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Kaplan Review Course

www.ncsbn.org is a website that has good practice test questions (the hard
ones) (the knockout questions)
safe and effective are the two key points (is what I am going to do going to
be effective?
Median number of questions is 118 (75 is abnormal)
Np4hepc@yahoo.com
Missing a lot of questions in a row is bad. Once you are consistently above
the passing line, you will pass
Stop runs of errors. Take breaks if you are in a rut
If you dont cut off at 75, or close, it shows you are not being consistently
above the line
18-25 select all that apply regardless of if you finish at 75 or 265
The fill in the blanks are math, and maybe short answer
To Do Tonight/Tomorrow: Do Q Banks on tutorial mode (5 questions per
night USING DECISION TREE)
o Take assigned test
o Take question trainer tests 1 2 3 OVER WEEKEND (NOT THIS
WEEK)
o Watch content lectures
o Watch strategy seminar (FRIDAY)
o Watch test taking workshop (FRIDAY)

QT1: 75 questions (Comprehension/Recall)


QT2: 75 questions (comprehension/recall)
QT3: 100 Recall/Recog/Compr/Applic

ON THURSDAY: If you get 60 or above, come at 1pmif below 60, come at


1130 to show the results and analyze
More than 2-3 in a row wrong is a problem
After Friday, only read chapters 1 and 2 (in the purple)
Chapters 8/9 are the guts
Dont watch content lectures unless you are weak in a highly tested
area after instructor tells you to do watch
Decision tree is how we are going to run our life in class
WHY in the answer (the word WHY) is ALWAYS WRONG ON THE NCLEX!!!!!!
NEVER ASK WHY!
Validation: how you verify that something you suspect about the patient, is
accurate (an ASSESSMENT (Proving what you think is going on with the
patient))
If two answers have the same outcome (i.e. comfort measure (abd pain and
you have to choose between heating pad on abdomen and Tylenol if two
have same outcome then it cannot be the right answer))
Healthy behavior vs. unhealthy behavior will be tested
SAFE AND EFFECTIVE is best answernot just safe, not just effective

If you rule out an answer, then just rule it out and dont go back to ityour
gut instinct is usually rightchoose another answer!
DO NOT READ INTO THE QUESTION: There is no go tell the nurse, and you
cant say come to the clinic all of the timethere is something more
important to do first, before you call them. Also, there is probably not a
there is no order in the emergent or urgent situations, you do what you
have to do FIRST, and THEN you call to get the order

Transferring in and out of a wheelchair is best indicator of ability to complete ADL


RESTLESS MEANS HYPOXIA
AGITATED MEANS HYPOXIA
The word ACTION may be an action, or MAY BE AN ASSESSMENT
NEVER MILK A CATHETER IT IS ALWAYS WRONG
Sometimes the answer is the least risky (move the patient to their side)
You may suspect something (a patient is in pain due to appearance), but you
need to VALIDATE FIRST ( Are you in pain?)
A patient in SHOCK (confirmed) needs FLUID REPLACEMENT FIRST (A 23F has
Toxic shock syndrome, what is first action? Kick psychosocial out because
there are physical actions GIVE FLUID)
Each pound of weight gain is a liter of fluid
Increase fluid intake: demonstration of improved fluid status=good fluid
output
ACE inhibitors drop blood pressures. So dont stack 2 anti-hypertensive
meds on top of each other
Depression shows improvement when: better sleep
Muscle tension relates to anxiety, not depression
Aspirin: NSAIDs have cross sensitivity (Dont mix ASA and Aleve/Naproxen)
Cephalosporins and Penicillins always have a cross sensitivity
If you have decreased urine output, you should expect some weight gain
(pitting edema and weight gain)
Crohns: need to restrict fiber and fat (dont want to promote peristalsis)
Someone newly hired needs to verify their skill before doing something and
showing that they know how to do it right
NPO means NPO previous 8 hrs
Glucophage cannot go anywhere near a patient who is getting IV Contrast
Dye for a CT (causes lactic acidosis)
With schizophrenics: Always try to reorient and bring them back to reality
Hct: normal is 41-49
Specific Gravity: FIXED is bad
Specific Gravity: 1.010-1.030
Influenza: Cant give to people to anyone allergic to any fowl (feathery
animal) (ask if they have any FOOD allergies)
Nurses who come from a surgical floor to another unit should be assigned to
a surgical patient
Alcohol and barbiturates tox need to be admitted to the hospital due to
withdrawal risks
Other drugs: dont need to be admitted for detox

Vitamin B shots are once a month for loss of intrinsic


Renal failure = hyperkalemia = spiked T wave
Hypokalemia: muscle weakness
High BUN without a Cr number, means dehydration
High BUN but Cr normal, means dehydration
BUN: 7-20
Isolating someone increases confusion. Let them socialize and be with
others (unless they are contagious)
Rubella: greatest risk is during first trimester of pregnancy
Rubella: it is like chickenpoxyou are only contagious 4-7 days before the
rash appears
Rubella: takes 2-3 weeks to incubate after first exposure to rubellaso you
are not contagious until day 14 through 21and you wont see a rash until
day 28
Can never give Rubella vaccine to a pregnant woman
Assume that a CHF patient has 1 liter in their lungs if they gain a pound
Fruits and veggies help prevent hypokalemia
Patients on TB moving through the hallways need to wear a mask when
moving around the hospital (i.e. going to radiology)
Juvenile Arthritis: they should be active in NO IMPACT sports/activities
Nurses check patients.check the patient, not the monitor. If you are
looking for something in particular, check the patient
Renal failure = retain potassium and become acidotic
WE ARE NOT BIOMEDICAL ENGINEERS, WE ARE NURSES. CHECK THE
PATIENT AND NOT THE ECG IF THE PATIENT HAS SUDDEN SYMPTOMS
Anterior wall MI: cause L sided CHF, so pulmonary edema and hypotension
PREVENT HIP CONTRACTURES AFTER AMPUTATIONS
Only elevate stuff after surgery for about 1 day
Only patient who gets pillows between their legs is HIP patients
All urine collection MUST BE STERILENOT CLEAN!
When there is a list of symptoms, your diagnosis has to be the one that
encompasses all of the symptoms
If someone is not NPO, and is not eating much (especially sick people at risk
for malnutrition (not eating)), find out what they want and give them
ANYTHING THEY WANT! They need calories
Milk has tons of sodium. Carbonated drinks have lots of sodium. Tomato juice
has lots of sodium
Eating disorders hide it from others so getting them to talk about it is
therapeutic
Unexpected abnormal from transfusion reaction: stop transfusion
immediately
The longer the question, the more you have to simplify it before you answer it
Synthetic blood volume expanders: albumin, dextran, albumin (can be used
for hypovolemia) along with isotonic: LR/NS
Tourniquets: 4-6 inches above IV site is the correct location, not 1-2 inches
If two right answers, one action and one assessment, but the action that is
NOT URGENT TO CARRY OUT, do the assessment first

ABCs is first when determining which order to see patients


You can leave up to 100ml of Dialysate solution inmore than that, you gotta
go get it
Only one drug do you need to alter your dietand that med is COUMADIN
patients (need to change their leafy green intake)(dont increase))
Antacids: one hour after meals
Glomerulonephritis: watch for signs of other infections first, because
glomerulonephritis may show up as an infection easier to spot in another
body area before it will show up in kidney issues
SLE/Lupus: decrease sunlight, high infection risk, avoid gardening, avoid UV
light, avoid cuts and scrapes
Critical K+ values: important to give IV K+ before PO K+, also checking
monitor for dysrhythmias is important
Post op: Signs of infection is highest priority, after ABCs
TPN: Air embolus is big risk, so place patient left side head flat to keep air
bubble from rising to head if that is not a choice, keep them flat
Gingko: anti platelet properties, so the risk for bleeding increases with
ibuprofen or antiplatelet meds
Asthmatic: a productive cough is a sign of URI, not airway / asthma issue, so
the cough is not highest priority
Rhinoplasty: nose job- cannot do oral temps because the person cant
breathe through their nose while the thermometer is in their mouth
Li toxicity: diarrhea, sedation, ataxia, tinnitus, muscle weakness
Prednisone: take with meals due to GI irritation
After a thyroidectomy, check for paresthesias due to low serum calcium if
parathyroid glands damged (and muscle twitching too)
PAD: decreased sensation, so caution with hot pads. Exercise until start of
pain, then stop, rest, and then resume exercise
Heart failure: expect right heart failure stuff (edema, JVD), but dont expect
left heart stuff (rales, pulmonary edema)
NO psych med should cause stiffness/tremorsthat is an EPS
No bananas with MAOI
Kidney stones: lots of water is a priority
Below knee amputation: elevate for 24 hrs, then periods of prone to prevent
contractures
If halo in place, and the patient states it hurts to chew, that is a problem
EEG: need someone a little sleep deprived (i.e. wake at 2am before test)
Elevated BUN: ALOC, fall, confusion (N is the nitrogen)
LVN: care for stable patient with predictable outcome
Disseminated herpes zoster (chicken pox): air and droplet precautions
PCNs are cross sensitive to cephalosporins (cefaclor)
-cillins and mycins: take with foodother ABX on empty stomach
-cyclins are NOT to be taken at bedtime or lying flat (will cause esophageal
damage)
Compartment syndrome cardinal sign: UNRELIEVED PAIN after receiving pain
meds

Decision Tree: Steps 1-2-5 are hardest, and steps 1-5 are the most
challenging to figure out
When giving a drug, and it asks What is the priority action, you are then
required to assess for the adverse effects/worst possible outcome (i.e. blood
volume expanders you are concerned with pulmonary edemaso you want to
assess for pulmonary edema (lung sounds)
Increased difficulty chewing is a risk for airway, so that patient gets their
meds first
If patients concern/question is What is dialysis like that is a good scenario
to bring someone in who has undergone that same treatment.otherwise,
the nurse should do the education/teaching when a patient is refusing or
questioning care
NAP/CNA can obtain a capillary blood glucose
Intervening when supervising others, looking for negligence (What would
other people in same condition do) OR practicing out of scope
LPN/LVN MAY perform trach care on a stable patient
ASSIST PATIENTS TO COMMODE or TOILET EVERY 2 HOURS2 hours2
hours!!!!! We also REORIENT every 2 hours.
Check RESTRAINTS Q30 MIN
2-3 BM and 10-12 wet diapers is the average for newborn
Toddler: 2-5 yrs
Warning signs for elderly: regret about their earlier life and success/failure is
a risk factor for depression/self harm
Primigravida feel quickening/movement at 20 weeksmultipara feels
quickening/movement at 18 weeks
You should expect NO DISCHARGE from any biopsy, amniocentesis if there
is discharge, that is a DANGEROUS SITUATION FOR POTENTIAL INFECTION
Rescue position for ALL PREGNANT WOMEN IS LEFT SIDED (THEN if given the
opportunity, knees flexed up)(for all times that there is an issue with the
mother not feeling well (i.e. syncope))
BOGGY FUNDUS: MASSAGE FUNDUS UNTIL FIRM (NO TIME LIMIT!!!!!)
Spontaneous jerky movements of a newborn: hypoglycemia (if jerking, need
an assessment, so check a bG)
Newborns withdraw from heroin 12-16 hrs (so assess infant cry/RR at the 1216 hrs mark)
With an IUD, the cervix is always a bit opentherefore monogamous
relationship is important to reduce infection risk because the
boyfriend/husband may be cheating ONLY IUD IS IN A MONOGOMOUS
RELATIONSHIP
If OCD behavior is not disruptive/destructive, we dont try to do anything
about it. If someone washes their hands raw, you have to REMOVE FROM THE
STIMULI (i.e. sink) and EXTINGUISH the behavior.
NEVER FEED INTO THEIR MONSTER (Dont ask about someones delusion)
Neuroleptic Malignant Syndrome: Super high fever (suddenly stop taking
psych meds), semi-coma or seizing. Treat with BROMOCRYPTINE AND
DANTROLENE SODIUM
Anti psychotics (Haldol) IS ONLY FOR psychosis

Benzodiazepines (Xanax)are only for anxiety/agitation


Before you confront abusers (elderly or child), be sure you have all your
ducks in a row (Child Prot Services, LASO) do you go in and confront the
abuser and let them know you are reporting them. Let the supervisor know
what is going on, so they are prepared for the shit storm about to occur
SSRI (Paxil): complication includes possibly making them hyper (even though
most patients get drowsy). If they get confused, that is the abnormal we have
to be confused about.
Manic patients should be given activities to use up energy(i.e. help clean up
the floors/sweep) and remain with staff
People on lithium (lithium sodium) need to be drinking a lot of water due to
the dehydration aspect. So new lithium patients may feel
tachycardic/hypotensive intervention includes increasing water intake.
If someone says they are afraid of radioactivity, dont ask them why do you
think there is radioactivity here?. rather say This is a hospital, you are
safe here.
Geodon is an antipsychotic and helps people be more coherent
Bacterial meningitis shots: for military, people living in group situations, dorm
rooms ONCE in their life
Adults get DT, not DPT shots
LATE DECELS: gradually drop for the entire contraction and also decelerates
at the end of the contraction
LATE DECELS GET EMERGENCY C-SECTION
Newborn: if BP is too low or too high, it is a congenital heart defect
Acceptable newborn: 80/45 to 60/40
Baby chest shouldnt move much during respirations
We turn everyone every 2 hours
Dont cover infants eyes under the bili lights for the entire day they should
be uncovered q4H or so
For a patient to get C-Diff, they HAVE TO BE ON AN ANTIBIOTIC SO if
they are suspected to have C-Diff, need to evaluate their medications and IV
fluids currently or past
2 risk factors for cancer: virus (HPV). Then most cancers otherwise are
caused by chronic state of inflammatory response (obese (tissue pressing on
cells))
The GOLD STANDARD for TB determination is the Acid Fast Bacillus sputum
test
TB Induration: More than 10mm is a positive for healthy/nonimmunocompromised patients More than 5mm induration in
immunocompromised is positive for TB
Isoniazid for TB:
How to make a bedroom a negative pressure room: open the window and
point the fan out
TB: Government can FORCE YOU TO TAKE MEDSTHEY CAN LOCK YOU UP IN
JAIL TO FORCE YOU TO TAKE THE INH FOR A YEAR
The only med they can make you take is TB meds

TB: three drug cocktail (Isoniazid) and a NEGATIVE PRESSURE ROOM (TB is
the ONLY situation that you need a negative pressure room)
If the SIDE EFFECTS FOR A SURGERY ARE MAJOR THEN THE
HOSPITALIZATION WILL BE LONGER
HIV prejudice: There is NO RATIONAL REASON TO REFUSE CARE TO AN HIV
PATIENT because we expect/anticipate everyone to be HIV positive and
infected with stuff. So we assume all people are sick
CD4 count at or less than 300: start treating
HIV: three med cocktail
CD4 count LESS THAN 200: AIDS
CD4 dropping means viral load increasing
Possibly infected nurses with TB or anything else airborne MUST WEAR A
MASK FOR THEIR ENTIRE SHIFT (Not just when you are working on the unit)
STD questions: keep them from spreading the disease
Three diseases mean AIDS: Kaposis Sarcoma (immunocompromised),
PJP/PCP, CMV retinitis
Patient who frequently pushes the call light: Do an assessment (figure out
what is wrong)
Lead poisoning: it affects coordination, cognition, size (they will be small
(they eat paint instead of food, so they are malnourished)). Lead also causes
constipation. Poverty is the risk factor.
All skin ulcerations are considered infected prednisone patients often have
infections.
toxic hepatitis does not mean viral hepatitis, it often happens in blue collar
workers who inhale dust (plumbers, AC technicians, etc). So these patients
are not infectivethey just have an inflamed liver
We use universal precautions to protect us from the patients
Nurses from NEWBORN NURSERY deal with healthy kidsso they dont have
lots of transferrable skills to the other units. They should insist on requesting
an orientation to the unit and let the supervisor know that you havent been
caring for patients in several years.
Treat actual problems before potential problems (i.e. two patients, one has an
infiltrated IV, the other has nauseago to the patient with the infiltration
first as long as the nausea patient is not vomiting)
IF YOU ARE NOT SURE WHAT IS GOING ON, BE SURE YOU ASSESS FIRST
When doling out assignments as a charge nurse, only reassign patients IF
THERE IS A GREAT REASONnot just because
MUST LOOK AT ARMBAND TO ID PATIENT, NOT VERBAL FROM PATIENT AS
SINGLE SOURCE OF ID
HEPARIN SQ: Dont need to aspirate, since it is SQno blood supply
Only a RN should feed a myasthenia gravis patient, since the way you feed
the patient (pocket the food) with MG is a RN skill
LVN/NAP shouldnt suction, DUE TO THE ASSESSMENT ASPECT
As long as membranes are intact, the patient can walk

When things are encased (liver, amniotic sac, spinal tap, bone from bone
marrow, etc) they should NEVER LEAK that is why they only get a bandaid
on itnot a big
When to go straight to State Board with a complaint: when the person you
are complaining about is a higher up and nothing has been done internally
(waiting an appropriate amount of time between incident reports)
Assume most CVA patients have HTN
Most patients with CVA will have orthostatic HoTN normally, so we are not
overly concerned about it in the questions that ask What are you MOST
concerned about.
If any patient tells you THEY FEEL FUNNY you should be concerned.
Dont freak out about high blood pressures, but be concerned about blood
pressures that CAUSE SYMPTOMS (Treat the patient, not the numbers)
because HTN is a chronic condition that requires follow up, not necessarily
acute treatment
If they are Hypertensive with ringing in ears, that is something to be
concerned about (about to stroke)
THE BIGGER INCISION IS HIGHER PRIORITY
CNA/NAP: Cannot assess or determine problems, and you shouldnt tell them
something they should already know
If someone refuses an assignment, be sure to determine what the issue is,
before forcing them to do the assignment (determine what the concern is)
Trach suctioning: if suctioning mouth too, do the trach first, then mouth
(sterile to unsterile), never use powder around trach, and never instill saline
Acute confusion/dyspnea after a operation often is a fat emboli, and that is
more seriousness than things (except for airway and breathing)
During seizure: NOTHING INTO THE PATIENTs MOUTH, and keep them safe
If a person is immune suppressed, there is a likelihood of getting a disease
from a person who has it (i.e. HIV)
If a person is immunocompromised, there is an almost certainty that the
person will get the illness from the person they are exposed to (i.e. AIDS)
MEAT TEMP MUST BE AT 165F OR HIGHERNEVER LOWER
Anyone immunocompromised should rinse toothbrush daily in bleach solution
Googles are only for droplet
o TB/Varicella/Measles are airborne
o MENINGITIS is DROPLET
Droplets can only get you if you are within 2 armlengths of the
person
If a elderly person has multiple symptoms, then the assessment you do has
to be inclusive of all of the symptoms: often the answer is to assess all of the
medications the patient is taking
When salt or salt substitutes is brought up, we are looking to address a
persons confusion due to hyper or hyponatremia issues
Thrombotic strokes: once you are at 48+ hrs, they are in a chronic stateso
not urgent

Embolic strokes: once you are at 5 + days, they are in chronic state, so not
urgent
Healthy nap is 25-30 minutesdoes not mess sleep cycle up.longer or
shorter is bad
It is always a good thing to decrease your bad habitsunless you are still
contributing to disease, then it is still a bad thing
G meds cause bleeding risk
Asthma TRUMPS ALL be sure their asthma is proven stable, until proven
otherwise so you need to know what the best asthma assessment is
which is PEAK EXP FLOW RATE
POVERTY IS A RISK FACTOR FOR ASTHMA because the number one risk factor
for asthma is the cockroach
Best nutritional assessment, besides muscle strength, is albumin (normally
>4.5)
Always ask is the condition described affecting the patient? unless it tells
you a diagnosis (i.e. septic shock)
Femur Fracture: Keep the limb neutrally positioned
Hips: No more than 15 degree angle changes and dont sit for long periods of
time
We dont really do STERILE dressings in the home settingjust aseptic
technique
History: we want to know what happens right happens before an event
For insomnia: what happened right before sleep, and what did you do to
prepare for sleep
If you are INVESTIGATING, you are looking for UNEXPECTED abnormal
Compartment syndrome
Renal calculi: gets TONS of fluidneed to move the rock into the bladder to
get it into bladder. Like a liter an hour or more! AND ALL STONES ARE
SCREENED AND SENT TO LAB TO RULE OUT Cancer give MORPHINE
IT IS NEVER EVER EVER EVER EVER EVER NORMAL TO BE FORGETFUL IF
THE ELDERLY PERSON IS HAVING TROUBLE REMEMBERING THINGS, THAT IS
SOMETHING TO INVESTIGATE
Implanted cervical radiation: we dont do their COMPLETE bed bath unless the
patient is comatose
Nurses only get 30 minutes with patient each 4 hours with implanted
radiation
If internal radiation is a delegation question, dont give implanted radiation
therapy to the LVNRN only
Remember we dont give all the personal hygiene care unless the patient is
completely comatoseso if you see ALL or complete as words in the
question, it would be wrong
Rotating patches (transdermal) is good
Crutches: good up, bad down (when going up/down stairs, the good leg goes
up first, the bad leg goes down first)
Degenerative Joint Disease: IF I cant use my big joints, I use BOTH my little
joints

PCA is NEVER for terminal or chronic cancer painONLY FOR ACUTE PAIN and
BREAKTHROUGH PAIN
Bipolar and adolescent boys have same problemno captain of the
ship(risky behavior)
Psych therapeutic treatment:
Explore is always wrong!!!! They dont care how you got to where you are
just the behavior right in front of you at the time
Focusing on the nurse is wrong We are doing all we can that is trying to
get the nurse to feel better, not the patient
Never say anything close to DONT WORRY. we do this all the time this
is a simple procedure and not dealing with what they are really worried
about
Guilt: never with patient i.e. dont worry about that, think about your family
all of those are blowing them off
You have to be sure you know why the patient is saying what they are
saying. Are you saying you look like a freak because you have no hair
If you have a a list of complaints (i.e fatigue, menses, brittle hair, etc.) then
your implementation has to address ALL OF THE COMPLAINTS, not just one of
them!
DIETS
o UNLESS DIET IS VERY SPECIFIC (FULL LIQUID OR LIQUID): All have to
have protein, vegetable/fruit, AND A CARB
o Focus on what you are RESTRICTING;
Renal diet: restrict proteins (long grain rice, meats)
Seafood: +++
Meat: ++
Non meat: +
Salt:
Most: +++
Medium: ++
Least: +
For vegetarian diet, everyone is vegan at the base (plant products only)
o Lactovegetarian: milk and plant
o Ovovegetarian: eggs and plant only
o Lactoovovegetarian: dairy, egg, plant
TPN: Sepsis, air embolism, hyperglycemia are concerns so watch for those
It is totally expected to be above normal temp a little for any type of
indwelling tube (NG, foley, etc)
Glomerulonephritis: the urine will look horriblenot expected to have no
urine, and NEVER
FIXED URINE SPECIFIC GRAVITY. You do expect hematuria, proteinurianot a
surprise
If asking intake: DONT SUBTRACT unless asking I/Obut for dialysate, only
count as intake the stuff that was left behind during dialysis (i.e. 2000
dialysate in, 1900 dialysate out would equal a total of 100 input)
Continuous ambulatory peritoneal dialysis: your activity SHOULD NOT be
restricted should be able to carry on life

The word SUDDEN indicates it is URGENT issue and needs ABCs addressed in
order (airway first)
Post Op Day doesnt matter. It is the INCISION SIZE that matters on NCLEX
(smaller the incision more stable the patient is)
A Harrington rod: for scoliosis
To test for scoliosis: bend over, and spine should run straight
An UNEVEN HEM on a little girl indicates that she has scoliosis.she is
crooked
If you dont know why something is going wrong you must ASSESS first
(find out what is wrong first before you change things (including polling coworkers, investigating, etc.)
NEVER TEACH THE TASK YOU ARE DELEGATING. THEY SHOULD ALREADY
KNOW IT (so you shouldnt teach the CAN/NAP the jobdont instruct the
CAN/NAP.just give directions)if they dont already know it, then it
shouldnt delegated to them
Always assume a floor has 50 bedsso unless you can do something for
everyone, dont do it (i.e. switching assignments around)
RN must handle all new admissions and discharge planning
RNs are the SUPERVISOR of the CNAs and LVNs.
Pain that is sharp and unrelenting is a concern if it comes and goes it is less
worrisome
Your boss is your bossand that is who you report toyou REPORT TO YOUR
IMMEDIATE SUPERVISOR
FLOATING: Never give a floater a specialized patienttry to match their skill
o i.e. post partum nurse can get a post op patient
o you can only give chemo if chemo certified
o match the skill to the nurse
You assess gag ONE TIME before the first time you use the mouth after NPO)
We do things every 2 hours (water, reassess, organize thoughts, etc)
After CVA, you should be in THERAPY most of the day dont waste the CVA
patient energy with menial things
When determining WHO TO CALL FIRST, call the person with the
UNEXPECTED abnormal
ACTION: DONT LEAVE YOUR PATIENT!!!!!!!!!! EVER
OBTAIN=LEAVING YOUR PATIENT, SO DONT DO IT
Agitated: May leave the patient in a darkened room, but that is an exception
A patient taking a medication for the first time, about 3 days to develop an
adverse reaction, so stop taking the meds, THEN come into the clinic/office
(ASSUME THE WORSE OUTCOME (even if you are wrong later))
STEROIDS: delay wound healing, make you osteoporotic, immune
suppressed, hyperglycemic
Immunosuppressed patients can only go in a room with a clean patient
Blood tests done routinely/monitored: coumadin, lithium, etc..
G-G-G-G-K: cause really fucking bad thrombocytopenia (both Ginkgo and
Kava are very bad..pull them off it)
o G: Garlic
o G: Ginseng
o G: Ginger

o G: Ginkgo
o Kava
Everyone should use soft toothbrush and drink 8-10 glass water a daythat
is good
Benzotropine (cogentin): not for glaucoma (atropine/anticholinergic)
Pediatrics should not lose weight come to clinic/see doctor
Do bronchodilator before steroid for inhalers.
MRI/MRA (magnet):
Dyes are not iodine based when scanning stuff above the diaphragm
itching and swelling from dyes are important when dealing with angiograms
between groin and diaphragmotherwise, not an iodine based scan
If the diuretic is causing symptoms, it would be muscle cramps, not nausea
When a patient is out of the health care setting, and there is an adverse
effect from a medication (an unexpected outcome), you need to go to the
hospital or doctorcant treat the patient in the home or field setting
Lasix: be sure you check for muscle weakness (if K is low, muscle weakness)
Most concerns refers to a complication of a medication:
Never check Homans
I/O: should be 1500-2000 per day
Urine Output: 300cc/24 hrs is OK
Respiratory Rate: 12-20if 10/min, that is low
When you see two diseases listed in a question, think about what those two
diseases share as a complication (i.e. Raynauds and DM1: peripheral
circulation issues)
Dont put SpO2 and BP cuff on same arm
BPs best on left arm
OK to delegate SpO2 to CNA, but dont assume anything (give explicit
instructions, no assessment portion)
RN never delegate assessment, teaching, or tasks requiring clinical judgment
Most unstable patient to RN
LVN only get patients with predictable outcomes and stable (never do
admission or discharge! Those involve teaching), never prepare for pre-op,
but they can give the meds. Never teaching for LVN. Never flush a tube (NG,
ET, IV, etc), never let LVN give blood.
LVN, on test, MAY: stable patients, sterile procedure with predictable outcome
(no assessment portion) (Go do dressing change in room 5, if it is pink and
dry, that is fineif it is anything else, come get me.)
LVN may not do PRN (because assessment portion involved, so they cant do
it)
LVN may never mess with IVs
Nursing assistants CAN DO ACCUCHECK
Tube feeding: NAP/CNA can do it (take out plunger, pour feeding into). They
cannot do the residual or placement check, only RN.
Pumps: RN only
All women should be on calcium and Vit D so it is not the answer if
someone has bone lossthey should have been on it before that
Platelets: normal 140K-400K
Bleeding risk: less than 100K

Bleeding high risk: less than 50K


Big trouble for platelets less than 20K
RICE: rest, ice, compression, elevation
Thrombocytopenia bangs arm ice the arm
People calling from HOME (especially after an outpatient procedure) with an
unexpected abnormal come in and be seen or follow up with doctor is the
answer
1 cup: 240ml, 1 oz 30ml
You cant grow bone back, so you cant restore bone loss (dont expect to
grow bone back if it is gone)
All cath labs: post cath, distal pulse assessment is more important than
checking for slight bleedingCHECK DISTAL PULSES
Post paracentesis, most important thing to do is check BP right after
Third space fluid IS part of your circulation, so removing it can cause
hypovolemia
STEROID trumps most other things as it relates to wound healing (if on
steroids, higher risk for poor healing than diabetes or smoker)
Most meds should not be taken before laying flat
Patient statements are always assessments
Treat the primary tumor first, before the metastasis
NEVER GIVE SHORT ACTING NARCS ON A TIMED SCHEDULE! Always PRN for
breatkthrough pain (i.e. NEVER GIVE MS at 7-11-5p. the answer is NEVER
DO IT)
Prune juice is good for patients on opiates because it reduces constipation
(acts as a stool softener)
NTG/nitroglycerin (happy Rebecca???) : cause BP drop and HR increase
Old people: move slower, stiffer, renal insufficiency (not liver problems
normally)
ALOC: sodium may be the cause
Older old (over 70): move slower, stiffer, renal insufficiency
We want people to pee every 2 hours if they have stress incontinence or
other incontinence
Flomax: slows down the frequent peeing take it at bedtime. It is an alpha
blocker, and may cause hypotensionbest time to take it the first time is
before they go to bed
Stop a medication for angioedema
How to know a treatment is effective? Answer is looking for the NORMAL
assessment
o HDL is good cholesterol: >40
o Cholesterol: <200
o Tg: <150
o LDL<137
Stomach is most empty overnight, so best to take PPI at night, to reduce acid
Calcium blocks thyroid meds so dont take calcium 2 hr before or 3
hr after synthroid
Synthroid taken at night
Grapefruit juice: hypers all drugs (makes them all toxic)

Chemo drugs: the most important thing is hydration (N/V must be controlled
to avoid hydration issues)
CK and CRP for MI assessment
Temperatures brought on by disease dont worry until OVER 102.5F THEN
CALL DOCTOR
Surgical temps or anything done to your body: EXPECT slight temp for first 48
hrs but NOT MORE THAN 101.5F AFTER 48 HRS, NO TEMPERATURE ABOVE
NORMAL
ALT/AST for liver disease
BUN/Cr: kidney problems
RESTLESS = HYPOXIA = IMMEDIATE NEED FOR INTERVENTION
Vomiting around a NG means the fenestrated end holes are cloggedso you
know what the problem is, and you need an action
NEVER change suction to continous (in NCLEX or real life)
Pretty much when something is draining, and not it stopped, it is probably
clogged
FLUSH-MED-FLUSH-MED-FLUSH (avoids compatibility issues)
Never hook up G-Tube for 30 minutes after you give a med.WAIT TO
RESTART FEEDINGS
With PEEP on an ET:
o Great for cardiac output, but bad for venous return, so expect some
edema (normal to have edema and some weight gain)
o Normal ET cuff pressure is 18-20mmHg
Following up means you are concerned about something that was done or
said
Ileostomy: Should always have a never ending river of green goothat is
normal but can cause orthostatic HoTN, so be careful
Native American Highest Chance of DM2
Hispanics at risk because of their native American heritage
Dumping syndrome: imagine sitting at a green light, being late, and having a
funeral procession crossing on your cross street. The dumping is a
syndrome of food going into mouth, then 10 minutes later being eliminated
the whole system runs way too quickly (GI Tract too quick) need frequent
small meals, not 3 regular meals a day. Lots of fat/protein in diet, lie down
after meals, and dont drink and eat at same time
Unexpected abnormal: call the doctor unless it is a position change only
Humira: immunosuppressant (avoid people who are sick)
HIV Prejudice on NCLEX
Pregnant women: no more than 1 serving fish per week (due to mercury)
Steroids all cause SODIUM RETENTION, that puts them at risk for low K
(hypokalemia), which can cause dig toxicityso dont mix steroids plus
digoxin
Hct normal: 41-49
BUN : high end of normal is 20 (normal 16-20)
Bleeding/ecchymosis around umbilicus: we know the problem, so start an IV
(no assessment neededwe know the problem)

N/V with a DM1: check blood glucose, then (if in the question), start a sliding
scale and do normal insulin (this is how you treat diabetics on their sick days)
Autonomic Dysreflexia causes: something is binding them (a tube clogged, or
too much swaddling up (like an infant), or constipation)
A patient who has massive urine output with head injury, probably has
Diabetes insipidus (but needs validation (assessment))
Spec gravity: 1.010-1.030
Fixed specific gravity is bad it should vary during the day.
Fixed low is DI, fixed high is renal failure (tea colored)
The only way wild side effects are allowed are for chemo drugs (SIADH, for
example)
Best assessment of hypomagnesemia
Tetralogy of fallot: DO NOT OVER FATIGUE THE CHILD (such as use high flow
nipple for feeding)
Infants are fed every 2 hours when awake no exceptions
No oral replacement for infants who are hypovolemicIV only
When looking at comparing normals, the best normal is the one in the middle
If they are awake enough to gag then they should not be getting an NG for
suctioning.
o
You are chocking someone, so take it out!!!
Tracheostomy general anesthesia most important thing to observe?
o 120 mm 160 mm Hg of suctioning, usually no more than 120. So 180
mm Hg would be too high.
o Coarse wheezes are normal for a patient with a trach.
Ok lung sounds;
o Fine crackles with bases OK
o One lobe OK cause its just one lobe
o At the bases is OK
o NOT ok lung sounds;
o 2 lobes
o One whole side
o If 2 answers are saying the same thing (ie, better lung sounds), then
neither is the answer
Honey Colored Crusts: Impetigo (an infection)
o Treat with ABX
o Wash hands
o Not food allergya bacterial infection
o ABX after 24 hr, ok to interact with others
Toddler: 2-5 yrs
Teaching stuff: The NURSE MUST BE PRESENT and do things not showing a
video and leaving the room.
Play is as vital as oxygen to a kid
PLAY is the key to their world
Assessing and teaching with kids is always related to playing
Eye surgeries: keep pressure down, dont sneeze or bend over, no
constipation
Never apply ice to tips (Ears, nose, fingers, toes)
No ASA for kids under 10yrs Reyes Syndrome

Moderate sedation is procedural sedation and risk for airway is highest


concern
Always VALIDATE your thought/interpretation of what is going on, with an
assessment, unless the question specifically tells you the diagnosis
Checking vital signs is very broad and not specificso often not the answer
Elderly pulling out tubes: give him something else to hold ontolike a towel
NEVER ASK A FAMILY MEMBER TO BE THE SITTER USE A TRAINED PERSON
they are not trained
Private rooms: immunocompromised or super infected (gonna get sick or will
make others sick)
o High WBC
Respiratory Acidosis and alkalosis: pH/CO2 opposite (ph up, CO2 down, etc)
Metabolic Acidosis and alkalosis: ph/HCO3 match (up and up or down and
down)
Suctioning is an assessment driven procedure (only when needed) therefore
ONLY RNs CAN SUCTION!
On the test, dont believe:
o Substance abusers
o Anorexics
o Bulimics
If PaO2 is low, almost always on test answer is OXYGEN
If you already know that they are hypoxic, no reason for pulse oxjust do
something to fix it.
Paperwork comes after psychosocial (lowest priority)

DECISION TREE
1) Figure out what the question is really asking
a. Cover all answer choices
b. Read only stem of the question
c. ID what the question is asking by rewording the question in your own
words (2-3 words) (i.e. Priority toxic.shock)
d. If you can ID topic of the question, proceed to step 2 (SIMPLIFY THE
TOPIC)
2) Are the answers assessments or implementations? IF VALIDATION IS
REQUIRED, IT IS AN ASSESSMENT (IE I HAVE TO LISTEN TO LUNGS FOR PE)
(If they give all the info, that is an implementation issue, not an assessment
issuethey are telling you what you need to know) TRAP: If you thought you
needed an assessment with validation, but they are all implementation
answers, then just go forward)

a. A mix of assessments and implementation


i. If yes, read stem to determine if you should assess or implement
(if validation required (you need more info), then it is an
assessment)
1. Select correct answer
b. Are answers ALL assessment or implementation?
i. If yes, go to step 3
3) Does Maslow Heirarchy fit? (Physical needs outweigh psychosocial needs)
(Meds to allow a procedure to be undertaken (i.e. reduction of dislocation) is
physical. Requesting pain meds for pain relief is a psychosocial issue. ONCE
A PHYSICAL ISSUE IS THERE, IT OUTWEIGHS/TRUMPS ALL PSYCHOSOCIAL.
PAIN MEDS FOR PAIN IS PSYCHOSOCIALNOT PHYSICAL
a. If yes, eliminate psychosocial answers
i. Do physical needs make sense?
1. Apply ABCs
b. If no, are all answers physical
i. Yes: Step 4
ii. No, all answers psychosocial
1. If yes, proceed to step 5
4) Are all answers physical???
a. ABCs
5) What is the OUTCOME of each of the remaining answers? (TRAP: Dont select
answers that sound right)
a. If all answers are assessment, ID why each assessment is performed.
Determine the outcome of each assessment. Is it desired for the
situation.
b. Are all answers implementation: ID why each implementation is
performed. Determine outcome of each answer. Is it desired?
Step 5 Sub Parts
A) Expected abnormal vs. unexpected abnormal
i. i.e.: Asthma: wheezing is not unexpected,
but absent lung sounds is problematic
Heart failure: right sided issues are normal
and expected, but left side symptoms are
bad and worrisome. Post op slight bleeding is
expected abnormal, but pools of blood is an
unexpected abnormal and worrisome.
B) Chronic vs. Acute: When to decide who to see
first, chronic diseases with chronic drugs is not a
high priority acute diseases and acute issues are
higher priority
C) Worse case ABC (ABCs first) (AIRWAY ISSUES
BEFORE CIRCULATION OR BLEEDING ISSUES)
(ASTHMATIC WITH ANY AIRWAY BREATHING ISSUE
WILL BE SEEN BEFORE HEART ATTACKS AS LONG
AS MI HAS AIRWAY AND BLEEDING. IE: Femur
fracture, worse case scenario is bleedingso a

patient with an airway issue must come first on


NCLEX