MY NCLEX NOTES & CHARTS

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"Our greatest weakness lies in giving up. The most certain way to
succeed is always to try just one more time."
-Thomas A. Edison
 Cerebral Angiography
BEFORE
1. Informed consent
2. Explain procedure
3. Lie the patient flat
4. Dye injected into femoral artery. Fluoroscopy & radiologic films taken after injection
5. Procedure Sedation
6. Skin prep; Chosen site shaved
7. Mark peripheral pulses
8. May experience feeling of warmth and metallic taste when dye injected

AFTER
1. Neurological assessment every 15-30 minutes until vitals stable
2. Keep flat in bed 12 to 14 hours
3. Check puncture site every hour
4. Immobilize site for 6 to 8 hours
5. Assess distal pulses, color & temperature
6. Observe symptoms of complications (allergic response to dye, puncture site,
hematoma)
7. Force fluids
8. Accurate I&O
 Lumbar Puncture
BEFORE
1. Informed Consent
2. Explain procedure
3. Position patient in lateral recumbent\fetal position at edge of bed

AFTER
1. Neuro checks every 15-30 minutes
2. Position flat for several hours
3. Encourage P.O. fluid to 3,000 mL
4. P.O. analgesics for headache
5. Observe insertion site for bleeding
 Urinary Frequency Teaching

1. Empty the bladder frequently (every 2 hours)

2. Drinking at least 2000 mL of fluid per day
3. Limiting fluid intake before bedtime (NOT avoiding fluid
intake)
4. Perform kegel exercises to strengthen the perineal muscles
5. Wearing a perineal pad

OB Maternity
*May occur in the first trimester and then again late in the third
trimester because of pressure placed on the bladder by the enlarged
uterus
Potassium Rich Foods

• Kiwi • Dried Beans/Peas

• Oranges • Lima Beans
• Dried Fruit • Mushrooms
• Bananas • Potatoes
• Cantaloupe • Seaweed
• Avocados • Soybeans
• Broccoli • Spinach
Sanguineous
• BRIGHT RED Indicates active bleeding

Serous
• Watery or Clear usually normal

Serosanguineous
• Pink tinged  Indicative of some bleeding

Purulent
• Yellow/Green Infection
 CVA (Stroke)
LEFT CVA
• Aphasia (language difficulty)
• Alexia (reading difficulty)
• Agraphia (writing difficulty)
• Right hemiplegia or hemiparesis
• Slow, cautious behavior
• Depression & quick frustration visual changes, such as hemianopsia
*Responsible for language, mathematic skills, & Analytic thinking

RIGHT CVA
• Unawareness of deficits
• Loss of depth perception
• Disorientation
• Impulse control difficulty
• Poor Judgment
• Left hemiplegia OR hemiparesis
• Visual changes, such as hemianopsia
*Responsible for visual and spatial awareness &proprioception
Phosphate Rich Foods

• Fish
• Eggs
• Milk
• Cheese
• Large amounts of meat & fish
• Whole grains
• Carbonated beverages
 Cardiac Catheterization

BEFORE
1. Informed consent
2. Explain procedure
3. NPO 8-12 hours
4. Empty bladder
5. Check pulse
6. Explain client may experience heat palpitations; desire to cough
when dye injected

AFTER
1. Monitor vitals every 15 min for 2 hours. Then every 30 min for 1
hour
2. Check pulses, sensations, and bleeding at insertion site
3. Bed rest 6-8 hours with insertion site extremity straight!
 SIADH
Early symptoms
1. Headache
2. Muscle cramps
3. Weight gain (no edema: Due to water being retained, NOT sodium)

Nursing Interventions
1. Restrict oral fluids 500-1000mL/day
2. Weigh daily same clothes + same time
3. Report altered LOC [headaches, confusion, lethargy]
4. Take seizure precautions
5. Monitor intake/output accurately
6. Medications: Demeclocycline or Lithium carbonate
7. Monitor Vitals: tachycardia, increased BP, hypothermia
8. Monitor decreased serum sodium + elevated urine sodium
osmolality
 Heart Failure Teaching

Teaching
1. Follow fluid and sodium restrictions
2. Conserve energy  schedule REST PERIODS
3. Adhere to medication regimen
4. Weight self daily  notify health care provider of weight gain of
2lbs/24 hours OR 5lbs in 1 week*
5. Get influenza vaccine yearly
6. If prescribed  DIGOXIN, take pulse for 1 minute. Notify health
care provider if pulse is below 60bpm.
7. Take diuretics in early morning and early afternoon
8. Notify health care provider of increased dyspnea, orthopnea, and
inability to wear rings or shoes*
Iron Rich Foods

• Red meat • Carrots

• Kidney & Lima beans • Raisins
• Egg yolk • Apricots
• Chickpeas • Kale
• Cooked Swiss chard • Spinach
• Liver • Organ Meats
• Molasses • Clams
• Lentils
 Blood Transfusion Reactions

Circulatory overload
*Chest or lumbar pain, cyanosis, dyspnea, moist productive
cough, crackles in the lung bases, distended neck veins,
increased BP

Sepsis
*Tachycardia, Fever, abdominal cramps, N/V, diarrhea

Allergic + Transfusion Reaction

*Flushing, itching, urticarial, tachycardia, low back pain

Febrile Reaction
*Fever, chills, nausea
 Magnesium (1.5-2.5)
Below 1.5 = Hypomagnesaemia
• Arrhythmias
• Seizures
• Tetany
• Muscle weakness
• Irritability
• Lethargy
• Dizziness
• Confusion

Above 2.5 = Hypermagnesaemia

• Arrhythmias
• Muscle weakness and fatigue
• Nausea/Vomiting
• Flushing & Sweating
• Loss of deep tendon reflexes
• Respiratory depression
• Hypotension
• Loss of consciousness
 Sodium (135-145)
Below 135 = Hyponatremia
• Nausea
• Seizures
• Confusion
• Muscle weakness
• Headache
• Apprehension
*Fresh water drowning

Above 145 = Hypernatremia

• Lethargy
• Neuromuscular excitability
• Irritability
• Muscle twitching
• Weakness
• Fever
• Increased Blood Pressure
• Edema
*Heart Failure, Cushing's Syndrome, Diabetes Insipidus
Tyramine Rich Foods
• Red wine
• Beer
• Chocolate
• Aged Cheese
• Yogurt
• Soy Sauce
• Sauerkraut (sour cabbage)
• Liver
• Pizza or Homemade bread
• Meats that have been fermented
• Figs
• Bananas
 Peripheral IV Complications
Infiltration Thrombosis
• Pain on IV site • Presence of a blood clot
• Cool and pale • Absent pulses below the site of
• Flow of IV Stopped the clot formation
• IV now into subcutaneous Thrombophlebitis
tissue • Pain & swelling
Phlebitis • Redness
• Redness • Warmth
• Pain • Fever
• Swelling • Leukocytosis (Increased
• Inflammation of vein WBC)
Infection Hematoma
• Fever • Leak of blood
• Pain at the site • Bruise
• Swelling
 Peripheral IV Treatment (Contin.)
Treatment
1. Stop the IV
2. Apply warm compress
3. Elevate arm
4. Start IV in new site OR opposite arm
*Infiltration, Phlebitis, Infection, Thrombosis, Thrombophlebitis

Treatment
1. Discontinue IV
2. Apply pressure
3. Apply cool compress
4. Start IV in new site OR opposite arm
*Hematoma
 Therapeutic Drug Levels

Digoxin: 0.5-2.0 ng/mL

Lithium: 0.8-1.5 mEq/mL

Dilantin: 10-20 mcg/mL

Theophylline: 10-20 mcg/mL

 Need to know *** Lab values***
Electrolytes Chemistry
Sodium: 135-145 Glucose: 70-110
Potassium: 3.5-5.0 BUN: 7-22
Calcium: 8.5-11 Creatinine: 0.5-1.2
Chloride: 95-105 CPK: 21-232
Magnesium: 1.5-2.5 Urine specific gravity: 1.010-
Phosphorus : 2.5-4.5 1.030
Bilirubin: <1.0
Hematology Total Cholesterol: 130-200
RBC: 4.5-5.0 million LDH: 100-190
WBC: 5,000-10,000 Triglyceride: <150
Platelets: 200,000-400,000 Protein: 6-8
Hemoglobin: 12-18 Albumin: 3.5-5.0
Uric acid: 3.5-7.5
 Breast Self-Examination

1. Stand in front of the mirror. Observe both breasts for anything unusual, such as lumps,
dimpling, nipple retraction or scaling of the skin.
2. Watching closely in the mirror, clasp hands behind your head and press hands forward.
3. Next, press hands firmly on HIPS and bow slightly as you pull your shoulders and
elbows forward.
4. Raise your left arm behind your head. Use three or four fingers of your right hand to
feel for nodes, irregularity, and tenderness. Beginning at the outer edge, press the flat part
of your fingers in small circles, moving the circles slowly around the breast. Gradually
work toward the nipple. Then switch to the right arm behind your head and use the left
arm to exam the breast.
5. Gently squeeze each nipple and observe for discharge.
6. Steps 4 and 5 should be repeated while lying flat on your back.
 Testicular Self-Examination

1. Stand in front of a mirror and check for any swelling on the scrotal skin.
2. Cup one testicle at a time using both hands. This is best performed during or after a
warm shower.
3. Roll the testicle gently between the thumbs and fingers. You should not feel any pain
when doing the examination.
4. Feel for lumps, changes in size or irregularities.
 Calcium (8.5-11)
Below 8.5 = Hypocalcemia
• Tetany
• Positive Trousseau's sign
• Positive Chvostek's sign
• Seizures
• Confusion
• Irritability

Above 11 = Hypercalcemia
• Muscle weakness
• Lethargy
• Constipation
• Kidney stones
• Nausea
• Dysrhythmias
 Potassium (3.5-5.0)
Below 3.5 = Hypokalemia
• Dysrhythmias
• Muscle weakness
• Nausea/Vomiting
• Respiratory Depression
• Constipation

Above 5.0 = Hyperkalemia

• EKG changes
• Dysrhythmias-Irregular
• Muscle weakness
• Irritability &Anxiety
• Decreased BP
• Diarrhea
• Nausea
*Addison's Disease
 The FIVE P's and F's

Fractures - 5 P's
Pallor
Pain
Pulselessness
Paralysis
Parasthesia

Cholelithiasis - 5 F's
Fat
Forty
Fair Skin
Fertile
Female
Calcium Rich Foods

• Collard greens
• Dairy
• Spinach
• Tofu
• Sesame Seeds
• Almonds
• Cereal
• Broccoli
• Bok Choy
• Black beans
• Turnip greens
 Parkinson's Disease

Clinical manifestations
• Resting tremor
• Pill rolling of fingers
• Drooling
• Shuffling gait
• Mask-like face
• Forward flexion of trunk
• Muscle rigidity + weakness

Alzheimer's Disease
Clinical manifestations
• Forgetfulness
• Short attention span
• Night wandering
• Dysphasia
• Inability to perform ADLS
• Depression
• Combativeness
 Blood Transfusion Reaction
If transfusion reaction suspected
1. STOP blood transfusion
2. Run normal saline to maintain IV access
3. Notify physician and blood bank of reaction STAT
4. Administer ordered medications
5. Draw blood sample for culture, plasma and hemoglobin
6. Collect urine sample and send to lab
7. Monitor voiding for hematuria

Anaphylactic Reaction
• Support airway, breathing, circulation
• Administer epinephrine, antihistamines, and corticosteroids

Hemolytic Reaction
• Consider low-dose dopamine to improve renal blood flow
• Maintain renal perfusion with aggressive fluid resuscitation
• Furosemide to increase renal blood flow

Febrile
• Acetaminophen to treat fever
• If patient develops chills, cover with blanket unless temp is >102 F.
 Pediatrics - Normal Vitals
Newborn
RR 30-60 per min
HR 120-160 bpm
BP 65/40 mm Hg

1-4 years
RR 20-40 per min
HR 80-140 bpm
BP 90-99/60-65 mm Hg

5-12 years
RR 15-25 per min
HR 70-115 bpm
BP 100-110/56-60 mm Hg

Adult
RR 12-20 per min
HR 60-100 bpm
BP <120/80 mm Hg
 Diets and Diseases

Gout: Low purine diet (no fish or organ meats)

Celiac disease: Gluten free diet (No wheat, oats, rye, barley)

Renal failure: High calorie, low protein diet, as allowed by kidney function

Cystic Fibrosis: Replacement of pancreatic enzymes before or with meals. High

protein and High Calorie

Atherosclerosis: Low saturated fat die, Cholesterol lowering agents given before
meals
 Iron Supplements

• Take with Vitamin C [Increase absorption]

• DO NOT take with antacids
• Will have greenish black stools from meds
• Should always be taken with food to decrease gastric upset

Decrease Iron Absorption

1. Milk
2. Antacids
3. Caffeine (coffee, tea, soda)
4. Calcium supplements
 Diabetes

Patient Teaching
• Inspect feet daily
• Wash feet daily with mild soap and warm water
• Pat feed dry; especially between toes
• Use mild foot powder on sweaty feet
• Consult podiatrist
• No commercial remedies to remove calluses or corn
• The best time to cut nails is after a bath or shower
• Separate overlapping toes with cotton
• Avoid open toe or open heel shoes
• Leather shoes preferred over plastic ones
• DO NOT go barefoot
• Wear clean cotton socks
• Avoid prolonged sitting; standing; crossing legs
 Strokes
Always be sure to assess a client's ability to swallow before feeding and a
post-stroke client
• Medications do NOT always need to be crushed
• ALL medications should be administered one at a time
• Assess gag reflex; ability to swallow and cough
• If unilateral weakness, place medication on stronger side of the mouth
• Straws are NOT to be indicated to patients with swallowing impairment
(Increases risk for aspiration)
 Expected Normal Postpartum Vitals
Temperature
• Could increase to 100.4 F. Any higher elevation may be caused by infection
and must be reported.
Pulse
• May decrease to 50 beats/min. Pulse<100 beats/min could indicate
excessive blood loss or infection.
Respirations
• Should be within normal limits. If RR increase significantly, suspect
pulmonary embolism, uterine atony or hemorrhage.
Blood Pressure
• Should be within normal limits. Suspect hypovolemia if it decreases
 Pneumonia

Interventions
• Administer heated and humidified oxygen therapy as prescribed
• Position the client in high-fowler's position to facilitate air exchange
• Encourage coughing, or suction to remove secretions
• Encourage deep breathing with an incentive spirometer to prevent alveolar collapse
• Administer medications as prescribed:
-Antibiotics
-Bronchodilators
-Corticosteroids
-Immunizations
• Promote adequate nutrition
• Provide support to the client and family
• Encourage verbalization of feelings
 Tuberculosis
Assessment
• Persistent cough
• Purulent sputum; possibly blood-streaked
• Fatigue + lethargy
• Weight loss + anorexia
• Night sweats + Fever
Interventions
• Administer heated and humidified oxygen therapy as prescribed
• Obtain sputum samples
• Prevent infection transmission.
-Wear N95 or HEPA respirator when caring for hospitalized TB client
-Negative airflow room and Airborne precautions
-Client must wear a mask if transportation to another department is necessary
• Administer medications and encourage fluid intake
• Diet: Foods rich in protein, iron and vitamin C
Teaching
• Teach client and family importance of medication regimen (6 months to a year)
• Encourage proper hand washing
• Cover the mouth and nose when coughing or sneezing
• Clients with active Tb should wear masks when in public places
• Clients are not longer considered infectious after three negative sputum culture
 Barbiturates
Intoxication Withdrawal
-Talkative -Decrease respiration
-Slurred Speech -Seizures
-Hallucinations/Delirium -Insomnia
-Euphoric -Tremors
-Fever -Anxiety/Tachycardia

Opioid/Narcotics
Intoxication Withdrawal
-Pin point pupils -Dilated eyes
(dolls eyes) -Fever
-Slurred Speech -Yawning
-Respiratory & -Abdominal cramps
circulatory depression -Watery eyes
-Unconsciousness/death -Diaphoresis

Alcoholism
Minor Withdrawal Major withdrawal
-Anxiety -Life threatening
-Agitation -Hypertension
-Irritability -Tachycardia
-N/V -Tremors
-Hangover -Seizures
 Strategies I used for the NCLEX

Expected vs. Unexpected

Chronic vs. Acute
Stable vs. Unstable
Potential vs. Actual Problem
Safe vs. Unsafe
Fast vs. Slow
Physical vs. Psychosocial

A, B, C's
Getting clues from the answers
If you can do one thing and go home for your patient
 NCLEX TIPS
1. NEVER ask "why?" or say "do not worry"
2. NEVER leave the patient alone
3. ALWAYS choose the safest answer possible
4. DO NOT read into the question
5. DO NOT pass the buck
6. DO NOT "do nothing" or "continue to document" UNLESS everything is normal or expected!
7. NEVER persuade the patient
8. ELIMINATE answers with absolute words: "ALWAYS, NEVER, ONLY"
9. DO NOT delegate assessment, teaching, or evaluation
10. ELIMINATE answers with YES/NO questions
11. COMA, COMA AND RULE: All parts of the answer must be correct!
12. Pay attention to words such as: PRIORITY, FIRST, BEST, INITIAL etc.
13. You ALWAYS have an order
14. READ the question and the answer you choose before clicking NEXT.
15. DO NOT be too quick to answer familiar questions. ALWAYS carefully read and understand
questions before answering.
16. NEVER panic when you don't know the topic or answer to a question. Don't give up. Try getting
clues from the answers and begin to eliminate choices that are: not safe, are not priority, etc.
17. RELAX:) Take a few deep breaths before each question. It only takes a few seconds! IT HELPS!
18. TAKE A BREAK! Even if you want to keep going, your brain needs a break.
19. REST AND DIGEST the night before!
20. STAY POSITIVE! Would it hurt to stay positive? :) You CAN do this!!!!