NCLEX and CGFNS

Basic Pharmacology - Scope of Pharmacology on NCLEX Test

noreply@blogger.com (sunandar) — Mon, 11 Jul 2011 09:45:00 +0000

It is also important for nurses to understand and apply knowledge or pharmacology in nursing practice. Nurses are frequently responsible for instructing the client and family regarding the safe administration of medications. National Council Licensure Exam (NCLEX) devoted 13% - 19 % of the physiological integrity section to pharmacology.

There are three major areas of pharmacology as followed here:

Pharmacokinetics: How drugs are absorbed, distributed, metabolized and excreted by the body.
Pharmacodynamics: How drugs are used by the body.
Pharmacotherapeutics: How the client response to the drugs.

Nurses are expected to use their knowledge of pharmacology to:

Recognize common uses, side effects, and adverse effects.
Challenge medication errors
Meet the client's learning need.

Administering of medication depend on the area of practice and the assigned patient. Here are medication classifications that commonly prescribed for adult patient:

Anti-infectives: for the treatment of infections have common side effects - GI upset
Antihypertensive: to lower blood pressure and increase blood flow to the myocardium, have common side effects such as orthostatic hypotention,
Antidiarrheals: to decrease gastric motility and reduce water content in the intestinal tract, have side effects include bloating and gas.
Diuretics: to decrease water and sodium absorption from the loof of Henle or inhibit antidiuretic hormone (potassium-sparing diuretics). Side effects include hypokalemia.
Antacids: to reduce hydrochloric acid in the stomach. The calcium and aluminum based antacids have side effect of constipation whereas the magnesium based antacids have side effects of diarrhea.
Antipyretics: to reduce fever
Bronchodilators: to dilate large air passages (for asthma patient), have common side effect of tachycardia.
Laxatives: to promote the passage of stool (such as stool softeners, cathartics, fiber, lubricants and stimulants).
Anticoagulants: to prevent clot formation by decreasing vitamin K levels and blocking the clotting chain or by preventing platelet aggregation.
Antianemics: to increase factors necessary for red blood cell production such as B12, iron, and Epogen.
Narcotics / analgesics: to relieve moderate to severe pain, include opioids (morphine and codeine), synthetic opioids (meperidine), and NSAIDs (ketoralac).
Anticonvulsants: to treat seizure disorder and bipolar disorder, such as phenobarbital, phenytoin and lorazepam.
Anticholinergics: to dry mucous membranes such as atropine.
Mydriatics: to dilate the pupils, such as for cataract patients.
Miotics: to constric the pupil, such as pilocarpin HCl for treatment of glaucoma.

Time-released Drugs:
Here are abbreviations of time-released drugs:

Dur = Duration
SR = Sustained release
CR = Continuous release
SA = Sustained action
Contin = Continuous action
LA = Long acting

Administrating Medication

noreply@blogger.com (sunandar) — Mon, 11 Jul 2011 05:19:00 +0000

When preparing to administer medication, the physicians order must be reviewed by the nurse such as the rout of the medicines. Many medication are supplied in various preparation and need specific right route. Of course the choice of medication administration is depend on several factor including the client's blood level, ability to swallow and disease or disorder being treated.

However there is the seven rights when administering medication to the patient. They include five rights of drug administration and two of patient's bill of rights.

These seven rights of medication administration are:

Right client / patient: should be done by asking the client to state his name and checking the identification band.
Right route: medications should be given as physician's prescribed route of administration.
Right drug: the name of the drug as well as the generic name ordered by physician should be checked promptly. The nurse should investigate when the patient's diagnosis does not match the drug category.
Right amount: The nurse is expected to know common dosages for both adults and children.
Right time: the nurse can administer the medication either 30 minutes before or after the assigned time.
Right documentation (as the Patient's Bill of Rights and legality issues in nursing): it mus be done to prevent duplicating drug administration,
Right to refuse treatment (as the Patient's Bill of Rights): the patient / client has the right to refuse medication or treatment physician ordered.

NCLEX-CGFNS: Magnetic Resonance Imaging

noreply@blogger.com (sunandar) — Mon, 30 Mar 2009 06:47:00 +0000

Magnetic Resonance Imaging

Magnetic resonance imaging provides cross-sectional images of brain tissue. It is more detailed than a CT scan
The procedure is contraindicated to pregnant women, obesity (more than 300 lbs), claustrophobic patients, patients with metal implants (pacemaker, hip replacements and jewelries)

NCLEX-CGFNS: Mantoux Test

noreply@blogger.com (sunandar) — Mon, 30 Mar 2009 06:43:00 +0000

Mantoux Test

Mantoux test is done to determine the exposure to mycobacterium tuberculosis
Positive reaction means there is an exposure to the TB bacilli
Positive test: induration of 10 mm or more for foreign-born patient and children under 4 years old, and induration of 5 mm or more if the patient is HIV (+), with healed TB and if patient has had contact with a patient with active TB
BCG vaccine may cause false positive reaction
Assess the patient for previous history of TB and report it to the physician

NCLEX-CGFNS: Mammography

noreply@blogger.com (sunandar) — Mon, 30 Mar 2009 06:38:00 +0000

Mammography

Mammography procedure detects the presence of breast tumor
Instruct patient not to use deodorant, talcum powder, lotion, perfume and any ointment on the day of the exam since they contain calcium oxalate which may crystallize and may give a false positive result
Inform the patient that the breast will be placed between two x-ray plates
The procedure is best done a week after menstruation
During the procedure, the patient will be positioned on lying down with pillow under the shoulder of the breast being examined

NCLEX-CGFNS: Lung Scan

noreply@blogger.com (sunandar) — Mon, 30 Mar 2009 06:35:00 +0000

Lung Scan

Lung scan determines lung perfusion when pulmonary emboli and infarction are suspected
It needs consent
Assess patient for allergy to dye, iodine and sea-foods
Remove jewelry from the chest area if any
Sedative is given as prescribed
The procedure involves injection of radioactive isotope into the body
Nurse should wear gloves within 24 hour after the procedure when urine is being discarded

NCLEX-CGFNS: Lumbar Puncture

noreply@blogger.com (sunandar) — Sat, 28 Mar 2009 19:32:00 +0000

Lumbar Puncture

Lumbar puncture is a procedure to withdraw CSF and it is used to determine the abnormalities of CSF
Empty bladder and bowel before the procedure
Place patient on C-position
During the procedure, the needle is inserted between L3-L4 or L4-L5
After the procedure, increase fluid intake and place the patient on flat position to prevent spinal headache

NCLEX-CGFNS: Liver Biopsy

noreply@blogger.com (sunandar) — Sat, 28 Mar 2009 19:28:00 +0000

Liver Biopsy

This diagnostic procedure is mainly done to rule out liver disorder
Bleeding is a common complication, so obtain the result of hemostatis tests before procedure
Patient is positioned on the left side or supine during biopsy
To stabilize the position of the liver and to prevent accidental puncture to the diaphragm, instruct patient to inhale, exhale and hold breath during needle insertion
Patient is positioned on the right side after biopsy for two hours to prevent hemorrhage
Encourage patient to bedrest for 24 hours after biopsy

NCLEX-CGFNS: Laparoscopy

noreply@blogger.com (sunandar) — Sat, 28 Mar 2009 19:23:00 +0000

Laparascopy

Laparoscopy is done to evaluate the pelvic pain and infertility and treat endometriosis lesions
Patient should NPO before the procedure
Enema is administered prior to procedure
Patient will have shoulder and abdominal discomfort after the procedure since the use of carbon dioxide

NCLEX-CGFNS: IVP (Intravenous Pyelography)

noreply@blogger.com (sunandar) — Sat, 28 Mar 2009 19:18:00 +0000

IVP (Intravenous Pyelography)

This diagnostic test is used to visualize the urinary tract
It needs consent from patient
Patient should NPO for 8-10 hours before the procedure
Administer laxative to clear bowels before the procedure
The procedure requires the use of iodine base dye
Assess patient if has an allergy to iodine, seafoods or shellfish before the procedure
Epinephrine should be kept at the bedside to counteract possible allergic reaction
Inform patient that salty taste may be experienced during procedure
Encourage patient to increase fluid intake after procedure to facilitate excretion of the dye

NCLEX-CGFNS: Incentive Spirometry

noreply@blogger.com (sunandar) — Sat, 28 Mar 2009 19:17:00 +0000

Incentive Spirometry

It is mainly used in the prevention and treatment of atelectasis
Patient should be kept in semi-fowler's position
Patient should take deep breath slowly and easily from the mouthpiece

NCLEX-CGFNS: Hysterosalpingography

noreply@blogger.com (sunandar) — Fri, 20 Mar 2009 19:36:00 +0000

Hysterosalpingography

Hysterosalpingography determines the patency of fallopian tube
It also detects pathology in the uterine cavity
It is done by x-ray examination and administration of a radiopaque dye into the uterine cavity

NCLEX-CGFNS: Guthrie Capillary Blood Test

noreply@blogger.com (sunandar) — Fri, 20 Mar 2009 19:33:00 +0000

Guthrie Capillary Blood Test

It is a screening test for phenylketonuria
Normal level of phenylketonuria is 2 mg/dl
Patient should take a high protein diet 24-48 hour before the test

NCLEX-CGFNS: Glucose Tolerance Test

noreply@blogger.com (sunandar) — Fri, 20 Mar 2009 19:29:00 +0000

Glucose Tolerance Test

Glucose tolerance test is done to confirm the presence of sugar in the blood
Procedure: patient take high carbohydrate diet 24-48 hours before the procedure is done.
Blood is drawn after an overnight fast

NCLEX-CGFNS: Gastric Analysis

noreply@blogger.com (sunandar) — Fri, 20 Mar 2009 19:24:00 +0000

Gastric Analysis

This procedure is done to assess ulcers or to rule out pernicious anemia
It also used to analyze acidity, appearance and volume of gastric secretions
Gastric samples should be refrigerated if not tested within four hours
HCL is normal in gastric ulcer and will be elevated in duodenal ulcer

NCLEX-CGFNS: Fetal Heart Monitoring

noreply@blogger.com (sunandar) — Fri, 20 Mar 2009 19:17:00 +0000

Fetal Heart Monitoring

Fetal heart monitoring is done to assess fetal heart rate abnormalities. There are there types of result:

Early Decelerations

It indicates fetal head compression
Mirror image is reflected on monitor
No specific treatment is required

Late decelerations

It indicates placental insufficiency
Reverse mirror image is reflected on monitor
Patient needs oxygen administration

Variable decelerations

It indicates cord compression
U or W shape image is seen on monitor
Nursing interventions: change the patient position to left lateral recumbent and administer oxygen

NCLEX-CGFNS: Endoscopy (Gastroscopy, Esophagoscopy)

noreply@blogger.com (sunandar) — Thu, 15 Jan 2009 04:04:00 +0000

NCLEX-CGFNS: Endoscopy (Gastroscopy, Esophagoscopy)

This procedure is done to assess the esophagus and the stomach by inserting a tube into them
It needs an informed consent
Remove patient’s denture if any
Patient should be in NPO 6-8 hours before the procedure of endoscopy and resume feeding after gag reflex returns

NCLEX-CGFNS: Endoscopic Retrograde Cholangio Pancreatography (ERCP)

noreply@blogger.com (sunandar) — Thu, 15 Jan 2009 04:01:00 +0000

NCLEX-CGFNS: Endoscopic Retrograde Cholangio Pancreatography (ERCP)

It provides radiographic visualization of the bile and pancreatic ducts
It is used to diagnose problems in the liver, gallbladder, bile ducts, and pancreas
It is contraindicated in pancreatitis
Patient should be kept in NPO before and after the procedure
Keep narcan at the bedside
There might be hoarse and sore throat several days after the procedure

NCLEX-CGFNS: Electromyography – EMG

noreply@blogger.com (sunandar) — Mon, 29 Dec 2008 12:06:00 +0000

Electromyography – EMG

This test used to monitor the electrical activity of muscles
It needs informed consent
Inform the patient to avoid any stimulant and sedative before the procedure
Patient is positioned depends on the muscle being tested
Ask the patient to contract the muscle slowly and progressively
Inform the patient that a needle will be inserted into the muscle

NCLEX-CGFNS: Electroencephalogram – EEG

noreply@blogger.com (sunandar) — Mon, 29 Dec 2008 11:18:00 +0000

Electroencephalogram – EEG

Electroencephalogram records the electrical activity of the brain as well as detects intracranial hemorrhage and tumors
Clean patient’s hair using shampoo before and after the procedure
If the electrode gel is not removed by shampooing, use acetone
Avoid caffeine containing foods and mind altering substances before the test
Withhold stimulants, antidepressants, tranquilizers and anticonvulsants for 24-48 hours prior to the test

NCLEX-CGFNS: Electrocardiogram – ECG

noreply@blogger.com (sunandar) — Mon, 29 Dec 2008 11:12:00 +0000

Electrocardiogram – ECG

Electrocardiogram records electrical waves of the heart
Let the patient to lie still, breath normally and refrain from talking during the procedure
ST segment elevation or T wave inversion indicates Myocardial Infarction

NCLEX-CGFNS: Cystoscopy

noreply@blogger.com (sunandar) — Sat, 27 Dec 2008 21:07:00 +0000

CYSTOSCOPY

Cystoscopy is an Endoscopy of the urinary bladder via the urethra
It is implemented to inspect bladder and urethra
The procedure needs informed consent
Patient should be in NPO status if general anesthesia is used, and liquid diet if local anesthesia is used
Force fluids as prescribed after procedure
Administer sitz bath for abdominal pain
Pink-tinged or tea-colored urine is expected
If bright red urine or clots occur, notify the doctor

NCLEX-CGFNS: CVP (Central Venous Pressure Monitoring)

noreply@blogger.com (sunandar) — Sat, 27 Dec 2008 20:50:00 +0000

Central Venous Pressure Monitoring

Central Venous Pressure (CVP) is the pressure of blood in the thoracic vena cava, near the right atrium of the hear
The purpose of central venous pressure monitoring is to provides an indication of pressure in the right atrium
The zero level of manometer should be placed at the level of the right atrium at the 4th intercostals space
Teach patient to avoid coughing and straining since it increases the readings
Normal CVP : 2-12 mmHg. when the tube is at the superior vena cava

NCLEX-CGFNS: CT Scan

noreply@blogger.com (sunandar) — Sat, 27 Dec 2008 20:32:00 +0000

CT SCAN

CT Scan is implemented to provides photograph of tissue densities with the use of radiation
Keep the patient NPO for 4 hours before the procedure and check for allergies (if a dye is used)
CT Scan has contraindications to pregnant women, obesity (more than 300 lbs), claustrophobic patients, patient with allergy to dye, and patient with unstable vital signs

NCLEX-CGFNS: Cranial Nerve Assessment

noreply@blogger.com (sunandar) — Tue, 16 Dec 2008 15:02:00 +0000

CRANIAL NERVE ASSESSMENT

Cranial nerve assessment is performed to determine abnormalities in brain stem activity
It usually performed by the physician or advance practice nurse

Here is the list of cranial nerves: