NCLEX-PN

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. Phosphorus:

. RBC: 4.5–5.0 million

. WBC: 5,000–10,000

. Plt.: 200,000–400,000

. Hgb: 12–16 gms women; 14–18 gms men

. HCO3: 24–26 mEq/L

. CO2: 35–45 mEq/L

. PaO2: 80%–100%

. SaO2: > 95%

. Glucose: 70–110 mg/dL

. Specific gravity: 1.010–1.030

. BUN: 7–22 mg/dL

. Serum creatinine: 0.6–1.35 mg/dL

(< 2 in older adults)

*Information included in laboratory test may vary

slightly according to methods used

. LDH: 100–190 U/L

. CPK: 21–232 U/L

. Uric acid: 3.5–7.5 mg/dL

. Triglyceride: 40–50 mg/dL

. Total cholesterol: 130–200 mg/dL

. Bilirubin: < 1.0 mg/dL

. Protein: 6.2–8.1 g/dL

. Albumin: 3.4–5.0 g/dL

. Digoxin: 0.5–2.0 ng/ml

. Lithium: 0.8–1.5 mEq/L

. Dilantin: 10–20 mcg/dL

. Theophylline: 10–20 mcg/dL

. Heart rate: 80–100

. Respiratory rate: 12–20

. Blood pressure: 110–120 (systolic);

60–90 (diastolic)

. Temperature: 98.6° ?/–1

. FHR: 120–160 BPM.

. Variability: 6–10 BPM.

. Contractions: normal frequency 2–5 minutes

apart; normal duration < 90 sec.; intensity

< 100 mm/hg.

. Amniotic fluid: 500–1200 ml (nitrozine

urine-litmus paper green/amniotic fluidlitmus

paper blue).

. Apgar scoring: A = appearance, P = pulses,

G = grimace, A = activity, R = reflexes

(Done at 1 and 5 minutes with a score of

0 for absent, 1 for decreased, and 2 for

strongly positive.)

. AVA: The umbilical cord has two arteries and

one vein (Arteries carry deoxygenated blood.

The vein carries oxygenated blood.)

—Folic acid = B9. Hint: B stands

(decreases the incidence of neural tube defects);

the client should begin taking B9 three months

. Early decelerations—Begin

peak of the contraction and end by the end

of the contraction. They are caused by head

compression. There is no need for intervention

if the variability is within normal range

(that is, there is a rapid return to the baseline

fetal heart rate) and the fetal heart rate is

within normal range.

. Variable decelerations—Are noted as

V-shaped on the monitoring strip. Variable

decelerations can occur anytime during

monitoring of the fetus. They are caused by

cord compression. The intervention is to

change the mother’s position; if pitocin is

infusing, stop the infusion; apply oxygen; and

increase the rate of IV fluids. Contact the

doctor if the problem persists.

. Late decelerations—Occur

the contraction and mirror the contraction in

length and intensity. These are caused by

uteroplacental insuffiency. The intervention is

to change the mother’s position; if pitocin is

infusing, stop the infusion; apply oxygen;,

and increase the rate of IV fluids. Contact the

doctor if the problem persists.

This is

a combination of diseases. These

toxoplasmosis, rubella (German measles),

cytomegalovirus, herpes, and syphyllis. Pregnant

nurses should not be assigned to care for the

client with toxoplasmosis or cytomegalovirus.

1. Stop pitocin if infusing.

2. Turn the client on the left side.

3. Administer oxygen.

4. If hypovolemia is present, push IV fluids.

. Coumadin (sodium warfarin) PT: 10–12 sec.

(control).

. Antidote: The antidote for Coumadin is

vitamin K.

. Heparin/Lovenox/Dalteparin PTT: 30–45 sec.

(control).

. Antidote: The antidote for Heparin is

protamine sulfate.

. Therapeutic level: It is important to maintain

a bleeding time that is slightly prolonged so

that clotting will not occur; therefore, the

bleeding time with mediication should be

1 1/2–2 times the control.

*The control is the premedication bleeding time.

. Head = 9%

. Arms = 18% (9% each)

. Back = 18%

. Legs = 36% (18% each)

. Genitalia = 1%

—Females

avoid eye contact with males; touch is

done by same-sex healthcare providers;

decisions are made by males; Muslims

refuse organ donation; most Arabs do not

they avoid icy drinks when sick or

together; colostrum might be considered

to the newborn.

—They

avoid direct eye contact; feet are

dirty (the feet should be touched last

assessment); males make most of the

they usually refuse organ donation; they

do not prefer cold drinks, believe in the “hot-cold”

theory of illness.

—They

sustain eye contact; blood and organ

generally refused; they might refuse

may prefer care from the tribal shaman

than using western medicine.

—They

might avoid direct eye contact with

they might refuse organ donation; most are

emotional during

“hot-cold” theory of illness.

—No blood products

should be used

. Renal diet—High calorie, high carbohydrate,

low protein, low potassium, low sodium,

fluid restricted to intake = output + 500

. Gout diet—Low purine; omit poultry (“cold

chicken”) medication for acute episodes:

Colchicine; maintenance medication:

. Heart healthy diet—Low fat (less than 30%

of calories should be from fat)

. ROME (respiratory opposite/metabolic

is a quick way of remembering that in

acid/base disorders the pH is opposite

to the other components. For example, in

respiratory acidosis, the pH is below normal

and the CO2 is elevated, as is the HCO3 (respiratory

opposite). In metabolic disorders, the

components of the lab values are the same.

An example of this is metabolic acidosis.

In metabolic acidosis, the pH is below

and the CO2 is decreased, as is the HCO3.

This is true in a compensated situation.

. pH down, CO2 up, and HCO3 up = respiratory

acidosis

. pH down, CO2 down, and HCO3 down =

metabolic acidosis

. pH up, CO2 down, and HCO3 down =

respiratory alkalosis

. pH up, CO2 up, and HCO3 up = metabolic

alkalosis

—Addison’s and

Cushing’s are diseases of the endocrine

involving either overproduction or

production of cortisol:

. Treatment for the client with Addison’s:

increase sodium intake; medications

cortisone preparations.

. Treatment for the client with Cushing’s:

restrict sodium; observe for signs of

—RICE

(rest, ice, compression, and elevate

—HHOP (heat,

hydration, oxygen, pain medications)

. Pain

. Pallor

. Pulselessness

. Paresthesia

. Polar (cold)

—Hip fractures commonly

hemorrhage, whereas femur fractures are at

risk for fat emboli.

—Fair, fat, forty,

five pregnancies, flatulent (actually

disease can occur in

. Delegate sterile skills such as dressing

changes to the RN or LPN. Where nonskilled

care is required, you can delegate the

client to the nursing assistant. Choose

most critical client to assign to the RN,

as the client who has recently returned

from chest surgery. Clients who are being

discharged should have final assessments

done by the RN.

. The PN, like the RN, can monitor clients

with IV therapy, insert urinary catheters

feeding tubes, apply restraints,

IVs, drains, and sutures.

. For room assignments, do not coassign the

post-operative client with clients who

vomiting, diarrhea, open wounds, or chest

tube drainage. Remember the A, B, Cs

(airway, breathing, circulation) when

questions choices that ask who would

you see first. For hospital triage, care

client with a life-threatening illness or

first. For disaster triage, choose to

those clients who can be saved with the

least use of resources.

LEGAL ISSUES IN NURSING

tort, negligence, malpractice,

slander, assault, battery.

Legalities—The RN and the physician

protection. The MD or the hospice nurse

the client dead.

*The generic name is listed first with the

: Benazepril (Lotensin), lisinopril

(Zestril), captopril

(Vasotec), fosinopril (Monopril),

(Univas), quinapril (Acupril), ramipril

**Persistent dry cough**

: Acebutolol

(Monitan, Rhotral, Sectral), atenolol

(Tenormin, Apo-Atenol, Nova-Atenol),

(Brevibloc), metaprolol (Alupent,

Metaproterenol), propanolol (Inderal)

BBW: Do not stop abruptly

Gentamicin

(Garamycin, Alcomicin, Genoptic),

(Kantrex), neomycin (Mycifradin),

(Streptomycin), tobramycin (Tobrex,

Nebcin), amikacin (Amikin)

**Peak and Trough**

Clonazepam

(Klonopin), diazepam (Valium),

(Librium), lorazepam (Ativan), flurazepam

(Dalmane)

Chlopromazine

(Thorazine), prochlorperazine (Compazine),

trifluoperazine (Stelazine), promethazine

(Phenergan), hydroxyzine (Vistaril),

fluphenazine

Prednisolone

(Delta-Cortef, Prednisol, Prednisolone),

prednisone (Apo-Prednisone, Deltasone,

Meticorten, Orasone, Panasol-S),

(Celestone, Selestoject, Betnesol),

dexamethasone (Decadron, Deronil, Dexon,

Mymethasone, Dalalone), cortisone

hydrocortisone (Cortef, Hydrocortone

Phosphate, Cortifoam), methylprednisolone

(Solu-cortef, Depo-Medrol, Depopred,

Rep-Pred), triamcinolone (Amcort,

Atolone, Kenalog, Triamolone)

Acyclovir (Zovirax), ritonavir

(Norvir), saquinavir (Invirase,

indinavir (Crixivan), abacavir (Ziagen),

cidofovir (Vistide), ganciclovir

Vitrasert)

Atorvastatin

(Lipitor), fluvastatin (Lescol),

(Mevacor), pravastatin (Pravachol),

(Zocar), rosuvastatin (Crestor)

Valsartan (Diovan), candesartan

losartan (Cozaar), telmisartan (Micardis)

Celecoxib

(Celebrex), valdecoxib (Bextra)

Cimetidine

(Tagamet), famotidine (Pepcid), nizatidine

(Axid), rantidine (Zantac)

: Esomeprazole

(Nexium), lansoprazole (Prevacid),

(Protonix), rabeprazole (AciPhex)

Heparin sodium

(Hepalean), enoxaparin sodium (Lovenox),

dalteparin sodium (Fragmin)

. Schedule I—Research use only (example

LSD)

. Schedule II—Requires a written prescription

(example Ritalin)

. Schedule III—Requires a new prescription

after six months or five refills (example

codeine)

. Schedule IV—Requires a new prescription

after six months (example Darvon)

. Schedule V—Dispensed as any other

prescription or without prescription if

law allows (example antitussives)

. Antacids—Reduce hydrochloric acid in the

stomach

. Antianemics—Increase red blood cell

production

. Anticholenergics—Decrease oral secretions

. Anticoagulants—Prevent clot formation

. Anticonvulsants—Used for management of

seizures/bipolar disorder

. Antidiarrheals—Decrease gastric motility

and reduce water in bowel

. Antihistamines—Block the release of

histamine

. Antihypertensives—Lower blood pressure

and increase blood flow

. Anti-infectives—Used for the treatment of

infections

. Bronchodilators—Dilate large air passages

in asthma/lung disease

. Diuretics—Decrease water/sodium from the

Loop of Henle

. Laxatives—Promote the passage of stool

. Miotics—Constrict the pupils

. Mydriatics—Dilate the pupils

. Narcotics/analgesics—Relieve moderate to

severe pain