NCLEX LVN Exam//Expert Reviews, Human Case
Analysis | Solution A+
Tuberculosis - CORRECT ANSWERS-Risks: lower socioeconomic status,
homelessness, long-term care facilities, prisons S/S: persistent cough lasting < three
weeks, purulent possibly blood-tinged sputum, fatigue, lethargy, weight loss, anorexia,
night sweats, low-grade fever Family members should be screened Dx: Quantiferon-
Gold (blood test); Mantoux test (skin test; palpable, raised, hardened area of 10mm or >
is positive; 5mm is considered positive for an immunocompromised patient); Acid-fast
bacilli smear/culture (obtain 3 earlymorning sputum samples) Airborne precautions, N95
mask, negative-airflow room Patient should wear surgical mask if transfer necessary
Tuberculosis Medications - CORRECT ANSWERS-Must be taken for 6-12 months -
Isonazid (monitor for hepatotoxicity and neurotoxicity-tingling of hands and feet; B12 is
used to prevent neurotoxicity) -Rifampin (will turn urine and other secretions orange;
can interfere with birth control; can cause hepatotoxicity) -Pyrazinimide (can cause
hepatotoxicity) -Ethambutol (can cause ocular toxicity; obtain baseline visual acuity
tests; remember that "E= eyes" -Streptomycin sulfate (for drug resistant TB; can cause
ototoxicity) Inform patient that sputum samples will be needed every 2-4 weeks to
monitor therapy effectiveness Patients no longer infectious after 3 consecutive sputum
cultures
pulmonary embolism (PE) - CORRECT ANSWERS-DVT is most common cause Risks:
birth control, estrogen therapy, smoking, obesity, surgery, chronic a-fib, long bone fx
S/S: anxiety, feeling of impending doom, pain with inspiration, chest wall tenderness,
dyspnea, air hunger, tachycardia, hypotension, tachypnea, petechiae on chest/axillae
Dx: elevated D-Dimer (normal range= 0.43-2.33mcg/mL)
pulmonary embolism (PE)
COPD (chronic obstructive pulmonary disease) - CORRECT ANSWERS-Loss of lung
elasticity and destruction of alveoli which results in CO2 retention Risks: increased age,
air pollution, smoking is the primary risk factor S/S: dyspnea upon exertion, crackles,
wheezes, rapid/shallow respirations, accessory muscle use, barrel chest,
hyperresonance upon percussion, dependent edema secondary to right-sided HF,
clubbing of fingers and toes (late s/s), decreased O2 % (92% is expected/okay) Labs:
increased Hct (due to low O2), hypercarbia (excess CO2 retention- PaCO2 > 45
COPD (chronic obstructive pulmonary disease)
MGMT - CORRECT ANSWERS-: high-fowler's, cough/deep breathe, incentive
spirometer, increased workload of breathing increases caloric demands so soft/high-
calorie foods are best, refer older adults to assistance programs that can help with food
delivery/portable oxygen services Diaphragmatic (abdominal) breathing: lie on back with
knees bent, rest hand over abdomen to create resistance Pursed-lip breathing
Medications: Prednisone/fluticasone, montelukast, acetylcysteine (mucolytic nebulizer
,tx), guaifenesin (mucolytic) Chest PT: uses percussion and vibration to mobilize
secretions Complications: right-sided heart failure (s/s= hepatomegaly, JVD, and
dependent edema)
MEDICATIONS - CORRECT ANSWERS-: -Anticoagulants: thins blood to prevent clot
from growing and future clots from forming---heparin (monitor PTT/CBC), enoxaprin,
warfarin (monitor PT and INR) -Thrombolytics: actually dissolve the clot--- alteplase,
reteplase Embolectomy, vena cava filter Mgmt: if patient is homebound, set up home
care services for weekly blood draws; smoking cessation, avoid immobility; avoid
crossing legs, compression stockings; limit intake of vitamin K (green, leafy veggies)
because it decreases anticoagulant effects of warfarin; no aspirin; electric razor and
soft-bristled toothbrush; avoid blowing nose too hard; if bleeding occurs gently apply
pressure
Pneumothorax/Hemothorax, Flail Chest: - CORRECT ANSWERS-Air, gas, or blood in
pleural space Tension pneumothorax occurs when air enters pleural space during
inspiration through one-way valve and is unable to exit upon exhalation Flail chest
occurs when at least 2 neighboring ribs, usually on one side of chest, sustain multiple fx
causing instability of chest wall
Pneumothorax/Hemothorax, Flail Chest:
S/S, MEDS, TX - CORRECT ANSWERS-Tachypnea, tachycardia, dyspnea, accessory
muscle use, tracheal deviation to unaffected side (tension pneumothorax),
decreased/absent breath sounds on affected side, asymmetrical chest wall movement,
hyperresonance upon percussion on affected side (pneumothorax), dull percussion
(hemothorax) Medications: -Lorazepam/Diazepam -Morphine/Fentanyl Tx: chest tube
cardiac enzyme studies - CORRECT ANSWERS-Troponin I: < 0.03; elevated 2-3 hours
after and stays elevated for a week Troponin T: < 0.01; elevated 2-3 hours after and
stays elevated 2-3 weeks Myoglobin: elevates 2-3 hours after and stays elevated for 24
hours Total cholesterol: < 200 LDL: < 130 HDL: 35-70 Triglycerides: < 150
Echocardiogram: measures EF of heart Stress testing: treadmill or chemical; patient
should fast 2-4 hours prior and avoid alcohol, tobacco, and caffeine Line Insertion: -
Level transducer with phlebostatic axis (4th intercostal, mid-axillary line) which
corresponds with right atrium -Zero system with atmospheric pressure -Verify placement
with x-ray CVP normal range: 2-6 mmHg Increased CVP, pulmonary artery
systolic/diastolic, PAWP, and SVO2 with decreased CO= heart failure
cardiac enzyme studies
ANGIOGRAPHY - CORRECT ANSWERS-Inserted into femoral or brachial artery and
threaded up to right or left side of the heart Pre-Procedure: NPO 8 hours prior; assess
shellfish allergy; assess renal function Post Procedure: assess vitals q 15 minutes x4, q
30 minutes x2, q 1 hour x4, and then every 4 hours; document pedal pulse/color/temp;
administer aspirin/clopidogrel/ticlodipine/heparin/enoxaparin; monitor output and
administer IV fluids for hydration -Patients who have stent placed will be on
, anticoagulation meds 6-8 weeks (will need to have regular lab tests done to check
levels)
cardiac enzyme studies
Mass casualty patient tagging: - CORRECT ANSWERS-1 Resuscitation/Red:
airway/cardiovascular Class 2 Emergent/Yellow: immediate tx but not life threatening
(fracture) Class 3 Urgent/Green: minor/not immediate (laceration) Class 4 Less
Urgent/Black: expected to die so divert attention to red and yellow tags (penetrating
head wound
Pt unresponsive no head trauma-
Pt unresponsive with head trauma-
Prevent hypothermia- - CORRECT ANSWERS-Patient unresponsive without suspicion
of head trauma the airway should be opened with the head-tilt/chin-lift maneuver Patient
unresponsive with suspected head trauma the airway should be opened with modified
jaw thrust maneuver Prevent hypothermia by removing wet clothing, cover with warm
blankets, increase room temp, heat lamp, warm IV fluids Tx poisoning with activated
charcoal, gastric lavage (if done within 1 hour of ingestion), and aspiration
Alpha 1 drugs
Beta 1 drugs
Beta 2 drugs
Dopamine drugs - CORRECT ANSWERS-Alpha-1 drugs= vasoconstriction Beta-1
drugs= increases HR and conduction through AV node Beta-2 drugs= bronchodilation
Dopamine= renal blood vessel dilation
cerebral angiography - CORRECT ANSWERS-visualization of cerebral blood vessels
Uses contrast dye Inform pregnant women dye can be harmful to fetus No food or water
4-6 hours prior History or bleeding or anti-coagulation meds requires further
considerations for monitoring after procedure for possible bleeding Assess BUN and
Creatinine to determine kidney's ability to excrete dye
EEG (electroencephalogram) - CORRECT ANSWERS-Determine seizure activity, sleep
disorder, behavioral changes No prior fasting required Wash hair prior Instruct patient to
be sleep deprived for procedure because it promotes cranial stress and can induce
seizures Increased electrical activity can be induced by flashing lights or
hyperventilation for 3-4 minutes
Glascow Coma Scale (GCS) - CORRECT ANSWERS-Best possible score is 15 Score <
8 associated with comatose and severe head injuries Eye opening: best eye response
(ranges 4-1) Verbal: best verbal response (ranges 5-1) Motor: best motor response
(ranges 6-1)
CP Monitoring: - CORRECT ANSWERS-Placed by surgeon for patients with low
Glascow Score Biggest risk is infection Intraventricular catheter aka ventriculostomy
Subarachnoid screw or bolt Epidural or subdural sensor Increased ICP S/S: severe
Analysis | Solution A+
Tuberculosis - CORRECT ANSWERS-Risks: lower socioeconomic status,
homelessness, long-term care facilities, prisons S/S: persistent cough lasting < three
weeks, purulent possibly blood-tinged sputum, fatigue, lethargy, weight loss, anorexia,
night sweats, low-grade fever Family members should be screened Dx: Quantiferon-
Gold (blood test); Mantoux test (skin test; palpable, raised, hardened area of 10mm or >
is positive; 5mm is considered positive for an immunocompromised patient); Acid-fast
bacilli smear/culture (obtain 3 earlymorning sputum samples) Airborne precautions, N95
mask, negative-airflow room Patient should wear surgical mask if transfer necessary
Tuberculosis Medications - CORRECT ANSWERS-Must be taken for 6-12 months -
Isonazid (monitor for hepatotoxicity and neurotoxicity-tingling of hands and feet; B12 is
used to prevent neurotoxicity) -Rifampin (will turn urine and other secretions orange;
can interfere with birth control; can cause hepatotoxicity) -Pyrazinimide (can cause
hepatotoxicity) -Ethambutol (can cause ocular toxicity; obtain baseline visual acuity
tests; remember that "E= eyes" -Streptomycin sulfate (for drug resistant TB; can cause
ototoxicity) Inform patient that sputum samples will be needed every 2-4 weeks to
monitor therapy effectiveness Patients no longer infectious after 3 consecutive sputum
cultures
pulmonary embolism (PE) - CORRECT ANSWERS-DVT is most common cause Risks:
birth control, estrogen therapy, smoking, obesity, surgery, chronic a-fib, long bone fx
S/S: anxiety, feeling of impending doom, pain with inspiration, chest wall tenderness,
dyspnea, air hunger, tachycardia, hypotension, tachypnea, petechiae on chest/axillae
Dx: elevated D-Dimer (normal range= 0.43-2.33mcg/mL)
pulmonary embolism (PE)
COPD (chronic obstructive pulmonary disease) - CORRECT ANSWERS-Loss of lung
elasticity and destruction of alveoli which results in CO2 retention Risks: increased age,
air pollution, smoking is the primary risk factor S/S: dyspnea upon exertion, crackles,
wheezes, rapid/shallow respirations, accessory muscle use, barrel chest,
hyperresonance upon percussion, dependent edema secondary to right-sided HF,
clubbing of fingers and toes (late s/s), decreased O2 % (92% is expected/okay) Labs:
increased Hct (due to low O2), hypercarbia (excess CO2 retention- PaCO2 > 45
COPD (chronic obstructive pulmonary disease)
MGMT - CORRECT ANSWERS-: high-fowler's, cough/deep breathe, incentive
spirometer, increased workload of breathing increases caloric demands so soft/high-
calorie foods are best, refer older adults to assistance programs that can help with food
delivery/portable oxygen services Diaphragmatic (abdominal) breathing: lie on back with
knees bent, rest hand over abdomen to create resistance Pursed-lip breathing
Medications: Prednisone/fluticasone, montelukast, acetylcysteine (mucolytic nebulizer
,tx), guaifenesin (mucolytic) Chest PT: uses percussion and vibration to mobilize
secretions Complications: right-sided heart failure (s/s= hepatomegaly, JVD, and
dependent edema)
MEDICATIONS - CORRECT ANSWERS-: -Anticoagulants: thins blood to prevent clot
from growing and future clots from forming---heparin (monitor PTT/CBC), enoxaprin,
warfarin (monitor PT and INR) -Thrombolytics: actually dissolve the clot--- alteplase,
reteplase Embolectomy, vena cava filter Mgmt: if patient is homebound, set up home
care services for weekly blood draws; smoking cessation, avoid immobility; avoid
crossing legs, compression stockings; limit intake of vitamin K (green, leafy veggies)
because it decreases anticoagulant effects of warfarin; no aspirin; electric razor and
soft-bristled toothbrush; avoid blowing nose too hard; if bleeding occurs gently apply
pressure
Pneumothorax/Hemothorax, Flail Chest: - CORRECT ANSWERS-Air, gas, or blood in
pleural space Tension pneumothorax occurs when air enters pleural space during
inspiration through one-way valve and is unable to exit upon exhalation Flail chest
occurs when at least 2 neighboring ribs, usually on one side of chest, sustain multiple fx
causing instability of chest wall
Pneumothorax/Hemothorax, Flail Chest:
S/S, MEDS, TX - CORRECT ANSWERS-Tachypnea, tachycardia, dyspnea, accessory
muscle use, tracheal deviation to unaffected side (tension pneumothorax),
decreased/absent breath sounds on affected side, asymmetrical chest wall movement,
hyperresonance upon percussion on affected side (pneumothorax), dull percussion
(hemothorax) Medications: -Lorazepam/Diazepam -Morphine/Fentanyl Tx: chest tube
cardiac enzyme studies - CORRECT ANSWERS-Troponin I: < 0.03; elevated 2-3 hours
after and stays elevated for a week Troponin T: < 0.01; elevated 2-3 hours after and
stays elevated 2-3 weeks Myoglobin: elevates 2-3 hours after and stays elevated for 24
hours Total cholesterol: < 200 LDL: < 130 HDL: 35-70 Triglycerides: < 150
Echocardiogram: measures EF of heart Stress testing: treadmill or chemical; patient
should fast 2-4 hours prior and avoid alcohol, tobacco, and caffeine Line Insertion: -
Level transducer with phlebostatic axis (4th intercostal, mid-axillary line) which
corresponds with right atrium -Zero system with atmospheric pressure -Verify placement
with x-ray CVP normal range: 2-6 mmHg Increased CVP, pulmonary artery
systolic/diastolic, PAWP, and SVO2 with decreased CO= heart failure
cardiac enzyme studies
ANGIOGRAPHY - CORRECT ANSWERS-Inserted into femoral or brachial artery and
threaded up to right or left side of the heart Pre-Procedure: NPO 8 hours prior; assess
shellfish allergy; assess renal function Post Procedure: assess vitals q 15 minutes x4, q
30 minutes x2, q 1 hour x4, and then every 4 hours; document pedal pulse/color/temp;
administer aspirin/clopidogrel/ticlodipine/heparin/enoxaparin; monitor output and
administer IV fluids for hydration -Patients who have stent placed will be on
, anticoagulation meds 6-8 weeks (will need to have regular lab tests done to check
levels)
cardiac enzyme studies
Mass casualty patient tagging: - CORRECT ANSWERS-1 Resuscitation/Red:
airway/cardiovascular Class 2 Emergent/Yellow: immediate tx but not life threatening
(fracture) Class 3 Urgent/Green: minor/not immediate (laceration) Class 4 Less
Urgent/Black: expected to die so divert attention to red and yellow tags (penetrating
head wound
Pt unresponsive no head trauma-
Pt unresponsive with head trauma-
Prevent hypothermia- - CORRECT ANSWERS-Patient unresponsive without suspicion
of head trauma the airway should be opened with the head-tilt/chin-lift maneuver Patient
unresponsive with suspected head trauma the airway should be opened with modified
jaw thrust maneuver Prevent hypothermia by removing wet clothing, cover with warm
blankets, increase room temp, heat lamp, warm IV fluids Tx poisoning with activated
charcoal, gastric lavage (if done within 1 hour of ingestion), and aspiration
Alpha 1 drugs
Beta 1 drugs
Beta 2 drugs
Dopamine drugs - CORRECT ANSWERS-Alpha-1 drugs= vasoconstriction Beta-1
drugs= increases HR and conduction through AV node Beta-2 drugs= bronchodilation
Dopamine= renal blood vessel dilation
cerebral angiography - CORRECT ANSWERS-visualization of cerebral blood vessels
Uses contrast dye Inform pregnant women dye can be harmful to fetus No food or water
4-6 hours prior History or bleeding or anti-coagulation meds requires further
considerations for monitoring after procedure for possible bleeding Assess BUN and
Creatinine to determine kidney's ability to excrete dye
EEG (electroencephalogram) - CORRECT ANSWERS-Determine seizure activity, sleep
disorder, behavioral changes No prior fasting required Wash hair prior Instruct patient to
be sleep deprived for procedure because it promotes cranial stress and can induce
seizures Increased electrical activity can be induced by flashing lights or
hyperventilation for 3-4 minutes
Glascow Coma Scale (GCS) - CORRECT ANSWERS-Best possible score is 15 Score <
8 associated with comatose and severe head injuries Eye opening: best eye response
(ranges 4-1) Verbal: best verbal response (ranges 5-1) Motor: best motor response
(ranges 6-1)
CP Monitoring: - CORRECT ANSWERS-Placed by surgeon for patients with low
Glascow Score Biggest risk is infection Intraventricular catheter aka ventriculostomy
Subarachnoid screw or bolt Epidural or subdural sensor Increased ICP S/S: severe
