GatorRN08

The BON website was updated this PM, and I took the exam yesterday AM so wasn't a complete 48 hours for me! I'm pretty sure you passed but I know how it feels, people tell you that but until you see your name of the BON website it doesn't sink in! Let us know how it goes Grouchy so we can ditch the grouchy bit and keep the happy part :)

I passed !!!!!!! I guess 20 + SATAs and no MATH can be a good thing... :hpygrp:

:hlk: I just murdered the NCLEX :hlk: WOOHOOOOO, GatorRN IN THA HIZZOUS ! :clpty: My Advice: 1) Don't be your own worst enemy, don't second guess yourself. Think through the questions but don't second guess yourself. Don't let the difficulty of the question throw you off ! Do your best, re-read the question if you're having some difficulty narrowing down, select a choice, click next and start a new question and a fresh slate. 2) When studying, focus on the less known, less obvious signs and symptoms. For example, we all know about the pendulous abdomen, striae, moon face, hump back, etc associated with Cushing's but what about hyperuricemia? polycythemia? psychosis? 3) Content is great but you gotta gotta know your infection control guidelines and what diseases require what precaution. KNOW the diseases that require standard precautions well. I really would advise checking out the "Laharti: Priority, Delegation, Assignments" book. It really does something for your confidence level when, during the exam, you can say to yourself, "Hey, these questions are just like the ones I saw in that book!" 4) Know EXPECTED outcomes vs UNEXPECTED outcomes. For example, if a pt with ulcerative colitis has bloody diarrhea, you're not gonna FREAK OUT, cuz it's expected. Now if the pt had s/s of a COMPLICATION of Ulcerative colitis (s/s of bowel perf, etc) THEN you'd freak out and assign them a higher priority. So when studying my advice would be to know what is expected, what the complications are and what the signs and symptoms of the complications are. *Disclaimer - none of the examples I used were on my test * Long Live This Thread ! Now, its time for some :tbsk:

Grouchy I stopped counting but I had about 23-26 SATAs..I just kept a lil grin on my face and shook my head everytime they popped up cuz I knew there was NO way I'd get them all right..did my best tho..they were really tricky for the most part. SATAs play with your head, cuz if you only think one of them applies you think to yourself " Well, certainly it just can't be ONE" and then you feel obligated to include another one, then you have to be nit picky with the way the options are worded and if one word is off or vague you have to consider that and look into it or you may read too much into the question.. ARGH.... and get this, I got ZERO MATH! Not sure what to think of that... NO MATH, NO HOTSPOT, NO ORDERED RESPONSE, just a battalion of SATAs and multiple choice questions... after 74 I told myself this better be the last darn question, I'm tired of these treacherous SATAs....

Took NCLEX this AM....went into it expecting it to be really tricky and difficult (that way, I'd be more at ease and relaxed when I saw the easier ones). Calmed my nerves by singing in my car to some LOUD music at 7:30 AM and psyching myself up (Honestly, I looked like I'd gone bananas) . I weighed the pros and cons of being so nervous that my mental faculties shut down and I failed...so I decided to kick the nerves to the curb and I marched into the Pearson Vue office with my ID and ATT and said out loud " GatorNurse08, it's JUST a test. What's the worse that can happen? You fail? You take it again, life goes on..." ** 75 Questions ** Upwards of 23 SATAs... ** 1 OB question, WEIRD psych questions 2-3...like bizarre weird... ** ZERO MATH?!??!! Huhn?!?!? I still don't get it, no math question whatsoever...no hotspot either... no ordered response...don't know whether that's reassuring or not... just multiple choice and a butt load of SATAs ** All the meds I saw, I knew, except one random one. I'm a med-geek though, I've been this way ever since nursing school started so I guess it payed off, hopefully *crosses fingers* But the patient teaching part was a lil tricky. I just erred on the side of caution and picked the choice that would be most threatening to the patient since patient safety is #1. ** There was one random disease SATA that was mentioned in the Random Fact Throwing: Rare Diseases thread I started...I was a happy camper seeing that question. ** I felt well prepared for the Infection Control questions by drilling myself with the help of that Yale Website... I'll swear by it. (http://info.med.yale.edu/ynhh/infection/). ESPECIALLY focusing on the diseases that you think would require a certain type of precautions but are just standard....I felt prepared for the delegation/assigments/priority questions with that Laharti book (I'll swear by it as well)..went to Barnes and Nobles and did a couple chapters from it for about a week.. very helpful ! ** There were those questions that I was just like..."For real? Like, are you serious NCLEX?!! What in the world are you asking me? And is this really of any significance to my anticipated career as a professional nurse?" Trying to decode the question was a challenge so I just went with my gut and picked an answer...I expected LEFT-FIELD crap like that, it's the NCLEX though, and I guess it comes with the territory... OVERALL... I know for a fact I got alot right, and I know for a fact I got alot wrong with all those darn SATAs. So I don't know for a fact that I passed. The wait hasn't been bad for me. There's no use worrying, I told myself that from the beginning. Got a long-awaited 1 hour massage post-NCLEX...if I had to re-take the exam, I really don't even know where I'd begin to study. Say a prayer for GatorNurse08 tonight...

Quick Question: For the math questions, does the test tell you how they want you to round up or how many decimal places to include, etc etc? MORE RANDOM FACTS: While reviewing some diseases, I decided to focus on the less "obvious" signs and symptoms so that when those SATAs come I can butcher them !!! ALS: muscle fasciculations and nasal quality of voice, linked to high levels of neurotransmitter glutamate, Rilutek is med they've found to be helpful Autonomic Dysreflexia: Dilated pupils + blurred vision Multiple Sclerosis: Decreased sense of touch, pain, temp, parasthesias, nystamus, blurred vision, diplopia, ataxia, vertigo, emotional disturbances , lower extremity spasticity, (such as EUPHORIA, DEPRESSION, APATHY), CSF shows increase in gamma globulins .boy these MS folks have it ROUGH ! Bell's Palsy: Loss of Taste Guillian Buarre: CSF shows increased protein, parasthesias Parkinson's: Constipation, tremors increase with fatigue and at rest, decrease with purposeful activity and sleep. Watch out for some Medical/Surgical emergencies (these should always be the clients you see first) - Client exhibiting s/s of epidural hematoma ( for example after a head injury: conscious, lose consciousness, regain it...) - Client exhibiting s/s of testicular torsion (scrotal pain unresponsive to pain meds/elevating with a donut/pillow) - Tumor Lysis Syndrome (hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, acute renal failure) Good sources of Vit B6 (MEAT, FISH, POULTRY, YEAST, CORN) Make sure you include Vit B6 when taking INH to prevent peripheral neuritis and AVOID it when taking Levodopa. ** One of the things I like about this thread is the repetition of some of the content. It really makes it stick ***

I've been using this website everyday for the past couple weeks and it's AMAZING. Now I just go to "Disease List" and I quiz myself on what kinds of precautions a certain disease would require.... can't wait to MURDER the infection control questions on the NCLEX !! Just gets sticky when it says that you're going in to start an IV, put in an NG, irrigate a wound, change a dressing, etc..... I'd advise EVERYONE to bookmark this link and review it QD until the day before boards seeing as infection control questions make up a good proportion of questions asked...so I hear. T - a couple days for me ...my time draweth nearer....

~ Omphalitis - infection of umbilical stump. Don't rely on smell to detect infection b/c umbilical stump heals thru gangrene. ~ Make sure to assess vernix and heel creases soon after baby is born cuz vernix will be wiped off and heel creases develop as soon as foot dries. ~ SQUARE WINDOW - term infants can flex wrist onto arm, preterms can only do a 90degree flexion which creates a "square window" ~ SCARF SIGN - term infants can't extend elbow past midline but preemies can, they extend hand across created a "scarf" effect since they have no resistance ~ On the Ballard Scale, score of 35 is 38 weeks, 40 is 40 weeks and 45 is 42 weeks. ~ Post-term babies are at risk for.. - Polycythemia r/t hypoxia, less 02 from placental (placental insufficiency) - Meconium Aspiration - hypoxia relaxes anal sphinter and they poop - Hypoglycemia - Interference with nutrient supply as placenta deteriorate ~ When performing a heel stick, put thumb over walking surface of the heal, strike later aspect of heal, wipe of 1st drop, don't smear, streak or sqeeze area (due to high ECF in infants) ~ Before infant feeds, insert gloved hand into mouth to assess palate. ~ Head circumference should be 2cm > than chest when born, but equal by 1 year. ~ Skin tags and low set ears in infants - suspect chromosomal abnormalities ~ Circumoral cyanosis in infants - see if it improves with crying. If it doesn't , report it cuz it might indicate cardiac pathology. ~ Toilet Training - when kid can communicate need to go (non verbal or verbal), holds on to please mom and doesn't let go to please self, sphincter control 18 months - 24 months (myelination of the cord is complete now), motor skill. Ability to stay dry for 2hours, can sit still on toilet for 5 - 10 mins without fussing, curiousity about older people's habits. No right or wrong time ! ~ 1 TABLESPOON per year of age = a serving (so 2 year old's serving is 2 tablespoons or an ounce) ~ Toddlers should be drinking 3-4 cups of milk max, need to make sure they get nutrients from other foods. ~ Infants need 110kcal/kg/day ~ Breast milk has 20 kcals per ounce (so 20 kcal per 30 cc) ~ Breast milk has everything BUT slightly deficient in Vitamin D ~ Autosomal DOMINANT disorders : **Marfans (prone to aneursyms, long long long people "Abe Lincoln" type folks ). **Polydactly (too many digits) **Achondroplastic dwarfism ** PKD polycystic kidney disease **Huntingon (doesn't show up until 40s 50s, which is why the gene is perpetuated in the gene pool cuz when the symptoms show up in ur 40s/50s, you've probably already had kids and passed the gene along) Autosomal Recessive ** Sickle Cell ** Cystic Fibrosis ** PKU ** Galactosemia (can't digest galactose in breast milk) ~ Shoulder and Upper back lanugo is normal for term baby and vernix in deep creases and skin folds is also ok for term babies.

1) Detached Regina - curtain being drawn over field, floaters, must patch BOTH EYES ! 2) Cataracts - decreased Color vision, Cloudy, better vision with dim light (pupil dilation) 3) Glaucoma - halo around lights, decrease peripheral vision, intraocular pressure > 22mmHg. They see better with light. COAG (chronic open angle glaucoma has little to no symptoms, pressure in the eye gradually increases 30-50mmHg), while acute closed angle glaucoma has sudden pain and the pressure in the eye is usually higher ( 50 - 70). 4) Ishihara chart - to assess color vision (specifically red -green blindness) 5) Post op stapedectomy - vertigo, nausea, vomitting is expected 6) Neuroleptic Malignant Syndrome R - Rigid, Respiratory distress L - LOC changes P - pallor, pee (loss of bladder tone) T - Tachycardia, Temperature increase S - seizure and sweat E- extrapyramidal BP can either be high or low

Hey Nancy, If I'm not mistaken, Parvovirus B19 requires (Respiratory) Droplet Precautions and is one of the TORCH organism (O for Other: syphilis, parvovirus, etc etc) for the HOSPITALIZED client, so pregnant ladies shouldn't care for kids with 5ths. Also, I think CVP measures pressure in the R. Atrium (the recieving chamber) and the Swan is threaded through the R heart into the Pulmonary Artery. A Swan is also called a PA cath (pulmonary artery) so I'm not sure about it going to the L. Ventricle like you said. Ok some more random facts: - Contraindications to Breast feeding include 1) Baby has galactosemia 2) Mom Hiv +, on antiretrovirals 3) Mom on Chemo or Radiation - Folks with Cushings are often put on enzyme inhibitors (mitotane, etc) - Ditropan / VesiCare / Detrol (are all anticholinergic antispasmodics that aid with over active bladder) - Byetta is an antidiabetic

The Phillipine Nurse Blogspot website is AWESOME ! I've been on it for a while doing a myraid of Kaplan questions. There are so many goodies on the internet... Thanks Kleona

** Apparently with a PHEO, you get orthostatic hypotension..even though you're hypertensive up the wazzo.. (according to NCSBN) ** Plaquenil causes eye problems. Get your yearly annual exam to see if you have a PLAQUE in your eye (LOL) ** Lyrica - analgesic indicated for diabetic periperal neuropathy, postherpetic neuralgia. ** Chloral hydrate - sedative...think about a beach...with CORAL reefs....ahhhh....sleep into sweet sweet sedate while thinking about CORALS after getting some CHLORAL...get it?!? ** BOTOX ** (Botulin Toxin) can be used with strabismus also to relax vocal cords in spasmodic dysphonia.

Wow what an inspirational story ! Congratulations ! "Weeping may only last for a night, but joy comes in the morning" TIME TO DO THE HAPPY DANCE !!!!

- Anorexia: Everything slows down your body needs FOOD! Bradycardia, Hypotension, Decreased Temp, Constipation, scaly dry skin, amenorrhea X 3 months consecutively, cyanosis and numbness of extremities. - Ankle Brachial Index > 0.9 indicative of PVD (peripheral vascular disease). If PVD, elevate leg but NOT above the level of the heart. Smoking is #1 cause of PVD. - Chelation therapy in kids. Normal serum level should be less than 10mg/dl. If 20 - 44 inspect environment, you start ORAL chelation > 45 and IV chelation therapy >70. WATCH OUT FOR THE KIDNEYS, chelation is hard on the kids (no pun intended :).I&O, Bun, Ct, etc) - Nocturia seen in R heart Failure (in addition to systemic fluid congestion JVD, edema, RUQ pain, hepatosplenomegaly) - Vistaril, the perfect pre op med, potentiates narcotics (decreased need for pain meds), decreases secretions, decreases anxiety, decreases nausea/vomiting. - Ig A found in breast milk - Serum Uric Acid Levels (2 - 7ish8ish) - Gout - monoarticular (ONE JOINT, usu big toe "toe-phi" :), RA bilateral, uniform and OsteoArth is weight bearing joints. - LPNs CAN do routine assessments such as auscultating for lung sounds...don't let this throw you off ! They can't take admissions, do discharges or "hard core" patient teaching. They can re-inforce what RN said or show patients how to do REALLY BASIC things... (The Priority/Delegation/Assignments book by Laharti is gr8! Stop by a Barnes and Nobles, order an Italian sandwich and read that book!) - Dysgeusia - decrease sense of taste - Infectious Mono - think SPLEEN SPLEEN SPLEEN (LUQ) - Apical puls is at 4th intercostal for kids (not 5th like it is in adults). I believe if they are under 3 y/o its at the 4th intercostal. - Down Syndrome babies are really FLEXIBLE, but have hypotonic muscles, increased incidence of leukemia (so if they present with bruises suspect leukemia over child abuse), Brushfields spots, Simian crease, wide gap btw first and second toe. - Ig A breAst milk - Incontinence, dementia, decrease in cognition or intelligence are NOT normal changes with aging - If you're patient is FLEXed (muscle tension) give them FLEXERIL, but make sure they haven't been on an MAO (Nardil, Parnate, Marplan, etc) in the past 2 weeks. - Hemmorrhagic Fevers such as Ebola, Lassa, Marburg are airborne + contact precautions. - Leprosy, HIV, Infectious Mono is STANDARD PRECAUTIONS.

But really, I've been thinking about it and I have to ask myself, What does it say about an exam when everyone who takes it thinks they've failed but then again, 85% pass on the first try?

Insomnia is a side effect of thyroid hormones. Saunders confirms it. Makes sense though! Increased met. rate, your body is "too busy to sleep" as opposed to the folks with hypothyroidism who may report somnolence (dec. met rate, body is slow and sleepy). Ok some more facts. ** BOTOX for strabismus. Patch the GOOD eye so that the weaker eye can get stronger. Found a cool link about its use in peds pt with strabismus. I had to look it up cuz I heard it was important *ah hem ah hem* http://www.childrenshospital.org/clinicalservices/Site1340/Documents/Ophth-WTE-%20BOTOX%20Treatment.pdf ** TIDAL VOLUME is 7 – 10ml / kg ** COPD patients REMEMBER: 2LNC or less (hypoxic NOT hypercapnic drive), Pa02 of 60ish and Sa02 90% is normal for them b/c they are chronic CO2 retainers. ... ** Neostigmine/Atropine (anticholinergic) to reverse effect of pancuronium. **Ampho B causes hypokalemia (amongst many other things..gotta premedicate before giving. Pts will most likely get a fever) ** Test 4 hypersensitivity before the administration of asparginase. ** Take Vermox with high fat diet (increases absorption) ** Kidney Glucose threshold is 180 ** Amphogel and Renegal take with meals ** Stranger anxiety is greatest 7 - 9 months, Separation anxiety peaks in toddlerhood ** MMR is a SQ shot

** Anaphylactic reaction to baker's yeast is contraindication for Hep B vaccine. ** Ask for allergy to eggs before Flu shot ** Ask for anaphylactic rxn to eggs or neomycin before MMR ** When on nitroprusside, monitor thiocynate (cyanide). Normal value should be 1, >1 is heading toward toxicity **If kid has cold, can still give immunizations **SARS (severe acute resp syndrome) airborne + contact (just like varicella) ** Hepatitis A is contact precautions ** Tetorifice, Hepatitis B, HIV are STANDARD precautions ** William's position - Semi Fowlers with knees flexed (inc. knee gatch) to relieve lower back pain. ** SIGNS of a Fractured hip: EXTERNAL ROTATION, SHORTENING, ADDUCTION ** Fat Embolism: Blood tinged sputum (r/t inflammation), inc ESR, respiratory alkalosis (not acidosis r/t tachypnea), hypocalcemia,increased serum lipids, "snow storm" effect on CXR. **Complications of Mechanical Ventilation: Pneumothorax, Ulcers ** Paget's Disease - tinnitus, bone pain, enlargement of bone, thick bones. ** NO VITAMIN C with Allopurinol ** IVP requires bowel prep so they can visualize the bladder better **Acid Ash diet - cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread ** Alk Ash diet- milk, veggies, rhubarb, salmon ** Orange tag in triage is non emergent Psych ** Greenstick fractures, usually seen in kids bone breaks on one side and bends on the other

Scleroderma, immune disorder, chronic connective tissue. INFLAMMATION (over time leads to)- FIBROSIS (which leads to) - SCLEROSIS. Sclero - hardening Derma - skin. Affects skin, joints, lungs, heart, kidneys, GI - Taut shiny skin, tight , red, decreased elasticity - Dysphagia - Stiff, muscle weakness, - Hard skin, decreased ROM, contractures Tx with steroids, sit up after meals r/t dysphagia, no temp extremes

JACKY-POO - Heard you killed in NCLEX, dude !! For you to feel like you did "OK" without all the N,V,D that everyone else seems to report after taking the exam, gives me the indication that you killed it! Any advice? Hmm so you DID get rare diseases afterall......interesting... Keep us updated so we can do the happy dance with you!

Legionnaire's Disease - fancy term for bacterial pneumonia caused by the Legionella critter. One can be exposed to bacteria from bodies of water. Similar s/s of regular pneumonia. Hanson's Disease - AKA "leprosy" bacterial infection (Mycobacterium leprae). Destruction of nerve endings causes loss of sensation. Affects nerves on skin, hands, feet, mucous membranes. Curable but deformities associated with loss of sensation are permanent.

EMTB2RN, definitely agree with what you're saying and I'm obviously focusing my 99% of my time on the horses. This thread is dedicated to that 1% of my time. Hey, it doesn't hurt to know these random disease. If not for the NCLEX, for practice as an RN. You never know when you'll have a patient with Bernard-Horner Syndrome. *wink*

Since the original RFT thread was such a hit, I thought I'd start one for the RANDOMEST OF THE RANDOMS !! This thread is not for the "horses", it's for the ZEBRAS - the obscure, random, uncommon, rare diseases or facts that may pop up on NCLEX . So no facts about HTN, ESRD, CHF, etc...those are way too commonplace. I'm talking about Zollinger-Ellision Syndrome, Maple Syrup Urine Disease, Kawasaki, Polyarteritis Nodosa, Good Pastures, Sjoren's, Pemphigus Vulgaris...get my drift ? :) Ok lemme start: Pemphigus Vulgaris: An IMMUNE condition. Occurs btw middle and old age, unknown etiology, potientially fatal. Initial lesions on oral mucosa then spread and become generalized. Blisters, crusts, bullae, malaise, pain, chewing and swallowing difficulties, foul smelling discharge from skin, inc WBC. NIKOLSKY's sign - epidermis separates when skin is rubbed. TX with oatmeal/potassium permanganate baths, oral care, steroids/cytotoxic meds. YOUR TURN !!

OK soooo what is the deal with infection control and a nurse going into the room... AIRBORNE - When a nurse goes into the room she/he must have respirator (N95) mask. Pt wears (surgical ) mask when leaves the room. Door closed, 6-12 exchanges, hepa, blah blah blah..Got it...my question is does the nurse WEAR GLOVES if she's going to touch the patient? (I ask b/c standard precautions for everyone right?) I understand that if you're going to deal with something that could spalsh, wear a gown. Can someone please clarify what ABSOLUTELY must be worn into the room and then the "situational extras" Oh and don't forget. RSV is CONTACT precautions NOT DROPLET ! Some more nuggets: 1) Oligomenorrhia/Amenorrhia - Thyroid Storm/Thyrotoxicosis 2) Menorrhagia - Hypothyroidism 3) PTU, used to tx hyperthy causes leukopenia, agranulocytosis - watch out for sore throat and other signs of dec. immune sys 4) Addison's pts may need more glucocorticoids (sugar) in times of stress: ie before dental surgery/oral procedure / surgery 5) Excessive Prolactin causes galactorrhea (excessive milk flow), decreased libido in men, impotence. Hypophysectomy can help. 6) Incision in a transphenoidal hypophysectomy is made between the gingival mucosa of the upper teeth and upper lip area. (So btw upper gum and upper lip) 7) S/S Disulfram rxn - flushing, angina, palpitations, vertigo, 8) It is the OCULOMOTOR (CN III) not OPTIC that causes the pupillary changes in increased ICP. 9) Loss of central vision is a sign of macular degeneration

SPINAL NERVES cross tracts as opposed to CRANIAL NERVES… if you are paralyzed on the left, your right brain is screwed up. HOWEVER, if your left eye doesn’t constrict it’s your LEFT BRAIN that’s screwed up (Get it? Cuz the cranial nerves don’t cross tracts but the spinal nerves that innervate your skeletal muscles do..) Most likely for things to go down the Right Bronchus cuz it’s shorter, fatter and more vertical. If after intubation, there are decreased breath sounds/ decreased lung expansion on the left, it’s probably b/c the person who intubated put the ETTube down too far, past the carina (where it’s supposed to be) and it’s in the right bronchus. Kids with spina bifida are more prone to latex allergies Pregnant women can not administer Ribavarin (for RSV) Mumps can lead to male infertility BNP (B type natriuretic peptide) should be RAST radioallergosorbent test measures Ig E for latex allergy 6L Nasal Cannula is the most you can give, anything above that really doesn’t improve oxygenation. 1L NC = 24% Fi02, 2 L = 28%, 3 L = 32% …get it? Keep adding four until you get to 6L = 44% Fi02 Nonrebreather give you the most Fi02, Venturi allows you to give the most precise amount, Face tent is use with facial trauma/burns Incentive spirometer – tell patient to inspire, hold, get floater-thing to about 600-900 then exhale.. 10X per hour awake. Pt must be able to breathe spontaneously and make a tight seal around the mouthpiece. Yearly Occult blood tests are good to catch colon cancer (I would be hesitant to pick colonoscopy over occult blood tests). With Hepatitis, early signs include bone pain (arthalgia) and flu like symptoms T tube to drain bile. Normal output/day = 500 – 1000cc. Clamp before meals so pt can use bile to digest food. With pneumonia, you will hear BRONCHIAL sounds in areas of consolidation. BiPAP = CPAP and PEEP ARDS is often unresponsive to increased 02 – intubate. Placing prone may help.

Good Luck Jack.. make sure you let us know how it went ! YOU CAN DO IT !!!