MEGA STUDY PLAN FOR NURS113 FINAL EXAM FALL 2026 Test 3
MEGA STUDY PLAN: FINAL EXAM FOR NURS113 FALL 2026
This plan outlines a 6-day revision strategy leading up to the final exam, detailing concepts covered on each day, hours dedicated to study, and practice questions to reinforce learning.
6-DAY TIMELINE
Dates: November 28, 2025 – December 3, 2025
Study Focus: Review tests and concepts relevant to the final exam.
DAY 1: Test 1 Review
Concepts Included: Clinical Decision Making, Communication, Physical Assessment, Vital Signs, Infection
Hours: 3–4 hrs
Practice Questions: 200 questions
Score: 90.5%
DAY 2: Test 2 Review
Concepts Included: Medication Administration, Legal/Ethical, Oxygenation, Perfusion, Mobility, Elimination
Hours: 3–4 hrs
Practice Questions: 250 questions
DAY 3: Test 3 Review
Concepts Included: Stress/Coping, Sensory, Development, Sexuality, Culture, Spirituality, Professional Behaviors
Hours: 3–4 hrs
Practice Questions: 250 questions
DAY 3 -- CONCEPT FOCUS (7)
Stress & Coping
Sensory Perception
Development (Older Adult)
Sexuality
Culture
Spirituality
Professional Behaviors
To Do:
Review anxiety levels + interventions
Review conditions (cataracts, glaucoma)
Complete 25 NCLEX psych/social questions
Review communication types (therapeutic vs. non-therapeutic)
Review FICA, cultural humility, values/beliefs
Review delegation and professionalism
Goal: Strengthen psychosocial & communication mastery.
DAY 4: Test 4 Review
Concepts Included: All previous 12 concepts including Inflammation, Immunity, Infection Review, Perfusion Review, Gas Exchange, Fluids & Electrolytes, Tissue Integrity, Metabolism, Pain, Mobility Review, Elimination Review, Clinical Judgment
Hours: 4–5 hrs
Practice Questions: 350 questions
DAY 5: Full Mixed Review
Concepts Included: All 30+ concepts reviewed
Hours: 2–3 hrs
Practice Questions: 200 questions
DAY 6: Cram Day
Focus: Final Preparation – Review of high-yield master list with no new content
Hours: 2 hrs
Practice Questions: 100 questions
MOST HIGH-YIELD AREAS FOR THE FINAL
MUST-KNOW List Topics:
Fluid & Electrolytes
Vital Signs interpretation
Oxygenation + lung sounds
Perfusion (cardiac basics)
Infection control / PPE / isolation
Medication administration safety
Pressure injury staging
Pain assessment
Inflammation vs Infection
Clinical Judgment (NGN Model)
Mobility & fall precautions
Tissue integrity
Stress & coping / anxiety levels
Sensory deficits (cataracts/glaucoma)
Delegation (RN vs LPN vs UAP)
DAY 3 FOCUS (PSYCHOSOCIAL & SENSORY) — Details on each key concept
Stress & Coping: Understand anxiety levels and appropriate interventions.
Sensory Perception: Review specific conditions such as cataracts, glaucoma, ARMD, and Meniere’s.
Therapeutic Communication: Distinguish between therapeutic and non-therapeutic communication.
Cultural Competency: Familiarity with concepts like FICA for assessing spirituality.
Delegation: Differences between RN, LPN, and UAP duties.
NURS 113 – CONCEPT: METABOLISM - STUDENT LEARNING OUTCOMES (SLOs)
SLO 1 – Identify Risks and Clinical Manifestations of Altered Metabolism
Risk Factors:
Age: Infants and older adults have decreased metabolic rates and altered appetites.
Chronic Illnesses: Diabetes, thyroid disorders, renal disease, hepatic disease impact metabolism.
Socioeconomic Status: Poverty leads to poor diet and food insecurity.
Lifestyle: Sedentary behavior, alcohol use, smoking, and poor dietary habits diminish metabolic function.
Medications: Corticosteroids, antidepressants, chemotherapy affect appetite and metabolism.
Psychological Factors: Conditions like depression, stress, and eating disorders influence eating behaviors.
Cultural/Religious Constraints: Certain dietary restrictions, including fasting traditions.
Hospitalization: being an NPO (nothing by mouth) status, surgery, trauma, and burns can increase energy requirements.
Clinical Manifestations:
Obesity: Defined by a BMI ≥ 30. Symptoms include fatigue, dyspnea, joint pain, hypertension, and insulin resistance.
Malnutrition: Presents as unintended weight loss, muscle wasting, brittle hair/nails, pale mucous membranes, poor wound healing, anemia, and delayed capillary refill.
Micronutrient Deficiencies:
Iron: Symptoms include pallor and fatigue, leading to a spoon-shaped fingernail.
Vitamin B12: Symptoms include numbness and confusion.
Protein Deficiency: Symptoms include edema and ascites.
SLO 2 – Appropriate Assessment Tools and Diagnostic Testing for Nutritional Status
Assessment Tools:
Screening Tools:
Mini Nutritional Assessment (MNA) targeted for older adults.
MUST (Malnutrition Universal Screening Tool).
Braden Scale correlating skin integrity with nutrition risk.
Anthropometric Measures:
Height, weight, BMI, waist circumference.
Triceps skinfold thickness (subcutaneous fat measurements).
Mid-arm circumference (assessing muscle mass).
Dietary Intake: Methods like 24-hour recall, food frequency surveys, or calorie counts.
Physical Exam: Assess hair, skin, oral mucosa, muscle tone, and edema.
Functional Assessments: Evaluate grip strength, mobility, and swallowing ability.
Diagnostic Tests:
Serum Proteins:
Albumin (3.5–5 g/dL): a long-term nutritional indicator.
Prealbumin (15–36 mg/dL): a short-term indicator of nutritional status.
Hemoglobin/Hematocrit: Monitoring for anemia.
Transferrin: An indicator of iron transport in the body.
BUN/Creatinine Levels: Evaluate renal protein metabolism.
Glucose/A1C Levels: Evaluates carbohydrate metabolism and control of diabetes.
Lipid Panel: Normal cholesterol level is below 200 mg/dL; triglycerides below 150 mg/dL.
SLO 3 – Nursing Interventions to Promote Optimal Nutrition
Independent Interventions:
Encourage a balanced diet according to MyPlate guidelines.
Offer small, frequent meals for patients with poor appetite.
Provide oral care before meals to increase willingness to eat.
Limit sodium or fat intake in patients with cardiac issues.
Teach patients how to read food labels and measure portion sizes accurately.
Work collaboratively with a dietitian to create individualized meal plans.
Continuously monitor weight and intake/output trends.
Health Promotion:
Encourage appropriate physical activity levels based on patient age and health condition.
Address socioeconomic barriers by providing information about community resources and food programs.
Manage nausea or pain that interferes with eating.
Promote adequate hydration (2–3 L/day unless medically restricted).
SLO 4 – Alternative Feeding Methods, MNT, and Therapeutic Diets
Alternative Feeding:
Enteral Nutrition: Use NG, PEG, or jejunostomy tubes when oral intake is inadequate.
Verify correct placement via x-ray before first feeding.
Maintain HOB (Head of Bed) at a minimum of 30° during and after feedings.
Monitor tube residuals and patency.
Parenteral Nutrition (TPN): Administered via central line; requires sterile technique.
Monitor blood glucose and electrolytes; there is a risk of infection during use.
Medical Nutrition Therapy (MNT):
Diabetes: Involves carbohydrate counting and choosing low-glycemic foods.
Cardiac: A focus on low sodium, low fat, and increased fiber intake.
Renal: Restrictions on protein, sodium, potassium, and phosphorus intake.
Gastrointestinal Disorders: Depending on the disorder, therapeutic options include bland, low-residue, or high-fiber diets.
Therapeutic Diets:
Gradually transition patients through different dietary consistencies: clear liquid → full liquid → soft → regular.
Soft or pureed diets for dysphagia patients.
High-calorie, high-protein diets to promote wound healing.
Low-cholesterol diets for those with hyperlipidemia.
SLO 5 – Nursing Process for Obesity and Malnutrition
Nursing Process Steps:
Assessment: Analyze weight trends, BMI, laboratory results, and psychosocial factors.
Diagnosis: Identify imbalanced nutrition: less than or more than body requirements.
Planning: Establish realistic and measurable goals, such as “gain 1 lb/week”.
Implementation:
Coordinate with a dietitian.
Educate patients about portion control and healthy substitutions.
Address barriers to emotional eating or finances.
Evaluation: Constantly monitor weight, lab results, and comprehension of the patient regarding education provided.
Clinical Application:
Clinical SLOs Related to Nutrition:
Identify patients with altered nutrition and those at risk.
Target populations include elderly, postoperative, oncology, and critically ill patients, those with gastrointestinal disorders, or those experiencing dysphagia and chronic illness.
Plan safe and appropriate care for patients with altered nutrition.
Complete swallow assessments before feeding.
Maintain patient in an upright position > 45°.
Execute aspiration precautions and document the calorie and fluid intake accurately.
Identify appropriate assessment and diagnostic testing.
Utilize screening tools upon patient admission, collect lab work (albumin, prealbumin, electrolytes), and monitor daily weights and fluid balances.
CONCEPT: TISSUE INTEGRITY - STUDENT LEARNING OUTCOMES (SLO)
SLO 1: Risk Factors Contributing to Pressure Injury Formation
Intrinsic Factors:
Immobility, poor nutritional status, dehydration, diminished sensation, aging skin, vascular diseases, fever, chronic illnesses (e.g., diabetes).
Extrinsic Factors:
Friction, shear forces, excessive moisture, prolonged pressure, and poor patient positioning.
High-Risk Patients:
Older adults, bed-bound patients, those who are incontinent, postoperative individuals, or those with neurological impairments.
Summary:
Pressure injuries occur due to extended pressure on bony prominences (like the sacrum, heels, and elbows). The resulting tissue ischemia can cause cell death over time without proper relief measures. Prevention involves identifying high-risk patients using screening tools like the Braden Scale.
SLO 2: Pressure Injury Staging System
NPIAP Classification:
Stage I: Non-blanchable erythema of intact skin. Appearance: Red, warm, possibly painful.
Stage II: Partial-thickness skin loss with exposed dermis; may present as shallow open ulcers or blisters.
Stage III: Full-thickness skin loss; subcutaneous fat may be visible; potential for sloughing and undermining.
Stage IV: Full-thickness loss including exposed bone, tendon, or muscle; may present with eschar or slough and potential tunneling.
Unstageable: Base covered by slough or eschar; depth unknown until debris is removed.
Deep Tissue Pressure Injury (DTPI): Persistent non-blanchable deep red/maroon discoloration and signs of blood-filled blisters.
SLO 3: Phases of Tissue Healing Process
Inflammatory Phase (Days 1–5):
Initial vasoconstriction followed by vasodilation leading to increased exudate and infiltration of white blood cells (WBCs).
Goal: To control bleeding while cleaning the site.
Proliferative Phase (Days 5–21):
Involves fibroblasts producing collagen, formation of granulation tissue, and wound contraction.
Maturation Phase (Remodeling) (After Day 21 - Up to months):
Collagen is remodeled and scar tissue strengthens reaching up to 80% of its original strength.
SLO 4: Types of Wound Healing
Primary Intention: Wound edges are approximated causing minimal tissue loss; Examples: Surgical incisions with sutures or staples.
Secondary Intention: Wound healing occurs from the inside out, where granulation fills the gap; Examples: Pressure injuries, large open wounds.
Tertiary Intention: Initial wound left open for drainage and cleaned before closure; Examples: Contaminated or abdominal wounds requiring drainage.
SLO 5: Complications of Tissue Healing
Hemorrhage: Excessive blood loss during or post-surgery.
Infection: Symptoms include purulent discharge, erythema, swelling, warmth, and fever.
Dehiscence: Separation between wound layers either partially or completely.
Evisceration: Internal organs protruding through the wound.
Fistula Formation: An abnormal connection developed between organs or two skin surfaces.
Scarring: Hypertrophic or keloid scars result from excessive collagen production during healing.
Nursing Interventions:
Constant monitoring of drainage, vital signs, and signs of redness or swelling is crucial.
Maintain sterile techniques during dressing changes.
SLO 6: Factors Impeding or Promoting Tissue Healing
Promote Healing:
Adequate nutrition (high protein, vitamin C, zinc).
Proper hydration and oxygenation, maintaining effective tissue perfusion.
Assuring a clean wound environment and implementing thorough infection control measures.
Impair Healing:
Nutritional or hydration deficits, history of smoking, obesity, corticosteroid usage, chronic stress or illness, advancing age.
SLO 7: Nursing Process for Impaired Tissue Integrity
Assessment: Examine and document wound characteristics including size, location, color, drainage, and odor, using the Braden Scale for risk assessments.
Diagnosis: Examples include Impaired Skin Integrity, Risk for Infection, Acute Pain.
Planning: Goals should include measurable outcomes (e.g., “Wound to reduce by 1 cm within one week”).
Implementation:
Schedule repositioning every 2 hours, ensure proper nutrition, and provide prescribed wound dressings.
Evaluation: Regularly assess wound healing progress, document findings, and adjust the care plan as necessary.
SLO 8: Medical Terminology for Tissue Integrity
Key Terms:
Eschar: Black, necrotic tissue requiring debridement.
Slough: Yellow, moist tissue necessitating cleaning.
Granulation Tissue: Pink, moist tissue indicating healing status.
Maceration: Softened tissue from excess moisture.
Undermining: Subsurface tissue damage under intact skin edges.
Tunneling: Passageways that form beneath the wound surface.
Debridement: Removal procedures for dead tissue (surgical, enzymatic, or autolytic).
Example Documentation: “Stage III pressure injury on left heel, 2 cm × 3 cm, with pink granulation, scant serosanguinous drainage, negligible odor.”
Clinical SLOs Examples
Clinical SLO 1: Nursing Process Application
Conduct daily skin assessments from head to toe.
Document findings with appropriate wound measurement tools.
Use the ADPIE nursing process framework for careful planning of wound care.
Clinical SLO 2: Braden Assessment Tool Utilization
Use the Braden Scale to assess risk through scoring in the categories of:
Sensory perception
Moisture
Activity
Mobility
Nutrition
Friction & shear
Scoring: 6–23; a score of ≤18 indicates risk.
Clinical SLO 3: Implementing Pressure Injury Prevention Measures
Reposition patients every 2 hours.
Ensure skin remains clean and dry.
Use supportive surfaces (special mattresses, heel protectors).
Encourage dietary measures rich in protein and hydration.
Minimize shear and friction during repositioning activities.
Document nursing interventions and changes observed in skin condition.
Clinical SLO 4: Assessing Pressure Injury Status
Evaluate stage, color, tissue condition, drainage, odor, and size.
Determine whether the injury is healing or worsening.
Maintain consistent documentation language and applicable NPIAP classifications.
Report any new or deteriorating wounds to the medical provider promptly.
Exemplar: Pressure Injury
Definition: Localized tissue damage over a bony prominence due to unrelieved pressure.
Contributing Factors: Pressure, friction, shear, moisture, immobility.
Nursing Responsibility: Early detection and prevention using Braden Scale assessments.
Goal: To maintain skin integrity and prevent disease.
Exemplar: Wound Healing Process
Phases: Inflammatory → Proliferative → Maturation.
Complications: Infection, dehiscence, evisceration.
Nursing Action: Keep the wound clean, provide nutritional support, and maintain sterile techniques during care delivery.
NURS 113 – CONCEPT: FLUID & ELECTROLYTES - STUDENT LEARNING OUTCOMES (SLO)
SLO 1: Physiology of Body Systems Maintaining Fluid & Electrolytes
Key Regulators:
Kidneys: Adjust urine volume and composition; the renin–angiotensin–aldosterone system (RAAS) conserves sodium (Na⁺) and water.
Lungs: Regulate acid-base balance by controlling CO₂; quick compensation occurs as needed.
Heart: Produces atrial natriuretic peptide (ANP) to ease fluid volume.
Pituitary Gland: Releases antidiuretic hormone (ADH) promoting renal water resorption.
Parathyroid Gland: Manages calcium and phosphate levels via parathyroid hormone.
Cell Membranes: Regulate electrolyte distributions through active transport mechanisms (e.g., Na⁺/K⁺ pump).
SLO 2: Assess Laboratory Values for Fluid Volume Status
Electrolytes and Normal Ranges:
Na⁺: 135–145 mEq/L (High = dehydration; Low = hyponatremia)
K⁺: 3.5–5.0 mEq/L (High = renal failure; Low = loss via GI/diuretics)
Cl⁻: 95–105 mEq/L (Mirrors Na⁺ changes aiding acid-base balance)
Ca²⁺: 8.4–10.5 mg/dL (Low leads to tetany risk; High indicates excessive bone resorption)
Mg²⁺: 1.5–2.5 mEq/L (Low levels suggest neuromuscular irritability; High leads to decreased DTR)
BUN: 10–20 mg/dL; Creatinine: 0.6–1.2 mg/dL (Elevated values indicate dehydration or renal impairment)
SLO 3: Signs & Symptoms of Fluid/Electrolyte Imbalances
Fluid Volume Deficit (FVD):
Symptoms: ↓ skin turgor, thirst, dry mucous membranes, rapid weak pulse, hypotension, elevated hematocrit/BUN.
Fluid Volume Excess (FVE):
Symptoms: Edema, crackles in lung sounds (due to pulmonary edema), JVD (Jugular Venous Distention), bounding pulse, weight gain, and ↓ hematocrit.
Na⁺ Imbalances:
Hyponatremia: confusion, seizures; Hypernatremia: thirst, dry skin.
K⁺ Imbalances:
Hypokalemia: muscle weakness, life-threatening arrhythmias; Hyperkalemia: paresthesia, bradycardia.
Ca²⁺ Imbalances:
Hypocalcemia: tetany, Chvostek's/Trousseau's signs; Hypercalcemia: lethargy, constipation.
Mg²⁺ Imbalances:
Hypomagnesemia: muscle tremors, increased DTR (Deep Tendon Reflexes); Hypermagnesemia: decreased DTR, respiratory depression.
SLO 4: Apply Nursing Process to Fluid & Electrolyte Imbalances
Assessment: Daily weights, I&O tracking, vital signs, skin turgor, lung auscultation, and lab values.
Diagnosis: Conditions such as FVD/FVE, risks for electrolyte imbalance, or decreased cardiac output can be recognized based on assessments conducted.
Planning: Focus on maintaining a balanced I&O within 24 hours and preventing potential complications.
Interventions: Involve fluids replacive therapy (IV/oral), electron supplementations, lab monitoring, and adherence to fluid restrictions when deemed necessary.
Evaluation: Goals aim for the patient to return to normal fluid volume status.
SLO 5: Common Treatments & Foods Containing Electrolytes
Electrolyte Replacement/Treatment:
Dietary Sources:
Na⁺: Normal saline, table salt, soups, processed foods
K⁺: Oral/IV potassium chloride and rich food sources like bananas and oranges.
Ca²⁺: Calcium carbonate supplements and dietary intake from dairy, leafy greens, and sardines.
Mg²⁺: IV magnesium sulfate or foods like nuts, whole grains.
Cl⁻: Same sources as Na⁺, particularly in saline.
Phosphate: K-phos orally or via IV; found in meat, dairy, and whole grain foods.
SLO 6: Patients at Risk for Fluid & Electrolyte Imbalances
Populations at risk include very young infants or the elderly, individuals experiencing GI losses (e.g., vomiting/diarrhea), trauma patients, individuals with chronic health issues (heart, renal, liver failure), those using certain medications like diuretics, and post-operative patients who, amidst NPO status, experience blood loss or go under stress.
Clinical Applications SLOs:
Clinical SLOs Summary from Chapter 35 (Tony's Book):
Anatomy & Physiology: Awareness of ICF & ECF compartments and electrolyte distributions, alongside osmosis, diffusion processes, filtration, and active transport.
Clinical Management & Collaboration: Utilization of team approaches to monitor lab values, replace fluids, and adjust IV therapy in conjunction with provider/pharmacy insights.
Nursing Process Application: Continual monitoring and evaluating via nursing statuses to detect fluid balance shifts.
Signs & Symptoms Identification: Recognition of neurologic, cardiac, and musculoskeletal changes amid electrolyte imbalances.
Understanding Patient Risks: Targeting vulnerable populations such as geriatrics, infants, and those with chronic conditions for potential fluid imbalances.
Risks Awareness: Being cognizant of dehydration, edema signs, arrhythmias, shock, and seizure risks.
Exemplar – Homeostasis Definition
Homeostasis: The dynamic processes through which the body maintains internal stability, encompassing temperature regulation, pH balance, electrolyte control, and fluid volumes.
Key Mechanisms:
Osmosis: Water moves from areas of low solute concentration to high.
Diffusion: Movement of solutes from areas of high to low concentrations.
Filtration: Hydrostatic pressure propelling fluids through membranes (e.g., capillaries).
Active Transport: ATP-fueled transport systems for ions (e.g., Na⁺/K⁺ pump).
Nursing Relevance:
Maintain accurate I&O records.
Conduct daily weight assessments (noting that 1 kg = change of 1 L fluid).
Monitor for signs and symptoms of fluid volume deficit (FVD) or excess (FVE).
Adjust IV therapies according to orders and evaluate patient responses.
NURS 113 – CONCEPT: COMFORT / PAIN - STUDENT LEARNING OUTCOMES (SLO)
SLO 1: Psychological, Emotional, and Physical Influences on Pain
Pain Definition: Pain is subjective; it is perceived as whatever the patient expresses.
Influencing Factors:
Psychological Factors: Anxiety, fear, stress, depression, coping ability, attention, and previous pain experiences affect pain levels.
Emotional Factors: Feelings of helplessness, isolation, anger, and emotional distress heighten pain perception.
Physical Factors: Fatigue, age, illness, injury, and neurological states directly influence pain experiences.
Cultural/Spiritual Influences: Beliefs and cultural norms shape pain expression and treatment preferences.
Common Misconceptions:
Vital signs always reflect pain presence.
Patients who can communicate or sleep are not experiencing pain.
An additional fear that opioid use will lead to inevitable addiction.
Children or older adults perceive lesser pain than adults do.
Nursing Implications
Assess individual psychological/emotional factors that might exacerbate or mask pain responses.
Provide emotional support while ensuring therapeutic communication is used.
Encourage patient involvement in the decision-making process for pain relief measures.
SLO 2: Health History and Physical Assessment in Pain Management
Health History Components:
Gather data on onset, duration, location, intensity, perception qualities, and factors aggravating/relieving pain.
Review prior pain experiences, medications employed, and coping strategies.
Assess cultural/spiritual influences on pain expression and treatment.
Physical Assessment:
Observe nonverbal indicators: grimacing, guarding, restlessness, crying, moaning, or detectable increases in HR/BP/RR.
Employ standardized pain scales to quantify pain levels from Vol. 2, Chapter 28:
Numeric Rating Scale (0–10)
Wong-Baker FACES Scale
FLACC (Face, Legs, Activity, Cry, Consolability) for nonverbal patients
PAINAD for dementia patients
Evaluate pain's impact on mobility, sleep, mood, and overall care participation.
SLO 3: Pain Control through Pharmacological and Non-Pharmacological Approaches
Pharmacological Interventions:
Non-opioid Analgesics: Includes acetaminophen and NSAIDs for mild to moderate pain relief.
Opioids: Such as morphine and hydromorphone for managing moderate to severe pain; must monitor for respiratory depression, constipation, and sedation.
Adjuvant Therapies: Antidepressants, anticonvulsants, and corticosteroids for neuropathic or chronic pain.
PCA (Patient-Controlled Analgesia): Allows safe self-administration while avoiding drastic peaks or troughs in pain control through constant availability.
WHO 3-Step Pain Ladder: Non-opioid analgesic → weak opioid → strong opioid.
Non-Pharmacological Methods:
Physical Methods: Heat and cold therapies, massage, repositioning, utilizing TENS units.
Cognitive-behavioral Techniques: Applying distraction, relaxation, guided imagery, and deep breathing exercises.
Environmental Adjustments: Controlling noise/light, and providing comfort items.
Spiritual and Emotional Support: Having a presence for the patient, engaging in prayer, and offering counseling opportunities.
SLO 4: Individualized Plan of Care for Pain Management
Planning & Implementation:
Individual Patient Treatment Plans: Create based on the pain's type, cause, and respective patient goals.
Outcome Objectives: Both short-term (e.g., pain rating <4 within one hour of intervention) and long-term goals focusing on improved function, sleep, and mood.
Interventions should be inclusive of assessment and reassessment.
Collaborative inputs from interdisciplinary team members (PT, OT, palliative care, pharmacy) should be integrated.
Reevaluate outcomes frequently to adjust care plans as necessary.
NANDA Diagnoses Examples:
Acute pain due to surgical procedures.
Chronic pain as a result of degenerative conditions like joint disease.
Anxiety attributable to inadequate pain control measures.
SLO 5: Culturally Competent Pain Management
Culturally Competent Care Overview:
Recognize that cultural factors influence patients’ perceptions, expressions, and responses to pain.
Some cultures promote stoic displays, while others value open communication of discomfort.
Leverage interpreters to navigate language barriers effectively.
Include culturally relevant non-pharmacological methods adhering to patients’ beliefs (herbal remedies, prayer, or meditation).
Nursing Process Elements:
Assessment: Ask open-ended questions about personal pain management experiences.
Diagnosis: Identify any cultural influences that might impact care delivery.
Planning: Establish patient preferences within setting pain management goals.
Implementation: Rely on culturally respectful interventions.
Evaluation: Assess pain relief efficacy alongside satisfaction in culturally sensitive care.
SLO 6: Performing Pain Assessments
Assessment Focus:
Utilize a systematic, thorough approach (Vol. 2, Chapter 28) including:
Location: “Where does it hurt?”
Intensity: Numeric, FACES, or verbal descriptor assessments.
Quality: Describe pain using terms such as sharp, dull, burning, throbbing, or aching.
Onset/Duration: Ascertain when the pain started; is it constant or intermittent?
Aggravating/Relieving Factors: Identify variables that exacerbate or alleviate pain symptoms.
Impact on Functionality: Assess pain's influence on daily activities, emotional state, sleep quality, and cognitive focus.
Assessing Difficult Patients: Ensure diligence in assessing pain for cognitively impaired, sedated, non-verbal patients, children, or those with language barriers.
Reassessment: Conduct a follow-up assessment on pain within 30–60 minutes post-intervention.
SLO 7: Implementing Nursing Care for Pain Management
Implementation Strategies:
Administer analgesics as ordered while monitoring pain relief effectiveness and side effects.
Integrate non-pharmacological comfort strategies to enhance overall pain management efforts.
Educate both patients and families concerning the agreed-upon pain management plan.
Advocate for appropriate pain management and address potential under-prescribing practices seen in providers.
Ensure accurate documentation of pain levels, interventions administered, and patient responses.
Continuously evaluate and adapt interventions as needed based on ongoing assessments.
Exemplars of Comfort:
Exemplar 1 - Factors Affecting Comfort:
Discomfort is influenced by physical, emotional, environmental, sociocultural, and spiritual elements. Identifying these parameters is fundamental to appropriate management.
Exemplar 2 - Pain Types:Acute Pain: Short-term; serves as a protective mechanism related to injury or surgical intervention.
Chronic Pain: Persists beyond three to six months, affecting mood, sleep, and daily function.
Neuropathic Pain: Arises from injury to the nervous system; described with descriptors akin to burning or tingling sensations.
Summary:
Pain Management Essentials: Holistic and focused on patient needs and conditions, effective care incorporates understanding biological mechanisms, emotional influences, and cultural aspects while using validated assessment tools and implementing both pharmacologic and non-pharmacologic combined strategies adaptable to each patient's unique context.
NURS 113 – CONCEPT: GRIEF & LOSS - STUDENT LEARNING OUTCOMES (SLOs)
SLO 1: Examining Factors Influencing Grief Responses
Types of Loss:
Actual Loss: Clear identification by others, such as death or limb loss.
Perceived Loss: Internally felt, not immediately observable, such as self-esteem or dignity loss.
Physical Loss: Involves the loss of body parts or mobility.
Psychological Loss: Loss concerning one’s identity or control.
External Loss: Loss of possessions or environments (e.g., moving, changing jobs).
Loss of Significant Relationships: Such as through divorce or death.
Factors Influencing Grief Responses:
Developmental Stage: Different responses across the lifespan.
Young adults struggle with lifestyle role disruptions and identity conflicts.
Middle adults face role strain along with financial challenges.
Older adults contend with accumulated losses that can heighten the risk of complicated grief.
Significance of Loss: Degree of attachment and meaning attributed influences the grieving process.
Support System Availability: Access to robust support systems is crucial during grieving periods.
Cultural and Spiritual Beliefs: These shape rituals and death perceptions, impacting grief responses.
Cause of Death: Sudden, traumatic losses impact individuals differently compared to expected losses.
Previous Experiences with Loss: Past coping styles inform current reactions to new losses.
Stages of Grief (Kubler-Ross Model):
Phases of Grief Include: Denial, Anger, Bargaining, Depression, Acceptance.
Not linear; individuals experience and cycle through these stages distinctly.
Nursing Roles to Facilitate the Grief Process:
Allow open channels for emotional expression and processing.
Provide presence, reassurance, and cultural sensitivity tailored for individual client backgrounds.
Offer resources such as chaplain, social worker, or support groups.
Assess adaptiveness and risks for complicated grief patterns.
SLO 2: Nursing Process Application to Grieving Patients
Assessment Components:
Identify the type of loss, patient’s stage of grief, and both emotional and physical manifestations.
Inquire about sleep, appetite, fatigue, and social withdrawal indicators.
Consider cultural/spiritual practices that might impact the grieving experience.
Evaluate available support systems relative to patient needs.
Assess the risks for complicated grief based on history.
Nursing Diagnoses:
Grieving
Anticipatory Carding
Family Coping Compromise
Spiritual Distress
Ineffective Coping
Powerlessness
Planning:
Focus on fostering comfort and promoting emotional expressions.
Aim to support adaptive coping styles.
Involve the family in goal setting and interventions.
Address cultural rituals related to loss and preferences for end-of-life matters.
Interventions:
Engage in active listening and therapeutic communication practices.
Provide factual information about prognosis and the death process.
Encourage emotional expression through open dialogue.
Collaborate with palliative care, hospice, and pastoral care resources as needed.
Create spaces for family presence and participation whenever possible.
Facilitate pain relief and comfort measures.
Evaluation:
Patient and family express their needs and feelings.
Demonstrates adaptive coping mechanisms.
Actively participates in relevant rituals and decision-making processes.
SLO 3: Develop an End-of-Life Care Plan
Key Aspects of the End-of-Life Care Plan:
Symptom Management: Address pain, dyspnea, nausea, and anxiety levels.
Comfort-Oriented Interventions: Focus on appropriate positioning for easier breathing, oral care, gentle bathing, and lowering environmental stressors.
Emotional/Spiritual Needs: Honor cultural rituals while providing privacy and companionship during the process.
Family Support: Educate families about the dying process while encouraging their participation in care activities to boost morale and presence.
Safety Components: Implement fall risk prevention measures and gentle handling methods based on individual assessments.
SLO 4: Postmortem Care Integrity
Steps in Performing Postmortem Care:
Confirm death (a duty addressed by the provider).
Follow cultural, legal, and facility protocols meticulously.
Afford patient privacy while allowing family time to grieve.
Remove all tubes unless the circumstance requires preservation for coroner inspection.
Gently clean the body while managing all aspects of dignity.
Close the patient's eyes, position the body supine, and place any necessary belongings accurately to respect personal ownership.
Dress the body and secure large allen pads for potential drainage needs as required.
Tag the body per policy reality checks and document any aspects cared for, including items removed.
Provide emotional support along with information/resources during the aftermath.
Clinical Application SLOs for Grief and Loss
Clinical SLO 1: Care for Dying Patients and Their Families
Apply comfort measures to minimize suffering during the dying process.
Provide family education concerning the anticipated physical changes (e.g., cooling skin, decrease in urine output, cyclical breathing changes).
Facilitate opportunities for family presence, support, and touch.
Maintain patient dignity through cleanliness, privacy, and appropriate respect.
Clinical SLO 2: Promoting Comfort in Dying Patients
Administer pain control including both scheduled and breakthrough medications.
Support dietary measures to mitigate nausea or discomfort and manage secretions effectively.
Maintain skin integrity and promote psychological relief via calming surroundings and familiar items.
Clinical SLO 3: Recognizing Signs & Symptoms of Death
Anticipated features of imminent death may show as:
Decreased pulse and blood pressure.
Irregular and shallow respiratory patterns.
Coolness in extremities with mottling appearances.
Decreased urinary output along with bowel and bladder control loss.
Unresponsiveness characteristics.
Fixed pupils and lack of reflexive responses.
Clinical SLO 4: Postmortem Care Approach
Ensure respectful cleansing parameters are maintained.
Attend to dignity while acknowledging cultural sensitivities concerning postmortem practices.
Readiness for family viewing if requested should be secured appropriately.
Ensure secure handling of all personal effects, complete documentation as per facility policies, and convey empathetic communication with families.
EXEMPLARS
Exemplar 1: Types of Loss and Grief
Loss Types: Actual, perceived, physical, psychological, external, environmental, relationship losses.
Grief Variations:
Normal Grief: Expected reaction fluidly experienced.
Anticipatory Grief: Experienced before the actual loss.
Complicated Grief: Extended dysfunction amid grieving.
Disenfranchised Grief: Lacking formal recognition socially.
Exemplar 2: Responses to Loss
Emotional Responses: Sadness, anger, guilt, anxiety, loneliness, fatigue.
Physical Responses: Crying, sleep disruption, appetite fluctuations, and somatic complaints.
Cognitive Responses: Confusion, concentration challenges, disbelief in the loss.
Behavioral Responses: Withdrawal from others, seeking relationships, participating in rituals, altered daily routines.
Spiritual Responses: Exploring meaning or expressing anger toward higher powers or strengthening spiritual inquiries.
NURS 113 – CONCEPT: COGNITION - STUDENT LEARNING OUTCOMES (SLO)
SLO 1: Analyzing and Assessing Cognitive Function in Healthy Adults
Cognition Definition: Encompasses all mental processes related to thinking, learning, memory, and communication.
Health Cognition Indicators: Includes alertness, orientation, attention, memory, judgment, reasoning, and the ability to communicate clearly.
Normal Findings: Alert and oriented to person, place, time, and situation; intact short and long-term memory; clear speech and logical reasoning abilities.
Assessment Tools:
Mini-Mental State Examination (MMSE).
Montreal Cognitive Assessment (MoCA).
Confusion Assessment Method (CAM).
Glasgow Coma Scale (GCS).
Lifespan Considerations: In older adults, some decline in processing speed and short-term memory may be evident, but overall intelligence, long-term memory, and vocabulary tend to remain consistent.
SLO 2: Assessing Delirium in Relation to Cognition
Delirium Definition: Acute and reversible cognitive disturbances; onset occurs suddenly (hours to days).
Causes of Delirium: May stem from infections (e.g., UTI, pneumonia), medications, metabolic imbalances or dehydration, and sensory deficiencies.
Manifestations of Delirium: The condition can result in fluctuating attention, disorientation, hallucinations, agitation, and agitation tendencies with disrupted sleep-wake patterns.
Assessment Tool: Utilize the Confusion Assessment Method (CAM) to identify features of delirium via assessment.
Nursing Actions for Delirium: Maintain safety for the patient, utilize orientation tools in the environment, promote hydration, eliminate causative agents, and include family members in the care delivery plan.
SLO 3: Identifying Clinical Manifestations of Impaired Cognition
Common Manifestations:
Disorientation and poor judgment capabilities.
Memory challenges (short-term or long-term).
Variabilities in agitation or withdrawal patterns.
Differences in speech clarity, analysis capabilities, or recognition of familiar individuals.
Functional Impact: Patients may experience difficulties caring for themselves, wandering tendencies, neglecting personal hygiene, or encounter social isolation.
Assessment Indicators: Any changes in baseline behavior, level of consciousness, or ability to follow directives suggest potential cognition impairment.
SLO 4: Differentiating Delirium from Dementia
Feature | Delirium | Dementia |
|---|---|---|
Onset | Sudden (hours or days) | Gradual and progressive (months or years) |
Course | Fluctuates, may worsen at night | Steady, irreversible decline |
Consciousness | Impaired and fluctuating | Usually clear until late stages |
Attention | Greatly impaired | Generally preserved early |
Reversibility | Reversible when cause is treated | Not reversible |
Common Causes | Infection, drugs, electrolyte imbalance | Alzheimer's, vascular impairment, Lewy body dementia |
Key Interventions | Treat the underlying cause, ensure patient reorientation, and maintain safety | Support functional abilities, memory aids, and caregiver education |
SLO 5: Analysis and Assessment Data Related to Impaired Cognition
Subjective Data: Includes patient self-reports about confusion, forgetfulness, or behavioral adjustments from patient/family.
Objective Data: Findings such as altered consciousness levels, poor short-term recall, and mood/speech changes.
Assessment Tools:
MMSE / MoCA for assessing memory, attention, and orientation deficiencies.
CAM for delirium screening.
Clock Drawing Test for visual and spatial capabilities.
Nursing Priorities: Include identifying basal cognitive statuses, reviewing medications prescribed, appropriate lab evaluations (electrolytes, glucose levels, oxygen saturation), and addressing any environmental factors potentially affecting cognition.
Clinical Application SLOs
SLO 6: Nursing Process in Care for Patients with Impaired Cognition
Assessment: Document findings regarding level of consciousness, memory, speech proficiency, and ability to follow instructions.
Diagnosis: Identify risk for injury factors, acute confusion, impaired memory problems, or challenges in communication.
Planning: Focus should include safety, patient orientation, and promoting rest and hydration.
Implementation:
Provide reality orientation (like clocks and calendars).
Consistent caregiver presence and maintaining routines reduce confusion levels.
Assist family participation in the care plan to encourage them effectively.
Evaluation: Patient should maintain safety, show improved orientation capacities, and demonstrate decreased agitation levels.
SLO 7: Differentiating Common Assessment Techniques for Mental Status
Mini-Mental State Examination (MMSE): Evaluates orientation, registration, recall, and attention capabilities.
Confusion Assessment Method (CAM): Quick tool to identify delirium characteristics (acute onset of inattention, disorganized thoughts, altered consciousness levels).
GCS (Glasgow Coma Scale): Assesses eye, verbal, and motor responses to measure alertness effectively.
Clock Drawing Test / SLUMS / MoCA: Evaluates higher reasoning capabilities, planning, and visuospatial skills.
Braden and Depression Screens: Examine associated risk factors and the emotional impact of cognitive impairments.
SLO 8: Management and Care of Patients with Delirium
Immediate Goals: Identify and handle the underlying cause of delirium effectively.
Nursing Management Include:
Create a calm, well-lit environment with orientational cues.
Maintain synchronized routines and caregiver attendance for healing.
Engage family/support member participation in all rounds of patient care.
Monitor for vital signs indicating status fluctuations, I&O trends, and lab values signaling susceptible imbalances.
Avoid restraints unless absolutely necessary; consider utilizing sitters or alarms for safety in mobility.
Encourage mobility and adequate sleep periods to help mitigate confusion.
Pharmaceutical Considerations: If safety becomes a concern, low-dose antipsychotics may provide short-term relief from agitation.
Desired Outcome: Patients return to basal cognitive function while maintaining safety during recovery transitions.
Exemplar: Delirium Overview
Definition: An acute and reversible cognitive disturbance in attentiveness, awareness, and cognition.
Associated Causes:
Infections including UTI and pneumonia
Medications causing exacerbating outcomes
Hydration deficits or electrolyte imbalances
Sensory overload or deprivation can lead to a comprehensive variability.
Assessment Findings: Symptoms include fluctuating confusion states, restlessness, disorientation, hallucinations, altered levels of consciousness, agitation, and disturbed sleep-wake cycles.
Nursing Process: Includes assessing baseline understanding, removing potential triggers, frequent orientation practices, safety measures, involvement of interdisciplinary members, and fulfilling comprehensive patient plans throughout care.
Prevention Strategies: Heightened hydration and nutritional status, promoting rest, sleeping patterns, steady routines, maintaining sensory aids, and early mobility routines reinforce cognitive abilities and diminish delirium risks.
Patient Education: Involve families concerning early signs of anticipatory confusion and safety protocols promoting swift responses to cognitive alterations.
Outcome: Patient re-establishes baseline cognitive functioning while maintaining safety through recovery stages as required.
NURS 113 – CONCEPT: TEACHING & LEARNING - STUDENT LEARNING OUTCOMES (SLOs)
Interrelated Concepts:
Health & Wellness
Cognition
QSEN Competencies:
Evidence-Based Practice
Informatics
Quality Improvement
Patient-Centered Care
Safety
Teamwork & Collaboration
EXEMPLARS:
Principles of Learning
Hierarchy of Needs (Maslow)
SLO 1: Identifying Factors Affecting Learning and Assessing Needs
Key Points (from Treas):
Motivation: Primary determinant of learning; closely tied to readiness and relevance.
Readiness to Learn: Influenced by physical/emotional conditions (pain, fatigue, and anxiety affect cognitive engagement).
Active Involvement: Adult learners flourish when they are engaged and participatory.
Feedback and Reinforcement: Helpful in strengthening the learning process.
Repetition and Timing: Regular reviews during alertness can foster retention.
Environment: Factors they include privacy, proper lighting, noise control, appropriate temperatures, and supportive family roles boost focus.
Cultural & Literacy Factors: Consideration of language and cultural norms as well as patient reading levels is essential in adapting educational techniques.
Assessment of Learning Needs:
Employ nursing processes to collect data about patient perceptions, beliefs, and knowledge levels.
Ascertain preferred learning styles (auditory, visual, kinesthetic).
Identify any barriers that may impede learning (vision issues, hearing loss, cognitive processing limits).
SLO 2: Principles of Teaching and Learning Applied to Patient Education
Principles Overview (from Treas):
Learning is active and directed toward accomplishing set goals.
Pre-existing knowledge and experiences impact retention and success.
Readiness, motivation, and reinforcement are essential factors for effective learning.
Adults appreciate self-directed and problem-centered learning approaches.
Environmental factors and support systems play roles in the overall learning process.
Nurse as Educator:
Facilitation of learning rather than lecturing is essential.
Tailor instruction to patient needs, health literacy, and cultural practices.
Incorporates the Teach-Back method for understanding verification.
SLO 3: Constructing a Teaching Plan Based on Bloom's Domains of Learning
Teaching Plan Domains:
Cognitive: Focusing on knowledge and understanding (e.g., patient lists signs of infection).
Psychomotor: Physical skills demonstrated (e.g., patient properly administering insulin).
Affective: Attitudinal and emotional components (e.g., patient expressing readiness to adhere to treatment).
Steps to Develop a Teaching Plan:
Assess learning requirements and readiness.
Formulate measurable outcomes in each learning domain.
Select the content material, strategies, and timing of instruction.
Implement and evaluate the learning effectiveness.
SLO 4: Importance of the Nurse's Teaching Role
Nursing as Teacher:
Central to health promotion, disease prevention, and restoring health.
Legally and ethically mandated; encompassed within the Nurse Practice Act and ethical standards outlined in the ANA Code (Provision 7).
Teaching enhances patient autonomy, safety, and compliance while reinforcing the nurse's role in team settings.
Promotes self-care mechanisms that can lead to reduced readmissions.
SLO 5: Teaching Strategies for Diverse Populations
Older Adults:
Allow extra time, employ larger print, and amplify audio when necessary.
Present information in shorter sessions tying to lived experiences.
Assess for any sensory deficits that could hinder understanding.
Low Literacy Patients:
Utilize plain language devoid of medical jargon.
Incorporate pictorial aids and demonstrations while reverting to the Teach-Back method for confirmation of understanding.
Highlight essential information first to avoid overwhelming patients.
Culturally Diverse Populations:
Assess language levels and preferred learning styles carefully.
Use professional interpreters instead of family members to maintain confidentiality.
Ensure the respect of health beliefs during educational interactions, adjusting examples to the context of the patient's worldview.
Teach-Back Method (Hoffman & Sullivan):
An evidence-based phenomenon to check understanding effectively.
Ask the patient to explain the key points of learning in their own words, allowing immediate correction of misunderstandings.
Supported by safety and quality improvement goals by mitigating miscommunication exposure.
Clinical Application SLOs
SLO 6: Assessment of Patient's Learning Needs
Recognize what the patient comprehends, any misconceptions present, and practical skills required.
Review medical diagnoses, cultural backgrounds, ages, educational levels, and literacy considerations.
Include family or caregivers when appropriate to foster wider understanding.
SLO 7: Performing Learning Assessments
Major Components:
Motivation: “What do you wish to learn?”
Readiness: Physical, emotional, and cognitive preparedness to learn.
Learning Style: Designate learning preferences (visual, auditory, reading/writing, hands-on).
Barriers: Acknowledge any impediments from sensory deficits, language barriers, or emotional conditions like pain or anxiety.
SLO 8: Evaluating Teaching and Learning OutcomThe paper ends here
Evaluation Techniques:
Employing Teach-Back and return demonstrations for assessments.
Verbal feedback acquisition through open Q&A sessions.
Behavioral observation signaling change (e.g., safe insulin application).
Documentation of the content presented during education, responses, and follow-up needs.
SLO 9: Incorporating Teaching into Routine Nursing Activities
Integration Strategies:
Leverage teachable moments throughout standard care engagements (e.g., during showers or medication administration).
Reinforce learning via daily interactions, encouraging interdisciplinary teamwork alongside (PT, nutritionists, pharmacists).
Documentation and communication about patient education aspects are crucial for continuity of care support.
Expanded Exemplars:
Exemplar 1 - Learning Principles:
The relevance of motivation and readiness in significant learner engagement.
Necessity of reinforcement and repetition to bolster retention.
Environmental conditions and timing impact outcomes tangibly.
Include feedback and stimulate active involvement within the process.
Exemplar 2 - Hierarchy of Needs (Maslow)
Addressing basic physiological requirements are paramount for any further learning to manifest.
Safety and security must precede learner focus toward higher needs.
Following basic meeting of needs, growth towards love, belongingness, esteem, and self-actualization signifies progression.
Structure teaching strategies to address corresponding needs appropriately.
Summary Table:
Phase | Nurse’s Role | Key Concepts |
|---|---|---|
Assessment | Determine learning needs, readiness, barriers | Motivation, literacy, environment |
Planning | Set objectives per Bloom’s domains | Cognitive, Affective, Psychomotor |
Implementation | Employ suitable methods (Teach-Back, demonstration) | Patient-centered teaching |
Evaluation | Assess if objectives are met | Behavior change and Teach-Back |
Cram Tips:
Adults maximize learning when information is relevant and applicable to their current lifestyle.
Always assess learning readiness and literacy prior to teaching initiatives.
Employ Teach-Back as a safety tool ensuring that understanding is confirmed while decreasing potential for readmissions.
Utilize Bloom's domains for articulating teaching objectives effectively.
Comprehensive documentation surrounding education presented, patient engagement, and future follow-up plans enhances continuity and coordination.
DAY 3 - STUDY QUESTIONS (30 from TEST 3)
Stress & Coping (1–7)
MCQ - Anxiety Levels: A patient exhibits pacing, rapid breathing, and states, “I can’t focus!” This showcases:
A. Mild anxiety
B. Moderate anxiety
C. Severe anxiety
D. Panic-level anxietySATA - Signs of Stress Response: Which findings indicate activation of sympathetic stress response?
Select all that apply.
A. Dilated pupils
B. Decreased heart rate
C. Increased blood pressure
D. Decreased respiratory rate
E. Increased blood glucoseMCQ - Coping Mechanisms: If a patient blames their nurse for making them sick, it exemplifies:
A. Displacement
B. Projection
C. Denial
D. CompensationMCQ - Therapeutic Intervention: Which nursing action BEST assists a patient experiencing moderate anxiety?
A. Speak in a firm, loud voice
B. Provide detailed instructions
C. Offer short, simple sentences
D. Leave the patient alone to restSATA - Adaptive Coping Strategies: Select which actions showcase health-conscious coping. Select all that apply.
A. Talking with a support person
B. Drinking alcohol to unwind
C. Using relaxation breathing techniques
D. Openly journaling feelings
E. Denying feelings of stressMCQ - General Adaptation Syndrome: What occurs during the alarm stage?
A. The body returns to baseline
B. Fight-or-flight response activates
C. The body becomes exhausted
D. Coping mechanisms failMCQ - Crisis Intervention: If a patient suddenly faces a job loss and expresses, “I don’t know what to do.” What should be the PRIORITY?
A. Provide advice
B. Encourage problem-solving
C. Comfort them by saying it will improve
D. Ask about current support systems
Sensory Perception (8–15)
MCQ - Cataracts: A patient with cataracts typically reports:
A. Sudden sharp pain in the eye
B. Halos and tunnel vision
C. Cloudy or blurred vision
D. Flashing lightsMCQ - Glaucoma: Primary open-angle glaucoma most commonly leads to:
A. Acute eye pain
B. Gradual loss of peripheral vision
C. Total blindness in hours
D. Sudden severe headacheSATA - ARMD Symptoms: Which symptoms are indicative of age-related macular degeneration? Select all that apply.
A. Central vision loss
B. Peripheral vision loss
C. Straight lines appearing wavy
D. Difficulty reading
E. Eye discomfortMCQ - Meniere’s Disease: The MOST concerning symptom is:
A. Tinnitus
B. Vertigo
C. Nausea
D. Hearing lossMCQ - Priority Safety Intervention: For a patient with Meniere's disease, which teaching is MOST critical?
A. Avoid caffeine
B. Avoid rapid movements
C. Increase daily fluid intake
D. Wear eye protectionSATA - Safety Interventions for Individuals with Visual Impairments: Which approaches promote safety? Select all that apply.
A. Reduce clutter in living areas
B. Enhance lighting conditions
C. Position items within reach
D. Speak in a loud voice
E. Use large-print literatureMCQ - Communicating with a Patient Experiencing Hearing Loss: Which method is most effective?
A. Shouting into their ear
B. Facing them directly while talking
C. Speaking rapidly
D. Exaggerating lip movementsMCQ - Post-Operative Cataract Surgery Teaching: What is the correct instruction?
A. “Do not bend over for several days.”
B. “It is normal to feel severe pain.”
C. “Avoid using an eye shield.”
D. “Expect sudden loss of vision.”
Development — Older Adult (16–19)
SATA - Normal Aging Changes: Which changes are considered normal in older adults? Select all that apply.
A. Reduced lung elasticity
B. Thicker skin
C. Declined renal function
D. Heightened reflexes
E. Slowered reaction timeMCQ - High-Risk for Falls: What factor places the elderly at the HIGHEST risk for falls?
A. Wearing glasses
B. Utilizing multiple medications
C. Regularly ambulating4
D. Receiving timely mealsMCQ - Confusion vs. Dementia: An acute onset confusion in an elderly person is likely indicative of:
A. Early dementia
B. Delirium
C. Normal aging
D. DepressionSATA - Promoting Independence: Which activities encourage autonomy in aging individuals? Select all that apply.
A. Stimulate ADL participation
B. Allocate longer times for tasks
C. Complete tasks for them quickly
D. Advocate for assistive device usage
E. Avoid providing them choices
Sexuality (20–22)
MCQ - Sexual Health Assessment: Which inquiry is the MOST fitting for sexual health?
A. “You aren’t active sexually, right?”
B. “What changes do you have regarding your sexual health?”
C. “What concerns do you have regarding your sexual life?”
D. “Do you know the reason behind your issues?”MCQ: Affecting Sexuality: What is the primary factor that typically reduces sexual desire among older adults?
A. Inadequate nutrition
B. Medications
C. Increased physical activities
D. Social engagementsSATA: Sexual Health Education: Safe and effective sexual health education includes: Select all that apply.
A. Open communication with partners
B. Avoiding screening unless symptoms arise
C. Utilizing condom protection
D. Moderation in alcohol usage
E. Recognizing medication effects
Culture (23–25)
MCQ - Cultural Sensitivity: An appropriate cultural sensitivity response by a nurse would entail:
A. Applying uniform beliefs across all patients
B. Evading personal questions
C. Querying patients about preferences
D. Assuming families will make choicesSATA - Appropriate Use of an Interpreter: Which actions represent effective use of an interpreter? Select all that apply.
A. Addressing the patient directly
B. Engaging with the interpreter instead
C. Emphasizing uncomplicated language
D. Seeking confirmations of comprehension
E. Utilizing family members in interpretationMCQ - Cultural Considerations in Food: For a diabetic patient refusing hospital food based on cultural beliefs, the best response would be:
A. Inform that their meal options are unsafe
B. Notify the dietary team for alternative culturally appropriate meals
C. Urge them to eat regardless
D. Request family members to deliver food without formal approvals.
Spirituality (26–27)
MCQ - Conducting a Spiritual Assessment: Which of the following aligns best with the FICA assessment tool?
A. “Why don’t you attend church?”
B. “What role does your faith play in your care?”
C. “Who could I speak to regarding your issues?”
D. “Would you like a priest to visit?”SATA: Indicators of Spiritual Distress: Which points reflect signs of spiritual distress? Select all that apply.
A. Manifesting hopelessness
B. Feeling punished
C. Expressing sentiments of anger toward God
D. Refusal to communicate
E. Exhibiting a cheery demeanor
Professional Behaviors (28–30)
MCQ - Delegation: Which task is appropriate for delegation to the UAP?
A. Education on wound care procedures
B. Conducting lung sound assessments
C. Collecting vital signs
D. Evaluating pain levels post-medication administrationMCQ - Accountability: The concept of accountability means that the nurse:
A. Decides not to document errors made
B. Accepts responsibility for their actions
C. Evades discussions on mistakes
D. Delegates unsafe tasks to othersSATA: Actions Exhibiting Professional Behavior: Which actions demonstrate professionalism comprehensively? Select all that apply.
A. Upholding professional boundaries
B. Arriving late to scheduled shifts
C. Guarding patient confidentiality
D. Reporting unsafe practices when noticed
E. Disregarding facility policies and protocols