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Student resources: Good links
Clinical guidelines and
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Council of State Boards of Nursing
associations: American Nurses Association, National Student Nurses'
Career sites: J&J's
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Learn a new word
The cul-de-sac, about 6 cm in depth, lying below the terminal ileum forming the first part of the large intestine
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To remember the four causes of cell injury, think of how the injury tipped (or TIPD) the scale of homeostasis:
Toxin or other lethal (cytotoxic) substance
Physical insult or injury
Deficit, or lack of water, oxygen, or nutrients
Source: Pathophysiology made Incredibly Easy!,
4th edition, Lippincott Williams & Wilkins,
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Welcome to the Nursing2007
American Nursing Student (ANS) eNews, brought to
you by the editors of Nursing2007 in conjunction
with NursingCenter.com--absolutely . Written especially
for nursing students, it includes practice NCLEX questions,
medication errors to avoid, advice on how to care for
dying patients, tips from experienced nurses, and much
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In this issue...
||NCLEX Advice: Last question in NCLEX
||Test Yourself: NCLEX practice questions
|| Match game: Weight-management drugs
||Ask a Colleague: Following up after
a medication error
||Protect Yourself: Myths and facts about
||Action Stat: Dehydration emergency
||Charting Tips: Late entries
||Patient Teaching: Diverticular disease
||Recommended readings from Nursing2007
||Click on icon to e-mail this to a friend
|Q. Does the level of difficulty
of the last question you take (whether you get
it right or wrong) determine if you pass or fail
the National Council Licensure Examination (NCLEX)?
A. No, that's a widely held myth. The
NCLEX uses computer adaptive testing, so each
question is selected based on your response to
the previous one. The test will end when there
is a 95% confidence that you've answered enough
questions to determine whether you've passed or
Source: Diane M. Billings, RN, EdD, FAAN, Professor
Emeritus, Indiana University School of Nursing,
Indianapolis. Billings is the author of Lippincott's
Review for NCLEX-RN, 9th edition, Lippincott
Williams & Wilkins, 2008.
|Test Yourself: NCLEX practice
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.
- The primary goal of nursing care
during the emergent phase after a burn injury
- replace lost fluids.
- prevent infection.
- control pain.
- promote wound healing.
- Which of the following laboratory
tests should the nurse monitor when the client
is receiving warfarin (Coumadin) therapy?
- partial thromboplastin time (PTT)
- serum potassium
- arterial blood gases
- prothrombin time (PT)
- A client with a moderate level of
anxiety is pacing quickly in the hall. As
the nurse approaches, he states, "Help me.
I can't take it anymore." Which of the following
would be the best response initially?
- "It would be best if you would lie down
until youíre calmer."
- "Let's go to a quieter area where we
can talk if you want."
- "Try doing your relaxation exercises
to calm down."
- "I'll get some medicine to help you
- Which of the following should the
nurse teach a client with generalized anxiety
disorder to help him cope with anxiety?
- cognitive and behavioral strategies
- issue avoidance and denial of problems
- rest and sleep
- withdrawal from role expectations and
- Which of the following assessment
findings should a nurse expect to find in
a client with bacterial pneumonia?
- increased tactile fremitus
- bilateral expiratory wheezing
- resonance on percussion
- vesicular breath sounds
|Match game: Weight-management
the terms in column 1 with a definition, example,
or related statement in column 2.
Answers: 1d, 2f, 3e, 4c, 5a, 6g,
7j, 8h, 9i, 10b.
||a. a source
of commercial caffeine found in weight-loss
||b. a combination
dietary supplement associated with severe
||c. the most
frequently prescribed adrenergic anorexiant
absorption of dietary fat from the intestine
||e. a measurement
a feeling of stomach fullness, causing
a person to eat less
|7. guar gum
the effects of phentermine and sibutramine
the effects of phentermine and sibutramine
||i. the most
commonly prescribed antiobesity drug
fiber found in weight-loss products
Source: Study Guide to Accompany Abrams' Clinical
Drug Therapy: Rationales for Nursing Practice,
8th ed., Lippincott Williams & Wilkins,
|Ask a Colleague: Following
up after a medication error
|Q. What should I do if I make
a medication error--or discover someone else's?
A. First and foremost, do everything
you can to prevent or minimize any adverse effects
to the patient. Then report the error according
to your facility's policy (starting with your
instructor and the patient's assigned nurse).
Most hospitals require you to complete an event
report and a quality indicator form. Also, record
the facts of the event in the patient's record.
Document what happened, how the patient responded,
and any drugs or interventions you delivered.
Don't document that you completed an event report.
The best way to prevent errors is by knowing about
the drugs you administer, never giving a drug
without knowing what it does, being careful, meeting
accepted standards of nursing practice, and following
your facility's guidelines.
Source: Ask a Colleague: Expert Nurses Answer
More Than 1,000 Complex Clinical Questions,
Lippincott Williams & Wilkins, 2005.
|Protect Yourself: Myths and
Facts about Alcohol
holiday parties but don't be fooled by these myths
Myth: I can drink and still be
Fact: Drinking impairs your judgment,
which increases the likelihood that you'll do
something you'll later regret, such as having
unprotected sex, being involved in date rape,
damaging property, or being victimized by others.
Myth: Drinking isn't all that
Fact: One in three 18 to 24-year-olds
admitted to an emergency department for serious
injuries is intoxicated. And alcohol is also associated
with homicides, suicides, and drownings.
Myth: I can sober up quickly
if I have to.
Fact: Eliminating the alcohol
content of two drinks takes about 3 hours, depending
on your weight. Nothing can speed up this process--not
even coffee or cold showers.
Myth: I can manage to drive well
enough after a few drinks.
Fact: About half of all fatal
traffic crashes among 18 to 24-year-olds involve
alcohol. If you're under 21, driving after drinking
any alcohol is illegal and you could lose your
license. The risk of a fatal crash for drivers
with positive blood alcohol content (BAC) compared
with other drivers (that is, the relative risk)
increases with increasing BAC, and the risks increase
more steeply for drivers younger than age 21 than
for older drivers.
Myth: Beer doesn't have as much
alcohol as hard liquor.
Fact: A 12-ounce bottle of beer
has the same amount of alcohol as a standard shot
of 80-proof liquor (either straight or in a mixed
drink) or 5 ounces of wine.
National Institute on Alcohol Abuse and Alcoholism.
|Action Stat: Dehydration
dehydration emergency can trigger these signs
- Increased thirst
- Decreased urination
- Weakness or lightheadedness
- Dry mouth and mucous membranes
- Dry eyes and few tears when crying
- Decreased skin turgor
- Sunken cheeks, eyes, possibly abdomen, fontanelle
- Listlessness, low energy level
- notify the health care provider.
- institute I.V. fluid replacement therapy.
- draw blood for electrolytes, renal studies,
liver function tests, and complete blood cell
- assess vital signs frequently until patient
- administer antiemetic (such as prochlorperazine,
metoclopramide, droperidol, ondansetron, granisetron,
or lorazepam) depending on the underyling
cause of vomiting and effectiveness.
- offer supportive care while patient is vomiting.
- provide thorough mouth care after episodes.
Source: Nurses Quick Check: Signs & Symptoms,
Lippincott Williams & Wilkins, 2006.
|Charting Tips: Late entries
|You should try to avoid late entries to patients'
medical records, but in some situations late entries
are appropriate, including:
Keep in mind that a late or altered chart entry
can arouse suspicions and can be a significant
problem in the event of a malpractice lawsuit.
- if the medical record was unavailable when
you needed it--for example, when the patient
was away from the unit (in radiology or physical
- if you need to add important information
after completing your notes.
- if you forgot to write notes about a particular
If you must make a late entry or alter an earlier
one, find out if your health care facility has
a protocol for doing so. If not, the best approach
is to add the entry to the first available line
and label it "late entry" to indicate that it's
out of sequence. Then record the time and date
of the entry and, in the body of the entry, record
the time and date it should have been made.
Source: Chart Smart: The A-to-Z Guide to Better
Nursing Documentation, 2nd
ed., Lippincott Williams & Wilkins, 2007.
Teaching: Diverticular disease
teaching your patient about diverticular disease,
be sure to share these key points:
- Teach about the disease process and its
- Reinforce the importance of dietary fiber
and the harmful effects of constipation and
straining during defecation.
- Encourage increased intake of food high
in indigestible fiber, including fresh fruits
and vegetables, whole grain bread, and wheat
or bran cereals.
- Warn that a high-fiber diet may temporarily
cause flatulance and discomfort.
- Advise the patient to relieve constipation
with stool softeners or bulk-forming cathartics.
- Teach about prescribed medications, including
their names, indications, dosages, adverse
effects, and special considerations.
- Discuss warning signs of complications,
such as obstruction, infection, and hemorrhage,
and the need to seek immediate medical attention
if they occur.
- If the patient is having surgery, explain
surgical procedures and refer him to an enterostomal
Source: Managing Chronic Disorders,
Lippincott Williams & Wilkins, 2005.
|Recommended readings from Nursing2007
miss these substantive, peer-reviewed features
from Nursing2007. They'll help you
learn about evidence-based practice.
- Getting ahead of acute meningitis & encephalitis
By Cristina Matthews, RN, CNRN, BSN;
Laurie Miller, RN, CNRN, CS, MS; and Mary
Mott, RN, CNRN, CS, MS
- Protecting patients from harm: Taking
aim at heart failure
By Donna Chojnowski, RN, CRNP, MSN
|Answers to NCLEX practice questions
During the emergent phase of burn care, one
of the most significant problems is hypovolemic
shock. The development of hypovolemic shock
can lead to impaired blood flow through the
heart and kidneys, resulting in decreased cardiac
output and renal ischemia. Efforts are directed
toward replacing lost fluids and preventing
hypovolemic shock. Preventing infection and
controlling pain are important goals, but preventing
circulatory collapse is a higher priority. Itís
too early in the stage of burn injury to promote
Warfarin interferes with clotting. The nurse
should monitor the PT and evaluate for warfarin's
therapeutic effects. A therapeutic PT range
is between 1.5 and 2.5 times the control value;
the health care provider should establish the
range. It may also be reported as an International
Normalized Ratio (INR), a standardized system
that provides a common basis for communicating
and interpreting PT results. The PTT is monitored
in clients who are receiving heparin therapy.
Serum potassium levels and arterial blood gas
values arenít affected by warfarin.
The nurse should initially lead a client with
moderate anxiety to a less stimulating environment
and help him discuss his feelings. Doing so
helps him gain control over anxiety that could
be overwhelming. Telling him that it would be
best to lie down until heís calmer isnít appropriate
because heís too anxious to benefit from this
intervention. Suggesting that he try relaxation
exercises could be helpful after the nurse takes
him to a less stimulating environment and lets
him vent and discuss his feelings. Getting an
order for medication to help the client relax
is an intervention that the nurse would carry
out later after trying to help him decrease
anxiety through ventilation and relaxation exercises.
A client with generalized anxiety disorder needs
to learn cognitive and behavioral strategies
to cope with anxiety appropriately. In doing
so, his anxiety decreases and becomes more manageable.
The client may need assertiveness training,
reframing, and relaxation exercises to adaptively
deal with anxiety.
Increased tactile fremitus can be present
in bacterial pneumonia, indicating the presence
of pulmonary consolidation. Additional findings
would include crackles, bronchial breath sounds,
and dullness on percussion. Bilateral expiratory
wheezing and resonance on percussion arenít
present in bacterial pneumonia. Vesicular
breath sounds are normal and wouldnít be an
expected finding in bacterial pneumonia.
Source: Lippincott's Review for NCLEX-RN Examination,
9th edition, D. Billings, Lippincott Williams
& Wilkins, 2008.
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