ATI MED SURG PROCTORED EXAM REAL EXAM QUESTIONS AND ANSWERS ALREADY A GRADE.REVISED

ATI MED SURG PROCTORED EXAM REAL EXAM QUESTIONS AND ANSWERS ALREADY A GRADE.REVISED phenytoin (Dilantin) - ANSWER - Antiepileptic drug (Initial goal is to use only one med. If not effective, either the dose is increased, or another med is added or substituted) Lab tests associated with seizures - ANSWER - Blood tests performed on a routine schedule to ensure compliance and effectiveness of the med phenytoin (Dilantin) specific instructions - ANSWER - Avoidance of oral contraceptives (decreases effectiveness), warfarin (Coumidin) should not be combined with this med -- phenytoin may decrease absorption and increase metabolism of oral anticoagulants. Vagal Nerve Stimulation Client Education - ANSWER - Avoid diagnostic procedures such as MRI, ultrasound diathermy, use of microwave ovens, and shortwave radios Status epilepticus Nursing Actions - ANSWER - Maintain an airway, provide O2, establish IV access, perform ECG monitoring, and monitor pulse ox, and ABG results As prescribed, administer a loading dose of diazepam (Valium) or lorazepam (Ativan) followed by continuous infusion of phenytoin (Dilantin). Chemotherapy Complications - ANSWER - Monitor temp and WBC count -- fever greater than 37.8 C (100 F) should be reported. Monitor skin and mucous membranes for infection. Cultures should be obtained prior to initiating antimicrobial therapy. If WBC count drops below 1000/uL, place client in a private room and initiate neutropenic precautions. Chemotherapy Client Education - ANSWER - Take temp daily. Avoid food sources that could contain bacteria: fresh fruits & veggies; undercooked meat, fish, and eggs; pepper and paprika. avoid yard work. avoid fluids that have been sitting at room temp for longer than an hour. Always wash cups and glasses after 1 use. Wash toothbrush daily in the dishwasher. Do not share toiletry. Chemo-induced nausea/vomiting nursing actions - ANSWER - administer antiemetic meds -- prior to treatment, during treatment, after treatment. Administer megestrol (Megace) to increase appetite if needed. Assess for dehydration/electolyte imbalance. Perform mouth care. Chemo-induced nausea/vomiting Client Education. - ANSWER - Antiemetics prior to meals. Eat several small meals a day; low-fat and dry foods. Avoiding drinking liquids during meals can prevent nausea. Encourage consumption of high-protein, high-calorie, nutrient-dense foods and avoidance of low or empty calorie foods. Use plastic utensils. Avoid red meat. Create a food diary to ID items that can trigger nausea. Mucositis (during Chemo) Nursing Actions - ANSWER - inflammation of tissues in mouth (gums, tongue, oral lesions.) Nonalcoholic mouthwash. topical anesthetic. avoid spicy foods. Offer oral hygiene before and after each meal. Use lubricating moisturizing agents to counteract dy mouth. Mucositis Client Education - ANSWER - rinse mouth with a solution of half 0.9% NS and half peroxide at least twice a day, and to brush teeth with soft-bristled toothbrush. Meds to control infection: nystatin (Mycostatin) and acyclovir (Zovirax). Eat soft, bland foods and supplements that are high in calories. Chemo-induced Anemia and Thrombocytopenia (Nursing Action) - ANSWER - Monitor for fatigue, pallor, dizziness, and SOB schedule activities with rest periords in between. Administer epoetin alfa (Epogen) and antianemic meds such as ferrous sulfate (Feosol) as prescribed. Monitor Hgb values. Be prepared to administer blood products if prescribed. Nursing actions for Thrombocytopenia - ANSWER - Monitor for petechiae, ecchymosis, bleeding of the gums, nosebleeds, and occult or frank blood in stools, urine, or vomitus. Institute bleeding precautions. Administer thrombopoietic meds such as: oprelvekin (Interleukin 11, Neumega) to stimulate platelet production. Monitor platelet count and be prepared to administer platelets if the count falls below 30,000/mm Thrombocytopenia Client Education - ANSWER - Use electric razor, soft bristled toothbrush, avoid blowing nose vigorously, ensure dentures fit. Avoid NSAIDs. Wear closed-toe shoes, apply cold if injury occurs. Radiation Therapy - ANSWER - Limit direct contact (HCPs and visitors). Maintain indidcated distances from sources of radiation.