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Saunders Comprehensive Review For The NCLEX-RN Examination, 8 Ed. | Registered Nurse (RN) School Study Aid

69 - Complex Care
42 Picmonics to Learn | 1 hr 11 mins
IV Solutions
Hypotonic (< 280 mOsm/L)
1/4 Normal Saline (0.225% NaCl)
1/2 Normal Saline (0.45% NaCl)
Isotonic (280-300 mOsm)
Normal Saline (0.9% NaCl)
Lactated Ringer's (LR)
Dextrose 5% in Water (D5W)
Hypertonic (> 300 mOsm)
3% or 5% NaCl
Dextrose 5% in 0.45% NaCl
Dextrose 10% in Water (D10W)
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3 mins
Cardiac Catheterization
Considerations
Fluttering Sensation
Contrast Media
NPO 6-12 Hours
After Procedure
Bed Rest
Assess Circulation
Assess for Bleeding
Monitor Vital Signs
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2 mins
Total Parenteral Nutrition (TPN)
Mechanism
Nutrition Given Outside GI
Side Effects
Hyperglycemia
Hyperlipidemia
Refeeding Syndrome
Nausea and Vomiting
Considerations
Slow IV Infusion
Use Large Central Vein
No Added Meds to TPN Line
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2 mins
Insulin
Rapid Acting
Insulin Lispro (Humalog)
Insulin Aspart (Novolog)
Insulin Glulisine (Apidra)
Short Acting
Regular Insulin (Humulin R)
Intermediate Acting
Isophane NPH (Humulin N)
Long Acting
Detemir (Levemir)
Glargine (Lantus)
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2 mins
Blood Glucose Lab Value
70-100 mg/dL
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25 secs
Calcium (Ca2+) Lab Value
8.5 to 10.5 mg/dL
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26 secs
Magnesium (Mg2+) Lab Value
1.5 to 2.5 mEq/L
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28 secs
Sodium (Na+) Lab Value
135-145 mEq/L
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24 secs
Potassium (K+) Lab Value
3.5 to 5.0 mEq/L
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20 secs
Chloride (Cl-) Lab Value
95-105 mEq/L
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28 secs
Liver Enzyme Tests: AST and ALT
AST/ALT Ratio
AST: 8-20 U/L
ALT: 8-20 U/L
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1 min
Platelet Lab Value
150,000-400,000 Micro L
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40 secs
Hemoglobin (Hgb) Lab Values
Men: 13 - 17 g/dL
Women: 12 - 16 g/dL
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47 secs
Blood Types and Compatibilities
ABO Compatibility
No Antigens (Type O Blood)
Universal Donor
A Antigen (Type A Blood)
B Antigen (Type B Blood)
AB Antigen (Type AB Blood)
Universal Recipient
Rhesus (Rh) Compatibility
Rh (Rhesus) Antigen
Never Rh+ to Rh-
Considerations
Blood Transfusion
Obstetric Patient
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2 mins
Types of Blood Products
Types
Whole Blood
Packed Red Blood Cells
Fresh Frozen Plasma
Immunoglobulins
Clotting Factors
Albumin
Platelets
Considerations
Use within 24 Hours
Washing Removes Antibodies
Irradiation Destroys WBCs
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2 mins
Blood Transfusion Administration
Proper Patient Identification
Large Bore Needle
Y Tubing
Baseline Vital Signs
Slow IV Infusion
Monitor During First 15 Minutes or 50 mL of Blood
Monitor for Reactions
Considerations
Do Not Add Anything To Same IV Line
No Dextrose or Lactated Ringers
Jehovah's Witnesses, No Transfusions
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3 mins
Transfusion Reactions
Acute Hemolytic
Febrile, Non-Hemolytic
Mild Allergic
Anaphylactic
Circulatory Overload
Sepsis Reaction
Transfusion-Related Acute Lung Injury (TRALI)
Massive Blood Transfusion
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2 mins
Hyperkalemia
Assessment
> 5.0 mEq/L K+
Abdominal Cramps
Muscle Weakness
Diarrhea
Arrhythmia
Tall, Peaked T Waves
Interventions
IV Calcium
Infusion of Glucose and Insulin
Loop or Thiazide Diuretics
Kayexalate
Dialysis
Prevention Education
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2 mins
Tracheostomy Care
Inner Cannula Removed and Cleaned
Clean Q8 Hours Around Stoma
One Finger Under Ties
Considerations
Speak with Deflated Cuff
Can Eat with Tube in Place
Keep Replacement Tube Nearby
Immediately Replace if Dislodged
Physician Does First Tube Change
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2 mins
Pneumothorax
Mechanism
Air Enters Pleural Space
Assessment
Sudden Dyspnea
Absent or Restricted Movement on Affected Side
Decreased or Absent Breath Sounds on Affected Side
Chest Pain
Tracheal Deviation
Vital Sign Changes
Crepitus
Considerations
High Fowler's Position With Oxygen
Prepare For Chest Tube Placement
Educate High Risk Patients
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2 mins
Chest Tubes: Management and Care
Confirm suction order
Assessment
Crepitus
Kinking
Shortness of Breath (SOB)
Infection
Excessive bubbling
Quick Interventions
If tube dislodges from patient, use petroleum gauze taped 3 ways
If drainage system is damaged, place disconnected drainage tube in sterile water
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1 min
Burns Assessment
Stage and Extent of Burn
Dyspnea
Singed Nasal Hairs
Pain
Initial Decrease Urinary Output
Paralytic Ileus
Signs of Inadequate Hydration
Shock
Hypothermia
Hyperkalemia
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2 mins
Burns Interventions
Ensure Airway Patency
O2
IV Fluid Replacement
Dry Sterile Dressing
Debridement
Elevate Burned Limbs
Analgesics
Silver Sulfadiazine
Escharotomy
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2 mins
Rule of 9's for Burns
Total Body Surface Area (TBSA)
Head
Anterior Torso (18%)
Chest
Abdomen
Posterior Torso (18%)
Upper Back
Lower Back
Extremities
Posterior Leg (each)
Anterior Leg (each)
Each Arm
Genitalia 1%
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2 mins
Stages of Burn Care
Phase / Stage 1
Resuscitative/Emergent Phase
Injury to Return of Capillary Permeability
48-72 hours
IV Fluid Replacement
Phase / Stage 2
Acute Phase
Diuresis to Near Wound Closure
Phase / Stage 3
Wound Closure to Return of Optimal Level
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2 mins
Types of Burns
Superficial Thickness
Sunburn
Superficial Partial Thickness
Blisters
Blanching
Deep Partial Thickness
Little or Non-blanching
Full Thickness
Waxy White, Yellow or Black
Decreased Pain
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2 mins
Types of Wound Healing
Types of Wounds
Acute
Chronic
Healing Process
Primary Intention
Approximated Edges
Secondary Intention
Edges Not Approximated
Tertiary Intention
Delayed Closure due to Infection and Necrosis
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2 mins
Wound Drainage Types and Devices
Drainage Types
Serous
Serosanguineous
Sanguineous
Purulent
Drainage Devices
T-tube
Penrose
Jackson-Pratt (JP)
Hemovac
Considerations
Record Drainage Amounts
Check Device Function
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2 mins
Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)
Pathophysiology
Hypersecretion of ADH
Increased Sensitivity to ADH
Signs & Symptoms
Serum Hypoosmolality
Coma and Seizure
Dilutional Hyponatremia
Cramps and Tremors
Euvolemia
Change in LOC
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2 mins
Hypercalcemia Causes
Two CHIMPANZEES Acronym
Thyroid Disorders
Calcium Supplements
Hyperparathyroidism
Iatrogenic (Drugs, immobility)
Milk-Alkali Syndrome
Paget's Disease of Bone
Acromegaly or Addison's Disease
Neoplasms
Zollinger-Ellison Syndrome
Excessive Vitamin A
Excessive Vitamin D
Sarcoidosis
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2 mins
Hypercalcemia
Assessment
> 10.5 mg/dL Ca2+
Pathologic Fractures
Lethargy
Hypercoagulation
Constipation
ECG Changes
QT Shortening
Interventions
No Calcium Intake
Chelating Drugs
Calcitonin
Bisphosphonates
Loop Diuretics instead of Thiazide Diuretics
Considerations
Increased Risk for Renal Calculi
Increase Fluids
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3 mins
Hypercalcemia Treatments
Treat Underlying Disorder
Hydration
Dialysis
Calcium Restriction
Bisphosphonates
Calcitonin
Cinacalcet
Glucocorticosteroids
Denosumab
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2 mins
Hypocalcemia Causes
Hypoalbuminemia
Hypomagnesemia (Less Common Hypermagnesemia)
Hypovitaminosis D
Hypoparathyroidism
Medications
Hyperphosphatemia
Malnutrition
Acute Pancreatitis
Alkalosis
Sepsis
Chronic Kidney Disease
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2 mins
Supine Hypotension (Vena Cava Syndrome)
Mechanism
Compression of the Vena Cava and Descending Aorta
Signs and Symptoms
Hypotension
Dizziness
Tachycardia
Decreased Renal Perfusion
Decreased Uteroplacental Perfusion
Intervention
Side-lying Position
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2 mins
Oxygen Delivery Methods
Nasal Cannula
Simple Face Mask
Non-Rebreather Mask
Venturi-Mask
Safety Precautions
Oxygen In Use Sign
No Electrical Sparks
Six Feet Away from Open Flames
Nursing Considerations
Dry Nasal and Upper Airway Mucosa
Skin Irritation
Home Education
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1 min
Acute Respiratory Distress Syndrome (ARDS) Assessment
Cause
Damaged Alveolar-Capillary Membrane
Assessment
Restlessness
Dyspnea
Refractory Hypoxemia
Decreased PaO2
Diffuse Pulmonary Infiltrates
Atelectasis
Pulmonary Hypertension
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2 mins
Acute Respiratory Distress Syndrome (ARDS) Interventions
Interventions
Closely Monitor Patient
ABG's (Arterial Blood Gases)
Oxygen
Assess for O2 Toxicity
Mechanical Ventilation
PEEP
Assess for Pneumothorax
Permissive Hypercapnia
Considerations
High Mortality Rate
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2 mins
Types of Shock
Hypovolemic
Depleted Volume
Cardiogenic
Pump Failure
Obstructive
Indirect Pump Failure
Distributive
Lost Vascular Tone
Neurogenic
Anaphylactic
Septic
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2 mins
Coronary Artery Bypass Grafting (CABG)
Indications
ST-Segment Elevation Myocardial Infarction (STEMI)
Cardiovascular Disease (CAD)
Uncontrolled Angina
Considerations
Internal Mammary Artery
Saphenous (Leg) Vein
Transient Limb Edema
Closely Monitor Patients
Venous Thromboembolism (VTE) Prophylaxis
Incentive Spirometer
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2 mins
Increased Intracranial Pressure (ICP) Assessment
Change in LOC
Headache
Cushings Triad
Irregular Respirations
Widening Pulse Pressure
Bradycardia
Projectile Vomiting
Abnormal Pupils
Papilledema
Posturing
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2 mins
Increased Intracranial Pressure (ICP) Interventions
Interventions
Elevate Head Of Bed
Foley Catheter
Mannitol (Osmitrol)
High Dose Barbiturates
Passive Hyperventilation
Dexamethasone (Neoplasm or Infection)
Considerations
Neuro Assessment
Maintain Normal Temperature
Avoid Activities That Increase ICP
Intracranial Monitoring System
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2 mins
Level of Consciousness: Descriptive guide for Glasgow Coma Scale
Conscious
Confused
Delirious
Somnolent
Obtunded
Stuporous
Comatose
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3 mins

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