NCLEX Review: Gastrointestinal and Accessory Organs of Digestion Module

Welcome to the Gastrointestinal NCLEX Review from BrainyNurses.com!

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This week, we will be covering the Gastrointestinal and Accessory Organs of Digestion Module from our Online NCLEX Review. The topics covered in the Gastrointestinal NCLEX Review are Gastrointestinal Pharmacology, Upper GI Series Diagnostic Test, Diverticulitis, and Gastroesophageal Reflux Disease.

Gastrointestinal NCLEX Review Preview Video

Straight from our full course to you!!

Gastrointestinal Pharmacology

The main pharmacology classifications that the nursing student needs to know for the Gastrointestinal NCLEX Review are:

• Antacids neutralize acid and have a protective action on the stomach.
• H-2 blockers reduce acid in the stomach by blocking the acid producing cells.
• Proton pump inhibitors prevent the acid producing pump from working in the stomach. Results in a cessation of all acid production.
• Antiemetics block the chemicals and the pathways to the brain which cause nausea.  Safety a priority consideration with administration.
• Antiflatulents are used as a defoaming agent to help with gas symptoms.
• Anticholinergics are used for irritable bowel symptoms.
• Antidiarrheal: Adsorbents coat the intestinal wall and bind with causative bacteria and toxins to eliminate them from the gastrointestinal tract through the stool.
• Laxatives: Numerous mechanisms of action including adding bulk to the stool, increasing liquid in the stool, providing lubrication or stimulation of the nerves resulting in increased peristalsis.

Upper GI Series Diagnostic Test

The Upper GI Series diagnostic test is an examination of the upper gastrointestinal tract. Series of x-ray images to follow the contrast through the esophagus, stomach and duodenum. May be done with Barium or Gastrografin.

It may be used for diagnosis of Gastroesophageal reflux disease (GERD) and hiatal hernia:

This disorder is the regurgitation of acid into the esophagus. May be due to weakening of the lower esophageal sphincter and/or because the upper part of the stomach has herniated through the diaphragm.

Some facts about the test:

• Takes 5-6 hours to complete.
• Clear liquid diet after supper the evening before the exam
• NPO after midnight.
• Enemas and laxatives are not given in preparation for the procedure.
• Laxative or enema post-procedure if barium is used.
• Barium takes 14 days to clear the colon.
• Gastrografin may cause diarrhea.

Diverticulitis

Diverticulitis is the inflammation of the pouches leading to pain and potentially perforation of the bowel.

Assessment

• Nausea, vomiting
• Low grade fever
• Palpable mass
• Distention
• Constipation alternating with frequent stools.
• Most cases are asymptomatic or present with mild complaints.
• Rectal bleeding may be present on diagnosis or develop later.
• Pain is constant or cramping and ranges from mild to severe.
• If perforation, pain is generalized.

Diagnostics

• Flat plate of the abdomen
• Colonoscopy
• Barium enema
• Stool for occult blood

Drug therapy includes antibiotics, opioids, stool softeners and bulk forming laxatives

Gastroesophageal Reflux Disease

We talked earlier about the Upper GI Series Test and how it is used to test for Gastroesophageal Reflux Disease.

Management of Gastroesophageal Reflux Disease

• Avoid tight, restrictive clothing
• No bending over after meals
• Avoid straining for bowel movements
• Upright position for 30-60 minutes after eating
• Put the bed on 4-6 inch blocks to decrease tracheal aspiration

Dietary Do’s and Dont’s

Do:

• Small frequent meals
• High protein
• Low fat
• Moderate to high carbohydrate
• Increase fluids with meals

Don’t:

• No large meals
• No eating within 3 hours of HS
• No caffeine
• No fruit juices except apple
• No tomatoes

 

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NCLEX Review: Neurological Module

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This week, we will be covering the Neurological NCLEX Review from our Online Program. The topics covered in this review are Brain Physiology, The Cranial Nerves, Spinal Cord Syndromes, and Guillain-Barré.

Neurological NCLEX Review Sample Video

Straight from our course!

Brain Physiology

• Frontal lobe
  • Voluntary motor movement
  • Compare left and right for symmetry
  • Morals and emotions
  • Reasoning, judgment and concentration
  • Brocca’s area for motor speech (Left side)

• Parietal lobe
  • Spatial perception
  • Interpretation of senses
  • Language, reading and writing

• Temporal lobe
  • Auditory center and smell
  • Wernicke’s area for sensory and speech comprehension (Left side)

• Occipital lobe
  • Visual area

• Cerebellum
  • Balance, coordination and smooth movements
  • Gait assessment. Walk normally and then on heels and toes

• Limbic system
  • Emotional and visceral patterns for survival
  • Learning and memory

The Cranial Nerves

Cranial Nerves come off the brain stem

1. Olfactory
2. Optic
3. Oculomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Acoustic
9. Glossopharyngeal
10. Vagus
11. Spinal Accessory
12. Hypoglossal

“You have 1 nose and 2 eyes and CN 3, 4, and 6 make your eyes do tricks.”
“5 rhymes with Tri (Trigeminal nerve) and 7 is on your face.”
“8 is the shape of your earrings and 9 and 10 are under your chin.”
“11 with 1 on each shoulder to shrug them and 12 to stick out your tongue.”

For testing

• Oculomotor (CN III) for pupil reactions
• Trigeminal (CN V) affected in trigeminal neuralgia
• Facial (CN VII) used to smile
• Vagus (CN X) is parasympathetic activity
• Hypoglossal (CN XII) to stick out your tongue

 

Spinal Cord Syndromes

Cord Syndromes

• Central cord syndrome
  • Most common.
  • Cervical injury from hyperextension injury.
  • Greater motor loss in the upper extremities.
  • Loss of sensation below the level of injury is variable.
• Anterior cord syndrome
  • Flexion injury such as a violent impact to the back of the head.
  • Lose motor, pain and temperature sensation.
• Posterior cord
  • Extension injury such as a violent impact to the chin.
  • Lose proprioception, vibration, and light touch.
• Brown-Séquard
  • Penetrating or rotation-flexion injury.
  • Lose motor, proprioception, pressure, touch and vibration.
  • Lose ability to sweat on the site of the injury
  • Horner’s syndrome may occur. Ptosis and pupillary constriction.

Guillain-Barré

Guillain-Barré:  Acute disorder affecting the peripheral nervous system including the cranial nerves. Damages the myelin sheath and disrupts nerve conduction. Remyelinization occurs in opposite direction. Generally affects patients age 30-50 years.

Ascending paralysis from “ground to brain” (Guillain-Barré).  Initial symptoms will be seen and can lead to total paralysis, respiratory failure and the need for ventilator support.

Assessment

• Paresthesia and pain
• Muscle aches and cramping
• Night time pain
• Diplopia
• Difficulty with eye movements
• Difficulty speaking
• Dysphagia

Autonomic dysfunction

• Orthostatic hypotension
• Hypertension
• Changes in heart rate/bradycardia
• Deep vein thrombosis
• Bowel and bladder dysfunction
• Flushing
• Diaphoresis

Thanks for taking the time to read this article on Neurological NCLEX Review from “The Pearls for NCLEX Review”. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest to make personalized NCLEX review boards!

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Musculoskeletal NCLEX Review: Musculoskeletal and Connective Tissue Module

Welcome to this weeks article from BrainyNurses.com, Musculoskeletal NCLEX Review. We love bringing you information for your NCLEX review and nursing education!

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This week, we will be covering the Musculoskeletal and Connective Tissue Module from our Online NCLEX Review. The topics covered in this review are Corticosteroids, Muscle Spasms, Herniated Disk, and Traction Principles.

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Side Effects from Corticosteroids

Corticosteroids decrease the amount of swelling in the joints and are used in rheumatoid arthritis, bursitis, and tendonitis.

The side effects are shown in the flashcard below and include:

• Muscle weakness
• Osteoporosis
• Immunosuppression
• Polyuria
• Polydipsia
• Abnormal fat distribution
• Growth retardation in children
• Weight gain
• Mood swings such as depression
• Edema

Select medications for corticosteroids include:

• Betamethasone (Celestone)
• Cortisone (Cortone)
• Hydrocortisone (Solu-Cortef)
• Methylprednisolone (Medrol)
• Nabumetone
• Prednisone (Deltasone)

Muscle Spams and Muscle Spasticity

Muscle spasms are sudden, involuntary, painful muscle contractions which may occur after injury

Muscle spasticity is an increase in muscle tone which produces stiff muscle movements, which may occur with many disorders

Assessment of these disorders is as follows:

• Bruising
• Edema
• Joint swelling
• Inflammation

Use this flashcard to help you remember the management of muscle spasms and muscle spasticity. When in doubt, think of the P-R-I-C-E for musculoskeletal injuries.

• Protect
• Rest
• Ice
• Compression
• Elevation

Herniated Disk

Herniated disk is a condition when all or part of the soft center of a spinal disk is forced through a weakened part.

Assessment

• Numbness or tingling
• Muscle weakness
• Problems with bowel or bladder control

Pain characteristics

• Unilateral. Sudden or gradual. Constant or intermittent
• Worsened by sitting, prolonged standing, bending or twisting motions, sneezing, coughing or straining with defecation

A Myelogram may be used for diagnosis

Traction

Traction may be used after a fracture. May be a temporary measure until surgical repair can take place. Therapeutic benefits of traction:

• Reduces the fracture
• Lessens muscle spasms
• Relieves pain
• Corrects deformities
• Promotes rest
• Allows for exercise

Skin traction uses tape, boots and splints.

Skeletal traction uses pins and wire inserted into bones or joints. Uses balanced suspension to immobilize the body part.

Traction principles

T = Temperature of the extremity and oral to monitor for infection.

R = Ropes hang freely.

A = Alignment of the extremity, checks the set up, and assess for swelling.

C = Circulation checks for the 6 Ps.

T = Trapeze is frequently part of the traction.

I = Increase fluid intake. Address nutritional concerns such as increased roughage. Fluids and dietary prevent complications such as constipation, UTI and renal calculi.

O = Overhead trapeze to increase independence and muscle strength. Do exercises to maintain muscle tone, endurance and prevent bone demineralization.

N = No weights on the bed or the floor. Do not release once established.

For more information on Buck’s Traction, Russell’s Traction, Bryant’s Traction, and other types or Traction, you need to see purchase the textbook, which comes with the online NCLEX Review.

Thanks for taking the time to read this article on the Musculoskeletal and Connective Tissue Module from our online NCLEX review. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest to create personalized NCLEX review boards!

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Acid Base NCLEX Review

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This week, we will be covering the Acid Base Module from our Online NCLEX Review. The topics covered in this review are Acid Base Physiology, Acid Base Interpretation, and Acid Base Imbalances.

Acid Base Physiology

The priorities for Acid Base are Assessment and Management

Assessment parameters to detect acid base imbalances

• Vital signs
• Level of consciousness
• Respiratory effort
• Lung sounds

Management treats cause of the problem and the imbalance

• IV fluid
• Medications
• Respiratory interventions

The flashcard above shows acid base physiology. One area that is not covered in detail here, though, is the effects on potassium.

1. Hydrogen and potassium will always exchange for each other in the cell.
2. When the patient becomes acidotic, some of the hydrogen moves into the cell and pushes the potassium out.
3. As acidosis is corrected, or when the patient is in alkalosis, the hydrogen will move out of the cell and potassium will move back in.

 

Acid Base Interpretation

An easy way for you to remember acid base interpretation during your NCLEX is to use the acronym ROME.

R = Respiratory

pH ↑ PCO2 ↓ = Respiratory alkalosis

O = Opposite

pH ↓ PCO2 ↑ = Respiratory acidosis

M = Metabolic

pH ↑  HCO3 ↑ = Metabolic alkalosis

E = Equal

pH ↓  HCO3 ↓ = Metabolic acidosis

You can also remember the “Quick and dirty” rule: If the pH and Bicarbonate are Both in the same direction, then it is a metabolic problem.

For more information, check out this video.

 

Acid Base Imbalances

So, let’s conclude with a sample question that you can expect during your NCLEX Exam.

Pause here (Don’t cheat!!) and read this slide before scrolling down to get the answer.

 

 

Got your answer? Read the slide below for the answer and explanation.

Metabolic acidosis is increased production of H+ by the body or the inability to form bicarbonate (HCO3) in the kidneys.

Metabolic Acidosis Assessment:

• ↑ Respiratory rate (Kussmaul’s)
• ↑ Potassium
• ↓ Blood pressure
• ↓ LOC and disorientation
• Headache

Potential causes are:

• Infection
• Diarrhea
• Renal failure
• Malnutrition
• Diabetic ketoacidosis
• Late shock
• Aspirin overdose

The nurse should treat the cause and may need to give bicarbonate in some situations.

 

Thanks for taking the time to read this article on the Acid Base Module from our online NCLEX review. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest for your personalized NCLEX review boards!

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NCLEX Review: Renal and Urological Module

This week, lets take some time to go over some of the material that we cover in the Renal and Urological Module of “The Pearl for NCLEX Review”.

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The topics covered in this article are Urological Pharmacology, Acute Renal Failure, Evaluating Dialysis Candidates, and Catheters.

Urological Pharmacology

There are five classifications of pharmacology that are covered in this section.

1. Diuretics cause the kidneys to remove more sodium and water from the body, which helps to relax the blood vessel walls, thereby lowering blood pressure.
2. Cholinergic agents help the bladder to contract when the muscle has lost its tone such as in patients with flaccid neurogenic bladder or some types of incontinence. They usually work within one hour after oral administration.
3. Anticholinergic agents cause the bladder to relax and fill. They also help the patient to contract the external urethral sphincter on command and regain control of continence. Can be used for spastic bladder conditions. They usually work within one hour after oral administration.
4. Antispasmodics prevent bladder spasms which can be very painful and lead to incontinence.
5. Phosphate binders are used in renal failure to bind phosphate in the gastrointestinal tract so the body cannot absorb it.

Below is a flashcard showing which diuretics are potassium wasters, one of the sample questions that is covered during our NCLEX Review.

Acute Renal Failure

Acute renal failure (ARF) is a sudden and almost complete loss of the function of the kidneys over a short period of time. Various types and phases are discussed in this section.

Types of ARF:

Pre-renal

• Caused by decreased blood flow to the kidneys
• Urine output falls and the kidneys are unable to excrete waste products effectively
• BUN to creatinine ratio > 15:1
• Causes include severe dehydration, diuretic therapy, hypovolemia and shock

Intra-renal

• Damage to the kidneys
• Lose the ability to concentrate urine and excrete waste products
• BUN to creatinine ratio 10:1
• Caused by a disease process, ischemia, toxic chemicals or severe infection
• Iatrogenic causes include antibiotics and contrast dyes

Post-renal

• Obstruction to urine flow
• Leads to the inability to excrete waste products and hydronephrosis
• Causes include benign prostatic hypertrophy, renal calculi or tumors

Phases of acute renal failure:

Initiation phase

• Oliguric or non-oliguric depending on the cause

Maintenance phase

• Diuretic phase
• May put out up to 10 liters of urine a day

Recovery phase

• Renal function returns to normal
• Could take up to one year

 

Evaluating Dialysis Candidates

Peritoneal dialysis is less expensive and easier to train for home use than hemodialysis. It is better for patients with cardiovascular instability.

Insufficient outflow may occur during the procedure.

• Evaluate for catheter obstruction from clots or kinking
• Ask if a recent history of constipation
• Reposition patient and ambulate if able

Hemodialysis: Short term access is accomplished by the insertion of a catheter with two lumens which allows the blood to be withdrawn, cleansed and then returned.

AV fistula is a joining of an artery and a vein. Two needles are inserted during a treatment.  This is the preferred method of long term dialysis.

• You can “feel the thrill and hear the bruit” of the fistula
• Monitor for arterial steal syndrome where too much blood is diverted to the vein and perfusion is compromised
• Need to protect the site. Don’t use the arm for any other procedures such as BP or venipuncture
• Avoid any pressure to arm. Don’t sleep on the side of fistula or carry heavy objects
• No jewelry or constrictive clothing

Use the below flashcard and this YouTube Video to remember the considerations for dialysis candidates. When in doubt, stick with the vowels!

Catheters

Our founder Cindy Liette has over 35 years experience in nursing and provides you with expert tips and tricks that she has learned throughout her career.

The flashcard below is one of the hundreds of tips provided throughout the course!

Thanks for taking the time to read this article on the renal and urological module for NCLEX review. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest for your personalized NCLEX review boards!

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Thank you again and have a great day!

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Male and Female NCLEX Review

This week, we will cover the Male and Female NCLEX Review from our full course, which uses our textbook, slideshow, and video to make sure that you know all you need for the NCLEX.

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The topics covered during this Male Female NCLEX Review are the Male and Female Pharmacology, Prostatitis, Sexually Transmitted Infections, and Contraceptives.

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Brainy Nurses has helped thousands of nurses achieve their goals and dreams through our NCLEX Review. Below you will find a small sample of our celebrated course, which has proven to be successful for thousands of nurses.

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Male and Female Pharmacology

Female reproductive hormones are administered to treat hormone deficiencies in the female or to prevent pregnancy.

The most serious complications of estrogen replacement therapy are listed below:

• Deep vein thrombosis
• Acute myocardial infarction
• Breast and Endometrial Cancer

Anti-androgens and androgen hormone inhibitors are used to treat BPH and prostate cancer and have the following side effects:

• Gynecomastia
• Impotence
• Pain in the testicles
• Angioedema
• Alopecia
• Gastrointestinal disturbances
• Fluid and electrolyte imbalances

Prostatitis

Prostatitis is the inflammation of the prostate gland which can be acute or chronic. Below is a flashcard to help with remember the key factors to assessment. There are two types, bacterial and non-bacterial.

Bacterial Prostatitis

• Originates from the urinary tract, blood or lymph nodes
• E coli is the most common organism cultured

Non-bacterial type

• Most common type
• Cause is unknown and cultures are negative
• Spasms of the urethra may lead to the symptoms experienced by the patient
• Symptoms present but cause is unknown and cultures are negative
• May be known as prostatodynia

Sexually Transmitted Diseases

Sexually transmitted infections (STIs): More than 21 diseases are classified as STIs. They can be caused by bacteria, viruses, protozoans, fungi, and ectoparasites.

There are many different options for treatment, including:

• Many treated with antibiotics with follow up after completion
• Also treat sexual contacts within previous 60 days
• Ideally, avoid intercourse during treatment
• Condoms to prevent spread of infection
• Lesion care may include soaking in a tub two to three times a day.  Keep lesions dry in between
• Wear loose clothing, cotton lined panties, and no pantyhose
• Avoid alcohol because it interrupts healing process, especially of the urethra
• All information confidential even if a minor

Below is a flashcard to help you remember screening and prevention principles that you will be tested on for the NCLEX.

Contraceptives Pharmacology

All medications are classified as pregnancy X and should be stopped one week prior to surgery.  Patients should not smoke while on estrogen replacement therapy. Below is a list of all the possible medications.

Some side effects that have been observed are:

• Headache
• Dizziness
• Nausea
• Weight gain
• Hypertension
• Impotence
• Aggression
• Depression
• Breast pain
• Breakthrough bleeding
• Testicular atrophy
• Contact lens intolerance

We hope that you have gotten a lot of useful information from the Male Female NCLEX Review that will help you in your NCLEX preparation and to improve your capabilities as a nurse. Thank you for helping us to spread the word of the Online NCLEX Review from BrainyNurses.com, and we hope that you stay with us after becoming certified for your continuing education needs.

To be notified of new blog posts and receive additional free flashcards, click the button below and provide us your email address! We promise not to sell your personal information or flood your inbox with emails every day. On average, we only send out one email every week.

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To be notified of new blog posts and receive additional free flashcards, click the button above and provide us your email address! We promise not to sell your personal information or flood your inbox with emails every day. On average, we only send out one email every week!

If you have any feedback please send us an email.

Just want the textbook? Get it immediately here.

Please check out our website to learn more about our Online NCLEX Review, 12 Lead ECG Course, Advanced Assessment Course, Digital Flashcards, and other great products.

Thank you again and have a great day!

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Cardiovascular System NCLEX Review

Welcome back to the Brain Nurses weekly NCLEX blog providing a needed tips from our comprehensive Cardiovascular System NCLEX review to help you prepare for your examination! Thank you for taking the time to read this and far sharing this with your friends.

That moment when you finally pass your NCLEX will be well worth all the effort that you are putting in. We all remember the diligent work that goes into this effort and are here to support you. As a reader of this blog, you are already a step above everyone else!

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The topic for this week is the cardiovascular system. Vital signs are always a major consideration especially orthostatic hypotension in the elderly and those on medications. The nurse must learn to look, listen, and feel in the assessment of their patients.

The areas covered during this weeks blog are Cardiovascular Pharmacology Classifications, General Cardiovascular Principles, Acute Myocardial Infarction, and Pericardial Effusion.

Cardiovascular Pharmacology Classifications

Pharmacology is always a needed topic by our students and we are happy to provide this overview of the pharmacology classifications that are important for a successful attempt at the NCLEX. Considerations when discussing the cardiovascular system are as follows:

1. Inotropic agent: Increases the force of contraction and perfusion to the organs. An increase in urine output would indicate an increased perfusion to the kidneys.
2. Antidysrhythmics: Treat abnormal heart rhythms which can begin the atria or the ventricles.
3. Nitrates and vasodilators: Relax the smooth muscles in the coronary arteries to increase blood supply to the heart muscle for better perfusion and to relieve chest pain.  These drugs can also relax the blood vessels in the peripheral circulation to lower blood pressure and decrease preload and afterload to improve heart function.
4. Beta blockers: Block the effects of the sympathetic nervous system and can be used to treat abnormal rhythms, chest pain, and can protect the heart after an acute myocardial infarction
5. Calcium channel blockers: Relax the blood vessels reducing blood pressure and improving blood flow.  They also slow down the electrical conduction in the heart and can be used to control rapid dysrhythmias.
6. Angiotensin-converting enzyme (ACE) inhibitors: Used to control high blood pressure and help the heart function better in those with heart failure and after a heart attack.
7. Angiotensin II receptor blockers (ARBs): These agents work like the ACE inhibitors except they allow for an additional step in the drug’s conversion which decreases the incidence of the side effect of a dry, annoying cough.
8. Central acting alpha-blockers: Used to treat hypertension.
9. Coagulation modifiers: Antiplatelet and anticoagulants interfere with the formation of blood clots to prevent heart attacks, strokes, and deep vein thrombosis.  Thrombolytics dissolve blood clots.
10. Antilipemic agents: Decrease the amount of LDL cholesterol in the blood stream and reduce the amount of plague deposits.  Some agents can increase the amount of HDL cholesterol.
11. Colony stimulating factors used for numerous conditions affecting production of cells from the bone marrow

General Cardiovascular Principles

Heart sounds reflect the function of the valves, and can be difficult for the nursing student to master. In order to make this easier to remember for the NCLEX and for use in clinical practice. Several audio hints and can be studied:

• “Swish” sound: Murmur
• Extra Heart Sounds: Gallop
• Grating Sound: Friction rub. Heard on inspiration and exhalation
• Irregular Rhythm: Atrial fibrillation or atrial flutter
• Skipped beat: Premature ventricular contraction

Acute Myocardial Infarction

Acute myocardial infarction is damage to the myocardium resulting from an interruption of blood flow. The main cause of AMI is coronary heart disease.

There are many symptoms of AMI that the nurse must be able to identify for the NCLEX and during their clinical work. To asses acute myocardial infarction, look for the following symptoms, which are also all sign of tissue hypoxia:

• Chest pain
• Sailor
• Cool, clammy
• Increased BP
• Dyspnea
• Heart failure
• Fatigue
• Weakness
• Nausea and vomiting
• Decreased level of consciousness
• Temperature elevation

To manage acute myocardial infarction, conduct:

• Frequent Assessments
• Repeat ECG with new pain or change in condition
• Follow up diagnostics to evaluate for blockage
• Echocardiogram to evaluate function

Pericardial Effusion/Tamponade

Pericardial effusion and tamponade is the accumulation of fluid or blood in the pericardial sac.  If blunt or penetrating trauma to the pericardium or heart, blood will accumulate rapidly and be life threatening.  The larger the effusion, and the faster it develops, the more symptomatic the patient will be.

To conduct the assessment of pericardial effusion, look for:

• Clear lung sounds
• Tachycardia
• Pulsus paradoxus
• Elevated CVP

Beck’s Triad

• Narrowing pulse pressure
• Jugular vein distention
• Muffled heart tones

Use an echocardiogram to diagnose and pericardiocentesis to drain the pericardial cavity.

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Pulmonary System NCLEX Review

Thank you for once again checking out the NCLEX Review blog, brought to you by BrainyNurses.com. We know that you have many choices for your nursing education, but are proud that you have come here.

Have you thought of beginning the preparation for the NCLEX? It is never too early to start, and with our program, you have a full three months of access to the NCLEX Review. Many of our students have purchased the program to supplement their nursing education well before taking the exam. We are happy to provide this service, and will provide a discount code for access to the course again during the period before the exam to allow you to refresh the information.

The topic covered during this weeks blog is a review of the Pulmonary System for the NCLEX. We will cover Pulmonary Pharmacology Classifications, Testing for Tuberculosis, the ‘P’s’ of Dyspnea, and the Flail Chest Disorder. To be added to our mailing list and receive notifications of new blog posts, click the link below!

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Pulmonary System Pharmacology Classifications

Pharmacology classifications are frequently requested by our students during their preparation for the NCLEX. This is no different during the Pulmonary module, and we are happy to provide you this infographic to show the various classifications of medications that are applicable to this module.

The Pharmacology Classifications that are important for the Pulmonary System module are:

• Oxygen: Oxygen is a medication.  Keep oxygen concentrators open to air for adequate circulation.  Don’t place near a wall or in a closed container.
• Antihistamines: Block the immune system from reacting to a foreign substance.
• Antitussives: Relieve coughing by suppressing the cough center or numbing the nerves.
• Bronchodilators: Bronchodilators open up the airways of the respiratory system to allow for air passage into and out of the lungs.
• Decongestants: Decrease the swelling in clogged breathing passages through vasoconstriction of the blood vessels.  They will also help to drain the sinus cavities of fluid.  Many are available over-the-counter.
• Expectorants: Thin secretions in the respiratory tract
• Inhaled and nasal corticosteroids: Block the ability of the body to respond to foreign substances resulting in a decrease in inflammation or swelling of the breathing passages.
• Leukotriene modifiers: Prevent the release of chemicals during inflammation which can cause the airway passages of the bronchial tree to become constricted or narrower.  They are used to prevent asthma attacks, not for acute exacerbations.
• Mast cell stabilizers: Prevent the release of histamine from cells in the body known as mast cells.  Preventing this release blocks the immune system from reacting to a foreign substance.  Used to prevent asthma attacks especially ones that are caused by exercise.
• Mucolytics: Nebulized medication primarily used for cystic fibrosis clients.  Loosen respiratory secretions so they can be coughed up.
• Antitubercular agents: Liver function studies prior to therapy and monthly during therapy.  Toxic to the liver.

Testing for Tuberculosis

Tuberculosis is a potentially serious disease which primarily affects the lungs.  Transmitted by droplets.  Most people infected with the bacteria don’t develop symptoms of the disease.  Less than 1% of the population readily progresses to clinical illness, or active disease.  In 5%-10%, illness develops after an interval of months, years, or decades, when the bacteria begin to replicate and produce disease.  This is most likely in immunocompromised clients.

Testing for Tuberculosis is conducted through a PPD test which can be read after 48-72 hours. Some considerations for the PPD test that are important for the NCLEX are:

1. Must be given intradermal.
2. After an exposure, takes 6-10 weeks for a positive PPD.
3. If positive test, do a CXR and monitor for symptoms of TB.
4. Abnormal results:
   10 mm in general public or extended care residents
   5 mm in HIV, AIDs or recent close contact with active TB.
5. BCG vaccine is for ________________________.  Anyone getting this vaccine will always test positive.  Evaluate with a CXR.
6. Can have a false positive or a false negative reading.
7. If a Tine test is positive, then a PPD test is to be done to confirm.
8. Notify the primary care provider of a positive reading. CXR should follow to determine if there are white spots where the bacteria have been walled off. May also see nodules or cavities caused by active TB, or old, healed lesions.

The ‘P’s’ of Dyspnea

Dyspnea is a common complaint in respiratory disorders and has many causes. To remember the common causes of dyspnea, you have to remember to ‘P’s’!

• P = pulmonary asthma
• P = possible foreign body
• P = pulmonary embolism
• P = pneumothorax
• P = pneumonia
• P = pump failure
• P = pericardial tamponade
• P = peak seekers
• P = psychogenic
• P = poisons

Proper positioning of the patient can decrease episodes of dyspnea and include sitting upright while leaning on an over bed table, sitting upright in a chair with the arms resting on the knees, and leaning against a wall while standing.

Pulmonary System Disorders: Flail Chest

Flail Chest is the instability of the chest wall due to multiple rib fractures sustained by considerable force. Two or more ribs are fractured at two different places on each rib, leaving a rib section that isn’t connected at either end. Broken segment moves opposite normal. Pulls inward with inspiration.

The clinical assessments of Flail Chest are provided in the below infographic for your review.

To treat Flail Chest:

1. Support the chest with the hands during the emergent phase to help with pain.
2. Chest tube, intubation and ventilation needed.
3. Flail segment may need surgical repair.
4. Epidural catheter or nerve block above and below the fracture may be used for severe pain.

That concludes this weeks addition to the BrainyNurses.com NCLEX Review Blog, We hope that you were able to gain information that will be useful to your review and help you achieve success.

For any additional information or feedback, please email us at adam@brainynurses.com or visit our website!

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Endocrine System NCLEX Review

This week, Brainy Nurses brings you a review of the endocrine system and some key components that will help you to be successful in your NCLEX.

What areas of the endocrine system have provided you the most difficulty during your study? Do you feel comfortable answering the questions that the NCLEX will grade you on, and what steps are you taking to prepare for the NCLEX? Click the link below to receive information like this post in your inbox.

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If this article is helpful for you, you won’t believe what we have in store in our full NCLEX Review!

The topics that will be covered during the course of this blog include: the Three S’s, Adrenal and Anti-Adrenal Agents, Cushing’s Syndrome, and Hypoglycemia Assessment. We hope that this review, along with the videos and flashcards, help you to prepare for your examination and career as a Nurse.

The Three S’s

Adrenal medulla secretes catecholamines such as epinephrine and norepinephrine.  Pheochromocytoma is the tumor which can occur in the medulla.

The adrenal cortex secretes what you can remember as the three “S’s”

• Sugar (Cortisol)
• Salt (Alsosterone)
• Sex (Estrogen and Testosterone)

For a more detailed explanation of the three S’s, please check out this portion of our online NCLEX Review and hear Cindy discuss this concept.

Adrenal and Anti-Adrenal Agents

Adrenal and Anti-Adrenal Agents are used by the provider to correct abnormalities of the secretion of the adrenal gland. There are numerous lab effects, including and increase in WBC, BS, Na+, and a decrease in K+

Systemic steroids can cause adrenal insufficiency if they are not gradually withdrawn. Some other side effects of steroids include:

1. Muscle Weakness
2. Osteoporosis
3. Immunosuppression
4. Polyuria
5. Polydipsia
6. Abnormal fat distribution
7. Growth retardation in children
8. Weight gain
9. Mood swings such as depression
10. Edema

There are numerous medications that can be administered by the provider. An easy way to quickly identify there steroids is that most end in -zone.

Here are all the potential medications that can be provided to correct these abnormalities:

• Betamethasone (Celestone)
• Dexamethasone (Decadron)
• Cortisone (Cortone)
• Fludrocortisone (Florinef)
• Hydrocortisone
• Methylprednisolone (Solu Medrol)
• Prednisolone (Pred Forte)
• Prednisone (Deltasone)
• Triamcinolone (Aristacort)

Cushing’s Syndrome

This section of Endocrine System review will talk about Cushing’s Syndrome. Cushing’s syndrome is caused by too much of the adrenal hormones, especially cortisol. This may be due to the overproduction of hormones or the long term use of steroids.

There are numerous clinical manifestations that will be observed by a patient suffering from Cushing’s Syndrome. They are easier to remember if you group them into the three S categories: Sugar, Salt, and Sex.

Too Much Sugar:

Hypoglycemia, an increase in the risk of infection, fat deposits on the back, personality changes and irritability, osteoporosis, thin skin and extremities, bruises and peterchiae, GI distress and an increase in acid

Too Much Salt:

Hypertension, moon face, Na+ and Fluid Retention, Profound weakness due to hypokalemia,

Too Much Sex:

Purple Striae, Gynecomastia (Males) Amenorrhea and Hirsutism (Females)

To treat Cushing’s Syndrome, the following treatment options are needed for successful NCLEX completion:

1. If due to steroid therapy, taper the medication and discontinue if possible.
2. Surgical resection if adrenal adenoma or pituitary tumor.
3. Medications to inhibit cortisol synthesis such as ketoconazole or metopirone (Metyrapone).
4. Mifepristone (Mifeprex) is a glucocorticoid receptor antagonist

Hypoglycemia Assessment

Hypoglycemia occurs then the blood sugar is less than 60-70, at which signs and symptoms appear and mental efficiency is impaired. It is caused by not enough food, too much insulin, or too much exercise.

To easily recall hypoglycemia during the NCLEX examination, remember the acronym TIRED.

T = Tachycardia
I = Irritability and Nervous
R = Restless
E = Excessive Hunger
D = Diaphoresis

In general, the patient will appear to be “drunk and in shock”. Other potential clinical manifestations that may be present by a patient experiencing hypoglycemia include:

Sweating
Tremors
Dizziness
Headache
Confusion
Convulsions
Hunger
Hypothermia
Hallucinations
Ultimately Death

To treat hypoglycemia, here are three recommendations:

• Simple Sugar, followed by a complex carbohydrate and then a protein. Don’t give chocolate
• Orange juice for adults. Milk for children, which provides sugar, protein, and fat
• Glucagon subcu or IM if unconscious

We hope that you have enjoyed this review of the endocrine system and the potential questions that you may be asked during the course of your NCLEX examination.

Have you struggled to prepare for the NCLEX? Do you find the number of potential review programs to be confusing or too expensive? Have you tried the major programs, but have yet to pass the NCLEX? We would like to invite you to give our NCLEX review a try, which has been successful for thousands or nurses.

How is our program different? We provide nursing training programs, developed entirely by professional nurse Cynthia Liette. Cindy uses not only the academic facts, but puts it into context from a career of service as a nurse, providing the nursing student with a more practical application of the material into a clinical setting,

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Become the Nurse You Want to Be

Mental Health NCLEX Review

Welcome back to the free NCLEX Review blog from BrainyNurses.com!

Lets get right into it. Our topic for this weeks blog is Mental Health, one of the many subjects that you need to understand in order to successfully navigate the NCLEX. Through many years of on-the-job experience and continuing education, I have developed some of the helpful hints that are highlighted in this module that will help you be successful in your journey to finishing your nursing education and becoming registered.

If this article is helpful for you, you won’t believe what we have in store in our full NCLEX Review!

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Two common degenerative disorders that involve the brain are Alzheimer’s Disease and Dementia. The progressive and permanent memory loss and personality changes due to damage within the brain structure and function. Vascular dementia is more rapid in onset because it is caused by a lack of blood flow to the brain.

In addition to those that are afflicted with these diseases, loss of brain cells can also occur due to the use of alcohol, tobacco, and exposure to pollution. This is for all patients and all conditions, not just dementia.

An easy way to remember the various causes of dementia for the NCLEX is to use the acronym DEMENTIA. If breaks down just like this

D = Drugs and Alcohol
E = Eyes and ear problems
M =  Metabolic/endocrine disorders
E = Emotional disorders
N = Neurological disorders
T = Tumors and trauma
I = Infection
A = Arteriosclerosis

No matter the cause or stage of dementia, it is important to remember that dementia is a type of psychosis where the patient is not reality based. Treat by acknowledging their feelings and redirecting them.

Most of our nursing students stress that pharmacology classifications is something that they struggle with when preparing for examinations, including the NCLEX. If that includes you, we will touch on one of the pharmacology classifications that is important to consider in a mental health situation.

Benzodiazepines are a common class of medications that have many uses in practice, to include mental health disorders, alcohol withdrawal, muscle spasms, and to help with sleep.

As always, recognizing the potential side effects that the medication may cause is important for not only the NCLEX, but during your daily shifts. The side effects that are observed when administering benzodiazepines include:

1. Sedation
2. Drowsiness
3. Disorientation
4. Dizziness
5. Blurred vision
6. Ataxia
7. Hypotension

In addition to these side effects, Benzodiazepines have three observed withdrawal symptoms that may be anticipated from patients requiring the medication:

1. Tremors
2. Nausea and vomiting
3. Abdominal or muscle cramp

For a full list of Benzodiazepines that are commonly administered, refer to the flashcard below.

To wrap up this blog post, I would like to leave you with a flashcard that includes the potential lab effects for several pharmacology classifications. The classifications that are covered in this flashcard include:

1. Cyclic Antidepressants
2. Selective Serotonin Reuptake Inhibitors
3. Phenothiazines
4. Non-Phenothiazines, Typical and Atypical Antipsychotics
5. Acetylcholinesterase Inhibitors

Have you struggled in your goal to pass the NCLEX? Do you feel like no matter what you do, you are unable to put the pieces together during the exam? We understand and love to work with future nurses like you. Most of our clients have tried the other NCLEX review programs, but ultimately find success with our review. Thank you for trusting us to help you accomplish your goals.

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If you have any feedback please send us an email.

Just want the textbook? Get it immediately here.

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Medical Administration, Pharmacology, and Nutrition Module

Hello, Nurses and Nursing Students! Welcome to another edition of the BrainyNurses.com newsletter, specifically designed to provide you the information that you need to master the NCLEX and become the nurse that you want to be. Get ready for a discussion that will include Pharmacology and other valuable information!

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We hope that you are having a great school year and are ramped up for taking the NCLEX! It is a great week here, as our celebrated NCLEX Review textbook is now also available through Amazon.

Now, getting on to the topic this week. We will be discussing some key considerations that are taught in greater detail during our “Medication Administration, Pharmacology, and Nutrition” Module of our Online NCLEX Review. Many of our students struggle with pharmacology, but we will try to point us some methods that have been developed by our founder Cindy Liette, RN, during her years of nursing and instructing future nurses.

Cindy likes to use acronyms to help her students remember complex subjects, which will enable quicker recall during the stress of taking the NCLEX. The first acronym that we will discuss is SLUDGE

SLUDGE is used to describe the cholinergic (parasympathetic) and anticholinergic (sympathetic) side effects that may occur with drugs that we administer to our patients. Lets break down SLUDGE into its individual letters to show the different symptoms that may be observed in the patient

S = ↑ Salivation and sweating (Cholinergic)
↓ Salivation and sweating (Anticholinergic)
(Dry mouth and inability to perspire)
(Decreased tolerance to heat)

L = ↑ Lamacrition (Cholinergic)
↓ Lacrimation (Anticholinergic)
(Dry eyes, pupillary dilation, impaired vision)

U = ↑ Urinary incontinence (Cholinergic)
↓ Urinary incontinence (Anticholinergic)
(Urinary retention)

D = ↑ Diarrhea (Cholinergic)
↓ Diarrhea (Anticholinergic)
(Constipation)

G = ↑ Gastrointestinal cramps (Cholinergic)
↓ Gastrointestinal cramps (Anticholinergic)
(Constipation)

E = ↑ Emesis (Cholinergic)
↓ Emesis (Anticholinergic)
(Not a side effect)

For your studying, you can also refer to this flashcard made just for your enhanced understanding of SLUDGE!

We will also discuss intramuscular injections and the important considerations that the nurse must remember to take care of their patients when administering medication. Prior to discussing the various intramuscular sites, it is important to remember that the nurse must position the patient to relax the muscle prior to giving the injection.

The four main IM sites and their individual considerations that must be mastered for successful completion of the NCLEX are below.

1. Vastus Lateralis
•    Large muscle in adults.
•    Use in kids at any time, even < 3 years.

2. Deltoid
•    OK for nonirritating meds in adults.
•    Never in kids.

3. Ventrogluteal
•    Preferred in adults due to sciatic nerve injury with dorsogluteal
•    Use in kids > 3 years.

4. Gluteus Medius or Dorsogluteal
•    May cause sciatic nerve injury

For more information on this important subject, the below infograph will be helpful to enhancing your understanding!

The final subject will be discussed during the Pharmacology newsletter is the importance of considering which medications are the most likely to cause nausea and how to mitigate the impact that this will have on the patient. When administering one of these medications, ensure that it is given with food. When a medication causes nausea, give it with food. On rare instances, the dosage may need to be increased if given with food. Avoid dairy products except with steroids.

The following medications are the most likely to result in nausea and be administered in accordance with the proper considerations to decrease the nausea that the patient may experience.

• Carbamazepine (Tegretol)
• Hydralazine (Apresoline)
• Lithium (Lithobid)
• Propranolol (Inderal)
• Ketoconazole (Nizoral)
• Spironolactone (Aldactone)
• Iron and iron containing medications
• Non-steroidal anti-inflammatory agents
• Theophylline (Theo-dur, Slo-bid, Uniphyl)

There are so many other considerations that the nursing student must master in order to successfully pass the NCLEX, which are discussed in great detail in our online course and NCLEX review book. We hope that the flashcards provided in the post are helpful to you and ask that you share them with your friends in nursing to spread this information.

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To be notified of new blog posts and receive additional free flashcards, click the button above and provide us your email address! We promise not to sell your personal information or flood your inbox with emails every day. On average, we only send out one email every week!

If you have any feedback please send us an email.

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Thank you again and have a great day!

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Fundamental Skills NCLEX Review Module

Welcome to the Fundamental Skills NCLEX Review Module from BrainyNurses.com!

We hear from former students every day on how much they love their life as a nurse.

Are you ready to get on with your career and passed the NCLEX?

Do you need an experienced hand to guide you through the preparation process?

Then you NEED to meet Cindy Liette, the founder of BrainyNurses.com, bringing the experience of an in-person NCLEX review to your personal computer, tablet or smartphone. Thousands of nurses have attended the seminars, and now we are thrilled to bring this experience to your device.

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This week, we will be covering the Fundamental Skills Module from our Online NCLEX Review. The topics covered in this review are Safety and Infection Control, Caring for Elderly Patients, Nursing Math Skills, and a Sample NCLEX Question.

Safety and Infection Control

RACE is the acronym to remember for fire situations.  Refers to remove, activate, contain, extinguish.  After RACE, then “PASS” which refers to pull the pin, activate the extinguisher, squeeze and sweep.

For any questions dealing with restraints, remember to avoid whenever possible.  Try alternative measures first.  Get an order for the restraint.  In an emergency to provide for safety, may need to apply and then get the order.  Restraints of any kind can constitute false imprisonment.

Isolation: You need to know the types of isolation required, protective equipment and how to remove protective equipment.

1. Untie the gown at the waist.
2. Remove gloves.
3. Untie gown at the neck and allow it to fall from shoulders.
4. Remove the gown touching only the inside and fold inside out.
5. Remove mask and eye wear.
6. Wash hands.

Risks of Contamination

• Gloves are required for any contact with draining lesions, gloves.
• Gowns are needed if a bath or some type of activity where you will lean over the client and contact might occur with body fluids.

Caring for Elderly Patients

There are several special considerations that the Nurse must remember when caring for elderly patients. They are listed below. The flashcard has the conditions that elderly patients have an increased risk.

Please pin this flashcard to your Pinterest Board for easy review later!

• Anyone with a chronic condition should be considered immunocompromised and will have anxiety about their disorder.
• Reinforce strengths and promote reminiscing. This enhances self esteem and promotes adaptation.
• Disabling illnesses divert the older person’s energies making it difficult to maintain an optimum level of functioning.
• Will need to treat co-existing medical disorders such as cardiac problems, peripheral vascular disease, and neurological disorders.
• They will have a decreased tolerance to medications. Decrease doses to prevent over sedation and complications.

Nursing Math Skills

We all know that there are some basic math skills that the nurse needs to have. Memorizing this list will really help you during the NCLEX!

One thing that I like to do is find ways to incorporate this into every day life. Try to think of the temperature in Celsius, convert measurements while cooking, or quiz each other!

C to F = C X 1.8 + 32
1 tsp = 5 mL
1 tbl = 15 mL
1 oz. = 30 mL
1 cup = 8 oz
2 cup = one pint
4 cup = one quart = one liter
2.2 lb = one kilogram
1 inch = 2.5 cm
IV formula:  Volume x drop factor divided by time in minutes for the infusion

Hint: Pin this flashcard on Pinterest to bring it on the go!

Thanks for taking the time to read this article on the Fundamental Skills Module from our online NCLEX review. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest for your personalized NCLEX review boards!

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To be notified of new blog posts and receive additional free flashcards, click the button above and provide us your email address! We promise not to sell your personal information or flood your inbox with emails every day. On average, we only send out one email every week!

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Just want the textbook? Get it immediately here.

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Become the Nurse You Want to Be

NCLEX Review: NCLEX Preparation Module

Welcome to the BrainyNurses.com weekly NCLEX Review!

To receive email updates when new information is posted, please click on the link below to be added to our mailing list. You will also receive free flashcards in each email for your personal studying.

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This week, we will be covering the NCLEX Preparation Module from our Online Review. The topics covered in this review are Preparing Yourself for the Exam, Triage Questions, Maslow’s Hierarchy, and a Sample NCLEX Question.

Preparing Yourself for the Exam

1. Think and look positive on the day of exam. Prepare your brain by studying and your psyche by what you tell yourself. Groom for success on that day and believe in yourself. Remember, you are in control of your thoughts and your success.
2. Get a good night’s sleep the night before the exam.
3. Feed your body by eating breakfast on the day of the exam and limit your caffeine intake.
4. Keep your composure, stay positive during the test, and answer each and every question to the best of your ability. Take deep breaths when you get nervous and force yourself to relax.  Don’t question yourself.

The questions will focus on the following:

• Safe and effective care:  This is collaborating and providing for care. Remember the importance of hand washing, call bells, bed position and infection control.
• Physiologic integrity: Utilizes Maslow’s hierarchy and the ABCs in the nursing process. It is providing comfort, ADLs, giving medications and performing treatments.
• Psychosocial integrity:  Promotion of emotional, mental and social well-being. Using therapeutic communication is vital. Focus on the feelings of the client and family.
• Health promotion and maintenance:  Development of a plan of care to assist clients to their maximum potential. Focus on prevention and early detection of diseases and teaching plans. Also includes pharmacology and physiology.

Triage Questions

It is helpful to remember a stoplight when you are answering questions related to triage. Little reminders like this will be useful during the long exam!

Below is a flashcard to help you study!

Maslow’s Hierarchy

1. Maslow’s hierarchy of needs may be used to determine priority. Physiologic and safety needs must be met first.
2. Physiologic includes need for food, shelter, water, sleep, oxygen, and sexual expression.
3. Safety is avoiding harm, having security and order, and physical safety.
4. Love and belonging is giving and receiving affection and companionship, identification with a group, respect of others, self esteem, and success in work.
5. Self-actualization is fulfillment of potential.

ABCD’s may also be used to determine priority.

• Airway
• Breathing
• Circulation
• Disability

Sample NCLEX Question

Check out this sample NCLEX Question and how Cindy will teach you to work through the steps to get to the right answer!

• Attack #1: Topic – Priority Invervention for head injury patient
• Attack #3: Assessment vs Implementation – all responses are implementation
• Attack #4: Maslow – not relevant
• Attack #5: Priority – The nurse needs to identify that the s/s exhibited by the patient is a critical change in status.  The nurse must contact the physician so further medical interventions can take place.
• Attack #6: Expected Outcome – Responses #2,and #3 may help the patient momentarily, however it does not significantly improve the ICP.
• Notifying the physician is the best response.

We don’t just give you the answer, but show how you can apply your learning! And know how to react during the NCLEX exam!

Pretty cool?

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Thanks for taking the time to read this article on the NCLEX Preparation Module from our online NCLEX review. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest for your personalized NCLEX review boards!

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NCLEX Review: Pediatrics Module

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This week, we will be covering the Pediatrics Module from our Online NCLEX Review. The topics covered in this review are Pediatric Safety Considerations, Muscular Dystrophy Assessment, Pediatric Disorders, and a Sample NCLEX Question

Pediatric Safety Considerations

Challenges in the hospital

• Child may have separation anxiety. Playing peek-a-boo and hide and seek demonstrates to the child the parent is going to return.
• Stages of separation anxiety include protest, despair, and detachment. Crying and kicking is the protest phase.

General safety considerations

• No small toys under the age of 4 years.
• Always remember the importance of supervision in the toddler years. They are inquisitive and can reach things that could start a fire or hurt them.
• Accidents are the major cause of death for children and adolescents.  Need to consider safety and accident prevention in the population.
• No metal or electric toys with oxygen.
• No toys or items which harbor germs. Stuffed toys are not good. Should be washed if at the hospital.

Pain in children

• Pain is remembered after 6 months of age.
• Wong-Baker Faces scale commonly used.
• After age 9, they can use numeric pain scale.

Muscular Dystrophy Assessment

Muscular dystrophy: Genetic disorder with progressive muscle weakness and wasting and increasing disability and deformity. Various types with specific muscle groups are affected.

Assessment

• Ptosis
• Impaired chewing
• Difficulty swallowing
• Abnormal gait
• Fatigue
• Frequent falls
• Delayed intellect in some

Diagnostics

• CPK elevated.
• EMG identifies origin of muscle weakness.
• Muscle biopsy to confirm

Management

• Care focuses on preserving and promoting mobility
• Prevention of complications of immobility
• Interact at developmental age
• ROM important
• Aspiration precautions
• Genetic counseling

Pediatric Disorders

Care of the chronically ill child

• Focus on developmental age, not chronological.
• Determine how the child is cared for at home.
• Maintain routine if possible.
• Assess family response to child’s illness and involve them in care as much as possible.
• Assist child/family to return to normal pattern of living.
• Promote maximum growth and development.

In children with heart failure, implement measures to decrease the workload of the heart and increase cardiac output.

• Limit the time for bottle feed or breast feed.
• Elevate the head of the bed.
• Allow for uninterrupted rest periods.
• Provide oxygen during stressful periods.
• Digoxin (Lanoxin) frequently given.
  • Give one hour before or 2 hours after a meal.
  • Do not mix with formula, breast milk or other foods.
  • Keep locked up for safety.
  • Vomiting is an early sign of toxicity.
  • Neurological signs of toxicity includes fatigue, muscle weakness and drowsiness.

Sample NCLEX Question

Take a quick look at this sample NCLEX Question and the detailed explanation below.

Respiratory syncytial virus (RSV): Most common cause of lower respiratory tract infections (pneumonia and bronchiolitis) in children worldwide. Virtually all children contract it by the age of three.

Contact precautions are implemented.  Not airborn precautions. The virus can live on paper or skin for up to one hour and on other surfaces for six hours.

Treat with ribavirin (Virazole) in severe cases. Should wear goggles and a mask whenever given. Causes headaches, burning nasal passages and eyes, and crystallization of soft contact lenses. Can damage the fetus in a pregnant woman. Those pregnant should not be around the child.

Palivizumab (Synagis) may be given to high risk children to provide passive immunity.  Includes those with a history of prematurity, lung disease, or congenital heart disease.

It may play a major role in the pathogenesis of asthma and chronic obstructive pulmonary disease.

Thanks for taking the time to read this article on the Pediatrics Module from our online NCLEX review. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest for your personalized NCLEX review boards!

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NCLEX Review: Maternity Module

Have you thought of beginning the preparation for the NCLEX? It is never too early to start, and with our program, you have a full three months of access to the NCLEX Review for less than half the price of our competitors. You will learn everything you need for the NCLEX, including the maternity module.

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This week, we will be covering the Maternity Module from our Online NCLEX Review. The topics covered in this review are Maternal Risk Factors, Risks in the Prenatal Period, Complications in Labor, and Care of the Newborn.

Maternal Risk Factors

For maternal risk factors and newborn effects, use the acronym TORCH for any kind of infections.

• T = Toxoplasmosis
• O = Other infections
• R = Rubella
• C = Cytomegalovirus
• H = Herpes simplex

Toxoplasmosis

• Related to exposure to cats, gardening or eating raw meat
• Treat during the pregnancy with sulfa drugs
• Can lead to stillbirth, microcephaly, hydrocephalus blindness and deafness

Other infections

• Syphilis
• HIV
• Gonorrhea
• Chlamydia
• Condylomata acuminate (venereal warts)

Rubella

• Causes a rash
• Infection of the mother during pregnancy can be serious
• If the mother is infected within the first 20 weeks of pregnancy, the child may be born with congenital rubella syndrome (CRS), which entails a range of serious incurable illnesses

Cytomegalovirus

• Can lead to stillbirth, congenital CMV, microcephaly, intrauterine growth retardation, cerebral palsy, mental retardation and liver enlargement
• No treatment available for mother or infant

Herpes

• Can cross the placenta and be transmitted at delivery
• If active lesions are present, C-section recommended

Additional information on this subject is covered in the full NCLEX review book, available with our online NCLEX review or on Amazon and iTunes.

Risks in the Prenatal Period

We do an in-depth discussion on each of these risk factors in the Maternity Module full book and program. For this article, we’ll just discuss the risks of pregnancy induced hypertension.

Pregnancy induced hypertension (Gestational hypertension)

Develops after the 20th week of gestation.  Most common type of hypertension in pregnancy.

Classic triad of PIH:  Increased BP, proteinuria, and edema.

Risk factors

• First pregnancy
• Age < 19 or > 40 years
• Chronic renal failure
• Chronic hypertension
• Diabetes
• Rh incompatibility
• History of PIH

HELLP syndrome can occur with eclampsia

• Hemolysis
• Elevated Liver function tests
• Low Platelet count

Seizure is the major complication.  As they move from preeclampsia to eclampsia, priority is airway because of the seizures.

The additional risks in the prenatal period that are covered thoroughly are:

• Cardiac disease
• Chronic hypertension
• Gestational diabetes
• Diabetes mellitus

Complications in Labor

Early deceleration

Transient decrease in HR

• Possible head compression or fetal descent. Doesn’t indicate fetal distress. Usually see at 4-7 cm.

Variable decelerations

• The decelerations are not related to the timing of contractions. May drop 10-60 beats per minute below the baseline.
• Can be cord compression or the baby is rapidly declining. Put Mom in knee chest to take the pressure off the cord. May need a C-section if not resolved.
• If it occurs after a gush of fluid, do a sterile vaginal examination and check for cord compression.

Late deceleration

• Due to uteroplacental insufficiency.  Rarely below 100 BPM
• Causes
  • Post-maturity
  • Preeclampsia
  • Diabetes mellitus or cardiac disease.
  • Abruption of the placenta or the uterus.
• Severe is <70 BPM lasting longer than 30-60 seconds and a slow return to baseline.
• To remember: Decels are acceptable in labor but “never be late”…..late decels means baby is in trouble.

VEALCHOP is used frequently by OB instructors.

Care of the Newborn

Apgar scores are done several times, remember that a ten is the best score that you can get.

Please use this flashcard to remember more about Apgar Scores

• Done at 1 and 5 minutes.
• If ≤ 6 at 5 minutes, repeat.
• Score 7-10: Baby is good.
• Score 4-6: Baby needs moderate resuscitation.
  Gentle stimulation and oxygen.
• Score 0-3B: Baby severely compromised.
  Resuscitation needed.

Thanks for taking the time to read this article on the Maternity Module from our online NCLEX review. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest for your personalized NCLEX review boards!

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NCLEX Review: Integumentary Module

Welcome to the Integumentary NCLEX Review from BrainyNurses.com!

What makes our NCLEX review different from the other ones on the market?

Unlike many of the other companies, our review was designed and written by Cindy Liette, a veteran nurse of over 35 years who is still active in the profession.

Helping nursing students and nurses get the education they need is her passion, and she has been teaching for over 10 years. With this program, you get all the current information plus her personal experiences from the hospital where she still works.

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This week, we will be covering the Integumentary NCLEX Review Module from our Online NCLEX Review. The topics covered in this review are Management of Animal Bites, Wounds, Burns, and a sample NCLEX Question on Homografts.

Integumentary NCLEX Review Preview Video

Straight from the FULL online course!

Management of Animal Bites

Bites such as dog, cat, rodent, human, insect/bee, spider, tick and snake. May or may not have a break in skin integrity. Pain and tenderness present with all fresh bites.

Assessment

Local reactions with many

• Itching
• Swelling
• Local inflammation

Systemic reactions with spider and snake

• Nausea and vomiting
• Respiratory difficulty
• Seizures

Management

• Determine type of injury to direct treatment
• Thoroughly clean and irrigate. Sterile dressing if applicable but may leave the wound open
• Topical antibiotic ointment and monitor for signs of infection and healing
• IV antibiotics with human bites, and severe, high-risk animal bites
• Tetanus prophylaxis
• Rabies prophylaxis if bite from bats, raccoons and most wild animals.  In some cases, animal control will be involved.  They will
• impound the animal to evaluate for 10 days for rabies.
• Snake and spider bites, such as the black widow, may require symptomatic care.
  • Ice to the site to decrease absorption
  • Anti venom therapy which may need to be obtained from the health department
  • Observe for signs of neurotoxicity and administer muscle relaxants as prescribed

Wounds

Draining wounds may need a drainage system such as a wound VAC.

• Factors affecting wound healing
• Hyperglycemia
• Renal insufficiency or failure
• Presence of infection
• Stress which alters the immune response
• Medications such as such as anti-inflammatory drugs, cancer-fighting agents and anticoagulants can alter the normal healing process
• Inadequate nutrition
• Dehydration
• Vascular insufficiency

Tip: Pin this Flashcard to your Pinterest boards to review your study material on the go!

Burns

Care of Burns

Determining surface area

• Rule of Nines
• Lund Browder in children. More accurate but more complex.
• Rule of hands

IV fluids are calculated with the Parkland (Baxter) formula

One half of the total amount of fluid should be administered in the first 8 hours.  Calculate from the time of the burn.
Weight x 4 mL/kg x % of burned area.  Include calculation of burn percentage when caring for burn patients.
Not uncommon to give over 500-1000 ml per hour during various phases of burn care.

Central line is recommended in larger burns for volume resuscitation, pain control and nutrition with TPN if needed.

Fluid and electrolyte balance a major concern with burns and any thermal injury.  Intake and output, daily weights, and IV fluid replacement.  Goal is 1 mL/kg/hr.  Monitor for fluid overload in the acute or intermediate phase.  Avoid “free water” as a fluid replacement.  Need electrolytes and protein in drinks.

Skin grafts are sometimes needed for burn victims, especially for larger burns.

For more information and management of burns, you need to get our full textbook. It is provided with our online review or available on Amazon and iTunes.

Sample NCLEX Question

As we talked about during the previous section, skin grafts are sometimes needed for burn patients.

Heterograft (Allograft)

• Temporary grafts
• May be pig skin or from another species
• Used to relieve pain and promote rapid epithelialization

Homograft

• Skin graft from a skin bank (homo sapien)

Autograft

• Skin (automatically) from the patient
• Donor site and grafted site

Thanks for taking the time to read this article on the Integumentary NCLEX Review from our online NCLEX review. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest for your personalized NCLEX review boards!

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NCLEX Review: Senses Module

Welcome to this weeks article, the Senses NCLEX Review from BrainyNurses.com!

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This week, we will be covering the Senses Module from our Online NCLEX Review. The topics covered in this review are Pharmacology Classifications, Glaucoma, Ear Surgery, and Ménière’s Disease.

Senses NCLEX Review Preview Video

Straight from our full online course!

 

Pharmacology Classifications

In the pharmacology module, there are several classifications of pharmacology that are covered in depth. They are:

• Ophthalmic glaucoma agents
• Ophthalmic anti-infective agents are used for eye infections
• Ophthalmic anti-inflammatory agents are used for many eye conditions with or without infection
• Ophthalmic anti-histamines are used for allergic reactions
• Ophthalmic anesthetics and cycloplegic drugs are used to perform eye exams
• Otic agents are used for various types of disorders of the external ear

Glaucoma

Glaucoma: Disease of the optic nerve leading to a loss of sight which is most frequently associated with increased intraocular pressure. Increased incidence in the elderly population. May be detected on a routine eye exam

Open angle is the chronic type.

• It is also known as simple glaucoma or wide angle glaucoma
• Because the flow of aqueous humor is gradually blocked, patients are often asymptomatic
• It may be picked up as part of a regular eye exam
• Incidence increases in the older population

Closed angle is the acute type.

• It is also known as narrow angle glaucoma
• It is triggered by sudden pupil dilation often associated with high emotion or darkness
• Permanent vision loss can occur in 48 to 72 hours after angle closure
• This now becomes a surgical emergency

The flashcard below shows how the nurse should assess glaucoma. You should save this image or pin it to your Pinterest page for your personal studying.

Ear Surgery

After the patient receives ear surgery, there are guidelines that should be followed by the nurse and patient.

General guidelines after ear surgery

• Bedrest for 24 hours with HOB usually elevated.  Lie on nonoperative side
• Assess for nausea, vomiting, dizziness, and vertigo.  Medicate as needed
• Assess hearing. May be decreased due to edema and drainage
• Keep any outer dressing clean and dry. Do not shower or shampoo for at least one week
• Keep ear dry for 6 weeks using a Vaseline cotton ball in the ear
• Avoid those with respiratory infection
• Avoid activities that increase pressure in the head
  • No bending or straining afterwards
  • Sneeze with mouth open to prevent changes in air pressure in the ear
  • No travel for 2-3 weeks to prevent barotrauma

Symptoms to report

• Persistent headache
• Increased drainage
• Fever
• Pain or dizziness
• Decreased hearing

Ménière’s Disease

Ménière’s disease: Disorder of the inner ear that can affect hearing and balance. Symptoms are caused by an increase in volume and pressure of the endolymph of the inner ear.

Assessment:

• Nausea
• Headache
• Tinnitus
• Recurrent attacks of vertigo
• Sense of fullness in the ears
• Roaring or ringing in the ears
• Progressive sensorineural hearing loss, usually unilateral.

Enjoy this sample Senses NCLEX Review Question regarding this disease for your review!

Thanks for taking the time to read this article on the Senses NCLEX Review from our online NCLEX review. If you like this content, please share it with your classmates and follow us on our social media platforms. The flashcards are also available as pins on Pinterest for your personalized NCLEX review boards!

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Become the Nurse You Want to Be

 

NCLEX Review: Cancer Module

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Welcome back to BrainyNurses.com weekly NCLEX Review, where this week we will talk about our Cancer Module. We hope that you are having an effective review for the big test, and have many resources available to help you.

Patients with cancer will be in a hypermetabolic state due to the rapid and uncontrolled growth of the cancer. Malnutrition, muscle breakdown and dehydration a concern.

The topics covered from the Cancer Module are Warning Signs of Cancer, Side Effects of Radiation and Chemotherapy, and Hodgkin’s Lymphoma.

Warning Signs of Cancer

As shown in the flashcard below, the warning signs of cancer can be remembered by using the acronym CAUTION. We like to use these acronyms to help remember this information and have many more available through our text book. There are also four stages to cancer that can be easily remember. We urge you to keep it simple for the NCLEX and remember that Stage I is Limited Treatment while Stage 4 is Aggressive Treatment.

Other definitions and characteristics of cancer are:

• Benign Neoplasm – Slow-growing, localized, and encapsulated with well-defined borders.
• Malignant neoplasm – Aggressive form that invades and destroys tissues.
• Metastasis – Cells travel through the blood or lymphatic system and invade other tissue and organs to form a secondary tumor.

For Cindy’s explanation, straight from the video course, here is a short YouTube video.

Age is the biggest risk factor for cancer, with 78% of all cancer occurring after the age of 55 years.

Side Effects of Radiation and Chemotherapy

There are numerous side effects of radiation and chemotherapy that the nurse must be prepared for. The are displayed in the flashcard below for your continued study. There are some key takeaways from some of these side effects that we will go into greater detail.

Bone Marrow Suppression:

• Occurs frequently.
• Monitor for signs and symptoms of low RBC, WBC and platelets.
• Neutropenic precautions will be in place
• Avoid infections including coming in contact with someone who has received a live vaccine
• Prevent secondary infection since immune system is suppressed. Fever may not occur even in the presence of an infection
• Diet should be low-bacteria, well-balanced, have adequate protein, minerals and vitamins, especially vitamin C

Alopecia

• Wigs are frequently covered by insurance and should be chosen before the hair is lost.
• Care of the hair
  • Wash 2-3 times a week with mild shampoo. Pat hair dry
  • No hair dye or harsh chemicals

Tissue Damage

• Radiation pneumonia with external radiation
• Tissue damage to target area with external radiation
• Moist desquamation can occur due to destruction of the basal cells

Hodgkin’s Lymphoma

Type of malignant B cell lymphoma characterized by the orderly spread of disease from one lymph node group to another usually beginning in the cervical or supraclavicular area. ◊ Systemic symptoms develop with advanced disease and it primarily affects those between 15 and 30 years of age and those older than age 55 years

Remember: you can Help Hodgkin’s.

Assessment usually starts on one side of the neck and Systemic Manifestations associated with poorer prognosis are:

• Fatigue
• Weakness
• Fever
• Night Sweats
• Weight Loss

Below is a sample question that you can expect during the NCLEX.

Answer: 1) Weight Gain. Any time there is a cancerous process, hyper-metabolism is occurs and weight loss can be observed during assessment.

Management of Hodgkin’s Lymphoma

• Combination of radiation and chemotherapy
• Alopecia common with treatment
• May make the male sterile so sperm banking may be done prior to therapy

We hope that you have gotten a lot of useful information from the Cancer Module that will help you in your NCLEX preparation and to improve your capabilities as a nurse.

Thank you for helping us to spread the word of the Online NCLEX Review from BrainyNurses.com, and we hope that you stay with us after becoming certified for your continuing education needs.

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Our online courses include our celebrated NCLEX review, a comprehensive, 53 video review of all the information that you need in order to be successful.

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Please check out our website to learn more about our Online NCLEX Review, 12 Lead ECG Course, Advanced Assessment Course, Digital Flashcards, and other great products.

Thank you again and have a great day!

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