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70 Cheat Sheets for
for Nursing School, NCLEX® Studying,
and New Grads
Table of Contents
Test-Taking Strategies��������������������������������������������������������������������������� 5
Lab Values ������������������������������������������������������������������������������������������������ 10
Fundamentals������������������������������������������������������������������������������������������ 16
Cardiovascular���������������������������������������������������������������������������������������� 25
Respiratory������������������������������������������������������������������������������������������������ 32
Integumentary ����������������������������������������������������������������������������������������38
Immune������������������������������������������������������������������������������������������������������42
Endocrine��������������������������������������������������������������������������������������������������� 44
Gastrointestinal���������������������������������������������������������������������������������������50
Electrolytes���������������������������������������������������������������������������������������������� 54
Hematological ����������������������������������������������������������������������������������������60
Musculoskeletal�������������������������������������������������������������������������������������64
Nervous������������������������������������������������������������������������������������������������������66
Reproductive / Obstetrics������������������������������������������������������������������ 73
Pharmacology������������������������������������������������������������������������������������������76
References������������������������������������������������������������������������������������������������82
©Picmonic
Hello Future Nurse!
No matter where you are in your nursing journey - your first day, a week
before the NCLEX®, or practicing in the field - you could use cheat
sheets! Luckily, Picmonic is here to help. We don’t encourage cheating,
but we’re here to make it so easy to be successful it FEELS like you’re
cheating.
We know your time is valuable so we came up with these cheat sheets
to help you retain the information faster than ever. We got you covered
in all the areas that you need fast visuals and tricks when you’re on
your toes in clinicals; from fundamentals, med-surg, pharmacology, all
the way to psych.
We recommend you use these cheat sheets in conjunction with the
Picmonic app, as you’ll get more bang for your buck. However, if that’s
not possible, don’t stress! We designed these little life-savers so you
can use them all on their own; the app is only optional.
If you do decide to use these with the app, you’ll notice we added in
the QR codes for specific Picmonics, and they are easy enough to use.
All you have to do is open your camera app and
point it steadily for 2-3 seconds towards the
QR codes to view the Picmonics mentioned in
each section, and voilà! You’ll become a nursing
memory master in no time.
Now go on and study your little heart out, and
whip these bad boys out of your back pocket
whenever you need a little refresher or support.
Happy cheat sheeting!
The Picmonic Team
©Picmonic
Contributing Authors
Ron Robertson
Marlee Liberman, BSN, RN
CO-FOUNDER + CEO
MASTER NURSING SCHOLAR
Shelby Tuskey, BSN, RN
Josh Lawler, RN, DNP Student (Yr2)
NURSING SCHOLAR
NP SCHOLAR
Stephanie Ballard-Stucjus, BSc.
PUBLIC HEALTH SCHOLAR
Image and Illustration Team
Sara Eason
Alana Yuen
CREATIVE CONTENT DIRECTOR
ILLUSTRATOR
Chelsie Ashburn
Luke Wyssman
ILLUSTRATOR
ILLUSTRATOR
Jonny Antoni
Ian Rosenthaler
ILLUSTRATOR
ILLUSTRATOR
Melanie Thomas
ILLUSTRATOR
©Picmonic
5
Section 1
Test-Taking Strategies
Let’s face it, tests are scary! But with Picmonic by your side, you
can ace them with ease. Welcome to the section entitled TestTaking Strategies! In this section we’ll be talking about some key
strategies that are helpful when taking the NCLEX®. We’ll begin
with Maslow’s Hierarchy of Needs, followed by strategies for how to
use prioritization on exam questions. We’ll go over strategic words
to look for. You’ll also be given guidance for how to use ADPIE
(Assessment, Diagnosis, Planning, Implementation, and Evaluation)
during the exam.
In this section:
Follow along with the
Picmonic playlist!
•
Maslow’s Hierarchy of Needs
•
How to Use Prioritization
•
Strategic Words
•
How to Use ADPIE in Exam Questions
“Tell me and I forget. Teach me and I remember. Involve me and I learn.”
- Benjamin Franklin
©Picmonic
6
Test-Taking Strategies
Maslow’s Hierarchy of Needs
The Maslow five-stage hierarchy of needs can be thought of as a pyramid. The base of
the pyramid, and first priority, are physiological needs including oxygen, food/water,
elimination, temperature and sleep. Deficiency needs are grouped in the first four
levels of the pyramid, and include physiological, safety and security, love and
belonging and esteem needs. These needs are to be more or less met before
progressing to higher needs on the pyramid. Individuals experience increased
motivation when addressing their deficiency needs, and will experience
Maslow’s Marshmallow
decreased motivation once their need is satisfactorily met. The hierarchy is
not rigid, but reflects a flexibility of needs, where external circumstances and individual
differences can dictate the priority of needs. During nursing exams when a question is
asking you to prioritize patient care needs, remember Maslow’s hierarchy of needs to
help recall the different priority categories and how to prioritize patients.
5
SELF-ACTUALIZATION
Helping Others • Objectivity • Personal Growth
4 ESTEEM
Esteem for Oneself • Reputation • Respect
3
LOVE AND BELONGING
Love • Affection • Relationships
2
SAFETY AND SECURITY
Physical Safety • Physiological Safety •
Financial Security
©Picmonic
1
Pro TIp:
PHYSIOLOGICAL NEEDS
Oxygen • Food • Water •
Elimination • Temperature •
Rest • Shelter
Prioritization of patients relies on nursing judgement to
determine whose need takes precedence, and physiological
needs often are prioritized first during nursing exams.
Test-Taking Strategies
7
How to use prioritization
Prioritizing patient care is a key skill that nurses utilize when having to
balance patient care demands. Nursing exams will test students on
prioritization to analyze whether they can recognize patients requiring
more urgent care. Prioritization can be categorized into first priority, second
priority and third priority. On a nursing exam, a patient experiencing a first
priority issue must be attended to first. These issues include a patient
experiencing ABC difficulties; airway, breathing and circulation. After
these patients are managed, or if none of the patients are experiencing
ABC issues, patients experiencing second priority problems are the
next focus. Patients with altered LOC, sepsis, acute pain and untreated
medical problems fall into the second category. Finally, after all the
patients experiencing health issues are cared for, the nurse can focus on third
priority questions. Third priority questions include patients requiring education, help
understanding and dealing with feelings, and any patients waiting to be discharged.
Maslow’s Hierarchy of Needs can be remembered as a test-taking strategy to help
remember the different priority categories and how to prioritize patients in exam
questions.
PRIORITIZE FIRST
PRIORITIZE SECOND
PRIORITIZE THIRD
Airway
Change in LOC
(Altered Mental Status)
Education
Breathing
Sepsis
Feelings
Circulation
Acute Pain
Patient Waiting to be Discharged
©Picmonic
Untreated Medical Problems
Test-Taking Strategies
8
Strategic Words
A vital test-taking strategy is to focus on strategic words in exam questions. This
will help to eliminate incorrect options and understand what the question is asking.
These words usually present themselves in the stem of the question and are easy to
identify. Examples of words that reflect the need to prioritize are: “first,” “initial,” “early,”
“highest priority,” and “most appropriate.” Examples of words that reflect the need
to assess a patient are: “assess,” “collect/gather,” and “identify.” Examples of words
that reflect the need to intervene are: “action” and “intervention.” Options with words
that are open-ended should be choices that are considered possible correct options.
These include words like, “usually,” “normally,” or “generally.” Options with words that
are closed-ended (extreme or fixed meaning) should be choices that are eliminated
as they are usually incorrect. These are words like, “always,” “never,” and “none.”
WORDS THAT REFLECT THE NEED TO
First/Initial/Early
Highest Priority
Most Appropriate
Assess
Collect/Gather
Identify
INTERVENE
Action
Intervention
OPEN-ENDED WORDS
Normally
Generally
CLOSED-ENDED WORDS
Always
Never
PRIORITIZE
WORDS THAT REFLECT THE NEED TO
ASSESS
WORDS THAT REFLECT THE NEED TO
None
©Picmonic
Test-Taking Strategies
9
To answer nursing exam questions, a very common test-taking strategy is using
the steps of the nursing process (ADPIE) to help you prioritize. ADPIE is an acronym
for these steps, which are assessment, diagnosis, planning, implementation
and evaluation, and they follow this specific order. Assessment questions are
asking you to collect data about the patient; both objective and subjective data.
Remember that assessment is the first step in the nursing process, so when
you are asked what the nurse would do first, make sure to follow the nursing
process steps to help you prioritize and bring you to the correct answer. Nursing
diagnosis questions require interpretations of the assessment data, analyzing it,
then applying critical thinking to the results. Planning questions involve using the
nursing assessment and analysis to determine interventions, goals and outcomes
in an individualized cohesive plan. Intervention questions are focused on actions
or interventions to achieve goals, assisting in the performance of activities of
daily living (ADLs), administering ordered medications, or educating the patient.
Evaluation questions are focused on actual outcomes of care, if the expected
goals were achieved and how effective care was. Follow the steps to help you
answer exam questions; read the entire question, identify the step in the nursing
process, and eliminate answer choices that don’t reflect the root of the question.
ASSESSMENT
QUESTIONS
NURSING
DIAGNOSIS
QUESTIONS
“Data Collection”
©Picmonic
How to use ADPIE in exam questions
PLANNING
QUESTIONS
INTERVENTION
QUESTIONS
EVALUATION
QUESTIONS
“Plan of Care”
“Action or
Intervening”
“Outcomes of Care”
“Data Analysis”
Follow these steps to help you answer exam questions:
Step
1
Read Entire Question
Step
2
Identify Step in the
Nursing Process
Step
3
Eliminate Answer Choices;
Choose the Best Answer
10
Section 2
10
Lab Values
In this section we’ll be discussing Lab Values and some important
items you’ll want to study to do well during the exam. Helpful
information in this section includes a reference page with a general
table. You’ll also find therapeutic drug levels, lab values for clinicals,
and conversions.
In this section:
Follow along with the
Picmonic playlist!
•
Clinical Quick Hits
•
Reference Lab Values
•
Therapeutic Drug Levels
•
Conversions
“A scientist in his laboratory is not a mere technician: he is also a child confronting natural
phenomena that impress him as though they were fairy tales..”
- Marie Curie
©Picmonic
Lab Values
11
Clinical Quick Hits*
Chem-7
Na
K
Cl BUN
CO2 Cr
CBC
Glu
LFTs
Hgb
WBC
PLT
HCT
Ca
AST
TP
ALT
Alb
ALP
Na
135 - 145 mEgil
WBC
4.5 - 10 x 103/pL
K
3.5 - 5 MEci/L
Hgb Male
13 - 17 g/d
Cl
95 - 108 mEq/L
Hgb Female
12 -16 g/dL
CO2
22 - 26 mEWL
HCT Male
41 - 50%
BUN
10 - 20 mg/dL
HCT Female
36 - 44%
Ca
8.4 - 10.2 mg/dL
Cr
0.7 - 1.4 mg/dL
PLT
100 - 450 x 103/pL
TP
6 - 8 gidL
Glucose
70 - 115 mg/dL
Alb
3.5 - 6 g/dL
AST
12 - 37 U/L
ALT
13 - 69 U/L
ALP
40 - 130 U/L
TBili
0.1 - 1.2 mg/dL
Imbalance
EKG Changes
HYPOcalcemia
Prolonged ST, Prolonged QT
HYPERcalcemia
Shortened ST, Widended T
HYPOkalemia
ST Depression, T Wave Changes, U
Wave
HYPERkalemia
Peaked T, Flat P, Wide QRS,
Prolonged PR
HYPOmagnesemia
Tall T, Depressed ST
HYPERmagnesemia
Prolonged PR, Wide QRS
TBili
ABG’s
pH
PO2
PCO2
HCO3
O2 Sat
7.35 - 7.45
75 – 105 mm Hg
33 – 45 mm Hg
22-26 mEq/L
94-100%
pH
CO2
HCO3
Respiratory Acidosis
↓
↑
Normal
Respiratory Alkalosis
↑
↓
Normal
Compensated Respiratory Acidosis
↓
↑
↑
Compensated Respiratory Alkalosis
↑
↓
↓
©Picmonic
Acid Base Disorders
Lab Values
12
Normal Electrolyte Lab Values
Potassium (K+)
3.5 to 5.0 mEq/L
Calcium (Ca2+)
8.5 to 10.5 mg/dL
Phosphate (PO4 )
2.5 to 4.5 mg/dL
Magnesium (Mg2+)
1.5 to 2.5 mEq/L
Sodium (Na+)
135 to 145 mEq/L
Chloride (Cl–)
95 to 105 mEq/L
3–
Albumin Lab Value
Normal Range
Cholesterol Lab Values
LDL
(Low Density Cholesterol)
< 100 mg/dL
HDL
> 40 mg/dL Males
(High Density Cholesterol)
> 50 mg/dL Females
Total Cholesterol
< 200 mg/dL
Triglycerides Lab Value
Normal Range
< 150 mg/dL
Total Protein Lab Values
3.5 - 5.0 g/dL
Normal Range
6.4 - 8.3 g/dL
Creatinine Lab Values
Normal Range
Cre-am
0.6 - 1.3 mg/dL
Creatinine Lab Values
Measures Renal Function
Belly-ribbon Dancer
Bilirubin Lab Value
Normal Range
Increased Bilirubin
Causes Jaundice
0.2-1.2 mg/dL
Jaundice Janitor
©Picmonic
Lab Values
Red Blood Cell Count (RBC) Lab Values
13
pH - Blood and Urine Lab Value
Women
3.5-5.5
million cells/ MuL
Blood
7.35 - 7.45
Men
4.3-5.9
million cells/ MuL
Urine
4.0 - 8.0
PT/PTT Lab Values
Prothrombin Time
(PT)
10-14 seconds
Activated Partial
Thromboplastin
Time (PTT or aPTT))
25-35 seconds
Urine Specific Gravity Lab Value
Normal Range
1.003-1.030
Hemoglobin A1c Lab Value
Normal Range
70-100 mg/dL
INR Lab Value
Normal Range
0.8-1.2
Warfarin
2.0-3.0
Blood Glucose Lab Value
Normal Range
70-100 mg/dL
Platelet Lab Value
Normal Range
150,000-400,000
Micro L
Bleeding Time Lab Values
Normal Range
2-7 Minutes
©Picmonic
*Disclaimer: The reference ranges in this resource are based on the most current, best-available evidence.
However, a variability of reference ranges may appear from various resources.
Lab Values
Therapeutic drug levels
Lithium
Lithium Battery
Theophylline
Tee-off-feline
Phenytoin
Phone-tow-truck
Vancomycin
Van-tank-mice
Carbamazepine
Car-bomb-maze-pine
Gentamicin
Magenta-gentleman-mouse
Phenobarbital
Phantom-barbara-doll
Procainamide
Pro-cane
Amitriptyline
Amish-trip
Digoxin
Digital-ox
0.8 - 1.2 mEq/L
10 - 20 mcg/mL
10 - 20 mcg/mL
Trough 10 - 20 mcg/L
150 - 300 mg/L
5 - 10 mcg/mL
10 - 40 mcg/mL
4 - 10 mcg/mL
120 - 150 ng/mL
0.8 - 2 ng/mL
©Picmonic
14
Lab Values
15
Conversions
Temperature
0° C
32° F
To convert Celsius to Fahrenheit,
multiply Celsius by 1.8 and then
add 32. To convert Fahrenheit to
Celsius, minus 32 and divide by 1.8.
©Picmonic
When °C is freezing, it shapes it’s mouth into a “0.”
When °F is freezing, it finds warmth by rolling
around in the dirt and puting on a tutu.
Volume
30 mL is equivalent to 1 ounce.
Things get messy when you get 30 milli-colas together. They
party too hard and get dirty - 30 dirty. The one to save them
is the wonderful wizard of ounce!
1 mL
1 cc
5 mL
1 Tsp
15 mL
1 Tbsp
30 mL
1 oz
1000 mL
1L
2 Tbsp
1 oz
8 oz
1 cup
Weight
1000 mcg
1 mg
1000 mg
1g
1000 g
1 kg
2.2 lb
1 kg
Ballerinas in 2.2 tutus, and
they use a 1 pound weight to
crunch that one killa-grahamcracker.
16
Section 3
16
Fundamentals
The NCLEX® exam is going to encompass a lot of information.
Important things to know are the fundamentals of nursing and what
those entail. This section will guide you through critical areas of
study. These areas include patient safety, crystalloid IV solutions, IV
colors, and gauges. You’ll also find patient positioning, fire safety and
triage content as well as nutrition basics which discuss therapeutic
diets in this section. Lastly, everything will be wrapped up with an
NCLEX® review for head-to-toe assessments.
In this section:
Follow along with the
Picmonic playlist!
•
Patient Safety
•
Fire Safety
•
Infection Prevention & Control
•
Crystalloid IV Solutions
•
Therapeutic Diet
•
Triage
•
Patient Positioning
•
Head-to-Toe Assessment
“Success is neither magical nor mysterious. Success is the natural consequence of consistently
applying the basic fundamentals.”
- Jim Rohn
©Picmonic
Fundamentals
17
Patient Safety and Needs
A patient’s safety is a nurse’s greatest and most important responsibility. A nurse
must ensure that all actions to prevent harm are practiced. Some of the patient
safety issues surrounding nursing fundamentals involve latex allergies and fall
prevention. Latex reactions can be avoided by being aware of the risk factors.
These risk factors include food allergies to bananas, papaya, and kiwi fruit,
as well as people with asthma, spina bifida, or a history of multiple surgical
procedures. To ensure patient safety, fall prevention strategies should be
utilized. These include having the call bell available, eliminating physical
hazards, leaving items within reach, leaving the patient bed in a low position,
and putting side rails up.
LATEX ALLERGY RISK FACTORS
FALL PREVENTION
•
Allergy to Banana, Papaya,
Chestnuts and Kiwi
•
Call Light within Reach
•
Eliminate Physical Hazards
•
Asthma
•
Leave Items within Reach
•
Spina Bifida
•
Bed in Low Position
•
History of Multiple Surgical
Procedures
•
Side Rails Up
Use of RestraintS
Seizure Precautions
•
Last Resort
•
Reduce Environmental Stimuli
•
Frequent Observations
•
Pad Side Rails
•
Obtain Order within 1 Hour
•
Bed Lowest Position
•
Quick-Release Tie
•
Oxygen and Suction Available
Bleeding Precautions
Things to Avoid:
•
Hard Foods
•
Aspirin Products
•
Blowing Nose Forcefully
•
Straining During BMs
•
Enemas or Rectal Suppositories
•
Tampons
©Picmonic
Pro Tip
When caring for a patient who has an
increased risk of bleeding, you shold limit
needle sticks. When needle sticks cannot
be avoided, use higher gauge needles, as
higher gauge needles have smaller lengths
and diameters than small gauge needles.
Apply pressure and or ice to the area after any
injection.
Fundamentals
18
Fire - Environmental Emergencies
Proper awareness of the priortity actions that should be taken during a
fire are important for the best outcome of the patients. Fires in homes
typically arise from smoking, especially careless smoking in bed. Fires in
facilities are often electrical or during anesthesia procedures.
RACE and PASS
RACE is a common mnemonic used for remembering the proper order of actions
to be initiated in the event of a fire emergency.
PASS is a mnemonic for operating a fire extinguisher. P- Pull the pin. A- Aim at the
base of the fire. SS - Sweep from Side to Side until the fire is controlled.
R.A.C.E
P.A.S.S
R: Rescue
P: Pull the pin
A: Alarm
A: Aim at the of the fire
C: Confine
S: Sweep
E: Extiguisher
S: Side to side
Other nursing considerations in
this situation include being aware
of and keeping clear fire exits,
the fire exit being used by the
nurse, as well as knowing that
you do not use elevators. It is also
important that patients who are on
mechanical ventilators will require
bag mask manual ventilation.
©Picmonic
Fundamentals
19
Infection Prevention & Control
It’s a dirty job,
but someone’s
gotta do it!
©Picmonic
Personal Protective Equipment (PPE) ORDER:
Standard Precautions
Hand Hygiene: Wash In / Wash Out
Pro Tip
Personal Protective Equipment (PPE)
Remember airborne precaution diseases
with the mnemonic “MTV is on the air”.
Discard Sharps in Puncture-Resistant
Container
M: Measles T: Tuberculosis V: Varicella
Cough Etiquette
Contact Precautions vs Droplet vs Airborne Precautions
It is important to isolate patients that have a known active infection. The mode of transmission will
depend on the organism, but to prevent the possible spread from person to person in a hospital
setting, patients are required to be in a private room.
CONTACT
DROPLET
AIRBORNE
DISEASES: C. difficile, Shigella,
Norovirus, Rotavirus, Major
Wound Infections, Scabies,
MDROs
DISEASES: Influenza, Meningitis,
Mumps, Rubella, Pneumonia,
Sepsis, Pertussis
DISEASES: COVID-19, TB,
Measles, Chickenpox
Personal Protective Equipment
(PPE)
Distance 3 Feet of Patient
Airborne Infection Isolation
Room (AIIR)
Limit Time Patient Leaves Room
Droplets Larger than 5 Microns
Droplets Smaller than 5 Microns
Same Pathogen, Same Room
Surgical Mask with Face Shield
N95 Respirator
Fundamentals
20
Crystalloid IV Solutions
IVF
D5W
D10
1/2 NS
NS
3%NS
D5 - 1/4 NS
D5 - 1/2 NS
D5 - NS
Content
•
50 g/L Glucose
•
170 kcals/L
•
No Electrolytes
•
100 g/L Glucose
•
340 kcals/L
•
No Electrolytes
•
0.45% Saline
•
77 mMol/L of Na+ and Cl-
•
No Calories
•
0.9% Saline
•
154 mMol/L of Na+ and Cl-
•
No Calories
•
3.0% Saline
•
513 mMol/L of Na+ and Cl-
•
0.225% Saline
•
50 g/L Glucose
•
170 kcals/L
•
38.5 mMol/L of Na+ and Cl-
•
0.45% Saline
•
50 g/L Glucose
•
170 kcals/L
•
77 mMol/L of Na+ and Cl-
•
0.9% Saline
•
50 g/L Glucose
•
170 kcals/L
•
154 mMol/L of Na+ and Cl-
©Picmonic
Tonicity
Osmolarity
(m0sm/L)
Isotonic
252
Hypertonic
505
Hypotonic
154
Isotonic
308
Hypertonic
1026
Isotonic
330
Hypertonic
406
Hypertonic
560
Fundamentals
21
Therapeutic Diets
A gradual progression of diet is often seen in postoperative patients with the return
from an NPO state to a regular diet. The length of time on each of the following
therapeutic diets varies based on the patient’s medical condition.
©Picmonic
NPO
(nil per os)
Nothing by Mouth
Consistent Carb
(Diabetic Diet)
Cardiac
Limit Starches,
Sugars and Milk
Control
Carbohydrate
Intake
Restrict Fat and
Sodium Intake
Sodiumrestricted
Limit Sodium
Intake to Set
Amount
Avoid Processed
Foods
Fundamentals
22
Triage
Simple triage and rapid treatment (START) is a triage system used by
first responders to quickly sort patients on the extent of their injury by
identifying each with triage tags. The triage tags are color coded to indicate
the priority and level of care. Red tags are first priority and considered
immediate and critical. Yellow tags are second in priority which are delayed yet
still urgent. Green tags are third in priority and are considered minor compared to
the higher priority tag due to the patient’s ability to speak and walk. Black tags are
unfortunately the fourth and final priority in the START triage system and are given to
those who are labeled as expectant or deceased.
Black: Deceased (Expired)
Black Tree with Death and Expiredsticker
Green: Minor (Ambulatory)
Green Tree with Miner Walking
Yellow: Delayed (Urgent)
Yellow Tree with Delayed-sign and
Urgent Alarm
Red: Immediate (Critical)
Red Tree Immediately-ate by Criticalcrickets
Step
1
Step
2
Step
Step
3
4
MOVEMENT
RESPIRATIONS
PERFUSION
MENTAL STATUS
The first step of triage is
to clear out all ambulatory
patients. Ask victims to
move to a designated
safe area. Those who
respond are given a
green tag.
If the patient breathes
more than 30 breaths/
minute, they should
be tagged as red
(immediate). If their
inspirations are less than
30 breaths/minute, you
will move onto step 3.
Check for pulses/
perfusion. If the radial
pulse is present, move
onto step 4.
The final step of triage
is to check a patient’s
mental status by giving a
simple command, such
as, “can you squeeze my
hand?”. If no response, tag
Red (Immediate). If they
obey the command, tag
as yellow (delayed).
If capillary refill is more
than 2 seconds, you
will tag them as red
(immediate). If their
capillary refill is less than
2 seconds, you will move
onto step 4.
©Picmonic
Fundamentals
23
Patient Positioning
Fowlers Position
Supine Position
Supported Fowl in Fowler’s Position
Spine Position
In Fowler’s position the head of the bed
is elevated to 45 to 60 degrees. A pillow
is placed under the knees to keep them
slightly flexed.
The patient is placed flat on his or her back.
Trendelenburg
Side-Lying Position
T-bird in Trendelenburg Position
Side-Lying Position
Tendelenburg is accomplished by lowering
the head of bed below the feet.
Maintain body alignment in a lateral position
at about 30 degrees.
Prone Position
Prune Position
In this position the patient lies face down. A
pillow can be placed under the lower legs
to promote dorsiflexion.
Sims’ Position
Sims-game in Sims’ Position
Also known as semi-prone position. The
patient is on their side lying partially on their
abdomen.
©Picmonic
Positioning a patient properly is an essential for nursing care. Specific positions
are required for procedures (need comma) while others are required to promote
healing. It is vital that the patient’s safety comes first and proper communication
takes place before moving the patient. Perform a safety check on all equipment and
make sure lines will not interfere with the procedure.
24
Fundamentals
Head to Toe Assessent
Eyes
Hair
•
Inspect for inflamation, edema or
lesions
•
Check for patterns of hair loss
or growth
•
Inspect for tearing, dryness or
discharge
•
Assess Scalp for erythena,
scaling and encrustations
•
Palpate bullar and palebral conjuntivae
•
Examine the pupils for equal size,
shape and reactivity
Neck
Ears
•
Palpate carotid arteries
•
Check carotid pulse
•
Check lymph nodes
•
Check position and symmetry
•
Inspect external ear for lesions,
drainage, nodules or inflammation
Chest
•
Inspect and palpate mastoid area
•
Listen to heartbeat
•
Otoscopic Examination
•
Listen to lung sounds
•
Whisper Test
•
•
Weber’s Test
Assess respiratory expansion
level
•
Rinne Test
•
Ask about coughing
•
Palpate thorax
Back
•
Assess lung sounds
•
Percuss kidney
Skin
•
Observe for skin lesions
•
Braden Scale
•
Check moisture content
•
Palpate skin for texture
•
Assess for pale, flushed
cyanotic skin color
©Picmonic
Neurological
•
Glasgow Coma Scale score
•
Assess gait
•
Check coordination
•
Assess reflexes
Extremities
•
Check capillary refill
•
Assess range of motion
•
Assess sharp and dull sensation on
extremeities
25
Section 4
Cardiovascular
The cardiovascular portion of the NCLEX® will no doubt have your
heart racing. Maybe not, but regardless, some good information
to have for the exam will include right vs left heart failure, angina,
and types of shock. Helpful anagrams such as, HEAD, MONA, and
TV SPARC CUBE and their meanings are useful to know. You’ll also
want to know blood pressure values, how to assess for myocardial
infarction and methods for management. ECG rhythms are also
important and are discussed in this section.
In this section:
Follow along with the
Picmonic playlist!
•
Types of Heart Failure
•
Angina
•
Types of Shock
•
Blood Pressure Classification
•
MI Assessment and Management
•
ECG Rhythms
“All the knowledge I possess everyone else can acquire, but my heart is all my own.”
- Johann Wolfgang Von Goethe
©Picmonic
CARDIOVASCULAR
26
Right vs Left Heart Failure
Pulmonary
Congestion
Jugular Venous
Distention (JVD)
Jug Veins Bulging
Lungs with Congestedtraffic
Peripheral Edema
Pink Frothy Sputum
Peripheral Edamame
Pink Froth
Hepatosplenomegaly
Wheezing or Crackles
Liver-and-spleenballoons
Noctural-moon-urine
Weight Gain
Up-arrow Scale
Ascites
Ascites Iced-tea
Fatigue
Sleepy-guy
Pro Tip
Remember RIGHT-sided heart failure with
the acronymn H.E.A.D:
Hepatomegaly. Edema, Ascites and
Distended Neck Veins
©Picmonic
Nocturia
Weasel with Crackers
Dyspnea w/ Exertion
Disc-P-lungs
Cough
Coughing Coffee-pot
Fatigue
Sleepy-guy
Tachycardia
Tac-heart-card
Weak Peripheral
Pulse
Pulse from Weak Arm
S3, S4 Heart Sounds
Triangular S3stethoscope with (4) Fork
CARDIOVASCULAR
27
Stable Angina vs Unstable Angina
Chest Pain w/
Exertion
ASSESSMENT
Chest Pain-bolt
Relieved within 15
Mins
15 Mins Timer
ST Depression
Depression St.
Nitro-glacier
Chest Pain-bolt with Bed
or Exertion
Limits ADLs
Limit Tools for Daily Living
> 15 Minutes
Timer > 15 Minutes
Not Relieved by
Nitroglycerin Alone
Not Relieved by Nitroglacier
ASSESSMENT
Nitroglycerin
Chest Pain w/ Rest or
Exertion
Up to 3 Doses q 5 Mins
3 Doses of Q-clock with
(5) Hand
Bed
Antiplatelet
Medication
Ant-tie-plate with Medbottle
CABG
Cabbage
Depression St.
Fatigue
Sleepy-guy
Acute Coronary
Syndrome (ACS)
Treatment
Acute-angle Crown-heart
Emergency Treatment
Emergency-lights
Angioplasty
Angel-pastry
©Picmonic
INTERVENTIONS
INTERVENTIONS
Rest
ST Depression
CARDIOVASCULAR
28
Types of Shock
Shock is a condition characterized by decreased tissue perfusion and impaired cellular metabolism.
The four main types of shock are classified by either the functional impairment or the site of origin and
are known as hypovolemic, cardiogenic, obstructive, and distributive. More than one type of shock
can be present at the same time.
Hypovolemic
Cardiogenic
Hippo-volume-cup
Heart
Hypovolemic shock occurs due to a loss of
intravascular fluid volume. In this shock state, the
size of the vascular compartment stays the same,
but the volume of blood or plasma is decreased.
A reduction in intravascular volume results in a
decreased venous return to the heart leading to
decreased cardiac output.
Cardiogenic shock occurs when the heart is
unable to pump enough blood to meet the body’s
metabolic needs as a result of direct pump
failure. There are various reasons why cardiogenic
shock occurs (i.e., myocardial ischemia, structural
problems, dysrhythmias); however, they all result in
pump failure leading to impaired tissue perfusion
and cellular metabolism.
Obstructive
Distributive
Obstruction of blood flow
Distributor-cap
Obstructive shock occurs when a physical
obstruction to blood flow occurs. This can result
from conditions such as pulmonary embolism,
cardiac tamponade, tension pneumothorax,
or superior vena cava syndrome. These cause
restrictive diastolic filling of the ventricles leading to
decreased cardiac output and impaired delivery of
oxygen to tissues.
Distributive shock occurs due to abnormal
distribution of blood flow in the vessels. This
category of shock differs from the others in the
sense that it occurs even though output of the heart
is normal.
Pro Tip
©Picmonic
Remember RIGHT-sided heart failure with the acronymn TV SPARC CUBE:
Thirst • Vomiting • Sweating • Pulse Weak • Anxious • Respirations Weak • Cool •
Cyanotic • Unconcious • BP Low • Eyes Blank
CARDIOVASCULAR
29
Blood Pressure Classification
Blood pressure, expressed in millimeters of mercury (mm Hg), is a measure of how hard the heart
is working to maintain end organ perfusion, and can be measured using a blood pressure cuff, or
a sphygmomanometer. High blood pressure, or hypertension, can increase risk of cardiovascular
disease, stroke and other end-organ damage. Hypertension is one of the most common
reasons for office visits and medication use in the United States. To be diagnosed with essential
hypertension, a patient must have two readings done at two separate outpatient visits that are at
least two weeks apart.
SBP
DBP
Normal
<120 mmHg
and <80 mmHg
Elevated
120–129 mmHg
and <80 mmHg
Stage 1
Hypertension
130-139 mmHg
80-89 or Higher
Stage 2
Hypertension
140-179 mmHg
90-119 mmHg
©Picmonic
Pro Tip
Remember: less than 120
over less than 80 is normal.
To help remember the
upper limit values for each
hypertension stage, you
can add certain values
to the previous max. For
example, the next stage is
elevated blood pressure
which is defined as a
systolic of 120-129, or an
addition of 10 to a normal
blood pressure.
CARDIOVASCULAR
30
Myocardial Infarction
Assessment
Diagnosis
Substernal Chest Pain
12 Lead ECG
Crushing or Dull Sensation
ST Elevation
Arm, Jaw, and Neck
Q Wave
> 20 Minutes
T Wave Inversion
Unrelieved by Nitro
Troponin T and I
Palpitations
CK-MB
Diaphoresis
Fear of Impending Doom
CONSIDERATIONS
Nausea and Vomiting
Early ECG
Shortness of Breath
Cardiac Stress Test
CONSIDERATIONS
Monitor for Arrhythmias
©Picmonic
Evolution of Myocardial Infarction and Complications
In the time following a myocardial infarction, gross changes in the heart may lead to various
complications in the recovery period. The cardiac timeline is the description of what complications
occur and when they occur following a myocardial infarction.
HOURS TO DAYS
Arrhythmia
BEFORE 7 DAYS
BEFORE 14 DAYS
Fibrinous Pericarditis
Papillary Muscle Rupture
Ventricular
Pseudoaneurysm
Interventricular Septum
Rupture
Ventricular Free Wall
Rupture
AFTER 14 DAYS
True Ventricular
Aneurysm
Dressler Syndrome
Left ventricular failure can occur secondary to many of the complications of a myocardial infarction
and therefore must be considered throughout the entire infarction recovery period.
CARDIOVASCULAR
31
ECG Rhythms
Normal Sinus Rhythm
Complexes normal, evenly spaced. Rate 60-100 bpm
Arrhythmia
All complexes normal, rhythm irregular
Bradycardia
Complexes normal, evenly spaced. Rate < 60 bpm
Tachycardia
Complexes normal, evenly spaced. Rate > 100 bpm
Atrial Fibrillation
Baseline irregular. Ventricular response irregular
Ventricular Fibrillation
Rapid, wide irregular ventricular complexes
©Picmonic
32
Section 5
32
Respiratory
Take a deep breath. That’s right, we’re going to talk about the
respiratory portion of the NCLEX®. Things you’ll want to know
include lung sounds and pneumothorax signs and symptoms. COPD
is covered in this section along with some vital information about
proper chest tube care.
In this section:
Follow along with the
Picmonic playlist!
•
Lung Sounds
•
Pneumothorax Signs and Symptoms
•
COPD
•
Emphysema vs Chronic Bronchitis
•
Chest Tube Care
•
O2 Delivery Systems
“As long as there’s breath in our lungs our story is still being written.”
- Bart Millard
©Picmonic
Respiratory
Lung Sounds
Wheezes (Weasels)
Description: High-Pitched, Musical
Due to: Air Moving Through Narrowed
Airways
33
Rhonchi (Rattle)
Description: Low- Pitched Rumbling or
Gurgling
Due to: Narrowed Airways
Location: Trachea and Bronchi
Example: Chronic Bronchitis
Location: Throughout Entire Lung
Example: Asthma Exacerbations
Pleural Friction Rub (Pearl)
Description: Dry, Rubbing or Squeaking
Crackles (Crackers)
Description: Fine: Hair Moving
Through Fingers, Course: Velcro
Due to: Inflamed Pleura
Location: Anterior Lateral Lung
Example: Autoimmune Disorders
Due to: Collapsed Small Airways
and Alveoli “Popping Open”
Location: Lower Lobes
Example: Pulmonary Edema
©Picmonic
Respiratory
34
Pneumothorax
Pneumothorax is when air enters the pleural space, leading to a partial or complete collapse of the
lung. The negative atmospheric pressure in the pleural space is lost as air rushes in causing all or
part of the lung to collapse. This medical emergency requires the provider and nurse to act quickly
to relieve the respiratory distress and prevent further complications.
Pneumothorax
Tension Pneumothorax
Spontaneous Pneumothorax
MECHANISM
MECHANISM
MECHANISM
•
•
Air Enters Pleural Space,
but Can’t Exit
•
Accumulation of Air in
Pleural Space
Trauma or Infection
•
Tall and Thin Young
Males
Decreased Breath
Sounds
•
Underlying Disease
•
Bleb or Bulla Rupture
Trachea Deviates Away
from Affected Side
ASSESSMENT
•
Chest Pain
Air Enters Pleural Space
ASSESSMENT
•
Sudden Dyspnea
•
•
Absent or Restricted
Movement on Affected
Side
ASSESSMENT
Decreased or Absent
Breath Sounds on
Affected Side
•
•
Chest Pain
•
Chest Pain
•
Hypoxemia
•
Tachycardia
•
Tracheal Deviation
•
Decreased Sounds
•
Tachypnea
•
Vital Sign Changes
•
Hyperresonance
•
Hypotension
•
Crepitus
•
•
Hypoxemia
Shortness of Breath
(SOB)
CONSIDERATIONS
•
Hyperresonance
•
Oxygen
•
Emergency
•
High Fowlers Position
With Oxygen
•
Educate High-Risk
Patients
•
•
©Picmonic
Respiratory
35
Chronic Obstructive Pulmonary Disease
COPD, or chronic obstructive pulmonary disease, is primarily caused by inhaled
toxins. This can come from smoking or environmentally inhaled toxins or fumes.
This can also be caused by alpha-1-antitrypsin deficiency, which is an autosomal
co-dominant disorder that decreases lung elasticity. Types of COPD include
asthma, chronic bronchitis and emphysema, which can be diagnosed using
spirometry studies. COPD is characterized by persistent airflow limitation that
progresses slowly.
CAUSES
ASSESSMENT
CONSIDERATIONS
•
Inhaled Toxins
•
Emphysema
•
Spirometry
•
Smoking
•
Chronic Bronchitis
•
Slow Progression
•
AAT Deficiency
•
Asthma
Chronic Bronchitis
Emphysema
VS
Blue Bloater
Crone Broccoli-on-fire
•
C.O.P.D-Cop
Pink Puffer
M-fist-zebra
Chronic Productive Cough
•
Pursed-Lip Breathing
•
•
Barrel Chest
•
Dyspnea on Exertion
•
Thin Appearance
> 3 Months for 2 Years
•
Early-Onset Cyanosis
•
Wheezes
©Picmonic
Respiratory
36
Chest Tube Care
Chest tube placement is a life-saving medical procedure, and understanding the
management and care of patients with chest tubes is critical for nurses. It’s important
to confirm the suction order, assess the condition of the chest tube and patient, and
understand the quick interventions required of nurses.
Step
Step
1
Step
2
3
CONFIRM SUCTION ORDER
ASSESS
QUICK INTERVENTIONS
It is important to know if the
drainage system should be
hooked up to continuous wall
suction or water seal. Also,
confirm that suction control is
dialed to correct pressure, and
the drainage system is kept below
the level of the chest.
•
Crepitus
•
•
Kinking
•
Shortness of Breath (SOB)
If tube dislodges from
patient, use petroleum
gauze taped 3 ways
•
Infection
•
•
Excessive Bubbling
If drainage system
is damaged, place
disconnected drainage
tube in sterile water
Remember causes of chest tube insertion
with the mnemonic:
“Don’t Ever Fail”
D: Drain fluid, blood, or air
E: Establish negative pressure
F: Facilitate lung expansion
©Picmonic
Respiratory
37
O2 Delivery Systems
Room air is around 21% oxygen. Supplemental oxygen is used to help during times
of tissue hypoxia, and when the body requires more than the normal 21%. The
patient’s oxygen needs will determine which delivery method should be used.
Knowing if the patient has a condition that retains CO2 or has a respiratory disease
will also influence which method is used. It is important to remember that “oxygen
is a medication” and an order needs to be written by the health care provider, if it
is going to be used.
Nasal Cannula
Nasal cannulas are
the most widely used
method of delivering
oxygen. At 1L/min nasal
cannulas deliver an FiO2
of 24%. Every 1L you can
add 4%, all the way to
6L/min for an FiO2 of
44%. Oxygen should be
humidified if you will be
administering greater
than 3L/min.
Simple Face Mask
Non-Rebreather Mask
Venturi-Mask
Venturi Mask allows
Simple face mask can
This mask has a valve on
providers to set a
deliver an FiO2 of 40% to the exhalation port and
specific FiO2 to be
60% oxygen with a flow
between the reservoir
delivered to the patient.
of 6 to 12L/min. It can
bag and mask. The
Venturi masks have,
be used in patients that
valves prevent room air
what is called, an air
are in mild respiratory
from coming into the
entrainer that allows
distress. If a simple mask
system. This method
oxygen to be mixed
has a reservoir bag on
delivers an FiO2 up to
with the room air. This
it, it is called a partial
95% at 8-15L/min. Make
can deliver a precise
rebreather mask. Partial
sure that the reservoir
FiO2 to the patient
rebreather masks deliver remains at least ½ full on
ranging from 24% to
an FiO2 of 50% to 60%.
inspirations.
60%.
©Picmonic
38
Section 6
Integumentary
Need the “skin-ny” on the integumentary portion of the NCLEX®?
Well, you’ve come to the right place. In this section you’ll find
information related to pressure ulcers and assessing different stages
of skin breakdown. We’ll also review types of burns.
In this section:
Follow along with the
Picmonic playlist!
•
R.I.C.E
•
Pressure Ulcers
•
Types of Burns
“Nobody grows old merely by living a number of years. We grow old by deserting our ideals. Years may
wrinkle the skin, but to give up enthusiasm wrinkles the soul.”
- Samuel Ullman
©Picmonic
Integumentary
39
R.I.C.E. (Treating Soft Tissue Injury)
R.I.C.E. is an acronym helpful to remember interventions to provide
first-aid treatment for soft tissue injuries and related inflammation.
Rest
R
Movement should be restricted in musculoskeletal
injuries, which allows the body to use its nutrients and
oxygen to promote healing. Also, fibrin and collagen can
more easily form across wound edges when there is little
movement or disruption to the area.
Ice
I
Cold application promotes vasoconstriction and decreases
swelling, pain, and congestion in the inflamed or injured
area.
Compression
C
Direct pressure reduces vasodilating effects and the
development of edema, along with compression
bandages that provide support to injured joints, tendons,
and muscles.
Elevation
E
When an extremity is elevated above the level of the
heart, edema is reduced at the injury site by increasing
venous and lymphatic return.
©Picmonic
Integumentary
40
Pressure Ulcers
A pressure ulcer can develop when there is pressure on any part of the body for an
extended period of time. Blood flow gets cut off to areas of the skin where pressure is
present causing cell death. This results in skin breakdown, and if left untreated an ulcer
can form. This puts the patient at risk for infections. It’s common for pressure ulcers to
form over bony areas where pressure can be higher, including the tailbone, buttocks,
elbows, heels, shoulders, and ears. Always assess the patient’s skin during every
assessment.
Stage 1
Stage 2
Stage 3
Stage 4
Non-Blanchable
Redness
Partial Thickness
Full Thickness Skin Loss
Full Thickness Tissue
Loss
In this stage the skin is
still intact. This is typically
the first indication of
skin breakdown, and
frequent turns should be
initiated while avoiding
putting pressure on
the reddened area.
To determine if the
reddened area is a stage
one, push a finger into
the reddened area. If the
skin does not turn white,
then it has entered into
stage one.
In stage two, the ulcer
can be classified as
partial thickness open or
partial thickness closed.
The ulcer will either
develop a blister (closed)
or become an open
sore. Skin is not intact at
this stage and at risk for
becoming infected.
In stage three the
ulcer has cratered
into the dermis and
subcutaneous tissue.
Fat could be visible with
sloughing of the tissue.
Nerve damage can also
occur at this stage.
Bone is exposed in
stage four. Slough and
eschar may be present.
The wound could also
have undermined
or tunneled into the
surrounding tissue.
Braden Scale
Remember the management and
prevention of pressure ulcers with the
mnemonic:
The Braden Scale is a tool for
predicting pressure ulcer risk.
Categories assessed include sensory
perception, moisture, activity,
mobility, nutrition, friction and shear.
It is important to remember that the
lower the score, the higher the risk
of developing a pressure ulcer.
“Skin”
S: Surface should be smooth
K: Keep moving
I: Incontinence management
N: Nutrition
Braided Scale
©Picmonic
Integumentary
41
Types of Burns
Burn injuries involve the destruction of the integumentary system and are
classified by the depth of skin destruction. While burns continue to be
defined by degrees: first, second, third, and fourth degree, the American Burn
Association recommends a more precise description.
Superficial
Thickness
(Super-fish)
• Sunburn (Sun)
Superficial
Partial
Thickness
(Super-fish)
• Blisters (Blister)
• Blanching
(Bleach)
©Picmonic
Deep
Partial
Thickness
(Partial
Deep-diver)
• Little or Nonblanching (Little
Nun-bleach)
Full
Thickness
(Full Glass)
• Waxy white,
yellow or black
(Waxy-candle)
• Decreased
Pain (Downarrow Pain-bolt)
42
Section 7
42
Immune
In this immune section, we’ll go over some important information
you’ll find on the exam relating to the immune system and immune
responses, specifically hypersensitivity reactions.
In this section:
•
Hypersensitivity Reactions
Follow along with the
Picmonic playlist!
“Think about your immune system as being an army, and it’s fighting infection.”
- Mikhail Varshavski, D.O.
©Picmonic
Immune
Hypersensitivity
Reactions
©Picmonic
43
44
Section 8
44
Endocrine
During your exam, you might experience symptoms like sweating or
feelings of anxiousness. Well, you can thank your endocrine system
for these lovely stress responses. Not to worry, though! This section
will prepare you for everything you need to know to fight your way
through the endocrine portion of the NCLEX®. We’ve included a
study guide chart, as well as the 3 S’s (sugar, salt, and sex). You’ll
also be given some more anagrams to help you remember details
about hyper and hypothyroidism. We’ll cover Addison’s vs. Cushing’s
disease. Finally, we’ll go over hypoglycemia signs and symptoms
and things to know about type I/type II diabetes.
In this section:
Follow along with the
Picmonic playlist!
•
Endocrine Cheat Sheet Chart
•
Hyper vs Hypothyroid
•
Addison’s vs Cushing’s
•
Hypoglycemia Assessment
•
Diabetes Type I / Type II
“The more you worry, the more you throw off the delicate balance of
hormones required for health.”
- Andrew J. Bernstein
©Picmonic
Endocrine
45
Endocrine Cheat Sheet Chart
Under Production
Syndrome
Over Production
Syndrome
Hormone
Gland
GH
Anterior Pituitary
ADH
Posterior Pituitary
Diabetes Insipidus
SIADH
T3, T4
Thyroid
Myxedema Coma
Graves
PTH
Parathyroid
Hypoparathyroid
Hyerparathyroid
Cortisol
Adrenal
Addisons
Cushings
Insulin
Pancreas
Diabetes Mellitus
Acromegaly
The mnemonic “FLAT PeG” can be used to
recall all of the hormones released by the
anterior pituitary.
“FLAT PeG”
F: Follicle-Stimulating Hormone (FSH)
L: Lutenizing Hormone (LH)
A: Adrenocorticotropic Hormone (ACTH)
T: Thyroid-Stimulating Hormone (TSH)
P: Prolactin (PRL)
e
G: Growth Hormone (GH)
©Picmonic
Endocrine
46
Hyperthyroidism vs Hypothyroidism
Hiker-thigh-droid
Hippo-thigh-droid
Assessment
Assessment
•
Heat Intolerance
•
Cold Intolerance
•
Weight Loss
•
Weight Gain - Edema
•
Diarrhea
•
Constipation
•
Warm, Moist Skin and Silky Hair
•
Brittle Nails and Dry Skin
•
Amenorrhea
•
Prolonged Menses
•
Tachycardia
•
Bradycardia
•
Tremors
•
Lethargy
•
Exophthalmos
•
Slowed Thinking
•
Goiter
•
Goiter
DIAGNOSis
DIAGNOSis
•
Decreased TSH with Elevated Free T4
•
Decreased Free T4
•
Radioactive Iodine Uptake (RAIU)
•
Increased TSH
Heat Intolerance
Sweating Fire-guy
Brittle Nails and Dry Skin
Broken Nails and
Dry Skin-suit-man
Weight Loss
Skinny with Baggy-pants
Weight Gain - Edema
Up-arrow Scale Edamame
SWEATING:
Sweating • Weight Loss • Emotional
Lability • Amenorrhea • Tremor/
Tachycardia •
Intolerance of Heat • Nervousness • GI
Issues
©Picmonic
MOM’S TIRED:
Memory Loss • Obesity • Menorrhagia • Skin
Dryness• Tiredness •
Intolerance of Cold • Raised BP • Energy Levels
Fall • Delayed Reflexes
Endocrine
47
Addison’s vs Cushing’s
Add-sun
Cushion
ASSESSMENT
ASSESSMENT
•
Deficiency of Cortisol and
Aldosterone
•
Increased Cortisol Levels
•
Truncal Obesity
•
Irritability
•
Purple Abdominal Striae
•
Hyperkalemia
•
Buffalo Hump
•
Muscle Weakness
•
Decreased Bone Density
•
Skin Hyperpigmentation
•
Moon Face
•
Hyponatremia
•
Thinning Skin
•
Hypotension
•
Hyperglycemia
•
Hypoglycemia
•
Hypertension
CONSIDERATIONS
CONSIDERATIONS
•
•
Long Term Glucocorticoid
Use
•
Immunosuppression
Addisonian Crisis
©Picmonic
Endocrine
48
Hypoglycemia
Hypoglycemia is a condition characterized by an abnormally low level of blood
glucose (generally < 70 mg/dL), which serves as the body’s main energy source.
Causes for this include excess insulin, as well as decreased glucose.
MECHANISM
•
Too much insulin
•
Decreased glucose
ASSESSMENT
< 70 mg/dL
•
Change in LOC
•
Lethargic
•
Confusion and Irritability
•
Tremors
•
Diaphoresis
•
Tachycardia
•
Vision Changes
•
Weakness
•
Seizures
Glue-King-Kong
bottle
-glue-
Hippo
•
Interventions
MILD TO MODERATE HYPOGLYCEMIA
•
•
Simple Carbohydrate (Oral Dextrose, Fruit
Juice, Candies)
SEVERE HYPOGLYCEMIA OR UNCONSCIOUS
•
50% Dextrose
•
Glucagon
Complex Carbohydrate (Whole Grains,
Vegetables)
©Picmonic
Endocrine
49
Diabetes
Diabetes mellitus is a chronic multisystem endocrine disorder, which results in
elevated blood sugar (hyperglycemia). It is classified as follows – Type I (autoimmune; idiopathic) and Type II (insulin resistance), and gestational diabetes (GDMglucose intolerance during pregnancy).
TYPE II
TYPE II
GESTATIONAL DIABETES
Juvenile-Onset
Adult-Onset
Onset During Pregnancy
Absent Insulin Production
Insulin Resistance
Glucose Intolerance
Ketosis Prone
Obesity
COMPLICATIONS
•
Retinopathy
•
Nephropathy
•
Peripheral Vascular Disease
•
Neuropathy
©Picmonic
50
Section 9
50
Gastrointestinal
In preparation for the GI portion of the NCLEX®, we’ll review some
important information related to the gastrointestinal tract and liver.
We’ll compare ulcerative colitis vs. Crohn’s disease. This section will
also go over the appendicitis assessment, as well as liver diseases
like hepatitis.
In this section:
Follow along with the
Picmonic playlist!
•
UC vs Crohn’s
•
Appendicitis Assessment
•
Hepatitis
“The mind is like the stomach. It is not how much you put into it that
counts, but how much it digests.”
- Albert J. Nock
©Picmonic
Gastrointestinal
Ulcer-volcano Colon
Ulcerative Colitis Assessment
Ulcerative colitis is an inflammatory bowel
disorder that primarily affects the colon.
The disease is characterized by periodic
remissions and exacerbations.
Assessment
•
Affects Colon & Rectum
•
Cramping Abdominal Pain
•
Tenesmus
•
Bloody Diarrhea
•
Up to 10-20 per Day
51
Crown-of-intestines
vs
Crohn’s Disease
Crohn’s disease is an inflammatory bowel
disorder that can involve any segment of
the GI tract from the mouth to the anus but
preferentially is found in the terminal ileum.
The disease is characterized by periodic
remissions and exacerbations.
Assessment
•
Affects Entire GI Track
•
Diarrhea
•
5-6 per Day
•
Cramping Abdominal Pain
•
Fever
Complications
•
Weight Loss
•
•
Malabsorption
•
Fever
Hemorrhage
•
UC Hits Hard Like a Hammer
The superficial layers of the intestine are
often inflamed and hyperemic due to
increased blood flow. This inflammation
may cause weakening of the blood
vessels and cause hemorrhage. Patients
will present with hematochezia, or large
amounts of frank blood from the rectum.
©Picmonic
Hemorrhage
Hemorrhage-hammer
Anemia
COMPLICATIONS
•
Obstruction
•
Fistulas
Fistulas
Fist-shaped-tunnel
Gastrointestinal
52
Appendicitis assessment
Appendicitis is inflammation of the appendix often as a result of an
obstruction of the lumen of appendix. Obstruction results in distention, venous
engorgement, and the buildup of bacteria and mucus, leading to possible
complications, such as peritonitis and sepsis. It results in one of the most
common abdominal surgical emergencies that occurs in children, with the
average age being 10 years, affecting boys and girls equally before puberty.
Symptoms may include periumbilical pain, RLQ pain, nausea, vomiting, anorexia,
rebound tenderness, increased white blood cells, and fever.
MECHANISM
•
Obstruction of Appendix
ASSESSMENT
Appendix-pen
•
Periumbilical Pain
•
RLQ Pain
•
Nausea/Vomiting/Anorexia
•
Increased White Blood Cells
•
Rebound Tenderness
•
Fever
COMPLICATIONS
•
Peritonitis
•
Sepsis
Interventions
Appendectomy: Removing the appendix is the gold standard treatment for appendicitis. An
appendectomy is surgical removal of the appendix.
PREOPERATIVE CARE
POSTOPERATIVE CARE
•
Antibiotic
•
Semi-Fowler’s Position
•
No Enema or Laxative
•
Nasogastric Tube
•
IV Fluids
•
Diet as Tolerated
•
Pain Management
•
Early Ambulation
©Picmonic
Gastrointestinal
53
Hepatitis
Hepatitis A is an acute infectious disease of the liver caused by the hepatitis A
virus (HAV). Its incidence in the United States has declined since vaccination was
recommended for children and at-risk individuals. Both Hepatitis B and Hepatitis
C viruses can be spread by exposure to infectious blood. This includes perinatal
transmission, meaning a mother can pass the virus to the fetus during childbirth.
Additionally, accidental needle sticks contaminated with infected blood are
another source of transmission.
©Picmonic
TRANSMISSION
Happy-tie-liver (A) Apple
Hepatitis C
Happy-tie-liver (B) Bee
Happy-tie-liver (C) Cat
•
Fecal-Oral
•
Bodily Fluids
•
Bodily Fluids
•
Ingestion of
Contaminated Food
or Water
•
Blood Transmission
•
Blood Transmission
•
IV Drug Abusers
•
High Risk Sex (Rare)
•
IV Drug Abusers
4 Weeks
INCUBATION
CHRONIC DISEASE
CONSIDERATIONS
Hepatitis B
Hepatitis A
ASSESSMENT
•
Self-Limiting
•
Proper Hand
Washing
Variable 1-6 Month
•
Cirrhosis
•
Hepatocellular
Carcinoma
Vaccination
7 Weeks
Cirrhosis
Barrier Protection
54
Section 10
54
Electrolytes
It’s important to find balance in your life, so what better way to do
that than by talking about electrolytes? This section encompasses
a plethora of useful information including an ABG flow chart and
ABG analysis. Your HYPERs and HYPOs are here - as in hyper/
hypokalemia, hyper/hyponatremia and hyper/hypocalcemia!
Inclusion of specific assessment findings, interventions and
considerations are also discussed.
In this section:
Follow along with the
Picmonic playlist!
•
ABG Flow Chart
•
Acid Base Disorders
•
Hyperkalemia vs Hypokalemia
•
Hypernatremia vs Hyponatremia
•
Hypercalcemia vs Hypocalcemia
“Because Brawndo’s got electrolytes.”
- ANTHONY ‘CITRIC’ CAMPOS
©Picmonic
Electrolytes
55
ABG Flow Chart
Interpreting acid-base disorders is an essential nursing skill involving a threestep process: 1) Checking the pH, 2) Checking the partial pressure of carbon
dioxide in the blood (pCO2), 3) Checking the bicarbonate levels (HCO3).
Alkalosis
Elk-loser
HIGH pH
Alkalosis
LOW
pCO2
HIGH
HCO3
Respiratory
Alkalosis
Metabolic
Alkalosis
Acidosis
Acidic-lemon
Acidosis
LOW pH
HIGH
pCO2
Respiratory
Acidosis
LOW
HCO3
Metabolic
Acidosis
©Picmonic
Use this mnemonic to remember the relationship between pH and CO2.
“ROME”
Respiratory Opposite - In respiratory disorders, the pH and CO2 arrows move in
opposite directions.
Metabolic Equal - In metabolic disorders, the pH and CO2 arrows will move in the
same direction.
56
Acid Base Disorders
Electrolytes
Electrolytes
57
Hyperkalemia vs Hypokalemia
Hiker-banana
Hippo-banana
ASSESSMENT
Assessment
•
> 5.0 mEq/L K+
•
< 3.5 mEq/L
•
Abdominal Cramps
•
Muscle Weakness
•
Muscle Weakness
•
Arrhythmia
•
Diarrhea
•
Arrhythmia
•
Ileus
•
•
Hyporeflexia
•
Tall, Peaked T Waves
U Wave
INTERVENTIONS
INTERVENTIONS
•
Infusion of Glucose and Insulin
•
IV K+ Infusion at 5-10 mEq/hr
•
Diuretics
•
Oral Potassium with Food
•
Kayexalate
•
Prevention Education
Considerations
©Picmonic
Recall the causes of hyperkalemia with the
acronym
“MACHINE”
M: Medications (ACE Inhibitors, NSAIDS,
Potasium-Sparing Diuretics
A: Acidosis
Severe hypokalemia may lead to
respiratory muscle weakness and the
development of respiratory acidosis;
therefore, it is important to monitor
respiratory status. Observe this through
an adequate cough reflex.
A prominent U wave
may be seen on the
EKG due to prolonged
repolarization of
ventricular Purkinje fibers.
This is seen as an upward
deflection after the T
wave.
C: Cellular Destruction
H: Hypoaldosteronism (Addison’s Disease)
I: Intake
N: Nephrons (Renal Failure)
E: Excretion (Impaired)
Recall the signs and symptoms of hypokalemia
the 6L’s:
Lethargy, Leg Cramps, Limp Muscles, Low,
Shallow Respirations, Lethal Cardiac Arrhythmias,
Lots of Urine.
Electrolytes
58
Hypernatremia vs Hyponatremia
Hiker-salt-shaker
Hippo-salt-shaker
ASSESSMENT
Assessment
•
> 145 mEq/L Na+
•
< 135 mEq Na+
•
Abdominal Cramps
•
Nausea and Vomiting
•
Change in LOC
•
Decreased LOC
•
Extreme Thirst
•
Orthostatic Hypotension
•
Dry Flushed Skin
•
Muscle Twitching
•
Seizures
•
•
Confusion / Lethargy
Seizures
PRIORITY INTERVENTIONS
PRIORITY INTERVENTIONS
•
Assess Airway
•
Reduce Diuretic Dosage
FLUID EXCESS HYPONATREMIA
•
Prevent Dehydration
•
Hypotonic Solutions (0.225% or 0.45%
NaCl)
•
Sodium Restriction
•
Diuretics
•
Mannitol (Osmitrol)
•
Fluid Restriction
FLUID Deficit HYPONATREMIA
•
Recall the signs and symptoms of
hypernatremia with the acronym:
“FRIED”
Hypertonic Solution (3% or 5% NaCl)
Recall the signs and symptoms of
hyponatremia with the acronym:
“SALT LOSS”
F: Fever / Flushed Skin
R: Restless
S: Stupor
I: Increased Fluid Retention
A: Anorexia
E: Edema
D: Decreased Urinary Output & Dry Mouth
L: Lethargy
T: Tendon Reflexes Decreased
L: Limp Muscles
O: Orthostatic Hypotension
S: Seizures
©Picmonic
S: Stomach Cramps
Electrolytes
59
Hypercalcemia vs Hypocalcemia
Hiker-calcified-cow
Hippo-calcified-cow
ASSESSMENT
Assessment
•
> 10.5 mg/dL Ca2+
•
< 8.5 mg/dL Ca2+
•
Pathologic Fractures
•
Decreased Bone Density
•
Lethargy
•
Muscle Spasms
•
Hypercoagulation
•
Tetany
•
Constipation
•
Chvostek’s Sign
•
ECG Changes
•
Trousseau’s Sign
•
QT Shortening
INTERVENTIONS
•
Increased DTR
•
ECG Changes
•
QT Prolongation
•
No Calcium Intake
•
Chelating Drugs
CONSIDERATIONS
•
Calcitonin
•
Oral and IV Replacement of Ca2+
•
Bisphosphonates
•
Seizure Precautions
•
Loop Diuretics instead of Thiazide
Diuretics
Recall the signs and symptoms of
hypercalcemia with the mnemonic:
“Stones, Groans, Moans, Bones, Thrones,
and Psychiatric Overtones!”
STONES: Kidney Stones
GROANS: Malaise, Fatigue, Lethargy
MOANS: Joint Pain
BONES: Loss of Bone Desity
Recall the signs and symptoms of
hypocalcemia with the acronym:
“CATS”
C: Convulsions
A: Arrhythmias
T: Tetany
S: Spasms and Stridor
THRONES: The Porcelain Throne
(polyuria, polydipsia, and constipation)
OVERTONES: Psychiatric Overtones
©Picmonic
60
Section 11
60
Hematological
This section is a bloody great guide to the hematological information
you’ll want to focus on for the exam. We’ll look at sickle cell anemia
signs and management. It’s also important to study about blood
transfusions and blood compatibility.
In this section:
Follow along with the
Picmonic playlist!
•
Sickle Cell Assessement
•
Blood Transfusions
•
Blood Compatibility
“Because we are linked by blood and blood is memory without language.”
- joyce carol Oates
©Picmonic
Hematological
61
Sickle Cell Anemia Assessment
Sickle cell anemia (SCA) is an autosomal-recessive genetic
disorder that causes normal hemoglobin A to be partially
or completely replaced by hemoglobin S. The disease is
prevalent among Black or African American patients, but
does occur among Americans with Hispanic heritage. Unlike
normal RBCs that are shaped like biconcave discs, RBCs
are sickled or crescent-shaped in patients with SCA. In these
Sickle Cell Anemia
Sickle Anemone
patients, RBCs undergo rapid breakdown (hemolysis), which
can lead to a build-up of bilirubin, causing noticeable yellowing
of the skin and sclera. Patients may also experience severe pain in the hands,
feet, joints, and abdomen. Other clinical manifestations include changes in
vision, blood in the urine, and persistent, painful penile erections. Symptoms of
thrombosis and infarction (pulmonary embolism and stroke) can occur during
a vaso-occlusive crisis, in which blood vessels are obstructed by sickled RBCs
causing tissue ischemia and pain. Keep in mind that individuals with SCA are at
an increased risk for infection due to splenic damage. If SCA is not diagnosed
during infancy, patients with this disease may remain asymptomatic until a sickle
cell crisis occurs.
CAUSE/MECHANISM
INTERVENTIONS
•
Hemoglobin S (Genetic
Defect)
•
Increase Hydration
•
Analgesics
Sickle-Shaped RBCs
•
Oxygen
•
Warm Compress
•
Bone Marrow Transplant
•
Hydroxyurea
•
ASSESSMENT
•
Jaundice
•
Vaso Occlusive Crisis
•
Fever
CONSIDERATIONS
•
Priapism
•
Avoid High Altitudes
•
Severe Pain
•
Prophylactic Antibiotics
•
Prominent in African
Americans
•
Avoid Strenuous Exercise
•
May be Asymptomatic
•
Vaccines
•
Increased Risk of
Infection
©Picmonic
62
Hematological
Blood transfusions
A blood transfusion is the administration of whole blood or blood components to
correct deficiencies caused by trauma or hematological diseases. Before administration,
baseline vital signs must be obtained, and a two-nurse check must also be performed
to ensure proper patient identification. Blood should be administered slowly through
Y tubing, using a large bore needle to prevent hemolysis of cells. The patient should
be monitored closely for adverse reactions during the first 15 minutes, or 50 mL of
the transfusion. Fever is often the first sign of a transfusion reaction. It is important to
remember that nothing should be added to the IV line containing the blood product.
Normal saline is the only fluid approved for use during a blood transfusion, as dextrose
and lactated ringers will cause hemolysis. Keep in mind, administration of blood
products may not be acceptable to a patient, such as a Jehovah’s Witness, due to their
religious beliefs.
Administration
•
Proper Patient Identification
•
Large Bore Needle
•
Y Tubing
•
Baseline Vital Signs
•
Slow IV Infusion
•
Monitor During First 15 Minutes or 50 mL of Blood
•
Monitor for Reactions
CONSIDERATIONS
•
Do Not Add Anything To Same IV Line
•
No Dextrose or Lactated Ringers
•
Jehovah's Witnesses, No Transfusions
Transfusion Reactions
•
Acute Hemolytic
•
Febrile, Non-Hemolytic
•
Mild Allergic
•
Anaphylactic
•
Circulatory Overload
•
Sepsis Reaction
•
Transfusion-Related Acute Lung Injury (TRALI)
•
Massive Blood Transfusion
©Picmonic
Hematological
63
Blood Types and Compatibility
Genotype AB is Co-dominant
and has Type AB Blood
A-Apple with B-Bee Sharing Domino at AB-Blood
Allele A is Dominant
(A) Apple Tree with Domino
Allele B is Dominant
(B) Beehive with Domino
Genotypes BB and BO
on
ic
Genotypes AA and
have Type B Blood
B-bee with B-bee and B-bee with
O-owl at B-blood Bee-hive
@p
icm
AO have Type A Blood
A-apple with A-apple and A-apple
with O-owl at A-blood Apple Tree
Allele O is Recessive
O-Owl with Recessive
Chocolate Nest
Genotype OO Results
in Type O Blood
O-owl with O-owl at O-blood
Owl-nest
DONOR
OAB+
AB-
Patient
A+
AB+
BO+
©Picmonic
O-
O+
B-
B+
A-
A+
AB-
AB+
64
Section 12
64
Musculoskeletal
Moving right along to the musculoskeletal system. This section
might be short and sweet, but it’s important to study the key
differences between osteoarthritis and rheumatoid arthritis for the
exam.
In this section:
•
Osteoarthritis vs Rheumatoid Arthritis
Follow along with the
Picmonic playlist!
“Courage is very important. Like a muscle, it is strengthened by use.”
- Ruth Gordon
©Picmonic
Musculoskeletal
Osteoarthritis vs Rheumatoid Arthritis
This disease is the most common joint
disorder. It is a slowly progressive and chronic
noninflammatory disorder also known as
degenerative joint disease. Loss of articular
cartilage combined with new bone formation
leads to pain and deformity. Osteoarthritis
(OA) involves asymmetric joint involvement,
pain that improves with rest, morning stiffness
usually under 30 minutes, crepitus, and often
affects the DIP and PIP joints.
Rheumatoid arthritis (RA) is a chronic,
systemic autoimmune disease
characterized by inflammation of
connective tissue in the diarthrodial
(synovial) joints with periods of
remission and exacerbation. There is
an increased incidence in women and
while RA can occur at any age, it peaks
between the ages of 30 and 50 years.
Symptoms include joint stiffness, pain,
and limitation of movement with the
physical presentation of nodules and
possibly joint deformities.
MECHANISM
•
Aging
•
Articular Cartilage Destruction
•
Biomechanical Stress
MECHANISM
SIGNS AND SYMPTOMS
•
Autoimmune
•
Destruction of Connective Tissue
and Synovial Membrane
•
Asymmetric
•
Pain Decreases with Rest
SIGNS AND SYMPTOMS
•
Morning Stiffness under 30 Minutes
•
Inflammation of Joints
•
Crepitus
•
Morning Stiffness
•
DIP and PIP Joints
•
Nodules
•
Joint Deformities
Ostrich-King-Arthur
©Picmonic
Roman-King-Arthur
65
66
Section 13
66
Nervous
Nervous? No, not like that. The information contained in this section
will guide you through your study of cranial nerve function, stroke
assessments (FAST), meningitis signs and symptoms, indicators of
Parkinson’s disease, and Alzheimer’s. While that is great advice for
everyday living, we’ll explain how you can use the aforementioned
anagram to remember the routine neuro assessment.
In this section:
Follow along with the
Picmonic playlist!
•
Cranial Nerve Function
•
Left vs Right Stroke Assessment
•
Meningitis Assessment
•
Parkinsons Assessment
•
Alzheimers
•
Routine Neuro Assessment
“Courage is very important. Like a muscle, it is strengthened by use.”
- Ruth Gordon
©Picmonic
Nervous
67
Cranial nerve function
There are 12 cranial nerves with nuclei located in the tegmentum of the brain
stem. These nerves are classified as either sensory, motor, or both.
SENSORY
MOTOR
BOTH
CN I
Number (1) Foam-finger and Nose
CN III
(3) Trident with Eye
CN V
(5) Face
Olfactory Nerve
Oculomotor Nerve
Trigeminal Nerve
CN II
(2) Tutu with Optics
CN IV
(4)x4 Truck
CN VII
(7) Facial-lotion
Optic Nerve
Trochlear Nerve
Facial Nerve
CN VIII
(8) Ball Headphones
CN VI
Mr. (6) Pack
CN IX
(9) Lollipop
Vestibulocochlear Nerve
Abducens Nerve
Glossopharyngeal Nerve
CN XI
(11) Wheelchair
CN X
Vegas (10) Sign
Accessory Nerve.
Vagus Nerve
CN XII
V(12) Motor on Hippo-glass
Hypoglossal Nerve
©Picmonic
Nervous
68
Left vs Right
Stroke Assessment
Left Brain
Stroke-crew
Hemiplegia
Opposite Side Weak
and drooping
Hemiplegia
Opposite Side
Weak and drooping
Poor
Proprioception
Broken
Propeller-scepter
Side to Side
Discrimination
Can’t Discriminate
Between Sides
Aphasia
A-fish with Aphasia
Right Brain
Stroke-crew
Disoriented to
Person, Place, Time
Disoriented-map with Person,
Place, & Time
Prosopagnosia
Unrecognizable Faces
Agraphia
A-graph-paper
Loss of Judgement
& Awareness
Judge & Witnesses Leaving
Slow
Performance
Snail Performing
Aware of
Deficits
Aware of Losing
Impulsiveness
Impulsive M-pushing
Personality
Changes
Three-faced-masks
Anxiety
Anxiety-bag
Depression
Depressed-emo
©Picmonic
Tonal
Hearing Loss
Can’t Hear Tuning-fork
Nervous
69
Meningitis Assessment
Meningitis is an inflammation of the meningeal membrane surrounding the brain
and spinal cord. Most cases are viral, but occurrence of bacterial and fungal
cases are most concerning. Meningitis is contagious and spreads via respiratory
droplets.
ASSESSMENT
INFANTS AND YOUNG CHILDREN
•
Nausea and Vomiting
•
•
Fever
•
Nuchal Rigidity
•
Severe Headache
•
Purpura
•
Seizures
•
Photophobia
Opisthotonus
Position
Severe hyperextension
of Pistol-body
•
High Pitched Cry
•
Bulging Fontanel
Crying baby
Bulging Fountain
Interventions
•
IV Antibiotics
•
Dexamethasone
•
Analgesics
•
Antipyretics
CONSIDERATIONS
Meningitis
Men-in-tights
•
Closely Monitor for Increased ICP
•
Bed Rest
•
Preventative Vaccinations
•
Droplet-Airborne
Precautions
Closely Monitor for
Increased ICP
Monitor with Up-arrow
Pressure-cooker Cranium
©Picmonic
Nervous
70
Parkinson’s Assessment
Parkinson’s disease is a progressive neurological disorder affecting many
older adults. It is characterized by a decrease production of dopamine by the
substantia nigra in the brain, which leads to a resting tremor, bradykinesia,
shuffling gait, and potential cognitive decline.
Parkinson's Disease
Park-in-sun garage
ASSESSMENT
•
Decreased Dopamine
•
Older Adult
•
Cogwheel Rigidity
•
Bradykinesia
•
Shuffling Gait
•
Resting Tremor
•
Pill-Rolling
•
Mask-Like Face
•
Cognitive Decline
Decreased Dopamine
Down-arrow Doberman
Commonly used Parkinson’s
drugs can be remembered by
the acronym BALSA:
B
©Picmonic
Bromocriptine
Drugs on Holiday
A
Amantadine
L
Levodopa
S
Selegiline
A
Antimuscarinics
Due to the side effects and tolerance
that can develop after long-term use
with Parkinson’s medications (particularly
levodopa), a controversial technique known
as a “drug holiday” may be initiated. During
a drug holiday, which can last up to 10 days,
the patient is instructed to stop taking their
medication for PD in an effort to improve
the response to the drug and to manage
the complications. The patient should be
carefully monitored for symptoms of PD
during this period.
Nervous
71
Alzheimer’s Assessment
The 5 A’s of Alzheimer’s Disease is one way to remember and understand
commonly seen symptoms associated with Alzheimer’s disease. The 5 A’s stand
for agnosia, anomia, aphasia, apraxia, and amnesia.
2
3
1
Anomia
A-name-tag
Aphasia
Fish with Aphasia
Agnosia
Egg-nose with no face
5
4
alzheimer’s
Amnesia
Apraxia
Memory-eraser
Ape-axe
©Picmonic
Nervous
72
Routine Neuro Assessment
Pupillary Reaction: perrla pupil size chart
Remember pupillary reaction with the acronym PERRLA:
Pupils Equal • Round • Reactive to Light • Accommodation
Glasgow Coma
Scale
Glass-Cow Scale
1mm
2mm
3mm
4mm
5mm
6mm
8mm
Level of Consciousness: Descriptive Guide for Glasgow Coma Scale
Conscious
Normal, attentive; oriented to self, place, and mind
Confused
Impaired or slowed thinking; disoriented
Delirious
Disoriented, restless, clear deficit in attention; possible incidence of hallucinations
and delusions
Somnolent
Excessive drowsiness; little response to external stimuli
Obtunded
Decreased alertness, slowed motor responses; sleepiness
Stuporous
Conscious but sleep-like state associated with little or no activity; only
responsiveness is reaction to pain
Comatose
No response to stimuli, cannot be aroused; no gag reflex or pupil response to light
Glasgow Coma Scale
Score
1
2
3
4
5
Eyes
No Opening
Open to Pain
Open to Voice
Open
Spontaneously
Verbal
No Response
Incomprehensible
Sounds
Inapproprate
Words
Disoriented
Oriented
Motor
No Response
Abnormal
Extension
Abnormal
Flexion
Withdraws to
Pain
Localizes to
Pain
Muscle Strength Scale
6
Follows
Commands
©Picmonic
Score
0
1
2
3
4
5
Ability
No Muscle
Contraction
Muscle Twitch
Movement
Without Gravity
Movement
Against Gravity
Movement
Against
Resistance
Full Strength
73
Section 14
Reproductive / Obstetrics
As we push on to the reproductive/OB portion of the NCLEX®,
we’ll review what to do when caring for patients in labor. We’ll also
guide you through what to look for when performing the newborn
assessment.
In this section:
•
Labor
•
Newborn Assessment
Follow along with the
Picmonic playlist!
“If the cardiologist thinks the heart is a wonderful organ,
the cardiologist never have heard of the uterus.”
- Elmar P. Sakala
Reproductive / Obstetrics
74
Labor
Movements of the fetus through the birth canal during the mechanism of labor are known as cardinal
movements. These movements consist of engagement, descent, flexion, internal rotation, extension,
restitution and external rotation, and expulsion of the infant.
Mechanism of Labor
Engagement
Engagementring
Descent
Descending
Flexion
Flexing with
Flexion
Internal
Rotation
Internally
Rotating-in
Extension
Extending with
Extension
VEAL CHOP is an acronym to remember fetal heart rate pattern
changes in which the order of the letters in VEAL correlate to
accelerations or decelerations and the letters in CHOP help you
remember the cause of each FHR change.
V
Variable Deceleration
C
Cord Compression
E
Early Deceleration
H
Head Compression
A
Acceleration
O
Okay
L
Late Deceleration
P
Placental Insufficiency
External
Rotation
(Restitution)
Externally
Rotating-out
Expulsion of
Infant
Explosion of
Infant
©Picmonic
Reproductive / Obstetrics
75
Newborn Assessment
Newborn assessment consists of a comprehensive review of the neonate within 2 hours after delivery.
Within 1- and 5-minutes of birth, an APGAR score considers the newborn’s heart rate, respiratory rate,
muscle tone, reflexes, and skin color. A gestational age assessment is performed. The umbilical cord
is checked for 2 arteries and 1 vein. The anterior and posterior fontanels are assessed and expected
to close as the infant grows. Newborn measurements include birth weight, head circumference,
and body length. Antibiotic eye prophylaxis and intramuscular vitamin K are administered within 1
hour of birth. Keeping the infant warm is critical since neonates lack sufficient fat stores to maintain
temperature. After birth, an identification bracelet is placed on the infant’s foot and thumb prints are
collected.
APGAR Score
0
1
2
A
Appearance
Blue or Pale
Body Pink
Completely Pink
P
Pulse
Absent
Slow (<100 bpm)
Normal (>100 bpm)
G
Grimace
No Response
Grimace
Grimace with Cough,
Sneeze, or Cry
A
Activity and Muscle
Tone
Flaccid
Some Flexion
Good Flexion
R
Respiration
Absent
Slow or Irregular
Regular respiration or
Crying
The total of each of the 5 areas are added together for the final APGAR Score.
These scores indicate 0-3 = Severe Distress, 4-6 = Moderate Distress, 7-10 = Minimal to no Distress
MEASUREMENTS
ASSESSMENT
•
Umbilical Cord
5 lbs 8 oz and 8 lbs
13 oz
•
2 Arteries 1 Vein
•
Eye Prophylaxis
Head
Circumference
33-35.5 cm (13-14
inches)
•
Fontanels
•
Vitamin K Injection (Phytonadione)
Length
45-53 cm (19-21
inches) long
•
Gestational Age Assessment (GAA)
Birthweight
©Picmonic
76
Section 15
76
Pharmacology
Kids, don’t do drugs, but definitely do study for the drugs portion of
the NCLEX®. Some critical information to remember for the exam
is included in this section. Here you’ll find common medication
prefixes/suffixes, antidotes, and 50 of the most commonly
prescribed medications.
In this section:
Follow along with the
Picmonic playlist!
•
Common Medications Prefix / Suffix
•
Antidotes
•
Cardiac
•
Insulins
•
Antibiotics
“Courage is very important. Like a muscle, it is strengthened by use.”
- Ruth Gordon
©Picmonic
Drugs
77
Drug Endings
©Picmonic
Drugs
78
Antidotes
Medication
Antidote
Benzodiazepine
Flumazenil
Iron
DeFEroxamine
Acetylcholinesterase
Inhibitor
Atropine, Pralidoxime
Acetaminophen
N-Acetylcysteine
Antimuscarinic
Physostigmine Salicylate
Amphetamine
Ammonium Chloride (NH4Cl)
Beta Blocker Antidote
Glucagon
Arsenic, Gold and
Copper
Dimercaprol (BAL),
Penicillamine, Succimer
Warfarin
Vitamin K, Fresh Frozen
Plasma
Opioid
Naloxone
Tricyclic
Antidepressant (TCA)
Sodium Bicarbonate
(NaHCO3)
Lead
Penicillamine, Dimercaprol,
CaEDTA, Succimer
©Picmonic
A nuclear runoff has caused the
beta blocker beta-fish to grow
uncontrollably. She leaps from the
water and starts to build her own city
with blocks. The only one that can
defeat her is Glue-King-Kong, for
glucagon. He steals away her glue and
pours it on her head; sticking her in her
tracks.
Warfarin is like this fairy, who was
forced to go to war to defend her
magical kingdom, becoming war-fairy,
for Warfarin. As an anticoagulant, she
makes her enemies bleed. And the
only one with the authority to make
her stop is the Viking King, for vitamin
K. He turns her attention to fairy
tales on the plasma-TV, like Frozen,
representing fresh frozen plasma.
Drugs
79
Cardiac
Beta-Blockers
Beta-fish with Blocks
ACE Inhibitors
Ace in Inhibiting-chains
Calcium Channel Blockers
Calcium-cows Channel Blocked
-OLOL
-PRIL
-IPINE
MECHANISM OF ACTION
MECHANISM OF ACTION
MECHANISM OF ACTION
•
Decreases Heart Rate and
Contractility
•
Decreases Peripheral Vascular
Resistance
•
Decreases Renin Release
•
Inhibits ACE
•
Decreases GFR
•
•
Slows AV Conduction
Inhibits Constriction of
Efferent Arteriole
INDICATIONS
INDICATIONS
INDICATIONS
•
Hypertension
•
Hypertension
•
Essential Hypertension
•
Heart Failure
•
CHF
•
Angina Pectoris
•
Angina Pectoris
•
Diabetic Nephropathy
•
Arrhythmias
SIDE EFFECTS
SIDE EFFECTS
•
Masks Hypoglycemia
Increased Bradykinin
•
Bradycardia
•
SOB
•
•
Hypotension
•
Fatigue
•
Rash
•
Constipation
•
Dizziness
•
Headache
•
Peripheral Edema
•
Headache
•
Dizziness
•
Gingival Hyperplasia
•
Constipation
•
Low BP
©Picmonic
•
SIDE EFFECTS
Cough
Drugs
80
-
-
-
-
©Picmonic
Drugs
81
Antibiotics
Multiple different classes of antibiotics exist, all with varying mechanisms of action. Cell wall inhibitors
represent a major class, whose mechanism of action involves preventing the bacterial cell wall from
forming. Another class of antibiotics are the protein synthesis inhibitors, which bind to bacterial ribosomes
and prevent the production of crucial proteins. Two other important classes of antibiotics are the
fluoroquinolones and the sulfonamides.
©Picmonic
References
Assessment Made Incredibly Easy, 5th Ed., Wolters Kluwer, Lippincott, Williams
& Wilkins
Saunders Comprehensive Review For The NCLEX-RN Examination, 8 Ed.
Pharmacotherapeutics for Advanced Nursing Practice, 1st. Ed., Demler &
Rhoads, 2018
Nursing: A Concept-Based Approach to Learning, Volume 1, 3rd Ed.
Understanding Pathophysiology, 6th Ed., Huether, McCance, Brashers, & Rote
Pharmacology for Nurses - A Pathophysiologic Approach, 6th Ed., Adams,
Holland & Urban.
Jarvis - Physical Examination & Health Assessment, 8th Ed.
Fundamentals of Nursing, 9th Ed., Taylor, Lynn, Bartlett
Fundamentals of Nursing, 10 Ed., Potter, Perry, Stockert & Hall, 2020
Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th Ed., Hinkle &
Cheever
Medical-Surgical Nursing, 11th Ed., Harding, Kwong, Roberts, Hagler & Reinisch
Medical-Surgical Nursing, 10th Ed., Lewis, Dirksen, Heitkemper & Bucher
Medical-Surgical Nursing, 9th Ed., Ignatavicius & Workman, 2018
Pharmacology and the Nursing Process, 9th Ed., Lilley, Rainforth Collins &
Snyder, 2019
Medical-Surgical Nursing, 8th Ed., Ignatavicius & Workman, 2015
Lehne's Pharmacology for Nursing Care, 10th Ed., Burchum & Rosenthal, 2019
Maternity and Women's Health Care, 12th Ed., Lowerdermilk, Perry, Cashion &
Aldon, 2020
Wong's Nursing Care of Infants and Children, 11th Ed., Hockenberry, Wilson &
Rogers
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