Your brain is part of your body. If your body is uncomfortable, your brain has a harder time doing its work. When you're studying, you need your brain to focus on your work, not your aching back. You can stay comfortable by having good posture, avoiding eyestrain, moving around, and eating healthy snacks during long study sessions.

Here are some ways to stay alert and be comfortable as you study.

• Sit up straight to keep your back and neck from getting stiff. It's worth the effort, and it can become a habit if you stick with it. Sitting up straight also keeps you alert and helps you concentrate.
  
• Make sure your reading material is propped up at a 45-degree angle from your work surface. And keep your eyes at least 15 inches away from what you're reading. If you're too close, your eyes can't focus properly. If you're too far away, you'll strain forward.
  
• Don't be afraid to get up and walk around every so often when you're studying. Stay in your study area, but try pacing around, doing jumping jacks, or performing simple stretching exercises. When you stand, 5% to 15% more blood flows to your brain. This means your brain gets more oxygen and is more stimulated!
  
• What about food? If you're going to study for more than an hour at a time, bring a healthy and easy snack, like grapes, so you can eat without mess or distraction.
  

Source: Student Success for Health Professionals Made Incredibly Easy! by Nancy Olrech, Lippincott Williams & Wilkins, 2008.

Negative language and inappropriate information don't belong in a patient's medical record and can return to haunt you in a lawsuit. The charting mistakes below are legal land mines--avoid them.

• Don't record staffing problems. Staff shortages may affect patient care or contribute to an incident, but you shouldn't mention this in a patient's chart because it can be used against you if the chart lands in court. Instead, write a confidential memo to your nurse-manager and review your facility's policy and procedure manuals to see how you're expected to handle this situation.
  
• Don't record staff conflicts. Don't chart disputes with other nurses, questions about a doctor's treatment, or a colleague's rude or abusive behavior. Instead of charting these problems, talk with your nurse-manager or consult with the doctor directly if an order puzzles you.
  
• Don't mention incident reports. Incident reports are confidential and filed separately from the patient's chart. Document only the facts of an incident in the chart, and never write incident report or indicate that you filed one.
  
• Don't use words associated with errors. Terms like mistake, accidentally, somehow, unintentionally, miscalculated, and confusing are bonus words to the plaintiff's attorney. Steer clear of words that suggest an error was made or a patient's safety was jeopardized. Let the facts speak for themselves.
  
• Don't name a second patient. Naming a second patient in a patient's chart violates confidentiality. Instead, write roommate, the patient's initials, or his room and bed number.
  
• Don't chart casual conversations with colleagues. Telling your nurse-manager in the elevator or restroom about a patient's deteriorating condition doesn't qualify as informing her. She's likely to forget the details or may not even realize you expect her to intervene. Before notifying someone, clearly state why you're notifying the person so she can focus on the facts and take appropriate action. Otherwise, you can't chart that you informed her.

Source: Charting Made Incredibly Easy!, 3rd edition, Lippincott Williams & Wilkins, 2006.

• Toxoplasmosis is transmitted to the fetus primarily via the mother's contact with contaminated cat box filler.
  
• A therapeutic abortion is recommended if the diagnosis is made before the 20th week of gestation.
  
• Effects include increased frequency of stillbirths, neonatal deaths, severe congenital anomalies, deafness, retinochoroiditis, seizures, and coma.
  
• Maternal treatment involves anti-infective therapy (sulfa or clindamycin).
  

Source: Straight A's in Maternal-Neonatal Nursing, 2nd edition, Lippincott Williams & Wilkins, 2007.

Worried about passing the NCLEX? The more practice questions you do, the more confident you'll feel. Try these, then review the answers and rationales that follow. Experts recommend taking many practice questions before the NCLEX, so take advantage of review courses, books, and other products to help you succeed and pass the NCLEX. ANSWERS BELOW.

1.	A client with celiac disease is being discharged from the hospital. Which food item should be included in his diet?
	1.	Oatmeal cereal
	2.	Sliced pepperoni
	3.	Cheese pizza
	4.	Rice
2.	When a nurse is teaching the parents of a neonate newly diagnosed with hypothyroidism, which statement should be included?
	1.	"A large goiter in a neonate doesn't present a problem."
	2.	"Preterm neonates usually aren't affected by hypothyroidism."
	3.	"Usually the neonate exhibits obvious signs of hypothyroidism."
	4.	"The severity of the disorder depends on the amount of thyroid tissue present."
3.	A child has been diagnosed with acute glomerulonephritis. Which component should the nurse expect the child's urine to contain?
	1.	Blood
	2.	Calcium casts
	3.	Cystine crystals
	4.	Glucose
4.	A 1-year-old client is treated in the clinic for a burn to the anterior surface of the left hand. Which way to measure burn size would be accurate for this child?
	1.	The rule of nines
	2.	Percentage based on the child's weight
	3.	The child's hand equals 1.25% of the child's body surface area
	4.	Percentage can't be determined without knowing the type of burn
5.	A staff nurse on a busy pediatric unit is an excellent role model for her colleagues. She encourages them to participate in the unit's decision-making process and helps them improve their clinical skills. This nurse is functioning effectively in which role?
	1.	Manager
	2.	Autocrat
	3.	Leader
	4.	Authority

If you're caring for a Spanish-speaking patient, you'll make him feel more at ease if you can ask basic questions in his native language. Here are some phrases you can use.

• How are you feeling?   ¿Cómo se siente Ud.?
• What time is it?   ¿Qué hora es?
• What day is it?   ¿Qué día es hoy?
• What is today's date?   ¿A qué fecha estamos?
• Where are you?   ¿Dónde está Ud.?
• How old are you?   ¿Cuántos años tiene Ud.?
• Did you come alone?   ¿Vino Ud. solo(a)?
• Who brought you?   ¿Quién lo (la) trajo?
• Where were you born?   ¿Dónde nacío Ud.?
• Where do you live?   ¿ Dónde vive Ud.?
• What's your address?   ¿Cuál es su direccíon?

Source: Medical Spanish Made Incredibly Easy!, 3rd edition, Lippincott Williams & Wilkins, 2008.

• National Student Nurses Association Annual Convention
  Making it Big: Nursing Students Stepping Up & Stepping Out. April 15-19, 2009, at the Opryland Hotel in Nashville, Tenn.
  
• Nursing2009 Symposium
  May 6-10, 2009, at Disney's Coronado Springs Resort, Orlando, Fla.

Don't miss this substantive, peer-reviewed feature from the Decmber issue of Nursing2008. It'll help you learn about evidence-based practice.

• Caring for a Patient with Chronic Hepatitis C
  By Susan Simmons Holcomb, ARNP-BC, PhD
  Brush up on new treatments and interventions to support a patient infected with this life-threatening virus.

1. 4 Sources of gluten found in wheat, rye, barley, and oats should be avoided. Rice and corn are suitable substitutes because they don't contain gluten. Pizza, luncheon meat, and cereal contain gluten and, when broken down, can't be digested by people with celiac disease.
2. 4 The severity of the disorder depends on the amount of thyroid tissue present. The more thyroid tissue present, the less severe the disorder. A large goiter in a neonate could possibly occlude the airway and lead to obstruction. Preterm neonates are usually affected by hypothyroidism due to hypothalamic and pituitary immaturity. Usually the neonate doesn't exhibit obvious signs of the disorder because of maternal circulation.
3. 1 Urinalysis findings consistent with glomerulonephritis should include specific gravity less than 1.030, positive blood and protein casts, and white and red blood cell casts. Calcium casts and glucose aren't usually found in the urine of a client with acute glomerulonephritis. The presence of cystine crystals typically indicates a congenital metabolic problem.
4. 3 The anterior surface of a child's hand is equal to 1.25% of that child's body surface. The rule of nines is used for children ages 14 years and older. The child's weight is important to calculate fluid replacement for extensive burns, not to estimate total body surface area. Burn type doesn't determine the percentage of body surface involved.
5. 3 A leader doesn't always have formal power and authority but influences the success of a unit by being an excellent role model and by guiding, encouraging, and facilitating professional growth and development. A manager has formal power and authority from the status within the organization, and such power and authority is detailed in the manager's job description. An autocrat isn't interested in guiding or encouraging staff or in being an effective role model. Authority, a characteristic of a managerial position, is given by virtue of position within an organization.

Source: NCLEX-RN Questions & Answers Made Incredibly Easy!, 4th edition, Lippincott Williams & Wilkins, 2007.

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