NCLEX Overview by Amanda (BeautifulNursing.com)

Introduction

• Amanda shares her experience as a fresh nursing graduate
• Aim: Provide a comprehensive NCLEX review on YouTube
• Emphasis on NCLEX being a safety test
• Agenda includes various key nursing topics

Topics Covered

Lab Values

• Potassium: 3.5 - 5 mEq/L
• Chloride: 95 - 105 mEq/L
• Hemoglobin: Males 13 - 18 g/dL, Females 12 - 16 g/dL
• Magnesium: 1.5 - 2.5 mEq/L
• BUN: 10 - 20 mg/dL
• Calcium: 9 - 11 mg/dL
• Phosphate: 2.5 - 4.5 mg/dL
• Creatinine: 0.5 - 1.5 mg/dL
• WBC: 4,000 - 11,000 cells/mm³
• Sodium: 135 - 145 mEq/L

Critical Lab Values

• PH: < 6 or > 7.45
• Potassium: > 6
• CO2: > 60
• O2: < 60
• Platelets: < 40,000

Neutropenic Precautions

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

ABGs

• HCO3 (Bicarbonate): 22 - 26 mEq/L
• PaCO2: 35 - 45 mm Hg
• PH: 7.35 - 7.45

ABG States

• Alkalosis: High PH; causes: vomiting, suction, hyperventilation
• Acidosis: Low PH; causes: diarrhea, hypoventilation
• Symptoms of Acidosis: Bradycardia, lethargy, hypotension, coma

PPE and Safety Precautions

• Standard Precautions: Hand hygiene, gloves, gown, mask
• Droplet: Pertussis, Pneumonia, Influenza; use surgical mask
• Airborne: Measles, TB, Varicella; use N95, negative pressure room
• Contact: MRSA, VRE; use gloves, gown, hand hygiene
• PPE Donning: Gown, mask, goggles, gloves
• PPE Doffing: Gloves, goggles, gown, mask (alphabetical order)

Crutches, Canes, Walkers

• Crutches: 2 finger breadths below axilla
• Gait Types: 2-point, 3-point, 4-point, swing-through
• Stairs: Good leg up, bad leg down (heaven/hell mnemonic)

Restraints

• Types: Chemical and Mechanical
• Usage Times: <9 years - 1 hour; 9-17 years - 2 hours, >18 years - 4 hours
• Need: Informed consent, MD order within an hour if emergency

Medication Administration Basics

• IV Onset: 5-15 minutes
• SubQ/IM Onset: 35-45 minutes
• Ear Drops (3+ years): Pull pinna up and back
• Essential Rights: M.P.D.I.E.D.

Diabetes

• Type 1: Insulin-dependent, common in kids, DKA risk
• Type 2: Adult-onset, managed with diet, oral hypoglycemics
• Symptoms: Polyuria, polyphagia, polydipsia
• DKA: Treat with IV fluids, regular insulin
• Hypoglycemia: Treat with rapid carbs or glucagon
• HHS: Type 2, BG > 600, treat with hydration, insulin
• Insulin Types: Rapid (lispro/aspart), Short (regular), Intermediate (NPH), Long (lantus)
• Blood Glucose Targets: Normal: 70-110, Hospital: 140-180
• A1C: <6 normal, <8 for diabetics

OB Maternity

• Probable Signs: Goodell's sign (softening cervix), Chadwick's sign (cyanosis)
• Fundus Position: 12 weeks palpable, 22 weeks at umbilicus, after 24 weeks equals weeks of pregnancy
• Labor Stages: Stage 1 (latent 1-4 cm, active 4-7 cm, transition 8-10 cm)
• Meds: Terbutaline (slows contractions), Pitocin (induces labor)
• Complications: Placenta previa (painless bleeding), Abruptio placentae (painful bleeding), Preeclampsia (proteinuria, BP), Eclampsia (seizures), LION mnemonic (Lie, IV, O2, Notify)
• Fetal Heart Rate: 110-160, interventions (Stop Pitocin, LION)
• Fetal Positioning: LOA, ROA, knee-chest for OP
• Fundus Check Postpartum: Displaced = catheterize, Boggy = massage

Pediatric Basics

• Tetralogy of Fallot: VORP mnemonic
• Normal Bilirubin: 10-20 mg/dL, risks of kernicterus
• Developmental Milestones: 1 month (grasp), 4 months (roll front-back), 6 months (roll back-front, teeth), 8 months (sit unsupported), 9-12 months (walk), 2 years (kick ball), 3 years (run, draw circles), 4 years (use scissors)
• Supine for Infants: Prevents SIDS
• Pain Scales: Wong-Baker (3+), FLACC (2 months - 7 years)
• School-age Nutrition: 1/2 fruits/veggies, 1/4 grains, 1/4 protein, 1 cup dairy
• Medication Dosing: Usually based on weight

Pharmacology

• Toxic Levels: Lithium > 2, Digoxin > 2, Theophylline > 20, Phenytoin > 20
• Antihypertensives: Beta-blockers, ACE inhibitors, Calcium channel blockers, Diuretics
• Psychiatric Meds: Anticholinergics, SSRIs, Benzodiazepines, MAOIs
• Antidotes: Warfarin (Vitamin K), Acetaminophen (Acetylcysteine), Opioids (Naloxone), Aspirin (Sodium bicarbonate), Magnesium sulfate (Calcium gluconate), Heparin (Protamine sulfate)

Blood and IV Fluid Administration

• Blood: Compatibility check, administer within 30 minutes, infuse within 4 hours, stay with patient first 15 minutes
• IV Fluids: Isotonic (0.9% NaCl, LR), Hypotonic (0.45% NaCl), Hypertonic (3% NaCl)

Burns

• Types: Superficial, Superficial Partial Thickness, Full Partial Thickness, Full Thickness
• Higher Caloric Intake for Burn Patients

EKG Basics

• Waves: P wave (atrial depolarization), QRS (ventricular depolarization), T wave (ventricular repolarization)
• Rhythms: Sinus Tachycardia (beta blockers), Sinus Bradycardia (atropine), Atrial Flutter/Fibrillation (adenosine, beta blockers), VFib (CPR, defibrillation), Asystole (Atropine, Epinephrine)

Chest Tubes

• Re-establish negative pressure in pleural cavity
• Bubbling in water seal indicates leak
• Actions if dislodged: Apply tented dressing, monitor hourly, notify provider

Tracheostomies

• Suction PRN, not more than 10 seconds
• Sterile technique needed
• Essential bedside items: Obturator, ambu bag, O2 device, suction, trach sizes
• Actions if decannulated: Call rapid response, lay supine, provide O2

Addiction and Overdose

• Withdrawal Symptoms: Opposite of drug's effect
• Depressants: Alcohol, Benzos (Withdrawal = high HR, BP)
• Stimulants: Caffeine, Cocaine (Withdrawal = low HR, BP)
• Opioids: Hold if RR < 12; treat overdose with Naloxone

Prioritization and Delegation

• Look for most unstable patients
• Acute issues over chronic
• Rights of Delegation: Task, Circumstance, Person, Communication, Supervision

Test-Taking Tips

• Turn each answer into a true/false statement
• Opposites: Usually one is right
• Best action: Most effective intervention

Conclusion

• Encourages comments and feedback
• Hopes to help at least one person pass the NCLEX
• Emphasis on safety and proper judgment in nursing practice