NCLEX, what do you say about it?

National Council Licensure Examination (NCLEX) is an exam that a fellow nurse has to pass in order to get licensed to legally practice as a nurse in the United States. A prospective nurse must pass either a NCELX-RN (to become registered nurse) or NCLEX-PN (to practice as a practical nurse) after completion of nursing school. According to the data from the NCLEX statics, a candidate studied in the US has good passing percentage of 87.50% while as student from other countries have very low passing rate of 38.26%. Student apart from US educated have a great problem dealing NCLEX exam. My blog with some samples questions with rational answers might help those students who wish to appear in NCLEX exam. I will be submitting around 20 questions with rational answers in each of blog. Hope my effort will help international students.

1. After the lungs, the kidneys work to maintain body pH. The best explanation of how the kidneys accomplish regulation of pH is that they

a. Secrete hydrogen ions and sodium.
b. Secrete ammonia.
c. Exchange hydrogen and sodium in the kidney tubules.
d. Decrease sodium ions, hold on to hydrogen ions, and then secrete sodium bicarbonate.



2.. A female client has orders for an oral cholecystogram. Prior to the test, the nursing intervention would be to

a. Provide a high fat diet for dinner, then NPO
b. Explain that diarrhea may result from the dye tablets
c. Administer the dye tablets following a regular diet for dinner
d. Administer enemas until clear

3. The nurse explains to a client who has just received the diagnosis of Noninsulin-Dependent Diabetes Mellitus (NIDDM) that sulfonylureas, one group of oral hypoglycemic agents, act by

a. Stimulating the pancreas to produce or release insulin
b. Making the insulin that is produced more available for use
c. Lowering the blood sugar by facilitating the uptake and utilization of glucose
d. Altering both fat and protein metabolism


4. Myasthenic crisis and cholinergic crisis are the major complications of myasthenia gravis. Which of the following is essential nursing knowledge when caring for a client in crisis?

a. Weakness and paralysis of the muscles for swallowing and breathing occur in either crisis
b. Cholinergic drugs should be administered to prevent further complications associated with the crisis
c. The clinical condition of the client usually improves after several days of treatment
d. Loss of body function creates high levels of anxiety and fear


5. A 54-year-old client was put in Quinidine (a drug that decreases myocardial excitability) to prevent atrial fibrillation. He also has kidney disease. The nurse is aware that this drug, when given to a client with kidney disease, may

a. Cause cardiac arrest
b. Cause hypotension
c. Produce mild bradycardia
d. Be very toxic even in small doses


6. A client is about to be discharged on the drug bishydroxycoumarin (Dicumarol). Of the principles below, which one is the most important to teach the client before discharge?

a. He should be sure to take the medication before meals
b. He should shave with an electric razor
c. If he misses a dose, he should double the dose at the next scheduled time
d. It is the responsibility of the physician to do the teaching for this medication


7. A cyanotic client with an unknown diagnosis is admitted to the emergency room. In relation to oxygen, the first nursing action would be to

a. Wait until the client's lab work is done
b. Not administer oxygen unless ordered by the physician
c. Administer oxygen at 2 liters flow per minute
d. Administer oxygen at 10 liters flow per minute and check the client's nail beds


8. A client with a diagnosis of gout will be taking colchicine and allopurinol bid to prevent recurrence. The most common early sign of colchicine toxicity that the nurse will assess for is

a. Blurred vision
b. Anorexia
c. Diarrhea
d. Fever

9. A client has chronic dermatitis involving the neck, face and antecubital creases. She has a strong family history of varied allergy disorders. This type of dermatitis is probably best described as

a. Contact dermatitis
b. Atopic dermatitis
c. Eczema
d. Dermatitis medicamentosa



10 . The physician has just completed a liver biopsy. Immediately following the procedure, the nurse will position the client

a. On his right side to promote hemostasis
b. In Fowler's position to facilitate ventilation
c. Supine to maintain blood pressure
d. In Sims' position to prevent aspiration

11 When a client has peptic ulcer disease, the nurse would expect a priority intervention to be

a. Assisting in inserting a Miller-Abbott tube
b. Assisting in inserting an arterial pressure line
c. Inserting a nasogastric tube
d. Inserting an IV


12. The nurse would expect to find an improvement in which of the blood values as a result of dialysis treatment?

a. High serum creatinine levels
b. Low hemoglobin
c. Hypocalcemia
d. Hypokalemia


13. A 24-year-old client is admitted to the hospital following an automobile accident. She was brought in unconscious with the following vital signs: BP 130/76, P 100, R 16, T 98F. The nurse observes bleeding from the client's nose. Which of the following interventions will assist in determining the presence of cerebrospinal fluid?

a. Obtain a culture of the specimen using sterile swabs and send to the laboratory
b. Allow the drainage to drip on a sterile gauze and observe for a halo or ring around the blood
c. Suction the nose gently with a bulb syringe and send specimen to the laboratory
d. Insert sterile packing into the nares and remove in 24 hours


14. A 24-year-old male is admitted with a possible head injury. His arterial blood gases show that his pH is less than 7.3, his PaCO2 is elevated above 60 mmHg, and his PaO2 is less than 45 mmHg. Evaluating this ABG panel, the nurse would conclude that

a. Edema has resulted from a low pH state
b. Acidosis has caused vasoconstriction of cerebral arterioles
c. Cerebral edema has resulted from a low oxygen state
d. Cerebral blood flow has decreased


15 In preparation for discharge of a client with arterial insufficiency and Raynaud's disease, client teaching instructions should include

a. Walking several times each day as a part of an exercise routine
b. Keeping the heat up so that the environment is warm
c. Wearing TED hose during the day
d. Using hydrotherapy for increasing oxygenation


16. A client is admitted following an automobile accident in which he sustained a contusion. The nurse knows that the significance of a contusion is

a. That it is reversible
b. Amnesia will occur
c. Loss of consciousness may be transient
d. Laceration of the brain may occur


17. A client with tuberculosis is given the drug pyrazinamide (Pyrazinamide). Which one of the following diagnostic tests would be inaccurate if the client is receiving the drug?

a. Liver function test
b. Gall bladder studies
c. Thyroid function studies
d. Blood glucose


18. Which one of the following conditions could lead to an inaccurate pulse oximetry reading if the sensor is attached to the client's ear?

a. Artificial nails
b. Vasodilation
c. Hypothermia
d. Movement of the head


19. While on a camping trip, a friend sustains a snake bite from a poisonous snake. The most effective initial intervention would be to

a. Place a restrictive band above the snake bite
b. Elevate the bite area above the level of the heart
c. Position the client in a supine position
d. Immobilize the limb


20. There is a physician's order to irrigate a client's bladder. Which one of the following nursing measures will ensure patency?

a. Use a solution of sterile water for the irrigation
b. Apply a small amount of pressure to push the mucus out of the catheter tip if the tube is not patent
c. Carefully insert about 100 mL of aqueous Zephiran into the bladder, allow it to remain for 10 hour, and then siphon it out
d. Irrigate with 20mL's of normal saline to establish patency

Answers
1. Answer: d

Rationale: By decreasing NA+ ions, holding onto hydrogen ions, and secreting sodium bicarbonate, the kidneys can regulate pH. Therefore, this is the most complete answer, and while this buffer system is the slowest, it can completely compensate for acid-base imbalance.
2. Answer: b

Rationale: Diarrhea is a very common response to the dye tablets. A dinner of tea and toast is usually given to the client. Each dye tablet is given at 5 minute intervals, usually with 1 glass of water following each tablet. The number of tablets prescribed will vary, because it is based on the weight of the client.
3. Answer: a

Rationale: Sulfonylurea drugs, Orinase for example, lowers the blood sugar by stimulating the beta cells of the pancreas to synthesize and release insulin.

4. Answer: a

Rationale: The client cannot handle his own secretions, and respiratory arrest may be
imminent. Atropine may be administered to prevent crisis. Anticholinergic drugs are administered to increase the levels of acetylcholine at the myoneural junction. Cholinergic drugs mimic the actions of the parasympathetic nervous system and would not be used.

5. Answer: a

Rationale: Kidney disease interferes with metabolism and excretion of Quinidine, resulting in higher drug concentrations in the body. Quinidine can depress myocardial excitability enough to cause cardiac arrest.

6. Answer: b

Rationale: Dicumarol is an anticoagulant drug and one of the dangers involved is bleeding. Using a safety razor can lead to bleeding through cuts. The drug should be given at the same time daily but not related to meals. Due to danger of bleeding, missed doses should not be made up.

7. Answer: c

Rationale: Administer oxygen at 2 liters per minute and no more, for if the client is emphysemic and receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function

8. Answer: c

Rationale: Diarrhea is by far the most common early sign of colchicine toxicity. When given in the acute phase of gout, the dose of colchicine is usually 0.6 mg (PO) q hr (not to exceed 10 tablets) until pain is relieved or gastrointestinal symptoms ensue.


9. Answer: b

Rationale: Atopic dermatitis is chronic, pruritic and allergic in nature. Typically it has a longer course than contact dermatitis and is aggravated by commercial face or body lotions, emotional stress, and, in some instances, particular foods.
10. Answer: a

Rationale: Placing the client on his right side will allow pressure to be placed on the puncture site, thus promoting hemostasis and preventing hemorrhage. The other positions will not be effective in achieving these goals.

11. Answer: c

Rationale: An NG tube insertion is the most appropriate intervention because it will determine
the presence of active gastrointestinal bleeding. A Miller-Abbott tube is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line is not appropriate at this time and an IV is optional.

12. Answer: a

Rationale: High creatinine levels will be decreased. Anemia is a result of decreased production of erythropoietin by the kidney and is not affected by hemodialysis. Hyperkalemia and high base bicarbonate levels are present in renal failure clients.

13. Answer: b

Rationale: The halo or "bull's eye" sign seen when drainage from the nose or ear of a
head-injured client is collected on a sterile gauze is indicative of CSF in the drainage. The collection of a culture specimen using any type of swab or suction would be contraindicated because brain tissue may be inadvertently removed at the same time or other tissue damage may result.

14. Answer: c

Rationale: Hypoxic states may cause cerebral edema. Hypoxia also causes cerebral vasodilatation particularly in response to a decrease in the PaO2 below 60 mmHg.

15. Answer: b

Rationale: The client's instructions should include keeping the environment warm to prevent vasoconstriction. Wearing gloves, warm clothes, and socks will also be useful in preventing vasoconstriction, but TED hose would not be therapeutic. Walking will most likely increase pain.

16. Answer: d

Rationale: Laceration, a more severe consequence of closed head injury, occurs as the brain tissue moves across the uneven base of the skull in a contusion. Contusion causes cerebral dysfunction which results in bruising of the brain. A concussion causes transient loss of consciousness, retrograde amnesia, and is generally reversible.

17. Answer: a

Rationale: Liver function tests can be elevated in clients taking pyrazinamide. This drug is used when primary and secondary antitubercular drugs are not effective. Urate levels may be increased and there is a chemical interference with urine ketone levels if these tests are done while the client is on the drug.

18. Answer: c

Rationale: Hypothermia or fever may lead to an inaccurate reading. Artificial nails may distort a reading if a finger probe is used. Vasoconstriction can cause an inaccurate reading of oxygen saturation. Arterial saturations have a close correlation with the reading from the pulse oximeter as long as the arterial saturation is above 70 percent.
19. Answer: a

Rationale: A restrictive band 2 to 4 inches above the snake bite is most effective in
containing the venom and minimizing lymphatic and superficial venous return. Elevation of the limb or immobilization would not be effective interventions.

20. Answer: d

Rationale: Normal saline is the fluid of choice for irrigation. It is never advisable to force fluids into a tubing to check for patency. Sterile water and aqueous Zephiran will affect the pH of the bladder as well as cause irritation.

Back Again

Wow, it feel great to be back again to the blog. It's been a long time since i post a blog. Actually it was not being busy or not being unable to access the medium but there is something which hinders me from getting to this limit. Anyway, now seems those hinderance has been vanished or became opaque, anyway now the way is much more clear.

Anyway i feel more than happy to be back with blog.
Dear friends and my dearest reader, my appology not being able to be in touch with you for a such a long time, but now i hope i will be in touch with you constantly.

My happiness, my apology, my promish is the basic of this back again blog. Hope you will be giving me comments and suggestions on my blog like

Monograph of Respiridone

Monogram of Respiridone

General description of Respiridone:
Respiridone is an antipsychotic drug with dopaminergic and serotonergic effect. Respiridone is used to treat schizophrenia, the mixed and manic states associated with bipolar disorder, and irritability in children with autism. The drug was developed by Janseen-Cilag.
RISPERDAL ® ( risperidone) s a psychotropic agent belonging to the chemical class of benzisoxazole derivatives. The chemical designation is 3-[ 2-[ 4-( 6-fluoro-1,2-benzisoxazol-3-yl) -1-piperidinyl ] ethyl ] -6,7,8,9-tetrahydro-2-methyl-4H-pyrido [ 1,2-a ] pyrimidin-4-one. Its molecular formula is C23H27FN4O2 and its molecular weight is 410.49.

Risperidone is a white to slightly beige powder. It is practically insoluble in water, freely soluble in methylene chloride, and soluble in methanol and 0.1 N HCl. (http://www.healthcentral.com/druglibrary/408/risperdal-drug_description.html)


Therapeutic group:
Respiridone is the categorized in the therapeutic group of drug for the antipsychotic drug.
Mode of action:
Risperidone is extensively metabolized in the liver. The main metabolic pathway is through hydroxylation of risperidone to 9-hydroxyrisperidone by the enzyme, CYP 2D6. A minor metabolic pathway is through N-dealkylation. The main metabolite,
9-hydroxyrisperidone has similar pharmacological activity as risperidone. Consequently, the clinical effect of the drug (e.g., the active moiety) results from the combined concentrations of risperidone plus 9-hydroxyrisperidone.
CYP2D6, also called debrisoquin hydrozylase, is the enzyme responsible for metabolism of many neuroleptics, antidepressants, antiarrhythimics, and other drugs, CYP 2D6 is subject to genetic polymorphism (about 6% -8% of Caucasians, and a very low percentage of Asians, have little or no activity and are “poor metabolizers”) and to inhibition by a variety of substrates and some non-substrates, notably quinidine. Extensive CYP 2D6 metabolizers convert risperidone rapidly into 9-hydroxyrisperidone, whereas poor CYP 2D6 metabolizers convert it much more slowly. Although extensive metabolizers have lower risperidone and higher 9-hydroxyrisperidone concentrations than poor metabolizers, the pharmacokinetics of the active moiety, after single and multiple doses, are similar in extensive and poor metabolizers.
Respiridone contraindication:
Respiridone is contraindicated in patients with a known hypersensitivity to the product and who have a history of high blood sugar and diabetes, and older patient treated for mental illness from dementia. Patient with history of seizures, cardiovascular disease, cerebrovascular disease, dehydration, diabetes, hyperglycemia, pancreas problem, hypovolemia, Alzheimer’s disease, hypothyroidism, pregnancy and hepatic impairment have to consult with doctor before using Respiridone. (http://www.resource4defectivedrugs.com/topics/risperdal.html)


Indications:
Respiridone is indicated for acute and chronic schizophrenic psychoses and other psychotic conditions with positive and negative symptoms and even indicated for affective symptoms associated with schizophrenia (ABPI, 1998). This drug has some effect on the bipolar affective disorder. Respiridone has been used to SSRIs in obsessive compulsive disorder. (http://priory.com/focus9.htm#Clinical%20Indications)
Interactions of Respiridone
Risperidone could be subject to two kinds of drug-drug interactions First, inhibitors of CYP 2D6 interfere with conversion of risperidone to 9-hydroxyrisperidone. This occurs with quinidine, giving essentially all recipients a risperidone pharmacokinetic profile typical of poor metabolizers. The therapeutic benefits and adverse effects of risperidone in patients receiving quinidine have not been evaluated, but observations in a modest number (n@70) of poor metabolizers given risperidone do not suggest important differences between poor and extensive metabolizers. Second, co-administration of known enzyme inducers (e.g. phenytoin, rifampin, and phenobarbitital) with risperidone may cause a decrease in the combined plasma concentrations of risperidone and 9-hydroxyrisperidone. It would also be possible for risperidone to interfere with metabolism of other drugs metabolized by CYP 2D6. Relatively weak binding of risperidone to the enzyme suggest this is unlikely
Side effects of Respiridone:
agitation, anxiety; blurred vision; confusion; constipation; cough; decreased sexual interest or ability; dysfunction of erection; ejaculation and orgasmdiarrhea; difficulty breathing or swallowing; difficulty falling asleep or staying asleep; difficulty urinating; dizziness; dreaming more than usual; drowsiness; dry mouth; dry or discolored skin; fainting; faintness; fast or irregular pulse; fast, pounding, or irregular heartbeat; fever; heartburn; hives; increased appetite; itching; muscle or joint pain; muscle stiffness; painful erection of the penis that lasts for hours; rash; restlessness; runny nose; seizures; slow movements or shuffling walk; sore throat; stomach pain; sweating; unusual movements of your face or body that you cannot control; upset stomach; weight gain.

Precautions while using Respiridone
RISPERDAL (risperidone) may induce orthostatic hypotension associated with dizziness, tychycardia, and in some patients, syncope, especially during the initial dose-titration period, probably reflection its alpha-adrenergic antagonistic properties. A dose reduction should be considered if hypotension occurs. RISPERDAL should be used with particular caution in patients with known cardiovascular disease (history of myocardial infraction or ischemia, heart failure, or condition abnormalities), cerebrovascular disease, and conditions, which would predispose patients to hypotension, e.g., dehydration and hypovolemia. Clinically significant hypotension has been observed with concomitant use of RISPERDAL and antihypertensive medication.

Special warnings
A 2003 study for the Risperdal reported that 49% more cases of diabetes among the users of Risperdal than amoung older anti-pscyhotic drug. So, Risperdal has been linked to type 2 diabetes, juvenile diabetes, hyperglycemia, other blood sugar disorders, diabetic coma, and pancreatitis- a dangerous inflammation of the pancreas. Respirdone is even linked with excessive weight gain, Neuroleptic malignant Syndrome (NMS) and Tardive Dyskinesia. Elderly patient treated with Rispierdal for demential had a higher chances of death by stroke and cardiac arrest than patient who did not take the drug.( http://www.resource4defectivedrugs.com/topics/risperdal.html)

How to create account in PPP 4

working with the PPP for at least 2 years is very great. I have not been able to make a lots of money cause i had some other stuffs heating me hard and could not give a time to it. Anyway it was real great working with PPP 3. Now i do want to work with PPP4 as well. i thought may be my PPP3 username and password will work out but to my surprise for it i need a password from the social spark. Anyway, i hit the password and then i was asked to submit my blog url, i did it. But to my surprise, it wants to verify my blog, so they asked me to paste certain text in my blog, which is "euphonious flavoured crisps, with real euphonious pieces". euphonious flavoured crisps, with real euphonious pieces is the text that i have to post in my blog for certain time and publish a blog to verify my blog and then i have to press cliam to verify my blog. Well this seems bit a odd job to do but technically i think those people also want to be sure aboout the genuine one.

Let’s ride own car in affordable price

Do you have a dream to ride a good car and having a problem of not being able to fulfill it just because you can’t afford it financially? If somebody asks a question to anybody with the middle class people, the answer would be of course or why not. Well this answer shoots not only for the middle class people but for everybody isn’t it? If we can get the good car in the cheap price, why not to ride a car. BuyYourCar.Co.Uk is helping lots of people to fulfill their dream with the very good car in the cheap price. They will provide you with a used cars, which you can find it in very good condition and very good price. They do the purchase of good car and sells a good car are affordable price. If you have a problem with money to pay all at lump some at a time, they help to get you along with the insurance as well. If you want to buy a new one also, they have lots of great new cars to offer you as well. So it’s better to have a check at them for once and you won’t regret for your time consumed in surfing internet.

Heart failure and your life style

Heart failure (HF) is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs. This heart failure is termed as most expensive disease to the human life. Around 35 billion dollars is spent each year only in the USA for the treatment and hospitalization of the heart failure patient.
This must of money can be saved if we have control over our own daily activities. Sedative life style is the greatest risk factors for the heart failure. Some other causes of heart failure are myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease and cardiomyopathy.
Other things which contribute in heart failure are: Ischaemic Heart Disease 62%, Cigarette Smoking 16%, Hypertension (high blood pressure)10%, Obesity 8%, Diabetes 3% , Valvular heart disease 2% (much higher in older populations)
Some rare causes of heart failure are: Viral Myocarditis (an infection of the heart muscle), Infiltrations of the muscle such as amyloidosis , HIV cardiomyopathy (caused by Human Immunodeficiency Virus), Connective Tissue Diseases such as Systemic lupus erythematosus, Abuse of drugs such as alcohol, Pharmaceutical drugs such as chemotherapeutic agents. And Arrhythmias.

Anyway if you can prevent from getting heart failure by controlling over your life style, why not to change it.

Scent to your choice

Lots of teenagers do love to get attracted in the first meeting with the other, especially girls love to attract the gents at the first site. They do use lots of stuffs, for example, make up, dressing and lots other stuffs. Putting the great scent in the body has been used from the long time and now ladies do love to have strong and attractive scent. Gents are not far behind this rapt attention technique and do loves use the scent, so do I. Like girls, I do love to have a strong scent which can be smell for long distance and which lasts for the long time. Dolce & Gabbana has been a best for me for a long time and I am just craze for this. I am sure that lots of people are fond of Dolce & Gabbana, but I can’t say all of people are fond of it. Anyway everybody has their own taste. Considering the taste of different people, Scent has tried to aggregate the different scent in its website in the cheap and affordable price. I would suggest you to have a look in it, if you are real fond of scent.

Stem Cell

I have been hearing a stem cell research for a long, but being medical student as well I was not able to explain what the stem cell really means. I know what stem cell can be converted to and what can be done with the stem cell for the cure of the disease. As I heard about the stem cell being able to convert to the sperm cell I got more enthusiastic to find out about the stem cell. According to the Wikipedia, stem cells are the cell found in most, if not all, multicellular organisms and are characterized by the ability to renew themselves through mitotic cell division and differentiating into a diverse range of specialized cell types. Embryonic stem cells, a cell isolated from the inner cell mass of blastocysts, and adult stem cells that are found in adult tissue are the two broad types of mammalian stem cells. A stem cell from embryonic can be differentiated or converted to into all of the specialized embryonic tissues and the adult stem cell acts repair system of the body, replenishing specialized cells, but also maintain the normal turnover of regenerative organs, such as blood, skin or intestinal tissue.
Now it’s a sort of requirement that the stem cell are collected from the umbilical cord blood and is saved for the later medical purposes to help the person. During the child birth, the umbilical blood is collected before just for the diagnosis of the disease in the child but nowadays it’s been stored for the future medical help purpose, as stem cell can be used to treat lots of medical problems. It has been found that stem cell can be used to treat stroke, traumatic brain injury, blindness, baldness, deafness and lot other disease.

What about a game of billiard online?

It’s really hard to find the pal to pay billiard nowadays in real as everybody is getting busy with their business and other stuffs. So the person like me having a interest in billiard player has found out the way to get in touch with billiard through the chess game online. I can find the people down there from the entire world with the great interest and with great talent which can challenge my talent. I am sure that I could find the good player out of that place to have a challenging game. The site is multilingual with the Arabic language as well. I am sure that it site would be a great choice for the people like me all over the world to have their wishes of playing billiard being fulfilled.

Swine flu now in cyprus

Swine flu as everybody knows has a long term history of outbreak since 1918 in the human individual. But to the current, this outbreak takes place the Mexico in April of 2009. The swine flu is the flu that affects the pig and is the respiratory diseases of the pig. This is caused due to the new strain of the influenza A virus subtype H1N1, which has a capacity of transferring between the human. The sings and symptoms of this swine flu is more or less common to the common human flu. The outbreak of the swine flu from Mexico in the April of 2009 lead Mexican government to shut down most of the Mexico City’s public and private offices and now is pandemic in 139 countries including developing and developed countries. WHO has placed this swine flu in the dangerous pandemic at the rate of 5 out of 6. In the context of the Cyprus, the swine flu confirmed cases has reached up to 201 cases with the test given for the 416 persons. The infection rate is getting higher in the Cyprus, with no proper treatment and medications. First case of swine flu is Cyprus was reported in the 30 May 2009, form the 39-year-old woman, a foreign national who is married with Cypriot and lives in the island.