Nclex Review
Nclex Review
Nclex Review
Blood Products
IV Therapy
Parental Nutrition
Medication Classification
Focus on the subject of the question and note whether the question is asking
about the intended effect, side effect, or adverse effect.
It is nearly impossible to learn everything about every individual medication.
Learn medications by their classifications because of the similarities that exist
among medications in a given classification (e.g., bronchodilators dilate the
bronchi of the lungs).
Learn medications belonging to a particular classification by remembering
commonalities in their names (e.g., the names of xanthine bronchodilators,
such as theophylline, end in -line). (Specific commonalities are discussed on
the next screen.)
Learn to recognize the side effects commonly associated with each class of
medications and then relate the appropriate nursing interventions to each
side effect (e.g., if a side effect is hypertension, the associated nursing
intervention would be to monitor the client's blood pressure).
Look at the medication name and use medical terminology to help determine
the medications action (e.g., lopressor lowers ["lo"] the blood pressure
["pressor"]).
Assess the client for allergies and hypersensitivity to the prescribed
medication.
Assess the client for existing medical disorders that contraindicate the
administration of a prescribed medication.
The older client and the neonate and infant are at greater risk for medication
toxicity than are the adult client.
Nursing interventions always include checking the client's vital signs,
monitoring significant laboratory results, watching for side effects of the
medication, and client education.
Many medications are contraindicated in pregnancy, during breastfeeding,
and in infants and children.
The client should avoid taking over-the-counter medications or any other
medications (e.g., herbal preparations) unless they are approved for use by
the healthcare provider.
The client should wear a Medic-Alert bracelet if he or she is taking certain
medications such as anticoagulants, oral hypoglycemics or insulin, certain
cardiac medications, corticosteroids and glucocorticoids, antimyasthenic
medications, anticonvulsants, and monoamine oxidase inhibitors.
The client should follow up with the healthcare provider as prescribed.
Androgens: Most names end with -terone (e.g., testosterone).
Angiotensin-converting enzyme (ACE) inhibitors: Most names end with
-pril (e.g., enalapril [Vasotec]).
Antidiuretic hormones: Most names end in -pressin (e.g., desmopressin
[DDAVP]).
Antilipemic medications: Many end with -statin (e.g., atorvastatin
[Lipitor]).
Antiviral medications: Most contain vir (e.g., acyclovir [Zovirax]).
Benzodiazepines: Although this class includes medications such as
alprazolam (Xanax) and chlordiazepoxide (Librium), most names such as
diazepam (Valium) end in -pam. (Another tip for identifying a benzodiazepine:
The name includes a vowel-z-vowel combination.)
Beta-adrenergic blockers: Most names end with -lol (e.g., atenolol
[Tenormin]).
Calcium channel blockers: Most names end in -pine (e.g., amiodipine
[Norvasc]); exceptions include diltiazem (Cardizem, Cardizem SR) and
verapamil (Calan, Isoptin).
Carbonic anhydrase inhibitors: Most names end in -mide (e.g.,
dorzolamide [Trusopt]). These medications are used to treat glaucoma.
Estrogens: Most names contain -est (e.g., estradiol (Estrace) or conjugated
estrogen [Premarin]).
Glucocorticoids and corticosteroids: Most names end in -sone (e.g.,
prednisone).
Histamine H2 receptor antagonists: Most names end in -dine (e.g.,
cimetidine [Tagamet]).
Nitrates: Most names contain nitr (e.g., nitroglycerin [Nitrostat]).
Pancreatic enzyme replacements: Most names contain pancre (e.g.,
pancrealipase [Pancrease]).
Proton pump inhibitors: Most names end in -zole (e.g., lansoprazole
[Prevacid]).
Cardiac Disorders
Stay with the client when the client is experiencing chest pain.
The head of the bed is elevated for a client with a cardiac disorder.
Vital signs are monitored and the apical heart rate counted for 1 full minute.
Assist the client in identifying risk factors that can be modified and help the
client set goals that will promote the necessary lifestyle changes.
The client must be instructed in the use of prescribed medications.
Teach the client about necessary dietary changes; such changes are not
temporary and must be maintained for life.
Aid the client who has mobility restrictions in performing range-of-motion
exercises to prevent thrombus formation and maintain muscle strength.
Provide reassurance to the client and family.
Provide information to the client on community resources for exercise,
smoking cessation, and stress reduction.
Venous Disorders
Arterial Disorders
Teach the client to walk to the point of claudication, stop and rest, then walk
a little farther.
Instruct the client to elevate the feet while at rest but to refrain from
elevating them above the level of the heart, because extreme elevation slows
arterial blood flow to the feet. (In severe peripheral arterial disease, a client
with edema may sleep with the affected limb hanging from the bed or sit
upright in a chair for comfort.)
The client should avoid crossing the legs, avoid exposing the extremities to
cold (which causes vasoconstriction), and wear socks or insulated shoes for
warmth at all times.
Warn the client never to apply heat directly to the limb (e.g., heating pad or
hot water), because the decreased sensitivity in the limb make it easier to
sustain a burn.
The client should inspect the skin of the extremities daily and report signs of
skin breakdown.
Advise the client to avoid the use of tobacco and caffeine because of their
vasoconstrictive effects.
Endocrine Disorders
Integumentary Disorders
Oncology Disorders
Priority concerns for the client with an oncological disorder include relieving
pain, monitoring for life-threatening conditions such as infection and
bleeding, and addressing end-of-life issues as appropriate.
Remember that pain is what the client says that it is; do not undermedicate
the cancer client who is in pain.
GI Disorders
Respiratory Disorders
Renal Disorders
Intake and output, weight, and vital signs should be monitored closely in the
client with a kidney disorder.
The blood urea nitrogen (BUN) and creatinine levels must be monitored,
because they reflect renal function.
The nurse must be aware of any nephrotoxic medications being taken by the
client.
The manifestations of acute kidney injury and chronic kidney disease are the
result of the retention of waste and fluids and the inability of the kidneys to
regulate electrolytes.
Continuous cardiac monitoring should be instituted in the client with acute
kidney injury or chronic kidney disease, because hyperkalemia may develop,
resulting in life-threatening dysrhythmias.
Graft rejection is a primary concern after transplantation.
Eye Disorders
Ears Disorders
Risk factors for ear disorders include advancing age, infection, medications,
ototoxicity, trauma, and tumors; genetics may also play a part.
The nurse must choose an appropriate means of communication with the
client with a hearing disorder.
Safety is a priority concern for the client with an ear disorder.
Ear irrigation is contraindicated in clients with tympanic membrane
perforation or a history of perforation.
The maximal amount of irrigation solution that should be used is 50 to 70 mL.
The temperature of irrigation solution should be close to that of the body.
During irrigation, the solution is directed toward the wall of the ear canal.
Neurological Disorders
Measures to ensure safety are a priority for the client with a neurological
disorder.
Promote independence in regard to self-care activities as much as possible.
Encourage discussion about the psychosocial issues that may occur as a
result of the neurological disorder (e.g., body image alterations, altered
sexual function).
Musculoskeletal Disorders
Immune Disorders
Protecting the client with an immune disorder from infection is the primary
intervention.
Standard precautions are maintained to prevent infection.
Provide protective isolation if the clients immune system is depressed.
Immunotherapy may be prescribed to stabilize the immune system.
Have resuscitation equipment available if skin testing is performed, because
the allergen may induce an anaphylactic reaction.
The infant or child infected with HIV is at risk for life-threatening opportunistic
infection; monitor the client closely for signs of infection and report these
signs immediately to the physician if they occur.
Medical Emergencies
Hemodynamics
Women infected with HIV may first demonstrate symptoms at the time of
pregnancy or contract life-threatening infection because normal pregnancy
involves some suppression of the maternal immune system.
The mother with HIV is managed as high-risk because she is vulnerable to
infection.
The mother with cardiac disease may be unable to physiologically cope with
the added plasma volume and increased cardiac output that occur during
pregnancy.
During the first trimester, insulin needs in the diabetic client decrease.
During the second and third trimesters, increases in placental hormones
cause an insulin-resistant state, requiring an increase in the diabetic mother's
insulin dose.
Causes of disseminated intravascular coagulation include abruptio placentae,
intrauterine fetal death, amniotic fluid embolism, severe preeclampsia,
sepsis, and hemorrhage.
HBV is transmitted through blood, saliva, vaginal secretions, semen, and
breast milk and across the placental barrier.
Pyridoxine (vitamin B6) should be administered with isoniazid to the pregnant
woman with tuberculosis to help prevent fetal neurotoxicity.
If a pregnant woman is not immune to rubella, she should be vaccinated
during the postpartum period and avoid becoming pregnant for at least 3
months after receiving the vaccine.
The classic signs of preeclampsia are hypertension, generalized edema, and
proteinuria.
If umbilical cord prolapse occurs, relieve cord pressure immediately by
putting a sterile gloved hand into the vagina and holding the presenting part
off the umbilical cord; place the mother in a modified Sims, Trendelenburg, or
knee-chest position to minimize pressure on the cord.
Sudden onset of painless bright-red vaginal bleeding in the second half of
pregnancy is a sign of placenta previa.
Painful dark-red vaginal bleeding occurs in placental abruption.
Regardless of the serum bilirubin level, the appearance of jaundice during the
first day of life indicates a pathological process.
Hypoglycemia, respiratory distress, hypocalcemia, and hyperbilirubinemia
can occur in an infant born to a mother with diabetes mellitus.
Pediatric Disorders