NCLEX Success by Erickson Arado

Cane Walking & Heart Enzymes: NCLEX Review

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That's just a principle That's just a principle Good leg up bad leg down Another question is about canes for the same question Where will the caregiver stand Where will the caregiver stand during ambulation It's on the affected side Just like the same with crutches because that's the side that the patient needs you Another thing health teaching select all that apply Where are you going to hold the cane if you're the patient I'm going to give you a scenario just like in NCLEX The patient has left-sided weakness I will repeat the patient has left-sided weakness So which side of the body you will offer the cane On the left hand or on the right hand Right What about the rest Right Assist Okay On the right hand of course Why on the right hand Because how can you hold the cane on the weak side The patient will just fall So it has to be on the stronger side Some questions may use the word strong side Some words some questions may use the word unaffected side So the cane must be held by stronger hand Another thing so you have to adjust the cane as well on the level of the hip bone If it's too low the patient might fall forward If it's too high it's going to be very hard for the patient to walk No leaning on the cane the patient might fall Another question in NCLEX how would you instruct the patient to walk while using cane This is the principle Pay attention Move the cane with the affected leg Let's put it in a scenario The patient has left-sided weakness Let's continue using that The left patient has left-sided weakness Where is the cane On the right hand So how would you instruct the patient to walk So how would you do that The first is to use the right hand with the cane with affected leg which is what The left leg Perfect So that's how you would understand You will sit in option How would you instruct the patient to walk Right hand with the cane with the left leg and then the other option is just going to confuse you The rule is move the cane with the affected leg Since you put the cane you place the cane on the stronger side on the right hand When you move the right hand the affected leg should move with it So right hand and left leg So that's how is the combination is Okay because that cane will serve as the support for the affected leg So that's why it has to move with the affected leg So that's the principle It's very easy Same thing The patient has right-sided weakness Where are you going to place the cane On the left hand So how do you instruct the walking Left hand and what Left leg or right leg I will repeat that patient has right sided weakness Of course we're opposite Right side of the weakness Where are you going to place the cane Left hand or right hand .........

NCLEX Neuro & Musculoskeletal: EMG, Arthrocentesis, Crutches

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Very similar with EEG Stimulants and downers must be really held 24 hours or 48 hours before the procedure Why What did I tell you Stimulants and downers affects the brain And what did I tell you Brain control muscles If we're going to simulate the brain it's going to simulate the muscle If we're going to put down the brain it's going to also put down the muscle activity So it's going to affect the reading If they use needles it is normal to expect for slight bruising You can just put on ice to relieve that or analgesics for pain Ice or analgesics for pain But just like what I told you between the needle and electrodes you will encounter more electrodes than needle in NCLEX questions if you would encounter this EMG in the question All right Now that's for the neuro It's the most common that you may encounter so we put it all in one discussion Now any questions you may have please feel free to interrupt me you know otherwise I will continue I will continue doing the lecture okay so anytime you have questions don't be shy feel free to interrupt me okay because your questions might help other students as well okay Another one let's go down to the next one which is the musculoskeletal system the arthro-synthesis Another thing one thing I would like to tell you trust me when you sit for your NCLEX there will be terms wherein it may sound so unfamiliar to you If in case you encounter terms that you are very unfamiliar with don't go frantic look the term carefully And it will give you a hint Usually nurses medical term have hints That's how they coin the words The medical terms will give you hints Like in this case I know as Arthur is it means joints Synthesis means aspiration So that means aspiration of the joints or I would say aspiration of the fluid in the joints So the main purpose of this is to confirm if there's inflammation The most common condition you may encounter in NCLEX that they relate with arthrosynthesis are those with arthritis Rheumatoid arthritis and osteoarthritis Those are the most common conditions where you would encounter arthrocentesis They're going to aspirate the fluid They're going to check if there's blood or pus If there's pus you know that there is an inflammation If there's blood you know that there's an injury And they can also use this procedure to administer some medications like steroids for those with arthritis Now how do you prepare the patient then Of course it's invasive What did I tell you If a procedure is invasive consent is needed but we're done discussing it already After the procedure nurses look at this Why do you think it is important for you to apply elastic compression bandage What is the purpose Anyone from the group What is the purpose It's perfect because after the procedure remember the patient has been punctured Okay The patient has been punctured to expect for edema afterwards or bleeding afterwards So that is the purpose of elastic compression to prevent edema to relieve edema to prevent bleeding because this is invasive Okay So if it swells then you can make use of ice to control the pain and swelling If in case the patient complains of pain so the doctor can order analgesics and the patient must not use the joints by doing weight-bearing activities or exercises for 8 24 hours So the patient must remain resting for the next day for the next 24 hours to prevent more injury to the joints Mr Arrado is it normal for a patient to have fever and excessive swelling on the joints The answer is what No Okay for the swelling that's the purpose why you are applying elastic compression to prevent that Because one of the possible causes of swelling is maybe because of too much bleeding inside So that's why the doctor needs to assess that Fever is never normal It's a sign that the area has been infected Notify the physician Hey let's move forward Another question that came out in NCLEX is about crotch walking Okay first safety All crotches are individualized That's why you cannot borrow one crotch from another or from someone Another concept ......... ......... ......... ......... When a patient is ambulating or walking while using crutches question where do you think the caregiver should stand Is it on the affected side or on the unaffected side You have the answer in front of you The caregiver must stand on the affected side Why Because that's where the patient needs you Affected side is the side that the patient is weak So that's the side that a patient needs you Not only for crotches but also for canes Where will the caregiver stand It should be on the affected side This came out in my other student's question in a form of celiac all that apply health teachings you will tell your patient who will use crutches Number one you never rest on the axilla or the axillary bars because it can cause the brachial plexus damage To prevent fall in injury look up and outward during ambulation That's given Next You have to place the crutches 6 to ten inches The question was saying I think 11 to 12 inches That's too far If we're gonna place the crutches you know 11 to 12 inches that's too far more likely the patient might fall forward So it needs to be 6 to ten inches diagonally in front of the foot to make it like more stable for the patient when walking and when standing So that's the keyword there 16 inches That was not part of the answer because they gave a different number Okay different distance Another thing you have to tell the patient to stop ambulation if the patient experiences numbness or tingling in the hands That means this numbness and tingling is a sign that the patient is experiencing brachial plexus damage Okay brachial plexus damage Okay hold on Okay so I want you guys to remember this concept because this came up in my other students you know NCLEX especially for the instructions Another concept for this scratch walking is when going up and going down Although these very seldom I have a very few students who encounter this kind of questions but the principle is when you are going up you have to basically use your good leg up or you have to use first the good leg Meaning you have to make a step first using your good leg when you're going up You know why Because when you are going up so when you use your good leg when you try to lift the other leg the weight will be shifted all to the good leg Now if you will use the bad leg first in going up okay So that means when you try to lift the other leg all the weight will go to the bad leg Do you think the bad leg can carry the weight if you try to lift the good leg No So that's why you have to use the good leg up first so that when you try to lift the bad leg the good leg can carry all the weight But it's a different story when you're going down So it's a bad leg down So when you try to use your bad leg first what's going to happen is when you try to use it all the weight will be carried by the good leg So it's safer So that's why it has to be a bad leg when going down and good leg when going up That's just a principle That's just a principle Good leg up bad leg down Another question is about canes for the same question Where will the caregiver stand Where will the caregiver stand during ambulation It's on the affected side Just like the same with crutches because that's the side that the patient needs you Another thing health teaching select all that apply Where are you going to hold the cane if you're the patient I'm going to give you a scenario just like in NCLEX The patient has left-sided weakness I will repeat the patient has left-sided weakness So which side of the body you will offer the cane On the left hand or on the right hand Right What about the rest Right Assist Okay On the right hand of course Why on the right hand Because how can you hold the cane on the weak side The patient will just fall So it has to be on the stronger side Some questions may use the word strong side Some words some questions may use the word unaffected side So the cane must be held by stronger hand Another thing so you have to adjust the cane as well on the level of the hip bone If it's too low the patient might fall forward If it's too high it's going to be very hard for the patient to walk No leaning on the cane the patient might fall Another question in NCLEX how would you instruct the patient to walk while using cane This is the principle Pay attention Move the cane with the affected leg Let's put it in a scenario The patient has left-sided weakness Let's continue using that The left patient has left-sided weakness Where is the cane On the right hand So how would you instruct the patient to walk So how would you do that The first is to use the right hand with the cane with affected leg which is what The left leg Perfect So that's how you would understand You will sit in option How would you instruct the patient to walk Right hand with the cane with the left leg and then the other option is just going to confuse you The rule is move the cane with the affected leg Since you put the cane you place the cane on the stronger side on the right hand When you move the right hand the affected leg should move with it So right hand and left leg So that's how is the combination is Okay because that cane will serve as the support for the affected leg So that's why it has to move with the affected leg So that's the principle It's very easy Same thing The patient has right-sided weakness Where are you going to place the cane On the left hand So how do you instruct the walking Left hand and what Left leg or right leg I will repeat that patient has right sided weakness

CT Scan & MRI: Easy NCLEX Review

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CT Scan & MRI: Easy NCLEX Review

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So there should be no headache Okay Next question When you look at the site or the punctured site and you notice that there's redness there's sweating So what do you think is happening to this patient There is redness there is swelling What do you think is happening to this patient There is infection going on Specifically There is a what Vertisine swelling around the pancreas It means there is infection Perfect When you see clear drainage that means there is CSF leakage So they will aspirate amounts of this fluid So that means one of the goal after the procedure is to replace the fluid CSF replacement How By drinking fluids of course okay If there's no contraindications so just encourage fluids if there are no contraindications Okay that's for a lubricant puncture Next CT scan So like what I've said CT scan is for different systems not only in the neurologic but even in the GI you will encounter CT scan So let's go by the principles CT scan can be done with or without the dye Will they ask me about them Mr Arado No you won't Will they ask me Mr Arado about the purpose of CT scan Like is this for stroke for neck injury They will not ask you about it That's not how they will ask you because that's too objective Yay So what are the focus of questioning about the CT scan Mr Arado Based from my students' experience they were asked about if this procedure is done with the dye So you have to assess for possible what Allergies Allergies to what Allergies to Or what is it again sorry Iodine Iodine That's the most common question that you may encounter What about for the instruction you will give to your patient You just have to lie still and flat and that's it Another thing I encountered in a lot of practice questions is they are asking if the CT scan is invasive Is it invasive yes or no What do you think No It is not invasive force The only invasive aspects here is when the patient will receive what The diet And that's it Now for the post procedure there are a lot of questions in NCLEX in the post procedure And I will tell you what are those NCLEX concepts on the post procedure Number one One of the most important health features is hydration Why do you think so Why you will tell the patient to increase fluid intake Why To flush out the dye Perfect To flush it out Follow-up question Why do you think the patient needs to flush them out Why Because what This dye is what It's very damaging to the kidneys I think It is nephrotoxic that is correct This dye is nephrotoxic that if it will stay in the blood it will cause acute renal failure Acute renal failure So it needs to be flushed out by hydration And the same concept nurses there was a question that came out as well about the CT scan with the dye The question was which among the following laboratory tests is important for the nurse to evaluate or for the doctor to evaluate before injecting the dye And the answer was serum creatinine Creatinine BUN and creatinine Why Because if the BUN creatinine is high so that means there is a possible damage in the kidneys in that patient is that the good candidate for the administration of the dye because it can all the more cause insults and damage into the kidneys So creatinine and BUN because the dye is nephrotoxic Another concept that came out is after you have administered the dye you have to check the pulse distal to the site of injection When I say distal that is the pulse after the site of injection keep the pulse that is closer to the site of injection Like for example if the dye was injected somewhere right here on your forearm like for example look at me if the dye was injected here so the pulse we should be checking is the breakout or the radial So when you say distal pulse these are pulse that are closer to the site of injection but it's like should be after I've read from our lesson that why we ask if the patient is taking metformin before giving the iodine Yes that is correct So that's one of the most common questions as well Why Okay The byproduct of metformin is lactic acid The byproduct of metformin the byproduct of metformin is lactic acid production If the patient has an acute renal failure because of the damage of this diet so that means the kidney will not be able to flush it out Lactic acid is toxic It's toxic to the blood So it is not good to stay in the blood It needs to be cleared out Do you understand So that's why they are saying that you have to withhold metformin before administering the dye because of the possibility that this dye may cause damage into the kidneys And if it happened that this dye damaged the kidneys and you've taken metformin that means That's a very popular question Yes Okay No another one is MRI Okay Next another same concept It's non-invasive Okay Mr Robert will I be asked about this description of tissues tumor do I need to remember that No it's not NCLEX Don't waste your time Okay The most common question in MRI are the contraindications trust me The most common question if in case we encounter this are the contraindications You know this nurses If they have metal implants they cannot go through MRI So like all that apply you may encounter this Those with pacemaker metal implants knee prosthesis came out already before Vascular eclipse came out The patient is to undergo MRI The patient who is a twenty seven year old female is to undergo MRI Which among the following question is the most important to ask I'm paraphrasing it I'll give you a tip When you encounter in NCLEX gender and age it's a hint There is a purpose why they needed to mention that the patient is a female And in this case the reason why is because if this patient is pregnant you know for the fact that they cannot be exposed to MRI because it can cause damage to the fetus But what question is this Mr Arano It is important for you to ask to this patient The answer was when was your last menstrual period It is asking indirect question if the patient is pregnant Because you don't ask direct questions Are you pregnant That's maybe too invasive So you ask it in a more professional way by asking when was your last menstrual period And of course assist for claustrophobia If they are claustrophobic they can still undergo MRI but they have to receive anti-anxiety medication Anti-anxiety medication The only health teaching you will tell your patient is to remain still There's no any other instruction except that That's for MRI Let's move forward Another one is EEG Now we have different kind of this We have EMG we have ECG we have EEG What are the similarities All of this EEG EMG ECG all of these 3 evaluates electrical activity However for EEG we are talking about specifically of the brain You don't have to memorize the descriptions in my handouts and in other ENTLEX resources Trust me you will not be asked about the description but you know that EEG is for this That's what I'm trying to say but you don't have to memorize them What you may probably encounter in ENTLEX is how are you going to prepare a patient for EEG first Wash the client's hair to remove oil and dirt And I'll tell you why later Well the answer is right next So that the electrode can properly attach to the head Because if these hairs are with oils it's going to be very hard for the electrodes to attach And if there is no good attachment of electrodes to the scalp and to the head so more likely you will get a false reading Next question Mr Arado are we going to place the patient on NPO Not really In fact they can eat breakfast in the morning So NPO is not a requirement However what you would need to tell the patient is to withhold all stimulants Why Because stimulants affects brain activity If they will consume fluids or food that is a stimulant to the brain you will get a false reading So what are those stimulants that Possibly you may encounter all of those with caffeine coffee tea and other caffeinated beverages should be withheld And even medications such as antidepressants or anticanvulsants for 20 to 48 hours Because antidepressants yes it is a stimulant but it is a downer Don't be confused Antidepressants and anticonvulsants are not stimulants but they are a downer meaning they can depress the function of the brain So in short nurses both stimulants and downers must be withheld because otherwise you will get a wrong reading But if the patient appears to be anxious the doctor might give or may give a minimal dosage of sedatives just to calm the patient down but not enough to change and alter the electrical activity of the brain But in general concept they should not be receiving any of the stimulants or donors that can greatly affect the activities of the brain Now after the procedure you have to wash the clients here because of the gel that they will put on the electrodes to wash it off and then maintain safety precaution of our side rails Okay But of course you need doctor's order for that That's for the EEG

NCLEX Diagnostic Tests: Master Lumbar Puncture & Informed Consent

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All right Okay so for tonight so the first discussion is about diagnostic test solution procedures What I did here is I collected the most common diagnostic test procedures that you may possibly encounter in NCLEX and put it all together in one lecture Like for example CT scan CT scan can be used in different systems And as we discuss in the coming weeks the systems I don't want us to keep on going back discussing CT scan So as in for all let's discuss the most common diagnostic tests and procedures that you may encounter in the majority of these systems and majority of these nursing concepts And we'll discuss them in one at 1 point at one time Okay so first One of the possible questions that you may encounter in NCLEX is about an informed consent Some of my students by the way NCLEX is computer adaptive The questions that you have encountered when you took your NCLEX before you will not encounter them again The computer can remember the questions that was given to you in the past so they will not give it to you anymore But the concept is still there So it doesn't mean that you will not be asked about diabetes you will still be asked about diabetes but it's going to be a different type of concept and questions Do you understand Now majority of my lecture is a product of my previous students' feedback Hey Mr Arraro I encountered questions about informed consent and this is what I encountered and I put it in my lectures This is how I created that binder Those are byproducts of my students' feedback who have taken their inquiries In the previous NCLEX that my students have witnessed or have encountered when you talk about informed consent the most common question that you may probably encounter in NCLEX are questions about eligibility That's it Meaning which among these clients in the options are eligible to sign this consent That is the most common question It could be in the form of select all that apply So you will see here this group of people who are not eligible to sign a consent The bottom line here is when you have a patient sign an informed consent the patient must have an understanding of the procedure or surgery and the patient can make decision If the patient is unable to fully understand if a patient cannot make or is not able to make a decision then that patient is not eligible to set a consent Like for example you have it in front of you mentally ill individual Among all of these nurses what came out in NCLEX is letter D under the influence of medications When a patient was given any kind of medications that depresses the level of consciousness that means the patient is not anymore capable of thinking right So it means that makes the patient ineligible to sign a consent There was an actual scenario that Maestro encountered in her NCLEX The situation was the patient is scheduled for a surgery and the floor nurse have given already the pre-anesthetic agents The pre-anesthetic are usually anti-anxiety drugs However after administering the medications they found out that the patient has not yet signed the consent question Can the patient still sign the consent after the nurse have given the medications the pre-anesthetic medications Yes or no What do you think The patient is still conversant The patient could still think The patient is still okay It would just take a few minutes after the administration of the medications Can you still give the patient the form to sign for the consent Yes or no No It should be like before not after the administration Those kind of questions Another question that my student encountered was this By the way when I say Previous NTSS questions these were all the concepts that my students gave me that I remember that I'm giving it to you Another situation was the patient was a 17yearold female so that this patient has a child already but this patient needs to go through a surgery 17 years old that has a family already Can this 17 years old patient sign a consent yes or no Yes by virtue of being emancipated minor So if a patient is a minor so what age is eligible to sign for a consent What age do you know is eligible to sign for a consent Hold on let me just let me close my door hold on Hold on Okay So remember that So you have this eligibility and the emancipated minor Okay Let's proceed Let's move on Now the way we will discuss the other that's for the informed consent By the way informed consent are needed for all kind of procedures that are invasive Okay That are invasive Now for the rest of this of these diagnostic procedures to make it like more organized so we will discuss this per system Okay Let us start first with neurological system One of the most common possible procedure you would encounter under neurological system or you would encounter in the question is lumbar puncture ......... Another term for lumbar puncture is spinal tap Okay Spinal tap Okay So there's a question here about those who are in the military Okay Same thing Same thing If the patient is in a very far out place and there's no any other relatives for example who can sign a consent or any other person and the patient is unconscious the patient is at the brink of death or in the death or life situation so they can waive the consent so the doctor can proceed with the procedure If there's no other person who can sign on behalf of the patient because the patient is unconscious the patient is severely should I say like injured so the doctor can proceed with the procedure If that patient is in a very remote And there's no any other way to contact any close relatives So that's how you would do it and see it By the way sometimes in the chat it's kind of late that I see it Okay so please bear with me Okay now so for the other so we'll discuss this like for a system like what I've said for the lumbar puncture Another term that they use in the previous NCLEX is spinal tap Spinal tap or TAP they're just the same Now before I proceed when you talk about diagnostic procedures there are 3 main aspects that I want you guys to know if you are studying them Number one you need to have an understanding of the purpose of the procedure or surgery What is the purpose Number 2 preparation first P is the purpose Number 2 is the preparation How would you prepare the patient That's the most common question in NCLEX And lastly the post-procedure health teaching Post-procedure teaching So 3 P's Purpose preparation and post-procedure teaching So these are the 3 main aspects that NCLEX is asking students about procedures Like in this case nurses what is the purpose of lumbar puncture There's a lot for them to check for the infections for the cause of infection right So that's the main purpose of this lumbar puncture for them to know you know if what kind of specific microorganisms you know is causing an infection to the patient Now we know that by the way in NCLEX you will not be asked about the definition that is non NCLEX The purpose of you knowing the purpose is for you to have an understanding why the lumbar puncture is being used in that question but you will not be asked about the purpose it's just within you in your brain that you know the purpose why they are asking for how they are doing the lumbar puncture okay second look at this in the description here okay you will not be asking NCLEX on where to insert this don't worry about it it will not be asking NCLEX but it's going to be between L3 and L4 but that's non NCLEX don't worry about it This came out in NCLEX the contraindication So those people who have high ICP they are not a good candidate for lumbar puncture Why Because if the ICP is high and the patient was punctured here it's going to pull the brain downward It's called brain herniation It is called brain herniation If the ICP is high and they puncture the patient puncture hole when you aspirate the fluid will cause the brain to be pressed downward because of the high pressure in the brain So that's why increased ICP is contraindicated Now there was a question that came out in NCLEX So this is the background of the question I can't remember the exact words but this is the background of the question The patient fell to the ground So that means the patient fell So it's a case of injury Now which among the following is not good or not warranted for the Which among the following diagnostic test is not warranted for this patient And one of the options is lumbar puncture Why lumbar puncture For 2 reasons Number one this patient fell to the ground so you are suspecting a possible fracture in the back And you don't change the position right because you may cause more injury And how would you position the patient for the repulsor You have to bend the back which is not good for people with fracture Although there's no fracture yet but you're suspecting it because of the background of a question that says the patient fell to the ground second is if there is an injury in the spinal area it will cause an increase in the ICP which is going to indicate for patients with increased ICP it's going to indicate for them to go through a lumbar puncture So just remember the concept for increased ICP Let's move forward Now next be preparation Of course we will not talk about consent anymore We're done with this Preparation You have to make sure that the patient's bladder and bowel is empty before the procedure Why do you think so If it's possible you have to make sure that the bladder and bowel is empty Why Why do you think so Because after the procedure the patient must remain flat on bed for 30 minutes to one hour up to 2 hours So you want to make sure that the patient will get up from the bed going to the bathroom because otherwise there's going to be a complication which I'll discuss later Now what about for the position Mr Arado will I be asking NCLEX about how are we going to position the patient The answer is no That's so easy And you will not be asking NCLEX about it But this is the position for lumbar puncture They will describe it lateral recombinant position or draw sneeze after the abdomen The bottom line is they need to make sure that there's enough space for them to puncture the Yes sir