DjKaeDae

It's been a bit over two years since I've written or logged into this website. I recall the last time I was on this page was right before my NCLEX and I was freaking out... but I passed. I'm almost one year into working nights on a medical surgical floor of a community hospital... and I LOVE IT. I have my moments where I'm super busy 12 hours at night from ensuring all orders have been carried out correctly, pt's are all stable, medicated appropriately for pain, clean, and safe from trying to jump out of bed and whatnot... However, I have moments where I go home and think about what I could have done to make a situation better for my patient. Long story short, here it is... Two nights ago, my 55 year old patient was admitted for hypotension on neutropenic precautions. Hx of COPD and colon ca stg 4 with mets to liver. (trying not to give so much pt info out here) No hx of cardiac disease. 2 weeks into chemo. In ER, he was bolused 500ml NS. Patient was hypotensive at the start of my shift SBP:86 HR at 113. Called the on call MD and MD ordered 250ml NS + albumin. Administered it. SBP now in 80s and 70s with HR at 125s. Called MD again, MD ordered same thing, 250ml NS + albumin. I told this MD that this pt should be in ICU for that BP, but MD still ordered the same thing and said let's see how he is after this one. I told the MD that he has some labored breathing but has had it since start of shift (in which the pt is alert and oriented) and when asked states he's breathing fine with no difficulties. O2 saturations were maintained at 95%. RT has been in and out of the room for breathing treatments and suctioning. After the second 250ml NS and albumin, pt's SBP was at 107 with a HR of 138. Called MD. Orders to transfer to telemetry. Transfered the pt to telemetry. 20 minutes later, I was told he was intubated and taken to the ICU. I was told his ABG's were all off and he was acidotic. I felt horrible that night and morning. I kept thinking to myself what I could have done to make that situation better for this pt. I mean, I followed up with this MD frequently. I thought I was taking the right steps. He appeared fine to me prior to transfer. Pt stated he was fine and had no difficulties in breathing. Saturation was wnl. I was concerned about his BP dropping and his HR being tachy. I didn't ignore his respiratory status (at least I dont think i did) as I knew RT was there a few times, and myself and another RN was there a few times to suction him orally as he had small amounts of thick sputum in his throat, but not lower. The MD and I were concerned about overloading him on fluid and that was her rationale for bolusing him 250ml at a time. The only subtle change I saw was after the second order of 250NS and albumin where his breathing was a TINY bit more labored, but still denied any difficulty breathing. Saturation being 95 96%. Still alert oriented. When I transfered him to his new room on Tele, he was even asking us to put it back on the same channel he was watching... I still feel like a piece of trash for what happened. How do I sharpen my skills from that situation? What could I have done or what should I have done to prevent him from going down like that? To me, he wasn't stable being on a medical surgical floor to begin with. Thanks for taking the time to read this. Any and all criticism or advise and pointers is appreciated.

Just a status update.... Status: ACTIVE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I passed!!! After taking the test Oct. 1 friday at 8AM, I got the good pop up but kept refreshing the BRN website and saw my name as an active RN this morning!

High Five!! At least you can participate in the quick results. Ca doesn't have that...

Oh man... It's Monday night in Cali at 6pm... I can't stop refreshing the BRN website to see if I'm on it. I got (and keep getting) the PVT pop up but I just can't stop waiting and refreshing!!!! I'm going nuts!!! lol.

Okay so I've just gotten back home from taking the NCLEX-RN. This is my second take at it and I must say, I wasn't as nervous as I was the first time around. I was scared, yes, but not nervous. It shut me off at 79 questions at around 2 and a half hours. I was sh*ttin' bricks when I got 15 SATA's and so many med questions and quite a few math problems. I got questions that I didn't know what it was and could have sworn wasn't in my Kaplan book or other books (unless I just skimmed past them.) like Pheochromocytoma? WHY? but anyway, I hit the 75 mark and was about to freak out when I pushed next and it kept going. Then I freaked out even more when it stopped me at 79. At that moment, I was thinkin' to myself... the computer might not be sure if I'm passing... so i'll keep asking him stuff... oh waite, nevermind, i'll stop him here cause he got these wrong... BOOM. So I was too nervous to go home and confront my gf and family who I figured would be wating to ask me how I did and read the expression on my face to determine how confident I am in my results, So I went to a local coffee shop to do the pop up trick and it worked. So, at least that will keep my nerves in place for a few days until I see my name on the BRN website... 3-4 days for that to happen I was told?

Thanks for the good luck. And yeah, I'm thinkin' positively all day today to keep from losing my nerves and psyching myself out today. Tomorrow prior to testing, I'm gonna have to double dose myself with guts so I don't crack. haha. I've burned a cd of all my favorite encouragement songs and that's all I've been listening to all week. It's the same songs I used to listen to before each nursing test in RN school... It helped me escape the nervousness just prior to walking into class and taking a test. Thank you for the support and advice.

Thanks for the response. =) It's not so much of setting a certain pace for myself, but more of, I think if really sit there on a question too long, it seems as though I'm reading too much into it and then second guessing myself. I try not to, and i WOULD like to take my time on each question to pass at 75 questions... But I'm afraid that I might start reading into it again...

Okay, So hi first of all. New member but I've been turning to this forum for words of wisdom. Here's my situation. I took the NCLEX-RN last June and didn't pass. Then I enrolled for Kaplan and am schedule to take my second test Oct. 1 this friday. I'm 70% into the QBbanks and am scoring about high 50's and low 60%... My issue is, I've noticed that i score in the high 50's low 60's when I answer questions in a faster paced manner... So then I ask myself, "Hey, I should score higher if I take my time reading the question and really thinking each answer choice out." But I don't... the times I've answered a set of 50 questions on the Qbanks taking my time... I score disappointingly bad at 40 something percent!!!!!!!!!!! I don't want to go into the NCLEX friday morning answering questions at a faster pace... but if the trend I've been noticing were true, then shooting for accuracy to pass at 75 questions and take my time answering, just might harm me... I'm lost and this isn't the feeling where I wanted to be at at this point in time... I was confident Monday morning. It's Wednesday evening, and I feel terrible and lost.