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IES--'f SM AR -1= : HOW TO P SS NCLEX l'ifes t -TaK ing S t ra te gi es

I. Prioritizing - Means ranking the client's problems in order of importance depending on:* Iss.u~of the ~uestion < - ~n\! c\:ients rrobie.m* Clinical settmg \ 7cUn icoJ se .. - t- -r i ( ).9* Client's condition [acu\e \~-\ -\hen chm"lc) > ellet,\1 -s co \'1cll h''' n* Needs/problems that require immediate attention ~ trob\-evY) o~i'ng oa-l aci-u,

A. Priority Classification System. ".ll..r.t 'f un'J~~ ~\\i r~t)t+ in h a r : m / i n ~ : : r1. High Priority .?H"ft t\1ttO -\e .nH9 ct?roIltlf>{)~,....... I d~\rlt require ItrliYlfdlOln;. ~u.. I~ non ~~erx;..f\OO It'1'~T1\'lXt-rc-n r~ ..3. Low Priority

B. Guides for Prioritizing1. Keywords or key phrases7.Maslow's Hierarchy of Needs Theorya. Physiological needs are the first priority:(!)A-A\~)' ~f'AI)JB - ~th,w:s. (!).sIt1'~'~.0C - 0I~\Cd'10 ""'b. Painc. Safety3. Steps of the Nursing Process

a. Assessment vs. Implementationb. Expected outcome ~cY' '("0""" c . ~tC:Jae

C. Other PrioritieV. 6# . /6 v-d' I"'-~1. Most acute fleast stable chent2. Complication of the disease condition ..notan expected outcome'

II. Delegation 'andAssignment-makingA. Principles and Guidelines

1. Ensure client safety.2. Focus on what the question is asking for.3. Determine which activity can be delegated safely and legally.4. Match the activity on the basis of the nurse practice Act.5. Provide adequate supervision.

B. Who can do what?1. Unlicensed personnel - Noninvasive tas,the following:

a Ambulationb.Bathing.c. Client transportd. Groominge. Hygiene measures

..i oasic client care activities that include >1iO\.l-1 N\JASVC,Ask

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-2. Licensed Practical or Vocational Nurse - Certain invasive tasks and client careactivities that include the following:

a. Administering oral d. Irrigating woundsmedications e. Monitoring an intravenous

b. Administering intramuscular flow rateand subcutaneous injections f. Suctioning

c. Changing dressings g. Urinary catheterization3. Registered Nurse - Some of the tasks and client care activities that only the registerednurse can perform are as follows:a. Administering intravenous medications

b. Leading others and managing the client care environmentc. Teachingd. Using the nursing process: assessment, analyzing data, planning client care,

implementing.care, and evaluating care

> 1 ' 1 6 \v'PR\,)0S'> f I I O vc; f"'.

m . Test-Taking TechniqueA. Identify the parts of a question.

1. Case situation2. Question stem3. Options

B. Read the question carefully. LOok for ke ords or phrases in the case situation ana stemofUie uestion .Examples:1. What is an early sign of shock? (ee\-\e SSleSc;2. What is the initial nursing action? .Indicates that options are correct and you have toprioritize'3. Which statement by the client indicates understanding of the instruction? /Indicates atrue response question.'

4. Which statement by the client indicates the need for additional teaching? Indicates afalse response question ..

C. Identif}t the issue.What is the question asking?D. Use tlie process ot:elimination.

Involves reading each question and removing the options that are incorrect and do notaddress the issue of th e question.

E . A oi

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-DRUG ADMIHISTRAT-ION~ II

X Volume (or Tab) = Amount of DrugsStock

II. DRUG PREPARATION1. Crushed tablet or capsule should be added to small amount of pureed fruit to facilitateadministration to children or adults with swallO'Ning difficulty.2. Shake bottle of suspensions to evenly distribute drug.3. Prevent incorrect dosage to avoid adverse reaction.

Uf. RATIENrASSESSME1. Check that prescribed dose is within safe range.2. Assess emotional and physical state of patient3. Make sure concurrent therapies do not contraindicate drug.4. Monitor patienfs response to drug therapy.

ESSENTIAL CONSIDERATIONSORAtDRUGS

I. GASTRIC IRRITA:rtON1. Indigestion and Nausea are first indications followed by vomiting.2. Give anti-emetic before drug administration.3. Food or antacid may decrease gastric irritation but its effect on decreased aosorpnon of somedrug must be considered.4. 00not crush or chew enteric-coated tablet..

II. SELECT CONTAAI~DICATION1. Cough syrup nas glucose. Considered this in-patient with Diabetes Mellitus.2. Sodium Bicarbonate and Sodium Penicillin are contraindicated inpatient with Sodiumrestriction.Alternative is Potassium Penicil lin ' : > se~ l : l R . . .ttJ,.~~V1~O:r:13. Elixir and Tincture - consist of alcohol. Considered this in alcoholic patientFOOD AND DRtJG INTeRACTION

h PRESENCE OF FOOD IN G. I. TRACT1. May decrease drug absorption.2. May inactivate drug.3. May enhance therapy by decreasing G. I. Oistress.!h AI:>MINIST-ER : : r : a E FOE~OWING 9RUGS ON AN EMB:r:'l S-TOMACB1. All penicillin and ampicillin.2. Tetracycline --) c tv\l l1'C1\:S Of ~o lovt w I G\ 't'rito..tim c- crac.ke.r~3. Erythromycin4. If G. I. distress occurs, give drug with food.III. - STRESS.DMINISTER THE FOLLOWING DRUGS WITH FOOD TO PREVENT G. I.1. Analgesic and anti-inflammatory agent (indocin and Butazolidin).

2. Anticonvulsant (DUantin)3. Diuretics4. Hematinics - FESO . - Food may decrease absorption of iron.5. Steroids ;>COk'\ ca,vs-e c,t a"eeoi~6. Flagyl7. Furadantin8. Theophylline

IV. ANTICOAGULANT PLUS ASPIRIN MAY LEAD TO BLEEDING TENDENCIES.E xc ell P ro fe ssio na l ... P a ge f

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PARENTAL DRUGSl. INTRAMUSCULAR ADMINISTRATION IN GLUTEAL MUSCLES

1. Patient Position - muscle relaxed, prone with toes or feet pointed inward.2. Encourage deep breathing.3; Distract patient or ask him to wiggle toe.II. INTRAVENOUS FLUID THERAPYWhen the doctor orders an IV to be infused at a specific mUhr volume, you will need three pieces ofinformation in order to calculate the flow rate in gttImln. These are the total volume to be infusedin mt, the calibration of the tubing being used (which you just leamed locate). andthe time (inminutes) ordered for the infusion. This information is used in the following formula.

FORMULAFlow Rate = Volume x Calibration

Time (min)

EXAMPLE 1 The doctor orders an IV to infuse at 125 mllhr. Calculate the ftow rate using aset calibrated at 10 gtVmL .Start by converting 1 hour to 60 minutes

./

125 (mL) x 10 (gttImL)60 (min)

125 x 10= 20.8 = 21 gttlmin60

EXAMPLE 2 Administer an IV of 100 mLln 40 min using a set calibrated at 15 gttImL.100 x 15 = 37.5 = 38 gUlmin

EXAMPLE 3- i O

15 mL of an IV medication is ordered to infuse In 30 min. The set canbration Is60gUlmL15 x 60 = 30 gUlmin

30When an IV order is written specifying volume to be administered in more than one hour theformula can stili be used. However, in order to keep the numbers you are working with as sma. andsimple as possible it is best to add a preliminary step. and determine how many mLlhr the orderedvolume will represent.

EXAMPLE 1 Calculate the ftow ralefor an IV of 1000 mLlo run il') over 8hrs with a setcalibrated at 2Ogtt/mL .1000 mUShr = 1000 + 8 = 125 mUhr125 (mL) x 20 (gttImL)

60 (min) = 41.6 = 42 gttJmin

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VI.VII.

I.IMPLICATIONS: PENICILLINS AND CEPHALOSPORIN - lI,EFt .,

HISTORY OF DRUGALLERGY: Assess the following - l : > eep\-a\ (t?o,t\~ ce.p-alo> p>a) Allergy to any drug. . no ~ c:be;ntb) Infant under 3 months of age. ~tatt C e e p h a . - Jc) Cross-sensitization to bothdrugs.

II. DRUG ADMINISTRATIONa) Oral form bindswith food.b) Poor1yabsorbed in acidic medium.III. I.V. ADMINISTRATIONa) Penicillins are NA or K Salts.1. Check for signs and symptoms of Hyperkalemia or Hypematremia.2. Assess renal insufficiency.3. Assess heart action.IV. ADVERSE REACTIONS OF ALLERGIES MAYBE IMMEDIATE AND MAY OCCUR WITHIN ONEHOUR.A. CLINICAL MANIFESTATIONS1. Urticaria2. Bronchospasm3. Laryngeal Edema4. Hypotension

B. TREATMENT1. Epinephrine2. Airway3. Antihistamines4. Treabnent of shock

I.TETRACYCLINES

FORM NON-ABSORABLE COMPOUND WITH:1. Milk and milk products2. Antacids3. FE preparation4. NSG IMP. Don't give with milk, antacid ~GIVEWITH FOOD IFWITH G. I. SIDE EFFECT.t.iDISCOLORS TEETH AND DELAYS BONE GROWTH UNDER 7YEARS OF AGE.DON'T ADMINISTER TO PREGNANT MOTHER.DECOMPOSES IN FOLLOWING CONDITION:1. Age2. Exposure to light3. Extreme heat and humidity

' > G\\le c fCOd Il'- c G t O\S\~'E~~PATIENT TEACHING> NO\l) $U~ 'E."'XPOSUR.'EADVERSE REACTION1. Nausea, vomiting.2. Diarrhea3. Phototoxic skin reaction (sunburn)

II.III.IV.V .

Excel Professional ...Page ~

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" " , . 1 . S .~\vrV--~s: , ~ (AMINOGl:YCOSIDES 7 p~ ~\)'(" or .~ (Stregtom)'dn, Gentamicin, Kanamycin, Neomycin, Amikasln) ~

I I . Nephrotoxicity .'11 a) Intake and output - > \l9unO\ I{b\CObb) Urinalysisc) Renal function - BUN (~ro-tel< 1 '-/ e ' > u N ~')- f c Ci:iiiitinineI I I . Serum Concentrationa) Therapeutic blood level - 4-10 ug' mlb) Toxic blood level - above 1ctug' mI

I"\\ero.ph c L G \ e J - s : . t < W 'S t l.:.tlo l . J 1 o . J ,G~~c..t'r') ) 4-\0 \ .1 9 .'0 " e a 0')