It is not enough to work as a nurse in the United States from just graduating. Aside from graduating, it is also a must for you to be licensed by the state where you intend to practice. It should be noted that there is a requirement of that license, which is the passage of the National Council Licensure Examination, which is also more known as NCLEX in short.
In order to help you to get a license, there is a thing known as Mark Klimek NCLEX Review for you. There are a few instructors of this review. One of them is Mark Klimek. For those who are not familiar with him, he is known as Associate Professor of Nursing at Cedarville University. He has been there since 1983. The specialty areas of him include Med-Surg/ICU and Psych Mental-Health Nursing.
Furthermore, Mark is an expert nurse and communicator who has been providing state board or NCLEX Reviews for than 30 years. The main focus of him is the thing that is essential to know. One of the good things about this man is he has the ability to explain difficult concepts with clarity and creativity. Besides, he also teaches strategies for test-taking.
As an instructor, Mark Klimek gives a few lecture notes for his students. All the lecture notes 1-12 of him are as follows:
Lecture 1:
- Acid Base Balance
- Ventilators
Lecture 2:
- Alcohol
- Wernicke
- Overdose and Withdrawal
- S/Sx
- Aminoglycosides
- Peak and Trough
Lecture 3:
- Drug Toxicities (Lithium, Lanoxin, Dilantin, Bilirubin, Aminophylline)
- Kernicterus
- Dumping/HH
- Electrolytes: K+, CA, MG, and NA
- TX for HyperKalemia
Lecture 4:
- Crutches
- Canes
- Walkers
- Delusions
- Hallucinations
- Psychosis
- Psychotic and Non-Psychotic
- Hallucination
- Illusion
- Delusion
Lecture 5:
- Diabetes Mellitus
- Diabetes Insipidus
- SIADH
- Insulin
- DKA
- HHNK
Lecture 6:
- Drug Toxicities (Lithium, Lanoxin, Dilantin, Bilirubin, Aminophylline)
- Kernicterus
- Dumping/HH
- Electrolytes: K+, CA, MG, and NA
- TX for HyperKalemia
Lecture 7:
- Thyroid (Hyper-, Hypo-)
- Adrenal Cortex (Addison Disease, Cushing)
- Toys
- Laminectomy
Lecture 8:
- Lab Values
- Five Deadly Ds
- Neutropenic Precaution
Lecture 9:
- Psych Drugs
- Tri
- Benzo
- MAOI
- Lithium
- Prozac
- Haldol
- Clozaril
- Zoloft
Lecture 10:
- Maternity and Neonatology
Lecture 11:
- Fetal Compilations
- Stages of Labor
- Assessments
- Variations for NB
- Maternity Meds
- Medication Hints
- Psych Tips
- Operational Stages
Lecture 12:
- Prioritization
- Delegation
- Staff Management
- Guessing Strategies
This followings will only explain about the first part of Lecture 1, which is Acid/Base Balance. Make sure to read everything well and do not even try to skip a thing so that you will be able to understand every single thing about it.
To be able to solve acid-based disorder, knowing the normal for pH, CO2 and HCO3 (bicarbonate) is really important. All of them are shown below:
- pH 7.35 to 7.45
- CO2 3w5 to 45
- HCO3 22 to 26
The pH is known is the first value to look at in an acid-base disorder.
- If pH is less than 7.35, the acid-base imbalance is acidotic.
- If pH is less than 7.45, the acid-base imbalance is alkalotic.
In order to determine if the imbalance is metabolic or respiratory, it will be needed for you to determine whether HCO3 goes in the same or opposite direction with pH. Take a note that if pH and Bicarb move both in the same direction, then the acid-base imbalance is metabolic. If they move in the different direction, then it is respiratory.
Example #1:
- pH 7.3 Acidotic
- HCO3 20 Metabolic
- This is an example of metabolic acidosis
Example #2:
- pH 7.58 Alkahotic
- HCO3 32 Metabolic
- This is an example of metabolic alkalosis
Example #3:
- pH 7.22 Acidosis
- HCO3 35 Respiratory
- This is an example of respiratory acidosis
As the pH goes, the patient also follows its step with the exception of Potassium. Here are what it means:
- If pH is low, all the things are low with the exception of potassium
- If pH is high, all the things are high with the exception of potassium
If the pH goes more than 7.45, then it is considered as alkalosis.
- It means everything is up, including tachycardia, tachypnea, HTN, seizures, irritability, spastic, diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+)
- However, the thing called potassium is the opposite. It means it is hypokalemia.
- The nursing intervention is pt need suctioning because of seizures.
If the pH goes under 7.35, it means it is acidosis:
- Therefore, all the things, including bradycadia, constipation, absent bowel sounds, flaccid, obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP are down.
- However, the thing called potassium is high. It means it is hyperkalemia.
- The nursing prevention is pt needs to be ventilated with an Ambu bad respiratory arrest.
It is worth noting that MAC Kussmaul is the only acid-base imbalance to cause Metabolic Acidosis with Kussmaul respirations.
There are a few causes of acid-base imbalance. First of all, you have to ask yourself whether it is a lung. If the answer to the question is yes, it means it is respiratory. After asking about it, then you should also ask yourself whether they are overventilating or underventilating. If they are overventilating, then you will have to choose acidosis with the pH under 7.35. If they are overventilating, then it is called alkalosis which the pH is more than 7.45.
There are some acid-base derangements presented, as follows:
- In labor: Respiratory alkalosis. It is known as overventilating with pH increases.
- Drowning: Respiratory acidosis. It is known as underventilating with pH decreases.
- Pt is on PCA (patient controlled anesthecia) pump: Ventilation is down. It is known as Respiratory acidosis.
If it is no lung, then it is considered as metabolic. Please choose alkalosis in case the patient has prolonged gastric vomiting or suction (sucking out acid). As for everything else aside from lung, make sure to choose metabolic acidosis. Basically, just pick metabolic acidosis if you have no idea what to choose.
There are two things that you have to remember. The first thing is to set your default setting to Metabolic Acidosis and the second thing is to always pay attention to modifying phrase rather than the original noun.
