Do a least one a day and LOOK AT THE RATIONALE WHETHER RIGHT OR WRONG
http://www.mightynurse.com/nclex-practice-questions/
http://nurseslabs.com/nclex-practice-questions/
https://www.google.ca/webhp?sourceid=chrome-instant&rlz=1C1CHFX_enCA564CA567&ion=1&espv=2&ie=UTF-8#q=nclex+questions
http://brilliantnurse.com/shop/75-free-nclex-practice-questions/
http://narzing.blogspot.ca/2011/02/feuer-nursing-review-lecture-audio-free.html
Focus on your successes encouraging yourself to greater achievements in the future and Forget your past
mistakes.
Always do your best so you can be proud that you gave it your best shot.
Focus on your achievements rather than your failures. If you do find yourself thinking about how you
failed then look at what you managed to do right and how you could correct what you did next time.
A mind that is troubled with doubt won't be able to focus on the victory to be had.
Take time for yourself. A fried mind can't focus or learn.
Look carefully when you have no idea. In a word like rhabdomyosarcoma you can easily ascertain it has
something to do with muscle (myo) cancer (sarcoma). The same thing goes for drug names. For
example, if it ends in –ide it’s probably a diuretic, as in Furosemide, and Amyloride.
When getting down to two answers, choose the assessment answer (assess, collect, auscultation,
monitor, palpate) over the intervention except in an emergency or distress situation. If one answer has
an absolute, discard it. Give priority to answers that deal directly to the patient’s body, not the
machines/equipments.
Key words are very important. Avoid answers with absolutes for example: always, never, must, etc.
When choosing an answer, think in this manner… if you can only do ONLY one thing to help this patient
what would it be? Pick the most important intervention.
If two of the answers are the exact opposite, like bradycardia or tachycardia... one is probably the
answer.
If two or three answers are similar or are alike, none is correct.
When asking patients’ questions NEVER use “why” questions. Eliminate all “why?” answer options.
If you have never heard of it… please don’t pick it!
Never release traction UNLESS you have an order from the MD to do so
Always deal with actual problems or harm before potential problems
Always select a “patient focused” answer.
An answer option that states "reassess in 15 minutes" is probably wrong.
An answer that delays care or treatment is ALWAYS wrong
DO NOT delegate what you can EAT! or PACET
P – Planning
A – Assess (Primary/Initial)
C – Collaboration (with RT, OT, PT, ETC)
E – Evaluate (for trends)
T – Teach
* Assessment, teaching, i.v. meds, evaluation, unstable patient cannot be delegated to an Unlicensed
Assistive Personnel.
* LVN/LPN cannot handle blood.
Vit K is to coumadin as Protamine Sulfate is to Heparin as Ca Glu is to MgSo4 as Mucomyst is to
Acetominophen as Amicar is to TPA…get it? Antidotes/treatments for overdose
REVERSE AGENTS FOR TOXICITY
ammonia= lactulose acetaminophen= n-Acetylcysteine. Iron= deferoxamine, Digitoxin/digoxin= digibind.
Alcohol withdraw= Librium.
- methadone is an opioid analgesic used to detoxify/treat pain in narcotic addicts.
- Potassium potentiates dig toxicity.
Order of assessment: Inspection, Palpation, Percussion and Ausculation. EXCEPT with abdomen cuz you don’t
wanna mess with the bowels and their sounds so you Inspect, Auscultate, Percuss then Palpate (same with
kids, I suppose since you wanna go from least invasive to most invasive since they will cry! Gotta love them
kids!)
No Pee, no K (do not give potassium without adequate urine output)
,EleVate Veins; dAngle Arteries for better perfusion
For PVD remember DAVE (Legs are Dependent for Arterial & for Venous Elevated)
Arterial – PPP, Pain, paller, pulselessness. Stand up to reduce pain
>8 no interventions, 4-7 stimulate/rub back/give O2/rescore, 0-3 Full CPR/Rescore
Each worth 2 points:
Points: 2 ↘ 1 ↘ 0
A= appearance {skin colour} (color all pink ↘ pink and blue ↘ blue [pale])
P= pulse {HR} (>100 ↘ < 100 ↘ absent)
G= grimace {reflex irritability} (cough/pulls away ↘ facial movement/grimace only with stimulation ↘ no response)
A= activity {muscle tone} (spontaneous activity ↘ arms/legs flexed with little movement ↘ limp/floppy tone)
R= respirations {effort} (30-60 bpm/strong cry ↘ irregular/slow breathing/weak cry ↘ absent)
TRANSMISSION-BASED PRECAUTIONS:
AIRBORNE - Private Room - negative pressure with 6-12 air exchanges/hr, Mask, N95 for TB
My - Measles or remember... MTV=Airborne
Chicken - Chicken Pox/Varicella Measles
Hez - Herpez Zoster/Shingles TB Varicella-Chicken Pox/Herpes Zoster-
TB Shingles
DROPLET - Private Room or cohort Mask
think of SPIDERMAN!
S – sepsis, S - scarlet fever, S - streptococcal pharyngitis
P - parvovirus B19, P - pneumonia P - pertussis
I - influenza
D - diptheria (pharyngeal)
E - epiglottitis
R - rubella
M – mumps, M – meningitis, M - mycoplasma or meningeal pneumonia
An - Adenovirus
CONTACT PRECAUTION
MRS.WEE
M - multidrug resistant organism W - wound infxn
R - respiratory infection E - enteric infxn - clostridium difficile
S - skin infections * E - eye infxn - conjunctivitis
SKIN INFECTIONS
VCHIPS
V - varicella zoster
C - cutaneous diphtheria
H - herpez simplex
I - impetigo
P - pediculosis
S - scabies
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of
impending doom) → turn pt to left side and lower the head of the bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal bradycardia, etc) →
turn on left side (and give O2, stop Pitocin, increase IV fluids)
3. Tube Feeding w/ Decreased LOC → position pt on right side (promotes emptying of the stomach) with
the HOB elevated (to prevent aspiration)
4. During Epidural Puncture → side-lying
,5. After Lumbar Puncture (and also oil-based Myelogram)→ pt lies in flat supine (to prevent headache
and leaking of CSF). AFTER the procedure, the client should be placed in the supine position for 4 to 12
hrs as prescribed. (Saunders 3rd ed p. 229)
6. Pt w/ Heat Stroke → lie flat w/ legs elevated
7. During Continuous Bladder Irrigation (CBI) → catheter is taped to thigh so leg should be kept
straight. No other positioning restrictions.
8. After Myringotomy → position on side of affected ear after surgery (allows drainage of secretions)
9. After Cataract Surgery → pt will sleep on unaffected side with a night shield for 1-4 weeks.
10. After Thyroidectomy → low or semi-Fowler's, support head, neck and shoulders.
11. Infant w/ Spina Bifida → position prone (on abdomen) so that sac does not rupture
12. Buck's Traction (skin traction) → elevate foot of bed for counter-traction
13. After Total Hip Replacement → don't sleep on operated side, don't flex hip more than 45-60 degrees,
don't elevate HOB > 45 degrees. Maintain hip abduction by separating thighs with pillows.
14. Prolapsed Cord → knee-chest position or Trendelenburg
15. Infant w/ Cleft Lip → position on back or in infant seat to prevent trauma to suture line. While
feeding, hold in upright position.
16. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries) → eat in reclining position,
lie down after meals for 20-30 minutes (also restrict fluids during meals, low CHO and fiber diet, small
frequent meals) and increase fat and protein, wait 1 hr after meals to drink. Unusual positional tip -
Low-fowlers recommended during meals to prevent dumping syndrome.
17. Above Knee Amputation → elevate for first 24 hours on pillow, position prone daily to provide for hip
extension.
18. Below Knee Amputation → foot of bed elevated for first 24 hours, position prone daily to provide for
hip extension.
19. Detached Retina → area of detachment should be in the dependent position
20. Administration of Enema → position pt in left side-lying (Sim's) with knee flexed
21. After Supratentorial Surgery (incision behind hairline) → elevate HOB 30-45 degrees
22. After Infratentorial Surgery (incision at nape of neck) → position pt flat and lateral on either side.
Tongs
23. During Internal Radiation → on bedrest while implant in place, treat pt as they are radioactive.
24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache, profuse sweating, nasal
congestion, goose flesh, bradycardia, hypertension) → place client in sitting position (elevate HOB)
first before any other implementation.
25. Shock → bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated
(modified Trendelenburg)
26. Head Injury → elevate HOB 30 degrees to decrease intracranial pressure
27. Peritoneal Dialysis when Outflow is Inadequate → turn pt from side to side BEFORE checking for
kinks in tubing (according to Kaplan)
, Demorol for pancreatitis, NOT morphine sulfate. 1. Morphine is contraindicated in Pancreatitis. It causes
spasm of the Sphincter of Oddi. Therefore Demerol should be given.
Myasthenia Gravis: worsens with exercise and improves with rest caused by a disorder in the transmission of
impulses from nerve to muscle cell (does not affect the bladder & bowel). *Tensilon test given if muscle is tense in myasthenia gravis.
Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms and confirms the diagnosis
Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon will make it worse
DUMBELLS A G: Defecation, Urination, Misosis, Bradycardia, Emesis, Lacrimation, Lethargy, Salivation,
Abdominal cramps G.I. upset
Give neostigmine to clients with Myesthenia Gravis about 45 min. before eating, so it will help with
chewing and swallowing.
Head injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use filter needle
Prior to a liver biopsy it’s important to be aware of the lab result for prothrombin time
From the a$$ (diarrhea) = metabolic acidosis From the mouth (vomitus) = metabolic alkalosis
Thyroid – TSH test will differentiate btw primary and secondary
Thyroid scan – no seafood, meds, or cough meds 7-10 days prior.
Myxedema/hypothyroidism: slowed physical and mental function, fatter, sensitivity to cold, dry skin and
hair. ↓ BMI. Give meds and correct hypothermia warming blanket).
* Anti-HTN and thyroid meds in the A.M. otherwise INSOMNIA.
Synthroid: TX of hypothyroidism..may take several weeks to take effect...notify doctor of chest pain..take in
the AM on empty stomach..could cause hyperthyroidism.
HYPERthyroidism think of MICHAEL JACKSON in THRILLER! Skinny, Nervous, Buldging Eyes, Up all
night, heart beating fast
Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat, fine/soft
hair, Goiter, Bulging eyes. Eating +++ but still thin. When giving meds watch for hypothyroidism.
Thyroid storm: increased temp, HR and HTN d/t: Surgery (Physical movement of thyroid), infection, stress
Post-thyroidectomy: semi-Fowler’s, prevent neck flexion/hyperextension, trach at bedside, freq swallowing
is bad
Esophageal varices – bleeding results in abdo distention not swallowing
Sengstaken blakemore tube used for TX of esophageal varices, keep scissors at bedside in case of shock.
Insomnia is a side effect of thyroid hormones. Increased met. rate, your body is "too busy to sleep" as
opposed to the folks with hypothyroidism who may report somnolence ( met rate, body is slow and sleepy).
Burning sensation in the mouth, and brassy taste are adverse reactions to Lugol solution (for
hyperthyroid). Report it to the doc.
Give synthroid on an empty stomach
PTU and Tapazole- prevention of thyroid storm
Hypovolemia – increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine specific
gravity >1.030
Hypervolemia – bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific
gravity <1.010; Semi-Fowler’s
Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration, weakness,
administer Pitressin
SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA;
administer Declomycin, diuretics
http://www.mightynurse.com/nclex-practice-questions/
http://nurseslabs.com/nclex-practice-questions/
https://www.google.ca/webhp?sourceid=chrome-instant&rlz=1C1CHFX_enCA564CA567&ion=1&espv=2&ie=UTF-8#q=nclex+questions
http://brilliantnurse.com/shop/75-free-nclex-practice-questions/
http://narzing.blogspot.ca/2011/02/feuer-nursing-review-lecture-audio-free.html
Focus on your successes encouraging yourself to greater achievements in the future and Forget your past
mistakes.
Always do your best so you can be proud that you gave it your best shot.
Focus on your achievements rather than your failures. If you do find yourself thinking about how you
failed then look at what you managed to do right and how you could correct what you did next time.
A mind that is troubled with doubt won't be able to focus on the victory to be had.
Take time for yourself. A fried mind can't focus or learn.
Look carefully when you have no idea. In a word like rhabdomyosarcoma you can easily ascertain it has
something to do with muscle (myo) cancer (sarcoma). The same thing goes for drug names. For
example, if it ends in –ide it’s probably a diuretic, as in Furosemide, and Amyloride.
When getting down to two answers, choose the assessment answer (assess, collect, auscultation,
monitor, palpate) over the intervention except in an emergency or distress situation. If one answer has
an absolute, discard it. Give priority to answers that deal directly to the patient’s body, not the
machines/equipments.
Key words are very important. Avoid answers with absolutes for example: always, never, must, etc.
When choosing an answer, think in this manner… if you can only do ONLY one thing to help this patient
what would it be? Pick the most important intervention.
If two of the answers are the exact opposite, like bradycardia or tachycardia... one is probably the
answer.
If two or three answers are similar or are alike, none is correct.
When asking patients’ questions NEVER use “why” questions. Eliminate all “why?” answer options.
If you have never heard of it… please don’t pick it!
Never release traction UNLESS you have an order from the MD to do so
Always deal with actual problems or harm before potential problems
Always select a “patient focused” answer.
An answer option that states "reassess in 15 minutes" is probably wrong.
An answer that delays care or treatment is ALWAYS wrong
DO NOT delegate what you can EAT! or PACET
P – Planning
A – Assess (Primary/Initial)
C – Collaboration (with RT, OT, PT, ETC)
E – Evaluate (for trends)
T – Teach
* Assessment, teaching, i.v. meds, evaluation, unstable patient cannot be delegated to an Unlicensed
Assistive Personnel.
* LVN/LPN cannot handle blood.
Vit K is to coumadin as Protamine Sulfate is to Heparin as Ca Glu is to MgSo4 as Mucomyst is to
Acetominophen as Amicar is to TPA…get it? Antidotes/treatments for overdose
REVERSE AGENTS FOR TOXICITY
ammonia= lactulose acetaminophen= n-Acetylcysteine. Iron= deferoxamine, Digitoxin/digoxin= digibind.
Alcohol withdraw= Librium.
- methadone is an opioid analgesic used to detoxify/treat pain in narcotic addicts.
- Potassium potentiates dig toxicity.
Order of assessment: Inspection, Palpation, Percussion and Ausculation. EXCEPT with abdomen cuz you don’t
wanna mess with the bowels and their sounds so you Inspect, Auscultate, Percuss then Palpate (same with
kids, I suppose since you wanna go from least invasive to most invasive since they will cry! Gotta love them
kids!)
No Pee, no K (do not give potassium without adequate urine output)
,EleVate Veins; dAngle Arteries for better perfusion
For PVD remember DAVE (Legs are Dependent for Arterial & for Venous Elevated)
Arterial – PPP, Pain, paller, pulselessness. Stand up to reduce pain
>8 no interventions, 4-7 stimulate/rub back/give O2/rescore, 0-3 Full CPR/Rescore
Each worth 2 points:
Points: 2 ↘ 1 ↘ 0
A= appearance {skin colour} (color all pink ↘ pink and blue ↘ blue [pale])
P= pulse {HR} (>100 ↘ < 100 ↘ absent)
G= grimace {reflex irritability} (cough/pulls away ↘ facial movement/grimace only with stimulation ↘ no response)
A= activity {muscle tone} (spontaneous activity ↘ arms/legs flexed with little movement ↘ limp/floppy tone)
R= respirations {effort} (30-60 bpm/strong cry ↘ irregular/slow breathing/weak cry ↘ absent)
TRANSMISSION-BASED PRECAUTIONS:
AIRBORNE - Private Room - negative pressure with 6-12 air exchanges/hr, Mask, N95 for TB
My - Measles or remember... MTV=Airborne
Chicken - Chicken Pox/Varicella Measles
Hez - Herpez Zoster/Shingles TB Varicella-Chicken Pox/Herpes Zoster-
TB Shingles
DROPLET - Private Room or cohort Mask
think of SPIDERMAN!
S – sepsis, S - scarlet fever, S - streptococcal pharyngitis
P - parvovirus B19, P - pneumonia P - pertussis
I - influenza
D - diptheria (pharyngeal)
E - epiglottitis
R - rubella
M – mumps, M – meningitis, M - mycoplasma or meningeal pneumonia
An - Adenovirus
CONTACT PRECAUTION
MRS.WEE
M - multidrug resistant organism W - wound infxn
R - respiratory infection E - enteric infxn - clostridium difficile
S - skin infections * E - eye infxn - conjunctivitis
SKIN INFECTIONS
VCHIPS
V - varicella zoster
C - cutaneous diphtheria
H - herpez simplex
I - impetigo
P - pediculosis
S - scabies
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of
impending doom) → turn pt to left side and lower the head of the bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal bradycardia, etc) →
turn on left side (and give O2, stop Pitocin, increase IV fluids)
3. Tube Feeding w/ Decreased LOC → position pt on right side (promotes emptying of the stomach) with
the HOB elevated (to prevent aspiration)
4. During Epidural Puncture → side-lying
,5. After Lumbar Puncture (and also oil-based Myelogram)→ pt lies in flat supine (to prevent headache
and leaking of CSF). AFTER the procedure, the client should be placed in the supine position for 4 to 12
hrs as prescribed. (Saunders 3rd ed p. 229)
6. Pt w/ Heat Stroke → lie flat w/ legs elevated
7. During Continuous Bladder Irrigation (CBI) → catheter is taped to thigh so leg should be kept
straight. No other positioning restrictions.
8. After Myringotomy → position on side of affected ear after surgery (allows drainage of secretions)
9. After Cataract Surgery → pt will sleep on unaffected side with a night shield for 1-4 weeks.
10. After Thyroidectomy → low or semi-Fowler's, support head, neck and shoulders.
11. Infant w/ Spina Bifida → position prone (on abdomen) so that sac does not rupture
12. Buck's Traction (skin traction) → elevate foot of bed for counter-traction
13. After Total Hip Replacement → don't sleep on operated side, don't flex hip more than 45-60 degrees,
don't elevate HOB > 45 degrees. Maintain hip abduction by separating thighs with pillows.
14. Prolapsed Cord → knee-chest position or Trendelenburg
15. Infant w/ Cleft Lip → position on back or in infant seat to prevent trauma to suture line. While
feeding, hold in upright position.
16. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries) → eat in reclining position,
lie down after meals for 20-30 minutes (also restrict fluids during meals, low CHO and fiber diet, small
frequent meals) and increase fat and protein, wait 1 hr after meals to drink. Unusual positional tip -
Low-fowlers recommended during meals to prevent dumping syndrome.
17. Above Knee Amputation → elevate for first 24 hours on pillow, position prone daily to provide for hip
extension.
18. Below Knee Amputation → foot of bed elevated for first 24 hours, position prone daily to provide for
hip extension.
19. Detached Retina → area of detachment should be in the dependent position
20. Administration of Enema → position pt in left side-lying (Sim's) with knee flexed
21. After Supratentorial Surgery (incision behind hairline) → elevate HOB 30-45 degrees
22. After Infratentorial Surgery (incision at nape of neck) → position pt flat and lateral on either side.
Tongs
23. During Internal Radiation → on bedrest while implant in place, treat pt as they are radioactive.
24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache, profuse sweating, nasal
congestion, goose flesh, bradycardia, hypertension) → place client in sitting position (elevate HOB)
first before any other implementation.
25. Shock → bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated
(modified Trendelenburg)
26. Head Injury → elevate HOB 30 degrees to decrease intracranial pressure
27. Peritoneal Dialysis when Outflow is Inadequate → turn pt from side to side BEFORE checking for
kinks in tubing (according to Kaplan)
, Demorol for pancreatitis, NOT morphine sulfate. 1. Morphine is contraindicated in Pancreatitis. It causes
spasm of the Sphincter of Oddi. Therefore Demerol should be given.
Myasthenia Gravis: worsens with exercise and improves with rest caused by a disorder in the transmission of
impulses from nerve to muscle cell (does not affect the bladder & bowel). *Tensilon test given if muscle is tense in myasthenia gravis.
Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms and confirms the diagnosis
Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon will make it worse
DUMBELLS A G: Defecation, Urination, Misosis, Bradycardia, Emesis, Lacrimation, Lethargy, Salivation,
Abdominal cramps G.I. upset
Give neostigmine to clients with Myesthenia Gravis about 45 min. before eating, so it will help with
chewing and swallowing.
Head injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use filter needle
Prior to a liver biopsy it’s important to be aware of the lab result for prothrombin time
From the a$$ (diarrhea) = metabolic acidosis From the mouth (vomitus) = metabolic alkalosis
Thyroid – TSH test will differentiate btw primary and secondary
Thyroid scan – no seafood, meds, or cough meds 7-10 days prior.
Myxedema/hypothyroidism: slowed physical and mental function, fatter, sensitivity to cold, dry skin and
hair. ↓ BMI. Give meds and correct hypothermia warming blanket).
* Anti-HTN and thyroid meds in the A.M. otherwise INSOMNIA.
Synthroid: TX of hypothyroidism..may take several weeks to take effect...notify doctor of chest pain..take in
the AM on empty stomach..could cause hyperthyroidism.
HYPERthyroidism think of MICHAEL JACKSON in THRILLER! Skinny, Nervous, Buldging Eyes, Up all
night, heart beating fast
Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat, fine/soft
hair, Goiter, Bulging eyes. Eating +++ but still thin. When giving meds watch for hypothyroidism.
Thyroid storm: increased temp, HR and HTN d/t: Surgery (Physical movement of thyroid), infection, stress
Post-thyroidectomy: semi-Fowler’s, prevent neck flexion/hyperextension, trach at bedside, freq swallowing
is bad
Esophageal varices – bleeding results in abdo distention not swallowing
Sengstaken blakemore tube used for TX of esophageal varices, keep scissors at bedside in case of shock.
Insomnia is a side effect of thyroid hormones. Increased met. rate, your body is "too busy to sleep" as
opposed to the folks with hypothyroidism who may report somnolence ( met rate, body is slow and sleepy).
Burning sensation in the mouth, and brassy taste are adverse reactions to Lugol solution (for
hyperthyroid). Report it to the doc.
Give synthroid on an empty stomach
PTU and Tapazole- prevention of thyroid storm
Hypovolemia – increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine specific
gravity >1.030
Hypervolemia – bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific
gravity <1.010; Semi-Fowler’s
Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration, weakness,
administer Pitressin
SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA;
administer Declomycin, diuretics
