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NCLEX Review on Hepatitis

Hepatitis is a very important topic in the NCLEX.

Hepatitis is basically a viral infection that causes  inflammation of the liver cells.

Classifications of Hepatitis Virus and its way of TRANSMISSION:

(If we look at the transmission: Hepatitis B and C are the only ones transmitted through blood and sexual contact).

Hepatitis A (transmitted through oral/fecal/water route)
Hepatitis B (transmitted through blood/drug use/sexual contact/childbirth)
Hepatitis C (transmitted through blood/drug use/sexual contact/childbirth)
Hepatitis D (transmitted through oral/fecal/water route)
Hepatitis E (transmitted through oral/fecal/water route)

Hepatitis A

– Incubation period usually lasts from 15-45 days.

– Transmitted primarily through fecal/ oral route.

– Prevention includes sanitation and handwashing.

– There is a vaccine available for Hepatitis A.

– Prevention against Hepatitis A includes:

  • Proper Handwashing
  • Avoidance of contaminated food and water
  • Recieving the HAV Vaccine

Hepatitis B

transmitted through blood to blood contact sexual contact or drug use (needles, razors).

– There is a vaccine available for Hepatitis B.

Hepatitis C

Hepatitis C is transmitted through blood to blood contact sexual contact or drug use (needles, razors)

– The patient can be asymptomatic and others are only diagnosed once abnormality is detected in the liver enzymes.


  • Fever
    Loss of appetite
    Abdominal pain
    Dark urine
    Clay-colored bowel movements
    Jaundice (yellow color in the skin or eyes)

Some of these symptoms can also be present on other classifications of Hepatitis* .

Keep in mind: ↓↓↓↓↓↓↓↓

Hepatitis B and Hepatitis C is connected with cirrhosis and liver cancer.

Blood and Blood Products before 1992 were not screened for Hepatitis.

Enzyme-linked immunosorbent assay (ELISA) is the initial screening test for clients suspected of infected of the Hepatitis C (HCV) Virus.

Liver Biopsy can also be used to confirm the diagnosis of Hepatitis.

Treatment most often used for Hepatitis C is a combination of two medicines, interferon and ribavirin.


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NCLEX Review Cirrhosis

So what is cirrhosis and why is it very important to review for the the NCLEX ?

Cirrhosis is basically scarring of the liver.  It occurs when there is severe hepatic inflammation or necrosis.

Common causes of cirrhosis:

  • Alcohol
  • Hepatits C
  • Hepatitis B

Complications of Cirrhosis:

(It is very important to understand these complications for the NCLEX.)

Portal Hypertension

An increase in the pressure in the portal vein.  It is usually due to an obstruction of blood flow within the portal vein.


– an accumulation of fluid within the peritoneal cavity.

– there will be retention of water and sodium in the body.

Esophageal Varices

– occurs when thin walled esophageal veins become distended from an increase in pressure.


– is caused by hepatic cirrhosis.  Develops because the liver cells cannot effectively excrete bilirubin.

Portal-Systemic Encephalopathy

– a manifestation by neurological symptoms

Physical Assessment

in patients with Cirrhosis:

  • Fatigue
  • Abdominal pain
  • Weight Loss
  • Asterixis

Laboratary Assessment:

There will be an increase in serum levels of (AST)/ Aspartate aminotransferase, (ALT) / Alanine aminotransferase and (LDH) / Lactate Dehydrogenase.

♣ Interventions:

– depends on the SYMPTOM and the COMPLICATION.


  • Intervention for ascities includes *PARACENTESIS – if diet and drug management fails.


– The procedure is performed in the bedside.

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“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:


– 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.


  • 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.


– 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.

For a lot of people it is the start of Nursing School, while for others who have already started Nursing School, its another start of a gruesome Semester.  For those who just started into the Nursing Program, it is a start of a very exciting journey towards the new Nursing School life.

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.


I have plenty of friends that have graduated Nursing School, who has taken their NCLEX examinations and have failed. These people are some of my closest friends and I know most of their personalities, but when they found out that they failed, some of them felt really down and depressed about their situation.  All the while, others remain very positive about their situation.  These “positive” people ended up having a higher rate of passing the NCLEX the second time around compared to the students who thought that they are going to fail the NCLEX again. I always believe that attitude is everything.  I believe that a POSITIVE attitude is what’s necessary in passing the NCLEX exam.

The NCLEX is very much a mental game,  and in order to play the game right, it is important to have a positive mental attitude.  Don’t ever ever give up…

Story By: Victor Rodriguez  (BSN, RN)

Oh, the dreaded NCLEX exam, how can I thou art slay thee…lol.  After being in college for what seems like an eternity, not only do I have to take an “Exam” after I got my degree, but I have to take a pretty quite “tough” exam, to say the least.  In all honesty, I was not prepared to take this exam after graduating Nursing School, I felt like I needed some time off to get my mind together and take all the stresses out of my system.  All those years of clinicals and weeks of no sleep in preparation for a Med Surge exam has drained all my brain cells into oblivion.  But having been in college for 8-9 yrs of my life also meant a lot of school loans being piled up.  Long story short, I was in a lot of debt, a “hole” lot of debt…lol.

To a lot of people, this circumstance may seem like a deterrent for them to be depressed and down about their situation, while others may deal with it a different way and just try to shove it off on the side and forget about it.  But I personally felt that whatever problems I go through, I have to tackle it on my own terms.  I try to look at the NCLEX as a monster that I have to slay before I can move on with my life.  An in order to slay this demon, you have to give it your all.  But you can’t just go out there and slay this dragon without a plan.  You need a strategy in order to slay this dragon.  And that would be the only way to beat this monster.

Having graduated with a Bachelors in Nursing,  I felt very privileged to have my degree on hand.  As I reminisce and look back on my Nursing School days, I can definitely say that it was a very interesting and one of the toughest experience that I have ever experienced.  There were many ups and downs and high’s and lows.  Today,  I was previliged enough to Interview a good friend of mine, (her name is Stephanie) who is now a nurse and I asked her about her experiences with nursing school and how it has come to shape her now.  I choose Stephanie, because, I think her story is one that is very inspiring and shows how determination and strong will can help anyone succeed in life.

Stephanie’s Story

This was my background before getting into Nursing, I was a single female in my mid 30’s with a 6 yr. old child.  I began my life growing up in the Midwest and moved over here in the East Coast when I graduated High School.  Ever since I was young, I always thought about being a nurse, but for some reason, I was also very passionate about money and finance.  Soon after High School, I proceeded to get my degree in Finance from a state college.  It was not very productive having a Econ Degree without a master and sad to say, being in the opposite side of the ‘male’ dominated spectrum.  I worked in a small firm as their Primary Consultant, and enjoyed working in that firm for about 3 yrs. before transferring to another job.  I met the father of my baby that year, I pretty much fell in love (at least, I thought I was) and we both considered building a family.  Long story short, the father cheated on me with one of my closest friends.  My baby’s father then tried to avoid paying child support by leaving the country, in which he succeeded.   I became a single mom when my son was born.  Zack (my son) is such a beautiful boy, unfortunately their were several complications during my labor, with the umbilical wrapped around his neck and cutting the blood circulation to his brain.  My son was born with a cerebral palsy and became mentally handicapped.

This was a very huge devastating blow to me.  Having quit my job, I was able to get support from my parents, but it was a very hard struggle.  It took me at least a year to get a part time job, while taking care of Zack.  When my son was about two and a half years old.  I decided to pursue and apply for Nursing School, which was a harder process that I thought.  I began the journey by taking all my pre-requisites and trying to achieve the highest possible GPA that I can get (since that was what everyone has told me).

It was a pretty tough journey for me.  I applied to at least three nursing programs, until I finally got accepted in to a Bachelors program in a private college.  I graduated with my Bachelors of Nursing this year, passed my NCLEX in August and I now currently work as an ER nurse in Good Samaritan Hospital here in my County.  I love my job very much, but when I try to  reminisce   about my past experience in Nursing School, there were a lot of bitter and happy memories that are all still embedded in my head.

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