How I Passed NCLEX on 3rd attempt

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. :)