Just like the title says, I checked the BON this morning and finally saw my name! 
I am grateful to this site and all the contributions everyone has made. :)
Since I am now an official RN I will tell you what worked and did not work for me during my 3 attempts at passing this test.
First Exam
Materials Used:
Virtual ATI class ($300)
Outcome: Waste of money and did not help, I would not recommend this class to anyone. I was stopped at 110 questions. The review information is overwhelming. You are much better using the Exam Cram review book or Saunders review book.
Second Exam
Materials Used:
Lacharity, Prioritization and Delegation
NSCBN: The questions are good practice but the review is horrible. I just used this for questions but only got through half of it because something came up and ran out of time.
Sanders Q & A: Ok review for content, but the questions were too easy
Outcome: I went to the end at 265 questions and failed. I stayed there the whole 6 hrs.
Third Exam
Sanders Review Book: Excellent Book for Content, I especially covered OB because it was my weakest. I think everyone should try and cover as much as they can in this book. I took about 3 weeks reviewing this book, I ignored the peds section.
Exam Cram Review Book: Another excellent concise book that gives you only what you need to know. The med section was helpful. I think I went through this book in two days by skimming it. I also did the two 250 q practice tests. I feel it gave me endurance for the test.
Exam Cram Practice questions Book: I used the CD and took about three 250 question practice exams and one practice exam. The questions on here got easier the more tests I took and since Pearson makes the Nclex I thought this was important to review.
NCLEX 3500: http://nursing.slcc.edu/nclexrn3500/mainMenu.do;jsessionid=20D721724A16FE55BB72B233991C0E6B
Works on Safari. Excellent for questions, I took the Pre-test and got about a 65%. The questions are harder than any review book I have taken and you can practice countless topics. I did not go through the whole thing but did as many questions as I could. I would score 65-75 on practice tests. I usually did 75 questions. I would say this is even better than NCBSN.
Lacharity: I only went over the practice questions this time and not the case studies. Great book.
Lippencotts SATA practice questions: I went through about 1/3 of this book and did not buy it, I would work on it during my visits to Barnes and Noble. This along with Nclex 3500 gave good SATA practice questions.
Infection Control mneumonic- The high recommendations speak for themselves.
Newgradq's Study Guide: Excellent study guide, I found a lot of the notes helpful during the exam and worked out great during my final week for review.
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)
1st degree AV © Block
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
o Wide QRS complexes
o V Tach and awake drugs I must take (Amiodarone or Lidocaine)
o V Tach and a nap (unconscious) zap zap zap (defibrillate)
o Can only stay in for 2-3 min (can die)
V Fib
o Irreg makes no sense
o Only way to tx = defribillate start at 360 Jules
o Epi (to HR)
Stroke
Right Sided: Impatient, easily distracted, impulsive, less concerned about life events, safety is a big issue (impulse)
Left Sided: Slow, cautious, particular, very aware of deficits, greater depression/anxiety
(Think rt brain = creative, left brain = logical, math, science)
Outcome: Passed at 75 questions. During the exam I was hoping it would shut off at 75 questions. I did not want to go the distance like the 2nd attempt. When I was on question 75 I prayed hoping it would shut off and to my surprise it did. Right then I knew I had passed.
Most importantly, never, never, never give up. I read a lot of people freaking out on this board because they did not pass the first, second, or third time. I personally think too many people overhype it and scare others.
You can pass it you just have to be diligent about studying. Notice I never took the Kaplan review course? Each time I took the exam I felt it got easier and don't understand why people freak out about it so much. I understand its nerve racking but if you fail just retake it.
I told people and family I failed it twice and have no shame in telling them because it is a hard exam but you have to get used to the questions and feel comfortable with them. I am a bad test taker and I was certain I was not going to pass it because I needed to first get a feel for the exam. Good luck to everyone and I hope I can help you out. Remember, who cares if you have to repeat over and over, you will pass it and it does not mean you will be a bad nurse. Good luck to everyone!
Please feel free to ask me any questions on any of the review materials I used. I will be more than happy to share my experiences. :)
:lol2:
restuti
7 Posts
Thank you for sharing it. bless your heart...!!!! I didn't pass my nclex for the 3rd times. i know it's shame on me, but wish me luck for my 4th times test..!!