2021 NCLEX RN Uworld Comprehensive Study Guide 100 PagesPharmacology & Need to Know Medications................Page 3-13Fundamentals & Delegation..........................................Page 14-17Ethical Principals & Law..................................................Page 18-20Integumentary.................................................................Page 21-23Respiratory Disorders & Nursing
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2021 NCLEX RN Uworld Comprehensive Study Guide 100 Pages
Pharmacology & Need to Know Medications................Page 3-13
Fundamentals & Delegation..........................................Page 14-17
Ethical Principals & Law..................................................Page 18-20
Integumentary.................................................................Page 21-23
Respiratory Disorders & Nursing Considerations.......Page 24-32
Disorders of the Heart & Circulation...........................Page 33- 44
Musculoskeletal Disorders.............................................Page 45-47
Diabetes & Insulin.................................................................Page 48
Contact Precautions & Infectious Disease....................Page 49-53
Renal Disorders & Nursing Considerations..................Page 54-58
GI Disorders......................................................................Page 59-60
Spinal Cord Injuries..........................................................Page 61-62
Neuro & Brain..................................................................Page 63- 68
Visual/Auditory & Nursing Considerations...................Page 69- 71
Psychiatric Nursing..........................................................Page 72- 75
Endocrine Disorders........................................................Page 76- 79
Reproductive & Sexual Health........................................Page 80- 81
Maternal- Antepartum.....................................................Page 82- 88
Labor & Delivery................................................................Page 89- 92
Postpartum & Newborn...................................................Page 93- 95
Pediatric Nursing............................................................Page 96- 100
PHARMACOLOGY
Vitamin k is the antagonist
used to prevent blood clots in clients with atrial fibrillation, artificial heart valves, or a
history of thrombosis
Intake of vitamin k rich foods can decrease effect ( broccoli, spinach, liver)
Monitor INR levels
Pregnant women should not take
Avoid aspirin, NSAIDS, and alcohol If recovering from a PE,
Warfarin is usually taken for 3-6 months
Antibiotics can affect INR levels
INR level 3.0-3.5
contraindicated in pregnancy
First line drug therapy for SVT
Administer over 1-2 minutes then flush with saline
Find a line closest to the heart
End with -il, controls high blood pressure
Check blood pressure before administering
Check potassium levels before administering because these medications increase
potassium levels
Can cause a dry cough and reflex tachycardia
Can have severe adverse effects of angioedema
Do not take while pregnant
Can cause orthostatic hypertension
If a client cannot tolerate ACE inhibitor then they are prescribed ARBS (-an) drugs
CCB are like valium to your heart
Help control atrial fibrillation
End in -em like diltiazem
Also end in -ine (Amlodipine)
Most severe adverse effect is dizziness
Do not drink grapefruit juice while taking this or statins
Measure blood pressure before administering, if systolic is under 100 then you hold CCB
Warfarin
Adenosine
ACE Inhibitors
Calcium Channel Blockers
Clients with hypertension should not take over the counter medications for colds, these
medications have decongestants and can cause vasoconstriction
Calcium channel blocker vasodilator
Brings blood pressure down, usually after stroke and patients get extremely hypertensive
(systolic over 240)
The nurse should bring the blood pressure down but not below 170 (systolic)
Priority nursing interventions are to monitor for hypotensive effects of this drug
Helps control heart rate and blood pressure (mainly heart rate)
Side effects may be bronchospasms
Do not give to people with asthma
The nurse should assess for any wheezing
May mask signs of hypoglycemia
End with - an like Losartan (sartans)
Should not be taken while pregnant
Helps lower blood pressure
Can cause hyperkalemia
Do not take with salt substitutes
Increases cardiac contractility and slows the heart rate and conduction (slows the rate of
conduction through the AV node)
NOT a vasodilator
Decreases workload of the heart It is used in heart failure and atrial fibrillation
Excreted exclusively by the kidneys so need to check kidney function (creatinine and BUN)
Digoxin toxicity: N/V, GI symptoms are the earliest sign, confusion, weakness,
Toxic level above 2
visual symptoms, cardiac arrhythmias
Hypokalemia can cause digoxin toxicity
Treats A fib and heart failure
Increased risk for bleeding
Helps prevent platelet aggregation
Clients should be assessed for black tarry stools, bleeding gums, hematuria, bruising,
monitor platelets
Should not be taken with Ginko
Inhibits platelet aggregation, prevents thrombus formation, and reduces heart
inflammation
Clients can receive this when they do not have signs of bleeding or low platelet levels
Nicardipine
Beta Blockers
ARBS
Digoxin
Antiplatelet Therapy Drugs
plavix , antiplatelet medication that should be discontinued 5-7 days before surgery
Can increase risk of bleeding so the HCP should be notified if low platelet levels (<150000)
Helps prevent blood clots
Decreases preload
Nitrate that causes vasodilation
At risk for hypotension
Can cause headache
The nurse should follow up of the client feels dizzy or lightheaded
1 pill every 5 minutes and up to 3 doses EMS should be called if pain is not alleviated by 5
minutes after the first pill
Headache and flushing are common side effects
Sit or lie down before taking the pill
Store away from heat and light
Helps lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease
Reduces LDL levels, triglycerides, and total cholesterol levels
Taken at night with evening meals
Muscle aches are a serious side effect
Report muscle pains or weakness, could be a sign of rhabdomyolysis
Liver function test should be assessed before giving
Lower LDL lipid levels
Monitor for muscle pain or weakness
All NSAIDS are associated with: GI bleeding, black tarry stools, stomach pain can be
reduced if taken with food
Kidney injury, long term use is associated with this
Hypertension and heart failure
Increase risk for bleeding
Should be avoided in clients with kidney disease, nephrotoxic, COPD
Long term use can cause peptic ulcers and chronic kidney disease, exacerbate
hypertension and cardiac problems
Ibuprofen
NSAID
Commonly prescribed to relieve joint pain and inflammation
Clopidogrel
Nitroglycerin
Statin
Atorvastatin
NSAIDS
Naproxen
Toradol
Highly potent NSAID
Subcutaneous or IV anticoagulation medication
Administer at 90 degrees or 45 degrees depending on how much adipose tissue they have
Administer 2 inches away from umbilicus
Works immediately
Cannot be given for longer than 3 weeks (accept for lovenox)
Antidote is protamine sulfate
Lab test that monitors heparin is PTT
PTT time should be 1.5 - 2.0 times the normal clotting time of 25-35 seconds
Too long could cause spontaneous bleeding
Can be given to pregnant women
Risk is HIT (drop in the number of platelets) Heparin should be held when there is a drop
in platelet
Must be administered in 3-4.5 hours
Surgery within 2 weeks is contraindicated
Platelet less than 100000 or coagulation disorders should not receive it
muscle relaxer
Side effects: Fatigue and muscle weakness
Teach: don't drink, don't drive, and don't operate heavy machinery for patients
Muscle relaxer
Flex = muscle
Iron supplement, avoid giving with calcium supplements and antacids because that
decreases absorption
Client should increase intake of fluids because these cause constipation
Taking with vitamin c like orange juice enhances absorption
Administer 1 hour before meals or 2 hours after meals
Keterolac
Heparin
TPA
Baclofen
Flexeril
Ferrous Sulfate
Medication for hypothyroidism
Used to replace thyroid hormone
Safe to take during pregnancy
Do not take with antacids, calcium or iron (avoid over the counter
multivitamins)
Take on an empty stomach, in the morning, separately from other
medications
Lifelong therapy, blood test needed
This medication will improve mood, higher energy levels, take up to 8 weeks to
work, normal heart rate
Takes 3-4 weeks for effect
Prednisone
Given to combat inflammation in the lungs to COPD patients
These medications can cause in increase in sugar
If the patient is a diabetic, anticipate giving more insulin
Started high dose then tapered slowly
Treats diabetes insipidus
Mimics ADH
Increases renal water absorption and concentrates urine
Clients receiving this must have their electrolytes closely monitored for water
intoxication/ hyponatremia (headache, mental status, weakness)
Severe hyponatremia may cause seizures, neurological damage, or death
Treats rheumatoid arthritis and psoriasis
Can cause bone marrow suppression, clients are at risk for infection
They should avoid large crowds and receive killed immunizations (flu,
pneumonia)
Avoid alcohol (can cause hepatotoxicity) and pregnancy with these drugs
Endocrine Medications
Levothyroxine
Corticosteroids
Desmopressin
Methotrexate
Keppra
Anticonvulsant prescribed for seizures
Depresses the CNS and can cause drowsiness, this improves after a few weeks
Associated with suicidal ideations and should be reported to the HCP
Can trigger steven johnsons syndrome
No driving until approved by HCP
Treats migraine headaches
Work by constricting cranial blood vessels
Contraindicated in clients with coronary artery disease and uncontrolled
hypertension
For motion sickness
Apply 4 hours before
Keep on for 72 hours
Apply behind ear
Dilantin, is an anti seizure medication with a therapeutic index of 10-20
Tube feedings decrease phenytoin absorption which can reduce the drugs
effect and produce seizures
The nurse should pause tube feedings for 1-2 hours before and after
administration of these drug to increase absorption
Early signs of toxicity include: horizontal nystagmus and gait unsteadiness
Commonly taken at bedtime
Antianxiety drug
Do not ever stop abruptly
Versed
Benzodiazepine commonly used to induce conscious sedation
Flumazenil ( Romazicon) is the antidote to reverse benzo effects
Neurological Medications
Levetiracetam
Sumatriptan
Scopolamine
Phenytoin
Benzodiazepine
Midazolam
Patients are usually prescribed Flagyl ( Metronidazole)
For severe C Diff vancomycin may be used
For treatment of TB
Can experience neurological effects due to the decrease in the body's ability to
utilize B6
The patient needs additional doses of B6
Zyvox
Should not be taken with SSRI because can cause serotonin syndrome
Azithromycin
These can cause prolonged QT intervals in patients
ECG should be monitored
Can also cause hepatotoxicity
Draw trough prior to administration, 10-20 is a therapeutic level Infuse
medication over at least 60 minutes
Monitor blood pressure
Assess for hypersensitivity (red man syndrome)
Monitor for anaphylaxis
Check IV site every 30 minutes CVC catheter is preferred
Creatinine levels are the most important value to monitor because
vancomycin can cause nephrotoxicityIf creatinine is high this is a complication
of nephrotoxicity
Helps fight bacterial infections of the skin
Take on an empty stomach
Avoid taking with dairy products, iron supplements, or antacids
Take with a full glass of water
Wear sunblock because risk of photosensitivity
Use additional contraceptive medications
Infectious Disease Medications
Medications for CDiff
Isoniazid (INH)
Linezolid
Macrolide Antibiotics
IV Vancomycin
Tetracycline
Stool softener that reduces straining during bowel movement, puts less stress on heart
Straining can also cause bradycardia due to vagal response
Most commonly used drug for heart failure
Lasix
Can increase risk of bleeding
COX- 2 I inhibitor
Black box warning with increased risk for cardiovascular complications
Back pain, nausea, vomiting, would need to be assessed immediately
Decreases cardiac workload
Pain treatment and terminal dyspnea
Decreases cardiac irritability
Avoid intake of alcohol and limit use of acetaminophen
Take vitamin B6 to prevent leg tingling
Avoid aluminum containing antacids
Report changes in vision
Report jaundice, dark urine
Does not change color or urine, that is Rifampin
Adverse effects: hepatotoxicity, peripheral neuropathy
Rifampin: reduced the efficiency of oral contraceptives, changes the color of the urine,
used for TB
Codeine
Opioid and is smaller doses is a cough suppressant
Can cause constipation just like opioids do
Take medicine with food
Drink lots of water
Sit on side of bed before getting up because it can cause hypotension in patients
Never shave before placing patch
Antihypertensive patch that is reapplied every 7 days
Do not remove patch if dizziness occurs
Rotate site with each use
Miscelleneous Drugs
Docusate Sodium
Furosemide
Ginko
Celecoxib
Morphine
Lidocaine
Isoniazid INH
Transdermal Patches
Clonidine
Available in many forms
If a patient has difficulty swallowing, the nurse should consult with the pharmacist to see
if there is other forms
Maybe liquid
Fold when discarding
Change every 72 hours
Not cutting patches
Do not apply heat over the patch (does not aid in absorption)
Over 3 years years pull ear up and back
Less than 3 pulled down and back
Children should be placed prone or supine
Warm ear drops to room temperature
Drop medication against wall of the canal
Age appropriate distraction
Toddlers and infants toys
Preschool and older children deep breaths or count
Infant placed supine with knees and and feet raised
Other children side lying with knees bent
Use water soluble jelly
Insert using 5th finger with children under 3
Hold buttocks together after insertion
Y tubing
Connected with normal saline to keep vein open
Continuous IV fluids used PCA pumps
Children can use as long as they understanding of the device
10-20, above 20 is toxic
Helps relax bronchioles
Seizures in toxicity
Do not take vitamin A supplements, can cause toxicity
Do not give blood on this medication
For severe or cystic acne
Most important to use 2 forms of contraception
KCL
Fentanyl Patch
Ear Drops
Rectal Suppository
PCA PUMP
Aminophylline
Isotretinoin
May cause ototoxicity, especially in patients with kidney disease
High doses should be administered slowly to prevent this ototoxicity in patients
Viagra
Nitrates and viagra are contraindicated with each other as it can cause life threatening
hypotension
The use of these should be reported to HCP
Glucose should be monitored in those receiving this
End in -ide and -one
Treats hypertension and edema
Major side effects: hypokalemia (muscle cramps and dysrhythmias)
hyponatremia (AMS and seizures)
Hyperglycemia
Used to prevent gout attacks
Inhibits uric acid production and improves solubility
Should be taken with a full glass of water and increase fluids (most important teaching)
Used in the treatment of rheumatoid arthritis
Adverse effects: bone marrow suppression, hepatotoxicity, gastrointestinal irritation
Can lead to thrombocytopenia (small purple dots)
Anticonvulsant for seizures
Never stop taking abruptly
Exception is the development of a rash that may indicate steven johnsons syndrome (flu
like symptoms and a painful rash)
Good dental care is a must, can cause gingival hyperplasia
Can cause suicidal ideation and depression, this an adverse effect
-micine ending
(azithromycin, zithrominine, and clarithromycin)
Treat serious
Think “mice” think ears think ototoxic, tinnitus, vertigo, equilibrium, ringing of the ear,
dizziness
Another toxic effect is nephrotoxicity (monitor creatinine)
IM or IV PO, does not absorb
Oral micines will sterilize the bowels before surgery (neomincine and canominice)
IV Furosemide
Sildenafil
Prednisone
Thiazide Diuretics
Allopurinol
Methotrexate
Phenytoin
Aminoglycosides
IV Fluids
Iv should not exceed 10 mEq/ hr
Iv should be diluted and never given at a concentrated amount, high risk
Can cause hypotension, this side effect is not as noticeable when the client is sitting
down but when they stand up they can have orthostatic hypotension
Those at highest risk for respiratory depression due to administration: the elderly, those
with underlying pulmonary disease, snoring, obesity, smokers
Adverse effect is paralytic ileus (absent bowel sounds) also can happen with potassium
is low
Itching is a normal side effect
Hydromorphone, morphine
Control moderate to severe pain
Side effects: sedation, respiratory depression, hypotension, constipation
Client is at risk for falls and should not get out of bed unless with assistance
Administer daily stool softeners
Administer slowly over 2 to 3 minutes
Recheck pain 15-30 minutes after administering the medication
Can take up to 72 hours for full effect
Not prescribed to patients 1 day post op or for acute pain because of the time it takes
to reach full effect
KCL
Opioids
Opioid Analgesics
Transdermal Fentanyl Patch
FUNDAMENTALS & DELEGATION
Always take it off in alphabetical order
Gloves, goggles, gown, mask OFF
ON reverse for alphabetical for G but mask comes second
Gown, mask, googles, gloves
Hold the cane on the strong side
Close clients eyes
Replace dentures
Disconnect all tubes and lines
Straighten the body and limbs
Place pad under perineum
Wash body
Allow family members to assist with care
Place pillow under the head
Fold towel to put under the chin to close mouth
Address client directly
Speak in short sentences
Pre conference with interpreter
Use qualified interpreter when possible
Avoid translation through family members
The nurse should be mindful to choose interpreter with the patients prefered
age, gender
PPE
Canes
Postmortem Care
Speaking with an Interpreter
Can perform passive range of motion exercises
Take and document vital signs
No trach care or cleaning
Can collect urine specimen
Cannot document color and characteristic of it
They cannot offer orange juice to a client with hypoglycemia
Can assist 1 day post op out of bed to the bathroom
Cannot reinforce teaching
Can remind client to use incentive spirometer
Pick up blood products from the blood bank
Can take vital signs before blood transfusion and after the first 15 minutes of the
transfusion
Can perform oral suctioning (not sterile)
Report patient behavior but not monitor
Can transport body to morgue
Can give topical over the counter barrier creams
Can do vitals and accuchecks
Can delegate ADL’s Measure output in a drainage collection bag
Should be assigned stable clients with expected outcomes
Cannot perform initial teaching, assessments, or evaluate a client’s condition
Can do teaching reinforcement
Can administer anticoagulant medications
Can suction
Can perform sterile procedures (catheterizations)
Can auscultate lung sounds but cannot use that information to evaluate
Can monitor RN findings
Can monitor for bleeding
Cannot start an IV, hang or mix IV meds, push IV meds
They can maintain an IV and document the flow
They cannot administer blood or mess with central lines
Cannot plan care , the LPN can implement it
Cannot perform or develop teaching, they can reinforce it
Cannot take care of unstable patients
They cannot do the very first of anything
They can do tube feedings, but not the first
They can change dressings, but not the first
Cannot do admission, discharge, transfer, or the first assessment after a change
Can not administer or monitor blood transfusions/ products
UAP
LPN
Age is not a criteria for prioritization
Gender is not a criteria for prioritization
Acute beats chronic (higher priority than)
Post op is within 12 hours, beats medical or other surgical
Stable patients: indicate they are stable, chronic illness, post op greater than 12 hours,
regional anesthesia, experiencing the typical, expected signs and symptoms of the disease
with which they were diagnosed
Unstable: suspected, acute, post op less than 12 hours, general anesthesia, patient is
unstable if they are experiencing unexpected signs and symptoms
Always Unstable:Hemorrhage High fevers over 105 Hyperglycemia pulselessness/
breathlessness
Prioritizing Organs :Brain, lung, then heart, then liver, kidneys, pancreas
Prioritization
Assessment is the first step in the nursing process, the nurse should assess and
then intervene
when in doubt, ASSESS FIRST
The breast, axillary nodes, and superior apical nodes are removed, but the
muscles are preserved
Complication of this is lymphedema, can prevent by positioning each joint higher
than the proximal one
Can cause bone marrow suppression and tumor lysis syndrome
Filgrastim stimulate neutrophil production
Assessment
Modified Radical Mastectomy
Chemotherapy
Place client in semi fowler's position
Affected side’s arm needs to be placed on several pillows to promote drainage
Never ignore inappropriate behavior by staff
Ask yourself if what they are doing is illegal?If yes, tell supervisor No, then ask if anyone is
in any immediate danger, if yes, then confront immediately because you don’t want to
delay to put someone at risk If behavior is legal, no harmful, but simply inappropriate,
then speak with them later on
Client allergies and history are confirmed
Assessment
Confirming Informed consent has taken place
Ensuring the client has been NPO
Client voids before surgery
Witnessing that the correct surgical site has been marked
Occurs when doctor does not sign order
Doctor puts wrong amount or unit
The handwriting is not legible
High fowlers for paracentesis
Trendelenburg position and on the left lying side if suspected air embolism
Position client with arms raised above head for chest tube placements
After a liver biopsy the client should lay on the right side for at least 2 hours and then
supine for an additional 12-14 hours
Thoracentesis the patient is upright sitting position on the side of the bed leaning over on
side table with pillow
Teaches activities of daily living (bathing, dressing, cognitive or perception issues)
Focuses on mobility, ambulation, ability to walk, use the walker or other assistive devices
Physical therapy focuses on “below the waist” rehabilitation
Do most good for the most people
Start with victims farthest away from the radioactive explosion
These victims are the most salvageable
Do not accept blood components of any type
DO accept normal saline, Lactated Ringer’s etc., DO accept Epoetin alfa
Mastectomy
Staff Management
Nursing Responsibilities Prior to Surgery
Error in Transcription
Positioning Clients
Occupational Therapy
Physical Therapy
Radioactive Disasters
Jehovah witness
ETHICAL PRINCIPALS/ LAW
Veracity: being truthful
Justice: treating every client equally regardless of background
Accountability: accepting responsibility for actions and admitting errors
Nonmaleficence: do no harm, it also relates to protecting clients who cannot
protect themselves due to mental or physical condition
Fidelity: fulfilling commitments and showing loyalty to one's self and others
Beneficence: the action of promoting good will
“Let’s talk about it”
Surgeon explains the diagnosis and procedure (not the nurse)
Client indicates understanding
The client is competent and gives voluntary signature
The nurse is responsible for witnessing the signature
If the surgery requires additional procedures after the surgery has already
begun and the consent has been signed for specific procedures, then medical
power of attorney, next in kin, or legal guardian should be contacted to
discuss
Nurses role: witness client has signed, voluntarily and competently, document
in medical record that client has signed with date and time,
Physician is responsible for: explaining procedure, answering questions about
procedure, offering alternative options, reinforcing right to refuse
Assault and injury
Failure of treatment or intervention
Hospital equipment fail
Falls
Never document an incident report was filed
Failure to report an important lab value
Mislabeled laboratory specimens
Ethical Principle
Informed Consent
Incidence/ Occurrence Report
Prevents civil action when helping individuals off the job
Cannot receive payment
Essential for the nurse to perform in the same way as on the job (applying
pressure if bleeding)
Must act competently
Universal criteria that are used to determine if appropriate, professional care
has been delivered
Sources used to define standards of care include statements from
professional organizations, agency policies and procedures, textbooks, current
literature, the Nurse practice act, and regulatory organizations
Does not depend on good intentions
Nurse has obligation to report abuse
Child abuse is common in all children ages
Most child abusers have low self-esteem
Abusers have history of growing up in a domestic violence
Abusers have substance abuse problems
When child is dying and parents don’t want treatment, priority is to assess
parents knowledge of situation
This helps clients determine treatment plans and decision makers when or if
the client is unable to do so
Documents include: health care proxy (durable power of attorney or medical
power of attorney) and living will (advance directive)
Providing oxygen via nasal cannula is not considered resuscitation and can be
given
Notified for every clinical death per hospital protocol
Cardiac and respiratory support continue as organ donation is discussed or
performed
Consent is not needed by family if patient has signed to be organ donor
Organ donation does not leave the body disfigured
Good Samaritan Law
Standards of Nursing Practice and Care
Abuse
Advance Care Planning
Local Organ Procurement Services
Practicing outside of scope
Abandonment (leaving patients)
Stealing narcotics
Falsifying documentation
An act that threatens the client and makes them feel harm but they are not
touched
Physical contact with a client without consent
Assesses process standards (guidelines, systems, and operations)
Assesses clinical issues that affect delivery of client care and client outcomes
Implements processes to improve performances
Unanticipated event in the healthcare setting that results in death serious
injury
Radiation damages DNA, which causes cell destruction
Early manifestations of radiation contamination include: oral mucosa
ulcerations, vomiting, diarrhea, and low blood cell count
PPE should be put on before decontamination
Victims should be decontaminated outside the facility
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