ReMar Nurse University #RNU - 0 - www.ReMarReview.com Mark your Calendar! Note to adjust time zone: Our class will be live on Facebook every Monday at 8:00 P.M. EST. Please be sure to adjust your schedule to match 8:00 PM New York time zone which is EST for students in the United States or UTC/ GMT -05 for international nurses. In some countries this may change the day of the class. For example - If you are in the Philippines the class will be live Tuesday mornings at 8:00 A.M. so please be sure to confirm the times. $50 off Sale begins! Faith-Over-Fear Meet-up đđȘ 8PM EST Sale ends June 1st ReMar Nurse University #RNU - 1 - www.ReMarReview.com April 30, 2018 Dear ReMar Nurse, Congratulations! I’m so glad that you have made the decision to join the ReMar Nurse University (RNU) Class of 2018! With this opportunity you are joining the most outstanding group of nurse from across the globe coming together for the common goal of uplifting and motivating each other to put faith over fear and pass NCLEX. Every Monday, we will come together with more than 1,500 nurses studying together via Facebook Live. I will present you with my best content from the NCLEX DVD Self-Study Program and give you an amazing discount during the month of May to help you complete your study! I want this to be a special event, so I’ve also added extra bonus sections for advanced study! We’re going to study the material and learn the content. This is how our ReMar Nurses pass NCLEX! If you have the Self-Study program during RNU you will be ready to test before the end of June! (See my six-week NCLEX Calendar in the rear of this workbook!) On behalf of everybody on the ReMar Team, thank you for letting us be a part of your journey. You CAN, You WILL, You MUST PASS NCLEX!! Sincerely, Regina Callion MSN, RN Your Favorite NCLEX Instructor 1-855-NCLEX-NOW . Support@ReMarReview.com www.ReMarReview.com ReMar Nurse University #RNU - 2 - www.ReMarReview.com WELCOME to ReMar Nurse University Live #RNU May is going to be an amazing month! I’m so excited because we’re going to review several major topics from the DVD Self-Study Program which has helped thousands of nurses pass NCLEX. We’ll break down the core-content in a way that’s easy to understand give you $50 off plus free shipping worldwide to boost your confidence and help you complete the process! Take a look at some of our most recent testimonials from ReMar Nurses who put their faith over fear and passed! One day soon, YOUR story will also be used to encourage a future RN or future LPN not to give up on their dreams. Always remember, with God all things are possible! Nurse Barbarah Kibirige to ReMar for NCLEX - April 28, 2018 at 6:59pm Hallelujah Jesus l am a ReMar a nurse! My heartfelt thanks to Regina for the Best NCLEX content ever and Mark for your spiritual support! ! I am a repeat-tester from Herzing University in Wisconsin who stumbled on ReMar Review browsing through Facebook after failing my first NCLEX. I was instantly attracted to the program! Long story short l did my NCLEX on the 25th April 2018, had 229 questions, and my time expired! I had 52 SATA, 10 diagnostic tests, lots of peds and OB, 3 delegations, 38 priority lots of Alzheimer's!!!!!!!! But by God's grace by 5 pm in the evening my license had been issued. Glory be to God in the highest! đ đ đ đ Nurse Kim Collins Lvn to ReMar for NCLEX - April 28 at 1:26pm I Passed my NCLEX on the 3rd try, April 23,2018! Before that I felt completely defeated I almost lost faith I’ve tried some many other programs I’ve practiced thousands of questions but it wasn’t working. One day I had a talk with God and he told me to give him just two-months of studying consistently and he’ll promise it will be so worth it. So I decided to buckle down and I ran across Regina’s Program I had doubts but I came across her program for a reason not by mistake. I bought the Self-Study program, Question bank and My Baby My Life the QUICK FACTS for NCLEX BOOK đ this book is so Awesome! I took this book everywhere. I learned it, I memorized it, and it has all you need to know and the program has even more! I’m so Happy and so blessed to have found Regina and I will continue her program to RN school! Thank you Regina I am proud to say I’m a ReMar Nurse â †Steph Rose to ReMar for NCLEX - April 14 at 7:20pm Thank you ReMar it's been 3 years out of nursing school! I used the DVD workbook and your study plan. Thank you so much for all your encouragement and prayers. I had Hyperemesis Gravidarum with both my boys bit got pregnant right after I graduated in 2014 and failed once after 1-year. I was in and out of the hospital so it was put on the back burner. Nothing else has worked but this did! I'm so very grateful! Don't give up on your dreams it's possible and ReMar can help! ReMar Nurse University #RNU - 3 - www.ReMarReview.com ReMar Nurse University Table of Contents & Review Schedule SESSION I – Monday, May 7th RNU NCLEX Orientation…………………………………………………….….. Pediatric Overview………………………………………………………....…..... 1 Pediatric Practice Questions…………………………………………….…...........5 RNU Session I Assigned.…………………………………..…………..…....……6 SESSION II – Monday, May 14th RNU Session I Homework Reviewed…………………………………………….. Antibiotics………………………………………………………………….…......9 Diabetes Insipidus vs ADH Symptoms ………………………………...……….10 Herbal Medications……………………………………………………...…….....11 RNU Session I Homework Reviewed…………………………………….……….. RNU Session II Homework Assigned…………………………………….…......12 SESSION III – Monday, May 21st Delegation………………………………………………………………….….….15 Prioritization………………………………………………………….…….…….17 EKG Overview……………………………………………………….……….….18 RNU Session II Homework Reviewed……………………………………………. RNU Final Exam Assigned.…...…………………………………………..……..25 SESSION IV – Wednesday, May 23rd Faith of Fear Facebook LIVE Meet up @ 8:00 PM EST SESSION V – Monday, May 28th RNU Final Exam Homework Reviewed………………………………………….. May’s Special Offer……………………………………………………….……..30 DVD Self-Study Six Week Study Calendar………………………………...…....31 NCLEX Study Profile ………………..……………………....…………….....…32 NCLEX Grief / Preparedness form…………………………...…….……………36 ReMar Nurse University #RNU - 0 - www.ReMarReview.com ReMar Nurse University Session I - Monday May, 7th 2018 Pediatric Overview A. Developmental Stages AGE 0-6 months S____________ ACTIVITY NCLEX tips DRINKS from a cup? Uses a spoon? Favorite word? Hoarding is first seen. Avoid ___________ why? fine motor skills Ritualistic Infants at this age are beginning to realize sounds come out of their mouths. They also learn by placing objects in their mouths. Keep them safe by giving them soft toys. __________ months ___________months __________ years _____________years 7-12 years 12 – 18 years ReMar Nurse University #RNU - 1 - www.ReMarReview.com Child’s Response to ______________ Infants & Toddlers 0-3 _________ only in the present. Can sense sadness in others. Preschoolers 4-6 See _________ as ___________. Think it is like _____________. _________ and ___________ children may _______________. School Age 7-12 Feel _________ is a _____________________. Understands _______________. Feel _______________ having others __________ __________. Adolescents 13-18 ReMar Nurse University #RNU _______________expressed towards ______________. Find it difficult to talk about. May ________________ to help with __________________. - 2 - www.ReMarReview.com B. Normal & High Risk Newborn C. ________ ____________ is done at ____ and _______ minutes. Sign Score = 0 Score=1 Score=2 Rate Respirations Muscle Appearance (color) Reflex (Irritability) Calculate the __________ ______________: Baby Jones Baby White Heart rate Heart rate Respirations Respirations Muscle Muscle Appearance Appearance Reflexes Reflexes Total: Total: ReMar Nurse University #RNU - 3 - www.ReMarReview.com Pediatric Overview ReMar Review C. Congenital Defects 1. Rule of 10’s: Position: Increased risk of: Add ____________ ______________________ 2. Spina bifida Watch for: Treatment: Best Prone: __________________ infants will have issues with ____________________. When ____________ ____________ ____________ in the neonate the ____________ is the best place. Pediatric __________________ ReMar Nurse University #RNU - Position 4 - www.ReMarReview.com Pediatric Practice Questions ReMar Review 1. The nurse is caring for a 4 month-old infant and notices the child is crying. Which of the following would be the least concern for the nurse? A. A decrease in blood pressure. B. A decrease in respirations. C. Depressed sunken fontanels. D. Low set ears on the head. 2. The nurse in charge hears an infant’s mother screaming at her child to drink his formula bottle. What is the best course of action for the nurse in charge to do? A. Explain to the mother that yelling is not best for the child. B. Tell the mother to use a loud slow tone instead of yelling. C. Do not say anything to the mother as she has a right to parent in her own way. D. Notify the physician and document the findings. 3. A nurse is evaluating the ability of a 9 month-old during a routine assessment. At this age the child should be able to accomplish what task? A. Crawls forward and backwards. B. Classify simple geometric shapes. C. The ability to say 4 words D. Ability to take small steps with little help. ReMar Nurse University #RNU - 5 - www.ReMarReview.com ReMar University NCLEX Review Advanced Study Homework *Do this after listening to the lecture Scenario 1 S.G. is a 6 month-old who is scheduled for a repair of her cleft lip and palate. She has recently been adopted from China and her past medical history is unknown. S.G. weighs 6.5 kg. What information regarding her health history is important to obtain from the mother to plan her perioperative care? Select all that apply. A. B. C. D. E. F. Current known health status. Current method of feeding. Parent’s employment status. Immunization status. Adoption status. Gross motor milestones. S.G. returns to the unit 8 months after her surgical repairs for a new issue. Which of these nursing interventions are appropriate to plan her care? Select all that apply. A. B. C. D. E. F. Position patient on abdomen postoperatively. Use elbow restraints as needed. Clear fluids; advance as tolerated. Patient may use a straw. Administer pain medications as ordered. Oral suction with a Yankauer catheter as needed. Maintain strict intake and output. Scenario 2 B.H. is a 4-year old boy with no significant medical history. He is brought to the emergency room because his parents state he has been irritable, has a poor appetite, and has been falling around the house. He has also complained that “his head feels bigger” and he is having difficulty seeing. The nurse documents these findings in the client’s medical record. 1. Which of the following diagnostic procedures is most beneficial for B.H. at this time? A. Cerebral angiogram B. MRI C. Somatosensory-evoked potentials D. Lateral x-ray ReMar Nurse University #RNU - 6 - www.ReMarReview.com Case Progress Case progress: B.H. requires immediate surgery. The surgery lasts 6 hours. He returns to the pediatric intensive care unit. He is arousable but can not answer questions. His pupils are equal and reactive to light. He has a head dressing covering the entire scalp with a small amount of bloody drainage. His IV is intact and his breath sounds are clear. His pulse ox is 98% on room air. 2. The nurse checks the post-operative orders which are listed in the chart. Which order should the nurse question? Select all that apply. Postoperative Orders: 1. Vital signs every 15 minutes x 4, and then every 15 to 30 minutes until stable. 2. Contact healthcare provider for temperature less than 36 degrees C or over 38.5 degrees C (96.8 F to 101.3 F). 3. Maintain NPO until fully awake; may offer clear liquids as tolerated. 4. Maintain Trendelenburg position. 5. Reinforce bandage as needed. 6. Neuro checks every 2 hours x 4 every than 4 hours x 8. 7. Elbow restraints if needed. Case Progress Case progress: B.H. test results return and shows another 2 cm mass in the posterior region of the brain not previously seen. B.H. is transferred to oncology service for 7 days of chemotherapy. The nursing assistive personnel (NAP) is in the room caring for B.H. 3. Which of these safety observations should the nurse address? A. B. C. D. NAP encourages B.H. to use a soft toothbrush for oral care NAP applies the disposable probe cover to the rectal thermometer. NAP applies hand gel before and after assisting B.H. to the restroom. NAP assists B.H. out of the bed to prevent a fall. ReMar Nurse University #RNU - 7 - www.ReMarReview.com Case progress: On day 7 after chemotherapy, you receive B.H.’s laboratory results shown in the chart below. 4. Which of the laboratory results would you be concerned about and why? Laboratory Test Results: Hemoglobin (Hgb) Hematocrit (Hct) White blood cells (WBCs) Red blood cells (RBCs) Platelets Albumin 12.5 g/dL 36% 7.5 x 103 4.0 million/ mm3 80,000 x 103/mm3 2.5 g/dL 5. Calculate each Apgar Score Baby Brown Baby Grey Heart rate Heart rate is 100 Respirations Respirations weak gasping Muscle Spontaneous movements noted Appearance Trunk is blue, hands are blue Heart rate Heart rate is 100 Respirations Crying loudly Muscle Well flexed Appearance Trunk is pink, hands are pink, feet are blue Reflexes Slight grimace Total: Reflexes Pulls away when stimulated Total: 6. A 16-year-old female accuses a nurse of sexual misconduct during a routine examination. Which of the following are examples of medical appropriateness that should be reported and documented by the charge nurse? Select all that apply. A. B. C. D. The nurse washes his hands and inspects the patient’s breast without gloves. The nurse shows the client images of the male genitalia as a teaching tool. The nurse remains present in the room as the client changes in to a gown. The nurse informing the patient that he is a bi-sexual male and will not judge her for her sexual orientation. E. The nurse reassuring the client that the conversation will be kept confidential and the information will be used for treatment only. ReMar Nurse University #RNU - 8 - www.ReMarReview.com ReMar Nurse University Session II – Monday May 14, 2018 Antibiotics Class Examples How They Help How They Harm 1.Aminoglycosides 2. 3. ReMar Nurse University #RNU - 9 - www.ReMarReview.com DIABETES INSIPIDUS VS SYMPTOM OF INAPPROPRIATE ADH ReMar Review Both are a problem with __________________________. Diabetes Insipidus is ______ _____ ______________________. _______ of diabetes insipidus are ________________________. ____________________________________________________ ____________________________________________________ Treatment for diabetes insipidus are _____________________. SIADH is _____ _______ ____________________________. _________ of SIADH are _____________________________ ____________________________________________________ ____________________________________________________ ___________________________________________________ _________________ for SIADH is ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ReMar Nurse University #RNU - 10 - www.ReMarReview.com Herbal Medications ReMar Review Herbal Action Used to treat insomnia/muscle pain Patient Teaching Decreases the effects of Anti-Parkinson’s meds General Patient Teaching: ReMar Nurse University #RNU - 11 - www.ReMarReview.com ReMar University NCLEX Review Advanced Study Homework 1. A male patient is admitted to the unit with Pseudomonas aeruginosa sepsis. The physician orders two medications: an aminoglycoside and a penicillin. Both drugs are to be given intravenously. How should the nurse administer these drugs? A. By mixing both drugs in normal saline and administering over 8 hours. B. By administering the drug in separate IV bags. C. By administering the aminoglycoside in 5% dextrose and the penicillin in normal saline. D. By administering the drugs every other day. 2. A male patient demonstrates symptoms of laryngeal edema and shock after a single intravenous dose of penicillin. What interventions are most necessary at this time? Select all that apply. A. B. C. D. E. Epinephrine A tongue blade Oxygen Tracheostomy Nasogastric tube 3. A male patient is prescribed aminoglycosides for a bladder infection secondary to benign prostatic hypertrophy. The nurse understands that these drugs reach higher concentrations in which areas of the body? Select all that apply. A. B. C. D. E. Kidneys Inner ears Pericardium Peritoneum Central nervous system 4. What symptom should the nurse expect to find if a patient begins to exhibit signs of ototoxicity? A. B. C. D. Fatigue Anorexia Tinnitus Rash ReMar Nurse University #RNU - 12 - www.ReMarReview.com 5. The physician orders an aminoglycoside kanamycin for a ventilator-dependent patient who is admitted to the critical care unit. His current diagnoses include respiratory arrest, type 2 diabetes, hepatitis C, and chronic obstructive pulmonary disease. Which statement indicates the risk of using this class of medication in this patient? A. Risk for hepatic impairment is significant because the drug is metabolized in the liver. B. Risk for hepatic impairment is significant because of a higher risk for toxicity. C. Risk for hypertensive crisis is increased. D. Risk for hepatic impairment is not significant, because the drug is excreted through the kidneys. 6. The nurse is administering mannitol. The nurse knows that it is used to manage oliguria. The nurse is also aware the medication is used for what other conditions? Select all that apply. A. B. C. D. E. Reduction of intracranial pressure. Reduction of mild to moderate swelling of the extremities. Reduction of intraocular pressure. Increasing potassium during periods of fluid overload. Reduction of venous jugular pressure. 7. The nurse is preparing to administer a diuretic to a patient in the critical care unit. The nurse knows that what method of administration of fast acting diuretics would be most effective and least likely to produce adverse effects in a critically ill patient with pulmonary edema? A. B. C. D. Intravenous bolus doses Continuous intravenous infusion Subcutaneous doses Intramuscular doses 8. A nurse is scheduled to work on the postoperative unit. Her client has been diagnosed with diabetes insipidus. The client has received steroids before an adrenalectomy. The nurse understands the reason for this is to: A. B. C. D. Compensate for sudden lack of these hormones following surgery. Increase the inflammatory action to promote scar formation. Foster accumulation of glycogen in the liver. Facilitate urinary excretion of salt and water following surgery. ReMar Nurse University #RNU - 13 - www.ReMarReview.com 9. The nurse obtains information during the admission interview that the client is taking herbal supplements in addition to prescribed medications. What is the nurse’s primary concern for this client? A. Herbal products are natural and pose no risk to the client but may be costly. B. Herbal products are a welcome supplement to conventional medications but do not always come with instructions. C. The client may be at risk for allergic reactions. D. The herbal products may interact with prescribed medications and affect drug action. 10. The client states that he has been using the herbal product saw palmetto. The nurse recognizes that this supplement is often used to treat which condition? A. B. C. D. Insomnia Urinary problems associated with prostate enlargement Symptoms of menopause Urinary tract infection ReMar Nurse University #RNU - 14 - www.ReMarReview.com ReMar Nurse University Session III – Monday May 21, 2018 Delegation A. DelegationRN LPN Aide No: Can LPNs delegate tasks to Aides? ReMar Nurse University #RNU Can Aides delegate tasks to other Aides? - 15 - www.ReMarReview.com Delegation Practice Questions ReMar Review 1. The registered charge nurse, a licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP) are caring for clients in a progressive care unit. Which task would be most appropriate for the RN nurse to assign/delegate? A. B. C. D. Instruct the UAP to obtain the client’s arterial blood gas sample. Request the LPN to change the central line dressing. Ask the LPN to bathe the client and change the bed linens. Tell the UAP to obtain urine output for the 12-hour shift. 2. The new graduate nurse is assigned to work with an unlicensed assistive personnel (UAP) to provide care for a group of clients. Which action by the nurse is the best method to evaluate whether delegated care is being provided? A. B. C. D. Check with the clients to see whether they are satisfied. Ask the charge nurse whether the UAP is qualified. Make rounds to see that the clients are being turned. Watch the UAP perform all the delegated tasks. 3. The charge nurse is making assignments on a pediatric unit. Which client should be assigned to the licensed practical nurse (LPN)? A. B. C. D. The 6-year-old client diagnosed with acute sepsis. The 8-year-old client diagnosed with systemic inflammation response syndrome. The 10-year-old client diagnosed with poisoning. The 13-year-old client diagnosed with diabetes mellitus type 1. ReMar Nurse University #RNU - 16 - www.ReMarReview.com Prioritization ReMar Review All the answers will seem right but only one is the PRIORITY 1. Example: A new nurse working in the emergency room department reports for duty. Four patients arrive at the same time, who should she see first? A. The 44-year-old male diagnosed with a DVT who is complaining of left leg pain 9/10. B. The 3-year-old child with a fever, drooling and complaining of sore throat whose mother states “is teething.” C. The 8-year-old abused child with bruises around the ears and a gunshot wound to the left lower extremity. D. The 25-year-old female with a blood sugar 425 who has frequent urination, thirsty all the time and has lost weight. Don’t let NCLEX distract you with: _______________ or _______________________. Only think about what is happening: Look for the patient who is going to: Reverse Priority 1. 2. 3. 2. The charge nurse of an intensive care unit is making assignments for the night shift. Which client should be assigned to the newly graduated nurse? A. The client diagnosed with a traumatic brain injury resulting from a fall whose Glasgow Coma Scale score is 14. B. The client diagnosed with excessive laxative use who has severe diarrhea and has a serum K+ level of 3.1 mEq/L. C. The client diagnosed with renal insufficiency who is lethargic and has a blood pressure of 80/45, pulse of 124, and respiration rate of 26. D. The client diagnosed with hyperthyroidism who has undergone a thyroidectomy and has muscle spasms and paresthesia. ReMar Nurse University #RNU - 17 - www.ReMarReview.com EKG NCLEX Information ReMar Review Cardiology Depolarization/Repolarization- What do these words mean to you? Start with __________________________________________________-means a resting state, no electrical activity. There are special cells in the heart that generate electrical activity. Starts in the _________________ ___________________ located in ________________________ ______________________. ____________________________ means-movement of ions across the cell membrane. Ions move through channels A. B. C. Movement of ions across cell membrane causes _________________________________________. ________________________ means-return of the ions to their previous resting state During repolarization ______________ ________________ are relaxed. P wave QRS atrial repolarization and relaxation & simultaneous ventricular depolarization and contraction T wave U wave final state of repolarization of the ventricles source unknown usually follows T wave ReMar Nurse University #RNU - 18 - www.ReMarReview.com EKG Overview ReMar Review The NCLEX may give you a question with rhythm strips that look just like this. You must be able to identify what they are and/or treatment. Normal sinus rhythm= __________________________________________________________________ 1. What is the rate? 2. What is the rhythm? 3. Is there a P wave before each QRS? 4. Are the P waves upright and similar? 5. What is the length of the PR interval? 6. What is the length of the QRS complexes Rules: ____________________________________________________________________________ Can you circle each p wave on this ECG strip? Can you circle each QRS complex on this ECG strip? ReMar Nurse University #RNU - 19 - www.ReMarReview.com EKG Overview ReMar Review The saw tooth pattern looks like shark teeth. So think I see a shark and my heart flutters! Atrial Flutter= __________________________________________________________ 1. What is the rate? Atrial: 250-400 bpm Ventricular: variable 2. What is the rhythm? Atrial regular Ventricular irregular 3. Is there a P wave before each QRS? 4. Are the P waves upright and similar? Normal P waves are absent Saw tooth pattern 5. What is the length of the PR interval? Can’t measure 6. What is the length of the QRS complexes 0.06-0.12 These NCLEX patients have Atrial Flutter: Valve disorder (mitral) Cardiomyopathy Thickening of the heart muscle COPD Emphysema Ischemia NURSING INTERVENTIONS FOR ATRIAL FLUTTER ___________________________________________________– treatment of choice for NCLEX! **Slow the ventricular rate by using: diltiazem, verapamil, digitalis, or beta blocker ____________________________________________________________ to reduce incidence of thrombus formation. ReMar Nurse University #RNU - 20 - www.ReMarReview.com EKG Overview ReMar Review Ventricular Tachycardia=____________________________________________ 1. What is the rate? Atrial: Q Ventricular: 100-200 2. What is the rhythm? Regular 3. Is there a P wave before each QRS? Absent 4. Are the P waves upright and similar? Absent 5. What is the length of the PR interval? Not measurable 6. What is the length of the QRS complexes Wide greater than 0.10 sec Ask first if it is ______________________________ or_______________________________. What is the difference? These patients have ventricular tachycardia: Cocaine users Chest trauma DIGOXIN takers Enlarged heart hx Treatment: _____________________________________________________________________ Never pick __________________as a treatment for ventricular tachycardia because it _____________________________________________________________________________! Cardioversion Defibrillation ReMar Nurse University #RNU - 21 - www.ReMarReview.com EKG Overview ReMar Review Asystole= ________________________________________________________ Treatment: _______________________________________________________ *If the monitor says asystole but the patient is clearly alive then check for _________________________________ _____________________________ ____________= ___________________________________________________ Do not put ___________ over _______ _________________ or _______ _______________. Some possible causes are: Treatment: _____________________________________________ ReMar Review YouTube Channel has free videos on: Sinus, Atrial, & Ventricular Tachycardia ReMar Nurse University #RNU - 22 - www.ReMarReview.com EKG Overview ReMar Review Heart Blocks Normal Sinus Rhythm First degree heart blockThe ____________________ interval is ___________________________________. Is this an emergency? What is the treatment? Second degree heart block type 1 (Mobitz Type 1 or Wenckebach) The _____________________ interval is _______________________ ___________________ and then the _______________________ complex _________________________________. Is this an emergency? What is the treatment? ReMar Nurse University #RNU - 23 - www.ReMarReview.com EKG Overview ReMar Review Second degree heart block type 2 (Mobitz Type 2) The _____________________ interval is _______________________ ___________________ and then the _______________________ complex _________________________________. Is this an emergency? What is the treatment? Third degree heart block The ____________________________ and ___________________________ are beating _____________________________ from ________________ ______________________. Is this an emergency? What is the treatment? Note: EKG/ECG only shows you electrical activity not ________________activity ReMar Nurse University #RNU - 24 - www.ReMarReview.com ReMar Nurse University - Final Exam 1. The nurse has just finished the change of shift report. Which patient should the nurse assess first? A. A postoperative cholecystectomy patient who is complaining of pain but received an IM injection of morphine five minutes ago. B. A postoperative appendectomy patient who will be discharged in the next few hours. C. A patient with asthma who had difficulty breathing during the prior shift. D. An elderly patient with diabetes who is on the bedpan. 2. The unlicensed assistive personnel (UAP) accidentally pulled the client’s chest tube out while assisting the client to the bedside commode. Which intervention should the nurse implement first? A. B. C. D. Securely tape petroleum gauze over the insertion site. Instruct the UAP how to move a client with a chest tube. Assess the client’s respirations and lung sounds. Obtain a chest tube and a chest tube insertion tray. 3. Which client should the nurse in the post-anesthesia care unit (PACU) assess first? A. The client who received general anesthesia who is complaining of a sore throat. B. The client who had bilateral knee surgery and has a pulse oximeter reading of 90%. C. The client who received spinal epidural and has a palpable 2+ dorsalis pedal pulse. D. The client who had abdominal surgery and has green bile draining from the N/G tube. 4. The nurse has just completed listening to morning report. Which client will the nurse see first? A. The client who is going for a bronchoscopy in three hours. B. A client who has a leaking colostomy bag. C. The client who has been receiving a blood transfusion for the past 4 hours and had a recent hemoglobin of 7.4 grams/dL. D. The client with a sickle cell crisis and an infiltrated IV. ReMar Nurse University #RNU - 25 - www.ReMarReview.com 5. A new graduate nurse has just received her morning assignment. She asks the experienced nurse, “I have received four patients, who should I see first?” What is the best response by the experienced nurse? A. “Check the policy and procedure manual for whom to see and assess first.” B. “See the patient who takes the most time last.” C. “Assess the patients in the order that their medications are due to stay on track.” D. “I would assess the patient who is having respiratory distress first.” 6. A nurse can enhance personal productivity by doing which of the following? Select all that apply. A. Estimating how much time each activity takes, delegating tasks, and utilizing end of shift reports. B. Getting up an hour early, answering the phones, and distributing magazines for busywork for patients. C. Avoiding working and going to school at the same time. D. Controlling unwanted distractions such as texts, e-mails, and unplanned phone calls. E. Using downtime by having educational reading and writing materials available. 7. Who should the nurse make rounds on second? A. Patient who is concerned that he has had no bowel movement for two days. B. Patient who has suffered several acute asthmatic attacks within the last 24 hours. C. Patient who just returned from spinal surgery and is reporting breakthrough pain. D. Patient who is severely allergic to peanuts who just ate a peanut butter cracker. 8. The nurse has just instructed the patient on stroke management as part of discharge planning for home. The patient states, “I don’t feel I am ready to go home so soon. I am scared.” What should the nurse say next? A. B. C. D. Tell the patient to call the rehabilitation nurse every hour for reassurance. Ask the patient in a soft reassuring voice to further express his concerns. Provide and review stroke education in a soft empathetic voice. Instruct the client to write all the questions down so they can be reviewed with the doctor. ReMar Nurse University #RNU - 26 - www.ReMarReview.com 9. Which of the following behaviors may indicate that your patient has a low health literacy? Select all that apply. A. B. C. D. Identifying pills by color after opening up the bottle. Signing a consent form after reading the first paragraph. Refusing to read an entire form and saying “I am too busy to read.” Responding when asked about why he takes a medication “I take it because you guys told me to!” E. Becoming angry about nurses asking “too many questions.” F. Patient responds, “I’ll read it later.” 10. A nurse practitioner has ordered Mr. House to be discharged from the hospital, despite a new temperature of 102.4 F. The practitioner refuses to talk with you about the patient. In this situation, which of the following is an appropriate nursing action? A. Administer an antipyretic medication, and discharge the patient. B. Discharge the patient with instructions to call 911 if he has any problems. C. Do not discharge the patient until you have discussed the matter with your nursing manager and are satisfied regarding patient safety. D. Discharge the patient, and tell the patient to take acetaminophen when he arrives at home. 11. Which situation can a nurse be accused of false imprisonment? Select all that apply. A. B. C. D. Inappropriate use of a chemical restraint. Inappropriate use of a physical restraint. Restraining a competent person. Failure to follow the institution policies regarding the type and frequency of restraints. E. Using restraints in an emergency situation to protect the patient from harm. False imprisonment notes: 12. The nurse notices that a coworker has been drinking and is not able to practice nursing safely. The nurse should do which of the following? A. Inform the manager. B. Fix the co-worker black coffee. C. Confront the co-worker and ask sincerely and directly if they have been drinking. D. The nurse should not get involved in this situation. ReMar Nurse University #RNU - 27 - www.ReMarReview.com 13. During morning report, the nurse states that Mrs. Reed is an alcoholic, drug addict who is admitted for pancreatitis and has caused all of her own problems. You realize that the nurse is exhibiting a lack of which of the following? A. B. C. D. Autonomy Compassion Truthfulness Trustworthiness 14. A nurse is caring for a population of patients from various cultures. She should include which of the following in a spiritual assessment? Select all that apply. A. B. C. D. E. Prayer needs Affiliations with religious organizations Medicinal regimes Coping mechanisms Pastoral care visits 15. Which of the following isolation measures would the nurse institute when a patient has tuberculosis? Select all that apply. A. B. C. D. E. Use gloves when there is a risk of exposure to blood or body fluids. Place patient in a private, positive airflow pressure room. Use a respirator mask at all times while in a patient’s room. Place a mask on the patient when transporting him or her out of the room. Let all unit visitors know that there is a patient with tuberculosis on the unit. 16. A registered nurse has just drawn an arterial blood gas on a patient. Which of the following is most important for the nurse to do? A. B. C. D. Apply pressure to the puncture site for 5 minutes. Shake the vial of blood before transporting it to the lab. Keep the patient on bed rest for 1 hour. Encourage the patient to inhale deeply several times. 17. The nurse is administering an intramuscular injection to a 1 year old patient. Which of the following sites is most appropriate for the nurse to select? A. B. C. D. Ventral forearm Ventral gluteal Vastus lateralis Dorsal gluteal ReMar Nurse University #RNU - 28 - www.ReMarReview.com 18. Which precaution is most important for the nurse to take when assisting a patient with self-monitoring of blood glucose? A. B. C. D. Wear gloves when performing the test. Rinse lancet between uses. Recalibrate the glucometer before each use. Give the patient a machine for his use only. 19. The nurse is caring for a postoperative patient who develops a wound dehiscence. Which of the following is the priority nursing when this occurs? A. B. C. D. Approximate the wound edges with tape. Irrigate the wound with sterile saline. Cover the wound with sterile, most saline dressings. Hold the abdominal contents in place with a clean gloved hand. 20. A nurse is working on a neurology unit. She is caring for a client with a T6 injury. The client has nausea, bradycardia, and profuse sweating. She suspects autonomic dysreflexia. Which is the most likely cause? A. Bowel obstruction B. Viral infection C. Bladder distension D. Airway blockage 21. The home health nurse is caring for a patient with a diagnosis of diabetes mellitus. The nurse notices the patient’s toenails are thick and ingrown. The patient asks the nurse to cut the toenails before she leaves. Which is the most appropriate action by the nurse? A. B. C. D. Gather a diabetic toenail clipper and cut the nail to the curve of the toe. Encourage the client to make an appointment with his physician. Instruct the client that the toenails should be cut after soaking the feet first. Notify the client of the potential harm that can be done then cut the toenails. ReMar Nurse University #RNU - 29 - www.ReMarReview.com TAKING THE NEXT STEPS FOR NCLEX - MAY’S SPECIAL OFFER How did you feel the content that you’ve covered so far? Did you learn something new or did you find the content easier to understand then before? The ReMar DVD Self-Study Program is the absolute best resource for mastering NCLEX content. I want to make sure you have everything you need to build your content knowledge and pass NCLEX-RN or NCLEX-LPN. This month, we are helping to help encourage you on this journey with a special offer! You’ve invested your time with me so I’d like to give you $50 off of our DVD Self Study Program plus free priority shipping. Save even more if you already have Quick Facts for NCLEX! Sale ends June 1st! Here is what is included in your Self-Study Review, four (4) NCLEX Lecture DVDs and four (4) NCLEX Study workbooks including Quick Facts for NCLEX! Here is how you’ll use the DVD SelfStudy Program to pass NCLEX in six weeks studying 1.5 hrs. – 3 hrs. a day for 4-5 days each week! • • • • • • Watch NCLEX Lecture DVDs daily Read DVD Workbook daily Read Quick Facts for NCLEX daily Write in Homework book daily Respond to questions in the NCLEX Activity Book at end Respond to questions in the NCLEX Practice Exams at end $50 ReMar Nurse University #RNU - 30 - OFF www.ReMarReview.com ReMar Nurse University #RNU - 31 - www.ReMarReview.com NCLEX STUDY PROFILE [ RN / PN ] What you need to study to pass NCLEX! On the following pages I have provided the list of ReMar specific topics that you will need to know and study before taking NCLEX. It may seem like a great deal of material to cover but as you will see studying for NCLEX becomes so much easier when you focus on the content! All of these topics are covered in the NCLEX DVD Self-Study Review and outlined in my six-week NCLEX Study Calendar of the self-study review. The calendar can be adjusted to between four to eight weeks to best fit your study schedule as needed. The content of the NCLEX Test Plan is organized into four major Client Needs categories. Two of the four categories are divided into subcategories: Safe and Effective Care Environment • Management of Care [RN] & Coordinated Care [PN] • Safety and Infection Control Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity • Basic Care and Comfort • Pharmacological Therapies • Reduction of Risk Potential • Physiological Adaptation ReMar Nurse University #RNU - 32 - www.ReMarReview.com Areas To Study Management of Care RN Coordinated Care PN ReMar Specific Topics for NCLEX • • • • • • • • • • • • Safety & Infection Control Case Management Client rights-HIPPA, informed consent-components that make up Do not resuscitate (DNR) order Assault Battery False Imprisonment Communicable Diseases Establishing Priority Assignment, Delegation, Supervision Reporting impaired co-workers Organ Donation • • • • • • • • • • • • • • • • • • • ReMar Nurse University #RNU Populations at risk for falls Position of personnel when ambulating a client Assistive devices (cane, walkers, etc and patient education) Seizure precautions Use of seclusion room/restraints Alternatives to restraints How long does an order for a restraint last Fire response and RACE Client’s allergies/sensitivities (latex, food Incident reports for medication errors Hand hygiene Room assignments Verify appropriateness of a written order Infection control measures (contact, droplet, respiratory) Surgical Asepsis Immunization (schedule, live, reactions) Child safety seat/ car seats Transmission of pathogens Appropriate toys for children - 33 - www.ReMarReview.com Health Promotion & Maintenance • • • • • • • • • • • • • • • • • • • • Psychosocial Integrity • • • • • • Basic Care & Comfort • • • • • • • • ReMar Nurse University #RNU Expected changes in aging Diagnostic Tests Levels of intervention (primary, tertiary) Neurological Assessment Glasgow Coma Scale Neuro-Checks Phototherapy patient education Signs of Pregnancy Physical Adaptations and Discomforts of Pregnancy Teratogenic Effects on Fetal Development Stages of Labor Complications During the Postpartum Period Substance Abuse and the Newborn Congenital Heart Defects Erikson's stages of psychosocial development, Developmental milestones Dietary counseling Steps to use a meter induced inhaler Hepatitis A, B, C, D transmission Hepatitis A, B vaccine administration Eating disorders and treatment Schizophrenia Therapeutic communication Psychiatric medication classes, side effects, patient teaching Religious influences on healthcare Mental health concepts Non-Pharmacological comfort interventions Assistive devices Apply and maintain devices used to promote venous return antiembolic stockings Sequential compression devices Assess the client’s need for pain management Enema administration Z track method IM injection What are abnormal assessment findings after a bronchoscopy? - 34 - www.ReMarReview.com Pharmacological & Parenteral therapies (This section is for RN Students) Reduction of Risk Potential Physiological Adaptation ReMar Nurse University #RNU • • • • • • • • • • • • Provide the client with nutrition through continuous or intermittent tube feedings Central line management Administration of blood/plasma/blood products Evaluate the therapeutic effect of medications Dosage calculation Laboratory values Blood gas interpretation Shock CPR EKG interpretation EEG Position placement after a liver biopsy? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Electrolyte imbalance Allergic reactions and treatment Amputation Gout Systemic Lupus Erythematosus Rheumatoid Arthritis vs. Osteoarthritis Hepatitis Cirrhosis Pancreatitis Crohn’s Disease and Ulcerative Colitis Venous Disorders Transient Ischemic Attacks Head Injury Laminectomy Multiple Sclerosis Parkinson’s Disease Myasthenia Gravis Meniere’s Disease Guillain-Barre Syndrome Detached Retina Cataract Glaucoma Increased Intracranial Pressure Endocrine System Disorders Adrenal Gland disorders Thyroid Gland disorder Hyperthyroid storm signs, treatment Parathyroid Gland function Asthma COPD • - 35 - www.ReMarReview.com NCLEX Grief & Mental Preparedness Form Regina M. Callion MSN, RN ReMar Nurse University #RNU - 36 - www.ReMarReview.com Directions: You are doing this form because you have failed NCLEX or have a general anxiety or doubts about studying for NCLEX. If this is correct, you are in need of the healing process. It’s time to begin the process of healing by allowing yourself to be open about where you are now by moving past your past Answer each question open and honestly and allow the answers to provide insight into your steps toward success. This is for your eyes only! Did you / have you give NCLEX preparation your all? How do you know? If you could go back what things would you do exactly the same? If you could go back what things would you do differently? I believe I failed because? Select all that apply • • • • • • • • I needed to study more I had external pressures affecting me (i.e. job, family, deaths, ) I was overly anxious I was unprepared I over thought the questions I was not confident in my abilities I was over confident in my abilities I had too many different study resources If you selected any of the above choices which ones were out of your control? Which ones could you have controlled? ReMar Nurse University #RNU - 37 - www.ReMarReview.com As each question on your NCLEX exam went on how did you feel? Do you have difficulty talking about the experience to others? Have you gone through any of the following emotions? Guilt Shame Defeat Mistrust Disconnected Helplessness *If you are experiencing guilt, shame, defeat, mistrust etc. recognize that these are all normal responses however you must choose to identify those thoughts and replace them with a more balanced picture of what actually happened. What do you feel you need moving forward? What are your strengths when it comes to learning? What are your strengths when it comes to overcoming adversity? Are you willing to give yourself the best opportunity to pass this exam? ReMar Nurse University #RNU - 38 - www.ReMarReview.com
