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ATI comprehensive Exit (Nclex 2013)|319 Questions with complete solutions
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- ATI Comprehensive Exit |319 Questions
ATI comprehensive Exit (Nclex 2013)|319 Questions with complete solutions
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ATI comprehensive Exit (Nclex 2013)|319Questions with complete solutions
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
-Addisons - -
-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 tbSmeasles(Rubeola),
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 (German measles),
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
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