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NCLEX LABS Flashcards

1
Q

INR

A

2-3

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2
Q

INR >4

A

C= Critical.

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3
Q

When INR is critical (Greater than 4)

A

Hold Coumadin
Assess For Bleeding
Prepare Vitamin K
Call Doctor

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4
Q

Creatinine? (Best Indicator
of Kidney Function)

A

0.6-1.2 (Same as Lithium)

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5
Q

Elevated Creatinine Greater than 1.2 =

A

A (Abnormal)
Do nothing.

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6
Q

Potassium

A

3.5-5.3

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7
Q

Low Potassium (Less than 3.5) = C (Critical)

A

C (Critical)

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8
Q

What should you do if your K is low?
(Less than 3.5)

A

Assess Heart
Prepare to Give K
Call Doctor

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9
Q

Elevated Potassium?
If it’s 5.4-5.9 =

A

Critical
High but Still in the 5’s

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10
Q

What to do if K is in Critical Range?
(5.4-5.9)

A

Hold K
Assess Heart
Prepare Kayexalate + D5W+Regular Insulin

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11
Q

Potassium Over 6?

A

D= DEADLY DANGEROUS. DO SOMETHING NOW.

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12
Q

When Potassium is over 6 you?

A

First get Vitals.
Then get help, Look for severe acidosis - that’s what this is and is the biggest priority.

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13
Q

BUN?

A

8-30

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14
Q

Elevated BUN? (Over 30)

A

B. Be concerned

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15
Q

What do you do if BUN is elevated?
(Over 30)

A

Check for Dehydration

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16
Q

Hemoglobin?12-18. Remember Teenage hemoglobin

A

12-18

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17
Q

If Hemoglobin is moderately low (8-11) B. (Be concerned). Check for Bleeding.

A

B. (Be concerned). Check for Bleeding.

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18
Q

What do you do if Hemoglobin is less
than 8?

A

C= Critical.
Assess for Bleeding
Prepare Blood Transfusion
Call Doctor

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19
Q

HCO3 (Bicarb)?

A

22-26 (Young Adult Age)

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20
Q

Normal Bicarb?

A

A= Abnormal. Not really concerned

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21
Q

CO2?

A

35-45

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22
Q

Beware, C02 Range doesn’t count in?

A

COPD Patients

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23
Q

If CO2 is in the 50s?

A

C= Critical

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24
Q

What should you do if C02 is in the 50s?

A

Assess Respiratory Status
Do Pursed Lip Breathing
Never Pick Give 02!!!

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25
If the CO2 is the 60s?
D= Respiratory FAILURE
26
What should you do if CO2 is in the 60s?
Assess Respiratory Status Do Pursed Lip Breathing Prepare for Intubation Call Respiratory Call MD
27
Hematocrit (HCT)
36-54 Abnormal= B.
28
What should you do if Hematocrit is Elevated?
Assess for Dehydration
29
PO2 (This is Partial 02 in Arterial blood. From ABG Only)
78-100
30
Kind of Low P02 ? (70-77)
C= Critical
31
What should you do if P02 is 70-77?
Assess Respiratory Status Give 02
32
P02 < 60
D= DEADLY DANGEROUS
33
What should you do if P02 is really low?
Assess Respiratory Status Give Respiratory Status Prepare 02 Call Respiratory Call Doctor
34
02 Saturation
93-100 (Lower than 95 is bad for Peds pts)
35
Always ____ for 02 levels
Over React
36
If 02 is less than 93 C= Critical.
Assess Respiratory Give 02
37
BNP Normal
< 100
38
If BNP is Elevated
B. Be Concerned. Look for signs of CHF
39
SODIUM (NA)
135-145 If NA is Abnormal It's a B
40
If SODIUM (NA) is Abnormal WITH A change in LOC
C= Critical. Huge Safety Risk
41
WBC?
5,000-11,000
42
If WBC is <5000
C- Critical
43
ANC Normal (Absolute Neutrophil Count)
C - Critical
44
CD4 Count < 200
AIDS. =Critical. Neutropenic Precautions
45
High WBC Count(Greather than 11,000)
Leukocytosis
46
Low WBC Count
Leukopenia Neutropenia Agranulocytosis Immunosuppression Bone Marrow Suppression
47
Neutropenic Precautions (Low WBC, Less than 5,000)
Strict Handwashing Shower BID with antimicrobial soap Avoid Crowds Private Room Limit numbers of staff entering room Limit Visitors for Healthy Adults No fresh flowers or potted plants Low Bacteria Diet: No Raw Fruits, Veggies, Salads No Undercooked meat. Do not drink water than has been standing longer than 15 minutes Vital signs (Especially Temperature) every 4 hours Check WBC (ANC) Daily Avoid the use of an indwelling catheter Do not re-use cups.. must wash between uses Use disposable plates, cups, straws, plastic knife, fork, spoon Dedicated Items in Room: Stethoscope BP Cuff Thermometer Gloves ASSESS FOR INFECTION!!!
48
Platelets (Help Clotting)
150-400,000 (Wide Range)
49
Platelets <90,000
C= Critical
50
Platelets <40,000
D= Deadly Dangerous
51
Bleeding Precautions/Thrombolytic Protocol
No unnecessary venipuncture For injections or IV, Use Small Gauge Handle Pt Gently, use drawsheet Use Electric Razor No toothbrush or flossing No Hard Foods Well fit dentures ( No rubbing) Blow Nose Gently No rectal temperature, enema, or suppository No Aspirin No contact sports No walking in bare feet No tight clothes or shoes Use stool softener. No straining Notify MD of blood in urine, and stool.
52
RBC's
4-6
53
Abnormal RBC (Not 4-6)
B= Be concerned
54
K>6
DEADLY DANGEROUS
55
PH<6
DEADLY DANGEROUS
56
CO2 in the 60's
DEADLY DANGEROUS
57
Platelets 40,000 or less
DEADLY DANGEROUS
58
When should you call a Rapid Response Team?
Symptomatic D's
59
Absolute Neutrophil count
1500-8000mm/3 or 1.5 to 8.0
60
Normal Glasgow Coma Scale
15, less than that is not stable
61
Peak flow for Asthma
80% or higher is stable and means good control, 50-79% means caution, and less then 50 is a medical alert
62
Normal MAP
70-105 mm Hg. A MAP <60 will not allow for adequate perfusion of vital organs
63
Normal Troponin
<0.5 for Troponin 1 and <0.1 for Troponin T
64
Normal Uric Acid Level
4.0-8.5
65
Normal Carboxyhemoglobin Level (Carbon monoxide) 2-3% in non smokers and slightly higher in smokers
2-3% in non smokers and slightly higher in smokers
66
Parkland Formula
4mg/ kg of body weight, and first half within the first 8 hours
67
Normal newborn levels
RR 30-60, Glucose <70-100, but > 40 Bo 70/40

NCLEX-LABS (6 decks)

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