Fundamentals of Nursing Final Exam Practice Flashcards

Chapter 1: Nursing Today

• Core Components of Nursing     - Nursing is defined as a profession that combines the art of caring with the science of healthcare.     - Nurses serve multiple roles including:         - Caregivers: Providing direct physical and emotional support.         - Advocates: Safeguarding and protecting the rights of the patient.         - Educators: Teaching patients and their families about health and recovery.         - Leaders: Managing care teams and influencing health policy.         - Communicators: Facilitating information exchange between the patient and the healthcare team.     - Patient-centered care: A philosophy where the patient is the central focus of all healthcare decisions and actions.

• Benner’s Stages of Nursing Proficiency     1. Novice: A beginning nursing student or any nurse entering a situation where there is no previous level of experience.     2. Advanced Beginner: A nurse who has had some level of experience with the situation which may only be observational in nature.     3. Competent: A nurse who has been in the same clinical position for $2$ to $3$ years.     4. Proficient: A nurse with more than $2$ to $3$ years of experience in the same clinical position who perceives a patient’s clinical situation as a whole.     5. Expert: A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem.

• Key Vocabulary in Professional Nursing     - Accountability: State of being professional and legally responsible for one's nursing actions.     - Advocacy: The support and protection of patient rights.     - Burnout: A state of emotional and physical exhaustion resulting from prolonged exposure to job-related stress.     - Autonomy: The initiation of independent nursing interventions without medical orders.

Chapters 15–20: Critical Thinking & Nursing Process

• The Nursing Process (ADPIE)     - The standard five-step process for providing high-quality nursing care:         1. Assessment: The systematic collection of data regarding the patient's health status.         2. Diagnosis: Identifying the patient's problems based on the assessment data.         3. Planning: Developing goals and expected outcomes and choosing nursing interventions.         4. Implementation: Performing the nursing interventions identified in the plan.         5. Evaluation: Determining whether the goals were met and if the patient's condition improved.

• Critical Thinking and Clinical Judgment     - Critical Thinking: The use of logic and reasoning to make safe and effective nursing decisions. This skill is vital for prioritizing care and preventing medical errors.     - Clinical Judgment: The process of making decisions based on synthesized patient data and established nursing knowledge.

• Data Types in Assessment     - Subjective Data: Symptoms or verbal descriptions provided by the patient that cannot be independently measured. Example: A patient stating, ‐I have pain.‑     - Objective Data: Findings that are measurable and observable by the nurse. Example: A Blood Pressure (BP) reading of $180/90\,mmHg$.

• Nursing Diagnosis Formulation     - The structural formula for a nursing diagnosis is: [Problem] related to [Etiology/Cause] as evidenced by [Defining Characteristics/Signs and Symptoms].     - Verbatim Example: ‐Impaired skin integrity related to immobility as evidenced by open wound on coccyx.‑

• SMART Goals     - Goals for patient care must be:         - Specific         - Measurable         - Attainable         - Realistic         - Timed

• Priority Frameworks     - The ABCs (Immediate Life Threats):         1. Airway (Must be clear for breathing).         2. Breathing (Effective ventilation).         3. Circulation (Adequate perfusion/heart rate/BP).     - Maslow’s Hierarchy of Needs (Order of Importance):         1. Physiological needs: Food, water, warmth, rest (Highest priority).         2. Safety and security.         3. Love and belonging.         4. Esteem.         5. Self-actualization: Achieving one's full potential (Lowest clinical priority).

• Vocabulary and Definitions     - NANDA-I: Use of the North American Nursing Diagnosis Association International system for standardized nursing diagnoses.     - Collaborative Problem: A physiological complication that requires both nursing and prescriber (provider) interventions to manage.     - Implementation: The phase where interventions are actively performed.     - Evaluation: The phase used to determine if patient goals have been successfully met.

Chapter 28: Infection Prevention & Control

• The Chain of Infection     - To prevent infection, one must break the link between any of these six elements:         1. Infectious agent (Pathogen).         2. Reservoir (Place where pathogen survives).         3. Portal of exit (Way to leave the reservoir).         4. Mode of transmission (How it moves to a new host).         5. Portal of entry (How it enters the new host).         6. Susceptible host.

• Modes of Transmission     - Contact: Direct or indirect touch.     - Droplet: Large particles from the respiratory system (travels short distances).     - Airborne: Small particles that remain suspended in the air.     - Vector: Transmission via insects or animals.     - Vehicle: Transmission via contaminated items like food, water, or blood.

• Personal Protective Equipment (PPE)     - Standard items include: Gloves, Gown, Mask, and Goggles/face shield.

• Isolation Precautions and Examples     - Contact Precautions: Used for organisms like MRSA (Methicillin-resistant Staphylococcus aureus) and C. diff (Clostridioides difficile).     - Droplet Precautions: Used for infections such as Influenza and Meningitis.     - Airborne Precautions: Used for diseases including TB (Tuberculosis), Measles, and Varicella (Chickenpox).

• Hand Hygiene Standards     - Use soap and water specifically for hands that are visibly soiled or when caring for patients with C. diff.     - Scrub hands for at least $20\,seconds$.

• Health Care-Associated Infections (HAIs)     - CAUTI: Catheter-Associated Urinary Tract Infection.     - CLABSI: Central Line-Associated Bloodstream Infection.     - VAP: Ventilator-Associated Pneumonia.     - SSI: Surgical Site Infection.

• Vocabulary     - Colonization: The presence of a microorganism on or in the body without causing tissue invasion or damage (disease).     - Inflammation: A protective vascular and cellular response to injury or infection.     - Convalescence: The final stage of infection where symptoms disappear and the patient recovers.

Chapter 40: Hygiene

• Clinical Best Practices     - Always maintain patient dignity during care.     - Eye Care: Wipe the eyes from the inner to the outer canthus.     - Perineal Care: Wipe from front to back (anterior to posterior) to prevent infection.     - Oral Care: Regular mouth care reduces the risk of pneumonia, especially in hospitalized patients.

• Care for High-Risk Patients     - Diabetes: Foot care is extremely important; nurses should not cut toenails without specialized training.     - Anticoagulant Therapy: For patients on blood thinners, an electric razor is the safest option for shaving to prevent bleeding.

• Vocabulary     - Aspiration: The accidental inhalation of fluids, food, or foreign objects into the lungs.     - Perineal care: The procedure for cleaning the genital and anal areas.     - Body mechanics: The coordinated efforts of the musculoskeletal and nervous systems to maintain balance, posture, and alignment during movement to prevent injury.

Chapter 46: Urinary Elimination

• Common Urinary Problems     - Retention: The inability to partially or completely empty the bladder.     - UTI: Urinary Tract Infection.     - Incontinence: Involuntary loss of urine.

• Types of Incontinence     - Stress: Leakage during physical exertion (coughing, sneezing, lifting).     - Urge: Sudden, strong desire to void that is difficult to suppress.     - Overflow: Dribbling of urine because the bladder is overfull.     - Functional: Leakage due to factors outside the urinary tract (e.g., mobility or cognitive issues).     - Reflex: Involuntary loss at somewhat predictable intervals when a specific bladder volume is reached.

• Catheter Types     - Indwelling Foley: Remains in place for continuous drainage.     - Suprapubic: Surgically inserted through the abdominal wall above the symphysis pubis.     - Intermittent: Used for one-time bladder emptying and then removed.     - External catheter: A condom-like device for males attached to a drainage bag.

• UTI Prevention and Management     - Practice front-to-back wiping.     - Maintain adequate hydration.     - Perform regular catheter care.     - Avoid unnecessary Foley use to reduce CAUTI risks.

• Vocabulary     - Dysuria: Painful or difficult urination.     - Oliguria: Diminished or low urine output.     - Polyuria: Excessive output of urine.

Chapter 47: Bowel Elimination

• Common Bowel Problems     - Constipation: Infrequent or difficult evacuation of stool.     - Diarrhea: Increase in the number of stools and the passage of liquid, unformed feces.     - Impaction: A collection of hardened feces wedged in the rectum that a person cannot expel.     - Incontinence: Inability to control the passage of feces and gas.

• Stool Diversions (Ostomies)     - Colostomy: An opening (stoma) into the colon.     - Ileostomy: An opening (stoma) into the small intestine (ileum).

• Constipation Risk Factors     - Diets with low fiber.     - Physical immobility.     - Use of opioids (analgesics).     - Low fluid intake.

• Vocabulary     - Melena: Dark, black, tarry stools usually indicating upper gastrointestinal bleeding.     - Hematochezia: The passage of fresh, bright red blood in the stool.     - Flatulence: The accumulation of gas in the intestines causing the walls to stretch.

Chapter 48: Skin Integrity & Wounds

• Stages of Pressure Injuries     - Stage 1: Intact skin with nonblanchable redness over a localized area.     - Stage 2: Partial-thickness skin loss involving the epidermis and/or dermis. Presents as a blister or shallow open sore.     - Stage 3: Full-thickness skin loss where subcutaneous fat may be visible, but bone, tendon, and muscle are not exposed.     - Stage 4: Full-thickness skin loss with exposed bone, tendon, or muscle.     - Unstageable: Full-thickness tissue loss where the actual depth of the ulcer is completely obscured by slough (yellow) or eschar (black).

• Types of Wound Drainage     - Serous: Clear, watery plasma.     - Sanguineous: Bright red, indicates active bleeding.     - Serosanguineous: Pale, pink, watery; a mixture of clear and red fluid.     - Purulent: Thick, yellow, green, tan, or brown; indicates pus and infection.

• Wound Complications     - Dehiscence: Partial or total separation of wound layers.     - Evisceration: Protrusion of visceral organs through a wound opening (a surgical emergency).     - Infection: Bacterial contamination.     - Hemorrhage: Excessive bleeding from a wound site.

• Prevention Strategies     - Turn and reposition patients at least every $2\,hours$.     - Ensure adequate nutrition and hydration for tissue repair.     - Use pressure relief devices.

• Vocabulary     - Braden Scale: A standardized tool used to predict pressure injury risk.     - Eschar: Black, brown, or tan necrotic (dead) tissue.     - Slough: Soft, yellow or white stringy necrotic tissue.

Chapter 27: Safety

• Fall Risk Populations     - Older adults.     - Patients taking sedatives.     - Patients exhibiting physical weakness or mental confusion.

• Fire Safety Mnemonics     - RACE (The order of action during a fire):         1. Rescue: Protect and evacuate patients in immediate danger.         2. Alarm: Activate the fire alarm and report the fire.         3. Confine: Close doors and windows to contain the fire.         4. Extinguish/Evacuate: Put out the fire or leave the area.     - PASS (The steps for using a fire extinguisher):         1. Pull the pin.         2. Aim low at the base of the fire.         3. Squeeze the handle.         4. Sweep from side to side.

• Clinical Prioritization     - Generally, the nurse must prioritize and treat the patient who will die first without immediate intervention.

• Vocabulary     - Restraints: Devices used to restrict a patient’s physical activity or normal access to their body.     - Nocturia: Awakening at night to urinate.

Chapters 38/39: Mobility & Exercise

• Systemic Effects of Immobility     - Skin: Pressure injuries.     - Respiratory: Pneumonia.     - Cardiovascular: DVT (Deep Vein Thrombosis).     - Gastrointestinal: Constipation.     - Musculoskeletal: Muscle atrophy (wasting).

• DVT Prevention Strategies     - Use of SCDs (Sequential Compression Devices).     - Early and frequent ambulation.     - Performing leg exercises.

• Transfer Assistance Levels     - Independent: No help needed.     - Standby assist: Oversight needed for safety.     - Minimal assist.     - Moderate assist.     - Maximal assist.     - Dependent: Full assistance required.

• Vocabulary     - ROM: Range of motion; the maximum amount of movement available at a joint.     - Contracture: Permanent shortening of a muscle or joint resulting in deformity.

Chapter 29: Vital Signs

• Normal Adult Reference Ranges     - RR (Respiratory Rate): $10-20\,breaths/min$.     - SPO2 (Oxygen Saturation): $95-100\%$.     - BP (Blood Pressure): $120/80\,mmHg$.     - HR (Heart Rate): $60-100\,bpm$.     - Temp (Temperature): $98.6^{\circ}F$.

• Definitions of Abnormal Values     - Tachycardia: Heart Rate > $100\,bpm$.     - Bradycardia: Heart Rate < $60\,bpm$.     - Tachypnea: Respiratory Rate > $20\,breaths/min$.     - Bradypnea: Respiratory Rate < $12\,breaths/min$.     - Hypotension: Low blood pressure.     - Hypertension: High blood pressure.

Chapter 45: Nutrition

• Essential Nutrients     - The body requires six classes of nutrients: Carbohydrates, Proteins, Fats, Vitamins, Minerals, and Water.

• Body Mass Index (BMI)     - Formula:     - $\text{BMI} = \frac{\text{weight (lb)}}{\text{height (in)}^2} \times 703$

• BMI Classification Ranges:     - Underweight: < $18.5$     - Healthy weight: $18.5\u201324.9$     - Overweight: $25\u201329.9$     - Obese: \u2265 $30$

• Therapeutic Diets     - NPO: Nothing by mouth.     - Clear liquid: Broth, coffee, tea, clear fruit juices, gelatin, popsicles.     - Full liquid: Clear liquids plus smooth-textured dairy like ice cream and custards.     - Mechanical soft: Ground or finely diced meats, flaked fish, etc.     - Diabetic: Balanced intake of carbs, fats, and proteins.     - Low sodium: Limiting salt intake.

• Vocabulary     - Dysphagia: Difficulty swallowing.     - Aspiration: Inhalation of food or liquid into the lungs.

Chapter 42: Fluids & Electrolytes

• Fluid Compartments     - Intracellular fluid (ICF): Fluid within cells ($2/3$ of total body water).     - Extracellular fluid (ECF): Fluid outside of cells ($1/3$ of total body water).

• Normal Electrolyte Ranges     - Sodium ($Na^{+}$): $136-145\,mEq/L$     - Potassium ($K^{+}$): $3.5-5.0\,mEq/L$     - Magnesium ($Mg^{2+}$): $1.3-2.1\,mEq/L$     - Calcium ($Ca^{2+}$): $9.0-10.5\,mg/dL$     - Chloride ($Cl^{-}$): $98-106\,mEq/L$     - Phosphorus ($PO_{4}^{3-}$): $3.0-4.5\,mg/dL$

• Clinical Signs of Impaired Balance     - Dehydration: Tachycardia, dry mucous membranes, hypotension, confusion, and decreased urine output.     - Fluid Volume Overload: Edema (swelling), crackles in the lungs, hypertension, and rapid weight gain.

• Vocabulary     - Hypokalemia: Low potassium level in the blood.     - Hyperkalemia: High potassium level in the blood.     - Hypovolemia: Decreased circulating blood volume.

Chapter 36: Loss, Grief, & End-of-Life

• Kubler-Ross Stages of Grief     1. Denial     2. Anger     3. Bargaining     4. Depression     5. Acceptance

• Care Settings     - Palliative Care: Focused on providing comfort and symptom relief while the patient is still receiving curative treatment for a disease.     - Hospice Care: Focused specifically on comfort and quality of life for terminally ill patients, typically with a life expectancy of less than $6\,months$.

• Physiological Signs of Approaching Death     - Mottling: Blue/purple blotching on skin due to poor circulation.     - Cheyne-Stokes breathing: Irregular respiratory pattern with alternating periods of apnea and hyperventilation.     - Decreased BP (Blood Pressure).     - Cool extremities.

Chapter 22 & 23: Ethics & Legal

• Ethical Principles     - Autonomy: Respect for the patient’s right to make their own decisions.     - Beneficence: Taking positive actions to help others.     - Nonmaleficence: The avoidance of harm or hurt.     - Justice: Fairness and distribution of resources.     - Fidelity: Keeping promises; being faithful to the patient.

• Legal Vocabulary     - Negligence: Conduct that falls below the generally accepted standard of care.     - Malpractice: Professional negligence.     - Assault: A threat toward another person that creates a reasonable fear of harmful contact.     - Battery: Any intentional offensive touching without consent or lawful justification.     - False imprisonment: Restraining a patient without legal warrant.

• Advanced Directives     - Living will: Documenting the patient's wishes regarding medical treatment.     - Durable power of attorney: Designating a person to make decisions on the patient’s behalf if they become incapacitated.

Chapter 24: Communication

• Therapeutic Communication Techniques     - Effective Actions (GOOD):         - Using open-ended questions (encourages broad responses).         - Using silence (allows patient time to think).         - Clarifying (validating what the patient said).         - Active listening.     - Non-therapeutic Behaviors (BAD):         - Asking ‐Why‑ questions (can sound accusatory).         - Giving advice.         - Providing false reassurance (e.g., ‐Everything will be okay‑).         - Changing the subject.

• SBAR Standardized Reporting     - Situation: What is happening right now?     - Background: Relevant clinical history.     - Assessment: What the nurse thinks is going on based on data.     - Recommendation: What the nurse thinks should be done.

Medication Mathematics & IV Formulas

• Basic Dosage Formula     - $\frac{\text{Desired (ordered)}}{\text{Have (on hand)}} \times \text{Quantity (volume/form)}$     - Example: An order is for $500\,mg$. The medication is available as $250\,mg$ tablets.         - $\frac{500\,mg}{250\,mg} \times 1 = 2\,tablets$

• IV Flow Rate (Gtt/min) Formula     - $\frac{\text{Total volume (mL)}}{\text{Time (min)}} \times \text{Drop Factor (gtt/mL)} = \text{Flow Rate (gtt/min)}$     - Verbatim Example:         - Infuse $1000\,mL$ over $8\,hr$. Drop factor = $15\,gtt/mL$.         - Convert $8\,hr$ to minutes: $8 \times 60 = 480\,min$.         - $\frac{1000\,mL}{480\,min} \times 15 = 31.25 \rightarrow 31.3\,gtt/min$.

Questions & Discussion

• Practice Questions and Answers     - Question 1: A nurse should see which patient first?         - A. Pain $8/10$         - B. Oxygen saturation $87\%$         - C. Needs discharge teaching         - D. Constipated for $2\,days$         - Answer: B. Using ABCs, oxygenation is the priority.     - Question 2: Which patient is at highest risk for pressure injuries?         - A. Ambulatory patient         - B. Young athlete         - C. Immobile older adult         - D. Patient with glasses         - Answer: C.     - Question 3: Which intervention helps prevent CAUTIs?         - A. Daily catheter irrigation         - B. Maintain sterile closed system         - C. Disconnect tubing frequently         - D. Raise drainage bag above bladder         - Answer: B.     - Question 4: A patient says, ‐I’m scared I’m dying.‑ What is the best response?         - A. ‐Don’t say that.‑         - B. ‐Everything will be okay.‑         - C. ‐Tell me more about your fears.‑         - D. ‐You shouldn’t think negatively.‑         - Answer: C.     - Question 5: A patient has: BP $88/50$, HR $124$, and dry mucous membranes. The nurse suspects:         - A. Fluid overload         - B. Dehydration         - C. Hyperkalemia         - D. Infection         - Answer: B.

• Math Practice Questions and Answers     - Question 1: Order: Amoxicillin $500\,mg$. Available: $250\,mg$ capsules. How many capsules?         - Answer: $2\,capsules$.     - Question 2: Infuse $500\,mL$ over $4\,hr$. What is the $mL/hr$?         - Answer: $125\,mL/hr$.     - Question 3: $1000\,mL$ over $10\,hr$ with drop factor $20\,gtt/mL$.         - Answer: $33\,gtt/min$.

Last-Minute Test-Taking Strategies

• General Prioritization Principles     - ABCs always matter: Airway, Breathing, and Circulation are the top priority.     - Safety first: The environment must be safe for patients.     - Least restrictive intervention first: Always try non-invasive measures before physical or chemical restraints.     - Acute beats chronic: Prioritize a new problem over an long-term condition.     - Unstable beats stable: Focus on patients with fluctuating or dangerous vitals.     - Assess before implementing: Always gather data before taking action when possible.

• Answering Techniques     - Do not ignore oxygen-related issues.     - Utilize therapeutic communication principles (e.g., validation and exploration).     - If two answer choices are very similar, neither is usually the correct answer.     - Identify High-Stakes Keywords: Pay close attention to words like FIRST, PRIORITY, BEST, and IMMEDIATE.