NCLEX –PN NEXT GEN 2024 UPDATE QUESTIONS AND ANSWERS ACTUAL GUIDE, Exams of Nursing

Download NCLEX –PN NEXT GEN 2024 UPDATE QUESTIONS AND ANSWERS ACTUAL GUIDE and more Exams Nursing in PDF only on Docsity! NCLEX –PN NEXT GEN 2024 UPDATE QUESTIONS AND ANSWERS ACTUAL GUIDE Fifth Disease - --"slapped face" - viral illness mainly affects school children Spread through secretions Will recover in 7-10 days Give ibuprofen for join pain Cover mouth during coughing or sneezing Naproxen -NSAID - --Take with food Notify Dr of tarry stools Increased bleeding risk GTPAL - --Gravida - # of pregnancies Term - # of term (37 weeks) Preterm - #of 20 - 36 weeks Abortion - # of abortion Living - # living Teens with illness.. - --engage in risk taking behavrios and want to be like their peers. They may have difficulty managing their illness or have a false sense ofsecurity Pseudomenstration - --Small amount of bleeding that may happen in newborns; this is normal and just continue to monitor Nocturnal Enuresis teaching - --Enuresis alarm attached to underwear Encourage fluids during the day but restrict at night void before bed positive reinforcement (calendar) avoid diapers awaken at night to void Anorexia Nervosa s/s - --Amenorrhea Fluid Electrolyte imbalance Lanugo weight loss of 25% below normal excessive exercise cold intolerance Cyclobenzaprine - --muscle relaxant metabolized by the liver, avoid with pts with liver disease -distended abdomen -difficulty feeding -vomiting green bile -do not pass meconium w/in 24-28 hours Ectopic Pregnancy - --emergency if ruptured - sudden onset of abdominal or pelvic pain. May also have shoulder pain. Molar Pregnancy - --not a viable pregnancy -dark brown discharge -cannot become pregnant within one year and have frequent checks for cancer -sartan -pril cannot be given to..... - --pregnant women normal platelet count - --150,000 - 400,000 vancomycin & -myacin drugs - --can cause nephrotoxicity and ototoxicity be alert for increased BUN & creatinine levels Erythropoietin - ---Initiated when hemoglobin <10 -d/c >11 -HTN major side effect, BP should be checked -given IV Paracentesis - ---removes excess fluid from abdominal cavity -obtain baseline vitals & girth -void to prevent bladder puncture -high fowlers -after reassess vitals/girth -monitor site for bleeding NPO NOT required Informed consent is obtained from the PCP - not nurse how to apply suppository to children <3 - ---supine w/ knees & feet raised -guide against rectal wall -fifth finger -hold buttocks together -must be past the external and internal sphincter During a panic attack, what is priority.. - ---stay with the patient, offer support and reassurance -calm enviroment -speak calmly using simple clear words C-Diff care - ---Private room (isolation) -hand washing -disposable gown & gloves -all surfaces w/in 3 feet considered contaminated -dedicated equipment contact diesease - ---draining abscess -c-diff -head lice, scabies -pink eye -diarrhea (in young child) -herpes (open lesions) -impetigo -mrsa S/S of DVT - ---unilateral leg edema -local warmth -erythema -low grade fever Note: varicose veins can be risk factor Postpartum Endometritis S/S - ---Fever -Chills -Uterine Tenderness Position for paracentesis - ---High Fowler's - facilitate flow of fluid to the bottom of the peritoneal cavity where needle will be inserted have empty bladder Position for air embolism - ---Trendelenburg and on left side. This will cause the air to rise to right atrium Position for chest tube insertion - ---arm raised above head. Semi-fowlers to reduce injury to diaphragm Position for liver biopsy - --lie on right side for min of 2 hours. (to apply pressure) and then supine for 12-14 hours position for lumbar puncture - ---side lying with head, back, and knees flexed. Nursing intervention to reduce aspiration risk in patients with enteral tube feeding - ---asses tube placement -keep head of bed >30 -keep endotracheal cuff inflated -suction secretions -use caution w/ sedatives -avoid bolus feeding -gastric residual should be checked q4 hrs Cane Use - ---used on the unaffected side Cardiac Catheterization exp: coronary angiography - --report signs of back or flank pain, possible bleeding ways to reduce SIDS - ---back to sleep -breastfeeding -stop smoking -firm bed -pacifier use at bed best indicator that treatment of acute asthma attack has been successfull - ---improved o2 sat -statin meds report what s/s - --muscle aches or weakness may be rhabdomyolysis Pavlik Harness - ---assess skin for redness -dress child in shirt and knee socks under harness -avoid lotion or powders -lightly massage skin -place diaper under straps -DO NOT remove during diaper changes Disulfiram - --used for alcoholism priority is including list of items that contain hidden alcohol risk factors for child otitis media - ---frequent use of pacifier -infant immunization schedule -position while drinking bottle -smoke exposure first trimester weight gain - --1-4.4 lb beta blockers are not good for - --acute decompensated heart failure OMEPRAZOLE - --helps prevent ulcer due to stress of surgery. helpful for GERD S3 is normal for.. - --children abstinence syndrome - --mothers who used drugs while pregnant - baby will have issues -stuffy nose, yawning, sneezing -irritability, high-pitched cry -abnormal sleep -poor feeding -V/D -avoid milk - keep no more than 1 month Sleep hygiene - ---engage in physical activity 5 hours before bedtime -receive at least 20 minutes of natural sunlight -take a bath, read, listen to soft music right before bed -dark, cool, quiet room -drink warm milk Licorice root - --can increase potassium loss when taking thiazide diuretics spironolactone may be given in addition to hydrochlorothiazide for what reason - --to reduce potassium loss S/S of Uterine Rupture - --VBAC (Vaginal birth after cesarean) have a increased risk for uterine rupture. -encouraged to wait for natural labor rather than induction -signs, abnormal FHR, constant abdominal pain, loss of fetal station, sudden cease in contraction, maternal tachycardia methotrexate - --Rheumatoid arthiritis med can cause bone marrow suppression. be alert for any infections Sputum Collection - ---rinse mouth w/ water -Sit on the side of the bed or in high fowerls -inhale deeply several times -cough deeply into sterile container beta blockers - --can cause broncho constrictions Rheumatoid Arthritis - ---relieve pain with moist heat -perform ROM -use ice on joints -do NOT sleep w/ pillow under knees - can leade to contracture Peak Flow Meter Use - ---exhale quickly and forcibly -perform 3 times -highest volume is recorded Neonate findings - --- 30-60 breaths per min -milia (white papules) -Glucose (<70-100) neonate w/ single transverse crease across palm - --sign for downs syndrom paroxetine - --antidepressant -SSRI -weight gain is common side effect -increased suicide thoughts at beginning of treatment -sexual dysfunction -never discontinue suddenly varicella vaccine - patient gets 2 vesicles and redness at injection site - ---cover with clothing or small bandage teaching for patients with heart failure - ---measure & record daily weight -restrict sodium -caution w/ OTC meds, such as laxatives, cough meds, & antacids -taking pulse for 1 min -increase walking & other activities gradually -avoid extreme temps pyrosis - --heartburn ways to relieve heartburn associated with pregnancy - ---keep the head of the bed elevated -sitting upright after meals -small meals -avoid tight clothes -eliminate dietary triggers -drink minimal fluids while eating Delirium Tremens - --Patient who are in alcohol withdrawal after a procedure: 48-96 hrs since last drink -2 finger pincer grasp -hits 2 objects together -3-5 words -waving -separation anxiety -searches for hidden objects 18 month old - ---walks up & down stairs -throws -jumps in place -builds 3-4 block tower -turn 2-3 pages -scribbles -uses cup/spoon -10+ words -identifies common items -has tantrums -"mine" -imitates 2 year old - ---walks up & down stairs alone -runs -kick ball -build 6-7 block tower -turn 1 book page -draw line -300+ word -2-3 phases -states name -gain independence Displacement - --Shifts uncomfortable feelings about one situation to another person. Exp. family yells at patient, then patient yells at room mate Projection - --Feeling uncomfortable with an impulse of feeling and easing the anxiety by assigning it to another person. EXP. husband w/ thoughts of infidelity who than accuses wife of being unfaithful Lumbar Puncture - ---patients head and knees tucked in and back rounded Tonsillectomy post op teaching - ---Bleeding can be a complication up to 2 weeks -Report frequent swallowing -avoid coughing, clearing throat, and blowing nose -Limit physical activity -avoid gargling and vigorous teeth brushing -low grade fever and ear pain are expected Acute Diarrhea (children) nurse teaching - ---oral rehydration #1 -continue normal diet (brat diet not recommended) -do NOT give antidiarrhea meds -record # of wet diapers, check for sunken eyes, pt at risk for dehydration Kawasaki Disease priority - --Disease that causes inflammation of the arterial walls -NOT contagious -causes red tongue, cracked lips, skin peeling Initial treatment is IV immune globulin and aspirin -should be monitored for pulmonary edema & signs of fluid overload. Heat failure Report decrease urinary output, and additional heart sounds tachycardia and difficulty breathing digoxin OKAY TO GIVE INSULIN Nystatin use - --swish liquid in mouth for several minutes and then swallow it Patient w/ TB, or measles, or varicella...when being out of the negative pressure room.. - --wear a surgical mask target glucose for patients on TPN - --140-180 anything under <70 is hypoglycemia CD4 normal limits - --500-1,200 how to give infants liquid medication - ---admin small amounts at the back of the cheek using a syringe decreases choking hazard EpiPen use - ---always have within reach at all times -give at first signs of shock -mid-thigh and okay through clothes -call 911 or go to ER How often do you change Peripheral IV - --72-96 hours Prevention of falls in a long term facility - ---Exercise Programs (help gain strength) -Proper lighting -Handrails -hourly rounds -Non-slip shoes Interventions to reduce thick mucus and facilitate removal - ---increase fluids -cool mist humidifier -give guaifenesin -abdominal breathing w/ huff -chest physiotherapy -air way clearance devies Herbal Supplements that pose a risk for bleeding - ---Garlic -Ginger -Ginkgo Biloba -Ginseng Is Huntington's genetic? - --Yes, patients should receive genetic counseling before starting a family Buerger Disease (thromboangiitis oblitrans) - --nonatherosclerotic - involving small and medium arteries. Young men who smoke are typically affected. -avoid exposure to cold -stop smoking Mastectomy surgery - post surgery position - --Semi Fowler w/ affected arm on several pillows to promote drainage and prevent pooling Levothyroxine - --taken separately from other meds - in the am how long is warfarin given following a PE - --3-6 months and then can be discontinued. may be on a longer duration if recurrent PE are happening Risk Factors for DVT - ---Drink plenty of fluids, decrease caffeine & alcohol -elevate legs and dorsiflex -begin walking as soon as possible -stop smoking -avoid tight clothes -traveling does not need to be avoided carbamazepine - --associated w/ agranulocytosis Histrionic Personality Disorder - --likes to be center of attention, exaggerated emotional expression, demands immediate gratification PTSD symptoms - ---Difficulty Concentrating -Feeling detached from others -Flashbacks patient experiences vertigo, N/V, drop attacks -fall precautions -quiet dark room, no TV position after cardiac cath lab - --flat w/ affected extremity straight position after lumbar puncture - --flat to reduce headache water broke and umbilical cord is protruding - --position patient on hands and knees or trandelenburg - the cord may cause cord compression a emergency c section is usually required incident/occurance reports - --document events that pose unanticipated actual or potential risk for health or safety of client, visitor, or employee Exp: assault to employee client/staff/visitor falls failure to obtain or follow up on results delayed meds or therapy how long can you suction the trach? - --5-10 seconds Best way to relieve contraction pain when baby is in fetal occiput posterior position - --this causes intense back pain, nurse can apply counter pressure to moms sacrum Best way to relieve best engorgement pain - --allow newborn to nurse for at least 10-15 min each breast When assessing a child.. - --ears,mouth, nose last! minimal contact initally Corticosteroid teaching - ---do not stop abruptly -report s/s of infection -times of stress may require increase -diet high in calcium and protein -take w/ food -yearly eye appt for cataracts -flaxacin meds - --report pain in achilles tendon what ethnicity has the highest risk for getting a cough side effect on a -pril - --Asains first intervention when a feeding tube is clogged - --flush and aspirate w/ warm water in a back & forth motion if that doesn't work, try digestive enzyme Pediculosis Capitis treatment - ---boil hair brushes -vacuum rugs and carpets frequently -nit comb every daily for 2 weeks -may need to treat siblings AVF - for hemodialysis care - ---report numbness/tingling -do not draw blood or BP on that arm -do not carry heavy objects -squeeze small soft object several times a day -do not sleep on that side psoriasis - --autoimmune disease -rapid turnover of epidermal cells - silver plaques on reddened skin -Sunlight can slow turnover (good) -no cure -avoid triggers drawing blood - ---do not leave tourniquet on for more than 1 minute -if pulsating red blood is noted, withdraw needle and apply pressure for 5 minutes -do not use veins on the ventral side of wrist -invert tube gently 5-10 times to mix -npo 8-12 hours before test peritoneal dialysis - related perotonitis - --rebound tenderness chills abdominal pain stop dialysis and collect c/s theophylline toxicity - --worried about seizures and arrhythmia normal creatinine - --0.6-1.3 biggest concern of a thyroidectomy - --"noisy breathing" may be a stridor hep b transmission - --b = body fluids hep a - --feces/hand washing food handling long term use of omeprazole causes increased risk for.... - --C-DIFF, decreased bone density, pneumonia common meds to avoid during pregnancy - --doxycycline, isotretinoin, -pril hypoglycemia s/s - --diaphoresis pallor trembling palpitations restlessness/anxiety caring for patient w/ exophthalmos (eye bulging) - ---raise head of bed -artifical tears -tap eyes shut during sleeping if they dont close -use dark glasses -restrict salt -stop smoking -move eyes to maintain felxibility african americans women at risk for - --HTN, ischemic stroke, cervical cancer more at risk for angioedema tongue swelling symptoms to report for patient w/ acute pancreatitis - --high grade temp and worsening abdominal pain how to feed a baby w/ cleft palate - ---burp the baby often -feed upright -use specialty bottle -tilt bottle down and away from cleft -slowly feed over 2-3- mins waysto avoid dysplasia in infants - ---swaddle -car seats w/ wide bases live virus vaccines - --varicella-zoster vaccine, measles-mumps-rubella, rotavirus newborn respirations - --Newborns normally have respirations of 30-60/min, with periodic pauses lasting <20 seconds. Sustained tachypnea, nasal flaring, retractions, and grunting are signs of newborn respiratory distress. meds that cannot be given via NG tube - ---Eteric coated -slow/extended/sustained release nursing interventions for polycythemia vera - --at risk for blood clots -elevate leg & feet when sitting -increase fluid -report swelling or tenderness -do NOT increase iron -may cause itchyness nurses role post amniotomy - ---monitor temp q2 hours calm & quiet Serotonin syndrome - --Clinical manifestations of serotonin syndrome include mental status changes (eg, anxiety, agitation, disorientation), autonomic dysregulation (eg, hyperthermia, diaphoresis, tachycardia/hypertension), and neuromuscular hyperactivity (eg, tremor, muscle rigidity, clonus, hyperreflexia). signs of sepsis - --absent bowel sounds cap refill >3 increased BS SOB restless/difficult to wake corticosteroids can worsen.. - --increased blood sugar (may need increased insulin) HTN also paired w/ NSAIDS increase risk for peptic ulcer nursing care persecutory delusions: schizophrenia - --patient feels they are being persecuted or harmed focus on feelings secondary to delusion Example: "I understand that it is frightening to think that someone is trying to poison you." Focusing on reality and verbally reinforcing it will decrease the time that the client spends thinking about the delusions lithium levels - --0.6 - 1.2 1.5 is toxic = confusion, tremors, ataxia Infant w/ Tetralogy of Fallot is expeiencing a 'tet spell' what to do first? - --Tet spells can happen when a infant is crying, becomes upset or is feeding. The baby should be placed in knee to chest position. S/S are cyanotic, difficulty breathing Peptic Ulcer Disease - --avoid -NSAID -Smoking -food before sleeping -limit alcohol & caffeine Child Abuser statistics - ---Often have a hx of growing up in an enviroment of domestic abuse -hx of substance abuse -both men & women equally do it -teenage parents Bishop Score - --determines cervical favorability and readiness for induction of labor. >8 will be successful Apraxia - --Loss of ability to perform a learned movement Pulmonary TB S/S - ---Night sweats -Purulent or blood tinged sputum -Weight loss -low grade fever -Cough -SOB Where is 'continuous bubbling' found in the chest tube drainage system? - --Suction Control chamber. this is normal Esophageal Atresia (EA) & tracheoesophageal fistula (TEF) newborn - --Can be corrected surgically. S/S - Frothy saliva, choking, coughing, and drooling interventions: -NPO -Supine w/ elevated head -G-Tube may be placed -no feedings or irrigations through tube until surgery -keep suction equipment near bismuth subsalicylate - --is pepto bismol & contains aspirin and children cannot have this can have acetaminophen & ibuprofen - ok Kawasaki disease - what to report - --Parents should report any fever. It should be checked every 6 hours for 48 hours. Patient should hold cath lab if... - ---previous allergy to IV contrast -renal impairment (>1.3) -taken metformin in the last 24-28 hours CNA responsibility w/ restraints - ---ROM -Reapply after toileting -Report skin changes -turn implanted cardioverter defibrillator - ---NO ARM LIFTING the affected arm above the shoulder -firing may be painful -travel is not restricted -driving may be approved after healing SIADH - --*water retention, increased body water, hypoatremia -Seizure precautions -Fluid RESTRICTIONS -Salt tablets -Hypertonic saline - not normal saline -strict I&O -daily weights -neurologic status (confusion, seizures) Bacterial Meningitis - --Inflammation of brain & spinal cord -common complication is ICP and hydrocephalus - check for bulging fontanel acute otitis media - ---pulling ear -refusal to eat -restless irritable -tympanic membrane bulging & very red -high fever up to 104 Pursed-lip breathing - --Inhale for 2 seconds through nose, keeping mouth closed Exhale for 4 seconds through pursed lips Buspirone - --for anxiety -not habit forming, no withdrawal symptoms when stopping -will take 2-4 weeks for full effect -not for acute panic attacks Benztropine - --used for extrapyramidal symtoms dabigatran - --reduces clots enforce bleeding precautions kept in original container take w/ glass of water notify if blood in stool Reduce risk of diverticullitis - --encourage fluids exercise regularly include whole wheat, fruit, and veggies high fiber thoughts on death (kids) - --birth-2: no understanding 3-5: reversible 6-9: understands 10-12: understands, eventually affects everyone teens: adult level; spiritual etc