Companion2thewind 4,068 Views
Joined Apr 26, '12.
Posts: 12 (17% Liked)
Wow, one night is a good name for this, look at this ingredient list
Almost everyone has experienced it: the sensation of butterflies in your stomach as you prepare for a presentation or an appearance in traffic court. The dry mouth that makes you feel like you're spitting cotton. The rapid heart rate and slight shortness of breath that characterize a normal response to stressful stimuli. In other words, you're feeling anxious.
Now imagine those sensations writ large. Instead of butterflies, you feel nausea and may even vomit or experience diarrhea. Your hands tremble visibly and your voice shakes whenever you try to speak. Your heart pounds; you break out in a cold sweat; your throat closes up. And worst of all, you have the horrid suspicion that if you don't run away from the situation, you just might have a heart attack and die.
Anxiety disorders are among the most common mental illnesses in early 21st century America. Tens of millions of men, women, and children suffer from one or more of these maladies, which include---but are not limited to---obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and the phobias. What's more, anxiety goes hand-in-glove with many of the major psychiatric illnesses, particularly the affective disorders.
Almost any event that occurs in the course of one's life can contribute to the development of anxiety that rises to the level of impairment. Childhood trauma, such as physical or sexual abuse, is thought to be a common cause; so are the adult experiences of war and natural disaster. But sometimes, anxiety or panic can arise from comparatively insignificant occurrences, such as being laid off or enduring a minor surgical procedure, and the intensity can be so severe that it renders the sufferer incapable of completing even normal daily activities.
To say the least, the cost to society in lost productivity and health care utilization is staggering. A severely anxious person is paralyzed, in effect; he or she may not be able to focus on work or school, attend to everyday business such as paying bills, or even perform basic laundry or meal preparation. Substance abuse is common among this population, as victims will often try to self-medicate their anxiety by consuming large amounts of alcohol or turning to marijuana and illegally obtained prescription drugs. And tragically, unrelieved anxiety---like its companion, major depression---can even lead to suicide.
What can be done to help the anxious patient? For one thing, medication in the form of antidepressants like paroxetine (Paxil) and fluoxetine (Prozac) have mild anxiolytic properties, and this may be all some people need to calm the storm. However, those with more complex and severe anxiety may require stronger agents called benzodiazepines, which unfortunately carry a high risk of dependency, but are often the only effective pharmaceuticals for this condition.
These include short-acting medications like lorazepam (Ativan, or "Vitamin A" as health professionals often call it) and drugs with moderate duration like alprazolam (Xanax), as well as the long-acting clonazepam (Klonopin). All are controlled substances which must be prescribed by a doctor---preferably a psychiatrist---and carefully monitored for abuse, as tolerance tends to develop with the passage of time. Ideally, benzos should be used only for a brief period to bring a crisis under control, but since anxiety disorders are often chronic, the meds may be taken for months and even years. (Note: a patient should NEVER attempt to stop a benzo on his/her own; withdrawal may cause seizures, along with a rapid increase in symptoms.)
Psychotherapy can also be helpful in managing anxiety and panic. Mindfulness and cognitive behavioral therapy are popular forms of treatment in which patients learn how to be aware of their thoughts during periods of stress, and to replace negative thinking patterns with healthier ones. Another therapeutic intervention is one in which the patient is gradually re-introduced to situation(s) that contribute to his/her anxiety, and taught more constructive methods of handling them. The latter remains controversial, but can be extremely effective for some patients.
But above all, people with anxiety disorders need to know that the condition is not their fault. They are NOT being 'weak' or 'silly'. Research has shown that the brain goes through changes during exacerbations, thus the need for medication and treatment of episodes. The good news is, anxiety---like almost all mental illnesses---can be managed if not cured, and sufferers can regain their ability to live happy, productive lives.
Hospitals / corporations are laying off nurses and merging job duties / responsibilities to improve their bottom line. What do you think about these moves? Is this happening in your area? Do you think it will improve "customer" satisfaction?
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Back in 2000 I was a a failing science major. My ideal career at the time was a double major in Physics and Chemistry. In 1996, after failing even choir, the only words on my mind were "Academic Bankruptcy". Bouncing in and out of community centers for the next few years was basically my attempt at finding a path, but instead finding nothing but slowly mounting student debt.
Around 2000 I was dating a mediocre man who suggested I "just be a nurse". I didn't take him seriously because he had also told me to "just be a secretary like my mom" which pretty much showed me how much respect her had for her. A few months later I gave up on that relationship, earned some cash waitressing, and set off for a new city. $1000 in my pocket, a casual boyfriend to crash with while I looked for a studio, and no plan other than to work at a local restaurant.
I moved in January and by May that year I was itching to figure something out with school. I had several friends in the massage therapy schools so I went to the local technical college with that idea in mind. That was when my life changed completely.
"What other careers have you thought about?" mused the adviser.
"Well some have mentioned nursing." I stated matter of factually.
"Ok well then, how about that?"
Up until this point I was convinced the only way to gain a meaningful career, especially nursing, was through a four year college. However something about the ease of this adviser was all I needed. She informed me of the lottery process for the program, the two year completion, and the career opportunities afterwards. I felt like I was being handed a good movie that someone recommended. I took it home, watched it, and before I knew it was #109 on the waiting list for an ADN program.
While it took me about a year and a half to get into the program, this gave me time to build something I desperately needed, confidence. After repeated mediocre work and failings at the university level I was approaching my mid-twenties and didn't have much to show other than the ability to hold a waitressing job and maintain an apartment.
In that year and a half I grew to love my school. I mentored other students in my Natural (super beginner) Chemistry class and got my first A+ ever. I moved on to take microbiology, Anatomy and Physiology, and Spanish. Being able to take these classes at an easy pace, while maintaining my minimal lifestyle was great for me. I learned to be involved, joining Student Senate, and actively enjoying my classmates and classes.
By the time I started my ADN program I was already showing improved study skills, attention to detail, and proficiency. What I loved about the nursing program was the combination of science and humanity. Learning how patient's bodies were working, while at the same time getting to know them as people in clinical was mind-altering for me.
I remember my first clinical. I hated my instructor. She was the type of instructor that liked to talk about how wonderful of a nurse she was. Sufficed to say her and I did not get along. Being an more descriptive writer at the time we went round and round about my nursing journal. Where I expressed my days in poems and stories, she wanted a break-down of tasks and perceptions. I tailored my work to fit her needs and garnered a strong B, but what I remember despite that were my patients.
The clinical was at a LTC, as most first rotations are. We were expected to help with ADLs and later med passes. I learned not to get someone up before putting their TEDs on first, I learned which ear my patient could hear out of, and I knew exactly what time Price is Right was on. I was fortunate enough to get scheduled with the same resident for two weeks straight, which gave me time to really appreciate her.
On the third week my patient was given to another student, however one day she came and got me, nearly in tears. The patient wouldn't take her medications because of some intermittent confusion she was experiencing. When I approached the patient she was pill rolling her shirt and confusing her buttons with the medications. I stood behind her, as she was mostly blind, spoke into her good ear and explained what was going on. The student had waves of stress coming off of her and it seemed to have exacerbated the patients confusion. After a few quiet moments she took her medications and started to watch Price is Right.
I will never forget that sense of accomplishment in my life. While I felt bad for the student who had issues, I felt this was beginning to solidify the idea that I was on the right path.
Two semesters later I hit a wall I never expected. I was in a clinical focused on management. It was a cardiac unit and I was heavily engrossed in Student Senate, serving as President at the time. My world was spread pretty thin and the student group I was in was older and aggressive, however I hadn't realized this just yet.
In the 7th week of an eight week clinical my instructor pulled me aside and told me I wasn't safe to pass the clinical. She could tell I wasn't focused, didn't know my meds, and generally wasn't ready to move on. I was destroyed. After so much success and realization on my path, I was failing again. I remember telling my classmates that I would have to repeat the clinical, which meant I wouldn't be with them anymore. I cried like a baby in front of my class while unimpressed faces looked on. I felt broken.
However, this instructor assured me I just needed to focus and I would move on with grace. I took her word on that and also the comfort that I would have a different instructor and re-evaluated my priorities. I dropped back to a more manageable role in Senate, got a new job at a more prosperous restaurant allowing me to work mostly high volume weekends, and focused on what I could do better in this clinical.
Thankfully, my instructor couldn't have been more on point. Because of my prior experience in the clinical, and the fact that the new group of students I was with were younger and more team-oriented, I was able to serve as more of a mentor to the group. We worked together, studying medications, evaluating patients, and in the end I got another strong B. I went back to my previous instructor and thanked her for helping me get my head back together and on a better path.
The rest of nursing school went pretty normally. I was challenged by a clinical instructor known for flunking students based on confidence, and got a solid A from her. My last clinical was on cardiac and I knew I had found my love. The instructor was wonderful and taught me so much about patient care beyond the tasks. She taught me how simple tidying up in a room, or washing someone glasses could make a huge impact on that patient's day. I graduated in 2006 with a solid 3.1 GPA. It wasn't stellar, but it was an amazing achievement for me. I also managed through a bad roommate break-up that cost me $675 a month in rent for most of my last year in nursing school. I was proud.
I applied to two hospitals. One was a Magnet hospital in the metro area I lived. I quickly received a "thanks but no thanks" letter and moved on. Understanding my experience was an issue, I moved out of the area about forty minutes and applied at a small rural hospital. I quickly received an interview and offer, and began my orientation in January 2007.
2007 was a year of change and trust. I had met someone online in a video game that I had a crazy obsession for. An obsession so hard core that I actually scheduled myself 11p-7a so I would be available to participate in nightly online events. I moved from a house full of loving students and friends, to being isolated in a town of less than 10,000. The only entertainment I had during the night was my game or a trip to the 24 hour Wal-Mart. I gained 20 lbs on McDonald's and Pizza Hut. I was miserable. The job was interesting and I had some of my first profound patient-caregiver moments there, however managing the isolation and a long distance relationship was taking a large toll on my life. I knew I couldn't stay there, but I didn't know where to go.
It was then I made the second biggest move of my life. I left my home state, my family (I am an only child), and moved to Georgia. I applied at one hospital and within a few minutes of posting my application had a call for an interview. At the time I was still home, so I flew down between shifts, had an interview and was hired that day. A month later I moved, waited for orientation and began my life as a complex medical-surgical/cardiac nurse.
Thankfully by this time I knew what I wanted from my relationship and one year later we were married. Then came the itch to do more. I knew I loved nursing, however I knew my body and mind might not be built to do it forever. I casually mentioned to my husband about going back to school. He was completely supportive and I posted my applications to a local brick and mortar. After about three months of no response I moved on to evaluate online colleges. I had some experience with an online medical terminology class in my ADN, and was skeptical the environment would work for me.
The first college I applied to was at a education fair held by my employer. Walden University happily took my application, however they never followed up. I would get more mailings from them in the subsequent years after starting with my current school, than I did when I was trying to get in.
I heard around work that there was a pairing with Grand Canyon University. Rumors of tuition discounts made me request information from them. Within 15 minutes of posting my online request I got a call. By the end of the week I was enrolled, and shortly there after I started my first RN-MSN class.
Midway through my undergrad classes I got pregnant. However, something in that was just perfect. I delivered my Emma approximately two weeks after completion of my undergraduate classes. It was the only time in my accelerated program where I could take an extended break from my classes. Two months later I was back in the groove and charging forward on my MSN-Ed classes.
Here I am now, less than six weeks from completion of my Master's and due with baby #2 in eight weeks. Timing once again seems to be on my side.
So what is the point of all this "here is your life" monologue? Perspective.
There were several points in my life where I had to look at conflict and failure in a different light. I had to focus on what I could change in the future, and not what I had done in the past. Among those conflicts were also people who made simple impressions on me that turned out huge outcomes. From an adviser who wasn't afraid to set me on a path I didn't see, to an instructor who knew that I needed a kick to move forward, to patients who taught me not to be afraid, there were influences in my life that to this day I don't even think know how influential they were on me.
So this brings me to my final point. Sometimes a simple action can have an amazing effect on a person. A comment, a statement on a forum, or an encouraging conversation can provide more to someone than you may ever be aware of.
I had an incident come up recently, but I wanted to see what you all thought. I don't remember all the specifics, but I'll give you the scenario as best I can. I had a patient who had surgery a few days prior. Some kind of Ortho surgery. The patient had been draining from his incision and had been monitored for a few days. I had the patient for night shift. If his drainage was improved in the morning, he was going to be discharged. However, in the unlikely scenario his drainage increased, the plan was to take the patient back to the OR. He was therefore NPO at midnight. At midnight, I removed the food and fluids from the bedside and told the patient he couldn't eat or drink. He basically said he'd tolerate while he was sleeping but there was no way he was agreeing to go the OR and in the morning he was eating. Everything was fine until the residents rounded at 5am. They didn't give him a definitive answer (they were waiting for the attending) and the man began to demand something to drink and food. I told him he was still NPO, but I'd check with the doctors. The residents refused to change the order, even if he was refusing the OR and also refused to come see him and speak with him about it. I tried to keep stalling the patient, but at this point he was becoming quite angry. He was physically not really capable of walking to the ice/water machine. I gave him some ice chips to tide him over. I personally felt like I should give him what he wanted. After all, he can refuse anything he wants to, including being NPO. But my manager said that if I gave him the fluids it was legally questionable. I managed to stave it off till I left at 7am and I'm not really sure what happened after that. Was I right or was my manager right?
The first year of nursing is, in countless cases, also one of the most challenging years of a nurse's career because many different events are taking place.
First of all, a significant number of newer nurses are acquiring the procedural skills that they did not fully cover in their nursing school clinical rotations, especially if one is immediately transitioning into a highly specialized area as a first healthcare job. Secondly, aspects of the 'real world' of nursing may clash with the idealized 'textbook version' of nursing. Third, it simply takes time for a newer nurse with less than one year of experience to find one's groove in the workplace and develop a comfort zone.
Finally, untold numbers of new nurses have been pumped with the often paralyzing fear of the consequences that might result from mistakes. The fear of causing profound harm to a patient comes to mind. Also, the fear of action being taken against one's nursing license is frequently mentioned as a source of worry. "I'm afraid of losing my license" is an immensely common phrase.
Moreover, some nurses live with the fear of someone personally filing a lawsuit against them. For instance, several years ago a new grad administered a deep intramuscular injection of promethazine (Phenergan) to the left arm when the patient had requested for the medication to be injected into the right arm. Later on during the shift the nurse was asking, "Can I get sued for giving it in the wrong arm?"
In instances like the aforementioned scenario, knowledge is power. A little knowledge about legal issues in nursing can go a long way to alleviate many worries. As a general rule of thumb, unless the patient is irreparably injured or dead as a result of something the nurse has done (or failed to do), it is highly unlikely that the event is lawsuit material. Patients and families sometimes say the words "I'm going to sue you" to nurses as an intimidation tactic, and they do have the right to pursue legal action.
However, they would first need to find a medical malpractice attorney who would be willing to take the case. And, as long as the proper injection technique was used and no harm resulted, most lawyers in existence would not waste the time on a case that involved giving an injection to the supposedly 'wrong' arm.
I advise all nurses to take a course in nursing and the law to become reassured regarding the types of events that patients and families can and cannot sue for. A patient or family member must have a cause of action in order to sue you. And if you have not been found guilty of a tort (civil wrong), then any action to sue you would most likely be dismissed if it was filed. Generally, personal injury suits are extremely risky and very expensive for medical malpractice attorneys, so they typically do not take the case unless there is a clear cause of action (read: irreparable harm or death) and a large amount of monetary recovery is likely.
In this litigious day and age, nurses can be individually named in lawsuits. However, physicians pay tens of thousands of dollars in premiums for medical malpractice policies, while nurses usually pay in the range of $100 yearly. The physician pays more because (s)he is more likely to be sued than the nurse.
What is the point of all of this? Take a deep breath, practice safely, consider the ethical implications of everything you do, stay within your scope, ask for help when needed, don't allow anyone to intimidate you, and keep on learning about the wonderful art and science of nursing. Sometimes the words "I am going to sue" might be an everyday part of a person's vocabulary, even if he knows little about the process of suing.
Hello everyone!! =)
I recently graduated from nursing school in June (LPN), passed my boards in August 2012.. and now I am continuing my studies -- I want to be a RN and hopefully one day a nurse practitioner =)
Today I had to take a Hesi Admission Assessment Exam for the nursing school I want to go to. I passed it =) Total Average = 88.5%
We were tested in the following major topics : Math, Reading Comprehension, Grammar, Vocabulary.
My scores were as follows:
Reading Comprehension = 86%
Grammar = 84%
Vocabulary = 84%
Math = 100% (Omg, I can't believe I got a 100 in math! Lol .. But I did put a lot of time into studying math since it was always a weak subject for me. I'm glad my hard work payed off.)
For the school I am applying to, you pass the exam if you get a 75% or better in math, and a 75% or better average of Reading Comprehension, Grammar, and Vocab.
My school had us purchase the following book to review and prepare for the exam : "HESI Admission Assessment Exam Review Edition 3" - ISBN# 9781455703333
I really liked the review book. I thought it was extremely helpful (especially in the math - it kind of "dumbs it down" for you, and makes it easy to understand.
My school allowed us to use a basic calculator for the math section.
The book goes over and teaches you how to add, subtract, multiply, and divide decimals..
I feel that since you can use a calculator, dont stress yourself out over it. I had no idea we could use a calculator for my exam so I studied everything,
Honestly, I dont really know what to tell you. Just do the practice questions in the book, read over the tips in the chapter for reading comprehesion. The more you practice, the better of you will be. (Btw, the passages were not ridiculously long, so that was good.
For me, I looked over all the words in the vocabulary chapter. Made flash cards on those I didnt know. The vocabulary for me was not that bad because I knew most of the words already. Make flash cards on those you dont know, study them.
Thats pretty much it. We had a total of 4 hours to finish up the sections. I finished in about 3. But take your time!! Dont rush!! But make sure you have good time management!! Maybe have a hand watch on the day of your exam.
**(Oh also for those wondering, the test was computerized. Once you answer a question you cannot go back)
***********In the back of this review book; there is an appendix. There is a appendix for each topic. The appendix contains review questions. I suggest you go over them and do them once you have gone over the content to see if youre ready or not.***********
I basically studied hard core for about 1 week and 2 days. But it depends on you, and how comfortable you feel with the material. You know what your weak areas are, so focus on them. But that doesnt mean you dont review the other sections. Its important to review all the sections in the Review Book that you will be tested on.
Goodluck! You will be a LPN 24hrs from now
I'm really glad you brought up addiction vs. judgment OP, because I think we as a society still know so little about it. It is one of the most complex disease processes to treat, and I think one reason Healthcare Professionals hate addiction soooo much is the damage it causes.
Sometimes we ourselves feel forced to be enablers, and part of the complexity is we can't know if the patient is really in need or want (or both) of narcotics. Addicts are hard to help. In active addiction/relapse, the patient is mentally ill, and is processing thoughts different than a normal person, just as a diabetic with hypoglycemia- altered mental status.
Simply denying them narcs won't help either if a program of recovery isn't offered, but that's a near impossibility because of 3 walls. First, the patient must identify as having a problem, secondly, getting a detox/rehab bed is tough(tougher without insurance), and alas maintenance of addiction is so expensive(Suboxone/Methadone) that nearly only insured and Medicaid patients can reach it.
Addiction must be the largest robber of personal dignity in the disease realm, and until we can REALLY treat or cure it, widely/cost effectively- it will continue to plague our friends, family, and patients- with little hope for good recovery rates in substantial numbers.
The addict has fallen through the crack- and maybe if you don't let that empathy, care, and passion die in you- you could be the one that changes it all!!!!
When I was in nursing school, one thing I always remember hearing the instructors say is straight A's are not what makes a good nurse. There's nothing wrong with getting straight A's of course, but it takes a lot more than that to truly be a good nurse.
I believe one of the most important qualities of being a good nurse is having compassion. A nurse with compassion is one who truly cares about her patients well-being and outcome. This nurse treats her patients as she would expect any other nurse to treat herself or own loved ones.
The nurse with experience, not experience as a nurse but as a patient. This nurse applies her own experiences into practice. The only way to truly understand what a patient is going through is to have experienced it yourself. Each nurse has different experiences but at some time almost all of us will experience an ER visit, a surgery, or even labor and delivery as a patient.
Another great quality in a nurse is being non-judgmental.
I know long ago in nursing school we were taught this, but I see it so often and I admit that I've caught myself judging patients.
As an example: "30 year old with back pain coming by ambulance, gotta be a drug seeker." Turned out the patient had a back injury after an accident. It seems that many of these patients being judged are being judged because of known or suspected drug abuse. These people are struggling with an illness; addiction is an illness and should be treated that way. These people have their own stories and struggles that have led them to where they are today, some of these struggles way more difficult than we can ever imagine.
It's important for nurse's to be efficient, one way of doing this is to be part of a team. Working together with others and delegating to other members of your team helps increase your efficiency. Part of being a team is also helping other members of your team. Being efficient helps you to give your patients the best care. There are many aspects to having an effective team, but it's very important that all members of the team are respectful of each other.
Nurses need to be respectful of each other and of their patients. There are many little things about an individual that may drive you crazy, but just remember none of us are perfect. There is probably something about yourself that drives someone else crazy.
First off, most companies won't hire you without a min. of a year's experience. The reason being, you have to be able to hit the ground running. You may only get a few hours of orientation. Travel nursing is not the way to learn which specialty that you want to go into. Most experienced travelers, already have at least one specialty under their belt. It is not for the faint hearted.
This is a list I complied of references I feel were of great value in nursing school. They were discovered by trial and error. Of course, this is only my opinion…you all may find resources that suit your needs better, and bottom line is that no matter what, great effort must be made to pass nursing school. What I found was that I needed things broken down as simple as possible, not intimidating to read and not too comprehend. Outside of the Nurse Practitioner Reference, I suggest that anyone interested should try to either borrow from the library or order used to cut the incurring costs of nursing school. I provided the hyperlinks from Amazon, only because this is where I purchased them (most in used condition for dirt cheap)...you can certainly obtain them from elsewhere. So, please browse and see if anything is of interest. As I think of more, I will certainly add on. Good luck, future nurses!
Nurse Practitioner Prescribing Reference (paperback, compact digest that includes all current drugs being prescribed; is delivered quarterly): Nurse Practitioners' Prescribing Reference | Nurse Practitioners' Prescribing Reference Magazine
Delmar’s Comprehensive NCLEX-PN Review (has great pharmacology chapter-nice summaries for medications, with hints for common prefixes and suffixes in related drug catagories): Amazon.com: NCLEX-PN Review (Delmars Nclex-Pn Review) (9781428310940): Judith C. Miller: Books
Medical Dosage Calculations: Amazon.com: Medical Dosage Calculations (9th Edition) (9780132384704): June L. Olsen, Anthony P. Giangrasso, Dolores Shrimpton, Patricia Dillon: Books
The Human Body in Health and Illness (To me this is EXCELLENT): Amazon.com: The Human Body in Health and Illness (9781416028864): Barbara L.
Mosby’s Pharmacology Notecards (this is a wonderful way to learn drugs…the cartoons are comical, but stay in your memory!): Amazon.com: Mosby
Basic Pharmacology for Nurses (if you can get a used one for dirt cheap, it may be helpful): Amazon.com: pharmacology by bruce clayton: Books
Introduction to Clinical Pharmacology (part of the LPN Thread Series…written specifically for LPNs): Amazon.com: Introduction to Clinical Pharmacology (9780323056205): Marilyn Winterton Edmunds PhD ANP/GNP: Books
Essentials of Pharmacology for Health Occupations (great for summary): Amazon.com: Essentials of Pharmacology for Health Occupations (9780827370227):
Mosby’s Medical Dictionary (Used by nursing and other health occupations- VERY graphic pics): Amazon.com: Mosbys Dictionary of Medicine, Nursing, and Health Professions) (9780323049375): Mosby: Books
Basic Nutrition and Diet Therapy (another part of the LPN thread series that is excellent):
Amazon.com: Williams Diet Therapy (9780323026024): Staci Nix: Books
Memory Notebook for Nursing (great for fun ways to remember the disease processes, etc...): Amazon.com: Memory Notebook of Nursing: A Collection of Visual Images and Mnemonics to Increase Memory and Learning (9781892155122): Joann Graham Zerwekh, Jo Carol Claborn, C. J. Miller: Books
Test Success (strategies for taking nursing tests): Amazon.com: Test Success: Test-Taking Techniques for Beginning Nursing Students 4th Edition (9780803611627): Patricia M. Addendum: Suggestion to supplement this is to obtain as many CD ROMS with test questions as possible, to encounter many different styled questions...ie from Saunders, Lippicott, Incredibly Easy, Mosby, etc... and start practicing test questions.
Nursing Diagnosis Reference Manual (excellent to me because it also included medical diagnosis, which, then, provides suggested nursing diagnosis): Amazon.com: Nursing Diagnosis Reference Manual (9781582550725): Sheila M. Sparks, Cynthia M. Taylor: Books
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