Nclex Important Topics

Question: Vitamins (A,B,C,D,E) - know what each vitamin benefits

Answer: Vitamin A - eyes, immune system, and reproduction
Vitamin B - make energy from food
Vitamin C - helps your body heal - immune deficiency
Vitamin D - Helps your bones
Vitamin E - Healthy skin and eyes

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Question: KNOW SIDE EFFECTS OF COMMON MEDICATIONS

Answer: should be taken with food - do not give to a patient who has not eaten

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Question: Nsaids (ibuprofen):

Answer: Metronidazole - treats various of infections

may discolor urine. Also pyridum makes urine orange (medicine for UTI to reduce burning)

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Question: Flagyl

Answer: common side effect is discoloration of urine

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Question: Levadopa

Answer: know that antacids (Maalox, Mylanta) are used to keep the PH of gastric contents above 3.5. They DO NOT reduce gastric secretions.

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Question: GI medications

Answer: reduce gastric secretions - pepcid or prilosec

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Question: H2 blockers

Answer: elevate blood sugar, be careful with diabetics.
Also, there usually are questions regarding steroid use. Always taper off of steroids to avoid addisons disease. Steroids should always be taken with food.

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Question: Steroids and immunosuppresants

Answer: Lopressor - It can treat high bp, heart failure, and chest pain. check patients apical heart rate before admin. Hold medication if HR less than 60 or SBP less than 90. Contact physican.

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Question: Metoprolol

Answer: Hydrazine (Apresoline)

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Question: Which IV medication can be used if a patient is in a hypertensive crisis with a heart rate of 50?

Answer: - swelling of tongue, lips, or face. Usually caused by ace inhibitors. This is a medical emergency. Pril (enalapril, lisinopril)
- There is almost always a question on this.
- First priority is airway. Most patients present as an allergic reaction (swollen face, lips, tongue) but are awake. A good way of checking if the patient has a patent airway is if they are speaking complete sentences. In severe cases, a patient will have respiratory symptoms (stridor, wheezing, SOB). GIVE EPI! If this is the case, get a physician immediately and prepare for intubation. There are rare cases where the doctor cannot pass the ET tube and the patient will require an emergency cric.
Most often medication used for treatment is IV BENADRYL, SALUMEDROL (STEROIDS), PEPCID (HISTAMINE BLOCKER), AND IV FLUIDS.

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Question: ANGIOEDEMA

Answer: Insulin regular - 15-30 minutes, fast acting
Humalog (lispro) - given with meals (short acting), usually smaller unit amount (1-5 unit)
Levemir (lantus) - given at night, long acting, usually large unit amount (10-20 units)
There almost always is a select all that apply question about mixing insulin, even though in clinical practice we NEVER mix insulin. Remember, inject air into cloudy, then inject air into clear, draw clear, then draw cloudy. They try to trick you with these questions and one of the answers will not include (use an alcohol wipe) and that will not be one that you will select.

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Question: In the most severe case, a patient may be in anaphylactic shock (low blood pressure) and require 2 large bore IV's and a lot of IV fluids and possibly pressors

Answer: For some reason NCLEX focuses a lot on tic bites.
- Know the signs and symptoms of tic bite/lyme disease.
Bullet eye rash (look up other symptoms)


Also know what type of clothing to wear when walking in the forest (you want to wear light colored clothes so the tic does not mistake you for a tree)

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Question: INSULIN:

Answer: Answer: 1
Rationale: Lyme disease is a multisystem infection that results from a bite by a tick carried by several species of deer. Persons bitten by Ixodes ticks can be infected with the spirochete Borrelia burgdorferi. Lyme disease cannot be transmitted from one person to another. Toxoplasmosis is caused from the ingestion of cysts from contaminated cat feces. Histoplasmosis is caused by the inhalation of spores from bat or bird droppings.

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Question: Know the difference of short acting and long acting insulin:

Answer: Answer: 2
Rationale: The hallmark of stage I is the development of a skin rash within 2 to 30 days of infection, generally at the site of the tick bite. The rash develops into a concentric ring, giving it a bullseye appearance. The lesion enlarges up to 50 to 60 cm, and smaller lesions develop farther away from the original tick bite. In stage I, most infected persons develop flu-like symptoms that last 7 to 10 days; these symptoms may reoccur later. Neurological deficits occur in stage II. Arthralgias and joint enlargements are most likely to occur in stage III.

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Question: TIC BITES

Answer: Answer: 4
Rationale: A blood test is available to detect Lyme disease; however, the test is not reliable if performed before 4 to 6 weeks following the tick bite. Antibody formation takes place in the following manner: immunoglobulin M is detected 3 to 4 weeks after Lyme disease onset, peaks at 6 to 8 weeks, and then gradually disappears; immunoglobulin G is detected 2 to 3 months after infection and may remain elevated for years. Options 1, 2, and 3 are incorrect.

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Question: The camp nurse prepares to instruct a group of children about Lyme disease. Which of the following information would the nurse include in the instructions? 1. Lyme disease is caused by a tick carried by deer.
2. Lyme disease is caused by contamination from cat feces.
3. Lyme disease can be contagious by skin contact with an infected individual.
4. Lyme disease can be caused by the inhalation of spores from bird droppings.

Answer: Answer: 3
Rationale: In the prevention of Lyme disease, individuals need to be instructed to use an insect repellent on the skin and clothes when in an area where ticks are likely to be found. Long-sleeved tops and long pants, closed shoes, and a hat or cap should be worn. If possible, one should avoid heavily wooded areas or areas with thick underbrush. Socks can be pulled up and over the pant legs to prevent ticks from entering under clothing.

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Question: The client is diagnosed with stage I of Lyme disease. The nurse assesses the client for which characteristic of this stage? 1. Arthralgias
2. Flu-like symptoms
3. Enlarged and inflamed joints
4. Signs of neurological disorders

Answer: - These are usually pretty straight forward but the questions are usually regarding psychiatric patients.
Ex - the monsters are going to get me!
- Bring the patient back to reality and say I am a nurse and you are in the hospital.
Ex - a mom is in the lobby of a clinic and her children (age 2 and 4) are running around the waiting room screaming and playing. Best nursing response "children can be tough to handle at that age". Don't say something stupid like "control your children" or something like that.
Pretty much never say anything that can offend someone. If you don't know the answer, get someone who does.

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Question: A female client arrives at the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease. The client tells the nurse that she removed the tick and flushed it down the toilet. Which of the following nursing actions is appropriate? 1. Refer the client for a blood test immediately.
2. Inform the client that there is not a test available for Lyme disease.
3. Tell the client that testing is not necessary unless arthralgia develops.
4. Instruct the client to return in 4 to 6 weeks to be tested, because testing before this time is not reliable.

Answer: It is ok to milk a chest tube, all that means is you raise the tubing (like a foley) and drain the drainage into the device.
When a chest tube is connected to suction, there should be no bubbles or fluctuation
When a chest tube is connected to gravity (no suction), bubbles and fluctuation (rise and fall of the little ball) are expected.
Sample question - a patient with a chest tube develops sudden shortness of breath. After applying oxygen via NRB and contacting the physician, the nurse should anticipate what? Stat portable chest xray to check for pneumothorax

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Question: A Cub Scout leader who is a nurse is preparing a group of Cub Scouts for an overnight camping trip and instructs the scouts about the methods to prevent Lyme disease. Which statement by one of the Cub Scouts indicates a need for further instructions? 1. "I need to bring a hat to wear during the trip."
2. "I should wear long-sleeved tops and long pants."
3. "I should not use insect repellent because it will attract the ticks."
4. "I need to wear closed shoes and socks that can be pulled up over my pants."

Answer: Once you have a few patients on a vent they are really easy, but for students they seem confusing. The best way to remember is by using the DOPE pneumonic.
When dealing with an intubated patient, when something suddenly changes, that change is usually not a positive change. When the intubated patient suddenly becomes worse, we need to identify and correct the problem quickly. The patient is somehow suffocating.

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Question: THERAPEUTIC COMMUNICATION

Answer: D - DISLODGED - the ET tube is not in the right place. Either the patient pulled the tube or somehow it became dislodged. In this case you would immediately use bag valve mask and call a rapid response
O - OBSTRUCTED - the tube is either kinked or the patient has a mucus plug. Suction the patients ET tube.
P - PNEUMOTHORAX - this is scary because usually it is a tension pneumo. The patient will not have breath sounds on the affected side. If it is a tension, that means the air pressure is so high from the collapsed lung that it is pushing the heart, major blood vessels, and trachea to the other side. Call a doctor immediately. Treatment is needle decompression or chest tube.
E - EQUIPMENT - either the ventilator is not working or the ventilator unhooked from the patients tube. If the vent isn't working right or becomes unhooked, bag the patient with high flow oxygen.

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Question: What is the best nursing response?

Answer: This question is always asked
1. Reposition to left lateral position
2. Apply high flow O2 (NRB)
3. IV fluid bolus
4. Contact physican
5. If the patient is getting IV pitocin, you would first stop the infusion

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Question: CHEST TUBES

Answer: These questions are asked a lot and is also important because a patient with ruptured ectopic is probably one of the sickest patients you will ever see. They will decline fast.
Symptoms are severe, sharp abdominal pain out of nowhere. The problem is the patient is bleeding internally at a rapid rate.
1. Establish 2 large bore IV's and administer 0.9 NS
2. Apply high flow O2
3. Place in reverse trendelenberg
4. Confirmed by ultrasound
5. The patient will usually be rushed to surgery

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Question: VENTILATORS

Answer: Previa is painless bleeding and abrupto is associated with severe pain

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Question: DOPE

Answer: When was your last period. We ask this because we want to determine due date. If the child is premature, less than 22 weeks, steroids are given along with surfactant to help lung development - dexamethasone

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Question: OB -

Answer: used to induce labor and also used to stop uterine bleeding after labor because it contracts the uterus

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Question: Monitor is showing late decels, what do you do first

Answer: contraindicated in patients with high blood pressure, used to tx severe bleeding from the uterus after childbirth

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Question: Ruptured ectopic pregnancy

Answer: contraindicated in patients with tachycardia (elevates heart rate).. delays preterm labor

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Question: PLACENTA PREVIA VS ABRUPTO

Answer: used for mothers if they have both high blood pressure and tachycardia

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Question: PREMATURE LABOR:

Answer: -variable decelerations
-You may have to place your hand in the vagina and put your fingers between the cord and the fetus' neck. Have the woman lay on her back and bend her knees towards her chest

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Question: A patient comes in with contractions and her water broke. What question should the nurse ask?

Answer: Initiate seizure precautions. Low sodium levels commonly cause seizures
Most patients with low sodium have congestive heart failure. The patient retains a lot of fluid which dilutes the sodium. Correction of this is fluid restriction. Do not give more 0.9 normal saline, it will not help correct the electrolyte problem and will most likely make the patient worse due to more fluids in the lungs and rest of the body.

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Question: Know your drugs

Answer: severe dehydration (nursing home patients) 0.45 ns

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Question: Pitocin

Answer: Place on cardiac monitor. Patients with high or low potassium are at risk for cardiac arrhythmias.

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Question: Methergine

Answer: is insulin, glucose, calcium, kayexelate, and albuterol.

Insulin, calcium, and albuterol all cause the potassium to go into the cells.

The glucose is given to make sure the patient doesn't become hypoglycemic. Give the glucose first then the insulin.

Check the patients blood sugar 15 minutes after administration.

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Question: Terbutaline

Answer: When a patient has low calcium, we always give calcium gluconate IVPB over 2 hours. Calcium chloride is only used in cardiac arrest. If we give a patient calcium chloride fast IVP, we can cause asystole.

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Question: Magnesium Sulfate

Answer: Low magnesium levels can cause VTACH. If a patient has VTACH, always check a mag level.
Here is an example of a critical ICU patient. In this patient, we would give potassium (K-rider) 40meq IVPB over 4 hours and magnesium 4grams over 4 hours.

1.6 - 2.6 mg/dL

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Question: PROLAPSED CORD

Answer: The first symptom these patients present with is nausea/vomiting

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Question: FLUIDS/ELECTROLYTES:

Answer: Always questions on this

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Question: A patient has a sodium level of 117 (normal 135-145). What is the most appropriate nursing intervention?

Answer: nausea, vomiting, sweating, and tachycardia.
In the most severe form the patient will have altered mental status, lethargic, or possible coma.

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Question: High sodium level give?

Answer: is IV fluids (a lot, sometimes 3-4L or more) and IV insulin.
The problem with these patients are that there blood is very acidic.
An arterial blood gas will be done to determine the patients PH.

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Question: Potassium - always questions on potassium

Answer: The patient will have frequent potassium checks and will most likely need supplemental potassium

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Question: Your patient has a potassium of 3.1 (low), what is the first nursing intervention?

Answer: At highest risk for suicide, especially in men
Highest risk of falls
Highest risk of depression

UTI in older adult will - altered mental status

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Question: Remember, a patient with high potassium is very sick and can go into sudden cardiac arrest or asystole.

Answer: Obtain a sterile urine sample.

- UTI in older adult often presents with similar symptoms as a stroke.

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Question: Treatment of high potassium:

Answer: - Most common in older adults
- Patient will present with extreme pain
- Affected leg will be externally rotated and will be shorter than the other. Always check a pedal pulse and cap refill to make sure a major artery is not being obstructed by the fracture.
- Patients with hip fracture are at highest risk for fat embolism

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Question: With low potassium, we usually infuse potassium over 4 hours IVPB.

Answer: Know your stages of ulcers.

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Question: The rule is a patient can receive potassium 10meq/hr through a peripheral IV and 20meq/hr through a central line. It must always be on a pump.
Rapid infusion of potassium will cause asystole.

Answer: Skin is intact with non blanchable areas of redness, skin feels warm, firm, painful. This stage may be hard to see in patients with darker skin tones.

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Question: Never give potassium IV push - this will be a test question

Answer: Shallow open ulcer with red/pink wound bed. No slough is present. Stage 2 ulcers can also be seen as intact or open blisters, abrasions, or shallow craters

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Question: Calcium:

Answer: Full thickness skin loss with some subcutaneous fat may be visible but bone, tendon, or muscle tissue are not exposed. Stage 3 may include undermining and tunneling.

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Question: Magnesium

Answer: Full thickness loss with bone, tendon, muscle involvement. Slough/eschar may be present, tunneling is usually present.

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Question: LITHIUM/DILANTIN TOXICITY/DIGOXIN

Answer: Full thickness tissue loss where base of the ulcer is covered by slough or eschar. There is no way to tell what is underneath the covered surface.

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Question: DIABETIC KETOACIDOSIS

Answer: 9% front 4.5, back 4.5

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Question: Typical symptoms are:

Answer: 9% each (4.5% for anterior/4.5% for posterior)

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Question: Treatment:

Answer: 18% each, anterior leg 9, posterior leg 9

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Question: ***REMEMBER - a patient receiving IV insulin or on an insulin drip is at high risk for having a low potassium level (remember insulin is given for patients with high potassium).

Answer: 18% Chest 9, Abdomen 9

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Question: GERIATRIC/OLDER ADULTS:

Answer: Back trunk 18% upper back 9, lower back 9

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Question: A 85 year old male comes in with altered mental status, slurred speech, and muscle weakness. A stroke alert is called. After the patient is stable and the CT scan is complete, what is the next priority nursing intervention?

Answer: 1%

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Question: HIP FRACTURE:

Answer: - temperature control, infection prevention, and IV fluids
- The patient will be at high risk for infection so cover with sterile dry sheets
- 2 large bore IV's

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Question: PRESSURE ULCERS:

Answer: lactated ringers, NOT 0.9 NS

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Question: Stage 1-

Answer: pt must be intubated immediately even if they appear normal and are talking.

- These patients have laryngeal edema and there airway will close in a matter of minutes

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Question: Stage 2-

Answer: Common side effects are tachycardia and shakiness. Tell the patient this is expected

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Question: Stage 3-

Answer: NEBULIZER

have the mother assist in administering blow by oxygen

Do not stimulate the child, child may get worse

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Question: Stage 4-

Answer: poor skin turgor, sunken fontanels, less than 8 wet diapers/day

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Question: Unstageable

Answer: hydrocephalus or meningitis. This child should be seen right away.

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Question: BURNS: Know your rule of 9's - guaranteed question

Answer: Most commonly cause by ear infections. 50% of children will have a febrile seizure.
Tylenol/motrin for fever and remove childs clothes

- If the temp is very high, >104, ice packs may be applied

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Question: Head and Neck =

Answer: cause enamel hypoplasia and tooth discoloration in children under 8 years of age

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Question: Each arm =

Answer: of the person, the environment or situation, and health

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Question: Each leg =

Answer: Clients with parkinsons disease frequently experience difficulty in initiating, maintaining, and performing motor activities
They may even experience being rooted to one spot and unable to move

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Question: Front trunk =

Answer: The best indicator that the tubing is properly placed is a chest x-ray
Other methods include auscultation and aspiration of GI contents, but x-ray is the best

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Question: Back trunk =

Answer: Completes education and becomes self supporting

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Question: Genitalia =

Answer: - Demonstrate a conceptualization of death and dying

-Creates a new definition of self and roles with others

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Question: Priorty for burn patient:

Answer: Develops a strong need for parental support and approval

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Question: The IV fluid used for burns:

Answer: Always carry a medic alert card stating that he is a total neck breather
If they have cardiac arrest, mouth to neck breathing can be done

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Question: Remember that a patient with burns to the chest will shortly develop eschar and will not be able to breath.

Answer: The therapeutic level is 10-20 mcg/dl ***usually on NCLEX

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Question: Singed nasal hairs or soot in the mouth or nose :

Answer: Reposition the client, provide oxygen via face mask, increase IV fluid, call the healthcare provider
To stabilize the fetus, intrauterine resuscitation is the first priority, and to enhance fetal blood supply

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Question: Albuterol:

Answer: When working in group therapy, if there is a client who continually talks over the group
After several weeks, the group is in the working phase and the group members should be allowed to determine the direction of the group
The nurse should ignore the client's comments and allow the group to handle the situation
A good leader should not have separate meetings with group members
Remember, identify what phase the group is in (initial, working, or termination) and this will help determine communication style

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Question: PEDIATRICS:

Answer: The four elements of malpractice are breach of duty, failure to adhere to the recognized standard of care, direct causation of injury, and evidence of actual injury (you must have all 4)

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Question: Any child who has nasal flaring or grunting needs immediate attention

Answer: Beta 1 adrenergic agonist that is indicated for short term use in cardiac decompensation or heart failure
Reduced cardiac contractility due to organic heart disease or cardiac surgical procedures
Alpha and beta agonists, such as epinephrine and dopamine

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Question: Any child who is drooling needs immediate attention (epiglotitis)

Answer: A - notfity physican immedately
B- take patient for stat cat scan
C- start IV fluids at 150/hr
D- Give pt PRN tylenol

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Question: Racemic epinephrine -

Answer: Never give to someone with low blood pressure

left sided heart failure - SOB, pulm edema, rales/crackles (VERY HIGH BLOOD PRESSURE)

give nitro tabs or nitro drip and possibly DOBUTAMINE

ride sided heart failure - edema in feet/lets, JVD, swollen liver,

never give nitro to a right sided MI → give IV fluids possibly dopamine

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Question: Common signs of dehydration:

Answer: wear gloves when touching a patient, use this for everyone

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Question: Bulging fontanels:

Answer: gown and gloves - > used for patients with MRSA or other skin infections.

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Question: Febrile seizures :

Answer: CDIFF

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Question: PRIORITY QUESTIONS (WHO NEEDS TO BE SEEN FIRST)

These are always on NCLEX

Always go with airway first

The answer is usually the person with difficulty breathing or the patient with chest pain.

Answer: influenza and RSV

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Question: ADDITIONAL SUBJECTS AND IMPORTANT INFO:

Answer: chicken pox, active shingles or TB or ebola

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Question: Tetracycline:

Answer: - clot buster

A patient comes in who is unresponsive with left facial droop and left sided paralysis. When asking the family when the patient was last seen normal, they respond before going to bed 4-5 hours ago.

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Question: Nursing theories serve to describe, explain, predict, or prescribe nursing care measures.

Answer: reasons for immediate cat scan and stopping TPA
headache
change in mental status for the worse
change in pupil size
any other negative changes in neuro exam
neuro assessments Q 15

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Question: The domain of nursing theory consists of :

Answer: NORMAL PH - 7.35-7.45
O2 - 80-100
CO2 - 35-45
HCO3 - 22-28

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Question: Delusions often generate fear and isolation, so the nurse should help the client participate in activities that avoid focusing on the false belief and encourage interaction with others

he nurse should reassure the client that he/she is in a safe place

So, if the client is delusional, try to encourage him/her to go to occupational therapy and start a project

Answer: COPD patients drive to breathe is low oxygen, so if you give more, they will stop

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Question: PARKINSONS:

Answer: NUCHAL RIGIDITY, FEVER, BLURRED VISION, ALTERED MENTAL STATUS

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Question: NG TUBE:

Answer: BACTERIAL IS VERY CONTAGIOUS, SYMPTOMS HAPPEN VERY FAST, RAPID DETERIATION, WIDE SPREAD ABX

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