Multiple Myeloma Elevated serum

calcium
COPD Complication
INH adverse reaction
Procardia Adverse reaction/toxicity
Metered Dose Inhaler Process ho to
use it
AID!
Immuni"ations Aller#y to E##s $DP%&'
immunocompromised house mate
Droplet Precaution
Disaster Nursin#
Dele#ate sta(le diseases vs) non*sta(le
In+ant vital si#ns
!i#ns/!ymptoms o+ dehydration in
in+ants
Myocardial In+arction
,heumatoid Arthritis
%hrom(ople(itis
!i#ns/!ymptoms o+ Hypercalcemia
!i#ns/!ymptoms o+ In+ection
!i#ns/!ymptoms o+ COPD
!i#ns/!ymptoms o+ ,i#ht*!ide CH-
Di#oxin side e++ects
%ria#e priority
Complications o+ Emphysema
!i#ns/!ymptoms o+ Hypothyroidism
Iron De+iciency Anemia
Hepatitis .
Chronic ,enal -ailure
Cancer
/laucoma
%hrom(ocytopenia
Neutropenia
%horacotomy
-etal Monitorin# causes o+ decelerations
/roth and Development
Procardia
Pilocarpine
NPH
Neupo#en
!ynthroid
Calcium Channel .loc0ers
1evothyroxine synthroid
Her(al Medicines2 Echinacea' /in#er
roots
Medication +or ruptured cere(ral
aneurysm $3antac4& eh di
throm(olytics
5terine tumor smo0in#4
1e+t*sided CH-
Mastitis and .reast+eedin#*do not use
hot compress' cold compress and
expose to air
Dumpin# !yndrome Diet*lo sodium'
lo CHON' hi#h +at
Endocrine system
Crutches' Canes' 6al0ers
Death vieed +rom each a#e #roup
!i#ns/!ymptoms o+ Hepatitis A
Halo 7est
Metered Dose Inhaler u need to use
some spacer i+ di++iculty inhalin# it
Cataract !ur#ery
Insulin Pea0 %imes
Dia(etes I2 Had to do ith a toe ulcer
Dia(etes II
Measles
1a(2 Ho does Chemo dru#s a++ect
renal la(s nephrotoxic' causes #outy
arthritis' hi .5N' creatinine'
hemorrha#ic cystitis
,adiation %herapy*lead apron' lon#
handled +orceps' lala0i' 8meters aay'
min 9:mins exposure
In+ectious Diseases2 M,!A' %.
Isolation precautions
Mitral 7alve ,e#ur#itation
!i#ns/!ymptoms o+
%u(erculosis/Medications/Air(orne
!i#ns/!ymptoms o+ 7ulva Cancer
Endometriosis medications pills4
Postoperative care +or total 0nee patient
Hepatitis A'.'D'C causation
1ead Poisonin#
Antipsychotic medications side e++ects
%hallium test
Non*stress test
End sta#e renal disease diet* lo
potassium diet' lo sodiun
1
I;ve encountered a lot o+ in+ectious
diseases)!o try to study the isolation
precautions o+ diseases li0e
7,E'1<ME!'AID!'M,!A E%C)
!tudy too the sta(le and unsta(le pts) co"
a lot o+ these =uestions came out li0e
/c pt ould u dischar#e/trans+er +irst)
>no the normal 7ital si#ns o+ di++)a#e
#roup)
Diet such as hi#h in
ma#nesium'potassium'sodium and
others)
speci+ic toys/#ames +or children
study on al"heimer;s ds)'post*op)care +or
total hip replacement'COPD)
!/! o+ +i(romyal#ia'!1E'Acute
pancreatitis'lymes ds)
Nursin# care +or elderly pts))a#in# process
>no the client;s ri#hts)
.eta*adrener#ic dru#s'tricyclic anti*
depressants)
Normal #roth and dev;t o+ ?*?@mos old
>no a(t the rotavirus
Dele#ation on nely hired nurse
!o +ar i only #ot one =uestion same / my
?st exam)a(t the pneumocystis carinii
pneumonia
Advance Directive
Assessment o+ elderly client' 6hat do you
expect4
!i#n A symptom o+ hemophilia
Hemophilia 6ith hemarthosis* increase
+luid inta0e
AID! client test +or candida' mumps and
PPD
-racture +emur* Client had an accident

%PN* Ho to prevent complications chec0

+or #lucose' patency o+ vein
Ne(orn* 6hat is your priority4
temperature
C7A ith ,i#ht sided hemiple#ia
C7A ith 1e+t sided hemiple#ia
!i#ns/!ymptoms o+ 7ulva
CancerEndometriosis medications pills4
Postoperative care +or total 0nee patient
Hepatitis A'.'D'C causation
1ead Poisonin#
Antipsychotic medications side e++ects
%hallium test
Non*stress test
End sta#e renal disease diet* lo
potassium diet' lo sodiun
>no a(t the rotavirus
?) A con+used client +or sur#ery) Client
si#ned the consent +or his sur#ery)
6hat is the nurse initial action4
A& Document and monitor later
.& noti+y the anesthesiolo#ist
C& Determine hen the patient (ecame
con+used
D& as0 the relative a(out the patientBs
status
NO%EC I personally experienced this
situation i+ any(ody 0no the anser
pleased tell me)
@) A nurse*in*char#e sent a maternity
nurse to a sur#ical unit) 6hich client
ill the nurse in char#e assi#n to the
nurse +rom maternity ard4
6hich o+ the +olloin# client is
appropriate +or a nursin# assistant4
9) A client ith rheumatoid arthritis tells DI
havin# (ac0 pain ith this (ed' I li0e my
(ed at home) 6hat is the immediate
response o+ the nurse4
A& I ill massa#e your (ac0 to help you
.& As0 the physician +or opoid
anal#esia
C& I ill re+er you to the occupational
therapy
D& As0 the hus(and ho she sleeps at
home
E) Mild Al"heimer* si#n and symptoms
select all that apply
2
F) %u(erculosis instructions
8) A client ith myocardial in+arction
ta0in# lasix and di#oxin
G) : A client ith ICP
H) Chest tu(e inadvertently out 6hat is
the nurse initial action4
I) A ne(orn ith hite papule on +ace
and trun0) 6hat is the nurse
dischar#e instruction4
?:) Phototherapy
??) A client ith naso#atric tu(e +eedin#
at home)
?@) D>A* 6hat is your initial action4
?9) 1aenneacBs cirrhosis
?E) End sta#e renal +ailure diet
?F) %ransesopha#eal echocardio#ram*
?8) !ynthroid
?G) Cervical implant
?H) Autonomic dysre+lexia si#n and
symptoms
?I) 5%I* 6hich statement o+ the client
needs essential +ollo up4
@:) Phones calls* hich client needs to
immediate +ollo up4
@?) Pre*op client* hich la(oratory result
needs to noti+y the physician4
@@) Assessment o+ the ne nurse in the
unit* 6hich o+ the +olloin# action (y
the ne nurse needs +ollo up4
@9) %he nurse put the client in seclusion
a+ter (ein# assaultive and hittin#
other client) 6hich o+ the +olloin#
statement o+ the nurse is appropriate
+or the client4
A& 6e are very disappointed that you can
not control yoursel+' you ill (e in
seclusion until you calm don
.& Hittin# is not alloed here' you ill (e in
seclusion
C& <ou hit someone' you ill (e in
seclusion call us i+ you need us' e are
here to help you
D& I +or#ot444
@E) A mother called the nurse +rom home
statin# that her child is havin# chic0en
pox) 6hich o+ the +olloin# statement
(y the mother needs immediate +ollo
up4
A& -ather o+ the child ith liver +ailure
.& !i(lin# ith anemia
C& Child Just had tonsillectomy
D& Child has intermittent lo #rade
+ever
@F) A client ith aller#y to !uda+ed) 6hich
o+ the statement is correct4
A& I ill ta0e valerianK)
.& I ill ta0e ma huan#K)
C& I ill ta0e Echinacea +or acute viral
in+ection
D& I ill ta0e (lac0 cohoshK)
@8) A client ith schi"ophrenia* Ho ill
the nurse assess the a++ect4
@G) A client ith (ipolar disorder* manic
phase) 6hat is your immediate response4
@H) A client ith severe anxiety* 6hat is
the outcome o+ the nurseBs short term
#oal4 A ?F year old client* 6hat do you
expect4 Antisocial (ehavior
@I) A client ith dia(etes mellitus $type I&)
NPH insulin #iven at H2:: am* 6hen do
you expect the e++ect4
A& at noon
.& late a+ternoon
C& early a+ternoon
D& early evenin#
3
9:) Expressive/receptive aphasia* 6hat is
your essential response hen
communicatin# ith this client4
9?) A child @ year old ith a suspected
dia#nosis o+ hearin# impairment) 6hich o+
the +olloin# action (y the child contri(ute
to the dia#nosis4
A& Child tal0in# +e ords
.& Child plays alone ith other
children around
C& /esture and pointin# hat he
ants
D& I +or#ot4444
!a+e nurse intervention
COPD
9@) A client had an accident ith (ro
laceration and +ractured o+ the Ja)
!uturin# o+ the laceration and maxillary
pinnin# as done) 6hich o+ the +olloin#
action o+ the nurse is appropriate4 I
ansered 0eep ire cutter at (edside
99) Proper documentation o+ incident
9E) ,i#ht side heart +ailure si#n/symptoms'
select all that apply
9F) 5se o+ Contaceptives
98) Calculation
1ast =uestion in my NC1EL examK)
9G) -ood processin#K))
A& +ro"en +ood can (e de+rost +or up to six
hours))))
.& -ro"en +ood hich has (een de+rost can
(e return (ac0 to +rid#e)))
C& Coo0 perisha(le +ood should cover
and cool))))
D& -ro"en +ood should (e de+rost (y
usin# hot ater))))
?) I+ you have a Pt thatBs aller#ic to Msul+aM
dru#s)) 6hat class o+ dru#s are they also
aller#ic too4
@) 6hich pt is most li0ely to #et %.4
a) @8 yo ho smo0e mariJuana ith a
#roup o+ +riends
() GE yo retired elder
c) don;t remem(er the others
9) 6hat diet ould you #ive a pt /
esopha#eal varicies4
E) Pt) recievin# internal radiation)) !hould the
nurse limit her time / the patient to 9:
mins max444 I thou#ht this as the
anser (/c 0aplan tou#ht me hen you
deal / radiation thin0 Mtime' distance'
shieldM anyone 0no444
F) Assessment o+ a pt / scoliosis ould
present ith4
a) concave cervical and lum(ar spine
() asymmetical iliac crest
8) Nurse should rite an incident report i+4
a) pt reports she is in a sexually a(usive
relationship
() room mate tells pt that he (rou#ht his
home sleepin# pills and is secretly ta0in#
them
c) a sta++ nurse is seen #ivin# a pt that is
not assi#ned to a med
d) don;t remem(er
G) Hi#h alarm ill sound i+4
a) pt is (itin# the tu(e
() lea0 in the cu++
c) don;t remem(er the rest
H) Pt understands teachin# a(out the care o+
his prostetic eye(all hen he states4
a) I ill #ently pull my loer eyelid don
and press inard untill the eye(all comes
out) $I chose this&
() I ill store my eye(all in tap ater
overni#ht
4
c) I ill put drops in my eye continually
throu#hout the day
I) A youn# pt is most li0ely to #et lead
poisonin# i+4
a) he is drin0in# +rom a ceramic pitcher
() -ather re+ernishes old +urniture at their
home
$I;m torn (/ these (/c I 0no a is correct
(ut old +urniture may contain lead in the
paint and the child could eat the paint
chips444&
?:) A %. pt understands that he can reduce
the ris0 o+ spreadin# his disease i+ he
states4
a)& I on;t sleep in the same room / my
i+e +or ?*@ months
() &I ill stay aay +rom pre#nant omen
and children
c)& I ill use plastic utensil hen I eat $this
anser as on @ o+ my %. =uestions&
d)& don;t remem(er
??) Pt in s0eletal halo traction
a) pt should use sterile techni=ue hen
cleanin# insicions
() pt should put lu(ricant on insicions
?@) Pre#nant pt should see0 in+o) +rom a
re#istered dietitian i+4
a) on a ve#an diet
() ta0es vitamin . every day
c) eats at least ? meal o+ +ast +ood every
day
?9) Pt / a %?@ spinal inJury ould4
a) urinate a little every @ hrs
() urinate a lot every E hrs
c) dri((le unrine
d) pt on;t urinate on his on
?) symptoms o+ another complication o+ atrial
+i(2 Can;t remem(er the ansers except +or
the one I chose) I chose slurrin# speech
and ea0ness $em(olic stro0e is a
secondary compication o+ A-i(&
@) char#e nurse to assi#n ?: ee0 pre#nant
,N to hich patient2 -i+th;s disease'
chic0en pox' ,!7' thrush) I chose thrush
(ecause I 0no it doesn;t harm pre# and
all other illnesses are air(orne)
9) =uestion hat meds +or patient history o+
heart +ailure' 0idney disease' hi#h
cholesterol' and potassium o+ @)I2 Di#oxin'
lol (eta 4' "ocor' lasix' and ace chec0 all
that apply2 I chose di#oxin and
lasix$potassium level&
E) alot o+ dischar#e instruction =uestions +or
various sur#eries' sinus' etc)
F) si#ns o+ autonomic dysre+lexia2
hypotension' tach' severe headache' 4
8) hen ould you stop a student nurse a+ter
seein# her do hat4 can;t remem(er hat
exactly) one as ta0in# a pulse ox ith a
sao@ machine +rom the nurses station on a
pt ith pc pneumonia' leavin# old ties until
ne ties ere put on durin# trach care)
G) assi#nin# a lpn2 ta0in# a pt ith %. to the
xray dept)' etc)
H) assi#nin# a maternity nurse to hich pt on a
med*sur# +loor2 rad mastectomy (ein#
dischar#ed in next to hours' etc)
I) chec0 all that apply hat ould you expect
to see in the a#in# process2 shortness o+
(reath' dry s0in' loss o+ vision' etc)
?:) closed head inJury receivin# osmotic
diuretic' expect to see shoin# it is
or0in#2 increased pulse' increased pulse
pressure' etc4
??) ta0in# iv chemo at home hat is correct2
+lush remainin# iv solution in toilet' put
used iv (a#s in red (ioha""ard trash (a#
and put in re#) trash' leave pt alone hile
receivin# meds' or do not let children #o
into (athroom or near toilet until a+ter EH
hours)
?@) per+ormin# a mammo#raphy hat ould
you =uestion2 usin# poder or per+umes in
the last @ days' do you have an internal
5
pacema0er$anser&' etc4
?9) tx +or ,A2 apply cold pac0s$not anser&'
etc4
?E) dischar#e instr) +or pt ith scleraderma2
,OM exercises' emollient to s0in (e+ore
#oin# outside' dry o++ thorou#hly a+ter (ath'
0eep a cool house)
?F) (ipolar manic hat to do2 #roup therapy'
0eep in room' one on one therapy to
reduce stimulation$anser&' etc)
?8) ho ould nurse demonstrate concept o+
patient sel+ determination act2 this is
advance dir and livin# ill)
?G) hat ould you =uestion at pt #ettin# a
thallium stress test2 aller#y to iodine as
anser
?H) Pt ith thyroidectomy and +eedin#2 #round
(ee+ and cran(erry Juice' #round chic0en
and chocolate mil0' ve#eta(les and +ruit'
tuna +ish ith mayo) I chose tuna in mayo)
%hou#ht that the +irst @ ansers had li=uid
to hard to sallo ithout aspiration and
tuna as only anser that as mushy and
so+t (ut not too thin)
?I) A./;s hat ould you do (e+ore ta0in#2
suction' chec0 +or ulnar pulse' etc)
@:) in la(or #ettin# pitocin) hat demonstrates
a complication o+ pit2 contractions @*9 min
apart ith 8: sec) duration' accelerations
up to ?8: ith contraction' +etal hr drops to
?:F durin# acme o+ contration' etc)
@?) hat room to put a pt ith multidru#
resistant %.2 private vented outside'
isolation ith side room +or supplies'
isolation etc)4
@@) hat patient diet ould you correct2
cardiac pt states I include mushrooms and
carrots in my diet' etc)44 can;t remem(er
rest
@9) Normal ne(orn exam2 head and chest
si"e the same' etc)4
@E) E math pro(lems) to as0in# ml/hr' one
#tts/min' units/ml
@F)symptoms o+ +at emo(li2 pettechie on s0in'
etc)
5 Post-Op causes of FEVER:
?) 6ind2 the pulmonary system is the primary
source o+ +ever in the +irst EH hours)
@) 6ound2 there mi#ht (e an in+ection at the
sur#ical site)
9) 6ater2 chec0 intravenous access site +or
si#ns o+ phle(itis)
E) 6al02 deep venous throm(osis can
develop due to pelvic poolin# or restricted
mo(ility related to pain and +ati#ue)
F) 6hi"2 a urinary tract in+ection is possi(le i+
urinary catheteri"ation as re=uired)
8) Also 8th M6M 6onder dru#s * dru# +evers)
%he recommendations presented (elo
are cate#ori"ed as +ollos2
Cate#ory IA) !tron#ly recommended +or all
hospitals and stron#ly supported (y ell*
desi#ned experimental or epidemiolo#ic
studies)
Cate#ory I.) !tron#ly recommended +or all
hospitals and revieed as e++ective (y
experts in the +ield and a consensus o+
HICPAC (ased on stron# rationale and
su##estive evidence' even thou#h
de+initive scienti+ic studies have not (een
done)
6
Cate#ory II) !u##ested +or implementation in
many hospitals) ,ecommendations may
(e supported (y su##estive clinical or
epidemiolo#ic studies' a stron#
theoretical rationale' or de+initive studies
applica(le to some' (ut not all' hospitals)
No recommendationC unresolved issue)
Practices +or hich insu++icient evidence or
consensus re#ardin# e++icacy exists)
%he recommendations are limited to the
topic o+ isolation precautions) %here+ore'
they must (e supplemented (y hospital
policies and procedures +or other aspects
o+ in+ection and environmental control'
occupational health' administrative and
le#al issues' and other issues (eyond the
scope o+ this #uideline)
I. Administrative Controls
A) Education
Develop a system to ensure that hospital
patients' personnel' and visitors are
educated a(out use o+ precautions and
their responsi(ility +or adherence to them)
Cate#ory I.
.) Adherence to Precautions
Periodically evaluate adherence to
precautions' and use +indin#s to direct
improvements)
Cate#ory I.
II. Standard Precautions
5se !tandard Precautions' or the
e=uivalent' +or the care o+ all patients)
Cate#ory I.
A) Handashin#
$?& 6ash hands a+ter touchin# (lood' (ody
+luids' secretions' excretions' and
contaminated items' hether or not #loves
are orn) 6ash hands immediately a+ter
#loves are removed' (eteen patient
contacts' and hen otherise indicated to
avoid trans+er o+ microor#anisms to other
patients or environments) It may (e
necessary to ash hands (eteen tas0s
and procedures on the same patient to
prevent cross*contamination o+ di++erent
(ody sites) Cate#ory I.
$@& 5se a plain $nonantimicro(ial& soap +or
routine handashin#) Cate#ory I.
$9& 5se an antimicro(ial a#ent or a
aterless antiseptic a#ent +or speci+ic
circumstances $e)#)' control o+ out(rea0s
or hyperendemic in+ections&' as de+ined (y
the in+ection control pro#ram) Cate#ory I.
$!ee Contact Precautions +or additional
recommendations on usin# antimicro(ial
and antiseptic a#ents)&
.) /loves
6ear #loves $clean' nonsterile #loves are
ade=uate& hen touchin# (lood' (ody
+luids' secretions' excretions' and
contaminated items) Put on clean #loves
Just (e+ore touchin# mucous mem(ranes
and nonintact s0in) Chan#e #loves
(eteen tas0s and procedures on the
same patient a+ter contact ith material
that may contain a hi#h concentration o+
microor#anisms) ,emove #loves promptly
a+ter use' (e+ore touchin#
noncontaminated items and environmental
sur+aces' and (e+ore #oin# to another
patient' and ash hands immediately to
avoid trans+er o+ microor#anisms to other
patients or environments) Cate#ory I.
C) Mas0' Eye Protection' -ace !hield
6ear a mas0 and eye protection or a +ace
shield to protect mucous mem(ranes o+
the eyes' nose' and mouth durin#
procedures and patient*care activities that
7
are li0ely to #enerate splashes or sprays o+
(lood' (ody +luids' secretions' and
excretions) Cate#ory I.
D) /on
6ear a #on $a clean' nonsterile #on is
ade=uate& to protect s0in and to prevent
soilin# o+ clothin# durin# procedures and
patient*care activities that are li0ely to
#enerate splashes or sprays o+ (lood'
(ody +luids' secretions' or excretions)
!elect a #on that is appropriate +or the
activity and amount o+ +luid li0ely to (e
encountered) ,emove a soiled #on as
promptly as possi(le' and ash hands to
avoid trans+er o+ microor#anisms to other
patients or environments) Cate#ory I.
E) Patient*Care E=uipment
Handle used patient*care e=uipment soiled
ith (lood' (ody +luids' secretions' and
excretions in a manner that prevents s0in
and mucous mem(rane exposures'
contamination o+ clothin#' and trans+er o+
microor#anisms to other patients and
environments) Ensure that reusa(le
e=uipment is not used +or the care o+
another patient until it has (een cleaned
and reprocessed appropriately) Ensure that
sin#le*use items are discarded properly)
Cate#ory I.
-) Environmental Control
Ensure that the hospital has ade=uate
procedures +or the routine care' cleanin#'
and disin+ection o+ environmental sur+aces'
(eds' (edrails' (edside e=uipment' and
other +re=uently touched sur+aces' and
ensure that these procedures are (ein#
+olloed) Cate#ory I.
/) 1inen
Handle' transport' and process used linen
soiled ith (lood' (ody +luids' secretions'
and excretions in a manner that prevents
s0in and mucous mem(rane exposures
and contamination o+ clothin#' and that
avoids trans+er o+ microor#anisms to other
patients and environments) Cate#ory I.
H) Occupational Health and .lood(orne
Patho#ens
$?& %a0e care to prevent inJuries hen usin#
needles' scalpels' and other sharp
instruments or devicesC hen handlin#
sharp instruments a+ter proceduresC hen
cleanin# used instrumentsC and hen
disposin# o+ used needles) Never recap
used needles' or otherise manipulate
them usin# (oth hands' or use any other
techni=ue that involves directin# the point
o+ a needle toard any part o+ the (odyC
rather' use either a one*handed MscoopM
techni=ue or a mechanical device
desi#ned +or holdin# the needle sheath) Do
not remove used needles +rom disposa(le
syrin#es (y hand' and do not (end' (rea0'
or otherise manipulate used needles (y
hand) Place used disposa(le syrin#es and
needles' scalpel (lades' and other sharp
items in appropriate puncture*resistant
containers' hich are located as close as
practical to the area in hich the items
ere used' and place reusa(le syrin#es
and needles in a puncture*resistant
container +or transport to the reprocessin#
area) Cate#ory I.
$@& 5se mouthpieces' resuscitation (a#s' or
other ventilation devices as an alternative
to mouth*to*mouth resuscitation methods
in areas here the need +or resuscitation is
predicta(le) Cate#ory I.
I) Patient Placement
Place a patient ho contaminates the
environment or ho does not $or cannot (e
expected to& assist in maintainin#
appropriate hy#iene or environmental
8
control in a private room) I+ a private room
is not availa(le' consult ith in+ection
control pro+essionals re#ardin# patient
placement or other alternatives) Cate#ory
I.
III. Airorne Precautions
In addition to !tandard Precautions' use
Air(orne Precautions' or the e=uivalent' +or
patients 0non or suspected to (e in+ected
ith microor#anisms transmitted (y
air(orne droplet nuclei $small*particle
residue NF Om or smaller in si"eP o+
evaporated droplets containin#
microor#anisms that remain suspended in
the air and that can (e dispersed idely (y
air currents ithin a room or over a lon#
distance&) Cate#ory I.
A) Patient Placement
Place the patient in a private room that
has2
?& monitored ne#ative air pressure in
relation to the surroundin# areas'
@& 8 to ?@ air chan#es per hour' and
9& appropriate dischar#e o+ air outdoors or
monitored hi#h*e++iciency +iltration o+ room
air (e+ore the air is circulated to other
areas in the hospital)$@9& >eep the room
door closed and the patient in the room)
6hen a private room is not availa(le' place
the patient in a room ith a patient ho
has active in+ection ith the same
microor#anism' unless otherise
recommended'$@9& (ut ith no other
in+ection) 6hen a private room is not
availa(le and cohortin# is not desira(le'
consultation ith in+ection control
pro+essionals is advised (e+ore patient
placement) Cate#ory I.
.) ,espiratory Protection
6ear respiratory protection $NIF
respirator& hen enterin# the room o+ a
patient ith 0non or suspected in+ectious
pulmonary tu(erculosis)$@9'H?&
!uscepti(le persons should not enter the
room o+ patients 0non or suspected to
have measles $ru(eola& or varicella
$chic0enpox& i+ other immune care#ivers
are availa(le) I+ suscepti(le persons must
enter the room o+ a patient 0non or
suspected to have measles $ru(eola& or
varicella' they should ear respiratory
protection $NIF respirator&)$H?& Persons
immune to measles $ru(eola& or varicella
need not ear respiratory protection)
Cate#ory I.
C) Patient %ransport
1imit the movement and transport o+ the
patient +rom the room to essential
purposes only) I+ transport or movement is
necessary' minimi"e patient dispersal o+
droplet nuclei (y placin# a sur#ical mas0
on the patient' i+ possi(le) Cate#ory I.
D) Additional Precautions +or Preventin#
%ransmission o+ %u(erculosis
Consult CDC M/uidelines +or Preventin#
the %ransmission o+ %u(erculosis in Health*
Care -acilitiesM$@9& +or additional
prevention strate#ies)
IV. !roplet Precautions
In addition to !tandard Precautions' use
Droplet Precautions' or the e=uivalent' +or
a patient 0non or suspected to (e
in+ected ith microor#anisms transmitted
(y droplets $lar#e*particle droplets Nlar#er
than F Om in si"eP that can (e #enerated
(y the patient durin# cou#hin#' snee"in#'
tal0in#' or the per+ormance o+ procedures&)
Cate#ory I.
9
A) Patient Placement
Place the patient in a private room) 6hen
a private room is not availa(le' place the
patient in a room ith a patient$s& ho has
active in+ection ith the same
microor#anism (ut ith no other in+ection
$cohortin#&) 6hen a private room is not
availa(le and cohortin# is not achieva(le'
maintain spatial separation o+ at least 9 +t
(eteen the in+ected patient and other
patients and visitors) !pecial air handlin#
and ventilation are not necessary' and the
door may remain open) Cate#ory I.
.) Mas0
In addition to earin# a mas0 as outlined
under !tandard Precautions' ear a mas0
hen or0in# ithin 9 +t o+ the patient)
$1o#istically' some hospitals may ant to
implement the earin# o+ a mas0 to enter
the room)& Cate#ory I.
C) Patient %ransport
1imit the movement and transport o+ the
patient +rom the room to essential
purposes only) I+ transport or movement is
necessary' minimi"e patient dispersal o+
droplets (y mas0in# the patient' i+ possi(le)
Cate#ory I.
V. Contact Precautions
In addition to !tandard Precautions' use
Contact Precautions' or the e=uivalent' +or
speci+ied patients 0non or suspected to
(e in+ected or coloni"ed ith
epidemiolo#ically important
microor#anisms that can (e transmitted (y
direct contact ith the patient $hand or
s0in*to*s0in contact that occurs hen
per+ormin# patient*care activities that
re=uire touchin# the patient;s dry s0in& or
indirect contact $touchin#& ith
environmental sur+aces or patient*care
items in the patient;s environment)
Cate#ory I.
A) Patient Placement
Place the patient in a private room) 6hen
a private room is not availa(le' place the
patient in a room ith a patient$s& ho has
active in+ection ith the same
microor#anism (ut ith no other in+ection
$cohortin#&) 6hen a private room is not
availa(le and cohortin# is not achieva(le'
consider the epidemiolo#y o+ the
microor#anism and the patient population
hen determinin# patient placement)
Consultation ith in+ection control
pro+essionals is advised (e+ore patient
placement) Cate#ory I.
.) /loves and Handashin#
In addition to earin# #loves as outlined
under !tandard Precautions' ear #loves
$clean' nonsterile #loves are ade=uate&
hen enterin# the room) Durin# the course
o+ providin# care +or a patient' chan#e
#loves a+ter havin# contact ith in+ective
material that may contain hi#h
concentrations o+ microor#anisms $+ecal
material and ound draina#e&) ,emove
#loves (e+ore leavin# the patient;s room
and ash hands immediately ith an
antimicro(ial a#ent or a aterless
antiseptic a#ent)$G@'IE& A+ter #love
removal and handashin#' ensure that
hands do not touch potentially
contaminated environmental sur+aces or
items in the patient;s room to avoid trans+er
o+ microor#anisms to other patients or
environments) Cate#ory I.
C) /on
In addition to earin# a #on as outlined
under !tandard Precautions' ear a #on
$a clean' nonsterile #on is ade=uate&
hen enterin# the room i+ you anticipate
that your clothin# ill have su(stantial
contact ith the patient' environmental
sur+aces' or items in the patient;s room' or
i+ the patient is incontinent or has diarrhea'
an ileostomy' a colostomy' or ound
10
draina#e not contained (y a dressin#)
,emove the #on (e+ore leavin# the
patient;s environment) A+ter #on removal'
ensure that clothin# does not contact
potentially contaminated environmental
sur+aces to avoid trans+er o+
microor#anisms to other patients or
environments) Cate#ory I.
D) Patient %ransport
1imit the movement and transport o+ the
patient +rom the room to essential
purposes only) I+ the patient is transported
out o+ the room' ensure that precautions
are maintained to minimi"e the ris0 o+
transmission o+ microor#anisms to other
patients and contamination o+
environmental sur+aces or e=uipment)
Cate#ory I.
E) Patient*Care E=uipment
6hen possi(le' dedicate the use o+
noncritical patient*care e=uipment to a
sin#le patient $or cohort o+ patients in+ected
or coloni"ed ith the patho#en re=uirin#
precautions& to avoid sharin# (eteen
patients) I+ use o+ common e=uipment or
items is unavoida(le' then ade=uately
clean and disin+ect them (e+ore use +or
another patient) Cate#ory I.
-) Additional Precautions +or Preventin# the
!pread o+ 7ancomycin ,esistance
Consult the HICPAC report on preventin#
the spread o+ vancomycin resistance +or
additional prevention strate#ies)
!E"E#A$IO%
Question2 A G year old (oy ith a
compound +racture is (ein# admitted to a
pediatric unit) 6hich o+ the +olloin#
actions is (est +or the nurse to ta0e4
$?& As0 the nursin# assistant to o(tain
the child;s 7! hile the nurse
o(tains a history +rom the parents
$@& As0 the 1PN/17N to assess the
peripheral pulses o+ the child;s le+t
le# hile the nurse completes the
admission +orms
$9& As0 the 1PN/17N to stay ith the
child and his parents hile the
nurse o(tains phone orders +rom
the physician
$E& As0 the nursin# assistant to o(tain
e=uipment +or the child;s care
hile the nurse tal0s ith the child
and his parents
RRR<ou may (e thin0in#' M6hy are
they as0in# me this4 I have never
had the opportunity to as0 the
1PN/17N or nursin# assistant to
do anythin#SM Every three years'
the National Council o+ !tate
.oards o+ Nursin# conducts a Jo(
analysis study to determine the
activities re=uired o+ a nely
licensed re#istered nurse)
.ased on this study' National Council
adJusts the content o+ the test to
accurately re+lect hat is
happenin# in the or0 place) %his
ensures that the NC1EL test is
hat is needed to (e a sa+e and
e++ective nurse)
6ith recent chan#es in health
care' the role o+ the nurse has expanded)
In addition to providin# =uality patient care'
the nurse is also responsi(le +or
coordination and supervision o+ care
provided (y other health care or0ers)
Many health care settin#s are sta++ed (y
re#istered nurses licensed vocational
nurses/licensed practical nurses and
unlicensed assistive personnel $5AP& such
as nursin# assistants and support sta++) It
is the responsi(ility o+ the re#istered nurse
to coordinate the e++orts o+ these health
care or0ers to provide a++orda(le =uality
11
patient care) Appropriate supervision o+ the
1PN/17N and/or unlicensed assistive
personnel (y the re#istered pro+essional
nurse is essential +or sa+e and e++ective
patient care)
%o re+lect these chan#es' the
NC1EL test plan no contains =uestions
a(out dele#ation and assi#nment o+
patient care) %here are several reasons
hy you may +ind these =uestions di++icult
to correctly anser on the NC1EL) <ou
mi#ht not have any practice anserin#
multiple choice =uestions a(out
mana#ement) Many nursin# schools test
the content presented in the mana#ement
course ith essay =uestions rather than
multiple*choice =uestions) <ou have
received lectures re#ardin# mana#ement
o+ care' (ut your clinical rotation in
mana#ement may have (een less than
ideal) <our experience may have (een
restricted to carin# +or one or to patients
ithout any opportunity to supervise
others' or you may have spent time on a
hospital unit providin# patient care under
the supervision o+ a preceptor) %hese
experiences don;t necessarily prepare you
to anser the mana#ement o+ care
=uestions you ill see on the NC1EL)
Don;t despair) Her are some rules
o+ mana#ement that ill help you choose
the ri#ht ansers hen anserin#
mana#ement o+ care =uestions on the
NC1EL)
$&e Rules of 'ana(ement
,ule T?2 Do not dele#ate the +unctions o+
assessment' evaluation and nursin#
Jud#ment) Durin# your nursin#
education' you learned that
assessment' evaluation and nursin#
Jud#ment are the responsi(ility o+ the
re#istered pro+essional nurse) <ou
cannot #ive this responsi(ility to
someone else)
,ule T@2 %his is not the real orld) Do not
ma0e decisions re#ardin# mana#ement
o+ care issues (ased on decisions you
may have o(served durin# your clinical
experience in the hospital or clinic
settin#) ,emem(er' the NC1EL is ivory
toer nursin#) %he ansers to the
=uestions are +ound in nursin# test
(oo0s or Journals) Alays as0 yoursel+'
MIs this text(oo0 nursin# care4M
,ule T92 Dele#ate activities +or sta(le patients
ith predicta(le outcomes) I+ the patient
is unsta(le' or the outcome o+ an
activity not assured' it should not (e
dele#ated)
,ule TE2 Dele#ate activities that involve
standard' unchan#ed procedures)
Activities that +re=uently reoccur in daily
patient care can (e dele#ated) .athin#'
+eedin#' dressin# and trans+errin#
patients are examples) Activities that
are complex or complicated should not
(e dele#ated)
,ule TF2 ,emem(er PrioritiesS ,emem(er
Maslo' the A.C;s' and sta(le versus
unsta(le hen determinin# hich
patient the ,N should attend to +ist)
>eep in mind that you can see only one
patient or per+orm one activity hen
aserin# =uestions that re=uire you to
esta(lish priorities)
1ets ta0e a closer loo0 at the =uestion a(ove
and use these rules to eliminate anser
choices )))))))))
)uestion: A * +ear old o+ ,it& a
compound fracture of t&e left femur is
ein( admitted to a pediatric unit.
-&ic& of t&e follo,in( actions is est
for t&e nurse to ta.e/
12
A) As0 the nursin# assistant to o(tain
the child;s 7! hile the nurse
o(tains a history +rom the parents
.) As0 the 1PN/17N to assess the
peripheral pulses o+ the child;s le+t
le# hile the nurse completes the
admission +orms
C) As0 the 1PN/17N to stay ith the
child and his parents hile the
nurse o(tains phone orders +rom the
physician
D) As0 the nursin# assistant to o(tain
e=uipment +or the child;s care hile
the nurse tal0s ith the child and his
parents
On +irst #lance' all the ansers seem
possi(le) 1ets loo0 at this =uestion usin#
the steps outlined in this (oo0)
!tep ?) ,eord the =uestion in your on
ords) It as0s hat the nurse should do
hen a child ith a +ractured +emur is
+irst admitted) %hat =uestion is a very
(road =uestion) %o esta(lish exactly
hat is (ein# as0ed' you must read the
anser choices) In each anser' the
,N is dele#atin# tas0s to the 1PN/17N
or nursin# assistant) %he real =uestion
is' M6hat is appropriate dele#ation4M
!tep @) Eliminate anser choices (ased on
the ,ules o+ Mana#ement)
$A& As0 the nursin# assistant to o(tain the
child;s 7! hile the nurse o(tains a history
+rom the parents) O(tainin# vital si#ns is
an important part o+ assessment)
Accordin# to ,ule T?' the re#istered nurse
cannot dele#ate assessment) Elimated this
anser choice)
$.& As0 the 1PN/17N to assess the peripheral
pulses o+ the child;s le+t le# hile the nurse
completes the admission +orms) Chec0in#
the peripheral pulses is an important
assessment +or this patient (ecause o+ the
dia#nosis o+ a +ractured le+t +emur) %he
nurse needs to assess the patient (e+ore
dele#atin# activities to someone else)
Assessment o+ the patient is much more
important than completin# paperor0)
Eliminate it)
$C& As0 the 1PN/17N to stay ith the child and
his parents hile the nurse o(tains phone
orders +rom the physician) %here is no
assessment' evaluation or nursin#
Jud#ment involved in this option so leave it
in +or consideration)
$D& As0 the nursin# assistant to o(tain
e=uipment +or the child;s care hile the
nurse tal0s ith the child and his parents)
%he nurse is ith the child and his parents
hile the nursin# assistant o(tains needed
e=uipment) %here is no assessment'
evaluation or nursin# Jud#ment hen
#atherin# e=uipment' so leave this choice
in +or consideration)
<ouBre le+t ith anser choices 9 and E)
<ou are hal+ay to the correct anser) Can
you apply rule T@ ** this is not the real
orld ** to eliminate another anser
choice4
,emem(er' you shouldn;t ma0e decisions
on mana#ement o+ care issues (ased on
hat you may have seen in the hospital or
clinic settin#) Anser T9 indicates that the
nurse is on the phone and the 1PN/17N is
ith the patient) Have you seen this done
in the real orld4 Pro(a(ly) Is this nursin#
text(oo0s and Journals say should (e done
in this situation4 Pro(a(ly not) Eliminate it)
13
Here is another mana#ement o+ care
=uestion)
0. -&ic& of t&e follo,in( tas.s is
appropriate for t&e nurse to dele(ate to
an e1perienced nursin( assistant/
A) O(tain a @E hour diet recall +rom a
patient recently admitted ith anorexia
nervosa
.) O(tain a clean catch urine specimen
+rom a patient suspected o+ havin# a
urinary tract in+ection
C) O(serve the amount and
characteristics o+ the returns +rom a
continuous (ladder irri#ation +or a
patient a+ter a transuretheral resection
D) O(serve a patient nely dia#nosed
ith dia(etes mellitus practice inJection
techni=ues usin# an oran#e
!tep ?) ,eord the =uestion) M6hich tas0 ill
you assi#n to a nursin# assistant4M %he
+act that a nursin# assistant is
MexperiencedM is a distracter) Do not +all
+or this trapS Uust anser the =uestion)
!tep @) Eliminate anser choices usin# the
,ules o+ Mana#ement)
$A& O(tain a @E hour diet recall +rom a
patient recently admitted ith anorexia
nervosa) !ome students may consider
this anser choice (ecause eatin# is
certainly a recurrin# daily activity' (ut
this anser isn;t a(out +eedin# a
patient) Eatin# has special si#ni+icance
+or a patient ith anorexia nervosa) An
important assessment that the nurse
must ma0e is the =uantity o+ +ood
consumed (y this patient) %he nurse
cannot dele#ate assessment) Eliminate
this anser choice)
$.& O(tain a clean catch urine specimen
+rom a patient suspected o+ havin# a
urinary tract in+ection) ,ule TE states'
MDele#ate activities that involve
standard' unchan#in# procedures)M
%here is no indication that this patient
has a catheter so this is a routine
procedure) >eep it in +or consideration)
$C& O(serve the amount and
characteristics o+ the returns +rom
continuous (ladder irri#ation +or a
patient a+ter a transuretheral resection)
%he color o+ the +luid needs to (e
assessed to determine i+ hemorrha#e is
occurrin#) %his is an assessment)
Eliminate this choice)
$D& O(serve a patient nely dia#nosed
ith dia(etes mellitus practice inJection
techni=ues usin# an oran#e) %his
anser involves patient teachin#)
Accordin# to ,uleT?' the nurse cannot
dele#ate evaluation o+ patient care)
Eliminate this choice)
1et;s try one more =uestion)
2. -&ic& of t&e follo,in( patients
s&ould t&e nurse on a pediatric unit
assi(n to t&e "P%3"V%/
A. A 9 year old #irl admitted yesterday ith
larny#otracheo#ronchitis ho has a
tracheostomy
B. A F year old #irl admitted a+ter #astric
lava#e +or tylenol in#estion
C. A 8 year old (oy admitted +or a +racture o+
the +emur in (alanced suspension traction
D) A ?: year old (oy admitted +or o(servation
a+ter an acute asthmatic attac0
!tep ?) ,eord the =uestion in your on
ords) %he =uestion is as0in# +or the
appropriate assi#nment +or a 1PN/17N)
14
!tep @) Eliminate anser choices usin# the
,ules o+ Mana#ement) ,emem(er'
MDele#ate activities +or sta(le patients
ith predicta(le outcomes)M
$A& A 9 year old #irl admitted yesterday ith
larny#otracheo#ronchitis ho has a
tracheostomy) As0 yoursel+' is this a sta(le
patient ith a predicta(le outcome4 A 9
year old ith a ne tracheostomy is not
sta(le or predicta(le) Elimate this anser
choice)
$.& A F year old #irl admitted a+ter #astric
lava#e +or tylenol in#estion) %his child may
(e unsta(le and the outcome is o+ a
poisonin# is unpredicta(le) Elimate this
anser choice)
$C& A 8 year old (oy admitted +or a +racture o+
the +emur in (alanced suspension traction)
%his child has a pro(lem that has a
predicta(le outcome) No in+ormation is
provided in the choice to lead you to
(elieve that this child is unsta(le at this
time) >eep this anser in +or consideration)
$D& A ?: year old (oy admitted +or o(servation
a+ter an acute asthmatic attac0) .ecause
o+ the narro airay o+ a child' this child
may (e unsta(le and the outcome
unpredicta(le) Elimate this anser choice)
Estalis&in( Priorit+
********************************************************
Is this #ettin# easier +or you4 1ets try a
couple o+ more =uestions ith a sli#htly
di++erent +ocus2 priority) Many students are
uncom+orta(le ith these types o+
=uestions (ecause more than one anser
loo0s ri#ht)
4. A &ome care nurse is plannin( &er
visits for t&e da+. -&ic& of t&e follo,in(
patients s&ould t&e nurse visit first/
A. A 8@ year old man to days a+ter an
in#uinal hernia repair
B. A E: year old oman ith type ? dia(etes
mellitus $?DDM& ith a +oot ulcer
C. A G8 year old man ith chronic o(structive
pulmonary disease $COPD&
D) A F: year old oman three days a+ter a
ri#ht mastectomy
!tep ?) ,eord the =uestion in your on
ords) %he =uestion is a priority
=uestion2 6hich patient ta0es hi#hest
priority4 As ith all priority =uestions'
more than one anser ill seem
correct)
!tep @) Eliminate the ansers usin# the ,ules
o+ Mana#ement)
$A& A 8@ year old man to days a+ter an
in#uinal hernia repair) %here is nothin#
stated that leads you to (elieve that
this patient is unsta(le) 5sually'
recovery +rom hernia repairs are
unevent+ul) Elimate this anser)
$.& A E: year old oman ith type ?
dia(etes mellitus $?DDM& ith a +oot
ulcer) Impaired circulation is a
complication o+ the dia(etic and this
client;s situation is potentially unsta(le)
1eave this in +or consideration)
(C) A G8 year old man ith chronic
o(structive pulmonary disease
$COPD&) 6hile this client has a chronic
condition that re=uires close monitorin#
(y the nurse' there is no indication o+
an acute situation) Eliminate this
anser)
15
$D& A F: year old oman three days a+ter a
ri#ht mastectomy) %his is a relatively
ne postop client that has the potential
+or maJor complications) %he patients
should (e assessed (y the nurse)
1eave this in +or consideration
<ou are no choosin# +rom ansers @ and
E) 6hich client do you consider the least
sta(le4 ,emem(er the only ay to anser
priority =uestions correctly is to eliminate
anser choices) It is too di++icult to Just pic0
the ri#ht anser +rom the +our anser
choices)
1et;s loo0 at one more =uestion)
5. After receivin( report from t&e ni(&t
nurse5 ,&ic& of t&e follo,in( patients
s&ould t&e nurse see first/
A. A 9? year old oman re+usin# Car+ate
(e+ore (rea0+ast
B. A E: year old man ith le+t sided ea0ness
as0in# +or assistance to the (edside
commode
C. A F@ year old oman complainin# o+ chills
ho is scheduled +or a cholecystectomy
D) A 8F year old man ith a naso#astric tu(e
ho had a (oel resection yesterday
!tep ?) ,eord the =uestion in your on
ords) %his =uestion as0s' M6ho is the
hi#hest priority +or the nurse4M
!tep @) Eliminate ansers usin# the ,ules
o+ Mana#ement)
(A) A 9? year old oman re+usin# Car+ate
(e+ore (rea0+ast) <ou;re not told hat;s
ron# ith this patient or hy she;s
receivin# Cara#ate' (ut this patient is
pro(a(ly not the priority) 1et;s loo0 at
the other choices)
(B) A E: year old man ith le+t sided
ea0ness as0in# +or assistance to the
(edside commode) %his can certainly
(e a messy situation i+ not attended to
in a timely manner' (ut assistin# a
patient to the (edside commode does
not re=uire a re#istered nurse) Elimate
this anser)
(C) A F@ year old oman complainin# o+
chills ho is scheduled +or a
cholecystectomy) %his is an unsta(le
situation since chills are indicative o+
an in+ectious process and the patient is
scheduled +or sur#ery) 1eave this
anser in +or consideration)
$D& A 8F year old man ith a naso#astric
tur(e ho had a (oel resection
yesterday) A patient ho is one day into
postop certainly has the potential +or
complications even thou#h none are
indicated) 1eave this in +or
consideration)
<ou can no choose (eteen 9 and E)
6hich patient is the hi#hest priority4
Althou#h you may still +eel sli#htly
uncom+orta(le hen anserin#
mana#ement =uestions' continue to
practice anserin# =uestions usin# the
,ules o+ Mana#ement) <ou ill choose
more correct ansersS
Here are other techni=ues in choosin# the
ri#ht anser as ell2
?& ,emem(er to use your Airay'
.reathin# and Circulation ,ules)
@& Assess +irst)
9& %a0e care o+ the pt' not the machine)
16
E& !tay ith the pt)
F& Don;t pass the (uc0 Ncallin# the doctor is
not the anserP)
8& Pain is not alays the +irst choice in
ta0in# care o+ a pro(lem)
?) pt has #raves disease hat ould you
expect to see
all (ut one ere hypothyrodism
choices) ans2 protrudin# eye (alls
@) pt had hypothroidism hat ould nurse
expect to seeC three choices not related
to conditon) ans2 intolerance to cold)
9) Na level ?E:' potassium @)I hat
medications i+ ordered ould cause the
nurse to have most concern' chec0 all
that apply2 choices2 "ocor' di#oxin'
lasix' "estril' hydroclorothyia"ide' and i
thin0 re#lan) ans2 di#oxin' lasix'
hydroclorothia"ide
E) hat ould (e most concernin# to the
nurse i+ this pattern +or a I month
pre#nant pt as experiencin#)
choice2to ere a(out acceleration o+
+etal heart rate' I discounted these
(ecause i don;t remem(er ever hearin#
this' the other to ere a(out2
deceleration that return to normal or
deceleration (y @: (eats durin#
contraction' i chose deceleration (y @:
(eats)
F) this one as very di++icult +or me and
happens to (e the last =uestion i
received) %he patient is @ months old
and has /E,D' hat ould concern
the nurse most i+ you sa the mom
doin#) choices2 addin# cereal to
+ormula' +eedin# (a(y @ounces o+
+ormula every to hours' or i+ the mom
positioned the (a(y in a side lyin#
position' the +ourth choice as
somethin# psychosocial so i thre it
out) ans2 side lyin# position' (ecause i
assumed this meant the child ould (e
lyin# +lat (ut a+ter reviein# post nclex'
i (eleive it mi#ht (e addin# cereal to the
+ormula)
8) ),e#lan*ho does it or0)ans2increase
emptyin# time o+ stomach)
G) dumpin# syndrome*hat should pt do
to avoid)choice2 limit +luid in (eteen
meals' decreased car( consumption' to
avoid lyin# don a+ter meal' can;t
remem(er +ourth choiceC ans2 decrease
car( inta0e
H) pediatric nurse +loated to med sur# ho
ould you assi#n her to) choice2 pt
(ein# dischar#ed ho had a %5,P
leavin# ith a +oley' pt ith +x internal
+ixation' post sur#ical pediatric pt' cant
remem(er TE' ans2 pt ith +x) the rule is
you treat the +loat nurse li0e an lvn' in
that you assi#n her sta(le pt ith
expected outcome that does not
re=uire teachin# or +re=uent
assesments)
I) pt on vent' nurse Just suctioned pt yet
vent started alarmin# sayin# Mhi#h
alarmM hat should nurse do) choice2
call respiratory therapist' adJust settin#s
on vent' stay ith pt and have another
nurse call dr)' or disconnect pt +rom
vent and am(u(a# the pt) ans2
disconnect and am(upt) this indicated
to me that the vent as mal+unctionin#'
so i needed to do somethin# +or the pt
in li#ht o+ hen a hi#h pressure alarm
settin# #oes o++ erroneously it could
seriously compromise the pt;s lun#
(ecause the vent is or0in# harder to
deliver the ordered tidal volume o+ air
and could there+ore cause a
pnemothorax' so (est anserin my
opinion is disconnect +rom a
mal+unction machine) to stay ith the pt
and do nothin# is ne#li#ent this is one
reason each pt has an am(u (a# at the
(edside)
17
?:) ho ould the nurse see +irst)
pt ith endsta#e renal disease'
receivin# epo#en and hemo#lo(in ?:
pt ith hepatic cirrhosis receivin#
lactulose ith a hi#h amnonia level
pt ith chronic cardica disease ith lo
ma#nesium level
pt ith type @ dia(etes receivin#
#lucotrol ho (lood su#ar is @@8) i
chose this one (ecause the other ones
ere all chronic condition hich nothin#
could (e done +or them to improve
there condition' this one indicated to
me that the pt has converted to a type i
dia(etic and is no lon#er a(le to (e
mana#ed (y the diet and oral
hypo#lycemic a#ents) i;m not that
con+ident in this choice i must admit)
??) a ten month old toddler in a cast hat
0ind o+ toy ould you #ive him to play
ith) choice2 cups o+ varyin# si"e' a tiny
toy such as plastic alli#ator' a (i# lar#e
stac0a(le (loc0s' or another stac0a#e
toy) ansC (i# lar#e stac0a(le (loc0s)
one on al"ehemiers can;t remem(er
choices' somethin# a(out their al0in#
pattern
?@) one on lyme disease sorry can;t
remem(er choice or even the direction
the =uestion ent in)
?9) one on #uillian (arre syndrome' sorry
same as a(ove
?E) in+ective endocarditis* hat system
ould you expect to (e most at ris0 +or
+urther dama#e' the o(vious heart as
not a choise' i Just rememe(er choicin#'
0idney +ailure' hen i #ot home and
chec0ed my text(oo0 it mentioned
chronic 0idney +ailure is a conse=uence
o+ this condition) i hope i;m ri#ht (ut still
not ?::V)
?F) (a(y H months old hat ould you
expect them to (e a(le to do) ans) hold
a (ottle
?8) this one as told to me (y my +riend
ho too0 the test in anaheim cali+ornia
in octo(er and i ended up havin# the
exact same =uestion) pt has a second
de#ree partial thic0ness (urn' hat
ould concern the nurse most) ans)
speci+ic #ravity ?):9F' this hi#h sp) #r)
indicates dehydration or +luid volume
loss)
?G) train derailment ho ould you see
+irst) choices i only remem(ered three2
child ith a (ro0en le#' #irl ith va#inal
(leedin#' or child ith a deviated trach)
ans2 child )deviated trach' this is a
medical emer#ency' this indicates
pnemo or hemothorax
?H) ho ould you put a pt in a sic0le cell
crisis ith) choice2 ne#ative pressure
room' ith pt on contact isolation' ith
an AID! pt' cant remem(er TE) ans2
ith an AID! pt' they (oth are
immunosuppressed and are very
suscepti(le to in+ections
?I) pt on pca pump' resp H' (/p I:/8: hat
should nurse do +irst) #ive narcan' #ive
o@' call md) ans2 #ive narcan' this is the
antidote to morphine)
@? pt dx /M)I) has lots o+ crushin# pain
hat should nurse do +irst' #ive
morphine' #ive o@) ans2 #ive morphine)
this choice deals ith the pain and
morphine decreases the or0load o+
heart (y decreasin# preload there+ore
decreases the o@ consumption o+ heart'
hich is hat one ants ith this
codition'
%ria#e depends lot on the speci+ics o+ the
situation (ut hen you have a mass
casualty or multiple casualty situation ie2
<our resources are overhelmed (y the
num(er o+ patients at one time then there
18
are some rules to +ollo) A.C is the
(i##est thin# (ut do not (e distracted (y
the patient ho is not li0ely to survive and
do not resusitate anyone and i+ you ever
see anyone #iven as havin# +ixed and
dilated pupils then the =uestion ill ant
you to cate#orise them as dead and rule
them out same +or anyone ho is not
(reathin# or has no pulse) Any patient ith
(reathin# or airay di++iculties #oes to the
top o+ the list ith airay ahead o+ course
+olloed (y circulation inJuries* such as
ounds' #unshots and +ractures etc) Head
inJury patients can o+ten come into the
airay cate#ory so dont alays over loo0
them (ut it depends on hat in+ormation is
#iven a(out them (ecause they could ell
(e the dead one or near dead one so (e
care+ul)
.asically thou#h stic0 ri#idly to the A.C
priority system and rule out the patient ho
is too +ar #one to save as most tria#e
=uestions has one o+ those and it should
(e +airly easy' alays as0 yoursel+* could
this patent have airay di++iculty i+ it doesnt
say then as0 yoursel+ i+ the inJury could
cause airay pro(lems' the (urns =uestion
someone posted is a per+ect exampleSS I+
there is noone ith a potential airay
pro(lem or the one that has is dead then
loo0 at the patient ith (reathin# pro(lems
and so on) %he hardest (it o+ a tria#e
=uestion is choosin# the one that you
i#nore) Its not natural +or us to leave dead
as dead these days) 6hen I as in the
Army e had tria#e ithin tria#e (ut I ont
complicate thin#s ith that and that o+ten
involved ?: or more seiously inJured
patients' you ill not have more than E on
the NC1ELSSSS Do not con+use these
=uestions ith priority =uestions (ecause
tria#e =uestions ill alays involve more
than one priority patient or critical patient at
a time and it ill alays involve trauma or
inJured patients) Hope I havent con+used
you anymoreSSS
Actually)))) he never didS *
.ut some other #irl sent me some
in+ormation re#ardin# the external/internal
disaster stu++) I too0 my NC1EL on Uuly
?@th' $didn;t pass&' (ut had %ON! o+ these
internal/external M4M;s) <ou;d thin0 the
A.C;s ould correlate ith each =uestion
(ut they don;t) And there is a di++erence
(eteen ho you;d access +irst in the
in/external situations)
I;ll (e more than happy to send that to you
i+ you;d li0e)
Have you ta0en the NC1EL already44 i+
so' hat study materials did you #o (y4*
!o much pressure' ))))you #o thru years o+
nursin# school' to come don to a GF*@8F
=uestion test) !o much material it;s hard to
tell hat to +ocus on)
** /ood luc0' and let me 0no i+ you;d li0e
+or me to send hat in+ormation that i
have)
Preparin# +or the NC1EL Exam2
W %he test is on computer) <ou ill have to
anser anyhere +rom GF*@8F =uestions)
W %he #oal is to +ocus on the +irst @:*9:
=uestions) %he computer maps out your
competency level +rom there)
W Process o+ elimination*%heir su##estions)
?) I+ there are ords li0e alays or all' they
are more li0ely to (e incorrect) @) Choices
ith commonly or possi(ly tend to (e
ron#) 9) In+ormation in the =uestion tends
to repeat itsel+ in the anser)
W <ou must anser every =uestion in order
to move on)
Dele#ation rules in the 5)!)2
A re#istered nurse may not dele#ate2
R Initial nursin# assessment or advanced
nursin# assessment)
R Nursin# dia#nosis determination
R Development o+ nursin# care plans
R Evaluation o+ the patient re#ardin# the
nursin# care plan
REsta(lishment o+ nursin# care #oals
19
RPatient care activities that re=uire
pro+essional nursin# 0noled#e'
Jud#ement and s0ills)
A re#istered nurse MA< dele#ate2
R -eedin# a client
R %a0in# vital si#ns
R Hy#eine Care
%he F dele#ation ri#hts2
?) ,i#ht tas0
@) ,i#ht Circumstance
9) ,i#ht Person
E) ,i#ht Direction and Communication)
F) ,i#ht !upervision
Prioriti"ation2
%ypical prioriti"ation =uestion loo0 li0e the
+olloin#2
?) 6hat is the most important4
@) 6hat is the initial action o+ the nurse4
9) 6hat is the (est nursin# action4
E) 6hich client ould the nuse care +or
+irst4
Here are some tools that ill help anser
these types o+ =uestions2
?) MA!1O6B! HIE,A,CH< O- NEED!2
R Physiolo#ical Needs $survival&
R !a+ety Needs $Physical and
psycholo#icval&
R Psycholo#icla Needs $Care and
.elon#in#&
R !el+ Actuali"ation
Next is their Nursin# Process APIE
Assessment
Plan
Implement
Evaluate
Next (ac0 to the old A.CBs2
Airay
.reathin#
Circuation
6hen dealin# ith +ire use ,ACE2
,EMO7E the client
!ound the A1A,M
CA11 the +ire department
EL%IN/5I!H the +ire)
A!6"$ P78SIO"O#ICA" I%$E#RI$8
Compri"es E8*FEV o+ the test) %hey lay it
out accordin# to system)
,emem(er ?) Maintainin# the cts airay is
alays T?) @) %here is alays somethin#
you could do (e+ore callin# the doctor)
%HE NE,7O5! !<!%EM)
%he nervous system is comprised o+ the
CN!' PN! AAN!)
CEN%,A1 NE,7O5! !<!%EM .rain
and spinal cord)
PE,IPHE,A1 NE,7O5! !<!%EM
Cranial and spinal nerves)
A5%ONOMIC NE,7O5! !<!%EM
Controls DautomaticX +unction o+ the (ody
li0e (reathin and our heart(eat) It also
maintains a sta(le internal environment)
%he A)N)!) (ranches in the !<MPA%HEIC
and the PA,A!<MPA%HE%IC Nervous
!ystems
!<MPA%HE%IC PA,A!<MPA%HE%IC
D-i#ht or -li#htX Maintains normal (ody
+unctionin#
Increases respiratory rate Normali"es
heart rate and (lood pressure
Decreases Peristalsis Increases peristalsis
!ecretes Epinephrine and Nor epinephrine
!ecretes Acetylcholine
Dilates pulmonary (ronchi Constricts
pulmonary (ronchioles
NE5,O%,AN!MI%%E,! $acetylcholine'
serotonin' epinephrine' norepinephrine and
dopamine& trans+er in+ormation +rom one
neuron to another across a synapse)
20
A--E,EN% IMP51!E $%o CN!&)
E--E,EN% IMP51!E! $+rom CN!&)
%he .,AIN
-rontal 1o(e W Personality' (ehaviourW
MO%O, -unctionW .,OCAB! A,EA $Aids
+ormation o+ ords&W Concentration'
a(stract thou#ht' memory
%emporal 1o(e W Hearin#' taste ' smellW
6E,NIC>EB! A,EA $Interpretation o+
lan#ua#e&W Interpretive Area* Uunction o+
temporal' parietal' and occipital lo(es
$Inte#ration o+ somatic' auditory' and visual
associations occur here&)
Parietal 1o(e W !ensation Determination
o+ si"e' shape' ei#ht' and texture o+
sensory input)W Orientation o+ space and
space perception $propriception&
Occipital 1o(e R 7ision $reception and
interception&)
.,AIN !%EM
W Nerve pathays connectin# the (rain and
the spinal cord
W Cardiac' vasomotor and respiratory
centres
DIENCEPHA1ONY %HA1AM5! AND
H<PO%HA1AM5!' located (eteen the
(rain stem and the cere(rum)
%HA1AM5! Y Interpretation o+
!EN!A%ION $Pain' temperature and
touch&)
H<PO%HA1AM5! Y %emperature control'
ater meta(olism' control o+ hormonal
secretion' heart rate' peristalsis' appetite
control' thirst centre' sleep*a0e cycle)
$7E 90 CRA%IA" %ERVES
I Ol+actory !mell
II Optic 7ision
III Oculomotor Eye movement
I7 %rochlear Eye Movement
7 %ri#eminal Chein#' -acial sensation
7I A(ducens Eye movement
7II -acial %aste' +acial movement
7III 7esti(ulocochlear Hearin#' .A1ANCE
IL /lossopharyn#eal %aste $Posterior
%on#ue&' !alloin#
L 7a#us Pharynx',espiratory' cardiac and
circulatory re+lexes
LI !pinal Accessory !houlders' head
movement
LII Hypo#lossal %on#ue movement
%he American Exam ill re=uire any more
0noled#e than the a(ove a(out the
cranial nerves) A #ood one ould (e III' I7
and 7I all control eye movement)
NE5,O1O/ICA1 A!!E!!MEN%
6hat is the +irst thin# a nurse should
assess to determine the presence o+
neurolo#ical chan#es4 $1OC&
%HE /1A!/O6 COMA !CA1E
E<E OPENIN/ Z .E!% MO%O,
,E!PON!EZ .E!% 7E,.A1 ,E!PON!E
Y !CO,E
9 is orst score' ?F is (est)
DECO,%ICA%E Y Arms turned in and up'
toard CO,%EL)
DECE,E.,A%E Y Extension' lim(s aay
+rom (ody)
CERE:RA" !8SF6%C$IO%
?) /NO!IA Ina(ility to reco#ni"e
common o(Jects
@) AP,ALIA Ina(ility to per+orm a s0illed
motor tas0' assumin# the ct is not
paraly"ed)
9) APHA!IA * %he ina(ility to
communicate) $ELP,E!!I7E spea0'
,ECEP%I7E 5nderstand speech&)
21
? to @ years o+ a#e' #ross motor a(ility2
,uns' al0s up and don stairs' li0es
push*pull toys
@ to 9 years o+ a#e' #ross motor a(ility2
Uumps' 0ic0 (all' thros (all overhand)
%oys and activities' .i# 6heel tricycle' !o+t
(all and (at' 6ater and sand' .ean (a#
toss)
9 to 8 years $preschooler& #ross motor
a(ility2
,uns ith ease' holds a (at' thros (alls
o+ various type' clim(s ell' rides a tricycle
$at a#e 9& then a (icycle ith trainin#
heels' and (y end o+ preschool years
rides a (icycle)
lo pressure alarm **[ chec0 connection
hi#h pressure alarm **[ chec0 airay
o(struction) pt) needs to (e suctioned
Hi' Nico the +irst =uestion is not =uite
understood) In hat medical condition are
you #oin# to administer the (*(loc0ers and
steroids4
I +ound the similar =uestion in the Internet *
A client ith acute asthma shoin#
inspiratory and expiratory hee"es and a
decrease +orced expiratory volume should
(e treated ith hich o+ the +olloin#
classes o+ medications ri#ht aay4
a) .eta (loc0ers
() .ronchodilators
c) Inhaled steroids
d) Oral steroids
.ronchodilators +irst provide dilation o+
the spasmodic (ronchioles
Inhaled steroids second deliver
medication +or +urther treatment o+ the
diseaseC a+ter them have the pt rinse the
mouth)
.eta (loc0ers * contraindicated in all
asthmatics
1o pressure alarm on a ventilator means
tu(e disconnection or lea0 in the tu(e)
Common Causes o+ 1o*Pressure Alarms2
Patient disconnection' Circuit lea0s' Airay
lea0s' Chest tu(e lea0s
<our actions as a nurse +irst detect the
lea0 or disconnection and +ix it)
Common Causes of 7i(&-Pressure
Alarms:
Patient cou#hin#' !ecretions or mucus in
the airay' Patient (itin# tu(e' Airay
pro(lems' ,educed lun# compliance $e#)
pneumothorax&' Increased airay
resistance' Patient +i#htin# the ventilator'
Accumulation o+ ater in the circuit'
>in0in# in the circuit' Pro(lems ith
inspiratory or expiratory valves
<our actions detect the pro(lem' +ix all
the 0in0s' remove ater O, disconnect the
ventilator and am(u(a# the patient)
A nurse is schedulin# multiple dia#nostic
procedures +or a client ith activity
intolerance) %he procedures ordered
include2 Echocardio#ram' Chest L*ray' and
CA% scan) %he nurse schedules these
tests in the +olloin# se=uence2
A) L*ray in the mornin#' Echo in the
a+ternoon' CA% scan the next mornin#
.) L*ray and Echo to#ether in the mornin#'
CA% scan in the a+ternoon the same day)
C) Echo in the mornin#' CA% scan and
chest L*ray in the a+ternoon the same day)
D) CA% scan in the mornin#' Chest L*ray
and Echo the next mornin#)
6HA% I! %HE .E!% PO!I%ION -O, A
MO%HE, IN AC%I7E 1A.O, 4
1oo0in# at the eyes o+ native Indians hen
communicatin# ould mean hat4
Ho do you do health teachin# to 8F years
old #roup p+ patients
.est toy +or toddler ith pneumonitis
I!O1A%ION P,ECA5%ION -O, %.'
scarlet +ever)
8:'::: platelet Y interpretation
22
hat meds should (e =uestioned +or P5D
AMINO/1<CO!IDE! * toxicity and s/e
nueroleptic dru#s s/e
dru# computation * d/sx= $ +ormula&
I7* ho many ml/hr
prioriti"ation * a lot S AAA' pneumonia'
HP%' 1OC?:
memori"e u Cranial nerves' and
assessment o+ CN in elderly)
!efinitel+ .no, t&e &ers medications.
And also disaster dele#ation very
important) and in+ection control
li0e hat is more important in menin#itis
patients +or in+ection control2
ear a #on hen u chan#e the (ed
or 0eep the door closed at all times
Other =uestion as hat in+ormation can u
#ive over the phone)
and =uestions a(out teachin# other nurses
a(out several su(Jects' li0e #eriatric care)
!he said to 0no the therapeutic levels o+
Coumadin' di#oxin' potassium) Also 0no
a(out lasix and (lood trans+usions) !he
also had some chemo) dru#s on her exam)
the her( medication !t) Uohn 6ort
depression treatment
/uys here are some o+ my encountered
=uestions2
her( =uestions2
?) /in#0oY tx +or hypertension' rel to
.P
@) EchinnaceaY remem(er E +or
immune system
hepa A same as hepa E +or mode o+
transmission
varia(le decelarationY chan#e position
o+ the mother
lo pressure alarmY chec0 +or 0in0
patient is (itin# the tu(e
restraintsYas0 the dr +irst in restrainin#
and unrestrainin# the pt) even the pt
say he is +ine already
/15COPHA/EY /I distur(ance
diarrhea
1A!ILY #ood outcome decrease in t
raduim implantsY re+rame sel+ +rom pt
DO NO% #o ith pt in the (athroom
Her( >ava*0ava +or stress and anxiety
relie+)
a client ith hepatic encephalopathy)
hat diet ill (e restricted4
?) +ats
@) car(ohydrates
9) protein
E) +olic acid
?) A patient on (lood trans+usion
develop hemolytic reaction a+ter you
stop (lood trans+usion' hat is the next
action you should do4
a) continue the I7 saline
() send the (lood unit to the la(
c) call the doctor asap
d) assess the patient;s vital si#ns
Anser is DY assessment o+ vital si#ns
then call the doctor ith data) !ince it;s
pressumed that the trans+usion had
(een stopped already) I thou#ht A and
. in this situation ill not #ive a critical
solution to the pro(lem)
@) %he nurse is carin# +or a patient in
the coronary care unit) %he display on
the cardiac monitor indicates the
ventricular +i(rillation) 6hat should the
nurse do +irst4
a) per+orm de+i(rillation
() administer Epinephrine as ordered
c) assess +or presence o+ pulse
d) institute CP,
It;s a toss (eteen c or d) 7- is a +orm
o+ heart attac0) %o con+irm 7- you need
to chec0 +or a pulse or H,' a(sence o+
that con+irms 7-) %o institute CP,' you
also chec0 +or pulse (ut (reathin#
comes +irst) !o' I;d say' C' +inal
anser2&
23
9) %he nurse in a ell* child clinic
examines many children on a daily
(asis) 6hich o+ the +olloin# toddlers
re=uires +urther +ollo*up4
a) ?9 mo) old una(le to al0
() @: month old usin# only @ or 9
sentences
c) @E month old ho cries durin#
examination
d) 9: month old only drin0in# +rom a
sippy cup
c is out' practically every 0id cries
durin# exam)
D is correct)
client ith morphine sul+ate in a pca
has a respiration o+ H (eats/minutes)
hat ill the nurse to do +irst4
a) #ive the narcan prn order in the chart
() #ive oxy#en @1/min prn order in the
chart
c) call the physician
d) assess the (reath sounds
A is correct
6hich evaluation ould (est determine
i+ +luid is amniotic versus urine4
? di#ital evaluation
@ ph determination o+ +luid
9 urinalysis (y la(
E #lucose determination
@ is correct
>no your la( values)))!odium'
Potassium' 6.C' platelet count'
hemo#lo(in' hematocrit) >no in+ant
and child;s vital si#ns $H,' ,,' .P&)
DM'pre#nant 98AO/ scheduled +or C!)
6hich one should (e reported
immediately4
a)(c?9'F::
()(ld #lucose @@: * correct
c)1/! ?2@
d)HC% 9HV
%he nurse is responsi(le +or decisions
re#ardin# client room assi#nments)
6hich one o+ the +olloin# possi(le
roommates ould (e MO!%
appropriate +or a three year*old child
ith minimal chan#e nephrotic
syndrome4
A& %o year*old ith respiratory
in+ection
.& %hree year*old +racture hose
si(lin# has chic0enpox
C& -our year*old ith (ilateral in#uinal
hernia repair * correct
D& !ix year*old ith a sic0le cell anemia
crisis
?) mechanical ventilation' hi#h alarm
#oes o++) A) listen +or cu++ lea0 .)
assess ,,4
@) Experiencin# alcohol ithdraal' ?@
hrs later do hat
A) #ive hi#h car(s
.) +luid A electrolyte replacement
C) sedate
D) put in dim lit room4
9) A+ter external radiation dischar#e
teachin#' hat pt) comment is correct*
A) cover s0in /clean #au"e () ash
s0in /antimicro(ial soap c) apply ice to
s0in d) expose air to s0in once4
E) %umor on cere(ellum' expect to see*
a) expressive aphasia () receptive
aphasia4
F) 6hich is a hereditary disease a)
nonaller#ic asthma () M! c) par0insons
8) pt) is on m# sul+ate' stop in+usion
hen* a) 9Z proteinuria () 5rine output
o+ 8:cc in last hour c) resp) o+ @E)
G) 9 yr) old can say a) F:: ords /@FV
understanda(le () 9 to E ord phrases4
H) Health screenin#' hat is correct' a)
#ive tylenol to a child /chic0enpox ()
24
#ive motrin to hemophilia pt4
?)Mechanical vent alarms o++ +irst
assess rr then proceed to am(u (a#
patient i+ somethin# ron# ith vent
call technician)
@)Alcohol ithdraal ** +luid and
electrolyte replacement
9)external radiation***cover s0in ith
#au"e**i+ slou#hin# s0in cover ith
sterile #au"e
E)tumor in the cere(ellum**expressive
aphasia (ec cere(ellum is here the
a(ility to tal0' eat and other motor
+unction is indicated)
8)Ma#nesium sul+ate***respiratory
depression so @E (r/min
F) Hereditary**Non aller#ic asthma**
other to M! **autoimmune or
par0inson usually in older people
G)9 yr old can say up to I:: ords so
9*E ord phrases
H) Health screenin# tylenol to chic0en
pox donBt #ive motrin to hemophiliac
there is aspirin in motrin)
pt) / PNE5MOC<!%I! CA,INII
PNE5MONIA' can share a room ith2
a) dia(etic pt) / ound ulcer
() an A11 pt)
c) HI7 pt
d) G: yr)old al"heimer;s pt correct
I) hich pt)u shld see +irst
a)asthmatic pt)/ Oxy#en sat)H: and
hee"es on lun# (ase
()a pt) / D7% on anticoa#ulant therapy
complainin# o+ havin# di++iculty ta0in#
deep (reath *correct
c)post appendectomy @ days a#o
d)post C/! 9hrs a#o'sleepin#
?:) asthmatic pt)on metered*
inhaler'hat is ur advise on its proper
use)
a)ta0e a lon# expiration * correct
()ta0e a =uic0 (reath
c)hold his (reath +or @:secs)
d)ait Fmins a+ter +or another pu++
??) hat type o+ a diet ould a patient
havin# a calcium oxalate renal calculi
(e on4
a) acid ash diet * correct
() al0aline ash diet
c) purine diet
d) #luten +ree diet
?@) %he nurse instructs the patient
ta0in# dexamethasone $Decadron& to
ta0e ith +ood or mil0 (ecause this
medication2
?) ,etards Pepsin production
@) !timulates hydrochloric acid
production * correct
9) !los stomach emptyin# time
E) Decreases production o+ hydrochloric
acid
?9) Need to chec04 pt) ith #las#o scale
o+ H or pt) ith (lood #lucose o+ ?@F4
H is the correct anser
?) pt is in meta(olic al0alosis hat is the
(ody;s ay o+ compensatin#
a) increasin# resp +rom ?@ to @:
() decrease (reathin# @: to ?@
%he respiratory rate #oes don to
conserve CO@)
6hat is the primary nursin# dx +or a pt
ith (uc0s traction ho you +ind at the
(ottom o+ the (ed ith the ts) on the
+loor4
a) !a+ety
() ris0 +or in+ection
c) s0in inte#rity
25
A correct .uc0s %raction the ei#hts
should not (e on the +loor and the patient
should not (e at the (ottom o+ the (ed
there+ore chec0 sa+ety
ho ould you see +irst a pt ith a past
history o+ MI ho is complainin# o+
epi#astric pain or H hr post op laminectomy
ho has @cc o+ serious +luid on his
dressin#4 MI (ecause patient is
symptomatic and ith past history) %he
post*op patient is sta(le ith only @cc
serous +luid on the (anda#e)
@) Proper +unctionin# assessment o+ chest
tu(e 2
?)#entle (u((lin# pressure in all 9
(ottle
@)constant #entle (u((lin# pressure in
a suction (ottle) * correct
9)constant (u((lin# in ater sealed
(ottle)
E)vi#orous (u((lin# in suction (ottle)
9) Hi#h ,is0 +or Osteoporosis
?)Patient FF y/o +emale ho is smo0in#
ci#arette) * correct
@)Patient 8: y/o +emale ith thin (ody
+rame)
9)Patient 9F y/o man or0in# in heavy
li+tin# and has lo serum Calcium level)
E) Patient receives 9 times a ee0
hemodialysis' has antihypertensives
dru# to (e #iven at Iam)hen is the
(est time to #ive the dru#4
?)durin# hemodialysis
@)#ive dru# at Gpm
9)#ive hemodialysis at @pm
E)#ive dru# a+ter hemodialysis * correct
F) A E year old child is +or dischar#e) 6hat
is the suita(le car seat to this child4
a)rear +acin# seat
()+ront +acin# car seat
c)(ooster seat ith car seat (elt *
correct
d)(ac0 seat
8) pt had an automatic pacema0er is +or
dischar#e) Health instruction (y the
nurse should avoid
a)microve oven
()electroma#netic +ield * correct
conclusive/indication that pt is
dehydrated
a)taut s0in
()scanty urine * correct
G) a toddler is admitted tot he pediatric
unit +or sur#ical repair o+ a
hydronephrosis) hat indicated
reduction o+ environmental ris0s to
childs health
a)recovery is shortened and the toddler
returns home in 9 days
()parents compliment nurse on #ood
care
c)the child (e#ins to ta0e clear li=uids
ithin 8 hrs post sur#ery* correct
d)post op recovery proceeds accordin#
to schedule
H) hat is the most important #oal in the
nursin# care o+ a toddler a+ter sur#ery
a)alter the childs (ehavior to insure
compliance
()in+orm parents a(out the sur#ery and
the need +or a sterile environment
c)modi+y environmental +actos o+ the
unit to enhance sa+ety* correct
d)(e prepared +or the toddler to re#ress
to an earlier developmental sta#e
I) %HE N5,!E DOC5MEN%! IN %HE
CHA,% O- A C1IEN% A-%E, A
CHO1EC<!%EC%OM<)Ma(dominal
dressin# chan#ed)small amount o+
serous draina#e noted)ound ed#es
26
approximated)moderate amount o+
erythema noted alon# incision line and
drain site)drain is patent and intact)
hat is indicated (y the nursin# note
a)more +re=uentdressin# chan#es is
indicated
()early si#ns o+ evisceration are
evidenced
c)early si#ns o+ in+ection are evidenced
d)+re=uency o+ dressin# chan#es is
appropriate correct
?:) hich nursin# intervention is most
appropriate hen administerin# a soap
sudes enema to a three year old
a)use a potty chair
()have a nurse administer it
c)explain the procedure (e+ore doin# it
correct
d)position the client ith the ascendin#
colon at the loest point
??) hich +ood selection is most
appropriate +or the client ith sic0le cell
anemia in vaso occlusive crisis4
a) raisins
()(anana
c)chic0en sandich
d #elatin correct
?@) %he nurse is or0in# ith a client ho
a(uses alcohol) 6hich o+ the +olloin#
+acts should the nurse communicate to
the client44
?) A(stinence is the (asis +or
success+ul treatment) * correct
@) Attendance at Alcoholic Anonymous
meetin#s everyday ill cure alcoholism)
9) -or treatment to (e success+ul'
+amily mem(ers must participate)
E) An occasional social drin0 is
accepta(le (ehavior +or the alcoholic)
?9) A client comes to a nurse +or +irst aid in
a +actory some metal part is #one to his
eye hat ould (e the nurse;s +irst
action4
?) irri#ate the eye ith ater
@) patch the eye ith sterili"e dressin#
A re+er to doctor * correct
9) re+er to physician
E) try to remove the metal part ith
cloth
?E) A nurse is carin# +or client ith cancer)
%he client tells the nurse that a layer
ill (e arrivin# today to prepare a livin#
ill) %he client as0s the nurse to act as
one o+ the itnesses +or the ill) %he
most appropriate action is to2
a) A#ree to act as a itness
() ,e+use to help a client
c) In+orm the client that a nurse carin#
+or a client can;t serve as a itness to a
livin# ill*correct
d) Call the physician
?F) hen removin# the chest tu(e' hat
should you tell the client to do4
A) inhale and hold (reath
.) exhale and hold (reath correct
?8) A client suspected o+ P%. have (een
admitted in the hospital) 6hat particular
mas0 to (e used (y the health care
providers2 hepa mas0
?G) ?) Multiple !clerosis is characteri"ed (y
hich o+ the +olloin#2
?) A pro#ressive neurolo#ical disorder
characteri"ed (y the de#eneration o+
(asal #an#lia in the cere(rum
@) A pro#ressive demyelinatin# disease
hich a++ects +i(ers (rain and spinal
cord * correct
9) A pro#ressive and sometimes +atal
disease hich results in de#eneration
27
o+ the motor neurons
E) A pro#ressive disease involvin#
neuro*muscular transmission o+
impulses o+ voluntary muscle
?H) <ou are assi#ned to care +or a client
dia#nosed ith .ell;s Palsy) 6hich o+
the +olloin# ould (e an INCO,,EC%
nursin# action or intervention42
?) O++er small +re=uent +eedin#s o+ so+t
+oods
@) Apply a +acial slin# to support +acial
muscles
9) %each the patient to close the lid$s&
o+ the a++ected eye$s& periodically' and
to instill arti+icial tears
E) 7i#orously massa#e muscles o+ the
a++ected side at least tice daily' to
restore circulation and muscle tone
correct
?I) In carin# +or a client ith A1!
$Amyotrophic 1ateral !clerosis&' the
nursin# dia#nosis ith the HI/HE!%
priority ould (e2
?) Impaired Physical Mo(ility
@) Altered ,ole Per+ormance
9) Potential +or Ine++ective Airay
Clearance * correct
E) Potential +or Impaired 7er(al
Communication
@:) A patient has attended a medication
class +or tricyclic antidepressants) He
demonstrates he understands the
teachin# (y statin#2
?) MI must exercise and eat +oods hi#h
in +i(er)M
@) MI must have my (lood dran at least
once a month a+ter dischar#e)M
9) MI must stay out o+ the sun or ear
sun (loc0)M
E) MI cannot eat cheese or drin0 ine)M *
correct
@?) Patient admitted in psych ard clench
his +ace to the nurse a+ter not #ivin# his
re=uestC hat action ill you do)
a& tal0 to him calmly $(& as0 another
sta++ to help you (rin# to his room $ the
patient is harm+ul and need sa+ety o+
others&
@@) 6hat are the cares +or post
pneumonectomy4
@9) Patient havin# cold and complains o+
loss o+ appetite' hich o+ the +olloin#
dia#noses is appropriate
a&,is0 +or aspiration $(& altered nutrition
less than (ody re=uirement $c& +luid
volume de+icit $d& +ati#ue ,/% anorexia
@E) In oncolo#y department hich one o+
the +olloin# patient ill the nurse see
+irst2
A& Patient ith internal radiation sittin#
on the chair near the (edC
.& patient ho is to receive a
radioactive solution and havin# a visitor
ho is @80s pre#nantC
C& patient ith prostate cancer ith
radium implant seeds ho is
am(ulatin#C
D& patient a+ter ? hour o+ external
radiotherapy tal0in# ith his son)
@F) In an emer#ency department hich o+
the +olloin# patient ill the nurse see
+irst4
a&patient complainin# o+ severe pain in
the ,1Q o+ the a(domen
$(& patient ith pneumonia spittin#
(lood
$c& Patient ith motor vehicular
accident ho is nauseous
28
$d& patient ith +emur +racture complain
dyspnea and chest pain
@8) %he nurse is completin# the inta0e and
output record +or a client no had an
a(dominal sur#ery @ days a#o) %he
client has had the +olloin# inta0e and
output durin# the shi+t)
Inta0e2 Eo" o+ oran#e Juice
?/@ servin# o+ scram(led e##s
8 o" o+ ater
?/@ cup o+ +ruit*+lavored #elatin
? cup o+ chic0en (roth
E:: cc o+ :'EFV sodium chloride$hal+*
stren#th saline&'iv
Output2 ?'::: ml o+ urine
?@: ml o+ draina#e +rom the %*tu(e
Ho many milliliters should the nurse
document as the client;s inta0e4
%he anser is ?:8:)
-irst o+ all' total inta0e is all the li=uids the
client receives durin# the shi+t $or over
#iven period o+ time&) 1i=uids (y
de+inition are all su(stances that
(ecome li=uids in room temperature)
!o'
Eo" o+ oran#e Juice * ?@: cc
8o" o+ ater * ?H: cc
?/@ cup o+ Jello * ?@: cc $Jello is
considered to (e a li=uid * pro(a(ly this
thin# con+used you&
? cup o+ (roth * @E: cc
Hal+ normal saline * E:: cc
?@:Z?H:Z?@:Z@E:ZE::Y?:8:)
CO''O% 7ER:A" 'E!S
C&amomile
5ses2 Chamomile is o+ten used in the +orm
o+ a tea as a sedative)
,eactions2 Aller#ic reactions can occur'
particularly in persons aller#ic to ra#eed)
,eported reactions include a(dominal
cramps' ton#ue thic0ness' ti#htness in the
throat' sellin# o+ the lips' throat and eyes'
itchin# all over the (ody' hives' and
(loc0a#e o+ the (reathin# passa#es) Close
monitorin# is recommended +or patients
ho are ta0in# medications to prevent
(lood clottin# $anticoa#ulants& such as
ar+arin)
Ec&inacea
5ses2 1ar#ely (ecause hite (lood cells in
the la(oratory can (e stimulated to eat
particles' Echinacea has (een touted to (e
a(le to (oost the (ody;s a(ility to +i#ht o++
in+ection)
,eactions2 %he most common side e++ect is
an unpleasant taste) Echinacea can cause
liver toxicity) It should (e avoided in
com(ination ith other medications that
can a++ect the liver $such as 0etacona"ole'
le+lunomide $Arava&' methotrexate
$,heumatrex&' isonia"ide $Ni"oral&)
St. ;o&n<s -ort
5ses2 !t) Uohn;s 6ort is popularly used as
an her(al treatment +or depression'
anxiety' and sleep disorders) It is
technically 0non as Hypericum
per+oratum) Chemically' it is composed o+
at least ?: di++erent su(stances that may
produce its e++ects) %he ratios o+ these
di++erent su(stances varies +rom plant to
plant $and manu+acturer&) !tudies o+ its
e++ectiveness (y the National Institutes o+
Health are in pro#ress)
,eactions2 %he most common side e++ect
has (een sun sensitivity hich causes
(urnin# o+ the s0in) It is recommended that
+air* s0inned persons (e particularly care+ul
hile in the sun) !t) Uohn;s ort may also
leave nerve chan#es in sun(urned areas)
%his her( should (e avoided in
com(ination ith other medications that
29
can a++ect sun sensitivity $such as
tetracycline/Achromycin' sul+a* containin#
medications' piroxicam $-eldend&) !t)
Uohn;s ort can also cause headaches'
di""iness' seatin#' and a#itation hen
used in com(ination ith serotonin
reupta0e inhi(itor medications such as
+luoxetine $Pro"ac& and paroxetine $Paxil&)
#arlic
5ses2 /arlic has (een used to loer (lood
pressure and cholesterol $Dr) 1ucinda
Miller notes that there is M)))still insu++icient
evidence to recommend its routine use in
clinical practice)M&
,eactions2 Aller#ic reactions' s0in
in+lammation' and stomach upset have
(een reported) .ad (reath is a notorious
accompaniment) !tudies in rats have
shon decreases in male rats; a(ility to
ma0e sperm cells) /arlic may decrease
normal (lood clottin# and should (e used
ith caution in patients ta0in# medications
to prevent (lood clottin# $anticoa#ulants&
such as ar+arin /Coumadin)
Feverfe,
5ses2 Most commonly used +or mi#raine
headaches)
,eactions2 -ever+e can cause aller#ic
reactions' especially in persons ho are
aller#ic to chamomile' ra#eed' or yarro)
Nonsteroidal anti*in+lammatory dru#s
$N!AIDs such as i(upro+en $Advil&'
naproxen $Aleve& or Motrin& can reduce the
e++ect o+ +ever+e) A condition called
Mpost+ever+e syndromeM +eatures
symptoms includin# headaches'
nervousness' sti++ness' Joint pain'
tiredness' and nervousness) -ever+e can
impair the action o+ the normal (lood
clottin# element $platelets&) It should (e
avoided in patients ta0in# medications to
prevent (lood clottin# $anticoa#ulants&
such as ar+arin $Coumadin&)
#in.o :iloa
5ses2 %his her( is very popular as a
treatment +or dementia $a pro#ressive
(rain dys+unction& and to improve thin0in#)
,eactions2 Mild stomach upset and
headache have (een reported) /in0o
seems to have (lood thinnin# properties)
%here+ore' it is not recommended to (e
ta0en ith aspirin' nonsteroidal anti*
in+lammatory dru#s $Advil&' naproxen
$Aleve& or Motrin&' or medications to
prevent (lood clottin# $anticoa#ulants&
such as ar+arin $Coumadin&) /in0o
should (e avoided in patients ith epilepsy
ta0in# sei"ure medicines' such as
phenytoin $Dilantin&' car(ama"epine
$%e#retol&' and pheno(ar(ital)
#insen(
5ses2 /insen# has (een used to stimulate
the adrenal #land' and there(y increase
ener#y) It also may have some (ene+icial
e++ect on reducin# (lood su#ar )in patients
ith dia(etes mellitus) $Dr) Miller
emphasi"ed that there is su(stantial
variation in the chemical components o+
su(stances (randed as M/insen#)M&
,eactions2 /insen# can cause elevation in
(lood pressure' headache' vomitin#'
insomnia' and nose (leedin#) /insen# can
also cause +alsely a(normal (lood tests +or
di#oxin level) It is unclear hether #insen#
may a++ect +emale hormones) Its use in
pre#nancy is not recommended) /insen#
may a++ect the action o+ the normal (lood
clottin# element $platelets&) It should (e
avoided in patients ta0in# aspirin'
nonsteroidal antiin+lammatory dru#s $such
as i(upro+en $Advil&' naproxen $Aleve& or
Motrin&' or medications to prevent (lood
clottin# $anticoa#ulants& such as ar+arin
$Coumadin&) /insen# may also cause
headaches' tremors' nervousness' and
sleeplessness) It should (e avoided in
persons ith manic disorder and
psychosis)
30
#in(er
5ses2 /in#er has (een used as a
treatment +or nausea and (oel spasms)
,eactions2 /in#er may lead to (lood
thinnin#) It is not recommended to (e
ta0en ith medications that prevent (lood
clottin# $anticoa#ulants& such as ar+arin
$Coumadin&)
Sa, Palmetto
5ses2 !a palmetto has (een most
commonly used +or enlar#ement o+ the
prostate #land) $Dr) Miller emphasi"ed that
studies veri+yin# this assertion are
necessary)& !a palmetto has also (een
touted as a diuretic and urinary antiseptic
to prevent (ladder in+ections)
,eactions2 %his her( may a++ect the action
o+ the sex hormone testosterone' there(y
reducin# sexual drive or per+ormance) Dr)
Miller states that M6hile no dru#*her(
interactions have (een documented to
date' it ould (e prudent to avoid
concomitant use ith other hormonal
therapies $e)#)' estro#en replacement
therapy and oral contraceptives)))M&
%his listin# represents only a small portion
o+ her(al treatments) Nevertheless' the
popularity o+ her(al therapies is
un=uestiona(le) Doctors routinely con+ront
the un0non ith their patients ho are
usin# her(s) Doctors simply do not have
any ay o+ helpin# you to decide hether
these her(s are help+ul or harm+ul +or you,
or whether they are interacting with your current
medications. There are no data.
Black Cohosh
Claims, Benefts: A natural way to treat
menopausal symptoms.
Bottom Line: Little is known about its benefts and
its risks. I you try it, tell your physician, since it
might interact with other medications you are
taking.
31