1.

Paracenteses procedure – pierce cathether into peritoneal cavity to drain it

a. Consent signed?
b. Assess labs – albumin, protein, amylase, BUN, creatinine
c. Gather equipment
d. Has pt voided? Insert foley cath it needed
e. Lie on back with arms above head HOB elevated
f. Baseline vitals
g. Adm IV bolus albumin prior to or after paracentesis to restore fluid balance

2. Portal HTN – increased resistance to blood flow through liver b/c of damaged liver cells causes high BP in liver. Dur to collateral
circulation the abdominal cavity is able to accept increased fluid volumes that the body is unable to get rid of (ascites)
a. Normal portal pressure is 5-10 mmHg

3. Ascites causes dehydration, kidney can’t get rid of fluid (manifestation of portal HTN)
a. Hyperaldosteronism too much is causing fluid retention
b. Hypoalbuminemia from dilutional effect
c. ↓ urinary output = Pt is Dehydrated

4. s/s dehydration
a. hypernatremia, hyperkalemia
b. tachycardia
c. poor skin turgor
d. beefy red tongue

5. Ascites – causes dilutional effect of lab values (low values) from excessive fluid accumulation

6. Hepatitis – yellow if ducts are blocked, how do you check for jaundice
a. Puritis, the body will find a way to expel the toxins, as the toxins leave through the skin it make sot itchy
b. Yellow sclerdoma (eyes)

7. Sengstaken-Blakemore tube & priority intervention – control bleeding, prevent complications

a. Vasopressin - Control hemorrhage/bleeding
b. Establish lg bore IV access – for possible blood transfusions & high vol fluids
c. Monitor VS & H&H
d. Type & crossmatch for possible blood transfusion
e. Monitor for overt & occult bleeding

8. Therapeutic response intoxicated intubated patient

a. Provide a calm, quiet environment. Speak softly and calmly. Remove as much stimulation as possible
b. Tell the patient where they are, what the date is and who you are

9. Early s/s of ARDS at cellular level

a. acute injury/insult ↓ blood flow to lungs → platelets aggregate initiating inflammatory response releasing histamines
(H), serotonin (S) and bradykinin (B)

10. Pain mgnt in blunt chest trauma – morphine

a. Place pt in fowlers
b. Adm pain meds to maintain adequate ventilation
c. Monitor resp status
d. Self-splint
e. Prepare pt for intercoastal nerve block if pain is severe

11. Manifestation of metabolic & respiratory alkalosis – select all

a. Metabolic Alkalosis – decrease pts resp rate; GI suction, vomiting, hypokalemia, vol depletion (diuretics), antacids,
corticosteroids, Cushing’s disease & aldosteronism
 i. Confusion, belligerence, coma, seizures, tetany
ii. Arrythmias, Hyper-irritable muscle reflexes
iii. Slow respirations, numbness, tingling & weakness

b. Respiratory Alkalosis – breathe into paper bag, calm & sedate pt, decrease fever, sepsis, trauma
i. Hyperventilating, rapid shallow breathing (too much CO2 expelled)
ii. (4 T’s) Tachycardia, tingling in fingers & toes, tinnitus, tetany
iii. Confusion, irritable, dizzy

12. Mechanical ventilation & worse or getting better pg114 ATI

a. Hypoxemia (Refractory), hypotension, decreased urine output – worse
b. Spontaneous breaths - better

13. Heparin & Coumadin, mixing them together

a. Initially take bot medications b/c warfarin (coumadin) takes 5-7 days to take effect
i. Low molecular weight Heparin antidote – protamine sulfate
ii. Coumadin(warfarin) antidote – vit K
iii. Others: Factor Xa inhibitor, humanized monoclonal-antibody fragment & synthetic small molecule

14. LPN what can you assign, when do you intervene – can’t do blood draws, can’t start PICC line
a. Can change some IV piggy-back meds
b. Can give all oral medications, VS, changing bandages, catheters & IV’s
c. Can feed patients who are unable to feed themselves
d. Can Keep detailed records of patients’ overall health
e. Can report any changes in patients’ health to doctors and nurses
f. Can collect routine lab samples – urine, feces, saliva

15. Orders on Pulmonary embolism?

a. #1 maintain adequate cardio/pulmonary functions during resolution of obstruction
b. #2 prevent further growth/multiplication of thrombi, prevent embolization from extremities to pulm system
1. Lung scan (V/Q scan) 6. CXR, EKG
2. D-die 7. Spiral CT
3. US 8. CBC c diff
4. Pulmonary angiography - definitive 9. Base line chem
5. ABG’s 10. CPR/ACLS

16. PE & therapeutic order SATA

a. Administer O2 to relieve hypoxemia & dyspnea – place in high Fowlers for max ventilation
b. Initiate/maintain IV access
c. Administer prescribed meds – anticoags, factor Xa inhibitor, thrombolytics
d. Assess resp status >q30min
e. Assess cardiac status
f. Emotional support
g. Monitor LOC
h. Therapeutic Procedures
i. Embolectomy or Vena Cava filter
1. Prepare pt for procedure – NPO, informed consent
2. Monitor postoperatively – VS, SaO2, incision drainage, pain mgmt.

17. Priority nsg Dx for hepatic encephalopathy r/o aspiration; impaired gas exchange; impaired tissue perfusion

18. Neomycin for necrotic enceph

19. Shift change at report who you see 1st? pt who would be the most fatal; airway, breathing, circulation
20. What can you delegate in certain situations?
a. RN can do LPN &UAP job
b. LPN can do UAP job
c. UAP can do UAP job

21. Change of shit pts – who you see 1st

a. the most at risk, safety & lethality are crucial

22. Transdermal pts safe spot, application – abdomen, upper chest, back, outer/upper arms, clip hair, not on tattoos

23. ** Member of Profession – in dept, someone wants you to check on how to charge for procedures – select all that apply
a. What would you do to find a way to change they pts are charged for a procedure

24. Math questions

25. PE & V/Q – what do you tell the pt

a. V/Q mismatch – the ratio between air and blood is supposed to be an even ratio, 1:1, but with disease or conditions it
sometimes causes the ratio of air breathed in vs the amt of blood flow to be uneven
b. PE – you have an obstruction in one of the veins or arteries in your lung from either an air bubble, blood clot or fat
droplets
26. Results – not allowed to interpret it,
a. that’s Dr.s job,
b. we need more results,
c. cannot explain results unless they want clarification after Dr. explained results

27. Heparin math problem

a. https://www.registerednursern.com/heparin-drip-practice-calculation-problems/

28. Hand hygiene inappropriate

29. Intubated math question

30. Pt care delivery model, in Modules

a. Total Care – oldest method of organizing pt care, nurses responsible for planning, organizing, and performing all care,
including personal hygiene, medications, treatments, emotional support, and education required for their assigned
group of patients during the assigned shift
b. Functional nursing – staff assigned to complete certain tasks for a group of pts rather than care for specific pts
i. RN performs all assessments, adm all IV meds
ii. LPN adm all oral meds
iii. CNA performs hygiene tasks, VS
iv. Charge Nurse makes assignments & coordinates care
c. Team Nursing – from 1950-1960’s, team leader/members provide various aspects of nsg to group of pts – pt care is
fractured and questionable
d. Primary Nsg – comprehensive, individualized care from same nurse throughout period of care – emphasis continuity of
care by having 1 nurse provide care for sm group of pts, allows direct care for 24 hr period, rejected b/c toocostly
e. Progressive care – the right patient, in the right bed, with the right services, at the right time: ICU, med-surg, out-patient,
long term

31. A patient with a pulmonary embolism is receiving anticoagulation w/IV Heparin. What instructions would the nurse give the
UAP who will help the pt w/ADLs? SATA
a. Use a lift sheet when moving & positioning the pt on the bed
b. Use an electric razor
c. Use a soft-bristled toothbrush or tooth sponge
d. Be sure the pt’s footwear has a firm sole when the pt ambulates
32. Liver biopsy pre or post
a. Pre
i. IV pain med & sedative
ii. Local anesthesia injected at site
iii. Lie on back w/R arm above head
iv. Located w/US
v. Swab w/local anesthetic
b. Intra – pt holds breath while taking sample, do not move
c. Post
i. Pressure at site
ii. Bandage on inciscion
iii. Lie on R. side for min 1 hr
iv. BP & HR monitored
v. Lie on back for additional 3 hrs till d/c
vi. Outpatient

33. Lactulose – explain to pt used to get rid of high ammonia levels in body thru stool
a. Normal ammonia level 15-60 mcg/dL

34. ABG’s – 3 or 4 http://survivenursing.com/abg/

35. Math question

36. Combination of drugs you would question? NSAIDS w/Anticoagulants

37. Pt intubated, been suctioned, what VS would you immediately report? Drop in BP & increased HR
a. Primary action – stop the procedure & reoxygenate

38. Lab tests & neomycin? May accumulate in pts w/cirrhosis & age-related renal impairment
a. Monitor blood levels & renal function tests
i. Sp gravity, BUN, ALT, AST, phosphate, bilirubin, creatinine, UA

39. Home Health –

a. who do you see first on morning visit? Plan on most critical 1st
b. How to keep yourself safe? really
c. Don’t overload pt w/info – what’s important, don’t use medical jargon, keep it simple

40. Oxyhemoglobin curve – know conditions, shift to right & left, normalcy shouldn’t have shifts, only sick pt
a. Shift to the left indicates infection
b. The RN clinical instructor is discussing a patient’s oxy-hemoglobin dissociation curve w/a student. The student states
that the patient’s oral body temp is elevated at 100.8ºF (32.C). Which statement by the student indicates correct
understanding of this patient’s curve shift?
i. When the pts body temperature is elevated, there is a shift to the right so that the HGB will dissociate oxygen faster.

41. Metabolic Alkalosis – select all

 Confusion, belligerence
 Tetany, seizers, coma, hyper-irritable muscle reflexes
 N/V, slow respirations
 Arrythmias, numbness, tingling

42. ARDS select all r/t gases

a. What ABG levels identify respiratory acidosis and hypoxia that don’t respond to oxygenation?
b. Severe hypoxemia
i. PaO2 <60 mm Hg
ii. O2 <90%
 iii. PaCO2 >45 mm Hg
iv. pH <7.35

43. Therapeutic diet for cirrhosis pt

a. ↑ carbs & protein diet, moderate fat, low sodium - no protein if high ammonia levels
b. Vitamins B, C, K, thiamin & folic acid

44. Most therapeutic response for some who can’t remember or confused
a. Tell them where they are, who you are and why they’re here

45. What is primary prevention?

a. Immunization against specific diseases
b. Health education about preventing illness
c. Risk assessment for specific diseases
d. Child car seat education
e. Nutrition, fitness activities

46. Cirrhosis – highest priority w/varices

a. Bleeding/ruptured esophageal varices causing vomiting, blood in stool or
b. portal HTN hypertensive gastropathy

47. Baseline for Ascites – measure abdominal girth

48. What info can you share w/clients after looking at their labs? Can you tell them they have cirrhosis b/c albumin levels are up?
a. No, that is something they need to further discuss with their doctor
b. Further studies are needed

49. ARF intervention

a. Maintain open airway
b. PEEP (mechanical ventilation) – positive-end expiratory pressure or CPAP – prevents alveolar collapse during expiration
i. High pressure can cause alveoli collapse
c. EKG monitoring for hypoxemia when repositioning
d. ABG’s
e. VS – lung sounds, O2, respiratory status especially
f. Pain level
g. Suction prn/ oral care q2hr – oxygenate before suctioning
i. Assess sputum
h. NG tube for nutrition
i. prevent infection
j. position pt to facilitate ventilation & perfusion
k. emotional support

50. Drug for wasting w/AIDS

a. A hospitalized pt w/AIDS has wasting syndrome. Which nsg action is appropriate to assign to an LPN/LVN/ who is
providing care to this pt?
i. administer Oxandrolone 5mg/day it’s an appetite stimulant/enhancer

51. AIDS pt, nsg Dx is impaired nutrition from diarrhea, what worsens diarrhea? Fat, greens, coffee, dairy

52. Pts w/AIDS - meat must be cooked very well or bacterial infection can kill them

53. Pt Dx w/non-Hodgkin’s asks about impact of Dx on his life – assess his comprehension, need to know what the Dr. told him first

54. Acute leukemia – document previous cancer Dx very important, had Hodgkin’s as a teen, need to document that
55. Fatigue w/cancer, pt increased eating but isn’t gaining weight.
a. Any changes your activity? Let them explain.
b. C.A.U.T.I.O.N. acronym
i. Change in bowel or bladder habits
ii. A sore throat that doesn’t heal
iii. Thickening lump
iv. Unusual bleeding or discharge
v. Indigestion or difficulty swallowing
vi. Nagging cough or hoarseness

56. G-CSR granulocyte colony stimulating factor –bad cells are engulfed like phagocytosis; neutrophils & granulocytes fight
infections. What do these drugs do? Phagocytosis
a. G-CSR is a glycoprotein that stimulates bone marrow to produce granulocytes & stem cells & releases them into the
blood stream where they use phagocytosis to destroy infection
b. Filgrastim (GCSF) stimulates WBC to help fight infection and neutropenia caused by chemo

57. Pt w/wasting syndrome, to increase nutrition give megestrol (Megace) progesterone hormone increases appetite/weight gain in AIDS

58. Hodgkin’s disease pt admitted staging process –lymph node & bone marrow biopsy

59. Debulking pt and post op or laminectomy (clean surgery) do not put in w/neutropenic or chemo pt

60. Stuck w/pt who you gave an IM, no info on HIV status, SATA – who do you report to?
a. Discuss HIV status with the patient first!

61. Cytoxan’s (IV chemo drug for lymphoma) have labs: WBC 5,000-11,000, RBC f-3.6-5, m-4.2-5.8, platelets 150,000-450,000,
creatinine 0.5-1.2, Na 135-145, looking at your labs, determine whether what the greatest risk is.
a. WBC, RBX & platelets usually decrease

62. Neupogen stimulating factor for oncology pts

a. can elevate their temperature,
b. premedicate w/Tylenol
c. rotate injection sites

63. ANC of 900 is low, platelets 175,000 low –

a. reverse isolation,
b. consult w/oncology-hematology phys.
c. Anticipate bone marrow flow cytomic study of the cells (biopsy)

64. Megakaryocytes (mega platelets aren’t working as well as regular platelets) in bone marrow, high %, lineage

65. Reed-Steinberg bone Marrow biopsy, review procedure before & after. After VS, pressure over site, dry sterile dressing,
frequent monitoring. Before something for pain.
a. Before
i. Baseline vitals
ii. Anticeptic skin
iii. Inject numbing (localized) numbing agent at site
iv. bone marrow is taken from iliac crest in hip w/coring needle,
v. sample is put in formaldehyde
vi. Looking at cells to see the cell pattern
b. After
i. VS
ii. Pressure over site w/dry sterile dressing 5-10 min
iii. Apply pressure dressing
 iv. Frequent monitoring

66. Multiple myeloma appropriate diet is low Ca, low purine diet (meat, processed meat, alcohol, sardines, anchovies)

67. Neupogen response to Tx – WBC count, ANC would be increased

68. SLE – taking prednisone every day for 4 days, what might you question on med orders?
a. She had a flare of lupus, - do not stop abruptly, taper down most important thing

69. A few minutes after the nurse has given an intradermal injection of an allergen to a patient who is undergoing skin testing for
allergies, the pt reports feeling anxious, short of breath and dizzy. Which action included in the emergency protocol should the
nurse take first? – give epinephrine 0.5mg IM

70. Rheumatory factor is elevated, constant teary eye, dry mouth – Sjogren’s syndrome
a. white blood cells mistakenly attacking moisture-producing glands

71. Delegation questions on neutropenia – what can nursing assistant do?

a. In the care of a patient w/neutropenia, what tasks can you assign?
i. Practice good hand hygiene
ii. Take VS q4hr
iii. Gather supplies to prepare the room for protective isolation
iv. Report temp > 100.4º F (38ºC)

72. Client has bone marrow transplant-potential sources of infection; how would you care for that pt environment wise?
a. No fruit & flowers.
b. Nobody whose had diarrhea all night even if it’s from coffee. NOPE!
c. No small children
d. No who has or getting over cold/infection

73. Know your s/s of mult myeloma (BBFFWWUTI)

a. Bone pain – especially in ribs or back
b. Broken bones
c. Weakness/Fatigue
d. Weight loss
e. Infection & Fevers
f. Thirsty
g. Frequent Urination – Bentz protein positive for mult myeloma
h. Labs show ↑ CA, K & creatinine

74. Public health dept, HIV infection – not all pts are using drugs & sharing used needles but for the ones that are,
a. give them clean needles
b. bleach the used needle
c. give them bleach for the used needles

75. Pt has cancer & develops itchy oozing rash – what is it? Shingles (vaccine for it now)

76. Pt has cancer & develops itchy oozing rash, what kind of room? Private, isolation

New Rule – can be none or all!