NCLEX-RN 2023

Isotonic IV fluids
NS And lactated Ringers

Are used as fluid replacement for fluid volume deficit

Serum phenytoin

10-20 mcg/ml

Normal glucose
Infant

40-60mg/dl

Normal resp for infant

30-60

Normal temp for infant

97.7-99.7

What is the antidote for norepinephrine?

Phentolamine (Regitine)

What is autonomic dysreflexia?

Life-threatening condition in a client with high spinal cord injury

Classic symptoms of autonomic dysreflexia?

Severe hypotension, throbbing headache,diaphoresis,bradycardia,flushing and piloerection.

Magnesium

1.5-2.5 mEq

What is the therapeutic magnesium level to prevent seizures in a preeclamptic client?

4-7 mEq

Absent or decreased deep-tendon reflexes

Earliest sign of magnesium toxicity

Calcium gluconate (antidote)

Magnesium toxicity

Magnesium sulfate IV antidote?

Calcium gluconate IV

Acetaminophen

N-acetylcysteine
Most effective if given w/in 8hrs of ingesting acetaminophen

Anticholinergics

Physostigmine

Arsenic

Chelation therapy:
1.dimercarpol
2.penincillamine
3.calcium disodium edetate
4. Succimer

Benzodiazepines

Flumazenil

Beta blockers

(High dose) glucagon

Calcium channel blockers

Glucagon, calcium chloride, calcium gluconate

Cholinergics

Atropine,pralidoxime

Cyanide

Amyl nitrate
Sodium thiosulfate
Hyperbaric oxygen chamber

Digitalis/digoxin

Digoxin antibodies: digoxin immune fab, digifab,digibind

Dnoxaparin

Protamine sulfate

Ethylene glycol

Ethanol
Fomepizole
Pyridoxine hydrochloride(vitamin b6)

Heparin

Protamine sulfate

Hypoglycemic agents

Glucagon
Octreotide

Iron

Deferoxamine mesylate

Lead

Chelation therapy
1. Dimercarpol
2. Penincillamine
3. Succimer

Mercury

Chelation therapy

Methanol

Folic acid and then folic acid fomepizole

Mushrooms,muscarinic

Atropine sulfate

Nerve gas( sarin, soman and VX)

Atropine sulfate
Pralidoxime chloride

Opiods(codeine,morphine)

Naloxone, nalmefene

Snakes( rattle snakes,copperheads, cottonmouth)

Antivenin(crotalidae) polyvalent(equine origin) crotalidae polyvalent immune fab(ovine)

Spiders(black widow)

Antivenin( latrodectus Mactans) equine

Tricyclic antidepressants

Sodium bicarbonate

Vasopressor infiltration and extravasation

Phentolamine mesylate

Warfarin

Phytonadione( vitamin k)

Normal neonate HR

110-160

Creatinine

0.6-1.3

BUN

6-20

Hematocrit

39-50%

Hemoglobin

13.2 -17.3

Therapeutic INR
Client with mechanical heart valve

2.5-3.5

Normal INR

0.75-1.25

Therapeutic INR to treat A-FIB

2-3

Normal CVP

2-8

Elevated CVP can indicate?

Right ventricular failure aka fluid volume over load

S/S fluid overload:

Peripheral edema
Increase urine output that is dilute
Rapid weight gain
S3 heart soundin adults
Tachypnea,dyspnea,crackle in lungs
Boundig peripheral pulses

What is refeeding syndrome?

A potential lethal complication of nutritional replenishment in malnourished pt

Key signs of refeeding syndrome?

Rapid decline in phosphorus, potassium, and/or magnesium

What is a potential complication of acute pericarditis?

Cardiac tamponade

S/S of tamponade

JVD, distant heart sounds, and decreased bp

5 stages of grief

denial, anger,bargain,depression,acceptance

what is wernickes (kortakoff's) syndrome?

Psychosis induced by Vitamin B1(thiamine) deficiency

Primary symptoms of wernickes (kortakoof's) syndrome?

amnesia with confabulation (making up stories)

what is aversion therapy?

when you try and make the patient hate something

antabus/Revia onset and duration used for aversion therapy?

2 weeks

pt. teaching on antaeus /Revia:

avoid all forms of alcohol to avoid nausea, vomiting, death

the difference between alcohol withdrawals and delirium tremens?

alcohol withdrawals is NOT life threating
delirious tremens CAN kill you

how to remember aminoglycoslides?

think " A MEAN OLD MACIN"

when are aminoglycolides given?

used to treat serious, life threatening and resilienant infection

what most you remember about aminoglycolides?

all aminoglycolides end in MYCIN but not all drugs that end in MYCIN are aminoglycolides

examples of wanna be mycin's?

azythromycin, clarithromycin, arthromycin

toxic effect of aminoglycolides?

ototoxicity: monitor hearing, balance, and tints
neprotoxocoty: monitor creatine (kidney)

frequency of aminoglycolides adminstration?

every 8 hrs

when do you only give amnioglycolides PO?

hepatic encepalopathy ( r/t high ammonia levels)
pre op bowel prep

who can sterilize your bowels?

"Neo-Kan"

when do you ALWAYS draw the through?

30 minutes before next dose

when do you draw the peak levels of sublingual medications?

5-10 min after drug dissolved

when do you draw the peak level IV medications?

15-30 min after medication is finished

when do you draw the peak level of IM medication?

30-60 min after injecting it

how to take off PPE? take it off alphabetic order

gloves, googles, gowns, mask

how to put on PPE? put it on alphabetic order only that mask comes second

gowns, mask, googles, gloves

what are calcium channel blockers?

they are like valium for the heart. what does that mean? it relaxes the heart

what are calcium channel blockers consider?

calcium channel blockers are cardiac depressants.
they are considered negative inotropic, chronotropic, dromotropic.
medications: calcium channel blockers, beta blockers

what are cardiac stimulants?

positive inotropic, chronotropic, dromotropic
medications are: atropine, epinephrine, and norepinephrine

what does calcium channel blockers treat?

anti hypertensive (decrease bp)
anti angina
anti-atrial arrhythmic ( atrial flutter, atrial fibrillation)

what are some of the side effects of calcium channel blockers?

headache- vasodilation of brain
hypotension- relaxes heart and bp

can you give calcium channel blockers on a client with supra ventricular tachycardia ?

yes. because the indication of supra ventricular means its above the ventricle which is were the atrial is located.

name of calcium channel blockers can be remember by

anything finished in DIPINE
BUT verapamil and cardizem are also calcium channel blockers

what do you monitor for cardizemp?

check bp. if bp systolic is less than 100 hold calcium channel blockers

QRS refers to?

ventricular

P WAVE refers to?

atrial

what is systole?

a lack of QRS depolarization ( flat line)

atrial flutter is?

rapid P wave depolarization in a "saw tooth pattern"

atrial fibrillation is?

chaotic P wave depolarization

chaotic P wave depolarization?

used to describe fibrillation

ventricular fibrillation?

chaotics QRS

ventricular tachycardia?

wide bizarre QRS

PVC IS?

periodic wide, bizarre QRS

Be concerned about PVC's if?

more than 6 per minute
6 in a row
PVC falls on T wave of previous beat

what are the lethal arrhythmias?

asystole and ventricular fibrillation ( high priority)

what do asystole an ventricular fibrillation have in common?

they have no cardiac output

what is the potentially life threatening arryhtmias?

V TACH, A FIB, A FLUTTER

When dealing with an IV push drug?

if you don't know go slow EXCEPT adenocard

what is the treatment for PVC's?

lidocaine and amiodarone

What is the treatment for V tach?

lidocaine and amiodarone

what are the treatment for supra ventricular arrhythmias?

A- adenocard/adenosine ( push in less than 8 secs: fast IV push)
B- beta blockers ( lol) headache & hypotension
C-calcium channel blockers- better for asthma and COPD pts.
D- digatilis- digoxin( lanoxin)

what is treatment for V FIB?

YOU DEFIB (SHOCK THEM)