Uworld Nclex notes about how to pass board exams PDF

Preview

Summary

Uworld Lectures notes about how to pass nclex board exams board exams...

Description

NG Tube Insertion: During NG tube insertion, the tube sometimes slips into the larynx or coils in the throat, which can result in coughing and gagging. The nurse should withdraw the tube slightly and then stop or pause while the client takes a few breaths. After the client stops coughing, the nurse can proceed with advancement , asking the client to take small sips of water to facilitate advancement to the stomach. The client should not be asked to swallow during coughing or aspiration may occur. If resistance or obstruction occurs during tube advancement, the nurse should rotate the tube while trying to advance it. If resistance continues, the tube should be withdrawn and inserted into the other naris if possible. Foley Catheter: In the male client, it is recommended that the catheter be inserted 7-9 in (17-22.5 cm) or until urine flows out, due to the longer urethra. The catheter should then be inserted at least an additional 1 in (2.5 cm) or to catheter bifurcation. Insert the Foley urinary catheter further if drops appear in the tubing to ensure that the tip with the balloon is in the bladder. Inflating the balloon before advancing the catheter could result in urethral trauma. Shingles: (herpes zoster) is a reactivation of the varicella-zoster (chicken pox) virus. It is more likely to occur when a client's immune system is compromised by disease (eg, HIV infection) or treatments (eg, chemotherapy). Shingles lesions that are open may transmit the infection by both air and contact. The client with disseminated shingles that are not crusted over will require contact precautions, airborne precautions, and a negative airflow room to prevent transmission of the infection to others in the hospital. Negative airflow pulls air from the hospital environment into the room, and the air from the hospital room then goes directly to the outside rather recirculating to the rest of the hospital. Localized shingles require only standard precautions for clients with intact immune systems and contained/covered lesions. Heimlich maneuver: primary rescue intervention for children over age 1 with a foreign body airway obstruction causing respiratory distress. Back blows and chest thrusts are appropriate interventions for a choking infant under age 1. Blind sweeping of a child's mouth should not be attempted. Contact Precautions: Clients with multidrug-resistant organisms (MRSA, VRE), C difficile diarrhea, and scabies require nursing staff to implement contact precautions. Mastectomy: Immediately after mastectomy surgery, the client is placed in a semi-Fowler's position with the affected side's arm and hand elevated on several pillows to promote drainage and prevent venous and lymphatic pooling. Flexing and bending of the affected side's fingers is begun immediately with gradual increase in arm movement over the next few postoperative days. Postoperative arm and shoulder exercises are initiated slowly with the goal of full range of motion of the affected side within 4-6 weeks of the mastectomy. Management for lymphedema includes decongestive massage therapy, compression bandages or sleeves, elevation of the arm above heart level, isometric exercises, and avoidance of venipuncture or blood pressure measurements on the affected limb. Postmenopausal: A postmenopausal woman (usually after age 51) is at risk for osteoporosis and heart disease. Clients should take med with full glass of water and remain upright for 30 minutes after taking a bisphosphonate and consume calcium and vitamin D for bone health. Clotting disorder is a risk with HRT/ hormone replacement therapy. Intermittent vaginal spotting after menopause can be a sign of endometrial cancer. Weight Loss:

"Create My Plate" method for meal planning: 1. Monitor carbohydrate intake; 2. Manage caloric intake if weight loss is desired

3. High-fiber foods (30-35 g of fiber per day), including whole grains, legumes, fruits, vegetables, and low-fat dairy products 4. Use monounsaturated fats, limit use of saturated fat, and eliminate trans fatty acids 5. Choose foods with a low glycemic index 6. Consume total cholesterol of 50 mm Hg (respiratory acidosis)  PaO2 3 mL/kg/hr over 3 consecutive hours or 5-10 mL/kg over 1 hour. This could indicate postoperative hemorrhage. Cardiac tamponade can occur rapidly in children and can be lifethreatening. Hypocalcemia: Acute hypocalcemia can be life-threatening due to seizures, tetany (laryngeal stridor), and cardiac arrhythmias. Inadvertent removal of the parathyroid gland can result in rapid development of severe hypocalcemia. Fifth Disease: Children with fifth disease are communicable only prior to onset of symptoms (eg, rash, joint pains). The causative agent, human parvovirus, spreads via respiratory secretions. Fifth disease is self-limiting and short-lived; treatment is given to alleviate symptoms. Isolation is not usually required for a non-hospitalized child. above-the-knee amputation: Care of the client with above-the-knee amputation includes placement in prone position for 30 minutes 3 or 4 times a day and using a figure eight compression bandage to decrease edema. The client's residual limb should not be elevated as this will promote flexion contractures. Pericarditis: Characterized by typical pleuritic chest pain that is sharp. It is aggravated during inspiration and coughing. Pain is typically relieved by sitting up and leaning forward. Treatment includes a combination of NSAIDs or aspirin plus colchicine. Bacterial meningitis: Key characteristics of bacterial meningitis in infants under age 2 include frequent seizures, a high-pitched cry, poor feeding, nuchal rigidity, and possible bulging fontanelles. MAP should be maintained at >65 mm Hg in septic or anaphylactic shock. Normal PAWP is 6-12 mm Hg. left-to-right cardiac shunts: All left-to-right cardiac shunts (eg, ventricular septal defect, atrial septal defect) will cause an increase in pulmonary blood flow. Shunt reversal can eventually result in heart failure. Children should be kept in an upright position and offered small, frequent feedings to decrease workload of the heart and lungs. Celiac disease: A child with celiac disease cannot eat barley, rye, oats, or wheat (mnemonic - BROW). Cane: The nurse may use the mnemonic "up with the good and down with the bad." Cane always moves before the weaker leg. Licorice: The nurse should discourage the client from using the herbal remedy licorice root when taking thiazide diuretics. Licorice root can potentiate potassium loss and increase the client's risk for hypokalemia. Use of licorice root should be reported to the PCHP. infant: Infants grow rapidly and by age 12 months, the head and chest circumference are equal, triple the birth weight, the infant should also be able to sit down from a standing position without assistance. Infants should double in birth weight by age 6 months and triple in birth weight by age 12 months. At birth, head circumference is slightly more than chest circumference, but these equalize by age 12 months. The posterior fontanelle fuses by age 2 months, and the anterior fontanelle fuses by age 18 months.

Hemolytic uremic syndrome: Hemolytic uremic syndrome is a life-threatening complication of Escherichia coli diarrhea. Clinical features include anemia (pallor), low platelets (petechiae and purpura), and acute kidney injury (low urine output). allergy skin testing: To ensure an accurate result, the client should avoid taking any antihistamines such as diphenhydramine and loratadine for a week or more prior to the test. Antihistamines block mast cell release of histamines that are responsible for allergic symptoms. Systemic corticosteroids, which are used to treat the inflammatory component of asthma, can interfere with the accuracy of allergy skin testing as well; therefore, the use of these medications should be assessed. Acetaminophen will not interfere with allergy skin testing, but nonsteroidal anti-inflammatory drugs and aspirin may be included in the list of medications to avoid. Albuterol, a short-acting beta adrenergic agonist that is the client's asthma "rescue" medication, should not be discontinued as it is necessary to ensure safety during an asthma attack. It will not interfere with allergy skin testing results. "Permissive hypertension": is allowed within the first 24-48 hours of an acute ischemic stroke provided that the blood pressure is 5 L). The nurse should first validate the presence of light-headedness and unsteady gait, monitor vital signs, and assess for manifestations of hypovolemia (eg, orthostatic hypotension, tachycardia, reduced pulse volume, decreased urine output), as decreased circulating volume can lead to hemodynamic instability. Placental abruption: is a possible complication of preeclampsia that can be life-threatening to mother and baby. It occurs when the placenta tears away from the wall of the uterus due to stress, causing significant bleeding to the mother and depriving the baby of oxygen. Bleeding can be concealed inside the uterus. This may require immediate delivery of the baby. HELLP: Elevated liver enzymes can indicate the start of a more serious condition called HELLP ( Hemolysis, Elevated Liver enzymes, Low Platelets), another complication of preeclampsia. This client will need additional laboratory work. If HELLP is diagnosed, the only treatment is delivery. Preeclampsia: in pregnancy manifests with high blood pressure and protein in the urine. Edema is expected, although it is not part of the criteria. Complications of preeclampsia include eclampsia, placental abruption, and HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome. Initial interventions in emergency management of chest pain are as follows:  Assess airway, breathing, and circulation (ABCs)  Position client upright unless contraindicated  Apply oxygen, if the client is hypoxic  Obtain baseline vital signs, including oxygen saturation  Auscultate heart and lung sounds  Obtain a 12-lead electrocardiogram (ECG)  Insert 2-3 large-bore intravenous catheters  Assess pain using the PQRST method  Medicate for pain as prescribed (eg, nitroglycerin)  Initiate continuous electrocardiogram (ECG) monitoring (cardiac monitor)  Obtain baseline blood work (eg, cardiac markers, serum electrolytes)  Obtain portable chest x-ray  Assess for contraindications to antiplatelet and anticoagulant therapy  Administer aspirin unless contraindicated Hyperemesis gravidarum: is a disorder that causes pregnant clients to have severe nausea and vomiting. This leads to fluid and electrolyte imbalances, nutritional deficiencies, ketonuria, and weight loss. On assessment, the nurse should expect signs and symptoms of dehydration, which include dry mucous membranes, poor skin turgor, decreased urine output, tachycardia, and low blood pressure. Ketonuria indicates that the body is breaking down fat to use for energy due to the client's starvation state.

Sickle Cell: Laboratory results that support a vaso-occlusive crisis (pain crisis) in a client with sickle cell disease include elevated reticulocytes, elevated bilirubin, and anemia. Addison's disease: Corticosteroid therapy is the primary classification of drugs used to treat Addison's disease, an adrenocortical insufficiency. Signs and symptoms of infection should be reported to the PHCP immediately. Use of corticosteroids can cause immunosuppression. Infection can develop quickly and spread rapidly. Its anti-inflammatory effects may also mask signs of infection such as inflammation, redness, tenderness, heat, fever, and edema. In addition, physiological stress such as infection can trigger addisonian crisis, a life-threatening complication of Addison's disease Addison disease include the following:  Slow, progressive onset of weakness and fatigue  Anorexia and weight loss  Orthostatic hypotension  Hyponatremia and hyperkalemia  Salt cravings  Nausea and vomiting  Depression and irritability Acute glomerulonephritis: is most often caused by recent streptococcal infection. Nursing care is focused on monitoring vital signs (particularly blood pressure), assessing fluid status, avoiding salt in the diet, and conserving energy. Prostatitis: Care of the client with prostatitis includes anti-infective and anti-inflammatory medications, stool softeners, sitz baths, and decreasing retained prostatic fluid via ejaculation. Hydration and avoidance of caffeine should also be promoted. Types of impaired thought processes seen in individuals with schizophrenia include the following:  Neologisms – made-up words or phrases usually of a bizarre nature; the words have meaning to the client only. Example: "I would like to have a phjinox."  Concrete thinking – literal interpretation of an idea; the client has difficulty with abstract thinking. Example: The phrase, "The grass is always greener on the other side," would be interpreted to mean that the grass somewhere else is literally greener  Loose associations – rapid shifting from one idea to another, with little or no connection to logic or rationality  Echolalia – repetition of words, usually uttered by someone else  Tangentiality – going from one topic to the next without getting to the point of the original idea or topic  Word salad – a mix of words and/or phrases having no meaning except to the client. Example: "Here what comes table, sky, apple."  Clang associations – rhyming words in a meaningless, illogical manner. Example: "The pike likes to hike and Mike fed the bike near the tyke."  Perseveration – repeating the same words or phrases in response to different questions Systemic inflammatory response syndrome (SIRS): occurs when the body undergoes a major insult (eg, trauma, infection, burns, hemorrhage, multiple transfusions). Stimulation of the immune response leads to activation of white blood cells (WBCs), release of inflammatory mediators, increased capillary permeability, and inflammation of organs. Diagnostic criteria for SIRS include 2 or more of the following manifestations:  Hyperthermia (temperature >100.4 F [38 C]) or hypothermia (temperature 90/min  Respiratory rate >20/min or alkalosis (PaCO 2 12,000/mm3 [12.0 x 109/L] or 10% immature neutrophils [bands]) polycythemia vera: are at risk of developing thrombosis and should be taught preventive measures (eg, elevating the legs when sitting) and symptoms to report. They should take measures to prevent dehydration, and avoid iron-rich foods and hot showers/baths. Polycythemia vera (PV) is a chronic myeloproliferative disorder in which the bone marrow produces an abnormally high

number of red blood cells (RBCs). Although PV is an abnormality of the bone marrow, secondary polycythemia can occur in an individual with chronic hypoxemia, such as chronic obstructive pulmonary disease or chronic lung disease. The danger of PV is seen when the client develops blood clots—due to the increased viscosity of the blood, which makes the circulation sluggish—and decreasing tissue perfusion. Treatment of PV usually includes periodic phlebotomy, the removal of 300 to 500 milliliters of blood through venipuncture, to reduce the RBC count and achieve a hematocrit of less than 45%. Initially, clients may require phlebotomy every other day until the goal hematocrit is reached. Hematocrit is then monitored monthly, and additional blood draws performed as necessary. hypoglycemia-associated symptoms: including increased heart rate, shakiness, sweating, hunger, anxiety, and pallor. Fetus: Fetal heart tones can be detected by 7 weeks gestation. Fetal sex may be determined on ultrasound as early as the end of 12 weeks gestation. Fetal movements are typically felt at around 16-20 weeks gestation. cleft palate: (CP) is at risk for aspiration and inadequate nutrition due to eating and feeding difficulties. This is due to the infant's inability to create suction and pull milk or formula from the nipple. Until CP can be repaired, the following feeding strategies increase oral intake and decrease aspiration risk:  Hold the infant in an upright position, which promotes passage of formula into the stomach and decreases the risk of aspiration  Tilt the bottle so that the nipple is always filled with formula. Point down and away from the cleft.  Use special bottles and nipples, including cross-cut and preemie nipples and assisted delivery bottles. These devices allow formula to flow more freely, decreasing the need for the infant to create suction. Using a squeezable bottle allows the caregiver to apply pressure in rhythm with the infant's own sucking and swallowing  These infants swallow large amounts of air during feeding and so need to be burped more often to avoid stomach distension and regurgitation  Feeding slowly over 20–30 minutes reduces the risk of aspiration and promotes adequate intake of formula.  Feeding every 3–4 hours; more frequent feedings may be tiring for the infant and the mother. Some infants may need to be fed more frequently if they are not consuming adequate amounts of formula. the priority needs: 1. ABCs plus V – airway, breathing, circulation, and vital signs 2. Mental status changes, acute pain, unresolved medical issues, acute elimination problems, abnormal laboratory values, and risk 3. Longer-term issues such as health education, rest, and coping Hypomagnesemia: a low blood magnesium level (normal 1.5-2.5 mEq/L [0.75-1.25 mmol/L]), is associated with alcohol abuse due to poor absorption, inadequate nutritional intake, and increased losses via the gastrointestinal and renal systems. It is associated with 2 major issues: 1. Ventricular arrhythmias (torsades de pointes): This is the most serious concern (priority). 2. Neuromuscular excitability: Manifestations of low magnesium, similar to those found in hypocalcemia and demonstrated by neuromuscular excitability, include tremors, hyperactive reflexes, positive Trousseau and Chvostek signs, and seizures. epiglottitis (supraglottitis): It is an inflammation by bacteria of the tissues surrounding the epiglottis, a long, narrow structure that closes off the glottis during swallowing. Edema can develop rapidly (as quickly as a few minutes) and obstruct the airway by occluding the trachea. There has been a 10-fold decrease in its incidence due to the widespread use of the Hib. The classic symptoms include a high-grade fever with toxic appearance, severe sore throat, and the 4 Ds - dysphonia (muffled voice), dysphagia (difficulty swallowing), drooling, and distressed respiratory effort. The tripod position opens the airway and helps air flow. The child should be allowed to assume a position of comfort (usually sitting rather than lying down). The priority nursing response is to protect the airway.

Third-degree AV block: results in disassociation of atrial and ventricular contraction due to blocked electrical conduction pathways. Temporary or permanent pacing is necessary to stabilize the client. Signs of adequate hydration: are normal urine specific gravity (1.003 to 1.030), adequate volume of urine output (>30 mL/hr), and capillary refill of less than 3 seconds. Pulse pressure narrows in shock, and positive orthostatic vital signs (decreasing systolic blood pressure and rising heart rate) with position change indicate dehydration. The examination for skin cancer follows the ABCDE rule: 1. Asymmetry (eg, one half unlike the other) 2. Border irregularity (eg, edges are notched or irregular) 3. Color changes and variation (eg, different brown or black pigmentation) 4. Diameter of 6 mm or larger (about the size of a pencil eraser) 5. Evolving (eg, appearance is changing in shape, size, color) Positive end-expiratory pressure (PEEP): applies a given pressure at the end of expiration during mechanical ventilation. It counteracts small airway collapse and keeps alveoli open so that they can participate in gas exchange. PEEP is usually kept at 5 cm H2O (3.7 mm Hg). However, a higher level of PEEP is an effective treatment strategy for acute respiratory distress syndrome ( ARDS), a type of progressive respiratory failure that causes damage to the type II surfactant-producing pneumocytes that then leads to atelectasis, noncompliant lungs, poor gas exchange, and refractory hypoxemia. High levels of PEEP (10-20 cm H2O [7.4-14.8 mm Hg]) can cause overdistension and rupture of the alveoli, resulting in ba...