ATI Comp. Predictor Remediation Questions with complete solutions

ATI Comp. Predictor Remediation Questions with complete solutions Risk Factors For Latex Allergy (AMS RN 10.0 Ch 95) Allergies to bananas and kiwis Home Oxygen Safety (FUND 9.0 Ch 13) Safe Use of Equipment) - No smoking in home, place a 'no smoking' sign on the front door and bedroom door. - Electrical equipment repaired and not damaged. - No nylon, wool or synthetics. Only cotton items. - Keep flammable items away from oxygen tanks. - Have a fire escape plan and a fire extinguisher. Hyperthermia (FUND 9.0 Ch 27) - Monitor WBC and electrolytes - Admin antibiotics (if needed) - Antipyretics (aspirin, acetaminophen) - Prevent shivering, give blankets. - Keep room temperature at 70-80 degrees. Cleansing Agents For Immunocompromised Patients (FUND 9.0 Ch 11) Alcohol Caring for a Client Who Has an Infection (FUND 9.0 Ch 11) Pg. 49 Treatment of Positional Plagiocephaly (NCC RN 10.0 Ch 42) Prevention: Encourage parents to allow their infant to lie prone for 30-60 minutes a day. Also, alternate the infant's head position each night. Tx: PT and a helmet. Caring for a Client Who Is in Seclusion and Restraints (MH RN 10.0 Ch 2) - Complete documentation every 15-30 minutes that describes the events the lead to the need for restraints, alternative actions that were attempted prior, the time treatment began, the clients current behavior, foods or fluids offered/taken, needs provided and vitals, medications administered and time released from restaints. Teaching About Phenytoin (Pharm RN 7.0 Ch 13) - Instruct patient to take medication as directed, at the same time each day. If a dose is missed from a once-a-day schedule, take as soon as possible and return to regular dosing schedule. If taking several doses a day, take missed dose as soon as possible within 4 hr of next scheduled dose; do not double doses. Consult health care professional if doses are missed for 2 consecutive days. - May cause drowsiness or dizziness. - Caution patient to avoid alcohol and CNS depressants. - Instruct patient on importance of maintaining good dental hygiene and seeing dentist frequently for teeth cleaning to prevent tenderness, bleeding, and gingival hyperplasia. Institution of oral hygiene program within 10 days of initiation of phenytoin therapy may minimize growth rate and severity of gingival enlargement. Patients under 23 yr of age and those taking doses 500 mg/day are at increased risk for gingival hyperplasia. - Advise diabetic patients to monitor blood glucose carefully and to notify health care professional of significant changes. - Advise patient not to take phenytoin within 2- 3 hr of antacids. Manifestations of False Labor (MN RN 10.0 Ch 11) - Painless, irregular frequency and intermittent. - Decrease in frequency, duration and intensity with walking or position changes. -Felt in lower back or abdomen above the umbilicus. Often stop with sleep or comfort measures such as oral hydration of emptying of the bladder. - No significant changes to the cervix. - Cervix remains in posterior position. - No bloody show - Presenting part of the fetus is not engaged in the pelvis Screening Tests at 16 Weeks of Gestation (MN RN 10.0 Ch 4) - Begin assessing for fetal movement. - Maternal serum alpha-fetoprotein (MSAFP) Infants (2 Days to 1 Year): Expected Growth and Development Findings (NCC RN 10.0 Ch 3) - Posterior fontanel closes 6-8 weeks - Anterior fontanel closes 12-18 months (Pg. 15) 3 to 6 Years: Developmental Age (NCC RN 10.0 Ch 5) 3: Rides a tricycle, jumps off the bottom step, stands on one foot for a few seconds. 4: Skips and hops on one foot, throws a ball overhead, and catches a ball. 5: Jumps rope, walks backwards with heel to toe and throws a ball and catches with ease. (Pg. 25) Client Teaching About Exercise During Pregnancy (MN RN 10.0 Ch 4) Consists of 30 minutes of moderate exercise (walking or swimming) daily. Stroke: Priority Findings to Assess (AMS RN 10.0 Ch 15) - Expressive and receptive aphasia (inability to speak and understand language) - Agnosia (unable to to recognize familiar objects) - Alexia (reading difficulty) - Agraphia (writing difficulty) - Extremity paralysis or weakness - Slow cautious behavior - Vision loss Preventing Neural Tube Defects (MN RN 10.0 Ch 5) Protein and folic acid. Indications of Withdrawal From Opioid Medications (MN RN 10.0 Ch 27) - Low birth weight and small for gestational age. - Manifestations of neonatal abstinence syndrome (seizures, sleep pattern disturbances or high birth weight). - Increased risk of SIDS. Use and Addictive Disorders: Stimulant Withdrawal (RM MH RN 10.0 Ch 18) Headache, nausea, vomiting, muscle pain, irritability, inability to focus and drowsiness. Infections of the Renal and Urinary System: Dietary Choices (AMS RN 10.0 Ch 60) UTI: 3 L of fluids Pyelonephritis: 2 L of fluids Glomerulonephritis: Fluid restriction Assessing for Nephrotoxicity (Pharm RN 7.0 Ch 45) - Decreased creatine - Fluid retention - Decreased urine output - SOB - Fatigue - Weakness - Confusion Intravenous Therapy: Documenting a Complication (FUND 9.0 Ch 49) Notify the provider, document and start a new IV with new tubing and catheters. Client Teaching for Beta Blocker Medication (Pharm RN 7.0 Ch 20) - Do not discontinue without notifying a physician - Do not change positions suddenly - Do not crush or chew - Monitor pulse and BP daily - Take with food Preparing to Administer Packed RBCs (AMS RN 10.0 Ch 40) - Assess vitals and temperature - Remain with the pt. for 15-30 minutes of the transfusion. - Assess lab values (platelet ct. less than 20,000 and a hemoglobin less than 6) - Verify prescription - Obtain consent - Cross match - Initiate 18 or 20 gauge needle. - Obtain blood product. Inspect for discoloration, excessive bubbles of cloudiness. - Verify ID - Verify with another nurse - Prime with o.9% sodium chloride - Begin transfusion, use a blood warmer if indicated. Initiate within 30 minutes of obtaining the product. Care for a Client Who Has an Implanted Venous Port (AMS RN 10.0 Ch 27) - Wear a mask - Apply topical anesthetic cream to skin if indicated. Palpate skin to locate the port body septum to ensure proper insertion of the needle. - Assess with a noncoring needle - Check blood return prior to medication administration to confirm patency and placement. - Flush with 5 ml heparin 100 units/ml after every use and at least once per month. Peripherally Inserted Central Catheter (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Ch 27) - 12 month use - 18- 29 in with multiple lumens - Used to administer blood, long term chemo agents, antibiotics and TPN. (Pg. 166) Teaching About Cervical Ripening Medication (MN RN 10.0 Ch 11) Cervix becomes soft (open) and partially effaced and can begin to dilate. Medications Affecting Urinary Output: Medications for Heart Failure (Pharm RN 7.0 Ch 19) - Furosemide, Ethacrynic acid, Bumetanide and Torsemide. (Pg. 143) Client Teaching About Amitriptyline (MH RN 10.0 Ch 22) - Chew sugarless gum - Sip water - Wear sunglasses outdoors - Eat foods high in fiber - Exercise regularly - Increase fluids to 2 L a day - Void before taking - Avoid hazardous activities - Take at bedtime _ Weigh weekly _ Encourage good nutrition and exercise Interventions After Epidural Administration (MN RN 10.0 Ch 12) - Bolus IV fluids - Encourage pt. to remain side lying - Encourage pt. to push and assess pain while pushing - Monitor vitals and FHR - Maintain Iv and have O2 close by - Assess for orthostatic hypotension - No ambulating and raise the bed rails - Assess bladder for distention - Monitor for return of sensation and motor control Diagnostic Test for Pernicious Anemia (AMS RN 10.0 Ch 41) Complete blood ct., B12 deficiency test, biopsy, and IF deficiency test.