eee to Mara ais a fs & ) yeT NTY vu Welcome to RoadMap to NCLEX®. A study guide that enables you to conquer your accomplishment as a nurse. In the next succeeding routes of this work are the vital parts towards passing the NCLEX®. It comprises high probability topics which are translated into easier comprehension such as highlighted “pinned facts” and images from various sources of learning in the nursing profession. Certainly, visual tool has an impact to effective learning to most nurses according to many studies, and ultimately headed for effective and safe nursing practice in the future. “Commit to the Lord whatever you do and all your plans will succeed” Proverbs 16:3i _ Know the NCLEX Computer Adaptive Testing eS a, Passing Level (line of minimum competency) Question Difficulty As you answer a question, the computer determines your competency based on the answer you selected. If you selected a correct answer, the computer scans the question bank and selects a more difficult question. If you selected an incorrect answer, the computer scans the question bank and selects an easier question until you meet the PASSING standard or otherwise a failing mark. There are 75 — 265 number of questions and as long as 6 hours to complete the exam.CSBN Test Plan Physiological Adaptation 0%, Management of Care 20% Racuetian of Risk Potential 12% Safety and infection Canal 2% Pharmacological and Parental Therapies Health Promotion and Maintenance: 7% asic Care and Comfort. cs Type of question . Multiple Choice . Ordered Response (Place the sequence in order) . Select all that apply (SATA) . Fill in the blank (usually computations) . Drag and drop . Hotspot (place the cursor over the area on the diagram that does the selected action) . Chart/Exhibit . Graphic Option . Audio The NCSBN provides specific directions for you to follow with all question types to guide you in your process of testing. Be sure to read these directions as they appear on the computer screen before you start answering the graded exam. ari | eee) a Pass with 75 questions as much as possible. To pass with 75 questions you will most likely need to answer more difficult and multiple response questions correctly like the BEAST “Select All That Apply.” The key to slay this is to be a master of the content! Don't panic if you exceeded the minimum 75 item. The goal is to pass the exam, so take a break and relax before you answer the next succeeding questions. In 2012, the average number of Items (questions) administered per candidate was around 119 on the NCLEX-RN and 117 on the NCLEX-PN. Gy se It's important to know your strong and weak concepts for you to’ focus on. Itis not good to hope that it would not come out during exam, the secret is focus on your weakness and maximize you strengths. NCLEX® knows how to target weak points by throwing more questions until you hit their standards.\_ Apply test strategies ¥ Don't start being anxious and especially don't pani v You don't need to read extra meaning to the question. ¥ Look for keywords and phrases to help you understand. ¥Y Interpret the question correctly first before reading into the choices. v Read the stem correctly and notice, is it asking for the best response or the initial response v Understand what the question is asking before considering the distracter. ¥ Rephrasing technique translates the question into your own words. Y lsolate choice that is relevant from what is not. ¥ Judge all four alternative choices/options against the stem and not against one another. v Use the process of elimination, cross out those variables that are incorrect.ri | eee) U vy When you come across a difficult question and you cannot immediately identify the answer, go back to your body of knowledge and draw all the information that you do know about the condition. Even though you do not know exactly what to do, you might know what not to do v fone is the exact opposite of another (e.g. complete bed rest is different from activity as tolerated; both cannot be correct since they are of opposites), choose the one that seems to be most logical. vy lf you cannot choose an alternative, use your intuition. Let yourself feel which alternative might be right. Remember, it's better to choose one answer than none at all. Do we depend on this "hunch?" (Intuition). Current studies supports that hunches are often correct, for they are based on rapid subconscious connections in the brain.f eee Y So, if you have an initial hunch, go with it! Do not change the answer if and only if, upon reflection, it just doesn’t seem right. (If you are taking NCLEX®, you can take time as you want, but do not dwell too much.) v Remember, this is a nursing test and questions are designed to test your nursing competency and safety. ¥ It is unlikely that a question would require a medical action for the correct answer; it may, however offer these actions as distracter. v Beware of answers that contain specific qualifiers, such as “always’ and “never,” they rarely fit within a logical framework. ¥ Content is King: “Select all that Apply” (SATA) format questions are very much like a “T & F” quiz you may have taken during nursing school. Unfortunately, there is no short cut to preparing for the SATA questions, a candidate just has to have enough content.eee Wt | Heart rate: 80-100 bpm Respiratory rate: 12-20 rom Blood pressure: 110-120/60-70 mmHg Temperature: 37 °C (98.6 °F) T (°C) = (T (°F) - 32) x 5/9 T (°F) =T (°C) x 9/5 + 32 ml 1 tablespoon (T) = 3t=15 ml 1 gram (g) = 1,000 mg 1mg= 1000 meg (ie SSSTaGaER 1 kilogram (kg) = 2.2 Ibs 1 mgz= 65 grain (gr) 1 lb = 16 oz 10z=30ml 1 cup = 240 ml 1 cup =8 oz 1 quart = 2 pints 1 pint = 2 cups 1 meter = 3.28 feet Eeeri | eee) WW é Hematologic | RBCs: 4.5—5.0 million : WBCs: 5,000—10,000 ' Platelets: — 200,000—400,000 i Hemoglobin (Hgb): i 12—16 gm (f) 3 14—18 gm (m) : Hematocrit (Hct): 37—47 (f) 40— 54 Never Let Monkeys Eat Bananas. Neutrophils: [ENE 54 - 62% Lymphocytes: 25 — 32% Monocytes: [JEnnews Sea Eosinophils: i 1-3% | Basophils: Bananas| <0.75%ri | eee) Ws Normal Values Serum Electrolytes Sodium: 135 -145 mEq/L Potassium: 3.5 - 5.5 mEq/L Calcium: 9 -10.5 mEq/L Chloride: 90 - 110 MEq/L Magnesium: 1.7 - 2.2 mEq/L Phosphorus: 3- 4.5 mEq/L ABG Values pH: 7.35—7.45 HCO3: 22—26 mEq/L co2: 35—45 mEq/L PaO2: 80—100 mmhg Sa02: >95% Anticoagulant Therapy (§imusiBelmemonzedyy) £ Heparin aPTT: 30-40 sec (more sensitive) (1.5 - 2X is therapeutic) PTT: 25 — 35 sec (less sensitive) (1.5 - 2.5X is therapeutic) > Ezri | eee) ug Normal Values Warfarin (Coumadin) PT: 10—12 sec (1.5 - 2X is therapeutic) INR: 0.9—1.2 (upto 3X is therapeutic) : Chemistry Ammonia: 15-110 ug/dl AST (Aspartate Aminotranferase): 10—S50 IU/L ALT (Alanine Aminotransferase): 5—35 IU/L LDH: 100-190 U/L Albumin: 3.5—5.0 g/dL Total Protein: 6-8 g/dL Bilirubin: <1.0 mg/dL Total Cholesterol: <200 mg/dL Triglyceride: <150 mg/dL HDL (Good Cholesterol): >45 mg/g! (m) >50 mg/gl (f) LDL (Bad Cholesterol): 60—80 mg/dl Glucose: 70—110 mg/dL (+18 for mmol/L)ri | eee) Mo Normal Values HBAIC: < 7% Good control > 9% Poor Control > 12% Very Poor Control BUN: 10 - 20 mg/dL Serum creatinine: 0.5 - 1.5 mg/dL Specific Gravity: 1.010 - 1.030 Uric acid: 3.5 - 7.5 mg/dL Acute Coronary Syndrome (AMI) In order rising: Myoglobin: 0 - 85 ng/ml Troponin: <0.6ng/ml AST: 10 - 50 1U/L CPk: 12-70 U/ML (m) 10 - 55 U/ml (f) LDH: 100 - 190 U/L Heart failure: B-Type Natriuretic Peptide (BNP): <125 pg/mL (0-74 YO) <450 pg/mL (75-99 YO)eT NTY 9 al Values Hemodynamics / Pressures (mmHg) ; CVP: 6-12 mmHg PAP: 20 - 30 mmHg PCWP: 8-13mmHg ICP: 0-10 mmHg «IOP: 12-15 mmHg Pulmonary Artery Catheter Thesnistor Intoctate S PA Diatal Port RA Proximal Port £8 Thoristor Connectioneee Wt mal Values Drug Therapeutic Levels Carbamazepine (Tegretol): 4—10 mcg/ml Phenobarbital : 15—40 mcg/mL Digoxin (Lanoxin): 0.8—2.0 ng/ml Theophylline (Aminophylline): —§ 10—20 mcg/dL Phenytoin (Dilantin): 10—20 mcg/dL Valproic Acid (Depakene): 50—100 mcg/ml Lithium (Eskalith): 0.5—1.5 mEq/L (Acute/Adult) 0.6—1.2 mEq/L (Maintenance) 0.4—1.0 mEq/L (>65 YO) 108 meq TESS Vancomycin: 20 -- 40 meg/m| (peak) | min afierscose 515 mcg/m (rover SORES Magnesium Sulfate: 4 to 8 mg/dl 8-10 Absence of reflexes 10 - 12 Respiratory depression > 15 Respiratory depression | Mustbeintubated ¢ aeee Wt 5 U- Safe Level 10 U-Toxic Level 70 - Medical Emergency Carbon Monoxide 10 to 20% (Headache) > 20 % (Generalized weakness) > 30% (Chest Pain) > 40% (Seizure, unconsciousness) > 60% (Coma - Death) 50 - 100 mg /ml : Infant - Choking | Toddler — Poisoning | Preschooler — Drowning School age - Vehicular Accidenteee Wt Child Safety The safest place for all children to ride, regardless of age, isin the back seat of the car. Lock the car doors; 4-door cars should be equipped with child safety locks on the back doors. Do not leave the infant unattended in the bath. Check for water temperature. Do not hold the infant near hot liquids or items. Use cool vaporizers instead of steam should if needed, to prevent burn injuries. Prevent choking by avoiding round shaped food or similar to the size of the airway. Toys must have no small parts. Toys hanging over the crib should be out of reach, to prevent strangulation. Avoid placing large toys in the crib because an older infant may use them as steps to climb. Cribs should be positioned away from curtains Cover electrical outlets. Remove chemicals such as cleaning or other household products, medications, poisons, and plants from the infant's reach. Toddlers need to be supervised at play to ensure safety. Keep all medicines, poisons, household plants, and toxic products in high areas and locked out of reach. Teach a preschooler and school-age child to leave an area immediately if a gun is visible and to tell an adult. Children should always wear a helmet when riding a bike or using in-line skates or skateboards. Teach the child water safety rules.ri — eee) 1 Maternity gan jotic fluid: 500—1000 ml > 1500 ml Polyhydramnios < 500 ml Oligohydramnios Additional calorie intake: Pregnancy- 300 kcal/day Lactating - 500 kcal/day Weight gain: First trimester— 1 lb/month 2nd Trimester— 1 lb/week 3rd Trimester- 1 Ib/week Protein Intake 65 g/dl (Pre-pregnant) 45 — 50 g/dl (Female) 65-70 g/dl (Male)eT NTY “J Maternity Stages of Labor 1. Cervical Dilatation (Dilatation - Duration - Interval) Latent: 0-3 cm - 20-40 secs - 5— 10 mins Active: 4-7 cm - 40 - 60 secs - 3-5 mins Transitional: 8 — 10 cm — 60 - 90 secs — 1-3 mins 2. Expulsion of baby Hallmark: = Crowning RBOW: Primi 10 cm Multi 7-8 cm 3. Placental Separation Calkin’s sign (Globular shape of abdomen) Sudden gush of blood Lengthening of cord Schultz Mechanism - shiny inverted umbrella Duncan Mechanism - Raw red umbrella 4. Immediate post-partum (1 - 4 hrs) Lochia — Psychological Task Rubra: 1-3 days - Taking In - physiologic need Serosa: 4-10 days Taking Hold - accepting status Alba: 11-20 days Letting Go - adapted to roles aeee Wt Maternity Fetal Heart Monitoring: IVEAL CHOP| Variable deceleration Cord compression Early deceleration Head compression Acceleration Okay! Late deceleration Poor placental perfusion _ ero oe Ue ai i. Fee Beplasonen Variable in eatonshi te convactons be H oa ee —_ Ely onost N 2 a)eee Wt Maternity _Meabyeclerton Fetal Heat Rate ie serene = £ Contractions Late recouery 2 Lawonscteee Wt Maternity STOP - Treatment for | Maternal hypotension ¢ * — Stop infusion of Pitocin. * Turn the client on her left side. ¢« Administer Oxygen. * — If hypovolemia is present, Push IV fluids | Pregnancy Categories of Drugs $F 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, Theophylline Category D: Positive evidence of risk. Examples: Phenytoin, Tetracycline. Category X: Contraindicated in Pregnancy. Examples: Isotretinoin (Accutane) Category N: Not yet classified aeT NTY ea} Acute Glomerulonephritis: Low Na, low protein Addison's disease: High Na, low potassium ADHD: High-calorie, finger foods Bedsore: High Protein, High Vitamin C Bipolar Disorder: Finger foods Burns: High protein, high caloric, high Vitamin C. Cancer: High-calorie, high-protein. Celiac Disease: Gluten-free diet (no BRW: barley, rye, and wheat) Cholecystitis: High protein, High carb, Low fat Chronic Renal Disease: Low protein, low Na & K, Low Phosphate, fluid-restricted Cirrhosis (stable): Normal protein Cirrhosis with hepatic insufficiency: Low protein, Low Sodium Constipation: High-fiber, increased fluids COPD: Soft, high-calorie, low-carbohydrate, high-fat, small frequent feedings Crohn's disease: High protein, High Carb, low fat Cushing's disease: High potassium, Low NaPry eee Wt ystic Fibrosis: High fluids & Na, High Calorie Cystitis (Stones): Acid ash for alkaline stones (Uric, Cystine), Alkaline ash for acid stones (Calcium, Struvite), Increase OFI Diarrhea: Liquid, low-fiber, regular, fluid & electrolyte replacement Diabetes Mellitus: Balanced Diverticulitis: Low residue Diverticulosis: High Residue Dumping Syndrome: High Fat, High Protein, Drink 30 - 60 minutes before or after meals (No fluids with meals) Gallbladder diseases: Low fat, Low Calorie, regular Gastritis: Low-fiber, bland diet Gouty Arthritis: Low purine Hepatitis: regular, high-calorie, high-protein Hirschprung’s: High Calorie, high protein, low residue Hyperlipidemias: Fat-controlled, Low calorie perparathyroidism: Low calciumeT NTY ms Hypertension, CHF, CAI tt controlled Hyperthyroidism: High calorie, High protein Hypoparathyroidism: High Calcium, Low Phosphate Hypothyroidism: Low calorie, low fat Kawasaki disease: Clear Liquid Meniere's disease: Low Na Nephrotic Syndrome: Low Na & Potassium, high calorie & protein Osteoporosis: High Calcium, High Vitamin D Pancreatitis: Low-fat, regular, small frequent feedings; tube feeding or TPN Peptic ulcer: Bland, High Carb, Low protein Phenylketonuria: Low Phenylalanine protein Pregnancy Induced Hypertension (PIH): High Protein Pernicious Anemia: High Vitamin B12 (Cobalamin), (shellfish, beef liver, and fish) Renal Failure (Acute): High Protein, high-calorie, fluid-controlled, sodium and potassium controlled. Low Na, Low-calorie, fa:eee Wt Renal Failure (Chronic protein Sickle Cell Anemia: Increase fluids to maintain hydration Stroke (CVA): Mechanical soft, regular, or tube- feeding (8) Laboratory & Diagnostic abnormalities Se Abdominal Aortic Aneurysm (AAA): Increased BUN, Creatinine Acoustic Neuroma: Caloric Stimulation (-) Nystagmus Acromegaly: Increased HGH Acute Glomerulonephritis: Increased BUN, Creatinine, ASO Titer Acute Pancreatitis: Increased WBC, amylase, lipase, decreased calcium and Mg Acute Renal Failure: Increased BUN, Creatinine aeT NTY ms Laboratory & Diagnostic abnormalities Addison's disease: HyperK, HypoNa, Hypoglycemia AIDS: (+) ELISA, Western Blot Allergic Reaction: IgE, increased eosinophils, decreased basophils Anemia (Pernicious): Increased LDH Anemia (Sickle Cell): Decreased RBC, dec. ESR, decreased or normal HgB, Increased WBC Anorexia Nervosa: HypoKk, Hypoglycemia Appendicitis: Slightly Increased WBC Arthritis (Gouty): Increased Uric acid Arthritis (Rheumatoid): Increased ESR, ANA (+) Aspirin Toxicity: Respiratory Alkalosis - Meta Acidosis Asthma: Increased IgE, Respiratory Acidosis Bipolar Disorder: Increased Norepinephrine & Serotonin(Mania), decreased in (depression) Bulimia: Hypokalemia, Hypoglycemia Burns: Hyperglycemia, Hyperk, anemia Cancer (Bladder): Increased Serum acid phosphatase Cancer (Colon): Carcinoembryonic Ag —- Tumor marker Cancer (Prostate): Increased acid phosphatase & PSA Cancer (Testicular): Increased HCG, AFP aeT NTY rad Laboratory & Diagnostic abnormalities Cardiogenic Shock: Increased BUN, Creatinine, Liver enzymes Chronic Renal Failure: Increased Creatinine Congestive Heart Failure: Increased CVP (Right Sided Failure), Increased PAP, PCWP (Left Sided) Increased B-Type Natriuretic Peptide (BNP) Cretinism (Hypothyroid in Children): Decreased 1314, Increased TSH Cushing’s syndrome: Increased Cortisol, HyperNa, Hypok, HPN, Hyperglycemia Cystic Fibrosis: Increased Sweat Chloride Cystitis: C/S E. Coli Delirium Tremens: >2% alcohol level Diabetes Insipidus: HyperNa, Hypok, Decreased Urine Specific Gravity, Decreased Urine concentration Disseminated Intravascular Coagulation (DIC): Prolonged PT, PTT Down Syndrome: Decreased AFP (Amniocentesis) Endocarditis: Increased ESR Gestational DM: Increased GTT, FBS Guillain Barre Syndrome: Increased Protein (CSF) Hemophilia: Prolonged PTT Hepatitis: Increased AST, ALT a