ati Capstone test bank_Latest Fall 2021- complete solution guide.

Document Content and Description Below

1. what is montelukast (singular) for? a. a leukotriene modifier, and is taken on a regular basis, once a day, and not prn, and is not used for exercise induced asthma 2. what does advance directives ... contain? a. written instructions regarding end of life care 3. what is the greatest risk to a pt receiving hemodialysis? a. disequilibrium syndrome as a result of rapid loss of fluids and decrease bun 4. what is the clinical manifestation of disequilibrium? a. restlessness and decreased level of consciousness 5. what are expected findings in hemodialysis? a. elevated temp weight loss decreased bp 6. what should the nurse do when a pt feels lightheaded and begins to fall? a. spread feet apart and extend one leg for the pt to slide down while lowering the pt to the floor 7. what are the characteristics of a pt with dependent personality disorder? a. they have problems making everyday decision without input from others 8. a pregnant pt who is bleeding is always? a. priority 9. what should a pregnant pt with urgency and frequent urination do? a. should perform kegel exercises should a pregnant pt with odorless vaginal mucus do? a. practice good hygiene, use perineal pads 11.a pregnant pt with edema of the ankles do? prolonged standing, to wear support hose, and rest through out the day with legs/hip elevated should a colostomy bag be changed? is 1/3 ­1/2 full large should the opening of the stoma pouch be? larger than 1/4 inch should the pt with a colostomy avoid? use of moisturizers, which will decrease the adherence of the pouch to the skin should the pt do with the pouch removing it? should empty the pouch to avoid spilling the effluent on to the skin should drops be instill into? the conjuctival sac is a positive way of dealing with a terminal illness? 24."remembering things they used to do together" are normal findings after a colonoscopy? cramping fatigue passage of liquid stools are unexpected finding after a colonoscopy? ing­ can indicate bowel perforation do you do if an order is questioned? nurse should record seeking clarification from the provider should pt with gastritis eat? 32.a well balanced diet, they should keep a record of foods that cause discomfort, pts can modify their diet accordingly is the cause autonomic dysreflexia? er distention are s/s of icp? essness change in LOC is late s/s of ICP? ing pulse decerebrate posturing can a child with varicella(chickenpox) return school? child can return to school when the blisters are dry and no longer drained (scabbed over) is an appropriate behavior of a pt with hx of violence? will avoid violence provoking situations is a skin cancer prevention? should use sunscreen that protects against uva and uvb is the first thing you should do with excessive lochial discharge? rm a fundal massage is the nurse responsibility of the nurse when witnessing the pts signature on an informed consent? the pt is fully informed and understands the procedure befor signing the consent form are at greater risk for std? es because of increased vascularity to the vagina trichomonas vaginalis increased the risk for cervical cancer? 52.NO 53.Gonorrhea can lead to? c inflammatory disease and tubal scarring and can result in infertility should you do with postmortem care? s check about religious practices prior to body preparation in order to honor fam wishes can you not give to a pt with thickened liquids? ice chips no water no icepops can a pt with thickened liquids have? al should a pt do with incentive spirometer? should elevate the cylinder by inhaling deeply assume semi fowlers or high fowlers position order to maintain sterile technique what should the nurse do? d open all sterile packages prior to donning sterile gloves is psycho­motor learning? the pt demonstrate back the procedure places a newborn at risk for respiratory depression? istration of an opioid analgesic exa: fentanyl (sublimaze) is an effective method of bowel retraining? stimulation with a gloved finger after the evening meal, it will help stimulate the gastrocolic reflex inserting an NG tube? nurse should insert the tube into the airway that is patent and has greater airflow technique should be NG tube insertion? technique NG tube meets resistance? nurse should rotate the tube without forcing it past the area of resistance kind of lubricant should be used during NG tube insertion? ­ based lubricant NOT petroleum jelly is pediculosis capitis management? child's clothing in a separate cubicle at school boil brushes and combs in water for 10 mins dry bed lines and clothing in a hot dryer for at least 20 mins can visual disturbances indicate? lampsia is expected 24 hrs after surgery? active bowel sounds pain is an abnormal finding 24 hrs after surgery? HGB must be done in bucks traction? pt must be in proper alignment boots are secured by 3 straps, around pt leg weights must hang freely footplate is resting 15.24 cm (6inches) from the footboard does pts with delirium demonstrate? 90.a fluctuating LOC often at night or in am with dementia demonstrate? culty finding correct words to use with anxiety disorders demonstrate? sive behavior would the nurse determine progression of ascites? inal girth should be measured daily is a food high in potassium? loupe is an indication of peripheral venous disease? 100. brown pigmentation around ankles 101. what is indication of peripheral arterial disease? 102. intermittent, leg muscle pain 103. what is some skin care for pts on radiation therapy? 104. pat area when drying use hand to wash do not use sunscreen 105. what can hydromorpone cause? 106. urinary retention 107. what does bethanechol (urecholine) causes? 108. it stimulates urinary out put 109. how is nystatin best absorb? 110. if given 1 hour before or after a feeding 111. what is a sign that a newborn has finished eating? 112. a slowed suck/swallow pattern is a sign that the newborn is finished eating 113. what not to do when breastfeeding? 114. is not necessary for the entire areola be in the mouth each feeding should start at the opposite breast do not push back of newborns head­toward the nipple 115. what should be included in a stool specimen? 116. visible blood, pus, or mucus 117. what is the first action in an infiltrated IV? 118. to d/c the saline lock 119. what is the first action when preparing to do a dressing change? 120. to determine the pts level of pain 121. what should a with hemonymous hemionopsia with right visual field, what will help pt eat better? 122. the pt should turn head to the right to see all food on tray 123. what are some side effect for theophylline (theo­dur)? 124. is used to prevent wheezing,sob, chest tightness in asthma irregular pulse and dysrhythmias seizures anxiety urinary frequency anorexia n/v diarrhea 125. what should you do when given enoxaparin (lovenox)? 126. it should be injected SUBQ do not aspirate do not massage do not inject in same area 127. what is the babinski reflex? 128. stroke sole of the foot upward, toward the great toe 129. what is the moro reflex? 130. startle the infant by clapping hands` 131. what is the stepping reflex? 132. hold infant upright and allow one foot to touch tables surface 133. what is the palmer grasp reflex? 134. place an object in the palm of infant hand 135. what should you do when catheterizing a male pt? 136. pt should be place in supine position penis should be at 90 degree angle retract the foreskin and clean the glans prior to catherization 137. what color is the meconium? 138. it is the first stool passed and it is dark green and viscous 139. what is an inportant thing to ask when pt having cardiac catherization? 140. if pt allergic to iodine 141. what should be done with nitroglycerin (nitrostat)? 142. if pt continues to have pain after taking 1 tab, they should call 911 and take a second tab 143. what is normal after taking a nitroglycerin (nitrostat) tab? 144. h/a change positions slowly it should be kept in original, dark colored bottle to avoid light exposure 145. what to do for restrains use? 146. observe skin condition before applying restrains use a quick release knot to secure the restraints belt restrains should be placed over pts waist able to insert two fingers under restraints do not use all four side of rails to restrain pt *************CONTINUED**************** [Show More]

Last updated: 1 year ago

Preview 1 out of 45 pages