ATiExitReview 2013 B

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1. • Delegating care to **Chronic Trach** is fair game for AP 16. • Preventing contractures Trochanter rolls between the
an AP to suction; Can collect specimens legs
and measure I&O's
17. • Caring for a client in Offer fluids every 2 hours
2. • Nurse Manager's Staffing seclusion
main concern
18. • Phenytoin (Dilantin) Causes Nausea
3. • Organizing Schedule priorities, Focused on
19. • Prenatal care findings to Facial, orbital edema (pre-
workload and time organizing treatments and
report eclampsia)
management scheduled meds by priority.
20. • Risk factor for DM HA1C- Average of glucose
4. • Provide cost ◯ Using all levels of personnel to
for 3 months
effective care their fullest when making
assignments. 21. • Mild Anxiety Heightened perceptual field
◯ Providing necessary equipment 22. • Sibling binding Give the older sibling a gift
and properly charging clients. when the infant receives a
◯ Returning uncontaminated, unused gift
equipment to the appropriate
23. • Teaching relaxation Muscle relaxation techniques
department for credit.
techniques
◯ Using equipment properly to
prevent wastage. 24. • Use of therapeutic involve the peers
◯ Providing training to staff communication with an
unfamiliar with equipment. adolescent
◯ Returning equipment (IV, kangaroo 25. • Postpartum priority action Run warm water over
pumps) to the proper department for difficulty voiding
(central service, central
distribution) as soon as it is no 26. • Pressure ulcers and Apply lubricating lotion to
longer needed. This action will impaired skin integrity the top of the feet
prevent further cost to clients. 27. • Turning a client Chose the answer with the
5. • Reporting client Report the abuse to the Charge sheet
abuse Nurse (chain of command) 28. • Parkinson's disease client rinse mouth out
6. • Elder abuse The family is giving the elderly safety
patient sedative medications 29. • MRI Question Place the client's ring in the
7. • Potential child abuse "the infant should be sleeping safe/vault
throughout the night" 30. • Acarbose med Take medication AFTER the
8. • Prioritizing the - First check for bleeding first bite of foot
needs of multiple (impending shock) 31. • Misoprostol (Cytotec) Foley cath
clients - Second priority is potential cardiac cervical ripening med
emergency
32. • Methersol Osteoporosis
9. • Hyperthermia seizure precautions. (febrile seizures)
33. • Nephrotic diet Low protein, low sodium
10. • Parkinson Meds cause dizziness
34. • Prevent uric acid stones Add citrus to diet (orange)
(Carbidopa/levodopa)
35. • Simvastatin (Lipitor) AE Muscle weakness
11. • Kawasaki disease choose the heart option (can give
the child aspirin) 36. • Contraindications to Nephrotoxic, DO NOT GIVE
Metformin for DM w/ dye
12. • In a chemical take the clothes off incoming
disaster patients 37. • AE of ACE inhibitor Orthostatic hypotension

13. • Practice Resources Clinical Judgement/Clinical Practices 38. • Meds for bipolar disorder, Liver enzymes
labs to monitor
14. • Pressure Ulcers: refer the patient to the wound clinic
Referrals 39. • AE of Proton Pump osteoporosis
inhibitors
15. • Protecting a client cover tubing/equipment
with latex allergy 40. • AE of Methotrexate Immunosuppression
41. • Zidovudine lab values CBC and Platelet count
42. • Teaching about Stop before surgery (5 days or more 65. • ICP Body alignment keep the body positioned
Clopidogrel (Plavix) prior) at the midline, (Elevate the bed 30 degrees
and no suction and quiet environment)
43. • Med Reconciliation Client returning from Surgery
REQUIRES med rec 66. • Sign of ICP Unequal pupils
(eye diagram)
44. • Perforated No pain; "release of pressure within
appendicitis effected area expresses decreased 67. • Burns take the pts clothes off and fluids
pain"
68. • DVT take off once a day, DO NOT fold (could be
45. • Intervention after Increase fluids, monitor for a not what to do ?)
epidural hypotension
69. • Pt. wants to Tell them you will start the process; there is
46. • Pernicious Anemia Schilling test see their med protocol to initiate
DX test record
47. • Collecting a Sterile gloves and change gloves 70. • Non-stress Transducer, Toco
specimen and urine test
culture
71. • Contraindication: History of DVT
48. • Urine culture take from the port Contraceptives
49. • Risk factor for Overdue child 72. • Celiac diet Potato pancakes (no gluten: wheat or
newborn grains)
hypoglycemia
73. • Infant cord Keep it dry
50. • Expected findings A warming feeling care
during cardiac cath
74. • Frayed cord Remove it
51. • Gastric Bipass Puree for 6 months in client room
surgery
75. • NG tube Sit patient up, High Fowlers
52. • Evaluating Increase CD4
76. • NG tube, why To rest the bowels
antiretroviral TX
77. • Thyroid Everything increases
53. • Dehydration in a 3 lethargic; most accurate assessment
storm
month old infant of neonate hydration is daily weights
78. • Paracentesis Sit up right
54. • Feeding a client Stay at eye level; lowered chin action
with dysphagia is desired 79. • Weight loss, check Albumin; low albumin or pre-albumin
and overall indicates malnutrition
55. • Inserting peripheral advance the cath after flash
nutritional
IV
status
56. • After mastectomy decompress the suction bulb
80. • Lyme disease Reportable
57. • COPD High carb diet
81. • Chlamydia Reportable
58. • Hyperthyroidism seizure precautions, decreases
82. • TB Put mask on pt when transferring pt
potassium
83. • Dehydration Causes oliguria
59. • Identifying the A FIB, no P wave; tachycardia
arrhythmia 84. • Vaginal Interventions; insert urinary catheter
radiation
60. • Purpose of To identify dysrhythmias
implant
telemetry
85. • DVT: Measure leg circumference, NOT Homan's
61. • Cancer disorder, infection?
interventions sign (only indicates/supports diagnosis)
client data to report
86. • Interpreter Use hospital interpreter or interpreter line
62. • Assessing a client Petechiae at the trunk
EVERY TIME, ALL THE TIME
who has a fat
embolism 87. • Advance Can be changed by pt
directive;
63. • Complications of A Clot formation
changes?
FIB
88. • Advance Place a copy in the chart
64. • Pulmonary Dyspnea
directive; pt
Embolism
charting
89. • Advance directive Nurse must adhere to wishes of pt 108. Post-mortem body 1. Notify organ procure team
when daughter is designated the prep for organ 2. Remove tubes and vascular lines
power of attorney, **not the harvest 3. Cleanse Body
partner** 4. Collect necessary specimens
5. Apply name tags to client's body
90. • Sexual assault/ rape Priority assessment: Asses the
anxiety level of the patient 109. Serum Sodium less indicates dehydration
than 130
91. • Pt experiencing an "I understand you hear voices, but I
hallucination don't hear them"; therapeutic 110. Crutches Stair 1. Tripod position
response climb 2. Body weight on crutches
3. Advance unaffected leg
92. • If you have a Seek clinical reference. IOM and
4. Advance affected leg with crutches
question about a State Practice Act does not cover
particular med this material. 111. Crutches Make sure rubber tips are secure;
elbows need to be 30 degrees when
93. • Referral for a pt Speech therapy/pathologist
palms rest on handles
who has swallowing
difficulties 112. Tonsillectomy No ice cream
94. • Psych med teens Headache 113. Theophylline (Anorexia), Tachycardia, Albuminuria
toxicity expected and Hypotension
95. • X- ray Cover pelvis to prevent radiation of
finding
ovaries/uterus
114. Breast Cold treatment
96. • Cdiff Gown; contact precautions
engorgement
97. • Naegele's rule Subtract 3 MONTHS and add 7 Treatment
DAYS
115. Steps for Bowel 1. Stay with client and call for help
98. • Hyperthyroidism: Tremors protrusion 2. Place saline soaked gauze on the
S/S wound
99. • Clozapine Weight gain 3. Position client supine with knees
bent
100. Quad cane Never place cane on affected side
4. Take vital signs
(cane should ALWAYS be placed on
UNaffected side) 116. Estradiol Side (Headaches) and High blood pressure
effects
101. Warfarin Client "I should report a change in color of
understanding (watch my stools." (blood in stool indicates 117. Hemolytic Mannitol - causes sweating
for bleeding) bleeding) transfusion
reaction
102. Who to assess first? Post-op client with abdominal
(look for client who distention and absent bowel sounds 118. Hemolytic Tachycardia, LOW BACK PAIN
may have active transfusion
bleed) reaction:
Manifestations
103. Increased ICP (look Memory loss; (Nuchal rigidity is a
for Altered Mental sign of Bacterial Meningitis, but not 119. Bead on the P6 Alternative medicine that aids in
Status) ICP) meridian on wrist alleviation of nausea/vomiting

104. Staffing issues Task (Stages of Change) First action, form 120. Priority findings Bleeding trumps everything
forces (trouble a task force to investigate 121. Newborn Normal - Apnea for 10 seconds;
w/weekend staffing) assessment Acrocyanosis
105. Client teaching: Pre- 1. Report swelling of hands and face 122. Oxygen at home Use COTTON fabrics; Function checks
eclampsia 2. Rest in side-lying position Teaching daily
3. Notify provider of decreased
123. Infant age 1. Sitting unsupported; stranger anxiety
Urine output
indicators (8 months)
4. Perform daily fetal kick counts
2. Drinking from a cup (9 months)
106. CPR for infant Check pulse at Brachial site 3. Ability to say words (12 months)
107. Delegating: Checking AP is qualified to perform BP check; **Anterior fontanel open = less than
Blood Pressure for a Other tasks are not time consuming 18 months**
client on PCA as listed
124. Staffing issues: Float nurses
125. Most common risk factor for
elderly osteoperosis
126. Alkalosis vs Acidosis
If assigning a nurse to a specialized floor he/she is unfamiliar with, assign a nurse on that floor
as a resource for the oncoming nurse.
Sedentary lifestyle; long periods of inactivity