NCLEX Review

Question 1

ACID BASE

Answer 1

if the pH is the BiCarb are both in the same direction -> metabolic

draw arrows beside each component to see each direction

down = acidois
up = alkalosis

Question 2

ACID BASE

Answer 2

respiratory -> has no b in it; if in other directions (or if bicarb is normal value)

KNOW NORMAL pH, BiCarb, CO2

Question 3

HINT:
DO NOT MEMORIZE LISTS
- for SATA questions -

Answer 3

in general/principle what do opioids/pain medications do?
- they sedate you, CNS depressors

ex:
dilaudid - do not memorize specifics or a list of dilaudid, know principles of opioids
- sedation, CNS depression -> lethargy, flaccidity, reflex +1, hypo-reflexia, obtunded

Question 4

Principles of S&S
ACID BASES

as the pH goes so goes my patient, EXCPET FOR K+

Answer 4

pH up = PT up
-> body system gets more irritable, hyper-excitable (EXCEPT K+)
-> Alkalosis = think of the body system and go high: hyper-reflexiva (+3, +4 (2 is normal)), tachypnea, tachycardia, borborygmi, seizure

pH down = PT down
-> body systems shut down (EXCEPT K+)
-> Acidosis = think of the system and go low: hypo-reflexive (+1, 0), bradycardia, lethargy, obtunded, paralytic illeus, respiratory arrest (coma)

ambu-bag by bedside: acidosis (respiratory arrest)
suction by bedside: alkalosis (seize and aspirate

MAC Kussmaul - present in only 1
M = Metabolic AC = Acidosis

Question 5

HINT:

Answer 5

most common mistake with select all that apply questions:
selecting one more than you should
STOP when you select the ones you know! do not get caught up on the could be’s

NEVER think of the words: if, maybe, might, could, possibly in SATA

Question 6

DON’T MIX UP S&S and CAUSATION

Answer 6

often what causes something is the opposite of the S&S
- ex: diarrhea will cause a METABOLIC ACIDOSIS but once you are acidotic your bowel shuts down and you get a paralytic illeus

Acidosis: adynamic illeus, +1 reflex, type 2 heart block, urinary retention

Question 7

when you get scenarios:

Answer 7

if it’s a lung scenario = respiratory
- check if the client is over - ventilating (alkalosis) or under - ventilating (acidosis)
- remember to look for words -> over, under ventilating -> “as the pH goes so goes my PT”

Ventilating does NOT mean respiratory rate; respiratory rate is irrelevant with acid - base ventilation has to do with gas exchange not respiratory rate (look at SaO2 -> if your respiratory rate is fast but SaO2 is low you are under-ventilating)

PCA pump - What acid - base disorder indicated they need to come off of it = respiratory acidosis (respiratory depression -> respiratory arrest)
- under - ventilating

Question 8

when you get scenarios:

Answer 8

if it isn’t lung -> its metabolic
- metabolic alkalosis - really only one scenario: if the PT has prolonged gastric vomiting/suctioning
- because you are losing acid
ex: GI surgery with NG tube with suctioning for 3 days; hyperemesis gravidium
- otherwise everything alse that isn/t lung you pick METABOLIC ACIDOSIS (default)

Question 9

there is only 4 to pick from:
respiratory alkalosis
respiratory acidosis
metabolic alkalosis
metabolic acidosis

Answer 9

if you don’t know what it is;
METABOLIC ACIDOSIS is the default

Question 10

Pay more attention to the modifying phrases than the original noun

Answer 10

ex:
a person with OCD who is now psychotic (psychotic trumps OCD); hyperemesis with dehydration (pay attention to dehydration)

modifying phrase trumps the noun

Question 11

VENTILATION

Answer 11

know alarm systems
(you set it up so that the machine doesn’t use less than or more than specific amounts of pressure)

Question 12

high pressure alarm

Answer 12

increased resistance to airflow (the machine has to push too hard to get air into the lungs)
- from obstructions
1. kinks in the tubing (unkink it)
2. water condensation in tube (empty it!)
3. mucous secretions in the airway (change positions/turn, cough and debrief, and THEN suction

SUCTION IS ONLY PRN
- priority questions = you would check kinks first, suction is NOT first

Question 13

low pressure alarm

Answer 13

decreased resistance to airflow (the maching had to work too little to push air into the lungs)
- from obstructions
1. main tubing (reconnect it, DUH!)
2. O2 sensor tubing (which senses FiO2 at the airway/trach area; black coated wire coming from maching right along the tubing - reconnect it!)

Question 14

ventilators -> know blood gases

Answer 14

respiratory alkalosis = ventilation settings might be too high (OVER-VENTILATING)

respiratory acidosis = ventilation settings might be set too low (UNDER-VENTILATING)
- call the provider
ex:
weaning a patient off ventilator -> should not be under-ventilated, they need the ventilator; if they are over-ventilating then they can be weaned

NEVER pick an answer where you as the nurse don’t do anything and someone else has to do something

Question 15

ABUSE (Psych and Med-Surg)
Psychocological Aspect/Psycho - Dynamics

Answer 15

1 psychological problem is the same in any and all abusive sitations -> DENIAL

• abusers has an infinite capacity for denial so that they can continue the behavior without answering to it

Can use alcoholism rules for abuse
ex: #1 psych problem in child abuse, gambling, or cocaine abuse is denial

WHY is DENIAL the problem?
- HOW CAN YOU TREAT SOMEONE WHO DENIES/DOESN’T RECOGNIZE THEY HAVE A PROBLEM

**DENIAL = refusal to accept reality of a problem **
treat denial by CONFRONTING the problem (it’s not the same as aggression which attacks the person, not the problem) = they DENY you CONFRONT

Question 16

HINT

Answer 16

NEVER PICK ANSWERS THAT ATTACK THE PERSON
-> bad answers have bad pronouns = “you”
-> good answers have good pronouns = “I” “We”
-> “you wrote the order wrong” vs. “I’m having difficulty interpreting what you want”

Question 17

loss and grief

Answer 17

for this denial you must SUPPORT it
DABDA = denial, anger, bargaining, depression, acceptance

Question 18

HINT

Answer 18

for questions about denial, you must look to see if it is LOSS or ABUSE
- loss and grief -> support it
- abuse -> confront

Question 19

2 psychological problem in abuse

Answer 19

**DEPENDENCY and CO - DEPENDENCY **
dependency = when the abused gets signifcant other to do things for them or make decisions for them
- the dependent -> the abuser
co - dependency = when the signifcant other derives positive self - esteem from making decisions for or doing things for the abuser
- the abuser gets a life without resposibilities
- the signifcant other gets positive self - esteem (which is why they can’t get out of the relationship)

how to treat it:
- set limits and enforce them
-> start teaching significant other to say NO (and they have to keep going it)
- must also work on self - esteem of the co - dependent (I’m a good person because I am saying NO)

Question 20

Manipulation

Answer 20

when the abuser gets the significant other to do things for them that are not in the best interest of the significant other
- the nature of the act is dangerous and/or harmful

How is manipulation like dependency?
- in both the abuser is getting the other peson to do something for them

How to tell the difference between manipulation and dependency?
- NEUTRAL vs. NEGATIVE (look at what they’re being asked to do)
- if the significant other is being asked to do something neutral (no harm) its dependency/co - dependency
- if the significant other is being asked to do something that will harm them or is dangerous to them they are being manipulated

How do you treat manipulation?
- set limits and enforce them -> NO
- easier to treat than dependency / co - dependency because no one likes to be manipulated (no positive self - esteem issue is going on)

Question 21

ALCOHOLISM

Answer 21

Wernicke’s (encephalopathy) and Korsakoff’s (psychosis; loss touch with reality)
- typically seperate BUT boards lumps them together
- tend to go together, find them in the same patient