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VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEW, Exams of Nursing

Chamberlain College of NursingNursing

VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEW VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEW VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEW

Typology: Exams

2023/2024

Available from 08/05/2024

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VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEW
❖
Management of Care – (9)
➢
Advance Directives – (1)
▪
Legal Responsibilities: Purpose of a Living Will (RM FUND 9.0 Chp 4)
•
A living will is a legal document that expresses the client’s wishes regarding
medical treatment in the event the client becomes incapacitated and is facing
end- of-life issues. Most state laws include provisions that protect health care
providers who follow a living will from liability.
➢
Assignment, Delegation and Supervision – (2)
▪
Delegation and Supervision: Delegating Tasks to an Assistive Personnel (RM FUND
9.0 Chp 6)
•
Examples of tasks nurses may delegate to Aps (provided the facility’s policy and
state’s practice guidelines permit)
◆
Activities of daily living (ADLs) – bathing, grooming, dressing, toileting,
ambulating, feeding (without swallowing precautions), positioning
◆
Routine tasks – bed making, specimen collection, intake and output,
vital signs (for stable clients)
▪
Managing Client Care: Delegation Strategy for Effective Task Management (RM
Leadership 7.0 Chp 1)
•
Consideration for selection of an appropriate delegate include the following:
education, training, and experience; knowledge and skill to perform the task;
level of critical thinking required to complete the task; ability to communicate
with others as it pertains to the task; demonstrated competence; the
delegatee’s culture; agency policies and procedures and licensing legislation
(state nurse practice acts)
➢
Case Management – (1)
▪
Cardiovascular Disorders: Tetralogy of Fallot (RM NCC RN 10.0 Chp 20)
•
Tetralogy of Fallot – four defects that result in mixed blood flow: Pulmonary
stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
◆
Cyanosis at birth: progressive cyanosis over the first year of life. Systolic
murmur. Episodes of acute cyanosis and hypoxia (blue or “Tet” spells)
•
Surgical procedures – shunt placement until able to undergo primary
repair; complete repair within the first year of life
➢
Collaboration with Interdisciplinary Team – (1)
▪
Communicable Diseases, Disasters, and Bioterrorism: CDC Reportable Diagnoses
(RM CH RN 7.0 Chp 6)
•
Anthrax. Botulism. Cholera. Congenital rubella syndrome (CRS). Diphtheria.
Giardiasis. Gonorrhea. Hepatitis A, B, C. HIV infection. Influenza-associated
pediatric mortality. Legionellosis/Legionnaires’ disease. Lyme disease. Malaria.
Meningococcal disease. Mumps. Pertussis (whooping cough). Poliomyelitis,
paralytic. Poliovirus infection, nonparalytic. Rabies (human or animal). Rubella
pf3
pf4
pf5
pf8
pf9
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pf13
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VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEW

❖ Management of Care – (9) ➢ Advance Directives – (1) ▪ Legal Responsibilities: Purpose of a Living Will (RM FUND 9.0 Chp 4)

  • A living will is a legal document that expresses the client’s wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. Most state laws include provisions that protect health care providerswho follow a living will from liability. ➢ Assignment, Delegation and Supervision – (2) ▪ Delegation and Supervision: Delegating Tasks to an Assistive Personnel (RM FUND 9.0 Chp 6)
  • Examples of tasks nurses may delegate to Aps (provided the facility’s policy and state’s practice guidelines permit) ◆ Activities of daily living (ADLs) – bathing, grooming, dressing, toileting, ambulating, feeding (without swallowing precautions), positioning ◆ Routine tasks – bed making, specimen collection, intake and output, vitalsigns (for stable clients) ▪ Managing Client Care: Delegation Strategy for Effective Task Management (RM Leadership 7.0 Chp 1)
  • Consideration for selection of an appropriate delegate include the following: education, training, and experience; knowledge and skill to perform the task; levelof critical thinking required to complete the task; ability to communicate with others as it pertains to the task; demonstrated competence; the delegatee’s culture;agency policies and procedures and licensing legislation (state nurse practice acts) ➢ Case Management – (1) ▪ Cardiovascular Disorders: Tetralogy of Fallot (RM NCC RN 10.0 Chp 20)
  • Tetralogy of Fallot – four defects that result in mixed blood flow: Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy ◆ Cyanosis at birth: progressive cyanosis over the first year of life. Systolic murmur. Episodes of acute cyanosis and hypoxia (blue or “Tet” spells)
  • Surgical procedures – shunt placement until able to undergo primary repair;complete repair within the first year of life ➢ Collaboration with Interdisciplinary Team – (1) ▪ Communicable Diseases, Disasters, and Bioterrorism: CDC Reportable Diagnoses (RM CH RN 7.0 Chp 6)
  • Anthrax. Botulism. Cholera. Congenital rubella syndrome (CRS). Diphtheria. Giardiasis. Gonorrhea. Hepatitis A, B, C. HIV infection. Influenza-associated pediatric mortality. Legionellosis/Legionnaires’ disease. Lyme disease. Malaria. Meningococcal disease. Mumps. Pertussis (whooping cough). Poliomyelitis, paralytic. Poliovirus infection, nonparalytic. Rabies (human or animal). Rubella

(German measles). Salmonellosis. Severe acute respiratory syndrome- associatedcoronavirus disease (SARS-CoV). Shigellosis. Smallpox. Syphilis. Tetanus/C. tetani. Toxic shock syndrome (TSS) (other than Streptococcal). Tuberculosis

▪ Professional Responsibilities: Demonstration of Veracity (RM Leadership 7.0 Chp 3)

  • Veracity: the nurse’s duty to tell the truth ➢ Legal Rights and Responsibilities – (1) ▪ Professional Responsibilities: Rights of Clients (RM Leadership 7.0 Chp 3)
  • Client rights are the legal guarantees that clients have with regard to their healthcare ◆ Clients using the services of a health care institution retain their rights as individuals and citizens of the United States. The America Hospital Association (AHA) identifies client rights in health care settings in the Patient Care Partnership (www.aha.org) ◆ Residents in nursing facilities that participate in Medicare programs similarly retain resident rights under statutes that govern the operation of these facilities
  • Nurse are accountable for protecting the rights of clients. Situations that requireparticular attention include informed consent, refusal of treatment, advance directives, confidentiality, and information security. ❖ Safety and Infection Control – (5) ➢ Accident/Error/Injury Prevention – (2) ▪ Medications Affecting Urinary Output: Indications for the Use of a Diuretic (RM Pharm RN 7.0 Chp 19)
  • High-ceiling loop diuretics work in the ascending limb of loop of Henle – block reabsorption of sodium and chloride and prevent reabsorption of water. Causes extensive diuresis even with severe renal impairment
  • They are used when there is an emergent need for rapid mobilization of fluid
  • pulmonary edema caused by heart failure; conditions not responsive to other diuretics, such as edema caused by liver, cardiac, or kidney disease; or hypertension ◆ Unlabeled use – hypercalcemia ▪ Seizures: Maintaining Seizure Precautions (RM NCC RN 10.0 Chp 13)
  • Seizure precautions for any child at risk – pad side rails of bed, crib, and wheelchair; keep bed free of objects that could cause injury; have suction andoxygen equipment available ➢ Handling Hazardous and Infectious Materials – (1) ▪ Cancer Treatment Options: Implanted Internal Radiation Device (RM AMS RN 10. Chp 91)
  • Brachytherapy describes internal radiation that is placed close to the target tissue.This is done via placement in a body orifice (vagina) or body cavity (abdomen) ordelivered via IV such as with radionuclide iodine, which is absorbed by the thyroid ◆ Brachytherapy provides radiation to the tumor and a limited amount to surrounding normal tissues. Waste products are radioactive until the Isotope has been completely eliminated from the body. Waste products should not betouched by anyone.
  • Nursing Considerations
  • Keep the family informed of the client’s condition

▪ Skin Infections and Infestations: Expected Findings of Pediculosis Capitis (RM NCC RN 10.0 Chp 30)

  • Manifestations – intense itching; small, red bumps on the scalp; nits (whitespecks) on the hair shaft
  • Nursing interventions – 1% permethrin shampoo; Spinosad 0.9% topical suspension; Remove nits with a nit comb, repeat in 7 days after shampoo treatment; wash clothing, bedding in hot water with detergent; difficult cases; usemalathion 0.5% ❖ Health Promotion and Maintenance – (2) ➢ Health Promotion/Disease Prevention – (2) ▪ Hepatitis and Cirrhosis: Client Teaching About Viral Hepatitis (RM AMS RN 10. Chp 55)
  • Viral hepatitis is the most common type of hepatitis. After exposure to a virus ortoxin, the liver becomes enlarged from the inflammatory process. As the disease progresses, there is an increase in inflammation and necrosis, interfering with blood flow to the liver. Individuals can be infected with hepatitis and remain freeof manifestations, and therefore are unaware that they could be contagious.
  • Nursing Care – most clients will be cared for in the home unless they are acutely ill. Enforce contact precautions if indicated. Provide a high-carbohydrate, high- calorie, low- to moderate-fat, and low- to moderate-protein diet, and small, frequent meals to promote nutrition and healing. Promote hepatic rest and the regeneration of tissue (administer only necessary medications; avoid over-the- counter medications or herbal supplements; avoid alcohol; limit physical activity). Educate the client and family regarding measures to prevent the transmission of the disease to others at home (avoid sexual intercourse until hepatitis antibody testing is negative; use proper hand hygiene). Provide culturally sensitive care.

▪ Immunizations: Recommendation for Older Adults (RM AMS RN 10.0 Chp 85)

  • Td booster. MMR vaccine. Varicella vaccine. Pneumococcal vaccine. Hepatitis A. Hepatitis B. Influenza vaccine. Meningococcal polysaccharide vaccine (MPSV4) and Meningococcal 4-valent conjugate (MenACWY) vaccine. Human Papilloma virus HPV2, HPV4, or HPV9. Zoster vaccine ❖ Psychosocial Integrity – (5) ➢ Abuse/Neglect – (1) ▪ Family Violence: Evaluating Child Abuse (RM MH RN 10.0 Chp 32)
  • Infants – shaken baby syndrome: shaking can cause intracranial hemorrhage.Assess for respiratory distress, bulging fontanels, and an increase in head circumference. Retinal hemorrhage can be present. Any bruising on an infantbefore age 6 months is suspicious.
  • Preschoolers to Adolescents – assess for unusual bruising, such as on abdomen, back or buttocks. Bruising is common on arms and legs in these age groups. Assess the mechanism of injury, which might not be congruent with the

shape of a belt buckle or other object. Assess for burns. Burns covering “glove” or “stocking” areas of the hands or feet can indicate forced immersion into boiling water. Small, round burns can be from cigarettes. Assess for fractures with unusual features, such as forearm spiral fractures, which could be a result of twisting the extremity forcefully. The presence of multiple fractures is suspicious. Assess for human bite marks. Assess for head injuries, level of consciousness, equal and reactive pupils, and nausea or vomiting.

➢ Mental Health Concepts – (2) ▪ Anxiety Disorders: Expected Findings for a Client who has Social Anxiety Disorder (RM MH RN 10.0 Chp 11)

  • Social anxiety disorder (social phobia) – the client experiences excessive fear ofsocial or performance situations ◆ The client reports difficulty performing or speaking in front of others or participating in social situations due to an excessive fear of embarrassment orpoor performance ◆ The client might report physical manifestations (actual or factitious) in anattempt to avoid the social situation or need to perform ▪ Personality Disorders: Antisocial Personality Manifestations (RM MH RN 10.0 Chp
  • Antisocial – characterized by disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit, and failure to accept personal responsibility; sense of entitlement, manipulative, impulsive, and seductive, nonadherence to traditional morals and values; verbally charming and engaging ➢ Support Systems – (1) ▪ Neurocognitive Disorders: Planning Care for a Stage 2 Alzheimer’s Disease (RM MH RN 10.0 Chp 17)
  • Stage 2: Moderate ◆ Forgetting events of one’s own history. Difficulty performing tasks that require planning and organizing (paying bills, managing money). Difficulty with complex mental arithmetic. Personality and behavioral changes: appearing withdrawn or subdued, especially in social or mentally challengingsituations; compulsive, repetitive actions. Changes in sleep patterns. Can wander and get lost. Can be incontinent. Clinical findings that are noticeable to others.
  • Nursing Care ◆ Perform self-assessment regarding possible feelings of frustration, anger, or fear when performing daily care for clients who have progressive cognitive decline. Nursing interventions are focused on protecting the client from injury,as well as promoting client dignity and quality of life. Provide for a safe and therapeutic environment – assess for potential injury, such as falls or wandering. Assign the client to a room close to the nurses’ station for close

observation. Provide a room with a low level of visual and auditory stimuli. Provide for a well-lit environment, minimizing contrasts and shadows. Have

▪ Musculoskeletal Trauma: Skeletal Traction (RM AMS RN 10.0 Chp 71)

  • Nursing actions – assess neurovascular status of the affected body part every hourfor 24 hr and every 4 hr after that. Maintain body alignment and realign if the client seems uncomfortable or reports pain. Avoid lifting or removing weights. Ensure that weights hang freely and are not resting on the floor. If the weights areaccidentally displaced, replace the weights. If the problem is not corrected, notifythe provider. Ensure the pulley ropes are free of knots, fraying, loosening, and improper positioning at least every 8-12 hr. Notify the provider if the client experiences severe pain from muscle spasms unrelieved with medications or repositioning. Move the client in halo traction as a unit, without applying pressureto the rods. This will prevent loosening of the pins and pain. Routinely monitor skin integrity and document. Use heat/massage as prescribed to treat muscle spasms. Use therapeutic touch and relaxation techniques.
  • Pin Site Care – pin care is done frequently throughout immobilization (skeletal traction and external fixation methods) to prevent and to monitor for manifestations of infection (drainage and redness [color, amount, odor], looseningof pins, tenting of skin at pin site [skin rising up in]). Pin care protocols (chlorhexidine) are based on provider preference and facility policy. A primary concept of pin care is that one cotton swab is designated for each pin to avoid cross-contamination. Pin care is provided usually once a shift, 1-2 times a day, perfacility protocol. ➢ Nutrition and Oral Hydration – (1) ▪ Renal Disorders: Dietary Prevention of Nephrolithiasis (RM Nutrition 6.0 Chp 14)
  • The most common type of kidney stone is made of calcium oxalate. Contributingfactors include inadequate fluid intake, elevated urine pH, and excess excretion through the kidneys of oxalate, calcium, and uric acid. Kidney stone formation ismore influenced by the amount of oxalate in the client’s system than calcium. A client who has an ileostomy has an increased risk of kidney stones
  • Preventative nutrition – excessive intake of protein, sodium, calcium, and oxalates (rhubarb, spinach, beets) can increase the risk of stone formation
  • Therapeutic nutrition – increasing fluid consumption is the primary intervention for the treatment and prevention of kidney stones. Daily fluid intake should be at least 1,500 mL to 3,000 mL. At least 8-12 oz (240-360 mL) of fluid, preferably water, should be consumed before bedtime because urine becomes more concentrated at night. Recommendation for calcium oxalate stone formation is to limit animal protein, excess sodium, alcohol, and caffeine use. Low potassium cancontribute to calcium stone formation. Foods high in oxalates include spinach, rhubarb, beets, nuts, chocolate, tea, wheat bran, and strawberries, and should be limited in the diet. Avoid megadoses of vitamin C, which increase the amount of oxalate excreted. Recommendation for prevention of uric acid stones is to limit foods high in purines, which include lean meats, organ meats, whole grains, and legumes.

▪ Medications for Psychotic Disorders: Screening for Extrapyramidal Adverse Effects (RM MH RN 10.0 Chp 24)

  • Acute dystonia – severe spasm of the tongue, neck, face, and back. Crisissituation that requires rapid treatment ◆ Nursing considerations – begin to monitor for acute dystonia anywhere between 1-5 days after administration of first dose. Treat with an antiparkinsonian agents such as benztropine. IM or IV administration diphenhydramine can also be beneficial. Stay with the client and monitor theairway until spasms subside (usually 5-15 min)
  • Pseudoparkinsonism – bradykinesia, rigidity, shuffling gait, drooling, tremors ◆ Nursing considerations – observe for pseudoparkinsonism for the first monthafter the initiation of therapy. Can occur in as little as 5 hr following the firstdose. Treat with an antiparkisonian agent, such as benztropine or trihexyphenidyl. Implement interventions to reduce the risk for falling.
  • Akathisia – inability to sit or stand still. Continual pacing and agitation ◆ Nursing considerations – observe for akathisia for the first 2 months after theinitiation of treatment. Can occur in as little as 2 hr following the first dose. Manage with antiparkinsonian agents, beta blockers, or lorazepam/diazepam.Monitor for increased risk for suicide in clients who have severe akathisia
  • Tardive dyskinesia (TD) – late EPS, which can require months to years of medication therapy for TD to develop. Involuntary movements of the tongue andface, such as lip smacking and tongue fasciculations. Involuntary movements of the arms, legs, and trunk ◆ Nursing considerations – evaluate the client every 3 months, if TD appears, dosage should be lowered, or the client should be switched to another type of antipsychotic agent. Once TD develops, it usually dose not decrease, even with discontinuation of the medication. There is not a treatment for TD. Teachclient that purposeful muscle movement helps to control the involuntary TD.
  • Neuroendocrine effects – gynecomastia, weight gain, menstrual irregularities ◆ Nursing considerations – monitor weight. Some clients gain 100 lb or more. Advise the client to observe for these manifestations and to notify the providerif they occur.
  • Neuroleptic malignant syndrome – sudden high fever, blood pressure fluctuations,diaphoresis, tachycardia, muscle rigidity, drooling, decreased level of consciousness, coma, tachypnea ◆ Nursing considerations – this life-threatening medical emergency can occurwithin the first week of treatment or any time thereafter. Stop antipsychoticmedication. Monitor vital signs. Apply cooling blankets. Administer antipyretics. Increase the client’s fluid intake. Administer dantrolene or bromocriptine to induce muscle relaxation. Administer

medication as prescribed to treat arrhythmias. Assist with immediate transfer to an ICU.

  • Orthostatic hypotension

➢ Expected Actions/Outcomes – (1) ▪ Parkinson's Disease: Effects of Levodopa (RM AMS RN 10.0 Chp 7)

  • When given orally, medications such as levodopa are converted to dopamine in the brain, increasing dopamine levels in the basal ganglia. Dopaminergics may becombined with carbidopa to decrease peripheral metabolism of levodopa, requiring a smaller dose to make the same amount available to the brain. Side effects are subsequently less. Due to medication tolerance and metabolism, the dosage, form of medication, and administration times must be adjusted to avoid periods of poor mobility ◆ Nursing considerations – monitor for the “wearing-off” phenomenon and dyskinesias (problems with movement), which can indicate the need to adjustthe dosage or time of administration or the need for a medication holiday ➢ Medication Administration – (4) ▪ Bipolar Disorder: Teaching the Client About a Mood Stabilizer (RM Pharm RN 7. Chp 9)
  • Expected pharmacological action – lithium produces neurochemical changes in the brain, including serotonin receptor blockade. There is evidence that the use oflithium can show a decrease in neuronal atrophy and/or an increase in neuronal growth
  • Therapeutic uses – lithium is used in the treatment of bipolar disorders. Lithiumcontrols episodes of acute mania, and helps prevent the return of mania or depression
  • Nursing Administration ◆ Monitor plasma lithium levels during treatment (At initiation of treatment, monitor levels at least 5 days after starting lithium therapy and after any dosage change, until therapeutic level has been achieved; then every 1 to 3 months, depending on length of treatment and stability. Older adult clients often require more frequent monitoring. Lithium blood levels should be obtained in the morning, usually 12 hr after the last dose. During initial treatment of a manic episode, levels should be between 0.8 to 1.4 mEq/L. Maintenance level range is between 0.4 to 1.0 mEq/L. Plasma levels at or greater than 1.5 mEq/L can result in toxicity). Care for clients who have a toxic plasma lithium level in an acute care setting, and provide supportive measures. Hemodialysis can be indicated. Monitor CBC, serum electrolytes, renal function tests, and thyroid function tests during lithium therapy. Advise clients that effects begin within 7 to 14 days. Advise clients to take lithium as prescribed. Lithium must be administered in 2 to 3 doses daily due to a short half-life. Taking lithium with food will help decrease GI distress. Encourage clients to adhere to laboratory appointments needed to monitor lithium effectiveness and adverse effects. Emphasize the high risk of toxicity due to the narrow therapeutic range. Provide nutritional counseling. Stress the importance of adequate fluid and sodium intake. Instruct clients to monitor formanifestations of toxicity and when to contact the provider. Clients should withhold medication and seek medical attention if experiencing