LovesnursingWilliams

Try the Hurst Review

Please go back through older post also for some very helpful links and information.

God be with you tomorrow!

what ever you do do not use xanax or any form of drugs for stress release during the nclex exam! pray and i mean pray often during the exam. also make sure you take all of your breaks and during your breaks walk around the hallways and take deep breaths. sing a short song to yourself. it will make you feel like you are just taking a practice test and you will relax more. most important talk to god. if everyone is asking why, it is because true relaxation is better then any drugs. that is what helped me the second time anyway. core content is so important to passing that exam so don`t rely on practice test to let you know if you are ready or not to pass your exam. it would only truly matter if you were going to have the same questions on your nclex exam. trust me your not! the best supplies to me are saunders, hurst review and la charity. i hope this will help someone out there. signed: lovesnursing, rn. 11-2011. just get used to answering questions. make sure you read the rationale and fully understand what is being asked. make sure that you have plenty of practice with answering prioritizing questions and delegation. nclex questions: http://learningshark.com/nursing/nur..._questions.pdf kaplan question trainer..(its old version its very useful still.. just try to cover the answer) http://www.slideshare.net/thinkrn/ka...-sample-exam-7 http://www.megaupload.com/?d=ao75i99q - here is the link for nclex 4000 after downloading it, unzip it then install it. important facts: 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 e(impulse) left sided: slow, cautious, particular, very aware of deficits, greater depression/anxiety (think rt brain = creative, left brain = logical, math, science)

What ever you do do not use Xanax or any form of drugs for stress release during the nclex exam! Pray and I mean pray often during the exam. Also make sure you take all of your breaks and during your breaks walk around the hallways and take deep breaths. Sing a short song to yourself. It will make you feel like you are just taking a practice test and you will relax more. Most important talk to God. If everyone is asking why, it is because true relaxation is better then any drugs. That is what helped me the second time anyway. Core content is so important to passing that exam so don`t rely on practice test to let you know if you are ready or not to pass your exam. It would only truly matter if you were going to have the same questions on your nclex exam. Trust me your not! The best supplies to me are Saunders, Hurst review and la charity. I hope this will help someone out there. signed: Lovesnursing, RN. 11-2011. Just get used to answering questions. Make sure you read the rationale and fully understand what is being asked. Make sure that you have plenty of practice with answering prioritizing questions and delegation. There is a way to torrent Nurse NCLEX 4000 online for free, at: www.Thepiratebay.org ) NCLEX Questions: http://learningshark.com/Nursing/Nur..._Questions.pdf IMPORTANT FACTS: 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 e(impulse) Left Sided: Slow, cautious, particular, very aware of deficits, greater depression/anxiety (Think rt brain = creative, left brain = logical, math, science) CHAPTER 3 FLUID, ELECTROLYTE AND ACID BASE.pdf Critical Thinking Flow Sheet for Nursing Students.doc

Congrats!!!!!

: dncgbby: Congrats to everyone that never gave up.

I had alot of pharmacy questions and who would you see first questions. I also had some cardiac strips and endocrine system questions. I had alot of who would you call first and what would you delegate to the LPN and nursing assistant. I can`t go into depth because of the contract they make you sign.

Whatever you do don`t give up! Have you tried the Hurst review because it is amazing and breaks down everything you needs to understand to be able to pass the exam.

Thank God it worked for me with 100 questions!

You should check into the Hurst Review.

God is so good! I graduated in December 2010 but was injured in a serious car crash the next week. I still tried to take my nclex exam but, failed with 200 questions 6 weeks later after trying to study. After weeks of testing I was diagnosed with a TBI and started to wonder if I would ever be able to pass my exam and be a RN. God reached out to me from a younge lady on allnurses.com and I started studying the Hurst Review. My Dr insisted that it was no way that I would be able to pass my nclex exam but, I kept praying and believing in God first and then The Hurst Review to help me pass my nclex exam and here I am 4 weeks later a licensed Registered Nurse! If I can do it you can do it too!

How did you use HurstRiview to study for your second exam? Also did you do everything that she said to do? Last how long did you study everything?

@ helpme22 What did you use to study for the priority questions?

Thank you so much for that information and that explains why I felt every answer was correct when I failed my first nclex exam. Any other tips far as priority questions? I don`t know about everybody else but I could really use it for my next exam.