Wednesday, 28 June 2017

Q. Nurses teach infant care and safety classes to assist parents in appropriately preparing to take their neonates home. Which statement about automobile restraints for infants is correct?

A. An infant should ride in a front-facing car seat until he weighs 20 lb (9.1 kg) and is 1 year old.
B. An infant should ride in a rear-facing car seat until he weighs 25 lb (11.3 kg) or is 1 year old.
C. An infant should ride in a front-facing car seat until he weighs 30 lb (13.6 kg) or is 2 years old.
D. An infant should ride in a rear-facing car seat until he weighs 20 lb and is 1 year old.

Correct Answer: D
Explanation:  An infant should ride in a rear-facing car seat until he weighs 20 lb and is 1 year old.
Having proper work-life balance is essential if you want to be happy and healthy. However, as a nurse with an extremely busy schedule, it can take more than just good time management skills to achieve that.

Nursing Art, Nursing Career

In line with this year’s Nurses Week, with the theme “Nursing: the Balance of Mind, Body, and Spirit”, here are some great tips you can use to keep up with the demands of your work without compromising your well-being.

1. Know your situation


One of the first things you have to do is to assess your situation. Evaluate where most of your time goes and where you want to focus more. Busyness is something you choose and you can always make a different choice.

Be honest about yourself so you’d know exactly which areas you’re paying less attention to. Remember that you won’t be able to work on all areas of your life at once so know how to prioritize depending on your age, situation or status.

2. Address conflicts


Relationship conflicts can drain your energy. They can take off your focus and concentration at work and these can spell problems for your patient and the hospital. Medication errors, for example, can easily happen when you are distracted.

To solve the issue, don’t hesitate to engage in necessary conversations with your co-worker or your family. Don’t judge into conclusions and be open to what they have to say. Talk about how you feel and what you can do to ease the tension.

Nursing Art, Nursing Career
Conflicts at work can affect the way you care for your patients. Settle your differences as early as possible.

If it’s your co-worker, be open for feedbacks. Ask for some help if you need to and don’t hesitate to offer a hand when you’re free. Fulfill your duties and responsibilities as much as possible. For your family, make sure to set aside some time for them. Go out and treat them to lunch once in a while.

3. Learn how to say no


Whether it’s the supervisor or your co-worker asking you extend your working hours, be comfortable in saying no, especially if that is what you really mean. Saying yes when you really don’t feel like doing it can only make you regret the decision later on. Worse, it might even affect the way you deliver care to your patients.

“One time, a patient came up to me to complain about one of the nurses. The patient was extremely dissatisfied that the nurse was frowning the entire shift and was looking annoyed each time the patient asked questions. It turned out that it was the same nurse I asked earlier that day to work an extra 4 hours to cover a sick nurse’s shift,” a nurse supervisor shared.

4. Schedule rest


No matter how busy you get or how often you do night shifts, it’s essential that you get enough rest and sleep. Remember, you are a nurse and you need to be fit physically, mentally, and emotionally when dealing with patients.

Although going out with your friends and engaging in a hobby can help you achieve better work-life balance, it doesn’t mean that you have to sacrifice your sleep. If you need to go out, schedule it after you’ve rested.

5. Do something that makes you feel good


Nursing Art, Nursing Career
Do something you’ve always wanted to try. Discover your passion one step at a time.

Do something you’ve always wanted to try. Discover your passion one step at a time.
Whether it’s soaking in a warm bubble bath or gardening, if it nurtures your soul, just do it. Schedule it in your week and prioritize it during your free days. Take care of not just your body, but your spirit, emotions, and intellect, too. It’s one of the best ways to combat stress and burnout.

6. Pay attention to your body


When you’re a  nurse, it’s quite easy to neglect your own health. You can skip lunch, drinking water or taking your vitamins when you’re too busy making sure your patients are full, hydrated and healthy.

If you feel like a cold is coming or you feel pain on your back or feet, take the necessary interventions. See a doctor when you need to and make sure that you give yourself the tender, loving care you freely give to other people.

7. Exercise


Exercise is one of the easiest and cheapest ways to get rid of depression and stress. You can enroll in a Pilates or Yoga class. If attending a special class isn’t your cup of tea, you can always do a 10-minute walk or run outside your home or on your way to the hospital. If budget permits, you can invest in exercise equipment and do your workout at home.

Exercise can help you recharge and clear your mind, especially if you are feeling overwhelmed. Apart from that, it can also help you shed off some extra weight.

Tuesday, 27 June 2017

Q. The nurse is caring for several mother-baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains?

A. G 4, P 1 client who is breastfeeding her infant.
B. G 3, P 3 client who is breastfeeding her infant.
C. G 2, P 2 cesarean client who is bottle-feeding her infant.
D. G 3, P 3 client who is bottle-feeding her infant.

Correct Answer: B
Explanation: The major reasons for afterbirth pains are breast-feeding, high parity, overdistended uterus during pregnancy, and a uterus filled with blood clots. Physiologically, afterbirth pains are caused by intermittent contraction and relaxation of the uterus. These contractions are stronger in multigravidas in order to maintain a contracted uterus. The release of oxytocin when breast-feeding also stimulates uterine contractions. There is no data to suggest any of these clients has had an overdistended uterus or currently has clots within the uterus. The G 3, P 3 client who is breast-feeding has the highest parity of the clients listed, which—in addition to breast-feeding—places her most at risk for afterbirth pains. The G 2, P 2 postcesarean client may have cramping but it should be less than the G 3, P 3 client. The G 3, P 3 client who is bottle-feeding would be at risk for afterbirth pains because she has delivered several children, but her choice to bottle-feed reduces her risk of pain.
Before you step into the real world of nursing, you must pass their licensure examination first to prove that you’re a safe and effective nurse! Reviewing board exam questions are just a way of further enhancing your knowledge and confidence for one of the most important test in your life. What you must remember is that you are already knowledgeable about cores of nursing, but this knowledge would be futile if you cannot apply effective test-taking skills during your exams. You have a substantial amount of knowledge about nursing, but how do you really know how to use this knowledge during exams?

NCLEX Exam Tips

Researches suggest that an examiner who fully understands test construction and familiar with appropriate test-taking strategies score higher than those with similar level of knowledge but with inadequate test-taking skills.

Multiple choice tests are different from tests such as essays, identifications and true/false. In multiple choice exams, the question is called the stem. The stem is followed by four alternative answers. One answer is correct, and the other three are called distracter because they distract your attention from identifying the correct answer. Note also that these distracter are not necessarily incorrect answers but rather they may not be as correct as as the one you are required to choose.

Here we have 10 effective test-taking skills and strategies that can help you during your examinations:

1. Extra meaning need not apply!


Test questions are made to be direct and to the point so you don’t need to read extra meaning to the question. The question asks for one particular response and you should not read or add other information into the question.

Often you will find questions that require “common sense” answers and that reading into these questions may give you another interpretation. You should not search for subtle meaning about the questions or answers.

Ask yourself “What is the question asking?” Look for keywords and phrases to help you understand. Interpret the question correctly first before reading into the choices.

2. Understand the question


Make sure you read the stem correctly and notice particularly the way the question is phrased. Is it asking for the best response or the initial response? Understand what the question is asking before considering the distracter.

3. Rephrase


Rephrasing technique requires you to interpret or translate the question into your own words so that it is very clear in your own mind. Rephrasing the stem of the question can assist your read the question correctly and in turn choose the appropriate response.

Placing the question into your own words would help you in removing extraneous data and get into the core of the stem.

4. Isolate


When analyzing the distracter, isolate what is important in the answer alternatives from what is not important relative to the question. In a good test construction, all of the distracter should be feasible and reasonable, and should apply directly to the stem. There should be a commonality in all of the distracter.

Also, all of the distracter may be correct but not the right choice for the specific question that is being asked. The technique here is to ask yourself whether each possible alternative is true or false in relation to the stem.

5. Recheck


Many test-takers fail to recheck the answer with the stem, and they answer the question incorrectly. After choosing the correct answer alternative and separating it from the distracter, go back to the stem and make sure your choice does, in fact, answer the question.

An effective strategy is to judge all four alternative choices/options against the stem and not against one another. Read the stem, then check option 1 against the stem, then check option 2 against the stem and so on. This process will eliminate choosing an alternative that does not fit with the question.

6. Process of Elimination


When a question contains multiple variables as alternative choices, use the “elimination of variable” technique. Each question may pose different alternatives with several variables. Use the process of elimination.

Study the question first and ask yourself what variable fits with this condition, or after examining the distracter underline the symptom that you know is correct. Now ask yourself what variable is not present with this condition. Again examine the distracter and cross out those variables that are incorrect. By this process you’ve probably eliminated at least two distracter even without taking the time to consider the other two.

7. Go back to the basics


When you come across a difficult question and you cannot immediately identify the answer, go back to your body of knowledge and draw all the information that you do know about the condition.

If you are unfamiliar with the disease or disorder and cannot choose the right nursing action, try to generalize to other situations. For example, if the question asks about dog bites, and you’ve never learned the course of the disorder, go back to an area of knowledge that you do know, for example, circulation and body response to toxic substances.

Even though you do not know exactly what to do, you might know what not to do. Eliminate distracter to increase your chances of arriving at the correct answer.

8. Educated guesses


The ability to guess correctly is both a skill and an art.

The board exams is not a “right minus wrong” type. It is important for you to answer every question even if you have to guess. Guessing gives you only a 25% chance of getting the correct answer.

Try to eliminate at least one (or more) distracter as this will increase the percentage margin of chance for guessing correctly.

Examine the distracter and if one is the exact opposite of another (e.g. complete bed rest is different from activity as tolerated; both cannot be correct since they are of opposites), choose the one that seems to be most logical.

Try to identify the underlying principle that supports the question. If you can answer the question, you might then be able to guess the correct answer. This strategy is especially true with a psychosocial question.

Look at the way the alternatives are presented. Are there two answers that are very close? Often when this occurs, the ability to discriminate will show evidence of judgement. Check to see if one, more than the other, is the best choice for the question.

Are there any distracter that are presented not logical (which are correct in themselves but do not have anything to do with the question)? Eliminate these and focus on other alternatives.

Use your intuition. If you cannot choose an alternative from a logical point, allow yourself to feel which one might be right. Often your subconscious mind will choose correctly (based on all the conscious knowledge you have of course) so simply let yourself feel which alternative might be right. Remember, its better to choose one answer than none at all.

9. Choosing answer from a hunch


There comes a time when you are faced with a certain question and you have a hunch that this particular choice is correct. Do we depend on this “hunch?”. Current studies supports that hunches are often correct, for they are based on rapid subconscious connections in the brain.

Your stored knowledge, recall, and experience can combine to assist you in arriving at the correct answer. So, if you have an initial hunch, go with it! Do not change the answer if and only if, upon reflection, it just doesn’t seem right. On the other hand, if later in the test you find relevant information or make new connection of information and you feel that your answer was incorrect, do go back and change it.

10. Choosing the best answer from a strategy point-of-view.


Frequently, the most comprehensive answer is the best choice (Longest the best!). For example, if two alternatives seems reasonable but one answer includes the other (i.e., it is more detailed, more comprehensive), than this answer would be the best choice. If an answer focuses on medical knowledge, be wary, for this alternative might be just a good distractor. Remember, this is a nursing test and questions are designed to test your nursing competency and safety.

It is unlikely that a question would require a medical action for the correct answer; it may, however offer these actions as distracter.

Monday, 26 June 2017

Q. A pregnant client in her third trimester is started on chlorpromazine (Thorazine) 25 mg four times daily. Which of the following instructions is most important for the nurse to include in the client's teaching plan?

A."Don't drive because there's a possibility of seizures occurring."
B. "Avoid going out in the sun without a sunscreen with a sun protection factor of 25."
C. "Stop the medication immediately if constipation occurs."
D. "Tell your doctor if you experience an increase in blood pressure."

Correct Answer: B
Explanation: Chlorpromazine is a low-potency antipsychotic that is likely to cause sun-sensitive skin. Therefore the client needs instructions about using sunscreen with a sun protection factor of 25 or higher. Typically, chlorpromazine is not associated with an increased risk of seizures. Although constipation is a common adverse effect of this drug, it can be managed with diet, fluids, and exercise. The drug does not need to be discontinued. Chlorpromazine is associated with postural hypotension, not hypertension. Additionally, if postural hypotension occurs, safety measures, such as changing positions slowly and dangling the feet before arising, not stopping the drug, are instituted.
Working with lazy nurses is, perhaps, one of the most annoying things you can experience on the floor. This goes particularly true when you’re running a very busy shift. With your co-nurses pretending to be “busy” reading the paper, disappearing for a few minutes to a full hour and leaving empty coffee cups and candy wrappers almost everywhere, it’s hard not to feel annoyed and frustrated.
Although tattling might be able to relieve some of your frustrations, the truth is it won’t really get you anywhere. In fact, telling in on your co-nurses might even result in more issues. You could be subjected to bullying, jealousy and receive the cold treatment.

If you are dealing with the same issues at work, here are a few tips on how to handle nurses who are just plain lazy.

1. Refuse to cover for your lazy co-worker.


If your co-worker frequently takes brakes, don’t agree to cover for her. You can tell her that your hands are full and that you have a lot of patients to look after.

If your co-worker doesn’t have anyone else to attend to her patients or administer their due medications, she’ll be forced to do the job herself. A bad behavior will continue if you tolerate and allow it.

2. Don’t allow them to distract you.


When you’re a nurse,  the last thing you want to happen is to get distracted while performing your duties. Remember, medication errors can easily happen when you’re not focusing or your concentration is divided.

Medication error can compromise not only your license but your patients’ lives, too. Remain focused on your work and limit distractions as much as possible.

If you find your co-workers chatting in the nurse station, excuse yourself and find another quieter spot to finish your paperwork. If you are in the middle of preparing your patients’ medications, don’t hesitate to ask them to leave the area. Don’t put too much energy focusing on what your co-workers aren’t doing. Instead, just concentrate on your tasks.

3.  Give guidance than doing the work.


If you are finding it hard to say no when someone asks for help, set limitations on how much help you can give. You can always provide guidance but never do the work for your co-nurses.

“ALWAYS PROVIDE GUIDANCE BUT NEVER DO THE WORK FOR YOUR CO-NURSES.”

Remind them of their tasks and deadlines. Organize their duties for them or give tips on how you’re able to accomplish more things in the same amount of time.

4. Don’t make them change your attitude.


It’s incredibly frustrating to see your co-nurses slacking off and leaving the other nurses to pick up after them. No matter how frustrated you get, don’t let it affect your attitude, especially the way you interact with your patients.

“I’ve been in this ward for several years already and I’ve been able to work with nurses with a wide range of attitudes. One thing I learned is that no matter what they do, you are you. If you let them affect you, it’s your patients who will ultimately bear the effects. And with their poor health, that won’t be of any help. Always consider your patients first,” an 8-year surgical ward nurse shared.

Don’t fall into the trap of following their lead, too. Don’t get stuck into the long hours of chatting and the frequent trips to the restroom.

5. Know when to speak up.


In case you are at the point that you’re too stressed out about the situation that it’s negatively affecting your work, consider speaking with your co-workers first.

Your co-workers might not be that lazy after all. Perhaps, they just lack proper management and organizational skills that they miss out on deadlines and tasks. It could be that they’re distracted with personal issues, too. In essence, there’s nothing that a good, respectful conversation can’t solve.

Talking to your co-workers about your issues with them can give you a clearer understanding of their behaviors as well as possible solutions.

If for some reason, they still can’t change their ways, you can communicate your frustrations to your superior. Be honest with your report. And if your superior failed to do something about it, you can discuss it with human resources.

As much as possible, don’t whine or share your sentiments with your other colleagues. This can only create misunderstandings as well as hurt feelings.

Friday, 23 June 2017

Q. A client was talking with her husband by telephone, and then she began swearing at him. The nurse interrupts the call and offers to talk with the client. She says, "I can't talk about that bastard right now. I just need to destroy something." Which of the following should the nurse do next?

A. Tell her to write her feelings in her journal.
B. Urge her to talk with the nurse now.
C. Ask her to calm down or she will be restrained.
D. Offer her a phone book to "destroy" while staying with her.

Correct Answer: D
Explanation: At this level of aggression, the client needs an appropriate physical outlet for the anger. She is beyond writing in a journal. Urging the client to talk to the nurse now or making threats, such as telling her that she will be restrained, is inappropriate and could lead to an escalation of her anger.

Becoming a nursing professional (whether it’s an RN, or an advanced nurse practitioner) requires a strong educational foundation. Nurses earn a bachelor’s or advanced degree and pass the required certification exams before seeing their first patient. But once you’ve put on your scrubs and entered the working world, the learning doesn’t stop.
Nurse CE and CEU, RN

In fact most states require nurses to complete continuing education every two to three years in order to keep their licenses and special certifications current and active. This continuing education – sometimes referred to as CEs or CEUs – are designed so that nurses can keep their patient care skills fresh, stay on top of any industry changes, and learn about new nursing techniques and practices.

The amount of required CEUs vary widely. Some states including New Jersey, California, Arkansas, and Iowa require 30 hours every two years. In other states like Montana and Ohio, requirements are a bit less -- just 24 hours every two years. In Washington, there is a 45-hour requirement, but it must be completed every three years.

In other words, each state board of nursing varies when it comes to CEU requirements, so it’s important to understand what you’ll need to do to continue practicing nursing in your state. What is more consistent is that every 50-60 minutes of participation in a CE-approved activity is equal to one CE contact hour. For nursing-related courses taken in a college program, a semester course will earn you 15 contact hours, while a quarter course will count as 10 contact hours.

There are so many different options available to nurses when it comes to earning CEUs (continuing education units), and as you can tell, the requirements will be different depending on where you work. With a busy nursing work schedule, fitting in CE might seem like quite the challenge. Luckily, there are lots of options that make CEUs accessible and manageable. And because you do have a good period of time to complete your requirements, you can space out the hours so that they can best fit into your schedule. This guide will have you navigate CE for nurses so that you can keep your credentials up to date with as little hassle as possible.

Finding ANCC Approved CE


Let’s start with a quick explanation of what CEs and CEUs actually are, since you might be wondering if those terms can be used interchangeably. CE is just the abbreviation for continuing education, so it’s really more of a generic term. On the other hand CEU (a continuing education unit) refers to a unit of credit equal to 10 hours of participation in an educational course or approved activity. The key here is choosing approved or accredited programs. In order for a CEU to count toward your required hours, it must be administered by an approved CE provider. Usually, if it’s nursing CE coursework from a college or university or a nursing school, you should have no issues with having such credits approved. However, the study hours must be related to nursing in some way, so taking a liberal arts course, for example, wouldn’t count.

That being said, you don’t have to earn all of your CEUs in a college classroom. On the contrary, there are professional seminars, online webinars, correspondence courses, and other industry events that can count toward your continuing education hours. It is also possible to complete CE hours out of state as long as they are given by a provider that is approved by an ANCC (American Nurses Credentialing Center) regional accrediting body.

When in doubt, the best way to confirm that an activity, conference, course, or seminar will be counted toward your required CEU hours is to check with your state board of nursing. For easy access, you can find your state board’s website via the National Council of State Boards of Nursing .

Along those lines, some states do expect some portion of your continuing education to be on specific topics. For instance, in New York, nurses must take an Identifying and Reporting Child Abuse course and an Infection Control course as part of their hours. In Michigan, one hour of Pain Management education must be completed. The remaining hours can be decided by you.

The other thing to keep in mind is that CEUs must be earned within a specific renewal period as identified by your state. So if you need to earn X number of CEUs every two years, you can’t double up and apply extra hours to the following two years. They do not carry over.

What is the easiest way to earn CEUs?


If you’re employed by a large hospital and are part of a union, it’s quite possible that your employer will pay to send you to conferences and training sessions that can help fulfill your CEU requirements. Of course, every institution is different, but check with your employer to see if any such opportunities are offered.

If you’re completing your CEUs independently, there are lots of options for completing CE hours online or at your own pace.  The American Association of Colleges of Nursing and the Commission on Nurse Certification lists nationally accredited CE providers on its website. Again, just be sure to double check with your state board before you start randomly signing up for courses from one of those providers. The few minutes it will take to confirm that a course is accepted is worth it to avoid wasting time and money on ones that don’t count.

Paying for CE


CEUs can usually be completed without having to spend a large sum of money. Some hours can be done for free, or for minimal costs under $50. Some providers offer the option to pay a flat fee to take as many courses as you want. And as mentioned above, sometimes your employer will sponsor a portion of your continuing education and training. For those nurses who are non-union or who work for a smaller health care provider that doesn’t have the resources to sponsor training, the costs for CEUs can usually be included as a tax write-off when you do your tax returns.

Getting credit for your hard work


After completing CE hours, you want to be sure that your time and effort will be recorded properly. Usually, the provider will give you a certificate of attendance. If it’s done online, you will likely receive an electronic notification that you completed the course, but you can request a hard copy as well. In most cases, the acronym BRN should appear on the completion certificate, signifying that it is an approved “Board of Registered Nursing” continuing education provider.

Be sure to keep paperwork or digital copies of your CE completion records for a few years in case your credentials are ever called into question.

Keeping your RN and specialty nursing licenses up to date is something that all nurses have to do in order to keep working in the field. However, don’t overlook the other benefits that CEUs can provide, namely staying on the cutting edge of new innovations in the industry so you can thrive professionally. In other words, choose your CE hours carefully so that you can get the most out of the experience, whether it’s networking with fellow RNs at a conference or learning a new skill that can be directly applied in your day-to-day job.

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