NCLEX- RN
REVIEW NOTES 2018
Anonymous
USRN
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CONTENTS
Few Tips and
... [Show More] Mnemonics Included Fundamentals of Nursing Neurology & Sensory Disorders Endocrine System Gastrointestinal System Genitourinary System Respiratory System Musculoskeletal System Hematology
Immunology Cardiovascular System
Psychiatric & Mental Health Nursing Pediatric Nursing
Nursing Issues Oncology Integumentary
Maternal & Child Nursing
More reminders/notes
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SERIOUS ALERT:
If you have this file, PLEASE READ!!!! RULE:
NEVER EVER DISCLOSE THIS TO ANY
REVIEW CENTERS, just keep it for yourself.
CONSIDER THIS AS YOUR OWN
NOTES. If you are confused with some topics verify it with your books or any materials you have trusted.
You may share it to your friend or anybody who needs it but remind them the golden RULE.
Let us protect the one who compile this for you! PLEASE KEEP YOUR PROMISE.
You may verify the topic but never ever tell them cause this notes says blablablah believe/trust what you want to….let us go back to the primitive side.
KNOWLEDGE IS ALWAYS FREE UNTIL PEOPLE MAKE IT A BUSINESS.
Unfortunately, some of us can’t pay for the review for any other reasons. The essence of NURSING IS CARING & SHARING.
So, let us renew our hearts content. As much as I would love to hear your feedback. I removed my email for security purposes.
May this will help you.
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Real talk!
Hello! fellow nurses! NCLEX is expensive! But our hard work will pay off soon, success is at hand for those who strive. I made a promise to myself to do this once I pass. I hope I can help you with the content. If you are a 1st taker I hope you can PASS right away with a little help from me.
For repeat test takers do not despair, there is hope. You are not alone. I have been through a lot of hurdles from start to finish. We must control our thought as it is so powerful. They said a real warrior never quit, winners never quit which is true! we don’t fail in life if we keep on trying, you will only fail, for real once you QUIT. Fighting! We can do this!
Oh! well allow me to share my story. I graduated long ago. It's been a while before I decided to take the exam. I failed twice! I must pick myself up. I still got lucky I have my family and friends with me 😍. So, we got you! I know the process is expensive, and so it goes with the review materials. We don't know where to start. We don't know what to do. Whom to talk to. No matter what people say to inspire us...it doesn't make any sense at all. It's okay not to be okay but we have to fight! So, shake it off. I’d say I know how it feels, been there, done that. It's like you have wasted a lot money, time, effort, etc. It's okay not to be okay when you do but it’s never okay to give up, everything happens for a reason.
Life teaches us a lesson and here we are taking God's exam every day as we explore in this world.
Experience is the best teacher. The world is so wide and life if too short. We must learn from our mistakes or else we will fail over and over. I hope you will learn from mine. Chances are thousands, let us use it wisely. When I was down. I must reassess what's missing, what are my mistakes, instead of using my beloved defense mechanism Rationalization and Projection plus procrastination. And so, IT WAS MY FAULT. I should never blame anybody. I just have to
restart, I am not dying so my game is not over yet.
😋.
We must prepare in a different way this time. Make a commitment. Have enough time to prepare. Apply nursing process. Assess our strategies. Diagnose- time management. Plan for the next battle. Intervene, study with Comprehension, Practice! Practice! Don’t rush, tendency is that we overlook the minute details which is very important (Avoid, Best, Further teaching etc.) And Evaluate yourself. If information is overloaded! STOP! Do the things that inspire you! then Go back fresh, to study.
If you don’t get the scores that you’re looking for while you study, shake it off and move on, it only means we must keep studying and practice more. If you feel like you can absorb better solo or within a group session/classes, then do it! Suit yourself consider the setting! whatever you think will help you out and make you at ease. Don't assume that you don't know anything at all. you got this! you just need to refresh your memory.
I am not super techie so pardon me. so as with my grammar...lol. This will not replace any books. This is merely for review purposes. Tried my best to compile this and add pics so it’s easier for you to create a mental imagery during the actual exam. If you dislike the color, feel free to change it, if you want to add notes please do so. I do not own this, it's an accumulation of notes, strategies and techniques that I’ve got while I study from different sources, some are my own...you can use it if you think it is useful or you can create your own mnemonic. It's a bit colorful cause I am not the kind of person that enjoys reading that much (not my thing) so I must make it fun for my eyes to read and I use black background so it’s not too bright. You may change it, whatever your preference is.
None of this is a guarantee, everything is still up to you! This is not about spoon feeding, this is merely for review purposes. This is not a guarantee, but it
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might help you. I must remind you, you still have to help yourself, honey. I should say none will help us if we study NCLEX literally, no matter how good the review materials we have, we must comprehend, analyze and understand the principles. Be like a spy look for cues. So, give it your best shot!
I'd really hope I will be able to help you reach your goal. And we will together continue to serve and help people live healthier lives.
Do your best, God will do the rest! The strongest weapon in every battle is PRAYER!
“Whatever you do, work at it with all your heart, as working for the Lord, not for human masters, since you know that you will receive an inheritance from the Lord as a reward. It is the Lord Christ you are serving.” (Colossians 3:23-24).
2 Timothy 4:7. I have fought the good fight, I have finished the race, I have kept the faith.
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TipS
If you may install this app and as much as possible answer at least
25 questions each day, make it a habit, no need to unlock or purchase and the
content is almost
the same as this app OR whatever Q&A books/app works for you…
Practice looking for hints/cues, improve your strategies, techniques and hone your skills. Then for a week or two practice Q&A for 265, timed! Increase your endurance
*Just familiarize the anatomy ;)
We can use this if we dissect the questions . Unfamiliar question? don’t rush make an educated guess, I know you can, I believe in you!
every Q & A count.
*What I meant about dissecting ;) “-ectomy” – so it is talking about removal of something.
*Make something like this:
Caput succedaneum – it succeeds - crosses the suture Cephalohematoma – do not cross
Nursing is an art! So be creative
*If the question is talking about RUQ then it is talking about the liver, so just familiarize what organs are in that specific quadrant (location)? Functions?
*If the question is talking about an injury Think about what site is affected? (cervical)
Possible effect? (difficulty breathing, complete paralysis below the neck)
*If you are confused about the effects of the drug (only if you do not know, use critical thinking), ask yourself
-is it an excitatory drug? Then S/E SNS, A/E PNS
-is it an inhibitory drug? Then S/E PNS, A/E SNS
Ex: Epinephrine (excitatory)
*Remind yourself that NCLEX is book base/nursing theory, it’s not about our personal experience.
* What if? STOP! Focus on what the question is asking, be alert with the setting. In the exam you have everything you need. staff, materials, etc. It is a perfect world. Your client in the only person presented in the question. Stop overthinking everything.
*Try to create a mental image of the anatomy, diseases, procedures, terminology and theory. This will also help you with the hot spot (?) Skim and scan, then go back with the Q & A to improve your training as a spy ;)
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*If the question does not have data in it, then answer will most probably be about assessment, if it’s present then move on_ it probably requires intervention.
ANALYZE
*Don’t expect to get everything right, to know all. The harder it gets then the closer you are.
*Don’t just choose answer choices based on a hunch/feeling, apply your nursing knowledge instead, recall the principles. NCLEX is not merely about identification, so memorizing might not work…Please ANALYZE. Let us use our Critical thinking skills.
*Familiarize yourself with the computer adaptive test
*Visualize yourself as you read through the Q & A
*Umbrella question_ answer that covers all of the others
*Consider all choices, do not predict, then use the process of Elimination to narrow down your options.
*Identify if it is a negative/positive question_ write (-) / (+)
*Tricky words_ALERT_avoid, further teaching, 1st (so it means you can still do the other options, but which one is 1st among the choices) best (all are correct, but you must select the highest), etc.
*Familiarize proper delegation
*Decide which patient is sickest/healthiest Answers always have age, gender, dx and
modifying phrase (most important)
*PRIO – will the result be worse?
Unstable vs Stable Unexpected vs Expected Acute vs Chronic Physiological vs Psychological Maslow’s hierarchy
ABC
Nursing process Safety
*Select the time of the day that you test your best, wherein you can absorb better. Or If you schedule
your exam in the morning then practice in the morning of otherwise.
*For SATA_answer it like a true or false in each choice. Verify if negative/positive query.
*Don’t expect to complete at 75, expect for 265. So you won’t despair if it won’t stop at 75 you are still in the game, and to just answer the question to get through the rest of the exam.
*If there are topics that confuses you JOT it down and read it over and over REPETITION with COMPREHENSION is the key (have a pocket notebook). Again, Scan and Skim.
*During the exam they will provide you with an erasable board and pen. Make use of it. This is very important. It is provided for a reason.
Imagine of it as if you are asking a friend for clarification. Think of it as me .
what are you going to write ex. (-) Needs further teaching_Cushing? So you will now look for the Negative query. It will remind you about what the question is really asking.
*Don’t be lazy during the exam. Think hard. Remember this is what you are preparing for. Your 6 hour-time frame will decide. So, give it your best shot!
*During the exam if you become fatigued take a break and a snack. Bring a dark chocolate whatever helps you.
*A day before the exam, pamper yourself. Prepare for your big day! Feel fresh and comfy.
*Write your name with RN in the end. Claim it!!!
Jeremiah 29:11
For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future.
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FUNDAMENTALS OF NURSING
1. Fluids and Electrolytes
Risk for Imbalances:
• Infants - 80%
• Male – 60 %
• Female – 50 % *(more body fats)
• Elderly – 40 % 2/3 – ICF
1/3- ECF – intravascular & interstitial tissues
2. Cellular Transport
Passive – No energy
• Osmosis – Movement of H2O from lOw to high
concentration
• Diffusion –*(diffuse) Movement of solutes from high to low concentration.
Active – Uses energy (ATP)
• Na+ and K+ pump
Impulses contraction
Na+ K+
Ca+ =
Repolarization = Depolarization Relaxation Contraction
Pressure
• Oncotic – pulling force, prevent leakage of fluids that causes edema or ascites Albumin- balancing act
Pressure (artery) Pressure (veins)
Ex: NephrOtic Syndrome damage to the glomerulus (filter)
Nrsg Intervention: give IV Albumin
• Hydrostatic – pushing force, to prevent
hypertension.
Pressure (artery) Pressure (veins)
TONICITY OF IV SOLUTIONS
Tonic – concentration of solution
1. Hypotonic - tonicity of the cell
• can lead to cell lyses
• produces cellular swelling
• osmosis, movement of water into the cell
• for patients cause: DKA, hyperosmolar hyperglycemia
• Avoid: patient with ICP, burns, trauma
• ex. Dehydration, Fluid Vol. Deficit
• ex. 0. 33 % NaCl *(almost all <1/with point)
0. 45 % NSS
0. 22 % Saline
D5W (inside the cell)
2. Isotonic – equal, no cellular change
• fluid maintenance, replacement for patients with burn, dehydration due to N/V
• ex. 5% dextrose in 0.225 Saline PNSS
PLR (burn)
D5W (outside isotonic)
3. Hypertonic - tonicity of the cell
• shrinking of the cell, movement of water out of the cell
• ICF
• usually central line, mostly in ICU
• Watch out for or WOF: pulmonary edema
• ICP – give mannitol
• ex. D5050 * (not less than 1/ no point) D5LR - hyperglycemia
3 % Saline
5 % Saline
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FLUID IMBALANCE
1. Fluid Volume Deficit (FVD)
S/Sx: Neonate: sunken fontanels and eyeballs
• flat neck veins
• dry poor skin turgor
• constipation
• oliguria
• weight loss
• ex. shock (isotonic)
• V/S: Hypotension BP
• Tachycardia PR
• Tachypnea RR
• Pulse pressure – Narrow - 90/60
*( N- 40 ); (systolic – diastolic = Pulse pressure)
• HCT - concentrated
*( N : M – 42 - 52 %, F – 35 - 47 % )
• CVP – measure fluid balance
• CVP -
*( N – 5 - 10 cm H2O / 3 – 8 mmHg)
Mgt:
- IVF
- I&O replacement & monitoring
2. Fluid Volume Excess (FVE)
• periorbital or facial edema
• distended jugular neck veins
• CHF
• Ex. ICP LOC
• V/S: Hypertension BP
• Bradycardia PR
• Bradypnea RR
• Pulse pressure – widened - 140/90
- HCT - dilution CVP –
• Lungs – Left Systemic – Right
• pulmonary edema - edema generalized
• crackles / rales - ascites
• DOB - weight gain
• coughing
Mgt. Diuretics Dialysis Digoxin
• replace albumin (IV)
ELECTROLYTE IMBALANCE
1. SODIUM (Na+) – N 135 – 145 mEq/L
HYPONATREMIA
• cause: SIADH
ADH
Fluid retention Weight gain
Serum Urine
Hemodilution Oliguria Dilutional hyponatremia USG
N – 1.010-1.030
HCT Mgt: Demeclocycline (Declomycin)
H2O S/Sx FVD
Mgt: IVF
HYPERNATREMIA
• Cause: DI
ADH
Fluid loss Weight loss
Serum Urine
Hemoconcentration Polyuria HCT Diluted
Hypernatremia USG
Mgt: Vasopressin
Desmopressin Cause: Na
H2O S/Sx FVE
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Mgt: Diuretics
Digoxin Albumin
2. POTASSIUM (K+) K+ = impulses
• Directly proportional impulses
N – 3.5-5.1 mEq/L
HYPOKALEMIA = K+= impulses
• CNS – lethargy
• HEART – T wave inversion/ depression,
U wave*
• GIT – constipation
• MUSCLES – Early – cramping
Late – weakness
Mgt: replacement K+; oral kalium durule IVF KCl
• No IV push always incorporate
• Never add more than 40 mEq/ L
• Never infuse in more than 10 mEq/L
• K+ rich diet
Potatoes (baked with skin)
Apricot (dried)
Banana
Orange Kiwi
Watermelon Cantaloupe
Strawberries
• Avoid digoxin because it will lead to digitalis toxicity*
• Avoid K+ wasting
Bumetanide (Bumex)
Furosemide (Lasix) – loop diuretic
Hydrochlorothiazide Mannitol – osmotic diuretic
HYPERKALEMIA= K+= impulses
• CNS – seizures
• HEART – tall peak T wave
• GIT – diarrhea
• MUSCLES: Early: spasm
Late: weakness
Mgt: (Sodium polystyrene) Kayexalate – permanent to
K+
• Oral (powder, dilute in H2O), enema
• IV GI solution (D5050 with insulin) – temporary solution/emergency cases
Avoid K+ sparing diuretics Spironolactone Amiloride Triamterene
K+ foods Apples Blueberries Blackberries Cherries Grapefruit Peaches Pineapple
3. CALCIUM – 4.5 – 5.5 mEq/L
8.6 – 10 mg/ dL
• opposite with impulses
HYPOCALCEMIA = Ca+ = impulses
• Tetany
• (+) Chvostek sign – facial muscle twitching
• (+) Trousseau sign – carpal spasm
• Prolonged ST/QT interval
WOF: laryngospasm (airway problem) Mgt: diet – milk /dairy products
• IV calcium gluconate
• Oral calcium chloride/ carbonate
HYPERCALCEMIA= Ca+ = impulses
• Bones (brittle)- Ca+ cause it’s in the blood
• Stones – renal calculi
• Moans – muscle weakness
• Groans - GIT – constipation
Mgt: Calcitonin (movement of Ca+
blood bones)
Fosamax (bone mineralization) Diuretics excess calcium excretion Dialysis
• Shortened ST & widened T wave
4. PHOSPHORUS – 2.7- 4.5 mg/dL
HYPOPHOSPHATEMIA
Ph – malnutrition / starvation / antacids
• alcoholism
HYPERPHOSPHATEMIA Ph – tumor lysis syndrome
• renal insufficiency
5. MAGNESIUM Mg+ = impulses
• opposite impulses
• N – 1.5 – 2.5 mEq/L
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HYPOMAGNESEMIA = impulses CNS: Brain – seizure
Spinal cord – hyperreflexia + 4 (N +2)
MUSCLES: Spasm
Tetany Cramps
HEART: V tach*
Polymorphic VT (Torsade’s de Pointes)
• Tall T waves and depressed ST
Mgt: MgSO4 IV
Mg Salts p.o.
HYPERMAGNESEMIA= impulses
DTR (-) or absent
Respiratory –
Oliguria
bP decrease
Mgt: Calcium gluconate (antidote Mg toxicity)
Diuretics Dialysis
O2 (mechanical ventilator)
• Prolonged PR
• Widened QRS complexes
Add note : N Cholesterol 200 mg/dL
ABG (ARTERIAL BLOOD GASSES)
Patency radial and ulnar artery -Allen’s Test
a. Occlude both radial and ulnar artery
b. Close and open hands 3 times
c. Release ulnar artery
d. Access perfusion hands
PRACTICE DRILLS: ABG INTERPRETATION
Step 1: pH Acidosis
Alkalosis
Step 3: Compensation???
If Normal pH: Fully compensated
If abnormal pCO2 or HCO3 but pH is abn – Partially If Normal pCO2 or HCO3: Uncompensated Compensation:
Respiratory Acidosis & Alkalosis
• pH is normal (compensated)
• HCO3 is abn (partial compensation)
• HCO3 is normal (uncompensated) Metabolic Acidosis & Alkalosis
• pH is normal (compensated)
• paCO2 is abn (partial compensation)
• paCO2 is normal (uncompensated)
Normal Values:
pH 7.35 – 7.45 PRIO
PaCO2 35 – 45 mmHg
HCO3 22 – 26 mEq/ L
paO2 80 – 100 mmHg PO2 < 60
SaO2 95 -100 % PCO2 > 60
Ph 7.5
PaCO2 32
HCO3 26 N Uncompensated
Respiratory Alkalosis
Ph 7.37 N
PaCO2 32
HCO3 19 Fully compensated Metabolic Acidosis [Show Less]