NCLEX Review - Advanced Clinical Concepts
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| What PO2 value indicates respiratory failure in adults? | show 🗑
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| What blood value indicates hypercapnia? | show 🗑
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| show | Hypoxemia
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| List three symptoms of respiratory failure in adults. | show 🗑
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| show | Congenital heart disease; infection or sepsis; respiratory distress syndrome; aspiration; fluid overload or dehydration
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| show | 100%
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| show | Widespread, serious reduction of tissue perfusion, which leads to generalized impairment of cellular function
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| show | Hypovolemia
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| show | Release of endotoxins by bacteria, which act on nerves in vascular spaces in the periphery, causing vascular pooling, reduced venous return, and decreased cardiac output and result in poor systemic perfusion
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| What is the goal of treatment for hypovolemic shock? | show 🗑
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| What intervention is used to restore cardiac output when hypovolemic shock exists? | show 🗑
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| show | History of MI with left ventricular failure or possible cardiomyopathy, with symptoms of pulmonary edema
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| show | Pulmonary edema; administer medications to manage preload, contractility and/or afterload. For example, to decrease afterload, nitroprusside (Nipride) may be administered.
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| List five assessment findings that occur in most shock victims. | show 🗑
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| Once circulating volume is restored, vasopressors may be prescribed to increase venous return. List the main drugs that are used. | show 🗑
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| show | 30 mL/hr
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| show | BP mean of 80 to 90 mm Hg; PO2 >50 mm Hg; CVP 2 to 6 mm HG H2O; urine output at least 30 mL/hr
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| show | ARDS is an unexpected, catastrophic pulmonary complication occurring in a person with no previous pulmonary problems. Clients are critically ill and are managed in an intensive care setting. The mortality rate is high (50%).
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| List Interventions to prevent complications of clients on mechanical ventilation with ARDS | show 🗑
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| Define DIC. | show 🗑
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| show | PT, prolonged; PTT, prolonged; platelets, decreased; FSPs, increased
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| What drug is used in the treatment of DIC? | show 🗑
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| show | Gently provide oral care with mouth swabs. Minimize needle sticks and use smallest gauge needle possible when necessary. Turn frequently. Minimize the number of BP measurements. Use gentle suction. Apply pressure to any oozing site.
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| What is the first priority when a client with an unwitnessed cardiac arrest is found? | show 🗑
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| Define myocardial infarction. | show 🗑
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| What criteria should alert a client with known angina who takes nitroglycerin tablets sublingually to call EMS? | show 🗑
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| show | For adults check carotid pulse and if no pulse deliver C-A-B.
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| In feeling for presence of a carotid pulse during CPR, how long should you palpate? | show 🗑
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| During CPR, what is the ratio of compressions to ventilations for an adult? | show 🗑
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| During CPR, what is the ratio of compressions to ventilations for a child? | show 🗑
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| show | Epinephrine
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| A client in cardiac arrest is noted on bedside monitor to be in pulseless ventricular tachycardia. What is the first action that should be taken? | show 🗑
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| How would the nurse assess the adequacy of compressions during CPR? | show 🗑
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| How would the nurse assess the adequacy of ventilations during CPR? | show 🗑
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| show | When the person points to his or her throat and can no longer cough, talk, or make sounds
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| One should never make blind sweeps into the mouth of a choking child or infant. Why? | show 🗑
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| show | Gastrointestinal (GI) causes: vomiting, diarrhea, GI suctioning; decrease in fluid intake; increase in fluid output such as sweating, massive edema, ascites
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| List four common causes of fluid volume overload. | show 🗑
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| show | Ringer’s lactate; normal saline
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| show | Lungs; kidneys; chemical buffers
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| Why is the Allen test used before drawnig a sample for ABGs from the radial artery? | show 🗑
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| Describe the Allen test | show 🗑
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| show | 7.35 to 7.45 pH
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| Normal PCO2 | show 🗑
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| show | 21 to 28 mEq/L HCO3
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| show | Respiratory alkalosis
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| Determine the following acid-base disorder: pH 7.30, PCO2 42, HCO3 20 | show 🗑
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| show | Metabolic alkalosis
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| Determine the following acid-base disorder: pH 7.29, PCO2 55, HCO3 28 | show 🗑
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| Identify the waveforms found in a normal ECG. | show 🗑
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| show | Represented by the P wave
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| show | QRS complex
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| show | The time required for the impulse to travel from the atria through the AV node
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| If the U wave is most prominent, what condition might the nurse suspect? | show 🗑
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| Describe the calculation of the heart rate using an ECG rhythm strip. | show 🗑
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| show | Ability of the client to tolerate the arrhythmia
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| show | Age: very young and very old, obesity and malnutrition, preoperative dehydration/hypovolemia, preoperative infection, use of anticoagulants (aspirin) preoperatively
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| show | Impairs ability to detoxify medications used during surgery; impairs ability to produce prothrombin to reduce hemorrhage
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| Preoperative teaching should include demonstration and explanation of expected postoperative client activities. What activities should be included? | show 🗑
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| What items should the nurse assist the client in removing before surgery? | show 🗑
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| show | Usually on the side or with head to side to prevent aspiration of any emesis
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| show | Teaching client to splint incision when coughing; encouraging coughing and deep breathing in early postoperative period when sutures are strong; monitoring for signs of infection, malnutrition, and dehydration; encouraging high-protein diet
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| show | Avoiding postoperative catheterization; increasing oral fluid intake; emptying bladder every 4 to 6 hours; early ambulation
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| show | Early ambulation; limiting use of narcotic analgesics; NG tube decompression
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| List four nursing interventions that prevent postoperative thrombophlebitis. | show 🗑
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| show | Ascertain correct sponge, needle, and instrument count; position client to avoid injury; apply ground during electrocautery use; apply strict use of surgical asepsis
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| Identify the ways HIV is transmitted. | show 🗑
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| show | Vertical transmission occurs 30% to 50% of the time.
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| show | Protection from blood and body fluids is the goal of standard precautions. Include handwashing; using gloves; using gowns and masks; using eye protection as indicated; preventing needle sticks by not recapping needles.
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| What are the side effects of amphotericin B? | show 🗑
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| What does the CD4 T-cell count describe? | show 🗑
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| show | CD4 T-cell count drops because the virus destroys CD4 T cells as it invades them and replicates.
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| show | Pediatric acquisition may occur through infected blood products, through sexual abuse, and through breast milk.
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| What modalities are associated with the gate control pain theory? | show 🗑
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| How does past experience with pain influence current pain experience? | show 🗑
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| show | Acupuncture, administration of placebos, TENS
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| show | Location, intensity, comfort measures, quality, chronology, and subjective view of pain
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| What mechanism is involved in the reduction of pain through the administration of NSAIDs? | show 🗑
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| If narcotic agonist/antagonist drugs are administered to a client already taking narcotic drugs, what may be the result? | show 🗑
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| List four side effects of narcotic medications. | show 🗑
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| show | Narcan (naloxone)
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| show | Decreased duration of drug effectiveness
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| Which route of administration for pain medications has the quickest onset and the shortest duration? | show 🗑
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| show | Heat and cold applications; TENS; massage; distraction; relaxation techniques; biofeedback techniques
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| show | Denial, anger, bargaining, depression, acceptance
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| A client has been told of a positive breast biopsy report. She asks no questions and leaves the health care provider’s office. She is overheard telling her husband, “The doctor didn’t find a thing.” What coping style is operating at this stage of grief? | show 🗑
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| Your client, an incest survivor, is speaking of her deceased father, the perpetrator. “He was a wonderful man, so good and kind. Everyone thought so.” What would be the most useful intervention at this time? | show 🗑
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| show | This is a normal expression of the anger and guilt that occur. Try to minimize rumination on these thoughts.
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| Mrs. Green lost her husband 3 years ago. She has not disturbed any of his belongings and continues to set a place at the table for him nightly. Is this response indicative of a normal or a complicated grief reaction? | show 🗑
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| Order of blood flow through the heart | show 🗑
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