Content That Joe V Likes

Content That Joe V Likes

Joe V Admin 55,833 Views

If you made it this far--thanks for visiting. My name is Joe. I'm's Information Architect. I'm the tech behind the scene. I'm in charge of everything that makes tick. Isn't she a beauty! I consider myself to be extremely fortunate, because I love what I do.

Sorted By Last Like Given (Max 500)
  • Jul 19

    I am getting rather down and frustrated. I am aware that they want experience but how can I get any experience if no one is willing to give me a chance to show that I want to work hard for them and they won't regret their decision... all my classmates have jobs now and I am still in search for a chance. I have given my resume to friends to critique, but they all say it is great but the experience area is lacking. I have gotten references from friends, wrote the nurse manager on the floor, and now I feel like I will stand in front of a hospital with a sign saying "RN will work for experience". I would love your help in any way.

    Dear Discouraged,

    First of all, congratulations on passing your NCLEX, RN! Hang in there- you will land a job. It’s been a relatively short time, so don’t despair. You do need a plan.

    In today’s market, it takes strategy to land a new grad nursing interview, stand out, and WOW them. Your joke about standing in front of a hospital with a sign saying “RN will work for experience” is funny (although I know you are not feeling it right now) and actually on target for “standing out from the others”, but too extreme.
    Read “How to Land Your First Nursing Job” for helpful hints.

    You say that all your classmates have jobs. In thinking about it, what have you determined is the difference between you and all your classmates? This is key. You all have the same qualifications. You say they have landed jobs while you have not.


    Did you wait to apply until you passed the NCLEX? For readers out there, start applying in your last semester. Waiting until you pass your NCLEX can put you months behind your classmates and competitors. Many new grad programs accept applicants into the program contingent upon obtaining their nursing license prior to the start of the residency program, or close to it.


    References from friends do not carry weight. You need a reference from a Clinical Instructor who supervised you. References from clinical instructors carry a lot of weight for several reasons. They observed you during your clinical rotations when you were under stress to perform. Clinical instructors often have strong ties to the local hospitals, and many even work in the hospitals. Their recommendation is invaluable.

    Again, a note to nursing students who may be reading this- obtain these all-important references while you are still in school. At the end of a clinical rotation, ask your instructor for a letter of reference. They should be on school letterhead (but they know this).


    If you are not landing interviews, then your resume may be the culprit. The fact that your friends say your resume is “great” - again, does not carry weight. Read “Revamp Your Resume” and make sure your resume is succinct, tailored to each employer, and contains pertinent keywords.

    Your resume must be error free and visually appealing. Avoid lengthy descriptions of your clinical rotations- they do not add value. It’s a given that you “administered medications” and “inserted Foleys”- but these do not set you apart from other candidates.

    Application Letter

    Many employers ask new nurses applying to a new grad residency program to submit an application letter along with their application.

    They may ask the applicants to answer one of a few choices of questions in a short essay. Examples of these type of questions may include “Why did you become a nurse?” “Why do you want to work here (at St. John’s, or Adventist Health, etc.)?”

    Often times a point system is employed to rank new grad applicants. For example, applicants can score 1-9 points. Take special care with your letter, as it is worth points in the application process.

    Interview Prep

    What have you done to prepare for your nursing interviews? Have you anticipated commonly asked questions, such as “ What’s Your Greatest Weakness?” and
    “Tell Us About Yourself”....because you will be asked. You must have two or three story form examples you plan to use that illustrate your skills. Here’s an example of what nurse interviewers really think.

    Try to think like an employer. Employers are looking for employees who fit in. Nurse managers are protective of the culture and work ethic they have promoted. During an interview, if you can show that you fit into the culture and are eager to learn, you stand a good chance.

    Good luck, and keep your spirits up.

    Nurse Beth

  • Jul 11

    Herbal supplements are popular, as are street drugs in modern America. Both are misused. Then there are those that fall into both categories. Salvia (Salvia officinalis - known better as Sage) is an herb that can season your stuffing, and help with your digestive issues, while a different type of Salvia (Salvia divinorum) can be used as an hallucinogenic. We will look at the Salvia divinorum in detail, it’s history, describe hallucinogens and how salvia is subject to that definition, and its reaction in the human brain.

    What is Salvia used for?

    Herbs are plants in which any part or parts can be used in food, perfume, or medicine. Herbs have been used since the beginning of time, just their smell can soothe the soul and their taste can evince joy.

    Being part of the mint, sage family, Salvia is used as a medicinal herb to help aid people with diarrhea and regulating bowel habits. It is an easy to grow annual with pretty purple blue blooms. The Black and Blue variety attracts hummingbirds if you are a bird lover.

    The stems, flowers and leaves are used for their medicinal, aromatherapy, and culinary uses. Salvia is also used as a deodorizer and disinfectant. Herbs have multiple purposes, making them a delight to grow and use. However, when using herbs for medicinal reasons, always check with your doctor. As of now, there are no approved medical uses for Salvia in the United States.

    History of Salvia

    Salvia is native to Mexico, for hundreds of years, the Mazatec Indians ( Sierra Mazateca, Oaxaca Southern Mexico) have used salvia for medical practices, shamanism (practitioner reaching altered states of consciousness to interact with spirit world), and divination (gaining insight through ritual) according to the article, “What Are the Effects of Using Salvia” by Kathleen Davis FNP.

    The indians would brew a tea from the Salvia leaves, or roll fresh leaves to chew without swallowing so it is absorbed into the bloodstream and not be deactivated in the gastric juices.

    Because of salvia’s fast action and low addictive and side effects, it is popularly used as an hallucinogenic among young people. Chewing on the leaves, inhaling, and extracts under the tongue are ways that Salvia is used as a recreational drug. Being legal in most states, it can be purchased in smoke shops and on the internet. Tennessee, Oklahoma, Delaware, Louisiana, Maine, and Missouri have declared Salvia illegal according to the article on WebMd, “Salvia Divinorum Overview Information.”

    Salvia as an Hallucinogen

    According to Davis, Salvia’s hallucinogenic effects are similar to LSD. Salvia is popular because it produces visual hallucinations quickly with low side effects. Also, due to the fact that Saliva has little potential for addiction makes it popular.

    Salvia is not just grown in Mexico, but parts of the United States. Users can experience time and space distortions with its most “potent naturally occurring hallucinogen”. It can cause slurred speech along with loss of coordination.

    Delaware took action after a teen committed suicide in 2007 while using Salvia passing “Brett’s Law,” putting Salvia in the class of schedule 1 controlled substance. The same year the DEA put salvia on the list of drugs that they were concerned about, calling it a risk to its users.

    Salvia possesses an active ingredient called “Salvinorin A, a kappa opiate receptor (KOR) agonist”. The agonist stimulates some central nervous system receptors in the brain. This is where much of the human perception is located.

    Effects of Salvia are felt within two minutes and can last up to 30 minutes when smoking such as in a hookah, but when taken orally the effects are lessened but can last from 1 to 3 hours.

    Those most likely to use Salvia are wealthy, white males between the age of 18 and 25 according to Davis. In the survey, “2015 Monitoring the Future Survey,” showed that just below 2% of 12th graders had used Salvia in the past year, with over half expressing no desire to use it again.
    In certain vulnerable people the space and time disturbances can last hours after the effects are gone when the dose is 500mg or above.

    Health risks listed in Davis’ article when using Salvia can be:

    Lack of coordination
    Slurred speech
    Difficulty concentrating

    How Does Salvia work in the brain?

    In the article, “Brain’s Reaction to Potential Hallucinogen Salvia Explored” a chemist named Jacob Hooker is one of the first to study the effects of Salvia on the brain in- primates using PET scans. The purpose of the study was to track how salvia travels through the brain to see its relevance for medicinal purposes and understand why it is used as a recreational drug.
    Salvia’s peak concentration was found to be 10 times greater than that of cocaine at the fast rate of 40 seconds. The most concentrations of the drugs were found in the cerebellum and the visual cortex which makes sense that the effects are felt in motor and visual function of the brain. Hooker concluded that as little as 10 mcg is needed for a psychoactive response in humans. Because it does not give people a euphoric sense, it can be studied for pain control and mood disorders. They plan to do more research on Salvia in the future.


    Salvia can be dangerous, even deadly. Because it can easily be bought, the thought may be that is not harmful. For those touched by drug abuse, this can be scary. Hopefully as research comes in, more regulations will be put into place making it illegal to buy as a recreational drug. Keep enjoying it in your food and grow it in your garden for its beauty.

    If you know someone who has tried Salvia as an hallucinogen, please share your story with us.


    Davis, Kathleen FNP. “What Are The Effects Of Using Salvia?” May 2, 2016. MedicalNewsToday. 2 May, 2016. Web.

    DOE/Brookhaven National Library. “Brain’s Reaction To Potent Hallucinogen Salvia Explored.” April 28, 2008. ScienceDaily. 2 May, 2016. Web.

    “Salvia Divinorum.” WebMD. Nd. 2 May, 2016. Web.

  • Jul 7

    Scroll down to WHAT I LEARNED to get what you came here for.

    Everyone studies differently, and what works for me will not work for everyone.
    None of the tips are absolute guarantees: there will always be a question that seems to contradict what you'll read here.

    Fluff about Ravenpuff:

    I graduated from a BSN program in early May 2016 and took my exam in late June 2016. I was a B student who felt more capable at my clinical site than I did in the classroom. I also worked as a CNA during nursing school (not essential but highly recommended).

    How I studied for the NCLEX:

    Weeks 1-2: Focused Review

    I used a hard copy of Lippincott Q&A NCLEX-RN to help me determine which organ-systems I was struggling with. I aimed to get 60% correct for each chapter exam that I took (though did not complete every single chapter). Turns out I was great with pulm, cardiac, and renal, but I was not good at GI and heme/onc, so I did extra practice questions on GI and heme/onc using a couple of Davis NCLEX-RN ebooks that were available via my university library.

    Weeks 3-4: Comprehensive Review

    Once I was able to hit around ~60% correct for my organ-system practice exams in Lippincott and Davis, I moved on to comprehensive reviews with the Holy Grail of NCLEX reviews, aka UWorld. Uworld is a bank of about 1800 questions, and the program lets you take exams of 75 questions max at a time. I aimed to complete about 2-3 UWorld tests per day (each test with the max of 75 questions) leading up my NCLEX. By the time I took my NCLEX, I was averaging about 65% on Uworld exams. UWorld will make you confident in your ability to tackle the SATAs and prioritization questions, and will virtually eliminate the need for you to consult your nursing textbooks because its rationales are logical and detailed. I did dabble with a Kaplan review book that I borrowed from my local library, but at the risk of sounding like a Uworld snob, I thought that Kaplan's rationales were very disappointing and the questions were not challenging enough.

    Day of the Exam

    After checking in and sitting down at the computer, I put on the noise-cancelling headphones and took several deep breaths. I had one math problem, several prioritization questions, and a handful of SATA, and a good number of questions that tested my knowledge of PPE/isolation precautions. After 75 questions, it stopped my exam. It was a very hard test, and I was crushed by the end, thoroughly convinced that I might as well have wiped my tears and snot on the computer screen instead of taking the exam as seriously as I did.

    After walking out of the testing site, I went to the public restroom and cried some more, then went home and listened to some punk rock as loud as I could possibly tolerate.
    I made plans to make a new study schedule and cancel a whole bunch of events I had already planned to attend for the summer,

    But....I checked my BoN site a day later and saw "Examination Status: passed"
    And you can do it too! was an essential resource for positive encouragement and study tips, so I'll pay it forward by sharing with you my NCLEX strategies.


    When prioritizing order of patients to be seen, ask yourself…

    ~ Who has a condition that involves a threat to their Airway, Breathing, Circulation, or consciousness (we'll call it ABC+C)? Put this/these patients at the top of the list
    -of your ABC+C patients, which of them are in imminent (aka immediate) danger? (at risk for harm vs facing actual harm?)
    -neuro changes from expected baseline are usually a priority finding, especially if it was a neuro change plus vomiting because of the association with increased ICP
    -life > limb (in other words, saving a pt's life takes priority over saving another pt's leg or arm)

    ~ Does the patient potentially have an issue based on the data given, or does the data provide evidence for a problem that is present at this moment?
    -remember that a threatened air way takes priority over a loss of blood. What does it matter if you stabilize your patient's fluids if they can't breathe?

    ~ But wait, all my patients seem to be stable! If that is case, then ask yourself...
    Which patient is at risk for, or already has an active infection?
    -but remember, ABC+C is priority over active infection; for example, you'll die quicker from a ruptured abdominal aortic aneurysm than you would from peritonitis
    -usually the least unstable patients are the ones who is exhibiting s/sx that are
    a) not imminently life-threatening
    b) expected to be seen in their given diagnosis/condition
    For example, compare the post-op pt with hypoactive bowel sounds (expected in post-operative patients) vs the traction patient whose pin sites are oozing purulent drainage (not expected for traction patients!)

    Once you have narrowed your answer to your two most critical patients, ask yourself...
    “Who will die the soonest and/or suffer the most harm if I don't tend to them now?”
    and this will usually guide you toward the correct answer. Again, check your ABC+C and risk of harm vs. actual harm.

    ~ Toxic megacolon is probably the only instance in which a bowel obstructed patient could take priority over your other patients (unless of course another patient is at risk for threatened ABC+C) because of its association with bowel perforation and subsequent risk for infection of all the other internal organs
    -furthermore, toxic megacolon is an awesome band name, or an awful band name, depending on who you ask

    If the prioritization question asks you to prioritize pts based on their lab values…

    ~ First determine which labs are abnormal. If only one is abnormal, that one is your answer.

    ~ But if more than one lab value is abnormal, determine which one will most likely lead to imminent death or harm, considering what you know about the patient in the question? The most threatening lab value is usually the right answer.
    -use ABC+C to guide you here; usually, an abnormal BUN/Cr is less threatening than a set of abnormal ABGs.

    ~ You can usually eliminate the choice(s) containing an abnormal lab that
    a) is expected for the pt's given situation (eg. low Hgb in a sickle cell pt or high BNP in a CHF pt)
    b) does not imminently threaten ABC+C and consciousness

    For example: let's say you have two liver failure patients and both have abnormal labs.
    Pt A has low albumin Pt B has high ammonia.
    Both of these findings are abnormal, but which lab is most threatening to the pt's ABC+C?
    Recall that high ammonia levels are associated with hepatic encephalopathy, which threatens the patient's neuro system, which therefore threatens their consciousness.
    So, I would attend to Pt B first.

    When in doubt Hypo- or hyperkalemia almost always takes precedence over all other abnormal labs due to risk of fatal cardiac arrhythmias.

    Petechiae and purpura are usually a critical findings because of their association with thrombocytopenia and therefore indicate that the patient is at risk for bleeding

    Mild temps are expected in the immediate post-op period.

    Hypokalemia increases risk for digoxin toxicity

    Live vaccines should not be given to the pregnant or the immunosuppressed. These vaccines include the NASAL version of the flu vaccines, the MMR vaccines, and varicella vaccine

    Keep suction equipment at the bedside for any patient who has a condition that threatens to obstruct their airway (trach pts, TEF and/or EA, surgeries around the throat area, etc. )

    When you are doing patient education about drugs:

    ~ Remember there are expected side effects and then there are life-threatening side effects that will harm a patient's ABC+C. Therefore, the priority education topics will almost always be related to ABC+C
    -This strategy sometimes comes in handy when the question asks you to educate the patient on a drug whose name you don't recognise.

    ~Know which drugs are nephrotoxic because the answer usually involves telling the pt should to drink lots of water with that medication

    ~If the question is about lithium, remember that you want to prevent the pt from becoming hyponatremic, as this will increase risk for lithium toxicity.
    -lithium has a narrow therapeutic range; keep it at (0.6-1.12 mmol/L) and definitely keep below 1.5

    ~If the question asks you to choose the most important point to emphasize when teaching about a medication, choose the option that is most unique to that drug (eg. almost all drugs are to be stored in a dark cool place, but if you know that the drug in the given question causes orthostatic hypotension, choose the answer relates to this side effect)

    ~ Antacids can decrease the effect of pretty much every medication, so don't take meds with antacids.
    -pregnant women should avoid antacids with aluminum or sodium

    ~ When given a list of meds and the question asks to you choose which med order(s) to clarify with the prescriber, ask yourself…
    -which med has side effects that will worsen the s/sx of the pt's current condition?
    -Hepatically metabolized meds prescribed for liver patients, or nephrotoxic drugs in renally compromised patients are usually the ones to be questioned
    -also have a general idea of what meds are NOT for pregnant ladies (metformin comes to mind here)
    -make sure the prescription has five rights

    The questions presents some data, then asks what to do next for that patient. How do you decide the next course of action?

    ~ Ask yourself which choice most appropriately addressed the problem that the assessment data was describing (if the issue is an airway problem, which of the choices will maintain a patent airway?)

    ~ Ask yourself if further assessment was needed.
    Sometimes you do assess further, especially if the question about a patient concern then presents some data that contains everything you need except for an important detail. For example, let's say that the question gives you a CHF pt who needs her digoxin. The question gives you the pt's metabolic panel (all normal) and vital signs (all normal) but oddly enough, potassium is missing from the metabolic panel. Since hypokalemia increases risk for digoxin toxicity, the next course of action would be for the RN to further assess the pt's potassium level before giving the digoxin.

    -however, do not delay interventions if you have all the data you need, especially if the patient's ABC+C is threatened

    - if you are deciding between further assessment vs taking action, ask yourself if any additional data will significantly alter your intervention, or will it just tell you what you already know?

    RNs CANNOT OBTAIN CONSENT. For some reason, I was always tripped up by this, so learn from my mistake. It is the doctor who obtains consent, not the RN. The RN's role is to verify that the patient gave consent, document that consent was given, and clarify questions about the surgery (clarification is not the same as education about the surgery; the surgeon is the one who educates the patient)

    When tackling the ever popular SATA questions, be aware of the distracting choices that aren't necessarily bad nursing practice, but they don't address the stem of the question you're reading.
    For example, let's say the questions asks you to SATA all the things the RN does to prevent infection when accessing a CVC. One of the options is “waste the first 10mL of the blood draw.” It's not bad practice to waste the first 10mL of blood when doing labs (I think it's actually part of most facilities' protocols), but this action does not address infection prevention. A better answer is to “scrub the port for 30 seconds before accessing it.”

    Should you call the Doctor?

    ~ Check the other options to see if the Doctor would ask you to complete them before calling him.
    -for example, if you have a hypoxic patient, apply prescribed O2 first and check the patient's response. That way you have assessment details to give the Doctor before you call.

    ~ If you are unsure about the other options, ask yourself “will doing any of these other interventions tell me something I don't already know?”

    Application of heat/hot packs causes vasodilation, so REFRAIN FROM applying heat to anything that you don't want to vasodilate, such as the appendix (vasodilation could rupture it) or a leg suspected of containing a blood clot (vasodilation will dislodge the clot).

    Alcohol should be avoided entirely eg. “Pt needs further teaching when he says: “I can still enjoy drinking a glass of wine on Sundays.”

    People with gout should avoid what I like to call “cocktail party foods” which includes wine, cheese, alcohol, and cured meats (I hope I never get gout)

    Know thy Airborne vs Droplet Isolation Precautions

    I was having a hard time remembering which diseases were droplet vs airborne. So because I am lazy, I memorized just the airborne precautions because there are less diseases to remember. That way, if I encountered an isolation precautions question about a disease that wasn't one these four, I could assume that one in question was probably droplet.
    Herpes zoster

    The anatomy of pain

    Flank pain = kidney stones
    Peri-umbilical radiating to RLQ = appendicitis (and keep in mind that if the inflamed appendix bursts, the patient becomes at risk for peritonitis)
    RUQ pain radiating to the back = pancreatitis (radiates to back because the pancreas is a retroperitoneal organ)
    RUQ radiating to shoulder = cholecystitis

    If a pt is described as having some back pain AND the stem mentions that the pt has kind of cardiovascular condition or is returning from a cardiac diagnostic procedure, you should consider that the pt is probably are bleeding out from a ruptured aortic aneurysm

    Excess Magnesium and Excess Calcium will cause decreased muscle tone. Think of them as depressants. They depress sodium's ability to permeate cell membrane, which lowers cellular excitability.

    Almost any question involving the IV or PO contrast can be answered by addressing the need to ask pt about iodine/shellfish allergies and educating pt to drink lots of fluids in post-procedure period to flush out the contrast from the system (remember that contrast is nephrotoxic)

    When sending a pt to MRI, check for metal and babies/missed periods.

    Duodenal ulcer pain is relieved during a meal, but pain is returns after a meal.
    DURING meal= DUODENAL relief

    Strokes and their manifestations:
    Right side stroke patients will be appear to be “alright” because they act without awareness of their deficits: they move around normally, but they are impulsive, show poor judgement, lack depth perception, deny their deficits, and overestimate their capabilities.

    Left side stroke patients will appear “lousy” (Left and Lousy start with L) because they move slowly and cautiously, and experience depression or worthlessness from deficits

    When assigning a patient to a newly graduated RN, assign only the patients that...

    Require the most basic level care and basic level nursing skills, which includes
    -assessment of VS, lung sounds, swallowing ability, and gag reflex
    -maintain NPO status
    -prepare a basic pre procedure checklist
    -check for ABCs after procedure
    Basically, which patient is the least physiologically and psychologically complicated?

    In NCLEX-World (*eye roll*), the newly graduated RN should NOT care for:

    -new diagnosis of anything
    -new onset of anything
    -any patient with a newly prescribed IV drip involving multiple lab checks, weight-dose-calculation, or titrations according to current lab values; drugs like a heparin or insulin gtt (by “newly prescribed” I mean that the patient was not on the drip in the past)
    -any pts requiring extensive pre-op and/or discharge teaching that require advanced therapeutic communication (transplant patients comes to mind here)
    -patients with an acute onset of a condition requiring an advanced synthesis of various assessment information (I realize that this statement pretty much describes every patient you'll ever encounter in real life, but remember, this is the NCLEX-World)

    TPN should be administered forever alone, meaning don't hang another med or fluid with TPN ever.
    -if the TPN bag runs dry and there isn't a replacement in your med room yet, hang a bag dextrose in its place to prevent pt from becoming hypoglycemic

    Most drugs should be taken with meals, but some exceptions (meaning, pt should take these meds on an EMPTY stomach) that I can remember are
    -Iron supplements (encourage pt to take with juice or foods high in vitamin C. Avoid taking iron with milk)

    As other testers have recommended, do not delegate to LPNs and UAPs/CNAs what you as the RN can E.A.T. (educate, teach, or assess).
    -At the risk of offending the CNAs out there, it helped me to think that in
    NCLEX -World, the UAPs as basic-level mindless robots: mindless robots can measure I&O, take vitals, weigh pts, turn pts, feed pts, empty drains, obtain blood sugars, and ambulate with stable patients but that is pretty much it.
    -However, UAPs should not measure vital signs in the first 15 minutes of blood transfusion, nor should they ambulate with the fresh post-op patient
    *Again, these tips in the context of NCLEX-World only. Please understand that I do not think of real life CNAs as robots at all. I was/am a CNA. We are way more capable than mindless robots.

    Decorticate posturing vs decerebrate posturing

    -Decorticate posturing is characterised by flexion posturing, while decerebrate is mostly extension posturing. Also, “extension” and “decerebrate” are spelled spelled with lots of letter E's.
    -A transition from decorticate to decerebrate posturing is a worsening sign.

    Important items to study for Mother-Baby content included

    ~ pre eclampsia and eclampsia care, include assessment findings, Mag sulfate administration (know therapeutic mag levels, signs of mag toxicity)

    ~ If you see variables decelerations followed by accelerations AND this all occurred AFTER the mother reports a gush of fluid, RN should suspect cord compression

    ~ Types of placental problems
    -placenta previa covers the uterus and is characterised by painless spotting?
    -placenta accreta is a deeply attached placenta (accreta sounds like 'a creeper', which is a person who is too deeply emotionally attached to you… I know it's weird. but this mnemonic makes sense to me)
    -abruptio placentae (which sounds like a Harry Potter spell) is when the placenta abruptly starts to peel away from the uterus (are you cringing? me too) and presents with uterine tenderness
    - is often associated with mothers who used cocaine during pregnancy because of its vasoconstrictive effects.

    ~ When you look at fetal heart rhythms, decreased variability and late decelerations are BAD and correct answers usually involved...
    -turning mom on side or in knees-chest position
    -giving supplemental O2 and/or a fluid bolus (bolus boosts amniotic fluid volume to prevent further cord compression)
    -stopping the oxytocin drip if the fetus shows any sign of fetal distress

    If you take away nothing else from Mother/Baby…

    -FHR is 120-160 bpm
    -neonatal RR is 30-50
    -baby's heelstick glucose should be between 40-70
    -infants belong in a rear facing car seat in the back seat

    You won't be able to remember every detail for every drug, but I definitely invested effort in learning about

    -insulin (especially onset, peak, duration times for each type)
    -corticosteroids (especially its adverse effects)
    -diuretics (remember “spare”-onolactone [aka spironolactone ]spares potassium)
    - digoxin safety measures (count pulse, monitor serum potassium)

    Orange -colored urine is not an alarming finding in patients on antibiotics

    A high-pitched cry in an infant is almost always a priority finding.

    Someone on a nursing student forum once referred to lactulose as “Ass-Lasix for ammonia” After reading that, I never forgot the therapeutic action of lactulose again.

    Within your exam, NCLEX gives you fifteen 'experimental' questions that do NOT count against your score, but rather are used by test developers to ensure that the NCLEX is a fair exam. You will not know which of your questions are the 'experimental' ones.

    NCLEX is all about safety. When in doubt, choose answer that will make the patient safe.

    Be forgiving to yourself when you get questions wrong on your practice exams. This is a learning moment! Wouldn't you rather get a question wrong on a practice test than the actual NCLEX?

    If this guide has helped even just one or two people score better on their exams, I will be happier than a post-op patient with a cup of ice chips

    Feel free to PM me with feedback or corrections.


  • Jun 29

    I was visiting a very ill friend in the hospital where I work, and as I pulled up beside her bed, I leaned forward to hear her whispered words, “I hope I get that nice nurse again today.” I smiled because I knew just who she meant. On my visit the previous day, I had encountered her: professional, kind, competent, cheerful without being silly or inappropriate and deeply compassionate.

    As I left that day, I wondered to myself, “So what makes us ‘that nurse that everyone wants to have?’”

    Some people come by the necessary qualities quite naturally, being born with a sunny disposition and a penchant for perseverance through hard work. But most of us must cultivate the qualities that make that model nurse that we all long to be. We have to learn the balance between focusing on the patient and on their IV drip, numbers, labs; we have to learn to see the love in the family that interferes, knowing that they feel they are simply doing the right thing; we have to leave our home life at home and find ways to access professionalism from deep within our spirits when things outside work are not going well.

    In nursing school we learn the anatomy and physiology, the technology and some of the emotional resources needed. We observe our instructors and the nurses where we work and learn, always making mental notes about how we want to copy (or not!) their example. We can all look back and see the nurses that set the bar high—challenging us to be more than we are.

    I can think of a couple of nurse managers that stand out in my career:

    In one job, I had the same nurse-manager for twenty years—a true rarity in today’s mobile society. She was an example of caring and of continuing to encourage learning and growth through the years. She knew how to prod us along and how to lift us up when we were down. She could also be a great defender when we needed an advocate.

    In a hospice job, I had a great nurse manager, too. She worked under all kinds of corporate pressures to carve out that place of excellent patient care right in the middle of reimbursement nightmares, changes galore, and an ever-shifting staff complexion. She expected a lot, but offered a deep well of compassion, helping us all get through hard times.

    What are some ways that we can cultivate the qualities that help make us that nurse that everyone wants to have?

    Be technically competent while maintaining a spirit of compassion.

    Let’s face it, when we are sick, we want a nurse that knows her stuff. Being comfortable with the mechanics of caring for patients lowers our stress levels and allows us to have more presence of mind about our words and attitudes.

    Give each other the benefit of the doubt.

    Support one another. There is an expression that you may have heard, “Nursing eats their young.” Ouch. That is not very nice. But it does speak to our tendency to withdraw support when we feel someone is not pulling their load or doing a good job. Yes, there are some nurses that need to find other work, that don’t belong in direct patient care, but so many times there is much more to the story than is visible. Taking an attitude of listening, helping, encouraging, mentoring, not only contributes to their growth but it also makes our workplace more pleasant in general. So many times, I hear one side of the story from a patient or a visitor and then go to hear the nurse’s version. It’s surprising how often those two stories are widely divergent! I am always thankful when I withhold judgement and try to hear from all the parties involved.

    Work to cultivate a well-balanced life.

    Have fun! Do things you enjoy. Don’t let the passive activities (screen time) absorb all your leisure time. Push yourself to physical activity, to spiritual activity, to reading that fills you with wonder and learning. When we are able to find ways to renewal, then we are closer to being all we can be at work, too.

    Find a mentor, a confidant.

    We don’t need to process our work days every day, but there are times when a difficult day, left unattended in our souls, can lead to decay from within—troubling our sleep and haunting our days. Finding a person who can listen confidentially, or a journal where we can spill out our troubles, can get us through troubled times. We all make mistakes. We all have times when we don’t handle things well. Being perfect is out of our grasp. So when we slip up, the sooner we deal with it, the better able we are to carry on. It’s amazing how far a simple apology can carry us!

    Perhaps you can look back —or even at your current job— and find nurses that set a good example. If you were in the hospital would you want to have YOU for a nurse?

  • Jun 23

    Google worked with Harvard Medical School and Mayo Clinic to build a smart symptom search engine that doesn't leave you thinking that your headache must be a rare blood disease.

  • Jun 23

    We've all been taught the importance of washing our hands since we were kids. And when we got to nursing school, the importance was stressed even more. I don't know about you, but antibacterial soap and water is all we had when I hit the floor as a brand new nurse. Heck....we didn't even use gloves unless we were doing "sterile procedures", which did not include the handling of bodily fluids.

    Now, we have even more options for protecting ourselves and others from those nasty germs that are waiting to infect us. One almost feels naked these days without donning gloves as well as appropriate PPE.

    In spite of all the various types of PPE, we can all pretty much agree that frequent use of appropriate hand hygiene is the basis of protecting everyone involved.....whether or not they work in healthcare.

    There has been debate over the years about the effectiveness of hand washing vs. sanitizers when it comes to infection control in hospitals and other healthcare settings. Studies conducted by the National Center for Biotechnology Information (NCBI) found that health care workers follow hand washing guidelines as set forth by the CDC only about 40 % of the time. It is common sense that sanitizers are more convenient for the healthcare team, and thus would help in increasing compliance. But do we know how to use hand sanitizers effectively? How long must we rub our hands together for the gel to do their deed of sanitizing? Is a squirt and go method enough?

    Research presented June 18, 2016 at ASM Microbe 2016 (a meeting for the American Society for Microbiology and the Interscience Conference on Antimicrobial Agents and Chemotherapy) recommended that in order to kill bacteria, you need to rub for at least 15 to 30 seconds. There is no gain in effectiveness for rubbing longer than 30 seconds.

    How many of your workplaces have a policy for hand hygiene?
    Are there any punitive actions taken if you don't comply?

    To read more about how the study was conducted, please read Hand Hygiene with Alcohol-Based Handrub: How Long is Long Enough?

    For more allnurses articles about hand hygiene, go to:

    Hand washing vs. Sanitizer, What are the Facts

    Hand Hygiene Saves Lives, But Is It Realistic For All Nurses ...

  • Jun 23

    Do you need more options to enhance your user experience? You can now upgrade today. appreciates your participation in our nursing community! It is the members of this community who make this the vibrant and engaging community it is.

    We want to make sure your on-line experience on is fully enhanced. Therefore, we are offering options for you to personalize your experience.


    • Pro Access: $2.50 month
    • Ad-Light Experience: $2.50 month

    Lock in to this low introductory rate before the price increases. Upgrade today!



    Save $6 per add-on when you purchase annual plan @ $24 each. Lock into this low introductory price before price increase.

    More details can be found at.....

  • Jun 20

    This past weekend is still something that has struck fear into the core of my community, even though I live on the other side of the country. I’m not going to debate about how it could have been prevented, because hindsight is always 20/20. I’m not going to debate it because there are as many different ideas on how to prevent it as there are people who know about it. What I want to do is expose myself, and explain why something that happened so far away from me could affect me on such a personal level.

    No matter what you call it, LGBT(Q,+,A), QUILTBAG, or my personal favorite Alphabet Soup Gang... there is a community out there for those of us who don’t quite fit the norm. My favorite comes from the fact that we are all a bit alike, all a little different, and we’re all floating in this big huge bowl we call Earth. Also the letters change all the time depending on who you talk to and if I am going to offend someone for using the wrong ones, at least I’m going down in style.

    I get a little flack at times from the community, at times, for not getting it, because “you pass... no one knows unless you choose to tell them.” See, I’m not what most people think of when they think of the LGBTQ. Mostly because I don’t get all twiterpatted when I see someone posed in what someone would consider sexual nature. My response tends more towards “Oh… look at that… “and insert interesting bit of biology about their tattoo, a mole, or the muscle structure. I’m someone who dates for romance and companionship instead of physical attraction. I was married when I was younger. I’m Christian. I can easily come off as heterosexual with no time or too conservative to join the local dating scene. Personally I don’t care about someone’s gender. I date people for being interesting and kind hearted with similar interests. In the community I’m often referred to as panromantic. I don’t usually bother with a label though.

    At the same time, I’ve also been on the receiving end of attacks from people mad at me for not being interested in them. Be it because how dare I not be attracted, or because they think I just haven’t met the right person yet, or just because I find comfort being around the others with the same experiences. Many of my first experiences out into the world involved going to the local “gay bar” to sing karaoke with all the other people who just didn’t feel like they fit society’s expectations for them. Going to a friend’s place to support them because someone had threatened them.

    Our culture, as a community comes from the places and experiences we have been through. We’ve had the awkward conversations with medical professionals when they ask if we are sexually active and the follow up is about birth control or pregnancy, and we end up outing ourselves to strangers who are not always understanding. We’ve been bullied for similar reasons. Been told we don’t really exist. That we’re going through a phase. Sometimes by the medical community itself. We trade names of providers who are “safe” like most people trade the titles of their favorite books.

    It bothers me because… those people who were hurt and died… I have a common thread to them. I cried when I found out what happened. Those people were someone’s child, parent, cousin, friend... They remind me of my own monkey sphere of people I know. Even if it hadn’t been people I know… I’ve seen the threats towards LGBTQ and Muslim students at my school. I go to an awesome school in a progressive area. We are great and inclusive and that things like that still happen… is scary. It bothers me that media wants to focus on who did it and how, rather than the bright and brilliant people who are lost to the community.

    It’s something that should bother everyone. It should bother us all. Today it was the LGBTQ community. It’s happening in black communities. It happens in our schools. Even if we have no personal connection to what has happened, it should at the very least bother us, because who is to know what the next target of choice will be. If we can’t find a way to be bothered that people died because someone’s personally held belief was so strong they felt it was alright to kill someone… even if we disagree with the person’s lifestyle, they didn’t deserve this. No one does, and that bothers me.

  • Jun 17

    There are a lot of reasons a patient can be stressful for a healthcare provider. The diagnosis may be challenging, the situation could be demanding, or the patient is “difficult”. Whatever the reason, some patients cause healthcare providers’ heart rates to increase and blood pressure to rise. This reaction is totally natural. While many articles advise that people should remove themselves from situations that cause stress, healthcare providers typically don’t have that option or luxury during their practice.

    In the 2006 study, How Respected Family Physicians Manage Difficult Patient Encounters1, physicians describe successful methods to working with challenging patients. While this study is shared from a physician’s perspective, there are several options that can be very helpful for nurses and other healthcare professionals during these stressful encounters:

    • Acknowledge your emotions. It’s okay to feel stressed by a patient, but using that feeling to learn about yourself should be the goal. Discovering which emotions are causing you stress—frustration, anger, sadness, etc.—can help you learn and grow from those situations. Additional research has found that healthcare providers who acknowledge and accept their emotions have improved client relationships. Recognize that you cannot control the patient’s behavior and it is not your responsibility to change their emotion, but by acknowledging your own emotion, you have the control over your own reaction3.

    • Know your professional values. Some describe particular patient encounters as challenging when their professional identity is challenged. For nurses who value punctuality, a patient who is consistently late to their scheduled appointment could be very frustrating. Nurses who value improved health outcome may find a non-compliant patient challenging. Understanding your own professional values can help in identifying why a patient is causing you stress.

    • Understand your biases and judgments. When a patient gets a reputation as being ‘difficult,’ subsequent healthcare professionals often develop a similar prejudice. This inherited prejudice can lead others to treat that patient as difficult from the beginning and lead to an undeserved increase in stress. When giving report to another healthcare professional , avoid using negative adjectives (difficult, needy, etc.) to describe a patient’s behavior to stop this stressful cycle.

    • Talk to the patient. While this point sounds obvious, it is often sadly overlooked. Talking to the patient provides insight into where they are coming from and lays the foundation for empathy. It’s easy to assume that a grumpy person is always grumpy, but you won’t know otherwise until you learn about them by listening. Try acknowledging the patient’s feelings or verifying your observation. You may be drawing a wrong conclusion about your patient’s behavior. Maybe the patient is upset because they’re in pain, hungry, afraid, or lonely. Assume nothing about a patient, because they’ll often surprise you.

    While the suggestions above may help at work, there are many ways to manage stress outside of work as well, including: leading a healthy lifestyle of well-balanced meals, regular exercise, and sleep, discussing stressful events with co-workers or family, and acknowledging when you need additional help2.

    Managing your stress will never be a smooth road. Some days will be easier than others--just as some patients will be easier than others--but using the tactics above on a regular basis will enrich your coping abilities and lead to improved interactions for both you and your patient.

    In addition to better patient encounters, managing your stress can lead to improved health. Stress has been shown to induce headaches, increase fatigue, and contribute to long-term health issues like heart disease and high blood pressure. There are a multitude of reasons to manage your stress, whether it’s improved patient interactions, better health, or simply less headaches, so choose the reasons that motivate you.

    There are new and fascinating challenges everyday in the healthcare field, so consider managing your stress a new challenge. Stress-inducing patients and situations are a struggle in the healthcare field, but you can always strive to control your reaction to them.

    1Elder, N., Ricer, R., Tobias, B. (Nov-Dec 2006). How Respected Family Physicians Manage Difficult Patient Encounter. Journal of the American Board of Family Medicine, 19(6). Retrieved from How Respected Family Physicians Manage Difficult Patient Encounters

    3Sherman, Rose O, EdD, RN, NEA-BC, FAAN. American Nurse Today, Dealing with Difficult People. May 2014, Vol 9. No. 5. Retrieved from Dealing with difficult people - American Nurse Today

    2CDC. (2 Oct 2015). Coping with Stress. Retrieved from Tips for Coping with Stress|Publications|Violence Prevention|Injury Center|CDC

  • Jun 16

    I have been a Nurse for five years, I love it. I work in a skilled Nursing facility, and I am a summer camp Nurse. Those are my two loves.

    Part of my job as a Nurse in a skilled Nursing facility is to give sad news, the other aspect is to be a Nurse to rehabilitation patients. We have hospice patients as well as many geriatric patients, so the sad news tends to be related to advising a family that a loved one is moving towards death. Our rehabilitation patients typically have a goal of returning home. They participate in PT, OT, and ST, all in an effort to regain their strength. The largest hurdle here is pain control. Surgery hurts, PT and OT hurt, and pain control is vital to a patient's success.

    I was a relatively healthy 31 year old female. I took a prozac a day and lamotrigine to manage my Bi polar sub-type II disease, it worked very well and I had been stable for years. I took a BP pill, but I am active, 5'6 and 132 pounds, so weight loss was not going to manage this case of hypertension. I was working as a Nurse, living life, having fun, so I considered myself fortunate.

    It was June 19th of 2014, just about three weeks prior my 32nd birthday, when those three words fell into my life "You have cancer." I felt a lump in my breast in early spring, so I went through all of the steps a patient normally would when they suspected a problem. I suspected a problem, but not Breast Cancer. I was diagnosed with Infiltrating Ductal Carcinoma. It was a nuclear grade of 3, 1.7 cm, and was ER+ PR+ and Her2+. I had an aggressive type of breast cancer, but I had zero family history. No explanation, no faulty DNA or genes, it was just a fluke. I began to grieve, I became angry, sad, strong, and defiant all at once. My life, my plans, what would become of them? My risk of recurrence was high, would I accomplish my dreams? Would my husband be able to handle this? What would I do? I made choices regarding my care. I saw specialists, attended support groups, and armed myself with information related to a disease that I was not accustomed to.

    I made the choice to have a bilateral mastectomy with reconstruction, and afterwards I would begin chemo. I went through surgery, and recovered well. I had a Bard port a cath placed for chemo, and I shaved my head prior to my first cycle. I also gave myself a pink mohawk, because when have I ever had a chance to do that?!

    For the first time in my life I understood what surgical pain felt like. I grasped it's intensity, it's hopelessness, and it's ability to be relieved. I experienced having a foley catheter post surgery, as well as it's removal. For one day I was unable to place my hands in a position to wipe my own butt. It was a humbling experience to feel that vulnerable, to NEED that help. I took more colace those weeks than I ever had my entire life, yet I still ended up with an impaction. Yes, I handled that myself. It sucked, but I experienced it. Chemo left me nauseated, unable to work, and further dependent on people to care for me. The Oncologist said that he had never seen someone as young as myself have such a reaction. My hemoglobin went down to 5.2, I earned my first blood transfusion for that. I still have my armband. I quit chemo after 4 of the planned 6 rounds due to poor quality of life. I also quit Herceptin 8 months into a 12 month plan. I found a new Oncologist whom I felt was more supportive, and she is amazing.

    I returned to work 2 months ago. I saw the healthcare world through a Nurse's eyes and a patient's eyes. I have experienced both worlds. I have an intimate understanding of what pain control does for quality of life and healing. I no longer look at a narcotic card and occasionally think "Wow, that is a high dose." I took that dose, maybe even more sometimes. I have an intimate understanding of vulnerability, losing the ability to care for ones self, and grieving the possibility that life may not turn out how I had hoped. Giving bad news comes with slower, more thoughtful words. I know what it is like to hear bad news, and the way it is relayed matters more than I have ever known. I have experienced pain, loss , sickness, and the need to make my wishes known in the event that I cannot do so. I truly understand quality of life over quantity.

    I offer the voice, touch, care, and compassion of someone who has been through hell and back. I am a better Nurse because I have experienced what a patient has. I have had the ultimate Nurse/patient relationship.

  • Jun 15

    AWARENESS is the first step before you can take any kind of action. If you don’t know what you need, you won’t know what action to take. There are always signs that indicate you are ready for change but sometimes we miss them, disregard them, misinterpret them or blame others for them. Here’s an example.

    In my last job as an employee, I had a great reign for 18 years as a wellness specialist for a major medical center. It was a dream job because my boss, who was a visionary, believed in empowering his employees to determine what needed to get done and then left us alone to do it the best we could. For me that was a gift, because I am very creative and work best when I can control my destiny and am not micro-managed. Our department did great things during his tenure and we were all very productive, had a lot of fun and loved coming to work every day. But then things changed.

    A corporate merger occurred, my boss moved on, our team was split up and we were all sent to other departments to work. I was miserable. But I told myself I could stick it out for the next 5 years until I could take an early retirement. Besides I needed the paycheck and benefits! Well that idea lasted for about 2 years when I started to succumb to stress-related disorders that required multiple referrals to physicians, occupational therapy, and finally to a counselor where I was told to learn to live with pain.

    Finally, the light bulb went off and I realized I had become someone whom I am not. I am not a person who is in pain, has no joy in my work, has a negative attitude, has lost her creativity and hates to go to work every day. Instead, I am a happy, positive, creative person who loves creating exciting and meaningful programs that help people lead better lives. So what happened to the real me? (Does this ring true for you?)

    Apparently I had to be in so much pain that I finally got it. AWARENESS occurred and I knew I had to change. Here’s a helpful quote from Abraham-Hicks that says it all.
    Sometimes your Source will lead you to an awareness of a problem because it is part of the path to the solution.

    I now recognized the path I was on was not only wrong for me, but my health had taken a toll as well. And Nurse Wellness (AKA – ME!) was always a health role model so I knew I had lost myself somewhere along the way. Time to take charge and do what I needed to do to get back to being ME! So I took some vacation time, had a heart-to-heart talk with myself (and my financial advisor), discussed my options with the HR Department and learned I could take an early retirement immediately. Talk about having a new lease on life!

    With that weight lifted, I was able to create my exit strategy and start taking steps to move out of that job and into my next adventure as a wellness business owner. Note – within 6 months of leaving that nightmare, all my stress-related symptoms disappeared. A big message that we are able to heal ourselves once we become AWARE of what our symptoms are telling us.

    Awareness is like the sun. When it shines on things they are transformed. Thich Nhat Hanh

    So what about you? Does my experience resonate with your life experience? What is your story? How did you become aware of your need to change? What steps did you take? Would love to have you share so we all can learn from each other.

  • Jun 15

    Time to prep for surgery!

    Your wife said it was ok, just stay still...

  • Jun 14

    The Survey

    In January 2015, invited members and readers holding an active nursing license via the allnurses site as well as newsletters, emails and facebook to participate in a 10-minute online survey about nursing salaries. Respondents were asked 20 questions to characterize their educational background (degree, license), main roles as nurses, employer type, experience level, geographic location, etc……. After just 2 weeks from January 22 through February 3, more than 18,800 responses were received.

    After reviewing the results, feel free to post your questions and comments. We can all learn from each other's input.

    Respondent Profile

    As shown in Figure 1, the majority of the respondents have a Bachelor’s or Associate’s Degree in Nursing(39.23% and 38.89% respectively), followed by Diploma (14.81%), Master’s Degree in Nursing (6.38%), PhD (0.29%), Doctor of Nursing Practice(0.29%), and Doctor of Nursing Science(0.10%). With the difference in the number of BSN (6,891) and Associate (6,831) respondents so slim, it will be interesting to see what effect the mandates of some health systems requiring BSN or higher will have on these numbers in future surveys. To see what allnurses readers are already saying about this, go to BSN and Associate Nurses are Neck and Neck. Will this change?

    FIGURE 1

    Figure 2 shows that the majority of respondents were overwhelmingly RNs (82.39%). A couple of questions this brings to mind: are fewer nurses beginning their career as LPNs/LVNs (14.84%), and will the number of APRNs (2.09%) increase fast enough to help meet the needs of a rapidly growing population in need of more autonomous healthcare providers.

    FIGURE 2

    When asked, “Are you a manager or supervisor?” 17.58% (3,316) responded YES, while 82.42% (15,542) answered NO.

    In response to the question, "What percentage of time is spent in direct patient care?", half of the respondents(51.85%) spend 75-100% of their time in direct patient care while 8.79% spend less than 5% in direct patient care. (Figure 3)

    FIGURE 3

    It's not any surprise that the survey revealed that 92.26% of respondents are female and 7.74% are male.

    FIGURE 4

    FIGURE 5

    Experience: Figure 6 show that 62% of the respondents have 10 years or less experience.

    FIGURE 6

    Additional demographic of our respondents:

    • 82% work full-time; 11% part time; 7% other
    • 55% work at a Not-for-Profit facility
    • Facility Size: 25.47% less than 100; 21.45% = 100-300; 15.93% = 300-800; 11.94% = 800 - 1500; 11.54% = 1500 - 3000; 13.67% = more than 3000
    • Population Setting: 45.38% Urban; 32.15% Suburban; 22.47% Rural
    • 56% of nurses work in a hospital. To see the other places that top the list, read Where Do Most Nurses Work?

    FIGURE 7

    FIGURE 8

    FIGURE 9 - Total Number of Respondents by Primary Specialty


    The interactive charts below will allow you to customize your view to include various filters that will affect the range of figures shown. You can do this by selecting items in the drop down menus at the top of the charts. Be sure to hover your cursor over the chart for more details.

    These salary figures do account for cost of living indexes, which can greatly affect the value of salaries. Generally, the cost of living is highest on the West Coast and in the Northeast. The states in the South, Midwest, and sections of the Mountain West have the lowest cost of living. For more discussion about this, please read What States Pay the Highest and Lowest Nursing Salaries?

    Although women dominate the nursing profession, do men make more money? - Read what our readers have said. Look at interactive graphs below and see what you think.

    FIGURE 10 - Annual Salary Base Pay by Gender

    FIGURE 11 - HourlyBase Pay by Gender

    FIGURE 12

    FIGURE 13

    FIGURE 14

    FIGURE 15 - Avg Salary by Degree/State

    FIGURE 16 - Annual Salary by Degree/State

    FIGURE 17 - Avg Annual Salary + Hourly Pay by Degree/State

    FIGURE 18 - Annual Salary + Hourly Pay by Degree/State

  • Jun 14

    I'm surprised WV isn't in the bottom 6. Woohoo a list we're not on the bottom of!

  • Jun 14

    Well I been a RN almost 4 years now 2 years as a travel nurse. From my experience this is how much I got paid

    NC $22hr and $3 night different

    LI, NYC as a travel $65 hourly

    NJ $55 hourly as a travel

    NJ $45 hourly as a staff will start next month cause I need benefits