Transcript for:
NCLEX Review Highlights

[Music] All right, future nurses. Welcome to the ENCLEX Ultimate Crash Course. I'm Mark Johnson, your ENCLEX guide here at YNS. And my goal is simple, to help you pass this exam with confidence. This is a high yield, no fluff review covering the most important topics you need to know for the ENLEX. We will first review key lab values, acid base imbalances, and electrolytes imbalances so you never second guessess them on test day. Then we'll start with test taking strategies, including how to break down tricky questions and tackle SATA like a pro. Next, we'll dive into prioritization and delegation, showing you how to pick the right patient first. We'll also go over must know meds, covering insulin and high alert drugs that often trip students up. From there, we'll break down cardiac, respiratory, neuro, endocrine, and renal emergencies, making sure you can recognize and respond to critical conditions fast. We'll also touch on maternal, pediatric, and peroperative nursing, reviewing essential newborn care and pre and posttop priorities. Then, we'll finish strong with infection control, safety, and final ANLEX tips, including pneumonics and test strategies to keep you calm and confident. And if you want to follow along this lecture with detailed notes, check out your nursing space link in the bio for our ultimate enclelex mastery study guides designed to make everything click. So if you're ready to crush the enclelex, let's dive in. Okay, we will first talk about acidbased balance interpretation. One of the enlex's favorite topic. While a lot of people get stuck on this topic easily, but don't worry if this sounds tricky at first. I'm going to walk you through it step by step from the basics to compensatory and uncompensatory states. We'll use some simple pneummonics, tricks and tips to make it stick. Plus, I'll throw in examples and then we'll cover causes, signs, symptoms, and management. By the end, you'll feel like a pro. Ready? Let's get started. First, let's talk about what acid base balance even means. Your body likes to keep its pH between 7.35 and 7.45. That's the sweet spot. Too acidic, below 7.35, and you've got acidosis. Too basic, above 7.45, and it's alkyossis. Two main players control this. Your lungs, which handle carbon dioxide, and your kidneys, which manage bicarbonate. Carbon dioxide is an acid, and bicarbonate is a base. Simple, right? Lungs blow off acid. Kidneys hold on a base. Keep that in mind. It's the foundation. Now, how do we figure out what's going on in a patient? We use arterial blood gas results or ABG for short. You'll look at three key numbers. PH value, partial pressure of carbon dioxide, and bicarbonate. Here's the step-by-step trick to interpret them. I call it the three look method. Look at PH first, PIC2, then by carb. Let's break it down. Step one, check the pH. Is it below 7.35? That's acidosis. Above 7.45, that's alkalossis. Between 735 and 745, it's normal. But hang on, there might be compensation hiding there. We will revisit the compensation part in the later part of this section. But first, let me give you an example. Let's say pH is 7.30. That's low. So, we're dealing with acidosis. Easy so far. Step two, look at PA2. Normal is 35 to 45 mm of mercury. If it's high, like 50, the lungs aren't blowing off enough carbon dioxide, so it's a respiratory problem. If it's low, like 30, the lungs are working overtime, and that's a clue for something else. In our example, let's say Pa CO2 is 55. High means respiratory acidosis. The lungs are the issue here. Step three, check by carb. Normal is 22 to 26 mill equivalents per liter. If it's high, like 30, the kidneys are holding extra base. If it's low, like 18, they're losing it. If it is still tricky for you, here's a pneummonic to lock this in. Remember, roam, respiratory opposite, metabolic equal. For respiratory issues, pH and pa2 move in opposite directions. For metabolic issues, pH and by carb move together in equal direction. Say it with me. R O M E. It's your cheat code. Let's try an example. pH is 7.50, CO2 is 30, and by carb is 24. Step one, look at your pH. pH is higher than normal range 7.45. So it's alkalossis. Step two, you look at CO2 level and it is lower than normal range 35 to 45. PH is high and CO2 low and you remember respiratory opposite from Rome. So it is respiratory alkyossis. So that means the lungs are blowing off too much carbon dioxide. Let's try another example. So pH is 7.20 which is low. So it is acidosis. Then CO2 is 38 which is normal. Bicarb is 18 which is low. So remember metabolic equal from Rome. PH is low and by carb is low which is the equal pattern. So it is metabolic acidosis. Now what about compensation? Simple analogy here. Think of AG compensation like a team trying to fix a mistake. Fully compensated means the other system has completely fixed the problem. And this is when the pH is in the normal range 7.35 to 7.45. Uncompensated on the other hand means the other system is doing nothing to fix the problem. Partially compensated means the other system is trying but the problem isn't fully fixed yet. So in here if the lungs mess up the kidneys step in and vice versa. Let's try some examples. PH is 7.35 CO2 is 55. Bicarb is 30. PH is normal but it is in the lower side of the normal range as it is lower than 7.4. So it is normal but acidic. CO2 level of 55 is higher than 45. So, pH is low and CO2 is high. They are opposite respiratory opposite. Therefore, it is respiratory acidosis. But because pH is within the normal range, it is fully compensated. Normal pH but abnormal CO2 and by carb means compensation's at play. But if the pH is abnormal and one of the other two CO2 and by carb values are abnormal causing the problem, then it is uncompensated. The other value is normal, which means it hasn't tried to fix it yet. It's like the lungs or kidneys haven't stepped in to help yet. It's like a fire starting, but no one has called the firefighters yet. And if pH is abnormal, meaning the problem is not fully fixed, and both CO2 and by carb are abnormal, meaning the other system is trying to fix it, but hasn't fully corrected it yet. It's like firefighters showing up to a fire, but the fire is still burning. And it's when all of these three values are abnormal, and this is called partially compensated. Let's practice one more example. pH 7.25, CO240, bicarb 18. pH is low so it is acidosis and it is abnormal as it is less than 7.35 so it is not fully compensated next CO2 is normal so the lungs are fine then by carb is low so the kidneys lost base and so metabolic equal which means it is a metabolic acidosis but because CO2 is normal it is uncompensated metabolic acidosis all right now let's shift gears what causes these imbalances Respiratory acidosis comes from anything slowing breathing aka under ventilating. Think COPD, pneumonia or drug overdoses like opioids. Respiratory alkalossis is hyperventilation like panic attacks, pain or high altitude. What about metabolic acidosis? It's anything non-respiratory related except vomiting. So like kidney failure, diarrhea or diabetic ketoacidosis, DKA for short, metabolic alkyossis is basically vomiting, meaning too many antacids. Enclelex tips and tricks here. If you are not sure what it is and it is not respiratory, then choose metabolic acidosis. Higher chance to get it right. Signs and symptoms depend on the problem. Remember this key concept. As the pH goes, so does my patient. So as pH goes up your patient goes hyper while as pH goes down so does your patient except potassium. So for any acidosis whether respiratory or metabolic your pH is going down which means your patient goes down too leading to their heart rate go down blood pressure go down lethargic and constipated. But for potassium it is opposite so you experience hypercalemia. What about alkalossis? Alkalossis means your pH goes high meaning your body goes high too which means you experience symptoms like tacic cardia tacupneia hypotension and seizure except potassium which goes opposite so hypocalemia management is where it gets practical for respiratory acidosis fix the breathing they are under ventilating so oxygen and ventilators if needed if patient is experiencing respiratory alkyossis they are hyper for ventilating so slow the breathing. Paper bag trick for panic attacks work sometimes. How about metabolic acidosis? You got to treat the cause. Give insulin for DKA and fluids for diarrhea. What about metabolic alkalossis? They are losing fluids from vomiting. So replace fluids and electrolytes. So give IV saline. Always treat the root problem, not just the numbers. And let's shift the gear into electrolyte imbalances. Enclelex loves to ask you about these questions because those sneaky little shifts can throw a patient off balance. We'll cover the signs, symptoms, and how to manage them, plus some Enclelex hacks to make this stick. I'll throw in a couple of practice questions, too, so you can test your skills. Let's dive in and make this as painless as possible. First off, electrolytes are like the body's electricians. Potassium, calcium, magnesium, sodium. They keep things running smoothly. When they're out of whack, you'll see patterns in the symptoms and management. Here's the deal. The earliest sign of any electrolyte imbalance is numbness and tingling, also called paristhesia. Picture your patient saying their fingers or lips feel buzzy. That's your red flag. Another big one, muscle weakness or parasis. It shows up with all imbalances, so keep an eye out. With that being said, let's break it down by electrolyte. Starting with potassium are calm. Normal potassium is 3.5 to 5. Too high is hypercalemia. Too low is hypocalemia. Here's a trick for enclelex. Potassium follows the prefix except for heart rate in urine output. So hypercalemia means high energy like muscle cramps, restlessness but low heart rate and low urine output. Hypocalemia is the opposite. So everything is low like lethargy, weak muscles except heart rate and urine output. So high heart rate and more urine output. Memorize that exception. This is enlex's favorite. Next up, calcium are calcas. Normal is 8.5 to 10.5. Here's the tip. Calcium does the opposite of the prefix. Hypocalcemia, low calcium, means overexited nerves and muscles. Think twitching, cramps, even spasms in the throat. Hypercalcemia, high calcium, slows things down. Lethargy, weak reflexes, constipation. Opposite of the prefix, lock that in. Magnesium follows the same rule, opposite of the prefix. Normal is 1.5 to 2.5. Hypomagnesmia revs things up. Tremors, seizures, fast reflexes. Hypermagnesmia calms it down. Drowsiness, slow breathing, weak muscles. Same as calcium, just flipped from what you guess. Sodium's a little different. It ties to fluid status. Normal is 135 to 145. Hyponetriia, which is low sodium, means fluid volume overload. Think swollen, confused patients, maybe seizures if it's bad. Hyperremia, which is high sodium, means dehydration or fluid volume deficit. They're thirsty, dry, and irritable. Sodium is all about water balance. Now let's prioritize. Hyperc calmia is your top concern as it can stop the heart cold with those peak T- waves on the ECG. Assess early. So like early signs like paristhesia or muscle weakness are your clues something's up. You have to intervene smart like fix the imbalance but watch for complications. Potassium messes with the heart. This is number one electrolyte imbalances you have to prioritize. Okay. What about management? It depends on the type of imbalance. For hypoc calmia, obviously you should give potassium chloride PO or IV, but make sure you are giving it slow if given through IV. Also, don't forget to monitor the heart first. Hyperc calmia too much K. Giveate K exit late will remove potassium from the system. Also, you can give insulin with glucose and maybe calcium gluconate to protect the heart. What about hypocalcemia? It definitely needs calcium. Give it through IV if it's urgent. Oral if it's mild. Hypercalcemia, flush it out with fluids and diuretics. Magnesium's similar to calcium treatment. Replace it for low, dilute it for high. What about sodium? For hyponetriia, you should restrict fluids or give hypertonic saline if severe. Hyperremia needs slow rehydration to dilute the fluid. All right, let's try an ENLEX style question. A client with heart failure is on furmide lasix and the nurse sees muscle weakness, irregular heartbeats, and a potassium of 2.8. What's the first action? Options: A, encourage potassium richch foods. B, give potassium chloride as prescribed. C, place the client on a cardiac monitor. D, hold the next dose of Lasix. Pause and think. What's your pick? The answer is C. Place the client on a cardiac monitor. Here's why. 2.8 is dangerously low. Hypocalemia can trigger deadly arrhythmias. Monitoring the heart is priority one for safety before you replace potassium. Foods won't fix it fast enough. And giving potassium comes after you've assessed the risk. Smart move, right? One more. A nurse assesses a client with hypocalcemia. Which finding needs action now? A. Positive truso sign. B. Numbness and tingling around the mouth. C. New onset of luringial strider. D. Muscle cramps in the legs. What's your gut say? It's C. Lingial strider. Low calcium overexites nerves and muscles. And strider means the airway spasming. That's life-threatening. Trusos and tingling are classic signs but not urgent. Strider, you act fast to keep them breathing. So, here's your takeaway. Memorize the patterns. Potassium follows the prefix except heart rate and urine output. Calcium and magnesium go opposite. Sodium tracks fluids. Spot paristhesia early. Prioritize hypercclemia and intervene with safety first. All right, let's dive into the test taking strategies, which is the most important topic of our ultimate onlex mastery guide. And this is the number one type of questions and tricks that you need to master before sitting for the board exam. This stuff is gold for cracking those tricky ENLEX questions. I mean, the ENLEX can feel like a total brain teaser sometimes, but no stress anymore. We've got some awesome tools like the ABCs, Maslo's hierarchy, and a few clever tricks up our sleeve to make it so much simpler. We're going to nail things like prioritizing patients, ace those select all that apply questions, and break down even the toughest scenarios. First up, let's talk about high yield test taking strategies, starting with the ABCs: airway, breathing, circulation. This is your go-to framework for emergencies. Always prioritize airway issues first, like if someone's got an obstruction, they're choking, or maybe it's anaphilaxis. Next, check breathing. Think respiratory distress, low oxygen levels, or trouble ventilating. Then circulation. Deal with stuff like bleeding, shock, or cardiac arrest. If a scenario throws multiple problems at you, stick to this order. Airway, breathing, circulation, unless the question says otherwise. For example, in a trauma case, if a patient's airway is blocked with blood or debris, you clear that first, even if they're losing blood fast. The ABCs are huge in emergency and critical care. It's how nurses and providers tackle life-threatening stuff step by step. Now, let's shift gears to Maslo's hierarchy. This one's all about prioritizing patient needs based on a pyramid. Starting with the basics at the bottom, you've got physiological needs. Oxygen, water, food, bathroom stuff, sleep. Those come first, no question. Once those are handled, move to safety and security. Think preventing falls, controlling infections, keeping things stable. After that, you can address love and belonging like support systems or social vibes. Then self-esteem, coping skills, body image, and finally self-actualization like personal growth or hitting goals. The rule here is physiological needs trump everything. Safety comes second and psychosocial stuff like anxiety or feelings waits until the lower needs are met. Picture this. A dehydrated patient gets IV fluids before you chat about their hospital jitters. Makes sense, right? Next, let's hit the nursing process. ADPI. That's assessment, diagnosis, planning, implementation, evaluation. It's your systematic roadmap for patient care. Step one is always assessment. Gather data like vitals, symptoms or lab results. Both what you see and what the patient tells you. Then diagnosis. Figure out nursing problems like impaired gas exchange or risk for infection. Planning comes next. Set goals that are specific, measurable, and doable. You know, smart goals. Implementation is where you act. Give meds. Do treatments. Finally, evaluation. Check how it went and tweak the plan if needed. Assessment kicks it all off unless it's a dire emergency like cardiac arrest. In that case, you might jump to CPR first, but you still assess right after to guide the next steps. For example, if a patient's got chest pain, you check vitals and symptoms, diagnose acute pain, plan oxygen and meds, carry it out, and see if the pain eases up. Okay, now let's tackle those select all that apply questions, SATA for short. These can trip you up if you're not careful. First trick, read the stem, the question itself, super carefully. Figure out exactly what it's asking. Correct actions, wrong ones, or maybe symptoms. If you misread it, you're toast. Then evaluate each option on its own, like a true or false statement tied to the question. Don't assume the choices connect unless it's spelled out. Say the question is select all that apply signs of dehydration. You'd check dry mucous membranes. True and increased urine output, false separately. Another tip, trust your gut. Overthinking can make you flip a right answer to a wrong one. If something clicks with what you know, go for it unless you're dead sure it's off. With SATA, you might have two to six right answers. So, don't just pick one and stop. Keep going through all the options. Let's move to next generation enclelex strategies, NGN. This version loves case studies, unfolding scenarios, and funky formats to test your clinical judgment. Watch for key words like acute, meaning sudden and severe versus chronic, which is long-term. Stable versus unstable, also hints at priority. An acute issue usually beats a chronic one. In case studies, track trends, vital signs, symptoms, labs. If a patient's temp is climbing or oxygen's dropping, that's a red flag. Use your clinical judgment by walking through AD PI in your head, assess. Identify the issue. Pick the right interventions. For instance, if oxygen saturation falls from 95% to 88% over 4 hours, you'd prioritize oxygen over passing routine meds. All right, let's apply this to some examples. Here's one. A nurse is assessing a patient with hypoalmic shock. Which interventions come first? Options are A. Apply oxygen. B. Establish large bore IV access. C. Initiate IV fluid resuscitation. D. Obtain consent for a blood transfusion. E. Place the client supine with legs elevated. The correct answers are A, B, C, and E. Oxygen boosts circulation. IV access and fluids tackle lost volume and positioning helps profusion. All ABC priorities. Consent for a transfusion is important, but stabilizing the patient comes first. Here's another. A nurse is prioritizing care for multiple clients. Which ones need assessing first? Options: A, a posttop patient with sudden shortness of breath and chest pain. B, an asthma patient with absent breath sounds. C. A patient with a deep laceration actively bleeding. D. A patient with a fever of 101.2 degrees Fahrenheit and body aches. E. A heart failure patient with worsening dispnnea. The correct answers are A, B, C, and E. These all tie to ABC issues. Possible pulmonary embolism, airway obstruction, bleeding, and respiratory failure. The fever in D is worrying, but it's not an immediate life threat like the others. So, there you go. These strategies, ABCs, Maslo's, ADPI, SATA tricks, and NGN tips are your secret weapons. They'll help you cut through the enclelex chaos and come out on top. Before we dig further into other important topics, make sure you know all the normal and critical values of vital signs, BMP numbers, CBC, PTT, PT, INR, tropponin, and electrolytes. If you haven't studied on those yet, refer to our full enclelex ultimate mastery guide on our website for the complete list of what you must know for ENLEX success. All right, everyone. Let's dive into prioritization and delegation because these are absolutely essential skills not only for passing the INLEX, but also for succeeding as a nurse in real world situations. Why are they so important? Well, imagine you're working a busy shift with a full patient load and limited time, and you need to decide who needs your attention first and what task you can pass off to someone else. It might sound overwhelming at first, but don't worry because I'm going to break it all down step by step with some simple tricks, Inlex friendly strategies, and a few practice questions at the end so that everything clicks into place. So, let's get started with prioritization, which is all about figuring out who you see first. The golden rule here is that ABCs come first. Airway, breathing, circulation. And it's critical to remember this. If a patient can't breathe, then nothing else matters. So, let's walk through how this works. Airway is always your top priority. And if it's blocked, perhaps because the patient is choking or you hear a high-pitched strider sound, it becomes an emergency and you need to act immediately by suctioning or even assisting with intubation if necessary. Next comes breathing. And if a patient is struggling, maybe gasping or showing low oxygen saturation levels, you'll need to provide oxygen, or perhaps set up a BiPAP to help them out. Then there's circulation, which is just as vital, and you're looking for signs like low blood pressure, weak pulses, or significant bleeding because these indicate the body isn't getting enough oxygen rich blood. So, you might need to start IV fluids or perform CPR in severe cases. For the ENLEX, there's a handy trick. Watch for keywords like sudden, acute, severe, or unstable. Because when you spot those, it's a clear signal that this patient needs you first since unstable patients always take priority over stable ones. Now, here are some priority rules to lock in. ABCs always come first. So, breathing issues outrank everything else. Acute conditions beat chronic ones, meaning sudden chest pain is more urgent than stable hypertension. Fresh posttop patients, especially within the first 12 hours, outrank stable patients due to their higher risk. Unexpected changes beat expected ones. So, sudden confusion after surgery needs attention before mild incision pain, and actual problems beat potential risks, meaning active bleeding trumps a risk for a clot. A quick way to remember this is ABC's acute, fresh, unexpected. Say that a few times and it'll stick. But what if the ABCs aren't obvious? That's when Maslo's hierarchy becomes your backup plan. And it tells us physical needs come first. So if a patient can't breathe or stay conscious, that's where you focus. Physiological needs like oxygen and fluids top the list, followed by safety concerns like fall risks or infections. and only later do you address emotional needs like belonging or self-esteem because survival trumps feelings every time on the enclelex. Now, let's shift to delegation because you can't do everything yourself and nursing relies on teamwork with RNs, LPNs, and UAPs, each with specific roles. Registered nurses handle unstable patients, perform initial assessments, give IV meds like blood transfusions, and provide new patient education. LPN's care for stable patients with predictable conditions, administer most oral meds, but not IV pushes, and reinforce teaching after the RN starts it. UAPs focus on basic care like bathing, feeding, and taking vitals on stable patients. A simple trick is this. RNs think, LPN's do, and UAPs help. So, keep that in mind when delegating. Avoid mistakes like assigning UAPs to assess or LPNs to handle unstable patients. And remember, RNs are accountable for what they delegate. Sometimes you'll face staff issues, too. So, if someone's acting illegally, like stealing meds, report it immediately. Or if they're unsafe, like giving wrong IV meds, step in and fix it. But if it's just unprofessional behavior, handle it later after ensuring patient safety. Now, let's test this with practice questions. First, who do you see first? A post-top patient with seven out of 10 pain, a pneumonia patient with 91% oxygen saturation, a heart failure patient with leg swelling, or an asthma patient with wheezing and a respiratory rate of 32? The answer is the asthma patient because wheezing and a high respiratory rate signal an ABC emergency, outranking pain, low but stable oxygen, and expected swelling. Second, what do you delegate to a UAP? Listening to lung sounds, giving oral meds, feeding an Alzheimer's patient, or performing wound care? It's feeding because UAPs handle basic tasks while the others require higher training. Here's a third one. a diabetic patient with a blood sugar of 50, a patient awaiting discharge teaching, a posttop patient with a fever, or a patient with mild nausea. Who's first? It's the diabetic because low blood sugar is an acute physiological threat. Imagine you're on a night shift and a patient suddenly drops their oxygen sats to 88% while another asks for pain meds. ABCs tell you to grab the oxygen first. So your takeaways are ABC's first then acute fresh unexpected. RNs think, LPN's do, UAPs help, and always protect the patient first. You've got the tools now to ace the Enclelex and shine as a nurse. So trust yourself and go make a difference. Let's practice some questions on the priority and management topic. The question is, a nurse receives a report on the following four clients. Which client should the nurse assess first? A. A client with a history of COPD with an oxygen saturation of 91% on room air. B. A client who had a total knee replacement and is requesting pain medication. C. A client with a post-operative appendecttomy who has a fever of 38° C. D. A client with newly diagnosed atrial fibrillation with a heart rate of 140 beats per minute. The correct answer is D. A client with newly diagnosed atrial fibrillation with a heart rate of 140 beats per minute. This client is experiencing tacic cardia with new onset atrial fibrillation which could lead to complications such as stroke, heart failure or hemodynamic instability. This is a priority. Option A. COPD clients often have baseline lower oxygen saturation which is between 88 to 92. No acute distress noted. Option B, pain control is important but not life-threatening. Option C, a low-grade fever posttop is expected due to inflammation and does not indicate immediate danger. Next question. A charged nurse is delegating tasks to a team of nurses. Which task should the charge nurse delegate to a licensed practical nurse? A. Administering IV pain medication to a posttop client. B. Teaching a newly diagnosed diabetic client how to inject insulin. C. Monitoring a client with pneumonia for respiratory distress. D. Obtaining a urine sample from a client with suspected UTI. The correct answer is C. Monitoring a client with pneumonia for respiratory distress. LPNs can monitor stable patients and report changes but cannot assess, diagnose, or evaluate. Option A, fourth pain meds, requires RN supervision due to the potential for rapid side effects. Option B, teaching a diabetic client, involves new education, which is only within the RN scope. Option D, urine sample collection, can be delegated to a UAP since it is a non-complex task. Last question. A nurse is working in the emergency department and receives four clients simultaneously. Which client should the nurse see first? A. A 30-year-old with asthma who reports mild shortness of breath but is speaking in full sentences. B. A 45-year-old with chest pain radiating to the left arm and diapharesis. C. A 22-year-old with a laceration to the forearm actively bleeding but controlled with pressure. D. A 55year-old with nausea, vomiting, and a history of diverticulitis. The correct answer is B. a 45-year-old with chest pain radiating to the left arm and diapharesis. Chest pain with radiation and diapharesis is highly suspicious for an MI and requires immediate intervention. Option A, asthma with mild sob and full sentences suggests stability. Option C, bleeding is controlled, so this client is not in immediate danger. Option D, nausea and vomiting may indicate GI issues, but this is not a priority over potential cardiac issues. All right, now let's talk about some pharmarmacology stuff that's going to save your bacon on the enclelex. And out there in the real world when you're a nurse juggling a million things at once, pharmarmacology can feel like a monster under your bed at first, right? All those names and numbers. But don't sweat it because we're going to chop it up into bite-sized pieces with examples and little memory hacks. And by the end, you'll be like, "Oh, I totally got this." So, let's kick things off with insulin types because managing blood sugar is like the superhero duty of nursing. And the Enclelex loves throwing curveballs about it. Insulin's all about timing, like when it kicks in, when it's doing its big show, and when it finally clocks out. And trust me, the Enclelex is obsessed with testing. if you've got this down because if you mess up the timing in real life, your patients sugar could go haywire. Picture insulin like a relay race with different runners. Okay? You've got the speed demons who sprint out of the gate, the steady joggers who pace themselves, and the marathon champs who just keep trucking all day long. And that's how we're going to break it down. First up, rapid acting insulin. Think Lispro, aspart, glucosine. And this stuff is fast. Like Usain Bolt fast, starting in about 15 minutes, hitting its peak at one to two hours and hanging around for three to five hours total. It's your meal buddy. So you give it right before someone chows down. Imagine you're at a diner, burgers on the way, and boom, rapid acting insulin's there to tackle that sugar spike from the fries and soda. My little trick to remember it. Rapids ready in 15. It's like, hey, food's here in 15 minutes. Let's get this insulin party started. Next, we've got short acting insulin, which is regular insulin like Humlain R or Novalin R. And this one's a bit more chill. It starts in 30 minutes, peaks at 2 to 4 hours, and lasts 5 to 8 hours. So, it's still good for meals, but needs a head start, like giving it before the appetizers hit the table. What's cool about regular insulin is it's the only one you can shoot through an IV, which is a lifesaver in emergencies like diabetic ketoacidosis, DKI, when sugar's through the roof and you need to act fast. Stick this in your head with regular runs 30. It's like, give me 30 minutes to warm up, then I'm ready to roll. The Enclelex might try to trip you up here, asking if you'd give it four or not. So, keep that in your back pocket. Moving along, let's talk intermediate acting insulin NPH, which sounds fancy because it's neutral proamine hagodorn, but it's just a middle-of the road guy, starting in 1 to 2 hours, peaking between 4 and 12 hours, and sticking around for 12 to 18 hours. You'd use this twice a day to keep sugar steady between meals or overnight, like a trusty babysitter watching the levels while you're off duty. I like to say M PH needs patience because it's not rushing in like rapid. It's more like Hold on. I'll get there. Just give me a couple hours. Oh, and heads up, it's cloudy, so you roll it gently like you're kneading dough, but don't shake it up like a soda can because that messes it up. And the Enclelex loves asking about that little detail. Then we've got the long acting crew. Glarene data mayor Degludek and these are the marathon runners starting in two to four hours. No peak because they're super chill and steady and lasting over 24 hours. So you just dose it once a day and it's like a security blanket keeping sugar stable all day and night. Think long lasts all day while and here's the biggie. Don't mix it with other insulins in the same syringe because it's a lone wolf and likes its space, which is another inclelex trap to watch for. All right, quick heads up. Hypoglycemia is the sneaky villain with all insulins, and it shows up with sweat, shakes, and confusion. So, I always say, "Cold and clammy, grab some candy." You fix it with 15 grams of carbs, juice, glucose tabs, then check the sugar again in 15 minutes. And the danger zones are peak times like 1 to two hours for rapid 4 to 12 for MH cuz that's when sugar can crash like a bad stock market day. So keep your eyes peeled. Now, let's switch lanes to blood thinners because Heperin and Warfaren are like the Batman and Robin of clotbusting, but they've got totally different vibes, and you need to know their quirks inside out. Heperin's the fast one given IV or under the skin. And it kicks in within minutes to hours, perfect for emergencies like deep vein thrombosis, pulmonary embolism, or keeping clots away after surgery. and you track it with a PTT, aiming for 60 to 80 seconds to keep it in the sweet spot. If it goes overboard, protein sulfates your rescue squad and I remember it with H for haste because Hepin's like, "I'm here. I'm fast. Let's stop that clot now." But watch out. Enclelex might toss in hepin induced thrombocytoenia or hit where platelets tank below 100,000 and that's a red flag to stop it cold because it's rare but nasty. Then there's warfaren the slowpoke you take by mouths and it takes days to get going. So it's for long-term gigs like atrial fibrillation, fake heart valves or chronic DVT and you monitor it with Indian rupees shooting for two to three. Vitamin K is the fix if it's too high. And I go with W for weight because warfare and all chill. I'll get there eventually. Fun fact, tell patients to ease up on spinach and kale because too much vitamin K from those greens can throw off the INR. And the Enclelex loves that diet question like, "Hey, your patient's INR is low. What's up?" Picture this. A patient's on Hepin. APTT hits 95 seconds. Way too high. So, you stop the drip, call the doc, and grab proamine. And that's real life nursing right there. Okay, let's talk IV fluids because they're like the hydration superheroes fixing all kinds of messes. Too little fluid, too much, or just sloshing around where it shouldn't be. And picking the right one's a game changer. So, let's make it fun. Hypotonic fluids. Think 0.45% sodium chloride, 0.225% 225% or D5W are the ones that shove water into cells, making them puff up. And they're great for dehydration, high sodium levels, or DKA after the first round of fluids. And I say hypo equals hippo because those cells swell like a big old hippo waddling around, which is goofy but sticks in your head. Isotonic fluids like 0.9% sodium chloride, lactated ringers or D5W before it breaks down stay right in the bloodstream pumping up volume for stuff like blood loss, trauma or burns. And it's iso equals I stay because it hangs out in the veins like I'm not going anywhere. I've got you covered. Then hypertonic fluids 3% sodium chloride 5% D5NS yank water out of cells shrinking them down and therefore low sodium or brain swelling and it's hyper shrinks because those cells shrivel up like raisins and it's weirdly satisfying to picture. The enlex might go patients sodium is 120 too low. What fluid do you pick? and you'd snag hypertonic, but you'd watch it like a hawk because overdoing it no joke. Now, blood transfusions. Oh boy, this is where you're the gatekeeper keeping things safe because it's a big deal with lots of steps. So, let's walk through it like we're prepping for a mission. Before you even start, double check the patient with two IDs, name, birthday, whatever, because mixing up blood is a disaster movie waiting to happen. Then, confirm the blood type in cross match. Use a chunky 18 or 20 gauge IV so it flows smooth and grab baseline vitals because if they're feverish or tanking already, you're not starting until the doc says go. When you're giving it, start slow 2 milliliters per minute for 15 minutes because that's prime reaction time and you're like a hawk eyeing everything. Then wrap it up in 4 hours max since blood's picky and spoils fast. and check vitals before at 5:15 30 minutes hourly and an hour after. Easy to recall with 51531 like a countdown to safety. Reactions stop fast. Hemolytics fever, chills, back pain so flush with saline and yell for help. Febral's attempt jump and chills so pause and call. Allergics rash and itching so antihistamines if it's chill. Tr's breathing trouble. So oxygen fluid overloads crackles so slow it down. My trick st transfusion tubing change open saline phone provider like a little dance move for your brain. Let's try some practice to lock this in because doing it is how you own it. First patient gets rapid acting insulin before lunch. 2 hours later they're sweaty, shaky. What's up? What do you do? Hypoglycemia because it's peak time. So 15 grams of carbs, juice, candy, recheck in 15 and bam, you're a hero. Second warfare and patients INR is four. Too high. Now what? Hold it. Call the doc. Prep vitamin K because bleeding's knocking at the door and you're on it. Third blood transfusion patient gets fever and chills at 10 minutes. What's the move? Stop new tubing, saline. Call the provider. It's federal and STOP saves the day because those first 15 minutes are clutch. Let's start exploring several critical medical surgical topics. Starting with an in-depth look at the cardiac system because cardiac emergencies and congenital heart disease are essential areas that frequently appear on exams. Today, we'll examine heart failure by comparing left-sided and right-sided presentations. And then we'll move on to discuss coronary artery disease often abbreviated as CAD followed by myocardial inffection commonly known as MI which is a pivotal emergency condition you'll need to understand thoroughly. First let's tackle heart failure a condition where the heart simply cannot pump blood effectively as it should. Understanding the distinction between left-sided and right- sided heart failure is absolutely crucial because their symptoms and implications differ significantly. When we talk about left-sided heart failure, we're focusing on a weakened left ventricle and as a result, blood backs up into the lungs causing a cascade of respiratory issues. You'll notice patients experiencing shortness of breath, and when you listen to their lungs, you might hear crackles, which are those wet, popping sounds indicating fluid buildup. In severe cases, they could even cough up pink, frothy sputum, which is a classic sign of pulmonary edema and a major red flag that demands immediate attention. Patients often find it easier to breathe when sitting upright, a position known as orthopeneia, because lying flat worsens their struggle. For example, imagine a patient who's gasping for air with oxygen saturation levels dropping to 88% and their lungs sounding distinctly wet during oscultation. That's a textbook case of leftsided heart failure loudly signaling for intervention. On the other hand, right-sided heart failure occurs when the right ventricle struggles to pump blood forward and consequently blood pulls back into the systemic circulation affecting the body as a whole. This leads to noticeable swelling or edema typically in the legs, ankles, and sometimes even the abdomen where it's called acetis. You might also observe the jugular veins bulging, a condition referred to as jugular vein distension or JVD, and the liver could become enlarged due to congestion. Picture this scenario. A patient presents with pitting edema in their lower extremities, their neck veins visibly distended, and they report feeling unusually sluggish. That's right-sided heart failure manifesting clearly in front of you. Here's a quick memory trick to keep it straight. Left is lungs and right is the rest. Left-sided failure floods the lungs with fluid while right-sided failure floods the rest of the body with backed up blood. The ENLEX exam loves to test your ability to match symptoms to the correct side. So remember that crackles point to leftsided failure, whereas peripheral swelling indicates right-sided failure. For management, left-sided heart failure often requires oxygen to improve breathing. diuretics such as for a semi commonly known as LASIX to offload excess fluid and sometimes ACE inhibitors to reduce the heart's workload by dilating blood vessels. Meanwhile, right-sided heart failure also relies heavily on diuretics to reduce fluid buildup and elevating the patients legs can help drain that persistent edema more effectively. Now let's shift our focus to coronary artery disease or CAD and its progression to myioardial inffection. Coronary artery disease develops gradually as the coronary arteries narrow due to plaque buildup which restricts blood flow to the heart muscle over time. Several risk factors contribute to this condition including smoking, elevated cholesterol levels, hypertension, and diabetes all of which accelerate the process of atherosclerosis. Symptoms tend to emerge subtly at first with patients reporting chest pain known as angina which often feels dull or squeezing and may radiate to the arm, shoulder or jaw. Stable angina typically occurs during physical exertion and subsides with rest or nitroglycerin, a medication that dilates blood vessels. However, unstable angina is far more concerning because it strikes unpredictably, intensifies over time, and serves as a warning that a mocardial infuction might be imminent. Myocardial inffection or MI is the acute emergency that occurs when a plaque ruptures, a clot forms, and the artery becomes completely blocked, causing heart muscle to begin dying from lack of oxygen. The chest pain in an MI is severe and unrelenting, often lasting 30 minutes or more. And unlike angina, it doesn't respond to nitroglycerin. Patients frequently experience additional symptoms such as profuse sweating, nausea, and shortness of breath. And interestingly, women might present atypically, feeling only profound fatigue or vague discomfort rather than classic chest pain. On an ECG, you'll see telltale signs like ST segment elevation or the appearance of new Q waves confirming the diagnosis. For instance, consider a patient who's clutching his chest, looking pale and sweaty, reporting pain at 8 out of 10 that's persisted for an hour. That's a clear myioardial infarction requiring urgent action. The initial management of MI follows the acronym Mona, which stands for morphine to relieve pain. oxygen if saturation levels drop, nitroglycerin if blood pressure remains stable, and aspirin to prevent further clotting. After these immediate steps, the next interventions include perccutaneous coronary intervention or PCI such as angoplasty to open the blocked artery or thrombolytic therapy if it can be administered quickly, ideally within 3 hours of symptom onset. A handy pneummonic to recall this is Mona greets MI linking morphine, oxygen, nitroglycerin, and aspirin to the emergency response. PostMI, you'll need to monitor closely for arhythmias because ventricular fibrillation or VIB is a life-threatening complication that can arise suddenly and requires defibrillation. Let's briefly touch on some additional topics that might appear on the enclelex such as congenital heart defects and other cardiac emergencies. One notable congenital condition is tetrology of filot which involves four distinct defects. A ventricular septile defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. Children with this condition often squat to relieve shortness of breath and exhibit cyanosis turning blue due to poor oxygenation. The definitive treatment is surgical correction. In contrast, a cyanotic defects like a ventricular septile defect alone involve blood shunting from left to right and are less immediately critical, though they still require repair eventually. A useful pneummonic for tetrology of fallow is tets terrible four highlighting the four defects that result in one cyanotic child. Beyond that consider a couple of acute emergencies. Cardiac tampenod occurs when fluid accumulates in the paricardial sack compressing the heart and impairing its ability to pump. You'll hear muffled heart sounds, see a drop in blood pressure, and note jugular vein distension, a combination known as beex triad. The life-saving intervention is paricardioentesis, which drains the fluid. Another emergency aortic dissection presents with sudden tearing chest pain radiating to the back, often with unequal pulses in the arms, and requires either urgent surgery or aggressive blood pressure management to stabilize the patient. To wrap up, let's test your understanding with a couple of quick scenarios. Imagine a patient who's short of breath, has bilateral crackles in the lungs, and oxygen saturation at 89%. Is this left-sided or right-sided heart failure? It's leftsided because the lungs are flooded with fluid pointing to a left ventricular issue. Now consider another patient with chest pain for an hour sweating profusely and no relief from nitroglycerin. Is this CAD or MI? It's an MI because the duration and severity of symptoms indicate a full-blown heart attack rather than chronic artery narrowing. With these distinctions clear, you're well equipped to tackle cardiac topics on your exam. All right, let's dive into the respiratory stuff, physiology, key conditions, and the equipment you'll face on the test. Let's begin with respiratory physiology basics. The lungs handle gas exchange. Oxygen comes in and carbon dioxide slips out. Two big things to know here, ventilation and oxygenation. Ventilation is all about air moving, so you're inhaling and exhaling. just the mechanics of breathing, but oxygenation, that's when oxygen hits the blood. Think oxygen saturation or sites shown as a percentage. Normal SATs sit between 95 and 100%. But if they drop below 90, you're in trouble. For instance, imagine a patient huffing and puffing with SATs at 88%. Ventilation's fine, air is moving, but oxygenation's failing because oxygen isn't getting into the blood properly. Enclelex tip. They'll test this hard. Ventilation's the process. Oxygenation's the payoff. Mix them up and you're sunk. Write that down. Now, asthma is when airways get tight. Chronic inflammation narrows them. And triggers like dust, pollen, or cold air can spark it off. You'll hear wheezing, that classic high-pitch sound, plus shortness of breath, and sometimes chest tightness. If an acute attack hits, you move quick. Elbuterol is your star because it's a fast bronco deator opening those airways up. Then you follow with steroids like predinosone to settle the inflammation down. Picture it. A kid's wheezing loud respirations at 32 per minute. You hit them with albuterol stat and if their sats fall below 90, you add oxygen. An eninklex trick. They might ask, "What's first?" It's always the bronco dilator. Speed matters here. Next up, COPD. Chronic obstructive pulmonary disease, usually tied to smoking. It's a mix of emphyma or chronic bronchitis, so air gets trapped, and exhaling is a real chore. You'll spot a barrel-shaped chest, purse, lip breathing, and sats often hang low, like 92% on room air. Oxygen's dicey with these folks, though. Too much can suppress their breathing drive. So aim for sats of 88 to 92%. Meds, bronco dilators like tatotropium keep it manageable and sometimes steroids help. Say you've got an older guy huffing away on oxygen at 2 L via nasal canula. You keep it there. Don't bump it up. Or you could knock out their drive to breathe. Enclelex heads up. They'll throw a curveball like patients sats are 90 crank oxygen to six lers. Nope. low and steady winds. Then there's pneumonia, an infection in the lung tissue sparked by bacteria, viruses, or whatever creeps in. You'll see fever, a wet cough with gunk, crackles when you listen, and maybe chest pain. SATs might dip, say, to 90%. Treatment straightforward. Antibiotics like levofluxisonin for bacterial cases, oxygen if sats drop, and fluids to loosen that mucus. Imagine a patient coughing up green junk. Temp at 101 degrees Fahrenheit. You start antibiotics pronto and you're checking SATs to see if oxygen's next. Enclelex tip. If they mention crackles and a fever, lean pneumonia, don't get distracted by heart failure options. Now, pulmonary embolism or PE is a clot jamming up lung blood flow. It hits fast. Sudden shortness of breath, sharp chest pain and tacocardia, heart rate spiking. Sometimes blood pressure tanks and SATs crash. Think 85%. You jump on Heperin, an IV bolus, then a drip to stop that clot from growing bigger. Picture a posttop patient gasping, heart rate at 120, sats at 86. That screams PE, so you're calling it and starting Heper instat. Enclelex trick. Sudden onset is your clue. Don't pick asthma or pneumonia when the symptoms explode out of nowhere. Switching gears. Ventilator alarms are enclelex gold. They love these. A high pressure alarm means something's blocking the flow, like mucus or a kink tube, so you suction or fix it. But a low pressure alarm, that's a leak. Maybe a disconnected tube or loose fitting. Check those connections fast. For example, the alarm's blaring, pressure sky high, you suction the mucus, and breathing calms down. Memory hack. High's blocked, lows loose. Say it twice. It'll stick. Chest tubes drain air or fluid from the plural space. Like with a numoththorax or hemoththorax. Bubbling in the water seal chamber fine if there's an air leak. But if the suction chamber's bubbling non-stop, you've got a problem. Check for leaks in the system and never clamp it. Clamping risks attention pumothorax, which can kill fast. Say a trauma patients tube is bubbling like crazy. You tape a loose connection in sats climb back up. Enclelex tip. If they ask, "What's bubbling mean?" It's air escaping, not suction overkill. Don't overthink it. Let's test a patient's wheezing sats at 89. That's asthma. So give albuterol fast. Another one is when barrelchested sats at 91. It's COPD. So give lowflow oxygen and keep it chill. Alarms screaming high then suction the vent. What if the tube's bubbling non-stop? Then hunt that leak. Now we are going to cover some high yield enclelex neuro topics that are crucial for both the exam and real world nursing practice. We'll go step by step connecting key concepts to help you remember them more easily. To start, let's briefly review the nervous system structure. The central nervous system, which includes the brain and spinal cord, acts as the control center, processing and sending out signals. On the other hand, the peripheral nervous system connects the CNS to the rest of the body, enabling movement, sensation, and reflexes. Disorders affecting either of these systems can have significant consequences, which is why understanding their functions is key when assessing patients. A thorough neuro assessment helps us detect early signs of neurological dysfunction before they become critical. One of the first things we assess is the cranial nerves, which control a range of sensory and motor functions. There are 12 cranial nerves, and because they are commonly tested, using a pneummonic makes them easier to remember. A useful one is oo o to touch and feel very green vegetables. Ah heaven which helps recall their names. Oldactory optic ocula motor tleier trageeminal abducins facial vestibular coclear glossopherial vagus accessory and hypoglossal. While all are important, the ones that frequently come up in enclelex scenarios include the optic nerve which controls vision, the facial nerve which is responsible for facial movements and taste and the vagus nerve which plays a role in heart rate and digestion. Another essential tool for neuro assessment is the Glasgow coma scale or GCS which helps evaluate a patients level of consciousness especially in cases of head injuries or strokes. GCS measures three components. Eyeoping response, verbal response, and motor response. Scores range from 3 to 15 with a lower score indicating more severe impairment. a GCS score of eight or lower signals a coma and suggests the need for intubation. Pupil assessment is another vital part of a neurological exam commonly referred to as parallel which stands for pupils equal round reactive to light and accommodation. If pupils are unequal or non-reactive this could indicate increased intraraanial pressure or severe brain damage making it a critical observation in neurological emergencies. Moving on, let's talk about stroke. One of the most common neurological emergencies. A stroke occurs when blood flow to the brain is interrupted leading to brain cell death. There are two main types, eskeemic and hemorrhagic. An eskeemic stroke is caused by a blood clot blocking blood flow to the brain and is the most common type. In contrast, a hemorrhagic stroke results from a ruptured blood vessel leading to bleeding in the brain. Recognizing a stroke quickly is crucial and the easiest way to do this is by using the fast pneumonic. Face drooping, arm weakness, speech difficulty, and time to call 911. Treatment depends on the type of stroke. For eskeemic strokes, tpa can be administered within 3 to 4.5 hours if there are no contraindications. However, for hemorrhagic strokes, tpa is not used. Instead, treatment focuses on controlling blood pressure, preventing increased intraraanial pressure, and monitoring for further complications. Now, let's talk about increased intraraanial pressure or ICP, which can result from trauma, stroke, tumors, or infections like menitis. When pressure builds up inside the skull, it can lead to serious complications including brain herniation. Early signs include restlessness, headache, and nausea or vomiting. As ICP worsens, late signs appear, including Cushing's triad, which consists of brady cardia, widened pulse pressure, and irregular breathing. Managing ICP requires elevating the head of the bed to 30 to 45°, avoiding activities that increase pressure such as coughing or straining, and administering osmotic diuretics like manitol to reduce swelling and prevent further complications. A seizure is an abnormal burst of electrical activity in the brain. There are different types and understanding them is key for enclelex. Tonic clonic seizures, also known as grand mau seizures, involve loss of consciousness, stiffening, and jerking movements. Absence seizures, which are more common in children, cause brief staring spells. Myoconlonic seizures involve sudden muscle jerks, while status epilepticus is a life-threatening emergency where a seizure lasts longer than 5 minutes and requires immediate intervention. Seizure safety is a priority in patient care. If a patient is actively seizing, the nurse should turn them on their side to prevent aspiration, avoid restraining them, and remove hazardous objects from their surroundings. Once the seizure stops, reorienting the patient and assessing for injuries is necessary to ensure recovery. Finally, let's discuss menitis, which is an infection of the meninges, the protective layers around the brain and spinal cord. It can be caused by bacteria or viruses with bacterial menitis being more severe. Symptoms include fever, stiff neck, altered mental status, impositive kernigs and brzinski signs. The management of menitis depends on the cause. Bacterial menitis requires IV antibiotics and droplet precautions while viral menitis is treated with supportive care and standard precautions. Diagnosis is confirmed through a lumbar puncture. If bacterial the cerebral spinal fluid will show low glucose, high white blood cells and increased protein. In viral menitis, glucose levels remain normal while white blood cells are elevated. Neurology is a complex but essential topic and recognizing patterns can make it easier to remember key details. To recap, use fast for stroke recognition. Be aware of Cushing's triad for increased ICP. Assess pupils with parallel and evaluate consciousness with GCS. These concepts will help not only in passing the enclelex but also in developing strong clinical judgment in real world scenarios. Now let's go over some practice questions to reinforce what we've learned. Question. A nurse is caring for a patient admitted with a suspected eskeemic stroke. The patient arrived at the emergency department 2 hours after symptom onset and is exhibiting right-sided weakness in slurred speech. Vital signs are blood pressure 180 over 100, heart rate 88, respiratory rate 18, SPO2 96% on room air. Which action should the nurse prioritize? A. Administer aspirin 325 mg orally as prescribed. B. Prepare the patient for a CT scan of the head. C. Initiate an IV line with 0.9% sodium chloride at 100 ml per hour. D. Perform a complete neurological assessment using the Glasggo coma scale. The answer is B. Prepare the patient for a CT scan of the head. For a suspected eskeemic stroke, the priority is to confirm the diagnosis and rule out a hemorrhagic stroke before administering thrombolytics like or antiplatelets like aspirin. A CT scan is time-sensitive. The goal is within 25 minutes of arrival and guides treatment, especially since the patient is within the 4.5 hour window for tpa. While a neurological assessment D is important, it's secondary to diagnostic imaging. Aspirin A is contraindicated until hemorrhage is ruled out and IV fluids C are not the immediate priority. Another question. A nurse is caring for a patient with gueret syndrome, GBS, who was admitted 3 days ago. The patient reports increasing difficulty breathing and has a respiratory rate of 26 per minute. Arterial blood gas ABG results show PH 7.3, PCO250, PAO280, HCO324. Which intervention should the nurse implement first? A. Administer oxygen via nasal canula at 2 L per minute. B. Notify the health care provider and prepare for intubation. C. Encourage the patient to use an incentive sperometer every hour. D. Position the patient in high fowler's position. The answer is B. Notify the health care provider and prepare for intubation. In GBS, ascending paralysis can impair respiratory muscles, leading to hypoventilation and respiratory acidosis, PH7.3, PCO250. The increasing respiratory rate, 26, and AG findings indicate impending respiratory failure, a life-threatening complication. Preparing for intubation B is the priority to secure the airway. Oxygen A may help temporarily, but doesn't address the underlying issue. incentive spometry C and positioning D. Now, we're going to break down some of the highest yield topics that you absolutely need to know on endocrine system. We'll cover the basics of diabetes, dive into the differences between DKA and HHS, compare Addison's and Cushing disease, and finally sort out SIADH versus diabetes incipitus. So, let's jump right in. The endocrine system is like the body's hormone control center. It regulates metabolism, growth, reproduction, and a bunch of other vital functions all through hormones. Some of the major players here include the pituitary gland, thyroid, adrenal glands, pancreas, and parathyroid glands. One of the key things to understand is how the body maintains balance using negative feedback loops. Think of it like a thermostat. When the temperature drops, the heat turns on. And when it gets too hot, the heat turns off. Similarly, hormones are released when needed and stop when levels are sufficient. When something goes wrong in the endocrine system, it usually means there's either too much hormone called hyperfunction or not enough hormone called hypofunction. That's why understanding endocrine disorders is really about recognizing which hormones are missing, excessive, or completely out of balance and how that affects the body. Now let's talk about diabetes malitis, one of the most common endocrine disorders. There are two main types, type one and type two. Type one is an autoimmune condition where the pancreas doesn't produce insulin at all. That means these patients are insulin dependent for life. You'll often see this in younger patients. And because their bodies cannot regulate blood sugar without insulin, they are at a much higher risk for diabetic ketoacidosis or DKA. Type two, on the other hand, is caused by insulin resistance. The body still makes insulin, but the cells don't respond to it properly. This is much more common in adults, especially those with obesity, and is typically managed with diet, exercise, oral medications, and sometimes insulin. When it comes to diagnosing diabetes, there are a few key lab values to remember. A fasting blood glucose level of 126 mg per deciliter or higher is diagnostic for diabetes. A random blood glucose over 200 mg per deciliter along with symptoms of hypoglycemia also confirms it. Another test you need to know is the hemoglobin A1C test which tells us about a patient's long-term glucose control over the past 2 to 3 months. An A1C level of 6.5% or higher confirms diabetes. If blood sugar levels aren't managed properly, diabetes can lead to serious complications like neuropathy, kidney damage, vision loss, and cardiovascular disease. So, patient education is crucial. Now, let's go over two major diabetic emergencies, DKA and HHS. Both involve dangerously high blood sugar levels, but they have key differences. DKA or diabetic ketoacidosis happens mostly in type 1 diabetes. It occurs when the body doesn't have enough insulin. So, it starts breaking down fat for energy. This process creates ketones which are acidic leading to metabolic acidosis. The classic signs of DKA include cousal breathing which is deep rapid breathing as the body tries to blow off excess acid, fruity breath odor, and severe dehydration. When you look at lab values, patients will have glucose over 250 mg per deciliter, a pH below 7.3, and positive ketones in the urine. Treatment for DKA follows a simple pattern. IV fluids first, followed by IV insulin, and then careful potassium replacement since insulin can cause potassium to shift into the cells, leading to dangerously low potassium levels. Now let's compare that to HHS or hyperosmolar hypoglycemic syndrome which is more common in type 2 diabetes. It's similar to DKA in that blood sugars extremely high. But the big difference is that there are no ketones and no acidosis. Instead the main problem is severe dehydration often with glucose levels above 600 mg per deciliter. Since there are no ketones, you won't see kosal breathing or fruity breath. But patients can still experience confusion, seizures, and even coma due to extreme dehydration and high serum osmolality. The treatment is the same as DKL, IV fluids first, then insulin. But these patients often need even more aggressive fluid replacement since the dehydration is so severe. A simple way to remember this is that DKA has ketones and acidosis while HHS does not. Next, let's talk about adrenal disorders, specifically Addison's disease and Cushing syndrome. Addison's disease occurs when the adrenal glands don't produce enough cortisol and aldoststerone. The most important thing to remember about Addison's is that patients need lifelong steroid therapy because their body cannot make stress hormones on its own. The classic signs include bronzecoled skin, weight loss, hypotension, salt craving, and hypercalemia. If left untreated, an Addisonian crisis can occur causing a dangerous drop in blood pressure and shock. These patients need IV steroids and fluids immediately. Now, let's flip it and talk about Cushing syndrome, which is the opposite of Addison's. It's caused by too much cortisol. This can happen due to long-term steroid use or an adrenal tumor. Patients with Cushing syndrome have a round moon face, a buffalo hump, trunkal obesity, purple stri osteoporosis, and high blood sugar. They're also at risk for hypertension, infections, and slow wound healing. A great way to remember these two disorders is that Addison's need steroids added while Cushings has too much cushion, meaning excess fat and fluid retention. Finally, let's clear up SIADH and diabetes incipitus, two disorders related to antid-iuretic hormone or ADH. In sciah or syndrome of inappropriate ADH, the body retains too much water leading to delusional hyponetriia. This means the sodium in the blood becomes dangerously low causing fluid overload, very little urine output and confusion or even seizures. The main treatment is fluid restriction and in severe cases patients may need hypertonic saline such as 3% sodium chloride to correct sodium levels. On the other hand, diabetes incipitus or WI is the opposite. Instead of retaining water, the body loses too much water because there's not enough ADH. This results in massive urine output, dehydration, hyperetriia, and excessive thirst. The treatment depends on the cause, but most cases of central DI require demopressin or DDEVP which replaces the missing ADH. A simple trick to remember these is that cih means soaked inside because of water retention while DI means dry inside because of excessive urination. And that wraps up our high yield endocrine review. Remember, the ENCLEX loves to test lab values, key symptoms, and priority interventions for these disorders. Always think about what's too high, what's too low, and how it affects the body. I hope this breakdown made everything a little easier to understand. Let's practice on some inclelex type questions. First question, a nurse is caring for a patient admitted with suspected diabetic ketoacidosis, DKA. Which set of laboratory values would confirm the diagnosis? A. Glucose 550 pH 7.38 serum ketones negative. B glucose 310 pH 7.45 bicarbonate 22 mill equivalents per liter. C glucose 620 pH 7.28 28 serum ketones positive D glucose 700 pH 7.38 bicarbonate 24 mill equivalents per liter the correct answer is C glucose 620 pH 7.28 28 serum ketones positive. The rationale is DKA is characterized by hypoglycemia greater than 250 mg per deciliter metabolic acidosis pH less than 7.3 low bicarbonate less than 18 mill equivalents per liter and keinemmia option A and D suggest HHS high glucose without ketones or acidosis. Option B reflects normal acid base balance and does not indicate DKA. Next question. A nurse is assessing a patient diagnosed with Cushing syndrome. Which of the following findings requires immediate intervention? A. Blood pressure of 160 over 90 mm of mercury. B. Blood glucose of 250 mg per deciliter. C. Serum potassium of 2.9 mill equivalents per liter. D. weight gain of 5 lbs in 1 month. The correct answer is C. Serum potassium of 2.9 mill equivalents per liter. Cushing syndrome causes hyperetriia, hypocalemia, hypoglycemia, and hypertension due to excessive cortisol. Severe hypocalemia less than 3.0 mill equivalents per liter can cause life-threatening cardiac arhythmias requiring urgent potassium replacement. BP of 160/90A and glucose of 250B are expected findings in Cushings. Weight gain D is common but not immediately life-threatening. Last question. A patient with syndrome of inappropriate antidiuretic hormone SIADH is on fluid restriction and has developed confusion and muscle cramps. The nurse anticipates which of the following interventions? A. Administer 3% hypertonic saline of arm. B give additional fluids to correct dehydration. C administer insulin subcutaneously. D administer desmopressin DWABP intraasally. The correct answer is A. Administer 3% hypertonic saline IV CDH causes dilutional hyponetriia. Low sodium levels usually less than 120 mill equivalents per liter which can lead to seizures. Hypertonic saline 3% sodium chloride is used for severe hyponetriia to prevent brain swelling. Option B is incorrect since fluid restriction is required in sidh. Option C insulin is unrelated to cadh. Option DD-AVP is used for DI notadh. Now, we'll break down some of the highest yield topics for renal and GI system. We'll start with the basics of how the renal system works, discuss the differences between acute kidney injury, AKI, and chronic kidney disease, CKD, and cover essential care for diialysis patients. Then, we'll move on to the GI system looking at upper versus lower GI bleeding, bowel obstructions, ental care with feeding tubes, and total parental nutrition. Renal system overview. The renal system is responsible for maintaining fluid and electrolyte balance, filtering waste, regulating blood pressure, and producing ariththropoin, which helps in red blood cell production. The kidneys filter about 50 gallons of blood per day, removing toxins and maintaining homeostasis. Each kidney contains tiny filtering units called nephrons where waste is filtered in the glomemeilus and essential substances like water and electrolytes are reabsorbed in the tubules. When the kidneys fail, the body loses its ability to maintain balance. Waste products build up in the blood leading to aotia, elevated bun and creatinine, electrolyte imbalances, metabolic acidosis, and fluid overload. Since the kidneys help regulate blood pressure, kidney dysfunction often results in hypertension, understanding how the kidneys work is essential for recognizing the early signs of kidney failure and complications that require immediate intervention. A helpful way to remember kidney function is the pneummonic a wet bed which stands for acid base balance, water removal, ariththropoesis, toxin removal, blood pressure control, electrolyte balance, and vitamin deactivation. Acute kidney injury is a sudden loss of kidney function that occurs over hours to days and is often reversible. It is categorized into three types, prenal, intrarrenal, and post-renal. Prennal AKI happens before the kidneys and is caused by low blood flow such as in dehydration, hypoalmia or shock. Intrarrenal AKI occurs within the kidneys due to nephrotoxic drugs like NSAIDs, contrast dye or acute tubular necrosis. Postrenal AKI is caused by obstruction such as kidney stones, benign prostatic hyperlasia, BPH or tumors. The classic signs of AKI include oligura, urine output less than 400 milliliters per day, elevated bone and creatinine, hyperc calmia and metabolic acidosis. Chronic kidney disease is progressive and irreversible. It is most commonly caused by diabetes and hypertension. CKD progresses through five stages with stage 5 GFR less than 15 milliliters per minute being endstage renal disease. ESD requiring dialysis or kidney transplant. Patients with CKD are at risk for fluid retention, hypercalemia, uremia, toxins in the blood, metabolic acidosis, anemia, and bone disease due to low calcium and high phosphate levels. One key enclelex tip is no P, no K. If urine output is low, potassium levels rise leading to hypercalemia and a high risk for cardiac arhythmias. Diialysis is necessary when kidney function is severely impaired and it helps remove waste, excess fluid and toxins from the blood. There are two types of dialysis. Hemodialysis and paritinal dialysis. Hemmoiialysis involves using a machine to filter blood and is performed three times per week in a diialysis center. Peritineal dialysis is done at home using the peritineal membrane as a filter. For hemodialysis, the AV fistula or graft is the access site and it must be protected. Never take blood pressure, insert IVs, or draw blood from the arm with the fistula to avoid clotting. Before dialysis, check the patients weight, blood pressure, and potassium levels, and hold anti-hypertensive medications to prevent hypotension. After dialysis, monitor for hypotension, muscle cramps, and disequilibrium syndrome, which causes confusion and headaches due to rapid fluid shifts. Paratonial dialysis requires sterile technique to prevent perodonitis, which presents as cloudy effluent, fever, and abdominal pain. If perodonitis is suspected, notify the provider immediately. The gastrointestinal system is responsible for digestion, absorption, and elimination. The stomach secretes acid and enzymes to break down food while the small intestine absorbs nutrients. The large intestine absorbs water forming stool. Knowing which part of the GI tract is affected helps determine the cause of symptoms. For example, pain in the epigastric area with burning may indicate gastritis or peptic ulcers. While right lower quadrant pain is often seen in appendicitis, a GI bleed can be upper esophagus, stomach, douadinum or lower small intestine, large intestine, rectum. An upper GI bleed is typically caused by peptic ulcers, esophageal veraces or gastritis. The hallmark signs include hematis which is vomiting blood, coffee ground appearance and melina which black terry stools. A lower GI bleed is usually caused by diverticulosis, inflammatory bowel disease or hemorrhoids and it presents with hematsia which is bright red blood in stool. One easy way to remember is upper GI equals upchuck vomiting blood and lower GI equals lower rectal blood. Bowel obstructions occur when something blocks the movement of stool. Small bowel obstructions cause severe vomiting, abdominal distension, and high-pitched bowel sounds early on. Large bowel obstructions cause gradual distension, constipation, and ribbon-like stools. Never give laxatives for a bowel obstruction as they can worsen the condition. Treatment includes NG tube decompression, IV fluids, and surgery if necessary. NG tubes are used for feeding or decompression. Always confirm placement with an X-ray before first use and keep the head of the bed at 30 to 45 degrees to prevent aspiration. PEG tubes are surgically placed for long-term feeding and proper skin care is important to prevent infections. Total parental nutrition TPN is given through a central line when a patient cannot tolerate ental feeding. Since TPN is high in glucose, monitor for hypoglycemia and never stop TPN suddenly. Win it off slowly to prevent hypoglycemia. If TPN runs out, hang dextrose 10% D10W to prevent a drop in blood sugar. Let's try some Amlex style questions. Question. A patient with CKD reports nausea, itching, and confusion. Which lab value should the nurse check first? A. Hemoglobin. B U N C sodium. D calcium. The answer is B. Blood ura nitrogen BUN. Symptoms of this patient suggest uremia which occurs when BUN and creatinine levels are excessively high. Next question. A nurse is caring for a patient on hemodialysis. Which finding requires immediate intervention? A. Fatigue. B. Weight loss. C. Hypotension. D. Itching. The answer is C hypotension. Low blood pressure after diialysis can indicate excessive fluid removal and requires intervention. Last one. A patient receiving TPN is diaphoretic and confused. What is the nurse's priority action? A. Slow the TPN infusion. B. Check blood glucose. C. Stop the TPN immediately. D. Administer insulin. The answer is B. Check blood glucose. TPN can cause hypoglycemia or hypoglycemia if stopped suddenly. Now, we're going to cover some essential maternal and newborn and pediatric concepts with some pneumonics and exam tips to help you confidently answer questions on this topic. Make sure to pay attention to key interventions. As Enclelex loves to test your ability to prioritize care, let's dive right in. Pregnancy stages. Pregnancy is divided into three trimesters, each with unique milestones. In the first trimester, from 0 to 12 weeks, organogenesis takes place, meaning the baby's organs are forming. This is why folic acid is so important to prevent neural tube defects. Morning sickness is common, and patients should be encouraged to eat small, frequent meals. Moving into the second trimester, which is weeks 13 to 26. Fetal movement, also known as quickening, usually starts around 16 to 20 weeks. A good landmark to remember is that at 20 weeks, the fundal height should be at the umbilicus. Finally, in the third trimester, the baby's lungs are maturing and lightning occurs around 36 weeks, which means the baby drops lower into the pelvis. This is also when we watch for complications like preeclampsia or preterm labor. Next, let's talk about fetal heart rate FHR monitoring. A normal fetal heart rate is between 110 and 160 beats per minute. We look for accelerations. Those are temporary increases in the fetal heart rate and they are a reassuring sign. Decelerations, on the other hand, can be concerning. To remember them, use the pneummonic ve chop. Variable decelerations mean chord compression, reposition the mother. Early decelerations are from head compression. These are benign and expected during labor. Late decelerations indicate placental insufficiency. This is bad and interventions include oxygen, repositioning, fluids, and stopping ptocin. Labor occurs in four stages. Stage one is all about cervical dilation from 0 to 10 cm. It includes three phases. Latent 0 to 3 cm mild contractions. Active 4 to 7 cm stronger contractions. This is when an epidural is usually given. And transition 8 to 10 cm. Intense contractions. The patient may feel the urge to push. Stage two starts at full dilation and lasts until the baby's delivered. Stage three is the delivery of the placenta, which usually happens within 5 to 30 minutes. Stage four is the recovery period where we closely monitor for hemorrhage. Now let's talk about hypertensive disorders in pregnancy. Preeacclampsia is defined by hypertension, protein ura and edema. Severe cases may have headaches, vision changes and right upper quadrant pain. Treatment includes magnesium sulfate to prevent seizures. Aclampsia is preeacclampsia plus seizures. This is an emergency and we need to protect the airway and continue magnesium sulfate administration. LP syndrome stands for hemolysis, elevated liver enzymes, and low platelets. These patients are at risk for bleeding and DIC. Gestational diabetes is screened between 24 and 28 weeks with a 1-hour glucose tolerance test. If the blood sugar is over 140, further testing is needed. Poorly controlled GDM can lead to macrosomia, large baby, neonatal hypoglycemia, and preeacclampsia. Management starts with diet control, but insulin may be required if glucose levels remain high. Postpartum hemorrhage is a leading cause of maternal mortality and it's crucial to know the causes. Remember the four T's. Tone, uterine atoni, the most common cause, funal massage is the first intervention. tissue, retained placenta, trauma, lacerations, thromben, coagulopathy. We treat PPNH with uterotonics like oxytocin, misoprosttol or methagene but avoid methagine in hypertensive patients. The APGAR score is assessed at 1 and 5 minutes after birth. It evaluates appearance, pulse, grimace, activity, and respiration. Each category gets a score from 0 to two with a total possible score of 10. Anything above seven is normal, but a score below seven requires intervention such as oxygen or stimulation. Newborn jaundice is common, but we need to differentiate between physiologic and pathologic jaundice. Physiologic jaundice appears after 24 hours and resolves on its own. Pathologic jaundice appears within the first 24 hours and may indicate hemolysis or infection. Treatment includes phototherapy if Billy Rubin levels are too high and parents should be encouraged to increase feeding as Billy Rubin is excreted in stool. Some newborns face critical conditions right after birth. Let's go over three common ones. Respiratory distress syndrome RDS seen in preterm babies due to lack of surfactant. Treatment includes oxygen and surfactant replacement. Necroizing interacolitis NEC a serious intestinal disease in preeis often triggered by early formula feeds. The best prevention breastfeeding mcconium aspiration syndrome happens when a post-term baby inhales mcconium stained amniotic fluid. These infants may need immediate suctioning and respiratory support. Let's practice some enclelex questions. Question. A 2-hour postpartum client has a bogggy uterus. saturated paranal pad within 15 minutes and blood pooling under the buttocks. What is the nurse's priority action? A. Increase the IV oxytocin infusion rate. B. Perform funal massage and reassess bleeding. C. Administer methyl ergonom. Notify the healthcare provider immediately. The correct answer is B. Perform funal massage and reassess bleeding. A bogggy uterus and excessive bleeding indicate uterine atonia, the most common cause of postpartum hemorrhage, PPH. Fundal massage is the first intervention to stimulate uterine contraction and reduce bleeding. A is wrong as increasing oxytocin is appropriate but is not the first intervention. C is wrong as methylonavine is used for PP PH but is not the immediate action. D is wrong as the provider should be notified after initial nursing interventions. Next, a newborn at one minute of life has the following assessment. Heart rate 120 beats per minute, weak cry, some flexion of extremities, acroyanosis, not blue hands and feet, grimaces when stimulated. What is the APGAR score? Let's solve it step by step. The APGAR scoring breakdown is heart rate of 120 beats per minute which means two points. Respiratory effort weak cry which is one point. Muscle tone some flexion which is point reflex irritability grimace which is point color acroyanosis which is one point. So the total score is six. This time we're covering all the big hitters for pediatrics. growth and development milestones, psychosocial stages, dehydration, respiratory distress, some key diseases like Kawasaki and cickle cell, vaccines, and pediatric meds. Let's dive in and make it stick. Starting with growth and development since this is where you'll spot what's on track or off the rails. For growth and development, picture a baby's first year, 0 to 12 months. Their head circumference grows about 12 cm because their brain's expanding like crazy. The posterior fontel, that little soft spot in the back, closes up by 2 months, while the anterior one up front takes longer, usually shutting between 12 and 18 months. Motor-wise, they're rolling over by 4 to 6 months, sitting unsupported by 6 to 8 months, and by their first birthday, they're toddling around. Fast forward to toddlers, 1 to 3 years. That anterior fontel is fully closed and they're chatting in two to three word sentences by age two like me want juice. They're into parallel play too. Playing side by side, not really together yet. Preschoolers 3 to 5 get whimsical with magical thinking. Think a kid believing they made the rain stop. They're pedalling tricycles by three and tying shoes by five. Schoolagage kids 6 to 12 shift to logical thinking. Thank you, Pia. And their baby teeth start swapping for permanent ones. Then adolescence 13 to 18 hit puberty. Girls around 10 to 14, boys 11 to 16, and they're wrestling with abstract ideas like who am I really? Here's a handy trick. Walk, talk, play. They walk by one, talk in sentences by two, and play cooperatively by four or five. On the enlex, watch for delays. If a kid's not walking by 18 months or saying words by two, that's a red flag worth investigating. Now, let's ease into psychosocial development. And Ericson's our guy here. He maps out how kids grow emotionally. For infants, it's trust versus mistrust. If caregivers are steady, feeding them, cuddling them, they learn the world's a safe place. Mess that up and mistrust creeps in. Toddlers 1 to three tackle autonomy versus shame. This is potty training territory. If they master it, they feel independent. If you push too hard and they fail, shame takes over. Preschoolers 3 to five are in initiative versus guilt. They want to try things like building a tower or picking their clothes. Encourage that and they grow confident. Criticize too much and guilt sets in. Schoolaged kids 6 to 12 face industry versus inferiority. Doing well in school or sports makes them feel capable, but constant failure. That's inferiority. Adolescence wrestle with identity versus role confusion. Figuring out who they are through friends and experiences. Succeed and they're solid. Flounder and they're lost. Picture a 2-year-old refusing veggies. It's not rebellion, it's autonomy. Offer peas or carrots, not a fight. Inlex loves this. Match the behavior to the stage. You'll see tantrums at two are just part of the deal. Okay, let's shift to dehydration because kids lose fluids fast. And you need to know the signs and fixes. Mild dehydration about 5% body weight loss shows up with dry lips and a slightly quick heartbeat. Nothing drastic yet. Moderate at 10% gets trickier. Sunken fontineels in babies, sunken eyes, skin that doesn't bounce back unless pee. Severe at 15% is an emergency. Lethargy, no tears, a capillary refill over 2 seconds and maybe even low blood pressure. For mild to moderate, oral rehydration solution works wonders. Small sips over time. But severe, you're starting an IV with normal saline, 20 milliliters per kilogram, fast to get that circulation back. Here's a pneummonic ST, sunken eyes, absent tears, lethargy, thirsty. It paints the severe picture perfectly. On the enclelex, prioritize ABCs. Severe dehydration hits circulation, so IV fluids trump everything else. Speaking of emergencies, respiratory distress is next. And kids give you loud clues here. Look for nasal flaring, like their nostrils are working overtime. Retractions, where the chest pulls in above the sternum or between ribs, grunting at the end of breaths, fast breathing, or bluish skin from low oxygen. Step one's always oxygen. Get those levels up. Then position them. Upright helps if it's something like CRO. and add bronco deators if the doctor orders it. Imagine a kid with CRO, barking cough, strider, horse voice, cool mist, and recemic epinephrine. Calm that down. Enclelex tip: Assess breathing first. Grunting is a late scary sign, so jump in quick. Now, let's tackle some diseases. Starting with Kawasaki. It's a vasculitis that loves to test your memory. You've got a fever over 5 days, plus four out of five crash symptoms. Conjunctivitis, red non- goopy eyes, rash all over, adinopathy, swollen neck glands, strawberry tongue, bright red, and hand or foot edema. Treatments IV immunoglobulin, IVIG, to cool the inflammation, plus aspirin to prevent heart issues. Yes, aspirin's rare in kids, but Kawasaki is the exception. Try Crash and Burn. Those symptoms plus fever. Ray syndrome is the opposite. Linked to aspirin after a virus like flu or chickenpox causing brain swelling and liver failure. Skip aspirin unless it's Kawasaki. Croos simpler luringot tracheo bronchitis with that barking cough and straighter. Cool mist and epinephrine fix it. But epiglotitis, that's a beast. H influenza, sudden onset, drooling, sitting tripod style, it's an airway emergency. Don't check the throat or you'll block it. Each one's distinct, so know the vibe. Let's keep going with hydrophilis and cickle cell anemia. Hydrophilis is too much fluid in the brain. Babies show bulging fontels and setting sun eyes where the irises dip down. Older kids get headaches, vomiting, irritability, all from pressure. A shunt drains it. But after surgery, watch for infection, fever or blockage, worsening symptoms. Sickle cells, different red blood cells sickle, clogging vessels, causing pain crises. Triggers like dehydration or low oxygen spark it so a kid might scream about leg pain after a hot day outside. Fix it with fluids, oxygen, and opioids for pain. Enclelex loves shunt complications and cickle cell triggers. Stay alert. Vaccines are up next and it's all about timing and safety. HEP B kicks off at birth. First dose in the delivery room. DTAP rolls out at 2, 4, and 6 months. Dipthetheria, tetanus, protosis protection. MMR and vicella land at 12 months. Measles, mumps, reubella, and chickenpox. Live vaccines like MMR are a no-go for imunompromised kids. Think chemo patients. Here's a trick. MMR equals 12. It locks in that 12-month mark. If a kid misses a shot, don't panic. It's catchup, not a redo. Enclelex tests those schedules and contraindications, so memorize the basics. Lastly, pediatric meds, because dosing's a whole different game with kids. It's weight-based, milligrams per kilogram, and you'll double check every calculation. For IM shots, the vastest lateralis muscles you're spot in infants. Nice and safe. Oral meds, use a syringe for accuracy, not a spoon that spills. IVs need tiny needles. Kids veins are delicate. Take a cetaminophen, 10 to 15 mg per kilogram every 4 to 6 hours. A 5 kg baby gets 50 to 75 mg per dose. Simple math, but verify it. Enclelex drills their rights, right patient, dose, time, because a crying kid or a busy unit can throw you off. Okay, now let's practice some questions. A nurse assesses a two-year-old during a wellchild visit. Which finding requires further evaluation? A speaks in two to three-word sentences. B walks upstairs with assistance. C cannot kick a ball. D engages in parallel play. The answer is C. Cannot kick a ball. By 2 years, a toddler should kick a ball. Gross motor milestone. A and B are expected for age. D. Parallel play is normal until approximately 3 to four years when cooperative play begins. Delay in kicking suggests motor issue. Evaluate further. Next, a 4-year-old with gastronoritis is admitted with sunken eyes, no tears, and a capillary refill of 3 seconds. The nurse expects which initial intervention? A. Administer oral rehydration solution at 5 milliliters per minute. B. Start a Vbolis of 0.9% normal saline at 20 ml per kilogram. C. Offer small sips of water every 10 minutes. D. Apply a cool compress to the forehead. The answer is B. Starb bolus of 0.9% normal saline at 20 ml per kg. Severe dehydration, sunken eyes, no tears, delayed cap refill. Requires rapid IV fluid resuscitation. 20 milliliters per kilogram. Normal saline is standard. A and C are for mild dehydration. D doesn't address fluid loss. Last one. A 3-year-old with a fever for 6 days is diagnosed with Kawasaki disease. Which medication does the nurse anticipate administering? A. Acetaminophen. B. ibuprofen. C. Intravenous imogloabblin iVIG. D. Penicellin. The answer is C. Intravenous immunoglobulin IVIG. IVIG is the primary treatment for Kawasaki disease with aspirin to reduce inflammation and prevent coronary artery aneurysms. A and B reduce fever but don't treat the vasculitis. D is for bacterial infections, not Kawasaki. Let's continue rolling with mental health lecture. We're kicking things off with alcoholism and substance use disorders, a major topic you'll see plenty of. So, picture this. Chronic alcohol use builds tolerance, hooks someone into dependence, and then withdrawal hits when they stop. That withdrawal can start with tremors or escalate to seizures. But the one to really watch for is delirium tremend. It shows up about 48 to 72 hours after the last drink. And it's no joke. Think spiking fevers and seizures that scream emergency. If your patients temperature shoots up or they're seizing, you're jumping in with safety first. Seizure precautions and tight monitoring are key. Now, long-term drinking also messes with thamine or vitamin B1, leading to vernikica cors. Vernicus brings confusion, shaky walking, and odd eye movements. It's like the body's coordination goes haywire. Then Corso's piles on memory loss and confabulation where patients make up stories to cover those gaps. A quick trick to keep it straight. Vernick's wobbly eyes, Corsacov's confused lies. Oh, and one more thing. Antabuse or dissolum is a gamecher for alcohol use disorder. It's aversion therapy. So if they drink, they're hit with nausea and vomiting. You've got to drill into them. Avoid all alcohol, even sneaky stuff like mouthwash or cooking sherry because it all counts. All. All right, let's glide into dependency, codependency, and manipulation since these weave through so many mental health questions. Dependency is when someone's hooked, maybe on opioids or even a person, to cope with life. Codependency flips that. It's the family or friends enabling it. like slipping cash to an addict knowing it's for drugs and manipulation. That's the tricky part. It shows up a lot with substance use or personality disorders. Think a patient saying, "Give me pain meds or I'll hurt myself." Your move is to stay firm, set clear boundaries, and lean on therapeutic communication. No giving in, even if they push hard. Enclelex loves testing how you handle that, so keep your radar up for boundary setting scenarios. Now, let's shift smoothly into anxiety disorders because they're all over the exam. These range from generalized anxiety disorder, GAD, with its non-stop worry, to panic attacks that crash and fast and furious. A panic attack might look like sweating, a pounding heart, or I can't breathe. It peaks in about 10 minutes and feels overwhelming. A GAD's more chronic, simmering for 6 months or more. Your job. Stay calm. Guide them with slow breathing and cut down on noise or chaos around them. Meds like SSRIs help long-term while benzoazipines can step in short term, but safety is the priority. Don't leave someone mid panic. It's about being their anchor when everything's spinning. Flowing from there, let's hit depressive disorders, which tie right into some heavy inklex moments. We're talking persistent sadness, losing joy in life, that's anhidonia, and sometimes a deep hopelessness. You might notice sleep or appetite swinging high or low, energy tanking, or suicidal thoughts creeping in. A slick way to catch it is side caps. Sleep, interest, guilt, energy, concentration, appetite, psychoot changes, and suicidal thoughts. Meds like SSRIs, say certrilline, are go-tos. But here's the catch. Early on, suicidal thoughts can actually spike. So, you're watching close. And if a patient's mood lifts out of nowhere, don't assume it's all good. It might mean they've settled on a plan. So, dig deeper. Since we're on intense stuff, let's slide into suicide prevention and crisis management. risk jumps with past attempts, depression, substance use, or isolation. Big warning signs. You've got to be direct. Are you thinking of hurting yourself? No sidstepping. It's the only way to know. If they've got a plan in the means, like pills at home, it's immediate action, onetoone observation, clear out hazards, maybe a safety contract. Enclelex drills this. The patient with a concrete plan beats out vague thoughts every time for priority. It's about spotting the tipping point and stepping in. Next up, personality disorders, which can throw you a curveball. Bipolar is a mood disorder, not a personality one. Easy mixup, but antisocial personality is the real deal here. It's about ignoring others rights, lying, acting on impulse, zero remorse. Imagine a patient swiping something and shrugging it off. It's in the cluster B crew. Dramatic types like borderline or narcissistic. Enclelex test your boundaries here because these folks might charm or guilt trip you. Stay cool, keep it professional, and don't budge. Let's pivot to eating disorders. Another sneaky but critical topic. Anorexia nervos is about extreme restriction, low weight, warped body image, and a phobia of gaining. Bulimia is binging then purging with normal or higher weight and maybe eroded teeth from vomiting. Starting nutrition and anorexia. Watch for refeeding syndrome. Electrolytes like phosphorus can crash, so you're monitoring labs. Go slow, build trust, don't push food, and keep an eye on the heart. Arrhythmias are a killer risk to flag. flowing naturally from there. Let's cover therapeutic communication and coping, your breadand butter tools. Ask open-ended stuff like, "How are you feeling?" or reflect with, "You sound upset." Silence is golden, too. Gives them space to think, but skip why questions or empty promises like, "It'll all be fine." Those shut things down. Coping's either healthy, like exercise, or unhealthy, like drowning in denial. If a patient says, "I'm a failure," try, "Tell me more about what's making you feel that way." It keeps them talking and builds trust. Now, let's tackle delirium versus dementia because nailing the difference is pure Enclelex gold. Delirium's fast and fixable. Sudden confusion, bouncing attention, maybe from an infection or surgery. Dementia's slow and steady like Alzheimer's with memory fading over time. Onsets your giveaway. Delirium's a lightning strike. Dementia is a creeping fog. For delirium, hunt the cause, say a UTI, and treat it. Dementia is about safety and support long-term. Mix them up and you're toast on the test. Let's wrap this up with psychopharmarmacology basics because meds are everywhere on ENLEX. Anti-depressants like SSRIs, think fluoxitine, take weeks to kick in and you're on suicide watch early. Anxolytics like laorazzipam are fast but addictive so they're a short-term fix. Antiscychotics split two ways. Typical ones like haloparadol might stiffen muscles, those are extra pyramidal side effects while atypical ones like resperadone can pack on pounds. Mood stabilizers like lithium keep levels tight, check thyroid and kidneys because it's a fine line between help and harm. Knowing side effects like muscle twitches or lithium toxicity can clinch the right answer. Let's practice some questions. A nurse is caring for a client who stopped drinking alcohol 48 hours ago and is now restless, sweating, and reporting bugs crawling on the walls. Which action should the nurse prioritize? A. Encourage the client to drink fluids to stay hydrated. B administer a prescribed dose of laorazzipam as needed. C. Place the client in a quiet, dimly lit room. D. Teach the client relaxation techniques to reduce anxiety. The answer is C. Place the client in a quiet, dimly lit room. The client's symptoms, restlessness, sweating, and hallucinations point to alcohol withdrawal, likely delirium tremens, DTS, which hits around 48 to 72 hours after the last drink. and go a DTS is a medical emergency and the priority is safety and reducing stimuli to prevent escalation like seizures. A quiet dimly lit room aligns with this by calming the environment. Fluids A are helpful but not the priority over safety. Laorazzipam B might be used but the question doesn't confirm it's prescribed yet and administration isn't the first step. Relaxation techniques D are impractical during acute hallucinations. Environmental control comes first. Next question. A nurse is speaking with a client diagnosed with major depressive disorder who says, "I've been feeling better today, like a weights lifted. Which response by the nurse is most appropriate? A, that's great to hear. You must be turning a corner. B, I'm glad you're feeling better. What's changed for you today? C, don't worry. Everything will be fine now that you're improving. D. Why do you think you're feeling better all of a sudden? The answer is B. I'm glad you're feeling better. What's changed for you today? In depression, a sudden mood lift can signal a hidden risk. Like the client deciding to act on suicidal thoughts rather than true recovery. The nurse needs to assess further. And this response uses therapeutic communication. It's open-ended, validates the client, and digs deeper without assuming. Option A gives false reassurance and misses the risk. Option C is dismissive and shuts down exploration. Option D's why can feel confrontational, which isn't ideal here. The lecture stressed watching for sudden improvement as a red flag, making B the safest bet. Next, a nurse is educating a client with anorexia nervosa who is beginning nutritional rehabilitation. Which statement should the nurse include in the teaching? A. You'll need to eat large meals right away to gain weight quickly. B. We'll check your blood work often to watch for any imbalances. C. You should avoid all exercise until you're fully recovered. D. Weight gain will happen fast, so don't be surprised. Answer: B. will check your blood work often to watch for any imbalances. Starting nutrition in anorexia risk refeeding syndrome where electrolytes like phosphorus can drop dangerously. Think heart arhythmias. Frequent lab monitoring is critical as the lecture highlighted making this the key teaching point. Large meals a are wrong. Refeeding starts slow to avoid complications. Exercise C might be limited, but avoid all is too absolute and not the focus here. Fast weight gain D isn't accurate or the priority. Safety trumps speed. B nails the high yield concern from the eating disorder section. All right, let's jump into the critical care and emergencies section. First, let's tackle ECG basics. When you're staring at an ECG strip, you're decoding the heart's electrical language. The Pwave is where it begins. It's that small upward bump showing atrial deolarization or the atria squeezing blood into the ventricles. It's normally upright in leads 2, 3, and a VF. Then comes the PR interval, the time from atrial kick to ventricular response traveling through the AV node. It should be 0.12 to 0.20 seconds or three to five small boxes on the strip. If it stretches longer, like 0.24 seconds, you might have a firstderee AV block. Think of it as a sluggish signal. Next, the QRS complex shows ventricular depolarization. It's sharp and should be under 0.12 seconds. A wide QRS, say 0.16 seconds, could mean the rhythms starting in the ventricles or there's a bundle branch block messing things up. Finally, the QT interval covers ventricular repolarization. Too long and you're flirting with torsetes de a dangerous arhythmia will cover soon. Here's an NLEX tip. Count those boxes. One small box is 0.04 seconds. One big box is 0.20 seconds. Imagine a question asking PR is 0.28 seconds. What's the rhythm? You'd spot that delay instantly. Now let's slow things down with brady cardias. Sinus bradic cardia is a heart rate below 60 but the rhythm stays regular with normal pqrst waves. If the patient's fine you just watch but if they're symptomatic say heart rate 38 bp 88 over 50 and dizzy give atropene 1 mgram voy every 3 to 5 minutes up to 3 mg max. If that doesn't work, pacing's next. Then there are AV blocks. First degree is a long PR over 0.20 seconds. Monitor it. No panic. Second degree type of one or wankach is trickier. The PR gradually lengthens until a QRS drops like a hiccup in the rhythm. It's usually benign, but secondderee type 2 has a fixed PR with random drop beats. And third degree has no link between Pwaves and QRS. Total chaos for those you're prepping a pacemaker fast. Here's a pneummonic. Block party. First delays the party. Second drops some guests. Third shuts it down. Picture a patient with third degree block. Heart rate 30. No pulse coordination. That's a code waiting to happen. All right, let's pick up the pace with tachicardias. Super ventricular tachicardia or SVT is a rapid rhythm, heart rate over 150, narrow QRS and regular. Start with veagal maneuvers like asking them to bear down. Then adenosine 6 milligrams of V push followed by 12 milligs if needed. Imagine a stable patient heart rate 170 BP. Adenosine's your star given fast with a saline flush. Atrial fibrillation's different. It's irregularly irregular. No clear P waves like a jittery scribble. You'd control the rate with beta blockers like Metipol and anti-coagulate based on stroke risk. Now ventricular tacic cardia or VT has a wide QRS. If they're stable, give amioderone 150 mg IV. If unstable, low blood pressure or chest pain, synchronized cardio version at 100 jewels. But if it's pulseless VT or ventricular fibrillation, that chaotic wavy mess, defibrillate at 200 jewels by phasic and start CPR. Enclelex loves this distinction. Stable means drugs. Unstable means shock. Know it cold. Before we leave ECGs, let's zoom in on special patterns. They're enclelex gold. A STEMI is ST elevation at least 1 millimeter in two or more contiguous leads like V1 to V4 for an anterior MI from an L blockage. Get them to the Kath lab stat. Hypercalemia shows peaked T- waves. Think tall tense from high potassium say 6.5 mill equivalents per liter. Give calcium gluconate IV to stabilize the heart first. Hypocalemia flips it. Flattened T- waves and U waves pop up replace potassium slowly 10 to 20 mill equivalents per hour V and T torsad's deuant with its twisting QRS pattern from a prolonged QT needs magnesium sulfate 2 g IV these tie lababs to ECGs like a patient with muscle cramps K plus 2.8 8 and U waves. Potassium's your fix. Okay, let's shift to the primary survey. Our AB CDE E lifeline in emergencies. A is airway. Check for blockages like vomit or a fallen tongue. Use a head tilt chin lift if there's no trauma or jaw thrust if there is like after a car accident. If they're unresponsive with a GCS below 8, intubation's likely. Then B for breathing. Check respiratory rate. oxygen saturation and listen for lung sounds. Give oxygen two to six liters via nasal canula for mild hypoxia or 10 to 15 with a non-rebreather for worse. Watch for tension, pneumathorax, tracheal deviation, no breath sounds on one side, needle decompression at the second intercostal space, mid-clavicular line saves the day. Here's a mountic racultate tension check. It's quick and sticks. Next C is circulation. Feel pulses. Check BP and capillary refill. Under two seconds is normal. Stop bleeding with direct pressure or a tourniquet if it's gushing. And start two large bore IVs with normal saline or lactated ringers. Say a one liter bolus for hemorrhagic shock. D is disability. Use the Glasgow coma scale. eyes, verbal, motor, 3 to 15 total. Look for stroke with FAST, facial droop, arm weakness, speech trouble. Time to call 911. If they're confused, check glucose, too. Then E for exposure. Strip them down to spot hidden injuries, but keep them warm with blankets or heated fluids. Hypothermia is a sneaky killer. Once ABCDE is solid, the secondary survey kicks in. Head to toe plus ample. Allergies, meds, past history, last meal, events. Enclelex tip: stabilize ABCDE first. Don't rush to history with a crashing patient. Now on to CPR and basic life support. For one rescuer, it's 30 compressions to two breaths. Adults, kids, infants. With two rescuers, kids and infants get 15 to two. Depth matters. 2 in for adults, about two for kids, 1.5 for infants, all at 100 to 120 beats per minute. Think stay in alive tempo. Here's a pneummonic. Push hard, push fast. Nail depth and speed. Let the chest fully recoil too. Enclelex tests that for circulation if an AED is handy, attach it fast. It shocks via fib or pulseless VT at 200 jewels by FASIC. Picture VIB on the monitor. Shock, then CPR for two minutes. No delay. Let's step up to advanced cardiac life support or ACLS. For cardiac arrest with VFIB or pulseless VT, defibrillate at 200 jewels. Start CPR. Give epinephrine 1 milligram IV every 3 to 5 minutes and add amiotarone 300 mg IV for those shockable rhythms. a cy or pea flatline or organized rhythm without a pulse. Focus on CPR, epinephrine, and reversible causes H's and T's like hypoxia or tension pneumathorax. For symptomatic bradic cardia, say heart rate 40 with dizziness, give atropene 1 milligram up to 3 millig. If it flops, transcutaneous pacings next. Tacic cardia is trickier unstable like heart rate 200 with hypotension get synchronized cardio version starting at 100 jewels but stable SVT heart rate 190 narrow QRS try veagal maneuvers then adenosine 6 mg then 12 mg IV it's all about stability NCL X drills that all right let's dive into shock types they're big on the test hypoalmic shock from bleeding or burns shows tacocardia, low blood pressure and cold clammy skin. Bolus 1 to 2 L of normal saline and if hemoglobin below 7 transfuse blood cardiogenic shock say postMI has low blood pressure, lung crackles and jugular vein distension use vasopressors like dopamine or inotropes like debutamine but fluids can worsen it. So caution there. Distributive shock splits into three. Septic shock from infection needs 30 ml per kilogram fluids about 2 L for an average adult. Broadspectctrum antibiotics and norepinephrine if mean arterial pressures are below 65 after fluids. Neurogenic shock from a spinal cord injury gives low blood pressure, slow heart rate and warm skin, fluids and dopamine lifted. An anaphylactic shock from a peanut allergy say shows airway swelling and rash. Epinephrine 0.3 to 0.5 mg intramuscularly plus antihistamines. Enclelex tip septic shock sequence fluids first pressor second. Get it down. Since we mentioned sepsis, let's flow into that. CRS, systemic inflammatory response syndrome, needs two or more temperature over 38 or under 36 Celsius, heart rate above 90, respiratory rate over 20, or white blood cells over 12,000 or under 4,000. Add an infection and it's sepsis. Draw blood cultures, start antibiotics like venkcomy and push fluids. Imagine a patient temperature 39 heart rate 110 white count 15,000 fluids and antibiotic stat no hesitation now trauma management quick and critical chest trauma might show pumothorax needle decompression or cardiac tampenade pericardioentesis if muffled heart sounds and JVD appear head trauma uses GCS below 8 intubate and watch for Cushing's triad head. High blood pressure, low heart rate, irregular breathing signaling rising incraanial pressure, spinal trauma, immobilize with a C collar and monitor for neurogenic shock, low blood pressure, brady cardia, abdominal traumas, sneaky cullen sign, a bruise around the naval hints at retroparitinal bleeding like from a ruptured spleen. Prioritize and act fast. Enclelex loves trauma scenarios. Finally, let's wrap with neutropenic fever, an oncology emergency. If a chemo patients fever hits over 38.3 C, and their absolute neutrfil count is under 500, infection's a massive risk. Start broadspectctrum antibiotics. Sephip's a go-to. And put them in protective isolation. No flowers or raw veggies allowed. Enclelex tip: Every minute counts. Delay in antibiotics skyrockets mortality, so move quick. All right, let's practice some questions and see if you are understanding well. Question. A 25-year-old male is brought to the emergency department after a motor vehicle accident. He is unresponsive with snoring respirations. His Glasggo coma scale GCS score is six. What is the priority intervention? A. Perform a jaw thrust maneuver. B. Insert an oral airway and monitor. C. Administer 100% oxygen via a non-rebreather mask. D. Prepare for endotraccheial intubation. The answer is D. Prepare for endotraccheial intubation. A GCS less than 8 indicates inability to protect the airway necessitating intubation. The jaw thrust maneuver A is used initially to open the airway in trauma but does not secure it. An oral airway B may help but does not ensure protection from Next. Which statement by a nursing student about chest compressions indicates a need for further teaching? A. I should compress at a rate of 100 to 120 per minute. B. For an adult, I should compress at least 2 in deep. C. I should allow full chest recoil after each compression. D. For an infant, I should compress at least 2 in deep. The answer is D. For an infant, I should compress at least 2 in deep. Infant compression should be 1.5 in 4 cm deep, not 2 in. The other options correctly state the recommended CPR guidelines, 100 to 120 compressions per minute, full chest recoil, and at least 2 in depth for adults. A patient is found unresponsive, pulseless, and in a cy on the monitor. Which intervention should the nurse perform first? A. Start high quality CPRB. Defibrillate at 200 jewels by phasic C. Administer amioderone 300 mg IV push D. Perform synchronized cardio version. The answer is A. A cy is not a shockable rhythm. The priority is CPR and epinephrine. DefB and cardio version are only used for shockable rhythms. AMO is used for VIB and VTAC after defibrillation. All right, everyone. Now, we're diving into infection control, safety, positioning, and perioperative plus post-operative care, which are absolutely crucial for the exam. Let's kick things off with infection control since stopping the spread before it even begins is a huge deal. When it comes to airborne precautions, we're talking about diseases like tuberculosis or measles. So, you'll need to slip on that N95 mask, fit tested, of course, along with a gown and gloves, and then place that patient in a negative pressure room. The reason, those tiny particles just hang in the air, and we can't let them float around unchecked. So, you'll also want to limit transport and mask the patient if they have to move. Then there's droplet precautions which come into play for things like the flu or ptus where a surgical mask within 6 f feet does the job paired with a gown and gloves. And if there's no private room cohorting works just fine. Now for contact precautions. Think C diff or me. You'll grab a gown and gloves. But here's the catch. It's soap and water only because alcohol won't touch those C diff spores. And with MRSA, picture an oozing wound that needs culturing and vancomy to knock it out. Prevention ties all this together, and hand hygiene is your best buddy here. Use soap and water for C diff or anything dirty, and go with alcohol rubs for routine stuff before and after touching a patient. The chain of infection is pretty straightforward. It goes from pathogen to reservoir to exit, then transmission, entry, and finally the host. So you break it with hygiene or sterile technique like when you're inserting a foley catheter because messing that up means a UTI with cloudy urine. Oh, and if you spot sepsis, say a fever over 100.4, heart rate above 90, and breathing over 20, you've got to act fast with fluids and antibiotics in an hour to save that life. Teaching simple, too. Just tell patients to cough into their elbow and finish their meds and you're golden. Shifting gears now, let's talk safety because keeping patients out of trouble is a massive focus on Enclelex. Falls are a top concern. So, for that confused patient, you'll flip on a bed alarm, slap some non-skid socks on those shaky legs, and lower the bed to minimize injury if they tumble. Plus, if they're woozy from surgery, let them dangle their legs for a minute before standing to keep orthostatic hypotension at bay. Because a short rotated leg after a fall screams hip fracture, and we don't want that. Moving right along, restraints need an MD order every time, and you'll check them every 15 minutes, releasing every 2 hours. Always go least restrictive first, like MITs over a vest. Med safety comes next, so double check those tricky ones like insulin or Hepin, sticking to the five rights: patient, drug, dose, root, and time. If a fire breaks out, just remember race, rescue, alarm, contain, extinguish, and you're set. While for seizures, you'll get them sidelineing and pad those rails to keep them safe. In a disaster, triage is your game. Red for airway emergencies, yellow for urgent fractures, and green for minor bumps. And with equipment, keep oxygen tanks upright and away from flames. Then yell clear before shocking with a defibrillator. Oh, and if you spot abuse, think weird bruises or a kid with a spiral fracture, report it to CPS or APS without confronting anyone. Always check ID with name and DOB first because that's your priority every single time. And when teaching, tell patients to call, not fall, and keep oxygen safe at home by skipping the candles. Let's roll into positioning next. Since where you place your patient can totally make or break their recovery, Fowler's position, ranging from 45 to 90°, is your go-to for destinia or postlung surgery because it opens up those lungs beautifully and at 90° it's perfect for slipping in an NG tube. Just tilt the head forward to avoid the trachea. But watch out because sliding down means shearing, so lift with a draw sheet instead. For stroke patients, keep the head of the bed at 30 degrees to boost brain flow. Avoid hip flexion to dodge contraurs. And if they're paralyzed, prop that affected side down with pillows while testing swallowing before feeding since drooling means aspiration risk. Other positions flow in here, too. Supine's great postcath with the legs straight. Prone helps ARDS by patting knees and chest. And sideline works after a lumbar puncture where you'll stay flat for 6 to 8 hours first or for seizures to keep that airway clear. Sims is your friend for enemas. Chest tubes love semifers to drain right and burns need elevated limbs to cut edema. Don't let them flex or you'll end up with contraurs. You'll turn everyone every two hours to stop pressure ulcers, catching that red non-b blanching skin early, and ease them up slowly from supine to sitting to standing to avoid orthostatic drops. If a patient walks at prone for modesty, adjust and note it. And here's a quick tip. If a chest tube patient has tracheal deviation, that's attention pumothorax emergency time. Now, let's hit peroperative and post-operative care because there's a lot to cover, but we'll keep it tight. Preop starts with NPO, 6 to 8 hours for solids, two for liquids to dodge aspiration, and you're checking allergies and marking the surgery site, while antibiotics hit 30 to 60 minutes before the cut. Positioning depends, lethtomy for pelvic, lateral for hip, and you'll stop aspirin 7 days out to prevent bleeding, knowing your anesthesia. general risks, respiratory depression, spinal risks, hypotension. So, preload those fluids. Tell them no smoking 24 hours before to keep lungs happy. And that's preop in a nutshell. Posttop is all about ABCs. Suction for strider, oxygen if SAD has dropped below 92, and watch BP for bleeding while assisting that first walk to avoid falls. Especially with ortho patients, infections follow a timeline. Day one or two fever is atasis. So splint and cough, but day three plus with pus means wound infection. Culture first. Positioning is key here. Fowlers 45 for lung cases, semifoulers for abdominal, and flat 6 to 12 hours postspinal to avoid CSF leaks. while pushing incentive sperometry with 10 breaths every 1 to two hours, aiming for 500 to 1,000 milliliters to keep lungs clear. Fluids matter, too. Potassium below 3.5 means cramps and no deoxin. Sodium over 145 means thirst from drains. And complications to catch include DVT with calf pain needing TED hose, dehissence with a pink gush getting saline gauze, and a call to the dock, plus respiratory depression with a rate under 10 from opioids needing Narcan fast. Teach them to splint incisions when coughing and skip lifting for 6 weeks to keep everything intact. And you've got posttop lockdown. Let's wrap up with some questions. A nurse is caring for a patient with suspected tuberculosis awaiting sputum results. Which action should the nurse prioritize? A. Place the patient in a semi-private room with a curtain. B. Initiate droplet precautions with a surgical mask. C. Use contact precautions with gown and gloves only. D. Implement airborne precautions with an N95 respirator. The answer is D. Implement airborne precautions with an N95 respirator. Suspected TB requires airborne precautions in a 95 negative pressure room until ruled out with three negative spuda as TB spreads via tiny airborne particles. A is wrong. TB needs isolation, not a shared room. B is droplet, not airborne, eg flu. C misses the respiratory risk. Quick tip here. If the question says suspected, you have to act now. Don't wait. Next. A post-operative patient 2 days after hip surgery reports calf pain and swelling in the operative leg. Which intervention should the nurse implement first? A. Encourage ambulation to improve circulation. B. Apply warm compresses to the calf. C. Elevate the leg and notify the physician. D. Massage the calf to relieve discomfort. The answer is C. Elevate the leg and notify the physician. Calf pain, swelling posttop, screams DVT. Elevate to reduce swelling and notify MD for heperin. Ted hose 2. A. Risk dislodging a clot. Pulmonary embolism. B. Heat worsens DVT inflammation. D massage can embleize the clot. Dangerous. Quick tip here. When it says posttop and leg pain, we can assume it's DVT until proven otherwise. Last question. A nurse is assessing a patient 6 hours after a lumbar puncture who reports a severe headache. Which action should the nurse take first? A administer an oral analesic for standing order? B. Position the patient flat in bed. C. Encourage increased fluid intake. D. Assess the puncture site for leakage. The answer is B. Position the patient flat in bed. Headache post lumbar puncture equals CSF leak. Flat position 6 to 8 hours postprocedure. Reduces pressure and stops the leak. A treats pain but not the cause. C. Fluids help later, not first. D. Leakage check is secondary. Position fixes it faster. When it says headache and lumbar puncture, position the patient flat first. Always. We're wrapping up this crash course with some game-changing ENLEX tips. First, always prioritize ABCs, airway, breathing, circulation, because if a patient can't breathe, nothing else matters. Next, timing is key. If you see a posttop fever on day one or two, think adalcttois. So, focus on lungs and spometry. But if it's day three or four, it's likely an infection. So, you'd culture it first. When you're stuck, go for safety. Assist that posttop patient instead of risking a fall. And positioning, keep it simple. Use Fowlers for lung issues, flat for spinal headaches, and elevate for burns. For delegation, remember RNs assess, LPN's handle dressings, and CNAs reposition. If you suspect infection, act fast. Airborne for TB, droplet for flu, no waiting for labs. Finally, read every option carefully because notify the physician often trumps monitor when it's urgent, like with dehissance or respiratory distress. Ready to elevate your enclelex preparation? Visit your nursingspace.com to access the ultimate notes on this crash course and our comprehensive step-by-step mastery program. You'll also gain access to Exam ASOP, our advanced adaptive testing platform featuring over 5,000 peer-reviewed questions designed to mirror the ENLEX experience. It includes detailed ration, daily content updates, and a 247 AI tutor, resources recognized as industry-leading and proven to enhance your performance. Everything you need is available at your nursing space. Okay, that's a wrap for the crash course, everyone. Here are my last words for you. Take a deep breath. Trust your instincts and own it because your mindset is what clenches it. Walk into that exam thinking, "I've got this." Not, "I hope I pass." You're prepared, so go out there and crush it. See you in the next lecture. [Music]