VATI RN COMPREHENSIVE PREDICTOR REMEDIATION QUESTIONS

VATI RN COMPREHENSIVE PREDICTOR REMEDIATION QUESTIONS

• The nurse is reviewing a client's chart upon admission. The nurse notes the client has a Living

Will, a Durable Power of Attorney and a prescription for 'allow a natural death' (AND). Define each type of Advance Directive.

• Living will is a legal document that expresses the client’s wishes for medical treatment if

the client were to become incapacitated and is facing end-of-life issues.

• Durable power of attorney for health care is a document that appoints a person (health care

proxy) to make decisions regarding the client’s health if they are unable to make decisions for his/herself

• Provider’s orders means that if a provider does not write a “do not resuscitate” (DNR) or

“allow natural death” (AND) order in the client’s medical chart, the nurse’s job is to begin CPR when the client does not have a pulse or respirations. The provider will consult the client and the family before administering a DNR or AND order.

• Nursing role in advance directives is to provide written information about advance

directives for the client and the family; document the client’s advance directives status; ensure that the advance directives reflect the client’s current decisions; inform all members of the health care team of the client’s advance directives.

• A registered nurse (RN) is delegating tasks to an assistive personnel (AP). What are five (5)

factors to consider when delegating tasks?

• Predictability of the outcome – will the completion of the task have a predictable outcome?

(Is it a routine treatment? Is it a new treatment for that client?)

• Potential for harm – (Is there a chance that something negative could happen to the client

(bleeding, aspiration)? Is the client unstable?)

• Complexity of care – (Does the client’s care require complex tasks? Does the state’s

practice act or the facility’s policy allow the delegate (AP) to perform the task, and does she have the necessary skills?)

• Need for problem solving and innovation – (Is judgment essential while performing the

task? Does it require nursing assessment or data-collection skills?)

• Level of interaction with the client – (Does the delegate need psychosocial support or

education during the performance of the task?)

• A registered nurse (RN) at the beginning of the shift is delegating tasks to the licensed practical

nurse (LPN) and the assistive personnel (AP). Identify five (5) tasks that the LPN can be delegated and five (5) tasks the AP can be delegated to complete during their shift.

• Tasks that can be delegated to the LPN: monitoring findings as input to the RNs ongoing

assessment); reinforcing client teaching from a standard care plan; performing tracheostomy care; suctioning; checking NG tube patency; administering enteral feedings; inserting a urinary catheter; administering medication (excluding IV medication in some states)

• Tasks that can be delegated to the AP: 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])

• A registered nurse (RN) has delegated tasks to the licensed practical nurse (LPN). What are

characteristics of an effective delegator to manage task completion?

• The five rights of delegation: tasks the delegate (right task), to whom (right person), what

information to communicate (right direction and communication), how to oversee and

appraise (right supervision and evaluation). The nurse should use professional judgment and critical thinking skills when delegating.

• A nurse is caring for an infant client with Tetralogy of Fallot. What are cardio/pulmonary

defects noted with this cardiac disorder? What are clinical manifestations associated with this cardiac disorder?

• 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)

• Clinical manifestations – cyanosis; shortness of breath and rapid breathing, especially

during feeding or exercise; fainting; clubbing of fingers and toes; poor weight gain; tiring easily during play or exercise; irritability; prolonged crying; a heart murmur

• Diuretics are given regularly in the acute care setting. Which of the following clients is not a

good candidate for diuretics?Client with pulmonary edema Client with hypercalcemia Client with hypokalemia Client with kidney stone formation

• Client with hypokalemia because diuretics can cause loss of potassium (unless a potassium-

sparing diuretic)

• A nurse is caring for a 9-year-old client who has cerebral edema status post MVA. What are

seizure precautions the nurse should ensure are in place?

• Pad side rails of bed, crib, and wheelchair. Keep bed free of objects that could cause injury.

Have suction and oxygen equipment available.

• A client with thyroid cancer is receiving brachytherapy. Define this therapy.
• Is internal radiation that is placed close to the target tissue through 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 surrounding normal tissues. Waste products are radioactive until the isotope has been completely eliminated from the body. Waste products should not be touched by anyone.

• A nurse is providing education on home safety specific to the school-age client to

parents. Identify four (4) examples of home safety concerns for this age group.

• Firearms – be sure to keep them unloaded, locked in somewhere safe where the child

cannot reach it. Teach the importance of never touching a gun. Also be sure to keep the bullets in a different location from the guns.

• Play injury – do not allow the child to run with candy or anything in the mouth as it could

cause choking or aspiration. Teach the child to wear protective helmets, knee and elbow pads when needed. Teach the importance of “stranger danger” and avoiding strangers, as well as keeping parents informed of strangers

• Burns – the water heater setting in the home should be set to no higher than 120’F. Teach

the dangers of playing with matches, fireworks, and firearms and how to properly use microwave and other cooking utensils

• Poison – teach the child about the hazards and dangers of alcohol, cigarettes, and

prescription, non-prescription, and illegal drugs. Also, keep any potentially dangerous substances out of reach.

• What are guidelines when cleaning contaminated equipment a nurse should follow?

• Wear gloves and protective eyewear; rinse with cold water; wash in warm water with soap;

use a brush or abrasive to clean corners; rinse well in warm water; dry; clean equipment used in cleaning and sink – follow disinfection or sterilization

• A mother is being taught about the benefits of breastfeeding. Identify five (5) benefits of

breastfeeding.

• Reduces the risk of infection by providing IgA antibodies, lysozymes, leukocytes,

macrophages, and lactoferrin the prevents infections. Promotes rapid brain growth due to large amounts of lactose. Provides protein and nitrogen for neurological cell building and improves the newborn’s ability to regulate calcium and phosphorus levels. Contains electrolytes and minerals. Breast milk is easy for the newborn to digest.

• A postpartum client has evidence of uterine atony. What uterine atony and what are three (3)

risk factors?

• Uterine atony results from the inability of the uterine muscle to contract adequately after

birth. This can lead to postpartum hemorrhage.

• Risk factors – retained placental fragments; prolonged labor; oxytocin induction or

augmentation of labor; overdistention of the uterine muscle (multiparity, multiple gestations, polyhydramnios [hydramnios], macrosomic fetus); precipitous labor; magnesium sulfate administration as a tocolytic; anesthesia and analgesia administration; trauma during labor and birth from operative delivery (forceps- or vacuum-assisted birth, cesarean birth)

• A nurse is conducting a physical assessment on a newborn client. Which of the following are

expected physical assessment findings? (Select all the Apply) Strong cry Chest: transverse diameter to anteroposterior diameter is 2:1Movement is in an irregular rhythm Rounded abdomen Spine is midline with C-shaped lateral curve

• Strong cry; Rounded abdomen
• A nurse is caring for a client who has hepatitis B and is jaundiced. The client asks what caused

this viral infection. The nurse would respond by teaching the client, what about the transmission of hepatitis B?

• Route of transmission – blood
• When an immunization is given to a client, what physiological actions occur specific to the

microbe?

• It causes production of antibodies to prevent illness from specific microbe
• A charge nurse is making shift assignments for the nurses on the unit. One nurse is 6-months

pregnant. Which client assignment is not appropriate for the pregnant nurse?An airborne isolation room with a client diagnosed with varicella zoster virus. A post- operative client receiving antibiotic therapy and physical therapy. A client with a diabetic ulcer and on antibiotic therapy. A homeless client who requires teaching about corticosteroid therapy.

• An airborne isolation room with a client diagnosed with varicella zoster virus
• A client complains that she "hates taking pills." What birth control methods can the nurse

discuss with the client as an alternative contraception?

• A female condom could be used. They protect against pregnancy, and STIs. Replacement

of the devices are usually every 2 years. Transdermal contraceptive patches (replaced every

• weeks), and injectable (shot every 11-13 weeks) are also options. Implantables are

available and are effective for up to 3 years. An IUD is an effective option that can be in place up to 10 years.

• A nurse is conducting a physical assessment on a 9-month-old infant who is suspected of being

abused and demonstrates signs of shaken baby syndrome. What should the nurse assess when conducting an examination?

• Signs and symptoms of shaken baby syndrome are vomiting, poor feeding and restlessness,

respiratory distress, bulging fontanels, retinal hemorrhages, seizures, posturing, alterations in level of consciousness, apnea, bradycardia

• A client with obsessive-compulsive disorder (OCD) has a great deal of anxiety in group

therapy to address his disorder. What is the anticipated plan of care for a client with anxiety during therapy?

• The nurse could use behavioral therapies for this client such as relaxation training. This is

used to control anxiety. The modeling allows a client to see a demonstration of appropriate behavior in a stressful situation, with hopes that the client will imitate the behavior.

• A client with anorexia nervosa is in therapy for her eating disorder. Provide three (3) measures

of care to address this disorder.

• Develop and maintain a trusting nurse/client relationship through consistency and

therapeutic communication. Use a positive approach and support to promote client self- esteem and positive self-image. Encourage client decision making and participation in the plan of care to allow for a sense of control

• Differentiate the two personality disorders, Antisocial and Narcissistic Personality Disorder.
• Antisocial personality disorder is 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

• Narcissistic personality disorder is characterized by arrogance, grandiose views of self-

importance, the need for consistent admiration, and a lack of empathy for others that stains most relationships; they also may often be sensitive to criticism.

• Define three (3) characteristics of Stage 2--moderate Alzheimer's (middle-stage) Disease.

Provide three (3) approaches on how best to communicate effectively with a client in this neurocognitive disorder.

• Characteristics of stage 2 – moderate Alzheimer’s disease – 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

• Approaches on how to best communicate effectively with a client in this neurocognitive

disorders include communicating in a calm, reassuring tone; speaking in positively worded phrases. Do not argue or question hallucinations or delusions. Reinforce reality and orientation to 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.