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QUICK NCLEX NOTES

An informed consent is needed for any invasive procedure, including those that use a
contrast medium (dye).

For the client with increased ICP, elevate the head of the bed 30 to 40 degrees, avoid the
Trendelenburg’s position, and prevent flexion of the neck and hips.

CSF can be distinguished from other fluids by the presence of concentric rings (bloody fluid
surrounded by yellowish stain; halo sign) when the fluid is placed on a white sterile background,
such as a gauze pad.

Carbidopa-levodopa taken with a monoamine oxidase inhibitor antidepressant can cause a

hypertensive crisis.

Phenytoin must be given slowly to prevent hypotension and cardiac dysrhythmias. Also, it
may decrease the effectiveness of some birth control pills and may cause teratogenic effects, if
taken during pregnancy.

Flumazenil reverses the effects of benzodiazepines. It should not be administered to clients

with increased intracranial pressure or status epilepticus who were treated with
benzodiazepines, because these problems may recur with reversal.

If an anticholinergic medication is discontinued abruptly, the signs and symptoms of

parkinsonism, such as rigidity, tremors, akinesia, bradykinesia, stooped forward posture,
shuffling gait, and masked facies, may be intensified.

The client with osteoporosis is at risk for pathological fractures.

The concurrent use of antigout medications and aspirin causes elevated uric acid levels; the
client should be instructed to take acetaminophen if prescribed rather than aspirin.

Because of the risk of esophagitis, bisphosphonates must be administered in the morning

before eating or drinking with a full glass of water; the client must then remain sitting or standing
and postpone ingesting anything for at least 30 minutes (60 minutes with ibandronate).

For the client with SLE, monitor the blood urea nitrogen and creatinine levels frequently for
signs of renal impairment.

Acute angle-closure glaucoma is a medical emergency that causes sudden eye pain and
possible nausea and vomiting.

Assessment of a child with suspected rheumatic fever includes inquiring about a recent sore
throat, because rheumatic fever manifests 2 to 6 weeks after an untreated or partially treated
group A beta- hemolytic streptococcal infection of the upper respiratory tract.

The classic manifestations of nephrotic syndrome are massive proteinuria, hypoalbuminemia,

and edema.

A high, shrill cry in an infant can be a sign of increased ICP.

Monitor vaginal bleeding following hysterectomy. More than 1 saturated pad per hour may
indicate excessive bleeding.

Antineoplastic medication causes the rapid destruction of cells, resulting in the release of
uric acid. Allopurinol may be prescribed to lower the serum uric acid level.

Cyclophosphamide and ifosfamide are medications that can cause hemorrhagic cystitis.
Encourage the client to drink increased fluids (2 to 3 L/day) during therapy, unless
contraindicated.

When administering methotrexate in large doses, prepare to administer leucovorin as

prescribed to prevent toxicity. This is known as leucovorin rescue.

Following transsphenoidal hypophysectomy, monitor for and report postnasal drip or clear
nasal drainage, which might indicate a cerebrospinal fluid leak. Clear drainage should be
checked for glucose.
COMMON SIGNS AND SYMPTOMS
- Pulmonary tuberculosis: low-grade afternoon fever.
- Pneumonia: rust-colored sputum.
- Asthma: wheezing on expiration.
- Emphysema: barrel chest.
- Pernicious anemia: red beefy tongue.
- Cholera: rice-watery stool and wrinkled hands from
dehydration.
- Malaria: stepladder like fever with chills.
- Typhoid: rose spots in the abdomen.

- Dengue: fever, rash, and headache; positive Herman’s sign.

- Diphtheria: pseudo membrane formation.
- Measles: Koplik’s spots (clustered white lesions on buccal
mucosa).
- Systemic lupus erythematosus: butterfly rash.
- Leprosy: leonine facies (thickened folded facial skin).
- Appendicitis: rebound tenderness at McBurney’s point;
Rovsing’s sign (palpation of LLQ elicits pain in RLQ); psoas sign
(pain from flexing the thigh to the hip).
- Meningitis: Kernig’s sign (stiffness of hamstrings causing
inability to straighten the leg when the hip is flexed to 90º);
Brudzinski’s sign (forced flexion of the neck elicits a reflex
flexion of the hips).
- Tetany: hypocalcemia; positive Trousseau’s and Chvostek
sign.
- Tetanus: Risus sardonicus or rictus grin.
- Pancreatitis: Cullen’s sign (ecchymosis of the umbilicus); Grey
Turner’s sign (bruising of the flank).
- Pyloric stenosis: olive like mass.
- Patent ductus arteriosus: washing machine-like murmur.
- Addison’s disease: bronze-like skin pigmentation.
- Cushing’s syndrome: moon face appearance and buffalo
hump.
- Graves’ disease (hyperthyroidism): Exophthalmos.
- Intussusception: sausage-shaped mass.
- Multiple sclerosis: Charcot’s triad: nystagmus, intention
tremor, and dysarthria.
- Myasthenia gravis: descending muscle weakness, ptosis.
- Guillain-Barre syndrome: ascending muscle weakness.
- Deep vein thrombosis: Homan’s sign.
- Angina: crushing, stabbing pain relieved by nitroglycerin
(NTG).
- Myocardial Infarction: crushing, stabbing pain radiating to left
shoulder, neck, and arms; unrelieved by NTG.
- Cytomegalovirus infection: owl’s eye appearance of cells
(huge nucleus in cells).
- Retinal detachment: flashes of light, shadow with curtain
across vision.
- Basilar skull fracture: raccoon eyes (periorbital ecchymosis)
and Battle’s sign (mastoid ecchymosis).
- Buerger’s disease: intermittent claudication (pain at buttocks
or legs from poor circulation resulting in impaired walking).
- Diabetic ketoacidosis: acetone breathe.
- Pre-eclampsia: proteinuria, hypertension, edema.
- Diabetes mellitus: polydipsia, polyphagia, polyuria.
- Hirschsprung’s Disease (Toxic Megacolon): ribbon-like stool.
- Herpes Simplex Type II: painful vesicles on genitalia.
- Genital Warts: warts 1-2 mm in diameter.
- Syphilis: painless chancres.
- Chancroid: painful chancres.
- Gonorrhea: green, creamy discharges and painful urination.
- Chlamydia: milky discharge and painful urination.
- Candidiasis: white cheesy odorless vaginal discharges.
- Trichomoniasis: yellow, itchy, frothy, and foul-smelling vaginal
discharges.
- Pulmonary edema: pink, frothy sputum, tachypnea, use of
accessory muscles, crackles, anxiety/restlessness (Tx:
furosemide)
THERAPEUTIC DIETS
- Acute renal disease: protein-restricted, high-calorie, fluid-
controlled, Na and K controlled.
- Addison’s disease: high sodium, low potassium.
- ADHD and bipolar: high-calorie and provide finger foods.
- Anemia: high protein/iron/vitamins.
- Atherosclerosis: low saturated fats.
- Burns: high protein, high caloric, !Vitamin C.
- Cancer: high-calorie, high-protein.
- Celiac disease: gluten-free (no BROW: wheat, oats, rye,
barley).
- Cholecystitis/Cholelithiasis: low fat liquids, powder
supplements high in protein/carb into skim milk; avoid fried
foods, pork, cheese, alcohol.
- After surgery may need low fat diet for several weeks.
- Low fat, high carb/protein.
- Chronic renal disease: protein-restricted, low-sodium, fluid-
restricted, potassium-restricted, phosphorus-restricted.
- Cirrhosis (stable): normal protein.
- Cirrhosis with hepatic insufficiency: restrict protein, fluids,
and sodium.
- Constipation: high-fiber, increased fluids.
- COPD: soft, high-calorie, low-carbohydrate, high-fat, small

frequent feedings.
- Cushing’s disease: low sodium, high potassium.
- Cystic fibrosis: increase in fluids; pancreatic enzyme
replacement before or with meals; high protein, high calorie in
advanced stages.
- Diarrhea: liquid, low-fiber, regular, fluid and electrolyte
replacement.
- Diverticular disease: high-fiber, avoid seeds.
- Dumping syndrome (rapid passage of food: diaphoresis,
diarrhea, hypotension): restrict fluids w/ meals, drink 1h
before or 1h after; eat in recumbent position, lie down 20-30
min after eating; small frequent meals; low-carb/low-fiber.
- Gallbladder disease: low-fat, calorie-restricted.
- Gastritis: low-fiber, bland diet.
- Gout: low purine (no fish and organ meats).
- Hepatitis: regular, high-calorie, high-protein.
- Hepatobiliary: low-fat, high protein, vitamins.
- Hirschsprung's disease: low fiber, high calorie/protein before
surgery.
- Hypertension, heart failure, CAD: low-sodium, calorie-
restricted, fat-controlled.
- Kidney stones: increased fluid intake, calcium-controlled,
low-oxalate.
- Meniere’s: low sodium, avoid caffeine, nicotine and alcohol.
- Nephrotic syndrome: sodium-restricted, high-calorie, high-
protein, potassium-restricted.
- Obesity/Overweight: calorie-restricted, high-fiber .
- Ostomy: high calorie/protein/carb; low residue before
surgery.
- Ileostomy: low residue diet, no meats, corn, nuts.
- Colostomy: diet not restricted after 6 weeks.
- Pancreatitis: low-fat, regular, small frequent feedings; tube
feeding or total parenteral nutrition.
- Peptic ulcer: bland diet.
- Pernicious anemia: !Vitamin B12.
- IM B12 shot (25-100 !g), followed by 500-1000 !g shot
every 1-2 months or cyanocobalamin nasal spray.
- Phenylketonuria (PKU): special milk substitutes for infants,
low protein for children.
- Pheochromocytoma: increase calories, vitamins and minerals
intake; avoid coffee, tea, cola, tyramine foods.
- Sickle cell anemia: increase fluids to maintain hydration since
sickling increases when patients become dehydrated.
- Stroke: mechanical soft, regular, or tube-feeding.
- Underweight: high-calorie, high protein.
- Ulcerative colitis & Crohn’s disease: high protein/calorie; low
fat/fiber.
- Ulcers: 3 meals/day, avoid Tº extremes, avoid
caffeine/alcohol/milk&cream.
- Postoperative: Vit B12 parenteral for life and iron
supplements.
- Vomiting: fluid and electrolyte replacement.
"NURSING FUNDAMENTALS"

POSITIONING AT A GLANCE-
Mandatory to change or alter position every 2 hour interval.

Significance of Positioning-

1. To determine absolute blood circulation to those who are chronic bed ridden (e.g: CVD client)
or with mechanical ventilator support.
2. Therefore, to minimize the risk of pressure sore.
3. To prevent the flexion contracture of extremities (e.g: Burn clients)
4. To prevent Deep Vein Thrombosis (DVT)
5. To prevent the risk of atelectasis or collapse lungs.
6. To facilitate drainage under gravity force, particularly for the client with Jackson Pratt drainage
(Chest Tube) followed by cardio thoracic surgery, or postural drain.
7. To facilitate breathing and provide comfort to the client with asthma or severe respiratory
failure.

Positioning in Different Circumstances-

AUTOGRAFT- Use site immobilize for 3-7 days

BURNS OF FACE, NECK, & HEAD- Using elevate of bed, to patent the the airway in Semi Fowler
or Propped up position also reduce tracheal, bronchial or face edema.

CIRCUMFERENTIAL BURN- elevate the extremities above level of heart, to prevent DVT,
decrease the chance of edema in affected areas.

CLEFT LIP- Supine Position to protect the sutures. When feeding, hold upright.

CLEFT PALATE- Prone position to prevent any possible aspiration.

AIR EMBOLISM- Trendelenberg position with left lateral lying.

FAT EMBOLISM- Semi or High Fowler's position.

MASTECTOMY- Semi- Fowler's position.

PERINEAL or VAGINAL PROCEDURE- Lithotomy Position

THYROIDECTOMY/ HYPOPHYSECTOMY- Semi- Fowler's to prevent increase Intra Cranial

Pressure.

HEMORRHOIDECTOMY- Lateral side lying position.

GERD- Riverse trendelenberg position.

LIVER BIOPSY- Supine Position.

PARACENTESIS- Semi- Fowler's position

N/G FEEDING- High Fowler's position.

RECTAL ENEMA & IRRIGATION- Sims Position.

COPD or ASTHMA Sitting Position.

SEVERE RESPIRATORY DISTRESS- Orthopnic Position

LARYNGOSCOPY/ BRONCHOSCOPY- Semi- Fowler's position.

AMPUTATION OF LIMB- First 24 hours elevate foot of the bed, support the residual limb with a
pillow.

COVID PATIENT- Prone position at least 30-40 mins 2 hourly.

POSTURAL DRAINAGE
a. Each position holds for a 5 mins.
b. While in a postion inform the client to breathe in through nose and out through the mouth for a
longer.

# POSITIONS

ON BACK (TO DRAIN BOTTOM PART OF THE LUNG)- Chest should be lower than hips. Propping
up the hips by placing a pillow under hips. This position is best to clear the bottom front part of
the lungs.

ON STOMACH- Drape the body over a stack of pillows or other object. rest the arms by head,
with chest lower than the hips. This position is best for clearing mucus in the lower back area of
the lungs.

ON CLIENT RIGHT SIDE LYING- To clear the congestion from the front of the left lungs.

ON CLIENT LEFT SIDE- To clear the congestion from the right lungs.
NCLEX PHARMACOLOGY QUICK TIPS

•Administer Chlordiazepoxide(LIBRIUM) during alcohol withdrawal.

•ANTABUSE is given for alcohol deterrence. Do not take over the counter cough medicine.

•When taking HYPERTENSIVE MEDICATIONS, teach patient about orthostatic hypotension.

Patient must change positions slowly.

•Administer DIURETICS in the morning so patient doesn't constantly wake up to urinate.

•Do NOT give GRAPEFRUITS with: BUSPIRONE(Buspar), VERAPAMIL,

CARBAMAZEPINE(Tegretol), and SIMVASTATIN

• RIFAMPIN turns urination orange.

•DIGOXIN - Side effects are increased when the patient is hypokalemic. Monitor the potassium.
Digoxin has a negative chronotropic effect (slows the heart rate). Hold the dose if heart rate is
less than 60. Digitalis toxicity - bradycardia, tachycardia, dysthythmias, nausea, vomiting, and
headache. Contact physician as soon as possible.

•MAOIS - Do not give food with tyramine as it may cause hypertensive crisis.

•Do not give TETRACYCLINE at bed time. Do not let patients lie down because it might cause
gastric reflux.

•Do not give METFORMIN to someone having procedures with contrast dye. Metformin can
cause acute renal failure.

•Drawing INSULIN - (RN), Draw up regular before drawing up NPH.

•Never give POTASSIUM in IV push.

•When giving LOOP DIURETICS, watch for potassium depletion.

•DISULFIRAM is given to alcoholics to curb impulsive drinking.

•DOPAMINE treats cardiogenic shock.

•PROPRANOLOL is contraindicated in patients with bronchial asthma.

•ANTICHOLINERGIC effect - Won't be able to spit, pee, poop, or see.

•CARBAMAZEPINE is contraindicated within 14 days of MAOI administration.

•ANTICOAGULANT drugs - Monitor PTT for heparin and monitor platelet count, bleeding, and s/s
infection.

•SUCRALFATE - before meals.

•CIMETIDINE - with food.

•ANTACIDS - after meals.

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