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Exam 4 Study Guide
Fundamentals of Nursing (Galen College of Nursing)
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Exam 4 Study Guide
1. What are the 3 checks?
a. Check the mar before you pull the medicine
b. Check it when you pull the medicine
c. Check it before you give it to the pt one final time
2. What do you do if a PT has a reaction to the medication they’re given? Stop giving
them the medication.
3. When do you do a med rec?
a. Admission
b. Transfer
c. Discharge
4. SCENARIO: pt with temperature is given Tylenol. Later the pt was still running a
temperature, what do you do?
a. Call the Dr
5. What do you do when an ordered medication is in powdered form?
a. Reconstitute it
6. 5 Rights
a. Right patient
b. Right Time
c. Right Dose
d. Right Route
e. Right Medication
7. What do you assess before giving Morphine?
a. Respirations
8. What do you do when it's time to give a PT they’re medications and they are asleep?
a. Wake them and give the medication (do not leave meds in the room or w/ family)
9. How do you read a syringe?
a. Know each line is .2 on a milliliter scale
b. Know that insulin syringes are measured in units and mL.
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10. What do you do when taking a phone order from a doctor? Read back & verify
11. What do you do if meds are skipped or not given? Document why the meds weren’t
given, then call the doctor. If it is not life threatening, do not file an incident report.
12. How do you give the medicine through an NG tube?
a. Check placement
b. Feed by gravity, no force
c. If medication comes in liquid form further dilute the medication with sterile water
d. If medication has to be crushed dissolve in at least 30 mL of warm sterile water.
e. Administer each medication separately and flush with 15-30mL of water after
each medication.
f. Flush after all medications have been administered with 15-30mL of water to
clear the tube.
13. What do you use to flush an IV?
a. 0.9% sodium chloride (NaCl) or NS
14. Shot angles
a. Intradermal 5 - 15
b. SubQ 45 - 90
c. Intramuscular 90
15. What are the different needle sizes?
a. 18 gauge - never use for injections
b. Intradermal
i. TB Syringe
ii. #25-27 gauge
iii. ¼-⅝ inch
c. Subcutaneous
i. 1-2 mL syringe/ insulin syringe
ii. #25gauge, #30 gauge for insulin
iii. Adult of normal weight- ⅝ inch at 45 or ⅜ inch at 90
d. Intramuscular
i. Deltoid:
1. 1 mL syringe
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2. #23-25 gauge
3. 1 inch
ii. Ventrogluteal
1. 3-5 mL syringe
2. #21 or #22 gauge
3. 1.5 inches
16. What shots do you want to aspirate?
a. IM ventrogluteal
17. How many mL do you administer in a subQ injection?
a. 0.5-1 mL
18. How do you split a pill? Use a pill splitter
19. How do you insert a rectal suppository?
a. Assist pt. To a left lateral/left Sims’ position, with the upper leg flexed
b. Fold back the top bedclothes to expose buttocks
c. Put a glove on the hand used to insert the suppository
d. Unwrap the suppository and lubricate the smooth rounded end
e. Lubricate your gloved index finger
f. Encourage pt to relax
g. Insert suppository gently into the anal canal, rounded end first, along the rectal
wall using the gloved index finger (about 4 in.)
h. Avoid embedding the suppository in feces
i. Press pt buttocks together for a few minutes
j. Instruct pt to remain in left lateral or supine position for 5 minutes to help retain
suppository
20. How do you insert a vaginal suppository?
a. Explain to the client what you are going to do
b. Perform hand hygiene
c. Provide privacy
d. Asses and clean perineal area
e. Lubricate the rounded (smooth) end of the suppository
f. Lubricate your gloved index finger
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g. Expose the vaginal orifice by separating the labia w/ nondominant hand
h. Insert suppository about 8-10 cm (3-4 in.) along the posterior wall of the vagina,
or as far as it will go
i. Instruct pt. To remain to remain lying in supine position for 5-10 minutes
following insertion
21. What is Pruritus? Red, itchy skin
22. What is the technique of how to administer transdermal medications?
a. Select a clean, dry area that is free of hair
b. Remove the patch from the protective covering without touching the adhesive
edges
c. Apply by pressing firmly with the palm of the hand for about 10 seconds
d. Initial and date
e. Never place in the same spot twice in a row
f. If this is a pain patch have a second RN witness you waste the used patch.
23. How do you administer eye drops? Clean the eyelid/eyelashes (in-out), instruct pt. To
look up at the ceiling, place thumb of nondominant hand just below the eye and gently
pull the skin down, place dominant hand on pt.’s forehead, approach eye from the side,
instill the correct number of drops onto the outer 3rd of the lower conjunctiva
24. How do you administer ear drops? Clean the pinna and meatus of the ear with qtip,
warm medication container in your hands, partially fill the ear dropper with medication,
pull pinna back and upwards, instill the correct number of drops, gently but firmly press
the ragus of the ear, ask client to remain on side for 5 minutes to prevent the drops from
escaping.
25. What are cognitive skills? Cognitive function includes decision making, problem
solving, planning and paying attention.
26. What is Bloom’s Domain? three domains of educational activities or
learning (Bloom, 1956):
a. Cognitive: mental skills (Knowledge)
b. Affective: growth in feelings or emotional areas (Attitude or self)
c. Psychomotor: manual or physical skills (Skills)
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27. SCENARIO: pt newly diagnosed with a chronic illness comes in, what do you do
first? Find out the best way they learn.
28. What is “motivations to learn”? A desire to learn. It greatly influences how quickly and
how much a person learns.
29. Clinical manifestations: ACUTE vs CHRONIC pain
a. Acute
i. Increased pulse rate
ii. Increased respiratory rate
iii. Elevated blood pressure
iv. Diaphoresis
v. Dilated pupils
vi. Resolves with healing
vii. Pt. may be restless and anxious; reports pain; may exhibit behavior
indicative of pain (crying, rubbing/holding area)
b. Chronic
i. Vital signs normal
ii. Dry, warm skin
iii. Pupils normal or dilated
iv. Continues beyond healing
v. Pt. is usually depressed and withdrawn; often does not mention pain unless
asked; pain behavior often absent
30. What are the non-pharmacological ways of pain management?
Targe Domain of Pain Control Intervention
Body Massage
Heat or cold treatment
TENS
Positioning, bracing (selective
immobilization)
Acupuncture
Diet, nutritional supplements
Exercise, pacing activities
Invasive interventions (blocks)
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Sleep Hygiene
Mind Relaxation, imagery
Self hypnosis
Pain diary
Distractions
Repattering thinking
Attitude adjustment
Reducing fear, anxiety, stress, sadness
and helplessness
Information about pain
music
Spirit Prayer, meditation
Self reflection on life and pain
Meaningful rituals
Energy work
Spiritual healing
Social Functional restoration
Improved communication
Pet therapy
Family therapy
Problem solving
Vocational training
Volunteering
Support groups.
31. When does a post of PT experience pain the worst? 12-36 hours post-op
32. Wong-Baker faces scale. Includes a number scale along with an illustration of facial
expressions (used on our clinical packets) so that pain intensity can be documented. The
patient's facial expression does not need to match the illustration.
33. FLACC scale. Has been validated in children 2 months to 7 years of age. Rates pain
behaviors as manifested by Facial expression, Leg movement, Activity, Cry and
Consolability. 0-10 scale.
34. If you care for a PT that has family in the room, what are you gonna do? Figure out
if it is beneficial to the pt to have family in the room
35. What are cultural responsive cares? Not forming biases, opinions and never assuming
36. What are the Kubler Ross stages of grief? *****
a. Denial
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i. Refuses to believe that loss is happening; is unready to deal with practical
problems; may assume artificial cheerfulness to prolong denial.
b. Anger
i. Client or family may direct anger at nurse or staff about matters that
normally would not bother them
c. Bargaining
i. Seeks to bargain to avoid loss (eg. “let me just live until … and then i will
be ready to die”)
d. Depression
i. Grieves over what has happened and what cannot be. May talk freely or
may withdraw.
e. Acceptance
i. Comes to terms with loss; may have decreased interest in surroundings
and support people; may wish to begin making plans.
37. If a pt. Loses their home from a tornado while they are in the hospital, what do you
do? Make sure they are in touch with community services (Red Cross, etc.)
38. If a pt. comes into the ER and does not speak english, what do you do? Get an
interpreter.
39. The main priority when caring for a dying pt? Comfort and dignity
40. If a pt is dying, what do you tell the family? Encourage the family to stay with the pt.
41. How do you respond to pt that feels they have no hope? Ask them why
42. What are ALL the cultural beliefs of dying?
a. Autopsies may be prohibited, opposed, or discouraged by Eastern Orthodox
religions, Muslims, Jehova’s witnesses and Orthodox Jews. Hindus may oppose
because they do not want non-Hindus to touch the body.
b. Organ donation is prohibited by Jehova’s witnesses and Muslims.
c. Cremation is discouraged, opposed or prohibited by Baha’i, Mormon, Eastern
Orthodox, islamic, and Roman Catholic. Hindus prefer cremation.
d. Christian Science are unlikely to recommend medical means to prolong life.
Jewish oppose prolonging life after irreversible brain damage. Buddhist permit
euthanasia in hopeless illness.
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e. Muslims turn the body toward Mecca.
f. Mormons dress the body in their temple clothes.
g. Native Americans dress the body in elaborate apparel and jewelry and wrap them
in new blankets with money.
43. What are the signs of impending death?
a. Loss of Muscle Tone - Relaxation of facial muscles, difficulty speaking,
difficulty swallowing, Possible urinary and fecal incontinence, diminished body
movement.
b. Slowing of circulation- Diminished sensation, mottling and cyanosis of
extremities, cold skin, slow weak pulse, decreased bp
c. Respirations- Rapid, shallow, irregular, or abnormally slow respirations, noisy
breathing (death rattle), mouth breathing (dry oral mucous membrane)
d. Sensory Impairment- Blurred vision, Impaired sense of taste and smell.
44. How do you do post mortem care? Nurse needs to place the body in anatomical
position, place dentures in mouth and close the eyes and mouth of the body before rigor
mortis sets in.
45. How do you determine which insulin to withdraw? Clear before cloudy; regular
insulin is clear and NPH is cloudy due to the proteins in the insulin.
