Key Concepts for an NCLEX-PN Cram Sheet

Key Concepts for an NCLEX-PN Cram Sheet Vital signs HR: 60-100 bpm BP: 90/60 to 120/80 mm Hg RR: 12 to 20 breaths per minute Temperature: 36.5 to 37.2 °C (97.8-99 °F) Lab values Lipoproteins & Triglycerides Total: < 200 mg/dL Triglycerides: < 150 mg/dL HDL: > 60 mg/dL LDL: < 70 mg/dL AST: < 40 u/L ALT: < 40 u/L ALP: 42-128 u/L Hematology HCT female: 37-47% HCT male: 42-52% HGB female: 12-16 g/dL HGB male: 14-18 g/dL WBC: 5,000-10,000 /uL Platelets: 150,000-400,000 mm3 PT: 11-12.5 seconds (1.5-2.5 times this if on warfarin) aPTT: 30-40 seconds (1.5-2 times this with heparin) INR: 0.8-1.1 (if on warfarin 2-3) Cardiac Troponin: < 0.01 ng/mL C-reactive protein: ≤ 0.8 mg/dL CD40 ligand: 1.51-5.35 mg/L Creatinine kinase: 0-3 mcg/L Serum Electrolytes Sodium: 135-145 mEq/L Potassium: 3.5-5 mEq/L Chloride: 98-106 mEq/L Calcium: 9-10.5 mEq/L Magnesium therapeutic range: 1.3-2.1 mEq/L (4-7 mEq/L if on magnesium) Phosphorus: 3.5-4.5 mEq/L Chemistry Amylase: 56-90 IU/L Lipase: 0-110 units/L Total bilirubin: 0-1 mg/dL Albumin: 3.5-5 g/dL Alfa-fetoprotein: < 10 ng/mL is the adult normal > 500 indicative of liver tumors. Ammonia: 15-110 mg/dL BUN: 10-20 mg/dL Serum creatinine: 0.6-1.2 mg/dL Creatinine clearance: females = 80-125 mL/min, males = 90-139 mL/min GFR: 125 mL/min Fasting blood glucose: < 100 mg/dL HbA1C: Normal = < 5.7, prediabetic = 5.7-6.4, diabetic if 6.5 or higher on 2 separate tests. Thyroid function Total T3: 70-205 ng/dL T4: 4-12 mcg/dL TSH: 0.4-0.6 microunits/mL Urinalysis Urine specific gravity: 1.003-1.030 Volume: 1-2 L/day pH: 4.5-8 Glucose: <130 mg/dL RBC: ≤3 RBCs WBCs: ≤2-5 WBCs/hpf Protein: ≤150 mg/dL Bacteria: none Ketones: none Nitrites: negative Blood Gas pH: 7.35-7.45 PaO2: 80-100 mm Hg PaCO2: 35-45 mm Hg HCO3: 22-26 mEq/L SaO2: >95% Pharmacology Pharmacology is tricky, but it’s not impossible. By memorizing drug categories and their name endings, you’ll be able to knock out many pharmacology questions on exam day. ACE inhibitors: -pril (captopril) Beta-blockers: -lol (labetalol) Abx: -ycin or -cillin (azithromycin, amoxicillin) Benzodiazepines: -pam (lorazepam) Phenothiazines: -zine (perphenazine) Glucocorticoids: -one (betamethasone) Antivirals: -vir (valcyclovir) Cholesterol lowering drugs: -statin (simvastatin) ARBs: -artan (losartan) H2 receptor blockers: -tidine (ranitidine) PPIs: -azole (omeprazole) Anticoagulants: -arin (warfarin) Therapeutic Drug Levels Carbamazepine: 4-12 mcg/mL Digoxin: 0.8-2 ng/mL Gentamycin: 5-10 mcg/mL Lithium: 0.8-1.5 mEq/L Phenobarbital: 10-40 mcg/mL Phenytoin: 10-20 mcg/mL Theophylline: 10-20 mcg/dL Valproic acid: 50-125 mcg/mL, if greater than 150 mcg/mL it’s considered toxic Acid-Base Balance Most nursing students will agree that acid-base balance questions can take a while to master. But with our easy to remember trick, you’ll be able to work your way through any acid-base problem. All you need to do is memorize ROME (respiratory opposite/metabolic equal). With respiratory imbalance, pH and PaCO2 move in opposite directions to find equilibrium. With metabolic imbalance, pH and HCO3 move in the same direction to find equilibrium. Look: Respiratory acidosis: pH low, PaCO2 high, HCO3 normal Respiratory alkalosis: pH high, PaCO2 low, HCO3 normal Metabolic acidosis: pH low, PaCO2 normal, HCO3 low Metabolic alkalosis: pH high, PaCO2 normal, HCO3 high When the body starts to compensate, you’ll see it in the opposite system. For example, partially compensated respiratory alkalosis will still have a high pH, but the HCO3 will decrease to find equilibrium. Partially compensated metabolic alkalosis will have a high pH, and the PaCO2 will increase to reach equilibrium. With full compensation, the pH will be in the normal range. Maternity FHR: 120-160 BPM Decelerations: Just remember VEAL CHOP. That’s not a joke! VEAL CHOP will help you with interpreting strips. Variable – Cord Early – Head Accelerations – Ok Late – Placental insufficiency Pregnancy Drug Categories A: Safe in pregnancy. No known adverse reactions. B: Animal studies have shown no fetal risk. C: Animal studies have shown risk to fetus; there are no studies in humans. Benefit may outweigh risk. D: Evidence of risk in humans. Avoid in pregnancy unless it is the only option. X: Evidence of fetal risk in humans. Risks outweigh benefits. APGAR Performed 1 and 5 minutes after birth. Scoring: Absent = 0 points, decreased = 1 point, present = 2 points. Total score: low = 0-3, moderately abnormal = 4-6, reassuring = 7-10. Appearance: (color: blue, acrocyanotic, pink) Pulses: (HR: not present, less than 100 bmp, greater than 100 bmp) Grimace: (reflex: no response, grimace, crying or active) Activity: (muscle tone: absent, flexion present, actively moving) Respiration: (not present, weak cry, strong cry) Gestational Diabetes GCT: Glucose challenge test comes first at 24-28 weeks gestation (everyone gets CHALLENGED). One hour after drinking Glucola, the patient will have a blood draw. If the blood glucose level is < 140 mg/dL, it’s considered normal and the patient doesn’t need a GTT. If ≥ 140 mg/dL, the patient will be scheduled for a GTT. The patient can keep a normal diet before the GCT and doesn’t need to fast. GTT: The glucose tolerance test is done when a patient fails the GCT. First, a fasting blood glucose level will be obtained. After drinking Glucola, the patient will have blood drawn at 1, 2, and 3 hours after finishing to obtain blood glucose levels. The patient can maintain a normal diet in the days leading up to the test but should fast for the eight hours right before the test. The patient will be diagnosed with gestational diabetes with two or more of the following results: Fasting: > 95 mg/dL 1 hr: > 180 mg/dL 2 hr: > 155 mg/dL 3 hr: > 140 mg/dL NST: A reactive or normal NST will show the FHR accelerating at least 15 beats above baseline for 15 seconds twice in 20 minutes. If it’s less than this, it’s considered non-reactive. AVA: There are two arteries and one vein in the umbilical cord. STOP: If maternal hypotension is present, do the following: Stop the Pitocin Turn patient onto the left side Oxygen Push IV fluids if hypovolemia is present Other study secrets The following will also help you with questions on the NCLEXPN exam: ABCs for prioritizing care. These should always be checked first: Airway: Is the airway clear? Breathing: is the patient able to breath? Circulation: is the HR normal? Rule of nines for burns. This will tell you what percentage of the body surface area has been burned. Head: 9% Arms: 18% total Back: 18% Chest & abdomen: 18% total Legs: 36% total Genitalia: 1% TORCH: For memorizing common infections that can cause congenital abnormalities during pregnancy. T: Toxoplasmosis O: Other (varicella-zoster, syphilis, parovirus B19) R: Rubella C: Cytomegalovirus (CMV) H: Herpes Conversions 1 tsp = 5 mL 1 tbsp = 3 tsp 1 oz = 30 mL 1 cup = 8 oz 1 pint = 2 cups 1 quart = 2 pints 1 kg = 2.2 lbs