ATI Fundamentals Proctored Practice 2023/2024

ATI Fundamentals Proctored Practice 2023/2024 State board of nursing - CORRECT ANSWER-laws and regulations that govern nursing in their state o Ensure the state hospitals are complying with regulations o Issue and revoke nursing license Nurses must have license in every state they practice in JCHO - CORRECT ANSWER-Regulations for health care facilities Medicare - CORRECT ANSWER-Eligibility: 65+ , on disability for 2 years, or diagnosed with ALS and end state renal failure and on dialysis o Four parts A: inpatient, limited skill nursing care, home health B: outpatient care: diagnostics services, and OT/PT C: combines A and B and provided through private insurance companies D: prescription drug coverage Medicaid - CORRECT ANSWER-Eligible: low socioeconomic status, no insurance, dependent on size of household Ch. 2 Interprofessional Team - CORRECT ANSWER-Dietician: assist with NTR needs - Lab tech: blood draws - Pharmacy: reviews meds, put in MAR - PT: mobility - OT: helps Pt regain ability to perform ADL's - Provider: can be the doctor or advanced practiced nurses or PA - Social workers: identifies and coordinates community resources, medical equipment, and other needs of the Pt to be discharged from acute care - Speech/language pathologist: help with speech and swallowing assessments o Dysphagia and difficulty swallowing Ch. 3 nursing ethical principles - CORRECT ANSWER-Autonomy: Pt has a right to make his/her decision even it is not in their best interest o Ex. Going AMA - Beneficence: doing good and best for the patient o Providing medications, helping the patient, doing the right thing - Fidelity: keeping your promise o If you say you're going to find out, then find out - Justice: providing fairness in care in the allocation of resources o You are not giving one Pt more resources than another - Nonmaleficence: do no harm o Catching an incorrect prescription dose - Veracity: telling the truth o If the Pt asks their diagnosis, tell them their diagnosis Torts - CORRECT ANSWER-Unintentional tort o Negligence: Pt is at high risk for falls and you didn't set their bed alarm, and they fell o Malpractice: medication error - Intentional tort o Assault: threatening o Battery: following through with a threat o False imprisonment: inappropriately restrain or administering a sedative Informed consent - CORRECT ANSWER-necessary for all procedures o Provider: communicating purpose, giving Pt a complete description of procedure in the Pt's primary language, explains R v. B and alternatives to the procedure o RN: make sure the provider did everything they were supposed to, make sure the pt was competent to make the decision (not mentally impaired), have Pt sign consent document, and notify provider if Pt has any more questions o Who can give informed consent? DPOA: durable power of attorney (Pt gave this person the right to make decisions) Emancipated minors Refusal of treatment - CORRECT ANSWER-Allowed if competent o AMA: tell provider, tell of risks, and have sign document Advanced directives - CORRECT ANSWER-Living will: communicates wishes if becomes incapacitated - DPOA (durable power of attorney): individual that the Pt designates as their Proxy - Providers order for DNR or AND (allow natural death) - Mandatory reporting o If you suspect abuse: you must report that o Communicable reporting mandated by the state o Impaired coworker Do not gather more info or talk to her directly—tell the manager Information Technology - CORRECT ANSWER-Nursing documentation o Both objective and subjective data Objective: see, hear, feel, or smell—no interpretation Subjective: direct quotes or identify as information provided by the patient o Never leave blank spaces, never corrections, never scratch or black out, always include name and title o Incident reports: accident of some kind or an unusual event (medication error or fall) Do not: refer to incident report in Pt charting, NOT IN THE MEDICAL RECORD - Telephone order o Have 2nd RN on call o Read back prescription order o Have provider sign this within 24 hours - HIPPA/information security o In place to ensure confidentiality of health information o Only persons responsible for Pt care are allowed to read record o Communication about Pt must be in private or at the nurses station o Password protect electronic records, don't share records o Don't share information with unauthorized people Such as the people in the room o Code system can be used: like a number—family can ge Delegation - CORRECT ANSWER-Do not delegate o Pt information (initial teaching) o Any task that require nursing judgement or nursing assessment - Can be delegated to LVN (practical nurse) o Medication admin o Enteral feedings o Suctioning o Tracheostomy care o Reinforce patient teaching - Can be delegated to CAN o Bathing, dressing, ambulating, toileting, feeding Pt's who do not have swallowing difficulties (if Pt has dysphagia, you need to do it), positioning, taking vitals, collecting specimens, reporting I/O - 5 rights of delegation o Right task: repetitive, relatively non-invasive, and doesn't require supervision o Right circumstance: never assign an unstable Pt to an LVN, right person o Right direction and communication: timeline, expected result, and follow-up communication (such as if vitals are abnormal) o Right supervision and evaluation: may need to intervene or provide feedback Nursing Process - CORRECT ANSWER-Assessment and date collection o Subjective data (symptoms): pain level, how they're feeling o Objective data (signs): temp, BP, capillary refill - Analysis and more data collection o Cluster collected date, ID patterns and trends, compare data to expected values o Forms picture of Pt condition and identifies trends o primary source: what they Pt tells you and what you see yourself o Secondary source: what others tell the nurse about the patient Can come from the medical record - Planning: o Prioritize interventions o Identify measurable outcomes: time limited, not vague Vague: hopefully they will breathe better tomorrow Not vague: Pt will not complain of dyspnea tomorrow - Implementation: o Perform actual nursing care using your interventions o Document Pt response to those interventions - Evaluation: o Compare results with planned outcomes and determine where you go from there Admission - CORRECT ANSWER-Document advanced directive status: DNR or full code o Collect vitals, height and weight, allergies o Head to toe assessment, health history, spiritual/cultural considerations o Assess for swallowing issues: do they have r/f aspiration If yes: need evaluation from speech pathologist o Safety assessment: r/f falls o Inventory Pt belongings o Put valuables in facility safe or have family take it home o Medication reconciliation: compare home meds to providers prescriptions o Discharge planning starts at admission**** Transfer - CORRECT ANSWER-Use SBAR Discharge - CORRECT ANSWER-Pt receives pamphlet with instructions Diet/activity restrictions Instructions for home procedures: wound care Instructions and supply Meds: what to take, when to take, and precautions s/s of complications and when to seek medical attention ex. If they spike a fever or have increased erythema follow up appointment provide names and numbers of providers and community resources medical and surgical asepsis - CORRECT ANSWER-hand hygiene: o alcohol based: used between 3 and 5 mL of the product rub hands until dry o antimicrobial soap and water: visibly soiled, before eating, after using the restroom, and contact with bodily fluids scrub for 15 seconds dry hands before turning off the faucet - preventing spread of microorganisms o stand at least 3 feet away from those coughing or have them wear a mask o never use artificial nails or gel polish o remove jewelry from hands or wrist before washing o clear least soiled area first - setting up a sterile field o top, right, left, close flap o sterile solution: remove bottle cap and place it facing up on a sterile surface place label against palm waste 1-2 mL don't touch bottle to site you're pouring it on o don't talk over a sterile field o above the chest is not sterile o drop 6 inches above field Immunities - CORRECT ANSWER-nonspecific innate o out body's barriers that respond to all antigens o skin, mucous membranes, stomach acid - Specific adaptive o Body produces B and T lymphocytes for specific immunity o More efficient and effective once immunity is developed - Active natural o Body produces antibodies from exposure to live antigen o Example, getting the cold - Active artificial o Antibodies produced in response to vaccine - Passive natural o Mom to baby through breastmilk or placenta - Passive artificial o Immunoglobins administered after being exposure to a pathogen Chain of infection - CORRECT ANSWER-Causative agent: bacteria or toxin o Reservoir: where the causative agent lives Human, soil o Portal of exit: how that pathogen leaves the host Blood, respiratory tract o Mode of transmission Contact, droplet, airborne o Portal of entry How that pathogen enters the host o Susceptible host - Risk factors for developing an infection - CORRECT ANSWER-Compromised immunity o Chronic or acute injury o Poor hygiene o Crowded living o IV drug use o Unprotected sex o Poor sanitation Virulence - CORRECT ANSWER-ability of a pathogen to produce a disease Stages of infection - CORRECT ANSWER-Incubation: when the pathogen enters the body to the first symptom o Prodromal: onset of general symptoms (malaise, fatigue, fever) to specific symptoms o Illness: when specific symptoms occur o Convalescence: symptoms disappear to complete recovery Ssytemic Infection - CORRECT ANSWER-fever, chills, malaise, fatigue, increased RR, increased pulse, enlarged lymph nodes Local Infection - CORRECT ANSWER-edema, pain, erythema, warmth in one part of the body Inflammation - CORRECT ANSWER-local response to injury or infection o 1 st stage: erythema, warmth, edema and pain o 2 nd stage: wbc come to kill the organism and exudate and dead tissue cells form Types of exudate Serous: clear Sanguineous: bloody Serosanguineous: pink or red streaked Purulent: indicates an infection, contains leukocytes and bacteria o 3 rd stage: scar tissue forms Labs for infection - CORRECT ANSWER-Wbc count: between 5,000 and 10,000 o Left shift: when immature wbc are released bc the body is overwhelmed by infection o ESR (erythrocyte sedimentation rate): indicated inflammation in the body o CRP: c-reactive protein indicated inflammation o + culture result o Blood culture, sputum culture Get the culture before starting antibiotics - Diagnostic procedures o Gallium scan: identifies hot spot of wbc in the body o X-ray, CT, and MRI o Biopsy Precautions - CORRECT ANSWER-Standard: used for all Pt's regardless of infection o Hand hygiene—alcohol based antiseptic unless hands are visibly soiled o Used face masks when splashing of bodily fluids may take place o Wear clean gloves o Moisture resistant bag for soiled items o Use sharps container - Airborne—MTV o Measles, varicella, and TB o Private room on negative airflow o All caregivers and visitors will need to wear N95 - Droplet o Influenza, pneumonia, pertussis, mumps, sepsis, rubella, and bacterial meningitis o Private room or roomed with someone with exact infection o Everyone wears masks - Contact o Impetigo, scabies, rabies, MRSA, C. dif, other enteric infections, RSV, and wound infections o Private or same infection room o Gown and gloves - Herpes zoster aka shingles o Reactivation of varicella zoster virus (chickenpox) o Risk factors: compromised immune system o Symptoms: painful unilateral rash that runs along the dermatome o Rash is vesicular, pustular, or crusting o Low grade fever o Pares More Precautions - CORRECT ANSWER-Fall prevention o Regular toileting for those that require assistance o Skid proof socks o r/f falls: place close to the nurse's station o hourly rounding o make sure frequently used objects are within reach - seizure o during: lower Pt to floor or bed, turn them on their side, loosen restrictive clothing, do not restrain Pt or put anything in their mouth note onset and duration o after: check vitals, perform neuro checks, re-orient the patient, identify the trigger, and implement seizure precaution - restraints o physical: vest, belt, or mittens o chemical: sedative or antipsychotic o alternative: re-orientating, have a sitter, give diversion o rules: in an emergency: nurse can place them, but order must be placed within 1 hour worn up to 4 hours for adults every 2 hours: remove restrains, 1 at a time, to assess for skin integrity to do neuro and skin checks, and to provide ROM least restrictive: mittens 2 fingers fit between restraint and skin Quick release not - Fire safety - CORRECT ANSWER-RACE Rescue: move pt's to a safe location: first horizontal evacuation and then a lateral or vertical evacuation Alarm Contain: close doors and windows, turn off oxygen Extinguish using PASS Pull the pin Aim at the fire Squeeze the handle Sweep side to side injury prevention by age group - CORRECT ANSWER-Infants and toddlers o Choking hazards: popcorn, raisons, grapes, hot dogs, celery, PB, peanuts, candy and tough meat o Place infants on their back to prevent SIDS o Nothing in the crib—not even blankets o Make sure crib slats are less than 2 and 3/8 inches apart o Keep plastic bags, houseplants, and cleaning agents out of reach o Lock up medications o Rear facing car seat until age 2 with 5 point harness in back seat of car o Close bathroom doors and close toilet lids - School age o Booster seat if less than 40 lbs or 4'9" o Backseat until 12 years old o Protective hear with sports o Water temperature heater to less than 120 degrees Fahrenheit to prevent burns o Enclose pools with locked fence - Adolescence o Educate on risky substances and risky sex o Educate on distracted driving and seatbelts o Monitor for mental health issues - Older adults: o Remove trip hazards from the home—such as scatter rugs and lose carpets o Place electrical cords behind furniture Oxygen Safety - CORRECT ANSWER-Increases r/f combustion o No smoking sign at entry of home o Make sure electrical equipment is grounded and in good shape o Cotton bedding and clothes No synthetic or wool o Keep flammable objects away, including nail polish