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VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEW, Exams of Nursing

A.T. Still University of Health Sciences (ATSU)Nursing

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

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2023/2024

Available from 08/08/2024

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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,
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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 (German measles). Salmonellosis. Severe acute respiratory syndrome-

associated coronavirus disease (SARS-CoV). Shigellosis. Smallpox. Syphilis. Tetanus/C. tetani. Toxic shock syndrome (TSS) (other than Streptococcal). Tuberculosis

◆ Recognizing that the timing of administration of antidiabetic and antimicrobial medications is more important than administration of some other medications ➢ Ethical Practice – (1)

▪ 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 health care ◆ 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 require particular 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 and oxygen 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) or delivered via IV such as with radionuclide iodine, which is absorbed by the thyroid ◆ Brachytherapy provides radiation to the tumor and a limited amount to

◆ Place the client in a private room away from other clients when possible. Keep door closed as much as possible. Place a sign on the door warning of the radiation source. Wear a dosimeter film badge that records personal amount of radiation exposure. Limit visitors to 30-min visits, and have visitors maintain a distance of 6 feet from the source. Visitors and health care personnel who are pregnant or under the age of 18 should not come into contact with the client or radiation source. Weal a lead apron while providing care keeping the front of the apron facing the source of radiation. Keep a lead container in the client’s room if the delivery method could allow spontaneous loss of radioactive material. Tongs are available for placing radioactive material into this container. Follow protocol for proper removal of dressings and bed linens from the room.

  • Client Education ◆ Inform the client of the need to remain in an indicated position to prevent dislodgement of the radiation implant. Instruct the client to call the nurse for assistance with elimination. Instruct the client and family about radiation precautions needed in health care and home environments. ➢ Standard Precautions/Transmission-Based Precautions/Surgical Asepsis – (2) ▪ Acute Neurological Disorders: Priority Intervention for Meningitis (RM NCC RN 10.0 Chp 12)
  • The presence of petechiae or a purpuric-type rash requires immediate medical attention
  • Isolate the client as soon as meningitis is suspected, and maintain droplet precautions per facility protocol – droplet precautions require a private room or a room with clients who have the same infectious disease, ensuring that each client has his or her own designated equipment. Providers and visitors should wear a mask. Maintain respiratory isolation for a minimum of 24 hr after initiation of antibiotic therapy
  • Monitor vital signs, urine output, fluid status, pain level, and neurologic status
  • For newborns and infants, monitor head circumference and fontanels for presence of or changes in bulging
  • Correct fluid volume deficits and then restrict fluids until no evidence of increased ICP and serum sodium levels are within the expected range
  • Maintain NPO status if the client has a decreased level of consciousness. As the client’s condition improves, advance to clear liquids and then a diet the client can tolerate
  • Decrease environmental stimuli – provide a quiet environment; minimize exposure to bright light (natural and electric)
  • Provide comfort measures – keep the room cool; position the client without a pillow, and slightly elevate the head of the bed. The client can also be positioned side-lying to reduce neck discomfort
  • Maintain safety (keep the bed in a low position, implement seizure precautions)
  • Keep the family informed of the client’s condition

appearance of the injury. Numerous bruises at different stages of healing can indicate ongoing bearings. Be suspicious of bruises or welts that resemble 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 of social 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 or poor performance ◆ The client might report physical manifestations (actual or factitious) in an attempt 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 challenging situations; 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

the client sit in a room with windows to help with time orientation. Have the client wear an identification bracelet. Use monitors and bed alarm devices as needed. Use restraints only as an intervention of last resort. Use caution when administering medications PRN for agitation or anxiety. Assess the client’s risk for injury and ensure safety in the physical environment, such as a lowered bed. ◆ Cognitive support – provide compensatory memory aids, such as clocks, calendars, photographs, memorabilia, seasonal decorations, and familiar objects. Reorient as necessary. Keep a consistent daily routine. Maintain consistent caregivers. Cover or remove mirrors to decrease fear and agitation. ◆ Physical needs – monitor neurological status. Identify disturbances in physiologic status which can contribute to the cause of delirium. Assess skin integrity which can be compromised due to poor nutrition, bed rest or incontinence. Monitor vital signs. Tachycardia, elevated blood pressure, sweating, dilated pupils can be associated with delirium. Implement measures to promote sleep. Monitor the client’s level of comfort and assess for nonverbal indications of discomfort. Provider eyeglasses and assistive hearing devices as needed. Ensure adequate food and fluid intake. Underlying causes of delirium can result in electrolyte imbalance. ◆ Communication – communicate in a calm, reassuring tone. Speak in positively worded phrases. Do not argue or question hallucinations or delusions. Reinforce reality. Reinforce orientation t time, place, and person. Introduce self to client with each new contact. Establish eye contact and use short, simple sentences when speaking to the client. Focus on one item of information at a time. Encourage reminiscence about happy times. Talk about familiar things. Break instructions and activities into short timeframes. Limit the number of choices when dressing or eating. Minimize the need for decision-making and abstract thinking to avoid frustration. Avoid confrontation. Approach slowly and from the front. Address the client by name. Encourage family visitation as appropriate.

❖ Basic Care and Comfort – (3) ➢ Assistive Devices – (1) ▪ Sensory Perception: Speaking to a Client Who Has a Hearing Impairment (RM FUND 9.0 Chp 45)

  • For clients who have hearing loss – sit and face the clients. Avoid covering your mouth while speaking. Encourage the use of hearing devised. Speak slowly and clearly. Do not shout. Try lowering vocal pitch before increasing volume. Use brief sentences with simple words. Write down what clients do not understand. Minimize background noise. Ask for a sign-language interpreter if necessary. Do not shout. ➢ Mobility/Immobility – (1)

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

❖ Pharmacological and Parenteral Therapies – (7) ➢ Adverse Effects/Contraindications/Side Effects/Interactions – (1)

▪ 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. Crisis situation 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 the airway until spasms subside (usually 5-15 min)
  • Pseudoparkinsonism – bradykinesia, rigidity, shuffling gait, drooling, tremors ◆ Nursing considerations – observe for pseudoparkinsonism for the first month after the initiation of therapy. Can occur in as little as 5 hr following the first dose. 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 the initiation 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 and face, 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. Teach client 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 provider if 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 occur within the first week of treatment or any time thereafter. Stop antipsychotic medication. Monitor vital signs. Apply cooling blankets. Administer antipyretics. Increase the client’s fluid intake. Administer dantrolene or

◆ Nursing considerations – the client should develop tolerance in 1-2 weeks. Monitor blood pressure and heart rate for orthostatic changes. Hold medication until the provider is notified if systolic blood pressure is less than 80 mm Hg. Instruct clients about the indications of orthostatic hypotension (lightheadedness, dizziness). If these occur, advise the client to sit or lie down. Orthostatic hypotension can be minimized by getting up or changing positions slowly. Encourage the client to increase fluid intake to maintain hydration.

  • Sedation ◆ Nursing considerations – inform the client that effects should diminish after about 1 week. Instruct the client to take the medication at bedtime to avoid daytime sleepiness. Advise the client not to drive until sedation has subsided.
  • Seizures – indications – greatest risk in clients who have an existing seizure disorder ◆ Nursing considerations – advise the client to report seizure activity to the provider. An increase in antiseizure medication can be necessary
  • Severe dysrhythmias ◆ Nursing considerations – obtain baseline ECG and potassium level prior to treatment, and periodically throughout the treatment period. Avoid concurrent use with other medications that prolong QT interval
  • Sexual dysfunction ◆ Nursing considerations – advise the client of possible adverse effects. Encourage that the client report effects to the provider. The client can need dosage lowered or be switched to a high-potency agent
  • Skin effects – photosensitivity that can result in severe sunburn. Contact dermatitis from handling medications ◆ Nursing considerations – Advise clients to avoid excessive exposure to sunlight, to use sunscreen, and to wear protective clothing. Advise clients to avoid direct contact with the education
  • Liver impairment ◆ Nursing considerations – assess baseline liver function, and monitor periodically. Educate clients to observe for indications (anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice) and to notify the provider ➢ Central Venous Access Devices – (1) ▪ Cardiovascular Diagnostic and Therapeutic Procedures: Care of the Nontunneled Percutaneous Central Venous Catheter (RM AMS RN 10.0 Chp 27)
  • Description 18-25 cm (7-10 in) in length with one to five lumens. Length of use: short-term use only. Insertion location: subclavian vein, jugular vein, tip in the distal third of the superior vena cava. Indications: administration of blood, long-

term administration of chemotherapeutic agents, antibiotics, and total parenteral nutrition.

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