2nd Time Around Passed here is how MUST READ

goodstudentnowRN · Mar 31, 2010

Thanks! This will help those who are still studying for the NCLEX.

caliotter3 · Mar 31, 2010

:ancong!: and many thanks for consolidating a lot of useful info!

Gold2010 · Mar 31, 2010

i passed after taking nclex this past monday/ pearson trick immediately after getting home. kaplan takes months to fully get all out of it. not weeks, it works. review all content review and write it all out. takes months. it took many 7 months to fully absorb all of kaplan and i kept changing my class in order to get more time. i highly recomend th live on line course, not the in person course. you must cover all the course content review which is huge. do all the q-trainers and know all the rationales, i never got to the q-bank and still passed. write it all out if you are slow like me.
priority and delegation by charity is a must.
i get tired very easily. i ate breakfast, went back to bed for 3 hours. got ready downed a red bull ate chocolate and was fully charged for the nclex. the brain uses lots of sugar when you are concentrating this kept me going.
below are also a must know that i had copied pasted from different posts. i must emphasize this is a must know:
varicella (chickenpox) requires use of airborne precautions and contact precautions as well.
if a patient is on contact precautions, have family members and other visitors wear a gown and gloves as outlined by your facility (hospital).
1) droplet room assignment: preferably private, if not available roomate with same illness and same pathogen. and if thats not an option 3 feet away from roomate with the curtain pulled.
2) when transporting a patient with airborne precautions (for essential purposes only) they must wear a surgical mask.
for contact precautions
diseases/conditions include: c. diff, e. coli, scabies
room needs to be private unless room has another patient infected with the same organism
for droplet precautions
diseases/conditions include: meningitis, pneumonia, pertussis (whooping cough), rubella, mumps
room needs to be private unless room has another patient infected with the same organism. maintain spacial distance of 3 feet when near patient.
also remember standard precautions apply to all patients regardless of diagnosis when in contact with any bodily fluid, blood, secretions/excretions, nonintact skin, and mucous membranes
#1. when wearing gown and/or gloves, make sure to take them off and properly dispose of them, before leaving the patien'ts room.
#2. pt's with herpes zooster (shingles) that is active should have the same precautions as a patient with chicken pox---airborne and contact
#3. pt's on droplet precaution can have their room door left open.
#4. instruct visitors for pt's with droplet precautions to try to keep a distance of three feet between them and the pt.
#5. pt's with croup should be on contact precautions
bacterial meningitis is transmitted via droplets, and when suctioning pt, wear goggles, eyewear, mask, and gloves. pt should wear a face mask when being transported.
cdc recommends airborne precautions against varicella/rubeola.
measles, chicken pox (varicella), disseminated varicella zoster, tuberculosis
barrrier protection: single room maintained under negative pressure
door kept closed except when someone is entering
exiting the room
negative airflow pressure used in room, (min of 6 - 12 air exchanges per hour depending on the facility
ultraviolet germicide irradiation or high-efficiency
particulate air filter used in the room
mask or personal respiratory protection device used
mask placed on the client when client needs to
leave the room; client only leaves only if necessary!
rsv is contact precautions. so wear gloves and a gown. it is a respiratory infection that is transmited through contact with the secretions.
when you put your protective gear on start from top to bottom : mask-> gown-> and gloves. when you take them off start from bottom to top: gloves->gown->mask. (i tried to research this part just to make sure it is what i remember it to be, but found nothing so im not 100% certain)
wash hands between patients and whenever visibly soiled.
donning ppe (personal protective equipment)
gown
fully cover torso from neck to knees, arms to end of wrist, and wrap around the back
fasten in back at neck and waist
mask or respirator
secure ties or elastic band at middle of head and neck
fit flexible band to nose bridge
fit snug to face and below chin
fit-check respirator
goggles/face shield
put on face and adjust to fit
gloves
use non-sterile for isolation
select according to hand size
extend to cover wrist of isolation gown
safe work practices
keep hands away from face
work from clean to dirty
limit surfaces touched
change when torn or heavily contaminated
perform hand hygiene
removing ppe
remove ppe at doorway before leaving patient room or in anteroom
gloves
outside of gloves are contaminated!
grasp outside of glove with opposite gloved hand; peel off
hold removed glove in gloved hand
slide fingers of ungloved hand under remaining glove at wrist
goggles/face shield
outside of goggles or face shield are contaminated!
to remove, handle by "clean" head band or ear pieces
place in designated receptacle for reprocessing or in waste container
gown
gown front and sleeves are contaminated!
unfasten neck, then waist ties
remove gown using a peeling motion; pull gown from each shoulder toward the same hand
gown will turn inside out
hold removed gown away from body, roll into a bundle and discard into waste or linen receptacle
mask or respirator
front of mask/respirator is contaminated - do not touch!
grasp only bottom then top ties/elastics and remove
discard in waste container
hand hygiene
perform hand hygiene immediately after removing all ppe!
chicken pox(13-17 days)--prodromal, child have malaise, fever, anorexia.
rash is pruritic, and starts out as a macule then papule then a vesicle.
spread by direct contact, droplet and contaminated object.
isolate till all vesicles are crusted; it can be spread from 2 days before the rash begins.
avoid use of aspirin due to reye's syndrome, use tylenol.
airborn--door can be closed..measles (rubeola), m. tuberculosis, disseminated zoster(shingles), varicella(chicken pox)--again can cohort and place in same room with the same infective organism.
droplet--door may be open---streptococcus pharyngitis, meningitis, pnemonia...private room or pt with same infection--involves contact with mucous membranes of nose or mouth...happens during talking, coughing, suctioning. maintain 3feet between infected patients and visitors.
rubella--there's a maculopapular rash on face and all over the body. prodromal: malaise and fever which is followed by cough.
sread by droplets and contaminated objects. placed on contact precautions, isolate child from pregnant women.
tuberculosis, pt is on isolation for 2-4 weeks (until there are 3 negative sputum cultures.)
syphilis--painless chancre that fades within 6 weeks...on palms and soles there is a copper colored rash...spread by contact with mucous membranes and also congenitally...tx with penicillin g im
heres how i remember that rubella is droplet and rubeola is airborne...rubella sounds like umbrella and umbrellas protect you from raindrops...
transmission-based precautions: adc
a - airborne
d - droplet
c - contact
airborne precaution (credit goes to the one who posted this on april thread, sorry can't remember your name)
my - measles
chicken - chickenpox
hez - herpes zoster (disseminated)
tb - tb
private room
negative pressure with 6-12 air exchanges per hour
uv
mask
n95 mask for tb
droplet precaution
think of spiderman!
s - sepsis
s - scarlet fever
s - streptococcal pharyngitis
p - parvovirus b19
p - pertussis
p - pneumonia
i - influenza
d - diptheria (pharyngeal)
e - epiglottitis
r - rubella
m - mumps
m - meningitis
m - mycoplasma or meningeal pneumonia
an - adenovirus
private room
mask
contact precaution
mrs.wee
m - multidrug resistant organism
r - respiratory infection - rsv
s - skin infections
w - wound infections
e - enteric infections - clostridium defficile
e - eye infections
skin infections:
v - varicella zoster
c - cutaneous diptheria
h - herpes simplex
i - impetigo
p - pediculosis
s - scabies, staphylococcus
private room
gloves
gown

wash your hands before patient care and after patient care.
when in doubt, wash your hands again.
gloves needed when passing meds to pt. with mrsa, if you'll be close to patient need gown too.( just in case you touch anything that might be contaminated )
my preceptor at work likes to say," better to have on too much ppe than not enough."
ppe = personal protective equipment
in removing ppe:
1. gloves
2. goggles/face shield
3. gowns
4. last will be the mask

from: cdc
yes you are right!
donning ppe:
-gown
-mask
-goggles
-gloves
removing ppe:
-gloves
-goggles
-gown
-mask
for tb skin test, if client has 5mm induration, assess if patient is immunocompromised, if yes, positive.
if not, 10mm/greater induration = positive
for treatment of tb and major side effects:
rifampicin (red-urine, tears, sweat)
inh (the n is for neurological

, h is for hepatic)
pyrazinamide (hyperurecimia)
ethambutol (optic neuritis)
for hepatitis, you get the vowels from the bowels (hepa a and e-"fecal-oral route)
according to cdc, patients infected with anthrax do not generally pose a transmission risk. standard (universal) precautions are required though...
vre = vancomycin resistant enterococcus
localized herpes zooster is also known as a cold sore. it's not airborne, and is not spread by touching, so standard precautions is all that is needed.
mumps is respiratory precautions.
rubella
is keep away from pregnant women.
scarlet fever is respiratory precautions till 24 hr after therapy is started.
german measles ( rubella ) requires standard precautions and droplet precautions.
rsv is contact precautions. so wear gloves and a gown. it is a respiratory infection that is transmited through contact with the secretions.
mmr immunization:
1st vaccine dose given at age 12-15 mo.
2nd dose at age 4-6 yrs
before administration; ask if allergic to eggs
mumps: incubation period 14-21 days
communicable period, immediately before and after the swelling begins
transmitted via airborne droplets, saliva, and possibly by contact with
infected person's urine
respiratory precaution; isolation for 9 days following the onset of parotid swelling
most common complication; aseptic meningitis, signs include- nuchal rigidity, lathargy, & vomiting
other complications; orchitis (red swollen tender testicles)
rubella (german measles): hospitalized child-contact isolation; mask, gown,and gloves
incubation period: 14-21 days
communicable period: 7 days before to ~ 5 days after rash appears
source: nasophryngeal secretions, virus present in blood, stool, & urin
transmission: airborne or direct contact with infectious droplets,
indirect via articles freshly contaminated with nasopharyngeal secreations, feces, or urin
assessment: low grade fever, malaise, pinkish-red maculopapular rash that begins on the face and spreads to entire body, petecheae may occur on the soft palate
implementation: supportive care
transplacental: isolate from pregnant women
rubeola (measles)
koplik's spot (sm blue/white spots with a red base on the buccal mucosa
transmission: via airborne particles or contact with infectious droplets
precautions: mask and gloves
sars severe acute respiratory syndrome= it's droplet precaution...so mask.
-remember to tuck the gown cuffs inside each glove..and not over the gloves
-hiv/aids clients, you should always practice standard precautions (on all patients)...hiv/aids patients are not required to state that they have hiv/aids and the healthcare providers will not know which patient has what unless specify in their charts.
to those wondering about the n95 respirator with infectious tb patient..
-use n95 but during bronchoscopy on the same patient (with infectious tb), use a stronger respirator such as a powered air-purifying respirator or papr.
-to do a respirator fit check: during inhalation, the respirator should collapse, and during exhalation, check for leakage around the face
-removing the respirator, you will want to lift the bottom elastic over your head prior to the top elastic. remember to do it slowly because you don't want it to snap off your face.
-remember you would want to remove the respirator outside the patient's room after the door has been closed. all other ppes should be removed inside the patient's room at the doorway or in an anteroom. but if the procedure only requires that you use gloves, then you can remove your gloves in the patient room followed by hand hygiene
-there are three types of respirator, n95, n99, n100 but the n95 is used for infectious tb.
hepatitis b is something that if we are not careful, we can make a mistake very easy, this is a standard precaution unless we are suctioning the pt, then it becomes droplet
http://www.youtube.com/results?searc...rch_type=&aq=f
keep those hands off that mouse!!!!!!!!!!!!!!!!!!!!!!!!!!!!
side note one: while you are practicing your nclex style questions, practice, practice, practice, critical thinking, by taking your time and trying to narrow down your answer and deciding between two possible correct answers. don't get the quick mouse hand, take your hand off the mouse and don't answer the question until you are confident that it's the one you want to choose!!!!!!! i guarantee you that if your practice this you will become a better nclex test-taker. i personally like to keep my hand in my lap while deciding my answer. it kind of helps to keep you calm.
low ph, high co2, high hco3 = resp. acidosis
high ph, low co2, low hco3 = resp. alkalosis
low ph, low co2, low hco3 = metabolic acidosis
high ph, high co2, high hco3= metabolic alkalosis
ph goes to the left= acid ph goes to the right=alkine
acid>>>>>>alkine
hco3 22-26 co2 35-45
so if ph is 7.55(up)& hco3 is 28 (up) both are up = met alkalosis
ph hco3 both up = met alkalosis
ph hco3 both down = met acidosis
ph down co2 up = resp acidosis
ph up co2 down =resp alkalosis
rome:
respiratory= opposite:
- ph is high, pco2 is down (alkalosis).
- ph is low, pco2 is up (acidosis).
metabolic= equal:
- ph is high, hco3 is high (alkalosis).
- ph is low, hco3 is low (acidosis).
acidosis alkalosis
ph 7.45
pco2 >45
co2 22
co2 might be hco3 in some labs and the 18 or 22 might be 1-2 numbers different.
just write down this down and then circle which ones apply to your abg results. then what it is called is the one that caused the acidosis or alkalosis. pco is resp and co2 is metabolic
ex your pt abgs are ph 7.30, pco2, 40 co2 10 this is metabolic acidosis.
pharmacology - know indication/action/effect
prefix/suffix
-ase = thrombolytic
-azepam = benzodiazepine
-azine = antiemetic; phenothiazide
-azole = proton pump inhibitor, antifungal
-barbital = barbiturate
-coxib = cox 2 enzyme blockers
-cep/-cef = anti-infectives
-caine = anesthetics
-cillin = penicillin
-cycline = antibiotic
-dipine = calcium channel blocker
-floxacin = antibiotic
-ipramine = tricyclic antidepressant
-ine = reverse transcriptase inhibitors, antihistamines
-kinase = thrombolytics
-lone, pred- = corticosteroid
-mab = monoclonal antibiotics
-micin = antibiotic, aminoglycoside
-navir = protease inhibitor
nitr-, -nitr- = nitrate/vasodilator
-olol = beta antagonist
-oxin = cardiac glycoside
-osin = alpha blocker
-parin = anticoagulant
-prazole = ppi's
-phylline = bronchodilator
-pril = ace inhibitor
-statin = cholesterol lowering agent
-sartan = angiotensin ii blocker
-sone = glucocorticoid, corticosteroid
-stigmine = cholinergics
-terol = beta 2 agonist
-thiazide = diuretic
-tidine = antiulcer
-trophin = pituitary hormone
-vir = anti-viral, protease inhibitors
-zosin = alpha 1 antagonist
-zolam = benzo/sedative
-zine = antihistamine
pharm facts
-don't give non-selective beta-blockers to patients w/respiratory problems
-vitamin c can cause false +ive occult blood
-avoid the 'g' herbs (ginsing, ginger, ginko, garlic) when on anti-clotting drugs (coumadin, asa, plavix, etc)
-asa toxicity can cause ringing of the ears
-no narcotics to any head-injury victims
-mg2+ toxicity is treated with calcium gluconate
-do not give calcium-channel blockers with grapefruit juice
-oxytocin is never administered through the primary iv
-lithium patients must consume extra sodium to prevent toxicity
-maoi patients should avoid tyramine:
oaacados, bananas, beef/chicken liver, caffeine, red wine, beer, cheese (except cottage cheese), raisins, sausages, pepperoni, yogurt, sour cream.
-don't give atropine for glaucoma - it increases iop
-don't give ant-acids with food -- b/c it delays gastric emptying.
-don't give stadol to methadone/heroin preggo's -- cause instant withdrawal symptoms
-insulin - clear before cloudy
-don't give meperidine (demerol) to pancreatitis patients
-always verify bowel sounds when giving kayexelate
-hypercalcemia = hypophosphatemia (and vice versa)
-radioactive dye - urine excretion
-signs of toxic ammonia levels is asterixis (hands flapping)
-d10w can be substituted for tpn (temporary use)
-dopamine and lasix are incompatible
-hypoglycemic shivers can be stopped by holding the limb, seizures cannot (infants)
-common symptom of aluminum hydroxide - constipation
-thiazide diuretics may induce hyperglycemia
-take iron with vit c - it enhances absorbtion - do not take with milk
-b1 - for alcoholic patients (to prevent wernicke's encephalopathy & korsakoff's synd)
-b6 - for tb patients
-b9 - for pregnant patients
-b12 - pernicious anemia, vegetarians.
-complications of coumadin - 3h's - hemorrhage, hematuria & hepatitis
-ffp is administered to dic b/c of the clotting fx
-mannitol (osmtic diuretic [head injury]) crystallizes at room temp - use a filter needle
-antianxiety medication is pharmacologically similar to alcohol -used for weaning tx
-administrate glucagon when pt is hypoglycemia and unresponsive
-phenazopyridine ( pyridium)--urine will appear orange
-rifampicin -- red-urine, tears, sweat)
-hot and dry = sugar high (hyperglycemia)
-cold and clammy = need some candy (hypoglycemia)
-med of choice for v-tach is lidocaine
-med of choice for svt = adenosine or adenocard
-med of choice for asystole = atropine
-med of choice for chf is ace inhibitor.
-med of choice for anaphylactic shock is epinephrine
-med of choice for status epilepticus is valium.
-med of choice for bipolar is lithium.
-give ace inhibitors w/food to prevent stomach upset
-administer diuretics in the morning
-give lipitor at 1700 since the enzymes work best during the evenin
-common tricyclic meds - 3 syllabes (pamelor, elavil)
-common maoi's - 2 syllables (nardil, marplan)
-tpn has a dedicated line & cannot be mixed ahead of time
-rhogam -- given at 28 weeks & 72 hrs postpartum
-do not administer erythromycin to multiple sclerosis pt
-benadryl and xanax taken together will cause additive effects.
-can't take lasix if allergic to sulfa drugs.
-acetaminophen can be used for headache when the client is using nitroglycerin.
-dilantin - can not give with dextrose. only give with ns.
addison is skinny ( hypoglycemic, you get weight loss, you got weakness, and you get postural hypotn) cushing is fat ( hyperglycemic, you get moon face big cheeks, and you retain a lot of na and fluid)
-never give via ivp:
okcl
oheparin
oibuprofen
oinsulin
odobutamine
oasa
oalbumin
oacetaminophen
-insulin:
orapid: lispro - onset
oshort: regular - onset ½ - 1 hr. peak: 2-3hr. duration: 4-6 hr
oint: nph or lente - onset: 2 hr. peak 6-12 hr. duration: 16-24hr
olong: ultralente - onset 4-6 hr. peak: 12-16 hr. duration: >24hr
ov.long: lantus - onset 1 hr. peak: none. duration: 24 hr continuous
-anticholergic side effects:
ocan't see
ocan't pee
ocan't spit
ocan't sh*t
-hypocalcemia - cats
oconvulsions
oarrythmias
otetany
ospasms & stridor
-hyper kalemia causes: 'machine'
omedicationa (ace inhibitors, nsaids)
oacidosis (metabolic & repiratory)
ocellular destruction (burns, traumatic injuy)
ohypoaldosteronism, hemolysis
onephrons, renal failure
oexcretion (impaired)
-signs of increased k ' murder'
omuscle weaknes
ourine - olyguria, anuria
orespiratory distress
odecreaed cardiac contractility
oecg changes
oreflexes - hyperreflexia, or flaccid
-substance poisoning and antidotes
omethanol -- ethanol
oco2 -- oxygen
odopamine -- phentolamine
obenzo's (versed) -- flumazenil
olead -- succimer, calcium disodium
oiron -- deferoxamine
ocoumadin -- vitamin k
oheparin -- protamine sulfate
othorazine -- cogentine
owild mushrooms - atropine
orat poison - vit k
-parkland formula: 4cc * kg * bsa burned = total volume necessary
o1st 8hrs - ½ total volume
o2nd 8hrs - ¼ total volume
o3rd 8 hrs - ¼ total volumes
nclex drugs??? most-prescribed meds in the us!
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 stoppe 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) thi 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 a least 8 glasses of water per day
antilipidemic - usually ends in statin
simvastatin (zocor) can cause liver problems & muscle soreness
do not take this drug with grape-fruit juice
antiulcer/histamine blocker
ranitidine hci (zantac) 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 wit 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
i highly recomend this link it is organized and less confusing and not over done as cdc website which can be over whelming:
http://info.med.yale.edu/ynhh/infection
this is sir silas he kept me company during this long journey. he wants me to find a job now. yet another hurdle
hope it helps!!! good luck!:yeah:

thx for sharing this information. i too took exam today not good pop up but lolts of prioritization and infection control . congrates. i will pass too soonnnn

Lmcgrady · Mar 31, 2010

Hello Everyone , I took my NCLEX today and I was wondering if anyone knows how long it takes before the unofficial results are posted on Pearson Vue?

Thanks

Hopscotch81 · Apr 1, 2010

Good info!

missaphrodite · Apr 4, 2010

thank you for sharing this.. im gonna copy this now on my notes.. thank you so much!!1

Brenda101 · Apr 5, 2010

Thank You so much for sharing your info with us, Congrats on your passing nclex. I will ve attempting for the third time at the end of may. Going to byuy the Charity book tomorrow...

mariyahsmommy · Apr 5, 2010

Universal Nurse--

All I can say is THANK YOU! You obviously put alot of time and effort into posting all of this very valuable info on to us. I graduate in May 5 more weeks and then am planning on taking a Review Course. This is AMAZING stuff! I will pass it on to my buddies as well. Congratulations to you on passing! Woo-Hoo! :yeah: