NCLEX Holy Grail Exam 4 Study
Questions: Nursing Practice Revie
2026/2027 – Questions and
Answers | 100% Verified |
Detailed Rationales – Pass
Guaranteed – Already Graded
A+ |
C
Terms in this set (334)
Do NOT DELEGATE what you can EAT E = Evaluate
A = Assess
T = Teach
Addison's S/S down, down, down, up, down
HYPOnatremia
HYPOtension
DECREASED blood volume
HYPERkalemia
HYPOglycemia
Cushing's S/S up, up, up, down, up
HYPERnatremia
HYPERtension
INCREASED blood volume
HYPOkalemia
HYPERglycemia
No Pee, No K Do NOT give potassium without adequate urine output
,VVAA EleVate Veins
dAngle Arteries
for better perfusion
APGAR A = Appearance (color all pink, pink & blue,
blue/pale) P = Pulse (>100, < 100, absent)
G = Grimace (cough, grimace, no response)
A = Activity (flexed, flaccid, limp)
R = Respirations (strong cry, weak cry, absent)
AIRBORNE Precautions MTV
M = Measles
T = TB
V = Varicella (Chicken Pox) (Herpes Zoster-Shingles)
AIRBORNE Precautions Protective private room, neg pressure with 6-12 air exchanges/hr mask &
Equipment respirator N95 for TB
DROPLET Precautions think of SPIDERMAN
S = Sepsis, Scarlet Fever, Streptococcal Pharyngitis
P = Parovirus B19, Pneumonia, Pertussis
I = Influenza
D = Diptheria (Pharyngeal)
E = Epiglottis
R = RUBELLA
M = Mumps, Meningitis, Mycoplasma, Meningeal Pneumonia
An = Adenovirus
Droplet precautions PPE gloves, gown, mask
- PRIVATE ROOM
CONTACT Precautions MRS. WEE
M = Multidrug Resistant Organism
R = Respiratory Infections
S = Skin Infections
W = Wound Infections
E = Enteric Infections (C. diff)
E = Eye Infections (Conjunctivitis)
Skin Infections that need CONTACT think VCHIPS
Precautions V = Varicella ZOSTER
C = CUTANEOUS Diptheria
H = Herpes SIMPLEX
I = Impetigo
P=
Pediculosis S
= Scabies
, Air/Pulmonary Embolism S/S
- chest pain
- difficulty breathing
- TACHYcardia
- pale/cyanotic
- sense of impending doom
turn the pt to the LEFT side and LOWER the HOB
Woman in Labor with UN REASSURING FHR V (Variable) C (Cord Compression
E (Early) H (Head Compression)
A (Accelerations) O (Okay!)
L (Late) P (Placental Insufficiency)
turn on LEFT side
- give O2
- STOP PITOCIN
- INCREASE IV Fluids
Tube Feeding with DECREASED LOC position pt on RIGHT side with HOB ELEVATED
- promotes emptying of Stomach & prevents aspiration
During Epidural Puncture SIDE LYING
After Lumbar Puncture (& Oil Based pt lies in FLAT SUPINE
Myelogram) - prevents headache & leaking of CSF
pt with Heat Stroke lie FLAT with legs ELEVATED
during Continuous Bladder Irrigation (CBI) catheter is taped to the thigh so leg must be kept straight
After Myringotomy position on the side of AFFECTED ear
- allows drainage
After Cataract Surgery pt will sleep on UNAFFECTED side with a night shield for 1-4
weeks
After Thyroidectomy LOW or SEMI-fowler's position
- support head, neck and shoulders
Infant with Spina Bifida position PRONE (on abdomen) so that sac doesn't rupture
Buck's Traction (skin traction) ELEVATE FOOT of bed for counter traction
After Total Hip Replacement do NOT sleep on operated side
- DO NOT flex hip more than 45 to 60 degrees
- DO NOT elevate HOB more than 45 degrees
- maintain hip ABDUCTION by separating thighs with
PILLOWS
Prolapsed Cord Knee to Chest or Trendelenburg
Questions: Nursing Practice Revie
2026/2027 – Questions and
Answers | 100% Verified |
Detailed Rationales – Pass
Guaranteed – Already Graded
A+ |
C
Terms in this set (334)
Do NOT DELEGATE what you can EAT E = Evaluate
A = Assess
T = Teach
Addison's S/S down, down, down, up, down
HYPOnatremia
HYPOtension
DECREASED blood volume
HYPERkalemia
HYPOglycemia
Cushing's S/S up, up, up, down, up
HYPERnatremia
HYPERtension
INCREASED blood volume
HYPOkalemia
HYPERglycemia
No Pee, No K Do NOT give potassium without adequate urine output
,VVAA EleVate Veins
dAngle Arteries
for better perfusion
APGAR A = Appearance (color all pink, pink & blue,
blue/pale) P = Pulse (>100, < 100, absent)
G = Grimace (cough, grimace, no response)
A = Activity (flexed, flaccid, limp)
R = Respirations (strong cry, weak cry, absent)
AIRBORNE Precautions MTV
M = Measles
T = TB
V = Varicella (Chicken Pox) (Herpes Zoster-Shingles)
AIRBORNE Precautions Protective private room, neg pressure with 6-12 air exchanges/hr mask &
Equipment respirator N95 for TB
DROPLET Precautions think of SPIDERMAN
S = Sepsis, Scarlet Fever, Streptococcal Pharyngitis
P = Parovirus B19, Pneumonia, Pertussis
I = Influenza
D = Diptheria (Pharyngeal)
E = Epiglottis
R = RUBELLA
M = Mumps, Meningitis, Mycoplasma, Meningeal Pneumonia
An = Adenovirus
Droplet precautions PPE gloves, gown, mask
- PRIVATE ROOM
CONTACT Precautions MRS. WEE
M = Multidrug Resistant Organism
R = Respiratory Infections
S = Skin Infections
W = Wound Infections
E = Enteric Infections (C. diff)
E = Eye Infections (Conjunctivitis)
Skin Infections that need CONTACT think VCHIPS
Precautions V = Varicella ZOSTER
C = CUTANEOUS Diptheria
H = Herpes SIMPLEX
I = Impetigo
P=
Pediculosis S
= Scabies
, Air/Pulmonary Embolism S/S
- chest pain
- difficulty breathing
- TACHYcardia
- pale/cyanotic
- sense of impending doom
turn the pt to the LEFT side and LOWER the HOB
Woman in Labor with UN REASSURING FHR V (Variable) C (Cord Compression
E (Early) H (Head Compression)
A (Accelerations) O (Okay!)
L (Late) P (Placental Insufficiency)
turn on LEFT side
- give O2
- STOP PITOCIN
- INCREASE IV Fluids
Tube Feeding with DECREASED LOC position pt on RIGHT side with HOB ELEVATED
- promotes emptying of Stomach & prevents aspiration
During Epidural Puncture SIDE LYING
After Lumbar Puncture (& Oil Based pt lies in FLAT SUPINE
Myelogram) - prevents headache & leaking of CSF
pt with Heat Stroke lie FLAT with legs ELEVATED
during Continuous Bladder Irrigation (CBI) catheter is taped to the thigh so leg must be kept straight
After Myringotomy position on the side of AFFECTED ear
- allows drainage
After Cataract Surgery pt will sleep on UNAFFECTED side with a night shield for 1-4
weeks
After Thyroidectomy LOW or SEMI-fowler's position
- support head, neck and shoulders
Infant with Spina Bifida position PRONE (on abdomen) so that sac doesn't rupture
Buck's Traction (skin traction) ELEVATE FOOT of bed for counter traction
After Total Hip Replacement do NOT sleep on operated side
- DO NOT flex hip more than 45 to 60 degrees
- DO NOT elevate HOB more than 45 degrees
- maintain hip ABDUCTION by separating thighs with
PILLOWS
Prolapsed Cord Knee to Chest or Trendelenburg
