*TA Norma: nclex-expert@kaplan.

com

1. What is the TOPIC of the question?

(Put ques in your own words)
2. Are the answers ASSESSMENTS or
IMPLEMENTATIONS?
3. Does Maslow fit? PHYSICAL vs. PSYCHOSOCIAL
4. Are all physical? apply ABCs
5. What is the OUTCOME of each answer choice?
STRATEGIES FOR THE NCLEX-RN EXAM
1. Always ask yourself, Is this what the textbooks say should be done in this
situation?
The correct answers on the exam can be found in nursing textbooks.
2. Always remember your ABCsairway, breathing, and circulation.
3. Dont assign auxiliary nursing personnel based on the equipment required by a
patient. Assignments should be determined by the acuity of patient care and level
of patient needs.
4. Remember, on this exam, the nurse has no limits on equipment, time, or
personnel.
5. Always make sure the patients physical needs are met before you address the
patients psychosocial needs. Apply Maslows hierarchy of needs!
6. Read all of the answer choices before you decide on one.
7. Make a decision about each possible answer choice as you read it.
Is the statement true/correct? If it is wrong, eliminate it from consideration.
8. Eliminate as many answer choices as you can.
Frequently you will be left with two options.
Then, go with your best guess.
9. As you read a question, focus on the key words.
You may want to jot these down on the scrap paper provided.
10. Always choose the safest possible action.
11. Look at yourself in the mirror a few times before the test and say, Its just a
test of minimum competency. I am more than minimally competent.
I am going to pass this test.
12. Dont agonize over any one question. It can upset your pacing and confidence.
If you read a question and dont know the answer, just take a deep breath and start
eliminating options.
13. Take charge of your own well-being at the test site. Get comfortable in the chair.
Adjust the light and brightness on the computer screen.
14. If the video cameras bother you, wave at them and smile, smile, smile!
15. Negative questions will not be identified by the capitalized word EXCEPT.
Questions may include phrases such as know further teaching is necessary,

or require an intervention by the nurse. These questions require you to look for a
wrong behavior or statement on the part of the nurse or client.
16. Always care for the patient before you pay attention to equipment or machines.
17. Picture yourself in the situation as described. What is the first, or most
important, action that you should take?
18. Be suspicious of any options to call the physician, clergy, etc.
Usually there is something you need to do before you make that call.
19. Be mindful of the nursing process as you answer each question. Make sure your
assessment is complete before you diagnose, plan, or intervene.
20. Goals for a patient should be patient-centered, have a limited time frame, and
be measurable.
21. Form a mental image of the patient as described in the question. It can help. For
instance, sometimes the answer is age-dependent.
22. In all clinical situations, take full responsibility for your actions
STUDYING MEDS - TIPS
- Look at meds that are used for each disease, illness, complication or problem while
you are studying it. It helps to learn the meds in the context of the content item.
-Focus on the family or classification of the med. So, if you know about beta bockers
in general, it's easier to know about the specific drugs in that family.
-Look for the life-threatening reactions, interactions and signs of toxicity
-Know the contraindications
-Don't forget the herbals!
-Dig out your 'math for meds' book for calculations
-You will have a drop-down calc for the exam.
-They will tell you if rounding off is needed, and what to round off to.
-Know how to recognize a med is working, and if appropriate, how long it takes to
see an effect. -Know if you need to taper a med off, not just d/c it.
ACCESSING YOUR ONLINE MATERIALS
-Go to mykaptest.com
-Sign in using the email address you used when you signed up for class and the
password that was emailed to you (sign in is in the upper right corner)
-Click on online syllabus
-Select one of the following:
--My Syllabus (contains reading assignments, Strategy Seminar video, access to
Diagnostic and Readiness exam)
--My Tests (access Question Trainer Tests and access for taking Diagnostic and
Readiness Tests)
--My Toolbox (to review the results of the Diagnostic and Readiness Tests, access
LOD Content [lectures], access LOD Class Questions [review of each class sessions
questions] and access Qbank questions
GRAPEFRUIT JUICE: MED INTERACTION
Grapefruit Interaction:
Anxiety: Valium, Buspar, Versed, Halcion
Depression: Zoloft

Antiarrythmics: Many Calcium Channel blockers like Cordarone or cardizem, also

Quinidine and Amiodarone
Anticoags: Coumadin
Epilepsy: Tegretol
many Statins
many HIV Anti-virals
THERAPEUTIC COMMUNICATION
1. Respond to feeling tone
2. Provide Information
3. Do not ask "why" ques
4. watch "yes / no " ques
5. Do not focus on the nurse
6. Do not explore
7. Do not say, "don't worry"
ASSIGNMENT STRATEGY
RN: Patients requiring: Assessment, Judgment, Evaluation
LPN: Stable patients with expected outcomes **Recognizes normal from abnormal
** Knows sterile procedure
Nsg Aides: Standard unchanging procedures (Vital signs, O2 sats, ADL, etc.)
*TA AMY*: Tip: For any mental status change in the elderly, always look for physical
reasons first (i.e. drug toxicity or polypharmacy).
*TA AMY*: Tip: If the topics are suicide or homicide, you DO ask a yes/no question ''Are you thinking of hurting yourself or someone else?''
*TA AMY*: Tip: Lithium has a diuretic effect. Patients are encouraged to drink noncaffeine drinks. Do NOT restrict sodium. Hyponatremia increases the risk of lithium
toxicity.
*TA AMY*: For delusions: Reflect the feelings and give factual information.
Comprehensive notes
Session 2, Pharmacological/Parenteral Therapies, Reduction of Risk
Potential
***Use the Decision Tree on every question. Regardless of the question type, you
will always determine the TOPIC (step 1) and evaluate the answer choices (step 5).
The full DT may not apply well to all questions, like med questions. However, it
takes only seconds to check if Assess vs Imp, Maslow, or ABCs might apply. Stay in
the habit of briefly considering each step so the process stays fresh in your mind.
The NCLEX will always give you the trade name as well as the generic name.
Be able to recognize blood transfusion reactions and their causes.
Medications:
The nurse can never change a medication dosage Instead, the nurse may

withhold a medication dosage

In NCLEX World:
You have an order for anything you need!
You can get anything you need in your NCLEX closet!
IV FLUIDS - Know the correct fluids for a given situation. IV Fluids pg. 57
Isotonic Solutions - same concentrations as our bodily fluids
Hypotonic Solutions - are 'watered down'
Hypertonic Solutions - are far more concentrated
Hetastarch - is a hypertonic solution and is used as a plasma volume expander
such that fluids will move into the intravascular space and improve fluid volume
status.
Hetastarch (Hespan) is a colloid solution. Similar action to Albumin but less
expensive. Used to treat some forms of shock, liver failure, and burns.
Prioritization questions for Pharm - who do you see first? Think about the
acuity of the client, the action of the medication, as well as the onset, peak, and
duration of the meds.
Remember that you are not looking for "right" answers. You are looking for BEST
answers! Dont get distracted by the fact that the answer you were wanting is not
there look for the best answer that represents a correct choice of those you have
to work with.
Ask yourself how each answer choice may represent the concept given in the
question. Also ask yourself what concept does this answer represent? does it
make sense for the situation.
Picture the action an answer represents.
Read every word carefully, slow down and do not accept and answer that is almost
correct.
Key Word Tip: "Restlessness" can indicate hypoxemia.
-The phrases Requires intervention, requires further teaching, should be
concerned and similar phrases mean something is WRONG, incorrect or false.
-When a question says the pt is allergic to a med, consider cross allergies. Your med
tables will list cross allergies, contraindications, interactions etc. You need to know
these!
-#1 most common reason for med non-compliance is side effects
-Know the labs monitored with a med and WHY.

-Know what the labs represent and what high or low values for them would mean to
the pt.
-Pay attention to therapeutic levels/ranges for meds. A narrow therapeutic range
means less room for error as far as levels go.
-Know side effects, and understand that adverse reactions are more significant.
These are listed in the med tables in your book. Know all life-threatening reactions
or interactions, why they occur and any treatments listed.
-If you know why a drug is used, how it works and how that relates to the adverse
response you will not need to memorize all that information. Read to understand!
-Study the meds used as you study the illness, disease or problem. Learning about
the meds while you read about the illness helps the meds make sense. If you look at
a med every time it is mentioned before you know it, youll know the meds! Do
this as you review any practice questions/tests you do.
-Chemo drugs start on 96
-Know central lines and the complications associated with them.
-when doing med calculations, make SURE you understand if they are asking for
each dose, or the total needed for 24 hrs. worth of doses.
-If there is any question of a med allergy, stop the med! You CAN stop a med a pt
may be allergic to. You cannot prescribe a med or change the dose.
-Cocaine - is a MAJOR vasoconstrictor and stimulant
Remember the 4 "Gs" * Garlic
* Ginger
* Ginkgo
* Ginseng
> These decrease platelet aggregation/cause or add to a bleeding risk - use any of
these herbals w/caution if taking any other meds that prevent clots, or alter
bleeding time.
-Watch for pt. or family statements that describe a side effect or complication of a
med.
Kava Has similar activity to benzodiazepines. Used for insomnia or anxiety. It
decreases effect of Sinemet which is given to increase dopamine in Parkinsons. (Pg.
137 in RN Course Book)
You MUST know the herbal medications!
-When a pt. is on more than one inhaler or eye drop, it usually DOES matter which
one you use first. Know the order taken, and why.

-Diarrhea is an EARLY sign of Digoxin Toxicity ... KNOW LANOXIN!! (Pg. 113 in RN
Course Book)
-The Double-Ds Dig and diarrhea think dig toxicity. It may not be that, but
always consider it.
-Mag is a DRAG, slowing cellular metabolism. It slows everything from reflexes to
breathing.
-For evaluation questions, you must know why the medication is prescribed and the
action of the drug. NCLEX will not tell you why it has been prescribed you need to
KNOW why its used and apply that to the answers.
-When looking at electrolyte problems, look at assessments and think about why the
assessment is made and how it relates to the electrolyte in question.
-Be able to recognize when a med is working
-some meds require labs be drawn before starting them know these
-when determining priority pts related to meds consider the acuity of the pts.
illness (ABCs?). When evaluating pt complaints, consider if it is an expected side
effect, a non-life threatening response, or a life threatening reaction.
-Know what effects or side effects you must educate your pt. about. A true side
effect should not be considered expected.
-Grapefruit juice interactions usually mean the juice increases the action of the
med.
***Start Session 3, Reduction of Risk Potential, cont and start
Physiological Adaptation
Reductions of Risk Potential, continued
-When looking for pt. most at risk for complications from a procedure, consider the
procedure, the pts. history and how their health problem, etc. may be effected by
the procedure.
-It's a little different than finding the most unstable pt, you are looking for the pt
most likely to have a complication from whatever the question is about.
-For any question that you are asked to prioritize pts. to see or follow up on or are
most concerned about use the Who do you see first strategy. You are looking for
the most unstable pt. To do this, consider:
Who is most unstable?
-stable vs unstable (are they having a symptom of their diagnosis or do they just
have a diagnosis without active symptoms)
-Chronic vs Acute situation
-Potential problem vs actual, right here/right now problem
-Expected vs Unexpected

-Use the ABCs

-compare each pt to the next one and eliminate the more stable pt of each pair
- Usually a confused pt cannot be reasoned with, follow directions or be expected to
think rationally or reasonably. Find the answer that best keeps them safe and
reduces chance of self harm.
-When considering who needs a private room, think of someone who is infectious, or
is at risk to GET an infection.
-At risk pts. may have low white counts, chemo, a medication or a disease that
causes lowered immunity making them at risk to get an infection and give the
infection to their roommate.
-Chest pain on inspiration is different that angina pain. Pleuritic pain like this may
mean pneumonia or atelectasis in the lungs. Treatment is pulmonary toilet cough
and deep breathe, breathing exercises.
-Know your ABGs and what each value represents.
-Review bronchoscopy complications may be pneumothorax, or bronchospasm
-When considering allergies to dyes, know that it is the iodine in the dye that is
related to shellfish allergies. An MRA is an angiography done in MRI. The contrast
dye used does not use iodine, it uses gadolinium so shellfish allergies are not an
issue. There is a magnet, so no metal allowed.
-pacemakers, neuro stimulators, hip replacements, shrapnel (metal left in body
from war injuries), earrings/piercings etc. cannot go into the giant magnet.
- Know the nursing considerations for tests and procedures. Recognize expected
from unexpected responses and the usual care for before the test and after the
procedure.
-For I&O calculations, know that 1 Cup=8oz, 30 cc=1 oz
- Be aware that if they ask for the intake, any output they mention is a
distracter!
-Intake is anything that goes in and STAYS in - PO fluids, IV fluids and
any irrigation fluids that do not come back out as drainage.
-Always look at the time frame given 2 hrs post-op has different needs and
potential complications than 2 days post op.
-the time line in a question is very important...are they in recovery, or back on the
floor? did they just start chemo, or are they weeks into it?
-Is this the first dose of med or 2nd week on it? Is it a new colostomy, or older?
-consider what would be expected at the given point in the process.
-***NCLEX may not give you the best or most perfect answer they may not offer
you the answer you want to see listed. Evaluate the answers carefully to see if a
less-than-perfect answer represents the correct concept you want.

-***Anything that causes a significant fluid shift out of the body can drop the BP
very low. This includes things like IV diuretics, paracentesis, thoracentesis, or
significant rapid NG drainage or diarrhea. Check the BP!!
-Know chest tubes, p 229
-documentation is only done when everything is good, or normal.
-When giving meds through a NG tube or G-tube, flush before and after everything
you do starting with after checking residual. Finish with a flush before resuming tube
feeding.
**End Reduction of risk, Begin Physiological Adaptation
-When someone is choking, if they can cough or speak, they have an airway.
-consider the type of surgery or the procedure and the complications that may
occur
-Do one thing and go home
-Never remove any impaled object
-Understand the basic pathophysiology of the problem and now how a med works to
treat the problem
-Review how to instill eye and ear drops
-Know the principles of O2 administration
-When looking at who has the most risk factors, practice using a piece of paper as if
it was the white board/dry erase board you will have for the exam. Total up the risk
factors for each pt.
-Know target lab values in order to determine risk factors or to recognize successful
treatment.
-to keep the question clear in your head with select all questions, repeat the
question with each answer choice. Use True/False to keep it simple am I looking for
a true statement about this, or a false statement.
-When reviewing meds, diseases, abnormal findings, complications etc. always
focus on something life threatening. Lose of life and limb are nclex priorities.
-When considering Maslow, usually psychosocial things are eliminated. BUT,
sometimes things like therapeutic touch or communication ARE the priority. If
physical items are wrong, eliminate them and go for an appropriate psych/soc
answer.
-Know if a diagnosis is contagious or not. If it is contagious, know the precautions
required.

-Passing the buck means asking someone else to do something YOU should do, or
passing responsibility to someone else. Call the Doc may be passing the buck is
there something appropriate you should assess or do BEFORE calling the health
care provider? Consider any nursing action you could or should take before calling.
Do not ask family to do something you should do.
-Know newborn normal assessment and complications
-Know Spinal cord injuries and the complications, eye injuries and treatment.
-Know the significant complications and treatments of surgeries found in your
course book.
-know labs and what they represent to the bodys functions
-Review ABGs and what each component means
-Review all tests/procedures and know if they require any special prep or postprocedure care. Know the complications that can occur and the symptoms of those
complications.
-Look up any word you dont know and make a note in your book so you see it every
time you look at the page!
-calculations/ formulas are found in your book 30ml= 1 ounce, 8 ounces=1 cup. To
change cups to mls, first change cups to ounces, then multiply ounces by 30 to get
mls.
-Review CVAs, intracranial pressure, suctioning to understand care of CVA and
preventing increased ICP. Suctioning, vomiting gagging, straining at BM all can
increase ICP in CVA, head injuries, intracranial hemorrhage.
-When thinking of preventing increased ICP, answers may reflect measures to
prevent this like anti-nausea meds, antihypertensives, laxatives, positioning.
-Before we give anything PO to a pt who is dysphasic, we must assess their ability to
swallow and protect their airway. The 2 most tested things are gag and swallow
reflexes. Regardless of their diagnosis, checking gag does raise ICP. We check it
once prior to PO, and we dont need to check it again unless pts condition changes.
Testing it too often raises ICP unnecessarily. However - - if the pt cannot swallow,
there is NO reason to check the gag!!!! If they cant swallow and we gag them, they
will aspirate!
-Review trachs, endotracheal intubation and ventilator care(p 244), know suctioning
-Review chest tubes, pg 229
-Know about central lines and their care, what they measure and complications of
central lines.
-Review NG tubes, and G-tubes pg 232
-Know MI, know angina vs MI
*Remember MONA (treatments for MI's)
Morphine
Oxygen
Nitroglycerin
Aspirin

-High glucose, DKA pts. are pouring out urine making them dehydrated. Labs will
reflect dehydration. When they have been treated successfully, labs will return to
normal reflecting rehydration.
-Pain unrelieved by pain meds must be evaluated. If you are wondering if pain is
P/soc, look at your other answer choices - if you can correctly eliminate them, then
the pain answer is correct.
-When considering pain in a question, dont get stuck on the strategy that it is
P/Soc. If pain is the topic, you must address it. No strategy is intended to apply
100% of the time, things are not always black and white
-Abd trauma: Cullens sign bruising around belly button means retroperitoneal
bleed.
-Epi is not given until and unless anaphylaxis is present. Epi p 64, allergic reactions
145,534 epinephrine=adrenalin, produced by adrenal gland
-anticonvulsants numb erratic brain signals so they decrease seizures. Because of
this effect, anesthesia may need to be reduced.
-Know risk factors for diseases if they could be found in the nclex exam, they are
in your book
-Review Autonomic Dysreflexia sympathetic nervous system has become over
stimulated and is going crazy. P266
-Fluid overloaded pts will have increased HR and BP, decreased Sp Grav, Hct and
BUN. They may present with SOB, rales/crackles, JVD. Give diuretics, fluid and Na
restrictions, daily wt., monitor lungs, CVP, edema, I&O. p269
-Review DI often seen in head injuries. With head injuries need to promote
drainage, prevent inc. ICP and watch for DI. P 270
-Look at its opposite, SIADH holding on to water/dilutional low Na, seen with lung
Ca.
Know electrolyte imbalances, symptoms and complications
-Review Tetralogy of Fallot 286
-Know your pacers!
-Review shock states. Shock is shock is shock know treatment of each type.
-DIC is a global anticoagulation problem. It is a cascade of events where none of the
clotting factors work. The signs may be subtle at first, like bruising and petechia,
but you will also see oozing from IV sites, old lab sticks, nosebleeds, blood in the NG
and bleeding from where you shaved them earlier.
**Session 4, Physiological Adaptation, cont, Basic Care and Comfort,
Management of Care
PHYSIOLOGICAL ADAPTATION, cont NOTES:

-With metastatic breast cancer, watch for hypercalcemia electrolytes start on p

271
-In some questions, medicating for pain is an option, but there will be something
else that is the real priority that you should do first, so always consider the pain is
psychosocial strategy. However, some situations like dsg changes for burns are
extremely painful, pre-medication is important. When evaluating answers in a
situation where pain really IS the topic Be careful not to immediately eliminate the
option of medicating them. Once you eliminate the other answers, dont be afraid to
give the med.
-Sometimes age is a distracter, but with children, they are often looking for age
appropriate actions or care plans.
- The pain from sickle crisis, burn dressing changes may be considered physical due
to their intensity the question or answer choices will help you decide if it is
physical.
-An action CAN be an assessment. Getting an O2 saturation is an action, but it gets
information or data so it is an assessment.
-Know about Addisons insufficient aldosterone from adrenals. Aldosterone is a
steroid, promotes reabsorption of Na and water and is part of the renin-angiotensin
system. Steroids also regulate blood sugar, hold back the immune response
(making the pt. immunosupressed) and they are needed and released during times
of Physical or emotional stress.
Addisons Crises or Adrenal Crises is life threatening and occurs in times of
physical/emotional stress when steroid needs cannot be met. P 278
-Remember to review Addisons opposite, Cushings too much steroid production.
-Spinal Cord Injuries know the levels of injury and the abilities and disabilities that
occur - pg. 266-267...
-Know Autonomic Dysreflexia. MEDICAL EMERGENCY- Problem below T1
usually caused by excessive sympathetic nervous system stimulation above the
level of injury. Usually caused by bladder or bowel distention. Seen after Spinal
Shock. Will see hypertension, bradycardia, pounding headache and nasal
congestion
-Review heart failure and know the physiology behind right and left failure.
-Know if specific labs are required for a med and why they are important
-Know sickle cell, its treatment and about sickle cell crises. The irregularly shaped
red blood cells clog vessels and cause pain. Keeping them well hydrated reduces
the chance of blocking vessels. Because the RBCs are not normal, they carry less
O2 so pts. must rest.
-For sickle cell: HOP to it Hydration, O2 and pain relief.

-Cancer treatments are important, radiation treatments are on p 552

-Review chemo and when you would see the various side effects occur. For chemo,
pay attention to how long theyve been on it. Early complication is stomatitis the
mouth mucosa cells are rapid growing cells and are affected soon after chemo
starts.
Comma, Comma, Comma Strategy
If the answer contains multiple phrases, evaluate each separately
All parts, steps or phrases must be correct for that answer choice to be considered
correct
Select All That Apply:
Repeat what you are looking for prior to each answer choice
Approach each choice as True or False
Passing the Buck ~ Referring to another professional
Acceptable when you have eliminated all other answers as something legitimate
for you to do in the here and now
- If "notify the physician" looks like an attractive option, look at the other choices to
ensure that there isn't a better nursing option.
You MUST Know Lab Values for NCLEX use normals in your Kaplan NCLEX book
Know what the labs MEAN for the patient
-Laryngectomy pts. will need to learn self suctioning, they require humidified O2.
In order to check a gag reflex the patient MUST have a swallow reflex.
Remember on the NCLEX: YOU HAVE THE ORDER.
If you see the word RESTLESS in the stem, think HYPOXIA!!! You can always rule it
out but think of it. If hypoxia is not the problem, consider other reasons for the
restlessness like pain, alcohol withdrawl/DTs or even manic.
-When you see answer choices in quotes, think about what the words really mean what do they convey? What idea or concept are they describing?
When given the age of a client in the stem, consider the developmental stage of
that client when selecting your answer.
Diabetes Insipidus pg. 270 in RN Course Book. Also understand its opposite, SIADH.
Pulmonary toilet, also called pulmonary hygiene, is a set of methods used to
clear mucus and secretions from the airways. Methods used for pulmonary toilet
include coughing and deep breathing, suctioning of the airways, chest
physiotherapy, blow bottles, incentive spirometers and nasotracheal suction.
Bronchoscopy, in which a tube is inserted into the airways so that an examiner can
view them, can be used therapeutically as part of pulmonary toilet. While in there,
they will suction secretions and may do biopsy of tissue.

NG Tubes:
When given an option, always obtain x-ray for INITIAL verification of placement. Pg
232. After initial x-ray, we check pH of NG returns by aspirating a small amount to
confirm it is still in the stomach. pH should be less than 4.
-General rule is to check pt before equipment. Exception is any sort of drainage
tube. If the question describes symptoms that indicate a drainage tube may be
occluded, you are to check the drainage tube FIRST. This includes foleys or any
urinary drainage tube, chest tubes, NG tubes/G-tubes, etc.
-G-Tubes: Placed by doc into stomach, sutured in place. This means you do NOT
need to check PLACEMENT (its in the pt, or on the floor!)But, you DO need to check
residuals before any feedings or meds.
-By national standard, nurse aides can do gravity tube feedings. However, RN must
check placement and residual in NG and residual for G-tube before feeding can be
done. Aides may NOT make these assessments and may not irrigate the tubes.
-Smoking - proven risk factor associated with osteoarthritis -> promotes
cartilage loss.
Specific Gravity: Remember it as a time 10:10 - 10:30! Value is 1.010 - 1.030
Fat embolism symptoms include: dyspnea, tachycardia, fever, petechial skin rash.
Nutritional questions: the NCLEX does not often state the type of the diet
required by the client. First determine the type of diet required by the client, then
select the best menu from the answer choices.
- Diets like vegan or vegetarian etc, assume they are getting complete nutrition
unless the question is specifically about a deficiency with that diet.
***Begin Basic Care and Comfort
-For the arthritis diseases, maintaining joint mobility is the goal gentle stretching.
Avoid activities that cause stress to joints like jumping, hopping. High impact
exercises or activities are avoided.
-Long term severe malnutrition and lack of calorie (especially protein) intake leads
to low serum albumin because the body will consume the albumin as a protein
source for energy needs.
-To evaluate the asthmatics respiratory status, one important tool is the peak flow
meter. Measures force of expired air. Pts track their peak flows regularly and
frequently. Peak flow meter: 80 to 100% of personal best is normal, 79% to 50%
beginning to have exacerbation, under 50% is severe bronchoconstriction and the
patient needs treatment with steroids, etc.
Asthma p 281
-Remember that fluid shifts may drop BP when removing fluid from a pt at a rapid
rate, check BP
-The treatment of anemia is based on the cause of the anemia. Iron deficiency
anemia is treated with iron & Vit C. Microcytic or Pernicious anemia requires B12,
hemolytic anemia is treated with transfusions. p 295.

-Time plus distance equals exposure to radiation. Care of implanted radiation 301
- Assistive devices are commonly tested. Know them - they begin on page 318.
- Up with the good, down with the bad go up stairs with the strong (good) leg first
and down stairs with the weak (bad) leg first when using cane, crutches or walker.
- Choose the answer choice that best addresses the stated issue in the question
the correct answer will address the topic or problem.
-High protein meals interfere with the absorption of Sinemet
-Info on pain assessment p 341
-Emboli from bone marrow/fat emboli come from large bone fractures or bone
surgeries. Most end up as pulmonary emboli, but some can cause strokes or MIs.
When they go to the lungs this causes significant SOB and is an emergency. ABCs!
-Traction is all about alignment and pull pt must not turn or twist, wts must not rest
on floor or bed.
-after hip replacements, pt can only flex hip to 45-60 degrees, never more than 90
-slight and moderate usually describe normal or expected findings
-Know about thyroid diseases, and thyroid storm. Know the meds that treat them.
-TPN is high glucose high urine output is the bodys way of trying to get rid of the
glucose. It can only be given through a PICC line or central line.
-Review myasthenia gravis, and myasthenic/cholinergic crises- total loss of
voluntary muscle control pg337
-Review multiple sclerosis
-Halo traction has risk of meningitis know meningitis!
-know about glomerulonephritis and its role in renal function and failure
-Crush injuries and large fractures pose risk of compartment syndrome be able to
recognize this emergency.
-5Ps of compartment syndrome:
Paresthesias
Pulselessness
Pallor
Pain
Paralysis.
-Some or all may be present. Watch for SUDDEN increase in pain, SEVERE pain
describing this in the setting of crush or large bone break. p346

MANAGEMENT OF CARE NOTES:

Chain of Command:
* Vertical chain of command is used when abuse is suspected, legal issues
arise, or client safety is a concern. This means you report up the food chain in
NURSING when these situations occur. If another department in the hospital or
workplace is involved, or needs to be involved in a situation, we do not report to
them, we go to the nursing representative above us listed in answers.
* The vertical chain of command is used in cases of suspected child abuse (all
types), client safety issues or legal issues
* Failure to report is professional negligence
IN NCLEX LAND:
You have all the time, resources, equipment and staff needed to do the ideal
answer. **DO NOT think about the real world of nursing for this test!!!
- NCLEX likes for you to stay with your patient
-Focus on the problem that is right here, right now. Potential problems are never as
important as a legitimate right now problem. There are times they want you to
recognize potential problems, but remember actual is the priority over potential.
-You have anything you need
o Doctors order you always have an order for the correct answer
o A Magic closet never eliminate a correct answer because you dont have
the equipment or staff. You have it if it is something you need to do the best thing.
ASSIGNMENT / DELEGATION: p411
RN = Assessment, Teaching, Nursing Judgments/Evaluations. Only an RN can do
these things. Fresh post-ops, immediate recovery period, admissions, transfers,
discharges all need RN. Assignments and delegation are based on the license, not
experience.
LPN = Stable patient with a predictable outcome
Recognizes abnormal from normal - would notify RN of abnormal finding or
assessment information and RN will evaluate.
Knows sterile procedure does dressing changes
Aide = Standard / unchanging procedures
VS, O2 Stats, assist w/ADL's, etc.
-Aide can collect data, RN must evaluate the data. Aide might get the finger stick
glucose, but RN evaluates the number.
-When looking at pts for assigning staff, the time frame is very important. A surgical
pt just back from recovery needs RN skills, the same pt. 2 days post op may be
stable and OK for LPN. Look carefully at each pt.
TO ENSURE PATIENT SAFETY:
** Floats: Assign as you would an LPN/LVN **
-Avoid unit specific skills & knowledge (like chemo or death or prognosis/treatment
options)

> A float nurse should request an orientation to the unit, to ensure that you, the
nurse, are fully competent to care for assigned pts. and provide for patient safety.
> RN Skills are transferable, but the transfer RN should perform only skills where
competency has been demonstrated. This means an RN can certainly transfer skills
like VS, basic assessment skills, recognizing a problem. They are not expected to
have unit specific skills.
> The transferred RN should be assigned stable pts. with expected or predictable
outcomes.
-therapeutic communication applies to all interactions the nurse has pts, family, or
other staff.
-legal issues, informed consent p402
***Start session 5 MOC cont, Safety and Inf Control
-SVCS Superior Vena Cava Syndrome lung cancer tumors can impair or obstruct
venous drainage of the head, neck, arms and chest causing edema, swelling,
dyspnea, nosebleeds etc.
-pt can withdraw consent at any time!
-When reporting change of condition to family, use therapeutic communication. Give
facts in a way that provides information without alarming them. Dont give you
opinion or judgement tell what happened, what we did, how they responded.
-Sexual harassment is frequently tested do not confront, do not look into the
accused past, you must take action-know your policy and follow it exactly.
-When delegating, give specific instructions and guidelines, it may include what to
report to you for assessment by you.
-Review proper documentation guidelines for suspected abuse p 595. Remember,
they may not give you perfect choices look for the BEST answer of those given.
-for nclex, we NEVER assess a pt that is not assigned to us! If there is an issue with
another nurses pt, as a staff nurse, you would report it to the person above you
charge nurse, supervisor, manager whoever they give you that represents going
up the chain of command in nursing. Do not check the pt., do not confront the nurse
assigned to the pt.
-Review documentation of med errors, incidents etc p 415
-Temporary or agency nurses are expected to be able to function as full staff.
Someone will take a minute to confirm their skill level and if they have the skills
needed for a given area, they do not need a light assignment, they do not require a
resource person. There is no reason to check on a float, if there was a float
available, you would have them.

-when considering which pt needs their meds first, look at the med, and why they
need it
-Once you make staff assignments, you do not change them based on staff
preferences
-Restraints, either physical or chemical are a last resort. Only used for physically
threatening or violent pts. Confused pts need frequent reorientation you have the
time in nclex land.
-Review teaching, p 421. Pt must be ready to learn, you must adjust your teaching
to the pts needs, respect fears and adjust teaching plan to meet THEIR needs at
that time.
-simple instructions or information may not require a translator. Complex things DO
admissions, teaching, consents, discharges all would need a translator.
Demonstrating using the scrub in a shower do not require translator.
-any pt with neuro issue like stroke, head injury etc. with a widened pulse pressure
has increased ICP and must be treated immediately. p 263
**End MOC, Start Safety and Inf Control
-For seizure precautions, we no longer use anything as a bite block. We do not insert
things in the mouth like airways. Side rails are considered restraints in more
facilities, nclex supports this and we use a mat on the floor to protect from injury.
Mattress may also be placed on floor. P261
-Goggles are required for droplet prec. If staff needs to wear goggles, the infection
is spread by droplets. Prec p 428
-age approp care 205
-Mono 426 Review the job of the spleen and what happens with mono that the
spleen is at increased risk for rupture. Avoid contact sports.
-TB test positive is 10 or more. Immunosupressed pts lack the ability to respond to
antigen, so a 5 cm bump may be positive for them. If they are NOT
immunosupressed, the 5mm bump is negative. Know everything about TB,
exposure, meds and treatments.
-PROM is at risk for infection because the membrane protecting fetus has ruptured
leaving an open path for germs to travel up to baby and mom.477, PP infections
501
-pts with difficult behaviors need therapeutic commun to determine reason for
negative behavior.
-know lead poisoning

**Session 6, cont Safety/Inf Control, Health Promotion and Maint. and

Psych
-Review hazardous materials/spills.
-Know the safety issues with buying used car seats. RN must discharge pt with
properly labeled, tagged, approved car seat or supply pt with loaner seat.
-Recognize hazards to children food, environmental, poisons
-Auto safety is the number one risk for young males
**Start Health Prom. And Maint.
-Erikson is extremely important for the examages and stages throughout the
lifespan. Nclex loves Erikson and growth and development P 454
-Play is the work of childhood 453
-know amniocentesis pre and post amino needs, complications
-Understand Rh incompatibility, treatment
-Fetal positions are on p479
-Vena cava syndrome mom is on her back, baby compresses vena cava causing
drop in BP and symptoms. Turn mom to L side and keep flat to restore circ.to both
mom and baby.
-Late decels mean fetal distress from lack of O2. Give mom high flow O2 to help
baby. Remember VEAL CHOP:
Variable = Cord Compression
Early = Head Compression
Acceleration = OK
Late = Placenta Insufficiency
-Babies need to be fed frequently to maintain hydration. For breastfeeding moms,
increasing intake without increasing frequency of feeding will not help baby
rehydrate. Amount of voids and stools indicates hydration, baby is hydrated when
output is normal again. Nl outputs 506
- Infant NORMALS:
2-3 BM's daily
8 wet diapers daily
-difficulty sleeping may be tested, or may be used as a symptom. You must
determine if this is the thing being tested if so, it is a physical issue. However, in
some cases it may just be one of several symptoms or a P/Soc answer choice. You
must determine if in a particular situation it is a physical problem or simply an item
to be discarded for a more important need or problem. Sleep p 355

-Know normal newborn assessment 503

-Know hyperbilirubinemia, phototherapy and the complication of encephalopathy
510
-C-Diff is a highly contagious infection that develops with antibiotic use, especially
longer term use of IV antibiotics in the elderly. You must eval meds if that option is
given to determine if it may be a side effect of anything they are taking before you
call it c-diff and get a stool spec. Do 1 thing FIRST. You cannot place this pt with
anyone who does not have the infection.
-When dealing with hazmat contamination, find out what has been done BEFORE
they come into your facility. Risk of contaminating everything and everyone.
-If risk factors are listed in your book for a disease, you need to know them.
-Post partum hemorrhage is major risk after birth p 500
-Understand the pathophysiology behind newborn hypoglycemia
-Review care of babies born to addicted moms 513
-Low temp in newborns is cardinal sign of newborn sepsis cold babies cannot
digest food. Medical emergency! P515
-make sure when a pt has multiple symptoms that you think of what the entire
group of symptoms may be. Think about the big picture. If you think the symptoms
represent an illness or disease or adverse reaction, eliminate answers that only
address ONE symptom. However, keep in mind that the question may also give you
lots of distracting symptoms or diagnosis, and be asking only about 1 thing.
Consider both possibilities. Dont lock yourself in to an idea and not recognize that
you need to change your thought. Do NOT manipulate answers by making up
stories to support a wrong theory.
-A saturated peri pad is 100ccs of blood, 1 saturated pad per hour is hemorrhage!
-nclex views the urge to void, feelings of pressure as a problem to be investigated
and NOT expected. Assess the drainage tubing.
-Know the childhood diseases, incubation periods, exposure and precautions
required. 426
-Know immunization schedules for all age groups there are no tricks, you just need
to memorize these
-Know landmarks for heart sounds and where the valves are.
***Begin Psychosocial Integrity

-Even though this is about psych, valid physical needs will take priority over P/Soc
needs. When deciding if something is physical or P/Soc, if you cant tell
immediately, tell yourself youll go back to it if you need to. Do NOT spend a lot of
time going back and forth or you will go into a swamp and start making up reasons
to call it something. JUST MOVE ON! You can go back if you need to, but chances are
it wont matter either way. It will be correct, or you will eliminate it no matter what
label you give it.
-manic pts need food and fluids to maintain their high metabolic needs. They need
safety and supervision and low stimulation from the environment. They need limits
on things like exercise they are already in constant motion.
-Know lithium!!!!
-Use therapeutic communication and know specific techniques used for specific
psych problems. Ther Comm p552
-Know alcohol withdrawl, DTs and when you will see them based on time of last
drink. 589
-OCD is an anxiety disorder. 557
-Review all side effects and adverse reactions with psych meds. They are frequently
tested. Know at what point you would see what problems based on when the med
was started. Know which problems must be treated immediately.
-In most cases, belligerent, agitated pts cannot be reasoned with. Remove to quiet
area with supervision. The problem pt is removed from common areas we do not
ask the unit to revolve around the uncooperative pt.
-Review anxiety states in your book.
-Depression is frequently tested. When assessing depressed pts, think of sleep,
appetite, concentration, energy and interest.
-an important need in psych is trust. You must establish trust before you can begin
to work effectively with them. This is especially important with depressed pts.
Therapeutic tip: Sit down, hush up and listen.
-Drug classifications are important with psych meds. Never just d/c an SSRI
-To understand the meds, know what they do. What does serotonin DO, so how does
a serotonin reuptake inhibitor help the depression? Doing this with any med you
study will decrease the amount of stuff you need to memorizeread to understand!
Yes, it takes some timeso does memorization and it is totally ineffective. Spend
the time actually learning and you will carry that information beyond the nclex
exam and into your practice as an RN.
-Lithium causes diuresis much like DI. They must drink 2500-3000 mls a day to
keep hydrated.

-With delusions and hallucinations, acknowledge the feelings it causes the pt but do
not acknowledge the delusion itself. Do not invite discussion, explanation or
argument about the delusion or hallucination. Provide facts or reinforce reality. P582
-Review schizophrenia 579
-Know the antipsychotic meds, side effects, interactions and adverse reactions. Life
threatening reactions will be tested. 102
-pts in rehab are master manipulators. Remember that in psych, we use rules and
limit setting to prevent manipulation. We do it gently but firmly. Consistency among
staff is key to prevent staff splitting.
-A violent or physically threatening pt is the only pt we dont stay with
-Assault cycle p586
HEALTH PROMOTION & MAINTENANCE NOTES:
Frothy Sputum = Esoph/Trach (Pg. 181-182)
Serious Situation
Needs immediate treatment -> Surgical
Toddlers should NOT be given peanuts, gum, popcorn, carrots or hotdogs = Choking
hazards
PSYCHOSOCIAL NOTES:
THERAPUTIC COMMUNICATION:
1.) Respond in feeling tone
2.) Provide information
3.) Don't ask "why" questions
4.) Don't ask "yes/no" questions
5.) Don't focus on the nurse
6.) Don't explore/probe/prod
7.) Don't say, "don't worry"
(Pg. 552 in your book)
Depression & Antidepressants:
> Be aware of onset, peak, duration and time required to reach therapeutic serum
levels for medications
> Increased energy is a common response to antidepressant medications
> Depressed pt. responds better to activity-based therapy, participating in
activities that provide socialization
Manic Patients:
Don't play well with others
You need to stay with the patient and provide supervision
Can distract manic patients and toddlers
Suicidal Patients:
Be direct

 Ask them if they have a plan

It is OK to ask a yes/no question in these situations because we need to find out if
they are thinking about possible suicide!
HIPPA always applies
Pain between the shoulder blades: possible MI or triple-A rupture
Potential problems are lower priority than actual problems right now
Compartment syndrome: increased pressure within the fascia, can result in
destruction of all tissues within. Seen after crush injuries and too tight casts
When you have answer choices that list vitals or state "vital signs stable", go with
the specific vitals
Patient assignments are based ONLY on the patient's needs/acuity
Don't check the gag reflex in someone who lacks swallow reflex due to risk for
aspiration if stomach contents come up with the gag
Interpreters are needed for questions or assessments. A simple skill that can be
demonstrated doesn't require an interpreter.
Mastectomies, ostomies, and amputations are considered more complex surgeries
due to the body image change that accompanies the surgery.