MollyMel

And.... I passed! Yup, no nursing diagnoses (more peds than I would have liked though ;-) I really feel like the practice exam from the CEN website, and of Solheim's material (the little flip book or the med ed site) and the questions on the MC Strategies review were most useful. Ahh, now I can enjoy christmas!

i've done bot the med ed and mc strategies reviews. I think they complimented each other nicely. I also have been reading one of the ENA books. I just wish I had more access to practice questions. I did the ones on the CEN website, and did well, so I am feeling a little better. I'm really glad I get a differential for passing the CEN because studying has been expensive!

Thanks! Yes, I had read the outline (many many times) and didn't see anything about nursing diagnoses. It's just that Lipincott's has so many ND questions I got a little scared. I'm not to thrilled about lipincott's questions I must say. thanks again

Hey there, Been lurking a bit lately, but not posting (I've been too busy with the first year of nursing thing!) I have a CEN question. I did the online MedEd review class by Jeff Solheim to study, and have loved it (I loved his classes at ENA conference in San Antonio too). I recently started doing questions from Lipincott's Q&A review. Here's my dilemma... Jeff Solheim says clearly that there are no nursing diagnoses on the exam, and that they won't give symptoms and ask you to name the sign (ie Cullen, Kehr, Murphy). They may give the symptoms and the sign and want you to identify what you are looking for, but it's not a vocab test. Lippincott's has lots of nursing diagnosis questions. Anyone have personal experiences with this? I'm okay with signs, I've always been a little dorky with that. Seriously though, I have put nursing diagnoses pretty far out of my mind this past year and just don't feel like I think that way. I could get it back, but there is sooooo much else to study! Thanks!

Thanks! There are a few nurses who will change the documentation to say they gave it IV in 50cc ns, but more who do not. While on orientation I have been documenting what I do (IVP or IV), and figured I could always fall back on the "I'm new" excuse if I did in fact get in trouble. Since I am going off orientation (tomorrow!) I want a clearer guidelines. I'm not sure what the concern is, but I have definitely been told not to let the department head or NM see me put reglan or compazine in 50cc bags, and been chastised for labeling my bag with the drug and dosage (crazy, I know, and these are many of the same nurses who's precepting consisted mostly of ways to protect your license). Are 50cc bags really that expensive? Also, I have seen nurses ask MDs switch from Reglan to Zofran if the pt has any psych history or psych med use (which would increase the risk of tardive dyskinesia or extra pyramidal SEs). I've read studies that say Zofran is more effective than reglan at relieving nausea and has fewer side effects, but I realize it is way more expensive. I also saw many references to using benedryl with Compazine, but not reglan. I will definitely take this to my nurse educator. Thanks!

Hello, I am a new grad, just finishing my orientation in the ED, and I have a question for the more experienced out there... Does your hospital have a policy regarding IV push Reglan and Compazine? My hospital states we can push Metoclopramide and Prochlorperazine, and the MDs routinely order it that way. The nurses are unanimous in their resistance to push Compazine, but are split when it comes to Reglan. All of them tell me to dilute either med in a 50ml bag of ns, but chart that I gave it IVP (that's what the MD ordered) and never tell management. The nurses are pretty hush hush about it too. I have been researching the akathisia common with both these drugs and have found some interesting info I want to take to our ED nurse educator (I think she's kind of on everyone's team, us and management). Most of the studies are pretty old, but I guess the meds themselves have been around a while. First, some degree of akathisia is really common with compazine administration (44% of pts according to a study in the Annals of Emergency Medicine, *1) but slowing the infusion rate is actually ineffective at preventing these symptoms (*2, *3). My Davis guide says you can administer up to 5mg/min IV, but online searches say no bolus. I'm not at work so I can't check Lexicomp. Is the best option just to make sure pts have never had a reaction before, warn them that it could happen, and give them benadryl if a reaction occurs? On the other hand, I can't find incidence data for akathisia with Reglan, but there are a couple of studies that show that increasing the infusion time (from 2min to 15min) is very effective at reducing the feelings of restlessness etc. One study showed akathisia experienced in 11% of bolus pts vs 0% of infusion pts (*4), another 24.7% of bolus pts vs 5.8% of infusion pts. (*5) Any thoughts? Thanks! *1- Drotts DL, Vinson DR. (1999) Prochlorperazine induces akathisia in emergency patients,Annals of Emergency Medicine Oct;34(4 Pt 1):469-75. *2 Pollack, Charles. (2002) Akathisia Is No Less Likely If Prochlorperazine Is Given Slowly, Journal Watch Emergency Medicine January 2, 2002 (reviewing Collins RW et al., Ann Emerg Med 2001 Nov; 38:491-49) *3 Vinson DR, Migala AF, Quesenberry CP Jr. (2001) Slow infusion for the prevention of akathisia induced by prochlorperazine: a randomized controlled trial. Journal of Emergency Medicine. Feb;20(2):113-9 *4 Regan LA, Hoffman RS, Nelson LS. (2009) Slower infusion of metoclopramide decreases the rate of akathisia. American Journal of Emergency Medicine. 27(4):475-480. *5 Parlak I, Atilla R, Cicek M, Parlak M, Erdur M, Guryay M, Sever M, Karaduman S. (2005). Rate of metoclopramide infusion affects the severity and incidence of akathisia, Emergency Medical Journal, 2005;22:621-624. doi: 10.1136/emj.2004.014712

Hey, I am just finishing up in the ATOP program. You do need to be generally available during those times (Thurs 3-8, Fri 8-3, Sat 7-7) but you will not actually be there all those times. First year, we had lecture Thursday 3-8, a lab or clinical Friday 8-12, and clinical Saturday 8-12 or 3. Second year we were up to lecture Thurs 3-8, lab or clinical Fri 8-12 or 3 and clinical Sat 7-7. You might need to scale back your hours in second semester, or at least second year. Nursing classes are very different than other school, but the first semester wasn't that hard (the biggest challenge is getting used to nursing exam questions). Most of us work, but many people scaled back hours this year to keep up with reading. Good luck!

I was in a similar boat, all pre-reqs done and a previous bachelors. I did apply for accelerated bachelors, but also a 2 year associates. I ended up choosing the ADN because it was cheaper and started in September (I would have had to wait until May for the accelerated). I second what Rhone said, the 8 credit nursing class may not sound like alot, but it will take up a huge chunk of time, especially if you are putting in a good amount of time studying. Also, the 2 years have flown by, I will be done in May and it feels like I just started. I know I would have been fine in an accelerated program, but I have been really happy I wasn't so crazy busy. I had time to do service projects, student government, extra classes, conferences, have a tiny sliver of my prior social life. 2 Years isn't nearly as long a it sounds.

Hello, I am wondering what your school's exam review policy is? We used to go over tests question by question, as long as everyone had taken the test, and with the understanding that no one take notes. Recently they changed the policy and there are no more test reviews at all. They are also not giving us a printout that shows which questions we got wrong (so we could see it was the musculoskeletal section vs. the respiratory section. We are also forbidden from discussing the test among ourselves, I will admit this is a bit of a relief, some people were a little obsessive lol. If we had enough wrong they will meet with us and give us general feedback, as in "you need to review the fundamentals of suctioning" or "you did not know your cardiac meds". If you only got a couple wrong they may not have time to go over them with you. So, what does your school do? They told us that since you can't discuss the NCLEX, we are just trying to get in line with that. I think that it is nice to get reviews and rationals for questions that caused us problems expecially if it is something that applies to our nursing practice. (my:twocents:) Thanks!

You mean the IV infusion pump right? This site: http://classes.kumc.edu/general/IVPump/IVSimulation.html gives a general practice. You should also find out what pump your hospital has and look that one specifically, they are all slightly different. Ultimately though you are selecting A or B (on some of them), Primary or secondary (on the one we use), the rate of infusion, and the volume to be infused. The buttons will be in different places, the order you enter things may be different, but that is the information the machine needs to know. good luck (you can also ask the person you are watching to slow down, or talk you through what they are doing)

Hey, Our school (in NYC) told us that RN students could no longer write the LPN exam after the first year of clinical classes. I do think it changed in the last few years. Some of our students were able to get jobs as PCA's though. good luck

- which solution do you use to clean the area? (alcohol, iodine etc.) we (my school and the hospitals we have clinicals at) use alcohol, but we make sure it dries fully before we do the test or it will give a false (low) reading. (unfortunately i know from experience, nursing 101). - do you check the first blood sample or do you clean the first sample and take the second? or do you want your patient to clean his/her hand? we were taught to clean off the first drop and use the second drop. obviously most of the nurses don't since pt's always ask why i am doing that. in truth, sometimes if it has been a chore to get that first drop out and i am worried about getting enough blood for a sample i will just use the initial drop to avoid squeezing the pt's finger too much (mostly with very elderly pt's with poor circulationa and callused fingers). generally we do exactly as chenoaspirit and sharrie said: 1. cleanse area with alcohol swab 2. lancet the area. 3. wipe alcohol and blood off area to ensure proper reading 4. take sample with glucometer 5. apply 2x2 and let patient hold pressure if still bleeding. we also do not cleanse the site with alcohol after as our in-service edcation said alcohol will just increase bleeding. (vasodilation?)

Hi, I'm curious... In our book it says Scabies is transmitted through extended contact with the infected person, as in housemates, sexual partners etc. but not through casual contact such as handshakes. I personally had always believed that it was more aggressive than that. If you can catch it from a patient then I am right. I guess a 12 hr nursing shift might be considered "extended contact" lol. The people I have known who had scabies were miserable, it sounds like a special level of hell and I definitely have no interest in experiencing it for myself.

Hello, I am really interested in Public Health Nursing, but I'm a second career nursing student and really don't want to go back to M-F 8-5. I have always done better in jobs where I had irregular hours, but am I going to find that in PH? Even many of the clinics I have seen have regular business hours. When I have kids I will probably change my mind, but that is a few years off still. totally unrelated... I went to the free student morning at the APHA conference last year and really enjoyed myself. I had to go to annual conferences in my last career and believe they afford great networking and learning opportunities. Does anyone have any opinion on how making the trip out to the APHA conference in San Diego could help my chances of getting into an MPH after I finish my RN degree? Has anyone ever been asked about conference attendance at an interview? Thanks!

They changed the med-surg book? I guess that means none of us can sell ours. Oh well, I wasn't really planning on it anyway, I like having the reference around. Make sure you do buy both volumes of the Brunner and Suddarth book, the link is just for volume 1. Including the PDA programs that is definitely more books than we were required to buy! Also, do you know when the 25% off discount at Skyscape expires and if there is a code to get the discount? (pm me if there is) thanks!