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NCLEX Review Notes:

NCLEX Review on Cardiac Diseases: Heart Failure

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– It is an insufficiency and the inability of the pumping ability of the heart.

LEFT SIDED HEART

– 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

NCLEX Review on Heart Failure Cont.

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.
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NCLEX Review of Endocrine Medications

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[youtube http://youtu.be/l9ePztPoSwQ w=400&h=300]

NCLEX Review Notes:

A quick NCLEX Review on Pituitary Gland Disorders

Pituitary Gland Disorders

HYPOPITUITARISM

Insuffecient quantities of anterior pituitary gland hormones.

ASSESSMENT

  • Lethargy
  • Hypothermia
  • Weight loss
  • Amenorrhea
  • Dry Skin
  • Hypotension

– Monitor the patient’s risk for infection.

Treatment

Surgery: if hypopituitarism is caused by a tumor.

Hormone therapy

  • Corticosteroids (cortisol)
  • Growth hormone
  • Sex hormones (testosterone for men and estrogen for women)
  • Thyroid hormone

HYPERPITUITARISM

Also called Acromegaly and Cushings’s Disease

ACROMEGALY
Often a result of a benign tumor

ASSESMENT

  • – large hands and feet
  • – protruding jaw and forehead

TREATMENT

  • Hypophysectomy
  • Corticosteroids
  • Elevate head at least 30 degrees.
  • Glucocoritcoids
  • Hormones
  • * Surgery ( Transsphenoidal Pituitary Surgery) to remove the pituitary tumor might be the best treatment.
Meds. used to control increased GH:
  • Octreotide (Sandostatin)
  • bromocriptine (Parlodel)

DISORDER OF THE POSTERIOR PITUITARY GLAND.

♣ DIABETES INSIPIDUS


– Hyposecretion of the ADH hormone.
Assessment:

  • POLYURIA (4-24 L/DAY)
  • POLYDIPSIA
  • DEHYDRATION
  • LOW URINE SPECIFIC GRAVITY 1.006 OR LOWER
  • FATIGUE
  • HYPOTENSION
  • TACHYCARDIA

– * Fluid Deficit is a priority

Medication:

  • VASOPRESSIN (PITRESSIN) *used as an antidiuretic hormone

Examples of Antidiuretic Hormones:

  • Desmopressin acetate
  • Vasopressin (Pitressin)

Side Effects (Antidiuretic Hormones)

  • Headache
  • Nausea & Vomiting
  • Water Intoxication
  • Hypertension
Vasopressin
  • it’s an antidiuretic hormone
  • prevent the loss of water from the body by reducing urine output and reabsorbing water in the body
  • (Increases BP)= by constricting (narrowing) blood vessels
Side Effects (VASOPRESSIN)
  • throbbing headache
  • stomach pain, bloating
  • dizziness, nausea
  • blanching of the skin
♦ Due to increase urine output -> pt. is in risk of HYPOVOLEMIC SHOCK.

♠ SIADH

♠ Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

– excess ADH is being released

Assessment:

  • FLUID OVERLOAD
  • WEIGHT GAIN
  • HYPERTENSION
  • TACHYCARDIA
  • HYPONATREMIA

Interventions:

  • – Monitor fluid & electrolyte imbalance
  • – Fluid restriction.

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NCLEX Review: Neurological System

[youtube http://youtu.be/5AHvjKjCJhA w=400&h=300]

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Show Notes:

Lou Gehrig’s Disease/ Amyothropic Lateral Sclerosis (ALS)

Degeneration of the nerves that controls the voluntary muscles.

ASSESSMENT:

  • Muscle Weakness and Twitching
  • Fatigue
  • dysphagia
  • dysarthia (difficulty swallowing)
  • cramping

– Lowe extremities are usually involved late in the disease.

Treatment:

Riluzole (Rilutek)

Side Effects:

  • nausea, stomach pain, low fever, loss of appetite
  • dark urine, clay-colored stools, jaundice
  • fever, chills, body aches, flu symptoms

Antispasmodics

  • baclofen
  • diazepam

Interventions:

Conserve energy by spacing activities.

Small frequent feedings.

The Nervous System

NCLEX Review on the Neurological System

Time Management:

  • Make sure to read and understand the overview of the Nervous System:
  • Focus in understanding the causes and logic behind each disease.
  • Have an understanding of the signs and symptoms of the disease.
  • Know the medications and the rationale behind using those meds.

Understand that the Nervous system includes the Central Nervous System (CNS), the Peripheral Nervous Sytem (PNS) and the Autonomic Nervous System or the (ANS).

When I say the CENTRAL NERVOUS SYSTEM, We can simplify at as the BRAIN and the SPINAL CORD.

The PERIPHERAL NERVOUS SYSTEM on the other hand, contains the Cranial NERVES and the SPINAL NERVES.

  • WHEN WE TALK ABOUT THE AUTONOMIC NERVOUS SYSTEM, WE ARE BASICALLY TALKING ABOUT THE “SYMPATHETIC” (FIGHT OR FLIGHT) SYSTEM OR THE “PARASYMPATHETIC” SYSTEM.
  • .THE BASIC COMPONENT OF THE NERVOUS SYSTEM IS THE NERVE CELL OR NEURON

NEURON

– is the primary component of the nervous system.

– it is composed of cell body (gray matter), axon and dendrites.

BRAIN (Central Nervous System: Brain and Spinal Cord).

CEREBRUM- Outermost area (cerebral cortex) is gray matter, deeper area is composed of white matter

  • TWO HEMISPHERES: LEFT AND RIGHT AND EACH HEMISPHERE IS DIVIDED INTO TWO LOBES.

FRONTAL LOBE

  • PERSONALITY, BEHAVIOR
  • HIGHER INTELLECTUAL FUNCTIONING
  • BROCA’S AREA: (MOTOR SPEECH AREA)

PARIETAL LOBE

  • POSTCENTRAL GYRUS: REGISTERS SENSATION (TOUCH, PRESSURE)
  • INTEGRATES SENSORY INFORMATION

TEMPORAL LOBE

  • HEARING, TASTE, SMELL (hint: location of ears – close the temples)
  • WERNICKE’S AREA: SENSORY SPEECH AREA
  • (UNDERSTANDING, FORMATION OF LANGUAGE)

OCCIPITAL LOBE

  • VISION

Peripheral Nervous System- composed of Spinal Nerves (31)

Autonomic Nervous System- part of the Peripheral Nervous System

  • REGULATES FUNCTIONS OCCURRING AUTOMATICALLY IN THE BODY.
  • ANS REGULATES SMOOTH MUSCLE, CARDIAC MUSCLE AND GLANDS.

IT IS NOT NECESSARY TO KNOW EVERY PHYSIOLOGY FOR EVERY SINGLE PART OF THE BRAIN. BUT JUST IN CASE WE GO END UP GETTING LOW LEVEL QUESTIONS ON THE EXAM, THEN IT IS IMPORTANT THAT WE UNDERSTAND THE BASIC CONCEPT AND FUNCTION OF EACH AREA. IT WOULD ALSO BE A GREAT IDEA TO KNOW THE CRANIAL NERVES.

The CRANIAL NERVES

GLASCOW COMA SCALE

INCREASED INTRACRANIAL PRESSURE

MENINGITIS

ENCEPHALITIS

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NCLEX Review of the Urinary System

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   Show Notes:

An NCLEX Review of the Urinary System: We will go over the major diseases that you most likely encounter in the NCLEX Exam.

The Urinary System

– is a vital system in the body that enables us to produce, store and eliminate urine.

MAINLY COMPOSED OF:
– the Kidneys
– the Prostate
– the Ureters
– the Bladder
– the Urethra

Although it is not necessary to have the physiology of each anatomy committed to your memory, it is very important to understand the concept and function of each.

DIAGNOSTIC TESTS WITH THE URINARY SYSTEM:

URINANALYSIS  

Very important to remember these values for the NCLEX.

BUN Level            10-20 mg/dl
Creatinine Level            0.5- 1.5 mg/dl
Calcium                 9- 11 mg/ dl
Urine Specific Gravity        1.003- 1.030

ELECTROLYTE IMBALANCE

Hyponatremia (decreased sodium)
Muscle weaknes, Headaches
Fatigue, confusion, vomiting, coma

Hpernatremia (increased sodium)
Tachycardia, dry mucus membrane
decreased urinary output

Hypokalemia (decreased pottasium)
Anorexia, nausea, vomiting
abdominal distention

Hyperkalemia (increased pottasium)
Irritability, nausea and vomiting
diarrhea

Hypokalcemia (decreased calcium)
osteoporosis, fractures, muscle spasms
tetany, n & v, vomiting.

Hypercalcemia (increased calcium)
Renal calculi, coma, arrythmias, decreased reflex

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POLYCYSTIC KIDNEY DISEASE

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NEPHROTIC SYNDROME

GLOMERULONEPHRITIS/ PYELONEPHRITIS

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Urinary Calculi/ Ur0lithiasis

CHRONIC RENAL FAILURE

STAGES OF CHRONIC RENAL FAILURE

Stage 1 Diminished Renal Reserve

  • – renal function is reduced, but no accumulation of metablic wastes occurs.
    – the healthier kidney compensates for the diseased kidney
    – The ability to concentrate urine is decreased
  •   ♦ Results in nocturia and polyuria

– Stage 2 Renal Insufficiency

  • – metabolic waste begin to accumulate in the blood, because affected nephrons can no
    longer compensate.
    – responsiveness to diuretics is decreased, resulting in Oliguria and edema

Stage 3 End Stage Renal Disease.

  • – excessive amount of metabolic wastes such as
    urea and creatinine accumulate in the blood.
    – kidney is unable to maintain homeostasis
    – treatment is by dialysis

Metabolic Changes
– Urea and Creatinine
– Sodium
– Pottasium
– Acid Base Balance
– Calcium and Phosporus

Cardiac Changes
– Hypertension
– Hyperlipidemia
– Heart Failure
– Uremic Pericarditis

INTERVENTIONS
– It is important to monitor renal, respiratory and cardiovascular status and the fluid balance.

REMEMBER FOR NCLEX
– Patient with Chronic Renal Failure would have

  • ♣ UREMIA, ANEMIA AND ACIDOSIS

DIALYSIS:

Peritoneal Dialysis:

♣ Complication: can include Peritonitis

Hemodialysis:

♠ Pt. may use external shunt or surgically constructed internal arterivnous fistula (long-term)

Most common cause of renal failure is *poorly controlled diabetes & Hypertension.

Dopamine= can enhance renal perfusion and elevate blood pressure.

♠ Ways to control monitor kidney function:

  • Monitor I and O
  • Monitor Lab Values
  • Specific Gravity
  • BUN and Serum

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NCLEX Pharmacology

A Quick Review on Pharmacology

♣ Show Notes

NCLEX Review on Pharmacology

The fact is that pharmacology will always be a big part in your NCLEX Exam, and can be a huge catalyst in whether you pass or fail your NCLEX Exam.  It is quite important for us to focus a lot on the content that pertains to medications, if we are reviewing for the NCLEX.  The NCSBN (who is responsible for developing the NCLEX Exam) defines the category of Pharmacological and Parenteral Therapies as a sub-category within the Physiological Integrity area (of the exam)  in which the nurse is basically providing care related to the administration of medications and parenteral therapies.

To be more specific, Pharmacological and Parenteral Therapy has contents that  includes but is not limited to:

  • Adverse Effects/Contraindications/Side Effects/Interactions
  • Expected Actions/Outcomes
  • Medication Administration
  • Blood and Blood Products
  • Parenteral/Intravenous Therapies
  • Central Venous Access Devices
  • Pharmacological Pain Management
  • Dosage Calculation

First, I want to take a step back and look at Pharmacology from a technical sense and look at it more in depth.

What is Pharmacology?

♠ PHARMACOLOGY

Pharmacokinetics– The study if how drugs are being absorbed, distribuited, metabolized and excreted by the body.
Pharmacodynamics– is the study of how drugs are being used by the body.
Pharmacotherapeutics– the study of how the client responds to the particular drugs.

What’s in a drug name?
Chemical Name:
This tells you the chemical makeup of the drug.
Generic Name
This name is given by the company that developed the drug.
Trade Name
This is the name given to the drug by the company in which the medication originated.

The Seven Rights of Administering Drugs

  • Right Client
  • Right Route
  • Right Drug
  • Right Dose
  • Right Amount
  • Right Time
  • Right Documentation
  • Right to refuse treatment

Any drug can have a CHEMICAL NAME, A GENERIC NAME AND A BRAND OR TRADE NAME.

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

During this review, I want to focus specifically towards the drugs that is mostly in patients with hypertension.

DRUGS USED WITHIN THE CARDIAC SYSTEM

hypmeds

Cardiac Pharmacology

♣ Pharmacology Drugs for Hypertension:

DIURETICS

  • – Helps get rid of the sodium and fluid in the body.
  • – Used to lower the blood pressure.
    – Promotes the excretion of sodium and water
    – Diuretics interferes with the sodium absorption in the kidney.
    – Increases the urine output.  Decreases the preload and afterload..

If the patients blood pressure drop to low, it is important to give IV fluids to pt.

LETS GO OVER THE CATEGORIES OF DIURETICS ♠

♦ TYPES OF DIURETICS

♣ POTTASIUM SPARING DIURETICS

It promotes the excretion of soduium and water, while the retention of pottasium

Used for:

  • Hypertension
  • Edema
  • Hyperaldosteronism
  • Hypokalemia

Medication:

  • SPIRONOLACTON (ALDACTONE)
  • AMILORIDE (MIDAMOR)
  • TRIAMTERENE

Now lets go to the side effects:

First, of course the person can have too much potassium or HYPERKALEMIA:

Signs of HYPERKALEMIA

  • irregular heartbeat
  • nervousness
  • tingling in hands and feet
  • shortness of breath
  • tiredness or weakness

OTHER SIDE EFFECTS:

  1. Nausea and vomiting
  2. Cramping and diarrhea
  3. Dizziness & headache

Loop Diuretics

  • BUMETANIDE (BUMEX)
  • FUROSEMIDE (LASIX)

Osmotic Diuretics

MANNITOL

  • Thizade Diuretics

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

Very Important for the NCLEX:

SIDE EFFECTS OF DIURETICS

  • Frequent urination
  • Electrolyte abnormalitie
  • Muscle cramps or weakness
  • Blurred vision
  • confusion
  • headache
  • increased perspiration (sweating)
  • restlessness

BETA (ADRENERGIC)  BLOCKERS

– Helps lower blood pressure, puls rate and cardiac output.
– Can be used to treat headaches.
– Can be used to treat glacauma and prevent myocardial infarctions.
– Acts on the system, by blocking the symathetic vasomotor response.

For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).

SIDE EFFECTS:

  • Orthostatic hypotension
  • bradycardia
  • nausea and vomiting
  • diarrhea

NOTE: Some of the symptoms may MASK signs of 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 (protein, 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.

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Cardiac Pharmacology

♣ 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.
  • Remember:

– Blocks the calcium channels in the heart, causing a decrease in contractility.
Decreases the workload of the heart.

Used for:
Hypertension

Medications:

  • Nifedipine (Procardia)
  • Amplodipine (Norvasc)
  • Do not give Norvasc with grapefruit, causees increase in drug level.
  • Verapamil (Isoptin)
  • Diltiazem (Cardizem)

SIDE EFFECTS:

Constipation
Nausea
Headache
Rapid heartbeat (tachycardia)
Drowsiness

Remember:

  • Make sure to monitor the heart rate and the blood pressure.
  • Hold medication if HR is less than 60 or if BP is less than BP.

♠ 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.

SIDE EFFECTS:

  • COUGH
  • TACHYCARDIA
  • NAUSEA AND VOMITING.

Remember:
GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.

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How to Pass the NCLEX Exam

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Show Notes:

Now I have been getting plenty of questions lately and most of these questions pertains obviously mostly on how to pass the NCLEX Exam.  So, what I did was I did some research outside of the actual “Nclex review content” scenario  and took a step back and really look at the reasons why some people passed there NCEX Exam, the first time they take it.  Its quite obvious that the answer for that would be that the ones that pass on the first time really did studied hard invested plenty of time, energy and effort into the to the review while others, well…  Let me ask you this, have you noticed how some people are just really good in taking exams?. There are usually those people in our lives that just really good at taking exams.  On the outside it doesn’t seem like they’re really are studying that hard or investing that much time (which can be true) or we might not really know how much they’ve studied or how much time they invested yet at the end of the day they still pass their exam on the first try…

Sometimes it boggles our minds and we can even get quite jealous.  Now I think for the most part these people really did invest plenty of the time and energy and resources in passing this exam (which I personally did, and it paid off ) but I also believe that these people do have a good amount of test taking skills because for me personally I really did invest plenty of time, effort, energy and sacrifice in order to pass the NCLEX Exam the first time I took it about three years ago.  Anyhow,  I also believe that these people unconsciously were able to adapt to a certain strategic approach on learning that worked on their own specific learning styles.

I did my own research on most of these test takers and found out that these people are more analytic in their review methods than I thought.

nclex study review pass guides

And this is what I have learned:

You need to learn a deeper level way of studying that is complimentary to our learning style.  When we just try to memorize words it’s what researchers have called the, “shallow level of processing,” basically you are just looking at the words and trying to memorize them without making any connections or understanding (in depth) by looking and analyzing the bigger picture.  Instead, we need a more “deep level processing” way of reviewing the NCLEX.  This can be accomplished by trying to connect it with our own experience and also understanding more in depth the NCLEX Review Contents.

What can really enhance the deeper level processing way of reviewing for the NCLEX Exam  is by allowing your brain to match your learning style whether you are an (auditory learner, visual learner or a tactile learner).  So this includes looking at NCLEX Review Videos (HERE IS THE LINK), maybe even playing an AUDIO NCLEX Review CD in your car while driving (HERE IS THE LINK) or just trying to connect, what you are learning with your everyday experience.

Attention and Interest is an important subject when studying for the NCLEX.  Sometimes, reviewing for the NCLEX exam can just become too tedious and boring.  There are plenty of times when we are reading unconsciously just word after word without actually retaining and understanding the content (which is counter productive).

Therefore, there is no reason for our NCLEX Review not to be fun and interesting (while learning at the same time).  We need to look at other ways such as media (audio and video) and websites to enhance our NCLEX Review.

Don’t settle for boring, check out some stuff below…  : )

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The NCLEX exam is a content based exam in which you are tested based on your overall knowledge  and ability of the Nursing content.  It is a computerized adaptive exam in which you need to answer a certain amount of questions correctly deemed acceptable by NCBSN.  Although there are plenty of strategies and techniques you can use to succeed in passing your NCLEX exam, it very important to know and understand the NCLEX contents.   At the end of the day, you are being tested based on the contents that you either fully know or not.  That is why it is very important to keep doing NCLEX questions, because it enables us to get familiarized with the NCLEX and is also a great method in learning and re-learning NCLEX contents.

(Some LINKS are only available on the actual NCLEX 26 Course)

 NCLEX CATEGORIES:

(Some LINKS are only available on the actual NCLEX 26 Course)

__________________________________

TOTAL STUDY TIME: Approx. 26 Hrs.

 

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