The SimpleNursing NCLEX® Cram Sheet
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Lab Values
Basic Metabolic Panel (BMP) Panel & Electrolytes
Sodium (Na+) – Normal range = 135-145 mEq/L
- LOW Sodium – Low & Slow
- HIGH sodium = Big & Bloated
Potassium (K+) – Normal range = 3.5-5.0 mEq/L, pumps the heart muscles
Chloride (Cl-) – Normal range = 97-107, helps to maintain acid base balance
Carbon Dioxide (CO2) – Helps to maintain acid base pH balance (too much can put the body in Acidosis)
- Normal range = 23-29 (mEq/L)Memory trick: Carbon DiACID
Bicarbonate (HCO3) – Pushes the body into an alkalotic state
- Normal range = 23-30 mEq/L
- Memory trick: Bicarb Base
BUN & Creatinine – 2 labs for 2 kidneys
- BUN Normal range = 10-20, over 20 usually means dehydration.
- Creatinine over 1.3 = Bad Kidney (kidney injury)
Glucose – Normal range = 70-110
- Hyperglycemia (over 120) usually clients with uncontrolled diabetes,
- Hypoglycemia (60 or less) brain will DIE! Very deadly
Calcium (Ca) – Normal range = 9.0-10.5 mEq/L
- Memory trick: Calcium Contracts Muscles
Magnesium (Mg+) – Normal range = 1.3 – 2.1 mEq/L
- Memory trick: Magnesium Mellows Muscles
Complete Blood Count (CBC)
Hemoglobin – Normal = 12-18
- Risky = 8-11
- Heaven or blood transfusion = 0-7
Hematocrit – Normal = 36-54%
- Elevated Hct = Dehydration
- Decreased Hct = Bleeding, Anemia, Malnutrition
Red blood cell count (RBC) – 4-6 million
- Low = Anemia, Renal Failure
- High = Dehydration
White Blood Cells (WBC) & Coagulation Panel
WBC Total Count – Normal = 5,000-10,000
- Higher = Leukocytosis
- Low = “Leukopenia”
CD4 Count – Normal = Over 200
- Below = AIDS
Platelets – Normal range = 150k – 400k
PTT – Normal range = 30-40
INR – Normal range = 0.9-1.2
Health Assessments
Head to Toe Assessment
Normal Range Vitals:
| Vital Sign | Normal Range | Location | Classification |
| Pulse | 60-100bpm | Radial, carotid, brachial, femoral, popliteal, dorsalis pedis, posterior tibialis, temporal pulse. | Absent, weak, normal, increased, bounding. |
| Respirations (RR) | 12-20bpm | Anterior (chest) and posterior (back) | Normal, adventitious, absent, diminished. |
| BP | 120/70-139/89 | Brachial, radial, popliteal, posterior tibialis. | Systole: Max contraction of the left ventricle. Diastole: Pressure of resting ventricles. |
| Temperature | 98.6/37*C | Temporal, rectal, oral, tympanic, axillary | Febrile, afebrile |
Circulation
Capillary Refill
Skin Turgor
Head & Neck
- Hair, Eyes, Nares, Mouth, Jaw & Neck
Chest
- Heart: All Pigs Eat Too Much
A – Aortic
P – Pulmonic
E – Erb’s Point
T – Tricuspid
M – Mitral
- Lungs
- Breast
Abdomen
- Bowel Sounds, Shape
Pain Assessment
Types of Pain – Chronic: Persistent, malignant pain that lasts more than six months.
- Acute: Sudden onset of pain, specific to injury. Lasts from seconds to six months
Effects of Pain – Chronic: Immune suppression, depression, disability, fatigue, anger, inability to perform ADLs
- Acute: Increased cardiac output, impaired insulin response, immune suppression, increased cortisol production, increased fluid retention.
Factors that Influence Pain – Past Experience, Anxiety, Depression, Age, Gender, Culture
Patho – Nociceptors, Nociception, Cox 1, Cox 2, Decrease pain sensation
Pharmacologic Treatments – Non opioids: NSAIDS, Acetaminophen, Ofirmev
- Opioids: Tramadol, Tylenol 3, Meperidine, Propoxyphene (with tylenol), Oxycodone, Fetanyl, Morphine, Dilaudid
- Other: PCA pump, PRN medications, Multi modal (use of one or more drugs), Routine admin (admin around the clock), Topical, Local anesthesia, Intraspinal
Non-pharmacologic Treatments – Cutaneous stimulation (TENS machine), Massage, Thermal therapies (heat and cold), Distraction, Relaxation, Guided imagery, Hypnosis, Music therapy, Alternative therapy (Acupuncture)
Focused Pain Assessment – Scale (0-10), Timing, Location, Duration, Quality, Aggravating and Alleviating factors
Mother Assessment
Admission – Birth imminence, Fetal status, Maternal status, Risk assessment
Assessment Components – Obstetric History, Current Labor Status, Medical–Surgical History, Social History, Desires/Plans for Labor and Birth
GTPAL – Gravida, Term, Preterm, Abortion, Living
Ambulation: Body Mechanics & Mobility
General ease of movement – Normal finding = voluntary, controlled, purposeful, fluid, and coordinated movements
- Abnormal finding = involuntary movements, tremors, tics, chorea, dystonia, fasciculations, oral or facial dyskinesias
Gait – Normal finding = head erect with vertebral straight, knees and feet forward, arms at side with elbows flexed, arms wing freely in alternation with leg swings
- Abnormal finding = spastic hemiparesis, scissor gait, steppage gait, sensor ataxia, cerebellar ataxia, parkinsonian gait, use of assistive devices
Alignment – Normal finding = when standing or sitting, a line can be drawn from the ear to shoulder and hip.
- Abnormal finding = spinal curvatures as seen in scoliosis, inability to maintain normal alignment
Joint structure – Normal finding = absence of joint deformities and full range of motion.
- Abnormal finding = limitation of full range of motion, swelling, heat, tenderness, crepitation, deformities
Muscles mass and tone – Normal finding = adequate mass, tone and strength to complete ADLs.
- Abnormal finding = atrophy, hypertrophy, flaccidity, spasticity, paralysis.
Endurance – Normal finding = turning in bed, maintaining correct alignment, ambulating, performing self-care activities
- Abnormal finding = increased pulse, respirations, BP, SOB, dyspnea, weakness, pallor, confusion, vertigo, pain.
Positioning
Fowler’s Position – The head and trunk are raised 30-90 degrees.
- For cardiac issues, SOB, or NG tube.
Lateral – Right lateral = The right side of the patient touches the bed.
- Left lateral = The left side of the patient touches the bed.
- For GI issues and rectal surgery.
Lithotomy – Most common in OB; patient lies flat on their back with knees elevated and hips level (often supported by stirrups).
- For gynecological procedures and childbirth.
Sim’s Position – Prone/lateral; Patient lies on their side with upper leg flexed and drawn towards the chest, and upper arm flexed at the elbow.
- For administering enemas, perineal examination, and comfort in pregnancy.
Prone – Patient lies on their stomach with back up, and head turned to one side.
- For drainage of the mouth after oral or neck surgery. It allows for full flexion of knee and hip joints.
Supine – On patient’s spine; Considered the most natural “at rest” position.
- For abdominal, facial, and extremity procedures.
Trendelenburg – “Upside Down”; Patient is in supine position and has their head sharply lowered and raised feet.
- For hypotension, gynecological and abdominal hernia surgeries, and placement and removal of central lines.
Reverse Trendelenburg – Patient is in supine position with head of the bed elevated and the foot of the bed down.
- For types of surgery to help promote perfusion in obese patients. Also helpful in treating venous air embolism and preventing pulmonary aspiration.
Maternity & Pediatric
Maternal Pharmacology
Pediatric –
| Drug | Mode of Action | Indication | Contraindication/Adverse Effects | Dose/Route |
| PhytonadioneVit K | Helps prevent bleeding by activating clotting factors. | Prevention and treatment of hypoprothrombinemia. | Pain, swelling, flushing, dizziness, rapid heartbeat, sweating. | IM Subcut, IV (Children 1mo): 1– 2 mg single dose. |
| ErythromycinErythrocin | Suppresses protein synthesis at the level of the 50S bacterial ribosome. | Administered immediately after birth along with Vitamin K shot. Infections caused by susceptible organisms. | Infantile hypertrophic pyloric stenosis, pancreatitis, interstitial nephritis rash. Benzyl alcohol should be avoided in neonates. | Eye drops/cream.IV/ P.OPO (Neonates ):Ethylsuccinate—20– 50mg/kg/day divided q 6– 12hr.IV (Children 1 mo): 15–50 mg/kg/day divided q 6hr, maximum 4 g/day. |
| HEp B vaccine | Causes a primary immune response. | Provides immunity against HEP B. | Do not give if baby is already+. | 5 mcg/0.5 mL ; 5 mcg/mL; 10 mcg/0.5 mL |
| HEP B IGBayHep B, Nabi-HB | Confers passive immunity to hepatitis B infection postexposure. | Hepatitis b infection in neonates born to HBsAg-+ women, provides passive immunity. | Erythema at IM site, pain, swelling, tenderness.Hypersensitivity to immune globulins, glycine, or thimerosal. | IM: 0.5 mL within 12 hr of birth. |
Postpartum –
| Drug | Mode of Action | Indications | Contraindications/Side Effects | Dose/Route |
| Phytonadion | Bind to opiate receptors in the CNS. | Management of moderate to severe pain. | Avoid chronic use. Dizziness, sedation, respiratory depression, hypotension. | ROUTE PO—2.5– 10 mg q 3– 6 hr as needed. |
| Simethicone Gas-X | Passage of gas through the GI tract by belching or passing flatus. | Relief of painful symptoms of excess gas in the GI tract that may occur postoperatively. | Not recommended for infant colic | ROUTE PO40– 120 mg qid, after meals and at bedtime (up to 500mg/day). |
| DocusatePeri-Colace | Promotes incorporation of water into stool, resulting in softer fecal mass. | Prevention of constipation (inpatients who should avoid straining, such as after MI or rectal surgery). | Hypersensitivity; Abdominal pain, nausea, or vomiting. | ROUTE PO2 tablets once daily at bedtime; maximum 4 tablets twice daily. |
Pregnancy
Signs of Pregnancy – Presumptive: subjective data the woman reports to the HCP.
- Probable: objective data, such as cervical changes.
- Positive: diagnostic confirmation such as, fetal heartbeat & ultrasound
Weight Gain – A pregnant patient should increase their caloric intake by 300 kcal/day during 2nd & 3rd trimesters.
- First Trimester: 3-4 lb total
- Remainder of Pregnancy: 1 lb per week
- Total weight gain: 25-35 lb for a patient with a normal BMI
Nutritional Requirements – Proteins, Minerals, Iron, Calcium, Phosphorus, Zinc, Iodine
Vitamin requirements – Folic acid (Vitamin B9), Vitamin A, Vitamin C, Vitamin B6, Vitamin B12
Hematologic Changes – Blood volume increases by 45-50%.
- Red blood cell count increases up to 30%.
- Plasma increases up to 50%
- Hemoglobin decreases
- Hematocrit decreases
Cardiac changes – Blood pressure slightly decreases
- Heart rate increases by 10-15 BPM
- Cardiac output increases
Integumentary changes – Chloasma, Linea nigra, Striae
Musculoskeletal changes – Lordosis, Diastasis rectus abdominis
Respiratory changes – Nasal mucosa edematous due to vasocongestion.
- Nasal congestion and voice changes are possible.
- Accommodations to maintain lung capacity.
- May feel short of breath when eupneic.
- Third-trimester diaphragm pressure.
GI changes – Intestines are displaced upwards & to the side.
- Pressure changes in the esophagus & stomach, which leads to heartburn
- Constipation
Pharmacology
Analgesics – Opioid; Increases pain threshold by altering pain perception
| Common Brands | Generic Brands |
| Demerol | Meperidine HCL |
| Dilaudid | Hydromorphone |
| Duragesic, Sublimaze | Fentanyl |
| Morphine Sulfate | Morphine Sulfate |
| Vicodin, Norco | Hydrocodone |
Anticoagulants – Interferes with blood clotting processes.
| Common Brands | Generic Brands |
| Coumadin | Warfarin |
| Lovenox | Enoxaparin |
| Heparin | Heparin Sodium-from beef/pork |
Anticonvulsants – Increases interval between seizures.
| Common Brands | Generic Brands |
| Dilantin | Phenytoin |
| Neurontin | Gabapentin |
| Tegretol | Carbamazepine |
| Depakote | Valproic Acid |
Antidepressants – SSRIs; Inhibits serotonin reuptake in CNS.
| Common Brands | Generic Brands |
| Celexa | Citalopram |
| Effexor | Venlafaxine |
| Lexapro | Escitalopram Oxalate |
| Paxil | Paroxetine |
| Prozac | Fluoxetine |
| Zoloft | Sertraline |
Anti-Diabetics – Sulfonylureas; Promotes insulin secretion by the pancreas; Increases tissue response to insulin.
| Common Brands | Generic Brands |
| Amaryl | Glimepiride |
| Diabeta, Glynase, Micronase | Glyburide |
| Glucotrol (XL) | Glipizide |
Antiemetics – Decreases/prevents nausea & vomiting.
| Common Brands | Generic Brands |
| Phenergan | Promethazine |
| Zofran | Ondansetron |
Antihypertensives–(PRIL) – ACE Inhibitors; Blocks the conversion of angiotensin I to angiotensin II (potent vasoconstrictor).
| Common Brands | Generic Brands |
| Altace | Ramipril |
| Capoten | Captopril |
| Prinivil, Zestril | Lisinopril |
| Vasotec | Enalapril |
Antilipidemics – Inhibits HMG-CoA reductase, an early step in cholesterol production.
| Common Brands | Generic Brands |
| Crestor | Rosuvastatin |
| Lipitor | Atorvastatin |
| Zocor | Simvastatin |
Antiplatelets – Interferes with the 1ST step in the clotting process: platelet aggregation.
| Common Brands | Generic Brands |
| ASA – aspirin | Acetylsalicylic Acid |
| Plavix | Clopidogrel |
Anxiolytics – Azaspirodecanedione derivatives; Decreases anxiety.
| Common Brands | Generic Brands |
| Buspar | Buspirone Hydrochloride |
Arbs-(SARTAN) – Blocks binding of angiotensin II at the receptor site.
| Common Brands | Generic Brands |
| Atacand | Candesartan |
| Cozaar | Losartan |
| Diovan | Valsartan |
Benzodiazepines (Pam & Lam) – Enhances/facilitates GABA, an inhibitory neurotransmitter
| Common Brands | Generic Brands |
| Xanax | Alprazolam |
| Valium | Diazepam |
| Ativan | Lorazepam |
| Versed | Midazolam |
Beta Blockers-(OLOL) – Prevents sympathetic heart stimulation, thus Decreases HR and contractility.
| Common Brands | Generic Brands |
| Inderal | Propranolol |
| Lopressor | Metoprolol Tartrate |
| Toprol-XL | Metoprolol Succinate |
| Tenormin | Atenolol |
Biguanides – Decreases hepatic glucose production & intestinal absorption of glucose.
| Common Brands | Generic Brands |
| Glucophage | Metformin |
Calcium Channel Blockers – Blocks Na+ influx into the beta-receptors.
| Common Brands | Generic Brands |
| Cardizem | Diltiazem |
| Norvasc | Amlodipine |
| Procardia | Nifedipine |
| Verelan, Isoptin, Calan | Verapamil |
Cardiac Glycosides – Positive inotropes (improve contractility and cardiac output).
| Common Brands | Generic Brands |
| Lanoxin | Digoxin |
Corticosteroids – Inflammation, produces intentional immunosuppression, and treats adrenocortical insufficiency.
| Common Brands | Generic Brands |
| Celestone | Betamethasone |
| Decadron | Dexamethasone |
| Deltasone | Prednisone |
| Solu-Cortef | Hydrocortisone |
| Solu-Medrol | Methylprednisolone |
Diuretics – Decreases fluid volume in the body.
| Common Brands | Generic Brands |
| Bumex | Bumetanide |
| Demadex | Torsemide |
| Lasix | Furosemide |
Glitazones – Decreases insulin resistance.
| Common Brands | Generic Brands |
| Actos | Pioglitazone |
| Avandia | Rosiglitazone |
H2-Histamine Receptor Antagonists – Inhibit histamine at histamine H2-receptor sites, gastric acid secretion.
| Common Brands | Generic Brands |
| Pepcid | Famotidine |
| Zantac | Ranitidine |
Nitrates – Peripheral and coronary vasodilators.
| Common Brands | Generic Brands |
| Nitro BID, Tridil, Transderm Nitro, Nitrostat | Nitroglycerin |
| Imdur | Isosorbide Mononitrate |
| Isorbid, Isordil, Sorbitrate | Isosorbide Dinitrate |
Proton Pump Inhibitors (PPI) – Blocks final step of gastric acid production; Ulcer-reducing.
| Common Brands | Generic Brands |
| Nexium | Esomeprazole |
| Prilosec | Omeprazole |
| Protonix | Pantoprazole |
Tricyclics – Blocks reuptake of norepinephrine and serotonin at nerve endings.
| Common Brands | Generic Brands |
| Elavil | Amitriptyline |
