ATI COMPREHENSIVE EXIT EXAM 2023 WITH NGN ATI COMPREHENSIVE EXIT EXAM 2023 WITH NGN REAL EXAM 2023
eggs what to ask before MMR allergy to eggs or neomyc... [Show More] in when on nitroprusside monitor: cyanide. normal value should be 1. William's position
semi Fowler's with knees flexed to reduce low back pain
S/S of hip fx
External rotation, shortening adduction Fat embolism
blood tinged sputum r/t inflammations. Increase ESR, respiratory alkalosis. Hypocalcemia, increased serum lipids. complications of mechanical ventilation pneumothorax, ulcers Paget's disease
tinnitus, bone pain, elnargement of bone, thick bones with allopurinol no vitamin C or warfarin! IVP requires
bowel prep so bladder can be visualized acid ash diet
cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread alk ash diet
milk, veggies, rhubarb, salmon orange tag in psych is emergent psych thyroid med side effects insomnia. body metabolism increases
Tidal volume is
7-10 ml/kg
COPD patients and O2
2LNC or less. They are chronic CO2 retainers expect sats to be 90% or less
Kidney glucose threshold
180
Stranger anxiety is greatest at what age?
7-9 months..separation anxiety peaks in toddlerhood
when drawing an ABG
put in heparinized tube. Ice immediately, be sure there are no bubbles and label if pt was on O2
Munchausen syndrome vs munchausen by proxy
Munchausen will self inflict injury or illness to fabricate symptoms of physical or mental illness to receive medical care or hospitalization. by proxy mother or other care taker fabricates illness in child multiple sclerosis
motor s/s limb weakness, paralysis, slow speech. sensory s/s numbness, tingling, tinnitis cerebral s/s nystagmus, atazia, dysphagia, dysarthia hungtington's
50% genetic autosomal dominanat disorder.. s/s uncontrolled muscle movements of face, limbs and body. no cure WBC left shift
pt with pyelo. neutrophils kick in to fight infections pancreatic enzymes are taken with each meal! infants IM site
Vastus lateralis
Toddler 18 months+ IM site
Ventrogluteal IM site for children deltoid and gluteus maximus Thoracentesis:
position pt on side or over bed table. no more than 1000 cc removed at a time. Listen for bilateral breath sounds, V.S, check leakage, sterile dressing
Cardiac cath
NPO 8-12 hours. empty bladder, pulses, tell pt may feel heat, palpitations or desire to cough with injection of dye. Post: V.S.--keep leg straight. bedrest for 6-8 hr Cerebral angio prep
well hydrated, lie flat, site shaved, pulses marked. Post--keep flat for 12-14 hr. check site, pulses, force fluids.
lumbar puncture
fetal position. post-neuro assess q15-30 until stable. flat 2-3 hour. encourage fluids, oral analgesics for headache.
ECG
no sleep the night before, meals allowed, no stimulants/tranquilizers for 24-48 hours before. may be asked to hyperventilate 3-4 min and watch a bright flashing light. watch for seizures after the procedure.
Myelogram
NPO for 4-6 hours. allergy hx phenothiazines, cns depressants and stimulants withheld 48 hours prior. Table moved to various positions during test. Post--neuro assessment q2-4 hours, water soluble HOB UP. oil soluble HOB down. oralanalgesics for HA. No po fluids. assess for distended bladder. Inspect site Liver biopsy
administer Vitamin K, NPO morning of exam 6 hrs. Give sedative. Teach pt to expect to be asked to hold breath for 5-10 sec. supide position, lateral with upper arms elevated. Post-position on RIGHT side. frequent VS. report severe ab pain STAT. no heavy lifting 1 wk Paracentesis
semi fowler's or upright on edge of bed. Empty bladder. post VS--report elevated temp. watch for hypovolemia laparoscopy
CO2 used to enhance visual. general anesthesia. foley. post--ambulate to decrease CO2 buildup PTB
low grade afternoon fever pneumonia
rusty sputum; when percuss-will hear dull sounds asthma
wheezing on expiration emphysema barrel chest kawasaki syndrome strawberry tongue pernicious anemia red beefy tongue downs syndrome protruding tongue cholera rice watery stool malaria stepladder like fever--with chills typhoid rose spots on the abdomen diptheria pseudo membrane formation measles koplick's spots sle (systemic lupus) butterfly rash pyloric stenosis olive like mass Addison's bronze like skin pigmentation Cushing's moon face, buffalo hump hyperthyroidism/ grave's disease exophthalmos myasthenia gravis descending musle weakness gullian-barre syndrome ascending muscle weakness angina
crushing, stabbing chest pain relieved by nitro MI
crushing stabbing chest pain unrelieved by nitro cystic fibrosis salty skin
DM
polyuria, polydipsia,polyphagia
DKA
kussmal's breathing (deep rapid) Bladder CA painless hematuria
BPH
reduced size and force of urine retinal detachment
floaters and flashes of light. curtain vision glaucoma
painful vision loss. tunnel vision. halo retino blastoma cat's eye reflex increased ICP
hypertension, bradypnea,, bradycarday (cushing's triad) shock
Hypotension, tachypnea, tachycardia Lymes disease bullseye rash intraosseous infusion
often used in peds when venous access can't be obtained. hand drilled through tibia where cryatalloids, colloids, blood products and meds are administered into the marrow. one med that CANNOT be administered IO is isoproterenol, a beta agonist.
sickle cell crisis two interventions to prioritize: fluids and pain relief.
glomuloneprhitis
the most important assessment is blood pressure children 5 and up
should have an explanation of what will happen a week before surgery
Kawasaki disease
(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms. ventriculoperitoneal shunt
watch for abdominal distention. watch for s/s of ICP such as high pitch cry, irritability and bulging fontanels. In a toddler watch for loss of appetite and headache. After shunt is placed bed position is FLAT so fluid doesn't reduce too rapidly. If presenting s/s of ICP then raise the HOB 15-30 degrees
3-4 cups of milk a day for a child?
NO too much milk can reduce the intake of other nutrients especially iron. Watch for ANEMIA MMR and varicella immunizaions after 15 months! cryptorchidism
undescended testicles! risk factor for testicular cancer later in life. Teach self exam for boys around age 12--most cases occur in adolescence
CSF meningitis
HIGH protein LOW glucose Head injury or skull fx no nasotracheal suctioning otitis media feed upright to avoid otitis media!
positioning for pneumonia
lay on affected side, this will splint and reduce pain. However, if you are trying to reduce congestion, the sick lung goes up! (like when you have a stuffy nose and you lay with that side up, it clears!) for neutropenic pts
no fresh flowers, fresh fruits or veggies and no milk antiplatelet drug hypersensitivity bronchospasm bowel obstruction
more important to maintain fluid balance than to establish a normal bowel pattern (they cant take in oral fluids)
Basophils reliease histamine during an allergic response Iatragenic
means it was caused by treatment, procedure or medication Tamoxifen
watch for visual changes--indicates toxicity post spelectomy
pneumovax 23 is administered to prevent pneumococcal sepsis
Alkalosis/ Acidosis and K+
ALKalosis=al K= low sis. Acidosis (K+ high) No phenylalanine
to a kid with PKU. No meat, dairy or aspartame never give potassium to a pt who has low urine output!
nephrotic syndrome
characterized by massive proteinuria caused by glomerular damage. corticosteroids are the mainstay the first sign of ARDS
increased respirations! followed by dyspnea and tachypnea normal PCWC (pulmonary capillary wedge pressure)
is 8-13 readings 18-20 are considered high first sign of PE
sudden chest pain followed by dyspnea and tachypnea Digitalis
increases ventricular irritability ----could convert a rhythm to v-fib following cardioversion Cold stress and the newborn biggest concern resp. distress Parathyroid relies on vitamin D to work
Glucagon increases the effects of? anticoagulants Sucking stab wound
cover wound and tape on 3 sides to allow air to escape. If you cover and occlude it--it could turn into a closed pneumo or tension pneumo! chest tube pulled out? occlusive dressing
PE
Needs O2!
DKA
acetone and keytones increase! once treated expect postassium to drop! have K+ ready Hirschprung's
diagnosed with rectal biopsy. S/S infant-failure to pass meconium and later the classic ribbonlike/foul smelling stools
Intussusception
Common in kids with CF. Obstruction may cause fecal emesis, current jelly stools. enema--resolution=bowel movements laboring mom's water breaks? first thing--worry about prolapsed cord!
Toddlers need to express
independence! Addison's causes sever hypotension!
pancreatitis
first pain relief, second cough and deep breathe CF chief concern? Respiratory problems a nurse makes a mistake?
take it to him/her first then take up the chain nitrazine paper
turns blue with alkaline amniotic fluid. turns pink with other fluids up stairs with crutches? down stairs with crutches?
good leg first followed by crutches(good girls go to heaven) crutches with the injured leg followed by the good leg. dumping syndrome?
use low fowler's to avoid. limit fluids TB drugs are hepatotoxic! clozapine, Clozaril antipsychotic anticholinergic clozapine s/e
weight gain, hypotension, hyperglycemia, agranulocytosis dehydration
-hypovolemia
- elevated urine specific gravity flumazenil, Romazicon benzo overdose umbilical cord compression reposition side to side or knee-chest short cord discontinue pictocin
TB
A positive Mantoux test indicates pt developed an immune response to TB.
Acid-fast bacilli smear and culture:(+suggests an active infection) the diagnosis is CONFIRM by a positive culture for M TB
A chest x-ray may be ordered to detect active le [Show Less]
