 Hematocrit (Hct): 37—47 (female); 40—54 Therapeutic Drug Levels

(male)
Test Information
 Carbamazepine (Tegretol): 4—10 mcg/ml
Serum electrolytes  Digoxin (Lanoxin): 0.8—2.0 ng/ml
 Six hours—the maximum time allotted for the
NCLEX is 6 hours. Take breaks if you need a time  Gentamycin (Garamycin): 5—10 mcg/ml (peak),
<2.0 mcg/ml (valley)
out or need to move around.  Sodium: 135—145 mEq/L
  Lithium (Eskalith): 8—1.5 mEq/L
75/265—the minimum number of question you can  Potassium: 3.5—5.5 mEq/L
answer is 75 and a maximum of 265.  Phenobarbital (Solfoton): 15—40 mcg/mL
 Calcium: 8.5—10.9 mEq/L
 Read the question and answers carefully—do  Phenytoin (Dilantin): 10—20 mcg/dL
 Chloride: 95—105 mEq/L
not jump into conclusions or make wild guesses.  Theophylline (Aminophylline): 10—20 mcg/dL
  Magnesium: 1.5—2.5 mEq/L
Look for keywords—Avoid answers with  Tobramycin (Tobrex): 5—10 mcg/mL (peak),
absolutes like always, never, all, every, only, must,  Phosphorus: 2.5—4.5 mEq/L 0.5—2.0 mcg/mL (valley)
except, none, or no.
 Valproic Acid (Depakene): 50—100 mcg/ml
 Don’t read into the question—Never assume
ABG Values  Vancomycin (Vancocin): 20—40 mcg/ml (peak),
anything that has not been specifically mentioned
5 to 15 mcg/ml (trough)
and don’t add extra meaning to the question.
 Eliminate answers that are clearly wrong or  pH: 7.36—7.45
incorrect—to increase your probability of  HCO3: 24—26 mEq/L Anticoagulant therapy
selecting the correct answer!
 CO2: 35—45 mEq/L
 Watch for grammatical inconsistencies—
Subjects and verbs should agree. If the question is  PaO2: 80%—100%  Sodium warfarin (Coumadin) PT: 10—12
an incomplete sentence, the correct answer should  SaO2: >95% seconds (control). The antidote is Vitamin K.
complete the question in a grammatically correct  INR (Coumadin): 0.9—1.2
manner.  Heparin PTT: 30—45 seconds (control). The
 Rephrase the question—putting the question into
Acid-Base Balance antidote is protamine sulfate.
your own words can pluck the unneeded info and  APTT: 3—31.9 seconds
reveal the core of the stem.  Remember ROME (respiratory opposite/metabolic  Fibrinogen level: 203—377 mg/dL
 Make an educated guess—if you can’t make the equal) to remember that in respiratory acid/base
best answer for a question after carefully reading disorders the pH is opposite to the other
it, choose the answer with the most information. components. Conversions
 Use the Tic-Tac-Toe Method for interpreting
ABGs. Read more about
Vital Signs it here (http://bit.ly/abgtictactoe).  1 teaspoon (t) = 5 ml
 1 tablespoon (T) = 3 t = 15 ml
 Heart rate: 80—100 bpm  1 oz = 30 ml
Chemistry Values
 Respiratory rate: 12-20 rpm  1 cup = 8 oz
 Blood pressure: 110-120/60 mmHg  1 quart = 2 pints
 Temperature: 37 °C (98.6 °F)
 Glucose: 70—110 mg/dL  1 pint = 2 cups
 Specific Gravity: 1.010—1.030  1 grain (gr) = 60 mg
 BUN: 7-22 mg/dL  1 gram (g) = 1,000 mg
 Serum creatinine: 0.6—1.35 mg/dL  1 kilogram (kg) = 2.2 lbs
 LDH: 100-190 U/L  1 lb = 16 oz
Hematology values  Protein: 6.2—8.1 g/dL  Convert C to F: C+40 multiply by 9/5 and subtract
 Albumin: 3.4—5.0 g/dL 40
 RBCs: 4.5—5.0 million  Bilirubin: <1.0 mg/dL  Convert F to C: F+40 multiply by 5/9 and subtract
 WBCs: 5,000—10,000  Total Cholesterol: 130—200 mg/dL 40

 Platelets: 200,000—400,000  Triglyceride: 40—50 mg/dL

 Hemoglobin (Hgb): 12—16 gm (female); 14—18  Uric acid: 3.5—7.5 mg/dL Maternity Normal Values
gm (male).  CPK: 21-232 U/L
  Fetal Heart Rate: 120—160 bpm  Schedule I—no currently accepted medical use  Trunk: 36%
 Variability: 6—10 bpm and for research use only (e.g., heroin, LSD,  Legs: 36% (18% each)
MDMA).
 Amniotic fluid: 500—1200 ml  Genitalia: 1%
 Schedule II—drugs with high potential for abuse
 Contractions: 2—5 minutes apart with duration of
and requires written prescription (e.g., Ritalin,
< 90 seconds and intensity of <100 mmHg.
hydromorphone (Dilaudid), meperidine (Demerol), Medications
 APGAR and fentanyl).
Scoring: Appearance, Pulses, Grimace, Activity, R  Schedule III—requires new prescription after six
eflex Irritability. Done at 1 and 5 minutes with a months or five refills (e.g., codeine,  Digoxin (Lanoxin)—Assess pulses for a full
score of 0 for absent, 1 for decreased, and 2 for minute, if less than 60 bpm hold dose.
testosterone, ketamine).
strongly positive. Scores 7 and above are generally Check digitalis and potassium levels.
 Schedule IV—requires new prescription after six
normal, 4 to 6 fairly low, and 3 and below are
generally regarded as critically low. months (e.g., Darvon, Xanax, Soma, and Valium).  Aluminum Hydroxide (Amphojel)—Treatment
of GERD and kidney stones. WOF constipation.
  Schedule V—dispensed as any other prescription
AVA: The umbilical cord has two arteries and one
vein. or without prescription (e.g., coughpreparations,  Hydroxyzine (Vistaril)—Treatment
Lomotil, Motofen). of anxiety and itching. WOF dry mouth.
 Midazolam (Versed)—given for conscious
STOP sedation. Watch out for (WOF) respiratory
Medication Classifications depression and hypotension.
Treatment for maternal hypotension after an epidural anesthesia:  Amiodarone (Cordarone)—WOF diaphoresis,
 Antacids—reduces hydrochloric acid in the dyspnea, lethargy. Take missed dose any time in
stomach. the day or to skip it entirely. Do not take double
 Stop infusion of Pitocin.  Antianemics—increases blood cell production.
dose.
  Warfarin (Coumadin)—WOF for signs
Turn the client on her left side.  Anticholinergics—decreases oral secretions. of bleeding, diarrhea, fever, or rash. Stress
 Administer oxygen.  Anticoagulants—prevents clot formation, importance of complying with prescribed dosage
 If hypovolemia is present, push IV fluids.  Anticonvulsants—used for management of and follow-up appointments.
seizures and/or bipolar disorders.  Methylphenidate (Ritalin)—Treatment of
 Antidiarrheals—decreases gastric motility and ADHD. Assess for heart related side-effects and
reduce water in bowel. reported immediately. Child may need a drug
holiday because the drug stunts growth.
 Antihistamines—block the release of histamine.
 Antihypertensives—lower blood pressure and
 Dopamine—Treatment of hypotension, shock, and
low cardiac output. Monitor ECG for arrhythmias
increases blood flow.
and blood pressure.
 Anti-infectives—used for the treatment of
 Rifampicin—causes red-orange tears and urine.
infections,
Pregnancy Category of Drugs  Bronchodilators—dilates large air passages
 Ethambutol—causes problems with vision, liver
problem.
in asthma or lung diseases (e.g., COPD).
  Isoniazid—can cause peripheral neuritis, take
 Category A—No risk in controlled human studies Diuretics—decreases water/sodium from the Loop
vitamin B6 to counter.
of Henle.
 Category B—No risk in other studies. Examples:
Amoxicillin, Cefotaxime.  Laxatives—promotes the passage of stool.
 Category C—Risk not ruled out. Examples:  Miotics—constricts the pupils. Developmental Milestones
Rifampicin (Rifampin), Theophylline (Theolair).  Mydriatics—dilates the pupils.
 Category D—Positive evidence of risk. Examples:  Narcotics/analgesics—relieves moderate to  2—3 months: able to turn head up, and can turn
Phenytoin, Tetracycline. severe pain. side to side. Makes cooing or gurgling noises and
 Category X—Contraindicated in Pregnancy. can turn head to sound.
Examples: Isotretinoin  4—5 months: grasps, switch and roll over tummy
(Accutane), Thalidomide (Immunoprin), etc. Rules of nines for Burns to back. Can babble and can mimic sounds.
 Pregnancy Category N—Not yet classified
Calculating Total Body Surface Area (TBSA) for burns
 6—7 months: sits at 6 and waves bye-bye. Can
recognize familiar faces and knows if someone is a
stranger. Passes things back and forth between
Drug Schedules hands.
 Head and neck: 9%  8—9 months: stands straight at eight, has favorite
 Upper limbs: 18% (9% each) toy, plays peek-a-boo.
  10—11 months: belly to butt. and diabetes are major health concerns; may divert  Pancreatitis—low-fat, regular, small frequent
eyes to the floor when they are praying or paying
 12—13 months: twelve and up, drinks from a cup.
attention.
feedings; tube feeding or total parenteral nutrition.
Cries when parents leave, uses furniture to cruise.  Peptic ulcer—bland diet
  Western Culture—May value technology almost
exclusively in the struggle to conquer diseases;
 Pernicious Anemia—increase Vitamin B12
(Cobalamin), found in high amounts on shellfish,
health is understood to be the absence,
beef liver, and fish.
minimization, or control of disease process; eating
Cultural Considerations
utensils usually consists of knife, fork, and spoon;  Sickle Cell Anemia—increase fluids to maintain
three daily meals is typical. hydration since sickling increases when patients
 African Americans—May believe that illness is
become dehydrated.
caused by supernatural causes and seek advice and  Stroke—mechanical soft, regular, or tube-feeding.
remedies from faith healers; they are family Common Diets  Underweight—high-calorie, high protein
oriented; have higher incidence of high blood  Vomiting—fluid and electrolyte replacement
pressure and obesity; high incidence of lactose  Acute Renal Disease—protein-restricted, high-
intolerance with difficulty digesting milk and milk calorie, fluid-
products. Positioning Clients
controlled, sodium and potassium controlled.
 Arab Americans—May remain silent about health  Addison’s disease—increased sodium,
problems such as STIs, substance abuse, and
mental illness; a devout Muslim may interpret
low potassium diet.  Asthma—orthopneic position where patient is
illness as the will of Allah, a test of faith; may rely  ADHD and Bipolar—high-calorie and provide sitting up and bent forward with arms supported on
on ritual cures or alternative therapies before finger foods. a table or chair arms.
seeking help from health care provider; after death,  Burns—high protein, high caloric, increase in  Post Bronchoscopy—flat on bed with head
the family may want to prepare the body by Vitamin C. hyperextended.
washing and wrapping the body in unsewn white  Cancer—high-calorie, high-protein.  Cerebral Aneurysm—high Fowler’s.
cloth; postmortem examinations are discouraged
unless required by law. May avoid pork and  Celiac Disease—gluten-free diet (no BROW:  Hemorrhagic Stroke: HOV elevated 30 degrees
alcohol if Muslim. Islamic patients observe barley, rye, oat, and wheat). to reduce ICP and facilitate venous drainage.
monthlong fast of Ramadan (begins approximately  Chronic Renal Disease—protein-restricted, low-  Ischemic Stroke: HOB flat.
mid-October); people suffering from chronic sodium, fluid-restricted, potassium-restricted,  Cardiac Catheterization—keep site extended.
illnesses, pregnant women, breastfeeding, or phosphorus-restricted.
 Epistaxis—lean forward.
menstruating don’t fast. Females avoid eye contact  Cirrhosis (stable)—normal protein
 Above Knee Amputation—elevate for first 24
with males; use same-sex family members as  Cirrhosis with hepatic insufficiency—restrict hours on pillow, position on prone daily for hip
interpreters.
protein, fluids, and sodium. extension.
 Asian Americans—May value ability to

endure pain and grief with silent stoicism; typically
Constipation—high-fiber, increased fluids  Below Knee Amputation—foot of bed elevated
family oriented; extended family should be  COPD—soft, high-calorie, low-carbohydrate, for first 24 hours, position prone daily for hip
involved in care of dying patient; believes in “hot- high-fat, small frequent feedings extension.
cold” yin/yang often involved; sodium intake is  Cystic Fibrosis—increase in fluids.  Tube feeding for patients with decreased
generally high because of salted and dried foods;  Diarrhea—liquid, low-fiber, regular, fluid and LOC—position patient on right side to promote
may believe prolonged eye contact is rude and an electrolyte replacement emptying of the stomach with HOB elevated to
invasion of privacy; may not without necessarily
 Gallbladder diseases—low-fat, calorie-restricted,
prevent aspiration.
understanding; may prefer to maintain a
regular  Air/Pulmonary embolism—turn patient to left
comfortable physical distance between the patient
and the health care provider.  Gastritis—low-fiber, bland diet
side and lower HOB.
  Postural Drainage—Lung segment to be drained
 Latino Americans—May view illness as a sign of Hepatitis—regular, high-calorie, high-protein
should be in the uppermost position to allow
weakness, punishment for evil doing; may consult  Hyperlipidemias—fat-controlled, calorie- gravity to work.
with a curandero or voodoo priest; family members restricted
 Post Lumbar puncture—patient should lie flat
are typically involved in all aspects of decision  Hypertension, heart failure, CAD—low-sodium, in supine to prevent headache and leaking of CSF.
making such as terminal illness; may see no reason calorie-restricted, fat-controlled
to submit to mammograms or vaccinations.  Continuous Bladder Irrigation (CBI)—catheter
 Kidney Stones—increased fluid intake, calcium-
 Native Americans—May turn to a medicine man controlled, low-oxalate
should be taped to thigh so legs should be kept
to determine the true cause of an illness; may value straight.
the ability to endure pain or grief with silent  Nephrotic Syndrome—sodium-restricted, high-  After myringotomy—position on the side of
stoicism; diet may be deficient in vitamin D calorie, high-protein, potassium-restricted. affected ear after surgery (allows drainage of
and calcium because many suffer from lactose  Obesity, overweight—calorie-restricted, high- secretion).
intolerance or don’t drink milk; obesity fiver
 Post cataract surgery—patient will sleep on continuous feeding or 1hour after intermittent  Appendicitis—rebound tenderness at McBurney’s
unaffected side with a night shield for 1-4 weeks. feedings. point. Rovsing’s sign (palpation of LLQ elicits
 Detached retina—area of detachment should be in  Pelvic Exam—lithotomy position. pain in RLQ). Psoas sign (pain from flexing the
the dependent position.  Rectal Exam—knee-chest position, Sim’s, thigh to the hip).
 Post thyroidectomy—low or semi-Fowlers, or dorsal recumbent.  Meningitis—Kernig’s sign (stiffness of
support head, neck and shoulders.  During internal radiation—patient should be on hamstrings causing inability to straighten the leg
when the hip is flexed to 90 degrees), Brudzinski’s
 Thoracentesis—sitting on the side of the bed and bed rest while implant is in place.
sign (forced flexion of the neck elicits a reflex
leaning over the table (during procedure); affected  Autonomic Dysreflexia—place client in sitting flexion of the hips).
side up (after procedure). position (elevate HOB) first before any other
 Tetany—hypocalcemia, [+] Trousseau’s sign;
 Spina Bifida— position infant on prone so that sac implementation.
Chvostek sign.
does not rupture.  Shock—bed rest with extremities elevated 20
 Tetanus— Risus sardonicus or rictus grin.
 Buck’s Traction—elevate foot of bed for counter- degrees, knees straight, head slightly elevated
traction. (modified Trendelenburg).  Pancreatitis—Cullen’s sign (ecchymosis of the
 umbilicus), Grey Turner’s sign (bruising of the
 Post Total Hip Replacement—don’t sleep on Head Injury—elevate HOB 30 degrees to
flank).
operated side, don’t flex hip more than 45-60 decrease intracranial pressure.
degrees, don’t elevate HOB more than 45 degrees.  Peritoneal Dialysis when outflow is  Pyloric Stenosis—olive like mass.
Maintain hip abduction by separating thighs with inadequate—turn patient side to side before  Patent Ductus Arteriosus—washing machine-like
pillows. checking for kinks in the tubing. murmur.
 Prolapsed cord—knee-chest position  Myelogram  Addison’s disease—bronzelike skin pigmentation.
or Trendelenburg. o Water-based dye—semi Fowler’s  Cushing’s syndrome—moon face appearance and
 Cleft-lip—position on back or in infant seat to for at least 8 hours. buffalo hump.
prevent trauma to the suture line. While feeding, o Oil-based dye—flat on bed for at  Grave’s Disease (Hyperthyroidism)—
hold in upright position. least 6-8 hours to prevent leakage Exophthalmos (bulging of the eye out of the orbit).
 Cleft-palate—prone. of CSF.
 Intussusception—Sausage-shaped mass.
o Air dye—Trendelenburg.
 Hemorrhoidectomy—assist to lateral position.  Multiple Sclerosis—Charcot’s Triad: nystagmus,
 Hiatal Hernia—upright position. intention tremor, and dysarthria.
 Preventing Dumping Syndrome—eat in reclining Common Signs and Symptoms  Myasthenia Gravis—descending muscle
position, lie down after meals for 20-30 minutes weakness, ptosis (drooping of eyelids).
(also restrict fluids during meals, low fiber diet,
 Pulmonary Tuberculosis (PTB)—low-grade  Guillain-Barre Syndrome—ascending muscles
and small frequent meals). weakness.
afternoon fever.
 Enema Administration—position patient in left-  Deep vein thrombosis (DVT)—Homan’s Sign.
side lying (Sim’s position) with knees flexed.  Pneumonia—rust-colored sputum.
  Angina—crushing, stabbing pain relieved by
 Post supratentorial surgery (incision behind Asthma—wheezing on expiration.
NTG.
hairline)—elevate HOB 30-45 degrees.  Emphysema—barrel chest.
 Myocardial Infarction (MI)—crushing, stabbing
 Post infratentorial surgery (incision at nape of  Kawasaki Syndrome—strawberry tongue. pain radiating to left shoulder, neck, and arms.
neck)—position patient flat and lateral on either  Pernicious Anemia—red beefy tongue. Unrelieved by NTG.
side.
 Down syndrome—protruding tongue.  Parkinson’s disease—pill-rolling tremors.
 Increased ICP—high Fowler’s.
 Cholera—rice-watery stool and washer woman’s  Cytomegalovirus (CMV) infection—Owl’s eye
 Laminectomy—back as straight as possible; log hands (wrinkled hands from dehydration). appearance of cells (huge nucleus in cells).
roll to move and sand bag on sides.
 Malaria—stepladder like fever with chills.  Glaucoma—tunnel vision.
 Spinal Cord Injury—immobilize on spine board,

with head in neutral position. Immobilize head
Typhoid—rose spots in the abdomen.  Retinal Detachment—flashes of light, shadow
with padded C-collar, maintain traction and  Dengue—fever, rash, and headache. Positive with curtain across vision.
alignment of head manually. Log roll client and do Herman’s sign.  Basilar Skull Fracture—Raccoon eyes
not allow client to twist or bend.  Diphtheria—pseudomembrane formation. (periorbital ecchymosis) and Battle’s sign (mastoid
 Liver Biopsy—right side lying with pillow or  Measles—Koplik’s spots (clustered white lesions
ecchymosis).
small towel under puncture site for at least 3 hours. on buccal mucosa).  Buerger’s Disease—intermittent claudication
 Paracentesis—flat on bed or sitting.  Systemic Lupus Erythematosus—butterfly rash.
(pain at buttocks or legs from poor circulation
resulting in impaired walking).
 Intestinal Tubes—place patient on right side to  Leprosy—leonine facies (thickened folded facial
facilitate passage into duodenum. skin).
 Diabetic Ketoacidosis—acetone breathe.
 Nasogastric Tubes—elevate HOB 30 degrees to  Bulimia—chipmunk facies (parotid gland
 Pregnancy Induced Hypertension (PIH)—
proteinuria, hypertension, edema.
prevent aspiration. Maintain elevation for swelling).
  Diabetes Mellitus—polydipsia, polyphagia,  Morphine is contraindicated hypertension in a patient who takes a monoamine
polyuria. in pancreatitis because it causes spasms of the oxidase inhibitor.
 Gastroesophageal Reflux Disease (GERD)— Sphincter of Oddi. Demerol should be given.  Projection is the unconscious assigning of a
heartburn.  Never give potassium (K+) in IV push. thought, feeling, or action to someone or
something else.
 Hirschsprung’s Disease (Toxic Megacolon)—  Infants born to an HIV-positive mother should
ribbon-like stool. receive all immunizations of schedule.  Sublimation is the channeling of unacceptable
impulses into socially acceptable behavior.
 Sexual Transmitted Infections:  Gravida is the number of pregnancies a woman
o Herpes Simplex Type II—painful has had, regardless of outcome.  Repression is an unconscious defense mechanism
whereby unacceptable or painful thoughts,
vesicles on genitalia  Para is the number of pregnancies that reached impulses, memories, or feelings are pushed from
o Genital Warts—warts 1-2 mm in viability, regardless of whether the fetus was the consciousness or forgotten.
diameter. delivered alive or stillborn. A fetus is considered
o Syphilis—painless chancres. viable at 20 weeks’ gestation.  People with obsessive-compulsive
o Chancroid—painful chancres. disorder realize that their behavior is
 Lochia rubra is the vaginal discharge of almost unreasonable, but are powerless to control it.
o Gonorrhea—green, creamy pure blood that occurs during the first few days
discharges and painful urination. after childbirth.  A significant toxic risk associated
o Chlamydia—milky discharge and  Lochia serosa is the serous vaginal discharge that
with clozapine (Clozaril) administration is blood
painful urination. dyscrasia.
occurs 4 to 7 days after childbirth.
o Candidiasis—white cheesy  Adverse effects of haloperidol (Haldol)
odorless vaginal discharges.  Lochia alba is the vaginal discharge of decreased administration include drowsiness; insomnia;
blood and increased leukocytes that’s the final
o Trichomoniasis—yellow, itchy, stage of lochia. It occurs 7 to 10 days after
weakness; headache; and extrapyramidal
frothy, and foul-smelling vaginal symptoms, such as akathisia, tardive dyskinesia,
childbirth. and dystonia.
discharges.
 In the event of fire, the acronym most often used  Hypervigilance and déjà vu are signs of
is RACE. (R) Remove the patient. (A) Activate the posttraumatic stress disorder (PTSD).
alarm. (C) Attempt to contain the fire by closing
the door. (E) Extinguish the fire if it can be done
safely.
Miscellaneous Tips
 Before signing an informed consent form, the
patient should know whether other treatment
 Delegate sterile skills (e.g., dressing change) to the options are available and should understand what
RN or LPN. will occur during the preoperative, intraoperative,
 Where non-skilled care is required, delegate the
and postoperative phases; the risks involved; and
the possible complications. The patient should also
stable client to the nursing assistant.
have a general idea of the time required from
 Assign the most critical client to the RN. surgery to recovery. In addition, he should have an
 Clients who are being discharged should have final opportunity to ask questions.
assessments done by the RN.  The first nursing intervention in a quadriplegic
 The Licensed Practical Nurse (LPN) can monitor client who is experiencing autonomic
clients with IV therapy, insert urinary catheters, dysreflexia is to elevate his head as high as
feeding tubes, and apply restraints. possible.
 Assessment, teaching, medication administration,  Usually, patients who have the same infection and
evaluation, unstable patients cannot be delegated to are in strict isolation can share a room.
an unlicensed assistive personnel.  Veracity is truth and is an essential component of
 Weight is the best indicator of dehydration. a therapeutic relationship between a health care
 When patient is in distress, administration of provider and his patient.
medication is rarely the best choice.  Beneficence is the duty to do no harm and the duty
 Always check for allergies before to do good. There’s an obligation in patient care to
administering antibiotics. do no harm and an equal obligation to assist the
patient.
 Neutropenic patients should not receive vaccines,
fresh fruits, or flowers.  Nonmaleficence is the duty to do no harm.
 Nitroglycerine patch is administered up to three  Tyramine-rich food, such as aged cheese, chicken
times with intervals of five minutes. liver, avocados, bananas, meat tenderizer, salami,
bologna, Chianti wine, and beer may cause severe