When you begin your clinical rotation, your clinical mentor (or preceptor) will coach you through your clinical experience. Do your best to start out on the right foot with your mentor--you just might learn something! Also, try to avoid making unfair judgments about your mentor based on what you may have heard from other students. Get to know your mentor before forming an opinion.

No name games
Remember to be polite and respectful. Address your mentor as Mr., Mrs., Dr., Ms., or by a first name, according to your mentor's stated preference. It's part of the mutual respect you want in your relationship.

Background check
Try to learn a little bit about how your mentor arrived at where he or she is today. For instance, you could ask questions about how he or she got into healthcare, where he or she went to school, and the positions he or she has held. You don't have to pry or overwhelm him or her with questions. These topics are general enough to come up in conversation.

You should have regular conversations with your mentor about what you're learning and doing. You don't have to worry that this will impose on him or her. He or she will be happy to answer your questions and to see that you're eager to learn.

Head off trouble
If you feel you're unable to develop a good relationship with your mentor, make an appointment to discuss your concerns. If you can't resolve the problems together, follow the procedures outlined in your student handbook for resolving grievances.

Source: Student Success for Health Professionals, Lippincott Williams & Wilkins, 2007.

Glaucoma is a group of diseases that differ in pathophysiology, clinical presentation, and treatment. It's characterized by visual field loss because of damage to the optic nerve caused by increased intraocular pressure. The increased intraocular pressure results from pathologic changes that prevent normal circulation and outflow of aqueous humor. There are two common types of glaucoma: primary open-angle glaucoma and acute angle-closure glaucoma.

Common causes

• Diabetes mellitus
• Previous eye trauma or surgery
• Plateau iris
• Family history

Key signs and symptoms
Primary open-angle:

• Begins in one eye and progresses to other eye
• Decreased peripheral vision
• Increased intraocular pressure

Acute angle closure:

• Unilateral
• Acute eye or facial pain
• Halo vision
• Increased intraocular pressure
• Nausea and vomiting

Diagnosis

• Tonometry: increased intraocular pressure
• Ophthalmoscopy: edema of the optic disc or excavation

Treatment

• Topical beta-adrenergic blocker
• Topical adrenergic agonist
• Carbonic anhydrase inhibitor
• Miotic agent
• Sodium restriction
• Surgery

Key nursing interventions

• Assess vision status.
• Monitor and record vital signs.
• Assess eye pain.
• Provide home care instructions.

Key complications

• Blindness
• Infection

Source: Straight A's in Medical-Surgical Nursing, 2nd edition, Lippincott Williams & Wilkins, 2008.

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 staff of an outpatient clinic has formed a task force to develop new procedures for swift, safe evacuation of the unit. The new procedures haven't been reviewed, approved, or shared with all personnel. When the nurse manager receives word of a bomb threat, the task force members push for evacuating the unit using the new procedures. Which action should the nurse manager take?
	1.	Determine that the procedures currently in place must be followed and direct staff to follow them without question.
	2.	Tell staff members to use whatever procedures they feel are best.
	3.	Ask staff members to quickly meet among themselves and decide what procedures to follow.
	4.	Tell staff members to assemble in the staff lounge; there the nurse manager will quickly gather opinions about evacuation procedures before deciding what to do.
2.	A 45-year-old client who's a member of the Jehovah's Witnesses refuses a blood transfusion based on his religious beliefs and practices. The client's decision must be followed based on which ethical principle?
	1.	The right to die
	2.	Advance directive
	3.	The right to refuse treatment
	4.	Substituted judgment
3.	A nurse is teaching a 50-year-old client how to decrease risk factors for coronary artery disease. He's an executive who smokes, has a type A personality, and is hypertensive. Which risk factor is nonmodifiable?
	1.	Age
	2.	Hypertension
	3.	Personality
	4.	Smoking
4.	A 2-year-old child is diagnosed with bronchiolitis caused by respiratory syncytial virus (RSV). The child's family also includes an 8-year-old child. Which statement is correct?
	1.	RSV isn't highly communicable in infants.
	2.	RSV isn't communicable to older children and adults.
	3.	The 2-year-old client must be admitted to the hospital for isolation.
	4.	The children should be separated to prevent the spread of the infection.
5.	A client is seen in the emergency department with bruises on her face and back. She has the signs of a domestic abuse victim. Which community resource could provide assistance to the client?
	1.	Alcoholics Anonymous (AA)
	2.	Crime Task Force
	3.	Lifeline Emergency Aid
	4.	Women's shelter

• 16th International Conference on Cancer Nursing
  March 7-11, 2010, at the Westin Peachtree Plaza in Atlanta, Georgia.
  

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• Winter emergencies: Managing ski and snowboard injuries
  By Linda Laskowski-Jones, RN, ACNS-BC, CCRN, CEN, MS, and Lawrence J. Jones III, NREMT-B, BA
  You're first on the scene after an accident on the slopes--do you know how to respond? This article will prepare you to handle common winter hazards.
  
• Glycemic control in the hospital: How tight should it be?
  By Christine Kessler, RN, ANP, BC-ADM, MN
  Too-tight glycemic control has a downside for hospitalized patients. Explore the latest evidence to make sure your nursing care is current.
  

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1. 1 In an emergency, such as a bomb scare, the nurse manager must determine, without hesitation, the best action for the safety and welfare of clients and staff. Allowing staff members to do whatever they think best will cause confusion and inefficient client evacuation because no one will know how to function effectively as a team during the crisis. Taking time to have staff meet, or gathering opinions about what to do, wastes valuable time.
2. 3 The right to refuse treatment is an ethical principle of respect for the autonomy of the individual. The client can refuse treatment if he's competent and aware of the risks and complications associated with that refusal. The right to die involves whether to initiate or withhold life-sustaining treatment for a client who is irreversibly comatose, vegetative, or suffering with end-stage terminal illness. An advance directive is a document used as a guideline for starting or continuing life-sustaining medical care; the client commonly has a terminal disease or disability and can't indicate his own wishes. Substituted judgment is an ethical principle used when a decision is made for an incapacitated client.
3. 1 Age is a risk factor that is nonmodifiable. Type A personality, hypertension, and smoking factors can be controlled.
4. 4 Toddlers easily transmit and contract RSV so they should be separated from other children. RSV is also communicable to older children and adults, but these clients may exhibit only mild symptoms of the disorder. Hospitalization is indicated only for children who need oxygen and I.V. therapy.
5. 4 A women's shelter can house women and children who need protection from an abusive partner or parent. AA is a support group for alcoholics and their families. The Crime Task Force and Lifeline Emergency Aid don't provide housing for women or children who want to leave an abusive relationship.

Source: NCLEX-RN Questions & Answers Made Incredibly Easy!, 4th edition, Lippincott Williams & Wilkins, 2008.

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