NCLEX Frequently Missed Topics

how long does it take for insulin NPH to peak/when is patient most at risk for hypoglycemia?

4-12 hours

how big does TB test induration have to be to be a positive TB test in a healthy patient?

>15mm in healthy individuals is positive if >10cm in immunocompromised then positive >5 if have HIV or were exposed to TB

T/F: to prevent constipation, clients should avoid caffeine and avoid using laxatives unless prescribed by provider

TRUE should increase fluids, fiber in diet, activity level, go when feel the urge

T/F: an AED can still be used if client is damp on body or lying in shallow pool of water

TRUE - just need to wipe of chest and remove any medication patches on skin

T/F: someone who is undergoing brachytherapy in the hospital's body fluids are able to be disposed of normally and flushed down toilet

TRUE - urine is not considered radioactive

how is HIV spread?

when nonintact skin comes into contact with infected blood, breast milk, semen, vaginal secretions

how long does it take for insulin lispro to peak?

works in 15-30 mins

when should pap tests be started?

age 21, regardless of sexual history

what does emphysema in COPD even mean?

air trapped in the alveoli - dyspnea, barrel chest, hyperresonance on percussion

placenta previa looks like

bright red bleeding, PAINLESS do not do digital cervical exams

where should you look for petechiae in AA patient with DIC?

bucal mucosa and conjuntiva of eye

a nurse is caring for a patient with DIC. which locations would be to assess for presence of petechiae?

buccal mucosa and conjunctiva of eyes

which hand do you don with sterile glove first?

dominant first then non-dominant

for a client with restraints, how often should you remove them and perform passive range of motion exercises?

every 2 hours

how often should an ostomy appliance and bag be changed?

every 5-10 days

how often should nurse reassess need for restraints?

every hour - should be removed ASAP

blood products should not be left at room temp for > ___how long?______________

for longer than 30 mins - they should be returned to blood bank

what supplements should patients avoid if taking blood thinners?

ginger, garlic, gingko, ginseng, saw palmetto

what does a negative stress test mean?

has no late or variable decelerations and is associated with good fetal outcomes

erikson stage for school age, adolescence, young adult

industry vs inferiority identity vs role confusion intimacy vs isolation

when a medication has been knowingly withheld by a nurse what is the first action a charge nurse should take?

instruct nurse to notify provider and

what is brachytherapy?

internal radiation treatment that is ingested, injected into cavity or bloodstream or implanted (seeds), it emits radiation in or near tumor

foods high in potassium

legumes, potatoes, beef, leafy greens, dried fruit, melon, avocado, oranges, bananas, strawberries, milk, most fish, whole grains, granola, bran

car seat rules for infants

must be rear facing until age 2 secured beneath armpits 45* angle

ectopic pregnancy may present with

shoulder pain

what is osteomalacia?

softening of the bones, typically through a deficiency of vitamin D or calcium.

what type of medication has greatest potential for increasing lithium's concentrations?

thiazide diuretics they also interact with NSAIDS (ibuprofen and antidepressants)

after a gastrectomy, how long should a client be kept NPO?

until bowel sounds return

A client with sickle cell crisis should be given what priority intervention first in vasoocclusive crisis?

high flow IV fluids - inadequate oxygenation and fluids causes crisis and ischemic pain/hypoxia hydration may reverse sickling

what lab abnormalities does the oncological emergency of tumor lysis syndrome cause?

hyperkalemia hypocalcemia hyperphosphatemia avoid loop diuretics (K sparing ones)

what are the sx of thyroid storm?

hyperthyroid crisis - fever, tachycardia, N/V, ams

what is priority teaching topic in a 15 yo first prenatal visit at 12 weeks pregnant?

importance of consistent prenatal care since adolescents are at increased risk of complications during pregnancy signs of preeclampsia arent a main teaching point until around week 20 (later on)

where should a car seat be installed in a car?

in back seat in the center (away from doors) if possible do not put the baby in sleep sack or blanket under the straps

why do ppl get IV albumin after a paracentesis to drain ascites?

to prevent hypotension and tachycardia - check VS

erikson stage for infants, toddlers, and preschoolers

trust vs mistrust autonomy vs shame/doubt initiative vs guilt

for someone who is hospitalized and bedbound while receiving brachytherapy, what should nurse do with their linens and trash?

they must remain in the room until radioactive implant is removed

how long should cervical cap remain in place after sex to work and kill sperm?

≥6 hours after sex; but not longer than 24 h

normal Cr

0.5-1.2 sign of kidney injury

what is therapeutic digoxin level?

0.8-2

how long does it take for glargine insulin to peak/when is patient most at risk for hypoglycemia?

3-14 hours

TPA after stroke must be given within what time period?

3-4 hours of symptoms starting sx: unilateral weakness, facial drooping, slurred speech

what is a normal troponin level?

<0.5

what are some specific criteria for caring for someone undergoing brachytherapy?

-limit the time of exposure (30min a day) -maximize distance from source -wear lead apron -turning back from client is risk for exposure

if we suspect a DVT in a patient, do we do Homan's sign?

NO - do not have patient dorsiflex and flex foot if we are trying to prevent DVT, you should tell them to flex and point feet while in bed

what is normal platelet count?

150,000-400,000

signs of preeclampsia

2+ pitting pedal edema, 300mg/24 protein in urine, headache and blurry vision, urine dipstick 1+, cerebral or visual sx, pulmonary edema

how long does it take for regular insulin to peak/when is patient most at risk for hypoglycemia?

2-5 hours

after restraints are on, how often should you reassess for need? how often should you remove restraints and do ROM exercises?

every hour every 2 hours

whenever mentions antipsychotic medication, what type of symptoms should you look out for?

extrapyramidal symptoms like restlessness, fidgeting, tremors, shuffling gait, pill rolling, mask like facies, agitation also anticholinergic and sedation

if you are giving client nitro IV for unstable angina and they have relief of pain but complain of headache what should you do?

give acetaminophen and document finding - do not slow down infusion rate HA is expected

in a sickle cell crisis, what is priority intervention first?

giving IV fluids

what are the signs of hyperglycemia to be on the lookout for in someone receiving TPN?

polydipsia, polyuria, headaches, blurred vision

why should client with constipation avoid caffeinated beverages?

promote diuresis, which may lead to dehydration and worsen constipation

if a patient who needs CPR needs AED is wearing a transdermal medication patch, what should you do?

remove transdermal patch before using AED

what are early signs of hypovolemic shock?

tachypnea, hypotension, pallor, tachycardia, anxiety, restlessness, confusion, oliguria

what is the main possible adverse effect of PEEP?

tension pneumothorax

if someone is on intermittent tube feeding and you get gastric residual of >100-250, what should you do?

you should hold or stop the feeding AND NO NOT REFEED RESIDUAL

in countries with high rates of TB, what vaccine do ppl get that often produces false positive TB skin test readings? what should you do as nurse?

Calmette-Guerin vaccine should do chest Xray if no symptoms of TB

what can increased itching in palms of hands of pregnant woman mean?

HELLP - Hemolysis RBCs, elevated Liver enzymes, low platelets

what does uterine tachysystole look like?

More than 5 contractions in 10 mins and each lasts longer than 90 secs

every pulseless individual gets _______

epinephrine

what is a pleural effusion?

accumulation of fluid in the pleural space

what are nursing interventions to reduce ICP?

administer stool softener dim lights when not providing care maintain body in midline position only perform oral suctioning when needed avoid extreme neck flexion keep calm environment

what are the physical manifestations of emphysema?

barrel chest, activity intolerance, hyperresonance on percussion

what is the #1 concern with cirrhosis of liver?

bleeding - low clotting factors

after blood has arrived on unit for transfusion, how long can it be on unit before it has to be sent back to lab if unused?

can only be out of lab for 30 mins; if longer than you need to send it back to blood bank bc they have the right type of refrigerator

what are PVCs caused by and what should you do if detected on cardiac monitor?

caused by hypoxia, electrolyte imbalances, stress, stimulants, fever, exercise if labs show hypokalemia then give potassium

foods low in potassium (for someone with end stage renal disease)

chicken, apples, grapefruit, turkey, corn, green peas, cucumber, white flour/rice, onion, asparagus

what are late signs of hypovolemic shock?

cold moist skin, cyanosis, weak thready pulses, anuria, hypotension, metabolic acidosis (lactic acid)

what should you do if you are transporting a patient and their chest tube becomes disconnected?

cover insertion site with clean gloved hand

abruptio placentae looks like

dark red bleeding, boardlike abdomen, PAIN would see late deccels - look at fetal monitor

you are turning a patient you is sedated and intubated, they cough and endotracheal tube is expelled, what should you do first???

deliver rescue breathing and 100 O2 with non-rebreather bag valve mask accidental extubation is a medical emergency, a sedated patient is unable to protect airway

describe the pain with pyelonephritis

dull flank pain, extending to umbilicus

what labs would you expect in cirrhosis of liver?

elevated LFTS, elevated ammonia, elevated bilirubin low albumin and low clotting factors

patient is brain dead and is an organ donor. family is worried about having an open casket, what should nurse say?

once body is dressed there will be no evidence of organ donation and open casket will be fine

is it an expected finding of a PEG tube to move 0.2cm when client coughs

yes