$7.95

Well worth it, the best $7.95 I ever spent - the price of knowing if you passed the NCLEX-RN (unofficial) is $7.75. I was so afraid to look, but to curious not to. I had only 75 questions, I don't remember any on drug calculations or OB questions, so I thought I must have bombed so bad it was not worth testing me any more. This was one time I was glad to be wrong! The only study books I used were - 

Neurosensory Disorders

• Acute Head Injury
• Amyotrophic lateral sclerosis (ALS or Lou Gehrig's Disease) - progressive degenerative disorder; nerve cells degenerate and die, muscle fibers atrophy - 3 times more prevalent in males. cause is unknown, ? genetic
• Bell's Palsy - inflammation around 7th cranial nerve (facial). unilateral facial weakness or paralysis, rapid onset; more common before 60, complete recovery in 1-8 weeks but longer in older adults, may reoccur, may result in contractures. caused from viral infection, hemorrhage, tumor, or trauma
• Brain Abscess - free or encapsulated collection of pus usually in the temporal love, cerebellum or frontal lobe, rare, can occur at any age, most common 10 - 35.prognosis is fatal or fair. causes - infection of ears, sinuses, or dental abscess and mastoiditis, subdural empyema or trauma.
• location of abscess
• temporal -
• auditory receptive dysphasia
• central facial wekness
• hemiparresis
• cerebrallar abscess -
• dixxiness
• coarse nystagmus
• gaxe weakness on lesion side
• tremor
• ataxia
• frontal
• expressive dysphasia
• hemiparesis with unilateral motor seizure
• drowsiness
• inattention
• mental function impairment
• seizures
• Brain tumor - causes - environmental, genetic
• frontal - aphasia, memory loss, personality changes
• temporal - aphasia, seizures
• parietal - motor seizures, sensory impairment
• occipital - homonymous hemianopsia (blindness or defective vision affecting the right halves or left halves of the visual field of the 2 eyes), visual hallucunation, visual impairment
• cerebellum - impaired coordination, impaired equilibrim
• Cartaract -
• Cerebral aneurysm - classified by size or shape, causes - atherosclerosis, congnital weakness, head trauma, keep lights low and no stress
• saccular - most common occur at the base of the brain at he juncture where the large arteries bifurcate, others include berry and dissecting.
• Crushing's triad (bradicardia, high sBP, wide pulse pressure, precussor to hemmorhage
• subarachnoid hemorrage - result of rupture, high motality rate, keep low lights, avoid overstimulation, HOB elevate 0 - 30 degrees, frequent neuro checks
• Conjuctivitis - inflammation of the conjucntiva, may be from infection (highly contagious), chemical, or allery
• causes -
• bacterial -
• staphylococcus aureus
• strptococcus pneumoniae
• neisseria gonorrhoeae
• n. meningitidis
• Chlamydial
• chlamydia trachomatis
• Viral
• Adenovirus types 3,7, and 8
• herpes simplex virus, type 1
• other causes -
• allergic -
• pollen
• grass,
• topidal medications,
• air pollution
• smoke
• fungal infections (rare)
• Occupationa irritans (acids and slkalies)
• parasitic diseases caused by phthirus pubis, or schistosoma haematobium
• tickettsial diseases (Rochy Mountain spotted fever)
• Corneal abrasion
• Encephalitis  severe inflammation and swelling of the brain, damages optic nerve.  usually caused by misquito or tick borne virus; may also occur by drinking infected goat milk, may cause permanent neurologic damage and is commonly fatal. Keep room cool and dark
• Glaucoma - increased intraocular pressure
• causes -
• diabetes mellitus
• long term steroid treatment
• previous eye trauma or surgeru
• Uveitis
• fisk factorw
• family history of glaucoma
• race - more prevailent in african-american
• Gukllain-Barre syndrome
• causes -
• cell mediated immune response with an attach on peripheral nerves in response to a virus
•  demyelination of the peripheral nerves
• respiratory infection
• test
•  history of preceding febrile illness (usually from a respiratory infection)
• CSF protein level begins to rise
• EMG shows repeated firing of the motr unit reather than widespread sectional stimulation
• nerve conduction velocities are slowed after paralysis
• potential complication
• mechanical ventilatory failure
• aspiration pneumonia
• sepsis
• joint contractions
• DVT
• Hearing Loss  3 major types of hearing loss
• conductive loss
• sensorineural loss
• mixed loss

Neurosensory Systems and Tests

• Neuron - nerve cell -
• axons carry away
• dentrites bring to
• neurotransmitters - help conduct impulses across the synapse
• acetylcholine
• seotonin
• dopamine
• endorphins
• gamma-aminobutyric acid
• norepinephrine
• CNS - central nervous system - brain and spinal cord
• Cerebrum - largest part of the brain 
• hemispheres - right and left opposite control because motor impulses cross in the deulla
• fissures divide cerebrum into 4 lobes
• frontal - personality, memory, reasoning, concetration and motor control of speech
• parietal  - sensation, integration of sensory information and spatial relationships
• temporal  - hearing, speech, memory, and emotion
• occipital - vision and involuntary eye movements
• Thalamus - 2 oval shaped parts deep in the brain, the relay station - recieves input form all senses except smell, analyses input and transmits to other parts of the brain.
• Hypothalamus - beneath the thalamus - control sleep and wakefulness, temperature, respiration, BP, sexual arousal , fluid balance, and emotioal response.
• Cerebellum - base of the brain - coordinates muscle movements, maintains balance and controls posture
• Brain Stem - connects brain and spinal cord has 3 sections
• midbrain - pupillary relexes and eye movements; relfex center of the 3rd and 4th cranial nerves
• pons - helps regulate respiration, mediates chewing, tasting, saliva and equilibruim; reflex center for the 5th, 6th, 7th and 8th cranial nerve
• medulla oblongata - vomiting, vasomotor, respiratory and cardiac centers
• Spinal cord - 2 way conduction system between brain and peripheral nervous system (PNS)
• gray matter - cell bodies and dendrites and axons
• white matter ascending (sensory) sends signalsto the brain and desending (motor) tracts send signals out to the muscles
• PNS - Periperal Nervous System - delivers messages (like the post office) main nerves grouped
• 31 pairs of spinal nerves - carry mixed impulses (motor and sensory)
• 12  pairs of cranial nerves -
1. olfactory
2. optic
3. oculomotor
4. trochlear
5. trigeminal
6. abducen
7. facial
8. acoustic
9. glossopharyngeal
10. vagus
11. spinal accessory
12. hypoglossal
• Autonomic nervous system - subdividsion of PNS - controls involuntary body functions
• digestion
• respiration
• cardiovascular
• 2 cooperating systems
• sypathetic - fight or flight
• parasympathetic - conserves and restores energy
• Eyes -
• external -
• eyelids
• conjuctivae (thin transparent membrane that line the lids)
• lacrimal apparatuses,extraocular muscles, and the eyeballs
• internal -
• iris
• cornea
• pupil
• lens
• vitreous humor
• retina
• retinal cones - visual acuity and color discrimination under bright lights
• retinal rods - peripheral vision under decreased light conditions
• optic nerve - 2nd cranial nerve
• Ears
• External -  pinna (auricle) and external auditory canal separated by the tympanic membrane
• Middle -  AKA tympanum - air filled cavity in the temporal bone - 3 small bones - malleus, incus, and stapes
• Inner - AKA Labyrinth - cochlea, vestibule and semicircular canals

Most Important Tests

• Electroencephalogram (EEG) electrical graph of brain activty
• Computer tomography (CT) - cross scetion veiws of brain images
• Magnetic Resonance Imaging (MRI) - magnetic snapshot - contraindications - pacemaker
• Cerebral Angiogram - upstairs artery exam blood flow using dye
• check site for bleeding
• assess distal pulses
• assess neuro status
• encourage fluids
• Lumbar Puncture L(P) - reveals pressure also used to inject dye for myelogram *contra indicated with increase intracranial pressur (ICP)
• keep flat
• monitor neuro status
• monitor site for leakage or bleeding
• encourage fluids
• Cerebrospinal fluid (CFS) analysis - LAB
• Electromypgraphy (EMG) - electrical acitivity of a muscle at rest and contraction
• Myelography - see the spine - subarachnoid space, spinal cord and verebrae contraindicated with seafood or iodine allergies
• keep flat after
• check site for leakage or bleeding
• encourage fluids
• Skull x-ray
• Positron emission tomography (PET) injection of radioisotope after visulaization of the brain's oxygen uptake, blood flow and glucose metabolism
• no tobacco, alcohol,  or caffeine 24 hours before
• Blood Chemestry Test - checking levels of potassium, sodium, calcium, phoshorus, protein, osmolality, glucose, bicarbonate, blood urea nitrogen and creatinine
• Hematologic study - WBCs, RBCs, erythrocyte sedimentation rate, platelets, hemoglobin, hematocrit.
• Coagulation study
• Visual Acuity
• Extraocular eye muscle testing - checks for parallet alignment of the eyes, muscle strength and cranial nerve function
• Visual field examinaitn
• Tonometry test - measures intra ocular pressure
• Tick-tock test is an auditory acuity test checking ability to hear a whispered phrase or a ticking watch
• Otoscopic examination to visulize the tympanic membrane
• Audiometry - measures degree of deafness

Chvostek's sign, Amin&Shwani 2010

Trausseau's sign

Hematologic and Immune System

• Serum Magnesium if less than 1.5mEq/l confirms hypomagnesemia; if greater than 2.5 mEq/l confirms hypermagnesemia.
• CD4=T cell count less than 200 cells/ul indicative of AIDS
• Serum ionized calcium leve less than 4.5 mEq/L confirms hypocalcemia; if greater than 5.5 confirms hypercalcemia
• Trousseau's  and Chvostek's signs
• Serum chloride level less than 98mEq/L confirms hypochloremia
• supportive values with metabolic alkalosis include a serum pH greater than 7.45 and a serum carbon dioxide level greater than 32 mEq/L
• Serum chloride level greater than 108 mEq/L confirms hyperchloremia
• supportive values with metabolic acidosios include a serum pH less than 7.35 and a serum carbon dioxide level less than 22 mEq/L
• Serum Phosphorus level less than 1.7 mEq/L (or 2.5 mg/dl) confirms hypophosphatemia, urine phosphorus level more than 1.3 g/24/hrs supports this
• Serum Phosphorus level greater than 2.6 mEq/L (or 4.5 mg/dl) confirms hyperphosphatemia, urine phosphorus level less than 0.9 g/24/hrs supports this
• Sodium - hyponatremia less than 135 mEq/;L hypernatremia greater than 145 mEq/L

• Disseminated Intravascular Coagulation - PT greater than 15 seconds; PTT greater than 60 to 80 seconds; fibrinogen levels less than 150 mg/sl; platelets less than 100,000; fibrin degradation products typically greater than 100 mcg/ml; and a positive D-dimer test specific for DIC
• Hemophilia Factor VIII assay reveals 0% to 25% of normal factor VIII (hemophilia A)
• hemophilia B factor IX assay shows deficiency in addition to baseline coagulation results similar to that of A
• Idiopathic Thrombocytopenic Purpura (ITP)  platelet count is less than 20,000/ul; prolonged bleeding time
• Iron Deficiency Anemia decreased Hb, HCT, iron, ferritin, reticulocytes, red cell indices, transferring and saturation; absent hemosiderin, and increased iron biding capacity.
• Aplastic Anemia - bone marrow biopsy shows fatty marrow with reduction of stem cells, Fecal occult blood test is positive, decreased granulocytes, thromobocytes, and RBCs, hematuria
• Pernicious Anemia - from vitamin B mal-absorption
• Polycythemia vera - chronic myeloproliferateve disorder characterized by increased RBC mass, leukocytosis, thrombocytosis and increased Hb, common with jewish males age 40 - 60
• Rheumatoid Arthritis -  antibodies attack the synnovium of the joint , then the articular cartilage and surrounding tendons and ligaments. ANA positive, elevated ESR, WBC, platelets and anemia, Rheumatoid factor test is positive
• Scleroderma - connective tissue disease, more women 30 -50 elevated ESR, positive rheumatoid factor 25% - 35% of the time, positive antinuclear antibody test. CXR - bilateral basilar pulmonary fibrosis, UA - proteinuria, microscopic hematuria, and casts
• Sickle Cell Anemia - congenital hematologic disease, inherited
• Systemic lupus erythematosus (SLE) - ANA test positive, decreased HB, HCT, WBC and platelets and an increased ESR, rheumatoid factor is positive, UA - proteinuria and heaturia. Lupus Erythematosus cell positive
• Vasculitis - inflammation and necrosis of blood vessels
• Wegener's Granulomatosis - affects medium to large vessels of upper and lower respiratory tract and kidney
• positive leukocytosis, elevated ESR, IgA, IgG; low titer rheumatoid factor; tissue biopsy shows narcotizing vasculitis with granulomatous inflammation
• Temporal arteritis - affects medium to large arteries, most connonly branches of th ecarotid artery
• decreased Hb and elevated ESR, tissue biopsy shows panarteritis with infiltration of mononucliar cells, giant cells within vessel wall, fragmentation of internal elastic lamina and proliferation of intima
• Takayasu's arteritis - AKA aortic arch syndrome 
• decreased HB, leukocytosis, positive lupus erythematosus cell preparation and elevated ESR; Arteriography shows calcification and obstruction of affected vessels; tissue biopsy shows inflammation of adventita and intima of vessels and thickening of vessel wall

PLATE = key blood components:
Plasma - liquid portion - water, protein (albumin and globulin), glucose, and electrolytes
Leucocytes- white blood cells
AB antigens - blood type
Thrombocytes - platelets clotting - contributors
Erythocytes - red blood cells - oxygen carrier

T-Cells -
killer, helper or suppressor
B-Cells -
 responsible for humeral or immunoglobulin-mediated immunity
Immunoglobulin -
Immunoglobulin G (IgG) - major antibacterial and antiviral antibody
Immunoglobulin M (IgM) - first Immunoglobulin produced too large to cross membrane barriers, usually only in vascular system
Immunoglobulin  A (IgA) - mainly found in body secretions, defends against pathogens on body surfaces, especially respiratory and GI tract
Immunoglobulin D (IgD) - in plasma, dominant antibody on surface of B cells mainly an antigen receptor.
Immunoglobulin E (IgE) - antibody involved in immediate hypersensitivity or allergic reactions, stimulates the release of mast cell granules which contain histamine and heparin.

• Lymphangiography - radiographic picture of lymphatic system -
• note allergies to iodine, seafood and radiopaque dyes
• possible throat irritation and flushing after dye
• NPO
• After procedure
• monitor V/S
• encourage fluids
• may have blue discolored skin, stool, and urine for about 48 hours

Schilling Test - oral radioactive cyanocobalamin then 24 hour urine (all urine, room temp) for vitamin B 12

Hodgkin's progress - 4 stages

• Stage I  - single lymph node region or single extralymphatic organ
• Stage II  - two or more nodes on same side of diaphragm or in an extralymphatic organ
• Stage III - spreads to both sides of the diaphragm or in an extralymphatic organ, the spleen or both
• Stage IV -  disease disseminates

*all review material was taken from - NCLEX-RN Review made Incredibly Easy 5th Edition Lippincott, Williams & Wilkins

Informative Videos of various tests

Romberg Test done to assess loss of balance for pernicious anemia