MY NCLEX NOTES & CHARTS

YouTube: @Heyrona

"Our greatest weakness lies in giving up. The most certain way to
succeed is always to try just one more time."
-Thomas A. Edison

Cerebral Angiography
BEFORE
1. Informed consent
2. Explain procedure
3. Lie the patient flat
4. Dye injected into femoral artery. Fluoroscopy & radiologic films taken after injection
5. Procedure Sedation
6. Skin prep; Chosen site shaved
7. Mark peripheral pulses
8. May experience feeling of warmth and metallic taste when dye injected
AFTER
1. Neurological assessment every 15-30 minutes until vitals stable
2. Keep flat in bed 12 to 14 hours
3. Check puncture site every hour
4. Immobilize site for 6 to 8 hours
5. Assess distal pulses, color & temperature
6. Observe symptoms of complications (allergic response to dye, puncture site,
hematoma)
7. Force fluids
8. Accurate I&O

Lumbar Puncture
BEFORE
1. Informed Consent
2. Explain procedure
3. Position patient in lateral recumbent\fetal position at edge of bed

AFTER
1. Neuro checks every 15-30 minutes
2. Position flat for several hours
3. Encourage P.O. fluid to 3,000 mL
4. P.O. analgesics for headache
5. Observe insertion site for bleeding

Urinary Frequency Teaching

1. Empty the bladder frequently (every 2 hours)
2. Drinking at least 2000 mL of fluid per day
3. Limiting fluid intake before bedtime (NOT avoiding fluid
intake)
4. Perform kegel exercises to strengthen the perineal muscles
5. Wearing a perineal pad

OB Maternity
*May occur in the first trimester and then again late in the third
trimester because of pressure placed on the bladder by the enlarged
uterus

Potassium Rich Foods

Kiwi
Oranges
Dried Fruit
Bananas
Cantaloupe
Avocados
Broccoli

Dried Beans/Peas
Lima Beans
Mushrooms
Potatoes
Seaweed
Soybeans
Spinach

Sanguineous
BRIGHT RED Indicates active bleeding
Serous
Watery or Clear usually normal
Serosanguineous
Pink tinged Indicative of some bleeding
Purulent
Yellow/Green Infection

CVA (Stroke)
LEFT CVA
Aphasia (language difficulty)
Alexia (reading difficulty)
Agraphia (writing difficulty)
Right hemiplegia or hemiparesis
Slow, cautious behavior
Depression & quick frustration visual changes, such as hemianopsia
*Responsible for language, mathematic skills, & Analytic thinking

RIGHT CVA
Unawareness of deficits
Loss of depth perception
Disorientation
Impulse control difficulty
Poor Judgment
Left hemiplegia OR hemiparesis
Visual changes, such as hemianopsia
*Responsible for visual and spatial awareness &proprioception

Phosphate Rich Foods

Fish
Eggs
Milk
Cheese
Large amounts of meat & fish
Whole grains
Carbonated beverages

Cardiac Catheterization
BEFORE
1. Informed consent
2. Explain procedure
3. NPO 8-12 hours
4. Empty bladder
5. Check pulse
6. Explain client may experience heat palpitations; desire to cough
when dye injected
AFTER
1. Monitor vitals every 15 min for 2 hours. Then every 30 min for 1
hour
2. Check pulses, sensations, and bleeding at insertion site
3. Bed rest 6-8 hours with insertion site extremity straight!

SIADH
Early symptoms
1. Headache
2. Muscle cramps
3. Weight gain (no edema: Due to water being retained, NOT sodium)
Nursing Interventions
1. Restrict oral fluids 500-1000mL/day
2. Weigh daily same clothes + same time
3. Report altered LOC [headaches, confusion, lethargy]
4. Take seizure precautions
5. Monitor intake/output accurately
6. Medications: Demeclocycline or Lithium carbonate
7. Monitor Vitals: tachycardia, increased BP, hypothermia
8. Monitor decreased serum sodium + elevated urine sodium
osmolality

Heart Failure Teaching

Teaching
1. Follow fluid and sodium restrictions
2. Conserve energy schedule REST PERIODS
3. Adhere to medication regimen
4. Weight self daily notify health care provider of weight gain of
2lbs/24 hours OR 5lbs in 1 week*
5. Get influenza vaccine yearly
6. If prescribed DIGOXIN, take pulse for 1 minute. Notify health
care provider if pulse is below 60bpm.
7. Take diuretics in early morning and early afternoon
8. Notify health care provider of increased dyspnea, orthopnea, and
inability to wear rings or shoes*

Iron Rich Foods

Red meat
Kidney & Lima beans
Egg yolk
Chickpeas
Cooked Swiss chard
Liver
Molasses
Lentils

Carrots
Raisins
Apricots
Kale
Spinach
Organ Meats
Clams

Blood Transfusion Reactions

Circulatory overload
*Chest or lumbar pain, cyanosis, dyspnea, moist productive
cough, crackles in the lung bases, distended neck veins,
increased BP
Sepsis
*Tachycardia, Fever, abdominal cramps, N/V, diarrhea
Allergic + Transfusion Reaction
*Flushing, itching, urticarial, tachycardia, low back pain
Febrile Reaction
*Fever, chills, nausea

Magnesium (1.5-2.5)
Below 1.5 = Hypomagnesaemia

Arrhythmias
Seizures
Tetany
Muscle weakness
Irritability
Lethargy
Dizziness
Confusion

Above 2.5 = Hypermagnesaemia

Arrhythmias
Muscle weakness and fatigue
Nausea/Vomiting
Flushing & Sweating
Loss of deep tendon reflexes
Respiratory depression
Hypotension
Loss of consciousness

Sodium (135-145)
Below 135 = Hyponatremia
Nausea
Seizures
Confusion
Muscle weakness
Headache
Apprehension
*Fresh water drowning

Above 145 = Hypernatremia

Lethargy
Neuromuscular excitability
Irritability
Muscle twitching
Weakness
Fever
Increased Blood Pressure
Edema
*Heart Failure, Cushing's Syndrome, Diabetes Insipidus

Tyramine Rich Foods

Red wine
Beer
Chocolate
Aged Cheese
Yogurt
Soy Sauce
Sauerkraut (sour cabbage)
Liver
Pizza or Homemade bread
Meats that have been fermented
Figs
Bananas

Peripheral IV Complications
Infiltration
Pain on IV site
Cool and pale
Flow of IV Stopped
IV now into subcutaneous
tissue
Phlebitis
Redness
Pain
Swelling
Inflammation of vein
Infection
Fever
Pain at the site

Thrombosis
Presence of a blood clot
Absent pulses below the site of
the clot formation
Thrombophlebitis
Pain & swelling
Redness
Warmth
Fever
Leukocytosis (Increased
WBC)
Hematoma
Leak of blood
Bruise
Swelling

Peripheral IV Treatment (Contin.)

Treatment
1. Stop the IV
2. Apply warm compress
3. Elevate arm
4. Start IV in new site OR opposite arm
*Infiltration, Phlebitis, Infection, Thrombosis, Thrombophlebitis
Treatment
1. Discontinue IV
2. Apply pressure
3. Apply cool compress
4. Start IV in new site OR opposite arm
*Hematoma

Therapeutic Drug Levels

Digoxin: 0.5-2.0 ng/mL
Lithium: 0.8-1.5 mEq/mL
Dilantin: 10-20 mcg/mL
Theophylline: 10-20 mcg/mL

Need to know *** Lab values***

Electrolytes
Chemistry
Sodium: 135-145
Glucose: 70-110
Potassium: 3.5-5.0
BUN: 7-22
Calcium: 8.5-11
Creatinine: 0.5-1.2
Chloride: 95-105
CPK: 21-232
Magnesium: 1.5-2.5
Urine specific gravity: 1.010Phosphorus : 2.5-4.5
1.030
Bilirubin: <1.0
Hematology
Total Cholesterol: 130-200
RBC: 4.5-5.0 million
LDH: 100-190
WBC: 5,000-10,000
Triglyceride: <150
Platelets: 200,000-400,000
Protein: 6-8
Hemoglobin: 12-18
Albumin: 3.5-5.0
Uric acid: 3.5-7.5

Breast Self-Examination
1. Stand in front of the mirror. Observe both breasts for anything unusual, such as lumps,
dimpling, nipple retraction or scaling of the skin.
2. Watching closely in the mirror, clasp hands behind your head and press hands forward.
3. Next, press hands firmly on HIPS and bow slightly as you pull your shoulders and
elbows forward.
4. Raise your left arm behind your head. Use three or four fingers of your right hand to
feel for nodes, irregularity, and tenderness. Beginning at the outer edge, press the flat part
of your fingers in small circles, moving the circles slowly around the breast. Gradually
work toward the nipple. Then switch to the right arm behind your head and use the left
arm to exam the breast.
5. Gently squeeze each nipple and observe for discharge.
6. Steps 4 and 5 should be repeated while lying flat on your back.

Testicular Self-Examination
1. Stand in front of a mirror and check for any swelling on the scrotal skin.
2. Cup one testicle at a time using both hands. This is best performed during or after a
warm shower.
3. Roll the testicle gently between the thumbs and fingers. You should not feel any pain
when doing the examination.
4. Feel for lumps, changes in size or irregularities.

Calcium (8.5-11)
Below 8.5 = Hypocalcemia
Tetany
Positive Trousseau's sign
Positive Chvostek's sign
Seizures
Confusion
Irritability
Above 11 = Hypercalcemia
Muscle weakness
Lethargy
Constipation
Kidney stones
Nausea
Dysrhythmias

Potassium (3.5-5.0)
Below 3.5 = Hypokalemia
Dysrhythmias
Muscle weakness
Nausea/Vomiting
Respiratory Depression
Constipation
Above 5.0 = Hyperkalemia

EKG changes
Dysrhythmias-Irregular
Muscle weakness
Irritability &Anxiety
Decreased BP
Diarrhea
Nausea
*Addison's Disease

The FIVE P's and F's

Fractures - 5 P's
Pallor
Pain
Pulselessness
Paralysis
Parasthesia
Cholelithiasis - 5 F's
Fat
Forty
Fair Skin
Fertile
Female

Calcium Rich Foods

Collard greens
Dairy
Spinach
Tofu
Sesame Seeds
Almonds
Cereal
Broccoli
Bok Choy
Black beans
Turnip greens

Parkinson's Disease
Clinical manifestations
Resting tremor
Pill rolling of fingers
Drooling
Shuffling gait
Mask-like face
Forward flexion of trunk
Muscle rigidity + weakness
Alzheimer's Disease
Clinical manifestations
Forgetfulness
Short attention span
Night wandering
Dysphasia
Inability to perform ADLS
Depression
Combativeness

Blood Transfusion Reaction

If transfusion reaction suspected
1. STOP blood transfusion
2. Run normal saline to maintain IV access
3. Notify physician and blood bank of reaction STAT
4. Administer ordered medications
5. Draw blood sample for culture, plasma and hemoglobin
6. Collect urine sample and send to lab
7. Monitor voiding for hematuria
Anaphylactic Reaction
Support airway, breathing, circulation
Administer epinephrine, antihistamines, and corticosteroids
Hemolytic Reaction
Consider low-dose dopamine to improve renal blood flow
Maintain renal perfusion with aggressive fluid resuscitation
Furosemide to increase renal blood flow
Febrile
Acetaminophen to treat fever
If patient develops chills, cover with blanket unless temp is >102 F.

Pediatrics - Normal Vitals

Newborn
RR 30-60 per min
HR 120-160 bpm
BP 65/40 mm Hg
1-4 years
RR 20-40 per min
HR 80-140 bpm
BP 90-99/60-65 mm Hg
5-12 years
RR 15-25 per min
HR 70-115 bpm
BP 100-110/56-60 mm Hg
Adult
RR 12-20 per min
HR 60-100 bpm
BP <120/80 mm Hg

Diets and Diseases

Gout: Low purine diet (no fish or organ meats)
Celiac disease: Gluten free diet (No wheat, oats, rye, barley)
Renal failure: High calorie, low protein diet, as allowed by kidney function
Cystic Fibrosis: Replacement of pancreatic enzymes before or with meals. High
protein and High Calorie
Atherosclerosis: Low saturated fat die, Cholesterol lowering agents given before
meals

Iron Supplements

Take with Vitamin C [Increase absorption]

DO NOT take with antacids
Will have greenish black stools from meds
Should always be taken with food to decrease gastric upset

Decrease Iron Absorption

1. Milk
2. Antacids
3. Caffeine (coffee, tea, soda)
4. Calcium supplements

Diabetes
Patient Teaching
Inspect feet daily
Wash feet daily with mild soap and warm water
Pat feed dry; especially between toes
Use mild foot powder on sweaty feet
Consult podiatrist
No commercial remedies to remove calluses or corn
The best time to cut nails is after a bath or shower
Separate overlapping toes with cotton
Avoid open toe or open heel shoes
Leather shoes preferred over plastic ones
DO NOT go barefoot
Wear clean cotton socks
Avoid prolonged sitting; standing; crossing legs

Strokes
Always be sure to assess a client's ability to swallow before feeding and a
post-stroke client
Medications do NOT always need to be crushed
ALL medications should be administered one at a time
Assess gag reflex; ability to swallow and cough
If unilateral weakness, place medication on stronger side of the mouth
Straws are NOT to be indicated to patients with swallowing impairment
(Increases risk for aspiration)

Expected Normal Postpartum Vitals

Temperature
Could increase to 100.4 F. Any higher elevation may be caused by infection
and must be reported.
Pulse
May decrease to 50 beats/min. Pulse<100 beats/min could indicate
excessive blood loss or infection.
Respirations
Should be within normal limits. If RR increase significantly, suspect
pulmonary embolism, uterine atony or hemorrhage.
Blood Pressure
Should be within normal limits. Suspect hypovolemia if it decreases

Pneumonia
Interventions
Administer heated and humidified oxygen therapy as prescribed
Position the client in high-fowler's position to facilitate air exchange
Encourage coughing, or suction to remove secretions
Encourage deep breathing with an incentive spirometer to prevent alveolar collapse
Administer medications as prescribed:
-Antibiotics
-Bronchodilators
-Corticosteroids
-Immunizations
Promote adequate nutrition
Provide support to the client and family
Encourage verbalization of feelings

Tuberculosis
Assessment
Persistent cough
Purulent sputum; possibly blood-streaked
Fatigue + lethargy
Weight loss + anorexia
Night sweats + Fever
Interventions
Administer heated and humidified oxygen therapy as prescribed
Obtain sputum samples
Prevent infection transmission.
-Wear N95 or HEPA respirator when caring for hospitalized TB client
-Negative airflow room and Airborne precautions
-Client must wear a mask if transportation to another department is necessary
Administer medications and encourage fluid intake
Diet: Foods rich in protein, iron and vitamin C
Teaching
Teach client and family importance of medication regimen (6 months to a year)
Encourage proper hand washing
Cover the mouth and nose when coughing or sneezing
Clients with active Tb should wear masks when in public places
Clients are not longer considered infectious after three negative sputum culture

Barbiturates
Intoxication
-Talkative
-Slurred Speech
-Hallucinations/Delirium
-Euphoric
-Fever

Withdrawal
-Decrease respiration
-Seizures
-Insomnia
-Tremors
-Anxiety/Tachycardia

Opioid/Narcotics
Intoxication
-Pin point pupils
(dolls eyes)
-Slurred Speech
-Respiratory &
circulatory depression
-Unconsciousness/death

Withdrawal
-Dilated eyes
-Fever
-Yawning
-Abdominal cramps
-Watery eyes
-Diaphoresis

Alcoholism
Minor Withdrawal
-Anxiety
-Agitation
-Irritability
-N/V
-Hangover

Major withdrawal
-Life threatening
-Hypertension
-Tachycardia
-Tremors
-Seizures

Strategies I used for the NCLEX

Expected vs. Unexpected
Chronic vs. Acute
Stable vs. Unstable
Potential vs. Actual Problem
Safe vs. Unsafe
Fast vs. Slow
Physical vs. Psychosocial

A, B, C's
Getting clues from the answers
If you can do one thing and go home for your patient

NCLEX TIPS
1. NEVER ask "why?" or say "do not worry"
2. NEVER leave the patient alone
3. ALWAYS choose the safest answer possible
4. DO NOT read into the question
5. DO NOT pass the buck
6. DO NOT "do nothing" or "continue to document" UNLESS everything is normal or expected!
7. NEVER persuade the patient
8. ELIMINATE answers with absolute words: "ALWAYS, NEVER, ONLY"
9. DO NOT delegate assessment, teaching, or evaluation
10. ELIMINATE answers with YES/NO questions
11. COMA, COMA AND RULE: All parts of the answer must be correct!
12. Pay attention to words such as: PRIORITY, FIRST, BEST, INITIAL etc.
13. You ALWAYS have an order
14. READ the question and the answer you choose before clicking NEXT.
15. DO NOT be too quick to answer familiar questions. ALWAYS carefully read and understand
questions before answering.
16. NEVER panic when you don't know the topic or answer to a question. Don't give up. Try getting
clues from the answers and begin to eliminate choices that are: not safe, are not priority, etc.
17. RELAX:) Take a few deep breaths before each question. It only takes a few seconds! IT HELPS!
18. TAKE A BREAK! Even if you want to keep going, your brain needs a break.
19. REST AND DIGEST the night before!
20. STAY POSITIVE! Would it hurt to stay positive? :) You CAN do this!!!!