NCLEX Comprehensive Nursing Review: Medical-Surgical & Pharmacology

Flashcards covering acute and chronic medical-surgical care, priority electrolyte imbalances, critical lab ranges, emergency drug pairs, and NCLEX pearls.

What is the priority initial action for a patient experiencing a suspected Myocardial Infarction (MI), and what does the MONA acronym stand for?

The priority action is to apply $O_2$ first (ABCs). MONA stands for Morphine, $O_2$, Nitroglycerin, and Aspirin.

What are the key clinical manifestations and positioning instructions for Peripheral Arterial Disease (PAD)?

Key signs include intermittent claudication (pain relieved by rest), cool pale skin, hair loss, thick nails, and weak pulses. Nursing instructions are to keep the environment warm, never elevate the legs above the heart, and avoid direct heat due to burn risk.

Following a thoracentesis, what assessment findings indicate the complication of a pneumothorax requiring immediate action?

Decreased breath sounds on the affected side, tachycardia ($> 100\text{ bpm}$), and subcutaneous emphysema (crackling under the skin).

What are the essential post-operative care interventions and medication holds for a patient following cardiac catheterization?

Enforce bedrest lying flat for $4\text{--}6\text{ h}$, monitor the puncture site for bleeding or hematoma, perform neurovascular checks with vital signs, assess for iodine/shellfish allergies, and hold metformin for $48\text{ h}$ before and after the procedure.

What are Osler nodes in infective endocarditis, and what causes them?

Painful red bumps on the pads of the fingers or toes caused by the buildup of immune complexes in small blood vessels.

What clinical triad and blood pressure change characterize cardiac tamponade?

Beck's triad (muffled heart sounds, jugular venous distention [JVD], and hypotension) and paradoxical blood pressure, which is a systolic BP drop of $> 10\text{ mm Hg}$ on inspiration.

What are the priority sequence of actions when a nurse suspects meningitis?

Isolate first by initiating droplet precautions immediately, and administer IV antibiotics second without waiting for lab results.

What are the 6 Ps assessed during neurovascular checks following a fracture, and what does severe pain out of proportion indicate?

Pain, Paresthesia, Pallor, Paralysis, Pulselessness, and Poikilothermia. Pain out of proportion to the injury indicates compartment syndrome, a surgical emergency caused by pressure buildup cutting off blood flow.

What is the primary bedside safety precaution for a patient following mandibular fixation surgery?

Keep wire cutters at the bedside at all times to cut the wires in case of an airway emergency, such as vomiting.

What nerve is compressed in carpal tunnel syndrome, and what clinical test confirms it?

The median nerve is compressed (causing numbness in the middle three fingers). It is confirmed by a positive Phalen's test (wrist pain when the backs of hands are held together at $90^\circ$).

Following a head injury, how does a nurse identify a cerebrospinal fluid (CSF) leak indicating a basilar skull fracture?

Look for clear fluid draining from the ear or nose that tests positive ($+\text{)}$ for glucose.

Why must serum sodium levels be monitored closely following a carotid endarterectomy or head injury?

Low sodium causes water to move into brain cells, leading to cerebral edema, which presents as headache, confusion, decreased LOC, and seizures.

What are the clinical signs of a fat embolism following a long bone fracture, and what is the nurse's first action?

Signs include sudden dyspnea, tachypnea, confusion, and petechiae on the chest and neck. The first action is to apply high-flow $O_2$, place the patient in high Fowler's position, and notify the provider.

How does morning stiffness differ between Osteoarthritis (OA) and Rheumatoid Arthritis (RA)?

In OA, stiffness is brief and joint pain occurs after activity. In RA, morning stiffness lasts $> 1\text{ hr}$ with swollen, symmetrical joints.

How does pneumonia typically present in older adult patients compared to younger adults?

Older adults frequently present with new onset confusion, weakness, and anorexia rather than a high fever or cough.

What infection control precautions and first-line multi-drug regimen are required for Tuberculosis (TB)?

Airborne precautions with an N95 mask in a negative-pressure room. The multi-drug therapy is RIPE: Rifampin, Isoniazid, Pyrazinamide, and Ethambutol.

What does continuous bubbling in the water-seal chamber of a chest tube indicate, and what does an absence of tidaling signify?

Continuous bubbling in the water-seal chamber indicates an air leak. An absence of tidaling means either the lung has fully re-expanded or the chest tube is obstructed.

What respiratory pattern is characteristic of metabolic acidosis caused by DKA, and what electrolyte imbalance frequently accompanies it?

Kussmaul respirations (deep, rapid breathing), frequently accompanied by hyperkalemia.

What is the primary laboratory hallmark and fluid status characteristic of Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

Dilutional hyponatremia ($\downarrow Na^+$) accompanied by fluid overload without peripheral edema, low urine output, and highly concentrated urine.

What clinical manifestations and life-threatening crisis are associated with Addison's disease?

Bronze skin pigmentation, fatigue, weight loss, hypotension, hyponatremia, and hyperkalemia. The life-threatening crisis is Addisonian crisis, characterized by severe, refractory hypotension leading to shock.

What potential adverse effect must be monitored when administering thiazide diuretics such as hydrochlorothiazide?

Hypokalemia ($K^+ < 3.5\text{ mEq/L}$), which increases the risk for cardiac dysrhythmias.

What are the clinical signs of a post-operative paralytic ileus, and what is the priority nursing intervention?

Abdominal distention, absent bowel sounds, vomiting, and lack of flatus. The priority intervention is to insert a nasogastric (NG) tube to decompress the stomach.

What is the clinical significance of feverfew and ephedra?

Feverfew is used for migraine prevention and must not be mixed with anticoagulants. Ephedra is used for weight loss but is dangerous due to risks of hypertension and stroke.

Why is new peripheral edema an urgent finding in a patient diagnosed with Systemic Lupus Erythematosus (SLE)?

It indicates possible lupus nephritis (kidney involvement), as damage to the glomeruli causes sodium and water retention and proteinuria.

Why is a full-thickness (third-degree) burn typically painless in the center of the wound?

The burn completely destroys both the epidermis and the dermis, damaging the underlying local sensory nerve endings.

What is the best hemodynamic indicator of fluid status during the acute resuscitation phase of severe burns?

Pulmonary artery pressure (PAP), measured using a pulmonary artery (Swan-Ganz) catheter.

What does serosanguineous drainage from a surgical incision after post-op Day 5 typically indicate?

Possible wound dehiscence, meaning the deeper layers of the surgical incision are beginning to separate.

What immediate actions should the nurse take if surgical wound evisceration occurs?

Stay with the patient, cover the protruding organs with a sterile saline-moistened dressing, position the patient in low Fowler's with knees bent, call the provider immediately, and never attempt to push the organs back in.

What is the mechanism of action and primary side effect of finasteride (Proscar) for benign prostatic hyperplasia (BPH)?

It shrinks the prostate tissue to alleviate urinary obstruction; a primary adverse effect is decreased libido.

How should cyclosporine be administered, and what beverage is strictly contraindicated?

Mix with milk or juice; never administer with grapefruit juice because it significantly increases drug bioavailability and toxicity.

What critical rule must be followed before administering neuromuscular blocking agents such as pancuronium or vecuronium?

Always administer sedation first, because neuromuscular blockers paralyze all skeletal muscles (halting breathing) but provide no sedation or analgesia.

Under what condition should morphine be withheld, and what is its specific reversal agent?

Hold morphine and notify the provider if the respiratory rate is $< 12\text{ breaths/min}$. Its antidote is Naloxone (Narcan).

What are the antidotes of choice for Benzodiazepine toxicity, Digoxin toxicity, and Malignant hyperthermia?

Benzodiazepines: Flumazenil (Romazicon); Digoxin: Digibind; Malignant hyperthermia: Dantrolene.

What are the emergency medications administered to manage severe hyperkalemia?

Insulin + Dextrose (shifts potassium into cells) and Calcium gluconate (stabilizes the cardiac membrane).

What are the ECG hallmarks associated with hypokalemia versus hyperkalemia?

Hypokalemia presents with flat T waves; hyperkalemia presents with tall, peaked T waves.

What are the classic signs of hypocalcemia ($Ca^{2+} < 8.5\text{ mg/dL}$)?

Tetany, positive Trousseau's sign, and positive Chvostek's sign.

What are the normal ranges and critical concern thresholds for serum Sodium ($Na^+$) and Potassium ($K^+$)?

$Na^+$ normal is $135\text{--}145\text{ mEq/L}$ (concern when $< 130$ or $> 150\text{ mEq/L}$ due to seizure risk). $K^+$ normal is $3.5\text{--}5.0\text{ mEq/L}$ (concern when $< 3.0$ or $> 6.0\text{ mEq/L}$ due to lethal dysrhythmias).

What are the normal ranges and critical concern thresholds for serum Calcium ($Ca^{2+}$) and Platelets?

$Ca^{2+}$ normal is $8.5\text{--}10.5\text{ mg/dL}$ ($< 7\text{ mg/dL} = \text{tetany}$, $> 12\text{ mg/dL} = \text{coma}$). Platelets normal is $150\text{--}400\text{ k}$ ($< 50\text{ k} = \text{severe bleed risk}$).

How does neurogenic shock differ in its vital signs compared to hypovolemic and septic shock?

Neurogenic shock presents with bradycardia and warm, dry skin due to loss of sympathetic tone, whereas hypovolemic shock presents with tachycardia and cool skin, and septic shock presents with tachycardia and fever.

What diseases require airborne precautions according to the 'My Chicken Hez TB' mnemonic, and what PPE/facility setup is needed?

Measles, Chickenpox, Herpes Zoster, and TB. They require an N95 respirator mask and a negative-pressure room.