Spinal Cord Injury

Common to highly educated person

Common in July

Cause: vehicular accident, violence, sports related injuries  eg diving

Areflexia- absence of reflexes after injury

HERBAL MEDS

Chamomile

Uses: Chamomile is often used in the form of a tea as a sedative.

Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin.

Echinacea

Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection.
Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral).

St. John's Wort

Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. C

NCLEX Practice Test 103

4. 
   

1. A client is admitted to the labor and delivery unit in active labor. During examination, the nurse notes a papular lesion on the perineum. Which initial action is most appropriate?

1. Document the finding

2. Report the finding to the doctor

3. Prepare the client for a C-section

4. Continue primary care as prescribed

2. A client with a diagnosis of HPV is at risk for which of the following?

1. Hodgkin's lymphoma

2. Cervical cancer

3. Multiple myeloma

4. Ovarian cancer

3. During the initial interview, the client reports that she has a lesion on the perineum. Further investigation reveals a small blister on the vulva that is painful to touch. The nurse is aware that the most likely source of the lesion is:

1. Syphilis

2. Herpes

3. Gonorrhea

4. Condylomata

4. A client visiting a family planning clinic is suspected of having an STI. The best diagnostic test for treponema pallidum is:

1. Venereal Disease Research Lab (VDRL)

2. Rapid plasma reagin (RPR)

3. Florescent treponemal antibody (FTA)

4. Thayer-Martin culture (TMC)

5. A 15-year-old primigravida is admitted with a tentative diagnosis of HELLP syndrome. Which laboratory finding is associated with HELLP syndrome?

1. Elevated blood glucose

2. Elevated platelet count

3. Elevated creatinine clearance

4. Elevated hepatic enzymes

6. The nurse is assessing the deep tendon reflexes of a client with preeclampsia. Which method is used to elicit the biceps reflex?

1. The nurse places her thumb on the muscle inset in the antecubital space and taps the thumb briskly with the reflex hammer.

2. The nurse loosely suspends the client's arm in an open hand while tapping the back of the client's elbow.

3. The nurse instructs the client to dangle her legs as the nurse strikes the area below the patella with the blunt side of the reflex hammer.

4. The nurse instructs the client to place her arms loosely at her side as the nurse strikes the muscle insert just above the wrist.

7. A primigravida with diabetes is admitted to the labor and delivery unit at 34 weeks gestation. Which doctor's order should the nurse question?

1. Magnesium sulfate 4gm (25%) IV

2. Brethine 10mcg IV

3. Stadol 1mg IV push every 4 hours as needed prn for pain

4. Ancef 2gm IVPB every 6 hours

8. A diabetic multigravida is scheduled for an amniocentesis at 32 weeks gestation to determine the L/S ratio and phosphatidyl glycerol level. The L/S ratio is 1:1 and the presence of phosphatidylglycerol is noted. The nurse's assessment of this data is:

1. The infant is at low risk for congenital anomalies.

2. The infant is at high risk for intrauterine growth retardation.

3. The infant is at high risk for respiratory distress syndrome.

4. The infant is at high risk for birth trauma.

9. Which observation in the newborn of a diabetic mother would require immediate nursing intervention?

1. Crying

2. Wakefulness

3. Jitteriness

4. Yawning

10. The nurse caring for a client receiving intravenous magnesium sulfate must closely observe for side effects associated with drug therapy. An expected side effect of magnesium sulfate is:

1. Decreased urinary output

2. Hypersomnolence

3. Absence of knee jerk reflex

4. Decreased respiratory rate

11. The client has elected to have epidural anesthesia to relieve labor pain. If the client experiences hypotension, the nurse would:

1. Place her in Trendelenburg position

2. Decrease the rate of IV infusion

3. Administer oxygen per nasal cannula

4. Increase the rate of the IV infusion

12. A client has cancer of the pancreas. The nurse should be most concerned about which nursing diagnosis?

1. Alteration in nutrition

2. Alteration in bowel elimination

3. Alteration in skin integrity

4. Ineffective individual coping

13. The nurse is caring for a client with ascites. Which is the best method to use for determining early ascites?

1. Inspection of the abdomen for enlargement

2. Bimanual palpation for hepatomegaly

3. Daily measurement of abdominal girth

4. Assessment for a fluid wave

14. The client arrives in the emergency department after a motor vehicle accident. Nursing assessment findings include BP 80/34, pulse rate 120, and respirations 20. Which is the client's most appropriate priority nursing diagnosis?

1. Alteration in cerebral tissue perfusion

2. Fluid volume deficit

3. Ineffective airway clearance

4. Alteration in sensory perception

15. The home health nurse is visiting an 18-year-old with osteogenesis imperfecta. Which information obtained on the visit would cause the most concern? The client:

1. Likes to play football

2. Drinks several carbonated drinks per day

3. Has two sisters with sickle cell tract

4. Is taking acetaminophen to control pain

16. The nurse working the organ transplant unit is caring for a client with a white blood cell count of During evening visitation, a visitor brings a basket of fruit. What action should the nurse take?

1. Allow the client to keep the fruit

2. Place the fruit next to the bed for easy access by the client

3. Offer to wash the fruit for the client

4. Tell the family members to take the fruit home

17. The nurse is caring for the client following a laryngectomy when suddenly the client becomes nonresponsive and pale, with a BP of 90/40 systolic. The initial nurse's action should be to:

1. Place the client in Trendelenburg position

2. Increase the infusion of Dextrose in normal saline

3. Administer atropine intravenously

4. Move the emergency cart to the bedside

18. The client admitted 2 days earlier with a lung resection accidentally pulls out the chest tube. Which action by the nurse indicates understanding of the management of chest tubes?

1. Order a chest x-ray

2. Reinsert the tube

3. Cover the insertion site with a Vaseline gauze

4. Call the doctor

19. A client being treated with sodium warfarin has a Protime of 120 seconds. Which intervention would be most important to include in the nursing care plan?

1. Assess for signs of abnormal bleeding

2. Anticipate an increase in the Coumadin dosage

3. Instruct the client regarding the drug therapy

4. Increase the frequency of neurological assessments

20. Which selection would provide the most calcium for the client who is 4 months pregnant?

1. A granola bar

2. A bran muffin

3. A cup of yogurt

4. A glass of fruit juice

21. The client with preeclampsia is admitted to the unit with an order for magnesium sulfate. Which action by the nurse indicates understanding of the possible side effects of magnesium sulfate?

1. The nurse places a sign over the bed not to check blood pressure in the right arm.

2. The nurse places a padded tongue blade at the bedside.

3. The nurse inserts a Foley catheter.

4. The nurse darkens the room.

22. A 6-year-old client is admitted to the unit with a hemoglobin of 6g/dL. The physician has written an order to transfuse 2 units of whole blood. When discussing the treatment, the child's mother tells the nurse that she does not believe in having blood transfusions and that she will not allow her child to have the treatment. What nursing action is most appropriate?

1. Ask the mother to leave while the blood transfusion is in progress

2. Encourage the mother to reconsider

3. Explain the consequences without treatment

4. Notify the physician of the mother's refusal

23. A client is admitted to the unit 2 hours after an explosion causes burns to the face. The nurse would be most concerned with the client developing which of the following?

1. Hypovolemia

2. Laryngeal edema

3. Hypernatremia

4. Hyperkalemia

24. The nurse is evaluating nutritional outcomes for an elderly client with bulimia. Which data best indicates that the plan of care is effective?

1. The client selects a balanced diet from the menu.

2. The client's hemoglobin and hematocrit improve.

3. The client's tissue turgor improves.

4. The client gains weight.

25. The client is admitted following repair of a fractured tibia and cast application. Which nursing assessment should be reported to the doctor?

1. Pain beneath the cast

2. Warm toes

3. Pedal pulses weak and rapid

4. Paresthesia of the toes

NCLEX sample q's 103

1. A nurse is reviewing a patient’s medication during shift change. Which of the following medication would be contraindicated if the patient were pregnant? Note: More than one answer may be correct.

A: Coumadin

B: Finasteride

C: Celebrex

D: Catapress

E: Habitrol

F: Clofazimine

2. A nurse is reviewing a patient’s PMH. The history indicates photosensitive reactions to medications. Which of the following drugs has not been associated with photosensitive reactions? Note: More than one answer may be correct.

A: Cipro

B: Sulfonamide

C: Noroxin

D: Bactrim

E: Accutane

F: Nitrodur

3. A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following patient’s medication does not cause urine discoloration?

A: Sulfasalazine

B: Levodopa

C: Phenolphthalein

D: Aspirin

4. You are responsible for reviewing the nursing unit’s refrigerator. If you found the following drug in the refrigerator it should be removed from the refrigerator’s contents?

A: Corgard

B: Humulin (injection)

C: Urokinase

D: Epogen (injection)

5. A 34 year old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb?

A: IgA

B: IgD

C: IgE

D: IgG

6. A second year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most important action that nursing student should take?

A: Immediately see a social worker

B: Start prophylactic AZT treatment

C: Start prophylactic Pentamide treatment

D: Seek counseling

7. A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect?

A: Atherosclerosis

B: Diabetic nephropathy

C: Autonomic neuropathy

D: Somatic neuropathy

8. You are taking the history of a 14 year old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect?

A: Multiple sclerosis

B: Anorexia nervosa

C: Bulimia

D: Systemic sclerosis

9. A 24 year old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Which of the following would you most likely suspect?

A: Diverticulosis

B: Hypercalcaemia

C: Hypocalcaemia

D: Irritable bowel syndrome

10. Rho gam is most often used to treat____ mothers that have a ____ infant.

A: RH positive, RH positive

B: RH positive, RH negative

C: RH negative, RH positive

D: RH negative, RH negative

Answer Key

1. (A) and (B) are both contraindicated with pregnancy.

2. (F) All of the others have can cause photosensitivity reactions.

3. (D) All of the others can cause urine discoloration.

4. (A) Corgard could be removed from the refigerator.

5. (D) IgG is the only immunoglobulin that can cross the placental barrier.

6. (B) AZT treatment is the most critical innervention.

7. (C) Autonomic neuropathy can cause inability to urinate.

8. (B) All of the clinical signs and systems point to a condition of anorexia nervosa.

9. (B) Hypercalcaemia can cause polyuria, severe abdominal pain, and confusion.

10. (C) Rho gam prevents the production of anti-RH antibodies in the mother that has a Rh positive fetus.

NCLEX Pharma

1. Muscarinic Agonists

A. Bethanecol (URECHOLINE) – increase GI motility

B. Carbachol (ISOPTO, MIOSTAT, CARBACHOL) – various types of glaucoma

C. Methacholine (PROVOCHOLINE) – test hyperactivity of airways

D. Pilocarpine – used for glaucoma

2. Anticholinesterases

A. Pysostigmine (ANTILIRIUM) – treat glaucoma, crosses BBB, reverse anticholinergic toxicity.

B. Neostigmine (PROSTIGMIN) – synthetic form of Pysostigmine

(Anticholinesterases) – used for Myasthenia gravis, glaucoma, and to increase tone in bladder

Symptoms of Anticholinesterase toxicity:

1. Miosis
2. Rhinitis
3. Bradycardia
4. GI spasms
5. brochoconstriction
6. involuntary voiding of urine

NCLEX Practice Test 101

1. A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every 2 hours. Which of the following outcome criteria would the nurse use?

1. Body temperature of 99°F or less

2. Toes moved in active range of motion

3. Sensation reported when soles of feet are touched

4. Capillary refill of <>

2. A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is the best position for this client?

1. Side-lying with knees flexed

2. Knee-chest

3. High Fowler's with knees flexed

4. Semi-Fowler's with legs extended on the bed

3. A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?

1. Taking hourly blood pressures with mechanical cuff

2. Encouraging fluid intake of at least 200mL per hour

3. Position in high Fowler's with knee gatch raised

4. Administering Tylenol as ordered

4. Which of the following foods would the nurse encourage the client in sickle cell crisis to eat?

1. Peaches

2. Cottage cheese

3. Popsicle

4. Lima beans

5. A newly admitted client has sickle cell crisis. The nurse is planning care based on assessment of the client. The client is complaining of severe pain in his feet and hands. The pulse oximetry is 92. Which of the following interventions would be implemented first? Assume that there are orders for each intervention.

1. Adjust the room temperature

2. Give a bolus of IV fluids

3. Start O₂

4. Administer meperidine (Demerol) 75mg IV push

6. The nurse is instructing a client with iron-deficiency anemia. Which of the following meal plans would the nurse expect the client to select?

1. Roast beef, gelatin salad, green beans, and peach pie

2. Chicken salad sandwich, coleslaw, French fries, ice cream

3. Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie

4. Pork chop, creamed potatoes, corn, and coconut cake

7. Clients with sickle cell anemia are taught to avoid activities that cause hypoxia and hypoxemia. Which of the following activities would the nurse recommend?

1. A family vacation in the Rocky Mountains

2. Chaperoning the local boys club on a snow-skiing trip

3. Traveling by airplane for business trips

4. A bus trip to the Museum of Natural History

8. The nurse is conducting an admission assessment of a client with vitamin B12 deficiency. Which of the following would the nurse include in the physical assessment?

1. Palpate the spleen

2. Take the blood pressure

3. Examine the feet for petechiae

4. Examine the tongue

9. An African American female comes to the outpatient clinic. The physician suspects vitamin B12 deficiency anemia. Because jaundice is often a clinical manifestation of this type of anemia, what body part would be the best indicator?

1. Conjunctiva of the eye

2. Soles of the feet

3. Roof of the mouth

4. Shins

10. The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical manifestations would be most indicative of the anemia?

1. BP 146/88

2. Respirations 28 shallow

3. Weight gain of 10 pounds in 6 months

4. Pink complexion

11. The nurse is teaching the client with polycythemia vera about prevention of complications of the disease. Which of the following statements by the client indicates a need for further teaching?

1. "I will drink 500mL of fluid or less each day."

2. "I will wear support hose when I am up."

3. "I will use an electric razor for shaving."

4. "I will eat foods low in iron."

12. A 33-year-old male is being evaluated for possible acute leukemia. Which of the following would the nurse inquire about as a part of the assessment?

1. The client collects stamps as a hobby.

2. The client recently lost his job as a postal worker.

3. The client had radiation for treatment of Hodgkin's disease as a teenager.

4. The client's brother had leukemia as a child.

13. An African American client is admitted with acute leukemia. The nurse is assessing for signs and symptoms of bleeding. Where is the best site for examining for the presence of petechiae?

1. The abdomen

2. The thorax

3. The earlobes

4. The soles of the feet

14. A client with acute leukemia is admitted to the oncology unit. Which of the following would be most important for the nurse to inquire?

1. "Have you noticed a change in sleeping habits recently?"

2. "Have you had a respiratory infection in the last 6 months?"

3. "Have you lost weight recently?"

4. "Have you noticed changes in your alertness?"

15. Which of the following would be the priority nursing diagnosis for the adult client with acute leukemia?

1. Oral mucous membrane, altered related to chemotherapy

2. Risk for injury related to thrombocytopenia

3. Fatigue related to the disease process

4. Interrupted family processes related to life-threatening illness of a family member

16. A 21-year-old male with Hodgkin's lymphoma is a senior at the local university. He is engaged to be married and is to begin a new job upon graduation. Which of the following diagnoses would be a priority for this client?

1. Sexual dysfunction related to radiation therapy

2. Anticipatory grieving related to terminal illness

3. Tissue integrity related to prolonged bed rest

4. Fatigue related to chemotherapy

17. A client has autoimmune thrombocytopenic purpura. To determine the client's response to treatment, the nurse would monitor:

1. Platelet count

2. White blood cell count

3. Potassium levels

4. Partial prothrombin time (PTT)

18. The home health nurse is visiting a client with autoimmune thrombocytopenic purpura (ATP). The client's platelet count currently is 80, It will be most important to teach the client and family about:

1. Bleeding precautions

2. Prevention of falls

3. Oxygen therapy

4. Conservation of energy

19. A client with a pituitary tumor has had a transphenoidal hyposphectomy. Which of the following interventions would be appropriate for this client?

1. Place the client in Trendelenburg position for postural drainage

2. Encourage coughing and deep breathing every 2 hours

3. Elevate the head of the bed 30°

4. Encourage the Valsalva maneuver for bowel movements

20. The client with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is:

1. Measure the urinary output

2. Check the vital signs

3. Encourage increased fluid intake

4. Weigh the client

21. A client with hemophilia has a nosebleed. Which nursing action is most appropriate to control the bleeding?

1. Place the client in a sitting position with the head hyperextended

2. Pack the nares tightly with gauze to apply pressure to the source of bleeding

3. Pinch the soft lower part of the nose for a minimum of 5 minutes

4. Apply ice packs to the forehead and back of the neck

22. A client has had a unilateral adrenalectomy to remove a tumor. To prevent complications, the most important measurement in the immediate post-operative period for the nurse to take is:

1. Blood pressure

2. Temperature

3. Output

4. Specific gravity

23. A client with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids (Solu-Medrol). Which of the following interventions would the nurse implement?

1. Glucometer readings as ordered

2. Intake/output measurements

3. Sodium and potassium levels monitored

4. Daily weights

24. A client had a total thyroidectomy yesterday. The client is complaining of tingling around the mouth and in the fingers and toes. What would the nurses' next action be?

1. Obtain a crash cart

2. Check the calcium level

3. Assess the dressing for drainage

4. Assess the blood pressure for hypertension

25. A 32-year-old mother of three is brought to the clinic. Her pulse is 52, there is a weight gain of 30 pounds in 4 months, and the client is wearing two sweaters. The client is diagnosed with hypothyroidism. Which of the following nursing diagnoses is of highest priority?

1. Impaired physical mobility related to decreased endurance

2. Hypothermia r/t decreased metabolic rate

3. Disturbed thought processes r/t interstitial edema

4. Decreased cardiac output r/t bradycardia

US demand for Filipino nurses declining - educator

Some 40 percent of Filipino nurses in the United States have undesirable work habits, which could likely be the cause for the slump in the demand for Pinoy nurses, an educator said Friday.

An article in Sun-Star Cebu quoted Henry Seno, president of the American Dream Review Institute Inc. (Amdream) as saying that the decline in the demand for Filipino nurses abroad is caused more by a change in work attitude of the latest batch of nursing professionals rather than the June 2006 nursing board exam cheating controversy.

Amdream's website said it is an affiliate of a Los Angeles-based company with operations in the Philippines that serves as a springboard for Asian operations. It was conceptualized for the purpose of assisting nurses to pass the different US immigration requirements. The Philippines is a haven for medical professionals. However, the dilemma is, only a handful passes the test required for migration to the US.

“Nurses in the Philippines now are no longer of the same quality as the nurses five to 10 years back," Seno said.

He said 40 percent of Filipino nurses in the United States, despite receiving an average salary of $8,000 to $10,000 a month, “do not show up for work (and) literally do not report to the hospitals, especially those with immigrant status (while) those who report act as if they are not there because they’re busy doing other things."

Seno also hits the growing number of nursing schools in the country, churning out nursing graduates who are lacking in hands-on experience and a good grasp of educational background.

“There are more nursing schools now and so many nursing graduates. These schools have become mere diploma mills," Seno said.

This negative scenario, he said, has caused hospitals and clinics in the United States to recruit more nurses from India, Korea and China compared to those they hire from Philippines as these institutions have become apprehensive in their choice of nursing imports.

Seno also blames local recruitment agencies for taking advantage of the need for nurses in the US by “duping" hospitals and health institutions to hire Pinoy nurses who are not qualified for nursing jobs.

- Luis Gorgonio, GMANews.TV

CDC ISOLATION

SAFE WORK PRACTICES

• Keep hands away from face
• Work from clean to dirty
• Limit surfaces touched
• Change when torn or heavily contaminated
• Perform hand hygiene

DISEASES THAT NEED DROPLET ISOLATION:

"DROPLETISMM"

• Diptheria
• Rubella
• Oral (mumps, strep, paryngitis)
• Pertussis
• Legionnaire’s
• Erythema infectiousum, Epiglottitis (Hemaphilus influenza type B)
• Tonsillitis
• Influenza
• Scarlet fever
• Meningitis
• Mycoplasma pneumonia

DISEASES THAT NEED CONTACT PRECAUTION:

• Major drainages
• Bronchiolitis C. difficile (gastroenteritis)
• Congenital Rubella
• Cutaneous diphtheria
• Hepa A (diapered or incontinent patient)
• Herpes zoster (+ airborne)
• Herpes simplex
• Impetigo
• Pediculosis
• Multi-drug resistant organism infection ( MRSA, VRE, VISA, ESBL)
• Eczema
• Scabies
• Major pressure ulcer

DISEASES THAT NEED AIRBORNE PRECAUTION:

• Measles
• SARS
• Smallpox
• Tuberculosis
• Varicella zoster
• Pulmonary / laryngeal diseases