Fundamentals Final Exam 180 Review Questions and

Fundamentals Final Exam 180 Review Questions and Answers 2023 Study Guide 1 / 3

• A nurse is assessing internal variables that are affecting the patient’s health status. Which area should the nurse

assess? Pg 70

• Perception of functioning
• Socioeconomic factors
• Cultural background
• Family practices

● Internal variables include a person's developmental stage, intellectual background, perception of function and emotional and spiritual factors ● External variables include family practices, socioeconomic factors and cultural background

• Wanda is a nurse on the night shift. She frequently has to wake her patient to check vital signs and administer

medications. How can these actions negatively influence her patient's overall health?

• causes the body temperature to peak in the afternoon, decrease gradually, and drop sharply after the

patient falls asleep

• causes the patient to experience anxiety, restlessness, irritability, and impaired judgment
• causes the excretion of hypOcretins (Orexins) that prOmOte wakefulness and rapid eye mOvement

(REM) sleep → hypOthalamus sleeping center

• causes stimulation of the ascending reticular activating system located in the upper brainstem

• The pulse is the palpable bounding of
• lymph flow in the lymphatic system
• blood flow in a peripheral artery
• blood flow in a peripheral vein
• blood flow in the aorta

• You are about to administer an oral medication and you question the dosage. What do you do next?
• administer the medication and notify the physician
• hold the dose and notify the physician → if HCP cOnfirms an order and yOu still believe it is

inapprOpriate, use chain of cOmmand tO infOrm yOur direct supervisOr

• hold the dose and notify the charge nurse
• document that the dose appears incorrect

• When thinking about setting priorities, in general
• longer-term chronic patient care needs and problems typically take priority over short-term acute needs
• problem-focused diagnoses and problems take priority over wellness, possible risk, and health

promotion problems

• priority setting is the ordering of a list Of care tasks → Organization of the desired OutcOmes fOr a

patient

• priority setting never changes once priorities are initially ranked

• Body tissues and cells function efficiently within a narrow range, which is
• 36° to 38°C (96.8° to 100.4°F)
• 37° to 39°C (98.6° to 102.2°F)
• 34° to 36°C (93.2° to 98.6°F)
• 35° to 36°C (95° to 96.8°F)

• The unlicensed assistive personnel (UAP) is preparing to assist in feeding a client. How will the nurse direct the UAP?

Pg 1130

• Position patient upright (45 to 90 degrees preferred) or according to medical restrictions during and

after feeding

• Assess patient’s current medications for use of sedatives, hypnotics, or other agents that may impair cough or

swallowing reflex.

• Use aspiration precautions while feeding patients who need help and explain feeding techniques that are 2 / 3

successful for specific patients.

• Immediately report any onset of coughing, gagging, or a wet voice or pocketing of food to the nurse.

• The acronym (PQRST) should guide your pain assessment, where PQRST stands for what?
• patterns, quantity, relationship, skills, temperament
• provokes, quality, radiate, severity, time
• provokes, quantity, radiate, severity, time
• provokes, quality, relationship, severity, time

● P—Provokes (precipitating and relieving factors): How did it come about? What might be the causes for the symptom? What makes it better or worse? Are there activities (e.g., exercise, sleep) that affect it?● Q—Quality What does the symptom feel like? (Have the patient explain in his or her own words.) If the patient has difficulty in describing symptoms, offer probes (e.g., “Is the pain sharp? Dull?” or “Do you feel light-headed, dizzy, off balance?”). What does the illness or symptom mean to the patient?● R—Radiate: Where is the symptom located? Is it in one place? Does it go anywhere else? Have the patient be as precise as possible.● S—Severity: Ask a patient to rate the severity of a symptom on a scale of 0 to 10 (with no symptom at 0 and the worst intensity at 10). This gives you a baseline with which to compare in follow-up assessments.● T—Time: Assess the onset and duration of symptoms. When did a symptom start? Does it come and go? If so, how often and for how long? What time of day or on what day of the week does it occur?

• What do we call the effort required to expand and contract the lungs?
• work of breathing
• why of breathing
• when of breathing
• need to breathe

• The nurse assesses pain, edema, and redness at a vascular access device (VAD) site. Which action is taken first?
• Apply a warm, moist compress.
• Aspirate the infusing fluid from the VAD.
• Report the situation to the health care provider.
• Discontinue the intravenous infusion.

• When repositioning an immobile patient, the nurse notices redness over the hip bone. What is indicated when a

reddened area blanches on fingertip touch?

• Sensitive skin that requires special bed linen
• A local skin infection requiring antibiotics
• Blanching hyperemia, indicating the attempt by the body to overcome the ischemic episode
• A stage 3 pressure injury needing the appropriate dressing

● The clinical presentation of obstructed blood flow occurs when evaluating areas of pressure. After a period of tissue ischemia, if the pressure is relieved and the blood flow returns, the skin turns red. The effect of this redness is vasodilation (blood vessel expansion), called hyperemia (redness). You assess an area of hyperemia by pressing a finger over the affected area. If it blanches (turns lighter in color) and the erythema returns when you remove your finger, the hyperemia is transient and is an attempt to overcome the ischemic episode, thus called blanchable hyperemia. However, if the erythematous area does not blanch (nonblanchable erythema) when you apply pressure, deep tissue damage is probable.

• Upon completing a past medical history, the nurse finds that a client has risk factors for lung disease. How should the

nurse interpret this finding? Pg 74

• A person with the risk factor will get the disease.
• The chances of getting the disease are increased.
• Risk modification will have no effect on disease prevention.
• The disease is guaranteed not to develop if the risk factor is controlled.

● Control of risk factors does not guarantee that a disease will not develop. However, risk factor modification can assist patients in adopting activities to promote health and decrease risks of illness.

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