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Infection Control NCLEX Review

Everyone taking the NCLEX or is about to take the NCLEX  has realized that the NCSBN had change some of the content format of the NCLEX.  One of the big changes includes the percent amount of Safety and Infection Control that will be on the NCLEX.  The “Safety and Infection Control” now makes up about 8-14% of the questions in the NCLEX, I believe that it only previously composed of about 9-12% prior (or I could be wrong).

Infection Control

Recently Infection Control makes up about 10- 13% of the NCLEX.  That means that if you are able to get the average of about 130-150 questions, then you are guaranteed to recieved between 15- 20 questions that is related to Infection Control.  Even if we get the least (75) amount of questions, we can still receive about 7-9 questions that is related to infection control, that is a HUGE help, if we do well on these questions.  I personally dont think that Infection control is a difficult area.  I believe that most of the nursing students never really studied “Infection Control,” when they were in Nursing School.  Therefore, this lack of knowledge did not prepare the majority of the Nursing Student for the NCLEX.

Standard Precautions

– is always done in congruent with the other types of precautions.

Transmission-based Precautions includes:

A – Airborne
D – Droplet
C – Contact

Airborne Precaution

  • is done when small droplets of infected pathogens are about ( 5 um) are suspended in the air over time and travels a distance of more than (3) three feet.

AIRBORNE PRECAUTION is used with these diseases:

My – Measles

  • Measles- or rubeola
  • Can be transmitted through blood urine and droplets
  • Communicable about 4-5 days after the rash
  • Treatment: Bedrest and antibiotics

Chicken – Chickenpox

  • Chickenpox (Varicella)
  • Pt. will have a slight fever
  • macular rash appears on trunk and eventually turn to crust.

Hez – Herpes Zoster (Disseminated)

TB – Tuberculosis

  • Private room
  • Negative pressure with 6-12 air exchanges per hour
  • UV
  • Mask
  • N95 Mask for TB

DROPLET PRECAUTION

S – Sepsis
S – Scarlet fever
S – Streptococcal pharyngitis
P – Pneumonia
I – Influenza
D – Diptheria (Pharyngeal)
E – Epiglottitis

What is necesary: Private room and Mask

Contact Precation
M – Multidrug resistant organism
R – Respiratory infection – RSV
E – Enteric infections – clostridium defficile
E – Eye infections

Skin Infections:
V – Varicella zoster
C – Cutaneous diptheria
H – Herpes simplex
I – Impetigo
S – Scabies, Staphylococcus

Private room
Gloves
Gowns

NCLEX Review on Infection Control

It is really important to study and understand Infection Control for the NCLEX Exam.

Lets look at Infection Control more closely for the NCLEX:

INFECTION CONTROL: NCLEX REVIEW

 

Nclex Infection Control Review on Contact Precautions 
Contact Precautions -Any Physical Skin-Skin Contact
-Contact with contaminated inanimate objects
*Clean (non-sterile) gloves must be used.
*Change gloves after contact with feces, and/or wound drainage
*Remove gloves & wash hands w/antimicrobial cleanser
* Use gown if RN will have contact with, or if client is incontinent, has an iliostomy/colostomy, wound drainage.
* Remove gown before leaving client’s room

Infection Control NCLEX Diseases
Contact Precautions Diseases:
* MRSA
* Vancomycin resistant organisms
* Herpes simplex & zoster
* Hep A
* GI, Wound, & UTIs
* Pediculosis
* Scabies
* C. diff
* RSV
* Hep A if patient is diapered or incontinent
Lyme Disease Stage 1 = rash/papule at area of tick bite (2-30 days), concentric rings/bull’s eye, lesion enlarges quickly. Regional lymphadenopathy. Flu-like symptoms (malaise, fever, HA, myalgia, arthralgia, conjunctivitis) within one to several months.

Stage 2 (if untreated for 1-6 mo.) = Cardiac conduction defects. Neurological disorders: facial paralysis, paralysis that is not permanent.

Stage 3 = Arthralgias, enlarged or inflamed joints, chronic fatigue, cognitive disorders.

 

 

♦ NCLEX DISEASES: Airborne Precautions 

Airborne Precautions < 5 Microns

Make sure that these patients would require:

  1. PRIVATE ROOM
  2. CLOSED DOOR
  3. FILTERED MASK
    Client requires a private room w/ neg air pressure and 6-12 air exchanges per hour.
    Door must remain closed
    N-95 Hepa filter mask

NCLEX DISEASES: Airborne Precautions
Diseases:
* TB (m. Tuberculosis) MUST WEAR FIT TESTED MASK
* Measles (rubeola)
* Chicken Pox (varicella)
* Shingles (disseminated zoster)

 

 

 Nclex Infection Control Review on Droplet Precautions 
Droplet Precautions > 5 Microns
Client requires a private room
Room door may remain open
Any contact with conjunctiva or mucous membranes (nose or mouth), coughing, sneezing, talking or procedures such as suctioning or bronchoscopy
Must maintain spatial separation of 3 feet
If < 3 feet, staff or visitors must wear a mask (i.e. staff giving direct care)

* When transporting client, s/he must wear a mask
Diseases:
* Diptheria
* Streptococcal pharyngitis/tonsillitis
* certain pneumonias
* Meningitis -If caused by H. influenzae Type B or N. meningitidis
* Mumps
* Pertussis
* Scarlet fever

 

Nclex Infection Control Review on Aids

AIDS — opportunistic infections

  • TB
  • PCP (P. carinii – pneumonia)
  • C. albicans
  •  C. neoformans (debilitating meningitis)
  • CMV, Kaposi’s sarcoma (most common malignancy)

AIDS Syndrome +ve for HIV in blood (+ve ELISA with a Western Blot or indirect immunoflourescence assay (IFA) follow up) and CD4/TC counts below 200

NCLEX Infection Control: Transmission of Hepatitis

  • Hep A transmission Fecal/Oral (shellfish in contaminated water, contaminated food handlers etc.)
    Hep B transmission Parenteral (blood). maternal – fetal, sexual contact
    Hep C transmission Parenteral (blood), sexual contact
    Hep D transmission co-infects w/ Hep B

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Nclex review on psychiatric nursing

Anxiety Related Disorders/ Neurotic Disorders

PTSD/ Post Traumatic Stress Disorder

– usually characterized according to onset, as either acute or delayed.

General Anxiety Disorder

Somatoform Disorder

  • Conversion Disorder
  • Hypochondriasis
  • Somatization Disorder

Obsessive Compulsive Disorder (OCD)

 

Remember: Therapeutic Communication is important to know for the NCLEX Exam:

Reflecting

  • Client: “I am really mad at my father for what he did.”
  • Nurse: “You sound angry.”

Exploring

  • Nurse: “Go ahead, tell me more..”

Summarizing

  • “During the last several minutes we have talked about…”

 

Personality Disorder (Composed of):

Cluster A:

  • Paranoid Personality
  • Schizoid Personality
  • Schizotypal Personality

Cluster B:

  • Histrionic Personality
  • Narcissistic Personality
  • Antisocial Personality
  • Borderline Personality

Cluster C

  • Dependent Personality
  • Avoidant Personality
  • Obsessive Compulsive Personality

 

Remember:

Know the different types of Common Behavioral Patterns:

  • Regression
  • Anger
  • Hostility/ Aggressiveness
  • Violence
  • Manipulation
  • Dependence
  • Detachment
  • Shame

 

Lets look at several gastrointestinal Diseases that we can see on the NCLEX:

Appendicitis

is an inflammation in the vermiform appendix, it can be gangrenous or perforates

Main Symptoms: Includes a generalized abddominal pain in the upper right abdomen, usually followed by anorexia, tachycardia, and nausea and vomiting.

Peritonitis can usually be a complication of appendicitis.

Treatment:

Apendectomy

Note: Never administer cathartics or enemas to pt. because it can cause a rupture in the appendix.

Gastrointestinal Diseases (Pediatrics)- A quick review glance on the GI diseases that is more common within the Pediatrics population.

Hirschsprung’s Disease (Anglionic Megacolon)

– An absence of ganglion cells in the distal colon.  Usually in these patients, their is a blockage in the large intestine.  In this condition, there is an improper muscle movement within the GI tract, due to this the patient will have symptoms of:

  • Decreased Peristalsis
  • Accumulation of intestinal contents

– This disease is more common in males

– associated with down syndrome

Symptoms in Newborn:

– failure to pass meconium within the first 24-48 hrs.

– refusal to eat, bile stained vomitus, ribbon like stools

Diagnosis:

  • Done through a Barium Enema

Treatment:

– Increase in fluid and fiber intake

Enterobiasis (Pinworms)

– There will be perianal itching

– Diagnosed: through the tape test.

Treatment: Vermox

– Make sure to wash clothings and bed linens in hot water. (this is a good NCLEX question)

Celiac Disease

– There is an intolerance of gluten in the small intestine.

– Gluten is found in oats, wheat, barley and rye.

Diagnosis: involves a jejunum biopsy.

Treatment: replacement of gluten containing foods with:

  • corn and rice.

Gastronintestinal System (Adults)

GI SYSTEM REVIEW (CLOSED DOWN)

“Pharmacology Review”

Lets start with the definition of Pharmacology: Pharmacology is the study of the mechanism of action, uses, side effects and fate of drugs in the body.

Pharmacodynamics is how the biologically active compounds do in the body.

Pharmacokinetics is  how the body reacts the drugs.

Most of the drugs are synthetic in origin which means that they are made and discovered in the laboratory.  Although others can still be obtained from natural sources.  Any drug can have a chemical name, a generic name and a brand or trade name.

Usually, the generic name of a drug is suggested by the manufacturer, and accepted by the international committee.

Drugs, hormones and neurotransmitters that activate receptors are called agonists.

How the drug is being affected affects the body and the patient’s response is called the effect.

Efficacy refers to the degree to which a drug is able to induce it’s maximal effects.

Adverse Effect is any unexpected or unintended response to a therapeutic use of a drug, it is also called side effect.

First I want to talk about drugs that are used to treat infections:

ANTIBIOTICS

– basically an antibiotic is a drug that us used to treat infectious diseases.

B Lactam Antibiotics-  are antibiotics that have a B-Lactam ring in their molecule.  Example of B Lactam Antibiotics would include Penicillins and Cephalosporins.

I just want to go over the two basic types of Penicillin Antibiotics:

  1. Natural Penicillin (penicillin G pottasium)- used to treat moderate to severe infections.
  2. Broad Spectrum penicillin (amoxicillin)- also used to treat mild and moderate infections.

Contraindications: penicillins are contraindicated for patients with a history of allergic reaction to any penicillin or cephalosporins (this is always very important to know).

Adverse Reaction: Like I have mentioned before, penicillins are one of the most common cause of drug allergy.  Hypersensitivities to penicillins may appear in the form of rash, pruritis, fever, wheezing, severe dyspnea, nausea and vomiting.  It is also important to note that adverse effects of penicillins generally involves the gastrointestinal (GI) system with glostitis, mouths sores (stomatitis, abdominal bleeding.

Toxicity: Toxicity for penicillin involves  the neurologic, nephrologic,  and hematologic system.

Penicillins, when given with anticoagulants, increases bleeding time.

Nursing Interventions to take note when giving Penicillins:

  • It is very important to be aware of any allergies to penicillins
  • Take the drugs on an empty stomach with water.
  • Do not take with fruit juices or soft drinks.
  • Make sure to give patient an adequate hydration.

Aminoglycosides

  • gentamycin sulfate (garamycin)
  • kanamycin sulfate (kantrex)

Aminoglycosides are batericidal, they both bind irreversibly to both the 30 S and 50S ribosomes to prevent bacterial protein synthesism.  Aminnoglycosides are used to treat serious nosocomial infections (ie. gram negative bacteria, peritonitis, pneumonia).

– Aminoglycosides should be administered with caution in neonates because of their immature renal systems.

Nursing Responsibilies

  • Administer an aminoglycoside and penicillin at least 2 hours apart
  • draw peak and trough levels periodically throughout the therapy.
  • encourage patient to take the full course of treatment.

Tetracycline

– is used as a treatment of gram positive and gram negative infections.

– Remember: That a use of tetracycline with oral contraceptives leads to breakthrough bleeding, altered GI bacterial flora, decreased contraceptive effectiveness and an increased risk of pregnancy.

Now, I want to talk about drugs that are used to treat Nervous System Disorders:

The Sypathetic Nervous System: Hormones (norepinephrine and epinephrine) activate the sympathetic nervous system.  The sympathetic nerces release both of these hormones whereas tha drenal gland also releases epinephrine.    There are four types of receptor that is found in the autonomic nerve pathways:

  1. Alpha 1 Adrenergic
  2. Alpha 2 Adrenergic
  3. Beta 1 Adrenergic
  4. Beta 2 Adrenergic

You have to understand that several physiologic responses results when each type of receptor is activated.

Alpha 1 receptors affects:

  • pupil dilation
  • gastrointestinal tract motility
  • vasoconstriction of arterioles
  • bladder contraction, prostate contraction

Alpha 2 affects:

  • gastrointestinal motility
  • vasoconstriction of arterioles

Beta 2  receptors affects:

  • Heart rate
  • contractility, automaticity and conduction

Beta 2 receptors affects:

    • bronchodilation (breathing)
    • heart rate contractility
    • uterus (relaxation)

Adrenergic Agonists (Adrenergics or sympathomimetic agents)

  • Adrenergic Agonists can stimulate any one or any combination of Alpha or beta receptors.  Adrenergic agonsits that stimulate beta receptors are called Beta adrenergic agonists.
  • Example of adrenergic agonists drugs includes: phenylephrine (neo-synephrine): used to treat shocj and nasal congestion
  • Ephidrine (ephedsol) temporary relief for nasal and sinus congestion
  • Albuterol (Proventil) bronchospasm associated with asthma or bronchitis.

So, basically we can say that Adrenergic agonsists are used primarily for three reasons: hemodynamic compromise such as (hypotension resulting from shock or CHF, bronchospasm and nasal or sinus congestion)

  • Contraindications includes: For Phenylephrine, it is contraindicated in patients with pheochromocytoma.  Alpha agonists are contraindicated in patients who have tachycardia and severe hypertension because stimulation of the alpha receptor can further cause vasoconstriction and cause more potentiating hypertension.  Because alpha-agonists causes pupil dilation (mydriasis), they are contraindicated in patients with glaucoma.

Remember: Adrenergic agonists should be avoided in patients with cardiac diseases beacause these agents may precipitate angina or myocardial infarction (MI).

Adrenergic Antagonists

Adrenergic Antagonists: inhibits or blocks the effects of the sympathetic nervous system neurotransmitters and are antagonists to the adrenergic agonists.  Adrenegic antagonists are also sometimes calle antagonist blockers because they block the sympathetic effects of the body.

  • The action of the alpha adrenergic antagonists inclcudes:
  • pupil constriction (miosis), increase GI tract motility, vasodilation of arterioles which can result in a decrease in Blood pressure, and prostate relaxation.
  • Alpha adrenergic antagonists are used primarily to treat five conditions:  hypertension, migraine headaches, alzheimer’s disease and benign prostatic hyperthrophy
  • Examples of these drugs includes: doxazosin mesylate (Cardura) which is used for treatment of hypertension.

When administering  alpha adrenergic antagonist medications, always try to: monitor for orthostatic hypotension, monitor for tachycardia, and tell patient to report any gain of 1 to 2 pounds accompanied with peripheral edema.

Parasympathetic Nervous System Drugs

The parasympathetic Nervous System drugs is primarily concerned with conserving energy and promoting digestion.  Several responses of stimulation of the parasympathetic drugs includes: pupil constriction, lacrimation, salivation, bronchoconstriction, a decrease in heart rate, conduction, automaticity and contraction of the bladder and relaxation of the sphincter.  The parasympathetic nervous system drugs includes:

  1. Direct acting cholinergic agonists
  2. cholinesterase inhibitors
  3. anticholinergics
  4. Dopaminergics

Knowing your pharmacology is essential for the nclex.  The proper way to study pharmacology and the drugs for the nclex exam is to understand the interaction of the drug with our body.  Memorizing the purpose and side effects of this drugs without understanding fully the rationale of its actions will set you to fail the nclex exam.  Therefore, to prepare for the nclex, a firm understanding and knowledge of pharmacology is essential, and yes there will be a lot of “drug” related questions in the nclex exam.  In this nclex review, we will start with the Central Nervous System:

Local Anaesthetics includes Lidocaine (xylocaine). It is an anesthetic that blocks nerve conduction; metabolized by hepatic enzymes.

Non- narcotic analgesics and antipyretic: This group would include your aspirins, and your antipyretic.  Acetysaalicylic Acid (aspirin) (ASA):  Action: Analgesia: inhibits formation of prostaglandins invlolved with pain. It is important to understand for the nclex, that an analgesia acts on the body by acting on the hypothalamus and blocking the generation of the pain impulses.  An antipyretic inhibits the formation of prostaglandins in production of fever.  The aspirin acts on the hypothalamus (as you remember from nursing school, is the thermostat on the body).   What it can do when inside the body: It is used for moderate pain, control fever, it is also used as an anti inflammatory and helps reduce the risk for MI in men with unstable angina.

  • Adverse reaction includes: tinnitus, confusion, dizziness, drowiness and bleeding (this is big for the nclex).
  • Other type of non narcotic analgesic: Acetaminophen (Tylenol).

A sample nclex review question:

  • Which condition is an indication for aspirin use?
  • 1. Asthma
  • 2. TIA    (correct answer) due to aspirin’s antiplatelet effect, aspirin can be use to decrease TIA.
  • 3.  Gout
  • 4. Nasal Polyps

Other Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) for the nclex includes:

  • Ibuprofen
  • Indomethacin (Indocin)
  • Ketorolac (Toradol)
  • Celecoxib (Celebrex)

Now we can talk about Narcotic Analgesics:

One of the most commonly used Narcotic Analgesic in the nclex is morphine or morphine sulfate:

  • Morphine Sulfate: acts on opiod receptors in the CNS and induces sedation, analgesia, and euphoria.  It is used to relief moderate to severe pain. Such as pain from an MI or myocardial infarction (big in the nclex).
  • Adverse effects can include: sedation, confusion, euphoria and impaired coordination.   A big adverse reaction to know (nclex) is respiratory depression, hypotension, tachycardia and bradycardia.
  • Observe for signs of tolerance with prolonged use  (nclex)
  • monitor respiratory rate and depth before giving the drug and periodically thereafter. (nclex)
  • Always remember to have narcotic antagonist (naloxone) Narcan available on hand.

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Two cardiac procedures that is normally done:

  • Percutaneous Transluminal Coronary Amgioplasty
  • Coronary Artery Bypass Surgery (CABG)

Percutaneous Transluminal Coronary Amgioplasty (PTCA) with or without placement of stent, can be performed as an alternative to coronary artery bypass graft surgery (CABG).  The aim of the PTCA is to revascularize the myoardiu, dercrease angina, and increase the survival of the patient.  The PTCA is performed in the cardiac atherization lab and involves the insertiopn of a balloon-tipped catheter into the stenotic diseased coronary artery.  Post op and preop nursing interventions is the same as for a lient undergoing cardiac catheterization.

Coronary Artery Bypass Surgery (CABG)

Coronary Artery Bypass Surgery (CABG): a coronary artery bypass graft is the surgery of choice for clients with sever CAD.  During a CABG or coronary artery bypass surgery, there is a new supply of blood brought to a diseased/occluded coronary artery by bypassing the obstruction with a graft that is attached to the aorta proximally and to the coronary artery.  Postoperatively after the procedure, make sure to try to promote lung expansion and monitor for drainage from the chest tubes and the chest systems.

As you have learned in Nursing School, beta adrenergic blockers are drugs that help lower blood pressure, puls 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 glacauma and used to prevent myocardial infarctions.  Try to remember that what beta blockers do is they act by blocking the symathetic 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 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.

Anti-Infectives (Aminoglycosides)

Anti Infective drugs usually indludes bacteriacidals and bacteriostatic Drugs.  What this drugs do is they usually interfere with the protien synthesis of the bacteria, causing the bacteria to die.  These drugs are also important drugs to know for the NCLEX and these drugs are active against most aerobic gram-negative bacteria and against some gram positive organisms.  For the NCLEX, it is important to note the syllables  (cin) in the end and many of them end in mycin.

Possible side effects to most anti-infective drugs would include:

  • ototoxicity
  • Nephrototoxicity
  • Seizures
  • Hypotension
  • Rash.

Polycythemia Vera

Polycythemia Vera is considered a blood disorder in which there is a thicker than normal viscosity of the blood.  When a patient has the polycythemia vera disorder, there is usually an increase in the client’s hemoglobin of 18g/dl, RBC of 16 million/mm and a hematocrit of 55% or better.

Symptoms that is usually associated with polycythemia vera includes an enlarged spleen, dizziness, tinnitus, fatigue, paresthesia, dyspnea, and pruritis.

Treatments of polycythemia vera includes:

  • Phlebotomy
  • hydration
  • anticoagulant therapy.

 

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