Nursing Key Strategies for Exam Success

Nursing Exam Cram Sheet The final mountain that nursing students must summit before becoming a registered nurse is the NCLEX. Preparing for the NCLEX can be stressful as taking in colossal amounts of information has never been easy. This is where this cram sheet can help-- it contains condensed facts about the licensure exam and key nursing information. When exam time comes, you can write and transfer these vital information from your head to a blank sheet of paper provided by the testing center. 1. Test Information  Six hours—the maximum time allotted for the NCLEX is 6 hours. Take breaks if you need a time out or need to move around.  75/265—the minimum number of questions you can answer is 75 and a maximum of 265.  Read the question and answers carefully—do not jump into conclusions or make wild guesses.  Look for keywords—Avoid answers with absolutes like always, never, all, every, only, must, except, none, or no.  Don’t read into the question—Never assume anything that has not been specifically mentioned and don’t add extra meaning to the question.  Eliminate answers that are clearly wrong or incorrect—to increase your probability of selecting the correct answer!  Watch for grammatical inconsistencies—Subjects and verbs should agree. If the question is an incomplete sentence, the correct answer should complete the question in a grammatically correct manner. Rephrase the question—putting the question into your own words can pluck the unneeded info and reveal the core of the stem.  Make an educated guess—if you can’t make the best answer for a question after carefully reading it, choose the answer with the most information. 2. Vital Signs  Heart rate: 80—100 bpm  Respiratory rate: 12-20 rpm  Blood pressure: 110-120/60 mmHg  Temperature: 37 °C (98.6 °F) 3. Hematology values  RBCs: 4.5—5.0 million  WBCs: 5,000—10,000  Platelets: 200,000—400,000  Hemoglobin (Hgb): 12—16 gm (female); 14—18 gm (male).  Hematocrit (Hct): 37—47 (female); 40— 54 (male) 4. Serum electrolytes  Sodium: 135—145 mEq/L  Potassium: 3.5—5.5 mEq/L  Calcium: 8.5—10.9 mEq/L  Chloride: 95—105 mEq/L  Magnesium: 1.5—2.5 mEq/L  Phosphorus: 2.5—4.5 mEq/L  5. ABG Values  pH: 7.36—7.45  HCO3: 24—26 mEq/L  CO2: 35—45 mEq/L  PaO2: 80%—100%  SaO2: >95% 6. Acid-Base Balance  Remember ROME (respiratory opposite/metabolic equal) to remember that in respiratory acid/base disorders the pH is opposite to the other components. 7. Chemistry Values  Glucose: 70—110 mg/dL  Specific Gravity: 1.010—1.030  BUN: 7-22 mg/dL  Serum creatinine: 0.6—1.35 mg/dL  LDH: 100-190 U/L  Protein: 6.2—8.1 g/dL  Albumin: 3.4—5.0 g/dL  Bilirubin: <1.0 mg/dL  Total Cholesterol: 130—200 mg/dL  Triglyceride: 40—50 mg/dL  Uric acid: 3.5—7.5 mg/dL  CPK: 21-232 U/L 8. Therapeutic Drug Levels  Carbamazepine (Tegretol): 4—10 mcg/ml  Digoxin (Lanoxin): 0.8—2.0 ng/ml  Gentamycin (Garamycin): 5—10 mcg/ml (peak), <2.0 mcg/ml (valley)  Lithium (Eskalith): 0.8—1.5 mEq/L  Phenobarbital (Solfoton): 15—40 mcg/mL  Phenytoin (Dilantin): 10—20 mcg/dL  Theophylline (Aminophylline): 10—20 mcg/dL  Tobramycin (Tobrex): 5—10 mcg/mL (peak), 0.5—2.0 mcg/mL (valley)  Valproic Acid (Depakene): 50—100 mcg/ml  Vancomycin (Vancocin): 20—40 mcg/ml (peak), 5 to 15 mcg/ml (trough) 9. Anticoagulant therapy  Sodium warfarin (Coumadin) PT: 10—12 seconds (control). The antidote is Vitamin K.  INR (Coumadin): 0.9—1.2  Heparin PTT: 30—45 seconds (control). The antidote is protamine sulfate.  APTT: 23.3—31.9 seconds  Fibrinogen level: 203—377 mg/dL 10. Conversions  1 teaspoon (t) = 5 ml  1 tablespoon (T) = 3 t = 15 ml  1 oz = 30 ml  1 cup = 8 oz  1 quart = 2 pints  1 pint = 2 cups  1 grain (gr) = 60 mg 1 gram (g) = 1,000 mg 1 kilogram (kg) = 2.2 lbs 1 lb = 16 oz Convert C to F: C+40 multiply by 9/5 and subtract 40  Convert F to C: F+40 multiply by 5/9 and subtract 40 11. Maternity Normal Values  Fetal Heart Rate: 120—160 bpm  Variability: 6—10 bpm  Amniotic fluid: 500—1200 ml  Contractions: 2—5 minutes apart with duration of < 90 seconds and intensity of <100 mmHg.  APGAR Scoring: Appearance, Pulses, Grimace, Activity, Reflex Irritability. Done at 1 and 5 minutes with a score of 0 for absent, 1 for decreased, and 2 for strongly positive. Scores 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally regarded as critically low.  AVA: The umbilical cord has two arteries and one vein. 12. STOP—Treatment for maternal hypotension after an epidural anesthesia:  Stop infusion of Pitocin.  Turn the client on her left side.  Administer oxygen.  If hypovolemia is present, push IV fluids. 13. Pregnancy Category of Drugs  Category A—No risk in controlled human studies  Category B—No risk in other studies. Examples: Amoxicillin, Cefotaxime.     Category C—Risk not ruled out. Examples: Rifampicin (Rifampin), Theophylline (Theolair).  Category D—Positive evidence of risk. Examples: Phenytoin, Tetracycline.  Category X—Contraindicated in Pregnancy. Examples: Isotretinoin (Accutane), Thalidomide (Immunoprin), etc.  Pregnancy Category N—Not yet classified 14. Drug Schedules  Schedule I—no currently accepted medical use and for research use only (e.g., heroin, LSD, MDMA).  Schedule II—drugs with high potential for abuse and requires written prescription (e.g., Ritalin, hydromorphone (Dilaudid), meperidine (Demerol), and fentanyl).  Schedule III—requires new prescription after six months or five refills (e.g., codeine, testosterone, ketamine).  Schedule IV—requires new prescription after six months (e.g., Darvon, Xanax, Soma, and Valium).  Schedule V—dispensed as any other prescription or without prescription (e.g., cough preparations, Lomotil, Motofen). 15. Medication Classifications  Antacids—reduces hydrochloric acid in the stomach.  Antianemics—increases blood cell production.  Anticholinergics—decreases oral secretions.  Anticoagulants—prevents clot formation,  Anticonvulsants—used for management of seizures and/or bipolar disorders.  Antidiarrheals—decreases gastric motility and reduce water in bowel.  Antihistamines—block the release of histamine.  Antihypertensives—lower blood pressure and increases blood flow.  Anti-infectives—used for the treatment of infections,  Bronchodilators—dilates large air passages in asthma or lung diseases (e.g., COPD).  Diuretics—decreases water/sodium from the Loop of Henle.  Laxatives—promotes the passage of stool.  Miotics—constricts the pupils.  Mydriatics—dilates the pupils.  Narcotics/analgesics—relieves moderate to severe pain. 16. Rules of nines for calculating Total Body Surface Area (TBSA) for burns  Head: 9%  Arms: 18% (9% each)  Back: 18%  Legs: 36% (18% each)  Genitalia: 1% 17. Medications  Digoxin (Lanoxin)—Assess pulses for a full minute, if less than 60 bpm hold  - -           dose. Check digitalis and potassium levels. Aluminum Hydroxide (Amphojel)— Treatment of GERD and kidney stones. WOF constipation. Hydroxyzine (Vistaril)—Treatment of anxiety and itching. WOF dry mouth. Midazolam (Versed)—given for conscious sedation. WOF respiratory depression and hypotension. Amiodarone (Cordarone)—WOF diaphoresis, dyspnea, lethargy. Take missed dose any time in the day or to skip it entirely. Do not take double dose. Warfarin (Coumadin)—WOF for signs of bleeding, diarrhea, fever, or rash. Stress importance of complying with prescribed dosage and follow-up appointments. Methylphenidate (Ritalin)—Treatment of ADHD. Assess for heart related sideeffects and reported immediately. Child may need a drug holiday because the drug stunts growth. Dopamine—Treatment of hypotension, shock, and low cardiac output. Monitor ECG for arrhythmias and blood pressure. Rifampicin—causes red-orange tears and urine. Ethambutol—causes problems with vision, liver problem. Isoniazid—can cause peripheral neuritis, take vitamin B6 to counter. 18. Developmental Milestones  2—3 months: able to turn head up, and can turn side to side. Makes cooing or gurgling noises and can turn head to sound.  4—5 months: grasps, switch and roll over tummy to back. Can babble and can mimic sounds.  6—7 months: sits at 6 and waves byebye. Can recognize familiar faces and knows if someone is a stranger. Passes things back and forth between hands.  8—9 months: stands straight at eight, has favorite toy, plays peek-a-boo.  10—11 months: belly to butt.  12—13 months: twelve and up, drinks from a cup. Cries when parents leave, uses furniture to cruise. 19. Cultural Considerations  African Americans—May believe that illness is caused by supernatural causes and seek advice and remedies form faith healers; they are family oriented; have higher incidence of high blood pressure and obesity; high incidence of lactose intolerance with difficulty digesting milk and milk products.  Arab Americans—May remain silent about health problems such as STIs, substance abuse, and mental illness; a devout Muslim may interpret illness as the will of Allah, a test of faith; may rely on ritual cures or alternative therapies before seeking help from health care provider; after death, the family may   want to prepare the body by washing and wrapping the body in unsewn white cloth; postmortem examinations are discouraged unless required by law. May avoid pork and alcohol if Muslim. Islamic patients observe month long fast of Ramadan (begins approximately mid-October); people suffering from chronic illnesses, pregnant women, breast-feeding, or menstruating don’t fast. Females avoid eye contact with males; use same-sex family members as interpreters. Asian Americans—May value ability to endure pain and grief with silent stoicism; typically family oriented; extended family should be involved in care of dying patient; believes in “hotcold” yin/yang often involved; sodium intake is generally high because of salted and dried foods; may believe prolonged eye contact is rude and an invasion of privacy; may not without necessarily understanding; may prefer to maintain a comfortable physical distance between the patient and the health care provider. Latino Americans—May view illness as a sign of weakness, punishment for evil doing; may consult with a curandero or voodoo priest; family members are typically involved in all aspects of decision making such as terminal illness; may see no reason to submit to mammograms or vaccinations. - - Native Americans—May turn to a medicine man to determine the true cause of an illness; may value the ability to endure pain or grief with silent stoicism; diet may be deficient in vitamin D and calcium because many suffer from lactose intolerance or don’t drink milk; obesity and diabetes are major health concerns; may divert eyes to the floor when they are praying or paying attention.  Western Culture—May value technology almost exclusively in the struggle to conquer diseases; health is understood to be the absence, minimization, or control of disease process; eating utensils usually consists of knife, fork, and spoon; three daily meals is typical. 20. Common Diets  Acute Renal Disease—protein-restricted, high-calorie, fluid-controlled, sodium and potassium controlled.  Addison’s disease—increased sodium, low potassium diet.  ADHD and Bipolar—high-calorie and provide finger foods.  Burns—high protein, high caloric, increase in Vitamin C.  Cancer—high-calorie, high-protein.  Celiac Disease—gluten-free diet (no BROW: barley, rye, oat, and wheat).  Chronic Renal Disease—proteinrestricted, low-sodium, fluid-restricted, potassium-restricted, phosphorusrestricted.                   Cirrhosis (stable)—normal protein Cirrhosis with hepatic insufficiency— restrict protein, fluids, and sodium. Constipation—high-fiber, increased fluids COPD—soft, high-calorie, lowcarbohydrate, high-fat, small frequent feedings Cystic Fibrosis—increase in fluids. Diarrhea—liquid, low-fiber, regular, fluid and electrolyte replacement Gallbladder diseases—low-fat, calorierestricted, regular Gastritis—low-fiber, bland diet Hepatitis—regular, high-calorie, highprotein Hyperlipidemias—fat-controlled, calorierestricted Hypertension, heart failure, CAD—lowsodium, calorie-restricted, fat-controlled Kidney Stones—increased fluid intake, calcium-controlled, low-oxalate Nephrotic Syndrome—sodium-restricted, high-calorie, high-protein, potassiumrestricted. Obesity, overweight—calorie-restricted, high-fiver Pancreatitis—low-fat, regular, small frequent feedings; tube feeding or total parenteral nutrition. Peptic ulcer—bland diet Pernicious Anemia—increase Vitamin B12 (Cobalamin), found in high amounts on shellfish, beef liver, and fish.