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.

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