Fundamentals

of Professional Nursing
Exam 1 Study Guide—Fall 2016
Intro to Nursing, Evidence-Based Practice, and Health (Chapters 1-4)

• Review terms at the beginning of each chapter.

• Review Florence Nightingale’s contributions to nursing.
• Define nursing according to the ICN & ANA.
ICN: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and
communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the
care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in
shaping health policy and in patient and health systems management, and education are also key nursing roles.
ANA: the protection, promotion, and optimization of health and abilities, prevention of illness and injury,
alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of
individuals, families, communities, and populations

• Know the four aims of nursing.

o Define health promotion, illness prevention, health restoration, and facilitation of coping with
disability and death.
• Review the differences in educational preparation for nursing
o LPN, Diploma, Associate Degree, Baccalaureate, and Master’s and Doctoral degrees.
• Review differences in the professional nursing organizations: ANA, NLN, AACN, and NSNA (p. 17).
• Review nursing standards of practice and the nurse practice acts and the definition of the nursing process.
• Review the current trends in nursing and health care (p. 19)
• Define the sources of knowledge: Traditional, authoritative, scientific and philosophical.
• Define “Nursing Research”. Know the difference between quantitative and qualitative studies.
• Describe evidence-based practice in nursing, including the rationale for its use.
• Outline the steps in implementing evidence-based practice.
• Review the PICO format for nursing research.
• Describe concepts and models of health, wellness, and illness.
o Wellness: intellectual, physical, environmental, emotional, sociocultural, and spiritual.
o Review acute illness versus chronic illness.
• Explain the levels of preventative care.
• Review Maslow’s Hierarchy of Needs.

Nursing Process: Assessment, diagnosis, planning, interventions, and evaluation (Chapters 10-15)

• Review each step and be ready to apply this information to a specific situation. For example, if the nurse had
collected all the data on a patient and was clustering the data to identify a problem, what phase does this represent?
The answer would be diagnosis, which is identifying the problem or potential problem. Be familiar with each phase
of the nursing process in order to identify the phase in an example.

Activity (Chapter 32):

• Review principles of body mechanics to prevent injury when lifting and moving objects and clients.
Develop a habit of erect posture (correct alignment).
Use the longest and the strongest muscles of the arms and the legs to help provide the power needed in strenuous
activities.
Use the internal girdle and a long midriff to stabilize the pelvis and to protect the abdominal viscera when stooping,
reaching, lifting, or pulling.
Work as closely as possible to an object that is to be lifted or moved. Face the direction of your movement.
Avoid twisting your body. Use the weight of the body as a force for pulling or pushing. Slide, roll, push, or pull an
object, rather than lift it.
Use the weight of the body to push an object by falling or rocking forward and to pull an object by falling or rocking
backward.
Push rather than pull equipment when possible.
Begin activities by broadening your base of support. Spread the feet to shoulder width.
Flex the knees, put on the internal girdle, and come down close to an object that is to be lifted.
Break up heavy loads into smaller loads
 Fundamentals of Professional Nursing
Exam 1 Study Guide—Fall 2016
• Review the effects of immobility on the body by systems.
Cardiovascular system: increased cardiac workload, orthostatic hypotension, and venous stasis, with resulting
venous thrombosis.
Respiratory System: decreased ventilatory effort and increased respiratory secretions. Decrease in the depth and rate
of respiration, reduced need for oxygen by body cells. When areas of lung tissue are not used over time, atelectasis
(incomplete expansion or col- lapse of lung tissue) may occur. Hypostatic pneumonia is a type of pneumonia that
results from inactivity and immobility.
Musculoskeletal system: decreased muscle size (atrophy), tone, and strength; decreased joint mobility and flexibility
(ankyloses); bone demineralization (osteoporosis); and limited endurance, resulting in problems with ADLs.
Metabolic processes: Decrease metabolic rate, fever, trauma, chronic illness, or poor nutrition increases and increase
catabolism. Anorexia, or decreased appetite, often accompanies and compounds this problem.
Gastrointestinal system: constipation, poor defecation reflexes, and an inability to expel feces and gas adequately.
Urinary system: Poor perineal hygiene, incontinence, decreased fluid intake, or an indwelling urinary catheter can
increase the risk for urinary tract infection in an immobile patient.
Skin: impaired circulation that accompanies immobility result in skin breakdown and pressure ulcers.
Psychosocial outlook: influence body image, diminished self-esteem and a person’s opportunities to interact socially
and deprive.
• Review safe patient handling and movement.
Assess the patient first. Encourage patients to assist tin their own transfers. Assess the patient’s ability to understand
instructions and cooperate with the staff to achieve the movement. Ensure that enough staff is available and present
to safely move the patient. Plan carefully what you will do before moving or lifting a patient. Explain to the patient
what you plan to do. Lock the wheels of the bed, wheelchair, or stretcher so that they do not slide while you are
moving the patient.
The gait belt is used to help the patient stand and provides stabilization during pivoting. Gait belts also allow the
nurse to assist in ambulating patients who have leg strength, can cooperate, and require minimal assistance. Do not
use gait belts on patients with abdominal or thoracic incisions.
Friction-reducing sheets can be used under patients to prevent skin shearing when moving patients in bed and when
assisting with lateral transfers. Their use reduces friction and the force required to move patients.
• Review patient positioning: Table 32-6
Fowler’s position: semi-sitting, fowler’s elevated 45 to 60 degrees. Used to promote cardiac and respiratory
functioning that providing maximal space in the thoracic cavity. High fowler’s 90 degree for maximal lung
expansion. The heels, sacrum, and scapulae are at risk for skin breakdown and require frequent assessment.
• Define the terms:
atrophy: decreased muscle size, contractures: permanent contraction of a muscle, dangling, flaccidity: decreased
muscle tone, footdrop: Planter flexion that can cause an alteration in the length of muscles, spasticity: increased
muscle tone, and osteoporosis.

Safety (Chapter 26):

• Assessment for fall risk and risk factors for falling.

• Interventions to prevent falls (Box 26-5)
 Fundamentals of Professional Nursing
Exam 1 Study Guide—Fall 2016
• Assessment for risk of injury including lifespan consideration (Teaching Tips 26-1)
Infant Risk: Suffocation, falls, insect bites, child abuse, SIDS
Toddlers: Falls, burs, poisoning, drowning, shock, automobile accidents
Preschoolers: Motor vehicle crashes, choking poisoning, burns, drowning, harm from people/animals
School-age children: Falls, accident, playground injuries, motor vehicle crashes, fires, burns, suffocation
Adolescents: Vehicular accident, recreational accidents, firearms, substance abuse
Young adults: Poisonings, motor vehicles, malignant cancers, suicide, and overexertion
Middle adults: Malignant cancers, heart disease, poisoning, motor vehicles, falls

• Review the nursing process for Maintaining Safety (pp. 691-717)

• Review restraint use and alternatives to restraints.

Documentation (Chapter 16):

• Review documentation guidelines (Box 16-1)

• Review measures to protect confidential patient information.
• Review the purpose of the patient record.
Communicating within the health care team and providing information for other professionals, primarily for individuals and
groups involved with accreditation, credentialing, legal, regulatory and legislative, reimbursement, research, and quality
activities.
Patient records also include diagnostic and therapeutic orders.
Documentation is the primary source of evidence used to continuously measure performance outcomes against predetermined
standards.
• Review the various methods of documentation and the advantages/disadvantages of each: EHR, Source-oriented,
problem-oriented, PIE, focus charting, charting by exception & case management model.
• Review the documentation of nursing interventions and the different possible formats: should be complete, accurate,
concise, and factual to avoid legal problems.

Communication (Chapter 20):

• Review the handout from lab with the various therapeutic communication techniques as well as the blocks to communication.
 Fundamentals of Professional Nursing
Exam 1 Study Guide—Fall 2016
• Review non-verbal communication
• Review the use of therapeutic communication in the nursing process (p.457-458).
• Review the phases of the helping relationship.

• Review “Communicating with Patients Who Have Special Needs” (Box 20-6).

Vital Signs (Chapter 24):

• Review the physiologic processes involved in homeostatic regulation of temperature, pulse, respirations, and blood
pressure.
• Review the factors that increase or decrease the body temperature, pulse, respirations, and blood pressure.
o Mechanisms of heat transfer: Radiation, convection, evaporation, conduction.
o Ranges of normal for blood pressure, pulse, respirations, temperature, and O2 saturation (Table 24-3)
o How each vital sign is measured and which equipment/site is most appropriate for the client
o Know terms: afebrile, febrile, bradycardia, tachycardia, bradypnea, tachypnea, apnea, eupnea.
o Pulse rhythm and amplitude (Table 24-5),
o Factors affecting VS
o When to take an apical pulse:
If a peripheral pulse is difficult to assess accurately because it is irregular, weak, or very rapid, the apical rate should
be assessed using a stethoscope. An apical pulse is also assessed when giving medications that alter heart rate and
rhythm. Apical pulse measurement is also the preferred method of pulse assessment for infants and children less
than 2 years of age.

Hygiene (Chapter 30):

• Functions of the bath

Cleansing the skin
Acting as a skin conditioner
Helping to relax a restless person
Promoting circulation by stimulating the skin’s peripheral nerve endings and underlying tissues
Serving as a musculoskeletal exercise through activity involved with bathing, thereby improving joint mobility and muscle
tonus
Stimulating the rate and depth of respirations
Promoting comfort through muscle relaxation and skin stimulation
Providing sensory input
 Fundamentals of Professional Nursing
Exam 1 Study Guide—Fall 2016
Helping to improve self-image
Providing an excellent opportunity to strengthen the nurse–patient relationship

• Terms: pruritus (Itching), maceration (overhydration that softening and breakdown of skin, results from prolonged
exposure to moisture), excoriation (scratch or abrasion of the epidermis), abrasion (friction; rubbing or scraping epidermal
layers of skin), pressure ulcers (compromised circulation secondary to pressure or pressure combined with friction).

• What duties can the RN delegate to the assistive personnel and what must be done by the professional RN?
Basic personal care measure has often been assigned to an unlicensed staff member rather than the professional nurse.
Unlicensed assistive personnel are increasingly performing hygiene measures, the nurse is responsible for ensuring that
hygiene measures are performed satisfactorily. Bed bath, oral hygiene

• Review procedure for bed bath: head to toe, clean to soiled areas.
• Care of the skin
• Bathing patients with dementia

• Foot care principles

• Oral care principles
• What bath to choose? Bedbath, partial bath, shower, tub, etc.
• A shower may be the preferred method of bathing for patients who are ambulatory and able to tolerate the activity. Tub baths
may be an option, particularly in long-term care or other community-based settings, depending on facility policy. Some
patients must remain in bed as a part of their therapeutic regimen but can still bathe themselves. Other patients are not on bed
rest but require total or partial assistance with bathing in bed due to physical limitations, such as fatigue or limited range of
motion.

Physical assessment (Chapter 25):

• Patient positions (p. 634).

Supine: lies flat on the back with legs extended and knees slightly flexed.
Dorsal Recumbent: lies on the back with legs separated, knees flexed and soles of the feet on the bed. Not be used for
abdominal assessment.
Sims: to assess the rectum or vagina
Prone: to assess the hip joint and the posterior thorax
Lithotomy: to assess female genitalia and rectum
Knee-chest: assess the anus and rectum

• Definitions and order of assessment for of abdomen: inspection, auscultation, palpation and percussion.
 Fundamentals of Professional Nursing
Exam 1 Study Guide—Fall 2016
• General survey (what is included?): It includes observing the
patient’s overall appearance and behavior, taking vital signs,
measuring height, weight, and waist circumference, and calculating
the body mass index (BMI).

• Assessments by system (heart, skin, lungs, abdomen,

musculoskeletal, etc.)
• See diagram for heart landmarks below
• Adventitious breath sounds: wheezes, rhonchi, crackles, stridor,
friction rub (Table 25-6)
Wheezes are musical or squeaking high-pitched, continuous sounds
heard as air passes through narrowed airways.
Rhonchi are low-pitched, continuous sounds with a snoring quality
that occur when air passes through secretions.
Crackles are bubbling, cracking or popping, low- to high-pitched,
discontinuous sounds that occur when air passes through fluid in the
airways.
Stridor is a harsh, loud, high-pitched sound due to narrowing of the
upper airway.