July 2011 Nurse Licensure Examination Result - July 2011 Nurse Board Exam Result

July 2011 Nurse Licensure Examination Result - July 2011 Nurse Board Exam Result

ABOUT BREAST FEEDING
I. Physiology of Breast milk production
As soon as delivery of the placenta is over there will be an abrupt decrease on both Estrogen and Progesterone -----> this will stimulate the APG to secrete PROLACTIN.
note: Be aware that sucking also stimulates Prolactin secretion as this will stimulate the nerves and impulse will travel from the nipple to the Hypothalamus
PROLACTIN will act on the acini cells (alveolar cells) of the breast to produce milk. This milk is called FOREMILK and is stored in the lactiferous sinus. FOREMILK is continously being produced.
What happens next?
When the baby sucks on the breast of the mother OXYTOCIN is stimulated and oxytocin will act on 2 organs.
1. Breast (Let down reflex)
2. Uterus (promotes Involutions)
OXYTOCIN will cause the mammary glands to contract and push the milk forward making it available for the baby.
What will stimulate the Let Down reflex?
1. Sucking of the baby
2. Sound of the baby's cry
note: After the Let Down Reflex a new milk will be formed and this is called HINDMILK and this contains more FATS that is needed for the growing newborn
.STAGES OF BREASTMILK:
1. Colostrum - 2-4 days present
-content: decrease fats, increase IgA, dec CHO, dec CHON, inc minerals, -inc fat soluble minerals
2. Transitional milk- 4 – 14 days
-content: inc lactose, inc water soluble vit., inc minerals
3. Mature milk- 14 & up
-content: inc fats (linoleic acid) – resp for devt of brain & integrity of skin
-inc CHO- lactose – easily digested, baby not constipated.- esp of sour milk smelling odor of stool.
-Lactose intolerance- deficiency of enzyme LACTASE that digest LACTOSE
-Decrease CHON- lactalbumin
Difference with cow's milk
Cows milk
–inc fats -Dec CHO
-Inc CHON – casing- has curd that’s hard to digest.
-Inc minerals–traumatic effect on kidneys of babies. Can trigger stone formation.
-Inc phosphorusnote:
Note Baby who are breastfed are least likely to develop tetany. It is seen that botlle fed infants have more difficulty in regulating calcium and phosporus. Because cow's milk have more fat contents, this fatty acids may bind with calcium in the GIT causing more decrease in calcium.
Note: Breast feeding can be iniated
if had Cesarian Section- after 4 hours
if NSD, ASAP
Advantages of Breast feeding
1. Economical
2.Always available
3. Breastfed babies have higher IQ than bottle fed babies.
4. It facilitates rapid involution
5. Decrease incidence of breast cancer.
6. Has antibodiesI(gA), lactoferrin, lyzozymes and interferon (inhibit and/or destroy pathogenic bacteria and viruses)
7. Has lactobacillius bifidus- interferes with attack of pathogenic bacteria in GIT
8. Has macrophages
Store milk- plastic storage container
Store milk – good for 6 months from freezer- put rm temp. don’t heat
Disadvantages:
1. Possibility of transfer HEP B, HIV, cytomegalo virus.
2. No iron
3. Father can’t feed & bond as well
Proper breast feeding technique
1. Be in a comfortable position
(Most appropriate is Upright sitiing for this position avoids tension)
2. Entire body of teh baby should be turned towards the mother's breast.
3. Initiate feeding by stimulating the Rooting reflex- by touching the side of lips/cheeks then baby will turn to stimulus. Disappear by 6 weeks- by 6 weeks baby can focus. Reflex will be gone-
Purpose rooting- to look for food.
Sucking Mechanism (breast)
a. Lips of the infant should clamp a C-shape
b. The tounge thrusts forward to grasp nipple and areola
c. The nipple is brought against the ahrd palate as the tounge pulls the areola into the mouth
d. the gums compresses the areola, squezing milk at the back of the throat
Sucking mechanism (bottle)
The large rubber nipple strikes the soft palate and interferes with the action of the tounge. The tounge moves forwards against the gum to control overflow of milk in the espphagous (same reason why dental malocllusion is prone to bottle fed babies, because they thrust their tounge FORWARD causing problem in the formation of the dental arch)
4. Burp or Bubble the babyduring and after feeding to allow escape of air (preventing colic). Sit infant on lap, flexed forward, then rub or pat the back (note: avoid jarring the infant)
Criteria of Effective Sucking
a.) Baby’s mouth is hiked up to areola
b.) Mom experiences after pain.
c.) Other nipple is also flowing with milk.
NOTE: Make sure that the mother feeds the baby at the same breast she last feed her baby. THis is to facilitated complete emptying of the breast and thereby promote complete filling of milk.
Contra Indications in Breast Feeding:
a. Maternal Conditions:
1. HIV, CMV, Hepa B
2. Recieving Coumadin, Lithium or Methotrexate
3.has breast cancer
4. has herpes lesion on breast
b.Newborn Condition - Inborn errors of metabolism such asErythrobastosis Fetalis – Rh incompatibility, Hydrops Fetalis, Phenylketonuria, Galactosemia, Tay Sachs disease
Problems experienced in Breastfeeding :
3RD day changes in breast post partuma.1
1)Engorged breast- feeling of fullness & tension in breast. - sometimes accompanied by fever known as MILK FEVER.
Mgt:Warm compress- for breastfeeding momCold compress
– for bottle feeding & wear supportive bra.
When is involution of breast- 4 weeks
b.) Sore nipple – cracked with painful nipple
Mgt: 1.) exposure to air – remove bra & wear dress, if not, expose to 20 Watt bulbavoid wearing plastic liner bra-will create moisture, cotton only
c.) Mastitis- inflammation of breast : staphylococcus aureus
Factors:
1. Improper breast emptying
2. Unhealthy sexual practices
- manually express inflamed breastfeed on unaffected breast- give antibiotics
– can still feed on unaffected breast
Type of stools with different milk products:
1. Transitional stool - - green loose & shiny, like diarrhea to the untrained eye
2. Breastfed stool
- golden yellow, soft, mushy with sour milk smell, frequently passed
- recur every feeding
3.. Bottlefed stool –
- pale yellow, formed hard with typical offensive odor, seldom passed, 2–3 x/day
- with food added -brown & odorous

15 ITEMS ACLS DRILL
1. To confirm proper placement of tracheal tube through 5-point auscultation, which of the following observations are appropriate? Check all that apply.
__ check breath sounds in the left and right lateral chest and lung bases
__ auscultate breath sounds in the left and right anterior sides of the chest
__ listen for gastric bubbling noises front the epigastrium
__ ensure equal and adequate chest expansion bilaterally
2. Which of the following is true about an oropharyngeal airway?
a. it eliminates the need to position the head of the unconscious patient
b. it eliminates the possibility of an upper airway obstruction
c. it is of no value once a tracheal tube is inserted
d. it may stimulate vomiting or laryngospasm if inserted in the semiconscious patient
3. Which of the following is an indication for tracheal intubation?
a. difficulty encountered by qualified rescuers in ventilating an apneic patient with a bag-mask device
b. a respiratory rate of less than 20 breaths per minute in a patient with severe chest pain
c. presence of premature ventricular contractions
d. to provide airway protection in a responsive patient with an adequate gag reflex
4. Which of the following is the most important step to restore oxygenation and ventilation for the unresponsive, breathless submersion (near drowning) victim?
a. attempt to drain water from breathing passages by performing the Heimlich maneuver
b. begin chest compressions
c. provide cervical spine stabilization because a diving accident may have occurred
d. open the airway and begin rescue breathing as soon as possible even in the water
5. You respond with 2 other rescuers to a 50 year old man who is unresponsive, pulseless, and not breathing. What tasks would you assign the other rescuers while you set up the AED?
a. one rescuer should call rescue assistance and the others rescuer should begin CPR
b. both rescuers should help set up the AED and provide CPR
c. one rescuer should open the airway and begin rescue breathing, and the second rescuer should begin chest compressions
d. recruit additional first responders to help
6. An AED hangs on the wall suddenly a code is called, you grab the AED and run to the room where the resuscitation is ongoing. A colleague has begun CPR and confirms that the patient is in pulseless arrest. As you begin to attach the AED, you see a transdermal medication patch on the victim’s upper right chest, precisely where you were going to place an AED electrode pad. What is your most appropriate action?
a. ignore the medication patch and place the electrode pad in the usual position
b. avoid the medication patch and place the second electrode pad on the victim’s back
c. remove the medication patch, wipe the area dry, and place the electrode pad in the correct position
d. place the electrode pad on the victim’s right abdomen
7. A patient who has Ventricular Fibrillation has failed to respond to 3 shocks. Paramedics started an IV and inserted a tracheal tube, confirming proper placement. Which of the following drugs should this patient receive first?
a. Amiodarone 300 mg IV push
b. Lidocaine 1 to 1.5 mg/kg IV push
c. Procainamide 30 mg/min up to a total dose of 17 mg/kg
d. Epinephrine 1 mg IV push
8. After giving epinephrine 1 mg IV and a fourth shock, a patient remains in VF. You want to continue to administer epinephrine at appropriate doses and intervals if the patient remains in VF. Which epinephrine dose is recommended under these conditions?
a. give the following epinephrine dose sequence, each 3 minutes apart: 1 mg, 3 mg, and 5 mg
b. give a single high dose of epinephrine: 0.1 to 0.2 mg/kg
c. give epinephrine 1 mg IV, then in 5 minutes start vasopressin 40 U IV every 3 to 5 minutes
d. give epinephrine 1 mg IV; repeat 1 mg every 3 to 5 minutes
9. Which of the following therapies is the most important intervention for VF/pulseless VT with the greatest effect on survival to hospital discharge?
a. Epinephrine
b. Defibrillation
c. Oxygen
d. Amiodarone
10. A 60 yr old man persists in VF arrest despite 3 stacked shocks at appropriate energy levels. Your code team, however, has been unable to start an IV or insert a tracheal tube. Therefore administration of IV or tracheal medications will be delayed. What is the most appropriate immediate next step?
a. deliver additional shocks in an attempt to defibrillate
b. deliver a precordial thump
c. perform a venous cut-down to gain IV access
d. administer intramuscular epinephrine 2 mg
11. A 75 year old homeless man is in cardiac arrest with pulseless VT at a rate of 220 bpm. After CPR, 3 shocks in rapid succession, 1mg IV epinephrine, plus 3 more shocks, the man continues to be in polymorphic pulseless VT. He appears wasted and malnourished. The paramedics recognize him as a chronic alcoholic known in the neighborhood. Because he remains in VT after 6 shocks, you are considering an antiarryhthymic. Which of the following agents would be most appropriate for this patient at this time?
a. Amiodarone
b. Procainamide
c. Magnesium
d. Diltiazem
12. You are called to assist in the attempted resuscitation of a patient who is demonstrating PEA. As you hurry to the patient’s room, you review the information you learned in the ACLS course about management of PEA. Which one of the following about PEA is true?
a. chest compressions should be administered only if the patient with PEA develops a ventricular rate of less than 50 bpm
b. successful treatment of PEA requires identification and treatment of reversible causes
c. atropine is the drug of choice for treatment of PEA, whether the ventricular rate is slow or fast
d. PEA is rarely caused by hypovolemia, so fluid administration is contraindicated and should not be attempted
13. For which of the following patients with PEA is sodium bicarbonate therapy (1 mEq/kg) most likely to be most effective?
a. the patient with hypercarbic acidosis and tension pneumothorax treated with decompression
b. the patient with a brief arrest interval
c. the patient with documented severe hyperkalemia
d. the patient with documented severe hypokalemia
14. Which of the following is the correct initial drug and dose for treatment of asystole?
a. epinephrine 2mg IV
b. atropine 0.5 mg IV
c. lidocaine 1mg/kg IV
d. epinephrine 1mg IV
15. You are considering transcutaneous pacing for a patient in asystole. Which of the following candidates would be most likely to respond to such a pacing attempt?
a. the patient in asystole who has failed to respond to 20 minutes of BLS and ACLS therapy
b. the patient in asystole following blunt trauma
c. the patient in asystole following a defibrillatory shock
d. the patient who has just arrived in the emergency department following transport and CPR in the field for persistent asystole after submersion
40 ITEMS COMPREHENSISE NCLEX REVIEW

1. Which individual is at greatest risk for developing hypertension?
A) 45 year-old African American attorney
B) 60 year-old Asian American shop owner
C) 40 year-old Caucasian nurse
D)55 year-old Hispanic teacher
The correct answer is A: 45 year-old African American attorney The incidence of hypertension is greater among African Americans than other groups in the US. The incidence among the Hispanic population is rising.
2. A child who ingested 15 maximum strength acetaminophen tablets 45 minutes ago is seen in the emergency department. Which of these orders should the nurse do first?
A) Gastric lavage PRN
B) Acetylcysteine (mucomyst) for age per pharmacy
C) Start an IV Dextrose 5% with 0.33% normal saline to keep vein open
D) Activated charcoal per pharmacy
The correct answer is A: Gastric lavage PRN Removing as much of the drug as possible is the first step in treatment for this drug overdose. This is best done by gastric lavage. The next drug to give would be activated charcoal, then mucomyst and lastly the IV fluids.
3. Which complication of cardiac catheterization should the nurse monitor for in the initial 24 hours after the procedure?
A) angina at rest
B) thrombus formation
C) dizziness
D) falling blood pressure
The correct answer is B: thrombus formation Thrombus formation in the coronary arteries is a potential problem in the initial 24 hours after a cardiac catheterization. A falling BP occurs along with hemorrhage of the insertion site which is associated with the first 12 hours after the procedure.
4. A client is admitted to the emergency room with renal calculi and is complaining of moderate to severe flank pain and nausea. The client’s temperature is 100.8 degrees Fahrenheit. The priority nursing goal for this client is
A) Maintain fluid and electrolyte balance
B) Control nausea
C) Manage pain
D) Prevent urinary tract infection
The correct answer is C: Manage pain The immediate goal of therapy is to alleviate the client’s pain.
5. What would the nurse expect to see while assessing the growth of children during their school age years?
A) Decreasing amounts of body fat and muscle mass
B) Little change in body appearance from year to year
C) Progressive height increase of 4 inches each year
D) Yearly weight gain of about 5.5 pounds per year
The correct answer is D: Yearly weight gain of about 5.5 pounds per year School age children gain about 5.5 pounds each year and increase about 2 inches in height.
6. At a community health fair the blood pressure of a 62 year-old client is 160/96. The client states “My blood pressure is usually much lower.” The nurse should tell the client to
A) go get a blood pressure check within the next 48 to 72 hours
B) check blood pressure again in 2 months
C) see the health care provider immediately
D) visit the health care provider within 1 week for a BP check
The correct answer is A: go get a blood pressure check within the next 48 to 72 hours The blood pressure reading is moderately high with the need to have it rechecked in a few days. The client states it is ‘usually much lower.’ Thus a concern exists for complications such as stroke. However immediate check by the provider of care is not warranted. Waiting 2 months or a week for follow-up is too long.
7. The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission?
A) A middle aged client with a history of being ventilator dependent for over 7 years and admitted with bacterial pneumonia five days ago
B) A young adult with diabetes mellitus Type 2 for over 10 years and admitted with antibiotic induced diarrhea 24 hours ago
C) An elderly client with a history of hypertension, hypercholesterolemia and lupus, and was admitted with Stevens-Johnson syndrome that morning
D) An adolescent with a positive HIV test and admitted for acute cellulitus of the lower leg 48 hours ago
The correct answer is A: A middle aged client with a history of being ventilator dependent for over 7 years and admitted with bacterial pneumonia five days ago The best candidate for discharge is one who has had a chronic condition and is most familiar with their care. This client in option A is most likely stable and could continue medication therapy at home.
8. A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication: