Nursing2006 ANS eNews -- December 2006
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Student resources:    Good links

Clinical guidelines and standards:
, Centers for Disease Control and Prevention, Joint Commission on Accreditation of Healthcare Organizations, National Guideline Clearinghouse

Clinical research:

Drug information:
Food and Drug Administration

Journal research:

Medical news:

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, CareerCenter at, Nursing2006 salary survey report

Learn a new word
Raynaud phenomenon
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.

provided by
Memory Jogger

When you perform endotracheal (ET) suctioning, remember EMS

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 . 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.

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Contents in this issue...
In the Know: FDA Alert, New recall
Confidentially: Distractions can be dangerous
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 memorize
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 recall
  • FDA 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.
  • New 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 immediately.

Confidentially: Distractions 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 drug administration

After administering a tablet or capsule, be sure to record:

  • drug given
  • dose given
  • date and time of administration
  • signing out of the drug on the patient's medication record
  • 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 reason.

Source: Fundamentals of Nursing made Incredibly Easy!, Lippincott Williams & Wilkins, 2007.

Quick Quiz: Match game

Match the terms about medication administration in column one with a definition, example, or related statement in column two.

Clues Choices
___1. parenteral a. coated with a substance that's insoluble in stomach acid
___2. vials b. after meals
___3. I.V. push c. direct injection of a medication into a vein
___4. controlled-release tablets d. drugs given for therapeutic purposes
___5. medications e. drugs dispensed in single-dose containers for individual patients
___6. gt f. contains high amounts of drug intended to be absorbed slowly and act over an extended period
___7. enteric-coated tablets g. refers to any route other than gastrointestinal
___8. pc h. closed glass or plastic containers with rubber stopper through which a needle can be inserted to withdraw medication
___9. ampule i. drop
___10. unit-dose system j. sealed glass containers with tops you have to break off so you can insert a needle to withdraw medication

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

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
  • 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
Causes of small-volume diarrhea
  • Inflammatory bowel disease
    • Crohn's disease
    • Ulcerative colitis
  • Infectious disease
    • Shigellosis
    • Salmonellosis
  • Irritable bowel syndrome

Source: Essentials of Pathophysiology: Concepts of Altered Health States, 2nd ed., by CM Porth, Lippincott Williams & Wilkins, 2007.

Insights on Death and Dying from Joy Ufema, RN, MS

Q: 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.

A: 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 here.

Ask a Colleague: Peptic ulcers
Q: How can I help my patient with a peptic ulcer understand his disease?

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.

Source: 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

When inserting an older adult's I.V. line, remember these tips:

  • 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 technique.
  • Release the tourniquet as soon as you get blood return.
  • 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.

Source: Medication Administration made Incredibly Easy!, Lippincott Williams & Wilkins, 2002.

Quick NCLEX Tip: Aim to understand instead of memorize

Don't 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 clients?"

Source: Study Tips for the NCLEX exam from the National Council of State Boards of Nursing.

Recommended readings from Nursing2006
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
  • 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 questions

Worried 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.

  1. 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.

    1. degeneration of axons
    2. demyelination throughout the central nervous system
    3. periodic and unpredictable exacerbations and remissions
    4. plaque formation that interrupts nerve impulses

  2. 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.

    1. pulmonary vein
    2. right ventricle
    3. pulmonary artery
    4. arterioles
    5. alveoli
    6. left atrium

  3. A client is diagnosed with herpes zoster. Place the pathophysiologic changes associated with this disorder in the proper sequence.
    1. Fever, malaise, and red nodules appear in dermatome distribution.
    2. The virus multiplies in the ganglia, causing deep pain, itching, and paresthesia or hyperesthesia.
    3. Vesicles crust and scab but no longer shed the virus.
    4. Residual antibiotics from the initial infection mobilize but are ineffective.
    5. Vesicles appear filled with either clear fluid or pus.
    6. Varicella-zoster virus is reactivated.

  4. 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.

    1. Flush the I.V. tubing and line with normal saline solution.
    2. Verify the blood bag identification, ABO group, and Rh compatibility against the client information.
    3. Stay with the client and watch for signs or a transfusion reaction.
    4. Record vital signs.
    5. Put on gloves, a gown, and a face shield.
    6. Check the packed cells for abnormal color, clumping, gas bubbles, and expiration date.

  5. 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.

    1. A high serum calcium level and inhibited PTH secretion
    2. A low serum calcium level
    3. Resorption of calcium
    4. PTH release by the parathyroid gland

Answers to NCLEX practice questions

  1. 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 varies.
  2. 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.
  3. 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. 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.
  5. 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, 2007.

Answers to Quick Quiz:
1g; 2h; 3c; 4f; 5d; 6i; 7a; 8b; 9j; 10e

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