NCLEX-RN Exam Review Key Points

NCLEX-RN Exam Review Key Points

• ABCs of Priority Care: Focus on Airway, Breathing, and Circulation first; use C-A-B during CPR.

• Maslow's Hierarchy of Needs: Prioritize physiological needs, followed by safety, love/belonging, esteem, and self-actualization.

• Nursing Process Steps:

  • Assessment: Gather and verify data.
  • Analysis: Interpret data and determine diagnoses.
  • Planning: Prioritize and modify outcomes.
  • Implementation: Manage care and assign tasks.
  • Evaluation: Compare actual vs. expected outcomes.

• Normal Ranges for Hemoglobin & Hematocrit:

  • Hemoglobin: Male 14-18, Female 12-16; Newborn 14-24.
  • Hematocrit: Male 42-52, Female 37-47; Newborn 44-64.

• White Blood Cell Count: Normal range for both genders is 5,000-10,000; can increase due to stress or decrease due to drug therapy.

• Red Blood Cell Count:

  • Males: 4.7-6.1 million, Females: 4.2-5.4 million.
  • Exercise and high altitude can increase levels; pregnancy usually lowers them.

• Platelet Counts: Normal is 150,000-400,000; may increase with exercise or OC usage but decrease from hemorrhage or certain drugs (e.g., aspirin).

• Electrolyte Ranges:

  • Potassium (K+): 3.5-5, specimen care prevents false elevation.
  • Sodium (Na+): 136-145, avoid drawing from an infusing IV.
  • Calcium (Ca+): 9-10.5; Thiazide diuretics can increase levels; positive Chvostek and Trousseau signs indicate hypocalcemia.

• Urine and Blood Tests:

  • BUN normal range is 10-20; indicates kidney function with a 20:1 ratio with creatinine.
  • Creatinine: Male 0.6-1.2 mg/dL, Female 0.5-1.1 mg/dL.

• Blood Gas Analysis: AC pH: 7.35-7.45, AL pCO2: 35-45, HCO3: 22-26.

• Prothrombin Time (PT) Ranges: Normal PT 11-12.5 seconds; therapeutic range for Coumadin is 1.5-2 times normal.

• International Normalized Ratio (INR): Normal range 0.8-1.1; individual target ranges for conditions like Afib and mechanical heart valves.

• Nursing Responsibilities: Adhere to Standards of Care from Nurse Practice Acts, laws, and agency procedures; nurses must follow or report errors in HCP prescriptions.

• Advanced Medical Directives: Assess patient knowledge, integrate into care plans, and provide information on limitations for life-prolonging measures when recovery is not probable.

• Restraint Usage: Must ensure patient safety, requires written order, and mandates monitoring and documentation of alternatives tried and follow-up assessments.

• Fluid Volume Management:

  • Excess: Causes include CHF and renal failure; symptoms involve edema and elevated BP. Treat with diuretics and monitoring.
  • Deficit: Causes include inadequate intake and hemorrhage; symptoms include weight loss and oliguria. Treat with isotonic fluids and strict I&O.

• Electrolyte Imbalances:

  • Potassium (K+): Critical for osmotic pressure; imbalance can be life-threatening.
  • Sodium (Na+): Maintains osmotic pressure; fluid shifts depend on concentration variations.

• Hyponatremia: Defined as Na+ <135 mEq/L; symptoms include confusion and muscle cramps; manage according to underlying causes.

• Pain Management Categories: Non-opioids for mild pain, opioids for moderate-severe pain, and co-analgesics/adjuvants for neuropathic pain.

• Informed Consent: Essential for validity; must be competent, voluntary, and fully informed of the procedure and risks involved.

• Communication Styles in Leadership:

  • Aggressive/Authoritarian: "Do it my way."
  • Passive/Laissez-Faire: "Whatever...as long as you like me."
  • Assertive/Democratic: "Let's consider the options available."

• Five Rights of Delegation: Right task, circumstance, person, direction/communication, and supervision.

• Non-Pharmacological Pain Relief Techniques: Preferred options include TENS, heat/cold therapy, massage, relaxation, and guided imagery.

• Invasive Pain Relief Techniques: Options include nerve blocks and acupuncture for targeted pain management.### Hypernatremia

• Sodium level above 145 mEq/L.

• Symptoms: pulmonary edema, seizures, thirst, fever.

• Treatment: restrict sodium intake, avoid IV fluids containing sodium, and weigh daily.

Hypokalemia

• Potassium level below 3.5 mEq/L.
• Cardiac effects: rapid, thready pulse, flat T waves, fatigue, anorexia, muscle cramps.
• Treatment: IV potassium supplements (max 20 mEq/hr) and encourage potassium-rich foods (e.g., bananas, spinach).

Hyperkalemia

• Potassium level greater than 5 mEq/L.
• Symptoms: tall, tented T waves, bradycardia, muscle weakness.
• Treatment options: IV glucose with insulin, Kayexalate, and possibly renal dialysis.

Hypocalcemia

• Calcium level below 8.5 mEq/L.
• Symptoms: positive Trousseau's and Chvostek's signs, diarrhea, numbness, convulsions.
• Treatment: calcium and vitamin D supplements; slow IV calcium administration; increase dietary calcium.

Chvostek's Sign

• Tested by tapping the face just below the zygomatic bone.
• Positive response: twitching of ipsilateral facial muscles, indicating neuromuscular excitability from hypocalcemia.

Trousseau's Sign

• Tested by inflating a sphygmomanometer cuff above systolic blood pressure.
• Positive response: muscular contraction with wrist flexion and finger hyperextension, indicating hypocalcemia.

Hypercalcemia

• Calcium level above 10.5 mEq/L.
• Symptoms include muscle weakness, constipation, nausea/vomiting, dysrhythmias, and behavioral changes.
• Treatment: limit vitamin D, increase fluid intake, avoid calcium-based antacids, administer calcitonin, and renal dialysis if necessary.

IV Fluids Classification

• Isotonic: 0.9% NS, LR, D5W.
• Hypotonic: 0.5% NS, 0.45% NS.
• Hypertonic: D5 0.45% NS, D5LR, D5NS.

Lactated Ringer's (LR)

• Contains normal saline with added electrolytes.

Normal Saline (NS) Use

• Utilized for volume replacement (plasma).

Stages of Grief

• Denial, anger, bargaining, depression, acceptance.

Support for Grieving Individuals

• Encourage expression of anger.
• Respect cultural customs regarding death and dying.

Nosocomial Infections

• Infections acquired in healthcare settings due to microorganisms.

HIV Transmission Routes

• Unprotected sexual contact, blood exposure through drug equipment, perinatal transmission (during pregnancy, delivery, breastfeeding).

Nursing Assessment for HIV

• Confirm positive ELISA results with Western blot test.
• Use PCR for neonates and OraQuick for preliminary home testing; requires confirmation by a healthcare professional.

HIV Symptoms

• Initial flu-like symptoms appear 1 to 3 weeks after exposure.
• Progression to severe weight loss, secondary infections, cancers, and neurological diseases over 8-10 years.

HIV Management

• Monitor disease progression and immune function.
• Initiate ART to decrease viral load and increase T cell counts.
• Prevent/manage opportunistic diseases and complications.

Goals of HIV Drug Therapy

• Reduce viral load, maintain or raise CD4+ T cell counts, delay symptoms, and ensure compliance.

HIV Medications

• NRTIs: zidovudine, lamivudine, abacavir, emtricitabine.
• NtRTI: Tenofovir DF.

Antidotes

• Heparin toxicity: protamine sulfate.
• Coumadin toxicity: vitamin K.
• Ammonia excess: lactulose.
• Digoxin toxicity: digibind.

Alcohol Withdrawal Medication

• Librium as the drug of choice.

Pain Management in Narcotic Addicts

• Methadone is used for detoxification and pain treatment.

Potassium and Digoxin Concern

• Potassium can enhance the risk of digoxin toxicity.

Heparin Function

• Prevents platelet aggregation.

Cardiac Medications

• Medication of choice for V tach: lidocaine.
• Medication of choice for SVT: adenosine.
• Medication of choice for Asystole: atropine.

Nitroglycerin Administration

• Administer up to 3 doses (every 5 minutes); do not give if blood pressure is less than 90/60.

Preload

• Refers to the volume of blood returning to the right ventricle.