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Vital Signs and Nursing Procedures Guide

The document provides information on various nursing topics including vital signs, pelvic examinations, menstrual cycle, progesterone function, sterile gloving technique, hand washing, administering oral medications, fetal development, genetics, administering IV medications, and changing IV solutions. It defines terms like vital signs, Bartholin's glands, secretory phase, menstruation, and progesterone function. It also provides guidelines for procedures like measuring vital signs, sterile gloving, hand washing, giving oral meds, intramuscular injections, and changing IV tubing sets.

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Ella Retiza
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0% found this document useful (0 votes)
94 views5 pages

Vital Signs and Nursing Procedures Guide

The document provides information on various nursing topics including vital signs, pelvic examinations, menstrual cycle, progesterone function, sterile gloving technique, hand washing, administering oral medications, fetal development, genetics, administering IV medications, and changing IV solutions. It defines terms like vital signs, Bartholin's glands, secretory phase, menstruation, and progesterone function. It also provides guidelines for procedures like measuring vital signs, sterile gloving, hand washing, giving oral meds, intramuscular injections, and changing IV tubing sets.

Uploaded by

Ella Retiza
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

 VITAL SIGNS

 what do you call during pelvic examination the nurse observe a swollen area,
right side of client rib curpos, an enlargement of which of the following?
-Bartholis glands
 The basal body temperature drops slightly after ovulation, this change in the
temperature is due to influence of what hormone?
-Progesterone
 This is the face of the uterine cycle wherein the uterus will be taken, glands will
become cork’s screw and capillaries form
-secretary face
 The menstrual cycle prepares the uterus for pregnancy, when the pregnancy
does not occur which of the following phenomena will follow
-menstruation
 An adolescent client ask what body structure is responsible for the production of
FSH
-anterior pituitary gland

 FUNCTION OF PROGESTERONE:
-it maintains the endometrium during pregnancy
-responsible for the growth and development of cells of mammary gland
-it prepares the endometrium for pregnancy
 WHAT ARE VITAL SIGNS?
-blood pressure
-respiratory rate
- pulse rate
-temperature
- oxygen saturation
-pain

 Normal range for pulse rate


-60-100 bpm
 Where is the apical pulse auscultated?
-Over the point of maximum impulse at the 5th intercostal space on the left
midclavicular line
 The patient who is feeling faint after sitting in the chair, the nurse would check
his/her? -BP
 How frequent should you check the vital signs of the patient post-operation? Or
when he/she is recovering and is about to go home today -every 4 hours or 2
hours
 When assessing the patient’s respiration, how will you check it? -you should
count the number of times the chest rises and falls in one full minute, also
observe if the patient is having difficulty of breathing
 You count the respiration while you are also counting what? -pulse rate
 Which is the temperature route the most accurate? -Rectal
 GLOVING
 sterile open gloves requires skills to prevent contamination of the sterile gloves
which is crucial in performing, in doing so, which hand will you put the gloves
first to effectively perform the procedure? -dominant hand
 Your clinical instructor ask you: “at what level of your body should you put
sterile gloves package?” -above your waist
 What is the most important and basic step before performing open sterile
gloving
- Hand hygiene
 When we should perform sterile open gloving
-antiseptic technique
 Which of the following would required the nurse put a new sterile gloves when
you are grasping the patient’s gown to move it out of the way
- this is consider as a non-sterile
 The first step in don the sterile gloves after choosing the correct size is what?
-wash your hands with soap and water using good washing technique
 After opening the outside wrapper of the gloves the inner package is place on a
dry surface on what:
~Handling it with clean hands
 What equipment is used don in sterile gloves
~Sterile gloves

 HAND WASHING:

 What is the act of cleaning once hands with use of liquid, soap with the purpose
of removing dirt or microorganisms
-Hand washing
 Your clinical instructor ask the students the rationale for hand washing. The
students are correct that they answer that hand washing is corrected to be
remove
~effective
 Which of the following is considered the most important aspect of hand washing
~Friction
 What is the time and duration of hand washing
~49-60 secs
 You should turn off the faucet after hand washing with;
~Dry paper towel
 The first step in performing the 2 mins hand washing is what;
~ Insert the hands observing visible dirt
 Remove all the jewelry of hand washing except;
~ Plain wedding ring

 ORAL MEDICATION
 Which of the following abbv. indicates that the medications must given orally
~ Per-orem (PO)
 The abbv. of QID stands for what
~ 4 times a day
 The best position to put the patient giving oral medication is what
~ Semi-fowlers education
 BID (twice a day) medication ticket color is
-Yellow
 Upon administering a medication , the safest and best method to identify your
patient
~ Name & Birthday

 SAS 9-11

 The nurse is giving a presentation about milestones of embryonic development.


Which should the information students include?
~ it should be 20 weeks of gestation , lanugo apper
 What is meconium
~first stool of the baby
Meconium is produced by: FETAL INTESTINE
 The nurse is carrying a pregnant client knows at the health teaching regarding
fetal circulation has been effective when . What position?
~ Side lying position
 Stage 1 labor includes which feces:
|. Transition
||. Laten
|||. Active
 What is the normal FHR
~120-160
 What is goodell’s sign?
~It is the softening of the cervix

 SAS 4-5

 If blond hair color is the recessive trait and one parent is heterozygous trait and
the other parent heterozygous trait . What are the chances that there off spring
will have a blonde hair
~ 50%
 You overhear the group nurses is talking, state that man never good at diapering
babies
~ Stereotyping
 It is the experimental technique that use genes to prevent disease
~ Gene replacement therapy
 Amniocentesis is the withdrawal through abdominal wall at what week?
~14-16 weeks
 The genetic disorder does not only two genes for the disease is presence
~homozygous recessive

 ADMINISTERING ORAL MEDS


 What is the best way for the nurse to make sure that right patient is receiving a
prescribed drug when the patient is alert and oriented
~ Ask the patient to state her/he Name and birth date
 When is acceptable for the nurse to take the verbal order from the prescriber
the doctor before giving the drug
~It is during emergency situation such as cardiac arrest
 In preparing for two different medications from two vials the nurse must?
~ discard the medications from vial no. 2 if the medication form vial no. 1 push
into it .
 If the nurse accidentally touches the tip of the syringe. What will you do?
~ change or get another syringe
 Why is it important to first inject the air into the vial ?
~ it helps prevents the build up of negative pressure in the vial
 What is the most common mistake in administering IV medications is
~ administering drug too quickly

 SAS 6-8

 So what are the three parts of decidua:


~ decidua Basalis
~ decidua Vera
~decidua Capsularis
 When the ovum is matured its surrounded by:
~ Zona pellucida and Corona radiata
 For how many seconds the sperm reach to the cervix
~ 80 secs.
 It is known as gelatinous muco polysaccharide which gives the cord body and
prevents pressure on the blood volume
~ Wharton’s Jelly
 Conception occurs in the fallopian tube the most common site is the
~ Ampulla
 What are the three embryonic germ layers:
~ ectoderm
~ mesoderm
~ endoderm
 What part of decidua does directly under the embryo
~ decidua basalis
 HCG stands for :
~Human chronic gonadotropin
 Goodell signs
~ softening of the cervix
 What do you call the purplish or dark bluish of discoloration in vagina
~ Chadwicks sign
 What medications will induce contractions?
~Oxytocin
 The pituitary hormone that stimulates the section of milk from mammary gland
~Prolactin
 How many you should administered the program
(medicine for 12th week of gestation) A client completely expels the product of
conception. The client is RH negative the nurse administer program within:
~72 hrs.
 What APGAR’S score after birth that needs resuscitation
~ apgar 1-3
 Abnormal Fetal heart rate is
~120-160 bpm
 Why should IM injection be given 90 degree angle?
~ to ensure that the medication reaches the muscle fiber
 In giving IM how many secs it should be given
-sa 1ml and 10 secs per ml, it allows the muscle fiber to expand, allowing
the drug to be absorb
 Which of the following best describe Z-track injection
~ a method of injecting of medication into a large muscle
 How much medication can the nurse safely administer to the deltoid muscle
- 1-2 ml?
 Which anotomical landmark which the nurse identifies to administer the
injection safely
-acromion process
 What nerve will be hit when we inject on the buttocks
-sciatic nerve
 What gauze when you give IM
-20-22 gauze
 Why is z-track technique is preferred for IM?
-it prevents the drug linkage on the subcutaneous tissue
 What should be done for our patient who requires a repeat injection like
bakuna?
-rotate injection sites

 CHANGING IV SOLUTION CONTAINER


 When the nurse accidentally touches the open entry site of the IV container,
what will you do?
-discard from container
 How many hours will you change the IV tubing set?
-72 hours
 If we do TPR, what will we TPR?
-vital signs, BP, RR, PR, T
 what is the pen color the nurse used in plotting a patient’s BP at 8pm? -blue
 How frequent should the nurse plot the vital signs? -every 4 hours
 T -black (if it’s morning, afternoon, night)
 RR -red
 PR -red

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