NCLEX NGN ACTUAL EXAM ALL 450 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES ALREADY GRADED A+

NCLEX NGN ACTUAL EXAM ALL 450 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES ALREADY GRADED A+ ACE inhibitors - CORRECT ANSWER--pril: HTN, HF. AD: angioedema, cough, hypotension, hyperkalemia, hepatotoxicity, neutropenia, agranulocytosis, pancreatitis, SJS. Contra: pregnancy. Nursing: empty stomach, monitor for infection, dry cough, use contraception (teratogenic), avoid sports drinks/salt substitutes (extra K) ARB - CORRECT ANSWER--sartan: HTN, HF. AE: angioedema, hypotension, hyperkalemia, renal impairment. Contra: pregnancy. Nursing: may take with food, take with full glass of water calcium channel blockers - CORRECT ANSWER--dipine: HTN, angina, arrhythmias. AE: hepatotoxicity, paralytic ileus, HF, AV block. CONTRA: A-FIB/FLUTTER, SSS, cardiogenic shock. Nursing: BUN/Cr, liver enzymes. Avoid: grapefruit juice, in older=constipation beta blockers - CORRECT ANSWER--olol: slow HR, decrease vasoconstriction, decrease O2 consumption. Used in: HF, HTN, HR control, angina, migraine. AE: HF, bronchospasm, dizzy, constipation, suppresses hypoglycemia indicators. Contra: asthma, bradycardia, SSS. Nursing: check HR before giving. Teach: take med at bedtime, do not stop abruptly. Propranolol=essential tremors, Parkinsons Vasopressor - CORRECT ANSWER-Å and ß: Dopamine/Levophed/Epinephrine: ^HR/BP, ACLS, CO, shock, refractory HF. AE: pulm edema, arrhythmias, HTN, cerebral hemorrhage. Antidote for extravasation: Regitine ß: Dobutamine: ^CO/BP. Used in HF. AE: seizures, cardiac arrest, bronchospasm, restlessness, tremor. Nursing: monitor BP and HR q15 mins Vasodilators - CORRECT ANSWER-Persantine adjunct thromboembolism prevention. AE: bronchospasm, MI. Teach: avoid ETOH, report bruising cardiac conduction - CORRECT ANSWER-SA node: "pacemaker" intrinsic rate 100 bpm AV node: 40-60 bpm Bundle branch/purkinje: 20-40 bpm Hemophilia - CORRECT ANSWER-bleeding disorder, sex linked, s/s: prolonged bleeding. Nursing: prevent bleeding/falls, brush teeth with soft toothbrush. Genetic counseling for parents Anemia - CORRECT ANSWER-aplastic=not producing RBC, congenital/pregnancy, hepatits. s/s: petechiae, bruising, fatigue, ha. Rx: steroids, abx, Nursing: hemorrhage precautions Antitubercular - CORRECT ANSWER-AE: hepatotoxicity, agranulocytosis, aplastic anemia, optic neuritis, neuropathy, psychosis. Nursing: Cr, liver enzymes, eradicated after 3 - sputum cultures, Avoid ETOH, tyramine, take vit B6 for neuropathy, duration of therapy months to years pH - CORRECT ANSWER-7.35-7.45 PCO2 - CORRECT ANSWER-35-45 HCO3 - CORRECT ANSWER-22-28 PO2 - CORRECT ANSWER-80-100% SaO2 - CORRECT ANSWER-96-100% BUN - CORRECT ANSWER-8-25 Creatinine - CORRECT ANSWER-0.5-1 Total cholesterol - CORRECT ANSWER-under 200 HDL - CORRECT ANSWER-30-70 LDL - CORRECT ANSWER-less than 130 Triglycerides - CORRECT ANSWER-under 200 protein - CORRECT ANSWER-6-8 albumin - CORRECT ANSWER-3.5-5 amylase - CORRECT ANSWER-25-151 lipase - CORRECT ANSWER-10-140 ammonia - CORRECT ANSWER-10-80 ALT/AST - CORRECT ANSWER-10-40 Bilirubin - CORRECT ANSWER-total less then 1.5 glucose - CORRECT ANSWER-70-100 A1C - CORRECT ANSWER-under 6% hemoglobin - CORRECT ANSWER-woman 12-15, male 14-16 hematocrit - CORRECT ANSWER-female 35-45% male 40- 50% platelets - CORRECT ANSWER-150,000-400,000 aPTT - CORRECT ANSWER-20-30 seconds PT - CORRECT ANSWER-9-11 seconds INR - CORRECT ANSWER-1 (with warfarin 2-3) K - CORRECT ANSWER-3.5-5.0: intracellular, neuromuscular/muscular contraction, regulated by kidney. o Foods: avocado, potatoes, spinach, strawberries, tomatoes, raisins o NEVER GIVEN IV PUSH, IM, SUBQ, max infusion 10 mEq/hr, K can cause phlebitis=assess IV site frequently, assess renal function before administering, monitor I&O o High/low=impacted heart rhythm, and muscle function w/ leg cramping o High d/t: K retaining diuretics, CRF, Addison's, tissue damage- if CRF=Kayexalate, IV glucose with insulin, Ca, dialysis, avoid salt substitutes o Low d/t diuretics/corticosteroids, vomiting, diarrhea, NG suction, CRF, -no supplements on empty stomach o Hypo=st depression Hyper=Tall T waves Na - CORRECT ANSWER-135-145: extracellular, regulates cell size and osmosis, maintains water balance, nerve impulses, muscle contraction, BP, blood volume, regulates acid-base balance, regulated by salt intake, aldosterone, urinary output o Hyponatremia: d/t burns, diarrhea, HF, diuretics, vomiting, diaphoresis, CRF, SIADH, ^BS *Lithium Tox! • S/s: mental confusion, seizures, hallucinations, brain herniation, death o Hypernatremia: HTN, edema, Cushing's, CRF, hyperaldosteronism, hormones, NSAIDS • s/s: lethargic, excitability, hypovolemia, pulm edema, muscle twitches, coma, dry flushed skin Chloride - CORRECT ANSWER-96-106: helps balance Na, extracellular fluid WBC - CORRECT ANSWER-5,000-10,oo0 60% Neutrophil: bacteria/fungus 40% Lymphocyte: virus/tumor 8% Monocyte: nonspecific 3% Eosinophil: allergies 0% Basophil: allergies Troponin - CORRECT ANSWER-lower then 0.1 BNP - CORRECT ANSWER-under 100 (+100=HF) Mg - CORRECT ANSWER-1.5-2.5: ½ in bone, muscle and nerve function, heart rhythm o Hypermg: d/t CRF, antacids, Addisons, DM- give calcium gluconate • s/s: lethargy, n/v, slurred speech, weakness, decreased DTR, slowed cardiac conduction o Hypomg: d/t malnutrition, pre-e, ETOH, DKA, Crohn's, hyperglycemia, sepsis • s/s: tingling, twitching, tetany, delirium, convulsions, + Chvostek/Trousseau, hyperreflexia Phosphorus - CORRECT ANSWER-2.8-4.5: cell metabolism, combines w/ Ca in bone, balanced by parathyroid gland. Ca~P (as one ^/other drops) Calcium - CORRECT ANSWER-9-11: cardiac contraction, bones, nerves, muscles, clotting o Hypercalcemia: d/t hyperparathyroidism, cancer, Paget's of bone, prolonged immobilization. s/s: weakness, paralysis, decreased DTR. Monitor for kidney stones o Hypocalcemia: d/t rickets, vit D deficiency, renal failure, pancreatitis, chelation therapy, hypoparathyroidism. • s/s: CATS: convulsions-arrhythmias-tetanyspasms/stridor, +Chvostek sign (cheek) Trousseau (BP arm) • when administering IV, warm solution to body temp Respiratory alKaLOsis s/s: - CORRECT ANSWER-lethargy lightheadedness confusion tachycardia dysrhythmias related to hypokalemia nausea vomiting epigastric pain numbness and tingling of the extremities hyperventilation (tachypnea) Normal plasma osmolality - CORRECT ANSWER-270-300 DO-ABLE mnemonic for heart failure interventions - CORRECT ANSWER-*Diuretics*- to relieve pulmonary congestion, fluid overload & return to baseline weight *Oxygen*- to correct hypoxia *ACE inhibitors*- to reduce preload and afterload, counteracting compensatory hormones *Beta-blockers*- to prevent arrhythmias and reduce heart workload *Low sodium diet*- to prevent fluid retention *Exercise as tolerated* - to monitor response to therapy and return to baseline functional status CARDIAc LeVeLS mnemonic for cardiac assessment: - CORRECT ANSWER-*C*hest discomfort *A*ctivity tolerance *R*esponse to drug therapy *D*epression & anxiety *I*ncreased weight *A*rrhythmias c... *L*ightheadedness