127, Head and Neck: Assessing Visual Acuity Using a Snellen Chart (ATI pg 146), -Use to screen for myopia. -ADLs- Bathing, grooming, dressing, toileting, ambulating, feeding(without swallowing precautions), positioning. Young adults at risk for: A middle adult client tells the nurse, "I feel so useless now that my children do not need me anymore." Which of the following changes should the nurse identify as an indication that the treatment was successful? Lastly, clients who are febrile and clients who are exposed to prolonged hot environmental temperatures will lose bodily fluids as the result of sweating and these unpercernable fluid losses. "When descending stairs, I will first shift my weight to my right leg.". -turn on music to comfort them, Integumentary and Peripheral Vascular Systems: Findings to Report From a Skin Assessment, Older Adults (65 Years and Older): Identify Expected Changes in Development, Older Adults (65 Years and Older): Teaching About Manifestations of Delirium, -infection (especially UTI-first manifestation!!!) Which of the following findings should the nurse identify as a potential indication of abuse? Edema is most often identified in the dependent extremities such as the feet and the legs; however, it can also become obvious with unusual abdominal distention and swelling. ATI Fundamentals Practice Exam 2016 Flashcards | Chegg.com Many people on a weight reduction diet or a diet to increase their weight are based on calories counts. Which of the following actions should the nurse take to prevent the spread of infection? For example, the client is assessed using the A, B, C and Ds of a nutritional assessment in addition to the use of some standardized tools such as the Patient Generated Subjective Global Assessment and the Nutrition Screening Inventory. ***Relaxation- meditation, yoga, and pregressive muscle relaxation. Determine the molecular formula of a compound that has the following composition: 48.648.648.6 percent C,8.2\mathrm{C}, 8.2C,8.2 percent H\mathrm{H}H, and 43.243.243.2 percent O\mathrm{O}O, and the molar mass is approximately 148g/mol148 \mathrm{~g} / \mathrm{mol}148g/mol. Clients must be encouraged to drink these supplements as ordered and the client's flavor preference should also be considered and provided to the client whenever possible. -Help clients establish and follow a bedtime routine. A nurse is caring for a client who has an indwelling urinary catheter. -Cutaneous stimulation- transcutaneous electrical nerve stimulation(TENS) heat, cold, therapeutic touch, and massage. The nurse opens the sterile field on a wet surface. Inform patient and family that foley cath drainage bag, and wound, gastric or CT drainage are: closely monitored , measured and recorded and who is responsible. Delegation and Supervision: Delegating Client Care to an Assistive Personnel, Delegation and Supervision: Delegating Tasks for a Client Who is Postoperative to an Assistive Personnel, Delegation and Supervision: Identifying a Task to Delegate to an Assistive Personnel, Ethical Responsibilities: Demonstrating Client Advocacy, Ethical Responsibilities: Recognizing an Ethical Dilemma (ATI pg. Remove tubes and indwelling lines . terrenos en venta houston Queijo Flamengo $ 17.00 - $ 35.00; cuphead infinite health mod Queijo da Serra Amanteigado $ 50.00; influencers church salisbury Biscoitos Amores $ 8.50; grenada wedding traditions Alho e salsa $ 7.50; robert spike'' mickens cause of death Morcela $ 12.25 A nurse on a medical unit is preparing to discharge a client to home. The doctor's order for these nutritional supplements states the name of the specific nutritional supplement and the number of cans per day. 264). 1.Maintaining standard precautions related to body fluids. blue line trax schedule; selena gomez makeup ulta; george m whitesides net worth; Media. The volume of bolus enteral feedings is usually about 200 to 400 mLs but not over 500 mLs per feeding. Identify patients with impaired what? What is the normal urine specimen gravity? ATI Remediation Fundamentals - ATI Remediation Fundamentals - Studocu What do you do if one or more patient's in the same room? Administer pain medication 45 min before changing the client's dressing. Edema is a sign of fluid excesses because edema occurs as the result of increases in terms of capillary permeability, decreases in terms of the osmotic pressure of the serum and increased capillary pressure. A nurse is educating a client who has a terminal illness about her request to decline resuscitation in her living will. Consider purchasing a generator for power backup. Dehydration occurs when one loses more fluid than is taken in. ATI Palliative Hospice Care Activity Gero Sim Lab 2 (CH) Business PLAN OF Pusong Lumpia; QSO 321 1-3: Triple Bottom Line Industry Comparison; Newest. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of nutrition and oral hydration in order to: Assess client ability to eat (e.g., chew, swallow) Assess client for actual/potential specific food and medication interactions. 34% to 40% for Males. -knee flexion: flex and extend the legs at the knees Experts are tested by Chegg as specialists in their subject area. Tachycardia, tachypnea, INCREASED R, HYPOtension, HYPOxia, weak pulse, fatigue, weakness, thirst, dry mucous membranes, GI upset, oliguria, decreased skin turgor, decreased capillary refill, diaphoresis, cool clamy skin, orthostatic hypotension, fattened neck veins!!! 399 0 obj <>stream Fluid Imbalances ATI Flashcards | Quizlet -inspect breasts in front of mirror and palpate in shower A nurse is teaching a client whose left leg is in a cast about using crutches. A nurse is teaching a client and his family how to care for the client's tracheostomy at home. 3. used only for the patient indicated. Which one of the following statement is not equivalent to the other two (assuming that the loop bodies are the same? Clients with poor dentition and missing teeth can be assisted by a dental professional, the nurse and the dietitian in terms of properly fitting dentures and, perhaps, a special diet that includes pureed foods and liquids that are thickened to the consistency of honey so that they can be swallowed safely and without aspiration when the client is adversely affected with a swallowing disorder. -Limit waking clients during the night. Which of the following instructions should the nurse provide to the client and his family? A nurse is caring for a client who is receiving parenteral fluid therapy via a peripheral IV catheter. Nutrition, Feeding, and Eating - ATI Testing 2. at the same time Which of the following instructions should the nurse include in the teaching? A nurse enters a client's room ad finds her on the floor. such as "I am available to talk if you should change your mind.". Which of the following actions should the charge nurse identify as contaminating the sterile field? Measure with a medicine cup. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. Assessing the Client for Actual/Potential Specific Food and Medication Interactions, Considering Client Choices Regarding Meeting Nutritional Requirements and/or Maintaining Dietary Restrictions, Applying a Knowledge of Mathematics to the Client's Nutrition, Promoting the Client's Independence in Eating, Providing and Maintaining Special Diets Based on the Client's Diagnosis/Nutritional Needs and Cultural Considerations, Providing Nutritional Supplements as Needed, Providing Client Nutrition Through Continuous or Intermittent Tube Feedings, Evaluating the Side Effects of Client Tube Feedings and Intervening, as Needed, Evaluating the Client's Intake and Output and Intervening As Needed, Evaluating the Impact of Diseases and Illnesses on the Nutritional Status of a Client, Adult Gerontology Nurse Practitioner Programs (AGNP), Womens Health Nurse Practitioner Programs, Advanced Practice Registered Nurse (APRN), Providing Information to the Client on Common Side Effects/Adverse Effects/Potential Interactions of Medications and Informing the Client When to Notify the Primary Health Care Provider, Non Pharmacological Comfort Interventions, Basic Care & Comfort Practice Test Questions, Assess client ability to eat (e.g., chew, swallow), Assess client for actual/potential specific food and medication interactions, Consider client choices regarding meeting nutritional requirements and/or maintaining dietary restrictions, including mention of specific food items, Monitor client hydration status (e.g., edema, signs and symptoms of dehydration), Apply knowledge of mathematics to client nutrition (e.g., body mass index [BMI]), Manage the client's nutritional intake (e.g., adjust diet, monitor height and weight), Promote the client's independence in eating, Provide/maintain special diets based on the client diagnosis/nutritional needs and cultural considerations (e.g., low sodium, high protein, calorie restrictions), Provide nutritional supplements as needed (e.g., high protein drinks), Provide client nutrition through continuous or intermittent tube feedings, Evaluate side effects of client tube feedings and intervene, as needed (e.g., diarrhea, dehydration), Evaluate client intake and output and intervene as needed, Evaluate the impact of disease/illness on nutritional status of a client, Personal beliefs about food and food intake, A client with poor dentition and misfitting dentures, A client who does not have the ability to swallow as the result of dysphagia which is a swallowing disorder that sometimes occurs among clients who are adversely affected from a cerebrovascular accident, A client with an anatomical stricture that can be present at birth, The client with side effects to cancer therapeutic radiation therapy, A client with a neurological deficit that affects the client's vagus nerve and/or the hypoglossal cranial nerve which are essential for swallowing and the prevention of dangerous and life threatening aspiration, 18.5 to 24.9 is considered a normal body weight. A nurse is calculating a client's fluid intake over the past 8 hr. hVio7+0e'VY@iSo[ip=rB Similar to the calculation of calories, as above, mathematics is also used to calculate other indicators about the client's nutritional status. -Release no faster than 2-3 mmHg per second Check the cord routinely for frays or tearing. -Discomfort (look at ATI page 334 for more details) A nurse is caring for a client who has recently started using a hearing aid worn behind the ear. Intake and Output Calculation NCLEX Review - Registered Nurse RN A nurse is caring for a client who is postoperative and has signs of hemorrhagic shock. Wash the client's body . For example, a client with a chewing disorder, such as may occur secondary to damage to the trigeminal nerve which is the cranial nerve that controls the muscle of chewing, may have impaired nutrition in the same manner that these clients are at risk: Clients with a swallowing disorder are often assessed and treated for this disorder with the collaborative efforts of the speech and language therapist, the dietitian, the nurse and other members of the health care team. A nurse is caring for a child who has a prescription for a blood transfusion. Teach family members the rationale for the, importance of offering fluids regularly to, clients who are unable to meet their own needs, cognition, or other conditions such as impaired. be measured and calculated in mL (1 ox = 30mL). -Use lowest setting that allowed hearing without feedback . Step 11. -summarizing Active Learning Template, nursing skill on fluid imbalances net fluid intake. The signs and symptoms of severe dehydration include, among others, oliguria, anuria, renal failure, hypotension, tachycardia, tachypnea, sunken eyes, poor skin turgor, confusion, fluid and electrolyte imbalances, fever, delirium, confusion, and unconsciousness. Measure and record all fluid intake. Leave 1-2 inches of catheter at end of penis, Urinary Elimination: Maintaining an Indwelling Urinary Catheter (ATI pg. In which of the following situations does the nurse demonstrate the ethical principle of veracity? Which of the following information should the nurse give to the client? Which of the following actions should the nurse take? Place a client who has tuberculosis in a room with negative-pressure airflow. Discharge Care Record intake when: What do you do if one or more patient's in the same room? Promote excellence in nursing by enabling future and current nurses with the education and employment resources they need to succeed. 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