Nursing Pearls of Wisdom


  1. Insulin generally lowers potassium and so does albuterol treatment
  2. Accurate I/O means literally just that
  3. Anuric is general < 100 cc a day & Oliguria <500 cc day. Measurement: 30 ml (cc) = 1 oz. A typical hospital patient pitcher is usually 800-1000 cc
  4. If patient gets SOA and is on IV fluids– stop IV fluids and call on call provider
  5. COPD tend to have chronic higher C02 levels
  6. Chronic kidney disease patient are often (almost always) anemic because of the lack of production of erythropoietin (hormone that stimulates RBC production) from kidney.
  7. Sodium bicarbonate helps to neutralize the body when it has become acidotic
  8. Renal patients taking calcium carbonate (tums) near meals- this is actually to help decrease the phosphorus as it attaches to phosphorus containing food. Phosphorus does not dialyze off
  9. If a renal patient has a fistula or AV graft- always assess the bruit (auscultation) & thrill (feel) to make sure working. This is their lifeline to remove toxins from their body!
  10. Steroids (solumedrol, prednisone, methyprednisolone) can cause insomnia, agitation, weight gain, lower extremity swelling, increased hunger.
  11. Have to be very cautious using norvasc (CCB) and steroids in patients with CHF as this can potentially cause this a patient with this diagnosis to go into exacerbation. Both of these meds can increase fluid retention.
  12. Alcoholics often have low magnesium and low platelets
  13. If giving Vancomycin & patient suddenly gets flushed – stop infusion call on call provider. It is likely that Redman syndrome is happening and that the infusion needs to be slowed
  14. Head of bed should always be at least 30 degrees if patient has peg tube feeding
  15. If patient has diarrhea or suddenly has diarrhea- they really should be tested for C-diff
  16. No sticks, IV insertion, draws, blood pressures on arm of dialysis access (AV graft, fistula)
  17. Don’t go outside of a contact precautions room with the protective gear on. You must take it off before going out of the room
  18. If patient nose dries out from nasal cannula do not put Vaseline (can potentially cause a flame) in their nose instead get a bubbler to humidify the air
  19. Consents: The provider needs to be the one to explain the procedure
  20. Do not wipe finger with alcohol pad right before taking a glucose (at least allow it to dry) as this may falsely elevate glucose due to the ETOH. Wiping finger with water & drying immediately after is best
  21. Best place for absorption of insulin is in abdomen (but make sure to rotate sites)
  22. Normal ejection fraction 55-60% but someone can still have a normal EF and have hx heart failure
  23. It is ideal that a patient is NPO for an abdomen ultrasound
  24. Metformin needs to be held if contrast is given (for 48 hrs after)
  25. Fluoroquinolones (levofloxacin, ciprofloxacin,) are antibiotics often given in hospital. It is important to watch for muscle pain ache as this may be a sign of the black box warning of tendon rupture. This adverse reaction is more common in patients >55 years old
  26. Do not be afraid to clarify an is your license!
  27. Stress tests: patient should not smoke the day of the test. The patient should not have any caffeine 24 hrs before the test. Patients should also not take beta blockers, nitroglycerin, and some other heart medications on day of the test (nurse should always clarify with cardiology if any questions on this)
  28. If you did not witness a fall you should not technically chart that the patient fell. You must chart what you actually witnessed and notify on call provider immediately
  29. Blood should be transfused within 4 hours (no longer). In general PRBC transfused is transfused under 2 hours. Exception include CHF & ESRD..both have to be ran closer to the 4 hrs due to risk of pulmonary edema
  30. Sickle cell crisis pain is REAL and can be SEVERE!
  31. If a patient begins to have confusion, in addition to a neurological exam a glucose should also be checked
  32. Often the better report you receive, the better shift you will have (not always but more likely). So the point is, ask questions, get details, clarify
  33. LPN’s generally do not do: IV pushes, administer blood products, admission assessment, IV insertion (allow I have heard of certification to do this). These are general and may possibly change so if anyone has any update on this info is always welcome!
  34. Chest pain: If an MI is suspected general orders include EKG, cardiac enzymes, EKG, CBC, BMP, Morphine, oxygen administration, nitroglycerin, aspirin
  35. Blood cultures should ideally be drawn before antibiotic administration
  36. If a patient suddenly develops severe headache or abdomen pain let on call provider know this!! Don’t just give pain medication available. Imaging may be needed. If it is truly severe, we need to know what is causing these severe symptoms
  37. Many hospitals require a second nurse to verify insulin dosage before being administered
  38. CHF and Renal patients need to have accurate intake and output along with daily weights
  39. Consider asking for a catheter if risk for skin breakdown likely, need accurate I/O but unable to obtain, and/or comfort measures
  40. If suspect urine retention– bladder scan before calling on call provider
  41. If a patient seem lethargic and or not as responsive always think about pain medication build up in system (especially with renal patients). They may need narcan. Many nurses miss this.

NOTE: The above is not intended as medical advice for patients. This is simply for educational purposes for medical professionals only. All patient should ALWAYS check with their primary care provider with any questions that they may have. This informational sheet does not serve as medical advice. As always, medical professionals should always call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly




So What is on Nclex Anyways?

You start studying for Nclex all bright eyed and bushy tailed. All your highlighters are in a row, pens in place, notebook pads ready to go, and a plethora of snacks at your side. You are radiating study time energy like a LED light bulb.

But after several days of endless studying, you realize that you may or may not have actually learned anything at all in nursing school. And suddenly you even question yourself; am I even enrolled in nursing school? Did I take the wrong classes? Someone must have mixed up their major with mine. Or is this all just a studying nightmare that you haven’t woken up from yet? Then you slap your self and remember- yes, why yes, I am a nursing student. And I have so faaaarrrrrr to go. You realize that you are no longer a ball of studying energy, all “ready, set, go”. You are not that LED lightbulb, rather a person fiddling around in the dark without matches, just trying to rub 2 sticks together to make a damn camp fire.

When you start studying for Nclex, you feel like you are on the last mile of your can see the finish line. Several days after studying, you realize that it wasn’t the finish line at all; you are actually only on mile 22 of 26. You have a mental breakdown, you throw yourself on the floor and began to look like Will Ferrell in the step brothers when he has a temper tantrum about his parents moving.You studied like a maniac and feel like you aren’t getting anywhere. You’ve even neglected some of your daily ADL’s for the sake studying for this test. You are still wearing your clothes that you were wearing from 4 days ago. You have forgotten what day it is. You are pretty sure you have developed a stage 2 pressure ulcer on your coccyx area from sitting so much while studying. You aren’t really sure if it’s you that smells or if it’s the stale food piling up insidiously near your study area. Your hair..well it looks like you got in a fight with it during the night. Your friends and family, well they think that you have secretly escaped to Puerto Vallarta to simply avoid this dreadful test. Let’s face it, you are a mess, moving at a snail pace, dramatically doubting yourself, and wondering “Why did I want to do this nursing thing again?”.

This is where you stop and picture  how you will feel the day after the test. This is where you start putting things into perspective.

The reality is, that you just don’t know where to start. You haven’t prepared to study. You have no idea what to expect and you are telling yourself, studying for Nclex is going to kill me! But its not, and you are signed up for this, have made it this far, and will keep making it. You know more than you think you do. But I understand why it’s so easy to feel lost when studying for this test. But never fear, MedMadeEz is here-we’ve got your back! We know that it can be quite overwhelming. And sometimes you just need some direction.

So where to start? What should you expect on the Nclex exam? And where do you find this out? Although you should never expect that you will know all (or any) of the exact question (that’s called cheating), you can at least focus on what areas to study. This can boost your confidence and just help you feel more motivated. And maybe even free up some time for you to throw out that stale food piling up, comb your hair, change your clothes, take a bath, and talk to your family! This is exactly why it is a great idea to do a little research beforehand to determine which areas to focus. So we have done this for you!

An absolutely perfect resource is the The National Council of State Board of Nursing website. They have an AWESOME  guide called: Detailed Test Plan for the National Council Licensure Examination for Registered Nurses .

I highly suggest you visit this site and read this guide (Guide link) before you determine how you are going to start studying for Nclex. Don’t start yourself frazzle-dazzled trying to figure it all out alone in the dark. Pictured below are 2 charts (with the same info, just pictured differently) from this “Detailed Test Plan Guide” guide. These are extremely valuable. The guide goes over these areas in detail.

Screen Shot 2017-04-07 at 8.32.59 PM
Above is from:   Detailed Test Plan for the National Council Licensure Examination for Registered Nurses Effective April 2016 through March 31, 2019
Screen Shot 2017-04-07 at 8.32.46 PM
Above graph is from: NCSBN -Detailed Test Plan for the National Council Licensure Examination for Registered Nurses Effective April 2016 through March 31, 2019


We also have an Instagram-MedMadeEz that you can follow for studying questions. This can really help build your confidence as well. And help test what you know and what you don’t know.

Good luck in this journey to Nclex. You are almost there!! You’ve got this!


  1. Both of the above charts come directly from NCLEX-RN Examination, Detailed Test Plan for the National Council Licensure Examination for Registered Nurse, Candidate Version

    Please visit this site for more information!

List of Nursing Certifications

1. BLS- Basic Life Support (every nurse needs to have this)
2. ACLS- Advanced Cardiac Life Support (If you are a telemetry, ER, ICU, and many other areas- you will need this.)
3. DOT: Department of Transportation certificate (For advanced care providers-FNP, PA, Doctors)
4. PALs: Pediatric Advanced Life Support
5. CWCA: Certified Wound Care Associate (for wound care nurses) American Board of Wound Management
6. CCRN: Certification for Adult, Pediatric and Neonatal Critical Care Nurses
7. CCRN-E – Adult Tele-ICU Acute/Critical Care Nursing Certification
8. CNML — Certification for Nurse Managers and Leaders
9. PCCN – Certification for Progressive Care Nurses

There are many other types of certifications available. These are just a few. is a great source for certification information! Nursing Certifications Link 

AACN Certification Corporation-Great site to go over details about many certifications

We may update this list periodically to add further links & information.

National Council of State Board of Nursing- What is it?

“National Council of State Boards of Nursing (NCSBN) is an independent, not-for-profit organization through which boards of nursing act and counsel together on matters of common interest and concern affecting public health, safety and welfare, including the development of nursing licensure examinations.”-NCSBN

“NCSBN was created to lessen the burdens of state governments and bring together boards of nursing (BONs) to act and counsel together on matters of common interest.”

Main site: