NCLEX PN Notes 6

Question 1

Lymes is found mostly in Conneticut

Answer 1

Asthma and Arthritis–swimming best

Question 2

Asthma has intercostal retractions–be concerned

Answer 2

Tardive Dyskinesia - irreversible - involuntary movements of the tongue, face and extremities, may happen after prolonged use of antipsychotics

Question 3

Akathisia - motor restlessness, need to keep going, tx with antiparkinsons meds, can be mistaken for agitation.

Answer 3

When drawing an ABG, you need to put the blood in a heparinized tube, make sure there are no bubbles, put on ice immediately after drawing, with a lable indicating if the pt was on room air or how many liters of O2.

Question 4

Remember to preform the Allen’s Test prior to doing an ABG to check for sufficient blood flow

Answer 4

Before going for Pulmonary Fuction Tests (PFT’s), a pt’s bronchodilators will be with-held and they are not allowed to smoke for 4 hrs prior

Question 5

For a lung biopsy, position pt lying on side of bed or with arms raised up on pillows over bedside table, have pt hold breath in midexpiration, chest x-ray done immediately afterwards to check for complication of pneumothorax, sterile dressing applied

Answer 5

For a lumbar puncture, pt is positioned in lateral recumbent fetal position, keep pt flat for 2-3 hrs afterwards, sterile dressing, frequent neuro assessments

Question 6

EEG, hold meds for 24-48 hrs prior, no caffine or cigarettes for 24 hrs prior, pt can eat, pt must stay awake night before exam, pt may be asked to hyperventilate and watch a bright flashing light, after EEG, assess pt for seizures, pt’s will be at increased risk

Answer 6

Diamox, used for glaucoma, can cause hypokalemia

Question 7

Dexedrine, used for ADHD, may alter insulin needs, avoid taking with MAOI’s, take in morning (insomnia possible side effect)

Answer 7

Cytovene, used for retinitis caused by cytomegalovirus, pt will need regular eye exams, report dizziness, confusion, or seizures immediately

Question 8

INH, used to treat and prevent TB, do not give with dilantin, can cause phenytonin toxicity, monitor LFT’s, give B6 along with, hypotension will occur initially, then resolve

Answer 8

Rifampin, for TB, dyes bodily fluids orange

Question 9

If mixing antipsychotics (ie Haldol, Throazine, Prolixin) with fluids, med is incompatible with caffine and apple juice

Answer 9

Haldol preferred anti-psychotic in elderly, but high risk extrapyramidal side effects (dystonia, tarditive dyskinesia, tightening of jaw, stiff neck, swollen tongue, later on swollen airway), monitor for early signs of reaction and give IM Benadryl

Question 10

Risperdal, antipsychotic, doses over 6mg can cause tarditive dyskinesia, first line antipsychotic in children

Answer 10

Levodopa, for parkinsons, contraindicated in pts with glaucoma, avoid B6

Question 11

Sinemet, for parkinsons, contraindicated with MAOI’s

Answer 11

Hydroxyurea, for sickle cell, report GI symptoms immediately, could be sign of toxicity

Question 12

Zocor, for hyperlipidemia, take on empty stomach to enhance absorption, report any unexplained musle pain, especially if fever

Answer 12

Decorticate is toward the ‘cord’. Decerebrit is the other way (out)

Question 13

** BOTOX ** (Botulin Toxin) can be used with strabismus also to relax vocal cords in spasmodic dysphonia.

Answer 13

Thank you, I finally realize why a person shouldn’t have cantaloupe before a occult stool test, because cantaloupe is high in vit c and vit c causes a false + for occult blood. Now I just need to figure out why they can’t have fish.

Question 14

is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness, in order to receive medical care or hospitalization. In a variation of the disorder –>

Answer 14

Munchausen Syndrome

Question 15

an individual, typically a mother, intentionally causes or fabricates illness in a child or other person under her care. –>

Answer 15

Munchausen by proxy (MSBP)

Question 16

is a chronic, progressive disease with demyelinating lesions in the CNS which affect the white matter of the brain and spinal cord. –>

Answer 16

Multiple Sclerosis

Question 17

Motor S/S: –>

Answer 17

limb weakness, paralysis, slow speech

Question 18

Sensory S/S: –>

Answer 18

numbness, tingling, tinnitus

Question 19

Cerebral S/S: –>

Answer 19

nystagmus, ataxia, dysphagia, dysarthria

Question 20

Huntington’s Chorea: –>

Answer 20

50% genetic, autosomal dominant disorder

Question 21

S/S: chorea –>

Answer 21

writhing, twisting, movements of face, limbs and body

• gait deteriorates to no ambulation
• no cure, just palliative care

Question 22

WBC shift to the left in a patient with pyelonephritis (neutrophils kick in to fight infection)

Answer 22

Definitive diagnosis for abd. aortic aneurysm (AAA) –> CT scan

Question 23

Don’t use Kayexalate if patient has hypoactive bowel sounds.

Answer 23

Uremic fetor –> smell urine on the breath

Question 24

Hirschsprung’s –> bile is lower obstruction, no bile is upper obstruction; ribbon like stools.

Answer 24

Pancreatic enzymes are taken with each meal! Not before, not after, but WITH each meal.

Question 25

abnormality in which urethral meatus is located on the ventral (back) surface of the penis anywhere from the corona to the perineum (remember hypo, low (for lower side or under side)

Answer 25

Hypospadias:

Question 26

opening of the urethra on the dorsal (front) surface of the penis

Answer 26

Epispadias:

Question 27

painful erection lasting longer than 6 hrs

Answer 27

Priapism:

Question 28

Anticholinergic effects--assessment 
dry mouth==can't spit 
urinary retention=can't **** 
constipated =can't ****
blurred vision=can't see

Answer 28

1. When you see Coffee-brown emesis, think peptic ulcer
2. Anytime you see fluid retention. Think heart problems first.
3. An answer that delays care or treatment is ALWAYS wrong
4. For PVD remember DAVE (Legs are Dependent forArterial & for Venous Elevated) more to come……….

Question 29

When choosing an answer, think in this manner… if you can only do ONLY one thing to help this ‘patient’ what would it be? Pick the most important intervention.

Answer 29

 If two of the answers are the exact opposite, like bradycardia or tachycardia…one is probably the answer.
 If two or three answers are similar or are alike, none is correct.
 When asking patients’ questions NEVER use “why” questions. Eliminate all “why?” answer options. If you have never heard of it…please don’t pick it!
 Never release traction UNLESS you have an order from the MD to do so
 Questions about a halo? Remember safety first, have a screwdriver nearby.
 Remember compartment syndrome is an emergency situation. Paresthesias and increased pain are classic symptoms. Neuromuscular damage is irreversible 4-6 hours after onset.
 Always deal with actual problems or harm before potential problems
 Always select a “patient focused” answer.
 An answer option that states “reassess in 15 minutes” is probably wrong.

Question 30

Interpersonal model (Sullivan) 
Behavior motivated by need to avoid anxiety and satisfy needs 
1. Infancy 0-18 months others will satisy needs 
2. childhood >6yrs learn to delay need gratification
3. juvenile 6-9 years learn to relate to peers 
4. preadolescence 9-12 yrs learns to relate to friends of of opposite sex 
5. early adolescence12-14yrs:learn independence and how to relate to opposite sex 
6. late adolecence 14-21yrs: develop intimate relationship with person of opposite sex is this not about communication?....

Answer 30

Fetal alcohol syndrome

• upturned nose
• flat nasal bridge
• thin upper lip
• SGA

Question 31

vastus lateralis is IM administration site for 6month infants
 For toddlers above 18 months ventrogluteal
 The deltoid and gluteus maximus are appropriate sites for children

Answer 31

OU- both eyes
OS- left eye
OD- right eye ( dominent Right eye- just a tip to remember)

Question 32

1. COAL (cane walking): 
C - cane 
O - opposite 
A - affected
L - leg

Answer 32

Red- Immediate:
“Injuries” are life threatening but survivable with minimal intervention. Ex: hemothrax, tension pneumothorax, unstable chest and abdominal wounds, INCOMPLETE amputations, OPEN fx’s of long bones, and 2nd/3rd degree burn with 15%-40% of total body surface, etc.

Question 33

Yellow- Delayed:
“Injuries” are significant and require medical care, but can wait hrs without threat to life or limb. Ex: Stable abd wounds without evidence of hemorrhage, fx requiring open reduction, debridement, external fixation, most eye and CNS injuries, etc.

Answer 33

Green- Minimal:
“Injuries” are minor and tx can be delayed to hrs or days . Individuals in this group should be moved away from the main triage area. Ex: upper extremity fx, minor burns, sprains, sm. lacerations, behavior disorders.

Question 34

Black- Expectant:
“Injuries” are extensive and chances of survival are unlikely. Seperate but dont abandoned, comfort measures if possible. Ex: Unresponsive, spinal cord injuries, woulds with anatomical organs, 2nd/3rd degree burn with 60% of body surface area , seizures, profound shock with multipe injuries, no pulse, b.p, pupils fixed or dilated.

Answer 34

Thoracentesis prep- Take v.s., shave area around needle insertion, position patient with arms on pillow on over bed table or lying on side, no more than 1000cc at a one time. Post- listen for bilateral breath sounds, v.s., check leakage, sterile dressing.

Question 35

CT- assess allergies

Answer 35

MRI- claustrophobia, no metal, assess pacemaker

Question 36

Cardiac cath- npo 8-12hr, empty bladder, pulses, tell pt may feel heat palpitations or desire to cough with dye injection. Post- Vital signs keep leg straight bedrest 6-8hr.

Answer 36

cerebral angio prep- well hydrated, lie flat, sire shaved, pulses marked post- keep flat 12-14hr, check site, pulses,force fluids.

Question 37

Lumbar puncture- fetal postion. post- nuero assess q15-30 until stable, flat2-3hr, encourage fluids, oral anlgesics for headache, observe dressing

Answer 37

EEG- no sleep the night before, meals not withheld, no stimulants for 24hr before, tranquilizer/stimulant meds held 24-48hr before, may be asked to hyperventilate 3-4min and watch a bright flashing light.

Question 38

Myelogram- Npo 4-6hr, allergy hx, phenothiazines, cns depressants, and stimulants withheld 48hr prior, table will be moved to various postions during test. Post- neuro q2-4, water soluble HOB up, oil soluble HOB down, oral analgesics for h/a, encourage po fluids, assess for distended bladder, inspect site.

Answer 38

Liver biopsy- Adm vit k , npo morning of exam 6hr, give sedative, Teach pt that he will be asked to hold breath for 5-10sec, supine postion, lateral with upper arms elevated. Post- postion on right side, frequent v.s., report severe ab pain stat, no heavy lifting 1wk.

Question 39

Paracentesis- semi fowlers or upright on edge of bed, empty bladder. Post- v.s., report elevated temp, observe for signs of hypovolemia.

Answer 39

Laparoscopy- CO2 used to enhances visual, general anesthesia, foley. Post- walk patient to decrease CO2 build up used for procedure.

Question 40

Pyelogram- assess allergies

Answer 40

Sengstaken blakemore tube used for tx of esophageal varices, keep scissors at bedside.

Question 41

Hemovac- used after mastectomy, empty when full or q8hr, remove plug, empty contents, place on flat surface, cleanse opening and plug with alcohol sponge, compress evacuator completely to remove air, release plug, check system for operation.

Answer 41

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