NCLEX-PN Study Guide: Comprehensive Reference for Nursing Exam Preparation, Exams of Advanced Education

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NCLEX-PN Study Guide

serum electrolyte - a blood test that measures the main electrolytes in the body: sodium, potassium, calcium, chloride, magnesium, phosphorus sodium - 135-145 mEq/L potassium - 3.5-5.5 mEq/L calcium - 8.5-10.9 mg/L chloride - 95-105 mEq/L magnesium - 1.5-2.5 mEq/L phosphorus - 2.5-4.5 mg/dL Hematology - STUDY OF BLOOD: RBC, WBC, Plt, Hgb RBC - 4.5-5.0 million WBC - 5,000-10, Plt (platelet count) - 200,000-400, Hgb (hemoglobin) women - 12-16 gms Hgb (hemoglobin) men - 14-18 gms

ABG values - arterial blood gas HCO3 - 24-26 mEq/L CO2 - 35-45 mEq/L PaO2 - 80%-100% SaO2 - >95% Glucose - 70-110 mg/dL specific gravity - 1.010-1. BUN (blood urine nitrogen) - 7-22 mg/dL serum creatinine - 0.6-1.35 mg/dL (<2 in older adults) LDH - 100-190 U/L CPK - 21-232 U/L Uric acid - 3.5-7.5 mg/dL Triglyceride - <150 mg/dL total cholesterol - 130-200 mg/dL Bilirubin - <1.0 mg/dL

Protein - 6.2-8.1 g/dL Alubumin - 3.4-5.0 g/dL Therapeutic drug levels - refers to the appropriate level of a medication in the blood, enough to produce the desired effect but not enough to cause harm Digoxin - 0.5-2.0 ng/mL Lithium - 0.8-1.5 mEq/L Dilantin - 10-20 mcg/dL Theophylline - 10-20 mcg/dL adult vital signs - HR: 80- Respiratory rate: 12- Blood pressure: 110-120 / 60- Temperature: 98.6 +/- maternity normals FHR (fetal heart rate) variability - 120-160 BPM with 6-10 BPM normal frequency contractions - 2-5 min apart normal duration contractions - <90 second

intensity of contractions - <100 mm/hg amniotic fluid - 500-1200 ml (nitrozine urine-litmus paper green/amniotic fluid litmus paper blue) Apgar Scoring - A-appearance P-pulses G-grimace A-activity R-reflexes done at 1 and 5 min with a score of 0 for absent, 1 for decreased, and 2 for strongly positive AVA - the umbilical cord has two arteries and one vein (arteries carry deoxygenated blood. The vein carries oxygenated blood) FAB 9-Folic acid=B9 (B stands for brain) decrease the incidence of neural tube defects - the client should be taking B9 three months prior to becoming pregnant abnormalities in the laboring obstetric client - decelerations are abnormal findings on the fetal monitoring strip decelerations are classified by: - early decelerations, variable decelerations, and late decelerations early decelerations - begin prior to the peak of the contraction and end by the end of the contraction. they are caused by head compression. there is no need for intervention if the variability is within normal range (that is, there is a rapid return to the baseline fetal heart rate) and the fetal heart rate is within normal range variable decelerations - are noted as V-shaped on the monitoring strip. variable decelerations can occur anytime during monitoring the fetus. they are caused by cord compression. the intervention is to change the mothers position; if pitocin is infusing, stop the infusion; apply oxygen; and increase the rate of IV fluids. contact the doctor is the problem persists late decelerations - occur after the peak of the contraction and mirror the contraction in length and intensity. these are caused by uteroplacental insufficiency. the intervention is to change the mother's position; if pitocin is infusing, stop the infusion; apply oxygen; and increase the rate of IV fluids. contact the doctor is the problem persists

TORCHS syndrome in the neonate - this is a combination of diseases. these include toxoplasmosis, rubella (German measles), cytomegalovirus, herpes, and syphyllis. pregnant nurses should not be assigned to care for the client with toxoplasmosis or cytomegalovirus STOP - this is the treatment for maternal hypotension after an epidural anesthesia

1. stop pitocin if infusing
2. turn the client on the left side
3. adminster oxygen
4. if hypovolemia is present, push IV fluids anticoagulant therapy and monitoring: - coumadin (sodium wararin) and heparin/lovenox/dalteparin Coumadin (sodium warfarin) PT - 10-12 seconds control coumadin antidote - vitamin K heparin/lovenox/dalteparing PTT - 30-45 seconds control heparin antidote - protamine sulfate therapeutic level of anticoagulant therapy - it is important to maintain a bleeding time that is slightly prolonged so that clotting will not occur; therefore, the bleeding time with medication should be 1 1/2- times the control (the control is the premedication bleeding time) Rules of nines for calculation TBSA for burns - head, arms, back, legs, genitalia head - 9% arms - 18 % (9% each)

back - 18% legs - 36% (18% each) genitalia - 1% Arab American cultural attributes - females avoid eye contact with males; touch is accepted if done by same-sex healthcare providers; most decisions are made by males; Muslims (Sunni), refuse organ donation; most Arabs do not eat pork; they avoid icy drinks when sick or hot/cold drinks together; colostrum is considered harmful to the newborn Asian American cultural attributes - they avoid direct eye contact; feet are considered dirty (the feet should be touched last during assessment); males make most of the decisions; they usually refuse organ donation; they generally do not prefer cold drinks, believe in the "hot-cold" theory of illness Native American cultural attributes - they sustain eye contact; blood and organ donation is generally refused; they might refuse circumcision; might prefer care from the tribal shaman rather than using western medicine Mexican American cultural attributes - they might avoid direct eye contact with authorities; they might refuse organ donation; most are very emotional during bereavment; believe in the "hot-cold" theory of illness Jehovahs Witness - no blood products should be used Hindu - no beef or items containing gelatin Jewish - special dietary restrictions, use of kosher foods Renal diet - high calorie, high carbohydrate, low protein, low potassium, low sodium, and fluid restricted to intake=output + 500 ml

Gout diet - low purine; omit poultry ("cold chicken") medication for acute episodes: Colchicine; maintenance medication: Zyloprim Heart Healthy Diet - low fat (less than 30% of calories should be from fat) ROME - respiratory opposite/metabolic equal-a quick way of remembering that in respiratory acid/base disorders the pH is opposite to the other components. For example, in respiratory acidosis, the pH is below normal and the CO2 is elevated, as is the HCO3 (respiratory opposite). In metabolic disorders, the components of the lab values are the same. An example of this is metabolic acidosis. in metabolic acidosis, the pH is below normal and the COs is decreased, as is the HCO3. This is true in a compensated situation. pH down, CO2 up, and HCO3 up= - respiratory acidosis Ph down, CO2 down, and HCO3 down = - metabolic acidosis pH up, CO2 down, and HCO3 down= - respiratory alkalosis pH up, CO2 up, and HCO3 up= - metabolic alkalosis Addisons versus Cushings - diseases of the endocrine system involving either overproduction or inadequate production of cortisol treatment of Addisons - increase sodium intake; medications include cortisone preparation treatment of Cushings - restrict sodium; observe for signs of infection treatment for spider bites/bleeding - RICE- rest, ice, compression, and elevate extremity treatment for sickle cell crises - HHOP-heat, hydration, oxygen, pain medications

Five Ps of fractures and compartment syndrome - pain, pallor, pulselessness, paresthesia, polar (cold) hip fractures - commonly hemorrhage, whereas femur fractures are at risk for fat emboli profile of gallbladder disease - fair, fat, forty, five pregnancies, flatulent (can occur in all ages and both sexes) tort - A breach of some obligation causing harm or injury to someone ; a civil wrong, such as negligence or libel negligence - Careless neglect, often resulting in injury malpractice - -if a professional violates her or his duty of care toward a client, the professional may be sued for this slander - False charges and malicious oral statements about someone assault - A threatened or attempted physical attack by someone who appears to be able to cause bodily harm if not stopped batter - the unlawful beating of a person; act of beating or pounding; any large group of related things Angiotensin-converting agents - Benazepril (Lotensin), lisinopril (Zestril), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), moexirpil (Univas), quinapril (Acupril), ramipril (Altace) Beta adrenergic blockers - Acebutolol (Monitan, Rhotral, Sectral), atenolol (Tenormin, Apo-Atenol, Nova- Atenol), esmolol (Breviblock), metaprolol (Alupent, Metaproterenol), propanolol (Inderal) Anti-infective drugs - Gentamicin (Garamycin, Alcomicin, Genoptic), kanamycin (Kantrex), neomycin (Mycifradin), streptomycin (Streptomycin), tobramycin (Tobrex, Nebcin), amikacin (Amikin)

Benzodiazepine drugs - Clonazepam (Klonopin), diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), flurazepam (Dalmane) Phenothiazine drugs - chlopromazine (thorazine), prochlorperazine (compazine), trifluoperazine (stelazine), promethazine (phenergan), hydroxyzine (vistaril), fluphenazine (prolixin) Glucocorticoid drugs - prednisolone (delta-cortef, prednisol, prednisolone), prednisone (apo-prednisone, deltasone, meticorten, orasone, panasol-s), betamethasone (celestone, selestoject, betnesol), dexamethasone (decadron, deronil, dexon, mymethasone, dalalone), cortisone (cortone), hydrocortisone (cortef, hydrocortone phosphate, cortifoam), methylprednisolone (solu-cortef, depo- medrol, depopred, medrol, rep-red), triamcinolone (amcort, aristocort, atolone, kenalog, triamolone) Antivirals - acyclovir (zovirax), ritonavir (norvir), saquinavir (invirase, fortovase), indinavir (crixivan), abacavir (ziagen), cidofovir (vistide), ganciclovir (cytovene, vitrasert) Cholesterol-lowering drugs - atorvastatin (lipitor), fluvastatin (lescol), lovastatin (mevacor), pravastatin (pravachol), simvastatin (zocar), rosuvastatin (crestor) angiotensin receptor blocker drugs - valsartan (diovan), candesartan (altacand), losartan (cozaar), telmisartan (micardis) histamine 2 antagonist drugs - cimetidine (tagamet), famotidine (pepcid), nizatidine (axid), rantidine (zantac) proton pump inhibitors - esomeprazole (nexium), lansoprazole (prevacid), pantoprazole (protonix), rabeprazole (AciPhex) anticoagulant drugs - heparin sodium (hepalean), enoxaparin sodium (lovenox), dalteparin sodium (fragmin) drug schedule I - research use only (example LSD)

drug schedule II - requires a written prescription (example Ritalin) drug schedule III - requires a new prescription after six months or five refills (example codeine) drug schedule IV - requires a new prescription after six months (example Darvon) drug schedule V - dispensed as any other prescription or without prescription if state law allows (example antitussives) antacids - reduce hydrochloric acid in the stomach antianemics - increase red blood cell production anticholenergics - decrease oral secretions anticoagulants - prevent clot formation anticonvulsants - used for management of seizures/bipolar disorder antidiarrheals - decrease gastric motility and reduce water in bowel antihistamines - block the release of histamamine antihypertensives - lower blood pressure and increase blood flow anti-infectives - used for the treatment of infections bronchodilators - dilate large air passages in asthma/lung disease

diuretics - decrease water/sodium from the Loop of Henle laxatives - promote the passage of stool miotics - constrict the pupils mydriatics - dilate the pupils narcotics/analgesics - relieve moderate to severe pain management and delegation 1 - delegate sterile skills such as dressing changes o the RN or LPN. where nonskilled care is required, you can delegate the stable client to the nursing assistant. choose the most critical client to assign to the RN, such as the client who has recently returned from chest surgery. clients who are being discharged should have final assessments done by the RN management and delegation 2 - the PN, like the RN, can monitor clients with IV therapy, insert urinary catheters and feeding tubes, apply restraints, discontinue IVs, drains, and sutures management and delegation 3 - for room assignments, do not coassign the post-operative client with clients who have vomiting, diarrhea, open wounds, or chest tube drainage. Remember the ABCs when answering questions choices that ask who would you see first. for hospital triage, care for the client with a life-threatening illness or injury first. for disaster triage, choose to triage first those clients who can be saved with the least use of resources