NCLEX Land Rules

1.​ You always have enough time, staff, equipment & order when taking NCLEX
a.​ If it says it; you can do it!
2.​ Do what med-surg textbook would say, do NOT do what you’ve seen in the clinical setting
3.​ Least invasive to most invasive => try to avoid surgery
a.​ Ex: Lifestyle changes > medications > procedures
4.​ Avoid “Do Nothing”
a.​ If you have an identified problem; you must do something about it
b.​ Common “Do Nothing” Answer => “Continue to Monitor, Document, Call me back in 3 hours”
c.​ Only Document when everything is stable
5.​ Do NOT Ditch the patient; Do NOT pass the “buck”
a.​ If it’s within the nursing scope of practice; you must do it; don’t tell family to do it
b.​ Do not leave to “go grab the chest tube kit”
6.​ Public Health Problems => the most good for the most people
a.​ eg in reduction of risk & safety & infection questions
7.​ You MUST use the Decision Tree on every single question
8.​ You have to Eliminate answer options to get to the right answer
a.​ You can only get the correct answer when you have narrowed it down to 50/50
9.​ Restless, agitated, confused => Hypoxia or Hypoglycemia
a.​ 1st S/S of Hypoxia => Restlessness
b.​ Diabetic => Hypoglycemic
10.​See most Unstable pt first (ABCs)
a.​ Expected or Unexpected outcome => Unexpected is priority
b.​ Acute vs Chronic => Acute is priority
i.​ Ex: COPD is chronic disease vs Pneumothorax is acute
c.​ Actual problem vs. Potential problem
11.​Safety! Study everything from a safety point of view
a.​ Basic safety knowledge tested
12.​Roles on Test: RN, LVN/LPN, UAP, Healthcare Provider (HCP)
a.​ UAP => unlicensed assistive personnel => canNOT care for people => Standard Unchanging
Procedures (VS, changing linens, delivering meal trays, feeding, emptying foleys, etc)
b.​ LVN/LPN => Stable pts w/ Expected Outcomes; Abnormalities get elevated to the RN
i.​ Must be abnormal for that pt (stage 3 pressure ulcer for 3 months => normal for pt vs.
stage 2 pressure ulcer for 1st time => abnormal)
c.​ RN => Complex, Unstable pts that need Assessments
i.​ Only RNs can do Admission or Discharge and Initial Teaching!
d.​ Float Nurses => get most Stable pts w/ Expected Outcomes
13.​Stick to the theory, Not to the Details
a.​ eg. start an IV w/ 19 Gauge => Theory is start an IV; Detail is 19 gauge
14.​Do NOT read into the question
a.​ No “What If ...”
15.​If you can do 1 thing only & leave, what will be most helpful?
16.​Actual vs. Potential
a.​ Take care of the Actual problem not a potential problem
b.​ Potential problem eg fall risk, aspiration risk, etc
17.​Study Generic Drug Names
18.​Rooming => Clean goes with Clean; Infectious goes with Infectious
a.​ Close to nurses station => pts need more monitoring; unstable/confused pts
19.​Treat the Pt before the Equipment
 a.​ Look at pt to see if equipment is correct
20.​For Public Health => most good for the most people
21.​Give the delegation w/ a follow up instruction of what to do with that
a.​ “Can you take vitals and chart them for me to look at in 15 mins?”
22.​Documentation & Communication w/ families => should be as objective as possible
a.​ Do NOT include personal words “they are worsening, do not deteriorating”
23.​Rescue Positions:
a.​ Shortness of Breath => Elevate HOB
b.​ Vomiting => turn pt to side
c.​ Pregnant pt => Left Lateral position
i.​ NOT supine => baby can compress
d.​ Generally position pts
24.​Bed Positions- Study
25.​Usually words “ALL; NONE; NEVER” => are not correct

NCSBN Updates
●​ NCLEX Exam:
○​ 75 minimum # of test items
○​ 145 maximum # of test items
○​ 5 hours is max testing time
●​ 15 Experimental Questions
●​ NCLEX will be testing on the 8 Client Needs Categories:
○​ Management of Care (20%)
○​ Pharmacology (15%)
○​ Physiological Adaptation (14%)
○​ Reduction of Risk Potential; Safety & Infection Control (12%)
○​ Basic Care & Comfort; Psychosocial Integrity; Health Promotion & Maintenance (9%)
●​ NOTE: Take NCLEX on Weekday; not on Friday (weekend might take longer to get results back)
○​ Turnaround for results is 2-3 days

NCLEX Safety
●​ Which is the safest action to take?
●​ WHich action will help most to keep the pt safe?
●​ Which action will cause harm if not used?

NCLEX Decision Tree

●​ Test Taking Rules:
○​ Identify the topic of the question
○​ Select an answer by eliminating choices. Must get to 50/50
○​ Do NOT use background information unless absolutely necessary
○​ Do NOT “read into” the question => No “What if”
○​ Think about what the answer choices really mean
○​ If you have a problem, you MUST DO SOMETHING => Avoid Do Nothing
○​ NCLEX is the “perfect world”

●​ Steps in Critical Thinking:

1.​ Identify the Topic (4-5 words)
●​ Safe or Unsafe; Prioritization; Delegation; etc
●​ eg “safest option for intense pain”, “next/initial/best action ...”
 ●​ Cover the answer options > only go to answer choices if topic is unclear
●​ Determine the right here right now problem/situation
○​ Look at keywords, time frames & ages
●​ Reword the question in 2-3 words of your own
●​ Ex: The nurse provides care to a pt reporting lightheadedness & tingling sensation in
fingers while experiencing a panic attack. Which action does the nurse take nex?
○​ Topic: Safest action for lightheadedness & tingling
1.​ Remain with the pt
2.​ Start an IV of 0.9% saline
3.​ Obtain an ABG
4.​ Ask the pt to breathe into a paper bag
​
2.​ Assessment vs. Implementation
●​ Assessment => Gathering Data
○​ eg. auscultating breath sounds; sending labs
○​ Do I need this information? Is it safe & relevant to my identified topic?
■​ Need to Know or Nice to Know?
○​ You do NOT always have to Assess before Implementing!!!
●​ Implementation => Not Gathering Data
○​ eg. raising HOB
●​ Ex: The nurse provides care to a pt reporting lightheadedness & tingling sensation in
fingers while experiencing a panic attack. Which action does the nurse take nex?
○​ Topic: Safest action for lightheadedness & tingling
1.​ Remain with the pt => Implement
2.​ Start an IV of 0.9% saline => Implement
3.​ Obtain an ABG => Assess => Remove Answer Choice
4.​ Ask the pt to breathe into a paper bag => Implement

3.​ Physical vs. Psychosocial

●​ Physical => physical assessment, labs, medications, etc
○​ Pain is psychosocial except ischemic pain/pain r/t losing an organ
●​ Psychosocial => referring to chaplain, hand-holding, pt education, religious things,
calling family, pain management, mental health/depression (except suicidal ideation)
●​ Most of the time, Physical is more important than Psychosocial!
○​ Physical > Psychosocial
●​ Ex: The nurse provides care to a pt reporting lightheadedness & tingling sensation in
fingers while experiencing a panic attack. Which action does the nurse take nex?
○​ Topic: Safest action for lightheadedness & tingling
5.​ Remain with the pt => Implement => Psychosocial => Remove Answer
Choice => Physical is more important than Psychosocial rn
6.​ Start an IV of 0.9% saline => Implement => Physical
7.​ Obtain an ABG => Assess
8.​ Ask the pt to breathe into a paper bag => Implement => Physical

4.​ ABCs
●​ Airway > Breathing > Circulation
●​ Airway => stridor, agitation, unable to speak/cry/make noise, aspiration, SUCTION
○​ Pt positioning => high fowlers for aspiration precautions; side for seizures so
secretions come out
 ●​ Breathing => respiratory rate, breath sounds, tripod position, retractions, pulse ox,
restlessness (hypoxia), respiratory distress
●​ Circulation => blood pressure, pulses, heart rate, cap refill, skin color/temp, IV starts &
IV fluids (for circulatory stability)
○​ Edema & Urine Output is NOT part of circulation
●​ Ex: The nurse provides care to a pt reporting lightheadedness & tingling sensation in
fingers while experiencing a panic attack. Which action does the nurse take nex?
○​ Topic: Safest action for lightheadedness & tingling
9.​ Remain with the pt => Implement => Psychosocial => Remove Answer
Choice => Physical is more important than Psychosocial rn
10.​Start an IV of 0.9% saline => Implement => Physical => Circulation
11.​Obtain an ABG => Assess
12.​Ask the pt to breathe into a paper bag => Implement => Physical =>
Breathing => CO2 retention

5.​ Evaluate the Outcome

●​ Last chance to make sure it makes sense
●​ If I choose this, what will happen; will the pt be safe?
●​ If you can only do one thing, what is the most helpful?
●​ Ex: The nurse provides care to a pt reporting lightheadedness & tingling sensation in
fingers while experiencing a panic attack. Which action does the nurse take nex?
○​ Topic: Safest action for lightheadedness & tingling
13.​Remain with the pt => Implement => Psychosocial => Remove Answer
Choice => Physical is more important than Psychosocial rn
14.​Start an IV of 0.9% saline => Implement => Physical => Circulation
15.​Obtain an ABG => Assess
16.​Ask the pt to breathe into a paper bag => Implement => Physical =>
Breathing => CO2 retention
●​ If you can only do 1 thing & leave, what is most helpful? Paper bag for breathing or IV for
circulation?

Ex:
●​ Topic: Safest plan of care for ruptured ectopic pregnancy
○​ IV fluid over Breathing because rupture is losing blood => IV fluid needed to replace lost fluid
●​ Topic: Safest action for fluid retention after peritoneal dialysis
○​ Least invasive to most invasive (turning side to side is less invasive than pushing down on
abdomen)
●​ Topic: Safest action for pain (clenched teeth & diaphoresis)
○​ Assess pain (get pain scale), before giving a pain med => Assess before Implement
●​ Topic: Prioritization for Injuries of a Car Accident:
○​ Broken jaw is Airway problem > Chest pain is Circulation problem
●​ Topic: Unsafe or Abnormal for Newborn
○​ Absent breath sounds, Negative Babinski, Resp rate of 80 is Abnormal
○​ Acrocyanosis is normal in babies in first 4 hours (blue in hands & feet) => expected outcomes
○​ 40-60 is normal RR in newborns

Pharmacological & Parenteral Therapies (15%)

●​ General Math Calculation:
 ○​ Rounding Rules:
■​ Follow the rule given in the question
■​ If no rule given, do NOT round
■​ You must consider what the question is asking. You cannot split a drop
○​ If the answer is a fraction, use the placeholder 9
■​ .3 is unsafe & incorrect
■​ 0.3 is safe & the correct
○​ If the answer is a whole #, do NOT use a trailing zero
■​ 5.0 is unsafe & incorrect
■​ 5 is safe & correct way
○​ Math answers do not use a separation comma:
■​ 1000 is the correct way
■​ 1,000 is an incorrect way

●​ Herbal Medication:
○​ Ginkgo
■​ For memory
○​ Garlic
■​ For infection & immune response
○​ Goldenseal
○​ St. John’s Wart
■​ For depression

●​ *** Need to Know Meds:

○​ Furosemide
○​ Aspirin
○​ Acetaminophen
○​ Ibuprofen
○​ Digoxin
○​ Beta Blockers
○​ Ace Inhibitors
○​ Steroids
○​ Insulins (different types)
○​ Antibiotics (classes of Abx: macrolide, cephalosporins, aminoglycosides etc)
○​ Haldol
○​ Lithium
○​ SSRI Generalizations
○​ Blood Products

●​ Topic: Safest action for Blood Transfusion reaction:

●​ Topic: Safest action for IV fluid for elderly:
○​ Breathing > Circulation
○​ Important to listen to breath sounds prior to starting IV fluids
○​ Elderly have high likely to get heart failure or fluid overload
●​ Topic: Safest action for Central Line:
○​ Don’t want to remove dressing against the direction the catheter is inserted
○​ Flush catheter lumen to ensure patency
●​ Topic: Safest action for IV Fluids
○​ Auscultate Lung Sounds => Breathing
 ○​ Safe & relevant to listen to lung sounds prior to IV fluids
●​ Topic: Unsafe statement about Lorazepam
○​ Stopping Lorazepam Abruptly => Unsafe
○​ Lorazepam is a Benzodiazepine
●​ Topic: Unsafe prescription for pt w/ allergy to amoxicillin sulfonamides
○​ Sulfonamides suffixes => -illin
○​ Penicillins have cross allergy to Cephalosporins (-ceph)
○​ Piperacillin, Cephalexin, Cefepime hydrochloride
●​ Topic: Unsafe statement for pt taking doxycycline monohydrate:
○​ Doxycycline CAN be crushed
●​ Topic: Mg per Dose Calculation
○​ 48 kg X 20 mg/kg/day = 960 mg/day / 3 doses/day = 320 mg/dose
●​ Topic: Safest question to ask for pt taking Propranolol
○​ Propranolol is Beta Blocker
○​ Dry cough happens w/ Ace Inhibitors, not Beta Blockers
○​ Describing breathing is open ended question vs. dry cough is closed ended
○​ Beta Blockers safety => Assess Breathing!
●​ Topic: Prioritization; Med for most unstable pt
○​ Difficulty chewing => Airway problem => risk for aspiration
○​ Myasthenia Gravis is muscle disease where pt could stop breathing => Airway/Breathing
problem
●​ Topic: Unsafe Statement made for clonidine hydrochloride transdermal patches
○​ Transdermal patches => usually at least q72 hours for changing
■​ Clonidine hydrochloride patches are q1 week
○​ Stopping antihypertensive meds abruptly => could lead to rebound HTN
○​ Transdermal patches DO stay on for showering
○​ Transdermal patches do NOT work immediately
●​ Topic: Rank in Order for RBC administration/Blood transfusion:
○​ Obtain Hx of transfusion rxn
○​ Start IV
○​ Obtain blood product from blood bank
○​ Begin transfusion at slow rate
●​ Topic: Safest action for depressed pt after starting lithium
○​ Monitor for SI
●​ Topic: First Action to take for pt w/ restlessness & SOB
○​ Elevate HOB to 90 is Breathing > IV flow rate is Circulation
●​ Topic: Best response for pt w/ red spots on chest after ciprofloxacin:
○​ Stop taking the medication
○​ Red spots => potential hypersensitivity => stop taking antibiotic
○​ Reactions to ABX => stop it & take a new one
●​ Topic: Safe statement about clopidogrel (plavix) => antiplatelet
○​ I should not continue to take ginkgo for my memory problems while taking clopidogrel
○​ Ginkgo side effect => Blood Thinner
○​ Ibuprofen side effect => Blood Thinner
○​ Pt should NOT be taking a blood thinner when taking an Antiplatelet
●​ Topic: Safest action for pt w/ Nausea taking dig & spironolactone
○​ For heart failure, don’t encourage increase of fluid intake
○​ Contact health care provider for more complete workup
○​ Digoxin toxicity => need more workup
 ●​ Topic: Priority Finding for pt receiving Lasix
○​ Decreased BP, Increased HR, HTN => all Circulation
○​ Would NOT give Lasix if pt had low BP
○​ Assess VS & potassium level prior to administering Lasix
○​ High BP is more safe than Low BP
●​ Topic: Most Concerning Finding for pt receiving Mag Sulfate
○​ Respiratory rate of 8 => Abnormal & Breathing
●​ Topic: Unsafe Statement by pt receiving oxycodone & acetaminophen
○​ Opiates can be given to suppress coughs
○​ Urinary retention is side effect of opiates
●​ Topic: Expected outcomes of Nitroglycerin
○​ BP should decrease after taking Nitroglycerin
○​ Baseline BP is 150/90; BP after Nitroglycerin should be lower & HR should increase to
compensate => BP decreases & HR increases
●​ Topic: Priority assessment for administration of Ketorolac
○​ AST is too specific
○​ Ketorolac is an NSAID => Nephrotoxic; Bad for Kidneys => check Creatinine levels prior to
administering NSAIDs
●​ Topic: Priority Information for pt in car crash w/ abdominal injury
○​ Clopidogrel => plavix => antiplatelet
■​ Antiplatelet medication is important for trauma pts => Increased risk for bleeding
○​ Glipizide => oral diabetic control (oral hypoglycemic)
○​ Levothyroxine => thyroid medication
○​ Zolpidem => sedative/ sleep aid
●​ Topic: Priority message to return => Most Unstable
○​ Levo => heart palpitations => Circulations
○​ Rifampin => orange urine => expected outcome
○​ Afib taking Beta Blocker => Coughing & Wheezing => Breathing & Circulation
●​ Topic: Priority action after administration of Losartan
○​ Assist pt on edge of bed before ambulating
○​ Losartan => ARB => BP medication
●​ Topic: Priority med to administer => Most Unstable
○​ Nimodipine => Calcium Channel Blocker => prevent vasospasms
○​ Dull throbbing headache after a subarachnoid hemorrhage is BAD => unexpected & unstable pt

Reduction of Risk Potential (12%)

●​ Topic: Most Unsafe/Unstable pt
○​ Swallowing frequently => S/S of Hemorrhaging => Airway
○​ Colostomy => see formed stool vs Ileostomy => liquid stool (earlier along GI tract)
●​ Topic: Unsafe/Incorrect Statement:
○​ Pt shouldn’t squeeze eyes shut after inserting eyedrops => eyedrops will come out & not absorb
○​ You can apply gentle pressure after eyedrops to increase absorption so it doesn’t enter eyeduct
●​ Topic: Greatest Risk for Type 2 DM:
○​ Age >45 is risk factor, hx of gestational diabetes, HDL < 35, triglycerides > 200
●​ Topic: Unsafe/Incorrect statement about dumping syndrome
○​ Dumping syndrome => Increased GI motility => fast stools => not enough nutrient absorption
○​ Follow up on high fiber meals & eating 3 meals a day
○​ Eating 3 meals/day is in opposition to smaller more frequent meals throughout the day
 ●​ Topic: Priority Action for Drooling/Frothy newborn
○​ Elevate HOB & turn on right side => Airway
■​ Turn on side so newborns don’t choke on secretions
●​ Topic: Safe Statement about scleral buckle repair & detached retina surgery
○​ Increase fluids & roughage to increase bowel movements => decrease straining from
constipation
●​ Topic: Unsafe statement for type 1 DM pt
○​ Glargine insulin => long acting insulin => NO PEAK => irrelevant to 9am
○​ Lispro Insulin => short acting insulin => peaking at 9am => hypoglycemic at 9am
●​ Topic: Safest Statement for child w/ acute otitis media
○​ Do NOT give Aspirin to kids => increase risk for Reyes syndrome
○​ Headache, stiff neck, & increased temp => S/S of Meningitis

Lab Values
●​ CBC (hgb, hct, wbc, platelets, etc)
○​ Study ranges & significance of high or low #s
○​ eg significance of low platelets => bleeding precautions
●​ Sodium, Potassium, Glucose
●​ BUN, Creatinine, Albumin
●​ Blood products
●​ Clotting Factors
○​ INR, PT, PTT
●​ Basic ABGs
○​ Acidotic, Alkalotic, Respiratory vs, Metabolic
●​ Troponin => cardiac injury, ischemia or infarct

Reduction of Risk Potential (12%)

●​ Topic: Unsafest pt for sedation
○​ Obstructive sleep apnea w/ CPAP => Airway problem
●​ Topic: Safest actin for restless/agitated/swallowing frequently
○​ Observe throat => Airway
○​ Early vs Late signs:
■​ VS are late signs vs. there are other s/s such as bleeding prior to VS changes
■​ Observing throat for breathing is early s/s
●​ Topic: Safest action for confused pt
○​ Give pt a small towel to hold => least invasive measure that actually treats the pt
●​ Topic: Safest assignment for private room
○​ Private room => needed for immunocompromised or infectious pt
○​ WBCs => infection ***
○​ Hgb level of 7 => low => anemia
○​ RBC of 4 => normal
○​ WBC or 20 => high => Infection
○​ Platelet of 350 => normal
●​ Topic: Safest action for Abnormal ABG trending up:
○​ O2 sat is less specific than an ABG => not needed
○​ Nursing process: Assess > Implement > Evaluate
○​ Left lateral recumbent position => lower HOB => not useful for Airway/Breathing
 ■​ Normal pH: 7.35-7.5
■​ Normal PaO2: 80 and above
■​ Normal PaCo2: 35-45
●​ Topic: Steps for using Incentive Spirometer:
○​ Assume high Flowlers => seal the lips tightly around mouthpiece => inhale slowly => hold
breath for 3 secs => exhale slowly for 2-6 secs => cough & deep breathe 2-3 times
●​ Topic: Med Math- Intake in mL:
○​ 30 mL + 300 mL + 60 mL + 500 mL = 890 mL
●​ Topic: Most unsafe assessment for pt post bronchoscopy:
○​ 1. Circulation
○​ 2. Breathing + Neuro => Expected outcome post-bronchoscopy
○​ 3. Breathing => Expected breathing for 3 year olds => belly breathers => RR of 30 is NORMAL
for toddlers
○​ 4. Airway + Breathing => Airway wins over breathing ***
■​ Supraclavicular contractions are BAD sign
■​ Neck Extended => Airway problem
●​ Topic: Safest action after cardiac cath:
○​ Telemetry strip => Vfib
○​ Go to pt room to assess the situation => see pt first before calling code
●​ Topic: Safest action for pt after abdominal paracentesis:
○​ Paracentesis => pulling out fluid => take out 5-7 L => I&O issue more than bleeding issue
○​ 1. Out
○​ 2. Abdominal => None but relevant to abdominal procedure
○​ 3. BP => Circulation => Priority *** => checks for internal bleeding & hemorrhaging
○​ 4. Dressing => Bleeding could be Circulation => checks only for external bleeding
●​ Topic: Most at risk pt for leg ulcer:
○​ 1. Lupus + steroid => delayed wound healing
■​ Lupus is autoimmune + corticosteroids delays wound healings & increases BS ***
■​ Steroids causes delayed wound healing, increased BS, cushing’s disease, psychosis
■​ Long-term steroid use is worse than Diabetes Mellitus
○​ 2. Type 2 DM + normal hbg
■​ Type 2 DM does delay wound healing but not as big as a factor if pt has tight glycemic
control
○​ 3. Hep C
○​ 4. Smoker
●​ Topic: Safest finding for O2 Therapy:
○​ Increased O2 delivery should increase LOC => pt more alert & less agitated is best outcome for
O2 status
○​ O2 doesn’t decreases crackles & secretions in airways => would be suctioning
●​ Topic: First Action for Water seal chamber not fluctuating
○​ 1. Visually Inspect first
●​ Topic: Unsafe Action for G Tube:
○​ You must FLUSH G Tube Line after Meds are given prior to reconnecting the Enteral Feeds

Physiologic Adaptation (14%)

●​ Topic: Safest action for conscious/coughing/choking:
○​ No need to ask to speak => Coughing => Airway is already patent
○​ Encourage pt to chough => best response to choking
●​ Topic: Unsafest statement for pt w/ Croup:
 ○​ Restless => Hypoxia => Breathing & Respiratory Distress
○​ Cries & barking cough => Expected outcome of Croup
○​ Hoarse voice & mild temp => Expected outcome of Croup
○​ Noisy breathing & irritable => Expected outcome of Croup
●​ Topic: Safest action for pt w/ abdominal pain post morphine:
○​ Do NOT apply heat post trauma & surgery => increases blood flow to area; vasodilates => more
swelling, bleeding, pain
●​ Topic: First action post Car Crash Abdominal Trauma pt:
○​ 1. A => Auscultating Bowel Sounds is NOT necessary => will NOT change plan of care
○​ 2. I
○​ 3. I => Starting an IV => Circulation ***
■​ Bleeding => distended, rigid, ecchymosis => IV fluids to prevent hypovolemic shock
○​ 4. A => Not first action
●​ Topic: Safest statement to DM pt w/ N/V:
○​ 1. I
○​ 2. A *** => assess BS before implementing anything for diabetes
■​ Diabetic sick days => illness, N/V, anything different (eg more exercise) => BS must be
checked more frequently
○​ 3. I => Out
○​ 4. I
●​ Topic: First action for post-op pt in SHOCK:
○​ Low BP & High pulse => Compensated Shock => not enough O2 getting to body because not
enough blood
○​ 1. I => Norepi by IV fluids
○​ 2. I => Breathing *** (Breathing > Circulation)
○​ 3. I => Out
○​ 4. I => Circulation => not point in IV fluids if pt is not getting enough O2
●​ Topic: First action for child stung by bee:
○​ 1. I
○​ 2. A => Breathing *** => must assess if pt is having Anaphylaxis or not
○​ 3. I => Out, helpful assessment prior to implementing
○​ 4. A => Not first assessment
●​ Topic; Most important teaching for post-stroke pt:
○​ 1 => Circulation => HTN is bigger risk factor for stroke than smoking
○​ 3 => Circulation => #1 reason for stroke is untreated HTN ***
●​ Topic: First pt to see:
○​ 1. Breathing/Airway => Unstable if pt is turning restlessly
○​ 3. Breathing => Expected outcome for pt to talk w/ ventilator & for peak airway pressure to
fluctuate
○​ 4. Airway => but expected after a laryngectomy
●​ Topic: Safest action for crackles/SOB:
○​ 1. Circulation
○​ 3. Breathing *** => safest most immediate action if High Fowlers position
○​ 4. Breathing
●​ Topic: First action for drop in BP & tachycardia => Shock:
○​ 1. I => Circulatory => IV fluids is safest action for shock
○​ 2. I => Out
○​ 3. I => Out
○​ 4. A => Breathing => Shocks is a Circulation problem; not a Breathing problem
●​ Topic: Safest response for vomiting baby:
○​ 1. Circulation
○​ 2. Breathing => Airway & Breathing is priority for Vomiting
●​ Topic: Priority action for TOF (congenital heart disease):
○​ 1. Water is not offered to infants
○​ 2. Soft nipple => to decrease effort of feeding
○​ 3. Position infant on abdomen after feedings => prevent aspiration
○​ 4. Weaning feedings
●​ Topic: Most unsafe finding for septic shock:
○​ 1. Safe & Expected
○​ 2. High WBC Expected w/ shock
○​ 3. Expected
○​ 4. Unexpected => Bleeding => Circulatory ***
■​ Bleeding at venipuncture site => DIC => can occur after sepsis
●​ Topic: Safest question for thrombolytic therapy for stroke:
○​ Must ask when first noticed stroke symptoms prior to thrombolytic
○​ Golder hour
●​ Topic: Safest action for severe pain post surgery:
○​ 1. Do Nothing
○​ 2. I ***
○​ 3. Ask Parents
○​ 4. Do Nothing
●​ Topic: First action for restless & anxious pt:
○​ 1. I => psychosocial => out
○​ 2. I => out
○​ 3. I => Breathing
○​ 4. A => Assess Breathing before Implementing ***
●​ Topic: Safest action for dressing change w/ burns:
○​ 1. I => psychosocial pain => premedicate ***
○​ 2. Do Nothing => out
○​ 3. I => psychosocial
○​ 4. Out
●​ Topic: First action for pt receiving O2 w/ HF:
○​ 1. Assess => Breathing ***
○​ 2. Assess => no ABC => out
○​ 3. Assess => no ABC
○​ 4. Implement => no ABC
●​ Topic: Safest Action for UAP w/ dyspnea pt:
○​ 1. Do Nothing
○​ 2. Do Nothing
○​ 3. Do Nothing
○​ 4. Assess pt ***
●​ Topic: First Action for low BP, slow HR, pale/shaky:
○​ 1, Assess => Circulation => BP assessment already gotten => out
○​ 2. Implement => Circulation (IV med)
■​ Atropine => speeds up HR => addressing the symptomatic bradycardia
○​ 3. Implement => Circulation (IV fluids)
■​ IV fluids => not addressing the problem of symptomatic bradycardia
○​ 4. Implement => Circulation
 ■​ Pacing is more invasive than IV atropine
●​ Topic: Hotspot- Location of tumor lobe:
○​ Frontal Lobe => deals w/ personality
○​ Occipital lobe => deals w/ vision
○​ Temporal lobe => deals w/ hearing
○​ Parietal lobe => deals w/ sensory
●​ Topic: Most unsafe statement about aspirin:
○​ Garlic => Antiplatelet/ blood thinning agent => do NOT combine w/ Aspirin or blood thinners
○​ 1 glass of wine/alcohol is ok with aspirin
●​ Topic: Safest question regarding itching on neck/chest
○​ Peak expiratory flow rate => Airway/Breathing
○​ Asthma => obstructive pulmonary disease => pt can breathe in but can’t breathe out

Basic Care & Comfort (9%)

●​ Topic: First action for ROM w/ arthritis:
○​ Assess pt’s ROM prior to implementation
●​ Topic: Safest action for bowel elimination at home:
○​ Assess pt in home bathroom setup
●​ Topic: Unsafe action for radiation exposure
○​ Giving complete bed bath => unsafe to stay in room w/ pt during a complete bed bath
○​ Masks & gloves do NOT protect against radiation
○​ NOTE: keep sheets in room since they have gained radiation exposure
○​ ALARA => as low as possible radiation exposure
●​ Topic: Risk factors for Pathological fracture:
○​ Cortisone/ steroids => osteomalasia => softens bones => increased risk for bone fractures
○​ Bone cancer => increased risk for bone fractures
○​ Osteoporosis => increased risk for bone fractures
●​ Topic: Best statement for pain in terminal cancer
○​ Assess previous pain control
●​ Topic: Most Unsafe assessment for fractured femur
○​ 4. Confusion is Unexpected after femur fracture => fat embolism could be lodged in the brain
○​ Slight SOB is expected after a femur fracture => lose lots of blood after a fracture
●​ Topic: Most unsafe assessment for right femur fracture w/ traction:
○​ 2. Do not want to turn on the side that you have traction/injury
●​ Topic: Priority order for diaphoretic & confused pt:
○​ IV fluids => Circulation
○​ Propranolol => Beta Blocker => Decrease HR & BP => Circulation
○​ Pt is experiencing a Thyroid storm => everything gets released in the bloodstream =>
everything becomes high!
●​ Topic: Best diet for older adult:
○​ Broiled chicken, broccoli & milk => most nutritious & balanced
●​ Topic: Lactovegetarian diet:
○​ Lactovegetarian => doesn’t eat meat or eggs but eats dairy
●​ Topic: Med Math in mL:
○​ 100 mL + (8oz x 30 = 240 mL) + (16oz x 30 = 480 mL) = 820 mL

Management of Care
●​ Topic: Prioritization of pts:
 ○​ 1. Unstable- 24 hrs post appendectomy => Expected
○​ 2. Unstable- 24 hrs post gastrectomy => Expected
○​ 3. Unstable- 10 hrs post realignment => Unexpected *** => Circulation (weak pulse)
○​ 4. Unstable- 6 hrs post prostatectomy => Expected
●​ Topic: RN provides care for which pt:
○​ 1. Acute asthma attack => Breathing & Acute ***
○​ 2. Cystic Fibrosis => Chronic
○​ 3. Osteomyelitis w/ Dressing change => Stable
○​ 4. Cerebral palsy receiving PT => stable
●​ Topic: Most Important Message to return:
○​ 1. Unstable => Airway (difficulty talking) ***
○​ 2. Unstable => no ABCs => out
○​ 3. Unstable => Chronic => no ABC
○​ 4. Unstable => no ABCs
●​ Topic: Best statement for HA, light sensitivity, rash, & napping:
○​ 1. Bring to ED *** => developed meningitis => halo traction => increased risk for meningitis =>
open holes to the brain
●​ Topic: Appropriate assignment for LVN:
○​ 1. 1 day post cleft repair => Airway
○​ 2. 1 day post umbilical hernia repair => no ABCs => not as invasive ***
○​ 3. Newly admitted nephrotic => Unstable
○​ 4. Harrington rod insertion => Invasive & Unstable
●​ Topic: Safest action for visiting hours:
○​ 3. Complete a survey of visitors => gather Assessment before Implementation
●​ Topic: Priority pt to see:
○​ 1. Stable; potential problem
○​ 2. Unstable; multiple myeloma (type of cancer) w/ back pain is expected
○​ 3. Unstable; unexpected; preop *** > chills could indicate infection => cannot go into OR w/
infection
○​ 4. Stable; expected
●​ Topic: Priority to see:
○​ 4. Close floor to admissions => close floor to admission prior to requesting more staff
●​ Topic: Staff for hip replacement recovery pt
○​ Years of experience do NOT matter!
○​ RN is the only one who can take new pts/Admits***
■​ LVN cannot do new admission paperwork
●​ Topic: Safest action for witnessing stealing- illegal:
○​ Chain of command for legal issues => report to your supervisor
●​ Topic: Priority pt to call:
○​ 1. Stable => expected
○​ 2. Stable => expected
■​ Itching at site of surgery is expected
○​ 3. Unstable => expected
■​ 1st sign of colon cancer is blood in stool => expected
○​ 4. Unstable => unexpected ***
■​ Lung cancer has nothing to do w/ urinary incontinence & difficulty ambulating
■​ Lung cancer travels to bladder & spine
●​ Topic: UAP tasks:
○​ 1. Standard, unchanging procedures => only things UAP can do
●​ Topic: Best response by Nurse for noncompliance:
○​ 3. Share with me your concerns
●​ Topic: Safest action for new left femur fracture:
○​ VS & newly admitted assessment can ONLY be performed by RN (not LVN/UAP)
●​ Topic: Priority pt:
○​ 1. Stable
○​ 2. Unstable => chronic => Airway ***
○​ 3. Stable
○​ 4. Stable
●​ Topic: Best Response:
○​ 4. Assessment prior to Implementation
●​ Topic: Best Statement to spouse:
○​ 3 => state objective data => difficulty breathing last night & started O2 at 4 L
○​ Words “worse or better” is Subjective Data => use Objective data when talking to pt & family
members***
●​ Topic: First action for nurse to take:
○​ 1 => review policy for this incident
○​ 2 => discussing w/ health care provider => not following chain of command
●​ Topic: Safest assignment for float nurse:
○​ 1. Post op => most stable w/ most expected outcome
■​ Float nurses can take care of post-op patients
○​ 2. Chronic => advanced stage cancer => unstable
■​ Bone metastasis is very unstable pt
○​ 3. Chronic cancer receiving chemotherapy => unstable
○​ 4. Pre op => new diagnosis for cancer => unstable
●​ Topic: Priority call to return:
○​ 2. HTN w/ pain between shoulder blades => Aortic Aneurysm => Unstable pt
●​ Topic: Safest Documentation about blistered areas on buttock
○​ Choose the most objective & detailed documentation
○​ Hallmark s/s of abuse => injury that does not match the hx/story
●​ Topic: Safest action for pt declining hemodialysis tx:
○​ 1. I => do not pass the buck => out
○​ 2. I => do not pass the buck => out
○​ 3. I => documentation => not done till problem is resolved
○​ 4. I => directly handles problem
●​ Topic: Delegate to UAP- standard, unchanging procedure:
○​ 1. I => 24 hr diet recall => plan of care for anorexia nervosa => not standard, unchanging
procedure => changes w/ each pt => evaluation of data
○​ 2. I => blood glucose/accucheck => standard, unchanging procedure
○​ 3. A => UAP cannot perform assessments => out
○​ 4. A => UAP cannot perform assessments => out
●​ Topic: Safe care for Vest Restraint for altered LOC:
○​ Vest restraints are more comfortable/less irritating for pts than extremity restraints
○​ NOTE: goal in US nursing care is Autonomy => do NOT do ALL of pt care
■​ Promote pt independence and autonomy
●​ Topic: Safest action for Float nurse:
●​ Topic: Safest action for RN:
○​ 1. Assess postop pt w/ expected outcome?
○​ 2. Out => potential problem not actual problem
 ○​ 3. Out => potential problem not actual problem
○​ 4. Implement => unstable pt w/ IV => only RN can do ***
■​ D/C an IV => Circulation
●​ Topic: Safest action of charge nurse to take for traveler RN:
○​ 1. Assess ***
○​ 2. Implement => out
○​ 3. Implement => out
○​ 4. Implement
●​ Topic: First medication to administer:
○​ 1. Morphine for MI + chest pain => expected & psychosocial => Circulation
■​ MI is more acute than BP
○​ 2. Enalapril for HF w/ edema => expected & chronic => Circulation
○​ 3. Nitroglycerin for hx of chest pain => not actual problem, potential
○​ 4. Nifedipine => BP 174/94 => unstable & actual problem => Circulation
■​ HTN is potential problem of stroke; MI is actual problem
●​ Topic: Safest action for delegation:
○​ 1. Pt education => only for RN => out
○​ 2. Abnormal finding => only for RN => out
○​ 3. Safe Delegation
○​ 4. Determining => only for RN => out
●​ Topic: Delegation for UAP:
○​ 1. VS for unstable pt => Cerebral aneurysm is Circulation ***
○​ 2. Out
○​ 3. Feeding for unstable pt => Potential Feeding problem => Airway problem
■​ Myasthenia Gravis => Always at risk for Aspiration => Acute problem, not Chronic
○​ 4. Out
●​ Topic: Unsafe Documentation:
○​ 3. Not objective/detailed documentation => “checked dilation & effacement”
●​ Topic: Safest action for illegal:
●​ Topic: Safest instruction from RN to UAP
●​ Topic: Priority pt to see:
○​ 2 day post mastectomy => Acute problem
○​ vs COPD w/ new meds => Chronic problem
○​ Inguinal hernia repair => outpatient survey, Not Acute problem
●​ Topic: Priority pt to see from Fire:
○​ 1. SOB => Airway & Breathing ***
○​ 2. Expected outcome => out
○​ 3. Severe pain + burns => out
○​ 4, disoriented, chest pain, pulse => Circulation
●​ Topic: Priority pt to see:
○​ 1. Purulent drainage => infection => no ABC
○​ 2, postop & unexpected => Breathing (dyspneic) ***
○​ 3. Unstable but expected no ABC
○​ 4. Unstable; no ABC
■​ “Something popped” after hysterectomy => stitches come undone
●​ Topic: priority pt to see:
○​ 1. Unstable; no ABC
○​ 2. Unstable; no ABC
○​ 3. Unstable’ Breathing***
 ○​ 4. Chest pain; Circulation

Safety & Infection Control (12%)

●​ Topic: Unsafe actions for Leukopenia:
○​ 1. Medium-rare steak => No raw/rare foods or sushi
○​ 2. Alcohol-based mouthwash => do NOT use alcohol based mouthwash
○​ 4. No planting/gardening => do NOT be in dirt
○​ 6. Leftovers => neutropenic should not eat leftovers
●​ Neutropenic Precautions:
○​ Positive pressure => don’t want anything to come in
○​ No dirt spores
○​ No rare, raw foods
○​ No flowers
○​ Avoid crowds & children
●​ Topic: First action for tornado => greatest good for the most people
○​ Close & shut shelter door
●​ Topic: Unsafe statement about Mono:
○​ Mononucleosis => liver & spleen get big => want to avoid anything that could potentially
damage the liver & spleen
■​ No contact or high impact sports
●​ Topic: Proper PPE:
○​ Gown, gloves, mak & goggles => Droplet Precautions ​
■​ Meningococcal meningitis
○​ Tuberculosis => Airborne Precautions
■​ Airborne Precautions is MTV => Measles, Tuberculosis & Varicella
○​ Varicella Zoster => Airborne
○​ Measles => Airborne
●​ Topic: Safest action for urinary catheter breaking sterility:
○​ 3 => safest action for pt to demonstrate procedure rather than allow new nurse to try again
●​ Topic: Initial action for HA, Nausea, irritable, confused:
○​ 1, Assess
○​ 2. Implement => Circulation => not applicable to situation
○​ 3. Assess => out
○​ 4. Assess => out
●​ Topic: Safest action for defib during code:
○​ Visually inspect to make sure no one is touching the pt
●​ Topic: Safest action for child w/ burns:
○​ Encourage child to ask questions => NOT age appropriate for preschool age child
○​ Put on gown & mask in front of pre-school child
●​ Topic: Seizure Precautions:
○​ Oxygen & suction equipment => needed for seizures
●​ Topic: First action for TB skin test:
○​ If pt is immunocompromised; you may not be able to amount a big response to TB
■​ Could be considered positive if they are 5 mm => impacts results
●​ Topic: Safest response about TB noncompliance:
●​ Topic: Highest risk for uterine infection:
○​ Premature ROM 72 hours prior to delivery
●​ Topic: Safe statements for AIDs/candida infection- Immunocompromised:
○​ Ok to share space w/ other people; Ok to wash clothes with others’ clothes
 ●​ Topic: Unsafe action for AIDS:
●​ Topic: Safest question for child w/ open bottle of tylenol:
●​ Topic: Roommate for post total hip replacement pt:
○​ 1. Infectious (c.diff?) => out
○​ 2. Noninfectious but immunocompromised (receiving steroids) => out
○​ 3. Noninfectious => mucous from muscular dystrophy & RT => out
○​ 4. Noninfectious ***
●​ Topic: First action for disoriented pt:
○​ 4 => Assess urine prior to calling provider
■​ UTI is biggest reason for older adults being confused
●​ Topic: Safest response for declining tx:
○​ If you have weight loss or decreased appetite => change from latent to active TB
●​ Topic: Safest response to chlamydia:
○​ Greatest good for the most amount of people
○​ Avoid all sex until you have been tested
●​ Topic: First action to take for anorexic cancer pt:

Health Promotion & Maintenance (9%)

●​ Topic: Unsafe statement by older pt:
○​ Older Adult Life Stage: Integrity vs. Despair
●​ Topic: Safest statement by nurse:
○​ Parallel play => playing separately but enjoying each other’s company
●​ Topic: First action for Impaired Circulation for pregnant women
○​ Rescue position for Pregnant women => Left side => get fetus off
○​ Dizzy & Faint => not getting enough blood to the brain => body will force you to faint
●​ Topic: VEAL CHOP:
○​ Administer O2 for Late Decels
●​ Topic: Safest action for dehydrated newborn:
○​ 6-8 wet diapers a day for newborn
○​ Do NOT give newborns water
●​ Topic: Unsafe assessment for newborn:
○​ Normal HR for newborns => 120-160 bpm
○​ Acrocyanosis for newborns => Normal
○​ Systolic BP of 65-80 is normal for newborns
○​ High pitch shrill cry => ABNORMAL => withdrawal symptom
○​ Newborns are belly breathers => chest breathing is ABNORMAL
○​ 30-60 bpm is normal RR for newborns
●​ Topic: Safest action for jerky movement of newborn:
○​ Spontaneous jerky movement of limbs => Seizure activity
○​ Hypoglycemia => reason for having seizure
■​ Normal BS for newborn is ~50
●​ Topic: Safest action for postpartum pt:
○​ Postpartum women are at high risk for bleeding/ hemorrhage
○​ Check lochia prior to VS
●​ Topic: Safest action for jaundiced & vomiting newborn:
○​ 1. Do nothing => out
○​ 2. Assess
○​ 3. Implementation for jaundice
○​ 4. Implementation => bring to ED => safest action for newborn
 ●​ Topic: Most unstable postpartum mom:
○​ Bleeding 1 pad every 1 hour => Hemorrhage
○​ Slight temp after birth is expected
○​ Slight burning upon urination after birth => expected
●​ Topic: Safest action for inability to urinate
○​ Bladder irrigation => clots that block pee from coming out
○​ Kink in irrigation system that is not allowing pee to come out

Psychosocial Integrity (9%)

●​ Depression S/S:
○​ Decreased interest in activities
○​ Decreased joy from activities
○​ Change in sleeping time
○​ Changes in eating pattern (over or under eating)
○​ Weight gain or weight loss
○​ Withdrawing from social events/activities
○​ Change in work habits & ADLs
○​ Depression scale => Screening to Diagnose Depression
■​ Positive depression screening => must screen for Suicide => ask if they have a plan
■​ Suicidal ideation & plan => pt must get admitted for safety
○​ Depression Pharmacological tx:
■​ SSRIs
●​ Prozac, zoloft, lexapro, etc
■​ Side Effects of SSRIs: ​
●​ Insomnia, weight gain, decreased libido
■​ Takes 2-3 weeks to work
○​ Depression Non Pharmacological tx:
■​ Socialization (may sit in silence next to them)
■​ Therapy (note: group therapy is not socialization)
■​ Open ended questions; explore “tell me more ...”
●​ Manic/Depressive episodes:
○​ Mania S/S:
■​ Insomnia (not sleeping for days), high risk behaviors, pressured speech, not taking care
of physical needs- dehydrated/unclean/etc, disruptiveness)
●​ Small frequent, high calorie snacks
■​ Pt in Manic episode should not go to group therapy/socialization => will be manipulative
& disruptive
●​ Small tasks that do not require lots of energy expenditure
●​ Short, attainable activities
○​ Pharmacological Tx:
■​ Lithium:
●​ Therapeutic blood levels need to be drawn
●​ Can lead to dehydration
●​ Schizophrenia:
○​ S/S:
■​ Disorganized thoughts, delusions, hallucinations (visual/tactile/olfactory), paranoia
○​ Non Pharmacological Tx:
■​ Reality based orientation => validate feelings but present reality; don’t explore
delusions/hallucinations
 ■​ Verbally redirect > redirect to room w/ lights off & door open (decrease stimulation) >
reorient to unit rules
○​ Pharmacological Tx:
■​ Antipsychotics => Haldol & Ativan *** => rescue medication
●​ Antipsychotic Side Effects:
○​ Tardive dyskinesia, extrapyramidal symptoms, etc
●​ Obsessive Compulsive Disorder (OCD):
○​ S/S:
■​ Repetitive movements that are irrational
○​ Non Pharmacological Tx:
■​ Note: rationalizing is NOT an effective treatment
■​ Distract
■​ “Provide more time’
●​ Anorexia Nervosa:

●​ Topic: Unstable Pt:

○​ Akathisia => agitation, restlessness, distress
○​ Tardive dyskinesia => repetitive, involuntary movement from long-time use of psych drugs
○​ Oculogyric crisis => sporadic movement of eyeballs
○​ Neuroleptic Malignant Syndrome => extreme fever, change LOC, muscle rigidity, acute
syndrome from use of psych drugs => Life-Threatening => Medical Emergency!!
●​ Topic: Safest action for agitation:
○​ Reduce environmental stimuli to help pt calm down
●​ Topic: First question for upset parent:
○​ Find out effective coping mechanisms
●​ Topic: Safest action for depressed pt:
○​ Socialize w/ pt => sit w/ client
●​ Topic: Safest statement for Suicide
●​ Topic: Safest activity for manic pt:
○​ Manic pt should not be left alone but not unsupervised
○​ Should not join social activities/ support groups => can be manipulative
●​ Topic: Safest action for dizziness:
○​ Lithium side effect is dehydration => instruct pt to drink more water
●​ Topic: Safest response for delusional pt:
○​ Address pt’s feelings & then reality base orient
●​ Topic: Prioritization for calling back- pt w/ Haldol:
○​ 2 > 4 > 3 > 1
○​ “Tongue keeps moving” => tardive dyskinesia
●​ Topic: Safest action for verbally abusive pt
●​ Topic: Safest activity for depressed pt:
○​ Socialization for depressed pt => eg cooking a meal w/ pts
Study Plan
●​ Goal: > 60% for each Client Needs Category ***
●​ Question Trainer 2-7 + Remediation
●​ Qbank for each Client Needs Category
○​ Use Qbank only for specific categories that you are scoring lowest in
●​ RN NCLEX Sample Tests 1-4 & Remediate
●​ Readiness Test => Last Test prior to taking NCLEX => Most Predictive of Passing NCLEX
○​ 1 Week before NCLEX & Remediate
○​ Do NOT study 1 day before NCLEX!
●​ NGN => New Generation NCLEX => No Need to Do

RN Practice Test:
●​ Topic: Most unsafe assessment from pt w/ tonic clonic seizures :
○​ 1. Unstable => no ABCs =>
○​ 2. Stable => out
○​ 3. Unstable => no ABCs
○​ 4. Unstable => expected => out
●​ Topic: Safest action to take w/ increased BP & decreased LOC:
○​ 1. Do Nothing => out
○​ 2. Implement => Zofran for nausea => out
○​ 3. Assess => 12 lead EKG
●​ Topic: Safest statement in Postpartum:
○​ 1. True & Safe
○​ 2. Untrue & Unsafe => out
○​ 3. True & Safe
○​ 4. Untrue => out
●​ Topic: Safest response regarding HA after Dialysis:
○​ 1. Dismissing concerns => out
○​ 2. True
●​ Topic: Safest action for inguinal hernia:
○​ 1. Implement
○​ 2. Implement => untrue => out
○​ 3. Implement =>
○​ 4. Implement => untrue => out
●​ Topic: Safe actions for Mech Ventilation w/ Peep:
○​ 1. Safe
○​ 2. Safe
○​ 3. Untrue
○​ 4. Untrue
○​ 5. Safe
●​ Topic: First action for suctioning trach:
○​ 1. Elevate HOB
●​ Topic: Most stable pt:
○​ 1. Stable => normal mag level
○​ 2. Unstable
○​ 3. Unstable => high Dig level
○​ 4. Unstable
●​ Topic: Most important lab for AKI:
○​ 1. Blood glucose => out
○​ 2. Uric acid => out
○​ 3. Protein =>
○​ 4. Urine specific gravity => tells about state of kidneys
●​ Topic: Safest action for Minor:
●​ Topic: Safest statement for MS with decreased ADLS:
○​ 1. Irrelevant
○​ 2. Irrelevant
●​ Topic: Safest response for non compliant pt:
○​ 1. Out
○​ 2. Pass the buck => out
○​ 3. Out
●​ Topic: Safe statements for BMA:
○​ 1. Untrue
○​ 2. Untrue
○​ 3. True
○​ 4. True
○​ 5. True
●​ Topic: Safest response for arguing spouse:
○​ 1. Assess
○​ 2. Out
○​ 3. Out
○​ 4. Out
●​ Topic: Safe Actions for Gtube feedings:
○​ 1. Untrue
○​ 2. Untrue
○​ 3. True ??
○​ 4. True
○​ 5. Untrue
●​ Topic: Most unsafe statement regarding abuse:
○​ 1. Unsafe
○​ 2. Out
○​ 3. Out
○​ 4. Unsafe
●​ Topic: Safest action for anti-embolism stockings:
○​ 1. Assess => relevant => out
○​ 2. Assess => relevant
○​ 3. Assess => irrelevant => out
○​ 4. Assess => relevant
●​ Topic: Unsafe statements for older pt w/ fractures:
○​ 1. Unsafe
○​ 2. Safe => out
○​ 3. Safe => out
○​ 4. Safe => out
○​ 5. Unsafe
○​ 6. Unsafe
●​ Topic: MedMath- mL/dose
○​ 50 mg/kg x 8.181818 kg = 409.0909 mg
 ○​ 409.0909 mg / 125 mg X 5 mL = 16.363636 mL
●​ Topic: Safe statements about AIDS:
○​ 1. Safe
○​ 2. Unsafe
○​ 3. Unsafe
○​ 4. Untrue
○​ 5. Safe
●​ Topic: Safest action for PN through PICC:
○​ 1. Assess => irrelevant => out
○​ 2. Assess =>
●​ Topic: Findings for Hemolytic Rxn:
○​ 1. True
○​ 2. False => out
○​ 3. False => out
○​ 4. True
○​ 5. Urticaria => Red rashes/hives => True
○​ 6. True
●​ Topic: Unsafe action w/ PICC:
○​ 1.Unsafe => discard 3-5 cc?
○​ 2. Safe => out
○​ 3. Safe => out
○​ 4. Safe => out
●​ Topic: Unsafe statement for suicide:
○​ 1. True => out
○​ 2. True => out
○​ 3. True => out
●​ Topic: Safest action for HF w/ VTach?
○​ 1. Implement
○​ 2. Implement => Valsalva
○​ 3. Assess => relevant
○​ 4. Assess => Irrelevant => out
●​ Topic: Unsafe statement regarding dumping syndrome:
○​ 1. Unsafe
○​ 2. Safe => out
○​ 3. Safe => out
○​ 4. Safe => out
●​ Topic: Safest action for heat stroke/dehydration:
○​ 1. Out
○​ 2. Implement => Safe
○​ 3. Assess => irrelevant
○​ 4. Implement => Safe
●​ Topic: Safest action for Wrong Documentation:
○​ 1. Out
○​ 2. True
○​ 3. Out
○​ 4. True
●​ Topic: Safest action for concerned pt:
○​ 1. Out
○​ 2. Out
 ○​ 3. Safe
○​ 4. Pass the Buck => Out
●​ Topic: Safest statement for spinal cord injury pts:
○​ 1. Out
○​ 2.
○​ 3. Out
●​ Topic: Unsafe LVN pt Assignment:
○​ 1. Safe
○​ 2. Unsafe => Croup is Airway/Breathing
○​ 3. Safe
○​ 4. Safe
●​ Topic: Safest statement for metoclopramide prior to cisplatin: ***
●​ Topic: First action for unsafe nurse:pt ratio:
○​ 1. Do Nothing => out
○​ 2. Out
●​ Topic: Safest question for Stroke:
●​ Topic: Safest action for potential child abuse:
○​ 1. Assess => irrelevant
○​ 2. Implement => psychosocial
○​ 3. Implement
●​ Topic: First action for collision w/ unconsciousness:
○​ 1. Assess => relevant => no ABCs
○​ 2. Assess => irrelevant => Circulation
○​ 3. Assess => relevant => no ABCs
○​ 4. Assess => relevant => Breathing
●​ Topic: Safest response for overwhelmed pt:
○​ 1. Out
○​ 2.
○​ 3. Out
○​ 4. Out
●​ Topic: First action for Diabetes Insipidus:
○​ 1. Implement => irrelevant
○​ 2. Implement => relevant
○​ 3. Assess => irrelevant
○​ 4. Implement => relevant => Circulation
●​ Topic: First action for morphine administration:
○​ 1.
○​ 2. Out
○​ 3. Out
●​ Topic: Unsafe findings for rheumatoid arthritis:
○​ 1. WBC 14 => high => expected ?
○​ 2. CRP 1.2 => normal => out
○​ 3. Hgb 9 => low => unexpected
○​ 4. Not relevant => out
●​ Topic: Safe actions documented for Restraints:
○​ 1. Unsafe => out
○​ 2. Safe
○​ 3. Unsafe => side rails are moving => out
○​ 4. Safe
 ○​ 5. Safe
○​ 6. Unsafe
●​ Topic: MedMath- mL/hr:
○​ 0.3 mcg/kg/min x 80 kg = 24 mcg/min
○​ 176 lbs / 2.2 = 80 kg
○​ 24 mcg/min / 1000 mcg/mg = 0.024 mg/min x 60 min/hr = 1.44 mg/hr
○​ 1.44 mg/hr / 50 mg x 250 mL = 7.2 mL/hr
●​ Topic: Blood Glucose location
●​ Topic: Safest action for resistance w/ bladder cath:
○​ 1.
○​ 2. Out
○​ 3. Out
●​ Topic: Safest response for clumsy child:
○​ 1. Out
○​ 2. Assess
○​ 3. Out
○​ 4. Out
●​ Topic: First action for continuous chest tube bubbling:
○​ 1. Implement
○​ 2. Implement => out
○​ 3. Implement => out
○​ 4. Assess
●​ Topic: Safe action for sterility:
○​ 1. Out
○​ 2.
●​ Topic: Safest action for safety events:
○​ 1. Implement
○​ 2. Out
○​ 3. Out
○​ 4. Out
●​ Topic: Safest response for Vertigo:
○​ 1. Out
○​ 2. Stress => relevant
○​ 3. Out => irrelevant
●​ Topic: Expected finding after chest tube insertion:
○​ 1. Unexpected
○​ 2. Unexpected => hemothorax
●​ Topic: First action for pt w/ SOB, crackles in lung
●​ Topic: Unsafe action of UAP:
○​ 1. Safe => out
○​ 2. Unsafe => not routine?
○​ 3. Safe => out
○​ 4. Unsafe
●​ Topic: Safest response for concerned LVN:
●​ Topic: First pt to see in postpartum:
○​ 1. Out => expected
○​ 2. Unexpected => hemorrhage
○​ 3. Out => expected
○​ 4. Expected
●​ Topic: First action for SOB w/ chemical exposure
●​ Topic: Safest statement for transdermal patch: ​
○​ 1. True
○​ 2. False => out
○​ 3. True
○​ 4. False => out
●​ Topic: Safest response for depressed pt:
○​ 1. Out
○​ 2. Assess
○​ 3. Out
○​ 4. Assess
●​ Topic: Safest action for underweight older pt:
○​ 1. Out
○​ 2. Out
●​ Topic: Safest action for stroke:
●​ Topic: Safest response for upset student: