Nclex UWorld 2024-2025/ Contains 1,823 Actual Exam Qs & Ans/ A+ Score Solution.
When do advanced directives go into effect? - Correct Answer: when a person is unable to speak for him/herself due to either:
1. M
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Nclex UWorld 2024-2025/ Contains 1,823 Actual Exam Qs & Ans/ A+ Score Solution.
When do advanced directives go into effect? - Correct Answer: when a person is unable to speak for him/herself due to either:
1. Mental Incapacity - coma (GCS score ≤ 7)
2. Aphasia
(≠as soon as signed; directives can always be changed later by person)
SBAR Communication Framework Components - Correct Answer: 1. S = Situation - what prompted the communication (eg what changes occurred)
2. B = Background - pertinent information, relevant history, vital signs
3. A = Assessment - nurse's assessment of the situation (when & what changes occurred)
4. R = Recommendation - request for prescription or action from HCP
Appropriate order of actions when client found on floor - Correct
Answer: 1. Assessment of physiological stability (ABCs)
2. Assessment of injuries
3. Moving client
4. Notifications
5. Documentation
Conditions of being ineligible to leave AMA - Correct Answer: 1 danger to self or others
2. lack of consciousness
3. Altered consciousness
4. Mental illness
5. Being under chemical influence
6. Court decision
Effective handoff communication components - Correct Answer: Nurse should:
1. Provide identifying information (eg client's name and room number)
2. Note care priorities and upcoming or outstanding tasks (eg time to replace medication infusion bag, need to perform delayed wound care and cause of delay)
3. Provide exact, pertinent information (eg medication dose, time, measurable outcomes)
4. Include multidisciplinary plans (eg radiology examinations, family meetings, physical therapy)
5. Relay significant client changes in a clear manner
Risk factors for cervical cancer - Correct Answer: 1. Infection with high-risk HPV strains
2. History of sexually transmitted diseases
3. Early onset of sexual activity
4. Multiple or high-risk sexual partners
5. Immunosuppression
6. Oral contraceptive use
7. Low SES
8. Tobacco use
what medications interact with grapefruit? - Correct Answer: 1. calcium channel blockers (diltiazem, nifedipine, verapamil, etc)
2. statins
3. SSRIs
Risk associated with stent placement using the femoral approach -
Correct Answer: retroperitoneal hemorrhage
what are early signs of bleeding into the retroperitoneal space? - Correct Answer: hypotension, back pain, flank ecchymosis (grey turner sign), hematoma formation, diminshed distal pulses
what is the grey-turner sign and what is it a sign of? - Correct Answer: bruising of the flanks and retroperitoneal hemorrhage and is a bluish color
what are some physical signs of peripheral arterial disease? - Correct Answer: intermittent calf muscle pain?, rest pain, hair loss, decreased peripheral pulses, cool, dry, shiny skin, thick brittle nails, gangrene, ulcers (all of these are in the extremities)
transplanted hearts are expected to be - Correct Answer: tachycardic like 90-110
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