NCLEX Review & Nursing School

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Quick Study Guide for the NCLEX

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Hey Guys, plenty have contacted me regarding having a content-based study guide that can help them pass their NCLEX Exam.  Of course I will not going to be able go over all of these review contents in this video.  But instead I will try to go over the CARDIAC SYSTEM first, and go over the major diseases that you will most likely encounter in your NCLEX exam.

Lets first look at the Cardiac Diseases which as we all know is essential information to know for the NCLEX.

As I have mentioned before on a previous video, I have went over what I call the Big MAC or Big M.A.C which goes over the 3 biggest main cardiac diseases that you will most likely encounter in your NCLEX Exam.

THE CARDIAC SYSTEM

The Big M.A.C

includes

1. Myocardial Infarction
2. Angina
3. Congestive Heart Failure

Other Important CARDIAC DISEASES that you will most likely encounter in your NCLEX exam can include questions related to topics of :

♦ HYPERTENSION
♦ PERICARDITIS
♦ CARDIOMYOPATHY

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As we all know, the Cardiac System is one of the most vital system in the body. It is important to study the Cardiac System for the NCLEX.

Quick Overview of the Heart:

Lets look at a quick anatomy of the The Cardiac Muscle  which is (composed) of

• MYOCARDIUM
• ENDOCARDIUM
• PERICARDIUM.

So let first look at Myocardial Infarction and the important things that we need to know to prepare for the NCLEX.  Ok, now as we all learn from nursing school a myocardial infarction is death of myocardial muscle cells due to lack of oxygen from inadequate perfusion in the body.

Major ASSESMENT that we need to know for the NCLEX in relation to Myocardial Infarction is that it USUALLY LONGER THAN 30 MINS and that it *IS UNRELIEVED BY REST OR NITROGLYCERIN, therefore we can differentiate angina from MI through the use of NITROGLYCERIN.

Now lets look at the DIAGNOSTIC TEST RESULTS for MI which can be essential in your NCLEX.

• ECG WOULD SHOW AN ENLARGED Q WAVE, AN ELEVATED OR DEPRESSED ST SEGMENT, AND T WAVE INVERSION. and you have to really know this.

In regards with the Drug Therapy for Myocardial Infarction:

• It is actually quite Very similar to the Drugs Used for treating Hypertension:
• Medications can include:
• ♣ ACE Inhibitors (CATOPEN), ENALAPRIL (VASOTEC)♥ Beta Blockers♦ Calcium Channel Blockers
  
  • ACE Inhibitor
  1. – ACE inhibitors “blocks” the conversion of Angiotensin 1 to Angiotensin 2.
  2. – Alters the “blood pressure” mechanism through the renin-angiotensin system.
  3. Medications includes the “Pril” : Catopril, Enalapril, Lisinopril, Ramipril.
  4. Side Effects: Cough, tachycardia, nausea and vomiting.
  5. Give on an empty stomach or 2-3 hrs. after a meal.
  • Beta Blockers
  1. – Reduces the cardiac output and decreases the sympathetic nervous system response.
  2. – Blocks the beta receptor, causing a decrease in blood pressure.
  3. – Medications include the “olol’s”: Metropolol, Propanalol, Acebutolol, Nadolol.
  4. – Used for Hypertension, Myocardial Infarction and Angina.
  5. – Adverse effects can include: Bradycardia, Hypotension and Hypoglycemia (distrupts the liver’s ability to convert glycogen to glucose).
  • Calcium Channel Blockers
  1. – Prevents the movement mechanism of Calcium within the cardiac system.
  2. – Therefore decreasing the cardiac workload, and cardiac muscle contractiliy.
  3. – Medications include the “dipine” : Dilitazem (Cardizem), Amlopidine (Norvasc), Nefedipine, Nicardipine.
  4. – Used to treat Angina.
  • Vasodilators (perheral)
  • Alpha Adrenergic Blockers
  • Diuretics

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ANGINA

Now lets quickly go over a patient with Angina.

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ANGINA PECTORIS

• – PAIN CAUSED BY INADEQUATE BLOOD FLOW THROUGH THE BLOOD VESSELS OF THE HEART.
• ♣ IT’S VERY IMPORTANT TO KNOW THE DIFFERENCE BETWEEN ANGINA PECTORIS AND MI.

– A paroxysmal chest pain caused by (ischemia) due to insufficient blood flow to the myocardium.
RISK FACTORS:

• ATHEROSCLEROSIS
• HYPERTENSION
• DIABETES MELLITUS
• CIGARETTE SMOKING

Assessment Findings:

THERE ARE DIFFERENT TYPES OF ANGINA

1. STABLE ANGINA PECTORIS- OCCURS WITH EXERTION, IT IS RELEIEVED BY REST AND DOES NOT INCREASE IN FREQUENCY OR SEVERITY.
2. VARIANT OR PRINZMETAL ANGINA-  IS USUALLY CAUSED BY CORONARY ARTERY SPASMS.
3. SILENT ANGINA- IS USUALLY ASYMPTOMATIC MYOCARDIAL ISCHEMIA THAT IS ASSOCIATED WITH DIABETES MELLITUS AND HYPERTENSION.

Major symptoms of ANGINA that we really need to know and understand would be that ANGINA:

• is USUALLY DESCRIBED AS A (SQUEEZING, HEAVY DISCOMFORT PRESSURE)
• PAIN* IS THE # 1 SYMPTOM.  SUBSTERNAL PAIN THAT CAN RADIATE TO NECK, JAW AND BACK
• MAY BE RELIEVED BY REST. (Compared to MI: Very important to know for your NCLEX).
• TACHYCARDIA, PALPITATIONS

DIAGNOSTIC TESTS:

• THE ECG WILL SHOW AN ST SEGMENT DEPRESSION AND T WAVE INVERSION DURING THE ANGINAL PAIN.
• THE HOLTER MONITOR WILL REVEAL AN ST SEGMENT DEPRESSION AND T WAVE INVERSION.

INTERVENTIONS:

• HOLD NITRATES IF THE BP IS LESS THAN 90 MM HG.

SIDE EFFECTS:

• BURNING OR TINGLING IN THE MOUTH
• DIZZINESS
• FLUSHING
• HEADACHE
• NAUSEA

When taking NITROGLYCERIN (Nitrostat)

– Store tablets in a dark bottle.  Lights lessens its effeciency.
– Do not take tablet with fluid
– Place nitroglycerin tablet under the tongue (and let it melt).
– Take up to three tablets 5 min. apart. (If still no relief, go to hospital).

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HEART FAILURE

– Now lets go ahead and look at HEART Failure, which is basically An insufficiency and the inability of the pumping ability of the heart.   Heart Failure can either be left sided or right sided.

With the LEFT SIDED HEART

– There is a Failure of the left side of the heart to pump enough blood to meet the metabolic demands of the body.

• THERE IS AN IMPAIRED OXYGENATION AND A DECREASE IN MYOCARDIAL WORKLOAD IN THE HEART.

ASSESSMENT FINDINGS in patients with Left Sided heart failure.

• CRACKLES
• DYSPNEA
• GALLOP RHYTHM: S3, S4

What we would usually find in patient with left sided heart failure  is that there is an INCREASE IN PULMONARY CONGESTION and there would be a left ventricular hypertrophy.
MANAGEMENT

• LOW SODIUM DIET
• SEMI FOWLERS POSITION ON PT.
• WEIGHT PATIENT DAILY
• ADMINISTER IV, OXYGEN AND MEDS AS ORDERED.
• MONITOR VITALS, I/O

RIGHT SIDED FAILURE

– Failure of the right side of the heart to pump enough blood to meet the metabolic demands of the body.
Causes:

• LEFT SIDED HEART FAILURE
• COPD
• ATHEROSCLEROSIS
• PULMONARY HYPERTENSION

Assessment:

• JUGULAR VEIN DISTENTION
• DEPENDENT EDEMA
• WEIGHT EDEMA

Diagnostic Procedures:

• B- TYPE NATRIURETIC PEPTIDE (BNP)  LEVELS= ELEVATED
• ABG’S INDICATES HYPOSEMIA AND HYPERCAPNIA.
• HEMODYNAMIC MONITOR= INCREASE CVP

TREATMENT:

• OXYGEN THERAPY
• PARACENTESIS
• THORACENTESIS

Drug Therapy:

• CARDIAC GLYCOSIDE (DIGOXIN) LANOXIN
• INOTROPIC AGENTS (DOPAMINE, DOBUTAMINE)
• DIURETICS: FUROSEMIDE (LASIX)
• HUMAN BNP: (NESIRITIDE (NATRECOR)

Interventions:

• KEEP CT. IN SEMI- FOWLERS POSITION TO INCREASE CHEST EXPANSION
• ASSESS CARDIOVASCULAR STATUS AND VITAL SIGNS
• WEIGH THE CLIENT DAILY: A WEIGHT GAIN OF 1 TO 2 LBS. INDICATES FLUID GAIN.

HYPERTENSION

Hypertension is a very important diseases that we can easily encounter on the NCLEX Exam, so it is vital that we know and understand HYPERTENSION.

WHAT IS HYPERTENSION?
– A SIGNIFICANT AMOUNT OF PRESSURE WITHIN THE BLOOD VESSELS
– EXCEEDS 140 MMHG SYSTOLIC AND 90 MMHG DIASTOLIC,
– LIFESTYLE CHANGES IS ALWAYS IMPORTANT: NO SMOKING * REDUCING ALCOHOL INTAKE.
* Remind patient that lifestyle changes such as smoking cessation and proper diet is essential.
– several factors such as the fluid volume within the body, which is regulated by the kidneys through the renin- angiotensin system.

Secondary Hypertension can be caused by:
– Cushing’s Disease (Too much Glucocorticoids)
– Brain Tumors
– Pheochromocytoma

* Remind Patient that smoking is the biggest factor.
* If Diet and exercise is not enough, meds are used.

♣ Pharmacology Drugs for Hypertension:

DIURETICS
– Helps get rid of the sodium and fluid in the body.
– Diuretics interferes with the sodium absorption in the kidney.
– Increases the urine output.  Decreases the preload and afterload.

MAJOR SIDE EFFECTS:

• – HYPONATREMIA
• – ORTHOSTATIC HYPOTENSION
• – DEHYDRATION

TYPES OF DIURETICS

(Drugs that you will ENCOUNTER IN THE NCLEX EXAM)

POTTASIUM SPARING DIURETICS
SPIRONOLACTON (ALDACTONE)
AMILORIDE (MIDAMOR)

LOOP DIURETICS
BUMETANIDE (BUMEX)
FUROSEMIDE (LASIX)

OSMOTIC DIURETICS
MANNITOL

THIAZADE DIURETICS
HYDROCHLOROTHIAZIDE (HYDRODIURIL)
CHLOROTHIAZIDE (DIURIL)
CAUSES THE DEPLETION OF SODIUM AND WATER.
♣ CAN INDUCE HYPERGLYCEMIA

BETA (ADRENERGIC) BLOCKERS

As you have learned in Nursing School, beta adrenergic blockers are drugs that help lower blood pressure, pulse rate and cardiac output.  Beta Blockers are an important set of drugs to know for the NCLEX.  Sometimes, beta blockers are also used to treat migraine headaches an other vascular headaches.  Beta blockers are also used to treat glaucoma and used to prevent myocardial infarctions.

Try to remember that what beta blockers do is they act by blocking the sympathetic vasomotor response.  For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).  Potential side effects of beta blocker that is necessary to know for the NCLEX would include: Orthostatic hypotension, bradycardia, nausea and vomiting, diarrhea and some of the symptoms may MASK hypoglycemia.

HYPOGLYCEMIC SYMPTOMS.

NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS:

Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker.  Monitor the client for signs of edema.  The nurse should also assess the lungs sounds for signs of rales and ronchi.  When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protien, BUN and creatinine) which can indicate nephrotic syndrome.  Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever.  It is also very important to taper off the medication properly.

CALCIUM CHANNEL BLOCKERS

1. – PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
2. – THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
3. – MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
4. – USED TO TREAT ANGINA.

• VASODILATORS (PERHERAL)
• ALPHA ADRENERGIC BLOCKERS
• DIURETICS

ACE INHIBITOR

1. – ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
2. – ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
3. MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.
4. SIDE EFFECTS: COUGH, TACHYCARDIA, NAUSEA AND VOMITING.
5. GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.

We can easily connect Hypertension with several diseases which can be a complication of Hypertension:

HYPERTENSION CAN LEAD TO
– Aneurysms
– Atherosclerosis
– Heart Failure
– Myocardial Infarction

On the next post and video we will go over the important category that you will most likely encounter in your NCLEX exam which are the major diseases of the Nervous System.

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Major Important Neurological Diseases

1. MENINGITIS  
2. LOU GEHRIG’S DISEASE/  
3. AMYOTHROPIC LATERAL SCLEROSIS (ALS)   
4. MULTIPLE SCLEROSIS  
5. MYASTHENIA GRAVIS  
6. TRIGEMINAL NEURALGIA (TIC DOULOUREUX)  

 I WILL GO OVER THE NEUROLOGICAL SYSTEM ON THE NEXT VIDEO/POST.