RN Comprehensive Online Practice 2019 A Remediation_2022/2023 | RN Comprehensive Online Practice 2019 A Remediation_Graded. A+

RN Comprehensive Online Practice 2019 (UPDATED 2022) A Remediation – Midlands Technical College 1. DVT – heparin – elevated leg to reduce edema and further risk 2. Child safety a. No skateboarding under 5yo b. No s ...

RN Comprehensive Online Practice 2019 (UPDATED 2022) A Remediation – Midlands Technical College 1. DVT – heparin – elevated leg to reduce edema and further risk 2. Child safety a. No skateboarding under 5yo b. No sun between 1000 and 1400 c. Cut hotdogs lengthwise 3. Infection prevention when on chemo a. No water or liquids at room temperature that have been out for over 1 hour b. Clean toothbrush in dishwasher once weekly c. Take temp once weekly and notify provider if over 100 d. Ambulate short distances to prevent pulmonary stasis and respiratory infections 4. 6m infant diet a. 1 Tbsp/year of age (in general) b. Under 12m – ½ to ¾ Tbsp appropriate c. 100% juice – 120 to 180 ml d (4-6 oz) after 6m 5. Mechanical restrains a. Don’t remove unless client calm, in control, and follows simple commands b. Assess physical needs, safety, comfort q 15-30 min and document c. New Rx q4 hr 18yo and older, q2 hr 9-17 yo, q1 hr under 9yo d. Staff remains continuously with client or constant viewing with audiovisual equipment 6. Umbilical cord prolapses a. Knee-chest position 7. True labor a. Cervix transitions to anterior position and begins to dilate in preparation b. Contractions primarily in lower abdomen and back c. Contractions intensifies with increased ambulation d. Cervix shortens and thins 8. Nurse manager changing scheduling system, action to facilitate a. Provide information about scheduling issues to the staff i. 1st stage of change process is unfreezing stage 1. Informing staff about issues increases understanding of why changes needed 9. Uric acid-based urinary calculi formation a. Can eat citrus fruits b. DO NOT EAT – liver & chicken (organ meats, which contain purine) and red wine the same 10. Estradiol teaching a. Headaches – indicate thromboembolic stroke 11. Multiple sclerosis a. Speech pathologist swallow study – dysphagia is complication b. Rest before eating – rest because of reported weakness and easy fatigue c. Thicken liquids before drinking – dysphagia 12. Chlorpromazine for schizophrenia – report to provider a. Greatest risk – injury from neuroleptic malignant syndrome i. High temp ii. Dysrhythmia iii. Decrease LOC iv. Labile BP 13. Maintain sterile technique with male indwelling urinary catheter a. Open outer flap away from body to prevent contamination of field by reaching over it when opening the remaining flaps b. Clean penis with dominant hand c. Don sterile gloves before touching any items in sterile field d. Place catheter tray on a work surface at or above waist level 14. Cranial nerve – optic II a. Clear objects from walking area 15. Hemolytic transfusion reaction a. Tachycardia b. Low back pain c. Hypotension 16. Child tonic-conic seizure a. Side-lying during seizure to maintain airway, decrease risk of aspiration, facilitate drainage of oral secretions b. Rescue breaths after seizure if child does not begin having spontaneous respirations c. Obtain vitals and ECG following seizure 17. Gastrostomy tube for enteral feedings – medication admin a. Flush with at least 30ml water before and after meds to clear residual in tube b. Crush each medication separately from tube feeding formula c. Change feeding bag and tubing q 24-48 hr to prevent clogs and infection d. Give each medication separate to prevent clogging 18. Macular degeneration a. Decreased central vision i. r/t bleeding int the macula or yellow spots under retina 19. Warfarin instructions understood by patient a. Report change in color of stools i. Red, black, tarry indicates bleeding (AE needs to be reported) b. Acetaminophen increases risk of bleeding c. NO calcium supplements d. Maintain intake of foods with Vitamin K e. Daily blood draws for 1st 5 days to establish appropriate warfarin dosage 20. Cystic fibrosis – priority to report to provider a. Hemoptysis 275ml/24hr i. Indicates risk for hemorrhage b. Report fever – indication of pulmonary infection, but not priority over hemoptysis >275ml/24hr c. Report anorexia and weight loss – indication of pulmonary infection, but not priority 21. Turning patient on right side a. Place pillow under right arm – prevents internal rotation of left shoulder 22. Fractured femur – fiberglass leg cylinder cast for 24hr a. Risks i. Dry, itching skin – offer hair dryer to use on cool to blow air on the skin to relive itching, not priority ii. Swelling and pain – when leg in dependent position; elevate leg to reduce edema and pain, not priority iii. Skin breakdown – caused by wet cast; ensure drying (fiberglass cast is waterproof), not priority b. Heel reddened and tender – pressure injury; priority assessment 23. Hepatitis A a. Clean kitchen surfaces with hydrogen peroxide to kill virus and prevent transmission b. Encourage safe food handling with hand hygiene 24. Enoxaparin injection a. Subcutaneous tissue of the periumbilical area 25. Skeletal traction for femur fracture priority a. Reposition or check weights to relieve muscle spasms, not priority b. Provide analgesia to relieve moderate pain level, not priority c. Upper chest petechia i. Greatest risk is organ damage from fat embolism syndrome 1. Obstructs blood vessels of major organs (lung, kidney, brain) 2. S/S – petechiae upper torso, dyspnea, hypoxia, headache, lethargy, confusion 26. Lithium for bipolar – priority to report a. Confusion – early manifestation of lithium toxicity i. Monitor for additional indications of toxicity – coarse hand tremors, incoordination, ECG changes, sedation b. Expected AE and nonurgent – lethargy, polyuria, fine hand tremors 27. Tracheostomy care a. 1st - Remove inner cannula b. 2nd - Remove soiled dressing c. 3rd - Clean stoma with 0.9% sodium chloride irrigation d. 4th - Change tracheostomy collar 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. MDMA a. Diaphoresis b. Increased tactile sensitivity c. Lowered inhibition d. Chills e. Muscle cramping f. Teeth clenching g. Mild hallucinogenic effects 29. Misoprostol and on long-term therapy with NSAIDs for arthritis teaching a. Pregnancy test before taking if childbearing age – causes contractions b. Diarrhea c. DOES NOT coat stomach; reduces gastric acid secretion so ulcers can heal and reduces risk of new ulcers developing d. AVOID magnesium-containing antacids – increase risk of diarrhea 30. Hypokalemia a. Hypoactive bowel sounds (decreased gastrointestinal mobility) b. Muscle weakness and decreased DTR 31. Abruptio placentae findings a. Persistent uterine contractions b. Board-like abdomen c. DARK RED vaginal bleeding 32. Placenta previa a. Fundal height > than expected gestational age b. Relaxed uterus c. Bright red vaginal bleeding 33. Preeclampsia a. Hyperactive DTR 34. Bipolar (manic phase) a. grandiose delusions b. euphoric c. abrupt mood changes d. expansiveness e. unlimited energy f. poor impulse control 35. Avoidant personality disorder a. Hypersensitive to criticism b. Exhibit feelings of inadequacy c. Fear of rejection 36. Borderline personality disorder a. Fear of real or imagined abandonment 37. Schizoid personality disorder a. Reclusive behavior b. Social withdrawal 38. Sublimation – accused of stealing, goes to gym to get out anger a. Substitutes socially unacceptable behavior for acceptable behavior 39. Vitamin A sources a. 1 medium raw carrot – 2,025 mcg b. ½ cup cooked raw spinach – 737 mcg c. ½ cup cooked butternut squash – 714 mcg d. 1 cup sliced cantaloupe – 516 mcg 40. Ear drops a. Over 3 – up and back b. Under 3 – down and back 41. Hemodialysis via AV fistula a. ROM okay to keep up muscle strength b. Auscultate for bruit q4 hr – indicates patency c. Palpate for thrill at the fistula – indicates patency – report absence 42. Car seat a. Rear-facing until 2yo or exceeds height and weight limit 43. Child with HSV a. Contact precautions – gloves in close contact 44. Amylase increased a. Acute pancreatitis, cholecystitis, renal failure 45. Troponin T a. Myocardial muscle protein – 2 to 3 hr after MI 46. LDL a. Risk of CAD and PVD i. Increases risk of MI - levels do not increase with MI 47. Homocysteine a. Risk for ischemic heart disease, cerebrovascular disease, PVD – DO NOT increase with MI 48. Amitriptyline for depression teaching a. Avoid foods that contain tyramine b. Common SE is constipation and dry mouth i. Increase fiber, fluids, chew sugar-free gum for anticholinergic effects of dry mouth and constipation c. Monitor for hypotension and change position slow d. Take hs to promote sleep and minimize drowsiness during day 49. Vomit on reusable BP cuff a. Labeled bag to send for decontamination 50. Newborn (2 hr old) a. PP 80-100 when sleeping, up to 180 crying b. RR 30 – 60 c. Temp 36.5/97.7 – 37.5/99.5 (97.2 – report to provider) 51. Emergency preparedness plan implementation a. 1st – notify incident commander to initiate command hierarchy and maintain order b. 2nd – contact triage officer to ensure personnel are available to evaluate incoming patients c. 3rd – implement patient tracking system to make client room assignments and inform family members d. 4th – Release press statement 52. Insulin injection prep a. Inject 20 units air into NPH vial first and withdraw needle without touching insulin b. Then inject 15 units air into the regular vial 53. 2 hr post cardia catheterization – info to report a. Neurologic status – slurred speech and extremity weakness – indication of stroke (potential complication of cardiac catheterization) 54. Thrombocytopenia a. Avoid venipuncture when possible – bleeding risk 55. NG tube insertion delegation a. LPN – NG tube insertion in scope of practice b. AP – stool specimen, preparation of postop bed 56. Cardiac tamponade finding a. pulsus paradoxus i. Systolic BP is 10mmHg or greater on expiration than inspiration, as an expected finding of cardiac tamponade, along with jugular vein distention, bradycardia, and hypotension 57. Delirium a. Rapid speech - Exhibit rapid, inappropriate, incoherent, and rambling speech patterns 58. Snellen test school-aged child with glasses instructions a. Keep both eyes open during test b. Screen with glasses, then without c. Stand 3m (10ft) away from chart d. To pass a line, identify four of the six symbols correctly 59. Insulin is high alert medication – check dosage with another nurse 60. Acupressure bands on wrists used to alleviate n/v in pregnancy 61. TPN pump not working, what to do while waiting on new one to come a. Provide dextrose 10% in water solution using manual drip tubing at 60 mL/hr. i. Use an infusion pump when administering TPN solution to ensure accurate dosage and should taper the infusion rate before discontinuing the solution to prevent hypoglycemia. ii. If the nurse is unable to continue the TPN infusion by infusion pump, the nurse should use manual drip tubing to infuse dextrose 10% in water at the same rate as the TPN solution. 62. NG gastric lavage a. 0.9 NS, sterile water, or tap water for irrigation of NG tube b. Instill solution in volumes of 200-300 ml at a time to reduce risk of injury c. After instilling lavage solution, manually withdraw solution and blood from NG tube d. Use solution at room temp 63. Clozapine for schizophrenia contraindication a. WBC 2,800/mm3 i. Clozapine can cause agranulocytosis, which can be life threatening. Therefore, a WBC count of less than 3,000/mm3 is a contraindication for the client to receive clozapine. The nurse should withhold the medication and notify the provider of the client's WBC count. 64. Kawasaki disease a. Acute phase i. Fever unresponsive to antibiotics or antipyretics ii. Tachycardia b. Sub-acute phase i. Pain in eight-bearing joints ii. Peeling of palms and hands and soles of feet 65. Cystic fibrosis – on O2 therapy for past 36 hr – indication of O2 toxicity a. Substernal pain – r/t increased work of breathing 66. Colostomy care of two-piece pouching system a. Place skin barrier over stoma and hold for 30 sec – to activate adhesive 67. Plasma administration a. Administer each unit over 30-60 min b. Slow rate of infusion if indications of overload 68. Autonomic dysreflexia s/s a. Facial flushing b. Nasal congestion c. Headache d. Blurred vision RN Comprehensive Online Practice 2019 B Remediation 1. Chron’s disease and enteroenteric fistula nutrition instructions a. Decrease fiber – to reduce diarrhea and inflammation b. Increase calories to 3,000 per day to promote fistula healing c. Increase protein – promote healing of fistula d. Increase potassium – risk for hypokalemia