PVL_RN86

I've been hung up on this situation for a while and wanted your honest thoughts.. I recently worked a 12 hour night shift on an Orthopoedic hospital unit where patients would come to stay for a night or few for monitoring after hip/knee surgeries. I reassessed all of my patients for pain exactly 45 minutes before the day shift came in. patient a: had right knee replacement. Pain controlled overnight with oxy 10mg times 2 over my shift upon my assessment of my patient and based on my patients complaints/signs/symptoms relating to pain. This patient ambulated to the restroom, then rated pain 4/10 after ambulating (during this 1 hour window before am shift coming). I gave patient a, oxy 5mg. patient b: left knee replacement done. No pain all shift, rated pain 0/10 all shift and tolerated all activity throughout my shift. This patient has denied needing pain mess due to zero pain even after activity (again during this 1 hour time window before am shift came). So... I give report and then the day nurse tells me in a bossy tone "you need to give patient a another pain pill because he is going to have therapy and is going to have pain." Same thing with patient b. This day nurse also tells me to give a pain pill to patient a because she "will have pain after therapy". In in my defense, I told her my patients wear comfortable and were satisfied with their current pain management.. Especially patient b, whom denied needing pain medication as she had NO PAIN. Also, patient a report his pain was mild only and it was not necessary to give him an additional pain pill if he was already comfortable at a 4/10. was I wrong for not medicating my patients?? What would you have done?? Thoughts??? please and thank u!! :)

Thank You MunoRN! :)

Hey everyone, I'm a new grad studying for my Tele Exam! I need ANY advice if you're willing to share!! So I understand how to do the whole systematic approach to interpret a strip, but I have hard time naming the actual rhythm. I get so nervous!! If you've got any advice for me, I'd be so happy to hear from you on what works for you and what else I could try to make it easier or me to name a rhythm!! Thanks in advance!!!

Hi everyone, thank you so much for your responses to my question. I'm a bit confused because I was always taught that no matter if a pump is used to infuse the antibiotic, whenever giving antibiotics via IVPB-- the antibiotic is always hung higher and the secondary bag is lower.. All of your response have helped me tremendously gain more insight on this matter... I'm a new RN and will definitely be questioning this with my workplace as I'm on orientation.. Also, your responses might explain to me WHY I have been seeing a LOT of IV antibiotics with some fluid left inside them without properly being infused all the way... This to me means that the patient likely is not getting their full dose of antibiotics. Again, thank you!!!! :)

Hi everyone, I'm a new nurse and wanted to ask you a question to clarify. So if you are doing an IV antibiotic that is supposed to be hung via IVPB with a pump, do you still hang the 0.9%NS fluid lower than the IV antibiotic? ---Or--- Do you just hang both the IV antibiotic and the 0.9%NS at the same height because you are using a pump? Reason being is because I was always taught to hang ANY IVPB like this, with the IV antibiotic higher than the NS fluid bag EVEN if you are using a pump. However, I am on orientation at a new job and was told that this is not necessary to hang IVPB in this way because it is being run with a pump? Your thoughts are greatly appreciated!!! THANKS! :)

Hi there, I think it's really important that you also remember to study for nclex in a way that suits you the best.. The reason I say this is because some people might find Kaplan helpful, whereas others may not. I'm one of those who found Kaplan really challenging in a way where I could not keep focus to be in that study mode for nclex. In my opinion, I felt Kaplan questions were very complex in nature. While Nclex is a complex exam designed to test our knowledge-- I don't agree that paying $400+ is a "for sure" way that you will pass your exam boards. I am not promoting in any way, but I decided to do NCSBN's practice online module for 3 weeks, no more, no less. What that does is, they provide you with solid need-to-know content material so that you can review whatever/whichever content material you want to review at your time between the purchased weeks (3 week, 5 week etc). You don't have to review and go through all of the modules, but they do have some great review points that I found were helpful to me. Remember that in nursing school, we could only have been taught so much in that time. NCSBN, to me, was really good at giving me those random in between content material that I missed or was not taught about in school. This I liked because it stuck to me. NCSBN also had practice test questions available to you at each end of the the content material module, OR just random test banks. If you do these, pay close attention to WHY you chose the wrong answer, and WHY you chose the correct answers. Overtime as you do more questions, you will find that there were reasons why you rationalized and selected that answer. This is a golden test taking skill that is really helpful in taking nclex. It helped me tremendously. You will find that you should be able to critically think your way out of each "incorrect" option so you can find the correct answer. I did NCSBN and did some hard core studying within a 2.5 weeks time before my test date and passed with 75 questions. In my opinion, nclex questions were closest in format to NCSBN's. I also bought a 1 month Kaplan QBank questions ONLY for $49 and oh my gawd.. that was the worst money spent ever. I could not stand the questions because I felt like I failed every time. Their questions were hard in a complex way. I did about 30 of Kaplan test bank questions for practice and called it quits and stuck with NCSBN and studying on my own. I liked nclex mastery app too, but couldn't afford that so i only got their free trial app with some of their neuro questions. If you have the moola, this is a good one I heard from my friends. If you can get your hands on some good questions, review and do as much as you can while reviewing content material you know you NEED to review on. Good luck! :)

I passed!!

Congratulations!! I didn't get my quick results yet.. so I will likely not know until tomorrow! I really didn't want to do the PVT trick (oh gosh.. I know I know, I will probably be scrutinized for doing it), but I gave in and tried it yesterday once, and this morning and got the "good pop up" as it would not let me re-register...

ADH causes body to hold onto water. DI is a deficiency in ADH. You can't hold water with this deficit so you're peeing like crazy and super thirsty! Since you're peeing water (4-30L/day) then you have hypernatremia. Other s/s are of dehydration. Tachy, low Bp, elevated temp! Meds to tx is pitressin! Give hypotonic fluids! SIADH: too much ADH. Your body holds onto too much water= you can't pee! Edema, high Bp because too much volume, hyponatremia! Treat with declomycin and give hypertonic fluids to pull fluids out the cells! Pc is cerebral edema! Thyroid indirectly stimulates the heart. You got problems with your thyroid, you can also bet your hearts gonna be in trouble too! Never give kayexate with diminished bowel sounds! Always assess bowel sounds before giving!

Congratulations! :)

Hi there, I took mine today 7/11... phew.. oh my gosh.. there were a few times I had to stop, regroup myself and breathe because I was so worried.. Mine shut off at 75 questions today. I'm relieved the test is over, but now worried about my results.. I really hate how they do this to us. Make us wait 48 hours! Yikes right! Well, I hope we all get good results from our tests soon! :)

Hi SweetLauren201, I just took my NCLEX RN today too at 2pm... I am so worried and anxious to find out if I passed. I know exactly how you feel and totally can relate. My exam shut off exactly at 75 questions too, and I was so confused because I actually thought it did NOT shut off; that it was prompting me to choose if I wanted to take a break. It didn't dawn in on me that I was done with the exam till I saw the screen with the survey. My heart just fell, and I was mixed with emotions. My teachers have told us that as long as we keep getting questions, we're still "in the game" for getting that RN title. So I felt completely, and utterly worried. As soon as I got out of the room with those big sound proof see through glassed area, my body just exhaled loudly and I felt all the blood rush to my head and I just cried. The testing lady who I needed to check out with was so sweet to me and hugged me and cried too and gave me well wishes.. sigh* Sorry for the long unnecessary yapping, but I know how you feel. I hope you and I get the good results we both want out of this exam, especially after it shut us off in 75 questions. I kept telling myself, either I did really crappy for it to tell me I sucked, or I did well enough to be deemed a competent, safe nurse. It definitely felt good to finish TAKING the exam, but now the waiting part is just so dreadfully pain stakingly terrible. Let's hang in there, try to stay positive, and distracted and keep in touch.

Hi ladies, hope you all stay positive. Wishing the best to you all who took yours today! I sit tomorrow! >_

Hi Stictch3296, Thank you for your advice. I feel like I do good (80-85%) on some of the NCSBN question banks, and some are around 70%-75%. I will keep studying and reviewing content. I'm super nervous for tomorrow!

Thanks everyone for your feedbank AND your suggestions and encouragement! Sending many blessings your way for contributing your comments, I find them very therapeutic and helpful to me.. Also very inspiring. Hope to pass real soon!