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Insulin Therapy and Medication Management for Diabetes Patients, Exams of Nursing

Essential information for healthcare professionals on insulin therapy and medication management for diabetes patients. Topics include assessing peak action times for various insulins, monitoring blood sugar levels before, during, and after exercise, foot care instructions, sick day management, and complications such as lipoatrophy and lipohypertrophy. Additionally, it covers various medications and their considerations, including digoxin, warfarin, methylphenidate, ethambutol, and hydroxyurea.

Typology: Exams

2023/2024

Available from 04/01/2024

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NCLEX EXAM CRAM SHEET FOR EXAM
PREPARATIONS
NCLEX TIPS
1) Do not read into the question- never assume anything
that has not been specifically mentioned (in the question)
and do not add extra meaning or history to the question—do
not make up a story to validate choosing an answer
2) NCLEX land is set at Utopia General Hospital - you have all
the time, all the resources, and all the staff you need!
3) Least invasive to most invasive – least restrictive to most
restrictive (restraints are rarely a good choice)
4) Avoid using absolutes- always, never, must, etc.
5) Assess the client first before implementing a treatment or action
—if there’s a choice that pertains to assessment of the patient—
it is usually the answer – assess unless in distress
6) Priority goes to assessments and answers that deal with the
patient (patient-focused) directly and not with
machines/monitors/equipment (unless the question is
specifically asking about them)
a. Ex: Auscultate fetal heart rate before checking the monitor
7) If it is the FIRST time doing something for or with the
patient (such as vital signs upon admission to the floor/unit,
or when a transfer is involved), the NURSE must complete
the assessment- including vital signs
8) If patient is an adult, answers with family options can be ruled
out (unless patient is not competent to make own decisions)
9) In emergency situations (mass casualty), patients with
greater chance to live are treated first
10) If you are asked about the FIRST action you would take in a
prioritization/discrimination question think: “If I can only
do one action, and then I must go home, what will the
outcome be?”
11) Therapeutic communication- reflect feelings and
provide correct information
12) Do not ask “why” questions (or yes/no) and do not say “I
understand
13) An answer that delays care or treatment is usually wrong (Ex:
reassess in 15 minutes, monitor the patient for a continuation
of symptoms)
14) When determining interventions to enhance a client’s
wellness, consider options that promote healthy nutrition,
regular exercise, proper weight maintenance, proper rest, and
avoidance of harmful chemicals (nicotine) and risk-taking
behaviors (not wearing a seat belt)
15) If two of the answer choices are the exact opposite, one is
probably the answer (ie. bradycardia, tachycardia)
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NCLEX EXAM CRAM SHEET FOR EXAM

PREPARATIONS

NCLEX TIPS

  1. Do not read into the question - never assume anything that has not been specifically mentioned (in the question) and do not add extra meaning or history to the question—do not make up a story to validate choosing an answer
  2. NCLEX land is set at Utopia General Hospital- you have all the time, all the resources, and all the staff you need!
  3. Least invasive to most invasive – least restrictive to most restrictive (restraints are rarely a good choice)
  4. Avoid using absolutes - always, never, must, etc.
  5. Assess the client first before implementing a treatment or action —if there’s a choice that pertains to assessment of the patient— it is usually the answer – assess unless in distress
  6. Priority goes to assessments and answers that deal with the patient ( patient-focused ) directly and not with machines/monitors/equipment (unless the question is specifically asking about them) a. Ex: Auscultate fetal heart rate before checking the monitor
  7. If it is the FIRST time doing something for or with the patient (such as vital signs upon admission to the floor/unit, or when a transfer is involved), the NURSE must complete the assessment- including vital signs
  8. If patient is an adult, answers with family options can be ruled out (unless patient is not competent to make own decisions)
  9. In emergency situations (mass casualty), patients with greater chance to live are treated first
  10. If you are asked about the FIRST action you would take in a prioritization/discrimination question think: “If I can only do one action, and then I must go home, what will the outcome be?”
  11. Therapeutic communication- reflect feelings and provide correct information
  12. Do not ask “why” questions (or yes/no) and do not say “I understand”
  13. An answer that delays care or treatment is usually wrong (Ex: reassess in 15 minutes, monitor the patient for a continuation of symptoms)
  14. When determining interventions to enhance a client’s wellness, consider options that promote healthy nutrition, regular exercise, proper weight maintenance, proper rest, and avoidance of harmful chemicals (nicotine) and risk-taking behaviors (not wearing a seat belt)
  15. If two of the answer choices are the exact opposite, one is probably the answer (ie. bradycardia, tachycardia)
  1. If two or three answers are similar, none are correct (*be careful—sometimes answers may seem similar but in fact are saying something different)
  2. Always look for the UMBRELLA option—one that is a broad universal statement and usually contains the concepts of the other options with it—often the correct answer
  3. If you have never heard of an answer—do not eliminate it—work around it…if you can safely eliminate all other answers, that is your answer—if you are down to two answers and you know one answer is right, go with what you know
  4. Prioritize actual problems over potential problems
  5. DO NOT leave the patient – think safety
  6. DO NOT “do nothing”- you always have to do something
  7. If the question is about endorsement— always report anything new or different to the next shift
  8. Only select “ document ” if the assessment is normal
  9. Put patients with the same or similar diagnoses in the same room-clean vs. dirty patients
  10. Never increase a patient’s fluids to “catch up”
  11. Answer SATA questions as true or false for each answer option
  12. Rephrase the question in your own words—this ensures you understand what the question is asking—if you cannot rephrase the question, you do not know what the topic is
  13. If you cannot determine the topic of the question, read all answer choices to help you understand the problem (look for patterns)
  14. Try not to determine the answer before reading the answer choices—NCLEX uses traps and answers that scream “pick me” but are wrong
  15. More often than not, pain will not be your answer -- pain is considered psychosocial—exception to this rule are signs and symptoms of compartment syndrome
  16. Try to focus on the here and now as much as possible
  17. With positioning questions- you are trying to prevent or promote something—evaluate the outcome of each option
  18. When the question asks what is ESSENTIAL —think SAFETY
  19. If you do not know what a word means, try to break it down using medical terminology a. Ex: Rhabdomyosarcoma – muscle (myo), tumor (sarcoma) → tumor of the muscle tissue b. Same idea applies to medications- use suffixes and prefixes to recognize classifications
  20. Make an educated guess—if you can’t make the best answer for

“Keep them breathing, keep them safe” Prioritization Techniques ● Prioritize systemic vs. local (life before limb) ● Prioritize acute before chronic ● Prioritize actual before potential future problems ● Prioritize according to Maslow’s- physiological needs before psychosocial (acute safety can take priority- ATI) ● Recognize and respond to trends vs. transient findings (recognizing a gradual deterioration) ● Recognize signs of emergencies and complications vs. “expected client findings” ● Apply clinical knowledge to procedural standards to determine the priority action- recognizing that the timing of administration of antidiabetic and antimicrobial medications is more important than administration of some other medications How to tackle- WHO DO YOU SEE FIRST- questions: ● Who is your most stable patient? ELIMINATE ANSWER ● Who is your most stable patient (of the 3 remaining)? ELIMINATE ANSWER ● Who is your most unstable patient (of the 2 remaining)? Airway? Breathing? Circulation? SELECT ANSWER Transmission-Based Precautions AIRBORNE MTV M- measles T- TB V- Varicella (chicken pox), varicella zoster (disseminated shingles)

  • Private room - negative pressure with 6-12 air exchanges/hr, mask, N Chicken pox can be rapidly transmitted to other clients—should be isolated quickly and placed in negative pressure room

CONTACT

MRS. WEE

M- multidrug resistant organism (MRSA) R- respiratory infection S- skin infections (localized herpes zoster) W- wound infections E- enteric infection → clostridium difficile E- eye infection → conjunctivitis (Also, Hep A) *A nurse with localized herpes zoster CAN care for patients as long as the patients are NOT immunocompromised and the lesions are covered!

Current CDC guidelines indicate that rapid implementation of standard, contact, and airborne precautions are needed for any client suspected of having SARS—in order to protect other clients and healthcare workers Skin Infections VCHIPS V- varicella zoster C- cutaneous diphtheria H- herpes simplex I- impetigo P- pediculosis S- scabies Impetigo - caused by Staph and Strep, untreated can cause acute glomerulonephritis (periorbital edema—indicates poststreptococcal glomerulonephritis) Order of PPE Application ● Gown Mask Goggles/face shield Gloves Order of PPE Removal ● Gloves Goggles/face shield Gown Mask Because the hands of health care workers are the most common means of transmission of infection from one client to another, the most effective method of preventing the spread of infection is to make supplies for hand hygiene readily available for staff to use. Because the respiratory manifestations associated with the avian influenza are potentially life threatening, the nurse’s initial action should be to start oxygen therapy! ● S/S: SOB, diarrhea, abdominal pain, epistaxis ● Institute airborne and contact precautions

According to the CDC, catheter associated UTIs are the most common health care-acquired infection in the US—primary CDC recommendations include avoiding the use of indwelling catheters and the removal of catheters as soon as possible!

Women in Labor with non-reassuring FHR- (S/S: late decels, decreased variability, fetal bradycardia, etc.) ● Turn mother on LEFT side (and give O2, stop Pitocin, increase IV fluids)

Tube Feeding w/ Decreased LOC ● Head of bead ELEVATED (to prevent aspiration) and position patient on RIGHT side (promotes gastric emptying) Postural Drainage ● Lung segment to be drained should be in the uppermost position to allow gravity to work During Epidural/Lumbar PunctureSide-lying (“C” curved spine)- lateral recumbent/fetal position Post Lumbar Puncture (LP) – (and also oil-based myelogram) ● Patient lies in flat supine (to prevent CSF leak and headache) for 2-3 hours ● Sterile dressing applied ● Frequent neuro checks Thoracentesis ● Position patient with arms on pillow over bed table or lying on side ● NO MORE THAN 1000cc at one time ● Post- check blood pressure, auscultate bilateral breath sounds, check for leakage, sterile dressing Patient with Heat Stroke ● Lie flat with legs elevated Hemorrhagic Stroke ● HOB elevated 30 degrees to reduce ICP and facilitate venous drainage Ischemic Stroke ● HOB flat (supine) During Continuous Bladder Irrigation (CBI) - catheter is taped to thigh ● Leg should remain straight to prevent pulling on catheter Post Myringotomy - surgical incision in eardrum to relieve pressure and drain fluid (tubes) ● Position on side of affected ear after surgery (allows

● Pain that is not relieved by prescription pain medication may signal hemorrhage, infection or increased ocular pressure Infant with Spina Bifida ● Position prone (on abdomen) to prevent sac from rupturing Buck’s Traction (skin traction) ● Elevate foot of bed for counter-traction Post Total Hip Replacement ● DON’T sleep on affected/operative side ● DON’T flex hip more than 45-60 degrees ● DON’T elevate HOB more than 45 degrees ● Maintain hip abduction by separating thighs with a pillow ● NO adduction or internal rotation Prolapsed CordKnee-chest or Trendelenburg (goal is to prevent pressure on cord) Vena Cava Syndrome (pregnant women) ● Position woman on her left side (relieves pressure off vena cava from fetus)—knees flexed (blood return) o Mother may present with hypotension Infant with Cleft Lip ● Position on back or in an infant seat to prevent trauma to suture line ● While feeding, hold in upright position

Infant with Cleft Palate ● Prone

● On bed rest while implant is in place *(Common NCLEX TOPIC) Autonomic Dysreflexia/Hyperreflexia (S/S: pounding H/A, profuse sweating, nasal congestion, goose flesh, bradycardia, HTN) ● Place patient in sitting position- HIGH FOWLER’S (elevate HOB- FIRST ACTION)— decreases venous return ● Check for kinks in foley catheter tubing Spinal Cord Injury ● Immobilize on spine board ● Head in neutral position ● Immobilize with padded C-collar ● Maintain traction and alignment of head manually ● Log roll client and do not allow to twist or bend Shock ● Bed rest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg) Head Injury ● Elevate HOB 30 degrees to decrease ICP Peritoneal Dialysis when Outflow is Inadequate ● Turn patient from side to side BEFORE checking for kinks in tubing (according to Kaplan) Nasogastric Tube ● Elevate HOB 30 degrees to prevent aspiration Maintain elevation for continuous feeding or 1 hour after intermittent feedings Cardiac Catheterization ● Keep site extended (usually involves femoral artery) Post-thyroidectomy ● Semi-Fowler’s position, prevent neck flexion/hyperextension (support head, neck and shoulders) ● Trach at bedside ● Monitor respiratory status every hour

Post-Bronchoscopy

Position in Semi-Fowler’s with arm (affected side) elevated

  • if left mastectomy, elevate left arm, if right mastectomy, elevate right arm!

o This facilitates removal of fluid through gravity and enhances circulation

Think positively and you can achieve great things!

Prior to liver biopsy it is important to check lab results for PT time (vascular organ) Liver biopsy - (prior) administer Vitamin K, NPO at midnight, teach patient that he will be asked to hold breath for 5-10 sec, supine position with upper arms elevated Morphine is contraindicated in pancreatitis— it causes spasm of the Sphincter of Oddi— Demerol is the pain medication of choice! *After pain relief, it is important to cough and deep breathe in pancreatitis—because fluid is pushing up in the diaphragm *With chronic pancreatitis, pancreatic enzymes are given with meals Diabetes Mellitus- pancreatic disorder resulting in insufficient or lack of insulin production leading to elevated blood sugar ● Type I (insulin dependent)- immune disorder, body attacks insulin producing beta cells with resulting Ketosis (result of ketones in blood due to gluconeogenesis from fat) o Excessive thirst and weight loss are characteristic of T1DM ● Type II (insulin resistant)- beta cells do not produce enough insulin or body becomes resistant ● NCLEX Points o Assessment ▪ 3 P’s ● Polyuria (excessive urination), polydipsia (extreme thirst), polyphagia (excessive hunger) ▪ Elevated blood sugar ▪ Blurred vision ▪ Elevated HbA1C ▪ Poor wound healing ▪ Neuropathy ▪ Inadequate circulation ▪ End organ damage is a major concern due to damage to vessels ● Coronary artery disease