Topics About 'nclex'.

Quick Glance: NCLEX-RN 2026 Shut-Off InsightsFor nursing students preparing for or having recently completed the NCLEX-RN in 2026, understanding how the exam determines a pass or fail can alleviate significant anxiety. Administered by the National Council of State Boards of Nursing (NCSBN), the NCLEX-RN is a critical Computerized Adaptive Test (CAT) that evaluates entry-level nursing competency. While official results are provided by your state's Board of Nursing, insights from the allnurses.com community suggest that the number of questions answered before the exam "shuts off" correlates strongly with your outcome. This guide integrates community data with expert advice, focusing on preparation, exam mechanics, and post-exam strategies to equip you with the success intelligence needed to navigate the NCLEX-RN journey confidently in 2026. Computerized Adaptive Testing (CAT) ExplainedThe NCLEX-RN is not a traditional test. It’s a sophisticated Computerized Adaptive Test (CAT) designed to efficiently and accurately assess your competency. Understanding its adaptive nature is fundamental to grasping why the exam "shuts off" and what that might signify. How the NCLEX CAT Algorithm WorksUnlike fixed-form exams, the NCLEX-RN uses a CAT system that tailors the exam to your ability level. Each question you answer influences the difficulty of the next. The system’s primary goal is to determine, with 95% certainty, whether your competency level is above or below the established "pass line." Here’s a simplified breakdown of the process: Initial Question: The exam starts with a question of moderate difficulty. Adaptation: If you answer correctly, the next question will be slightly more challenging. If you answer incorrectly, the next question will be slightly easier. Pass Line: The "pass line" represents the minimum competency standard for safe and effective nursing practice. The CAT algorithm continuously estimates your ability based on your responses. 95% Confidence Rule: The exam concludes when the system is 95% confident that your ability is either consistently above (pass) or consistently below (fail) the pass line. This confidence level is crucial for ensuring fair and reliable results. Minimum and Maximum QuestionsFor the Next Generation NCLEX (NGN) in 2026, the exam has a minimum of 85 questions and a maximum of 150 questions. This range allows the CAT algorithm sufficient opportunity to achieve the 95% confidence threshold. The number of questions you receive is a direct result of your performance: Fewer Questions (e.g., 85): Often indicates that the system quickly determined your competency, either well above or well below the pass line. More Questions (up to 150): Means your performance hovered around the pass line, requiring more questions for the system to reach 95% certainty. The exam will stop at 150 questions, and your final 60 questions will be evaluated for a pass/fail determination. Understanding Pre-Test Questions in the NGN FormatIncluded within the total question count are 15 unscored pre-test questions. These items do not count toward your final pass/fail determination. They are used by the NCSBN to gather data on new questions for future exams. You will not know which questions are pre-test items, so it is essential to treat every question as if it counts.

Jun 19Jun 19
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I am a student nurse & I've passed everything but my last class of the RN program (critical care). Because I failed this class by 2.5 points on my exam, I am unable to graduate & am being asked to take the LPN course & then re-enroll into the RN program after working as a full time LPN for 6 months. I feel that's far too long after I've already spent this long to get my RN! I would like to get my LPN ASAP. I can't find any solid information about it anywhere but I've heard that medics in the military & other RN students have challenged the NCLEX-PN to get their license. Any info would be appreciated. Thank you for your time!

Dec 20, 201411 yr
65 replies
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- nclex

In the fast-paced world of obstetrics, having a firm grasp of pregnancy mathematics is essential for patient safety and care planning. Whether you are a nursing student preparing for the NCLEX or a clinician verifying a chart, understanding how to manually compute the Age of Gestation (AOG) and the Expected Date of Confinement (EDC) is a core competency. The direct answer: AOG refers to the duration of pregnancy measured in weeks and days from the first day of the Last Menstrual Period (LMP). The EDC (often called EDD or Estimated Due Date) is the projected delivery date, calculated to be 40 weeks from the LMP. While ultrasound is the gold standard for confirmation, manual calculations remain the first line of assessment in prenatal care. According to the American College of Obstetricians and Gynecologists (ACOG), accurate dating is vital for timing screening tests, assessing fetal growth, and managing preterm labor complications. Quick Glance: Essential FormulasBefore diving into the deep mechanics, here is a snapshot of the primary formulas used in obstetric nursing. You can bookmark this section for quick reference during clinical rotations. Naegele's Rule (for EDC): Formula: (LMP - 3 months) + 7 days + 1 year. Use: Estimating the due date based on a regular 28-day cycle. McDonald's Rule (for AOG): Formula: Fundal Height (cm) = Weeks of Gestation (approximate between weeks 18 and 32). Use: Assessing fetal growth during physical exams. LMP Counting (for AOG): Formula: Total days since LMP ÷ 7. Use: Determining exact gestational age in weeks and days for current assessment.

Picmonic NCLEX-RN Overview Picmonic for Nursing covers many topics commonly tested on the NCLEX exam, such as pharmacology, fundamentals of nursing, medical-surgical nursing, pediatric nursing, psychiatric nursing, and more. The platform aims to make learning engaging and fun through visually appealing and memorable content. It provides a comprehensive library of mnemonic videos, quizzes, and other study resources to help nursing students review and retain key nursing concepts, medications, diseases, and procedures. When comparing Picmonic to its competitors in the realm of NCLEX study resources, several factors come into play. One standout feature of Picmonic is its extensive library of over 1,200 visual Picmonics, covering over 13,000 essential nursing facts for NCLEX, HESI, and ATI exams. This vast collection allows learners to associate complex concepts with memorable images, aiding information retention. Additionally, Picmonic offers unlimited quizzing with 13,000+ practice questions, providing ample opportunities for active engagement and reinforcement of knowledge. Another noteworthy aspect is the platform's daily quiz with spaced repetition, which leverages the power of regular review to enhance long-term memory recall. The personal dashboard, customized study recommendations, and the ability to create and share personalized playlists further contribute to a tailored learning experience. With mobile apps available for iOS and Android and access to study guides, webinars, and infographics, Picmonic offers a comprehensive and flexible solution for nursing students preparing for the NCLEX exam. Pros of Picmonic NCLEX-RN Some of the pros of Picmonic's NCLEX-RN study prep are: Visual Mnemonics: Picmonic utilizes visual mnemonic techniques, making it easier to remember complex nursing concepts by associating memorable images. Extensive Content Library: With over 1,200 visual Picmonics covering more than 13,000 nursing facts, Picmonic offers a comprehensive range of study materials for NCLEX preparation. Unlimited Quizzing: Picmonic provides unlimited access to practice questions, allowing learners to reinforce their knowledge and assess their understanding. Spaced Repetition: The daily quiz with spaced repetition helps optimize long-term memory retention by strategically reviewing previously learned information. Customization and Personalization: Picmonic offers personalized study recommendations, the ability to create customized playlists, and the option to add your own nursing facts, allowing for tailored learning experiences. Mobile Apps: The availability of mobile apps for iOS and Android platforms enables learners to study on the go and access materials offline. Money-back guarantee: If the user does not Pass the NCLEX® within one year of their Picmonic subscription expiration date, Picmonic will hook them up with a full refund or double the length of their access free (with restrictions). Related: 10 Best Bachelor of Science in Nursing (BSN) Programs in 2023 Cons of Picmonic NCLEX-RN Some of the cons of Picmonic's NCLEX-RN study prep are: Learning Style Suitability: While visual mnemonic techniques may be effective for some learners, individuals with different learning styles may not find them as beneficial. Price: The cost of a Picmonic subscription may be a consideration for some individuals, especially if budget constraints or other more affordable alternatives are available. Reliance on Visuals: Some learners may prefer a more text-based or auditory approach to studying, and the heavy reliance on visuals in Picmonic may not align with their preferred learning methods. Limited Depth: While Picmonic provides a comprehensive overview of nursing concepts, it may not delve into the same depth as traditional textbooks or other resources. Students may need to supplement their studies with additional materials for a more in-depth understanding. It's important to note that the pros and cons can vary depending on individual preferences and learning styles. It is advisable to consider your specific needs and preferences when evaluating whether Picmonic is the right NCLEX study resource for you. Picmonic NCLEX-RN Pricing Options Picmonic's pricing options are: Free – limited access to content $298. 80 billed once – ($2.49/month for life) $100.56 billed once – ($4.19/month for 24 months) $67.08 billed now – ($5.59/month for 1 year) – most popular option $44.94 billed now – ($7.49/month for 6 months) $12.99 billed now – ($12.99/month for a month-to-month subscription) Picmonic NCLEX-RN Curriculum Picmonic's NCLEX-RN test prep focuses on providing detailed information and comprehensive coverage of the essential nursing concepts and topics needed to excel in the exam. The platform offers over 1,200 visual Picmonics, covering over 13,000 nursing facts relevant to the NCLEX-RN. This extensive curriculum ensures that students can access a wide range of nursing content, including pharmacology, medical-surgical nursing, and anatomy. The information provided within the test prep is designed to be concise yet informative, allowing students to grasp key concepts quickly. The visual mnemonic approach aids in the retention and recall of important nursing facts, making it easier for students to remember and apply the information during the exam. Overall, Picmonic's test prep curriculum provides a robust foundation of nursing knowledge necessary for success in the NCLEX-RN. It covers the core topics and essential information students need to master, helping them build a solid understanding of nursing concepts and their applications. Picmonic NCLEX-RN Platform and Usability Technically, Picmonic's NCLEX-RN test prep platform performs well and offers a user-friendly experience. The platform provides a personal dashboard where students can access their study materials, recommendations, and progress tracking. This feature enhances usability by offering a centralized hub for organizing and managing study resources. The visual nature of Picmonic's content is appealing and engaging, helping to maintain student interest during long study sessions. The platform's integration of mnemonic videos, quizzes, and practice questions allows for interactive learning experiences, promoting active engagement and knowledge retention. However, the effectiveness and usability of the platform can vary depending on individual preferences and learning styles. Some students may find the visual mnemonic approach highly effective, while others may prefer more text-based or auditory learning methods. Picmonic provides mobile apps for iOS and Android devices, enabling students to study conveniently on the go. Offline access through mobile apps allows uninterrupted study sessions, even without an internet connection.

For those seeking to master their Next-Gen NCLEX-RN, we've compiled effective strategies to do so, helping to optimize your resources and conduct regular self-assessments for performance improvements. This article is part of a more extensive study guide for the Next-Gen NCLEX-RN: Best Free Online Next-Gen NCLEX-RN Study Guide The Nursing Process: Everything Next-Gen NCLEX-RN Test-Takers Need to Know Next-Gen NCLEX-RN Question Leveling: Recognition, Comprehension, Application, and Analysis Next-Gen NCLEX-RN: Identifying Prioritization, Delegation, and Scope of Practice Questions Expert Test-Taking Strategies One of the first things you should do when you begin preparing for the NCLEX is to determine your learning style to maximize your efforts. There are a variety of learning styles, and they can include: Auditory Learning: From listening to lectures, podcasts, or recorded discussions. Visual Learning: From seeing, watching videos, or observing. Tactile Learning: From hands-on experiences, return demonstration, or simulation. Sometimes, individuals can be learners that combine these learning styles. No matter what type of learner you may be, it is important to know how you best learn, retain, apply, and analyze your learning. Identifying The Topic There are several essential steps that test-takers must follow to be sure that they understand what the question is asking. Many times NCLEX questions have several components that can be confusing and cause candidates to get distracted from the topic. The following steps can help test-takers weed through the fluff and get straight to the point of answering NCLEX questions correctly. Here are the steps in identifying the topic: Step 1: Read the question carefully and thoroughly - from the first word to the last word. Be sure to read slowly. Do not skim or skip any part of the question. Step 2: After reading the question, you want to identify the nursing concept you are working in. This step is not so easy at first, but with practice, you will improve. Remember that the nursing concept is the bigger picture process that guides nurses in their practice. Sometimes, the concept is what we are trying to address, also known as the topic, focus, or problem. Here's an example: The nurse is caring for a 46-year-old male patient who came into the ED with chest pain 10/10 and tachycardia of 156 at rest. The patient states "I am scared, I feel like I am going to die.” Which response, if made by the nurse, would be most appropriate? Nursing Concept = Therapeutic Communication Topic/Focus/Problem = Priority response Step 3: (Not always necessary) If you cannot identify the nursing concept and topic, read all the answer choices for clues, then identify the nursing concept and topic/focus/problem. Once you have identified the topic of the question, it makes it much easier for you to stay focused on the topic and avoid getting distracted by other information that is not important or relevant to the topic/focus/problem that needs to be addressed. Reviewing What's Important Once you have identified the topic of a question, it is helpful to take a few moments to think about everything you know to be true about the topic. For example, if the topic of the question is teaching about cast care, you want to list out all the things you remember to be truly related to teaching a patient about cast care. The following are true about teaching for cast care: Do not get the cast wet Do not stick anything under the cast to scratch Do circulatory checks of the casted extremity If any findings are concerning, such as an odor, new or increasing pain, swelling, or drainage, notify the doctor immediately. When you take a few seconds to remind yourself of the following details regarding cast care teaching, answering the question is much easier. When you have some criteria to compare against the answer choices, it helps to keep you from getting distracted and to focus on the topic of the question. If the answer choices do not match what you know to be true, then it is most likely not the correct answer. Eliminating Answer Choices There are several things that candidates should consider when deciding which answer choices to eliminate and which ones to keep in consideration. We've already discussed that taking the time to review what's important about the topic of the question to create a set of criteria is one beneficial way to eliminate answer choices confidently. Another helpful tip is to consider every single word in an answer choice carefully. The creators of the NCLEX are masters at writing test questions that challenge the test-taker to be careful and apply what they've learned in school to answer questions correctly. Sometimes answer choices sound like the correct answer, but they may have just one word incorrect, which makes the entire answer choice incorrect. Candidates must be confident in their ability to move through the questions and answers thoroughly, making sure not to miss a word so they don't fall for the many NCLEX traps set by the test creators. Here is an example of how reading every single word can help in confidently eliminating answer choices: The nurse is instructing a student on how a midstream clean catch urine specimen should be collected. The nurse knows the student understands the instruction provided if the student states which of the following? "Cleanse the urinary meatus with a disinfectant towelette, have the client urinate into a sterile specimen cup, avoid touching the inside of the container, and cover immediately after." "Cleanse the urinary meatus with iodine solution, and insert a urinary catheter to obtain the sterile urine specimen." "Cleanse the urinary meatus with a disinfectant towelette, have the client empty their bladder ½ hour before the test, and then keep all other urine voided on ice for 24 hours." "Cleanse the urinary meatus with a disinfectant towelette, void a little bit of urine first, then stop, and then void the remaining urine into a clean specimen cup, avoid touching the inside of the container, cover immediately after." The correct answer is 1. When you take the time to read every single word while carefully considering whether the answer choice is true or false, you can see that answer 1 is the only one true regarding collecting a midstream clean catch urine specimen. Many test-takers may choose 4 as the answer; however, if the answer choice is read closely, one would note that a "clean specimen cup" is not the appropriate collection container for a midstream clean catch. This specimen collection procedure requires a sterile container. You want to be very careful every single time you're answering NCLEX questions. If you skim, read the question too fast, or focus on information that you think should be present rather than remaining objective and seeing the answers for what they are, then you may find yourself falling for many of the well-designed NCLEX traps. Here is one more example of how reading every single word can help in confidently eliminating answer choices: The nurse is observing an LPN perform cardiopulmonary resuscitation for a patient that is a full code. The nurse knows that the LPN is correctly performing CPR if which of the following is observed? The LPN is using the heel of her hand to compress the chest at a depth of 1 inch. The LPN is compressing at a rate of 99 compressions per minute. The LPN is delivering 30 chest compressions for every two breaths. The LPN is using her arm muscles to apply force to the chest with each compression. The correct answer is 3. When you take the time to read every single word while carefully considering whether the answer choice is true or false, you can see that answer choice 3 is the only one true regarding the correct CPR technique. Many test-takers may choose other options as the answer because each answer contains components of the correct technique. This question, in particular, challenges the candidate's understanding of the correct CPR technique. It seems pretty straightforward; however, skimming or reading too fast may miss important information that could get you into trouble. Remaining Objective Nursing school does an excellent job teaching us that nurses must remain objective. This helps nurses follow standards of practice that have been scientifically proven to be effective. The interventions that we implement have measurable outcomes. Even when nurses are faced with subjective data, it is the role of the nurse to take that subjective data and convert it into something objective. For example, when a patient says they are having pain, a nurse asks many follow-up questions that allow the subjective information to be measured. From 0 to 10, how bad is the pain? Where is the pain? How would you describe the pain? Does it radiate to any other location? When did it start? Does anything make it better? Does anything make it worse? By asking additional questions, nurses can objectively apply nursing principles and standards of care to effectively address the patient's pain. Test-takers must do the same thing with test questions and answer choices. Since NCLEX questions often contain much irrelevant information that can cause candidates to veer off-topic, asking specific questions to clarify and better understand the information is essential. Here are some key questions candidates should ask as they consider answer choices as options for the correct answer: Does this answer choice solve the problem or focus on the topic of the question? Does this answer choice meet the criteria for what's most important? Does this answer choice reflect textbook nursing practice standards? Does this answer choice make sense for the situation? You know you have chosen the correct answer when you confidently answer "yes" to these questions. Balancing Your Studying Work, study, eat, sleep, repeat—this is the routine many new grads find themselves in when they tirelessly work towards studying for the NCLEX. Although it does take a lot of practice answering NCLEX-style questions and reviewing nursing content, it does not mean that every waking hour needs to be devoted to NCLEX prep. Short studying periods, with lots of extra time to manage other aspects of life, have improved one's ability and performance. To help you find the balance in it all, we've put together a few simple yet effective tips that you can follow to get the most out of your effort. Study Smarter, Not Harder Set a time limit of 3 to 4 hours per day of study time. This includes answering NCLEX practice questions, as well as content review. Be sure to do practice questions when you are most alert and have the most uninterrupted time to complete a full set of 85 questions. Always answer practice questions as if you were taking the NCLEX. Give it your best effort each time. This only helps you to master the steps in thinking carefully about the question and answer choices. Use a blended approach to reviewing content, such as: Videos Flashcards Notes Reading Return Demonstration Create a concept map or flowchart of the NCLEX strategies and review it daily to keep the strategies in the front of your mind. Optimizing Your Resources Try to avoid engaging with too many NCLEX Prep resources. Some programs have very different approaches to answering questions, which could cause confusion. Stick to one process or program and complete it fully. If there is no improvement in accuracy, confidence, or ability after completing a particular NCLEX prep program or service, then trying another approach may be helpful. You need not spend frivolously on new textbooks, NCLEX prep materials, or other expensive nursing content materials. You only need access to an up-to-date question bank to practice answering NCLEX-style questions. Your nursing school textbooks, notes, and even Google can help you find the necessary information. Self-Assessment For Performance Improvement Weekly self-assessments should be completed every few days. A combined assessment of practice question accuracy, ability to recall information when quizzed (flashcards, notes, etc.), and self-confidence in feeling prepared are all good methods of assessing ability. NCLEX prep question banks that are online and/or automated are great tools to keep track of progress and identify areas that need improvement. Self-assessments shouldn't just focus on the ability to recall nursing content but also apply the knowledge and analyze the content in various ways. Ability also includes factors such as personal wellness. If you are ill, emotionally distraught, suffering from anxiety, or are going through a rough patch in your personal life, this can also affect your ability to perform well. Get plenty of sleep, water, and healthy food, and be sure to find time for laughter, love, and connection with others. When to Seek Expert Guidance and Support When candidates are overwhelmed with NCLEX Prep resources and don't know where to start. When candidates suffer from test anxiety and have a difficult time focusing. When candidates have unsuccessful attempts at passing the NCLEX. When candidates score below 65% accuracy on practice questions. When candidates need to have individualized tutoring to meet their learning needs. Test Day Tips Candidates must come to the test day prepared to stay focused and try their best. Here are some test-day tips that will help you do your best. Come Prepared For The Exam Schedule the exam during a time of day when you are most alert. If you are a morning person, perhaps scheduling the exam in the morning would be best. Arrive at least 30 minutes early. Some candidates find doing a "dry run" the day before the exam helpful so they know how to navigate to the testing center. Dress comfortably and in layers. The testing centers can be warm or cold depending on the time of year, so having layers will help to keep you comfortable. Make sure you have gotten enough sleep each night for a week or more leading up to the exam. You want to be alert and focused the entire time. Ensure you eat healthy foods and a high-protein and nutrient-dense meal before the exam to help fuel your brain and stay focused. Avoid drinking caffeine before the exam unless you find it worsens your ability to focus. Caffeine tends to cause anxiety and frequent urination, severely affecting your ability to stay focused. We hope you have found this NCLEX study guide helpful in your journey toward achieving NCLEX success. Remember, it's all about shifting your mindset from holding onto every detail to thinking more about the nursing concepts that help us make decisions within our practice. Whether you plan to take the NCLEX for the first time or it may be another attempt, we are confident you're on your way toward earning your nursing license. What's most important is that you believe in yourself. You deserve to pass the NCLEX and have already proven that you can do it because you have already completed the hardest part—nursing school.

I need some words of encouragement.. I am feeling pretty low My test stopped at 85.. It had a lot of the "check all that apply" doesn't that make the chances of getting it right lower? I hope I passed.. I am just really feeling afraid at this time. Help! Take our NCLEX Shut Off Survey to help other readers who are interested in learning the likelihood of whether or not they've passed the NCLEX based on number of questions answered!

I've heard many different methods how to pass or how to study and what steps were taken. I can't say my method would work for anyone else. I just want to share how I did it. I'm a mother so my goal is to provide for my family. I've always wanted to grow up as a nurse. Although being a mother is greater. So to be a great mother is to lead by example on how to strive for the best. Here are my steps on how I prepared for the exam: I graduated LVN/LPN nursing school in 2009. I took my first NCLEX exam in 2017. Days later I was notified I passed the exam! Many people asked why a long gap. Honestly, I was scared to fail and I got comfortable being in administration. At the time I was 19 years old when I graduated. As the years passed my fellow peers either passed or failed. I was still scared to be known as a failure, although I was already a failure for not taking the exam. So a failure by default. Until New Year's Day of 2016 I gave myself a lecture that since I was in middle school I wanted to help others as a nurse. So just try. I went to the nursing program I graduated from to get answers on how to take the exam. I got an answer from them in August 2016 to submit an application. In September, the director of the nursing program approved my process to start my application process and finger print scanning paperwork. January of 2017 my application was approved by the nursing board to take the NCLEX. The same month I registered and paid to take the NCLEX. I made my appointment to take the NCLEX 12 weeks from that date. I told myself will need only 12 weeks to prepare no matter what, no more excuses. Keep in mind it's been years since nursing school and never taken the NCLEX before. I bought the PDA by LaCharity, and Exam Cram plus Saunders. February 2017 got simplenursing.com NCLEX failure remediation course with a mentor. In the course, my mentor gave me suggestions on what to study on and follow the recommendations on how to study with others in the group keeping each other on check. Downloaded NCLEX mastery app on my phone to study on my downtime at work or waiting in a lobby or something instead using social media. March 2016 took a NCLEX simulation exam to see my progress and focus the area of improvement. April 2016 signed up for the Hurst review 2 weeks prior my NCLEX exam date. April 21 I took a day off from work, woke up late, went to the movies, went to my favorite restaurant for dinner, I was tempted to study but my friends kept me occupied to refrain myself from studying bc nothing was retaining the information. April 22nd I took the NCLEX exam. I was 100 something questions in the exam til the computer shut off. I cried in my car thinking I probably failed. May 1st I received my letter of passing the exam and paid the fee for my license. Received my license a week later. Also got license insurance coverage for a year. Hired as a Traveing nurse May 16th. August hired to work in Urgent care. Never give up. I did all this while I had a full-time job during the day and a part time job at night/weekend. Bible study once a week. Planned and did my oldest daughter's birthday in January and my youngest daughter in March as a single mom. My family has their own agendas so I hired a babysitter to help.

Good morning nurses. Does anyone knows how long does New York take to activate your Nurse lic? I just passed the Board last Thursday.

Sep 9, 20205 yr
35 replies
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- nclex

The National Council Licensure Examination (NCLEX) is the official licensing examination for nurses in the United States of America, Canada, and Australia, used to determine if nurses are safe to practice. There are many study guides available to help students prepare for the exam. Among them is UWorld, one of the most popular test prep tools on the market. UWorld NCLEX-RN Overview UWorld's test prep for NCLEX-RN includes over 2,700 practice questions authored by nurse educators and practicing nurses, with detailed rationales for correct and incorrect answers. They've recently introduced "next-gen questions" in line with the latest Spring 2023 NCLEX format, updating its content to match the most up-to-date nursing practice standards and guidelines. UWorld offers several great features, including performance tracking that helps students monitor their progress over time and identify areas that require more practice. Each subscription includes at least one self-assessment test that simulates the exam experience and allows students to predict their likelihood of passing. To further enhance learning, customizable digital flashcards and notebooks are available, making it easier to find specific information. UWorld also offers a mobile app that includes practice questions, flashcards, and the ability to take notes on the go. In terms of comparisons, UWorld differentiates itself from other nursing study platforms for its challenging and comprehensive question banks, detailed explanations, and up-to-date materials. While other study platforms may offer similar features, they may not be as extensive or up-to-date as UWorld's materials. Pros of UWorld NCLEX-RN Some of the pros of UWorld's NCLEX-RN study prep are: The questions are similar to the actual NCLEX. There are many select-all-that-apply questions, which help students become more comfortable tackling the questions in the NCLEX. Multiple next-gen questions include fill-in-the-blank and hot spot questions, which have been a recent addition to the NCLEX exam format as of Spring 2023. There are lots of delegation questions, which allow students to understand the roles of other healthcare teams. There are many different methods a student can use UWorld to study. For example, they can focus on specific subjects they may struggle with to become more comfortable. Or they can have the system ask them random questions from all subject areas if they want to practice in a more exam-style setting. The self-assessment tests help predict the likelihood of passing the NCLEX exam. According to UWorld, "99% of learners who earned an average QBank Score of 57% AND a "High" or "Very High" result on a Self-Assessment Exam passed the NCLEX-RN in 2022." The mobile app feature is convenient if you want to study casually on the go. Cons of UWorld NCLEX-RN Some of the cons of UWorld's NCLEX-RN study prep are: There may be some questions that are asked about obscure or rare diseases. However, the NCLEX is designed to test common and basic nursing content. The answers may be too medical-sounding and more relevant to how a doctor responds versus a nurse. The rationales may be too detailed and irrelevant to the nurse's scope of practice. This may result in too much time spent on reading rationales. The cons listed above can make students feel overwhelmed and unsure of their knowledge level. The price of UWorld may be considered relatively expensive compared to other study resources. There are no live instructors or tutoring offered. It's worth noting that these pros and cons are subjective and may not apply to every student's experience. Ultimately, whether UWorld is the perfect study resource for a particular student will depend on their learning style, budget, and goals. UWorld NCLEX-RN Pricing Options Depending on a student's study preference, there are a few different pricing options. NCLEX-RN QBanks $139 for 30-Day Access — with 2300+ practice questions, 500+ NGN Questions, Digital Flashcards, and 1 self-assessment. $169 for 60-Day Access — with 2300+ practice questions, 500+ NGN Questions, Digital Flashcards, and 2 self-assessments (1-2). $249 for 90-Day Access — with 2300+ practice questions, 500+ NGN Questions, Digital Flashcards, 3 self-assessments (1-3). $329 for 180-Day Access — with 2300+ practice questions, 500+ NGN Questions, Digital Flashcards, 4 self-assessments (1-4), and 1 Time Reset Option. $389 for 360–Day Access — with 2300+ practice questions, 500+ NGN Questions, Digital Flashcards, 6 self-assessments (1-6), 1 Time Reset Option. $449 for 730–Day Access — with 2300+ practice questions, 500+ NGN Questions, Digital Flashcards, 6 self-assessments (1-6), 1 Time Reset Option. Each self-assessment has a duration of 2 weeks for its dates of activation to complete. Related: 10 Best Master of Science in Nursing (MSN) Programs in 2025 Self-Assessment Exams $20 per exam — 100 questions per assessment, includes NextGen Items, Detailed performance report, the likelihood of passing, time accommodations, valid for 2 weeks from activation. $100 for all assessment exams — has all the same options listed for $20, but you get access to 6 exams versus 1 exam. The self-assessment option may be suitable if students would like to know how likely they are to pass the exam without purchasing the QBanks, or if they would like more self-assessments after completing the self-assessments included in the QBanks. QBank Renewals Ranges from $45 to $209 depending on the length of renewal (has options of 7-Day Renewals to 360-Day Renewals). The QBank Renewal option would be helpful if a student's QBank is about to expire and they need more time to study without losing all their progress. UWorld NCLEX-RN Curriculum UWorld is a learning tool that will guide students in determining the subjects, systems, and topic areas they can focus on. The practice questions and study materials include: Nursing fundamentals Pharmacology Medical-surgical nursing Maternal and child health nursing Rationales help students understand all the nursing concepts, as well as how to go about answering certain types of NCLEX-style questions. Additional information to what's listed above is also available within the test prep. UWorld NCLEX-RN Platform and Usability According to a recent student survey, "90% of [UWorld learners] report that UWorld's questions are the same difficulty or more difficult than the NCLEX." This allows students to feel readily prepared for the NCLEX, as they have been studying off a platform that has been considered a similar difficulty to the NCLEX. Additionally, the format of the practice questions is designed to look like the actual exam, including the feature of the "timer" and "calculator" on the practice question page, allowing users to have an exam-like experience. This may help reduce any anxiety that students may have during the exam, as the user interface of the NCLEX may feel familiar to them if they have used UWorld. Overall, UWorld is easy to use, and the interface is intuitive and user-friendly. The platform is convenient as it is compatible with desktops and mobile devices, allowing users to access their study materials anytime, anywhere.

May 12, 20233 yr
1 comment
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- uworld

The NCLEX-RN is a computerized adaptive test (CAT) designed to determine if nursing candidates meet minimum competency for entry into nursing practice. Minimum competency means that test-takers can make safe and sound nursing judgments and apply what they've learned in nursing school. It measures their ability to make careful decisions through the application of nursing knowledge, as well as analyzing data that is presented in each test question. Many nursing students and new grad nurses have expressed difficulty getting started with their NCLEX prep journey. As a result, we created a study guide that will help you focus your time and energy on what's most important, so you can be on your way to passing the NCLEX. Sections for Next-Gen NCLEX-RN Study: The Nursing Process: Everything Next-Gen NCLEX-RN Test-Takers Need to Know Next-Gen NCLEX-RN Question Leveling: Recognition, Comprehension, Application, and Analysis Next-Gen NCLEX-RN: Identifying Prioritization, Delegation, and Scope of Practice Questions Next-Gen NCLEX-RN Expert Test-Taking Strategies NCLEX-RN Background The NCLEX went live in 1994 after the National Council of State Boards of Nursing (NCSBN) spent seven years conducting numerous studies and trials to ensure the computerized NCLEX was meeting the needs of keeping the public safe. This new way of testing helped to increase candidate academic integrity, improved accuracy in scoring, and made the process for recording results and issuing nursing licenses much easier for the State Boards of Nursing. Next-Gen NCLEX-RN The Next-Gen NCLEX-RN is the most recent version of the exam by the NCSBN, launched on April 1, 2023. The Next-Gen NCLEX-RN aims to ensure that the exam reflects the evolving healthcare landscape and the changing demands of nursing practice. As per NCSBN, one of the critical areas of focus and updates in the Next-Gen NCLEX-RN is their clinical judgment measurement model, "developed as a framework for the valid measurement of clinical judgment and decision making within the context of a standardized, high-stakes examination. While clinical judgment and decision-making have been important elements in most prelicensure education programs for many years, significant research and development were required to isolate and measure these traits with psychometric rigor." The clinical judgment measurement model follows multiple layers, "starting from the broadest layer 0 defining the context of the clinical situation to the most specific contextual layer 4. It's recommended that test-takers carefully review the information provided by NCSBN and their sample questions and exam preview before testing. Next-Gen NCLEX-RN Format The Next-Gen NCLEX-RN includes a minimum of 85 and a maximum of 145 questions, including 15 pre-test questions that don't count toward your final pass, with a maximum test time of 5 hours. It's computerized adaptive test (CAT) format will stop administering questions once it is 95% sure whether a student will pass or fail. Overall, the Next-Gen NCLEX-RN is intended to prepare nurses for the complex healthcare environment better and ensure that newly licensed RNs are equipped with the necessary competencies to provide safe and quality care to patients.

"Tit-tit!Tit-tit!Tit-tit!" I woke up to the continuous beeping of my mobile phone. At first I thought that I was just dreaming. But there goes my phone again, wailing in the wee hours of the morning. I swear I could've thrown it out of my sight if only I didn't remember how much it cost me to buy that precious scrap of technology. And so, I was awake again. Okay fine, who's the culprit?! Good! Now I have to count at least a thousand sheep in my head again just so I can sleep! Grrr... Wondering who could be sending me mounds of text messages in that very indecent hour, I tried to read the messages with my hazy eyes. The first message I opened was from Kay, one of my college buddies and best friends. It read: "Sis! Congratulations! You're already a registered nurse! Wow!" My initial response was, "Huh?!" I thought she was just kidding. So I told her to knock it off and get some good night's sleep instead. As I was waiting for her reply, I browsed the other messages that came in. And almost all of them were saying: "Congratulations, Miss RN!" "Where's my treat from the new RN?!" "Where are you? Shouldn't a new nurse be out celebrating?!" I was dumbfounded. I didn't know what to think, or feel! What, are they serious?! They must be kidding me. The results are yet to be out next month! But at a second thought, why would all of them pick on me all at the same time? Definitely it's not a scheme because they don't know each other all too well. Then it struck me. Could the results have been released earlier than everyone expected? I decided to confirm. The internet was the best reference at the moment. When I was about to open my phone's web browser, it suddenly rang. It was Bob calling, a friend of mine who's a nurse for 5 years now. And his first words were, "Welcome to the club!" That could only mean one thing. Then he said that he's looking at the nursing licensure exam results at his laptop, and pronounced my complete name clearly from the list of PASSERS! As Bob was speaking thru the phone, I was already transported to another world thinking, "This is it. After all the sacrifices, tears and trials, I have succeeded." And I just can't believe it! I remembered myself crying before the licensure exam. I remembered all the things that I have gone through. These things flashed in front of my blank eyes..... My family is not that well off to send me to college. So I finished college with the help of my uncles and aunts. But this "I-Owe-You" set-up made me cry so many times. Especially when I graduated and I was supposed to get review classes as preparation for the licensure exam. I wasn't able to get that privilege. It seemed that they have forgotten me already, that they didn't care anymore. So I was forced to review at home, with a little-mote-than-nothing to study on, because I didn't have books and other references (during college, I only borrowed books from my cousins, classmates and dorm mates). This alone made me think that I can never do it. But I did not lose hope. Two months before the exam date, I was so close to the final steps of filing for the board exam, but I was financially short. I couldn't think of any way that I could pay the expenses. I felt like bursting at that moment. It was so frustrating. I was so close yet so far. So even if it was against my pride, I told a friend about this just so I can take it off my chest. I sent her a text message. But I did not receive any reply. The next day, I was surprised when she came up and slipped something into my left hand. When I checked what it was, I saw some bills in my hand. I looked at her, puzzled. Sensing my confusion, she said, "Our friends gave in part of their allowances to help you finish your filing." Without my friend knowing it, my tears fell as I hugged her tight. A short while after, my father got really sick that he cannot go to work anymore. So even in this very unfortunate timing, I applied as a call center agent. I was hired immediately. It was a difficult and demanding job, but I needed it so that I could put some food in our plates. I had to work at least 12 hours in graveyard shift. That gave me at least three hours of uninterrupted sleep and so little time to study. I was already losing hope that I nearly decided to quit. November 2009, I took the board exam with the tiny dent of hope that was left in me. What I held on to was the thought that I have always pushed into my mind, that "IT IS NOT ALWAYS YOUR FAITH IN GOD; SOMETIMES, IT'S HIS FAITH IN YOU." So I gave up all my faith unto Him, and hoped dearly that he would do the same for me. And he did. I was in cloud nine. I can't sleep, I tossed and turned, but I just couldn't shake the thoughts off my head. I was up and awake for the rest of the night. But eventually, before the first streak of sunshine kissed the heavens, I dozed off to sleep. I woke up at ten in the morning. My head ached like hell. The first thought that came to my mind was, "Wow. What a nice dream." But before I can even stretch a muscle, my phone, still in my numb hands, beeped. The notification said: "9 New Messages 1: from RC Message: Congratulations, Miss RN!" Oh yes, my beautiful nightmare was more than just a sweet dream!

Sep 6, 201015 yr
18 replies

All three of us passed the first time with 75 questions. If you know everything on this guide you will do well. Kind of long but worth studying. Best of luck to you Please give me feedback HESI Hints & NCLEX Gems Answering NCLEX Questions Maslow's Hierarchy of Needs Physiologic Safety Love and Belonging Esteem Self-actualization Nursing Process Assessment Diagnosis (Analysis) Planning Implementation (treatment) Evaluation ABCs Airway Breathing Circulation Before we continue Watch About A Nursing Student: The Life Of A Student video... Normal Values Hgb Males 14-18 Females 12-16 Hct Males 42-52 Females 37-47 RBCs Males 4.7-6.1 million Females 4.2-5.4 million WBCs 4.5-11k Platelets 150-400k PT (Coumadin/Warfarin) 11-12.5 sec (INR and PT TR = 1.5-2 times normal) APTT (Heparin) 0-70 sec (APTT and PTT TR = 1.5-2.5 times normal) BUN 10-20 Creatinine 0.5-1.2 Glucose 70-110 Cholesterol Bilirubin Newborn 1-12 Phenylalanine Newborn Na+ 136-145 K+ 3.5-5 HypoK+ . . . Prominent U waves, Depressed ST segment, Flat T waves HyperK+ . . . Tall T-Waves, Prolonged PR interval, wide QRS Ca++ 9-10.5 Hypocalcemia ... muscle spasms, convulsions, cramps/tetany, + Trousseau's, + Chvostek's, prolonged ST interval, prolonged QT segment Mg+ 1.5-2.5 Cl- 96-106 Phos 3-4.5 Albumin 3.5-5 Spec Gravity 1.005-1.030 Glycosylated Hemoglobin (Hgb A1c): 4-6% ideal, Dilantin TR = 10-20 Lithium TR = 0.5-1.5 Arterial Blood Gases ... Used for Acidosis vs. Alkalosis PH 7.35-7.45 CO2 35-45 (Respiratory driver) ... High = Acidosis HCO3 21-28 (Metabolic driver) ... High = Alkalosis O2 80-100 O2 Sat 95-100% Antidotes Digoxin ... Digiband Coumadin ... Vitamin K (Keep PT and INR @ 1-1.5 X normal) Benzodiazapines ... Flumzaemil (Tomazicon) Magnesium Sulfate ... Calcium Gluconate? Heparin ... Protamine Sulfate (Keep APTT and PTT @ 1.5-2.5 X normal) Tylenol ... Mucomist (17 doses + loading dose) Opiates (narcotic analgesics, heroin, morphine) ... Narcan (Naloxone) Cholinergic Meds (Myesthenic Bradycardia) ... Atropine Methotrexate ... Leucovorin Delegation RN Only Blood Products (2 RNs must check) Clotting Factors Sterile dressing changes and procedures Assessments that require clinical judgment Ultimately responsible for all delegated duties Unlicensed Assistive Personnel Non-sterile procedures Precautions & Room Assignments Universal (Standard) Precautions ... HIV initiated Wash hands Wear Gloves Gowns for splashes Masks and Eye Protection for splashes and droplets Don't recap needles Mouthpiece or Ambu-bag for resuscitation Refrain from giving care if you have skin lesion Droplet (Respiratory) Precautions (Wear Mask) Sepsis, Scarlet Fever, Strep, Fifth Disease (Parvo B19), Pertussis, Pneumonia, Influenza, Diptheria, Epiglottitis, Rubella, Rubeola, Meningitis, Mycoplasma, Adenovirus, Rhinovirus RSV (needs contact precautions too) TB ... Respiratory Isolation Contact Precautions = Universal + Goggles, Mask and Gown No infection patients with immunosuppressed patients Weird Miscellaneous Stuff Rifampin (for TB) ... Rust/orange/red urine and body fluids Pyridium (for bladder infection) ... Orange/red/pink urine Glasgow Coma Scale ... Myesthenia Gravis Myesthenic Crisis = Weakness with change in vitals (give more meds) Cholinergic Crisis = Weakness with no change in vitals (reduce meds) Diabetic Coma vs. Insulin Shock ... Give glucose first - If no help, give insulin Fruity Breath = Diabetic Ketoacidosis Acid-Base Balance If it comes out of your ***, it's Acidosis. Vomiting = Alkalosis Skin Tastes Salty = Cystic Fibrosis Lipitor (statins) in PMs only - No grapefruit juice Stroke ... Tongue points toward side of lesion (paralysis), Uvula deviates away from the side of lesion (paralysis) Hold Digoxin if HR < 60 Stay in bed for 3 hours after first ACE Inhibitor dose Avoid Grapefruit juice with Ca++ Channel Blockers Anthrax = Multi-vector biohazard Pulmonary air embolism prevention = Trendelenburg (HOB down) + on left side (to trap air in right side of heart) Head Trauma and Seizures ... Maintain airway = primary concern Peptic Ulcers ... Feed a Duodenal Ulcer (pain relieved by food) ... Starve a gastric ulcer Acute Pancreatitis ... Fetal position, Bluish discoloration of flanks (Turner's Sign), Bluish discoloration of pericumbelical region (Cullen's Sign), Board like abdomen with guarding ... Self digestion of pancreas by trypsin. Hold tube feeding if residual > 100mL In case of Fire ... RACE and PASS Check Restraints every 30 minutes ... 2 fingers room underneath Gullain-Barre Syndrome ... Weakness progresses from legs upward - Resp arrest Trough draw = ~30 min before scheduled administration ... Peak Draw = 30-60 min after drug administration. Mental Health & Psychiatry Most suicides occur after beginning of improvement with increase in energy levels MAOIs ... Hypertensive Crisis with Tyramine foods Nardil, Marplan, Parnate Need 2 wk gap from SSRIs and TCAs to admin MAOIs Lithium Therapeutic Range = 0.5-1.5 Phenothiazines (typical antipsychotics) - EPS, Photosensitivity Atypical Antipsychotics - work on positive and negative symptoms, less EPS Benzos (Ativan, Lorazepam, etc) good for Alcohol withdrawal and Status Epilepticus Antabuse for Alcohol deterrence - Makes you sick with OH intake Alcohol Withdrawal = Delerium Tremens - Tachycardia, tachypnea, anxiety, nausea, shakes, hallucinations, paranoia ... (DTs start 12-36 hrs after last drink) Opiate (Heroin, Morphine, etc.) Withdrawal = Watery eyes, runny nose, dilated pupils, NVD, cramps Stimulants Withdrawal = Depression, fatigue, anxiety, disturbed sleep Medical-Surgical Hypoventilation = Acidosis (too much CO2) Hyperventilation = Alkalosis (low CO2) No BP or IV on side of Mastectomy Opiate OD = Pinpoint Pupils Lesions of Midbrain = Decerebrate Posturing (Extended elbows, head arched back) Lesions of Cortex = Decorticate Posturing (Flexion of elbows, wrists, fingers, straight legs, mummy position) Urine Output of 30 mL/hr = minimal competency of heart and kidney function Kidney Stone = Cholelithiasis Flank pain = stone in kidney or upper ureter Abdominal/scrotal pain = stone in mid/lower ureter or bladder o Renal Failure ... Restrict protein intake Fluid and electrolyte problems ... Watch for HyperK+ (dizzy, wk, nausea, cramps, arhythmias) Pre-renal Problem = Interference with renal perfusion Intra-renal Problem= Damage to renal parenchyma Post-renal Problem = Obstruction in UT anywhere from tubules to urethral meatus. Usually 3 phases (Oligouric, Diuretic, Recovery) Monitor Body Wt and I&Os Steroid Effects = Moon face, hyperglycemia, acne, hirsutism, buffalo hump, mood swings, weight gain - Spindle shape, osteoporosis, adrenal suppression (delayed growth in kids) . . . (Cushing's Syndrome symptoms) Addison's' Crisis = medical emergency (vascular collapse, hypoglycemia, tachycardia ... Admin IV glucose + corticosteroids) ... No PO corticosteroids on empty stomach Potassium sparing diuretic = Aldactone (Spironolactone) ... Watch for hyperK+ with this and ACE Inhibitors. Cardiac Enzymes ... Troponin (1 hr), CKMB (2-4 hr), Myoglobin (1-4 hr), LDH1 (12-24 hr) MI Tx ... Nitro - Yes ... NO Digoxin, Betablockers, Atropine Fibrinolytics = Streptokinase, Tenecteplase (TNKase) CABG = Coronary Artery Bypass Graft PTCA = Percutaneous Transluminal Coronary Angioplasty Sex after MI okay when able to climb 2 slights of stairs without exertion (Take nitro prophylactically before sex) BPH Tx = TURP (Transurethral Resection of Prostate) ... some blood for 4 days, and burning for 7 days post-TURP. Only isotonic sterile saline for Bladder Irrigation Post Thyroidectomy - Keep tracheostomy set by the bed with O2, suction and Calcium gluconate Pericarditis ... Pericardial Friction Rub, Pain relieved by leaning forward Post Strep URI Diseases and Conditions: Acute Glomerulonephritis Rheumatic Fever ... Valve Disease Scarlet Fever If a chest-tube becomes disconnected, do not clamp ... Put end in sterile water Chest Tube drainage system should show bubbling and water level fluctuations (tidaling with breathing) TB ... Treatment with multidrug regimen for 9 months ... Rifampin reduces effectiveness of OCs and turns pee orange ... Isoniazide (INH) increases Dilantin blood levels Use bronchodilators before steroids for asthma ... Exhale completely, Inhale deeply, Hold breath for 10 seconds Ventilators ... Make sure alarms are on ... Check every 4 hours minimum Suctioning ... Pre and Post oxygenate with 100% O2 ... No more than 3 passes ... No longer than 15 seconds ... Suction on withdrawal with rotation COPD: Emphysema = Pink Puffer Chronic Bronchitis = Blue Bloater (Cyanosis, Rt sided heart failure = bloating/edema) o O2 Administration Never more than 6L/min by cannula Must humidify with more than 4L/hr No more than 2L/min with COPD ... (CO2 Narcosis) In ascending order of delivery potency: Nasal Cannula, Simple Face Mask, Nonrebreather Mask, Partial Rebreather Mask, Venturi Mask Restlessness and Irritability = Early signs of cerebral hypoxia IVs and Blood Product Administration 18-19 gauge needle for blood with filter in tubing Run blood with NS only and within 30 minutes of hanging Vitals and Breath Sounds ... before, during and after infusion (15 min after start, then 30 min later, then hourly up to 1 hr after) Check Blood: Exp Date, clots, color, air bubbles, leaks 2 RNs must check order, pt, blood product ... Ask Pt about previous transfusion Hx Stay with Pt for first 15 minutes ... If transfusion rxn ... Stop and KVO with NS Pre-medicate with Benadryl PRN for previous urticaria rxns Isotonic Solutions D5W NS (0.9% NaCl) Ringers Lactate NS only with blood products and Dilantin Diabetes and Insulin When in doubt - Treat for Hypoglycemia first First IV for DKA = NS, then infuse regular insulin IV as RX'd Hypoglycemia ... confusion, HA, irritable, nausea, sweating, tremors, hunger, slurring Hyperglycemia ... weakness, syncope, polydipsia, polyuria, blurred vision, fruity breath Insulin may be kept at room T for 28 days Draw Regular (Clear) insulin into syringe first when mixing insulins Rotate Injection Sites (Rotate in 1 region, then move to new region) Rapid Acting Insulins ... Lispro (Humalog) and Aspart (Novolog) ... O: 5-15 min, P: .75-1.5 hrs Short Acting Insulin ... Regular (human) ... O: 30-60 min, P: 2-3 hrs (IV Okay) Intermediate Acting Insulin ... Isophane Insulin (NPH) ... O: 1-2 hrs, P: 6-12 hrs Long Acting Insulin ... Insulin Glargine (Lantus) ... O: 1.1 hr, P: 14-20 hrs (Don't Mix) Oral Hypoglycemics decrease glucose levels by stimulating insulin production by beta cells of pancreas, increasing insulin sensitivity and decreasing hepatic glucose production Glyburide, Metformin (Glucophage), Avandia, Actos Acarbose blunts sugar levels after meals Oncology Leukemia ... Anemia (reduced RBC production), Immunosuppression (neutropenia and immature WBCs), Hemorrhage and bleeding tendencies (thrombocytopenia) Acute Lymphocytic = most common type, kids, best prognosis Testicular Cancer ... Painless lump or swelling testicle ... STE in shower > 14 yrs ... 15-35 = Age Prostate Cancer ... > 40 = Age PSA elevation DRE Mets to spine, hips, legs Elevated PAP (prostate acid phosphatase) TRUS = Transurethral US Post Op ... Monitor of hemorrhage and cardiovascular complication Cervical and Uterine Cancer Laser, cryotherapy, radiation, conization, hysterectomy, exenteration ... Chemotherapy = No help PAP smears should start within 3 years of intercourse or by age 21 Ovarian Cancer = leading cause of death from gynecological cancer Breast Cancer = Leading cause of cancer in women Upper outer quadrant, left > right Monthly SBE Mammography ... Baseline @ 35, Annually after age 50 Mets to lymph nodes, then lungs, liver, brain, spine Mastectomy ... Radical Mastectomy = Lymph nodes too (but no mm resected) Avoid BP measurements, injections and venipuncture on surgical side Anti-emetics given with Chemotherapy Agents (Cytoxan, Methotrexate, Interferon, etc.) Phenergan (Promethazine HCl) Compazine (Prochlorperazine) Reglan (Metocolpramide) Benadryl (Diphenhydramine) Zofran (Ondansetron HCl) Kytril (Granisetron) Sexually Transmitted Diseases Syphilis (Treponema pallidum) ... Chancre + red painless lesion (Primary Stage, 90 days) ... Secondary Stage (up to 6 mo) = Rash on palms and soles + Flu-like symptoms ... Tertiary Stage = Neurologic and Cardiac destruction (10-30 yrs) ... Treated with Penicillin G IM. Gonorrhea (Neisseria Gonorrhea) ... Yellow green urethral discharge (The Clap) Chlamydia (Chlamydia Trachomatis) ... Mild lady partsl discharge or urethritis ... Doxycyclin, Tetracycline Trichomoniasis (Trichomonas lady partslis) ... Frothy foul-smelling lady partsl discharge ... Flagyl Candidiasis (Candida Albicans) ... Yellow, cheesy discharge with itching ... Miconazole, Nystatin, Clomitrazole (Gyne-Lotrimin) Herpes Simplex 2 ... Acyclovir HPV (Human Pappilovirus) ... Acid, Laser, Cryotherapy HIV ... Cocktails Perioperative Care Breathing Es taught in advance (before or early in pre-op) Remove nail polish (need to see cap refill) Pre Op ... Meds as ordered, NPO X 8 hrs, Incentive Spirometry & Breathing Es taught in advance, Void, No NSAIDS X 48 hrs Increased corticosteroids for surgery (stress) ... May need to increase insulin too Post Op restlessness may = hemorrhage, hypoxia Wound dehiscence or extravisation ... Wet sterile NS dressing + Call Dr. Call Dr. post op if ... 100 or Post Op Monitoring VS and BS ... Every 15 minutes the first hour, Every 30 min next 2 hours, Every hour the next 4 hours, then Every 4 hours PRN 1-4 hrs Post Op = Immediate Stage ... 2-24 hrs Post Op = Intermediate Stage ... 1-4 days Post Op = Extended Stage Post Op Positioning THR ... No Adduction past midline, No hip flexion past 90 degrees Supratentorial Sx ... HOB 30-45 degrees (Semi-Fowler) Infrantentorial Sx ... Flat Phlebitis ... Supine, elevate involved leg Harris Tube ... Rt/back/Lt - to advance tube in GI Miller Abbott Tube ... Right side for GI advancement into small intestine Thoracocentesis ... Unaffected side, HOB 30-45 degrees Enema ... Left Sims (flow into sigmoid) Liver Biopsy ... Right side with pillow/towel against puncture site Cataract Sx ... Opp side - Semi-Fowler Cardiac Catheterization ... Flat (HOB no more than 30 degrees), Leg straight 4-6 hrs, bed rest 6-12 hrs Burn Autograph ... Elevated and Immob 3-7 days Amputation ... Supine, elevate stump for 48 hrs Large Brain Tumor Resection ... On non-operative side Incentive Spirometry ... Inhale slowly and completely to keep flow at 600-900, Hold breath 5 seconds, 10 times per hr Post Op Breathing Exercises ... Every 2 hours Sit up straight Breath in deeply thru nose and out slowly thru pursed lips Hold last breath 3 seconds Then cough 3 times (unless abd wound - reinforce/splint if cough) Watch for Stridor after any neck/throat Sx ... Keep Trach kit at bed side Staples and sutures removed in 7-14 days - Keep dry until then No lifting over 10 lbs for 6 weeks (in general) If chest tube comes disconnected, put free end in container of sterile water Removing Chest Tube ... Valsalvas, or Deep breath and hold If chest tube drain stops fluctuating, the lung has re-inflated (or there is a problem) Keep scissors by bed if pt has S. Blakemore Tube (for esoph varices)... Sudden respiratory distress - Cut inflation tubes and remove Tracheostomy patients ... Keep Kelly clamp and Obturator (used to insert into trachea then removed leaving cannula) at bed side Turn off NG suction for 30 min after PO meds NG Tube Removal ... Take a deep breath and hold it Stomach contents pH = NG Tube Insertion ... If cough and gag, back off a little, let calm, advance again with pt sipping water from straw NG Tube Length ... End of nose, to era lobe, to xyphoid (~22-26 inches) Decubitus (pressure) Ulcer Staging Stage 1 = Erythema only Stage 2 = Partial thickness Stage 3 = Full thickness to SQ Stage 4 = Full thickness + involving mm /bone Acute Care VA ... Hemorrhagic or Embolic A-fib and A-flutter = thrombus formation Dysarthria (verbal enunciation/articulation), Apraxia (perform purposeful movements), Dysphasia (speech and verbal comprehension), Aphasia (speaking), Agraphia (writing), Alexia (reading), Dysphagia (swallowing) Left Hemisphere Lesion ... aphasia, agraphia, slow, cautious, anxious, memory okay Right Hemisphere Lesion ... can't recognize faces, loss of depth perception, impulsive behavior, confabulates, poor judgment, constantly smiles, denies illness, loss of tonal hearing Head Injuries ... Even subtle changes in mood, behavior, restlessness, irritability, confusion may indicate increased ICP Change in level of responsiveness = Most important indicator of increased ICP Watch for CSF leaks from nose or ears - Leakage can lead to meningitis and mask intracranial injury since usual increased ICP symps may be absent. Spinal Cord Injuries Respiratory status paramount ... C3-C5 innervates diaphragm 1 wk to know ultimate prognosis Spinal Shock = Complete loss of all reflex, motor, sensory and autonomic activity below the lesion = Medical emergency Permanent paralysis if spinal cord in compressed for 12-24 hrs Hypotension and Bradycardia with any injury above T6 Bladder Infection = Common cause of death (try to keep urine acidic) Burns Infection = Primary concern HyperK+ due to cell damage and release of intracellular K+ Give meds before dressing changes - Painful Massive volumes of IV fluid given, due to fluid shift to interstitial spaces and resultant shock First Degree = Epidermis (superficial partial thickness) Second Degree = Epidermis and Dermis (deep partial thickness) Third Degree = Epidermis, Dermis, and SQ (full thickness) Rule of 9s ... Head and neck = 9%, UE = 9% each, LE = 18% each, Front trunk = 18%, Back Trunk = 18% Singed nasal hair and circumoral soot/burns = Smoke inhalation burns o Fractures Report abnormal assessment findings promptly ... Compartment Syndrome may occur = Permanent damage to nerves and vessels 5 P's of neurovascular status (important with fractures) Pain, Pallor, Pulse, Paresthesia, Paralysis Provide age-appropriate toys for kids in traction Special Tests and Pathognomonic Signs Tensilon Test ... Myesthenia Gravis (+ in Myesthenic crisis, - in Cholinergic crisis) ELISA and Western Blot ... HIV Sweat Test ... Cystic Fibrosis Cheilosis = Sores on sides of mouth ... Riboflavin deficiency (B2) Trousseau's Sign (Carpal spasm induced by BP cuff) ... Hypocalcemia (hypoparathyroidism) Chvostek's Sign (Facial spasm after facial nerve tap) ... Hypocalcemia (hypoparathyroidism) Bloody Diarrhea = Ulcerative Colitis Olive-Shaped Mass (epigastric) and Projectile Vomiting = Pyloric Stenosis Current Jelly Stool (blood and mucus) and Sausage-Shaped Mass in RUQ = Intussiception Mantoux Test for TB is + if 10 mm induration 48 hrs post admin (previous BCG vaccine recipients will test +) Butterfly Rash = SLE ... Avoid direct sunlight 5 Ps of NV functioning ... Pain, paresthesia, pulse, pallor, paralysis Cullen's Sign (periumbelical discoloration) and Turner's Sign (blue flank) = Acute Pancreatitis Murphy's Sign (Rt. costal margin pain on palp with inspiration) = GB or Liver disease HA more severe on wakening = Brain Tumor (remove benign and malignant) Vomiting not associated with nausea = Brain Tumor Elevated ICP = Increased BP, widened pulse pressure, increased Temp Pill-Rolling Tremor = Parkinson's (Tx with Levodopa, Cardidopa) - Fall precautions, rigid, stooped, shuffling IG Bands on Electrophoresis = MS ... Weakness starts in upper extremities - bowel/bladder affected in 90% ... Demyelination - Tx with ACTH, corticosteroids, Cytoxan and other immunosuppressants Reed-Sternberg Cells = Hodgkin's Koplik Spots = Rubeola (Measles) Erythema Marginatum = Rash of Rheumatic Fever Gower's Sign = Muscular Dystrophy ... Like Minor's sign (walks up legs with hands) Pediatrics Bench Marks Birth wt doubles at 6 months and triples at 12 months Birth length increases by 50% at 12 months Post fontanel closes by 8 wks Ant fontanel closes by 12-18 months Moro reflex disappears at 4 months Steady head control achieved at 4 months Turns over at 5-6 months Hand to hand transfers at 7 months Sits unsupported at 8 months Crawls at 10 months Walks at 10-12 months Cooing at 2 months Monosyllabic Babbling at 3-6 months, Links syllables 6-9 mo Mama, Dada + a few words at 9-12 months Throws a ball overhand at 18 months Daytime toilet training at 18 mo - 2 years 2-3 word sentences at 2 years 50% of adult Ht at 2 years Birth Length doubles at 4 years Uses scissors at 4 years Ties shoes at 5 years Girls' growth spurt as early at 10 years ... Boys catch up ~ Age 14 Girls finish growing at ~15 ... Boys ~ 17 Autosomal Recessive Diseases CF, PKU, Sickle Cell Anemia, Tay-Sachs, Albinism, 25% chance if: AS (trait only) X AS (trait only) 50% chance if: AS (trait only) X SS (disease) Autosomal Dominant Diseases Huntington's, Marfans, Polydactyl, Achondroplasia, Polycystic Kidney Disease 50% if one parent has the disease/trait (trait = disease in autosomal dominant) X-Linked Recessive Diseases Muscular Dystrophy, Hemophilia A Females are carriers (never have the disease) Males have the disease (but can't pass it on) 50% chance daughters will be carriers (can't have disease) 50% chance sons will have the disease (not a carrier = can't pass it on) This translates to an overall 25% chance that each pregnancy will result in a child that has the disease Scoliosis ... Milwaukee Brace - 23 hrs/day, Log rolling after Sx Down Syndrome = Trisomy 21 ... Simian creases on palms, hypotonia, protruding tongue, upward outward slant of eyes Cerebral Palsy ... Scissoring = legs extended, crossed, feet plantar-flexed PKU ... leads to MR ... Guthrie Test ...Aspartame (NutraSweet) has phenylalanine in it and should not be given to PKU patient Hypothyroidism ... Leads to MR Prevent Neural tube disorders with Folic Acid during PG Myelomeningocele ... Cover with moist sterile water dressing and keep pressure off Hydrocephalus ... Signs of increased ICP are opposite of shock ... Shock = Increased pulse and decreased BP IICP = Decreased pulse and increased BP ... (+ Altered LOC = Most sensitive sign) Infants ... IICP = Bulging fontanels, high pitched cry, increased hd circum, sunset eyes, wide suture lines, lethargy ... Treat with peritoneal shunt - don't pump shunt. Older kids IIPC = Widened pulse pressure IICP caused by suctioning, coughing, straining, and turning - Try to avoid Muscular Dystrophy ... X-linked Recessive, waddling gait, hyper lordosis, Gower's Sign = difficulty rising walks up legs (like Minor's sign), fat pseudohypertrophy of calves. Seizures ... Nothing in mouth, turn hd to side, maintain airway, don't restrain, keep safe ... Treat with Phenobarbitol (Luminol), Phenytoin (Dilantin: TR = 10-20 ... Gingival Hyperplasia), Fosphenytoin (Cerebyx), Valproic Acid (Depakene), Carbamazepine (Tegritol) Meningitis (Bacterial) ... Lumbar puncture shows Increased WBC, protein, IICP and decreased glucose May lead to SIADH (Too much ADH) ... Water retention, fluid overload, dilutional hyponatremia CF Kids taste salty and need enzymes sprinkled on their food Children with Rubella = threat to unborn siblings (may require temporary isolation from Mom during PG) Pain in young children measured with Faces pain scale No MMR Immunization for kids with Hx of allergic rxn to eggs or neomycin Immunization Side Effects ... T Call Physician if seizures, high fever, or high-pitched cry after immunization All cases of poisoning ... Call Poison Control Center ... No Ipecac! Epiglottitis = H. influenza B ... Child sits upright with chin out and tongue protruding (maybe Tripod position) ... Prepare for intubation or trach ... DO NOT put anything into kid's mouth Isolate RSV patient with Contact Precautions ... Private room is best ... Use Mist Tent to provide O2 and Ribavirin - Flood tent with O2 first and wipe down inside of tent periodically so you can see patient Acute Glomerulonephritis ... After B strep - Antigen-Antibody complexes clog up glomeruli and reduce GFR = Dark urine, proteinuria Wilm's Tumor = Large kidney tumor ... Don't palpate TEF = Tracheoesophageal Atresia ... 3 C's of TEF = Coughing, Choking, Cyanosis Cleft Lip and Palate ... Post-Op - Place on side, maintain Logan Bow, elbow restraints Congenital Megacolon = Hirschsprung's Disease ... Lack of peristalsis due to absence of ganglionic cells in colon ... Suspect if no meconium w/in 24 hrs or ribbon-like foul smelling stools Iron Deficiency Anemia ... Give Iron on empty stomach with citrus juice (vitamin C enhances absorption), Use straw or dropper to avoid staining teeth, Tarry stools, limit milk intake Sickle Cell Disease ...Hydration most important ...SC Crisis = fever, abd pain, painful edematous hands and feet (hand-foot syndrome), arthralgia ...Tx + rest, hydration ... Avoid high altitude and strenuous activities Tonsillitis ... usually Strep ... Get PT and PTT Pre-Op (ask about Hx of bleeding) ... Suspect Bleeding Post-Op if frequent swallowing, vomiting blood, or clearing throat ... No red liquids, no straws, ice collar, soft foods ... Highest risk of hemorrhage = first 24 hrs and 5-10 days post-op (with sloughing of scabs) Primary meds for ER for respiratory distress = Sus-phrine (Epinephrine HCl) and Theophylline (Theo-dur) ... Bronchodilators Must know normal respiratory rates for kids ... Respiratory disorders = Primary reason for most medical/ER visits for kids ... Newborn ... 30-60 1-11 mo ... 25-35 1-3 years ... 20-30 3-5 years ... 20-25 6-10 years ... 18-22 11-16 years ...16-20 Cardiovascular Disorders Acyanotic = VSD, ASD, PDA, Coarc of Aorta, Aortic Stenosis Antiprostaglandins cause closure of PDA (aorta - pulmonary artery) Cyanotic = Tetralogy of Fallot, Truncus Arteriosis (one main vessel gets mixed blood), TVG (Transposition of Great Vessels) ... Polycythemia common in Cyanotic disorders 3 T's of Cyanotic Heart Disease (Tetralogy, Truncus, Transposition) Tetralogy of Fallot ... Unoxygenated blood pumped into aorta ulmonary Stenosis VSD Overiding Aorta Right Ventricular Hypertrophy TET Spells ...Hypoxic episodes that are relieved by squatting or knee chest position CHF can result ... Use Digoxin ... TR = 0.8-2.0 for kids Ductus Venosus = Umbelical Vein to Inferior Vena Cava Ductus Arteriosus = Aorta to Pulmonary Artery Rheumatic Fever ... Acquired Heart Disease ... Affects aortic and mitral valves Preceded by beta hemolytic strep infection Erythema Marginatum = Rash Elevated ASO titer and ESR Chest pain, shortness of breath (Carditis), migratory large joint pain, tachycardia (even during sleep) Treat with Penicillin G = Prophylaxis for recurrence of RF Maternity Day 1 of cycle = First day of menses (bleeding) ... Ovulation on Day 14 ... 28 days total ... Sperm 3-5 days, Eggs 24 hrs ... Fertilization in Fallopian Tube Chadwick's Sign = Bluing of lady parts (early as 4 weeks) Hegar's Sign = Softening of isthmus of cervix (8 weeks) Goodell's Sign = Softening of Cervix (8 weeks) Pregnancy Total wt gain = 25-30 lbs (11-14 kg) Increase calorie intake by 300 calories/day during PG ... Increase protein 30 g/day ... Increase iron, Ca++, Folic Acid, A & C Dangerous Infections with PG ... TORCH = Toxoplasmosis, other, Rubella, Cytomegalovirus, HPV Braxton Hicks common throughout PG Amniotic fluid = 800-1200 mL ( Polyhydramnios and Macrosomia (large fetus) with Diabetes Umbelical cord: 2 arteries, 1 vein ... Vein carries oxygenated blood to fetus (opposite of normal) FHR = 120-160 Folic Acid Deficiency = Neural tube defects Pre-term = 20-37 weeks Term = 38-42 weeks Post-term = 42 weeks+ TPAL = Term births, Pre-term births, Abortions, Living children Gravida = # of Pregnancies regardless of outcome Para = # of Deliveries (not kids) after 20 wks gestation Nagale's Rule ... Add 7 days to first day of last period, subtract 3 months, add 12 months = EDC Hgb and Hct a bit lower during PG due to hyperhydration Side-lying is best position for uteroplacental perfusion (either side tho left is traditional ) 2:1 Lecithin:Sphingomyelin Ratio = Fetal lungs mature AFP in amniotic fluid = possible neural tube defect Need a full bladder for Amniocentesis early in PG (but not in later PG) Lightening = Fetus drops into true pelvis Nesting Instinct = Burst of Energy just before labor True Labor = Regular contractions that intensify with ambulation, LBP that radiates to abdomen, progressive dilation and effacement Station = Negative above ischial spines, Positive below Leopold Maneuver tries to reposition fetus for delivery Laboring Maternal Vitals ... Pulse NON-Stress Test ... Reactive = Healthy (FHR goes up with movements) Contraction Stress Test (Ocytocin Challenge Test)... Unhealthy = Late decels noted (positive result) indicative of UPI ... "Negative" result = No late decels noted (good result) Watch for hyporeflexia with Mag Sulfate admin . . . Diaphragmatic Inhibition Keep Calcium gluconate by the bed (antidote) Firsts etal HB ... 8-12 weeks by Doppler, 15-20 weeks by fetoscope Fetal movement = Quickening, 14-20 weeks Showing = 14 weeks Braxton Hicks - 4 months and onward Early Decels = Head compression = OK Variable Decels = Cord compression = Not Good Late Decels = Utero-placental insufficiency = BAD! If Variable or Late Decels ... Change maternal position, Stop Pitocin, Administer O2, Notify Physician DIC ... Tx is with Heparin (safe in PG) ... Fetal Demise, Abruptio Placenta, Infection Fundal Heights 12-14 wks ... At level of symphysis 20 weeks ... 20 cm = Level of umbilicus Rises ~ 1 cm per week Stages of Labor Stage 1 = Beginning of Regular contraction to full dilation and effacement Stage 2 = 10 cm dilation to delivery Stage 3 = Delivery of Placenta Stage 4 = 1-4 Hrs following delivery Placenta Separation ... Lengthening of cord outside lady parts, gush of blood, full feeling in lady parts ... Give oxytocin after placenta is out - Not before. Schultz Presentation = Shiny side out (fetal side of placenta) Postpartum VS Schedule Every 15 min X 1 hr Every 30 min X next 2 hours Every Hour X next 2-6 hours Then every 4 hours Normal BM for mom within 3 days = Normal Lochia ... no more than 4-8 pads/day and no clots > 1 cm ... Fleshy smell is normal, Foul smell = infection Massage boggy uterus to encourage involution ... empty bladder ASAP - may need to catheterize ... Full bladder can lead to uterine atony and hemorrhage Tears ...1st Degree = Dermis, 2nd Degree = mm/fascia, 3rd Degree = anal sphincter, 4th Degree = rectum APGAR = HR, R, mm tone, Reflex irritability, Color ... 1 and 5 minutes ...7-10 = Good, 4-6 = moderate resuscitative efforts, 1-3 = mostly dead Eye care = E-mycin + Silver Nitrate ... for gonorrhea Pudendal Block = decreases pain in perineum and lady parts - No help with contraction pain Epidural Block = T10-S5 ... Blocks all pain ... First sign = warmth or tingling in ball of foot or big toe Regional Blocks often result in forceps or vacuum assisted births because they affect the mother's ability to push effectively WBC counts are elevated up to 25,000 for ~10 days post partum Rho(D) immune globulin (RhoGAM) is given to Rh- mothers who deliver Rh+ kids... Not given if mom has a +Coombs Test ... She already has developed antibodies (too late) Caput Succedaneum = edema under scalp, crosses suture lines Cephalhematoma = blood under periosteum, does not cross suture lines Suction Mouth first - then nostrils Moro Reflex = Startle reflex (abduction of all extremities) - up to 4 months Rooting Reflex ... up to 4 months Babinski Reflex ... up to18 months Palmar Grasp Reflex ...Lessens by 4 months Ballard Scale used to estimate gestational age Heel Stick = lateral surface of heel Physiologic Jaundice is normal at 2-3 days ... Abnormal if before 24 hours or lasting longer than 7 days ... Unconjugated bilirubin is the culprit. Vitamin K given to help with formation of clotting factors due to fact that the newborn gut lacks the bacteria necessary for vitamin K synthesis initially ... Vastus lateralis mm IM Abrutio Placenta = Dark red bleeding with rigid board like abdomen Placenta Previa = Painless bright red bleeding DIC = Disseminated Intravascular Coagulation ... clotting factors used up by intravascular clotting - Hemorrhage and increased bleeding times result ... Associated with fetal demise, infection and abruptio placenta. Magnesium Sulfate used to reduce preterm labor contractions and prevent seizures in Pre-Eclampsia ... Mg replaces Ca++ in the smooth mm cells resulting relaxation ... Can lead to hyporeflexia and respiratory depression - Must keep Calcium Gluconate by bed when administering during labor = Antidote ... Monitor for: Absent DTR's Respirations Urinary Output Fetal Bradycardia Pitocin (Oxytocin) use for Dystocia... If uterine tetany develops, turn off Pitocin, admin O2 by face mask, turn pt on side. Pitocin can cause water intoxication owing to ADH effects. Suspect uterine rupture if woman complains of a sharp pain followed by cessation of contractions Pre-Eclampsia = Htn + Edema + Proteinuria Eclampsia = Htn + Edema + Proteinuria + Seizures and Coma ... Suspect if Severe HA + visual disturbances No Coumadin during PG (Heparin is OK) Hyperemesis Gravidarum = uncontrollable nausea and vomiting ... May be related to H. pyolori ... Reglan (metaclopromide) Insulin demands drop precipitously after delivery No oral hypoglycemics during PG - Teratogenic ... Insulin only for control of DM Babies born without lady partsl squeeze more likely to have respiratory difficulty initially C-Section can lead to Paralytic Ileus ... Early ambulation helps Postpartum Infection common in problem pregnancies (anemia, diabetes, traumatic birth) Postpartum Hemorrhage = Leading cause of maternal death ... Risk factors include: Dystocia, prolonged labor, overdistended uterus, abrutio placenta, infection Tx includes ... Fundal massage, count pads, VS, IV fluids, Oxytocin, notify physician Jitteriness is a symptom of hypoglycemia and hypocalcemia in the newborn Hypoglycemia ... tremors, high pitched cry, seizures High pitched cry + bulging fontanels = IICP Hypothermia can lead to Hypoxia and acidoisis ... Keep warm and use bicarbonate PRN to treat acidosis in newborn. Lay on right side after feeding ... Move stomach contents into small intestine Jaundice and High bilirubin can cause encephalopathy ... Nutrition K+ ... Bananas, dried fruits, citrus, potatoes, legumes, tea, peanut butter Vitamin C ... Citrus, potatoes, cantaloupe Ca++ ... Milk, cheese, green leafy veggies, legumes Na+ ... Salt, processed foods, seafood Folic Acid ... Green leafy veggies, liver, citrus Fe++ ... Green leafy veggies, red meat, organ meat, eggs, whole wheat, carrots Use Z-track for injections to avoid skin staining Mg+ ... Whole grains, green leafy veggies, nuts Thiamine (B1) ... Pork, beef, liver, whole grains B12 ... Organ meats, green leafy veggies, yeast, milk, cheese, shellfish Deficiency = Big red beefy tongue, Anemia Vitamin K ... Green leafy veggies, milk, meat, soy Vitamin A ... Liver, orange and dark green fruits and veggies Vitamin D ... Dairy, fish oil, sunlight Vitamin E ... Veggie oils, avocados, nuts, seeds BMI ... 18.5-24.9 = Normal (Higher = Obese) Gerontology Essentially everyone goes to Hell in a progressively degenerative hand-basket Thin skin, bad sleep, mm wasting, memory loss, bladder shrinks, incontinence, delayed gastric emptying, COPD, Hypothyroidism, Diabetes Common Ailments: Delerium and Dementia Cardiac Dysrhythmias Cataracts and Glaucoma CVA (usually thrombotic, TIAs common) Decubitus Ulcers Hypothyroidism Thyrotoxicosis (Grave's Disease) COPD (usually combination of emphysema and CB) UTIs and Pneumonia ... Can cause confusion and delerium Memory loss starts with recent - progresses to full Dementia = Irreversible (Alzheimer's) ... Depression, Sundowning, Loss of family recognition Delerium = Secondary to another problem = Reversible (infections common cause) Medication Alert! ... Due to decreased renal function, drugs metabolized by the kidneys may persist to toxic levels When in doubt on NCLEX ... Answer should contain something about exercise and nutrition. Advanced Clinical Concepts Erickson ... Psycho-Social Development 0-1 yr (Newborn) ... Trust vs. Mistrust 1-3 yrs (Toddler)... Autonomy vs. Doubt and Shame ... Fear intrusive procedures - Security objects good (Blankies, stuffed animals) 3-6 yrs (Pre-school) ... Initiative vs. Guilt ... Fear mutilation - Band-Aids good 6-12 yrs (School Age) ... Industry vs. Inferiority... Games good, Peers important ... Fear loss of control of their bodies 12-19 yrs (Adolescent) ... Identity vs. Role Confusion ... Fear Body Image Distortion 20-35 yrs (Early Adulthood) ... Intimacy vs. Isolation 35-65 yrs (Middle Adulthood) ... Generativity vs. Stagnation Over 65 (Older Adulthood) ... Integrity vs. Despair Piaget ... Cognitive Development Sensorimotor Stage (0-2) ... Learns about reality and object permanence Preoperational Stage (2-7) ... Concrete thinking Concrete Operational Stage (7-11) ... Abstract thinking Formal Operational Stage (11-adult) ... Abstract and logical thinking Freud ... Psycho-Sexual Development Oral Stage (Birth -1 year) ... Self gratification, Id is in control and running wild Anal Stage (1-3) ... Control and pleasure wrt retention and pooping - Toilet training in this stage Phallic Stage (3-6) ... Pleasure with genitals, Oedipus complex, SuperEgo develops Latency Stage (6-12) ... Sex urges channeled to culturally acceptable level, Growth of Ego Genital Stage (12 up) ... Gratification and satisfying sexual relations, Ego rules Kohlberg ... Moral Development Moral development is sequential but people do not aromatically go from one stage to the next as they mature Level 1 = Pre-conventional ... Reward vs. Punishment Orientation Level 2 = Conventional Morality ... Conforms to rules to please others Level 3 = Post- Conventional ... Rights, Principles and Conscience (Best for All is a concern) Calculations Rules & Formulas Round final answer to tenths place Round drops to nearest drop When calculating mL/hr, round to nearest full mL Must include 0 in front of values Pediatric doses rounded to nearest 100th. Round down for peds Calculating IV Flow Rates Total mL X Drop Factor / 60 X #Hrs = Flow Rate in gtts/min Calculating Infusion Times Total mL X Drop Factor / Flow Rate in gtts/min X 60 = Hrs to Infuse Watch HESI Study Tips... Conversions 1 t = 5mL 1 T = 3 t = 15 mL 1 oz = 30 cc = 30 mL = 2 T 1 gr = 60 mg 1 mg = 1000 ug (or mcg) 1 kg = 2.2 lbs 1 cup = 8 oz = 240 mL 1 pint = 16 oz 1 quart = 32 oz Degrees F = (1.8 X C) + 32 Degrees C = (F - 32) / 1.8 37 C = 98.6 F 38 C = 100.4 F 39 C = 102.2 F 40 C = 104 F Fall Precautions Room close to nurses station Assessment and orientation to room Get help to stand (dangle feet if light headed) Bed low with side rails up Good lighting and reduce clutter in room Keep consistent toileting schedule Wear proper non-slip footwear At home ... Paint edges of stairs bright color Bell on cats and dogs Neutropenic (Immunosuppressed) Precautions No plants or flowers in room No fresh veggies ... Cooked foods only Avoid crowds and infectious persons Meticulous hand washing and hygiene to prevent infection Report fever > 100.5 (immunosuppressed pts may not manifest fever with infection) Bleeding Precautions (Anticoagulants, etc.) Soft bristled tooth brush Electric razor only (no safety razors) Handle gently, Limit contact sports Rotate injection sites with small bore needles for blood thinners Limit needle sticks, Use small bore needles, Maintain pressure for 5 minutes on venipuncture sites No straining at stool - Check stools for occult blood (Stool softeners PRN) No salicylates, NSAIDs, or suppositories Avoid blowing or picking nose Do not change Vitamin K intake if on Coumadin LEARN how to pass the NCLEX... Download NCLEX Study Guide!

1. The Famous Pearson Vue Trick I tried this trick and it worked for me (So far, I have not heard that this trick was inaccurate) The link below will provide you step by step on how to do the Pearson Vue trick. Basically, if you get this pop-up message, "Our records indicate that you have recently scheduled this exam. Please contact your Member Board for further assistance. Another registration cannot be made at this time," then you PASSED the NCLEX. If you did not pass, then it will take you to the credit card page which lets you register for the exam again. I tried this trick about 4 hours after completing my NCLEX and it worked. *Make sure your Pearson account page state "Delivery Successful" before you try the trick* 2. Calling the Automated License # I called this # about 24 hours after the completion of my NCLEX and my results were already up. If you PASS, it will say, "First Name, Last Name, For the occupation registered nurse, your license status is: current active ..." It will also tell you when your license was issued and when it will expired. (For some people, their results are not up until a few days later, especially if you used your driver's license # to register for BON instead of your SSN). Remember, your results may take longer to be available so don't freak out! 3. Board of Nursing (VIRGINIA) My results was up on the website the next day, but it usually takes between 2-4 days. However, it has taken up to 1-2 weeks for some people. (The website is usually slower than the Automated License #). This is the VA BON license verification link: https://www.license.dhp.virginia.gov/license/ The page should show your name, license number, profession (nursing), license type, issue date, expire date, and license status (current active) OR Virginia DHP Health Professional Data Services! (For me, my name and license number did not show up until about 5 days later)

Hey everybody, So, my NCLEX test is coming up on Friday (AHHHHHHH) and this will be the second time I am taking it and extremely nervous to fail again, but that's not my question. A few days ago, I found a study guide here on allnurses.com. I was wondering if anyone has used this or could take a quick look over this to make sure I am not learning all the wrong information before I walk into this test again. I know it's an absurd question, but frankly, I am freaking out over here and don't want to fail this again. I'd be ultimately devastated even though I know it's not the end of the world. One of the main reasons I ask is because I could have sworn when reading in my ATI books it says for a patient who receives a lumbar puncture, they should line prone for 4-12 to prevent leakage of CSF and prevention of headaches, but on this guide (twice) it says lay supine. Any thoughts on both? Articles on Passing the NCLEX Passed my NCLEX-RN! My NCLEX Review Material Tips Passed NCLEX-RN 2015 in 75 questions NCLEX Study Tips! My Story For more information download the official allnurses® NCLEX Study Guide: Expert Insights to Help You Pass the NCLEX ebook... allnurses® Ebooks Library Check Out 'The Secret to Passing the NCLEX Test' Video... NCLEX-Study-Guide (1).pdf

Go to NCLEX Examinations :: Pearson VUE. Select the 'test taker services' tab at the top. Click 'register' on the right side. Click the 'credit card' link. Click the 'sign in' link in the second sentence. Enter your username. Enter your password. Click the button. Click 'register' on the left side. Select your test type. Click the button. Select your country. Click the button. Answer the yes/no questions. Select your country again. Select your state. Type in your city. Click the button. a list of schools should appear. Select your school. Select the month and year of your graduation. Select your board of nursing. Click the button. Very important: At this point, if you get a pop up that says 'the candidate currently has test results that are on hold. A new registration cannot be created at this time.', it has nothing to do with passing or failing; it just means that they are reviewing your records due to random reviews that they conduct, or because they needed to locate some data or papers, etc. This means you will possibly have to wait a few more days than your friends who did not get this message. If you get the message 'Records indicates you have recently registered for this test please contact BON. An appointment cannot be scheduled at this time.', that means you passed. If you do not get either message and go straight to the credit card information page, that means you did not pass. Your Pearsonvue account must state that delivery is successful before you try the trick. Poll to take once you have received your response: Pearsonvue trick - Poll once you receive your results - nursing for nurses The original thread (part 1 and 2) are now closed. Part 1: Pearsonvue. Is this true? does it work every time? Part 2: Pearson Vue Trick - Does it Work Every Time? Part 2

After shutting out distractions and really focusing on studying for the test, I ended up buying alot of NCLEX review materials, so I had the following: NCSBN online review course (5 wks) Content isn't great, very hard to learn from but the questions were NCLEX type questions. I would purchase this if you're only needing questions to study from and not for content review. Kaplan - The RN Course Book: Preparation for the NCLEX-RN Examination 15th edition No online review course, just the book from amazon.com. Must have for content if you don't have time to study, minimum time needed to read over this book is about 1 wk. Only thing about this book is that it may not have all the info you need and there are no NCLEX practice questions in this book. Probably contains about 50-60% info you would need to study for the NCLEX. You would have to purchase the online Kaplan review course for the questions or just use questions from another source. For more information download the official allnurses® NCLEX Study Guide: Expert Insights to Help You Pass the NCLEX ebook... allnurses® Ebooks Library Saunders Comprehensive Review for the NCLEX-RN Examination 5th edition. Good review book, I just feel like it's too showy and has more info than you actually need to study for. Questions to me are okay but appears to be easy. Prioritization, Delegation, and Assignment (PDA) by LaCharity 2nd edition Very important, must review for questions. I feel like this book helped me the most to prepare for the NCLEX style questions, especially for those priority, delegation, assignment type questions in which I saw alot when I sat for my 3 NCLEX attempts. Kaplan NCLEX-RN: Strategies, Practice, and Review 2011-2012 book I read through this book cover to cover but I don't think it helped me at all. Good book for questions only. Exam Cram NCLEX-RN 3rd edition You can actually skim through this book in about 2-3 hrs. It basically tells you the info you need to know for the NCLEX. Only thing, is it's a small book and the info is probably only 30% from what you would see from a Saunders's or Maryann. Good book for questions, as they are NCLEX style questions. Maryann Hogan Comprehensive Review for NCLEX-RN:Reviews and Rationales 2nd edition Must have for content and similar NCLEX type questions if you have time to study, minimum time needed to review this whole book is about 1 month, to me this is the best review book for the NCLEX-RN. The content is cut and dry, which was good for me. NCLEX 4000 Good for questions or alternative type questions, I didn't use it as much or maybe hardly at all. Kaplan Questions Trainers 1-7 from this website Questions are way harder than NCLEX, I would probably use this if I need questions to study. Lab Values Very important, must review right before you sit for NCLEX. Thank you for whoever posted this: LabValues[1]NCLEX review2.docx Yes, I used/reviewed them all. Some people say do as much questions as you can and others have said to study mostly content. It's really up to you on how you study. You must have the knowledge/content to answer NCLEX style questions. In addition, answering NCLEX style questions such as the ones in PDA book helps you to understand why you would choose this answer over the other. That's also important because it helps you to figure out what the questions are actually asking. You probably hear people say to review rationales all the time, well yes review them! It will tell you why you would choose this answer over the other, etc. Doing questions and reviewing the rationales to me is like reviewing content as well. For me, I mostly study content and used the questions from the book (end of chapter quizzes or the comprehensive test at the end of the book, no other review materials used for practicing NCLEX style questions). I think I ended up only studying a total of 500 questions or less from all of my 3 attempts at NCLEX-RN. You're probably thinking, why didn't I practice more questions, well I just ran out of time so I decided to review content more. And also, I did not get to finish reviewing any review books. Saunders was just too showy and hard to follow for me so I probably only read through 2-3 chapters and was like alright no more Saunders. Kaplan, the book has good straightforward info in ADPIE (assessment, diag, planning, etc) format. I probably ended up only using it for 5 chapters and switched bc I found out that Maryann book was better suited for me. The Maryann book I think I only studied through 50% of the book bc my NCLEX date was near so I didn't get to finish. I did finish the PDA and Kaplan strategies book as they were quick reads. It seems that if you're doing well during your exam, you would see more SATA questions. There will be lots of priority, delegation, assignment type questions so PDA is the best book for it. I would say that if you're pressed for time and only have about 1-2 week to study I would stick with the: Kaplan RN Course Book 15th edition, the lab value sheet I attached, the review sheet I attached, and PDA book. The Kaplan book is like a shortened version of Saunders's and/or Maryann Hogan. It seems to have about 60% of the materials you would see from either Saunders's or Maryann Hogan. Very good if you're very pressed for time. I would say that if you have about 1 month or more to study, I would use: Maryann Hogan 2nd edition book, the lab value sheet I attached, the review sheet I attached, and PDA book. The Hogan book is by far better than the Saunders and/or Kaplan RN course book. It even has NCLEX highlights, which highlights info in the chapter that is most commonly asked on the NCLEX-RN. Even if you don't have time to read through the whole book, review the NCLEX highlights in this book is probably enough. In addition, the questions in this book (end of chapter quizzes and comprehensive test is the most similar type questions you will see on the NCLEX). Hopefully, this helps those who have lots of NCLEX review materials and can't decide on which one to study on or for those who are deciding on what review material to buy for the NCLEX-RN. Good luck to everyone taking the NCLEX, if I can pass it without practicing lots of questions and reviewing all the content, you can too! NCLEX-Study-Guide-Must-READ-before-test.pdf LabValues[1]NCLEX review2.docx

Jun 28, 201213 yr
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The NCLEX is of the utmost importance to your future in the nursing profession. After all, you will not be issued a nursing license anywhere in the United States if you have not taken and passed the NCLEX. And if you do not possess a nursing license, you cannot legally obtain employment as a registered nurse (RN) or licensed practical nurse (LPN). In other words, your career as a licensed nurse will be placed on hold until you pass the NCLEX. Therefore, it is important to find out as much as possible about this exam before you walk into the testing center. Preparation is the key to conquering the NCLEX. Computerized adaptive testing (CAT) is the manner in which the NCLEX is currently administered. Computerized adaptive testing adapts to each test-taker's unique ability level by coming up with the next test question based how you have performed on preceding questions. Therefore, no two NCLEX exams are exactly alike since we all arrive at the testing center with very different knowledge bases. For instance, the test-taker who does well on a group of low-level questions will start receiving medium-level test questions. If the test-taker performs well on the medium-level questions, the computer will adapt to the person's ability level and start administering high level questions. On the other hand, if the test-taker answers too many of the medium-level questions incorrectly, the computer adapts by administering some low-level questions. The computerized adaptive test is continuously trying to discover the true ability level of the test-taker. In a nutshell, the computer is continually adapting to the individual test-taker by analyzing how he/she is answering previous test questions. The computer stops the test once the performance at a certain level is demonstrated to be the test-taker's highest ability level. Therefore, if you keep receiving test questions after you have already answered 200 questions, it is because the computerized adaptive test has not yet determined your ability level. If the test ends after you have answered less than 100 questions, it is because the computerized adaptive test quickly determined your ability level. People who take the NCLEX-RN may receive anywhere from 75 to 265 questions, and those who take the NCLEX-PN may answer anywhere from 85 to 205 questions. People can and do pass NCLEX after having received 200+ questions. These test-takers were given so many questions because the computer took longer to establish a passing standard. In addition, people can and do fail NCLEX after having received less than 100 questions because the computerized adaptive test swiftly determined that way too many medium-level and high-level questions were being answered incorrectly during that testing session. Think of computerized adaptive testing as a virtual balancing beam. If you answer too many questions incorrectly in a brief time period, the beam will tilt to the left and you will fail. If you correctly answer many questions in a short period of time, the beam will tilt to the right and you will pass. If you answer some questions correctly and then proceed to answer some questions incorrectly, the beam will basically stay in the same spot throughout the exam, which means that you could be answering 200+ questions before the computerized adaptive test shuts off.

It doesn't mean anything. It's irrelevant if you're wondering whether you passed or failed. Wish I could make this post on every thread that asks this question, but I guess I'll have to be satisfied with a thread for it. :) You could have 75, 85, 92, 104, 153, 161, 260 questions. You could have the minimum number or the maximum number for your exam, and it doesn't mean that you passed or that you failed. It isn't a good sign or a bad sign if you got . The ONLY thing to consider, when getting the minimum number of questions is "is it more likely that I did really well or really poorly when the test stopped at the minimum number?" Stopping at that point means either the test "knows" that giving you more and more questions is pointless, because you either obviously know your stuff, so you pass....or you obviously don't, and won't be allowed to continue. Getting the maximum number of question means that you were close to pass, close to fail for a long time, meaning that in order to determine your competency you needed to go the full distance. And you either ended up on the 'plus' side and passed, or the 'minus' side and failed. So yes, we've seen people who pass at the minimum number and fail at the minimum number. And pass at the maximum number and fail at the maximum number. And every single number in between. Don't make yourself crazy agonizing over what the number of total questions you had means. It won't matter, and you'll just end up feeling crazy!

ANALGESICS: Aspirin do not give together with other anticoagulants. Stop taking Aspirin some days before surgery. Do not give to children with viral infection(Reye syndrome) NSAID's e.g. Ibuprofen--Take with food; contraindicated for people with GI ulcers Morphine: A respiratory depressant. It should be withheld if the respirations are below 10 ANTI-CONVULSANTS Dilantin: Causes gum hyperplasia. Advice client to visit dentist frequently ANTIINFLAMMATORY / STEROIDS Predisone: Causes Cushing like symptoms. Common side effects are immunosupression(monitor client for infection), hyperglycemia ANTI-COAGULANTS Heparin: Monitor pt's lab work-PTT. Antidote is protamine sulfate Coumadin: Monitor pt's lab work--PT. Antidote is Vitamin K ANTI-PARKINSONIAN Cogentin: Used to treat EPS Sinemet: Drug is effective when tremors are not observed RESPIRATORY Theophylline/Aminophylline: Side effects--Tachycardia CARDIOVASCULAR Digoxin (Lanoxin): Signs of toxicity: Pt will complaint of visual change in colors. They would also complain of loss of appetite. ANTIHYPERTENSIVE (PRE-ECLAMPSIA) Magnesium Sulfate: Monitor for deep tendon reflex and respiratory depression DIURETICS Hydrochlothiazide: Monitor potassium levels Lasix: Monitor potassium levels Aldactone: Potassium sparing PSYCHOTROPICS Lithium Carbonate: Know therapeutic range (0.8 to 1.2mEq). Also know symptoms of toxicity. Adequate fluid and salt intake is important. MAOI inhibitors: Have dangerous food-drug interactions. Food with Tyramine should be avoided. For example: aged cheese, wine etc. Disulfiram (Antabuse): Used for alcohol aversion therapy. Clients started on Disulfiram must avoid any form of alcohol or they would develop a severe reaction. Teach pt to avoid some over-the-counter cough preparations, mouthwash etc. MATERNITY Oxytocin: Assess uterus frequently for tetanic contraction. ANTIDOTES Narcan: Reverses the effects of narcotics Calcium Gluconate: Antidote for magnesium sulfate Vitamin K: Antidote for Coumadin Questions have been asked on NCLEX recently about the following drugs: Tegretol: side effects. Atropine: What checks do you do before giving this drug (BP.) Epogen: Used in treating anemia because it increases RBC production. Acyclovir: anti-viral medication used in treating shingles. Notes: When a client is on antibiotics, teach the client to continue taking the medication even though they feel better Monitor client taking antibiotics such as Vancomycin for ototoxicity. Pt will complain of tinnitus, room spinning (vertigo) and nausea. Clients taking vasodilators e.g. Verapramil would complain of headache. Helpful video on Drug Suffixes

Hi All, My (possibly) future job as an RN resident requires I be licensed as an RN by Jan 21st. So I am scheduled for the NLCEX on Jan. 15th!! However I graduated mid-late December and I had to move back home, across the country which took up a week and a half. Given the holidays, I didn't get started on studying till Dec. 26th. As an RN BSN student I excelled in nursing school, but at this point I have forgotten some of the key med/surg I and Fundamentals basics. And OB & Peds developmental stages is a weak point of mine. I did score 92% and 95% on two exit HESI exams I took. So I feel at this point, the NCLEX could go either way for me. I am wondering with the following resources, if anyone has advice or a good study plan. Right now I'm getting really panicked and overwhelmed by everything. I have -Kaplan On Demand: (I have completed QT 1 with 67%, 2 Q Bank tests with 64, and 70, and Diagnostic Test with 70%). However I admit I did look a couple things up cause Kaplan emailed me and said with my short amount of time to prepare, its okay to just look it up. -Saunders Yellow Book - Comprehensive Review: I know I need to review much of this book, its just so overwhelming. I took a 100 question test on the Saunders CD and scored 81. I have reviewed the first 8 chapters. -LaCharity Priortization, Delegation etc: Did a Chapter out of there and did very well. -Davis NCLEX RN Success: Its a great book but its enormous and I don't know if I have time for it. So I'm trying to calm down and set a good study plan in the time I have left. It's very hard to focus cause I'm used to studying in my own place, with peace and quiet but my family is disruptive. Does anyone have any advice on how best to use my time in these remaining 2 weeks? If anyone is in a similar situation, I would love to support each other in these last few weeks. Thanks all in advance for your advice!

You know the feeling of waiting to see the results... What did you do to kill time? Click like if you enjoyed it. Post your comments below!

Feb 11, 201214 yr
20 replies
2
- nclex
- pearson-trick
- studentlife
- toons

Here is one for all your nursing students, but I am sure all nurses can remember those days too! "So far you've spent $12,837 on coffee. I'll be happy when you're done studying for the NCLEX." Click like below, if you enjoyed this cartoon ?

Jan 18, 201214 yr
27 replies
1
- nclex
- toons

I took the test Nclex-RN yesterday and OH MY. I felt like I had never gone to nursing school. I was hoping it would shut off at 75 but it kept rolling. When I started hitting 120...130 I started to tear up and am certain I was not successful. Finally in the 150's it shut down. I bolted out of there and cried my eyes out. I know that the PVT isnt reliable and I will only know my results when the BON posts "Active" (or not) Pearson Vue told me they do NOT process tests on the weekends. I tried the trick and it will not let me register for another exam and says "delivery successful". However, could that just be because its the weekend and the tests havent been processed yet? I start my new job Monday. I wont know until that day, while Im working, what the results are. I am a mess. I have NEVER taken such a difficult test in my life. So much for the advice that the test is "basic". I got a TON of "check all that apply". Ugh!

STEP 1 Familiarize Yourself With the ExamThe first thing you should do is become familiar with what the NCLEX-RN exam is, what is covered on it, how it's administered, etc. You can find this information on the website for the National Council of State Boards of Nursing (NCSBN). NCLEX & Other Exams | NCSBN On the NCSBN's website, you can find the "Candidate Bulletin", which covers an overview of the exam, registering and scheduling the exam, what to bring on your test day, test rules, how test day runs, the content covered on the NCLEX, and information on the structure of the exam, such as the adaptive testing and the passing standard. You can also find the Test Plan for the NCLEX-RN examination on the NCSBN's website. The Test Plan shows the general content areas covered on the NCLEX-RN exam, including the percentage of items that are covered in each content area. STEP 2 Start Preparing Your FIRST Semester of Nursing SchoolThe best thing you can do to prepare for the NCLEX-RN is to start early, as in, your first semester! In most nursing schools, your exams each semester will include NCLEX-style questions. In my program, many (including me ) complained about the number of select all that apply (SATA) questions on our exams. When I took the NCLEX, over 20 of the 75 questions I had were SATA! Good thing we had that preparation. When you're studying for your exams, you should be answering the questions at the end of each chapter you're studying. Nursing school textbooks generally also have companion websites with even more questions related to each chapter (note: to access these questions you may need a code, and this code generally is only available for new copies of the book, not used). All of these questions not only reinforce the content you learn from your lectures and readings but also help you get into the habit of answering NCLEX-style questions. In addition, look into review books that have NCLEX-style questions. Throughout nursing school, I used the "Success Q&A Review" series of books. I highly recommend these books, as each book has 1000+ questions just on that subject. There are books for Fundamentals, Pharmacology, Research, Pediatrics, Maternal/Newborn, Psychiatric/Mental Health, Medical-Surgical, and Leadership. Check them out here: https://www.fadavis.com/nursing/success-series You may also find the Pearson Reviews and Rationales series helpful as well. These books contain content review, as well as questions, for each subject. Check them out here: Nursing Reviews and Rationales Check your local library for these books, rent them from Amazon, split the cost with friends, either way, doing as many NCLEX questions as possible during school will not only help you do well on exams but minimize the amount of time you spend after graduation prepping. STEP 3 Standardized Preparation Programs During SchoolMany nursing schools also employ standardized test preparation programs throughout their curriculum. This can be ATI, Kaplan, HESI, etc. My program used HESI. Some schools will factor your scores on these exams into your course grades, some require you to obtain a certain minimum score on a comprehensive exam at the conclusion of your program to graduate, and others only use them as guides for you to focus your study. It is to your benefit to maximize your use of these programs. One major benefit to these programs is that they build your test-taking stamina. In my last semester, we took three comprehensive HESI exams, with 150 questions each. This helps you get used to sitting for an extended period of time, under testing conditions, answering NCLEX-style questions. STEP 4 Start FOCUSED Preparation As Soon as Possible After GraduationAfter I graduated nursing school, I took a full week off from everything. I was done with school, I was off from work, and I did absolutely nothing related to nursing. You should definitely take some time off after graduation as well. You completed a great accomplishment: you finished nursing school! Reward yourself with a vacation or a staycation. The next question is how long should you take off? Opinions vary on that. Personally, I think 2-3 weeks max is ideal. You should definitely treat yourself after graduating, and decompress. At the same time, you don't want to take too long to get back into study-mode, especially when, if your school used a standardized testing program, you probably just finished taking a comprehensive NCLEX-style exam, and are already in NCLEX mode. Therefore, after your break, it's time to get back into the books! STEP 5 Content Review BooksOne resource that you can use is a content review book. Lets fact it, there's no way you're going to reread all of those 1000+ page nursing school textbooks. There's no way you're going to go through thousands of PowerPoint slides. A content review book summarizes the most important information from all of your nursing classes, giving you the "high yield" information that can show up on the NCLEX. The most popular content review book seems to be "Saunders Comprehensive Review for the NCLEX-RN Examination". This book has very high reviews, and I recommend it. Now, although this book is a summary, it is still dense. You should focus your reading on areas that you know you aren't as strong in. For example, I knew that pediatric nursing wasn't my strong suit, especially congenital heart defects and GI anatomical disorders. I focused my content review in pediatrics. The Saunders review book is the one I recommend, and you can borrow it from the library, split the cost with friends, buy used, etc. Note that if you buy it new, you also get a code for online questions on the companion website, which help to reinforce content. Check out the Saunders book here : Saunders Comprehensive Review for the NCLEX You can also purchase through Amazon. STEP 6 Question Resources (Books, Apps, Programs)In addition to content, your primary focus on studying should be answering as many questions as possible. For many, content review with a book like Saunders can be skipped, especially if you did extremely well in nursing school. Question practice is a must for everyone. You should have practice answering all types of NCLEX-style questions (multiple choice, SATA, hot spot, ordered response, etc.). BooksThere are a number of books that contain NCLEX-style questions for you to practice. The most highly recommended I have heard are: Lippincott Q&A Review for NCLEX-RNPrioritization, Delegation, and Assignment by LaCharityLippincott NCLEX-RN Alternate Format QuestionsI personally used the Prioritization, Delegation, and Assignment book, and this book was consistently recommended here on allnurses, and I saw why. Many NCLEX questions ask you to prioritize. Whether it's which patient you will see first, which intervention you will carry out first, or which action requires you to intervene immediately, practicing these types of questions is essential to doing well on the NCLEX-RN. These questions are also on the more difficult side, therefore they give you quality practice for the NCLEX. AppsAs I'm sure you can imagine, there are many apps available for you to answer NCLEX-style questions on the go. If you're standing in a long line or sitting on the bus, instead of checking social media again, why not answer a few questions? The best-reviewed app, and the one I used is "NCLEX Mastery". This app has over 1300 questions, and it also has mnemonics and terminology to help you study. Highly recommended! nclexmastery ProgramsThere are also a number of computer programs that offer NCLEX-style questions. The most popular are UWorld and Kaplan, which offer question banks (Kaplan also offers courses). Both UWorld and Kaplan have 1600+ questions in their banks, with all the different types of questions you would see on the NCLEX. I tried both UWorld and Kaplan. I completed all of UWorld, and about 600 questions from Kaplan. Hands down, I recommend UWorld, and I have found consistently more positive reviews for UWorld than Kaplan. UWorld offers challenging questions with a large number of SATA questions. I believe this was critical in helping me pass the NCLEX-RN. As I mentioned earlier, over 20 of the 75 questions I had were SATA, and I often had 3-4 in a row. UWorld's user interface also mirrors the NCLEX, so when you're sitting for the exam, it won't be a shock. Finally, another major benefit of UWorld is the rationales. These are the best rationales you will find anywhere. They are detailed, given for the correct and incorrect options, often have color images, and are essentially a content review. Kaplan wasn't bad, but UWorld was better. The rationales given on Kaplan questions are not detailed, and sometimes it isn't clear why an option was wrong. If you only can get one, UWorld is the one you should choose, without question (they both cost the same). UWorld also has an app that you can use on your phone. NCLEX-RN Exam - Online Practice Questions & ReviewHow do you prefer to prep for the NCLEX-RN®? STEP 7 Review CoursesFinally, a number of companies offer review courses for the NCLEX. Kaplan and Hurst review courses are very popular, and I have especially heard Kaplan mentioned. Kaplan offers a live in person review, a live online review, and a self-paced online review course. Kaplan also offers a guarantee that you'll pass the NCLEX. I have heard good things about Kaplan's course and strategies, so if you have the money, perhaps that is another option for you to consider. A course offers you a set, structured schedule to study and prepare for the exam, which can be beneficial if you need guidance in your studies. My school offered us a virtual ATI online review course. This review course was ok, it offered a tutor who gave you recommendations on what to study based on your scores on assessment exams, as well as access to other questions banks, ATI review books, and powerpoints. I don't think I would recommend it if you have to pay for it. Kaplan Review CoursesHurst Review STEP 8 Focus on Question Strategies!Let's face it: there's absolutely no way you can know everything there is to know that may be tested on the NCLEX exam. But, you can still pass! When I was taking the NCLEX, there were many questions that I didn't explicitly know. However, using test strategies I learned, I was able to narrow down the options and make an educated guess. Kaplan advertises its decision-making tool that helps you answer questions. If you purchase their course, you will learn that strategy. The Saunders book has a chapter on test-taking strategies. There is also a Saunders Strategies for Test Success book that details their strategies and provides practice questions. ATI also has test-taking strategies, and I have attached the document found on their website (note: the exam plan they discuss is not the current one, however the strategies always remain the same). Either way, learn ways to answer questions you may not know, and use those during the NCLEX. For example, if a question asks you which intervention would you implement first, you may use the ABC (Airway, Breathing, Circulation) strategy and choose to open the airway first (by sitting the patient up, for example), then administer oxygen. You may also use Maslow's Hierarchy to answer questions (by focusing on physiological needs before love/belonging needs, for example). Learning question strategies is a must to be able to answer any NCLEX question thrown at you, even if you don't know exactly the disease process or the medication being asked about. STEP 9 So What Should I Use to Study? There's So Much Out There!From all of this, it seems like there's so much out there to help you prep for the NCLEX! Indeed, it can be overwhelming. The key is to only pick a few resources, and stick to them. You absolutely need a question resource, over 1000 questions. If you feel like your content foundation is lacking, even in one or two areas, then a content review book is helpful. If you feel like you need guidance from an instructor to help you prepare, a review course would be helpful. The key is to maximize your resources. For me here is what I used: Saunders Comprehensive Review BookI only used this for a few chapters. I would use it if I found I was consistently getting certain types of questions wrong. Virtual ATI Online ReviewI completed most of this before the NCLEX, but did not complete the Predictor Exam, though I completed all of the modules and assessments. UWorldI completed all 1900+ questions Prioritization, Delegation, and Assignment BookI completed all of the questions in the first half of the book (not the case studies) Kaplan QBankI only completed about 600 of these questions NCLEX MasteryI completed about 1000 of these questions, usually on my break at work or when I was out and had downtime. So, in general, most people would find success (again, if you maximize your study) A content review bookUWorld QBankPrioritization BookFor many, a review course such as Kaplan could also be added. Based on what I have seen posted on this website, the Saunders Book, UWorld, and the PDA LaCharity book all get consistently good reviews. STEP 10 When Should You Take the NCLEX?So you've applied to and paid the state board and Pearson Vue, you've received your ATT, and now you're looking at the dates available. When should you take it? The answer to that question is individual, however, you don't want to wait too long. For me, I finished my program on 8/4 (graduation 8/31), received my ATT on 9/16, and tested on 9/20. So, I was doing focused studying for over a month. If you are doing well on your practice questions and in your review course, then you should schedule your exam as soon as possible. The best thing to do is choose a date, and as long as it's over 24 hours from the test date/time, you can reschedule. I've found that once you choose a date, it becomes more "real", and your studying becomes more purposeful. STEP 11 Tips During the ExamRemember your test-taking strategies!Carefully read each question, and look for keywords/phrases (like "not", "further information", "first", "successful", "priority")Once you choose an answer, reread the question again, check your answer, then click next! Don't dwell on an answer, as you may choose a correct one to an incorrect answer. I know I have!Take your time! Give yourself a minute or two for each question.Take a break! Sometimes it's helpful to step away for a little to refocus your mind. You don't have to wait for the scheduled breaks. If you need a break, take one! STEP 12 After the ExamCongrats! You completed the NCLEX! This is a big accomplishment, and you should be proud of yourself. If your state participates in Quick Results, you can pay for your unofficial results 48 hours after your exam on the Pearson Vue website. My exam was at 8am, and two days later the results were available at 9am (of course I was checking every 2 minutes starting at 8, haha). During the time in between, do something fun to get your mind off of the exam. It can be nerve-wracking waiting what seems like an eternity, but taking your mind off of it helps. Yes, you can also try the Pearson Vue Trick (PVT) (I know you're wondering ). Basically, if you try to re-register for the NCLEX after you put in your credit card information and hit submit if you receive an error message saying that you have recently scheduled an exam, then you passed (maybe). If it accepts your credit card payment or says declined for insufficient funds (some try this with a gift card with $5, for example), then maybe you passed, maybe you didn't. The PVT isn't 100% right all the time, but many try it. I did as well. I tried it 20 minutes after the exam, 2 hours after, 6 hours after, and after 24 hours, all the so-called "good popup". I'm not recommending you do this, but I know that many do it, and at least for me, getting the "good popup" helped me convince myself that I passed while waiting the 48 hours for quick results. ConclusionThanks for reading! I hope this guide helps you in your NCLEX-RN prep. The key is to start early, use a limited number of study resources, do focused studying, learn test-taking strategies, and remain calm during the exam. Whether you're taking the NCLEX for the first time or taking it again, with preparation, you CAN pass the NCLEX.

Sep 29, 20169 yr
2
- hurst
- kaplan
- lacharity
- lippincott
- This topic is about:
  - hurst
  - kaplan
  - lacharity
  - lippincott
  - nclex
  - nclex-mastery
  - saunders
  - uworld

Gather 'round, boys and girls, and allow me to tell you a story. An unparalleled tale of exhaustion. A regalement of courage. A dirge of loss. May it serve to protect you from the evils that may befall you, should you follow in my footsteps. May it guide you through life with the utmost caution, a warning to stir fear into the hearts of the bravest of men. May it be a reminder that lady fortune does not smile upon us all; to some she cackles madly. A few weeks ago, I took my NCLEX. Like all Russians named Ethan in our nursing class, I waited to study until the night prior to the exam. Arriving at the testing center, I felt confident - the confidence that only a lack of preparation and a blissful ignorance could provide. I began the exam soon enough, going through the mountain of select-all-that-apply questions with the fury of a thousand suns. I will beat this exam, I thought to myself as the nursing gods laughed and laughed. I was ready for the dreaded question 75. It came soon enough. And went. Ok, no big deal; twenty-five more, I thought. I can do this. When the questions continued after the hundredth, I was a Bond martini: shaken, but not yet stirred. Every five questions brought with them an expectation of a cutoff. And every five questions were a mocking lie, an affront to all I knew was true in this life. By question 183, I was resigned to my fate. This is my life now, I thought. I will answer questions until the end of time. This is how it's always been. This is how it ends. After 200, I do not know what happened or how I answered. I returned to conscious test taking at around 240, and then again at what was apparently my final question. That's when it happened. The screen flashed, it was over. I was free to return to my life. I had a wife. I had a child. I remembered now. The nursing gods took pity on my soul and showed me their twisted mercy by giving the eternal exam an end. The moral here is not to study more, no. That was merely a prelude to my forthcoming misfortune. I was exhausted. I paid for the NCLEX with every IQ point I may have possessed. I was lost in a labyrinth - the walls of which were composed of the corpses of what were once my brain cells. They fought valiantly, I assure the survivors. They will be remembered. I need to know if I passed as soon as possible, I thought, in my delirious state. I asked several reputable sources if the "Pearson Vue trick" worked and received a majority response to the affirmative. "Do it," says Matt, my classmate, my coworker, my personal Sith Lord. I convinced him earlier to try it and the website wouldn't let him register, indicating a positive result. So I began the process, sending him a screenshot to see if I was doing it right. He nodded, as much as one can nod via text message. I completed my order. It let me register, indicating I failed. This means my orientation is halted and the classes that were already scheduled for this fall would have to be delayed an entire semester. I tell him that I failed, that the registration went through, and that I paid $100 to the board of nursing to find out. He tells me I'm on the wrong website. "My wife and I are laughing," he texts back, in gentle consolation, "thanks for that." In the wake of my exam, I paid the wrong people and now I have to try to get that money back. I call the number the BON website gives me, to no avail. They're closed; business hours are 0800-1700. I try the following day at 0800, before my software orientation starts. I'm put on hold for 20 minutes but have to hang up. I try again and hold for 10 minutes on my lunch break, decide that I liked having a social life during lunch, and hang up again. When I get home, I call again, this time holding for 40 minutes, and finally someone answered, just when I had forgotten I was on a call. I must submit a refund request via email, they say, which could take up to ten days to process. If approved, they'll send something in the mail. So to recap: I called them only to be told to write an email and possibly receive a response via the post office; the people handling the request are clearly the model of efficiency. At this point, not only do I not know how I did, but I'm down an extra $100. I did, however, try the real Pearson Vue trick and can confirm that it worked for me. Luckily, I was spared another extra payment. To those taking the NCLEX soon, I wish you the best of luck. You will basically be brain-dead after that exam - it's not the hardest test, just tedious (especially when a third to a half of your 265 questions are SATA). If you remember anything from this ill-fated story, let it be this: when you try the "Pearson Vue trick," make sure you are actually on the Pearson Vue website. You would think that would require no thought, but be wary: the NCLEX can be both cruel and unusual. It pillages your brain and destroys your ability to reason. So the moral of my story is this, my fellow Nightingales: Don't make financial decisions immediately after every question on the NCLEX.

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