MED SURG 245 {37 Page} Revised NCLEX Study Guide | MED SURG 245 NCLEX Study Guide_UPDATED

MED SURG 245 {37 Page} Revised NCLEX Study Guide Default Answers 1. Give meds either 1 hour before meal or 2 hours after meal 2. Give antacids 1 hour before med or 4 hours after med-after meals 3. When in doubt pick K (potassium) 4. 2 – 3 L of fluids 5. When in doubt pick answer that has you stay with patient 6. Anytime you see restless & ↓ level of consciousness = early sign always pick 7. Head of Bead → 30-45 degrees for any neuro patient 8. Elderly with acute onset confusion → UTI 9. Secretions will turn Orange/Red for meds 10. Anytime you have GI problem/exacerbation = NPO 11. All surgeries 1st 24 hrs – bleeding 48 hrs – infection 12. Check daily weights if it’s a fluid problem 13. Lateral position for maternity 14. Remove answer choices that are ‘absolutes’ position, prevent, promote Important Lab Values WBC 4K – 11K RBC 4 – 6 Hgb 12 – 16, 0r 12-18 Hct 36 – 48, or 37-52 Plt 150K – 400K BUN 8 – 20, or 7-22 Cr/Lithium 0.6 – 1.2 Urine Clearance 85 – 135, (GFR)=maintain above 60 Uric Acid 250 – 750 mg Na 135 – 145 Cl 98 – 106 Ca 8.5 – 10.5 K 3.5 – 5.0 PO 2.5 – 4.5g Mag 1.5 – 2.5, 4-7 if pregnant and receiving Toco Warfarin INR 2.0 – 3.5 Heparin PT 10 – 13 Seconds PTT 25 – 35 Seconds Therapeutic PTT: 1.5 – 2x the normal value (46 – 76 Seconds) Cholesterol Therapeutic Ranges Phenytoin Theophylline Acetaminophen 10 – 20 Digoxin 0.5 – 2.0 Albumin level 3.5 to 5.5 Acid-Base Balance From the ass (diarrhea) –Metabolic Acidosis From the mouth (vomitus) –Metabolic Alkalosis Potassium & Alkalosis – ALKALOSIS: K is LOW – Acidosis is just the opposite: K is High Arterial Blood Gases 1. Prior to drawing an ABG, perform the Allen’s Test to check for sufficient blood flow 2. When drawing an ABG, the blood needs to be put in a heparinized tube. ● Ensuring there are no bubbles. 3. Put on ice immediately after drawing, with a label. ● The label should indicate if the pt was on room air, or how many liters of O2. General Notes ● The person who hyperventilates is most likely to experience respiratory alkalosis. Antidotes ● Aspirin → Activated Charcoal ● Coumadin (Warfarin) → Vitamin K ● Heparin → Protamine Sulfate ● Tylenol (Acetaminophen) → Mucomyst (acetylcysteine) – administered orally ● Digoxin (Lanoxin) → Digibind (immune Fab) ● Opioids → Narcan ● Iron overdose → Deferoxamine ● PCP → Activated charcoal ● Magnesium Sulfate → Calcium Gluconate For blood types: ● "O" is the universal donor (remember "o" in donor) ● "AB" is the universal recipient Blood transfusion – sign of allergies in order: 1)Flank pain 2)Frequent swallowing 3)Rashes Blood 4)Fever 5)Chills Thrombocytopenia – Bleeding precautions! 1)Soft bristled toothbrush 2) No insertion of anything! (c/i suppositories, douche) 3)No IM meds as much as possible! Sickle Cell Anemia During sickle cell crisis there are two interventions to prioritize: fluids and pain relief. Iron deficiency anemia – easily fatigued 1) Fe PO (Iron) - give with Vitamin C or on an empty stomach 2)Fe via IM- Interferon via Z Track -- Peds: Kids are at risk for iron deficiency anemia if they ingest too much milk; 24oz/ day. Pernicious Anemia - s/s include pallor, tachycardia, and Sore Red, Beefy tongue; will take Vit.B12 for life! Shilling Test – test for pernicious anemia/ how well one absorbs Vit b12 General Notes ● A patient with a low hemoglobin and/or hematocrit should be evaluated for signs of bleeding, such as dark stools. The Number #1 Priority for Burn Patients is maintaining a patent airway 1st Degree – Red and Painful 2nd Degree – Blisters 3rd Degree – No Pain because of blocked and burned nerves Cancer A cancer patient is getting radiation. What should the nurse be most concerned about? ● Skin irritation? No. ● Infection kills cancer patients most because of the leukopenia caused by radiation. General Notes ● A breast cancer patient treated with Tamoxifen should report changes in visual acuity, because the adverse effect could be irreversible. ● Common sites for metastasis include the liver, brain, lung, bone, and lymph. ● Bence Jones protein in the urine confirms multiple myeloma (cancer of plasma cells) ● Patients with leukemia may have epistaxis (nosebleeds) b/c of low platelets - - - - Continued