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ReMar NCLEX RN Review NCLEX Pharmacology- Tetracyclines Tetracyclines Examples: Tetracycline (Achromycin), Demecyclines (Declomycin), Doxycycline (Vibramycin)

note the -mycin ending but these are not Aminoglycosides!!!! Uses: Treat bacterial infections, Acne

What to monitor for?   

Phototoxicity Nephrotoxicity Hepatotoxicity

NCLEX tips about Tetracyclines If clients are allergic to penicillin then tetracyclines are a viable treatment option. Tetracyclines will reduce the effects of Oral Contraceptives. Teach clients to use another form of birth control when taking them. Tetracyclines will cause photosensitivity teach clients to avoid direct sunlight. Tetracyclines will increase the effects of Anticoagulants (Aspirin, Coumadin, etc) increasing a client’s risk for bleeding. Can women who are pregnant or nursing take tetracyclines? No it will come through the breast milk and can cause bone defects. Taking the same idea of not giving tetracycline with breast milk do not give with cow’s milk either. Drinking milk with tetracycline will reduce the effect of the antibiotic by 50%. The same is true for antacids, give this drug with a full glass of water Do Not give tetracyclines to children under 12 as it will cause teeth discoloration. (major point) Page 1 of 61

Remember for NCLEX know general points about drugs such as indication, side effects, and teaching. Do not become busy knowing the smallest details such as tetracyclines block the tRNA attachment to ribosomes which inhibits protein synthesis. Doing this is a waste of your time, get the basic knowledge and move on to the next subject.

NCLEX Reye’s Syndrome Zdravstvuj! I recently found out that I have visitors from Russia. How cool is that? I tried to learn the language but gave up when I couldn’t find anyone to practice with me :/ Anyways here is Reye’s. Reye’s Syndrome is a systemic response to an unknown cause, however the three main staples of the syndrome   

acute encephalopathy fatty liver hypoglycemia

are commonly seen after a viral illness. You will most likely see this condition in children. What are the signs of Reye’s syndrome? Child will present with nausea and vomiting, mental confusion, seizures, fever The earlier the diagnosis the better the outcome! How do you diagnosis this syndrome? blood tests and liver biopsy (*know position and teaching for liver biopsy) What is the treatment?    

Antibiotics (for viral infection) IV fluids (for dehydration because of the vomiting) Dextrose in the IV fluids (for hypoglycemia) Vitamin K (a fatty liver does not absorb vitamin k very well which put client at risk for bleeding out)

NCLEX point to note: Do not give Aspirin to children with viral infections due to risk of Reye’s syndrome.

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Let’s quickly review for NCLEX in my style! Reye’s syndrome may occur after kids get aspirin to treat viral symptoms. Can you name two viral infections? 1. 2. Do not give aspirin to treat flu-like symptoms after what two immunizations?

What is another name NCLEX can (and probably will) use instead of aspirin?

What should you give to treat flu-like symptoms instead of aspirin?

Should a child with Reye’s syndrome be put in isolation?

Clients with encephalopathy (cerebral edema) are at risk for what?

One of the symptoms of Reye’s syndrome is seizures. What are seizure precautions? Answers: Influenza and Varicella Influenza and Varicella Salicylates Tylenol or Ibuprofen No-that would be cruel Increased intracranial pressure Seizure precautions- Raise and pad side rails, airway supplies at bedside, if seizure occurs time it, place pillow under head, do not put anything into the mouth, do not restrain client Page 3 of 61

NCLEX Study Guide Part 2 Yesterday I had a conversation with a private RN NCLEX tutor, I asked her why her hourly prices were so high? She stated because she was licensed in two states and had been a nurse for 15 years. I replied by stating that the longer you have been a nurse the harder it is to pass the NCLEX because your real life experience will mostly likely leave you with wrong answers. I then told her that I am licensed in Ohio, DC, Minnesota, and California and I don’t feel the need to charge $100/hr. Students beware there are lots of Instructors like this out there!

NCLEX Study Guide Part 2 1. If your 6 month old client has RSV what kind of transmission based precaution would you use?

2. Rhogam is most often used to treat Rh ____ mothers that have Rh _____ babies?

3. A client overdoses on Tylenol what medication would you give as an antidote?

4. A 22 year old was admitted to the ER according to Erickson’s psychosocial stage which stage is he in?

5. You are teaching at a conference on epiglottitis which microorganism has been linked to epiglottitis?

6. What is the most commonly used drug to treat angina and how is it given?

7. Using the Apgar Scale how many points would you give a baby whose body was pink but extremities blue?

8. How long can an insulin vial be kept unrefrigerated at room temperature?

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9. Rubella has an incubation period of 14 to 21 days what transmission based precaution would you use?

10. Your client is about to get a CT scan of the head, when the contrast dye is injected the client complains of a warm, flushing sensation is this normal?

Answers: 1 Contact 2 Negative, Positive 3 Mycomyst (17 doses plus loading dose) 4 Intimacy vs Isolation 5 Hemophilus influenza B 6 Nitroglycerin-sublingual 71 8 30 days 9 Droplet 10 Yes this is normal

Look Inside Quick Facts page 23! Chron’s Disease Chron’s disease is __________ of the bowels. Inflammation Can Chron’s disease be cured with surgery? No symptoms will reoccur What are the symptoms of Chron’s disease? Abdominal pain, weight loss, diarrhea (non bloody) Excessive diarrhea will cause what type of electrolyte imbalance? Hypokalemia What foods should be avoided and why? Dairy products and high fiber they worsens diarrhea Page 5 of 61

If the client is unable to tolerate foods what may be ordered? Total Parenteral Nutrition Chron’s disease can lead to what kind of cancer? Colon What are the treatment goals for Chron’s disease? Drugs/ nutrition to reduce inflammation

Cut your studying time in half get ReMar’s Quick Facts!

NCLEX Sexually Transmitted Diseases A sexually transmitted disease (STD) is a disease acquired through sexual contact with an infected person. STDs are the most common infectious diseases in the United States.

Syphilis: caused by the spirochete Treponema pallidum, spread by sexual contact or during birth Primary stage (10 days to 3 months)   

painless chancre on genitalia, mouth, or anal canal serous drainage from chancre enlarged lymph nodes

Secondary stage (2 weeks to 6 months after chancre heals)   

rash on palms of hands and feet wartlike growths signs of infection- hair loss, fever, malaise, weight loss

Latency stage  

no signs of infection will still test positive for syphilis

Tertiary stage   

slowly progressive inflammatory disease attacks multiple organs signs-dementia, psychosis, paresis, stroke, meningitis

Treatment: Penicillin G an IM injection NCLEX tips: know the signs of each stage, remember the painless chancre with syphilis. Page 6 of 61

Gonorrhea Cause by gram-negative N. gonorrhoeae Transmitted by sexual contact and birth May be asymptomatic Possible signs males  

discharge from penis dysuria (painful urination)

Possible signs female   

purulent yellow/greenish vaginal discharge vaginal bleeding Pelvic inflammatory disease (PID)- is an inflammatory condition of the pelvic cavity. Symptoms include lower abdominal pain, fever, malaise, nausea. This primarily affects the fallopian tubes. Gonorrhea and chlamydia are the most likely causes. Treatment includes pain meds and antibiotics.

Treatment: Rocephin (ceftriaxone)

Chlamydia Most common STD 70% of cases are asymptomatic Spread by sexual contact/birth Possible signs males  

urethritis frequent urge to urinate

Possible signs females   

PID infertility ectopic pregnancy

* If a client has gonorrhea, syphilis, or PID suspect they have Chlamydia

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Treatment: Doxycycline or Azithromycin (Do not give either during pregnancy) General patient teachings: 

Do not have sexual contact until after treatment is complete

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Treat sexual partners at the same time

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Take full course of antibiotics

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Use latex condoms to prevent STDs

NCLEX fact: Marijuana can reduce testosterone levels and sperm production in males. Get The ReMar Review Package today!

NCLEX Body Mechanics Well I bet you never thought NCLEX would ask you about proper body mechanics? They could so let’s quickly review.

When Bending Over: Always face the object you are bending in front of Keep your feet shoulder-width apart (having a wide base) Move your whole body as one unit Bend at your hips and knees, NOT at your waist Keep your spine straight when bending do not curve over

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Bending to the Floor: Lower yourself to one knee Rest one arm on raised knee Do not bend at waist Do not hunch your back to reach to the floor, actually drop down

Standing: Keep your spine straight, line up ears, shoulders, and hips Keep your knees relaxed and stomach muscles slightly flattened When standing for a long time put one foot on a foot rest if possible If reaching for objects overhead use a step ladder Elevate work surface to waist height *Bending can strain or even injure your back. When lifting an object use large muscles of the abdomen, arms, and legs.

Real life tip: The recommendations that are given for lifting objects do not always apply to patients. As a nurse you will notice patients are heavier and sicker than you could imagine. Some of them can help with transfers some cannot. My best advice is to protect yourself first, use the lifting equipment and/or grab another person to help you lift. Nurses are at greatest risk for back injuries when we are in the patient’s room because the work space is small and we are doing alot of twisting (eg. making beds, or getting patient in and out of the bed). Never think there isn’t time to call for help, allow patients to do as much as they can alone. Once your back is injured it takes a long time to recover, you can buy many new things but a spine is not one of them! As I get down from my soap box I just want to tell you new nurses once again heed my words. Ahhhh that felt good. Aren’t you glad you come here?

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Fractures for NCLEX

The musculoskeletal system includes the bones, joints, muscles, tendons, and ligaments in the body. There are 206 bones in the human body. The function of bones are:     

support protection movement mineral storage blood cell formation

A fracture is a break in the continuity of bone. Fractures occur when the bone is placed under a greater stress than it can absorb. There are several causes of fractures: Direct blows Crushing forces Sudden twisting motions When a bone has been fractures surrounding tissues may be affected resulting in soft tissue edema, hemorrhage, joint dislocations, ruptured tendons, severed nerves, and damaged blood vessels.

Clinical Signs:    

Pain Loss of function Deformity of extremity Swelling

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Types of Fractures: 

Simple- bone remains contained does not break the skin

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Compound- fracture that causes bone breaks through the skin

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Comminuted-fracture in which bone has splintered into several fragments

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Greenstick-fracture in which bone is cracked on one side but not all the way through

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Transverse- a fracture that is straight across the bone

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Spiral- fracture that twists around the shaft of the bone

If your client is suspected to have a fracture what test will they need? x-ray Fracture treatment will include reduction (open/closed), immobilization, and rehabilitation. What will the nurse teach? 

How to control pain and swelling

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Exercises to increase strength

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Use of assistive devices

The most commonly tested healing complication is compartment syndrome. Compartment syndrome occurs when there is 1) Increased pressure in the muscle compartment space due to edema, hemorrhaging, etc. 2) Decreased size in the muscle compartment space due to cast or dressing wrapped too tightly. When a client has a cast or dressing you must do frequent neurovascular checks. Clinical signs: 6 P’s-Pain, Pressure, Parethesia, Pulselessness, Pallor, Paralysis Which will client feel first parethesia or paralysis?????? Parethesia comes first.

Catch compartment syndrome early to prevent permanent nerve and muscle damage. Your biggest concern is ischemia which could lead to necrosis.

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NCLEX tips: 

If you suspect your client is experiencing compartment syndrome what should you do?

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Elevate extremity at or above heart level (do this first as it reduces pressure!)

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Notify MD

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Remove dressing/cast

If symptoms are not resolved within one hour then a fasciotomy (surgically removal of fascia to relieve pressure) will be needed. You will not suture the incision up. The wound will be left open so the muscles can expand, you will cover will moist sterile dressings. A few days later when symptoms have resolved then the wound will be sutured up.

NCLEX Emergency Preparedness The possibility of mass casualties associated with disasters, terrorism, and biological warfare are not new to human history but they are new to NCLEX. Terms to know: Disaster- an event that consumes all available resources and requires more to remedy the problem Weapon of mass destruction- weapons used to cause widespread death and destruction Biological warfare-use of a biological agent, such as anthrax as a weapon of mass destruction Chemical warfare- use of a chemical agent, such as chlorine as a weapon of mass destruction

There are three levels of a disaster. Disasters are often classified by the anticipated response needed to contain it. Level 1: Local emergency response personnel and organizations can contain and effectively manage the disaster and its aftermath. Level 2: Regional efforts and aid from surrounding communities are effective to manage the effects of the disaster and its aftermath. Level 3: Local and regional assets are overwhelmed; statewide or federal assistance is required.

Triage of Disaster Victims Page 12 of 61

Triage is the sorting of casualities to determine priority of health care needs and the proper site for treatment. During disasters the most critically ill does not always receive the most resources. When a disaster occurs healthcare providers are faced with a large number of casualities, the fundamental principle is to do the greatest good for the greatest number of people. Triage catergories separate clients according to the severity of injury using a color coded tagging system. Each color means a different level of priority. Red (1st priority)- Injuries are life threatening but surviable with moderate intervention. Common conditions will be airway obstruction, shock, hemothorax, pneumothorax, chest and abdominal wounds, open fractures of long bones, 2nd/3rd degree burns over multiple body surfaces Yellow (2nd priority)- Injuries are significant and require medical care but can wait for hours. Common conditions will be abdominal wounds without signifcant bleeding, soft tissue injuries, eye and CNS injuries, facial injuries without airway compromise Green (3rd priority)- Injuries are minor and treatment can be delayed for days if needed. Common conditions will be minor burns, sprains, lacerations without significant bleeding, also **behavior and psychological disorders** Black (4th/Last priority)- Injuries are extensive and client is unlikely to survive. Comfort measures should be provided if possible. Common conditions are unresponsiveness, penetrating head wounds, no pulse, no BP, high spinal cord injuries, profound shock with multiple injuries, seizures/vomiting 24hrs after radiation exposure, pupils fixed and dilated.

Indwelling Catheters on NCLEX Indwelling catheters are tubes inserted into the urinary bladder and left in place. There are typically two lumens (one is for urine to drain the second is to insert air into balloon). The catheter tube is connected to a closed collection system.

Reasons for indwelling catheters: Accurate measure of I & O’s, Pre/post surgery, Urinary retention. *This the last method to manage urinary incontinence* #1 risk associated with indwelling (foley) cathers is U.T.I. Page 13 of 61

Signs of U.T.I.- cloudy urine, dysuria, fever, chills. urine odor Treatment- antibiotics, encourage fluids, perineal care Common abnormalities in urine: 

Dysuria- pain during urination

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Hesitancy- difficulty initiating urination

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Hematuria- blood in the urine

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Nocturia- frequent urination during the night

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Oliguria- less than 400ml in 24 hrs

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Anuria- less than 100ml in 24 hrs

NCLEX tips: 

Remember to clean the perineal area with warm soapy water

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Inserting a indwelling catheter is a sterile procedure not clean!

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Never force a catheter during insertion.

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Wait for urine return before inflating the balloon.

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Collection bag should always be below the bladder.

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Secure the collection bag so it doesn’t pull the catheter during ambulation or movement.

**Contact MD if urine is less than 30 mL per hour.

FYI study this photo!!!: The catheter goes in the URINARY MEATUS not the Vagina in the female patient.

NCLEX Increased Intracranial Pressure Page 14 of 61

Increased intracranial pressure (ICP) is produced when pressure exerted by the intracranial contents rise within the cranial vault. Increased ICP is a syndrome that affects many patients with an acute neurological condition. This is because pathologic conditions alter the relationship between intracranial volume and pressure. Increased ICP is most commonly associated with head injury but may be seen in other conditions such as:    

brain tumors hemorrhage stroke meningitis

Normal ICP is 10-15 mm Hg, anything greater than 20mm Hg is considered increased. The earliest sign of increased ICP is change in level of conscious (restless, confusion, drowsiness) Other early signs are headache, nausea, vomiting, pupil changes Late signs of ICP are bradycardia, hypertension, and bradypnea (Cushing’s triad) Increased ICP is a medical emergency that must be treated promptly! Diagnostic tests: X-ray, CT, MRI

Treatments:    

Removal of the cause Elevate HOB above 30 degrees Protect the airway (possibly intubation) Diuretics (Mannitol)

When NCLEX asks increased ICP interventions pick the answer that has to do with ABC’s or repositioning the client first! You can give medications after the...