UNB IDR Entrance flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Informed consent elements

Capacity to understand, voluntariness free of coercion, and adequate disclosure of risks, benefits, alternatives, and consequences of refusal. The nurse witnesses consent, verifies understanding, and ensures the prescriber obtained it.

Negligence four elements

Duty of care owed to the patient, breach of the standard of care, causation linking the breach to harm, and actual damages. All four must be proven for a successful negligence claim.

Mandatory confidentiality exceptions

Duty to report suspected child or elder abuse, credible threats of serious harm to an identifiable person, reportable communicable diseases, court orders, and imminent suicide risk requiring protective action.

Nursing diagnosis versus medical diagnosis

A nursing diagnosis describes a human response to a health condition that nursing can treat independently, such as impaired gas exchange. A medical diagnosis identifies pathology and is made by a physician or nurse practitioner.

SMART outcome criteria

Outcomes must be specific, measurable, attainable, realistic, and time-bound. Each states a patient behavior, the criterion for success, and a target time for evaluation.

SBAR communication

A structured handoff: Situation (what is happening now), Background (relevant history), Assessment (what the nurse thinks is occurring), and Recommendation (what is requested). Used to escalate deterioration.

Abdominal assessment sequence

Inspect, auscultate, percuss, then palpate the abdomen. Auscultation precedes palpation and percussion because manipulation alters bowel sounds and may cause false findings.

Glasgow Coma Scale range

Total score from 3 to 15: eye opening 1-4, verbal response 1-5, motor response 1-6. A score of 8 or less generally signals need for airway protection and intubation.

Pitting edema grading

Grade 1+ is 2 mm depression, 2+ is 4 mm, 3+ is 6 mm, and 4+ is 8 mm, with increasing time to rebound. Document location and compare limbs at a marked reference point.

Rights of medication administration

Right patient via two identifiers, right drug, dose, route, time, documentation, reason, and right to refuse. Verify at removal from storage, preparation, and the bedside.

Narrow therapeutic index examples

Digoxin 0.5-2.0 ng/mL, phenytoin 10-20 mcg/mL, lithium 0.6-1.2 mEq/L, and warfarin titrated to INR 2-3. These drugs require serum level monitoring and careful dose titration.

Insulin onset and peak

Rapid-acting lispro and aspart peak in 1-3 hours; regular insulin peaks in 2-4 hours; NPH peaks in 4-12 hours; glargine is peakless. Only regular insulin may be given intravenously.

Heparin and protamine

Unfractionated heparin is monitored by aPTT, therapeutic at roughly 1.5-2.5 times control. Protamine sulfate is the antidote and is dosed by the amount of heparin given.

Left versus right heart failure

Left-sided failure causes dyspnea, orthopnea, crackles, and frothy sputum from pulmonary congestion. Right-sided failure causes jugular venous distension, hepatomegaly, ascites, and dependent peripheral edema.

DKA versus HHS

DKA shows ketones, anion gap metabolic acidosis, Kussmaul respirations, and glucose usually 250-600 mg/dL. HHS shows severe hyperglycemia often over 600 mg/dL, hyperosmolality, and minimal ketosis.

Cushing triad

Hypertension with widened pulse pressure, bradycardia, and irregular respirations. It is a late sign of increased intracranial pressure and signals impending brainstem herniation requiring emergency intervention.

Rule of nines adults

Head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%. Children have proportionally larger heads, so Lund-Browder charts are preferred.

Late decelerations meaning

Decelerations that begin after the peak of a contraction and recover after it ends, indicating uteroplacental insufficiency. Respond with position change, oxygen, IV fluids, and provider notification.

Postpartum hemorrhage causes

The four T's: tone (uterine atony, most common), trauma (lacerations, hematoma), tissue (retained placenta), and thrombin (coagulopathy). Blood loss over 500 mL vaginal or 1000 mL cesarean is diagnostic.

APGAR components

Appearance, Pulse, Grimace, Activity, and Respiration, each scored 0-2 at 1 and 5 minutes after birth. Scores of 7-10 are generally reassuring; 0-3 indicates need for resuscitation.

Pediatric 4-2-1 fluid rule

Maintenance fluids per hour: 4 mL/kg for the first 10 kg, 2 mL/kg for the next 10 kg, and 1 mL/kg for each kilogram above 20. Used for children who cannot take oral fluids.

Serotonin syndrome features

Agitation, hyperreflexia, clonus, hyperthermia, diaphoresis, and diarrhea after serotonergic agents. Stop the offending drug and give supportive care, benzodiazepines, and cyproheptadine if severe.

Neuroleptic malignant syndrome

Fever, lead-pipe muscle rigidity, autonomic instability, and elevated creatine kinase after antipsychotic use. Stop the drug immediately and treat supportively with dantrolene or bromocriptine.

Lithium toxicity signs

Coarse tremor, vomiting, diarrhea, ataxia, and confusion. Therapeutic range is 0.6-1.2 mEq/L; dehydration, NSAIDs, and thiazides raise levels by reducing renal excretion.

Levels of prevention

Primary prevents disease before it occurs (immunization, seat belts). Secondary detects disease early (screening). Tertiary limits disability and promotes rehabilitation after disease is established.

Incidence versus prevalence

Incidence is the number of new cases in a population over a period. Prevalence is all existing cases at a point or period, and rises as disease duration lengthens.

Sensitivity and specificity

Sensitivity is the proportion of true positives correctly identified; specificity is the proportion of true negatives correctly identified. Positive predictive value also depends on disease prevalence in the population.

Airborne precautions

Used for tuberculosis, measles, and varicella. Requires an N95 or equivalent respirator, a negative-pressure room with air exchanges, and door closed. Standard precautions continue in addition.

C. difficile hand hygiene

Wash hands with soap and water rather than alcohol-based rub, because alcohol does not kill spores. Use contact precautions, dedicated equipment, and bleach-based environmental cleaning.

Pressure injury stages

Stage 1 non-blanchable erythema; stage 2 partial-thickness skin loss; stage 3 full-thickness loss with visible fat; stage 4 full-thickness with exposed muscle, tendon, or bone. Eschar-covered wounds are unstageable.

Verbal order read-back

The receiving nurse writes the order, reads it back to the prescriber, and receives confirmation. The order is documented and countersigned by the prescriber within the timeframe set by policy.

Teach-back method

The patient explains or demonstrates the information in their own words. It tests comprehension rather than politeness, unlike asking whether the patient understands.