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nclex value

. 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
. RBC 4.5–5.0 million
. WBC 5,000–10,000
. Plt. 200,000–400,000
. Hgb 12–16 gms women; 14–18 gms men
. HCO3 24–26 mEq/L
. CO2 35–45 mEq/L
. PaO2 80%–100%
. SaO2 > 95%
. Glucose 70–110 mg/dL
. Specific gravity 1.010–1.030
. BUN 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 40–50 mg/dL
. Total cholesterol 130–200 mg/dL
. Bilirubin < 1.0 mg/dL
. Protein 6.2–8.1 g/dL
. Albumin 3.4–5.0 g/dL
. Digoxin 0.5–2.0 ng/ml
. Lithium 0.8–1.5 mEq/L
. Dilantin 10–20 mcg/dL
. Theophylline 10–20 mcg/dL
. Heart rate 80–100
. Respiratory rate 12–20
. Blood pressure 110–120 (systolic);60–90 (diastolic)
. Temperature 98.6° ?/–1
. FHR 120–160 BPM.
. Variability 6–10 BPM.
. Contractions normal frequency 2–5 minutes apart;
normal duration < 90 sec.; intensity < 100 mm/hg. Contractions
. Amniotic fluid 500–1200 ml (nitrozine urine-litmus paper green/amniotic fluidlitmus paper blue).
. Apgar scoring A = appearance, P = pulses,G = grimace, A = activity, R = reflexes (Done at 1 and 5 minutes 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.)
19. FAB 9—Folic acid = B9. B stands for brain (decreases the incidence of neural tube defects);
the client should begin taking B9 three months three months prior to becoming pregnant
Decelerations are abnormal findings on the fetal monitoring strip.
. Early decelerations Begin prior to the peak of the contraction. caused by head compression. no need for intervention if the variability is within normal range and the fetal heart rate is within normal range.
. Variable decelerations V-shaped on the monitoring strip. Variable decelerations can occur anytime. They are caused by cord compression. The intervention changes the mother’s position; if using pitocin, stop; apply oxygen; increase the rate of IV fluids. Contact doctor if proble
. Late decelerations after the peak of the contraction and mirror the contraction in length and intensity. caused by uteroplacental insuffiency. intervention is to change infusing, stop the infusion; apply oxygen;the mother’s reposition; if pitocin is and increase the rate of
TORCHS syndrome in the neonate toxoplasmosis, rubella (German measles), cytomegalovirus, herpes, and syphyllis. Pregnant nurses should not be assigned to care for the client with toxoplasmosis or cytomegalovirus.
STOP is the treatment for maternal hypotension after an epidural anesthesia: 1. Stop pitocin if infusing. 2. Turn the client on the left side. 3. Administer oxygen. 4. If hypovolemia is present, push IV fluids.
. Coumadin (sodium warfarin) PT 10–12 sec.
vitamin K. The antidote for Coumadin is
. Heparin/Lovenox/Dalteparin PTT 30–45 sec.
protamine sulfate. The antidote for Heparin is
. Therapeutic level It is important to maintain a bleeding time slightly prolonged so clotting will not occur; therefore, bleeding time with mediication should be 1 1/2–2 times the control.
. Head 9%
. Arms 18% (9% each)
. Back 18%
. Legs 36% (18% each)
. Genitalia 1%
25. 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 toget
26. 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
27. Native American cultural attributes They sustain eye contact; blood and organ donation is generally refused; they might refuse circumcision; may prefer care from the tribal shaman rather than using western medicine.
28. Mexican American cultural attributes They might avoid direct eye contact with authorities; they might refuse organ donation; most are very emotional during bereavement; believe in the “hot-cold” theory of illness.
. Jehovah’s 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)
ROME is a quick way of remembering that in respiratory acid/base disorders the pH is opposite to the other components.
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.
In metabolic acidosis, the pH is below normal and the CO2 is decreased, as is the HCO3.
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
Addison's and Cushing’s are diseases of the endocrine system involving either overproduction or inadequate production of cortisol:
Treatment for the client with Addison’s: increase sodium intake; medications include cortisone preparations.
Treatment for the client with Cushing’s: restrict sodium; observe for signs of infection.
33. Treatment for spider bites/bleeding RICE
34. Treatment for sickle cell crises HHOP (heat, hydration, oxygen, pain medications)
35. Five Ps of fractures and compartment . Pain Pallor Pulselessness Paresthesia Polar (cold)
Hip fractures hemorrhage, whereas femur fractures are at hemorrhage
femur fractures risk for fat emboli.
37. Profile of gallbladder disease at Fair, fat, forty, five pregnancies, flatulent
Delegate sterile skills such as dressing changes to RN or LPN.
delegate the stable client to the nursing assistant.
Choose the most critical client to assign to the RN,
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 byChoose the most critical client to assign the RN.
The PN, like the RN, can monitor clients with IV therapy, insert urinary catheters and feeding tubes, apply restraints, discontinue IVs, drains, and sutures.
For room assignments, do not coassign the post operative client with clients who have vomiting, diarrhea, open wounds, or chest tube drainage.
Remember the A, B, Cs (airway, breathing, circulation) when answering questions choices that askChoose the most critical client to assign 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.
The RN and the physician institute seclusion protection.
The MD or the hospice nurse pronounces the client dead.
Angiotensin-converting enzyme inhibiting agents: end in -pril
Angiotensin-converting enzyme inhibiting agents: Benazepril (Lotensin), lisinopril (Zestril), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), moexipril (Vasotec), fosinopril (Monopril), moexipril, (Univas), quinapril (Acupril), ramipril (Altace)
. Beta adrenergic blockers Acebutolol, (Monitan, Rhotral, Sectral), atenolol, (Tenormin, Apo-Atenol, Nova-Atenol), esmolol (Brevibloc), 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, (Solu-cortef, Depo-Medrol, Depopred, Medrol,Deltasone, Meticorten, Orasone, Panasol-S), betamethasone, Atolone, Kenalog, Triamolone)
. Antivirals Acyclovir (Zovirax), ritonavir, (Norvir), saquinavir (Invirase, Fortovase), indinavir (Crixivan), abacavir (Ziagen), cidofovir (Vistide), ganciclovir (Cytovene,
. 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)
. Cox 2 enzyme blocker drugs Celecoxib, (Celebrex), valdecoxib (Bextra)
. 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)
. Schedule I Research use only (example LSD)
. Schedule II Requires a written prescription (example Ritalin)
. Schedule III Requires a new prescription after six months or five refills (example codeine)
. Schedule IV Requires a new prescription after six months (example Darvon)
. 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 histamine
. 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
digoxin 0.5-2ng/ml
PT 9.6-11.8sec/male;9.5-11.3sec/female
serum phenytoin(dilantin) 10 - 20 mcg/ml
serum lipase level 10-140 units/L
Hct 42%-52%
client with DM=glucose to red blood cells/glycosylated hemoglobin A (HbA1c) <7.5% is ideal/7.6%-8.9% is fair/ 9%< is poor control
tegretol 5 to 12 mcg/ml
lanoxin(digoxin) 0.5 to 2ng/ml
gentamicin(Garamycin) 5 to 10mcg/mL
phyntoin(dilatin) 10-20mcg/mL
theophylline 10 to 20 mcg/mL
tobramycin (nebcin) 5 to 10 mcg/mL
diet for acute diverticulitis allow the bowel to rest by avoiding fiber foods.
gout avoid high purine content like scallops
riboflavin milk, lean meats, fish and grains.
vitamin c tomatoes and citrus
folic acid green leafy vegetables, liver, beef, fish, legumes, grapefruit and oranges
assessment subjective=what the patient says.
assessment objective= things we can see/blood pressure, weight, skin lesions, lab reports
diagnosis focused on the client's responses to actual or potential health problems,
diagnosis medical diagnosis is focused on the illness or disease process
planning 1.prioritize nursing diagnosis, 2.determine goals, 3.ID measurable outcome(has goal been met) 4.develop interventions 5. record plan of care in the client's record
inplementing 1.put plan into effect 2.it involves performing many skills/procedures 3.report activities and findings 4.document activities
documenting activities client's condition prior to intervention invtervention performed client's response to intervention
evaluation 1.are the goals met 2. is there a need for continued nursing action 3.if the goal is not met, why?
application of cold lower metabolic rate and body temperature, promote vasoconstriction, anesthetic effect
application of cold prevent tissue damage moist application penetrates better than dry use to reduce bleeding, inflammation, pain used for the first 24hrs after injury
application of cold cap and collar used no longer than an hour. a.monitor v/s b.assess skin,protect with oil c.reposition every 2 hours. d.muscle relaxant if shivering e.monitor temp for 72hrs after dc'd
application of heat relaxes muscle spams softens exudates for removal vasodilates and hastens healing
application of heat localizes infection reduces congestion increase peristalsis
application of heat prevent tissue damage moist applications penetrate better assess skin every 5min
application of heat remove after 15 to 20 min
protien and niacin peanuts
carbohydrates and vitamin D milk
vitamin A, iron, cholesterol eggs
calcium tofu, broccoli, mustard greens, sardines
before a transfusion the nurse assesses v/s before and every 15min after for 30min and every hour thereafter
pallor, coolness, and swelling at the IV site infiltration
check IV fluid every hour for fluid replacement
discomfort at the site, redness, warmth and swelling proximal to the IV phlebitis
during transfusion, how long should the nurse stay initially the first 15 min
chills, itching, rash possible signs of a transfusion reaction
client with cardiac, resp/renal/liver disease, elderly and very young most likely to develop fluid overload
MRSA precautions gloves, gown, goggles
in case of fire remove patient from fire area activate alarms close the doors obtain fire extinguisher
safety restraints never tie to bedrail, bed frame only
check restraints every 30min
how is anthrax contracted skin, inhalation, gastrointestinal
heparin glycosaminoglycan, is widely used as an injectable anticoagulant
trimethobenzamide hydrochloriden (tigan) an antiemetic used to prevent nausea and vomiting. It is often prescribed for patients with gastroenteritis
meperidine hydrochloride (demerol) indicated for the relief of moderate to severe pain
prochlorperazine (compazine) a dopamine (D2) receptor antagonist that belongs to the phenothiazine class of antipsychotic agents that are used for the antiemetic treatment of nausea and vertigo.
atropine sulfate potent parasympatholytic. It inhibits actions of acetylcholine at postganglionic parasympathetic neuroeffector sites, primarily at muscarinic receptors. Small doses inhibit salivary and bronchial secretions, moderate doses dilate pupils and increase heart
levodopa (dopar) medication used to treat Parkinson's disease.
maslow's hierarchy of needs physical=physiological/safety emotional=love/achievement/recognition aesthetic=need to know/explore/understand selffulfillment=self actualization
the body constantly making acid
how does the body get rid of acid respiratory, kidneys, stomach, buffering system (neutralizes acid)
urine normally acidic and contains H+
arterial blood gas (ABG) measures pH, bicarbonate levels and partial pressure of oxygen and CO2
ABG's are helpful in diagnosing treatment of tachy/dys-pnea,restlesness/anxiety,drowsiness while on O2,cardiopulmonary/lung disease
following puncture of ABG site pressure is applied for 5min
how do you prevent hip flexion in a coma patient place in prone position for at least one hour three times a day.
Parkinson's disease Levodopa is turned into dopamine in the body and therefore increases levels of this chemical. associated with low levels of a chemical called dopamine (doe PA meen) in the brain.
Levodopa is turned into dopamine in the body and therefore increases levels of this chemical.
detailed information about a surgery that is explained by the surgeon complications, alternatives, and expected postooperative care needs.
legal aspects of informed consent operative permit,for invasive procedures, adults sign own unless LOC unable/life threat/panel agrees/authorized person cannot be reached, emancipated minor, witness
pre-op meds major meperidine(demerol)+morphine sulfate=to relax, seconal+nembutal=sedative, atropine sulfate=decreases tracheobronchial secretions to minimize aspirations
pre-op meds minor versed/valium for sedative+fentanyl(duragesic) for pain
post op procedure airway, O2 as ordered, assess, cough and deep breath
post op assess resp, v/s@15min(stable)-30min, LOC, circulation, IV site and flow, drainage tubes, dressing/bleeding, temp
scopolamine large doses promote anesthesia
primary concern for postop patience immediately after surgery aspiration
surgical diagnostic testing cbc, electrolytes, PT/PTT, urinalysis, ECG>40yrs old, type-match
surgical baseline nursing assessment head-to-toe, v/s, height and weight
surgical history PMX, PSX, allergies, dietary restrictions
prevention of post surgery vascular problems SCD, leg excercises Q2hrs, ambulation, check v/s-skin color-temp Q4hrs
prevention of post surgery vascular problems bed rest, anticoagulant therapy:heparin followed by coumadin
immediate treatment for pulmonary embolism O2, place in upright position, morphine or demerol for pain as ordered, thrombolytics -kinase/activasel,+heparin,coumadin as ordered
Created by: SGT.MOSS