Summary
Highlights
The session emphasizes that the NCLEX is not about memorization but about critical thinking and acting as a safe nurse, prioritizing patient care, making sound clinical decisions, and ensuring patient safety. Key areas covered include prioritization, delegation, safety, infection control, pharmacology, medication calculations, restraints, crutches, lab values, ABGs, maternity, neonatal care, medical-surgical conditions and mental health. Three main tips for NCLEX questions are discussed: eliminating extreme answers, treating SATA questions as true/false, and trusting your gut instinct.
Prioritization focuses on the ABCs (Airway, Breathing, Circulation) as the top priority, followed by physical health needs over psychosocial needs. Unstable patients with new onset symptoms, acute conditions, post-operative complications, active bleeding, or severe abnormal vital signs require immediate attention. Stable patients with chronic conditions, controlled pain, or those ready for discharge can wait. Delegation is guided by the 'EAT' rule: RNs Evaluate, Assess, and Teach. LPNs care for stable patients and administer certain medications, while UAPs assist with ADLs and monitor stable patients.
This section covers proper PPE donning and doffing (Gowns, Masks, Goggles, Gloves for donning; Gloves, Goggles, Gown, Mask for doffing). Isolation precautions are detailed: Airborne (measles, chickenpox, TB – N95, negative pressure room), Droplet (meningitis, influenza – surgical mask), and Contact (MRSA, C. difficile, RSV – gown and gloves). Emphasis is placed on hand hygiene, especially with C. difficile (soap and water) and N95 seal checks.
High-yield drug toxicity levels discussed include Digoxin (0.5-2.0, toxicity >2.0, signs: visual changes, nausea), Lithium (0.6-1.2, toxicity >1.5, signs: extreme thirst, polyuria), Phenytoin (10-20, toxicity >20, signs: ataxia, slurred speech), Theophylline (10-20, toxicity >20, signs: seizures), and Acetaminophen (10-30, toxicity 150-200, signs: liver failure). Essential antidotes are covered, such as Naloxone for opioid overdose, Acetylcysteine for acetaminophen, Calcium Gluconate for magnesium sulfate toxicity, Protamine Sulfate for heparin, and Vitamin K for warfarin. Blackbox warnings include beta blockers (bronchospasm, bradycardia, CHF, masking hypoglycemia), ACE inhibitors (angioedema), and antidepressants (increased suicidal ideation).
The basic dosage formula D/H * Q = X is introduced, with examples for tablet and liquid medications. IV flow rates are explained using total volume / time in hours for ml/hr and total volume * gtt factor / total time in minutes for drip rates. Weight-based dosages require converting pounds to kilograms (1 kg = 2.2 lb) before calculation. Emphasis is placed on rounding to whole numbers for IV pumps and double-checking calculations.
Restraints are a last resort, used only to prevent harm, requiring a provider's order (can be obtained after emergency application). Alternatives like reorientation, moving patients closer to the nursing station, bed alarms, family presence, distractions, and low beds/mats should be tried first. Proper crutch fit requires a 2-3 finger gap under the armpit and 30-degree elbow flexion to avoid nerve damage (crutch palsy). Different gait patterns (two-point, three-point, four-point) are explained based on weight-bearing ability. The mnemonic 'Up with the good, down with the bad' is used for stairs.
Key electrolyte normal ranges and their implications are reviewed: Sodium (135-145, affects brain), Potassium (3.5-5, affects heart), Calcium (8.5-10.5, affects muscles), Magnesium (1.5-2.5, affects reflexes), Phosphorus (2.5-4.5, linked to calcium), and Chloride (95-105, affects acid-base balance). ABG interpretation involves pH (7.35-7.45), PaCO2 (35-45), and HCO3 (22-26), using the 'ROME' mnemonic (Respiratory Opposite, Metabolic Equal) to diagnose acid-base imbalances. CBC and coagulation labs (WBC, RBC, Hemoglobin, Hematocrit, Platelets, PT, INR, aPTT) are also covered with their normal and therapeutic ranges.
Fetal heart rate patterns are explained using 'VEAL CHOP': Variable decelerations (Cord compression - reposition mom), Early decelerations (Head compression - normal), Accelerations (Okay - good oxygenation), and Late decelerations (Placental insufficiency - stop Pitocin, reposition, O2, IV fluids). The stages of labor (latent, active, transition, pushing/birth, placenta delivery, recovery) are discussed, along with interventions for complications like uterine tachysystole, pushing too early, shoulder dystocia, retained placenta, and postpartum hemorrhage (PPH). Postpartum fundal assessment and its implications for bladder distention are also highlighted.
Heart failure (left-sided: lung symptoms; right-sided: systemic congestion) and its first-line medications (diuretics, ACE inhibitors) are reviewed. Stroke recognition using the 'FAST' mnemonic (Face drooping, Arm weakness, Speech difficulty, Time to call 911) is emphasized. Treatment differences for ischemic (TPA within 3-4.5 hours after CT scan) and hemorrhagic (stopping bleeding, BP control, no anticoagulants) strokes are vital. Diabetes emergencies, DKA (Type 1, acidosis, Kussmaul breathing, fruity breath, treat with fluids, insulin, potassium) and HHS (Type 2, severe dehydration, neurological changes, treat with fluids, insulin) are differentiated.
Therapeutic communication focuses on encouraging patients to express feelings, reflecting, clarifying, and using open-ended questions. Non-therapeutic communication (asking 'why', false reassurance, minimizing feelings, making it about oneself, blocking communication) is to be avoided. Schizophrenia symptoms (positive: hallucinations, delusions; negative: flat affect, withdrawal) are outlined. Strategies for responding to hallucinations (acknowledge feelings while staying in reality, redirect, ensure safety) and delusions/paranoia (acknowledge feelings without arguing, encourage reality-based thinking, maintain calm environment) are provided.