Quote from Nikki0727
Hello all! I graduated lpn nursing school in July and have not takin my boards yet!
Money wise its difficult but its beyond that. I struggled hard core in class to pass so I feel as if its going to b e the same for the boards. Noone from my class has failed so I'm becoming a bit more positive.
Real question..what did you study..when did you study. .how long did you study.
Ive looked this up and I still do not feel confident with the old suggestions.
Im a single mom of a four year old so its hard to find time for anything. Im only working part time at 11 an hour and its not cutting it anymore
Take that test and get it out of the way.
The longer you wait, the rustier you become on certain subjects.
I was tested over every subject. BUT...I concentrated on my drugs, med surg and fundamentals.
...because that's the core of everything. You must know your meds. There's no getting around it.
You've also gotta understand
patho and interventions. It's the basics of nursing.
I did a minimal amt of studying on maternity and peds. To this day, I can't tell you a thing about maternity or peds...although I really liked the L&D culture during clinicals. Odd. I never figured myself for a 'baby' nurse...but who knows where I'll end up.
I already knew mental health because I work/ed psych. I skimmed through leadership and management.
For maternity, I mainly focused on S/S pregnancy, complications, labor stages and PP stuff. Peds? I don't remember.
For meds, I studied the most common drug classes, first.
I mean, what do you think you're more likely to be tested on: Glaucoma...or HTN and diabetes? Of course, I was familiar with Glaucoma...but it was better to know HTN and diabetes meds like the back of my hand.
I studied with suffixes and prefixes. It improves recall. You can't do that for all meds, but you can knock out the majority this way.
I studied every day. My first test date was cancelled, so I had nothing else to do with my time BUT study.
I did ATI. Took me about 4 weeks to complete the course. After that, they just test you
I'd like to mention that doing questions are fine, but if you don't UNDERSTAND the material...it's a wash. A waste of time.
I tried to do the least amt of questions possible. My coach used to shove them down my throat. By the end, I got away with about 50 questions a week.
You don't have to buy these expensive coaching programs. ATI, for instance, just teaches you 'how' to study for NCLEX. Teaches you how to organize that material.
...but you can do it on your own.
Take your quiz. Read the rationale...THEN, crack open your textbook and read the section.
Do the critical thinking questions, if you must.
I just read my textbooks and did research on YT and this site to increase my knowledge level.
I don't have access to the Virtual ATI site, anymore. But...here's some Pharm and Maternity info that my coach sent to me a few months back. I think she did it in response to some homework that I sent her.
PHARM: Safety and Infection Control What components should be included in a medication order? When you are reviewing a medication order you need to ensure that all of the following are included for the order to be valid. The hard part is letting the doctor know when there is some information missing. Be sure that when completing chart audits and checks that all orders have these components: ·
The client’s name ·
Date and time of order ·
Name of medication (may be generic or brand) ·
Dosage of medication ·
Route of administration ·
Time and frequency of medication administration – exact times or number of times per day (dictated by facility policy or specific qualities of the medication). · Signature of prescribing provider. What are the best steps to take when a client refuses a medication?
Always remember that even though a client has a right to refuse there is a need to follow protocol:
Clients have the right to refuse to take a medication. Determine the reason for refusal, provide information regarding the risk of refusal, and notify the appropriate health care personnel, and document refusal and actions taken.
Health Promotion and Maintenance Briefly explain Lactation/Pregnancy Risk Categories Know these, as they are the basic information necessary for these pregnancy risk categories when dealing with medications. This boils down to the safety of medication administration to a pregnant client: Category A: Controlled studies in pregnant women fail to demonstrate a risk to the fetus in the first trimester with no evidence of risk in later trimesters. The possibility of harm appears remote.
Category B: Presumed safety based on animal studies, with no controlled studies in pregnant women, or animal studies have shown an adverse effect that was not confirmed in controlled studies in women in the first trimester and there is no evidence of a risk in later trimesters.
Category C: Studies in women and animals are not available or studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women. Drugs should be given only if the potential benefits justify the potential risk to the fetus.
Category D: There is positive evidence of human fetal risk (unsafe), however in some cases such as a life-threatening illness the potential risk may be justified if there are no other alternatives.
Category X: Highly unsafe: risk of use outweighs any potential benefit. Drugs in this category are contraindicated in women who are or may become pregnant.
Drugs that Affect the Cardiovascular System Potassium Channel Blockers… how do they help to treat dysrhythmias? What are two side effects that could be safety issues for the client?
Potassium Channel Blockers are class III antiarrhythmic.
• Action: bind and block the potassium channels that are responsible for repolarization = slowing down of repolarization = increases the action potential and increase an effective refractory period (ERCP) – long QT interval
• Indications: suppressing tachyarrhymias
• Side Effects: bradycardia and atrioventricular blocks You need to give your client Digoxin. What are your concerns with this medication? What do you monitor your client for before and after administering this medication?
Digoxin (Lanoxin) = Cardiac Glycosides
• Before administering one needs to check the patient’s apical pulse for one full minute. If pulse is less than 60 hold the medication and notify the physician.
• Concerns: digoxin toxicity (halo effect) and decrease potassium levels as that will increase the chance of toxicity. Calcium Channel Blockers: Block ___________ access to the cells, causing decreased heart _____________ and ____________ and leading to a decreased demand for ___________! Side effects include: decreased______________, _________ of the extremities, C_______________, nausea, arrhythmias.
Block calcium’s access to the cells, causing decreased heart rate and Contractility, leading to a decreased demand for oxygen. Side effects include decreased blood pressure, edema of the extremities, constipation, nausea, arrhythmias.
Drugs that Affect the Blood Procrit… what is it used to treat? How is it given? What do you monitor?
Procrit (Epoetin Alfa)
• Indications: anemia
• Administered: IV or SubQ
• Monitor: H/H levels and kidney function labs (if a patient is in kidney damage as they are then at an increased risk for cardiovascular and thromboembolic side effects)
Tell me about possible adverse effects when a client is taking clopidogrel (Plavix).
Here is what you NEED to remember: ·
Prolonged bleeding time, gastric bleed, thrombocytopenia ·
Monitor client for Monitor bleeding time. ·
Monitor for gastric bleed (coffee-ground emesis or bloody, tarry stools). ·
Monitor for bruising, petechiae, and bleeding gums. ·
Apply pressure to cardiac catheter access Drugs that Affect the Respiratory System What is parameter of the CV system do you monitor when a client is receiving Albuterol?
Short acting beta-agonist = monitor blood pressure and pulse as tachycardia and anticholinergic effects INH…What are appropriate supplements for a client during during INH therapy? What labs will need to be monitored? Why?
INH (Isnoiazid) = Antitubular
a. Lab monitor: liver function test
b. Supplement: vitamin B6 as vitamin B6 deficiency is a common side effect along with treating neuritis prophylaxis
Drugs that Affect the Nervous System What could happen to a client who has Parkinson’s disease and is prescribed a medication “holiday”? What are your concerns for this client? Medication holidays have to be ordered by the doctor but are necessary at times:
Parkinson’s Disease = decrease in dopamine a. Levodopa = converts to dopamine in the brain
• Carbidopa‐Levodopa = stimulates dopamine receptors
• “Holiday” patient would not be taking their prescribed medication thus the symptoms of the disease (shuffled gait, drooling, rigidity, tremors) would return.
• Nursing Concerns: safety, self‐care deficits, possible impaired communication, altered urinary elimination.
What are common side effects of lithium carbonate?
• GI distress, fine hand tremors, polyuria, weight gain, renal toxicity, hypothyroidism
• Bradydysrhythmia, hypotension, and electrolyte imbalances Drugs that Affect the Digestive and Endocrine System What are the therapeutic purposes of somatropin (Genotropin, Nutropin)?
Anterior pituitary hormones/growth hormones stimulate overall growth and the production of protein, and decrease the use of glucose. Therapeutic Uses
Anterior pituitary hormones/growth hormones are used to treat growth hormone deficiencies (pediatric and adult growth hormone deficiencies, Turner’s syndrome, Prader-Willi syndrome). Drugs Used to Treat Infections What are potential side/adverse effects of Acyclovir? Remember that an adverse reaction cannot be reversed and is sometimes fatal and a side effect is revisable and is NOT fatal: ·
Phlebitis and inflammation at the site of infusion ·
Mild discomfort associated with oral therapy (nausea, headache, diarrhea) Your client is prescribed Cipro… what does this med do? What class is it? What precautions/teaching do you share with this client? What does this med do?
What class is it?
- Action: blocks bacterial DNA replication. It’s a broad spectrum
- antibiotic that treats both gram negative and gram positive.
Drug Class: Fluorquinolones
What precautions/teaching do you share with this client?
- Avoid caffeine as the drug may potentiate the affects of
- Give 2 hours before/after iron or antacid supplements as it
- may affect absorption
- Can cause renal damage—avoid heavy exercise (ex. Achilles
- tendon rupture)
- Drink plenty of fluids
- No if pregnant or under the age of 18
What is a potentially serious drug interaction when a patient is taking the Macrolide Erythromycin?
The patient should not take any antihistamines, theophylline, carbamazepine, or warfarin, because it can result in toxicity.
Erythromycin inhibits the metabolism and subsequent clearance of warfarin from the body. The activity of warfarin may also be prolonged due to alterations in the intestinal flora and its production of vitamin K for clotting factor production. Drugs that Affect the Immune System
What is the difference between active and passive immunization?
Active natural immunity develops when the body produces antibodies in response to exposure to a live pathogen. Active artificial immunity develops when an immunization is given and the body produces antibodies in response to exposure to a killed or attenuated virus.
Passive natural immunity occurs when antibodies are passed from the mother to the newborn/infant through the placenta and then breast feeding. Passive artificial immunity is temporary, and occurs after antibodies in the form of immune globulins are administered to an individual who requires immediate protection against a disease after exposure has occurred. What do you teach your client about taking immunostimulants? ·
Clients should be educated to report dizziness and tingling/numbness of the hands or feet. ·
They should also be advised to monitor for bruising, bleeding, blood in the stool, sputum, urine, or emesis. ·
Due to the risk of hypotension, the client should also be advised to change positions slowly. ·
The client should also be educated about the signs and symptoms of infection (fever, etc.) and should be advised to report those signs to their health care provider. ·
Clients may also benefit from education about infection control, including proper hand washing techniques and avoidance of large crowds.
What are possible adverse effects of prednisone? How can these effects be prevented or minimized?
Glucocorticiods: prednisone (Deltasone)
• Osteoporosis: advise client to take calcium supplements, vitamin D, bisphosphonate.
• Adrenal suppression: administer fluids such as normal saline, salt, and hydrocortisone.
• GI discomfort: prophylactics use of H2 antagonists. Drugs that Affect the Urinary System Loop, Osmotic and Potassium Sparing Diuretics… compare and contrast how and where they work and what you teach the client Loop Diuretics
- inhibit reabsorption of sodium and chloride. This occurs within the nephron in the ascending loop of Henle (thus loop diuretic). Client teaching: medication lowers potassium; eat a potassium rich diet, get up slowly to prevent falls due to orthostatic hypotension, alcohol may aggravate orthostatic hypotension. Osmotic Diuretics
- Concentrate osmotic agent in the kidney, works in the kidney tubule. Has a profound diuretic effect and can be used for those with acute renal failure or intracranial pressure. IV infiltration could cause tissue necrosis. Client teaching; don't use at night. Potassium Sparing Diuretic
- often used in conjunction with other diuretics, inhibits potassium excretion. This occurs in the nephron within the distal tubule. The medication either inhibits the action of adrenal hormone aldosterone or directly blocks sodium reabsorption. Client teaching; go light on potassium rich foods, no potassium supplements. If you are on Aldactone it can cause drowsiness or mental confusion. Do not drive or perform other tasks that require alertness. Drugs that Affect Reproduction Progestins... what are the adverse effects of this type of medication? What’s it used for?
Adverse effects include thrombolytic events
, including MI, pulmonary embolism, thrombophlebitis, CVA
Clients should be discouraged from smoking and should be monitored for pain, swelling, warmth, or erythema of the lower legs). Side effects may also include breakthrough bleeding, amenorrhea, and breast tenderness
(a baseline breast exam and Pap smear should be obtained and the client should be instructed to report abnormal vaginal bleeding). Edema
may also occur, so I and O, weight gain, and blood pressure should also be assessed carefully.Progestins are steroids that specifically stimulate the uterine lining. They counter adverse effects of estrogen in hormone replacement therapy for treatment of dysfunctional uterine bleeding and amenorrhea due to hormone imbalance, endometriosis, and endometrial carcinoma.
They can be used to help restore menses, control the spread of endometrial cancer, or control uterine bleeding by assisting with the restoration of hormonal balance What are potential contraindications for a client being prescribed estrogen?
These medications are Pregnancy Risk Category X.
These medications are contradicted for clients who have: ·
Client or family history of heart disease ·
Abnormal vaginal bleeding that is undiagnosed ·
Breast or estrogen-dependent cancer ·
History or risk of thromboembolic disease ·
Use cautiously during breastfeeding ·
Use cautiously in prepubescent girls. ·
If administered, monitor bone growth, and check periodically for early epiphyseal plate closure. What are the possible andrgenic effects of a client being prescribed Testosterone (Andronaq-50, Testred)?
• In women these medications may cause irregularity or cessation of menses, hirsutism, weight gain, acne, lowering of voice, growth of clitoris, vaginitis, and baldness.
• In boys or men these medications may cause acne, priapism, increased facial and body hair, and penile enlargement. ·
May also cause epiphyseal closure – Premature closure of epiphysis in boys may reduce mature height. Drugs for Pain and Inflammation
Why would Torodol be prescribed at the same time as narcotics in a post op patient? Used for short term treatment of moderate to severe pain; when used concurrently with opioids, the analgesic effect is enhanced without the occurrence of adverse effects.
Sumatriptan(Imitrex) be avoided?
Sumatriptan should not be given to patients with history, symptoms, or signs of ischemic cardiac, cerebrovascular, or peripheral vascular syndromes as well as patients with other significant underlying cardiovascular diseases. Ischemic cardiac syndromes include, but are not limited to, angina pectoris of any type, all forms of myocardial infarction, and silent myocardial ischemia. Cerebrovascular syndromes include, but are not limited to, strokes of any type as well as transient ischemic attacks. Peripheral vascular disease includes, but is not limited to, ischemic bowel disease. May increase blood pressure, they should not be given to patients with uncontrolled hypertension Drugs that affect the GastroIntestinal System
What should the nurse teach a client who is prescribed Zantac?
Zantac and Ibuprofen: Clients who are taking Zantac should avoid aspirin and other NSAIDs unless taking low-dose aspirin therapy for the prevention of cardiovascular disease. Zantac can be taken with or without food. Clients should avoid smoking and drinking alcohol. Clients may also find it therapeutic to eat six small meals a day rather than three large ones. Concurrent use of antacids with Zantac can decrease absorption of the Zantac. Clients should be advised not to take an antacid one hour before or after taking Zantac. Antacids interfere with the absorption of vitamins and some medication, especially antibiotics.
MATERNITY: Safety and Infection Control What should the nurse teach the family about car seats? Car seat safety is very important and the education of the proper use needs to be number one! Do not forget to have the clients do a return demonstration: ·
Use an approved rear-facing car seat in the back seat, preferably in the middle, (away from air bags and side impact) to transport the newborn. ·
Newborns should be in rear-facing car seats for the first year of life and until they weigh 9.1 kg (20 lb). ·
It is recommended to have the infant ride rear facing until he has reached the weight limit allowed for the car seat as long as the top of his head is below the top of the seat back. ·
In addition, a five-point harness or T-shield should be part of the convertible restraint. · Do not use a used or second-hand car seat. Health Promotion and Maintenance Contraception
What kind of birth control would be contraindicated for a breastfeeding mother?
Any contraception that contains estrogen It's recommended that any estrogen-containing contraceptive be avoided until baby is at least six months old AND after baby is well-established on solid foods.
Combination contraceptives contain both progesterone and estrogen and come in several different forms:
- The combination birth control pill (Alesse, Yasmin, Seasonale, Mircette, Loestrin, Lo/ovral, Demulen, Desogen, Nordette, Ortho Tri-Cyclen, Triphasil, Norinyl, Ortho-Novum, Ovral, etc.)
- the monthly injection (Lunelle)
- the birth control patch (Ortho Evra)
- the vaginal ring (NuvaRing).
Milk supply: Estrogen-containing contraceptives have been linked to low milk supply and a shorter duration of breastfeeding even when started when baby is older, after milk supply is well established. Not all mothers who take contraceptives containing estrogen will experience a low milk supply, but these unaffected mothers appear to be a very small minority.
Safety: Both progestin (progesterone) and estrogen are approved by the American Academy of Pediatrics (AAP) for use in breastfeeding mothers. See below for additional information on side effects related to lactation
List at least two contraindications to diaphragm use. ·
History of toxic shock syndrome ·
History of frequent UTIs or STIs
When should a woman be refitted for her diaphragm?
Must be refitted every 2 years and after each pregnancy and any major weight change of 20 pounds or greater Antepartum
What is the definition of oligohydramnios?
Scant amount or absence of amniotic fluid
What is the definition of polihydramnios?
Too much amniotic fluid
What is the purpose of the non‐
stress test (NST)?
The NST evaluates FHR in response to fetal movement; reactive normal
How does the nurse determine the expected date of delivery or due date and what is this called?
Nägele’s rule: Begin at first day of the woman’s last period: subtract 3 months: add 7 days
What are the differences between identical and fraternal twins? ·
There are two basic
twin types - monozygotic - commonly known as identical
- and dizygotic, commonly known as fraternal
. · Monozygotic twins
= one egg and one sperm creating a zygote
or fertilized egg. The zygote then splits an extra time creating 2 zygotes sharing the same genetic information. ·
Approximately one-third of all twins are monozygotic. They are always the same sex and are usually very similar (identical to the eye) in their basic physical features although they can have some variations in coloring or birthmarks etc. ·
About 25% of these twins are 'mirror' twins
where they have similar but opposite features. ·
One is left-handed, one is right -handed, their hair may part to different sides or they may have matching birthmarks on opposite sides of their bodies. When their baby teeth come in, they will come on different sides of their mouths. They will suck opposite thumbs. It's fascinating! ·
If the split happens within 3 days of conception the identical twins will have 2 separate placentas, 2 chorions (inner membrane) and 2 amnions (outer membrane).This is called a diamniotic, dichorionic twin pregnancy. · If the split occurs 4-7 days after conception the twins will have separate amnions but share a chorion and their placentas will be fused together. This is called a diamniotic, monochorionic twin pregnancy. · If the split happens after the 8th day the twins will share the same placenta, the same amnion and the same chorion. This is called a monoamniotic, monochorionic twin pregnancy. A concern with this type of pregnancy is that the twins may not get equal access to the nutrition from the placenta. They can be at risk for such problems as twin-twin transfusion and some growth retardation.
Which foods contain large amounts of folic acid?
Green leafy vegetables and fruits
Physiological Adaptation Normal Pregnancy
What are 3 physiological changes of pregnancy during the first trimester?
Goodells’s sign Hegar’s sign
Fill in the following acronym
live births, living children
Fill in the following acronym
other (including HIV and Hep),
Gestational diabetes is diagnosed with what test?
Glucose tolerance test (GTT)
What are the risk factors from gestational diabetes?
Difficult and prolonged birth
At what point should the mother feel her baby kicking and what is this called?
Mom should feel baby by 20 weeks gestation and this is called quickening
What is the term for a very large baby?
List at least 5 common discomforts of pregnancy ·
Nausea and vomiting ·
Breast tenderness ·
Urinary frequency ·
Shortness of breath ·
Leg cramps ·
Nasal stuffiness and gingivitis from softening gums ·
Braxton hick’s contractions ·
List at least 5 dangers signs during pregnancy or symptoms the patient should always report to her provider Gush of fluid (rupture of amniotic membranes) ·
Any vaginal bleeding ·
Abdominal cramps or pains ·
Elevated temperature ·
Dysuria or any symptoms of urinary tract infections
Fill in the blanks:
If the father of the infant is Rh__________, and the mother is Rh__________ and Coombs is _____________ an injection of RhoGAM will be administered ___________ week and within _____________ hours of birth.
Rh incompatibility can cause symptoms ranging from very mild to fatal. In its mildest form, Rh incompatibility causes destruction of red blood cells. Rh incompatibility is almost completely preventable.
If the father of the infant is Rh positive
and the mother is Rh negative
and Coombs is negative an injection of RhoGAM will be administered at 28 weeks
and within 72 hours of birth
. But after the baby is born if the baby is Rh negative a second dose is not needed.
Rh incompatibility can cause symptoms ranging from very mild to fatal. In its mildest form, Rh incompatibility causes destruction of red blood cells. Rh incompatibility is almost completely preventable.
RhoGam injections prevent the development of antibodies against Rh‐
positive blood. These injections prevent the development of antibodies against Rh‐
The Coombs test detects the presence or absence of Rh antibodies. So a positive Coombs test means there are antibodies and it is too late for Rhogam
Complications of Pregnancy
List three signs of impending pregnancy induced hypertension (PIH) ·
Proteinuria: 1‐2+ protein in urine or severe Proteinuria 3‐4+ ·
Generalized edema ·
Elevated blood pressure: severe - Bp 160/110 ·
Brisk deep tendon reflexes ·
Epigastric pain ·
Blurred vision or any visual changes ·
Severe headache ·
The medication of choice to prevent seizures is _________ __________
The medication of choice to prevent seizures is magnesium sulfate.
List at least 3 signs of magnesium sulfate toxicity ·
Depressed or absence reflexes ·
Decreased respirations less than 12/min ·
Decreased level of consciousness ·
Urine output less the 30 ml/hr.
Your client is experiencing a placental abruption. Which patients are at highest risk for placental abruptio? What are the signs and symptoms? ·
What are the signs and symptoms: Severe pain, rigid abdomen, bleeding, signs of shock; · Which patients are at highest risk for placental abruptio: Hypertension, PIH, Cocaine use?
Your client has placenta previa. What are the signs and symptoms? What are the appropriate nursing actions?
Painless bleeding: No vaginal exams or anything invasive:
Assess both mother and baby: vital signs (observer for shock) labs (h&h): Fetal heart rate How is an ectopic pregnancy diagnosed?
HELLP syndrome occurs in severe cases of PIH and can often lead to maternal death. Fill in HELLP ·
Elevated Liver enzymes ·
Low Platelets ·
What are the 4 Ps of birth? ·
Passenger (baby) (fetal lie and attitude) ·
Passageway (pelvis) (cervix) ·
Powers (contractions and pushing) ·
How should the nurse assess uterine contractions? ·
Frequency: beginning of one to the beginning of another ·
Duration: how long they last ·
Intensity: how strong ·
When the fetal head drifts into the maternal pelvis it is called?
List and describe the 4 stages of labor and 3 phases ·
Stage 1: dilation from 0 cms to 10 cms ·
Stage 2: fully dilated until birth of the baby ·
Stage 3: birth of the placenta