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Mark Klimek Yellow Book (KV) 1st 500 questions with correct answers
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9/3/24, 12:46 NCLEX KlimekAM notes
LECTURE 1 ** DON’T MIX UP S&S and CAUSATION
- often what causes something is the opposite of the S&S
ACID BASES - ex. diarrhea will cause a metabolic acidosis but
• learn how to convert lab values to words once you are acidotic your bowel shuts down
• the rule of the B’s and you get a paralytic illeus
= if the pH and the BiCarb are both in the
same direction -> metabolic • when you get scenarios:
Hint: draw arrows beside each to see -> if it’s a lung scenario = respiratory
directions - then check if the client is over-
* down = acidosis ventilating (alkalosis) or under-
* up = alkalosis ventilating (acidosis)
- respiratory -> has no b in it; if in other - remember to look at the words (ex. over,
directions (or if bicarb is normal value) under, ventilating) -> “as the pH goes so
- KNOW NORMAL pH, BiCarb, CO2 goes my PT”
-> VENTILATING DOESN’T MEAN RESPIRATORY
• Hint: DON’T MEMORIZE LISTS…know RATE; resp. rate is irrelevant w/ acid-base,
principles (they test knowledge of ventilation has to do with gas exchange not
principles by having you generate lists..) - resp. rate (look at the SaO2 -> if your resp.
for “select all” questions rate is fast but SaO2 is low you are under-
- ex. in general/principle what do ventilating)
opioids/pain meds do? = sedate you, -> ex. PCA pump - What acid-base disorder
indicates they need to come off of it? =
CNS depressors
* ex. what does dilaudid do? don’t memorize specifics respiratory acidosis (resp. depression ->
or a list of dilaudid, know principles of opioids (such resp. arrest)
as sedation, CNS depression -> lethargy, —> if it’s not lung, it’s metabolic
flaccidity, reflex +1, hypo-reflexia, obtunded) • metabolic alkalosis - really only one scenario =
- boards don’t test by lists because all if the PT has prolonged gastric
books/ classes have different lists vomiting/suctioning
- because you are losing ACID
• principles of S&S acid bases: as the pH goes so * ex. GI surgery w/ NG tube with
goes my patient (except K+) suctioning for 3 days; hyperemesis
- pH up = PT up -> body system gets graviderum
more irritable, hyper-excitable - otherwise everything else that isn’t lung you
(EXCEPT K+) pick metabolic acidosis (DEFAULT)
-> alkalosis - think of a body system and go * ex. hyperemesis graviderum w/ dehydration
high: hyper-reflexive (+3, +4 [2 is acute renal failure, infantile diarrhea
normal]), tachypnea, tachycardia,
borborygmi, seizure • remember, you only have 4 to pick from:
- pH down = PT down -> body - respiratory alkalosis - respiratory acidosis
systems shut down (EXCEPT K+) - metabolic alkalosis - metabolic acidosis
-> acidosis - think of a system and go low:
hypo-reflexive (+1, 0), bradycardia, • pay more attention to the modifying phrases
lethargy, obtunded, paralytic illeus, than the original noun
respiratory arrest - ex. person w/ OCD who is now psychotic
• ex. which acid-base disorders need an ambu- (psychotic trumps OCD); hyperemesis with
bag at the bedside? = acidosis (resp. arrest) dehydration (pay attention to dehydration)
• ex. which acid-base disorders need suction
at the bedside? = alkalosis (seize and VENTILATION
aspirate) • ventilators -> know alarm systems (you set it
• Mac Kussmaul - Kussmaul’s (compensatory up so that the machine doesn’t use less than
respiratory mechanism) is only present in or more than specific amounts of pressure)
only 1 of the 4 metabolic (acid-base) a) high pressure alarm = increased resistance
disorders to airflow (the machine has to push too
* M = metabolic AC = acidosis hard to get air into lungs)
- from obstructions:
• most common mistake with select all questions = i. kinks in tubing (unkink it)
selecting one more than you should (stop when you ii. water condensation in tube (empty it!)
select the ones you know! don’t get caught up on iii. mucous secretions in the airway
the “could be’s”) (change positions/turn, C&DB, and
• Hint: don’t select none or all on select all that THEN suction)
apply questions (never only one and never *** suction is only PRN!!!
all) -> priority questions = you would
check kinks first, suction is not first
• Causes of Acid-Base Imbalance:
- scenarios and what acid-base disorder would
result (what would cause an imbalance)
about:blan 1/39
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,9/3/24, 12:46 NCLEX Klimek
AM notes
b) low pressure alarm = decreased
resistance to airflow (the machine had
to work too little to push air into
lungs)
- from disconnections:
i. main tubing (reconnect it duh!)
ii. O2 sensor tubing (which
senses FiO2 at the airway/trach
area; black coated wire coming
from machine right along the
tubing - reconnect!)
• ventilators -> know blood gases
- resp. alkalosis = ventilation settings
might be set too high (OVER-
VENTILATING)
- resp. acidosis = ventilation settings might
be set too low (UNDER-VENTILATING)
• ex. weaning a PT off ventilator -> should not
be under-ventilated, they need the
ventilator; if they are over-ventilating then
they can be weaned
• never pick an answer where you don’t do
something and someone else has to do
something
about:blan 2/39
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,9/3/24, 12:46 NCLEX Klimek
AM notes
about:blan 3/39
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, 9/3/24, 12:46 NCLEX Klimek
AM notes
- PT teaching = avoid ALL forms of alcohol to
• Alcohol Withdrawal Syndrome vs. Delirium Tremens
avoid nausea, vomiting & possibly death
-> including mouthwash,
- they are both different! not the same
aftershaves/colognes/perfumes (topical stuff will a) every alcoholic goes through withdrawal 24 hrs.
make them nauseous), insect repellants, any after they stop drinking
OTC that ends with “-elixer”, alcohol- based - only a minority get delirium tremens
hand sanitizers, uncooked (no-bake) icings - timeframe -> 72 hrs. (alcohol withdrawal
which have vanilla extract, red wine vinaigrette comes 1st)
- alcohol withdrawal syndrome ALWAYS
• Overdoses & Withdrawals: precedes delirium tremens, BUT delirium
- every abused drug is either an UPPER or tremens does not always follow alcohol
DOWNER withdrawal syndrome
-> the other drugs don’t do anything b)AWS is not life-threatening; DT’s can kill you
-> #1 abused class of drug that is not an c) PT’s w/ AWS are not a danger to
upper or downer = laxatives in the self/others; PT’s w/ DT’s are dangerous to
elderly self/others
a) first establish if the drug is an upper or - they are withdrawing from a downer so
downer they will be exhibiting upper S&S
- uppers (5) = caffeine, cocaine, PCP/LSD - DT’s are dangerous
(psychedelic hallucinogens), methamphetamines, Differences AWS DT
adderol (ADD drug) in Care
* S&S -> make you go up; euphoria, Diet Regular diet NPO/clear liquids
(because of risk for seizures
tachycardia, restlessness, irritability, which can cause risk of
diarrhea, borborygmi, hyper-reflexia, aspiration)
spastic, seize (need suction) Room Semi-private Private near nurses
station anywhere on (dangerous &
- downers = don’t memorize names -> unstable) the unit
anything that is not an upper is a downer! if Ambulation Up ad lib Restricted bed rest -> no
you don’t know what the med is, you have a bathroom
high chance that it’s a downer if it’s not part privileges (use bedpans/urinals)
Restraints No restraints Restraints (because dangerous)
of the uppers list (because not - not soft wrist or 4 point soft
* S&S -> make you go down; lethargy,
respiratory depression (& arrest)
- ex. The PT is high on cocaine. What is critical to assess? dangerous because they’ll get out
-> NOT resps below 12 because they will be high ) - need to be in vest or 2-pt.
locked leathers (opposite 1
-> maybe check reflexes arm & leg, rotate Q2hrs,
b) are they talking about overdose or withdrawal lock the free
- overdose/intoxication = too much limbs 1st before releasing the
locked ones)
- withdrawal = not enough They both get ANTI-HYPERTENSIVES &
TRANQUILIZERS
- ex. the PT has overdosed on an upper -> - because everything is up (downer
pick the S&S of too much upper withdrawal)
- ex. the PT has overdosed on a downer ->
They both get MULTIVITAMIN w/ B1
pick the S&S of too much downer
- ex. the PT is withdrawing from an upper • RN’s can accept but RPN’s can’t (because PT is
unstable)
-> not enough upper makes
- on med-surge, the RN who takes them must
everything go down
decrease their workload (i.e. reduce PT load if
- ex. the PT is withdrawing from a downer
they take a DT PT)
-> not enough downer makes
-> Hint: on boards, the setting is always
everything go up
• upper overdose looks like = downer withdrawal perfect (i.e. enough staff/time/resources
• downer overdose looks like = upper withdrawal on the unit etc.)
• In what 2 situations would resp. depression &
arrest be your highest priority:
- downer overdose
- upper withdrawal
• In what 2 situations would seizure be the
biggest risk:
- upper overdose
- downer withdrawal
• Drug Abuse in the Newborn:
- always assume intoxication, NOT withdrawal
at birth
- after 24 hrs -> withdrawal
- ex. caring for infant of a Quaalude addicted
mom 24 hrs. after birth, select all that apply:
-> downer withdrawal so everything is up =
exaggerated startle, seizing, high
pitched/shrill cry
about:blan 4/39
k
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