Things You Forgot

Throughout this book, we have tried to simplify your preparation

for the NCLEX® exam. This appendix includes information you
have learned during nursing school but might have forgotten.

Therapeutic Drug Levels

Therapeutic drug levels that are important for the nurse to remem-
ber when taking the NCLEX® exam include:
. Digoxin: 0.5–2.0 ng/mL

. Lithium: 0.8-1.2 mEq/L* (NIH value)

. Dilantin: 10–20 mcg/mL

. Theophylline: 10–20 mcg/mL

Vital Signs
Normal ranges for the vital signs of the adult and the newborn:
. Adult heart rate: 80–100 beats per minute

. Newborn heart rate: 100–180 beats per minute

. Adult respiratory rate: 12–20 respirations per minute

. Newborn respiratory rate: 30–60 respirations per minute

. Adult blood pressure: systolic pressure = 110–120 mm Hg;

diastolic pressure = 60–90 mm Hg
 . Newborn blood pressure: systolic pressure = 65 mm Hg; diastolic
pressure = 41 mm Hg
. Temperature: 98.6º F plus or minus one degree

Intrapartal Normal Values

Here are some of the normal ranges to remember when caring for the client
during the intrapartal period:
. Fetal heart rate: 120–160 beats per minute

. Variability: 6–10 beats per minute

. Contractions:

. Frequency of contractions: every 2–5 minutes

. Duration of contractions: less than 90 seconds

. Intensity of contractions: less than 100 mmHg

Anticoagulant Therapy
The nurse should be familiar with the tests ordered for the client receiving antico-
agulant therapy and for the control levels. Remember that the therapeutic range is
1.5–2 times the control:
. Coumadin (sodium warfarin) PT/Protime: 12–20 seconds.

. International normalizing ratio (INR): 2–3.

. The antidote for sodium warfarin is vitamin K.

Lab values may vary according to methods used.

. Heparin and heparin derivatives partial thromboplastin time (PTT):

30–60 seconds.
. The antidote for heparin is protamine sulfate.
Standard Precautions
Standard precautions are guidelines used to prevent infection with diseases
transmitted through blood or body fluids. The nurse should be familiar with
examples of diseases that require the use of standard precautions and those that
require transmission based precautions. Transmission-based precautions include
airborne precautions, droplet precautions, and contact precautions.
. Gloves should be worn when there is a chance of contact with blood and
body fluids, when handling other potentially infected material, and when
performing vascular access procedures.
. Gloves should be changed after each client contact and between contact
procedures with the same client.
. Masks and protective eyewear should be worn when there is a likelihood
of splashes or when body fluids might become airborne.
. Gloves and aprons should be worn during procedures in which there is a
likelihood of splashes of blood or body fluids.
. Hand washing should be done immediately after contact with body fluids
or other potentially infected material and as soon as gloves are removed.
. Needles and sharps should be disposed of in sharps containers. No
recapping, bending, or breaking of needles should occur.
. Mouth-to-mouth resuscitation should be performed using a mouthpiece
or other ventilation device.

saliva (the exception is during oral surgery or dentistry).

Airborne Precautions
Infections requiring airborne precautions are those caused by pathogens that
remain suspended in the air for prolonged periods of time. Clients with tuber-
culosis, measles (rubeola), and varicella should be cared for using airborne pre-
cautions. The client should be placed in a private, negative pressure room.
Healthcare workers should wear a HEPA mask (also referred to as an N-95 or
respirator mask) when caring for these clients.
Droplet Precautions
Infections requiring droplet precautions are those caused by pathogens that are
suspended in droplets that travel 3 feet, but are not suspended in the air for long
periods of time. Clients with influenza, mumps, pertussis, rubella (German
measles), diphtheria, pneumonia, scarlet fever, streptococcal pharyngitis, and
meningitis should be cared for using droplet precautions. The client should be
placed in a private room or in a room with a client who has the same illness.
Client beds should be no closer than 3 feet apart. The door to the room may
remain open. Healthcare workers should wear a mask when in direct contact
with the client.

Contact Precautions
Infections requiring contact precautions are those caused by pathogens spread
by direct contact. Clients with RSV, scabies, colonization with MRSA, and VRE
should be cared for using contact precautions. The client should be placed in a
private room or with a client with the same illness. Healthcare workers should
wear gloves when entering the room and wear gowns to prevent contact with the
client. Hands should be washed with an antimicrobial soap before leaving the
client’s room. Equipment used by the client should remain in the room and
should be disinfected before being used by anyone else. The client should be
transported only for essential procedures; during transport, precautions should
be taken to prevent disease transmission.

Revised Life Support Guidelines

(American Heart Association)
Frequently the American Heart Association releases guidelines for the care of
the client experiencing cardiac dysrhythmias. Refer to http://www.aafp.org/afp/
2006050/practice.html for these guilelines.
Defense Mechanisms
Here is a quick reference to some of the defense mechanisms:
. Compensation—The development of attributes that take the place of
more desirable ones.
. Conversion reaction—The development of physical symptoms in
response to emotional distress.
. Denial—The failure to regard an event or feeling.

. Displacement—The transference of emotions to another other than the

intended.
. Projection—The transferring of unacceptable feelings to another
person.
. Rationalization—The dismissal of one’s responsibility by placing fault
on another.
. Reaction formation—The expression of feelings opposite to one’s true
feelings.
. Regression—The returning to a previous state of development in which
one felt secure.
. Repression—The unconscious forgetting of unpleasant memories.

. Sublimation—The channeling of unacceptable behaviors into behaviors

that are socially acceptable.
. Suppression—The conscious forgetting of an undesirable memory.

Nutrition Notes
It is important for the nurse to remember dietary interventions used for various
disorders. Table A.1 is a quick reference to help you remember the diets.
TABLE A.1 Dietary and Nutrition Notes to Remember
Disorders Being
Treated Foods to Include Foods to Avoid
Bone marrow Cooked, processed, or peeled foods. Avoid foods from salad bars,
transplantation foods grown on or in the
ground, and foods that are
cultured.
Cancer Same as for Crohn’s and ulcerative Same as for Crohn’s and
(client with colitis. ulcerative colitis.
radium implant)
Celiac/gluten- Milk, buttermilk, lean meats, eggs, Malted milk, fat meats,
induced diarrhea cheese, fish, creamy peanut butter, luncheon meats, wheat,
cooked or canned juice, corn, bread salmon, prunes, plums, rye,
stuffing from corn, cornstarch, rice, oats, barley, and soups
soybeans, potatoes, bouillon, and thickened with gluten
broth. containing grains.
Congestive heart Meats low in cholesterol and fats, Foods high in salts, canned
failure, breads, starches, fruits, sweets, products, frozen meats,
hypertension vegetables, dairy cheeses, eggs, organ meats,
products. fried foods, and alcohol.
Inflammatory Meats, breads, and starches, fruits, Whole grains, legumes, nuts,
bowel disease vegetables, dairy products. vegetables with skins, prune
(Crohn’s and juice, and gristly meats.
ulcerative colitis)
Full liquid diet Milk, ice cream, soups, puddings, All solid foods.
custards, plain yogurt, strained
meats, strained fruits and vegetables,
fruit and vegetable juices, cereal gruel,
butter, margarine, and any component
or combination of clear liquids.
Lacto-vegetarian Primary sources of protein, dairy All meat products.
diet products, peanut butter, legumes,
soy analogs.
Peptic ulcer/hiatal Meats, breads, starches, fruits, Alcohol, coffee, chocolate,
hernia vegetables, and dairy products. black or red pepper, chili
powder, carminatives such as
oil of peppermint and
spearmint, garlic, onions, and
cinnamon.
TABLE A.1 Continued

Renal Meats, dairy products, breads and Eggs, organ meats, fried or
transplantation starches, vegetables, and sweets. fattyfood, foods containing
salt, driedfoods, salt substi-
tutes, and fruits.

Immunization Schedule
It is important for the nurse to be aware of the recommended immunization
schedule for various age groups. Figure A.1 is a recommended schedule for
childhood and adolescent immunizations. Figure A.2 is a recommended sched-
ule for adult immunizations.

FIGURE A.1 Recommended childhood and adolescent immunization schedule.

FIGURE A.2 Recommended adult immunization schedule.

The NCLEX-PN® Cram Sheet

This cram sheet contains the distilled, key facts about the licensure exam. Review this informa-
tion just before you enter the testing center, paying special attention to those areas where you
feel you need the most review. You can transfer any of these facts from your head onto a blank
sheet provided by the testing center. We also recommend reading the glossary as a last-minute
cram tool before entering the testing center. Good luck.

GENERAL TEST INFORMATION
1. Minimum 75/maximum 265—The maximum time
allotted for the test is 6 hours. Don’t get frustrated
if you need to take the entire number of items
or take the entire allotted time. Get up and move
around and take breaks if you need a time-out.
2. Take deep breaths and imagine yourself
studying in your favorite location—Take a small
item with you that you have had with you during
your study time.
3. Read the question and all answers carefully—
Don’t jump to conclusions or make wild guesses.
4. Look for keywords—Avoid answers that include
always, NEVER, all, EVERY, only, must, no, except,
or none.
5. Watch for specific details—Avoid vague
answers. Look for adjectives and adverbs.
6. Eliminate answers that are clearly wrong or
incorrect—Eliminating any incorrect answer
increases the probability of selecting the correct
answer by 25%.
7. Look for information given within the
question and the answers—For example, the
phrase “client with diabetic ketoacidosis” should
bring to mind the range of 7.35–7.45 or normal pH.
8. Look for the same or similar wording in the
question and the answers.
9. Watch for grammatical inconsistencies—
Subjects and verbs should agree, meaning singular
subject, singular verb or plural subject, plural verb.
If the question is an incomplete sentence, the
correct answer should complete the question in a
grammatically correct manner.
10. Don’t read into questions—Reading into the
question can create errors in judgment. If the
question asks for an immediate response or priori-
tization of action, choose the answer that is critical
to the life and safety of the client.
 . WBC: 5,000–10,000
11. Make an educated guess—If you are unsure
after carefully reading the question and all the . Plt.: 200,000–400,000
answers, choose C or the answer with the most . Hgb: 12–16 gms women; 14–18 gms men
information.
15. ABG values
12. Don’t hurry, you are not penalized for running
out of time. If you run out of time the computer . HCO3: 24–26 mEq/L
calculates the last 60 items for consistency above . CO2: 35–45 mEq/L
or below the pass-point. . PaO2: 80%–100%
13. Serum electrolytes—It is important for you to . SaO2: > 95%
remember these normal lab values because they
might be included in questions throughout the test. 16. Chemistry values
. Sodium: 135–145 mEq/L . Glucose: 70–110 mg/dL
. Potassium: 3.5–5.5 mEq/L . Specific gravity: 1.010–1.030
. Calcium: 8.5–10.9 mg/L . BUN: 7–22 mg/dL
. Chloride: 95–105 mEq/L . Serum creatinine: 0.6–1.35 mg/dL
(< 2 in older adults)
. Magnesium: 1.5–2.5 mEq/L
*Information included in laboratory test may vary
. Phosphorus: 2.5–4.5 mg/dL
slightly according to methods used
14. Hematology values
. RBC: 4.5–5.0 million
...............................................
 . LDH: 100–190 U/L
. CPK: 21–232 U/L
. Uric acid: 3.5–7.5 mg/dL
. Triglyceride: <150 mg/dL
. Total cholesterol: 130–200 mg/dL
. Bilirubin: < 1.0 mg/dL
. Protein: 6.2–8.1 g/dL
. Albumin: 3.4–5.0 g/dL
17. Therapeutic drug levels
. Digoxin: 0.5–2.0 ng/mL
. Lithium: 0.8–1.5 mEq/L
. Dilantin: 10–20 mcg/dL
. Theophylline: 10–20 mcg/dL
18. Vital signs (adult)
. Heart rate: 80–100
. Respiratory rate: 12–20
. Blood pressure: 110–120 (systolic); 60–90
(diastolic)
. Temperature: 98.6° +/–1
19. Maternity normals
. FHR: 120–160 BPM.
. Variability: 6–10 BPM.
. Contractions: normal frequency 2–5 minutes
apart; normal duration < 90 sec.;
intensity < 100 mm/hg.
. Amniotic fluid: 500–1200 ml (nitrozine
urine-litmus paper green/amniotic fluid-
litmus paper blue).
. Apgar scoring: A = appearance, P = pulses,
G = grimace, A = activity, R = reflexes (Done
at 1 and 5 minutes with a score of 0 for
absent, 1 for decreased, and 2 for strongly
positive.)
. AVA: The umbilical cord has two arteries and
one vein. (Arteries carry deoxygenated blood.
The vein carries oxygenated blood.)
20. FAB 9—Folic acid = B9. Hint: B stands for brain
(decreases the incidence of neural tube defects);
the client should begin taking B9 three months
prior to becoming pregnant.
21. Abnormalities in the laboring obstetric client—
Decelerations are abnormal findings on the fetal
monitoring strip. Decelerations are classified as
. Early decelerations—Begin prior to the
peak of the contraction and end by the end
of the contraction. They are caused by head
compression. There is no need for interven-
tion if the variability is within normal range
(that is, there is a rapid return to the baseline
fetal heart rate) and the fetal heart rate is
within normal range.
. Variable decelerations—Are noted as
V-shaped on the monitoring strip. Variable
decelerations can occur anytime during
monitoring of the fetus. They are caused
by cord compression. The intervention is to
change the mother’s position; if pitocin is
infusing, stop the infusion; apply oxygen;
and increase the rate of IV fluids. Contact the
doctor if the problem persists.
. Late decelerations—Occur after the peak
of the contraction and mirror the contraction
in length and intensity. These are caused by
uteroplacental insuffiency. The intervention
is to change the mother’s position; if pitocin
is infusing, stop the infusion; apply oxygen;,
and increase the rate of IV fluids. Contact the
doctor if the problem persists.
22. TORCHS syndrome in the neonate—This is a
combination of diseases. These include toxoplas-
mosis, rubella (German measles), cytomegalovirus,
herpes, and syphyllis. Pregnant nurses should not
be assigned to care for the client with toxoplasmo-
sis or cytomegalovirus.
23. STOP—This is the treatment for maternal
hypotension after an epidural anesthesia:
1. Stop pitocin if infusing.
2. Turn the client on the left side.
3. Administer oxygen.
4. If hypovolemia is present, push IV fluids.
24. Anticoagulant therapy and monitoring
. Coumadin (sodium warfarin) PT: 10–12 sec.
(control).
. Antidote: The antidote for Coumadin is
vitamin K.
. Heparin/Lovenox/Dalteparin PTT: 30–45 sec.
(control).
. Antidote: The antidote for Heparin is
protamine sulfate.
. Therapeutic level: It is important to maintain
a bleeding time that is slightly prolonged so
that clotting will not occur; therefore, the
bleeding time with medication should be
1 1/2–2 times the control.
*The control is the premedication bleeding time.
25. Rule of nines for calculating TBSA for burns
. Head = 9%
. Arms = 18% (9% each)
. Back = 18%
. Legs = 36% (18% each)
. Genitalia = 1%
...............................................
CULTURAL AND RELIGIOUS CONSIDERATIONS
IN HEALTH CARE
26. Arab American cultural attributes—Females
avoid eye contact with males; touch is accepted
if done by same-sex healthcare providers; most
decisions are made by males; Muslims (Sunni),
refuse organ donation; most Arabs do not eat pork;
they avoid icy drinks when sick or hot/cold drinks
together; colostrum is considered harmful to the
newborn.
27. Asian American cultural attributes—They avoid
direct eye contact; feet are considered dirty (the feet
should be touched last during assessment); males
make most of the decisions; they usually refuse
organ donation; they generally do not prefer cold
drinks, believe in the “hot-cold” theory of illness.
28. Native American cultural attributes—They
sustain eye contact; blood and organ donation is
generally refused; they might refuse circumcision;
might prefer care from the tribal shaman rather
than using western medicine.
29. Mexican American cultural attributes—They
might avoid direct eye contact with authorities;
they might refuse organ donation; most are very
emotional during bereavement; believe in the
“hot-cold” theory of illness.
30. Religions beliefs
. Jehovah’s Witness—No blood products
should be used
. Hindu—No beef or items containing gelatin
. Jewish—Special dietary restrictions, use of
kosher foods
31. Therapeutic diets
. Renal diet—High calorie, high carbohydrate,
low protein, low potassium, low sodium, and
fluid restricted to intake = output + 500 ml
. Gout diet—Low purine; omit poultry (“cold
chicken”) medication for acute episodes:
Colchicine; maintenance medication: Zyloprim
. Heart healthy diet—Low fat (less than
30% of calories should be from fat)
32. Acid/base balance
. ROME (respiratory opposite/metabolic equal)
is a quick way of remembering that in respi-
ratory acid/base disorders the pH is opposite
to the other components. For example, in
respiratory acidosis, the pH is below normal
and the CO2 is elevated, as is the HCO3
(respiratory opposite). In metabolic disorders,
the components of the lab values are the
same. An example of this is metabolic aci-
dosis. In metabolic acidosis, the pH is below
normal and the CO2 is decreased, as is the
HCO3. This is true in a compensated situation.
. pH down, CO2 up, and HCO3 up = respiratory
acidosis
............................... ................
. pH down, CO2 down, and HCO3 down =
metabolic acidosis
. pH up, CO2 down, and HCO3 down =
respiratory alkalosis
. pH up, CO2 up, and HCO3 up = metabolic
alkalosis
33. Addison’s versus Cushing’s—Addison’s and
Cushing’s are diseases of the endocrine system
involving either overproduction or inadequate
production of cortisol:
. Treatment for the client with Addison’s:
increase sodium intake; medications include
cortisone preparations.
. Treatment for the client with Cushing’s:
restrict sodium; observe for signs of infection.
34. Treatment for spider bites/bleeding—RICE (rest,
ice, compression, and elevate extremity)
35. Treatment for sickle cell crises—HHOP (heat,
hydration, oxygen, pain medications)
36. Five Ps of fractures and compartment syn-
drome—These are symptoms of fractures and
compartment syndrome:
. Pain
. Pallor
. Pulselessness
. Paresthesia
. Polar (cold)
37. Hip fractures—Hip fractures commonly hemor-
rhage, whereas femur fractures are at risk for fat
emboli.
38. Profile of gallbladder disease—Fair, fat, forty,
five pregnancies, flatulent (actually gallbladder
disease can occur in all ages and both sexes).
TIPS FOR ASSIGNING STAFF DUTIES
39. Management and delegation
. Delegate sterile skills such as dressing chang-
es to the RN or LPN. Where nonskilled care is
required, you can delegate the stable client to
the nursing assistant. Choose the most critical
client to assign to the RN, such as the client
who has recently returned from chest surgery.
Clients who are being discharged should have
final assessments done by the RN.
. The PN, like the RN, can monitor clients with
IV therapy, insert urinary catheters and feed-
ing tubes, apply restraints, discontinue IVs,
drains, and sutures.
. For room assignments, do not coassign the
post-operative client with clients who have
vomiting, diarrhea, open wounds, or chest
tube drainage. Remember the A, B, Cs (air-
way, breathing, circulation) when answering
questions choices that ask who would you
see first. For hospital triage, care for the
....................................................
client with a life-threatening illness or injury
first. For disaster triage, choose to triage
first those clients who can be saved with the
least use of resources.
LEGAL ISSUES IN NURSING
Review common legal terms: tort, negligence,
malpractice, slander, assault, battery.
Legalities—The RN and the physician institute seclusion
protection.
40. Examples of types of drugs
*The generic name is listed first with the trade
name in parentheses.
. Angiotensin-converting agents: Benazepril
(Lotensin), lisinopril (Zestril), captopril
(Capoten), enalapril (Vasotec), fosinopril
(Monopril), moexipril (Univas), quinapril
(Acupril), ramipril (Altace)
. Beta adrenergic blockers: Acebutolol
(Monitan, Rhotral, Sectral), atenolol
(Tenormin, Apo-Atenol, Nova-Atenol),
esmolol (Brevibloc), metaprolol (Alupent,
Metaproterenol), propanolol (Inderal)
. Anti-infective drugs: Gentamicin
(Garamycin, Alcomicin, Genoptic),
kanamycin (Kantrex), neomycin (Mycifradin),
streptomycin (Streptomycin), tobramycin
(Tobrex, Nebcin), amikacin (Amikin)
. Benzodiazepine drugs: Clonazepam
(Klonopin), diazepam (Valium),
chlordiazepoxide (Librium), lorazepam
(Ativan), flurazepam (Dalmane)
. Phenothiazine drugs: Chlopromazine
(Thorazine), prochlorperazine (Compazine),
trifluoperazine (Stelazine), promethazine
(Phenergan), hydroxyzine (Vistaril),
fluphenazine (Prolixin)
. Glucocorticoid drugs: Prednisolone (Delta-
Cortef, Prednisol, Prednisolone), prednisone
(Apo-Prednisone, Deltasone, Meticorten,
Orasone, Panasol-S), betamethasone
(Celestone, Selestoject, Betnesol),
dexamethasone (Decadron, Deronil, Dexon,
Mymethasone, Dalalone), cortisone (Cortone),
hydrocortisone (Cortef, Hydrocortone
Phosphate, Cortifoam), methylpredniso-
lone (Solu-cortef, Depo-Medrol, Depopred,
Medrol, Rep-Pred), triamcinolone (Amcort,
Aristocort, Atolone, Kenalog, Triamolone)
. Antivirals: Acyclovir (Zovirax), ritonavir
(Norvir), saquinavir (Invirase, Fortovase),
indinavir (Crixivan), abacavir (Ziagen), cidofo-
vir (Vistide), ganciclovir (Cytovene, Vitrasert)
. Cholesterol-lowering drugs: Atorvastatin
(Lipitor), fluvastatin (Lescol), lovastatin
(Mevacor), pravastatin (Pravachol),
simvastatin (Zocar), rosuvastatin (Crestor)
. Angiotensin receptor blocker drugs:
Valsartan (Diovan), candesartan (Altacand),
losartan (Cozaar), telmisartan (Micardis)
. Histamine 2 antagonist drugs: Cimetidine
(Tagamet), famotidine (Pepcid), nizatidine
(Axid), rantidine (Zantac)
. Proton pump inhibitors: Esomeprazole
(Nexium), lansoprazole (Prevacid), pantopra-
zole (Protonix), rabeprazole (AciPhex)
. Anticoagulant drugs: Heparin sodium
(Hepalean), enoxaparin sodium (Lovenox),
dalteparin sodium (Fragmin)
41. Drug schedules
. Schedule I—Research use only (example
LSD)
. Schedule II—Requires a written prescription
(example Ritalin)
. Schedule III—Requires a new prescrip-
tion after six months or five refills (example
codeine)
. Schedule IV—Requires a new prescription
after six months (example Darvon)
. Schedule V—Dispensed as any other
prescription or without prescription if state
law allows (example antitussives)
42. Medication classifications commonly used in a
medical/surgical setting
. Antacids—Reduce hydrochloric acid in the
stomach
. Antianemics—Increase red blood cell
production
. Anticholenergics—Decrease oral secretions
. Anticoagulants—Prevent clot formation
. Anticonvulsants—Used for management of
seizures/bipolar disorder
. Antidiarrheals—Decrease gastric motility
and reduce water in bowel
. Antihistamines—Block the release of
histamine
. Antihypertensives—Lower blood pressure
and increase blood flow
. Anti-infectives—Used for the treatment of
infections
. Bronchodilators—Dilate large air passages
in asthma/lung disease
. Diuretics—Decrease water/sodium from the
Loop of Henle
. Laxatives—Promote the passage of stool
. Miotics—Constrict the pupils
. Mydriatics—Dilate the pupils
. Narcotics/analgesics—Relieve moderate to
severe pain