NCLEX Review Flashcards: Management of Care, Fundamentals, Safety, Pharmacology (Based on Lecture Notes)

A set of practice flashcards covering management of care, fundamentals, safety, infection control, Ostomy care, NG feedings, central lines, TPN, pharmacology suffixes, and common NCLEX-style scenarios based on the provided lecture notes.

What NCLEX test plan area accounts for 17-23% of readiness and includes collaboration, confidentiality, delegation, prioritization, ethics, and informed consent?

Management of care

What component of management of care involves planning discharge and coordinating resources for optimal outcomes?

Case management (within management of care)

What is a clinical/critical pathway?

A standardized order set that predicts steps and timing for care to standardize treatment and control costs

What is the difference between an incident report and a variance report?

An incident report documents an incident; a variance report documents deviation from the expected plan; terms can be used interchangeably in practice

ISBAR is a communication framework used for handoffs. What does ISBAR stand for?

Introduction, Situation, Background, Assessment, Recommendation

What is the first step in priority-setting when multiple patient needs arise?

Begin with the highest priority task and complete it before moving to the next; re-prioritize as new information appears

In NCLEX-style prioritization, which type of problem is highest priority?

Acute (systemic) problems before local or chronic problems

Differentiate actual vs potential problems in prioritization.

Actual problems are current, real issues; potential problems are risks to monitor; address actual problems first

What is considered the most reliable indicator of fluid status in heart failure management?

Daily weights; weight is the best indicator of fluid status in HF

Which IV meds require titration and are usually within the RN scope?

IV insulin, heparin drips, and other continuously titrated IV meds (not typically started or titrated by LPN/UAP)

Who typically performs Foley catheter insertion and sterile dressing changes?

Licensed personnel (RN/LPN); UAP generally cannot perform Foley insertion (practice varies by setting)

Who obtains informed consent for a surgical procedure?

The surgeon performs the consent; the nurse witnesses and ensures patient understanding and voluntariness

Which action is the highest priority in a patient with acute glomerulonephritis and very low urine output?

Address the low urine output as a potential renal distress and monitor closely for renal function changes

Which tasks are appropriate for a UAP (unlicensed assistive personnel) to perform?

Ambulating a client with a walker (when not the first time); other ADL support; not initiating referrals or complex assessments

Which action should be taken before starting an IV or medication via IV piggyback?

Ensure IV access is established and notify if any issues; for IV meds, do not start IV if not already in place and under order

What is the purpose of an NG tube?

Gastric decompression and relief of distention in ileus/obstruction; bowel rest when needed

What is the best initial method to verify NG tube placement?

Chest X-ray verification is the gold standard for initial placement

What determines whether to refeed residuals during NG feeding?

For intermittent feeding: residuals >100 mL typically prompt holding/refeed decisions; for continuous feeding, residual limits vary (often 100-250 mL q4h) per order

What types of meds can be given via NG tube?

Most meds can be crushed and given via NG tube; avoid enteric-coated, extended-release (ER) meds; flush with 20-30 mL water between meds

If a patient with an NG tube is on suction, what should you do before giving meds?

Keep suction off for 60 minutes after giving medications through the NG tube

Name three enteral feeding routes.

Nasogastric (NG), nasoduodenal, nasojejunal tubes; also PEG, gastrostomy (G) or jejunostomy (J) tubes

What head-of-bed elevation is recommended for NG feeding to reduce aspiration risk?

Head of bed at least 30 degrees

Residual and placement checks during NG feeding: when are they performed and how often?

Placement verified by X-ray initially; residual checked per order (continuous q4h or as intermittent with each feed); pH check possible if tube is in place and appropriate

What is a common feeding complication that would require slowing or stopping the rate?

Symptoms of intolerance: cramping, nausea, vomiting, or high residuals

What is the difference between a G-tube and a J-tube?

G-tube feeds into the stomach; J-tube bypasses the stomach and feeds into the jejunum; choice depends on GI function and tolerance

What is the acronym for stoma color assessment and what color is normal?

Brick red to beefy red is normal; pale, dusky, blue, or black indicates compromised blood supply

What should you assess before applying an ostomy wafer?

Measure stoma size to ensure proper fit; ensure wafer is not too tight or too loose around the stoma

What feeding device might be used for newborns with cleft lip/palate?

Special feeding devices (e.g., cleft palate/nuc nipple feeders) to aid feeding and reduce aspiration

What are key SIDS prevention recommendations?

Back-to-sleep position; pacifier use can be protective; avoid pillows, stuffed toys, and loose bedding; car seat rear-facing in back seat

What are the four main types of central lines with a brief use case?

PICC (long-term IV access), implanted port (port-a-cath for frequent access), tunneled central line (long-term), non-tunneled central line (short-term, critical access)

Which type of central line requires sterile technique and usually a surgical dressing change?

Central lines (PICC, port, tunneled) require sterile technique and dressing changes; not peripheral lines

What is TPN and how is it delivered?

Total parenteral nutrition; hypertonic solution delivered via a central venous line; not through NG tube; bags changed every 24 hours; strict glucose monitoring

What lab monitoring is typically done for a patient on TPN?

Blood glucose every 4-6 hours; electrolytes; lipid panel; liver function tests; CBC; monitor hydration status

What are two major risks with TPN that require close monitoring?

Hyperglycemia/hypoglycemia due to dextrose; risk of infection from central line; ensure patency and sterile technique

What is the recommended approach to prepare and administer a TPN bag?

Every 24 hours, prepare a new bag with updated orders/labs; change tubing with each bag; use a dedicated line and monitor for signs of complications

Which antibiotic is first-line for syphilis treatment?

Penicillin

Which body system signs would you monitor in a patient with Lyme disease?

Fever, fatigue, joint pain; treat with doxycycline; report to provider as needed; consider skin rash after tick bite

What PPE is required for airborne isolation and what are the room requirements?

N95 respirator; private negative-pressure room; six feet distance; limit visitors to about 30 minutes

How do you manage a patient with suspected meningitis in terms of isolation and signs to monitor?

Place on appropriate isolation; initiate antibiotics after cultures; monitor Brudzinski and Kernig signs; seizure precautions; quiet room

What is the initial management for a patient on seizure precautions?

Provide a quiet environment; cluster care minimized; keep bed in safe position; monitor for seizures

What is PROM vs PPROM and their management goals?

PROM = premature rupture of membranes; PPROM = preterm PROM; monitor for infection; use tocolytics and bed rest as ordered; fetal monitoring

What is a key nursing intervention for preventing autonomic dysreflexia in patients with spinal cord injury?

Identify and remove triggering stimuli (e.g., kinked catheter, constipation); sit patient up; monitor BP and HR

What is the role of bleach in infection control for HIV/AIDS patients and other blood-borne pathogens?

Disinfect spills and contaminated surfaces with EPA-registered bleach solutions; treat all blood/bodily fluids as potentially infectious

What are common signs of neutropenic precautions in cancer patients?

Private room; no fresh fruits/flowers; meticulous hygiene; no raw foods; avoid infection risk; monitor for fever

What is the correct handling for ocular eye drops to minimize systemic absorption and interactions between drops?

Apply gentle pressure on the inner canthus for 1 minute; wait at least 5 minutes between different eye drops; avoid touching dropper to eye

Which suffix is associated with ACE inhibitors and give two examples?

Pril; examples: captopril, lisinopril

Which suffix is associated with ARBs and give an example?

Sartan; example: losartan, valsartan

Which suffix is associated with beta-blockers and give an example?

Lol; example: metoprolol, atenolol

Which suffix indicates calcium channel blockers and give an example?

Dipine (or sometimes other endings like diltiazem); examples: amlodipine, nifedipine

Which suffix is characteristic of H2 receptor antagonists and give an example?

Tid ine; examples: famotidine, ranitidine

Which suffix resembles a PPI but is not a PPI and requires careful attention to avoid trick questions?

Prazole-like endings; proper PPI examples: pantoprazole, omeprazole; an entrant impostor example discussed was aripiprazole (Abilify)

What is the teaching point for patients taking statins in terms of monitoring and dietary considerations?

Monitor liver enzymes (LFTs) and CK for rhabdomyolysis; avoid grapefruit juice; report muscle aches; normal total cholesterol <200

What are signs of statin-induced rhabdomyolysis and when is CK particularly important?

Muscle pain, weakness, dark urine; CK elevated; highest risk in first weeks of therapy

Which foods should be avoided with certain GI conditions like GERD and dumping syndrome, and what are the common diet strategies?

Smaller, more frequent meals; avoid large meals; for GERD remain upright after meals; for dumping syndrome separate meals and fluids; fluids separate from meals

What dietary advice is commonly given for diverticulitis during acute and recovery phases?

Clear liquids during acute phase; high-fiber diet after recovery; avoid seeds/nuts if prescribed; bowel rest initially

In Crohn’s disease, what appearance is typical in the GI tract and how does it differ from ulcerative colitis?

Crohn’s: cobblestone appearance; often bloody mucous diarrhea; ulcerative colitis: continuous colonic ulcers; both are inflammatory bowel diseases

What dietary considerations are common for Crohn’s disease and for celiac disease?

Crohn’s: high-calorie, high-nutrient, may require low-fiber during flares; celiac disease: no gluten; monitor GI symptoms and diet

What is the recommended pre-surgery status if a patient has taken Versed (midazolam) an hour before consent?

Consent should be canceled or rescheduled because patient may not be able to give informed consent while sedated

What is the standard oxygen safety precaution for patients on home continuous oxygen therapy?

Avoid wool blankets near oxygen; keep oxygen equipment organized and accessible; avoid smoking; ensure proper storage of fuels

What should be documented or considered when performing a sterile dressing change for a central line?

Use aseptic technique; sterile field; appropriate dressing; monitor for infection; maintain blood return; document care

What is the nursing approach to a patient with a G-tube that requires feeding after a meal?

Check placement (X-ray initially); check residuals; flush with 20-30 mL water between meds and feeds; slow rate if intolerance

What is a key nursing intervention to prevent infection in a patient with a central line?

Maintain aseptic technique; ensure dressing changes are sterile; monitor for signs of infection; monitor for blood return and patency

Which patient actions would require contact precautions as a nurse?

Treating a patient with a contagious infection requiring gown and gloves; hand hygiene is essential; PPE as per isolation type

What is the teaching point for correct urinary catheter care by patients with indwelling catheters?

Keep the catheter patent; secure to prevent traction; maintain clean technique around the meatus; avoid pulling on the catheter

Which steps are important in a proper urinary catheter port/collection care in culture collection?

Clean port, clamp tubing below the port; collect specimen aseptically; re-clamp and resume drainage; label and send specimen

What patient education points are important for a patient starting a new colostomy care regimen?

Educate on stoma care, measurement, skin barrier, proper wafer fit; assess stoma color; monitor output; keep skin intact

How should a patient with premature rupture of membranes (PROM) be managed?

Monitor for infection; fetal monitoring; consider tocolytics if indicated; bed rest as ordered; observe for signs of infection

What is a common nursing intervention for a patient with pancreatitis on TPN?

Monitor for signs of infection, monitor glucose, ensure proper electrolyte balance; monitor hepatic function; maintain hydration

What is a practical tip for managing enteral feeding with multiple medications?

Crush medications one at a time; flush between meds; avoid mixing multiple medications together

What is the best practice for a patient with acute kidney injury and requiring diuretics regarding urine output measurement?

Monitor daily weights; track urine output; adjust diuretic therapy based on response and lab data

What are the key signs of a pneumothorax risk when inserting central lines?

Acute chest pain, shortness of breath, decreased breath sounds; monitor for respiratory distress after line placement

What is the first-line management for a brachytherapy patient with sealed radiation implants regarding patient and staff safety?

Maintain distance (6 feet), limit time with the patient (30 minutes), use dosimeters and signage; restrict pregnant staff

Which patient teaching point is essential for patients taking levothyroxine?

Take on an empty stomach, first thing in the morning; wait at least 30 minutes before eating; separate from other meds that affect absorption

What is the recommended practice for administration of bisphosphonates (e.g., alendronate) to minimize GI side effects?

Take on an empty stomach with a full glass of water; remain upright for 30 minutes after taking; do not take with food

What is the clinical sign of digoxin toxicity early in presentation?

Gastrointestinal symptoms (nausea, vomiting, anorexia), later visual changes (blurred vision, halos)

What is the correct approach to a patient who is on hypotension-inducing nitroglycerin patches and experiences a headache?

Remove the patch; reassess; if pain persists, evaluate for alternative therapy; monitor BP and adjust dose

Which statement correctly describes the management of a vesicant chemotherapy extravasation?

Stop infusion, aspirate if possible, administer antidote per protocol, and use extravasation kit; notify physician

What is the main precaution for a patient on a neutropenic diet at home?

Avoid fresh fruits/vegetables, flowers; ensure good personal hygiene; avoid potential infection sources

Which nursing practice helps prevent medication administration errors in enteral feeding?

Verify tube placement; check residuals; crush meds one at a time; flush between meds; avoid crushing extended-release meds

What is the key dressing-change principle for a central venous catheter?

Sterile technique; maintain a sterile field; keep the line patent and dry; monitor for infection signs

Which patient scenario illustrates the need for a privacy-preserving change of shift report?

Handoff at the bedside with patient involvement; no hallway report; ensure patient safety and understanding

What is a common key difference between Crohn’s disease and ulcerative colitis in terms of pathology?

Crohn’s can affect any part of the GI tract with cobblestone appearance; UC is limited to colon with continuous ulcers

Which patient condition would benefit most from a high-calorie, high-nutrient diet and pancreatic enzyme supplementation with meals?

Crohn’s disease with malabsorption; pancreatitis with exocrine insufficiency

What is a standard nursing action when a patient has a new ostomy and is in the process of learning stoma care?

Provide hands-on instruction, assess comprehension, reinforce skin barrier and appliance fitting, monitor stoma color

For newborn injections, which site is preferred for IM administration?

Vastus lateralis (eyes and thighs) for infants; ventrogluteal for older children

What is a common discharge teaching point for a patient with a new colostomy regarding daily care?

Keep skin clean/dry, measure stoma size before applying wafer, monitor skin integrity, empty pouch regularly

Which of the following best describes the management of a patient with suspected Lyme disease?

Administer doxycycline (or appropriate antibiotic); monitor symptoms; prevent tick exposure; report if necessary

Which statement about SIRS/sepsis risk in neonates is accurate?

Neonates may present with temperature instability, poor feeding, tachypnea, lethargy; treat promptly with cultures and antibiotics

What is the correct action to take when a patient on IV fluids begins to show signs of dehydration during TPN?

Assess intake, monitor urine output, adjust electrolyte balance, ensure adequate hydration; verify line patency and nutrition content

What is the key concept of the ‘Parkland formula’ in burn care?

Fluids resuscitation calculation for burns (not detailed in notes); used to guide initial fluid management

What is the correct approach to a patient with severe hypoxic symptoms after chest tube insertion with continuous bubbling in the suction control chamber?

Assess tube placement and function; ensure suction is active; monitor for air leaks and chest tube patency

Which of the following actions is appropriate when assisting a patient with a walker?

Advance the walker, then step into it; use armrests to stand from a chair; ensure proper gait pattern (arm opposite leg)

What should you verify before giving an MMR vaccine (or other vaccines) to a patient?

Assess for contraindications and ensure eligibility; ensure patient is not currently acutely ill; verify vaccine timing and dosing

What is a key consideration when delivering IV piggyback medications?

Do not mix with IV push medications; ensure compatibility; verify administration sequence and flush between meds

Which of the following best describes the appropriate management of a patient with a sealed radiation implant?

Maintain distance (6 feet), limit time with patient (30 minutes), monitor with dosimeters, restrict visitors; keep radioisotopes shielded

What is a recommended nursing practice for preventing falls at home for elderly patients?

Install grab bars; wear proper shoes; remove throw rugs; use stair-edge markers; keep items within reach