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ATI study guide

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
Cushing’s Syndrome Physical Symptoms (increased cortisol and androgens), lifelong therapy, eat high calcium/Vit D, avoid infection   thin, fragile skin, bruising and petechiae, hypertension, tachycardia, weight gain, moon face, truncal obesity, buffalo hump, fractures, muscle wasting in extremities, Hirsutism, acne, red cheeks, striae, fever, swelling  
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Abnormal lab values revealing possibility of Cushing’s Syndrome   hyperglycemia, hypernatremia, hypocalcemia, hypokalemia (also lymphocytopenia)  
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proper use of quad cane, which leg   use on same side as affected leg  
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HF management, report weight gain of ___ pounds per ___ to HCP   2, day  
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a trach/intubated patient needs suction when an assessment of breath sounds is ___ and there is a presence of ___   abnormal, rhonchi  
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PICC line location   into superior vena cava  
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PICC line dressing change schedule: opaque - change every ___ days; transparent - change every ___   3 days, 24 hours  
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PICC line patient teaching – port used for long-term ___ ___   administration (antibiotic)  
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Nitro patient teaching – position, tablet placement, details of timing of use   sit down, nitroglycerin tablet under tongue, If pain is unrelieved in 5 minutes, client should call 911 or be driven to ER, take up to 2 more doses at 5 minute intervals  
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Patient has a chest tube and the water seal chamber is low on water, nursing action?   refill water  
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Family teaching of patient with conscious sedation   NPO ā 6hrs, do not walk around, no driving, sign informed consent  
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expected side effect and a complication of dialysis   hypotension is an expected side effect; hyperglycemia is a complication  
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contraindication of heparin use   low platelet count (thrombocytopenia)  
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Accutane contraindicated in a client with a ___   rash  
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Nurse's role during seizure   protect from injury, patent airway, prepare suction of oral secretions, turn client on side, loosen clothing, do not attempt to restrain client, do not open jaw or insert airway during seizure activity, do not use tongue blades, document onset, duration  
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Signs of digoxin toxicity   muscle cramps, weakness (hypocalcemia)  
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COPD patient experiencing SOB, nursing action   check ABC’s, check O2 saturation  
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First action when patient experiences VFIB   shock first  
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patient on Lasik, sign that its working   urine output >30mL/hr  
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How would you position a patient post liver biopsy?   lie on right side (liver side) to allow for pressure on incision  
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sign treatment is effective for myxedema coma   increase in O2 saturation, able to breathe  
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unexpected drainage color in NG tube   red-blood  
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reason for compression wrap on below the knee amputation   reduce swelling  
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Crohn's disease dietary recommendation   ↑ fiber,↓ fat,↓ sugar  
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sign/symptom of retinal detachment – acute ___ ___   vision loss  
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ART line, arm at ___ ___, tube pressure must remain at same pressure as ___ ___   heart level, heart pressure  
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What color should the fluid exiting the bag during peritoneal dialysis be?   clear  
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peritoneal dialysis bag placement   Keep outflow bag lower than client’s abdomen (drain by gravity, prevent reflux)  
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patient has a positive Mantoux skin test, next action is to perform what diagnostic procedure   chest x-ray  
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signs that patient has hearing difficulty   loud TV, turning head when listening, asking to repeat  
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meningitis assessment finding   nuchal rigidity  
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colostomy education, empty bag when?   at 1/4-1/2 full  
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skin ulcer care   rotate patient to relieve pressure  
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post-pacemaker implant precautions   don’t lift arm up, keep arm in sling  
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sign of hypocalcemia   muscle weakness  
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sign of circulation issue - decrease in? (2)   decrease in pulses, decrease in capillary refill  
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patient receiving RBC transfusing, becomes flushed, first nursing action   slow down infusion  
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signs, symptoms of hypervolemia   pink frothy sputum, HTN, crackles  
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effective Epogen treatment will result in increased   activity, RBC (used to treat anemia)  
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when to hold digoxin   low heart rate (<60bpm), teach patient to check HR and hold medication if necessary  
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ABG's post surgery, check for increase in ___   CO2 (caused by not breathing enough, holding in carbon dioxide)  
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regular intervention for patients on TPN   finger sticks for glucose (can cause hyperglycemia because they are NPO)  
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patient teaching for oxycontin   long acting medication, do not crush  
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patient has esophageal varices, how are they fed?   PEG tube  
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MI initial treatment   MONA (morphine, oxygen, nitro, aspirin)  
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gastric bypass nutrition education   1 cup per meal, 2 servings of protein per day  
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best way to check placement of ET tube   chest x-ray  
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gout is an excess of ___ ___   uric acid  
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What is hypervolemia?   fluid overload  
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how to assess pain   pain scale  
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identify STEMI on a ECG   baseline elevated on S-T interval  
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total hip replacement, can never ___ ___ again   cross legs  
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IV medication administration through PICC line, flush with ___ ___   normal saline  
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nursing actions with fractures (4)   check pulses, capillary refill, pain, risk for compartment syndrome  
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an ostomy should appear ___, ___, ___   red, beefy, moist  
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actions for hemorrhagic shock   stop bleeding, then administer isotonic fluid bolus  
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hormone replacement therapy side effect   hypercalcemia  
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signs that fluid replacement is working   no HTN, normal capillary refill, normal pulses  
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HF patients should avoid   salt  
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post bronchoscopy important assessment   oxygen saturation  
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(3) signs, symptoms of a perforated ulcer   increased temperature, increased WBC, dark stools  
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lab value - hematocrit   male 42-52, female 35-47  
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lab value - sodium   135-145  
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lab value - BUN   10-20  
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lab value - glucose   60-100  
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patient treated for DVT, you suspect PE because of increase in work required to breathe and SOB, nursing action (3)   assess, ABC’s, treat with O2  
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priority assessment after endoscopic retrograde cholangiopancreatography (ERCP)   gag reflex  
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teach patients with SLE to use   sunblock  
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mucositis interventions   examine mouth several times a day, document lesion location/size, avoid glycerin-based mouthwash, topical anesthetic prior to meals, discourage salty/acidic/spicy food, mouth care before/after meals, rinse-half 0.9% NaCl/peroxide, soft bristle toothbrush  
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