ATI Medical Surgical Proctored Exam 2019

What would you do for wound Evisceration (removal of internal organs), Emergency management? - Saline cover wound What would you do for an ASTHMA emergency management of a bee sting allergies? - Epi Pen Seizures and Epilepsy: Seizure precautions - During a seizure: 1) Position client on the floor 2)Provide a patent airway 3) Turn client to side 4) Loosen restrictive clothing Cancer treatment options: Protective Isolation - If WBC drops below 1,000, place the client in a private room and initiate neutropenic precautions. - Have client remain in his room unless he needs to leave for a diagnostic procedure, in that case transport patient and place a mask on him. - Protect from possible sources of infection (plants, change water in equipment daily) - Have client, staff and visitors perform frequent hand hygiene, restrict ill visitors - Avoid invasive procedures (rectal temps, injections) - Administer (neupogen, neulasta) to stimulate WBC production Infection control: Appropriate room assignment - Standard Precautions: 1. applies to all patients 2. Hand washing a. alcohol based preferred unless hands visually soiled ( then soap and water ) 3. Gloves - when touching anything that has the potential to contaminate. 4. Masks, eye protection & face shields when care may cause splashing or spraying of body fluids Droplet: 1. private room or with someone with same illness 2. masks Airborne: 1. private room 2. masks or respiratory protection devices a. use an N95 respirator for tuberculosis 3. Negative pressure airflow 4. full face protection if splashing or spraying is possible Contact: 1. private room or room with same illness 2. gloves & gowns 3. disposal of infections dressing materials into a single, nonporous bag without touching the outside of the bag TB: Priority action for a client in the emergency department - -Wear an N95 or HEPA respirator -Place client in negative airflow room and implement airborne precautions -use barrier protection when the risk of hand or clothing contamination exists Immunizations: Recommended vaccinations for older adult clients - Adults age 50 or older: - Pneumococcal Vaccine (PPSV) - Influenza vaccine - Herpes Zoster Vaccine - Hepatitis A - Hepatitis B - Meningococcal Vaccine Pulmonary Embolism: Risk factors for DVT - - Long term immobility - Oral contraceptives - Pregnancy - Tobacco use - Hypercoagulabilty - Obesity - Surgery - Heart failure or chronic A-Fib - Autoimmune hemolytic anemia (sickle cell) - Long bone fractures - Advanced age Disorders of the male reproductive system: Complications of continuous irrigation following Trans-urethral Resection - - Urethral trauma - Urinary retention - Bleeding - Infection Non-modifiable risk factors ( Page 3 ATI ) - 1) Age 2) Gender 3) Genetics 4) Developmental level Modifiable risk factors ( Page 3 ATI ) - 1) Smoking 2) Exercise 3) Health education and awareness 4) Nutrition 5) Sex practices Emergency nursing - Triage - BASED ON ACUITY 1) Emergent- Life threatening situation going on. 2) Urgent - Need to be treated soon but not life threatening. 3) Non urgent- The patient can wait for an extended period of time , without big issues. Mass casualty event - Class 1 - RED TAG - Immediate threat to life Examples: 1) Breathing issues 2) Chest pain 3) Heart attack coming on 4) Airway problem Class II - YELLOW TAG - Major injuries that require immediate treatment but not life threatening. Examples: 1) Major fracture Class III - GREEN TAG - Minor injury that does not require immediate attention. EXAMPLES: 1) Abrasion 2) Laceration Class IV - BLACK TAG - Expected to die EXAMPLES: 1) Penetrating head wound Triage priority setting - 1) Red tag 2) Yellow Tag 3) Green tag 4) Black tag Priorities: general rule - A - Airway - Secure the airway by head tilt , chin lift maneuver unless a fracture in cervical spinal. Brain injury or death in 3 - 5 minutes if airway not patent. B- Breathing - Auscultation of breath sounds, Chest expansion and respiratory effort, Rate and depth of respiration's, Look for chest trauma, Determine tracheal position, Check for jugular vein distension. C- Circulation - Heart rate, BP, Peripheral pulses, Cap refill. D - Disability - Clients level of consciousness with: 1) Glasgow coma scale a) <<< 8 Comatose state b) 3 Client totally unresponsive c) 15 A client within normal limits. E- Exposure - Hypothermia - Patient in cold icy water: 1) Remove wet clothing 2) Provide blankets 3) Increase the temperature of the room 4) Warm IV fluid going into the patient IF patient has had accidental or purposeful poisoning: 1) Activated charcoal 2) Gastric lavage 3) Whole bowel irrigation *** DO NOT INDUCE VOMITING OR SYRUP OF IPECAC Call rapid response team when client is rapidly declining. Cardiac Emergencies - If V fib or ventricular tachycardia you would initiate: 1) Basic life support ( BLS) and CPR 2) Establish IV access 3) Epinephrine is used to get the heart up and moving. Alpha 1 receptors - Activation Causes the skin , mucus membranes and veins to vasoconstrict. Help with: 1) Congestion 2) Superficial bleeding 3) In general help raise blood pressure by constricting the veins. DRUG: Epinephrine:Triggers the Alpha 1 receptors Causing vasoconstriction and increase blood pressure. Epinephrine side effects - Increases blood pressure 1) Hypertensive crisis 2) Dysrhythmia 3) Angina Dopamine side effects - 1) Dysrhythmia 2) Angina Dobutamine side effects - Increased heart rate Beta 1 receptors - Help stimulate the heart Beta I - You have 1 heart Stimulate the heart and increase the heart rate Used for treating: 1) AV block 2) Cardiac arrest DRUG: Epinephrine:Triggers the Beta 1 receptors Cause increase heart rate Beta II receptors - Help stimulate the heart and lungs Beta II You have 2 Lungs Causes: 1) Bronchodilation in the lungs 2) Causes uterine smooth muscle to relax 3) Asthma situation DRUG: Epinephrine:Triggers the Beta II receptors Cause bronchodilation and treat Asthma Dopamine - Causes renal blood vessels to dilate. DRUG: Epinephrine: Dopamine receptors and if given a little more Beta I Helps with: 1) Shock 2) Heart failure A nurse is monitoring a client who recently had a cast placed on his lower extremity for a bone fracture. Which of the following findings should the nurse recognize as abnormal? 1) Report a dull, throbbing pain 2) Lack of sensation between the first and second toes. 3) Capillary refill of three seconds in the nails of the toes. 4) Extremities that are cool bilaterally - 2) Lack of sensation between the first and second toes. - Lack of sensation between the toes indicates peripheral nerve impairment and is an abnormal finding that can indicate the client has compartment syndrome. The nurse should notify the provider immediately. - Dull, throbbing pain is an expected finding for a client who has a bone fracture. - A capillary refill of 3 seconds in the nail beds of the toes is slowed but still within the expected reference range after application of a cast. - Cool, bilateral extremities are an indication of the client's overall body temperature and general circulatory status and are an expected finding. A nurse is caring for a client who has a history of breast cancer. The client asks the nurse about birth control. Which of the following methods of birth control is contraindicated with this client? 1) Combination oral contraceptives 2) Intrauterine device 3) Latex condom 4) Contraceptive sponge - 1) Combination oral contraceptives - The nurse should identify that combination oral contraceptives are contraindicated for this client because they increase estrogen levels, which can stimulate the growth of any remaining cancerous breast cells. - The nurse should identify that the use of an intrauterine device requires the client to check the placement monthly and is not contraindicated for this client. - The nurse should identify that the use of latex condoms is contraindicated for clients, or their partners, who are allergic to latex. However, it is not contraindicated for this client. - The nurse should identify that prolonged use of a contraceptive sponge can increase the risk for toxic shock syndrome. However, it is not contraindicated for this client. A nurse is collecting data from a client who has heart failure and is on digoxin. Which of the following outcomes from the medication should the nurse expect? 1) Increased heart rate 2) Decreased urinary output 3) Decreased shortness of breath 4) Increased weight - 3) Decreased shortness of breath - The nurse should expect the client to have decreased shortness of breath. Digoxin increases the contractility of the heart, which decreases pulmonary congestion. - The nurse should expect the client's heart rate to decrease because digoxin decreases the client's sympathetic nerve tone, which slows the heart rate. - The nurse should expect the client to have an increase in urinary output because digoxin improves cardiac output and increases the client's renal blood flow through the kidneys, which results in an increased excretion of urine. - The nurse should expect the client's weight to decrease because of the increased excretion of fluid that is caused by improved cardiac output. A nurse is reinforcing teaching with a client who has Systemic Lupus Erthematosus (SLE) and is to begin taking mythylprednisolone orally. Which of the following statements should the nurse include in the teaching? 1) Limit contact with large groups of people. 2) Take medication on a empty stomach 3) Follow a low- protein diet 4) Avoid taking over the counter calcium supplements - 1) Limit contact with large groups of people. - Glucocorticoids cause immunosuppression and may mask infection. The client should limit contact with sources of possible infections, such as large groups of people. - The client should take glucocorticoids with food to prevent gastrointestinal upset and bleeding. - It is not necessary for a client who has SLE and is taking a glucocorticoid to restrict protein intake. - Clients who take glucocorticoids are at risk for osteoporosis, so they should take additional vitamin D and calcium supplements. A nurse is caring for a client who is 24 hours postoperative following abdominal surgery and has an NG tube. Which of the following actions should the nurse plan to take to decrease the risk of postoperative complications? 1) Place one or two pillows beneath the clients knee's while he is in bed. 2) Offer sips of water to the client following oral care. 3) Massage the clients lower extremities with lotion every 2 hours. 4) Encourage the client to use an incentive spirometer every hour while awake. - 4) Encourage the client to use an incentive spirometer every hour while awake. - The nurse should assist the client to use the incentive spirometer in addition to coughing and deep breathing every hour while awake for the first 24 hr postoperatively and at least every 2 hr while awake thereafter. An incentive spirometer will inflate the client's alveoli and improve ventilation to prevent postoperative pneumonia. - The nurse should elevate the foot of the bed slightly and apply prescribed compression stockings or sequential compression devices to promote venous return. However, pillows beneath the client's knees can create pressure and decrease venous return in the lower extremities, which can lead to thrombosis. - The nurse should provide frequent oral care and the use of moistened oral swabs to alleviate dry mucous membranes. However, oral fluids are contraindicated for a client who had abdominal surgery and has an NG tube. - The nurse should monitor the client's lower extremities for tenderness, warmth, or redness. However, massaging the client's lower extremities is contraindicated because, if there is a blood clot formation in the a lower extremity, it can loosen the clot and cause a pulmonary embolism. What are the signs and symptoms of pulmonary embolism? - 1) Hypotension 2) Tachycardia 3) Tachypnea A nurse is reinforcing teaching with a client who has Multiple Sclerosis and a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? 1) Take this medication on an empty stomach 2) Avoid stopping this medication suddenly. 3) Use Chamomile tea to alleviate insomnia. 4) Consume a low- purine diet - 2) Avoid stopping this medication suddenly. - The nurse should instruct the client to avoid stopping baclofen suddenly because it can result in adverse reactions, including seizures, paranoia, and hallucinations. - The nurse should instruct the client to take baclofen with milk or food to minimize gastric upset. - The nurse should instruct the client to avoid chamomile because it can interact with baclofen to increase CNS depression. - The nurse should recommend a low-purine diet for a client who has gout and a prescription for colchicine. A nurse is reviewing the laboratory results of a client who has type II diabetes mellitus. The nurse should identify that which of the following laboratory values indicates the client is at risk for delayed wound healing? 1) Prealbumin 12mg/dl 2) HBA1c 6% 3) WBC 8,000/mm3 4) Creatinine 0.8 mg/dl - 1) Prealbumin 12mg/dl - This laboratory value is below the expected reference range, indicating that the client's protein status is inadequate and that he is at risk for delayed wound healing due to malnutrition. - This laboratory value indicates glycemic control and does not indicate that the client is at risk for delayed wound healing. The nurse should identify that elevated HbA1c levels can increase the risk for delayed wound healing. - This laboratory value is within the expected reference range and indicates immune function. The nurse should identify that an elevated WBC count increases the risk for delayed wound healing. This laboratory value is within the expected reference range and indicates adequate kidney function. The nurse should identify that the client who is diabetic is at increased risk for the development of renal failure, which can increase the risk for infection and delayed wound healing. Prealbumin normal range - 23 - 43 Sodium normal level - 136 - 145 Calcium normal level - 9.0 - 10.5 Potassium normal level - 3.5 - 5.0 Magnesium normal level - 1.3 - 2.1 Chloride normal level - 98 -106 Phosphorus normal level - 30 - 4.5 Lithium level - 0.6-1.2 Digoxin therapeutic level - 0.5-2.0 RBC - 4.2-6.1 WBC - 5,000-10,000 Platelets - 150,000-400,000 (Low platelets-risk for bleeding) Hemoglobin - 12-18 Hematocrit - 37%-52% INR - 0.7-1.8; 2-3 if on warfarin (coumadin) therapy aPTT - 30-40 (<30=risk for clots, >40=risk for bleeding) Heparin pH - 7.35-7.45 HbA1c (glycosylated hemoglobin) - <6% *>6.5% indicated DM BUN - 10-20 mg/dL >>>> Dehydration <<<< Fluid overload Creatinine - 0.6 - 1.2 A nurse is assisting with discharge planning for a client who is postoperative following a total hip arthroplasty. Which of the following instructions should the nurse include in the discharge plan? 1) Avoid lying on the operative side. 2) Expect decreased sensation for the first postoperative week. 3) Cross legs at the ankles 4) Obtain a raised toilet seat - 4) Obtain a raised toilet seat - The nurse should instruct the client to use a raised toilet seat to avoid flexing the hip more than 90°, which increases the risk for dislocation. - The nurse should instruct the client that lying on the operative side is allowed but the client should place pillows between the legs to prevent dislocation of the hip. - The nurse should instruct the client to report decreased sensation in the affected foot or leg because this can indicate neurovascular compromise. - The nurse should instruct the client to avoid crossing her legs to prevent dislocation of the hip.