I'm Freaking Out Over Low Kaplan Score!~

suchababe · Jun 29, 2011

I know the feeling. Im scoring 40-45. Dont know what to do now. My exam is on july 8th. U still got much time to go back to basics. Its still early to lose hope so dont lose hope. In my case, im losing mine. :'(

EWrobelRN · Jun 29, 2011

I was averaged around a 62 for kaplan. my scores were anywhere from 58 to 65. I didn't worry about the scores to much. Just make sure you read the rational for EVERY question regardless if you got it right or wrong. Thats what i did and passed the NCLEX last thurs with 75 questions. Try to do as many questions as you can. Don't forget ABCs and Maslow, i used those more than that tree thing they recommend. Good Luck, you will do great!

EWrobelRN · Jun 29, 2011

I know the feeling. Im scoring 40-45. Dont know what to do now. My exam is on july 8th. U still got much time to go back to basics. Its still early to lose hope so dont lose hope. In my case, im losing mine. :'(

please don't lose hope. the scores are not important. Just make sure you read the rationals on why you got it right or wrong. Don't forget God, during my test i said a little prayer just to calm down. If you need anything, don't hesitate to ask. God bless.

caliotter3 · Jun 29, 2011

Stop freaking out over a predictor score. They are not reliable. Do you feel prepared? If not, then consider rescheduling.

keldel · Jun 29, 2011

caliotter is so right...its more about how prepared you feel and how well you know the core material

notgivingup1 RN · Jun 29, 2011

here's some tips that may help you...

memory devices for nursing topics

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the hyperkalemia "machine" - causes of increased serum k+

m - medications - ace inhibitors, nsaids

a - acidosis - metabolic and respiratory

c - cellular destruction - burns, traumatic injury

h - hypoaldosteronism, hemolysis

i - intake - excesssive

n - nephrons, renal failure

e - excretion – impaired

signs and symptoms of increased serum k+

m - muscle weakness

u - urine, oliguria, anuria

r- respiratory distress

d - decreased cardiac contractility

e - ecg changes

r - reflexes, hyperreflexia, or areflexia (flaccid)

hypernatremia

f - fever (low grade), flushed skin

r- restless (irritable)

i - increased fluid retention and increased bp

e - edema (peripheral and pitting)

d - decreased urinary output, dry mouth

can also use this one:

salt

s = skin flushed

a = agitation

l = low-grade fever

t = thirst

s/s of hyponatremia

s tupor/coma

a norexia, n&v

l ethargy

t endon reflexes decreased

l imp muscles (weakness)

o rthostatic hypotension

s eizures/headache

s tomach cramping

hypocalcemia

c - convulsions

a- arrhythmias

t - tetany

s - spasms and stridor

to remember which blood types are compatible, visualize the letter “o” as an orb representing the universe, because type o blood is the universal donor blood. patients with any blood type can receive it. but o also means “odd man out”: patients with type o blood can receive only type o blood.

think beep to remember the signs of minor bleeding:

b: bleeding gums

e: ecchymoses (bruises)

e: epistaxis (nosebleed)

p: petechiae (tiny purplish spots)

having difficulty distinguishing hypoplasia from hyperplasia? when you see plasia in any word, think of "plastic." plastic, in turn, means forming or developing. as for hypo and hyper, that’s the easy part. hypo means under, or below normal. hyper means excessive, or above normal. thus, hypoplasia means underdevelopment, and hyperplasia means overdevelopment.

a stand-up comedian who gets no laughs might say his audience has humoral immunity. but humor is the latin word for “liquid,” and humoral immunity comes from elements in the blood — specifically, antibodies. contrast this with cellular immunity, which comes about through the actions of t cells.

"hook" for serum sickness: each letter stands for a key sign or symptom

of serum sickness.

f: fever

a: arthralgias

r: rash

m: malaise

esp for skin biopsy? the three different techniques — excision, shave, or

punch — used to secure a skin biopsy specimen.

to remember the four causes of cell injury, think of how the injury tipped

(or tipd) the scale of homeostasis :

t: toxin or other lethal (cytotoxic) substance

i: infection

p: physical insult or injury

d: deficit, or lack of water, oxygen, or nutrients.

when asking assessment questions, remember the american cancer

society’s mnemonic device caution:

c: change in bowel or bladder habits

a: a sore that doesn’t heal

u: unusual bleeding or discharge

t: thickening or lump

i: indigestion or difficulty swallowing

o: obvious changes in a wart or mole

n: nagging cough or hoorificeness.

use the abcd rule to assess a mole’s malignant potential :

a: asymmetry--is the mole irregular in shape?

b: border--is the border irregular, notched, or poorly defined?

c: color--does the color vary (for example, between shades of brown, red, white,

blue, or black)?

d: diameter--is the diameter more than 6 mm?

rome (abg/ fluids and electrolytes)

respiratory opposite

metabolic equal

r respiratory

o opposite

ph > pco2

ph acidosis

m metabolic

e equal

ph> hco3 > alkalosis

ph

side effects of steroids. the 5 s's.

sick- easier to get sick

sad-causes depression

sex-increases libido

salt-retains more and causes weight gain

sugar-raises blood sugar

medical mnemonic for the order in which the heart valves close:

my — mitral

teeth — tricuspid

are — aortic

pretty — pulmonary

heart sounds :

s3= heart fail-ure (3 syllables)

s4=hy-per-ten-sion (4 syllables)

mr dice runs (systems of the body)

m= muscle

r= respiratory

d=digestive

i= integumentary

c= circulatory

e= endocrine

r= reproductive

u= urinary

n= nervous

s= skeletal

trouble figuring out which eye is which?

os is left eye

od is the right eye

another way to remember the eyes is : you look out with both eyes.

take the right dose so you won't od [overdose].

the only one that isleft isos.

both eyes=ou, right eye=od, left eye=os.

ad - right ear

as - left ear

au - both ears

remember that here in the usa you d drive on the right side of the road.

o= optical

a= auditory

immediate treatment of mi, think mona :

m morphine sulfate

o oxygen

n nitroglycerin

a asa

treatment of chf, think unload fast:

u sit upright

n nitro

l lasix

o oxygen

a aminophylline

d digoxin

f fluids- decrease

a afterload - decrease

s sodium - decrease

t tests: dig level, abg, k+

assistive devices -- canes:

c cane

o opposite

a affected

l leg

signs of a cholinergic crisis, think slud :

s salivation

l lacrimation

u urination

d defication

effects of anticholinergics :

can't see

can't pee

can't spit

can't --defecate

memory trick :need to remember which kind of beta blocker has which action?

b1 blocks the heart (you have only one heart)

b2 blocks the lungs (you have two lungs)

fetal accelerations and decelerations: just remember veal chop

variable cord compression

early head compression

accelerations ok

late placental insufficiency

nine-point postpartum assessment...

bubbleher

b- breasts

u- uterus

b- bladder

b- bowel function

l- lochia

e- episiotomy

h- homan's sign

e- emotional status

r- respiratory system

5 p's of circulation loss in a limb

pain,

pallor

pulselessness

parasthesia

poikilothermia

ekg lead placement

snow(white) over grass (green), smoke (black) over fire (red), and a big pile of poop(brown) in the middle.

diabetes

hot and dry: sugar high

cold and clammy need some candy

mneumonic device for remembering questions to ask emergency room admits :

car? (circumstances of event)

please (precipitating events)

listen (location of event)

to this: (time of event)

watch (when symptoms appeared)

underage (unconsciousness after injury?)

alcoholics (arrival time in er)

heading (hospital admits previously?)

home (previous history/health status)

and (allergies)

maybe (medications)

flattening (fears for safety)

my (meal, time of last)

poodle (period, time of last menstrual)

dog (primary doctor, name and location of)

tonight (tetorifice, date of last immunization)

hypokalemia “suction” signs and systems

s- skeletal muscle weakness

u- u wave present

c- constipation

t- toxcity digioxin

i- illeus (paralytic illeus)

o- ortostatic pressure

n- numbness or parathesis

tips in nclex exam part 8

propanolol causes bronchospasm- avoid it with copd

metronidazole should be taken with meals, avoid alcohol

morphine sulfate and atropine- everything is down except heart rate (tachycardia)

omeprazole- hepatotoxic, need to check liver enzymes

ginkgo biloba- risk for bleeding

need to check before surgery- anticoagulant and antihypertension

wet to dry- look for the word debride

consider teach as a psychosocial

iv medication can be given only by a registered nurse=update

solutions: ml/hr round off to whole number

solution: mg can be in decimal

colonoscopy-entire colon

sigmoidoscopy- only lower third

phototherapy- put eye cover

heroin intoxication- remember the words pinpoint pupils and respiratory depression

cocaine- remember the word dilated pupils

changing bag in ileostomy-weekly

changing bag in colostomy- daily

alzheimer’s disease- frequently orient patient to his surroundings

bike should be with helmet

digoxin loading dose-0.5-1mg, maintenance 0.125-0.25 mg

normal ptt 24-45 or x2, therapeutic 48-90 seconds

organ rejection- look for the word rejection and dull pain

medication error-do medication report

incident report- only if harm happens

only reason for clamming test tube is to check for leaks and changing apparatus

1. don’t hold anything especially when giving medications

2. don’t delay endorsement

3. all about neoplastic always look for estrogen

4. inflammation, always elevate

5. meniere’s disease look for vertigo

6. always stay will your patient

7. tracheostomy tube should be inflated to avoid aspiration when giving oral hygiene or feeding.

8. never clamp chest tube to prevent lung collapse

9. if the chest tube is disconnected from the client—apply a tented dressing to the clients’ insertion site.

10. if the chest tube is disconnected from the drainage—insert end of the chest tube in a container of a normal saline

11. if the chest tube reach the floor cut the end of the test tube (1inch) and insert in a normal saline bottle

12. about tpn, never stop or slow down the rate to prevent rebound hypoglycemia

13. hip displacement look for abducted

14. adducted—remember the letter add…means add to the body and abducted the vice versa of adducted

15. hypoglycemia— give glucagon for unconscious patient; but orange juice for conscious patient. because common mistakes of students is that they know that orange juice is for hypoglycaemia but unconscious patient can take oral fluids so its best to give glucagon parenterally.

16. 3 chamber water seal

a. drainage is the one close to the patient

b. water seal chamber- should be intermittent bubbling

c. suction- continuous bubbling

17. if asking about goal look for the specific goal

18. always delegate traction, fracture and tube feeding

19. step on the call light of nurse.

20. depressed patient—socialization

notgivingup1 RN · Jun 29, 2011

also here's some more tips....best wishes on your exam:

infection control

for isolation precautions:

airborne (my chicken has 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)

scarlet fever

sepsis

streptococcal pharyngitis

parvovirus b19

pneumonia

pertussis

influenza

diphtheria

epiglottitis

rubella

mumps

mycoplasmal/meningeal pneumonia

adenovirus

management:

-private room

-mask , gown, gloves all the time

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

(know what illness goes with what precaution, and for that precaution what measures should be taken ie: airborne needs n95 mask, negative pressure room, private room)

alex hez 5 coins here

alex = aids

hez= herpes zoster

5=5th dx

coins=croup

here= hepatitis and rsv

pharmacology

insulin, coumadin, heparin, antihypertensives, viagra, digitalis, ritalin, actonel, accutane, anti-ulcer medications, nitroglycern, to name a few. try to look at the suffixes:

ace inhibitors end with 'pril (eg: captopril) *note that this drug increases potassium in the blood,

angiotensinogen 2 inhibitors end in 'sartan (eg: losartan),

beta blockers end with 'olol (eg: metoprolol) *caution with patients who are diabetic or who are asthmatic,

cholesterol reducing drugs usually end with 'statin (eg: atorvastatin) * note that if the patient experiences muscular pain, they should stop immediately and report it to the doctor, also not to consume grapefruit juice,

impotence drugs end with "defil (eg: sildenefil-hope i spelled it correctly...if not please excuse the typo) *note that you cannot take this drug if you are taking nitrates such as nitroglycerin or isosorbide and go to the doctor if an erection last longer than 4 hours,

accutane is an acne drug, where a pregnancy test must be done on females before prescribing them

actonel (again, this may be a typo) cannot be taken unless a person is able to sit up for at least 1/2 hour to an hour after adminstration.

know the acting times of insulin, which is fast acting, long acting or the lente. they may ask when will a person become hypoglycemic, and that would be during peak hours.

penicillin: if a person has an allergy to penicillin, they may be at risk for an allergy to a cephalosporin, in that case suggest a macrolide such as clarithromycin. macrolides are known to cause severe stomach pain for some people. also, if a nurse administers penicillin or cephalosporin, that the patient should remain with the nurse for 1/2 hour afterwards to intervene with allergic reactions.

most drugs that end with 'mycin may cause nephrotoxicity or ototoxicity

parameters for digitalis administration, and also that if potassium is low and calcium and magnesium is high, there is a higher chance for digitalis toxicity.

corticosteriods usually end with 'sone (eg: predinsone), may cause medication related diabetes, increase chances of infection, cause cushoid symptoms (buffalo hump in back, thin skin, easy to bruise, etc...)

aspirin should not be consumed with alcohol, increases bleeding, causes ulcers, should be taken with food to diminish gastric distress

antidote for tylenol is mucomyst.

dont forget your diuretics ... esp. those are imp. also i have some for now ...

meds that end in -sartan=decrease blood pressure, increase cardiac load (used for those who side effect is cough with ace)

angiotensin ii receptor blockers

side effects 2nd degree av block, angina, muscle cramps monitor bun,bp and pulse

-vastatin(lovastatin)=decrease cholesterol, lower tricycerides (note*lipitor at night only do not take with grapefruit juice)

antihyperlipidemics

side effects muscle weakness, alopecia monitor liver/renal profile

cox=osteoarthritis, rheumatoid arthritis(relieve pain by reducing inflammation)

nsaid/co2 enzyme blocker

side effects tinnitus, dizziness monitor bowel habits (could cause gi bleed, platlet count) increase risk of strokes, heart attacks***

tidine=gerd

histamine 2 antagonist(inhibit gastric acids)

side effects agranulocytosis, brady/tachycardia monitor gastric ph/bun ***if taking antacids take one hour after or before taking these drugs***

-prazole=ulcers, indigestion, gerd (take before meals better absorption)

proton pump inhibitors

side effects gas, diarrhea, hyperglycemia monitor lfts

-parin=thin blood, dvt, m.i.,post surgeries (antidote protamine sulfate--check ptt should be 1.5-2.0x) anticoag. decread vit. k levels

side effects hematuria, bleeding, fever monitor ptt, hematocrit and occult testing q 3mths

-pam

-pate

-aze/azo =benzos/antianxiety/anticonvulsants

side effects incontinence, respiratory depression/ monitor for lft, respirations

-caine (anesthetic)

-mab (monoclonal antibodies)

-ceph or cef (cephalosporins)

-cycline (tetracyclines)

-cal (calciums)

-done (opioids)

ganciclovir sodium causes neutropenia and thrombocytopenia and nurse should monitor for s/s of bleeding just as equiv. to a pt. on anticoag. therapy.

ssris and maois used together potentially fatal

caine= local anesthetics

cillin= antibiotics

dine= anti-ulcer agents

done= opiod analgesics

ide= oral hypoglycemics

iam= antianxiety agents

micin= antibiotics

nium= neuromuscular blocking agents

olol= beta blockers

ole= anti-fungal

oxacin= antibiotics

pam= antianxiety agents

pril= ace inhibitors

sone= steroids

statin= antihyperlipidemics

vir= antivirals

zide= diuretics

generic name (trade name) major concerns

analgesic

acetaminophen (tylenol) watch for liver and kidney problems

hydrocodone with acetaminophen addictive

(lortab)

ibuprofen (motrin) can lead to hpn and kidney disease

naproxen (aleve) can lead to hpn and kidney disease

antianxiety

alprazolam (xanax) this drug can be addictive

diazepam (valium) watch for allergies, *also anticonvulsant*

lorazepam (antivan) sedation

promethazine hci (phenergan) *also antiemetic*

antibiotic

amoxicilline (augmentin) watch for allergic reactions

azithromycin (zithromax z-pak) watch for allergies

cephalexin (keflex) if you are allergic to cephalosporins, you might also be allergic to penicillin

doxycycline hyclate (vibramycin) avoid for pregnant clients

penicillin v potassium (penicillin) watch for allergies

sulfamethoxazole (septra, bactrim) can cause gi diturbance

anticoagulant

warfarin sodium (coumadin) teach the client to limit the intake of green leafy vegetables

watch for signs of bleeding

anticonvulsant

clonazepam (klonopin) should not be stopped abruptly

diazepam (valium) watch for allergies, also antianxiety

lorazepam (antivan) sedation

antidepressant

sertraline (zoloft) sedation

amitriptyline hci (elavil)

trazodone hci (desyrel)

antidiabetic

glipizide (glucotrol) watch for hypoglycemia

metformin (glucophage) this drug should be stopped prior to a dye study such as cardiac catheterization

antihistamine

cetirizine (zyrtec)

fexofenadine (allegra) dry mouth

antihypertensive

amiodipine (norvasc) hypertension

atenolol (tenormin) cause drop in pulse rate, check pr daily

doxazosin mesylate (cardura)

lisinopril (zestril) cause postural hpn, remain supine for at least 30mins

metoprolol succinate (toprol xl) teach the client to check his pulse rate

metoprolol tartrate (lopressor,toprol) teach the client to check his pulse rate

antihypertensive/antianginal

verapamil hci (calan)

anti-inflammatory

ibuprofen (motrin) can lead to hypertension and kidney disease

prednisone (deltasone) can cause cushing’s syndrome and gi problems

antigout

allopurinol (zyloprim) drink at least 8 glasses of water per day

antilipidemic – usually ends in statin

simbastatin (zocor) can cause liver problems & muscle soreness

do not take this drug with grape-fruit juice

antiulcer/histamine blocker

ranitidine hci best to take this drug with meals

antiulcer/proton pump inhibitor

lansoprazole (prevacid) take this drug prior to meals

omeprazole (prilosec)

bronchodilator

albuterol (proventil) tachycardia, md check blood levels for toxicity

diuretic

furosemide (lasix) hypokalemia

hydrochlorothiazide (hctz) hypokalemia

hormone replacement

estrogen (premarin) can ↑ blood clots

levothyroxine (levoxyl) can ↑ blood clots

levothyroxin (synthyroid) teach the clients to check his pulse rate

muscle relaxant

cyclobenzaprine hci (flexeril) sedation

oral contraceptive

necon (ortho-novum 7/7/7) can ↑ blood clots

trinessa (ortho triclen) can ↑ blood clots

osteoporosis

alendronate (fosamax) remain upright for at least 30mins after taking to prevent gerd.

take with water

potassium supplement

potassium chloride (k-lyte) check for renal function before giving this drug

sleep aid

zolpidem (ambien) allow at least 8hrs of sleep time to prevent daytime drowsiness

neutropenic precautions

■ for individuals with compromised immune system

■ use standard precautions, especially hand hygiene

■ caregivers and visitors should be free of communicable illnesses

■ private room if possible; keep room meticulously clean

■ teach to avoid sources of potential infection (crowds, confined spaces

such as airplanes, raw fruits/vegetables, flowers/plants)

delegation

as far as delegation, kaplan stresses that the rn is ultimately responsible for all tasks delegated.

now i know from experience, lpns can be given a lot of tasks that require assessment/gathering, planning, & evaluating loads of information...

but in terms of the nclex-rn...they can't do any assessing, planning, evaluation, or initial teaching. that is entirely the role of the rn on that exam!

also, lpns can only be given patients that are hemodynamically *stable*. they can't be given any patients that require constant monitoring for evaluation purposes. lpns are only allowed to implement written orders from mds/apns & follow instructions given to them by the rns in charge to cover their patients.

as far as the uaps (unlicensed assistive personnel)...they can only be given the most basic of psychomotor nsg tasks like taking vital signs on stable patients...assisting with adls & ambulating patients for therapy & again...no assessing, planning, & evaluation...etc.

another thing....mds/apns/nsg mgt/other interdisciplinary dept/personnel such as msw/chaplins/resp/occup/physical therapists are *always* available to the nclex-rn staff nsg! these people are multiple & fruitful...but remember this.... *do not pass the buck to them* !!! you have to assume that there are standing….if not written orders for your patients...remember...this is a *perfect world*.

if you see in your answer choice where "call the physician", "contact a supervisor from another dept", "refer grieving families to the chaplin", for example, before you've exhausted everything that you as the rn can do for the patient...don't pick those answers.

if though, you read that everything was done for the patient, i.e. o2 was started, the patient was repositioned, high vent alarms & you've disconnect the patient & started bagging...then & only then do you contact the physician, supervisor, resp therapist...etc.

you may be asked questions on what to do for a patient based on their abgs or common labs...you'll have to know the normals & what's expected when they're abnormal & know where to go from there.

the only other time that you will "pass the buck" is when an uap or a lpn observed something wrong with another rn's patient. you are not suppose to assess that patient since you don't know that patient's base vitals & situation. only then would you inform either that rn or contact your supervisor (staying within your chain of command)...or both.

i've seen questions that suggest an uap of 12 years or a lpn of 20 years observes a new grad rn do something that they know (or feel) isn't right. what do you do? confront said nurse, observed said nurse in their duties, or ask the reporting personnel to elaborate on how they come to feel this way. unless what the uap/lpn seen is unsafe...then you as the rn would ask that reporting personnel to explain their concerns further.

primary roles for the licensed nurse**

general education and support to promote wellness, health maintenance and disease prevention as requested by client *client initiates

care consultation related to health impairment, includes education and support to maintain client independence client or nurse initiates

care coordination nursing activities include: - consultation - needs assessment - teaching care provider to perform care activities - providing education, support and other direct care - monitoring client status - ongoing review of care provision client or nurse initiates/directs

care coordination nursing activities include all previous activities plus: - directing nursing care, including assignment and delegation of activities nurse directs

total care management includes direct care, assignment and delegation responsibilities within health care system; care provided by both licensed

nurses and ap (delegated activities) nurse directs

nurse671 · Jun 27, 2012

nice..

healthstar, BSN, RN · Jun 27, 2012

Thank you so much for posting those tips, you are awesome!

tintinatinapot · Jun 27, 2012

Thank you :)