NCLEX Review (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)

What does obtunded mean?

A little more than lethargic

What does clonus mean?

Muscle spasm

Potassium (hyper/hypo)

Same as prefix except urine output and HR

Calcium (hyper/hypo)

Opposite of prefix

Chevostek and Trousseau signs

Hypocalcemia

• Chevostek: tap cheek elict muscle spasm

• Trousseau: tight BP cuff, hand turns inside

Magnesium (hyper/hypo)

Opposite of prefix

Aldosterone

Hold onto sodium and water and rids potassium

Do cushing’s patients need a private room?

Yes

What diseases do we see with hypernatremia?

DI, DKA, HHNK

What diseases do we see with hyponatremia?

SIADH

Hypernatremia/Hyponatremia

Hyper: dehydration

Hypo: fluid volume excess

What can high potassium do? What do we do to treat it?

Stop the heart

• Give D5 with regular insulin to move potassium into the cell and out of the blood.

What is circumoral paraethesia?

Numbness and tingling of the lips

What is the universal sign of electrolyte disorder?

Paresis: muscle weakness

Patient has low potassium, when giving potassium what do we not do?

Give IV push and give over 40

What drug works overtime for hyperkalemia? What can it cause?

Kayexalate makes potassium exit the body, can cause hypernatremia so we give fluids

What are the two treatments for hyperthyroidism?

Radioactive Iodine and PTU

What do we need to know about radioactive iodine?

• Patient needs to be alone for 24 hours

• When they pee flush 3 times

• The pee is high risk because that is the way it is excreted

What is the risks for a total thyroidectomy versus partial thyroidectomy?

Total: hypocalcemia

Partial: thyroid storm or thyroid crisis

What are the four markers of thyroid storm? What do you do?

• High bp, tachycardia, high temp and psychotic delirium

• Give oxygen, ice packs and cooling blankets

When is infection a priority in any post op patient?

Passed 72 hours

What drug do you give to a patient that has hypothyroidsm?

Levothyroxine

If a patient is getting surgery and is NPO what is one exception and why?

Thyroid medication, because they will be getting sedated.

What happens in addisions? How do you treat?

Not enough corticosteroids, they are tan and do not adapt to stress so bp and glucose drop and they will die.

• Treat with steroids

What are the symptoms of cushings?

• Hyperglycemic, moon face, retain sodium and water and loose potassium, straie, truncal obesity, hirtusin, gynenocomastia, immunosuppressed, skinny arms and legs and buffalo hump.

What is the classic treatment for hypersecreatory gland?

ectomy

What toy can you not give to a child if oxygen is in use?

metal (diecast)

what is a fomite?

Non living object that harbors micro organisms

• Stuffed animals

When can kids do purposeful activity?

greater than 9 months

When do you not let adolescents have their peers visit in the hospital?

• contagious disease

• immunosuppressed

• less than 12 hours post op

What is a laminectomy and why?

Removing the back part of spine (spinal processes) to remove nerve compression

What do we check with a cervical, thoracic and lumbar surgery? What are the possible complications for each?

Cervical: breathing and arms and hands

• Pneumonia

Thoracic: cough and bowels

• Pneumonia and ileus

Lumbar: bladder and legs

• Urinary retention

How do we move spinal cord injured patients?

log roll

What position should we not let a spinal surgery patient be in?

No dangling, or sitting (no longer than 30 minutes)

Restrictions post laminectomy?

• Bend at knees

• Cervical lams can not lift anything over their head

• Nothing jerky

What do we think about spinal cord questions?

Location

What is the preferred site for a vaccination in an infant?

Vastus lateralis

What can a lumbar herniated disc cause?

Cauda equina syndrome

• Need to be decompressed in 24-48 hours

• Can cause permanent neurological damage

What is autonomic dysreflexia?

caused by spinal cord injury at T6 or higher

• Hypertension and decreased heart rate

What is the difference in abruptly stopping a beta blocker versus an ace inhibitor?

Betablockers: hypertension, palpitations and angina

Ace inhibotors: hypertension

When a baby draws there legs up to the abdomen and as an inconsolable cry this can indicative of?

Intussusception

What does isoniazid cause a deficiency in?

Vitamin B6 which may result in a patient feeling numbness and tinging in the hands and feet.

An allergic response is associated with what lab value increasing?

Eosinophils

Diet for diverticulitis versus diverticulosis

Diverticulitis: low fiber

Diverticulosis: high fiber

What is normal creatine level?

0.6-1.2

INR regulates what? What is normal and when are we worried?

Warfarin Therapy

• 2-3 normal

• >4 concerning

What is a normal PT value?

1.5-2

What is a normal PTT value?

1.5-2

What can we give to waste potassium from the body if it is too high?

• kayexalate

• D5W

• Insulin

What is a normal BUN value?

10-20

What do most elevated blood values indicate?

Dehydration

Hemoglobin level

12-18

Normal ESR and what it means

15-20 mm/hr

• Higher the number the more the inflammation

Normal pH, bicarb and CO2

pH: 7.35-7.45

CO2: 35-45

HCO3: 21-28

What do we do as a nurse if someones CO2 is over 50?

Pursed lip breathing to prolong exhalation and rid CO2

What may occur if CO2 is in the 60’s?

Respiratory failure

Hematocrit

37-52

Normal Pao2

80-100

When is SAO2 falsely elevated?

Anemia and after dye procedures

What is BNP indicative of? (brain naturetic peptide)

Congestive Heart Failure

What is a concerning CD4 count?

Below 200 means you have AIDS

Normal Neutrophil

above 500

“zines” meds & what are they used for? SE?

Phenothiazines

• Large doses are used for antipsychotics

• Small doses are antiemetics

• SE:

  • A: anticholinergic

  • B: blurred vision

  • C: constipation

  • D: drowsiness

  • E: EPS

  • F: Photosensitivity

  • aG: agranulocytosis

What are the two side effects of psych drugs?

Low bp and weight change (mostly gain some loose)

What is deconate?

A long term antipsychotic

When do you see effects on tricyclic antidepressants?

2- 4 weeks

“zep” what are they?

Benzodiazepines, antianxiety

“mar, nar and par” what to avoid?

MAOI’s, antidepressants

• Avoid tyramines

  • Bananas, avocados and dried fruit

  • No organ meat

  • No preserved meat

  • No processed (hot dog)

  • No alcohol

  • No choch

  • No cheese but mozz and cottage

3 normal side effects of lithium and 3 concerning SE to call the doc

Normal: peeing, pooping and paresthesia

Abnormal!!!! tremors, severe diarrhea, metallic taste (hydrate!!!!!!)

what electrolyte does lithium need to work properly?

sodium, if low give gatorade, if low it becomes toxic

What is a SE and NI for prozac?

Insomnia so give before 12 noon

What is the only antipsychotic that can be given to pregnant women?

Halperidol

What is neuroleptic malignant syndrome?

Adverse reaction with antipsychotics causing a severely high fever (106-108)

How do you calculate weight gain in a pregnant patient?

Week of gestation—9 = x

How much should a pregnant client gain in the first and second trimester?

First: 1 lbs per month

Second: 1 lbs per week

When is the fundus at the umbilicus?

20-22 weeks

When can you hear a babies heart beat?

8-12 weeks

When would a pregnant lady feel quickening?

16-20 weeks

Goodwell, chadwick and haegar sign: what are they and order?

Chadwick: cervical color change to cyanosis

Goodell: cervical softening

Haegar: changes in lower uterine segment

When do we schedule a c section or induction?

Week 42

How often does a mom receive prenatal care?

once a month till week 28

2 a month till 36 weeks

Every week till birth

What level drops in pregnancy that we are not very worried about?

Hemoglobin

When is urinary incontinence an issue in pregnancy?

1st and 3rd trimester because the baby is lower

Stages of labor

1. labor

2. birth

3. placenta expeled

4. postpartum

Phases of labor and how you know

1. Latent: below

2. Active: 5-7 cm 3-5 minutes, last 30-60 seconds

3. Transition: above

Contractions are dangerous when they are

Tetany and hyperstimulation: longer than 90 and closer than 2 minutes

What do you do for maternal hypotension?

LION

• Lie on side (left side)

• Increase IV rate

• Oxygen

• Notify provider

When do we not administer pain medication in labor?

If the baby is likely to be born when the medication peaks

When is a post op patient most unstable?

less than 12 hours

A fever over 105 is indicative of a?

Seizure

APETM locations

Aortic: 2nd right sternal border

Pulmonic: 2nd left sternal border

Erbs: 3rd left sternal border

Tricuspid: 4th left sternal border

Mitral: 5th left midclavicular line

How do we know proper placement of crutches?

• 2-3 finger widths below anterior axillary fold

• Elbow flexion is 30 degrees

Crutch gaits: 2 point, 3 point, 4 point and swing through

• 2 point: 1 crutch and opposite foot

• 3 point: moving two crutches and the bad leg

• 4 point: moving everything separately

• Swing through: non weight bearing (amputations)

How do we know what crutch gait to use?

• 1 leg affected: 3 point (odd number)

• 2 legs affected: 2 point if mild and 4 point if severe (even number)

Up and down stairs with crutches

• Up with the good leg

• Down with the bad leg

• Crutches always move with the bad leg

How should a cane be held?

With the strong side

Where do you not tie things on a walker?

The front

What is a somatic delusion?

When they are convinced something is wrong with their body

What is a tactile and gustatory hallucination?

• Tactile: feeling

• Gustatory: taste

Difference in hallucination and illusion?

Illusion has a reference to something that is there.