CRNE June 2012

mapleleafcn · May 30, 2012

Scenario: Just my imagination.

I am a nurse handling a MRSA patient and I am about to give a medication in liquid form. I am handing it to the patient. Suddenly on the other room I heard someone screaming for help. What to do?

delimma: patient safety

accountability

infection control

Any opinions?

mapleleafcn · May 30, 2012

Another imagination scenario of mine

A long term patient who is spinal cord injury. Insist that he wanted to have his favorite pin up nude photo of a woman in his room. What am I going to do?

Delimma: respect patient's rights?

confront the patient to have some decency in the institution

report to the unit manager

make a compromise like instead of nude why not a fully dress woman as a poster.

Think about this guys...and gals....

allicandoispray · May 30, 2012

pete, i agree with you. 1 was my answer as well. I crossed out 4 immediately based on the R-sided HF. shockingly, 4 was the answer. i have done almost 3000 practice questions and this one still bothers me, i am just going to note this one off as an error. the rationale in the book says "elevation of an extremity promotes venous and lymphatic drainage by gravity" and the rationale as to why 1 was wrong is that "this action is taken cautiously and should be the decision of a physician."

what gets me is that there was another similar question just before this question in the same book that states Mr. Mars has CHF and pulmonary edema. Which of the following nursing actions would help to alleviate his respiratory distress?

1. elevate lower extremities

2. encourage frequent coughing

3. place him in an orthopneic position

4. prepare him for modified postural drainage

Answer. 3 in case anyone is wondering HOWEVER, the rationale as to why #1 is wrong? (which i crossed out first) is that elevation of extremities should be avoided because it increases venous return, placing an increased workload on the heart! so wouldn't elevating the patient's extremities essentially be contraindicated in patient's with HF? confusing! if anyone agrees with the initial question + answer please share as to why you agree.

with that said thanks pete for your active involvement in this thread. i think you will blow this exam out of the water!

Exam is in 7 days! How do you all feel?

petethecanuck · May 30, 2012

Thanks Alli.. I'm doing the CRNE readiness test right now. Feeling pretty good with everything except for some the nurse-patient relationship stuff :)

Yeah I work on a cardiac unit and totally disagree with 4 being the answer in that question. I even resourced my educator and she concurred.

Good luck in the final week of studying!

Few last min tips

-Remember Pt safety: ABC's

-Nursing process. Assess always before an intervention.

-Maslow: Physical before psychosocial

allicandoispray · Jun 2, 2012

hey everyone,

i am aware that calculators are not permitted for the exam, i am completely fine with manual calculations when it comes to everything besides for fluid dosages. reason being it usually results in a decimal answer as one typically divides the smaller number from the larger one, and i have difficulty doing that by hand - with a calculator it is very simple and when i do it by hand i usually get the right answer but i am always unsure of my answer. i want to be as confident as i am when i do IV flow rates. can someone assist?

For instance, can you share step by step how you do this one by hand...

A client is ordered 5 milligrams of Flupenthixol decanoate by intramuscular injection. 40 milligrams in 2 millilitres of liquid for IM Injection is available. How many millilitres will you administer?

thanks in advance!

petethecanuck · Jun 2, 2012

ordered dose / dose on hand x volume = administered volume

5mg/40mg x 2ml = x

step 1: lets figure out what 5/40 is by reducing the fraction.

5 goes into 5: once, therefore numerator is 1

5 goes into 40: 8 times, therefore denominator is 8

step 2: now that the fraction is reduced, lets solve it using simple longhand division.

____

8)1

8 goes into 1: 0 times

_0___

8)1

now we add a 0 to the dividend, and a decimal place in the quotient.

_0.___

8)10

8 goes into 10 once.

_0.1___

8)10

___8__

___2__

this leaves 2 as the remainder. now we add a 0 to the dividend and carry it down to the remainder

_0.1___

8)100

___8__

__20__

8 goes into 20 twice leaving 4 as the remainder.

_0.12___

8)100

___8__

___20__

___16__

____4__

now we add another 0 to the dividend and carry it down to the remainder.

_0.12___

8)100

___8__

___20__

___16__

____40__

8 goes into 40 5 times leaving 0 as remainder. we have divided the fraction!

_0.125___

8)100

___8__

___20__

___16__

____40__

_____0__

step 3:

multiply 0.125 x 2 ml (volume) = 0.25 ml

∴ volume administered would be 0.25 ml.

Pediatric Critical Care Columnist · Jun 2, 2012

Wow, that was a very long way around a simple, very basic math problem. 40mg/2mL = 20mg/1 mL and 5mg/20mg = 0.25mL

jvre888 · Jun 3, 2012

5mg/40mg x 2ml = 0.25ml

allicandoispray · Jun 3, 2012

i love this place!!

thank you all! i wanted to know how to do it by hand step by step with accuracy. the fractions made it a whole lot easier, it has been a while! i have been testing myself and have been getting them all correct! i am truly grateful for this community.

kheemooy · Jun 3, 2012

pete, i agree with you. 1 was my answer as well. I crossed out 4 immediately based on the R-sided HF. shockingly, 4 was the answer. i have done almost 3000 practice questions and this one still bothers me, i am just going to note this one off as an error. the rationale in the book says "elevation of an extremity promotes venous and lymphatic drainage by gravity" and the rationale as to why 1 was wrong is that "this action is taken cautiously and should be the decision of a physician."
My answer is #4 too. I think among all the options "elevation of legs" is the most independent nursing action/intervention. #1 is also a nursing intervention but it is an dependent nursing action because you need a doctor's order for this. Fluid restriction cannot be implemented just like that without a doctor's order. That's why i thought of #4 coz it is an independent nursing action and it limits spread of edema of the legs.
what gets me is that there was another similar question just before this question in the same book that states Mr. Mars has CHF and pulmonary edema. Which of the following nursing actions would help to alleviate his respiratory distress?
1. elevate lower extremities
2. encourage frequent coughing
3. place him in an orthopneic position
4. prepare him for modified postural drainage
Answer. 3 in case anyone is wondering HOWEVER, the rationale as to why #1 is wrong? (which i crossed out first) is that elevation of extremities should be avoided because it increases venous return, placing an increased workload on the heart! so wouldn't elevating the patient's extremities essentially be contraindicated in patient's with HF? confusing! if anyone agrees with the initial question + answer please share as to why you agree.
In this case my answer is #3 because the question is more specific about respiratory distress. #2 and #4 are also related to pulmo to but it is for patients who have sputum/mucous in the lungs not for pulmonary edema. On the other hand, elevation of extremities does not increase the blood volume, pitting edema occurs because there is build up of blood in the lower extremities due to ineffective pumping of the heart and eventually there is third space fluid shifting or the fluid leaks to the interstitial space. When there is fluid shifting it is bad and you have to resolve it by elevating the legs so fluid goes back in the intravascular space/veins.

Hope that answers your question. Goodluck to all June 2012 examinees. :)

kheemooy · Jun 3, 2012

Hi
I am also studying for the June 2012 exam, I will take it in London, Ontario. I'm studying Mosby CRNE review, and the new edition of Community Health Nursing in Canada, Canadian Fundamentals in Nursing - Potter and doing the CARE CRNE review course here in London. I also did the IEHP course through the ACCESS center - online course, which helped.
Faithful did I meet you on line at the "Campbell Cohen forum", if so you can see I got my eligibility for CRNE last friday after 10 months.
Olga

Hi Olga, I am about to start the review course with CARE in Hamilton on Monday. What are your feedbacks about their workshop? Was it helpful?

petethecanuck · Jun 3, 2012

i love this place!!
thank you all! i wanted to know how to do it by hand step by step with accuracy. the fractions made it a whole lot easier, it has been a while! i have been testing myself and have been getting them all correct! i am truly grateful for this community.

That's what I figured you were asking about which is why I "tried" to show how to do it via the long division method. :)

@ Keemooy. #4 is not the answer to that question. #1 is. You wouldn't raise the legs of someone with Rt sided heart failure.