What is Nux Vomica? State Board Questions From the Turn of the 20thCentury: An Era Gone By
Have you ever wondered what the early NCLEX exams looked like? We will be exploring a sample of questions taken from a first edition Lippincott (1917 edition) nursing manual. They will give us a glimpse into a nurse's world at the turn of the century. I am excited about sharing this entry in the series “An Era Gone By” with you.
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New England turned out the first formally trained nurse, Linda Richards in 1873 from New England Hospital for Women and Children Training School for Nurses. In 1873 the first nursing school in the U.S. was in New York at Bellevue Hospital that was grounded in Florence Nightingale's principles of nursing.
Ida Jane Anderson was the first licensed nurse in 1904 out of Rochester. She was on the coattails of the Armstrong Act of 1903 when New York passed the required Registration of Nurses. Once the schools began to create a standard curriculum, regulation followed to become what we know in present day. Regulation and standardization help nursing to be professionalized and make sure that nursing students are taught according to standards that allow them to pass a state board exam.
The content of state board exams are always being updated and it takes a long time to formulate one question. In the book, Lippincott's Nursing Manuals State Board Questions and Answers for Nurses by John Foote, M.D. we can find some questions that nurses in 1917 and after would have studied to pass their state boards.
The book that I have the privilege to own, was once owned by an Edith Westhook. I found some typed notes she used to study along with a nurses' record she scribbled on from Philadelphia General Hospital. There was also a small envelope engraved "The Joseph Price Hospital 241 North 18th St. Philadelphia." I would love to have a conversation with Edith.
Exam Question #1:
"Name two preparations of nux vomica and give the dose of each. Answer -Tincture of nux vomica, dose to minims, extract of nux vomica, gr.1/6 …™".
This question gave me a headache, what is nux vomica? Nux vomica is a plant in which the seed is used as a supplement. Some of its uses are for heart and circulatory disorders, lung disease, Raynaud's disease, etc. This plant contains strychnine and has very ugly side effects such as anxiety, muscle spasms, convulsions, liver failure and death.
Exam Question #2:
"What is the dose of tincture of nux vomica and what is its action?
Answer - Tincture of nux vomica is given in dosage from 8 to 15 minims. It's action is that of strychnia - a stimulant to the circulation, respiration and digestive organs, through its action on the spinal nerve centres" (yes, that is the spelling used in the book).
Exam Question #3:
"Describe method of giving hypodermatic injections.
Scrub the skin well, preferably the outer part of the arm, with soap and water, followed by alcohol, or at least with alcohol alone, or paint the skin with ½ strength tincture of iodine.
Place the needle in a tablespoon filled with water and boil it for two minutes over a flame from a stove or gas jet.
Draw the hot water into the barrel of the syringe and return it several times to clean the syringe barrel. Boil the water again, fill the barrel with it, and empty excess from the spoon.
Screw needle into syringe barrel, being careful to touch nothing but the base of the needle.
Place a tablet in spoon, empty syringe on tablet, and draw solution again into the syringe.
Hold syringe needle up and push piston until air is expelled from needle and a well-formed drop appears at tip. PInch up a portion of cleaned skin which does not show any veins, insert the needle with a quick movement under the fold of raised skin, and expel the contents slowly, withdraw needle and gently massage the elevation produced. Wipe off puncture with alcohol.
Rinse needle and syringe in water, followed by alcohol."
Am I glad I don't have to worry about sanitizing a needle and the barrel of the syringe. Of course, there weren't the PPI standards we have today. Gloves are not spoken of, and needless to say, the chance of contamination was high with human error and shortcuts.
We are very fortunate to live in the times that we do, and have the experience and information of all the nurses that come before us to implement into the standards we have now. If you want more early 1900 state board questions, tell me and I will share. I have a whole book of them!
