NCLEX Exam Prep 2022/2023 with Complete solution

metabolic acidosis - ANSWER low pH, low HCO3 metabolic alkalosis - ANSWER high pH, high HCO3 respiratory acidosis - ANSWER low pH, high CO2 respiratory alkalosis - ANSWER high pH, low CO2 As the pH goes so go ...

metabolic acidosis - ANSWER low pH, low HCO3 metabolic alkalosis - ANSWER high pH, high HCO3 respiratory acidosis - ANSWER low pH, high CO2 respiratory alkalosis - ANSWER high pH, low CO2 As the pH goes so goes my patient except for? - ANSWER Potassium High pressure ventilator alarm - ANSWER *High pressure alarms* are triggered by *increased* resistance to air flow and can be caused by *obstructions* of three types: 1. kinked tubes = unkink it 2. Water in the tube = drain it 3. Mucus plugging tube = turn, cough, and deep breath actions listed from least invasive to most. *Must* turn, cough, and deep breath BEFORE suctioning the patient Low pressure ventilator alarm - ANSWER *Low pressure alarms* are triggered by *decreased* resistance to air flow and can be caused by disconnections of the tube. 1. check for disconnection of the tubing *action depends on *where* the tube lands: a. tubing lands on *floor*: bag the patient, call respiratory b. tubing on *patient chest*: clean tube and reconnect If a patient has an order to disconnect the ventilator and their ABG reveals respiratory acidosis, what should you do? - ANSWER Call the MD and hold order; the patient needs the ventilator and the settings are too low what is the number one problem in all abuse situations? - ANSWER denial How do you treat denial? - ANSWER 1. Confront it by pointing out to the person the difference between what they say and what they do. 2. In contrast, support the denial of loss and grief (b/c the use of denial is serving a functioning person) stages of grief - ANSWER DABDA Denial Anger Bargaining Depression Acceptance dependency in alcohol abuse *2 patients* - ANSWER abuser gets significant other to do things for them; the abuser is dependent on others codependency in alcoholism *2 patients* - ANSWER significant other derives positive self-esteem from making decisions for or doing things for the abuser "Aren't I such a great wife for calling in for you?" manipulation - ANSWER An indirect, dishonest way to control or influence others Wernicke-Korsakoff syndrome - ANSWER psychosis induced by vitamin B1/thiamine deficiency lose touch with reality psychotic people *primary symptom: amnesia with confabulation memory loss what can you take to prevent wernicke-korsakoff - ANSWER take vitamin B1 to prevent and stop it from getting worse Disulfiram - ANSWER Antabuse -aversion therapy -onset: 2 weeks -takes 2 weeks to exit body Disulfiram patient teaching - ANSWER avoid ALL alcohol -mouthwash -shaving cream -perfumes -insect repellent -any OTC that ends in -elixir -hand sanitizers -uncooked icings upper drugs - ANSWER caffeine, cocaine, PCP/LSD, methamphetamines, adderall Upper drugs s/s - ANSWER euphoria tachycardia tachypnea restlessness hypertension irritability diarrhea borborygmi 3+/4+ reflexes spastic seizures downers s/s - ANSWER bradycardia hypotension constipation constricted pupils flaccidity RESP ARREST decrease temp bradypnea Overdose of an upper causes everything to go? - ANSWER up Overdose of a downer causes everything to go? - ANSWER down Withdrawal of a downer causes everything to go? - ANSWER up! Withdrawal of an upper causes everything to go? - ANSWER down A patient is overdosing on cocaine. What do you expect to see? A. Irritability B. 4+ reflexes C. Resp rate less than 12 D. Difficult to arouse E. Borborygmi F. Increased temp - ANSWER A B E F intoxication in the newborn - ANSWER within 24 hours withdrawal in the newborn - ANSWER after 24 hours You are caring a newborn born to a quaalude addicted mom. What would you expect to see in the infant 24 hours after birth? A. difficult to console B. low core body temp C. exaggerated startle reflex D. respiratory depression E. seizure risk F. shrill high-pitched cry - ANSWER A C E F it was a downer drug , withdrawal Alcohol withdrawal syndrome - ANSWER regular diet semi-private anywhere on unit Up ad lib, go around anywhere they want to go No restraints Delirium Tremons - ANSWER NPO or clear liquids private room near nurses station strict bedrest, no washroom privileges restraints needed AWS and DT get what med - ANSWER antihypertensive and vit B1 to metabolize alcohol Amino-glycosides are mean old ______ - ANSWER -mycins *if its THROmycin, THRO it out! its not one Aminoglycosides used to treat - ANSWER infections that are life threatening resistant gram negative TB Sepsis Burn wounds Toxic effects of aminoglycosides? - ANSWER *MICE: ears- otoxic *ears are shaped like kidneys- nephrotoxic *number 8 is drawn in an ear- cranial nerve 8 and administer them q8 Route aminoglycosides - ANSWER IM or IV, never PO, ex. for hepatic encepalopathy or preop bowel surgery lowers ammonia and sterilizes the gut Which aminoglycosides sterilize the gut - ANSWER Who CAN sterilize my bowel? NEO CAN Neomycin and Canomycin TAP stands for - ANSWER Trough: drug at its lowest Administer Peak: drug at its highest Reason for trough levels - ANSWER the drug has a narrow therapeutic window small difference in what works and what kills draw TAPS sublingual TAPs - ANSWER trough: 30 min before next dose peak: 5-10 min after dissolved IV TAPs - ANSWER trough: 30 min before next dose peak: 15-30 min after drug is finished IM TAPs - ANSWER trough: 30 min before next dose peak: 30-60 min after injected SC TAPs - ANSWER trough: 30 min before next dose peak: depends on what type of insulin! PO TAPs - ANSWER trough: 30 min before next dose peak: don't need to know Calcium channel blockers are like _______ for your heart - ANSWER Valium What do calcium channel blockers treat? - ANSWER AAA (Antihypertensive, Anti anginal, Anti atrial arrhythmias) Side effects of calcium channel blockers - ANSWER hypotension, headache *Hold if systolic <100* CCBs end in - ANSWER DIPINE verpamil and cardizem are exceptions V fib - ANSWER V-tach - ANSWER Asystole - ANSWER P-wave is - ANSWER atrial depolarization QRS is - ANSWER ventricular depolarization T wave - ANSWER ventricular repolarization a-fib - ANSWER a-flutter - ANSWER PVC - ANSWER V tach treatment - ANSWER - Cardioversion when there is pulse - Defibrillate if pulseless - Oxygen, Lidocaine and treating underlying cause. Atrial Arrhythmias: ABCDE - ANSWER A- anticoagulants B- beta blockers C calcium channel blockers D digoxin / Lanoxin E electrocardioversion In a pneumothorax, the chest tube removes ____ - ANSWER air In a hemothorax, the chest tube removes ____ - ANSWER blood there is continuous bubbling in the water seal chamber, this is_____ - ANSWER BAD! Theres a leak! there is intermittent bubbling in the water seal chamber, this is _____ - ANSWER Good! document there is intermittent bubbling in the suction control chamber, this is ______ - ANSWER BAD! The suction isn't on high enough there is continuous bubbling in the suction control chamber, this is_____ - ANSWER good! suction is at the right level four defects in tetralogy of Fallot. - ANSWER *VarieD PictureS Of A RancH* ventricular defect pulmonary stenosis overriding aorta right hypertrophy A TRouBLe congenital heart defect shunts blood from - ANSWER Right to Left ALSO all trouble ones start with T, and cause cyanosis PPE donning - ANSWER gown, mask, goggles, gloves PPE doffing - ANSWER gloves, goggles, gown, mask Contact precautions - ANSWER Hep A C-dif Staph infections RSV (droplet too) Herpes Private room - door can be open Gloves Gown- if giving direct care Hand-washing Disposable supplies