Exam (elaborations) ATI RN COMPREHENSIVE EXIT EXAM 2

ATI RN COMPREHENSIVE EXIT EXAM 2 ATI RN COMPREHENSIVE EXIT EXAM Link to Quizlet: diet for chronic renal failure low protein & potassium DM pt teaching change shoes, wash feet w/soap & water pulse pressure subtract systolic value from diastolic value lantus never mix, long lasting, no peak rhogam given @ 28 weeks & 72 hours post delivery when mom is negative & baby positive indication of baby dehydration improving smooth fontanel pt w/orthostatic hypotension put near nursing station cleaning a wound clean to dirty use bulb syringe peripheral arterial disease cramp in leg while walking intermittent claudication seizure precautions supine position 20 weeks gestation, having urinary frequency u/a & c/s report to new nurse @ shift change pt @ xray s/s of hemolytic blood transfusion flank pain ER rape victim priority acess anxiety nutrition carbs 45%, protein 10-15% latex allergy tape up cords first ingredient on a food label most content thoracentesis, & painful w/breathing put pt on UNAFFECTED side for 1 hour or longer pt w/IV sedation check LOC if not responsive help older brother get used to baby get a gift for big brother early decelerations head compressions methergine contraindication HTN delegate to AP I & O HF monitoring weights location for peripheral line radial prioritizing care for multiple pt's low flank pain ativan for seizures med for diabetes insipidus desmopressin radiation tatoo use mild soap & water uric acid stones eat low fat yogurt antigout med decreases uric acid level allopurinol non-pharm relation technique for pain management in labor hypnosis psychotic disorder assessment finding flat affect newborn withdrawal from heroin (opioids) hypertonicity mitral valve location 5th intercostal amniocentesis go pee before procedure total gastrectomy lack b 12 takes 30-60 meal to eat a meal stoma color pink or red is normal MAOI's diet no pepperoni, no tyramine, COTTAGE CHEESE OKJ give iron w/? OJ statins contraindication Grapefruit juice haldol lip smacking mag sulfate decreased urine output decreased respirations decreased pulmonary edema antidote for mag sulfate calcium gluconate clozaril interventions monitor WBC valproic acid liver function thyroid med effectiveness weight loss diuretics don't skip doses DIG adverse effects N/V & HA prednisone take with milk hemo/peritoneal dialysis pt teaching medical asepsis cranial nerve 11 shoulder peripheral catheter insertion advance catheter when you see flash back of blood return dispose of insulin needles @ home in coffee container confirmation of ng placement x ray swallowing difficulty referral speech therapy acrabose skip a meal, skip dose, give w/1st bite of food sprains & strains RICE pt DNR-CC & family asking questions related to. therapeutic communication: THERAPEUTIC RESPONSE What did the dr tell you? delegating to AP about skeletal traction: NEEDS MORE TEACHING AP places weight on bed daughter feeling guilty about admitting parent into long-term facility: THERAPEUTIC RESPONSE rephrase what daughter is feeling how good nurse plans her day rechecks her priorities half way through her shift good nurse sets these when she works GOALS pt gets bad dx, & asks you not to tell her spouse:YOUR RESPONSE you have a right to privacy delegate to AP CPR baby in contact precautions in a private room, what would you do to save hospital $? bring formula prn how does a nurse properly manage her time mid-shift? reevaluates goals which psych pt would you see first? hallucinations dementia pt @ ER, w/marks on coccyx & wrist, suspected abuse. what do you do? ask pt. INTERVIEW HIM psych pt yelling in front of group. very agitated, what do you do? isolate pt charge nurse scheduling resolution between nurses nurse listens to both sides respite care gives family a break pt in seclusion documentation what happened prior to seclusion that caused for seclusion parkinson's : pt teaching nutrition- thicken liquids pt receiving radiation, what should you wear? lead apron pt suffering from hyperthermia seizure precautions pt refuses last minute for a procedure he already consented for okay to stop procedure s/s of smallpox rash on tongue xerostoma humidifier vagina procedure, cervical cancer place catheter Lyme disease report it lice (pediculodis capitis) can survive on surfaces for up to 48 hours RSV keep stethescope in room (droplet) 16 weeks gestation can get AFP test done bacterial meningitis droplet precautions when can kid return to school for chicken pox when lesions are crusted over kicks a ball: developmental stage 24 months baby w/cleft lip untie arms & perform ROM wrong ostomy care changing everyday may lead to skin irritation after male circumcision apply petroleum jelly w/every diaper change breastfeeding w/hep c don't breast feed if you have cracked nipples contraindication w/oral contraceptives HTN combination contraceptives contraindications pt w/migraines when percussing RUQ, what should we feel dullness dementia pt offer finger foods black males @ great risk for CVA med for alcohol withdrawal disulfiran (antabuse) better nutririon canola oil healthy eating 45 % carbs to prevent neuro tube defects folate prevnting delays of healing protein & o2 pt raped & @ ER assess anxiety pt reports abuse assess pt, check for injuries anorexia 60% refeeding-pre-albumin of 10 telemetry is used for check for dysrythmia do not give mmr to child bearing pt b4 pregnancy test pt w/hx of blood transfusion diet for hf dry spices to flavor food TURP: closed intrermittment irrigation let it drain Cranial nerve XI (hot spot) shoulder Proper lifting technique (picture) bending at knees 24 month old walk up steps Food label greatest weight listed first IV technique advance catheter Refeeding syndrome 60% Low fat diet canola oil instead of vegetable oil Prior to amniocentesis empty bladder Radiation implant limit visitors to 30 minutes Levothyroxine take on empty stomach, in am; increases tsh Metformin contraindication kidney disease, severe infection, shock, hypoxic conditions Mastectomy lay of affected side to promote drainage, support arm on pillow, HOB 30 Circumcision use petroleum jelly with every diaper change Check for NG tube placement in the jejunum X-ray Colostomy care cut the bag Seizure precautions saline lock IV Ethical medical error veracity Early decelerations head compressions Magnesium sulfate interventions (select all) calcium gluconate, stop infusion, UO less than 30, RR less than 12, decreased reflexes Thoracentesis causes pneumothorax expected finding not friction rub; tracheal deviation AP's talking in cafeteria tell them to stop talking Safety for parkinson's clear area Warfarin vitamin k for toxicity; INR 2-3; PT 11-12.5 Contraindication of MMR blood transfusion Diabetic foot care (select all) change shoes frequently, wash feet with soap and water Sprains avoid warm compress Expected finding of small pox rash in mouth 16 weeks pregnant alpha protein Psych med lip smacking Where to start IV first (picture) hand PRBC need further teaching start IV on other arm Delegate to AP CPR compressions Delegate to LPN sterile dressing Postural drainage give albuterol, trendelenberg; 1 hour before meals or 2 hours after Dumping syndrome high protein and fat; avoid milk, sweets, and sugar; small, frequent meals DASH diet increase fruit, vegetables, and low fat dairy; k, mg, ca Baby with reflux small, frequent meals, thicken formula with rice cereal, HOB 30 Cleft palate repair periodic restraints Nephrotic syndrome vitamin K Pernicious anemia schilling's test Peritoneal dialysis report cloudy; monitor glucose; warm solution before Gastric surgery eat 3 meals Gastrectomy small, frequent meals; vitamin B12, D, iron, and folate Statin grapefruit Preventing uric acid stones yogurt RSV have own stethoscope in room Change of shift report orthostatic hypotension by nurses station Confused patient raise 1 side rail Hypoglycemia cool and clammy skin Hyperglycemia thirst Glycosylated blood test HbA1C Priority for patient in seclusion document Buddhist patient vegetarian Positive TB hard raised bump Heart murmur sound blowing or swishing Dehydration oliguria NST PAD pain/cramping when walking, calf muscle atrophy, shiny cool extremities; elevate legs Cast with white extremity compartment syndrome Alcohol withdrawal expected finding n&v, tachycardia, diaphoresis, tremors, seizures Varicella scabs okay Hyperthermia not blanket or ice Purpose of ice decrease inflammation Sexual assault assess anxiety THA avoid flexion greater than 90 Beta blocker teaching don't stop abruptly; avoid in asthma; take with food Combination contraceptives increase BP Myelosuppression flu shot Glucocorticoid increase dose in DM; take with meals; avoid NSAIDs; Addison's crisis if stopped abruptly Extreme focus mild anxiety Good diet 30% carbs Family concern what has the doctor told you Adolescent 1300 mg of calcium Lyme disease report to health department Organize workload goals for the day Intervene pacing around wife Renal failure decrease protein, K, Na, increase carbs, strict I&O Preeclampsia proteinuria Urine frequency in pregnancy urine sensitivity test Lice can live for 48 hours on surfaces Chest tube complications bubbling in water seal Elderly abuse ask privately Informed consent signed willingly Sibling bonding offer gift each time sibling gets one TURP complication hematuria African american over Caucasian heart disease Sickle cell priority hydration Sickle cell complication SOB Respite care give caretaker break Acarbuse take with first bite of each meal Hallucination I understand you are scared Fire extinguisher PASS Advanced directive don't need a lawyer Breastfeeding and hepatitis c as long as you don't have cracked nipples ICP keep HOB midline Long term use of proton pump inhibitors osteoporosis Diabetes insipidus polyuria Difficulty voiding warm water ACE inhibitors cough What do you hear when you palpate abdomen resonance Negotiation strategy understand both sides Dying patient wants to be alone depression or dysfunctional Wife progressing quickly can you tell me more Pregnant non-pharmacological pain management aromatherapy, breathing techniques, imagery, music, use of focal points, subdued lighting Hypnosis purpose alter perception of pain Complication of conscious sedation with RR 6 stop infusion or give something Major depression, OCD give fluoxetine What causes constipation iron Patient can't sleep don't drink caffeine before bed Collecting urine culture on baby straight cath Electrolytes Na - 136-145 K - 3.5-5 Ca - 9-10.5 Mg - 1.3-2.1 P - 3-4.5 Cl - 98-106 Hypervolemia bounding, JVD, edema, confusion, increase everything Anorexia prealbumin 10 Dehydration improving baby flat fontanelle Unsaturated fat coconut oil Priority abdominal pain and went away Opioid agonist naloxone (Narcan) COPD increase calories and protein Needle disposal at home coffee container on top shelf Give RhoGAM in second pregnancy protect future pregnancy Swallow problem refer to speech therapist Nutrition for heart failure Decrease Na, increase fluids, increase fiber; increase K with diuretic Adverse affects of dogoxin Bleeding gums, bloody urine and stools, arrhythmias, petichiae NG nutrition Increase K Methotrexate adverse affect High blood pressure I.M. site for children VASTUS LATERALIS or antelolateral thigh is the site for IM injections in children 2 yrs. of age Peak Levels show the highest concentration Time for drawing Peak levels: Oral Intake 1 to 2 hour after administration Time for drawing Peak levels: I.M. 1 hour after administration Time for drawing Peak levels: I.V. 30 minutes after administration Trough Levels show the lowest concentration or residual level, usually obtained within 15 minutes before next dose. Do not administer until confirmed. Can meds be administered through blood tubing? NO. Never administer meds through tubing being used for blood administration How long should fluids be infused? Fluids should be infused within 24 hours, discard unused potion, to prevent infection Complications associated with IV infusion infiltration, extravasation, phlebitis, thrombophlebitis, hematoma, venous spasm Preventing Infiltration use smallest catheter for prescribed therapy, stabilize port-access, assess blood return Treatment of Infiltration stop, remove, cold compress, elevate extremity, insert new cath in opposite extremity Preventing Extravasation know vesicant potential before giving medication Treatment of Extravasation stop, discontinue, aspirate med if possible, cold compress, document Preventing Phlebitis & Thrombophlebitis rotate sites every 72 to 96 hrs, secure catheter, aseptic technique for PICC lines, limit activity with extremity Treatment of Phlebitis & Thrombophlebitis stop, remove, heat compress, insert new cath in opposite extremity Preventing Hematoma avoid veins not easily seen or palpated, obtain hemostasis after insertion Treatment of Hematoma remove, apply pressure, monitor for signs of phlebitis and treat Preventing Venous Spasm allow time for vein diameter to return after tourniquet removed, infuse fluids at room temp Treatment of Venous Spasm temporarily slow infusion rate, warm compress TPN hypertonic solution, contains dextrose, proteins, electrolytes, minerals, trace elements, and insulin prescribed, administered via central venous device like PICC line, subclavian, or internal jugular vein Care for TPN verify with another nurse, use infusion pump, monitor daily weights, I & O, fluid balance, serum glucose q4 to 6 hrs, infection, change dressing q48 to 72 hrs, change tubing and fluid q24 hours, if TPN is unavailable, administer dextrose 10% in water to prevent hypoglycemia Complications of central venous catheters pneumothorax during insertion, air embolism, lumen occlusion, bloodstream infection Pneumothorax during insertion use ultrasound to locate veins, avoid subclavian insertion when possible, treat with O2, assist with chest tube insertion Air Embolism have client lie flat when changing administration set or needleless connectors, ask client to perform Valsava maneuver, treat by placing client in left lateral trendelenberg, and O2 Lumen Occlusion flush promptly with NS between, before, and after each med, treat with 10 cc syringe with pulsing motion Bloodstream Infection maintain sterile technique, treat by changing entire infusion system, notify MD, obtain cultures, and administer antibiotics Antidote for Acetaminophen Acetylcysteine, Mucomyst Antidote for Benzodiazepine Flumazenil, romazicon Antidote for Curare edrophonium, tensilon Antidote for Cyanide Poisoning methylene blue Antidote for Digitalis digoxin immune FAB, Digibind Antidote for ethylene poisioning fomepizole, antizol Antidote for Heparin and enoxaparin or Lovenox Protamine Sulfate Antidote for Iron Deferoxamine, desferal Antidote for Magnesium Sulfate calcium gluconate 10%, kalcinate Antidote for Narcotics naloxone, narcan Antidote for Warfarin phytonadione, vitamin K aminophylline 10 to 20 mcg/ml carbamazepine 5 to 12 mcg/ml digoxin 0.8 to 2.0 mcg/ml gentamicin 0.5 to 0.8 mcg/ml lidocaine 1.5 to 5.0 mcg/ml lithium 0.4 to 1.4 mcg/ml magnesium sulfate 4 to 8 mcg/ml phenobarbital 10 to 30 mcg/ml phenytoin 10 to 20 mcg/ml quinidine 2 to 5 mcg/ml salicylate 100 to 250 mcg/ml theophylline 10 to 20 mcg/ml tobramycin 5 to 10 mcg/ml acetaminophen toxicity 250 aminophylline toxicity 20 amitriptyline toxicity 500 digoxin toxicity 2.4 gentamicin toxicity 12 lidocaine toxicity 5 lithium toxicity 2.0 magnesium sulfate toxicty 9 methotrexate toxicity 10 over 24 hours phenobarbital toxicity 40 phenytoin toxicity 30 quinidine toxicity 10 salicylate toxicity 300 theophylline toxicity 20 tobramycin toxicity 12 PRIL ace inhibitors, captopril, enalapril VIR antivirals, acyclovir, valacylovir AZOLE anti fungals, fluconazole, variconazole STATIN antilipidemics, atorvastatin, simvastatin SARTAN angiotensin 2 receptor blockers, ARBS, valsartan, losartan OLOL beta blockers, metoprolol, nadolol DIPINE calcium channel blockers, amlodipine, nifedipine AFIL erectile dysfunction meds, sidenafil, tadalafil DINE histamine 2 receptor blockers, ranitidine, famotidine PRAZOLE proton pump inhibitors, pantoprazole CAINE anesthetics PAM, LAM benzodiazepine ASONE, SOLONE corticosteroid CILLIN penecillin IDE oral hypoglycemic ASE thromolytic AZINE anti emetic PHYLLINE bronchodilator ARIN anticoagulant TIDINE anti ulcer ZINE anti histamine CYCLINE antibiotic MYCIN aminoglycoside FLOXACIN antibiotic TYLINE tryciclic antidepressant PRAM, INE SSRI anti hypertensives assess weight, VS, hydration, ortho BP, renal function, coagulation, educate to take same time each day, avoid hot tubs and saunas, do not discontinue abruptly ACE inhibitors (angiotensin converting enzyme) block the conversion of angiotensin 1 to angiotensin 2 Angiotensin 2 Receptor Blockers selectively block the binding of angiotensin 2 to angiotensin 1 receptors found in tissues ACE Inhibitors captopril or capoten, enalapril or vasotec, enalaripat or vasotec IV, fosinopril or monopril, lisinopril or prinivil ARBs losartan or cozaar, valsartan or diovan, irbesartan