Answering NCLEX Questions

o Maslow's Hierarchy of Needs

- Physiologic
- Safety
- Love and Belonging
- Esteem
- Self-actualization

o Nursing Process
- Assessment
- Diagnosis (Analysis)
- Planning
- Implementation (treatment)
- Evaluation

o A8Cs
- Alrway
- 8reaLhlng
- ClrculaLlon

- Norma| Va|ues
o ngb
- Males 1418
- lemales 1216
o nct
- Males 4232
- lemales 3747
o k8Cs
- Males 4761 mllllon
- lemales 4234 mllllon
o W8Cs
- 4311k
o |ate|ets
- 130400k
o 1 (Coumadln/Warfarln)
- 11123 sec (ln8 and 1 18 132 Llmes normal)
o A11 (Peparln)
- 6070 sec (A11 and 11 18 1323 Llmes normal)
o 8un 1020
o CreaLlnlne 0312
o Clucose 70110
o CholesLerol 200
o 8lllrubln newborn 112
o henylalanlne newborn 2 AdulL 6
o na+ 136143
o k+ 333
- Pypok+ romlnenL u waves uepressed S1 segmenL llaL 1 waves
- Pyperk+ 1all 1Waves rolonged 8 lnLerval wlde C8S
o Ca++ 9103
- Pypocalcemla muscle spasms convulslons cramps/LeLany + 1rousseau's + ChvosLek's prolonged
S1 lnLerval prolonged C1 segmenL
o Mg+ 1323
o Cl 96106
o hos 343
o Albumln 333
o Spec CravlLy 10031030
o ClycosylaLed Pemoglobln (Pgb A1c) 46 ldeal 73 Ck (120 days)
o ullanLln 18 1020
o LlLhlum 18 0313
o ArLerlal 8lood Cases used for Acldosls vs Alkalosls
- P 733743
- CC2 3343 (8esplraLory drlver) Plgh Acldosls
- PCC3 2128 (MeLabollc drlver) Plgh Alkalosls
- C2 80100
- C2 SaL 93100

- AnLldoLes
o ulgoxln ulglband
o Coumadln vlLamln k (keep 1 and ln8 [ 113 x normal)
o 8enzodlazaplnes llumzaemll (1omazlcon)
o Magneslum SulfaLe Calclum CluconaLe?
o Peparln roLamlne SulfaLe (keep A11 and 11 [ 1323 x normal)
o 1ylenol MucomlsL (17 doses + loadlng dose)
o CplaLes (narcoLlc analgeslcs heroln morphlne) narcan (naloxone)
o Chollnerglc Meds (MyesLhenlc 8radycardla) ALroplne
o MeLhoLrexaLe Leucovorln

- uelegaLlon
o 8n Cnly
- 8lood roducLs (2 8ns musL check)
- CloLLlng lacLors
- SLerlle dresslng changes and procedures
- AssessmenLs LhaL requlre cllnlcal [udgmenL
- ulLlmaLely responslble for all delegaLed duLles
o unllcensed AsslsLlve ersonnel
- nonsLerlle procedures

- recauLlons 8oom AsslgnmenLs
o unlversal (SLandard) recauLlons Plv lnlLlaLed
- Wash hands
- Wear Cloves
- Cowns for splashes
- Masks and Lye roLecLlon for splashes and dropleLs
- uon'L recap needles
- MouLhplece or Ambubag for resusclLaLlon
- 8efraln from glvlng care lf you have skln leslon
o uropleL (8esplraLory) recauLlons (Wear Mask)
- Sepsls ScarleL lever SLrep llfLh ulsease (arvo 819) erLussls neumonla lnfluenza ulpLherla
LplgloLLlLls 8ubella 8ubeola MenlnglLls Mycoplasma Adenovlrus 8hlnovlrus
- 8Sv (needs conLacL precauLlons Loo)
- 18 8esplraLory lsolaLlon
o ConLacL recauLlons unlversal + Coggles Mask and Cown
o no lnfecLlon paLlenLs wlLh lmmunosuppressed paLlenLs

- Welrd Mlscellaneous SLuff
o 8lfampln (for 18) 8usL/orange/red urlne and body flulds
o yrldlum (for bladder lnfecLlon) Crange/red/plnk urlne
o Clasgow Coma Scale 8 coma
o MyesLhenla Cravls
- MyesLhenlc Crlsls Weakness wlLh change ln vlLals (glve more meds)
- Chollnerglc Crlsls Weakness wlLh no change ln vlLals (reduce meds)
o ulabeLlc Coma vs lnsulln Shock Clve glucose flrsL lf no help glve lnsulln
o lrulLy 8reaLh ulabeLlc keLoacldosls
o Acld8ase 8alance
- lf lL comes ouL of your ass lL's Acldosls
- vomlLlng Alkalosls
o Skln 1asLes SalLy CysLlc llbrosls
o LlplLor (sLaLlns) ln Ms only no grapefrulL [ulce
o SLroke 1ongue polnLs Loward slde of leslon (paralysls) uvula devlaLes away from Lhe slde of leslon
(paralysls)
o Pold ulgoxln lf P8 60
o SLay ln bed for 3 hours afLer flrsL ACL lnhlblLor dose
o Avold CrapefrulL [ulce wlLh Ca++ Channel 8lockers
o AnLhrax MulLlvecLor blohazard
o ulmonary alr embollsm prevenLlon 1rendelenburg (PC8 down) + on lefL slde (Lo Lrap alr ln rlghL slde
of hearL)
o Pead 1rauma and Selzures MalnLaln alrway prlmary concern
o epLlc ulcers leed a uuodenal ulcer (paln relleved by food) SLarve a gasLrlc ulcer
o AcuLe ancreaLlLls leLal poslLlon 8lulsh dlscoloraLlon of flanks (1urner's Slgn) 8lulsh dlscoloraLlon of
perlcumbellcal reglon (Cullen's Slgn) 8oard llke abdomen wlLh guardlng Self dlgesLlon of pancreas by
Lrypsln
o Pold Lube feedlng lf resldual 100mL
o ln case of llre 8ACL and ASS
o Check 8esLralnLs every 30 mlnuLes 2 flngers room underneaLh
o Cullaln8arre Syndrome Weakness progresses from legs upward 8esp arresL
o 1rough draw 30 mln before scheduled admlnlsLraLlon eak uraw 3060 mln afLer drug
admlnlsLraLlon


- MenLal PealLh sychlaLry
o MosL sulcldes occur afLer beglnnlng of lmprovemenL wlLh lncrease ln energy levels
o MACls PyperLenslve Crlsls wlLh 1yramlne foods
- nardll Marplan arnaLe
- need 2 wk gap from SS8ls and 1CAs Lo admln MACls
o LlLhlum 1herapeuLlc 8ange 0313
o henoLhlazlnes (Lyplcal anLlpsychoLlcs) LS hoLosenslLlvlLy
o ALyplcal AnLlpsychoLlcs work on poslLlve and negaLlve sympLoms less LS
o 8enzos (ALlvan Lorazepam eLc) good for Alcohol wlLhdrawal and SLaLus LpllepLlcus
o AnLabuse for Alcohol deLerrence Makes you slck wlLh CP lnLake
o Alcohol WlLhdrawal uelerlum 1remens 1achycardla Lachypnea anxleLy nausea shakes
halluclnaLlons paranola (u1s sLarL 1236 hrs afLer lasL drlnk)
o CplaLe (Peroln Morphlne eLc) WlLhdrawal WaLery eyes runny nose dllaLed puplls nvu cramps
o SLlmulanLs WlLhdrawal uepresslon faLlgue anxleLy dlsLurbed sleep

- MedlcalSurglcal
o PypovenLllaLlon Acldosls (Loo much CC2)
o PypervenLllaLlon Alkalosls (low CC2)
o no 8 or lv on slde of MasLecLomy
o CplaLe Cu lnpolnL uplls
o Leslons of Mldbraln uecerebraLe osLurlng (LxLended elbows head arched back)
o Leslons of CorLex uecorLlcaLe osLurlng (llexlon of elbows wrlsLs flngers sLralghL legs mummy
poslLlon)
o urlne CuLpuL of 30 mL/hr mlnlmal compeLency of hearL and kldney funcLlon
o kldney SLone CholellLhlasls
- llank paln sLone ln kldney or upper ureLer
- Abdomlnal/scroLal paln sLone ln mld/lower ureLer or bladder
o 8enal lallure 8esLrlcL proLeln lnLake
- lluld and elecLrolyLe problems WaLch for Pyperk+ (dlzzy wk nausea cramps arhyLhmlas)
- rerenal roblem lnLerference wlLh renal perfuslon
- lnLrarenal roblem uamage Lo renal parenchyma
- osLrenal roblem CbsLrucLlon ln u1 anywhere from Lubules Lo ureLhral meaLus
- usually 3 phases (Cllgourlc ulureLlc 8ecovery)
- MonlLor 8ody WL and lCs
o SLerold LffecLs Moon face hyperglycemla acne hlrsuLlsm buffalo hump mood swlngs welghL galn
Splndle shape osLeoporosls adrenal suppresslon (delayed growLh ln klds) (Cushlng's Syndrome
sympLoms)
o Addlson's' Crlsls medlcal emergency (vascular collapse hypoglycemla Lachycardla Admln lv
glucose + corLlcosLerolds) no C corLlcosLerolds on empLy sLomach
o oLasslum sparlng dlureLlc AldacLone (SplronolacLone) WaLch for hyperk+ wlLh Lhls and ACL
lnhlblLors
o Cardlac Lnzymes 1roponln (1 hr) CkM8 (24 hr) Myoglobln (14 hr) LuP1 (1224 hr)
o Ml 1x nlLro ?es nC ulgoxln 8eLablockers ALroplne
o llbrlnolyLlcs SLrepLoklnase 1enecLeplase (1nkase)
o CA8C Coronary ArLery 8ypass CrafL
o 1CA ercuLaneous 1ranslumlnal Coronary AngloplasLy
o Sex afLer Ml okay when able Lo cllmb 2 sllghLs of sLalrs wlLhouL exerLlon (1ake nlLro prophylacLlcally
before sex)
o 8P 1x 1u8 (1ransureLhral 8esecLlon of rosLaLe) some blood for 4 days and burnlng for 7 days
posL1u8
o Cnly lsoLonlc sLerlle sallne for 8ladder lrrlgaLlon
o osL 1hyroldecLomy keep LracheosLomy seL by Lhe bed wlLh C2 sucLlon and Calclum gluconaLe
o erlcardlLls erlcardlal lrlcLlon 8ub aln relleved by leanlng forward
o osL SLrep u8l ulseases and CondlLlons
- AcuLe ClomerulonephrlLls
- 8heumaLlc lever valve ulsease
- ScarleL lever
o lf a chesLLube becomes dlsconnecLed do noL clamp uL end ln sLerlle waLer
o ChesL 1ube dralnage sysLem should show bubbllng and waLer level flucLuaLlons (Lldallng wlLh
breaLhlng)
o 18 1reaLmenL wlLh mulLldrug reglmen for 9 monLhs 8lfampln reduces effecLlveness of CCs and
Lurns pee orange lsonlazlde (lnP) lncreases ullanLln blood levels
o use bronchodllaLors before sLerolds for asLhma Lxhale compleLely lnhale deeply Pold breaLh for 10
seconds
o venLllaLors Make sure alarms are on Check every 4 hours mlnlmum
o SucLlonlng re and osL oxygenaLe wlLh 100 C2 no more Lhan 3 passes no longer Lhan 13
seconds SucLlon on wlLhdrawal wlLh roLaLlon
o CCu
- Lmphysema lnk uffer
- Chronlc 8ronchlLls 8lue 8loaLer (Cyanosls 8L slded hearL fallure bloaLlng/edema)
o C2 AdmlnlsLraLlon
- never more Lhan 6L/mln by cannula
- MusL humldlfy wlLh more Lhan 4L/hr
- no more Lhan 2L/mln wlLh CCu (CC2 narcosls)
- ln ascendlng order of dellvery poLency nasal Cannula Slmple lace Mask nonrebreaLher Mask arLlal
8ebreaLher Mask venLurl Mask
- 8esLlessness and lrrlLablllLy Larly slgns of cerebral hypoxla
lvs and 8lood roducL AdmlnlsLraLlon
o 1819 gauge needle for blood wlLh fllLer ln Lublng
o 8un blood wlLh nS only and wlLhln 30 mlnuLes of hanglng
o vlLals and 8reaLh Sounds before durlng and afLer lnfuslon (13 mln afLer sLarL Lhen 30 mln laLer
Lhen hourly up Lo 1 hr afLer)
o Check 8lood Lxp uaLe cloLs color alr bubbles leaks
o 2 8ns musL check order pL blood producL Ask L abouL prevlous Lransfuslon Px
o SLay wlLh L for flrsL 13 mlnuLes lf Lransfuslon rxn SLop and kvC wlLh nS
o remedlcaLe wlLh 8enadryl prn for prevlous urLlcarla rxns
o lsoLonlc SoluLlons
- u3W
- nS (09 naCl)
- 8lngers LacLaLe
- nS only wlLh blood producLs and ullanLln
ulabeLes and lnsulln
o When ln doubL 1reaL for Pypoglycemla flrsL
o llrsL lv for ukA nS Lhen lnfuse regular lnsulln lv as 8x'd
o Pypoglycemla confuslon PA lrrlLable nausea sweaLlng Lremors hunger slurrlng
o Pyperglycemla weakness syncope polydlpsla polyurla blurred vlslon frulLy breaLh
o lnsulln may be kepL aL room 1 for 28 days
o uraw 8egular (Clear) lnsulln lnLo syrlnge flrsL when mlxlng lnsullns
o 8oLaLe ln[ecLlon SlLes (8oLaLe ln 1 reglon Lhen move Lo new reglon)
o 8apld AcLlng lnsullns Llspro (Pumalog) and AsparL (novolog) C 313 mln 7313 hrs
o ShorL AcLlng lnsulln 8egular (human) C 3060 mln 23 hrs (lv Ckay)
o lnLermedlaLe AcLlng lnsulln lsophane lnsulln (nP) C 12 hrs 612 hrs
o Long AcLlng lnsulln lnsulln Clarglne (LanLus) C 11 hr 1420 hrs (uon'L Mlx)
o Cral Pypoglycemlcs decrease glucose levels by sLlmulaLlng lnsulln producLlon by beLa cells of pancreas
lncreaslng lnsulln senslLlvlLy and decreaslng hepaLlc glucose producLlon
- Clyburlde MeLformln (Clucophage) Avandla AcLos
- Acarbose blunLs sugar levels afLer meals
Cncology
o Leukemla Anemla (reduced 88C producLlon) lmmunosuppresslon (neuLropenla and lmmaLure
W8Cs) Pemorrhage and bleedlng Lendencles (LhrombocyLopenla)
- AcuLe LymphocyLlc mosL common Lype klds besL prognosls
o 1esLlcular Cancer alnless lump or swelllng LesLlcle S1L ln shower 14 yrs 1333 Age
o rosLaLe Cancer 40 Age
- SA elevaLlon
- u8L
- MeLs Lo splne hlps legs
- LlevaLed A (prosLaLe acld phosphaLase)
- 18uS 1ransureLhral uS
- osL Cp MonlLor of hemorrhage and cardlovascular compllcaLlon
o Cervlcal and uLerlne Cancer
- Laser cryoLherapy radlaLlon conlzaLlon hysLerecLomy exenLeraLlon ChemoLherapy no help
- A smears should sLarL wlLhln 3 years of lnLercourse or by age 21
o Cvarlan Cancer leadlng cause of deaLh from gynecologlcal cancer
o 8reasL Cancer Leadlng cause of cancer ln women
- upper ouLer quadranL lefL rlghL
- MonLhly S8L
- Mammography 8asellne [ 33 Annually afLer age 30
- MeLs Lo lymph nodes Lhen lungs llver braln splne
- MasLecLomy 8adlcal MasLecLomy Lymph nodes Loo (buL no mm resecLed)
- Avold 8 measuremenLs ln[ecLlons and venlpuncLure on surglcal slde
o AnLlemeLlcs glven wlLh ChemoLherapy AgenLs (CyLoxan MeLhoLrexaLe lnLerferon eLc)
- henergan (romeLhazlne PCl)
- Compazlne (rochlorperazlne)
- 8eglan (MeLocolpramlde)
- 8enadryl (ulphenhydramlne)
- Zofran (CndanseLron PCl)
- kyLrll (CranlseLron)
Sexually 1ransmlLLed ulseases
o Syphllls (1reponema pallldum) Chancre + red palnless leslon (rlmary SLage 90 days) Secondary
SLage (up Lo 6 mo) 8ash on palms and soles + llullke sympLoms 1erLlary SLage neurologlc and
Cardlac desLrucLlon (1030 yrs) 1reaLed wlLh enlclllln C lM
o Conorrhea (nelsserla Conorrhea) ?ellow green ureLhral dlscharge (1he Clap)
o Chlamydla (Chlamydla 1rachomaLls) Mlld vaglnal dlscharge or ureLhrlLls uoxycyclln 1eLracycllne
o 1rlchomonlasls (1rlchomonas vaglnalls) lroLhy foulsmelllng vaglnal dlscharge llagyl
o Candldlasls (Candlda Alblcans) ?ellow cheesy dlscharge wlLh lLchlng Mlconazole nysLaLln
ClomlLrazole (CyneLoLrlmln)
o Perpes Slmplex 2 Acyclovlr
o Pv (Puman appllovlrus) Acld Laser CryoLherapy
o Plv CockLalls

- erloperaLlve Care
o 8reaLhlng Ls LaughL ln advance (before or early ln preop)
o 8emove nall pollsh (need Lo see cap reflll)
o re Cp Meds as ordered nC x 8 hrs lncenLlve SplromeLry 8reaLhlng Ls LaughL ln advance vold
no nSAluS x 48 hrs
o lncreased corLlcosLerolds for surgery (sLress) May need Lo lncrease lnsulln Loo
o osL Cp resLlessness may hemorrhage hypoxla
o Wound dehlscence or exLravlsaLlon WeL sLerlle nS dresslng + Call ur
o Call ur posL op lf 30 mL/hr urlne Sys 8 90 1 100 or 96
o osL Cp MonlLorlng vS and 8S Lvery 13 mlnuLes Lhe flrsL hour Lvery 30 mln nexL 2 hours Lvery
hour Lhe nexL 4 hours Lhen Lvery 4 hours prn
o 14 hrs osL Cp lmmedlaLe SLage 224 hrs osL Cp lnLermedlaLe SLage 14 days osL Cp
LxLended SLage
o osL Cp oslLlonlng
- 1P8 no AdducLlon pasL mldllne no hlp flexlon pasL 90 degrees
- SupraLenLorlal Sx PC8 3043 degrees (Semllowler)
- lnfranLenLorlal Sx llaL
- hleblLls Suplne elevaLe lnvolved leg
- Parrls 1ube 8L/back/LL Lo advance Lube ln Cl
- Mlller AbboLL 1ube 8lghL slde for Cl advancemenL lnLo small lnLesLlne
- 1horacocenLesls unaffecLed slde PC8 3043 degrees
- Lnema LefL Slms (flow lnLo slgmold)
- Llver 8lopsy 8lghL slde wlLh plllow/Lowel agalnsL puncLure slLe
- CaLaracL Sx Cpp slde Semllowler
- Cardlac CaLheLerlzaLlon llaL (PC8 no more Lhan 30 degrees) Leg sLralghL 46 hrs bed resL 612 hrs
- 8urn AuLograph LlevaLed and lmmob 37 days
- AmpuLaLlon Suplne elevaLe sLump for 48 hrs
- Large 8raln 1umor 8esecLlon Cn nonoperaLlve slde
o lncenLlve SplromeLry lnhale slowly and compleLely Lo keep flow aL 600900 Pold breaLh 3 seconds
10 Llmes per hr
o osL Cp 8reaLhlng Lxerclses Lvery 2 hours
- SlL up sLralghL
- 8reaLh ln deeply Lhru nose and ouL slowly Lhru pursed llps
- Pold lasL breaLh 3 seconds
- 1hen cough 3 Llmes (unless abd wound relnforce/spllnL lf cough)
o WaLch for SLrldor afLer any neck/LhroaL Sx keep 1rach klL aL bed slde
o SLaples and suLures removed ln 714 days keep dry unLll Lhen
o no llfLlng over 10 lbs for 6 weeks (ln general)
o lf chesL Lube comes dlsconnecLed puL free end ln conLalner of sLerlle waLer
o 8emovlng ChesL 1ube valsalvas or ueep breaLh and hold
o lf chesL Lube draln sLops flucLuaLlng Lhe lung has relnflaLed (or Lhere ls a problem)
o keep sclssors by bed lf pL has S 8lakemore 1ube (for esoph varlces) Sudden resplraLory dlsLress CuL
lnflaLlon Lubes and remove
o 1racheosLomy paLlenLs keep kelly clamp and CbLuraLor (used Lo lnserL lnLo Lrachea Lhen removed
leavlng cannula) aL bed slde
o 1urn off nC sucLlon for 30 mln afLer C meds
o nC 1ube 8emoval 1ake a deep breaLh and hold lL
o SLomach conLenLs pP 4 (gasLrlc [ulces asplraLed)
o nC 1ube lnserLlon lf cough and gag back off a llLLle leL calm advance agaln wlLh pL slpplng waLer
from sLraw
o nC 1ube LengLh Lnd of nose Lo era lobe Lo xyphold (2226 lnches)
o uecublLus (pressure) ulcer SLaglng
- SLage 1 LryLhema only
- SLage 2 arLlal Lhlckness
- SLage 3 lull Lhlckness Lo SC
- SLage 4 lull Lhlckness + lnvolvlng mm /bone

- AcuLe Care
o CvA Pemorrhaglc or Lmbollc
- Aflb and AfluLLer Lhrombus formaLlon
- uysarLhrla (verbal enunclaLlon/arLlculaLlon) Apraxla (perform purposeful movemenLs) uysphasla
(speech and verbal comprehenslon) Aphasla (speaklng) Agraphla (wrlLlng) Alexla (readlng) uysphagla
(swallowlng)
- LefL Pemlsphere Leslon aphasla agraphla slow cauLlous anxlous memory okay
- 8lghL Pemlsphere Leslon can'L recognlze faces loss of depLh percepLlon lmpulslve behavlor
confabulaLes poor [udgmenL consLanLly smlles denles lllness loss of Lonal hearlng

o 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.
o 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)
o 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 Ps of neurovascular status (important with fractures)
- Pain, Pallor, Pulse, Paresthesia, Paralysis
- Provide age-appropriate toys for kids in traction

- Special Tests and Pathognomonic Signs
o Tensilon Test . Myesthenia Gravis (+ in Myesthenic crisis, - in Cholinergic crisis)
o ELISA and Western Blot . HIV
o Sweat Test . Cystic Fibrosis
o Cheilosis = Sores on sides of mouth . Riboflavin deficiency (B2)
o Trousseaus Sign (Carpal spasm induced by BP cuff) . Hypocalcemia (hypoparathyroidism)
o Chvosteks Sign (Facial spasm after facial nerve tap) . Hypocalcemia (hypoparathyroidism)
o Bloody Diarrhea = Ulcerative Colitis
o Olive-Shaped Mass (epigastric) and Projectile Vomiting = Pyloric Stenosis
o Current Jelly Stool (blood and mucus) and Sausage-Shaped Mass in RUQ = Intussiception
o Mantoux Test for TB is + if 10 mm induration 48 hrs post admin (previous BCG vaccine recipients
will test +)
o Butterfly Rash = SLE . Avoid direct sunlight
o 5 Ps of NV functioning . Pain, paresthesia, pulse, pallor, paralysis
o Cullens Sign (periumbelical discoloration) and Turners Sign (blue flank) = Acute Pancreatitis
o Murphys Sign (Rt. costal margin pain on palp with inspiration) = GB or Liver disease
o HA more severe on wakening = Brain Tumor (remove benign and malignant)
o Vomiting not associated with nausea = Brain Tumor
o Elevated ICP = Increased BP, widened pulse pressure, increased Temp
o Pill-Rolling Tremor = Parkinsons (Tx with Levodopa, Cardidopa) - Fall precautions, rigid, stooped,
shuffling
o IG Bands on Electrophoresis = MS . Weakness starts in upper extremities - bowel/bladder affected
in 90% . Demyelination - Tx with ACTH, corticosteroids, Cytoxan and other immunosuppressants
o Reed-Sternberg Cells = Hodgkins
o Koplik Spots = Rubeola (Measles)
o Erythema Marginatum = Rash of Rheumatic Fever
o Gowers Sign = Muscular Dystrophy . Like Minors sign (walks up legs with hands)

- Pediatrics
o 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
o 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)
o Autosomal Dominant Diseases
- Huntingtons, Marfans, Polydactyl, Achondroplasia, Polycystic Kidney Disease
- 50% if one parent has the disease/trait (trait = disease in autosomal dominant)
o X-Linked Recessive Diseases
- Muscular Dystrophy, Hemophilia A
- Females are carriers (never have the disease)
- Males have the disease (but cant pass it on)
- 50% chance daughters will be carriers (cant have disease)
- 50% chance sons will have the disease (not a carrier = cant pass it on)
- This translates to an overall 25% chance that each pregnancy will result in a child that has the
disease
o Scoliosis . Milwaukee Brace - 23 hrs/day, Log rolling after Sx
o Down Syndrome = Trisomy 21 . Simian creases on palms, hypotonia, protruding tongue, upward
outward slant of eyes
o Cerebral Palsy . Scissoring = legs extended, crossed, feet plantar-flexed
o PKU . leads to MR . Guthrie Test .Aspartame (NutraSweet) has phenylalanine in it and should not
be given to PKU patient
o Hypothyroidism . Leads to MR
o Prevent Neural tube disorders with Folic Acid during PG
o Myelomeningocele . Cover with moist sterile water dressing and keep pressure off
o 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 - dont pump shunt. Older kids IIPC = Widened pulse
pressure
- IICP caused by suctioning, coughing, straining, and turning - Try to avoid
o Muscular Dystrophy . X-linked Recessive, waddling gait, hyper lordosis, Gowers Sign = difficulty
rising walks up legs (like Minors sign), fat pseudohypertrophy of calves.
o Seizures . Nothing in mouth, turn hd to side, maintain airway, dont restrain, keep safe . Treat
with Phenobarbitol (Luminol), Phenytoin (Dilantin: TR = 10-20 . Gingival Hyperplasia), Fosphenytoin
(Cerebyx), Valproic Acid (Depakene), Carbamazepine (Tegritol)
o 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
o CF Kids taste salty and need enzymes sprinkled on their food
o Children with Rubella = threat to unborn siblings (may require temporary isolation from Mom during
PG)
o Pain in young children measured with Faces pain scale
o No MMR Immunization for kids with Hx of allergic rxn to eggs or neomycin
o Immunization Side Effects . T < 102, redness and soreness at injection site for 3 days . give
Tylenol and bike pedal legs (passively) for child.
o Call Physician if seizures, high fever, or high-pitched cry after immunization
o All cases of poisoning . Call Poison Control Center . No Ipecac!
o 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 kids mouth
o 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
o Acute Glomerulonephritis . After B strep - Antigen-Antibody complexes clog up glomeruli and
reduce GFR = Dark urine, proteinuria
o Wilms Tumor = Large kidney tumor . Dont palpate
o %EF = %racheoesophageal Atresia . 3 Cs of TEF = Coughing, Choking, Cyanosis
o Cleft Lip and Palate . Post-Op - Place on side, maintain Logan Bow, elbow restraints
o 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
o 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 < 32 oz/day
o 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

o 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)
o Primary meds for ER for respiratory distress = Sus-phrine (Epinephrine HCl) and Theophylline
(Theo-dur) . Bronchodilators
o 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
o Acyanotic = VSD, ASD, PDA, Coarc of Aorta, Aortic Stenosis
- Antiprostaglandins cause closure of PDA (aorta - pulmonary artery)
o Cyanotic = Tetralogy of Fallot, Truncus Arteriosis (one main vessel gets mixed blood), TVG
(Transposition of Great Vessels) . Polycythemia common in Cyanotic disorders
- 3 Ts of Cyanotic Heart Disease (Tetralogy, Truncus, Transposition)
o Tetralogy of Fallot . Unoxygenated blood pumped into aorta
- Pulmonary Stenosis
- VSD
- Overiding Aorta
- Right Ventricular Hypertrophy
- TET Spells .Hypoxic episodes that are relieved by squatting or knee chest position
o CHF can result . Use Digoxin . TR = 0.8-2.0 for kids
o Ductus Venosus = Umbelical Vein to Inferior Vena Cava
o Ductus Arteriosus = Aorta to Pulmonary Artery
o 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
o 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
o Chadwicks Sign = Bluing of Vagina (early as 4 weeks)
o Hegars Sign = Softening of isthmus of cervix (8 weeks)
o Goodells Sign = Softening of Cervix (8 weeks)
o Pregnancy Total wt gain = 25-30 lbs (11-14 kg)
o Increase calorie intake by 300 calories/day during PG . Increase protein 30 g/day . Increase iron,
Ca++, Folic Acid, A & C
o Dangerous Infections with PG . TORCH = Toxoplasmosis, other, Rubella, Cytomegalovirus, HPV
o Braxton Hicks common throughout PG
o Amniotic fluid = 800-1200 mL (< 300 mL = Oligohydramnios = fetal kidney problems)
o Polyhydramnios and Macrosomia (large fetus) with Diabetes
o Umbelical cord: 2 arteries, 1 vein . Vein carries oxygenated blood to fetus (opposite of normal)
o FHR = 120-160
o Folic Acid Deficiency = Neural tube defects
o Pre-term = 20-37 weeks
o Term = 38-42 weeks
o Post-term = 42 weeks+
o TPAL = Term births, Pre-term births, Abortions, Living children
o Gravida = # of Pregnancies regardless of outcome
o Para = # of Deliveries (not kids) after 20 wks gestation
o Nagales Rule . Add 7 days to first day of last period, subtract 3 months, add 12 months = EDC
o Hgb and Hct a bit lower during PG due to hyperhydration
o Side-lying is best position for uteroplacental perfusion (either side tho left is traditional )
o 2:1 Lecithin:Sphingomyelin Ratio = Fetal lungs mature
o AFP in amniotic fluid = possible neural tube defect
o Need a full bladder for Amniocentesis early in PG (but not in later PG)
o Lightening = Fetus drops into true pelvis
o Nesting Instinct = Burst of Energy just before labor
o True Labor = Regular contractions that intensify with ambulation, LBP that radiates to abdomen,
progressive dilation and effacement
o Station = Negative above ischial spines, Positive below
o Leopold Maneuver tries to reposition fetus for delivery
o Laboring Maternal Vitals . Pulse < 100 (usually a little higher than normal with PG - BP is
unchanged in PG). T < 100.4
o NON-Stress Test . Reactive = Healthy (FHR goes up with movements)
o Contraction Stress Test (Ocytocin Challenge Test). Unhealthy = Late decels noted (positive result)
indicative of UPI . "Negative result = No late decels noted (good result)
o Watch for hyporeflexia with Mag Sulfate admin . . . Diaphragmatic Inhibition
- Keep Calcium gluconate by the bed (antidote)
o Firsts
- Fetal 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
o Early Decels = Head compression = OK
o Variable Decels = Cord compression = Not Good
o Late Decels = Utero-placental insufficiency = BAD!
o If Variable or Late Decels . Change maternal position, Stop Pitocin, Administer O2, Notify Physician
o DIC . Tx is with Heparin (safe in PG) . Fetal Demise, Abruptio Placenta, Infection
o Fundal Heights
- 12-14 wks . At level of symphysis
- 20 weeks . 20 cm = Level of umbilicus
- Rises ~ 1 cm per week
o 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
o Placenta Separation . Lengthening of cord outside vagina, gush of blood, full feeling in vagina .
Give oxytocin after placenta is out - Not before.
o Schultz Presentation = Shiny side out (fetal side of placenta)
o 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
o Normal BM for mom within 3 days = Normal
o Lochia . no more than 4-8 pads/day and no clots > 1 cm . Fleshy smell is normal, Foul smell =
infection
o Massage boggy uterus to encourage involution . empty bladder ASAP - may need to catheterize .
Full bladder can lead to uterine atony and hemorrhage
o Tears .1st Degree = Dermis, 2nd Degree = mm/fascia, 3rd Degree = anal sphincter, 4th Degree =
rectum
o APGAR = HR, R, mm tone, Reflex irritability, Color . 1 and 5 minutes .7-10 = Good, 4-6 =
moderate resuscitative efforts, 1-3 = mostly dead
o Eye care = E-mycin + Silver Nitrate . for gonorrhea
o Pudendal Block = decreases pain in perineum and vagina - No help with contraction pain
o Epidural Block = T10-S5 . Blocks all pain . First sign = warmth or tingling in ball of foot or big toe
o Regional Blocks often result in forceps or vacuum assisted births because they affect the mothers
ability to push effectively
o WBC counts are elevated up to 25,000 for ~10 days post partum
o 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)
o Caput Succedaneum = edema under scalp, crosses suture lines
o Cephalhematoma = blood under periosteum, does not cross suture lines
o Suction Mouth first - then nostrils
o Moro Reflex = Startle reflex (abduction of all extremities) - up to 4 months
o Rooting Reflex . up to 4 months
o Babinski Reflex . up to18 months
o Palmar Grasp Reflex .Lessens by 4 months
o Ballard Scale used to estimate gestational age
o Heel Stick = lateral surface of heel
o Physiologic Jaundice is normal at 2-3 days . Abnormal if before 24 hours or lasting longer than 7
days . Unconjugated bilirubin is the culprit.
o 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
o Abrutio Placenta = Dark red bleeding with rigid board like abdomen
o Placenta Previa = Painless bright red bleeding
o 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.
o 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 DTRs
- Respirations < 12
- Urinary Output < 30/hr
- Fetal Bradycardia
o 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.
o Suspect uterine rupture if woman complains of a sharp pain followed by cessation of contractions
o Pre-Eclampsia = Htn + Edema + Proteinuria
o Eclampsia = Htn + Edema + Proteinuria + Seizures and Coma . Suspect if Severe HA + visual
disturbances
o No Coumadin during PG (Heparin is OK)
o Hyperemesis Gravidarum = uncontrollable nausea and vomiting . May be related to H. pyolori .
Reglan (metaclopromide)
o Insulin demands drop precipitously after delivery
o No oral hypoglycemics during PG - Teratogenic . Insulin only for control of DM
o Babies born without vaginal squeeze more likely to have respiratory difficulty initially
o C-Section can lead to Paralytic Ileus . Early ambulation helps
o Postpartum Infection common in problem pregnancies (anemia, diabetes, traumatic birth)
o 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
o Jitteriness is a symptom of hypoglycemia and hypocalcemia in the newborn
o Hypoglycemia . tremors, high pitched cry, seizures
o High pitched cry + bulging fontanels = IICP
o Hypothermia can lead to Hypoxia and acidoisis . Keep warm and use bicarbonate prn to treat
acidosis in newborn.
o Lay on right side after feeding . Move stomach contents into small intestine
o Jaundice and High bilirubin can cause encephalopathy . < 12 = normal . Phototherapy decomposes
bilirubin via oxidation . Protect eyes, turn every 2 hours and watch for dehydration . The dangerous
bilirubin is the unconjugated indirect type.

- Nutrition
o K+ . Bananas, dried fruits, citrus, potatoes, legumes, tea, peanut butter
o Vitamin C . Citrus, potatoes, cantaloupe
o Ca++ . Milk, cheese, green leafy veggies, legumes
o Na+ . Salt, processed foods, seafood
o Folic Acid . Green leafy veggies, liver, citrus
o Fe++ . Green leafy veggies, red meat, organ meat, eggs, whole wheat, carrots
- Use Z-track for injections to avoid skin staining
o Mg+ . Whole grains, green leafy veggies, nuts
o Thiamine (B1) . Pork, beef, liver, whole grains
o B12 . Organ meats, green leafy veggies, yeast, milk, cheese, shellfish
- Deficiency = Big red beefy tongue, Anemia
o Vitamin K . Green leafy veggies, milk, meat, soy
o Vitamin A . Liver, orange and dark green fruits and veggies
o Vitamin D . Dairy, fish oil, sunlight
o Vitamin E . Veggie oils, avocados, nuts, seeds
o BMI . 18.5-24.9 = Normal (Higher = Obese)

- Gerontology
o 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

o Common Ailments:
- Delerium and Dementia
- Cardiac Dysrhythmias
- Cataracts and Glaucoma
- CVA (usually thrombotic, TIAs common)
- Decubitus Ulcers
- Hypothyroidism
- Thyrotoxicosis (Graves Disease)
- COPD (usually combination of emphysema and CB)
- UTIs and Pneumonia . Can cause confusion and delerium
o Memory loss starts with recent - progresses to full
o Dementia = Irreversible (Alzheimers) . Depression, Sundowning, Loss of family recognition
o Delerium = Secondary to another problem = Reversible (infections common cause)
o Medication Alert! . Due to decreased renal function, drugs metabolized by the kidneys may persist
to toxic levels
o When in doubt on NCLEX . Answer should contain something about exercise and nutrition.

- Advanced Clinical Concepts
o 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
o 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
o 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
o 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
o Round final answer to tenths place
o Round drops to nearest drop
o When calculating mL/hr, round to nearest full mL
o Must include 0 in front of values < 1
o Pediatric doses rounded to nearest 100th. Round down for peds
o Calculating IV Flow Rates
- Total mL X Drop Factor / 60 X #Hrs = Flow Rate in gtts/min
o Calculating Infusion Times
- Total mL X Drop Factor / Flow Rate in gtts/min X 60 = Hrs to Infuse

- Conversions
o 1 t = 5mL
o 1 T = 3 t = 15 mL
o 1 oz = 30 cc = 30 mL = 2 T
o 1 gr = 60 mg
o 1 mg = 1000 ug (or mcg)
o 1 kg = 2.2 lbs
o 1 cup = 8 oz = 240 mL
o 1 pint = 16 oz
o 1 quart = 32 oz
o Degrees F = (1.8 X C) + 32
o 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
o Room close to nurses station
o Assessment and orientation to room
o Get help to stand (dangle feet if light headed)
o Bed low with side rails up
o Good lighting and reduce clutter in room
o Keep consistent toileting schedule
o Wear proper non-slip footwear
o At home .
- Paint edges of stairs bright color
- Bell on cats and dogs

- Neutropenic (Immunosuppressed) Precautions
o No plants or flowers in room
o No fresh veggies . Cooked foods only
o Avoid crowds and infectious persons
o Meticulous hand washing and hygiene to prevent infection
o Report fever > 100.5 (immunosuppressed pts may not manifest fever with infection)

- Bleeding Precautions (Anticoagulants, etc.)
o Soft bristled tooth brush
o Electric razor only (no safety razors)
o Handle gently, Limit contact sports
o Rotate injection sites with small bore needles for blood thinners
o Limit needle sticks, Use small bore needles, Maintain pressure for 5 minutes on venipuncture sites
o No straining at stool - Check stools for occult blood (Stool softeners prn)
o No salicylates, NSAIDs, or suppositories
o Avoid blowing or picking nose
o Do not change Vitamin K intake if on Coumadin