2023 NCLEX Child Care Preparation Test Study Guide With Answers (394 Solved Questions)

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DO NOT delegate what you can EAT!E - evaluateA - assessT - teachaddisons= down, down down up downcushings= up up up down upaddisons= hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemiacushings= hypernatremia, hypertension, incrased blood vol, hypokalemia, hyperglycemiaNo Pee, no K (do not give potassium without adequate urine output)EleVateVeins; dAngleArteries for better perfusionA= appearance (color all pink, pink and blue, blue [pale])P= pulse (>100, < 100, absent)G= grimace (cough, grimace, no response)A= activity (flexed, flaccid, limp)R=respirations(strong cry, weak cry, absent)TRANSMISSION-BASED PRECAUTIONS:AIRBORNEMy - MeaslesChicken - Chicken Pox/VaricellaHez - Herpez Zoster/ShinglesTBor remember...MTV=AirborneMeaslesTBVaricella-Chicken Pox/Herpes Zoster-ShinglesPrivate Room - negative pressure with 6-12 air exchanges/hrMask, N95 for TBDROPLETthink of SPIDERMAN!S - sepsisS - scarlet feverS - streptococcal pharyngitisP - parvovirus B19P - pneumoniaP - pertussisI - influenzaD - diptheria (pharyngeal)E - epiglottitisR - rubellaM - mumpsM - meningitisM - mycoplasma or meningeal pneumoniaAn - AdenovirusPrivate Room or cohortMask1A MUST READ NCLEX GUIDE BEFORE TEST

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CONTACT PRECAUTIONMRS.WEEM - multidrug resistant organismR - respiratory infectionS - skin infections *W - wound infxnE - enteric infxn - clostridium difficileE - eye infxn - conjunctivitisSKIN INFECTIONSVCHIPSV - varicella zosterC - cutaneous diphtheriaH - herpez simplexI - impetigoP - pediculosisS - scabies1.Air/Pulmonary Embolism(S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic,sense of impending doom) --> turn pt toleftside andlowerthe head of the bed.2.Woman in Labor w/ Un-reassuring FHR(late decels, decreased variability, fetalbradycardia, etc) --> turn onleftside (and give O2, stop Pitocin, increase IV fluids)3.Tube Feeding w/ Decreased LOC--> position pt onrightside (promotes emptying of thestomach) with theHOB elevated(to prevent aspiration)4.During Epidural Puncture-->side-lying5.After Lumbar Puncture(and also oil-based Myelogram)--> pt lies inflat supine(to preventheadache and leaking of CSF)6.Pt w/ Heat Stroke--> lieflatw/legs elevated7.During Continuous Bladder Irrigation(CBI) --> catheter is taped to thigh so leg should bekept straight. No other positioning restrictions.8.After Myringotomy--> position on side ofaffected earafter surgery (allows drainage ofsecretions)9.After Cataract Surgery--> pt will sleep onunaffected sidewith a night shield for 1-4weeks.10.After Thyroidectomy--> low or semi-Fowler's, support head, neck and shoulders.11.Infant w/ Spina Bifida--> positionprone(on abdomen) so that sac does not rupture12.Buck's Traction(skin traction) --> elevate foot of bed for counter-traction13.After Total Hip Replacement--> don't sleep on operated side, don't flex hip more than 45-60 degrees, don't elevate HOB more than 45 degrees. Maintain hip abduction by separatingthighs with pillows.14.Prolapsed Cord--> knee-chest position or Trendelenburg2

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15.Infant w/ Cleft Lip--> position on back or in infant seat to prevent trauma to suture line.While feeding, hold in upright position.16.To Prevent Dumping Syndrome(post-operative ulcer/stomach surgeries) --> eat inreclining position, lie down after meals for 20-30 minutes (also restrict fluids during meals, lowCHO and fiber diet, small frequent meals)17.Above Knee Amputation--> elevate for first 24 hours on pillow, position prone daily toprovide for hip extension.18.Below Knee Amputation--> foot of bed elevated for first 24 hours, position prone daily toprovide for hip extension.19.Detached Retina--> area of detachment should be in the dependent position20.Administration of Enema--> position pt inleft side-lying(Sim's) with knee flexed21.After Supratentorial Surgery(incision behind hairline) --> elevate HOB 30-45 degrees22.After Infratentorial Surgery(incision at nape of neck)--> position ptflatand lateral oneither side.23.During Internal Radiation--> onbedrestwhile implant in place24.Autonomic Dysreflexia/Hyperreflexia(S&S: pounding headache, profuse sweating, nasalcongestion, goose flesh, bradycardia, hypertension) --> place client insitting position (elevateHOB) first before any other implementation.25.Shock--> bedrest with extremities elevated 20 degrees, knees straight, head slightlyelevated (modified Trendelenburg)26.Head Injury--> elevate HOB 30 degrees to decrease intracranial pressure27.Peritoneal Dialysis when Outflow is Inadequate--> turn pt from side to side BEFOREchecking for kinks in tubing (according to Kaplan)28.Lumbar puncture=> AFTER the procedure, the client should be placed in the supineposition for 4 to 12 hrs as prescribed. (Saunders 3rd ed p. 229)Demorol for pancreatitis, NOT morphine sulfateMyasthenia Gravis: worsens with exercise and improves with rest.Myasthenia Crisis: a positive reaction to Tensilon--will improve symptomsCholinergic Crisis: caused by excessive medication-stop med-giving Tensilon will make it worseHead injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS usefilter needlePrior to a liver biospy its important to be aware of the lab result for prothrombin timeFrom the a** (diarrhea)= metabolic acidosisFrom the mouth (vomitus)=metabolic alkalosisMyxedema/hypothyroidism: slowed physical and mental function, sensitivity to cold, dry skinand hair3

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Graves’ disease/hyperthyroidism:accelerated physical and mental function; sensitivity toheat, fine/soft hairThyroid storm:increased temp, pulse and HTNPost-thyroidectomy:semi-Fowler’s, prevent ncek flexion/hyperextension, trach at bedsideHypo-parathyroid:CATS – convulsions, arrhythmias, tetany, spasms, stridor (decreasedcalcium), high Ca, low phosphorus dietHyper-parathyroid: fatigue, muscle weakness, renal calculi, back and joint pain (increasedcalcium), low Ca, high phosphorus dietHypovolemia– incrased temp, rapid/weak pulse, increase respiration, hypotension, anxiety,urine specific gravity >1.030Hypervolemia– bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urinespecific gravity <1.010; Semi-Fowler’sDiabetes Insipidus (decreased ADH):excessive urine output and thirst, dehydration,weakness, administer PitressinSIADH (increased ADH):change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a,HA; administer Declomycin, diureticsHypokalemia: muscle ewakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges,beans, potatoes, carrots, celery)Hyperkalemia:MURDER – muscle weakness, urine (oliguria/anuria), respiratory depression,decreased cardiac contractility, ECG changes, reflexesHyponatremia: nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmoticdiuretics, fluidsHypernatremia:increased temp, weakness, disorientation/delusions, hypotension, tachycardia;hypotonic solutionHypocalcemia:CATS – convulsions, arrhythmias, tetany, spasms and stridorHypercalcemia: muscle weakness, lack of coordination, abdominal pain, confusion, absenttendon reflexes, sedative effect on CNSHypoMg: tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicityHyperMg:depresses the CNS, hypotension, facial flushing, muscle ewakness, absent deeptendon reflexes, shallow respirations, emergencyAddison’s: hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress,fractures, alopecia, weight loss, GI distressCushings:hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness,edema, HTN, hirsutism, moonface/buffalo humpAddisonian crisis:n/v, confusion, abdominal pain, extreme weakness, hypoglycemia,dehydration, decreased BPPheochromocytoma: hypersecretion of epi/norepi, persistent HTN, increased HR,hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks,avoid cold and stimulating foods, surgery to remove tumor1. Neuroleptic malignant syndrome (NMS):-NMS is like S&M;-you get hot (hyperpyrexia)-stiff (increased muscle tone)-sweaty (diaphoresis)-BP, pulse, and respirations go up &-you start to drool4

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2. I kept forgetting which was dangerous when you're pregnant; regular measles (rubeola), orGerman measles (rubella), so remember:-never get pregnant with a German (rubella)3. When drawing up regular insulin & NPH together, remember:-RN (regular comes before NPH)4. Tetralogy of fallot; remember HOPSThink DROP(child drops to floor or squats) or POSHDefect, septalRight Ventricular hypertrophyOverriding aortsPulmonary stenosis5. MAOI's that are used as antidepressants:weird way to remember, I know. pirates say arrrr, so think; pirates take MAOI's when they'redepressed.- explanation; MAOI's used for depression all have an arrr sound in the middle (Parnate, Marplan,Nardil)Autonomic dysreflexia: potentially life threatening emergency- elevate head of bed to 90 degree- loosen constrictive clothing- assess for bladder distention and bowel impaction (triger)- Administer antihypertensive meds (may cause stroke, MI, seisure )easy way to remember MAOI'S!think of PANAMA!PA - parnateNA - nardilMA - marplanmetallic bitter taste.Digoxin-check pulse, less than 60 hold, check dig levels and potassium levels.Amphojel: tx of GERD and kidney stones....watch out for contipation.Vistaril: tx of anxiety and also itching...watch for dry mouth. given preop commonlyVersed: given for conscious sedation...watch for resp depression and hypotensionPTU and Tapazole- prevention of thyroid stormSinemet: tx of parkinson...sweat, saliva, urine may turn reddish brown occassionally...causesdrowsinessArtane: tx of parkinson..sedative effect alsoCogentin: tx of parkinson and extrapyramidal effects of other drugsTigan: tx of postop n/v and for nausea associated with gastroenteritisTimolol (Timoptic)-tx of gluacoma5

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Bactrim: antibiotic..dont take if allergic to sulfa drugs...diarrhea common side effect...drink plentyof fluidsGout Meds: Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim)Apresoline(hydralazine)-tx of HTN or CHF, Report flu-like symptoms, rise slowly from sitting/lyingposition; take with meals.Bentyl: tx of irritable bowel....assess for anticholinergic side effects.Calan (verapamil): calcium channel blocker: tx of HTN, angina...assess for constipationCarafate: tx of duodenal ulcers..coats the ulcer...so take before meals.Theophylline: tx of asthma or COPD..therap drug level: 10-20Mucomyst is the antedote to tylenol and is administered orallyDiamox: tx of glaucoma, high altitude sickness...dont take if allergic to sulfa drugsIndocin: (nsaid) tx of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis.Synthroid: tx of hypothyroidism..may take several weeks to take effect...notify doctor of chestpain..take in the AM on empty stomach..could cause hyperthyroidism.Librium: tx of alcohol w/d...dont take alchol with this...very bad nausea and vomiting can occur.Oncovin (vincristine): tx of leukemia..given IV ONLYkwell: tx of scabies and lice...(scabies)apply lotion once and leave on for 8-12 hours...(lice) usethe shampoo and leave on for 4 minutes with hair uncovered then rinse with warm water andcomb with a fine tooth combPremarin:tx after menopause estrogen replacementDilantin: tx of seizures. thera drug level: 10-20Navane: tx of schizophrenia..assess for EPSRitalin: tx of ADHD..assess for heart related side effects report immediately...child may need adrug holiday b/c it stunts growth.dopamine (Intropine): tx of hypotension, shock, low cardiac output, poor perfusion to vitalorgans...monitor EKG for arrhythmias, monitor BPHave trouble remembering fhr patterns in OB? Think VEAL CHOPV CE HA OL PV = variable decels; C = cord compression causedE = early decels; H = head compression causedA = accels; O = okay, not a problem!L = late decels = placental insufficiency, can't fill6

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For cord compression, place the mother in the TRENDELENBERG position because this removespressure of the presenting part off the cord. (If her head is down, the baby is no longer beingpulled out of hte body by gravity)If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and tominimize infection.For late decels, turn the mother to her left side, to allow more blood flow to the placenta.For any kind of bad fetal heart rate pattern, you give O2, often by mask...When doing an epidural anesthesia hydration before hand is a priority.Hypotension and bradypnea / bradycardia are major risks and emergencies.NEVER check the monitor or a machine as a first action. Always assess the patient first; forexmaple listen to the fetal heart tones with a stethoscope in NCLEX land. Sometimes it's hard totell who to check on first, the mother or the baby; it's usually easy to tell the right answer if themother or baby involves a machine. If you're not sure who to check first, and one of the choicesinvolves the machine, that's the wrong answer.If the baby is a posterior presentation, the sounds are heard at the sides.If the baby is anterior, the sounds are heard closer to midline, between teh umbilicus and whereyou would listen to a posterior presentation.If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby isvertex, they are a little bit above the symphysis pubis.Also for ventilator alarmsHOLDHigh alarm-Obstruction due to incr. secretions, kink, pt. coughs, gag or bitesLow press alarm-Disconnection or leak in ventilatior or in pt. airway cuff, pt. stops spontaneousbreathing1. to remember blood sugar:hot and dry-sugar high (hyperglycemia)cold and clammy-need some candy (hypoglycemia)2. ICP AND SHOCK HAVE OPPOSITE V/SICP-increased BP, decreased pulse, decreased resp.shock- decreased BP, increased pulse, increased resp.3. cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema, jvd, ifit is a choice.)4. herion withdrawal neonate: irratable poor sucking5. Jews: no meat and milk together6. Brachial pulse: pulse area cpr on an infant.7. Test child for lead poisioning around 12 months of age8. bananas, potatoes, citrus fruits source of potassium11. Cultures are obtained before starting IV antibiotics7

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12. a pt with leukemia may have epitaxis b/c of low platelets13. best way to warm a newborn: skin to skin contact covered with a blanket on mom.14. when a pt comes in and she is in active labor...nurse first action is to listen to fetal hearttone/rate15. phobic disorders...use systematic desensitiztion.NCLEX TIPS1. When getting down to two answers, choose the assessment answer (assess,collect, auscultate, monitor, palpate) over the intervention except in anemergency or distress situation. If one answer has an absolute, discard it.Give priority to answers that deal directly to the patient’s body, not themachines/equipments.2. Key words are very important. Avoid answers with absolutes for example:always, never, must, etc.3. with lower amputations patient is placed in prone position.4. small frequent feedings are better than larger ones.5. Assessment, teaching, meds, evaluation, unstable patient cannot bedelegated to an Unlicensed Assistive Personnel.6. LVN/LPN cannot handle blood.7. Amynoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity.8. IV push should go over at least 2 minutes.9. If the patient is not a child an answer with family option can be ruledout easily.10. In an emergency, patients with greater chance to live are treated first11. ARDS (fluids in alveoli), DIC (disseminated intravascular coagulaton)are always secondary to something else (another disease process).12. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).13. in pH regulation the 2 organs of concern are lungs/kidneys.14. edema is in the interstitial space not in the cardiovascular space.15. weight is the best indicator of dehydration16. wherever there is sugar (glucose) water follows.17. aspirin can cause Reye’s syndrome (encephalopathy) when given tochildren18. when aspirin is given once a day it acts as an antiplatelet.19. use Cold for acute pain (eg. Sprain ankle) and Heat for chronic (rheumatoid arthritis)20. guided imagery is great for chronic pain.21. when patient is in distress, medication administration is rarely a goodchoice.22. with pneumonia, fever and chills are usually present. For the elderlyconfusion is often present.23. Always check for allergies before administering antibiotics (especiallyPCN). Make sure culture and sensitivity has been done before adm. First doseof antibiotic.24. Cor pulmonale (s/s fluid overload) is Right sided heart failure causedby pulmonary disease, occurs with bronchitis or emphysema.25. COPD is chronic, pneumonia is acute. Emphysema and bronchitis areboth COPD.26. in COPD patients the baroreceptors that detect the CO2 level aredestroyed. Therefore, O2 level must be low because high O2 concentration8

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blows the patient’s stimulus for breathing.27. exacerbation: acute, distress.28. epi always given in TB syringe.29. prednisone toxicity: cushing’s syndrome= buffalo hump, moon face, highglucose, hypertension.30. 4 options for cancer management: chemo, radiation, surgery, allow todie with dignity.31. no live vaccines, no fresh fruits, no flowers should be used forneutropenic patients.32. chest tubes are placed in the pleural space.33. angina (low oxygen to heart tissues) = no dead heart tissues. MI=dead heart tissue present.34. mevacor (anticholesterol med) must be given with evening meal if it isQD (per day).35. Nitroglycerine is administered up to 3 times (every 5 minutes). Ifchest pain does not stop go to hospital. Do not give when BP is < 90/60.36. Preload affects amount of blood that goes to the R ventricle.Afterload is the resistance the blood has to overcome when leaving the heart.37. Calcium channel blocker affects the afterload.38. for a CABG operation when the great saphenous vein is taken it isturned inside out due to the valves that are inside.39. unstable angina is not relieved by nitro.40. dead tissues cannot have PVC’s(premature ventricular contraction. Ifleft untreated pvc’s can lead to VF (ventricular fibrillation).41. 1 t (teaspoon)= 5 ml1 T(tablespoon)= 3 t = 15 ml1 oz= 30 ml1 cup= 8 oz1 quart= 2 pints1 pint= 2 cups1 gr (grain)= 60 mg1 g (gram)= 1000 mg1 kg= 2.2 lbs1 lb= 16 oz* To convert Centigrade to F. F= C+40, multiply 9/5 and substract 40* To convert Fahrenheit to C. C= F+40, multiply 5/9 and substract 40.42. angiotensin II in the lungs= potent vasodialator. Aldosterone attractssodium.43. REVERSE AGENTS FOR TOXICITYheparin= protamine sulfatecoumadin= vitamin kammonia= lactuloseacetaminophen= n-Acetylcysteine.Iron= deferoxamineDigitoxin, digoxin= digibind.Alcohol withdraw= Librium.- methadone is an opioid analgesic used to detoxify/treat pain innarcotic addicts.- Potassium potentiates dig toxicity.44. heparin prevents platelet aggregation.45. PT/PTT are elevated when patient is on coumadin46. cardiac output decreases with dysrythmias. Dopamine increases BP.47. Med of choice for Vtach is lidocaine48. Med of choice for SVT is adenosine or adenocard49. Med of choice for Asystole (no heart beat) is atropine9

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50. Med of choice for CHF is Ace inhibitor.51. Med of choice for anaphylactic shock is Epinephrine52. Med of choice for Status Epilepticus is Valium.53. Med of choice for bipolar is lithium.54. Amiodorone is effective in both ventricular and atrial complications.55. S3 sound is normal in CHF, not normal in MI.56. give carafate (GI med) before meals to coat stomach57. Protonix is given prophylactically to prevent stress ulcers.58. after endoscopy check gag reflex.59. TPN(total parenteral nutrition) given in subclavian line.60. low residue diet means low fiver61. diverticulitis (inflammation of the diverticulum in the colon) pain isaround LL quadrant.62. Appendicitis (inflammation of the appendix) pain is in RL quadrant withrebound tenderness.63. portal hypotension + albuminemia= Ascites.64. beta cells of pancreas produce insulin65. Morphine is contraindicated in Pancreatitis. It causes spasm of theSphincter of Oddi. Therefore Demerol should be given.66. Trousseau and Tchovoski signs observed in hypocalcemia67. with chronic pancreatitis, pancreatic enzymes are given with meals.68. Never give K+ in IV push.69. mineral corticoids are give in Addison’s disease.70. Diabetic ketoacidosis (DKA)= when body is breaking down fat instead ofsugar for energy. Fats leave ketones (acids) that cause pH to decrease.71. DKA is rare in diabetes mellitus type II because there is enoughinsulin to prevent breakdown of fats.72. Sign of fat embolism is petechiae. Treated with heparin.73. for knee replacement use continuous passive motion machine.74. give prophylactic antibiotic therapy before any invasive procedure.75. glaucoma patients lose peripheral vision. Treated with meds76. cataract= cloudy, blurry vision. Treated by lens removal-surgery77. Co2 causes vasoconstriction.78. most spinal cord injuries are at the cervical or lumbar regions79. autonomic dysreflexia ( life threatening inhibited sympathetic responseof nervous system to a noxious stimulus- patients with spinal cord injuriesat T-7 or above) is usually caused by a full bladder.80. spinal shock occurs immediately after spinal injury81. Multiple sclerosis= myelin sheat destruction, disruption in nerveimpulse conduction.82. myasthenia gravis= decrease in receptor sites for acetylcholine. Sincesmallest concentration of ACTH receptors are in cranial nerves, expect fatigueand weakness in eye, mastication, pharyngeal muscles.83. Tensilon test given if muscle is tense in myasthenia gravis.84. Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratorysystem.85. parkinson’s = RAT: rigidity, akinesia (loss of muscle mvt), tremors.Treat with levodopa.86. TIA (transient ischemic attack) mini stroke with no dead brain tissue87. CVA (cerebrovascular accident) is with dead brain tissue.88. Hodgkin’s disease= cancer of lymph is very curable in early stage.89. Rule of NINES for burnsHead and Neck= 9%Each upper ext= 9%Each lower ext= 18%10

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