CRNE June 2012 - page 3
Anyone started to prepare for CRNE June 2012?... Read More
0May 26, '12 by allicandoisprayMr. Del Ray is experiencing an acute exacerbation of right sided heart failure. Which of the following independent nursing actions should the nurse implement to limit spread of Mr. Del Ray's ankle edema?
1. Restricting his fluids
2. Applying elastic bandages
3. Performing range-of-motion exercises
4. Elevating his legs
2May 26, '12 by petethecanuck, BSN, RN1
My rationale: Patients with right sided HF are susceptible to systemic fluid overload. Restricting fluid intake will help mitigate edema in the lower extremities.
- I could see how answer 4 may look like a possible option. Elevating the patients legs could promote fluid movement and help with edema (in a healthy person). The fact this patient has RIGHT sided HF eliminates #4 as a possible option because the right ventricle has a lower ejection fraction and fluid is "backing up" into the venous system (causing an increased JVP, edema etc). Raising his legs and promoting venous return could in fact exacerbate his condition.
0May 27, '12 by mapleleafcnyeah I agreeeee. weeeeeh it will be in June 6. I am studying hard right now. whew!
0May 27, '12 by mapleleafcnwhat is the difference between no CPR and do not resuscitate request? Any samaritan nurse out there to explain. Thanks in advance?
1May 27, '12 by petethecanuck, BSN, RNDo not resuscitate (DNR) basically means no life saving measures will be undertaken (intubation, ACLS protocols etc) in the event of a code. Someone with a no CPR (chest compressions) order is giving consent to all life saving measures sans chest compressions.
0May 28, '12 by mapleleafcnthank you eh!
Any techniques in differentiating
Primary prevention versus secondary prevention?
Health promotion somehow, I intertwined it with primary prevention.
0May 28, '12 by petethecanuck, BSN, RNThink of health promotion as enabling someone to increase control over improving their health.
There are 3 levels of prevention.
Primary: Prevention of health problems or diseases before their onset and promoting health. IE) Immunizations, wearing seat belts, bike safety classes, safe driving classes
Secondary: The earliest possible identification of disease or health problems in asymptomatic persons. IE) Screening
Tertiary: Reduce the negative impact and complications in persons who already have a disease/health problem.
0I am very much confuse on this issue... Are we going to give Regular insulin before a major surgery? Why and why not?
number 2...Mosby comprehensive review book says child's first teeth are the upper central incisors then on the other page it says first to appear are lower central incisors...which is which
more quick challenging issues .... what could be the CRNE's point of view when it comes to medication administration. Are we going to give them on time, I mean the exact time or thinking that we are allowed to have 30 minutes before and 30 minutes after rule?
what could be the ideal time of medication administration?Last edit by NotReady4PrimeTime on May 30, '12
1May 30, '12 by NotReady4PrimeTime, RN Senior ModeratorQuote from mapleleafcnRegular insulin is short-acting. Think about what stress does to the diabetic person's metabolism.I am very much confuse on this issue... Are we going to give Regular insulin before a major surgery? Why and why not?
Quote from mapleleafcnThat type of question is SO unlikely to appear on the CRNE. But in response, most children cut their lower central incisors first.number 2...Mosby comprehensive review book says child's first teeth are the upper central incisors then on the other page it says first to appear are lower central incisors...which is which
Quote from mapleleafcnIt is absolutely impossible to give ALL medications at EXACTLY the ordered time. when you have 6 patients in 6 different rooms, all of whom have 6 medications due at 0800, it takes organization and efficiency to get all of them given within the 30-minutes-before-to-30-minutes-after window. Where I work, I only have 1 patient most of the time and it's still impossible to get all meds given at the exact time they're ordered for.more quick challenging issues .... what could be the CRNE's point of view when it comes to medication administration. Are we going to give them on time, I mean the exact time or thinking that we are allowed to have 30 minutes before and 30 minutes after rule?
what could be the ideal time of medication administration?
0Scenario: Just my imagination.
I am a nurse handling a MRSA patient and I am about to give a medication in liquid form. I am handing it to the patient. Suddenly on the other room I heard someone screaming for help. What to do?
delimma: patient safety
0Another imagination scenario of mine
A long term patient who is spinal cord injury. Insist that he wanted to have his favorite pin up nude photo of a woman in his room. What am I going to do?
Delimma: respect patient's rights?
confront the patient to have some decency in the institution
report to the unit manager
make a compromise like instead of nude why not a fully dress woman as a poster.
Think about this guys...and gals....Last edit by mapleleafcn on May 30, '12 : Reason: cannot read
0May 30, '12 by allicandoispraypete, i agree with you. 1 was my answer as well. I crossed out 4 immediately based on the R-sided HF. shockingly, 4 was the answer. i have done almost 3000 practice questions and this one still bothers me, i am just going to note this one off as an error. the rationale in the book says "elevation of an extremity promotes venous and lymphatic drainage by gravity" and the rationale as to why 1 was wrong is that "this action is taken cautiously and should be the decision of a physician."
what gets me is that there was another similar question just before this question in the same book that states Mr. Mars has CHF and pulmonary edema. Which of the following nursing actions would help to alleviate his respiratory distress?
1. elevate lower extremities
2. encourage frequent coughing
3. place him in an orthopneic position
4. prepare him for modified postural drainage
Answer. 3 in case anyone is wondering HOWEVER, the rationale as to why #1 is wrong? (which i crossed out first) is that elevation of extremities should be avoided because it increases venous return, placing an increased workload on the heart! so wouldn't elevating the patient's extremities essentially be contraindicated in patient's with HF? confusing! if anyone agrees with the initial question + answer please share as to why you agree.
with that said thanks pete for your active involvement in this thread. i think you will blow this exam out of the water!
Exam is in 7 days! How do you all feel?Last edit by allicandoispray on May 30, '12 : Reason: sp