NEED TO MEMORIZE FOR NCLEX

Tonometry: normal (10-21 mm Hg) PR Interval: normal (0.12-0.20 seconds) Serum Amylase: normal (25-151 units/dL) Serum Ammonia: normal (35 to 65 mcg/dL) Calcium: adult (8.6-10 mg/dL) child (8 to 10.5 mg/dL) term<1week (7 to 12 mg/dL) Partial Thromboplastin Time (aPTT): normal (20-36 seconds) therapeutic 1.5-2.5 Prothrombin Time: normal (Male: 9.6-11.8 seconds) and (Female: 9.5-11.3 seconds) Platelet Count: normal (150,000-400,000 cells/uL) Albumin level: normal (3.4 to 5 g/dL) Serum Osmolality: normal (285 to 295 mOsm/kg) high value indicates dehydration Safe Suction Range: normal [Infant] 50-95 mm Hg [Child] 95-115 mm Hg [Adult]100-120 mm Hg) Serum Lithium: normal (1 to 1.5 mEq/L) acute mania (0.6 to 1.4 mEq/L) maintenance treatment Phenytoin (Dilantin): normal serum (10 to 20 mcg/mL) Digoxin: therapeutic blood level (0.8 to 2.0 ng/ml) Magnesium Sulfate: Therapeutic Range (4 to 8 mg/dl) Pregnancy Temperature: normal (36.2-37.6 celcius or 98-99.6 Farenheit) WBCs In Pregnancy: normal (11,000 to 15,000 cells/mm3, up to 18,000 cells/mm3). Immediate postpartum period, (maybe as high as 25,000 to 30,000 cells/mm3) Stomach Capacity: Newborn infant (10 to 20 mL) 1-week-old (30 to 60 mL) 2-3-week-old infant (75 to 100 mL) 1-month-old infant (90 to 150 mL) Left Atrial Pressure: normal (1 to 10 mm Hg) Fibrinogen Levels: normal (male: 180 to 340 mg/dL) and (female: 190 to 420 mg/dL) INSULIN (Regular, Humulin R) Type: Fast acting Onset: -1 hr Peak: 2-4 hr Duration: 6-8 hr Insulin (NPH, Humulin N) Type: Intermediate acting Onset: 2hr
1

Peak: 6-12hr Duration 18-26hr Insulin (Ultralente, Humulin U) Type: Slow acting Onset: 4hr Peak: 8-20hr Duration: 24-36hr Insulin (Humulin 70/30) Type: Combination Onset: hr Peak: 2-12hr Duration: 24hr Central Venous Pressure: < 3 mm Hg = inadequate fluid and >11 mm Hg = too much fluid Potassium: 3.5-5.0 mEq/L Sodium: 135-145 mEq/L Calcium: 4.5-5.2 mEq/L or 8.6-10 mg/dL Magnesium: 1.5-2.5 mEq/L Chloride: 96-107 mEq/L Phosphorus: 2.7 to 4.5 mg/dL PR measurements: normal (0.12 to 0.20 second) QRS measurements: normal (0.04 to 0.10 second) Ammonia: 35 to 65 ug/dL Amylase:25 to 151 IV/L Lipase: 10 to 140 U/L Cholesterol: 140 to 199 mg/dL LDL: <130 mg/dL HDL: 30 to 70 mg/dL Triglycerides: <200 mg/dL Bilriubin Direct: 0 to 0.3 mg/dL Indirect: 0.1 to 1.0 mg/dL Total: <1.5 mg/dL Protein: 6.0 to 8.0 g/dL Uric acid: Male 4.5 to 8 mg/dL Female 2.5 to 6.3 mg/dL Glycosylated Hemoglobin HbA1c: good control 7.5% or less Serum creatinine: 0.6 to 1.3 mg/dL BUN: 9-25 mg/dL

Normal CK is 26-174 U/L Troponin I value: normal (<0.6 ng/mL) Troponin T >0.1 to 0.2 ng/mL = MI Erythrocyte studies: 0-30 mm/hour Serum iron: Male 65-175 ug/dL Female 50-170 ug/dL RBC: Male 4.5 to 6.2 M/uL Female 4.0 to 5.5 M/uL Theophylline levels normal (10 to 20 mcg/dl) AT THE PLAY GROUND * Stranger anxiety: 0 -1 year * Separation anxiety: 1 - 3 years * Solitary play: 0 1 year PSYCHOLOGICAL DEVELOPMENT AGE Infant 0 1.5 Toddler 1.5 -3 Pre-school 3-6 School age ERIKSON Trust vs. mistrust (trust & dependence Autonomy vs. shame Initiative vs. guilt 6 - 11 Industry vs. inferiority Identity vs. role confusion Intimacy vs. isolation Generativity vs. stagnation Integrity vs.despair
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* Parallel play: 2 3 years * Group play: 3 4 years

FREUD

PIAGET

Oral

sensorimotor

Anal (holding vs. letting out) Phallic (Oedipus complex) latency

preoperational

preoperational Concrete operational Formal operational

11 - 20

genital

20 25

25 50

50 - ?

MOTOR DEVELOPMENT

Chin up : 1 month Chest up : 2 month Knee push and swim : 6 month Sits alone/stands with help : 7 month Crawls on stomach : 8 month Stands holding on furniture : 10 month Walks when led : 11 month Stands alone : 14 month Walks alone : 15 month LABORATORY VALUES ELECTROLYTES Sodium (Na+): 135 145 meq/L (increase-dehydration; decrease overhydration) Potassium (K+): 3.5 - 5.0 meq/L Magnesium (Mg++): 1.5 2.5 meq/L Calcium (Ca++): 4.5 5.8 meq/L Neonate : 7.0 to 12 mg/dL Child: 8.0 to 10.5 mg/dL Phosphorus (PO4): 1.7 2.6 meq/L Chloride (Cl-): 96 106 meq/L COAGULATION STUDIES Activated partial thromboplastin time(APTT): 20 36 seconds depending on the type of activator used Prothrombin time(PT): male: 9.6 11.8 seconds Female: 9.5 11.3 seconds International Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin therapy 3.0 4.5 for high-dose Coumadin therapy Clotting time: 8 15 minutes Platelet count: 150,000 to 400,000 cells/Ul Bleeding time: 2.5 to 8 minutes SERUM GASTROINTESTINAL STUDIES Albumin: 3.4 to 5 g/dL Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL Ammonia: 15 to 45 ug/dL Amylase: 50 180 Somogyi U/dL in adult 20 160 Somogyi U/dL in the older adult Bilirubin: direct: 0 - 0.3 mg/dL Indirect: 0.1 1.0 mg/dL Total: less than 1.5 mg/dL Cholesterol: 120 200mg/dL Lipase: 31 -186 U/L Lipids: 400 800 mg/dL Triclycerides: Normal range: 10 190 mg/dL Borderline high: 200 400 mg/dL

High: 400 1000mg/dL Very high: greater than 1000mg.dL Protien: 6.0 8.0 g/L Uric acid: male: 4.5 8 ng/dL Female: 2.5 6.2 ng/dL GLUCOSE STUDIES Fasting blood sugar: 70 105 mg/dL Glucose monitoring (capillary Blood): 60 110 mg/dL RENAL FUNCTION TEST Creatinine: 0.6 1.3 mg/dL Blood urea nitrogen (BUN): 5 20 mg/dL ERYTROCYTES STUDIES Erytrocyte sedimentation rate(ESR): 0 30 mm/hr depending on age Hemoglobin: male: 14 16.5 g/dL Female: 12 15 g/dL Hematocrit: male: 42% - 52% (increased in hemoconcentration, fluid loss and dehydration) Female: 35% - 47% ( decreased in fluid retention) Red blood cell (RBC): male: 4.5 to 6.2 million/uL Female: 4 to 5.5 million/uL White blood cell (WBC): 4500 to 11,000/uL Erytrocyte Protoporthyrin (EP) : <9ug/dL Phenylalanine Level: <2 mg/dL PKU: >25 mg/dL ARTERIAL BLOOD GAS (ABG) pH: 7.35 7.45 PCO2: 35 - 45 mmHg PO2: 80 - 100 mmHg HCO3: 22 - 27 mEq/L O2 saturation: 96% - 100% Acid-base RAMS(Respiratory Alternate, Metabolic Same) GLASGOW COMA SCALE Eye opening response Motor response Verbal response CRANIAL NERVES I. Olfactory (S) II. Optic (S) III. Oculomotor (M) IV. Trochlear (M) MAJOR FUNCTIONS smell vision Eye movement
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V. Trigeminal (S-M)

Facial sensation Jaw movement VI. Abducent (M) Eye movement VII. Facial (S-M) Taste Facial expression VIII. Acoustic (S) Hearing and balance IX. Glossopharyngeal (S-M) Taste Throat sensation Gag and swallow X. Vagus (S-M) Gag and swallow Parasympathetic activity XI. Spinal Accessory (M) Neck and back muscles XII. Hypoglossal (M) Tongue movement *On Old Olympus Towering Tops, A Finn And German Viewed Some Hops Some Says Marry Money, But My Brother Says Bad Business Marry Money AUTONOMIC NERVOUS SYSTEM SYMPATHETIC/ADRENERGIC PARASYMPATHETIC/CHOLINERGIC Heart Bronchi GI tract Rectum Bladder Erection Ejaculation Pupils of eye Salivary glands Blood vessels -a constrict -b dilates Increased heart rate Increased conduction Increased force dilation Reduced motility Allows filling Empties rectum Allows filling Empties bladder Maintains erection Big (mydriasis) Secretion Depends on receptors Decreased heart rate constriction Increased motility Relaxes internal sphincter Relaxes internal sphincter Triggers ejaculation Small (miosis)

FLOW OF BLOOD THROUGH THE HEART Inferior vena cava and superior vena cava right atrium tricuspid valve right ventricle pulmonic valve pulmonary artery lungs pulmonary veins left atrium bicuspid valve (mitral) left ventricle aortic valve aorta systemic circulation CARDIAC IMPULSES

Sinoatrial (SA) node right and left atria (atria contract) atrioventricular (AV) node bundle his bundle brabches purjinjes fibers ventricles contract. Blood volume: 5000mL Central venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration) Pressure within the right atrium: 2 to 7 mmHg Capillary refill time: <3 seconds Normal sweat chloride: <40 mEq/L Normal pupil diameter: 3 to 5mm Normal ocular pressure: 10 to 21 mmHg Normal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhg Normal cardiac output : 4 to 8 L/min. THERAPEUTIC SERUM MEDICATION LEVELS Acetaminopen (Tylenol) 10 20 ug/mL Amikacin (Amikin) 25 30 ug/mL Amitryptyline (Elavil) 120 -150 ng/mL Carbamazepine (Tegretol) 5 -12 ug/mL Chloramphenicol (Chloromycetin) 10 20 ug/mL Desipramine (Norpramin) 150 -300 ng/mL Digotoxin ( Crystodigin) 15- 25 ng/mL Digoxin ( Lanoxin) 0.5 2.0 ng/mL Disopyramide (Norpase) 2 -5 ug/mL Ethosuximide ( Zarontin) 40 100 ug/mL Gentamycin (Garamycin) 5 10 ug/mL Imipramide (Tofranil) 150 300 ug/mL Lidocaine (Xylocaine) 1.5 5.0 ug/mL Lithium (Lithobid) 0.5 -1.5 ug/mL Magnesium sulphate 4 -7 mg/dL Nortriptyline (Aventyl) 50 150 ng/mL Phenobarbital (Luminal) 10 30 ug/mL Phenytoin (Dilantin) 10 -20 ug/mL Primidone (Myoline) 5 20 ug/mL Procainamide (Pronestryl) 4 10 ug/mL Propranolol (Inderal) 50 100 ng/mL Quinidine (Quinalaglute, Cardioquin) 2 5ug/mL Salisylate 100 -250 ug/mL Theophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mL Tobramycin (Nebcin ) 5 -10 ug/mL Valproic acid (depakene) 50 -100 ug/mL Pulmonary capillary wedge pressure: 5 to 13 mmHg Pulmonary artery pressure: systolic: 16 to 30 mmHg Diastolic: 0 to 7 mmHg Spinal pressure: 70 to 200mmH2O Morphine sulphate pediatric dose: 0.1mg/kg every 3 4 hour
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SULFONYLUREAS For treatment of NIDDM Sulfonylureas should not be given to patients with liver or kidney failure. Accummulation of drug will increase risk of hypoglycaemia. DURATION tolbutamide : 8 h Glycburide, glipizide : 20 h, most potent chlorpropamide : 48 h Apothecary and Household System Grain gr 1 gr = 60 mg Dram dr 5 gr = 300 mg Ounce oz 15 gr = 1000mg or 1g Minim min, M, m 1/150 gr =0.4 mg Quart qt 1 oz = 30 mL Pint pt 1 dr = 4 mL Drop gtt 1 T = 15 mL or 3 tsp Tablespoon T or tbs 1 min = 1 gtt Teaspoon t or tsp 15 min = 1mL Pound lb 60 min = 1 dr 8 dr = 1 oz 1 qt = 1000mL or 1L 1 qt = 2 pt or 32 oz 1 pt = 16 oz 16 oz = 1 lb 2.2lb = 1 kg Fahrenheit to Celcius (F 32) divide 1.8 = C Celcius to Fahrenheit 1.8 C + 32 = F Formula for Calculating a Medication Dosage D (desired ) = the dosage that the physician ordered S (stock/available) =the dosage strength as stated on the medication label Q (quantity ) = the volume that the dosage strength is available in, such as tablet, capsules, or mL DXQ=X S Formulas for Intravenous Calculations Flow Rates: Total volume x gtt factor = gtt per min Time in minutes Infusion Time: Total volume to infuse = Infusion time

mL per hour being infused IMMUNIZATION Birth Hepatitis B 1 months Hepatitis B 2 months OPV, DPT, HIB 4 months DPT, HIB, OPV 6 months DPT, HIB, hepatitis B 12 months HIB, OPV 15 months MMR 18 months DPT 12 18 months Varicella vaccine 4 -6 years DPT, OPV, MMR 11 12 years MMR ( if not administered at 4 -6 years) 11 16 TD booster SPINAL CORD INJURY Cervical Injury: C2 to C3 injury usually fatal C4 is the major innervation to the diaphragm by th phrenic nerve Involvement above th C4 causes respiratory difficulty and paralysis of all the four extremities C5 or below client may have movement in the shoulder Thoracic Level Injury: loss of movement of the chest, trunk, bowel, bladder, and legs, depending on the level of injury Leg paralysis (paraplegia) Autonomic dysreflexia with lesions above T6 and in cervical lesions Visceral distention from a distended bladder or impacted rectum may cause reactions such as sweating, bradycardia, hypertension, nasal stuffiness, and gooseflesh Lumbar and Sacral Level Injuries: loss of movement and sensation of the lower extremities. S2 and S3 center on micturation; therefore below this level, the bladder will contract but not empty (neurogenic bladder) Injury above S2 in males allows them to have an erection, but they are unable to ejaculate because of sympathetic nerve damage. Injury between S2 and S4 damages the sympathetic and parasympathetic response, preventing erection and ejaculation. RULE OF NINE Head and neck 9% Anterior trunk 18% Legs (18%) 36% Arms (9%) 18% Posterior trunk 18% Perineum 1%
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NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL

Neutrophils 56% or 18000 7800/uL Bands 3% or 0 700/uL Eosinophils 2.7% or 0 450/uL Basophils 0.3% or 0 200/uL Lymphocytes 34% or 1000 4800/uL Monocytes 4% or 0 800/uL THYROID STUDIES Thyroid stimulating hormone (thyrotropin; THS): 0.2 to 5.4 ug/dL Thyroxine (T4): 5.0 to 12.0 ug/dL Thyroxine free (FT3) : 0.8 to 2.4 ng/dL Triiodothyronine (T3): 80 to 230 ng/dL Normal Fribrinogen level: for men: 180 to 340mg/dL Women: 190 to 420mg/dL Fribrinogen is used up in the clotting process. Erythrocyte Protoporhyrin (EP): < 9ug/dL Phenylalanine level: < 2mg/dL PKU: >25 mg/dL Urine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in diabetes insipidus Normal CSF protein: 15 45 mg/dL increase in Guillain-Barre syndrome Normal CSF pressure: 5 15 mmHg Normal serum osmolality: 285 295 mOsmlkgH2O increase in dehydration; Decrease in over hydration Normal scalp pH: 7.26 and above Borderline acidosis: 7.20 to 7.25 / Acidosis: < 7.15 HERBAL MEDICINES Aloe vera Gel abrasionsand dermatologic conditions American Ginseng (Panax quinquefolius) boost energy, relieve stress, improve concentration and enhance physical or cognitive performance. Ashwagandha (Withania somnifera) stress arthritis Asian gingseng (Panax ginseng) enhance health and combat stress and disease Bilberry (Vaccinium myrtillus) vision and peripheral vascular disorders and as antioxidant Black Cohosh (Cimicifuga racemosa) menopausal Black Currant and Borage oil (Ribes nigrum and Borago offinalis) anti-inflammatory, rheumatoid arthritis Capsicum Peppers (Capsicum spp.) arthritis, neuralgia and other painful treatment Chamomile (Matricaria recutita) manzanilla- skin inflammation, colic, or dyspepsia and anxiety Chaste tree (Vitex agnus-castus) menstrual related disorders, PMS, cyclical mastalgia Chodroitin osteoarthritis Coenzyme Q10 antioxidant Coltsfoot ( Tussilago farfara ) cough and other respiratory disoders Cranberry (Vaccinium macrocarpon) UTI Devils Claw ( Harpagophytum procumbers) anti inflammatory and analgesic

Echinacea (Echinacea spp.) acute viral URI symptoms Ederberry (Sanbacus nigra) respiratory tract infection Ephedra or Ma Huang (Ephedra sinica) Source of ephedrine and pseudoephedrine Evening Primrose Oil (Oenothera biennis) eczema, breast pain associated with PMS and inflammatory condition Fenugreek (Trigonella foenum-graecum) lowering blood glucose Feverfew ( Tanacetum parthenium) migraine headache prophylaxis Garlic (Allium sativaum)- help prevent cardiovascular disease and cancer Ginger (Zingiber officinale) nausea and motion sickness, anti-inflammatory Ginkgo (Ginkgo biloba) dementia and intermittent claudication, memory enhancement and treatment of vertigo nad tinnitus Glucosamine osteoarthritis Goldenseal ( Hydrastis Canadensis) tonic and antibiotic Gotu Kola (Centella asiatica) mental support, wound healing and venous disorders Hawtorn ( Crategus species) CHF and related cardiovascular conditions Horebound (Marribium vulgare) primary cough suppression and expectoration Horse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiency Ivy (Hedera helix) coughs, rheumatic disordes and skin disease Kava ( piper methysticum) mild psychoactive and antianxiety property Lemon Balm (Melissa officinalis) sedative and for dyspepsia Licorice (Glycyrrhiza glabra) respiratory disorders, hepatitis, inflammatory diseases, and infections Melatonin insomia, jet lag Milk Thistle hepatitis, liver desease Mints (Mentha species) minor calcium channel antagonists, used for upper respiratory problems, irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical counterirritant Nettle (Urtica dioica) arthritis pains, allergies, BPH, or as diuretic Papaya (Carica papaya) digestive aid, dyspepsia, and for inflammatory, topically applied to wounds Passion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herb Pokeroot (Phytolacca Americana) inflammatory conditions also as an emetic/cathartic Pygeum (Pygeum africanum) mild symptoms of BPH Red Clover (Trifolium pratense) used as a natural estrogen substitute for womens health St. Johns Wort (Hypericum perforatum) antidepressant effect Tea Tree Oil (Melaleuca alternifolia) antifungal and antibacterial Turmeric (Curuma longa ) anti-inflammatory, anti-arthritis, anti cancer, and antioxidant Uva Ursi (Arctostaphylos uva ursi) urinary antiseptic and diuretic Yohimbe erectile dysfunction FOUR STRATEGIES: 1. If the question asks what you should do in the situation. Use the nursing process to determine which step in the nursing process would be next? 2. If the question asks what the client needs. Use maslows hierarchy to determine which need to address. 3. If the question indicates that the client doesnt have urgent physiologic need, focus on the patient safety.
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4. If the question involves communicating with a patient. Use principles of therapeutic communication. REMEMBER: AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS) Q: The nurse in primary care clinic is caring for a 50-year-old woman. History reveals that she had experienced on and off chest pain. After series of cardiac tests (EKG & Blood Chem), the doctor orders for THALLIUM STRESS TEST. Which of the following medications should the RN prepare if the patient needs an alternative exercise in thallium test? 1.Nitroglycerin 3.Aminophylline 2.Morphine 4.Persantin The correct answer is #4. Persantin (dipyridamole) Persantin is use as an alternative to exercise in thallium myocardial perfusion imaging for the evaluation of CAD in those who cannot exercise adequately. Purpose: to determine myocardial wall viability Other names: 1. Cardiac pooling 2. MUGA-multigated radionuclide angiographic scanning 3. nurclear scan 4. sestamibi test 5. thallium scan 6. dipyridamole or persantin stress test 7. In short, heart scan :) Cervical Cancer Etiology: * Early age of sexual intercourse * Multiple sexual partners * Sexually Transmitted Disease (Venereal Wart); Virus - HPV Cancer Carcinoma in SITU - only in epithelial linings Situ sounds like Ziru - Stage 0 Tumor marker - CEA Signs and Symptoms (3 P's): POST COITAL BLEEDING; PAINFUL INTERCOURSE; PROFUSE (PERIOD IRREGULARITIES- menorrhagia and metrorrhagia) Management: Surgery (HYSTERECTOMY); Radiation (intracavitary cessium - remember STD - shielding, timing and distance); Chemotherapy to destroy the DNA,RNA & CHON synthesis.