NCLEX Cram Sheet

1. Lab Values Arterial Blood Gases (ABGs) Cardiac Labs

Basic Metabolic Panel (BMP) pH: 7.35-7.45 Troponin: <0.012 mcg/L

• <7.35 = acidosis CK-MP: 0%-6%
Sodium (Na): 135-145 mEq/L
• >7.35 = alkalosis BNP: <100 pg/mL
• Hyponatremia - low
• Hypernatremia - high PaCO2 : 35-45- mmHg
Urinalysis
Potassium (K): 3.5-5.3 mEq/L • <35 = hypocapnia; alkalosis
• >45 = hypercapnia; acidosis Color: Straw
• Hypokalemia - low Phosphates/urates may cause cloudiness
• Hyperkalemia - high HCO3 : 22-26 mEq/L Turbidity: Clear
Calcium (Ca): 9-11 mg/dL (total) • <22 = acidosis Specific gravity: 1.001-1.02
4.5-5.6 mg/dL (ionized) • >26 = alkalosis Low: sickle cell, DM, diabetes insipidus

Chloride (Cl): 95-105 mEq/L Dipstick: pH 4.5-7.5

PaO2 : 80%-100%
Albumin: 3.9-5.0 g/dL Protein: Negative
Oxygen saturation: >95% Positive: nephritic syndrome, renal tubular disease, pyelonephritis,
ALP: 44-147 IU/L and polycystic kidney disease

Complete Blood Cell Count (CBC) Sugar: Negative

ALT: 8-37 IU/L Positive: diabetes and other endocrine diseases

AST: 10-34 IU/L RBC: Male = 4.5-6.0 µL Acetone/ketones: Negative

Female = 4.0-5.0 µL Positive: non-controlled diabetes, alcoholism, and starvation
BUN: 7-20 mg/dL
WBC: 3.5-10 × 103/mm3 Bile: Negative
CO2 : 20-29 mmol/L
Hgb: Male = 13.5-18.0 g/dL Hemoglobin: Negative
Creatinine: 0.8-1.4 mg/dL Positive: bleeding, kidney/bladder irritation
Female = 12.0-16.0 g/dL
Glucose: 70-100 mg/dL Nitrite: Negative
Hct: Male = 40%-54% Positive: indication of bacteria
Total bilirubin: 0.2-1.9 mg/dL Female = 36%-46%
Leukocyte esterase: Negative
Total protein: 6.3-7.9 g/dL
Nurse illustrations by Storyset
 Urobilinogen: Positive 2. Assessments Wong-Baker FACES:
Urine output: 800-2,000 mL/day (with
Burns - Depth of Injury
intake of 2,000 mL)
1st degree: superficial; reddened skin but 0 2 4 6 8 10
intact
Lipid Profile • Appropriate for children, non-English
2nd degree: partial thickness; loss of skin, speakers, and illiterate patients or
Total cholesterol: 200 mg/dL into dermis (most painful) patients with cognitive impairment
• Moderate risk: 200-240 mg/dL 3rd degree: full thickness; loss of all skin, • Pediatric and adult versions
• High risk: >240 mg/dL can see fat/muscle
CPOT:
High-density lipoprotein (HDL): 4th degree: full thickness + underlying
tissue, can see to bone • Used in critical care settings
• 29-77 mg/dL
Low-density lipoprotein (LDL): PAINAD:
Rules of Nines
• 60-160 mg/dL • Appropriate for adults with cognitive
Head and neck: 9% impairment
Triglyceride level: 10-190 mg/dL Children: 18%
CRIES:
Anterior torso: 18%
• Used to assess pain in neonates
BMI Posterior torso: 18%
Crying
Scores for adults 20+ Each leg: 18%
Children: 13.5% Requires O2
Underweight: <18.5
Each arm: 18% Increased vital sign
Normal weight: 18.5-24.9
Genitalia/perineum: 1% Expression
Overweight: 25.0-29.9
Sleepiness
Obese: 30+ Pain Assessment/Pain Scales
FLACC:
Scores for adults <20 Visual Analog Scale (VAS): • Appropriate for children up to 3 years
Underweight: <5th percentile • Used to determine baseline pain and older children with cognitive
Overweight risk: 85th percentile
Patient Comfort Assessment Guide: impairment
Overweight: >95th percentile • Used to assess pain status and pain Face
relief, and response to medications
Legs
Weight in kilograms (Weight in pounds) × 703 Brief Pain Inventory: Activity
BMI = =
(Height in meters)2 (Height in inches)2
• Used to assess pain’s affect on activity Cry
Consolability
 3. Newborn Newborn Reflexes Trunk incurvation:
With the infant prone, stroking down one
Vital Signs Babinski: side of the spine should result in the pelvis
The toes should hyperextend when the turning toward the stroked side.
Heart rate: 100-160 (average 140-160) side or sole of the foot is stroked from
Respiratory: 30-60 heel to ball of the foot.

Blood pressure: systolic 70-90 mmHg Blinking:

4. Pharmacology
The eyes should close if a light is flashed
Apgar Score into them.
Prefixes/Suffixes and Roles
Appearance (color): Moro (startle): Blood pressure medications
• 0: pale blue The limbs and neck should extend ACE inhibitors (-pril ):
• 1: body pink, extremities blush symmetrically and then pull back in Relax blood vessels, which decreases the
response to a loud noise or jolt. heart’s workload
• 2: completely pink
Pulse (heart rate): Palmar gasp:
Beta-blockers (-lol ):
When the palm is stroked with one finger,
• 0: absent Reduce blood pressure by slowing the
the infant should grasp that finger.
• 1: slow or <100 heart rate and reducing myocardial
Rooting: contractility
• 2: >100
When the cheek is stroked, the infant’s
Grimace (reflex irritability): mouth should open and the head should Calcium channel blockers (-dipine):
• 0: none turn to the side that was touched. Relax blood vessels, which increases
blood supply and oxygen to the heart
• 1: grimace
Sucking:
• 2: vigorous crying The infant should suck when the mouth Angiotensin blockers (-sartan):
is touched. Inhibit blood vessel constriction
Activity (muscle tone):
• 0: flaccid Tongue extrusion: Potassium-sparing diuretics (-actone):
• 1: some extremity flexion The tongue should push out of the mouth Promote diuresis while retaining
• 2: active motion when the tip of the tongue is touched. potassium in the body

Respirations (muscle tone): Tonic neck (fencing): Thiazide diuretics (-thiazide):

• 0: absent With the infant lying flat and the head Promote diuresis by inhibiting the
turned to one side, the limbs on the reabsorption of luminal sodium
• 1: slow and irregular
opposite side should flex, and the limbs
• 2: vigorous crying on the same side should extend.
Cardiovascular medications Intestinal medications Miscellaneous medications

Anticoagulants (-arin): Antiemetics (-azine): Antifungals (-azole):

Prevent blood coagulation or prolong Treat nausea and vomiting Treat fungal infections
clotting time
Proton pump inhibitors (-prazole): Antivirals (-vir):
Antilipidemics (-statin): Reduce gastric acis production Treat viral infections
Reduce LDL cholesterol and
cardiovascular disease H2 receptor antagonists (-tidine): Barbiturates (-barbital):
Block the action of histimine in the Increase the effect of GABA in the CNS,
Thrombolytics (-ase): stomach, which decreases the production which reduces excitability and produces
Relax blood vessels, which increases of stomach acid sedation
blood supply and oxygen to the heart
Respiratory medications Corticosteroids (-sone OR -lone):
Control many different systems as
Antibiotic medications Antihistamines (-ine):
anti-inflammatory drugs
Treat allergy symptoms
Aminoglycosides (-mycin):
Treat aerobic gram-negative infections Local anesthetics (-caine):
Bronchodilators (-terol ):
Treat asthma and its symptoms and Prevent the transmission of nerve
Cephalosporins (ceph- OR cef-): impulses or pain without causing
dilate the bronchi and bronchioles, which
Treat bacterial infections unconsciousness
increases airflow to the lungs
Fluoroquinolones (-floxacin): Methylxanthines (-phylline): Oral hypoglycemics (-ide):
Treat bacterial infections as Treat airway obstructions and asthma Lower blood sugar for diabetic patients
broad-spectrum antibiotics symptoms and relax the smooth muscle
of the bronchioles, which results in Protease inhibitors (-navir):
Penicillins (-cillin): dilation of the airway Treat viral infections as antiretroviral
Treat bacterial infections agents
Anti-anxiety and antidepressant medications
Tetracyclines (-cycline):
Treat/prevent bacterial infections by Benzodiazepines (-pam OR -lam): Avoidances
slowing bacterial growth as Treat anxiety
broad-spectrum antimicrobials ACE inhibitors:
SSRIs (-pram OR -ine ): • Foods high in potassium
Sulfonamides (sulfa-): Treat major depressive disorders and
anxiety disorders by blocking or • Potassium supplements
Treat bacterial and fungal infections
delaying the reabsorption of serotonin
Antibiotics: MAO inhibitors: Eight Rights of Medication Administration
• Milk • Alcohol 1. Right patient
• Caffeine • Non-alcoholic beer/wine
2. Right medication
• Products containing iron • Caffeine
3. Right dose
• Foods high in tyramine
Anticoagulants: 4. Right route
• Foods high in vitamin K 5. Right time
• Vitamin E supplements Toxicity Reversal Agents 6. Right documentation
Antifungals: Acetaminophen: N-Acetylcysteine 7. Right to education
• Alcohol Alcohol withdrawal: Librium 8. Right to refuse
• Milk products Ammonia: Lactulose
Antihistamines, antidepressants, Warfarin: Vitamin K Intravenous Infusions
and anti-anxieties: Drop factor: Number of drops in 1 mL
Digoxin: Digibind
• Alcohol of solution
Heparin: Protamine sulfate
• Grape juice
Iron: Deferoxamine Microdrip: 60 gtts/mL
For small or precise infusions
Beta-blockers, nitrates, narcotics,
Narcotics: Naloxone
and NSAIDs: Macrodrip: 10-20 gtts/mL
For large or quick infusions
• Alcohol
Therapeutic Drug Levels
Bronchodilators:
Digoxin: 0.5-2.0 ng/mL
• Alcohol
• Caffeine Lithium: 0.8-1.5 mEq/L
Dilantin: 10-20 mcg/dL
Carbamazepine, cyclosporine, Calculating number of mL to infuse per hour
tacrolimus, HIV medications, Theophylline: 10-20 mcg/dL
and statins: Warfarin:
Volume (mL)
= mL/hour
Time (hours)
• Grapefruit juice • IRN levels of 2-3 (A-fib, MI, CVT, PE)
Diuretics (potassium-sparing): • IRN levels of 2.5-3.5 (mechanical Calculating IV flow rate in drops per minute
• Foods high in potassium heart valves) Volume (mL)
× Drop factor = IV flow rate in
Time (min) drops per minute
Injections Intramuscular (IM): Trendelenburg:
• Injected deep into muscle The supine position, with the body and
Intradermal (ID): head positioned lower than the feet
• Injected into the dermal layer of the • Given into the entrogluteal,
dorsogluteal, vastus lateralis, and
skin
deltoid muscle
• Causes a bleb to form
• Angle of 90°
• Given into the back or the inner
• 23 g
forearm
• Length of 1-1.5 inches
• Angle of 10°-15°
• You must aspirate for blood prior to
• 27-30 g Reverse Trendelenburg:
an IM injection to ensure medication
• Length of 1/4-1/8 inch will not be delivered intravenously The supine position, with the body and
• A Mantoux test for TB exposure and head positioned higher than the feet
allergy testing requires ≤1 mL of fluid
5. Patient Positioning
Subcutaneous (SQ):
• Injected into adipose tissue Supine:
Dorsal recumbent position, or lying flat
• Given into the anterior thigh, on the back
abdomen, and upper outer arm
• Angle of 45° (90° for insulin and
heparin) Lithotomy:
• 25-28 g This is a modification of the supine
position. The legs are secured in stirrups,
• Length of 5/8 inch which elevate and abduct them. The
• 0.5-1.0 mL fluid for insulin, heparin, Fowler: buttocks are positioned evenly with the
and enoxaparin The supine position, with the head of the break or the end of the table.
bed raised between 45° and 60°
Prone:
Semi-Fowler:
Laying flat with the stomach side down
The supine position, with the head of the
bed raised between 30° and 60°
Lateral:
A side-lying position, lying opposite the
side of the procedure
 6. Psychology Maslow’s Hierarchy of Needs Time:
• Punctuality is the cultural norm for
Kübler-Ross Phases of Grief
the United States
Denial: Self-actualization • Latin Americans and Mexicans may
The individual does not really believe consider time in relation to day/night
loss has occurred and talks as if nothing Esteem or before/after meals rather than a
has changed. clock
Love/belonging
Anger: Complementary/folk medicine:
The individual is upset about the loss and Safety
People from other countries may
may act out, exhibiting previously unfelt utilize alternative medical systems:
Physiological
agression at the lost individual. They may
• Chinese herbal medication
blame caregivers for the loss.
• Healers
Bargaining: Cultural Health Considerations • Meditation
The individual tries to change the results Proxemics (space considerations): • Body-based therapies
of the loss and avoid consequences of • Coining/cupping
• North Americans and Northern
the loss. They may ask God to change
Europeans tend to want the most
what happened. Touch:
space
• Restrictions in touch between males
Depression: • Latin Americans, Asians, Middle
and females in some cultures
The individual experiences a loss of Easterners, and Southern Europeans
often feel comfortable standing very • Asian cultures may be upset if the
interest and may feel that life is fatalistic
close to others head is touched without permission,
and/or not worth living. They may
as they believe the spirit resides in
withdraw from friends and family.
Eye contact: the head
Acceptance: • Direct eye contact is the cultural
The individual comes to terms with the norm in many North American and Family hierarchy:
loss and is able to cope and accept the European countries In some cultures (Mexican, Asian, and
consequences. They fall back into a • Latin Americans, Asians, Middle Middle Eastern), decisions are made by
normal pattern of daily living. Easterners, and Southern Europeans the males or the head of the family
often feel comfortable standing very rather than the individuals.
close to others
 7. Miscellaneous ROME Method for ABG Questions 8. Resources
ANA Ethical Principles When the cause for ABG imbalance is
Free Resources
respiratory in nature, CO2 and pH will
• Autonomy • Justice be outside the normal range. When the Visit mometrix.com/academy to
• Beneficence • Veracity cause for ABG imbalance is metabolic in
take advantage of free NCLEX
• Nonmaleficence • Fidelity nature, the HCO3 and pH will be out of
range. practice tests, exam information,
study tips, and more.
• Respiratory
Levels of Disease Prevention
• Opposite Online Prep Course
Primary: • Metabolic
Prevent initial occurrence of a health SAVE 20% BY USING CODE NCLEX20
• Equal
problem via immunizations, smoking
cessation, fluoride supplementation of In the ROME method, the “opposite” and
water, seat belt use, and child care seat “equal’” refer to the increase or decrease
restraints. in pH against the increase or decrease in
CO2 (in respiratory conditions) or HCO3
Secondary: (in metabolic conditions).
Identify diseases/conditions quickly and
• In respiratory acidosis, CO2 ↑ pH ↓
provide prompt intervention for the
(opposite)
treatment and prevention of further Example: CO2 52, HCO3 23, pH 7.3
disability via BP screenings, breast and
testicular self-screening, hearing and • In respiratory alkalosis, CO2 ↓ pH ↑
vision screenings, mammography, and (opposite)
Example: CO2 29, HCO3 24, pH 7.5
pregnancy testing.
• In metabolic acidosis, HCO3 ↓ pH ↓
Tertiary: (equal)
Prevent further progress of a disease or Example: CO2 40, HCO3 18, pH 7.2

disability and allow people to achieve

• In metabolic alkalosis, HCO3 ↑ pH ↑
the maximum quality of life via support
(equal)
groups, counseling, diet and exercise, Example: CO2 36, HCO3 35, pH 7.6
stress management, and supportive
services.