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.

Thursday, 22 June 2017

There are so many pathways to becoming a nurse from earning a diploma to a master’s, and every degree in between. As with most professions, usually the more nursing education credentials you earn, the more opportunities for advancement you’ll afford yourself. What’s great about nursing, however, is that you can be a part of the workforce – and be well compensated – after just a year or two of schooling.

Nursing Degrees

Many nurses do end up heading back to the classroom at their own pace as they look to advance or specialize, while many others are content with remaining a staff RN for the duration of their career.

Take a look at the educational pathways you can pursue in nursing to decide which degree level is right for you and your career goals.

Diploma/Associate Degree for LPN

Licensed practical nurses (sometimes called Licensed Vocational Nurses) are a step below Registered Nurses, but often perform the same types of patient care. Like RNs, they must complete a state-approved program of study and take a licensing exam, in their case, the National Council Licensure Examination for Practical Nurses (NCLEX-PN). LPN training can be found at community colleges as well as technical and vocational schools, and usually take about one year of classroom study and hands-on patient care.


Earning an LPN license can get you into the field quickly so you can begin earning valuable hands-on experience in nursing. This will come in quite handy should you decide to keep moving forward with your studies, not to mention give you something to list on your resume when you begin looking for RN jobs in a couple of years.


LPNs don’t have the same amount of job opportunities as they once did. More and more nursing employers are looking for RNs these days with lower level positions going to medical assistants. You can still find work, but if you hope to stay competitive, striving for an RN license down the line might be wise.

Associate Degree in Nursing

The minimum education required to become an RN is an associate degree, so in reality, you can enter the nursing profession in as little as two years. Graduates need to pass the NCLEX-RN national licensing examination in order to begin practicing.


With an associate and the RN designation, it’s one of the few high-paying and well-respected positions that does not require a bachelor’s degree. Many people choose to begin working while they continue on for their bachelor’s, but you don’t necessarily have to go that route.


Some more competitive nursing positions will give preference to those who have a bachelor’s degree from the get-go, and in order to pursue advanced positions, you’ll most likely be locked out without a four-year degree.

Bachelor of Science in Nursing (RN to BSN)

Whether you begin your nursing career with a bachelor’s degree from the start, or go back later on to earn it, a bachelor’s degree is becoming the standard for most RN jobs these days. That’s why one of the most popular educational options for working nurses is to enter a bachelor’s degree in nursing program after having already having completed a diploma or associate degree program. They’ve already been working in the field, but have come to find that employers are seeking those with four-year degrees, and not having one has prevented them from changing jobs or advancing. These kinds of programs are referred to as RN to BSNs, and are offered by most major colleges and universities.


Bachelor’s degrees for RNs are the way to go if it’s an option for you. Not only is it a minimum requirement for some jobs, but in other cases, it could mean a boost in salary to the tune of a few thousand dollars.


Earning a four-year degree is a big investment of time and money, which can be especially challenging for adults who are already in the workforce. If you’re in that situation, you have to try to figure out if the return on investment is worth it for you – such as if it could lead to better paying opportunities or make you more marketable.

Master of Science in Nursing (MSN)

For nurses who want to take on a specialized track or pursue a management position, earning a master’s degree can really help set them apart. In fact, for some advanced nursing practices - like Certified Registered Nurse Anesthetist or Family Nurse Practitioner - a master’s degree is a requirement.


Becoming an Advanced Practice Registered Nurse (APRN) can lead to huge salary increases in the tens of thousands range, so investing in a master’s program can pay for itself in a couple of years.


Master’s programs are intense and challenging, and usually take about two years to complete. In other words, you need to be prepared to dedicate a lot of time to your studies. This can be tough to do if you’re working full-time, but many nurses do just that.

Adding specializations to your nursing career through advanced education can truly open up a lot more career doors and give you additional job security. By weighing the pros and cons of each degree type and thinking about your personal goals, you can choose the program of study that’s right for you.
Q. A 7 year old with a history of tonic-clonic seizures has been actively seizing for 10 minutes. The child weighs 22 kg and currently has an intravenous (IV) line of D5 1/2 NS + 20 meq KCL/L running at 60 ml/hr. Vital signs are a temperature of 38 degrees C, heart rate of 120, respiratory rate of 28, and oxygen saturation of 92%. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for:

A. Rectal diazepam (Diastat).
B. IV lorazepam (Ativan).
C. Rectal acetaminophen (Tylenol).
D. IV fosphenytoin.

Correct Answer: B
Explanation: IV ativan is the benzodiazepine of choice for treating prolonged seizure activity. IV benzodiazepines potentiate the action of the gamma-aminobutyric acid (GABA) neurotransmitter, stopping seizure activity. If an IV line is not available, rectal Diastat is the benzodiazepine of choice. The child does have a low-grade fever; however, this is likely caused by the excessive motor activity. The primary goal for the child is to stop the seizure in order to reduce neurologic damage. Benzodiazepines are used for the initial treatment of prolonged seizures. Once the seizure has ended, a loading dose of fosphenytoin or phenobarbital is given.

Wednesday, 21 June 2017

Q. A 10-month-old child with recurrent otitis media is brought to the clinic for evaluation. To help determine the cause of the child's condition, the nurse should ask the parents:

A. "Does water ever get into the baby's ears during shampooing?"
B. "Do you give the baby a bottle to take to bed?"
C. "Have you noticed a lot of wax in the baby's ears?"
D. "Can the baby combine two words when speaking?"

Correct Answer: B
Explanation: In a young child, the eustachian tube is relatively short, wide, and horizontal, promoting drainage of secretions from the nasopharynx into the middle ear. Therefore, asking if the child takes a bottle to bed is appropriate because drinking while lying down may cause fluids to pool in the pharyngeal cavity, increasing the risk of otitis media. Asking if the parent noticed earwax, or cerumen, in the external ear canal is incorrect because wax doesn't promote the development of otitis media. During shampooing, water may become trapped in the external ear canal by large amounts of cerumen, possibly causing otitis external (external ear inflammation) as opposed to internal ear inflammation. Asking if the infant can combine two words is incorrect because a 10-month-old child isn't expected to do so.
Gone are the days when nursing was just about hands-on patient care and manually filling out medical charts all day long. Today’s nurses are not only skilled health care practitioners, but they must also be tech savvy in order to keep up with medical advances, unique patient care solutions, and communications tools.
Nursing Career

The good news is that such technological improvements have made it possible to spend more time caring for the actual patients, have helped limit human error (such as mixing up charts), and have even helped ease some of the physical demands of being a nurse.

Take a look at some of the ways that nurses are using technology including apps and software to advanced equipment, so you know what to expect when you head to work in a health care setting.

Nursing technology at a glance

With more and more technology enhancements being used in health care institutions and hospitals – from electronic health records and GPS-tracked medical equipment to tech-driven drug dosing and smarter alarm and alert systems – nurses are expected to know their technology. And that doesn’t only go for advanced nurse practitioners. Staff RNs must be able to learn and adapt quickly so they can begin implementing various tech updates into their daily work.

Here are some of the popular nursing technologies that are becoming more commonplace:

▣ Smart phone apps are being used more often to stay in communication with one’s health care team. This will eventually replace the old pager systems that are not always 100 percent reliable.
▣ Mobile access to information about drug interactions and other reference materials allows nurses to pull up information on the spot, rather than having to lug around heavy books, or step out to search for information.
▣ Electronic patient records are becoming the norm so that patient medical histories can be instantly accessed, and their progress can be tracked in one centralized database. Expect this to be a major part of your nursing training when you begin a new job since it will be a big part of your daily responsibilities.
▣ Non-invasive diagnostic tools are being introduced to help evaluate patients. This means less sticking, prodding, and probing, which is easier for patients, plus it reduces the risk of infection for everyone. Learning how to properly use these tools and equipment is key to making accurate diagnoses.
▣ Implantable devices that administer medication to patients with complex dosing needs is helping to eliminate human error, and freeing up nurses’ time.
▣ Patient-lifting equipment is an advancement that is slowly being adopted by some medical and nursing facilities. However, it is one that nurses who have to lift and move patients surely appreciate as it will help reduce their chance of injury.

How technology is improving patient care

Although learning new technologies can sometimes be intimidating – especially for the nurses who are on the frontlines of patient care and have to get up to speed right away – in most cases, everyone benefits in the long run. For patients, when nurses have better monitoring tools and easy access to their medical histories, they are more likely to get the best course of treatment for their specific situation, and in a timelier fashion. In addition, technology can help streamline nursing tasks so that RNs have more time to focus on the patients themselves, rather than chasing down equipment, or waiting long periods of time for medication to arrive so they can administer them.

Technology in advanced nursing positions

The good news is that by developing health technology skills, many nurses are able to not only thrive in their roles, but also explore new career opportunities in a variety of nursing specialties. For instance, Genetics Nurses use cutting-edge software to analyze patients’ genes in order to determine their risk for various diseases and conditions. Radiology Nurses must be comfortable working with high-tech equipment to perform radiation therapy, MRIs, and other diagnostic exams. And Cardiac Nurses have to love technology in order to keep up with advances in implantable cardioverter-defibrillators (ICDs) and pacemakers.

Keep in mind that all such specialized positions in nursing will require advanced education, certifications, and/or licenses. What they have in common, however, is that they all involve getting schooled on the technologies that are used in the field.

Perhaps no other industry benefits more from technological advances as the medical field. It improves patient care, introduces more effective solutions and treatments, and literally saves lives. That’s why as an aspiring nursing professionals, your success in the field is directly related to your willingness to keep up with technology trends and stay ahead of the curve.

Tuesday, 20 June 2017

Q. A client complains of severe abdominal pain. To elicit as much information as possible about the pain, the nurse should ask:

A. "Do you have the pain all the time?"
B. "Can you describe the pain?"
C. "Where does it hurt the most?"
D. "Is the pain stabbing like a knife?"

Correct Answer: B
Explanation: Asking an open-ended question such as "Can you describe the pain?" encourages the client to describe any and all aspects of the pain in his own words. The other options are likely to elicit less information because they're more specific and would limit the client's response.
When Cheryl Talamantes moved to southern California in 1987, she saw an ad in the newspaper for nurses at Disneyland.
Disney Nurse

“I was intrigued and did a quick look at it but never pursued it. Being married to a Marine meant frequent moves. When we moved back to the area in 1999, a dear friend of mine was working as a Disney nurse and encouraged me to apply,” she says.

Soon after, Cheryl applied for the position and embarked on her nursing adventure with Disney. This month marks her 17th year as a Disney nurse.

As an RN-BSN for over 34 years, Talamantes spent the first half of her career in all types of departments and specialties including med-surg, telemetry, oncology, pediatrics, orthopedics, home health, and even case management for a large insurance company.

All of those positions gave her a great foundation and the versatility needed for serving employees and guests at Disneyland.

Unique Patient Care

Now the Guest Health Services manager at the Disneyland Resort in California, Talamantes gets to work with princesses, cartoon characters, and people from all walks of life.

“We are fortunate to meet guests from all over the country and the world, and there are situations where we are working through language barriers as well as cultural traditions when it comes to medicine,” she says.

In addition to having First Aid locations in all of the parks, they also offer care at state-of-the-art urgent response clinics to the hotel guests.

“We are the primary medical first responders at the resort, and can be dispatched to anywhere in our parks, hotels or parking lots,” she adds.

The resort is open 365 days out of the year, and the nurses work in all types of weather and physical locations.

“You could find yourself climbing down into a submarine or up the stairs to a treehouse. We work around entertainment like parades and support four, half marathons a year,” she adds.

They provide basic First Aid. But if the situation warrants it, the nurses assess and assist guests in getting to a higher level of care. Having a large population of people in the resort on any given day means the medical staff can see and respond to just about anything.

“So, our nurses need to have strong assessment skills and be comfortable in the first responder role and working with all age groups,” she says.

The Magic of Working at Disney

Talamantes feels the biggest highlights of being a nurse in a place like Disneyland is first, the cast members.

“In our own department, we truly are a second family. In my entire career, it's something I have never experienced to the level we have here. We are fortunate that we work alongside so many other departments who truly respect our team and are willing to assist us as needed,” she says.

They do their best to turn around a guest’s day when an unexpected situation arises which could impact their visit or vacation. But mostly, the nurses realize they are fortunate to work in a place that is rewarding on so many levels.

How To Apply for a Disney Nurse Position

When a position opens, it is posted on the Disney careers site for a certain location, as is true for all of the parks’ roles, said Melissa Britt, manager for media/external communications public affairs, Disneyland Resort.

“We have Disney Nurses at each site: Disneyland Resort, Walt Disney World Resort, Disneyland Paris, Tokyo Disney Resort, Hong Kong Disneyland and Shanghai Disney Resort. We hire year-round for various roles at the Disneyland Resort,” she says.

Qualifications for Disney Nurses

To become a Disney Nurse, one needs to be a Registered Nurse with a minimum of 5 years of experience, CPR/AED certified and have a valid driver’s license, says Talamantes.

They look for someone who has a calm, friendly demeanor, and an outgoing personality in order to engage guests of all ages. Helpful traits to have include kindness, patience and empathy.

A Disney Nurse needs to have strong critical thinking, problem solving and assessment skills, is confident working autonomously in a first responder role, and is energetic in order to be able to manage the physical nature of the job.

Salary range for Disney nurses
Britt says that they don’t typically provide salary ranges, since it varies by experience, location and responsibilities. For information on average salaries by state.

There are definitely perks when working for an international company like Disney. Some employees receive free entrance to theme parks around the world and discounts on hotels and merchandise.

“I don’t know of any other type of nursing specialty you can work and be able to have Mickey Mouse or a Princess come by to make an ill guest feel better. Disney nurses understand the magic and do everything they can to provide it for our guests,” she says.




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