ATI Questions and Answers

ATI Questions and Answers Atropine Accelerates the HR by interfering with vagal impulses Patient with digoxin sees objects with a yellowish tint and is nauseated Hold the med and call provider Patient with preterm labor is prescribed nifedipine. Why? To relax muscles of uterus Patient is in DKA what is most appropriate to administer? Glucagon Normal range for albumin 4.5-5.0 g/100mL What value should be monitored with TPN? Albumin Normal fasting glucose range for diabetic 90-130 mg/dL Normal HgA1C 7% Normal HgA1C for diabetic 4-6% Advice to pt when giving nitroglycerin to tx angina To sit or lie down Education for pt with rheumatoid arthritis receiving methotrexate CBC should be monitored Most important side effect to monitor with TCAs Arrhythmias Ginkgo with warfarin Increases the effects - don't take ginkgo with warfarin Monitor with Lithium Sodium loss - diuretics should be questioned Therapeutic response to digoxin for MI Decrease in pulmonary crackles Important to monitor before giving lisinopril (side effect) Hyperkalemia Side effect that would indicate adverse reaction to gentamicin sulfate Urinary output of 185 mL in 8 hr shift Best site for 10 mg IM injection of morphine sulfate Ventrogluteal Education for patient with gout starting allopurinol Drink 2-3 L of water to prevent kidney injury Potential adverse effect of glucocorticoids Infection - watch for temperature of 100.5 degrees Fahrenheit How is mannitol administered? Syringe, filter needle, IV filter tubing If a patient doesn't accept blood products what can be given Epoetin Alfa What should be reported immediately when a patient is taking buproprion? Seizures Medications associated with gastric irritation and peptic ulcers NSAIDs such as naproxen - gastric irritation Corticosteroids - such as prednisone Corticosteroids Side Effects - Truncal obesity (Cushing's syndrome - fluid retention, HTN, wt gain, fat redistribution - moon face, buffalo hump, susceptible to infection, hyperglycemia, osteoporosis, menstrual irregularities, thin fragile skin, hirsutism) - Osteoporosis - Susceptibility to infection Digoxin Education - Will cause heart to beat slower, contact provider if experiencing visual changes or excessive nausea Medications to treat glaucoma Acetazolamide, Timolol maleate Medications to avoid taking with glaucoma Scopolamine, Methylphenidate, Diphenhydramine Findings from combining anesthetic agents with opioids - Decrease RR - Low O2 Antidote for Warfarin Vitamin K Antidote for Heparin Protamine sulfate Education about Warfarin - Monitor intake of foods high in vitamin K ex. green leafy veggies, cabbage, broccoli, mayo, and canola - Oral contraceptives will decrease anticoagulant effects - Concurrent use of glucocorticoids should be avoided DKA symptoms - Kussmaul breathing, increased serum potassium, decreased pH, hyperglycemia (300 mg/dL) Hypocalcemia signs Fractures, seizures, Trousseau's sign (Hand finger spasms with sustained BP cuff inflation Indications of fluid imbalance - Oliguria - Cap refill 5 seconds - Sunken eyes What side effect should be monitored for with use of oral albuterol? Tachycardia and dysrhythmias How often should cromolyn be taken? Routinely, usually 3-4 times per day, within 1 hr prior to physical activity (ideally 10-15 mins before) What med should be given to counteract benzodiazepines? Flumazenil Anti-infective that inhibits bacteria growth Moxifloxacin Med for maintenance of BP and sodium imbalance for pts with adrenocortical insufficiency Fludrocortisone What is didanosine used for? HIV Syphilis medication Benzathine penicillin G Side effects of Acetazolamide Electrolyte imbalance, respiratory acidosis, diarrhea, black tarry stools, nephrolithiasis, myopia, tinnitus, paresthesias, photosensitivity, anorexia, drowsiness What med should be given when a pt has Trousseau's sign? Calcium glutinate What med should be given to tx metabolic acidosis? Sodium bicarbonate Contraindication for sumatriptan (Vasocontrictor) Angina pectoris, uncontrolled HTN, CAD, ischemic heart disease Side effect of spironalactone Muscle weakness - indications of hyperkalemia including dysrhymias Hydrochlorothiazide side effect - Hyperglycemia and other electrolyte imbalances Ciprofloxacin (and other fluoroquinolone) side effects - Phototoxicity - Muscle weakness - N/V/D - Hepatotoxicity Ketorolac side effects - Oliguria (renal insufficiency, renal toxicity) - Dry mouth - Altered taste Sodium polystyrene sulfonate - Treats hyperkalemia by excreting serum potassium Amiodarone Education - Get liver enzyme tests periodically - Report development of jaundice - Side effects include optic neuropathy and optic neuritis - Can cause loss of appetite/constipation - Can cause CNS manifestations including confusion, hallucinations, dizziness, and insomnia Esomeprazole education - Take 30 mins before meal - Side effects include headache, constipation, dry mouth, diarrhea Tamoxifen education - Monitor calcium level for hypercalcemia (elevated BP and pulse) - Monitor for pulmonary embolus - Advise for potential of menstrual irregularities and hot flashes Furosemide education - Eat foods high in potassium - Report indications of hearing loss - Educate to rise slowly - Should be taken early in day - Check wt daily Medication to help prevent N/V for chemo pts Granisetron Side effects from Ipratropium Xerostomia (anticholinergic effects) Somatropin Monitor child's height monthly, hypo/hyperglycemia When do you hold atenolol? HR 50 Acyclovir nursing action Assess for increase in creatinine Raloxifene - Can lower the risk off breast cancer in menopausal pts - Should not take prior to periods of immobility Med that causes gingival hyperplasia Haloperidol First action when administering a medication that wasn't prescribed Review possible side effects Education for pts receiving ondansetron for chemo Combinations of antiemetics are usually more effective than single-med therapy - serotonin antagonist (ondansetron) with corticosteroid (dexamethasone) Metformin is contraindicated with Alcohol use disorder PT & INR PT: 11-12.5 seconds INR: 2-3 (norm: 0.8-1.1) aPTT PTT aPTT: 60-80 seconds (1.5-2.5x the normal value of 30-40 seconds) PTT: 60-70 seconds Intradermal injection guidelines - 0.5-5/8 in. length of needle - 25-27 gauge - 5 to 15 degree angle of needle - inner surface of forearm (hairless) - skin taut, look for wheal, no rubbing, no aspirating - 0.01 to 0.1 mL Subcutaneous injection guidelines - 3/8 to 5/8 in. length of needle (may need 1 inch for large patient) - 25-27 gauge - 45 to 90 degree - upper arm, thigh, abdomen, gluteal, scapula - pinch up tissue, no aspirating, no rubbing - Maximum 1.5 mL Intramuscular injection guidelines - 1-1.5 in. length of needle (1/2 inch for child, 2-3 inch for obese pt) - 20-25 gauge - 90 degree - Deltoid, ventrogluteal, vastus lateralis, rectus femoris (pediatrics), dorsogluteal - skin taut (unless limited muscle mass, then pinch), aspirate, remove needle and start over if blood appears in syringe -2-3 mL How much weight should women with a normal BMI (19.8-26) gain during pregnancy? 25-35 pounds How much should women who are below optimal weight (BMI 19.8) gain during pregnancy? 28-40 pounds How much should overweight women (BMI 26-29) gain during pregnancy? 15-25 pounds How much weight should women carrying twins gain during pregnancy? 35-45 pounds How much weight should women carrying triplets gain? 50 pounds Where does the extra weight go during pregnancy? Baby: 7-8 lbs Placenta: 1-2 lbs Amniotic fluid: 2 lbs Uterus: 2 lbs Maternal breast tissue: 2 lbs Maternal blood: 4 lbs Fluids in maternal tissue: 4 lbs Maternal fat and nutrient stores: 7 lbs How many additional calories should a pregnant patient consume? 300 calories a day more than pre-pregnancy 2,200 calories daily for most active women and teens 1,600 for sedentary women Protein: 60-80 g/day Iron: 18-30 g/day Folate: 400-600 g/day Nursing intervention when performing trach care Change tracheostomy ties when soiled A nurse is caring for a client with a diagnosis of sepsis with a temperature of 40.8 C (105.5 F). The provider has ordered a cooling blanket. Which intervention is appropriate to delegate to an Unlicensed Assistive Personnel (UAP)? a. Obtain a fan for the client's use b. Assess the client's skin for any reddened c. Bathe the client to keep the skin damp d. Report shivering by the client d. Report shivering by the client A nurse is caring for a client when the IV infusion pump malfunctions and delivers 1 Liter of IV fluid over 2 hours. Which intervention is the priority? Select one: a. Monitor urine output. b. Fill out an incident report. c. Report the defective equipment. d. Document the amount of fluid infused. b. Fill out an incident report A newly-licensed nurse is preparing the surgical suite for a client who has a latex allergy. Which action demonstrates a need for further education? Select one: a. Placing monitoring devices in stockinet. b. Using glass syringes. c. Scheduling the case late in the day. d. Covering IV tubing ports with tape. c. Scheduling the case late in the day A nurse is orienting a newly licensed nurse to the operating room. Which of the following actions by the new nurse indicates a need for further education about surgical aseptic hand hygiene? Select one: a. Rinsing hands and arms while keeping them lower than elbows. b. Lathering hand and arms with soap to 5 cm (2 inches) above the elbows c. Cleaning under nails of both hands with a nail pick while under running water. d. Drying with a sterile towel moving from the hands to the elbows. a. Rinsing hands and arms while keeping them lower than elbows. A client has just returned to the surgical unit after an open cholestectomy. A nurse notes the abdominal dressing is saturated with sanguineous drainage. Which of the following is the most appropriate intervention? Select one: a. Remove the dressing to assess the incision. b. Document the assessment findings. c. Outline the drainage size with a marker. d. Reinforce the dressing with additional gauze. d. Reinforce the dressing with additional gauze. When the nurse takes morning medications to a client, the client states "I've never seen that one before." Which of the following is the most appropriate action for the nurse to take? Select one: a. Recheck the medication with the medication administration record (MAR). b. Tell the client that the medication must be new and to go ahead and take it. c. Administer the rest of the medications and recheck the one that was questioned. d. Return to the nurse's station and check all medications against provider orders d. Return to the nurse's station and check all medications against provider orders A nurse is caring for a client following a right below the knee amputation. Which of the following should the nurse include in the plan of care to prevent infection? Select one: a. Encourage the client to lie prone for 20-30 minutes several times a day. b. Encourage the client to lie supine for 20-30 minutes several times a day. c. Position the affected limb in a dependent position. d. Position the affected limb elevated on a pillow. c. Position the affected limb in a dependent position. A nurse is teaching parents how care for their newborn. Which of the following statements indicates a good understanding of how to use a bulb syringe to suction excess mucous from the infant's airway? Select one: a. "I should suction my baby's mouth before the nose." b. "I should compress the bulb syringe after I place it in my baby's mouth." c. "The bulb syringe should be sterilized after each use." d. "The bulb syringe should reach to the back of my baby's throat." a. "I should suction my baby's mouth before the nose." A nurse correctly understands which of the following characteristics is a possible developmental delay for a 3-month-old client? Select one: a. The infant is unable to point to objects b. The infant is unable to sit with support c. The infant demonstrates stranger anxiety d. The infant does not raise his head when placed on his abdomen d. The infant does not raise his head when placed on his abdomen A nurse has administered the first DTaP (diphtheria toxoid, tetanus and pertussis) immunization to a two-month-old infant. For which of the following symptoms should the nurse teach the parents to seek immediate medical attention? Select one: a. The baby is crying inconsolably for more than three hours b. The baby develops swelling or redness at the injection site c. The baby develops a localized or generalized rash d. The baby has an axillary temperature of 100.4o F. (38o C) a. The baby is crying inconsolably for more than three hours Foods appropriate for Chron's disease Foods that are appropriate for clients with Crohn's Disease include: Tender, ground, well-cooked meat, eggs, fish, poultry, refined pasta and cereal, white rice and bread, canned or cooked vegetables without skin or seeds and juices without pulp. Aluminum Hydroxide Gel To bind phosphate in food and stop phosphate absorption Water Deprivation Test Dehydration is induced by withholding fluid. Urine output is measured and tested hourly. Test positive if kidneys are unable to concentrate urine Vasopressin Test Is positive when a SQ injection of vasopressin produces urine output with an increased specific gravity Meds for Diabetes Insipidus ADH Replacement Demopressin Acetate, ADH Stimulant Carbamazepine, Vasopressin Labs for Diabetes Insipidus Urine - DILUTE - specific gravity: 1.005, decreased urine pH, Na, K Serum Chemistry - CONCENTRATED 300 Osm/L, increased Na and K Decreased ADH Diabetes Insipidus Results from a deficiency of ADH, secreted by the posterior pituitary gland that leads to a large quantity of diluted urine A client is admitted to the surgical unit after sustaining a compound fracture of the left femur. The client is alert and oriented with the following vital signs: T 99.4 F, P 88, R 20, B/P 94/58. The nurse notes a 4 cm. area of bright red blood on the pressure dressing on the left lower extremity. The client is receiving intravenous fluids of normal saline at 150 ml/hr. One hour after being admitted to the unit, the nurse finds the client confused and combative. Which of the following is the most likely cause of the change in the client's condition? Select one: a. Hypoxia related to fat embolism from the fractured bone. b. Fluid overload related to aggressive isotonic volume replacement c. Hypovolemic shock related to hemorrhage from the open wound d. Infectious process related to contamination of the open wound. Feedback a. Hypoxia related to fat embolism from the fractured bone.