Med Surg ATI Proctored Exam Flashcards
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Questions and Answers

Which of the following actions should the nurse plan to take before performing ocular irrigation?

  • Assess the client's visual acuity prior to irrigation
  • Perform the irrigation with sterile water for irrigation (correct)
  • Hold the irrigator syringe 3.81 cm (1.5 in) above the eye
  • Have the client turn their head toward the unaffected eye
  • What is the setting in drops per minute for administering lactated ringer's at 200 ml/hr with a drop factor of 10 drops/ml?

    33 gtt/min

    Which client statement indicates an understanding of discharge teaching for sublingual nitroglycerin?

  • I can take up to five tablets in 15 minutes before seeking medical attention
  • I should lie down when I take this medication (correct)
  • I should discontinue this medication if I develop a headache
  • I can keep my medications for 1 year before replacing it
  • Which instruction should the nurse include in the discharge teaching for a client following a left total hip arthroplasty?

    <p>Install a raised toilet seat in your bathroom</p> Signup and view all the answers

    Which action should the nurse take for a client following a cardiac catheterization?

    <p>Maintain the client's affected extremity in extension</p> Signup and view all the answers

    Which statement by a client indicates adaptation to using crutches?

    <p>I will need to have my partner take over shopping for groceries and cooking the meals for us</p> Signup and view all the answers

    Which assessment finding indicates a client is experiencing dehydration?

    <p>Decreased BP</p> Signup and view all the answers

    For a client with a contusion of the brainstem and high urinary output, which IV medication should the nurse anticipate?

    <p>Desmopressin</p> Signup and view all the answers

    What should the nurse advise a client who has a nagging dry cough after starting an ACE inhibitor?

    <p>Your cough may require that you stop or change your medication</p> Signup and view all the answers

    Which finding should the nurse identify as a potential trigger for exacerbations of Raynaud's disease?

    <p>Using a nicotine transdermal patch</p> Signup and view all the answers

    What should the nurse take first when a client with a central venous access device experiences dyspnea and tachycardia?

    <p>Clamp the catheter</p> Signup and view all the answers

    For a client with reddened areas over bony prominences, which intervention should the nurse include in the care plan?

    <p>Support bony prominences with pillows</p> Signup and view all the answers

    What is the priority action for a home health nurse visiting a client with multiple sclerosis?

    <p>Discuss recommendations for eating and swallowing techniques</p> Signup and view all the answers

    Which action should the nurse take first when assessing a client in the emergency department?

    <p>Initiate airborne precautions</p> Signup and view all the answers

    For a client at increased risk for colorectal cancer, what finding should the nurse identify?

    <p>History of Crohn's disease</p> Signup and view all the answers

    What should the nurse say to a client unsure about having a mastectomy?

    <p>I can give you additional information about the procedure</p> Signup and view all the answers

    Identify the sequence of steps a nurse should follow when preparing to administer a unit of packed RBCs.

    <p>Obtain venous access using a 19-gauge needle</p> Signup and view all the answers

    Which instruction should the nurse include for a client with mucositis related to chemotherapy?

    <p>Floss your teeth following each meal</p> Signup and view all the answers

    What Glasgow Coma Scale score should the nurse assign to a client with a severe head injury who doesn't respond to painful stimuli?

    <p>5</p> Signup and view all the answers

    Which statement indicates understanding of sodium intake restrictions for a client with heart failure?

    <p>I can have a frozen fruit juice bar for dessert</p> Signup and view all the answers

    What is the first action the nurse should take when preparing for ocular irrigation after a chemical splash to the eye?

    <p>Collect information about the irritant that caused the injury</p> Signup and view all the answers

    Which of the following findings should the nurse intervene immediately after extubation?

    <p>Stridor</p> Signup and view all the answers

    Which laboratory finding should the nurse expect for a client with acute pancreatitis?

    <p>Elevated blood glucose</p> Signup and view all the answers

    What finding should a nurse expect in a client with diabetes insipidus?

    <p>Urine specific gravity 1.001</p> Signup and view all the answers

    Study Notes

    Ocular Irrigation and Eye Care

    • Perform ocular irrigation with sterile water to flush out chemicals or irritants.
    • Assess visual acuity prior to irrigation.
    • Hold irrigator syringe approximately 1.5 inches above the eye.

    IV Infusion Calculations

    • Continuous IV infusion of lactated Ringer's at 200 ml/hr requires a rate of 33 gtt/min using tubing with a drop factor of 10 drops/ml.

    Sublingual Nitroglycerin

    • Advise to lie down when taking sublingual nitroglycerin.
    • Replace medication every 6 months; do not stop if headaches occur without consulting a provider.
    • Up to five tablets may be taken within 15 minutes before seeking emergency care.

    Post-Hip Arthroplasty Care

    • Recommend installing a raised toilet seat for ease of use after hip arthroplasty.
    • Crossed legs should be avoided to prevent dislocation.

    Cardiac Catheterization Recovery

    • Maintain the affected extremity in extension and keep patient on bed rest for the prescribed duration.

    Role Change Adaptation

    • Acknowledge the necessity for a partner to assist with household tasks after acquiring crutches.

    Gastroenteritis and Dehydration

    • Decreased blood pressure is a key sign of dehydration in gastroenteritis patients.

    Brainstem Injury Care

    • Anticipate a prescription for desmopressin in cases of excessive urinary output in clients with brainstem injury.

    ACE Inhibitor Side Effects

    • A nagging dry cough often arises from ACE inhibitors, possibly necessitating a change in medication.

    Raynaud's Disease Triggers

    • Using nicotine transdermal patches may exacerbate symptoms of Raynaud's disease.

    Central Venous Access Care

    • In the case of disconnection leading to dyspnea, first action: clamp the catheter to prevent air embolism.

    Skin Integrity in Older Adults

    • For intact skin with reddened areas over bony prominences, support with pillows; do not massage.

    Multiple Sclerosis Home Care

    • Prioritize discussing eating and swallowing recommendations to enhance safety and nutrition.

    Emergency Department Protocols

    • In assessing a client, initiate airborne precautions to prevent the spread of infection.

    Colorectal Cancer Risk Factors

    • A history of Crohn's disease classifies as a significant risk factor for colorectal cancer.

    Mastectomy Patient Education

    • Provide comprehensive information about the mastectomy procedure to alleviate concerns.

    Blood Transfusion Protocol

    • Follow a specific sequence for administering packed RBCs, including obtaining venous access and verifying compatibility.

    Mucositis Management

    • Flossing teeth after meals is crucial in patients with mucositis to maintain oral hygiene without irritation.

    Glasgow Coma Scale Assessment

    • A score of 5 indicates severe impairment with non-responsiveness to stimuli, decerebrate posturing, and incomprehensible sounds.

    Sodium Intake in Heart Failure

    • Heart failure patients should adhere to a 2 g sodium limit; healthy alternatives include frozen fruit juice for dessert.

    Emergency Ocular Care

    • Collect information about the irritant causing eye injury as the first action before irrigation.

    Post-Extubation Monitoring

    • Stridor indicates a potential airway obstruction and requires immediate intervention post-extubation.

    Acute Pancreatitis Laboratory Expectations

    • Elevated blood glucose levels are common in cases of acute pancreatitis, signaling metabolic distress.

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    Description

    Test your knowledge with these flashcards focused on the Med Surg ATI proctored exam. Each card presents a scenario relevant to ocular irrigation and emergency procedures. Enhance your nursing skills and preparation for clinical situations by reviewing these important concepts.

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