A

APPENDIX A

Things You Forgot

Throughout this book, we have tried to simplify your preparation
for the NCLEX exam. This appendix includes information you
have learned during nursing school but might have forgotten.

Therapeutic Drug Levels

Therapeutic drug levels that are important for the nurse to remember when taking the NCLEX exam include:
. Digoxin: 0.52.0 ng/mL
. Lithium: 0.8-1.2 mEq/L* (NIH value)
. Dilantin: 1020 mcg/mL
. Theophylline: 1020 mcg/mL

NOTE
*The therapeutic range for lithium may vary slightly according to laboratory
methods used. Lithium toxicity occurs at levels greater than 1.5 mEq/L.

Vital Signs
Normal ranges for the vital signs of the adult and the newborn:
. Adult heart rate: 80100 beats per minute
. Newborn heart rate: 100180 beats per minute
. Adult respiratory rate: 1220 respirations per minute
. Newborn respiratory rate: 3060 respirations per minute
. Adult blood pressure: systolic pressure = 110120 mm Hg;

diastolic pressure = 6090 mm Hg

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Appendix A: Things You Forgot

. Newborn blood pressure: systolic pressure = 65 mm Hg; diastolic

pressure = 41 mm Hg
. Temperature: 98.6 F plus or minus one degree

Intrapartal Normal Values

Here are some of the normal ranges to remember when caring for the client
during the intrapartal period:
. Fetal heart rate: 120160 beats per minute
. Variability: 610 beats per minute
. Contractions:
. Frequency of contractions: every 25 minutes
. Duration of contractions: less than 90 seconds
. Intensity of contractions: less than 100 mmHg

Anticoagulant Therapy
The nurse should be familiar with the tests ordered for the client receiving anticoagulant therapy and for the control levels. Remember that the therapeutic range is
1.52 times the control:
. Coumadin (sodium warfarin) PT/Protime: 1220 seconds.
. International normalizing ratio (INR): 23.
. The antidote for sodium warfarin is vitamin K.

NOTE
Lab values may vary according to methods used.

. Heparin and heparin derivatives partial thromboplastin time (PTT):

3060 seconds.
. The antidote for heparin is protamine sulfate.

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Standard Precautions

Standard Precautions
Standard precautions are guidelines used to prevent infection with diseases
transmitted through blood or body fluids. The nurse should be familiar with
examples of diseases that require the use of standard precautions and those that
require transmission based precautions. Transmission-based precautions include
airborne precautions, droplet precautions, and contact precautions.
. Gloves should be worn when there is a chance of contact with blood and

body fluids, when handling other potentially infected material, and when
performing vascular access procedures.
. Gloves should be changed after each client contact and between contact

procedures with the same client.

. Masks and protective eyewear should be worn when there is a likelihood

of splashes or when body fluids might become airborne.

. Gloves and aprons should be worn during procedures in which there is a

likelihood of splashes of blood or body fluids.

. Hand washing should be done immediately after contact with body fluids

or other potentially infected material and as soon as gloves are removed.

. Needles and sharps should be disposed of in sharps containers. No

recapping, bending, or breaking of needles should occur.

. Mouth-to-mouth resuscitation should be performed using a mouthpiece

or other ventilation device.

CAUTION
Body fluids likely to transmit blood-borne disease include blood, semen, vaginal/cervical
secretions, tissues, cerebral spinal fluid, amniotic fluid, synovial fluid, pleural fluid, peritoneal fluid, and breast milk. Body fluids not likely to transmit blood-borne disease unless
blood is visible include feces, nasal secretions, sputum, vomitus, sweat, tears, urine, and
saliva (the exception is during oral surgery or dentistry).

Airborne Precautions
Infections requiring airborne precautions are those caused by pathogens that
remain suspended in the air for prolonged periods of time. Clients with tuberculosis, measles (rubeola), and varicella should be cared for using airborne precautions. The client should be placed in a private, negative pressure room.
Healthcare workers should wear a HEPA mask (also referred to as an N-95 or
respirator mask) when caring for these clients.

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Appendix A: Things You Forgot

Droplet Precautions
Infections requiring droplet precautions are those caused by pathogens that are
suspended in droplets that travel 3 feet, but are not suspended in the air for long
periods of time. Clients with influenza, mumps, pertussis, rubella (German
measles), diphtheria, pneumonia, scarlet fever, streptococcal pharyngitis, and
meningitis should be cared for using droplet precautions. The client should be
placed in a private room or in a room with a client who has the same illness.
Client beds should be no closer than 3 feet apart. The door to the room may
remain open. Healthcare workers should wear a mask when in direct contact
with the client.

Contact Precautions
Infections requiring contact precautions are those caused by pathogens spread
by direct contact. Clients with RSV, scabies, colonization with MRSA, and VRE
should be cared for using contact precautions. The client should be placed in a
private room or with a client with the same illness. Healthcare workers should
wear gloves when entering the room and wear gowns to prevent contact with the
client. Hands should be washed with an antimicrobial soap before leaving the
clients room. Equipment used by the client should remain in the room and
should be disinfected before being used by anyone else. The client should be
transported only for essential procedures; during transport, precautions should
be taken to prevent disease transmission.

Revised Life Support Guidelines

(American Heart Association)
Frequently the American Heart Association releases guidelines for the care of
the client experiencing cardiac dysrhythmias. Refer to http://www.aafp.org/afp/
2006050/practice.html for these guilelines.

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Nutrition Notes

Defense Mechanisms
Here is a quick reference to some of the defense mechanisms:
. CompensationThe development of attributes that take the place of

more desirable ones.

. Conversion reactionThe development of physical symptoms in

response to emotional distress.

. DenialThe failure to regard an event or feeling.
. DisplacementThe transference of emotions to another other than the

intended.
. ProjectionThe transferring of unacceptable feelings to another

person.
. RationalizationThe dismissal of ones responsibility by placing fault

on another.
. Reaction formationThe expression of feelings opposite to ones true

feelings.
. RegressionThe returning to a previous state of development in which

one felt secure.

. RepressionThe unconscious forgetting of unpleasant memories.
. SublimationThe channeling of unacceptable behaviors into behaviors

that are socially acceptable.

. SuppressionThe conscious forgetting of an undesirable memory.

Nutrition Notes
It is important for the nurse to remember dietary interventions used for various
disorders. Table A.1 is a quick reference to help you remember the diets.

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Appendix A: Things You Forgot

TABLE A.1

Dietary and Nutrition Notes to Remember

Disorders Being
Treated

Foods to Include

Foods to Avoid

Bone marrow
transplantation

Cooked, processed, or peeled foods.

Avoid foods from salad bars,

foods grown on or in the
ground, and foods that are
cultured.

Cancer
(client with
radium implant)

Same as for Crohns and ulcerative

colitis.

Same as for Crohns and

ulcerative colitis.

Celiac/gluteninduced diarrhea

Milk, buttermilk, lean meats, eggs,

cheese, fish, creamy peanut butter,
cooked or canned juice, corn, bread
stuffing from corn, cornstarch, rice,
soybeans, potatoes, bouillon, and
broth.

Malted milk, fat meats,

luncheon meats, wheat,
salmon, prunes, plums, rye,
oats, barley, and soups
thickened with gluten
containing grains.

Congestive heart
failure,
hypertension

Meats low in cholesterol and fats,

breads, starches, fruits, sweets,
vegetables, dairy
products.

Foods high in salts, canned

products, frozen meats,
cheeses, eggs, organ meats,
fried foods, and alcohol.

Inflammatory
bowel disease
(Crohns and
ulcerative colitis)

Meats, breads, and starches, fruits,

vegetables, dairy products.

Whole grains, legumes, nuts,

vegetables with skins, prune
juice, and gristly meats.

Full liquid diet

Milk, ice cream, soups, puddings,

All solid foods.
custards, plain yogurt, strained
meats, strained fruits and vegetables,
fruit and vegetable juices, cereal gruel,
butter, margarine, and any component
or combination of clear liquids.

Lacto-vegetarian
diet

Primary sources of protein, dairy

products, peanut butter, legumes,
soy analogs.

All meat products.

Peptic ulcer/hiatal
hernia

Meats, breads, starches, fruits,

vegetables, and dairy products.

Alcohol, coffee, chocolate,

black or red pepper, chili
powder, carminatives such as
oil of peppermint and
spearmint, garlic, onions, and
cinnamon.

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Immunization Schedule

TABLE A.1 Continued

Diseases Being
Treated

Foods to Include

Foods to Avoid

Renal
transplantation

Meats, dairy products, breads and

starches, vegetables, and sweets.

Eggs, organ meats, fried or

fattyfood, foods containing
salt, driedfoods, salt substitutes, and fruits.

Immunization Schedule
It is important for the nurse to be aware of the recommended immunization
schedule for various age groups. Figure A.1 is a recommended schedule for
childhood and adolescent immunizations. Figure A.2 is a recommended schedule for adult immunizations.

FIGURE A.1

Recommended childhood and adolescent immunization schedule.

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Appendix A: Things You Forgot

FIGURE A.2

Recommended adult immunization schedule.