Exam 2 Review

A penrose drain should be emptied every 4 hours, true or false

• True

• False

• You're guess is as good as mine

• Sounds like a good idea

When developing learning objectives, what is HIGHEST priority?

• Patient's age

• Learning needs of the patient

• Availability of family

• Past experiences of the nurse

A nurse has to teach the patient how to administer injections. What is MOST important for the nurse to assess?

• Patient's ability to read

• Patient's preferred language

• Patient's willingness to learn

• The patient's learning style

A patient is at risk for impaired skin integrity. What is a priority nursing intervention?

• Keep head of bed at 45 degrees or higher

• Turn patient every 3 hours while in bed

• Perform Braden scale every other day

• Reposition patient in chair every hour

The nurse notices a reddened non-blanchable area on the patient's coccyx. The patient has developed a what?

• Stage 1 pressure ulcer

• Stage 2 pressure ulcer

• Stage 3 pressure ulcer

• Stage 4 pressure ulcer

The nurse should consider all of the following when teaching an older adult EXCEPT

• Lighting

• Previously taught materials

• Providing all teaching in one session

• Readiness to learn

True or False: Stuffed animals can be used to teach children self care

• True

• False

• Inappropriate

• Why not

All are included in the Braden Scale EXCEPT

• Age

• Mobility

• Friction

• Nutrition

True or False: Non-verbal communication has little to no meaning

• True

• False

• Doubtful

• Perhaps

The nurse is assessing this patient's Jackson Pratt drain. What action should the nurse do FIRST

• Depress the bulb

• Document the amount of drainage

• Secure drain to patient's gown

• Empty the drain