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Sunday, August 12, 2007

NCLEX Notes: Preparing for Nclex Exam

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St. John's wort - antidepressant, photosensitive (C/I
in SULFA drugs)

Garlic - antihypertensive (avoid aspirin)

Ginseng - Anti stress (C/I in coumadin)

Green tea - antioxidant (check if risk for

Echinacea - immune stimulant (6-8 weeks only)(C/I in

Licorice - cough and cold

Ginger root - antinausea (C/I in Coumadin)

Ginkgo - improves circulation (C/I in anticoagulant,
headache side effect - check PT)

Ma huang - bronchodilator, stimulant (Ephedra)

Digitalis Toxicity includes..
N - nausea
A - anorexia
V - vomiting
D - diarrhea
A - abdominal pain

Drugs which can cause URINE DISCOLORATION
Adriamycyn------ Reddish
Rifabutin--------- Red orange
Rifampicin------- Red orange
Bactrim---------- Red orange
Robaxin--------- Brown, Black or Greenish
Azulfidine------ Orange yellow
Flagyl------------ Brownish
Dilantin---------- Pink tinged
Anti Psychotic-- Pinkish to Red brown
Early signs of hypoxia:
Late signs of hypoxia:
E-extreme restlessness
In pedia-
F-feeding difficulty
I-inspiratory stridor
N-nares flare
E-expiratory grunting
S-sternal retractions
Respiratory Patterns
Kussmaul- fruity acetone breath odor
Cheyne-stokes- near death breathing pattern

Seasonal Affective Disorder (SAD) may affect over 10 million Americans.
The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving for sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in the spring. Some individuals experience great bursts of energy and creativity in the spring or early summer.
Susceptible individuals who work in buildings without windows may experience SAD-type symptoms at any time of year. Some people with SAD have mild or occasionally severe periods of mania during the spring or summer. If the symptoms are mild, no treatment may be necessary. If they are problematic, then a mood stabilizer such as Lithium might be considered. There is a smaller group of individuals who suffer from summer depression.
SAD is recognized in the DSM-IV (The American Psychiatric Association's diagnostic manual) as a subtype of major depressive episode.
Some individuals who work long hours inside office buildings with few windows may experience symptoms all year round. Some very sensitive individuals may note changes in mood during long stretches of cloudy weather.

A sign of improvement from dehydration would be a decreased urine specific gravity and a decreased/decreasing hematocrit. So the SG of 1.015 and a Hct of 46% would be the answer. It is the best answer of the two you had in you question.
The normal urine SG is 1.003-1.035 (Usually between 1.010-1.025 with normal hydration and volume) (different texts give a slightly different range).
SG 1.025-1.030+ (concentrated urine)
SG 1.001-1.010 (dilute urine)
SG 1.001-1.018 in infants under 2 years of age
Specific gravity is a measurement of the kidney's ability to concentrate urine. The range of urine's SG depends on the state of hydration and varies with urine volume and the load of solids to be excreted under standardized conditions; when fluid intake is restricted or increased, SG measures the concentrating and diluting functions of the kidney. Loss of these functions is an indication of renal dysfunction.
SG values usually vary inversely with amounts of urine excreated (decrease in urine volume = increase in specific gravity). However in some conditions this is not the case.

OU- both eyes
OR- right eye
OS- left eye

CUSHINGS (Hypersecretion of Adrenal Cortex Hormones)

C = Check VS, particularly BP
U = Urinary output & weight monitoring
S = Stress Management
H = High CHON diet
I = Infection precaution
N = Na+ restriction
G = Glucose & Electrolytes Monitoring
S = Spousal support

ADDISON'S (Hyposecretion of Adrenal Cortex Hormones)
Always Remember the 6 A's of Addison's disease

1.) Avoid Stress
2.) Avoid Strenuous
3.) Avoid Individuals with Infection
4.) Avoid OTC meds
5.) A lifelong Glucocorticoids Therapy
6.) Always wear medic alert bracelet

Hirschsprung’s diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal sign in infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools.

Intussusception common in kids with CF. Obstruction may cause fecal emesis, currant jelly-like stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping. Resolution is obvious, with onset of bowel movements.

With omphalocele and gastroschisis (herniation of abdominal contents) dress with loose saline dressing covered with plastic wrap, and keep eye on temp. Kid can lose heat quickly.

After a hydrocele repair provide ice bags and scrotal support.

No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame).

Second voided urine most accurate when testing for ketones and glucose.

Never give potassium if the patient is oliguric or anuric.

Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused by glomerular damage. Corticosteroids are the mainstay. Generalized edema common.

A positive Western blot in a child <18 months (presence of HIV antibodies) indicates only that the mother is infected. Two or more positive p24 antigen tests will confirm HIV in kids <18 months. The p24 can be used at any age.

For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza. MMR is avoided only if the kid is severely immunocompromised. Parents should wear gloves for care, not kiss kids on the mouth, and not share eating utensils.

Hypotension and vasoconstricting meds may alter the accuracy of o2 sats.

An antacid should be given to a mechanically ventilated patient w/ an ng tube if the ph of the aspirate is <5.0. Aspirate should be checked at least every 12 hrs.

Ambient air (room air) contains 21% oxygen.

The first sign of ARDS is increased respirations. Later comes dyspnea, retractions, air hunger, cyanosis.

Normal PCWP is 8-13. Readings of 18-20 are considered high.

First sign of PE (pulmonary embolism) is sudden chest pain, followed by dyspnea and tachypnea.

High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcing potassium out). Carbon dioxide narcosis causes increased intracranial pressure.

Pulmonary sarcoidosis leads to right sided heart failure.

An NG tube can be irrigated with cola, and should be taught to family when a client is going home with an NG tube.

Q&As found in the NCLEX FORUM

Question # 1 (Multiple Choice) History and exam indicates your 77 year old
female patient has digitalis toxicity. Which drugs are contraindicated in this
case? Plz provide your rationale.

A) lidocaine and atropine
B) adenosine and amiodarone
C) magnesium sulfate and sodium bicarbonate
D) bretylium and verapamil


A) lidocaine and atropine-Don't affect dig level/dig toxicity.

B) adenosine and amiodarone-Amiodarone, increases serum dig levels, possibly
causing dig toxicity. Adenosine doesn't affect dig toxicity. Only one of these
meds is contraindicated in dig levels/toxitiy.

C) magnesium sulfate and sodium bicarbonate. Neither drug affects dig levels

D) bretylium and verapamil-BEST ANSWER: Verapamil, increases serum dig levels,
possibly causing dig toxicity. Bretylium aggravates dig toxicity and digoxin
toxic arrhytmias are exacerbated by bretylium. This answer has two meds that are
should not be given to dig toxic patients.

Question # 2(Multiple Choice) Regarding abruptio placentae

A) Blood loss is confined within the amniotic sac
B) Internal bleeding is generally minimal.
C) Blood loss may be concealed between the uterine wall and the placenta
D) There is always excessive external vagina bleeding

what's the correct one? I just don't agree with c.


C. is the best answer because it does describe placenta previa, most correctly.
Placenta previa is premature separation of the placenta, and the blood loss can
be either apparent or concealed. If the edges of the placenta remain attached to
the uterus then there will be no apparent loss of blood. However the woman is
still have significant internal bleeding.

A. is incorect because it does not describe A.P.

B. is incorrect because blood loss is usually significant, not minimal.

D. is incorrect because blood loss can be hidden.

Question # 3 (Multiple Choice) The geriatric patient suffering from organic
brain syndrome or dementia may not be able to make a rational decisions
regarding emergency care. In these situations, you may use ____to permit you to
legally render care

A) Good Samaritan Laws
B) Standards of Care
C) Implied Consent
D) Informed Consent

c is given as correct. why?

Answer:: Implied consent means that the patient most likely has been found in
distress and it is assumed that person wants to live. Therefore, you are within
the law to treat a person who is unable to make a decision about his/her care
who is in an emergency situation.

Above answer to your question explains why C is the best answer. Let me point
out a test taking tip to further support how you would choose this answer on an
exam, like NCLEX. First look at your question and identify, the key words, i.e.
what the question is asking. This question is asking which law will permit you
to deliver care in an emergency situation, when the patient is unable to give
consent. Now define each of the possible reponses.

A) Good Samaritan Laws-This law is to protect the individual that intervene to
provide care in an emergency from litigation. In other words, if a nurse stops
at an accident scene and provides care, the nurse will not be held liable for
their actions, if the care was provided in good faith according to practice
standards. Therefore this is not the answer.

B) Standards of Care-These are established guidelines for the nurse/health care
provider that outline safe and effective nursing care/interventions for given
diagnoses, etc. So, again this is not the answer to the question.

C) Implied Consent-Best answer, the patient can't verbalize consent, due to
their OBS/dementia, but they need emergency care. Because care is required then
consent to provide life saving care is implied. The same principle applies when
giving emergency care to unconscious patients. You can't wait for them to tell
you it is OK, to save their life, the law allows you to intervene. This is
implied consent.

D) Informed Consent-This is when the physician describes the procedure that is
to be preformed. Included in this explanation is the benefits and risks
associated with the procedure. The patient is INFORMED about the procedure and
then they give their consent. Again, this is not the best answer.

Try this technique when answering NCLEX-like questions, and you will find that
you will get more correct.

SOURCE: Emailed to me by the

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