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I just had my Certification last October at MSNCB paper and pen. I didn't go for any review class or bought any review materials. I just used my old NCLEX-CDs and go through the concept -MED-SURG from Lippincott, Mosby, Saunders (old reviewers). Just study everynight after work if not tired and answered Q and A's at least 10 to 20 items because I find it so draining after work answering more than 20. If I'm off and in the mood, I would answer 50 to 100 Q and As. It's really worth, I was little cramming a night before the exam, I still studied a little, I slept late and got up early. Well, I was sleeply and so I did take energy drink to keep me awake and prayed. Just used some test taking strategies - elimination when I ddn't really know the answer. During the exam, I was very calm though. I reviewed those answers I was doubtful by placing a mark in the questionnaire that I have to go back. 4 hour-exam. Whew! I'm not a paper and pen test-taker because I lose patience easily but I made it. Just believe in yourself and pray of course.

How fast do we infuse albumin? Is it 30 minutes or 1 hour or 2 hours? Special long tubing-a primary tubing comes from pharmacy. I thought it would be secondary tubing. It has that rolling drip regulator, and I can't even put in the IV pump but only to flow by gravity. It's kind of tiring because I have to manually regulate and count the rate. Do you infuse it by gravity too? Can I directly connect the tube to the IV heplock or I can Y tube it nearest to the patient but still by gravity? Or can I connect it as secondary using the special long tubing provided by pharmacy but only thing is it will be long enough to use as secondary. Now, I have to raise the IV pole as high as possible. Am I doing the right thing? There are occasions that the drip stops, so I have to squeeze the drip chamber and open and close the vent. The albumin comes in glass bottle. Please help.

Some portacaths that I accessed have no blood return, but is flushing well. Sometimes have but need to reposition the patient, raise the arms, twist the head to either left or right, lower the headpart and then you will get blood return. Even if the portal system was deaccessed and reaccessed. Still the same with no blood return. What do you think are the causes? Is it safe to use the portacath without blood return with the vesicant chemotherapy agents but is flushing well?

Where can I be trained to place PICC line. I am very very enthusiastic to do PICC line placement. I salute to nurses who do PICC lines really.

I am a regular Nurse but sometimes delegated to be Charge Nurse on a 34 bed floor. I get 4 or 5 patients as well as charge is crazy. I am busy enough to look after my patients at the same time handling disputes or problems in the floor. Help other nurses who needs assistance with their patients. It's really draining at the end of the shift. That's why I said, do not put me on charge role again when you give me patients because it's horrible, patient care-wise, you don't have enough time and also to do the staffing for the evening. Sometimes when I get busy with my patients and it's 2 hours before the next shift, I wouldn't even notice that I need to cancel a staff. It really sucks when they give you both responsibility. Taking 1 dollar per hour being a charge with patients is not worth.

I see, you are right, not reciprocity but license by endorsement. Thank you.

Hi, I want to know how reciprocity works. I am planning to move to Washington from Illinois. I've noticed they have this new online Nursys where you can verify license online with few participating states. How long is the processing of reciprocity of RN-license? If I can get a license in Washington through reciprocity, will my license in Illinois still active so that would mean I will renew two licenses during the renewal period? Thank you.

Hi, what can you suggest as the best or if not the best a good review book for the Med-Surg Certification exam. What are the questions like? Is it similar with the nclex? I highly appreciate if you can share your points.

Thank you so much for all your feedback!

What is the normal range for ANC that you can start chemotherapy?

Can anyone tell me the most recommended way to flush a PICC line? Do we have to use a 10 cc syringe or the smallest possible like a 1 cc tuberculin syringe. As what was recommended by our Interventional Radiologist to flush the PICC line with the smallest syringe specifically 1cc or 3 cc syringe with normal saline. But it's contradicting with what is normally read in written notes about care of PICC line, to flush using a 10 cc syringe. I've noticed too that PICC line easily clots. Do we have to flush them with heparin every time when not in use too? Does anybody has any idea?

several times whenever my cna is not around, i have to answer call lights of my patient. unluckily, when my patient says that she has made a bowel movement in her diaper, so i have to clean and change it. everytime i open the diaper and smell the poop, i always gag, teary eyes, and almost vomit in front of my patient and straight to the sink i go to continue gagging and do vomit sometimes. i couldn't take the smell and even the looks of long standing urine, feces, emesis. one time, a resident physician came to the room and saw me and asked what happened. she felt sorry for me when i told her because i'm one kind of gaggy person when it comes to terrible smell.

t'was really great reading your message. may i ask permission from you if i can forward them to my classmates and friends and aspiring nurses to give them the idea, the inspiration, the daily routine the nurse does.