Nursing Med Surg 324 ati Live Review

ATI LIVE REVIEW – DAY 1 PEARSONVUE.COM/NCLEX – check under tutorial -check lung / heart sounds prior to exam day -contact ATI w/in 3 days of failing nclex -45 day wait for 2nd attempt Drag/drop Qs: -take first and last answer and work w/ the ones in the middle SELECT ALL THAT APPLY: -don’t pick “always” answers EXHIBIT Qs: -if other responses are right, pick the “best” answer -look for “global” answer Review Questions: -half of the questions review and look over material on those topics -check rationales- refer to review book - if your getting 6/10 questions right = ideal NCLEX ITEMS WILL BE:Application -requiring use of nx knowledge to solve client problems - finding the best answer Bronchodilators AE: increased myocardial o2 use -expect client to have tachycardia after admin of bronchodilator ARTERIAL DEFICIENCY CLASSIC SIGN: • Intermittent claudication (arterial) • Put feet up (venous) • DVT: red, swollen, warm to touch NCLEX QS: think “perfect” in able to pick the best answer -don’t talk yourself out of the right answer PRIORITY QS: Look at the options narrow it down to 2 A client receives a transfusion of packed RBI’s and tells the nurse “my iv site is painful and looks like it is swollen.” Which action should the nurse take? -start new IV site and another site and resume the transfusion at the new site (Focus on the story: INFILTRATED IV) Priority intervention is address the IV site, not transfusion reaction -make sure to evaluate the question A client who has recently undergone sx for a tracheostomy is now at home. The nurse recognizes a need for immediate intervention when the caregiver does which of the following • Remove old tracheostomy ties before the new ones are secured • 10 sec suction • Don’t cut 4x4 – aspiration risk – always use split gauze ! • If no split gauze available – cut around it PRIORITY QS GUIDELINES : -ABC -Nx process - if asking for assessment make sure the answer you pick addresses assessment - verify that the question has enough assessment information – then provide intervention answers -SAFETY AND RISK REDUCTION -Maslow’s – you must meet phys needs before safety Ex- breathing problem – side rails not priority Respiration cut off : 12 • 13-16 = still okay • 12 below – intervene SCI – expected findings • Low bp , hr Older adult – schedule for colonoscopy – priority = PLACE PORTABLE COMMODE AT BEDSIDE ED : preg reports a hx of G3P2 which should be the nx’s initial action after observing a presenting part -prep for delivery of the NB in the ED A nurse enters the room of a client who is at the foot of the bed lying on the floor. Which should be the initial be the initial nx action? • Assess vital signs and loc (global options) PRIORITY STRATEGIES: 1. Survival potential – pg 22 a. Red – immediate, don’t delay tx b. Yellow - c. Green d. Black 2. Least restrictive/invasive 3. Acute/Chronic 4. Stable/Unstable 4days after a ventral hernia repair, a client who is obese and has hx of COPD vomits and reports severe abd pain. The O2 sat is 90%. Which action should the nx implement first? -assess the sx incision site A nx provides care for a client who is 24 hrs post acute mi and reports “I cant breathe now that I am lying down after lunch?” Which should be the nx initial action • Place in high-F position Respiratory strider – narrowing of the airway -priority is incubate – keep it open Default strategies: 1. Time elapsed 2. Pre,intra,post 3. Early vs late s/s -pay attn to priority interventions required Disorientation post injury for 12 hrs- not expected can indicate head injury = increased ICP Client admitted 12 hrs ago following mvc . Multiple skeletal fractures were sustained . Client is in balanced suspension traction – shallow respiration’s is expected A nurse provides care for a client who is sched for ECT which med should you withhold? Phenytoin – anticonvulsant Atropine sulfate – common antisecretion Methohexital – sedative? Succinylcholine – paralytic A home health nurse is performing an admission assessment on a client who had a knee arthroplasty one wk ago. Which client statement should concern the nx? • “I am so glad to be off those blood thinners” – needs to be 2 weeks – most critical ` • Putting a pillow under the knee a wk later is okay post arthroplasty More default strategies: 1. Stay w/ client 2. Use what you know 3. Prevent harm to the client – safety risk /reduction 4. Safe/effective delegation 5. Look for the most complete answer Client has not voided 8 hrs following cath removal . Priority? • Perform bladder scan = least invasive Nx provides care for chest tube client , gets disconnected priority action? • Immerse the end of the CT in a bottle of sterile water Client death from CVA, partner at the bedside priority? Stay w/ client at the beside Client newly Dx w/ RA, and is Rx methotrexate therapy . Whats AE? Methotrexate – suppressed immune system • Low wbc 1200 • Platelets 5,000 • Oral temp 37.2 (99f) Note for temperature – if increased = oncology emergency (not an AE of methotrexate) AP: DON’T DRINK TEA T- TEACH E- EVAL A-ASSESS Crutches: concern? Client moves leg w/ opposite arm • Weight bearing – use 4 pt gait • Non-w bearing – 3 pt gait • Crutch and bad leg – move the same time PEDS at playground priority? Child squatting after a game of ball – cyanotic sign = not expected , actual problem • (SIGN OF TOF) SOB – BENDS OVER (RECOVERY POSITION) • Allows for better oxygenation Semi coma client after CVA , started on TPN today. Which action to prevent fluid vol deficit? • Monitor blood glucose q4-6hr • High blood glucose causes osmotic dieresis = dehydration • TPN contains a lot of sugar – monitor blood glucose is priority Lithium – monitor Na -Lithium Tox: ND, drowsiness, slurred speech Haloperidol – antipsychotic = EPS high risk AE – neuroleptic malignant syndrome = pt suddenly gets high fever/by , presents rigidity Zolpidem – sedative hypnotic Indication – insomnia SE: daytime fatigue drowsiness, dizziness Monitor : complex behaviors, depression Onset – rapid Esomeprazole : PPI Indication : GERD, Gi ulcer Important to take 1 hr prior to eating SE: NV , abd pain Amiodarone – 1st line drug for Vtach Indication : a fib, fib, vtach SE: pulm tox, liver injury, heart block Findings for respiratory failure: dyspnea, diminished breath sounds, rales, friction rub Aripiprazole: atypical antipsychotic Indication : schizo, major dep disorder , autism, bipolar mania SE: anxiety, insomnia, agitation , EPS (low risk) Concerns: increased depression / SI Epoetin : growth factor Indication : anemia (CKD/chemo) SE: htn, thrombotic stroke , clotting of AV fistula Labs to monitor : H/h, bun, K , iron Risedronate: biphosphonate = increases bone density Indication: osteoporosis Concerns : drink full glass of water, empty stom, 30 mins before eating, sit/stand after they eat for 30 min, due to high gerd risk SE: bone pain, leg cramps, colitis Pregabalin : anticonvulsant Indication : neuralgia, partial seizures, fibromyalgia SE: dizziness, ataxia, confusion, w gain Concern: how would the nx assess pain in non verbal pt? Grimacing , guarding, restlessness Aspart : insulin Indication : type ½ D SE: hypoglycemia Concern : give w/in 5-10 mins , 15 min threshold Diltiazem: CCB Indication: htn, angina, afib, aflutter, svt SE: hf, peripheral edema Concern: w gain, edema , Varenicline (Chantix?): Smoking cessation aid Indication: aid efforts to stop smoking SE: N, anorexia, unusual dreams, mood changes, SI thoughts Concern: start 1 wk prior to quitting smoking, must take for 3 mos (12 wks) Furosemide : loop diuretic Indication: he, renal/hepatic failure, uncontrolled htn, pulm edema SE: hypokalemia, ototoxicity Concern: assess for ototoxicity: -observe for ringing in the ear, indifference, turning up vol, irritability when conversing (when unable to hear) Levofloxacin : Antibiotic Indication: pneumonia, sinusitis, skin inf SE: tendinitis, photosensitivty Concern:client exp joint plain : notify hcp for tendinitis/tendon rupture -stop infusion Atorvastatin: statin Indication : lower cholesterol, LDL level , raise HDl levels Se: rhabdomyolysis, hepatotoxic Concern: alt/ast, rhabdo : myoglobin , CK (gets too high kidneys cant excrete = kidney failure) Sildenafil : Phosphodiesterase inhibitor ( ED) Indication:ED SE: hypotension , priapism, flushing, ha Concern: contraindicated w/ nitroglycerin = life threatening hypotension can occur -both vasodilators Sertraline : SSRI IndicationL depression, ocd, ptsd , panic attacks SE: insomnia , agitation, w gain, sexual dys, SI Concerns : 14 day break from SSRI to MAOI FENTANYL : NARCOTIC ANALGESIC Ind: chronic pain, sx analgesia, control of breakthrough pain in clients taking other opioids SE: resp depression, sedation Fluticasone: Glucocorticoid Ind: asthma , allergic rhinitis SE: oropharyngeal Propranolol Concern: black box warning : slows hr/ by • Exacerbation of angina / MI if abruptly d/c • Affects beta cells in lungs – note for bronchoconstrction Donepezil : cholinesterase inhibitor Concern: take at bedtime, may cause unusual dreams , implement safety Lisinopril Concern: SE dry cough • Must be on reliable birth control, assoc w/ fetal injury/death Rifampin: for Tb Concern: liver tox, causes body secretion to turn orange, dark urine, light stools, RUQ pain Enoxaparin: LMWH Concern : bleeding , neuro injury Antidote : vit k Leadership and Management: Management styles: 1. Authoritative a. Ex. Code situation 2. Laissez-Faire : a policy or attitude of letting things take their own course w/o interfering a. Ex. Smoothing 3. Democratic Conflict resolution: 1. INTRA: yourself 2. INTER : between 2 or more people 3. INTERGROUP: department / organization Collaboration – win-win Competing – win-lose Cooperating – lose-win Smoothing – not fixing the problem Avoiding – lose-lose A nx preps a staff in service on incident reports. Which info should the nx include ?sata - risk management investigates the incident – T -copy of report is placed in the clients record – F -reports include description of incident and actions taken – T - reports are confidential and not shared w/ noninvolved staff – T -document in the nurse’s notes- F A nx is unsure of the proper technique when caring for a client who is rx enteral feedings . Which actions should the nx take? • Consult the unit procedure manual for guidance A nx admits a client from a long term care . Which actions should be implemented? -verify the admin meds rx by the provider T -review the current med regimen w/ the client T - obtain the most recent list of meds from the lt facilty T -locate a list of discharge meds from the most recent hospitalization -Discuss any discrepancies w/ the hcp T DELEGATION & PRIORITIZATION RIGHT : person, tasks, circumstances, directions, supervision The Rn asks the ap to ambulated w/ a client who is 2 days postop. Then Rn tells the AP to ambulated 200 yards q2h • Missing supervision and direction A nx cares for a client w/ terminal lung cancer. Which action should be delegated to the AP? -assist the client to ambulated to the beside chair twice a day -Complete vital that include o2 sats q4h No: obtaining specimen A nx cares for group of clients on med surg unit . Which client should be delegated to the PN? • Facial lacerations w/ subdural hematoma • -newly dx dm type 2 • Bronchitis receiving bronchodilator tax • Exacerbation of myasthenia Gravis admitted 3 hr ago • Advanced reg diet 2 days postop cholecystectomy AP: ADLS Vitals W I/o Safety PN: Stable client Data collection Reinforcement teaching RN Unstable client Assess teach, plan care PN should notify RN immediately when? • When client baseline reg spica pulse is 88 and is not 120 Admin med first for : a scheduled IV antibiotic for a client w/ resolving pneumonia Types of consent: general, implied, informed Role of Rn – witness, make sure they understand COMMUNITY HEALTH Provide tertiary care to fam Develop influenza vaccine program for refugee center Speaks to adolescents about the impact CULTURALLY COMPETENT PG 23 Asian – health achieved by restoring balance Hispanic – soup/herbal tea to speak healing Mormon – alcohol coffee, and tea not permitted Jews – milk / meat not served same meal Pharmacology A nx cares for a client receiving vanco IV therapy . Which lab vocal should prompt the nurse to question a med dosage increase? • Don’t increase if serum peak level that is higher than expected TPN : more concentrated solution = hypertonic CCB – slow movement of calcium on the cells = vasodil slows hr Can lead to signs of HF Monitor for this not to get worse Doesn’t have the same -suffixes Very – verapamil Nice - nifedipine Drugs – diltiazem