Category Archives: Junior I

Foundations: Sequence for Removal of Personal Protective Equipment (PPE)

UNITE GOWN AT THE WAIST

REMOVE GLOVES

UNTIE GOWN AT NECK AND ALLOW TO FALL OFF SHOULDERS

DISCARD GOWN

REMOVE MASK

PERFORM HAND HYGIENE

Image Sources: #1, #2, #3#4, #5, #6.

“Reviews & Rationales”

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These supplemental reads were recommended by a nurse graduate YouTuber. She expressed how beneficial these books where in reviewing & emphasizing the material of the corresponding topics. They come in a variety of topics that cover from Pre-Nursing to Senior II. According to reviews on Amazon.com, many buyers recommend these reads as it has helped them during their courses.

I just ordered the Medical-Surgical & Mental Health R&R books to try them out. It couldn’t hurt to consider them if you’d want to spend a little extra. I personally have found them to be great as additional abbreviated material alongside the textbook material from the theory class. Below are the estimated, minimum, used prices.

Pre-Nursing:
Prentice Hall Nursing Reviews & Rationales: Anatomy & Physiology: Amazon ($14)
Prentice Hall Nursing Reviews & Rationales: Pharmacology: Amazon ($20)
Prentice Hall Nursing Reviews & Rationales: Pathophysiology: Amazon ($20)

Junior I:
Prentice Hall Nursing Reviews & Rationales: Nursing Fundamentals: Amazon ($15)
Prentice Hall Nursing Reviews & Rationales: Health Assessment: Amazon ($20)
Prentice Hall Nursing Reviews & Rationales: Fluid, Electrolyte, Acid-Base Balance: Amazon ($20)

Junior II:
Prentice Hall Nursing Reviews & Rationales: Medical-Surgical Nursing: Amazon ($20)
Prentice Hall Nursing Reviews & Rationales: Mental Health Nursing: Amazon ($18)

Senior I:
Prentice Hall Nursing Reviews & Rationales: Child Health Nursing: Amazon ($17)
Prentice Hall Nursing Reviews & Rationales: Maternal-Newborn Nursing: Amazon ($20)

Senior II:
Prentice Hall Nursing Reviews & Rationales: Nursing Leadership & Management: Amazon ($12)

Images from amazon.com

Test Taking Tips

Exams in nursing school differ from traditional paper & pencil types. They’re computerized, timed & can only be progressed forward. They are also formatted for higher level of thinking, requiring the use of analytical and application critical thinking skills. It’s quite an adjustment for those of us who like to double check over their exams, especially when one question triggers an answer to a previous question. The most challenging questions, from experience, are those where all the answers are right but you have to choose the “most right” answer & communication-type questions. It’s important to know how to think & prepare for these exams. Here are some basic tips straight from Strategies for Test Success: Passing Nursing School and the NCLEX Exam.

I. Cover the answer choices & read the question. Read EVERY word

II. Look for key words.

  • For words such as initial, best, priority or most important:Photobucket
    i. ABCs (Airway, Breathing, Circulation) are a priority ALWAYS (when applicable)
    ii. Maslow’s Hierarchy of Needs: 1st physiologic, 2nd safety, 3rd emotional support; pain.
    iii. Consider preventive measures (example: manage pain early before it gets worse)
    iv. Do least invasive first
    v. Remember the Nursing Process ADPIE –  Assessment → Diagnosis → Planning → Implementation → Evaluation. ASSESS first. If you have enough information, DO something.
  • Look for superlative/inclusive words such as all, every, never, none, each.
  • If the question is about the patient, the answer should be PATIENT CENTERED
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  • Therapeutic communication: no opinions, closed-ended questions, you want to explore feelings & address emotions

III. How you you restate the questions?

IV. Look for negative words: except, need additional info, lacks understanding, etc.

V. What do you think the answer may be? You are not focusing on the question?

VI. When you uncover your answers, read the choices for content only. Refrain from saying “yes” or “no” until you have read the four choices.

VII. Do NOT look for the right answer. Eliminate the ones you know are incorrect. When you have two choices left, return to the question. Remember the key words.

THINK: How will the nurse use this information in the clinical setting?

Teach yourself the information. Review, did you include all the key points?

When doing the NCLEX practice questions, use these:

1. What are the key words?

2. What is the question asking?

3. What do you think the answer is?

4. Is this a priority question? Does Maslow apply (physiological, safety, psychosocial)?

5. Look for comparable answer; they both can’t be correct.

6. Eliminate the answers you know are wrong. Look at key words.

Don’t forget to practice, practice, practice!

Content derived from Saunders Strategies for Test Success: Passing Nursing School and and the NCLEX Exam, 2nd Edition.

Intro to Math for Medications

Medication math involves simple algebra and competence in certain formulas and conversion rates that you will be required to know for the exam, which you need to make a 90%+ in order to pass (in our program at least). Here, I’m just going to go through the basic info you will need. KNOW THESE:

CONVERSIONS:

  • 1 teaspoon = 5 mL
  • 1 tablespoon = 15 mL
  • 1 ounce = 30 mL (therefore 1 ounce also = 2 tlbs or 6 tsps)
  • Roman numerals – V(5), X(10), XV(15)
  • 1 kg = 2.2 lbs
  • 1 grain (gr) = 60 mg; 65 mg for Tylenol
  • 1 L = 1000 mL
  • 1 mg = 1000 mcg
  • 1 gm = 1000 mg

ABBREVIATIONS:

  • AC = before meals
  • PC = after meals
  • PRN = as needed
  • q2h, q4h … = every 2 hours, every 4 hours
  • BID = twice daily
  • TID = 3x daily
  • QID = 4x daily
  • IVPB = intravenous piggy back
  • mcg = microgram VS mg = milligram
  • tabs = tablets

ADDITIONAL FYI:

  • Always LEAD with a ZERO. Never TRAIL with a ZERO.
    – 0.5 or 5 ✔ (correct)
    – .5 or 5.0 × (wrong)
  • Round to the nearest tenth when calculating for most medication problems, unless specified otherwise
  • Round to the nearest hundredth when calculating for drugs to be administered in a TB syringe (<1mL)
  • Round to nearest whole number for drops (gtt/min) & IV pumps (mL/hr)
  • For pills & tablets, make sure you answer is either a whole number or halves.
  • Insulin is only given in units.
  • Make sure all of your answers are label appropriately (tabs, mL/hr, mg, etc)

FORMULAS:

  • The easiest way, for me, to calculate simple drug dosages is through Ducks Have Quacks (Hurrrr??). You’ll learn the origin of that but it’s simply DESIRED/HAVE x QUANTITY = X (amount)
  • For an IV infusion when using a pump: amount to be given (mL)/time (hours)
  • For an IV infusion without a pump: amount (mL) x drip factor (gtt/mL)/T(hr) x 60 min

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Let’s try one out for fun. Basically your math exam will have a series of 20 questions, with a couple of pages of medicine labels on the back to refer to. Here’s an example of a test question:

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Here’s an example of the medicine label that you will read in order to get the information needed to solve this question:

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First thing you would do is LABEL. What are we looking for here? TABLETS! So label like so:

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Now, determine what formula you are going to use. We’re simply looking for “how many tablets per dose”. We can use the DHQ formula, but let’s double check. We have our D “desired” (375 mg), we have our H “have” (250 mg – from the drug label) & we have our Q “quantity” (1 mL – which is usually the case, unless otherwise specified). Now set up our equation & solve:

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Now double check your answer again. It’s in tablets so 1.5 is an acceptable number. Congratulations! You (most likely) just got first taste of medication math!

Again, this is just a small example of what to expect once you get closer to the math exam. You’ll learn more through practice. I highly encourage you to practice frequently. Take advantage of the opportunity!

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Care Plans

A care plan is an outline of the care that is expected to be provided to a patient based on their clinical picture. A well constructed care plan consists of the following:

  1. a holistic approach, taking into consideration psychosocial and socioeconomic concerns
  2. focuses on interventions to relieve or minimize a current health problem
  3. has mutually set goals and parameters that are SMART (Specific, Measurable, Action-oriented, Relevant, Time-bound)

NURSING DIAGNOSES
Nursing diagnoses are clinical judgments set based on a patient’s response to actual or potential health problems. The following is a typical set up of a nursing diagnosis:

(nursing diagnosis) related to (medical diagnosis or primary complaint) as evidence by (signs & symptoms)
Example: Acute pain R/T abdominal incision AEB grimacing, rating of pain 6/10.

The North American Nursing Diagnosis Association-International (NANDA-I) is the main organization for defining standard nursing diagnoses. It is important to note the different between a NURSING and a MEDICAL diagnosis.

A MEDICAL diagnosis focuses on the primary complaint, disease or illness.
A NURSING diagnosis focuses on the patient’s response to actual or potential health problems.

There are four types of nursing diagnoses as defined by NANDA-I:

  • Actual diagnosis – an existing health problem
  • Potential diagnosis – a “risk for” problem
  • Health promotion/Wellness diagnosis – readiness to enhance well-being and self health
  • Syndrome diagnosis – a cluster of nursing diagnoses that are better addressed together

In nursing school, take the time to construct these efficiently. These care plans are meant to train you to think like a nurse. What is the patient’s background? What is your plan of action? What are several nursing diagnoses you can associate with this patient? What is your priority intervention? All of these questions need to be answered once you begin your shift as an RN in the real world.

Content Source: #1, #2.

Get organized!

Before you dive into the sea of information you will encounter your first semester, it may be helpful to organize yourself.

By that I mean seting up a binder with dividers for each of the courses you will be taking this semester. Every course should come with a syllabus & in that syllabus should be a general timeline of the content throughout the semester.

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Look for exam dates, clinical assignments & other important information.

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Label your dividers based on the number of exams you will have. For example, if you will be having 3 exams, label “Exam I”, “Exam II”, “Exam III”, etc. As you go progress through the semester, any notes you print out or write down will then go under the exam covering it.

Set aside other dividers/tabs for clinical assignments. You will be turning in a lot of them, more specifically Care Plans, Critical Thinking Journals, Evaluations & Teaching Projects. Print out the templates for the CTJs & Care Plans to serve as a reference.

It may also help to assign a particular highlighter color to content under a certain exam. For example, I like to use a blue highlighter for material under exam 1, green for exam 2 and so forth. This way, I’ll be able to retrieve whatever information I need from past exams for a comprehensive final or other purpose.

Set yourself up for success! Maintaining an organized layout of notes & assignments may help to prevent any additional stress later in the semester. With exams & clinicals, finding where your notes should not be an additional problem!

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Useful Apps. Should I spend $200?

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You may have heard word about the $200 smartphone app that was considered a requirement for the nursing program. It’s called Skyscape. I have that app & I actually do like it, using it for care plans & during clinicals to look up medications & interventions. It comes with several categories: IV medications, Med-Surg Nursing, Mosby’s Dx & Lab Test Reference, Mosby’s Nursing Drug Reference, Mosby’s Pocket Dictionary, MosbyLab, Nursing Dx Handbook, Outlines in Clinical Medicine & RxDrugs. However, there are other apps that were recommended to me that I found to be pretty helpful.

I. Medscape – Medscape offers a variety of functions including: drug referencing, drug interaction checker, diseases & conditions, procedures reference, tables/protocols, daily medical news, hospital directories & continuing medical education activites. This is my favorite of the free apps. It’s very comprehensive & I would say it is almost just as good as the Skyscape app. You are required to make an account to sign into the app.

II. WebMD – This goes along with the same network as Medscape. It provides tools such as Symptom Checker, Drugs, First Aid Essentials & Local Health Listings.

III. NCLEX – This is a great NCLEX-RN quiz card game to use during your free time. It comes with rationales & covers a variety of nursing topics from Basic Care to Management. This app is designed to help you pass the NCLEX. I would suggest getting this as a review once your first semester is over.

IV. VitalSource Bookshelf – This app is simply for storing your nursing textbook & read them on the go.

V. Micromedex Drug Information – I haven’t used this one much, I just downloaded it for the fun of it. It’s simply another drug reference. It covers generic vs trade names, dosages throughout the lifespan, contra/indications, ADEs, pregnancy categories, pharmacokinetics, etc.

VI. 3M Littmann SoundBuilder – This is a very fun, interactive app. I find it very useful for Assessment. It’s designed to help you refine your auscultation skills for key heart sounds. It covers normal vs abnormal heart sounds & goes into detail under each type of heart sounds.

VII. iPharmacy – This is another drug reference, but it includes actual pictures of the pills & packages of about 12,000 drugs. This is helpful for the visual type of person.

The best part about these? They’re free! Consider playing around with these before buying the Skycape app. I personally like it & have found it very useful, but for those trying to save on money, I feel these will be just as sufficient.

FYI: If you do buy the skyscape app, there will be some text/books from the package in there already: Mosby’s Dictionary, Nursing Diagnosis Handbook, 2011 Drug Reference & (later on) Lab & Dx Test Reference for J1/S1. So I would advise if you consider buying the app, do some research to purchase the other textbooks at lower costs (you’ll still need to buy the Evolve codes & Assessment lab manual). If you choose to buy the package, then forget the app & download the above free ones.

Health Assessment: The Basic Study Skills

Assessment is one of those universal, important skills that every nurse needs to be able to do. This course is very interactive to cover the variety of skills performed in a head-toe-assessment. In studying for this course:

  • link the signs & symptoms of certain disease processes with the overall diagnosis of a patient,
  • differentiate between NORMAL & ABNORMAL
  • know how certain S&S manifest throughout the lifespan, more specifically infancy-childhood, adolescence, pregnancy & aging adult
  • familiarize yourself with the different tests used during an assessment
  • successfully perform an Objective Subjective Clinical Evaluation (OSCE)

Effective studying for this class entails reading the chapter(s) before class and adding any additional information to the notes provided for you. Making your own blueprints (assuming they are not provided for you) are fantastic in setting up an organized set of notes, focusing what you need to know for the exams. However, studying them alone may not be sufficient enough for you to make a high grade on the exam. You need to follow along with the textbook & write down any additional notes (like abnormals, values, etc) that can classify as potential test material. Here’s an example of a section of an exam blueprint covering a list of abnormals:

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Simply knowing that these conditions are abnormal is not enough. You need to know the signs & symptoms associated with these conditions, the definitions of these conditions, how/why is it abnormal, treatment & any other defining characteristics. Here’s an example of the same section, but now with additional thorough notes:

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Exam questions are typically not cut-and-dry, neither is real life nursing. They are probably not going to be: “I am a condition with small period-sized bleeding under the skin. I start with a P & rhyme with crème brûlée. What am I?” Instead they could be worded as:

“A patient presents to the clinic with tiny, pinpoint, non-blanching hemorrhages measuring around 2mm around her oral mucosa. Based on the following signs & symptoms, a nurse can conclude that this condition is known as __________ and is often caused by _________.”
A.) Purpura, scurvy
B.) Petechiae, septicemias
C.) Strawberry Mark, blood disorder
D.) Port Wine Stain, congenital condition

B is the answer. See how a bit more in detail the question is? Information regarding the definition & cause of these skin conditions (assuming you did not know what petechiae was) may have helped lead you to correct answer.

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Nursing Foundations: The Basic Study Skills

Foundations covers the basic knowledge and skills required to be a competent nurse. You have one semester to cover a variety of topics ranging from therapeutic communication and documentation to medication administration and end-of-life care. It may be overwhelming considering the amount of reading involved. My goal here is to show a more abbreviated way of studying while trying to get as much information possible out of the content, which is then applied in both exam questions and real life. It is all dependent on the student & his/her way of studying.
It is important to try to get a general grasp of this course because it is basically the “foundation” of nursing practice. A lot of the material here concerns nursing care and interventions, which is revisited throughout the upcoming semesters. Here’s some tips to get you up & running:

I. Pay attention to the objectives. They are a general overview of what you should learn after studying that particular chapter. Try to answer them as you go through the chapter.

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II. Don’t skip the information boxes. You’ll come across boxes with headlines such as “Focus on Older Adults”, “Concept Map”, Tables, Figures, “Cultural Aspects of Care”, “Client Teaching”, “Procedural Guidelines”, etc. They contain valuable information that is fair game for test questions. Review the “Nursing Care Plan” that comes with each chapter. They are great for putting all the information together in one coherent format as you would apply in real life.

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III. Do your EVOLVE modules early! You’ll find out how tedious doing these modules can be, but they are very helpful in supplementing the textbook material. They come with a variety of activities, diagrams, quizzes & photos as resource material.

IV. Do the Critical Thinking Exercises & NCLEX question at the end of the chapters. These help to reinforce the information you just learned & identifies any material that may need review.

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V. Utilize the resources provided for you to help you succeed in nursing school. The Learning Resource Center (LRC) has a software called NCLEX 4000. NCLEX 4000 breaks down question into certain topics (for this semester, concentrate on Nursing Fundamentals) & randomizes them to cover a variety of topics covered in your theory classes. You set up your own personalized exam to automatically give you rationales after answering a question. Another resource is the Student Success Center where you talk with instructors for any concerns you may have concerning your courses. There are also many supplemental books that are beneficial for use alongside your textbook. Examples include Reviews and Rationales, Saunders Comprehensive Review for the NCLEX and the Illustrated Guide to the NCLEX. The more you expose yourself to the material, the more it may become familiar to you. Evolve has multiple choice questions for each chapter. Although they are not completely reflective of an actual exam question, they are for knowledge-based practice.

VI. Attend the brown-bag sessions during the early part of the semester. They will be covering Test-taking Skills & Math for calculating medications. Being competent in math is one of the more important skills you’ll need this semester, not only because you’ll be required to take an exam in which you have to score 90%+ or else you’ll fail, but also you will be dealing with medications.

VII. Stay organized. As I mentioned earlier, you will be turning in many assignments throughout the course of the semester. Keeping them all in one place, like a binder, & make sure to turn them in one time. You’ll find that some assignments are only worth 1%-3% of you grade. Do not brush them off as unimportant. 1% could mean the difference between a letter grade. You’re a nursing student now, take your academics seriously.

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Content derived from Fundamentals of Nursing, 7th Edition.