Saturday, March 24, 2007

NCLEX Passers

I am happy to congratulate Dr. Tetch Fernandez & Dr. Eva Macasinag for passing NCLEX. I am so proud of your hardwork and dedication in your review.

Friday, March 23, 2007

NCLEX-RN Trigger Questions & Answers

Q: What are the priorities for a patient with Wilm's tumor?
A: Protect the child from injury to the encapsulated tumor and prepare the family and child for surgery.

Q: What is the most important indicator of increased ICP?
A: The most important indicator is a change in the patient's level of responsiveness.

Q: Why is hydration a priority in treating sickle-cell disease?
A: Hydration promotes hemodilution & circulation of the red cells through the blood vessels

Q: What are the metabolic effects of PKU?
A: The metabolic effects include: CNS damage, mental retardation & decreased melanin.

Q: Which postpartum women experience afterpains more than others?
A: More afterpains are expereinced by women who are breastfeeding, multiparas and those who experienced over distension of the uterus.

Q: What should a nurse do to extinguish a thermal burn?
A: The nurse should remove the clothing and immerse the affected part(s) in tepid water.

Q: What is the only intravenous fluid compatible with blood products?
A: Normal saline.

Saturday, March 17, 2007

New NCLEX Passers: Another success story

Pls. congratulate Dr. Gay Gonzales and Hazel de la Cruz for recently passing the NCLEX. I was in tears when I heard the news, mainly with great joy & happiness. I am proud of what they have accomplished. How they both stayed relentless and focused inspite of some personal challenges. Hazel and Dr. Gonzales are great examples of how to grace through difficult storms.

The EntraLink family is proud of your success.

Some Quick Questions & Answers

Q: What test, associated with cystic fibrosis, reveals high sodium and chloride levels in a child’s sweat?
A:Sweat Test

Q: Skin burns that form blisters are _______ degree burns.

A: Second

Q: Only infants under ____ can get SIDS.

A: 1 year of age

Q: Before it spreads to the rest of the body, childhood leukemia starts in the __________.

A: Bone marrow

Q: Children showing signs of Kawasaki disease, are treated with high doses of aspirin and IVIG. What is the purpose of these treatments?
A: Aspirin is meant to lower the fever, help the rash, decrease the swelling and pain in the joints and keep blood clots from forming. The immuno-globulin (IVIG) decreases the risk of seriously damaging the arteries in the heart.

Q: How is fifth disease spread?
A: It is spread by fluids in the mouth and throat, like when someone coughs or sneezes.

Saturday, March 10, 2007


Battering, psychological abuse, sexual assault or any act omission by personal caregiver, family or legal guardian that results in harm or threatened harm.


Characteristics of elder abuse victims include diminished self esteem, feelings of isolation and feeling responsibility for the abuse.

Elders who are currently being abused often abused their abusers
TRUE. Violence is a learned behavior.

The only types of elder abuse are associated with neglect, psychological and physical abuse.
FALSE. Financial abuse, such as theft and fraudulent monetary schemes also fall within the elder abuse category.


  • Agitation, anger, depression, fear and withdrawal
  • Weight loss
  • Unexplained cuts, bruises or injuries
  • Recent changes in the pateint's last will & testament
  • Unusual banking activities


  • Referring caregivers to community services before serious abuse occurs
  • Reporting the case to law enforcement agencies
  • Providing the elder with a phone number for a confidential hotline
  • Referring counseling, support and self-help groups to the victim

Friday, March 09, 2007

More NCLEX Questions

1. A client seen in the ER with the primary diagnosis of (+) TB and for
admission. Which room will you think the charge nurse will place this

Answer: Private room with air vent outside of the building. This means a negative pressure is being used where air is drawn towards inside to prevent spread of TB.

2. A 6 y.o. child at the pediatric unit with history of mylomeningocoele as an infant. When will you get concern?

Answer: Drawing balloons with marker pens. Avoid exposure to latex, the patient is prone to developing latex allergy.

3. A client at the ER with cerebral aneurysm continuously monitored by
the nurse suddenly manifests the following, which will you get concerned?

Answer: Headache, a sign of increased intracranial pressure.

4. Client is manifesting a maculo-papular rash on palms and feet. Upon
consultation what is the appropriate question to ask the client?

Answer: Have you been bitten by a tick? This is characteristic symptoms of Rocky Mountain Spotted Fever. Symptoms normally appear 3-12 days after exposure with a tick.

Other symptoms are: Sudden fever (which can last for 2 or 3 weeks), severe headache, tiredness, deep muscle pain, chills, nausea, and a characteristic rash. The rash might begin on the legs or arms, can include the soles of the feet or palms of the hands, and can spread rapidly to the trunk or the rest of the body.

Another possible question to ask the patient is: Have you been to wooded areas or fileds where ticks are commonly found?

Treatment: Antibiotics

5. At the psychiatric unit, a client with bipolar is on lithium meds.
Which manifestation will you get concerned of?

Answer: Diarrhea. A common side effect of lithium toxicity especially when levels go up to more than >1.6.

Also report: fever, prolonged vomiting
Normal: .8-1.6
Avoid: High sodium diet, can reduce effect of drug

6. A client at the ER is on IV drip of lidocaine(xylocaine). Suddenly, the client manifests the following S/S.

a. Paresthesia and confusion
b. Constipation and lethargy

Answer: Paresthesia and confusion, a common side effect or a sign of CNS toxicity. Also monitor for prolonged pr interval.

7. Myasthenia Gravis?

What is myasthenia gravis? A neuromuscular disease characterized by weakness, easily fatigue which is aggravated by increased activity and improves with rest.

Pathophysiology: Decrease acetylcholine or excessive or altered cholinesterase. Thus, resulting to impaired nerve impulses at muscles myoneural junction.

Treatment: Mestinon or neostigmine/prostigmin, to increase concentration of acethylcholine at myoneural junction.

8. What precautions to apply with following?

1. MRSA (Methicillin Resistant Staphylococcus Aureaus),
2. VRE (Vancomycin Resistant Enterococcus)
3. RSV (Respiratory Synctival Virus or Parainfluenza Virus)
4. Pediculosis
5. Lyme disease or parainfluenza
6. E. Coli

Contact Precautions:
• Handwashing
• Gloves

Droplet Precautions:
• Private room, if private room unavailable, place pt in a room with same microorganism but with no other infection (cohorting).
• Keep pt and visitors at least 3 ft apart
• No special air or ventilation, may keep door open

8. TB, Varicella, Measles: Airborne

9. What is pernicious anemia?

Answer: Lack of intrinsic factor found in gastric mucosa needed for Vit B12 absorption.

Mgt: Vit B12 for rest of life, diet, rest

10. Angina - (remember the management, S/S, medications). See notes from Intensive Review

11. Best Excercise for osteoporosis?
Answer: Muscle exercise against resistance as tolerated, range of motion exercises.

12. A client is on blood transfusion when will you intervene?
Answer: Taking ferrous sulfate 3x a day, pt already on therapy.

13. A client with burns, when will the charge nurse intervene to a
student nurse?
Answer: Administering IM injection on the burn site. Burn patients normally are third spacing. Thus, IM injection is not recommended due to decrease circulation. Preferred site is IV.

14. An elderly is on digoxin medications the Home health nurse
noted that client is manifesting in which she will get most concerned.
Answer: Loss of appetite (anorexia), nausea, vomiting, malaise, yellow color vision, arrythmias (slow or fast heart rate) are signs of toxicity.

15. Clubbing of fingers?
Answer: Clubbing is associated with a wide number of diseases. It is most often noted in heart and lung diseases that cause decreased blood oxygen and blue skin

Associated with:
• Congenital heart disease (cyanotic type)
• Tetralogy of Fallot
• Tricuspid atresia
• Transposition of the great vessels
• Total anomalous venous return
• Truncus arteriosus
• Cystic fibrosis
• Bronchiectasis
• Lung abscess
• Crohn's disease
• Celiac disease
• Cirrhosis
• Lung cancer
• Pulmonary fibrosis

16. A pregnant woman seen at the clinic c/o 2+ pitting edema and
numbness. MD ordered MgSO4 IM and the client ask the nurse what is the
purpose of the medication.
a. Answer: Relax smooth muscle.
b. Mgso4 is given to preeclampsia patient as sedative, anticonvulsant, or vasodilator
c. or to preterm labor to help relax smooth muscle of the uterus.

17. A client with hx of glaucoma and MD ordered eye gtts. when
will you intervene?
Answer: Client c/o burning sensation, a common side effect of most glaucoma meds. Patient with glaucoma usually are given meds.

Mgt: XALATAN is the first of a new class of glaucoma drugs called prostaglandins. Your body produces prostaglandins naturally for many things. In the eye, one particular prostaglandin has been shown to help the fluid in the eye flow out by opening alternative drainage canals, thus keeping the eye pressure from becoming elevated. Xalatan works similarly to this natural prostaglandin and is believed to increase the fluid outflow through this secondary drainage system.

18. A COPD client is under Theophylline drip how will you know if
the client is manifesting toxicity?
Answer: Nausea and vomiting, sign of toxicity. Other signs of toxicity, seizure and arrythmias.

19. A client is under lipidimic meds. what blood work up
the doctor will order?
Answer: Increased liver enzymes (check liver function test)

20. What is the best position for a client post thyroidectomy?
Answer: semi fowlers with head neutral

21. Variable decelaration
Answer: Usually noted with cord compression or prolapsed cord.

Friday, March 02, 2007

Cholecystitis (NCLEX TOPIC)

What is it?

The inflammation of the gallbladder wall and nearby abdominal lining. The most common type of cholecystitis involves cholesterol in the bile.

What are its causes?

Usually it occurs because of gallstones. The bile is blocked and it infects the tissue.

Who is at risk?

Women, especially those over 40 and those who use birth control pills.

What are the signs and symptoms?

The patient typically experiences: (i) a colicky pain in the upper right quadrant - which can radiate into the right shoulder and back, (ii) nausea and vomiting, (iii) indigestion after eating fatty foods, (iv) jaundice - if the liver is involved or inflamed, and possibly (v) low grade fever.

How is cholecystitis diagnosed?

Diagnosis could include ERCP, ERCG and ultrasound.

What is part of the treatment process?

A patient's treatment would include a focus on rest, low-fat diet and pain control. The patient may be given Chenodiol or UDCA to dissolve cholesterol stones. A choledocholithotomy may be performed to remove or break up the stones.

Other notes

  • Cholecystitis can occur suddenly or gradually over many years.
  • A typical attack of cholecystitis usually lasts two to three days.