NCLEX study from Mark Klimek

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Mark Klimek NCLEX review flashcards

Hyperthyroidism is also called

Grave's disease or hypermetabolism

Tip to remember Grave's disease s/s's

"Run yourself into the Grave" - everything is up ... diarrhea, thin, hot, high BP, high HR, cold tolerance, hot intolerance

Treatment for Grave's disease

Radioactive Iodine, PTU (put thyroid under), surgically remove

Total thyroidectomy ... totals get

tetany, need lifelong hormone replacement

After thyroidectomy patients are at risk for

hypocalcemia, remember hypocalcemia is opposite of the prefix and anything to BP so tetany, parasthesia

parathesia

numbness and tingling, first sign of electrolyte imbalance

Subtotal thyroidectomy ... subs get

storm

S/S of thyroid storm

Extremely high vital signs, hyperpyrexia, psychotic delerium

How to treat thyroid storm

give o2, lower temp to spare brain

Risks post op for total thyroidectomy

airway, hemorrhage for 1st 12 hours then for 12-48 hours hypocalcemia leading to tetany

Risks post op for sub total thyroidectomy

airway, hemorrage for 1st 12 hours then for 12-48 hours thyroid storm

Hypothyroidism is also called

Myxedema or hypometabolism

S/S of mydexema

everything is down, constipation, heat tolerance, cold intolerance

Treatment for mydexema

give thyroid medications

Where to put the 5 ice packs to cool a thyroid storm patient

neck pits groin

If you cool a patient too fast what might happen?

Heart arrythmias

Never hold the hormone for what patient?

patient who is NPO with mydexema

Addison's disease easy way to remember

Add a Sone (sone = steroid)

Adrenal Cortex diseases easy way to remember

A in Adrenal stands for Addison's
C in Cortex stands for Cushing's

Addison's disease is

undersecretion of adrenal cortex, not enough hormone, BRONZE/tan, go into shock very easily. STRESS can trigger.

Addison's disease treatment

give a steroid, chronic steroid therapy

Cushing's syndrome

Over secretion of adrenal cortex, too much hormone, too much steroid.

S/S of Cushing's syndrome

same as steroid use ... moon face, think cushman "I'm mad I have an infection", high blood sugar, losing Potassium,

Treatment for Cushing's syndrome

Surgery, bi or uni lateral adrenalectomy (bilateral is worse)

Donning PPE's order

Gown, Mask, Goggles, Gloves

Removing PPE's order

alphabetically inside the room

For airborne precautions the mask is removed where?

outside of the room

Avoid answers with what words for children 9 mths and younger?

build, sort, stack, construct, make

Toddlers (1-3) work on

their gross motor skills (jump, hop, throw), NO fine motor, parallel play

Preschoolers (3-6) work on

fine motor, balance (tumbling, dance, tricycle), cooperative play, pretend

School age (7-11) work on

creative, collect, competitive

Best default order for click and drag order questions?

Hold ..... med
Assess ..... what med does
Prepare ...... the correction
Call ..... or notify

Rarely if ever answer ...

call Doctor, NCLEX wants you to think critically

Creatinine lab values

same as lithium 0.6-1.2 Not a huge worry, not a dangerous lab to worry about

INR lab values

2-3, critical value if off, potential for patient to bleed. Use default order for order ?'s (hold all coumadin, assess for bleeding, prepare Vit K (antidote for Coumadin), Call or notify

Potassium lab values

3.5-5.3 If low it is a critical lab to worry about assess the heart and then prepare to give K
if high, hold all K, assess heart (EKG), give D5W and reg insulin, call
if really high, hold, assess, prepare, call STAT Get someone else involved! Dangerous!!

pH lab values

7.35-7.45 if pH is in the 6;s VERY dangerous remember as the patient's pH goes so goes the patient
If bad vitals, call rapid response team

BUN lab values

8-30 check for dehydration if elevated not a big deal, just be concerned

If a deadly or dangerous lab value is discovered AND they have symptoms call the

rapid response team!

HgB lab values

12-18 check for bleeding if low or high, if low prepare for tranfussion

HCO3 lab values

22-26 if it is abnormal so what!

CO2 lab values

35-45 if in the 50's assess respiratory status and have patient do pursed lip breathing, if in 60's considered deadly and respiratory failure, need intubated

Hct lab values

36-54 thickness of blood if abnormal not too big of a deal, assess for dehydration

PO2 lab values

78-100 this is only obtained from an ABG if low give O2 but if really low it is respiratory failure give O2, prepare for intubation, call resp therapy and call Dr

O2 sat lab values

93-100 pulse ox, if under 93 assess resp status and give O2

BNP lab value

less than 100 is normal, good indicator of CHF, edema, if elevated assess s/s of CHF

NA lab values

135-145, if a change in LOC then evaluate for fall/safety risk

WBC lab values

5000-11000 if low assess for infection

CD4 count less than 200 equals

AIDS

Neutropenic precautions (low WBC)

strict handwashing, avoid crowds, private room, low bacteria diet (no raw or undercooked), no water that has been standing longer than 15 min, vital signs Q4H

Platelets lab value

150000-400000 if lower than 90000 bad if lower than 40000 REALLY bad, if they sneeze they could die. Called thrombocytopenia

Bleeding precautions

no venipuncture, injection or IV, if necessary use small guage, handle patient gently, use drawsheet, no razor, no toothbrush, blow nose gently, no aspriin, no rectal temp, no hard foods

RBC lab values

4-6 million abnormal doesn't really matter

Reason for laminectomy

treat nerve root compression

S/S of nerve root compression

Pain
Parasthesia (numbness & tingling)
Paresis (muscle weakness)

Cervical

Diaphram and Arms affected, breathing, respiratory pattern

Thoracic

Abd muscles and gut affected, ability to cough

Lumbar

Bladder and legs affected, when did they last void, are they distended

#1 post op answer for spinal problems is

log roll patient

Activity post op spinal issue

do not dangle
stand, walk, lie down w/o restricitons
limit sitting to 30 min at a time

Post op complications for cervical spinal surgery

pneumonia

Post op complications for thoracic spinal surgery

pneumonia (no cough), paralytic illeus (gut shuts down)

Post op complications for lumbar spinal surgery

urinary retention

How long does temporary restrictions usually mean?

6 weeks (driving, lifting, etc.)

Nagele's Rule

1st day of last period + 7 days - 3 months

Weight gain during pregnancy

28 lbs plus or minus 3 lbs

1st trimester weight gain

1 lb/month or 3 lbs for 1st trimester

2nd/3rd trimester weight gain

1 lb/week

Easy way to calculate appropriate weight gain during pregnancy

The week number minus 9 so if 12 weeks pregnant 12-9=3 lbs. not allowed to be off by more than 2 lbs.

Fundal Height

not palpable until 12 weeks, 2nd and 3rd trimesters week gestation 20-22 in cm so at the navel is 20 weeks

Positive signs of pregnancy

xray, ultrasound, auscultation of fetal HR on doppler 10 weeks, examiner (not the mother) palpates fetal movement

Probable signs of pregnancy

blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign

Chadwick's sign

Cervical color changes to Cyanosis See all the CCCCCC's!

Goodell's sign

Cervical softening

Hegar's sign

Uterine softening

All changes in cervix and vagina occur in what order?

alphabetical order

Pattern of Office Visits for prenatal care

once a month until 28 weeks, once every 2 weeks until week 36, once a week until delivery or week 42 when induction is scheduled

Pregnancy hemoglobin

normal is 12-18, first trimester falls to 11 which is okay, second trimester falls to 10.5 which is okay and then third trimester falls to 10 also okay

Easy way to remember station

has it made it through the "tight squeeze" (ischial spine) no then its a negative, yes then its a positive, 0 station is when it's at the ischial spine

Presenting part is 99% of the time the

head

What is bad as far as Lie?

Transverse is bad, vertical is good, parallel is good

Stage 1 of L&D

Labor - thinning and opening, has 3 phases, Latent, Active, Transitional, nothing to do with the baby just the cervix, no baby at the end of labor

Stage 2 of L&D

Delivery - pushing the baby out

Stage 3 of L&D

Placenta delivery

Stage 4 of L&D

Recovery (1st 2 hrs after delivery of placenta), considered unstable patient, stop the bleeding in stage 4

Memorize 1st stage 2nd phase of L&D then you know the rest

Active phase
CM dilated 5-7 cm
CXN Freq 3-5 min
Duration 30-60 sec
Intensity moderate

Contractions should not be longer than ____ seconds or closer than every _____ minutes.

90, 2

Prolapsed cord

OB emergency, baby will die if you don't do something

What to do with prolapsed cord

Push then position! Push head off cord then position in knee/chest of trendelenburg (head down)

Lithotomy position

on back with knees drawn up

Easy to remember interventions for complications of L&D

LIONPit
L left side, I increase IV, O oxygenate, N notify Dr, Pitocin

If question says there is pitocin running and there are complications

stop pit first then LIONpit

Pain meds in labor

know your peaks for IV, IM, PO, Subling. If baby is likely to be born when the pain med is peaking don't give! Why? Respiratory depression in baby

Fetal monitor patterns

if it starts with L it's bad so do LIONPit, ex; low fetal heart rate, low baseline variability, late decels

V C
E H
A O
L P

Variable Decels Cord Compression (bad)
Early Decels Head (bad)
Acels Okay (good)
Late Decels Placenta (bad)

Best answer for what to check first in fetal monitoring is

fetal heart rate, it's the ace of spades!

During the 2nd stage (delivery of baby), order of actions.

Deliver the head then stop pushing, suction the mouth first then the nose, check for nuchal cord, deliver shoulders and body, ID band

If the baby has to leave the delivery area, the priority is

the ID band

Umbilical cord has what in it

AVA 2 arteries and a vein

4th stage of L&D recovery stage, what do do?

4 things you do 4 times an hour in 4th stage
Vitals (assess for s/s of shock)
Fundus (want midline and firm, if boggy, massage, if displaced void/cath)
Pads (check and replace)
Roll on side (check for bleeding under patient)

Excessive Lochia is

a pad saturated in less than or equal to 15 minutes

Postpartum Uterus Tone

Firm NOT boggy

Postpartum Fundal Height

Fundal height should equal day post partum, day 5 = 5 cm below navel

Postpartum Uterus location

midline, if not void/cath

Postpartum Lochia color

Rubra - Red (ruby red)
Serosa - Pink (rosa pink)
Alba - whitish (albino white)

Postpartum Lochia amount

Moderage 4-6 inches on pad in one hour
Excessive pad saturated in 15 min

Best way to measure DVT is

calf circumferences, NOT Homan's sign, but if select all that apply question, include Homan's sign

Postpartum assessment of extremities

Pulses, Edema, S&S of Thrombophlebitis

Postpartum assessment includes assessment of

Uterus, Lochia and Extremities

Way to remember difference between Cephalohematoma and Caput Succedaneum

C S in Caput Succedaneum = Crosses suture lines, both are swelling on scalp caused by bleeding and both are normal or okay.

OB medications tocolytics

stop contractions, Brethine causes maternal tachycardia, Nifedipine (dipine - CCB) causes Hypotension and headache

OB medications oxytocics

makes labor more intense, Pitocin, Methergine, Cervidil

Uterine Hyperstimulation

contractions longer than 90 seconds or closer than 2 minutes

OB medications Fetal/Neonatal Lung meds

Betamethasone, speeds the development of the baby's lungs, given to Mom before baby is born, given IM, will increase the blood sugar of Mom

Survanta (surfactant)

given to baby after baby is born given trastracheal through the airway develops lungs

Med hints for IM injections

Look for 1's in both parts (the 1 looks like an I), guage and length, 21 g, 1 inch means IM

Med hints for SQ injections

look for 5's in both parts (the 5 looks like an S), guage and length, 25 g, 5/8 inch means SQ

Drawing up Insulin rules

R then N, Draw up R then N, NRRN the whole process

Pressurizing Insulin rule

put air into N then R , NRRN the whole process

If 70/30 insulin it is

70% N and 30% R, may have to make your own on boards, no 70/30 on the floor

Heparin is given IV or SQ NOT PO, info re: Heparin

works immediately, labs Ptt or any clotting or bleeding time, antidote: protamine sulfate, course: 21 days, pregnancy: YES (Class C pregnancy drug, use caution)

Coumadin is given PO, info re: Coumadin

takes days to work, labs ONLY PT-INR, antidote: Vit K (think Koumadin), course: forever, prengancy: NO (never use)

If a diuretic ends in the letter X it is a potassium

wasting drug plus Diurel

Baclofen/ Flexoril

muscle relaxant, think on your back loafin'! makes a patient drowsy, weak muscles, don't drink, don't drive, don't care of kids under 12

Piaget's stage Sensorimotor

age 0-2, totally present oriented, only think about what they sense or what they are doing NOW. tell them what you are doing as you are doing it

Piaget's stage Pre-Poperational

age 3-6, fantasy oriented, illogical, no rules, if they can think it it can happen, play with them, tell them what you are going to do the day of the event.

Piaget's stage Concrete Operations

age 7-11, rule oriented, live and die by the rules,only 1 way to do things, everything different is wrong, tell them days ahead what you are going to do plus skills, reading and visual tools

Piaget's stage Formal Operations

age 12-15, able to think abstractly, understand cause and effect, tell them like an adult

Child has to be at least what age for PRE op teaching?:

3

When can a child give themselves their own insulin shot?

7

What 2 parts are always irrelevant in a prioritization question?

age and gender (NCLEX is testing discrimination against agism)

If it is a pediatric question the age is critical but if it is a prioritization question ...

age is not critical

In prioritization questions decide which patient is _________ or ____________

sickest, healthiest

Rule #1 for prioritization

Acute beats Chronic, unstable beats stable. Ex: COPD, CHF, CRF and acute appendicitis, who wins? Acute appendicitis. No ABC's, an acute gut beats a chronic COPD all day long

ABC's don't count for

acuity

Prioritize patients at this very moment, not

3 seconds later or 10 minutes ago, Right NOW, right HERE, as they say it!

Rule #2 for prioritization

Fresh post op (12 hours out) beats medical or other surgical, Ex: 2 hr post op cholesysectomy beats acute appendicitis and post op one day CABG and COPD, CHF, CRF (then do ABC's)

Rule #3 for prioritization

Unstable beats stable

Things that make a patient stable

the word stable, chronic, post op greater than 12 hours, local or regional anesthesia, unchanged assessment, to be discharged, lab values that aren't urgent

Stable patients are experiencing the ___________ or __________ s/s's of the disease with which they have been diagnosed and for which they are receiving treatment

Typical, expected

Things that make a patient unstable

the word unstable, acute, post op less than 12 hours, general anesthesia, changing assessment, newly, recently admitted or diagnosed, lab values that are critical or deadly

Unstable patients are experiencing _________ or ____________ s/s's, complications

unexpected, atypical

Patients who are always unstable

hypoglycemia, hemorrhaging clients, fevers over 104, pulselessness, breathlessness

Faulty reasoning, prioritizing by symptom severity

It is not how severe the symptom is, its if the symptom has changed or if its typical or expected.

Rule #4 for prioritization

Tie-breaker, ONLY use for a tie breaker, the more Vital the organ the higher the priority.

Vital organ priority list

brain
lung
heart
liver
kidney
pancreas

LPN's can't do

IV anything (don't assume they have IV cert unless it says so), assessments, planning, admission, discharge, transfer, teaching, taking verbal orders or 1st of anything

AID's can't do

charting (only document what they did), assess, meds, IV, treatments, fleet enemas

AIDS can do

Soap suds enema, beds, bath, ADL's VS (not the first set), Accu check (not the first one)

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