Actual-Nclex-Questions-Final

Actual-Nclex-Questions-Final ▪ Multiple Myeloma – Elevated serum calcium ▪ COPD – Complication ▪ INH – adverse reaction ▪ Procardia – Adverse reaction/toxicity ▪ Metered Dose Inhaler – Process how to use it ▪ AIDS ▪ Immunizations – Allergy to Eggs (DPT), immunocompromised house mate ▪ Droplet Precaution ▪ Disaster Nursing ▪ Delegate stable diseases vs. non-stable ▪ Infant vital signs ▪ Signs/Symptoms of dehydration in infants ▪ Myocardial Infarction ▪ Rheumatoid Arthritis ▪ Thromboplebitis ▪ Signs/Symptoms of Hypercalcemia ▪ Signs/Symptoms of Infection ▪ Signs/Symptoms of COPD ▪ Signs/Symptoms of Right-Side CHF ▪ Digoxin side effects ▪ Triage priority ▪ Complications of Emphysema ▪ Signs/Symptoms of Hypothyroidism ▪ Iron Deficiency Anemia ▪ Hepatitis B ▪ Chronic Renal Failure ▪ Cancer ▪ Glaucoma ▪ Thrombocytopenia ▪ Neutropenia ▪ Thoracotomy ▪ Fetal Monitoring causes of decelerations ▪ Growth and Development ▪ Procardia ▪ Pilocarpine ▪ NPH ▪ Neupogen ▪ Synthroid ▪ Calcium Channel Blockers ▪ Levothyroxine synthroid ▪ Herbal Medicines: Echinacea, Ginger roots ▪ Medication for ruptured cerebral aneurysm (Zantac?) –eh di thrombolytics ▪ Uterine tumor –smoking? ▪ Left-sided CHF ▪ Mastitis and Breastfeeding-do not use hot compress, cold compress and expose to air ▪ Dumping Syndrome Diet-low sodium, low CHON, high fat ▪ Endocrine system ▪ Crutches, Canes, Walkers ▪ Death viewed from each age group ▪ Signs/Symptoms of Hepatitis A ▪ Halo Vest ▪ Metered Dose Inhaler –u need to use some spacer if difficulty inhaling it ▪ Cataract Surgery ▪ Insulin Peak Times ▪ Diabetes I: Had to do with a toe ulcer ▪ Diabetes II ▪ Measles ▪ Lab: How does Chemo drugs affect renal labs –nephrotoxic, causes gouty arthritis, hi BUN, creatinine, hemorrhagic cystitis Radiation Therapy-lead apron, long handled forceps, lalaki, 6meters away, min 30mins exposure Infectious Diseases: MRSA, TB ▪ Isolation precautions ▪ Mitral Valve Regurgitation ▪ Signs/Symptoms of Tuberculosis/Medications/Airborne ▪ Signs/Symptoms of Vulva Cancer ▪ Endometriosis medications – pills? ▪ Postoperative care for total knee patient ▪ Hepatitis A,B,D,C causation ▪ Lead Poisoning ▪ Antipsychotic medications side effects ▪ Thallium test ▪ Non-stress test ▪ End stage renal disease diet- low potassium diet, low sodiun ▪ I've encountered a lot of infectious diseases.So try to study the isolation precautions of diseases like VRE,LYMES,AIDS,MRSA ETC. ▪ Study too the stable and unstable pts. coz a lot of these questions came out like w/c pt would u discharge/transfer first. ▪ Know the normal Vital signs of group. ▪ Diet such as high in magnesium,potassium,sodium and others. ▪ specific toys/games for children ▪ study on alzheimer's ds., for total hip replacement,COPD. ▪ S/S of fibromyalgia,SLE,Acute pancreatitis,lymes ds. ▪ Nursing care for elderly pts..aging process ▪ Know the client's rights. ▪ Beta-adrenergic drugs,tricyclic anti- depressants. ▪ Normal growth and dev't of 1-12mos old ▪ Know abt the rotavirus ▪ Delegation on newly hired nurse ▪ So far i only got one question same w/ my 1st the pneumocystis carinii ▪ pneumonia ▪ Advance Directive ▪ Assessment of elderly client, What do you expect? ▪ Sign & symptom of hemophilia ▪ Hemophilia With hemarthosis- increase fluid intake ▪ AIDS client – test for candida, mumps and PPD ▪ Fracture femur- Client had an accident ▪ TPN- How to prevent complications – check for glucose, patency of vein Newborn- What is your priority? – temperature CVA with Right sided hemiplegia CVA with Left sided hemiplegia Signs/Symptoms of Vulva CancerEndometriosis medications – pills? Postoperative care for total knee patient Hepatitis A,B,D,C causation Lead Poisoning ▪ Antipsychotic medications side effects ▪ Thallium test ▪ Non-stress test ▪ End stage renal disease diet- low potassium diet, low sodiun ▪ Know abt the rotavirus 1. A confused client for surgery. Client signed the consent for his surgery. What is the nurse initial action? A) Document and monitor later B) notify the anesthesiologist C) Determine when the patient became confused D) ask the relative about the patient’s status NOTE; I personally experienced this situation if anybody know the answer pleased tell me. 2. A nurse-in-charge sent a maternity nurse to a surgical unit. Which client will the nurse in charge assign to the nurse from maternity ward? Which of the following client is appropriate for a nursing assistant? 3. A client with rheumatoid arthritis tells “I having back pain with this bed, I like my bed at home. What is the immediate response of the nurse? A) I will massage your back to help you B) Ask the physician for opoid analgesia C) I will refer you to the occupational therapy D) Ask the husband how she sleeps at home 4. Mild Alzheimer- sign and symptoms select all that apply 5. Tuberculosis –instructions 6. A client with myocardial infarction taking lasix and digoxin 7. 0 A client with ICP 8. Chest tube inadvertently out – What is the nurse initial action? 9. A newborn with white papule on face and trunk. What is the nurse discharge instruction? 10. Phototherapy 11. A client with nasogatric tube feeding at home. 12. DKA- What is your initial action? 13. Laenneac’s cirrhosis 14. End stage renal failure –diet 15. Transesophageal echocardiogram- 16. Synthroid 17. Cervical implant 18. Autonomic dysreflexia sign and symptoms 19. UTI- Which statement of the client needs essential follow up? 20. Phones calls- which client needs to immediate follow up? 21. Pre-op client- which laboratory result needs to notify the physician? 22. Assessment of the new nurse in the unit- Which of the following action by the new nurse needs follow up? 23. The nurse put the client in seclusion after being assaultive and hitting other client. Which of the following statement of the nurse is appropriate for the client? A) We are very disappointed that you can not control yourself, you will be in seclusion until you calm down B) Hitting is not allowed here, you will be in seclusion C) You hit someone, you will be in seclusion call us if you need us, we are here to help you D) I forgot??? 24. A mother called the nurse from home stating that her child is having chicken pox. Which of the following statement by the mother needs immediate follow up? A) Father of the child with liver failure B) Sibling with anemia C) Child just had tonsillectomy D) Child has intermittent low grade fever 25. A client with allergy to Sudafed. Which of the statement is correct? A) I will take valerian…. B) I will take ma huang…. C) I will take Echinacea for acute viral infection D) I will take black cohosh…. 26. A client with schizophrenia- How will the nurse assess the affect? 27. A client with bipolar disorder- manic phase. What is your immediate response? 28. A client with severe anxiety- What is the outcome of the nurse’s short term goal? A 15 year old client- What do you expect? Antisocial behavior 29. A client with diabetes mellitus (type I). NPH insulin given at 8:00 am- When do you expect the effect? A) at noon B) late afternoon C) early afternoon D) early evening 30. Expressive/receptive aphasia- What is your essential response when communicating with this client? 31. A child 2 year old with a suspected diagnosis of hearing impairment. Which of the following action by the child contribute to the diagnosis? A) Child talking few words B) Child plays alone with other children around C) Gesture and pointing what he wants D) I forgot???? ▪ Safe nurse intervention COPD 32. A client had an accident with brow laceration and fractured of the jaw. Suturing of the laceration and maxillary pinning was done. Which of the following action of the nurse is appropriate? I answered – keep wire cutter at bedside 33. Proper documentation of incident 34. Right side heart failure sign/symptoms, select all that apply 35. Use of Contaceptives 36. Calculation Last question in my NCLEX exam…. 37. Food processing….. A) frozen food can be defrost for up to six hours.... B) Frozen food which has been defrost can be return back to fridge... C) Cook perishable food should cover and cool.... D) Frozen food should be defrost by using hot water.... 1. If you have a Pt that’s allergic to "sulfa" drugs.. What class of drugs are they also allergic too? 2. Which pt is most likely to get TB? a. 26 yo who smoke marijuana with a group of friends b. 74 yo retired welder c. don't remember the others 3. What diet would you give a pt w/ esophageal varicies? 4. Pt. recieving internal radiation.. Should the nurse limit her time w/ the patient to 30 mins max??? I thought this was the answer b/c kaplan tought me when you deal w/ radiation think "time, distance, shield" anyone know??? 5. Assessment of a pt w/ scoliosis would present with? a. concave cervical and lumbar spine b. asymmetical iliac crest 6. Nurse should write an incident report if? a. pt reports she is in a sexually abusive relationship b. room mate tells pt that he brought his home sleeping pills and is secretly taking them c. a staff nurse is seen giving a pt that is not assigned to a med d. don't remember 7. High alarm will sound if? a. pt is biting the tube b. leak in the cuff c. don't remember the rest 8. Pt understands teaching about the care of his prostetic eyeball when he states? a. I will gently pull my lower eyelid down and press inward untill the eyeball comes out. (I chose this) b. I will store my eyeball in tap water overnight c. I will put drops in my eye continually throughout the day 9. A young pt is most likely to get lead poisoning if? a. he is drinking from a ceramic pitcher b. Father refernishes old furniture at their home (I'm torn b/w these b/c I know a is correct but old furniture may contain lead in the paint and the child could eat the paint chips???) 10. A TB pt understands that he can reduce the risk of spreading his disease if he states? a.) I won't sleep in the same room w/ my wife for 1-2 months b. )I will stay away from pregnant women and children c.) I will use plastic utensil when I eat (this answer was on 2 of my TB questions) d.) don't remember 11. Pt in skeletal halo traction a. pt should use sterile technique when cleaning insicions b. pt should put lubricant on insicions 12. Pregnant pt should seek info. from a registered dietitian if? a. on a vegan diet b. takes vitamin B every day c. eats at least 1 meal of fast food every day 13. Pt w/ a T12 spinal injury would? a. urinate a little every 2 hrs b. urinate a lot every 4 hrs c. dribble unrine d. pt won't urinate on his own 1. symptoms of another complication of atrial fib: Can't remember the answers except for the one I chose. I chose slurring speech and weakness (embolic stroke is a secondary compication of AFib) 2. charge nurse to assign 10 week pregnant RN to which patient: Fifth's disease, chicken pox, RSV, thrush. I chose thrush because I know it doesn't harm preg and all other illnesses are airborne. 3. question what meds for patient history of heart failure, kidney disease, high cholesterol, and potassium of 2.9: Digoxin, lol beta ?, zocor, lasix, and ace check all that apply: I chose digoxin and lasix(potassium level) 4. alot of discharge instruction questions for various surgeries, sinus, etc. 5. signs of autonomic dysreflexia: hypotension, tach, severe headache, ? 6. when would you stop a student nurse after seeing her do what? can't remember what exactly. one was taking a pulse ox with a sao2 machine from the nurses station on a pt with pc pneumonia, leaving old ties until new ties were put on during trach care. 7. assigning a lpn: taking a pt with TB to the xray dept., etc. 8. assigning a maternity nurse to which pt on a med-surg floor: rad mastectomy being discharged in next two hours, etc. 9. check all that apply what would you expect to see in the aging process: shortness of breath, dry skin, loss of vision, etc. 10. closed head injury receiving osmotic diuretic, expect to see showing it is working: increased pulse, increased pulse pressure, etc? 11. taking iv chemo at home what is correct: flush remaining iv solution in toilet, put used iv bags in red biohazzard trash bag and put in reg. trash, leave pt alone while receiving meds, or do not let children go into bathroom or near toilet until after 48 hours. 12. performing a mammography what would you question: using powder or perfumes in the last 2 days, do you have an internal pacemaker(answer), etc? 13. tx for RA: apply cold packs(not answer), etc? 14. discharge instr. for pt with scleraderma: ROM exercises, emollient to skin before going outside, dry off thoroughly after bath, keep a cool house. 15. bipolar manic what to do: group therapy, keep in room, one on one therapy to reduce stimulation(answer), etc. 16. how would nurse demonstrate concept of patient self determination act: this is advance dir and living will. 17. what would you question at pt getting a thallium stress test: allergy to iodine was answer 18. Pt with thyroidectomy and feeding: ground beef and cranberry juice, ground chicken and chocolate milk, vegetables and fruit, tuna fish with mayo. I chose tuna in mayo. Thought that the first 2 answers had liquid to hard to swallow without aspiration and tuna was only answer that was mushy and soft but not too thin. 19. ABG's what would you do before taking: suction, check for ulnar pulse, etc. 20. in labor getting pitocin. what demonstrates a complication of pit: contractions 2-3 min apart with 60 sec. duration, accelerations up to 160 with contraction, fetal hr drops to 105 during acme of contration, etc. 21. what room to put a pt with multidrug resistant TB: private vented outside, isolation with side room for supplies, isolation etc.? 22. what patient diet would you correct: cardiac pt states I include mushrooms and carrots in my diet, etc.?? can't remember rest 23. Normal newborn exam: head and chest size the same, etc.? 24. 4 math problems. two asking ml/hr, one gtts/min, units/ml 25. symptoms of fat emobli: pettechie on skin, etc. 5 Post-Op causes of FEVER: 1. Wind: the pulmonary system is the primary source of fever in the first 48 hours. 2. Wound: there might be an infection at the surgical site. 3. Water: check intravenous access site for signs of phlebitis. 4. Walk: deep venous thrombosis can develop due to pelvic pooling or restricted mobility related to pain and fatigue. 5. Whiz: a urinary tract infection is possible if urinary catheterization was required. 6. Also 6th "W" Wonder drugs - drug fevers. The recommendations presented below are categorized as follows: Category IA. Strongly recommended for all hospitals and strongly supported by well- designed experimental or epidemiologic studies. Category IB. Strongly recommended for all hospitals and reviewed as effective by experts in the field and a consensus of HICPAC based on strong rationale and suggestive evidence, even though definitive scientific studies have not been done. Category II. Suggested for implementation in many hospitals. Recommendations may be supported by suggestive clinical or epidemiologic studies, a strong theoretical rationale, or definitive studies applicable to some, but not all, hospitals. No recommendation; unresolved issue. Practices for which insufficient evidence or consensus regarding efficacy exists. The recommendations are limited to the topic of isolation precautions. Therefore, they must be supplemented by hospital policies and procedures for other aspects of infection and environmental control, occupational health, administrative and legal issues, and other issues beyond the scope of this guideline. I. Administrative Controls A. Education Develop a system to ensure that hospital patients, personnel, and visitors are educated about use of precautions and their responsibility for adherence to them. Category IB B. Adherence to Precautions Periodically evaluate adherence to precautions, and use findings to direct improvements. Category IB II. Standard Precautions Use Standard Precautions, or the equivalent, for the care of all patients. Category IB A. Handwashing (1) Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross-contamination of different body sites. Category IB (2) Use a plain (nonantimicrobial) soap for routine handwashing. Category IB (3) Use an antimicrobial agent or a waterless antiseptic agent for specific circumstances (e.g., control of outbreaks or hyperendemic infections), as defined by the infection control program. Category IB (See Contact Precautions for additional recommendations on using antimicrobial and antiseptic agents.) B. Gloves Wear gloves (clean, nonsterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and nonintact skin. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching noncontaminated items and environmental surfaces, and before going to another patient, and wash hands immediately to avoid transfer of microorganisms to other patients or environments. Category IB C. Mask, Eye Protection, Face Shield Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. Category IB D. Gown Wear a gown (a clean, nonsterile gown is adequate) to protect skin and to prevent soiling of clothing during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Select a gown that is appropriate for the activity and amount of fluid likely to be encountered. Remove a soiled gown as promptly as possible, and wash hands to avoid transfer of microorganisms to other patients or environments. Category IB E. Patient-Care Equipment Handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. Ensure that reusable equipment is not used for the care of another patient until it has been cleaned and reprocessed appropriately. Ensure that single-use items are discarded properly. Category IB F. Environmental Control Ensure that the hospital has adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces, and ensure that these procedures are being followed. Category IB G. Linen Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures and contamination of clothing, and that avoids transfer of microorganisms to other patients and environments. Category IB H. Occupational Health and Bloodborne Pathogens (1) Take care to prevent injuries when using needles, scalpels, and other sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles. Never recap used needles, or otherwise manipulate them using both hands, or use any other technique that involves directing the point of a needle toward any part of the body; rather, use either a one-handed "scoop" technique or a mechanical device designed for holding the needle sheath. Do not remove used needles from disposable syringes by hand, and do not bend, break, or otherwise manipulate used needles by hand. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers, which are located as close as practical to the area in which the items were used, and place reusable syringes and needles in a puncture-resistant container for transport to the reprocessing area. Category IB (2) Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable. Category IB I. Patient Placement Place a patient who contaminates the environment or who does not (or cannot be expected to) assist in maintaining appropriate hygiene or environmental control in a private room. If a private room is not available, consult with infection control professionals regarding patient placement or other alternatives. Category IB III. Airborne Precautions In addition to Standard Precautions, use Airborne Precautions, or the equivalent, for patients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei (small-particle residue [5 µm or smaller in size] of evaporated droplets containing microorganisms that remain suspended in the air and that can be dispersed widely by air currents within a room or over a long distance). Category IB A. Patient Placement Place the patient in a private room that has: 1) monitored negative air pressure in relation to the surrounding areas, 2) 6 to 12 air changes per hour, and 3) appropriate discharge of air outdoors or monitored high-efficiency filtration of room air before the air is circulated to other areas in the hospital.(23) Keep the room door closed and the patient in the room. When a private room is not available, place the patient in a room with a patient who has active infection with the same microorganism, unless otherwise recommended,(23) but with no other infection. When a private room is not available and cohorting is not desirable, consultation with infection control professionals is advised before patient placement. Category IB B. Respiratory Protection Wear respiratory protection (N95 respirator) when entering the room of a patient with known or suspected infectious pulmonary tuberculosis.(23,81) Susceptible persons should not enter the room of patients known or suspected to have measles (rubeola) or varicella (chickenpox) if other immune caregivers are available. If susceptible persons must enter the room of a patient known or suspected to have measles (rubeola) or varicella, they should wear respiratory protection (N95 respirator).(81) Persons immune to measles (rubeola) or varicella need not wear respiratory protection. Category IB C. Patient Transport Limit the movement and transport of the patient from the room to essential purposes only. If transport or movement is necessary, minimize patient dispersal of droplet nuclei by placing a surgical mask on the patient, if possible. Category IB D. Additional Precautions for Preventing Transmission of Tuberculosis Consult CDC "Guidelines for Preventing the Transmission of Tuberculosis in Health- Care Facilities"(23) for additional prevention strategies. IV. Droplet Precautions In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a patient known or suspected to be infected with microorganisms transmitted by droplets (large-particle droplets [larger than 5 µm in size] that can be generated by the patient during coughing, sneezing, talking, or the performance of procedures). Category IB A. Patient Placement Place the patient in a private room. When a private room is not available, place the patient in a room with a patient(s) who has active infection with the same microorganism but with no other infection (cohorting). When a private room is not available and cohorting is not achievable, maintain spatial separation of at least 3 ft between the infected patient and other patients and visitors. Special air handling and ventilation are not necessary, and the door may remain open. Category IB B. Mask In addition to wearing a mask as outlined under Standard Precautions, wear a mask when working within 3 ft of the patient. (Logistically, some hospitals may want to implement the wearing of a mask to enter the room.) Category IB C. Patient Transport Limit the movement and transport of the patient from the room to essential purposes only. If transport or movement is necessary, minimize patient dispersal of droplets by masking the patient, if possible. Category IB V. Contact Precautions In addition to Standard Precautions, use Contact Precautions, or the equivalent, for specified patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct contact with the patient (hand or skin-to-skin contact that occurs when performing patient-care activities that require touching the patient's dry skin) or indirect contact (touching) with environmental surfaces or patient-care items in the patient's environment. Category IB A. Patient Placement Place the patient in a private room. When a private room is not available, place the patient in a room with a patient(s) who has active infection with the same microorganism but with no other infection (cohorting). When a private room is not available and cohorting is not achievable, consider the epidemiology of the microorganism and the patient population when determining patient placement. Consultation with infection control professionals is advised before patient placement. Category IB B. Gloves and Handwashing In addition to wearing gloves as outlined under Standard Precautions, wear gloves (clean, nonsterile gloves are adequate) when entering the room. During the course of providing care for a patient, change gloves after having contact with infective material that may contain high concentrations of microorganisms (fecal material and wound drainage). Remove gloves before leaving the patient's room and wash hands immediately with an antimicrobial agent or a waterless antiseptic agent.(72,94) After glove removal and handwashing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patient's room to avoid transfer of microorganisms to other patients or environments. Category IB C. Gown In addition to wearing a gown as outlined under Standard Precautions, wear a gown (a clean, nonsterile gown is adequate) when entering the room if you anticipate that your clothing will have substantial contact with the patient, environmental surfaces, or items in the patient's room, or if the patient is incontinent or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing. Remove the gown before leaving the patient's environment. After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces to avoid transfer of microorganisms to other patients or environments. Category IB D. Patient Transport Limit the movement and transport of the patient from the room to essential purposes only. If the patient is transported out of the room, ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other patients and contamination of environmental surfaces or equipment. Category IB E. Patient-Care Equipment When possible, dedicate the use of noncritical patient-care equipment to a single patient (or cohort of patients infected or colonized with the pathogen requiring precautions) to avoid sharing between patients. If use of common equipment or items is unavoidable, then adequately clean and disinfect them before use for another patient. Category IB F. Additional Precautions for Preventing the Spread of Vancomycin Resistance Consult the HICPAC report on preventing the spread of vancomycin resistance for additional prevention strategies. DELEGATION Question: A 7 year old boy with a compound fracture is being admitted to a pediatric unit. Which of the following actions is best for the nurse to take? (1) Ask the nursing assistant to obtain the child's VS while the nurse obtains a history from the parents (2) Ask the LPN/LVN to assess the peripheral pulses of the child's left leg while the nurse completes the admission forms (3) Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone orders from the physician (4) Ask the nursing assistant to obtain equipment for the child's care while the nurse talks with the child and his parents ***You may be thinking, "Why are they asking me this? I have never had the opportunity to ask the LPN/LVN or nursing assistant to do anything!" Every three years, the National Council of State Boards of Nursing conducts a job analysis study to determine the activities required of a newly licensed registered nurse. Based on this study, National Council adjusts the content of the test to accurately reflect what is happening in the work place. This ensures that the NCLEX test is what is needed to be a safe and effective nurse. With recent changes in health care, the role of the nurse has expanded. In addition to providing quality patient care, the nurse is also responsible for coordination and supervision of care provided by other health care workers. Many health care settings are staffed by registered nurses licensed vocational nurses/licensed practical nurses and unlicensed assistive personnel (UAP) such as nursing assistants and support staff. It is the responsibility of the registered nurse to coordinate the efforts of these health care workers to provide affordable quality patient care. Appropriate supervision of the LPN/LVN and/or unlicensed assistive personnel by the registered professional nurse is essential for safe and effective patient care. To reflect these changes, the NCLEX test plan now contains questions about delegation and assignment of patient care. There are several reasons why you may find these questions difficult to correctly answer on the NCLEX. You might not have any practice answering multiple choice questions about management. Many nursing schools test the content presented in the management course with essay questions rather than multiple-choice questions. You have received lectures regarding management of care, but your clinical rotation in management may have been less than ideal. Your experience may have been restricted to caring for one or two patients without any opportunity to supervise others, or you may have spent time on a hospital unit providing patient care under the supervision of a preceptor. These experiences don't necessarily prepare you to answer the management of care questions you will see on the NCLEX. Don't despair. Her are some rules of management that will help you choose the right answers when answering management of care questions on the NCLEX. The Rules of Management Rule #1: Do not delegate the functions of assessment, evaluation and nursing judgment. During your nursing education, you learned that assessment, evaluation and nursing judgment are the responsibility of the registered professional nurse. You cannot give this responsibility to someone else. Rule #2: This is not the real world. Do not make decisions regarding management of care issues based on decisions you may have observed during your clinical experience in the hospital or clinic setting. Remember, the NCLEX is ivory tower nursing. The answers to the questions are found in nursing test books or journals. Always ask yourself, "Is this textbook nursing care?" Rule #3: Delegate activities for stable patients with predictable outcomes. If the patient is unstable, or the outcome of an activity not assured, it should not be delegated. Rule #4: Delegate activities that involve standard, unchanged procedures. Activities that frequently reoccur in daily patient care can be delegated. Bathing, feeding, dressing and transferring patients are examples. Activities that are complex or complicated should not be delegated. Rule #5: Remember Priorities! Remember Maslow, the ABC's, and stable versus unstable when determining which patient the RN should attend to fist. Keep in mind that you can see only one patient or perform one activity when aswering questions that require you to establish priorities. Lets take a closer look at the question above and use these rules to eliminate answer choices ......... Question: A 7 year old boy with a compound fracture of the left femur is being admitted to a pediatric unit. Which of the following actions is best for the nurse to take? A. Ask the nursing assistant to obtain the child's VS while the nurse obtains a history from the parents B. Ask the LPN/LVN to assess the peripheral pulses of the child's left leg while the nurse completes the admission forms C. Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone orders from the physician D. Ask the nursing assistant to obtain equipment for the child's care while the nurse talks with the child and his parents On first glance, all the answers seem possible. Lets look at this question using the steps outlined in this book. Step 1. Reword the question in your own words. It asks what the nurse should do when a child with a fractured femur is first admitted. That question is a very broad question. To establish exactly what is being asked, you must read the answer choices. In each answer, the RN is delegating tasks to the LPN/LVN or nursing assistant. The real question is, "What is appropriate delegation?" Step 2. Eliminate answer choices based on the Rules of Management. (A) Ask the nursing assistant to obtain the child's VS while the nurse obtains a history from the parents. Obtaining vital signs is an important part of assessment. According to Rule #1, the registered nurse cannot delegate assessment. Elimated this answer choice. (B) Ask the LPN/LVN to assess the peripheral pulses of the child's left leg while the nurse completes the admission forms. Checking the peripheral pulses is an important assessment for this patient because of the diagnosis of a fractured left femur. The nurse needs to assess the patient before delegating activities to someone else. Assessment of the patient is much more important than completing paperwork. Eliminate it. (C) Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone orders from the physician. There is no assessment, evaluation or nursing judgment involved in this option so leave it in for consideration. (D) Ask the nursing assistant to obtain equipment for the child's care while the nurse talks with the child and his parents. The nurse is with the child and his parents while the nursing assistant obtains needed equipment. There is no assessment, evaluation or nursing judgment when gathering equipment, so leave this choice in for consideration. You’re left with answer choices 3 and 4. You are halfway to the correct answer. Can you apply rule #2 -- this is not the real world -- to eliminate another answer choice? Remember, you shouldn't make decisions on management of care issues based on what you may have seen in the hospital or clinic setting. Answer #3 indicates that the nurse is on the phone and the LPN/LVN is with the patient. Have you seen this done in the real world? Probably. Is this nursing textbooks and journals say should be done in this situation? Probably not. Eliminate it. Here is another management of care question. 2. Which of the following tasks is appropriate for the nurse to delegate to an experienced nursing assistant? A. Obtain a 24 hour diet recall from a patient recently admitted with anorexia nervosa B. Obtain a clean catch urine specimen from a patient suspected of having a urinary tract infection C. Observe the amount and characteristics of the returns from a continuous bladder irrigation for a patient after a transuretheral resection D. Observe a patient newly diagnosed with diabetes mellitus practice injection techniques using an orange Step 1. Reword the question. "Which task will you assign to a nursing assistant?" The fact that a nursing assistant is "experienced" is a distracter. Do not fall for this trap! Just answer the question. Step 2. Eliminate answer choices using the Rules of Management. (A) Obtain a 24 hour diet recall from a patient recently admitted with anorexia nervosa. Some students may consider this answer choice because eating is certainly a recurring daily activity, but this answer isn't about feeding a patient. Eating has special significance for a patient with anorexia nervosa. An important assessment that the nurse must make is the quantity of food consumed by this patient. The nurse cannot delegate assessment. Eliminate this answer choice. (B) Obtain a clean catch urine specimen from a patient suspected of having a urinary tract infection. Rule #4 states, "Delegate activities that involve standard, unchanging procedures." There is no indication that this patient has a catheter so this is a routine procedure. Keep it in for consideration. (C) Observe the amount and characteristics of the returns from continuous bladder irrigation for a patient after a transuretheral resection. The color of the fluid needs to be assessed to determine if hemorrhage is occurring. This is an assessment. Eliminate this choice. (D) Observe a patient newly diagnosed with diabetes mellitus practice injection techniques using an orange. This answer involves patient teaching. According to Rule#1, the nurse cannot delegate evaluation of patient care. Eliminate this choice. Let's try one more question. 3. Which of the following patients should the nurse on a pediatric unit assign to the LPN/LVN? A. A 3 year old girl admitted yesterday with larnygotracheogronchitis who has a tracheostomy B. A 5 year old girl admitted after gastric lavage for tylenol ingestion C. A 6 year old boy admitted for a fracture of the femur in balanced suspension traction D. A 10 year old boy admitted for observation after an acute asthmatic attack Step 1. Reword the question in your own words. The question is asking for the appropriate assignment for a LPN/LVN. Step 2. Eliminate answer choices using the Rules of Management. Remember, "Delegate activities for stable patients with predictable outcomes." (A) A 3 year old girl admitted yesterday with larnygotracheogronchitis who has a tracheostomy. Ask yourself, is this a stable patient with a predictable outcome? A 3 year old with a new tracheostomy is not stable or predictable. Elimate this answer choice. (B) A 5 year old girl admitted after gastric lavage for tylenol ingestion. This child may be unstable and the outcome is of a poisoning is unpredictable. Elimate this answer choice. (C) A 6 year old boy admitted for a fracture of the femur in balanced suspension traction. This child has a problem that has a predictable outcome. No information is provided in the choice to lead you to believe that this child is unstable at this time. Keep this answer in for consideration. (D) A 10 year old boy admitted for observation after an acute asthmatic attack. Because of the narrow airway of a child, this child may be unstable and the outcome unpredictable. Elimate this answer choice. Establishing Priority -------------------------------------------------------- Is this getting easier for you? Lets try a couple of more questions with a slightly different focus: priority. Many students are uncomfortable with these types of questions because more than one answer looks right. 4. A home care nurse is planning her visits for the day. Which of the following patients should the nurse visit first? A. A 62 year old man two days after an inguinal hernia repair B. A 40 year old woman with type 1 diabetes mellitus (1DDM) with a foot ulcer C. A 76 year old man with chronic obstructive pulmonary disease (COPD) D. A 50 year old woman three days after a right mastectomy Step 1. Reword the question in your own words. The question is a priority question: Which patient takes highest priority? As with all priority questions, more than one answer will seem correct. Step 2. Eliminate the answers using the Rules of Management. (A) A 62 year old man two days after an inguinal hernia repair. There is nothing stated that leads you to believe that this patient is unstable. Usually, recovery from hernia repairs are uneventful. Elimate this answer. (B) A 40 year old woman with type 1 diabetes mellitus (1DDM) with a foot ulcer. Impaired circulation is a complication of the diabetic and this client's situation is potentially unstable. Leave this in for consideration. (C) A 76 year old man with chronic obstructive pulmonary disease (COPD). While this client has a chronic condition that requires close monitoring by the nurse, there is no indication of an acute situation. Eliminate this answer. (D) A 50 year old woman three days after a right mastectomy. This is a relatively new postop client that has the potential for major complications. The patients should be assessed by the nurse. Leave this in for consideration You are now choosing from answers 2 and 4. Which client do you consider the least stable? Remember the only way to answer priority questions correctly is to eliminate answer choices. It is too difficult to just pick the right answer from the four answer choices. Let's look at one more question. 5. After receiving report from the night nurse, which of the following patients should the nurse see first? A. A 31 year old woman refusing Carfate before breakfast B. A 40 year old man with left sided weakness asking for assistance to the bedside commode C. A 52 year old woman complaining of chills who is scheduled for a cholecystectomy D. A 65 year old man with a nasogastric tube who had a bowel resection yesterday Step 1. Reword the question in your own words. This question asks, "Who is the highest priority for the nurse?" Step 2. Eliminate answers using the Rules of Management. (A) A 31 year old woman refusing Carfate before breakfast. You're not told what's wrong with this patient or why she's receiving Caragate, but this patient is probably not the priority. Let's look at the other choices. (B) A 40 year old man with left sided weakness asking for assistance to the bedside commode. This can certainly be a messy situation if not attended to in a timely manner, but assisting a patient to the bedside commode does not require a registered nurse. Elimate this answer. (C) A 52 year old woman complaining of chills who is scheduled for a cholecystectomy. This is an unstable situation since chills are indicative of an infectious process and the patient is scheduled for surgery. Leave this answer in for consideration. (D) A 65 year old man with a nasogastric turbe who had a bowel resection yesterday. A patient who is one day into postop certainly has the potential for complications even though none are indicated. Leave this in for consideration. You can now choose between 3 and 4. Which patient is the highest priority? Although you may still feel slightly uncomfortable when answering management questions, continue to practice answering questions using the Rules of Management. You will choose more correct answers! Here are other techniques in choosing the right answer as well: 1) Remember to use your Airway, Breathing and Circulation Rules. 2) Assess first. 3) Take care of the pt, not the machine. 4) Stay with the pt. 5) Don't pass the buck [calling the doctor is not the answer]. 6) Pain is not always the first choice in taking care of a problem. 1. pt has graves disease what would you expect to see all but one were hypothyrodism choices. ans: protruding eye balls 2. pt had hypothroidism what would nurse expect to see; three choices not related to conditon. ans: intolerance to cold. 3. Na level 140, potassium 2.9 what medications if ordered would cause the nurse to have most concern, check all that apply: choices: zocor, digoxin, lasix, zestril, hydroclorothyiazide, and i think reglan. ans: digoxin, lasix, hydroclorothiazide 4. what would be most concerning to the nurse if this pattern for a 9 month pregnant pt was experiencing. choice:two were about acceleration of fetal heart rate, I discounted these because i don't remember ever hearing this, the other two were about: deceleration that return to normal or deceleration by 20 beats during contraction, i chose deceleration by 20 beats. 5. this one was very difficult for me and happens to be the last question i received. The patient is 2 months old and has GERD, what would concern the nurse most if you saw the mom doing. choices: adding cereal to formula, feeding baby 2ounces of formula every two hours, or if the mom positioned the baby in a side lying position, the fourth choice was something psychosocial so i threw it out. ans: side lying position, because i assumed this meant the child would be lying flat but after reviewing post nclex, i beleive it might be adding cereal to the formula. 6. .Reglan-how does it :increase emptying time of stomach. 7. dumping syndrome-what should pt do to e: limit fluid in between meals, decreased carb consumption, to avoid lying down after meal, can't remember fourth choice; ans: decrease carb intake 8. pediatric nurse floated to med surg who would you assign her to. choice: pt being discharged who had a TURP leaving with a foley, pt with fx internal fixation, post surgical pediatric pt, cant remember #4, ans: pt with fx. the rule is you treat the float nurse like an lvn, in that you assign her stable pt with expected outcome that does not require teaching or frequent assesments. 9. pt on vent, nurse just suctioned pt yet vent started alarming saying "high alarm" what should nurse do. choice: call respiratory therapist, adjust settings on vent, stay with pt and have another nurse call dr., or disconnect pt from vent and ambubag the pt. ans: disconnect and ambupt. this indicated to me that the vent was malfunctioning, so i needed to do something for the pt in light of when a high pressure alarm setting goes off erroneously it could seriously compromise the pt's lung because the vent is working harder to deliver the ordered tidal volume of air and could therefore cause a pnemothorax, so best answerin my opinion is disconnect from a malfunction machine. to stay with the pt and do nothing is negligent this is one reason each pt has an ambu bag at the bedside. 10. who would the nurse see first. pt with endstage renal disease, receiving epogen and hemoglobin 10 pt with hepatic cirrhosis receiving lactulose with a high amnonia level pt with chronic cardica disease with low magnesium level pt with type 2 diabetes receiving glucotrol who blood sugar is 226. i chose this one because the other ones were all chronic condition which nothing could be done for them to improve there condition, this one indicated to me that the pt has converted to a type i diabetic and is no longer able to be managed by the diet and oral hypoglycemic agents. i'm not that confident in this choice i must admit. 11. a ten month old toddler in a cast what kind of toy would you give him to play with. choice: cups of varying size, a tiny toy such as plastic alligator, a big large stackable blocks, or another stackage toy. ans; big large stackable blocks. one on alzehemiers can't remember choices, something about their walking pattern 12. one on lyme disease sorry can't remember choice or even the direction the question went in. 13. one on guillian barre syndrome, sorry same as above 14. infective endocarditis- what system would you expect to be most at risk for further damage, the obvious heart was not a choise, i just rememeber choicing, kidney failure, when i got home and checked my textbook it mentioned chronic kidney failure is a consequence of this condition. i hope i'm right but still not 100%. 15. baby 8 months old what would you expect them to be able to do. ans. hold a bottle 16. this one was told to me by my friend who took the test in anaheim california in october and i ended up having the exact same question. pt has a second degree partial thickness burn, what would concern the nurse most. ans. specific gravity 1.035, this high sp. gr. indicates dehydration or fluid volume loss. 17. train derailment who would you see first. choices i only remembered three: child with a broken leg, girl with vaginal bleeding, or child with a deviated trach. ans: child ted trach, this is a medical emergency, this indicates pnemo or hemothorax 18. who would you put a pt in a sickle cell crisis with. choice: negative pressure room, with pt on contact isolation, with an AIDS pt, cant remember #4. ans: with an AIDS pt, they both are immunosuppressed and are very susceptible to infections 19. pt on pca pump, resp 8, b/p 90/60 what should nurse do first. give narcan, give o2, call md. ans: give narcan, this is the antidote to morphine. 21 pt dx w/M.I. has lots of crushing pain what should nurse do first, give morphine, give o2. ans: give morphine. this choice deals with the pain and morphine decreases the workload of heart by decreasing preload therefore decreases the o2 consumption of heart, which is what one wants with this codition, Triage depends lot on the specifics of the situation but when you have a mass casualty or multiple casualty situation ie: Your resources are overwhelmed by the number of patients at one time then there are some rules to follow. ABC is the biggest thing but do not be distracted by the patient who is not likely to survive and do not resusitate anyone and if you ever see anyone given as having fixed and dilated pupils then the question will want you to categorise them as dead and rule them out same for anyone who is not breathing or has no pulse. Any patient with breathing or airway difficulties goes to the top of the list with airway ahead of course followed by circulation injuries- such as wounds, gunshots and fractures etc. Head injury patients can often come into the airway category so dont always over look them but it depends on what information is given about them because they could well be the dead one or near dead one so be careful. Basically though stick rigidly to the ABC priority system and rule out the patient who is too far gone to save as most triage questions has one of those and it should be fairly easy, always ask yourself- could this patent have airway difficulty if it doesnt say then ask yourself if the injury could cause airway problems, the burns question someone posted is a perfect example!! If there is noone with a potential airway problem or the one that has is dead then look at the patient with breathing problems and so on. The hardest bit of a triage question is choosing the one that you ignore. Its not natural for us to leave dead as dead these days. When I was in the Army we had triage within triage but I wont complicate things with that and that often involved 10 or more seiously injured patients, you will not have more than 4 on the NCLEX!!!! Do not confuse these questions with priority questions because triage questions will always involve more than one priority patient or critical patient at a time and it will always involve trauma or injured patients. Hope I havent confused you anymore!!! Actually he never did! - But some other girl sent me some information regarding the external/internal disaster stuff. I took my NCLEX on July 12th, (didn't pass), but had TONS of these internal/external "?"'s. You'd think the ABC's would correlate with each question but they don't. And there is a difference between who you'd access first in the in/external situations. I'll be more than happy to send that to you if you'd like. Have you taken the NCLEX already?? if so, what study materials did you go by?- So much pressure, you go thru years of nursing school, to come down to a 75-265 question test. So much material it's hard to tell what to focus on. -- Good luck, and let me know if you'd like for me to send what information that i have. Preparing for the NCLEX Exam: · The test is on computer. You will have to answer anywhere from 75-265 questions. · The goal is to focus on the first 20-30 questions. The computer maps out your competency level from there. · Process of elimination-Their suggestions. 1. If there are words like always or all, they are more likely to be incorrect. 2. Choices with commonly or possibly tend to be wrong. 3. Information in the question tends to repeat itself in the answer. · You must answer every question in order to move on. Delegation rules in the U.S.: A registered nurse may not delegate: * Initial nursing assessment or advanced nursing assessment. * Nursing diagnosis determination * Development of nursing care plans * Evaluation of the patient regarding the nursing care plan *Establishment of nursing care goals *Patient care activities that require professional nursing knowledge, judgement and skills. A registered nurse MAY delegate: * Feeding a client * Taking vital signs * Hygeine Care The 5 delegation rights: 1. Right task 2. Right Circumstance 3. Right Person 4. Right Direction and Communication. 5. Right Supervision Prioritization: Typical prioritization question look like the following: 1. What is the most important? 2. What is the initial action of the nurse? 3. What is the best nursing action? 4. Which client would the nuse care for first? Here are some tools that will help answer these types of questions: 1. MASLOW’S HIERARCHY OF NEEDS: * Physiological Needs (survival) * Safety Needs (Physical and psychologicval) * Psychologicla Needs (Care and Belonging) * Self Actualization Next is their Nursing Process APIE Assessment Plan Implement Evaluate Next back to the old ABC’s: Airway Breathing Circuation When dealing with fire use RACE: REMOVE the client Sound the ALARM CALL the fire department EXTINGUISH the fire. ADULT PHYSIOLOGICAL INTEGRITY Comprizes 46-54% of the test. They lay it out according to system. Remember 1. Maintaining the cts airway is always #1. 2. There is always something you could do before calling the doctor. THE NERVOUS SYSTEM. The nervous system is comprised of the CNS, PNS &ANS. CENTRAL NERVOUS SYSTEM – Brain and spinal cord. PERIPHERAL NERVOUS SYSTEM – Cranial and spinal nerves. AUTONOMIC NERVOUS SYSTEM – Controls “automatic” function of the body like breathin and our heartbeat. It also maintains a stable internal environment. The A.N.S. branches in the SYMPATHEIC and the PARASYMPATHETIC Nervous Systems SYMPATHETIC PARASYMPATHETIC “Fight or Flight” Maintains normal body functioning Increases respiratory rate Normalizes heart rate and blood pressure Decreases Peristalsis Increases peristalsis Secretes Epinephrine and Nor epinephrine Secretes Acetylcholine Dilates pulmonary bronchi Constricts pulmonary bronchioles NEUROTRANSMITTERS (acetylcholine, serotonin, epinephrine, norepinephrine and dopamine) transfer information from one neuron to another across a synapse. AFFERENT IMPULSE (To CNS). EFFERENT IMPULSES (from CNS). The BRAIN Frontal Lobe · Personality, behaviour· MOTOR Function· BROCA’S AREA (Aids formation of words)· Concentration, abstract thought, memory Temporal Lobe · Hearing, taste , smell· WERNICKE’S AREA (Interpretation of language)· Interpretive Area- Junction of temporal, parietal, and occipital lobes (Integration of somatic, auditory, and visual associations occur here). Parietal Lobe · Sensation – Determination of size, shape, weight, and texture of sensory input.· Orientation of space and space perception (propriception) Occipital Lobe * Vision (reception and interception). BRAIN STEM · Nerve pathways connecting the brain and the spinal cord · Cardiac, vasomotor and respiratory centres DIENCEPHALON= THALAMUS AND HYPOTHALAMUS, located between the brain stem and the cerebrum. THALAMUS = Interpretation of SENSATION (Pain, temperature and touch). HYPOTHALAMUS = Temperature control, water metabolism, control of hormonal secretion, heart rate, peristalsis, appetite control, thirst centre, sleep-wake cycle. THE 12 CRANIAL NERVES I Olfactory Smell II Optic Vision III Oculomotor Eye movement IV Trochlear Eye Movement V Trigeminal Chewing, Facial sensation VI Abducens Eye movement VII Facial Taste, facial movement VIII Vestibulocochlear Hearing, BALANCE IX Glossopharyngeal Taste (Posterior Tongue), Swallowing X Vagus Pharynx,Respiratory, cardiac and circulatory reflexes XI Spinal Accessory Shoulders, head movement XII Hypoglossal Tongue movement The American Exam will require any more knowledge than the above about the cranial nerves. A good one would be III, IV and VI all control eye movement. NEUROLOGICAL ASSESSMENT What is the first thing a nurse should assess to determine the presence of neurological changes? (LOC) THE GLASGOW COMA SCALE EYE OPENING + BEST MOTOR RESPONSE+ BEST VERBAL RESPONSE = SCORE 3 is worst score, 15 is best. DECORTICATE = Arms turned in and up, toward CORTEX. DECEREBRATE = Extension, limbs away from body. CEREBRAL DYSFUNCTION 1. GNOSIA – Inability to recognize common objects 2. APRAXIA – Inability to perform a skilled motor task, assuming the ct is not paralyzed. 3. APHASIA - The inability to communicate. (EXPRESSIVE – speak, RECEPTIVE – Understand speech). 1 to 2 years of age, gross motor ability: Runs, walks up and down stairs, likes push-pull toys 2 to 3 years of age, gross motor ability: Jumps, kick ball, throws ball overhand. Toys and activities, Big Wheel tricycle, Soft ball and bat, Water and sand, Bean bag toss. 3 to 6 years (preschooler) gross motor ability: Runs with ease, holds a bat, throws balls of various type, climbs well, rides a tricycle (at age 3) then a bicycle with training wheels, and by end of preschool years rides a bicycle. low pressure alarm -- check connection high pressure alarm -- check airway obstruction. pt. needs to be suctioned Hi, Nico – the first question is not quite understood. In what medical condition are you going to administer the b-blockers and steroids? I found the similar question in the Internet - A client with acute asthma showing inspiratory and expiratory wheezes and a decrease forced expiratory volume should be treated with which of the following classes of medications right away? a. Beta blockers b. Bronchodilators c. Inhaled steroids d. Oral steroids Bronchodilators – first – provide dilation of the spasmodic bronchioles Inhaled steroids – second – deliver medication for further treatment of the disease; after them have the pt rinse the mouth. Beta blockers - contraindicated in all asthmatics Low pressure alarm on a ventilator means tube disconnection or leak in the tube. Common Causes of Low-Pressure Alarms: Patient disconnection, Circuit leaks, Airway leaks, Chest tube leaks Your actions as a nurse – first detect the leak or disconnection and fix it. Common Causes of High-Pressure Alarms: Patient coughing, Secretions or mucus in the airway, Patient biting tube, Airway problems, Reduced lung compliance (eg. pneumothorax), Increased airway resistance, Patient fighting the ventilator, Accumulation of water in the circuit, Kinking in the circuit, Problems with inspiratory or expiratory valves Your actions – detect the problem, fix all the kinks, remove water OR disconnect the ventilator and ambubag the patient. A nurse is scheduling multiple diagnostic procedures for a client with activity intolerance. The procedures ordered include: Echocardiogram, Chest X-ray, and CAT scan. The nurse schedules these tests in the following sequence: A. X-ray in the morning, Echo in the afternoon, CAT scan the next morning B. X-ray and Echo together in the morning, CAT scan in the afternoon the same day. C. Echo in the morning, CAT scan and chest X-ray in the afternoon the same day. D. CAT scan in the morning, Chest X-ray and Echo the next morning. WHAT IS THE BEST POSITION FOR A MOTHER IN ACTIVE LABOR ? Looking at the eyes of native Indians when communicating would mean what? How do you do health teaching to 65 years old group pf patients Best toy for toddler with pneumonitis ISOLATION PRECAUTION FOR TB, scarlet fever. 60,000 platelet = interpretation what meds should be questioned for PUD AMINOGLYCOSIDES - toxicity and s/e nueroleptic drugs s/e drug computation - d/sxq ( formula) IV- how many ml/hr prioritization - a lot ! AAA, pneumonia, HPT, LOC10 memorize u Cranial nerves, and assessment of CN in elderly. Definitely know the herbs medications. And also disaster delegation very important. and infection control like what is more important in meningitis patients for infection control: wear a gown when u change the bed or keep the door closed at all times Other question was what information can u give over the phone. and questions about teaching other nurses about several subjects, like geriatric care. She said to know the therapeutic levels of Coumadin, digoxin, potassium. Also know about lasix and blood transfusions. She also had some chemo. drugs on her exam. the herb medication St. John Wort – depression treatment Guys here are some of my encountered questions: herb questions: 1. Gingko= tx for hypertension, rel to BP 2. Echinnacea= remember E for immune system hepa A same as hepa E for mode of transmission variable decelaration= change position of the mother low pressure alarm= check for kink patient is biting the tube restraints=ask the dr first in restraining and unrestraining the pt. even the pt say he is fine already GLUCOPHAGE= GI disturbance diarrhea LASIX= good outcome decrease in wt raduim implants= reframe self from pt DO NOT go with pt in the bathroom Herb Kava-kava for stress and anxiety relief. a client with hepatic encephalopathy. what diet will be restricted? 1. fats 2. carbohydrates 3. protein 4. folic acid 1. A patient on blood transfusion develop hemolytic reaction after you stop blood transfusion, what is the next action you should do? a. continue the IV saline b. send the blood unit to the lab c. call the doctor asap d. assess the patient's vital signs Answer is D= assessment of vital signs then call the doctor with data. Since it's pressumed that the transfusion had been stopped already. I thought A and B in this situation will not give a critical solution to the problem. 2. The nurse is caring for a patient in the coronary care unit. The display on the cardiac monitor indicates the ventricular fibrillation. What should the nurse do first? a. perform defibrillation b. administer Epinephrine as ordered c. assess for presence of pulse d. institute CPR It's a toss between c or d. VF is a form of heart attack. To confirm VF you need to check for a pulse or HR, absence of that confirms VF. To institute CPR, you also check for pulse but breathing comes first. So, I'd say, C, final answer:) 3. The nurse in a well- child clinic examines many children on a daily basis. Which of the following toddlers requires further follow-up? a. 13 mo. old unable to walk b. 20 month old using only 2 or 3 sentences c. 24 month old who cries during examination d. 30 month old only drinking from a sippy cup c is out, practically every kid cries during exam. D is correct. client with morphine sulfate in a pca has a respiration of 8 beats/minutes. what will the nurse to do first? a. give the narcan prn order in the chart b. give oxygen 2L/min prn order in the chart c. call the physician d. assess the breath sounds A is correct Which evaluation would best determine if fluid is amniotic versus urine? 1 digital evaluation 2 ph determination of fluid 3 urinalysis by lab 4 glucose determination 2 is correct Know your lab val