April 2008 NCLEX test takers, COME ON IN!

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Per the request of janina08 ;) I've started the April NCLEX takers support group. When do you take it? What are you using to study? Would anyone like to review any of the systems/meds that he/she feels weakest on? Let's keep each other in our prayers and good thoughts as we go through one of the biggest experiences of our lives. :) :nurse:

Specializes in ED.

Do not worry to much, just relax and you will be fine. I have to give my test end of April. Good luck

3rd shot on April 3rd coming up. I'll be coming here often to read the thread before the test.

Ive taken NCSBN 3 times, done Saunders and Mosbys and Lipincot's. Still have FEAR in my head over this test. Oh, also did Kaplans.

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Specializes in Clinical Nursing and OR Nursing.

Wow! This thread is amazing, I am so happy to belong in this support group. I am learning more and more each day.

Thank u so much guys for the posts!:yeah:

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Is there a way, we could go through infections dividing them in subcategories. I feel lost :uhoh3: and I think this is definitely covered in professional RN exam.

For example: Divide them:

Airborne: Which diseases/conditions would fall under that?

Contact:

Droplet:

Let's keep adding. Veterans please help us also :bowingpur

Does anyone have more knowledge in this area? Please help.

And also, please, let's discuss about how to assign patients in the same room or private room etc. With radiations or if they have MRSA etc. Can we please go over this. I promise, none of us will be dissapointed that we went over these information. This is very important that we need to know for the exam. So, can we please go over this information? Thanks.

So, when assigning room to the patients based on the infections: how would you assign them? What factors do you keep in mind while assigning them room? Of course, safety always. So, which illnesses can be assigned same room, which illnesses need private room?

For example: assign two chicken pox patients in same room?

Assign private room to TB patient?

Etc.

Can we please go over this information.

Thank you.:bowingpur :bluecry1: :bowingpur

If this area is your strong point, please don't hesitate to post. It will definitely help all of us. Thanks

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Specializes in ICU.

:thankya:medications used to treat pain and inflammation::thankya:

pain is whatever the client says it is:

nsaids:

  • uses:suppress inflammation, used for pain, reduces fever, lowers level suppresion of platelete aggregation


  • ex: aspirin, celebrex, motrin, advil, naprosyn, toradol, bextra


  • side effects: gi problems so take w/ glass of water, bleeding so check for bloody stool (use cytotec if gi problems occur), renal problems, salicylism (watch for tinnitus and resp alkalosis), reyes syndrome (if asprin is given to kids with viral illness)


  • stop aspirin 1 week b4 surgery


  • take aspirin with water or milk


  • if you take nsaids with warfarin, glucocorticoids or alcohol it will increase the risk of bleeding.


tylenol:

  • use: pain and fever


  • antidote is mucomyst


  • causes liver damage especially if taken with alcohol.


  • tylenol increases warfarin level, so tell patient to check for bleeding


opiods:

  • use: analgesia, sedation, reduce bowel motility and codine suppreses cough


  • ex: fentanyl, meperidine, methadone, codeine, and oxycodone


  • side effects: resp depression, constipation, orthostatic hypotension, urinary retention, cough suppresion, sedation, biliary colic, emesis


  • opiod overdose triad includes coma, resp depression and pin point pupils.


  • contraindications: don't give morphine to someone with biliary tract surgery or premarure infants due to resp depression. repeat use of meperidine causes seizures and neurotoxicity.


  • if you take opiods with antichlinergics then increase fluids b/c of constipation


  • don't give maoi with meperidine b/c of hyperpyrexic coma


  • antihypertensive will add to hypertensive effects of opiods.

    :no:


talwin and stadol used for moderate pain not severe.

naloxone/naltrexone/revex: used to treat overdose, reverse resp depression-

side effects are tachycardia, tachypnea and abstinence syndrome

antigout medication- colchicine, indocin, probenecid, allopurinol

  • allopurinol and probenecid decreases uric acid production


  • colchicine and indocin reduce inflammation in clients with gout.


  • side effects: colchicine cause gi problems so take with food


  • avoid foods high in purine (red meat, sauces) and alcohol


medication for migrains:

  • ex: ergot alkaloids (caefergot, ergostat), triptans (axert, frova, amerge and zomig), imitrex,


  • ergot alkaloids- cause gi discomfort, muscle pain, physical dependence, and abortion (don't give if patient has liver or renal problem)


  • triptans and imitrex- cause chest pain and coronary vasospasm (don't give to someone with hx of mi or other heart problems.)


dmards:

  • ex: rheumatrex, solganal (gold salt), plaquenil, azulfidine, enbrel, remicade, cuprimine, depen, and prednisone (a glucocorticoid)


  • use- slow progression of ra (rheumatoid arthitis)


  • rheumatrex causes hepatic fibrosis, bone marrow suppresion, gi ulceration, fetal death


  • solganal- causes renal toxicity, blood dyscrasis, hepatitis and gi discomfort


antimalaria drugs like plaquenil causes retinal damage such as blindness

glucocorticoids cause osteoporosis, adrenal suppresion, and gi discomfort.

sulfasalazine causes gi problems, hepatic dysfunction, and bone marrow suppresion.

if anyone notices any major errors, or any additional information that you think we should know for the exam, please post on thread. :typing

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thank you so much to the ladies who posted the meds information!!! :yeah: you guys are amazing! :) i'm going to print out your information and carry it around so that i can study it whenever i have a chance to look at it.

alright. so, we mostly voted that a lot of us have trouble with the cardiac system. it's one of the most interesting systems in the body, but one of the most complex too! so, i'm going to start with the basic things, and move on from there.

anatomy of the heart. :redbeathe

four chambered hollow muscular organ approximately the size of a fist; lies within the thorax between the lungs and the mediastinal space.

point of maximal impulse (pmi) which arises at the apex of the heart, can be palpated and auscultated at the fifth intercostal space approximately 2 inches left of the midline.

there are three layers that the heart is composed of: endocardium (the innermost layer of the heart), myocardium (a layer of muscle), and a fibrous outer layer (the epicardium).

the heart is surrounded by the pericardium.

****if you know your suffixes, you can pretty much figure where these layers are located.

1. endo- inner

2. myo- muscle

3. epi/extern- outer

4. peri- surrounds/around.

there's a small amount of pericardial fluid that lubricates the space between the pericardial layers and prevents friction between the surface as the heart beats.

four chambers:

1. right atrium

2. right ventricle

3. left atrium

4. left ventricle.

the heart is divided by the septum.

the walls of the chambers of the heart vary in thickness. the atrial myocardium is thinner than that of the ventricles, and the left ventricular wall is three times thicker than the right ventricular wall.

this is important because the thickness of the left ventricle provides force to pump the blood into the systemic circulation.

blood flow through the heart: :heartbeat

the right atrium receives blood from the superior and inferior venae cavae and the coronary sinus.

blood then passes through the tricuspid valve into the right ventricle.

right ventricle pumps blood through the pulmonic valve into the pulmonary artery.

left atrium receives oxygenated blood from the pulmonary veins.

then, it passes through the mitral valve and into the left ventricle. blood is pumped through the aortic valve into the aorta and thus enters the high-pressure systemic circulation.

bloodcirculation.jpg

***the four valves of the heart serve to keep blood flowing in a forward direction. the cusps of the mitral and the tricuspid valves are attached to thin strands of fibrous tissue termed chordae tendineae.

blood supply to the myocardium:

the coronary circulation is the myocardium's own supply of blood.

blood flow into the coronary arteries occurs primarily during diastole.

(when the heart/myocardium is at rest of a contraction.)

the right coronary artery usually supply the right atrium, ventricle, and a portion of the posterior wall of the left ventricle.

the left coronary artery (which include the left anterior descending artery (lad), and the left circumflex artery (lca)) supply the left atrium and the left ventricle.

conduction system: :redpinkhe

this is made up of the electrical impulses or action potential. this impulse initiates depolarization and therefore cardiac contraction.

the electrical impulse is initiated by the sinatrial (sa) node. this is the pacemaker of the heart.

impulses generated/started in the sa node travel fast through the muscle fibers of the atria by the internodal pathways and cell-to-cell conduction.

the conduction system goes like this:

sa--> av--> bundle of his--> right and left bundle branches--> purkinje fibers

electricalconductionofheart.gif

ekg/ electrocardiogram of the heart:

p wave: represents sa node and depolarization of the fibers of the atria.

qrs complex: represents depolarization from the av node throughout the ventricles.

t wave: represents repolarization of the ventricles.

u wave: this wave in an ekg is always abnormal. this wave may represent hypokalemia or repolarization abnormalities.

electrocardiogram.gif

mechanical system:

systole: contraction of myocardium

diastole: relaxation of the myocardium and it is the time when the filling of the chambers occur.

cardiac output: measurement of mechanical efficiency. (the amount of blood pumped by each ventricle in one minute.)

okay. i'm getting a headache. :lol: i'll post more in a little bit. i'm gonna take a break. :)

***references: medical-surgical nursing sixth edition; lewis et al. mosby: philadelphia, 2004.

encyclopedia britannica, community memorial online, evolve online.

thank you mave.

to add to mave's note:

cardiac assessment: if we get a diagram and we need to select the point where we do the assessment:

order of assessment: ape to man

a- aortic valve (2nd intercoastal space on the right side)

p- pulmonic valve (2nd intercoastal space on the left side)

e- erb's point: (3rd intercoast space on the left side)

t0- tricusipid valve (5th intercoastal space on the left side)

man- mitral valve/bicuspid valve: (5th intercoastal space, midclavicular ...)

apical pulse in infants: assessed lateral to their left nipple

apical pulse (left ventricle is strongest) adults: assessed ( i cannot remember :crying2: - see this is what i'm talking about :banghead: :crying2::bluecry1: --- i think 5th intercoast space lateral to midclavicular line towards left side)

someone please correct me if i have typed wrong. or if you have more specific information, please post it. thanks

p.s: if you get confused with tricuspid valve like me. i remember it this way:

tricuspid - is on the right between right atrium and right ventricle

so that leaves mitral/bicuspid on the left side. mitral - left

tricuspid - right

mitral - left

thanks.

please someone post about apical pulse location. thanks

thank you so much genny with all your hardwork with meds :icon_hug: god bless you :icon_hug:

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Specializes in ICU.

good Point Moments! That is a VERY IMPORTANT TOPIC AND ALWAYS ON THE NCLEX!

Let me look through my book and see what i find!

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Hi

Take me in. I am taking my exam in april end. Please help me out with some tips to pass NCLEX. Thanks

Wc. All of us r in the same boat hun. Let's help each other out. They say, when there are more men rowing the boat (that is we have to row in the same direction of course:yeah:), the boat will definitely not sink and pass the dangerous tides/waves SAFELY and SWIFTLY. So, let's chip in (depending how much time each of us got)whatever we can to make sure ALL of us will make it safely and successfully to the other side of the storm. More the merrier :nuke:

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good Point Moments! That is a VERY IMPORTANT TOPIC AND ALWAYS ON THE NCLEX!

Let me look through my book and see what i find!

Thank you Genny, that will really help. I hope u are doing questions also. I need to spend more time doing that.

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Specializes in ICU.

airborne: single room, use negative airflow pressure, use mask or resp protection device, put mask on client if he leave room.

measles

chikenpox

tb

varicella zoster

droplet: private room or cohort, use mask and place mask on client when he is leaving the room

diptheria

flu

epiglotitis

meningitis

mumps

pertusis

pnemonia

scarlet fever

sepsis

strep pharingitis

contact: private or cohort- use gloves and gown

enteric infections: c. difficile

rsv (and other resp infection)

wound infections

skin infections (herpes, impetigo, diptheria, pediculosis, staph, varicella zoster, conjunctivitis)

from saunder 4th edition pg191-192

i don't know where to find info and which clients should be placed with whom... but someone with a simple issue shouldn't be placed with someone with an infection.... i think it just depends on the situation....

there was a question on saunders that asked about placing a client with autism in an appropriate room--- the answer was: they should be placed alone b/c they lack social skills for the most part..... so i think it just depends on the condition and the available choices..... does anyone have an idea how we can identify appropriate room placements?:mad:

post on thread if you notice something incorrect or to add!

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Specializes in ICU.

Hey Moments, I am doing a bit over 100 questions everyday :uhoh21:. I spend almost all day doing questions then reading pharm and reviewing saunders! I am even looking forward to April 14!!!!! I just want to take the test and get it over with!!!! I have already done 1560 questions..... So I still have a little less then 3000 before I finish the CD..... I should be done with the questions by April 11th! :mad:

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hey moments, i am doing a bit over 100 questions everyday :uhoh21:. i spend almost all day doing questions then reading pharm and reviewing saunders! i am even looking forward to april 14!!!!! i just want to take the test and get it over with!!!! i have already done 1560 questions..... so i still have a little less then 3000 before i finish the cd..... i should be done with the questions by april 11th! :mad:

wow yay :yeah:

"opiods:

  • use: analgesia, sedation, reduce bowel motility and codine suppreses cough


  • ex: fentanyl, meperidine, methadone, codeine, and oxycodone


  • side effects: resp depression, constipation, orthostatic hypotension, urinary retention, cough suppresion, sedation, biliary colic, emesis


  • opiod overdose triad includes coma, resp depression and pin point pupils.


  • contraindications: don't give morphine to someone with biliary tract surgery or premarure infants due to resp depression. repeat use of meperidine causes seizures and neurotoxicity.


  • if you take opiods with antichlinergics then increase fluids b/c of constipation


  • don't give maoi with meperidine b/c of hyperpyrexic coma


  • antihypertensive will add to hypertensive effects of opiods. :no:"


antihypertensive will add to hypotensive effects of opiods. typing error :)

wow thank you so much for the infection information.

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correction:

Mitral valve: 5th intercoastal space - at left midclavicular line

Point of maxmal impulse/apical impulse: Left - 5th coastal space - mid clavicularline.

5th coastal space: tricuspid, mitral and apical impulse

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