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NCLEX Practice Questions Review

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NCLEX Practice Questions Review

NCLEX Practice Questions Review

 

 

Leopold maneuvers

  • 1st maneuver- determines fetal part lying in fundus and fetal presentation
  • 2nd- which direction fetus back facing
  • Third maneuver determines part of fetus at inlet and mobility
  • 4th- fetal attitude and degree of flexion of head

Meconium aspiration

  • Intubation and immediate suction needed-no longer than 5 sec
  • If HR low, PPV given and suction performed later
  • Don’t suction with bulb syringe when head pass-no longer recommended

RR

  • 20-40breaths/min

HR

  • 90-130 bpm

BP

  • 90/56

Calories

 

  • An increase of 340 calories/day is recommended during the second trimester.
  • An increase of 462 calories/day is recommended during the third trimester.
  • Add 330 when breastfeeding

Protein

 

  • Folic acid- prevent neural tube defects
  • Leafy green veggies, dry beans/peas, Orange juice

Iron

  • Increase rbc mass
  • Take 1 hour before meals
  • Take empty stomach
  • Give with vit C
  • Don’t give with milk/caffeine
  • Can cause constipation- give fiber
  • Increase absorption of iron
  • Avoid calcium containing foods-milk and yogurt
  •  

Maternal PKU

  • Genetic disease
  • Increase levels phenylalanine
  • Resume diet 3 months before pregnancy and throughout pregnancy
  • Avoid high protein foods in phenylalanine
  • Mental retardation/behavior problems

Pap Smear

  • Class 1 through Class V
  • Class 3- indicate abnormal but doesn’t confirm cancer diagnosis
  • Reveal abnormal cervical cell growth

Supine Hypotension

  • Vena cava syndrome
  • Dizziness common sign

Epidural anesthesia

  • Maternal blood pressure decrease(hypotension)-give fluids
  • CNS depressant
  • Most effective in active labor
  • Cause bradycardia in fetus-bolus mom with 500 mL of IV fluid before inserting epidural catheter
  • Given before active phase of labor- prolongs the labor-take longer for cervix to dilate and efface

Spinal anesthesia

  • headaches

Fundus

  • Displaced when bladder full
  • Post-delivery- found firm at midline

Magnesium sulfate

  • Calcium gluconate antidote-reverse CNS depression
  • Given to women to prevent preterm labor/stop contractions
  • Can cause resp depression in mom
  • Treat PIH- decrease BP
  • Prevent seizures in pre-eclamptic women
  • Cause CNS depression in neonate-monitor for respiration depression
  • Smooth muscle relaxant
  • Report decreased U/O
  • Reduce RR
  • Depressed or absent reflexes
  • Hypotension
  • Decreased cardiac function
  • AE
    • Decreased bp
    • Depressed dtr
    • Lethargy

Nalbuphine

  • Opioid pain relief

 

Pre-eclampsia/PIH

  • Cause HTN and proteinuria-monitor closely
  • Edema of hands and face common finding
  • Indicate hepatic involvement
  • Report epigastric pain
  • Report pitting edema of ankles
  • Expect 3+ deep tendon reflex
  • Oliguria
  • Proteinuria greater than 0.3 q 24 hrs
  • Expect blurred vision and photophobia
  • Symptoms- sudden weight gain, swelling, edema, severe headache, reports of seeing spots, blood in urine, dizziness, nausea, vomiting
  • When worsened- baby may need to be delivered or mag sulfate given IV to prevent seizures
  • Call 911 to be evaluated
  • Can last for many weeks after delivery
  • Rest sidelying-increase tissue perfusion
  • Daily fetal kick count

Drug Addiction

  • Increased muscle tone
  • Respirations greater than 60
  • Hyperactivity –CNS irritability
  • Don’t stimulate infant-need calm environment with minimal stimulation to promote rest and reduce stress

Active Labor

  • Check cervix before giving pain meds
  • Given too close to delivery can cause resp depression in neonate

Contraction Stress Test

  • Fetus repeated decels of FHR response to contractions
  • Don’t give oxytocin for positive CST at 38 weeks- compromise fetal oxygen supply
  • Positive-abnormal-late decels
  • Neg- normal-no late decels
  • Nipple stiumation

Ectopic Preg

  • Fertilized egg implant outside uterus
  • Scarring from tubal infection/surgery- PID

Betamethasone(Celestone)

  • Glucocorticoid
  • Prevent resp distress syndrome in premature infants
  • No effect on neonatal VS
  • No effect on baby temp
  • Given at 30 weeks gestation
  • Given to stimulate fetal lung maturity-prevent resp distress
  • Cause hyperglycemia in mom
  • Can cause baby to have hypoglycemia 1st few hours after delivery

PIH

  • Develop edema, elevated BP, proteinuria
  • Reflex normally plus 2

 

Nonstress Test(20 min)

  • Measure FHR accelerations with normal movement
  • Fetal acc. Positive sign
  • Increase 15/min and last 15 sec
  • Nonreactive- no acc.
  • Reactive- norm baseline/moderate variability
  • Sit in reclining chair or on left side/don’t walk
  • Give mom OJ and crackers to stimulate fetus movement
  • Press button when feel fetal movement

FHR

  • V C- variable decels cord compression
  • E H-early decels- head compression
  • A O-accelerations ok
  • L P-late decels placenta insufficiency

Oxytocin

  • Stimulate contractions
  • Can cause decreased FHR and hypoxia due to increased uterine pressure
  •  
  • AE- subarachnoid hemorrhage, seizure, coma, HTN, abruption placenta
  • Don’t bolus
  • Give through IV pump
  • Always monitor FHR
  • Discontinue when contractions q 1-2 min lasting 90-100 sec

Weight Gain

  • 25-30 lbs entire preg
  • 4 lb- 1st tri
  • 12 lb- 2/3 tri
  • normal- 1-3kg/month 2nd/3rd trimester

 

ITP

  • Autoimmune response with decreased platelet count
  • Increased megakaryocytes

 

6 weeks gestation + 24 weeks

  • GBS done at 35-37 weeks
  • Rubella titer done at initial prenatal visit to determine rubella immunity
  •  

Glucose tolerance test

  • 3 hour gtt done in women with elevated glucose levels after 1 hour test is done at 28 weeks

 

LGA(macrosomnic infant)

  • heel stick glucose 50 normal
  • respirations 50 notmal
  • acrocynaosis normal
  • jittery is sign of hypoglycemia

 

Breastfeeding and engorgement

  • apply cold cabbage to relieve pain
  • breast binders suppress lactation
  • breast shells for patients with inverted nipples or flat or pts with sore nipples

 

Prolapsed umbilical cord

  • call for help
  • apply internal upward pressure to presenting part

 

Abruptio placenta

  • cocaine use increase risk for vasoconstriction and abrupted placenta

Infant safety

  • set hot water heater no higher than 49 C 120 F
  • crib slats no more than 6.3 cm 2 3/8 in apart
  • no comforter in crib

 

hyperemesis gravidarum

  • eat to taste to avoid nausea
  • eat healthy snack at bedtime
  • alternate liquids and solids every 2 hour
  • eat protein following sweet snack

 

Vaginal hematoma

  • pressure in vagina
  • persistent vaginal pain

 

 

 

terbutaline

  • protect from light
  • relax smooth muscle
  • primary action- bronchodilation
  • subqqa 4 hrs no longer than 24 hr
  • AE- headache, dizzy, arrhythmias, nausea, paradoxical bronchospasms, tachycardia, hyperglycemia, hypoklemia

Hydatidiform mole

  • Placental abnormal
  • Chorionic villi of placenta develop into grape like mass-clear vesicles
  • With or w/o fetus present
  • Avoid preg for 1 year
  • As cells slough- discharge dark brown vaginal

Jaundice

  • Pathological- 1st 24 hrs, inform HCP- stat bilirubin test
  • Physiological- breastfed after 24 hours

Late decels

  • Placental insufficiency
  • Pressure on IVC-decrease O2 to placenta and fetus
  • Turn on left side, give O2, then give fluids

Naloxone

  • Reverse respiratory depression, hypotension of opiods
  • AE- seizures, pulmonary edema, tachycardia, HTN, V FIB

Diaphragm

  • Remove after 24 hrs-clean with mild soap water
  • Replace q 2 years
  • Insert on empty bladder
  • Weight gain greater/less 10-15 lbs refitted
  • Keep in place 6 hours after sex

Chadwick sign

  • Blue discoloration in cervix, vagina

 

Low Back pain

  • Posterior-face mom back
  • Rub lower back-help relax muscles in low back and relieve pressure of fetus head

Cerclage

  • Reinforce weak cervix
  • Use sutures that go around cervix, hold it close
  • Go to hospital first sign of labor
  • Can have sex

Polyhydramnios

  • Excessive fluid surrounding fetus
  • Increased fundal height
  • Increased weight gain
  • Increased urination
  • GI fetal malformations and neuro disorders-anticipate

Oligohydraminos

  • Volume amniotic fluid less than 300
  • Fetal renal dysfunction
  • Obstructive uropathy
  • Confirmed by US
  • IUGR

Mineral oil

  • Treat constipation
  • Take at bedtime on empty stomach
  •  

Abruption placentae

  • Premature separation of placenta from uterine wall
  • Platelet count decreased
  • Prolonged partial thromboplastin
  • Decreased fibrinogen
  • Normal clotting time
  • Abdominal pain-sharp painful bleeding

Placenta previa

  • Placenta attach low in uterus
  • Painless vaginal bleeding
  • Life threatening-need continued hospitalization and close monitoring
  • Near or covering cervix opening- partially or totally
  • Don’t perform vaginal exams
  • Monitor fetal heart tones- continuous EFM
  • Take vs q 15 min
  • Most common in 3rd trimester

 

Abdominal US

  • Need full bladder
  • Ask when last voided

Rubella

  • When mom titer neg, give another after delivery
  • Avoid preg at least one month after vaccine
  • Mild rash and joint ache 7-10 days after
  • Get each preg
  • May have low grade fever

 

Erythromycin ophthalmic

  • Give within 1st hour
  • Gonorrhea/chlamydia

Hep B vaccine

  • Given several hours after birth
  • Parent consent

Vitamin K

  • Used for synthesis of clotting factors in liver
  • Given to prevent bleeding
  • Newborns risk of bleeding-lack of intestinal flora needed to make vit K

Cephalhematoma

  • 2-6 weeks for edema and discoloration to disappear
  • no treatment needed

caput succedaneum

  • resolve 2-3 days

 

 

 

Ergotamine

  • treat migraine
  • one tab at onset of migraine
  • max 3 in 24 hr period
  •  

Methylergonovine(methergine)

  • treat PP hemorrhage
  • monitor VS and vag bleeding
  • AE- seizures, stroke, headache, nausea, chest pain, palpitations, increased BP
  • CI- high BP

 

Bethanechol

  • Cholinergic stimulate muscarinic receptors

 

Phenytoin

  • Don’t take with mil or calcium
  • Less than 10mcg subtherapeutic-cause seizures
  • Levels more than 20 toxic effects
  • Cause gingival hyperplasia- tell dentist
  • Report nystagmus

 

Anticholinergic drugs

  • Worsen urinary retention
  • Atropine
  • Scopolamine
  • Benztropine
    • Constipation
    • Tachycardia
    •  

                                                      

Glucose in infants

  • Normal ranges 40-95 mg/dL
  • Fasting glucose 60-90 for pregnant

Bilirubin

  • Report greater than 8

Hct

  • Normal 48-69%

LGA

  • Weight above 90th percent
  • Increase risk for hypoglycemia

 

Congenital hip dysplasia

  • Limited abduction indicate head femur slipped out of acetabulum
  • Limited abduction of hip
  • Asymmetrical gluteal folds

Stepping reflex

  • Should be gone by 4 weeks

Moro reflex aka startle reflex

  • 8 weeks

Babinski reflex

  • 1 years
  • Stroke bottom of foot

Extrusion

  • Infant spit out food

tonic neck

  • 3-4 months

 

 

 

 

 

Jet hydrotherapy

  • Doppler device, fetoscope, wireless external monitor safe
  • Don’t use internal electrode

Newborn assessment

  • Posterior fontanel should be larger than anterior
  • Assess apical pulse for 1 full minute-when baby quiet
  • Overlapping suture line
  • Lanugo over shoulders normal
  • Breast nodules up to 10mm
  • T 36.5-37.2C
  • Weight 2.5-4 kg
  • Length 45-55cm
  • Chest circumference in term 2 cm less than head circumference-measured at nipples
  • Head circumference greater than 37cm or less than 33cm investigate for neurologic involvement

Neonatal sepsis

  • Temp instability
  • Tachypnea
  • Hypotonia
  • Lethargy
  • Nasal flaring
  • Irritability

Vaginal hematoma

  • Pressure in vagina
  • Persistent vaginal pain

 

Infant safety

  • Hot water heater no higher than 49 C 120 F
  • Crib slats no more than 2 3/8 inch
  • No loose bedding in crib

 

Amniocentesis

  • Rhogam given following procedure
  • Potential of fetal RBC entering maternal circulation
  • Given at 28 wks

Circumcision

  • Sterile gauze for bleed
  • Petroleum jelly each change
  • Don’t wipe off yellow exudate- normal
  • Document voids after- secondary
  • Change diaper at least q 4 hours
  • Avoid soap and water
  • Rim usually fall off in 1 wk
  • 1st priority is to monitor for bleeding q 15 min for 1st hour after procedure
  • DON’T APPLY petroleum jelly after circumcision when plastibell used
  • Complications-hemorrhage, infection, urethral fistula formation

Mastitis

  • Unilateral breast pain with tenderness

Reposition, increase fluids, give oxygen 8L

 

Itp

  • Decreased platelet
  • Increased megakaryocytes

GBS

  • 35-37 wks

3 hr glucose

  • 28 wks

Heparin

  • don’t take aspirin
  • bedrest
  • don’t massage
  • apply warm compress not cold

hperbilirubinemia

  • yellow mucous membranes, bron or gold urine, maculopapular rask normal
  • irritable complication

Uterine Inversion

  • Don’t remove placenta if still attached- can cause larger SA for bleeding
  • Large amt blood suddenly gush from vagina
  • Fundus not palpable in abdomen
  • Don’t give oxytocics- compounds the inversion
  • Assess VS and establish IV access and fluids
  • Discontinue uterotonic drugs-allow uterine relaxation for replacement

 

 

 

 

 

Pharmacology NCLEX practice questions

 

 

 

Acetazolamide

  • Diuretic
  • For chronic open angle glaucoma, epilepsy, edema
  • AE
    • Paresthesia-tingling fingers
    • Hyperglycemia

Oxybutynin

  • For urinary incontinence
  • Anticholinergic effects-dry mouth, photophobia, constipation, blurred vision, tachycardia

 

Dopamine

  • Increase BP in cardiogenic shock
  • Cardiac stimulation
  • No effect on RR
  • Increase renal circulation- incr UO

Doxycycline

  • Tetracycline antibiotic
  • CI
    • Pregnancy
    • Effects on developing bone and teeth

Regular insulin

  • Manage gestational diabetes

Baclofen

  • Decrease seizure threshold in pt with epilepsy
  • Decr freq and severity of muscle spasms
  • No effect on cognition
  • Inhibits reflexes at spinal level

Tamoxifen

  • Treat breast cancer
  • AE
    • Menstrual irregular
    • Hot flashes-anti estrogen
    • Bruising

 

Inhibitor overdose

  • Antidote- atropine sulfate

Neuromuscular blocker overdose

  • Neostigmine- cause nausea, increased salivation, bradycardia

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