NCLEX Updates, Tips, Reviews and News

8 Important Tips from an NCLEX Passer

1. Choose the least invasive intervention first remember ADPIE (Assess Diagnose Plan Intervention Evaluate) 2. Also narrow your answers down to two if you can. Then dissect them closely before choosing your final answer. When you get to this point. Reread the question and look at what it’s asking for. I saw some NCLEX answers that looked straight from the book “the-always-safe-types” NCLEX knows that you know they’re safe and unfortunately that’s not what they’re asking. This is done on purpose to confuse you. 3. Use your ABC’s and Maslow. If your airway is compromised in anyway then it’s probably going to be that answer. 4. When priority questions appear don’t expect the “LPN can’t give blood so you should stop her!” you’ll get something that will force you to think about each situation. Choose the one that will become critical unless you do something right now. 5. Alt. Format questions means your doing well, study those —> Saunders. (I got about 22 of them, my friend got 30) 6. If you get a question that you have no idea about read it carefully. Reread it. Then try to see if you can get any idea what it’s asking for. If you can’t look at the options and select the one that meets the safety criteria. Remember, NCLEX wants safe nurses. 7. If you hit 75 and it keeps going. Take a break, you’ll be panicking by then. (I went to the bathroom freshened up then ran up and down the hallway doing jumping jacks to get pumped up again. Drank some water, and had my snack (take one... read more

NCLEX Pharmacology Quick Review

Administer librium during alcohol withdrawal. Antabuse is given for alcohol deterrence. Do not take over the counter cough medicine. When taking hypertensive medications, teach patient about orthostatic hypotension. Patient must change positions slowly. Administer diuretics in the morning so patient doesn’t constantly wake up to urinate. Do not given grapefruits with: Buspar, Veramapmil, Tegretol, and Simvastatin Rifampin turns urination orange. Digoxin = Side effects are increased when the patient is hypokalemic. Monitor the potassium. Digoxin has a negative chronotropic effect (slows the heart rate). Hold the dose if heart rate is less than 60. Digitalis toxicity = bradycardia, tachycardia, dysrhythmias, nausea, vomiting, and headache. Contact physician as soon as possible. MAOIs – Do not give food with tyramine as it may cause hypertensive crisis. Do not give tetracycline at bed time. Do not let patients lie down because it might cause gastric reflux. Do not give metformin to someone having procedures with contrast dye. Metformin can cause acute renal failure. Drawing insulin – (RN), Draw up regular before drawing up NPH. Never give potassium in IV push. When giving loop diuretics, watch for potassium depletion. Disulfiram is given to alcoholics to curb impulsive drinking. Dopamine treats cardiogenic shock. Propranolol is contraindicated in patients with bronchial asthma. Anticholinergic effect – patient won’t be able to spit, pee, poop, or see. Carbamazepine is contraindicated within 14 days of MAOI  administration. Anticoagulant drugs – Monitor PTT for heparin and monitor platelet count, bleeding, and s/s infection. Carafate is taken before meals. Tagamet is taken with food. Antacids is taken after... read more

Antidotes NCLEX Pharmacology

Coumadin = Vitamin K Benzodiazepines = Romazicon (Flumazenil) Magnesium Sulfate = Calcium Gluconate Heparin = Protamine Sulfate Tylenol = Mucomyst Opiates = Narcotic analgesics, heroin morphine, Narcan (Naloxone) Cholinergic Meds = Atropine, pralidoxime (2-PAM) Digoxin = Digiband Acetaminophen = n-Acetylcysteine Iron = Deferoxamine Alcohol Withdrawal = Librium Anticholinergics = Physostigmine Beta Blockers = Glucagon Methotrexate = Leucovorin Anticoagulants = Vitamin K, FFP Aspirin = Sodium bicarbonate Calcium Channel Blocker = Calcium, glucagon, insulin Cyanide = Tydroxycobalamin, any nitrite, sodium thiosulfate Hydrofluoric acid = Calcium Gluconate Insulin = Glucose Isoniazid = Deferoxamine Methanol = Ethanol Ethylene glycol = Fomepizole, ethanol Methemoglobin = Methylene blue Tricyclic antidepressant = Sodium... read more

Meds for Neuro

Mannitol (Osmitrol) is used to decrease cerebral edema during increased ICP. It is an osmotic diuretic, which means the blood will be drawn from interstitial areas to vascular space and then be eliminated in the urine excretion. Electrolytes are also drawn into blood and excreted, so monitor for electrolyte imbalance Hyponatremia is a life threatening side effect, causes seizures and death. Maintain strict I&O. Can have rebound ICP’s about 12 hours after drug administration Dobutamine (Dubutrex) and Norepinephrine (Levophed) – cardiac stimulants used to maintain cerebral perfusion during increased ICP. Dexamethasone (Decadron) Corticosteroid used to decrease inflammation surrounding a brain tumor Used in medical management of meningitis. Used post craniotomy for cerebral edema Administer IV q 6 hours for 24-72 hours, change to oral a.s.a.p., taper dosage over 5-7 days As with any steroid, fluid retention, increased sugar, lowed immune system Common side effect nasal irritation, cardiovascular edema, hyperglycemia, cataract, oral candidiasis, impaired would healing If using with Mannitol (makes electrolytes be excreted) (by the way the two together are contraindicated according to the book) add potassium-rich foods or supplement to diet. Use good oral hygiene to prevent oral candidiasis Phenytion (Dilantin) Anticonvulsant – to reduce risk of seizures Especially after supratentorial neurosurgical procedure (prone to seizures) Used to prevent grand mal and complex partial seizures During Ictal phase of seizure give ativan (lorazepam), then start dilantin Life threatening side effects are cardiovascular collapse, Agranulocytosis, aplastic anemias, dermatitis (bullous, exfoliative, or purpuric), Steven-Johnson syndrome. Common side effects gingival hyperplasia (swollen gums), give good mouth care.  Self care pt should brush, floss and massage gums after each meal. Other side... read more

Neuromuscular and Skeletal Diseases and Conditions

MS – multiple sclerosis, autoimmune, progressive, permanent myelin destroyed and nerve fiber breakdown, 20-40, environmental factors, relapsing/remitting most common type FATIGUE, weakness, vision, spas. & trem., pain w/ parasthesia, no 2 patients alike MRI & imunoglobin G bonded Mobility, no heat, urinary and bowel – embarrassing young, eye dr. often, sex dysfunction MEDS: Rebif, Betasteron SQqod / Avonex IMqwk / Copaxone SQqd / ßflulike symptoms / Methylprednisone for exacerbations, Mitoxarone IVq3mos (all to slow progression & reduce relapses MG – Myasthenia Gravis Autoimmune, myoneural junction, antibodies get in ACH receptors, 20-40W – 60-70M, face, throat (bulbar) swallow, voice, big thymus may hold antibodies Tensilon test – bradycardia – Atropine MG crisis ¯ or late meds (respir failure) , ACH crisis ­ meds (respir failure), always have suction available hospital and home, no sedative (hypoxia), conserve energy, energy for eating timed meds, sit ­ to eat MEDS:  ACHsterase inhib – Mestinon / immuno mod (¯antibodies) Prednisone, Imuron, Cyclosporin, Cytoxan / Plasmaphoresis for exacerbations / Thymectomy GBS – Guillain Barre Syndrome Acute fixable myelin problem, after virus (CMV, pneum, flu) 16-25, 45-60, ASCENDING, fast Respiratory failure, pulmonary embolis, , autonomic dysfunction, CV instability In ICU, CSF will have ­ protein, Plasmaphoresis, IVIG Have intubation close by, early detection, support limbs, temp pacemaker, TPN, communications before can’t talk, positive atmosphere, G-tube risk for aspiration Parkinson Progressive, basal ganglia, substantial nigra, dopamine ¯ – symptoms only after 80% decrease ? cause – 2 out of 4 (trem, ridg, bradykensia, posture) tremors, dementia, micrography, suffling gait thalamotomy, Pallidotomy, stem cells exercise, rest periods, assistive devices, no rugs, OT MEDS: Antiparkinson –Levadopa, Carbidopa / AntiACH... read more

10 Diagnoses for Student Nurses

Top 10 NANDA Nursing Diagnoses for nursing students 10. Fluid volume deficit r/t dehydrating effects of caffeine associated with increased student sightings at coffee bars. 9. Impaired social interactions r/t inappropriate topics of conversation associated with incessant discussions of bowel and bladder functions. 8. Sexual dysfunction r/t time constraints and stress-induced impotence associated with increased irritability of nursing students and their significant others. 7. Functional constipation r/t lack of time to go to the bathroom associated with moving at the speed of light and still not getting everything done. 6. Impaired skin integrity r/t increased intake of fat, chocolate, and alcohol associated with return to adolescent facial breakouts. 5. Anticipatory grieving r/t impending midterms and final exams associated with crying fits in October, December, March, and May. 4. Maturational enuresis r/t trauma-induced regression to childhood associated with frequent changing of linens. 3. Ineffective individual coping: obsessivecompulsive behaviors r/t high demand of nursing school associated with continual checking and rechecking of calendars, date books, course syllabi, and other nursing students to reassure that one is not forgetting assignments. 2. Altered thought processes: caffeine-induced psychosis r/t increased coffee consumption. 1. Self-care deficit r/t being a nursing... read more

Thrombotic Thrombocytopenic

The disease Thrombotic Thrombocytopenic Purpura (TTP) is a blood disorder that affects the normal clotting process.  If diagnosed correctly and treated properly this disease is acute for most patients, however due to the incidence of thrombi, if it is misdiagnosed or goes untreated, it can lead to death very quickly. Pathophysiology TTP can be familial or acquired.  In the familial form of TTP, it has been discovered there is a congenital deficiency of the ADAMTS13 gene; this is rare.  The acquired form of TTP is thought to be caused by an inhibitory autoantibody to the action of the ADAMTS13 gene which is responsible for cleaving large multimers in the clotting process.  These multimers aggregate platelets or cause them to stick together and produce thrombi (George, 2007). These thrombi can lead to hemolysis or accelerated break down of red blood cells and present in the typical objective TTP symptom of purpura or small bruises under the skin (Nanda, 2007).  The most urgent concern is the possibility of thrombi causing blockage in small capillaries, which could lead to myocardial infarction, renal failure, or stroke.  Acquired TTP can be trigger by associated disorders such as pregnancy, surgery, and pancreatitis. It is often misdiagnosed as gastroenteritis, sepsis, transient cerebral ischemic attack, and preeclampsia. Tests and Procedures used to Diagnose In diagnosing TTP a Complete Blood Count (CBC) blood test should be taken which will show, according to McBrien, in the AJN, a platelet count of 2,000-10,000 per ml (1997, p.28).  This is dangerously low compared to the normal of 150,000-400,000 per ml (Daniels, 2002, p. 233).  The CBC will also show a hematocrit... read more

Markers and Values

Hematology Values  MCHC (Mean Corpuscular Hemoglobin Concentration)  Normal Adult Range: 32 – 36 % Optimal Adult Reading: 34 Higher ranges are found in newborns and infants MCV (Mean Corpuscular Volume)  Normal Adult Range: 80 – 100 fl Optimal Adult Reading: 90 Higher ranges are found in newborns and infants MCH (Mean Corpuscular Hemoglobin)  Normal Adult Range: 27 – 33 pg Optimal Adult Reading: 30 HEMOGLOBIN (HGB)  Normal Adult Female Range: 12 – 16 g/dl Optimal Adult Female Reading: 14 g/dl Normal Adult Male Range: 14 – 18 g/dl Optimal Adult Male Reading: 16 g/dl Normal Newborn Range: 14 – 20 g/dl Optimal Newborn Reading: 17 g/dl HEMATOCRIT (HCT)  Normal Adult Female Range: 37 – 47% Optimal Adult Female Reading: 42% Normal Adult Male Range 40 – 54% Optimal Adult Male Reading: 47 Normal Newborn Range: 50 – 62% Optimal Newborn Reading: 56 R.B.C. (Red Blood Cell Count)  Normal Adult Female Range: 3.9 – 5.2 mill/mcl Optimal Adult Female Reading: 4.55 Normal Adult Male Range: 4.2 – 5.6 mill/mcl Optimal Adult Male Reading: 4.9 Lower ranges are found in Children, newborns and infants W.B.C. (White Blood Cell Count)  Normal Adult Range: 3.8 – 10.8 thous/mcl Optimal Adult Reading: 7.3 Higher ranges are found in children, newborns and infants. PLATELET COUNT Normal Adult Range: 130 – 400 thous/mcl Optimal Adult Reading: 265 Higher ranges are found in children, newborns and infants NEUTROPHILS and NEUTROPHIL COUNT  – this is the main defender of the body against infection and antigens. High levels may indicate an active infection. Normal Adult Range: 48 – 73 % Optimal Adult Reading: 60.5 Normal Children’s Range: 30 –... read more

16 NCLEX Test Taking Tips for NCLEX 2016

TIP 1 BE POSITIVE You learned the material in school & graduated You choose to take the test, so you can prepare & schedule when ready Establish a study schedule Worry in a constructive manner TIP 2 Know the structure of the test plan:  Client Needs A.Safe, Effective Care Environment: Management of care  13-19% Safety & Infection Control  8-14% B.Health Promotion & Maintenance           6-12% C.Psychosocial Integrity                             6-12% D.Physiological Integrity: Basic Care & Comfort  6-12% Pharmacological/Parenteral Therapy  13-19% Reduction of Risk Potential  13-19% Physiological Adaptation  11-17% INTEGRATED CONCEPTS Nursing Process Caring Communication and Documentation Teaching/Learning Integrated throughout the four major Client Needs categories TIP 3 Schedule your study time The minimum time for preparation is 2 hours/day for six to eight weeks. Spend 1/3 time reviewing content Spend 2/3 time answering test questions Develop a study plan/calendar (see example) Review med/surg, peds, maternal/child, psych Spend 50% time in med/surg TIP 4 Answer many questions Answer a minimum of 3,000 test questions Include answering questions in your study plan.  For example, answer 100 questions/day for a month. Use at least three different review books Your scores should be at least 75%, preferably, 75-85%. Review wrong answers. TIP 5 ANSWERING QUESTIONS Read the situation and stem question carefully.  Try to understand what knowledge the question is asking for. Determine whether there is a true-response or false-response stem. Be clear before you look at answer options. If not clear, reword using your own words. TRUE RESPONSE STEM Requires an answer that is a true statement: An appropriate nursing action The most essential or highest priority nsg action A safe nursing judgment A therapeutic... read more

Lipoprotein Physiology

Anyone that is a visual learner who feels like they could get through sections of nursing such as cardio or neuro a little easier if they could just visualize how the body works? Watch the videos below made by Walid Aziz Basharyar.  He draws physical anatomy and explains how the heart works, how blood pressure is controlled, and much... read more

Taking the NCLEX and Passing

The Day Before the Test On the day before the exam try to take it easy. If you feel compelled to study do a short overall review or one practice test and call it a day. Watch what you eat, get a little exercise, hydrate, and try to get a full night’s sleep. Make sure you know how to get to the testing center; maybe even drive it once to be sure you know where it is. Plan what you will wear, make it comfortable and I recommend layers. You have no idea what the temperature will be in the testing center, best to be prepared. Make sure your alarm clock is set appropriately. Test Day It’s the day you’ve been preparing for since you decided you wanted to be a nurse. It’s a big deal but it’s manageable. Here are a few more tips. Read. – I mean read everything. Read the intro. It will tell you how to turn the pages, where the notepad is, and calculator. Read each question all the way through. Pick out keywords (best, first, initial, never). Rephrase to yourself, what does the question ask? Read all the answers. Just read before you ever click an answer button. Prioritize. – Remember all your concepts from above and pick carefully. Is the question about ABCs (airway, breathing, circulation) or Needs (remember Maslow – physiologic needs then safety, etc.), or Nursing Process (assessment, diagnosis, planning, implementation, evaluation)? Remember patient’s feelings are paramount. Eliminate. – There is almost always a clearly wrong answer. Eliminate it from your thought process. Absolute answers (always, never) are often incorrect... read more

The Weeks Before the NCLEX

So here are some other tips for the weeks leading up to taking your NCLEX: Have an appropriate study area. – You just finished school so you should have somewhere you have been studying. However, you may find it helpful to now set aside a place most like where you will be taking the test. An area of no distractions. Like at the testing center make it a quiet place (no television, no stereo), sit at a desk just you and your computer when you use the practice disks. Make a schedule. – Set aside a reasonable amount of time 4-5 days a week for test prep only. Break your studies into categories of nursing and stick to a single category a day. Don’t overwhelm or overload. Feeling guilty about not getting something done won’t help your general testing attitude. Focus. – Studying for extended periods of time with short, scheduled breaks will keep you focused and improve your ability to concentrate on test day. Plan for two hour periods with 15 minute breaks and you will recreate the testing conditions exactly. Read all the answers. – Whether you get the question wrong or right, reading the answers broadens your understanding of why the way you answered was correct or not. It is also a means of reinforcing the questions you get right. Know concepts. – The point of the NCLEX is applying nursing theories and judgment. You don’t need to memorize an endless string of diagnoses or medications but understand symptoms and drug classes and how to apply the knowledge to benefit the patient. The only facts I... read more

Top 10 NCLEX Hints

1.Trust your instincts, if an answer feels right – go with it.  Your first answer is usually the right one. 2. When you have two direct opposite answers (unless able to eliminate for sure) often one of them is the answer. Ie. Hyperkalemia, Hypokalemia 3. KNOW your NORMALS: Vital Signs and Labs. 4. Remember to Access 1st.  Intervene 2nd. 5. If you have never heard of an answer, don’t pick it (you didn’t spend hundreds of hours of studying and miss that one thing you’ve never seen before). 6. More often than not, pain is not the answer (exception is chest pain and a few examples from obstetrics) 7. Always think: Is this answer going to 1. Kill or harm my patient or 2. Delay treatment.  If it does, chose another answer. 8. Eliminate answers that have “always or never” because nothing is 100% always or never in the world of NCLEX. 9. When you see “assessment or evaluation” in the stem of the question – look for a “sign or symptom” in the answer. 10. When giving report at change of shift share “new” or “different” information – don’t report the obvious to the oncoming... read more

NCLEX Study Guide Notes – A MUST read BEFORE you take the NCLEX Test

Prioritization, Delegation, and Assignment (PDA) by LaCharity 2nd edition Very important, must review for questions. This book will help you to prepare for the NCLEX style questions, especially for those priority, delegation, assignment type questions in which there’s a lot in the exam. Kaplan RN Course Book 15th edition The Kaplan book is like a shortened version of Saunder’s and/or Maryann Hogan. It seems to have about 60% of the materials you would see from either Saunder’s or Maryann Hogan. Very good if you’re very pressed for time. Maryann Hogan 2nd edition book If you have about one month or more to study, use this book. The Hogan book is by far better than the Saunder’s and/or Kaplan RN course book. It even has NCLEX highlights, which highlights info in the chapter that is most commonly asked on the NCLEX-RN. Even if you don’t have time to read through the whole book, reviewing the NCLEX highlights in this book is probably enough. In addition, the questions in this book (end of chapter quizzes and comprehensive test is the most similar type questions you will see on the NCLEX). Hopefully, this helps those who have lots of NCLEX review materials and can’t decide on which one to study on or for those who are deciding on what review material to buy for the NCLEX-RN. NCLEX-Study-Guide Must READ before... read more

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