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NCLEX Review

Day of exam
o arrive 30 min early
o Bring valid ID
o Picture fingerprint and palm vein scan will be done.
o Pearsonvue.com/NLCEX board of nursing application
o Dont even bring your phone, dont bring any education materials
o Only bring a snack
Alternate item formats
o Multiple response
o Fill in the blank
o Hot spot
o Multiple choice
o Chart/exhibit
o Audio
o Drag and drop
On select all that apply, at least 2 will be correct
Test taking strategies
o Stop method
i. S story
1. Identify the issue and client
ii. T think
1. Key words
2. Identify the stem true or false
a. Manager reconizes a need for futher education when the nurse
does which of the following False stem
iii. O Options
1. Consider potential options/answers
2. What do you the answer should be
iv. P Pick
1. Make your selection and do not change it
SN - continue to monitor when there is nothing wrong
More priority strategies
o Choose the least restrictive/invasive answer
o Determine the clients survival potential
i. See the sickest client first
o Acute before chronic
o Stable before unstable
i. Delegation applies to stable patient

Default strategies
o Early vs Late signs and symptoms
o Pre, post, intra
o Time elapsed
o Stay with client
o Use what you know
o Prevent harm to client / What will do the least harm to the client?
o Look for most complete answer
o Safe and effective delegation
i. Evaluate
ii. Assess
iii. Teach
Things that are of concern to the nurse are things that are not expected.
2-point gate left foot right crutch at same time, then right foot left crutch same time
4-point gate individual points hit the ground separately
Swing to gait move crutches forward, swing both feet forward
o Similar to 3 point gate

Safe and effective care environment

Management of care
5 rights of delegation
o Person
o Task
o Circumstance
o Communication
o Supervision
i. RN
1. Unstable clients, assessments, initiate care plans, teaching, blood
products, IV fluids and IV push medications
ii. PN
1. Stable clients only, gather data, contribute to care plan, reinforce
teaching, monitor IVFs, and blood transfusions, administer piggybacks
iii. AP
1. Stable clients, obtain vital signs, gather specific data, hygiene care, bed
making, feeding, positioning, ambulation, NO BLOOD GLUCOSE CHECKS

Pharmacology

Tips for pharm pg. 31


Generic names only on NCLEX
o Antibiotics = Cillin, -mycin, micin, -cycline, ceph-, -floxacin
o Antivirals = -vir
o Antifungals = -azole
o Antianxiety agents = -lam, -pam
o ACE inhibitors = -pril
i. Can cause angioedema Tx with tracheostomy
ii. Can cause hyperkalemia
iii. Side effect dry hacking cough
o ARBs = -sartan
o Beta blockers = -olol
i. No grapefruit juice cause toxicity
o Calcium-channel blockers = -dipine
o Corticosteroids = -sone, -lone
i. Dont stop suddenly
o H2 blockers = -dine
o Proton pump inhibitors = -prazole
o Lipid lowering agents = -statin
i. May cause muscle weakness
ii. Dont combine with nitrates
o Erectile dysfunction meds = -afil
o CNS stimulants = -phetamine
o Antidiuretic hormones = -pressin
Blood administration pg. 42
o Packed RBC for Anemia and monitor Hgb 12-16
o Platelets for Thrombocytopenia and monitor platelets 150,000 to 400,000
o PPF (plasma protein fraction) for burns and monitor Albumin 3.5-5
o Cryoprecipitate Factor VIII for hemophilia and monitor PTT Normal 30-40 and
therapeutic (if client is on heparin therapy so we want it to take longer to clot) so
monitor PTT 45-80.
o **Every unit of blood should increase the Hgb by 1

Hypothyroid vs Hyperthyroid medications


o Levothyroxine hypothyroidism
i. Monitor for s/s of hyperthyroidism
1. Increased HR
2. Diaphoresis
3. Weight loss
o PTU and Tapozole hyperthyroidism
i. Monitor for s/s of hypothyroidism
1. Lethargy
Magnesium sulfate causes smooth muscle relaxation, antedote = calcium gluconate
Oxytocin
o Used for:
i. Induction of labor
ii. Control bleeding
iii. Interventions?
1. Monitor FHR, contractions, BP, HR, RR
Pain medications
o Opioid agonists
o NSAID
o Cannabinoids
Psychosis and ati-psychotics
o Typical (for schizophrenia, delusional disorder, schizoaffective disorder)
i. Haloperidol (antedote Cogentin)
ii. Thiothixene hydrochloride
o Typicals may cause:
i. SEATANS
1. Sedation
2. EPS
3. Anticholinergic effects
4. Tardive dyskinesia
5. Agranulocytosis
6. Neuroleptic malignant syndrome
7. Seizures
o Atypical
i. Olanazapine
ii. Aripiprazole
o Atypicals may cause
i. Lower risk of EPS and TD
ii. Added risk of weight gain, diabetes and dyslipidemia
iii. Agranulocytosis, seizures, and orthostatic hypotension

Reduction of Risk Potential

Hemophilia pg 248 lack of clotting factor


o Avoid injections and NSAIDS
Sickle cell pg 122
o s/s anemia hyposic dame to tissue, infection
o nursing intervention assess h&h
o plan activities the conserve energy
Angina myocardial infarction pg. 126
o Stable angina relieved by rest and or ntg
o Unstable angina is called preinfarction
o Prinzmetals is caused by coronary artery spasm
o TX: MONA-B
i. Morphine for pain and decreases preload and afterload
ii. Oxygen for ischemic myocardium
iii. Nitroglycerin improves coronary perfusion
iv. Aspirin decreases clot formation
ECG interpretation
o Pg. 133
o Small box 0.04 s
o Large box 0.20 s
o 5 large squares = 1 sec
o 300 = 1 min
o 15 blocks = 3 sec strip
o 30 blocks = 6 sec strip
Left and right heart failure pg 127
o CVP normal <8
o Elevated wedge pressure with left sided heart failure
Hypovolemic shock pg. 130
Diabetes pg. 118, 192
Acid-base balance p 81
o ROME
i. Resp opposite, Metabolic equal
ii. Uncompensated pH and 1 other not within expected range
iii. Partially compensated all 3 values are not within expected range
iv. Fully compensated pH is within normal, other 2 values are not within normal
v. 7.4 is absolute normal for compensation
o Above the waste you lose acid
o Below the waste you lose base
Chest tubes pg. 87
Pulmonary embolus pg. 86

Physiologic integrity basic care and comfort

Colostomy care
o 2 types of colostomies -2 piece and one piece
i. One piece you have to take it off every time you have to change it
Diets pg. 162
Enteral Nutrition
o Enteral GI tract
o Parenteral vascular
Residual less than 100ml is what you should get

Safety and infection control

Meningitis pg. 243


Premature rupture of membranes pg. 203
o Prom 1 hour before onset of labor
o PPROM anytime before 37 weeks gestation
o Biggest concern for PROM = infection risk
SEPSIS AND SEPTIC SHOCK
o Pg. 130
o You see
Subnormal temp and temp greater than 104
vascular changes
Hypovolemia
Hypotensive
Hot skin/ mottled
Respiratory compromise
ARDS ventilator
o Higher the peep the lower the blood pressure so give fluids
Renal
No perfusion U/O decreases which could decreased GFR and renal
failure
CNS alterations
o Nursing interventions
Blood tests ordered
Identify cause and treat appropriately
Broad spec antibiotics then more specific later
Progress oxygen intubation
Fluids
Inotropic meds dopamine and dobutamine
Monitor GFR, BUN, and Creatinine

Physiologic adaptation

Cancer management
o Staging I, II, III, IV
o Chemo s/s
Bone marrow suppression
Infection
Bleeding
Anemia
Stomatitis
Inflammation of mouth
o Interventions
Assess for signs of infectinos neurtopenic
Assess for signs of bleeding
Encourage energy conservation
Provide soft bland diet and frequent oral care
Promote hydration and nutrition
Pain managemtn
Assess psychosocial needs
Cirrhosis pg. 102
o s/s
portal hyptertension
esoph varices
clotting abnormalities
hepatic enceiph
ascites/peritonitis
altered nutrient and vitamin metabolism
need high calorie, low protein, low fat, low sodium diet
Emergency burn care pg. 158
o 4 x weight (kg) x % = total fluid after a burn
Half must be given within 8 hours after burn
Fat embolus pg. 108
o Petechial rash is hallmark sign
Traction pg. 109
Compartment syndrome pg. 109
Head injury and ICP pg. 144-145
Spinal cord injury 147-148
Autonomic dysreflexia pg. 148
Hemodialysis pg. 140
Peritoneal dialysis pg. 140

Decelerations pg. 197


o Turn
o BP
o IV fluid bolus
o Discontinue oxytocin
o Oxygen
o Prepare for delivery
o VEAL CHOP MINE pg 196.
VEAL
Variable, early, acceleration, late
Chop
Cord compression, head compression, other/okay, placental
insufficiency
MINE
Move, identify labor progress, no action needed, execute actions
immediately
Hypertension in pregnancy pg. 191
Abruptio placenta pg 193

Psychosocial integrity

OCD let patient finish behavior unless its harmful


Delirium vs dementia
o Delirium develops suddenly due to fever, head injury or med reaction
Therapeutic communication
o Restating
I cannot focus
Youre having trouble focusing?
o Ask open-ended
What do you perceive as your biggest stressor?
o General leads
o Focus
Depression pg. 176
Suicide precautions pg. 177
Schizophrenia pg. 174-175
Substance dependence vs. Abuse pg. 178-179

Health promotion and maintenance

Areas to review
o Harder questions are generally the analysis questions such as delegation, prioritization,
and evaluation of treatment/intervention
o The recall/recognition questions are more the below passing level questions
o Venous insufficiency legs go up (Peace up)
o Arterial insufficiency legs go down (A-town down)
o Normal WBC 5,000 to 10,000 mm
o Low urine spec. gravity is dilute urine
o Normal platelets
o Methotrexate
o Prevent fluid volume deficit by monitoring blood glucose every 4-6 hours if patient has
total parenteral nutrition.
o Wedge pressure normal range 4-12
Too high = fluid vol. overload
o 1 Liter of fluid = 1 kg of weight = 2.2 pounds
o Serum albumin of 2.8 is expected with nephrotic syndrome
o BP of 138/86 is expected with glomerulonephritis
o Hyperthyroid and hypothyroid meds
o Methylergonovine administration question if client has pre-existing medical condition
of gestational hypertension
o Dont take alcohol with Antabuse
o Phenelzine MAOI dont eat bacon & eggs, liver pepperoni pizza
o s/s of hyperkalemia vs hypokalemia
o proton pump inhibitor Side effects
o digoxin toxicity muscle weakness, blurred vision, nausea/vomiting, irregular heart
rhythm
o methimazole to treat hyperthyroidism, SE is agranulocytosis
o blood types
o lab values
o V-tach and awake meds I take
o V-tach and a nap ZAP ZAP ZAP
o Pancreatitis keep NPO so you dont secrete enzymes to digest food that eats the
pancreas
o Diverticulitis give clear liquids
o Cholecystitis low fat diet
o Liver disease decrease protein intake
o Celiac glutens BROW Barley Rye Oats and Wheat.
o N/V clear liquids

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Gout avoid purines


Dumping syndrome small frequents and avoid sugar, dont drink a lot of water with
meals too (hour before and hour after
GERD avoid large meals, eating late, alcohol, caffeine
Dont refeed if residual more than 100
Normal residual is <100 ml
Check placement of NG tube with CXR most reliable
E. coli causes massive bloody diarrhea
Anorexia causes yellow skin, amenorrhea, hypokalemia, muscle weakening,
hypotension
Uric acid stones prevent with drinking 3 liters of fluid daily
Brudzinskis sign - flexing of knees when head is tilted forward
Kernigs sign cant move knee towards stomach
Isolation
Gown mask goggles gloves
Gloves gown goggle mask
Psych drugs
Clozaril
Cytotec
For peptic ulcer disease
Diarrhea common
Neg preg test confirmed prior to starting