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ATI – NCLEX Predictor Remediation Study Notes
Renal Calculi - Pain: Flank pain → Kidney or Ureter (if pain radiates → stones in ureter or bladder)
Performing Ear Irrigation: Sterile technique, warm meds, pull up & back, tilt toward affected ear
Thrombolytic Therapy (Stroke): Reteplase recombinant (rTPA – clot buster) w/ in 4.5 hours of initial symptoms
Trach care: Dressing ∆, inner cannula ½ hydrogen peroxide, & stoma □ knot
Head injury (changes in LOC): Length of time unconscious & GCS
General anesthesia (post-op): ABC’s – full body assessment, Vitals every 15 minutes, Lateral position (if unresponsive or
unconscious - monitor LOC), Fluids/Electrolytes
Superficial Burns: Painful, pink, red, mild edema (3-6 day healing), damage to epidermis
Dialysis (reporting unexpected findings): Temp of 100 degrees, ↓ BP, bleeding, 1 L of fluid = 1Kg, clotting, H/A, Nausea,
Disequilibrium syndrome (rapid ↓ BUN & Fluid volume), anemia, peritonitis, ↑ BG, ↑ cholesterol
Pacemaker (complications): Infection, hematoma, pneumothorax, hemo-thorax, arrhythmias, pacer spikes before P or QRS, hiccups
/ muscle twitching
Magnesium (Mg) Sulfate → Increase Mg+ > 1.3 Mg/dL
↑ Mg foods = (Dairy, dark leafy greens veges)
↓ Mg causes → Hyperactive deep tendon reflexes
* Paresthesia’s, muscle tetany, positive chvostek’s & Trousseau’s sign, hypoactive bowels, constipation,
abdominal distention, paralytic Ileus.
TPN Admin: (Total parenteral nutrition) -feeding that bypasses the GI tract. Fluids are given into a vein to provide most of the
nutrients the body needs. Given when person cannot/ should not receive feedings or fluids by mouth.
Hypertonic (20-50% dextrose), Used in chronic pain, peritonitis, burns, Infection, etc
No more than 10% hourly, ↑ in rate for body adjustment, check BG
Hyperglycemia, hypoglycemia, vitamin deficiencies, air embolism (clamp, place in Trendelenburg pos., O2)
Fluid imbalance → Fluid volume excess
Wound Culture specimen: Sterile field, press / rotate over wound surface inside the wound (center) in drainage
Diabetes Mellitus (Nephropathy): Kidney damage d/t prolonged ↑ BG & dehydration
Monitor I & O, Creatinine, BP
Avoid Soda, alcohol, acetaminophen/NSAIDS / 2 – 3 L fluid from food / beverages
Kidney Biopsy (Post op):
Monitor VS → Client receives sedation
Assess dressings & urinary output (hematuria-blood in urine)
Labs: HgB & Hct values, Admin PRN pain meds, Complications hemorrhage / infection
Thyroidectomy (Post Op): Needs Thyroid hormone replacement
Client in high fowler’s position, Respiratory (trach supplies) present, Check for laryngeal nerve damage
Pain management, Hypocalcemia / Tetany can occur
Prioritization: Apply knowledge to Standards to determine priority action
Systemic before Local – “Life before Limb”
Acute before Chronic
Actual Problems before Potential Future
Listen carefully to clients & Don’t Assume
Recognize & Respond - Trends vs. Transient findings
Recognize indications - Emergencies vs. Expected
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Delegate to LPN: Monitoring Findings, Reinforcing teaching, performing trach care, suctioning, checking NG tube patency,
administer tube feedings, inserting urinary catheter, administering meds (No IV)
Delegate to AP: ADLs, Bathing, Grooming, Dressing, toileting, Ambulating, feeding w/out swallowing precautions, positioning,
routine tasks, bed making, specimen collection, I & O, VS for stable clients, monitoring clinical manifestations after initial RN
assess/eval.
Paracentesis (prep) - take out fluid from belly (peritoneal fluid) Have client VOID
Bariatric Surgery: (weight loss surgery) – Semi fowlers, 6 small meals/day, liquid/pureed food for first 6 weeks (not to exceed 1cup),
Vitamin / mineral supplements, & 2 servings of protein daily.
Ostomy (in small intestine) Avoid odorous & gas foods (dark green veges, dairy, fish, eggs, beans, corn), yogurt ↓ gas
Avoid ↑ fiber foods for first 2 months, ↑ fluid intake
Dumping Syndrome: Happens within 15mins of eating.
Sx: cramps, diarrhea, tachycardia, dizziness, fatigue, hypoglycemia
Interventions: small frequent meals, drink liquids 1hr b4/after
Parkinson’s disease: Tremor, muscle rigidity, bradykinesia (slowness in movement), postural instability
Stages:
1. Unilateral shaking / tremor of one limb
2. Bilateral limb involvement, difficulty walking/balance
3. Slowed physical movements
4. Akinesia & Rigidity make ADL’s difficult
5. Unable to stand/walk, dependent of cares, dementia
Assault: threat Battery: touching
Hypoglycemia Sx: Shakiness, confusion, sweating, tachycardia, diaphoresis, palpitations, H/A, lack of coordination, blurred vision,
seizures, coma
Oral Hypoglycemic Agents: promote insulin release from pancreas (Type2 DM)
Glipizide (Glucotrol), Chlorpropamide (Diabines), Glyburide (Diabinese), Metformin (Glucophage).
* Med for insulin overdose = Glucagon
Radiation Adverse Effects: Skin changes, hair loss, debilitating fatigue, 30 minute visits / stays 6ft away / private room
Infection control in clients home: good hygiene, avoid crowded areas, avoid raw foods (veges/meats), avoid cleaning litter boxes,
clean home and avoid sick family.
Client evacuation in response to fire: greatest good for the greatest amount of people
Client in seclusion: 18 yo+ → 4 hours, 9 – 17 yo →2 hours, 8 yo & younger →1 hour
Conduct Disorders: lack of remorse, bullies, threatens, low self-esteem, tempers, physical cruelty, destroys property, truant, and
shoplifts
Manic Phase: ↑ mood, irritable, lasts at least a week, euphoria, agitation, restless, ↑ in talking, flight of ideas, grandiose view of
self, impulsive, manipulative, poor judgement, attention seeking.
Paranoid: distrust / suspiciousness
Schizoid: emotional detachment, disinterest in relationships, indifferent to praise/criticism, uncooperative
Schizotypal: odd beliefs, eccentric appearance, magical thinking, perceptual distortions
Antisocial: disregard for others, lack of empathy, unlawful, failure to accept responsibility, manipulative, impulsive, seductive
Borderline: instability of affect, identity & relationships, splitting behaviors, fear of abandonment, self-injurious, impulsive
Histrionic: attention seeking, seductive, flirtatious
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Narcissist: arrogant, constant admiration, lack of empathy
Avoidant: anxious, wants close relationships, fear of rejection
Dependent: dependency on another individual
OCD: perfectionist, orderly, and control
Clozapine (Anti-psychotic Atypical )
Adverse effects: metabolic syndrome, orthostatic hypotension, anti-cholinergic effects, agitation, dizziness,
sedation, mild EPS, ↑ prolactin levels(galactorrhea, amenorrhea, gynecomastia), & sexual dysfunction
Anti-lipemic Agents: (Statins) – treats high levels of fats/cholesterol in blood -called lipid-lowering drugs
Monitor liver enzyme levels (hepatotoxicity) and muscles – monitor CK levels (myopathy & peripheral
neuropathy)
Med interactions: Fibrates (Genfibrozil) - ↑ myopathy risk, Erythroycin & Ketoconazole, Amiodarone, &
Cyclosprine = Grapefruit juice can ↑ statin levels
Gentamicin (effects urine output) -causes ototoxicity w/ diuretics, digoxin, lithium, ototoxic meds, NSAIDs, & anti-hypertensives
Long term therapy for RA: DMARDs (methotrexate, etanercept, infliximab, adalimubrab, Azathioprine, Cyclosporine)
** Slow joint degradation
Glucocorticoids (Prednisone) & NSAIDs provide symptom relief from inflammation & pain
Bulb Syringe (for babies): Mouth first, then nose, depress. Then insert into mouth, avoid center of mouth- may stim. gag reflex.
Priority action to an allergic response:
Mild rashes/hives – Benadryl
Anaphylaxis - treat with epi, bronchodilators, and anti-histamines
Provide respiratory support & notify HCP
Losartan (ARBs -Anti-Hypertensive (HTN) & kidney disease) - Cough & hyperkalemia are for ace inhibitors.
Side Effects: Angioedema, hypotension, dizziness
Tracheostomy Care: 2 xtra tubes, adequate humidification, oral care every 2 hours, trach care every 8 hours, sterile suctioning,
surgical asepsis to remove / clean inner cannula, secure trach ties before removing old, square knot, clean from stoma
outward
Appropriate Doc.: Subjective/objective data, Accurate/concise, Complete/current, Organized/ date/ time/ blk ink
Crutch safety: Support bodyweight at hand grips with elbows at 30 degrees, Position crutches on unaffected side when sitting or
rising from a chair
Varicella (chicken pox) Transmission: Direct contact, droplet, from person with shingles, 10-21 days, 1-2 days before lesions appear
and all lesions have sabs
Scoliosis: Lateral curvature of spine & spinal/truncal rotation that causes ribs asymmetry. Curve needs to be at least 10 degrees One
leg shorter than the other. Asymmetry in scapula, ribs, flanks, shoulders, hips.
Screening for Idiopathic Scoliosis: During pre-adolescence - Observe child from back
Bend at waist with arms handing down & observe for asymmetry of ribs and flank
Measure truncal rotation with a scolio-meter
Use Cobb technique to determine degree of curvature
Use riser scale to determine skeletal maturity
↓ Cardiac output (interventions): Maintain bedrest, Semi fowler’s/ fowler’s position while awake, Sleep w/ pillows
Cardiac output positioning for optimal output: Left lateral side, Semi fowlers, Supine with wedge under one hip
Infant car seat: Position infant in car seat at 45 degree angle, Safety restraints loose and low on abdomen
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Correct use of Condoms: On erect penis, empty space at tip for sperm reservoir (May be used with spermicidal gel to ↑
effectiveness), Protects against STI’s, only water soluble lube with latex condoms
Amnio-infusion for Oligohydramnios: (not enough amniotic fluid around fetus)
Infusion or NS or LR into amniotic cavity to reduce severity of variable decelerations caused by cord compression
Scant amount or absence of amniotic fluid, Membranes must have ruptured to perform - Warm fluid
Rhogam for Clients who are RH-Negative: (Antibodies from human plasma injected into RH+ mother to protect fetus)
Chadwick’s sign – violet/blue color or cervix & vaginal mucosa Goodell’s sign – softening of cervical tip
HSV (Herpes simplex virus): direct contact transmission to fetus is greatest during vaginal birth if woman has active lesions, Lesions
& tender lymph nodes, Obtain cultures from women who have HSV or are at or near term
Urinary frequency Interventions: ↓ fluid intake b-4 bed, Use perineal pads, and Kegel exercises ↓ stress incontinence
Buddhist Dietary practices: vegetarian, nuts, legumes (dried peas/cooked beans), No eggs, no milk products
Notifiable Communicable diseases: anthrax, botulism, cholera, diphtheria, gonorrhea, hep A/B/C, HIV, legionaries, lymes, malaria,
mumps, pertussis, polio, syphilis, tetanus, TSS, TB, Typhoid fever, VRSA, At risk populations, transmissions routes
Anterior Pituitary Hormones: Stimulate growth - Caution in DM patients – can cause hyperglycemia (Somatropin)
Anti-Convulsants: Tx- seizures (caphe) Petit Mal (Valet)
Carbamazepine, valproic acid, ethosuximide, Phenytoin/phenobarbital – adverse effects = yellowing of skin,
nystagmus, teratogenicity, osteomalacia, H/A, vertigo, ataxia
Ophthalmic Agents:
Beta Blockers: ↓ aqueous humor production (betotopic, betaxon, betagan, betimol)
Prostaglandin Analogs: ↑ aqueous humor outflow (xalantan, travatan)
Alpha Adrenergic Agonists: ↓ aqueous humor & ↑ outflow (Alphagan)
Direct Acting Cholinergic Agonist: ↓IOP & ↑ outflow of AH (Pilocarpine)
Side effects for Ophthalmic Agents: Blurred vision, angle closure glaucoma, dry eyes, photophobia,
ocular pressure, can cause systemic effects, ciliary muscle constriction
Mixing Insulin: (Clear before Cloudy)
Air into NPH (Cloudy), Air into Regular (Clear), Draw up Regular (Clear), Draw up NPH (Cloudy)
* Hypoglycemia is most likely to occur during peak.
Obstetric History: (GTPAL) Gravida, Term, Preterm, Abortions, Living Children
Pre-Term Infant: Anticipated Problems (TRIES) Temperature regulation (poor), Resistance to infections (poor), Immature Liver,
Elimination problems (Necrotizing Enterocolitis), Sensory-Perceptual Functions (Retinopathy)
Fetal Heart Rate: (VEAL CHOP)
Variable Decels Cord Compression
Early Decels Head Compression
Accelerations O2 (Baby is well-oxygenated)
Late Decels Placental Utero Insufficiency
Pregnant Client - Med. Surg Floor: (FETUS)
Fetal heart tones (document every shift)
Emotional Support
Temperature (Measure maternal)
Uterine Activity/Contractions (early-low back pain)
Sensations of fetal movement
Placenta Previa: low implantation of the placenta / Bright red bleeding present that is painless. Place mother on bedrest in side
lying position / Weigh perineal pads
