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NCLEX > NCLEX 3 > Flashcards

NCLEX 3 Flashcards

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1
Q

IV gauges?

A

24 G = infant/peds and temporary access

22 G = Peds, IV contrast, med/surg, and easily blown veins

20 G = most adults, CT angiography, and blood transfusions

18 G = massive trauma, codes, and RRTs (increased risk for mechanical phlebitis)

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2
Q

kids under 5 yo, inflammation of blood vessels throughout body.

A

Kawasaki Disease
S/S: strawberry tongue, fever, rash, conjunctivitis, oral mucosa changes, and swollen lymph nodes

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3
Q

Addison’s disease S/S?

A

hair loss, hyperpigmentation (tan), wt loss, GI upset, fatigue, hypoglycemia, postural hypotension, and weak

Adrenal crisis – extreme fatigue, dehydration, fever, hypotension, renal shut down, increased serum K+, and decreased serum Na+

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4
Q

Lumbar puncture?

A

spinal needle inserted into subarachnoid space to collect CSF sample
pt fetal side lying position (stay still)
post: keep pt flat for several H, monitor for comp. (increased ICP), and encourage increase fluid intake

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5
Q

Acute glomerulonephritis?

A

secondary to many conditions/ infection processes (strep, mono, hepatitis)

clinical feat. – oliguria, fatigue, fluid retention, proteinuria, hematuria, and increased BP.

Prevent FVO, no fluids, Na+, and K+, monitor I&O, wt, and BP

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6
Q

most common heart anomaly

A

CoA
monitor – VS, BP, HR, and O2, reg assess peripheral pulses, cap refill, skin color, and temp
Help w/ feeding – poor heart output and resp compromised = poor feeding, monitor I&O

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7
Q

potential causes of late decels?

A

uteroplacental insufficiency, maternal hypotension, uterine hyperstimulation, and maternal hypoxemia

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8
Q

anaphylactic shock treatment?

A

epi
corticosteroids
bronchodilators

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9
Q

neurogenic shock treatment?

A

spinal cord injury
cooling
supportive care

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10
Q

septic shock treatment?

A

systemic RTX cause release of inflammatory cytokines
IV ABX
IV fluids

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11
Q

preterm labor causes?

A

dehydration
infection
sex
exercise (strenuous)
activities
stress
environmental factors

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12
Q

neurogenic shock CM?

A

hypotension
bradycardia
hypothermia
tachypnea
decreased U/O
anxiety

significant peripheral vasodilation, inhibition of baroreceptor response, and impaired thermoregulation

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13
Q

hyperthyroidism S/S?

A

tremor
HR drop
fatigue
restless
oligomenorrhea and amenorrhea
intolerant to heat
diarrhea
irritable
sweat
muscle wasting and wt loss

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14
Q

DKA?

A

factors: infection, stress, inadeq. insulin dose
S/S: ketosis, kussmaul resp, rotting fruit breath, nausea, and abd pain
serum glucose: >300
serum ketones: yes, increased anion gap >12
ABGs: acidosis
more likely to occur in DMT1

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15
Q

HHS?

A

factors: infection, stress, poor fluid intake
S/S: dehydration and altered LOC
serum glucose: >600
serum ketones: no
ABGs: metabolic alkalosis

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16
Q

heart auscultation?

A

Aortic: 2nd ICS to R of sternal border
Pulmonic: 2nd ICS to L of sternal border
Erbs point: 3rd ICS to L of sternal border
Tricuspid: 4-5th ICS to lower L of sternal border
Mitral: 5th ICS at midclavicular line (Apex)

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17
Q

Liver Biopsy?

A

post-procedure position pt R side w/ pillow under site, observe for bleeding 2-4 H post procedure

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18
Q

calf pain at dorsiflexion of foot, DVT

A

Homans sign

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19
Q

pt lies on back and leg = extended, painful and leg cannot be fully extended, meningitis

A

Kernings sign

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20
Q

hip and knee flex when neck = flexed, meningitis

A

Brudzinskis sign

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21
Q

blue discolor of umbilicus, pancreatitis

A

cullens sign

22
Q

blue discolor of flanks, pancreatitis

A

grey turners sign

23
Q

CV tamponade treatment?

A

pericardiocentesis (needle inset to aspirate the pericardial fluid in U/S guided procedure)

24
Q

+ pressure vent complications?

A

barotrauma
vent associated injury
neurodynamic effect

25
Q

what is the priority for V-Fib?

A

defib and then high quality CPR

26
Q

inflammation of bone caused by bacterial infection

A

osteomyelitis

27
Q

dangerous S/S of a concussion?

A

one pupil larger
drowsy/not able to wake
HA that gets worse
slurred speech
weak
numb
decreased coordination
repeated N/V
convulsions
restless
agitated
LOC

28
Q

fear of wt gain w/ distorted body image, BMI < 18.5 kg

A

anorexia

29
Q

recurrent of unconscious binge eating, vomit, laxatives, diuretics, or inappropriate exercise, excessive concern on body wt, and shape, and normal to low BMI

A

bulimia

30
Q

what treat varicella?

A

antiviral meds – acyclovir and valacyclovir

31
Q

what is normal ICP?

A

10-15 mmHg

32
Q

herd therapy?

A

ginkgo: memory increase and SE = bleeding

ginseng: mental performance and SE = bleeding

saw palmetto: benign prostatic hyperplasia and SE = bleeding

St. Johns Wort: depression and insomnia and SE = HTN, decreased anticoagulant effect, interacts with antidepressants, steroids, and digoxin

licorice extract: ulcers and bronchitis and SE = HTN and hypokalemia

33
Q

corticosteroid SE?

A

cataracts
up all night
suppressed immune
HTN
infection
necrosis
wt gain
striae
bone loss (osteoporosis)
acne
hyperglycemia
myopathy
depression/emotional change

34
Q

hypernatremia management?

A

free H2O admin
loop diuretics
agent causing (remove)
give IVF

35
Q

HTN treatment?

A

ACEs
Beta-blockers
CCB
Diuretics

36
Q

parkinsons S/S?

A

tremor
rigidity
akinesia (absent movement)
ataxia (poor muscle control)
postural instability

37
Q

GCS rating?

A

eye response 1-4
verbal response 1-5
motor response 1-6

less than 8 = intubate

38
Q

L sided heart failure S/S?

A

fatigue
orthopnea
rales/restless
cyanosis/confused
extreme weak
dyspnea

39
Q

cardiogenic shock meds?

A

vasodilator
epi (adrenergic)
inotropes
nor-epi (vasopressor)

40
Q

what do you do when there are variable decels and umbilical cord is protruding through the vagina?

A

apply pressure to lift presenting fetal part
stay w/ pt and call for help
pt in trendelenburg
O2 via face mask
prepare for immediate c-section

41
Q

what is cardiogenic shock?

A

pump failure, heart cannot pump adeq. blood to the body
unable tp pump blood, despite normal blood volume, due to heart emergency
blood pools in L vent and backs up into lungs – pulm edema and decreased CO
lack of blood to tissues – inadeq. O2 – impaired cellular metabolism

S/S: hypotension, tachycardia, weak/rapid pulse, tachypnea, shallow/fast breathing, diaphoresis and cool/clammy skin, and arrhythmias and JVD

42
Q

S/S of transfusion reaction?

A

rash
elevated temp
anxiety/apprehension
chills
tachypnea
increased pulse
oliguria and hemoglobinuria
nausea

43
Q

spermatic cord twist, decreased blood flow to the testicles, surgery, emergency.

A

testicular torsion
s/s: sudden severe scrotal pain, swell, and nausea

44
Q

Rh factor?

A

inherited protein attached to surface of RBCs
positive = can receive pos or neg blood
negative = can only receive neg blood

45
Q

What are common drug classes for ABX?

A

aminoglycosides (-mycin/-micin)
cephalosporins (cef-/ceph-)
fluoroquinolones (-floxacin)
glycopeptides (-in (mycin))
macrolides (-thromycin)
penicillins (-cillin)
tetracyclines (-cycline)

46
Q

percussion sound over hallow organs, small intestine, and colon

A

tympathy

47
Q

sound heard when tapping on chest

A

hyperresonance

48
Q

low pitched hallow sound heard over healthy lung tissue

A

resonance

49
Q

replaces resonance when fluid or solid tissue replaces air containing lung tissues, pneumonia, tumors, or pleural effusions

A

dullness

50
Q

early and late CM of increased ICP?

A

early: decreased LOC, behavior change (restless, irritable, and confused), HA, and N/V (possible projectile)

late: cushing’s triad, and abnormal posture

NCLEX (4 decks)

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