Does anyone you know love taking tests? Probably not! Tests are something all students face, and they cause almost everyone some anxiety. Here's a checklist of things to do the next time you're feeling nervous about a test.

Before the test

• Talk to your instructor and classmates about what the test will cover.
  
• Divide your study time over several days instead of trying to review everything the night before the test.
  
• When studying, use all your resources, including your textbook, lecture notes, and completed homework assignments.
  
• Create 3 x 5 cards for each key concept or formula that might appear on the test. Then, use the flash cards to test your memory.
  
• Take a practice test. Find a room that's free of distractions and give yourself a specific amount of free time to complete the test.
  
• Try to avoid studying right before taking the test. Put those notes away and take some time to relax!
  
• Arrive 5 minutes early so you'll be ready when the instructor begins the test. Just don't arrive too early--sitting in an empty classroom or listening to other students' nervous chattering might make you feel anxious.
  

During the test

• Break the tension. If your instructor allows it, get up to ask a question, sharpen your pencil, or get a drink.
  
• Focus on tensing and relaxing muscles in different parts of your body, such as your neck and shoulders. Then, close your eyes and take a few deep breaths.
  
• Calm your nerves by putting the test into perspective. Life will go on after the test is over. Remember that doing your best is sufficient.
  
• Think of something calm and soothing when you feel test anxiety getting the best of you.
  

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

Parkinson's disease is a progressive degenerative disease of the extrapyramidal system associated with dopamine deficiency.

Common causes

• Imbalance of dopamine and acetylcholine in basal ganglia
• Cerebrovascular disease
• Drugs
• Head trauma

Key signs and symptoms

• "Pill rolling" tremors
• Shuffling gait
• Stiff joints
• Masklike facial expression
• Dyskinesia
• "Cogwheel" rigidity
• Stooped posture

Diagnosis

• EEG: minimal slowing
• CT scan: normal

Treatment

• High-residue, high-calorie, and high-protein diet; soft foods
• Anticholinergics
• Antiparkinsonian agents
• Antispasmodic
• Antidepressant
• Dopamine receptor agonists

Key nursing interventions

• Assess neurovascular and respiratory status.
• Promote measures to prevent falls.
• Maintain a patent airway.
• Reinforce gait training.
• Reinforce independence in care.

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.	Before a routine checkup in the pediatrician's office, an 8-month-old infant is sitting contentedly on his mother's lap, chewing on a toy. When preparing to examine this infant, which action should the nurse perform first?
	1.	Measure the head circumference.
	2.	Auscultate heart and lung sounds.
	3.	Elicit pupillary reaction.
	4.	Obtain body weight.
2.	Which statement best defines the term cardiogenic shock?
	1.	Decreased cardiac output
	2.	A reduction in circulating blood volume
	3.	Overwhelming sepsis and circulating bacterial toxins
	4.	Inflow or outflow obstruction of the main bloodstream.
3.	In the latter stages of Reye's syndrome, which major intervention is directed toward preventing or reducing cerebral edema?
	1.	Noninvasive pressure monitoring
	2.	Paralysis and sedation
	3.	Liberal fluid replacement
	4.	Nonassisted ventilation
4.	An infant is brought to the ED and pronounced dead with the preliminary finding of sudden infant death syndrome (SIDS). Which question to the parents is appropriate?
	1.	Did you hear the infant cry out?
	2.	Was the infant's head buried in a blanket?
	3.	Were any of the siblings jealous of the new baby?
	4.	How did the infant look when you found him?
5.	Which nursing action is appropriate when a child has a seizure?
	1.	Inserting a nasogastric tube to prevent emesis
	2.	Restraining the extremities with a pillow or blanket
	3.	Inserting a tongue blade to prevent injury to the tongue
	4.	Padding the side rails of the bed to protect the child from injury

• National Student Nurses' Association Mid-Year Conference
  October 29 to November 1, 2009, at the Phoenix Convention Center in Phoenix, Arizona.
  
• American Academy of Nursing 36th Annual Meeting & Conference
  November 5-7, 2009, at the Marriott Atlanta Marquis in Atlanta, Georgia.
  

Don't miss these substantive, peer-reviewed features from the August issue of Nursing2009. They'll help you learn about evidence-based practice.

• Wrapping your head around cranial nerves
  By Rachel L. Palmieri, RN-C, ANP, MS
  Get up your nerve to perform these critical assessments by following this step-by-step guide, which includes a helpful summary of common disorders associated with each nerve.
  
• Too fast, too slow, too ugly: Dysrhythmias every nurse should recognize
  By AnneMarie Palatnik, RN, APN-BC, MSN
  You don't have to work in a cardiac unit to care for patients who need continuous cardiac monitoring. This comprehensive review will teach you to recognize an abnormal rhythm immediately and respond appropriately.
  

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1. 2 Heart and lung auscultation shouldn't distress the infant, so it should be done early in the assessment. Placing a tape measure on the infant's head, shining a light in his eyes, or undressing the infant before weighing may cause distress, making the rest of the examination more difficult.
2. 1 Cardiogenic shock occurs when cardiac output is decreased and tissue oxygen needs aren't adequately met. Hypovolemic shock describes a reduction in circulating blood volume. Septic shock describes overwhelming sepsis and circulating bacterial toxins. Obstructive shock is seen with an inflow or outflow obstruction of the main bloodstream.
3. 2 Skeletal muscles are paralyzed with the administration of pancuronium (Pavulon). This might increase intracranial pressure (ICP). Invasive monitoring is essential to detect increased ICP. Liberal fluid replacement may increase cerebral edema and should be strictly monitored. Tracheal intubation is performed as soon as possible to prevent hypoventilation and increased carbon dioxide levels.
4. 4 Only factual questions should be asked during the initial history in the ED. The other questions simply imply blame, guilt, or neglect.
5. 4 A child having a seizure could fall out of bed or injure himself on anything, including the side rails of the bed. Attempts to insert anything into the child's mouth may injure the child. Attempting to restrain the child won't stop seizures. In fact, tactile stimulation may increase the seizure activity; therefore, it must be limited as much as possible.

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

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