STUDY TIP~NCLEX Questions

If your answer choice has the words...None, Never, Only, Always, Must or Cannot it is safe to say that you can eliminate this answer choice. With the human body things change and can change quickly therefore there will not be a definitive answer for a certain question. 

STUDY TIP~Be Open to Learn from anyone

You should be open and receptive to learn from anyone in any discipline. Even housekeeping could give you some tips on proper cleaning and sanitation. During clinicals ask if you could follow the medical students, LVN's and UAP's. Most often this will stimulate your curiosity to learn more. It will also stimulate you to critically think. 

STUDY TIP~Independent Nursing Action Questions

You may be asked a question to test your knowledge on the difference between independent nursing action and dependent nursing action. When answering questions about independent nursing action it is helpful to ask yourself if this action requires an order.

Nursing actions that do not require an order are repositioning a patient, giving a massage and providing emotional support. 

Nursing actions that do require and order are dependent nursing actions such as administering medications, administering oxygen, wound care, getting an EKG reading or monitoring telemetry. 

STUDY TIP~Practicing Questions

When practicing questions write notes next to each answer choice as to why you chose that answer or why you did not choose the answer choice. Then read the rationale for the question. If the rational matched your thought process then you are on the right track if it did not then assess why you chose to answer the question as you did. This will help you to figure out where you may be going wrong when answering questions and help you to figure out what you need to study more. 

STUDY TIP~Health Assessment

When studying HA you must know how to properly perform the assessment, understand abnormal situations and diseases, recall anatomy and physiology, understand elderly abnormals and cultural implications.

A good way to critically think about HA is to ask yourself questions.

1. What am I observing? 
2. What are the normal findings? 
3. What position should the patient be in? 
4. What could I see abnormally? 
5. How would I know if it is an abnormal finding? 
6. What would I do if there was an abnormal finding? 
7. What would I do in an emergency situation?

For example: When testing for symmetry of the chest using the chest expansion test you would give your partner instructions, "I observed my thumbs moving apart symmetrically."

What position should the patient be in? At least 30 degrees at all times with lung problems 

If this did not happen then ask why not? If your thumbs did not move apart symmetrically this could indicate atelectasis, rib fracture, pneumonia,  pleural effusion or collapsed lung. 

How would you know if it is a rib fracture vs. collapsed lung?  Understand the signs and symptoms of the possible causes. 

Is this an emergency situation? A fractured rib and a collapsed lung are both emergency situations but the pneumothorax would need to be addressed first (always think critically because not every situation is alike). With a collapsed lung or pneumothorax you will see signs of shortness of breath, tachycardia, tracheal deviation to the opposite side  (one of the main signs) and cyanosis. 

What would the nurse do? The nurse would give oxygen if ordered, put the pt. in a high fowlers position, monitor the chest tube, monitor for subcutaneous emphysema. 

When practicing your head to toe assessment it could be helpful to speak out loud to your partner giving instructions and saying normal and abnormal findings. 

MED SURG~Peripheral Arterial Disease PAD

PAD 

What is it: Artery wall thicken 

Pathophysiology: The walls of the arteries narrow. 

What Normally Happens in the Body: Thickening happens with cholesterol deposits in the vessel walls. 

What makes it worse: Tobacco, diabetes, hyperlipidemia, family history, increased age, hyperuricemia, obesity, sedentary lifestyle and stress. 

Signs and Symptoms: intermittent claudications, paresthesia, skin is shiny and taut  pallor, decreased or absent femoral pulse 

Possible Causes: atherosclerosis 

Labs and Diagnostics: Doppler ultrasound, segmental BP, angiography and ABI

Meds: Antiplatelets 

Nursing Interventions: femoral pulse absent or decreased, pallor present, have the pt walk, nutrition therapy, Pre-op and Post-op care

Dosage Calculation~Gtt/min

MED SURG~Hyperthyroidism

Hyperthyroidism 

What is it: Hyperactive thyroid gland. It is an excessive amount of thyroid hormones circulating.

Pathophysiology: Graves disease causes excessive thyroid hormone production. The body develops antibodies to the TSH receptor. They attach to the receptors and cause an excessive release of T3 and T4. 

What makes it worse: Smoking and iodine 

What Normally Happens in the body: The thyroid gland secretes T3 and T4 hormones. Iodine synthesises these hormones. The release of thyroid hormones generation and release is triggered by TSH by the anterior pituitary gland. 

Possible Causes: Graves Disease

Signs and Symptoms: Increased hr, bounding pulse, palpations, angina, increased respirations, dyspnea on exertion, increased appetite and thirst, diarrhea, increased bowel sounds, thin nails, hair loss, clubbing, fine hair, premature gray in men, diaphoretic, vitiligo, hyperthermia, restless, delirium, coma, shock, and seizures. 

Lab and Diagnostics: Increased T3 and T4 levels and RAIU test 

Medications: Antithyroid drugs and Beta Adrenergic blockers

Nursing Interventions: Auscultate the thyroid gland for bruits, palpate for a goiter, abnormal eye appearance/exophthalmos, dry corneas present, is there any diplopia, look for thyrotoxicity, get rest, eye care related to dryness, pre-op and post-op care for thyroidectomy. 

DOSAGE CALCULATION

You review your MAR and see that Mrs. Hobbit has been ordered Ranitidine 150 mg b.i.d by NG tube. It is 0800 and time for her first dose. You then read the medication label that you have available. How much of the medication would you administer to Mrs. Hobbit via NG tube? 

https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=20640

150mg/15mg X 1mL = 10mL