CRNE June 2012 CRNE June 2012 - pg.3 | allnurses

CRNE June 2012 - page 3

Anyone started to prepare for CRNE June 2012?... Read More

  1. Visit  petethecanuck profile page
    #26 0
    Shouldn't be a problem to post review questions.
  2. Visit  allicandoispray profile page
    #27 0
    Mr. 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
  3. Visit  petethecanuck profile page
    #28 2
    1

    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.
  4. Visit  mapleleafcn profile page
    #29 0
    yeah I agreeeee. weeeeeh it will be in June 6. I am studying hard right now. whew!
  5. Visit  mapleleafcn profile page
    #30 0
    what is the difference between no CPR and do not resuscitate request? Any samaritan nurse out there to explain. Thanks in advance?
  6. Visit  petethecanuck profile page
    #31 1
    Do 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.
  7. Visit  mapleleafcn profile page
    #32 0
    thank you eh!

    Any techniques in differentiating

    Primary prevention versus secondary prevention?

    Health promotion somehow, I intertwined it with primary prevention.

  8. Visit  petethecanuck profile page
    #33 0
    Think 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.
  9. Visit  mapleleafcn profile page
    #34 0
    I 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
  10. Visit  NotReady4PrimeTime profile page
    #35 1
    Quote from mapleleafcn
    I am very much confuse on this issue... Are we going to give Regular insulin before a major surgery? Why and why not?
    Regular insulin is short-acting. Think about what stress does to the diabetic person's metabolism.

    Quote from mapleleafcn
    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
    That type of question is SO unlikely to appear on the CRNE. But in response, most children cut their lower central incisors first.

    Quote from mapleleafcn
    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?
    It 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.
  11. Visit  mapleleafcn profile page
    #36 0
    Scenario: 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
    accountability
    infection control

    Any opinions?
  12. Visit  mapleleafcn profile page
    #37 0
    Another 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
  13. Visit  allicandoispray profile page
    #38 0
    pete, 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

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