Overview
This lecture is a comprehensive NCLEX review covering key lab values, safety precautions, medication administration, common conditions, and test-taking strategies essential for safe nursing practice.
Lab Values & ABGs
- Know normal lab values: potassium 3.5-5, sodium 135-145, calcium 9-11, magnesium 1.5-2.5, phosphate 2.5-4.5, BUN 10-20, creatinine 0.5-1.5, WBC 4,000-11,000.
- Critical labs: ph in 6’s, potassium >6, CO2 >60, O2 <60, platelets <40,000.
- Neutropenic precautions: WBC <1000 or neutrophils <500—strict hygiene, no fresh foods/flowers, limit visitors.
- ABG normals: pH 7.35-7.45, PaCO2 35-45, HCO3 22-26. High pH = alkalosis (irritable/elevated vitals). Low pH = acidosis (lethargy, low BP/HR).
Precautions & PPE
- Standard: hand hygiene, gloves, gown, mask.
- Droplet: mask, private room (influenza, mumps).
- Airborne: N95, negative pressure room (measles, TB, varicella).
- Contact: hand hygiene, gloves, gown (MRSA, VRE).
- PPE removal: gloves, goggles, gown, mask (alphabetical). Donning: gown, mask, goggles, gloves.
Mobility Aids & Restraints
- Crutches: two finger widths below axilla; gait types refer to points on ground.
- Stairs: up with good leg, down with bad.
- Restraints: <9 yrs: 1 hr; 9-17: 2 hrs; adults: 4 hrs. Need MD order, informed consent.
Diabetes
- Type 1: insulin-dependent, kids, risk of DKA. Tx: diet, insulin, exercise.
- Type 2: adult onset, no ketosis. Tx: diet, oral meds, activity.
- DKA (type 1): BG >250, dehydration, ketones, Kussmaul, acidotic, treat with IV fluids/insulin.
- Hypoglycemia: BG <70, give carbs or glucagon.
- Insulin: rapid (15min onset), short (regular, IV), intermediate (NPH), long-acting (glargine).
- Normal A1c <6%; specific gravity 1.003–1.030.
OB/Maternity
- Fundus at umbilicus by 22 wks, quickening at 16–20 wks.
- Stages of labor: latent (1–4cm), active (4–7cm), transition (8–10cm).
- Danger: contractions >90 sec or <2 min.
- Meds: terbutaline slows labor, oxytocin induces labor.
- Complications: placenta previa (painless bleeding), abruption (painful), preeclampsia (proteinuria, high BP), eclampsia (seizures).
- FHR: 110–160. Variable decels = cord, early = head, late = placenta.
Pediatric Key Points
- Tetralogy of Fallot: 4 heart defects (VORP).
- Milestones: grasp (1mo), roll (4–6mo), sit (8mo), walk (9–12mo), run (3yr).
- Nutrition: half plate fruits/veggies, quarter protein/grains, 1 cup dairy.
- Pain scales: Wong-Baker (3+), FLACC (2mo–7yr).
- Meds dosed by weight.
Pharmacology
- Lithium: 0.6–1.2; Digoxin: 0.5–2; Theophylline/Phenytoin: 10–20 (toxic >20).
- Antihypertensives: beta blockers, ACE inhibitors ("pril"), ARBs ("sartan"), diuretics.
- SSRIs: serotonin syndrome (sweating, apprehension, dizziness).
- Antidotes: warfarin—vitamin K, heparin—protamine sulfate, opioids—naloxone, acetaminophen—acetylcysteine.
- Watch for drug interactions (cephalosporins & penicillins).
IV, Blood, & Safety
- Blood: start within 30 min, end <4hrs, double-check with another nurse, stay 15 min.
- IV fluids: isotonic (NS, LR), hypotonic (½ NS), hypertonic (3% saline).
- IV complications: infiltration (cool, edema), extravasation (burning, necrosis), phlebitis (red streak).
EKGs & Cardiac
- P wave: atrial. QRS: ventricular. T: repolarization.
- VTach/VFib: defibrillate. Asystole: atropine, epinephrine.
Test Strategies, Delegation, & Prioritization
- Prioritize unstable, acute, or unexpected patients (hemorrhage, high fever, hypoglycemia, no pulse).
- LPNs: no IV meds, assessments, teaching, unstable.
- UAPs: vitals, ambulation, no meds, no assessing.
- Turn select-all-that-apply into true/false statements.
Key Terms & Definitions
- NCLEX — National licensing exam for nurses, tests safety and foundational knowledge.
- Neutropenic Precautions — Infection-prevention for low immune patients.
- DKA — Diabetic Ketoacidosis, acute complication in Type 1 diabetes.
- A1c — 3-month average blood glucose.
- VEAL CHOP — Fetal heart rate monitoring mnemonic.
- VORP — Tetralogy of Fallot defects.
Action Items / Next Steps
- Memorize normal lab values, critical values, and insulin types.
- Review rights of medication administration and delegation.
- Practice EKG rhythm identification.
- Complete assigned readings or practice questions as directed by your instructor.