MONA

joycee8 · Jul 28, 2009

That's what gets me...certain schools teach certain things differently. Kaplan might say morphine first, the NCLEX people might think differently..I still want to know what the NCLEX people say because they make the question that may determine if I fail or not...because you know they love MASLOW...and pain is PSYCHological...not PHYSiological. I don't really agree with Maslow in all cases. Sex is physiological...that's more important than a safe environment. So if I have a patient who wants to stick his finger in a light socket, sex and food are more important than providing an evironment with covers over the plugs. I missed that question in Kaplan about a manic pt who was doing all kinds of crazy things that would kill her. She was on an airplane wing! But it said the PRIORITY is to give her food and rest since she hasn't eaten in 3 days instead of the answer I picked....provide a safe environment. Back to the light socket or plug, if she wants to stick her finger in a light socket because she's manic..I think that would kill her faster than if she waited a few hours to eat while I make her surroundings safe.

*** i found the above question ***

I received a book from KAPLAN 2010 Strategies for NCLEX-RN exam, yesterday. i found the confusing question in page 85.

"A client with a hx of bipolar d/o is admitted to the psychiatric hospital. She was found by the police attempting to climb onto the wing of a plane at the airport. Her husband reports that she has not eaten or slept in 2 days, and he suspects she has stopped taking lithium. On admission, the nurse should place the highest priority on which of the following client care need?"

1. Teaching the client about the importance of taking lithium as prescribed.

2. Providing the client with a safe environment with few distractions.

3. Arranging for food and rest for the client.

4. Setting limits on the client's behavior.

Rationale: Eliminate all answer choices that are psychological-(1)&(4)

Focus on physiological,

"Whats takes highest priority?" Providing for a safe environment or providing for food and rest? According to Maslow, food and rest take highest priority. The correct answer is (3).

For my own little understanding and opinion, i would say the answer is (2), if there's no continuation of "few distractions". Hence, that makes wrong (2), because it is not really/fully a safe environment.

What do you think guys?

Again, accdg to our clinical instructor, SAFE is the highest priority in PSYCHIATRIC clients, exceptions to Maslow's. i just forgot to ask his source!

Aside from that, this book is really great! Strategies are different from Saunders, so we can apply both approach in taking NCLEX exam. I like KAPLAN book along with my SAUNDERS!

Anyway, i haven't seen a book that is perfect, it doesn't exist! The authors of the book and editor are all human being! We are not GOD! who is the only 1 perfect!

I also saw in Saunders book, maybe 2 typical errors, the rationale is contradicting the answer. i saw in La Charity Prioritization&Delegation book, maybe 3-5 typical errors, e.g. instead of factor VIII, they type factor something, other than VIII.

But in general, all these 3 books are awesome! GOD BLESS US test takers!

We should be thankful to the Authors, otherwise we will not become a NURSE! :nurse:

joycee8 · Jul 28, 2009

although the aha coined the acronym mona, this was not a recommendation that this be the ordered that the interventions were applied. if you review the 2005 american heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 8: stabilization of the patient with acute coronary syndromes the administration of these 4 medications is discussed in several sections.
the following was copied from the acute coronary syndromes algorithm:
ems assessment and care and hospital preparation:
- administer oxygen, aspirin, nitroglycerin, and morphine if needed.
immediate ed general treatment
- start oxygen at 4/min; maintain o2 sat >90%
- aspirin 160 - 325 mg (if not given by ems)
- nitroglycerin sublingual, spray, or iv
- morphine iv if pain not relieved by nitroglycerin
the following was copied from initial general therapy for acs section:
morphine sulfate: morphine sulfate is the analgesic of choice for continuing pain unresponsive to nitrates, and it is also effective in patients with pulmonary vascular congestion complicating acs. morphine is a venodilator that reduces ventricular preload and oxygen requirements. for this reason it should not be used in patients who may have hypovolemia. if hypotension develops, elevate the patient's legs, administer volume, and monitor for signs of worsening pulmonary vascular congestion. start with a 2 to 4 mg iv dose, and give additional doses of 2 to 8 mg iv at 5- to 15-minute intervals
furthermore, in 3 years in the emergency department as well as 3.5 years doing critical care transport, i have never administered morphine as the first intervention, nor have i ever heard of it being done.
i hope this information is helpful.

:yeah: :yeah: :yeah: , wow! good explanation! maybe the arguments will then be end???

yeah! really confusing, our clinical instructor told us that it's up to us to think and evaluate about mona because different books and authors has their own condicting/opposite ideas.

thanks chare!!!:bowingpur:bow::bowingpur

kgh31386, BSN, MSN, RN · Jul 28, 2009

Hey I was wondering what you meant by this.

"For my own little understanding and opinion, i would say the answer is (2), if there's no continuation of "few distractions". Hence, that makes wrong (2), because it is not really/fully a safe environment." I figured fewer distractions would be good, sounds like you're saying fewer is bad.

cardiacRN2006, ADN, RN · Jul 28, 2009

I don't have my old NS books for reference. I can just tell you what we do in real life.

Many, many times pts with CP have NOT received MS. That's because the NTG worked.

So, in order for us, in the ICU (the ASA has already been given)

O2

NTG

Then MS if pain is not relieved.

But, come on...O2 is the priority-always.

kgh31386, BSN, MSN, RN · Jul 28, 2009

Someone should tell Kaplan that.

joycee8 · Jul 28, 2009

Hey I was wondering what you meant by this.
"For my own little understanding and opinion, i would say the answer is (2), if there's no continuation of "few distractions". Hence, that makes wrong (2), because it is not really/fully a safe environment." I figured fewer distractions would be good, sounds like you're saying fewer is bad.

Accdg to Saunders strategy, a little wrong words included in the correct answer, then that will make the WHOLE sentence WRONG.....it's a Distraction!

if we consider SAFETY is the first PRIORITY, then SAFETY in all the way is important, not half safety or few safety (few distractions).

Does this make sense?????

joycee8 · Jul 28, 2009

I mean 100% SAFETY without any distractions!

kgh31386, BSN, MSN, RN · Jul 28, 2009

Oooh so you meant if it said with NO distractions, then it would be correct. But the fact it only says few or something, then there are still distractions present. Haha sorry I was tired last night.

joycee8 · Jul 29, 2009

Oooh so you meant if it said with NO distractions, then it would be correct. But the fact it only says few or something, then there are still distractions present. Haha sorry I was tired last night.

Absolutely! i understand that we been studying very hard for the preparation of our big day! That's really happen if we are tired or lack of sleep. GOD BLESS!

govelasco · Nov 3, 2011

Don't take anyone's word for it, reference the literature. Evidence based practice is essential to providing consistent and safe care.

American Nurse Today states "But keep in mind that while MONA might be easy to remember, the drugs aren't given in the MONA sequence. They're given in the order of OANM."

Emergency cardiac drugs: Essential facts for med-surg nurses

Issue Date: July 2010 Vol. 5 No. 7

Author: Ira Gene Reynolds, MSNEd, RN, PCCN-CMC