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Career sites: J&J's
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Spasm of the digital arteries, with blanching and numbness or pain of the fingers, often precipitated by cold. Fingers get variably red, white, and blue.
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Explain what's happening to your patient.
Maintain ET tube stability during suctioning.
Stop for respiratory distress immediately.
Source: Emergency Nursing made Incredibly Easy!
Lippincott Williams & Wilkins, 2007.
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Dear NursingCenter member,
Welcome to the Nursing2006
American Nursing Student (ANS) eNews, brought to
you by the editors of Nursing2006 in conjunction
with NursingCenter.com--absolutely .
Written especially for nursing students, it includes
practice NCLEX questions, medication errors to avoid,
tips on how to care for dying patients, advice from
experienced nurses, and much more.
You're getting this issue because you subscribed to
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Contents in this issue...
||In the Know: FDA Alert, New recall
||Confidentially: Distractions can be
||Take Note: Documenting oral drug administration
||Quick Quiz: Match game
||Key Concepts: Causes of diarrhea
||Insights on Death and Dying
||Ask a Colleague: Peptic ulcers
|| Ages and Stages: Inserting an older
adult's I.V. line
||Quick NCLEX Tip: Understand, don't
||Recommended readings from Nursing2006
||Test Yourself: NCLEX practice questions
||Click on icon to e-mail this to a friend
|In the Know: FDA Alert, New
Alert: The FDA has received
reports of death and life-threatening adverse
reactions in patients taking methadone, which
can cause slow or shallow breathing and dangerous
changes in heart rate that the patient may
not feel. Pain relief from a dose of methadone
lasts about 4 to 8 hours, but it stays in
the body much longer—from 8 to 59 hours after
it's taken. So patients may feel the need
for more pain relief before methadone is gone
from their body. Methadone may build up in
the body to a toxic level if it's taken too
often, if the amount taken is too high, or
if it's taken with certain other medicines
or supplements. Read this alert to learn what
to teach your patient taking methadone.
recall: Complete MoisturePLUS
Contact Lens Care Products. There's a nationwide
recall of 18 lots of Complete MoisturePLUS
multipurpose contact lens care solution and
Active Packs distributed in the United States.
Certain lots were found to have bacterial
contamination. Contact lens users who have
the recalled product should discontinue use
immediately. Individuals who experience symptoms
of an eye infection, such as redness, pain,
tearing, increased light sensitivity, blurry
vision, discharge or swelling, should remove
their lenses and consult their eye care provider
can be dangerous
| I was caring for a new patient, Mrs.
Walker, 27, who had Lyme disease. Her health care
provider prescribed high doses of I.V. penicillin,
so I prepared to start an I.V. infusion. I gathered
the equipment I'd need, then went into her room
to start the procedure.
After connecting the tubing to the solution bag,
I was interrupted by a physician who asked for
an update on another patient. When I got back
to Mrs. Walker, I inserted the catheter, connected
the tubing to it, then opened the I.V. line. Suddenly,
I realized that I'd forgotten to prime the tubing.
The air in it had entered my patient's bloodstream.
In a panic, I clamped off the tubing and turned
Mrs. Walker onto her left side. I called her provider
and a respiratory therapist. I connected a cardiac
monitor and started I.V. fluids properly. I was
concerned that the air could have caused an embolism,
but by some miracle, nothing happened.
Now I never stop a procedure in the middle and
try to pick up where I left off (unless the interruption
is an emergency). It's just too risky.
|Take Note: Documenting oral
administering a tablet or capsule, be sure to
- drug given
- dose given
- date and time of administration
- signing out of the drug on the patient's
- patient's ability to swallow the drug you
administered (if the patient has had problems
swallowing oral drugs)
- patient's vital signs if you give a drug
that could affect them
- adverse reactions that arise
- patient's refusal and notification of a
health care provider as needed (if a patient
refuses a tablet or capsule)
- omission or withholding of a drug for any
Source: Fundamentals of Nursing made Incredibly
Easy!, Lippincott Williams
& Wilkins, 2007.
Match the terms about medication administration
in column one with a definition, example, or related
statement in column two.
with a substance that's insoluble in stomach
||b. after meals
injection of a medication into a vein
||d. drugs given
for therapeutic purposes
||e. drugs dispensed
in single-dose containers for individual
high amounts of drug intended to be absorbed
slowly and act over an extended period
to any route other than gastrointestinal
glass or plastic containers with rubber
stopper through which a needle can be
inserted to withdraw medication
glass containers with tops you have to
break off so you can insert a needle to
Source: Study Guide to Accompany Abrams' Clinical
Drug Therapy: Rationales for Nursing Practice,
8th ed., Lippincott Williams & Wilkins,
|Key Concepts: Causes of diarrhea
|Diarrhea commonly is divided into
two types, large volume and small volume, based
on the characteristics of the diarrheal stool.
Large-volume diarrhea results from an increase
in the water content of the stool, and small-volume
diarrhea results from an increase in the bowel's
propulsive activity. Some of the common causes
of small- and large-volume diarrhea are listed
below. Keep in mind that in many cases, diarrhea
is a combination of these two types.
Causes of large-volume diarrhea
Causes of small-volume diarrhea
- Secretory diarrhea
- Acute infectious diarrhea
- Failure to absorb bile salts
- Fat malabsorption
- Chronic laxative abuse
- Carcinoid syndrome
- Zollinger-Ellison syndrome
- Fecal impaction
- Osmotic diarrhea
- Saline cathartics
- Lactase deficiency
- Inflammatory bowel disease
- Crohn's disease
- Ulcerative colitis
- Infectious disease
- Irritable bowel syndrome
Source: Essentials of Pathophysiology: Concepts
of Altered Health States, 2nd
ed., by CM Porth, Lippincott Williams &
|Insights on Death and Dying
from Joy Ufema, RN, MS
While assessing the patency of a central line
for an unresponsive, terminally ill patient,
I was startled when the patient’s wife said
to me, "This isn't how it was supposed to be.
He's just a year away from retirement, and we
had wonderful plans to travel across the country."
I didn’'t know what to say except, "I'm sorry."
I'd like to do better if this situation comes
up again. What should I have said?—V.B., ARIZ.
I think saying "I'm sorry" was just fine. It
showed that you heard the woman's grief and
validated her misfortune. Sometimes the only
thing to say is, "I don't know what to say,
but I do know I want to be here with you awhile."
Often patients or family members speak rhetorically,
not really expecting an answer. But they always
welcome "presence." And sometimes that's the
only thing you have to give. Take a few minutes,
sit down, and give your undivided attention.
Lean slightly toward her. Let your body language
tell her, “I truly want to hear your concerns."
Don't interrupt or change the subject. Don't
fidget or think ahead about questions you want
to ask. Just listen.
When she stops speaking, you may ask a question
related to her last words. Be sympathetic. Touch
her arm gently. Listen to her response. Forget
about how much of your precious time is being
taken. Choosing to give the gift of yourself
is always time well spent.
Don't miss Joy Ufema's
regular column, "Insights on Death and Dying,"
in Nursing2006. Check out her new book,
Insights on Death and Dying. Have
a question for Joy? You can e-mail it to her
|Ask a Colleague: Peptic ulcers
|Q: How can I help my patient with a peptic
ulcer understand his disease?
A: Explain to your patient that a peptic
ulcer is an erosion of the stomach lining caused
by a bacterial infection called H. pylori.
A peptic ulcer may be located in the duodenum
of the small intestine or in the stomach. Regardless
of location, the ulcer develops in the same way.
Tell your patient that if the disease is to be
cured, the bacteria that caused the ulcer must
be removed. This is typically accomplished with
a drug regimen that usually includes a proton
pump inhibitor or bismuth and treatment with an
antibiotic such as amoxicillin or clarithromycin.
Advise him that he needs to take the drugs as
prescribed for treatment to be successful.
Mention that the gnawing, burning, or aching pain
in the epigastric area typically subsides when
food, milk, and antacids neutralize stomach acid.
Ask a Colleague: Expert Nurses Answer More
than 1,000 Complex Clinical Questions,
Lippincott Williams & Wilkins, 2005.
|Ages and Stages: Inserting
an older adult's I.V. line
inserting an older adult's I.V. line, remember
- Use warm compresses to dilate the patient's
veins, especially if he's cold or his peripheral
veins are constricted.
- Use a 24G or 22G catheter to avoid trauma.
- Use the patient's nondominant arm, if possible.
- Use little tourniquet pressure to prevent
tissue trauma, especially if he takes a corticosteroid
or an anticoagulant.
- Avoid inserting the line in areas where
valves are located.
- Maintain tension on the skin during the
venipuncture. Consider using a one-handed
- Release the tourniquet as soon as you get
- Stabilize the catheter using a device that
doesn't interfere with assessment or care
of the catheter and site. Use of a manufacturer's
stabilization device is preferred.
- Use a padded arm board, stretch netting,
or stockinette dressing to protect the site.
Medication Administration made Incredibly
Easy!, Lippincott Williams & Wilkins,
|Quick NCLEX Tip: Aim to understand
instead of memorize
simply memorize material. Instead, aim for understanding
the material. Remember that the NCLEX isn't designed
to test for memorization but rather for an understanding
of the concepts. When studying content, ask yourself,
"How can I use this information when I care for
Source: Study Tips for the NCLEX exam
from the National Council of State Boards of
|Recommended readings from
|Don't miss these substantive, peer-reviewed
features in the November issue of Nursing2006.
They'll help you learn about evidence-based practice
and are FREE to access online at www.NursingCenter.com.
- Managing symptoms for a "good death"
By Marylou Kocuh, APRN,BC, MSN
Your terminally ill patient is nearing death.
Do you know how to keep her comfortable? Here,
you'll learn how to manage common signs and
symptoms she's likely to experience.
Earn 2.5 ANCC/AACN contact hours
- Understanding the 12-lead ECG, part I
By Guy Goldich RN, CCRN, MSN
Find out how the ECG translates the heart's
electrical activity into a waveform and what
it tells you about your patient's condition.
Earn 2.5 ANCC/AACN contact hours
|Test Yourself: NCLEX practice
about passing the National Council Licensure Examination
(NCLEX), the test from the National Council of
State Boards of Nursing (NCSBN) that your state
board of nursing will use to determine whether
you’re ready to practice nursing? 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.
One of the new format questions you're likely
to see is called "sequencing." With these questions,
you need to put the possible answer choices
in priority order. Here are a few samples you
can practice on.
- A community nurse is leading a discussion
with clients in a support group on the progressive
nature of multiple sclerosis (MS). Arrange
the degenerative changes shown below in the
order in which they occur.
- degeneration of axons
- demyelination throughout the central
- periodic and unpredictable exacerbations
- plaque formation that interrupts nerve
- A nurse is preparing a staff-education
program about pulmonary circulation. Place
the options below in the order that matches
the path of pulmonary circulation.
- pulmonary vein
- right ventricle
- pulmonary artery
- left atrium
- A client is diagnosed with herpes
zoster. Place the pathophysiologic changes
associated with this disorder in the proper
- Fever, malaise, and red nodules appear
in dermatome distribution.
- The virus multiplies in the ganglia,
causing deep pain, itching, and paresthesia
- Vesicles crust and scab but no longer
shed the virus.
- Residual antibiotics from the initial
infection mobilize but are ineffective.
- Vesicles appear filled with either clear
fluid or pus.
- Varicella-zoster virus is reactivated.
- A client is to get a blood transfusion
of packed red blood cells for severe anemia.
Place the following steps in the order a nurse
would follow to administer this product.
- Flush the I.V. tubing and line with
normal saline solution.
- Verify the blood bag identification,
ABO group, and Rh compatibility against
the client information.
- Stay with the client and watch for signs
or a transfusion reaction.
- Record vital signs.
- Put on gloves, a gown, and a face shield.
- Check the packed cells for abnormal
color, clumping, gas bubbles, and expiration
- A nurse is caring for a client with
low calcium levels. Prioritize the regulation
of parathyroid hormone (PTH) release in relationship
to low calcium levels.
- A high serum calcium level and inhibited
- A low serum calcium level
- Resorption of calcium
- PTH release by the parathyroid gland
Answers to NCLEX practice questions
- 2-1-4-3 Rationale:
Multiple sclerosis produces patches of demyelination
throughout the central nervous system, resulting
in myelin loss from the axis cylinders and
degeneration of the axons. Plaques form in
the involved area and become sclerosed, interrupting
the flow of nerve impulses and resulting in
various symptoms. Periodic and unpredictable
exacerbations and remissions occur. The prognosis
- 2-3-4-5-1-6 Rationale:
The blood leaves the right ventricle and travels
through the pulmonary arteries to the arterioles
of the lung. Carbon dioxide and oxygen are
exchanged where the pulmonary capillary interfaces
with the alveoli. The pulmonary vein carries
oxygenated blood back to the left atrium for
circulation throughout the body.
- 6-4-1-2-5-3 Rationale:
Herpes zoster is an acute inflammation caused
by infection with the herpes virus varicella-zoster
(chickenpox virus). The pathophysiologic changes
associated with this disorder occur in the
order shown here.
- 4-6-2-5-1-3 Rationale:
To administer a blood transfusion, the nurse
should follow the steps in the order listed
here. Note that the transfusion may be withheld
if the client's temperature is 100° F
or greater. The nurse must check two client
identifiers before the transfusion.
- 2-4-3-1 Rationale:
Simple feedback occurs when the level of one
substance regulates the secretion of hormones.
A low calcium level stimulates the parathyroid
gland to release PTH, which promotes resorption
of calcium, resulting in normalized calcium
levels. When calcium levels are elevated,
PTH secretion is inhibited.
Source: NCLEX-RN 250 New-Format Questions,
2nd ed., Lippincott Williams & Wilkins,
Answers to Quick Quiz:
1g; 2h; 3c; 4f; 5d; 6i; 7a; 8b; 9j; 10e
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