NCLEX Tips

NCLEX is quite easy if you know what to study and you prepare really well for it. NCLEX is designed to pass the student rather than to fail them.

Its purpose is to test your understanding of what you already learned, it all boils down on what you know, and that’s why preparation is the sole most important factor of passing the test.

That’s why my advice is for you to read and read and read…

Unfortunately, memorization doesn’t work out that well in this case since if you’re going to memorize everything you will end up as one dazed and confused examinee.

Rather it is the way you prepare and approach the issue. Instead of memorizing those kilometric explanations and descriptions in the book, it will do you more good to take notes of what you deem are important in every topic/ system that you encounter in your review. Familiarization and repetition of critical concepts in Nursing will surely help you pass the exam.

Thus, making some flash cards will be of much help in this particular case.

Here are some topics that I found on the net which will help you in passing the NCLEX. Learn about them and they will make your life come examination day really easy.


* Types of Nosocomial Infections
* Principles of Surgical Asepsis
* Medical Testing and Labs
* TURP Procedure
* Romberg’s Test
* Lithotripsy Procedure
* Levels of Consciousness
* Mental Exam Basics
* Grading of Deep Tendon Reflexes
* Glascow Coma Scale
* Normative Values
* Methods of Oxygen Delivery
* Dementia and Delirium
* Types of Injections
* Ethical Duties of Nurses
* Patient Rights
* Bioethical Principles
* Changes Associated with Aging
* Drip Rate Calculations
* Barriers to Communication
* Nutrition and TPN
* Attributes of Nutrients
* Methods of Absorption
* Metabolism and Nutrition
* Medical Nutrition Therapy
* Cultural Aspects of Diets
* Placenta Previa
* Stages of Labor
* Assessing Fetal Lung Maturity
* Pathology of Eclampsia
* PMS and Menopause
* Attributes of Battered Women
* Apgar Scores
* Types of Cardiomyopathies
* Opportunistic Infections
* Classifications of Cancer
* Medical Nutritional Therapy
* Staging of Pressure Ulcers
* Disease Pathology
* Types of Shock
* Lipid Profile Labs
* Coagulation Studies
* CBC Components
* Acne Treatment Medications
* Phases of Adolescence
* Three Types of Jaundice
* Pain Assessment
* Lymphoma Characteristics
* Sexually Transmitted Diseases
* Tanner Staging
* Vaccinations and Immunizations
* Symptoms of Child Abuse
* Performing Newborn Assessments
* Motor Development
* Development of Language
* Pharmacology
* Types of Adrenergic Receptors
* Properties of Decongestants
* Classifications of Drugs
* Antipsychotic Classifications
* Drug Interactions
* Major Injection Sites
* Calcium Channel Blockers
* Phases of Burn Management
* Types of Burns
* Wound Healing Phases


Here's an example of what a flash card should look like (Click on the photo for a closer look)--

To TPA or not to TPA?

That is the question.




Tissue Plasminogen Activator or more commonly TPA is a genetically- engineered blood clot dissolver that was first used to prevent heart damage after a heart attack since the late 1980s and through the years have been one of the mainstays in the treatment of Stroke because of its ability to reduce the long- term disability that usually result from the disease.

TPA is usually given within three hours of a Stroke which is usually known in legal parlance as the “window- period” or “golden hour” to be effective and beyond that there‘s the clear and present danger of bleeding in the brain which is the TPA’s worst complication .

However recent findings by researchers and scientists in the medical field are now reconsidering that old belief and are now concluding that it is still safe to give TPA beyond the so- called “three- hour” window period.


Here's the news from the Associated Press- Study: Extending time of stroke drug treatment OK



And here's the article of the study from the New England Journal of Medicine - Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

Easy ECG

Even in the advent of modern diagnostic machines in the world of medicine, ECG or EKG remains the fastest and simplest way to look into the heart. It is still very useful especially in the Clinical or Emergency Room settings where a quick determination of the heart’s function is paramount especially in cases of Acute Myocardial Infarction or Heart Attack.

The Electrocardiogram can determine a heart block, enlarged heart muscles and rhythm disturbances. It also helps determine previous cases of heart attack. Thus, the ECG is a valuable tool because it helps diagnose irregularities and changes in the heart as well as to establish a baseline for subsequent ECGs.

Here are some videos that will help you further understand the concept and importance of the Electrocardiogram--








video credits:

Dr. Dean Keller and Dr. Melissa Stiles
University of Wisconsin School of Medicine and Public Health

Assessing Lung Sounds

Normal Breath Sounds
The correct sequence of auscultation of the posterior chest is shown in the picture below. The sequence is from the apex to the base of the lungs from one side to the other including the lateral areas of the lungs.

Credits: Dr. Pat O'Leary
David W. Woodruff, MSN, RN- BC, CNS, CEN

Gastric bypass anatomy leads to diabetes control

The Reuters article below which is about the relationship between gastric bypass and diabetes control further reinforce the phenomenon that many physicians are now encountering in their practice.

I have seen a lot of people who has diabetes and high levels of blood glucose but are now symptom- free after undergoing a gastric bypass. Now, this article will further explain the mechanism behind this new phenomenon.

So, read on…

NEW YORK (Reuters Health) - The rapid and substantial control of diabetes seen after gastric bypass surgery is due, at least in part, to the intestinal rearrangement involved in the procedure, the results of an animal study suggest.

Besides removing a substantial portion of the stomach, gastric bypass also attaches the output of the stomach to the lower intestines. The lower portion of the gut usually produces little glucose, but because of the direct input from the stomach it increases its production, French researchers report in the research journal Cell Metabolism.

The liver senses the higher level of glucose and reduces its own production of the sugar. Since the liver contributes much more to the body's overall glucose production than do the intestines, the net effect is enhanced glucose control, say Dr. Gilles Mithieux, from Universite de Lyon, and colleagues.

The increase in intestinal glucose formation was only noted with gastric bypass, not with gastric banding, which doesn't re-route the intestines. This may explain why only gastric bypass has been associated with enhanced diabetes control, the investigators conclude.

Furthermore, they note, sensors in the liver detect the elevated glucose and send an appetite-suppressing signal to the brain, which contributes to the satiety and weight loss seen with gastric bypass.

SOURCE: Cell Metabolism, September 3, 2008.

Urethral Catheterization

Urethral catheterization is a frequently performed bed side procedure; if done haphazardly it may lead to infection, particularly if the catheter is left for long periods.

Urethral catheterization is done usually with a balloon tip Foley Catheter of varying sizes (8 Fr* to 26 Fr). The balloon size for most of the applications is designed to hold little over 5 ccs of fluid. Larger Foley catheters with balloon capacity in excess of 30 ccs are available for specific urology purposes. For an average adult sizes 14 to 18 Fr catheters are usually utilized.

Indications for urethral catheterization:
1. Urinary retention (palpable, prominent urinary bladder)
2. To keep the patient dry and manageable when he is obtended or comatose
3. Management of incontinence of urine
4. To watch hourly urine output in intensive care situation.
5. As a part of urologic studies and also managing post operative status.
6. To obtain a catheterized specimen of urine for culture and sensitivity when specially required. (Spontaneously voided midstream specimen is good enough under majority of circumstances and it is rarely necessary to catheterize for diagnosis of UTI).

NOTE: Where there is obvious injury to urethra following trauma Foley catheterization should not be attempted before cystourethrogram is performed.

Procedure:

Although the procedure may vary minimally between male and female patients, the basic principles of aseptic precautions and positioning are essentially the same.
Preliminary hand wash and wearing of cap and mask recommended.

Patient should be in the supine position with legs slightly apart for the male and with legs apart and knees flexed for the female patient.

A preliminary soap and water wash to the external genitalia is desirable.
From this point all procedures are done with sterile gloves.

External preparation of genitalia is performed using betadine pain and sterile drapes are laid to provide adequate exposure to the external genitalia.

Appropriate catheter is picked up and the integrity of the balloon is checked by introducing 5 cc of water into the balloon and deflated.

The sterile catheter is lubricated adequately with sterile jelly lubricant.

Catheterization of the male patient:

The penis is held with the left hand away from the scrotum and holding the catheter firmly with the right hand the well lubricated catheter is gently passed through the external urethral meatus. This is gently and gradually advanced and under most circumstances it is passed through the urinary sphincter without any problem.

Occasionally some resistance may be encountered at the level of the sphincter due to prostatic hypertrophy. By gently advancing further through the sphincter this can be overcome to some extent and catheter can be passed into the bladder.

Occasionally a larger catheter or a “coude” type of catheter may be required to overcome this obstruction. When the catheter passes into the bladder, urine will be seen coming through the catheter. At this point, it is advanced by another 1 to 2 cms and the balloon is inflated with 5 cc or sterile water.

The Foley catheter after collecting specimens for urinalysis and culture is then connected to the Foley bag. Some physicians prefer to apply betadine ointment at the external urethral orifice. The Foley catheter may be stabilized to the medial aspect of one of the thighs using adhesive tapes. This prevents the Foley catheter advancing more towards the bladder thereby carrying infection and also prevents it from unnecessary movements causing discomforts.

Catheterization of the female patient:

In the female, the vulval outlet and labia are carefully washed and painted with betadine and appropriate sterile drapes are laid. With the left hand exposing the urethral meatus by separating the labia with the thumb and index fingers the external urethral meatus is identified and previously lubricated catheter is carefully and gently advanced through it into the bladder.

Care should be taken not to contaminate the catheter by touching the unprepared parts of the genitalia and the vagina. Once the catheter is well placed inside the bladder and the urine is seen coming out of the tube the balloon is distended with 5 cc of sterile water and catheter connected and fixed as described earlier.


Post Catheterization management has to be carefully planned to avoid infections. Except in selected patients, routine antibiotic administration is not necessary. Catheter care and change of catheters when necessary should be remembered. In a hospital set up, catheter induced nosocomial infections of the urinary tract are fairly common. When prolonged catheterization is required appropriate urological and where necessary neurological consultations are obtained to plan long term management of the catheter dependent patient. Ambulatory patients who have Foley catheters left in situ are given appropriate instructions and training in the care of the catheters and also plan periodical visits to the doctors and health care staff.

Note: Consider – use of silicon coated catheter for long-term placements

Credits: NurseReview.Org/ Medindia.net