Topics To Review Med surge proctored exam remediation PDF

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ATI Medsurge practice questions and answers...

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Topics To Review Med-surge ATI Proctored exam 1. Burns: First Aid for a Minor Burn (RM AMS PN 11.0 Chp 67 Burns,Active Learning Template: Basic Concept)  Stop the burning process.  Remove clothing or jewelry that might conduct heat. apply cool water soaks or run cool water over injury; Do not use ice  Flush chemical burns with a large volume of water .  Cover the burn with a clean cloth to prevent contamination in hypothermia  provide warmth 2. Arthroplasty: Reinforcing Client Teaching Following Total Hip Arthroplasty (RM AMS PN 11.0 Chp 60 Arthroplasty,Active Learning Template: Therapeutic Procedure)  Arthroplasty is surgical removal of a disease joint due to osteoarthritis, osteonecrosis, rheumatoid arthritis, trauma, or congenital abnormalities , and replacing it with prosthetics or artificial components made of metal and or plastic  Extensive physical therapy is required to regain mobility  Monitor for evidence of incisional infection  Care for the incision . Clean it daily with soap and water  Monitor for deep vein thrombosis  Perform deep breathing and coughing, and use incentive spirometer to prevent respiratory complications 3. Home Safety: Reinforcing Teaching with Client about Home Safety (RM Fund 10.0 Chp 13 Home Safety,Active Learning Template: Basic Concept)  Remove items that could cause the client to trip, such as a throw rugs or loose carpet.  Place electrical cords and extension cords against a wall behind furniture .  monitor gate in balance, and provide aids as needed  Make sure the steps in sidewalks are in good repair  Place grab bars near the toilet and in the tub or shower, an install a stool riser  Use non skid mat in tub or shower  Place a shower chair in the shower and provide a bedside commode if needed  Ensure that lighting is adequate inside and outside of the home 4. Infection Control: Reinforcing Teaching About Methods of Infection Control (RM Fund 10.0 Chp 11 Infection Control,Active Learning Template: Basic Concept)  Use frequent and effective hand hygiene before and aftercare  educate the client in acts for a return demonstration of good oral hygiene  Encourage the client to consume an adequate amount of fluids  For immobile clients, ensure that pulmonary hygiene is done every two hours or as prescribed  Use aseptic technique and proper personal protective equipment in the provision of care to all clients prevent unnecessary exposure to micro organisms

5. Hypertension: Reinforcing Teaching About Heart Disease Prevention (RM AMS PN 11.0 Chp 31 Hypertension,Active Learning Template: System Disorder)

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 Maintain body mass index less than 30  Clients who have diabetes Chucky blood glucose within recommended reference range  Limit caffeine alcohol intake  Stress management techniques  Stop smoking  Engage in exercise at least three times per week  Limit sodium and fat intake Immunizations: Identifying Immunization Needs for an Older Adult Client (RM AMS PN 11.0 Chp 75 Immunizations,Active Learning Template: Growth and Development)  pneumococcal vaccine : two types are available  Follow recommendations for admin to adults who are immune compromised  For adults 65 years in order who have not been immunized with PCV13 or PP SV23  No additional Bose is required for adults who received a dose of PPSV23at age 65 years or older Osteoporosis: Reinforcing Teaching to Decrease Risk (RM AMS PN 11.0 Chp 62 Osteoporosis,Active Learning Template: System Disorder)  Is sure the diet includes adequate amounts of calcium, phosphorus, and vitamin D, especially before age 35  Take calcium supplements with vitamin D if dietary intake is inadequate  Limit the amount of carbonated beverages which contain phosphorus and can cause calcium loss  Expose areas of skin to sun 5 to 30 minutes twice a week  Discuss the pros and cons of post-menopausal hormone replacement therapy with the provider  Engage in weight bearing exercises: walking, lifting weights, or climbing stairs Tuberculosis: Collecting Data From the Site of a Tuberculin Skin Test (RM AMS PN 11.0 Chp 20 Tuberculosis,Active Learning Template: Diagnostic Procedure)  read within 48 to 72 hours  An ID injection of an exact of the tubercle ballas is made  And induration, palpable, raised, Harden area, of 10 millimeters or greater in diameter indicates a positive skin test  An induration of 5 millimeters is considered a positive skin test for immunocompromised clients  A positive Mantoux test indicates that the client have developed a immune response to TB. It does not confirm that active disease is present period clients who have been treated for TB can have a positive reaction Opioid Agonists and Antagonists: Manifestations of Opioid Toxicity (RM Pharm PN 8.0 Chp 31 Opioid Agonists and Antagonists,Active Learning Template: System Disorder)  Respiratory distress: withhold opioids for respiratory rate less than 12 breaths per minute . Have naloxone and resuscitation equipment on standby  Constipation: increase fluid and fiber intake in physical activity  Orthostatic hypotension: sit or lie down if feeling lightheaded or dizzy. Provide assistance with ambulation as necessary. avoid sudden changes in positions by slowly moving from lying to a sitting position or standing position.

10. Osteoarthritis and Low-Back Pain: Interventions for Feeding Difficulty (RM AMS PN 11.0 Chp 64 Osteoarthritis and LowBack Pain,Active Learning Template: Basic Concept)  A physical therapist can instruct the client on muscle strengthening exercises, application of heat, diathermy, ultrasonography, or stretching and strengthening exercises  A nutritionist may assist the client in diet for weight loss in relation to reduce activity level, providing teaching regarding a balanced diet and foods high in calcium and vitamin D  A occupational therapist is used to increase independent functions such as personal care in home skills like eating 11. Postoperative Nursing Care: Nursing Actions for Postoperative Pain (RM AMS PN 11.0 Chp 85 Postoperative Nursing Care,Active Learning Template: Basic Concept)  Provide continuous pain relief through the use of a patient control analgesia pump. Intra tracheal infusions are also used post operatively. Monitor pain level frequently  Encourage the client to ask for pain medication before pain gets severe  Monitor for manifestations of pain  Monitor for adverse effects of opioids  Encourage the client to change position slowly  Provide analgesia 30 minutes before ambulation or painful procedures  Monitor for effectiveness of pain medication after administration 12. Cardiovascular and Hematologic Disorders: Evaluating Client Understanding of Dietary Changes to Prevent Hypertension (RM Nutrition 7.0 Chp 12 Cardiovascular and Hematologic Disorders,Active Learning Template: System Disorder)  Dash diet is a low sodium, high potassium, high calcium diet that has proven to lower blood pressure and cholesterol  Decrease sodium intake  Foods high in sodium include canned soups and sauces, potato chips, pretzels , smoked meats, seasonings, and processed food  Include low fat dairy products to promote calcium intake  Include fruits and vegetables rich in potassium such as: apricots, bananas, tomatoes, potatoes  Limit alcohol  Other lifestyle changes include exercising, weight loss, smoking cessation 13. Gastrointestinal Disorders: Foods for a Client Who is Recovering From Gastroenteritis (RM Nutrition 7.0 Chp 13 Gastrointestinal Disorders,Active Learning Template: Basic Concept)  Ease back into eating.  Otherwise, gradually begin to eat bland, easy-to-digest foods, such as soda crackers, toast, gelatin, bananas, applesauce, rice and chicken.  Stop eating if your nausea returns. Avoid milk and dairy products, caffeine, alcohol, nicotine, and fatty or highly seasoned foods for a few days. 14. Angina and Antilipemic Agents: Interactions with Nitroglycerin (RM Pharm PN 8.0 Chp 21 Angina and Antilipemic Agents,Active Learning Template: Medication)  Drinking alcohol can contribute to the hypotensive effect of nitroglycerin  Anti hypertensive medications : beta blockers, calcium channel blockers, diuretics can contribute to hypotensive effect

Clients taking PD E5 inhibitors: sildenafil, tadalafil, vardenafil. These meds taking concurrently with nitroglycerin can result in life threatening hypotension Non-Opioid Analgesics: Medication That Have Cross-Sensitivity With Sulfa (RM Pharm PN 8.0 Chp 30 Non-Opioid Analgesics,Active Learning Template: Medication)  Second generation NSAIDS: Celecoxib  Clients who have cardiovascular disease require caution when taking second generation NSAIDS  Celecoxib Suppresses inflammation, relieves pain , decreases fever, and protects against colorectal cancer  And allergy to sulfaonamides is a contradiction for receiving celecoxib Dosage Calculation: Calculating Caloric Intake for Weight Loss (RM Pharm PN 8.0 Chp 3 Dosage Calculation,Active Learning Template: Basic Concept)  I can't find the answer in the book but apparently I just added incorrectly. Pain Management: Collecting Data to Determine Pain Status (RM AMS PN 11.0 Chp 4 Pain Management,Active Learning Template: Basic Concept)  Pain is whatever the person experiencing says it is, and it exists whenever the person says it does. The clients report of pain is the most reliable diagnostic measure of pain. Self report using standardized pain scales is useful for clients older than seven years old period  Specialized pain scales are available for use with younger children. Like the cry scale or the face scale.  Monitor for and document pain (the 5th vital sign )according to the client's condition and agency guidelines. Pain is categorized by duration (acute or chronic ) or by origin ( nociceptive or neuropathic) .  Use a focus assessment to obtain subjective data Gastrointestinal Therapeutic Procedures: Monitoring Total Parenteral Nutrition (RM AMS PN 11.0 Chp 40 Gastrointestinal Therapeutic Procedures,Active Learning Template: Therapeutic Procedure)  Review daily laboratory test to monitor for metabolic imbalance. Monitor for hypoglycemia  A pressure change during tubing changes can lead to air embolism. The nurse monitor from manifestation of an air embolism: sudden onset of dyspnea, chest pain, anxiety, hypoxemia  Observe the central line insertion sites for local infection: tenderness, exudate, erythema  Do not use TPN line for other Ivy bolus fluids and medication . Repeated access increases the risk of infection  Observed from manifestations of systemic infection: fever, increased WBC, chills, malaise Heart Failure and Pulmonary Edema: Laboratory Values (RM AMS PN 11.0 Chp 28 Heart Failure and Pulmonary Edema,Active Learning Template: Basic Concept)  B-type natriuretic peptides (BNP) : If clients who have dyspnea, Elevated BNP confirms a diagnosis of heart failure rather than a problem originating in the respiratory system. BNP levels direct the aggression of treatment interventions  Less than 100 pg/mL indicate to know heart failure 

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 Greater than 100 pg/mL suggest heart failure is present 20. Respiratory Diagnostic and Therapeutic Procedures: Interpreting Arterial Blood Gases (RM AMS PN 11.0 Chp 15 Respiratory and Diagnostic Therapeutic Procedures,Active Learning Template: Diagnostic Procedure)  PH : amount of free hydrogen ions in the arterial blood (7.35-7.45)  PA 02: partial pressure of oxygen  PA CO2: partial pressure of carbon dioxide (35-45)  HCO 3 : concentration of bio carbonate in arterial blood (21-28)  SA 02: percentage of oxygen bound to HGB as compared with the total amount that can be possibly carried (95-100%)  Blood pH levels less than 7.35 reflect acidosis, and levels greater than 7.45 reflect alkalosis 21. Integumentary and Peripheral Vascular Systems: Checking for Pallor (RM Fund 10.0 Chp 30 Integumentary and Peripheral Vascular Systems,Active Learning Template: Basic Concept)  pallor : loss of color  Location: face, conjunctiva, nailbeds, palms, lips, buccal mucosa  Indication: anemia, shock, or lack of blood flow 22. Gastrointestinal Structural and Inflammatory Disorders: Postoperative Complications (RM NCC PN 11.0 Chp 22 Gastrointestinal Structural and Inflammatory Disorders,Active Learning Template: Therapeutic Procedure)  perform standard postoperative care : monitor VS, O2 , providing pain management  Keep the infant pain for you to decrease crying and stress on repair  Monitor operative sites for indications of crusting, bleeding, an infection  Avoid having infants suck on a nipple or pacifier  Monitor taken out takes in way daily observe family interaction  Reinforce teaching to parents on postoperative diet and feeding techniques 23. Emergency Nursing Principles and Management: Priority Action For a Client Who Has Hemophilia (RM AMS PN 11.0 Chp 2 Emergency Nursing Principles and Management,Active Learning Template: System Disorder)  Hemophilia is a hereditary bleeding disorder in which blood clots slowly and abnormal bleeding occurs. It is caused by a deficiency in the most common clotting factor, factor VIII (hemophilia A).  Aggressive factor replacement is initiated to prevent hemarthrosis that can result in long-term loss of range of motion in repeatedly affected joints. 24. Heart Failure and Pulmonary Edema: Findings to Report to the Provider (RM AMS PN 11.0 Chp 28 Heart Failure and Pulmonary Edema,Active Learning Template: System Disorder)  A life threatening medical emergency : acute pulmonary edema  Expected findings: anxiety, tachycardia, acute respiratory distress , dyspnea at rest, change in level of consciousness, ascending fluid level within lungs  cardiogenic shock: serious complication of pump failure that occurs commonly following an MI an injury to greater than 40% of the left ventricle  Expected findings : tachycardia, hypertension , diminished urinary output, altered LOC , respiratory distress  Pericardial tamponade: this can result from fluid accumulation in the pericardial SAC

Expected findings: hypo tension, jugular vein distention, muffled heart sounds,, paradoxical pulse Infections of the Renal and Urinary System: Manifestations of Cystitis (RM AMS PN 11.0 Chp 52 Infections of the Renal and Urinary System,Active Learning Template: System Disorder)  Older adult manifestations : confusion, incontinent, loss of appetite, nocturia and dis urea , hypertension, tachycardia, tachypnea, and fever  Expected findings : lower back pain , lower abdominal pain and discomfort over the bladder area, N/ V, urinary frequency an urgency, dysuria, itching, hematuria, pyuria, fever, little pee, discharge, cloudy or foul smelling urine Seizures and Epilepsy: Caring for a Client During a Generalized Tonic-Clonic Seizure (RM AMS PN 11.0 Chp 6 Seizures and Epilepsy,Active Learning Template: System Disorder)  Protect the clients privacy  Protect the client from injury  Position the client to provide a Peyton airway  Be prepared to suction oral secretions  Turn to client to decide to decrease the risk of aspiration  Loosen restrictive clothing  Do not attempt to open the jaw or insert airway during seizure activity  Do not use padded tongue blades  Document onset of duration of seizures an findings Skin Disorders: Reinforcing Client Teaching About Psoriasis Treatment (RM AMS PN 11.0 Chp 66 Skin Disorders,Active Learning Template: System Disorder)  Topical therapies: use warm, moist, inclusive dressings of plastic wrap after applying the topical medication. These can be left in place up to 8 hours each day. Avoid application of medication on the face or into skinfolds. Medication may be applied to the scalp  Vitamin D analogs: sun exposure due to increase risk of developing skin cancer., taking pregnancy test prior to application of the medication. Expect some burning or stinging following application . Do not apply the medication onto the face or skinfolds  Vitamin A : avoid exposure to sunlight or artificial UV light. Use reliable forms of birth control . Discontinue use if pregnancy occurs. Valvular Heart Disease and Cardiac Inflammatory Disorders: Identifying Location of a Mitral Valve Heart Murmur (RM AMS PN 11.0 Chp 29 Valvular Heart Disease and Inflammatory Disorders,Active Learning Template: Nursing Skill)  Systolic murmur at the apex  S3 sounds  Fatigue and weakness, a trio fibrillation, orthopedic, A-fib, atypical chest pain, palpitations, JVD, pitting edema, pulmonary congestion, crackles in the lungs, possible diminished lung sounds , hepatomegaly Stroke: Priority Findings to Report (RM AMS PN 11.0 Chp 9 Stroke,Active Learning Template: System Disorder) PN Data Collection 28 53.6% The data collection step of the nursing process  The left cerebral hemisphere: expressive and receptive aphasia, right extremity hemiplegia or hemiparesis, slow, cautious behavior, depression, anger , visual changes 

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The right cerebral hemisphere: alter perception of deficits , loss of death perception, poor impulse control and judgment, inability to solve problems, emotional liability, left hemiplegia or hemiparesis, visual changes, such as hemianopsia other manifestations: agnosia , alexia, agraphia, unilateral neglect syndrome, apraxia, incontinent of bowel and bladder...