NCLEX-PN High-Yield Study Guide: Master Essential
consepts Pass Your Exam on the First Attempt and
Avoid Resits
the brain---> anxious patient/change in LOC QRST -
ANSWER//- AV node - ventricle - controlled by
potassium P wave - ANSWER//- SA node - atrial
depolarization - calcium calculation of HR on ECG
estimation - ANSWER//measure big boxes between R-R
300/# of big boxes between R-R normal sinus rhythm -
ANSWER//heart rhythm originating in the sinoatrial
node with a rate in patients at rest of 60 to 100 beats
per minute sinus bradycardia - ANSWER//<60 normal
sinus rhythm *give atropine* (don't give to pt with
glaucoma) sinus tachycardia - ANSWER//>100 (100-150)
normal sinus rhythm *caused by:* - excessive caffeine -
anxiety - dehydration - hyperthyroidism *give beta
blockers, be aware of bronchoconstriction and
bronchospasm, contraindicated in asthma* atrial
fibrillation - ANSWER//- SA node not firing properly -
absence of P wave, quivering P wave - AV node fires
irregularly because its waiting for SA node to work -
*worried about clots* - calcium channel blockers work
for a-fib because the atrium uses calcium to work
(diltiazem, verapamil) INR & warfarin - ANSWER//want it
to be 2-3x the normal value except for when there is a
valve replacement heparin & warfarin homegoing -
ANSWER//- don't go home on this, usually gradually
introduce warfarin simultaneously so that they can go
home on it instead (called *bridging*) - wait for INR to
,get to 2-3, then d/c heparin and continue warfarin
potassium sparing diuretics and cardio -
ANSWER//*aldosterone antagonists* *examples* -
spironolactone - eplerinone aldosterone increases
sodium--->decreases potassium leads to decreased
sodium and water, keeps potassium same ACE inhibitors
pneumonic - ANSWER//ACE-I Angioedema Cough Excess
K+ Instead, ARB's (still increased K+) ACEs and ARBs are
both - ANSWER//Teratogens agents, such as chemicals
and viruses, that can reach the embryo or fetus during
prenatal development and cause harm priority *what
am I freaking out about?? ASK GRAPH* - ANSWER//A-
airway S- sepsis K- potassium G- glucose below 70 R-
child with lethargy A- altered mental status suddenly P-
peritonitis H- hemorrhage cushings vs addisons -
ANSWER//Cushing is gushing cortisol. Addison's
patient's cortisol doesn't add up. cushing's syndrome -
ANSWER//*A*- increased appetite *B*- increased blood
pressure *I*- increased insulin resistance *G*- increased
gluconeogenesis *F*- decreased fibroblasts (healing
factors)-->striae *I*- decreased inflammatory
process/immune system *B*- decreased bone formation
(osteoblasts) *physical symptoms* - buffalo hump -
moon face - abdominal striae - hirsutism ("hairy suit-
ism") - weight gain - truncal obesity causes of cushing's
disease - ANSWER//- steroids (long term therapy -
tumor (pituitary, adrenal) - small cell lung cancer
treatment for cushings - ANSWER//cut out tumor or
steroids (slowly decrease) cortisol increased by ______ -
ANSWER//4 S's Surgery Stress Sepsis Strenuous activity
adrenal gland monitors ________ - ANSWER//salt:
,regulates aldosterone sugar: cortisol sex: sex and hair
*all increased in cushings, all decreased in addison's*
addison's disease - ANSWER//occurs when the adrenal
glands do not produce enough of the hormones cortisol
or aldosterone *aldosterone knocked out:* - low salt
and water---> low BP - increased potassium---
>*hyperkalemia* *cortisol knocked out:* - increased
ACTH---> increased melanin production (bronze skin,
*hyperpigmentation*) *androgens knocked out:* -
decreased libido - low sex drive - erectile dysfunction -
infertility *nursing considerations* - monitor Na and
H20 - monitor fluid volume - give them cortisol - give
them estrogen and testosterone (*these thicken the
blood and makes person hyper-coagulable, monitor for
clots to prevent DVTs and PE*) increased estrogen
caused by: - birth control - obesity - patient taking
tamoxifin causes of addison's disease - ANSWER//A-
autoimmune (body kills adrenals or pituitary D- diseases
(cancer, infections (TB/HIV) D- damage (adrenal
hemorrhage, trauma) most common cause of addison's
disease - ANSWER//tuberculosis *treat with RIPE* *R*-
Rifampin (red expected) *I*- Isoniazid (this is very
hepatotoxic) *P*- Pyozinimide *E*- Ethambutol (E for
eye, look for vision issues like diplopia, blurred vision)
addison's treatment - ANSWER//- add "-sones" - diet
high in protein, carbs, sodium - dont abruptly stop
steroids - dont believe this medication will cure you -
*lifelong hormone replacement* cushings sydrome -
ANSWER//increased cortisol - primary tumor (high
cortisol, low ACTH) - secondary tumor (high ACTH, high
cortisol) - exogenous (high cortisol, low ACTH) infant
, growth - ANSWER//- rapid growth - birth *weight*
should *double by 6 months* and *triple by 12 months*
*fontanelles* - *posterior closes first* - between 1 and
2 months - anterior closes between 9 and 18 months
infant gross motor skills - ANSWER//- *sitting up without
support*: 6-8 months - *rolling over*: 6 months -
*standing without support*: 10-12 months - *first
steps*: 12 months infant fine motor skills - ANSWER//-
*palmar grasp*: 6 months - *pincer grasp*: 9 months -
*brings objects to mouth*: 4 months - *transfers objects
from hand to hand*: 6-8 months infant language -
ANSWER//- *first words*: 12 months - can understand
"no": 11 months - *following simple directions*: 12
months infant psychosocial development - ANSWER//-
*trust vs mistrust* - sensorimotor ("taking it all in") -
*social smile*: 6-8 weeks - *object permanence*: 9
months - *stranger anxiety*: 9 months therapeutic
communication with infants - ANSWER//- speak in a soft
voice - warm hands before touching baby *always
involve caregivers* - explain everything you are doing to
them - have them hold infant - parents are your best
team member. they know how to keep their child happy
and calm.. it is hard to assess a screaming baby! toddler
growth - ANSWER//ages 1 to 3 years old - growth slows -
language develops quickly - height increases by 3 inches
per year - weight increases by 4-6 pounds per year -
head does not grow as rapidly as the body; *head
circumference should equal chest circumference by 1-2
years* - anterior fontanelle closes between 9 and 18
months toddler fine and gross motor development -
ANSWER//should be able to: - hold crayons or pencils to
consepts Pass Your Exam on the First Attempt and
Avoid Resits
the brain---> anxious patient/change in LOC QRST -
ANSWER//- AV node - ventricle - controlled by
potassium P wave - ANSWER//- SA node - atrial
depolarization - calcium calculation of HR on ECG
estimation - ANSWER//measure big boxes between R-R
300/# of big boxes between R-R normal sinus rhythm -
ANSWER//heart rhythm originating in the sinoatrial
node with a rate in patients at rest of 60 to 100 beats
per minute sinus bradycardia - ANSWER//<60 normal
sinus rhythm *give atropine* (don't give to pt with
glaucoma) sinus tachycardia - ANSWER//>100 (100-150)
normal sinus rhythm *caused by:* - excessive caffeine -
anxiety - dehydration - hyperthyroidism *give beta
blockers, be aware of bronchoconstriction and
bronchospasm, contraindicated in asthma* atrial
fibrillation - ANSWER//- SA node not firing properly -
absence of P wave, quivering P wave - AV node fires
irregularly because its waiting for SA node to work -
*worried about clots* - calcium channel blockers work
for a-fib because the atrium uses calcium to work
(diltiazem, verapamil) INR & warfarin - ANSWER//want it
to be 2-3x the normal value except for when there is a
valve replacement heparin & warfarin homegoing -
ANSWER//- don't go home on this, usually gradually
introduce warfarin simultaneously so that they can go
home on it instead (called *bridging*) - wait for INR to
,get to 2-3, then d/c heparin and continue warfarin
potassium sparing diuretics and cardio -
ANSWER//*aldosterone antagonists* *examples* -
spironolactone - eplerinone aldosterone increases
sodium--->decreases potassium leads to decreased
sodium and water, keeps potassium same ACE inhibitors
pneumonic - ANSWER//ACE-I Angioedema Cough Excess
K+ Instead, ARB's (still increased K+) ACEs and ARBs are
both - ANSWER//Teratogens agents, such as chemicals
and viruses, that can reach the embryo or fetus during
prenatal development and cause harm priority *what
am I freaking out about?? ASK GRAPH* - ANSWER//A-
airway S- sepsis K- potassium G- glucose below 70 R-
child with lethargy A- altered mental status suddenly P-
peritonitis H- hemorrhage cushings vs addisons -
ANSWER//Cushing is gushing cortisol. Addison's
patient's cortisol doesn't add up. cushing's syndrome -
ANSWER//*A*- increased appetite *B*- increased blood
pressure *I*- increased insulin resistance *G*- increased
gluconeogenesis *F*- decreased fibroblasts (healing
factors)-->striae *I*- decreased inflammatory
process/immune system *B*- decreased bone formation
(osteoblasts) *physical symptoms* - buffalo hump -
moon face - abdominal striae - hirsutism ("hairy suit-
ism") - weight gain - truncal obesity causes of cushing's
disease - ANSWER//- steroids (long term therapy -
tumor (pituitary, adrenal) - small cell lung cancer
treatment for cushings - ANSWER//cut out tumor or
steroids (slowly decrease) cortisol increased by ______ -
ANSWER//4 S's Surgery Stress Sepsis Strenuous activity
adrenal gland monitors ________ - ANSWER//salt:
,regulates aldosterone sugar: cortisol sex: sex and hair
*all increased in cushings, all decreased in addison's*
addison's disease - ANSWER//occurs when the adrenal
glands do not produce enough of the hormones cortisol
or aldosterone *aldosterone knocked out:* - low salt
and water---> low BP - increased potassium---
>*hyperkalemia* *cortisol knocked out:* - increased
ACTH---> increased melanin production (bronze skin,
*hyperpigmentation*) *androgens knocked out:* -
decreased libido - low sex drive - erectile dysfunction -
infertility *nursing considerations* - monitor Na and
H20 - monitor fluid volume - give them cortisol - give
them estrogen and testosterone (*these thicken the
blood and makes person hyper-coagulable, monitor for
clots to prevent DVTs and PE*) increased estrogen
caused by: - birth control - obesity - patient taking
tamoxifin causes of addison's disease - ANSWER//A-
autoimmune (body kills adrenals or pituitary D- diseases
(cancer, infections (TB/HIV) D- damage (adrenal
hemorrhage, trauma) most common cause of addison's
disease - ANSWER//tuberculosis *treat with RIPE* *R*-
Rifampin (red expected) *I*- Isoniazid (this is very
hepatotoxic) *P*- Pyozinimide *E*- Ethambutol (E for
eye, look for vision issues like diplopia, blurred vision)
addison's treatment - ANSWER//- add "-sones" - diet
high in protein, carbs, sodium - dont abruptly stop
steroids - dont believe this medication will cure you -
*lifelong hormone replacement* cushings sydrome -
ANSWER//increased cortisol - primary tumor (high
cortisol, low ACTH) - secondary tumor (high ACTH, high
cortisol) - exogenous (high cortisol, low ACTH) infant
, growth - ANSWER//- rapid growth - birth *weight*
should *double by 6 months* and *triple by 12 months*
*fontanelles* - *posterior closes first* - between 1 and
2 months - anterior closes between 9 and 18 months
infant gross motor skills - ANSWER//- *sitting up without
support*: 6-8 months - *rolling over*: 6 months -
*standing without support*: 10-12 months - *first
steps*: 12 months infant fine motor skills - ANSWER//-
*palmar grasp*: 6 months - *pincer grasp*: 9 months -
*brings objects to mouth*: 4 months - *transfers objects
from hand to hand*: 6-8 months infant language -
ANSWER//- *first words*: 12 months - can understand
"no": 11 months - *following simple directions*: 12
months infant psychosocial development - ANSWER//-
*trust vs mistrust* - sensorimotor ("taking it all in") -
*social smile*: 6-8 weeks - *object permanence*: 9
months - *stranger anxiety*: 9 months therapeutic
communication with infants - ANSWER//- speak in a soft
voice - warm hands before touching baby *always
involve caregivers* - explain everything you are doing to
them - have them hold infant - parents are your best
team member. they know how to keep their child happy
and calm.. it is hard to assess a screaming baby! toddler
growth - ANSWER//ages 1 to 3 years old - growth slows -
language develops quickly - height increases by 3 inches
per year - weight increases by 4-6 pounds per year -
head does not grow as rapidly as the body; *head
circumference should equal chest circumference by 1-2
years* - anterior fontanelle closes between 9 and 18
months toddler fine and gross motor development -
ANSWER//should be able to: - hold crayons or pencils to
