ATI NCLEX LIVE REVIEW

ATI NCLEX LIVE REVIEW

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NCLEX EXAM PREVIEW

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NCLEX-RN

Teacher 230 terms cmscercaPreview ATI Comp B, RN Comprehensive Onl...302 terms Jennifer_Harrison55 Preview ATI com 198 term h_tr A nurse cares for a client receiving vancomycin IV therapy. Which lab value should prompt the nurse to question a medication dosage increase?a.) A WBC count of 15,000/mm3 b.) A WBC count of 3,000/mm3 c.) A serum trough level that is lower than expected d.) A serum peak level that is higher than expected d.) A serum peak level that is higher than expected

Rationale: We would want to question why we would INCREASE the dosage if the

peak level is higher than expected. We draw the peak level around one hour after the medication has been administered.The trough level is drawn around 30 minutes or sooner before the medication administration.A nurse provides teaching to a client prescribed lisinopril.Which finding should be reported to the provider immediately?a.) A persistent dry cough b.) A rash on the torso and neck c.) Swelling of the tongue and lips d.) Lightheadedness when standing c.) Swelling of the tongue and lips

Rationale: Persistent dry cough is a common side effect with ACE inhibitors.

Angioedema is an ADVERSE effect.InfiltrationAccidental leakage of non-vesicant solutions (antibiotics) out of the vein into the surrounding tissue.

Prevention: Use the smallest catheter for prescribed therapy, stabilize port-

access, assess blood return.

Treatment: Stop infusion, remove peripheral catheters, elevate extremity, apply

cold compress, insert new catheter in opposite extremity.

Catheter EmbolusPrevention: Do not reinsert stylet needle into catheter

Treatment: Immediately apply tourniquet high on extremity to limit venous flow. It is essentially a clot, therefore we do not want the clot to travel to the lungs.Prepare for removal under x-ray.ExtravasationThe leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it.

Prevention: Know vesicant potential before giving medication.

Treatment: Stop infusion, discontinue administration set, aspirate drug if possible, apply cold compress, document condition of site (may photograph).HematomaA pool of mostly clotted blood that forms in an organ, tissue, or body space.

Prevention: Avoid veins not easily seen or palpated; obtain hemostasis after

insertion.

Treatment: Remove IV device and apply light pressure if bleeding; monitor for

signs of phlebitis and treat.Phlebitis/thrombophlebitisPhlebitis is inflammation of a vein near the surface of the skin. Thrombophlebitis is due to one or more blood clots in a vein that cause inflammation.

Prevention: Rotate sites every 72 to 96 hours, secure catheter, use aseptic

technique; for PICCs, avoid excessive activity with the extremity.

Treatment: Stop infusion, remove peripheral IV catheters, apply heat/warm

compress, insert new catheter in opposite extremity.Insulin (regular and NPH)CLEAR BEFORE CLOUDY -Draw up regular insulin before NPH (do not want contamination) Calcium Channel BlockersAntihypertensives -May increase heart failure ACE InhibitorsAntihypertensives -Can cause angioedema Beta BlockersAntihypertensives -Caution use with asthma VasodilatorsAntihypertensives -Rapidly drops blood pressure Alpha2 AgonistsAntihypertensives -Contraindicated with anticoagulants Beta2 Adrenergic AgonistsPromote Air Exhange -End in -erol (albuterol) -Contraindicated for clients with tachydysrhythmias

MethylxanthinesPromote air exchange by relaxing bronchial smooth muscle resulting in bronchodilation

-Ex: Aminophylline, Theophylline

-Cause rapid heart rate -Therapeutic range = 10-20 mcg/mL AnticholinergicsPromote Air Exchange -Contraindicated in clients with peanut allergies -Effects may take 2-3 weeks GlucocorticoidsPromote Air Exchange -Abrupt cessation may cause an Addisonian Crisis -Chronic use can result in Cushing's syndrome A nurse provides teaching to a client prescribed two sprays of desmopressin acetate per nostrils as directed.Which instruction should be included?a.) Discard medication bottle every 7 days b.) Instill both sprays into same nostril daily c.) Sit upright for 30 minutes after administration d.) Store unused medication in the refrigerator d.) Store unused medication in the refrigerator Insulin Precautions-Only REGULAR and NPH can be mixed -Only REGULAR can be given IV Insulin Uses-Type I and II DM -Pregnancy (oral hypoglycemics can no longer be used) -Hyperkalemia -Illness -Oral agents are inefficient -Severe kidney or liver disease is present -Undergoing diagnostic tests (NPO status) Types of Insulin-Rapid-Acting (Lispro) -Short-Acting (Regular) -Intermediate (NPH) -Long-acting (Insulin glargine) A nurse cares for a client receiving levothyroxine. Which findings indicate the medication dosage should be increased? SATA a.) Tachycardia b.) Hypotension c.) Paresthesia d.) Constipation e.) Excessive sweating f.) Decreased appetite b.) Hypotension c.) Paresthesia d.) Constipation f.) Decreased appetite

Growth FactorsFilgrastim:

-Stimulate WBC production -Side effects include leukocytosis -Interventions include monitoring CBC

Oprelvekin:

-Stimulate platelet production -Side effects include cardiac dysrhythmias -Interventions include giving after chemotherapy Iron PreparationsCLIENT EDUCATION -Vitamin C increases absorption -Calcium and tannin decrease absorption

-Stools: color change and constipation

-If GI upset, take with food

-Liquid preparation: use a straw and rinse mouth afterward to prevent teeth

discoloration

-IM injections: IM Z-track method (ventrogluteal preferable, never in deltoid)

-IV preferred over IM Thrombolytic Medication Contraindications-Intracranial hemorrhage -Active internal bleeding -Aortic dissection -Brain tumors A nurse provides teaching to a client who is prescribed omeprazole. Which statement indicates a need for further instruction?a.) "Ibuprofen should be avoided." b.) "I will eat addition dairy products." c.) "This medication is taken with each meal." d.) "My provider will be called if I have a cough." c.) "This medication is taken with each meal."

Rationale: Given early in the morning on an empty stomach, therefore not taken

with each meal.What are common side effects of non-potassium sparing diuretics?-Hypokalemia -Hyponatremia -Hyperglycemia What are two potassium-sparing diuretics?-Spironolactone -Triamterene How does the provider determine the most effective antibiotic?Culture and Sensitivity (blood) Two antibiotics that are nephrotoxic-Vancomycin -Gentamicin What cranial nerve may be affected by vancomycin and gentamicin?Acoustic (8th)