March 2008 NCLEX support group

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A thread for all those in March who are planning to take the NCLEX offering both support and any hints or tips that help

Good luck to all :D

Specializes in med/surg/tele/neuro/rehab/corrections.

Is my book wrong? Saunders says normal magnesium level is 1.6-2.6

someone please explain. I don't want to memorize the wrong thing!

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Specializes in Med/Surg.
Is my book wrong? Saunders says normal magnesium level is 1.6-2.6

someone please explain. I don't want to memorize the wrong thing!

In school I was told Mg was 1.5-2.5, Ca 9-10 but in Saunders it's something different, I think lab values are slightly different based on the source you use. I wouldn't go about memorizing the exact numbers but know them approximately.

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Specializes in med/surg/tele/neuro/rehab/corrections.

Ok good but was just reacting to that one post that said

magnum condoms ....... 18-24 year olds.

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Specializes in Med/Surg.
Ok good but was just reacting to that one post that said

magnum condoms ....... 18-24 year olds.

Yeah, I know what you were referring to...when I saw that I automatically knew that that the interpretation was 1.8-2.4 which makes more sense than looking at it as a whole number. Good luck!!!

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Specializes in comprehensive.

Hi there.....I am taking my NCLEX in March and I am a bit nervous cause i dont know where to start! :o

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Specializes in Med Surg, Telemetry, Long Term Care.
Hi there.....I am taking my NCLEX in March and I am a bit nervous cause i dont know where to start! :o

trying browsing on questions and analyzing its rationales...try using the saunders cd..:D

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hey everyone! sorry this is a day late... but here are some of my maternity notes. there's some stuff i need to look through & finish, but better than nothing!! LOL!! hope this helps...

Danger signs of pregnancy:

lady partsl bleeding in any amt or any color (could be placental problem)

Rupture of membranes

Severe, persistent H/A, epigastric pain (may be impending seizure)

Visual disturbances (sx of pregnancy induced HTN - aka preeclampsia - or 1 that is worsening)

Edema of face, feet or hands (sx of PIH or 1 that is worsening)

Abdominal/ epigastric pain (may be impending seizure)

Elevated temp > 101F or 38.3 C w/ chills (can be infection of uterus or amnionitis)

Persistent vomiting (last for more than 1 day)

Painful urination (could be UTI, can cause pre-term labor)

Significant change or absence of fetal movement for 6-8 hrs

Complicationa w/ pregnancy:

Hyperemesis Gravidum : severe vomiting during pregnancy; typical sx are: persistent, uncontrollable vomiting, rapid pulse, decreased urinary output, low grade fever, weight loss. Complications are: dehydration, metabolic alkalosis, electrolyte

imbalance, weight loss *** advise pt to avoid spicy or fried foods & eat 6 small meals a day; sit upright for 30 after eating, & eat crackers when arising

PIH : pregnancy induced hypertension; have woman lay on L side to reduce BP & increase uterine & renal blood flow; non stress test used to check fetal well being; use seizure precautions because this could become eclampsia (seizure state). Eclampsia poses woman for fatal pulm edema, cardiac failure, organ failure, cerebral hemorrhage, Keep pt calm & 1st tx is magnesium sulfate - use calcium gluconate for resp depression

* s/sx of mild preeclampsia: BP 140/190 or above (or increases 30 mm systolic &

15 mm of diastolic; 1+ pitting edema after 12 hrs of bedrest (and does not go

away); proteinuria is 1+ or 2+ or higher

* s/sx of severe preeclampsia: BO 16/110 or higher & extensive generalized edema; proteinuria of 3+ or 4+ or higher; H/A, visual disturbances, abdominal

Pain

Gestational diabetes: teach pt to monitor fetal activity (fewer than 3 poses danger); no oral hypoglycemics d/t adverse affects on fetus

Spontaneous abortion: infection, DM, hormonal deficiencies: abodminal cramping, low back pain (hemorrhage & infection most risk)

Placenta previa: painless lady partsl bleeding- bright red (total & partial). May be d/t closely spaced pregnancies; given Bethamethasone; no lady partsl exams d/t hemorrhage

Abrupto Placenta: most common risk factor is high BP during pregnancy, folic acid deficiency, trauma to abdomen (usually occurs @ 3rd trimester); s/sx: EXTREMELY PAINFUL ( UTERINE TENDERNESS) & RIGID, BOARD LIKE ABDOMEN

DIC: rapid pulse; pt upset

Intrapartum

Factors of Labor (process of labor & delivery):

1. Passenger - Fetus, placenta, soft tissue

2. Passageway (bony pelvis) - "molding" (sutures mold to birth canal- lady partsl)

- size of pelvis helps to determine ability of good passageway

- pelvis is divided into superior (stabilizes fetus' head during last months of

pregnancy & inferior (passage of fetus during birth -lady partsl delivery)

3. Powers - contractions/ bearing down

4. Position (maternal position) - standing, walking, on hands & knees, squatting, side

lying:

- fetal presentation, position, attitude

- is baby: breech, shoulder/head first? flexed, vertical/horizontal position of baby in pelvis

- upright position most helpful to bring baby to birth canal ("semi-recumbent" typical)

5. Psychological Response - mother's mental state

* True Labor vs. False Labor *

- Comfort measures don't wrk / comfort measures wrk (ie: walking make contractions go

away)

- Experience regular contractions / irregular contractions

- Cervix dilate & efface / cervix not dilated

- pain in lower back to lower abdomen (true labor)

- bloody show (true labor)

Signs of Labor:

- contractions frequent

- cervix softens & dilates

- bloody show

- amniotic membranes rupture

- pt. has burst of energy

- pt. may get diarrhea/ indigestion

Process of Labor:

1. Dilating (3 stages)

a. Latent - excitement, contractions 15-20 mins aprt (last 20-30 secs) cervix

dilates, 0-4 cm/ 6-9 hrs; meds not given, may show prog of labor; walking

intensifies labor

b. Active - cervix 4 cm dilated, ends @ 8 cm; 2-3 mins apart (last 60 secs); high

discomfort; membranes rupture

c. Transition - every 1 to 2 mins aprt (last 60-90 secs); cervix 10 cm dilated

(full dilation); urge to push, pt. tired

2. Expulsion - most dangerous; full cervical dilation (begins), ends w/ delivery of baby

3. Placental stage - delivery of baby (begins), ends w/ expulsion of placenta; placenta

Detaches 5 mins after delivery, expelled after 30 mins

4. Recovery - 1st 4 hrs of placenta; bonding

Deliveries:

episiotomy (used to prevent perineal injuries); heals 3-4 wks after delivery

Forceps

Complications of delivery:

Cephalopelvic disproportion

*Conditions that affect labor are maternal fatigue & placement of fetus' shoulder

Prolapsed cord

** distocia: failure of labor to progress

Pain Management:

Can be managed by non pharmacological measures & pharmacological measures

Non-pharmacological:

1. TENSE: transcutaneous electrical nerve stimulation (non pharmacological

measure)

Pharmacological :

1. Systemic analgesics - ie: narcotics; decrease sensation of pain or pain perception w/out loss of consciousness & often reduce maternal anxiety (opiods & sedatives); may not provide adequate pain relief & can cause n&v & may cause placental barrier by simple diffusion; 4 hrs after delivery, may cause CNS & resp

depression - give Narcan (naloxone), which is a narcotic antagonist, to reverse

neonatal narcosis *** Benzo's (diazepam & valium) are rarely given d/t potent sedative affects ***

2. Regional analgesics & general anesthetics - ie: lidocaine, novocaine;

* Anesthesia:

Pre-Term Delivery:

Prior to 37 wks

Restrict activity & sex

Factors: younger than 18, older than 35; late/no prenatal care, smoking, stress, uterine surgery, infection, inadequate nutrition, anemia

s/sx:

1. Contractions q 10 mins or often, w/ or w/o pain

2. Intestinal cramping w/ or w/o diarrhea

3. Menstrual like cramps

4. Lower backache

5. Bleeding; changes of lady partsl discharge

6. Premature rupture of membranes

7. Cervix 80% effaced

8. Bedrest @ L lateral position

Nsg Interventions:

1. Monitor I&O & drugs that can cause hypocalcaemia/hypokalemia

2. Monitor signs of tachycardia

3. Drink 2-3 glasses of h20

4. Call MD if lady partsl order present

** Mag sulfate given IV to lower uterine contractility - monitor BP, uterine output**

Post-Term Delivery:

After 42 wks

Pt @ risk for lacerations, forceps, induction of labor, etc

After 41 wks, placenta ages & declines its function; O2 & nutrients supplied to fetus altered - risk for fetal distress of asphyxia, aspiration me conium, dismaturity, resp distress

Post term risks: estrogen insufficiency

Signs of risks: fetal distress, fetal inactivity

Nsg Interventions:

1. Induce labor by oxytocin (induction procedure done by forceps, vacuum,

c-section

2. Test infants glucose 1 hr after delivery; have mother breastfeed early to

Prevent hypoglycemia

3. Anticipate resp problems & ALWAYS monitor FHR

Postpartum

Complications:

Hemorrhage

infection

mastitis

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Specializes in Pysch, SN, Med-Surg.

HI everyone!!! Lets see, where do i begin...ok i take my boards on march 6th and i am scared crapless...i study every chance i get at work and late into the night after work. I have been using saunders and the kaplan Q-bank. I have been scoring 60-80% using saunders and 55-65% using kaplan, so yeah i'm freaking pretty bad.:uhoh21: I try to break down the content and focus on my weak points, but the more i do that the lower my score seems to go and the more frustrated i become:angryfire. I really do need tons and tons of prayer and advice!!!

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hey guys... i knoe suzanne is saying that we shouldn't do anything else while doing her plan... but i'm also considering doing kaplan just for test strategy info. i bought the kaplan book & when i did the practice questions, it made me feel so dumb & unmotivated! now i don't know if i want to buy those kaplan q bank questions online!! AUGH!! any suggestions? thanks!!

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Specializes in Medical and general practice now LTC.
hey guys... i knoe suzanne is saying that we shouldn't do anything else while doing her plan... but i'm also considering doing kaplan just for test strategy info. i bought the kaplan book & when i did the practice questions, it made me feel so dumb & unmotivated! now i don't know if i want to buy those kaplan q bank questions online!! AUGH!! any suggestions? thanks!!

If you are following Suzanne's plan then you should really stick to it how she requests. She has had a very good success rate and you will find the ones that do fail stating they used her plan did in fact use other stuff as well

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Specializes in OB/GYN/OR.

Hi

I got a med calculation Q while practicing (Saunder's)...where it is written....I hope i am allowed to ask this....for eg

Gantrisin drug 1 gm,orally 4 times daily is ordered by physician.The med label reads "500 mg tablets".How many tablets does the nurse administer per dose?

Please solve this pretty simple sum and post the answers here, would like to see what answers you guys get...I got it wrong...

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Hi

I got a med calculation Q while practicing (Saunder's)...where it is written....I hope i am allowed to ask this....for eg

Gantrisin drug 1 gm,orally 4 times daily is ordered by physician.The med label reads "500 mg tablets".How many tablets does the nurse administer per dose?

Please solve this pretty simple sum and post the answers here, would like to see what answers you guys get...I got it wrong...

1gm = 1000 mg... 1000mg/4 = 250mg... if the does comes in 500mg tablets then you would administer 0.5 tablets per dose. Make sure it is okay to cut tablet.

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