April NCLEX-PN Takers: Please Post Your Thoughts

Mercedes_RN_ · Apr 12, 2011

I wish you the best of luck!!!!!!! Wish I could help, but haven't tested yet!!!! Just study hard!!!

Jia! · Apr 12, 2011

it's almost 6am here in ca and i can't sleep. i took the nclex pn yesterday (041111) and had 86 questions. it was my second attempt. i had 7-8 satas, 2 exhibits, 1 drag-and-drop. plus tons of infection control, prioritizations, and medications (teachings).

http://quizlet.com/3106757/dugs-26-50-side-effects-flash-cards/

http://quizlet.com/3435372/side-effects-75-100-flash-cards/

http://quizlet.com/854307/major-side-effects-of-medications-flash-cards/

i used la charity, exam cram, saunders. i also used the ncsbn review (3weeks for $50).

try to relax!!!! take your time and carefully read everything (esp. every choices). get a good night sleep, eat well, remain hydrated, and last but definitely not least, pray!

airborne (my chicken hez tb)

measles

chicken pox

herpes zoster

tuberculosis

management:

-private room

-negative airflow pressure, minimum of 6-12 air exchanges per hour

-uv germicide irradiation/ high efficiency air

filter is used, mask, n95 mask for tb

droplet (spiderman)[color=#ffff00]

scarlet fever

sepsis

streptococcal pharyngitis

pertussis

parvovirus b19

pneumonia

influenza

diphtheria

epiglottitis

rubella

mumps

mycoplasmal/meningeal pneumonia

adenovirus

management:

-private room

-mask -eye protection and face shield

contact (mrs.wee)

multi-resistant organism

respiratory syncitial virus

s.kin infections (e.g:vchipss- varicella zoster, cutaneous diphtheria, herpes simplex, impetigo, pediculosis, staph infection and scabies)

wound infection

enteric infection (clostridium difficile)

eye infection (conjunctivitis)

management:

-mrsa: gloves, gown, goggles, face shield

-patients should be in a private room

pharma:

pharmacology - know indication/action/effect

prefix/suffix

-ase = thrombolytic

-azepam = benzodiazepine

-azine = antiemetic; phenothiazide

-azole = proton pump inhibitor, antifungal

-barbital = barbiturate

-coxib = cox 2 enzyme blockers

-cep/-cef = anti-infectives

-caine = anesthetics

-cillin = penicillin

-cycline = antibiotic

-dipine = calcium channel blocker

-floxacin = antibiotic

-ipramine = tricyclic antidepressant

-ine = reverse transcriptase inhibitors, antihistamines

-kinase = thrombolytics

-lone, pred- = corticosteroid

-mab = monoclonal antibiotics

-micin = antibiotic, aminoglycoside

-navir = protease inhibitor

nitr-, -nitr- = nitrate/vasodilator

-olol = beta antagonist

-oxin = cardiac glycoside

-osin = alpha blocker

-parin = anticoagulant

-prazole = ppi’s

-phylline = bronchodilator

-pril = ace inhibitor

-statin = cholesterol lowering agent

-sartan = angiotensin ii blocker

-sone = glucocorticoid, corticosteroid

-stigmine = cholinergics

-terol = beta 2 agonist

-thiazide = diuretic

-tidine = antiulcer

-trophin = pituitary hormone

-vir = anti-viral, protease inhibitors

-zosin = alpha 1 antagonist

-zolam = benzo/sedative

-zine = antihistamine

pharma facts

-asa toxicity can cause ringing of the ears (tinnitus) and hyperthermia; with large doses of asa, clotting time is prolonged

-symptom of carbon monoxide poisoning - is the red cherry color

-signs of digitalis toxicity low potassium level (a slice of watermelon is high in potassium; black licorice- decreased potassium levels), anorexia, n/v, blurred vision, cardiac dysrythmia (bradycardia)

-signs of toxic ammonia levels is asterixis (hands flapping)

-acetaminophen(4g max daily dose) - can be used for headache when the client is using nitroglycerin.

- acetaminophen poisoning - occurs in 4stages. 3rd stage is hepatic involvement which may last up to 7days or may be permanent. mucomyst is the chelating agent by mouth within 72 hours.

-aminophylline - side effects: restlessness and palpitations; toxicity: muscle twitching or nausea

-lithium (for bipolar) - toxicity: increased thirst/urination, early signs: vomiting, diarrhea, lethargy (must consume extra sodium to prevent toxicity)

-no narcotics to any head-injury victims

-don’t give non-selective beta-blockers to patients w/respiratory problems

-calcium channel blockers- do not take with grapefruit juice; check bp and hr before administering; these are more effective in african/americans and older adults

-ace inhibitors (-pril)- on an empty stomach or 1 hr before or 2hours after; contraindicattions: hyperkalemia and renal insufficiency; increased risk of hypersensitivity reaction if given with zyloprim

-zyloprim (for gout) -with or immediately following meals or mil; side effects: drowsiness, diarrhea, nausea; drink at least 8 glasses (2000-3000ml) of fluid everyday; report rash, swelling of lips and/or mouth, irritation of the eyes

-maoi patients should avoid tyramine: avocados, bananas, beef/chicken liver, caffeine, red wine, beer, cheese (except cottage cheese), raisins, sausages, pepperoni, yogurt, sour cream; should not be taken with ssris (risk of serotonin syndrome, wait 14days)

-don’t give antacids with food (b/c it delays gastric emptying)

-antacids (amphojel and basaljel) -commonly used to accomplish lowered phospate

-insulin – clear before cloudy (draw regular first then nph)

-don’t give meperidine (demerol) to pancreatitis patients; an injection of demerol, hold pressure on the injection site for 3-5 min

-always verify bowel sounds when giving kayexelate

-diuretics - given in the morning; at high risk for hypokalemia (muscle weakness/leg cramps, paresthesia dysrythmias, fatigue, anorexia, n/v

-thiazide diuretics may induce hyperglycemia

-take iron (supplement) with orange juice (vit c) through a straw – it enhances absorbtion – do not take with milk; administer between meals

-b1 - for alcoholic patients (to prevent wernicke’s encephalopathy & korsakoff’s synd)

-b6 - for tb patients

-b9 (folic acid) - for pregnant patients; sources of folic acid are dark green leafy veges, the cabage family, beets, kidney beans, cantaloupe, oranges

-b12 - pernicious anemia, vegetarians.

-complications of coumadin - 3h’s - hemorrhage, hematuria & hepatitis

-antianxiety medication is pharmacologically similar to alcohol –used for weaning tx

-phenazopyridine ( pyridium) -urine will appear red-orange color

-rifampin - red-orange secretions (urine, tears, sweat)

-inh (for tb with rifampin= 6months) side effects hepatitis, neuropathy, gi intolerance; should have a negative sputum culture within 3 months; avoid tuna, red wine, soysauce, yeast extracts; take vitamin b6; take both inh and rifampin on empty stomach

-hot and dry, 3p's = sugar high (hyperglycemia)

-cold and clammy, sweating, shaking = need some candy (hypoglycemia)

-med of choice for v-tach is lidocaine

-med of choice for svt = adenosine or adenocard

-med of choice for asystole = atropine

-med of choice for chf is ace inhibitor

-med of choice for anaphylactic shock is epinephrine

-med of choice for status epilepticus is valium (dilantin and luminol)

-administer diuretics (-ide at high risk for hypokalemia) in the morning

-give lipitor at 1700 since the enzymes work best during the evening

-1st day of tpn (child) therapy- priority is to monitor serum glucose levels

-rhogam -- given at 28 weeks & 72 hrs postpartum (mother=negative; father=positive)

-do not administer erythromycin to multiple sclerosis pt

-benadryl and xanax taken together will cause additive effects.

-can't take lasix if allergic to sulfa drugs

-gantrisin for uti and other sulfa drugs should be given 30min before meals (on an empty stomach; in divided doses throughtout the day) to enhance absorption; monitor wbc

-bactrim - take full 8 glasses of water

-antispasmodic should be given 30min before meals

-sinemet- avoid vb6; 6months; toxicity: spasmodic eye winking, an involuntary twitching of muscles, facial grimaces, severe tongue protrusion

-tagamet- at bedtime

-zantac- with each meal

-pancreatic enzymes- with each meal or snack

-zyprexa- is responsible for the development of parkinsonian symptoms

- lead poisoining- chelating agents

-treatment of alcohol withdrawal- ativan, klonopin

-cyclosporine- clients at risk for infection, changes in v/s esp temp are early sign of infection; avoid grapefruitjuice

-older adults are susceptible to the side effects of anticholinergics (antihistamines) which is confusion

-atropine sulfate -antidote: cholinergic crisis; side effects: ventricular tachycardia, palpitations, irritability, drymouth, ha

-atropine as pre-op med - 0.4 - 0.6mg

-don’t give atropine for glaucoma – it increases iop

-anticholinergics (used to reduce spasms and treat urinary incontinence) -side effects: dry mouth, blurred vision, constipation, urinary retention (cant see,pee,spit,****); anticholinergics may aggravate gerd; increase fluids and fiber in diet; contraindicated for clients with glaucoma

-baclofen (for ms and spinal cord injury)- therapeutic effect: decrease muscle spasm; side effects: diziness, drowsiness, weakness, nausea

-tetracycline - can stain the "baby" teeth (avoid during 4th month of pregnancy to 8 years of age) teach good oral hygiene and use a straw when taking this; give between meals, if gi symptoms occur administer with food except milk products or other foods high in calcium (interferes with absorption); avoid sun exposure; side effects are photosensitivity, gi upset, renal, hepatic and hemological abnormalities

-steroids meds- only eat cooked or processed foods; steroids dependency tends to delay wound healing; report slight change in temperature

-protein and albumin monitoring - protein deficiency leads to decreased wound healing

-antibiotic therapy - complete the full course of meds

-antabuse - avoid alcohol/vinegar

-topical glucocorticoids - systemic effect: growth retardatin (children)

adrenal suppression (all age groups)

-nsaids- common side effects: occult bleeding, abdominal aching, cramping/diarrhea; always take this with food or antacids or with a full glass of water

-fosamax (osteoporosis) - take this with water in the morning; remain upright for 30min after taking this

-synthroid- 1hour before breakfast (empty stomach) ; hypothyroidism, goiter 0.1 - 0.2mg daily

-0.5% erythromycin - opthalmic neonatorum -caused by neisseria gonorrhoeae

-riboflovin vb12 food high in milk (fetal growth/development)

-adalat- bp management (pulse, weight, palpitations, be careful when rising from sitting to standing)

-plavix- side effects: upper resp tract infection, chest pain, ha; adverse effect: epistaxis; discontinue 7-10 days before surgery; protect medication from light; avoid taking anticogulants, nsaids, feverfew, garlic, ginger, and ginko

-avoid the ‘g’ herbs (ginsing, ginger, ginko, garlic) when on anti-clotting drugs (coumadin, asa, plavix, etc)

-dilantin -gingival hyperplasia, bleeding, swelling/tenderness of the gums can occur; teach good oral hygiene, gum massage, and the need for regular dental visits (soft toothbrush); capsules must be swallowed; should not skip med doses, this could precipitate a seizure; report sore throat, fever, glandular, swelling, any skin reaction (hematological toxicity); side effects: constipation, bleeding gums, hyperglycemia, decreased platelet count; signs and symptoms of dilantin toxicity: ataxia, nausea, restlessness, depression

-tegretol- side effects: increased bun, decreased wbc, dizziness, unsteadiness, nausea

-digoxin- take apical pulse for full 1minute before administering (120 for adults, 160 for infants and children); side effects: anorexia, n/v

-wellbutin- side effects: dizziness, weight loss, constipation; give no more 150mg

-mevacor- side effects: diarrhea, dyspepsia, constipation

-zoloft- side effects: diarrhea, dyspepsia, nausea

-metoprolol- side effects: fatigue, depression, sob, bradycardia

-atenolol- side effects: fatigue, dizziness, drowsiness

-prozac- give early morning; side effects: insomnia, anorexia, nausea; adverse effect: gi dysfunctions

-have the client empty his/her bladder prior to administering the pre-op meds

-addison is skinny ( hypoglycemic, you get weight loss, you got weakness, and you get postural hypotn); appropriate diet: increase sodium and fluids, decrease potassium

-cushing is fat ( hyperglycemic, you get moon face big cheeks, and you retain a lot of na and fluid)

-hypercalcemia = hypophosphatemia (and vice versa)

-hypoglycemic shivers can be stopped by holding the limb, seizures cannot (infants)

-administrate glucagon when pt is hypoglycemia and unresponsive

anorexia nervosa - brittle hair, lanugo, dehydration, lowered metabolic rate and abnormal v/s

bulimia - dental erosion, parotid enlargement, electrolyte imbalances (low potassium levels)

symptoms of cholinergic crisis: n/v, diarrhea, blurred vision, pallor, dereased bp, pupillary meiosis

myasthenia crisis: increased hr/rr/bp, anoxia, absence of the cough reflex

- pernicious anemia - finding common: loss of coordination and position sense; paresthesia would indicate that client has been noncompliant with vit b12

-potassium is lost in diabetic (type 1) acidosis; expect blood ph level below 7.30

-insulin:

-rapid: lispro/aspart – onset

-short: regular – onset 30min peak: 1½ - 2 hr. duration: 8-10 hr

-int: nph or lente – onset: 2-4hr. peak 4-8hr. duration: 12-20hr

-v.long: lantus – onset 1 hr. peak: none. duration: 18-24 hr continuous

-

hypocalcemia – cats

-convulsions

-arrythmias

-tetany

-spasms & stridor

-hyper kalemia causes: -machine

-medicationa (ace inhibitors, nsaids)

-acidosis (metabolic & repiratory)

-cellular destruction (burns, traumatic injuy)

-hypoaldosteronism, hemolysis

-nephrons, renal failure

-excretion (impaired)

-signs of increased k -murder

-muscle weaknes

-urine – olyguria, anuria

-respiratory distress

-decreaed cardiac contractility

-ecg changes

-reflexes – hyperreflexia, or flaccid

-parkland formula: 4cc * kg * bsa burned = total volume necessary

-1st 8hrs – ½ total volume

-2nd 8hrs – ¼ total volume

-3rd 8 hrs – ¼ total volumes

i hope this helps..

and please keep me in your prayers.. i really do hope we all pass.

good luck to all the (nclex pn/rn) test takers!!!!

-jia :loveya:

Mercedes_RN_ · Apr 12, 2011

Omg @ JIA!!!!!!

Thanks alot I know you will be just FINE!!!!! Thank you so much for the help!!!!!!!!!!!!

Don't worry yourself you got the hard part out the way!!!!

pnky_18 · Apr 12, 2011

This is really helpfull!! Thanku so much! Good luck to all!!

Jia! · Apr 13, 2011

i wish i could send all my (handwritten) notes to you guys lol... anyways, here are some more facts/notes that have helped me :)

coordinated care

rns cannot delegate to up

- initial assessment of pts (however data collection of vs, history, and other admission data may be delegated)

- evaluation of pt data

- nursing judgment

- pt/family education/evaluation

- nursing diagnosis/nc planning

lpn - are equipped to assist in implementing a defined plan of care and to perform proccedures according to protocol. assessment skills are directed at differentiating normal from abnormal. competence is in caring for phisiologically stable pts with predictable conditions.

up - bathing, transferring, ambulating,feeding, toileting, obtaining measurements such as vs,height, weight, i&o, specimen collection, glucose monitoring, housekeeping, transporting ang stocking supplies.

documentation has six key aspects: co-acts

confidential

organized - chronological

accurate - objective, factual

complete - date, time, correct spelling, punctuation, grammar, approved abbreviation, no blank spaces

timely - as soon as possible after completion of action

subjective and objective data - quotes for subjective if appropriate

to help you remember the five client's rights: parfi (privacy, advance directives, refusal of treatment, freedom from safety device (restraint), informed consent)

safety and infection control

falls are the most frequent cause of injury for elderly clients in acute care.

special (n95) respirator masks are necessary to care for clients under airborne precautions who have tb.

protective (neutropenic) isolation is used for clients with immunosuppression and low white blood counts.

- neutropenic precautions require either cooked or canned foods. raw fruits, vegetables, and unpasturized milk are to be avoided.

never induce vomiting for: iye, househould cleaners, petroleum products, and furniture polish. if you suspect someone has taken poison, save any vomitus and take it with the victim to an er.

health promotion and maintenance

abortion- most common complications: infection; retained products of conception or intrauterine blood clots; continuing pregnancy; cervical or uterine trauma; and excessive bleeding; dic

administration of rh immune globulin prevents rh sensitization in mother and blocks formation of antibodies and prevents resulting hemolytic anemia called erythroblastosis of the newborn if antibodies cross the placenta

folic acid, iron supplements, kegel exercises, avoid hot tubs, dry toast for morning sickness, small, low-fat meals for heartburn

warning signs in pregnancy

first trimester

excessive vomiting

lower abdominal cramping

lady partsl bleeding

elevated temperature - persistent temperature greater than 100 degrees fahrenheit

lady partsl discharge

dysuria

exposure to infections, including childhood diseases

second trimester

absence of quickening

change in fetal activity

leaking lady partsl fluid - water type consistency

lady partsl bleeding

fever, chills

lady partsl discharge

uterine contractions or low backache

persistent vomiting

dysuria

edema of hands, face

signs of preterm labor

sudden weight gain, greater than one pound in one week

third trimester

decreased or absent fetal movement

lady partsl bleeding

abdominal pain, especially sudden and severe epigastric pain

headaches with or without visual disturbances

leaking fluid from lady partsl orifice

edema - generalized (anasarca)

signs of preterm labor

sudden weight gain of greater than one pound in one week

lab tests

urinalysis for protein, glucose, ketones

afp - screen for neural tube deficit (spina bifida) or ds at 16-18wks

screen for gestational diabetes at 24-28wks; tested 1hr after drinking a sweetened liquid that contains 50 grams of glucose.

viral screening for hiv, hepa etc

tb test can be done in 1st or 2nd trimester only

observe fluid retention for preeclampsia

presentation

cephalic: head alone is presenting part

breech: head alone is not presenting part

late decelerations: heart rate slows after contraction ends. they signal placental insufficiency. action required:

immediately turn the woman to the side

administer oxygen, and

notify the provider of care immediately.

variable decelerations: heart rate slows, but in inconsistent pattern, during a series of contractions. variable decelerations usually signal umbilical cord compression. action required:

turn the woman to the side

give oxygen, and

notify the provider of care immediately

bedrails and lateral position; do not give analgesic during latent and transition phase. ok to give during active phase.

oytocin stimulates uterine contraction and milk letdown reflex

fundus - within 12 hrs fundal height is approximately 1cm above umbilicus, it descends 1-2cm every 24hrs

lochia - rubra changes to lochia serosa after 3-4days

postpartum reportable findings in mother

temperature above 100.4 degrees fahrenheit

in the first 24 hours after delivery may indicate dehydration

continuing six hours apart after the first 24 hours after delivery may indicate postpartum infection

increased lochia, clots or foul odor, sudden bright red bleeding

increasing perineal pain or swelling

calf tenderness and swelling; possible thrombophlebitis

appetite loss

sleep disturbances - insomnia

continued mood swings or depression - last for a few months while hormones are stabilizing

elimination problems, constipation, painful urination

hot or reddened areas on breast

infant

axillary temp above 100.4 degrees f (38 degrees c) or below 97.8 (36.6)

frequent vomiting, refusal to feed for two feedings or six hrs, listlessness or difficulty in waking baby

excessive fussiness, jaundice increasing, 2 or more loose black or green watery stool

fewer than 6 wet diapers in a 24 hr period

initial lactation

lactation mechanics

begin with placental delivery, stimulates prolactin from anterior pituitary, which stimulates milk.

sucking stimulates the "let-down" response and the release of oxytocin from the posterior pituitary.

oxytocin expels milk through the duct system, and contracts uterine muscle.

nurse's knowledge and support play a vital role in reinforcing information and encouraging breast feeding.

put the newborn to breast right after birth or in recovery phase of intrapartum.

help the mother to a comfortable position so newborn can fully grasp the areola.

let the baby nurse vigorously, held so breast does not block its nose. show mother how to break suction when the baby has finished nursing.

if woman has not breast fed before, stay until she feels comfortable.

be aware of cultural influences, which may affect initial breast feeding.

briefly reinforce information about the lactation process.

suggest warm compresses or a shower just before feeding.

suggest that the mother wear a supportive bra night and day.

be available to answer questions, such as using alternate breasts or stimulating a sleepy infant.

encourage the mother. follow up with printed materials, films, discussions with other mothers and referral to a lactation specialist or laleche league.

colostrum - breast milk precursor. present usually 48 to 72 hours after birth then changes to mature milk.

apgar score

apgar scoring totals and interventions

8-10 is normal

5-7 means mild depression. the neonate may require some stimulation, such as

gently but firmly slapping the soles of the feet or rubbing the spine or the back.

oxygen may be necessary.

3-4 means moderate depression. the baby may need oxygen, and/or the insertion

of a feeding tube to decompress the stomach

0-2 means severe depression, requiring immediate life support

prophylactic eye treatment of newborn

choices of ointment or drops to prevent ophthalmia neonatorum

ophthalmic erythromycin 0.5% ointment or drops in single-dose tubes or ampules

tetracycline 1% ointment or drops in single dose tubes or ampules

silver nitrate 1% in single-dose ampules

erythromycin and tetracycline are more effective than silver nitrate. currently, most practitioners prefer erythromycin or tetracycline, since they are less irritating to the eye. they kill many organisms, including chlamydia.

timing

some clinicians administer eye drops in the first hour, others in the first few hours after delivery

first, promote bonding with the mother, then, instill ophthalmic ointment, which may temporarily obscure the newborn's vision

screening for pku after initial 24-48hrs when newborn has consumed adequate protein (milk); test is invalid with inadequate protein intake

erikson's theory of psychosocial development

infancy: trust vs. mistrust

toddlerhood: autonomy vs. shame and doubt

preschool: initiative vs. guilt

school age: industry vs. inferiority

adolescence: identity vs. identity diffusion

young adult: intimacy vs. isolation

middle adult: generativity vs. stagnation

elder adult: ego integrity vs. despair

dtap- encephalopathy, neurological disorder

mmr- pregnancy, severe imunocompromised individuals

hib- younger than 6wks

varicella- severe cellular immunity compromised, pregnancy

influenza- allergy to egg protein

allergies- individuals should not receive the following immunizations

neomycin (gelatin)- mmr, varicella, inactivated polio vaccine (ipv)

polymyxin b- ipv

streptomycin- ipv

psychosocial integrity

types of ego – defense mechanisms

compensation - extra effort in one area to offset real or imagined lack in another area

example: short man becomes assertively verbal and excels in business.

conversion - a mental conflict is expressed through physical findings

example: wife becomes blind after seeing her husband with another woman.

denial - treating obvious reality factors as though they do not exist because they are consciously intolerable

example: mother refuses to believe her child has been diagnosed with leukemia. "she just has the flu."

displacement - transferring unacceptable feelings aroused by one object to another, more acceptable substitute

example: adolescent lashes out at parents after not being invited to party.

dissociation - walling off specific areas of the personality from consciousness

example: adolescent talks about failing grades as if they belong to someone else; jokes about them.

fantasy - a conscious distortion of unconscious wishes and need to obtain satisfaction

example: a student nurse fails the critical care exam and daydreams about her heroic role in a cardiac arrest.

fixation - becoming stagnated in a level of emotional development in which one is comfortable

example: a sixty year old man who dresses and acts as if he were still in the 1960's.

identification - subconsciously attributing to oneself qualities of others

example: a girl dresses like her favorite female teacher.

intellectualization - use of thinking, ideas, or intellect to avoid emotions

example: parent becomes extremely knowledgeable about child's diabetes.

introjection - incorporating the traits of others

example: husband's symptoms mimic wife's before she died.

projection - unconsciously projecting one's own unacceptable qualities or feelings onto others

example: woman who is jealous of another woman's wealth accuses her of being a gold-digger.

rationalization - justifying behaviors, emotions, motives, considered intolerable through acceptable excuses

example: "i didn't get chosen for the team because the coach plays favorites."

reaction formation - expressing unacceptable wishes or behavior by opposite overt behavior

example: recovered smoker preaches about the dangers of second hand smoke.

regression - retreating to an earlier and more comfortable emotional level of development

example: four year old insists on climbing into crib with younger sibling.

repression - unconscious and involuntary forgetting of unacceptable or painful thoughts, impulses, feelings or acts

example: adolescent "forgets" appointment with counselor to discuss final grades.

example: a man is unable to recall a car accident he was in last week in which his brother was killed.

supression - voluntary rejection of an unacceptable thought

example: "i’ll worry about finishing that tomorrow. "

sublimation - diversion of unacceptable instinctual drives into personally and socially acceptable area

example: an unmarried woman who desires children becomes a grammar school teacher.

suicide precautions

remove all harmful objects from the environment

one to one monitoring of the client day and night; having the client in view at all times, even during toileting; gradually progress to 15 minute and then hourly checks

ask client exactly how she/he would commit suicide. identify how lethal the attempt would be, and how quickly it could be carried out.

keep client within one arm's length distance or less at all times

allow client the use of plastic utensils

keep electrical cords to a minimum length

screen and remove all potentially harmful gifts from visitors

keep all windows locked and if possible keep client in room with unbreakable glass in windows

do not assign a private room

discuss with family that the greatest risk for suicide is often two to four weeks after the onset of medication therapy. this is when client has increased energy.

withdrawal effects of abused substances

opiates

runny nose, watery eyes

severe anxiety to panic; irritability

gooseflesh (also called goosebumps); tremors

loss of appetite; nausea and vomiting

muscle cramps

tachycardia; hypertension

increased respirations

increased temperature

insomnia

alcohol

acute withdrawal

agitation, tremors, tachycardia

nausea and vomiting; abdominal cramps

diaphoresis

visual or tactile hallucinations

severe withdrawal - delirium tremens (dts) in order of occurrence

tachycardia

diaphoresis, fever

confusion, disorientation

visual, tactile hallucinations

grand mal seizures

sedatives/hypnotics

agitation, anxiety

weakness, nausea and vomiting

hypertension, tachycardia, orthostatic hypotension

disorientation

gross tremors

hallucinations, delirium

convulsions

stimulants

cravings

disturbed sleep

fatigue

apathy

depression

hallucinogens - no withdrawal symptoms reported but flashbacks can occur episodically after use for many years

marijuana

irritability

loss of appetite

perspiration

nausea

insomnia

tremors

basic care and comfort

foods high in water-soluble vitamins

vitamin c - citrus fruits, cabbage, tomatoes, strawberries, broccoli

thiamine (b1) - lean meat, legumes, unrefined or enriched grains and cereals

riboflavin (b2) - enriched grains, milk, organ meats, poultry, fish

niacin - peanuts, peas, beans, meat, poultry

pyridoxine (b6) - kidneys, liver, meats, corn, wheat, eggs, poultry, fish

cyanocobalamin (b12) - kidneys, lean meats, liver, dairy products, eggs

folic acid - liver, eggs, leafy green vegetables, fruits, enriched grain products

foods containing fat-soluble vitamins

vitamin a - fruits, green and yellow vegetables, butter, milk, eggs, liver

vitamin d - milk, fish

vitamin e - green vegetables, vegetables oils, wheat germ, nuts

vitamin k - liver, cheese, leafy green vegetables, milk, green tea

note: vitamin d is also obtained from direct sunlight.

increased cardiac workload

- reiforce for client to avoid bearing down or valsalva manuever

- minimize coughing

- limit sitting in high fowler's position for more than 1-2hrs.

crutch walking - up with the good, down with the bad

reduction of risk potential

barium contrast studies

- low residue or clear liquid diet for 2days prior to tests

- npo after midnight

- before test, give suppository or enema

- encourage drinking more fluids to aid in elimination of barium; retained barium may harden and cause an obstruction; a mild laxative or cleansing enema may be ordered to help expel barium

genaral nursing interventions in all contrast studies

- check for hypersensitivity to contrast medium

- observe for allergic reactions post-test

- force fluids after studies

- require a signed consent within 24-72hrs of procedure in most instances or according to facility protocol

general nursing interventions in electrodiagnostic studies

- reinforce information about the test to client

- instruct client to remain still during test unless instructed to do otherwise

- reinforce that client should avoid stimulants 24-48hrs before test

ct scans

- noninvasive procedure

- contraindicated in pregnancy

- nursing intervention (same with pet): reinforce info about the test to client

provide mild sedation for selected clients

instruct the client to lie very still

advise client to be npo past midnight

if barium studies were done,do not schedule for a ct scan for at least four-days barium obscures film

mri

- contraindicated in clients with metalimplants such as pacemakers aneurysm clips, metallic orthopedic devices, extensive tattoos

- nursing interventions: reinforce info about the test to client

instruct client to lie very still

check prior to procedure if client has claustrophobia

offer ear plugs

have client remove all metal such as jewelry and watches, before procedure

biopsy

nursing interventions: reinforce info about the test to client

-review client's history for signsof bleeding disorders or use

of antiplatelet or anticoagulant agents within 48-72hrs of test

-instruct that if the clients are awake, they may experience

discomfort or pain during biopsy

-if general anesthesia is used, implement perioperative care

-observe client for signs of bleeding 48-72hrs after biopsy

and infection at biopsy site for 5-10days

- administer or advise client that mild anelgesics may be

prescribed for post-test discomfort

nursing interventions for client with any ostomy

- pouches to be emptied when they are about 1/3 to 1/2 full

- if needed, protect skin around ileostomy stoma

- ostomies threaten body image; do not force client to look at stoma

- feelings of mutilation, shame, rejection are common

- clients may feel powerless because they cannot fully control their bodily functions

- assist client to establish normal elimination routine

- observe client's tolerance of colostomy irrigation; report immediately if

1. stoma oozes blood when touched

2. blood is see in the pouch

3. bleeding occurs from the stoma

4. urinary diversion puts out

5. urine smells foul, strong, sweet

6. blood in urine

7. urine is cloudy, unless ileal conduit mucus may make cloudy

8. client reports burning sensation around base of urinary diversion stoma

9. client reports back pain above the waist, chills, or fever

- reinforce teaching of client regarding

1. the types of equipment and their use

2. how to irrigate the colostomy

3. prevention of complications

4. how to avoid constipation

5. that it is vital to drink plenty of fluids, at least 3000-4000 ml per day, unless contraindicated

urinary drainage

catheterization: nursing interventions

- review info about the procedure to the client

- maintain standard precautions

- place client in low fowler's or supine position

- female: externally rotated thighs with bent knees

- insert catheter maintaining sterile technique according to facility policies

1. inset catheter to full extent for males

2. insert catheter to 3-6 inches for females

- collect urine or attach to collecting system

- if ordered, send specimen for lab analysis

- measure and record initial urine output

- record color and consistency - clear or cloudy - of urine

- maintain patency of catheter by avoiding dependent loops during gravity drainage

- force fluids to over 2000-3000ml/day as condition permits

- provide perineal hygiene at least twice daily

- care for catheter as per facility policies or prescribed

- observe client for signs of urinary inflammation/infection

- irrigate catheter only as ordered; usually not routinely irrigated

- empty collection system as needed when 1/2 to 3/4 full or every shift

guidelines for clients taking oral anticoagulants

take medication at the same time every day - often in the afternoon around 4:00 pm

wear medical identification jewelry: "wearer takes oral anticoagulants"

use a soft toothbrush; report any bleeding gums

use an electric razor, not a straight razor

use minimal alcoholic beverages, as directed by care provider

report any findings of bleeding, red or black bowel movements, headaches, rashes, red or pink-tinged urine, sputum, persistent sore throat

avoid activites with risk of trauma or contact sports

have inr serum levels of the anticoagulant effects every four to eight hours

check over-the-counter medications for aspirin; take only after care provider consultation

avoid drastic changes in diet for green leafy vegetables

a significant increase in these will decrease the effectiveness of oral anticoagulant

a significant decrease in these will increase the effectiveness of oral anticoagulant

know that serum tests for effectiveness are the international normalized ratio (inr) or prothrombin time (pt)

be aware the effects of drugs will last three to seven days after drug is stopped

good luck to all and remember don't forget to pray !

-jia :loveya:

mene79 · Apr 17, 2011

Hi JIA thanks a bunch. It was nice to cram some more in before my test today. I passed (or at least the PVT says I did :) ) For anyone else. I too was freaked out about the April 2011 test. I finished my program in May 2010 and well life happened. I went back to teaching for the year and knew it was now or never. So happy I passed I studied about 900 questions in 2 weeks.Here's how my test went. I had 85 questions. In all it didn't seem too difficult and nothing like the study questions from Saunders. Although I didn't feel it was difficult I did leave there thinking geez I think I got this one or that one wrong! Would I spend time studying? Yes! Even though the questions weren't much like the ones I studied they were helpful for content and critical thinking. I think what helped me was reading the rationals and thinking about the systems and what happens next to make connections with prior knowledge of labs and s/s. Don't psych yourself out. :) I did for so long and had to take the dreaded harder April 2011 test :) Really just study and you will be fine. Good Luck.

4Karrie2 · Apr 19, 2011

Thanks for the feedback! Congrats on passing the test!!! :yeah:

Could you give us some info on how many alternate format questions you were given?

Did you use any study aids besides Saunders and how closely did you use Saunders (did you read most chapters or did you just do the questions)?

Thanks and Congratulations again, Nurse!! :nurse:

mene79 · Apr 20, 2011

Thanks 4Karrie2,

I mainly just studied questions from Saunders 4th under the study mode to get all 3500 questions to come up and did 900 of them and you can bookmark ones you got wrong or want to go back to understand better and I read the rationals. When there was something I needed a refresher on I googled it or looked it up in my notes/books from class. I did make it a point to study up on hyper/hypocalcemia, hyper/hypothyroidism, well all the hyper/hypos. I hate those! There were about 10 prioritizing questions(who do you see first)another friend told me she had a lot of these too, 3 pictures, 10 SATA, and 4 drop and drag on procedures (not hard, just common sense:) ), maybe 10 direct drug questions. Infection control (droplet, airborne,contact) pt/staff teaching/safty. There a couple of diseases that I never heard of so I guessed that I did well enough to get the tough ones or at least that's what I told myself on the test to not stress. It all seems like a blur when you are done. JIA's mnemonics were very helpful too. I know some people say they got a lot of OB or Peds, or Cardiac. I do not believe that my test focused on anything specific. Which may seem troubling and vague, but I do think just studying questions and working on thinking them through is a good idea and when you keep getting some wrong then you know you have to study that content area. I didn't feel ready for the test and even woke up at 430am to study more LOL. I honestly thought I wasn't prepared and would fail because we learned so much in class how can they possibly narrow it down to 85-205 questions, but it wasn't nearly as difficult as I had made it in my mind.

msburney31 · Apr 20, 2011

Hello all I am also one of the ones that have taken the NCLEX as of today about 3 hours ago. My test consisted mainly of priorization. I had about 3 drugs and 4 SATA and one ordered response. My friend took hers on yesterday and she got mostly pharm and SATA. We both cut off at 85. She found out her response today and she passed , now I am waiting until tomorrow to call and find out mines. Alot of the books ppl are reading really dont help with this NCLEX well thats my opinion. I done over 2000 questions in 3 wks and it did teach me how to pick out the best answers out of two. I would like to wish all the test takers coming up just relax, dont let your nerves get the best of you and go in with faith and u will do fine. :nurse:

4Karrie2 · Apr 21, 2011

Thanks so much, mene79 and msburney31, for sharing your NCLEX-PN experiences with us. I'm puzzled how the test could be an equal measurement of competence for everyone when one person gets many pharm and SATA (which seem harder) while another hardly gets any of either. Then again, of the first 85 questions a certain number aren't even counted, so maybe it's much more balanced than it appears. Kind of intimidating to know that none of the books really prepares you that well for the actual test yet that's what almost everyone is saying. I guess studying core content and strategies is about the best we can do --- and a lot of prayer, too! :)

msburney31 · Apr 21, 2011

4Karrie2, I thought the same thing about how it worked but only the NCSBN knows the answer too that. In my opinion none of the books helped me out because I knew about priorizating before I left school, so all I could do was pray. I am up waiting for my results now which should post in next 3 hrs so keep your fingers crossed for me. :idea:

4Karrie2 · Apr 21, 2011

You got it, msburney31! Sounds like you were well-prepared and have an excellent chance at passing. Good luck and God bless you!