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N138 Midterm Exam
- Question: What are the three stages of the Return to School Syndrome as described by Dr. Donea Shane? Answer: The three stages are: Honeymoon: Students feel positive about returning to school with a sense of satisfaction and optimism. Conflict: Students feel inadequate to meet new professional demands. Reintegration: This stage has multiple phases, starting with hostility and potentially leading to positive resolution (biculturalism) or maladaptation.
- Question: According to Bridge's Model of Transition, what are the three stages individuals experience during a transition? Answer: The three stages are: Ending, Losing, and Letting Go: Individuals experience emotional resistance, fear, and a sense of loss. The Neutral Zone: A period of confusion and uncertainty where the old is gone but the new isn't fully operational. The New Beginning: Individuals embrace new understandings, values, and attitudes, leading to acceptance and energy.
- Question: What is the difference between a medical diagnosis and a nursing diagnosis? Answer: Medical Diagnosis: Identification of a disease or condition based on specific evaluation of signs and symptoms; typically made by physicians. Nursing Diagnosis: Clinical judgment about the client's response to actual or potential health problems; focuses on the patient's holistic needs and is formulated by nurses.
- Question: What are the key components of the nursing process, often abbreviated as ADPIE? Answer: The nursing process consists of five steps: Assessment: Collecting and analyzing patient data. Diagnosis: Identifying patient problems based on assessment data. Planning: Setting patient goals and determining appropriate interventions. Implementation: Carrying out the planned interventions. Evaluation: Assessing the effectiveness of the interventions and modifying the care plan as needed.
Right Direction/Communication – Clear instructions, expectations, and feedback must be provided. Right Supervision/Evaluation – The delegating nurse must monitor performance and provide appropriate follow-up.
- Question: Explain Maslow’s Hierarchy of Needs and how it applies to nursing care. Answer: Maslow’s Hierarchy of Needs is a five-tier model of human needs: Physiological Needs – Basic survival needs (food, water, oxygen, sleep). Nurses address these first in patient care. Safety Needs – Protection from harm (e.g., fall prevention, infection control). Love & Belonging Needs – Emotional support, relationships, and social inclusion (e.g., therapeutic communication, family involvement). Esteem Needs – Respect, confidence, and self-worth (e.g., encouraging independence and patient autonomy). Self-Actualization Needs – Personal growth and fulfillment (e.g., helping patients set and achieve personal goals). Nurses prioritize lower levels before higher-level needs in care planning.
- Question: What are the key ethical principles in nursing practice? Answer: Autonomy – Respecting a patient’s right to make decisions about their care. Beneficence – Acting in the best interest of the patient. Nonmaleficence – Avoiding harm to the patient. Justice – Providing fair and equitable care to all patients. Fidelity – Maintaining trustworthiness and keeping promises to patients. Veracity – Being truthful in communication with patients.
- Question: Describe the stages of the Transtheoretical Model of Change and their significance in health promotion. Answer: The Transtheoretical Model describes behavior change as a process: Precontemplation – No intention to change behavior; patient may be unaware of the need for change. Contemplation – Patient considers making a change but has not committed. Preparation – Patient intends to take action soon and may begin small steps toward change. Action – The patient actively implements behavior change. Maintenance – The patient works to sustain behavior change and prevent relapse. Nurses use this model to tailor interventions for patient education and behavior modification.11. Question: What are the four types of nursing assessments? Answer: Initial (Comprehensive) Assessment – Conducted upon patient admission to gather baseline data. Focused Assessment – Conducted when a specific problem is identified (e.g., assessing for pain in a patient with chest discomfort). Emergency Assessment – Rapid assessment performed during critical situations (e.g., assessing airway, breathing, circulation in an unresponsive patient). Ongoing (Follow-Up) Assessment – Performed at regular intervals to monitor changes in the patient’s condition.
- Question: Define evidence-based practice (EBP) and its components. Answer:
- Question: Explain the difference between therapeutic and non-therapeutic communication in nursing. Answer: Therapeutic Communication: Promotes trust, understanding, and emotional support (e.g., active listening, open-ended questions, empathy). Non-Therapeutic Communication: Blocks communication and can create barriers (e.g., giving false reassurance, interrupting, being judgmental). Example: ✔ Therapeutic: “Tell me more about how you’re feeling.” ✘ Non-Therapeutic: “You’ll be fine, don’t worry about it.”
- Question: What are the key differences between acute and chronic illnesses? Answer: Acute Illness: Rapid onset, short duration, often curable (e.g., pneumonia, appendicitis). Chronic Illness: Long-term, progressive, often requiring ongoing management (e.g., diabetes, hypertension). Nursing care for chronic illness focuses on symptom management, education, and quality of life improvement.
- Question: What are common barriers to patient education in nursing? Answer: Cognitive barriers – Low health literacy, language differences.
Emotional barriers – Anxiety, fear, or denial. Physical barriers – Vision/hearing impairments, fatigue. Environmental barriers – Lack of privacy, distractions. Nurses should adapt teaching strategies to overcome these barriers.
- Question: What is the purpose of SBAR communication in nursing? Answer: SBAR is a structured method for effective communication in healthcare settings: S (Situation): Briefly describe the problem (e.g., “The patient’s blood pressure dropped to 80/50.”). B (Background): Provide relevant history (e.g., “Patient had surgery 24 hours ago.”). A (Assessment): Give an analysis (e.g., “I suspect internal bleeding.”). R (Recommendation): Suggest action (e.g., “I recommend ordering a STAT CBC and IV fluids.”). SBAR improves clarity and reduces communication errors.
- Question: What are the differences between medical asepsis and surgical asepsis? Answer: Medical Asepsis: Reduces the spread of pathogens (e.g., hand hygiene, clean gloves, disinfection). Surgical Asepsis: Eliminates all microbes for sterile procedures (e.g., sterile gloves, sterile field, surgical hand scrubbing). Proper aseptic technique prevents healthcare-associated infections.
- Question:
What are the early and late signs of hypoxia? Answer: Early Signs: Restlessness, anxiety, tachycardia, increased respiratory rate. Late Signs: Cyanosis, confusion, bradycardia, decreased level of consciousness. Interventions include oxygen therapy, airway management, and repositioning.
- Question: What are the different oxygen delivery systems and their flow rates? Answer: Nasal Cannula: 1–6 L/min (24%–44% FiO₂) Simple Face Mask: 6–10 L/min (40%–60% FiO₂) Non-Rebreather Mask: 10–15 L/min (up to 90% FiO₂) Venturi Mask: 4–12 L/min (precise FiO₂, 24%–50%) CPAP/BiPAP: Used for sleep apnea and respiratory distress
- Question: What is the difference between enteral and parenteral nutrition? Answer: Enteral Nutrition (EN): Nutrition delivered through the gastrointestinal tract (e.g., via NG tube, PEG tube). Parenteral Nutrition (PN): Nutrition delivered intravenously (e.g., via TPN in central line). EN is preferred unless the GI tract is nonfunctional.
- Question: List the common electrolyte imbalances and their key symptoms.
Answer: Hyponatremia (low sodium): Confusion, seizures, muscle cramps. Hypernatremia (high sodium): Thirst, dry mucous membranes, irritability. Hypokalemia (low potassium): Weakness, arrhythmias, muscle cramps. Hyperkalemia (high potassium): Muscle twitching, cardiac arrest. Hypocalcemia (low calcium): Muscle spasms, Chvostek’s & Trousseau’s signs. Hypercalcemia (high calcium): Lethargy, kidney stones, bone pain.
- Question: What are the types of wound healing? Answer: Primary Intention: Edges are approximated (e.g., surgical incision). Secondary Intention: Wound heals from the bottom up, with granulation tissue (e.g., pressure ulcer). Tertiary Intention: Delayed closure due to infection risk. Proper wound care promotes faster healing.
- Question: What are the different types of isolation precautions? Answer: Standard Precautions: Hand hygiene, gloves (used for all patients). Contact Precautions: Gown, gloves (e.g., MRSA, C. diff). Droplet Precautions: Mask (e.g., flu, pertussis). Airborne Precautions: N95 mask, negative-pressure room (e.g., TB, measles, COVID- 19). Proper PPE use prevents infection spread.
- Question:
Nurses provide support and therapeutic communication at each stage.
- Question: What are the five components of cultural competence in nursing? Answer: Cultural Awareness: Understanding one’s own biases. Cultural Knowledge: Learning about other cultures. Cultural Skill: Applying knowledge in patient care. Cultural Encounter: Engaging with diverse patients. Cultural Desire: Being willing to learn and adapt care. Culturally competent care improves patient outcomes.
- Question: What are the four major types of law in healthcare? Answer: Constitutional Law: Defines rights (e.g., patient privacy). Statutory Law: Laws made by legislatures (e.g., Nurse Practice Act). Administrative Law: Regulations by agencies (e.g., OSHA, Board of Nursing rules). Common Law: Legal precedents from court cases (e.g., malpractice rulings). Understanding legal principles helps protect nurses and patients.
- Question: What are the major causes of medication errors, and how can they be prevented? Answer: Causes: Miscommunication, incorrect dosage calculation, distractions, look-alike/sound-alike drugs.
Prevention: Follow the "Six Rights" (Right Patient, Drug, Dose, Route, Time, Documentation), use barcode scanning, and clarify unclear orders. Safe medication practices reduce harm.
- Question: What is the difference between delegation and supervision in nursing? Answer: Delegation: Transferring a task to a qualified team member (e.g., assigning a CNA to take vital signs). Supervision: Overseeing the work of another to ensure proper completion (e.g., monitoring a new nurse’s IV insertion skills). Both require accountability and follow-up.36. Question: What are the legal and ethical responsibilities of nurses in medication administration? Answer: Follow the "Six Rights" of medication administration. Adhere to scope of practice and hospital policies. Verify physician orders before administration. Educate patients on their medications. Report and document any medication errors immediately. Respect patient autonomy by obtaining informed consent. Failure to meet these responsibilities may result in legal consequences, including malpractice.
- Question: Explain the difference between subjective and objective nursing data. Answer:
- Question: What are the different levels of consciousness (LOC) used in neurological assessments? Answer: Alert: Fully awake, responsive. Lethargic: Slow to respond, drowsy. Obtunded: Requires repeated stimulation to respond. Stupor: Minimal response to painful stimuli. Coma: No response to stimuli. The Glasgow Coma Scale (GCS) is often used to assess LOC.
- Question: What are the differences between left-sided and right-sided heart failure? Answer: Left-Sided Heart Failure: Pulmonary congestion, dyspnea, crackles, orthopnea, fatigue. Right-Sided Heart Failure: Peripheral edema, jugular vein distention (JVD), ascites, hepatomegaly. Treatment includes diuretics, ACE inhibitors, beta-blockers, and lifestyle changes.
- Question: What are the normal ranges for arterial blood gases (ABGs)? Answer: pH: 7.35–7. PaCO₂ (Carbon Dioxide): 35–45 mmHg
HCO₃ (Bicarbonate): 22–26 mEq/L PaO₂ (Oxygen): 80–100 mmHg SaO₂ (Oxygen Saturation): >95% ABG analysis helps diagnose respiratory and metabolic imbalances.
- Question: What are the early and late signs of increased intracranial pressure (ICP)? Answer: Early Signs: Headache, nausea, vomiting, restlessness, altered LOC. Late Signs: Cushing’s Triad (hypertension, bradycardia, irregular respirations), fixed pupils, posturing (decerebrate/decorticate). Immediate interventions include elevating the head of the bed (HOB), administering osmotic diuretics (mannitol), and monitoring neurological status.
- Question: What are the warning signs of a stroke (CVA)? Answer: Use the FAST acronym: F – Face drooping A – Arm weakness S – Speech difficulty T – Time to call 911 Other symptoms include sudden vision changes, confusion, or loss of coordination.
- Question: Differentiate between DKA (Diabetic Ketoacidosis) and HHS (Hyperosmolar Hyperglycemic Syndrome).
- Question: What are the signs of hypovolemic shock? Answer: Tachycardia Hypotension Cool, clammy skin Weak pulses Decreased urine output Altered mental status Immediate treatment includes IV fluids, oxygen, and monitoring for organ failure.
- Question: What are the types of burns, and how are they classified? Answer: Superficial (First-Degree): Redness, no blisters (e.g., sunburn). Partial-Thickness (Second-Degree): Blisters, swelling, severe pain. Full-Thickness (Third-Degree): White/charred skin, no pain (nerve destruction). Fourth-Degree: Damage extends to muscles and bones. Fluid resuscitation and wound care are critical in burn management.
- Question: What are the major complications of immobility? Answer: Musculoskeletal: Muscle atrophy, contractures. Cardiovascular: Deep vein thrombosis (DVT), orthostatic hypotension.
Respiratory: Pneumonia, decreased lung expansion. Gastrointestinal: Constipation, reduced appetite. Integumentary: Pressure ulcers, skin breakdown. Nurses should encourage mobility, reposition patients, and monitor for complications.51. Question: What are the different types of urinary incontinence? Answer: Stress Incontinence: Leakage with increased abdominal pressure (e.g., coughing, sneezing). Urge Incontinence: Sudden, strong urge to urinate (overactive bladder). Overflow Incontinence: Bladder overfills, leading to leakage. Functional Incontinence: Physical or cognitive impairment prevents timely bathroom access. Mixed Incontinence: Combination of two or more types. Management includes bladder training, pelvic floor exercises, and medications.
- Question: What is the difference between active and passive immunity? Answer: Active Immunity: Body produces its own antibodies (e.g., vaccination, infection recovery). Passive Immunity: Antibodies are given (e.g., maternal antibodies, immunoglobulin therapy). Active immunity provides long-term protection, while passive immunity is temporary.
- Question: What are the different types of anemia and their causes?
