HURST REVIEW NCLEX RN READINESS EXAM: LATEST A+
QUESTIONS AND ANSWERS EDITION.
Early signs of ICP
change in LOC
Restlessness
Confusion
Slow Speech
Delay in response
Pupillary changes
Impaired ocular movement
Weakness one extremity or one side
HA (constant, increases intensity)
Early signs of bowel obstruction
High-pitched bowel sounds are indicative of an early bowel obstruction and worsens as
it develops.
total laryngectomy
Surgical removal of the entire larynx- cannot speak/whisper cause trachea is closed off
and air can no longer move air through the nasopharynx so client will have a hard time
smelling.
Educate client about having smoke detectors installed at home.
What can cause the development of right sided heart failure?
High blood pressure in the lungs.
Higher pressure in the pulmonary circuit from such things as emphysema, the
pulmonary pressure will excess the systemic pressure, The result is back flow to the
right side of the hear and resulting right sided heart failure.
Hyperventilation will cause what kind of acid base imbalance?
Respiratory alkalosis
since you blowing out an excessive amount of acidic CO2, you are left with an alkalosis
state.
What is the Guthrie's test?
,Positive test (bad sign) indicates decreased metabolism of phenylalanine (metabolic
disorder), leading to phenylketonuria. The normal level in newborns is 0.5-1. Guthrie
test detects levels greater than 4. Only fresh HEEL blood can be used for this test, The
main objective for diagnosing and treating this disorder is to prevent cognitive
impairment. A lack of protein intake can interfere with the test. Most reliable after the
baby ingest a source of protein. Usually performed no later than 6-7 days after birth.
NPO if have pancreatitis because?
Reduce pancreatic enzyme from eating away your pancreas cause there might be a
blockage. Also called autodigestion. Keep NPO and empty so it allow some time for
healing. Can be painful.
Health history data that shows increased risk for developing cancer:
Family history
Alcohol consumption
Tabaco use
Human papillomavirus (warts in various parts of the body and most common STI-
depends on the strain)
The best indicator of ACTUAL fluid deficit:
WEIGHT! I&O
Admission and current. It's an ACTUAL objective data.
MAOIs (monoamine oxidase inhibitors): AVOID what kind of food?
Tyramine:
Eating food high in tyramine whole on MAOI's is dangerously high level of tyramine in
the body. This can lead serious rise in blood pressure.
Foods such as:
aged cheese. cured meats, smoked or process meats, liver, pickled , sauces, soybeans,
dried or overripe fruits. alcohol beverages (yeast), and caffeine such as tea/coffee.
phenytoin is for? and how long should you push it?
For seizures
2 minutes (should not exceed 50mg/min in peds but 100 mg can be safely delivers over
a period of 2 min)
, What medication is used for mothers going through preterm labor and is used to
stimulate maturation in baby's lungs?
Betamethasone
What assessment should be notified to the HCP when beta-blockers are ordered?
Heart rate lower than 60 bpm
HR lower than 60 should not be given beta-blockers since it does lower it even more.
What order should you administer an IVP through a non-tunneled central venous
catheter?
1. Cleanse access port
2. Connect 10 mL normal saline to access port
3. Gently aspirate for blood
4. Flush saline using push-pause method
5. Administer med
6. Flush with normal saline, then with heparin
heparin is usually given to maintain catheter patency for a longer period of time to
prevent thrombus formation.
What is prednisone?
What S/S can the nurse expect after client has taken it for two months?
Prednisone is a steroid.
Side effect of prolong use is decreased wound healing, hypertension (due to fluid and
sodium retention) and moon face (due to fat distribution from prolong steroid use).
Facial and body hair will increase with prolong steroid use as well and weight gain.
How long can you administer blood for?
Blood be administered within the 4 hour time frame due to risk of hemolysis and
bacterial invasion. If not completed, send back to the lab to be discarded. Must be given
within 30 min after pickup.
What is the best indication of a positive Mantoux tuberculin skin test?
A central area of induration of 15 mm surrounded by erythema.
What is serotonin syndrome?
(Everything is increased)
QUESTIONS AND ANSWERS EDITION.
Early signs of ICP
change in LOC
Restlessness
Confusion
Slow Speech
Delay in response
Pupillary changes
Impaired ocular movement
Weakness one extremity or one side
HA (constant, increases intensity)
Early signs of bowel obstruction
High-pitched bowel sounds are indicative of an early bowel obstruction and worsens as
it develops.
total laryngectomy
Surgical removal of the entire larynx- cannot speak/whisper cause trachea is closed off
and air can no longer move air through the nasopharynx so client will have a hard time
smelling.
Educate client about having smoke detectors installed at home.
What can cause the development of right sided heart failure?
High blood pressure in the lungs.
Higher pressure in the pulmonary circuit from such things as emphysema, the
pulmonary pressure will excess the systemic pressure, The result is back flow to the
right side of the hear and resulting right sided heart failure.
Hyperventilation will cause what kind of acid base imbalance?
Respiratory alkalosis
since you blowing out an excessive amount of acidic CO2, you are left with an alkalosis
state.
What is the Guthrie's test?
,Positive test (bad sign) indicates decreased metabolism of phenylalanine (metabolic
disorder), leading to phenylketonuria. The normal level in newborns is 0.5-1. Guthrie
test detects levels greater than 4. Only fresh HEEL blood can be used for this test, The
main objective for diagnosing and treating this disorder is to prevent cognitive
impairment. A lack of protein intake can interfere with the test. Most reliable after the
baby ingest a source of protein. Usually performed no later than 6-7 days after birth.
NPO if have pancreatitis because?
Reduce pancreatic enzyme from eating away your pancreas cause there might be a
blockage. Also called autodigestion. Keep NPO and empty so it allow some time for
healing. Can be painful.
Health history data that shows increased risk for developing cancer:
Family history
Alcohol consumption
Tabaco use
Human papillomavirus (warts in various parts of the body and most common STI-
depends on the strain)
The best indicator of ACTUAL fluid deficit:
WEIGHT! I&O
Admission and current. It's an ACTUAL objective data.
MAOIs (monoamine oxidase inhibitors): AVOID what kind of food?
Tyramine:
Eating food high in tyramine whole on MAOI's is dangerously high level of tyramine in
the body. This can lead serious rise in blood pressure.
Foods such as:
aged cheese. cured meats, smoked or process meats, liver, pickled , sauces, soybeans,
dried or overripe fruits. alcohol beverages (yeast), and caffeine such as tea/coffee.
phenytoin is for? and how long should you push it?
For seizures
2 minutes (should not exceed 50mg/min in peds but 100 mg can be safely delivers over
a period of 2 min)
, What medication is used for mothers going through preterm labor and is used to
stimulate maturation in baby's lungs?
Betamethasone
What assessment should be notified to the HCP when beta-blockers are ordered?
Heart rate lower than 60 bpm
HR lower than 60 should not be given beta-blockers since it does lower it even more.
What order should you administer an IVP through a non-tunneled central venous
catheter?
1. Cleanse access port
2. Connect 10 mL normal saline to access port
3. Gently aspirate for blood
4. Flush saline using push-pause method
5. Administer med
6. Flush with normal saline, then with heparin
heparin is usually given to maintain catheter patency for a longer period of time to
prevent thrombus formation.
What is prednisone?
What S/S can the nurse expect after client has taken it for two months?
Prednisone is a steroid.
Side effect of prolong use is decreased wound healing, hypertension (due to fluid and
sodium retention) and moon face (due to fat distribution from prolong steroid use).
Facial and body hair will increase with prolong steroid use as well and weight gain.
How long can you administer blood for?
Blood be administered within the 4 hour time frame due to risk of hemolysis and
bacterial invasion. If not completed, send back to the lab to be discarded. Must be given
within 30 min after pickup.
What is the best indication of a positive Mantoux tuberculin skin test?
A central area of induration of 15 mm surrounded by erythema.
What is serotonin syndrome?
(Everything is increased)
