ATI Comprehensive Predictor Exam Study Guide 2024

Do not delegate - What you can EAT E-evaluate A-assess T-teach Addison's & Cushings - Addison's = down down down up down Cushings= up up up down up hypo/hypernatremia, hypo/hypertension, blood volume, hypo/hyperkalemia, hypo/hyperglycemia Better peripheral perfusion? - EleVate Veins, DAngle Arteries APGAR - Appearance (all pink, pink and blue, blue (pale) Pulse (>100, <100, absent) Grimace (cough, grimace, no response) Activity (flexed, flaccid, limp) Respirations (strong cry, weak cry, absent) Airborne precautions - MTV or My chicken hez tb measles, chickenpox (varicella) Herpes zoster/shingles TB Airborne precautions protective equip - private room, neg pressure with 6-12 air exchanges/hr mask & respirator N95 for TB Droplet precautions - spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis, influenza, diptheria, epiglottitis, rubella, mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room and mask) Contact precaution - MRS WHISE protect visitors & caregivers when 3 ft of the pt. Multidrug-resistant organisms RSV, Shigella, Wound infections, Herpes simplex, Impetigo, Scabies, Enteric diseases caused by micro-organisms (C diff), Gloves and gowns worn by the caregivers and visitors Disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag PMGG= Private room/ share same illness, mask, gown and gloves Skin infection - VCHIPS Varicella zoster Cutaneous diptheria Herpes simplez Impetigo Peduculosis Scabies Air or Pulmonary Embolism - S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of impending doom. (turn pt to LEFT side and LOWER the head of bed.) Woman in labor (un-reassuring FHR) - (late decels, decreased variability, fetal bradycardia, etc) Turn pt on Left side, give O2, stop pitocin, Increase IV fluids! Tube feeding with decreased LOC - Pt on Right side (promotes emptying of the stomach) Head of bed elevated (prevent aspiration) After lumbar puncture and oil based myelogram - pt is flat SUPINE (prevent headache and leaking of CSF) Pt with heat stroke - flat with legs elevated during Continuous Bladder Irrigation (CBI) - catheter is taped to the thigh. leg must be kept straight. After Myringotomy - position on the side of AFFECTED ear, allows drainage. After Cateract surgery - pt sleep on UNAFFECTED side with a night shield for 1-4 weeks after Thyroidectomy - low or semi-fowler's position, support head, neck and shoulders. Infant with Spina Bifida - Prone so that sac does not rupture Buck's Traction (skin) - elevate foot of bed for counter traction After total hip replacement - don't sleep on side of surgery, don't flex hip more than 45-60 degress, don't elevate Head Of Bed more than 45 degrees. Maintain hip abduction by separating thighs with pillows. Prolapsed cord - Knee to chest or Trendelenburg oxygen 8 to 10 L Cleft Lip - position on back or in infant seat to prevent trauma to the suture line. while feeding hold in upright position. To prevent dumping syndrome - (post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals for 20-30 min. also restrict fluids during meals, low CHO and fiber diet. small, frequent meals. AKA (above knee amputation) - elevate for first 24 hours on pillow. position prone daily to maintain hip extension. BKA (below knee amputation) - foot of bed elevated for first 24 hours. position prone to provide hip extension. detached retina - area of detachment should be in the dependent position administration of enema - pt should be left side lying (Sim's) with knee flexed. After supratentorial surgery - (incision behind hairline on forhead) elevate HOB 30-40 degrees After infratentorial surgery - (incision at the nape of neck) position pt flat and lateral on either side. During internal radiation - on bed rest while implant in place Autonomic Dysreflexia/Hyperreflexia - S/S pounding headache, profuse sweating, nasal congestion, chills, bradycardia, hypertension. Place client in sitting position (elevate HOB) FIRST! Shock - bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated (modified Trendelenberg) Head Injury - elevate HOB 30 degrees to decrease ICP Peritoneal Dialysis (when outflow is inadequate) - turn pt from side to side BEFORE checking for kinks in tubing Lumbar Puncture - After the procedure, the pt should be supine for 4-12 hours as prescribed. Myesthenia Gravis - worsens with exercise and improves with rest Myesthenia Gravis - a positive reaction to Tensilon---will improve symptoms Cholinergic Crisis - Caused by excessive medication ---stop giving Tensilon...will make it worse. Liver biopsy (prior) - must have lab results for prothrombin time Myxedema/ hypothyroidism - slowed physical and mental function, sensitivity to cold, dry skin and hair. Grave's Disease/ hyperthyroidism - accelerated physical and mental function. Sensitivity to heat. Fine/soft hair. Thyroid storm - increased temp, pulse and HTN Post-Thyroidectomy - semi-fowler's. Prevent neck flexion/hyperextension. Trach at bedside Hypo-parathyroid - CATS---Convulsions, Arrhythmias, Tetany, Spasms, Stridor. (decreased calcium) give high calcium, low phosphorus diet Hyper-parathyroid - fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) give a low calcium high phosphorous diet Hypovolemia - increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety. Urine specific gravity >1.030 Hypervolemia - bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific gravity <1.010. semi fowler's Diabetes insipidus (decreased ADH) - excessive urine output and thirst, dehydration, weakness, administer Pitressin SIADH (increased ADH) - change in LOC, decreased deep tendon reflexes, tachycardia. N/V HA administer Declomycin, diuretics hypokalemia - muscle weakness, dysrhythmias, increase K (rasins bananas apricots, oranges, beans, potatoes, carrots, celery) Hyperkalemia - MURDER Muscle weakness, Urine (olig, anuria) Resp depression, decreased cardiac contractility, ECG changes, reflexes Hyponatremia - nausea, muscle cramps, increased ICP, muscular twitching, convulsions. give osmotic diuretics (Mannitol) and fluids Hypernatremia - increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give hypotonic solution. Hypocalcemia - CATS Convulsions, Arrythmias, Tetany, spasms and stridor Hypercalcemia - muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, shallow respirations, emergency! Hypo Mg - Tremors, tetany, seizures, dysthythmias, depression, confusion, dysphagia, (dig toxicity) Hyper Mg - depresses the CNS. Hypotension, facial flushing, muscle weakness, absent deep tendon reflexes, shallow respirations. EMERGENCY Addison's - Hypo Na, Hyper K, Hypoglycemia, dark pigmentation, decreased resistance to stress fx, alopecia, weight loss. GI stress. Cushings - Hyper Na, Hypo K, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump Addesonian crisis - N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP Pheochromocytoma - hypersecretion of epi/norepi. persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bathing and rest breaks, avoid cold and stimulating foods (surgery to remove tumor) Tetrology of Fallot - DROP (Defect, septal, Right ventricular hypertrophy, Overriding aortas, Pulmonary stenosis) Autonomic Dysreflexia - (potentially life threatening emergency!) HOB elevate 90 degrees, loosen constrictive clothing, assess for full bladder or bowel impaction, (trigger) administer antihypertensives (may cause stroke, MI, seizure) FHR patterns for OB - Think VEAL CHOP! V-variable decels; C- cord compression caused E-early decels; H- head compression caused A-accels; O-okay, no problem L- late decels; P- placental insufficiency, can't fill what to check with pregnancy - Never check the monitor or machine as a first action. Always assess the patient first. Ex.. listen to fetal heart tones with stethoscope. Position of the baby by fetal heart sounds - Posterior --heard at sides Anterior---midline by unbilicus and side Breech- high up in the fundus near umbilicus Vertex- by the symphysis pubis. Ventilatory alarms - HOLD High alarm--Obstruction due to secretions, kink, pt cough etc Low alarm--Disconnection, leak, etc ICP and Shock - ICP- Increased BP, decreased pulse, decreased resp Shock--Decreased BP, increased pulse, increased resp Cor pumonae - Right sided heart failure caused by left ventricular failure (edema, jugular vein distention) Heroin withdrawal neonate - irritable, poor sucking brachial pulse - pulse area on an infant lead poisoning - test at 12 months of age Before starting IV antibiotics - obtain cultures! pt with leukemia may have - epistaxis due to low platelets when a pt comes in and is in active labor - first action of nurse is to listen to fetal heart tones/rate for phobias - use systematic desensitization NCLEX answer tips - choose assessment first! (assess, collect, auscultate, monitor, palpate) only choose intervention in an emergency or stress situation. If the answer has an absolute, discard it. Give priority to the answers that deal with the patient's body, not machines, or equipment. ARDS and DIC - are always secondary to another disease or trauma In an emergency - patients with a greater chance to live are treated first Cardinal sign of ARDS - hypoxemia Edema is located - in the interstitial space, not the cardiovascular space (outside of the circulatory system) the best indicator of dehydration? - weight---and skin turgor heat/cold - hot for chronic pain; cold for accute pain (sprain etc) When pt is in distress ... medication administration - is rarely a good choice pneumonia - fever and chills are usually present. For the elderly confusion is often present. before IV antibiotics? - check allergies (esp. penicillin) make sure cultures and sensitivity has been done before first dose. COPD and O2 - with COPD baroreceptors that detect CO2 level are destroyed, therefore, O2 must be low because high O2 concentration takes away the pt's stimulation to breathe. Prednisone toxicity - Cushings (buffalo hump, moon face, high blood sugar, HTN) Neutropenic pts - no fresh fruits or flowers Chest tubes are placed - in the pleural space Preload/Afterload - Preload affects the amount of blood going into Right ventricle. Afterload is the systemic resistance after leaving the heart. CABG - Great Saphenous vein in leg is taken and turned inside out (because of valves inside) . Used for bypass surgery of the heart. Unstable Angina - not relieved by nitro PVC's - can turn into V fib. 1 tsp - 5 mL 1 oz - 30 mL 1 cup - 8 oz 1 quart - 2 pints 1 pint - 2 cups 1 g (gram) - 1000 mg 1 kg - 2.2 lbs I lb - 16 oz centigrade to Fahrenheit conversion - F= C+40 multiply 5/9 and subtract 40 C=F+40 multiply 9/5 and subtract 40 Angiotenson II - In the lungs...potent vasodialator, aldosterone attracts sodium. Iron toxicity reversal - deferoxamine S3 sound - normal in CHF. Not normal in MI After endoscopy - check gag reflex TPN given in - subclavian line pain with diverticulitis - located in LLQ appendicitis pain - located in RLQ Trousseau and Chvostek's signs observed in - Hypocalcemia never give K+ in - IV push DKA is rare - in DM II (there is enough insulin to prevent fat breakdown) Glaucoma patients lose - peripheral vision. Autonomic dysreflexia - patients with spinal cord injuries are at risk for developing autonomic dyreflexia (T-7 or above) Spinal shock occurs - immediately after injury multiple sclerosis - myelin sheath destruction. disruptions in nerve impulse conduction Myasthenia gravis - decrease in receptor sites for acetylcholine. weakness observed in muscles, eyes mastication and pharyngeal musles. watch for aspiration. Gullian -Barre syndrome - ascending paralysis. watch for respiratory problems. TIA - transient ischemic attack ... mini stroke, no dead tissue. CVA - cerebriovascular accident. brain tissue dies. Hodgkin's disease - cancer of the lymph. very curable in early stages burns rule of Nines - head and neck 9% each upper ext 9% each lower ext 9% front trunk 18% back trunk 18% genitalia 1% birth weight - doubles by 6 months triples by 1 year if HR is <100 (children) - Hold Dig early sign of cystic fibrosis - meconium in ileus at birth Meningitis--check for - Kernig's/ brudinski's signs wilm's tumor - encapsulated above kidneys...causes flank pain hemophilia is x linked - passed from mother to son when phenylaline increases - brain problems occur buck's traction - knee immobility russell traction - femur or lower leg dunlap traction - skeletal or skin bryant's traction - children <3 y <35 lbs with femur fx eclampsia is - a seizure perform amniocentesis - before 20 weeks to check for cardiac and pulmonary abnormalities Rh mothers receive Rhogam - to protect next baby anterior fontanelle closes by...posterior by.. - 18 months, 6-8 weeks caput succedaneum - diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days