NCLEX Study Guide
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
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Help!
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| Addisions | down,down, down, up, down
hyponatremia, hypotension, increased blood volume, hyperkalemia, hypoglycemia
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| Cushings | up, up, up, down, up
hypernatremia, hypertension, increased blood volume, hypokalemia, hyperglycemia
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| NO Pee | NO K - do not give potassium without adequate urine output
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| EleVate Veins | dAngle arteries for petter perfusion
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| APGAR | appearance, pulse, grimace, activity, respirations
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| Do not delegate what you can EAT | E- evaluate
A- assess
T- Teach
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| AIRBORNE | MTV
Measles, TB, Varicells (chix pox, herpes, shingles). Private room, negative pressure with 6-12 air exchanges/hr Mask, N95 for TB
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| Droplet precaution | Superman
Sepsis, Scarlet Fever, Streptococcal pharyngitis ,
parvovirus B19, Pneumonia, pertusis
influenza
diphtheria(pharyngeal),
epiglottis
rubella
mumps, menngitis, mycoplasma, or meingeal pneumonia
Advenovirus
Private room or cohort mask
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| Contact precaution | Mrs. Wee
Mulitdrug resistant organisms
Respiratory infections
skin infections
wound infection
enteric infection - clostridium difficile
eye infection - conjunctivitis
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| Skin infections | vchips
Varicella zoster
cutaneous diptheria
herpez sinplelx
impetigo
pediculosis
scabies
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| Air/pulmonary Embolism | chest pain, diff. breathing, tachycardia, pale/cyanotic, sense of depending doom. Turn pt to left side and lower the head of the bed
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| Woman in labor w/ un-reassuring FHR | late decals, decreased variability, fetal bradycardia) turn on left lise and give 02, stop piton, increase IV fluids
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| Tube feeding w/ decreased LOC | Position pt on right side - this promotes emptying of the stomach. HOB elevated to prevent aspiration
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| during epidural | side lying
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| after lumbar puncture (myelogram) | pt lies in flat supine (to prevent headache and leaking of CSF)
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| Pt with heat stroke | lie flat with legs evaluated
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| During continuous bladder irrigation | Catheter is taped to thigh so leg should be kept straight. no other positions restrictions.
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| after myringotomy | position on side of affected ear after surgery (allows drainage of secretions)
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| after cataract surgery | pt will sleep on unaffected side with a night shield for 1-4 weeks
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| after Thyroidectomy | low or semi-fowlers, support head, neck and shoulders
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| infant withe Spina Bifida | prone, or abdomen - so that sac does not rupture
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| Bucks transaction | elevate foot of bed for counter traction
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| after total hip replacement | don’t sleep on operated side, don’t flex hip more than 45-60 degrees. don’t elevate HOB more that 45 degrees. Maintain hip adduction by separating thighs with pillows
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| prolapsed cord | knew chest position of trendelenburg
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| infant with cleft lip | position on back or in infant seat to prevent trauma to suture line. While feeding, hold in upright position.
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| To prevent dumping syndrome | (post operative ulcer/stomach surgeries) - eat in reclining position, lie down after meals for 20-3- minutes (also restrict fluids during meals, low CHO and Fiber diet, small frequent meals.
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| Above knee amputation | elevate for first 24 hours on pillow, position prone daily to provide for hip extension
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| Below knee amputation | foot of bed elevated for first 24 house, position prone daily to provide for hip extension.
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| Detached Retina | area of detachment should be in the dependent position
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| Administration of Enema | position pt in left side lying (sim’s) with knee flexed
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| After Supratentorial Surgery | (Incision behind hairline) - elevate HOB 30-45 degrees
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| After Infratentorial Surgery | (Incision at nape of neck) - position pt flat and lateral on either side
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| During internal radiation | on bed rest while implant in place
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| Autonomic dysreflexia/Hyperreflexia | pounding headache, profuse sweating, nasal congestion, goose flesh, bradycardia, hypertension - pt in sitting position, (elevate HOB) first before any other implementation.
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| Shock | bed rest with extremities elevated 20 degrees to decrease intracranial pressure
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| Head Injury | elevate HOB 30 degrees to decrease intracranial pressure
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| Peritoneal Dialysis when Outflow is inadequate | turn pt from side to side before checking for kinks in tubing
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| Lumbar puncture | after the procedure, the client should be placed in the supine position for 4-12 hours as prescribed
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