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NR224 NR226 Final Exam Key Concepts with Answers (42 Solved Questions)

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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 -- 1 st Level -- 2 nd Level -- 3 rd 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

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    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 1 st ) -- use the 3-point gait -- transfer body weight to crutch, then advance unaffected leg to the stair

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