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Copyright © 2015 by Regina Callion- ReMar Review LLC Warren, Ohio Email: www.remarreview@gmail.com | www.remarreview.com This book, or parts thereof, may not be reproduced in any form without permission, except in the case of brief quotations embodied in

critical articles or reviews. The scanning, uploading, and distribution of this book via the Internet or any other means without the permission of the publisher is illegal and punishable by law. Please purchase only authorized electronic editions, and do not participate in or encourage

piracy of copyrighted materials. Your support of the author’s rights is appreciated

Remarks from the Author:

“This can’t be it!” “How am I supposed to REMEMBER all of

this?” Many people say these things to themselves as they are

studying for NCLEX. I know I have. There seemed to be a

disconnection from the computer to my brain. I decided that I

was not going to stress myself out trying to study things that

didn’t make sense to me. I was going to put the information

into an easy format and build my knowledge from there. I

decided I was going to take my learning into my own hands and

make the best of the situation I found myself in.

I passed NCLEX with 75 questions on my first try! I hope you are

ready to pass too because I am going to take you on a journey

of education, inspiration, and elevation!

I have made it my business to share with you the things that

have led me to my successful nursing career. Get ready!

You’ve Officially Reached the Starting Line!

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ReMar Online Academy Table of Contents

Best Bet for kids………………………………………………………………………………………….. 3 Normal/High Risk Newborn…………………………………………………………….......... 5 Age Specific Care…………………………………………………………………………………….. 9 Pregnancy……………………………………………………………………………………….………. 15 Diets….……………………………………………………………………………………………..……… 20 Expected Changes in Aging……………………………………………………………………… 21 Basic Care & Comfort…………………………..………………………………………….………. 22 Orthopedics…….…………………………………………………………………………….………….………...26 Medication Administration………………………………………………………………….…… 28 Antibiotics…………………………………………………………………………………………………... 29 Central Lines……………………………………………………………………………………………….. 30 TPN……………………………….…………………………………………………………………………. 31 Pain Management……………………………………………………………………………..……. 32 Substance Abuse…………………………………………………………………………………….. 33 Tonicity of IV fluids…………………………………………………………………………………... 34 Blockers……………………………………………………………………………………………………. 35 Labs………………………………………………………………………………………………..…….… 36 Easy Electrolytes………………………………………………………………………………..………………..39 Diabetes Insipidus vs SIADH……………………………………………………..………………. 40 Positions………………………………………………………………………………………………………. 41 Disaster Management………………………………..………………………………………….…………...42 Herbal Medications…….……………………………………………………………………………. 43 Blood Gas Interpretation……………………………………………………………………………… 46 Chest Tubes & Vents…………………………………………………………………………………… 49 Congestive Heart Failure…………………………………………………………………………… 54 Diagnostic Procedures……………………………………………………………………….………………..56 Lowering Cholesterol….……………………………………………………………………………………. 57 Ear Spotlight….…………………………………………………………………………………………………….58 Diabetes Overview………………………………………………………………………………….. 59 Endocrine Overview…………………………………………………………………………………………. 63 Therapeutic Communication………………………………………………………………..…. 66 Psych Overview………………………………………………………………………………………….. 68 EKG Overview…………………………………………………………………………………………………….. 75 Isolation Precautions……………………..…………………………………………………………………. 79 Accident Prevention, Case management, Legal Eagle……………………………………….….83 Delegation………..………………………………………………………………………….………………….…..85 Prioritization………………………………………………………………………………………………..……...87 Tips to Master NCLEX…………………………………………………………………………………………..90

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Best Bet for Kids

AGE ACTIVITY NCLEX Tips 0-6 mths

6-9 mths

9-12 mths

1-3 yrs

3-6 yrs

7-12 yrs

12-18 yrs

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Best Bet Practice Questions ReMar Review

A 8 yearS old is in the hospital for a broken leg. He requests some activities to keep him busy. Which activities would the nurse bring into the client’s room after breakfast? A. A coloring book and some crayons B. A few board games C. A stuffed doll to comfort the child D. A video on how to prevent complications from a broken leg A teenager is admitted to the hospital with influenza. The teenager refuses to let his friends come to visit. As the nurse you know this is a result of what? A. His inability to explain what is happening to the friends B. His perception of altered body image C. His need to be in the center of attention D. His anger on being left out of school activities A nurse is evaluating the ability of a 9 month old during a routine assessment. At this age the child should be able to accomplish what task? A. The ability to sit up without support B. The ability to hold a spoon and bowl C. The ability to say 4 words D. The ability to stand alone

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Normal and High Risk Newborn ReMar Review

A.) Apgar Scoring is done at ______ and ________ minutes

Sign Score = 0 Score=1 Score=2

Rate

Respirations

Muscle

Appearance

(color)

Reflex (Irritability)

Score at _____________ ____________ is more valuable.

Eyes: _______________________________________________________

Temperature:_________________________________________________

Pulse: _________________ Respirations:_________________________

Abdomen:_____________________________________________________

Skin:__________________________________________________________

______________________ and lethargy can indicate __________________

Which vital sign is the top nursing priority for a normal newborn infant?

1. Temperature 2. Heart rate 3. Respirations 4. Blood pressure

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NORMAL & HIGH RISK NEWBORN ReMar Review

B.) Drug Addicted Newborn- illegal substances taken during pregnancy

signs/symptoms: _________________________________________________

_______________________________________________________________

nursing care: ____________________________________________________

_______________________________________________________________

C.) HIV Mother

NCLEX Question:

A nursing student is giving a mother who has A.I.D.S. an IM injection and accidentally sticks

herself while injecting the mother. What should she do immediately?

1) Ask the charge nurse for the report forms that need to be filled out. 2) Start antibiotic treatment 3) Start antibiotic AZT treatment 4) Finish passing all her am medications before leaving the floor.

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High Risk Newborn ReMar Review

B.) Fetal Alcohol Syndrome

C. Spina bifida

ReMar Tip: Nutrition is a major concern for both of these birth defects

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Infant Heart Defects ReMar Review

B______ B________ P__________ B_________ 1.

2.

3.

4.

1.

2.

3.

All B______ B____________ problems begin with the letter ___________. Emergency Position:

Disease to know

How should a nurse identify a child? NCLEX QUESTION: An infant with Tetralogy of Fallot is discharged with a prescription for digoxin elixir. The nurse should instruct the mother to:

A. Administer the medication using a nipple B. Administer the medication using the calibrated dropper in the bottle C. Administer the medication using a plastic baby spoon D. Administer the medication in a baby bottle with 1. Oz of water

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Age Specific Nursing Care ReMar Review

No matter the age all patients have the same rights for: 1. 2. 3. 4. 5. 6.

� Privacy

Age Group 1-12

The top 2 nursing concerns are:

1. Pediatric patients are ___________times______ more likely to have a medication error. 2.

Before admisitering medication ask client for: If patient too young? Position properly before oral medications and feeding due to risk for aspiration. #1 fear of children________________________________ #1 fear of adults__________________________________

ReMar Tip: When kids this age get sick they tend to regress!

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Age Group: 13-18 Goals:

1. _________________relationships with the _____________ ______.

2. ___________________ with body ___________________________. The need to establish independence from primary care giver Patient Priority concerns Female: Male: NCLEX acne medications

Medication NCLEX Points Isostritonen (Accutane)

Psych Priority: Depression- ___________________is a prevalent cause of death in this age group Age Group: 19-40

1. 2.

Psych Priority: Overcome barriers to learning

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Age Group: 40-60 #1 Concern is to identify ________________early on. The best way to anticipate disease is to look at ______________ ___________. Community health nursing-There are 3 levels of prevention

Primary Prevention DO NOT ADD SCREENING TO THIS

Secondary Prevention-early recognition

Tertiary Prevention

Psych concerns: Caring for _____________& ________________at the same time Age Group 60-up Goals

1. _____________________ physical abilities

2. _____________________ cognitive ____________________

3. ____________________ grieve the loss of __________ or ______________.

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Age Group 60-up NCLEX Nursing concerns

1.

2. 1. Communication:

2. 3. Prevention

3.

1.

2.

3.

4. Braden scale-standardized tool to assess risk

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National Pressure Ulcer Advisory Panel states the following:

Stage I

Intact skin with an area of persistent, non-blanchable

redness, typically over

a bony prominence, that may feel warm or cool to

touch.

Stage 2

Partial-thickness skin loss involving the epidermis and

the dermis. The ulcer

is visible and superficial and may appear as an abrasion,

blister, or shallow crater.

Edema persists, and the ulcer may become infected,

possibly with pain and scant drainage.

Stage III

Full-thickness tissue loss with damage to or necrosis of

subcutaneous tissue.

The ulcer may extend down to, but not through,

underlying fascia. The ulcer appears

as a deep crater with or without undermining of

adjacent tissue and without exposed muscle or bone.

Drainage and infection are common.

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Stage IV

Full-thickness tissue loss with destruction, tissue

necrosis, or damage to

muscle, bone, or supporting structures. There may be

sinus tracts, deep pockets of

infection, tunneling, undermining, eschar (black scab-

like material), or slough (tan, yellow, or green scab-like

material).

Unstageable

Ulcers whose stage cannot be determined because

eschar or slough covers the wound.

Note: The pictures are not ReMar Review’s I got them from this great website. Source:

http://facilitywebsource.com/page/pressure-ulcers.html

◯◯

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PREGNANCY ReMar Review

A.) Human chorionic gonadotropin (HCG) is the hormone responsible for

pregnancy.

B.) Probable Signs- ____________________________________________

C.) Positive Signs- _____________________________________________ D.) Naegele’s Rule-

add _________ days

subtract __________months

add __________ year

Example: LMP was April 14, 2000 Estimated due date: _____________

D.) Doctor’s Visits: up to 28 weeks- ______________

28-36 weeks- ________________

36-42 weeks- ________________

1.) gravidity-_________________________________________________ 2.) parity-___________________________________________________

A woman has 4 children (2 singles and a set of twins) her parity=

E.) Pregnancy and ………

1) Morning sickness-

2) Backache-

3) Leg cramps-

4) Diet-

5) Anemia-

6)Kegel’s exercises-

After 42 weeks induce labor or do a c-section.

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PREGNANCY ReMar Review

E.) Danger Signs- __________________________

__________________________

__________________________

__________________________

F.) Complications of Pregnancy

1.) Preterm Labor-

Medications to stop premature labor

If you Give: Terbutaline Watch for:

If you Give: Magnesium Sulfate Watch for: 2.) Pre-eclampsia-

The 3 defining characteristics are 1_________________________

2_________________________________ 3__________________________ Treatment: Only cure is to _____________ the __________________.

Nursing care for pre-eclampsia

If the baby is not full term these signs indicate

a woman needs to go to the hospital

immediately.

If a pregnant woman is bleeding never assess

vaginally!

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PREGNANCY ReMar Review

G.) Labor-

1) If you want to help labor along give?

2)Stop when?

I.) Stages of Labor

1) First Stage

-Pre-Labor-____________________________________________________

-Early Labor- __________________________________________________

-Active Labor- _________________________________________________

-Transition- ___________________________________________________

2) Second Stage-

-Pushing/Birth- __________________________________________________

3)Third Stage-

-Deliver Placenta-________________________________________________

__________________________________________________ 4) Fourth Stage

-Recovery- _______________________________________________________

_______________________________________________________

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Pregnancy ReMar Review

Fetal Heart Response to Labor

A.)Reassuring

B.)Non-reassuring

If you see any of the bad signs treat with LION

L

I

O

N

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Pregnancy

ReMar Review

A.)Post-partum Assessment

1) Biggest risk for post-partum complications is ________ _______ _________.

B

U

B

B

L

E

H

E

Client Teaching:

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Diets

ReMar Review

Diet Indication Food

Liquid

Soft

Bland

Low Protein

Low Sodium

High Fiber

Low Purine

High Protein Elderly & burn patients Foods are red meat, fish, &

beans. This is the focus

Diabetic

Celiac’s

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Expected Changes During Aging ReMar Review

As we age our bodies undergo certain physiological changes that are a natural part of growing old.

System Changes Tested on NCLEX Cardiac

Respiratory

Integumentary

Reproductive

Musculoskeletal

Genitourinary

Gastrointestinal

Nervous

Sensory Vision Hearing Taste Smell

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Basic Care & Comfort 1

ReMar Review

A. Non- Pharmacological Efforts

Non-Pharmacological means no medicine.

1. 2. 3. 4. 5. 6.

Which method works best in children? Which method works best in teens? Which method works best in adults? B. Nutrition Vitamins- Quick Facts Diets- we covered already!

Calories per gram

Protein Carbohydrate

Fats

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Basic Care & Comfort 2 ReMar Review

Hydration- To know hydration you have to be able to properly assess __________.

Signs:

Cardiac Changes:

In dehydration urine levels may drop below 30ml hour

Labs to watch: USG: normal 1.000 to 1.030 increases Urine color: dark yellow color BUN/ creatine ratio: Normal ratio is 10:1 to 15:1. Ratios greater than 20:1 blood is not getting to

the kidneys so it is either Dehydration or CHF

Common Causes:

ReMar’s Tip: Oral hydration can be just as effective as IV hydration if started early

enough.

NCLEX TIPS:

1. 2. 3.

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Basic Care & Comfort 3 ReMar Review

Bladder & Bowel Elimination A: Urine

How much a day?

Odor?

Specific gravity 1.016-1.022

pH

NCLEX QUESTION: Why are UTI more common in women than men?

Alteration in normal urine pattern matching

1. Anuria A. glucose in the urine 2. Glycosuria B. involuntary urination at

night 3. Hematuria C. no kidney function

4. Pyuria D. blood in the urine 5. Enuresis E. Pus in urine

NEED TO KNOW NCLEX SKILL: Collection of 24 hour urine

1. Start with an __________ __________. Ask patient to void then throw away.

2. All urine must be kept in _____________ _____________.

3. If one urine sample missed then ______________ ________________.

4. Keep urine __________________ _____________________.

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Basic Care & Comfort 3 ReMar Review

B. Bowel

HANDLING NORMAL STOOL

Age How Often They Go

Infants

Children Elderly

Listen for bowel sounds in all four quadrants for __________ ____________

Definition of constipation

Definition of diarrhea

When doing any enemas or digital removal of impaction watch out for:

__________________________________________________________________________

Bowel Tests to know

Guaiac Test

Culture & Sensitivity

NCLEX Skills Question:

The nurse administering an enema to a patient knows that the tip of the tubing should be inserted into the rectum while the patient is in a sitting position, as on the toilet.

A. True

B. False

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Orthopedics ReMar Review

1) Canes- The cane moves with the __________ leg. Then the ___________ leg follows.

1) Casts- Use_____________ to handle during 1st 24 hrs.

Do not ________ _________.

What about scratching underneath cast?

Always remember to do_________ _________.

2) Crutches- Top of crutches should be ________ below armpits.

Do not let the _________ press into __________.

Gaits (Weight bearing on uninjured leg)

2-point- Move left crutch with right foot then right crutch

with left foot.

3-point- Move crutches and weaker leg, then strong leg.

4-point- Move left crutch, then right foot, then move right

crutch and follow with left foot.

(Non weigh bearing) amputations, fractures

Swing through- Move both crutches forward then

bear all weight on crutches and swing legs

forward at the same time.

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ORTHOPEDICS ReMar Review

Stair walking with Crutches

Stairs- Up 1st w/_______ leg, then ________ w/crutches

Down 1st ________leg w/crutches, then _________.

3) Walkers- Never try to use __________ or ______________.

Elbows flexed at ______ to _____degrees. Same measurements

as cane.

Step first with ______ leg then follow with ________

leg.

Do not ______ _ ________________when walking.

Promoting Circulation 1. NEED AN ______________

Thromboembolic Compression (TED)

Sequential Compression device

Clients are NOT ALLOWED TO: 1. Cross their legs 2. Sit for long periods of time 3. Put pillow behind the knees

Again, up with the good and down with the bad!!!

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Medication Administration ReMar Review

Before you give medications check the 6 rights. 1. Patient 2. Drug 3. Dose

4. Route 5. Time 6. Documentation

PO Crushed- Liquid-

Ear Adult- Child-

Enema

Eye

Gastric Tube

IM

Topical

Meds that…… Change color of urine

Change color of stool

Should always be refrigerated

Should never be refrigerated

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Antibiotics ReMar Review

Class Examples How They Help How They Harm

1.Aminoglycosides

2.

3.Tetracyclines

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Central Lines ReMar Review

Very Important to know what kind of line your patient has end in vena cava

Why Do Clients Need It?

#1 Priority is to prevent infection Top 4 ways to prevent infection

1. 2. skin asepsis 3. Assessing hub clean with alcohol 4. 2 Types of Central Lines

Peripherally inserted central

catheter (PICC lines)

Port-a-cath

Both are verified with a chest xray!

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Total Parenteral Nutrition ReMar Review

What are the nutrients going through?

Who needs TPN?

What labs to monitor?

How often does the nurse change the tubing? ______________________________

What electrolyte imbalances can TPN cause?

What is your emergency substitute for TPN?

How do you stop TPN?

32

Pain Management ReMar Review

Pain is _____________________.

Rating Technique

Adults

Babies/Children

Routes for pain medication:

Major NCLEX concern:

Medication Classifications See Quick Facts

NCLEX Pain Traps

Idiopathic Pain:

Patients ask for pain meds before time?

Give before ________________________________________________________________--

ReMar Tip: This is a lot of stuff to learn but you are doing great!

33

Substance Abuse ReMar Review

A. Alcoholism-excessive consumption & dependence

Most alcoholics are in: Nursing communication should be ____________and ____________________

Withdrawal symptoms:

Treatment:

Names to know Wernicke’s syndrome:

Korsafoff’s psychosis:

Medications for Alcoholism-NO CURE ONLY ABSTINANCE

Antibuse (disulfiram):

Librium:

Room Assignment: Severe Withdrawal Signs: Treatment:

B. Narcotics-

Room Assignments: Severe Withdrawal Signs: Treatment:

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Tonicity of IV Fluids ReMar Review

Tonicity means:

This is in relationship to __________________ _______________.

Tonicity IV fluids

Hypotonic

Hypertonic

Isotonic

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Blockers ReMar Review

BETA BLOCKERS CALCIUM CHANNEL BLOCKERS

NAME

Examples are Lopressor (metoprolol), Tenormin (atenolol)

Examples are Norvasc (amlodipine) Procardia (nidedipine)

ACTION

EFFECTS

CONTRAINDICATIONS

A.)What do they treat?

1________________ 2_____________________ 3 ___________________

4___________________

1) What to watch for?

2) Before you give it check?

3) What drink should a person taking a dysrhythmic avoid?

A) Milk B) Pepsi C) Gatorade D) Pineapple Juice

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Easy NCLEX LABS ReMar Review

No need to lecture on labs study just study this page.

Labs Purpose Values

Hgb Transport oxygen to tissue and Co2

back to lungs. RBC’s are made up of

hemoglobin. If this is Low think Iron

deficiency anemia

-male 14-16.5 g/dl

-female 12-15 g/dl

RBC These carry oxygen from the lungs to

the tissues around your body. -male 4.5-6.2 %

-female 4-5.5 %

Hematocrit The hematocrit is the ratio of the

volume of packed rbc's to the total

blood volume. If it’s Low = decrease in

O2 capacity/overhydration

If its High=burns, diarrhea,

polycythemia vera

-male 41-51%

-female 36-46%

WBC This is the body's defense against

infectious organisms and foreign

substances.

Chemotherapy would make this Low!

5,000-10,000 /uL or mm3

K Mineral & electrolyte

Carries and electrical charge important

for functions

3.5-5.1 mEq/L

Na Maintains Fluid levels

Muscle/nerve functions

135-145 mEq/L

Ca Mineral

Bone/teeth development

8.6-10 mEq/L

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Mg Important for nerves, muscles helps

neutralize acid in the stomach

Medication that contains Mg=

Milk of magnesia

1.6-2.6 mEq/L

Cl Electrolyte keeps the fluid balance

in/out of cells in check. We get most

of chloride from the sodium chloride

we eat. It is Digested in the intestines.

95-105 mEq/L

CO2 Waste product of the respiratory

system but also is necessary for our

body to function properly

22-32 mEq/L

BUN

Blood urea nitrogen

Liver/kidney test

The test measures the level of urea in

the blood. Urea is a waste product

that comes from protein. It’s what is

left over. Urea is made in the liver but

then it’s the kidneys job to get rid of it

through the urine.

8-25 mg/dL (microgram/deciliter)

Creatinine Kidney test from muscle that has been

metabolized to waste products

0.6-1.3 mg/dL

High creatinine signals renal

failure

Liver Enzymes 1. aspartate aminotransferase (AST)

(sgot)

LIVER INJURIES

2. alanine aminotransferase (ALT)

(Sgpt)

1. 10 to 40 IU/L.

internation units per liter

2. 5-35 U/L

ELEVATE W/ HEP/JAUNDICE

Glucose Serum glucose is the amount of sugar

in the blood. Most of our sugar comes

from carbs.

70-110 mg/dL

PTT How long it takes blood to clot

Clotting should occur in

30-45 seconds

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Partial Thromboplastin

Time Blood thinner 1.5-2x longer

INR

international

normalised ratio

Clotting time when a patient is on a

blood thinner 1-2

Urine specific

gravity

This is done to test kidney function.

This test looks at all of the particles in

the urine

1.016-1.022

1 to 2 oz first thing in the

am. Like most

cultures/tests

Platelets Smallest of the 3 major types of blood

cells, red-white-platelets

Where are these 3 made in the body?

Bone marrow

Function is to prevent bleeding

150,000-400,000 μL microliter

What common

medication will quickly

disrupt platelet function?

ASPIRIN

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Easy Electrolytes ReMar Review

Electrolyte Hyper Signs Hypo Signs

Potassium

In Acidosis K is HIGH

In Alkalosis K is LOW

Calcium

What glands help absorb calcium?

3 T’s Tetany Twitches Trousseau’s sign

Magnesium

Sodium

Think _______

soDium

sOdium

Lithium

40

DIABETES INSIPIDUS VS SYMPTOM OF INAPPROPRIATE ADH

ReMar Review

Both are a problem with __________________________. Diabetes Insipidus is too little ______________________.

Signs of diabetes insipidus are ___________________________

____________________________________________________

____________________________________________________

Treatment for diabetes insipidus are _____________________.

SIADH is too much ___________________________________.

Signs of SIADH are ___________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Treatment for SIADH is ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

41

Positions ReMar Review

Dorsal Recumbent

Fowlers

Lateral

Lithotomy

Prone

.

Supine

Trendelenburg

Who would need to be on a turning schedule?

42

Disaster Management ReMar Review

Inside Disasters Outside Disasters

Triage:

Emergency Priority Treatment

1.

2.

3.

4.

5.

Discharge Rules Who goes home or get relocated 1. 2. 3.

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Herbal Medications

ReMar Review

Herbal Action Patient Teaching

St. John’s Wort

Garlic

Ginko Biloba

Echinacea

Ginger

Black Cohosh

Kava Kava

Used to treat insomnia/muscle pain

Decreases the effects of Anti-Parkinson’s meds

General Patient Teaching:

44

Herbal Medications Practice Questions ReMar Review

A. Your client is receiving chemotherapy for stage 1 prostate cancer. You ask him to list his home medications, which herbal drug would you be concerned about? 1. Ginger 2. St. John’s Wort 3. Kava Kava 4. Echinacea

B. Your client is newly diagnosed with hemophilia. You are doing your education on herbal medications and their drug interactions, which statement indicates your client needs further instruction? 1. “Instead of salt I can use alternatives such as garlic or ginger to season my food.” 2. “ St. John’s wort may be able to help with my affective seasonal disorder.” 3. “ I have to be careful if I decide to take Kava Kava as it may cause drowsiness.” 4. “ Finsun liver is especially important to rebuild red blood cells.”

C. Your client is on suicide watch for life threatening statements. He refuses to be social however he is compliant with all medications. When going over his medication list which would you questions? 1. St. John’s wort for severe depression and suicidal ideation 2. Kava Kava for insomnia 3. Garlic for hypertension 4. Echinacea for immune health

45

You are doing great!

Yes this is a lot But guess what?

Good things come after hard work!

Take a deep breath

and let’s get back to it!

46

Blood Gas Interpretation Numbers ReMar Review

pH-level of acuitity HCO3

THINK R.O.M.E.!

Respiratory Opposite Metabolic Equal

A.) How would you interpret this blood gas? pH 7.48 PaCO2 33 HCO3 30 PaO2 72

pH 7.48____ HCO3 30_______= _______________

B.) How would you interpret this blood gas? pH 7.50 PaCO2 24 HCO3 16 BE-3

pH 7.50____ HCO3 16_______= ________________

C.) How would you interpret this blood gas? pH 7.32 PaCO2 35 HCO3 18 PaO2 89

pH 7.32____ HCO3 18______= ________________

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Blood Gas Interpretation Words ReMar Review

48

Critically Think:

1) Which blood gas value would you expect to see in a client with acute renal

failure?

2) Which blood gas value would you expect to see in a client who was

hyperventilating?

3) Which blood gas value would you expect to see in a client who had

continuous gastric suctioning?

4) Which blood gas value would you expect to see with depressed respirations

from a drug overdose?

5) Which blood gas value would you expect to see in a client who entered into

a marathon and ran for 40 hours straight?

6) Which blood gas value would you expect to see in a client who currently has

a blood glucose level of 6?

49

CHEST TUBES

ReMar Review

A.)FUNCTION: To remove __________ and/or ___________ from the pleural

space.

Chest tubes re-expand the lungs Hemothorax-blood in pleural space

Pneumothorax-air in pleural space

Remember normal breathing works on ____________ ______________.

Tension pneumothorax- _________ is in between ________ and ________

________; which can be caused by trauma, surgery, falls etc. Outside air creates a

one way valve inside the lung.

Classic signs of a tension pneumothorax:

Trachea

Blood pressure

Heart rate

Lung expansion

Oxygenation

Jugular Veins

Deviated trachea and distended neck veins are late signs due to restricted blood flow.

This is a medical emergency, client needs treatment right away!

50

Treatment of tension pneumothorax:

B.) Chest tube Setup: All chest tube systems have these three chambers

Collection chamber Water Seal Suction Control

Record drainage- Notify M.D.-

_________ comes in while

________ comes out

Bubbling Continuous Intermittent

Amount of suction applied

Bubbling Continuous Intermittent

51

Chest Tubes ReMar Review

C.) Care of a client with a chest tube

1) _______________client for _____________ ______________,

______________ _______________, and _______________ _______________

________________.

2) Chest tubes should be placed ______________ chest level.

3) ___________ _________milk/strip chest tube without M.D. order.

4) ___________ _________ are needed to check fluid removal.

5) Clients will have ___________ __________ at insertion site.

6) Never ___________ a chest tube without a M.D. order.

D.) Common NCLEX TROUBLE SHOOTING……

a. Noticed the water seal is broken…

b. Pulled the chest tube out…..

c. Received an order to have client cough and deep breath to prevent…..

52

Chest Tubes ReMar Review

Critically Think Future Nurses??? What kind of lung sounds would you expect to hear with a patient who needs a chest tube?

When caring for a client with a chest tube what should the nurse do to evaluate

the effectiveness of the chest tube?

Empty chest tube drainage every shift Mark chest tube drainage every shift Clamp the chest tube when transferring the patient Add water to the water seal chamber when she notices it is low

What should be done once the fluid in the water seal chamber no longer

fluctuates with inspiration/expiration?

After a patient has his chest tube removed by the physician which dressing should

the nurse have ready to place over the incision site?

Transparent film dressing Xeroform petroleum dressing Seaweed healing dressing Sterile cotton dressing

53

Vent Alarms ReMar Review

These are the only two you need to know

ReMar Tip about Ventilator Alarms! High alarm sound= If you don’t know what to do then: Low alarm sound=

Youtube Help

H High Alarm

O Obstruction L Low Alarm

D Disconnection

Minor NCLEX Definitions

FiO2 Amount of oxygen vent delivers

Assist control Vent doing all the work whether patient is breathing on their own or with the vent only

PEEP Positive end-expiratory

pressure

This allows the lungs to stay open instead of collapsing after every breath Normal to start with 5 cm should never be greater than 20

cm

SIMV Synchronized intermittent

mandatory ventilation

This allows the patient to draw some breaths on his or her own, not every breath is assisted. He or she is able to breathe on their own

between assistance

54

Congestive Heart Failure

ReMar Review

A.) CHF happens when the heart can’t pump enough blood to meet the body’s needs.

Left Side Right Side L think R think

-Most clients have failure_______ ________ _________.

B.) Tests 1. 2. 3.

C.) Medications 1. 2. 3. 4. D.) Nursing Interventions

55

Congestive Heart Failure Practice Questions

1. Mr. Green is scheduled to receive furosemide 60mg IV BID for a diagnosis of congestive heart failure. The medication will have which of the following effects? Select all that apply.

Decrease blood pressure Increase urine output Increase blood pressure Decrease urine output Decrease pain Increase edema

2. A 62 years old client presents with dyspnea and blue colored nails and lips. The client has a suspected

history of congestive heart failure and is admitted to emergency room. The client has not been compliant with his medication regimen and states he has not taken his hydrochlorothiazide for 4 days. The nurse should anticipate a diagnosis of which of the following?

Pneumonia Pulmonary edema Pneumothorax Atelectasis

3. The client is admitted with left-sided congestive heart failure. In assessing the client for edema, the nurse should check the:

Feet Neck Hands Sacrum Irregular pulse

4. You are teaching the parents of a child with congestive heart failure about fluid intake. Which statement indicates understanding of monitoring fluid retention?

I will calculate all of the fluids that my child drinks as this is the best method to monitor fluid retention. I will weigh each diaper daily as this is the best way to monitor fluid retention. I will weigh the child each day at the same time as this is the best way to determine fluid retention. I will listen to the lungs with my stethoscope as this is the best way to monitor fluid retention.

5. A client comes into the wellness clinic after being diagnosed with congestive heart failure. She complains of becoming tired after only very little activity. Which activity suggestion would the nurse give to preserve energy and decrease oxygen demands?

Setting a specific time during the day and accomplishing all daily tasks at one time. Eating small frequent meals throughout the day. Removing oxygen therapy during rest to build up a tolerance without it. Exercise shortly after waking up in the morning when energy levels are highest.

56

Diagnostic Procedures ReMar Review

Lumbar Puncture-__________________________________________________

Position_____________________________________________________

Pt. Teaching__________________________________________________

M.R.I.-____________________________________________________________

Position______________________________________________________

Pt. Teaching___________________________________________________

C.T.-_______________________________________________________________

Position______________________________________________________

Pt. Teaching__________________________________________________

EGD-______________________________________________________________

Position_______________________________________________________

Pt. Teaching___________________________________________________

Liver Biopsy-________________________________________________________

Position_______________________________________________________

Pt. Teaching___________________________________________________

Thoracentesis-_______________________________________________________

Position_______________________________________________________

Teaching______________________________________________________

57

LOWERING CHOLESTEROL ReMar Review

The goal of therapy is to lower __________ _______________ and _________________. Why does cholesterol matter? Values to know: LDL(Bad)= __________ HDL (Good)= ______________ Total Cholesterol= ______________ Triglycerides= _________________ Examples of Dyslipidemias: Zocor (Simvastatin) Crestor (Rosuvastatin) Atorvastatin (Lipitor) Drug name ends in: - Side effects of Statins: What about the B3 vitamin Niacin? Side effects of Niacin: Flushing face **Advicor (Niacin + Statin) side effects of both classes When your client is on a dyslipidemia assess them for? How will the muscle tissue be excreted? How to treat: NCLEX teaching about Statins: Goal of Low Cholesterol diet-

58

Ear Spotlight ReMar Review

Meniere’s Disease: A _______ disease that occurs in the ______ ear resulting in too much endolymphatic fluid.

The cause of Meniere’s is __________. 3 main symptoms:

Pt may also complain of: Best position during a Meniere’s attack: Diagnosis: Diet: Treatment: Medical-

Surgical- NCLEX Prep:

Many factors: Viruses, Bacteria, allergies etc.

59

Diabetes Overview ReMar Review

A.)Diabetes mellitus is a metabolism disorder in which the _________ _________

levels are ___________ _________.

Two Types of Diabetes mellitus

Diabetes Type 1 Diabetes Type 2

1. Age

2. Is body producing

insulin

3. Insulin dependent

4. Ketone production

5. Treatment

- - -

- - -

B.) Signs/Symptoms:

60

Diabetes Overview

ReMar Review

C.)Complications of Diabetes

Hyperglycemia- High Blood Sugar

Diabetes Type 1 Diabetes Type 2

Cause

Diabetic Ketoacidosis (DKA)

Hyperosmolar, Hyperglycemic Non-Ketotic (HHNK)

Signs

D K A

Treatment

61

Diabetes Overview

ReMar Review

D.)Complications cont.

Hypoglycemia- Low Blood Sugar

Diabetes Type 1 Diabetes Type 2

Cause

Signs

Treatment

1.) Hemoglobin A1C is a blood test used to determine blood sugar control

over___________ months. You want it to be less than______________.

62

Diabetes Overview

ReMar Review

E.)Insulin Types and Actions

Types Generic Name Onset Peak Duration

Rapid

Novolog

Short

Novolin R (Regular)

Intermediate

NPH

Long Acting

Lantus

Oral Antidiabetics Agents: Metformin, Byetta, Glucophage, Avandia

Contraindicated Meds

1.

2.

3.

F.) Insulin and……..

1) Diet

2) Exercise

63

Endocrine Review

ReMar Review

Hyperthyroidism Hypothyroidism

Signs:

Signs:

Treatment:

Precautions:

Or

Treatment:

Levothyroid/Synthroid

Watch For:

Watch For:

64

Nursing Care:

After a thyroidectomy is a hoarse voice normal?

Nursing Care:

65

ENDOCRINE REVIEW ReMar Review

B.) Adrenal Disorders

The adrenal glands help us _________ __________.

1)Addison’s Disease- “too little” by ___________ _____________.

Signs of Addison’s: ___________________________________________________________

__________________________________.

Treatment: _________________________________

2)Cushing’s Syndrome “too much” by _________ _______________.

Signs/symptoms: _____________________________________________________

__________________________________________________________________________

Treatment: ___________________________________________________________

(Remember never abruptly stop taking steroids teach client to taper the drug off)

Patient’s with Addison’s disease can not handle

stress well. Ex. If they are told they need surgery

they faint. Remember steroids end in “sone”

example cortisone, prednisone.

66

THERAPEUTIC COMMUNICATION ReMar Review

The purpose of using these strategies is to help your client express their feelings more

effectively.

Do This:

Don’t Do This:

Giving ________________________opinions

Changing _______________ _________________

____________________reassurance

________________________ with the client

On NCLEX Choose……

Never ask _________________________.

Open ended questions

Answers that focus on feelings

Answers that reflect or rephrase what client is saying

67

THERAPEUTIC COMMUNICATION

ReMar Review

Digoxin Parameters

Age Hold

Newborn

1-3 years 3-8 years

8-adult

Drug Antidotes

Magnesium Sulfate Calcium glutonate

Needle Information

Route Skin layers Gauge Length

SQ

Intradermal

IM

68

Psych ReMar Review Lesson A.) Depression/Mania

These clients are oriented to ____________________.

Depression Mania

Signs

Similarities

Treatments

B. Schizophrenia- can’t tell the difference between________ and

_____________. Disease is _______________ and requires _______

__________ treatment

1.) Positive Psychotic symptoms

1) Delusions-

2) Hallucinations-

3) Neologism-

4) Echolalia-

5) Flight of Idea-

Negative psychotic signs: Mute, Catatonic, Homicidal, Suicidal, Withdrawn

69

Psych ReMar Review

Nursing Care:

1) Always keep in mind ________________________________________.

2) ________________ their _____________________________________.

3) __________________ _______________________________________.

4) ___________________ ______________________________________.

5) _________________ _________________ the____________________.

C.) Psych Drugs

1.) Anxiolytics

-Benzodiazepines Valium (diazepam) Dalmone (flurazepam) Xanax (alprazolam), Ativan (lorazepam) 1._______________________________________________________________

2._______________________________________________________________

3._______________________________________________________________

4._______________________________________________________________

5._______________________________________________________________

-Benzodiazepines can also be used as ________________, _______________,

__________________.

Side Effects: Think “ABCDS” A- B- C- D- S- -If client overdoses on benzodiazepines give? __________________________

70

Psych ReMar Review

2.) Phenothiazines-

Examples: Thorazine, Compazine, Stelazine, Promethazine

Route:

Phenothiazines are ______________________ _________________________

Typical psych drugs work best on the “positive psychotic symptoms”

Examples of typical psych drugs: Haloperidol (haldol) Thiothixene (navene) Perphenazine (trilafon),

Chlorpromazine (thorazine)

Typical antipsychotics are also called: First generation or neuroleptics

What does neurolepsis mean?

Side Effects: ABCDS + _______________ _______________

Nursing Assessments: What drug can we give to lessen side effects? Cogentin (benztropine)

We have to tell patients that:

Note: Study Parkinson’s disease and NMS in Quick Facts

Neuroleptic Malignant Syndrome (NMS)-

Signs: ABCDs + Tardive dyskinesia+ _____________ _______________ Nursing Care:

*Compazine and Promethazine in smaller

doses can be used as anti-emetics.

71

Psych ReMar Review

3. Atypical Antipsychotics are also known as

_________________________ _______________________ antipsychotics

Examples: Clozapine (clozaril) Olanzapine (zyprexa) Risperidone (resperda) Quetiapine (seroquel) Aripiprazole

(abilify) KNOW THESE MEDICATIONS!

Most of these drugs end in: “pine”

Atypical antipsychotics have less ___________________ ______________

Monitor your patient for ___________________ _________________

Atypical antipsychotics can cause

1)

2)

3)

ReMar’s NCLEX tip: When your patient is on an atypical antipsychotic medication monitor them for agranulocytosis (low WBC’s). If they have agranulocytosis they will complain of fever, body aches, chills, sore throat etc. Basically signs of the flu

72

Psych ReMar Review

4.) Antidepressants

-M.A.O.I. (Monoamine Oxidase Inhibitors)

These drugs block M.A.O. enzyme that breaks down epinephrine, dopamine,

serotonin which leads to depression. They also block tyramine which puts client at

risk for a hypertensive crisis.

***Not used as often due to various drug and food interactions***

Mar____________

Nar____________

Par____________

Side Effects: _______________________________________________________

_________________________________________________________________

Diet Restrictions: See Tyramine diet chart

Client Teaching: ___________________________________________________

__________________________________________________________________

ReMar Tips: MAOI makes glaucoma worse Chronic or acute.

73

Psych

ReMar Review

Tyramine Restricted Diet

Meats

Grains

Vegetables

Fruits

Dairy

Sweets/Oils

Condiments

74

Psych

ReMar Review

5.) Antidepressants

-S.S.R.I. (Selected Serotonin Reuptake Inhibitors)

These drugs inhibit the reuptake of serotonin.

Side Effects: _________________________________________________________________

__________________________________________________________________

Prozac-

Celexa-

Zoloft-

Effexor-

Contraindications:

Client Teaching:

1)_________________________________________________________________

2) All S.S.R.I. may cause _______________________________________________

Symptoms: S A D Head

75

EKG Overview

ReMar Review

Normal sinus rhythm= __________________________________________

1. What is the rate?

2. What is the rhythm?

3. Is there a P wave before each QRS?

4. Are the P waves upright and similar?

5. What is the length of the PR interval?

6. What is the length of the QRS complexes

Rules: _No treatment needed for this patient, do not give any meds_

Can you circle each p wave on this ECG strip?

Can you circle each QRS complex on this ECG strip?

The NCLEX may give you a question with rhythm

strips that look just like this. You must be able to

identify what they are and/or treatment.

76

Atrial Flutter= ____________________________________

1. What is the rate? Atrial: 250-400 bpm

Ventricular: variable

2. What is the rhythm? Atrial regular

Ventricular irregular

3. Is there a P wave before each QRS? Normal P waves are absent

4. Are the P waves upright and similar? Saw tooth pattern

5. What is the length of the PR interval? Can’t measure

6. What is the length of the QRS

complexes

0.06-0.12

These NCLEX patients have Atrial Flutter:

Valve disorder (mitral) Thickening of the heart muscle

Ischemia

Cardiomyopathy COPD Emphysema

NURSING INTERVENTIONS FOR ATRIAL FLUTTER

______________________________________– treatment of choice for NCLEX!!!

**Slow the ventricular rate by using: diltiazem, verapamil, digitalis, or beta blocker

_______________________________ to reduce incidence of thrombus formation.

The saw tooth pattern looks like shark teeth. So

think I see a shark and my heart flutters!

77

Ventricular Tachycardia= ________________________________________

1. What is the rate? Atrial: Q

Ventricular: 100-200

2. What is the rhythm? Regular

3. Is there a P wave before each QRS? Absent

4. Are the P waves upright and similar? Absent

5. What is the length of the PR interval? Not measurable

6. What is the length of the QRS

complexes

Wide greater than 0.10 sec

Ask first if it is ___________________________ or ______________________________

These patients have ventricular tachycardia:

Cocaine users Chest trauma DIGOXIN takers

Enlarged heart hx Hypokalemia or low serum potassium

Treatment: ___________________________________________________

Never pick ______________ as a treatment for ventricular tachycardia because it

_______________________________________!

78

EKG Overview

ReMar Review

Asystole= ___________________________________________________

Treatment: __________________________________________________

*If the monitor says asystole but the patient is clearly alive then check for

__________________ _____________________________

Premature Ventricular Contraction (PVC) =

Treatment: __________________

A client is having frequent premature ventricular contractions. A nurse would place priority on

assessment of which of the following items?

1. Blood pressure and peripheral perfusion

2. Sensation of palpitations

3. Causative factors such as caffeine

4. Precipitating factors such as infection

These patients have PVCs: INFECTION CAFFEINE NICOTINE ETOH ABUSE

ReMar Review Youtube Channel has free videos on: Sinus, Atrial, & Ventricular Tachycardia

PVC’s can happen in healthy individuals without cause. Be concerned if more than 6 in

one minute or 6 in a row.

79

Isolation Precautions ReMar Review

A.) Universal Precautions Do these things no matter what.

B.) Contact Precautions

Contact Disease:

__________________________________________________________________

C.) Droplet Precautions:

Droplet Disease:

__________________________________________________________________

D.) Airborne Precautions:

Airborne Disease:_______________________________________________

Cohort Tip:

80

ISOLATION PRECAUTIONS ReMar Review

Pick the precaution (standard, contact, droplet, airborne) for each disease.

Disease Precaution

AIDS

Vaginal Yeast Infection

Diarrhea

Mononucleosis or Epstein Barr Virus

West Nile Virus-transmitted by mosquitos

Hepatitis C

MRSA- staph infection

C-difficile

Rota virus

Shigellosis

Head Lice

Epiglottitis

Influenza (seasonal)

Rubella (German Measles)

Whooping Cough (Pertussis)

Meningitis

Varicella (Chicken Pox)

Monkey Pox

Rubeola (Measles)

Remember cohort patients with same precaution

81

Isolation Practice Questions ReMar Review

A nurse manager reports for duty and has to evaluate each nurse’s assignment. A nurse has a client with A.I.D.S. and the nurse manager is evaluating his care by the healthcare team. She should intervene when she sees which situation? A. A housekeeper cleans up spilled blood with a bleach solution. B. A nurse takes the client’s blood pressure wearing a mask and gloves. C. A phlebotomist wears gloves to perform a blood draw. D. A nurse attendant allows visitors to enter his room without masks. A 7 year old client is being admitted to the pediatric unit. What personal protective equipment must be placed outside the room when the nurse sees the client is diagnosed with varicella? A. Gloves, disposable thermometer, gown, private room B. Goggles, mask, gown, private room, gloves C. Gown, private room, goggles, 6 fresh air exchanges per/hour D. Private room, goggles, mask, gloves, face/eye shield What isolation precaution would you use for cutaneous anthrax? A. Standard B. Droplet C. Contact D. Airborne What isolation precaution would you use for rotovirus? A. Standard B. Droplet C. Contact D. Airborne

82

ACCIDENT & ERROR PREVENTION ReMar Review

A. Top NCLEX accidents 1. 2. 3.

Let’s Talk Seizures

B. Error Prevention 1. Restraints-

Prescriptions have 1. 2. 3. 4.

2. Charting-

3. Incident Reports

83

CASE MANAGEMENT ReMar Review

*This makes sense because nurses are on the front lines doing the most assessment,

they are able to tell what the patient needs.

Case management is NOT __________________ __________________

Managed care is techniques used to reduce the cost of health benefits.

I am being nice

Collaboration means working with MD, OT, RT, PT, & Social workers.

Nurses are always the ________________ ___________________________.

NCLEX QUESTION:

1. A 14 years old male is newly diagnosed with cystic fibrosis. The nurse is a team

manager along with a physician, respiratory therapist, and social worker. Which of

the following actions represents the nurse’s role as a patient advocate?

A. Teaching the patient how to take pancreatic enzymes with meals

B. Referring the client to a dietician

C. Advising the client to follow up with a home health services

D. Educating the client on how to apply for disability through an agency

84

LEGAL EAGLE

ReMar Review

A.) Advanced Directives-

Durable Power of Attorney Living Will

***Know client’s status!!!

B) Informed Consent- make sure client is able to understand what is going to

happen during a procedure, exam, test. Advantages/Disadvantages do not give if patient is sedated.

___________________________________________________________________

Need written consent to do

Can do without written consent

Who gets it? ________________________________________________________

How to handle the Impaired (drug/alcohol using) Nurse 1. Get the facts, only report subjective behaviors. Not your opinion

2. Report to the supervision or nurse manager

3. Never confront the co-worker. Stay in your lane!

New NCLEX topic!

CPR on DNR= Assault!

85

Delegation

ReMar Review

A. Delegation- know who can do what.

RN

LPN

No:

Aide

Can LPNs delegate tasks to Aides? Can Aides delegate tasks to other Aides?

86

Delegation Practice Questions ReMar Review

A. Who would be the most appropriate to feed a confused elderly client who can become combative? 1.) RN 2.) LPN/LVN 3.) Nurse’s Aide 4.) Physical Therapist B. Who would be most appropriate to assist a client ambulating down the hall for the first time after a hip replacement? 1.) RN 2.) LPN/LVN 3.) Nurse’s Aide 4.) Speech Therapist C. Your client is terminally ill and only is expected to live a few hours. The doctor orders comfort care only. The client requests a bath, what is the best response by the nurse. 1. “I will give you a bath as soon as I pass my morning medications.” 2. “I will have the senior nursing student bath you this morning.” 3. “I am afraid a bath will not be needed today as you have no visitors.” 4. “ I will have the LPN bath you and then care for you the rest of the day.” D. As part of the nurse’s aide daily tasks she should complete the following tasks. Select all that apply Bath the client ________ Provide assistance with ambulation________ Chart and calculate intake for shift _________ Obtain sputum specimen _________ Assist with feeding _________ E. A nurse is caring for a client with increased intracranial pressure, the client suddenly becomes unresponsive. A code is called and the nurse calls for assistance, who is most appropriate to gather the code cart? 1. Another registered nurse 2. A licensed practical nurse 3. A nurse’s aide 4. The charge nurse of the unit

87

Prioritization

ReMar Review

All the answers will seem right but only one is the PRIORITY

A.) Example: A new nurse working in the emergency room department reports for

duty. Four patients arrive at the same time, who should she see first?

1) A 100 years old female with a temperature of 102 and diarrhea.

2) A 55 years old male with severe abdominal pain from a kidney stone.

3) A 2 years old female with a heat rash complaining of itching.

4) A 89 years old female with a poor gag reflex.

Don’t let NCLEX distract you with: _______________

Only think about what is happening:

Look for the patient who is going to:

Reverse Priority

1.

2.

3.

Go over answers

88

Priority Practice Questions ReMar Review

1. You are a nurse working in the emergency department at your local hospital. Four patients

approach the triage desk at the same time. List the order in which you will assess these patients. a. A 50 years old female with moderate abdominal pain and occasional vomiting

b. A 9 years old irritable female with a nuchal rigidity, petechiae, and a fever

c. A 22 years old jogger with a twisted ankle, having a pedal pulse and no bruising

d. A 19 years old male with a bandaged head wound

_______________, _______________________, __________________, _________

2. A nurse has just finished inserting an indwelling catheter and checked that it was in the

proper position. Which is the priority nursing action?

A. Collect a sterile urine specimen while the tubing is free from bacteria and first urine

is available.

B. Document the procedure in a nursing note.

C. Check the patient’s vital signs to assess whether the procedure was tolerated well.

D. Delegate to the unlicensed personnel staff to record the amount of collected urine

to assess the effectiveness of the indwelling catheter.

3. These patients present to the ED complaining of acute abdominal pain. Prioritize them in order

of severity.

A. 22 years old college student complaining of severe, intermittent cramps with three episodes of

watery diarrhea, 2 hours after eating

B. A 22 years old female with a low-grade fever, left lower quadrant tenderness, nausea and an

inability to eat for the last 3 days. COLON

C. A 12 years old female with moderate left upper quadrant pain, vomiting small amounts of yellow

bile, and worsening symptoms over the past 3 days LIVER PANCREAS STOMACH LFT KIDNEY

D. A 56 years old male with a pulsating abdominal mass and sudden onset of pressure-like pain in

the abdomen and flank within the past hour

______ , ______, _______, _______

89

Priority Practice Questions ReMar Review

4. A client with chronic immune thrombocytopenic purpura has just received an

appendectomy. The patient is currently in recovery and the nurse has checked his

airway and vital signs which are normal. Which action is the next priority?

A. Administer the pain medication as prescribed to keep the pain level within normal range

B. Administer the packed red blood cells to prevent hemorrhaging

C. Check the bandage for excessive drainage

D. Check the IV placement for patency in case of an emergency situation

THE NEXT QUESTION IS BASED OFF OF QUICK FACTS 2.0 YOU ALL SHOULD GET IT RIGHT!

5. A new nurse is preparing to administer blood to a client. The nurse verifies the order

and the client’s blood type. The nurse should use which of the following to administer

the blood.

A. Nonfiltered tubing with an 18 gauge needle.

B. Micron mesh filter set

C. Microdrip blood administration set

D. Clot prevention unfiltered administration set

6. A 3 year old is admitted to the emergency room with a sudden temperature of 102. F,

sore throat, and drooling saliva. The child is leaning forward and will not lie down for an

exam. Which of the following should the nurse do next?

A. Give 500 mg of acetaminophen (Tylenol) rectally.

B. Obtain a sputum specimen to culture any bacteria

C. Gather an appropriate sized tracheostomy kit.

D. Assess the child’s throat while they are sitting on the parent’s lap.

90

Tips to Master NCLEX

ReMar Review

Test Day Tips

1) Know the location (parking, room, etc.)

2) Pack everything you need the night before

3) Do not study the night before

4) Eat breakfast and dress in layers

5) Do not go in expecting to stop at minimum questions