ATI RN Concept-Based Assessment Level 3
Study Guide Questions And Answers Verified
100% Correct
What is Ewing Sarcoma? What are expected manifestations of this disease? -
ANSWER --rare malignant tumor arising in bone; most often occurring in children
-client will experience pain in the UPPER THIGH as well as LOCALIZED PAIN,
SWELLING, & PALPABLE MASS.
What are expected findings of Multiple Sclerosis (MS)? - ANSWER --decrease
visual acuity, diplopia, changes in peripheral vision, & nystagmus (repeat of
uncontrolled movements).
What are expected finding of Amyotrophic Later Sclerosis (ALS)? - ANSWER --
fascifulcations of the face, twitching of the face or tongue.
What is Amyotrophic Lateral Sclerosis (ALS)? - ANSWER -Also known an Lou
Gherig's disease, ALS is a motor neuron disease which can lead to paralysis.
borderline personality disorder - ANSWER -condition marked by extreme
instability in mood, identity, and impulse control.
-client's with this condition experience SUICIDAL IDEATION & SUBSTANCE
ABUSE.
narcissistic personality disorder - ANSWER -characterized by a grandiose sense of
self-importance, a preoccupation with fantasies of success or power, and a need for
constant attention or admiration or ARROGANCE
historonic personality disorder - ANSWER -Impulsive attention seeking behavaior
paranoid personality disorder - ANSWER -A personality disorder characterized by
a pervasive distrust and suspiciousness of the motives of others without sufficient
basis
, What are some complications of an infant born at or less than 32 weeks? -
ANSWER --apnea
-nectrotizing enterocolitis (due to intestinal ischemia and immature immune
system)
-hypoglycemia
-anemia
-polycythemia
-hypothermia
What teachings should the nurse include for a client that underwent a UTERINE
ARTERY EMBOLIZATION? - ANSWER --client may experience flu-like
symptoms for 7 days after procedure (embolectomy syndrome)
-inform client that a CLOSURE DEVICE or INJECTION that blocks blood flow to
the arteries of the FIBROID TUMOR is used
-inform client that SEVERE CRAMPING may occur in the first 24hr after the
procedure and can last up to 2 weeks.
What teachings should the nurse include for a client who has bipolar disorder and
has a new prescription of LITHIUM? - ANSWER --instruct client to take Li with
meals to decrease irritation of gastric mucosa.
-maintain adequate intake of salt (low Na can lead to Li retention, which can cause
Li toxicity).
-drink at least 1.5-3L of fluids each day (dehydration can lead to Li toxicity).
-expect WEIGHT GAIN (common adverse effect of Li).
Autism Spectrum Disorder (ASD) - ANSWER -A disorder characterized by
deficits in social relatedness and communication skills that are often accompanied
by repetitive, ritualistic behavior.
Immunization schedule - ANSWER -Birth: Hep B
2 mos: Hep B, ROTAVIUS, DTaP, Hib, Pneumococcal, Poliovirus
4 mos: Rotavirus, DTaP, Hib, Pneum, Poliovirus
,6 mos: Hep B, DTaP, Hib, Pneum, Poliovirus
12 mos: MMR, VAR, Hep A, Influenza, Hib
11-12 YEARS: Tdap, Meningococcal, HPV
ADHD (Attention-Deficit Hyperactivity Disorder) - ANSWER -a psychological
disorder marked by extreme inattention and/or hyperactivity and impulsivity
What should the nurse include in her planning for a patient who has ACUTE
phase of DIVERTICULITIS? - ANSWER --Instruct the client to AVOID
COUGHING (this can increase the intra-abdominal pressure and cause BOWEL
PERFORATION).
-ADMINISTER OPIOID analgesics to relieve pain (this can decrease bowel
motility)
-DO NOT administer EMEMAS or LAXITIVES (this will increase bowel motility
and places client at risk for bowel perforation)
-client should be NPO or on a clear liquid diet (this will decrease inflammation of
the bowels).
sickle cell crisis - ANSWER -condition in sickle cell anemia in which the sickled
cells interfere with oxygen transport, obstruct capillary blood flow, and cause fever
and severe pain in the joints and abdomen.
How should the nurse manage care for a client who is experiencing a sickle cell
crisis? - ANSWER --promote fluid intake to prevent dehydration
-monitor peripheral capillary refill, pulse O2, and skin temp every 1hr to assess
PERFUSION of EXTREMITIES.
-EXTEND client's knees to promote perfusion of lower extremities.
-elevate head or bed to 30 DEGREES or less to increase perfusion to lower
extremities.
What are the depressive manifestation of low self-esteem? - ANSWER --
hypersensitivity to criticism
-guilt
, -shame
-expression of helplessness
-lack of eye contact
-pessimistic outcome on life
What are the manifestations of spiritual distress? - ANSWER --express lack of
meaning in life
-anger
-refusing interactions with family
-discontinuing spiritual practice
What are the manifestations of disturbed thought process? - ANSWER --impaired
problem-solving skills
-confusion
-difficulty concentration
-inappropriate thinking
-memory deficits
What are the nursing interactions for palliative care of near death clients? -
ANSWER --administer analgesics like morphine SUB Q, SUBLINGUAL, or IV if
the client is NOT RESPONSIVE.
-APPLY A SOCOPALAMINE TRANSDERMAL PATCH or administer
ATROPINE to decrease oral or respiratory secretions.
-provide soothing music, use therapeutic touch, and keep noise level low
-don place heating pads on extremities
What teachings should the nurse include to a client who is preclamtic WITHOUT
severe features? - ANSWER --inform client to use SIDE-LYING POSITION when
resting in bed or on couch
-monitor blood pressure 2 times a week
What teachings should the nurse include to a client who is preclamtic WITH
severe features? - ANSWER --limit fluid intake to PREVENT PULMONARY
EDEMA
Study Guide Questions And Answers Verified
100% Correct
What is Ewing Sarcoma? What are expected manifestations of this disease? -
ANSWER --rare malignant tumor arising in bone; most often occurring in children
-client will experience pain in the UPPER THIGH as well as LOCALIZED PAIN,
SWELLING, & PALPABLE MASS.
What are expected findings of Multiple Sclerosis (MS)? - ANSWER --decrease
visual acuity, diplopia, changes in peripheral vision, & nystagmus (repeat of
uncontrolled movements).
What are expected finding of Amyotrophic Later Sclerosis (ALS)? - ANSWER --
fascifulcations of the face, twitching of the face or tongue.
What is Amyotrophic Lateral Sclerosis (ALS)? - ANSWER -Also known an Lou
Gherig's disease, ALS is a motor neuron disease which can lead to paralysis.
borderline personality disorder - ANSWER -condition marked by extreme
instability in mood, identity, and impulse control.
-client's with this condition experience SUICIDAL IDEATION & SUBSTANCE
ABUSE.
narcissistic personality disorder - ANSWER -characterized by a grandiose sense of
self-importance, a preoccupation with fantasies of success or power, and a need for
constant attention or admiration or ARROGANCE
historonic personality disorder - ANSWER -Impulsive attention seeking behavaior
paranoid personality disorder - ANSWER -A personality disorder characterized by
a pervasive distrust and suspiciousness of the motives of others without sufficient
basis
, What are some complications of an infant born at or less than 32 weeks? -
ANSWER --apnea
-nectrotizing enterocolitis (due to intestinal ischemia and immature immune
system)
-hypoglycemia
-anemia
-polycythemia
-hypothermia
What teachings should the nurse include for a client that underwent a UTERINE
ARTERY EMBOLIZATION? - ANSWER --client may experience flu-like
symptoms for 7 days after procedure (embolectomy syndrome)
-inform client that a CLOSURE DEVICE or INJECTION that blocks blood flow to
the arteries of the FIBROID TUMOR is used
-inform client that SEVERE CRAMPING may occur in the first 24hr after the
procedure and can last up to 2 weeks.
What teachings should the nurse include for a client who has bipolar disorder and
has a new prescription of LITHIUM? - ANSWER --instruct client to take Li with
meals to decrease irritation of gastric mucosa.
-maintain adequate intake of salt (low Na can lead to Li retention, which can cause
Li toxicity).
-drink at least 1.5-3L of fluids each day (dehydration can lead to Li toxicity).
-expect WEIGHT GAIN (common adverse effect of Li).
Autism Spectrum Disorder (ASD) - ANSWER -A disorder characterized by
deficits in social relatedness and communication skills that are often accompanied
by repetitive, ritualistic behavior.
Immunization schedule - ANSWER -Birth: Hep B
2 mos: Hep B, ROTAVIUS, DTaP, Hib, Pneumococcal, Poliovirus
4 mos: Rotavirus, DTaP, Hib, Pneum, Poliovirus
,6 mos: Hep B, DTaP, Hib, Pneum, Poliovirus
12 mos: MMR, VAR, Hep A, Influenza, Hib
11-12 YEARS: Tdap, Meningococcal, HPV
ADHD (Attention-Deficit Hyperactivity Disorder) - ANSWER -a psychological
disorder marked by extreme inattention and/or hyperactivity and impulsivity
What should the nurse include in her planning for a patient who has ACUTE
phase of DIVERTICULITIS? - ANSWER --Instruct the client to AVOID
COUGHING (this can increase the intra-abdominal pressure and cause BOWEL
PERFORATION).
-ADMINISTER OPIOID analgesics to relieve pain (this can decrease bowel
motility)
-DO NOT administer EMEMAS or LAXITIVES (this will increase bowel motility
and places client at risk for bowel perforation)
-client should be NPO or on a clear liquid diet (this will decrease inflammation of
the bowels).
sickle cell crisis - ANSWER -condition in sickle cell anemia in which the sickled
cells interfere with oxygen transport, obstruct capillary blood flow, and cause fever
and severe pain in the joints and abdomen.
How should the nurse manage care for a client who is experiencing a sickle cell
crisis? - ANSWER --promote fluid intake to prevent dehydration
-monitor peripheral capillary refill, pulse O2, and skin temp every 1hr to assess
PERFUSION of EXTREMITIES.
-EXTEND client's knees to promote perfusion of lower extremities.
-elevate head or bed to 30 DEGREES or less to increase perfusion to lower
extremities.
What are the depressive manifestation of low self-esteem? - ANSWER --
hypersensitivity to criticism
-guilt
, -shame
-expression of helplessness
-lack of eye contact
-pessimistic outcome on life
What are the manifestations of spiritual distress? - ANSWER --express lack of
meaning in life
-anger
-refusing interactions with family
-discontinuing spiritual practice
What are the manifestations of disturbed thought process? - ANSWER --impaired
problem-solving skills
-confusion
-difficulty concentration
-inappropriate thinking
-memory deficits
What are the nursing interactions for palliative care of near death clients? -
ANSWER --administer analgesics like morphine SUB Q, SUBLINGUAL, or IV if
the client is NOT RESPONSIVE.
-APPLY A SOCOPALAMINE TRANSDERMAL PATCH or administer
ATROPINE to decrease oral or respiratory secretions.
-provide soothing music, use therapeutic touch, and keep noise level low
-don place heating pads on extremities
What teachings should the nurse include to a client who is preclamtic WITHOUT
severe features? - ANSWER --inform client to use SIDE-LYING POSITION when
resting in bed or on couch
-monitor blood pressure 2 times a week
What teachings should the nurse include to a client who is preclamtic WITH
severe features? - ANSWER --limit fluid intake to PREVENT PULMONARY
EDEMA
