdomen |! with |! the |! legs |! extended |! and |! the |! head |! turned |! to |! the |! side
Trendelenburg |! - |! Correct |! answer |! ✔position |! on |! back; |! feet |! elevated |! higher |! than |! head Fowler's |! - |! Correct |! answer |! ✔semi-sitting |! body |! position |! in |! which |! a |! person's |! head |! and |! shoulders |! are |! elevated |! 45 |! to |! 60 |! degrees inspection |! - |! Correct |! answer |! ✔visual |! examination |! assessed |! using |! sight palpation |! - |! Correct |! answer |! ✔examination |! using |! sense |! of |! touch percussion |! - |! Correct |! answer |! ✔examination |! involving |! the |! act |! of |! striking |! the |! body |! surface |! to |! elicit |! sounds |! that |! can |! be |! heard |! or |! vibrations |! that |! can |! be |! felt ausculatation |! - |! Correct |! answer |! ✔examination |! by |! listening |! to |! sounds |! produced |! within |! the |! body pitch |! - |! Correct |! answer |! ✔frequency |! of |! vibrations intensity |! - |! Correct |! answer |! ✔refers |! to |! the |! loudness |! or |! softness |! of |! a |! sound
appears |! swollen, |! shiny, |! and |! taut vesicle |! - |! Correct |! answer |! ✔round |! and |! thin |! translucent |! mass |! filled |! with |! serous |! fluid |! or |! blood |! ex. |! small |! burn |! blister, |! herpes |! simplex, |! early |! chicken |! pox bulla |! - |! Correct |! answer |! ✔family |! of |! vesicles pustule |! - |! Correct |! answer |! ✔vesicle |! or |! bulla |! filled |! with |! pus |! ex. |! acne |! vulgaris, |! impetigo nodule |! - |! Correct |! answer |! ✔elevated, |! solid, |! hard |! mass |! that |! extends |! deeper |! into |! the |! dermis; |! circumscribed |! border |! = |! 0.5-2 |! cm ex. |! squamous |! cell |! carcinoma, |! tumors |! (>2 |! cm) cyst |! - |! Correct |! answer |! ✔larger, |! elevated, |! encapsulated, |! fluid-filled |! or |! semisolid |! mass |! arising |! from |! the |! subcutaneous |! tissue |! or |! dermis |! ex. |! chalazion |! of |! the |! eyelid wheal |! - |! Correct |! answer |! ✔reddened, |! localized |! collection |! of |! edema |! fluid; |! irregular |! in |! shape |! and |! size |! ex. |! mosquito |! bites, |! hives
clubbing |! - |! Correct |! answer |! ✔condition |! where |! the |! angle |! between |! the |! nail |! and |! the |! nail |! bed |! is |! 180 |! degrees |! or |! greater; may |! be |! caused |! by |! a |! long-term |! lack |! of |! oxygen blanch |! test |! - |! Correct |! answer |! ✔carried |! out |! to |! test |! capillary |! refill |! (peripheral |! circulation) should |! be |! less |! than |! 2 |! seconds Normocephalic |! - |! Correct |! answer |! ✔normal |! head |! size exophthalmos |! - |! Correct |! answer |! ✔protrusion |! of |! the |! eyeballs |! with |! elevation |! of |! the |! upper |! eyelids myopia |! - |! Correct |! answer |! ✔nearsightedness hyperopia |! - |! Correct |! answer |! ✔farsightedness presbyopia |! - |! Correct |! answer |! ✔loss |! of |! elasticity |! of |! the |! lens |! and |! ability |! to |! see |! close |! objects astigmatism |! - |! Correct |! answer |! ✔uneven |! curvature |! of |! the |! cornea |! that |! prevents |! horizontal |! and |! vertical |! rays |! from |! focusing |! on |! the |! retina
(type |! of |! breath |! sound) adventitious |! - |! Correct |! answer |! ✔abnormal |! breath |! sounds crackles |! (rales) |! - |! Correct |! answer |! ✔short, |! interrupted |! sounds; |! high |! pitched |! (rolling |! hair |! near |! ear) heard |! in |! lower |! lung |! lobes |! (type |! of |! adventitious |! breath |! sound) gurgles |! (rhonchi) |! - |! Correct |! answer |! ✔continuous, |! low |! pitched, |! harsh, |! loud |! sound |! (moaning/snoring)-- |! can |! be |! cleared |! with |! coughing |! (type |! of |! adventitious |! breath |! sound) friction |! rub |! - |! Correct |! answer |! ✔superficial |! grating |! or |! creaking |! sounds |! heard |! during |! inspiration |! and |! expiration (type |! of |! adventitious |! breath |! sound)
wheeze |! - |! Correct |! answer |! ✔continuous, |! high |! pitched, |! squeaky |! sounds |! that |! are |! best |! heard |! on |! expiration (type |! of |! adventitious |! breath |! sound) stridor |! - |! Correct |! answer |! ✔worse |! than |! wheezing |! sound |! (emergency) (type |! of |! adventitious |! breath |! sound) S1 |! - |! Correct |! answer |! ✔atrioventricular |! valves |! (tricuspid |! and |! mitral |! close) "lub" S2 |! - |! Correct |! answer |! ✔aortic |! and |! pulmonic |! valves |! close |! "dub" 2nd |! intercostal |! space, |! right |! sternal |! border |! - |! Correct |! answer |! ✔aortic |! area 2nd |! intercostal |! space, |! left |! sternal |! border |! - |! Correct |! answer |! ✔pulmonic |! area
percussion palpation |! - |! Correct |! answer |! ✔order |! of |! abdominal |! assessment RLQ, |! RUQ, |! LUQ, |! LLQ |! - |! Correct |! answer |! ✔order |! of |! listening |! to |! the |! 4 |! quadrants |! of |! the |! abdomen |! for |! bowel |! sounds 5-20 |! seconds, |! high |! pitched |! - |! Correct |! answer |! ✔normoactive |! bowel |! sounds every |! 3 |! seconds, |! high, |! loud, |! rushing |! - |! Correct |! answer |! ✔hyperactive |! bowel |! sounds 1 |! per |! minute, |! soft |! and |! infrequent |! - |! Correct |! answer |! ✔hypoactive |! bowel |! sounds R |! Hypochondriac, |! epigastric, |! L |! hypochondriac, |! R |! lumbar, |! umbilical, |! L |! lumbar, |! R |! inguinal, |! hypogastric, |! L |! inguinal |! - |! Correct |! answer |! ✔ 9 |! abdominal |! regions Romberg |! test |! - |! Correct |! answer |! ✔test |! for |! balance |! eyes |! closed, |! standing |! with |! feet |! together body |! temperature
pulse respirations blood |! pressure pain |! - |! Correct |! answer |! ✔vital |! signs 96.8-99.5 |! - |! Correct |! answer |! ✔normal |! temperature age circadian |! rhythms exercise hormones stress environment |! - |! Correct |! answer |! ✔factors |! affecting |! temperature
99.5 |! - |! Correct |! answer |! ✔pyrexia, |! hyperthermia, |! fever extremely |! high |! fever ex. |! 105.8 |! - |! Correct |! answer |! ✔hyperpyrexia <96.8 |! - |! Correct |! answer |! ✔hypothermia warm |! environment
