MED SURG 245 {37 Page} Revised NCLEX Study Guide
Default Answers
1. Give meds either 1 hour before meal or 2 hours after meal
2. Give antacids 1 hour
... [Show More] before med or 4 hours after med-after meals
3. When in doubt pick K (potassium)
4. 2 – 3 L of fluids
5. When in doubt pick answer that has you stay with patient
6. Anytime you see restless & ↓ level of consciousness = early sign always pick
7. Head of Bead → 30-45 degrees for any neuro patient
8. Elderly with acute onset confusion → UTI
9. Secretions will turn Orange/Red for meds
10. Anytime you have GI problem/exacerbation = NPO
11. All surgeries
1st 24 hrs – bleeding 48 hrs – infection
12. Check daily weights if it’s a fluid problem
13. Lateral position for maternity
14. Remove answer choices that are ‘absolutes’ position, prevent, promote
Important Lab Values
WBC 4K – 11K
RBC 4 – 6
Hgb 12 – 16, 0r 12-18
Hct 36 – 48, or 37-52
Plt 150K – 400K
BUN 8 – 20, or 7-22
Cr/Lithium 0.6 – 1.2
Urine Clearance 85 – 135,
(GFR)=maintain above 60
Uric Acid 250 – 750 mg
Na 135 – 145
Cl 98 – 106
Ca 8.5 – 10.5
K 3.5 – 5.0
PO 2.5 – 4.5g
Mag 1.5 – 2.5, 4-7 if pregnant
and receiving Toco
Warfarin INR 2.0 – 3.5
Heparin PT 10 – 13 Seconds
PTT 25 – 35 Seconds
Therapeutic PTT: 1.5 – 2x the normal value (46 – 76 Seconds) Cholesterol
Therapeutic Ranges
Phenytoin Theophylline
Acetaminophen 10 – 20
Digoxin 0.5 – 2.0
Albumin level 3.5 to 5.5
Acid-Base Balance
From the ass (diarrhea) –Metabolic Acidosis From the mouth (vomitus) –Metabolic Alkalosis
Potassium & Alkalosis – ALKALOSIS: K is LOW
– Acidosis is just the opposite: K is High
Arterial Blood Gases
1. Prior to drawing an ABG, perform the Allen’s Test to check for sufficient blood flow
2. When drawing an ABG, the blood needs to be put in a heparinized tube.
● Ensuring there are no bubbles.
3. Put on ice immediately after drawing, with a label.
● The label should indicate if the pt was on room air, or how many liters of O2.
General Notes
● The person who hyperventilates is most likely to experience respiratory alkalosis.
Antidotes
● Aspirin → Activated Charcoal
● Coumadin (Warfarin) → Vitamin K
● Heparin → Protamine Sulfate
● Tylenol (Acetaminophen) → Mucomyst (acetylcysteine) – administered orally
● Digoxin (Lanoxin) → Digibind (immune Fab)
● Opioids → Narcan
● Iron overdose → Deferoxamine
● PCP → Activated charcoal
● Magnesium Sulfate → Calcium Gluconate
For blood types:
● "O" is the universal donor (remember "o" in donor)
● "AB" is the universal recipient
Blood transfusion – sign of allergies in order: 1)Flank pain
2)Frequent swallowing 3)Rashes
Blood
4)Fever 5)Chills
Thrombocytopenia – Bleeding precautions! 1)Soft bristled toothbrush
2) No insertion of anything! (c/i suppositories, douche) 3)No IM meds as much as possible!
Sickle Cell Anemia
During sickle cell crisis there are two interventions to prioritize: fluids and pain relief.
Iron deficiency anemia – easily fatigued
1) Fe PO (Iron) - give with Vitamin C or on an empty stomach 2)Fe via IM- Interferon via Z Track
-- Peds: Kids are at risk for iron deficiency anemia if they ingest too much milk; >24oz/ day.
Pernicious Anemia - s/s include pallor, tachycardia, and Sore Red, Beefy tongue; will take Vit.B12 for life!
Shilling Test – test for pernicious anemia/ how well one absorbs Vit b12
General Notes
● A patient with a low hemoglobin and/or hematocrit should be evaluated for signs of bleeding, such as dark stools.
The Number #1 Priority for Burn Patients is maintaining a patent airway
1st Degree – Red and Painful 2nd Degree – Blisters
3rd Degree – No Pain because of blocked and burned nerves
Cancer
A cancer patient is getting radiation. What should the nurse be most concerned about?
● Skin irritation? No.
● Infection kills cancer patients most because of the leukopenia
caused by radiation.
General Notes
● A breast cancer patient treated with Tamoxifen should report changes in visual acuity, because the adverse effect could be irreversible.
● Common sites for metastasis include the liver, brain, lung, bone, and lymph.
● Bence Jones protein in the urine confirms multiple myeloma (cancer of plasma cells)
● Patients with leukemia may have epistaxis (nosebleeds) b/c of low platelets [Show Less]