all right everyone Welcome to today's lastm minute enclelex crash review My name is Mark Johnson I am ICU nurse and ENCLEX instructor This session is designed to reinforce the most high yield concepts that are frequently tested on the ENCLEX Let me be very clear This exam is not just about memorization It is about proving that you can think critically and act as a safe nurse Every question is designed to assess whether you can prioritize patient care make sound clinical decisions and above all protect patient safety So instead of focusing on cramming endless facts I want you to shift your mindset towards strategic thinking and prioritization Today we're going to break down some of the most frequently tested areas We'll cover prioritization and delegation safety and infection control pharmarmacology medication calculations and then the rest of the lecture will focus on the high yield topics like restraints and crutches lab values and AGs maternity and newborn care high yield medical surgical conditions and mental health nursing strategies By the end of this session you'll feel much more confident in tackling enclelex style questions So first how do we tackle enclelex the enclelex has patterns and if you know how to spot them you are already ahead of the game Enclelex is not about memorization It's about safe nursing Okay let me start the lecture with the three big tips for the ENLEX exam questions First eliminate extreme answers If you see words like never always only they are usually wrong Second for SATA questions treat each answer as true or false Do not overthink it Third trust your gut Your first instinct is usually right If you find yourself overanalyzing stop Go with your gut So stop stressing about cramming every tiny fact Instead think like a nurse Prioritize safety Use critical thinking All right let's get started with one of the most heavily tested topics Prioritization and delegation Enclelex loves prioritization and delegation questions When prioritizing patient care remember the ABCs first A is for airway If they cannot breathe nothing else matters B is for breathing Hypoxia fix it as soon as possible C is for circulation Poor circulation leads to organ failure which is bad For example a patient with strider airway obstruction versus a patient with a high fever Strider takes priority and a patient with an oxygen saturation of 82% versus a patient with a wound infection Go with the oxygen saturation issue first Also don't forget that physical health needs always come before psychosocial needs If a patient is having a panic attack and another patient is bleeding out the panic attack can wait Okay before we dig in further with more high yield topics don't forget to download some free guides on my website so that you don't have to write the notes by hand while listening to the lecture You will find some free notes and other wonderful resources on our website Don't forget to subscribe like and follow us on other platforms And without further ado let's dive deeper into the priority and delegation Okay you need to be able to tell which patient to see first and last when you are given multiple scenarios Unstable patients require immediate attention Examples include new onset symptoms such as sudden confusion chest pain or difficulty breathing Acute conditions such as stroke myioardial inffection or sepsis Post-operative patients within the first 24 hours Active bleeding severe abnormal vital signs such as hypotension bradic cardia or hypoxia What about stable patients they can wait Examples include chronic conditions such as chronic obstructive pulmonary disease diabetes hypertension expected post-operative pain controlled with medications discharge ready patients So a quick example a patient with blood pressure of 80 over 40 and confusion should be seen first over a diabetic patient needing insulin can wait The next most commonly asked topic is the delegation of work What are the stuff that RNs must do and what are the tasks that can be delegated to RPN or LPN or UAPs firstly never delegate what you can evaluate assess or teach We call them EAT EAT Registered nurses handle initial assessments post-operative assessments and new admissions They teach new medications procedures and discharge education They administer IV push medications and blood transfusions They handle unstable patients They develop care plans and nursing diagnosis On the other hand licensed practical nurses care for stable patients only They administer oral subcutaneous and intramuscular medications but no IV push They reinforce education that the registered nurse has already provided They perform wound care dressing changes and catheter insertions Unlicensed assistive personnel assist with activities of daily living such as bathing feeding toileting and ambulation They measure vital signs but only for stable patients They transport stable patients Okay example question Which task can a registered nurse delegate to a UAP the answer is ambulating a stable post-operative patient monitoring a patient after a blood transfusion is incorrect because that requires an RN assessment Another frequently asked topic is discharge criteria Who do we discharge first when hospital beds are full you need to free up space safely Discharge as soon as possible patients who have stable chronic conditions such as a patient with chronic obstructive pulmonary disease who is stable on home oxygen Patients with expected post-operative recoveries Do not discharge if the patient is unstable has new symptoms has been post-operative for less than 24 hours or is at high risk of complications For example a stable chronic obstructive pulmonary disease patient on home oxygen is safe to discharge whereas a post-operative patient with a sudden drop in blood pressure should remain hospitalized Enclelex quick tips to remember Always prioritize safety Falls airway issues and unstable vital signs must always come first Do not assume anything Only consider what is given in the question If unsure between two answers choose the safer option The ABCs in Maslo's hierarchy take priority over everything else Unstable patients must be seen by a registered nurse Stable patients can be delegated to an LPN or UAP All right class Now let's talk about safety and infection control A topic that Inclelex loves to test you on Let's start with how to put on PPE Remember there's a very easy pneummonic for this Google's make gowns great First you always put on the gown because you need that full body protection Then you put on the mask or N95 respirator if required making sure to seal check before entering the room Next you put on goggles or a face shield to protect your eyes Finally you put on gloves always last ensuring they cover the wrist of the gown You should always wash your hands first before dawning PPE And if you're using an N95 you must do a seal check before entering the room Now that you have PPE on you need to know how to take it off safely because this is where a lot of mistakes happen The trick is to remember the order Gloves goggles gown mask First you remove the gloves since they are the most contaminated Use the glove and glove technique or peel them from the inside out Next you remove goggles or a face shield making sure not to touch your face Then you take off the gown by untying it at the back and rolling it inward so the contaminated side stays inside Lastly you remove the mask always last And if it's an N95 you must remove it outside the room to avoid inhaling airborne particles You must wash your hands immediately after removing PPE Gloves first mask last prevents contamination Now let's talk about isolation precautions because enclelex frequently test this topic Airborne infections are those that float in the air requiring an N95 mask The pneummonic to remember is my chicken has TB which stands for measles chickenpox herpes zoster disseminated shingles and tuberculosis These patients require a private room with negative pressure to prevent the infection from spreading outside An N95 respirator is mandatory for anyone entering the room And if the patient has to leave the room they must wear a surgical mask If you are asked which patient should be placed on airborne precautions the answer is always someone with tuberculosis because they require an N95 mask and a negative pressure room Respiratory sensitial virus or RSV is a droplet precaution not airborne What about droplet droplet infections spread through coughing sneezing or talking So a surgical mask is required The pneummonic to remember is Spider-Man which includes sepsis scarlet fever strep feritis pertusis pneumonia influenza daptheria epiglatitis reubella mumps menenitis and adeno virus A private room is preferred but if necessary patients with the same infection can be placed together Healthare workers must wear a surgical mask when within 3 to six feet of the patient and if the patient leaves the room they must wear a surgical mask as well If you are asked what PPE should be worn for a patient with bacterial menitis the correct answer is a surgical mask because menitis is droplet precaution not airborne Okay Next contact infection spread through direct contact meaning you must wear a gown and gloves for any interactions The pneummonic to remember is M RSWE which includes multi-drugresistant organisms like MRSA and VRE respiratory infections like RSV skin infections like scabies and impedigo wound infections interic infections like claustrdium difficile and eye infections like conjunctivitis These patients should be in a private room or they can be cohorted with another patient who has the same infection You must always wear a gown and gloves when interacting with the patient And in the case of claustrdium diffosil you must wash your hands with soap and water because alcohol-based hand sanitizers do not kill spores If you are asked which patient should be placed on contact precautions the correct answer is someone with MRSA because they require both a gown and gloves However if the patient has measles they should be on airborne precautions and need an N95 mask Okay some enclelex tips for you You must remember that tuberculosis measles and vicella are always airborne Requiring an N95 mask in a negative pressure room Influenza and menitis require droplet precautions meaning you need a surgical mask and must stay at least 3 to 6 feet away from the patient MrE claustrdium difficil and RSV require contact precautions meaning you must wear a gown and gloves If a patient has claustrdium diffosil you must wash your hands with soap and water because alcohol- based hand sanitizers will not kill the spores Lastly always remember that when doawing PPE gloves come off first and the mask comes off last to prevent contamination Now we are going to focus on high yield must know drug toxicity levels major side effects blackbox warnings and of course antidotes First up let's talk about toxic drug levels Some medications have a narrow therapeutic range meaning that just a little bit too much can push the patient into dangerous territory This is why monitoring levels is so important Let's go over the big ones you need to know Digin used for heart failure and arrhythmias Normal range 0.5 to 2.0 Over 2.0 zero and we start seeing toxicity Classic signs nausea vomiting and this is the kicker Vision changes like difficulty reading or seeing yellow green halos If your patient says everything looks like Van Go's starry night you know what's up Lithium used for bipolar disorder Normal range 0.6 to 1.2 Once it hits 1.5 or higher we're in toxic territory What does that look like extreme thirst excessive urination nausea vomiting and diarrhea Basically your patient is drying out Phenito an anti-seizure medication Normal range 10 to 20 Go above 20 and you get a taxia which means the patient looks like they're drunk Unsteady gate hand tremors slurred speech If they're stumbling and mumbling that phenitoin level needs checking Theopilin a bronco dilator Normal range 10 to 20 Over 20 And we're worried about seizures Not fun Acetaminophen that go-to pain reliever Normal range 10 to 30 micrograms per milliliter But at 150 to 200 micrograms per milliliter we're looking at serious liver damage Remember ALT and A are your best friends when monitoring for liver failure So again deoxin toxicity is vision changes yellow green halos nausea bradic cardia Lithium toxicity is tremors confusion nephrotoxicity kidneys Phenito toxicity is atexia unsteady gate slurred speech Theopilin toxicity is seizures dysriythmias Acetaminophen toxicity is liver failure So you have to check ALT So what do we do if we suspect toxicity stop the medication immediately and check labs If needed administer the antidote Speaking of antidotes let's talk about those now Antidotes are life-saving and enclelex loves to test you on them Let's go through the key ones Opioid overdose give nlloxxone Acetaminophen overdose give n acetylcyine It protects the liver Magnesium sulfate toxicity give calcium gluconate heperin overdose give protamine sulfate warerin overdose give vitamin K doxin toxicity give digibine potassium overload Remember big K bicarb insulin glucose and kexalate alcohol withdrawal We use benzoazipines Calcium channel blocker overdose Treat with calcium gluconate If you can memorize even just a handful of these you'll be golden on test day Now let's talk about blackbox warnings These are the FDA's highest safety warnings and they must be taken seriously Let's start with beta blockers Anything ending in LOL meaprol or propranol Remember ABCD for their key risks Asthma They can cause bronospasm So we don't give them to asthma patients Brady cardia They slow down the heart rate and can cause heart block CHF In severe cases they can worsen congestive heart failure Diabetes They mask hypoglycemia which is dangerous for diabetic patients who rely on early symptoms like shakiness and sweating Other important blackbox warnings ACE inhibitors prill drugs like linopril can cause angioadeema swelling of the face lips and tongue This is a medical emergency Anti-depressants SSRIs SNRIs TCAs increased risk of suicidal ideiation especially in young adults QT prolongation drugs Many medications can prolong the QT interval increasing the risk of fatal heart arrhythmias So to recap know your toxic drug levels Lithium doxin theopilene phenitoine acetaminophen Memorize key antidotes Nlloxxone vitamin K digubind etc Stop the drug and check labs if you see toxicity signs Understand blackbox warnings like beta blockers ACE inhibitors anti-depressants and QT prolonging drugs are big ones All right class Let's get into medication calculations I promise this is going to be fun Well as fun as math can be but don't worry I'm going to make sure you never mess up a dosage calculation on the ENCLEX You will get at least one or two calculation questions in the ENLEX We're starting with the basic dosage formula It's super simple D / H * Q= X Remember D / H * Q= X D stands for desired dose That's what's ordered H is what you have on hand Q is the quantity the form of the drug whether it's one tablet 5 ml or whatever unit you're working with And X is the amount you need to give Got it perfect Let's do an example Your order says to give 50 mg of a drug but what you have available is 25 mg tablets So we plug it into our formula 50 / 25* 1T That gives us two tablets Easy right one more example The order is 600 mg of amoxicylin and what we have available is 200 mg per 5 ml Plug it in 600 / 200 * 5 ml That means we need to give 15 ml Boom That's how you do it Now let's talk IV flow rates This is where things get a little more fun because we're dealing with pumps and gravity First let's go over the formula for milliliters per hour Total volume divided by time in hours equals your rate Simple right here's an example The order says to give 1,00 ml of normal saline over 8 hours So we do the math 1,00 / 8 That gives us 125 ml per hour That's what you'll set your IV pump to Quick enclelex tip Always round to whole numbers for IV pumps No decimals allowed Now let's talk about drip rates That's when we don't have a fancy pump and have to count drops per minute Here's the formula Total volume x drop factor divided by total time in minutes equals drops per minute gtt per minute Example time You need to give 1,000 ml over 8 hours The drop factor is 15 gtt per millilit First convert hours to minutes 8 hours * 60 minutes equals 480 minutes Now plug it in 1 * 15 / 480 That gives us 31.25 drops per minute But remember we round to a whole number So we set it to 31 gtt per minute All right last calculation Weightbased dosages This is where we really need to pay attention because weight-based meds can be tricky The formula is simple Weight in kilogram times dose mg per kilogram equals total dose And before we even start always convert pounds to kilograms first 1 kilogram equals 2.2 lb Write that down Tattoo it on your arm Whatever helps you remember Example time The order is for acetaminophen 15 mg per kilogram The patient weighs 44 lb First convert the weight 44 lb / 2.2= 20 kg Now multiply 20 kg * 15 mg per kilogram equals 300 mg And that's your answer 300 mg See medication calculations aren't scary It's just plugging numbers into formulas and double-checking your work And the more you practice the faster you'll get And just remember when in doubt always check your work and never round too soon Restraints and crutches Now I know it might not sound like the most thrilling thing but trust me it's crucial for the ENCLEX and it's one of those things you need to know inside and out So let's make it fun and engaging as we go through this First off when do we use restraints and what are some alternatives we should try first the golden rule here is restraints should only be used as a last resort You can't just slap restraints on someone because it's easier The ENCLEX is very clear on that So when can you use restraints only to prevent harm to the patient or others This isn't just a rule It's a legal and ethical standard You're going to need a provider's order And yes you can get that order after applying restraints in an emergency but you better follow up and document it properly Let's look at some examples of when you can use restraints Imagine you're dealing with a violent patient who's trying to harm staff or themselves Restraints can be used here Or maybe you have a poststroke patient who keeps trying to pull out their IV or feeding tube You might need to consider restraints in that case And then there's the classic a confused patient trying to get out of bed even though they're a highfall risk But and this is a big butt there are times when you should not use restraints You never use them for patient convenience Just because they're agitated or annoying doesn't mean you get to take the easy way out And for dementia patients who are wandering around you've got to try alternatives first Let's talk about those alternatives So what should you try before jumping to restraints first reorient the patient Explain what's happening Sometimes a simple explanation can calm them down You can move the patient closer to the nurse's station That way you're keeping a closer eye on them Bed alarms are a fantastic option They alert you if they're trying to get up If the patient's family is around encourage them to sit with the patient Sometimes a familiar face can make all the difference And distractions gold Turn on the TV play some music have a conversation It can help keep them settled Finally use low beds and mats to reduce the fall risk if they do get out of bed Here's a quick Enclelex tip If you see an answer choice about trying a less restrictive method first pick that one Always go for the least restrictive option before jumping to restraints Let's do a quick example question A confused patient is trying to pull out their IV What should the nurse do first cover the IV site with a protective sleeve because that's a less restrictive option Applying wrist restraints immediately nope Try alternatives first All right Now let's switch gears a bit and talk about crutches You're going to see questions about proper crutch fit and gate patterns So let's make sure you've got this down When it comes to proper crutch fit you need a two to three finger gap between the armpit and the crutch top Not more not less just right And the elbows you're aiming for about a 30° flexion when holding the handles This helps keep the weight on the hands not on the armpits Why is that important because putting weight on the armpits can cause nerve damage We're talking about axillary nerve damage also known as crutch palsy So remember weight goes on the hands never the armpits Now let's talk gate patterns The type of gate pattern used depends on the patient's weight bearing ability Let's break it down First up the twopoint gate This one's for partial weightbearing on both legs The patient moves the opposite crutch and leg together It kind of mimics a normal walking pattern This is great for patients with minor leg weakness Then there's the three-point gate This one's for nonweightbearing on one leg Think fractures sprains or surgery on one leg The patient moves both crutches forward Then the good leg steps up Finally we have the four-point gate This is for full weightbearing and maximum stability It's crutch opposite leg crutch opposite leg One step at a time You'll use this for patients with severe weakness like with neuro disorders Going up and down stairs with crutches There's a pneummonic for that Up with the good down with the bad Going up lead with the good leg then the crutches then the bad leg Going down Crutches first then the bad leg then the good leg Easy to remember right and neglects tips to wrap this up Restraints are a last resort Always try alternatives first When you secure restraints tie them to the bed frame not the side rails and check every 15 to 30 minutes Crutches two to three finger gap under the armpits to avoid nerve damage And remember up with the good down with the bad on stairs All right everyone Super important topic Lab values and AG interpretation This is a high yield topic for ENCLEX and we're going to break it down in a way that makes it easy to understand and remember So let's get started While they won't necessarily ask you to recall exact numbers from memory you'll need to recognize abnormal values and know what they indicate Many ENCLEX questions present lab results as part of a case scenario and you'll have to interpret whether they're normal or concerning and what actions to take So while you don't need to memorize every single lab value you should be very familiar with the most commonly tested ones like sodium potassium calcium magnesium ABGs and coagulation labs because they directly impact patient safety Having a good grasp of these values before going into the exam will make it easier to quickly identify critical issues and choose the right interventions So electrolytes the basics Electrolytes are essential for body function and even small imbalances can cause major issues You need to know these normal ranges and what happens when they're off Sodium's normal range is 135 to 145 Sodium imbalances affect the brain Too high or too low think neuro changes seizures confusion even coma in severe cases If you see a patient with mental status changes check that sodium Potassium Potassium's normal range is 3.5 to 5 Potassium is all about the heart High potassium you'll see peaked T- waves and arhythmias Low potassium the heart gets irritable too leading to dysriythmias Watch those levels closely Normal range of calcium is 8.5 to 10.5 Calcium affects muscle function Low calcium Think tetany muscle spasms Chvastic's sign like face twitch when tapped And Truso's sign like carpal spasm with a BP cuff High calcium muscle weakness and decreased reflexes Magnesium's normal range is 1.5 to 2.5 Magnesium controls reflexes Low magnesium hyperactive reflexes High magnesium depressed reflexes It also plays a big role in cardiac function So keep an eye on that for arhythmias Phosphorus's range is 2.5 to 4.5 Phosphorus is linked to calcium When one goes up the other goes down High phosphorus kidney issues Low phosphorus bone issues Easy to remember Chloride's normal range is 95 to 105 Chloride helps with acid base balance If it's off your patient might be dealing with metabolic or respiratory imbalances For the enclelex tip electrolytes Electrolyte imbalances cause specific symptoms So focus on what body system is affected Sodium affects brain Potassium affects heart Calcium and magnesium affects muscles Phosphorus affects bones and kidneys Now let's dive into arterial blood gases AGs These tell us how well the lungs and kidneys are balancing pH First you have to know the normal AG ranges pH is between 7.35 and 7.45 Pa2 which is the partial pressure of carbon dioxide in arterial blood The normal range is 35 to 45 mm of mercury and this deals with the respiratory component Bicarb's normal range is 22 to 26 which deals with the metabolic component Respiratory versus metabolic imbalance If pH and CO2 are moving in opposite directions it's respiratory If pH and HO3 are moving in the same direction it's metabolic So once you remember these normal ranges let's figure out how to solve such questions First you look at the pH value and see if it is acidic or alkalotic If pH is lower than normal range 7.35 it is acidosis If it is higher than 7.45 it is alkyossis Then next you are going to look at the the partial pressure of carbon dioxide and by carb and see if they are lower or higher than their own normal range and see if the trends of their own are the same or opposite to the trend of pH And there is a memory tip here Remember a word roam Respiratory opposite metabolic equal So we say it is respiratory if the trend of pH and CO2 are the opposite and metabolic equal We can tell it is metabolic if the trend of pH and by carb are the opposite So let's say pH is lower than the normal range So it is acidosis And if the CO2 level is higher than its normal range it is respiratory acidosis Remember ROM the pneummonic for respiratory opposite metabolic equal If CO2 and pH are opposite it is the respiratory issue If bicarb and pH move together it is the metabolic issue Common AG conditions for each of them are important too Respiratory acidosis is when low in pH and high CO2 For this think hypoventilation like COPD pneumonia and sedation Respiratory alkalossis is when high in pH and low in CO2 For this think hyperventilation like panic attack fever For metabolic acidosis think DKA kidney failure diarrhea And for metabolic alkalossis when high in pH and high in by carb think vomiting excess antacid use Okay let's shift gears and talk about complete blood count CBC and coagulation studies EWBC white blood cells Normal range is 4,000 to 11,000 Low WBC high infection risk High WBC infection is present RBC red blood cells Normal range is 4.2 to 6.1 million This tells us about oxygen carrying capacity Low RBC think anemia high RBC think polyythemeia too many red blood cells Hemoglobin and hematocrit Hematocrit's normal range is 37 to 52% Low levels anemia high levels dehydration or polyythemeia platelets Normal range is 150,000 to 400,000 Low platelets means high bleeding risk That means if your patient is on heperin or aspirin you need to check those levels before giving the meds What about coagulation labs pt the proth throen time is normally between 11 to 14 seconds If you are on anti-coagulants 1.5 to two times normal we check the INR If you are on warfarin normal range INR is 0.8 to 1.2 but if you are on warfarin the therapeutic range is 2 to 3 AP is measured for Hepin The normal range is 30 to 40 seconds Therapeutic range when you are on Heperin is 60 to 80 seconds Enclelex tip for the coagulation labs If platelets are low bleeding risk is high So hold heeperin or aspirin If INR is too high warfin needs to be adjusted Always monitor these levels closely Let's now dive deep into fetal heart rate patterns stages of labor postpartum care and of course those high yield enclelex tips you need to pass Let's start with fetal heart rate patterns You might have heard of ve chop This is how we match decelerations with their causes First up variable decelerations These are caused by cord compression The baby's umbilical cord is getting squeezed So what do we do move the mom Reposition her left side right side hands and knees Whatever gets that cord free Easy fix Early decelerations Totally normal This happens because of head compression as the baby moves down No need to panic just means labor is progressing Give mom a high five because she's doing great Accelerations that's a sign of good oxygenation No intervention needed In fact we love accelerations If you see them smile and move on Now the one we don't want late decelerations This means placental insufficiency Baby isn't getting enough oxygen So what's the game plan stop ptocin reposition mom give oxygen and start IV fluids This is an emergency so act fast Quick Enclelex tip Late D cells equals B A Early D cells no worries Variable D cells move the mom Now let's talk stages of labor Knowing when to intervene is key Stage one is when dilation and contractions begin This stage has three phases First phase is the latent phase This is between 0 to 3 cm Contractions are mild and mama's chatty She's cracking jokes texting her friends Life is good Active phase is when it stretches to 4 to 7 cm Contractions are stronger and mom is now serious No more chitchat She's focused maybe breathing heavy This is where the real work begins Transition phase is between 8 to 10 cm This is intense Mom feels like she's dying She's not but it feels that way Lots of shaking nausea and yelling Totally normal When do we intervene if contractions last more than 90 seconds or are less than 2 minutes apart that's too strong This is called uterine tachycal Also if mom is pushing at 8 cm tell her to stop and breathe It's too early The stage two of the labor is pushing and birth part Mom is now fully dilated This is go time Time to push expect crowning That baby is almost here When do we intervene if mom has been pushing for hours with no progress we might need forceps or a vacuum If the baby's head delivers but the shoulders get stuck shoulder dystocia We do the McRoberts maneuver knees to chest and apply super pubic pressure Stage three of labor and delivery placenta delivery The placenta should deliver within 5 to 30 minutes after birth what's not normal If it takes longer than 30 minutes that's a retained placenta Call the provider If mom is bleeding a lot massage the fundus and give oxytocin to help the uterus contract Stage four is the recovery which is the first one to two hours postpartum This is when we watch for postpartum hemorrhage the biggest risk right now We check vitals funal height and loia every 15 minutes If the fundus is boggy soft not firm massage it asap If bleeding is excessive soaking more than one pad per hour that's bad Intervene now Postpartum hemorrhage and funal assessment What's considered postpartum hemorrhage for vaginal birth when there is more than 500 milliliters blood loss for C-section when there is more than 1,000 milliliters blood loss Priority actions for postpartum hemorrhage are important Massage the fundus first and check for bladder distension A full bladder pushes the fundus to the right Give oxytocin ptocin and if needed methine or hemabate watch for hypoalmic shock like low blood pressure high heart rate pale weak then who's at high risk for PPH with prolonged labor twins triplets big baby more than 8.8 8 pounds utterine atne like bogggy uterus n bad Okay Any cl loves funal assessment as well After birth the fundus should be at the umbilicus Then it moves down 1 cm per day By day 10 to 14 it should be back in the pelvis You shouldn't be able to feel it But what if the fundus is above the umbilicus or shifted that means mom's bladder is full have her empty it Now let's talk about some high yield meds topics heart failure Now heart failure comes in two flavors left-sided and right-sided And the best way to remember them think of L for lungs and R for the rest of the body Left-sided heart failure means the heart isn't pumping blood forward effectively so it backs up into the lungs What does that mean for our patients pulmonary congestion Symptoms include shortness of breath crackles in the lungs dispineia orthopeneia That's difficulty breathing when lying flat and the classic frothy pink sputum from pulmonary edema On the other hand right-sided heart failure backs up into the body Instead of lung symptoms we see systemic congestion Think swelling everywhere peripheral edema jugular vein distension acites and hpatomegaly which is an enlarged liver All of this is due to fluid overload Quick enclelex tip firstline medications for heart failure diuretics to pull off excess fluid and ACE inhibitors to reduce afterload and help that heart pump more efficiently Boom Simple right moving on to another critical enclelex topic strokes And let me tell you time is brain Recognizing the signs early can make all the difference So here's a quick way to remember it Fast F is for face drooping Ask the patient to smile One side might not move A is for arm weakness One arm drifts down when they try to lift both S is for speech difficulty If they're slurring their words or can't repeat a simple phrase that's a big red flag T is for time because you need to call 911 ASAP Now let's talk treatment There are two main types of strokes eskeemic and hemorrhagic Eskeemic strokes these are the most common caused by a clot blocking blood flow If caught early we can give TPA a clot busting medication but only within 3 to 4.5 hours of symptom onset And here's the key You must do a CT scan first to make sure there's no bleeding before giving tpa Hemorrhagic strokes no tpa Instead we need to focus on stopping the bleeding which could mean surgery blood pressure control and avoiding anything that could thin the blood So no aspirin no hepin no anti-coagulants All right let's switch gears to diabetes emergencies DKA and HGHS two different conditions but both serious DKA or diabetic ketoacidosis happens in type 1 diabetics and is all about acidosis Blood sugar is usually 250 to 500 plus and the key signs cousal breathing that deep rapid breathing trying to blow off acid fruity breath and metabolic acidosis The treatment IV fluids first then insulin and don't forget you need to replace potassium because insulin drives potassium into the cells which can cause dangerously low levels Now HHS or hyperosmolar hypoglycemic syndrome happens in type 2 diabetics Blood sugar is crazy high 600 or more But here's the difference No ketones no acidosis but severe dehydration and neurological changes like confusion and coma The treatment plan is similar IV fluids first then insulin but we're not as worried about acidosis like in DKA And there you have it Some of the highest yield topics you need to know for the ENCLEX Just remember heart failure L for lungs R for rest of the body stroke fast diabetes emergencies DKA is all about acidosis and ketones HHS is severe dehydration Psych is where a lot of students trip up But after today you'll know exactly how to approach these questions with confidence First things first therapeutic communication If there's one golden rule it's this Always encourage the patient to express their thoughts and feelings That's your go-to mindset when answering Enclelex questions So let's talk about what therapeutic communication actually looks like If a patient says they're feeling overwhelmed you reflect their feelings back It sounds like you're feeling really overwhelmed If they say they feel trapped you clarify When you say you feel trapped what do you mean if they're struggling to open up you use open-ended questions what has been on your mind lately and sometimes you say nothing at all Silence is powerful It gives them space to process and share more Now let's go over what not to do If you see one of these responses on the enlex do not pick it Never ask why Saying "Why do you feel that way?" comes across as judgmental Never give false reassurance Don't worry everything will be fine That just shuts down the conversation Never minimize feelings You should just try to stay positive That's dismissive Never make it about yourself I know exactly how you feel No you don't Never block communication Let's not talk about that right now That's a big red flag All right Now let's talk about schizophrenia and hallucinations Schizophrenia symptoms come in two categories Positive symptoms things added to reality like hallucinations delusions and disorganized speech Negative symptoms things that are missing like a flat affect social withdrawal and lack of motivation Now hallucinations are sensory seeing or hearing things that aren't there Delusions on the other hand are fixed false beliefs like I'm the president of the United States and paranoia That's when someone is suspicious of others like the nurses are trying to poison me So how do you respond when a patient is hallucinating first acknowledge their feelings while staying in reality Say something like "I understand that you hear voices but I don't hear them." Redirect their attention to something real Let's focus on what's happening here in the room Ensure safety If they're hearing voices ask "Are the voices telling you to hurt yourself or others?" And what do you never do never argue saying "That's not real Stop talking about it." Just shuts them down Never validate the hallucination Saying "I hear the voices too," is a big no Never encourage fixation Saying "Tell me more about the voices," just keeps them focused on the hallucination instead of reality All right Next delusions in paranoia If a patient believes something that isn't true acknowledge their feelings without arguing Say "I understand that's how you feel but let's focus on what's happening right now." Encourage reality based thinking Maintain a calm structured environment Routine equals safety What do you not do with delusions never say "That's not true." That just makes them more defensive Never ask why they believe something It feels confrontational Now before we wrap up let's go over some quick Enclelex test taking tips Safety first Always prioritize patient safety before anything else Follow ABCs airway breathing circulation unless safety is a concern For select all that apply SATA questions treat each option as true or false Don't second guessess yourself Be wary of 100% words like never always only They're usually wrong And finally your mindset matters Stay calm trust your preparation and avoid lastminute cramming A good night's sleep will do more for you than an extra 2 hours of studying You got this The Enclelex isn't about being perfect It's about being safe So go in with confidence read carefully and trust yourself Don't forget to check out our 45minut enclelex crash course notes at your nursingpace.com The same detailed notes used in this lecture to help you follow along and review the content While you're there explore all our other free guides and study notes available to support your ENLEX journey You can also check out our test bank platform Exam ASAP our advanced adaptive testing platform featuring over 5,000 peer-reviewed questions designed to mirror the INLEX experience It includes detailed ration daily content updates and a 247 AI tutor resources recognized as industry-leading and proven to enhance your performance Not only that our question bank platform has next generation enclelex question types with case studies We are adaptive and AI powered platform that allows you to pass the ENCLEX the first try With our question bank platform you are able to see the analysis of how ready you are for the ENCLEX exam with a detailed analysis based on your performance So check out our website for all those goodies And I hope this lecture helped you feel a bit more confident whether you're studying for nursing school or gearing up for the ENLEX Again I'm Mark Johnson your ENCLEX instructor here at YNS and I'll see you in the next lecture [Music]