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NCLEX prep

QuestionAnswer
artery vs vein problem? leg(s) cool, shiny, weak pedal pulses artery problem; "A" = legs go down
artery vs vein problem? leg(s) warm, red, swollen vein problem; "V" = legs go up
tag? expected and allowed to die; prepare for morgue black tag
tag? stable; minor injuries that require treatment; can delay treatment 2 to 4 hrs green tag
tag? major injuries that require treatment; can delay treatment 30-min to 2-hrs yellow tag
tag? immediate threat to life; do not delay treatment red tag
-mechanical brain reset? -chemical brain reset? -Electroconvulsive therapy (ECT) -Phenytoin
How many days after surgery are patients on anticoags? 14 days
child squatting after light activity indicates what? heart defect (squatting = tripod position)
-hot & dry... -cold & clammy... -sugars too high -give them candy
Client w/asthma. Effect should nurse recognize as an adverse response to bronchodilator therapy? -hyperkalemia -hypoglycemia -↑ myocardial oxygen use -limited routes of administration -↑ myocardial oxygen use
Pt receives transfusion of PRBCs and tells nurse "My IV site is painful and looks swollen." Nurse action? -monitor for signs of infection/infiltration -double check blood type w/another nurse -start new IV site and resume transfusion -d/c transfusion start new IV site and resume transfusion
Semi-comatose pt after CVA has NG tube and started on TPN today. Nurse action to prevent fluid volume deficit? -give 120mL bolus of water -monitor BG every 4-6 hr -determine total fluid intake every 8 hr -↑ oral fluid intake to 3L/day monitor BG every 4-6 hr (TPN has high sugar...hot & dry = sugars too high)
RN, LPN, UAP? establish goals for nursing care RN
RN, LPN, UAP? ambulate a client with a walker RN, LPN, UAP
RN, LPN, UAP? initiate a client referral RN
RN, LPN, UAP? obtain a urine sample from an indwelling catheter RN, LPN
RN, LPN, UAP? administer the MMR vaccine RN, LPN
RN, LPN, UAP? regulate IV insulin RN
RN, LPN, UAP? check bowel sounds RN, LPN
RN, LPN, UAP? apply lotion to intact skin RN, LPN, UAP
RN, LPN, UAP? change a sterile dressing RN, LPN
Created by: nurse savage
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