11.02.2010

http://www.nursereview.org/search/label/MYKS%20CORNER

NCLEX Bullets

  • Odynophagia is painful swallowing, in the mouth (oropharynx) or esophagus. It can occur with or without dysphagia, or difficult swallowing
  • Halitosis, oral malodor (scientific term), breath odor, foul breath, fetor oris, fetor ex ore, or most commonly bad breath are terms used to describe
  • Pyloroplasty is surgery to widen the opening of the end of the pylorus, which is found in the lower portion of the stomach,
  • Billroth I = gastroduodenal reconstruction
  • Billroth II = gastrojejunal reconstruction
  • ISOTONIC = the muscle shortens to produce contraction
  • ISOMETRIC = NO CHANGE in muscle length
  • ISOKINETIC = Involves muscle contraction or tension against a resistance
  • Measure correct crutch length
    LYING DOWN
    Measure from the Anterior Axillary Fold to the HEEL of the foot then:
    Add 1 inch (Kozier)
    Add 2 inches (Brunner and Suddarth)
  • Hyperalgesia—excessive sensitivity to pain
  • Bruxism- commonly called night teeth-grinding occurring during stage 2 sleep
  • Somnambulism- “sleepwalking"
  • POLYSOMNOGRAPHY is the only method that can confirm sleep apnea.
  • Urticaria - (or hives) is a skin condition, commonly caused by an allergic reaction, that is characterized by raised red skin wheals
  • Pruritus- is an itch or a sensation that makes a person want to scratch.
  • CAUTION ---- Mnemonics for early detection for CANCER
    C- Change in bowel/bladder habits
    A- A sore that does not heal
    U- Unusual bleeding
    T- Thickening or lump in the breast
    I- Indigestion
    O- Obvious change in warts
    N- Nagging cough and hoarseness
  • Alopecia begins within 2 weeks of therapy. Regrowth within 8 weeks of termination
  • Tenesmus is a feeling of incomplete defecation. It is experienced as an inability or difficulty to empty the bowel at defecation.
  • The CONDUCTING SYSTEM OF THE HEART
    Consists of the
    1. SA node- the pacemaker
    2. AV node- slowest conduction
    3. Bundle of His – branches into the Right and the Left bundle branch
    4. Purkinje fibers- fastest conduction
  • The Heart sounds
    1. S1- due to closure of the AV valves
    2. S2- due to the closure of the semi-lunar valves
    3. S3- due to increased ventricular filling
    4. S4- due to forceful atrial contraction
  • The lymphatic system also is part of the vascular system and the function of this system is to collect the extravasated fluid from the tissues and returns it to the blood
  • CARDIAC Proteins and enzymes
    CK- MB ( creatine kinase). Elevates in MI within 4 hours, peaks in 18 hours and then declines till 3 days
  • Troponin I and T
    Troponin I is usually utilized for MI. Elevates within 3-4 hours, peaks in 4-24 hours and persists for 7 days to 3 weeks!
    Normal value for Troponin I is less than 0.6 ng/mL
  • Cholesterol= 200 mg/dL
  • Triglycerides- 40- 150 mg/dL
  • Ischemic changes may show ST depression and T wave inversion
  • Nitrates- to dilate the coronary arteries
  • Aspirin- to prevent thrombus formation
  • Beta-blockers- to reduce BP and HR
  • Calcium-channel blockers- to dilate coronary artery and reduce vasospasm
  • After MI, Patients who are able to walk 3-4 mph are usually ready to resume sexual activities
  • Infective endocarditis >> Osler’s nodes- painful nodules on fingerpads
  • Infective endocarditis >> Roth’s spots- pale hemorrhages in the retina
  • LEFT SIDED CHF
    1. Dyspnea on exertion
    2. PND
    3. Orthopnea
    4. Pulmonary crackles/rales
    5. cough with Pinkish, frothy sputum
    6. Tachycardia
    7. Cool extremities
    8. Cyanosis
    9. decreased peripheral pulses
    10. Fatigue
    11. Oliguria
    12. signs of cerebral anoxia
  • RIGHT SIDED CHF
    1. Peripheral dependent, pitting edema
    2. Weight gain
    3. Distended neck vein
    4. hepatomegaly
    5. Ascites
    6. Body weakness
    7. Anorexia, nausea
    8. Pulsus alternans
  • CARDIOGENIC SHOCK
    1. HYPOTENSION
    2. oliguria (less than 30 ml/hour)
    3. tachycardia
    4. narrow pulse pressure
    5. weak peripheral pulses
    6. cold clammy skin
    7. changes in sensorium/LOC
    8. pulmonary congestion
  • CARDIAC TAMPONADE
    A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
  • BECK’s Triad- Jugular vein distention, hypotension and distant/muffled heart sound
  • ANEURYSM - Dilation involving an artery formed at a weak point in the vessel wall
    Saccular= when one side of the vessel is affected
    Fusiform= when the entire segment becomes dilated

    RISK FACTORS
    Atherosclerosis
    Infection= syphilis
    Connective tissue disorder
    Genetic disorder= Marfan’s Syndrome
  • PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (PAOD) - Refers to arterial insufficiency of the extremities usually secondary to peripheral atherosclerosis
  • INTERMITTENT CLAUDICATION- the hallmark of PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (PAOD)
    Intermittent claudication is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically calf muscle
  • RAYNAUD’S DISEASE - A form of intermittent arteriolar VASOCONSTRICTION that results in coldness, pain and pallor of the fingertips or toes
  • Cheilosis (also called cheilitis) is a painful inflammation and cracking of the corners of the mouth. It sometimes occurs on only one side of the mouth
  • APLASTIC ANEMIA - A condition characterized by decreased number of RBC as well as WBC and platelets
  • Pernicious Anemia - Beefy, red, swollen tongue (Schilling’s test)
  • Progesterone - maintains the uterine lining for implantation and relaxes all smooth muscles
  • Relaxin - is the hormone that softens the muscles and joints of the pelvis
  • Thyroxine - increases basal metabolic rates
  • Buck's Traction - Skin traction
  • Skeletal Traction - with Pins
  • Vit. B2 (riboflavin) deficiency - scaly skin
  • Vit. A deficiency - Night blindness
  • Vit. D deficiency - Skeletal Pain
  • Zinc deficiency - slow wound healing
  • Selenium deficiency - heart damage
  • Toxoplasmosis parasite - infection from inadequately cooked meat, eggs, or milk, ingestion or inhaling the oocyst excreted in feline feces
  • Sclerotherapy - injecttion of a sclerosing agent into a varicosity. The agent damages the vessels and causes aseptic thrombosis, which result in vein closure.
  • Deep Tendon Reflex Test
    1+ - diminished
    2+ - normal
    3+ - increased, brisker-than-average
    4+ very brisk, hyperactive
  • Involution is a progressive descent of the uterus into the pelvic cavity that occurse at approx. 1cm per day.
  • FHR can be first heard with fetoscope at 18 to 20 weeks gestation. 10 weeks with a doppler ultrasound.
  • Folic acid rich food are peanuts, sunflower seeds and raisins
  • Variable deceleration = cord compression
  • Early deceleration = pressure on the fetal head during a contraction
  • Later deceleration = uteroplacental insufficiency
  • Cystitis is inflammation of the urinary bladder.
  • Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek).
  • Partial weightbearing - 30% to 50% of the body weight on the affected limb
  • Touch-down weight bearing allows the client to let the limb touch the floor but not bear weight.
  • Thyroid supplements for hypothyroidism should be taken in the morning to avoid insomia.
  • Croup - dont administer cough syrup and cold medicines because they will dry and thicken secretions. Sips of warm fluid will relax the vocal cords and thin the mucos.
  • Koplik spots - small bluish-white spots with a red base found on the buccal mucosa
  • German measles - pinkish-rose maculopapular rash on the face, neck and scalp. Reddish and pinpoint petechiae spots found on the soft palate
  • Erythema infectiosum (fifth disease) [slapped cheek] - an intense, fiery-red, edematous rash on the cheeks.
  • Rocky Mountain Spotted Fever (RMSF) - rash on the palm and soles of the feed and on the remainder of the body. Fever, headache, anorexia and restlessness. Meds given is Tetracycline hydrochloride (achromycin)
  • Thioguanine and thiotepa are antineoplastic medications
  • Ticlopidine hydrochloride (Ticlid) is a platelet aggregation inhibitor
  • Erythema marginatum is characterized by red skin lesions that start as flat or slightly raised macules, usually over the trunk and that spread peripherally.
  • Atrial fibrillation - Auscultating the apical pulse for an irregular rate while palpating the radial pulse for pulse deficit
  • Triple dye is used for initial cord care because it minimizes bateria and promotes drying.
  • A low cardiac output will cause the increased build-up of blood in the heart and pulmonary system, causing crackles to be heard in the lung fields.
  • S3 heart sounds = ventricular gallop
  • Trachoesophageal fistual = abdominal distension
  • 3 stages of separation anxiety are PROTEST, DESPAIR AND DETACHMENT
  • Anaphylactic shock = fatal allergic reaction
  • Cardiac Tamponade - assessment findings include tachycardia, distant or muffled heart sounds, jugular vein distention and falling blood pressure accompanied by pulsus paradoxus ( a drop in inspiratory BY by > 10 mmhg)
  • Spironolactone (Aldactone) > pt. may experience body image changes due to threatened sexual identity. These body image changes are related to decreased libido, gynecomastia in males, and hirsutism in females.
  • Diabetic ketoacidosis (DKA) - fruity odor to the client's breath
  • Rhonchi - occur as a result of the passing of air through fluid-filled narrow passages. Rhonchi are sometimes referred to as "gurgles". Diseases with excess mucous product, such as pnemonia are associated with rhonchi. Rhonchi are usually heard on expiration and may clear with a cough.
  • Urolithiasis is a condition in which crystals in the urine combine to form stones, also called calculi or uroliths
  • Hodgkin's disease is a type of lymphoma distinguished by the presence of a particular kind of cancer cell called a Reed-Sternberg cell.
  • Cardiogenic shock (left-sided heart failure) - includes altered sensorium, tachycardia, hypotension, tachypnea, oliguria, and cold, clammy, cyanotic skin
  • Ovarian cancer symptoms include abdominal discomfort, irreg. menses, flatulence, fullness after a light mean and increase abdominal girth.
  • Myocardial infarction:
    -ST segment elevation usually occurs immediately or during the early stages of MI.
    -The CK-MB isoenzyme begins to rise 3 to 6 hourse after MI.
    -T wave depression and abnormal Q wave changes occur within several hours to several days after the MI.
  • Abdominal aortic aneurysm (AAA) symptoms are "heart beating" in the abdomen when supine or be able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be ausculated over the mass.
  • Neuroleptic Malignant syndrome experiences an elevated in temperature ( sometimes up to 107 F) and parkinsonian symptoms
  • Intermittent claudication usually refers to cramplike pains in the legs (usually the calf muscles, but may be in the thigh.
  • Cholinergic effect includes increase in salivation, lacrimation, urination and defecation, bradycardia, hypotension and increaes muscle weakness
  • Ventricular tachycardia is characterized by the absense of P waves, wide QRS complexes (usually greater then 0.14 second) and a rate between 100 and 250 impulses per minute.
  • Ventricular fibrillation is characterized by irregular, chaotic undulations of varying amplitudes. There are no measurable rate and no visible P waves or QRS complexes.
  • Inguinal hernia is a common defect that appears as a painless inguinal swelling when the child cries or strains.
  • Partial obstruction of the herniated loop of intestine - difficulty in defecating
  • Phimosis - a dribbling stream, indicating an obstruction in the flow of urine
  • Cryptorchidism - absense of the testes within the scrotum.
  • Triamterene (Dyrenium) is a potassium-sparing diuretic. Side effects include frequent urination and polyuria.
  • Erythroblastosis fetalis is a hemolytic disease of the fetus or newborn resulting in excessive destruction of red blood cells (RBCs) and stimulation of immature erythrocytes.
  • Glycosylated hemoglobin values of 8% or less are acceptable.

Choosing the Correct Answer!

*Which part of the Nursing Process: Assessment; Analysis; Planning; Implementation or Evaluation?

*Next, Decide the Order of Priority

First you must decide what part of the nursing process the question is connected with:

ANALYSIS--is the process of identifying potential and actual health problems. Most identify pertinent assessment information and assimilate it into the nursing diagnosis. Prioritize the needs that have been identified during analysis.

Some common words that are associated with ANALYSIS questions:
*diagnose; contrast; compare; analyze; order; prioritize; define; classify; catagorize; synthesize; sort; arrange;

ASSESSMENT--consists of a collection of data. Baseline information for pre and post procedures is included. Also included the recognition of pertinent signs and symptoms of health problems both present and potential. Verification of data and confirmation of findings are also included. Assess a situation before doing an intervention.

Some common words that are associated with ASSESSMENT questions:
observe; gather; collect; differentiate; assess; recognize; detect; distinguish; identify; display; indicate; describe;

PLANNING--Involves formulating goals and outcomes. It also involves various members of the health care team and the patient's family. All outcome criteria must be able to be evaluated with a specific time frame. Be sure to establish priorities and modify according to question.

Some common words that are associated with PLANNING questions:
rearrange; reconstruct; determine; outcomes; formulate; include; expected; designate; plan; generate; short/long term goal; develop;

IMPLEMENTATION--Addresses the actual/direct care of a patient. Direct care entails pre, intra and postoperative management, preforming procedures, treatments, activities of daily living. Also includes the coordination of care and referral on discharge. It involves documentation and therapeutic response to intervention and patient teaching for health promotion and helping the patient maintain proper health.

Some common words that are associated with IMPLEMENTATION questions:
*document; explain; give; inform; administer; implement; encourage; advise; provide; perform;

EVALUATION--Determines if the interventions were effective. Were goals met? Was the care delivered properly? Are modification plans needed. Addresses the effectiveness of patient teaching and understands and determines in proper care was offered. Evaluation can involve documentation, reporting issues, evaluates care given and determine the appropriateness of delegating to others. Most significantly, it finds out the response of the patient to care and the extent to which the goals we met.

Some common words that are associated with EVALUATION questions:
monitor; expand; evaluate; synthesize; determine; consider; question; repeat; outcomes; demonstrate; reestablish;

After determining what part of the nursing process the question is concerned with, next focus your attention on determining the category of priority:
Safe and effective care environment is always first. Patient safety is related to the proper preparation and delivery of nursing techniques and procedures as part of the nursing practice. It relates to every aspect of the delivery of care.

Physiologic integrity is the ability to provide competent care Information that may be described as traditionally medical- surgical and pediatric nursing falls into this category. Specific questions in this area can be related to many direct-care aspects of nursing practice. The importance of this area is highlighted because it is one in which planning, implementation and evaluation of care needs can easily be identified and tested. Physiologic integrity is always a slight lower priority than safety unless it involves airway, breathing and circulation. "ABC's" always comes first!

Psychosocial integrity tests the knowledge about a patients response to a disease or disorder. An understanding of stress, anxiety and ways to cope are essential. This is a lower priority the physiological integrity.

Health maintenance deals with health promotion, health teaching, disease prevention and assessment of risk factors for health problems. Normal growth and development is a major theme in this category. This however, is a low priority.

In Summary, when choosing the right answer for you NCLEX exam question 1) ask yourself, "what part of the nursing process is this question dealing with: analysis, assessment, planning, implantation or evaluation? and 2) Remember to prioritize your choices: safety always being first, 2)physiological integrity, 3)psychosocial integrity and health maintenance always has the lowest priority when choosing an answer.

Other tidbits:
avoid choices with the answers "all" "always" "never" or "none". Nothing is ever a definite in Science.
look for answers that are different. If three answers say the same thing but in different words, choose the answer that is different.
when given choices that are pharmacologically based or non pharmacologically based, choose the non pharmacological intervention. It is more often then not, the correct answer.


SOURCE: http://caring4you.net/answer.html

Composition and Analysis of the Multiple Choice Test Question

Stem- the question.
* Case scenario - explains the situation.
* Issue - the specific problem or subject of the question.
* Analysis - focus on what you know about the issue.
* Problem
* Procedure
* Drug
* Disorder
* Behavior
Options - choice of answers.
* Distracters - answers that dont answer the question
* Keywords - words that set priority or directionalized care.
* General keywords.
* Early
* Late
* Immediately after
* Most likely
* Least likely
* Initial or priority nursing action
* After several days
* On day of admission

* Universal keywords
* All
* Only
* Every
* Always
* Negative keywords
* No
* Not
* Never
* Rarely
* Least essential
* Lowest priority
* Inappropriate
* Contraindicated

-http://www.nursereview.org

Tips on How to Answer Multiple Choice Test Questions

* Try to construct the correct answer before you look at the options
* Identify patient-centered options
* Identify opposite answers first and closely -- then may be distracters
* Identify specific determiners in options such as always, never, all, etc.
* When any part of an option is wrong, the entire answer is wrong
* Some questions will have a false response; the question may ask you which action is contradicted so you should look for the wrong nursing action.
* Identify equally plausible or unique options
* Identify options that deny the patient's feelings, concerns or needs.

Tips for Answering True/False Questions

* Watch for keywords such as always, never, all or none. Qualified statements including words like these are probably false.
* If any part of the statment is false, then the entire statemetn is false.
* There are usually more true than false answers.
* Most true statement come right out of a textbook or lecture.
* Make yourself work quickly; dont't pause to analyze too much!

Empower Yourself by Controlling your Thoughts and Emotions

* Keep a postive mental attitude.
* Challenge negative thoughts.
* Practice relaxation techniques.
* Densitize yourself to your fear of tests
* Use positive imagery to reduce physical reactions to stress

Tips On How To Pass The Nursing Board Exam

1. Exercise! 30 minutes of brisk walking 3x a week will do. Exercise promotes circulation at the same time gives you energy to study for long periods of time. You will be surprise on how much energy you will have if you do regular exercise.

2. In your review session, I see people copying everything in the black board and does not anymore pay attention to the lecturer, try to listen more to what the lecturer has to say and just copy key points, remember you already took this up at school, the lecturer are only trying to refresh your mind. You will get lots of tips from your lecturer if you listen attentively that you could not find in textbooks.

3. When you get home, try to review what you have written down at review class.

4. Try to go over past board exam questions. Ex. Try to finish 300 questions weekly. It will improve your comprehension at the same time familiarize yourself on how they struture their questions.

5. Have a study partner and take turn to discuss specific areas to be reviewed (cardiovascular system, respiratory sytem, endo etc). As the saying goes "Two heads are better than one". If you can't concentrate at home because of distractions, try the coffee station, library or even go to the beach to study.

6. Make your mnemonics. Post it all around you- in the bathroom, bedside table, in your bag , in the car etc.

7. Focus more on Psychiatric, Maternal Nursing, Community Nursing and Research. Drugs are rarely asked in the Nursing Board Exam. Try to also go over some Nclex questions regarding prioritization. Remember, questions in the exam are to test your competence if you are qualified for an ENTRY LEVEL NURSE only.

8. Try to avoid fatty foods. Drink Vitamin B complex, it helps in blood circulation and better memory.

9. Recommended books are Carl Balita textbooks, Community Health Nursing, passed board exam questionnaires.

10. Think Positive! Love and pamper yourself because it will reep all benefits in the end.

11. It helps if you can group together and ask each other questions. It speeds up learning.

12. Decide on a study habit. Ex. 1 hour daily before you sleep.

13. If you are wondering, "What if i made a mistake shading the wrong box, should i go ahead and erase it and shade the correct one?" What i did was, if I know the correct answer and that I shaded the wrong box, i went off and corrected my answer. BUT, you have to make sure to shade the back portion also so that it will not create dent. Worked for me.

14. Pray! It can it really do wonders...

- www.nursereview.org/