Multiple Myeloma – Elevated serum calcium

COPD – Complication INH – adverse reaction Procardia – Adverse reaction/toxicity Metered Dose Inhaler – Process how to

use it AIDS Immunizations – Allergy to Eggs (DPT),

immunocompromised house mate Droplet Precaution Disaster Nursing Delegate stable diseases vs. non-stable Infant vital signs Signs/Symptoms of dehydration in

infants Myocardial Infarction Rheumatoid Arthritis Thromboplebitis Signs/Symptoms of Hypercalcemia Signs/Symptoms of Infection Signs/Symptoms of COPD Signs/Symptoms of Right-Side CHF Digoxin side effects Triage priority Complications of Emphysema Signs/Symptoms of Hypothyroidism Iron Deficiency Anemia Hepatitis B Chronic Renal Failure Cancer Glaucoma Thrombocytopenia Neutropenia Thoracotomy Fetal Monitoring causes of decelerations Growth and Development Procardia Pilocarpine NPH Neupogen Synthroid Calcium Channel Blockers Levothyroxine synthroid Herbal Medicines: Echinacea, Ginger

roots

Medication for ruptured cerebral aneurysm (Zantac?) –eh di thrombolytics

Uterine tumor –smoking? Left-sided CHF Mastitis and Breastfeeding-do not use

hot compress, cold compress and expose to air

Dumping Syndrome Diet-low sodium, low CHON, high fat

Endocrine system Crutches, Canes, Walkers Death viewed from each age group Signs/Symptoms of Hepatitis A Halo Vest Metered Dose Inhaler –u need to use

some spacer if difficulty inhaling it Cataract Surgery Insulin Peak Times Diabetes I: Had to do with a toe ulcer Diabetes II Measles Lab: How does Chemo drugs affect

renal labs –nephrotoxic, causes gouty arthritis, hi BUN, creatinine, hemorrhagic cystitisRadiation Therapy-lead apron, long handled forceps, lalaki, 6meters away, min 30mins exposureInfectious Diseases: MRSA, TB

Isolation precautions Mitral Valve Regurgitation Signs/Symptoms of

Tuberculosis/Medications/Airborne Signs/Symptoms of Vulva Cancer Endometriosis medications – pills? Postoperative care for total knee patient Hepatitis A,B,D,C causation Lead Poisoning Antipsychotic medications side effects Thallium test Non-stress test End stage renal disease diet- low

potassium diet, low sodiun I've encountered a lot of infectious

diseases.So try to study the isolation precautions of diseases like VRE,LYMES,AIDS,MRSA ETC.

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Study too the stable and unstable pts. coz a lot of these questions came out like w/c pt would u discharge/transfer first.

Know the normal Vital signs of diff.age group.

Diet such as high in magnesium,potassium,sodium and others.

specific toys/games for children study on alzheimer's ds.,post-op.care for

total hip replacement,COPD. S/S of fibromyalgia,SLE,Acute

pancreatitis,lymes ds. Nursing care for elderly pts..aging process Know the client's rights. Beta-adrenergic drugs,tricyclic anti-

depressants. Normal growth and dev't of 1-12mos old Know abt the rotavirus Delegation on newly hired nurse So far i only got one question same w/ my

1st exam.abt the pneumocystis carinii pneumonia Advance Directive

Assessment of elderly client, What do you expect?

Sign & symptom of hemophilia Hemophilia With hemarthosis- increase

fluid intake AIDS client – test for candida, mumps and

PPD Fracture femur- Client had an accident

TPN- How to prevent complications – check for glucose, patency of veinNewborn- What is your priority? – temperatureCVA with Right sided hemiplegiaCVA with Left sided hemiplegiaSigns/Symptoms of Vulva CancerEndometriosis medications – pills? Postoperative care for total knee patient Hepatitis A,B,D,C causationLead Poisoning Antipsychotic medications side effects Thallium test Non-stress test End stage renal disease diet- low

potassium diet, low sodiun Know abt the rotavirus

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1. A confused client for surgery. Client signed the consent for his surgery. What is the nurse initial action?A) Document and monitor laterB) notify the anesthesiologistC) Determine when the patient became confusedD) ask the relative about the patient’s status

NOTE; I personally experienced this situation if anybody know the answer pleased tell me.

2. A nurse-in-charge sent a maternity nurse to a surgical unit. Which client will the nurse in charge assign to the nurse from maternity ward?Which of the following client is appropriate for a nursing assistant?

3. A client with rheumatoid arthritis tells “I having back pain with this bed, I like my bed at home. What is the immediate response of the nurse?A) I will massage your back to help youB) Ask the physician for opoid analgesiaC) I will refer you to the occupational therapyD) Ask the husband how she sleeps at home

4. Mild Alzheimer- sign and symptoms select all that apply

5. Tuberculosis –instructions

6. A client with myocardial infarction taking lasix and digoxin

7. 0 A client with ICP

8. Chest tube inadvertently out – What is the nurse initial action?

9. A newborn with white papule on face and trunk. What is the nurse discharge instruction?

10. Phototherapy

11. A client with nasogatric tube feeding at home.

12. DKA- What is your initial action?

13. Laenneac’s cirrhosis

14. End stage renal failure –diet

15. Transesophageal echocardiogram-

16. Synthroid

17. Cervical implant

18. Autonomic dysreflexia sign and symptoms

19. UTI- Which statement of the client needs essential follow up?

20. Phones calls- which client needs to immediate follow up?

21. Pre-op client- which laboratory result needs to notify the physician?

22. Assessment of the new nurse in the unit- Which of the following action by the new nurse needs follow up?

23. The nurse put the client in seclusion after being assaultive and hitting other client. Which of the following statement of the nurse is appropriate for the client?

A) We are very disappointed that you can not control yourself, you will be in seclusion until you calm down

B) Hitting is not allowed here, you will be in seclusion

C) You hit someone, you will be in seclusion call us if you need us, we are here to help you

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D) I forgot???

24. A mother called the nurse from home stating that her child is having chicken pox. Which of the following statement by the mother needs immediate follow up?A) Father of the child with liver failureB) Sibling with anemiaC) Child just had tonsillectomyD) Child has intermittent low grade fever

25. A client with allergy to Sudafed. Which of the statement is correct?A) I will take valerian….B) I will take ma huang….C) I will take Echinacea for acute viral infectionD) I will take black cohosh….

26. A client with schizophrenia- How will the nurse assess the affect?

27. A client with bipolar disorder- manic phase. What is your immediate response?

28. A client with severe anxiety- What is the outcome of the nurse’s short term goal? A 15 year old client- What do you expect? Antisocial behavior

29. A client with diabetes mellitus (type I). NPH insulin given at 8:00 am- When do you expect the effect?

A) at noonB) late afternoonC) early afternoonD) early evening

30. Expressive/receptive aphasia- What is your essential response when communicating with this client?

31. A child 2 year old with a suspected diagnosis of hearing impairment. Which of the following action by the child contribute to the diagnosis?

A) Child talking few wordsB) Child plays alone with other

children aroundC) Gesture and pointing what he

wantsD) I forgot????

Safe nurse interventionCOPD

32. A client had an accident with brow laceration and fractured of the jaw. Suturing of the laceration and maxillary pinning was done. Which of the following action of the nurse is appropriate? I answered – keep wire cutter at bedside

33. Proper documentation of incident34. Right side heart failure sign/symptoms, select all that apply35. Use of Contaceptives36. Calculation

Last question in my NCLEX exam….

37. Food processing…..

A) frozen food can be defrost for up to six hours....B) Frozen food which has been defrost can be return back to fridge...

C) Cook perishable food should cover and cool....

D) Frozen food should be defrost by using hot water....

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1. If you have a Pt that’s allergic to "sulfa" drugs.. What class of drugs are they also allergic too?

2. Which pt is most likely to get TB?a. 26 yo who smoke marijuana with a group of friendsb. 74 yo retired welderc. don't remember the others

3. What diet would you give a pt w/ esophageal varicies?

4. Pt. recieving internal radiation.. Should the nurse limit her time w/ the patient to 30 mins max??? I thought this was the answer b/c kaplan tought me when you deal w/ radiation think "time, distance, shield" anyone know???

5. Assessment of a pt w/ scoliosis would present with?a. concave cervical and lumbar spineb. asymmetical iliac crest

6. Nurse should write an incident report if?a. pt reports she is in a sexually abusive relationshipb. room mate tells pt that he brought his home sleeping pills and is secretly taking themc. a staff nurse is seen giving a pt that is not assigned to a medd. don't remember

7. High alarm will sound if?a. pt is biting the tubeb. leak in the cuffc. don't remember the rest

8. Pt understands teaching about the care of his prostetic eyeball when he states?a. I will gently pull my lower eyelid down and press inward untill the eyeball comes out. (I chose this)b. I will store my eyeball in tap water

overnightc. I will put drops in my eye continually throughout the day

9. A young pt is most likely to get lead poisoning if?a. he is drinking from a ceramic pitcherb. Father refernishes old furniture at their home(I'm torn b/w these b/c I know a is correct but old furniture may contain lead in the paint and the child could eat the paint chips???)

10. A TB pt understands that he can reduce the risk of spreading his disease if he states?a.) I won't sleep in the same room w/ my wife for 1-2 monthsb. )I will stay away from pregnant women and childrenc.) I will use plastic utensil when I eat (this answer was on 2 of my TB questions)d.) don't remember

11. Pt in skeletal halo tractiona. pt should use sterile technique when cleaning insicionsb. pt should put lubricant on insicions

12. Pregnant pt should seek info. from a registered dietitian if?a. on a vegan dietb. takes vitamin B every dayc. eats at least 1 meal of fast food every day

13. Pt w/ a T12 spinal injury would?a. urinate a little every 2 hrsb. urinate a lot every 4 hrsc. dribble unrined. pt won't urinate on his own

1. symptoms of another complication of atrial fib: Can't remember the answers except for

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the one I chose. I chose slurring speech and weakness (embolic stroke is a secondary compication of AFib)

2. charge nurse to assign 10 week pregnant RN to which patient: Fifth's disease, chicken pox, RSV, thrush. I chose thrush because I know it doesn't harm preg and all other illnesses are airborne.

3. question what meds for patient history of heart failure, kidney disease, high cholesterol, and potassium of 2.9: Digoxin, lol beta ?, zocor, lasix, and ace check all that apply: I chose digoxin and lasix(potassium level)

4. alot of discharge instruction questions for various surgeries, sinus, etc.

5. signs of autonomic dysreflexia: hypotension, tach, severe headache, ?

6. when would you stop a student nurse after seeing her do what? can't remember what exactly. one was taking a pulse ox with a sao2 machine from the nurses station on a pt with pc pneumonia, leaving old ties until new ties were put on during trach care.

7. assigning a lpn: taking a pt with TB to the xray dept., etc.

8. assigning a maternity nurse to which pt on a med-surg floor: rad mastectomy being discharged in next two hours, etc.

9. check all that apply what would you expect to see in the aging process: shortness of breath, dry skin, loss of vision, etc.

10. closed head injury receiving osmotic diuretic, expect to see showing it is working: increased pulse, increased pulse pressure, etc?

11. taking iv chemo at home what is correct: flush remaining iv solution in toilet, put used iv bags in red biohazzard trash bag and put in reg. trash, leave pt alone while receiving meds, or do not let children go into bathroom or near toilet until after 48

hours.

12. performing a mammography what would you question: using powder or perfumes in the last 2 days, do you have an internal pacemaker(answer), etc?

13. tx for RA: apply cold packs(not answer), etc?

14. discharge instr. for pt with scleraderma: ROM exercises, emollient to skin before going outside, dry off thoroughly after bath, keep a cool house.

15. bipolar manic what to do: group therapy, keep in room, one on one therapy to reduce stimulation(answer), etc.

16. how would nurse demonstrate concept of patient self determination act: this is advance dir and living will.

17. what would you question at pt getting a thallium stress test: allergy to iodine was answer

18. Pt with thyroidectomy and feeding: ground beef and cranberry juice, ground chicken and chocolate milk, vegetables and fruit, tuna fish with mayo. I chose tuna in mayo. Thought that the first 2 answers had liquid to hard to swallow without aspiration and tuna was only answer that was mushy and soft but not too thin.

19. ABG's what would you do before taking: suction, check for ulnar pulse, etc.

20. in labor getting pitocin. what demonstrates a complication of pit: contractions 2-3 min apart with 60 sec. duration, accelerations up to 160 with contraction, fetal hr drops to 105 during acme of contration, etc.

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21. what room to put a pt with multidrug resistant TB: private vented outside, isolation with side room for supplies, isolation etc.?

22. what patient diet would you correct: cardiac pt states I include mushrooms and carrots in my diet, etc.?? can't remember rest

23. Normal newborn exam: head and chest size the same, etc.?

24. 4 math problems. two asking ml/hr, one gtts/min, units/ml

25.symptoms of fat emobli: pettechie on skin, etc.

5 Post-Op causes of FEVER:

1. Wind: the pulmonary system is the primary source of fever in the first 48 hours.

2. Wound: there might be an infection at the surgical site.

3. Water: check intravenous access site for signs of phlebitis.

4. Walk: deep venous thrombosis can develop due to pelvic pooling or restricted mobility related to pain and fatigue.

5. Whiz: a urinary tract infection is possible if urinary catheterization was required.

6. Also 6th "W" Wonder drugs - drug fevers.

The recommendations presented below are categorized as follows:

Category IA. Strongly recommended for all hospitals and strongly supported by well-

designed experimental or epidemiologic studies.

Category IB. Strongly recommended for all hospitals and reviewed as effective by experts in the field and a consensus of HICPAC based on strong rationale and suggestive evidence, even though definitive scientific studies have not been done.

Category II. Suggested for implementation in many hospitals. Recommendations may be supported by suggestive clinical or epidemiologic studies, a strong theoretical rationale, or definitive studies applicable to some, but not all, hospitals.

No recommendation; unresolved issue. Practices for which insufficient evidence or consensus regarding efficacy exists.

The recommendations are limited to the topic of isolation precautions. Therefore, they must be supplemented by hospital policies and procedures for other aspects of infection and environmental control, occupational health, administrative and legal issues, and other issues beyond the scope of this guideline.

I. Administrative Controls A. Education Develop a system to ensure that hospital patients, personnel, and visitors are educated about use of precautions and their responsibility for adherence to them. Category IB

B. Adherence to Precautions Periodically evaluate adherence to precautions, and use findings to direct improvements.

7

Category IB

II. Standard Precautions Use Standard Precautions, or the equivalent, for the care of all patients. Category IB

A. Handwashing (1) Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross-contamination of different body sites. Category IB

(2) Use a plain (nonantimicrobial) soap for routine handwashing. Category IB

(3) Use an antimicrobial agent or a waterless antiseptic agent for specific circumstances (e.g., control of outbreaks or hyperendemic infections), as defined by the infection control program. Category IB (See Contact Precautions for additional recommendations on using antimicrobial and antiseptic agents.)

B. Gloves Wear gloves (clean, nonsterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and nonintact skin. Change gloves between tasks and procedures on the

same patient after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching noncontaminated items and environmental surfaces, and before going to another patient, and wash hands immediately to avoid transfer of microorganisms to other patients or environments. Category IB

C. Mask, Eye Protection, Face Shield Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. Category IB

D. Gown Wear a gown (a clean, nonsterile gown is adequate) to protect skin and to prevent soiling of clothing during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Select a gown that is appropriate for the activity and amount of fluid likely to be encountered. Remove a soiled gown as promptly as possible, and wash hands to avoid transfer of microorganisms to other patients or environments. Category IB

E. Patient-Care Equipment Handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. Ensure that reusable equipment is not used for the care of another patient until it has been cleaned

8

and reprocessed appropriately. Ensure that single-use items are discarded properly. Category IB

F. Environmental Control Ensure that the hospital has adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces, and ensure that these procedures are being followed. Category IB

G. Linen Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures and contamination of clothing, and that avoids transfer of microorganisms to other patients and environments. Category IB

H. Occupational Health and Bloodborne Pathogens

(1) Take care to prevent injuries when using needles, scalpels, and other sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles. Never recap used needles, or otherwise manipulate them using both hands, or use any other technique that involves directing the point of a needle toward any part of the body; rather, use either a one-handed "scoop" technique or a mechanical device designed for holding the needle sheath. Do not remove used needles from disposable syringes by hand, and do not bend, break, or otherwise manipulate used needles by hand. Place used disposable syringes and needles, scalpel blades, and other sharp

items in appropriate puncture-resistant containers, which are located as close as practical to the area in which the items were used, and place reusable syringes and needles in a puncture-resistant container for transport to the reprocessing area. Category IB

(2) Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable. Category IB

I. Patient Placement Place a patient who contaminates the environment or who does not (or cannot be expected to) assist in maintaining appropriate hygiene or environmental control in a private room. If a private room is not available, consult with infection control professionals regarding patient placement or other alternatives. Category IB

III. Airborne Precautions In addition to Standard Precautions, use Airborne Precautions, or the equivalent, for patients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei (small-particle residue [5 µm or smaller in size] of evaporated droplets containing microorganisms that remain suspended in the air and that can be dispersed widely by air currents within a room or over a long distance). Category IB

A. Patient Placement Place the patient in a private room that has:

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1) monitored negative air pressure in relation to the surrounding areas,

2) 6 to 12 air changes per hour, and

3) appropriate discharge of air outdoors or monitored high-efficiency filtration of room air before the air is circulated to other areas in the hospital.(23) Keep the room door closed and the patient in the room. When a private room is not available, place the patient in a room with a patient who has active infection with the same microorganism, unless otherwise recommended,(23) but with no other infection. When a private room is not available and cohorting is not desirable, consultation with infection control professionals is advised before patient placement. Category IB

B. Respiratory Protection Wear respiratory protection (N95 respirator) when entering the room of a patient with known or suspected infectious pulmonary tuberculosis.(23,81) Susceptible persons should not enter the room of patients known or suspected to have measles (rubeola) or varicella (chickenpox) if other immune caregivers are available. If susceptible persons must enter the room of a patient known or suspected to have measles (rubeola) or varicella, they should wear respiratory protection (N95 respirator).(81) Persons immune to measles (rubeola) or varicella need not wear respiratory protection. Category IB

C. Patient Transport Limit the movement and transport of the patient from the room to essential purposes only. If transport or movement is necessary, minimize patient dispersal of

droplet nuclei by placing a surgical mask on the patient, if possible. Category IB

D. Additional Precautions for Preventing Transmission of Tuberculosis Consult CDC "Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities"(23) for additional prevention strategies.

IV. Droplet Precautions In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a patient known or suspected to be infected with microorganisms transmitted by droplets (large-particle droplets [larger than 5 µm in size] that can be generated by the patient during coughing, sneezing, talking, or the performance of procedures). Category IB

A. Patient Placement Place the patient in a private room. When a private room is not available, place the patient in a room with a patient(s) who has active infection with the same microorganism but with no other infection (cohorting). When a private room is not available and cohorting is not achievable, maintain spatial separation of at least 3 ft between the infected patient and other patients and visitors. Special air handling and ventilation are not necessary, and the door may remain open. Category IB B. Mask In addition to wearing a mask as outlined under Standard Precautions, wear a mask when working within 3 ft of the patient. (Logistically, some hospitals may want to implement the wearing of a mask to enter the room.) Category IB

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C. Patient Transport Limit the movement and transport of the patient from the room to essential purposes only. If transport or movement is necessary, minimize patient dispersal of droplets by masking the patient, if possible. Category IB

V. Contact Precautions In addition to Standard Precautions, use Contact Precautions, or the equivalent, for specified patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct contact with the patient (hand or skin-to-skin contact that occurs when performing patient-care activities that require touching the patient's dry skin) or indirect contact (touching) with environmental surfaces or patient-care items in the patient's environment. Category IB

A. Patient Placement Place the patient in a private room. When a private room is not available, place the patient in a room with a patient(s) who has active infection with the same microorganism but with no other infection (cohorting). When a private room is not available and cohorting is not achievable, consider the epidemiology of the microorganism and the patient population when determining patient placement. Consultation with infection control professionals is advised before patient placement. Category IB

B. Gloves and Handwashing In addition to wearing gloves as outlined under Standard Precautions, wear gloves (clean, nonsterile gloves are adequate)

when entering the room. During the course of providing care for a patient, change gloves after having contact with infective material that may contain high concentrations of microorganisms (fecal material and wound drainage). Remove gloves before leaving the patient's room and wash hands immediately with an antimicrobial agent or a waterless antiseptic agent.(72,94) After glove removal and handwashing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patient's room to avoid transfer of microorganisms to other patients or environments. Category IB

C. Gown In addition to wearing a gown as outlined under Standard Precautions, wear a gown (a clean, nonsterile gown is adequate) when entering the room if you anticipate that your clothing will have substantial contact with the patient, environmental surfaces, or items in the patient's room, or if the patient is incontinent or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing. Remove the gown before leaving the patient's environment. After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces to avoid transfer of microorganisms to other patients or environments. Category IB

D. Patient Transport Limit the movement and transport of the patient from the room to essential purposes only. If the patient is transported out of the room, ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other patients and contamination of

11

environmental surfaces or equipment. Category IB

E. Patient-Care Equipment When possible, dedicate the use of noncritical patient-care equipment to a single patient (or cohort of patients infected or colonized with the pathogen requiring precautions) to avoid sharing between patients. If use of common equipment or items is unavoidable, then adequately clean and disinfect them before use for another patient. Category IB

F. Additional Precautions for Preventing the Spread of Vancomycin Resistance Consult the HICPAC report on preventing the spread of vancomycin resistance for additional prevention strategies.

DELEGATIONQuestion: A 7 year old boy with a compound fracture is being admitted to a pediatric unit. Which of the following actions is best for the nurse to take?

(1) Ask the nursing assistant to obtain the child's VS while the nurse obtains a history from the parents

(2) Ask the LPN/LVN to assess the peripheral pulses of the child's left leg while the nurse completes the admission forms

(3) Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone orders from the physician

(4) Ask the nursing assistant to obtain equipment for the child's care while the nurse talks with the child and his parents

***You may be thinking, "Why are they asking me this? I have never

had the opportunity to ask the LPN/LVN or nursing assistant to do anything!" Every three years, the National Council of State Boards of Nursing conducts a job analysis study to determine the activities required of a newly licensed registered nurse.

Based on this study, National Council adjusts the content of the test to accurately reflect what is happening in the work place. This ensures that the NCLEX test is what is needed to be a safe and effective nurse.

With recent changes in health care, the role of the nurse has expanded. In addition to providing quality patient care, the nurse is also responsible for coordination and supervision of care provided by other health care workers. Many health care settings are staffed by registered nurses licensed vocational nurses/licensed practical nurses and unlicensed assistive personnel (UAP) such as nursing assistants and support staff. It is the responsibility of the registered nurse to coordinate the efforts of these health care workers to provide affordable quality patient care. Appropriate supervision of the LPN/LVN and/or unlicensed assistive personnel by the registered professional nurse is essential for safe and effective patient care.

To reflect these changes, the NCLEX test plan now contains questions about delegation and assignment of patient care. There are several reasons why you may find these questions difficult to correctly answer on the NCLEX. You might not have any practice answering multiple choice questions about management. Many nursing schools test the content presented in the management

12

course with essay questions rather than multiple-choice questions. You have received lectures regarding management of care, but your clinical rotation in management may have been less than ideal. Your experience may have been restricted to caring for one or two patients without any opportunity to supervise others, or you may have spent time on a hospital unit providing patient care under the supervision of a preceptor. These experiences don't necessarily prepare you to answer the management of care questions you will see on the NCLEX.

Don't despair. Her are some rules of management that will help you choose the right answers when answering management of care questions on the NCLEX.

The Rules of Management

Rule #1: Do not delegate the functions of assessment, evaluation and nursing judgment. During your nursing education, you learned that assessment, evaluation and nursing judgment are the responsibility of the registered professional nurse. You cannot give this responsibility to someone else.

Rule #2: This is not the real world. Do not make decisions regarding management of care issues based on decisions you may have observed during your clinical experience in the hospital or clinic setting. Remember, the NCLEX is ivory tower nursing. The answers to the questions are found in nursing test books or journals. Always ask yourself, "Is this textbook nursing care?"

Rule #3: Delegate activities for stable patients with predictable outcomes. If the patient is unstable, or the outcome of an activity not assured, it should not be delegated.

Rule #4: Delegate activities that involve standard, unchanged procedures. Activities that frequently reoccur in daily patient care can be delegated. Bathing, feeding, dressing and transferring patients are examples. Activities that are complex or complicated should not be delegated.

Rule #5: Remember Priorities! Remember Maslow, the ABC's, and stable versus unstable when determining which patient the RN should attend to fist. Keep in mind that you can see only one patient or perform one activity when aswering questions that require you to establish priorities.

Lets take a closer look at the question above and use these rules to eliminate answer choices .........

Question: A 7 year old boy with a compound fracture of the left femur is being admitted to a pediatric unit. Which of the following actions is best for the nurse to take?

A. Ask the nursing assistant to obtain the child's VS while the nurse obtains a history from the parents

B. Ask the LPN/LVN to assess the peripheral pulses of the child's left leg while the nurse completes the admission forms

C. Ask the LPN/LVN to stay with the child and his parents while the

13

nurse obtains phone orders from the physician

D. Ask the nursing assistant to obtain equipment for the child's care while the nurse talks with the child and his parents

On first glance, all the answers seem possible. Lets look at this question using the steps outlined in this book.

Step 1. Reword the question in your own words. It asks what the nurse should do when a child with a fractured femur is first admitted. That question is a very broad question. To establish exactly what is being asked, you must read the answer choices. In each answer, the RN is delegating tasks to the LPN/LVN or nursing assistant. The real question is, "What is appropriate delegation?"

Step 2. Eliminate answer choices based on the Rules of Management.

(A) Ask the nursing assistant to obtain the child's VS while the nurse obtains a history from the parents. Obtaining vital signs is an important part of assessment. According to Rule #1, the registered nurse cannot delegate assessment. Elimated this answer choice.

(B) Ask the LPN/LVN to assess the peripheral pulses of the child's left leg while the nurse completes the admission forms. Checking the peripheral pulses is an important assessment for this patient because of the diagnosis of a fractured left femur. The nurse needs to assess the patient before delegating activities to someone else. Assessment of the patient is much more

important than completing paperwork. Eliminate it.

(C) Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone orders from the physician. There is no assessment, evaluation or nursing judgment involved in this option so leave it in for consideration.

(D) Ask the nursing assistant to obtain equipment for the child's care while the nurse talks with the child and his parents. The nurse is with the child and his parents while the nursing assistant obtains needed equipment. There is no assessment, evaluation or nursing judgment when gathering equipment, so leave this choice in for consideration.

You’re left with answer choices 3 and 4. You are halfway to the correct answer. Can you apply rule #2 -- this is not the real world -- to eliminate another answer choice? Remember, you shouldn't make decisions on management of care issues based on what you may have seen in the hospital or clinic setting. Answer #3 indicates that the nurse is on the phone and the LPN/LVN is with the patient. Have you seen this done in the real world? Probably. Is this nursing textbooks and journals say should be done in this situation? Probably not. Eliminate it.

Here is another management of care question. 2. Which of the following tasks is appropriate for the nurse to delegate to an experienced nursing assistant?

A. Obtain a 24 hour diet recall from a patient recently admitted with anorexia nervosa

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B. Obtain a clean catch urine specimen from a patient suspected of having a urinary tract infection

C. Observe the amount and characteristics of the returns from a continuous bladder irrigation for a patient after a transuretheral resection

D. Observe a patient newly diagnosed with diabetes mellitus practice injection techniques using an orange

Step 1. Reword the question. "Which task will you assign to a nursing assistant?" The fact that a nursing assistant is "experienced" is a distracter. Do not fall for this trap! Just answer the question.

Step 2. Eliminate answer choices using the Rules of Management.

(A) Obtain a 24 hour diet recall from a patient recently admitted with anorexia nervosa. Some students may consider this answer choice because eating is certainly a recurring daily activity, but this answer isn't about feeding a patient. Eating has special significance for a patient with anorexia nervosa. An important assessment that the nurse must make is the quantity of food consumed by this patient. The nurse cannot delegate assessment. Eliminate this answer choice.

(B) Obtain a clean catch urine specimen from a patient suspected of having a urinary tract infection. Rule #4 states, "Delegate activities that involve standard, unchanging procedures." There is no indication that this patient has a catheter so this is a routine procedure. Keep it in for consideration.

(C)Observe the amount and characteristics of the returns from continuous bladder irrigation for a patient after a transuretheral resection. The color of the fluid needs to be assessed to determine if hemorrhage is occurring. This is an assessment. Eliminate this choice.

(D)Observe a patient newly diagnosed with diabetes mellitus practice injection techniques using an orange. This answer involves patient teaching. According to Rule#1, the nurse cannot delegate evaluation of patient care. Eliminate this choice.

Let's try one more question. 3. Which of the following patients should the nurse on a pediatric unit assign to the LPN/LVN?

A. A 3 year old girl admitted yesterday with larnygotracheogronchitis who has a tracheostomy

B. A 5 year old girl admitted after gastric lavage for tylenol ingestion

C. A 6 year old boy admitted for a fracture of the femur in balanced suspension traction

D. A 10 year old boy admitted for observation after an acute asthmatic attack

Step 1. Reword the question in your own words. The question is asking for the appropriate assignment for a LPN/LVN.

Step 2. Eliminate answer choices using the Rules of Management. Remember, "Delegate activities for stable patients with predictable outcomes."

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(A) A 3 year old girl admitted yesterday with larnygotracheogronchitis who has a tracheostomy. Ask yourself, is this a stable patient with a predictable outcome? A 3 year old with a new tracheostomy is not stable or predictable. Elimate this answer choice.

(B) A 5 year old girl admitted after gastric lavage for tylenol ingestion. This child may be unstable and the outcome is of a poisoning is unpredictable. Elimate this answer choice.

(C) A 6 year old boy admitted for a fracture of the femur in balanced suspension traction. This child has a problem that has a predictable outcome. No information is provided in the choice to lead you to believe that this child is unstable at this time. Keep this answer in for consideration.

(D) A 10 year old boy admitted for observation after an acute asthmatic attack. Because of the narrow airway of a child, this child may be unstable and the outcome unpredictable. Elimate this answer choice.

Establishing Priority -------------------------------------------------------- Is this getting easier for you? Lets try a couple of more questions with a slightly different focus: priority. Many students are uncomfortable with these types of questions because more than one answer looks right.

4. A home care nurse is planning her visits for the day. Which of the following patients should the nurse visit first?

A. A 62 year old man two days after an inguinal hernia repair

B. A 40 year old woman with type 1 diabetes mellitus (1DDM) with a foot ulcer

C. A 76 year old man with chronic obstructive pulmonary disease (COPD)

D. A 50 year old woman three days after a right mastectomy

Step 1. Reword the question in your own words. The question is a priority question: Which patient takes highest priority? As with all priority questions, more than one answer will seem correct.

Step 2. Eliminate the answers using the Rules of Management.

(A) A 62 year old man two days after an inguinal hernia repair. There is nothing stated that leads you to believe that this patient is unstable. Usually, recovery from hernia repairs are uneventful. Elimate this answer.

(B) A 40 year old woman with type 1 diabetes mellitus (1DDM) with a foot ulcer. Impaired circulation is a complication of the diabetic and this client's situation is potentially unstable. Leave this in for consideration.

(C) A 76 year old man with chronic obstructive pulmonary disease (COPD). While this client has a chronic condition that requires close monitoring by the nurse, there is no indication of an acute situation. Eliminate this answer.

(D) A 50 year old woman three days after a right mastectomy. This is a relatively

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new postop client that has the potential for major complications. The patients should be assessed by the nurse. Leave this in for consideration

You are now choosing from answers 2 and 4. Which client do you consider the least stable? Remember the only way to answer priority questions correctly is to eliminate answer choices. It is too difficult to just pick the right answer from the four answer choices.

Let's look at one more question. 5. After receiving report from the night nurse, which of the following patients should the nurse see first?

A. A 31 year old woman refusing Carfate before breakfast

B. A 40 year old man with left sided weakness asking for assistance to the bedside commode

C. A 52 year old woman complaining of chills who is scheduled for a cholecystectomy

D. A 65 year old man with a nasogastric tube who had a bowel resection yesterday

Step 1. Reword the question in your own words. This question asks, "Who is the highest priority for the nurse?"

Step 2. Eliminate answers using the Rules of Management.

(A) A 31 year old woman refusing Carfate before breakfast. You're not told what's wrong with this patient or why she's receiving Caragate, but this patient is

probably not the priority. Let's look at the other choices.

(B) A 40 year old man with left sided weakness asking for assistance to the bedside commode. This can certainly be a messy situation if not attended to in a timely manner, but assisting a patient to the bedside commode does not require a registered nurse. Elimate this answer.

(C) A 52 year old woman complaining of chills who is scheduled for a cholecystectomy. This is an unstable situation since chills are indicative of an infectious process and the patient is scheduled for surgery. Leave this answer in for consideration.

(D) A 65 year old man with a nasogastric turbe who had a bowel resection yesterday. A patient who is one day into postop certainly has the potential for complications even though none are indicated. Leave this in for consideration.

You can now choose between 3 and 4. Which patient is the highest priority?

Although you may still feel slightly uncomfortable when answering management questions, continue to practice answering questions using the Rules of Management. You will choose more correct answers!

Here are other techniques in choosing the right answer as well:

1) Remember to use your Airway, Breathing and Circulation Rules.

2) Assess first.

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3) Take care of the pt, not the machine.

4) Stay with the pt.

5) Don't pass the buck [calling the doctor is not the answer].

6) Pain is not always the first choice in taking care of a problem.

1. pt has graves disease what would you expect to seeall but one were hypothyrodism choices. ans: protruding eye balls

2. pt had hypothroidism what would nurse expect to see; three choices not related to conditon. ans: intolerance to cold.

3. Na level 140, potassium 2.9 what medications if ordered would cause the nurse to have most concern, check all that apply: choices: zocor, digoxin, lasix, zestril, hydroclorothyiazide, and i think reglan. ans: digoxin, lasix, hydroclorothiazide

4. what would be most concerning to the nurse if this pattern for a 9 month pregnant pt was experiencing. choice:two were about acceleration of fetal heart rate, I discounted these because i don't remember ever hearing this, the other two were about: deceleration that return to normal or deceleration by 20 beats during contraction, i chose deceleration by 20 beats.

5. this one was very difficult for me and happens to be the last question i received. The patient is 2 months old and has GERD, what would concern the nurse most if you saw the mom doing. choices: adding cereal to formula, feeding baby 2ounces of formula every two hours, or if the mom positioned the baby in a side lying position, the fourth choice was

something psychosocial so i threw it out. ans: side lying position, because i assumed this meant the child would be lying flat but after reviewing post nclex, i beleive it might be adding cereal to the formula.

6. .Reglan-how does it work.ans:increase emptying time of stomach.

7. dumping syndrome-what should pt do to avoid.choice: limit fluid in between meals, decreased carb consumption, to avoid lying down after meal, can't remember fourth choice; ans: decrease carb intake

8. pediatric nurse floated to med surg who would you assign her to. choice: pt being discharged who had a TURP leaving with a foley, pt with fx internal fixation, post surgical pediatric pt, cant remember #4, ans: pt with fx. the rule is you treat the float nurse like an lvn, in that you assign her stable pt with expected outcome that does not require teaching or frequent assesments.

9. pt on vent, nurse just suctioned pt yet vent started alarming saying "high alarm" what should nurse do. choice: call respiratory therapist, adjust settings on vent, stay with pt and have another nurse call dr., or disconnect pt from vent and ambubag the pt. ans: disconnect and ambupt. this indicated to me that the vent was malfunctioning, so i needed to do something for the pt in light of when a high pressure alarm setting goes off erroneously it could seriously compromise the pt's lung because the vent is working harder to deliver the ordered tidal volume of air and could therefore cause a pnemothorax, so best answerin my opinion is disconnect from a

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malfunction machine. to stay with the pt and do nothing is negligent this is one reason each pt has an ambu bag at the bedside.

10.who would the nurse see first.pt with endstage renal disease, receiving epogen and hemoglobin 10pt with hepatic cirrhosis receiving lactulose with a high amnonia levelpt with chronic cardica disease with low magnesium levelpt with type 2 diabetes receiving glucotrol who blood sugar is 226. i chose this one because the other ones were all chronic condition which nothing could be done for them to improve there condition, this one indicated to me that the pt has converted to a type i diabetic and is no longer able to be managed by the diet and oral hypoglycemic agents. i'm not that confident in this choice i must admit.

11.a ten month old toddler in a cast what kind of toy would you give him to play with. choice: cups of varying size, a tiny toy such as plastic alligator, a big large stackable blocks, or another stackage toy. ans; big large stackable blocks.one on alzehemiers can't remember choices, something about their walking pattern

12.one on lyme disease sorry can't remember choice or even the direction the question went in.

13.one on guillian barre syndrome, sorry same as above

14. infective endocarditis- what system would you expect to be most at risk for further damage, the obvious heart was not a choise, i just rememeber choicing, kidney failure, when i got home and

checked my textbook it mentioned chronic kidney failure is a consequence of this condition. i hope i'm right but still not 100%.

15.baby 8 months old what would you expect them to be able to do. ans. hold a bottle

16. this one was told to me by my friend who took the test in anaheim california in october and i ended up having the exact same question. pt has a second degree partial thickness burn, what would concern the nurse most. ans. specific gravity 1.035, this high sp. gr. indicates dehydration or fluid volume loss.

17. train derailment who would you see first. choices i only remembered three: child with a broken leg, girl with vaginal bleeding, or child with a deviated trach. ans: child w.deviated trach, this is a medical emergency, this indicates pnemo or hemothorax

18.who would you put a pt in a sickle cell crisis with. choice: negative pressure room, with pt on contact isolation, with an AIDS pt, cant remember #4. ans: with an AIDS pt, they both are immunosuppressed and are very susceptible to infections

19.pt on pca pump, resp 8, b/p 90/60 what should nurse do first. give narcan, give o2, call md. ans: give narcan, this is the antidote to morphine.21 pt dx w/M.I. has lots of crushing pain what should nurse do first, give morphine, give o2. ans: give morphine. this choice deals with the pain and morphine decreases the workload of heart by decreasing preload therefore decreases the o2 consumption of heart,

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which is what one wants with this codition,

Triage depends lot on the specifics of the situation but when you have a mass casualty or multiple casualty situation ie: Your resources are overwhelmed by the number of patients at one time then there are some rules to follow. ABC is the biggest thing but do not be distracted by the patient who is not likely to survive and do not resusitate anyone and if you ever see anyone given as having fixed and dilated pupils then the question will want you to categorise them as dead and rule them out same for anyone who is not breathing or has no pulse. Any patient with breathing or airway difficulties goes to the top of the list with airway ahead of course followed by circulation injuries- such as wounds, gunshots and fractures etc. Head injury patients can often come into the airway category so dont always over look them but it depends on what information is given about them because they could well be the dead one or near dead one so be careful.

Basically though stick rigidly to the ABC priority system and rule out the patient who is too far gone to save as most triage questions has one of those and it should be fairly easy, always ask yourself- could this patent have airway difficulty if it doesnt say then ask yourself if the injury could cause airway problems, the burns question someone posted is a perfect example!! If there is noone with a potential airway problem or the one that has is dead then look at the patient with breathing problems and so on. The hardest bit of a triage question is choosing the one that you ignore. Its not natural for us to leave dead as dead these days. When I was in the Army we had triage within triage but I wont

complicate things with that and that often involved 10 or more seiously injured patients, you will not have more than 4 on the NCLEX!!!! Do not confuse these questions with priority questions because triage questions will always involve more than one priority patient or critical patient at a time and it will always involve trauma or injured patients. Hope I havent confused you anymore!!!

Actually.... he never did! -But some other girl sent me some information regarding the external/internal disaster stuff. I took my NCLEX on July 12th, (didn't pass), but had TONS of these internal/external "?"'s. You'd think the ABC's would correlate with each question but they don't. And there is a difference between who you'd access first  in the in/external situations.I'll be more than happy to send that to you if you'd like. Have you taken the NCLEX already?? if so, what study materials did you go by?-So much pressure, ....you go thru years of nursing school, to come down to a 75-265 question test. So much material it's hard to tell what to focus on.-- Good luck, and let me know if you'd like for me to send what information that i have.

Preparing for the NCLEX Exam:· The test is on computer. You will have to answer anywhere from 75-265 questions.· The goal is to focus on the first 20-30 questions. The computer maps out your competency level from there.· Process of elimination-Their suggestions. 1. If there are words like always or all, they are more likely to be incorrect. 2. Choices with commonly or possibly tend to be wrong. 3. Information in the question tends to repeat itself in the answer.

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· You must answer every question in order to move on.

Delegation rules in the U.S.:

A registered nurse may not delegate:* Initial nursing assessment or advanced nursing assessment.* Nursing diagnosis determination* Development of nursing care plans* Evaluation of the patient regarding the nursing care plan*Establishment of nursing care goals*Patient care activities that require professional nursing knowledge, judgement and skills.

A registered nurse MAY delegate:* Feeding a client* Taking vital signs* Hygeine Care

The 5 delegation rights:1. Right task2. Right Circumstance3. Right Person4. Right Direction and Communication.5. Right Supervision

Prioritization:

Typical prioritization question look like the following:1. What is the most important?2. What is the initial action of the nurse?3. What is the best nursing action?4. Which client would the nuse care for first?

Here are some tools that will help answer these types of questions:

1. MASLOW’S HIERARCHY OF NEEDS:* Physiological Needs (survival)

* Safety Needs (Physical and psychologicval)* Psychologicla Needs (Care and Belonging)* Self Actualization

Next is their Nursing Process APIEAssessmentPlanImplementEvaluate

Next back to the old ABC’s:Airway BreathingCircuation

When dealing with fire use RACE:REMOVE the clientSound the ALARMCALL the fire departmentEXTINGUISH the fire.

ADULT PHYSIOLOGICAL INTEGRITY

Comprizes 46-54% of the test. They lay it out according to system.Remember 1. Maintaining the cts airway is always #1. 2. There is always something you could do before calling the doctor.

THE NERVOUS SYSTEM.

The nervous system is comprised of the CNS, PNS &ANS.CENTRAL NERVOUS SYSTEM – Brain and spinal cord.PERIPHERAL NERVOUS SYSTEM – Cranial and spinal nerves.AUTONOMIC NERVOUS SYSTEM – Controls “automatic” function of the body like breathin and our heartbeat. It also maintains a stable internal environment.

The A.N.S. branches in the SYMPATHEIC and the PARASYMPATHETIC Nervous

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SystemsSYMPATHETIC PARASYMPATHETIC“Fight or Flight” Maintains normal body functioningIncreases respiratory rate Normalizes heart rate and blood pressureDecreases Peristalsis Increases peristalsisSecretes Epinephrine and Nor epinephrine Secretes AcetylcholineDilates pulmonary bronchi Constricts pulmonary bronchioles

NEUROTRANSMITTERS (acetylcholine, serotonin, epinephrine, norepinephrine and dopamine) transfer information from one neuron to another across a synapse.

AFFERENT IMPULSE (To CNS).EFFERENT IMPULSES (from CNS).

The BRAIN

Frontal Lobe · Personality, behaviour· MOTOR Function· BROCA’S AREA (Aids formation of words)· Concentration, abstract thought, memoryTemporal Lobe · Hearing, taste , smell· WERNICKE’S AREA (Interpretation of language)· Interpretive Area- Junction of temporal, parietal, and occipital lobes (Integration of somatic, auditory, and visual associations occur here).Parietal Lobe · Sensation – Determination of size, shape, weight, and texture of sensory input.· Orientation of space and space perception (propriception)Occipital Lobe * Vision (reception and interception).

BRAIN STEM· Nerve pathways connecting the brain and the spinal cord· Cardiac, vasomotor and respiratory centres

DIENCEPHALON= THALAMUS AND HYPOTHALAMUS, located between the brain stem and the cerebrum.THALAMUS = Interpretation of SENSATION (Pain, temperature and touch).HYPOTHALAMUS = Temperature control, water metabolism, control of hormonal secretion, heart rate, peristalsis, appetite control, thirst centre, sleep-wake cycle.

THE 12 CRANIAL NERVES

I Olfactory SmellII Optic VisionIII Oculomotor Eye movementIV Trochlear Eye MovementV Trigeminal Chewing, Facial sensationVI Abducens Eye movementVII Facial Taste, facial movementVIII Vestibulocochlear Hearing, BALANCEIX Glossopharyngeal Taste (Posterior Tongue), SwallowingX Vagus Pharynx,Respiratory, cardiac and circulatory reflexesXI Spinal Accessory Shoulders, head movementXII Hypoglossal Tongue movement

The American Exam will require any more knowledge than the above about the cranial nerves. A good one would be III, IV and VI all control eye movement.

NEUROLOGICAL ASSESSMENT

What is the first thing a nurse should assess to determine the presence of neurological changes? (LOC)

THE GLASGOW COMA SCALEEYE OPENING + BEST MOTOR RESPONSE+ BEST VERBAL RESPONSE

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= SCORE3 is worst score, 15 is best.

DECORTICATE = Arms turned in and up, toward CORTEX.DECEREBRATE = Extension, limbs away from body.

CEREBRAL DYSFUNCTION

1. GNOSIA – Inability to recognize common objects2. APRAXIA – Inability to perform a skilled motor task, assuming the ct is not paralyzed.3. APHASIA - The inability to communicate. (EXPRESSIVE – speak, RECEPTIVE – Understand speech).

1 to 2 years of age, gross motor ability:Runs, walks up and down stairs, likes push-pull toys

2 to 3 years of age, gross motor ability:Jumps, kick ball, throws ball overhand. Toys and activities, Big Wheel tricycle, Soft ball and bat, Water and sand, Bean bag toss.

3 to 6 years (preschooler) gross motor ability:Runs with ease, holds a bat, throws balls of various type, climbs well, rides a tricycle (at age 3) then a bicycle with training wheels, and by end of preschool years rides a bicycle.

low pressure alarm --> check connection

high pressure alarm --> check airway obstruction. pt. needs to be suctioned

Hi, Nico – the first question is not quite understood. In what medical condition are you going to administer the b-blockers and steroids?

I found the similar question in the Internet -A client with acute asthma showing inspiratory and expiratory wheezes and a decrease forced expiratory volume should be treated with which of the following classes of medications right away? a. Beta blockers b. Bronchodilators c. Inhaled steroids d. Oral steroids

Bronchodilators – first – provide dilation of the spasmodic bronchioles Inhaled steroids – second – deliver medication for further treatment of the disease; after them have the pt rinse the mouth. Beta blockers - contraindicated in all asthmatics

Low pressure alarm on a ventilator means tube disconnection or leak in the tube. Common Causes of Low-Pressure Alarms:Patient disconnection, Circuit leaks, Airway leaks, Chest tube leaksYour actions as a nurse – first detect the leak or disconnection and fix it.

Common Causes of High-Pressure Alarms:

Patient coughing, Secretions or mucus in the airway, Patient biting tube, Airway problems, Reduced lung compliance (eg. pneumothorax), Increased airway resistance, Patient fighting the ventilator, Accumulation of water in the circuit, Kinking in the circuit, Problems with inspiratory or expiratory valves Your actions – detect the problem, fix all the kinks, remove water OR disconnect the ventilator and ambubag the patient.

A nurse is scheduling multiple diagnostic procedures for a client with activity intolerance. The procedures ordered

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include: Echocardiogram, Chest X-ray, and CAT scan. The nurse schedules these tests in the following sequence:A. X-ray in the morning, Echo in the afternoon, CAT scan the next morningB. X-ray and Echo together in the morning, CAT scan in the afternoon the same day. C. Echo in the morning, CAT scan and chest X-ray in the afternoon the same day. D. CAT scan in the morning, Chest X-ray and Echo the next morning.

WHAT IS THE BEST POSITION FOR A MOTHER IN ACTIVE LABOR ?Looking at the eyes of native Indians when communicating would mean what?How do you do health teaching to 65 years old group pf patientsBest toy for toddler with pneumonitisISOLATION PRECAUTION FOR TB, scarlet fever.60,000 platelet = interpretationwhat meds should be questioned for PUDAMINOGLYCOSIDES - toxicity and s/enueroleptic drugs s/edrug computation - d/sxq ( formula)IV- how many ml/hrprioritization - a lot ! AAA, pneumonia, HPT, LOC10memorize u Cranial nerves, and assessment of CN in elderly.

Definitely know the herbs medications.And also disaster delegation very important. and infection controllike what is more important in meningitis patients for infection control:wear a gown when u change the bedor keep the door closed at all times Other question was what information can u give over the phone. and questions about teaching other nurses about several subjects, like geriatric care.She said to know the therapeutic levels of Coumadin, digoxin, potassium. Also know

about lasix and blood transfusions. She also had some chemo. drugs on her exam.

the herb medication St. John Wort – depression treatmentGuys here are some of my encountered questions:herb questions:1. Gingko= tx for hypertension, rel to BP2. Echinnacea= remember E for immune system hepa A same as hepa E for mode of transmissionvariable decelaration= change position of the motherlow pressure alarm= check for kink patient is biting the tuberestraints=ask the dr first in restraining and unrestraining the pt. even the pt say he is fine already

GLUCOPHAGE= GI disturbance diarrheaLASIX= good outcome decrease in wtraduim implants= reframe self from pt DO NOT go with pt in the bathroomHerb Kava-kava for stress and anxiety relief.a client with hepatic encephalopathy. what diet will be restricted?1. fats2. carbohydrates3. protein4. folic acid

1. A patient on blood transfusion develop hemolytic reaction after you stop blood transfusion, what is the next action you should do?a. continue the IV salineb. send the blood unit to the labc. call the doctor asap

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d. assess the patient's vital signs

Answer is D= assessment of vital signs then call the doctor with data. Since it's pressumed that the transfusion had been stopped already. I thought A and B in this situation will not give a critical solution to the problem.

2. The nurse is caring for a patient in the coronary care unit. The display on the cardiac monitor indicates the ventricular fibrillation. What should the nurse do first?a. perform defibrillationb. administer Epinephrine as orderedc. assess for presence of pulsed. institute CPR

It's a toss between c or d. VF is a form of heart attack. To confirm VF you need to check for a pulse or HR, absence of that confirms VF. To institute CPR, you also check for pulse but breathing comes first. So, I'd say, C, final answer:)

3. The nurse in a well- child clinic examines many children on a daily basis. Which of the following toddlers requires further follow-up?a. 13 mo. old unable to walkb. 20 month old using only 2 or 3 sentencesc. 24 month old who cries during examinationd. 30 month old only drinking from a sippy cup c is out, practically every kid cries during exam. D is correct.client with morphine sulfate in a pca has a respiration of 8 beats/minutes. what will the nurse to do first?a. give the narcan prn order in the chart

b. give oxygen 2L/min prn order in the chartc. call the physiciand. assess the breath soundsA is correct

Which evaluation would best determine if fluid is amniotic versus urine?1 digital evaluation2 ph determination of fluid3 urinalysis by lab4 glucose determination 2 is correct

Know your lab values...Sodium, Potassium, WBC, platelet count, hemoglobin, hematocrit. Know infant and child's vital signs (HR, RR, BP).

DM,pregnant 36AOG scheduled for CS. Which one should be reported immediately? a.wbc13,500 b.bld glucose 220 - correctc.L/S 1:2 d.HCT 38%

The nurse is responsible for decisions regarding client room assignments. Which one of the following possible roommates would be MOST appropriate for a three year-old child with minimal change nephrotic syndrome? A) Two year-old with respiratory infection B) Three year-old fracture whose sibling has chickenpox C) Four year-old with bilateral inguinal hernia repair - correctD) Six year-old with a sickle cell anemia

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crisis

1. mechanical ventilation, high alarm goes off. A. listen for cuff leak B. assess RR?2. Experiencing alcohol withdrawal, 12 hrs later do what

A. give high carbs B. fluid & electrolyte replacement C. sedate D. put in dim lit room?

3. After external radiation discharge teaching, what pt. comment is correct- A. cover skin w/clean gauze b. wash skin w/antimicrobial soap c. apply ice to skin d. expose air to skin once? 4. Tumor on cerebellum, expect to see- a. expressive aphasia b. receptive aphasia? 5. Which is a hereditary disease a. nonallergic asthma b. MS c. parkinsons6. pt. is on mg sulfate, stop infusion when- a. 3+ proteinuria b. Urine output of 60cc in last hour c. resp. of 24.7. 3 yr. old can say a. 500 words w/25% understandable b. 3 to 4 word phrases?

8. Health screening, what is correct, a. give tylenol to a child w/chickenpox b. give motrin to hemophilia pt? 1.Mechanical vent alarms off first assess rr then proceed to ambu bag patient if something wrong with vent call technician.2.Alcohol withdrawal -- fluid and electrolyte replacement 3.external radiation---cover skin with gauze--if sloughing skin cover with sterile gauze4.tumor in the cerebellum--expressive

aphasia bec cerebellum is where the ability to talk, eat and other motor function is indicated.

6.Magnesium sulfate---respiratory depression so 24 br/min5. Hereditary--Non allergic asthma--other two MS --autoimmune or parkinson usually in older people7.3 yr old can say up to 900 words so 3-4 word phrases

8. Health screening tylenol to chicken pox don’t give motrin to hemophiliac there is aspirin in motrin.pt. w/ PNEUMOCYSTIS CARINII PNEUMONIA, can share a room with: a. diabetic pt. w/ wound ulcer b. an ALL pt. c. HIV pt d. 70 yr.old alzheimer's pt correct

9. which pt.u shld see first a.asthmatic pt.w/ Oxygen sat.80 and wheezes on lung base b.a pt. w/ DVT on anticoagulant therapy complaining of having difficulty taking deep breath -correctc.post appendectomy 2 days ago d.post C/S 3hrs ago,sleeping

10. asthmatic pt.on metered-inhaler,what is ur advise on its proper use. a.take a long expiration - correctb.take a quick breath c.hold his breath for 20secs. d.wait 5mins after for another puff

11. what type of a diet would a patient having a calcium oxalate renal calculi

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be on?a. acid ash diet - correctb. alkaline ash dietc. purine dietd. gluten free diet

12. The nurse instructs the patient taking dexamethasone (Decadron) to take with food or milk because this medication:1. Retards Pepsin production2. Stimulates hydrochloric acid production - correct3. Slows stomach emptying time4. Decreases production of hydrochloric acid

13. Need to check? pt. with glasgow scale of 8 or pt. with blood glucose of 125?8 is the correct answer

1. pt is in metabolic alkalosis what is the body's way of compensating a. increasing resp from 12 to 20b. decrease breathing 20 to 12 The respiratory rate goes down to conserve CO2.What is the primary nursing dx for a pt with bucks traction who you find at the bottom of the bed with the wts. on the floor?a. Safetyb. risk for infectionc. skin integrity

A – correct Bucks Traction the weights should not be on the floor and the patient should not be at the bottom of the bed therefore check safetywho would you see first a pt with a past history of MI who is complaining of epigastric pain or 8 hr post op laminectomy who has 2cc of serious fluid on his

dressing? MI because patient is symptomatic and with past history. The post-op patient is stable with only 2cc serous fluid on the bandage.

2. Proper functioning assessment of chest tube :1.gentle bubbling pressure in all 3 bottle2.constant gentle bubbling pressure in a suction bottle. - correct3.constant bubbling in water sealed bottle.4.vigorous bubbling in suction bottle.

3. High Risk for Osteoporosis 1.Patient 55 y/o female who is smoking cigarette. - correct2.Patient 60 y/o female with thin body frame.3.Patient 35 y/o man working in heavy lifting and has low serum Calcium level.

4. Patient receives 3 times a week hemodialysis, has antihypertensives drug to be given at 9am.when is the best time to give the drug?1.during hemodialysis2.give drug at 7pm3.give hemodialysis at 2pm4.give drug after hemodialysis - correct

5. A 4 year old child is for discharge. What is the suitable car seat to this child? a.rear facing seatb.front facing car seatc.booster seat with car seat belt - correctd.back seat

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6. pt had an automatic pacemaker is for discharge. Health instruction by the nurse should avoida.microve ovenb.electromagnetic field - correctconclusive/indication that pt is dehydrateda.taut skinb.scanty urine - correct

7. a toddler is admitted tot he pediatric unit for surgical repair of a hydronephrosis. what indicated reduction of environmental risks to childs healtha.recovery is shortened and the toddler returns home in 3 daysb.parents compliment nurse on good carec.the child begins to take clear liquids within 6 hrs post surgery- correctd.post op recovery proceeds according to schedule

8. what is the most important goal in the nursing care of a toddler after surgerya.alter the childs behavior to insure complianceb.inform parents about the surgery and the need for a sterile environmentc.modify environmental factos of the unit to enhance safety- correctd.be prepared for the toddler to regress to an earlier developmental stage

9. THE NURSE DOCUMENTS IN THE CHART OF A CLIENT AFTER A CHOLECYSTECTOMY."abdominal dressing changed.small amount of serous drainage noted.wound edges approximated.moderate amount of erythema noted along incision line and drain site.drain is patent and intact.

what is indicated by the nursing notea.more frequentdressing changes is indicatedb.early signs of evisceration are evidencedc.early signs of infection are evidencedd.frequency of dressing changes is appropriate – correct

10.which nursing intervention is most appropriate when administering a soap sudes enema to a three year olda.use a potty chairb.have a nurse administer itc.explain the procedure before doing it– correctd.position the client with the ascending colon at the lowest point

11.which food selection is most appropriate for the client with sickle cell anemia in vaso occlusive crisis?a. raisinsb.bananac.chicken sandwichd gelatin– correct

12.The nurse is working with a client who abuses alcohol. Which of the following facts should the nurse communicate to the client??1. Abstinence is the basis for successful treatment. - correct2. Attendance at Alcoholic Anonymous meetings everyday will cure alcoholism.3. For treatment to be successful, family members must participate.4. An occasional social drink is acceptable behavior for the alcoholic.

13.A client comes to a nurse for first aid in a factory some metal part is gone to his

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eye what would be the nurse's first action?1. irrigate the eye with water 2. patch the eye with sterilize dressing & refer to doctor - correct3. refer to physician4. try to remove the metal part with cloth

14.A nurse is caring for client with cancer. The client tells the nurse that a lawyer will be arriving today to prepare a living will. The client asks the nurse to act as one of the witnesses for the will. The most appropriate action is to:a. Agree to act as a witnessb. Refuse to help a clientc. Inform the client that a nurse caring for a client can't serve as a witness to a living will-correctd. Call the physician

15.when removing the chest tube, what should you tell the client to do?A. inhale and hold breathB. exhale and hold breath – correct

16.A client suspected of PTB have been admitted in the hospital. What particular mask to be used by the health care providers: hepa mask

17.1. Multiple Sclerosis is characterized by which of the following: 1. A progressive neurological disorder characterized by the degeneration of basal ganglia in the cerebrum 2. A progressive demyelinating disease which affects fibers brain and spinal cord - correct3. A progressive and sometimes fatal disease which results in degeneration

of the motor neurons 4. A progressive disease involving neuro-muscular transmission of impulses of voluntary muscle

18.You are assigned to care for a client diagnosed with Bell's Palsy. Which of the following would be an INCORRECT nursing action or intervention?: 1. Offer small frequent feedings of soft foods 2. Apply a facial sling to support facial muscles 3. Teach the patient to close the lid(s) of the affected eye(s) periodically, and to instill artificial tears 4. Vigorously massage muscles of the affected side at least twice daily, to restore circulation and muscle tone correct

19. In caring for a client with ALS (Amyotrophic Lateral Sclerosis), the nursing diagnosis with the HIGHEST priority would be: 1. Impaired Physical Mobility 2. Altered Role Performance 3. Potential for Ineffective Airway Clearance - correct4. Potential for Impaired Verbal Communication

20.A patient has attended a medication class for tricyclic antidepressants. He demonstrates he understands the teaching by stating:

1. "I must exercise and eat foods high in fiber." 2. "I must have my blood drawn at least once a month after discharge." 3. "I must stay out of the sun or wear sun block."

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4. "I cannot eat cheese or drink wine." - correct

21.Patient admitted in psych ward clench his face to the nurse after not giving his request; what action will you do.a) talk to him calmly (b) ask another staff to help you bring to his room ( the patient is harmful and need safety of others)

22.What are the cares for post pneumonectomy?

23.Patient having cold and complains of loss of appetite, which of the following diagnoses is appropriatea)Risk for aspiration (b) altered nutrition less than body requirement (c) fluid volume deficit (d) fatigue R/T anorexia

24. In oncology department which one of the following patient will the nurse see first:

A) Patient with internal radiation sitting on the chair near the bed; B) patient who is to receive a radioactive solution and having a visitor who is 26wks pregnant; C) patient with prostate cancer with radium implant seeds who is ambulating; D) patient after 1 hour of external radiotherapy talking with his son.

25. In an emergency department which of the following patient will the nurse see first?

a)patient complaining of severe pain in the RLQ of the abdomen (b) patient with pneumonia spitting blood

(c) Patient with motor vehicular accident who is nauseous (d) patient with femur fracture complain dyspnea and chest pain

26. The nurse is completing the intake and output record for a client wno had an abdominal surgery 2 days ago. The client has had the following intake and output during the shift.

Intake: 4oz of orange juice1/2 serving of scrambled eggs6 oz of water1/2 cup of fruit-flavored gelatin1 cup of chicken broth400 cc of 0,45% sodium chloride(half-strength saline),iv

Output: 1,000 ml of urine120 ml of drainage from the T-tube

How many milliliters should the nurse document as the client's intake?

The answer is 1060.

First of all, total intake is all the liquids the client receives during the shift (or over given period of time). Liquids by definition are all substances that become liquids in room temperature. So, 4oz of orange juice - 120 cc6oz of water - 180 cc1/2 cup of jello - 120 cc (jello is considered to be a liquid - probably this thing confused you)1 cup of broth - 240 ccHalf normal saline - 400 cc120+180+120+240+400=1060.

COMMON HERBAL MEDS

Chamomile

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Uses: Chamomile is often used in the form of a tea as a sedative.

Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin.

Echinacea

Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection. Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral).

St. John's Wort

Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. Chemically, it is composed of at least 10 different substances that may produce its effects. The ratios of these different substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the National Institutes of Health are in progress. Reactions: The most common side effect has been sun sensitivity which causes burning of the skin. It is recommended that

fair- skinned persons be particularly careful while in the sun. St. John's wort may also leave nerve changes in sunburned areas. This herb should be avoided in combination with other medications that can affect sun sensitivity (such as tetracycline/Achromycin, sulfa- containing medications, piroxicam (Feldend). St. John's wort can also cause headaches, dizziness, sweating, and agitation when used in combination with serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil).

Garlic

Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller notes that there is "...still insufficient evidence to recommend its routine use in clinical practice.") Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad breath is a notorious accompaniment. Studies in rats have shown decreases in male rats' ability to make sperm cells. Garlic may decrease normal blood clotting and should be used with caution in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin /Coumadin.

Feverfew

Uses: Most commonly used for migraine headaches. Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to chamomile, ragweed, or yarrow. Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of feverfew. A condition called "postfeverfew syndrome" features symptoms including headaches, nervousness, stiffness, joint pain,

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tiredness, and nervousness. Feverfew can impair the action of the normal blood clotting element (platelets). It should be avoided in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Ginko Biloba

Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction) and to improve thinking. Reactions: Mild stomach upset and headache have been reported. Ginko seems to have blood thinning properties. Therefore, it is not recommended to be taken with aspirin, nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be avoided in patients with epilepsy taking seizure medicines, such as phenytoin (Dilantin), carbamazepine (Tegretol), and phenobarbital.

Ginseng

Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It also may have some beneficial effect on reducing blood sugar .in patients with diabetes mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical components of substances branded as "Ginseng.") Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and nose bleeding. Ginseng can also cause falsely abnormal blood tests for digoxin level. It is unclear whether ginseng may affect female hormones. Its use in pregnancy is not recommended. Ginseng may affect the action of the normal blood clotting element (platelets). It should be avoided in patients taking aspirin,

nonsteroidal antiinflammatory drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause headaches, tremors, nervousness, and sleeplessness. It should be avoided in persons with manic disorder and psychosis.

Ginger

Uses: Ginger has been used as a treatment for nausea and bowel spasms. Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with medications that prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Saw Palmetto

Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland. (Dr. Miller emphasized that studies verifying this assertion are necessary.) Saw palmetto has also been touted as a diuretic and urinary antiseptic to prevent bladder infections. Reactions: This herb may affect the action of the sex hormone testosterone, thereby reducing sexual drive or performance. Dr. Miller states that "While no drug-herb interactions have been documented to date, it would be prudent to avoid concomitant use with other hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...") This listing represents only a small portion of herbal treatments. Nevertheless, the popularity of herbal therapies is unquestionable. Doctors routinely confront the unknown with their patients who are using herbs. Doctors simply do not have any way of helping you to decide whether these herbs are helpful or harmful for you,

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or whether they are interacting with your current medications. There are no data.

Black Cohosh

Claims, Benefits: A natural way to treat menopausal symptoms.Bottom Line: Little is known about its benefits and its risks. If you try it, tell your physician, since it might interact with other medications you are taking.

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