VATI Focused Review Questions

VATI Funds assessment Focused Review Questions: What interventions should a nurse take when caring for a client with a wound evisceration? - Call for help - Notify PCP immediately due to need for surgical intervention - Cover the wound any protruding orgasn with sterile towels or dressings soacked with strile normal saline solution - Position client supine with hips and knees bent - Observe for indications of shocl - Keep NPH in preperating for returning surgery A nurse is teaching a client about pursed-lip breathing. What should be included? - Form the mouth as if preparing to whistle - Take a breath in thru nose and our thru lips/mouth - Not puff the cheeks - Tape breaths deep and slow What interventions should be taken when caring for a client that has a fever? - Antipyretics) acetaminophen and aspirin help reduce fever and discomfort What questions would a nurse ask to assess a client’s sensory function? f - Can you tell me what I am placing in your hand right now Do Romberg tests Babinski test A nurse is caring for a client who has a tracheostomy. Identify how often oral care should be completed for this client and the reason why. - Provide oral care every 2 hr and as needed. - Maintain hygiene, maintain patency of the airway and to avoid infection . Pharmacology Assessment: Focused review questions: A nurse is caring for a newborn whose mother is an alcoholic. Describe withdrawal symptoms this newborn may exhibit. - CNS: High pitched cry, - Intense crying - Irrtiabilty - Tremors - Increase moral reflex - Hypertonicity - Nasal congestion with flaring - Frequent yawning - Retractions - Apnea - Tachypnea List two (2) actions the nurse should take following a near miss medication error. First the nurse should notify the nurse manager of the near miss incident, and then document the event in an incident report within the specified time frame, usually 24 hours - Notify the nurse manager Then document the event In an incident report within the specified time frame, usually 24 hrs. A new nurse is orienting to the labor and delivery unit. List three (3) potential adverse effects this new nurse should know prior to administering oxytocin. - FHR abnormalities Uterine hyperstimulation Dizziness. Med Surg Assessment: Focused review Questions: A nurse reviews an order for ceftriaxone in combination with vancomycin for a client diagnosed with meningitis. Identify three (3) components of the medication prescriptions that, if missing, would require clarification with the provider. - - Antibiotics given until culture and sensitivity results are available. Effective for bacterial infections. What type of fluids should be used to infuse? What mg/strength of dose of each of the medications, how long they should be infused and in what concertation of each medication should be used. 5 patient rights should be adhered to and included such as right patient as well, time dose, route, and medication. A preceptor is explaining the plan of care for a client receiving brachytherapy. Identify four (4) nursing actions the novice nurse should understand for this client’s care. - Follow protocol for proper removal of dressings and bed linens from the room. ( in most cases, all linens and dressings are kept in the client room until the radiation source is removed). - Place client in private room. Keep door closed as much as possible. - 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. A nurse is planning care for a client who has shingles. List three (3) nursing actions to include during care. - Contact precautions Gloves and gown word by caregivers and visitors . Dispose of infections dressing material into a single nonpours bag without touching outside of the bag. - Maternal Newborn Focused review questions A client asks about expected weight gain during pregnancy. What is the best response by the nurse? - Recommended weight gain during pregnancy; usually 25-35 lbs. Underweight clients should gain 28-40 lb Overweight client should gain 15-25 lb A client asks the nurse what are indications for a cesarean birth. Provide three (3) reasons a cesarean birth may be necessary. - Indications for C- birth would include: - Prior cesarean birth Nonreasoning fetal heart tones Breech, transverse lie Placenta anomalies; placenta previa, abruptio placentae A nurse is assisting a client with breastfeeding. Name two (2) client statements that would require further evaluation. - Statements regarding postpartum blues - Statements regarding depression