Comprehensive NCLEX-RN & ATI Review Exam Q&A | Delegation, Pharmacology, Lab Values, OB & Peds (2025/2026)

Maximize your NCLEX-RN and ATI scores with this ultimate, UPDATED 2025 Q&A guide! This comprehensive study tool delivers verified answers across all critical testing areas, including: Management of Care: The 5 Rights of Delegation, Non-Delegatable Tasks (LPN/AP), and Core Ethical Principles (Beneficence, Veracity, Fidelity). Pharmacology: Essential Antidotes (e.g., Naloxone, Protamine Sulfate) and detailed drug classes (ACE-I, Beta-Blockers, Statins). Clinical: Critical Lab Values (INR, PT, Electrolytes), Triage tags (RED/YELLOW), and complex conditions like DKA, SIADH, Cushing's Triad, and Abruptio Placentae. From pediatrics (APGAR, Reflexes, Motor Skills) to maternity (Nagele's Rule, Preeclampsia), this guide is your all-in-one resource. Stop studying outdated material. Get the 2025 advantage now and ensure you pass the NCLEX the first time! NCLEX Comprehensive NCLEX-RN ATI Review Exam Questions and Answers UPDATED 202/2026 Five rights of delegation -Correct Answer Right person Right task Right circumstance Right direction and communication Right supervision and evaluation Non-delegatable tasks -Correct Answer Nursing process Client education Tasks that require nursing judgement (care of unstable patients) LPN delegation -Correct Answer Tracheotomy care Suctioning Inserting urinary catheter Checking NG tube patency Medication administration Sterile specimen colection Reinforce client teaching AP delegation -Correct Answer ADLs Ambulating Feeding Positioning Vital signs I&Os Autonomy -Correct Answer The right to make ones own decisions Beneficence -Correct Answer The obligation to good for others NCLEX NCLEX Confidentiality -Correct Answer The obligation to observe the privacy of another and maintain strict confidence Fidelity -Correct Answer The obligation to be faithful to agreements and responsibilities, to keep promises Justice -Correct Answer The obligation to be fair to all people Nonmaleficence -Correct Answer The obligation to do no harm to others Paternalism -Correct Answer Assuming the right to make decisions for another Veracity -Correct Answer The obligation to tell the truth Nurses role of informed consent -Correct Answer Ensure the provider gave the necessary information Ensure the client understands the procedure Patient must be competent to sign informed consent Witness the clients signature Notify the provider if clarification is needed Mandatory Reporting -Correct Answer Abuse - vulnerable populations Communicable diseases Malpractice -Correct Answer The failure of a person with professional training to act in a reasonable an prudent manner within the identified scope of practice Negligence -Correct Answer The omission to do something that a reasonable person would do or something that a reasonable person would not do Emergency class 1 (red tag) -Correct Answer Immediate threat to life Do not delay care NCLEX NCLEX Urgent class 2 (yellow tag) -Correct Answer Major injuries that require treatment Delay of 30 minutes to 2 hours Non-urgent class 3 (green tag) -Correct Answer Minor injuries that do not require immediate attention Delay of 2-4 hours Expectant class 4 (black tag) -Correct Answer Expected/allowed to die Prepare for morgue TPN -Correct Answer Monitor serum glucose ever 4-6 hours Change dressing every 48 - 72 hours Change IV tubing and fluid every 24 hours If solution is temporarily unavailable, administer 10% dextrose in water to prevent hypoglycemia Acetaminophen (antidote) -Correct Answer Acetylcysteine (antidote) Benzodiazepine (antidote) -Correct Answer Flumazenil (antidote) Curare (antidote) -Correct Answer Edrophonium (antidote) Cyanide poisoning (antidote) -Correct Answer Methylene blue (antidote) Digitalis: (antidote) -Correct Answer Digoxin immune FAB (antidote) Ethylene poisoning (antidote) -Correct Answer Fomepizole (antidote) Heparin and enoxaparin (antidote) -Correct Answer Protamine sulfate (antidote) Iron (antidote) -Correct Answer Deferoxamine (antidote) Lead (antidote) -Correct Answer Succimer (antidote) NCLEX NCLEX Magnesium sulfate (antidote) -Correct Answer Calcium gluconate 10% (antidote) Narcotics (antidote) -Correct Answer Naloxone (antidote) Warfarin (antidote) -Correct Answer Phytonadione (vitamin K)(antidote) Calcium channel blockers -Correct Answer Suffix: dipine Causes: arterial dilation and decreased BP For: angina and HTN, verapamil and diltazem can be used for a-fib, a-flutter, svt Precautions: digoxin and beta blockers Contraindication: heart failure, heart block, of bradycardia Side effects: reflex tachycardia, peripheral edema, and toxicity Monitor: BP and HR Do not drink grapefruit juice Do not crush/chew IV administration 2-3 minutes ACE inhibitor -Correct Answer Suffix: pril For: hypertension, heart failure, MI, and diabetic nephropathy Monitor potassium, BP, angioedema Captopril should be taken 1hr before meals ARBS -Correct Answer Suffix: tan For: hypertension, heart failure, MI, and diabetic nephropathy Monitor potassium, BP, angioedema Beta 2 adrenergic agonists -Correct Answer For: Respiratory Albuterol - short acting (inhaled) for acute bronchospasm, onset 5-15 min Formoterol - long acting/long-term control (inhaled), onset 1-3 min, duration 10hr Salmeterol - long acting/long-term control (inhaled), onset 10-20 min, duration 12hr Terbutaline - long acting/long-term control (oral) NCLEX NCLEX Precautions: increased heart rate, tremors, beta blockers will decrease effect, MAOIs will increase effect Antilipemic -Correct Answer Suffix: statin For: reduction of formation of cholesterol precursors Drug interactions: digoxin, warfarin, thyroid hormones, thiazide diuretics, phenobarbital, NASIDs, tetracycline, beta blockers, gemfibrozil, glipizide, glyburide, oral contraceptices, and phenytoin Do not administer with grapefruit juice Glucocorticoids -Correct Answer Suffix: one, ide & ate For: Prevention of inflammatory responses by suppression of airway mucus production Interaction: DM may require higher doses Side effects: insomnia, psychotic behavior, hyperglycemia, peptic ulcer, fluid retention, withdrawal symptoms, increased appetite, risk for infection (prednisone & methotreaxate), risk for osteoporosis (prednisone) Administer medication with meals Do not take with NSAIDs Beta blockers -Correct Answer Suffix: olol For: decreased cardiac excitability, cardiac output, myocardial and oxygen demand Use: primary HTN, angina, tachydysrhythmias, heart failure, and MI Contraindications: AV Block and sinus tachy, asthma, bronchospasms, or heart failure Side effects: nasal stuffiness, bronchospasms Monitor blood glucose with propranolol Do not administer labetalol in same IV as furosemide Do not crush/chew Hold medications if pulse is less than 60 or systolic BP is less than 100 Vasodilators -Correct Answer Nitroglycerine, enalaprilat, nitroprusside, hydralazine For: vasodilation of arteries and veins resulting in decreased blood pressure NCLEX NCLEX Precautions: hepatic and renal disorders, older adults, electrolyte imbalances Side effects: cyanide toxicity Nitroprusside may not be mixed with any medication Continuious ECG and BP monitoring Insulin -Correct Answer Lispro: rapid acting, 15-30 min Regular: short-acting, 30min-1hr NPH: intermediate acting, 1-2hr Insulin glargine (lantus): 70 minutes Do not mix lantus with other insulin's (in syringe) Draw up regular and then NPH Regular insulin is the only insulin given IV (used for DKA) Penicillin -Correct Answer Suffix: cillin Hypersensitivity with possible anaphylaxis Proton pump inhibitors -Correct Answer Suffix: prazole & idine For: prevents/blocks selected receptors within the stomach Side effects: can increase risk for osteoporosis Antiviral -Correct Answer Suffix: vir Acylovir and valacyclovir to be given with food MAOIs -Correct Answer Isocarboxazid, tranylcypromine, phenelzine Avoid foods with tyramine Contraindications: SSRIs, tricyclics, heart failure, CVA, renal insufficiency Side effects: CNS stimulation, orthostatic hypotension, hypertensive crisis r/t tyramine, SSRI's and tricyclics SSRIs -Correct Answer Suffix: pram & ine Avoid alcohol Monitor: agitation, confusion, hallucinations for first 72 hours Side effects: weight gain, fatigue, drowsiness NCLEX NCLEX Ginko biloba -Correct Answer Use: improves cerebral circulation Treats: dementia & memory loss Interferes with: Alzheimer treatments Discontinue 2 weeks prior to surgery Seizures are a sign of overdose St. Johns wort -Correct Answer Use: depression, seasonal affective disorder, anxiety Side effect: headache, sleep disturbances, phototoxixcity, constipation Interactions: oral contraceptives, cyclosporine, warfarin, digoxin, CCBs, antidepressants ABX -Correct Answer Suffix: cycline & floxacin Consume at least 3L fluid daily Avoid sun exposure Permanent tooth discoloration if given to children </= 8 Bronchodialoator -Correct Answer Suffix: phylline For: Muscle relaxant of the bronchial smooth muscle. Long term control of asthma Contraindicated: PUD Precaution: caffeine, furosemide, cimetidine, fluoroquinolones, acetaminophen, pheylbutazone (falsely elevated levels) Side effects: irritability, restlessness Toxic: tachycardia, tachypnea, seizures Antiemetics -Correct Answer Promethazine: monitor EPS Metoclopramide: monitor EPS and tardive dyskinesia Ondansetron: monitor headache, EPS, dysrhythmia Scopolamine: monitor for blurred vision Glycopeptide -Correct Answer Suffix: mycin Contraindicated: allergy to corn Administer over 1hr Monitor trough NCLEX NCLEX Caution: nephrotoxic and ototoxic Inhaled anticholinergics -Correct Answer Suffix: ium For: preventing acute bronchospasms Not used for acute episodes Education: if using 2 inhaled medications, wait 5 minutes between Fire safety -Correct Answer R - rescue A- alarm C - contain E - extinguish CDC mandatory reporting -Correct Answer Hepatitis A, Hepatitis B, Hepatitis C, Measles (Rubeola) Meningococcal, Rubella, Salmonellosis, Shingllosis (dysentery), TB, VRE Contact precautions -Correct Answer Gloves/gown C-diff, Hep a w/ fecal incontinence, Herpes simplex, MRSA, Rotavirus, Salmonellosis, Shigellosis (dysentery), staph, VRE Airborne precautions -Correct Answer Herpez zoster (shingles), Measles (Rubeola virus), TB Droplet precaution -Correct Answer Meningococcal, pneumonia, RSV, Rubella Hypokalemia -Correct Answer Signs: muscle weakness, cramping, irritability, confusion, flat or inverted T waves Interventions: monitor rsp status, initiate seizure precautions, monitor ecg & I&Os If the patient is not urinating do not administer K Hyperkalemia -Correct Answer Signs: peaked T waves, centricular dysrhythmias, muscle twitching, paralysis, ascending muscle weakness NCLEX NCLEX Interventions: monitor bowel sounds, initiate dialysis, kayexalate, 50% glucose with insulin, calcium gluconate, bicarb, loop diuretics Hypernatremia -Correct Answer Signs: swollen dry tongue, hallucinations, hyperreflexia, pulmonary edema Interventions: daily weights, I&Os, seizure precautions Hypocalcimia -Correct Answer Signs: Prolonged QT interval, trousseaus sign, chvosteks sign, seizures Interventions: seizure precuations, IV calcium replacement (dilute with D5W), orthostatic hypotension Hypercalcemia -Correct Answer Signs: kidney stones, pathologic fx, flank pain, deep bone pain Interventions: isotonic IVF, dialysis, cardiac monitoring Hypomagnesemia -Correct Answer Signs: trousseaus sign, chvosteks sign, aggitation, confusion Interventions: seizure precautions, monitor swallowing Hypermagnesemia -Correct Answer Signs: facial flushing Do not administer to clients with renal failure Toxicity treat with calcium gluconate Metabolic Acidosis -Correct Answer Cause: Diarrhea, renal failure, DKA Metabolic Alkalosis -Correct Answer GI suction, blood transfusion, prolonged vomiting Respiratory Acidosis -Correct Answer RSP depression, pneumothorax, airway obstruction, inadequate ventilation NCLEX NCLEX Respiratory Alkalosis -Correct Answer Hyperventilation, altitude sickness, asthma, pneumonia Bronchoscopy -Correct Answer Visualize larynx, trachea, bronchi Tissue biopsy Foreign body removal Assess gag reflex prior to feeding, NPO 8-12 hours Cor pulmonale -Correct Answer Right sided heart failure caused by pulmonary disease Signs: Cyanotic lips, JVD, dependent edema TB -Correct Answer Manifestations: Positive sputum cx for acid-fast bacillus, low grade fever with night sweats, NAAT test for family of a TB patient 3 consecutive negative sputum cultures is negative TB after diagnosis Intervention: avoid food containing tyramine if on INH, rifampin can alter metabolism of certain medications, monitor liver/kidney function Rifampin - turns fluids orange, monitor AST/ALT for liver function, nephrotoxic drug Ethambutol - loss of red/green color distinction Acute pulmonary embolism -Correct Answer Factors: chrinc a-fib, long bone fx, PVD, DVT, sickle cell anemia, central venous catheter, Signs: dyspnea, tachypnea, tachycardia, diaphorisis, restlessness, chest pain, hemoptysis. Fat emboli: petechia over chest and axilla Interventions: manage airway, pain medication, heparin Low pressure alarm -Correct Answer Indicates low volume Associated with tube disconnection, cuff leak, or tube dislodgement High pressure alarm -Correct Answer Increased pressure NCLEX NCLEX Associated with increased secretions, kinking of tube, pulmonary edema, client coughing/biting tube Apnea alarm -Correct Answer No spontaneous breathing within a preset time period Crohn's disease -Correct Answer Diet: low residual, low fiber diet Foods: cream of wheat, puffed rice cereal, canned green beans Colostomy -Correct Answer Empty when 1/3 - 1/2 full No lotions Cranberry juice and yogurt hide odor Change and clean every 5-10 days (have also seen 3-7) Hepatitis A -Correct Answer Fecal-oral route Person to person Food/water contamination Report to CDC Signs: flu like symptoms Hepatitis B -Correct Answer Sexually transmitted Sharing needles Needle sticks Report to CDC Signs: RUQ pain, anorexia, N/V, dark urine, light stools, jaundice Hepatitis C -Correct Answer Blood-to-blood Illicit IV drug sharing Sexually transmitted Report to CDC Signs: asymptomatic, cirrhosis Osteoarthritis -Correct Answer Risk factors: age, female, metabolic disease, obesity, smoking NCLEX NCLEX Manifestations: pain which is diminished after rest, pain that increases after activity Medications: NSAIDs. corticosteroids, topical analgesics, glucosamine, chondroitin Rheumatoid arthritis -Correct Answer Chronic and progressive autoimmune disorder Risk factors: female Manifestations: morning stiffness, pain at rest, pain with movement, bilateral joint inflammation, decreased range of motion Intervention: ice/heat for comfort Medications: NSAIDs. corticosteroids, methotrexate, leflunomide, hydroxychloroquine Gouty arthritis -Correct Answer Risk factors: excessive alcohol intake, high intake of foods with purines (organ meats, yeast, sardines, spinach) Manifestations: excruciating pain and inflamation in one or more small joints Diagnosis: serum uric acid >= y mg/dL Intervention: bed rest during acute episodes, increase fluid intake to 3L daily Medication: colchicine, allopurinol, NSAID's, corticosteroids Diabetes insipidus -Correct Answer Deficient antidiuretic hormone due to disorder of the posterior pituitary gland resulting in the inability of kidneys to conserve water Cause: head trauma, tumor, surgery, radiation, CNS infection, malignant tumors, railure of renal tubules Signs: decreased urine specific gravity (>/= 1.001), increased urinary output, ice water cravings, dehydration SIADH -Correct Answer Excessive release of antidiuretic hormone resulting in the inability to excrete and appropriate amount of urine thus developing fluid retention and dilution of hyponatremia Cause: neoplastic tumors, head injury, meningitis, respiratory disorders, and some medications NCLEX NCLEX Intervention: restrict water (500-1000mL/daily), monitor I&O's and client weight, initiate seizure precautions Medication: tolvaptan Addison's disease -Correct Answer Hyposecretion of adrenal cortex hormones caused by an autoimmune disease, TB, histoplasmosis, adrenalectomy, tumors and HIV Hint: you need to ADD cortisol Signs: weakness, fatigue, N/V, hyperpigmentation, hypotension with increased heart rate, salty food cravings Intervention: monitor BP and heart rhythm, electrolytes, low urine output Addison's Crisis -Correct Answer Characterized by hypotension, tachycardia, tachypnea, pallor Secondary to infection, trauma, surgery, pregnancy, emotional stress Medication: hydrocortisone (prevents crisis) Cushing's disease/syndrome -Correct Answer Hypersecreation of glucocorticoids Cause: hyperplasia of adrenal cortex or pituitary gland tumor Manifestations: upper body obesity with thin extremities, moon face, buffalo hum, feck fat, osteoporosis, hyperglycemia, hypernatremia, hypokalemia, hyocalcemia, slow growth rate in children Intervention: monitor for infection, prevent falls, treat hyperglycemia, assess BP and heart rate Diabetic keto acidosis -Correct Answer Occurs in type 1 diabetes Blood glucose level 300 - 800 ABG: metabolic acidosis Signs: ketone uria, Kussmaul's respirations Intervention: regular insulin, blood glucose should decrease ~100mg/dL each hour Medication: glucose and insulin at same time to maintain rate of reduction Hyperglycemic hyperosmolar state -Correct Answer Occurs in type 2 diabetes Blood glucose is >= 600 NCLEX NCLEX Signs: not seen with ketosis, altered mental status Intervention: replace lost fluids Medication: insulin Atrial fibrillation -Correct Answer Characteristics: HR 120-200bpm, irregular ventrical rhythm, no clear p waves, QRS comples less than 0.12 seconds Medication: coumadin/warfarin 3rd degree heart block -Correct Answer Characteristics: p waves are not consecutively followed by a QRS complex; p wave could be present followed by additional p wave r/t no ventricular activity Ventricular tachycardia -Correct Answer Pulse = cardiovert No pulse = defibrillation Characteristics: 'saw tooth', 140-180bpm, irregular rhythm, p waves are typically not seen, QRS complex is wide Ventricular fibrillation -Correct Answer CPR - there is no pulse Characteristics: no recognizable waves or patterns Cause: most common MI TURP -Correct Answer Enlargement of the prostate, enlarged section removed Intervention: monitor continuous bladder irrigation (expect bloody drainage). encourage 3L fluid/daily, frequent irrigation prevents clots TURP syndrome signs: hyponatremia, confusion, bradycardia, hypo/hypertension, N/V, visual changes Increased ICP -Correct Answer Contributing factors: head injury w/ subdural or epidural hematoma, CVA, cerebral edema, brain tumor, hydrocephalus, meningitis Manifestations: changes in LOC, headache, Cushing's triad, ineffective thermoregulation Intervention: monitor vital signs, keep HOB 30-45, avoid coughing/sneezing/straining/suctioning, administer O2, decrease environmental stimuli NCLEX NCLEX Medication: mannitol Avoid: opiates and sedatives Cushing's triad -Correct Answer Signs: hypertension with widening pulse pressure, bradycardia, and irregular breathing (Cheyne-stokes respiration) Autonomic dysreflexia -Correct Answer Sudden severe HTN triggered by noxious stimuli below damage of spinal cord Causes: impaction, bladder distension, pressure points, ulcer, pain Manifestations: hypertension with bradycardia, headache, flushing, goose bumps, sweating, nasal congestion Guillan Barre -Correct Answer Ascending muscle weakness Intervention: respiratory monitoring Myasthenia gravis -Correct Answer Descending muscle weakness Intervention: respiratory monitoring Early signs: ocular involvement (dyplopia) Interventions: plan activity early in day to prevent fatigue, provide eye care Parkland Formula -Correct Answer 4mL/kg/% burn 1/2 of dose given during the first 8 hours 1/2 of dose given for the remaining 16 hours Superficial burn -Correct Answer Appearance: pink to red, tender, no blsiters, mild edema, no eschar Superficial partial thickness burn -Correct Answer Appearance: red to white with blisters, mild to moderate edema, no eschar Deep partial thickness burn -Correct Answer Appearance: red to white with moderate edema, no blisters, soft/dry eschar NCLEX NCLEX Full-thickness -Correct Answer Appearance: red to tan, black, brown, white, no blisters, severe edema, hard inelastic eschar May or may not be painful Deep full-thickness -Correct Answer Appearance: black with no edema No pain Burn labs -Correct Answer 0-14hrs: Hct/Hgb will be elevated, sodium decreased, potassium increased 48-72 hrs: Hct/Hgb will decrease, sodium is decreased WBC: initial increase followed by decrease Glucose: elevated ABG: hypoxemia and metabolic acidosis Total protein: low Albumin: low Burn intervention -Correct Answer Maintain airway (humidified oxygen) Maintain urine output of 30-50mL/hr 5000kcal/daily Vitamin A foods -Correct Answer liver, egg yol, whole milk, butter, green and yellow veggies Vitamin D foods -Correct Answer Fish oils, fortified milk and margarin Vitamin K foods -Correct Answer Egg yolks, liver, cheese, green leafy veggies Vitamin C foods -Correct Answer Citrus fruits, tomatoes, broccoli, cabbage Low cholesterol diet foods -Correct Answer Sardines, salmon, olive and flaxseed oils, shellfish, walnuts, fruits, veggies, lean meat, skinless fowl NCLEX NCLEX Iron alteration diet foods -Correct Answer Fish, meat, green leafy veggies, enriched breads, cereals, macaroni, whole-grain products, dried fruits (rasins, apricots) and egg yolks Calcium alteration diet foods -Correct Answer Milk and milk products, dark green veggies, dried beans and peas, shellfish, canned salmon Sodium -Correct Answer 136 - 145 mEq/L Calcium -Correct Answer 9 - 10.5 mg/dL Magnesium -Correct Answer 1.3 - 2.1 mEq/L RBCs -Correct Answer M 4.7-6.1million/uL F 4.2-5.4million/uL Hgb -Correct Answer M 14-18g/dL F 12-16g/dL Hct -Correct Answer M 42-52% F 37-47% WBC -Correct Answer 5,000 - 10,000 mm3 INR -Correct Answer 0.8-1.1 Anticoagulant: 2.0 - 3.0 Critical >5 PT -Correct Answer 11-12.5 seconds Anticoagulant 1.5-2x base aPTT -Correct Answer 30-40 seconds Anticoagulant 1.5-2x base NCLEX NCLEX Platelets -Correct Answer 150,000 - 400,000/mm3 Albumin -Correct Answer 3.5-5 g/dL Urine specific gravity -Correct Answer 1.001-1.030 Creatinine -Correct Answer M 0.3-1.2 mg/dL F 0.5 - 1.1 mg/dL BUN -Correct Answer 10 - 20 mg/dL Digoxin -Correct Answer 0.8-2.0 ng/dL Lithium -Correct Answer 0.4-1.4 mEq/L Amenorrhea -Correct Answer 4 weeks pregnancy Goodell's Sign -Correct Answer 5-6 weeks pregnancy Quickening -Correct Answer 16-20 weeks pregnancy Lightening -Correct Answer 38-40 weeks pregnancy Nutrition during pregnancy -Correct Answer Average weight gain is 25-35lbs Caloric increase 300-400 kcal/daily Protein increase 25g/daily Iron increase 30mg/day Folate increase 600 mcg/daily Limit caffeine Nagele's rule -Correct Answer Know LMP, add 7 days, subtract 3 months NCLEX NCLEX Positive signs of pregnancy -Correct Answer Fetal hear tones Visualization of fetus by ultrasound Fetal movement palpated by an experienced examiner Biophysical profile -Correct Answer Ultrasound that visualizes physiological characteristics of the fetus Assesses: fetal breathing movements, gross body movement, fetal heart rate, reactive fetal heart rate, amniotic fluid volume Amniocentesis -Correct Answer Genetic workup for fetal anomalies Anomalies: down syndreom trisomy 18, trisomy 13, neural tube defects Preformed: 14-16 weeks, if preformed later in pregnancy it is to check fetal lung maturity and fetal well-being Can tell fetus gender Intervention: Administer rhogam if client is Rh-negative GTPAL -Correct Answer G - gravida (#of pregnancies) T - term births (38 weeks) P - preterm births (20-37 weeks) A - abortions/miscarriages (prior to viability L - living children Gestation hypertension -Correct Answer Begins at 20 weeks pregnancy Elevated BP, will return to baseline 6 weeks postpartum No proteinuria Mild preeclampsia -Correct Answer Gestational hypertension Proteinuria of 1-2+ Severe preeclampsia -Correct Answer BP 160/110 or greater Proteinuria >3+ Creatinine >1.1 Headache, perephrial edema, pulmonary or cardiac involvement NCLEX NCLEX Eclampsia -Correct Answer Severe preeclampsia Seizure activity HELLP syndrome -Correct Answer H- hemolysis resulting in anemia or jaundice EL - elevated liver enzymes resulting in elevated ALT and AST, epigastric pain, N/V LP - low platelets; thrombocytopenia, abnormal bleeding, abnormal clotting time, bleeding gums, petechiae, possibly DIC Abrupto placentae -Correct Answer Contributing factors: trauma, preeclampsia, multiparity, cocaine use Signs: board like abdomen and dark vaginal bleeding Placenta previa -Correct Answer Contributing factors: placenta implants partially or completely over the cervical os Sings: painless bright red vaginal bleeding Hydatidiform mole -Correct Answer Manifestations: vaginal bleeding is grown with grape like clusters, anemia, cramping Interventions: administer rhogam Education: birth control for 1 year following True labor -Correct Answer Walking can increase contraction intensity Contractions continue despite comfort measures Contractions felt in lower back and radiate to abdomen Cervical dilation and effacement progresses Bloody show present as cervix dilates Fetus presenting part engages in pelvis Oxytocin -Correct Answer Stimulates uterine contractions May be used in all stages of labor NCLEX NCLEX Naloxone HCL -Correct Answer Antidote given to newborns of mothers who used opioids Antidote for opioid induced respiration depression Betamethason -Correct Answer Prevents/reduces neonatal respiratory distress syndrome in preterm patients Stimulate production or release of lung surfactant in preterm fetus Misoprostol, dinoprostone -Correct Answer Cervix ripening Prolapsed cord -Correct Answer Call for help first Notify provider use sterile gloved hand, insert two fingers and apply finger pressure on either side of the cord to the fetal presenting part to elevate it off the cord Cord compression -Correct Answer Position change is priority Administer O2 at 8-10L/min Rhogam -Correct Answer Given to rh-negative mothers after miscarriage At 28 weeks gestation Within 24hrs of birth is baby is rh positive Colostrum -Correct Answer Will remain present up to 3-5 days (have also seen 2-4 ATI) Breast milk production -Correct Answer Begins to occur day 2-3 Breast engorgement -Correct Answer Occurs 48 hours post partum Lactating: express milk to facilitate latch, frequent pumping/feeding, warm shower, breast massage, supportive bra NCLEX: breastfeed every 2-3hr, warm shower prior to breastfeeding, apply cold compress, ice, cabbage imminently after and in-between feedings NCLEX NCLEX Postpartum hemorrhage -Correct Answer Signs: saturation of one perineal pad in 15 minutes or less, numerous large clots APGAR -Correct Answer HR: 0: absent 1:</=100 2:>100 RSP effort: 0:absent 1:slow weak cry 2:good cry Muscle tone: 0: flaccid 1: some flexion of extremities 2: well-flexed extremities Reflex irritability: 0: no response 1: grimace 2: cry Color: 0: blue, pale 1: centrally pink with blue extremities 2: completely pink Sucking and rooting -Correct Answer Birth to 4months Stroke newborns cheek, newborn will turn head toward side stroked and attempt to suck Palmar grasp -Correct Answer Birth to 3 months Newborn grasp object in hand Plantar grasp -Correct Answer Birth to 8 months Curls toes when pad of foot pressed NCLEX NCLEX Moro reflex -Correct Answer Birth to 4 months Newborn arms/legs extend and abduct symmetrically Startle sensation If not gone by 3 months this is a sign of cerebral palsy Tonic neck reflex -Correct Answer Birth to 3/4 months Arm/leg will extend toward side of head rotation Babinski -Correct Answer Birth to 12 months Toes fan upward and out when pad of foot stroked Chlamydia -Correct Answer Azithromycin = 1 dose Doxycyline = 2x daily for 7 days 1 month motor skills -Correct Answer Head lag Strong grasp reflex 2 month motor skills -Correct Answer Life head from mattress when prone Holds hands in open position 3 month motor skills -Correct Answer Will raise head and shoulders in prone position No grasp reflex present Holds rattle Keeps hands loosely open 4 month motor skills -Correct Answer Rolls from back to side Holds object in both hands 5 month motor skills -Correct Answer Rolls from back to front Voluntary grasps Objects go directly to mouth NCLEX NCLEX 6 month motor skills -Correct Answer Rolls from back to front Holds bottle Picks up dropped objects 7 month motor skills -Correct Answer Bears full weight on feet Sits, leaning forward on both hands Moves object from hand to hand 8 month motor skills -Correct Answer Sits unsupported Uses thumbs/index fingers in crude pincer grasp 9 month motor skills -Correct Answer Creeps on hands and knees Pulls to standin Pincer grasp more precise 10 month motor skills -Correct Answer Changes from prone to sitting Grasps rattle by handle 11 month motor skills -Correct Answer Walks while holding onto something Neat pincer grasp Deliberately drops things to have them picked up Places objects in containers 12 month motor skills -Correct Answer Sits down from standing without help Walks with one hand held Attempts 2 block towers Can turn many pages in book at one time Vaccines -Correct Answer Birth: Hep B 2 months: DTaP, RV, IPV, Hib, PCV, Hep B 4 months: DTaP, RN, IPV, Hib, PCV 6 months: DTaP, IPV, PCV, Hep B, RB, Hib 6-12 months: Seasonal flu vaccination NCLEX NCLEX Crib -Correct Answer Slats are no more than 6cm apart Mattress is not covered in plastic Mattress fits snugly against frame of crib No blankets or pillows in crib Mattress is firm Car seat -Correct Answer Car seat at 45 degree angle Rear-facing, back seat Shoulder harness in slots at or below level of infant shoulders Retainer clip at axillary level Rear facing until 2 years old MVA = most common cause of death in infants Toddler health promotion -Correct Answer 12-15 months: Inactivated poliovirus, hemophilius influenzae type b, pneumoccocal conjugated vaccine, MMR, varicella 12-23 months: Hep A (2 doses 6 month apart) 15 - 18 months: DTaP 12-36 months: flu vaccine Diet: 24-28 oz milk daily, 1 cup of veggies, 2 oz protein, 1000kcalories per day, 1 cup fruid daily Pain scale -Correct Answer FLACC: 2 months to 7 years Faces: 3 years and older Children response to death and dying -Correct Answer Birth to 3 years: no concept 3 - 6 years: believes thoughts cause an event like death, death may be a punishment, temporary, lack of concept 6 - 12 years: Begins to have adult concept of death, fear of disease process (displayed thru uncooperative behavior), maybe curious about funeral procedure 12- 20 years: adult concept of death NCLEX NCLEX Ventricular septal defect -Correct Answer An abnormal opening in the septum between the left and right ventricle Blood flow: blood shunts from left to right ventricle, increased pulmonary vascular resistance, right ventricular hypertrophy potential enlargement of right arm Manifestation: Loud harsh murmur auscultated at left sternal border Mild cyanosis that worsens with crying Tetralogy of fallot -Correct Answer V - ventricular septal defects P - pulmonary stenosis R - right ventricular hypertrophy O - overriding aorta Manifestations: cyanosis and hypoxia, cardiomegaly, heart failure, systolic murmur No stridor No bounding peripheral pulses Aortic stenosis -Correct Answer Signs: hypotension, weak pulses, murmur Spina bifida -Correct Answer Failure of the spine to close Interventions: protect the sac, no rectal temperatures Complications: latex allergy Latex related food allergy -Correct Answer Apple, avocado, banana, carrot, celery, chestnut, kiwi, melons, papaya, raw potato and tomato. Intussusception -Correct Answer Tellescoping of intestin onto itself Manifestation: acute abdominal pain, palpable sausag-shaped mass in the RUQ, stools are mixed with blood and mucous Interventions: NPO, IV fluids, NG tube, monitor stools Medications: ABX Fix: surgery Cleft lip & cleft palate -Correct Answer Incomplete fusion of the oral cavity during intrauterine life NCLEX NCLEX Incomplete fusion of the palatine plates during intrauterine life Interventions: inspect lip, assess suck Cleft lip: encourage breast feeding, wide base nipple for bottle Cleft palate w/ or w/out cleft lip: position upright while feeding, modified bottles, wide or long nipples with a cut slid, burp after every oz, transition to up prior to repair Nephrotic syndrome -Correct Answer Glomeruli become permeable to protein, primarily albumin, which reduces the serum albumin level and lowers serum osmotic pressure Findings: facial puffiness, swelling abdomen, genitalia, lower extremities, ascites, diarrhea, anorexia, dark frothy urine, decreased output, pallor Medicine: corticosteroids, immunosuppressants, diuretics, ABX Intervention: quiet activities, daily weights, I&Os, protect from anyone who has an infection, low sodium diet Acute epiglottitis -Correct Answer Findings: stridor, drooling, tripod position, barking cough, frog-like voice Intervention: incubation and tracheotomy trays available, droplet precautions for the first 24 hours Meningitis -Correct Answer Cause: head trauma, head/neck/back surgery, cochlear implant Findings: infant have poor suck, poor feeding, high pitched cry, nuchal rigidity. Children and adolescents have headache, seizures, nuchal rigidity, photophobial, change in LOC Celiac disease -Correct Answer Intervention: gluten free diet, popcorn is a good snack Cystic fibrosis -Correct Answer Over secretion of mucous in the lungs Thereputic procedures: O2, IVF, feeding tube, CPT, high calorie diet, vaccinations Interventions: monitor RSP, ACT 2x dialy, monitor blood glucose NCLEX NCLEX Sickle cell anemia -Correct Answer Both parents carry sickle cell trait Findings: organ failure, osteoporosis, chronic anemia (hgb <10), hands/feet are cold, increased risk for infection, jaundice, pallor Vaso-occlusive crisis: extreme pain in joint, feet, hands, swelling of joints, severe abdominal pain, hematuria, symptoms of stroke Intervention: monitor O2, monitor hydration, exclude infected visitors, monitor spleenomegaly Hemophillia -Correct Answer Bleeding disorder Lab: aPTT (PT is normal), factor specific, CBC (platelets are normal) Interventions: venipunctures are preferred over finger/heel sticks, meds are administered subQ, monitor output for blood, do not administer aspirin, NSAIDs, salicylates Education: regular exercise is encouraged, create safe environment, participate in non-contact sports, follow vaccine schedule, RICE: rest, ice, compress, elevate NCLEX