LWW American Nursing Student E-Newsletter -- May 2009
Student resources:    Good links

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

Clinical research:
, MedlinePlus

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, Career Center at NursingCenter.com, Nursing2007 job satisfaction survey report

Learn a new word
Gaffky table
A numeric rating for the classification of tuberculosis according to the number of tubercle bacilli in the sputum, ranging from 1 (1–4 organisms in the whole preparation) to 9 (an average of 100 per field). Also called a Gaffky scale.

provided by stedmans.com

Memory Jogger

Think PLATE to remember key blood components:

AB antigens

Source: NCLEX-PN Review Made Incredibly Easy!, 3rd edition, Lippincott Williams & Wilkins, 2008.

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Dear Subscriber,

Welcome to the LWW American Nursing Student E-Newsletter, brought to you by the editors of Nursing2009 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...
Study Tips: Succeeding on math tests
Smart Charting: Documenting drug overdose
Test Yourself: NCLEX practice questions
Upcoming Conferences
Recommended readings from Nursing2009
Get Social! Visit Nursing2009 on Facebook
  Click on icon to e-mail this to a friend
Study Tips: Succeeding on math tests

Math questions generally fall into one of two categories: number questions and word problems. Both types involve solving problems and using math principles. Several strategies can be used to approach either type of test.

Number problems
Here are a few simple steps that can help you increase your likelihood of success when taking a number-problem test.

  • Work carefully and deliberately. You can really sabotage yourself by being careless or working too fast. Thorough work is required. Write carefully, perform the calculations in reverse to check your answer, keep numbers in straight columns, and copy accurately.
  • Write out all steps. Sometimes, students feel that showing all their work is childish. But it's good practice at any age. If you write out your work, you can catch errors more easily.
  • Estimate early. Try to estimate the answer to a problem before you start working. Then, solve the problem without referring to your estimate. When you finish your calculations, compare your answer with the estimate to see how close they are. If they're not close, you may have made a mistake in your calculations--a decimal point in the wrong place, an extra zero, etc.
  • Make sure your calculations use all the information given in the problem. There's rarely unnecessary data in a math problem. Most of the time, each piece of data is essential to solving the problem.
  • Read each question twice. After you think you have the right answer, read the question again. Have a checklist: Did you show your work? Did you answer in the correct units? Did you answer all parts of the question? Does your answer make sense? If your answers are yes, you're on the right track.
  • Be persistent. Everyone gets stuck sometimes. There are ways you can get yourself moving again. Round fractions up to whole numbers to put a problem into simpler form. Try to figure out what information you think you're missing. What doesn't make sense? Where do you lose track? If all else fails, move on to other questions and come back to the tougher ones later.

Word problems
Word problems have a bad reputation for being difficult. All word problems do is put numbers in a non-number context. There are some things you can do to make word problems more approachable.

  • Look at the big picture. Look at the whole test first. As you read each problem, jot down notes in the margin about how you might solve it. Work on the easiest problems first.
  • Plan well. Plan for the test as you would plan time for a study session. Allow more time for problems worth more points. Budget time at the end of the test to review and to go back to difficult problems.
  • Use strategies for dealing with difficult word problems. Mark key words and numbers to narrow the problem down to its essential elements. Sketch a diagram of the problem to make it more comprehensible. List all formulas you think are relevant and decide which to use first. Think about similar practice problems and how you solved them. Guess at a reasonable answer if other strategies fail, then check it.
  • Learn from past mistakes with similar problems. After the test is over and you get it back from the instructor, read through the comments and suggestions. Try to avoid making assumptions about why you missed certain problems. Ask yourself: Did I make careless mistakes? Did I misread questions? Did I miss the same kind of problem over and over? Did I remember formulas incorrectly or incompletely? Did I run out of time? Did I let my anxiety get the best of me, making me miss problems I really know how to solve? Based on your answers to these questions, you can identify ways to improve your performance on future tests.

Source: Student Success for Health Professionals Made Incredibly Easy! by Nancy Olrech, Lippincott Williams & Wilkins, 2008.


Smart Charting: Documenting drug overdose

Consumption of drugs in an amount that produces a life-threatening response is a drug overdose. The overdose can be intentional, such as a suicide gesture or attempt, or accidental, such as overmedicating with pain medicine. Either situation requires your prompt and skilled actions. To document drug overdose:

  • Record the date and time of your entry.
  • Chart a brief medical history, including allergies, current drugs, and history of substance abuse, if possible.
  • Record the type and amount of drug taken, route of ingestion, and signs and symptoms exhibited.
  • Document vital signs, noting the character of respirations and strength of pulses.
  • Note the patient's mental status, including level of consciousness, orientation, and ability to follow commands.
  • Document your neurologic assessment, including pupillary reaction, cranial nerve assessment, fine and gross motor activity, sensory functioning, and reflexes.
  • Record the findings of your cardiopulmonary assessment.
  • Record interventions implemented before the patient's arrival at your facility.
  • Note the name of the doctor notified, time of notification, and orders given.
  • Document your interventions, such as administering reversal agents (naloxone [Narcan] and flumazenil [Romazicon]) or gastrointestinal decontaminants (activated charcoal, ipecac syrup, gastric lavage, cathartics, and whole-bowel irrigation) as well as supportive interventions.
  • If gastric emptying is performed, document the character and contents of the emesis.
  • Use flow sheets to record your frequent assessments, vital signs, intake and output, I.V. therapy, and laboratory values.
  • Record your patient teaching, including strategies to prevent future drug overdose.

Source: Chart Smart: The A-to-Z Guide to Better Nursing Documentation, 2nd edition, Lippincott Williams & Wilkins, 2006.

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. A woman is worried she might have lice. Which assessment finding is associated with this infestation?
  1. Diffuse pruritic wheals
  2. Oval, white dots stuck to the hair shafts
  3. Pain, redness, and edema with an embedded stinger
  4. Pruritic papules, pustules, and linear burrows of the finger and toe webs
2. During group therapy, a client listening to another client's description of an abusive incident that occurred during childhood says, “I didn't think anyone else felt like I did as a child.” The nurse recognizes this statement as a reflection of which curative factor of group therapy, as identified by Yalom?
  1. Altruism
  2. Universality
  4. Existential factors
3. An 86-year-old client in an extended care facility is anxious most of the time and frequently complains of a number of vague symptoms that interfere with his ability to eat. These symptoms indicate which disorder?
  1. Conversion disorder
  2. Hypochondriasis
  3. Severe anxiety
  4. Sublimation
4. Which nursing intervention is given priority in a care plan for a client having an acute panic attack?
  1. Tell the client to take deep breaths
  2. Have the client talk about the anxiety
  3. Encourage the client to verbalize feelings
  4. Ask the client about the cause of the attack
5. A nurse is caring for a client with delirium. Which nursing intervention has the highest priority?
  1. Providing a safe environment
  2. Offering recreational activities
  3. Providing a structured environment
  4. Instituting measures to promote sleep

Upcoming Conferences

Recommended readings from Nursing2009

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

  • What you need to know about venous thromboembolism
    By Bill Pruitt, RRT, AE-C, CPFT, MBA, and Robin Lawson, RN, DNP
    Learn to recognize and respond to this life-threatening complication and follow evidence-based guidelines to protect your patients.
  • Helping patients combat colon cancer
    By Janice C. Colwell, RN, CWOCN, MS, FAAN, and Barbara Gordon, RN, OCN, MSN
    Give your patients a fighting chance against this common cancer. First, steer those at risk to screening, then help patients diagnosed with colon cancer to deal with treatment.

Get Social! Visit Nursing2009 on Facebook

Stop by our Facebook page and become a fan of Nursing2009! Join the fun with our lively discussions, nursing news updates, and more. Just click here.

Learning Center

Hospital Acquired Conditions: Prevent and Reduce the Impact
New CMS mandate presents challenges to nursing staff. Reducing the incidence of hospital acquired conditions, including pressure ulcers, catheter-related bloodstream infections and surgical site infections, is not only critical to patient care, it is crucial to minimizing the financial impact on the hospital.
Click here for key strategies.

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Answers to NCLEX practice questions

1. 2 Nits, the eggs of lice, are seen as white oval dots. Diffuse pruritic wheals are associated with an allergic reaction. Bites from honeybees are associated with a stinger, pain, and redness. Pruritic papules, vesicles, and linear burrows are diagnostic for scabies.
2. 2 One of the 11 curative factors of group therapy identified by Yalom is universality, which assists group participants in recognizing common experiences and responses. This action helps reduce anxiety and allows other group members to provide support and understanding. Altruism, catharsis, and existential factors are other curative factors Yalom described, but they don't describe this particular incident. Altruism refers to finding meaning through helping others; catharsis is an open expression of previously suppressed feelings; and existential factors describe the recognition that one has control over the quality of one's life.
3. 2 Complaints of vague physical symptoms that have no apparent medical causes are characteristic of clients with hypochondriasis. In many cases, the GI system is affected. Conversion disorders are characterized by one or more neurologic symptoms. The client's symptoms don't suggest severe anxiety. A client experiencing sublimation channels maladaptive feelings or impulses into socially acceptable behavior.
4. 1 During a panic attack, the nurse should remain with the client and direct what's said toward changing the physiologic response, such as taking deep breaths. During an attack, the client is unable to talk about anxious situations and isn't able to address feelings, especially uncomfortable feelings and frustrations. While having a panic attack, the client is also unable to focus on anything other than the symptoms, so the client won't be able to discuss the cause of the attack.
5. 1 The nurse's highest priority when caring for a client with dementia is to ensure client safety. Offering recreational activities, providing a structured environment, and promoting sleep are all appropriate interventions after safety measures are in place.

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

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