ATI - Predictor Study Notes (updated 2020) – Rasmussen
College
ATI – NCLEX Predictor Remediation Study Notes
Renal Calculi - Pain: Flank pain →
... [Show More] Kidney or Ureter (if pain radiates → stones in
ureter or bladder)
Performing Ear Irrigation: Sterile technique, warm meds, pull up & back, tilt
toward affected ear
Thrombolytic Therapy (Stroke): Reteplase recombinant (rTPA – clot buster)
w/ in 4.5 hours of initial symptoms
Trach care: Dressing ∆, inner cannula ½ hydrogen peroxide, & stoma □ knot
Head injury (changes in LOC): Length of time unconscious & GCS
General anesthesia (post-op): ABC’s – full body assessment, Vitals every 15
minutes, Lateral position (if unresponsive or unconscious - monitor LOC),
Fluids/Electrolytes
Superficial Burns: Painful, pink, red, mild edema (3-6 day healing), damage to
epidermis2
Dialysis (reporting unexpected findings): Temp of 100 degrees, ↓ BP, bleeding,
1 L of fluid = 1Kg, clotting, H/A, Nausea, Disequilibrium syndrome (rapid ↓ BUN &
Fluid volume), anemia, peritonitis, ↑ BG, ↑ cholesterol
Pacemaker (complications): Infection, hematoma, pneumothorax, hemo-thorax,
arrhythmias, pacer spikes before P or QRS, hiccups / muscle twitching
Magnesium (Mg) Sulfate → Increase Mg+ > 1.3 Mg/dL
↑ Mg foods = (Dairy, dark leafy greens veges)
↓ Mg causes → Hyperactive deep tendon reflexes
* Paresthesia’s, muscle tetany, positive chvostek’s & Trousseau’s sign,
hypoactive bowels, constipation, abdominal distention, paralytic Ileus.
TPN Admin: (Total parenteral nutrition) -feeding that bypasses the GI tract.
Fluids are given into a vein to provide most of the nutrients the body needs. Given
when person cannot/ should not receive feedings or fluids by mouth.
Hypertonic (20-50% dextrose), Used in chronic pain, peritonitis, burns,
Infection, etc
No more than 10% hourly, ↑ in rate for body adjustment, check BG
Hyperglycemia, hypoglycemia, vitamin deficiencies, air embolism (clamp, place
in Trendelenburg pos., O2)
Fluid imbalance → Fluid volume excess
Wound Culture specimen: Sterile field, press / rotate over wound surface inside
the wound (center) in drainage3
Diabetes Mellitus (Nephropathy): Kidney damage d/t prolonged ↑ BG &
dehydration
Monitor I & O, Creatinine, BP
Avoid Soda, alcohol, acetaminophen/NSAIDS / 2 – 3 L fluid from food /
beverages
Kidney Biopsy (Post op):
Monitor VS → Client receives sedation
Assess dressings & urinary output (hematuria-blood in urine)
Labs: HgB & Hct values, Admin PRN pain meds, Complications hemorrhage /
infection
Thyroidectomy (Post Op): Needs Thyroid hormone replacement
Client in high fowler’s position, Respiratory (trach supplies) present, Check for
laryngeal nerve damage
Pain management, Hypocalcemia / Tetany can occur
Prioritization: Apply knowledge to Standards to determine priority action
Systemic before Local – “Life before Limb”
Acute before Chronic
Actual Problems before Potential Future
Listen carefully to clients & Don’t Assume
Recognize & Respond - Trends vs. Transient findings
Recognize indications - Emergencies vs. Expected
Delegate to LPN: Monitoring Findings, Reinforcing teaching, performing trach care,
suctioning, checking NG tube patency, administer tube feedings, inserting urinary
catheter, administering meds (No IV)4
Delegate to AP: ADLs, Bathing, Grooming, Dressing, toileting, Ambulating, feeding
w/out swallowing precautions, positioning, routine tasks, bed making, specimen
collection, I & O, VS for stable clients, monitoring clinical manifestations after initial
RN assess/eval.
Paracentesis (prep) - take out fluid from belly (peritoneal fluid) Have client VOID
Bariatric Surgery: (weight loss surgery) – Semi fowlers, 6 small meals/day,
liquid/pureed food for first 6 weeks (not to exceed 1cup), Vitamin / mineral
supplements, & 2 servings of protein daily.
Ostomy (in small intestine) Avoid odorous & gas foods (dark green veges,
dairy, fish, eggs, beans, corn), yogurt ↓ gas
Avoid ↑ fiber foods for first 2 months, ↑ fluid intake
Dumping Syndrome: Happens within 15mins of eating.
Sx: cramps, diarrhea, tachycardia, dizziness, fatigue, hypoglycemia
Interventions: small frequent meals, drink liquids 1hr b4/after
Parkinson’s disease: Tremor, muscle rigidity, bradykinesia (slowness in movement),
postural instability
Stages:
1. Unilateral shaking / tremor of one limb
2. Bilateral limb involvement, difficulty walking/balance
3. Slowed physical movements
4. Akinesia & Rigidity make ADL’s difficult
5. Unable to stand/walk, dependent of cares, dementia5
Assault: threat Battery: touching
Hypoglycemia Sx: Shakiness, confusion, sweating, tachycardia, diaphoresis,
palpitations, H/A, lack of coordination, blurred vision, seizures, coma
Oral Hypoglycemic Agents: promote insulin release from pancreas (Type2
DM)
Glipizide (Glucotrol), Chlorpropamide (Diabines), Glyburide (Diabinese),
Metformin (Glucophage).
* Med for insulin overdose = Glucagon
Radiation Adverse Effects: Skin changes, hair loss, debilitating fatigue, 30 minute
visits / stays 6ft away / private room
Infection control in clients home: good hygiene, avoid crowded areas, avoid raw
foods (veges/meats), avoid cleaning litter boxes, clean home and avoid sick family.
Client evacuation in response to fire: greatest good for the greatest amount of
people
Client in seclusion: 18 yo+ → 4 hours, 9 – 17 yo →2 hours, 8 yo & younger →1
hour
Conduct Disorders: lack of remorse, bullies, threatens, low self-esteem, tempers,
physical cruelty, destroys property, truant, and shoplifts
Manic Phase: ↑ mood, irritable, lasts at least a week, euphoria, agitation, restless, ↑
in talking, flight of ideas, grandiose view of self, impulsive, manipulative, poor
judgement, attention seeking.6
Paranoid: distrust / suspiciousness
Schizoid: emotional detachment, disinterest in relationships, indifferent to
praise/criticism, uncooperative
Schizotypal: odd beliefs, eccentric appearance, magical thinking, perceptual
distortions
Antisocial: disregard for others, lack of empathy, unlawful, failure to accept
responsibility, manipulative, impulsive, seductive
Borderline: instability of affect, identity & relationships, splitting behaviors, fear of
abandonment, self-injurious, impulsive
Histrionic: attention seeking, seductive, flirtatious
Narcissist: arrogant, constant admiration, lack of empathy
Avoidant: anxious, wants close relationships, fear of rejection
Dependent: dependency on another individual
OCD: perfectionist, orderly, and control
Clozapine (Anti-psychotic Atypical )
Adverse effects: metabolic syndrome, orthostatic hypotension, anticholinergic effects, agitation, dizziness, sedation, mild EPS, ↑ prolactin
levels(galactorrhea, amenorrhea, gynecomastia), & sexual dysfunction
Anti-lipemic Agents: (Statins) – treats high levels of fats/cholesterol in blood -
called lipid-lowering drugs
Monitor liver enzyme levels (hepatotoxicity) and muscles – monitor CK levels
(myopathy & peripheral neuropathy)7
Med interactions: Fibrates (Genfibrozil) - ↑ myopathy risk, Erythroycin &
Ketoconazole, Amiodarone, & Cyclosprine = Grapefruit juice can ↑ statin
levels
Gentamicin (effects urine output) -causes ototoxicity w/ diuretics, digoxin,
lithium, ototoxic meds, NSAIDs, & anti-hypertensives
Long term therapy for RA: DMARDs (methotrexate, etanercept,
infliximab, adalimubrab, Azathioprine, Cyclosporine)
** Slow joint degradation
Glucocorticoids (Prednisone) & NSAIDs provide symptom relief from
inflammation & pain
Bulb Syringe (for babies): Mouth first, then nose, depress. Then insert into
mouth, avoid center of mouth- may stim. gag reflex.
Priority action to an allergic response:
Mild rashes/hives – Benadryl
Anaphylaxis - treat with epi, bronchodilators, and anti-histamines
Provide respiratory support & notify HCP
Losartan (ARBs -Anti-Hypertensive (HTN) & kidney disease) - Cough &
hyperkalemia are for ace inhibitors.
Side Effects: Angioedema, hypotension, dizziness
Tracheostomy Care: 2 xtra tubes, adequate humidification, oral care every 2 hours,
trach care every 8 hours, sterile suctioning, surgical asepsis to remove / clean inner8
cannula, secure trach ties before removing old, square knot, clean from stoma
outward
Appropriate Doc.: Subjective/objective data, Accurate/concise, Complete/current,
Organized/ date/ time/ blk ink
Crutch safety: Support bodyweight at hand grips with elbows at 30 degrees, Position
crutches on unaffected side when sitting or rising from a chair
Varicella (chicken pox) Transmission: Direct contact, droplet, from person with
shingles, 10-21 days, 1-2 days before lesions appear and all lesions have sabs
Scoliosis: Lateral curvature of spine & spinal/truncal rotation that causes ribs
asymmetry. Curve needs to be at least 10 degrees One leg shorter than the other.
Asymmetry in scapula, ribs, flanks, shoulders, hips.
Screening for Idiopathic Scoliosis: During pre-adolescence - Observe child from
back
Bend at waist with arms handing down & observe for asymmetry of ribs and flank
Measure truncal rotation with a scolio-meter
Use Cobb technique to determine degree of curvature
Use riser scale to determine skeletal maturity
↓ Cardiac output (interventions): Maintain bedrest, Semi fowler’s/ fowler’s
position while awake, Sleep w/ pillows
Cardiac output positioning for optimal output: Left lateral side, Semi fowlers,
Supine with wedge under one hip9
Infant car seat: Position infant in car seat at 45 degree angle, Safety restraints loose
and low on abdomen
Correct use of Condoms: On erect penis, empty space at tip for sperm reservoir
(May be used with spermicidal gel to ↑ effectiveness), Protects against STI’s, only water
soluble lube with latex condoms
Amnio-infusion for Oligohydramnios: (not enough amniotic fluid around fetus)
Infusion or NS or LR into amniotic cavity to reduce severity of variable
decelerations caused by cord compression
Scant amount or absence of amniotic fluid, Membranes must have ruptured to
perform - Warm fluid
Rhogam for Clients who are RH-Negative: (Antibodies from human plasma
injected into RH+ mother to protect fetus)
Chadwick’s sign – violet/blue color or cervix & vaginal mucosa Goodell’s
sign – softening of cervical tip
HSV (Herpes simplex virus): direct contact transmission to fetus is greatest during
vaginal birth if woman has active lesions, Lesions & tender lymph nodes, Obtain
cultures from women who have HSV or are at or near term
Urinary frequency Interventions: ↓ fluid intake b-4 bed, Use perineal pads, and
Kegel exercises ↓ stress incontinence
Buddhist Dietary practices: vegetarian, nuts, legumes (dried peas/cooked beans),
No eggs, no milk products10
Notifiable Communicable diseases: anthrax, botulism, cholera, diphtheria,
gonorrhea, hep A/B/C, HIV, legionaries, lymes, malaria, mumps, pertussis, polio,
syphilis, tetanus, TSS, TB, Typhoid fever, VRSA, At risk populations, transmissions
routes [Show Less]