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AA P P E N D I X A

Things You ForgotThroughout this book, we have tried to simplify your preparationfor the NCLEX® exam. This appendix includes information youhave learned during nursing school but might have forgotten.

Therapeutic Drug LevelsTherapeutic drug levels that are important for the nurse to remem-ber when taking the NCLEX® exam include:

. Digoxin: 0.5–2.0 ng/mL

. Lithium: 0.8-1.2 mEq/L* (NIH value)

. Dilantin: 10–20 mcg/mL

. Theophylline: 10–20 mcg/mL

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

Vital SignsNormal ranges for the vital signs of the adult and the newborn:

. Adult heart rate: 80–100 beats per minute

. Newborn heart rate: 100–180 beats per minute

. Adult respiratory rate: 12–20 respirations per minute

. Newborn respiratory rate: 30–60 respirations per minute

. Adult blood pressure: systolic pressure = 110–120 mm Hg;diastolic pressure = 60–90 mm Hg

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. Newborn blood pressure: systolic pressure = 65 mm Hg; diastolic pressure = 41 mm Hg

. Temperature: 98.6º F plus or minus one degree

Intrapartal Normal ValuesHere are some of the normal ranges to remember when caring for the clientduring the intrapartal period:

. Fetal heart rate: 120–160 beats per minute

. Variability: 6–10 beats per minute

. Contractions:

. Frequency of contractions: every 2–5 minutes

. Duration of contractions: less than 90 seconds

. Intensity of contractions: less than 100 mmHg

Anticoagulant TherapyThe nurse should be familiar with the tests ordered for the client receiving antico-agulant therapy and for the control levels. Remember that the therapeutic range is1.5–2 times the control:

. Coumadin (sodium warfarin) PT/Protime: 12–20 seconds.

. International normalizing ratio (INR): 2–3.

. The antidote for sodium warfarin is vitamin K.

NOTELab values may vary according to methods used.

. Heparin and heparin derivatives partial thromboplastin time (PTT):30–60 seconds.

. The antidote for heparin is protamine sulfate.

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Standard Precautions343

Standard PrecautionsStandard precautions are guidelines used to prevent infection with diseasestransmitted through blood or body fluids. The nurse should be familiar withexamples of diseases that require the use of standard precautions and those thatrequire transmission based precautions. Transmission-based precautions includeairborne precautions, droplet precautions, and contact precautions.

. Gloves should be worn when there is a chance of contact with blood andbody fluids, when handling other potentially infected material, and whenperforming vascular access procedures.

. Gloves should be changed after each client contact and between contactprocedures with the same client.

. Masks and protective eyewear should be worn when there is a likelihoodof splashes or when body fluids might become airborne.

. Gloves and aprons should be worn during procedures in which there is alikelihood of splashes of blood or body fluids.

. Hand washing should be done immediately after contact with body fluidsor other potentially infected material and as soon as gloves are removed.

. Needles and sharps should be disposed of in sharps containers. Norecapping, bending, or breaking of needles should occur.

. Mouth-to-mouth resuscitation should be performed using a mouthpieceor other ventilation device.

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

Airborne PrecautionsInfections requiring airborne precautions are those caused by pathogens thatremain suspended in the air for prolonged periods of time. Clients with tuber-culosis, measles (rubeola), and varicella should be cared for using airborne pre-cautions. 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 orrespirator mask) when caring for these clients.

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Droplet PrecautionsInfections requiring droplet precautions are those caused by pathogens that aresuspended in droplets that travel 3 feet, but are not suspended in the air for longperiods of time. Clients with influenza, mumps, pertussis, rubella (Germanmeasles), diphtheria, pneumonia, scarlet fever, streptococcal pharyngitis, andmeningitis should be cared for using droplet precautions. The client should beplaced 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 mayremain open. Healthcare workers should wear a mask when in direct contactwith the client.

Contact PrecautionsInfections requiring contact precautions are those caused by pathogens spreadby direct contact. Clients with RSV, scabies, colonization with MRSA, and VREshould be cared for using contact precautions. The client should be placed in aprivate room or with a client with the same illness. Healthcare workers shouldwear gloves when entering the room and wear gowns to prevent contact with theclient. Hands should be washed with an antimicrobial soap before leaving theclient’s room. Equipment used by the client should remain in the room andshould be disinfected before being used by anyone else. The client should betransported only for essential procedures; during transport, precautions shouldbe taken to prevent disease transmission.

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

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Nutrition Notes345

Defense Mechanisms Here is a quick reference to some of the defense mechanisms:

. Compensation—The development of attributes that take the place ofmore desirable ones.

. Conversion reaction—The development of physical symptoms inresponse to emotional distress.

. Denial—The failure to regard an event or feeling.

. Displacement—The transference of emotions to another other than theintended.

. Projection—The transferring of unacceptable feelings to another person.

. Rationalization—The dismissal of one’s responsibility by placing faulton another.

. Reaction formation—The expression of feelings opposite to one’s truefeelings.

. Regression—The returning to a previous state of development in whichone felt secure.

. Repression—The unconscious forgetting of unpleasant memories.

. Sublimation—The channeling of unacceptable behaviors into behaviorsthat are socially acceptable.

. Suppression—The conscious forgetting of an undesirable memory.

Nutrition NotesIt is important for the nurse to remember dietary interventions used for variousdisorders. Table A.1 is a quick reference to help you remember the diets.

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TABLE A.1 Dietary and Nutrition Notes to RememberDisorders BeingTreated Foods to Include Foods to Avoid

Bone marrow Cooked, processed, or peeled foods. Avoid foods from salad bars,transplantation foods grown on or in the

ground, and foods that arecultured.

Cancer Same as for Crohn’s and ulcerative Same as for Crohn’s and(client with colitis. ulcerative colitis.radium implant)

Celiac/gluten- Milk, buttermilk, lean meats, eggs, Malted milk, fat meats, induced diarrhea cheese, fish, creamy peanut butter, luncheon meats, wheat,

cooked or canned juice, corn, bread salmon, prunes, plums, rye, stuffing from corn, cornstarch, rice, oats, barley, and soups soybeans, potatoes, bouillon, and thickened with glutenbroth. containing grains.

Congestive heart Meats low in cholesterol and fats, Foods high in salts, cannedfailure, breads, starches, fruits, sweets, products, frozen meats, hypertension vegetables, dairy cheeses, eggs, organ meats,

products. fried foods, and alcohol.

Inflammatory Meats, breads, and starches, fruits, Whole grains, legumes, nuts,bowel disease vegetables, dairy products. vegetables with skins, prune (Crohn’s and juice, and gristly meats.ulcerative colitis)

Full liquid diet Milk, ice cream, soups, puddings, All solid foods.custards, plain yogurt, strainedmeats, strained fruits and vegetables, fruit and vegetable juices, cereal gruel, butter, margarine, and any component or combination of clear liquids.

Lacto-vegetarian Primary sources of protein, dairy All meat products.diet products, peanut butter, legumes,

soy analogs.

Peptic ulcer/hiatal Meats, breads, starches, fruits, Alcohol, coffee, chocolate, hernia vegetables, and dairy products. black or red pepper, chili

powder, carminatives such asoil of peppermint andspearmint, garlic, onions, andcinnamon.

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Immunization Schedule347

Renal Meats, dairy products, breads and Eggs, organ meats, fried or transplantation starches, vegetables, and sweets. fattyfood, foods containing

salt, driedfoods, salt substi-tutes, and fruits.

Immunization ScheduleIt is important for the nurse to be aware of the recommended immunizationschedule for various age groups. Figure A.1 is a recommended schedule forchildhood and adolescent immunizations. Figure A.2 is a recommended sched-ule for adult immunizations.

TABLE A.1 ContinuedDiseases BeingTreated Foods to Include Foods to Avoid

FIGURE A.1 Recommended childhood and adolescent immunization schedule.

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FIGURE A.2 Recommended adult immunization schedule.