NCLEX-RN Examination notes updated A+ latest

NCLEX-RN Examination notes updated A+ latest 1 Pg 1. Index Pg 3. Lab values Pg 7. Medications Pg. 7 Anticholinergics Pg. 7 GI meds Pg. 8 Tuberculosis meds Pg. 8 Antiviral meds Pg. 8 Antipsychotics Pg. 9 Antidepressants Pg. 9 Stimulants (for ADHD) Pg. 10 Bedwetting/nocturnal enuresis meds Pg. 10 Lithium Pg. 10 Anticonvulsants Pg. 11 Respiratory Meds Pg. 12 Biphosphonates Pg. 12 Alpha Adrenergic Blockers Pg. 12 Antifungals Pg. 12 Antibiotics Pg. 14 Smoking Cessation meds Pg. 14 Alcohol Cessation meds Pg. 14 Magnesium sulfate Pg. 14 Antihypertensives Pg. 15 Muscle Relaxants Pg. 16 Type 2 diabetic meds Pg. 16 Antithyroid Pg. 17 Antianxiety Pg. 17 Opioids Pg. 18 NSAID’s Pg. 18 Neuropathic pain relievers Pg. 18 Corticosteroids Pg. 19 Antineoplastic/Anticancer Pg. 20 Diuretics Pg. 20 Electrolyte and CBC meds Pg. 21 H1 Receptor Blocker/Antihistamines Pg. 21 Anesthetics Pg. 21 Tocolytics Pg. 21 Uterotonic meds Pg. 21 Phosphodiesterase Inhibitors Pg. 22 Anticoagulants Pg. 23 Statins Pg. 23 Vitamins Pg. 23 Antiparkinson meds Pg. 24 Oral Poisoning meds Pg. 24 All other meds Pg 27. Viruses/Skin Conditions/Vaccinations 2 Pg. 34 Med-surg Pg. 34 Electrolytes and fluid: Pg. 36 cardiac/Heart Pg. 39 Respiratory Pg. 42 Gastro/GI Pg. 47 Thyroid Pg. 48 Gallbladder Pg. 49 Renal/Kidney and Adrenal Glands Pg. 51 Bladder/Urinary/Pelvic Pg. 54 Musculoskeletal Pg. 59 Blood and Circulation Pg. 62 Sugar/Diabetes Pg. 63 Alcohol and drugs Pg. 63 Liver and spleen Pg. 65 Wound Care Pg. 67 Neuro Pg. 70 Tubes and ventilators Pg. 72 Cancer Pg. 74 Catheters Pg. 76 Shock Pg. 76 Allergy Pg. 77 Anemia Pg. 78 Contraceptive Pg. 78 Eyes and ears Pg. 79 Other Diseases Pg. 83 Psych Pg. 83. Phobias Pg. 83. Stress disorders Pg. 83. Schizophrenia Pg. 85. Depressive disorders Pg. 85. Bipolar Disorders Pg. 85 Delirium/Dementia/Alzheimer’s Pg. 87 Childhood disorders Pg. 87 Personality Disorders Pg. 88 Eating Disorders Pg. 91 Maternity Pg. 91. Physiological Changes I Pregnancy Pg. 92 Tests Pg. 92 Weeks Pg. 93 Pregnancy Complications Pg. 94 Fetal Movement Pg. 94 Phases/Stages of Labor Pg. 94 Labor Info Pg. 95 Labor Medications Pg. 96 Labor Complications Pg. 96 Other Complications Pg. 97 Postpartum Assessment Pg. 98 Postpartum Complications Pg. 99 Newborn Assessment Pg. 101 Newborn Defects Pg. 102 Infant (till 1 years old) Pg 104 Pediatrics Pg. 104 Growth and Development Pg. 104 Congenital Heart Diseases Pg. 105 Congenital Anomaly Pg. 107 Acute Conditions- GI Disorders Pg. 107 Acute Conditions- Urinary Disorders Pg. 108 Acute Conditions- Respiratory Disorders Pg. 108 Acute Conditions-Neurosensory Disorders Pg. 109 Acute Conditions-Neoplastic Disorders (Tumors) Pg. 109 Infectious Disorders Pg. 110 Communicable Diseases Pg. 111 Chronic Disorders- GI Disorders Pg. 111 Chronic Disorders- Respiratory Disorders Pg. 111 Chronic Disorders- Hematological Disorders Pg. 112 Chronic Disorders- Musculoskeletal Disorders Pg. 112 Other Pg 115 Non medical 3 LAB VALUES NOTES VITALS Blood Pressure (120-140)/(80-90) Pulse/Heart Rate 60-100 Temperature 97.7-99 F (36.6-37.2 C) Pulse Oximetry 95-100% Capillary Refill < 3 seconds ABG (Arterial Blood Gas) Ph 7.35-7.45 Po2 80-100 MM Hg pCO2 35-45 mm Hg HCO3 22-26 CBC White Blood Count (WBC) 4,000-11,000 Platelets 150,000-400,000 Absolute Neutrophil Count (ANC) • Neutropenia is when it drops below 1000. If it is below 500 it is severe neutropenia and is a critical emergency. Eosinophil 1-2% Leukocyte • Leukopenia is < 4000 LABS Albumin 3.5-5 g/dL BUN 6-20 Creatinine 0.6-1.3 Hgh male 13.2-17.3 female 11.7-15.5 Alanine Aminotransferase (ALT) 10-40 U/L (0.17-0.68) Urine Specific Gravity 1.003-1.030 Erythrocyte Sedimentation Rate (ESR) <30mm/hr Cerebral Spinal Fluid (CSF) pressure 60-150mm H2O C-Reactive Protein (CRP)-means something is inflamed OTHER BMI 18.5-24.9 is normal Normal urine output is 0.5-1mL/kg/hr or > 30mL/hr CD4 count 500-1200 4 Glascoma scale –normal is 15 Deep Tendon Reflexes (DTR)- normal is 2+ TSH (Thyroid Stimulating Hormone- 0.4-4.2 • T3 70-204 • T4 0.8-2.7 HEART Fasting total cholesterol <200 LDL(low Density Lipoproteins)<150mg HDL (High Density Lipoprotein) >40mg Mean Arterial Pressure (MAP) 70-105 • MAP=(SBP +(2 X DBP))/3 • SBP= systolic blood pressure and DBP=diastolic blood pressure Troponin- indicator of myocardial infarction CK-MB- indicator of myocardial infarction D-Dimer- indicated pulmonary embolism BNP <100-if more than 100-it indicates heart failure Cardiac Output 4-8 Central Venous Pressure (CVP) 2-8mm hg Pulmonary Venous Wedge Pressure (PAWP) 6-12 mm hg Pulsus Pardoxus –exaggerated fall in systemic blood pressure of >10, during inspiration BLEEDING AND CLOTTING aPTT-Activated Partial Thromboplastin Time • Done while on Heparin • Therapeutic level on Heparin 46-70 seconds (1.5-2 times the baseline value) • If it is high-spontaneous bleeding could occur • It is the newer version of PTT PT-Prothrombin Time • Done while on Warfarin • Therapeutic Range is 11-16 seconds INR-International Normalized Ratio • Done while on Warfarin • Tells you how fast the blood is clotting • If it is high, it means that it takes a long time to clot so the patient can bleed out • If it is low, it means that it its slow so clots can form • Affected by: Antibiotics • Therapeutic level of Warfarin is 2-3 GLUCOSE/DIABETIC 5 • Fasting Glucose 70-100mg/dL • The target blood pressure for a patient with diabetes is < 140/90mm Hg • The goal HbA1c (Hemoglobin A1C) for a diabetic patient is < 7% and 4-6% for a non-diabetic. The HbA1c tells you the glycemic control over the past 3 months. • For a critically ill patient or someone receiving nutrition support like TPN-you want the glucose to be 140-160 and hypoglycemia occurs when the glucose drops to less than 70 ELECTROLYTES Sodium 135-145 Calcium 9-10.5 Phosphorus 2.5-4.5 Potassium 3.5-5 Magnesium 1.5-2.5 INFANT (0-1yr) Wet diapers 6-10/day, or 1 every 4hrs Infants urinary output - 2 mL/kg/hr Newborn head circumference 12.5-14.5 in (32-37 cm) Pulse/Heart rate 100-160 Respiratory Rate- 30-60/min Hemoglobin 12.5-20.5 g/dL Temperature Range 97.7-99.7F (36.5-37.6 C) Blood Glucose 40-60 mg/dL within the first 24 hours after delivery 6 RIGHTS OF DRUG ADMINISTRATION Right Patient Right Drug Right Dose Right TIME Right Documentation CRANIAL NERVES 1. I Olfactory (Smell) 2. II Optic (Sight) 3. III Oculomotor (Moves eyelid and eyeball and adjusts the pupil and lens of the eye) 4. IV Trochlear (Moves eyeballs) 5. V Trigeminal (Facial muscles incl. chewing; Facial sensations) 6. VI Abducens (Moves eyeballs) 7. VII Facial (Taste, tears, saliva, facial expressions) 8. VIII Vestibulocochlear (Auditory) 9. IX Glossopharyngeal (Swallowing, saliva, taste) 6 10. X Vagus (Control of PNS e.g. smooth muscles of GI tract) 11. XI Accessory (Moving head & shoulders, swallowing) 12. XII Hypoglossal (Tongue muscles - speech & swallowing) HINT to remember the Cranial Nerves: 7 MEDICATION NOTES KEY: Orange- new drug class. Bold-the meds/category under that class Anticholinergic- Side Effects: Constipation. Sedation (don’t drive/operate heavy machinery), dry mouth. A hint: can’t see (blurred vision), cant pee(urinary retention), cant spit (dry mouth), cant shit (constipation). Contraindications : closed angle glaucoma (increases intraocular pressure), bowel ileus, urinary retention, BPH. Examples of anticholinergics: • Many antihistamines, and TCA are anticholinergic. • Oxybutynin (Ditropan), Tolterodine (Detrol), Solifenacin (Vesicare) –They are also antimuscularic used to treat overactive bladder • Dicyclomine (Bentyl)-They are also antispasmodic, and used to treat IBS (irritable bowel syndrome) • Atropine-It increases the heart rate for patients with symptomatic bradycardia. It can also be given to dry patient’s secretions with the death rattle. Before giving it do ECG. • Scopolamine-It’s an antiemetic for motion sickness and controls secretion. If it is given transdermally-put on hairless, clean, dry area behind ear. Apply before traveling. Replace every 72 hours. Remove old one and put on new. Dispose old. Wash hands. It can also be given to dry patient secretions with the death rattle • Benzotropine (Cogentin)-It is used to treat EPS (extrapyramidal symptoms) from antipsychotic medications. PPI (Proton Pump Inhibitors) • Examples: Pantoprazole (Protonix), Lansoprazole (Prevacid), Omeprazole, Esomeprazole • If taken long term, it decreases calcium absorption and promotes osteoporosis (think risk for fracture) • It can cause diarrhea, pneumonia, and c. diff infection (because it suppresses acid and ruins normal flora) • Take 30 minutes before meals. • It can be given when upper GI bleed to reduce GI secretions Metoclopramide (Reglan)- is used for delayed gastric emptying, GERD, and an antiemetic. It increases GI motility and promotes stomach emptying. • Side effects: with long term use: sedation/fatigue, restlessness, headache, sleeplessness, dry mouth, constipation, diarrhea • Side effects that are dangerous and needs to be reported to doctor immediately: EPS-extra pyramidal symptoms like tardive dyskinesia. (To reverse EPS symptoms-Benztropine (Cogentin)). Antacid-for ulcers 8 • Sucralfate (Carafate, Sulcrate)- Give before meals with water. Give at least 2 hours before and after other medications. Fiber • Psyllium, bran Antidiarrhea • Loperamide (Imodium)- don’t use for more 2 days or if fever Tuberculosis- • All are hepatoxic except Ethambutol. So, you will have signs/symptoms like dark colored urine, jaundice, fatigue, and anorexia. So do baseline liver function test, Avoid alcohol and hepatotoxic drugs (like Tylenol) • Rifampin (Rifadin)- Symptoms (that are normal) red/orange body fluids (like tears, sweat..). So, wear eyeglasses not contact. Use non hormonal birth control because it can decrease the effectiveness of oral contraceptives. Take with meals. • Isoniazid--used to treat latent TB (if active TB