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Wednesday, March 25, 2009

NCLEX Secrets Study Guide - Nclex Exam Prep Tips

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A major defining characteristic of Deficient Diversional Activity is expression of boredom by the client.

Phantom limb sensations are felt in the area of the amputated limb. These can include itching, warmth, and cold. The sensations are caused by intact peripheral nerves in the area amputated. Whenever possible, clients should be prepared that they may experience these sensations. The client may also feel painful sensations in the amputated limb, called phantom limb pain. The origin of the pain is less well understood, but the client should be prepared for this, too, whenever possible. This is not an abnormal response.

Following spinal surgery, concerns about finances and employment are best handled by referral to a social worker. This individual is able to provide information about resources available to the client.

Clients may be fearful of having a cast removed because of the cast cutting blade. The nurse should show the cast cutter to the client before it is used, and explain that the client may feel heat, vibration, and pressure. The cast cutter resembles a small electric saw with a circular blade. The nurse should reassure the client that the blade does not cut like a saw, but instead cuts the cast by vibrating side to side.

Fetal death in utero (stillbirth) is defined in most states as a demise at >/=20 weeks of gestation and/or weight of >/=500 grams.

An implanted port is placed under the skin and is not visible. There is no tubing external to the body. Tubing is used only when the port is accessed intermittently and the IV line is connected.

A cystourethrogram is an X-ray test that takes pictures of your bladder and urethra while you are urinating.

A person who is experiencing mania lacks insight and judgment, has poor impulse control, and is highly excitable. The nurse must take control without creating increased stress or anxiety to the client. “Insisting” the client go to her room may meet with a great deal of resistance.

Most clients and families benefit from knowing there are available resources to help them cope with the stress of self-care management at home. These can include telephone contact with the surgeon, cardiologist, and nurse; post-cardiac surgery sponsored cardiac rehabilitation programs; and community support groups such as the American Heart Association Mended Heart’s Club (a nationwide program with local chapters). The United Way provides a wide variety of services to people who might otherwise not afford them. The American Cancer Society Reach for Recovery helps women recover after mastectomy.

The ECG uses painless electrodes, which are applied to the chest and limbs. It takes less than 5 minutes to complete and requires the client to lie still. The ECG measures the heart’s electrical activity to determine rate, rhythm, and a variety of abnormalities.

Clients and families are often fearful about activation of the automatic implantable cardioverter-defibrillator (AICD). Their fears are about the device itself, and also the occurrence of life-threatening dysrhythmias that triggers its function. Family members need reassurance that even if the device activates while touching the client, the level of the charge is not high enough to harm the family member, although it will be felt. The AICD emits a warning beep when the client is near magnetic fields, which could possibly deactivate it, but does not beep before countershock.

A client with a renal disorder, such as renal failure, may become angry and depressed in response to the permanence of the alteration. Because of the physical change and the change in lifestyle that may be required to manage a severe renal condition, the client may experience Disturbed Body Image. Anxiety is not appropriate because the client is able to identify the cause of concern.

When diabetes mellitus is first diagnosed, the client may go through the phases of grief: denial, fear, anger, bargaining, depression, and acceptance. Denial is the most detrimental phase to the teaching/learning process. If the client is denying the fact that he or she has diabetes, the client probably will not listen to discussions about the disease or how to manage it. Denial must be identified before the nurse can develop a teaching plan.

Adult polycystic kidney disease is a hereditary disorder that is inherited as an autosomal dominant trait. Because of this, the client should have genetic counseling, as should the extended family. The client is likely to have hypertension, not hypotension.

Ureterolithotomy is removal of a calculus from the ureter using either a flank or abdominal incision. Because no urinary diversion is created during this procedure, the client has no need for a visit from a member of a support group. The client should have an understanding of the same items as for any surgery, which includes knowledge of the procedures, expected outcome, and postoperative routines and discomfort. The client should also be assessed for any concerns or anxieties before surgery.

Emphysema clients need to avoid smoking and all airborne irritants. The nurse who observes a maladaptive behavior in a client should not make judgmental comments and should explore an adaptive strategy with the client without being overly controlling. This will place the decision making in the client’s hands and provide an avenue for the client to share what may be expressions of frustration about an inability to stop what is essentially a physiological addiction.

The Allen test is performed to assess collateral circulation in the hand before drawing a radial artery blood specimen.

PTSD is a response to an event that would be markedly distressing to almost anyone. Characteristic symptoms include sustained level of anxiety, difficulty sleeping, irritability, difficulty concentrating, or outbursts of anger. OCD refers to some repetitive thoughts or behaviors. Panic disorders and social phobia are characterized by a specific fear of an object or situation.

The client taking anticoagulant therapy should be informed about the medication, its purpose, and the necessity of taking the proper dose at the specified times. If the client is unwilling or unable to comply with the medication regimen, the continuance of the regime should be questioned. Clients may need support systems in place to enhance compliance with therapy.

The nurse should be alert to the fact that the client taking spironolactone (Aldactone) may experience body image changes resulting from threatened sexual identity. These are related to decreased libido, gynecomastia in males, and hirsutism in females.

Aldactone is used to diagnose or treat a condition in which you have too much aldosterone in your body. Aldosterone is a hormone produced by your adrenal glands to help regulate the salt and water balance in your body.

Elder abuse is sometimes the result of frustrated adult children who find themselves caring for dependent parents. Increasing demands by parents for care and financial support can cause resentment and burden.

A grade II cerebral aneurysm rupture is a mild bleed in which the client remains alert but has nuchal rigidity with possible neurological deficits, depending on the area of the bleed. Because these clients remain alert, they are acutely aware of the neurological deficits and frequently have some degree of body image disturbance.

Smoking is highly detrimental to the client with Buerger’s disease, and clients are recommended to stop completely. Because smoking is a form of chemical dependency, referral to a smoking cessation program may be helpful for many clients. For many clients, symptoms are relieved or alleviated once smoking stops.

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