N-CLEX Study guide
Decision Tree:
1. What is the topic?
a. Simplify topic
b. Look at answers for clues
2. Assessment or Implementation (If all implementation or assessment go to step 3) do u
need validation for a diagnosis before implementation? If yes, pick assessment
3. Physical before Psychosocial-Maslow? (All physical-go to step 4) (All psychosocial-step 5)
(If both, eliminate psychosocial, and implement ABCs)
4. ABCs (For all physical only)
5. What does each answer mean?
a. Expected vs. Unexpected Abnormal
b. Worse Case Scenario-ABCs
c. Chronic vs. Acute
TRANSMISSION-BASED PRECAUTIONS:
Remember ADC - airborne, droplet, contact
AIRBORNE
My – Measles (rubeola)
Chicken - Chicken Pox
Hez - Herpez Zoster
TB
Private Room - negative pressure with 6-12 air exchanges/hr or cohort (same organism)
Mask, N95 for TB, door closed, place mask on patient if being transported
DROPLET
think of SPIDERMAN!
S - sepsis
S - scarlet fever
S - streptococcal pharyngitis
P - parvovirus B19
P - pneumonia
P - pertussis
I - influenza
D - diptheria (pharyngeal)
E - epiglottitis
R – rubella (german measles)
M - mumps
M - meningitis
M - mycoplasma or meningeal pneumonia
An - Adenovirus
Private Room or cohort
Mask, door may remain open, mask on patient being transported, visitors wear mask if less
than three feet away, maintain separation of 3-feet between infected patient and visitors or
other patients
CONTACT PRECAUTION
MRS.WEE
M - multidrug resistant organism (MRSA, VRE)
R - respiratory infection (RSV)
S - skin infections
W - wound infxn
E - enteric infxn - clostridium difficile
E - eye infxn - conjunctivitis
SKIN INFECTIONS
VCHIPS
V - varicella zoster (chicken pox)
C - cutaneous diphtheria
H - herpez simplex
I - impetigo
P - pediculosis
S – scabies
*also includes mononucleosis
Private room or cohort
Gloves (remove and dispose in patient’s room)
Gown (remove before leaving room)
LABS
Electrolytes
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Sodium: 135-148 mEq/L
Potassium: 3.5-5 mEq/L
Chloride: 95-105 mEq/L
Magnesium: 1.5-3.0 U/L
Total Serum Calcium: 8.5-10.5 mg/dL
Renal:
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BUN: 7-20 mg/dL
Creatinine: 0.6-1.5 mg/dL
Creatinine Clearance: 1.6-2.5 ml/s
Liver:
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AST: 8-40
ALT: 8-40
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Amylase: 6-160
Lipase: <200
Aspire pH: <4
GI:
Random:
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CO2: 24-30 mEq/L, different for ABGs
Glucose: 60-100 mg/dL fasting, Infants: 40-50 mg/dL, >125 hyperglycemia, >150 in
preterm
Albumin: 3.5-5 g/dL
Ionized Calcium: 4.5-5.2 mg/dL
Urine Specific Gravity: 1.010-1.030
CVP: 3-11 cm H2O, or 2-5 mmHg
Glucose Tolerance Test: Fasting: 60-110, 1 hour: 190, 2 hour: 140, 3 hour: 125
Cholesterol: <150 if no CAD, <100 if CAD
LDL: optimal <70 or 100
HDL: >40
Triglycerides: 100-200
CBC:
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RBC: 4-5.5, men: 4.5-6.2, women: 4.2-5.4, children: 3.2-5.2
WBC: Adults: 5,000-10,000, children: 5,000-13,000
Hemoglobin: 12-17
Hematocrit: 36-51%
Platelets: 150,000-400,000
Bleeding:
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Prothrombin Time (PT): 9.5-12 sec, check with coumadin
Partial Thromboplastin Time (PTT): 20-45 sec, Heparin: 1.5-2X normal for
therapeutic levels.
INR: Normal: 1.0, anticoag: 2-3, heart valves: 2.5-3.5
ABGS:
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PH: 7.35-7.45
PaCO2: 35-45
PaO2: 80-100
HCO3: 22-26
BE: +/-1
O2 Sat/SaO2: 95-99%
Growth and Development:
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Toddler: (Separation): Teach parents to expect regression
Preschooler: (Mutilation): Allow children to play with models or equipment,
encourage expression of feelings
School-ager: (loss of control): Explain procedures in simple terms, allow choices
when possible
Adolescent: (Loss of Independence/being different from peers/body image):
Involve in procedures and therapies, expect resistance, express understanding of
concerns, point out strengths.
EKG:
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Rate:
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Regular: count the number of little boxes between 2 r-waves, multiple 1500
by the number or little boxes between r-waves.
Irregular: count the number of QRS complexes in 6 second strip and multiply
by 10
PR-Interval: .12-.2
QRS: .04-.1
QT: .36-.44
Heart Sounds:
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Aortic: 2 ICS, Right Sternal border
Pulmonic: 2 ICS, Left SB
Erb’s Point: 3 ICS, Left SB
Tricuspid: 5 ICS, Left SB
Mitrial: 5 ICS, Left MCL (apex)
S1, S3, S4 heard at mitral area, S2 heard at aortic area
Eriksons Stages:
Drug Levels:
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Aminophylline: 10 to 20 mcg/mL, Toxicity: Nausea, Vomiting, Abdominal pain, Mild
metabolic acidosis, Hypokalemia, Hypophosphatemia, Hypomagnesemia,
Hypocalcemia/hypercalcemia, Hyperglycemia, Tachycardia
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Digoxin: 0.8 to 2.0 ng/mL, Toxicity: N/V visual disturbances, green halo, decreased HR
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Lithium: 0.8 to 1.2 mEq/L, Toxicity: N/V, temors, confusion, seizures, lethargy,
weakness, diarrhea
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Dilantin/Phenytoin: 10 to 20 mcg/mL (Toxicity: uncontrollable eye movements, loss of
coordination, slow or slurred speech, uncontrollable shaking of a part of the body,
nausea, vomiting, difficulty understanding reality, coma (loss of consciousness for a
period of time)
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Theophylline: 10 to 20 mcg/mL, Toxicity: Nausea, Vomiting, Abdominal pain, Mild
metabolic acidosis, Hypokalemia, Hypophosphatemia, Hypomagnesemia,
Hypocalcemia/hypercalcemia, Hyperglycemia, Tachycardia
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Valproic acid: 50 to 100 mcg/mL, Toxicity: tremor, stupor, respiratory depression,
coma, metabolic acidosis and death.
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Quinidine: 2 to 5 mcg/mL
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Salicylate: 100 to 250 mcg/mL
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Methotrexate: greater than 0.01 mcmol
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Phenobarbital: 10 to 30 mcg/mL
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Gentamicin: 5 to 10 mcg/mL, OTO toxic
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Lidocaine: 1.5 to 5.0 mcg/mL
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Carbamazepine: 5 to 12 mcg/mL
Pediatric Dosing:
1 kilo=2.2 pounds
BSA (M2)= √(weight (pounds) X Height (inches))/3131
BSA (M2)= √(weight (kilos) X Height (cm))/3600
Pediatric Fluid Requirements:
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1-10 kg= 100 ml/kg/day
11-20 kg= 1000 ml + 50 ml/kg for each kg over 10
>20 kg= 1500ml + 20 ml/kg for each kg over 20
>30 kg= 1750 ml + 10 ml/kg for each kg over 30
Medical Math:
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Volume= cc or ml
Flow rate= gtt/min
Infusion Time= Minutes or hours
Dosage= units or mg
IV tubing calibration= gtt/mL
Pediatric/Microdrip Set= 60 gtt/mL
Heparin Normal Range= 20,000-40,000 Units/24 hours
Pregnancy:
Multipara: Quickening at 18 weeks
Primapara: Quickening at 20 weeks
Weight Gain:
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First trimester: 2-4 lbs
Second trimester: 12-14 lbs
Third trimester: 8-12 lbs
Rescue position for pregnant woman is LEFT side
Fetal Heart Rate: 120-160, If there is a deceleration, it should always return to baseline
Massage fundus until it is firm- no time limit, just until firm
Saturated Peripad=each one is 100 mL
At 24 weeks gestation, expression of colostrum is normal
Fundal height raises 1 cm a week until week 30. At 20 weeks its at the umbilicus.
6-12 hours after delivery, the fundus is at the level of the umbilicus and it drops 1
fingerbreadth a day for each day after that.
GTPAL: gravida (# or pregnancies), term (after 38 weeks), Preterm (before 38 weeks),
Abortion (less than 20 weeks or <500 g), Living children.
Gravida is number of times being pregnant, Para is the number of births
Weight gain during pregnancy: total 24-28 lbs.
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1st: 2-4 lbs
2nd: 12-14 lbs
3rd: 8-12 lbs
Fetal Heart tones: positive sign of pregnancy, heard at 12 weeks with Doppler, and at 18-20
weeks with auscultation
Rupture of membranes: Infection risk
Babies/Children:
Infant BP 60-80/40-45
High Pitched Cry= hypoglycemia or drug addiction
Infants:
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Birth weight doubles by 5 or 6 months
Sit w/o support at 7-8 months
Moro reflex, strongest for first 2 months, disappears by months 3 or 4.
Newborn:
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Head Circumference: 33-35 cm
Chest Circumference: 30.5-33 cm
Heart Rate: 120 (asleep)-180 (crying)
Respiratory Rate: 30-60
Risk factors for lead poisoning: Poverty and renters or old house with chipping paint
Infant with Heroin withdraw: excessive mucus and high pitched cry about 12 hours after
birth
12 month old should not drink more than 24 ounces of milk per day
Lead Poisoning: houses before 1975, old toys, peeling paint
School-aged screening: hearing, vision, dental, height/weight, scoliosis
Adolescent: PPD/TB test, sexuality, puberty, self exams, paps smear
Pathologic Jaundice: within 24 hours, r/t Rh or ABO incompatability
Physiologic Jaundice: occurs after 24 hours, peaks at 72 hours, lasts 5-7 days. Occurs due to
immature hepatic function.
Infant Output: 10-12 wet diapers, 2-3 stools a day
Feed Infant every 2 hours, only get formula nothing else
Lead Poisoning: want 0 level- S/S: loss of coordination and weight loss
Teach through play with children
Psychology/Drugs:
Akathisia: doll eyes, side to side movement
Oculogyric crisis: eyes roll up
Neuroleptic Malignant Syndrome: Treat with cooling blankets, Ice, fluids, reduce fever, and
give bromocriptine and dantrolene
Drug addicts use manipulation
Heroin is an opioid, respiratory depression, pinpoint pupils
Speed/Meth/Cocaine: potent vasoconstrictors (worried about chest pain), dilated pupils
SSRI’s: suicide watch the 1st few weeks, takes 4-6 weeks to take effect
Disease:
Breast Cancer….aka cancer of the lymph nodes
Obesitypressure on the tissueschronic inflammationcancer
Only 1st degree relatives with cancer history puts you at risk for cancer (genetic/familial)
Infants and old people don’t have fever or leukocytosis with infection, first sign is usually
tachypnea.
IUD is only for monogamous relationships cause it sits in the cervix and creates and open
cervix so there is increased risk for STDs affecting more than just reproductive tract, but
also kidneys
Crohn’s disease: low fat/residual/fiber, high protein
STOP metformin 2 days prior to CT scan with contrast because it causes lactic acidosis
Never check the monitor, always check the patient
Rheumatoid Arthritis (juvenile): to stretch joints, hang on the monkey bars-NCLEX
question
Slim Fast/Adkins diet: cause lactic acidosis and gout from excessive protein
Aspirin is an acid
Anterior wall MI leads to left sided heart failure so check lungs
RICE for first 48 hours after musculoskeletal injury
BKA: lay prone occasionally (3 days post-op) to prevent hip flexion contracture
Tick bites cause lyme disease which cause bulls eye rash, intermittent fever, fatique, muscle
pain, stiff neck.
Mammograms after age 40, colonoscopy after 50(every 10 years), sigmoidoscopy (every 5
years)
Latex allergies have cross allergies with avocado, peaches, banana, kiwi.
Common pts with latex allergies: neural tube defect, urogenital problems, spinal cord
injury pts
Kussmaul Respirations: air hunger, increasing rate and depth, like with respiratory
acidosis.
Should see fluctuations in water seal chamber
CPR: CAB, adult: 30:2, child: 1 rescuer: 30:2, 2 rescuer: 15:2
Cane/Crutches: Bad foot first going down stairs, good foot first going up stairs
The BIGGER incision wins.
Immunocompromised: cook meat to 165 Degrees F
Spleenomegaly: avoid trauma/sports for 6 months at least
NG Tube placement: Initially-chest x-ray, after check residual and gastric acid pH
Never suction without assessment first
Salmonella: infectious for a year
TB: we can put u in jail if you refuse meds
Blood Transfusion: 1. Get transfusion hx, 2. Start IV, 3. Get blood from bank, 4. Double check
with 2 RNs, 5. Run at 5 ml/min (Must start within 30 minutes of receiving from bank, must
complete within 4 hours)
Older patients: smaller doses: renal insufficiency
CNAs: comfort care, accuchecks, tube feeding (PEG), no NG tube, can check residuals
Fats, Proteins, Fibers: slow digestion
Sugar: speeds digestion
Laproscopic SX: Inject CO2 to spread arteries/tissues, so CO2 floats to shoulder and causes
pain, treat by ambulating patient and have them fart
Vaccines:
TB, Measles, Varivcella-airborn- gloves, gown, mask
Menigococcal/Meningitis: Droplet, gloves, gown, mask, googles
Meningicoccal vaccine is given to college/dorm students to prevent meningitis (bacterial)
Flu vaccine contraindicated for fowl allergy
Contraindications for vaccines:
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Altered immune system
Vaccine contraindicated for fever is greater than 101.0
Previous allergic response
Recent acquired passive immunity
Rubella: Incubation 14-21 days, communicable days 5-7 before rash onset. If infected
during 1st trimester, abortion is recommended.
Rubella Vaccine (live), SQ, DO NOT get pregnant for 3 months after vaccination
DTP is tetanus shot for kids, DT is for adults or for cuts if 7-10 years has passed since
vaccine