NCLEX Review Flashcards from Klimek Nursing Notes - Lecture Topics Coverage

A comprehensive set of Q&A flashcards drawn from the lecture notes covering acid-base balance, ventilators, alcohol withdrawal, infectious disease precautions, cardiac care, chest tubes, obstetrics, neonatal effects, laminectomy, psychiatry topics, diabetes, electrolytes, and prioritization strategies for NCLEX-style questions.

What are the normal values used to interpret acid-base balance (pH, CO2, HCO3) most commonly taught in these notes?

pH 7.35–7.45; CO2 (PaCO2) 35–45 mmHg; HCO3 22–26 mEq/L.

In acid-base disorders, how do you determine whether the imbalance is metabolic or respiratory based on pH and HCO3 direction?

If pH and HCO3 move in the same direction, the imbalance is metabolic; if they move in opposite directions, it is respiratory.

What does the mnemonic “MAC Kussmaul” indicate in acid-base disorders?

Metabolic acidosis with Kussmaul respirations.

What is the correct order to address a high-pressure alarm on a mechanical ventilator?

1) Unkink the tubing; 2) Empty condensed water from the tubing; 3) Have the patient turn, cough or take deep breaths; 4) Suction as needed.

What should you do for a low-pressure alarm on a ventilator?

Low pressure indicates a disconnection or leak; reconnect the tubing, bag the patient, and notify Respiratory Therapy.

What is Wernicke-Korsakoff syndrome and how is it treated?

Wernicke (encephalopathy) and Korsakoff (psychosis) due to thiamine (B1) deficiency; treatment is thiamine replacement and redirecting/confabulating patients when needed.

What is Antabuse (Disulfiram) and Revia, and how do they relate to alcoholism treatment?

Alcohol deterrent therapy; onset about 2 weeks; duration about 2 weeks; patient needs to be on it at least 2 weeks prior to events to prevent drinking.

What are troughs, peaks, and the TAP method in drug monitoring?

Troughs are drug levels just before the next dose (lowest); peaks are highest levels after administration; TAP stands for Trough, Administer, Peak—the trough is drawn before administration, the peak after administration (timing depends on route).

Why are aminoglycosides considered highly test‑worthy (Mean Old Mycin) on NCLEX?

They are used for serious Gram-negative infections, are nephrotoxic and ototoxic (CN VIII), and many are still commonly tested; all end in -mycin and need monitoring (creatinine) due to toxicity.

List a couple of classic examples of aminoglycosides and one key toxic effect to monitor.

Gentamicin, Amikacin, Tobramycin, etc.; key toxic effects: CN VIII (ototoxicity/hearing/balance) and nephrotoxicity (monitor creatinine).

What is the difference between DKA and HHNK (HHNS) in diabetes?

DKA occurs in Type 1 with ketosis and metabolic acidosis; HHNK (HHS) occurs in Type 2 without significant ketosis, with severe hyperglycemia and dehydration.

What is HbA1C used for in diabetes management, and what are the general reference points given?

Long-term (about 90 days) average blood glucose; Hb < 6% normal in notes, Hb > 8% poor control, Hb around 7% borderline.

Match the insulin types to their onset/peak/duration (Regular, NPH, Lispro, Glargine).

Regular: onset ~1 h, peak ~2 h, duration ~4 h; NPH: onset ~6 h, peak ~8–10 h, duration ~12 h; Lispro (Humalog): onset ~15 min, peak ~30 min, duration ~3 h; Glargine (Lantus): no peak, duration ~12–24 h (long-acting).

What is a key management point for a diabetic patient during sick days?

Maintain insulin; watch for dehydration and hyperglycemia; adjust insulin as needed and ensure adequate fluids and carbohydrate intake.

What are the hallmark signs of hypoglycemia (drunk pattern) and the immediate treatment steps?

Signs: staggering, slurred speech, confusion, tachycardia, diaphoresis. Treatment: give rapidly metabolizable carbohydrate (juice, candy, soda), then recheck; if unconscious, give glucagon IM or D50 IV.

What are the typical signs and treatment considerations for DKA?

DKA signs: dehydration, ketones, acetone breath, Kussmaul respirations, abdominal symptoms; treatment: aggressive IV fluids and Regular insulin infusion; monitor electrolytes closely.

What is the difference between pathologic and physiologic jaundice in newborns?

Pathologic jaundice appears within the first 24 hours of life; physiologic jaundice appears after about 24 hours and usually resolves fairly quickly.

What symptom indicates potential kernicterus in a newborn?

Bilirubin level >20 mg/dL in brain; opisthotonos can be seen; urgent medical attention required.

Caput vs Cephalohematoma in the newborn: features and crossing of suture lines?

Caput crosses suture lines and is edematous swelling of the scalp; Cephalohematoma is a subperiosteal bleed that does not cross sutures.

What are Chadwick’s, Goodell’s, and Hegar’s signs in pregnancy?

Chadwick’s sign: blue/purple vaginal/cervical coloration; Goodell’s sign: softening of the cervix; Hegar’s sign: softening of the lower uterine segment.

What is Naegele’s rule for estimating the due date?

Add 7 days to the last menstrual period (LMP) and subtract 3 months.

What is the expected fundal height behavior postpartum and when does involution occur?

Fundus should be midline and at the level of the umbilicus postpartum; it involutes about 2 cm per day.

Name the four stages and three phases of labor (Stage 1 phases).

Stage 1: Phases are Latent, Active, Transition; Stage 2: Delivery of the baby; Stage 3: Delivery of the placenta; Stage 4: Recovery. (Stage 1 has Latent, Active, Transition.)

What is the LION acronym used for in fetal monitoring and emergencies?

LION: Left side, IV, Oxygen, Notify HCP; stop Pitocin if running; used for certain abnormal fetal heart rate patterns (start letter L in tracing cues).

What are the 7 fetal monitoring patterns commonly tested, and which are considered bad?

Patterns: early decelerations (normal), late decelerations (bad), variable decelerations (can be associated with prolapsed cord; bad when severe), baseline variability (low is bad; high is good); low HR (

What is the clinical meaning and management for a prolapsed cord in labor?

Prolapsed cord causes abrupt decelerations; management includes pushing the presenting part off the cord and placing the patient in knee-chest or Trendelenburg position and preparing for emergent delivery.

What is the function and the primary precautions for the fourth stage after delivery?

Fourth stage recovery: monitor vitals, assess fundus (boggy fundus massaged), monitor lochia, assess perineal pads, roll patient to assess for bleeding; repeat every 15 minutes for the first 4th stage checks.

What are the newborn skin and variation findings considered normal (Milia, Epstein pearls, Mongolian spot) and when do they appear?

Milia and Epstein pearls are common; Mongolian spots are common in darker-skinned babies; these are normal newborn skin findings documented at birth.

What is the difference between physiologic jaundice and pathologic jaundice in newborns?

Physiologic jaundice appears after 24 hours and resolves; pathologic jaundice occurs within the first 24 hours and may require intervention.

What is the meaning of the “TRouBLe” congenital heart defect mnemonic and which defects are included?

TRouBLe refers to cyanotic congenital heart defects that typically require surgical correction; commonly remembered defects include the Tetralogy of Fallot components: P ulmonary stenosis, RVH, Overriding aorta, VSD (PROVe). The board-style emphasis is on recognizing cyanotic defects.

What is the PROVe mnemonic in Tetralogy of Fallot?

Pulmonary stenosis, Right ventricular hypertrophy (RVH), Overriding aorta, Ventricular septal defect.

What is the typical management for a chest tube with apical vs basilar placement?

Apical chest tube drains air (pneumothorax); basilar chest tube drains blood or fluid (hemothorax/hemopneumothorax).

What is the first action if the water-seal chamber of a chest tube breaks?

Clamp the tube immediately; then cut, submerge the end under sterile water, and unclamp as appropriate per protocol.

What is the priority step if a chest tube becomes dislodged in a patient?

Cover the site with sterile dressing; if the tube is out, cover and notify; the first action is to prevent air entry and protect the wound.

What is a key preoperative assessment focus for a cervical laminectomy?

Assess breathing first because cervical involvement can affect diaphragmatic/arm function; monitor respiratory status and upper extremity function.

What are the three main post-op complications to monitor after a laminectomy?

Pneumonia (respiratory), paralytic ileus (GI), urinary retention (bladder/nerve function); monitor respective systems depending on level.

What safety principle governs activity restrictions after laminectomy?

Log roll to move and avoid bending at the waist; avoid prone/dangling and encourage early ambulation with precautions.

What precautions are included in Transmission-Based Precautions (4 types) and the PPE sequence for each?

Standard/universal; Contact (private room; gown and gloves; dedicated equipment); Droplet (mask; sometimes gown/gloves); Airborne (private room with negative pressure; mask or respirator; gown/gloves). Donning order varies by protocol; doffing order typically gloves → goggles/face shield → gown → mask.

What is the difference between “standard/universal” precautions and “transmission-based” precautions?

Standard precautions apply to all patients; transmission-based precautions apply based on suspected or confirmed infection (contact, droplet, airborne) to prevent spread.

What are the key electrolyte rules summarized as Kalemia, Calcemia, Magnesemia in relation to prefixes?

Kalemia: effects go in the same direction as the prefix, except HR and urine output (UO) go in the opposite direction. Calcemia: opposite direction to the prefix. Magnesemia: opposite direction to the prefix (sedative effect).

What is the U.S. NCLEX‑style rule for potassium management in labs (levels A–D) and the corresponding actions?

Level A: Cr 0.6–1.2 normal; Level C: potassium abnormal (high or low) requires assessment; Level D: potassium >6 requires immediate action (hold K+, assess ECG, prepare to give insulin/Kayexalate, call HCP; stay with patient). Treat abnormal potassium as a high-priority issue.

What are common signs and treatment for hyponatremia and hypernatremia in these notes?

Hypernatremia: dehydration signs; treat with IV fluids; hyponatremia: fluid overload concerns and management by fluid restriction or diuretics as appropriate.

What are the typical initial pregnancy weight-gain guidelines and how are they interpreted with Weeks gestation?

Ideal weight gain around 28 lbs +/- 3; quick-dirty method: weeks gestation minus 9 to estimate weight gain; small deviations prompt assessment (BPP).

What is the difference between hiatal hernia and dumping syndrome and their general treatments?

Hiatal hernia: regurgitation/GERD-like symptoms; treat with elevating HOB, fluids with meals, and carbs management. Dumping syndrome: rapid gastric emptying causing Drunk/Shock/Acute abdominal distress; treat by lowering HOB during meals, restricting fluids near meals, and reducing carbohydrate intake.

What is the mnemonic for neonatal skin findings and the common birthmarks (cephalohematoma vs caput) as described?

Milias (white pinhead-sized bumps), Epstein pearls (palatal cysts), Mongolian spots (bluish sacral region); Caput crosses suture lines; Cephalohematoma is subperiosteal and does not cross sutures.

What is the recommended nursing action for a patient with suspected thyroid storm?

Immediate cooling with ice packs or cooling blanket, oxygen, aggressive airway management, and rapid control of hyperthermia; monitor BP and tachycardia.

What is the first-line management for a patient with thyroidectomy in the notes (postop risk categories)?

Postop airway is the top risk in the first 12 hours due to edema; later risk for tetany due to hypocalcemia in total thyroidectomy and thyroid storm in subtotal thyroidectomy.

What is the primary concern after a postpartum delivery regarding the uterus and lochia (BUBBLE HEAD)?

Fundus (firm, midline, non-boggy), Lochia (rubra/serosa/alba sequence), Thrombophlebitis risk; assess breasts, uterus, bladder, bowels, lochia, perineum, extremities, etc.

What is the typical management stance for a non-psychotic patient versus a psychotic patient in nursing communication?

Non-psychotic: therapeutic communication (acknowledge feelings, present reality, set limits, enforce). Psychotic: determine functional vs dementing vs delirium; use reality-based strategies; redirect if possible; acknowledge feelings and ensure safety.

What are examples of delusions, hallucinations, and illusions as psychotic symptoms?

Delusions: fixed false beliefs (paranoid, grandiose, somatic). Hallucinations: sensory experiences (auditory, visual, tactile, gustatory, olfactory). Illusions: misinterpretations of reality with referents present.

What is the proper approach to patient education for a psychotic with delusions or hallucinations per the notes?

Acknowledge feelings; provide reassurance; redirect to safe activities; do not confront by arguing about the delusion; maintain safety and therapeutic boundary.

What are the major classes of psychiatric medications and one common S/E acronym to remember for antipsychotics?

Phenothiazines (typical antipsychotics ending in -zine) and others; S/E: ABCD (Anticholinergic, Blurred vision, Constipation, Drowsiness, EPS, Photosensitivity, agranulocytosis).

Which three major factors are used in the mnemonic ABCDF for antipsychotic S/E and what is the corresponding nursing action?

Anticholinergic, Blurred vision, Constipation, Drowsiness, F (EPS), D (photosensitivity), agranulocytosis; nursing action: educate about safety; hold drug for toxic effects and notify HCP.

Which electro‑drug is commonly used to treat A-fib and CHF and its therapeutic/toxic level range?

Digoxin (Lanoxin); Therapeutic level 1–2; Toxic level >2.

What are the key features and actions of Clozapine (Clozaril) and what major safety concern requires monitoring?

Atypical antipsychotic; no or fewer EPS; major risk is agranulocytosis; monitor WBC frequently.

What tyramine-containing foods should be avoided with MAO inhibitors and why?

Avoid foods rich in tyramine (certain fruits, cheeses, meats, yeasts, etc.) due to risk of hypertensive crisis.

What is the typical sign and consequence of hypothyroidism (myxedema) and the recommended treatment?

Hypometabolism; signs: fatigue, weight gain, cold intolerance; treatment: levothyroxine (Synthroid) daily on an empty stomach.

What is the difference between Addison’s disease and Cushing’s syndrome in terms of adrenal cortex function?

Addison’s: hypoadrenalism/adrenal insufficiency; Cushing’s: hyperadrenalism/steroid excess; clinical signs reflect cortisol excess vs deficiency.

What are three important neonatal assessment signs/trends for Piaget and child development in pediatric nursing?

Piaget stages (0–2 sensorimotor; 3–6 preoperational; 7–11 concrete operational; 12–15 formal operations); assess development with age-appropriate tasks and provide anticipatory guidance.

What are common toys safety considerations for children in hospital within these notes?

Safe toys for immunosuppressed children (hard plastic, easily disinfected); avoid small parts for under 4; avoid metal/dye-cast if on oxygen; beware of fomites.

What is the key step in managing a prolapsed umbilical cord during labor?

Push the presenting part off the cord and place the mother in knee-chest or Trendelenburg position; prepare for urgent delivery.

What is the meaning of the “LAP” rule in L&D emergencies and the order of interventions?

LION (Left side, IV, Oxygen, Notify HCP; stop Pitocin if running) plus immediate actions to stabilize and prepare for delivery.

What are the two typical presentations of edema in the newborn (Caput vs Cephalohematoma) and how do they differ in crossing sutures?

Caput: crosses sutures; Cephalohematoma: does not cross sutures and is subperiosteal.

What are some common signs of neonatal distress related to bilirubin and jaundice, and what is the threshold for kernicterus risk?

High bilirubin levels risk kernicterus (>20 mg/dL associated with brain involvement); monitor jaundice onset timing (pathologic vs physiologic) and intervene as indicated.

How should diabetes medications be managed on sick days and what is the key risk?

Continue insulin; monitor fluids and blood glucose; dehydration risk and hyperglycemia possible during illness.

What is the difference between DKA and HHNK/HHS regarding ketones and acid-base status?

DKA has ketosis and acidosis; HHNK/HHS lacks significant ketosis and has severe hyperglycemia and dehydration.

What is the appropriate nursing action for a patient on methylprednisolone (Solu-Medrol) during COPD exacerbation?

Monitor for hyperglycemia and perform frequent accuchecks; steroids can cause steroid-induced glucose intolerance.

What is the correct approach to newborn bilirubin management and phototherapy thresholds described in these notes?

Monitor bilirubin levels; treat pathologic jaundice promptly; phototherapy is used as indicated by bilirubin levels and age-the newborn.

What are two common signs of hypocalcemia and the associated tests/signs to look for?

Tetany, Chvostek sign, Trousseau sign; signs present with hypocalcemia; monitor for neuromuscular irritability.

What are the meanings of the 4 stages of labor in the obstetric framework?

Stage 1: onset of labor (latency, active, transition); Stage 2: delivery of the baby; Stage 3: delivery of the placenta; Stage 4: recovery.

What is the standard order to put on PPE and the order to take it off?

To put on: Gown → Mask → Goggles/Face shield → Gloves; to take off: Gloves → Goggles/Face shield → Gown → Mask.

What is the sign indicator for a normal fetal baseline variability and the contrasting patterns (VEAL CHOP) used to interpret patterns?

Normal baseline variability is good; VEAL CHOP summarizes the causes: Variable decelerations = Cord compression; Early decelerations = Head compression; Acceleration = Okay; Late decelerations = O2/placental issue.

What is the mnemonic PROVe and what does it stand for in Tetralogy of Fallot?

PROVe stands for Pulmonary stenosis, Right ventricular hypertrophy (RVH), Overriding aorta, Ventricular septal defect (VSD).

What is the function of thiamine in the treatment of Wernicke-Korsakoff syndrome and what is a common clinical presentation?

Thiamine replacement; amnesia with confabulation is common; early and preventable by B1 supplementation.

What is the primary nursing intervention for a patient with suspected thyroid storm?

Rapid cooling, airway management, oxygen, and aggressive measures to reduce hyperthermia and stabilize vitals.

What is the recommended approach to caring for a patient postpartum with boggy fundus or excessive lochia?

Massage fundus to firm; assess bladder status; monitor lochia flow (saturating pads quickly indicates hemorrhage) and manage accordingly.

What are the typical stages of Piaget’s theory and the corresponding ages for child development?

Sensorimotor (0–2), Preoperational (3–6), Concrete Operational (7–11), Formal Operational (12–15).

What is the role of the LPN in relation to IV starts, IV meds, and neurovascular assessments per the notes?

LPNs can maintain IVs and document flow; they cannot start IVs, push IV meds, or replace a first assessment; they handle routine care under RN supervision.

What is the general approach to prioritizing care using the ABCD scheme in Lab Values (e.g., potassium, pH, CO2)?

Rank patients by level of urgency: A = low priority; B = concerning; C = critical; D = highest priority; act accordingly (e.g., K+ abnormalities often move to C or D).