NCLEX

The Important Information Regarding NCLEX Examination

Examinations are my worst nightmares, especially coming to terms with the fact that all the information that a single NCLEX exam tests all the information gathered in nursing school. The logic seems unfair that the licensure of nursing depends on a single exam even after passing nursing school. However, the truth is that all the great nurses that one may admire went through the system, hence a glimmer of hope that it is achievable. Therefore, take the exams knowing that is huddle into the brighter sight of nursing care. Beyond knowing the ethical principles of nursing care, passing NCLEX exam will grant you your licence.

Ensure adequate knowledge in the following areas

1. A kid with Hepatitis A can return to school 1 week within the onset of jaundice.

2. After a patient has dialysis they may have a slight fever…this is normal due to the fact that the dialysis solution is warmed by the machine.

3. Hyperkalemia presents on an EKG as tall peaked T-waves

4. The antidote for Mag Sulfate toxicity is —Calcium Gluconate

5. Impetigo is a CONTAGIOUS skin disorder and the person needs to wash ALL linens and dishes separate from the family. They also need to wash their hands frequently and avoid contact…

6. Positive sweat test. indicative of cystic fibrosis

7. Herbs: Black Cohosh is used to treat menopausal symptoms, when taken with an antihypertensive, it may cause hypotension. Licorice can increase potassium loss and may cause dig toxicity.

8. With acute appendicitis, expect to see pain first then nausea and vomiting. With gastroenteritis, you will see nausea and vomiting first then pain.

9. If a patient is allergic to latex, they should avoid apricots, cherries, grapes, kiwi, passion fruit, bananas, avocados, chestnuts, tomatoes and peaches.

10. Do not elevate the stump after an AKA after the first 24 hours, as this may cause flexion contracture.

11. Beta Blockers and ACEI are less effective in African Americans than Caucasians.

12. For the myelogram post-op positions, water based dye(lighter) bed elevated. oil based dye heavier bed flat.

13. Autonomic dysreflexia– elevated bed first….then check foley or for impaction

14. Any of the mycin’s..check for tinnitus or hearing loss

15. Cloudy dialysate…always futher assess and call doctor

16. Osteoporosis prevention and mgt. choose weight bearing(walking) instead of calcium if both are choices

17. Dilantin can cause gingival hyperplasia, advise good oral hygiene and freq. dental visits, IVP 25-50 mg/min

18. Placentia Previa: is painless, bright red blood

19. Abruption is painful, board-like abdomen

20. Need MAP of 70-90 to perfuse organs

21. Vitamin C can cause false + occult blood

22. Celiac disease: can’t eat BROW! BARLEY RYE OAT WHEAT

23. Any eye surgery place pt on unaffected side

24. If pt has lung cancer, craniotomy, or some kind of pituitary Surgery, watch for diabetes insipidus

25. Sickle cell– hydration hydration important and treat pain ifin crisis

26. Don’t palpate a wilms tumor on the peds patient, it can cause cancer cells to be released!

27. Terbutaline (Brethine) and mag sulfate- tx for preterm labor

28. Librium-anti anxiety used to tx symptoms of acute alcohol withdrawal.

29. Cogentin-used to tx parkinsonian side effects of Thorazine (antipsychotic med)

30. Methadone hydrochloride-opiod analgesic; tx for narcotic withdrawal

31. Procardia-antianginal med (CCB) decreases myocardial O2 demand.

32. Digoxin-strengthens myocardial contraction & slows conduction thru AV

    node

33. Coumadin-inhibits prothrombin synthesis

34. Amicar-antifibrinolytic; prevents recurrence of subarachnoid hemorrhage.

35. Lithium-tx manic phase of bipolar

36. Nimodipine-CCB; decreases spasm in cerebral blood vessels

37. Diltiazem-CCB; inhibits Ca+ influx in vascular smooth muscle; reduces myocardial O2 demand & decreases force of ventricular contraction

38. Clotrimazole-antifungal; treats rashes.

39. NEVER NEVER NEVER administer KCl via IV push.

40. The level in the water seal chamber (chest tubes) fluctuates with respiration- no fluctuation indicates an obstruction and excessive bubbling indicates an air leak.

41. Stay with the client for 15 minutes at the start of a blood transfusion.

42. Nephrotic Syndrome leads to proteinuria while Glomerulonephritis leads to hematuria.

43. Goodell’s Sign is the softening of the cervix at the start of the 2nd month of pregnancy

44. Naegele’s Rule is First date of last menstrual period + 7 days – 3 months +1 year.

45. Vinca Alkaloids (Vincristine) lead to neurotoxicity and can present with numbness and tingling in the legs or paralytic ileus.

46. Avoid herbal supps like ginseng, ginger, ginkgo, garlic (all the G’s)if on any clotting drugs/products (coumadin, platelets, ASA, Plavix

47. High triglycerides may cause a false HIGH Hemoglobin A1C (normal is 2.6-6)

48. Deer ticks transmit Lyme Disease and it is most common in the NE Atlantic states.

49. Think of pain last or as a psychosocial UNLESS: Burns, sickle cell crisis, or kidney stones.

50. Anemia of pregnancy is common in the 2nd trimester due to rapid expanding blood volume and is not a cause for concern. It can get as low as 10.5 and still be OK. 1st and 3rd trimesters can go as low as 11 and still be ok

51. Preterm labor–after 20 weeks and before 37

52. True labor INCREASES with activity and usually moves from the back to the front(according to our instructors but from personal experience IT HURT ALL OVER THE DANG PLACE AND INCREASED WITH EVERYTHING).

53. Recommended weight gain for pregnancy 1.5-16 kg or 25-35 lbs

54. Normal newborn jaundice– AFTER 24 hours of life pathologic jaundice– BEFORE 24 hours of lif

55. If it come out your ass…its metabolic acidosis… If vomiting it’s metabolic alkalosis…

56. priority unstable pt- words to look for: cyanotic, sudden, increasing pain, hypoxic, restlessness

57. When left with two choices pick the one thing you can do to make pt. comfortable, safe, and more stable

58. No narcotics to any head injury..wont be able to accurately assess LOC. so pick the narcotic if you have an order to question.

59. Fluid versus burn formula: kg X 4 ml/kg X %(burn area)= total give half of total in first 8 hours

60. After thyroid surgery-maintain airway-keep emergency trach set nearby, check for blood at sides and back of dressing, teach pt to support neck

61. Bucks traction-no pins tongs. skin traction

62. You should not hear a bruit over anything except dialysis shunts. if so this is the unstable pt.

63. DVT- elevate extremity, bed rest, warm (not hot) compresses

64. Rubella- rash on face goes down to neck and arms then trunk and legs

65. Pregnant women should avoid contact with any child who has Rubella or just received the vaccine. if she does she has to get vaccine after she has delivered MMR #1 @ 12- 15 months MMR #2 4-6 years old

66. Before checking or measuring fundal height have the patient empty her bladder! A full bladder can throw off the measurement by 3cm.

67. Meniere’s disease= ringing in the ears and hearing damage cause from HIGH sodium levels. Need diuretics. Avoid caffeine, nicotine, and ETOH

68. Meningitis= look for nuchal rigidity, Kernig’s sign(can’t extend knee when hip is flexed) and Brudzinski sign (flex neck and knee flexes too) petechial rash. People who have been in close contact may need Rifampin as a prevention. Vaccine for meningitis after 65 years of age and every 5 years

69. MI=#1 pain relief, helps decrease 02 demand

70. Acute Asthma = diffuse expiratory wheezes

71. Cessation of wheeze omnimous

72. Infective endocarditis = murmur

73. Fluid overload = auscultate lungs first

74. 24 hours after thyroidectomy, watch for s/s of thyroid storm not for decreased levels of thyroid hormones

75. Hypoglycemia= T.I.R.E.D T-tachycardia

    I- irritability

    R- restless

    E- excessive hunger

    D- diaphoresis

76. Posturing- decerebrate (brainstem problem)- hands like an “e”,decorticate(cord problem)- hands pulled in toward the cord

77. Tetralogy of fallot- have child squat to increase return to heart. just remember fallot=squat

78. Can’t sign consent after preop meds are given…call doctor if not signed

79. Rubella (german measles)-airbone contact precautions, 3 day rash

80. Rubeola (red measles)- droplet contact precautions, koplik spots in mouth

81. Amphetamine= Depression , disturbed sleep, restlessness , disorientation

82. Barbituates= nausea & vomiting, seizures, course tremors, tachycardia

83. Cocaine= Sever cravings, drpression, hypersomnia, fatigue

84. Heroin= Runny nose, Yawning , fever, muscle & joint pain, diarrhea (Remember Flu like symptoms)

85. When using a cane to aid ambulation: Step up on the good extremity then place the cane and affected extremity on the step. Reverse when coming down. (Up with the good, down with the bad)

86. In infants, pyloric stenosis = projectile vomiting

87. Croup: seal-bark cough, dyspnea, inspiratory stridor, irritable. In children considered a medical emergency due to narrowed airway

88. Skull fracture: Battle’s sign (bruising over mastoid bone) and raccoon eyes

89. Pheochromocytoma: catecholamine secreting tumor. Look for persistent hypertension, pounding headache

90. Peritoneal dialysis- if outflow slow check tube for patency, turn pt side to side

91. Patients with the same infection can room together or two clean non contagious disorders can room together.

92. Pulsus paradoxus- pulse is weak on inspiration and strong on expiration…could be a sign of CARDIAC TAMPONADE

93. Fat embolism- high risk pt…fracture of long bone..greatest risk in first 48 hrs.

94. Pancreatitis-elevated amylase (cardinal lab value)

95. JP DRAIN- SQUEEZE=SUCK… squeeze the bottle to let air out then replace cap.

96.Lymphocytic leukemia causes a decrease in all blood cells, it causes RBCs to be low also!

97. Give Mannitol for ICP

98. Oxytocin is always given via an infusion pump and and can never be  administered through the primary IV.

99. One of the first signs of ICP (increased intracranial pressure) in infants is a high pitched cry.

100. Regarding blood transfusions, a hemolytic reaction is the most dangerous kind of reaction…S & S include NAUSEA, VOMITING, PAIN IN LOWER BACK

101. HEMATURIA Treatment is to STOP blood, get a urine specimen and maintain perfusion and blood volume.

102. Febrile reaction S&S are FEVER, CHILLS, NAUSEA, and HEADACHE

103. Narcan is given for to reverse respiratory depression…a rate of 8 or less is too low and requires nursing action.

104. Miller abbott tube is used for decompressing intestine, which relieves the small intestine by removing fluid and gas from small intestine.

105. If a client takes lithium the nurse should instruct the client to take in a good amount of sodium, without it causes retention of lithium and in turn leads to toxicity.

106. Rinne test- a vibrating tuning fork is held against the mastoid bone till pt can’t hear sound…then moved to ear.

107. A subarachnoid (spinal block) for labor may cause a headache, a lumbar epidural will not since the dura mater is not penetrated

108. Tracheoesophageal fistula: 3 C’s: coughing, choking, & cyanosis

109. Hypothyroidism: Decreased T3 +T4, but increased TSH  Hyperthyroidism: Increased T3 + T4, but decreased TSH

110. NO tyramine containing foods if taking and MAO inhibitor ( smoked meat, brewer’s yeast, aged cheese, red wine)

111. Regular insulin is the only type that can be given IV

112. Dilantin can cause gingival hyperplasia, advise good oral hygiene and frequent dental visits, IVP 25-50 mg/min.

113. ESSR method of feeding (cleft palate) ENLARGE nipple STIMULATE sucking, SWALLOW and REST

114. Immunizations-Before 1 years old: Hep B3x):Only one that is given at birth and one month (3rd dose at 6 months)IPV(4x), DTaP(5x), Hib(4x), PCV(4x): all given at 2, 4, & 6 months. Hib, PCV: again at 12-15 month. DTaP: again at 12-18 months. DTaP, IPV: last doses are given 4-6yrs 1yrs old and older. MMR: (2x) 12-15 months, then at 4-6 years* *if dose not given from 4-6 give from 11-12yrs old. Varicella Zoster: (1x) 12-18 months. Td: (1x): 11-12yrs old.

115. Fundal height: Pt. supine, measure from symphysis pubis to top of fundus, if patients is 18+ wks pregnant the height in cm will be same as weeks pregnant give or take 2 cm

116. Isolation**:STRICT Contact: use universal precautions, gown when contact with pt., single pt. room in most situations used with: Any colonizing infections, MSRV, Fifths disease, RSV, infected wounds, skin, or eyes

117. STRICTER Droplet: include all universal precautions, gown, goggles, masks on you, on pt. if leaving room, single pt. rooms used with: Majority of infectious diseases

118. STRICTEST Airborne: include all universal precautions and negative pressure single patient rooms, gown, goggles, mask on you, mask on pt. if leaving room which should only be done if absolutely necessary Used with:Measles Varicella Disseminated Varicella Zoster

     Tuberculosis **Always check facilities policies when following isolation precautions/procedures

119. Self breast exams: do monthly, 7-10 days after menses

120. Pt’s taking Monoamine Oxidase inhibitors for depression: should avoid foods containing tyramine which include: Avocados, banana Beef/chicken liver, Caffeine, Red wine, Beer, Cheese (except cottage cheese), Raisins, Sausages, pepperoni. Yogurt, sour cream

121. Dumping syndrome-TX no fluids with meals /no high cards /lie down after eating. they need a high fat high protein diet

122. Multiple sclerosis- avoid hot showers and baths

123. Partial thickness burns=blisters…… full thickness-charred, waxy

124 PKU- no nuts, meats, dry beans, eggs, dairy (basically no protein stuff) give specially prepared formula to baby because they can digest this protein well

125. introduce rice cereal to infant at 6 mos and strained veggies one at a time

126. PT must keep taking prescribed insulin on sick days, drink plenty of fluids and notify doctor. also insulin is also given when pt comes from surgery on NPO status because trauma and infection makes sugar go up!

127. In an infant of a diabetic mom, hypoglycemia 30-90 min after birth…then look for them to also have hypocalcemia after 24 hours

128. Non Stress Test on a preggo….should be REACTIVE (rise of 15 bpm above baseline for 15 sec) if it’s NOT reactive they need a contraction stress test and the result that you want from it is NEGATIVE

129. With Diabetic Ketoacidosis don’t give K+ until the patient has been hydrated and urine output is adequate.

130. Post-op Total Hip replacement– abduction (toes pointing in) or patient lying on non-operative hip. Avoid adduction (letting the foot turn out)

Best of luck in your NCLEX exams