Next Generation NCLEX NGN Exam Q&A/ NGN NCLEX PN Practice Questions and 100% Correct Ans, Exams of Nursing

Download Next Generation NCLEX NGN Exam Q&A/ NGN NCLEX PN Practice Questions and 100% Correct Ans and more Exams Nursing in PDF only on Docsity! Next Generation NCLEX NGN Exam Q&A/ NGN NCLEX PN Practice Questions and 100% Correct Answers Updated 2023-2024 When selecting an NCLEX answer or determining the order of priority what should you remember or use and what is the exception? -------- Correct Answer ------- Use the ABC rule: Airway breathing, and circulation. The exception to the rule is with actual CPR, use C-A-B for CPR. Also remember safety first and acute before chronic. If the pt. is not in distress then you assess. If the pt is in distress then you should do something. If the pt has diaphorisis you should always do something. How should you address questions related to Maslow's Hierarchy of Needs -------- Correct Answer ------- Address physiological needs first, followed by safety and security needs, love and belonging needs, self esteem needs and finally self actualization needs. *When a physiological need is not addressed in the question, look for the option that addresses safety. If a question is related to the nursing process, read the question to determine the step of the nursing process. What are the steps in the nursing process and what kind of question might be related to that step. -------- Correct Answer ------- Assessment question address the gathering and verification of data. Analysis questions require the nurse to: interpret data, collect additional information, identify and communicate nursing diagnoses and determine the health team's ability to meet the pts needs. Planning questions ask about determining, prioritizing, and modifying outcomes of care. Implementation questions reflect the management and organization of care and the assignment and delegation of tasks. Be prepared for questions on client teaching. Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes and on communicating and documenting findings. What are the normal ranges for H&H? What are the nursing implications -------- Correct Answer ------- Hemoglobin - Male 14-18 Female 12-16 Newborn 14-24 High altitude living increases value, slight decrease during pregnancy. Drug therapy can alter values. Hematocrit - Male 42-52 Female 37-47 Newborn 44-64 Prolonged stasis from vasoconstriction secondary to the tourniquet can alter values. Abnormalities in RBC size may alter Hct values What are the normal ranges for WBC? What can increase values? What can decrease values? How long does the postpartum period of pregnancy affect normal ranges? What range is normal during the postpartum period? -------- Correct Answer ------- Both genders 5000-10000 Newborn 9000-30000 Anesthetics, stress, exercise, and convulsions can increased values. Drug therapy can decrease values. 24-28 hr postpartum: a count as high as 25000 is normal What are the normal ranges for RBC? What can increase levels What happens to levels during pregnancy? -------- Correct Answer ------- Males: 4.7-6.1 million Female: 4.2-5.4 million Exercise and high altitudes can cause an increase levels pregnancy usually lower values drug therapy can alter values Never draw a specimen from an arm with an infusing IV. What are the normal ranges for PLATELETS? What may increase values? What may decrease values? What drugs decrease values? -------- Correct Answer ------- Both Genders: 150000- 400000 Living at high altitudes, exercising strenuously or taking oral contraceptives may increase values decreased values may be caused by hemorrhage, DIC, reduced production of platelets, infections, use of prosthetic heart valves, and drugs. Drugs that decrease platelets: acetaminophen, aspirin, chemotherapy, H2 blockers, INH, Levaquin, streptomycin, sulfonamides, thiazide diuretics. What are the normal ranges for K+? What should you keep in mind when getting a specimen? -------- Correct Answer ------- 3.5-5 is normal range for potassium Exercise of the forearm with tourniquet in place may cause an increased level. Hemolysis of specimen can result in a falsely elevated value What are the normal ranges for Na+? What should you consider when collecting a specimen? -------- Correct Answer ------- 136-145 is a normal sodium range 4. Right time 5. Right patient 6. Right documentation 7. Right to refuse When should you draw a peak level? -------- Correct Answer ------- 30-60 minutes after medication administration When should you draw a trough level? -------- Correct Answer ------- 30-60 minutes before medication administration When introducing foods to infants what should you teach the new parents? -------- Correct Answer ------- Introduce one food at a time to help identify allergies. Progression of food should be "AS TOLERATED" The nursing assessment guides decisions about progression. What is civil law concerned with? -------- Correct Answer ------- Protection of the patients private rights What does criminal law deal with? -------- Correct Answer ------- Rights of individuals and society as defined by legislative laws What is nursing negligence -------- Correct Answer ------- Negligence is malpractice that is NOT intentional. It is the failure to exercise the proper degree of care required by the circumstances that a reasonably prudent person would exercise under the circumstances to avoid harming others. It is a careless act of omission or commission that results in injury to another. What is nursing malpractice? -------- Correct Answer ------- Malpractice is not always negligence. It is often referred to as professional negligence, it is a type of negligence. It is the failure to use that degree of care that a reasonable nurse would use under the same or similar circumstances. Malpractice is found when: *The nurse owed a duty to the patient *The nurse did NOT carry out the duty/breached that duty *The patient was at a high risk of injury * The nurse's failure to carry out that duty caused the patients injury Where do Standards of Care originate? -------- Correct Answer ------- Nurses are required to follow standards of care, which originate in the Nurse Practice Acts, state and federal laws, accreditation recommendations, the guidelines of professional organizations, and the written policies and procedures of the healthcare agency What are nurses responsible for related to the standards of care? -------- Correct Answer ------- Nurses are responsible for performing procedures correctly and exercising professional judgment when implementing healthcare providers prescriptions. When can the nurse NOT follow the healthcare provider's prescription and what must they do about it? -------- Correct Answer ------- Nurses MUST follow the healthcare provider's prescription unless the nurse believes that it is in error; that it violates hospital policy; or that it is harmful to the patient. The nurse makes a formal report explaining the refusal. The nurse should file an incident (occurrence) report for any situation that may result in harm to the patient. What should the nurse do related to advanced medical directives (ADs) -------- Correct Answer ------- Assess the patients knowledge of advance directives. Integrate them into the patients plan of care Provide the patient with information about advanced directives or review ADs on admission. Have the knowledge that ADs can limit life-prolonging measures when there is little or no chance of recovery What is documented in a living will? -------- Correct Answer ------- A person documents his or her wishes regarding future care in the event of terminal illness What is a durable power of attorney for healthcare? -------- Correct Answer ------- The person appoints a representative (healthcare proxy) to make healthcare decisions in a document When can restraints be used? What must the nurse do if restraints are used? -------- Correct Answer ------- Restraints can be used only: to ensure the physcial safety of the patient or other residents, when less restrictive interventions are not successful, and must have a written order of a HCP. The nurse must follow agency policy and procedure to retrain any client, Documentation of the use of restraints and of follow-up assessments must detail the attempts to use less restrictive interventions. Liability for improper or unlawful restraint lies with the nurse and the healthcare facility. 30 min pulse checks, 2 hr ROM, one on one, Related to mental Health, how long can an involuntary admission last? -------- Correct Answer ------- 72 hours What is HIPPA and what does it require? -------- Correct Answer ------- Health Insurance Portability and Accountability Act of 1996 established standards for the verbal, written and electronic exchange of private health information. HIPPA created patient rights to consent to use and disclose health information, to inspect and copy one's medical record, and to amend mistaken or incomplete information. HIPPA requires all hospitals and health agencies to have specific policies and procedures in place to ensure compliance with its standards. What is required for informed consent to be valid? -------- Correct Answer ------- the patient giving consent must be competent and of legal age. The consent is given voluntarily. The patient giving consent understands the procedure, risks/benefits, and alternative procedures. The patient has the right to have all questions answered satisfactorily. It is the duty of the HCP performing the procedure or treatment to obtain informed consent and to answer any questions the patient might have about the procedure. The RN is witnessing the signature not providing informed consent. what type of communication and leadership is it if the person says "do it my way"? ------- - Correct Answer ------- Aggressive communication/authoritarian leader What type of communication and leadership is it if the persons says "Whatever...as long as you like me." -------- Correct Answer ------- Passive communication/laissez-faire leader What type of communication and leadership is it if the person says "Lets consider the options available."? -------- Correct Answer ------- Assertive communication/democratic leader What are the five rights of delegation? -------- Correct Answer ------- 1. right task 2. right circumstance 3. right person 4. right direction/communication 5. right supervision What skills are needed for Supervision -------- Correct Answer ------- Be able to: give direction/guidance evaluate/monitor following up What is the acronym S-BAR stand for? -------- Correct Answer ------- It is a interdisciplinary communication strategy that promotes effective communication between caregivers S = situation - State the issue or problem B = background - provide history A = assessment - most recent VS and current findings R = recommendation - state what should be done What are the 3 categories of pain medications -------- Correct Answer ------- 1. non- opioids: for mild pain or in combination for moderate pain 2. Opioids: for moderate to severe pain 3. Co-analgesic or adjuvant drugs (i.e. anticonvulsants, antidepressants) for neuropathic pain Name 4 types of Nonopioid Analgesics -------- Correct Answer ------- 1. Acetaminophen: Tylenol 2. Salicylates: Aspirin, Trilisate 3. NSAIDS: ibuprofen, Indomethacin, Ketorolac, Diclofenac 4. COX-2 inhibitors: Celebrex ALOC What may be some Lab findings r/t fld volume excess -------- Correct Answer ------- Everything will be decreased Decreased: BUN, Hgb/Hct, serum osmolality, urine specific gravity and electrolytes How would you treat fluid volume excess? -------- Correct Answer ------- Give Diuretics (Lasix), fluid restrictions, weigh daily, monitor K+ What can cause a fluid volume deficit -------- Correct Answer ------- Inadequate fluid intake hemorrhage vomiting or diarrhea massive edema What are some symptoms of fluid volume deficit -------- Correct Answer ------- weight loss oliguria (not enough urine) postural hypotension What lab findings may be present with a fluid volume deficit? -------- Correct Answer ----- -- Increased BUN Increased or normal creatinine Increased H/H Increased urine specific gravity How do you treat fluid volume deficits? -------- Correct Answer ------- Strict I&O Replace with isotonic fluids monitor Bp weight daily What is most important to remember about intracellular electrolyte balance? -------- Correct Answer ------- That potassium K+ maintains osmotic pressure and if K+ is not in balance it may be life threatening. What is most important to remember about extracellular electrolyte balance? -------- Correct Answer ------- That sodium Na+ maintains most abundant osmotic pressure. When either the ECF or the ICF changes in concentration, fluid shifts from the area of lesser concentration to the area of greater concentration. What is Hyponatremia? Symptoms? and How should you treat it -------- Correct Answer ------- Hyponatremia is a sodium (Na+) level less than 135 mEq/L, it creates Neuro/confusion and muscle cramps. Check blood pressure often, restrict fluids, and be cautious with IV fluid replacement. What is Hypernatremia? What symptoms might you see? How should you treat it? ------- - Correct Answer ------- Na+ greater than 145 mEq/L May see: Pulmonary edema Neuro: seizures, thirst, fever. Do Not Use Ivs that contain sodium Restrict sodium diet Weigh daily What is Important to remember about Hypokalemia -------- Correct Answer ------- Hypokalemia is a K+ level less than 3.5 mEq/L. Affects the cardiac system: The patient may exhibit a rapid, thready pulse, flat T waves, fatigue, anorexia, and muscle cramps. Give IV potassium supplements with a max flow rate of 20 meq/hr. Encourage foods high in K+ (bananas, oranges, spinach, potatoes, milk, strawberries, apricots) What is Hyperkalemia, what might you see with the patient and how do you treat it? ----- --- Correct Answer ------- Hyperkalemia is a K+ level greater than 5 mEq/L You may see tall, tented T waves, bradycardia, muscle weakness. Treatment may include: - 10%-20% glucose with regular insulin - Kayexalate - renal dialysis may be required What is Hypocalcemia, What might the patient exhibit? How will you treat it? -------- Correct Answer ------- Hypocalcemia is a Ca2+ level of less than 8.5 meq/L It affects the muscles: You may see a + Trousseau's sign, + Chvostek's sign, diarrhea, numbness, and convulsions. Treatment may include: calcium supplements and vitamin D to absorb. If giving IV calcium, give it slowly. Teach patient to increase dietary calcium. How do you test for the Chvostek sign and what happens if there is a positive response? -------- Correct Answer ------- Elicitation: Tapping on the face at a point just anterior to the ear and just below the zygomatic bone Postitive response: Twitching of the ipsilateral facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia How do you test for the Trousseau's sign and what happens if there is a positive response? -------- Correct Answer ------- Elicitation: Inflating a sphygmomanometer cuff above systolic blood pressure for several minutes Positive response: Muscular contraction including flexion of the wrist and metacarpophalangeal joints, hyperextension of the fingers, and flexion of the thumb on the palm, suggestive of neuromuscular excitability caused by hypocalcemia What is Hypercalcemia? What signs and symptoms may be present? and how do you treat it? -------- Correct Answer ------- Hypercalcemia is a calcium level above 10.5 mEq/L Calcium affects the muscles, you may see muscle weakness, constipation, n/v, dysrhythmias, and behavioral changes. Limit vitamin D intake but push fluids. Avoid calcium-based antacids. Administer calcitonin to reduce calcium Renal dialysis may be required Name 3 types of IV fluids -------- Correct Answer ------- Isotonic: 0.9% NS, LR, and D5w Hypotonic: 0.5% NS, 0.45% NS Hypertonic: d5 0.45% NS, D5LR, D5NS What is in a LR IV fluid -------- Correct Answer ------- NS + electrolytes When should you use NS IV fluids -------- Correct Answer ------- Use NS when you are trying to replace volume (plasma) What are the 5 stages of grief -------- Correct Answer ------- Denial, anger, bargaining, depression, and acceptance What should you remember when someone is dealing with death and grief -------- Correct Answer ------- - Encourage expression of anger - Do not take away the defense mechanism or coping mechanism the person uses in a crisis. - Customs surrounding death and dying vary among cultures. Make every attempt to understand and accommodate the family's cultural traditions when caring for a dying patient. What are nosocomial infections -------- Correct Answer ------- Infections acquired as a result of exposure to a microorganism in the hospital setting What routes of transmission are related to HIV exposure -------- Correct Answer ------- - unprotected sexual contact (most common) - exposure to blood through drug using equipment - perinatal transmission - most common for children - can occur during pregnancy, at the time of delivery, or after birth through breast feeding Angiotensin II in the lungs is a potent? -------- Correct Answer ------- vasodialator How do you convert Fahrenheit to Centigrade -------- Correct Answer ------- F+40, multiply 5/9 and subtract 40 How do you convert Centigrade to Fahrenheit -------- Correct Answer ------- C+40, multiply 9/5 and subtract 40 EPI is always given in what type of syringe -------- Correct Answer ------- TB syringe What should be avoided when a patient is neutropenic? -------- Correct Answer ------- No live vaccines no fresh fruit no flowers What happens when a patient has prednisone toxicity -------- Correct Answer ------- Cushing's syndrome, buffalo hump, moon face, high glucose, hpertension What is the medication of choice for CHF -------- Correct Answer ------- Ace inhibitors What is the medication used for anaphylactic shock -------- Correct Answer ------- Epinephrine What is the medication of choice for Status Epilepticus -------- Correct Answer ------- Valium What is the medication of choice for a bipolar person -------- Correct Answer ------- lithium What does a low residue diet mean? -------- Correct Answer ------- Low fiber Where is insulin produced? -------- Correct Answer ------- beta cells of pancreas What drug is contraindicated in Pancreatitis? What pain medication should be used? ---- ---- Correct Answer ------- Do not give Morphine for pancreatitis because it causes spasms of the Sphincter of Oddi, give Demerol instead. Never IV push what electroylte -------- Correct Answer ------- K+ What is a sign of a fat embolism and what medication would you give? -------- Correct Answer ------- petechiae is a sign of a fat embolism. Treat with heparin To much CO2 causes what? -------- Correct Answer ------- vasoconstriction What should be considered when communicating with a Chinese American? -------- Correct Answer ------- Most Chinese Americans maintain a formal distance with others, which is a form of respect. Many Chinese Americans are uncomfortable with face-to- face communications, especially when eye contact is direct. If the client turns away from the nurse during a conversation, the best action is to continue with the conversation. Walking around the client so that the nurse faces the client is in direct conflict with this cultural practice. The client may consider it a rude gesture if the nurse returns later to continue with the explanation. Telling the client about the importance of the instructions for the maintenance of health care may be viewed as degrading. What are low risk therapies -------- Correct Answer ------- Low-risk therapies are therapies that have no adverse effects and, when implementing care, can be used by the nurse who has training and experience in their use. Low-risk therapies include meditation, relaxation techniques, imagery, music therapy, massage, touch, laughter and humor, and spiritual measures, such as prayer. What Nationalities have a high risk r/t the development of obesity and diabetes mellitus? -------- Correct Answer ------- Because of their health and dietary practices, Native Americans, Latino Americans, Hispanic Americans, and African Americans have a high risk of obesity and diabetes mellitus. Asian Americans have a lower risk for obesity and diabetes mellitus. Define fluid volume excess: Hypervolemia -------- Correct Answer ------- too much fluid in the vascular space (first). Vascular equals the vessels --> veins, arteries, capillaries, heart chambers, etc. What can cause fluid volume excess: Hypervolemia -------- Correct Answer ------- Heart Failure (HF) where the heart is weak, CO is decreased, the kidneys have decreased perfusion and urinary output is decreased. **The volume stays in the vascular space! Renal Failure (RF) When the kidneys are not working. Medications: alka-seltzer, fleet enema's and IVF with Na. These medications have a lot of sodium causing water retention in the vascular space. What are the two main hormonal regulations related to fluid volume -------- Correct Answer ------- Aldosterone (steroid, mineralocorticoid) Atrial Natriuretic Peptide (ANP) Where is aldosterone found -------- Correct Answer ------- in the adrenal glands When blood volume gets low (vomiting, blood loss, etc.) what happens to the secretion of aldosterone and what happens because of it? -------- Correct Answer ------- Aldosterone secretion increases which causes a retention of sodium and water which will make blood volume go up or increase. What diseases are related to too much aldosterone? -------- Correct Answer ------- Cushings and Hyperaldosteronism (Conn's) Which disease is related to not enough aldosterone? -------- Correct Answer ------- Addisons: fluid volume is decreased Where is Atrial Natriuretic Peptide (ANP) found? -------- Correct Answer ------- In the atria of the heart How does atrial natriuretic peptide (ANP) work? -------- Correct Answer ------- It is the opposite of aldosterone, so it causes excretion of Nas and H2O aminoglycosides (mycins) -------- Correct Answer -------