Mark Klimek NCLEX Prep 2023 Study Guide Exam
Questions with Answers Best Graded A+
As the pH goes,
Answer: so, goes my patient, EXCEPT for potassium
(Mac) Kussmaul's is only seen in...
Answer: Metabolic Acidosis
In respiratory, if the patient is OVER ventilating,
Answer: Respiratory Alkalosis
In respiratory, if the patient is UNDER ventilating,
Answer: Respiratory Acidosis
The only cause for metabolic alkalosis is...
Answer: prolonged vomiting or suctioning
A High-pressure alarm is due to...
Answer: obstructions (kinks in tubing, mucus secretions)
A Low-pressure alarm is due to...
Answer: disconnections (disconnected main tubing or O2 sensor tubing)
BEFORE choosing to suction a patient, you should...
Answer: Change their position (turn, cough, deep breathe)
What are the stages of grief?
Answer: DABDA (Denial, Anger, Bargaining, Depression, Acceptance)
The number one problem in abusive situations is __________. How do you treat
it?
Answer: Denial Treat
The number two problem in abusers is...
Answer: Dependency/Codependency
If what a codependent person is being asked to do is harmful/dangerous, this is
called __________. How do you treat it?
Answer: Manipulation Treat by setting limits + enforcing it.
What is Wernicke-Korsakoff syndrome?
Answer: Psychosisinduced by vitamin B1 (thiamine) deficiency
Amnesia with confabulation (pt making up stories + believes it)
Answer: It is IRREVERSIBLE
How do you prevent Wernicke-Korsakoff syndrome?
Answer: Take vitamin B1
What is Disulfiram (Antabuse)? How long does it take to be effective?
Answer: Aversion therapy for alcoholism 2 weeks to be effective
What does Naltrexone (Revia) do?
Answer: Reduces alcohol cravings
What should you teach patients to avoid when taking Disulfiram?
Answer: Mouthwash, aftershaves, perfume/cologne, insect repellent, any OTC that
ends in "elixir", alcohol-based hand sanitizer, uncooked icings (no bake), red wine
vinaigrette
What are the 5 uppers?
Answer: Caffeine Cocaine
PCP/LSD
Methamphetamines
Adderall
Everything else is a downer...
What is an overdose? What are the sxs like?
Answer: Too much of an upper/downer
Upper overdose sxs make you GO UP
Downer overdose sxs make you GO DOWN
What is a withdrawal? What are the sxs like?
Answer: Too little upper/downer
Upper withdrawal sxs make you go DOWN
Downer withdrawal sxs make you go UP
In what two situations would respiratory arrest be your priority?
Answer: Downer overdose + Upper withdrawal
In what two situations would seizures be your priority?
Answer: Upper overdose + Downer withdrawal
In drug addiction in newborns, always assume __________ at birth/first 24 hours.
After 24 hours, assume the baby is __________.
Answer: Intoxication at birth/first 24 hours
After 24 hours, baby is in withdrawal 24 hours after an alcoholic stop drinking,
they go through __________.
Answer: Alcohol withdrawal syndrome
Only a minority of alcoholics go through __________ 72 hours after they stop
drinking.
Answer: Delirium tremens
AWS always __________, however DT does not always __________.
Answer: AWS always precedes DT, however DT does not always follow AWS.
What are some cares for AWS?
Answer: Reg diet Semi-private room anywhere
Up ad-lib
No restraints
What are some cares for DT?
Answer: NPO, clear liquids
(seizure/aspiration risk)
Private room near nurse's station
Restricted bed rest, no bathroom privileges
Must be restrained (using vest or 2-pt locked leathers)
Both patients in AWS and DT with receive these cares...
Answer: Antihypertensive
Tranquilizer
Multivitamin w/ vitamin B1
"No B1, you'll be one! (a crazy)"
Aminoglycosides are...
Answer: VERY powerful antibiotics "A mean old -mycin treats a mean old
infection"
They treat serious, life-threatening, resistant, gram negative infections
If it ends in -mycin, its a mean old -mycin, but if it has a "thro",
Answer: Throw it off the list! It is no longer a mean old mycin.
(i.e. Azithromycin, Clarithromycin)
Toxic effects of aminoglycosides?
Answer: -mycin = Mice
Mice = Ears → Ototoxicity
Ears = Kidney-shaped → Nephrotoxicity
Draw an 8 in the ear → Affects cranial nerve VIII
Administer them q8 hours
What is the route for aminoglycosides? Which route to avoid except for what 2
cases?
Answer: Route: IM or IV
Do NOT give PO, because they are not absorbed, EXCEPT for 2 cases – hepatic
encephalopathy and pre-op bowel surgery to clean out the bowels
Who can sterilize my bowel?
Answer: Neo Kan! (Neomycin, Kanamycin)
What is a trough?
Answer: When the drug is at its lowest point
What is a peak?
Answer: When the drug is at its highest point
"TAP" levels
Answer: Trough, Administer, Peak
When do you draw a trough level?
Answer: 30 minutes before next dose (true for ALL med routes)
When do you draw a peak for a sublingual med?
Answer: 5-10 mins after drug is dissolved
When do you draw a peak for a IV med?
Answer: 15-30 mins after drug is finished
When do you draw a peak for a IM med?
Answer: 30-60 mins after you give it
CCBs are like __________ for your heart, they __________. - Correct
Answer: Valium Calm it down!
CCBs are negative __________, __________, and __________.
Answer: inotropic, chronotropic, dromotropic
What would a positive inotropic, chronotropic, dromotropic do?
Answer: Cardiac stimulant
CCBs are A, AA, AAA...
Answer: Antihypertensives
Anti-Anginals
Anti-Atrial Arrhythmias
EXCEPTION: SVT, because "supra" means "above" the ventricles, which means it
is an atrial rhythm.
Side effects of CCBs are HNH...
Answer: Headache +
Hypotension
CCBs end in __________, except for __________ & __________.
Answer: dipine
Except for Verapamil and Cardizem
Treat V.Tach/PVCs with...
Answer: Lidocaine or Amiodarone
Treat SVT with...
Answer: ABCDs
Adenosine (rapid push)
Beta blockers
Calcium channel blockers
Digoxin/Digitalis/Lanoxin
Treat V.Fib with...
Answer: Defibrillation
For V.Fib, you defib!
Treat asystole with...
Answer: Epinephrine and Atropine
Epi before Atropine
An apical chest tube removes...
Answer: Air
A basilar chest tube removes...
Answer: Blood
What should you do if the water seal of a chest tube breaks?
Answer: Clamp, cut, submerge, unclamp
What should you do if the CT gets pulled out?
Answer: First thing to do is take a gloved hand and cover the hole
BEST thing to do is to cover it with vaseline gauze
If asked about bubbling—WHEN and WHERE is it bubbling?
Continuous bubbling in the water seal is...
Answer: BAD.
If something is sealed, you should NOT have continuous bubbling.
Never clamp a chest tube for longer than __________ without a doctor's order.
Answer: 15 secs
All congenital heart defects are either "TRouBLe" or not. What are the
characteristics?
Answer: T – All CHDs that start with "T" are trouble!
R + L – Shunts blood R → L
B – Makes them turn blue (cyanotic)
Examples:
Tetralogy of Fallot
Truncus arteriosus
Transposition of Great Vessels
Tricuspid atresia
Total Anomalous Pulmonary Vasculature
No-trouble defects shunt blood...
Answer: L → R
All CHD children will have two things, whether they are "trouble" or not:
Answer: A murmur An echocardiogram
The 4 Defects of Tetralogy of Fallot
"VarieD PictureS Of A RancH"
Answer: Ventricular Defect
Pulmonary Stenosis
Overriding Aorta
Right Hypertrophy
Droplet Precautions
Answer: Mask, gloves, hand-washing
Pt wears mask when leaving the room
Disposable supply dedicated equipment
Contact Precautions
Answer: Private room preferred unless cohorting
Gloves, gown, hand-washing, disposable supply dedicated equipment
Airborne Precautions
Answer: "MTV on Air" (MMR, TB, Varicella)
Mask, gloves, hand-washing
Special filter mask only for TB
Pt wears mask when leaving room
Negative airflow
What order to take off PPE?
Answer: Always take off in alphabetical order
Gloves
Goggles
Gown
Mask
What order to put on PPE?
Answer: Reverse alphabetical for the G's (mask is #2)
Gown
Mask
Goggles
Gloves
How do you know which crutch gait to use?
Answer: "Even for even, odd for odd" i.e. If both legs are bad, use 2-point (mild
issue) or 4-point (severe issue). If only one leg is bad, use 3-point.
For amputations or NON-weight bearing, use swingthrough.
How do you teach a patient with crutches in going up/down stairs?
Answer: "Up with the good, down with the bad"
On which side do you teach a patient to hold a cane?
Answer: Hold a cane on the stronger side
How do you teach a patient to use a walker?
Answer: Pick them up, set them down, and walk to them
Tie belongings to the side, not the front
What is the difference between an illusion and hallucination?
Answer: With illusions, there is a referent in reality (i.e. Client overhears nurses
talking and laughing, they say "I hear demon voices")
What are the 5 types of hallucinations?
Answer: Auditory, visual, tactile, gustatory, olfactory
How do you deal with psychosis patients?
Answer: Ask yourself, "what kind of psychosis do they have?"
1. Functional psychotic (schizo-schizo-major-manics)
2. Psychosis of dementia
3. Psychotic delirium
How do you address a functional psychotic?
Answer: Teach reality using 4-step process:
1. Acknowledge feeling
2. Present reality
3. Set a limit
4. Enforce the limit
Do NOT punish them!
How do you address psychosis of dementia?
Answer: They CANNOT learn reality.
1. Acknowledge feeling
2. Redirect them / reality orientation (person, place, time)
How do you address psychotic delirium?
Answer: 1. Acknowledge feeling
2. Reassure that it is temporary, it will go away, and that they're safe.
How do you address a patient with a personality disorder?
Answer: Use good therapeutic communication EXCEPT for abnormal (antisocial,
borderline, narcissists – treat these more like a functional psychotic and SET
LIMITS).
The lower the urine output, the __________ the urine specific gravity.
Answer: Higher
The higher the urine output, the __________ the urine specific gravity.
Answer: Lower
The opposite of diabetes insipidus is...
Answer: SIADH
Diabetes insipidus is...
Answer: polyuria, polydipsia, leading to dehydration due to low ADH
What are the 3 types of DM type 1?
Answer: Insulin-dependent
Juvenile onset
Ketosis prone
What are the 3 types of DM type 2?
Answer: Non-insulin dependent
Adult onset
Non-ketosis prone
What are the 3 P's of Diabetes?
Answer: Polyuria, polydipsia, polyphagia
How to treat a DM type 1 client?
Answer: "If you don't treat type 1's, they could DIE"
D = Diet
I = Insulin priority
E = Exercise
How to treat a DM type 2 client?
Answer: "If you don't treat type 2's, they could DOA"
D = Diet priority
O = Oral hypoglycemic
A = Activity
The main treatments for DM type 2 clients is...
Answer: Calorie restriction priority
They need 6 small feedings per day
Insulin to lower blood glucose
Regular insulin peaks at...
Answer: 2 hours
NPH insulin peaks at...
Answer: 8-10 hours
When do you check for hypoglycemia in a DM client?
Answer: At the insulin's peak time
What is the onset for rapid acting insulin?
Answer: 15 minutes
Lantus peaks at...
Answer: No essential peak (low risk for hypoglycemia, can give at bedtime)
Once an insulin vial has been punctured, it is good for...
Answer: 30 days from that date
In DM clients, think of exercise as...
Answer: Another injection of insulin
Teach patients who are going to exercise to bring rapidly metabolizable
carbohydrates.
If a DM client is sick, their glucose level will...
Answer: Increase Teach them to take insulin even if they're not eating + take sips
of water to prevent dehydration.
What are the 3 acute complications of DM?
Answer: Insulin shock/Hypoglycemia/Hypoglycemic shock
Diabetic ketoacidosis (DKA) only applies to DM type 1
HHNK (Dehydration)
What are S/S of hypoglycemia?
Answer: "DRUNK IN SHOCK"
What are S/S of DKA?
Answer: D - Dehydration, dry
K - Ketones (in blood), Kussmaul's resps, High K+
A - Acidotic (metabolic), acetone breath (fruity), anorexia d/t nausea
What is the #1 cause of DKA?
Answer: Acute viral upper respiratory infection within the last 2 weeks
What is the toxic level for Lithium?
Answer: ≥ 2
What is the toxic level for Digoxin/Lanoxin?
Answer: ≥ 2
What is the toxic level for Aminophylline/Theophylline?
Answer: ≥ 20
What is the toxic level for Dilantin/Phenytoin?
Answer: ≥ 20
What are the toxic & elevated levels of bilirubin in a newborn?
Answer: ≥ 20
Elevated is 10-20
What is phenytoin used for?
Answer: Seizures
What is theophylline used for?
Answer: Bronchodilator for asthma, COPD, emphysema; relaxes the airway
What is kernicterus?
Answer: Bilirubin in the brain; usually around ~20 can cause aseptic
meningitis/encephalitis
What is opisthotonus?
Answer: A position that the baby assumes when they have kernicterus; they
hyperextend and are very rigid (similar to decerebrate)
In what position do you place a child who demonstrates opisthotonus?
Answer: On their side
In hiatal hernia, gastric contents empty in the __________ direction at the
__________ rate.
Answer: wrong direction at the right rate
In dumping syndrome, gastric contents empty in the __________ direction at the
__________ rate.
Answer: right direction at the wrong rate (dump too quickly into the duodenum)
What are S/S of hiatal hernia?
Answer: GERD symptoms (heartburn, indigestion) when lying down after eating
What are S/S of dumping syndrome?
Answer: "DRUNK" + "SHOCK" + abdominal distress (cramps, pain, borborygmi,
diarrhea, guarding, bloating)
Treatment for hiatal hernia?
Answer: "In hatal hernia, everything needs to be high!" (except protein)
High HOB
High fluids
High carbs
LOW protein
Treatment for dumping syndrome?
Answer: "If you want the stomach to go slow, pick low." (except protein)
Flat HOB and eat on their side
Low fluids
Low carbs
HIGH protein
Kalemias do the __________ as the prefix, except for __________ and
__________.
Answer: Same as the prefix, except for heart rate and urine output (which are
opposite of the prefix)
Calcemias do the __________ of the prefix.
Answer: Opposite
Magnesemias do the __________ of the prefix.
Answer: Opposite
What is Chvostek's sign?
Answer: Tap the cheek and the face spasms
Sign of hypocalcemia
What is Trousseau's sign?
Answer: Hand spasm when BP cuff is inflated
Sign of hypocalcemia
For sodiums: The one with the __________ is dehydration, the one with the
__________ is overload.
Answer: HypErnatremia = Dehydration
HypOnatremia = Overload
The earliest sign of any electrolyte imbalance is...
Answer: paresthesia (numbness and tingling), especially circum-oral paresthesia
The universal sign of electrolyte imbalance is...
Answer: paresis (muscle weakness)
What are the two rules for treatment in potassium imbalance?
Answer: 1. Never push K+ IV
2. Not more than 40 of K+ per liter of IV fluid
How do you treat hyperkalemia?
Answer: D50W with regular insulin (fast temporary solution)
Kayexalate and a lot of fluids (slow, permanent solution)
Kayexalate = "K exits late"
"Thyroidism", think __________.
Answer: Metabolism
Hyperthyroidism is...
Answer: Hyper metabolism
Grave's disease ("run yourself into the grave")
What are S/S of hyperthyroidism?
Answer: Weight loss
High HR/BP
Heat intolerance, cold tolerance
Bulging eyes (exophthalmos)
Treatment for hyperthyroidism?
Answer: 1. Radioactive iodine (Pt needs to be in a room by themselves for 24
hours, after tx be careful with their urine).
2. PTU (Propylthiouracil = "Puts Thyroid Under", cancer drug that causes
immunosuppression)
3. Thyroidectomy (total or partial)
What is a patient with a total thyroidectomy at risk for?
Answer: Hypocalcemia, tetany d/t hypocalcemia
What is a patient with a subtotal (partial) thyroidectomy at risk for?
Answer: Thyroid storm/crisis MEDICAL EMERGENCY
1. High temps 105 F or >
2. High BPs
3. Severe tachycardia (180s)
4. Psychotic delirium
What is the treatment for thyroid storm?
Answer: Ice pack, cooling blanket, 10L O2 mask
NO MEDS
After a thyroidectomy, what are the post-op risks in the first 12 hours, 12-48 hrs,
and after 72 hrs?
Answer: First 12 hours: Airway, Hemorrhage
12-48 hours: Total = Tetany due to hypocalcemia,
Partial = Thyroid storm
After 72 hours: Infection
What are S/S of hypothyroidism?
Answer: Obesity
Flat/dull personality
Cold intolerance, heat tolerance
Low HR/BP
Treatment for hypothyroidism? 2 things to know about these patients?
Answer: Thyroid replacement (Levothyroxine/Synthroid)
1. Do NOT sedate these patients (can lead to myxedema coma)
2. NEVER hold thyroid medication without an order.
