Nursing2007 ANS eNews -- December 2007
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Student resources:    Good links

Clinical guidelines and standards:
AHRQ
, Centers for Disease Control and Prevention, The Joint Commission, National Guideline Clearinghouse

Clinical research:
AHRQ
, MedlinePlus

Drug information:
Food and Drug Administration

Journal research:
PubMed


Medical news:
Medscape


NCLEX info: National Council of State Boards of Nursing

Professional associations: American Nurses Association, National Student Nurses' Association

Career sites: J&J's Discover Nursing, Career Center at NursingCenter.com, Nursing2006 salary survey report

Stedman's
Learn a new word

cecum


The cul-de-sac, about 6 cm in depth, lying below the terminal ileum forming the first part of the large intestine

provided by stedmans.com
Memory Jogger

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
Infection
Physical insult or injury
Deficit, or lack of water, oxygen, or nutrients

Source: Pathophysiology made Incredibly Easy!, 4th edition, Lippincott Williams & Wilkins, 2008.

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Dear Subscriber,

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 more.

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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 alcohol
Action Stat: Dehydration emergency
Charting Tips: Late entries
Patient Teaching: Diverticular disease
Recommended readings from Nursing2007
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NCLEX Advice
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 failed.

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 questions

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. The primary goal of nursing care during the emergent phase after a burn injury is to
    1. replace lost fluids.
    2. prevent infection.
    3. control pain.
    4. promote wound healing.
  2. Which of the following laboratory tests should the nurse monitor when the client is receiving warfarin (Coumadin) therapy?
    1. partial thromboplastin time (PTT)
    2. serum potassium
    3. arterial blood gases
    4. prothrombin time (PT)
  3. 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?
    1. "It would be best if you would lie down until youíre calmer."
    2. "Let's go to a quieter area where we can talk if you want."
    3. "Try doing your relaxation exercises to calm down."
    4. "I'll get some medicine to help you relax."
  4. Which of the following should the nurse teach a client with generalized anxiety disorder to help him cope with anxiety?
    1. cognitive and behavioral strategies
    2. issue avoidance and denial of problems
    3. rest and sleep
    4. withdrawal from role expectations and role relationships
  5. Which of the following assessment findings should a nurse expect to find in a client with bacterial pneumonia?
    1. increased tactile fremitus
    2. bilateral expiratory wheezing
    3. resonance on percussion
    4. vesicular breath sounds

Match game: Weight-management drugs

Match the terms in column 1 with a definition, example, or related statement in column 2.

Column 1 Column 2
1. orlistat (Xenical) a. a source of commercial caffeine found in weight-loss products
2. glucomannan b. a combination dietary supplement associated with severe hepatotoxicity
3. kilocalories c. the most frequently prescribed adrenergic anorexiant
4. phentermine (Adipex) d. decreases absorption of dietary fat from the intestine
5. guarana e. a measurement of energy
6. epinephrine f. produces a feeling of stomach fullness, causing a person to eat less
7. guar gum g. increases the effects of phentermine and sibutramine
8. alcohol h. decreases the effects of phentermine and sibutramine
9. sibutramine (Meridia) i. the most commonly prescribed antiobesity drug
10. LipoKinetix j. dietary fiber found in weight-loss products
Answers: 1d, 2f, 3e, 4c, 5a, 6g, 7j, 8h, 9i, 10b.

Source: Study Guide to Accompany Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed., Lippincott Williams & Wilkins, 2007.

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
Enjoy holiday parties but don't be fooled by these myths about alcohol.

Myth: I can drink and still be in control.
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 dangerous.
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.

Source: National Institute on Alcohol Abuse and Alcoholism.

Action Stat: Dehydration emergency

A dehydration emergency can trigger these signs and symptoms:

  • 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 in infants
  • Irritability
  • Listlessness, low energy level
You should:
  • notify the health care provider.
  • institute I.V. fluid replacement therapy.
  • draw blood for electrolytes, renal studies, liver function tests, and complete blood cell count.
  • assess vital signs frequently until patient is stable.
  • 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:
  • if the medical record was unavailable when you needed it--for example, when the patient was away from the unit (in radiology or physical therapy).
  • if you need to add important information after completing your notes.
  • if you forgot to write notes about a particular patient.
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 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.

Patient Teaching: Diverticular disease

When teaching your patient about diverticular disease, be sure to share these key points:

  • Teach about the disease process and its treatments.
  • 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 therapist.

Source: Managing Chronic Disorders, Lippincott Williams & Wilkins, 2005.

Recommended readings from Nursing2007

Don't miss these substantive, peer-reviewed features from Nursing2007. They'll help you learn about evidence-based practice.

Answers to NCLEX practice questions

  1. 1 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 wound healing.
  2. 4 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.
  3. 2 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.
  4. 1 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.
  5. 1 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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