NCLEX Questions and Answers with Nurse Sarah: Asthma Medication and More

Hi everyone, it's Nurse Sarah! In this video, I'll walk you through some NCLEX questions and answers. Let’s dive right in.

Question 1: Asthma Medication Sequence

A patient with asthma is prescribed inhaled Salmeterol and Fluticasone for long-term management. You observe the patient taking these medications. Which option below best describes the correct order for taking these medications?

When tackling this question, start by analyzing the medications. The patient is using Salmeterol, a bronchodilator, and Fluticasone, a corticosteroid.

How These Medications Work:

• Salmeterol (Bronchodilator): Opens up the airways by dilating the bronchi.
• Fluticasone (Corticosteroid): Reduces inflammation in the airways, which is crucial for asthma management.

Correct Sequence:

First, the patient should take the bronchodilator (Salmeterol) to open the airways. This allows the corticosteroid (Fluticasone) to reach deeper into the lungs to effectively reduce inflammation.

Answer:

Option A is correct: Take Salmeterol first, wait five minutes, then inhale Fluticasone. Waiting five minutes gives the bronchodilator time to work, ensuring the corticosteroid can be fully effective.

Question 2: Understanding Beta Blockers and Diabetes

A patient with diabetes and hypertension is being discharged. The patient is prescribed Sotalol (a beta-blocker) and insulin. Which statement by the patient shows they did not understand the discharge instructions about Sotalol?

Key Points to Consider:

• Sotalol: A beta-blocker used to manage hypertension. It can mask symptoms of hypoglycemia (like a rapid heartbeat) in diabetic patients.

Incorrect Statement:

Option C is incorrect: "A fast heart rate is an early indication my blood glucose has dropped." Sotalol can prevent the heart rate from increasing, even when blood sugar is low. This is dangerous because it can mask the signs of hypoglycemia.

Question 3: Administering IV Antibiotics with Blood Transfusion

A patient is receiving one unit of packed red blood cells, scheduled to finish at 12:00. They also need IV antibiotics at 10:00. What should you do?

Key Considerations:

• Blood transfusions should not be stopped once started.
• IV antibiotics should be administered on time.

Best Action:

Option D is correct: Administer the IV antibiotic as scheduled using a second IV access, preferably in the opposite arm from the blood transfusion.

Question 4: Managing Hypernatremia with IV Fluids

A patient is receiving half-normal saline for hypernatremia. What finding requires you to stop the fluid and notify the doctor?

Understanding the Situation:

• Half-Normal Saline: A hypotonic solution that can move water into cells. Excessive movement can cause cells to swell, leading to confusion—a sign of cerebral edema.

Critical Finding:

Option C is correct: Confusion. This indicates possible cerebral edema, which is a medical emergency.

Question 5: Prioritizing Nursing Diagnoses in Burn Patients

A patient with full-thickness burns in the perineum and sacral area is in the acute phase of burn management. Which nursing diagnosis is the priority?

Key Points:

• The acute phase focuses on preventing infection, fluid balance, and wound care.

Priority Diagnosis:

Option C is correct: Risk for infection. Burns in these areas are prone to infection, which can lead to sepsis—a life-threatening condition.

Question 6: Dietary Management in Hepatic Encephalopathy

A patient with hepatic encephalopathy secondary to cirrhosis is choosing a meal. Which meal option should they avoid?

Understanding the Condition:

• Hepatic Encephalopathy: Caused by high ammonia levels due to impaired liver function. Patients should avoid high-protein foods.

Meal to Avoid:

Option A is correct: Beef tips and broccoli rabe. Beef is high in protein and should be avoided to prevent worsening hepatic encephalopathy.

Question 7: Responding to a Lethal Cardiac Rhythm

You observe a patient in a lethal rhythm on the ECG. The patient is unresponsive and has no pulse. What is your next step after calling a code blue?

Critical Action:

Option C is correct: Start high-quality CPR immediately. This maintains some blood flow until the code team arrives for defibrillation and medication administration.

Question 8: Identifying a First-Degree AV Block

You’re given an ECG strip to analyze. The patient’s atrial and ventricular rates are 70, with regular PR intervals, but the PR intervals are prolonged. What’s the rhythm?

Correct Identification:

Option C is correct: First-degree AV block. This condition is characterized by a prolonged PR interval but generally does not require treatment unless symptomatic.

Question 9: Post-Cataract Surgery Precautions

A patient is two hours post-op from cataract surgery on the right eye. Which behavior requires re-education?

Post-Surgery Care:

• Patients should avoid sleeping on the operated side to prevent increased pressure on the eye.

Behavior to Correct:

Option A is correct: The patient is asleep on their right side. They should sleep on their left side to protect the surgical site.

Question 10: Assessing Guillain-Barré Syndrome

A patient presents with unexplained paralysis from the hips downward and a recent history of illness. The doctor suspects Guillain-Barré syndrome. Which finding during your assessment requires immediate action?

Understanding the Syndrome:

• Guillain-Barré Syndrome: Can progress rapidly, potentially affecting respiratory muscles.

Immediate Concern:

Option B is correct: A weak cough. This suggests that the respiratory muscles are weakening, which could lead to respiratory failure.

Question 11: Proper Sequence for Abdominal Assessment

When performing an abdominal assessment, what is the correct order?

Correct Sequence:

1. Inspection
2. Auscultation
3. Percussion
4. Palpation

This sequence ensures you don't disturb the bowel sounds before listening to them.

Question 12: Characteristics of a Pleural Friction Rub

Which characteristic is associated with a pleural friction rub?

Understanding the Sound:

• Pleural Friction Rub: Occurs when inflamed pleural layers rub together.

Correct Answer:

Option A is correct: Pain with coughing, deep breathing, or laughing. It’s a low-pitched, harsh grating sound heard during respiration.