HURST REVIEW NCLEX RN Book-PDF Questions with Answers Latest Update 2023-2024, Exams of Health sciences

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HURST REVIEW NCLEX RN Book-PDF

Questions with Answers Latest Update

2023-

1. Fluid volume excesses also another word for? - Correct answer -

Hypervolemia

2. definition of fluid volume excess - Correct answer - too much

fluid in the vascular space ( any vessel in our body ex: vein , artery)

3. what are 2 causes of fluid volume excess? - Correct answer -

heart failure

• renal failure

4. Heart failure (HF) means what? - Correct answer - the heart is

weak

• the cardiac output is DOWN
• kidney perfusion is DOWN
• urinary output is DOWN
• the volume stays in the vascular space

5. Renal failure (RF) means what? - Correct answer - kidneys aren’t

working

6. what are three things that contain A LOT of sodium? - Correct

answer - canned process foods

• IVF with sodium
• fleet enemas

7. Aldosterone (steroid, mineralocorticoid) is found where? -

Correct answer - adrenal glands ( on top of the kidneys)

8. What is the normal action of aldosterone? - Correct answer When your blood volume gets low through for example vomiting or hemorrhage, the aldosterone secretion increases and makes your body retain sodium and water and therefore increases the blood volume
9. aldosterone makes us retain what? - Correct answer SODIUM AND WATER
10. when aldosterone secretion increases ----> retain sodium/water---> blood volume goes ________ ----> retain in

______________________ - Correct answer - up

• vascular space

11. what two diseases have too much aldosterone? - Correct

answer - Cushing’s ( too much steroids)

• hyperaldosterosteronism ( aka: CONNS)

12. what disease has too little aldosterone? - Correct answer -

Addison’s disease ( not enough aldosterone means you lose NA & water directly from the vascular space)

13. When taking an Anti-diuretic hormone (ADH) do you retain

or diuresis? - Correct answer - retain

14. When taking an anti-diuretic what do you retain? - Correct

answer - water

15. When you have too much ADH what happens in the body? -

Correct answer - RETAIN water

• fluid volume EXCESS
• Syndrome of inappropriate ADH ( TOO MANY LETTERS TOO MUCH WATER )
• urine is CONCENTRATED ( too much ADH and NA )
• blood is DILUTED

16. When you have not enough ADH what happens in the body?

• Correct answer - DIURESE water
• fluid volume DEFICIT
• DI ( diabetes insipid us) Diuresis
• urine is DILUTED
• blood is CONCENTRATED

17. when checking the urine specific gravity, sodium, and hematocrit on let’s say a urine test strip if the urine is

concentrated will it make the numbers go up or down? - Correct

answer - UP

18. when checking the urine specific gravity, sodium, and hematocrit on let’s say a urine test strip if the urine is diluted will

it make the numbers go up or down? - Correct answer - down

19. where is ADH found? - Correct answer - pituitary gland

20. what should you think about first when you think your patient has a ADH problem? - Correct answer head injuries ( craniotomy, increase ICP )
21. transsphenoidhypophysisectomy - Correct answer all the way through ( across) sinus pituitary removal
22. what are some drugs that are anti diuretic hormones ( ADH)
    • Correct answer - vasoPRESSIN
23. *ends in PRESSINS)

24. what are some S?S of fluid volume excess? - Correct

answer - distended neck veins/ peripheral veins ( VESSELS ARE

FULL)

• third spacing
• lungs are CRACKLED
• polyuria
• pulse INCREASED ( palpate the artery)
• Blood pressure INCREASES ( more volume = more pressure )
• weight INCREASES

25. what is the treatment for fluid volume excess? - Correct

answer - low NA diet

• restrict fluids
• daily I& Os and weights

26. what are some diuretics you can give to help FVE? - Correct

answer - FurosemIDE ( lasix ) ( DECREASES K+)

• drugs that end in IDE !!!!!

27. what is an example of a potassium spraing drug? - Correct

answer - spironolactone ( retain K+)

28. when thinking of fluid retention you should think what first?
    • Correct answer - HEART PROBLEMS
29. bed rest induces _________ by the release of ___________-

and lowers the production of ____________- - Correct answer -

diurese

- ANP

- ADH

30. what is another word for fluid volume deficit? - Correct

answer - HYPOvolemia

31. when you have a big time deficit you should think what

first? - Correct answer - SHOCK

32. what are the three causes of Fluid volume deficit? - Correct

answer - loss of fluid from annywhere

• third spacing
• diseases with polyuria

33. what is third spacing? - Correct answer - when fluid is in a

place that does you no good

34. ex: burns, ascites ( measure abdominal girth daily/ worry about HYPOtension)
35. what is an example of a disease that deals with polyuria? -

Correct answer - diabetes mellitus

36. when you see the word POLYURIA what should you think of

first? - Correct answer - SHOCK

37. what are some S/S of fluid volume deficit? - Correct

answer - weight DOWN

• decreased skin turgor
• dry mucous membranes
• urine output DECREASED ( kidneys arent being profused or they are trying to hold on to fluid ( compensate))
• blood pressure is DOWN ( less volume, less pressure )
• pulse is INCREASED ( heart is trying to pump what little fluid is left ) ( weak and thready in FVD)

38. respirations are INCREASED ( hypoxia)

• veins are CONSTRICTED
• urine specific gravity is INCREASED and CONCENTRATED

39. what is the treatment for FVD? - Correct answer - prevent

further losses

• replace volume

40. ex: mild deficit- PO fluids
41. severe deficit- IV fluids
42. what are patients are higher risk for when they are dealing

with FVD? - Correct answer - falls b/c of changes in V/S &

mental status

43. what happens in the body when you are given isotonic

solutions? - Correct answer - goes into the vascular space and

stays there

44. what are some examples of isotonic solutions? - Correct

answer - normal saline

• lactated ringers
• D5W

45. which fluid is best for shock patients? - Correct answer -

Lactated ringers

46. what do you use isotonic solutions for? - Correct answer -

pt's that lost fluids through nausea, vomiting, burns, sweating, trauma

• normal saline is the basic solution when administering blood

47. DO NOT use isotonic solutions in clients with what? -

Correct answer - hypertensions, cardiac disease or renal disease

48. isotonic solutions can cause what? - Correct answer - FVE,

hypertensions, or hypernatremia ( high concentration of sodium in the blood)

49. hypotonic solution does what in the body? - Correct

answer - goes into the vascular space and then shifts out into the

cells to REPLACE CELLULAR FLUID

50. hypotonic solution rehydrates but does not cause _____________ - Correct answer hypertension

51. what are some examples of hypotonic solutions? - Correct

answer - 1/2 NS

- 0.33 % NS

52. when and on who do you use hypotonic solutions? - Correct

answer - pt's who have hypertension, renal, or cardiac disease

and needs fluid replacement because of nausea, vomiting, burns, hemorrhage, etc.

• also used for dilution when a client has hypernatremia and cellular dehydration

53. what should you watch out for when adminstering

HYPOtonic solutions? - Correct answer - watch for cellular

edema because this fluid is moving out to the cells, which could lead to fluid volume DEFICET and decreased blood pressure

54. HYPERtonic solutions does what in the body? - Correct

answer - volume expanders that will draw fluid into the

VASCULAR SPACE from the CELL

55. what are some examples of hypertonic solutions? - Correct

answer - TPN, albumin

56. what do you use hypertonic solutions for? - Correct

answer - clients with HYPONATREMIA or a client who has shifted

large amts of vascular volume to a 3rd space or has severe edema, burns, or ascites

• hypertonic solutions will return the fluid volume to the vascular space

57. what should you watch out for when adminstering

hypertonic solutions? - Correct answer - watch for fluid volume

EXCESS

• monitor ICU setting with frequent monitoring of blood pressure , pulse, and CVP, esp. if they are receiving 3% NS or 5% NS

58. what are the top 5 joint commission high alert medications?

• Correct answer - insulin
• opioids/narcotics
• injectable potassium chloride or phosphate concentrate
• intravenous anticoagulants ( heparin)
• sodium chloride solutions ABOVE 9%

59. when thinking isotonic solutions think of what saying? -

Correct answer - " Stay where I put It"

60. when thinking of hypotonic solutions think of what saying? - Correct answer ' go Out of the vessel"
61. when thinking of hypertonic solutions think of what saying? - Correct answer " Enter the vessel"

62. magnesium and calcium act like a what? - Correct answer -

sedative

63. magnesium is excreted by the _________, but it can be lost in other ways ( GI tract) - Correct answer kidneys

64. what is the antidote for magnesium toxicity? - Correct

answer - calcium gluconate

65. what is the normal lab value for magnesium? - Correct

answer - 1.3- 2.1 me/L

66. what is the normal lab value for calcium? - Correct answer

- 9.0- 10.5 mg/dL

67. what are the causes for hypermagnesemia? - Correct

answer - renal failure

• antacids

68. signs and symptoms of hypermagnesemia - Correct

answer - flushing and warmth

• mg causes vasodilate

69. what is the treatment for hypermagnesmia? - Correct

answer - ventilator

• dialysis
• calcium gluconate

70. when calcium goes down the phosphate does what? -

Correct answer - goes up

• they have an inverse relationship which means they are opposite of each other

71. what are the causes of hypercalcemia? - Correct answer -

hyperparathyroidism: too much PTH  when your serum calcium gets low, parathormone (PTH) kicks in and oils CA from the BONE and puts it in the BLOOD; therefore the serum, calcium goes UP

• thiazides - retain CALCIUM
• immobilizations- you have to bear weight to keep Ca in the BONES

72. what are some S/S of HYPERcalcemia? - Correct answer -

bones are BRITTLE

• KIDNEY STONES * Majority or calcium*

73. what is the treatment for hypercalcemia? - Correct answer

- MOVE!!!! - fluids prevent KIDNEY STONES - ca has an inverse relationship with phosphurus - steroids

74. what are some causes of HYPOmagnesmia? - Correct

answer - diarrhea- lots of Mg in intestines

• alcoholism
• alcohol suppresses ADH & its hypertonic ( not eating or drinking)

75. what is the treatment of hypomagnesmia? - Correct

answer - give some Mg

• check KIDNEY function ( before and during IV mg )
• seizure precautions
• eat magnesium

76. what are the causes of hypocalcemia? - Correct answer -

hypoparathyroidism

• radical neck
• thyroidectomy  all these = not enough PTH)

77. serim calcium goes DOWN

78. what is the treatment for hypocalcemia? - Correct answer

- PO calcium - Vitamin D - phosphate binders: sevelamer hydrochloride ( renagel) calcium acetate ( PhosLO)

79. what kind of S/S does hypermagnesmia and hypercalcemia

have in common? - Correct answer - DTRs DECREASED

• muscle tone WEAK/FLACCID
• arrhythmias INCREASED
• LOC DECREASED
• Pulse DECREASED
• respirations DECREASED

80. what are some S/S does hypo magnesia and hypocalcemia

have in common? - Correct answer - muscle tone RIGID, TIGHT

• cloud the client have a seizure? YES
• stridor/laryngospasm- airway is a SMOOTH muscle
• • chovostek sign ( tap cheek "C" is fo cheek)
• • Trousseaus ( pump up BP Cuff)
• arrhythmias heart is a MUSCLE
• DTRs- INCREASED
• mind changes
• swallowing problems- esphagus is a smooth MUSCLE

81. what are some foods that are high in magnesium? - Correct

answer - spinach

• mustard GREENS
• squash
• pumpkin seeds
• flax seeds

82. the nurse is caring for a client post colonoscopy. the client reports a small amount of abdominal discomfort and there is a drop of bright red blood on the sheet. what is the priority nursing intervention?
83. reassess in 15 min
84. call the primary healthcare provider
85. call for STAT H&H
86. instruct the client to stay in bed - Correct answer 2. call the primary healthcare provider
87. intervention is required with which client?

• a client with a HX of generalized ( tonic clonic ) seizures or a

client that is 8 hr post heart cath? - Correct answer -

client that is 8 hr post heart cath

88. TIP: no happy questions. ALWAYS BE WORRIED about hemorrhaging maybe the doc. punctured/perforated something. pick an answer that fixes the problem.
89. when you think of sodium in the body what should you think

of first? - Correct answer - neuro changes

• the brain does not like when NA + is messed up
• the sodium level in your blood is totally deoendent on how much water you have in the blood

90. hypernatremia also another word for? - Correct answer -

dehydration

91. hypernatremia means what? - Correct answer - too much

sodium ; not enough WATER

92. what are the causes of hypernatremia? - Correct answer -

hyperventilation

• heat stroke
• diabetes insipidus ( DI)

93. what is the normal lab value for sodium? - Correct answer 135-145 mEq/L

94. signs and symptoms of hypernatremia - Correct answer -

dry mouth

• thirsty already dehydrated by the time you're thirsty
• swollen TONGUE
• neuro changes

95. what is the treatment for hypernatremia - Correct answer

- restrict sodium - dilute clients with fluids ( diluting makes sodium go DOWN - daily weights - I&O - lab work

96. If you have a sodium problem you have a _______ problem?

• Correct answer FLUID

97. hyponatremia is another word for what? - Correct answer

- dilution

98. definiton of hyponatremia - Correct answer too much water; not enough SODIUM

99. what are the causes of hyponatremia - Correct answer -

drinking H2O for fluid replacement ( vomiting, sweating) ( this only replaces water and dilutes the blood)

• psychogenic polydipsia; loves to drink WATER
• D5W ( sugar & water)
• SIADH; retaining WATER

100. what are the S/S of hyponatremia - Correct answer -

headache

• seizure

• coma

101. what is the treatment of hyponatremia? - Correct answer

- client needs SODIUM - client doesnt need WATER

102. case in point: feeding tube clients tend to become ___________ - Correct answer dehydrated

103. what is the normal lab values for potassium? - Correct

answer - 3.5- 5.0 mEq/L

104. potassium is excreated by the ________ - Correct answer kidneys
     • if the kidneys are not working well, the serum potassium will go UP!

105. what are the causes of hyperkalemia? - Correct answer -

kidney trouble

• spironolactone ( aldactone) - makes you RETAIN potassium

106. what are the signs and symptoms of hyperkalemia? -

Correct answer - begins with muscle twitching

• then proceeds to muscle twitching/weakness
• then flaccid paralysis

107. when the symptoms " begins with muscle twitching" what

does that alternative mean? - Correct answer - life threatening

arrhythmia

108. what is the treatment for hyperkalemia? - Correct answer

- dialysis- kidneys arent working - clacium guconate decreases ARRYTHMIAS - glucose and insulin= insulin carries GLUCOSE & POTASSIUM into the cell - sodium polystyrene sulfonate Kayexalate ( the K = pot. level)

109. sodium and potassium have what kind of relationship? -

Correct answer - inverse

110. what are the causes of hypokalemia? - Correct answer -

vomiting

• Ng suction ( we have lots of potassium in the stomach)
• diuretics
• not eating

111. what are the S/S of hypokalemia? - Correct answer -

muscle CRAMPS

• mulsce weakness

112. what is the treatment for hypokalemia? - Correct answer -

give potassium

• spironolactone ( Aldactone) - makes the client retain POTASSIUM
• EAT more potassium

113. what is the major problem with oral potassium? - Correct

answer - GI UPSET

114. what do you assess for when administering before/during IV

potassium? - Correct answer - urinary output ( UO)

115. what should you let the patient know will happen once you

start to administer IV potassium? - Correct answer - burning

sensation

116. what foods are high in potassium? - Correct answer -

spinach , kale, GREENS

117. what are three major chemicals one should remember? -

Correct answer - bicarb ( base)

• hydrogen ( Acid)
• CO2 ( acid)

118. what is a major lung chemical? - Correct answer - CO2

( ACID)

119. what is the major kidney chemical? - Correct answer -

bicarb ( hydrogen)

120. too much or too little of all the chemicals ( CO2, bicarb, and

hydrogen) can cause a what? - Correct answer - acid base

IMBALANCE

121. what is the normal PH level? - Correct answer - 7.35- 7.45

122. pH less than 7.35 means what? - Correct answer - acid

123. pH more than 7.45 means what? - Correct answer - base

( alkaline)

124. what part of the body hates when the pH is messed up? -

Correct answer - the body ( brain)

125. what kind of mental state can a pt. be when they are

acidotic? - Correct answer - lethargic

126. what kind of mental state can a pt. be when they are

alkalotic? - Correct answer - excitable

127. how does the body keep the pH within normal range? -

Correct answer - compensation

128. kidneys remove excess acid and bicarb by ________ them through the urine - Correct answer excreting
129. kidneys can ______ hydrogen and bicarb and return to the blood - Correct answer retain

130. what is one way the lungs get rid of CO2? - Correct answer

- exhale

131. hyperventilation does what to the lungs? - Correct answer

- lowers CO2 ----> retaining

132. hypoventilation does what to do the body? - Correct

answer - raises CO2------> eliminating

133. how long does kidneys take to compensate? - Correct

answer - hour to days

134. how long does the lungs take to compensate? - Correct

answer - FAST

135. what are the causes of resp. acidosis? - Correct answer -

retain CO 2

• mid- abdominal incision , narcotics, sleeping pills, pneumothorax, collapsed lung, and pneumonia

136. what are the Signs and symptoms of resp. acidosis? -

Correct answer - headache, CONFUSED, sleepy

• if those symptoms ^ are not corrected it could lead to a COMA
• as the acid increases the level of consciousness goes down

137. what should you do if a pt has hypoxic - Correct answer -

give pt oxygen

138. early signs and symptoms of hypoxia are what? - Correct

answer - restlessness & tachycardia

139. what happens if the CO2 level is increased? - Correct

answer - lowers the LOC & lowers the O2

140. what kind of relationship does CO2 and O2 have? - Correct

answer - inverse relationship

141. when you think of the word restlessness you should think of

what first? - Correct answer - HYPOXIA

142. what is the normal lab value for PaCO2? - Correct answer 35- 45 mmHg

143. what is the normal lab value for PaO2? - Correct answer -

80-100 mmHg

144. what is the normal lab value for HCO3 bicarbonate? -

Correct answer - 22-26 mEq/L

145. what is the treatment for respiratory acidosis? - Correct

answer - fix the BREATHING problems

• pneumonia
• pneumothorax ( will have chest tubes)
• encourage post -op clients to turn, cough, DEEP BREATHE

146. when you think of respiratory alkalosis you should think of what? - Correct answer hyperventilation

147. what are the causes of respiratory alkalosis? - Correct

answer - hyperventilation

• hysterical ( situation)
• acute aspirin overdose

148. is a patient is hysterical and has acute aspirin overdose the client is breathing _______ and therefore, removing ___________

• Correct answer - fast
• CO2

149. what are the signs and symptoms of resp. alkalosis? -

Correct answer - lightheaded or faint feeling

• peri-oral numbness and tingling in the fingers and toes

150. what is the treatment for resp. alkalosis? - Correct answer

- may have to SEDATE client to decrease resp. rate - treat the cause - monitor ABGs

151. what is the cause of metabolic acidosis? - Correct answer -

DKA

• Starvation
• Renal failure
• severe diarrhea ( lower GI think BASE, LOSING BASE)