READY TO PASS ING. READY TO PASS INC. THE NURSING REVIEW CENTER Table of Contents Disclosure Statement_____ Review Course Objectives 3 About NCLEX 4 10 Essential Tools. 1 Quick reference guide of essential facts. 17 Physiological Integrity essential facts, 50 Maternal/ Newborn Care essential facts, 445 Pediatric Nursing essential facts 4159 Psychosocial Integrity essential facts, 176 | Practice Questions. 188 Quick Reference Pages Normal Lab values, 29 Common respiratory medications. 77 Overview of pharmacology, 124 LPN medication List 437 RN medication list, 138 Alphabet List 140 Mneumonics, 142 Common maternity medications. 158 Common mental health medications, 187 Practice Questions and Rationales. 188 Graphics: Louise Martin and Rebecca Rivera 1 ———READY TO PASS INC. About NCLEX ‘The NCLEX@ is designed to determine whether you meet the minimal standard to practice as a nurse. NCLEX@ is an integrated exam, which means the subjects are all mixed together. The test follows the April 2010 NCLEX® RN/April 2011 LPN plan. Questions are drawn from four categories, including but not limited to the topics listed below. The following test plan structure is copyright of the National Council of State Boards of Nursing, Inc. All Rights Reserved. |. Safe, Effective Care Environment 3 A. Management of Care - RN 16 - 22 % LPN 13 - 19% Providing integrated, cost-effective care to clients by coordinating, supervising and/or collaborating with members of the multi-disciplinary health care team. + Ethical Practice + Advocacy + Informed Consent + Case Management + Information technology + Clon Care Assignment + Inforaton seeuty * Collaboration with Interdisciplinary Team + Legal Rights and Responsibilities + Concepts of Management & Supervision + Performance improvement + Confidentiality (Quality Improvement) + Consultation + Referrals Process + Continuity of Care + Resource Management + Staff education | B. Safety and Infection Control - RN 8-14 % LPN 11-17% Protecting clients and health care personnel from environmental hazards. + Accident Prevention + Medical and Surgical Asepsis + ‘Disaster Planning/internal & External Pins = «Reporting of incidenEvent/Irregular + Emergency Response Plan Occurrence/Variance + Error Prevention + Safe Use of Equipment + Security Plan Ergonomic principles - + Handling Hazardous & Infectious Materials | F + Homo Safety crmmeaaeralt + Injury Prevention + Restraints/Safety Deviceser READY TO PASS INC. | Il. Health Promotion and Maintenance- RN 6-12% LPN 7-13% Providing and directing nursing care of the client and family/significant others that incorporates the knowledge of expected growth and development principles, prevention and/or early detection of health problems, and strategies to achieve optimal health. + Aging Process + Health and wellness + Ante/Inira/Postpartum and Newborn Care + Health Promotion Programs + Data collection techniques + Health Screening + Developmental Stages and Transitions + High Risk Behaviors + Disease Prevention + Human sexuality + Expected Body Image Changes + Immunizations + Family Planning + Lifestyle Choices + Family Systems . "Principles of Teaching & Learning Self Care + Growth and Development + Techniques of Physical Assessment” Ill. Psychosocial Integrity- RN 6-12% LPN 7-13% Providing and directing nursing care that promotes and supports the emotional, mental, and social well-being of the client and family/significant others experiencing stressful events, as well as clients with acute or chronic mental illness. + AbuseiNeglect * Religious and Spiritual infuences on Health + Behavioral Interventions + Sensory/Perceptual Alterations * Chemical & Other Dependencies + Situational Role Changes + Coping Mechanisms + Stress Management + Substance Related Disorders Support Systems I + End of Life Concepts + Suicide/Violence Precautions * Family Dynamics + Therapeutic Communications — * Grief and Loss * Therapeutic Environment + Manta Heath Concepts : + Psychopathology Unexpected Body Image ChangesREADY TO PASS INC. IV. Physiological integrity 3 A. Basic Care and Comfort: RN 6-12 % / LPN 9-15% Providing comfort and assistance in the performance of activities of daily living, +Alternative and Complimentary Therapies + ‘Nutrition and Oral Hydration + Assistive Devices + Palliative/Comfort Care + Elimination + Personal Hygiene lit + Rest and Sleep B. Pharmacological and Parenteral Therapies: RN 13-19 % / LPN 11-17% Managing and providing care related to the administration of medications & parenteral therapies. + Adverse Effects/ Contraindications and Side + Medication Administration Effects: + Parenteral fluids + Blood and Blood Products * Pharmacological Agents/Actions - + Central Venous Access Devices + Pharmacological Interactions Pharmacological Pain Management ‘Total Parenteral Nutrition + Intravenous Therapy C. Reduction of Risk Potential: RN 10-16% LPN 9-15% Reducing the likelihood that clients will develop complications or health problems related to existing conditions, treatments or procedures. + Diagnostic Tests — te + Potential for Complications from Surgical + Laboratory Values Procedures and Health Alterations + Monitoring Conscious Sedation + System Specific Assessments * Potential for Alterations in Body Systems + Therapeutic Procedures + Polenta or Compzatons of agnosie eo D. Physiological Adaptation: RN 11-17% LPN 9-15% Managing and providing care to clients with acute, chronic or life- threatening physical health conditions. * Alterations in Body Systems + Medical Emergencies * Hemodynamics + Radiation Therapy + Illness Management + Unexpected Response to Therapies * Infectious DiseasesREADY TO PASS INC. ABOUT THE EXAM «The test is computer based; you will be required to use a mouse to select the correct answer. «There is an on screen calculator available to calculate medication dosages. «Once a question is answered you will not be allowed to change it. « NCLEX®is.a computer adaptive test which means itadjusts based on the answers you provide to previous questions. For example you will receive more difficult questions if you answer correctly but easier questions if you do not ‘tis very important that you do mot guesse tis better to take more time to answer correctly than to choose answers randomly, Attimes, content tested may be similar to a previously answered item, you should not assume that the first iter was answered incorrectly. The concepts may address different phases of the nursing process. Always select the answer believed to be correct. | Sichours are allotted for the RN exam to complete a minimum of 76 to @ maximum of 266 questions. Of these items, 15 are pretest items that are not scored. The LPN exam allots 5 hours and has 85 to 205 questions. There are 25 pretest items on the NCLEX PN exam. However you should stick to the rule of allowing 1 minute per question. The analysis level questions may require more than one minute in order to synthesize all of the information given. The length of an exam is not an indication of a pass or fail result. The computer will stop when it has been determined with 95% certainty that the candidate's ability is above or below the passing standard.READY TO PASS INC. ESSENTIAL TEST-TAKING TECHNIQUES Critical Thinking Is the Key To Successfully Answering NCLEX® Questions! Determine what the question is asking. Identify the topic of the question. [Determine the relevance of the facts about the client. For example, the client may not be the person with the health problem — it may be the spouse, a relative, a member of the health care team. |Rephrase the question, if possible. Do not read into questions. [Select the best option after eliminating incorrect choices. Focus on the last line of the question, as invariably what the question is asking will be found there. Look carefully for facts about the client, for example, age, gender, medical history, medications, psychological status. These will provide clues as to what the question is really asking, Donot answer questions based on your personal experiences. Critical thinking requires that you think purposefully Iwith outcome directed goals. Your thinking must be aimed at making judgments based on scientific evidence rather than tradition or guessing. NCLEX® is based on textbook knowledge not individual varied experiences. [Don’t be too hasty to choose “Notify the health care provider” as the answer. Is there some action, some part of the nursing process that you can perform before calling the physician? iRead every word in the question and each of the answer choices, looking for key words. Key words in the stem of the question will provide clues as to the type of response you are seeking, Please study the following key words and look for these in the question stem. Then rephrase the question to find out what itis really asking.READY TO PASS INC. Remember PAIN | PRIORITY/ FIRST: This indicates that you must determine the most essential respons [_ ‘Tools helpful to answering these questions include: 1. The developmental phases of Erkison (if age is designated) 2. The theorist Orem (Universal Self Care Needs) 3. Maslow (Hierarchy of Needs) 4, Nursing Process (assessment first) 5. ABC's (airway, breathing, circulation) 6. 7. 8. 9 Time . Expected/unexpected Safety Disaster & triage JaNTICIPATE: or most appropriate, correct, expected, should, include, instruct. These all indicate you are looking for a correct or expected response. INTERVENE; or requires follow-up, needs or requires additional teaching, avoid, notify health care provider, allindicate that you are looking for an incorrect or unexpected response. may imply you are currently in one phase of the nursing process and must proceed to the next one. Remember ADPIE (Assessment, Diagnosis, Plan, Intervention, Evaluation). PREPARING FOR THE EXAM "Study consistently, at least 2-3 hours a day. Practice time management: allow 1 — 1.5 minutes per question. ‘Apositive attitude is essential for success! p a study plan and remain focused. iintain a quiet, well-lit setting. oid distractions. ture adequate rest, as sleep deprivation can prevent you from focusing.READY TO PASS ING. SAMPLE QUESTION The nurse in a well-baby clinic has assessed several children today. It would be a priority for the nurse to suggest follow-up for the child who is: — ' Tico fr amauen Hh rena ae A. 2 months old with a positive Babinski reflex \2 B. 5 months old and cannot hold her/his own bottle we es 0 months old and cries among strangers ey ic) (B51 months old and needs support while ambulating 0" o) ‘The phrase “follow-up” indicates that you are looking for an incorrect response. Which of the previous choices. are not expected for the corresponding age or level of development? Knowledge of growth and development will help you select the most appropriate response. Note: The correct answer is (d). At 12 months, a child should be able to walk on her/his own or with one hand supported. SAMPLE QUESTION “The nurse is teaching a client about crutch walking. Which of the following statements, if made by the client, indicates an understanding of teaching? AL tat oot : A. “My elbows should be flexed 45 degrees while walking.” - 30° “When I climb stairs, | advance my affected leg first, with my crutches.” - sce<\ '*s\ vet ‘1 do not apply pressure under my arm when | use my crutches.” bed, ee D. “When | go to sit in a chair, | put both crutches in the hand of my affected side.”- -~“/f°” The phrase “understanding of teaching” indicates you are looking for a correct statement, that is, one choice Is true, while the other three are Incorrect. Knowledge of ambulation with crutches will allow you to select the correct or true statement. Eliminate all the false or incorrect choices first! _Note: (c) is true, and the other three are false. Therefore, (c) is correct. (Syotemien /F, 20/2. Schedule your test within 1 month after course completion! For information on scheduling or rescheduling your exam: * National Council of State Boards of Nursing: www.nesbn.org or 1-518-474-3817 /1-866-293-9600 *Pearson Testing Centers: www.pearsonvue.com or 1-866-49NCLEX “Unofficial test resulls available 48 hours after testing (cost $7 - $10) 1-900-776-2539ESSENTIAL TOOLSREADY TO PASS INC. Tool #4 Maslow’s Hierarchy of Needs HINT: Remember. Procter.) Esteem Needs eins) Pebaribe bless Cuoco) 12TOOL #2 ERIKSON’S THEORY OF DEVELOPMENT | does not. READY TO PASS INC. | Erikson believed that 8 major conflicts must be encountered during a lifetime, and that there are 8 developmental stages, each with a task that is to be achieved, that characterize a person's struggle each of these conflicts. Either @ person successfully resolves the crisis and masters the task at hand, or eel Sa Preemie) TASK | 1s Infancy (0-18 months) ‘Trust vs. Mistrust | succes lation Unsuccessful Resolution of Crisis Trust in people and hope about the | Difficulty relating to people; ‘Attachment to the primary care giver future suspicion; fear of the future 2. Toddler (18 months to3 years) | Autonomy vs. Shame & Doubt ‘Successful Resolution of Crisis Unsuccessful Resolution of Crisis _ Sense of self control and adequacy; _| Fear of independence, severe self- bet eee ‘environment will power doubt Ne oe 3.Pre School (3-6 years) Initiative vs. Guilt ‘Successful Resolution of Crisis, Unsuccessful Resolution of Crisis Ability to initiate one’s own Sense of inadequacy or guilt. Becomes purposeful and directive activities; sense of purpose case aia, [etic | a. School Age (6 -12 years) Industry vs. inferiority Successful Resolution of Crisis ‘Unsuccessful Resolution of Crisis Competence, ability tolearn and__| Sense of inferiority difficulty learning | Develops social, physical and schoo! skills ~~ _| and working, 0 ars identity vs. Role Confusion Z si ‘Successful Resolution of Crisis Unsuccessful Resolution of Crisis Sense of personal identity Confusion about self, identity submerged in relationships or group memberships Develops sense of identity gong, renda le Intimacy vs. Isolation Unsuccessful Resolution of Crisis Emotional isolation; egocentricity Establishes intimate bonds of love and. Dissatisfaction with life friendship Generativity vs. Stagnation z Unsuccessful Resolution of Crisis st Fulfil goals that involve family, career, Selfabsorption; inability to grow as a person beth hae ee ears a Unsuccessful Resolution of Criss Looks back over one’s life and accepting its meaning.» Ub lrsrat 2 FU operREADY TO PASS INC. TOOL#3 THE NURSING PROCESS This process con: sts of the following, in this order: | 4: Assessment | 2: Diagnosis (Analysis) | 3: Planning | 4: Implementation | 5: Evaluation 4, ASSESSMENT: ee | "TRE Words that mean to assess:\Ghack Look Ask Monitor Insect Evaluate (CLAMIE) 1. Assessment is done primarily by the RN. “a 2. BUT the LPN must understand this process because the LPN collects data, a critical role in assessment. 3. Types of data to be collected: History taking “Objective data: observable, measurable (vital signs) “Subjective data: symotoms experienced by client (‘My throat hurts") Data collected from the chart 4.Confirm data collected. 5.Communicate information received in the assessment. . DIAGNOSIS (ANALYSIS): 4. Identify actual or potential health care needs andor problems based on your assessment. 2. Interpret the data: validate, organize and determine if there is a need for more data collection. 3. In this phase, the nurse uses data to formulate a nursing diagnosis. [Ego DETERMINE CLIENT'S UNIQUE NEEDS PLANNIN 1..This is done to provide client care consistently and appropriately. 2. Ask yourself the following questions: What is the priority? How does this determine the client's needs? How will this affect the care the client is getting? 3. This is when the nurse: determines goals, formulates outcome criteria, develops a plan of care and collaborates with other health care professionals (the Interdisciplinary approach). IMPLEMENTATIOI To begin to do something...and then doing it! 1. Prepare: organize client's care, gather equipment, and explain procedures to client. 2. Counsel and Teach: directed at the client, their family members, significant others, and other members of the health care team. Perform: follow procedures, infection-control and OSHA guidelines, monitor client's response to care given. | After Care is Performed: make client comfortable, and then replace any equipment no longer needed. Record and Report: document everything accurately. The LPN reports findings to the RN. Teports abnormal findings to the health care provider. -UATION: the need been met? pare actual outcome with expected outcome. /aluate the problem list with the rest of the health care team. ae Evalvare the Plana as LC gt ph of READY TO PASS INC. | % Q Lega PP YF TOOL#4s “Fe oF TOOL#S REMEMBER THE ABC's fg THERAPEUTIC COMMUNICATION: (A. Remember to establish a patent airway 1, Remember to —_ utilize therapeutic for your client. communication: choose the response that B. Be sure your client is breathing. allows the client to express his needs, C. Check to see if your client has good fears or concerns. Leta 2. BUT, mental health questions may be handled Do not wait until there is a crisis to assess differently. For example, if an RN suspects for ABC’s!! suicide is an issue for her/his client, then direct questioning is required (e.g., you want to hurt yourself?”) TOOL #5 3. Inmental health cases, reality orientation may lt gE TE} TED also be called for. 1. Determine what the stem of the question is asking. 2. If 3 of the 4 choices given are correct, or TOOL#9 are expected findings, then you should choose the unexpected finding. The nurse must be concerned with the 3. If 3 of the 4 choices given are incorrect, or following ‘are unexpected findings, then you should UNIVERSAL HEALTH CARE NEEDS: choose the expected finding. 1. 2 ; 3. TOOL#S — 4 a Syaislty i The client most recently admitted is not ways seen first! 2/2 +9 te 7 @ck the client first, then the equipment! AIR: oxygen, airway, temperature WATER: dehydration, fluid volume excess. FOOD: malnutrition, feeding concerns. ELIMINATION: proper evacuation ofbladder and bowel. REST: sleep, comfort and freedom from “pain (not always a low priority). SOCIALIZATION: the right balance of solitude and social interaction must be struck HAZARDS: safety must be provided for. Sagt ey Remember: AWFERS Sc READY TO PASS INC. i) PRIORITY #4 > ea BLACK Life-threatening May require immediate | Treatment is needed _ | Injuries are intensive! injuries survivable with | attention, but can in hours to days. Chances of survival | minimal intervention. | sometimes wait for Client may be moved | are unlikely. hours. away from the triage | Give comfort, separate |+ Chest wounds area. | from others but do not Airway obstruction + Abdominal wounds: abandon Shock | without evidence of Pneumothorax | hemorrhage | Upper extremity + Penetratinghead | 2nd & 3rd degree Sof tissue injuries fracture wounds | burns to 15 ~ 40% of + Minor burns + Burns in excess of the body + Genitourinary injury |- Sprains 60% of the body + Eye injury + Small lacerations | surface area (BSA) Key Words + CNS injuries | without significant |. Seizures or vomiting = Anxiety | bleeding | within 24 hours of | * Apprehension | + Psychological exposure to radiation Restlessness | disturbance + Profound shock with Confusion Change in LOC. | istsin |p icp) | | caloh sche bruathing $ black 12 Plack Teag cleorttr 4 amy therd briathing Once) lan + Cet Fo ... WORDS OF WISDOM..... A wise person would not attempt a job without tools and the proper equipment. Why should you? Consistent studying to understand CONCEPTS is essential. You cannot memorize answers and questions from previous exams! You cannot cram to understand...ESSENTIAL FACTSREADY TO PASS INC. WHAT IS YOUR ROLE? ‘THE ROLE OF AN/RN: 1. Assess clients. Fresh post-operative clients + Clients with a change in conaition who need assessment *Admissions + Discharges “+ Transfers aacieneal 4, Assess available staff and their job descriptions. 5. Perform the most complex procedures, for example: + Starting IV's =U « Interpreting EKG's *'°'Y + Correlating lab values - ; otyaparagea. 0 only RN. 3, non-skiled care, such as bed baths, bed making, route vital signs, enemas,[ READY TO PASS INC. LEADERSHIP AND PROFESSIONAL ISSUES TYPES OF LEADERS: Laissez-faire: Offers little if any guidance. Autocratic / Authoritarian: Strict. Democratic: Consults with staff. PROFESSIONAL ISSUES: + Chain of command + Delegation to UAP’s + Taking verbal orders + Effective communication * Documentation Trefitostnoa tpt eases pen to never delegate the teaching or evaluation ae patient care. ‘The RN is ultimately responsible for all tasks delegated to UAP's. Be aware of the competence and job description of those to whom you delegate. Communicate effectively. The nurse must be sure to follow up on all tasks that were delegated. Ifcriticism is necessary, provide privacy. . Document unsafe practices and procedures. ). Manage your time effectively. Cerone RIGHTS OF DELEGATION TASK ———————> _ CAN YOU DELEGATE THIS TASK? RSON —————_———» IS THIS PERSON COMPETENT? IMMUNICATION —————» _ DID YOU GIVE CLEAR DIRECTIONS? JPERVISION/ FEEDBACK _ DID YOU MONITOR, EVALUATE, AND PROVIDE FEEDBACK? lurse client relationship is a legal status that occurs whenever a nurse renders care to another is relationship occurs, the law automatically imposes certain legal responsibilities upon the nurse.{ READY TO PASS INC. TERMS TO KNOW: VERACITY: Adherence to the truth. LIABILITY: The obligation one incurs or might incur through acting or failing to act. MALPRACTICE: Improper use of one's professional duties; a failure to meet care standards that causes harm to another person. NEGLIGENCE: The failure to provide care that a reasonable person would perform in similar circumstances. LIBEL: Defamation by written or printed words or pictures. "SLANDER: Defamation of character by speech [ACTS OF OMISSION OR COMMISSION: Doing wrong b) ral acting; doing wrong by selina, BENEFICENCE: To do good. Examples of beneficent actions: resuscitating a drowning victim, encouraging ‘smoking cessation. : To do no harm. Example of a non-maleficent action: stopping a medication that is , for example, a client is made to believe they cannot leave a bed, room, or floor. Also, the unauthorized Hf physical (e.g., lap tray) or chemical (e.g., sedatives). HINT: Authorized physical restraints must be be obtained from a client or their health care proxy for any invasive procedure. It is obtained by ire provider (physician), while the nurse's role is to insure the consents signed and in the chart procedure. (Assent = Consent) “Hicatth Care novicles /eathvo at eretiolune, et musk * ‘the medical team must maintain the privacy of the client's medical record as well as her! Physical privacy, for example, close the curtain or door when the client would otherwise be from parental custody and can become an “adult” in many ways. When a minor marries umed forces (with parental consent and permission from the courts), she/he becomes om her/his parents.READY TO PASS INC. MORE ABOUT LEGALITY 4. GOOD SAMARITAN LAW: This act protects those persons who choose to aid others who are ill or injured from liability. It does not cover gross negligence. 2, INCIDENT REPORTING: Reports unusual occurrences and deviation from care standards. Facilities use the document to evaluate care, determine potential risks or discover system problems that might have contributed to theeror. Vives sreceol in Charh~ gwen te manage- — siver 7 mnenosimen + 3. HARRISON NARCOTIC ACT OF 1941: This act classified certain habit forming drugs as narcotics and began to regulate them. It was later replaced by the Comprehensive Drug Abuse Prevention and Control Act of 1970. |. ADVANCE DIRECTIVES: are written instructions recognized under state law that are related to the provision of care a person wishes to have when she/he cannot make decisions themselves. Living wills GEVERAL Prepared by a competent adult and gives health care directions in the case when that person is unable to make decisions on their own. Durable power of attorney / health care proxy: Documents that specify who will make your health care decisions if you cannot. medical di I: Competent client consults with health care provider and specifies the kind of medical care they do/do not want in specific scenarios. : The Health Insurance Portability and Accountabi cots the confidentiality of a patient's health care information. It requires physicians, nurses, ls and other health care providers to inform clients how their health care information is used disclosed. Health care provider determines if organ is suitable before approaching family, Organs should be removed within one hour of the client's death. Each hospital has its own protocol regarding organ donation. Next-of-kin/closest living relative makes decisions when client cannot. direct assestent, dcdemninn cases, Infeeans ef Samana eres Stand ors m| RELIGIOUS AND SPIRITUAL INFLUENCES ON HEALTH READY TO PASS INC. BELIEFS AND PRACTICES HINDUISM RELIGION JUDAISM (ORTHODOX) Visits to dying are a religious duty ‘Autopsy: Only in special Awitness must be present at death to protect family and commit circumstances soul to God Torah and psalms read, prayers recited Conversation is kept to minimum Water is removed from the room Mirrors may be covered at family’s request — Buddhist priest present at death > Last rites chanted at bedside May prefer same sex wash body fopsy: Only for medical or legal reasons Before death, Koran read, prayers said + Dying confesses sins, asks. ev to oy : CATHOLIC = Sacrament of Sick administered to severely ill, those near death, newly dead RCH OF CHRIST (MORMON) + No ritual performed before or after death + NS urgida procedures; no autopsy + Morita! performed befor oy after death 'S WITNESS /: Only if required by law + No ritual performed before or after death + Clergy ministers through counsel and prayer + _ No blood or blood products accepted + Last rites optional + Last rites optional + Last rites mandatory and given by ordained priest Value silence + Head is considered sacred-do not touch the he Believe in yin (dark, cold) & yang (bright, hot “coldREADY TO PASS ING. RELIGIONS AND DIETARY PRACTICES 7TH DAY ADVENTISTS : (CHURCH OF GOD) + Some groups pro! it meat. Pork is prohibited. BAPTISTS + Alcohol prohibited, coffee, tea discouraged. — BUDDHISM. + Alto! and drug use discouraged + Some sects are vegetarian. ROMAN CATHOLICISM Avoid meat on Ash Wednesday and Good Friday. E CHURCH OF JESUS CHRIST OF LATTER DAY SAINTS (MORMON) + Limited consumption of meat. Avoid spices. Fasting is done on the first Sunday of each month. "Beef and veal prohibited, limited meat consumed. Many individuals are vegetarians. Fasting occurs on specific days of the week, depending on which god a person worships. * Children are exempt from fasting. + _ Fasting can be complete abstinence to one meal a day. ~ Pork is prohibited as is any meat not ritually killed. Alcohol and drugs are avoided. During Ramadan (9th month of Mohammedan year) fasting is practiced during the daytime. “Food to which blood has been added is prohibited Can consume flesh that has been drained of blood. + Orthodox believers adhere to dietary Kosher rules. + Meats that are allowed come from animals that are vegetable eaters, cloven- hoofed and ritually slaughtered. . (kinda clon cine (con have: white fish, halibut, haddock, canned tuna, sardines). dole + Sea scavengers, such as shrimp, are not allowed. + The combination of meat and milk is prohibited. + 24 hour fasting is observed on Yom Kippur. + Pregnant women are exempt from fasting + During Passover Week, only bread that is unleavened is permitted. + Alcohol is prohibited. * Avoid food to which blood has been added. +__ Some individuals avoid pork. + Meat and dairy are abstained from on Wednesday, Friday and during Lent. + During Lent, all animal products are abstained from. + Fasting is practiced during Advent. The ill or pregnant are exempt from fasting.READY TO PASS INC. HERBAL REMEDIES AND MEDICAL IMPLICATIONS HERBAL REMEDY / USES MEDICAL IMPLICATIONS. + Topical antiinflammatory for bums, abrasions |‘ |t ingested, may cause Gl upset Helps with tssue inury ‘Avoid with ragweed all + Blood purifier that fights colds, infections and | + cancer iia \ | SEU + Caution with HTN, DM, clotting disorders - Bere : capac) + Hypertension + May increase effect Benign Prostatic Hypertrophy Se ee ‘pam jou ing ‘oid with ETAL and ath mreunosuppression IA KAVA + Decrease anxiety and stress + Improves. IO sation + Improves attention span +_Takes 6-8 weeks to see results GINGER jj ot + Reduces morning sickness, nausea + Used to treat bums Increases effects of Barbiturates - < Used for migraine headaches and arthritis. Contraindicated in pregnancy _ Used for peptic ulcer, GERD, weight loss, Sczema, canker sores May increase blood pressure Avoid with ACE inhibitors, steroids, digoxin JREADY TO PASS INC. MISCELLANEOUS KEY POINTS COUMADIN T the tisk of bleeding when taken with: Chamomile \ Clove \ Dong Quai Ginger \ Ginseng \ Fever Few \ Licorice Saint John’s wort hs MADIN! Clients should AVOID THE SUN with the following: _ (Other phrases: avoid the beach, wear long sleeves, wear sunglasses, wear a wide brimmed hat) + Thorazine (chlorpromazine) «»/ esyehe4/< + Retin A (retinoic acid) + Bactrim (trimethoprim) a> -#9/"« ¢ 9 Griseofulvin (grifulvin) Exopthalmus (bulging eyes) Aveo“ "= Saint John's Wort Lupus Duragesic Patch (Fentanyl) yoo Cipro (ciprofloxacin) a» cba ebgofen chron iagra (sildenafil citrate) lucotrol (glipizide) alone “#3 aorky the one (amiodarone): discolors the skin blue- gray ladryl (dipenhydramine) a4) us vin eine: donot give to pregnant women or children under eight ait stains the teat luai: treats menstrual cramps, menses, as muscle relaxant; blood purifier, manages {avoid with bleeding & clotting disorders) (Loops & thiazides)READY TO PASS INC. MEDICATION CALCULATIONS REMEMBER: Microdrip = 60 gtts/m! Standard IV Set= 15 gtts/ml Blood Administration = 10 gtts/m! Ve in ml (e.g. 1: 4.Calculate an IV Infusion: Time in Minutes ‘To administer 500 mi of IV fluid in 8 hours using a microdrip_ ‘Sample Question: set, how many drops/minute will you administer? Answer: 500 (volume) x 60 (att factor) = 63 gtts/min. (rounded up from 62.5) 8 hours x 60 minutes (time in minutes) | 2. Calculate Parenteral Medications: ired Amount x Total Volum: Desire = order, prescription, want. give. Total Amount of Drug on Hand Have = on hand, available You have on hand Benadryl 50 mg / 2 mi. The prescription reads: Give Benadryl 25 mg IM STAT. Answer: 25 mq (desired amount) x 2 (total volume) = 1 ml 50 (total amount of drug on hand) Sample Question: = or iption, want, give Calculate Oral Medications: on hand, available The prescription reads: Administer Albuterol 6 mg po, tid. ‘Sample Question: On hand is Albuterol 2 mg tablets. mount) = 2 (dosage on hand) Desire xX Weight (kg) X Mi Have The prescription reads: Administer Dopamine 3meg/kg/min. On hand: Dopamine 800mg in 250 mi DSW The client weighs: 80 kg The IV should run at mi/hr 3meg X 250m! X 80kg X 60 minutes ‘800mg Convert meg to mg........-. 0.003mg X 250ml X 80kg X 60 minutes 800mg The IV should run at 4.5ml/hrGee eRe e Cee eee READY TO PASS INC. | Volume Weight (tsp 5ml 11mg 7,000 meg 7eup 240 ml 7 ome i tbsp 18 ral 4igm 1,000 =1ml 4 pint 473 mi ” pera 1oz. 30 ml kg 2.2 Ibs 4 quart 946 ml aL 4 kg = 1,000 mi CT 15-16 gtts 15-16 minims = 1 ml [i516 os sample Question: Ifa child weighs 35 Ibs., how much do they weigh in kg? ‘Answer: 22ibs = 35lbs 2.2x=35 x= 15.9k9 tkg xkg SAMPLE QUESTION scription reads: Administer Drug A 4mg/kg every 8 hours intravenously hand: 100mg in 50m! Normal Saline ; many mi/dose. WER: sf 286 Ibs to kg 286 + 2.2 = 130kg 430kg X 4mg = 520mg ulaDXV §20X 50 = 260ml/dose 400 BMI= weight in pounds. X703 (Height in inches) X (Height in inches) BMI < 18 Under Weight < 18.5 Thin for Height 18.6 - 24.9 Healthy Weight 25.0 - 29.9 Overweight for HeightREADY TO PASS INC. at. 13. 87 410, Prescription: 1,000 units SQ 202 _Imah Drug Available: 10,000 units / ml UT TBece Give_D. | mi Prescription: 0.6 mg IM Orem m\ Drug Available: 1 mg / ml 1 Tes Give 0.6 mi Prescription: 50,000 meg IM IH OOS RUG Drug Available: 10,000 meg /ml =~ aor Give Smt Prescription: 0.03 gm SQ O.OSs _18mz Ant Drug Available: 15 mg/ mi = ve 155 Give 2m Prescription: 500 mg po goo eb Drug Available: 250 mg / tab { aSoea Give_Z_tab(s) Prescription: 2. gm po 28 tab Drug Available: 0.5 gm/ tab t ov oe Give 4 tab(s) Prescription: 10 meq Ont te Drug Available: 5 meq/ tablespoon | Soey Give_2._ tbsp. 1 00. dele Prescription: 600 mgpo @20=2). __{ge= Drug Available: 0.3gm/tab | 180O™§ + Sw Give_Z_tab(s) 4mg=2mi,8mg=4\_ ml 4 Seid 2a Sarah drinks S cups of water, 120 cc of broth, 12 cup of pursed chicken, and a'oz of tea. Her total intake = "BEY ec S40 Prescription: Theophylline 160 mg poq 6h. [u Wek Drug Available: Theophylline 80 mg / 15 mi. “— os Give_30_mi Prescription: 300 ml Dextrose IV to infuse over 10 hours. Drop Factor: 10 gtt/ml. 3e0. ISIS Blow Rate =__S_gtt/ min Yous Prescription: 100 mi RL to infuse at 200 ml / hour. Drop factor: 15 gtt / ml. Boa es be Flow Rate=_S®_gtt/min = rok Dain Prescription: Insulin 6 Units/hr Bag available: Insulin 50 Units in 100 mi How many mi/hr__ V2. o, Oveks. 1b.) Re 1m 0%@ “OL es, SO vite Saez °s0 24M ZE bb 160 oO wz-v0 "uw #sn6 05 “Eb sqe 2 “80 Iw s "£0 un 7 398 § “Zi suoodsoigsi z-20 wg0'z0 moe “LL sa p80 worl 28atont 110 chum = give Voronin CO #8 Ly can comer Conetpationr Qrremin ~ poller, achorin, 7abivyes, rahasr , gue + blood 1a ean model caren pale WBC - ahh “perce + dof famernseon Ly jonetur CCiukirma ~TwRe - bt serrata, OT | yermrelrepenee eee Yoo - PwBC comms actin IRC ont Dinu & Papier > oo Seel- — yee oopeg 6 _ sal Kr act ° Ay elareets Meee Coen 7 Pee a fH = Hpotyed - of yak ° 7 mee eee hem Lyysning = wor’ pancy FORhO A?(Nor - READY TO PASS INC. PORTANT LAB VALUES rmal Ranges Vary by Resource) CBC (Complete Blood Count): Hematocrit (HCT): Hemoglobin (HGB): White Blood Cell Count: Red Blood Cell Count (RBC): 35 - 45% (female) 40 - 54% (male) 12-16 g/dL (female) 14 - 18 g/dL (male) 5,000 - 10,000 cells/mm? 4-5 million Kavendan Jet Abe ip we CBC. Platelet Count: 140,000 - 400,000/mL ae tts B Lymphocytes: 40 - 20% C3 a Block 60 - 80% - est T Lymphocytes: CD4 < 200 signifies AIDS —————-> increased risk for opportunistic infection. HIV kills CD4. cells which results in a significant impaired immune system. INALYSIS: Normal Color : “Yellow - Straw ecific Gravity: 1.005 - 1.030 5.0-8.0 MISTRY: Adult 135-145 mmol/L 95-110 mmol/L 60-120 mg/dL = 2-114 of 7lele= Om 3.5- 5.5 mEqiL - 8.0- 25 mgdL= BLN T olkyovation 4 FENAt anions 0.6-1.5 mgd cceatmete Gun T= Kid creatine icc, 22-34 mmol/dL 9.31 - 10.9 mg/dL 53-123 U/L “Increased in pancreatitis" 7.0 - 60 U/L “Increased in pancreatitis" ; 13-24 mgdL ys wenceve a creants J,“ RAPOCAIEIR 35-65 mgidL %\. ver dewerses 3.5-7.8 mgidL 1. aor A513 KAUIGL or ereqynn in hepatic dysfunction, Paget ’s disease & prostate cancer** 5-35 1U/L 0-35 IU/L 0.1 - 1.0 mg/dL (Adult Normal) 1.2 mg/dL (Adult Critical Value) 1.0 - 12 mg/dL (Newborn Normal) 15 mg/dL (Newborn Critical Value) “Requires treatment usually phototherapy** 4% - 6% aatibrakes SM Bre 2 bees fron 2 atl sles, sind bY \ 29 (ansirobe 4 asrohcy BIA collvce shevid be Hoken from yen NST ew (Ua) wow (UNEREADY TO PASS INC. HEMISTRY: Chitd Glucose Calcium Billirubin Platelets 40 — 125 mg/dl. 8.010 mg/dL 0.2-1.4 mg/dL 150,000 ~ 450,000 met. NORMAL Bugop GAS: ——————> REMEMBER! ROME / RAMS: 7.35 — 7.45 Pao2 80 — 100 mmol/L. PaCO2 35-45 mmol/L Hos 22-26 mmol/L sa02 > 95 % Acid - Base Imbalances eo” on pH Paco2 HCO3 | Respiratory Acidosis <7.35 > 45 mmHg na | Respiratory Alkalosis > 7.45 <36 mmHg nla | Metabolic Acidosis <7.35 nla <22 mEq/L jetabolic Alkalosis > 7.45 na > 26 mEq/L. BAMPLE QUESTIONS Label the acid — base imbalances: 1.4pH = 7.20, C023 64, HCO3 = 26 _#/ny, Aenctore’s afffor =7.50, co2 =95, 1003432 77) latrolic, (Dkolooes 3.ypH =7.30, C02 = 38, HCO3618_ Ve talnlec. “Jesctoow> SISopjoy aOqeIaN “E ‘SISOIEMIY OogeIeW\ 'Z ‘siSoppoy Aloyeutdsoy *L :SHAMSNYREADY TO PASS INC. | pIDS (CHOLESTEROL): Test is done fasting. TOTAL < 200 mg/dL F plebo! 7, Leva HDL (high-density lipids) 30 - 75 mg/dL. © SYaten cholesterol amed DL (low-density lipids) < 130 mg/dL © eee (od ns eee money 7% cnet fo we Pah aluaceng yortqnancy 10-14 seconds 25 - 35 seconds The ioe range is 2-3 only when the client is on anticoagulant therapy. BF qym) toy \cetaminophen 5.0 - 20 mg/L Use with caution with liver disease. Maximum Dose >aiday ithium 0.6 — 1.2 mEq/L Monitor Na+. 'Hyponatremia- frisk of toxicity. _ ilantin 40 -20 meg / mL Side effects: discolored urine, gingival hyperplasia. eophyline 40-20 mog /mL Side effects include tachycardia and palpitations. loronclied eter Lot az then, 0.5 -2 mg/L monitor electrolytes—hypokalemia, hypomagnesemia and be NOT 9h alee vere lagnesium Sulfate 4-7 mg/dL Macearts refitcs ertiolete calcium QWlona!t entamycin 5-10 ug/ml Causes oto =, neuro- and nephro— toxicity. a Ceynty Gt ceon canndaessREADY TO PASS INC. Vital signs must be assessed: on admission as per M.D. order with any change of health status with chest pain or any abnormal sensation before and after administration of preoperative medications; after surgery or invasive diagnostic procedures 6. before and after administration of blood and blood products or medications that affect cardiovascular or respiratory function 7. before and after any nursing intervention that affects the cardiovascular or respiratory system FREON a Vital signs include temperature (T), heart rate (HR), respiratory rate (RR), blood pressure (BP), _and pain assessment, SaQ2 is done as indicated. Factors Affecting Vital Signs {Blood | t Blood ye Wits Glucose |Giucone Nareate Amel | Pain AGH ti PY Wormat Norma Normal Normal Normal Vitals Across the Lifespan Pulse Rate | Respiratory Rate Blood Pressure 140 ~ 160 = = 130 = 150 30 - 60 73/55 110 - 130 24-30 90/55 90 = 110 20 - 24 85-90/50-60 80 - 90 18 = 20 90-110/60 70 = 90 16 = 20 110-130/70 50 = 100 16 = 20 120-129/80- 84 60 - 100 15 ~ 20 FdiastolicREADY TO PASS INC. NORMAL FLUID INTAKE AND OUTPUT INTAKE: 1,500 — 2,500 ml over 24 hours. OUTPUT: 1,500 — 2,500 ml over 24 hours. INSENSIBLE LOSS: 500 — 1,000 ml / day NORMAL FLUID FOR COLOSTOMY / ENEMA: 500 — 1,000 mi AMNIOTIC FLUID: 500 — 1,000 mi VAGINAL DELIVERY NORMAL BLOOD LOSS: 500 — 1000 ml / C-SECTION: 1000 mi ERI! Minimum uri ae eee. 1,000 mi = 1 kg BASIC ASSESSMENT 1. Obtain history: ‘Subjective Data: What the client tells you; history of current illness, pain, aggravating / relieving factors. Things that can be assessed by the examiner: name, age, gender, vital signs, diet, activity level, }edications (prescribed or illicit), alcohol intake, cigarettes smoked. AL ESS CLII REMEMBER TO INCLUDE: EAD Shape and symmetry of face. Condition of hair and scalp (e.g., thinning, balding, alopecia, etc) ES —————> Appearance of sclera, color of conjunctiva, appearance of pupils (They should be equal in size, round and regular in shape, and react to light and accommodation) PERRLA ‘Ss —————> Presence of drainage, hearing aids, pain, hearing disturbances |E ————> Drainage, sense of smell, nasal congestion IROAT ———— Presence of dentures Oral hygiene Oral mucosa (should be pink, moist) Tracheal alignment Presence of jugular venous distention (JVD) 33READY TO PASS INC. Use a pain scale from 0 — 10, 0 = no pain, 10 = worst pain. For a child or a client with a language barrier, use faces: no pain (2) moderate pain © worst pain jieces of pain or color scale can also be used. sess PORST: 'P: What provokes the pain? Q: What is the quality of the pain? (e.g., sharp, dull, stabbing). Does the pain radiate? (does it move around) : What is the severity of the pain? (eg., scale from 1 -10, associated signs & symptoms, such as diaphoresis, tachycardia, SOB) ‘T What was the time of onset (constant, intermittent?) Nursing implications: Pain Relief: + Reposition patient + Rest and relaxation techniques + Analgesics as per health care provider prescription + Offer reassurance: allow client to express fears and concerns + Distraction techniques: deep breathing, imagery, massage, eliminate stimuli