Login Get started

NCLEX Review - 4 hour masterclass ( Stancoast NCLEX Review )

Stancoast NCLEX Coaching・151 minutes read

The 4-Hour enlex Master Class is a comprehensive resource for enlex exam preparation, covering essential topics like acid base balance and ventilator alarms, with practical tips for care and prevention. Vital concepts, including fluid balance, parenteral nutrition, IV therapy, and diagnostic tests, are highlighted for exam success and nursing proficiency.

Insights

The 4-Hour enlex Master Class has helped over 10,000 students pass the exam and is based on feedback from successful students.
Acid base balance is a crucial topic covered in the crash course, with normal blood pH ranging from 7.35 to 7.45.
The rule of B's and Rome acronym help identify acid base imbalances based on pH, bicarbonate, and CO2 levels.
High pressure alarms in ventilators can be triggered by issues like kinks, water in the circuit, or bronchospasm.
Low pressure alarms are caused by decreased airflow resistance, such as disconnections, and require secure connections and proper mask fitting.
Proper intravenous therapy involves adjusting settings accurately to prevent acid-base imbalances and complications like air embolism or infections.
Parenteral nutrition provides essential nutrients directly through veins and requires careful monitoring to prevent complications like hypoglycemia or hypervolemia.
Perioperative nursing care is essential, covering preoperative, intraoperative, and postoperative phases, with informed consent, medication interactions, and vital sign monitoring being key aspects.

Get key ideas from YouTube videos. It’s free

Recent questions

What are the parameters used to assess acid base balance?
pH, CO2, and bicarbonate levels are used.

Related videos

Summary

00:00

"4-Hour enlex Master Class: Acid-Base Balance"

The 4-Hour enlex Master Class is a resource for enlex exam preparation, with over 10,000 students passing the exam with its help.
Crafted based on feedback from successful students, covering the board's favorite picks from the enlex exam.
More than 100 questions in the exam are derived from this crash course.
Acid base balance is a crucial topic in the crash course, with three to four questions asked in the exam.
Parameters like pH, CO2, and bicarbonate are used to assess acid base balance.
Normal blood pH ranges from 7.35 to 7.45, with values below indicating acidosis and above indicating alkalosis.
Bicarbonate acts as a buffer in the body, with normal levels ranging from 22 to 26 mEq/L.
The rule of B's helps determine acid base imbalances based on the relationship between pH, bicarbonate, and CO2 levels.
Rome acronym simplifies understanding of metabolic and respiratory imbalances based on pH and bicarbonate or CO2 levels.
Examples of acid base balance questions from past enlex exams illustrate how to identify respiratory or metabolic imbalances based on pH, CO2, and bicarbonate levels.

17:56

Managing Ventilator Alarms and Heart Conditions

High pressure alarms are triggered by increased resistance to airflow due to various reasons such as kinks in the patient ventilator circuit, water in the circuit, or bronchospasm.
Steps to correct high pressure alarms include endotracheal suctioning, using a bite block, checking for circuit kinks, administering a bronchodilator, and relocating the endotracheal tube if needed.
Low pressure alarms are caused by decreased resistance to airflow, such as disconnection from the ventilator or loose connections.
To address low pressure alarms, ensure secure connections, proper mask fitting, and monitor the patient's airway condition.
Ventilator settings must be adjusted accurately to prevent over or under ventilation, which can lead to acid-base imbalances.
Calcium channel blockers function similarly to dipan, calming the heart, but should not be given in certain conditions like shock or heart block.
Negative inotropic, chronotropic, and dromotropic agents classify calcium channel blockers, which are essential in treating specific heart conditions.
Congenital heart defects are categorized as trouble or non-trouble, with trouble defects shunting blood from right to left, leading to cyanosis.
Troublesome congenital heart defects include tetrology of Fallot and tricuspid atresia, while non-trouble defects include ventricular septal defects and patent ductus arteriosus.
Intravenous therapy involves various types of IV solutions, access devices, and components like canulas and IV sets, with specific considerations for gauge size and fluid rate calculations.

35:23

Essential Intravenous Therapy Guidelines and Precautions

Starting distally in selection sight strategy allows for adjustments and avoids issues that may arise if starting proximally.
Always inquire about the client's dominant arm to ensure proper monitoring.
Precautions for monitoring blood pressure include avoiding additional pressure on the IV site by choosing the other arm for monitoring.
Never place restraints over the venipuncture site and consider using an arm board near joint points or flexing areas to prevent unnecessary movement.
Change the venipuncture site every 72 to 96 hours, IV tubing every 96 hours, and IV bag or bottle every 24 hours to reduce bacterial contamination and sepsis risk.
Avoid peripheral intravenous sites on the same side as mastectomy, infected skin areas, weak or traumatized arms, edematous extremities, arms with anterior venous fistulas or shunts for dialysis.
Complications related to intravenous therapy include air embolism, catheter embolism, circulatory overload, electrolyte overload, hematoma, and infection.
Practical preventive measures for complications include priming tubing before use, securing connections, replacing fluids before depletion, and monitoring for symptoms like tachycardia, chest pain, hypotension, cyanosis, and decreased consciousness.
Fluid and electrolyte balance concepts are crucial for exams, involving electrolytes, fluid volumes, compartments, third spacing, edema, body fluid composition, and transport mechanisms like osmosis, diffusion, filtration, and hydrostatic pressure.
Parenteral nutrition (PN) provides essential nutrients directly through veins, with types including PPN and TPN, components like carbohydrates, fats, proteins, vitamins, minerals, electrolytes, and water, and administration methods through distal or central veins, with continuous or intermittent/cyclic PN options.

53:35

Managing Parenteral Nutrition Complications and Diabetes Mellitus

Hypoglycemia can occur due to high dextrose concentration, rapid solution infusion, insufficient insulin, or infections.
If hypoglycemia signs are noticed, contact a healthcare provider, adjust infusion rate, monitor blood glucose levels, and administer regular insulin if prescribed.
Complication of Parenteral nutrition includes hypervolemia, caused by excessive fluid administration or underlying conditions like renal dysfunction or heart failure.
To manage hypervolemia, slow or stop IV infusion, alert healthcare provider, consider fluid restriction, diuretics, or dialysis if necessary.
Hypoglycemia related to Parenteral nutrition can be prevented by gradually reducing PN solution, infusing a 10% dextrose solution, and closely monitoring glucose levels.
Infections from Parenteral nutrition can result from poor aseptic technique or catheter contamination; actions include notifying healthcare provider, removing catheter, obtaining blood cultures, and administering antibiotics.
Pneumothorax, a complication of Parenteral nutrition, can occur if the catheter punctures the pleural space; observe for symptoms, conduct a chest x-ray, and ensure proper catheter placement before starting PN.
Nursing considerations for Parenteral nutrition involve double-checking PN solution, avoiding mixing IV medications with PN, drawing blood from a different port, monitoring electrolytes, and conducting blood studies regularly.
Diabetes is a disorder affecting glucose metabolism, with diabetes insipidus and diabetes mellitus being distinct conditions; diabetes insipidus leads to fluid imbalance, while diabetes mellitus affects glucose processing.
Insulin plays a crucial role in regulating blood glucose levels, with various types like regular, NPH, lispro, and glargine having different onset, peak, and duration times; practical tips include checking expiration dates, mixing insulin, and rotating injection sites.

01:10:14

"Diabetic Ketoacidosis: Causes, Symptoms, Treatment"

Acidosis DKA is a severe issue caused by high sugar and acid levels in the blood, primarily affecting individuals with type 1 diabetes.
Common causes include illness, inadequate diabetes medication, overeating, or lack of exercise.
Signs of acidosis DKA include dehydration, deep and rapid breathing, fruity breath odor, and extreme drowsiness.
Diabetic ketoacidosis (DKA) is characterized by the presence of ketones in the blood, not just in urine.
The three main aspects of DKA are ketones in the blood, Kussmaul breathing (deep and rapid), and high potassium levels.
DKA is associated with metabolic acidosis, acetone breath, and anorexia due to nausea.
Treatment for DKA involves rapid intravenous fluid administration and insulin therapy.
Hyperosmolar hyperglycemic non-ketotic syndrome (HHNK) is linked to type 2 diabetes and dehydration.
The hemoglobin A1C test is crucial for assessing long-term blood glucose control.
Blood transfusion involves various components like packed red blood cells, platelets, fresh frozen plasma, cryoprecipitates, and granulocytes, each serving specific purposes and requiring distinct handling procedures.

01:27:11

Types and uses of medical tubes

The Leevan tube is a single-lumen tube made of plastic or rubber with a solid tip designed for stomach use, primarily for draining fluids and gas.
The Sangstaken-Blakemore tube is a three-lumen device with two ports for inflating balloons in the esophagus and stomach for tamponade, with the third lumen for nasogastric suction.
The Salem Sump tube is a double-lumen nasogastric tube with a small vent tube within a larger suction tube to regulate pressure and prevent mucosal suction damage.
The Cantor tube is a single-lumen long medical tube with an inflatable tungsten-filled bag at its distal end for specific gastrointestinal applications.
Nasogastric tube intubation procedures involve explaining the process to the patient, positioning them correctly, measuring tube length, lubricating the tip, and gently inserting the tube through the nose.
Nasogastric tube irrigation involves confirming tube placement, instilling 30-50 mL of water or saline, checking patency, and removing the tube slowly over 3-6 seconds.
Gastrointestinal tube feedings require verifying prescriptions, assessing residual stomach contents, warming feedings, and using infusion pumps or gravity flow for administration.
Gastric and esophageal tubes like the Ssten Blakemore and Minnesota tubes are used to control bleeding in the esophagus, with specific steps and precautions for insertion and monitoring.
Lavage tubes like the Lava Curator and Ewald tube are used for stomach cleansing in cases of toxic substance ingestion, with the former allowing continuous suction and the latter for rapid irrigation and evacuation.
Urinary and renal tubes include single, double, and triple-lumen catheters for different purposes like straight catheterization, continuous drainage, and bladder irrigation, with strict aseptic techniques required for insertion and care.

01:44:07

Urinary Catheter and Tracheostomy Tube Care

Females have catheters of 2.5 to 5 cm (1 to 2 in), while males have catheters of 12.5 to 17.5 cm (5 to 7 in).
Maintain sterility by keeping the sterile field and gloved hands above waist level.
Position female clients in a dorsal recumbent position with legs open for visualization.
Expose the urethral meatus by spreading the labia and clean the area with sterilized cotton balls.
Insert the catheter gently until urine flows, then inflate the balloon as per manufacturer's instructions.
Document all relevant details of the procedure, including catheter type and size, urine characteristics, and client response.
To remove a urinary catheter, explain the procedure to the patient and remove the securing device.
Withdraw all solution from the balloon using a 10ml syringe to ensure complete deflation.
Monitor the patient's urinary function post-removal, documenting time and amount of urine voided over 24 hours.
Tracheostomy tubes are essential for maintaining a patient's airway during mechanical ventilation or prolonged artificial airway needs.
Regularly assess cuff inflation, monitor cuff pressures, and keep a resuscitation bag nearby for immediate respiratory support.
The process of extubation involves hyperoxygenating the patient, deflating the cuff, and removing the endotracheal tube while suctioning the airway.
Monitor the patient post-extubation for respiratory distress and inform them of potential hoarseness or sore throat.
Tracheostomy tubes involve surgically creating an airway opening, with various types available for different clinical needs.
Regular assessments, monitoring cuff pressures, and maintaining proper care of the stoma and secretions are crucial for tracheostomy tube management.
Complications of tracheostomy tubes include tube obstruction, tracheomalacia, tracheal stenosis, tracheoesophageal fistula, and tracheoinnominate artery fistula.
Positioning of the patient is crucial for safety and comfort, considering their medical history and conditions.
Specific positions post-surgery, like for autografts, burns, skin grafts, mastectomies, require elevation and immobilization for optimal healing and comfort.

02:00:25

Optimal Positions for Various Medical Procedures

For perineal and vaginal procedures, use the lithotomy position for client comfort and access.
After a hypophysectomy, elevate the head of the bed slightly to reduce intracranial pressure.
Following a thyroidectomy, place the client in a semi-fowlers position to reduce swelling and provide comfort.
Post-hemorrhoidectomy, lay on the side to prevent pain and bleeding.
In cases of gastroesophageal reflux disease (GERD), use the reverse Trendelenburg's position to prevent acid reflux.
For liver biopsy, assist the client onto their right side to reduce bleeding and provide support.
After a paracentesis, have the patient in a semi position or sitting upright for comfort.
During nasogastric tube insertion, prop the client up in a high fowlers position to aid in tube placement.
For rectal enemas and irrigations, place the client in the left Sims position to facilitate drainage.
In cases of arterial vascular grafting, keep the affected limb straight to ensure proper healing.

02:18:07

Essential Perioperative Nursing Care for NCLEX

Perioperative nursing care is crucial for the NCLEX exam, typically featuring two or three questions.
Perioperative nursing encompasses care before, during, and after surgery, divided into preoperative, intraoperative, and postoperative phases.
Informed consent is vital, with the nurse playing a key role in ensuring understanding and documentation.
Nutrition considerations include NPO status, IV line setup, elimination procedures, and urinary catheter insertion.
Surgical site preparation involves cleaning, shaving, and documentation to ensure client safety and procedure success.
Pre-operative client education covers postoperative expectations, pain management, and smoking cessation.
The pre-operative checklist includes confirming identification, allergies, and documentation review.
In the operating room, measures are taken to prevent wrong-site surgery, with stringent checks and anesthesia administration.
Understanding medication interactions is crucial, with antibiotics, anti-coagulants, and anti-depressants impacting anesthesia.
Postoperative care involves respiratory and cardiovascular monitoring, thrombolytic risk prevention, and comprehensive nursing care for optimal recovery.

02:35:44

Vital Signs and Pain Management in Healthcare

Different methods for temperature measurement include oral, rectal, ear canal, and temporal artery measurements, with specific requirements for each method.
Pulse rate, typically ranging from 60 to 100 beats per minute in adults, is crucial for evaluating a client's activity tolerance and can be affected by age, exercise, emotional states, pain, body temperature, and various medications.
Pulse qualities are assessed based on rate, rhythm, and strength, with a grading scale ranging from 0 to 4 indicating the strength of the pulse.
Various pulse points in the body, such as the temporal artery, carotid artery, apical pulse, brachial pulse, radial pulse, femoral pulse, popliteal pulse, posterior tibial pulse, and dorsalis pedis pulse, are used for pulse assessment.
Blood pressure is measured to assess the force of blood on artery walls, with classifications including prehypertension, stage one hypertension, and stage two hypertension based on systolic and diastolic pressure measurements.
Orthostatic vital signs are checked by measuring blood pressure and pulse in supine, sitting, and standing positions to detect postural orthostatic hypotension.
Pulse oximetry measures oxygen saturation in the blood, with values typically ranging from 95% to 100%, and readings below 90% may require further action.
Pain assessment involves understanding different types of pain, using pain scales to assess intensity, and evaluating responses to non-pharmacological interventions like cutaneous stimulation, transcutaneous electrical nerve stimulation, supportive devices, and heat/cold applications.
Nonopioid analgesics, opioid analgesics, and acetaminophen are used for pain management, with considerations for contraindications, side effects, and monitoring respiratory rate and other vital signs.
Medication administration protocols in clinical practice involve understanding prescription orders, routine orders, PRN orders, STAT orders, and standing orders, with specific guidelines for each type of order.

02:52:43

"Medication Administration: Orders, Routes, and Rights"

Pantop 40 mg orally daily is a typical routine order for medication.
PRN orders are for medication administered as needed by the patient based on symptoms like pain or nausea.
Standing orders are standardized prescriptions that nurses can implement without immediate provider consultation.
Onetime orders are prescriptions meant for a single administration.
Stat orders are urgent one-time orders requiring immediate action.
Titration orders involve adjusting medication dose based on the patient's condition.
Medications can be administered through various routes such as oral, sublingual, internal, rectal, inhalation, intramuscular, subcutaneous, and transdermal.
The rights of medication administration include verifying the right patient, drug, dose, time, route, and documentation.
The three checks a nurse should perform before medication administration are first check, second check, and third check.
Oral medications come in various forms like scored tablets, enteric-coated tablets, sustained-release capsules, and liquid solutions administered using a medicine cup.

03:10:28

Essential Blood Tests for Health Monitoring

Hemostasis involves clot retraction and coagulation factor activation, with a normal platelet count range of 150,000 to 400,000 mm^3.
Factors like high altitudes, cold weather, and exercise can increase platelet counts, necessitating monitoring for bleeding in patients with thrombocytopenia.
Bleeding precautions are crucial when platelet counts drop significantly below normal, especially in patients undergoing chemotherapy.
Prior to invasive procedures, coagulation studies, platelet counts, hemoglobin, and hematocrit tests should be assessed.
Lipid panels include total cholesterol, HDL, LDL, and triglycerides, with fasting recommended for accurate results.
Fasting blood glucose levels, HbA1c tests, and renal function studies (serum creatinine and BUN) are vital for diagnosing diabetes and monitoring kidney function.
White blood cell counts and differentials are essential for understanding immune defense and detecting health conditions like infections or bone marrow recovery.
Metabolic tests like BMP and CMP are crucial for assessing fluid balance, blood glucose, liver function, and electrolyte levels.
Complete blood counts (CBC) provide information on red and white blood cells, platelets, and are crucial for diagnosing anemia or clotting disorders.
In the event of a fire, nurses must follow the MONIC race protocol, use the PASS technique for fire extinguishers, and ensure unobstructed fire exits for patient safety.

03:27:58

Toileting schedule reduces Falls; Enlex contest questions

Maintaining a regular toileting schedule for clients can reduce Falls in healthcare facilities
Enlex crash course offers a contest with 10 critical questions every hour to win prizes
Challenge question: cells in the stomach that produce intrinsic factor
Challenge question: gland that secretes melatonin for nursing acumen sharpening

Try it yourself — It’s free.