Medical surgical ATI proctored exam 2019
What would you do for wound Evisceration ( removal of internal organs) , Emergency
management? - ANSSaline cover wound
What would you do for an ASTHMA emergency management of a bee sting allergies? - ANSEpi
Pen
Seizures and Epilepsy: Seizure precautions - ANSDuring 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 - ANSIf 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 - ANSStandard 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 - ANS-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 - ANSAdults age 50 or older:
- Pneumococcal Vaccine (PPSV)
- Influenza vaccine
- Herpes Zoster Vaccine
- Hepatitis A
- Hepatitis B
- Meningococcal Vaccine
Pulmonary Embolism: Risk factors for DVT - ANS- 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 - ANS- Urethral trauma
,- Urinary retention
- Bleeding
- Infection
Non-modifiable risk factors ( Page 3 ATI ) - ANS1) Age
2) Gender
3) Genetics
4) Developmental level
Modifiable risk factors ( Page 3 ATI ) - ANS1) Smoking
2) Exercise
3) Health education and awareness
4) Nutrition
5) Sex practices
Emergency nursing - Triage - ANSBASED 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 - ANSClass 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 - ANS1) Red tag
2) Yellow Tag
3) Green tag
4) Black tag
Priorities: general rule - ANSA - 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 - ANSIf 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.
What would you do for wound Evisceration ( removal of internal organs) , Emergency
management? - ANSSaline cover wound
What would you do for an ASTHMA emergency management of a bee sting allergies? - ANSEpi
Pen
Seizures and Epilepsy: Seizure precautions - ANSDuring 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 - ANSIf 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 - ANSStandard 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 - ANS-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 - ANSAdults age 50 or older:
- Pneumococcal Vaccine (PPSV)
- Influenza vaccine
- Herpes Zoster Vaccine
- Hepatitis A
- Hepatitis B
- Meningococcal Vaccine
Pulmonary Embolism: Risk factors for DVT - ANS- 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 - ANS- Urethral trauma
,- Urinary retention
- Bleeding
- Infection
Non-modifiable risk factors ( Page 3 ATI ) - ANS1) Age
2) Gender
3) Genetics
4) Developmental level
Modifiable risk factors ( Page 3 ATI ) - ANS1) Smoking
2) Exercise
3) Health education and awareness
4) Nutrition
5) Sex practices
Emergency nursing - Triage - ANSBASED 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 - ANSClass 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 - ANS1) Red tag
2) Yellow Tag
3) Green tag
4) Black tag
Priorities: general rule - ANSA - 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 - ANSIf 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.
