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212 Cards in this Set
- Front
- Back
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What is the fastest way to give drugs
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IV administration
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IV piggy backs are what kind of infusions
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secondary infusions into an established line
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Legal guidelines that come from statutory regulatory and common law are known at
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Sources of law
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Standards of care are defined at
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Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care
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Hey nurses caring for a client his states "I just want to die" for this nurse to comply with that request the nurse should discuss
A living will B assisted suicide C passive euthanasia or D advanced directive |
Advanced directive d
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A student nurse employed as a nursing assistant may perform care:
A Learned in school B expected of a nurse at that level C identified in the hospital's job description D requiring technical rather than professional skills |
Identified in the hospital's job description
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You are about to administer an oral medication any question the dosage you should:
A administer the medication B notify the physician C withhold the medication D document the dosage appears incorrect |
B Notify the physician
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What is the difference between ethics and law
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Laws are rules that must be followed that are typically based in ethical beliefs
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The word ethical means
A absolute privileges because of being human B the right to make personal decisions C knowledge of right and wrong D situations that are controversial |
C knowledge of right and wrong related to human conduct
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Personal accountability consists of what three factors
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1 acceptt responsibility for your own actions
2 promptly report illegal unethical and unsafe behaviors 3 uphold the standards of the profession |
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What describes and defines the legal boundaries of nursing practice within each state
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Nurse practice acts
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When the State Board of nursing passes rules and regulation this demonstrates decision made by it
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Regulatory law administrative law
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----- results from judicial decisions made by courts when individual legal cases are decided
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Common law
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Legal guidelines for nursing practice provide the minimum acceptable nursing care
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Standards of care
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A legal document that designates a person or persons of one's choosing to make healthcare decisions when the client is no longer able to make decisions on his or her own behalf
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Power of attorney for healthcare
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This law provides rights to clients and protects employees from losing their health insurance when changing jobs providing portability the privacy section there Sanders regarding accountability in the healthcare setting
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H I P a a
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This act gave residents in certified nursing homes the right to be free of unnecessary and inappropriate restraints
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The federal nursing home reform act
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----represents written documents that direct treatment in accordance with the clients wishes in the event of terminal illness or condition
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Living will
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Willful acts that violate another person's rights such as assault battery in false imprisonment
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Intentional tort
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Ask where intent is lacking but volitional action and direct causation occur invasion of privacy and defamation of character
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Quasi intentional tort
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Negligence and malpractice are both this kind of tort
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Unintentional tort
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Any intentional threat to bring about harmful or offensive contact
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Assault
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Any intentional touching without consent
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Battery
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Unjustified restraining of a person without legal warrant
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False imprisonment
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The tort protects the clients right to be free from unwanted intrusion into his or her private affairs. Is known as
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Invasion of privacy
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The publication of false statements that result in a damage to persons reputation
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Defamation of character
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Conduct that falls below a standard of care
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Negligence
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Hanging the wrong intravenous solution for a client is an example of what unintentional tort
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Negligence
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Allowing a nursing assistant to administer medication is an example of what unintentional tort
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Negligence
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What four criteria defined nursing malpractice
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1) The nurse owed a duty to the patient
2) a nurse did not carry out that duty 3) the client was injured 4) the nurses failure to carry out that duty caused the injury |
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If the client gives consent for an appendectomy and the healthcare provider performs a tonsillectomy what has occurred
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Battery
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Threatening restraint of a client is an example of what intentional tort
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Assault
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Charting false entries is what example of quasi intentional tort
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Defamation
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Five obligations as a nurse are
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1) do good
2) do no harm 3) public trust 4) follow professional codes of ethics 5) maintain high ethical standards |
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A statement of the rights to which patients are entitled as recipients of medical care is known as
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Patient's bill of rights
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Seven freedoms of the patient's Bill of Rights include?
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1) to seek consultation with the physician of their choice
2) to contact the physician on a mutual agreeable term 3) to be treated confidentially with access to the records limited to those involved in their care or designated by the patient 4) to refuse medical treatment even if it is recommended by their physician 5) to use their own resources to purchase the care of their choice 6) to be informed about their medical condition the risk and benefits of treatment and the appropriate alternatives 7) to refuse third-party interference with their medical care and to be confident that their actions and seeking or declining medical Claire will not result in a third-party impose penalties for patients or physicians |
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Although provisions very among states these laws limit the liability and offer legal immunity to nurses to help in the scene of an accident
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Good Samaritan laws
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Public Law is also known as
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Statutory law
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Three laws that define public law are
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Constitutional law administrative law and criminal law
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Two laws that define private law are known as
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Contract law
Law of torts |
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Are private law is also known as
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Civil or common-law
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The Nurse practice act is enforced by who
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The board of nursing
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What does respondeat superior mean
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Both the nurse and the employer are responsible for injury to the patient
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---- describe what are you responsible nurse with you in a similar situation
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Standards of care
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Nursing standards of care are used to:
A) describe the nurse practice act B) define appropriate levels of care C) write license exam questions D) analyze performance for pay |
B) define appropriate levels of care
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What are two types of torts
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Intentional and unintentional
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What is a tort
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An injury or wrong committed by one person against another
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Failing to perform your duties as any responsible and prudent nurse would in a similar situation is known as
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Negligence
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An act so atrocious that human life has been lost or endangered this usually results in a criminal law and private malpractice suits
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Gross negligence
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A nurse works on a cardiac unit. She is taking care of a client who recently had a coronary bypass surgery. Which of the following represent legal sources of standards of care nurses used to deliver safe healthcare choose all that apply
1) information provided by the head nurse 2) policies and procedures of the employing hospital 3) nurse practice act of the state of the nurses working in 4) regulations identified in the joint commissions manual 5) the American nurses Association standards of nursing practice |
2) policies and procedures of the employing hospital
3) policies and procedures of the employing hospital 4) nurse practice act of the state in which the nurse is working 5) American nurses Association standards of nursing practice |
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Most litigation involving hospital care is related to situations in which:
A) the nurse abandons the clients when going to lunch. B) the nurse follows an order that is incomplete or incorrect C) the nurse documents that physicians blame when a mistake is made D) the supervisor watching a new employee checks his or her skill level |
B) the nurse follows an order that is incomplete or incorrect
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A nurse is sued for failure to monitor a client appropriately. Which statements are correct about professional negligence lawsuits?
A) the nurse is the plaintiff B) the person filling the lawsuit has the burden of proof C) the defendant must prove injury damage or loss D) the plaintiff must prove that a breach of the prevailing standard of care caused an injury |
B the person filing the lawsuit has the burden of proof
D the plaintiff must prove that a breach in the prevailing standard of care cost and injury |
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The nurse must follow standards of care to avoid potential litigation such as negligence suits. Which of the following described a potential nursing malpractice situation (select all that apply)
A) failure to question a healthcare provider about the appropriateness of a client order B) failure to make a nursing diagnosis C) failure to properly use medical equipment ordered for client monitoring D) failure to follow the six rights of medication administration E) failure to provide discharge instructions |
All of the above
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Which of the following statements are correct
1) consent for medical treatment may be given by a minor with a sexually transmitted disease 2) a second trimester abortion can be performed without state involvement 3) student nurses cannot be sued for malpractice well in nursing clinical 4) nurses to get sick and leave during a shift are not abandoning their clients if they call their supervisors and leave a message about emergency illness |
A ) consent for medical treatment can be given by a minor with a sexually transmitted disease
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Which of the following regulates hospitals to ensure safety in the provision of services establishes criteria that must be met for a hospital to receive funding from the government and provides penalties if guidelines are not followed
1) board of nursing examiners 2) nurse practice act 3) American nurses Association 4) Americans with disabilities act |
4) Americans with disabilities act
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A nurse notes that advanced direct in the clients medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case?
A ) a durable power of attorney for healthcare is invoked only when the client has a terminal condition or is in a persistent vegetative state B) a living will allows an appointed person to make a healthcare decision when the client is in an incapacitated state C) hey Living will is invoked only when the client has a terminal condition or is in a persistent vegetative state D) the client cannot make changes in the advanced directive once the client is admitted into the hospital |
C) hey LivingWell is invoked only when the client has a terminal condition or is in a persistent vegetative state
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The legal definition of death that facilitates organ donation is cessation of:
A pulse B respirations C functions of the entire brain D circulatory and respiratory functions |
Functions of the entire brain
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Even though the nurse may obtain the clients signature on a form, obtaining informed consent is the responsibility of
A the client B the physician C the nursing student D the supervising nurse |
B the position
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What is an IV drip
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Continuous IV administration
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What part of an IV helps prevent air emboli and allow for control of the IV flow rate
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Drip chambers
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What are five purposes of IV therapy
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1 to correct fluid and or electrolyte imbalances
2 to deliver medications via IV route 3 to administer blood transfusions 4 to administer chemotherapy 5 to provide glucose other nutrients when in enteral route cannot be used |
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PPn and or TPN is also call
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Parenteral
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When the enteral route cannot be used what route is nutrition delivered
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Parenteral
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IVPB stands for
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IV piggyback
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Secondary infusions used for intermittent delivery of medications into an established patent primary IV line
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IVPB
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An IV piggyback is typically what volume
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50-100 mL
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An IV piggyback is generally mixed with what two substances
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Generally normal salene or D5W
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What is a general infusion time for IV piggybacks
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30 to 60 minutes
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What three substances tightly regulate body's water
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Hydrostatic and as osmotic pressures along with hormones
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What are two hormones that tightly regulate the body's water
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Aldosterone and adh
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hydrostatic pressure simply reflects the way in volume of water result in
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The more volume of water in the intrvascular space and thus the higher the blood pressure
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Too much fluid stretches the vascular pores which causes all sizes of particles to escape from vessels and into interstitial space
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Edema
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The pressure needed to promote diffusion of water across a semi permeable membrane from an area of higher concentration to an area of lower concentration is known ass
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Osmosis
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And osmosis the pressure needed to promote diffusion of water across a semi permeable membrane goes from an area of what
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Higher concentration to an area of lower concentration
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With osmosis water moves into compartment with a higher concentration of what
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Particles or solute
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Water is actually pulled into the compartment in the same way as sponge soaks up Grisville this poll is called what
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Osmotic pressure
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Crystalloid fluid as what type of particles in it
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Small particles
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Calloid has what type of particles in it
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Large particles
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What are two types of IV solutions
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Chrystalloids
Colloids |
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Chrystalloids are classified by What
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Their tonicity
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Three types of Chrystalloids are categorized as
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Isotonics hypotonic hypertonic
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Normal saline solution has what type of tonicity
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Isotonic
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half normal saline has what type of tonicity
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Hypotonic
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Dextrose 5% has what type of tonicity
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Isotonic
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Dextrose 5% in half normal saline has what type of tonicity
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Hypertonic
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Lactated ringers has what type of tonicity
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Isotonic
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Ns has what type of tonicity
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Isotonic
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1/2 NS has what type of tonicity
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Hypotonic
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D5W has what type of tonicity
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Isotonic but may become hypertonic as dextrose is metabolize
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D5 W in 1/2 N S has what type of tonicity
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Hypertonic
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What constituents and amounts are in normal saline
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Sodium 154 mEq/L
Chloride 154 mEq/L |
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What constituents and amounts are in Half normal saline
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Sodium 77 mEq/L
Chloride 77 mEq/L |
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What constituents and amounts are in dextrose 5%
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Dextrose 278 mmol/L
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What constituents and amounts are in Lactated ringers
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Sodium 130
Chloride 109 Lactate 28 Potassium 4 Calcium three |
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If isotonics fluids are given correctly is it Edema a possibility
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No
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What is a volume expander that is closest to blood
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Lactated ringers
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What are the most commonly used isotonic fluids
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Normal saline and lactated ringers
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D5 W is generally used to do what
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Keep veins open
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What type of solution are Used to treat cellular dehydration or hyponatremia
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Hypertonic solutions
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What type of solution causes cells Lyse
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Hypertonic solutions
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What organ system is benefited by Freewater
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Kidneys
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What solution is primarily given to patients with hyponatremia and edema
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Hypertonic solution
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Hypertonic solution have what effect on Cells
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Causes the cells to shrink
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What solution as an added bonus of suppressing inflammation
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Hypertonic fluids
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What are often used to treat hypovolemia or hypovolimic shock
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Colloids
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Albumin is also known as what
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Plasma proteins 5% or 25%
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What colloid use to replace protein and treats shock
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Albumin 5% or 25%
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Dextran is also known as
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Polysaccharide
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40 K DA and 70 K DA are known as
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Dextran
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Dextran is used as
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Vascular expansion
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Dextran shifts fluid where
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Into vessels
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Hetastarch is known as
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Synthetic starch 6% or 10%
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HES as what action or use
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Shifts fluid into vessels
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Mannitol is also known as
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Alcohol and sugar 5% or 25%
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What are the three uses of mannitol
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Oliguric diuresis
Reduces cerebral edema Eliminates toxins |
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45% normal saline has what use
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Hydrate cells
Shift fluid out of vessels and into cell |
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45% and 25% normal saline ha's what type of tonicity
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Hypotonic
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90% normal saline has what type of tonicity
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Isotonic
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What type of IV lines can deliver fluids and medications that would normally be to irritating for peripheral veins because of the concentration or chemical
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Central IV lines
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What organ immediately receives medication and thus quickly distributes medication to the rest of the body with central lines
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The heart
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The multiple parallel compartments within the catheter itself are known as
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Lumens
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PICC stands for
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Peripherally inserted central catheter
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When I V accesS is required over a prolonged period of time what may be inserted
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Hey peripherally inserted central catheter a.k.a. P I CC
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A double or triple lumen catheter is inserted directly into what
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The subclavian or internal jugular vein
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What central venous line is intended for short term use
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A double or triple lumen catheter
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Tunneled lines inserted into a target vein then tunneled under this again to emerge a short distance away are known as
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Hickman and Boviac catheters
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These have a small reservoir that is covered with silicone rubber and is implanted under the skin for access with a needle
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Port a CAth mediport
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A percutaneous Central Venus catheter has what insertion point
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Subclavian
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PICC. Have how many lumen
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1 to2
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How long are percutaneous IV s left inside
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4 to 10 days
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How often should you flush and IV with normal saline
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Every eight hours and before or after Meds
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What is the maximum amount of time an IV solution can hang
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24 hours
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How often should IV tubing be replaced
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Every 72 hoursa
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In adults how much saline should one flush with
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10 mL
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How much saline Should you flush a pediatric or neonate patient
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5 mL
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After flushing with 10 Cc what should a nurse use
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4.525 mL of hepernarized saline
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How often should you monitor and document the condition of an IV site for pediatric patients
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Every hour
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How often should you monitor and document the condition of an IV site for an adult patient
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Every two hours
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What are five conditions to monitor when concerning site care
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Phlebitis cellulitis septicemia infiltration in thrombosis
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Wormstead site redness swelling and pain including inflammation of the vein are all types and manifestations of what infection of IV site
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Phlebitis
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When IV fluid enters or leaks into surrounding tissue rather than the vain what occurs
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Infiltration
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Four manifestations of infiltration include
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Power coolness localized swelling plasma or absent pain
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Edema paleness localized swelling minimal or absent pain are all symptoms of which IV therapy risk
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Infiltration
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Accidental leakage of potassium calcium or 50% dextrose into surrounding tissue that can lead to tissue necrosis it is known as which risk of IV therapy
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Extravasation
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Extravasation ha's what clinical manifestations
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Ecchymosis hematoma the escape of blood into tissues
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Two medications that assist in thrombo phlebitis
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Anti-inflammatory and analgesic medications
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Irritation to internal lumen of the vein during insertion of vascular access device appears shortly after insertion this type of phlebitus by this is call
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Mechanical
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What two social groups are at higher risk of fluid overload
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Elderly and very young patients
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When IV fluids are given at a rate larger volume then the body can absorb or excrete is known as
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Fluid overload
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When large volumes of cold IV fluids are infused what risk of IV therapy may occur
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Hypothermia
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This risk of IV therapy may occur when administering 82 dilute or two concentrated solution causing a disruption of a patient's balance of sodium potassium magnesium or other electrolytes
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Electrolyte imbalance
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What risk involves an embolism with administration of IV fluids
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And embolism may become mobilized in circulation and end up blocking a vessel at another site such is the longs this risk is greater with central line IVs
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Septicemia is most often caused by
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Poor insertion technique or poorer site care
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Air injected into IV system may cause what
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Air embolism
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Rapid IV infusion of May cause of what type of edema
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Pulmonary Edema
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A client experiences a loss of intracellular fluid. The nurse anticipates that the IV therapy that will be used to replace this type of loss is: A 45% normal saline
B 10% dexterous C 5% dexterous and lactated ringers D dextrose 5% in normal saline |
45% normal saline
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The healthcare provider orders 1000 mL of dextrose 5% in lactated ringers with 20 mL of potassium chloride to run eight hours using infusion set with a drop factor of 15 drops per milliliter the nurse actually served flow rate to be 12 drops per minute 22 drops for minute 32 drops for minute or 42 drops for minute
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32 drops for minute
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I client has IV therapy for administration of antibiotics and is stating that the IV site hurts and is swollen which of the following information SS on the client indicates the presence of phlebitis as opposed to infiltration
Intensity of pain Warmth surrounding the IV site Amount of sub q edem skin discoloration of bruised nature |
Warmth of integument surrounding the IV site
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For a client with a nursing diagnosis of fluid volume excess the nurse is alert to which of the following signs and symptoms
1 weak thready pulse 2 hypertension 3 dry mucous membranes 4 flush skin |
Hypertension
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A nursing diagnosis of fluid volume deficit would have what type of clinical manifestation
1 weak thready pulse 2 hypertension 3 dry mucous membranes 4 flush skin |
A weak thready pulse
Dry mucous membranes |
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Hey bounding pulse is a symptom of what nursing diagnosis
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Fluid volume exccess
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And IV solution of 125 mL is used to infuse over one hour a micro drip 60 drops per milliliter infusion set will be used the nurse calculates the infusion rate as
1) 32 drops per minute 2) 60 drops per minute 3) 125 drops per minute 4) 250 drops per minute |
125 drops per minute
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The client is prescribed .9% sodium chloride which is in isotonic solution the nurse recognizes the primary goal of such intravenous therapy is to
A expand the volume of fluid in the vascular system B pull the fluid from The cells C keep protein levels normal D move fluid into the cells |
Expand the volume of fluid in the vascular system
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A client is prescribed 3% sodium chloride which is a hypertonic solution the nurse recognizes the primary goal of the intravenous therapy is to
1) expand the volume of fluid in the vascular system 2) pull fluid from the cells 3) keep protein levels normal 4) move fluid into the cells |
Pull fluid from The Cells
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When should a nurse avoid and ministering D5 W in clients
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Clients at risk for increased intracranial pressure
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What solution is not commonly seen
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Hypotonic
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What solution treats ascites
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Hypertonic
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Interstitial over hydration can be treated with what type of solution
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Hypertonic
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Hey hypertonic solution should be avoided in what two types of failure
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Harding kidney
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What must be monitored closely with any dexterous concentration
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Blood sugar
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What is the most common complication of enteral feedings?
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Diarrhea
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What are some other complications with enteral feedings?
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Nausea vomiting
Hyperglycemia Dehydration if no free water is available Over hydration |
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What happens if the patient is lying flat enteral feedings are being given ?
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Aspiration
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How often do you check residuals with enteral feedings?
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Every four hours
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What residual would you like to draw waiting hour and three check the residual
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200- 250 ml
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What should you do if residual continues after an hour to be greater than 250 mL
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Hold feedings notify physician
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What are the classical manifestation of Phlebitis
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classic manifestations include warmth at site, redness, swelling, & pain
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When does infiltration of an IV cite occur
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Infiltration – occurs when IV fluid enters or “leaks” into surrounding tissue rather than the vein –
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What are some classic manifestations of infiltration
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classic manifestations include coolness & pallor (paleness) at site, localized swelling (edema), minimal or absent pain
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What is Extravasation
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accidental leakage of a vesicant (irritating substance) such as potassium, calcium or 50% dextrose into surrounding tissue that can lead to tissue necrosis
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Localized mass of blood that creates hard, painful lump is an IV error know as
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Echymosis hematoma
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Pain is a natural outcome of growing old.
T or m |
Myth
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Older adults are at greater risk (as much as twofold) than younger adults for many painful conditions, However, pain is not an inevitable result of aging.
T or M |
Truth
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Pain perception, or sensitivity, decreases with age.
T or M |
Myth
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This assumption is unsafe. Although there is evidence that emotional suffering specifically related to pain is possibly less in older than in younger clients, no scientific basis exists for the claim that a decrease in perception of pain occurs with age or that age dulls sensitivity to pain.
T or myth |
Truth
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If the older client does not report pain, he or she does not have pain.
T or myth |
Mythj
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Older clients commonly underreport pain. Reasons include expecting to have pain with increasing age; not wanting to alarm loved ones; being fearful of losing their independence; not wanting to distract, anger, or bother caregivers; and believing caregivers know they have pain and are doing all they can to relieve it. The absence of a report of pain does not mean the absence of pain.
T or myth |
Truth
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What areAutonomic reactions to pain
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↑ b/p, p & r → ↑ c.O.
↑ Sweating & peripheral vasoconstriction → pale & cold N & V |
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What are Skeletal muscle reactions to pain.
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Muscle tension & rigidity
Writhing, unusual postures, rubbing, restlessness Insomnia |
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Note: with severe pain the body’s defenses may
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collapse → weakness, prostration, ↓ b/p & slow P, à ↑ pallor & loss of consciousness*
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What are Psychological & behavioral reactions to pain
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Irritability
Depression Unusual quietness Withdrawal Behavior reversals |
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A postoperative patient is using a PCA. You will evaluate the effectiveness of the medication when:
A. You compare assessed pain with baseline pain. B. Body language is incongruent with the report of pain relief. C. Family members report that pain has subsided. D. Vital signs have returned to the baseline. |
A. You compare assessed pain with baseline pain
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If on PCA what should be assessed
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Vs and pain q4 hours
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*Sigmoid colostomy has what stool consistency
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Formed stool consistency
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What stool consistency is an ileostomy s contents what enzymes does it contain
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Stool is liquid to semiliquid consistency and contains proteolytic enzymes
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And ileostomy is there any Bowel irrigation
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No bowel regulation or irrigation.
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Doesn't ileostomy or cholostomy Requires wearing an appliance and skin barrier. Paste preferred.
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Ileostomy
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In an ileostomy or cholostomy Fecal output can range from 1000-1500ml every 24 hours. It should begin to decrease slightly within 10-15 days to an average of about 800 ml per day.
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Ileostomy
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Why is ileostomy care so different from colostomy care?
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The drainage from the ileostomy contains proteolytic enzymes that literally digest the skin. That is why skin care is so important for your ileostomy patient.
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What type of incontinence is caused by urethral blockage, where the bladder is unable to empty properly
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Overflow incontinence
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What type of incontinence is caused by increased abdominal pressure And a relaxed pelvic floor
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Stress incontinence
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What type of incontinent is caused by bladder over sensitivity from infection, or neuro disorders
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Urge incontinence
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If Intermitent catheterization is needed how long is the maximum amount of time between catheterizations
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8 hours
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What position should a patient be when receiving an enema
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Position patient in Sims’ position with right knee flexed
Use tepid (room temperature) solution |
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How deep should a tube be inserted for an enema
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3 to 4 inches
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How long should enema solution be retained in a patient
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5 to 10 minutes
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What is the purpose of an enema
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To promote defecation by stimulating peristalsis
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When Do NOT administer enema
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presence of abdominal pain, nausea, vomiting, or suspected appendicitis (may cause rupture
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What is the average daily urinary output
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*24-hour production – 1500-2000 ml
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What is a normal BUN level?
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normal = 10-20 mg/dl)
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What is a normal creatinine level
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(normal = 0.5-1.5 mg/dl)
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What is the normal pH of urine
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4.5-8.0
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