NCLEX RN Review Flashcards

Terms Definitions
Muscle Relaxant

• Mediterranean, Middle
East, Africa, South
China, Southeast Asia
• Synthesis beta Hgb chain impaired
• RBCs w/ less Hgb
• RBCs in marrow destroyed
• Increased erythropoietin,
but ineffective RBC
• Bone marrow hyperplasia
• Sequelae:
– Severe anemia
– Impaired growth/
– Without treatment: death
by 5 – 6 years
Dilate the pupils
1.6 to 2.6
discrimination directed toward individuals or groups who are perceived to be inferior because of bilogical differences; often accompanied by oppression
Diagnostic tests:

§ Neuroimaging studies

§ Cytogenic studies

§ Metabolic studies

o Treatments:

§ Braces or splints

§ Adaptive tools

§ High caloric diet

§ Artificial urinary sphincter

§ Range of motion (ROM)

§ Drug therapy:

· Muscle relaxants

· Anticonvulsants:

o Phenytoin (Dilantin)

o Phenobarbital (Luminal)

§ Assist in movement

§ Divide tasks into smaller components

§ Refer:

· Speech therapy

· Nutritional therapy

· Physical therapy

§ Provide safe environment
Emergency endotracheal intubation

§ Oxygen

§ Cool mist tent

§ IV fluid

§ Drug therapy:

· Antibiotics

§ Monitor:

· Respiratory status

· Cardiovascular status

· Vital signs

· Pulse ox

· I&O

§ Avoid inspection of throat until emergency equipment is available

§ Emergency tracheotomy and intubation equipment available at the bed side

§ Allow activities that reduce child’s anxiety

§ Provide emotional support to both child and parents
Nefazodone (Serzone)

Drug Class
SNRI (Antidepressant)

• Meds: ABX
• Isolation precautions
• Ventilation
• Fluid restriction
(how much? 1/2 to 2/3)
• Monitor for increased ICP
• Comfort measures
• Hearing tests
an expectation directed toward individual or groups who are perceived to be inferior because of biological differences; often accompanied by oppression
§ Monitor:

· Respiratory status

· Cardiovascular status

· Vital signs

· Pulse ox

· I&O

· For rebound obstruction

§ Provide emotional support

§ Age appropriate activities
Celiac disease:
Diagnostic tests:

§ Immunological assay

§ Intestinal biopsy

§ Stool specimen high fat content

o Treatments:

§ Gluten-free diet; rice and corn allowed

§ Vitamins:

· Folic acid

· Iron

· Vitamin A and D

§ Small frequent meals

§ Monitor growth and development

§ Record stool:

· Color

· Consistency

· Appearance

· Number of stools
What is arthrodesis?
fusion of joints
Spinal bifida
Diagnostic tests:

§ Elevated alpha-fetal protein

§ Amniocentesis

§ Acetylcholinesterase

o Treatments:

§ Surgical repair of meningocele and myelomeningocele

§ No treatment for spina bifida occulta

§ Per-operative interventions:

· Monitor:

o S/S of infection

o S/S of hydrocephalus

o Measure head circumference daily

o I&O

· Position infant on abdomen

· High caloric diet


· Clean, inspect and cover sac with sterile dressings moistened with sterile saline

· Usually unable to diaper infant

§ Post-operative interventions:

· Monitor:

o S/S of hydrocephalus

o Daily head circumference

o Vital signs

o Drainage from surgical site

· Prone position

· Allow parent to express emotions
a single fertilized ovum twins!
an atypical antipsychotic, side effects include leukopenia, gram-negative septicemia, drowsiness, tachycardia, and hypotension.
Diagnostic tests:

· Culture of drainage


· Moist heat application

· Pumping of breast milk

· Incision and drainage only to treat abscess

· Drug therapy:

o Antibiotics:

§ Cephalexin (Keftab)

§ Clindamycin (Cleocin)

o Analgesics:

§ Acetaminophen (Tylenol)

§ Ibuprofen (Motrin)

· Monitor vital signs

· Teaching tips:

o Breast feeding every 2-3 hours

o Change nipple shields often

o If abscess develops pump and discharge breast milk
Reye's syndrome
respiratory status

· Cardiovascular status

· Neurological status


· Vital signs

· Pulse ox

· I&O

· Seizure activity

· Blood glucose level

· Temperature every 15-30 minutes while using hypothermia blanket

· Reflexes

§ Seizure precaution

§ Head of bed 30o

§ Oxygen therapy

§ Hypothermia blanket

§ Provide skin and mouth care

§ Provide emotional support to patient and family
the dynamic network of knowledge, beliefs, patterns of behavior, ideas, attitudes, values and norms that are unique to a particular group of people
The drug that helps prevent ventricular remodeling in the treatment of MI is
Anti-protozoals: Metronidazole (Flagyl, Flagyl ER)
CNS symptoms, abd cramps, metallic taste,
N.C.: trtmt of wide variety of inf.including trichomoniasis and giardiasis
=IV:immediate onset, PO-pk 1-2 hrs
=dark-reddish brown urine
=avoid hazardous activities
=trtmt in both partners for trichomoniasis
=do not drink alcohol in any form, during and 48 hrs after use, disulfiram-like reaction can occur
preg B
pulmonary hypertension
elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles
MAOI (Antidepressant)

Foods to Avoid
Tyramine-rich foods
Matured/aged cheeses,
(incl. pizza, pastas that include their use)
Air dried, aged, and fermented meats,
Pickled herring
Broad bean pods
All tap & unpasteurized beers
Marmite, Sauerkraut,
Soy sauce, Soybean condiments
chemically similar to sodium, if sodium levels are reduced, such as from sweating or dieresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn’t restrict their intake of sodium and should drink adequate amts of fluid ea day. Signs of Lithium toxicity are diarrhea, vomiting, drowsiness, muscular weakness, ataxia, stupor, and lithargy
=dosages for lithium, an antimania drug. Usually are individualized to achieve a maintenance blood level of 0.6 to 1.2 mEQ/L. – a treatment level 1 to 1.4 mEq/L to prevent or control mania the serum level should measure 0.8-1.2 mEq/L should not exceed 2 mEq/L – used to treat clients with cyclical schizoaffective disorder . lithium helps control the affective component of this disorder. It is a nonantipsychotic drug- common s.e. are nausea, diarrhea, tremor and lithargy
Risk factor for Cataracts
prolonged nsaid use
may be from overstimulation of dopamine-cause hallucinatins, agitation, delusional thinking and grandiosity
minority group
an ethnic, cultural, racial or religious group that constitutes less than a numerical majority of the population
a grouping of people based on biological similarities. Members of which have similar physical characteristics, such as blood grion that all people withina group, facial features and color of skin, hair and eyes
The drug that minimizes bradycardia from vagal stimulation in the treatment of MI is
stol softner
Intestinal obstruction:

This is the complete or partial blockage in the lumen of the small or large intestines. It can occur in three forms: simple blockage of intestinal contents, no other complcation, strangulated lack of blood supply in addition to th
Contributing factors:

§ Mechanical:

· Adhesions

· Strangulated hernia

· Carcinomas

· Congenital bowel deformities

§ Other:

· Electrolyte imbalances

· Paralytic ileus

· Sepsis

· Neurogenic abnormalities

· Thrombus or embolus
Anti-malarials: Hydrozychloroquine (Plaquenil)
s.e.: eye disturbances, NV, Anorexia
N.C.: mgmt of malaria, lupus erythematosus, rheumatoid arthritis
-peak 1-2 hrs
-take at same time ea day to maintain bl levels
-for malaria, prophylaxis should be started 2 wks b4 exposure and for 4-6 wks after leaving exposure area
preg C
Cardiac Tamponade
Diagnostic tests used to detect cardiac tamponade is a chest x-ray which shows a slightly widened mediastinum and enlarged cardiac silhouette.
Atrial gallop, heard before S1, an abnormal heart sound
Complications of Thyroidectomy
Includes hypocalcemia injury to parathyroid glands causes decease in serum calcium, thus the RN should assess for hypocalcemia (tingling around the mouth, toes, fingers, and muscular twitching)
Which of the following signs is considered
a late sign of shock in children?
Respiratory Acidosis
Signs & Symptoms
1. Hypotension, dysrhythmias, tachycardia
2. Dyspnea
3. Rapid, shallow breaths
4. Muscle weakness & decreased LOC - Tremors, seizures, lethargy, stupor
Diagnostic tests:

§ CD4 T-cell less than 200cells/ul

§ ELISA positive HIV antibody titer

§ Western blot: positive

§ Decrease in:



· Platelets
· Developmental hip dysplasia:
Diagnostic tests:

§ Barlow’s sign

§ Ortolani’s click

§ Trendelenburg’s test is positive

§ X-rays

o Treatments:

§ Hip-spica cast for older children

§ Corrective surgery

§ Bryant’s traction

§ Casting or Pavlik harness for 3 months

§ Provide assurance to parents that condition is correctable

§ Provide assurances to parents that child will adjust to cast

§ Provide proper skin care

§ Monitor circulation
When does the posterior fontanelle close?
2-3 months
cultural diversity
the differences among groups of people that result from ethnic, racial and cultural variables
dominant culture
the group whose values prevail within a society
Acyanotic heart defects tx
Aortic stenosis: surgery

§ Atrial septal defect: surgery to patch hole

§ Coarctation of aorta: closed heart resection

§ Patent ductus arteriosus: ligation of patent ductus arteriosus

§ Pulmonary artery stenosis: open heart surgery

§ Ventricular septal defect: pulmonary artery banding

§ Drug therapy:

· Cardiac glycoside:

o Digoxin (Lanoxin) apical rate for 1 full minute hold for heart rate less than 60 beats/minute

· Diuretic:

o Furosemide (Lasix)
· Asthma inflammation of the respiratory tract
Contributing factors:

§ Hyperresponsiveness of lower airway

o Clinical findings:

§ Lung sounds:

· Prolonged expiration

· Expiratory wheeze

· Unequal or decreased breath sounds

· Possible inspiratory wheeze

§ Diaphoresis

§ Dyspnea

§ Use of accessory muscles

o Diagnostic tests:

§ Pulse ox

§ ABGs
Down syndrome :
This is a chromosomal disorder associated with mental retardation, dysmorphic facial features and other distinct abnormalities(such as heart disease, respiratory infections, chronic myelogenous leukemia and weakened immune system).

o Contributing factors:

§ Genetic disorders

§ Maternal age
Juvenile rheumatoid arthritis:

This is an autoimmune disease of the connective tissue. It is associated with inflammation of the synovial and possible joint destruction.

o Contributing factors:

§ Genetic predisposition

§ Autoimmune
o Clinical findings:

§ Inflammation of joints

§ Stiffness, pain and guarding of affected joints

o Diagnostic tests:

§ Elevated sedimentation rate

§ Positive antinuclear antibody test

§ Positive rheumatoid facture

o Treatments:

§ Splint application

§ Heat therapy

§ Drug therapy:

· Low-dose corticosteroids

· Low-dose methotrexate

· Nonsteroidal anti-inflammatory

§ Monitor for joint deformity


§ Provide assistance devices
· Cyanotic heart defects:
Types of cyanotic defects:

§ Transposition of great vessels

§ Tetralogy of Fallot

§ Hypoplastic left heart syndrome

§ Truncus arteriosus
Contributing factors:

§ Conditions that increase pulmonary vascular resistance

§ Structural defects
Negative signs of Schizophrenia
absence of typically displayed emotional responses
What is a form of arteriosclerosis in which deposits of fat & fibrin obstruct & harden arterial vessels?
Puerperal Infections:

This is a bacterial infection that can occur after childbirth. It occurs in 2-5% of vaginal births and 15-20% of cesarean deliveries.
Contributing factors:

· Catheterization

· Colonization of lower genital tract with pathogenic organisms

· Forceps deliveries

· Multiple vaginal examinations

· Intrauterine fetal monitoring

· Cesarean deliveries

· History of:

o Previous infections

o Pre-existing medical problems

o Poor general health

o Poor nutrition

· Lower socioeconomic status

· Retention of placental fragments

· Prolonged labor or rupture of membranes

· Trauma
this is strongest during the first 2 months it should disappear after 3 to 4 months of age.
What does the bone marrow produce?
RBC, WBC, platelets
In reviewing discharge instructions for a client recently starting on Humalog Insulin. The nurse stresses the importance of eating within _________of taking this medication.
5 to 15 minutes
Indications for the antidysrhythmic drug lidocaine include:
Ventricular arrhythmias.
Lidocaine is a sodium channel blocking drug used specifically to treat ventricular arrhythmias.
What is Fremitus
Vibratory tremors, esp. those felt through the chest wall by palpation.
Brazelton neonatal assessment
alertness, response to visual and auditory, and motor coordination
tarasoff act
duty to warn of threatened suicide or harm to others
Hypothyroidism :

This is the result of the thyroid gland not producing enough hormone. This can be present at birth or develop later. This disorder was cover earlier in the adult section, child specific issues will be covered here.
Contributing factors:

§ Congenital abnormality

§ Autoimmune disorders

§ Inherited disorder

o Clinical findings:

§ All S/S mentioned earlier

§ In infants:

· Persistent jaundice

· Hoarse cry

· Respiratory difficulties

§ In older children:

· Bone and muscle dystrophy

· Stunted growth

· Cognitive problem

o Diagnostic tests:

§ Low T3 and T4 levels

o Treatments:

§ Treatment same as adult
Celiac disease:

This disease is the result of decrease in amount or activity of intestinal enzymes. This results in a poor absorption of food and intolerance of gluten. Gluten is a protein found in grains. This disorder becomes apparent at 6-18 months
Contributing factors:

§ Immunoglobin A deficiency

§ Too-introduction of proteins solids

§ Gluten intolerance

o Clinical findings:

§ Generalized malnutrition

§ Failure to thrive

§ Steatorrhea

§ Height and weight below normal

§ Anorexia

§ Abdominal distention

§ Irritability
Rheumatic fever diagnostic tests
§ Increase Sedimentation rate

§ EKG prolonged PR interval
Pt on Tetracycline needs to avoid?"
the sun and milk
Contact dermatitis:

This is a localized rash in the area normally covered by a diaper. It is also known as diaper rash.
Contributing factors:

§ Harsh soaps and bubble baths

§ Clothing dye

§ Prolonged exposure to urine or stool

§ Moist warm environment

o Clinical findings:

§ Bright red maculopapular rash in diaper area

§ Irritability secondary to pain

o Diagnostic tests:

§ Based on physical inspection

o Treatments:

§ Clean with mild soap and water

§ Leave area exposed to air

§ Drug therapy:

· Vitamin A and D

· Zinc oxide

· Antibiotic cream if secondary infection occurs

§ Clean diaper area as clean as possible

§ Change diaper frequently

§ Avoid commercial diaper wipes on broken skin
Volkmann Contracture
this is a type of compartment syndrome caused by obstruction of arterial blood flow to the forearm and hand; cannot straighten fingers, has severe pain, and there may be signs of diminished circulation.
early decels
this occurs before the peak of the contraction, it results from fetal head compression.
What are the two ways to treat hyperbilirubinemia
Exchange transfusion
For what potential side effects would the nurse monitor patients prescribed amiodarone?
bluish skin discoloration (pulmonary?), hyper- or hypothyroidism, photosensitivity, visual halos, dry eyes, decreased libido (corneal microdeposits)
. Rationale: Dextroamphetamine is a psychostimulant and acts on the CNS. It would increase anxiety and elevate mood. CNS
Dextroamphetamine (Dexedrine) has been ordered for a client diagnosed with narcolepsy. The nurse understands that this medication act
What are the two high electrolytes in neonates?
na and cl
What is diabetes insipidus?
A disorder of water metabolism in which there is excess water loss due to hypo secretion of ADH, damage to posterior pituitary or inability of kidney's to respond to ADH.
Location to Auscultate for the Tricuspid
5th Intercostal Space Left Side
Signs and Symptoms of Lithium Toxicity
* Over sedation
* Tinnitus
* Ataxia
* Slurred Speech
* Muscle Weakness/Twitching
wilms tumor
A cancer of the kidney and one of the most important malignancies in childhood,
Rules for Sunctioning
Suction should be applied for 10 to 15 seconds at a time. Sunction is regulated to 80 to 120 cm. Suction should be applied only during withdrawal of the catheter. When suctioning the trachea, the catheter is inserted 4" to 6' or until resistance is felt.
Important teaching for a cleint receiveing risperidone (Risperdal) would include adivising the client to:
Notify Physician if an increase brusing occurs
Nursing Interventions to Promote Healing with Infection/Inflammation
1. Increase fluid intake
2. Diet high in protein, carbs, and vitamins A, C, and B complex
3. Immobilize an injured extremity with a cast, splint, bandage
4. Administer antipyretic medications
5. Identify early signs of infection
client with insulin-dependent diabetes mellitus (IDDM) is being discharged. The nurse knows that the client has understood essential teaching when the following statement is heard:
I need to cut my nails straight across.
What is the management taken for a patient with PROM?
emember: Amniotic fluids is continually produced, Hospitalized, Bed Rest, Trendelenberg position – If bag of water is bulging., Daily CBC (look at WBC for infection), CRP (C-reactive protein – checks for inflammation – if elevated = infection), Fetal well-being tests: Non-stress test, Biophysical Profile, Medication: Celestone or Beta methezone (Steroid) – IM injection to help mature baby’s lungs – given 1 – 2 times Q 24 hours. Lung surfactant ratio 2:1 (mature lungs).
s/S of primary dementia of the Alzheimer's type.
slight memory impairment and poor concentration, subtle personality changesand occasional ierritalbe aoutburst and lack of spontaneity
What are the types and differences of spontaneous abortions?
Spontaenous abortion – occuring naturally

Types of Spontaneous abortion:
Threatened – Pt has been bleeding
Imminent – Pt is bleeding, cervical os is open, cramping.
Complete – Fetus and placenta are expelled
Incomplete – Fetus is expelled and placenta is left inside.
Missed – Fetus dies before the 20th week of gestation
Habitual – Pt has 3 abortions between 14-16 weeks (usually due to incompetent cervix – cerclage performed)
· Acyanotic heart defects: blood is shunted left to right side of the heart
Types of acyanotic defects:

§ Aortic stenosis

§ Atrial septal defect

§ Coarctation of aorta

§ Patent ductus arteriosus

§ Pulmonary artery stenosis

§ Ventricular septal defect
The nurse injects 0.1 ml of purified protein derivative (PPD) intradermally into the inner aspect of the raction to this test as positive when the following is seen
induration greater than 10 mm
What causes the foramen ovale to close
when the systemic blood presessure rises, and the pressure inside the left atria is greater than the pressure in the right atria.
What to remember about jaundice and newborns
A “normal” jaundice can occur with babies. It happens 24 hours after the baby is born. An “Abnormal” jaundice is seen within 24 hours of delivery. S/S: Yellow skin, sclera of the eye, pale stools, dark urine, elevated liver enzymes (ALT and AST). This is due to intestine’s inability to process bilirubin (excreted through feces). So it builds up in the body (under skin and eyes and body tries to eliminate through urine). If there is too much bilirubin, it can cause Kernicterus – brain damage to the baby.
When giving adenosine, it is important to remember to:
Give it as a fast intravenous push.
Adenosine must be given as rapidly as possible, followed by a 50 mL normal saline flush in order to get all of the medication into the circulation quickly since the half-life of adenosine is A10 seconds.
Contagious Infection Period for TB
After 4 weeks of treatment for TB the disease is no longer considered infectious but the client must continue to take their medication.
Why is colchicine effective in the treatment of gout?
MOA for colchicine is that it DECREASES inflammation by reducing the migration of leukocytes to synovial fluid
What effects can infections have on a pregnant woman?
Sepsis to mother, PROM, Sepsis to neonate (high mortality rate)
What is the function of a Miller-Abbott Tube?
removes fluid and gas from the small intgestines..often used for tx of paralytic ileus
A patient's rhythm strip indicates a normal HR and rhythm with normal P wave and QRS complex, but the P-R interval is 0.26 seconds. The most appropriate action by the nurse is to:
. A rhythm pattern that is normal except for a prolonged P-R interval is characteristic of a first-degree heart block. First-degree heart blocks are not treated but are observed for progression to higher degrees of heart block.
A nurse assesses a rise in the fundal height and a sudden gush of blood from the vagina of a postpartum client five minutes after birth. The nurse appropriately interprets these finding as
Separation of the placenta is characterized by a rise in fundal height and sudden gush of blood five minutes after birth. Immediate postpartum hemorrhage is not characterized by a rise in fundal height. Late postpartum hemorrhage occurs 24-48 hours or more after birth. Delivery of the placenta is characterized by a decrease in fundal height.
A 45-year old client is receiving heparin sodium for a pulmonary embolus. The nurse evaluates which of the following laboratory reports of partial thromboplastin time as indicative of effective heparin therapy?
C. Two to 2.5 times the control (normal) value.
A pregnant client asks the nurse, "How will I know when I am close to starting labor?" The nurse correctly states that one possible sign of impending labor
Impending labor may be indicated by a weight loss of 2.2 to 6.6 kg (1 to 3 lb) resulting from fluid loss and electrolyte shifts produced by changes in estrogen and progesterone levels. Diarrhea, indigestion, or nausea and vomiting usually occur just prior to the onset of labor. Some women report a sudden burst of energy approximately 24 to 48 hours before labor. Abdominal discomfort can be a sign of false labor.
A Hmong client has just given birth to a five pound baby girl. What culturally sensitive nursing action is appropriate at this time?
Offering the mother a soft-boiled egg to eat is the culturally sensitive nursing action appropriate for the postpartum Hmong client. Commenting on the daintiness of her baby girl and assisting the mother in bathing the baby is not a cultural preference. Warm foods are preferred by this culture at this time so offering cold foods would not be appropriate.
A G4P3 client in the transition phase of labor asks the nurse, "How much longer will it be before I have my baby?" What would be the best estimate that the nurse could provide?
One hour is a reasonable estimate of time until delivery for a multipara woman in transition. Two hours or more would be a more appropriate answer for a nullipara woman.
A nurse is assigned to care for a clt who was just admitted to the hospital for the trmt of iron overload. The nurse reviews the physician's admission orders and anticiptes that the Md will prescribe which med to treat the iron overload?
Deferoxamine is an antidote used to treat iron toxicity.
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