NCLEX RN EXAM WITH CORRECT QUESTIONS AND ANSWERS

NCLEX RN EXAM WITH CORRECT QUESTIONS AND ANSWERS How should the temperature of the water be tested if no thermometer is available? - ANSWER-Dropping water on inside surface of your forearm. With which body part do you begin when bathing an infant? - ANSWER-Eyes always When cleansing an infant's eye, cleanse from _______ to _______ canthus? - ANSWER-No, inner to outer Should you retract the foreskin of a 5 week old male, uncircumcised infant to cleanse the area? - ANSWER-No, not until foreskin retracts naturally and without resistance- then it should be retracted, cleansed and replaced. When sponge-bathing with tepid water the correct temp is _____________. - ANSWER-98.6 F How long does it take for the umbilical stump to fall off? - ANSWER-7 to 14 days The primary reason why an infant is draped during the bath is to provide privacy. (T/F) - ANSWER-False, the primary purpose of draping is to prevent chilling. You may use friction to remove vernix caseosa from an infant's skin. (T/F) - ANSWER-False, it causes damage/bruising What solution is commonly used for care of umbilical cord? - ANSWER-70% alcohol to promote drying (trend is toward soap and water) What is glycogen? - ANSWER-It is a stored formed of glucose/energy manufactured by the liver When the body does not receive enough carbs it burns ___________ and _____________. - ANSWER-protein, fat The most concentrated source of energy for the body is ___________. - ANSWER-fats Fats carry vitamins - ANSWER-A,D,E,K (Remember FADE K!) The nutrient needed most for growth and repair of tissues is _____________. - ANSWER-protein (second best is Vit C) Vitamins and minerals provide energy for the body. (T/F) - ANSWER-False- they are necessary for a body's chemical reactions. Water is present in ALL body tissues. (T/F) - ANSWER-True (even bone) An individual is overweight if they are ________% above the ideal weight. - ANSWER-10 An individual is obese if they weigh ________% above the ideal weight. - ANSWER-20 What solution and material are used to cleanse the eyes of an infant? - ANSWER-Plain water, cotton balls, washcloths Can you use cotton swabs to clean the eyes, nares or ears of an infant? - ANSWER-No, this is dangerous Can you use the same cotton ball/washcloth edge for both eyes? - ANSWER-No, it would cross contaminate Should you cover an unhealed umbilical site with the diaper? - ANSWER-No, fold the diaper down. What temperature is appropriate for the water used to bathe an infant? - ANSWER-100 to 105 What is the #1 purpose of a tepid (slightly) sponge bath? - ANSWER-Lower body temperature during fever. What cranial nerve is affected in Bell's Palsy? - ANSWER-#7, facial nerve What is the #1 symptom of Bell's Palsy (idiopathic facial paralysis)? - ANSWER-One sided (unilateral) facial paralysis Complete recovery from the paralysis of Bell's Palsy should occur in _______ to ______ months. - ANSWER-4 to 6 In addition to the facial paralysis, the sense of ______ is also affected in Bell's Palsy. - ANSWER-taste Will the patient be able to close their eye on the affected side of Bell's Palsy? - ANSWER-no Give three eye interventions for the client with Bell's Palsy. - ANSWER-Dark glasses, artificial tears, cover eye at night As the prostate enlarges it compresses the ___________ and causes urinary ________. - ANSWER-Urethra, rentention At what age does BPH occur? - ANSWER-men over 50 years of age In BPH the man has (increased/decreased) frequency of urination? - ANSWER-increased In BPH the force of the urinary stream is (increased/decreased). - ANSWER-decreased The man with BPH has a _________-stream of urine - ANSWER-forked The man with BPH has hesitancey. What does this mean? - ANSWER-Difficulty starting to void Will the man with BPH have enuresis, nocturia or hematuria? - ANSWER-Enuresis (involuntary urination) -No Nocturia (Frequent urination at night) -Yes Hematuria (blood in urine) -Maybe What is the best way to screen men for BPH? - ANSWER-Digital rectal exam Should fluids be forced or restricted in BPH? - ANSWER-forced What does TURP stand for? - ANSWER-Transurethral resection of the prostate The most radical prostate surgery is the ____________ prostatectomy. - ANSWER-Perineal What type of diet is used in BPH? - ANSWER-Acid Ash Acid Ash diet - ANSWER-Decrease pH (makes urine acid) Chz, eggs, Meat, fish, oysters, poultry, Bread, Cereal, Whole Grains, Pastries, Cranberries, Prunes, Plums, Tomatoes, Peas, Corn, Legumes. What is the primary purpose of a 3 way continuous bladder irrigation (CBI) after TURP? - ANSWER-To keep the catheter clear of clots and to drain urine What solution is used for CBI? - ANSWER-Normal saline (0.9 NaCl) How fast do you run the CBI? - ANSWER-At whatever rate it takes to keep the urine flowing and free of clots What drug is use to treat bladder spasm? - ANSWER-B&O suppositories (Belladonna & Opiates) Should you take a rectal temp after prostatectomy? Give stool softeners? - ANSWER-No rectal temperatures, yes stool softeners You should call the MD after TURP when you see _________ thick ________, _____________ clots, and ____________ urine drainage on the dressing. - ANSWER-Bright thick blood, persistent clots, persistent urine on dressing (don't call MD for transitory clots and urine on dressing.) In a patient with a TURP, if you see an increase in blood content of urine coming out of the catheter, you would first ___________. - ANSWER-Pull carefully on the catheter to apply local pressure on the prostate with the Foley balloon. In a TURP, if you see clots in the tubing you would first ____________. - ANSWER-Increase the flow-rate. What exercises should the post prostectomy patient do upon discharge? Why? - ANSWER-Perineal exercises, start and stop stream of urine, because dribbling is a common but temporary problem post op Will the post prostectomy patient be impotent? - ANSWER-If TURP, no impotence, if perineal prostatectomy, yes impotence What is the most common problem due to catheterization? - ANSWER-UTI What is the most common organism to cause UTI with catheterization? - ANSWER-E. coli What is the most common route for organisms to enter the blader when a catheterization is used? - ANSWER-Up through the inside of the catheter in the days following catheterization