Practical Nursing Midterm – Key Concepts & Review Flashcards

80 question-and-answer flashcards summarizing essential concepts for the Practical Nursing midterm, including fundamentals, legal/ethical issues, infection control, vital signs, diabetes care, medical positions, and urinalysis. Use them to self-test and reinforce key facts.

What federal law (enacted in 1987) set minimum training standards for nursing assistants in long-term care?

OBRA – the Omnibus Budget Reconciliation Act of 1987.

What are the primary duties of a nursing assistant on the health-care team?

Provide basic nursing care (ADL assistance, vital-sign monitoring, safety, reporting changes) under the supervision of licensed nurses.

Define Activities of Daily Living (ADLs).

Routine self-care tasks such as bathing, dressing, grooming, toileting, eating, and mobility.

Why is following the health-care chain of command important?

Ensures problems reach the correct person, duties are clear, and care is safe and efficient.

What does “scope of practice” mean for a nursing assistant?

The tasks and responsibilities the assistant is legally permitted to perform based on training and certification.

When a nurse delegates a task, what must the nursing assistant do?

Confirm understanding, ensure competence, perform safely, report completion, and speak up if unsure.

Name two ways nursing assistants protect patient/resident rights.

Maintain privacy/confidentiality and promote dignity, independence, and informed consent.

List three personal qualities essential for a nursing assistant.

Compassion, dependability, and integrity (acceptable alternatives: professional grooming, honesty).

Differentiate acute care, long-term care, and home care settings.

Acute care treats short-term severe illness; long-term care provides extended services for chronic conditions; home care delivers services in the client’s residence.

How has managed/community-based care changed patient discharge patterns?

Patients leave hospitals earlier and receive follow-up care in homes or long-term facilities to control costs.

Give two examples of negligence by a nursing assistant.

Leaving side rails down when ordered up; failing to encourage fluids as prescribed.

What are the six links in the chain of infection (in order)?

Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host.

Define Standard Precautions and give one example.

Infection-control practices used with every patient (e.g., hand hygiene before and after contact).

When are Transmission-Based Precautions added to Standard Precautions?

For known or suspected highly contagious infections (contact, droplet, or airborne).

Why is hand hygiene considered the single most important infection-control measure?

Proper handwashing or sanitizing removes pathogens, preventing their transfer between people or surfaces.

What is PPE and list three common items.

Personal Protective Equipment; examples: gloves, gowns, masks/respirators, goggles, face shields.

How should used sharps be disposed of?

Immediately into a red, puncture-resistant sharps container without recapping or bending.

Differentiate asepsis from medical asepsis.

Asepsis = complete absence of pathogens; medical asepsis = practices that reduce the number and spread of microbes.

Normal adult oral temperature range (°F).

97.6 °F – 99.6 °F (36.5 °C – 37.5 °C).

Which site gives the most accurate core body temperature and why?

Rectal – it reflects internal (core) temperature and is least influenced by environment.

State one factor that can falsely elevate an oral temperature reading.

Recent hot food/drink, smoking, exercise, or late-day circadian rise.

Define pulse.

Rhythmic expansion of an artery produced by contraction of the left ventricle.

Normal resting adult pulse range.

60–100 beats per minute.

Which three characteristics are assessed when taking a pulse?

Rate, rhythm (regularity), and strength/volume (e.g., bounding, weak).

When is an apical pulse preferred?

For infants/children, patients with irregular or hard-to-palpate radial pulses, or before cardioactive meds.

Normal adult respiration range.

12–20 breaths per minute.

List two respiration characteristics besides rate that should be observed.

Rhythm (regular/irregular), depth (shallow/deep), effort (easy/labored), and breath sounds.

Define blood pressure.

Force of circulating blood on arterial walls during cardiac contraction (systole) and relaxation (diastole).

What is considered a normal adult blood pressure?

Approximately 120/80 mm Hg (systolic <120, diastolic <80).

Explain systolic vs. diastolic pressure.

Systolic: pressure when the heart contracts; diastolic: pressure when the heart relaxes between beats.

Name the five AHA blood-pressure categories.

Normal, Elevated, Hypertension Stage 1, Hypertension Stage 2, Hypertensive Crisis.

What equipment is required for manual BP measurement?

Sphygmomanometer (cuff/gauge) and stethoscope.

Describe orthostatic (postural) hypotension.

A drop in BP when moving from lying to sitting/standing, causing dizziness or fainting risk.

Convert 38.9 °C to Fahrenheit.

Approx. 102 °F (hyperthermia).

Define diabetes mellitus.

Chronic disorder of high blood glucose due to absent or ineffective insulin production/action.

Contrast Type 1 and Type 2 diabetes.

Type 1: autoimmune destruction of beta cells, absolute insulin deficiency; Type 2: insulin resistance ± relative deficiency, often linked to obesity/age.

List three common signs of hypoglycemia.

Sweating, trembling, dizziness/confusion (others: hunger, irritability).

Give two signs of hyperglycemia.

Increased thirst (polydipsia), frequent urination (polyuria), fatigue, blurred vision.

What is the purpose of ketone testing in diabetics?

Detects ketones that signal fat metabolism and risk for diabetic ketoacidosis, especially with high glucose or illness.

State two long-term complications of uncontrolled diabetes.

Retinopathy, nephropathy, neuropathy, heart disease, stroke, peripheral vascular disease.

Normal fasting blood glucose range (mg/dL).

65 – 120 mg/dL (3.6 – 6.6 mmol/L).

What does the HbA1c test measure?

Average blood glucose over 2–3 months; goal usually <7 %.

Why is daily foot care critical for diabetics?

Neuropathy and poor circulation raise ulcer/infection risk; early detection prevents amputations.

Define Standard Fowler’s, Semi-Fowler’s, and High Fowler’s angles.

Semi-Fowler’s 30–45°, Standard 45–60°, High 60–90° sitting upright.

Which position is ideal for a pelvic exam?

Lithotomy (supine, hips flexed, feet in stirrups).

Describe the Trendelenburg position and give one use.

Supine with feet elevated above head; used temporarily for hypotension/shock or certain abdominal surgeries.

What does protein in a urine sample usually indicate?

Possible kidney disease or UTI; healthy kidneys should not leak significant protein.

Presence of nitrites in urine suggests what?

Bacterial urinary-tract infection by nitrate-reducing organisms (e.g., E. coli).

Why are leukocytes significant in a urinalysis?

White blood cells signify infection or inflammation in the urinary tract.

Explain “specific gravity” in urinalysis.

Measurement of urine concentration; high = dehydration, low = over-hydration.

List two body fluids considered infectious under Standard Precautions.

Blood and saliva (others: urine, feces, mucus, semen, vaginal secretions).

When must gloves be removed and hands cleaned?

Immediately after a task, before touching a clean surface or another patient.

Explain “contact precautions” and give one example pathogen.

Gloves/gown for direct or indirect contact with infectious material; e.g., MRSA, C. difficile.

Which mask is required for airborne precautions (e.g., TB)?

NIOSH-approved N95 respirator (fit-tested).

What is considered an exposure incident?

Contact of eyes, mouth, mucous membrane, or non-intact skin with blood or other potentially infectious material.

State one reason the radial-apical pulse may be ordered.

To detect a pulse deficit before giving heart-rate-altering medication.

How many pounds are in 68 kg (approx.)?

About 150 lb (multiply kg by 2.2).

Convert 100.4 °F to Celsius.

Approximately 38 °C.

What does ‘q4h’ mean on a medication schedule?

Every 4 hours.

Define “informed consent.”

Permission given after full disclosure of procedure risks, benefits, and alternatives.

What is ‘false imprisonment’ in patient care?

Restraining or confining a person without proper authorization.

Give the medical abbreviation for ‘nothing by mouth.’

NPO.

Explain “polyuria.”

Excessive urination – a classic symptom of hyperglycemia/diabetes.

Which pulse site is assessed during CPR on an adult?

Carotid artery.

What infection-control label is used for cultures and vaccines disposal?

Yellow biohazard container for infectious waste.

Why are artificial nails discouraged in health-care settings?

They harbor microbes and hinder effective hand hygiene.

List two signs/symptoms of systemic infection.

Fever/chills, fatigue/weakness (others: increased pulse or respiratory rate).

Name one task nursing assistants must not perform because it is outside their scope.

Administer medications (unless specially trained and allowed by state/facility regulations).

What document outlines a patient’s wishes if they become unable to decide?

Advance directive (e.g., living will, durable power of attorney for health care).

Define “malpractice.”

Professional negligence that results in patient harm.

What is the normal adult BMI range considered ‘healthy’?

18.5 – 24.9 kg/m².

How should a glass oral thermometer be read?

Hold at eye level, rotate until the mercury column line is visible, read to the nearest 0.2 °F.

State one contraindication for rectal temperature measurement.

Recent rectal surgery, hemorrhoids, diarrhea, or cardiac conditions (vagal stimulation risk).

What does ‘stat’ mean on a physician order?

Immediately – without delay.

Describe the prone position and a clinical use for it.

Lying face-down; used to improve oxygenation in ARDS or during spinal surgery.

What are Korotkoff sounds?

Series of arterial sounds heard when deflating a BP cuff; first sound = systolic, last = diastolic.

What nursing assistant action is required after obtaining an abnormal vital sign?

Re-check if instructed and promptly report to the nurse; document accurately.

List two responsibilities of nursing assistants in diabetic foot care.

Inspect feet daily, keep skin clean/dry, report sores or color changes immediately.

What is the preferred order for removing PPE after isolation care?

Gloves → gown → mask/eye protection, then hand hygiene.

Define “tachypnea.”

Rapid breathing – respiratory rate above the normal range (>20 breaths/min in adults).

Why should respirations be counted covertly after pulse?

Awareness can alter patient’s breathing pattern, leading to inaccurate count.

What is the term for blue discoloration of skin due to low oxygen?

Cyanosis.