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NCLEX EXAM PREVIEW

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and Your pt has respiratory acidosis your pt has:

(select all that apply)

• +1 reflexes
• diarrhea
• a dynamic ileus
• spasm
• urinary retention
• paraxysmol atrial tachycardia
• 2nd degree, mobitz, type 2 heart block
• hypokalemia
• +1 reflexes
• a dynamic ileus
• urinary retention
• 2nd degree, mobitz, type 2 heart block

A pt has pneumonia present in 4 lobes, they have a RR of 52, and a SpO2 of 78. What acid-base imbalance is the patient exhibiting?

• respiratory alkalosis
• metabolic alkalosis
• respiratory acidosis
• metabolic acidosis
• respiratory acidosis

-the rate is less important than the gas exchange, if the SpO2 is 78 then gas exchange is not good and shows acidosis -they are under ventilating, under = acidosis -not about rate about SaO2 or SpO2

If your pt is on a PCA pump, what acid-base imbalance will cause you to take them off of it?

• respiratory alkalosis
• metabolic alkalosis
• respiratory acidosis
• metabolic acidosis
• respiratory acidosis

-PCA pumps depress respirations = underventilation If your male pt comes in with hyper-emesis what acid-base imbalance would he have?

• respiratory alkalosis
• metabolic alkalosis
• respiratory acidosis
• metabolic acidosis
• metabolic alkalosis

-vomiting or suctioning = met alkalosis -losing acid If a male pt comes in with prolonged hyper-emesis that has lead to dehydration what acid-base imbalance would they have?

• respiratory alkalosis
• metabolic alkalosis
• respiratory acidosis
• metabolic acidosis
• metabolic acidosis

-even though the pt is vomiting, they are now dehydrated which is the main take away from the question, dehydration = acidosis If an infant comes in with diarrhea, what acid-base imbalance is anticipated?

• respiratory alkalosis
• metabolic alkalosis
• respiratory acidosis
• metabolic acidosis
• metabolic acidosis

-diarrhea is not vomiting or suctioning so it is not alkalosis -diarrhea leads to dehydration = acidosis If your pt is in kidney failure, what acid-base imbalance do you expect to see?

• respiratory alkalosis
• metabolic alkalosis
• respiratory acidosis
• metabolic acidosis
• metabolic acidosis

-not a lung issue -not due to vomiting or suctioning

If a pt has third degree (full thickness) burns over 60% of their body in the first phase, what acid-base imbalance do you expect to see?

• respiratory alkalosis
• metabolic alkalosis
• respiratory acidosis
• metabolic acidosis
• metabolic acidosis

-not a lung issue -not due to vomiting or suctioning How often do you suction pts?

• every 2 hrs
• every 15 min
• every hour
• every 4 hours
• none of the above
• none of the above

-suction as needed only -suctioning is a double edge sword, the more your suction the more secretions are produced You have a type 2 DM, what is the best dietary route to take?

• restrict their calories
• divide their food into 6 feeding/day
• restrict their calories

**both are needed but since this is a "best" question this is the best option A young boy with type one diabetes comes into the E.R. with a blood glucose of 800, what is the best question to ask his parents to determine the cause of the DKA?

a) Has your child be involved in high activity today?

b) Did your child have an extra dose of insulin today?

c) Has your child had an URI in the last two weeks?

d) Did your child skip a meal today?

c) Has your child had an URI in the last two weeks?

**(A) is correct but not the BEST answer, the most common cause of DKA is upper respiratory infection --the stress of the illness causes the body to break down fats, leading to ketones --need to confirm with ketones in the blood, ketonuria can be present without DKA so this is not diagnostic In what position should you put an opisthotonus baby?

• side
• prone
• supine
• head elevated (sitting)
• side

**opisthotonus is a hyperextention of the neck and back and can occur when an elevated bilirubin passes the BBB of a baby --important to report immediately as its a sign of impending kernicterus

Your Pt has hyperkalemia, select all that apply:

• dynamic ileus
• obtundant
• +1 reflex
• clonus
• u wave
• depressed ST
• polyuria
• bradycardia
• clonus
• bradycardia

**-kalemias do the same as the prefix except for the HR and urine output ---U wave starts on the baseline and goes down, its a sign of cardiac depression (if you don't know what it is on a select all apply then don't pick it) Your pt has diarrhea, what caused it?

• hyperkalemia
• hypokalemia
• hypocalcemia
• hypomagnesemia
• hyperkalemia

**if a tie and its not muscle or nerves then its always K+ A student nurse runs to you and says they ran 1L of IV into the pt in 10 min b/c they forgot to clamp it, what electrolyte imbalance to you expect to see?-hyponatremia **would be put on fluid restriction, has fluid overload Your pt has hypothyroidism, what pre-op order would you question?

• penicillin
• insulin
• ambien
• ambien

**pt should not be given sedation medications, can lead to myxedema coma --their whole body is slowed b/c decreased coma