NCLEX-RN - Surgical Nursing - Review 1

Overview

You’re looking at a Select-All-That-Apply (SATA) med-surg set that’s really testing “pattern recognition + prioritization,” not trivia. By the end of this walkthrough, you’ll be able to (1) predict complications and symptoms from disease physiology, (2) choose prevention teaching that actually blocks transmission, (3) anticipate endocrine emergency adaptations, (4) delegate safely using scope-of-practice rules, and (5) pick nursing diagnoses that match heart failure physiology. I’ll talk through how to reason like the NCLEX wants—link the stem to the underlying mechanism, then filter options through safety and scope.

Concept-by-Concept Deep Dive

Hyperviscosity & Thrombosis Patterns in Polycythemia Vera

• What it is (2–4 sentences).
  Polycythemia vera is a myeloproliferative disorder where the body produces too many red blood cells (often with increased platelets and white cells too). The key consequence is thicker blood (hyperviscosity), which slows flow and raises the risk for clotting and impaired tissue perfusion. Many questions will ask you to predict either symptoms on admission or complications to teach—both come from the same physiology.

• Components / subtopics

  Why “thick blood” causes specific symptoms

  When viscosity increases, microcirculation becomes sluggish. That can show up as neurologic or sensory complaints (think reduced oxygen delivery), and skin/mucosal changes from congestion or histamine release. Also, increased cell turnover can raise uric acid, which matters for joint pain patterns.

  Why it causes dangerous complications

  Hyperviscosity + platelet abnormalities = elevated risk of venous and arterial thrombosis (e.g., stroke-like events, ischemia, DVT/PE patterns). There can also be bleeding tendencies in some myeloproliferative states due to abnormal platelet function—NCLEX loves the “clotting risk vs bleeding risk” nuance.

  What teaching should emphasize

  Patient education focuses on recognizing red flags of clotting or impaired perfusion early, and on actions that reduce risk (hydration, mobility as appropriate, follow-up labs/therapy adherence). Teaching also includes when to seek urgent care for neurologic changes, chest symptoms, or limb changes.

• Step-by-step reasoning recipe

  1. Translate the diagnosis into a mechanism: ↑RBC mass → ↑viscosity → ↓flow.
  2. Ask: “Where does slow flow hurt first?” (brain, heart, extremities).
  3. Add the complication layer: “What does slow flow increase?” (clots).
  4. For teaching questions, pick manifestations that signal thrombosis/ischemia or severe hyperviscosity and avoid unrelated findings.

• Common misconceptions and how to fix them

  • Misconception: “More red cells means better oxygenation, so fewer symptoms.”
    Fix: Oxygen-carrying capacity may rise, but perfusion can drop because thick blood doesn’t flow well—tissue delivery can worsen.
  • Misconception: “Only DVT matters.”
    Fix: Think arterial events too—neurologic deficits and cardiac ischemia patterns can be relevant.
  • Misconception: “All bleeding symptoms are irrelevant.”
    Fix: Some myeloproliferative disorders have platelet dysfunction—evaluate whether the question is asking about complications broadly vs a single direction (only clots).

Airborne Infection Control Teaching for Tuberculosis (TB)

• What it is (2–4 sentences).
  TB spreads through airborne droplet nuclei that remain suspended, especially with coughing, singing, or prolonged close indoor exposure. NCLEX teaching questions often test whether the client understands how to prevent spreading TB at home and in public. The “right” teaching focuses on mask use, cough etiquette, ventilation, adherence to therapy, and protecting close contacts.

• Components / subtopics

  Airborne vs droplet vs contact (the mental shortcut)

  TB = airborne. That means the prevention plan prioritizes respiratory containment and airflow, not just hand hygiene or surface cleaning (though those are still generally good health habits).

  Medication adherence is transmission prevention

  Effective treatment rapidly reduces contagiousness, but only if taken correctly. Teaching includes taking meds exactly as prescribed and following up for monitoring; incomplete therapy risks ongoing spread and resistance.

  Home strategies that actually reduce spread

  Think: reduce shared air exposure (ventilation, avoiding crowded enclosed spaces while infectious), use a mask when around others if instructed, and cough into tissues/elbow with proper disposal.

• Step-by-step reasoning recipe

  1. Identify the route: airborne.
  2. Choose actions that reduce airborne particles: cover cough, mask, ventilation, distance.
  3. Add the “system-level” prevention: complete meds + follow-up testing.
  4. Reject strategies that sound clean but don’t address airborne spread as the primary mechanism.

• Common misconceptions and how to fix them

  • Misconception: “If I wash hands, I’m not contagious.”
    Fix: Hand hygiene helps overall infection control, but TB control is mainly about air management and respiratory precautions.
  • Misconception: “I can stop meds when I feel better.”
    Fix: Symptoms can improve before the organism is eradicated; stopping early risks relapse and resistance.

Pneumonia: Priority Assessment Data & Early Deterioration Signals

• What it is (2–4 sentences).
  Pneumonia is an infection/inflammation of lung tissue that impairs gas exchange and can escalate to respiratory failure or sepsis. Priority assessment data centers on oxygenation/ventilation, work of breathing, and systemic infection severity. SATA items often mix “nice-to-know” findings with “must-assess-now” cues.

• Components / subtopics

  Respiratory status: oxygenation and ventilation

  Focus on what tells you if the patient is moving air and exchanging gases: respiratory rate/pattern, breath sounds, oxygen saturation, use of accessory muscles, mental status changes from hypoxia.

  Infection severity and systemic response

  Fever patterns, hemodynamics, and level of consciousness matter because pneumonia can trigger sepsis—especially in older adults who may present atypically.

  Sputum characteristics and cough effectiveness

  These help evaluate airway clearance and pathogen clues, but prioritize them after ensuring oxygenation is stable.

• Step-by-step reasoning recipe

  1. Use ABCs: Airway → Breathing → Circulation.
  2. For “priority data,” pick what changes fastest and kills fastest: SpO₂, RR, breath sounds, mental status, vitals.
  3. Then add data that guides therapy: sputum, chest discomfort, hydration status, ability to cough/deep breathe.

• Common misconceptions and how to fix them

  • Misconception: “Temperature is the top priority.”
    Fix: Fever matters, but hypoxia kills sooner—oxygenation comes first.
  • Misconception: “A normal SpO₂ means no problem.”
    Fix: Look at work of breathing, trend, mental status, and whether oxygen support is increasing.

Endocrine Emergencies: Hypoglycemia vs DKA Adaptations

• What it is (2–4 sentences).
  Hypoglycemia is a low blood glucose emergency with rapid neuro and adrenergic symptoms, while diabetic ketoacidosis (DKA) is an insulin-deficient state causing hyperglycemia, ketosis, metabolic acidosis, and dehydration. NCLEX questions often ask what signs you “expect” (pattern recognition) and what physiologic “adaptations” occur (compensations like respiratory changes). Your job is to map symptoms to the underlying problem: too little glucose in the brain vs acid + dehydration + electrolyte shifts.

• Components / subtopics

  Hypoglycemia: “adrenergic + neuroglycopenic”

  When glucose drops, the body releases catecholamines (sweaty, shaky, palpitations, anxiety-like symptoms) and the brain lacks fuel (confusion, behavior changes, headache, severe cases seizures). Think: fast onset, fast danger.

  DKA: dehydration + acidosis + electrolyte shifts

  DKA causes osmotic diuresis (polyuria → dehydration → tachycardia, hypotension), fat breakdown (ketones → acidosis), and compensatory deep/rapid breathing to blow off CO₂. Potassium is tricky: serum levels can mislead because total body potassium is often depleted even when lab values look “okay” early.

  “Adaptations” = compensations

  NCLEX uses “adaptations” to mean what the body does to compensate: respiratory pattern changes for acidosis, thirst mechanisms for dehydration, and altered mentation from osmolar changes.

• Step-by-step reasoning recipe

  1. Decide which emergency you’re in: low sugar vs acidotic hyperglycemic dehydration.
  2. For hypoglycemia: list adrenergic signs + CNS signs.
  3. For DKA: list dehydration signs + acidosis compensation + GI/neurologic effects.
  4. When options mention electrolytes, remember: serum ≠ total body in DKA.

• Common misconceptions and how to fix them

  • Misconception: “DKA always means low potassium.”
    Fix: Total body potassium is often low, but serum potassium can be normal/high initially due to shifts—interpret in context.
  • Misconception: “Hypoglycemia is mostly a GI problem (nausea).”
    Fix: The hallmark is sweating/shaking + confusion/altered behavior; GI symptoms can occur but aren’t the core pattern.
  • Misconception: “Any fast breathing = anxiety.”
    Fix: In DKA, breathing can be a compensatory response to acidosis—pair it with dehydration and hyperglycemic context cues.

Safe Delegation in Symptomatic Ulcerative Colitis (UC)

• What it is (2–4 sentences).
  Ulcerative colitis flares can involve frequent diarrhea, abdominal pain, urgency, fatigue, dehydration risk, and skin breakdown risk. Delegation questions test whether you understand what tasks require nursing judgment versus what can be safely assigned to a UAP. The rule: UAPs do routine, stable, non-assessment, non-teaching tasks.

• Components / subtopics

  What the nurse must keep

  Anything involving initial assessment, interpreting stool characteristics as worsening disease, evaluating dehydration, administering meds, teaching diet/meds, or responding to acute deterioration stays with the nurse.

  What UAPs can often do (when the patient is stable enough)

  Think supportive care: obtaining routine vitals (if not unstable), assisting with hygiene/toileting, measuring intake/output, reporting observations, helping with mobility, and basic comfort measures—always with clear parameters for what to report.

  UC-specific risk lens

  Frequent stools mean dehydration and skin integrity issues.