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These are NCLEX study tips (2013). Just short and simple pointers summing up an entire (hellacious) Nursing Program that should be helpful for NCLEX preparation. They are RANDOM, not organized in any particular subject or order. Sorry.
Terms in this set (42)
DO NOT delegate what you can...EAT (Acronym)
DOWN, DOWN, DOWN, UP, DOWN
- HYPOnatremia, HYPOtension, DECREASED blood volume, HYPERkalemia, and HYPOglycemia
UP, UP, UP, DOWN, UP
- HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia
No PEE, No ??
K+; DO NOT give Potassium without adequate urine output.
Increased perfusion for VEINS and ARTERIES
eins (*Think V,V*) and D*A*ngle *A*rteries.
*V*ate *V*eins (
) and D*A*ngle
*V*ate *V*eins (*Think V,V*) and D*A*ngle *A*rteries. (
APGAR: A (1st A)
Appearance - color pink/pink and blue/blue [pale]
Pulse - >100/<100/Absent
Grimace - cough/grimace/no response
APGAR: A (2nd A)
Activity - flexed/flaccid/limp
Respirations - strong cry/weak cry/absent
AIRBORN Transmission Precautions: MTV
= Varicella (Chicken Pox)/Herpes Zoster (Shingles)
Remember: Private room w/ negative pressure w/ 6 - 12 air exchange/hr AND MASK.
mask for TB.
DROPLET Precautions: SPIDERMAN (Some letters are repeated consecutively)
= Scarlet Fever
= Streptococcal Pharyngitis
= Paravirus B19
= Diptheria (Pharyngeal)
= Mycoplasma or Meningeal Pneumonia
Remember: Private room or cohort and MASK
CONTACT Precautions: MRS WEE
= Multidrug Resistant Organism
= Respiratory Infection
= Skin Infections
= Wound Infections
= Enteric Infection (Clostridium Difficile)
= Eye Infections (Conjunctivitis)
SKIN Infections: V CHIPS
= Cutaneous Diptheria
= Herepes Zoster
Air/Pulmonary Embolism: S&S and Care
S&S Include: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom.
Care: turn patient to the
the head of the bed
Woman in Labor w/ NON-Reassuring FHR: S&S and Care
S&S Include: late decelerations, decreased variability, fetal bradycardia, etc.
Care: turn on
(also give O2, stop pitocin and increase fluids)
Tube Feeding w/ DECREASED LOC: Care
Care Includes: Position pt on
(this promotes emptying of the stomach) with the HOB
(to prevent aspiration)
During Epidural Puncture: Care
Care Includes: position the patient
After a Lumbar Puncture (also an Oil Based Myelogram): Care
Care Includes: patient lies
(This is done to prevent headache and leaking of CSF)
Heat Stroke: Care
Care Includes: Lie
After an Myringotomy: Care
Care Includes: Position patient on the side of the
ear after surgery. (This allows drainage of secretions)
After Cataract Surgery: Care
Care Includes: The patient will sleep on the
side with a night shield for 1 - 4 weeks.
After Thyroidectomy: Care
Care Includes: Position
semi - fowlers
, support the head, neck and shoulders.
Infant w/ Spina Bifidia: Care
Care includes: Position
(on abdomen) so the sac does not rupture.
Buck's Traction (Skin Traction): Care
Care Includes: Elevate the foot of the bed for counter-traction.
After Total Hip Replacement: Care
Care Includes: Don't sleep on the operated side; don't flex hip for more than 45 - 60 degrees, don't elevate HOB more than 45 degrees. Also maintain hip
by separating thighs with pillows.
Prolapsed Cord: Care
Care Includes: Knee to Chest position OR Trendelenburg
Infant w/ Cleft Lip: Care
Care Includes: Position on the back or in an infant seat to prevent trauma to the suture line. While feeding, hold in the upright position.
To Prevent Dumping Syndrome: Care
(Post-Operatvie Ulcer/Stomach Surgeries)
Care Includes: Eat in the reclining position, lie down after meals for 20-30 minutes. Also
restrict fluids during meals, LOW CHO and fiber Diet
, and small frequent meals.
Above the Knee Amputation: Care
Care Includes: Elevate for the first 24 hours on a pillow, position prone daily to provide for hip extension.
Below Knee Amputation: Care
Care Includes: Foot of the bed elevated for the first 24 hours, position prone daily to provide for hip extension.
Detached Retina: Care
Care Includes: Area of detachment should be in the dependent position.
Administration of an Enema
Here, position the patient in
(Sims) w/ Knee Flexed.
After A Supratentorial Surgery (Incision Behind Hairline): Care
Care Includes: Elevate HOB 30-45 degrees
After A Infratentorial Surgery (Incision at the nape of the Neck): Care
Care Includes: Position the patient
and lateral on either side.
During Internal Radiation: Care
Care Includes: On bedrest while implant is in place.
Autonomic Dysreflexia/Hyperflexia: S&S and Care
- Acutely, this is a reaction of the autonomic (involuntary) nervous system to overstimulation (due to lesions or injury of the spinal cord)
S&S Include: Pounding headache, profuse sweating, nasal congestion, goose flesh, bradycardia,
Care Includes: Place the client in
(elevate HOB) FIRST before any other implementation.
Care Includes: Bed-rest w/ extremities elevated 20 degrees, knees straight, head slightly elevated (modified trendelenberg)
Head Injury: Care
Care Includes: Elevate the HOB 30 degrees to decrease ICP.
Peritoneal Dialysis w/ Inadequate outflow: Care
Care Includes: Turn patient from side to side
checking for kinks in the tubing (According to Kaplan)
Lumbar Puncture: Care After Procedure
Care Includes: Place the client in the supine position for 4 to 12 hours as prescribed.
Pain medication for Pancreantitis
With this, give
not Morphine Sulfate.
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