NCLEX Cram Sheet We exist to educate and empower people to achieve their maximum God-given potential, so they can serve others and provide for themselves and their families. We do this by creating and curating the world’s largest collection of educational materials for helping individuals pass high-stakes standardized tests. Founded as a new kind of educational publisher at the dawn of the online revolution in 2002, we utilize the power of the Internet to give much of our work away for free. 1. Lab Values Basil Metabolic Panel (BMP) Sodium (Na): 135-145 mEq/L • Hyponatremia – low • Hypernatremia – high Potassium (K): 3.5-5.3 mEq/L • Hypokalemia – low • Hyperkalemia – high Calcium (Ca): 9-11 mg/dL (total), 4.5-5.6 mg/dL (ionized) Chloride (Cl): 95-105 mEq/L Albumin: 3.9-5.0 g/dL Alkaline phosphatase (ALP): 44-147 IU/L ALT: 8-37 IU/L AST: 10-34 IU/L BUN: 7-20 mg/dL CO2: 20-29 mmol/L Creatinine: 0.8-1.4 mg/dL Glucose: 70-100 mg/dL Total bilirubin: 0.2-1.9 mg/dL Total protein: 6.3-7.9 g/dL Arterial Blood Gases (ABGs) pH: 7.35-7.45 • <7.35 = acidosis • >7.45 = alkalosis PaCO2: 35-45 mm Hg • <35 = alkalosis • >45 = acidosis HCO3: 22-26 mEq/L • <22 = acidosis • >26 = alkalosis PaO2: 80-100% Oxygen saturation: > 95% Complete Blood Cell Count (CBC) RBC: Male = 4.5-6.0 µL; Female = 4.0-5.0 µL WBCs: 3.5-10 x 103/mm3 Hgb: Male = 13.5-18.0 g/dL Female = 12.0-16.0 g/dL Hct: Male = 40-54% Female = 36-46% Cardiac Labs Troponin: <0.012 mcg/L CK-MP: 0-6% BNP: <100 pg/mL Urinalysis Color: straw (cloudiness may be due to phosphates/urates) Turbidity: clear Specific Gravity: 1.001-1.02 • Low: sickle cell, DM, diabetes insipidus Dipstick: pH 4.5-7.5 Protein: negative • Positive: nephritic syndrome, renal tubular disease, pyelonephritis, and polycystic kidney disease Sugar: negative • Positive: diabetes or other endocrine diseases Acetone/ketones: negative • Positive: non controlled diabetes, alcoholism, starvation Bile: negative Hemoglobin: negative • Positive: bleeding, kidney/bladder irritation Nitrite: negative • Positive: indicates bacteria Leukocyte esterase: negative Urobilinogen: positive Urine output: 800-2000 mL/day (with intake of 2000 mL) Lipid Profile Total cholesterol: <200 mg/dL • Moderate Risk: 200-240 mg/dL • High Risk: >240 mg/dL High-density lipoprotein (HDL): 29 77 mg/dL Low-density lipoprotein (LDL): 60 160 mg/dL Triglyceride level: 10-190 mg/dL BMI Scores for adults 20+ • Underweight: <18.5 • Normal weight: 18.5-24.9 • Overweight: 25.0-29.9 • Obese: 30+ Scores for <20 • Underweight: <5th percentile • At risk for overweight: 85th<95th percentile • Overweight: > 95th percentile 2. Assessments Burns – Depth of Injury 1st degree—superficial: reddened skin, but intact 2nd degree—partial thickness; loss of skin, into dermis (most painful) 3rd degree—full thickness; all skin is lost, can see fat/muscle 4th degree—full thickness + underlying tissue; can see to bone • 3rd and 4th degree are not painful since nerves are lost Rules of Nines Head and neck – 9% • children = 18% Anterior torso - 18% Posterior torso - 18% Each leg - 18% • children = 13.5% Each arm - 9% Genitalia/perineum - 1% Pain Assessment/Pain Scales Visual Analog Scale (VAS) (non-numeric) • Used to determine baseline pain. Patient Comfort Assessment Guide: • To assess pain status and pain relief, response to medications. Wong-Baker FACES • Graphic depictions of pain through different facial expressions • Appropriate for children, non-English speakers, and some illiterate patients or patients with cognitive impairment • Pediatric version and an adult version Brief Pain Inventory • Assesses the effect pain has on activities. CPOT • Used in critical care settings (ventilated patients) Pain Assessment in Advanced Dementia Scale (PAINAD) • Appropriate for adults with cognitive impairment CRIES • Crying • Requires O2 • Increased vital sign • Expression • Sleepiness • Assesses pain in neonates FLACC • Face • Legs • Activity • Cry • Consolability • Appropriate for children to 3 years of age and older children with cognitive impairment. 3. Newborn Vital Signs Heart rate: 100-160 (avg. 140-160) Resp: 30-60 BP: systolic 70-90 mm Hg APGAR Score Appearance (color): • 0, pale blue • 1, body pink, extremities bluish • 2, completely pink Pulse (heart rate): • 0: absent • 1: slow or below 100 • 2: >100 Grimace (reflex irritability): • 0: none • 1: grimace • 2: vigorous cry Activity (muscle tone): • 0: flaccid • 1: some extremity flexion • 2: active motion Respirations (resp. effect): • 0: absent • 1: slow and irregular • 2: vigorous crying Newborn Reflexes Babinski: Toes should hyperextend if side of sole of foot stroked from heel to ball of foot. Blinking: Eyes should close if light flashed in eyes. Moro (startle): Infant should extend limbs and neck symmetrically and then pull back in response to loud noise or jolt. Palmar grasp: Infant should grasp finger if palm stroked. Rooting: Infant should open mouth and turn to the side of touch when the infant’s cheek is stroked. Sucking: Infant should suck if mouth touched. Reflex may be weak in premature infants. Tongue extrusion: Infant should push tongue out of mouth if tip of tongue touched. Tonic neck (fencing): With infant lying flat and the head turned to one side, the infant should flex limbs on opposite side and extend limbs on the side to which head is turned. Trunk incurvation: With infant prone, stroking down one side of spine (1 inch from spine) should result in the pelvis turning to stroked side. 4. Pharmacology Prefixes/Suffixes & Roles Blood Pressure Medication ACE Inhibitor (-pril): relaxes blood vessels, decreasing workload of the heart Beta Blockers (-lol): reduce blood pressure by slowing the heart rate and reducing myocardial contractility Calcium Channel Blocker (-dipine): relax blood vessels increasing blood supply and oxygen to the heart Angiotensin Blocker (-sartan): inhibit blood vessel constriction Potassium-sparing diuretics (-actone): increase the fluid passed out by the kidneys, while retaining potassium in the body Thiazide diuretics (-thiazide): treats blood pressure Cardiovascular Medication Anticoagulant (-arin): prevent blood coagulation or prolong clotting time Antilipidemic (-statin): reduce LDL cholesterol and cardiovascular disease Thrombolytic (-ase): clot-buster drugs that break down unwanted blood clots Antibiotics Aminoglycosides (-mycin): treats aerobic gram-negative infections Cephalosporin (Ceph- OR Cef-): treats bacterial infections Fluoroquinolones (-floxacin): broad-spectrum antibiotic to treat bacterial infections (i.e. respiratory and urinary tract infections) Penicillin (-cillin): treat bacterial infections Tetracyclines (-cycline): broad-spectrum antimicrobial drugs to treat/prevent bacterial infections by slowing bacterial growth Sulfonamides (Sulfa-): treat bacterial and some fungal infections Intestinal Medication Antiemetic (-azine): treats nausea and vomiting Proton pump inhibitors (-prazole): anti-ulcer drugs that reduce gastric acid production H2 receptor antagonists (-tidine): block action of histamine in stomach, decreasing production of stomach acid Respiratory Medication Antihistamines (-ine): treat allergy symptoms (i.e. sneezing, runny nose, itching, or hives) Bronchodialators (-terol): treat asthma and symptoms; dilate the bronchi and bronchioles, which increases airflow to the lungs and makes breathing easier Methylxanthine (-phylline): treat airway obsruction and asthma symptoms; relax smooth muscle of bronchioles, resulting in dilation of airway Anti-anxiety and Antidepressant Medication Benzodiazepine (-pam OR -lam): treat anxiety SSRI (-pram OR -ine): treat major depressive disorders and anxiety disorder; block or delay reabsorption of serotonin Tricyclic antidepressants (-triptyline OR -ipramine): treat depression, bipolar disorder, anxiety, OCD, and other mood disorders Miscellaneous Antifungal (-azole): treats a fungal infection Antiviral (-vir): treats a viral infection Barbiturates (-barbital): increase effect of GABA in CNS, reducing excitability and producing sedation Corticosteroids (-sone OR -lone): anti-inflammatory drugs used to control many different symptoms Local anesthetics (-caine): prevent transmission of nerve impulses or pain w/o causing unconsciousness Oral hypoglycemic (-ide): lower blood sugar for diabetic patient Protease inhibitor (-navir): antiretroviral agents Avoidances ACE Inhibitors: avoid potassium supplements of foods high in potassium Antibiotics: avoid milk, caffeine, and products and vitamins/minerals containing iron Anticoagulants: avoid foods high in Vitamin K and vitamin E supplements Antifungals: avoid milk products and alcohol Antihistamines, antidepressants, anti-anxieties: avoid alcohol and grapefruit juice Beta blockers, nitrates, narcotics, NSAIDs: avoid alcohol Bronchodilators, histamine blockers: avoid caffeine and alcohol Carbamazepine, cyclosporine and tacrolimus, HIV medications, statins: avoid grapefruit juice Diuretics, potassium sparing: avoid food high in potassium MAO inhibitors: avoid alcohol and non-alcoholic substitute for beer/wine, food high in tyramine, and products containing caffeine Toxicity Reversal Agents Acetaminophen: N-Acetylcysteine Alcohol withdrawal: Librium Ammonia: Lactulose Warfarin: Vitamin K Digoxin: Digibind Heparin: Protamine Sulfate Iron: Deferoxamine Narcotics: Naloxone Therapeutic Drug Levels Digoxin: 0.5-2 ng/mL Lithium: 0.8-1.5 mEq/L Dilantin: 10-20 mcg/dL Theophylline: 10-20 mcg/dL Warfarin: • INR levels of 2-3 (A-fib, MI, DVT, PE) • INR levels of 2.5-3.5 (for mechanical heart valves) Eight Rights of Medication Administration Right Patient Right Medication Right Dose Right Route Right Time Right Documentation Right to Education Right to Refuse Intravenous Infusions Drop factor: number of drops in 1mL of solution Microdrip: For small or precise infusions; 60 gtts/mL Macrodrip: For quick or large infusions; 10-20 gtts/mL • 25-28 g; 5/8 inch long • 0.5-1 mL of fluid; insulin, heparin, enoxaparin, etc. Intramuscular (IM) • Deep into muscle; ventrogluteal, dorsogluteal, vastus lateralis, or deltoid muscle • Angle: 90° • 23 g; 1-1½ inch length • <3 mL of fluid; only 2 mL in deltoid • MUST aspirate for blood prior to giving an IM injection to ensure medication will not be delivered intravenously 5. Positioning Post-operatively Injections Intradermal (ID) • Dermal layer of the skin; shallow, causes “bleb”; given into skin of inner forearm, or back, rarely chest. • Angle: 10-15° • 27-30 g; 1/4 - 3/8 inch length • < 1 mL fluid: Mantoux test for TB exposure, allergy testing, etc. Subcutaneous (SQ) • Adipose (fat) tissue; upper, outer arm, the anterior thigh, and the abdomen • Angle: 45° (90° for insulin and heparin) Angiography: if an extremity is used, place restraint to keep the extremity straight for 6-8 hours Bronchoscopy: place in semi-Fowler’s position to prevent aspiration Myelogram: with air contrast, place in Trendelenburg position; with oil contrast, place flat for 6-8 hours; with water-based contrast, place with head of bed elevated for 8 hours Liver biopsy: position on right side with pillow placed beneath the puncture site Arteriovenous fistula formation: elevate extremity Abdominal aneurysm: elevate head of bed to <45 degrees Ear irrigation: position client on affected side to promote drainage Lumbar puncture: keep flat for 4-12 hours Appendectomy: place in Fowler’s position Cataract removal: place in semi-Fowler’s or Fowler’s position on back or opposite side of surgery Kidney transplant: place in SemiFowler’s position on back or turned to opposite side of surgery Mitral valve replacement: place in semi-Fowler’s position Thyroidectomy: place in high Fowler’s or semi-Fowler’s Tonsillectomy: prone or side-lying Amputation of leg (AK,BK): elevate limb for 24 hours; place in prone position at least 2 times/day Insertion nasogastric tube: keep head elevated to at least 30° 6. Psychology Kubler-Ross Phases of Grief Denial: does not really believe loss has happened, talks as if nothing has changed. Anger: upset about loss, may act out, exhibit previously unfelt aggression at the lost individual; may blame caregivers for loss Bargaining: trying to change results of loss/avoid consequences of loss; may ask God to change what happened Depression: loss of interest, may feel life is not worth living/fatalistic, withdraw from friends/family Acceptance: come to terms with loss and able to cope, accepted consequences; back into a pattern of daily living Maslow’s Hierarchy of Needs • Psychological Needs • Safety Needs • Love Needs • Esteem Needs • Self-Actualization Needs Cultural Health Considerations Proxemics (space considerations): • North Americans and Northern Europeans tend to want the most space • Latin Americans, Asians, Middle Easterners, and Southern Europeans often feel comfortable standing very close to others Eye contact • Direct eye contact = cultural norm in North American and many European countries • Native Americans, Asians, and Mexicans often avoid eye contact to show respect Time • Punctuality = cultural norm in U.S. • Latin Americans and Mexicans may consider time in relation to day/night or before/after meals rather than clock Complementary/Folk Medicine • People from other cultures may utilize alternative medical systems: » Chines herbal medication » Healers » Meditation » Body-based therapies » Coining/Cupping Touch • Restrictions in touch between male and females in some culture (i.e. Middle Eastern) • Asian cultures may be upset if head is touched without permission because they believe the spirit resides in the head Family Hierarchy: • In some cultures (Mexican, Asian, & Middle Eastern) decisions are made by the males or head of the family rather than the individuals 7. Miscellaneous ANA 6 ethical principles • Autonomy • Beneficence • Nonmaleficence • Justice • Veracity • Fidelity Levels of Disease Prevention Primary: goal is to prevent initial occurrence of a health problem (i.e. disease or injury) through activities such as: • Immunizations, smoking cessation, fluoride supple-mentation of water, promotion of seat belt use, and use of child care seat restraints Secondary: goal is to identify diseases or conditions quickly and provide prompt intervention for treatment and prevention of further disability through such activities as: • BP screenings, breast and testicular self-examinations, hearing and vision screenings, mammography, and pregnancy testing Tertiary: goal is to assist those who already have disease or disability to prevent further progress of the disease and to allow people to achieve the maximum quality of life through activities such as: • Support groups, counseling, diet and exercise, stress management, and supportive services Acronyms Drainage Amount: C-COAL • Color • Consistency • Odor • Amount • Location Wound Assessment: OREEDA • Odor • Redness • Edema • Ecchymosis • Drainage • Approximation Pathogens: SPIDERMAN • S: sepsid, scarlet fever, streptococcal pharyngitis • P: parvovirus B19, pneumonia, pertussis • I: influenza • D: diphtheria (pharyngeal) • E: epiglottis • R: rubella • M: mumps, meningitis, mycoplasma, meningeal pneumonia • AN: adenovirus 8. About the Tests General • Exam is computer adaptive • Unoffical results can be accessed 48 hours after exam date and time (small fee required) • Offical resuls received approximately 6 weeks after exam NCLEX-PN • Used to determine if you’re ready to begin practicing as an entry-level registered nurse • 85-205 questions (with 25 being pretest questions that are not scored) • Time limit = 5 hours with breaks • Test Plan: https://www.ncsbn. org/2020_NCLEXPN_TESTPLAN. pdf NCLEX-RN • Used to determine if you’re ready to begin practicing as an entry-level practical/vocational nurse • 75-265 questions (with 15 pre-test questions that are not scored) • Time limit = 6 hours with breaks • Test Plan: https://www.ncsbn. org/2019_RN_TestPlan-English.pdf 9. Resources https://www.mometrix.com/academy/ nclex-exam/ - free resources www.mometrix.com/university - online prep course that contains instant access to: • over 1,100 practice questions (8 fulllength practice tests) • dozens of review videos • hundreds of digital flashcards • audio versions of all lessons • a progress tracker • and more!