MARK KLIMEK NCLEX REVIEW QUESTIONS AND ANSWERS 2024/2025;( NEW EDITION SOLVED 100%)(OVER 1000 Q&A)

MARK KLIMEK NCLEX REVIEW QUESTIONS AND ANSWERS 2024/2025;( NEW EDITION SOLVED 100%)(OVER 1000 Q&A) Primary dietary prescription for calcium nephrolithiasis (kidney stones) ? PG. 85 Ans- Low calcium diet For client with nephrolithiasis the diet should be ___ ash Ans- Acid If kidney stone is calcium phosphate the diet must be low in ___ too Ans- Phosphorus Primary diet tx for uric acid nephrolithiasis is __ ____ Ans- Low purine Client with uric acid nephrolithiasis should have a diet low in ____ Ans- Methionine What is methionine? Ans- Precursor of the amino acid cystine 2 foods high in methionine? Ans- Eggs, milk Clients with cystine nephrolithiasis should have an ____ ash diet Ans- Alkaline Inc. fluids over 3000 cc /day is more effective in treating renal calculi than ANY dietary modification, T/F? Ans- True. Want to flush tract than worry about diet What is the common name for Laryngotracheobronchitis - LTB Ans- Croup What is the typical temp elevation in croup? Ans- Low grade, usually below 102, but can go up to 104. Are ATBs helpful for croup? For epiglottits? Ans- For croup, no. Epiglottitis, yes Is croup viral or bacterial? Ans- Viral With which condition is croup most often confused? Ans- Epiglottitis Can croup be managed at home? Can epiglottitis be managed at home? Ans- Yes. No, epiglottitis is a 911 emergency Are sedatives used for kids with croup? Ans- No, bc this would mask the signs of respiratory distress What causes epiglottitis? A virus or bacteria? Ans- H. influenza BACTERIA What is the best tx for croup? Ans- Cool moist air What should never be done to a child with epiglottitis? Ans- Never put anything in the child's mouth, ie, a tongue blade can lead to obstruction What are the typical signs and symptoms of croup? Ans- Barking cough, inspiratory stridor, labored resp. pattern What 3 signs tell you that the child has epiglottitis instead of croup? Ans- Muffled voice, drooling, increased fever When is croup bad enough to be evaluated by a doc? Ans- When retractions, and high pitched stridor are present What lead level needs intervention? Ans- 50-60 micrograms/ dl With which class of drugs will a child with lead poisoning be treated? Ans- Chelating agents What do chelating drugs do? Ans- They increase the excretion of heavy metals The most freq. cause of lead poisoning is... Ans- Ingestion of lead-based paint chips Name 3 common chelating agents for lead poisoning Ans- EDTA, desferal, BAL in oil S&S of lead poisoning Ans- Drowsiness, clumsiness, ataxia, seizures, coma, resp. arrest Sx of lead poisoning show up in the ____ system Ans- Neuro Leukemia is cancer of the ___ forming tissues Ans- Blood The type of cell that is most common and problematic in leukemia is ____ Ans- Immature WBC In leukemia the RBC count is ... Ans- Low, bc the bone marrow is going "wild" producing all those immature WBC - no energy or nutrients to make platelets In leukemia, the platelet count is ... Ans- Low, bc the bone marrow is going "wild" producing all those immature WBC - no energy or nutrients to make platelets Bc the RBCs are low, the pt will exhibit ___ and ___ Ans- Pallor and fatigue Bc of the immature WBCs, the pt is at risk for ___ Ans- Infection Bc of low platelets, the pt is at risk for ___, ___, and ___ Ans- Bruising, ecchymosis, bleeding, petechiae What causes lymph gland enlargement in leukemia? Ans- All those small immature WBC clog the lymph system Should you take a rectal temp on a child with leukemia? Ans- No Should you take an oral temp on a child with leukemia? Ans- Yes, as long as they are over 4 years old, in remission, and have no sores in their mouth Should the child with active leukemia use straws, forks, cups? Ans- NO straws, NO forks, YES cups RN's priority in tx a child with newly diagnosed leukemia is... Ans- Dec. risk of infection When the leukemia child's platelets and WBC's are low, his activities should be ... Ans- Limited When the platelet and WBCs are low the nurse should not insert a.. Ans- Suppository Are IM injections and IV sticks permitted on a child with leukemia? Ans- When labs are low IMs avoided and IVs limited; only done when absolutely necessary (to give chemo or measure blood counts) Why are kids on chemo also on allopurinol Ans- To prevent uric acid kidney stones (remember when chemo kills cancer cells, purines and uric acid build up and could cause kidney stones Why do some kids with leukemia have joint pain? Ans- The immature WBCs infiltrate the joint and cause inflammation Why is a child with leukemia at risk for neuro sx due to ICP Ans- The immature WBCs infiltrate the brain and cause inflammation What is alopecia? Ans- Hair loss If the platelet count is low what drug should the child not take? Ans- Aspirin Is the alopecia from chemo permanent? Ans- No. It will grow back. (Alopecia of radiation therapy is permanent bc the follicle is destroyed) What does ANC mean? Ans- Absolute Neutrophil Count What is the ANC used for in leukemia? Ans- If ANC <500, then pt will be on protective isolation Which is used more commonly to decide if the pt should be on isolation: WBC or ANC Ans- ANC is more reliable and valid By the end of the 1st 6 months of life an infants birthweight should ____ Ans- Double By the end of the first year of life an infants birthweight should ___ Ans- Triple Ideal food for infants is ___ Ans- Breast milk Breast milk contains substances that increase immunities T/F? Ans- True Bottle-fed infants dont bond well with their moms T/F? Ans- False The 1 nutrient that commercial formulas are typically low in is ___ Ans- Fe Breast milk does not contain iron T/F? Ans- False. However, it does not contain enough iron- so they should be fed iron fortified cereal starting at 6 months At what age should the infant be fed cows/goats milk? Ans- Not before 12 months What is the major problem with feeding an infant skim milk? Ans- They dont get enough calories and dont grow. Dehydration from excessive solute load and inability to concentrate urine When should the infant be introduced to textured solid foods? Ans- 4-6 months What is the first food that an infant should be introduced to? Ans- Iron fortified rice cereal When forced to eat, the preschool child will... Ans- Rebel Parents of preschool children should be taught that as long as the child eats ___ good nutritious meal per day, they should not make eating food an issue Ans- One Refusal to eat is common in preschoolers T/F? Ans- True, but still offer a variety Youngsters develop food preferences by.. Ans- Observing significant ppl in their environ School-age kids grow at a slower rate than infants, toddlers, or adolescents T/F? Ans- True What dietary strategy is most appropriate for the industrious school-age child? Ans- Wholesome snacks, bc they are often too busy too eat Girls in adolescence need more calories than adolescent boys T/F? Ans- False, boys need more cals Adolescents should take vitamin supplements T/F? PG. 90 Ans- True Mastitis and breast engorgement are more likely to occur in... Ans- Primipara Where does the organism that causes mastitis come from? Ans- The INFANTS nose or mouth Which organism most commonly causes mastitis Ans- Staph Prolonged intervals between breast-feeding (dec/inc) the incidence of mastitis Ans- Increase Cant too-tight bras lead to mastitis? Ans- Yes, by preventing emptying of ducts Mastitis usually occurs at least ___ days after delivery Ans- 10 When mastitis is present the breasts are ___, ____, and ____ Ans- Hard, swollen, warm Mastitis is accompanied with a fever over ___ Ans- 102 If mastitis is caused by an organism , what causes breast engorgement Ans- Temporary increase in vascular & lymph supply to the breast in preparation for milk production If mastitis occurs 1+ weeks after delivery, when does breast engorgement occur? Ans- 2-5 days after delivery Does breast engorgement interfere with nursing? Ans- Yes, the infant has a difficult time latching on What class of drugs is used to treat mastitis? Ans- ATBs ATBs are used to treat breast engorgement (T/F)? Ans- False Application of (warm H2O compresses/ice packs) is the preferred tx for breast engorgement Ans- Ice packs to dec swelling The mother with mastitis should stop breast feeding (T/F)? Ans- False. The mother must keep breast feeding. (Offer unaffected breast first). If the mother has an open abscess on her breast, she must not breastfeed (T/F)? Ans- True For breast engorgement, the non-breastfeeding mother should be told to express milk (T/F) Ans- No, that would increase milk production and would make the problem worse (warm compresses or a warm shower to let milk "leak" is okay - Ice is best What is the best tx for breast engorgement? Ans- Breast feeding - it will balance supply and demand What is mastoiditis? Ans- Inflammation / infection of the mastoid process What is the most common cause of mastoiditis? Ans- Chronic otitis media What are the 4 S&S of mastoiditis? Ans- Drainage from ear, high fever, HA, and ear pain, tenderness over mastoid process What unusual post-op complication can result from mastoidectomy? Ans- Facial nerve paralysis d/t accidental damage during surgery What should you do to assess for facial nerve paralysis post-mastoidectomy? Ans- Have the patient smile and wrinkle forehead What is the medical tx of mastoiditis? Ans- Systemic ATBs What is the surgery for mastoiditis called? Ans- Simple or radical mastoidectomy Will a simple mastoidectomy worsen hearing? Ans- No, a radical mastoidectomy may Should the nurse change the post-mastoidectomy dressing? Ans- No, reinforce it. Physician changes first post-op dressing What is a common side effect of mastoidectomy? Ans- Dizziness (vertigo) What is a major nursing diagnosis post-mastoidectomy ? PG 92 Ans- Safety Define Menieres diease Ans- An increase in endolymph in the inner ear causing severe vertigo What's the famous triad of S&S in Meniere's? Ans- Paroxysmal whirling vertigo - sensorineural hearing loss - tinnitus (ringing in the ears) Does Meniere's occur more in men or women? Ans- Women What should the client do if they have an attack? Ans- Bedrest What safety measures should be followed with Meniere's? Ans- Side rails up x4, ambulate only with assistance What age group in Meniere's highest in? Ans- 40-60 What can prevent the attacks of Meniere's? Ans- Avoid sudden movements What electrolyte is given to ppl with Meniere's? Ans- Ammonium chloride What surgery is done for Meniere's? Ans- Labyrinthectomy What disease often follows labyrinthectomy? Ans- Bell's palsy - facial paralysis, will go away in a few month What is the activity order after labyrinthectomy? Ans- Bed rest When surgery is preformed for Meniere's, what are the consequences? Ans- Hearing is totally lost in surgical ear What should the client avoid after labyrinthectomy? Ans- Sudden movements and increase Na foods What type of diet is the client with Meniere's on? Ans- Low salt What two classes of drugs are given in Meniere's? Ans- Antihistamines and diuretics (Diamox) Meningitis is an inflammation of the ___ of the ___ and spinal ___ Ans- Linings, brain, cord Meningitis can be caused by ___, ___, and ____. Ans- Viruses, bacteria, and chemicals The 4 most common organisms that cause meningitis are... Ans- Pneumococcus, meningococcus, streptococcus, H. Influenza Child with meningitis is most likely to be (lethargic, irritable) at first. Ans- Irritable What visual S&S will the pt with meningitis have? Ans- Photophobia (over-sensitivity to light) What is the most common musculo-skeletal S&S of meningitis? Ans- Stiff neck - nuchal rigidity Will the pt with meningitis have a HA? Ans- Yes Kernig's sign is positive when there is pain in the ___ when attempting to straighten the leg with the ___ flexed Ans- Knee; hip What type of vomiting is present in meningitis? Ans- Projectile What is the definitive diagnostic test for meningitis? Ans- Lumbar puncture with culture of CSF If the pt has meningitis, the CSF shows ___ pressure, ___ WBC, and ____ protein, ___ glucose Ans- Inc., inc., inc., dec On what type of isolation will the patient with meningitis be? Ans- Contact and respiratory precaution How long will the patient with meningitis be on these precautions? Ans- Until they have been on an ATB for 48h The room of a pt with meningitis should be ___ and ___ Ans- Dark and quiet The client with meningitis can develop ___ Ans- Seizures What is opisthotonos? Ans- Arching of back (entire body) from hyperextension of the neck and ankles, d/t severe meningeal irritation If a patient has opisthotonos, in what position would you place them? Ans- Side-lying Average duration of menstrual flow is ___. The normal range is ___ to ___ days. Ans- 5 days, 3-6 Average blood loss during menstruation is ____ cc Ans- 50-60 cc. Name the two phases of the ovarian cycle Ans- Follicular phase (first 14 days), luteal phase (second 14 days) In the menstrual cycle, day 1 is the day on which... Ans- Menstrual discharge begins How long does an ovarian cycle last? Ans- 28d How many days after ovulation does menstruation begin? Ans- 14 days What hormones are active during the follicular phase? Ans- FSH and Estrogen What is the major function of the luteal phase of the ovarian cycle? Ans- To develop and maintain the corpus luteum which produces progesterone to maintain pregnancy until placenta is est. If an ovum is fertilized during the luteal phase what hormone will be secreted? Ans- HCG (human chorionic gonadotropin) During menstruation, the average daily loss of iron is ___ mg. Ans- 0.5 to 1.0 mg What occurs during the follicular phase of the ovarian cycle? Ans- It accomplishes maturation of the graafian follicle which results in ovulation What type of environmental modification is best for a migraine? Ans- Dark, quiet, environment The long term tx of migraine focuses upon... Ans- Assessing things that bring on stress and then planning to avoid them What type of pain is typical of migraines? Ans- Throbbing Are migraines more or less common in men? Ans- Less Besides pain, ppl with migraines complain of what other S&S? Ans- N&V, and visual disturbances What are the processes occurring in migraines? Ans- Reflex constriction then dilation of cerebral arteries Where is the pain of migraines most likely located? Ans- Temporal, supraorbital Name a drug given to tx migraine? Ans- Sansert (methsergide), Cafergot (prophylaxis: Imipramine) Are migraine HAs usually unilateral or bilateral? Ans- Unilateral When Inderal is given in migraine headache, is it used to prevent or treat an attack? Ans- To prevent. It does not treat MS is a progressive ____ disease of the CNS. Ans- Demyelinating Myelin promotes ___, ___ ___ of nerve impulses. Ans- Fast, smooth conduction With demyelination the nerve impulses become ___ and ____. Ans- Slow, uncoordinated MS affects men more than women (T/F) Ans- False, affects women more than men What age group usually gets MS? Ans- 20-40 MS usually occurs in (hot/cool) climates Ans- Cool What is the 1st sign of MS? Ans- Blurred or double vision MS can lead to urinary incontinence (T/F) Ans- True MS can lead to impotence in males (T/F) Ans- True Patients with MS should be taught to walk with a ___ -___ gait Ans- Wide-based Why are Adrenocorticotropic Hormone (ACTH) and prednisone given during acute MS? Ans- To dec. edema in the demyelination process For acute exacerbations of MS ___ per IV is often used Ans- ACTH (Corticotropin) What drug can be given to treat urinary retention in MS? Ans- Urecholine, Bethanocol Will the muscles of MS clients be spastic or flaccid Ans- Spastic What 3 drugs can be given for muscle spasms? Ans- Valium, Baclofen (Lioresal), Dantrium Baclofen causes (constipation/ diarrhea) Ans- Constipation Dantrium causes (constipation/ diarrhea) Ans- Diarrhea (Hint: the D's go together, Dantrium and Diarrhea) Patients with MS should have (inc/restricted) fluids Ans- Increased to dilute urine and reduce incidence of UTI The diet of a patient with MS should be ___ -ash Ans- Acid What major sense is affected most in MS (besides vision)? Ans- Tactile (touch) - they burn themselves easily Which will bring on a MS exacerbation: over-heating or chilling? Ans- Both will; but they tend to do better in cool weather (summer will always be a bad time for MS patients) In Myasthenia Gravis (MG) there is a disturbance in transmission of impulses at the ___ ____. Ans- Neuromuscular junction The #1 sign of MG is ____ ____ ___ Ans- Severe muscle weakness What is the unique adj. given to describe the early signs of MG? Ans- The early signs (difficulty swallowing, visual problems) are referred to as BULBAR signs. MG affects men more than women (T/F) Ans- False, affects women more than men When women get MG they are usually old or young? Ans- Old What neurotransmitter is problematic in MG? Ans- Acetycholine What class of drug is used to tx MG? Ans- Anticholinesterases What ending do anticholinesterases have? Ans- -stigmine Are anticholinesterases sympathetic or parasympathetic? Ans- Parasympathetic Anticholinesterases will have (sympathetic/cholinergic) side effects Ans- Cholinergic (they will mimic the parasympathetic nervous system) What surgery CAN be done for MG? Ans- Thymectomy (removal of thymus) The severe muscle weakness of MG gets better with exercises (T/F) Ans- False, it is worse with activity What will the facial appearance of a patient with MG look like? Ans- Mask-like with a snarling smile (called a myasthenic smile) If a patient has MG, what will be the results of the Tensilon Test? Ans- The patient will show a dramatic sudden increase in muscle strength Besides the Tensilon Test, what other diagnostic tests confirm a diagnosis of MG? Ans- Electromylogram (EMG) What is the most important thing to remember about giving Mestinon and other anticholinesterases? Ans- They must be given EXACTLY ON TIME; at home, they might need to set an alarm ................................................................................................................................................................................................................................................. ........................................................................................................................