ATI RN Latest Predictor Test 5

Testing for TB - ANSWER-- A Mantoux skin test is the most accurate and valuable screening tool available for TB. A positive result means only that the client has been exposed to TB; it does not meant that the client has active TB. Testing for TB continue - ANSWER-- A sputum culture for acid fast bacillus (AFB) is used to confirm the diagnosis of pulmonary TB after a screening test and chest x-ray come back positive. Teaching instructions for the use of a cane: - ANSWER-(1) The cane is moved forward about 12 inches. (2) Then, the weak leg is moved even with the cane. (3) Finally, the strong leg is brought forward and ahead of the cane and weak leg. - Cane is held on stronger side. - The gripper of the cane should be level with the trochanter of the femur. Meningococcal vaccine - ANSWER-- Recommended that this vaccine be given to children who are 11 through 12 years of age and then given a booster dose at age 16. When should the single dose of Herpes zoster vaccine be given? - ANSWER-- To adults 60 years or older whether or not they report a previous episode of herpes zoster. Rotavirus should be given at what age? - ANSWER-- During the child's first year of life. Alendronate (Fosamax) - ANSWER-- This medication is used to prevent and treat postmenopausal osteoporosis and Paget's Disease. - Alendronate-taken in morning on an empty stomach. - The patient must be instructed to wait at least 30 minutes after taking Alendronate before eating, drinking, or taking other medications. What to expect with a patient having a chest tube? - ANSWER-- Continuous gentle bubbling in the suction control chamber. - Crepitus (with a pneumothorax, this will persist for several hours depending) - Oscillations-tidaling in the water seal chamber upon respiration are expected. What is a potential complication of a thyroidectomy? - ANSWER-- Hypocalcemia: numbness and tingling in the hands, soles of the feet and around the lips. What is Chvostek's sign? And how is it done? - ANSWER-Tap on the pt's face at a point just anterior to the ear and just below the zygomatic bone. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia. Brudzinski's sign - ANSWER-- Is an indication of meningeal irritation, which may be positive in patient's with meningitis. - To perform this, the client needs to be supine. The nurse: -places one hand behind patient's head. -places the other hand on the client's chest. Brudzinski's sign continue - ANSWER--raises the clients head (with the hand behind the head) while the hand on the chest restrains the clients and prevents the client from rising. Flexion of the clients lower extremities constitutes a positive sign. Kernig's sign - ANSWER-- Is an indication of meningeal irritation. The maneuver is usually performed with the client supine with hips and knees in flexion. Extension of the knees is attempted and the inability to extend the clients knee beyond 135 degrees w/out causing pain constitutes a positive test. Babinski sign - ANSWER-- This is used to test for brain damage or upper motor neuron damage. It is considered positive if the toes flare up upon stroking the plantar aspect of the foot. Cataract surgery discharge instructions - ANSWER-- Do not lift anything heavier than 10lbs for at least one week - Sleep on your back or unaffected side to lessen the pressure. - Need to report any pain, decrease in vision or increase in discharge in the eye. Cataract continue - ANSWER-- It is normal to feel itching and mild discomfort after surgery, but the pt should be instructed not to rub or place pressure on the eye. Exposure or possible exposure to anthrax - ANSWER-- Administer an antibiotic prophylaxis to all pt's newly exposed **Those exposed to anthrax do not require decontamination and are not considered contagious** Botulism treatment - ANSWER-- Give an antitoxin Why would lidocaine (Xylocaine) be given to someone following cardiac arrest? - ANSWER-- Lidocaine is an antiarrhythmic med that is commonly used to restore a regular heartbeat in a client who has arrhythmia. This effect is produced by delaying abnormal nerve pulses to the heart and reducing irritability of the heart tissue. Factors that can trigger an exacerbation of SLE? - ANSWER-- Infection (especially a strep or viral infection. This can be a major stressor and can trigger an exacerbation) - Pregnancy (due to hormonal changes. The pt should be advised of the risks and must be monitored closely for effects on the renal and cardiovascular system if she decides to get pregnant) - Sunlight (Exposure to sunlight and artificial UV light is the leading cause of SLE exacerbation manifestations, especially the characteristic skin manifestations of lesions and butterfly rash) What diagnostic test would help the nurse monitor and evaluate the effectiveness of the aspirin medication for an Rhematoid arthritis patient? - ANSWER-- Erythrocyte sedimentation rate (ESR) ** RA is a chronic inflammatory disease. ESR is useful in detecting and monitoring tissue inflammation in clients with RA.** Antinuclear antibody (ANA) - ANSWER-- ANAs are frequently present in pts who have systemic lupus erythematosus and other autoimmune disorders such as RA and scleroderma. Rheumatoid factor (RF) diagnostic test - ANSWER-This is helpful in diagnosing RA, but the levels do not always correlate with the severity of the disease activity. Cheyne-Stokes Respirations - ANSWER-- Is characterized by a rhythmic increase (to the point of hyperventilation) and decrease (to the point of apnea) in the rate and depth of respirations. - It is commonly seen in pts who are unconscious, comatose or moribund (approaching death). Cryoprecipitate - ANSWER-- Clients with hemophilia (deficiency of clotting factor), are given cryoprecipitate to replace the deficient factor as a prophylactic measure before any invasive procedure, surgery or when actively bleeding. Cryoprecipitate continue - ANSWER-- Cryoprecipitate provides therapeutic amounts of Facto 8, Factor 13, von Willebrand factor and fibrinogen. These concentrates are made with recombinant DNA technology and are the treatment of choice with hemophilic A and von Willebrands disease. Cisplatin (Platinol) - ANSWER-- Treatment for cancer. - If a client has reported fatigue it is important to check the patients most recent CBC. The client I likely to be anemic as a result of myelosuppression (bone marrow suppression) from the chem. Cisplatin continue - ANSWER-The pt may require tx for the anemia (transfusion, medications) and further chemo may be need to be delayed until the blood counts are higher. Jerking movements of the extremities - ANSWER-- Such as ataxia, may be seen with many neurologic conditions affecting the clients ability to produce a smooth movement. Ataxia - ANSWER-Jerky movements of the extremities Spasm of the extremities - ANSWER-- Involuntary spasms may be found with such conditions as cerebral palsy, trauma, cerebral infection and certain degenerative disorders. Peripheral neuropathy - ANSWER-- Is a neurological disorder resulting from damage to the peripheral nerves. It may be caused by diseases of the nerves, systemic illness or a side-effect from chemo. Peripheral neuropathy continue - ANSWER-If sensory nerve is damaged, the client is likely to experience pain, numbness, tingling, burning or a loss of feeling in the extremities. RAST testing - ANSWER-- Involves measuring the quantity of IgE present in the serum after exposure to specific antigens that are selected based on the pts symptom hx. An elevated IgE indicates a positive response to RAST testing and is seen in pts who have a hx of allergic manifestations, anaphylaxis and asthma. If clear drainage is coming out of a patient and you suspect that it could be CSF, first action is to? - ANSWER-- Test it for glucose, then notify doctor What is a complication that you should frequently assess if a patient is suspected of having diabetes insipidus? - ANSWER-- Hypotension **A pt who has diabetes insipidus will continue to excrete urine even though there is no intake. Hypovolemia, with resulting hypotension is possible.** Active TB treatment duration? - ANSWER-- Active TB is usually treated with the simultaneous administration of a combo of meds to which the organisms are susceptible. Such therapy is continued until the disease is controlled. A 6-9 month regimen consisting of two meds is frequently used. Chlorpromazine (Thorazine) - ANSWER-- Chlorpromazine is used to treat psychotic disorders such as schizophrenia or manic-depression, and severe behavioral problems in children ages 1 through 12. Chlorpromazine is also used to treat nausea and vomiting, anxiety before surgery, chronic hiccups, acute intermittent porphyria, and symptoms of tetanus. Chlorpromazine continue. - ANSWER-- This medication can cause photo-phobic skin reactions and damage to the retina of the eye if exposed to direct sunlight. Patients taking this should be reminded to wear protective clothing, apply sunscreen and wear sunglasses when they are outside. Ileal conduit - ANSWER-- It is used to divert urine outside of the body when the urinary bladder has been removed. The conduit cannot store urine the way the bladder did; therefore, urine will be flowing continuously and an appliance must be worn as a collection device. Ileal conduit continue - ANSWER-The bag should be emptied approx. every 2 hours to prevent leakage, skin irritation and infection. Manifestations of tardive dyskinesia - ANSWER-- Tongue thrusting and lip smacking - Facial grimacing and eye blinking - Repetitive involuntary movements Ulcerative Colitis - ANSWER-- Is a chronic, episodic, inflammatory disease of the large intestines and rectum characterized by bloody diarrhea. - Maintaining fluids and electrolyte balance is one of the most important nursing goals. To assess for cyanosis in a patient with dark skin where is the most appropriate areas to assess for this? - ANSWER-- Examine body areas with the least melanin, such as the underarm, soles of the feet, conjunctiva and mucous membranes. Post operative tx of arthroscopy - ANSWER-- This is used to visualize, diagnose and treat problems inside a joint. Applying ice to the affected area in the immediate postop period reduces pain and swelling. Pt may be allowed to walk as tolerated, but joint used should be minimizes for the first few days to reduces pain and swelling. Patient with Gout - ANSWER-- Gout is a painful and potentially disabling form of arthritis that is caused by an excess of uric acid in the body. - Pt should remain well hydrated (this will minimize uric acid stones) - Should avoid foods high in purines Gout continue - ANSWER-- Should limit alcohol consumption (too much alcohol can inhibit excretion of uric acid, leading to its build up and causes an onset of gout. - Pt's should not take aspirin and/or salicylates (this can interfere with uric acid excretion and may precipitate an acute onset. Colostrum - ANSWER-Colostrum is secreted from the mother's breasts during postpartum days 1 to 3. It contains the IgA immunoglobulin that provides passive immunity to the newborn. Breastfeeding schedule - ANSWER-- Newborns should be breastfed every 2 to 3 hr. Parents should awaken the newborn to feed at least every 3 hr during the day and at least every 4 hr during the night until the newborn is feeding well and gaining weight adequately. Breastfeeding should occur 8 to 12 times within a 24-hr window. Then, a feed-on-demand schedule may be followed. Breastfeeding continue - ANSWER-- Tell the mother how to tell if her newborn is receiving adequate feeding (gaining weight, voiding 6 to 8 diapers a day, and contentedness between feedings). Verapamil (Calan) - ANSWER-- Calcium channel blocker - Used to Tx angina, hypertension & arrhythmias Left Hemisphere - ANSWER-- Dominant for language Left-sided CVA - ANSWER-- Could have some aphasia and would need speech therapy - Will also demonstrate hemiplegia of the right side Right-sided Lesion (CVA) - ANSWER-- Most likely to have impulsive like behaviors Late signs of ICP - ANSWER-- Alterations in VS (Including increased systolic pressure) - Widening pulse pressures - Bradycardia Early signs of ICP - ANSWER-- Lethargy - Headache - Neck pain - Generalized muscle aches Pediculosis Capitis - ANSWER-- Head lice ** Nits shed into the environment and are able to hatch up to 7-10 days** Scabies - ANSWER-- Appear as grayish brown, threadlike burrows on the skin Cocaine intoxication - ANSWER-- Dilated pupils Hemianopsia - ANSWER-Blindness in one half of the field, a functional defect that can affect the right or left side. Hypothyrdoism expected lab results - ANSWER-- Elevated TSH levels - Decreased T4, T3 & free thyroxine Specific & Sensitive indicator for renal function - ANSWER-- Creatinine males 0.6 - 1.2 mg/dL female 0.5-1.1 Emphysema expected findings - ANSWER-- Dyspnea - Tachycardia - Barrel chested - Clubbing of the fingers - Shallow respirations Rescue breathing - ANSWER-- When someone is not breathing but has a pulse **Deliver a breath every 5 seconds for a adult** Addison's Disease Treatment: - ANSWER-- High protein, high carb diet - Weigh daily - Injectable IV fast acting steroid may be ordered or indicated for a patients experiencing an Addisonian crisis until the pt is no longer at risk for dehydration, hypotension and shock. SSRIs - ANSWER-- Citalopram (Celexa) an example of an SSRI - Used to treat depression - Can take 3-4 weeks before patients starts to experience signs of improvement and in some cases up to 8 weeks. Agoraphobia - ANSWER-- Fear of being in places in which help may not be available Pernicious anemia - ANSWER-- Caused by a lack of intrinsic factor, a substance needed to absorb Vit B12 from the GI tract. - Often has a red beefy looking tongue - Vit B12 is needed for the formation of RBCs. Iron deficiency Anemia - ANSWER-- Is a condition in which RBCs contain decreased level of hemoglobin Aplastic Anemia - ANSWER-- Caused by a failure of the bone marrow to produce sufficient number of RBC's. Hemolytic Anemia - ANSWER-- Hemolytic anemia involves erythrocyte destruction and maybe medication induced or caused by sickle cell disease, transfusion reaction or kidney disease. **Hematuria (blood in the urine) or hemoglobin present in the urine may indicate