Don`t let stress rob you from passing your nclex exam!

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What ever you do do not use Xanax or any form of drugs for stress release during the nclex exam! Pray and I mean pray often during the exam. Also make sure you take all of your breaks and during your breaks walk around the hallways and take deep breaths. Sing a short song to yourself. It will make you feel like you are just taking a practice test and you will relax more. Most important talk to God. If everyone is asking why, it is because true relaxation is better then any drugs. That is what helped me the second time anyway. Core content is so important to passing that exam so don`t rely on practice test to let you know if you are ready or not to pass your exam. It would only truly matter if you were going to have the same questions on your nclex exam. Trust me your not! The best supplies to me are Saunders, Hurst review and la charity. I hope this will help someone out there. signed: Lovesnursing, RN. 11-2011. Just get used to answering questions. Make sure you read the rationale and fully understand what is being asked. Make sure that you have plenty of practice with answering prioritizing questions and delegation. There is a way to torrent Nurse NCLEX 4000 online for free, at: www.Thepiratebay.org )

NCLEX Questions: http://learningshark.com/Nursing/Nur..._Questions.pdf

IMPORTANT FACTS:

Cardiac Rate- Peds

Remember: 311

(Fetal HR 120-160)

RR

-30 90-130 Infant 30-60

-10 80-120 Toddler 20-30

-10 70-110 Preschooler 16-22

Temperature

ºF = (1.8 * ºC) + 32

(Think of them as being ~ 2º apart)

37ºC = 98.6º F

38ºC=100.4º F

39ºC=102.2º F

40ºC =104 º F

Labs

á BUN/CR = Dehydration

â BUN/CR = Overhydration

El: Na (135-145) K (3.5-5) Mg (1.5-2.5) Ca (9-11) Cl (96-106) Phos (3-4.5)

Endocr:

BUN (7-22 or to remember put the buns in the oven for 10-20 min)

Cr (0.5-1.5)

Urine Spec Gravity (1.005-1.030)

Glucose:

Nml 80-110

Fasting

Infant BG 50-90 (

HgbA1c= 4-6% (or

Thyroid:

T3 (60-180)

T4 (5-11)

TSH (0.5-5) or 0.5-2 for hypothyroid pts

Free T4: 0.8-2.7 ( I remember it .8-2.8 easier to memorize)

Hypothyroid: TSH ;- T3 & T4

Hyperthyroid: - TSH ; T3 &T4

ABGs:

PH 7.35-7.45

pO2 80-100

pCO2 35-45

HCO3 22-26

ROME:

With Acidosis the PH is always - and PH is always in Alkalosis

Respiratory Opposite; Metabolic Equal

RESP OPP:

PH - PCO2 = Resp Acidosis

PH PCO2 - = Resp Alkalosis

METABOLIC =

PH - HCO3 -= Metabolic Acidosis

PH HCO3 = Metabolic Alkalosis

Blood:

RBC 4.2-6.1 million WBC 5000-10000 (or 4500-11000) Plt 150,000 - 450,000

Hgb F: 12-16 M: 14-18 Hct F: 37-47% M: 42-52%

Amylase: 53-123 Albumin: 3-4.3 Alk Phosphate: 14-100 NH3 (35-65)

Blood Osmol 280-300 Lipase 14-280

Bilirubin (Total: 0.3-1; Indirect: 0.2-0.8; Direct 0.1-0.3)

Phenylalanine: Newborn

Antidotes

Digoxin ® Digiband

Tylenol ® Mucomist (17 doses + loading dose)

Heparin® Protamine Sulfate

Benzodiazepine ® Flumzaemil (Romazicon)

Coumadin®Vit K

DI ®- ADH, u/o, - Urine Specific Gr, Na (think Na = urine spec gr)

SIADH® think syndrome of ed diuretic hormone ADH, - u/o, urine spec gr

Insulins

Rapid Reg Interm Very Long Long Acting

5-15m 30-60m 1-3h 1h 6-8h

1-2h 2-4h 6-12h peakless action 12-16h

4-6h 5-7h 16-20h 18-24h 20-30

Novolog Novolin R NPH Lantus Ultra Lente \

Humalog Humulin R Lente

Vaccines

Hep B 0, 1-2, 6-18mo

Hib 2, 4, 6, 12-15

Pneumo 2, 4, 6,12-15

Dtap 2, 4, 6, 15-18, 4-6yrs; Td q 10 yrs

IPV 2, 4, 6-18, 4-6yr

Varicella 12-15, 4-6yr

MMR 12-15, 4-6yr

Hep A 12-23 mo (2 doses, 6 mo apart)

Mening 9-11 yrs

Rota 2, 4, 6

Influenza at 6 mo and then yearly after

Random Stuff

Thiazides BG

Neupogen = Neutrophil

Epogen = RBC/Erythocyte

Lofenalac Formula = for PKU infants

Ototoxic drugs = loop diuretics (Lasix) and Platinol-AO

TB Meds (RISE)

Rifampin

INH

Streptomycin

Ethambutol

GCS

Eyes (4 points)

Verbal (5 points)

Motor (6 points)

Max = 15 (

APGAR Score

At 1 and 5 min after birth

(1st score is the transitional score and 2nd is planning care of newborn)

8-10 = ok

2 1 0

Appearance [All pink, pink&blue, blue/pale]

Pulse [> 100,

Grimace [cough, grimace, no response]

Activity [flexed, flaccid, limp]

Resp [strong cry, weak cry, no cry]

INFECTION CONTROL

Contact Precautions:

MRS WEE

VCHIPS

Alex Hez 5 Coins HeRe

M-MRSA

R-Resp Infections (those not listed in other categories below)

S-Skin Infections

W-Wound Infections

E-Enteric Infections (C.Diff, Shigella)

E-Eye Infections (Conjunctivitis)

SKIN INFECTIONS:

V-Varicella

C-Cutaneous Diptheria

H-Herpes Simplex

I- Impetigo

P- Pediculosis (lice)

S-Scabies

Alex = AIDS

Hez= Herpes Zoster

5=5th Dx

Coins=Croup

HeRe= Hepatitis and RSV

Droplet Precautions:

SPIDERMAN

Sepsis

Scarlet Fever

Streptococcal Pharyngitis

Parovirus B19 (virus that causes 5th dx)

Pertussis

Pneumonia

Influenza

Diptheria

Epiglottidis

Rubella (Measles)

Measles

Meningitis

Mycoplasma

AdeNovirus

Also Rhinovirus and RSV

FETAL © Strips

REMEMBER: VEAL CHOP

Variable is Cord

Early is Head

Acceleration is Ok

Late is Placental Insufficiency

Hypoventilation => Resp Acidosis ( CO2) "Retain CO2"

Hyperventilation=> Resp Alkalosis (- CO2) "Blow off CO2" (think of preg breathing)

Lasix/Bumex = K+ Wasting (can cause hypokalemia)

Aldactone = K+ Sparing (can cause hyperkalemia)

Tx of DIC = Heparin (safe during preg)

Post Masectomy Care: BREAST

BP NOT on affected side

Reach Recovery

Elevate affected side

Abduction and external rotation - no initial exercise (initial is extension/flexion)

Self Breast Exam (1x month - 7 day after period)

Try to promote a (+) self-image

Autosomal Recessive: Cystic Fibrosis, PKU, Tay-Sachs, Albinism, Sickle Cell Dx, Alpha Anti-Trypsin Deficiency, Galactetsemia

Autosomal Dominant: Huntington's Disease, Marfan's, Polydactly, Achandrophic Dwarfism, Polycystic Kidney Disease

X-Linked Recessive: Duchenne's Muscle Dystrophy, Hemophilia A (Females are carriers in these diseases and males are affected by the disease)

At Term:

Nml = wt: 6-9lbs, head circumference: ¼ body length, 13-14 in, chest: 12-13in

Umbilical cord falls off in 1-2 weeks

Stool: 1st stool (Mecconium) - black + tarry (passes w/in 12-24 hrs), thin/green/brown day 3, formula feedings (1-2 pale yellow/light brown stools) or breast feeding (loose golden yellow stools with sour milk odor)

Hypokalemia: Flat T wave, Depressed ST, and Prominent U wave

Hyperkalemia: Tall T wave, Wide QRS, Long PR Wave

5 P's of Fracture: Pain, pallor, pulseless, paresthesia, paralysis

Cushing's Triad: (Indicates ed ICP) - HR, -RR, BP

CONVERSIONS:

1 lb = 16 oz 1 T = 3 tsp = 15 mL

1c = 8 oz = 240 mL 1 t = 5 mL 1 lb = 454 g = 16 oz

2 c = 1 pt = 16 oz 1 oz = 30 mL= 8 drams 1 mg = 1000 mcg

2 pt = 1 qt= 32 oz 1 g = 15 gr

4 qt =1 gal=128 oz 1 gr = 60 mg

Med Trivia

Talwan and Stadol=> Avoid (opoid agonist antagonists) - much less effective then opoid agonists

No Tagamet with Warfarin

Erogostat => For Migraine

No Quinolones/Tetracyclines with pregnancy

No ASA/NSAIDS in Hemophilia A patients

Lipitor = PM ONLY, no grapefruit juice

tPA= dissolves clots (heparin does not)

SLE Tx

o Cytotax, Imuran (Immunosupressants)

o NSAIDs

o Plaquinil (also an anit-malarial drug)

More Maternity

Fundal Height

o Top of Symphis Pubis to top of fundus

o Gross estimate of dates

o Use a non-stretchable tape measure

o 12-14 wks (at level of symphis)

o show after week 14 (can tell preg)

o 20 wks (~ 20cm) at level of umbilicus

o rises 1 cm/wk till 36 weeks then varies

Quickening = fetal movement; 16-20 weeks

Fetal Heartbeat = 8-12 weeks (by Doppler) and 18-20 weeks by auscultating with stethoscope

Preterm: 20-37 weeks

Term: 38-42 weeks

Post-term: 42 weeks plus

Total preg weight gain: 11-14 kg (25-35 lb)

300 cal during preg (DAILY) and 200-500 cal during breastfeeding (DAILY)

Caffeine risk of spontaneous abortion or fetal intrauterine growth restriction

Uterine contractions can be felt after 4th month = Braxton Hicks Contractions facilitate uterine blood flow through placenta and promote O2 delivery to fetus

Amniotic Fluid:

o Nml: 800-1200 mL (transparent/clear, no odor)

o

Kidney problems

o Polyhydrimanos (too much amniotic fluid)

Umbilical Cord: 2 arteries and 1 vein

Placenta: Fetal lungs in utero

Alcohol, caffeine, nicotine, meds = easily cross placenta (viruses can cross, bacteria cannot; exs of viruses (HIV, AIDS, Herpes, Measles, Toxoplasmosis, Hep)

AFP Test: measured at 16-18 weeks

o ed Levels = risk of neural tube/abd wall defects (ex. spina bifida)

o -ed Levels: risk of Down Syndrome

Fetal Distress

o HR 160

o Fetal hyperactivity or no activity

o Fetal Blood pH

Other Stuff

Immed after put pt on a Mech Vent check BP (hypotension)

Lesions of midbrain = decerebrate positioning

Morphine Toxicity = Pinpoint pupils

Corticosteroid Effects: Acne, Hirituism, Mood Swings, ostoporosis and adrenal suppression (in kids = delayed growth)

No Paxil with MAOI)

Beta Blockers = Mask Effect Of Hypoglycemia

SOMogyi Effect = BG sometimes up and sometimes down

Dawn Phenomenon = high BG in DAWN hrs (5-8am)

AFTER

o Post tracheostomy: keep O2 and Suction at bedside

o Post pleural biopsy: chest tube and drainage system at bedside

o Post parathyroidectomy: tracheostomy at bedside

o Tonic Clonic Seizures: Suction apparatus at bedside

o Paracentesis: BP Cuff at Bedside

RACE-Priority in a fire

o R-Rescue

o A-Alarm

o C-Confine

o E-Extinguish

PASS - To use a fire extinguisher

o P-Pull Pin

o A-Aim at Base Fire

o S-Squeeze Handle

o S-Sweep fire from side to side

Folic Acid Rich Foods (FOL)

o F= Fish

o O=Organ Meats, Oranges

o L=Leafy green veggies

K+ Foods (ROYGBIV-Rainbow colors)

o Red= Strawberries, Tomatoes (not apples)

o Orange= Oranges

o Yellow=Banana

o Green= Avocado, green veggies

o Blue= Fish from the BLUE sea

o Indigo/Violet= Raisins

Cretenism = Congential Hypothyroidism (appears 3-6 mo in bottlefed infants and later in breastfed infants)

Hepatitis: low fat, high cal/carbs/protein, no alcohol

Hypothryoid: High Protein, low cal diet

Cystic Fibrosis: High Protein Diet and Pancr enzyme replacement

Hital Hernia: Fundopliction (tighten cardiac sphincter on stomach) don't lie down for 1 hr after meals, HOB 4-8 in when sleepy, no food before bed

Papable olive shaped tumor in epigastrim = pyloric stenosis (projectile vomiting)

o In adults from peptic ulcers; in infants from hypertrophy of pylorous (symp 2nd-4th wk after birth)

Toddler: Fear of separation (give simple directions)

Preschooler: Fear mutilation (Allow to play with equipment)

School Agers: Fear loss of control (allow to play with equipment)

Adol: Fear loss of independence

Pneumothorax Symp (P-Thorax)

o P-Pleurtic Pain

o T-Trachea Deviation

o H-Hyperresonance

o O-Onset Sudden

o R-Reduced breath sounds (dyspnea)

o A-Absent Fremitus

o X-X-Rays show collapse

Pul Edema Tx (MAD DOG)

o M-Morphine

o A-Aminophylline

o D-Digitalis

o D-Diuretics

o O-O2

o G-Gasses in blood (ABGs)

Cholecystisis: Gallbladder inflammation (RUQ pain)

Cholelithiasis: Gall Stones

Pancreatitis

o TURNER'S SIGN: Flank echymosis

o CULLAN's SIGN: Bluish periumbical (around the belly button)

Who needs Dialysis?

Vowels: AEIOU

A: Acid/Base Problems

E: Electrolyte Problems

I: Intoxications

O: Overload of fluids

U: Uremic Symptoms

Cushing's Dx

o (Cushion - too much Cortisone)

o (3 S's = high Steriods, high Sugars (hyperglycemia), high Sodium

o Moon Face, Buffalo Hump, Trunkal obesity, thin skinny extremities, slow wound healing, osteoporosis, HTN, muscle wasting

o - K+

Addison's Dx

o Need to ADD steroids

o (3 S's = Low Steroids, Low Sugars, Low Sodium)

o Low vascular volume (Not holding salt and H20 like in Cushing's), low BP

o Hyperkalemia ( K+)

o Bronze Skin, Hyperpigmentation

ALLEN TEST

o B4 drawing ABGs do an Allen's Test

o Compress both radial and ulnar arties (wrist) at same time on 1 hand

o Release the ULNAR side (pinky side) and hand should turn discolored and should be able to see blood flow back into it

(Radial - is located on the thumb side and ulnar is on the pinky side)

o Minutes of press on the ABG site after drawing blood?

5-10 min or 15-20 min if on anti-coagulants

After a liver biopsy place patient on the RIGHT Side

Mobility

o Cane

COAL = Cane Opp Affected Leg

o 2 point gait

One leg and 1 crutch touch ground at same time

Weight bearing

o 3 point gait

Both crutches and 1 foot are on the ground

Non-weight bearing

o 4 point gait

Both legs and both crutches touch the ground

Weight bearing

o Swing through gait

Advancing both crutches, then both legs, and requires weight bearing

Not as stable as other gaits

Laminectomy = removal of 1 or more vertebral laminae - need straight back after = LOGROLL and KEEP BACK STRAIGHT (so flat bed)

Intussceptation

o Seen in Non-Hodgkin's Lymphoma

o Hot dog mass in RUQ

o Red Currant Jelly Like mucous and bloody stool

Sweat Chol

o > 60 = CF

o 40-60 = Borderline CF

Ostomy = pouch opening 1/8 in larger than stoma

Macule = flat and round

Papule = rounded and red

Vesicle = filled with fluid

Impetigo = 1:20 Burrow's Soln, honey colored crusts

Permethrin [NIX] => 10% for lice tx and 5% for Scabies tx

o (Scabies = mites bury under skin)

RUQ: Right upper quadrant

Cholelithiasis (gallstones)

Cholecystitis (inflamm of gallbladder)

Hepatitis

Pancreatitis (severe knifelike pain; worse with eating/lying down; some relief with fetal position)

RLQ:

Crohn's Dx (Ileum, Rt Colon; pain after meals)

Appendicitis

o Pain at McBurney's Point

(1/2 b/w umbilicus and right iliac crest)

LLQ:

Ulcerative Colitis (Rectum, left colon; pain pre-defecation)

Diverticulitis

o Relieved by passage of stool/flatulus

Duodenal Ulcer: Pain 2-3 hrs after meals and nighttime (relieve pain with FOOD INTAKE)

Gastric Ulcer: Pain 1 hr after meal/when fasting; relieve pain with vomiting, not with food intake

(Starve the gastric ulcer and feed the duodenal)

Diverticular Dx: Cramping in LLQ relived by passage of stool and flatus (constipation alternates with diarrhea (from def in diet fiber) high fiber diet

Meckel's Diverticulum: congen sac or pouch in ileum, symp seen by age 2; painless rectal bleeding, abd, hematechezia, (currant jelly like stool), s/s of appendicitis (tx = remove diverticulum)

Cirrhosis:

Biliary obstruction, alcohol, Hepatitis

Early stage: high protein/carbs and Vit B

Adv stage: low fiber/salt/fat/protein, high cal, fluid restriction

Esophageal Varices

o Sengstaken Blakemore Tube or Minnesota Tube

Balloon on Esophagus and stomach to apply direct press on bleeding veins

o TIPS (transesophegal intrahepatic post systemic shunt)

Balloon Catheter inserted via jugular vein with angiography to create a metal stent b.w portal vein to vena cava channel (provides a pathway for blood b/w portal vein and hepatic vein = bypasses cirrhotic liver) and relieves press on esoph varicies

Jaundice (Icterus)

Hemolytic

o RBCs are destroyed (release bilirubin)

Hemolytic transfusion rxn

Hemolytic Anemia

Sickle Cell Crisis

Hepatocellular

o The impaired liver cell (hepatocyte) doesn't allow bilirubin to convert from the unconjugated to the conjugated form

Obstructive

o Bile flow is obstructed

Cholelithias (Gall Stones)

Tumors

EKGS

Nml Sinus

o 60-100

o PQRST nml EKG Strip

Sinus Brady

o

o Tx: Atropine

o (can be nml in physically fit/trainer person = then no tx needed)

o Prolonged PR interval

o Nml PR interval: 0.12-0.20

o Conduction Problem

o Drugs (Dig, Beta Blockers, Ca Channel Blockers) can cause by slowing conduction system (slows conduction from SA node to AV node to Purnjee Fibers = see slowed PR (Atrial Response)

o Usu don't see symp, so usu not treated

Atrial Flutter

o Saw Tooth Appearance

o Atrium racing away, blood pools and can throw a clot => stroke

o Treat with Cardioversion 20-50 Jules (NURSE must hit Synchronize button)

o Ventricle beats are regular

Atrial Fib

o Ventricle beats are irregular

o Atrium quivers, not good pump

o Cardiovert 50-100 Jules

o If in hospital and were stable b4 going into a fib = give cardizem drip and beta blockers b4 cardioversion

V-Tach