NR224 NR226 Final Exam Key Concepts with Answers (42 Solved Questions)
NR224 NR226 Final Exam Key Concepts with Answers provides key insights into previous exams to help you prepare better.
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NR 224NR 226 Final Exam Key Concepts
NOTE: The intent of this study tool is to outline the major concepts covered in NR 224 and NR 226.
NR 224 Concepts:
Critical Thinking
Be prepared to prioritize and to consider the
best option when answering exam questions.
-- ABC
-- Maslow’s Hierarchy
-- 1st Level
-- 2nd Level
-- 3rd Level
What considerations are important when
determining the best option?
--
When should the nurse delegate vs not
delegate?
--
What are essential steps the nurse should do
prior to performing any skill on a patient?
-- Two Pt Identifiers
-- Allergies
-- Pain levels
What are principles related to HIPAA?
Nursing Process
Review the steps in the nursing process. Be
prepared to interpret a scenario/situation to
determine the corresponding step in the
nursing process.
-- Assessment
-- Diagnosis
-- Planning/Outcome Identification
-- Implementing
-- Evaluating
Consider nursing diagnoses that are
applicable to a given situation/scenario.
-- Risk for infection
-- Impaired skin integrity
-- Impaired tissue perfusion
-- impaired physical mobility
-- ineffective airway clearance
-- social isolation
-- impaired urinary elimination
Infection Prevention and Control
What is the difference between clean and
sterile technique?
-- Sterile:
-- Clean:
What are examples of skills and procedures
that should be performed using clean
technique? Sterile technique?
-- Sterile: NG tube, Foley Cath, dressing
change, suctioning
-- Clean:
List strategies/interventions that may
prevent infection transmission.
-- maintaining the chain or infection
-- not breaking sterile field
-- HAND WASHING
-- proper disposal of waste
-- a proper diet
-- proper hygiene
-- immunizations
-- adequate rest and exercise
-- wearing ppe
-- coughing etiquette
What are principles associated with creating
and maintaining a sterile field?
-- avoid sudden movements of body parts
-- refrain from touching sterile supplies
-- avoid coughing, sneezing
What is PPE?
-- Personal Protective Equipment
What are the different types of isolation and
what items are worn with each type?
-- Standard: used with all pt, bodily fluids,
Gloves
-- Contact: VRE, MRSA,C-Diff, shigella,
herpes, scabies, varicella, RSV, private room
or similar pt & Gloves and Gowns
-- Droplet: > 5 micron w/3 ft, diphtheria,
rubella, strep, pharyngitis, pneumonia,
scarlet fever, pertussis, mumps, sepsis,
private room or similar pt & surgical mask
NOTE: The intent of this study tool is to outline the major concepts covered in NR 224 and NR 226.
NR 224 Concepts:
Critical Thinking
Be prepared to prioritize and to consider the
best option when answering exam questions.
-- ABC
-- Maslow’s Hierarchy
-- 1st Level
-- 2nd Level
-- 3rd Level
What considerations are important when
determining the best option?
--
When should the nurse delegate vs not
delegate?
--
What are essential steps the nurse should do
prior to performing any skill on a patient?
-- Two Pt Identifiers
-- Allergies
-- Pain levels
What are principles related to HIPAA?
Nursing Process
Review the steps in the nursing process. Be
prepared to interpret a scenario/situation to
determine the corresponding step in the
nursing process.
-- Assessment
-- Diagnosis
-- Planning/Outcome Identification
-- Implementing
-- Evaluating
Consider nursing diagnoses that are
applicable to a given situation/scenario.
-- Risk for infection
-- Impaired skin integrity
-- Impaired tissue perfusion
-- impaired physical mobility
-- ineffective airway clearance
-- social isolation
-- impaired urinary elimination
Infection Prevention and Control
What is the difference between clean and
sterile technique?
-- Sterile:
-- Clean:
What are examples of skills and procedures
that should be performed using clean
technique? Sterile technique?
-- Sterile: NG tube, Foley Cath, dressing
change, suctioning
-- Clean:
List strategies/interventions that may
prevent infection transmission.
-- maintaining the chain or infection
-- not breaking sterile field
-- HAND WASHING
-- proper disposal of waste
-- a proper diet
-- proper hygiene
-- immunizations
-- adequate rest and exercise
-- wearing ppe
-- coughing etiquette
What are principles associated with creating
and maintaining a sterile field?
-- avoid sudden movements of body parts
-- refrain from touching sterile supplies
-- avoid coughing, sneezing
What is PPE?
-- Personal Protective Equipment
What are the different types of isolation and
what items are worn with each type?
-- Standard: used with all pt, bodily fluids,
Gloves
-- Contact: VRE, MRSA,C-Diff, shigella,
herpes, scabies, varicella, RSV, private room
or similar pt & Gloves and Gowns
-- Droplet: > 5 micron w/3 ft, diphtheria,
rubella, strep, pharyngitis, pneumonia,
scarlet fever, pertussis, mumps, sepsis,
private room or similar pt & surgical mask
NR 224NR 226 Final Exam Key Concepts
-- Airborne: < 5 micron, measles,
chickenpox, varicella, TB, negative pressure
room & N95
-- Protective: stem cell transplant, positive
pressure room, pt wear mask outside room
What item should be removed first? Why?
-- Remove gloves first, to prevent spreading
microbes.
Vital Signs
What are the normal ranges associated with
each vital sign?
-- Temp:96.8-100.F
-- Pulse: 60-100 Beats/Min
-- Resp: 12-20 Breaths/Min
-- BP: 120/80
-- O2: 95-100% in room air
What is the technique for measuring each
vital sign?
--
Activity and Exercise
What should the nurse include in a teaching
session to a client who is using a
cane/walker/crutches for the first time?
Cane
-- CWS = Cane, Weak, Strong
-- move the cane first, then weak leg, then
strong leg
-- length is = to distance between the greater
trochanter and floor
-- 2 types: single straight legged & quad
-- single straight leg is more common
-- keep cane on stronger side
-- place cane 6-10 in forward
-- keep body weight on both legs
-- 2 point support required on the floor at all
times.
-- quad cane provides the most support
--used for partial or complete leg
paralysis/hemiplegia.
Walker
-- light weight movable device
-- used by pt who is weak or has balance
problems
-- walker with wheels are useful for pt who
have difficulty lifting
-- measure by having pt to relax arms and
stand straight
-- elbows flexed 15-30 degrees when
standing inside walker
--hold hand grips, takes a step, move walker
forward, take another step.
-- Step, Walker, Step
Crutches
-- needed to increase mobility
-- 2 types: double adjustable & forearm
-- measure crutches for appropriate length
-- don’t support weight on crutches
-- ensure crutch is 2 to 3 fingers width from
axilla.
-- position tips 2 in lateral and 4-6 in
anterior in front of shoe
-- support weight by the hand grips
-- flex elbows 20-25 degrees
-- gait by alternating bearing weight on one
or both legs on the crutches
-- four standard gaits: 4-point, alternating, 3-
point, 2-point, swing through
-- basic stance = tripod
-- tripod is when crutches are 6 in front and
6 in to side of each foot
-- provides a wider base of support
-- 4-point gives stability to the patient but
requires weight on both legs
-- each leg alternate moves with each crutch,
so 3 point are on the floor always
-- 3-point requires the patient to bear all
weight on one foot
-- bears weight on both crutch and the
unaffected leg
-- affected leg doesn’t touch the ground
during the early phase
-- gradually progresses to weight on the
affected leg
-- 2-point requires partial weight
-- Crutch walk on stairs
-- Ascending stair (Unaffected 1st)
-- use the 3-point gait
-- transfer body weight to crutch, then
advance unaffected leg to the stair
-- Airborne: < 5 micron, measles,
chickenpox, varicella, TB, negative pressure
room & N95
-- Protective: stem cell transplant, positive
pressure room, pt wear mask outside room
What item should be removed first? Why?
-- Remove gloves first, to prevent spreading
microbes.
Vital Signs
What are the normal ranges associated with
each vital sign?
-- Temp:96.8-100.F
-- Pulse: 60-100 Beats/Min
-- Resp: 12-20 Breaths/Min
-- BP: 120/80
-- O2: 95-100% in room air
What is the technique for measuring each
vital sign?
--
Activity and Exercise
What should the nurse include in a teaching
session to a client who is using a
cane/walker/crutches for the first time?
Cane
-- CWS = Cane, Weak, Strong
-- move the cane first, then weak leg, then
strong leg
-- length is = to distance between the greater
trochanter and floor
-- 2 types: single straight legged & quad
-- single straight leg is more common
-- keep cane on stronger side
-- place cane 6-10 in forward
-- keep body weight on both legs
-- 2 point support required on the floor at all
times.
-- quad cane provides the most support
--used for partial or complete leg
paralysis/hemiplegia.
Walker
-- light weight movable device
-- used by pt who is weak or has balance
problems
-- walker with wheels are useful for pt who
have difficulty lifting
-- measure by having pt to relax arms and
stand straight
-- elbows flexed 15-30 degrees when
standing inside walker
--hold hand grips, takes a step, move walker
forward, take another step.
-- Step, Walker, Step
Crutches
-- needed to increase mobility
-- 2 types: double adjustable & forearm
-- measure crutches for appropriate length
-- don’t support weight on crutches
-- ensure crutch is 2 to 3 fingers width from
axilla.
-- position tips 2 in lateral and 4-6 in
anterior in front of shoe
-- support weight by the hand grips
-- flex elbows 20-25 degrees
-- gait by alternating bearing weight on one
or both legs on the crutches
-- four standard gaits: 4-point, alternating, 3-
point, 2-point, swing through
-- basic stance = tripod
-- tripod is when crutches are 6 in front and
6 in to side of each foot
-- provides a wider base of support
-- 4-point gives stability to the patient but
requires weight on both legs
-- each leg alternate moves with each crutch,
so 3 point are on the floor always
-- 3-point requires the patient to bear all
weight on one foot
-- bears weight on both crutch and the
unaffected leg
-- affected leg doesn’t touch the ground
during the early phase
-- gradually progresses to weight on the
affected leg
-- 2-point requires partial weight
-- Crutch walk on stairs
-- Ascending stair (Unaffected 1st)
-- use the 3-point gait
-- transfer body weight to crutch, then
advance unaffected leg to the stair
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Subject
Nursing