Calcium Gluconate-Nifty NCLEX Tips
Calcium is an important electrolyte in the body. Responsible for cardiac function, blood clotting, renal function and teeth/bone health, low levels of Calcium can be devastating to one’s health. Calcium Gluconate is likely to be found on the NCLEX RN exam.
In individuals with hypocalcemia (amongst many other conditions), Calcium Gluconate is the drug of choice. As an aspiring nurse, it is important that you learn more about this drug before you take your NCLEX exam. Here are some pointers that can help you out.
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Indication for Use
To pass the NCLEX, nursing students should know indications for medications. Calcium Gluconate is used in the treatment of disorders with negative calcium balance, including Vitamin D deficiency, hypoparathyroidism, neonatal tetany and alkalosis. It is also used in cardiopulmonary resuscitation and the prevention of hypocalcemia during blood transfusion.
Calcium Gluconate is prescribed in patients with acute lead colic, hypersensitivity reactions and insect bite/sting-induced muscle cramps. Apart from being an antidote to magnesium sulfate, Calcium Gluconate is also used in the treatment of hyperkalemia-related cardiac toxicity.
Comprehensive nursing history-taking is a must prior to the administration of Calcium Gluconate. The presence of calcium allergy, hypercalcemia, renal calculi and digitalis toxicity should be noted.
As for physical examination, the nurse should perform vital signs, auscultation of lungs and bowel sounds, abdominal exam. He/She should check the client’s urinalysis and ECG exam prior to administering Calcium Gluconate as well.
Electrolyte tests should also be verified prior to Calcium Gluconate administration, as calcium and phosphorous levels usually vary inversely. Serum magnesium results should also be noted, as this electrolyte decreases along calcium depletion in the body. Nurses can find NCLEX tips and practice NCLEX questions on www.nclexpreceptor.com.
NCLEX Nursing Interventions
It is important for nurses to know the best practice interventions to pass NCLEX. Prior to administering IV Calcium Gluconate, the nurse should check the injection as extravasation can lead to necrosis and irritation. Additionally, the patient’s ECG should be monitored during administration. This can help you detect the presence of hypercalcemia, which is demonstrated by a decreased QT interval and an inverted T wave.
When administering the Calcium Gluconate injection, watch out for peripheral vasodilation (marked by a fall in BP) and reports of a ‘burning’ sensation. Throughout therapy, you should observe the patient for signs of hypocalcemia or hypercalcemia.
Important NCLEX Teaching Points
If Calcium Gluconate is used by your patient for disorders of negative calcium balance, inform him that zinc-rich foods can inhibit thorough Calcium absorption. As such, advise him to avoid food such as soy, legumes, sprouts, nuts and seeds.
Most importantly, patients taking Calcium Gluconate should be educated about the signs of hypercalcemia (constipation, nausea, vomiting, poor appetite and pain.) Emphasize that he needs to report any of the following symptoms to a healthcare provider right away.
Calcium Gluconate is an essential drug. However, a nurse like you should know all the important pointers in order to administer it safely. Be a stellar nurse by going through the medication must-knows at nclexpreceptor.com.
Alcoholism Core Measures
Alcoholism is a prevalent problem, causing approximately 1 out of 4 deaths in the United States. Not only does it lead to medical problems, it puts a strain on the society as well. In fact, alcoholism has cost the a whopping $185 billion in expenditures.
Apart from causing dependence, constant alcohol use can lead to stroke, cirrhosis, cancer and arrhythmias, to name a few. Since dependence and addiction to this substance can be easily prevented, the Joint Commission has come up with proven-effective core measures.
Alcohol Use Screening
Patients admitted in the hospital – with an alcohol test indicative of acute intoxication – are subjected to screening. These individuals should be 18 years of age. They should have been hospitalized anywhere from a day to 120 days. Data elements that should be included in the process are the following:
- Admission date
- Cognitive impairment
- Discharge date
As a registered nurse, you have to ensure that the screening process is done and documented – or why it has been refused by certain individuals.
Alcohol Use Brief Intervention Provided or Offered
An estimated 22.6 million people meet the criteria for alcoholism and substance use disorder. Fortunately, Obama care has expanded benefits for alcoholism treatment. Consequently, more and more individuals can receive the proper therapy they need.
Acknowledging the impact of alcohol use, several clinical trials were held to determine the best health care solution for these individuals. According to the studies, brief interventions, especially those given before the onset of addiction, can markedly reduce alcohol-related expenses. Treatment referral is also deemed beneficial in clients diagnosed with alcoholism.
As a nurse, you should know your facility’s policies regarding brief treatment. Make sure to initiate and document this process as indicated.
Alcoholism Treatment Provided or Offered at Discharge
While a stint in an urgent care facility can reduce alcoholism tendencies, the will to stay sober can immediately go away upon discharge. To prevent a relapse, the Joint Commission recommends medical and nursing personnel to provide/offer treatment upon discharge.
Such therapies that may be suggested after discharge include detoxification, rehabilitation and maintenance of sobriety. Medications that can be prescribed include Vivitrol, Disulfiram (Antabuse) and Naltrexone (Revia.)
Alcoholism: Assessing Status after Discharge
After discharge, the alcoholic patient is contacted 7 to 30 days after hospitalization. Information such as counseling, use of prescribed meds and quit status are established during this follow-up call.
While the nurse does not play a role in the follow-up process, he can ensure the compliance of the patient by educating him in the urgent care facility. He can foster follow-up by encouraging the patient to live a healthy, alcohol-free life.
Alcoholism can cause a variety of diseases. You, as a nurse, can help in the reduction of relapse and confinement by following these core measures. To learn more about these evidence-based practices, visit nclexpreceptor.com.
Pneumonia Core Measures
Pneumonia, an acute respiratory disorder, is the leading cause of death amongst children. Caused by bacteria, viruses and fungi, it accounts for 1.1 million annual deaths in kids under 5 years old.
Although common in children, pneumonia affects young and older adults as well. Causing an average of 5.2 days in confinement, the registered nurse can help lessen its medical and financial burdens by following these pneumonia core measures:
As it has been mentioned, pneumonia can be caused by bacteria, viruses or fungi. Depending on the culprit, the doctor will prescribe the appropriate antibiotic, anti-viral or anti-fungal agent.
Because of the various microorganisms that can cause pneumonia, it is important that the nurse facilitates blood cultures. Know that they should be done within 24 hours upon admission, especially if the patient is transferred to the ICU. Since it helps determine the organism and the subtype that can cause the disease, blood cultures pave the way for better and immediate pneumonia hospital treatment.
Since pneumonia can be caused by a variety of organisms, the foremost health care is to give appropriate antibiotics. The treatment will of course, depend on the blood cultures, as well as the patient’s condition.
For non-ICU pneumonia patients, the treatment options are:
- Beta-lactams (IV or IM) with Macrolide (IV or PO)
- Beta-lactams (IV or IM) with Doxycycline (IV or PO)
- Macrolide Monotherapy (IV or PO)
ICU patients with pneumonia, on the other hand, are given the following antibiotics for urgent care:
- Macrolide (IV) with Beta-lactams (IV) OR Antipneumococcal/ Antipseudomonal Beta-lactam (IV)
- Antipneumococcal/ Antipseudomonal Quinolone (IV) with Beta-lactam (IV) OR Antipneumococcal/ Antipseudomonal Beta-lactam (IV)
- Antipneumococcal/ Antipseudomonal Beta-lactam (IV) with Aminoglycoside (IV) with Antipneumococcal Quinolone (IV) OR Macrolide (IV)
Non-ICU patients with pneumococcal risk are prescribed the following medications:
- Antipneumococcal/ Antipseudomonal Beta-lactam (IV) with Antipseudomonal Quinolone (IV or PO)
- Antipseudomonal Beta-lactam (IV) with Aminoglycoside (IV) with Antipneumococcal Quinolone (IV or PO) OR Macrolide (IV or PO)
- Aztreonam (IV or IM) with Antipneumococcal Quinolone (IV or PO) with Aminoglycoside (IV)
- Aztreonam 2 (IV or IM) with Levofloxacin (IV or PO)
Depending on the medications prescribed to your patient, you should observe the appropriate nursing interventions per drug. For example:
- Beta-Lactams: Monitor for signs of opportunistic infections. Discontinue at the first sign of colitis.
- Aminoglycosides: Watch for signs of neurotoxicity, renal impairment or ototoxicity. Ensure patient is well-hydrated.
- Quinolones: Ensure that pneumonia patient is well-hydrated. Provide antacids 2 hours after administration.
- Macrolides: If taking Azithromycin or Erythromycin, advise patient to take the meds 1 hour before/2 hours after meals. Monitor for hepatic dysfunction.
- Levofloxacin: Advise patient to take the meds 1 hour before/2 hours after meals. Ensure patient is well-hydrated. Discontinue at first sign of hypersensitivity.
- Aztreonam: Inform pneumonia patient that IV Aztreonam may cause taste changes.
Proper nursing care can help reduce the cases of pneumonia, a very prevalent disease. Make Obama care successful by learning more about the various core measures here at nclexpreceptor.com.
Heart Failure Core Measures
Heart Failure is caused by the inability of the heart to supply the needed blood and oxygen to various body organs. It is sad that heart failure is a prevalent disease. It affects as many as 5.1 million Americans. Once diagnosed, heart failure patients usually die within 5 years.
Early diagnosis and treatment are pivotal in lengthening and improving the quality of life of the said individuals. Joint Commission drafted core measures that will help medical personnel provide quality health care. Here are some pointers that should help you provide effective heart failure nursing care:
Since heart failure can be complicated by unhealthy lifestyle choices, it is your role as a registered nurse to provide comprehensive health instructions prior to the patient’s discharge. Guidelines that you should include in your discharge teaching are the following:
- Healthy diet – low in salt and low in fat
- Weight monitoring
- Healthy levels of activity
- Medication compliance
- Signs of worsening symptoms: DANGER!
o Nocturnal Paroxysmal Dyspnea
o Gain in weight – 2 pounds/day, or 5 pound-change from baseline weight
o Edema of the lower extremities
o Respiratory distress – nasal flaring and use of accessory respiratory muscles
- Importance of follow-up treatments
Assessment of Left Ventricular Systolic Function
Left ventricular systolic (LVS) function is a measure of the pumping ability of the left ventricle (lower left heart chamber.) It also shows how well the ventricle can deliver blood to other parts of the body. This diagnostic test is an urgent care measure, as it is a foremost sign of heart failure. The goal of Joint Commission is for all hospitals to carry out this exam and deliver a higher level of patient care.
Apart from LVS function, the doctor or nurse should obtain the patient’s medical history and physical exam. Other exams that should be obtained include blood tests, chest x-ray, ECG and echocardiogram. As a nurse, you should ensure that the LVS function test and other exams are undertaken. At the same time, you should facilitate the needed heart failure procedure/s in a timely manner.
ACE Inhibitors and ARBs at Discharge
Since high blood pressure can lead to worsening heart failure, Obama care core measures emphasize the importance of prescribing ACE inhibitors and Angiotensin Receptor Blockers (ARB) at discharge. These medications block hormones that can lead to blood vessel constriction, which then leads to hypertension.
As a nurse, you need to make sure that your patient receives the appropriate medications upon discharge. Clients with decreased heart functions should receive ARBs at discharge. Those with heart failure/heart attack, on the other hand, should be prescribed with ACE inhibitors.
Heart failure might be fatal, but the patient can live a longer, better life with these core measures. Learn more about these care standards at nclexpreceptor.com.
How to Pass NCLEX on the 1st Time
Do you want to pass NCLEX on your 1st try? Follow these easy tips and you can pass NCLEX on your 1st try. Do you carefully read the questions and choose the appropriate answer but somehow your choice of answer still seems to be wrong? This article is for you. Here are some test taking strategies so you can survive the NCLEX with flying colours. You can use our test prep mobile app to study for and pass nclex.
Pass NCLEX with these tips
To pass NCLEX just answer what is specifically being asked
Avoid reading into the questions and looking for answers that aren’t asked for. This also includes asking yourself “what if…?” Just look at the keywords and identify what the question is asking. To pass NCLEX focus on what the question is asking. Lets take a look at some sample questions.
Prior to chorionic villi sampling, the pregnant client is encouraged to:
A. Receive Rhogam if Rh (-)
B. Report premature uterine contractions
C. Drink fluids so that the bladder is full
D. Observe signs of infection
Look at the above question and options. The correct answer is (c) because the question specifically asks about the action that needs to be done immediately prior to the procedure. It did not state whether the patient was Rh (-) so no need for Rhogam. Premature contractions and signs of infection are important assessments but looking at the question it only wants to know the action needed prior to the procedure. You can pass NCLEX by focusing on the main idea of the question.
To pass NCLEX carefully read and understand the stem of the question – the stem of the question follows the case situation. Always remember that all you need to know about this specific question is all in the case situation.
After surgical removal of a brain tumor, the physician orders to maintain the child in a flat position. In the postoperative period, the charge nurse notices that the child is restless, tachycardic, and the blood pressure has significantly dropped from the baseline value. The charge nurse suspects that the child is in shock. Which of the following is appropriate?
A. Elevate the head of the bed
B. Increase the rate of the IV fluids
C. Notify the physician
D. Place the child in a Trendelenburg position
Based on the above scenario, you would find that the case presents a post-operative child who had just undergone surgery for removal of a brain tumor. To pass nclex you need to understand what the question is asking. If you keep that in mind, you would remember that a Trendelenburg position would only place the child in more danger as it will increase the intracranial pressure (ICP) and risk for bleeding; so as increasing the rate of IV fluids would cause increase in ICP; and changing the post-operative child’s position should not be done without notifying the physician first. With these rationales, the correct answer is (c). You can pass NCLEX by identifying the stem of the question.
To Pass NCLEX use the process of elimination.
A very common tip for test takers, but really it never gets old. Through eliminations are options are narrowed down making it easier for test takers to analyze the choices left. Once you have eliminated at least two options, try to read the question again and identify what the question is specifically asking before choosing your final answer. To pass NCLEX eliminate as many answers as possible.
A nurse provides home care instructions to the parents of a child with congestive heart failure (CHF) regarding the procedure for administration of Digoxin (Lanoxin). Which statement by the mother indicates the need for further education?
A. “I will not mix the medication with food.”
B. “If the child vomits after I give him the medicine, I will repeat the dose.”
C. “I will take the child’s pulse before administering the medication.”
D. “If more than one dose is missed, I will call his doctor.”
The correct answer here is (b). General knowledge in the administration of Digoxin tells you that options (c) and (d) are dead giveaways, which leaves you with the other two choices. But repeating the dose after a child vomits it is a definite no-no as there is a risk for over dosage. You can pass NCLEX by eliminating any answers that you know are wrong.
No matter how well primed you are for the exam; note that it takes a thorough understanding and careful analysis of the given question to be able to answer the problem correctly. Just follow these simple tricks and I’m sure you will pass NCLEX on the first time. Always remember that it takes preparation, skill and determination in passing any kind of exam so good luck and keep those caps on as you practice, practice, and practice. You can find other test questions and NCLEX tips at www.NCLEXPreceptor.com. Remember these tips and You can pass NCLEX on your 1st try.
Author: Marisse Gonzales RN