Several CPNE questions

  1. Hi....I'm studying for my CPNE and have these questions:-

    1) For lab station IM/SQ inj, I know how to mix N and R insulin but what about mixing other meds for IM inj? I have never heard of mixing IM meds for injection in school or real world (hospital). How in the world do I figure out what to draw first? or compatibality issues? My pharm book (school book) also doesn't mention mixing IM inj. How do you tackle this problem?

    2) In the CPNE manual Physical Jeopardy page IV.D.5.b, it says leaving a confused pt without their call light is a violation. But even you give a confused pt his call light and leave, they may still be climbing out of bed and fall without even pressing the call light (because they are confused). So, I think leaving a confused pt with a call light is still not really safe unless somebody is with the pt, such as a sitter ?

    3) In real world, 9 out of 10 pt when I aspirate their IV before NS flush, there is no blood return, but the IV will flush fine. I know in lab, you can talk it out telling the CE that there is blood return. But what about in a PCS? What do you do if you don't see blood return when aspirate?

    4) Blood pressure: Female pt with IV site on RAC, mastectomy on L side. How and where do you take BP?

    Thanks !
    Last edit by AC439 on Oct 15, '06
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    About AC439

    Joined: Dec '03; Posts: 97; Likes: 9
    Student - LPN to RN


  3. by   tgb3rn
    1)It states in the study guide to consider all meds at the lab station to be compatable, EC told me there would be no order to draw them up first that would cause you to fail.
    2)I would assume in that situation the Pt would be on an alarm set up or that there would be someone avail. to watch the Pt. BUT if I remember right the study guide states they prescreen the Pt's and you would most likly not be given on that was THAT big of a fall risk.
    3)I have found that to be true as well, but my hospital uses a Saline lock instead of Hep. I would ask this of EC directly--I will befor I go to the CPNE in a few months myself, thanks for bringing it up.:wink2:
    4)I would invoke CDM and do it on the IV side in that situation.
  4. by   Mudwoman
    Login to your MyEC and then go to the chats. Review all the past CPNE chat dialogs from transcripts. There is a wealth of information there. You can also look at the chat schedule and join in and ask a bunch of questions and get answers.
  5. by   AC439
    Thanks a lot !
  6. by   anticoagulationurse
    I second the stuff said above.
    1) I'd like to add. I had IM mix meds for the sim lab. Had to mix Ativan and Toradol. I drew the Toradol first so as not to contaminate it if I had drawn up Ativan first since Ativan is a controlled substance. One student asked during the orientation to the lab stations if we had to worry about any med compatibility when ordered to mix, Nope. They don't try to trick you.

    2) You could delegate to either the CE as you leave to chart, or ask the NAC or primary nurse to take over if you have to leave the room. In doing so, the responsibility is on the sitter. Also, they do screen for appropriate patients for you and I doubt you'd get a confused patient.

    3) I don't think they are allowed to assign you a flush/IV push med on a real PCS.

    4) They will most likely designate on the assignment Kardex where to check BP, also you could ask the patient, and/or the CE. One student in my CPNE weekend had this situation and had to use the calf for BP (yes, it is possible), but both she and the CE couldn't hear the sounds so they used a dopplar.

    GREAT Questions! Remember don't be afraid to ask the CE anything, even if you feel like you should know it.
  7. by   Spazzy Nurse
    Re: your #4 question---- if there is something that is a tough call and you just don't know the answer to (like the question you posed) you can always ask the primary nurse what they have been doing. I had a situation like this where I was unable to feel any pulses in a lower extremity. I asked the primary nurse how they have been getting the pulses and she said that a dopplar had just been done so that pulses did not need to be checked. I invoked CDM on that one and it was just fine.
  8. by   AC439
    Thanks guys ! Can't believe this exam is getting close !
  9. by   EricJRN
    Good luck! When do you go?
  10. by   Jo Dirt
    It was the beginning of January when I took the CPNE but I don't exactly remember about drawing up the IM meds...I remember I was assigned to do this but I can't remember how I did it. The only thing I remember is that we are to assume all injections are compatable and that with an IM injection you had to aspirate for blood (though this CE changes with each edition, I have heard).

    Regarding the IV, we were not to administer any IV meds. I did prepare and hang the bag but the examiner turned it on after double checking my work.
  11. by   AC439
    Thanks guys ! I think I may have over-thought everything and driving myself nuts.

    I'm goin' to Atlanta tomorrow ! Wish me luck !!!!
  12. by   willtm
    Good Luck!!!!

    Quote from AC439
    Thanks guys ! I think I may have over-thought everything and driving myself nuts.

    I'm goin' to Atlanta tomorrow ! Wish me luck !!!!
  13. by   anticoagulationurse
    Good luck and may grace be with you!!!!!
  14. by   RN34TX
    I have to chime in here although I'll start by saying that my wisdom may be outdated as I took the CPNE several years ago.

    However, when I saw the comments about not worrying about med compatability, I just wanted to clarify that you all were referring to IM meds, right? Not subQ insulin?

    I say this because when I took the exam, if you were assigned SQ instead of IM, then you most definitely had to draw up the regular (clear) insulin first or it was considered a failure.

    One examinee in my group was taking his CPNE for the second time because he failed by drawing up the NPH insulin first during his first exam.

    I know that in real world practice everyone knows to draw up insulin clear to cloudy (so I'm not sure why he failed that other than nerves) but I didn't want someone reading these posts and ending up failing because they thought that it didn't matter which insulin you drew up first at the lab station.

    Maybe I'm so outdated that the CPNE doesn't even have subQ injections anymore. Does everyone get IM for their injection lab station these days?