NCLEX-RN Test Study Guide

Strategy 6: Avoiding Definites Answer choices that make definite statements with no “wiggle room” are often wrong. Try to choose answer choices that make less definite and more general statements that would likely be correct in a wider range of situations and aren’t exclusive. Example: A. The nurse should follow universal contact precautions at all times in every case. B. The nursing assistant completely demonstrated poor awareness of transfer safety. C. Never allow new medications to be accessible on the unit. D. Sometimes, the action taken by the aide was not well planned. Without knowing anything about the question, answer choice D uses the term “sometimes,” which has wiggle room, meaning there could have been a few strong points and weak points about the aide’s performance. All of the other answer choices have a more definite sense about them, implying a more precise answer choice without wiggle room that is often wrong. Strategy 7: Using Common Sense The questions on the test are not intended to be trick questions. Therefore, most of the answer choices will have a sense of normalcy about them that may be fairly obvious and could be answered simply by using common sense. Copyright © StudyGuideZ. All rights reserved. 18 While many of the topics will be ones that you are somewhat unfamiliar with, there will likely be numerous topics that you have some prior indirect knowledge about that will help you answer the questions. Strategy 8: Instincts are Right When in doubt, go with your first instinct. This is an old test-taking trick that still works today. Oftentimes if something feels right instinctively, it is right. Unfortunately, over analytical test takers will often convince themselves otherwise. Don’t fall for that trap and try not to get too nitpicky about an answer choice. You shouldn’t have to twist the facts and create hypothetical scenarios for an answer choice to be correct. Strategy 9: No Fear The depth and breadth of the NCLEX test can be a bit intimidating to a lot of people as it can deal with topics that have never been encountered before and are highly technical. Don’t get bogged down by the information presented. Don’t try to understand every facet of the nursing management process. You won’t have to write an essay about the topics afterwards, so don’t memorize all of the minute details. Don’t get overwhelmed. Copyright © StudyGuideZ. All rights reserved. 19 Strategy 10: Don’t Get Thrown Off by New Information Sometimes test writers will include completely new information in answer choices that are wrong. Test takers will get thrown off by the new information and if it seems like it might be related, they could choose that answer choice incorrectly. Make sure that you don’t get distracted by answer choices containing new information that doesn’t answer the question. Example: Which conclusion is best supported? A: Hyponatremia can cause the anxiety presented in this case. Was anxiety even discussed in the question? If the answer is NO – then don’t consider this answer choice, it is wrong. Strategy 11: Narrowing the Search Whenever two answer choices are direct opposites, the correct answer choice is usually one of the two. It is hard for test writers to resist making one of the wrong answer choices with the same wording, but changing one word to make it the direct opposite in meaning. This can usually cue a test taker in that one of the two choices is correct. Example: A. Calcium is the primary mineral linked to osteoporosis treatment. B. Potassium is the primary mineral linked to osteoporosis treatment. Copyright © StudyGuideZ. All rights reserved. 20 These answer choices are direct opposites, meaning one of them is likely correct. You can typically rule out the other two answer choices. Strategy 12: You’re not Expected to be Einstein The questions will contain the information that you need to know in order to answer them. You aren’t expected to be Einstein or to know all related knowledge to the topic being discussed. Remember, these questions may be about obscure topics that you’ve never heard of. If you would need to know a lot of outside knowledge about a topic in order to choose a certain answer choice – it’s usually wrong. Respiratory Conditions Pulmonary Valve Stenosis Causes: Congenital Endocarditis Rheumatic Fever Symptoms: Fainting SOB Palpitations Cyanosis Poor weight gain Tests: Cardiac catheterization ECG Chest-Xray Echocardiogram Treatment: Prostaglandins Dieuretics Anti-arrhythmics Copyright © StudyGuideZ. All rights reserved. 21 Blood thinners Valvuloplasty ARDS- low oxygen levels caused by a build up of fluid in the lungs and inflammation of lung tissue. Causes: Trauma Chemical inhalation Pneumonia Septic shock Tests: ABG CBC Cultures Treatment: Echocardiogram Auscultation Monitor the Patient for: Pulmonary fibrosis Multiple system organ failure Ventilator associated pneumonia Acidosis Respiratory failure Symptoms: Low BP Rapid breathing SOB Cyanosis Chest X-ray Mechanical Ventilation Treat the underlying condition Respiratory Acidosis- Build-up of Carbon Dioxide in the lungs that causes acid-base imbalances and the body becomes acidic. Copyright © StudyGuideZ. All rights reserved. 22 Causes: COPD Airway obstruction Hypoventilation syndrome Severe scoliosis Severe asthma Symptoms: Chronic cough Wheezing SOB Confusion Fatigue Tests: CAT Scan ABG Pulmonary Function Test. Treatment: Mechanical ventilation Bronchodilators Copyright © StudyGuideZ. All rights reserved. 23 Respiratory Alkalosis: CO2 levels are reduced and pH is high. Causes: Anxiety Fever Hyperventilation Symtpoms: Dizziness Numbness Tests: ABG Chest X-ray Pulmonary function tests Treatment: Paper bag technique Increase carbon dioxide levels RSV (Respiratory synctial virus) - spread by contact, virus can survive for various time periods on different surfaces. Symptoms: Fever SOB Cyanosis Wheezing Nasal congestion Croupy cough Tests: ABG Chest X-ray Treatment: Ribvirin Ventilator in severe cases IV fluids Bronchodilators Monitor the patient for: Pneumonia Respiratory failure Otitis Media Copyright © StudyGuideZ. All rights reserved. 24 Hyperventilation Causes: COPD Panic Attacks Stress Apnea: no spontaneous breathing. Causes: Obstructive sleep apnea Seizures Cardiac Arrhythmias Brain injury Nervous system dysfunction Lung surgery Causes: Cancer Lung abscesses Atelectasis Ketoacidosis Aspirin overdose Anxiety Drug overdose Prematurity Bronchospasm Encephalitis Choking Emphysema Pneumothorax Tumors Bronchiectasis Pneumonia: viruses the primary cause in young children, bacteria the primary cause in adults. Bacteria: Streptococcus pneumoniae, Mycoplasma pneumoniae pneumoniae (pneumococcus). Copyright © StudyGuideZ. All rights reserved. 25 Types of pneumonia: Viral pneumonia Walking pneumonia Legionella pneumonia CMV pneumonia Aspiration pneumonia Atypical pneumonia Legionella pneumonia Symptoms: Fever Headache Ribvirin SOB Cough Chest pain Tests: Chest X-ray Pulmonary perfusion scan CBC Cultures of sputum Presence of crackles Treatment: Antibiotics if caused by a bacterial infection Respiratory treatments Steroids IV fluids Vaccine treatments Pulmonary actinomycosis –bacteria infection of the lungs caused by (propionibacteria or actinomyces) Causes: Microorganisms Symptoms: Pleural effusions Facial lesions Chest pain Cough Weight loss Fever Tests: CBC Lung biopsy Thoracentesis CT scan Bronchoscopy Copyright © StudyGuideZ. All rights reserved. 26 Monitor patient for: Meningitis Emphysema Osteomyelitis Alveolar proteinosis: A build-up of a phospholipid in the lungs were carbon dioxide and oxygen are transferred. Causes: May be associated with infection Genetic disorder 30-50 yrs. Old Symptoms: Weight loss Fatigue Cough Fever SOB Tests: Chest X-ray Presence of crackles CT scan Bronchoscopy ABG- low O2 levels Pulmonary Function tests Treatment: Lung transplantation Special lavage of the lungs Pulmonary hypertension: elevated BP in the lung arteries Causes: May be genetically linked More predominant in women Symptoms: Fainting Copyright © StudyGuideZ. All rights reserved. Fatigue Chest Pain SOB with activity LE edema Weakness 27 Tests: Pulmonary arteriogram Chest X-ray ECG Pulmonary function tests CT scan Cardiac catheterization Treatment: Manage symptoms Diuretics Calcium channel blockers Heart/Lung Transplant if necessary Pulmonary arteriovenous fistulas: a congenital defect were lung arteries and veins form improperly, and a fistula is formed creating poor oxygenation of blood. Symptoms: SOB with activity Presence of a murmur Cyanosis Clubbing Paradoxical embolism Tests: CT Scan Pulmonary arteriogram Low O2 Saturation levels Elevated RBC’s Treatment: Surgery Embolization Pulmonary aspergilloma: fungal infection of the lung cavities causing abscesses. Cause: Fungus Aspergillus Symptoms: Wheezing SOB Chest pain Fever Cough Copyright © StudyGuideZ. All rights reserved. 28 Tests: CT scan Sputum culture Serum precipitans Chest X-ray Bronchoscopy Treatment: Surgery Antifungal medications Pulmonary edema: most commonly caused by Heart Failure, but may be due to lung disorders. Symptoms: Restless behavior Anxiety Wheezing Poor speech SOB Sweating Pale skin Drowning sensation Tests: Murmurs may be present Echocardiogram Presence of crackles Low O2 Saturation levels Treatment: Diuretics Oxygen Treat the underlying cause Idiopathic pulmonary fibrosis: Thickening of lung tissue in the lower aspects of the lungs. Copyright © StudyGuideZ. All rights reserved. 29 Causes: Response to an inflammatory agent Found in people ages 50-70. Linked to smoking Symptoms: Cough SOB Chest pain Cyanosis Clubbing Cyanosis Monitor the patient for: Polycythemia Pulmonary Htn. Respiratory failure Cor pulmonarle Tests: Pulmonary function tests Lung biopsy Rule out other connective tissue diseases CT scan Chest X-ray Treatment: Lung transplantation Corticosteroids Anti-inflammatory drugs Pulmonary emboli: Blood clot of the pulmonary vessels or blockage due to fat droplets, tumors or parasites. Causes: DVT- most common Symptoms: SOB (rapid onset) Chest pain Decreased BP Skin color changes LE and pelvic pain Sweating Copyright © StudyGuideZ. All rights reserved. 30 Dizziness Anxiety Tachycardia Labored breathing Cough Tests: Doppler US Chest X-ray Pulmonary angiogram Monitor the patient for: Shock Pulmonary hypertension Hemorrhage Palpitations Heart failure Pulmonary perfusion test Plethysmography ABG Check O2 saturation Treatment: Placement of an IVC filter Administer Oxygen Surgery Thrombolytic Therapy if clot detected Tuberculosis- infection caused by Mycobaterium tuberculosis. Causes: Due to airborne exposure Symptoms: Fever Chest pain SOB Weight Loss Fatigue Wheezing Phlegm production Tests: Thoracentesis Sputum cultures Presence of crackles Copyright © StudyGuideZ. All rights reserved. 31 TB skin test Chest X-ray Bronchoscopy Treatment: Generally about 6 months Rifampin Pyrazinamide Isoniazid Cytomegalovirus – can cause lung infections and is a herpes-type virus. Causes: More common in immunocompromised patients Often associated with organ transplantation Symptoms: Fever SOB Fatigue Loss of appetite Cough Joint pain Tests: Bronchoscopy Treatment: Antiviral medications Oxygen therapy Monitor the patient for: Kidney dysfunction Infection Decreased WBC levels Relapses CMV serology tests ABG Blood cultures Viral pneumonia – inflammation of the lungs caused by viral infection. Causes: Rhinovirus Herpes simplex virus Influenza Copyright © StudyGuideZ. All rights reserved. 32 Adenovirus Hantavirus CMV RSV Symptoms: Fatigue Sore Throats Nausea Joint pain Headaches Muscular pain Cough SOB Tests: Bronchoscopy Open Lung biopsy Sputum cultures Viral blood tests Treatment: Antiviral medications IV fluids Monitor the patient for: Liver failure Heart failure Respiratory failure Pneumothorax: a build-up of a gas in the pleural cavities. Types: Traumatic pneumothorax Tension pneumothorax Spontaneous pneumothorax Secondary spontaneous pneumothorax All rights reserved. Symptoms: SOB Tachycardia Hypotension Anxiety Copyright © StudyGuideZ. 33 Cyanosis Chest pain-sharp Fatigue Tests: ABG Chest X-ray Poor breath sounds Treatment: Chest tube insertion Administration of oxygen Copyright © StudyGuideZ. All rights reserved. 34 Functions Circulatory System The circulatory system serves: (1) to conduct nutrients and oxygen to the tissues; (2) to remove waste materials by transporting nitrogenous compounds to the kidneys and carbon dioxide to the lungs; (3) to transport chemical messengers (hormones) to target organs and modulate and integrate the internal milieu of the body; (4) to transport agents which serve the body in allergic, immune, and infectious responses; (5) to initiate clotting and thereby prevent blood loss; (6) to maintain body temperature; (7) to produce, carry and contain blood; (8) to transfer body reserves, specifically mineral salts, to areas of need. General Components and Structure The circulatory system consists of the heart, blood vessels, blood and lymphatics. It is a network of tubular structures through which blood travels to and from all the parts of the body. In vertebrates this is a completely closed circuit system, as William Harvey (1628) once demonstrated. The heart is a modified, specialized, powerful pumping blood vessel. Arteries, eventually becoming arterioles, conduct blood Copyright © StudyGuideZ. All rights reserved. 35 to capillaries (essentially endothelial tubes), and venules, eventually becoming veins, return blood from the capillary bed to the heart. Course of Circulation Systemic Route: a. Arterial system. Blood is delivered by the pulmonary veins (two from each lung) to the left atrium, passes through the bicuspid (mitral) valve into the left ventricle and then is pumped into the ascending aorta; backflow here is prevented by the aortic semilunar valves. The aortic arch toward the right side gives rise to the brachiocephalic (innominate) artery which divides into the right subclavian and right common carotid arteries. Next, arising from the arch is the common carotid artery, then the left subclavian artery. The subclavians supply the upper limbs. As the subclavian arteries leave the axilla (armpit) and enter the arm (brachium), they are called brachial arteries. Below the elbow these main trunk lines divide into ulnar and radial arteries, which supply the forearm and eventually form a set of arterial arches in the hand which give rise to common and proper digital arteries. The descending (dorsal) aorta continues along the posterior aspect of the thorax giving rise to the segmental intercostals arteries. After passage “through” (behind) the diaphragm it is called the abdominal aorta. At the pelvic rim the abdominal aorta divides into the right and left common iliac arteries. These divide into the internal iliacs, which Copyright © StudyGuideZ. All rights reserved. 36 supply the pelvic organs, and the external iliacs, which supply the lower limb. b. Venous system. Veins are frequently multiple and variations are common. They return blood originating in the capillaries of peripheral and distal body parts to the heart. Hepatic Portal System: Blood draining the alimentary tract (intestines), pancreas, spleen and gall bladder does not return directly to the systemic circulation, but is relayed by the hepatic portal system of veins to and through the liver. In the liver, absorbed foodstuffs and wastes are processed. After processing, the liver returns the blood via hepatic veins to the inferior vena cava and from there to the heart. Pulmonary Circuit: Blood is oxygenated and depleted of metabolic products such as carbon dioxide in the lungs. Lymphatic Drainage: A network of lymphatic capillaries permeates the body tissues. Lymph is a fluid similar in composition to blood plasma, and tissue fluids not reabsorbed into blood capillaries are transported via the lymphatic system eventually to join the venous system at the junction of the left internal jugular and subclavian veins. The Heart The heart is a highly specialized blood vessel which pumps 72 times per minute and propels about 4,000 gallons (about 15,000 liters) of blood daily to the tissues. It is composed of: Endocardium (lining coat; epithelium) Copyright © StudyGuideZ. All rights reserved. 37 Myocardium (middle coat; cardiac muscle) Epicardium (external coat or visceral layer of pericardium; epithelium and mostly connective tissue) Impulse conducting system Cardiac Nerves: Modification of the intrinsic rhythmicity of the heart muscle is produced by cardiac nerves of the sympathetic and parasympathetic nervous system. Stimulation of the sympathetic system increases the rate and force of the heartbeat and dilates the coronary arteries. Stimulation of the parasympathetic (vagus nerve) reduces the rate and force of the heartbeat and constricts the coronary circulation. Visceral afferent (sensory) fibers from the heart end almost wholly in the first four segments of the thoracic spinal cord. Cardiac Cycle: Alternating contraction and relaxation is repeated about 75 times per minute; the duration of one cycle is about 0.8 second. Three phases succeed one another during the cycle: a) atrial systole: 0.1 second, b) ventricular systole: 0.3 second, c) diastole: 0.4 second The actual period of rest for each chamber is 0.7 second for the atria and 0.5 second for the ventricles, so in spite of its activity, the heart is at rest longer than at work. Blood Blood is composed of cells (corpuscles) and a liquid intercellular ground substance called plasma. The average blood volume is 5 or 6 Copyright © StudyGuideZ. All rights reserved. 38 liters (7% of body weight). Plasma constitutes about 55% of blood volume, cellular elements about 45%. Plasma: Over 90% of plasma is water; the balance is made up of plasma proteins and dissolved electrolytes, hormones, antibodies, nutrients, and waste products. Plasma is isotonic (0.85% sodium chloride). Plasma plays a vital role in respiration, circulation, coagulation, temperature regulation, buffer activities and overall fluid balance. Copyright © StudyGuideZ. All rights reserved. 39 Cardiovascular Conditions Cardiogenic Shock: heart is unable to meet the demands of the body. This can be caused by conduction system failure or heart muscle dysfunction. Symptoms of Shock: Rapid breathing Rapid pulse Anxiety Nervousness Thready pulse Mottled skin color Profuse sweating Poor capilary refill Tests: Nuclear Scans Electrocardiogram Echocardiogram Electrocardiogram ABG Chem-7 Chem-20 Electrolytes Cardiac Enzymes Treatment: Amrinone Norepinephrine Dobutamine IV fluids PTCA Extreme cases-pacemaker, IABP Aortic insufficiency: Heart valve disease that prevents the aortic valve from closing completely. Backflow of blood into the left ventricle. Causes: Rheumatic fever Congenital abnormalities Endocarditis Marfan’s syndrome Ankylosing spondylitis Copyright © StudyGuideZ. All rights reserved. 40 Reiter’s syndrome Symptoms: Fainting Weakness Bounding pulse Chest pain on occasion SOB Fatigue Tests: Palpation Increased pulse pressure and diastolic pressure Pulmonary edema present Auscultation Left heart cathereterization Aortica angiography Dopper US Echocardiogram Treatment: Digoxin Dieuretics Surgical aorta valve repair Monitor patient for: PE Left-sided heart failure Endocarditis Aortic aneurysm: Expansion of the blood vessel wall often identified in the thoracic region. Causes: Htn Marfan’s syndrome Syphilis Atherosclerosis (most common) Trauma Possible back pain may be the only indicator Tests: Aortogram Chest CT X-ray Treatment