NCLEX-RN Review Notes

Bone marrow aspiration
· Local anesthesia

Administering intramuscular iron
· Z-track method, upper outer quadrant of the buttock

Foods high in iron
· red meat
· liver organ meats
· blackstrap molasses
· oysters
· kidney beans
· whole wheat bread
· egg yolk
· spinach
· kale
· turnip tops
· beet greens
· carrots
· raisins
· apricots

Client with metabolic alkalosis
· decreased respiratory rate and depth
· nausea, vomiting and diarrhea
· restlessness
· numbness and tingling in the extremities
· twitching in the extremities
· hypokalemia
· hypocalcemia
· dysrhythmias

Respiratory alkalosis
· decrease in the respiratory rate and depth
· headache
· lightheadedness
· vertigo
· mental status changes
· paresthesias
· hypokalemia
· hypocalcemia
· tetany
· convulsions

Normal magnesium level
· 1.6 to 2.6 mg/dL

Normal serum calcium level
· 8.6 to 10.0 mg/dL

Normal serum sodium level
· 135-145mEq/L

IV potassium chloride concentration
· Peripheral IV line: 20-40mEq/L
· Central IV line: 60mEq/L

Normal serum potassium level
· 3.5 to 5.1mEq/L

Normal serum albumin level
· 3.4-5.0g/dL

“Enemas until clear” order
· One to three enemas may be given

Identifying blood compatibility
· Indirect Coombs' test

Bradypnea
· Regular but abnormally slow respirations

Kussmaul’s respirations
· Abnormally deep, regular, and increased in rate

Hyperpnea
· Labored and increased in depth and rate

Apnea
· Respirations that cease for a number of seconds

Arterial Blood Gases (ABGs) specimen
· Use heparinized syringe

Client with ileostomy
· metabolic acidosis

Tetany from acute hypocalcemia
· Give calcium gluconate and calcium chloride

Sickle cell crisis classic symptom
· Pain

Hypokalemia
· peaked P waves
· flat T waves
· depressed ST segment
· prominent U waves

Hypercalcemia
· Give Calcitonin (calcimar)
· Avoid Vitamin D

Hypocalcemia
· Paresthesias
· hyperactive reflexes
· (+) Trousseau’s or Chvostek’s sign
· decreased heart rate
· hypotension
· hyperactive bowel sounds
· increased neuromuscular excitability
· muscle cramps
· tetany
· seizures
· insomnia
· irritability
· memory impairment
· anxiety

Fat emulsions
· Provide essential fatty acids and additional calories
· Assess hypersensitivity to eggs

Infiltration
· pallor
· coolness
· swelling

Phlebitis
· remove the IV
· apply warm moist compresses
· notify the physician

Insensible fluid loss
· Skin and lungs

Sensible fluid loss
· wound drainage
· gastrointestinal tract losses
· urine

Shock
· Hypotension
· Tachycardia
· cold, moist, pale, or cyanotic skin
· increased restlessness and apprehension

Pseudostrabismus
· Asian Americans
· American Indians
· Alaskan Native infants

Lactated Ringer’s solution
· Replace fluid from gastrointestinal (GI) tract losses

Albumin
· Shock and protein replacement

Scabies
· Gown and gloves

TB patients
· High intake of protein, iron, and vitamin C

Uric acid type of stone
· High intake of legumes, green vegetables, and fruits (except prunes, grapes, cranberries, and citrus fruits)

NGT attached to low suction
· Metabolic alkalosis

Late-stage salicylate poisoning
· Metabolic acidosis

Family history of general anesthesia problems
· Risk for post-operative malignant hyperthermia

Position post-liver biopsy
· Right side-lying position with a small pillow or folded towel under the puncture site for 2 hours

Client’s position during enema
· Left lateral position with the right leg acutely flexed

Position post-insertion of Cantor tube
· Right side

Post-supratentorial surgery
· Semi-fowler’s

Pre-MRI medication
· Sedative

Position of client with air embolism
· Left side with the feet higher than the head.

Client with TPN to receive antibiotic
· Ensure a separate IV access for the antibiotic

Priority management of sickle cell crisis
· Hydration therapy and pain relief

Before teaching cane-assisted ambulation
· Assess clients balance, strength and confidence

Normal serum osmolality
· 285-295mOsm/kg of water

Normal Oxygen saturation
· >95%

Hypoxemia
· Oxygen saturation ≤ 88%

Normal CSF Protein
· 15-45mg/dL

Function of progesterone
· Maintains uterine lining for implantation and relaxes all smooth muscle including the uterus
·
Hormones produced by the ovaries
· Estrogen and progesterone

Prior to intralipid infusion
· checked solution for separation or an oily appearance

Continuous tube feeding
· Check the residual every 4 hours

Air Embolism in client with TPN
· chest pain
· decreased level of consciousness
· tachycardia
· dyspnea
· anxiety
· feelings of impending doom
· cyanosis
· hypotension
· hypoxia
· auscultation over the right ventricle may reveal a “churning” windmill type of sound

Serum sodium level is lower than 125mEq/L
· IV hypertonic saline

Impaired Oral Mucus Membranes
· Avoid lemon-glycerin swabs

Vastus Lateralis muscle
· Best injection site for all age group especially ages >3

Assessing post-hysterectomy client
· Roll the client to one side after checking the perineal pad and the abdominal dressing

Least reliable method for determining accurate placement of the NG tube
· Placing the end of the tube in water to observe for bubbling

Position for thoracentesis
· Sitting at the edge of the bed leaning over the bedside table with the feet supported on a stool; or
· Left side-lying with the head of the bed elevated 30 to 45 degrees

Tracheostomy tube suctioning
· Goggles, mask, sterile gloves

Correct use of walker
· Put all four points of the walker 2 feet forward flat on the floor, puts weight on the hand pieces, and then walks into it

Post-radical vulvectomy
· Avoid using warm tap water

Hydraulic lift
· Position client in the center of the sling

Confused client with stable gait
· Alarm-activating bracelet or “wandering bracelet.”

Glass thermometer breakage
· Notify the Environmental Services Department of the spill

Client with internal radiation implant
· Long-handled forceps and a lead container (pig)

Incident reports
· Analysis of adverse client events by reviewing the quality of care and determine any potential risks for injury to the client

In corneal donor’s death
· Eyes are closed and gauze pads wet with saline are placed over them with a small ice pack
· Elevate head

Keeping the living will
· Medical record at the hospital
· Physician’s office
· Client’s home
· Lawyer’s office.

Appropriate test for asterexis
· Ask the client to extend an arm, dorsiflex the wrist, and extend the fingers

Primary prevention
· measures that keep illness, injury, or potential problems from occurring

Secondary prevention
· Measures that seek to detect existing health problems or trends (case finding, screening)

Tertiary prevention
· Measures that prevent occurrence of additional injury

Thiamine rich foods
· Pork products, nuts, whole-grain cereals, and legumes

Normal CVP
· 4 to 11 mm H2O

Accurate indicator of fluid status and nutritional management
· Body weight

Excessive use of oral antacids
· Metabolic alkalosis

Client with body or leg casts
· Use fracture pan

Isotonic solution
· 0.9% normal saline
· 5% dextrose in water

Hypotonic solution
· 0.45% normal saline

Hypertonic solution
· 10% dextrose in water
· 5% dextrose in 0.9% normal saline

Thrombophlebitis
· Elevate the affected leg

Severely anemic persons
· Hemoglobin >8 g/dL
· pale
· exhausted
· (+) palpitations
· sensitivity to cold
· loss of appetite
· dizziness
· headaches

Site for bone marrow aspiration
· Iliac crest and the sternum

Sickle cell anemia
· (+)hemoglobin S

Malnutrition
· Low serum transferrin and total iron-binding capacity (TIBC)

Iron-Deficiency anemia
· Decreased iron-binding capacity but increased transferrin levels

Schilling test
· Pernicious anemia

Classic signs of Pernicious anemia
· weakness
· mild diarrhea
· smooth, sore red tongue
· paresthesias
· difficulty with balance
· occasional confusion

Chronic venous insufficiency
· avoid crossing the legs
· avoid sitting in chairs where the feet don’t touch the floor
· avoid wearing garters or sources of pressure above the legs (such as girdles)
· avoid prolonged standing or sitting
· wear elastic hose for 6 to 8 weeks (or perhaps for life)
· elevate foot of the bed 6”during sleep

Sclerotherapy
· injection of a sclerosing agent into a varicosity to damage the vein and close it off

Thromboangiitis obliterans (Buerger’s disease)
· Smoking cessation program

Cause of anginal attacks
· eating heavy meals
· straining during bowel movements
· smoking
· overexertion
· emotional upset
· temperature extremes

Characteristic of atrial fibrillation
· Auscultate apical pulse for irregular rate and palpate the radial pulse for pulse deficit

Position for pericardiocentesis
· Supine with the head of the bed raised to an angle of 45-60 degrees

Low cardiac output
· (+) Crackles