1.
Presbyopia is an eye
disorder characterized by lessening of the effective powers of accommodation.
2.
The primary problem in
cataract is blurring of vision.
3.
The primary reason for
performing iridectomy after cataract extraction is to prevent secondary
glaucoma.
4.
In acute glaucoma, the
obstruction of the flow of aqueous humor is caused by displacement of the iris.
5.
Glaucoma is
characterized by irreversible blindness.
6.
Hyperopia is corrected
by convex lens.
7.
Pterygium is caused
primarily by exposure to dust.
8.
A sterile chronic
granulomatous inflammation of the meibomian gland is chalazion.
9.
The surgical procedure
w/c involves removal of the eyeball is enucleation.
10.
The client is for EEG
this morning. Prepare him for the procedure by rendering hair shampoo,
excluding caffeine from his meal & instructing the client to remain still
during the procedure.
11.
If the client w/
increased ICP demonstrates decorticate posturing, observe for flexion of
elbows, extension of the knees, plantar flexion of the feet,
12.
The nursing diagnosis
that would have the highest priority in the care of the client who has become
comatose following cerebral hemorrhage is Ineffective Airway Clearance.
13.
The initial nursing
action—for a client who is in the clonic phase of a tonic-clonic seizure—is to
obtain equipment for orotracheal suctioning.
14.
The first nursing
intervention in a quadriplegic client who is experiencing autonomic dysreflexia
is to elevate his head as high as possible.
15.
Following surgery for
a brain tumor near the hypothalamus, the nursing assessment should include
observing for inability to regulate body temp.
16.
Post-myelogram (using
metrizamide (Amipaque) care includes keeping head elevated for at least 8 hrs.
17.
Homonymous hemianopsia
is described by a client had CVA & can only see the nasal visual field on
one side & the temporal portion on the opposite side.
18.
Ticlopidine may be
prescribed to prevent thromboembolic CVA.
19.
To maintain airway
patency during a stroke in evolution, have orotracheal suction available at all
times.
20.
For a client w/ CVA,
the gag reflex must return before the client is fed.
21.
Clear fluids draining
from the nose of a client who had a head trauma 3 hrs ago may indicate basilar
skull fracture.
22.
An adverse effect of
gingival hyperplasia may occur during Phenytoin (DIlantin) therapy.
23.
Urine output
increased: best shows that the mannitol is effective in a client w/ increased
ICP.
24.
A client w/ C6 spinal
injury would most likely have the symptom of quadriplegia.
25.
Falls are the leading
cause of injury in elderly people.
26.
Primary prevention is
true prevention. Examples are immunizations, weight control, and smoking
cessation.
27.
Secondary prevention
is early detection. Examples include purified protein derivative (PPD), breast
self-examination, testicular self-examination, and chest X-ray.
28.
Tertiary prevention is
treatment to prevent long-term complications.
29.
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.”
30.
On noticing religious
artifacts and literature on a patient’s night stand, a culturally aware nurse
would ask the patient the meaning of the items.
31.
A Mexican patient may
request the intervention of a curandero, or faith healer, who involves the
family in healing the patient.
32.
In an infant, the
normal hemoglobin value is 12 g/dl.
33.
The nitrogen balance
estimates the difference between the intake and use of protein.
34.
Most of the absorption
of water occurs in the large intestine.
35.
Most nutrients are
absorbed in the small intestine.
36.
When assessing a
patient’s eating habits, the nurse should ask, “What have you eaten in the last
24 hours?”
37.
A vegan diet should
include an abundant supply of fiber.
38.
A hypotonic enema
softens the feces, distends the colon, and stimulates peristalsis.
39.
First-morning urine
provides the best sample to measure glucose, ketone, pH, and specific gravity
values.
40.
To induce sleep, the
first step is to minimize environmental stimuli.
41.
Before moving a
patient, the nurse should assess the patient’sv physical abilities and ability
to understand instructions as well as the amount of strength required to move
the patient.
42.
To lose 1 lb (0.5 kg)
in 1 week, the patient must decrease his weeklyv intake by 3,500 calories
(approximately 500 calories daily). To lose 2 lb (1 kg) in 1 week, the patient
must decrease his weekly caloric intake by 7,000 calories (approximately 1,000
calories daily).
43.
To avoid shearing force
injury, a patient who is completely immobile is lifted on a sheet.
44.
To insert a catheter
from the nose through the trachea for suction, the nurse should ask the patient
to swallow.
45.
Vitamin C is needed
for collagen production.
46.
Only the patient can
describe his pain accurately.
47.
Cutaneous stimulation
creates the release of endorphins that block the transmission of pain stimuli.
48.
Patient-controlled
analgesia is a safe method to relieve acute painv caused by surgical incision,
traumatic injury, labor and delivery, or cancer.
49.
An Asian American or
European American typically places distance between himself and others when
communicating.
50.
Active euthanasia is
actively helping a person to die.
51.
Brain death is
irreversible cessation of all brain function.
52.
Passive euthanasia is
stopping the therapy that’s sustaining life.
53.
A third-party payer is
an insurance company.
54.
Utilization review is
performed to determine whether the care provided to a patient was appropriate
and cost-effective.
55.
A value cohort is a
group of people who experienced an out-of-the-ordinary event that shaped their
values.
56.
Voluntary euthanasia
is actively helping a patient to die at the patient’s request.
57.
Bananas, citrus
fruits, and potatoes are good sources of potassium.
58.
Good sources of
magnesium include fish, nuts, and grains.
59.
Beef, oysters, shrimp,
scallops, spinach, beets, and greens are good sources of iron.
60.
Intrathecal injection
is administering a drug through the spine.
61.
When a patient asks a
question or makes a statement that’sv emotionally charged, the nurse should
respond to the emotion behind the statement or question rather than to what’s
being said or asked.
62.
The steps of the
trajectory-nursing model are as follows:
–
Step 1: Identifying
the trajectory phase
–
Step 2: Identifying
the problems and establishing goals
–
Step 3: Establishing a
plan to meet the goals
–
Step 4: Identifying
factors that facilitate or hinder attainment of the goals
–
Step 5: Implementing
interventions
–
Step 6: Evaluating the
effectiveness of the interventions
63.
A Hindu patient is
likely to request a vegetarian diet.
64.
Pain threshold, or
pain sensation, is the initial point at which a patient feels pain.
65.
The difference between
acute pain and chronic pain is its duration.
66.
Referred pain is pain
that’s felt at a site other than its origin.
67.
Alleviating pain by
performing a back massage is consistent with the gate control theory.
68.
Romberg’s test is a
test for balance or gait.
69.
Pain seems more
intense at night because the patient isn’t distracted by daily activities.
70.
Older patients
commonly don’t report pain because of fear of treatment, lifestyle changes, or
dependency.
71.
No pork or pork
products are allowed in a Muslim diet.
72.
Two goals of Healthy
People 2010 are:
–
Help individuals of
all ages to increase the quality of life and the number of years of optimal
health
–
Eliminate health
disparities among different segments of the population.
73.
A community nurse is
serving as a patient’s advocate if she tells av malnourished patient to go to a
meal program at a local park.
74.
If a patient isn’t
following his treatment plan, the nurse should first ask why.
75.
When a patient is ill,
it’s essential for the members of his family to maintain communication about
his health needs.
76.
Ethnocentrism is the
universal belief that one’s way of life is superior to others’.
77.
When a nurse is
communicating with a patient through an interpreter,v the nurse should speak to
the patient and the interpreter.
78.
In accordance with the
“hot-cold” system used by some Mexicans,v Puerto Ricans, and other Hispanic and
Latino groups, most foods, beverages, herbs, and drugs are described as “cold.”
79.
Prejudice is a hostile
attitude toward individuals of a particular group.
80.
Discrimination is
preferential treatment of individuals of a particular group. It’s usually
discussed in a negative sense.
81.
Increased gastric
motility interferes with the absorption of oral drugs.
82.
The three phases of
the therapeutic relationship are orientation, working, and termination.
83.
Patients often exhibit
resistive and challenging behaviors in the orientation phase of the therapeutic
relationship.
84.
Abdominal assessment
is performed in the following order: inspection, auscultation, palpation, and
percussion.
85.
When measuring blood
pressure in a neonate, the nurse should select a cuff that’s no less than
one-half and no more than two-thirds the length of the extremity that’s used.
86.
When administering a
drug by Z-track, the nurse shouldn’t use thev same needle that was used to draw
the drug into the syringe because doing so could stain the skin.
87.
Sites for intradermal
injection include the inner arm, the upper chest, and on the back, under the
scapula.
88.
When evaluating
whether an answer on an examination is correct, thev nurse should consider
whether the action that’s described promotes autonomy (independence), safety,
self-esteem, and a sense of belonging.
89.
Veracity is truth and
is an essential component of a therapeutic relationship between a health care
provider and his patient.
90.
Beneficence is the
duty to do no harm and the duty to do good.v There’s an obligation in patient
care to do no harm and an equal obligation to assist the patient.
91.
Nonmaleficence is the
duty to do no harm.
92.
Frye’s ABCDE cascade
provides a framework for prioritizing care by identifying the most important
treatment concerns.
93.
A = Airway. This
category includes everything that affects a patentv airway, including a foreign
object, fluid from an upper respiratory infection, and edema from trauma or an
allergic reaction.
94.
B = Breathing. This
category includes everything that affects thev breathing pattern, including
hyperventilation or hypoventilation and abnormal breathing patterns, such as
Korsakoff’s, Biot’s, or Cheyne-Stokes respiration.
95.
C = Circulation. This
category includes everything that affects thev circulation, including fluid and
electrolyte disturbances and disease processes that affect cardiac output.
96.
D = Disease processes.
If the patient has no problem with the airway,v breathing, or circulation, then
the nurse should evaluate the disease processes, giving priority to the disease
process that poses the greatest immediate risk. For example, if a patient has
terminal cancer and hypoglycemia, hypoglycemia is a more immediate concern.
97.
E = Everything else.
This category includes such issues as writing anv incident report and
completing the patient chart. When evaluating needs, this category is never the
highest priority.
98.
Rule utilitarianism is
known as the “greatest good for the greatest number of people” theory.
99.
Egalitarian theory
emphasizes that equal access to goods and servicesv must be provided to the
less fortunate by an affluent society.
100.
Before teaching any
procedure to a patient, the nurse must assess the patient’s current knowledge
and willingness to learn.
101.
Process recording is a
method of evaluating one’s communication effectiveness.
102.
When feeding an
elderly patient, the nurse should limit high-carbohydrate foods because of the
risk of glucose intolerance.
103.
When feeding an
elderly patient, essential foods should be given first.
104.
Passive range of
motion maintains joint mobility. Resistive exercises increase muscle mass.
105.
Isometric exercises are
performed on an extremity that’s in a cast.
106.
A back rub is an
example of the gate-control theory of pain.
107.
Anything that’s
located below the waist is considered unsterile; av sterile field becomes
unsterile when it comes in contact with any unsterile item; a sterile field
must be monitored continuously; and a border of 1″ (2.5 cm) around a sterile
field is considered unsterile.
108.
A “shift to the left”
is evident when the number of immature cells (bands) in the blood increases to
fight an infection.
109.
A “shift to the right”
is evident when the number of mature cells inv the blood increases, as seen in
advanced liver disease and pernicious anemia.
110.
Before administering
preoperative medication, the nurse should ensurev that an informed consent form
has been signed and attached to the patient’s record.
111.
A nurse should spend
no more than 30 minutes per 8-hour shift providing care to a patient who has a
radiation implant.
112.
A nurse shouldn’t be
assigned to care for more than one patient who has a radiation implant.
113.
Long-handled forceps
and a lead-lined container should be available in the room of a patient who has
a radiation implant.
114.
Usually, patients who
have the same infection and are in strict isolation can share a room.
115.
Diseases that require
strict isolation include chickenpox, diphtheria, and viral hemorrhagic fevers
such as Marburg disease.
116.
For the patient who
abides by Jewish custom, milk and meat shouldn’t be served at the same meal.
117.
Whether the patient
can perform a procedure (psychomotor domain ofv learning) is a better indicator
of the effectiveness of patient teaching than whether the patient can simply
state the steps involved in the procedure (cognitive domain of learning).
118.
According to Erik
Erikson, developmental stages are trust versusv mistrust (birth to 18 months),
autonomy versus shame and doubt (18 months to age 3), initiative versus guilt
(ages 3 to 5), industry versus inferiority (ages 5 to 12), identity versus
identity diffusion (ages 12 to 18), intimacy versus isolation (ages 18 to 25),
generativity versus stagnation (ages 25 to 60), and ego integrity versus
despair (older than age 60).
119.
When communicating
with a hearing impaired patient, the nurse should face him.
120.
An appropriate nursing
intervention for the spouse of a patient who has a serious incapacitating
disease is to help him to mobilize a support system.
121.
Milk is high in sodium
and low in iron.
122.
When a patient
expresses concern about a health-related issue, before addressing the concern,
the nurse should assess the patient’s level of knowledge.
123.
The most effective way
to reduce a fever is to administer an antipyretic, which lowers the temperature
set point.
124.
Bone scan is done by
injecting radioisotope per IV & X-rays are taken.
125.
To prevent edema edema
on the site of sprain, apply cold compress on the area for the 1st 24 hrs
126.
To turn the client
after lumbar Laminectomy, use logrolling technique
127.
Carpal tunnel syndrome
occurs due to the injury of median nerve.
128.
Massaging the back of
the head is specifically important for the client w/ Crutchfield tong.
129.
A 1 yr old child has a
fracture of the L femur. He is placed in Bryant’s traction. The reason for
elevation of his both legs at 90 deg. angle is his weight isn’t adequate to
provide sufficient countertraction, so his entire body must be used.
130.
Swing-through crutch
gait is done by advancing both crutches together & the client moves both
legs past the level of the crutches.
131.
The appropriate
nursing measure to prevent displacement of the prosthesis after a right total
hip replacement for arthritis is to place the patient in the position of right
leg abducted.
132.
Pain on non-use of
joints, subcutaneous nodules & elevated ESR are characteristic
manifestations of rheumatoid arthritis.
133.
Teaching program of a
patient w/ SLE should include emphasis on walking in shaded area.
134.
Otosclerosis is
characterized by replacement of normal bones by spongy & highly
vascularized bones.
135.
Use of high pitched
voice is inappropriate for the client w/ hearing impairment.
136.
Rinne’s test compares
air conduction w/ bone conduction.
137.
Vertigo is the most
characteristic manifestation of Meniere’s disease.
138.
Low sodium is the diet
for a client w/ Meniere’s disease.
139.
A client who had
cataract surgery should be told to call his MD if he has eye pain.
140.
Risk for Injury takes
priority for a client w/ Meniere’s disease.
141.
Irrigate the eye w/ sterile
saline is the priority nursing intervention when the client has a foreign body
protruding from the eye.
142.
Snellen’s Test
assesses visual acuity.
143.
Presbyopia is an eye
disorder characterized by lessening of the effective powers of accommodation.
144.
The primary problem in
cataract is blurring of vision.
145.
The primary reason for
performing iridectomy after cataract extraction is to prevent secondary
glaucoma.
146.
In acute glaucoma, the
obstruction of the flow of aqueous humor is caused by displacement of the iris.
147.
Glaucoma is
characterized by irreversible blindness.
148.
Hyperopia is corrected
by convex lens.
149.
Pterygium is caused
primarily by exposure to dust.
150.
A sterile chronic
granulomatous inflammation of the meibomian gland is chalazion.
151.
The surgical procedure
w/c involves removal of the eyeball is enucleation.
152.
Snellen’s Test
assesses visual acuity.
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