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Safe And Effective Care Environment Flashcards

Master one of the four core NCLEX categories with focused flashcards on management of care and safety/infection control. Practice high-yield scenarios on prioritization, delegation, legal/ethical issues, radiation safety, isolation precautions, and patient safety standards. These cards help you build clinical judgment, reduce errors, and answer the toughest NCLEX RN®/PN® questions with confidence.

Management Of Care Flashcards

Part 1

[{"q":"What is fluid volume excess?","a":"Retaining too much water and sodium in the vascular space."},{"q":"What is another term for fluid volume excess?","a":"Hypervolemia"},{"q":"What is another name for fluid volume deficit?","a":"Hypovolemia."},{"q":"How can fever and sweating induce hypovolemia?","a":"Fever and sweating can cause fluid loss."},{"q":"What will the patient’s symptoms be?","a":"Tight muscle tone, irritable, increased DTRs, depression; hallucinations + Chvostek’s + Trousseau’s."},{"q":"Why does it do this?","a":"It is compensating (building up in the blood), making the patient less acid."},{"q":"When a patient has any type of upper body burns, why do we have to worry about the airway?","a":"You have to worry about airway edema."},{"q":"Explain the general care for a patient with an internal radiation implant.","a":"Private room; mark room, bed rest – body fluids are active – no pregnant nurses or visitors; supine – log roll to turn; flush commode twice; don’t forget the patient is also immunosuppressed."},{"q":"When a patient has a radiation implant, there is a chance it will become dislodged. What would you do?","a":"Get gloves; using forceps, pick it up and put it in a lead-lined container – call the radiation department."},{"q":"Why is it important that the ileal conduit patient change their appliance in the morning?","a":"Because output is at its lowest in the morning. (Don’t want to let urine get on skin as excoriation will occur.)"},{"q":"Could the Addison’s disease patient also have a life-threatening arrhythmia? If so, why?","a":"Yes – too much K+"},{"q":"Does the Addison’s disease patient have too many steroids in their blood or not enough steroids in their blood?","a":"Not enough."},{"q":"After a patient has experienced hypoglycemia and they have drank a coke or eaten some candy or whatever, what do they need to do next? Explain why.","a":"Eat complex carbohydrates and protein (peanut butter and crackers, cheese and crackers) – so blood sugar won’t drop again; drink milk."},{"q":"Draw a picture of my square heart and include the lungs and the aorta and trace the normal blood flow through the heart.","a":"Check in your Hurst Review Book."},{"q":"What is a common and expected side effect of nitroglycerin?","a":"Headache."},{"q":"When you give somebody nitroglycerin, are they going to vasoconstrict or vasodilate? Therefore, what is going to happen to their blood pressure?","a":"Vasodilate – decrease"},{"q":"What does the wedge pressure tell you about?","a":"Pressures in the left side of the heart."},{"q":"If a patient’s wedge pressure is increasing, that means volume is building up in the left side of the heart. When volume is building up in the left side of the heart, that puts the patient at risk for developing what?","a":"Pulmonary edema"},{"q":"Why does a patient with a venous disorder need Heparin?","a":"To decrease the chance of a new clot forming and to keep the present clot from getting larger."},{"q":"How do TED hose help venous disorders?","a":"They enhance venous return and decrease pooling."},{"q":"When somebody has a positive skin test, what does that mean?","a":"It means the patient has been exposed."},{"q":"Does the nephrotic syndrome patient need a high-sodium diet or a low-sodium diet? Explain why.","a":"A low-sodium diet is needed to decrease further edema."},{"q":"Does the nephrotic syndrome patient need a high-protein diet or a low-protein diet? Explain why.","a":"A high-protein diet is needed to help offset the amount of protein this patient is losing through their glomerulus."},{"q":"Why does the oliguric patient go into a fluid volume excess?","a":"Retaining fluid"},{"q":"Does the patient who is being hemodialyzed have to watch what they eat and drink in between treatment? Why?","a":"Yes, because between treatments the patient is unable to excrete excess electrolytes and fluids."},{"q":"Once you get the blood from the blood bank, how long do you have to get it hanging?","a":"30 minutes"},{"q":"Why does a sickle cell patient develop ischemia or infarction in extremities?","a":"Little clots can form and cut off circulation to an area."},{"q":"Why does the sickle cell patient develop pain or have pain and swelling?","a":"Because the cells can cut off circulation to an area."},{"q":"There are two parts to a neurovascular check. a. What is the neuro component? b. What is the vascular component?","a":"A. Neuro - movement and sensation B. Vascular – capillary refill, skin temperature, skin color, pulse"},{"q":"When a patient is having a CT of the head, is it okay for them to talk?","a":"No"},{"q":"Can a CT scan be done with contrast medium (dye)?","a":"Yes"},{"q":"Can a patient become claustrophobic with a CT scan?","a":"Yes"},{"q":"What type of patient cannot tolerate an MRI scan?","a":"Claustrophobic"},{"q":"Explain everything that you would teach a patient about an MRI.","a":"They will be in a closed space; need to lie still, they will hear a clanging sound, they can talk to others while they are in the tube, and no metal objects are allowed in the tube."},{"q":"What is cerebral angiography?","a":"It is an x-ray of cerebral circulation using dye."},{"q":"When a patient is having cerebral angiography, what artery do they go through?","a":"Usually femoral."},{"q":"What other procedure did we use the femoral artery for?","a":"Heart Catheterization"},{"q":"When a patient is posturing, what happens to their caloric needs?","a":"Increases"},{"q":"Why do we give the pancreatitis patient anti-cholinergic drugs?","a":"To dry secretions"},{"q":"Explain the major symptoms of appendicitis.","a":"Right lower quadrant pain and an elevated white blood count; may have some nausea and vomiting and rebound tenderness."},{"q":"Why do we avoid giving an enema to a patient who has appendicitis?","a":"Because we do not want to rupture the appendix."}]

Part 2

[{"q":"If the pH and the BiCarb are both in the same direction then it is?","a":"Metabolic"},{"q":"If the pH is up it is?","a":"Alkalosis"},{"q":"If the pH is down it is?","a":"Acidosis"},{"q":"If disconnected tube on floor?","a":"Bag patient → call for help → new tube → reconnect."},{"q":"If disconnected tube on chest?","a":"Reconnect (above waist is ok)."},{"q":"“Bizarre” means?","a":"Tachycardia."},{"q":"If kernicterus & opisthotonos → ?","a":"Call MD, draw bili, increase IV, start phototherapy."},{"q":"Thyroidectomy post-op 0–12h risks?","a":"Hemorrhage, airway."},{"q":"Post-op 12–48h Subtotal risk?","a":"Thyroid storm."},{"q":"Adolescents (12–18 yrs) \"play\" is?","a":"Peer association."},{"q":"How often monitor in labor?","a":"q15min until 2h PP, then q1h."},{"q":"1st stage of labor has how many phases?","a":"3."},{"q":"3 phases of labor?","a":"Latent \/ Active \/ Transition."},{"q":"Side effects of Terbutaline?","a":"Maternal tachycardia (not safe if cardiac disease is present)."},{"q":"Side effects of Nifedipine?","a":"Headache and hypotension."},{"q":"Prioritization questions give what 4 details?","a":"Age \/ Gender \/ Diagnosis \/ Modifying phrase."},{"q":"Most important info in prioritization?","a":"Modifying phrase."},{"q":"What 2 details do NOT matter in prioritization?","a":"Age and gender."},{"q":"Four rules of prioritization?","a":"Acute > Chronic \/ others \/ Unstable > Stable \/ More vital organ > less vital (tie-breaker)."},{"q":"Best prioritization rule?","a":"Rule #4 (organ vitality)."},{"q":"What makes a patient stable?","a":"Chronic illness \/ >12h postop \/ Local\/regional anesthesia \/ Unchanged assessment \/ \"To be discharged\" \/ Lab values A or B \/ Expected signs and symptoms."},{"q":"What makes a patient unstable?","a":"Acute illness \/ &lt;12h postop \/ General anesthesia \/ Changed assessment \/ &quot;Newly admitted\/diagnosed&quot; \/ Lab values C or D \/ Unexpected signs and symptoms."},{"q":"Main 6 organs in order?","a":"Brain > Lung > Heart > Liver > Kidney > Pancreas."},{"q":"What do you NOT delegate to family?","a":"Safety responsibilities."},{"q":"Family can only do what you ____ them?","a":"Teach."},{"q":"If staff does something illegal you?","a":"Report to supervisor."},{"q":"If staff behavior is legal, not harmful but inappropriate you?","a":"Counsel them later."}]

Safety And Infection Control Flashcards

Part 1

[{"q":"Why is it so important to give IV fluids very slowly to the elderly?","a":"Their heart and kidneys are weak. The heart may not be able to pump the excess forward, and the kidneys may have problems excreting the excess."},{"q":"Why is it so important to be careful with drugs, like sedatives, hypnotics, and narcotics?","a":"Because they decrease respiration and retain CO2."},{"q":"Why does the hypoparathyroid patient need a quiet environment?","a":"To reduce stimuli – they are at risk for seizures."},{"q":"Why does the hypoparathyroid patient need a trach tray at the bedside?","a":"To provide emergency airway in case of laryngospasm."},{"q":"Do they use dye with a KUB?","a":"Not usually – it is just an x-ray"},{"q":"Does an IVP use dye? If so, what had you better ask the patient if they are allergic to?","a":"Yes - iodine"},{"q":"Why do we need to avoid IM injections in the leukemia patient?","a":"Because they don’t have enough platelets; therefore, they will bleed into the muscle."},{"q":"Why does the leukemia patient need to avoid aspirin?","a":"You wouldn’t want to give the patient anything that would promote more bleeding (they do not have enough platelets)."},{"q":"Who is the carrier and the transmitter of hemophilia?","a":"Females."},{"q":"Why does the hemophiliac patient need to avoid aspirin and IM injections?","a":"They don’t need anything that is going to increase their bleeding episodes."},{"q":"Why is dental hygiene so important with a hemophiliac?","a":"They don’t need to be having frequent dental work due to the chance of hemorrhage."},{"q":"Why is it so important that fractures be immobilized as soon as possible?","a":"To prevent further trauma."},{"q":"What would you do if a patient came in with an open fracture?","a":"Cover it with something sterile."},{"q":"What is one of the most important things you need to remember with a scalp injury?","a":"Fight infection."},{"q":"When a trauma patient comes into the emergency room, why do we have to assume a C-spine injury is present?","a":"Because with any trauma, we assume the C-spine is injured until proven otherwise."},{"q":"Why is it so important to keep the body in perfect alignment after trauma?","a":"To protect the cervical spine and spinal cord."},{"q":"When you have a head-injured patient, why is it so important that we keep the environment quiet?","a":"To decrease the stimuli which could initiate seizures."},{"q":"When you have a head-injured patient, why do we have to pad the side rails?","a":"Because we are worried about seizures."},{"q":"What is a major risk when a patient has an ICP monitoring device?","a":"Infection"},{"q":"Why is it so important that we keep the connections tight on an ICP monitoring device and also why is it so important to keep the dressings dry?","a":"To decrease the chance for infection."},{"q":"Why is it so important that vital signs be checked pre-liver biopsy?","a":"We are worried about hemorrhage."},{"q":"Why do you need to know med-surg core content first when delegating routine tasks to LPNs and unlicensed assistive personnel (UAPs)?","a":"because you have to look at every client situation and make a judgment call based on med surg knowledge"},{"q":"Why can UAPs only perform routine, simple, repetitive common activities on stable clients in uncomplicated situations?","a":"because these activities do not require nursing judgments"},{"q":"What types of assignment transfers both responsibility and accountability?","a":"RN to RN"},{"q":"Why is the RN responsible for knowing the staff’s strengths and weaknesses in regards to delegation?","a":"to help delegate to the right personnel and improve client care"},{"q":"What should the RN do when a weakness is identified in a staff member?","a":"teach"},{"q":"Why can the LPN not do any form of evaluation?","a":"because evaluation involves assessment, we never delegate assessment"},{"q":"Why should the RN assess the newly admitted client first?","a":"because a new admit is always considered unstable"}]

Part 2

[{"q":"High pressure alarms trigger when?","a":"Ventilator cannot push air in."},{"q":"High pressure alarms are caused by?","a":"Kinking \/ Water in dependent loops \/ Mucus in airway."},{"q":"If tube kinking present?","a":"Unkink."},{"q":"If water in dependent loops?","a":"Open system and empty."},{"q":"If mucus present?","a":"Turn, cough, deep breathe. If ineffective → suction."},{"q":"Low pressure alarms trigger when?","a":"Too easy to push air in."},{"q":"Low pressure alarms are caused by?","a":"Disconnection."},{"q":"If tubing disconnected?","a":"Reconnect."},{"q":"If O2 sensor line disconnected?","a":"Reconnect."},{"q":"Overdose of an upper?","a":"Everything ↑"},{"q":"Withdrawal of an upper?","a":"Everything ↓"},{"q":"Withdrawal of a downer?","a":"Everything ↑"},{"q":"Contact precautions for?","a":"RSV, herpes, staph, enteric infections."},{"q":"Contact precautions include?","a":"Private room, gloves, gown (direct care), handwashing, disposable supplies."},{"q":"Droplet precautions for?","a":"All meningitis, all influenza."},{"q":"Droplet precautions include?","a":"Private room, gloves, mask (#1), handwashing, patient mask when leaving, disposable supplies."},{"q":"Airborne precautions are for what 4 diseases?","a":"SARS, TB, measles, varicella."},{"q":"Airborne precautions have what 9 things?","a":"Private room (door closed), mask, gloves, gown, handwashing, special respirator mask, patient wears mask when leaving room, disposable-dedicated supplies, negative airflow room."},{"q":"PPE contains?","a":"Gloves, gown, goggles, mask (unless told otherwise)."},{"q":"Proper order for donning PPE?","a":"1. Gown, 2. Mask, 3. Goggles, 4. Gloves."},{"q":"Where do you remove PPE?","a":"Inside the room."},{"q":"Where do you put on PPE?","a":"Outside the room."},{"q":"In airborne precautions it is ok to remove what PPE outside the room?","a":"Mask."},{"q":"What position are your hands for handwashing?","a":"Hands below elbows."},{"q":"How long do you wash hands?","a":"15 seconds."},{"q":"Can the faucet have handles for handwashing?","a":"Yes."},{"q":"What do you use in handwashing?","a":"Soap and water."},{"q":"When do you wash your hands?","a":"Before\/after gloves, entering\/exiting room, after soiling hands."},{"q":"Hand position for scrubbing?","a":"Elbows below hands."},{"q":"Length of hand scrubbing?","a":"3–7 minutes."},{"q":"What agent is used for hand scrubbing?","a":"Cleaning agent with prefix \"chlor\"."},{"q":"Can the sink have handles for scrubbing?","a":"No."},{"q":"When do you use scrubbing?","a":"Immunosuppression, surgery, transplant, chemo, HIV."},{"q":"Dry your hands from...?","a":"Cleanest to least clean."},{"q":"When can you use alcohol-based solution?","a":"Before\/after gloves, entering\/leaving room."},{"q":"Allow adolescents in each other’s rooms unless?","a":"Contagious, immunosuppressed, or fresh post-op."},{"q":"If WBC low, precautions?","a":"Strict handwashing, BID antimicrobial showers, avoid crowds, private room, no fresh flowers\/plants, low-bacteria diet (no raw fruits\/veggies, no undercooked meat), no sitting water, vitals q4h, daily WBC, and no reusable utensils."},{"q":"What 4 conditions are always unstable?","a":"Hemorrhage \/ Hypoglycemia \/ Fever >104°F \/ Pulselessness & breathlessness."},{"q":"If staff endangers patient physically\/psychologically you?","a":"Intervene and take over."}]

Safe and Effective Care Environment – Maternal Safety, Infection Control, and Delivery Procedures

[{"q":"What should the nurse do first after rupture of membranes?","a":"Assess the fetal heart rate immediately to ensure there is no cord compression or prolapse."},{"q":"What is the priority nursing action when a patient has placenta previa?","a":"Avoid vaginal examinations and prepare for possible cesarean delivery if bleeding occurs."},{"q":"What is the nurse’s legal duty when obtaining informed consent?","a":"Ensure that the patient understands the procedure, risks, and alternatives before signing, but only the provider explains the details."},{"q":"What should the nurse do if a patient does not understand a surgical procedure before signing consent?","a":"Notify the surgeon to return and clarify; the nurse must not interpret or provide detailed explanations."},{"q":"What is the nurse’s role in verifying informed consent?","a":"Witness the patient’s signature and confirm that consent was given voluntarily."},{"q":"What is the nurse’s first priority during a fire emergency in the hospital?","a":"Follow RACE protocol: Rescue patients in danger first, then activate the alarm, contain the fire, and extinguish it if possible."},{"q":"What is the meaning of RACE in fire safety?","a":"Rescue, Alarm, Contain, Extinguish — the correct sequence of actions in a hospital fire emergency."},{"q":"What does PASS stand for when using a fire extinguisher?","a":"Pull the pin, Aim at the base, Squeeze the handle, Sweep side to side."},{"q":"What is the safest position for a pregnant woman experiencing hypotension?","a":"Turn the woman onto her left side to improve venous return and placental perfusion."},{"q":"What should a nurse do during a disaster when triaging patients?","a":"Treat those with the greatest chance of survival first, prioritizing airway and circulation."},{"q":"What is the best infection control measure for all patients?","a":"Consistent hand hygiene before and after every patient contact."},{"q":"What are standard precautions?","a":"Infection control practices applied to all patients, regardless of diagnosis, including handwashing and use of gloves."},{"q":"What are transmission-based precautions?","a":"Additional measures used for patients known or suspected to be infected with pathogens spread by contact, droplet, or airborne routes."},{"q":"What PPE is required for contact precautions?","a":"Gloves and gown must be worn; use dedicated equipment for the patient."},{"q":"What PPE is required for droplet precautions?","a":"Surgical mask, gloves, and gown; used for infections like influenza or pertussis."},{"q":"What PPE is required for airborne precautions?","a":"N95 respirator, negative pressure room, and closed-door policy; used for TB, measles, or varicella."},{"q":"What is the safest action after exposure to blood or body fluids?","a":"Wash the area immediately with soap and water and report the incident to the supervisor."},{"q":"What is the proper method for removing contaminated gloves?","a":"Grasp the outside of one glove, peel it away, holding it in the gloved hand, then slide an ungloved finger under the other glove to remove it without skin contact."},{"q":"What is the correct sequence for removing PPE?","a":"Gloves → Gown → Goggles → Mask — to minimize contamination."},{"q":"What is the correct order for donning PPE?","a":"Gown → Mask → Goggles → Gloves — ensuring clean-to-dirty technique."},{"q":"What is the best way to prevent needlestick injuries?","a":"Avoid recapping used needles and dispose of them immediately in puncture-resistant sharps containers."},{"q":"What should the nurse do after a needlestick injury?","a":"Wash the site, report immediately, and follow protocol for post-exposure prophylaxis."},{"q":"What is the most effective method to prevent hospital-acquired infections?","a":"Proper and consistent hand hygiene before and after any patient contact."},{"q":"How should linens contaminated with blood be handled?","a":"Wear gloves and place the linens in a leak-proof biohazard bag without shaking."},{"q":"What is the proper disposal method for infectious waste?","a":"Place all biohazard materials in red, labeled bags or containers according to facility policy."},{"q":"What is the purpose of patient identification bands?","a":"To ensure correct patient identification before administering medications or procedures."},{"q":"What information must be verified before medication administration?","a":"The “five rights”: right patient, right drug, right dose, right route, and right time."},{"q":"What should the nurse do if a medication error occurs?","a":"Assess the patient, notify the provider, complete an incident report, and do not document the error in the chart."},{"q":"What is the correct procedure for telephone orders?","a":"Repeat the order back to confirm accuracy and document with the provider’s name and time received."},{"q":"What is the nurse’s responsibility regarding patient confidentiality?","a":"Protect patient information and discuss it only with authorized personnel involved in care."},{"q":"What is HIPAA?","a":"The Health Insurance Portability and Accountability Act, which ensures confidentiality and security of patient health information."},{"q":"How should the nurse dispose of documents with patient information?","a":"Shred or place in a designated locked container for confidential disposal."},{"q":"What is the purpose of incident reporting?","a":"To document unusual occurrences for quality improvement and risk management, not for punishment."},{"q":"What should be done when a patient falls?","a":"Assess for injury first, notify the provider, and complete an incident report per facility policy."},{"q":"How should side rails be used safely?","a":"Raise only necessary rails to prevent falls while avoiding entrapment or restraint classification."},{"q":"When are physical restraints appropriate?","a":"Only when all less restrictive measures have failed and the patient poses a danger to self or others."},{"q":"What documentation is required for restraints?","a":"Reason for use, type, alternatives tried, time applied, and frequent reassessments per protocol."},{"q":"What should be done before applying restraints?","a":"Try verbal de-escalation, reorientation, or sitter supervision before restraint use."},{"q":"What are the nursing priorities for a patient in restraints?","a":"Check circulation, skin integrity, and range of motion every two hours."},{"q":"What is the maximum time a restraint order is valid?","a":"Typically 24 hours; it must be renewed daily by the provider."},{"q":"What is an advance directive?","a":"A legal document stating a patient’s wishes for healthcare decisions if they become incapacitated."},{"q":"What is a living will?","a":"A type of advance directive specifying medical treatment preferences at end of life."},{"q":"What is a durable power of attorney for healthcare?","a":"A legal appointment of another person to make healthcare decisions on the patient’s behalf."},{"q":"What is the nurse’s role in end-of-life care documentation?","a":"Respect the patient’s wishes, ensure comfort, and follow the advance directive accurately."},{"q":"What is the best action if a patient refuses a prescribed treatment?","a":"Respect the patient’s right to refuse, document the refusal, and notify the provider."},{"q":"What should the nurse do if a patient wants to leave the hospital against medical advice (AMA)?","a":"Explain risks, obtain the patient’s signature on the AMA form, and document the event thoroughly."},{"q":"What is the nurse’s legal protection when following physician orders?","a":"The nurse must clarify any order that seems unsafe or unclear; following a wrong order is not a defense."},{"q":"What is the correct method for transferring a patient using a wheelchair?","a":"Lock wheels, assist the patient into the chair using a gait belt, and position footrests properly."},{"q":"How should a fall-risk patient be assisted during ambulation?","a":"Walk slightly behind and to the side, holding a gait belt for support."},{"q":"What is the purpose of safety reminder devices like bed alarms?","a":"To alert staff when patients at risk for falls attempt to leave the bed unassisted."},{"q":"What is the priority nursing action after a patient experiences a seizure?","a":"Protect the head, maintain airway, place the patient on their side, and do not insert anything into the mouth."},{"q":"What precautions should be taken with oxygen equipment?","a":"Keep away from flames or sparks, avoid petroleum-based products, and post “No Smoking” signs."},{"q":"What is the first action if a patient’s IV site becomes red and swollen?","a":"Stop the infusion immediately, remove the IV, and restart at another site."},{"q":"What should the nurse do if a medication is spilled on the floor?","a":"Dispose of it safely and obtain a new dose; never administer contaminated medication."},{"q":"What is the correct response to a small electrical fire from equipment?","a":"Unplug the equipment if safe, use a CO₂ or dry chemical extinguisher, and report to maintenance."},{"q":"What is the nurse’s priority during a bomb threat call?","a":"Stay calm, keep the caller talking, gather details, and notify security immediately after the call."},{"q":"What is the protocol during a mass casualty event?","a":"Apply triage principles: treat those who can be saved first; tag and document patients clearly."},{"q":"What is the primary focus of risk management in healthcare?","a":"Identifying and reducing potential causes of harm to patients or staff."},{"q":"What is the nurse’s responsibility when delegating tasks?","a":"Ensure the delegated task matches the staff member’s competence and scope of practice."},{"q":"What should never be delegated by a registered nurse?","a":"Assessment, evaluation, and nursing judgment should not be delegated."},{"q":"What are the key principles of effective delegation?","a":"Right task, right circumstance, right person, right direction, and right supervision."},{"q":"What is the nurse’s responsibility after delegating a task?","a":"The nurse remains accountable for the outcome and must evaluate the results."},{"q":"What should be done if an unlicensed assistant reports abnormal findings?","a":"The nurse must reassess the patient personally to confirm and interpret the findings."},{"q":"What is continuity of care?","a":"Providing consistent, coordinated care as the patient transitions between settings or providers."},{"q":"What should be included in a handoff report?","a":"Current condition, recent changes, vital signs, treatments, and pending tests."},{"q":"What is the purpose of an interdisciplinary team conference?","a":"To collaborate across disciplines for comprehensive patient care planning."}]

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Safe And Effective Care Environment Flashcards

Management Of Care Flashcards

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Safety And Infection Control Flashcards

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Safe and Effective Care Environment – Maternal Safety, Infection Control, and Delivery Procedures

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