NCLEX uworld Questions and Answers
what medications interact with grapefruit? Ans: calcium channel
blockers: diltiazem, nifedipine, verapamil, etc
statins
caffeine
SSRIs
what are early signs of bleeding into the retroperitoneal space?
Ans: hypotension, back pain, flank ecchymosis (grey turner sign),
hematoma formation, diminshed distal pulses
what is the grey-turner sign and what is it a sign of? Ans: bruising
of the flanks and retroperitoneal hemorrhage and is a bluish color
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what are some physical signs of peripheral arterial disease? Ans:
intermittent calf muscle pain?, rest pain, hair loss, decreased
peripheral pulses, cool, dry, shiny skin, thick brittle nails,
gangrene, ulcers (all of these are in the extremities)
transplanted hearts are expected to be Ans: tachycardic like 90-
110
what is the priority intervention for pain with sickle cell crisis and
why? Ans: administer IV fluids to reduce blood viscosity and
restore perfusion to areas affected by vasoocclusion
what is the purpose of continuous bladder irrigation? Ans: it is
perscribed after TURP to prevent obstruction of urine outflow by
removing clotted blood from the bladder
what is the nurses care of monitoring CBI? Ans: monitor quality of
drainage, titrate the inflow rate, and manurally irrigating as
needed
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characteristics of a basilar skull fracture Ans: periorbital
hematomas (raccoon eyes), csf fluid rhinorrhea, and battle sign
(behind the ear bruising)
immediate client care for basilar skull fracture Ans: cervical spime
immobilization, close neurologic monitoring, and support of ABCs
vomiting with intake may mean Ans: viral or bacterial infection
tympanosomty tubes are placed for Ans: recurrent otis medias
nurse actions during a seizure Ans: assist them to lie down is
standing/sitting, put them on side for patent airway, loosen tight
clothing, give oxygen as needed, remove objects from immediate
area, document time and duration of seizure (for tests are done
later to see which type of seizure and maybe what exacerates it)
never put anything in mouth or restrain them since musclec
ontractions can occur during a seizure
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what are some early symptoms of ICP? Ans: altered LOC,
headache, abnormal reathing, rise in bp, slow pulse, vomiting
client who has a TIA is often placed on Ans: prophylactic
antithrombotic treatment like aspirin or clopidogrel
glascow coma scale ranges from Ans: 3-15; 3 being worst 15 being
best condition (8 or below in a coma)
what are the 3 components? Ans: eye opening
motor response
verbal response
what is a primary component in TPN? Ans: glucose, so the nurse
should be monitoring blood glucose and be assessing for signs of
hyperglycemia
when a client is on TPN, the nurse must assess for hyperglycemia
why? Ans: bc a primary component is glucose. therefore the nurse
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