Overview
This lecture provides a focused review of essential NCLEX-RN concepts, including lab values, nursing process priorities, legal/ethical guidelines, pain management, fluid and electrolyte balance, and medication safety.
NCLEX Prioritization and Nursing Process
- Use ABC rule (Airway, Breathing, Circulation); for CPR, use CAB (Circulation, Airway, Breathing).
- Prioritize: safety first, acute before chronic, assess if not in distress, act if in distress/diaphoresis.
- Maslow’s Hierarchy: meet physiological and safety needs before higher-level needs (love, esteem, self-actualization).
- Nursing process steps: Assessment, Analysis/Diagnosis, Planning, Implementation, Evaluation—questions may test specific steps.
Lab Values: Normal Ranges and Implications
- Hgb: Male 14-18, Female 12-16, Newborn 14-24; Hct: Male 42-52%, Female 37-47%, Newborn 44-64%.
- WBC: Adult 5,000-10,000; Newborn 9,000-30,000; Platelets: 150,000-400,000.
- K+: 3.5-5, Na+: 136-145, Ca+: 9-10.5, Mg+: 1.7-2.2, Cl-: 98-106.
- BUN: 10-20, Creatinine: M 0.6-1.2, F 0.5-1.1; BUN/Cr ratio 20:1 indicates kidney function.
- ABG: pH 7.35-7.45, pCO2 35-45, HCO3 22-26.
- PT: 11-12.5 sec; INR: 0.8-1.1 (therapeutic: Afib/DVT 2-3, valves 3-4), PTT: 60-70 sec, aPTT: 30-40 sec.
Medication Administration and Safety
- 7 Rights: drug, dose, route, time, patient, documentation, refuse.
- Draw peak: 30-60 min after dose; trough: 30-60 min before.
- DO NOT delegate what you can Evaluate, Assess, Teach (EAT).
- Heparin antidote: protamine sulfate; Coumadin: vitamin K; Digoxin: Digibind.
Fluid and Electrolyte Balance
- Fluid excess: edema, elevated BP, dyspnea; treat with diuretics, restrict fluids, monitor K+.
- Fluid deficit: weight loss, oliguria, postural hypotension; treat with isotonic fluids, monitor BP.
- K+ key for intracellular, Na+ for extracellular osmotic pressure.
Electrolyte Disorders
- Hyponatremia (<135): confusion, cramps—restrict fluids.
- Hypernatremia (>145): seizures, thirst—restrict Na+, daily weights.
- Hypokalemia (<3.5): cardiac arrhythmias—give K+ supplements.
- Hyperkalemia (>5): tall T waves, weakness—glucose+insulin, Kayexalate, dialysis.
- Hypocalcemia (<8.5): +Chvostek/Trousseau, numbness—give Ca+, vitamin D.
- Hypercalcemia (>10.5): weakness, constipation—limit Ca/D, fluids, calcitonin.
Pain Management
- Non-opioids: acetaminophen (max 4g/24h), NSAIDs, aspirin.
- Opioids: for pain ≥6; monitor for combination max doses.
- Non-pharmacologic options: TENS, heat/cold, massage, relaxation, guided imagery.
Law, Ethics, and Professional Standards
- Negligence: unintentional failure to act; malpractice: breach of professional duty.
- Standards of care come from laws, guidelines, and policies.
- Nurses must report unsafe HCP orders and document incidents.
- HIPAA protects patient information; informed consent requires voluntary, informed, competent agreement witnessed by RN.
Delegation, Communication, Leadership
- Five rights of delegation: task, circumstance, person, direction/communication, supervision.
- SBAR: Situation, Background, Assessment, Recommendation for communication.
- Leadership: authoritarian=a“do it my way”, laissez-faire=“whatever”, democratic=“let's consider options”.
Key Terms & Definitions
- Assessment — Collecting and verifying patient data.
- SBAR — Communication tool: Situation, Background, Assessment, Recommendation.
- Chvostek/Trousseau’s Sign — Signs of hypocalcemia; facial muscle twitch/contraction with specific stimuli.
Action Items / Next Steps
- Memorize normal lab value ranges and associated clinical implications.
- Review the nursing process and delegation rights.
- Practice NCLEX-style prioritization using ABC and Maslow’s Hierarchy guidelines.