Comprehensive NCLEX Review

Jun 26, 2024

NCLEX Study Guide Lecture by Amanda from BeautifulNursing.com

Introduction

  • Amanda from BeautifulNursing.com.
  • Created this guide because of lack of resources when she graduated from nursing school.
  • This guide covers essential information for the NCLEX exam.
  • The NCLEX is a safety test to ensure you are safe to practice as a nurse.

Agenda

  1. Lab Values
  2. ABGs
  3. Electrolytes
  4. Safety Precautions
  5. Casts, Traction, Crutches, Canes, Walkers
  6. Restraints
  7. Diabetes
  8. OB/Maternity
  9. Psych
  10. Pediatric
  11. Pharmacology
  12. Blood Therapy
  13. IV Fluid Types
  14. Anaphylaxis
  15. EKGs
  16. Delegation and Prioritization

Lab Values

  • Potassium: 3.5-5 (number of bananas)
  • Sodium: 135-145 (cost of a can of cola)
  • Calcium: 9-11 (emergency number)
  • Magnesium: 1.5-2.5 (Magnums for men)
  • Hemoglobin: Males: 13-18, Females: 12-16
  • WBC: 4,000-11,000
  • BUN: 10-20
  • Creatinine: 0.5-1.5
  • Phosphate: 2.5-4.5

Critical Values

  • PH: < 6
  • Potassium: < 6
  • CO2: > 60
  • O2: < 60
  • Platelets: < 40,000

Neutropenic Precautions

  • WBC < 1000 or Neutrophils < 500
  • Strict hand hygiene, no fresh fruits/vegetables/flowers, limit visitors

ABGs

  • HCO3 (Bicarbonate): 22-26
  • PaCO2: 35-45
  • PH: 7.35-7.45

Metabolic Conditions

  • Alkalosis: Excessive vomiting, suction, hyperventilation
  • Acidosis: Diarrhea (basic material lost, body becomes acidotic)

PPE and Safety Precautions

  • Standard Precautions: Hand hygiene, gloves, gown, mask
  • Droplet Precautions: Pertussis, pneumonia, influenza, rubella, mumps. Surgical mask, private room.
  • Airborne Precautions: Measles, TB, varicella. N95 mask, negative pressure room.
  • Contact Precautions: MRSA, VRE, herpes. Good hand hygiene, gloves, gown.
  • Donning PPE: Gown, mask, goggles, gloves (Big equipment first)
  • Doffing PPE: Gloves, goggles, gown, mask (Alphabetical)

Crutches, Canes, Walkers

  • Crutches: Two finger breadths below the axilla.
  • Gait Patterns:
    • Two-point: Left crutch + right foot together.
    • Three-point: Both crutches forward + weak leg, strong leg remains.
    • Four-point: Walking pattern, left crutch + right foot, right crutch + left foot.
    • Swing through: Both crutches forward, body swings through.
  • Stairs: Good leg first going up (to heaven), bad leg first going down.

Restraints

  • Usage: Only if patient is at present risk
  • Time Limits: <9 years: 1 hour, 9-17 years: 2 hours, 18+: 4 hours
  • Types: Chemical (medications), Mechanical (physical).
  • Informed consent and MD order needed.

Diabetes

  • Type 1: Keep insulin nearby, kids, ketosis.
  • Symptoms: Polyuria, polyphagia, polydipsia
  • Treatment: Diet, insulin, exercise
  • Type 2: Adult onset, insulin resistance.
  • Treatment: Diet, oral hypoglycemics (Metformin), activity
  • Complications: DKA (Type 1), HHS (Type 2), Hypoglycemia.
  • Insulin Types: Rapid (Lispro, Aspart), Short (Regular), Intermediate (NPH), Long (Lantus)
  • Blood Glucose Norms: 70-110, A1C < 6%

OB/Maternity

  • Probable Signs: Goodell sign, Chadwick sign
  • Fundus Location: 12 weeks (palpable), 22 weeks (umbilical), 24 weeks (height matches weeks)
  • Quickening: 16-20 weeks
  • Stages of Labor:
    1. Latent: 0-4 cm
    2. Active: 4-7 cm (24/7 mnemonic)
    3. Transition: 8-10 cm
  • Common Complications: Placenta Previa, Abruptio Placenta, Preeclampsia, Eclampsia.
  • Tocolytics: Terbutaline (slow labor).
  • Oxytocin: Induce labor, treat postpartum hemorrhage.
  • Fetal Heart Rate: 110-160
  • Lion Mnemonic: Lie on side, Increase IV fluids, Oxygen, Notify provider.

Psych

  • Major Disorders: Major depression, schizophrenia, bipolar.
  • Therapeutic Communication: Acknowledge feelings, present reality, set limits.
  • Dementia vs. Delirium: Dementia (gradual), Delirium (acute, often due to infections).

Pediatric

  • Tetralogy of Fallot: VORP (Ventricular Septal Deviation, Overriding Aorta, Right Ventricular Hypertrophy, Pulmonary Outflow Tract Obstruction).
  • Milestones:
    • 1 month: Grasp reflex
    • 4 months: Roll front to back
    • 6 months: Roll back to front, teeth
    • 8 months: Sit unsupported
    • 9-12 months: Walk
    • 2 years: Kick ball.
  • Pain Scales: Wong-Baker Faces, FLACC

Pharmacology

Toxic Drug Levels

  • Lithium: > 2
  • Digoxin: > 2
  • Theophylline: > 20
  • Phenytoin: > 20

Common Medications

  • Antihypertensives: Beta blockers, ACE inhibitors, calcium channel blockers
  • Psychiatric: Anticholinergics, Benzodiazepines, SSRIs.
  • Antibiotics: Aminoglycosides (ototoxicity, nephrotoxicity), Rifampin (turns fluids orange)
  • Emergency Drugs: Nitroglycerin, Epinephrine.
  • Diuretics: Reduce fluid overload.
  • Insulin: Rapid, short, intermediate, long.
  • Blood Administration: Verify with second nurse, stay with patient for first 15 minutes.

EKGs

  • Sinus Tachycardia: Beta blockers, calcium channel blockers, cardioversion
  • Sinus Bradycardia: Atropine, pacemaker
  • Atrial Flutter: Adenosine, beta blockers, calcium channel blockers, cardioversion
  • Atrial Fibrillation: ABCDs (Adenosine, Beta blockers, Calcium channel blockers, Digoxin)
  • Ventricular Tachycardia (V-tach): Amiodarone, epinephrine, defibrillation
  • Ventricular Fibrillation (V-fib): CPR, defibrillation
  • Asystole: Atropine, epinephrine

Delegation and Prioritization

  • Stable vs. Unstable: Prioritize unstable patients.
  • Unexpected Issues: Hemorrhage, high fever, hypoglycemia, no pulse.
  • Delegation Rights: Task, Circumstance, Person, Communication, Supervision
  • Tasks Not Delegable to LPN/UAP: Hanging IV, blood products, assessments, initial teaching.