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Question of the week

NCLEX Exam Practice Question of the Week - 4/14/21

What is the focus of the priority nursing assessment for a client with a serum magnesium level of 0.92 mEq/L?

LOC
Cardiac arrhythmias
DTR activity
Dysphagia

Show answer

Answer: 2

Rationale:
2. If the magnesium level is less than 1 mEq/L, the priority nursing assessment is to monitor closely for arrhythmias.

1. Although a neurological assessment is appropriate, at this severe level of hypomagnesemia, cardiac function is the priority.
3. Although an assessment of DTR activity is appropriate, at this severe level of hypomagnesemia, cardiac function is the priority.
4. Although muscular assessment is appropriate, at this severe level of hypomagnesemia, cardiac function is the priority.

Client Need:
Physiological Integrity

Cognitive Level:
Analysis

Nursing Process:
Planning

Practice Question Sourced From: Nursing Key Topics Review: Fluids & Electrolytes

NCLEX Exam Practice Question of the Week - 4/7/21

What process must be in hemostasis to maintain stable new bone replacement?

A balance between the function of both healthy osteoblasts and healthy osteoclasts
Parathyroid production sufficient to stimulate effective osteoclast activity
Sufficient collagen to produce fiber in quantities needed for bone strength
Sufficient production of calcitonin to stimulate osteoblast activity

Show answer

Answer: 1

Rationale:
1. A balance must be maintained between osteoblasts that produce new bone, and osteoclasts that reabsorb bone.

2. Parathyroid stimulates osteoclast function, one part of the necessary balance.
3. Collagen is the fiber that gives bones strength; a component of healthy, new bone.
4. Calcitonin stimulates osteoblast, one part of the necessary balance.

Client Need:
Physiological Adaptation

Cognitive Level:
Understanding

Integrated Process:
Teaching and Learning

Practice Question Sourced From: Nursing Key Topics Review: Pathophysiology

NCLEX Exam Practice Question of the Week - 3/31/21

A nurse is developing a teaching plan for an 8-year-old child who has recently been diagnosed with type 1 diabetes. What developmental characteristic of a child this age should the nurse consider?

Child is in the abstract level of cognition.
Child’s dependence on peer influence has reached its peak.
Child will welcome opportunities for participation in self-care.
Child’s developmental stage involves achieving a sense of identity.

Show answer

Answer: 3

Rationale:
3. An 8-year-old child is in the stage of industry versus inferiority and strives to complete assigned tasks.

1. Abstract levels of cognitions are true of an older child (adolescent).
2. Peer influences increase as the child enters the preadolescent and adolescent years.
4. The developmental stage involving achieving a sense of identity occurs during adolescence.

Client Need:
Health Promotion and Maintenance

Cognitive Level:
Application

Integrated Process:
Teaching/Learning

Nursing Process:
Assessment/Analysis

Practice Question Sourced From: Nursing Key Topics Review: Pediatrics

NCLEX Exam Practice Question of the Week - 3/24/21

A client in preterm labor at 35 weeks’ gestation asks the nurse, “What determines whether my baby’s lungs will be okay?” The nurse explains that a test of the amniotic fluid obtained through an amniocentesis will reflect fetal lung maturity. Which test should the nurse include in the discussion?

Amniotic fluid index (AFI)
Phosphatidylglycerol (PG) test
Alpha-fetoprotein levels (AFP)
Lecithin-sphingomyelin (L/S) ratio

Show answer

Answer: 2

Rationale:
2. The phosphatidylglycerol (PG) is a phospholipid that, if present in the amniotic fluid, indicates that the fetus’s lungs are mature.

1. The amniotic fluid index is a noninvasive measurement of the amount of amniotic fluid in the four quadrants of the uterus; it is done via ultrasonography.
3. The amount of alpha-fetoprotein in the amniotic fluid determines whether there is a neural tube defect.
4. Lecithin and sphingomyelin are surfactants, and by 36 weeks’ gestation, the L/S ratio should be approximately 2:1 and should indicate fetal lung maturity; however, the L/S ratio is not as accurate as the PG test.

Clinical Area:
Childbearing and Women’s Health Nursing

Client Needs:
Reduction of Risk Control

Cognitive Level:
Comprehension

Nursing Process:
Planning/Implementation

Integrated Process:
Teaching/Learning

Practice Question Sourced From: Nursing Key Topics Review: Maternity

NCLEX Exam Practice Question of the Week - 3/17/21

A 6-year-old child diagnosed with autism spectrum disorder is nonverbal and has limited eye contact. What should a nurse do initially to promote social interaction?

Encourage the child to sing songs with the nurse
Engage in parallel play while sitting next to the child
Provide opportunities for the child to play with other children
Use therapeutic holding when the child does not respond to verbal interaction

Show answer

Answer: 2

Rationale:
2. Entering the child’s world in a nonthreatening way helps promote trust and eventual interaction with the nurse.

1. Encourage the child to sing songs is unrealistic at this time; it is a long-term objective.
3. Expecting the child to play with other children is unrealistic at this time; it is a long-term objective.
4. The use of therapeutic holding may be necessary when the child initiates self-mutilating behaviors.

Client Need:
Psychosocial Integrity

Cognitive Level:
Application

Nursing Process:
Planning/Implementation

Practice Question Sourced From: Nursing Key Topics Review: Mental Health

NCLEX Exam Practice Question of the Week - 3/10/21

A client has been involved in an accident, does not speak English, is hemorrhaging, and requires immediate surgery. No one is with him. What is the best way for the nurse to handle this situation?

The hospital ethics review board must be contacted and approve the impending surgery.
The nursing staff and the surgical team should prepare to continue with the impending surgery.
The hospital should have an interpreter on call who can come and explain to the client his rights.
The physician can sign and witness that attempts were made to explain the information to the client.

Show answer

Answer: 2

Rationale:
If the client's life is at risk and consent cannot be obtained from the client, the surgery required to save the life is performed without client consent. Because this is an emergency situation, it would not be necessary to contact the hospital ethics review board, as valuable time would be lost. An interpreter is on call; again, valuable time would be lost trying to get the interpreter to the hospital. The physician signing and witnessing the attempts is not necessary. (Zerwekh, Garneau, 8 ed., p. 475.)

Practice Question Sourced From: Illustrated Study Guide for the NCLEX-RN Exam, 10e

NCLEX Exam Practice Question of the Week - 3/3/21

A client is complaining of pain at the peripheral IV site. The nurse determines the IV is not infusing, assesses the site, and finds the area swollen, pale, and cool to touch. What is the best nursing action?

Discontinue the IV and apply warm, moist, or cold compress to the involved area.
Slow the IV infusion and see whether the swollen area decreases.
Notify the health care provider regarding the status of the IV.
Discontinue the IV and start another IV in the same vein, distal to the current site.

Show answer

Answer: 1

Rationale:
The IV is infiltrated and should be discontinued. A warm, moist, or cold compress can be applied according to procedure for type of solution infiltrated to promote client comfort. The IV should be discontinued, but not restarted distal to the previous site; it should be started proximal to or above the current infiltrated site or in the other extremity. (Potter, Perry, 8 ed., p. 910.)

Practice Question Sourced From: Illustrated Study Guide for the NCLEX-RN Exam, 10e

What I Wish I Knew in My First Year of Nursing School

Written by Monique Nguyen

The transition from high school to university can be extremely intimidating and scary for many nursing students. There are many things I wish I had known before entering my first year of nursing school. Now that I am a nursing student entering my fourth and final year of nursing school, I have accumulated some tips, tricks and advice over the years. To help those just entering nursing school or those who are currently in nursing school, these are my top 5 things I wish I knew when I was in your shoes:

Don’t be afraid to ask questions
Whether it be in clinical or in class, always ask questions when you are unsure about how to do something. Your first clinical placement can be extremely intimidating, however, to provide the best care for your patients, ask your nurse/preceptor questions when you are unsure. When you ask questions, you are more likely to retain the information, thus, making it easier to recall the information in the future. Your professors, nurses and preceptors are there to aid in your learning and will always be there to answer any questions that you have, therefore, do not be afraid to ask questions when needed!
Be proactive in your own learning
As a nursing student, you are responsible for your own learning at clinical. When opportunities arise to perform a skill, take on the opportunity and do not be shy! You may not have the opportunity to practice this skill in the future as a nursing student, thus, don’t let the opportunity pass by. In clinical, instead of letting your nurse/preceptor do all the tasks, ask if you could practice the skill yourself. Demonstrating that you are interested in performing tasks shows that you are open to new learning opportunities and eager to learn. If you are interested in performing a specific task at clinical, voice your interest to your nurse or preceptor and ask if they could let you know if the opportunity arises for you to perform this skill. Remember, if you are not proactive in your own learning, you will be unable to maximize the knowledge learned.
Have a supportive group of friends
Being a nursing student can be stressful and overwhelming. It is important as a nursing student to step outside your comfort zone and have a supportive friend group. Having a study group and a supportive friend group will help you both academically and emotionally. Not everyone will understand the stressors of being a nursing student and being in clinical, thus having a group of friends that understands your situation is extremely helpful
Don’t be too hard on yourself
In my opinion, nursing school is nothing like high school. Do not expect to achieve 95+ on every assignment and exam like you did in high school. Your study habits that worked in high school may not work in college/university and your study habits may change throughout university... this is OKAY! If you did not achieve your desired grade on an exam/assignment, explore where you went wrong and use it as a learning experience to motivate yourself to do better on the next exam. Remember, your grades are not a reflection of your ability to be a great nurse. The most important part of nursing is being able to care for your patients competently and provide the best, holistic, patient-centered care.
Self-Care is Important
Take time for yourself and don’t forget to reward yourself. Nursing school burnout is real! Studying for exams, completing assignments, attending 12-hour clinical shifts, working part time and managing a social life is not easy. We often get so caught up with our schoolwork that we forget to take care of ourselves and put our needs first. As nurses and nursing students our job is to take care of our patients, however, we tend to forget to take care of ourselves. It is so important that we incorporate self-care activities into our routine such as hanging out with friends, taking a relaxing bath, or exercising to ensure that we do not get burnt-out. Rewarding yourself after a hard week is also important. Whether this be reflecting on your accomplishments and acknowledging how far you have come or treating yourself to an expensive meal, remember that these small acts can totally enlighten our mood. When we are able to properly care for ourselves, we can properly care for our patients.

Hands-on Pre-Nursing Experience Through Volunteering

Written by Darian Arias

I wanted to share with all of you a tip that I wish somebody would have shared with me sooner. During your prerequisites, or even if you are currently in nursing school, I would highly recommend getting involved in any clubs or organizations that do volunteer work to serve the community.

I say this because a couple of years ago I had the opportunity to go on a medical brigade to Ghana, which is in West Africa. While there I was able to practice many hands-on skills and was also able to shadow many healthcare professionals such as nurses, doctors, ophthalmologist, etc.

As a pre-nursing student getting your hands a little dirty is something that is very useful in your learning experience because it gives you a chance to practice on real patients, practice therapeutic communication, and it allows you to practice many other skills that you would not be able to do in a classroom setting. At first, I was nervous to see real patients because this was something that I had never been exposed to in the past, but we were always working alongside a licensed healthcare professional, so it made it easier to ask questions and/or get guidance in areas that we were not comfortable in.

I cannot begin to explain to all of you how much this trip changed my overall perspective on health care and how it gave me the confirmation that I needed to become a nurse. If you have the opportunity to get involved, whether that’s at your community college, university, or even a local volunteer center, I say DO IT- there’s NOTHING to lose and everything to gain from an experience like this!

It has taught me to be more humble, to not take life for granted, to give back to the community when I have the opportunity to do so, that there is more to life than what I’ve become accustomed to here in my town, and of course, it has shown me how much I love serving others! There’s just something about giving back to the community and seeing others smile that lights a fire again!

I came back from this trip more open-minded and eager than ever to become the best nurse that I can possibly be, not only myself but ultimately for others! I encourage all of you to travel the world and experience healthcare in a different way. I promise you when you do this you will start to look at life from a different perspective and, in my opinion, it just makes you a better person all around. If you can have the same feeling of fulfillment and excitement why wouldn’t you take advantage of it?

NCLEX Exam Practice Question of the Week - 2/24/21

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations?

Hypertension, tachycardia, and fever
Hypotension, bradycardia, and hypothermia
Restlessness, irritability, and generalized weakness
Headache, deteriorating level of consciousness, and twitching

Show answer

Answer: 4

Rationale:
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood–brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates. Tachycardia and fever are associated with infection. Generalized weakness is associated with low blood pressure and anemia. Restlessness and irritability are not associated with disequilibrium syndrome.

Test-Taking Strategy:
Focus on the subject, disequilibrium syndrome. Think about the pathophysiology and that brain cells are responsive to changes in osmolarity. This will assist you to choose the correct option describing neurological symptoms.

Level of Cognitive Ability:
Analyzing

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process-Assessment

Content Area:
Adult Health: Renal and Urinary

Health Problem:
Adult Health: Renal and Urinary: Chronic kidney disease

Priority Concepts:
Elimination; Intracranial Regulation

Reference:
Ignatavicius, Workman, Rebar (2018), p. 1417.

Practice Question Sourced From: Saunders Comprehensive Review for NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 2/17/21

The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective?

Muffled heart sounds
Client reports dyspnea
A rise in blood pressure
Jugular venous distention

Show answer

Answer: 3

Rationale:
Following pericardiocentesis, the client usually expresses immediate relief. Heart sounds are no longer muffled or distant and blood pressure increases. Distended neck veins are a sign of increased venous pressure, which occurs with cardiac tamponade.

Test-Taking Strategy:
Focus on the subject, expected outcome following pericardiocentesis, and note the strategic word, effective. Successful therapy is measured by the disappearance of the original signs and symptoms of cardiac tamponade. This will direct you to the correct option.

Level of Cognitive Ability:
Evaluating

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process-Evaluation

Content Area:
Complex Care: Emergency Situations/Management

Health Problem:
Adult Health: Cardiovascular: Cardiac Tamponade

Priority Concepts:
Evidence; Perfusion

Reference:
Lewis et al. (2014), pp. 815-816.

Practice Question Sourced From: Saunders Comprehensive Review for NCLEX-RN Examination, 8e

HESI™: How to study for Entrance Exams

Written by Brandon Thompson

You’ve completed your prerequisites and now it’s time to focus on the entrance exam. Here are a few tips and a breakdown of what the HESI™ A2 entrance exam consists of:

Grammar: Students are expected to display their knowledge of basic grammar concepts. Each student must show their comprehension of the parts of speech, typical grammatical errors, and important grammatical concepts. The HESI grammar test is 50 questions and students are given 50 minutes to complete. I failed the entrance exam twice! English is not my first language and I struggled with grammar. I am sharing this because nursing school is very diverse. Applicants are from all over the world, or newly immigrated to the U.S. Don’t be discouraged. I used the SATs language portion to prepare for the HESI grammar section along with the evolve HESI A2 entrance exam book.
Math: The HESI math questions evaluate a candidate’s knowledge of basic mathematical concepts. The math skills tested normally have some relation to health-related scenarios. Don’t be scared, breathe and extrapolate the needed information. Each student is expected to have a strong grasp of the following math skills: addition, subtraction, multiplication, division, fractions, proportions, ratios, and decimals. Questions will also be presented on roman numbers, calculating dosages, household measurements, and conversions. The section is 50 minutes long and consists of 50 questions. If you’re a math lover like me, you’ve got this!
Physics: This section is dependent on your program. For my program physics, is not required which means I did not have this section on my test. But for those who have to take it, here’s what included. The physics test will cover general physics concepts such as: rotation, friction, gravitation, energy, average speed, Newton’s Laws of Motion, projectile motion, light, optics and acceleration. Test takers are given 50 minutes to answer 25 questions. The physics test is usually only required for Nursing programs that require Physics as a prerequisite course. You got this physics lover!
Biology: This is by far my favorite section. The biology questions, I've noticed, focus on general biology topics including biology basics, cellular respiration, photosynthesis, metabolism, biological molecules, and cells. The HESI biology exam contains 25 questions. The biology test is not required by all Nursing programs.
Anatomy & Physiology: This section was not required for my program, so I have no insider tips on how to be successful. What I do know is this: The A&P exam evaluates a student’s understanding of fundamental Anatomy and Physiology concepts such as: anatomical systems, structures and general terminology. This section also has 25 questions.
Chemistry: This section seems to be the most difficult for most students I’ve talked with or tutor. The chemistry section is designed to quiz students on the periodic table, chemical equations, atomic structure, chemical bonding, nuclear chemistry and chemical reactions. This section is also 25 questions.

Knowing that these are the areas being tested on, I would advise that students take a post test on all these areas to identify gaps in knowledge. I have mentored students who did this and quickly realized that they needed an “Intersession course,” generally two weeks long, to brush up on the foundations. Most universities offer these courses.

Finally, invest in some resources! You are accountable and responsible for your education.

A Guide to using EAQs as a Successful Nursing Student

Written by Brandon Thompson

Elsevier Adaptive Quizzing (EAQ)™ really reflects what nursing questions are like. Most of my peers find EAQs challenging, and in fact they are. I believe the harder the questions, the better the student will become. I have seen a great improvement in my own course grades because I spent so much time practicing questions and reading the rationales.

Customize Quizzes

Custom quizzes are the greatest invention ever and honestly a great tool for all nursing students. You can specify EAQ target areas to focus on or simply the areas that will be tested during the course exam. The quiz is customizable to even the number of questions you want to do, so you can answer as few as five or as many as thirty questions while using study mode or exam mode. I prefer and would recommend using study mode because it gives you the answers with the rational after each question.

Practicing these quizzes changed my approach to studying for course exams. Normally, I would re-read slides, re-read chapters, and re-watch lectures, but now I practice questions. My exam score went from a 68% to an 82%, and I completed the semester with an 82% average. I credit these successes to practicing specific questions using EAQ.

Reading Rationales

I used to be someone who would answer a question, get it wrong or right, then move on. I never read the question rationale until one day I happened to glance at it and notice that they offer motivational advice, excerpts from specific textbooks, graphs, diagrams, processes, etc. From then on, even if I get a question correct, I would read the rationale provided. Sometimes it helped me realize that my rationale for picking the correct answer was not completely correct, and ultimately, it came down to me guessing.

I also use the answer rationale to guide my reading. It informs me of what information I need to focus on from the chapter, what assessment data I missed, if I listed the appropriate medications, and what common side effects I may have omitted. This is what the rationale does, it guides you.

Practicing Multiple Questions

Don’t give up just because you couldn’t answer the questions. Yes, the EAQs are hard, but it is for a reason. Practice the same concept at least five times. You’ll start to notice a pattern on how questions are asked for particular concepts. Do 30 questions at a time and repeat the process. Take notes while you go through.

Calendar View

I love this tool. I don’t need a planner because the EAQ already has a calendar available with all my due dates for assigned work. Use this to mark off study days before and after a concept is taught. This is a time gauge and requires dedication. After all, your grades depend on it. Use your calendar option to plan ahead. For example, if a coping EAQ is due 3 weeks from today, start gathering your coping materials and start customizing practice questions focused on coping. There is a trend in how questions are asked. Practice a lot so you can recognize different question formats and focus your studying on how to answer these questions.

Timing

I appreciate that EAQ times how long you spend on a question. This is very important since most nursing school exams (or at least mine) are 75-90 minutes long ranging from 50-60 questions per exam. Because practice questions with EAQs are timed, you get to see how long it took you to answer a specific question.

I am not encouraging anyone to speed through an exam, but I have mentored and seen far too many students not completing an exam because time ran out. Create a journal and log how much time it took you to answer 30 questions in EAQ. Aim to reduce your time. One piece of advice is to use the Forest app, something I used myself. I plant a tree for 1 hour and document how many questions I can answer within that hour before the tree is fully grown. This puts some fun into your studies as well.

Success from using EAQ is not a one-time deal. You must be consistent in practicing questions, which means you have to log in daily. Remember that calendar view I mentioned? Well, if you don't check your calendar daily you might miss an assignment. That has happened to me countless times and now I make it a priority to log in and check my EAQ daily.

Look at your Analytics

Most programs will require that you master a specific concept, which means you can spend anywhere from 10 minutes to hours mastering a concept, which is dependent on you doing practice questions.

What I’ve noticed is that whenever you practice questions on EAQ, let's say Maternity, those practice questions count towards you mastering the concept. EAQ has three levels, level three being mastery. If you never looked at your EAQ, or even practiced a few questions, this is where this mastery exam can take hours because now you have to go through all the levels (1, 2, 3).

This is where the analytics come in. Use this as a guide to identify what concept/content area needs leveling up. Your EAQ will often have a quick suggestion of some content on the top of the banner the moment you log in. Practice a few of these questions. It will save you some time on the mastery exam. See the image below for an example. Notice that in leadership I am currently at Level 1 mastery; I will need to practice more leadership questions to full master this content area. Log in and check it out.

Lastly, you got this. Stay the course and practice with EAQs, and trust me, you will see a difference. P.S. -- do not expect instant results, this takes time and a great understanding of oneself and one’s strengths and weaknesses.

How to Use Your HESI™ Analytics to Shape Your Studies.

Written by Brandon Thompson

After you’ve taken your HESI™ exam, logging in (after a sufficient mental break of course) to check and review your remediation packets afterward is the key to your HESI success. Remediation offers a direct insight as to what content areas you need to focus on based on the questions you’ve missed during the exam. After you’ve skimmed through your remediation packets while taking notes, take a look at your in-depth test scores. Below is a screenshot of my remediation packet for one specific exam:

Pay close attention to the subcategories and how you scored on them. What areas were you weak in? What areas are you strong in? After answering these questions for yourself, eliminate redundant studying. Don’t exhaust your time on content you know extensively. It is better to focus on your weak areas.

After you’ve diligently made a study plan to address your weakest areas, look at your scores. HESI normally has a required passing score, a passing score set by your institution, a national average, and your class average. I would advise you to focus on the national average since this represents how you did on a national level. I believe this is also an insight as to how you will perform on the NCLEX™ when the time comes. The other scores are for informational purposes. Avoid comparing yourself to others.

All the tools and analytics that are available to students are there to assist us in formulating the ideal study strategies for our future success. It is time to use your analytics! You will be more efficient with your study time.

NCLEX Exam Practice Question of the Week - 2/10/21

A client with a history of heart failure is due for a morning dose of furosemide. Which serum potassium level, if noted in the client’s laboratory report, should be reported before administering the dose of furosemide?

3.2 mEq/L (3.2 mmol/L)
3.8 mEq/L (3.8 mmol/L)
2 mEq/L (4.2 mmol/L)
8 mEq/L (4.8 mmol/L)

Show answer

Answer: 1

Rationale:
The normal serum potassium level in the adult is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The correct option is the only value that falls below the therapeutic range. Administering furosemide to a client with a low potassium level and a history of cardiac problems could precipitate ventricular dysrhythmias. The remaining options are within the normal range.

Test-Taking Strategy:
Note the subject of the question, the level that should be reported. This indicates that you are looking for an abnormal level. Remember, the normal serum potassium level in the adult is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). This will direct you to the correct option.

Level of Cognitive Ability:
Applying

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process-Implementation

Content Area:
Foundations of Care: Laboratory Tests

Health Problem:
Adult Health: Cardiovascular: Heart Failure

Priority Concepts:
Clinical Judgment; Fluids and Electrolytes

Reference:
Lewis et al. (2017), p. 280.

Practice Question Sourced From: Saunders Comprehensive Review for NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 2/3/20

A client with schizophrenia requires seclusion. The nurse plans care with the understanding that the determination for this treatment is made in which situation?

For convenience of the health care staff
When less restrictive methods are insufficient
If a sedative is not effective in calming the client down
As a form of punishment to deter the client from continuing the behavior

Show answer

Answer: 2

Rationale:
Restraints or seclusion require a written prescription from a primary health care provider and must be reviewed and renewed every 24 hours or per agency or state protocols. This treatment should be used only when less restrictive methods are insufficient (such as distraction or one-to-one supervision) and the client still presents a risk for harm to self or others. This treatment should not be used for the convenience of the health care staff. A sedative is also a form of restraint (chemical) and should not be used without a primary health care provider’s prescription. Seclusion should not be used as a form of punishment and can be considered a legal tort and violation of client rights if not used in the appropriate situation. Nursing measures include documenting the behavior leading to the restraint or seclusion; ensuring a prescription is in place for this treatment; ensuring the client in restraints or seclusion is protected from harm by having a staff member on one-to-one supervision within arm’s length of the client; and assessing physical, safety, and comfort needs every 15 to 30 minutes, such as the need for food, fluids, range-of-motion exercises, and ambulation or the need to use the bathroom.

Test-Taking Strategy:
Focus on the subject, indications for seclusion. Note that options 1 and 4 are comparable or alike and indicate violation of client rights; this will assist in eliminating these options. Noting that option 3 is also a form of restraint will assist in eliminating this option.

Review:
Indications for seclusion.

Tip for the Nursing Student:
Seclusion is a treatment measure in which the client is placed alone in a specially designed room that protects the client and allows for close supervision. Seclusion is the last selected treatment measure in a process to maximize safety to the client and others. Physical restraints include any manual method or mechanical device, material, or equipment that inhibits free movement. Chemical restraints include the administration of medications for the specific purpose of inhibiting a specific behavior or movement. The important point to remember is that these methods should be used as a last resort, and they require a written prescription from a primary health care provider.

Level of Cognitive Ability:
Applying

Client Needs:
Safe and Effective Care Environment

Integrated Process:
Nursing Process/Planning

Content Area:
Mental Health

Priority Concepts:
Caregiving; Safety

Level of Nursing Student:
Intermediate

Practice Question Sourced From: Saunders 2020-2021 Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 1/27/21

An antepartum client at 32 weeks’ gestation positioned herself supine on the examination table to await the obstetrician. The nurse enters the examination room, and the client says, “I’m feeling a little lightheaded and sick to my stomach.” The nurse recognizes that the client may be experiencing vena cava syndrome (hypotensive syndrome) and should take which immediate action?

Give the client an emesis basin.
Place a cool cloth on the client’s forehead.
Call the obstetrician to see the client immediately.
Place a folded towel or sheet under the client’s right hip

Show answer

Answer: 4

Rationale:
Lying supine (on the back) applies additional gravity pressure on the abdominal blood vessels (iliac vessels, inferior vena cava, and ascending aorta), increasing compression and impeding blood flow and cardiac output. This results in hypotension, dizziness, nausea, pallor, clammy (cool, damp) skin, and sweating. Raising 1 hip higher than the other reduces the pressure on the vena cava, restoring the circulation and relieving the symptoms. Although an emesis basin and a cool cloth placed on the forehead may be helpful, these are not the immediate actions. It is not necessary to call the obstetrician immediately unless the client’s complaints are unrelieved after repositioning.

Test-Taking Strategy:
Note the strategic word, immediate. Focus on the data in the question and the goals of care. In other words, think about what complications you want to prevent. Remember that if a question requires you to prioritize and 1 of the options relates to positioning a client, that option may be the correct one.

Review:
Care of the client experiencing vena cava syndrome.

Tip for the Nursing Student:
Vena cava syndrome, also known as supine hypotension, is a condition in which a fall in blood pressure occurs when a pregnant woman is lying on her back. It is caused by impaired venous return that results from pressure of the large uterus on the vena cava. Therefore, raising 1 hip higher than the other reduces the pressure on the vena cava, restoring the circulation and relieving the symptoms.

Level of Cognitive Ability:
Analyzing

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process/Implementation

Content Area:
Delegating/Prioritizing

Priority Concepts:
Perfusion; Clinical Judgment

Level of Nursing Student:
Intermediate

Practice Question Sourced From: Saunders 2020-2021 Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 1/20/21

A client is hospitalized for ingesting an overdose of acetaminophen. The nurse prepares to administer which specific antidote for this medication overdose?

Flumazenil
Phytonadione
N-acetylcysteine
Naloxone hydrochloride

Show answer

Answer: 3

Rationale:
Acetylcysteine restores sulfhydryl groups that are depleted by acetaminophen metabolism. Flumazenil is the antidote for benzodiazepine reversal. Phytonadione is the antidote for warfarin sodium. Naloxone hydrochloride reverses respiratory depression caused by an opioid.

Test-Taking Strategy:
Focus on the subject, the antidote for acetaminophen overdose. Recalling the specific antidotes for benzodiazepine and warfarin sodium will assist in eliminating flumazenil and phytonadione. Next, recalling that naloxone hydrochloride reverses respiratory depression caused by opioids will assist in eliminating that option.

Priority Nursing Tip:
Acetaminophen is contraindicated in clients with hepatic or renal disease, alcoholism, and/or hypersensitivity.

Reference:
Lilley et al. (2020), p. 151.

Level of Cognitive Ability:
Applying

Client Needs:
Physiological Integrity

Clinical Judgment/Cognitive Skills:
Generate solutions

Integrated Process:
Nursing Process/Planning

Content Area:
Complex Care: Poisoning

Health Codes:
N/A

Priority Concepts:
Clinical Judgment; Safety

Practice Question Sourced From: Saunders Q&A for the NCLEX-RN Examination, 10e

NCLEX Exam Practice Question of the Week - 1/13/21

A client diagnosed with chronic kidney disease (CKD) has been told that hemodialysis will be required. The client becomes angry and states, "I'll never be the same now." Based on this information, which would the nurse identify as the client's primary concern?

Anxiety about the hemodialysis
Inability to think clearly because of the treatments needed
Potential for noncompliance because of concerns about the disease
Altered body image because of the physical changes that may occur

Show answer

Answer: 4

Rationale:
A client with a renal disorder such as CKD may become angry in response to the permanence of the condition. Because of the physical changes and the change in lifestyle that may be required to manage a severe renal condition, the client may experience an altered body image. Anxiety is not appropriate because the client is exhibiting anger at this time. The client is not cognitively impaired, eliminating option 2, and is not stating a refusal to undergo therapy, so eliminate option 3.

Test-Taking Strategy:
Note strategic word, primary. Focus on the subject, an angry client who will have hemodialysis and states that she or he will never be the same. Note that the client's statement focuses on the self, which is consistent with altered body image.

Priority Nursing Tip:
The client undergoing hemodialysis will either have a subclavian or femoral catheter for short-term or temporary use in acute kidney injury. This will be used until a fistula or graft is created and matures, which typically takes 6 weeks, or the short-term catheter may be required if the permanent fistula has failed because of infection or clotting.

Reference:
Ignatavicius, Workman, Rebar (2018), pp. 1410-1411, 1425; Potter et al (2017), pp. 327-329.

Level of Cognitive Ability:
Analyzing

Client Needs:
Psychosocial Integrity

Clinical Judgment/Cognitive Skills:
Analyze cues

Integrated Process:
Nursing Process/Analysis

Content Area:
Adult Health: Renal and Urinary

Health Codes:
Adult Health: Renal and Urinary: Acute Kidney Injury and Chronic Kidney Disease

Priority Concepts:
Coping; Mood and Affect

Practice Question Sourced From: Saunders Q&A for the NCLEX-RN Examination, 10e

How to Know if Nursing School is Right for YOU!

Written by Samantha Fell

Hi everyone, my name is Sam and I am currently in my last semester as an Associate Degree Nursing Student at Lake Region State College in Devils Lake, ND.

A question I’ve been asked from quite a few students, whether they are in high school, college, or looking at switching their career is this: “How did you know nursing was what you wanted to do?” or “How do I go about getting into nursing school?”

I’ve known I wanted to be a nurse since I was 5 years old. I loved taking care of people and making them feel better, but as I got older, I thought that I couldn’t do it. I struggled with math all through high school and had such a negative mindset of “I have to be perfect or at least good at math to even get in.” I became very discouraged and eventually I gave up on that dream of being a nurse and I went to college to be a teacher. After that, I went to cosmetology school for a brief time, and while I loved both I soon began to realize that those two careers allowed me to educate and make people feel good or better about themselves…something nurses do every day!

I realized that I could do anything I put my mind to, I simply had to believe in myself and you should too!

How do I know if becoming a nurse/nursing school is right for me?

I think the best way to gauge if nursing school or nursing in general is a good fit, is to get some experience. Getting your Certified Nurse Assistant (CNA) License and working, working as an Unlicensed Assistive Personnel (UAP), volunteering at a medical facility like a nursing home, or even shadowing in a provider's office can shed some light on what to expect as a nurse.

For me, I started this process by working as an optician and eventually moved over to a bigger medical facility where I worked as a medical secretary and worked with scheduling, insurance, and had contact with patients, nurses, and doctors every day. By getting my foot in the door and gaining experience, not only did it look good on my application, but I got to get a feel for how the medical world actually was and I liked it!

So how do you go about getting into nursing school?

Know why you want to be a nurse
Maybe you care about helping people and want to make a difference in the lives of others, or maybe you’ve been impacted first-hand by healthcare. Either way, you should have a good understanding of why you want to do this. You will be asked many times and how you answer can increase or decrease your chances of getting into the school you want.
Start looking at schools that offer programs and look into their requirements for applying
Every school is a little bit different with how their program is run, who they’re accredited by, their requirements for entry, and their NCLEX pass rates. These are all attributes that can determine how long you go to school, where you will have clinicals, and how your overall experience might look.

Personally, I chose an accelerated 18-month program with a high NCLEX pass rate because I wanted to start working as soon as possible and I wanted to be highly prepared, but I know others have chosen a four-year BSN program because they wanted that higher degree and wanted summers off from school. It all depends on what you want and what works for you!
Take your required pre-requisites, entrance exam, and gain experience
Pre-requisites, sometimes called pre-reqs, are the classes you need before you can be considered a nursing student. In some cases, programs want these done before you apply to the specialized program, but other times schools may let you take these while you’re considered a nursing student.

Some schools also require an entrance exam. These are similar to the standardized tests you take while in high school, but also assess your decision-making skills, learning style, and critical thinking skills.

I chose a school that allowed the latter because I didn’t want to waste a year completing a few pre-reqs. They also did not require medical experience, but since I had some they counted it as a bonus for me to be considered for entry.
Apply!
Now is the time to apply! Make sure you apply early enough so you don’t miss out on the deadlines! Oftentimes these deadlines are in place so you can also get scholarships and other opportunities set up before starting school. Remember why you started and why you wanted to be a nurse! Nursing school can be overwhelming, but I promise it goes by quick and is SO worth it!

Everything You Need to Know Before Your First Day of Nursing School

Written by Hannah Lease, RN, BSN

Whether you’re about to start your nursing program or you have already started, I want to first start by saying CONGRATULATIONS! Coming from a recent accelerated nursing school graduate, there’s no denying that nursing school is tough, but it is also so worth it in the end. For me, I know that in the beginning of my program I thought there was no way I’d survive my first semester - like seriously, I thought I was going to have to beg my old boss to let me come back to work again! But here I am, a few weeks after graduating from my 16-month program and I did it! I want to give you some tips that I hope will help you as you navigate starting this new journey and how to make sure you can excel as much as possible throughout your program! Us nurses have to stick together, right?!

Preparing for Nursing School…

Get Organized → Being organized and having great time management are going to be two the most important skills throughout school. Be sure to get yourself a great planner, whether it’s digital or paper form, and hold yourself accountable to staying well organized and ahead of your assignments/studying! Doing something every day, even if it’s only a little bit, will make a huge difference for you in the long run!
Back-to-School Shopping → I don’t know about you, but shopping for school supplies is one of my favorite things! Supplies that were at the top of my list were a reliable laptop, binders, index cards, pens, markers, highlighters, sticky notes, and notebooks.
Find Your Tribe→ The friends you are about to make throughout nursing school are going to be some of your lifelong friends! There’s no way I could have survived without my classmates and especially my core group of friends. Once my school sent us the names of my cohort, I was immediately reaching out to them prior to even meeting them! I know everyone may not be a social butterfly like I am, but this was one of the best ways for me to start my program. I organized a group of us to meet up to get coffee prior to our first day of orientation and it was a huge hit! Also, when it comes to finding your study group, be sure to be with those who are a great mix of staying focused to make sure you’re getting some good studying done, but also able to unwind when you take breaks!
Study Style → Prior to starting school, start thinking about what methods of studying might work best for you. Do you think you’ll like to write out your own notes? Flashcards? Practice questions? Making study guides? Going into school with a general idea of what you think will best fit your studying needs can potentially help ease you into all your hours of studying! Also be sure to scope out your study spot! If it will primarily be at your house, make sure it’s in a spot that allows you to be free from distractions as much as possible but is still a cozy & peaceful area.

Need-to-Know Study Tips…

Do what works for you → Throughout school, I found myself comparing myself a lot to my classmates - whether it was how they chose to study, the time of day that they studied, how long they study for, etc. I finally realized that just like with everything else, I can’t compare the way I do things to how others do them. If the way you study is vastly different from your best friend in school but your way works for you, then that’s all that matters! For me, I would always do as much reading that I could, completed any study guides, wrote out my own notes, did a TON of practice questions, looked up videos for certain topics, and would always try to talk through/teach the material to anyone that would listen.
Practice Questions/EAQs → Every nursing student that I talk with and asks for advice will forever hear me talk about my love for practice questions/Elsevier Adaptive Quizzing through Elsevier. These were a big game changer for me and undoubtedly helped me be successful throughout my program. Even just doing 10-20 questions each day will quickly add up and help you feel more prepared for your exams. I think these are a great way to get you thinking about the material in a different way rather than just reading the book or taking notes.
Take breaks → I cannot stress enough how important it is to take study breaks! Please, please, please do not hide yourself away for hours without taking any type of break. Set up a study break schedule so that you can give your brain a quick recharge. Study for an hour then take a ten-minute break to grab a snack, drink some water, go for a quick walk, or do a quick chore around the house!
Use your resources → Reach out to your professors/instructors to see what resources are out there to help aid in your studying! Also, look inside your books to see if there are any codes/links listed that will offer access to more studying materials. Follow Elsevier on social media to see what new resources and tips they come out with to help you succeed! Look up videos on YouTube, reach out to other nursing students, or talk with nurses that you meet during your clinical rotations - anything to help you get the most out of the resources that are waiting to help you along this journey!

I’m rooting for you every step of the way and hope you can take a moment each day to realize how far you’ve already come in making your dream to be a nurse a reality! There will be tough days, but I PROMISE you can do this! Your future patients are going to be so lucky to have you as their nurse someday.

How to Prevent “Burning Out” in Nursing School

Written by Kymberly Wisniewski

Burnout: a state of emotional, physical and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained and feel as though you’re unable to meet constant demands.

Does this sound familiar to anyone? As nursing students, feeling burned out is unfortunately not uncommon. I find myself constantly feeling as though I need to be doing homework, studying or reading up on information to keep up. I always feel like I could be doing MORE. But the reality is, you don’t get an award for most all-nighters pulled during nursing school and your body and mind are going to hate you for trying.

When you’re feeling tired, REST but do not quit. It is important to give your mind a break from the constant stress of memorizing material or being able to critically think through scenarios. You cannot fix the feeling of being burned out by adding more work, stress and responsibilities into your plate. You must first try to slowly clear them off, bit by bit. I have found that the best way to handle the feeling of burnout it to simply take a step back. Whether it be for 20 minutes or the remainder of that evening, I give my mind a chance to rest. When you are physically exhausted, do you force yourself to continue running? No, you rest. The same goes for your mind.

Next, I make sure that I am organized. Feeling as though I have a mountain of homework assignments, exams, quizzes and projects to prepare for sometimes gives me the feeling that there is no way I will be able to accomplish everything. I organize a to-do list or planner which allows me to cross things off as I complete them. Not only does this give me a sense of accomplishment, but it also allows me to see that I am making progress and chipping away at the number of tasks to be completed. Managing the feelings of being overwhelmed and stressed are crucial to preventing burnout.

Finally, do something to ENJOY YOURSELF. I know that we have all heard from someone at some point or another, “say goodbye to your life while you’re in nursing school!” That simply isn’t true. Do we have to say no sometimes and make sacrifices for our schooling? Absolutely. Does that mean that we are unable to have fun or enjoy ourselves for the duration of nursing school? NO WAY. Whether it be a small trip, night out or relaxing night at home, it is good for the mind and soul to allow yourself to do things that you enjoy. Being a nursing student is one thing that you do, it is not the entirety of who you are.

During these times of uncertainty and difficulty, make sure that you take care of yourself. We are often our own harshest critic and it is so important to be kind to your mind and body.

How to Succeed in an MSN Program

Written by Polly Chan

Hello everyone, my name is Polly and I have just finished up my 3rd semester in my Master’s Entry - Masters in Nursing Science. This marks the halfway point of my two-year program! For those of you who are interested in applying to a ME-MSN program or are currently in one, I hope this can help you.

In order to apply for an ME-MSN program, you must have a bachelor’s degree in something else. Many may wonder if MSN’s get paid more than BSN’s but they do not. All new grad nurses will get the same pay when they first start. What really differentiates a master’s level nursing program is its emphasis on clinical leadership as well as public health. This can help in the future if you want to go into nurse leadership. Throughout my program, we have a bunch of clinical leadership classes ranging from healthcare outcomes, to nursing research, to educator role, and more. Expect to have a lot of research papers and presentations!

Here are some strategies that have helped me succeed in my CNL classes as well as my MSN Program:

Think like a leader: It might be obvious from the “CNL” part but when you take quizzes, exams, or answer free response questions for your leadership classes, you have to think like a leader. You need to analyze each question and answer it in a way that it will benefit the microsystem. Be inclusive, always hear the other people out to understand what needs to be changed in the microsystem to help improve health outcomes.
Plan out and start on your papers early: For all my CNL courses, I have been bombarded by research papers, leadership papers, and group projects. I would advise you to start on them early! Although they might seem like simple papers, sometimes when you finally read the instructions, you’ll realize how much work you have to put into it. These papers are usually all research based and require you to critically think and apply solutions to current problems.
Understand other Healthcare Professions: I think it is super important to understand most of the healthcare professionals' roles and scope of practice. You will often need to know what each role can and cannot do. This applies to HESI questions as well as NCLEX questions. Be able to delegate work to the appropriate professionals.
Know your Change Theories: Change theories come up a lot in CNL courses because they want you to implement these theories into projects that can be initiated in the hospital. I think it is super important to learn the change theories in order for you to apply it in your coursework. I’d highly advise watching a short YouTube video on them!
Be positive and don’t over think it: I think one thing that I changed about myself during my nursing journey is to be more positive about my grades and not to overthink my answers when I take an exam. Go with your first instincts and don’t doubt yourself because you are correct!

These tips may be more generalized, but I hope they can help you all regardless of BSN or MSN! Just remember to never lose hope and always strive for your best if you want to succeed. There will always be someone out there supporting you from a distance.

How to Become NCLEX-Ready with Only One Month to Go!

The 30-Day Study Challenge Featuring Saunders Q&A for the NCLEX-RN, 8th Edition

Written by Yu Liang

Studying for the NCLEX requires practice questions... a lot of practice questions. Personally, I’ll be using the Saunders Q&A Review for the NCLEX-RN, 8th edition; because I learn best through testing and there are over 6,000 practice questions! And while having a 747-page book to go through seems daunting at first, the best way to utilize it is by having a structured study plan. I’ve created a 30-day plan that I’m personally using to study for the NCLEX and I urge you to follow along with me!

Before you begin, know your game plan. Put everything on a calendar so you can visualize exactly what you need to do. Make sure you set aside time at least 1-2 hours every day so you have enough time to get through the material. Find a study spot, get some highlighters, buy the fancy pens. Do whatever you need to do to get yourself pumped! [Insert Your Name], RN, BSN in the making!

I’ve made you a checklist that you can print out and cross off when you finish a day here:

Day 1: This is an introduction to the book; there is information about the NCLEX itself, including what to expect, and the process of registering. This section gives you examples of the different types of questions, key phrases and concepts to look out for, and test-taking strategies to keep in the back of your mind when taking the exam. This is the foundation. Don’t skip it.

Days 2-29: This the bulk of your studying, and it’s only approximately 50 questions a day. Set aside 1-2 hours every day to really make sure you have enough time to take notes and understand the rationales. Remember; It’s not about getting them right. It’s about knowing why the right answers are right and why the wrong answers are wrong.

Day 30: The Comprehensive Test. This is it. This is the longest part of the study plan, but it’s also the last thing you have to do. Starting on page 639, there’s a full exam that’s 265 questions long. I’d recommend doing this all in one sitting, in a quiet room, with no distractions, just to see what it would be like to take the NCLEX if you were given the full set of questions.

Good luck! Keep me updated with your studying, and tag @elsevierstudentlife on Instagram if you’re using my checklist! You can do it! This is the last milestone, finish strong!

How to: Head to Toe Assessment

Written by Tiffany Lyle

Hello future nurses! Here is an outline of how to conduct a complete head to toe assessment. Included in this outline are some tips that will help you develop a routine and gain confidence when assessing your patients. Let's get started!

Initial Assessment
As soon as you walk into the exam room the assessment begins.The nurse should note:
- The patient’s general appearance (Hygiene, Dress, Affect)
- Posture (Is the patient sitting/standing with good posture?)
- If the patient is alert/oriented (Can they respond to questions appropriately?)
- Signs of distress (Labored breathing, Pallor, Confusion)
- Subjective Data (Medical History, Allergies, Pain)
These initial assessments are essential when assessing a patient’s mental status. During this time, you should also obtain subjective data from the patient to have a better understanding of why they are in the office. You can do this by asking how they are feeling or ask what they are in the doctor's office for today.
Vital Signs
After taking the time to speak with the patient, ask permission to collect their vital signs. Collecting vitals allows you to comfortably approach the patient with touch for the first time during the interview.

TIP: Remember to ALWAYS ask permission before touching the patient and explain each one of the assessments you will be performing.
Hair/Skin/Nails
When performing assessments on different areas of the body (ex. abdomen, arms, or legs), you should note abnormal findings of the skin and hair on these areas.
Abnormal findings include:
- Uneven hair distribution
- Color abnormalities (Pallor, Cyanosis, Erythema)
- Extremes in temperature or moisture of the skin
- Decreased skin turgor
- Note any lesions
Assess nails for:
- Delayed capillary refill
- Clubbing
- Fungus
Head
- Assess for symmetry, size, and shape.
- Ask the patient to smile and raise eyebrows (Assessing Facial Nerve)
- Palpate the patient’s scalp.
Neck
- Inspect and palpate lymph nodes and glands
Eyes
- Inspect external structures
- Check for red reflex using the otoscope
- Check pupils for PERRLA (Pupils Equal Round Reactive to Light and Accommodation)
- Assess extraocular movements to assess functions of the Oculomotor, Trochlear, and Abducens cranial nerves.
- Perform Visual Acuity Test (Assessing Optic Nerve)
Nose and Sinuses
- Assess for nasal patency in each nostril by having the patient blow out of each nostril. Then use a scented object such as vanilla or peppermint in each nostril to see if the patient can smell. This exam assesses the function of the Olfactory nerve.
- Inspect inside the nose with an otoscope.
- Inspect septum, determine the location.
- Palpate sinuses to determine if tenderness is present.
Ears
- Inspect external ear
- Inspect the internal ear canal with an otoscope. Note the appearance of the tympanic membrane and cerumen present.
- Test Hearing with Whisper Test (Assessing Vestibulocochlear Nerve)
Mouth and Throat
- Inspect lips
- Inspect the oral cavity
- Inspect tonsils and uvula
- Have the patient move their tongue from side to side (Assessing Hypoglossal Nerve)
- Assess the patient's ability to taste (salt vs sugar), ability to swallow, and gag reflex. (Assessing the Glossopharyngeal and Vagus Nerves)
Chest (Cardiovascular and Respiratory)
Cardiovascular
- Palpate and Auscultate Apical Pulse
- Auscultate heart sounds with the diaphragm and bell of the stethoscope. Areas: Aortic, Pulmonic, Erb's Point, Tricuspid, and Mitral.
Respiratory
- Compare anterior-posterior chest diameter to transverse chest diameter. Normal is 2:1
- Chest expansion
- Effort to breathe
- Auscultate Lungs
Abdomen
- Inspect
- Auscultate bowel sounds in all quadrants
- Palpate
Peripheral Vascular
- Inspect and palpate upper and lower extremities
Neurological & Musculoskeletal
- Palpate joints
- Demonstrate Range of Motion
- Assess Deep Tendon Reflexes
- Assess Balance - Romberg test
- Assess Gait by having the patient walk across the room and walk back towards you in a straight line, heel to toe.
Assessment Conclusion
- Let the patient know when the assessment is complete.
- Ask the patient if they have any questions or concerns.
Practice…Practice…Practice
- It takes a lot of practice to perfect your head to toe assessment.
- When in your clinical rotations, ask your nurse if you can assess the patient; this will help you gain confidence and skills as you practice with different clients.

The BEST Elsevier Assessment Resources

Now that you are confident and prepared... Get out there and assess those patients!
You’ve got this!

Being a Mom AND a Nursing Student

Written by Kymberly Wisniewski

I worked at a car dealership for 5 years leading up to my pregnancy. I bailed on going back to my job 3 days before maternity leave was set to end and tearfully informed my boss that I was going to stay home with my son and pursue my education. He wasn’t thrilled, but he was understanding and supportive.

I began my nursing school journey when my son was just 4 months old at my local community college. My partner would meet me at the parking lot from work and we’d swap our sweet little boy. He would wait around until my break because my son needed to be nursed every few hours. So we tucked away in a quiet hallway of my school, and back to chemistry lab I would go.

My little boy would come to daytime advisor meetings, interviews for nursing school, study sessions, you name it. Oliver was by my side.

As he has grown older, and especially with the pandemic, we have shifted into a new phase (as many of us have). For instance, I’ve become a pretty darn good one-handed typist because I will never deny a snuggle session. I have also learned to ALWAYS have my study material handy, because you never know when a two hour “car nap” will happen. Thank goodness I can register my textbooks with Evolve and have access to everything on my tablet! Multitasking has become second nature.

Having helpful resources has been vital to my success in maintaining straight A’s while being a full-time mommy. I particularly love the Saunders Comprehensive Review for the NCLEX-RN to practice those tricky questions.

Most of my schoolwork gets done after his bedtime (my prime homework/study hours fall between 9:00pm-1:00am). And seemingly in the blink of an eye Oliver is bright eyed and bushy tailed at 6:00am.

Countless times I have studied for an exam or completed a homework assignment as my little boy was asleep in my arms. Oliver has also attended some Zoom lectures right alongside me. My sweet little guy.

And you know what? Going through all of this is what FUELS me. To see that innocent, peaceful face right in front of me as I’m taking steps to accomplish my goal is what drives me to continue doing it.

I’ll be honest, some days, it is just plain TOUGH. We don’t have a lot of help (and even if we did, the pandemic has made that difficult to impossible in many circumstances). Luckily, I have an amazingly supportive and helpful partner. We truly operate as a team and I am extremely grateful for that. But we still feel tired, we get burned out, we sometimes need breaks. And that’s OKAY.

So, to my mama’s AND to everyone else, find your “why” and use it to motivate you. Take breaks if you need them and as a wise fish once said, “just keep swimming”.

Bullying in Nursing

Written by Courtney Smith

“Nurses eat their young” is a common phrase that is engrained into the minds of nurses everywhere. What I learned the hard way – it can start as early as nursing school.

It is so, so real.

This summer I started a job at a new long-term care facility and had my first shift on my own. However, I had done CNA work for 5 years, I know how to do cares like the back of my hand.

I was originally supposed to have an internship in the ED-Trauma department at a major hospital that I was extremely excited for. Due to COVID-19, it was unfortunately cancelled. I decided to take a position as a summer CNA at a facility that was desperate for CNA help due to the rising COVID-19 cases.

I was pulled to a floor I had never been on before, and of course I was slow as I have never been one to half-do my cares in order to get all the residents done faster.

I was told to take my lunch break, which I did, and had no clue what I was coming back to.

Long story short, I was completely belittled by a nurse manager on my floor in front of all of the other nurses and CNAs. I was accused of taking my break when I was not supposed to, not following the daily schedule correctly, and yelled at over our walkie talkie system which everyone, including the residents, can hear. Take into consideration this was my first day on my own in a separate facility and new floor I had never stepped foot on. I stood there, in tears, innocently and hopeless explaining I was brand new and had never been trained on this floor, but the nurse wasn’t taking it. I had never met this woman before.

I’d like to thank the angel of a LPN who noticed I was struggling and pulled me into a closet and let me break down into tears, personally went with me to the floor to help with cares, and gave me time to collect myself before I went back out on to the floor with tears still running down my face shield for the remainder of my shift.

All I could think of was, “I should be at my internship in the ED-Trauma department right now. I chose to move here. I chose to come help this facility because I knew they desperately needed the help due to COVID-19. I’m even running on five hours of sleep because I stayed late the previous night to finish all the cares and to help out on the other campus.” I wanted to defend myself, but I stood there paralyzed and struggled to return to work the rest of the summer.

According to the Joint Commission, 44% of nursing staff members have been bullied.

Never, will I ever belittle my CNAs, patient care techs, or anyone considered “lower” than me. I know how it feels to be a newbie, overworked, and underappreciated.

I highly encourage anyone who experiences workplace bullying to report it immediately. You aren’t “tattling,” you are saving yourself, and probably many others, from mental distress and abuse. No one deserves to go to work scared or dreading it.

Nursing doesn’t have room for bullying. Stop eating your young.

On the Other End (Stories from a Current Patient/Future Nurse)

Written by Koralys Rodriguez

The majority of us have had some kind of experience in a healthcare setting. We get sick, we get hurt, we see loved ones go through illness, we welcome new members into our family, and we have to say goodbye to others. It’s the (unfortunate) part of being human. I’ve had my fair share of those experiences. And I never truly realized how impactful many of those moments were until I started working in healthcare myself.

2016, my first major surgery. I prepared myself for a spinal fusion surgery that would correct my severe scoliosis. This was my first major experience as a patient, and it opened my eyes to my passion for nursing. I learned about how patient nurses are as I watched my nurse (and my amazing CNA) turn me every hour throughout the night, and how empathetic they are as they calmed my nerves when I walked for the first time after surgery. Pediatric and orthopedic nurses will forever have my respect.

Now fast forward to 2020, which seemed to be the year for literally everything to happen. I gained new respect for the nurses in women’s health services after a breast cancer scare, and the nurses who work in pre/OR/post-op after my breast mass removal surgery. Despite the darkness there is in those circumstances, my nurses remained calm and kept smiles on their faces.

2020 also brought me on a long journey towards an official medical diagnosis of dysautonomia (something I’ve struggled with for a while). I’m sure that others with chronic health problems will agree that these diagnosis journeys are frustrating. My symptoms and experiences were frequently brushed off by medical professionals. As a future nurse, I’ve learned how important it is to really listen to your patients and see things through (yes, even if it’s been a long day and you’re just ready to go home).

So why am I sharing all of this? I know, I know. The last thing anyone wants is more to be upset about. In reality, I want to share how influential being on that “other side” of healthcare has been in my own journey towards being a nurse. As a patient, I’ve seen both the good and the bad, and I know what patients look for in their healthcare team. There have also been so many moments where I think to myself that I won’t be able to be a good nurse because of my health struggles. But if I’ve learned anything during this journey, it’s that all those hard moments are only building me up to be a more insightful and compassionate nurse in the future.

I’m sharing this so that, even if you haven’t been a patient yourself, you can empathize with your own patients on a new level one day. Be there for them through the good and the bad, and really listen to them. And for those that have been the patient and know what I’m talking about, I hope you know that your struggles aren’t making you any less of an amazing healthcare worker (something I have to remind myself of every day)!

You have no idea of the impact you’re capable of.

Ps. I want to make sure I take a moment to thank all my fellow healthcare workers out there! You may never truly understand how big of a difference you make in your patients’ lives. We see you, we’re thankful for you, and we’re rooting for you.

Nursing School: The Real Deal

Written by Mykyla Coleman

So, you think you want to be a nurse. You’ve seen us on Instagram rocking our cute scrubs and stethoscopes. You see the pictures of us with notes piled high and enough books to create a library. And you think to yourself, do I really want to be a nurse?

I am pursuing nursing because I want to actively make a difference in the lives of others. By volunteering, shadowing, and interning, I have seen what nurses bring to the field. I’ve seen the lives and the families we will change. And I decided that I wanted to become a nurse. Maybe you have also decided to take a leap of faith and pursue this profession. Let me tell you some things I wish I would have known but was too afraid to ask!

The way you learn is completely different in nursing school. You must learn to speak “nursing”. It’s learning to look at lab values and ABGs and understand what’s going on with your patient, and what you need to be doing. It’s understanding a million different procedures, what they are, and how they affect the body. Nursing teaches you to learn the information to save someone’s life, not just to pass a test.
You can still have a life outside of nursing school. People may think you have to give up everything to be a nurse. That’s not true! I have been an involved student my entire college career and it has shaped me into who I am now. Leadership experiences help you learn how to work and collaborate with other people. If you have other interests outside of nursing, pursue them! Life is too short to be unhappy. Learn to time manage and prioritize your self-care even in the midst of a busy major.
You need a really strong support system. You can’t go through nursing school alone. You need family, students, teachers, and therapists just to name a few. Nursing is not easy and those who try to do it alone are not always successful. Remember you must take care of yourself in order to take care of other people. Lean on your friends, family, and nursing school family.

Finally, use social media to your advantage! There is a community of people out here to support you and to guide you. There are resources like Elsevier with the top studying materials in the country. Always lean on those who have been in the position you are in now. You can do this!

NCLEX Exam Practice Question of the Week - 1/6/21

The nurse provided education to the assistive personnel (AP) in preparation for communicating with a hearing-impaired client? Which statements by the AP indicates that teaching has been effective? Select all that apply.

"Speak using a normal tone of voice."
"Speak clearly when communicating with the client."
"Speak slowly and directly into the client's impaired ear."
"Face the client directly when carrying on a conversation."
"Be aware of signs that the client does not understand the conversation."

Show answer

Answer: 1, 2, 4, 5

Rationale:
When communicating with a hearing-impaired client, the caregiver should speak in a normal tone to the client and should not shout. One should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is being said, the caregiver should express the statement differently. Moving closer to the client and toward the better ear may facilitate communication, but one must avoid talking directly into the impaired ear.

Test-Taking Strategy:
Focus on the strategic word, effective, and the subject, communication techniques for a hearing-impaired client. Knowledge regarding effective therapeutic communication techniques will direct you to the correct options.

Priority Nursing Tip:
Hearing impairment occurs with aging; usually high-frequency tones are less perceptible.

Reference:
Ignatavicius, Workman, Rebar (2018), p. 998.

Level of Cognitive Ability:
Evaluating

Client Needs:
Safe and Effective Care Environment

Clinical Judgment/Cognitive Skills:
Evaluate outcomes

Integrated Process:
Communication and Documentation

Content Area:
Foundations of Care: Communication

Health Codes:
Adult Health: Ear: Hearing Loss

Priority Concepts:
Communication; Sensory Perception

Practice Question Sourced From: Saunders Q&A for the NCLEX-RN Examination, 10e

NCLEX Exam Practice Question of the Week - 12/30/20

Which ethical principle means avoidance of harm?

Veracity
Autonomy
Beneficence
Nonmaleficence

Show answer

Answer: 2

Rationale:
New orders must be written each time a client requires restraints; when a client is acting out, the nurse may use restraints or a seclusion room and then obtain the necessary order

Rationale for incorrect answers:
A. PRN restraint orders are not permitted. C. Less restrictive interventions should be used when the client begins to act out; restraints are used as a last resort. D. PRN restraint orders are not permitted

Memory Aid:
Use the letters P-R-N to help you remember that prn Restraints are Not Permitted. The Latin meaning is actually pro re nata, meaning “as needed,” but this abbreviation is not applicable to orders for restraints!

Client Need:
Management of Care;

Cognitive Level:
Comprehension

Nursing Process:
Planning/Implementation

Cognitive Level:
Comprehension

Practice Question Sourced From: Nursing Key Topics Review: Mental Health

NCLEX Exam Practice Question of the Week - 12/23/20

A nurse is teaching a client and family about the characteristics of dementia of the Alzheimer’s type. What characteristic should the nurse include?

Periodic exacerbations
Aggressive acting-out behavior
Hypoxia of selected areas of brain tissue
Areas of brain destruction called senile plaques

Show answer

Answer: 4

Rationale:
When an older person’s brain atrophies, some unusual deposits of iron are scattered on nerve cells; throughout the brain, areas of deeply staining amyloid, called senile plaques, can be found; these plaques are end stages in the destruction of brain tissue

Rationale for incorrect answers:
A. Dementia is associated with a chronic deterioration, not with remissions and exacerbations; B. Aggressive acting-out behavior may or may not be part of the disorder; C. Hypoxia of areas of brain tissue is typical of vascular dementia, not dementia of the Alzheimer’s type.

Cognitive Level:
Comprehension

Nursing Process:
Planning/Implementation

Practice Question Sourced From: Nursing Key Topics Review: Mental Health

NCLEX Exam Practice Question of the Week - 12/16/20

The clinic nurse prepares to develop a diabetic teaching program. To meet the clients’ needs, the nurse should take which action first?

Assess the clients’ functional abilities.
Ensure that insurance will pay for participation in the program.
Discuss the focus of the program with the interprofessional team.
Include everyone who comes into the clinic in the teaching sessions.

Show answer

Answer: 1

Test-Taking Strategy:
Note the strategic word, first, which indicates the need to prioritize. Use the steps of the nursing process to answer the question, remembering that assessment is the first step. The only option that addresses assessment is option A. The nurse should focus on individualized disease prevention and health promotion and maintenance. Therefore, the nurse must first assess the clients and their needs so as to effectively plan the program. Options B, C, and D do not directly address the clients’ needs. Remember that assessment is the first step in the nursing process!

Review:
Teaching and learning principles.

Practice Question Sourced From: Saunders Q & A Review for the NCLEX-RN Examination, 7e

NCLEX Exam Practice Question of the Week - 12/9/20

A client who has end-stage cancer is admitted to a hospice care facility from her home. Which intervention should the nurse implement to address the client’s psychosocial needs?

Administer total care for the client.
Engage the client in social activities.
Allow the client to verbalize feelings.
Provide pain medication every 4 hours.

Show answer

Answer: 3

Rationale:
Focus on the subject, meeting psychosocial needs. The client is experiencing loss from two life-changing experiences: the poor prognosis and the loss of control over the environment, independence, and privacy that accompanies admission to a hospice care facility. To meet the client’s psychosocial needs, the nurse should promote a therapeutic relationship and allow the client to verbalize her feelings. Options 1 and 4 manage physical needs. Although total care may be necessary, it does not address psychosocial needs. Providing pain medication is indicated as part of effective pain management; however, this can interfere with therapeutic communication if the client is too sedated. Engaging the client in social activities is unlikely to effectively meet the client’s psychosocial needs relating to loss; it is more likely to assist in diminishing loneliness and isolation. Review: interventions to meet the psychosocial needs of a client who is dying.

Practice Question Sourced From: Saunders Q & A Review for the NCLEX-RN Examination, 7e

Using Sherpath^® to Your Advantage!

Written by Ariana Speight

One of the best parts of being an Elsevier Student Ambassador, is when it crosses over into my schoolwork and the resources that I use throughout nursing school. This year, my professors have added Sherpath into the curriculum for Pharmacology and Medical Surgical Nursing – and I am so thankful!

It’s wonderful when professors provide resources to help you succeed, improve your critical thinking and practice for the NCLEX, and Sherpath does all of those things for me! Sherpath has so many different aspects to help you study and practice NCLEX style questions. From the lessons to EAQ^® (Elsevier Adaptive Quizzing), you will be well on your way to passing the NCLEX and doing super well on your nursing tests if you take full advantage of everything Sherpath has to offer!

Using Sherpath to study for tests
Doing practice questions is such a great way to study for tests because it allows you to get acquainted with the different styles of nursing questions. Whether it is knowledge recall, select all that apply, or application/analysis, Sherpath has every kind of question to prepare you for nursing tests and the NCLEX!

Understanding and learning concepts
Before you take quizzes, Sherpath has lessons for each chapter that reviews key concepts in the chapters of your textbooks and breaks it down for you to better understand the material. Along the way it tests your knowledge to make sure you are retaining the information and understand what you are learning. Taking notes on the lessons is super beneficial because it helps you retain key concepts and have them on paper to help you review and study later.

In my classes, the weekly Sherpath quizzes are graded, so we get an extra 100 points towards our grade. When professors give you the opportunity to earn additional points to boost your grade, it is so important to take complete advantage of that! Not only do those quizzes prepare you for the tests, those points will raise your grade and give you an extra cushion if you lost a lot of points on your tests. Do not solely rely on those Sherpath points, but use them as a nice cushion if you fall once or twice. Study hard, prepare yourself, manage your time well, and you will do amazing!

Preparation for the NCLEX begins the moment you start nursing school, and Sherpath is a great resource to study for your classes and to prepare for the NCLEX!

NCLEX Exam Practice Question of the Week - 12/2/20

On assessment of a newborn being admitted to the nursery, the nurse palpates the anterior fontanel and notes that it feels soft. The nurse determines that this finding indicates which condition?

Dehydration
A normal finding
Increased intracranial pressure
Decreased intracranial pressure

Show answer

Answer: 2

Rationale:
The anterior fontanel is normally 2 to 3 cm in width, 3 to 4 cm in length, and diamond-like in shape. It can be described as soft, which is normal, or full and bulging, which could indicate increased intracranial pressure. Conversely a depressed fontanel could mean that the infant is dehydrated.

Priority Nursing Tip:
The anterior fontanel is a diamond-shaped area where the frontal and parietal bones meet. It closes between 12 and 18 months of age. Vigorous crying may cause the fontanel to bulge, which is a normal finding.

Test-Taking Strategy:
Focus on the subject, an anterior fontanel that is soft. Recalling the normal physiological finding in the newborn will direct you to the correct option.

Review
normal newborn findings.

Level of Cognitive Ability:
Applying

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process/Assessment

Content Area:
Maternity: Newborn

Priority Concepts:
Clinical Judgment; Development

Reference:
Hockenberry, Wilson (2015), pp. 255, 261.

Practice Question Sourced From: Saunders Q & A Review for the NCLEX-RN Examination, 7e

NCLEX Exam Practice Question of the Week - 11/25/20

A client is diagnosed with early-stage septic shock. Which is the priority nursing assessment?

Gradual increase in body temperature
Respirations of 18 breaths per minute
Client report of experiencing chills
Slight body shaking

Show answer

Answer: 1

Rationale for correct Answer: A.
Fever is a characteristic of septic shock. An increase in body temperature would indicate a worsening of the fever.

Rationale for incorrect answers:
B. Tachypnea of 20 or more breaths per minute is considered rapid and a possible indicator of shock. C. Chills are associated with fever; the greater concern would be an increase in the chills. D. Shaking is associated with chills; the greater concern would be an increase in the shaking.

Practice Question Sourced From: Nursing Key Topics Review: Fluids & Electrolytes

Battling Imposter Syndrome

Written by Yu Liang

Imposter syndrome. Signs and symptoms include a lack of self-confidence, feelings of inadequacy, self-doubt, and irrational fears of incompetency. I thought I was the only one, but it turns out many of us can relate to this. If you ever feel like you don’t know anything - like you’ve only made it through this far because of pure luck - I’m here to tell you that you’re wrong. Nursing school is hard; getting in is hard and staying in is hard. The fact that you’ve made it as far as you have is a testament to your hard work and dedication to a selfless career. As someone who feels like a fraud all the time, here are some tips I have for mitigating imposter syndrome

Reframe your thinking. Instead of going into an exam thinking “I’m going to fail”, tell yourself, “I’ve studied as much as I can for this exam. I know the content. I’m doing the best that I can”. Negativity does not help anyone, and it’s really important that you give yourself credit for your successes and the work that you’ve put in.
Stop comparing yourself to other people. Everyone is on their own timeline and comparing yourself to someone else’s won’t do anything but make you feel inferior. For me, I felt imposter syndrome the most when I saw other classmates doing better than I was, who were already working at hospitals and still managing to get good grades. As soon as I stopped worrying about what everyone else was doing and focused on myself, it made me realize my own potential.
Abandon the need for perfection. Learn to appreciate your mistakes and the growth opportunities they offer. One of the reasons why my feelings of inadequacy began to take over was because I was so used to having a 4.0 GPA. That whenever I got anything less than an A, I felt like I was a fraud. Perfect grades do not equal being a good nurse, and this is something I need to remind myself of all the time.
Recognize your accomplishments. This is something that is so simple, yet often neglected. We’re so caught up in thinking about what we haven’t done, and what others are thinking about us, that we’ve forgotten to appreciate the work we have done. For example, passing a tough course like Pharmacology is something we don’t consider to be an accomplishment, but ask a non-medical relative if they can pronounce Carbamazepine. It really is the little things.
Talk about it. Tell someone else how you’re feeling. You’d be surprised how common it is. I felt like I was the only one feeling like a fraud, but once I voiced this to my peers, I found out that my friends were feeling the exact same way. I once told a nurse in clinical that I felt like I didn’t know anything and didn’t think I should be alone on the floor. She talked me through my fears and asked about what I was concerned about specifically. She told me that she felt the same way throughout nursing school and continues to doubt herself sometimes as a nurse. Knowing that I’m not alone in this battle made me feel so much better about it.

Imposter syndrome is not necessarily a bad thing to have. It keeps me grounded and motivated to learn more. It’s a reminder that there is always room for improvement, a core element in nursing. The key to battling imposter syndrome is not letting it keep you from being a better nurse/nursing student. Don’t let your own mind limit you from applying to opportunities you think you’re not qualified enough for and remind yourself that you are not alone in the way that you feel.

Four Ways to Ace Your Clinical Rotations

Written by Tien Duong

All nursing programs consist of didactic and “hands on” experiences, which are called clinical sections. In my nursing school, every semester includes lectures, simulation labs and clinical rotations. I have been lucky to have had amazing experiences through clinical in the Texas Medical Center in many specialties such as psychiatrics, geriatrics, pediatrics, maternity and med-surg. This clinical rotation created so many opportunities for me to be a better version of myself and helped me achieve one of the highest nursing student awards in my school.

So how did I overcome all the long hours of tiring and overwhelming clinicals to obtain the most knowledge and make a good impression on my nursing staff and clinical instructors? Here are some tips based on my own experiences that are helpful for nursing students who want to be outstanding and ace your clinical rotations.

Always prepare for the most difficult patients
My preceptors normally have 3-4 patients per shift. Each patient is on a different level of care based on their individual health conditions. I always first logged in to the system to read through the patient medical summaries, their latest vital signs, lab data and daily medications. I noted this information down and learned about my patient on my own while waiting for my nurse in the beginning of the shift. Patients with the most symptoms and medical diagnoses are always the ones who take up a preceptor’s time and keep you on your feet. It is hard to remember all of the patients, so I always picked one that represented most of them. I learned their medications by heart before entering the room, assessed them to see if any signs were different with their chart, and applied all the nursing skills that I could practice on those patients. At the end of the day, I already knew a lot about that most difficult patient, so I would pick them to do my care plan and save time on paperwork.
Make good impressions with staff nurses and instructors
Some of my clinical days were not busy. Sometimes, your slow days may be busy days for others. When I finished all my assessments and had checked on patients and completed charting, I would have some free time. To make the most of that, I reached out to other nurses and charge nurses to see if they needed any help. Even if it was just checking patients’ vital signs, it was a big help when that floor was short on staff. This is not only a way to help people, but also a way to make a connection. I got several references thanks to being helpful. The charge nurses even sought out my clinical instructors to compliment on my willingness to help and work hard.
Don’t be afraid to ask your instructors “dumb” questions
A lot people think that clinical instructors are intimidating but at the end of the day, they are our teachers. They are there to teach, observe and guide you to success through nursing school. There are many health problems, pathophysiology, and diseases mechanisms that I do not know. When I could not understand them completely, even after researching, I did not hesitate to ask my instructors so I could learn more. Their experiences and stories helped me to understand tremendously and inspired me to be a great nurse in my future career. Do not be afraid to look “dumb”! Remember that you are still students and asking is a way of learning
Share your experiences with your peers and learn from their experiences
At the post conferences, my classmates and I always shared our experiences of the day together. I heard stories on what they had done for their patients, some of which I had not had the chance to do. Through the point of view of others, I could get more knowledge for myself and vice versa. Also, clinical days are not always smooth. One of those days may be a bad day for you and your clinical mates. We shared how rough it was and encouraged each other to do better next time. Through clinical, I made so many friends who are now my second family.

We never know what is waiting for us on a new clinical day. Maybe a good friendship, maybe heaps of useful knowledge or maybe a valuable letter of recommendation. I got all of them, plus an award nominated and voted on by the faculty. So remember to always come prepared and take advantage of your clinical rotations.

How I Use My Favorite Pharmacology Resource to Study

Written by Kirsten Anderson

We all know pharm is a tough class, but it’s something all of us nursing students have to go through! As new quarters are starting, it is always so important to look back at information from previous quarters, especially your drugs! And if you haven’t taken pharm yet, you should do everything you can to prepare yourself for what’s to come!

That being said, my favorite resource to use is the 𝗡𝘂𝗿𝘀𝗶𝗻𝗴 𝗞𝗲𝘆 𝗧𝗼𝗽𝗶𝗰𝘀 𝗥𝗲𝘃𝗶𝗲𝘄: 𝗣𝗵𝗮𝗿𝗺𝗮𝗰𝗼𝗹𝗼𝗴𝘆 book! This is great for anyone who has taken pharm but needs those constant refreshers or are preparing for the NCLEX®! It covers everything from pharmacologic principals, to 19 different categories of drugs!

So how do I use this resource?

Practice questions: The best way I retain information is practice questions! So, the fact that this book has tons of practice questions and solutions has been my saving grace! The questions also emphasize critical, practical, and relevant information that helps you absorb the material in the best way possible.

Study and Test-Taking Tips: Another one of my favorite features are the study and test-taking tips throughout the book! In each chapter there is a section with a hint or trick to help you memorize the type of drug and what it does!

NCLEX Preparation: Like I said, this book is not only for those who are new to pharmacology. Everything you learn in this class will most likely be built upon throughout your schooling. Upon graduating, the NCLEX is your next beast and it WILL have pharmacology questions. So, this book is not only great for your classes, it also makes NCLEX prep a lot easier! The answers given are not just A or B, but actual answer explanations are used to help the student retain as much as possible!

Anatomy Review: There is no shame when it comes to not remembering every little detail from A&P, but when it comes to learning drugs and medications, we need to how they are going to affect the body. At the beginning of every chapter, there is an A&P review of the system relating to the content in that section.

Organization: Unlike big textbooks, there are not a lot of filler words and unnecessary information. Since this is about key topics, you will get everything you really need to know. I love the bullet point lists and neat tables, it makes all the information easy to read and memorize!

Studying on-the-go: Last but not least, another awesome feature about this book is the fact that it is not just a book! You can scan the QR code on the front page to access free mobile content! These online audio summaries cover every chapter and can be listened to anywhere!

This is how I love to use my Nursing Key Topics Review: Pharmacology book, as it has made one of the hardest nursing school courses one of the easiest and most fun to learn!

Leaning on Your Faculty in Nursing School

Written by Kayla Urbino

I recently had the opportunity to volunteer at my nursing school’s New Student Orientation. While I was there, I heard a speech by the head my nursing program and she said something that really stuck with me:

“The professors are here to help you, and they want you to succeed.”

I have thought about this idea for some time now and find great comfort in it. Being apart from them this semester has been hard, but I have witnessed that my professors truly do care.

My nursing faculty has gracefully led us through this transition to digital learning, trying to change the curriculum as much as possible to fit what is going in the world right now. Not all of us have computers that fit the standards of testing or have good, strong internet connections. However, they have tried their best to try and accommodate everyone. Some of the teachers have never gone through something like this before, and now they need to learn how to record video conferences for classes and clinical hours.

The more time I spend in the nursing program, the more I appreciate the professors. They have shaped who we are as nursing students and serve as an example of the kind of nurse we will be when we graduate.

I can think of many instances when a professor showed they truly care for us. A week after lockdown, one of my clinical professors actually reached out to check in with me. He asked how I was doing, if I was working, and how I was handling what was going on in the world. It was a conversation that lasted no more than 5 minutes, but to me it meant a lot. That I am not just another face in the crowd and that they actually wanted to know how I was doing.

Similarly, I have had the pleasure of having a very nurturing first-semester clinical teacher. She always responds to emails or texts regarding recommendations, scholarship letters, or just life advice. At the end of my first semester, she mentioned how her office will always be open for us and to come back and visit her when we can. I have tried to go visit her every semester since then and it’s like going to see a friend. She has not only been a teacher but a mentor.

All in all, I strongly believe that nursing school does go by quickly, and to enjoy the ride. That never again will we be in a program so stressful and tiring yet so rewarding. Enjoy the ups and downs of nursing school, even the little bumps along the way, and appreciate your professors. They do care. Ask for help if you need it because they want to make you the best possible nurse you can be.

Preparing to Enter Nursing school

Written by Kayla Gonzalez

Hello everyone! My name is Kayla and I am going to be starting the Bachelor of Science in Nursing program at the University of Texas Rio Grande Valley this upcoming August (Fall 2020)! Getting into nursing school is definitely a big accomplishment! While this is an amazing achievement, this is also a huge responsibility that should be prepared for before even entering Nursing school.

Committing to nursing school is just as important as any other life-long commitment in our existence. Entering nursing school can be challenging, nerve-wracking, and demanding. The new transition to digital learning is especially monumental to nurses as getting hands-on training is a necessity to our education. It is essential to not get overwhelmed with these changes as we are all going through it with you! We can get through this and come out victorious! These are just a few of the ways that you can start preparing for your entrance into nursing school.

Invest in a Planner: Purchasing a planner that is specific to your lifestyle and needs will help you with consistently using your planner for all aspects of your life and scheduling things ahead of time! Planners will aid in organizing your life both socially and academically during your nursing school years. Deadlines for assignments and documentations are essential, therefore making sure that they are submitted on time should be a priority. If your professors have begun uploading the syllabus for the course, it would be beneficial to sit down with your planner and gradually begin to fill out the due dates and exam dates in your planner before even starting nursing school.
Set a Routine and Hold Yourself Accountable: As I mentioned above, if you haven’t experienced online courses before, the transition to digital learning can be overwhelming, complex, and tedious. The key thing to do is treat digital learning as if it was already how things planned to go. Set boundaries for yourself and wake up early to check in to your courses and assignments for the week.

Get dressed as if you are going to class and plan out what assignments you are doing for each day of the week and hold yourself accountable. Accountability is going to be one of the motivating forces that keeps you going despite the online aspect of your courses this semester. Some courses may be held synchronously or asynchronously, but it is your job to keep track of the ever-changing conditions.
Communicate with Professors: Do not hesitate to ask for help! It’s important to reach out to faculty if there is a question about assignments, exams, homework, etc. Take advantage of office hours and any additional resources, such as tutoring, to help you understand the material better. Connecting with faculty is also a great way to start networking and showing your commitment to learning.
Self-Care: Incorporating self-care in preparation for nursing school should be a priority as well! Make sure to pay attention to what your body needs, whether it be taking a break from studying to prevent burnout, participating in movie night with your family or staying active.

Remember that we are all in this together! You can do this, and we all believe in you! Find a healthy balance of ensuring your mental health and self-care is at an optimum level along with your preparation for nursing school!

Six Things I Learned During my Final Year of Nursing School

Written by Kayla Del Mundo

2020 is the Year of the Nurse. Florence Nightingale once said, "To be ‘in charge’ is certainly not only to carry out the proper measures yourself but to see that everyone else does so too.” I feel as if the class of 2020 is a testament to this quote. We were the bunch of future nurses experiencing a pandemic that brought together the meaning of nursing and the duties that we will fulfill as Registered Nurses in the work field.

No one expected the world to be dealing with such a huge pandemic crisis 6 months ago, but it happened. I was starting my senior year of nursing school just months away from getting that BSN and RN license. I was expecting to do my senior preceptorship in my dream unit, Labor & Delivery/Postpartum. I was expecting to be with my friends in the study room, counting down the seconds until our exit exam and finding out we passed nursing school. I was expecting to have a big celebration with my cohorts at our pinning ceremony. I was expecting many things this year that unfortunately did not pull through because of the pandemic. And that's okay!!! There was no book on how to go to nursing school through a pandemic, but since we've been in this quarantine style learning for 6 months, here are 6 things I learned during my last year of nursing school.

Online learning is harder than it looks.
- If you love online classes, that's awesome! If you're more of an in-person learner, this pandemic situation may have been a struggle. Adapting to a new learning style may be difficult at first but ensure that you are staying organized and managing your time wisely. It's important that we don't slack off even though we are stuck at home doing school all day, every day.
I have never loved my bed so much in my life.
- I had to include this in here because for me, it's an understatement. I never was a person who took naps but being on my butt in a chair for 5 hours can do a lot to your body. Ensure that you are taking breaks and even a nap to recharge yourself for that next lecture or even clinicals.
Be patient with your school and professors.
- Transitioning from on campus to online was a shock to everyone. Your school probably wasn't prepared to have to close down or make changes within the curriculum. It's completely frustrating and I get it. I was a part of the many programs that had to do their skills check offs online and do clinicals online (Swift River for life!). Your school’s deans and professors are doing everything they can to provide you the best education in different circumstances.
Blue light glasses are your best friend.
- Staring at the screen all day can do damage to your eyes. Blue light glasses help to block out the blue light emitted from screens. One of my favorite blue light glasses is on Amazon! Effective and affordable!
Zoom Study Meetings are a LIFESAVER.
- My friends and I always met up with each other to study for quizzes and tests but not these past 6 months. Of course, we had to maintain the social distance of 6 feet apart, so we did the next best thing: Zoom Study Meetings! It's the best way to stay connected with your friends while getting work/studying done.
Cherish the last few moments you have with your cohorts.
- I know that it is hard to accept that you cannot see your nursing friends right now. But we just have to make the best of the situation. Reminisce on the times you guys had at school and think of all the memories you could make after graduating nursing school and passing NCLEX®!

But if you are a nursing student right now, something I want to tell you is everything will be okay. You are on this path of nursing for a reason and do not let any external barriers get in your way. There's a world full of sick people waiting to be treated. Although the circumstances aren't what we expected it to be, we need to remember that the future is bright. Provide yourself a good foundation with positive affirmations.

I AM capable of passing nursing school.

I WILL be a Registered Nurse.

I CAN do anything I set my mind to.

Online for Nursing School

Written by Hannah Lease

Amidst COVID-19, many changes have taken place around the world. This is also true regarding nursing programs. Some nursing programs have stopped their courses completely until further notice. Some have switched from in-person courses to online and clinical hours taking place inside the hospital have been halted until further notice. Although we all understand these changes have been made not only for our own safety but for the safety of everyone else, these changes can leave nursing students wondering how to go about these adjustments. I may just be one of many nursing students, but one thing I know for certain is that as long as you have the determination, self-discipline, organization, and time management skills, this bump in the road will only prepare us to become even stronger nurses someday.

When I began researching different accelerated nursing programs, I was torn between programs that were online versus in person. I ultimately took a leap of faith and chose an online-based program which I am even more grateful for with the current circumstances and since COVID-19 has created so many changes for those in traditional nursing programs. While others were left feeling uncertain after being switched from in-person lectures to online, all I’ve wanted to do was tell these students how this change will not alter their ability to still become great nurses. There are many ways to power through and make the most out of your nursing program, even if it is online.

The first key to success with an online nursing program is determination. Just because you are not meeting in person for the time being does not mean that you can lose sight of your end goals. Staying determined to keep turning in all your assignments on time, writing out your own notes, answering practice questions, working ahead instead of falling behind, and so on, will continue to keep setting you up to reach your goals.

Self-discipline, time management, and organization with an online-based nursing program are all HUGE. Since you are not always meeting up with your classmates, professors, or instructors, it is solely up to you and you alone to hold yourself accountable. Get a planner, dry erase board, notebook, or whatever you will put to good use in order to keep tabs on what you need to be getting done on a daily and weekly basis for your classes. I tend to treat my days like an actual “workday” where I will work on my courses from 8 a.m. to 5 p.m. I will develop a set plan of attack beforehand that could consist of me working on one class from 8 a.m. to 12 p.m., take a lunch break, and then finish the day with another class from 1 p.m. to 5 p.m.

Within those set timeframes for each class, I listen to the lectures online while simultaneously viewing the PowerPoint presentation and look up anything in the book that I may still be struggling with. Once I am finished with the lectures and readings, I make sure to write out my own notes and/or type out topics that are helpful towards a study guide. Finally, I ALWAYS finish up with Elsevier Adaptive Quizzing (EAQ).

When I say that EAQs have been a game changer for my success in my nursing program, I truly mean it. The more exposure I get to the material in a question format, the better understanding I begin to have overall. Being able to have rationales for every question, whether you get the question correct or not, adds even more learning. I always strive to do at least 20-30 EAQ questions a day, which can end up being hundreds of practice questions by the time of my exam! Anyone can make 20-30 EAQ questions a day happen no matter how busy they are – do them while you’re on the couch watching TV, when you’re lying in bed before you go to sleep, do 5-10 at a time in between assignments, etc. I promise you that it is doable, helpful, and there’s truly NO excuse to not take full advantage of these Elsevier resources!

In the end, it’s important to remind ourselves that all these changes will not last forever. These changes may have created a bit of chaos in the beginning, but in the end how we choose to handle this phase of our nursing programs will play a large role in our actual nursing careers. Keep pushing forward, friends! No matter what, we will all be amazing nurses someday.

How to Stand Out at Clinical – In a Good Way

Written by Cierra Hickson

Going through clinicals from day one of nursing school to now - I have learned a few things along the way. There were always older students around me giving me their advice and I shrugged it off thinking my experience would be different. I am here to tell you, take all the advice you can. Apply the advice you need and help those around you. Nursing school is competitive, but overall, it is about teamwork. These are a few tips I have learned along the way from my clinical experiences.

Always be Prepared

There are going to be many opportunities in clinical and you want to make sure you don’t miss out on a thing. Be prepared from the start. Get rest the night or day before so you are on top of your game. Have all your supplies with you. I bring my stethoscope, scissors, tape, dry-erase marker, pens, sharpies, watch, and as soon as I get to the unit I stock up on flushes and IV cover tips. This ensures that I am prepared for clinical and showcases professionalism. The staff around you will appreciate you being prepared and will be more willing to find extra opportunities for you.

Introduce yourself to everyone

Every person you meet during your clinical experience is a networking opportunity! Each staff member is a potential co-worker, or reference down the road. Get to know the staff on the unit with you. Introducing yourself to the doctors may allow you to sit in on a few procedures, or even help depending on what it is! Get to know the respiratory therapist on the floor! They are filled with so much knowledge and will be a good source for A-B-C priority type questions. The techs on the floor will be your best friend. They will be able to help with your patient load and show you a few tips and tricks along the way. It goes without being said but, get to know the nurses. The nurses on the unit each have something different to offer. They have learned things along the way and can help you improve your practice. They will make great references later in life and provide an insight to how life after graduation will be.

Ask all your questions

When I go to clinical, I remind myself constantly that I am a student. It is okay to not know everything. It is not okay to not ask. The patients know you are learning and most enjoy you asking questions in the room regarding their care because they get to learn more, too. Don’t be afraid to ask. If you see a patient with a disease process you have never seen before, ask them questions about it. The best source of information is the patient. It will help you put a picture to the disease process and will aid you in studying later. If you are not sure why the nurse is doing a certain intervention, ask them. Ask why that med was given for that condition. Ask the “what-if” question. It is okay to ask; we are all learning. Your clinical experience is about you learning so that you can be that primary nurse, so soak it all in now!

Put yourself out there

Keep in mind this is your learning experience. Offer to do everything! It shows a good work ethic and will encourage the staff to seek more opportunities for you. If there is an IV to be started, a Foley to be inserted, a wound to be cleaned, offer to do it (with help or assistance is fine if you need). If there is a procedure going on, ask to sit in on it. If a patient needs something, even if it isn’t your patient for the day, offer to help out.

These are simple ways to put yourself out there during clinical that make you stand out. Like I said earlier, it’s about learning and networking. There are departments going on and off the floor throughout the day, just because it’s not a nurse doesn’t mean you can’t still ask them if you can help or watch. It is important for nurses to know the procedures and diagnostics for their patients. Every conversation, procedure, or intervention performed for your patient is a great opportunity to learn.

TIPS FOR STUDYING AT HOME

Written by Bailey Thom

As many of us are transitioning from in-person to online classes, studying at home can be very challenging. Our homes can be full of distractions: family members, pets, fridges, beds, Netflix… Altogether, you might find yourself less motivated and productive than usual.

As someone who used to spend all of their time studying in libraries and coffee shops, I have had to put in a lot of time and effort into learning how to study from home.

That being said, here are tips that work for me!

Establish a Routine.
Prepare to study in similar ways that you prepared to go to the library or class. Especially if you are a morning person, set a specific time to wake up and get dressed. Establishing routines can help signal to your brain that “hey, it is time to get work done.”
Have a Dedicated Space.
Whether it is a dining room table or a desk, have a designated study space. Try to reserve your bed for sleeping and avoiding studying in it. I used to make the mistake of studying in bed but I found that I could not focus while studying and, when I wasn’t studying, I was not able to easily fall asleep. Don’t do it, friends. Lastly, keep your study space clean and organized – that way, you’ll spend more time studying and less time trying to find a pen that works.
Shut Off Unnecessary Technology.
Put your phone on Do Not Disturb mode. Turn off social media on your laptop. Try not to distract yourself while you are trying to focus!
Find a Study Method – with Breaks!
I love to use the Pomodoro effect to guide by studying, which involves 25-minute work intervals with a short break (~5-minute) in between. After every 4 work intervals, you take a long break (~15-30 minutes). Bonus: I use an app on my phone that helps me and, as per above, not use my phone for other reasons while I am studying. However, you can use any timer to help keep track of time and to make sure you stay focused. Lastly, when you take breaks – make them guilt-free. Scroll through Instagram aimlessly (psst, you can check out my profile @baileybscn). These breaks are not meant for you to be productive so keep them that way!
Study Groups.
Technology is amazing, hence why we are learning from home. That being said, there is no reason that you cannot continue to study with your friends! We all know that nursing students who study together, stay together.

I know there are dozens of different tips out there, which leads to my last tip: personalize your study habits to you. My tips are not going to be helpful to everyone. Finding what works for you may be trial and error and that is okay.

Happy studying, future nurses!

How I Study to Retain Critical Information in Nursing School

Written by Jehr Dotson

Before attending nursing school, I was able to study by writing a few things on flash cards and going about my day, often passing courses with As and Bs. That quickly changed after admission into nursing school. Not only did I have a load of coursework to study, but I had to study “learning how to study” before I could effectively learn any material …I’m sure any nursing student can totally relate to that!

Being a tutor for many nursing students as well as being a student myself, I can say the reason most students fail exams or pass with undesirable results is because they simply do not know how to study rather than not studying at all. Since my first semester of nursing school, I have invested in NCLEX® Prep books. When I suggest using an NCLEX book, the initial reaction is “aren’t those for people who are graduating?” My answer - absolutely not!

Using an NCLEX practice book is imperative to any student in nursing school. Why? Because NCLEX-style questions are typically what you will see on your exams up to and after graduation when you try to pass boards. Owning an NCLEX book will give you an opportunity to see how questions are structured, with lots of topics broken down into what you need to know.

The NCLEX book I use is the Elsevier Comprehensive NCLEX-RN examination book, 8th edition. Honestly, it is the best one I’ve used! It has every subject that you will see in nursing school from pathophysiology to critical care nursing. I use my NCLEX book to refresh on topics from the previous semester during school breaks and to ensure that I am prepared for my upcoming exams.

I am currently in my fourth semester of nursing school and this book has made learning critical care and pediatrics much easier. Learning material can feel overwhelming because it’s not always easy to follow along, but I use my book to get a baseline of what my professor would like me to know. Then, after taking notes from readings, YouTube videos, and lecture, I end the week off with my NCLEX practice book to help me narrow everything down.

Once I have gotten a pretty good idea of the material, I test myself using the questions provided in the book. There are over a thousand questions throughout the book and they are organized by subject and topic. I love that rationales are provided with each question. Not only am I developing better testing strategies, but I am able to see what areas I could improve in.

I recommend any student of nursing or graduate preparing to take their NCLEX examination to use an NCLEX Prep book. It always leaves me with a boost of confidence before my exams and wonderful grades to reflect.

Happy studying,
Jehr

NCLEX Exam Practice Question of the Week - 11/18/20

The nurse is preparing discharge instructions for a client who sustained a skeletal muscle injury and is receiving baclofen. Which instruction should be included in the teaching plan?

Restrict fluid intake.
Avoid the use of alcohol.
Stop the medication if diarrhea occurs.
Notify the primary health care provider (PHCP) if fatigue occurs.

Show answer

Answer: 2

Rationale:
Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants, because baclofen potentiates the depressant activity of these agents. Constipation, rather than diarrhea, is a side effect. Restriction of fluids is not necessary, but the client should be warned that urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the PHCP about fatigue.

Test-Taking Strategy:
Focus on the subject, teaching points for baclofen. Recalling that baclofen is a skeletal muscle relaxant will direct you easily to the correct option. If you were unsure of the correct option, use general principles related to medication administration. Alcohol should be avoided with the use of medications.

Level of Cognitive Ability:
Applying

Client Needs:
Physiological Integrity

Integrated Process:
Teaching and Learning

Content Area:
Pharmacology: Musculoskeletal Medications: Muscle Relaxants

Health Problem:
Adult Health: Musculoskeletal: Tissue or ligament injury

Priority Concepts:
Client Education; Safety

Reference:
Hodgson, Kizior (2018), pp. 113-114.

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 11/11/20

The nurse is caring for a postrenal transplantation client taking cyclosporine. The nurse notes an increase in one of the client’s vital signs, and the client is complaining of a headache. What vital sign is most likely increased?

Pulse
Respirations
Blood pressure
Pulse oximetry

Show answer

Answer: 3

Rationale:
Hypertension can occur in a client taking cyclosporine, and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitored most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.

Test-Taking Strategy:
Note the strategic words, most likely. Focus on the name of the medication and recall that this medication can cause hypertension. Also, noting that the client has a headache will assist you in answering correctly.

Level of Cognitive Ability
Analyzing

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process—Assessment

Content Area:
Pharmacology: Immune Medications: Immunosuppressants

Health Problem:
Adult Health: Immune: Transplantation

Priority Concepts:
Clinical Judgment; Immunity

Reference:
Lewis et al. (2017), pp. 209, 211.

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 11/4/20

The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the primary health care provider?

Dry cough
Hematuria
Bronchospasm
Blood-streaked sputum

Show answer

Answer: 3

Rationale:
If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure.

Test-Taking Strategy:
Note the strategic word, immediately. Eliminate option 2 first because it is unrelated to the procedure. Next, eliminate option 1, because a dry cough may be expected. Noting that a biopsy has been performed will assist in eliminating option 4, because blood-streaked sputum would be expected. Note that the correct option relates to the airway.

Level of Cognitive Ability:
Analyzing

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process—Implementation

Content Area:
Complex Care: Emergency Situations/Management

Health Problem:
N/A

Priority Concepts:
Clinical Judgment; Gas Exchange

Reference:
Ignatavicius, Workman, Rebar (2018), pp. 525-526.

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 10/28/20

A client comes to the clinic with decreased hearing. Examination of the ear canal reveals a large amount of cerumen. What is the recommended method for removal of the cerumen?

Curettage with suction and irrigation
Warm sterile solution irrigation
Cool tap water irrigation
Cotton swab applicator

Show answer

Answer: 2

Rationale:
Although the structures of the outer ear are not sterile, sterile drops and solutions are used for irrigations in case the tympanic membrane is ruptured. The addition of nonsterile solutions may result in possible infections of the middle ear. Cool irrigants will be uncomfortable, and tap water is not considered sterile. Curettage with suction and irrigation and use of a cotton swab applicator can damage the tympanic membrane.

Practice Question Sourced From: Illustrated Study Guide for the NCLEX-RN Exam, 10e

NCLEX Exam Practice Question of the Week - 10/21/20

Clients with liver disease frequently develop a problem with jaundice. What would the nurse identify as the physiologic cause of jaundice?

Increased levels of ammonia
Increased alanine aminotransferase (ALT) level
Bilirubin levels above 4 mg/dL (68.4 umol/L)
Increased red blood cell production

Show answer

Answer: 3

Rationale:
Increased levels of bilirubin (greater than 2.0 mg/dL [34 umol/L]) cause a discoloration of the skin called jaundice. The bilirubin value needs to be two to three times the normal level for jaundice to be manifested. Normal value of total bilirubin is 0.2 to 1.3 mg/dL (5–21 umol/L). Jaundice occurs because of an alteration in normal bilirubin metabolism or flow of bile into the hepatic or biliary system. Increased ammonia and ALT levels do not cause jaundice; they are problems associated with the malfunctioning liver. Hemolytic jaundice is due to an increased RBC production.

Practice Question Sourced From: Illustrated Study Guide for the NCLEX-RN Exam, 10e

NCLEX Exam Practice Question of the Week - 10/14/20

A client is taking amiloride hydrochloride daily. The nurse should tell the client to take the dose at what time?

At bedtime
On an empty stomach
Between lunch and dinner
In the morning with breakfast

Show answer

Answer: 4

Rationale:
Amiloride hydrochloride is a potassium-sparing diuretic used to treat edema or hypertension. A daily dose should be taken in the morning to avoid nocturia. The dose should be taken with food to increase bioavailability.

Test-Taking Strategy:
Eliminate options 1, 2, and 3 because they are comparable or alike in that they all indicate taking the medication dose without food. Review: Amiloride hydrochloride.

Tip for the Nursing Student:
Edema is the abnormal accumulation of fluid in body tissues. Hypertension refers to an elevated blood pressure and is a known cardiovascular risk factor. Potassium-sparing diuretics are 1 class of medications used to treat edema or hypertension. Only a few medications are potassium sparing, and amiloride is 1 of them. A concern with potassium-sparing diuretics is that the client retains potassium, which can lead to hyperkalemia (a high potassium level). Therefore, the nurse monitors the client for signs of hyperkalemia.

Level of Cognitive Ability:
Applying

Client Needs:
Physiological Integrity

Integrated Process:
Teaching and Learning

Content Area:
Pharmacology

Priority Concepts:
Client Education; Fluids and Electrolytes

Level of Nursing Student:
Intermediate

Practice Question Sourced From: Saunders 2020-2021 Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 10/7/20

The nurse is preparing to care for a pediatric client with an intravenous solution infusing. The nurse should ensure that which item is in place to prevent fluid overload in this client?

Armboard
Infusion pump
Macrodrip infusion set
Large-bore intravenous catheter

Show answer

Answer: 2

Rationale:
The most effective means of preventing irregularities in volume infusion for the pediatric client is the use of an infusion pump. This prevents both overhydration and underhydration. An armboard may be helpful in certain instances to minimize movement of the extremity with the catheter, but it is not an effective means for regulating intravenous flow. A small-bore catheter and a microdrip infusion set, rather than a macrodrip set, are used in the pediatric client.

Test-Taking Strategy:
Focus on the subject, preventing fluid overload. The only item in the options that will accomplish this is an infusion pump.

Review:
Care of the pediatric client receiving an intravenous infusion.

Tip for the Nursing Student:
When a child (or adult) is receiving fluids by the intravenous route, the nurse needs to monitor the client and infusion closely to ensure that the fluid is infusing at the prescribed rate. If the fluid infuses too rapidly, serious complications can occur from the excess fluid. An infusion pump, which controls the amount of fluid infusing, should be used to administer intravenous fluids to a pediatric client.

Level of Cognitive Ability:
Applying

Client Needs:
Safe and Effective Care Environment

Integrated Process:
Nursing Process/Implementation

Content Area:
Pediatrics

Priority Concepts:
Fluids and Electrolytes; Safety

Level of Nursing Student:
Intermediate

Practice Question Sourced From: Saunders 2020-2021 Strategies for Test Success, 6e

Top 10 NCLEX Study Tips Using Saunders Comprehensive Review

How I studied for, and passed, the NCLEX-RN® Examination

Written by Mary Euline Olayon-Yaw, RN

Studying for the NCLEX can be daunting. The most common problem I ran into is not knowing where to start since the NCLEX tests you on content you’ve learned all throughout nursing school. One NCLEX resource that I found incredibly helpful in tackling this issue was the Saunders Comprehensive Review for the NCLEX-RN Examination book. This review book was one of my top resources that I used to pass my NCLEX! Here are my top 10 NCLEX study tips when preparing for the NCLEX while using this review book!

Evaluate which areas/topics you need to review.
- Access the Evolve online resources using the code found inside your book.
- Select “Exam review” → “Assessments” → “Pre-test”.
- The results of your pre-test will guide you on where to begin your review and allows you to avoid simply going the entire book from front to back cover and over studying.
- The pre-test will also create a study plan/calendar tailored to your results, providing a structured plan on how to break down your studying.
Create an NCLEX study plan or calendar.
- As previously mentioned, once you finish the Pre-test on Evolve, it will curate a study plan for you. However, don’t limit yourself to this! If you think that you need to further review one topic more than the other, feel free to customize your plan. What I did was print out a blank calendar from the internet and filled each day with content from the study plan that I got from Evolve while making a few tweaks on what I wanted to review more.
- Creating a study calendar allows you to visually see what you’ll be doing day by day and alter it as you see fit depending on your schedule!
- A good rule of thumb is to begin studying as early as you can for the NCLEX and as late as 30 days prior to your test date.
Put together an NCLEX study binder.
- Any three-ring binder or a notebook will work perfectly.
- Use this binder to store any handwritten notes so that you can easily look back on any key information.
When reviewing a chapter, read/skim through the information at least twice.
- I recommend skimming through the chapter the first time without highlighting or jotting down notes
- Then, on your second read through, focus on the information that is typically bolded, placed in boxes, is visually drawn and/or has a triangle next to it (the triangle indicates that it’s an important NCLEX information to remember).
After finishing each chapter, answer the practice questions!
- When you go through these, remember to simulate it as if it was a question on the actual NCLEX.
- Read through each question thoroughly and use test taking skills to narrow down your options to the correct answer.
- Review the rationale for the answers and highlight or write a note on key details on why that is the correct answer.
Use the online Evolve resource to practice answering more NCLEX style questions!
- Evolve is easily customizable depending on what you want to review, allowing you to choose the category (ex: client needs, health promotions, etc.) and even the subcategories!
- “Study” mode prompts your practice questions with instant feedback, allowing you to read the rationale shortly after choosing your answer.
- “Exam” mode lets you choose the exam length (10, 25, 50, or 100 q’s) and will show your results after finishing the test.
Take the comprehensive test at the very back of the review book and/or complete the Post-test on Evolve.
- Once you’ve reviewed the whole book (which you don’t necessarily need to do!) or finished the chapters that you found were the ones that needed to be reviewed, take one of these practice tests.
- Each of these exams evaluate your comprehension of all the combined topics and will give you a better understanding of how prepared you are for the NCLEX.
Review the U.S. Top 100 Prescription Medications list on the very last page of the book!
- If you aren’t sure which medications to focus for the NCLEX, this list is a good place to start.
- The list contains many commonly used drugs that have also been seen on the NCLEX exam. Reviewing this list will help you prepare for the pharmacology section of the test by helping you understand how these drugs work, what they’re for, side effects, and it also includes patient teachings.
Read through the Test-taking Strategies chapter in Unit I.
- If you suffer from test anxiety or know that you have weak test taking skills, this chapter may be your life saver! Carefully read through the test taking skills this chapter provides.
- The Saunders authors also have a whole book dedicated to test strategies called Saunders Strategies for Test Success, which I highly recommend.
Take breaks when needed!
- As important as it is to review for the NCLEX as thoroughly as you can, remember to practice self-care too. Make sure that you schedule for “rest days” in your study plan that give you the time that you need to rest and regroup. Listen to your mind and body!

As anxious and giddy as you are to start preparing for the NCLEX, remember to take a moment and celebrate finishing nursing school! You’ve made it this far for a reason, so be confident in yourself and your skills. You’ve got this! Good luck!

NCLEX Exam Practice Question of the Week - 9/30/20

The client has had a right nephrostomy tube placed after a nephrolithotomy for removal of a kidney stone. When the client returns to the room, what is a priority nursing action?

Irrigate the tube with 30 mL of normal saline solution four times a day.
Clamp the tube if drainage is excessive.
Advance the tube 1 inch every 8 hours.
Ensure that the tube is draining freely.

Show answer

Answer: 4

Rationale:
Failure of the tube to drain freely can result in pain, trauma, wound dehiscence, and infection. If an irrigation is ordered for a nephrostomy tube, no more than 5 mL of sterile normal saline should be gently instilled

Practice Question Sourced From: Zerwekh Illustrated Study Guide, 10e

NCLEX Exam Practice Question of the Week - 9/23/20

When caring for a woman who had a positive contraction stress test (CST), what complication does the nurse suspect?

Preeclampsia
Placenta previa
Imminent preterm birth
Uteroplacental insufficiency

Show answer

Answer: 4

Rationale:
A positive contraction stress test (CST) indicates a compromised fetus with late decelerations during contractions; this is associated with uteroplacental insufficiency. (1) Preeclampsia does not cause a positive CST unless the fetus is compromised. (2) Ultrasonography demonstrates placenta previa; a CST is contraindicated because it may induce labor. (3) A CST is contraindicated for a woman with a suspected preterm birth or a pregnancy of less than 33 weeks’ gestation because it may induce labor.

Client Need:
Reduction of Risk Potential

Cognitive Level:
Application

Nursing Process:
Evaluation/Outcomes

Reference:
Antepartum Assessment Using Electronic Fetal Monitoring

Practice Question Sourced From: Nursing Key Topics Review: Maternity

NCLEX Exam Practice Question of the Week - 9/16/20

A client undergoes a cesarean birth because of cephalopelvic disproportion. What care is needed for this client in addition to the routine nursing care given to all postpartum clients during the first 24 hours?

Encourage early ambulation
Assess the fundus gently but firmly
Check vital signs for evidence of shock
Administer the prescribed pain medication.

Show answer

Answer: 4

Rationale:
Because of increased pain and increased flatus, these clients require more pain medication than do women who have vaginal births. (1) Early ambulation is encouraged for all postpartum clients. (2) Although it may be difficult because of the incision, palpating the fundus is a necessary part of postpartum care. (3) Checking vital signs is done routinely for all postpartum clients.

Clinical Area:
Childbearing and Women's Health Nursing

Client Needs:
Physiological Adaptation

Cognitive Level:
Application

Nursing Process:
Evaluation/Outcomes

Practice Question Sourced From: Nursing Key Topics Review: Maternity

NCLEX Exam Practice Question of the Week - 9/9/20

A 7-year-old child is admitted for surgery. What is an essential preoperative nursing intervention?

Allow a favorite toy to remain with the child
Document the child's ASO titer and C-reactive protein level
Inspect the child's mouth for loose teeth and report the findings
Encourage a parent to stay until the child leaves for the operating room

Show answer

Answer: 3

Rationale:
School-age children lose their primary teeth, which may be aspirated during surgery. Special precautions must be taken to maintain safety. (1) Allowing the child to keep a favorite toy is a comforting gesture, but it is not essential. (2) There is no reason to obtain an antistreptolysin O (ASO) titer or a C-reactive protein level. (4) It is not always possible for parents to stay until the child leaves for the operating room.

Client Need:
Safety and Infection Control

Cognitive Level:
Application

Integrated Process:
Communication/Documentation

Nursing Process:
Planning/Implementation

Practice Question Sourced From: Nursing Key Topics Review: Pediatrics

NCLEX Exam Practice Question of the Week - 9/3/20

How can a nurse best accomplish therapeutic communication with an adolescent?

Using teen language
Relating on a peer level
Establishing a relationship over time
Interacting by using concrete concepts

Show answer

Answer: 3

Rationale:
Several meetings with an adolescent provide an opportunity to develop trust and establish a relationship. (1) Using teen language is not necessary and may not help in establishing a relationship. (2) relating on a peer level is not realistic because the nurse is not the teenager's peer. (4) It is not necessary to communicate in concrete terms because the average adolescent is past this cognitive level.

Client Need:
Psychosocial Integrity

Cognitive Level:
Application

Integrated Process
Caring; Communication/Documentation

Nursing Process:
Planning/Implementation

Practice Question Sourced From: Nursing Key Topics Review: Pediatrics

How I Increased My HESI Exam Scores and Achieved NCLEX-RN® Success

Written by Cindy Nguyen

I used to dread taking HESI exams after every course. Since the HESI specialty exams are not written by my professors, I was never sure exactly what to expect. These exams test on the entire course and everything is fair game, even the things that we did not get to cover in lecture or weren’t emphasized in classes.

My first HESI covered all of fundamentals; I learned the hard way that I needed to change how I prepared for these types of exams. My university set a minimum score of 850 and I scored in the low 700s, which is very poor. This was certainly not the first impression I wanted to give off to my professors and classmates, I felt embarrassed and heartbroken. The entire situation left me confused and discouraged as I did well on most of my exams throughout the course.

HESI exams require a high level of critical thinking for each and every question to help you prepare for NCLEX style questions. Preparing for these types of questions requires a careful combination of studying, practice and remediation.

When it came time for me to take version 2 of the fundamentals HESI specialty exam, I was determined to prove myself and pass. I started to look into outside resources to study for HESI exams and improve my performance answering nursing school question types. While researching, I came across the HESI Comprehensive Review for the NCLEX-RN Examination book. The reviews I read online were very promising, students were scoring in the 1000s after utilizing this book (above the national average). Thankfully, I decided to purchase it. Here’s how I used it to prepare for my HESI exam:

I read every chapter corresponding to the exam.
I focused on the “HESI Hint” boxes scattered throughout the chapters:
I did the Review questions highlighted in yellow:
After I finished reading the material, I scratched off the access code inside the front cover and redeemed the code on Elsevier’s Evolve site. It unlocked many valuable online resources and tools, including practice questions. I completed all the online quizzes and read the very thorough rationales.

After completing HESI V2, I felt like I accomplished the impossible. I went from a failing score to scoring in the 1000s! I was able to confidently say that I had mastered the content and felt prepared to answer fundamental questions when presented during the NCLEX.

I followed the exact same process for every HESI exam afterwards, including the HESI Exit. Not only did I pass, I scored in the 1000s. According to my scores, HESI indicated that I had a very high probability of passing the NCLEX-RN. Fast forward one month later, I passed my NCLEX in the minimum of 60 questions.

I continually tell my classmates how this is the best book I have ever spent money on. Here's why: it's clear, concise, and to the point. The book points out the most important information for you to know on a topic and ways to answer questions. There are charts, pictures, and graphs that further illustrate concepts. All of these are great for studying for those HESI finals, exit exams, in class exams, and the NCLEX.

NCLEX Exam Practice Question of the Week - 8/26/20

A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed?

Echocardiography
Electrocardiography
Cervical radiography
Pulmonary function studies

Show answer

Answer: 4

Rationale:
Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

Test-Taking Strategy:
Eliminate options 1 and 2 first because they are cardiac-related and are therefore comparable or alike. From the remaining options, use the ABCs—airway–breathing–circulation—to direct you to the correct option.

Level of Cognitive Ability:
Analyzing

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process—Analysis

Content Area:
Pharmacology—Oncology Medications—Antitumor Antibiotics

Priority Concepts:
Cellular Regulation; Clinical Judgment

Practice Question Sourced From: Saunders Comp Review, 8e

NCLEX Exam Practice Question of the Week - 8/19/20

The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this oncological emergency?

Headache
Dysphagia
Constipation
Electrocardiographic changes

Show answer

Answer: 4

Rationale:
Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.

Test-Taking Strategy:
Note the strategic word, late. Focus on the name of the oncological emergency, hypercalcemia, to direct you to the correct option. Eliminate options 1 and 2 because they are not signs of hypercalcemia. Eliminate option 3 because it is an early sign of hypercalcemia.

Level of Cognitive Ability:
Applying

Client Needs:
Physiological Integrity

Integrated Process:
Teaching and Learning

Content Area:
Adult Health—Oncology

Health Problem:
Cancer/Prostate

Practice Question Sourced From: Saunders Comp Review, 8e

Using Your Differences to Make a Difference

Written by Koralys Rodriguez

Hello everyone, my name is Koralys Rodriguez - or Kory for short! I have about one year left until I have that RN next to my name, and I couldn’t be more excited.

As healthcare workers and students, the importance of reflection is something that is always stressed. In my personal life, and especially in light of recent events, reflecting on my ethnicity and culture is something I’ve been doing a lot more of. And this process of reflection has gone hand-in-hand with my growth as an advocate in healthcare.

I was born in Puerto Rico into a strong, diverse Latinx family. I grew up learning English and Spanish simultaneously. I was raised to be proud of who I was, and to represent my culture wherever I went.

I can’t count all the times in my life where I’ve looked at my differences as disadvantages, or as flaws. None of that was an issue for me when I was younger. But the older I’ve gotten, the more evident the cruelty in this world has become.

From subtle snarkiness and microaggressions, to blatant racism and even threats, the world is no longer sugarcoated for us. And these are the kinds of situations that make you want to change who you are to fit inside the bubble of what other people want.

Without even realizing it, I started to change myself to fit a mold I was never meant to match. This was the case until I started working in healthcare - when my perspective really changed.

Living in a southern state in an area with relatively low diversity, I started to realize the impact I could create as a Latinx healthcare worker. Over the past few years, I’ve had numerous opportunities to work with native Spanish-speaking clients. Many of these individuals had never received proper translations or culturally comprehensive care before I became a part of their care team. Some had never even seen someone who looked like them in the healthcare system before meeting me.

I’ve realized that I was never meant to change myself to fit into a system. Instead, I was meant to be who I am, unapologetically, and to change that very system! We can all do the same. Created change starts with us! And most of the time, it’s the little things that can make the biggest difference.

We all have our own strengths - our own qualities that make us unique. Now more than ever, we need to reveal the power of this uniqueness to help create a more open-minded and diverse healthcare system globally. The future of what healthcare looks like depends on us.

Are we actively working to create a more positive environment? Are we actively holding true to the basic principles of beneficence, non-maleficence, justice and respect? Or, are we conforming to a system that is outdated - one that has actively excluded people for not fitting the “mold”?

As healthcare workers and students, we are called to be ADVOCATES. We need to use our differences to make a difference

Resources for Hispanic and Minority Nursing Students:

While not all groups are available for students or for every location, these are all great resources and organizations to look into as you continue in your nursing journey!

National Association of Hispanic Nurses

National Coalition of Ethnic Minority Nurse Associations

Hispanic Scholarship Fund

Making the Most of Virtual Nursing School

Written by Courtney Franklin

I bet when you received your acceptance for nursing school, you never thought you’d be taking some of your most vital classes through a computer. When COVID took over our world, it unfortunately changed the way most of us did nursing too and left most of us wondering…what now? If you’re anything like me, you thrive off of face-to-face interaction, hands-on learning, and a set schedule. Because of this, I already knew that moving to a virtual format would not come without challenges. Because I attend an accelerated BSN program, my classes change every 8 weeks. With that being said, I am currently in my 4th online class and I wanted to share some tips and tricks I have found useful in making the most of being a virtual nursing student.

Form a Routine.

This is so very important. Being at home can make it easy to fall into your usual day-to-day routine and push off school related tasks. This is an easy way for you to fall behind. By creating a daily schedule, you are putting yourself back into a routine and practicing self-discipline.
Be Active in Class.

Although your professors may not be right in front of you like they would be in a traditional classroom, it is important to know that you still have your faculty’s support. If you are not understanding a concept, don’t be afraid to ask because chances are someone else in the classroom doesn’t understand as well. I know it can be intimidating to ask questions during online lecture, but the only silly question is the one left unasked! Remember that this is your learning experience and keeping an open line of communication with your professors is an important part of your success.
Use a Planner.

I cannot stress this enough! It is so easy to lose track of deadlines and due dates when your days seem to run together. Taking a day out of the week to fill out your planner will help you tremendously by allowing you to see what is due when and also how much extra time you’ll have from week to week.
Connect with Classmates.

Remember that during this challenging time, you are not alone! Connect with your classmates and set up virtual study dates. This is a great way to bounce ideas off of each other and to gain a different point of view on concepts of nursing.
Open mindset.

While this is a very trying time for most of us, it is important to remain optimistic. As future nurses, resilience is important, and this is the perfect opportunity to practice that personality trait. We did not ask for this and unfortunately it is the way of the world right now so keeping an open mind and remaining positive is important. Remind yourself of why you want to a nurse and remember that this is only temporary!

How to Cope with Testing Anxiety as a Nursing Student

Written by Kirsten Anderson

As most nursing students know, nursing school exams are not your average exam. It takes mastering a concept and applying that concept to a patient, to get that passing grade. Upon entry, most students don't know that nursing exams are NCLEX based. This means that your old study habits of strictly memorizing flashcards should be thrown out the door. In nursing school, you are learning how to deal with a patient, and that's what your focus should always be on while studying for an exam. Do not worry, once you get the hang of those awkward "action-based" questions, you will rock every test! Until you get used to these intense exams (and even once you do), you will definitely struggle with testing nerves or anxiety. Newsflash, this is totally normal! Testing anxiety is something I have struggled with, even more now that I am in nursing school. But don't fret, I have a few tricks and resources up my sleeve that I use to help get rid of my pre-testing jitters!

Practicing positive pampering is a concept I came across while engrossed in the Saunders 2020-2021 Strategies for Test Success book. This is an idea that is essential for having a healthy academic mindset and easing your skittish testing thoughts. Positive pampering is when a person learns to take care of themselves from a holistic perspective, allowing one to focus on academic and non-academic tasks. This creates a healthy balance, which leads to a clearer mind and an overall, more relaxed mentality. So how might one achieve this so-called "positive pampering," and how will it help reduce testing nerves?

Tip #1: Become Familiar.

The most obvious, yet effective way to get rid of testing anxiety is confidence. Building up confidence by becoming familiar with and understanding your learning objectives is a way to avoid failure and nervousness. The key here is to know when to stop with the academics. Make sure you have explored and found your unique way of retaining information. There are several learning methods and techniques, find one that works best for your learning style! Testing anxiety stems from the fear of failure, so practicing your material and studying in your own way will reduce some of that doubt!

Tip #2: Get your body moving.

Moving your body is a simple way to reduce testing anxiety or even anxiety as a whole. It is always important to get some movement in, especially if you're at a desk all day! The best part about this tip is there is no right or wrong way to do it! From taking a 3-mile jog to a short walk around the block, it gets your mind off school and gets those endorphins flowing! This is a great way to achieve the "non-academic" portion of positive pampering.

Tip #3: Balance Diet.

Not only should your mind be balanced, but your diet should be too! Believe it or not, diet has much to do with mental health. Establishing a healthy and balanced diet is helpful not only when it comes to test-taking, but will also help you long term! Eating lighter, well-balanced meals with complex carbs and proteins are vital when it comes to getting the most out of your meals. Allow food to be your fuel and energy source! That being said, try to avoid caffeine as a primary source of energy because chances are, it will contribute to the jitters and anxiousness when testing time arrives!

Tip #4: Just Relax the Night Before.

The most important tip to remember is this: RELAX. Often students (myself included) study all week for this big exam. Next thing you know, exam day is tomorrow, and everything you know and learned goes out the window and BOOM, anxiety kicks in. You start to doubt your knowledge and worry, which leads to a major cram session the night before the big day. By doing this, you are subconsciously creating that doubt by feeding into your nerves. Put the books away the day before the test and use that day for the ultimate self-care day. Do all of your favorite things, go on a walk, anything but study! At this point, you have already spent time studying and becoming familiar (refer to tip #1) with your materials and are good to go.

You will do great on that next exam and go in with a clearer mind now that you can properly positive pamper!

Good luck to all of my nursing peers. I wish you all the best throughout your programs! I cannot wait to take on the healthcare field together as one!

What to Expect Before Starting Nursing School

Written by Angelys Centeno

Each and every one of us experiences nursing school in a different way. One thing to always keep in mind is that you are about to begin a journey on a life changing career path. One that requires a lot of hard work, dedication, and many sleepless nights.

Before you start your nursing school journey, make sure you know what qualities a nurse must embody. A nurse is an advocate for their patients - meaning you stand up for them at all times. A nurse is caring, loving, and can put all of their personal problems aside to care for someone else. Are you ready to start your journey?

To help get you ready, here’s my survival guide to starting nursing school:

Expect things to be different…

I am currently a senior nursing student and I remember when I first started nursing school. I thought my life would remain the same only with school as an addition to my life. Boy, was I completely wrong. You have to know that nursing school is very demanding, and you must learn how to balance both your personal life and nursing school. So, the takeaway here is to remember that your life will change, because nursing school will become your number one priority.

Learn how to say no…

This is a very important to note. While you’re in nursing school, life outside remains the same. Life does not wait for you - meaning that events and holidays still occur with or without you. You must learn how to say no in times where you should be putting school first. For example: let’s say you have a test next week, but the day before your exam it’s your best friend’s birthday. You have two choices. Either study in advance and attend your friend’s birthday outing, or tell your friend ‘no’ and that you will make it up to them after your exam. The takeaway here is learning how to say no to things that can be a distraction. Remember, nursing school is only for a certain time frame – and it is important to do well so that you can become the best nurse possible.

Put your schoolwork first…

In nursing school, you must learn to put schoolwork first. This is the biggest tip I can give for being successful in your nursing program. Whether in a planner or on your phone, write down all of the things you have to accomplish throughout the week. Study in advance and don’t leave things for the last minute.

Saunders Comprehensive Review for the NCLEX…

I cannot stress enough how useful this book has been to me in nursing school. It has all the information you’ll need from your first semester to your last, and I love that it’s broken down by body system. It also gives you in-depth rationales and test-taking strategies for each practice question to help you be successful on exams. This book will get you used to the types of NCLEX-style questions that you’ll also see on course exams. It also comes with access to online resources and the ability to make custom quizzes using a ton of different filters.

Test-Taking Strategies for Beginners:

Remember your ABCs (Airway, Breathing, Circulation) -> In that order.
READ the test question thoroughly and remember that sometimes the last part of the sentence is really what the question is asking you. Sometimes the first part of the question can be a distraction!
Pay attention to the wording of the question for example “what indicates the patient needs further teaching” or if it says, “what indicates the patient understands the teaching”.
Learn Maslow’s hierarchy of needs!
Use mnemonics. My friends call me the mnemonic queen because I always come up with the funniest/craziest ways to remember things. If it sticks, use it!
Always take notes in class and then go home and type them out or re-write them! I’ve found that studying right after lectures makes thing much easier to remember.
When studying, use the Pomodoro technique.

NCLEX Exam Practice Question of the Week - 8/12/20

A client who is human immunodeficiency virus (HIV)–positive has had a tuberculin skin test (TST). The nurse notes a 7-mm area of induration at the site of the skin test and interprets the result as which finding?

Positive
Negative
Inconclusive
Need for repeat testing

Show answer

Answer: 1

Rationale:
The client with HIV infection is considered to have positive results on tuberculin skin testing with an area of induration larger than 5 mm. The client without HIV is positive with an induration larger than 10 mm. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client. It is possible for the client infected with HIV to have false-negative readings because of the immunosuppression factor. Options 2, 3, and 4 are incorrect interpretations.

Test-Taking Strategy:
Eliminate options 3 and 4 first because they are comparable or alike. From the remaining options, recalling that the client with HIV infection is immunosuppressed will assist in determining the interpretation of the area of induration.

Level of Cognitive Ability:
Analyzing

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process—Analysis

Content Area:
Adult Health—Respiratory

Priority Concepts:
Evidence; Infection

Practice Question Sourced From: Saunders Comp Review, 8e

Mnemonics for Memory

Written by Victoria Basler

It can be extremely overwhelming when you’re trying to remember all of the information nursing school throws at you. At times, it may feel impossible to memorize the action, origin, and insertion of all the muscles in the human body, all signs and symptoms of hypo/hyperglycemia, or the adverse effects of Digoxin. The bottom line is that our brains need help remembering and memorizing these key topics when it comes to nursing. I’ve found that using memory aids and mnemonics helps me remember important information easier. Here are some of my favorites:

When remembering key elements of a patient’s health history assessment I like to use SAMPLE:
- S – Symptoms
- A – Allergies
- M – Medications
- P – Past Medical History
- L – Last Oral Intake
- E – Events leading up to illness or injury
When I need to remember important emergency medications to lean on, I use LEAN:
- L – Lidocaine HCL
- E – Epinephrine
- A – Atropine Sulfate
- N – Naloxone (Narcan)
When I need to remember the signs and symptoms of hypoglycemia and hyperglycemia is use these:
- “Cold and clammy need some candy” – Hypoglycemia
- “High and dry, sugar high” – Hyperglycemia

These are just a few examples of so many memory aids and mnemonics available to nursing students, and they are super helpful when it comes to exams! You can find these memory aids and mnemonics anywhere, but most of them I found in my Elsevier textbooks. If you’re having trouble remembering important information, you can even try coming up with your own memory aid or mnemonic device!

Staying Motivated & Positive While Achieving That BSN Degree!

Written by Kayla Del Mundo

When I was a little girl, I always had trouble keeping up with my work in school. After being depressed about it for a while, I knew I had to change my mentality and become a more driven, positive, and lively person. Nursing school in general is a lot to take in so having a strong and positive outlook towards your journey to be a registered nurse will get you through! Here are some of things that I continue to do each term to ensure that I am motivated and feel positive to continue to achieve this BSN degree!

SET GOALS

Personally, I like to make "term goals". My school term is ten weeks long, and there are plenty of items to check off during this time. You can adjust your goals to however long your semester/quarter is, but I've learned that having smaller goals broken into my term makes it more exciting to achieve. For example, this term with my Public Health rotation, one of my main goals is to average an A for all my exams. Another one could be for clinical where you make it a goal to successfully administer at least two IVs. Whatever it may be, the smallest goals/wins are the best (which transitions into my next point...)

CELEBRATE THE SMALL WINS

If you’re like me, the biggest win you've had so far is getting accepted into nursing school! You are still in your nursing program and CRUSHING it! You want to be able to celebrate the little things that you do. Whether it’s getting a passing score on your exam, killing your validations check offs, or having a really good day at clinicals—GO CELEBRATE! Bring your nursing buddies with you for a bite to eat, a nice drink, or head to Disneyland (this is my favorite celebration after each term).

TAKE BREAKS

I think this is CRUCIAL when it comes to studying your material and just keeping up the motivation to study at all. Your brain and energy levels can only take on so much information at a time - sometimes a break is necessary. I know a lot of my nursing friends would say that time is precious, but a healthy mind is too.

I use the Pomodoro Technique in my study sessions. This technique can also be used outside of school, and improves productivity and efficiency in everything that I do in my daily routine. The Pomodoro Technique has six steps:

Decide on the task to be done.
Set the Pomodoro timer (traditionally to 25 minutes).
Work on the task.
End work when the timer rings and put a checkmark on a piece of paper.
If you have fewer than four checkmarks, take a short break (3–5 minutes), then go to step 2.
After four pomodoros, take a longer break (15–30 minutes), reset your checkmark count to zero, then go to step 1.

POSITIVE AFFIRMATIONS

If you were to only take one thing away from this blog post, please make it this... Positive affirmations have gotten me through some of the roughest, toughest, and most rewarding situations in my time during nursing school. Putting things out in the universe gives a sense of hope in the goal that you strive to accomplish. Examples of positive affirmations that I always tell myself are that "I will be a Labor & Delivery Nurse", "I am good enough to be in nursing school.", "I can accomplish anything I put my mind into." Anything that says that you are, can, and will be is a possible affirmation. I recommend writing these on sticky notes, or even on a bathroom mirror, somewhere you can see them every day as you work toward your reality.

NCLEX Exam Practice Question of the Week - 8/5/20

What information should be included in a discussion about type 1 diabetes mellitus? Select all that apply.

It can trigger protein catabolism
It can be triggered by pregnancy
It is believed to have a genetic risk factor
It ultimately results in the starvation of cells

Show answer

Answer: 1, 3, 4, 5

Rationale:
(1) Type 1 diabetes causes protein catabolism when there is no longer enough glucose to utilize. (3) Type 1 diabetes is believed to be create a genetic susceptibility passed from generation to generation. (4) Type 1 diabetes leads to hyperglycemia, and the cells begin to starve. (5) Type 1 diabetes causes the production of antibodies that destroythe beta cells in the pancreas. (2) Gestational diabetes is triggered by the stressors of pregnancy.

Client Need:
Physiological Adaptation

Cognitive Level:
Understanding

Integrated Process
Teaching and Learning

Practice Question Sourced From: Nursing Key Topics Review: Pathophysiology

NCLEX Exam Practice Question of the Week - 7/29/20

A malfunctioning posterior pituitary gland would affect which hormones? Select all that apply.

Oxytocin
Glucagon
Corticotropin
Parathormone
Anti-diuretic hormone

Show answer

Answer: 1 and 5

Rationale:
1) Posterior pituitary hormones include oxytocin. (5) Posterior pituitary hormones include anti-diuretic hormone. (2) Glucagon is a pancreatic hormone. (3) Corticotropin is an anterior pituitary gland hormone. (4) Parathormone is a parathyroid hormone.

Client Need:
Physiological Adaptation

Cognitive Level:
Understanding

Integrated Process:
Teaching and Learning

Practice Question Sourced From: Nursing Key Topics Review: Pathophysiology

NCLEX Exam Practice Question of the Week - 7/22/20

The nurse is caring for a client who has a fever and is diaphoretic. The nurse monitors the client’s intake and output and expects to note which finding?

The client’s urine is diluted
The client’s output is decreased
The client’s urine production is increased
The client’s majority of fluid loss is through the skin

Show answer

Answer: 2

Rationale:
Febrile conditions affect urine production. The client who is diaphoretic loses fluids through insensible water loss, which decreases urine production. However, the increased body temperature associated with fever increases accumulation of body wastes. Although urine volume may be reduced, it is highly concentrated. Some fluid (not the majority) will be lost through the skin.

Test-Taking Strategy:
Focus on the subject, care of the client experiencing a fever and diaphoresis. Think about the physiological response of the body to fever and diaphoresis. This will direct you to the correct option. Also remember that although some fluid is lost through the skin, the majority of fluid loss is not lost through this system. Review: Conditions that affect fluid imbalance.

Level of Cognitive Ability:
Applying

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process/Assessment/Data Collection

Content Area:
Foundations of Care

Priority Concepts:
Fluids and Electrolytes; Thermoregulation

Level of Nursing Student:
Beginning

Practice Question Sourced From: Saunders Strategies for Test Success, 6e

How To Make the Most of Your Time in Nursing School: While Building Your Resume in The Process

Written by Brandon Thompson

As we all know, nursing school requires time, dedication, and commitment. We spend hours away from our friends and family because we are either studying for an exam, writing a paper, completing EAQs or; catching up on assigned readings, practicing for skills check off, and catching up on more reading… (the list continues until the end of the semester).

On most days, before the COVID-19 outbreak, we are on campus for lectures, didactics, study sessions, and clinical sites. This valuable time spent away from our families is used to cultivate a professional relationship with our collogues, instructors, and various members of the healthcare team. This relationship creates the opportunity to form future references which is very important when job searching. Your time in nursing school should have meaning that makes you a better person both professionally and personally.

Here are a few ideas on how to make the most of your time in nursing school:

Building Relationships with Faculty

My professor once told me that I am accountable for my education, which is very true. You need to show initiative when it comes to nursing school. Go to office hours, ask questions, explain to faculty your ideas about the program – like what can be better, or changed. Form a student group and involve your instructors.

In an example, here is what I did this past semester:
I had noticed that during didactics, my peers and I struggled to remember what was practiced during class time. Most of us had different understandings of how to perform some of the skills and conflicting information was being shared. We had eight instructors for didactics, and we always receive eight different explanations for one concept. To help solve this issue, I initiated a 15 minute round table discussion at the end of every class where students and faculty discuss what was learned during that day, what skills were not understood, and address any questions that remain. Taking initiative like this shows leadership skills, your ability to think critically, and to maybe even be a future charge nurse.
Volunteering

Ideally, you want to volunteer in some healthcare capacity, but any volunteer opportunity is great – especially once doing what you’re passionate about. This is a great way to not only show off your various skill sets, but to learn the different scopes of practice in each profession. Make sure to add this to your resume and always put your best foot forward. A job or a recommendation might come out of this.
Shadowing

Shadowing is similar to volunteering, but also very different. To shadow an MD, RT, RN, PT etc., you have to be the initiator. You must put yourself out there to land a shadowing gig. Your academic performance, your nursing skills competence, your past experiences, and a solid recommendation from your faculty or your volunteer project will aid in your shadowing opportunities. See how these aspects build on each other? Because of my clinical presence, my care plan writing, my ability to ask questions when in clinical, and willingness to observe new procedures when on a unit; I was offered to shadow a PICU RN (my clinical instructor) anytime I wanted to. This is how you build relationships with members of the team. Yes, we are students, but we are held to the standards of an actual nurse when on clinical.
Clinical Presence

Never show up to clinical unprepared. Read up on your patient’s conditions the night before. Become familiar with the labs and medication your patient is on. You are a rock star when you show up to clinical prepared with questions and knowledge about your patient. Ask questions about why your patient is on a certain medication. Be engaging in your reflection session and during shift change. Your SBAR as a student nurse is a tool that helps to show not only your communication skills, but your competency as a nurse. Always have a solid recommendation in your SBAR. Your nursing peers on the unit will develop a level of respect for you and will probably request you as their student nurse. Last semester, I was unsure if I heard course crackles on my patient when auscultating the lungs. For my SBAR, I recommended that the nurse verify lung sounds because I was unsure. The same thing happened when I thought I heard Mitral Valve Regurgitation. L1 nurses, for my program, falls within a certain scope. It was not within my scope to diagnose regurgitation, so I recommended the nurse or MD take a listen.
Hobbies

If you are not working, spend your “free” time in nursing school doing hobbies that you love. Create an image outside of your professional image. Personally, I’m a beekeeper. I also have two 30-foot herb gardens, I tutor middle schoolers who are interest in STEM, and I hike. That is how I spend my “free” time. These activities add to my resume and show that I have other interests outside of nursing. You become relatable to your patients and you can share stories about hiking with a patient who is anxious. Basically, add it to your arsenal when partaking in therapeutic communication.

At the end of the day, your time is your time; what you do with it is up to you. But I believe nursing school is a growing experience. Once we’re out, we are a new person.

Overcoming Challenges in Nursing School

Written by Benjamin Ordaz

Nursing school is truly an amazing journey. You learn what interests you the most in the medical field, you gain a vast amount of knowledge in health care, and it pushes you. It pushes you to be a better person and health care professional. In some aspects of nursing school, it becomes a challenge and sometimes we feel a sense of resistance when we try to move forward. I am going to provide you with four tips to help you minimize and overcome those challenges that arise in nursing school.

Time Management: This is a crucial skill to master during nursing school. Everyone has something going on in their life such as work, fitness, religious obligations, school, family, and children. It benefits you to understand what tasks you must complete for the hour, the day, or the week. Allot a specific amount of time to each task you have. For example, I will go to school for four hours, then gym for one hour, study for two hours, and then have some free time for one hour.
Prioritize: Look at what tasks you have at hand and figure out which one should be done first. Understand what is non-urgent, urgent and emergent. The beauty of knowing how to prioritize is it make us more productive with our work which develops a strong work ethic. Aside from prioritizing your work, do not forget to prioritize yourself. It comes off selfish, but you must take care of yourself before you take care of others. It is like being on an airplane and when the oxygen masks come down, you must put it on yourself first before putting it on someone else who cannot. Make sure you are receiving adequate sleep, minimizing consumption of malnutrition food, and staying active!
Organize: In nursing school, there are going to be so many dates for when assignments are due, projects are due, and when exams are. Having all these dates and assignments recorded in an organized fashion allows you to stay on top of everything. There is a sense of being in control when this is accomplished, and you become more confident with what needs to be done. There won’t be any last-minute incidents where you realize you didn’t do an assignment or missed that online quiz that was due last night. Overall, being organized improves student outcomes and reduces unnecessary stress. Utilize calendars, planners, and various phone apps to assist you in staying organized.
Positive Attitude: Although nursing school can be stressful at times and you may feel overwhelmed, always maintain a positive attitude! If you are in a nursing program, you are in a great position in life because there are people who would love to be in a nursing program who are not. Don’t look at nursing school as, “There’s so much studying”, but rather, “I have multiple opportunities to learn so I can become a competent nurse”. Additionally, do not forget why you are in nursing school. You went to nursing school to become a nurse so please don’t let grades negatively affect you. Striving for A’s on exams is the goal, however, it is not the end of the world if you do not get an A. If the minimum to pass is 70% and you get 71%, congratulations, you have exceeded the school's standard. In my opinion, there is no test in nursing school that will define your capabilities as a clinical nurse. I have worked in the medical field for five years and I have NEVER had any patient ask me what my grades are. Grades are a number at the end of the day. Your GPA will not be on your RN license. The impact you make on your patient is what matters. Your knowledge on patient safety is what matters. Your patient advocacy is what matters. Comforting those in need and in a vulnerable state is what matters. Do not forget the purpose of nursing school. It's to be a phenomenal and competent nurse, not to have the highest grades.

Using these tips has helped me to be successful in nursing school, and I hope they do the same for you! You control nursing school; nursing school does NOT control you.

Effective Time Management for the Chronic Procrastinator

Written by Yu Liang

It’s the night before an exam and you’re cramming. Again. Last exam, you said that you wouldn’t procrastinate anymore, just like when you said that for the previous one. This used to be me. It worked when I was in high school, but in nursing school… My GPA is a reminder that cramming does not work. Not only is this ineffective because no information is being retained, but I was also setting myself up for unnecessary stress and anxiety that could’ve been prevented. I went into every exam feeling groggy and unprepared. I’d tell myself, “I don’t have time to read the textbook”, or “I’m too busy to study today”. But the truth is, you do have time. You just don’t know how to manage it effectively. Here are some tips to keep yourself from procrastinating:

Put everything on the calendar of your phone. I am a huge fan of cute planners, and I buy myself one every year, but always end up never touching it again after a few months or misplacing it. I’ve switched over to using my phone’s calendar app and it’s a life changer. The day my professors upload their syllabi, I put in every exam and assignment I have due, including the chapters associated with that exam. I’ve set it so that I get an automatic reminder two days before an exam or assignment is due, an hour before clinicals start, and 30 minutes before class. I have never missed an assignment because I’m always being reminded, and since I bring my phone everywhere, there’s no way I’d forget.
Set fake deadlines for yourself. You know that feeling you get when you realize you’ve procrastinated an assignment until the very last minute and you suddenly find yourself exhibiting symptoms of tachycardia and pyrexia? Manipulate it to your advantage by setting deadlines earlier than they actually are. When you see that deadline coming up, it tricks your brain into thinking you’ve procrastinated as much as you possibly could have, and now you’re forced to start. I’m a firm believer that the end to procrastination begins with starting. I find that this tip works best for assignments rather than for exams.
Limit your time on social media. Key word here is limit. I am guilty of spending way too much time on social media. I used to be on my phone upwards of five hours a day, and most of that wasn’t productive. Remove distractions, especially when you’re studying, and you’ll find that you have a lot more time in your day. Use this extra time to study, hang out with friends and family, or pamper yourself—because self-care and finding balance is important. Remember, everything in moderation.
Multitask. I used to spend two hours commuting to clinicals, and what did I do on the train? Waste my time playing Candy Crush and listening to music. Now, on my long commutes, I’ll download and listen to voice threads posted by my professor or listen to a nursing podcast. Usually I’ll look for something related to the content in class. Don’t have a long commute? Listen while you’re cooking, in the shower, working out, or even during your morning and nighttime skincare routine. It doesn’t matter if you’re not fully grasping the concepts, but it’s great to be exposed to some of the jargon before you attend the lecture for it.
Wake up earlier. There can be more hours in the day, if you sleep less. On days when you have an early lecture, there’s no getting past early mornings. But on your free days, do you find yourself waking up mid-afternoon and feeling like your whole day has been wasted already? I wake up every day, yes every day, at 6 a.m. and commit to the same routine of getting ready, studying for 30 minutes, and then leaving for class/work/clinical. Now I won’t lie to you—waking up at 6 a.m. on a Sunday was absolutely dreadful when I first began this, but since my circadian rhythm has reset it’s become a lot easier. Waking up early (with the help of coffee) starts my day on a positive note and gives me motivation to do work. It’s also good practice for the long run when we’re doing 12-hour shifts as nurses!
Change your mentality. Stop thinking of studying as such a dreadful task. I’ve found that if I read the textbook for pleasure, and not for the purpose of memorization, it’s actually a pretty interesting read. You need to rewire your brain to think of reading the textbook as a leisure activity and not a homework assignment. Perception is everything. Think of doing practice problems as a game to mentally challenge yourself; or even better, turn it into an actual game with your friends. You got into nursing because you were passionate about science and learning. Channel that energy when you’re studying!

Implementing these habits made me better at managing my time. I’m no longer scrambling to submit assignments before 11:59 p.m. I’m walking into exams feeling confident. Most importantly, I’m a lot happier and less stressed out. These tips helped me turn into a better student, and hopefully they’ll help you as well!

NCLEX Exam Practice Question of the Week - 7/15/20

A client is being admitted to the neurological unit from the emergency department with a diagnosis of a cervical (C4) spinal cord injury. Which action should the nurse take first when admitting the client to the nursing unit?

Listen to breath sounds
Check peripheral pulses
Check for muscle flaccidity
Determine extremity muscle strength

Show answer

Answer: 1

Rationale:
Because compromise of respiration is a leading cause of death in cervical cord injury, collecting data on the respiratory system is the highest priority. Checking the peripheral pulses and muscle strength can be done after adequate oxygenation is ensured.

Test-Taking Strategy:
Note the strategic word, first. Eliminate options 3 and 4 first because they are comparable or alike. Next use the ABCs—airway, breathing, and circulation—to direct you to the correct option. Remember that a cord injury, particularly at the level of C4, can affect respiratory status. Breath sounds will be diminished if respiratory muscles are weakened or paralyzed. Review: Priority care of the client with a C4 spinal cord injury.

Tip for the Nursing Student:
A spinal cord injury is caused by a traumatic disruption of the spinal cord occurring from a car crash or another type of violent impact. It is often associated with extensive musculoskeletal injury. Where the injury occurred in the spinal cord (level of injury) determines the effect on the client. A major concern with a cervical spinal cord injury is respiratory status.

Level of Cognitive Ability:
Analyzing

Client Needs:
Physiological Integrity

Integrated Process:
Nursing Process/Assessment/Data Collection

Content Area:
Delegating/Prioritizing

Priority Concepts:
Clinical Judgment; Safety

Level of Nursing Student:
Advanced

Practice Question Sourced From: Saunders Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 7/8/20

A client tells the nurse that she is really worried about knowing how to care for her firstborn child. The nurse should identify which priority problem for this client?

Inability to cope
Lack of knowledge
Ineffective grieving
Lowered self-esteem

Show answer

Answer: 2

Rationale:
Lack of knowledge indicates a lack of information or psychomotor ability concerning a skill, condition, or treatment. This problem best describes the situation presented in the question. Inability to cope implies that the person is unable to manage stressors adequately. Ineffective grieving implies prolonged unresolved grief leading to detrimental activities. Lowered self-esteem represents temporary negative feelings about self in response to an event.

Test-Taking Strategy:
Note the strategic word, priority. When a question asks to identify a priority client problem, focus on the data in the question. Option 2 will focus on the mother’s concern about knowing how to care for her firstborn child. Review: Psychosocial concerns of a new mother.

Tip for the Nursing Student:
Teaching is an important nursing responsibility. It is common for a new mother to be concerned about how to care for her newborn. The nurse needs to alleviate fears and concerns by providing the mother with opportunities to care for the newborn after delivery while hospitalized.

Level of Cognitive Ability:
Analyzing

Client Needs:
Health Promotion and Maintenance

Integrated Process:
Nursing Process/Assessment/Data Collection

Content Area:
Maternity

Priority Concepts:
Anxiety; Family Dynamics

Level of Nursing Student:
Intermediate

Practice Question Sourced From: Saunders Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 7/1/20

When considering client safety, which statements should the nurse stress most when discussing medication instructions with a client who has been recently prescribed a hypnotic sedative?

“I need to share with you the signs and symptoms of drug tolerance.”
“This medication will affect your rapid eye movement (REM) sleep.”
“This medication has more effect on sleep than sedatives do.”
“A barbiturate is a type of sedative-hypnotic.”

Show answer

Answer: 1

Rationale:
Tolerance to the sedative and hypnotic effects develops eventually with all these drugs, although it develops more slowly with the benzodiazepines than other drugs; tolerance can contribute to self-medication and dosage escalation. (2) While Although REM sleep may be affected, it is not a safety concern. (3) Although while it is true that hypnotic sedatives have more effect on sleep than sedative, it is not a safety concern. (4) Although Iit is true that barbiturates are a form of sedative-hypnotics, this statement doesn’t address a safety issue.

Client Need:
Pharmacological and Parenteral Therapies
Cognitive Level:
Analysis

Integrated Process:
Teaching/Learning

Nursing Process:
Planning/Implementation

Practice Question Sourced From: Nursing Key Topics Review: Pharmacology

NCLEX Exam Practice Question of the Week - 6/24/20

What medication should the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines?

Lithium
Flumazenil
Methadone
Chlorpromazine

Show answer

Answer: 2

Rationale:
Flumazenil (Romazicon) is the drug of choice in the management of overdose when a benzodiazepine is the only agent ingested by a client not at risk for seizure activity. This medication competitively inhibits activity at benzodiazepine recognition sites on GABA/benzodiazepine receptor complexes. (1) Lithium is used in the treatment of mood disorders. (3) Methadone is used for narcotic addiction withdrawal. (4) Chlorpromazine is contraindicated in the presence of central nervous system depressants.

Client Need:
Pharmacological and Parenteral Therapies

Cognitive Level:
Comprehension

Nursing Process:
Planning/Implementation

Practice Question Sourced From: Nursing Key Topics Review: Pharmacology

NCLEX Exam Practice Question of the Week - 6/17/20

The home care nurse visits an older client who has hyperparathyroidism with severe osteoporosis. The nurse identifies which client problem in the plan of care as the priority for this client?

Social isolation
Risk for loneliness
Susceptibility to injury
Possible low self-esteem due to deformities

Show answer

Answer: 3

Rationale:
The individual with hyperparathyroidism with severe osteoporosis is at risk for pathological fractures because of bone demineralization (option 3). Thus, home safety is a priority. No data in the question indicate that options 1, 2, and 4 are of concern.

Tip for the Nursing Student:
Hyperparathyroidism is an endocrine disorder characterized by excessive secretion of parathyroid hormone from the parathyroid glands. Osteoporosis is characterized by abnormal loss of bone density and deterioration of bone tissue. This disorder places the client at risk for bone fractures. Adequate calcium intake is an important intervention to prevent and treat the disorder. You will learn about hyperparathyroidism and osteoporosis in your medical-surgical nursing course when you study endocrine and musculoskeletal disorders.

Test-taking Strategy:
Focus on the client's diagnosis, and note the strategic word priority. Use Maslow's Hierarchy of Needs theory. Recall that if a physiological need is not identified in one of the options, then safety is the priority. Note that options 1, 2, and 4 are comparable or alike in that they address a psychosocial need.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 6/10/20

The nurse is preparing to assist a primary health care provider in performing a liver biopsy. The nurse should assist the client to which best position for this test to be performed?

Right Sims
Right lateral side-lying
Supine with the right hand under the head
Prone with the hands crossed under the head

Show answer

Answer: 3

Rationale:
The supine position is assumed with the right hand placed under the head for a liver biopsy. The client also is asked to remain as still as possible during the test. Options 1, 2, and 4 are incorrect because the primary health care provider would not be able to access the liver.

Tip for the Nursing Student:
A biopsy is a surgical procedure that involves removing tissue from a part of the body, such as an organ for microscopic diagnostic examination. A liver biopsy involves removing a piece of tissue from the liver. Positioning for the procedure is based on the anatomical location of the area where the biopsy needs to be performed. For a liver biopsy, the most optimal position is supine (lying flat on the back) with the right hand under the head because it allows easy access to the liver. You will learn about the procedure for performing a liver biopsy in your medical-surgical nursing course when you study gastrointestinal disorders.

Test-taking Strategy:
Note the strategic word best. Think about the anatomical location of the liver. Recalling that the liver is located on the right side will direct you to option 3.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 6/3/20

A client has been taking omeprazole for 1 month. The clinic nurse evaluates medication effectiveness by asking the client if relief was obtained from which symptom?

Diarrhea
Heartburn
Flatulence
Constipation

Show answer

Answer: 2

Rationale:
Omeprazole is a gastric acid pump inhibitor and is classified as an antiulcer agent. The medication relieves pain from gastric irritation, which is often referred to as heartburn by clients. The medication does not relieve the symptoms identified in options 1, 3, and 4.

Tip for the Nursing Student:
Heartburn, also known as pyrosis, is a substernal pain or burning sensation that is usually associated with regurgitation of acid and peptic gastric juice into the esophagus. Omeprazole works by increasing the gastric pH and reducing gastric acid production. You will learn about heartburn and omeprazole in your medical-surgical nursing course when you study gastrointestinal disorders and in your pharmacology course.

Test-taking Strategy:
Note the subject, the action of omeprazole, and the strategic word effectiveness. Focus on the name of the medication. Recalling that most medication names that end with the letters -zole are gastric acid pump inhibitors will direct you to option 2.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e

Building Confidence in Nursing School

Written by Tahmina Naseri

For me, having self-confidence means you can pass your exams and achieve great outcomes in nursing school. You can also gain high confidence when you put the time and effort into learning, studying, and practicing.

After you put the time and effort in, it is good not to doubt yourself. Always go with your instincts and believe in yourself. You should strive to have confidence in your answers and your knowledge. Don’t doubt your correct answers and overthink and change the answer.

Having good confidence in my knowledge and test-taking abilities has improved my grades in nursing school. I have been using Saunders Comprehensive Review for the NCLEX-RN® Examination to do practice questions. I complete practice questions in the book every week, and review all of them before the exam.

Doing practice questions has helped me gain confidence in my knowledge because it helps me understand what I know and what I am struggling with. I make sure to read the rationale for the right and wrong choices for every question. This helps me understand how to critically think about different concepts and increases my confidence in my critical thinking abilities.

It is also important to continue to take your confidence with you to the clinical setting. In the clinical environment, it is essential to have confidence in your patient care and critical thinking. This can help save a life.

Confidence does not mean knowing everything — it means that you are able to ask questions and ask for help when needed. It is important to believe in your knowledge and have confidence in yourself. This will help improve your critical thinking and patient care.

NCLEX Exam Practice Question of the Week - 5/27/20

Following the delivery of an infant, the nurse assists to perform an initial assessment and determines that the Apgar score is 9. What does this score indicate about the infant?

The infant requires vigorous resuscitation.
The infant is adjusting well to extrauterine life.
The infant requires some resuscitative intervention.
The infant is having difficulty adjusting to extrauterine life.

Show answer

Answer: 2

Rationale:
One of the earliest indicators of successful adaptation of the newborn infant is the Apgar score. Scoring ranges from 0 to 10. A score of 8 to 10 indicates that the infant is adjusting well to extrauterine life. A score of 5 to 7 often indicates an infant who requires some resuscitative intervention. Scores of less than 5 indicate infants who are having difficulty adjusting to extrauterine life and require vigorous resuscitation.

Tip for the Nursing Student:
The Apgar score is given after evaluation of a newborn's physical condition at 1 minute and 5 minutes after birth. The system was developed by Dr. Virginia Apgar and is a means to rapidly identify newborns requiring immediate intervention to sustain life. Five factors are rated in this scoring system: heart rate, respiratory effort, muscle tone, reflex irritability, and color. You will learn about the Apgar scoring system in your maternity and newborn nursing course.

Test-taking Strategy:
Recall that the Apgar score ranging from 8-10 indicates fetal well-being. Noting that the question addresses a score of 9 will direct you to the correct option. Eliminate options 1, 3, and 4 as they are comparable or alike.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e

Heading North for Nursing School: My Canadian Experience

Written by Breagh Fitzgerald

Born in Boston and raised in a small town south of the city, I always assumed my love for Massachusetts would keep me in my home state for my college years. However, when I was applying to nursing programs, I decided to look at every available opportunity. As a dual citizen of both Canada and the United States, I had a wide range of options I could explore.

As a university student with three years of biological sciences under my belt and no degree at the time, Canadian schools became more attractive. Most advanced nursing programs in the U.S. require students to have an undergraduate degree, while some Canadian programs do not.

My school search led me to Cape Breton University (CBU), located on the small island of Cape Breton Island. This was the clear choice for me as they offer three programs for students looking to become an RN: three-year direct entry from high school, a two-year advanced Standing Pathway, and an LPN-to-BScN Pathway. The two-year advanced option really appealed to me because, with nursing being my passion, I wanted to immediately start chasing my dreams.

An important factor when deciding on a Canadian nursing school was the NCLEX® officially being offered in Canada. With this expansion, I could receive my NCLEX-oriented education in Canada and have the option to work in both countries.

With the NCLEX implemented in Canada in 2015, CBU’s nursing education faculty knew they needed to start adapting their learning plan to the NCLEX requirements. Elsevier, a global information analytics company specializing in science and health, had the resources CBU was looking for and the partnership began.

After the first year of using Elsevier resources, CBU students produced a passing rate of 92% on their first NCLEX exam, with the national average, according to the Canadian Council of Registered Nurse Regulators, being just 69.7% for first-time test takers. If that doesn’t make a nursing student jump for joy, I don’t know what would!

I am currently in my second semester of the program and am already preparing to attend my second clinical rotation on a cardiac medical-surgical floor. As I continue my education at Cape Breton University, I am constantly receiving affirmation for my decision in choosing this school. CBU, along with the partnership with Elsevier, has designed their semesters to optimize student success. I am excited to see where my nursing career will take me and I am grateful to be surrounded by the resources I need to build the foundation to become a great nurse.

NCLEX Exam Practice Question of the Week - 5/20/20

What is the best nursing action when the client gives information that is pertinent to care?

Share this information with the nurses and physicians on the nursing unit.
Share this information with those needing to know for planning client care.
Write the information in the chart only.
Share this information only with other nurses on the nursing unit.

Show answer

Answer: 2

Rationale:
Conversation is confidential. It is covered under invasion of privacy, which states that the client has the constitutional right to be free from undesired publicity and exposure to public view. The information should be shared with health care providers who need to know to determine and/or provide appropriate health care

Practice Question Sourced From: Zerwekh: Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition

NCLEX Exam Practice Question of the Week - 5/13/20

Which nursing interventions will assist in reducing pressure points that may lead to pressure ulcers? Select all that apply.

Position the client directly on the trochanter when side-lying.
Avoid the use of donut-type devices.
Massage the bony prominences.
Elevate the head of the bed no more than 30 degrees when possible.
When the client is side-lying, use the
Avoid uninterrupted sitting in any chair or wheelchair.

Show answer

Answer: 2, 4, 5, 6

Rationale:
Elevating the head of the bed to 30 degrees or less will decrease the chance of pressure ulcer development from shearing forces. When placing the client in a side-lying position, use the 30-degree lateral inclined position. Do not place the client directly on the trochanter, which can create pressure over the bony prominence. Avoid the use of donut-shaped cushions because they reduce blood supply to the area, which can lead to extension of the area of ischemia. Bony prominences should not be massaged, because this increases the risk for capillary breakage and injury to underlying tissue, leading to pressure ulcer formation.

Practice Question Sourced From: Zerwekh: Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition

I Will Survive! Surviving Your First Clinical

Written by Ariana Speight

It’s the night before your first day of clinical. You can’t sleep because you’re thinking of every possible bad outcome that could happen to your patient. You can’t stop thinking about how you will mess something up. You get to clinical in the morning and it is not as bad as you think. The patient you are assigned to is very kind and the day ends up being great. I am sure every nursing student is familiar with this feeling and experience. As a nursing student who has completed two semesters of clinicals, here are some tips that helped me survive and excel in my first clinicals and beyond.

Get everything you need ready the night or morning before clinical.

If you set everything up and make it easy for yourself to grab everything and go, you will not be stressed about forgetting something or packing something you may not need. For every clinical, I have a small notebook and pen to write down reminders for my patient tasks, vitals that I need to chart, and anything that my nurse may tell me throughout the shift. Just remember to not write down any patient identifiers! Second, I always have my stethoscope; it is a necessity! I suggest an MDF® or Littman® for school, I have an MDF and I love it! Next, be sure to always have a watch. I use a scrub watch that I attach to my scrub top because I have a personal preference of not having anything on my wrists to avoid getting it wet or keeping germs around. You will use your watch for tracking medication administration times, glucometers, vitals, and SO much more. I also keep my penlight with me for vitals and anything else you may need it for. Since you will be washing your hands a lot, it is important to keep some unscented hand lotion with you to keep your hands moisturized. Sometimes this is not a necessity because hospitals provide their own hand lotion for you to use. Depending on your shift, be sure to pack lunch or dinner. Pack foods that will give you energy and keep your mind and body fueled for the shift. Make sure to pack and drink LOTS of water. You need to stay hydrated so you can be your best for the patients. Last thing is compression socks. If you have long 8+ hour shifts, these come in handy. If you pack all these items and keep them in a neat place and ready to grab before clinical, you will be all set!
Don’t be afraid to ask questions or ask for help.

You do not know everything and will, of course, need help or clarification. Do not think you are being a burden by asking your clinical instructor or registered nurse a question. They were in your shoes before and should understand. You may have nurses on the unit that are irritated or unwilling to help, so I would just approach them politely, but do not hesitate to ask questions. You are in the hospital to learn and become the best nurse possible. This is a cliché, but no question is a dumb question! Take advantage of the learning experience in the hospital and the opportunity to see RNs do what you will be doing in just a few years.
Be humble.

It is so important to be humble in clinical. Admit when you don’t know how to do something or don’t know the right answer. The last thing you want is to make a medical mistake because you did not admit that you couldn’t complete a task properly. It is better to get a nurse to demonstrate the skill before you perform it to be sure how to execute it properly.
Relax and enjoy the experience to learn.

Last but not least, just relax! You are a nursing student in clinical to learn. No one expects you to know everything and be able to complete every task on your own. That is the joy of nursing school! You are there to grow and take advantage of the opportunity to learn new skills in a hospital setting. Enjoy the amazing chance you get to preview your future profession in nursing.

From my first day of clinical, I was reassured that this profession is what I want to do. Nursing is such a rewarding field because we get to care for people at their most vulnerable moments in life. That is a great role, and we get the incredible opportunity to provide care for our patients. I hope these tips help you get through clinical. We got this!

NCLEX Exam Practice Question of the Week - 5/6/20

During the shift hand-off report, the nurse learns that one of the assigned clients is in first-degree heart block. What is a nursing measure to assess the status of this dysrhythmia?

Count the radial pulse for 1 full minute.
Determine the cardiac rate at the point of maximum impulse (PMI).
Evaluate an electrocardiogram (ECG) or monitor strip.
Take hourly pulse checks and correlate with blood pressure.

Show answer

Answer: 3

Rationale:
First-degree heart block can be evaluated only with an ECG or monitor tracing because the distinguishing factor is a prolonged P-R interval; all beats are being conducted. Other options are appropriate (determine cardiac rate, counting radial pulse for a full minute, and hourly pulse checks with blood pressure assessment) for this client; however, they do not assess first-degree block

Practice Question Sourced From: Zerwekh: Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition

NCLEX Exam Practice Question of the Week - 4/29/20

During a procedure, which protective item should be worn to minimize the risk associated with the splattering of body fluids into the nose and mouth?

Cap
Mask
Gown
Goggles

Show answer

Answer: 2

Rationale:
A mask would offer full protection of the nose and mouth. A cap would protect the nurse's hair. A gown would protect the nurse's uniform. Goggles would protect the eyes from getting injured.

Tip:
Wear masks, eye protection, or face shields if client care activities may generate splashes or sprays of blood or body fluid.

Strategy:
Focus on the subject, avoiding body fluid splattering near the nose and mouth. The only item that would protect these areas is a mask.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7th Edition

NCLEX Exam Practice Question of the Week - 4/22/20

A client is admitted to the hospital with a diagnosis of right lower lobe pneumonia. The nurse auscultates the right lower lobe, expecting to note which type of breath sounds?

Absent
Vesicular
Bronchial
Bronchovesicular

Show answer

Answer: 3

Rationale:
Bronchial sounds are normally heard over the trachea. The client with pneumonia will have bronchial breath sounds over area(s) of consolidation because the consolidated tissue carries bronchial sounds to the peripheral lung fields. The client may also have crackles in the affected area resulting from fluid in the interstitium and alveoli. Absent breath sounds are not likely to occur unless a serious complication of the pneumonia occurs. Vesicular sounds are normally heard over the lesser bronchi, bronchioles, and lobes. Bronchovesicular sounds are normally heard over the main bronchi.

Tip:
Pneumonia can be community acquired or hospital acquired. The sputum culture identifies organisms that may be present and assists in determining appropriate treatment.

Strategy:
Focus on the subject, breath sounds in a client with lower lobe pneumonia. Recalling that vesicular breath sounds are normal in the lung periphery and bronchovesicular sounds are normally heard over the main bronchi helps eliminate options 2 and 4. From the remaining options, recall that pneumonia transmits bronchial breath sounds, so they are heard over the area of consolidation.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7th Edition

NCLEX Exam Practice Question of the Week - 4/15/20

The nurse is caring for a hospitalized adolescent who is on respiratory isolation precautions. The nurse is preparing a plan of care and provides the adolescent with which appropriate age-related activity?

A puzzle
Finger paints
A computer iPad
Drawing materials

Show answer

Answer: 3

Rationale:
Age-related activities for adolescents include sports, videos, movies, reading, parties, hobbies, a computer iPad, and experimenting with makeup and hairstyles. The remaining options are most appropriate for the preschooler.

Tip:
Isolation precautions should be implemented for a hospitalized child with an upper respiratory infection until the cause of the infection is known.

Strategy:
Focus on the subject, an age appropriate activity for an adolescent. Note the age of the child, and think about the age-related activity that would be most appropriate. Note that options 1, 2, and 4 are comparable or alike in that they identify activities that are most appropriate for the preschooler.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7th Edition

NCLEX Exam Practice Question of the Week - 4/8/20

The nurse is monitoring an older client admitted with a diagnosis of urosepsis. The nurse should notify the health care provider of suspected shock based on which assessment finding?

Hypoventilation
Worsening confusion
Increased awareness
Increased urine output

Show answer

Answer: 2

Rationale:
Septic shock is a systemic inflammatory response to a suspected infection. Clinical manifestations include respiratory failure, hyperventilation, tissue hypoxia, altered neurological status such as decreased awareness and confusion, decreased urine output, and gastrointestinal dysfunction.

Tip:
The client with septic shock may need to be intubated and on a mechanical ventilator to sustain life.

Strategy:
Focus on the subject, septic shock. Recalling the pathophysiological processes that occur in septic shock will assist you in eliminating hypoventilation, increased awareness, and increased urine output.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7th Edition

NCLEX Exam Practice Question of the Week - 4/1/20

A maternity nursing instructor asks a nursing student to identify the hormones that are produced by the ovaries. The student responds correctly by identifying which hormones? Select all that apply.

Oxytocin
Estrogen
Progesterone
Luteinizing hormone (LH)
Follicle-stimulating hormone (FSH)

Show answer

Answer: 2,3

Rationale:
The ovaries are the endocrine glands that produce estrogen and progesterone. Oxytocin is produced by the posterior pituitary gland and stimulates the uterus to produce contractions during labor. The follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are produced by the anterior pituitary gland.

Tip:
Breast tenderness is caused by increased levels of estrogen and progesterone, which is a common occurrence during pregnancy. The nurse can instruct the client to relieve discomfort by wearing a supportive bra and avoiding the use of soap on the nipple and areolar area in order to prevent drying and cracking.

Strategy:
Focus on the subject, hormone physiology. Use knowledge regarding the anatomy and physiology of the reproductive system and the hormones produced by the ovaries to answer this question. Remember that the ovaries produce estrogen and progesterone.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7th Edition

NCLEX Exam Practice Question of the Week - 3/25/20

The nurse is preparing to administer an MMR (measles, mumps, and rubella) vaccine to a 15-month-old child. Before administering the vaccine, which question should the nurse ask the mother of the child?

Has the child had any sore throats?
Has the child been eating properly?
Is the child allergic to any antibiotics?
Has the child been exposed to any infections?

Show answer

Answer: 3

Rationale:
Before the administration of MMR vaccine, a thorough health history needs to be obtained. MMR is used with caution in a child with a history of an allergy to gelatin, eggs, or neomycin because the live measles vaccine is produced by chick embryo cell culture and because MMR also contains a small amount of the antibiotic neomycin. The questions in the remaining options are not directed at addressing contraindications to administering immunizations.

Strategy:
Focus on the subject, the contraindications related to administering the MMR vaccine. When thinking about contraindications to this vaccine, think about allergic reactions. Remember that MMR is used with caution in a child with a history of an allergy to gelatin, eggs, or neomycin.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 3/18/20

The nurse is collecting data from a client and notes that the client is taking carbamazepine. The nurse determines that this medication has been prescribed to treat which condition?

Glaucoma
Diabetes mellitus
Parkinson's disease
Trigeminal neuralgia

Show answer

Answer: 4

Rationale:
Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. It is not used to treat any of the conditions noted in the remaining options.

Strategy:
Focus on the subject, the use of carbamazepine. Specific knowledge of this medication and its clinical use is needed to answer this question. Remember that carbamazepine is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 3/11/20

The registered nurse (RN) directs the licensed practical nurse (LPN) to assist with the care of a client who has a sacral ulcer. Which is the most appropriate activity for the RN to delegate to the LPN?

Place the client in a side-lying position.
Initiate wound care protocol for standardized ulcer care.
Meet with the wound specialist to identify measures to improve healing.
Determine which treatments would best meet the healing needs of the client.

Show answer

Answer: 1

Rationale:
The best task for the LPN is to place the client in the side-lying position. Proper positioning requires nursing skills and is within the LPN's abilities and scope of practice. Initiating a wound care protocol, meeting with the wound specialist to identify measures to improve healing, and determining which treatments would best meet the healing needs of the client are outside the LPN's scope of practice, even though the LPN may assist the RN in determining the plan of care. These activities are the RN's responsibilities.

Strategy:
Note the strategic words, most appropriate. Focus on the subject, the best task for the LPN. Thinking about the roles and responsibilities of the LPN will direct you to the correct option. The activities in options 2, 3, and 4 are the responsibility of the RN.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

A Guide to Taking Nursing School Tests and Exams

Written by Mary E. Olayon-Yaw

Tests and exams in nursing programs are a breed of their own. They propose very different challenges than the tests taken in prerequisite courses; relying simply on memorization is not enough. For these tests, you must filter out each possible answer and use the material you’ve learned in a way that provides you with the most correct answer.

One of the biggest challenges I have endured in college was transitioning into what one could call the “nursing school life.” It was difficult to adapt to this new way of answering questions and it began to affect me psychologically. As a result, I failed my first three tests. The entire situation was incredibly discouraging as I was never the type of student to have problems in school, much less fail tests consecutively.

Eager to bounce back, I received advice from fellow nursing students and watched dozens of YouTube videos about test-taking skills. I realized that there was an entire “test-taking toolbox” for me to use in the way I study and approached future tests. As I started implementing these new strategies, I instantly saw the positive impact it would make on my grades. Five quarters of nursing school later, I feel more confident than ever in my test-taking skills. There is definitely a method to this madness that everyone is capable of learning. Here are the five test-taking strategies that have had the most positive impact for me:

Using ABCs, nursing process, and Maslow’s hierocracy — Refer back to these when you’re caught in a prioritization question! Airway, breathing, and circulation is the order of priority of nursing action in most cases to keep a patient stable and alive. The nursing process or ADPIE (assessment, diagnosis, plan, intervention/implementation, and evaluation) is another tool to use for systematically providing patient care. Whereas, Maslow’s hierocracy is the order of human needs that must be followed to provide effective patient care.
Pay attention to strategic key words in the questions such as “best,” “priority,” “initial,” and “most appropriate” — This is the most important tip for prioritization questions! In these types of questions, there is likely to be multiple “correct” answers, however, the key word determines which answer follows the order of priority. This can be combined with tip #1 when choosing the most accurate answer for priority-type questions.

Example question: The nurse is assessing the client’s condition after cardioversion. Which observation would be the highest priority?
1. Blood pressure
2. Status of airway
3. Oxygen flow rate
4. Level of consciousness
Correct Answer: B — Think about airway from the ABCs. Understand that maintaining a patient’s airway is the highest priority and written out as a nursing responsibility when a cardioversion is done.
Delegation/assignment-making questions require you to understand the scope of practice for nurses versus other parts of the care team (i.e., CAN/UAP can help patients with ADLs, LPNs can do med passes, etc.). Understand the different roles of the care team so that you know which tasks may be delegated and which tasks require a specific team player.
Use a process of elimination — When you really don’t know the answer, it’s best to work your way backwards. Try narrowing the choices down to the last two. You will have a better chance of being correct when only choosing from two answers versus guessing between four. This is a strategy that I only use when I’ve exhausted all my other test-taking skills and have no clue which answer is actually correct.
Do not change your answer! — UNLESS you are 100% sure that your original answer is not the correct one. You chose it first for a reason, so what’s making you second-guess it now? Trust your gut and instincts!

These are just a few of the test strategies I’ve learned over the past year and a half. One book that I highly recommend reading for more test-taking skills and tips is Saunders Strategies for Test Success. It does a great job of breaking down and explaining how to take nursing school tests and what the benefits are when using specific strategies. I’ve also decided to incorporate this book into my NCLEX® review. After all, the NCLEX is essentially the ultimate nursing school test. Nursing school can be difficult and nursing school tests will be challenging, but just remember that you made it this far for a reason! You can do this!

Your Grades Don’t Define Your Intelligence or Your Worth

Written by David Nguyen

Hey everyone! My name is David Nguyen and I attend nursing school at the University of Massachusetts, Lowell. Nursing school is very tough, but it is worth it in the end when you reach your goal and become a nurse.

Everyone has their own journey full of twists and turns during nursing school. I believe it’s important for every student to keep in mind that your grades don’t necessarily define your intelligence or your worth. Although your grades may weigh heavily on how success is perceived, every action leads to growth, including your failures. Your family and friends will be prouder of your perseverance in achieving your degree than what your grades may or may not be. Always know that your time will come, and you need to keep up your determination and resilience in order to get that degree. Just breathe and focus on what you can get done now.

Here are some tips to help you succeed and grow throughout your nursing school journey:

Meet with your professors during office hours. Your professors are great resources when you are having trouble understanding certain concepts that were covered in class. They want to see you succeed. Developing relationships with your professors will also help open the door to future opportunities, such as using them as a reference for continuing education, scholarships, internships, and jobs.
Push yourself, because no one is going to do it for you. Be aware of what you really want, chase after it, and don’t let anyone stop you. Start by allotting time in your schedule to focus on your studies and stick to it. Nursing school is hard work, but it helps you build resilience.
Breathe and focus on the present moment. It’s okay to take some time off for yourself. Always reach out to your friends, family, and professors for help.
Remember to enjoy nursing school and its journey. Build friendships with your classmates and power through it together. At the end of the day, nursing is a profession that people pursue because they love it with all their heart.

Lastly, believe in yourself. You can do it, and everyone is rooting for you!

NCLEX Exam Practice Question of the Week - 3/4/20

When communicating with a client who speaks a different language, which best practice should the nurse implement?

Speak loudly and slowly.
Arrange for an interpreter to translate.
Speak to the client and family together.
Stand close to the client and speak loudly.

Show answer

Answer: 2

Rationale:
Arranging for an interpreter would be the best practice when communicating with a client who speaks a different language. Options 1 and 4 are inappropriate and ineffective ways to communicate. Option 3 is inappropriate because it violates privacy and does not ensure correct translation.

Strategy:
Note the strategic word, best, in the question and note the subject, communicating with a client of a different culture. Eliminate option 3 first because this action can constitute a violation of the client's right to privacy, and does not represent best practice. Next, eliminate options 1 and 4, noting the word loudly in these options and because they are nontherapeutic actions and also are not best practices.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 2/26/20

The nurse assesses the vital signs of a 12-month-old infant with a respiratory infection and notes that the respiratory rate is 35 breaths/minute. On the basis of this finding, which action is most appropriate?

Administer oxygen.
Document the findings.
Notify the health care provider.
Reassess the respiratory rate in 15 minutes.

Show answer

Answer: 2

Rationale:
The normal respiratory rate in a 12-month-old infant is 20 to 40 breaths/minute. The normal apical heart rate is 90 to 130 beats/minute, and the average blood pressure is 90/56 mm Hg. The nurse would document the findings.

Strategy:
Focus on the data in the question and note the strategic words, most appropriate. Recalling the normal vital signs of an infant and noting that the respiratory rate identified in the question is within the normal range will direct you to the correct option.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 2/19/20

What electrolytes and amounts are usually contained in total parenteral nutrition (TPN) for an adult client without renal or hepatic impairment? Select all that apply.

Calcium 2 to 5 mEq
Sodium 1 to 2 mEq/kg
Magnesium 8 to 20 mEq
Potassium 1 to 2 mEq/kg
Phosphate 20 to 40 mmol

Show answer

Answer: 2,3,4,5

Rationale:
Individual requirements for TPN should be assessed daily at the beginning of therapy and then several times a week as the treatment progresses. The following are ranges for average daily electrolyte requirements for adult clients without renal or hepatic impairment: sodium 1 to 2 mEq/kg; potassium 1 to 2 mEq/kg; chloride as needed to maintain acid-base balance; magnesium 8 to 20 mEq; calcium 10 to 15 mEq; and phosphate 20 to 40 mmol.

Strategy:
Note the subject, electrolytes and amounts contained in TPN. It is necessary to understand the correct electrolyte ranges in these solutions in order to answer this question correctly.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

The Balanced Life

Written by Erica De Haro

The life of a nursing student can get very busy. However, it is an exciting time in our lives where we are introduced to a whole new world. We learn the language of nursing and manage a complicated course load while studying for countless hours and participating in clinicals. In the midst of our crazy schedules, I believe it is important to find balance. I am a big advocate of implementing balance into my life and I love to inspire others to do the same!

Here are some tips on how to achieve balance in nursing school:

Planner: A planner will help you master time management. Organizing your assignments, quizzes, exams, and volunteer events will aid you in staying on track. Managing your time should be about simplifying how you work to relieve stress, rather than squeezing multiple tasks into one day. Remember — work smarter, not harder.

Self-care: The director of our nursing program always reminds us to make time for ourselves, whether it’s watching a movie, spending time with loved ones, or going for a hike. Taking time for yourself is so important for your wellbeing. Find what works best for you to help reduce stress and prevent burnout. If you want to take care of others, you must first take care of yourself.
Practice healthy habits: Get six to eight hours of sleep each night, drink lots of water, eat nutritious foods, and exercise. As a nursing student, your emotional and physical wellbeing play vital roles in achieving academic and professional success. Establishing healthy habits early on in nursing school is essential to revitalizing your energy and incorporating wellness into your everyday life.

Ultimately, I hope you enjoy the beautiful journey of being a nursing student. Throughout all the challenges you may face in nursing school, always remember to find your balance. Take the time to learn and grow from these experiences and never forget how far you have come. Invest in your mind, invest in your health, and invest in yourself.

NCLEX Exam Practice Question of the Week - 2/12/20

A client is diagnosed with scleroderma. Which intervention should the nurse anticipate to be prescribed?

Maintain bed rest as much as possible.
Administer corticosteroids as prescribed for inflammation.
Advise the client to remain supine for 1 to 2 hours after meals.
Keep the room temperature warm during the day and cool at night.

Show answer

Answer: 2

Rationale:
Scleroderma is a chronic connective tissue disease similar to systemic lupus erythematosus. Corticosteroids may be prescribed to treat inflammation. Topical agents may provide some relief from joint pain. Activity is encouraged as tolerated and the room temperature needs to be constant. Clients need to sit up for 1 to 2 hours after meals if esophageal involvement is present.

Strategy:
Focus on the subject, scleroderma. Think about the pathophysiology associated with this condition and read each option carefully to assist in answering correctly.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 2/5/20

A nurse is caring for a client with cardiac disease who is beginning to experience denial. What is a primary indicator of denial?

Frequent, angry outbursts
Attempts to minimize the illness
Refusal to participate in self-care
Frequent complaints about nursing care

Show answer

Answer: 2

Rationale:
One of the classic symptoms of denial is the minimization of the problem or the projection of the problem onto other people.

Practice Question Sourced From: Zerwekh: Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition

NCLEX Exam Practice Question of the Week - 1/29/20

The nurse is observing a client who is ambulating after a prolonged period of bed rest. The nurse determines that the client should immediately stop the activity if the client exhibits which finding?

Some arm and leg weakness
Shortness of breath and diaphoresis
An increase in pulse rate from 78 to 80 beats/min
An increase in respiratory rate from 16 to 18 breaths per minute

Show answer

Answer: 2

Rationale:
Bed rest decreases the client's strength and endurance. Shortness of breath and diaphoresis are systemic signs of fatigue indicating that the client should rest. Options 1, 3, and 4 are normal findings.

Tip for the Nursing Student:
Bed rest means that the client remains in bed. There are many complications associated with bed rest. Additionally, prolonged bed rest may precipitate episodes of dyspnea (shortness of breath) and diaphoresis (increased sweating). You will learn about the effects and complications of bed rest in your fundamentals of nursing course.

Test-taking Strategy:
Note the strategic word immediately. Use the ABCs—airway, breathing, and circulation. Option 2 indicates that the client is not tolerating the activity from a cardiopulmonary standpoint. Options 1, 3, and 4 are expected effects.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 1/22/20

The nurse is providing discharge instructions to the client who is taking theophylline. When considering medication toxicity, the nurse instructs the client to report which clinical manifestations? Select all that apply.

Nausea
Insomnia
Indigestion
Constipation
Rapid heartbeat

Show answer

Answer: 1,2,5

Rationale:
Theophylline is classified as a methylxanthine bronchodilator. The client should be instructed to report nausea, vomiting, insomnia, and a fast heartbeat. Seizures can also occur. Indigestion and constipation are not signs that are associated with theophylline toxicity.

Tip:
Learn medications that belong to a classification by commonalities in their medication names; for example, medications that are methylxanthine bronchodilators end with the letters -line (e.g., theophylline).

Strategy:
Focus on the subject, clinical manifestations of toxicity related to theophylline administration. It is necessary to know the manifestations of toxicity to answer correctly. Also, think about the action of the medication to answer correctly.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7th Edition

NCLEX Exam Practice Question of the Week - 1/15/20

The nurse is caring for a client who has a fungal infection and is receiving amphotericin B intravenously. Which finding indicates that the client is experiencing an adverse or toxic effect from the medication?

Lethargy
Confusion
Muscle weakness
Decreased urinary output

Show answer

Answer: 4

Rationale:
Amphotericin B is an antifungal agent. Adverse reactions include nephrotoxicity (kidneys), as evidenced by decreased urinary output. Cardiovascular toxicity, as evidenced by hypotension and ventricular fibrillation, and anaphylactic reactions occur rarely. Vision and hearing alterations, seizures, hepatic failure, and coagulation defects also may occur. Options 1, 2, and 3 are not associated with an adverse effect.

Tip for the Nursing Student:
A fungal infection is one that is caused by a fungus. Most fungal infections are superficial and mild. In older, debilitated, or immunosuppressed persons, fungal infections may become systemic and life threatening. These systemic infections require aggressive therapy with intravenous (IV) medication to eradicate the infection. Amphotericin B is an effective medication used to treat systemic infections. You will learn about amphotericin B in your pharmacology course or in your medical-surgical nursing course when you study infectious disorders.

Test-taking Strategy:
Note the subject, an adverse effect of amphotericin B. Focus on the datainformation in the question. Noting that the client has a fungal infection will assist in determining that the medication is an antifungal. Remembering that this medication causes nephrotoxicity, cardiovascular toxicity, and vision and hearing alterations leads you to the correct option.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 1/8/20

A client has a long leg plaster cast applied. What nursing action should be implemented while the cast is drying?

Use only the fingertips when moving the cast.
Keep the client and cast covered with blankets.
Observe for neurovascular changes distal to the fracture.
Place a heat lamp directly over the cast.

Show answer

Answer: 3

Rationale:
After cast application, observe for signs of compartment syndrome by performing frequent neurovascular checks distal to the end of the cast. Palms of the hand should be used in turning the client. Heat should not be applied to a damp cast.

Practice Question Sourced From: Zerwekh: Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition

NCLEX Exam Practice Question of the Week - 1/1/20

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially?

Warm the client.
Maintain a patent airway.
Administer thyroid hormone.
Administer fluid replacement.

Show answer

Answer: 2

Rationale:
Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

Strategy:
Note the strategic word, initially. All the options are appropriate interventions, but use the ABCs–airway, breathing, and circulation–in selecting the correct option.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 12/25/19

The nurse is caring for a client following a liver transplant; the client is receiving tacrolimus. The nurse should monitor the client for which adverse effect of the medication?

Hypotension
Photophobia
Profuse sweating
Decrease in urine output

Show answer

Answer: 4

Rationale:
Tacrolimus is an immunosuppressant medication used in the prophylaxis of organ rejection in clients receiving allogenic liver transplants. Frequent side effects include headache, tremor, insomnia, paresthesia, diarrhea, nausea, constipation, vomiting, abdominal pain, and hypertension. Adverse and toxic effects include nephrotoxicity (kidneys), neurotoxicity (neurological system), and pleural effusion. Nephrotoxicity is characterized by an increase in serum creatinine and a decrease in urine output. Neurotoxicity is characterized by tremor, headache, and mental status changes.

Tip for the Nursing Student:
A liver transplant is a surgical procedure in which the liver is transferred from one person (donor) to another (recipient) to replace a diseased liver or restore function. A primary concern is rejection of the donor's tissue by the recipient's immune system. Therefore, after transplant the recipient is given an immunosuppressant medication to prevent rejection. Tacrolimus is one of the immunosuppressants used in the prophylaxis of organ rejection. You will learn about tacrolimus in your pharmacology course or in your medical-surgical nursing course when you study transplants.

Test-taking Strategy:
Note the subject, an adverse effect of tacrolimus. Specific knowledge about this medication is needed to answer the question. Recalling that nephrotoxicity is an adverse effect will direct you to the correct option.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 12/18/19

Which intervention should the nurse includein the plan of care for a client admitted to the hospital with ulcerative colitis?

Administer stool softeners.
Place the client on fluid restriction.
Provide a low-residue diet.
Add a milk product to each meal.

Show answer

Answer: C

Rationale:
A low-residue diet will help decrease symptoms of diarrhea, which are clinical manifestations of ulcerative colitis. Options A, B, and D are contraindicated and could worsen the condition.

Practice Question Sourced From: HESI Comprehensive Review for the NCLEX-RN Examination, 6e

The More the Merrier

Written by Hannah Lease

Hi, everyone! My name is Hannah and I am just a few weeks shy of finishing up the first semester in my accelerated nursing program at Marian University in Indianapolis, IN. To say that nursing school, in general, is a big commitment is an understatement. Trying to cram all of that learning and preparation into just 16 months…well, I am still trying to figure out how to describe it! Going into my program, I didn’t really have a set game plan for how I wanted to study. This is especially the case since the material I am learning is completely different from what I studied in my first degree. Little did I know that upon purchasing my books (all published by Elsevier), my studying concerns would go out the door. I quickly realized that with all the extra resources Elsevier offers, my new studying go-to would instantly become Elsevier Adaptive Quizzing, better known as EAQ.

For each of my nursing books, Elsevier offers an EAQ to generate quizzes based on the specific chapter(s) in the text. I can choose either the “Mastery” option, where I’m served unlimited questions until I level up in the topic(s) of my choice, or I can select the “Custom” option, where I pick a set number of questions in the topic(s) of my choosing to achieve a higher level of mastery.

I cannot express enough how much EAQ has helped not only myself, but my fellow classmates. Leading up to every exam, my classmates and I discuss how we plan to review as many Elsevier Adaptive Quizzes (EAQs) as we can because we know they have helped us be well prepared for our previous exams. I’ve learned that the more adaptive quizzes I can get under my belt, the more confident I feel walking into my exams.

I think a lot of us agree that we can only read the same information over and over again for so long until it starts to make us go stir crazy! That’s why I think it is so important to take a break from reading assignments and listening to lectures, and instead put your brain to the test by quizzing yourself over the material you’ve been reviewing nonstop. By taking EAQs, it makes the material come together in a way that you will be tested on, not only making you a better student, but also a better nurse in the future! In the end, we aren’t spending the majority of our time studying and taking our nursing exams to pass our classes…we are doing it in preparation to help save lives, take care of loved ones, and to make a difference in the world of nursing.

The moral of the story is this: don’t ever stop doing the most for yourself and your future career as a nurse. Work hard at your assignments, listen to your lectures as often as you can, find your tribe of like-minded classmates that push you to succeed, do all the EAQs you can and then some, crush your exams, and finally, CELEBRATE! Nursing school is hard, but with each exam you are one step closer to earning those letters behind your name — and Elsevier is there to help you every step of the way.

NCLEX Exam Practice Question of the Week - 12/11/19

The nurse in an ambulatory care clinic takes a client's blood pressure (BP) in the left arm; it is 200/118 mm Hg. Which action should the nurse implement next?

Notify the primary health care provider.
Inquire about the presence of kidney disorders.
Check the client's blood pressure in the right arm.
Recheck the pressure in the same arm within 30 seconds.

Show answer

Answer: 3

Rationale:
When a high BP reading is noted, the nurse takes the pressure in the opposite arm to see if the blood pressure is elevated in one extremity only. The nurse would also recheck the blood pressure in the same arm but would wait at least 2 minutes between readings. The nurse would inquire about the presence of kidney disorders that could contribute to the elevated blood pressure. The nurse would notify the primary health care provider because immediate treatment may be required, but this would not be done without obtaining verification of the elevation.

Tip:
Hypertension is a major risk factor for coronary, cerebral, renal, and peripheral vascular disease.

Strategy:
Focus on the subject, hypertension. Note the strategic word, next. Eliminate option 4 first because of the time frame, 30 seconds. From the remaining options, select the correct option because it provides verification of the initial reading.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7th Edition

NCLEX Exam Practice Question of the Week - 12/4/19

The nurse is caring for an infant with an unrepaired tracheoesophageal fistula. In planning care, the nurse will identify what priority nursing goal?

To promote oxygen exchange
To prevent lung infection
To promote bonding
To replace fluids and electrolytes

Show answer

Answer: 1

Rationale:
Promoting lifesaving oxygen exchange is a priority measure at this time. Prevention of infection will be appropriate after surgical repair. It is important to prevent pulmonary infection, especially aspiration, but oxygen exchange is still a priority.

Practice Question Sourced From: Zerwekh: Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition

Hello Nursing School, Goodbye Social Life: Balancing My Social Life and Nursing School

Written by Ariana Speight

Let’s face it, we have all heard, “Wow, nursing? How do you have a life?” My simple answer to that question: Balance. We are all familiar with the time commitment that nursing requires — between studying for tests, preparing for clinicals, gathering patient information, or writing patho papers and care plans for patients, nursing school is a huge commitment. On top of nursing school, I’m always learning how to balance relationships, social life, volunteer work, exercising, a job, and my relationship with God. Here are few of my tips for maintaining balance in the crazy life of a nursing student!

Disclaimer: My life is not perfect and never will be. I am still learning to apply these tips in my own life, and they are helping me daily.

Plan Your Weeks and Days in Advance

Having an organized agenda is very helpful for me. Before a new month begins, I go to Blackboard and write down every assignment so I don’t forget anything. I am always on top of my assignments when I write them down, but if I don’t, 9 times out of 10 I will probably forget about them! If I have plans during the week or on the weekends, I schedule my studying around what I have to do. This helps me ensure that I can have free time without worrying about missing an assignment. I have specific time frames to study, and I plan out what I’ll be studying during those times. I prioritize study time before fun events or time with friends so that when I do attend these events, I am not stressing about an assignment or test the entire time.

Communication is Key

Nursing is a huge time commitment, and some may even say you will lose friends because of it. That may be true for some people, but if you communicate with your friends and family that you’re busy, they will understand. For example, “Hey friend, I have a big pharm test tomorrow and need this time to study, can we make time to hang out on Friday? I have been so occupied with studying this week and I would love to spend time with you soon.” It’s as simple as that. If you’re at a school that’s far away from family, you may even say, “Hi family, I’m sorry I haven’t called recently. I have been busy with nursing. I will call first thing in the morning. I miss you and I can’t wait to see you very soon.” Communication is key to keeping healthy relationships because no one can read your mind if you don’t tell them what’s going on. We all get caught up in the business of life, but communication allows everyone to be on the same page.

Do Not Procrastinate — Plan How Much You Will Study Each Day

I have learned to plan full-on study days periodically throughout the month. I’ve also found that planning what I will study each day allows me to stay focused and have valuable study time. For example, I will write in my planner: One hour to study for health assessment test with a break in between, then study for my check-off final for another hour. Planning out my study time prior to when I start has been beneficial for my productivity. If I start studying blindly, my focus is all over the place and basically non-existent.

PUT YOUR PHONE DOWN!

My phone is my biggest distraction. I can easily admit that I love checking Instagram and always go to Twitter for a good laugh. However, I’ve learned that leaving my phone in my dorm, as hard as it is, helps me to grind out a good study session without the distraction of my phone. If I have my phone with me, I try to put it on the opposite side of the room and turn it off. Having it out of sight while I’m studying helps me to focus on the task at hand.

Conclusion

By using these techniques, I have learned how to balance daily tasks without the anxiety of not knowing how I will finish everything. Some days feel much longer than others and I do get stressed, but planning and finding a balance has helped me preserve my sanity throughout nursing school. Being a Christian, a great source of my positive mindset also comes from being at a like-minded university that encourages us to lean on the grace of God to get through our days.

I hope that you take it day-by-day and remember, you are doing amazing! We all have our own journeys and each journey is beautiful. Whether you are a new college student in nursing school, or a single mom of two trying to balance being a mom and a student, you are doing the best you can with the cards you have been dealt. I pray you all find the strength you need to get through the hardest days of nursing school and enjoy the easier ones. Keep pushing through, you got this!

NCLEX Exam Practice Question of the Week - 11/27/19

The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding?

Redness around the pin sites
Pain on palpation at the pin sites
Thick, yellow drainage from the pin sites
Clear, watery drainage from the pin sites

Show answer

Answer: 3

Rationale:
The nurse should monitor for signs of infection such as inflammation, purulent drainage, and pain at the pin site. However, some degree of inflammation, pain at the pin site, and serous drainage would be expected; the nurse should correlate assessment findings with other clinical findings, such as fever, elevated white blood cell count, and changes in vital signs. Additionally, the nurse should compare any findings to baseline findings to determine if there were any changes.

Strategy:
Note the strategic word, most. Determine if an abnormality exists. Recall that purulent drainage is indicative of infection, and that some degree of pain, inflammation, and serous drainage should be expected.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 11/20/19

A client is participating in a therapy group and focuses on viewing all team members as equally important in helping the clients to meet their goals. The nurse is implementing which therapeutic approach?

Milieu therapy
Interpersonal therapy
Behavior modification
Support group therapy

Show answer

Answer: 1

Rationale:
All treatment team members are viewed as significant and valuable to the client's successful treatment outcomes in milieu therapy. Interpersonal therapy is based on a one-to-one or group therapy approach in which the therapist-client relationship is often used as a way for the client to examine other relationships in his or her life. Behavior modification is based on rewards and punishment. Support groups are based on the premise that individuals who have experienced and are insightful concerning a problem are able to help others who have a similar problem.

Strategy:
Focus on the subject, characteristics of a type of therapy. Note the relationship between the words helping the clients to meet their goals and the correct option.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

Finally, the Perfect NCLEX® Prep Book for Visual Learners

Written by Morgan Brittain

Hello friends! My name is Morgan and I am in my second semester of nursing school at University of Arkansas–Fort Smith. Nothing personal against nursing school, but there's no denying that it can be stressful at times. Between worrying about exams and balancing your personal life around when to study for them, it can seem as though you never get the chance to just relax.

I know what it’s like. After taking an exam and finally getting caught up on making study guides, you catch a moment of peace. Then it hits you. In just a year, you will be faced with the most crucial and life-altering test you may ever take — the NCLEX. This was a very constant, panic-inducing thought for me. That is, until I discovered the best study workbook for visual learners ever to be written, the Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition, by JoAnn Zerwekh, EdD, RN.

When I first got this book, I began flipping through the pages and was immediately impressed with the colorful illustrations and eye-catching diagrams that really captivate the reader. Since I am a visual learner, I find that associating pictures with the content really helps me retain information.

Another thing I really like about this book are the Test Alert! boxes featured throughout that highlight key concepts frequently found on the NCLEX. There are symbols to accentuate high-alert medications, as identified by the Joint Commission, and for one of my favorite details — nursing priorities. The book also has symbols that identify pediatric and adult nursing priorities. I really appreciate this feature because we all know how much our instructors love nursing priority questions.

Just when I thought this book could not get any more convenient, I discovered that it comes with a corresponding code that allows you to access additional resources on the companion Evolve website. The website includes very helpful study material, such as practice questions and mock exams that you can take in study mode or quiz mode.

When you take practice tests in quiz mode, you receive feedback after each question, as well as a complete rationale for each option. I love seeing feedback and rationales because I always want to know exactly why the answers I choose are incorrect or correct, so I can do better on similar types of questions in the future (I tend to overthink my answers and it sometimes causes me problems). The book and its online resources offer more than 2,500 practice questions that are similar to those found on the NCLEX exam, so there is plenty of testing information to help you prepare.

Just for kicks, I signed in and took a 50-question test on a section we were about to cover in one of my classes. I actually surprised myself and did better than I thought I would. So, it might also be beneficial to use the practice tests to help prepare for class exams on different subjects. Just a thought!

I really think this book will help me when I begin preparing for the NCLEX exam, and calm some of my usual jitters, because I will be so well prepared. I highly recommend this book!

NCLEX Exam Practice Question of the Week - 11/13/19

The nurse is caring for a client receiving codeine sulfate for pain. The nurse determines that the client is experiencing a side or adverse effect of the medication based on which finding?

Distended jugular veins
Bounding peripheral pulses
No bowel movement in 3 days
Change in blood pressure from 120/60 mm Hg to 140/80 mm Hg

Show answer

Answer: 3

Rationale:
The client taking codeine sulfate is at risk for constipation. Thus, the nurse monitors the frequency of bowel movements. The nurse also would monitor the client for hypotension, decreased respirations, and urinary retention. The nurse would plan measures to counteract these expected effects, such as encouraging fluids, coughing and deep breathing, and increasing mobility to the extent tolerated by the client.

Strategy:
Focus on the subject, a side effect of codeine. Eliminate option 1 because there is no relationship of this finding to the medication. Eliminate options 2 and 4 because the blood pressure would become lower rather than higher and because if the client is experiencing hypotension, the pulses would be weak. Remember that codeine can cause constipation.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

NCLEX Exam Practice Question of the Week - 11/6/19

Following myelography, how should the nurse plan to best position the client?

On the left side
On the right side
Head slightly elevated
Head lower than the rest of the body

Show answer

Answer: 3

Rationale:
A myelogram uses x-rays and contrast material to view the bones and the fluid-filled space (subarachnoid space) between the bones in the spine. It may be done to diagnose the presence of a tumor, an infection, problems with the spine such as a herniated disc, or narrowing of the spinal canal caused by arthritis. The head should be slightly elevated to prevent complications such as leaking of cerebrospinal fluid.

Strategy:
Note the strategic word, best. Think about the name of the procedure and what it involves. Recalling that dye is put into the spinal column will assist in identifying the possible complications and answering correctly.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 8e

Tips for Acing Your Skills Check Offs

Written by Mary Euline Olayon-Yaw

Clinicals! They’re something we’re all excited to be a part of as nursing students - especially if it’s a rotation we’ve been eager to precept in. It’s a time where we can use our new skills and begin to gain real experience. However, most of us forget that before we can begin clinicals, we must go through skills check-offs with our instructors to evaluate those newly learned skills. Skills check-offs can definitely be a nerve-racking time if you are not prepared or are prone to overthinking. After all, who doesn’t get nervous and have their minds go blank with their instructor right in front of them?

I remember when I had my first skills check-off. I was beyond nervous and could feel the anxiety start to inch forward. I know I’m not the only one who has felt this way. Looking back, I realize that the mistakes I was marked off on could’ve been avoided with better preparation, which in turn, would’ve allowed for greater confidence. Here are a few tips that I’ve found to be extremely helpful for skills check-offs!

#1 – Go to open labs

Take advantage of open labs! Open labs are reserved time slots for students to come in and use the skills lab to practice. This is a huge help because it allows students to practice their skills with the proper equipment. Repetition is key when it comes to learning a new skill. The more times you do an action or skill, the better your muscle memory will be. This is especially the case if you’re using the proper equipment over and over again. There’s no better place to practice than in an open lab!

#2 – Create a step-by-step guide that works for you

Imagine trying to sing a song without the lyrics after only hearing it a couple of times. That’s exactly how I felt when performing some of the skills my first time around. Some skills can have several steps and the thought of properly executing all of them can be incredibly overwhelming! To help overcome this, I like to organize a “step-by-step” guide on how I would perform a specific skill. I still follow all the proper techniques given and required, but rearranging the sequence to perform it in a way that fits me better ultimately helps me remember the steps for a specific skill.

#3 – Role play with your classmates

The best way to make the most of skills or open lab is to form small groups of two to three people. Have one person be the nurse, one person as the patient, and one person as the evaluator (If you only have two people, then the patient will just have to double as the evaluator – anything works, just be creative!). Each person will then rotate through each role, which will give everyone an opportunity to act out the skills. It is also important to look at the rubric, provide feedback, and make mental notes on which areas you may need to improve in. I’ve found that practicing these skills in a group environment has not only been a more fun way to learn, but more engaging as well. This method has resulted in me improving my understanding with the skills I learn as well as being more confident in each skill I perform.

NCLEX Exam Practice Question of the Week - 10/30/19

The nurse instructs a laboring client to use accelerated blow breathing. The client begins to complain of tingling fingers and dizziness. Which action should the nurse take next?

Administer oxygen by facemask.
Notify the health care provider of the client's symptoms.
Have the client breathe into her cupped hands.
Check the client's blood pressure and fetal heart rate.

Show answer

Answer: C

Rationale:
Tingling fingers and dizziness are signs of hyperventilation (blowing off too much carbon dioxide). Hyperventilation is treated by retaining carbon dioxide. This can be facilitated by breathing into a paper bag or cupped hands. Option A is inappropriate because the carbon dioxide level is low, not the oxygen level. Options B and D are not specific for this situation.

Practice Question Sourced From: HESI Comprehensive Review for the NCLEX-RN Examination, 6e

NCLEX Exam Practice Question of the Week - 10/23/19

Which of the following biologic agents are disseminated by airborne release?

Botulism and anthrax
Anthrax and plague
Plague and smallpox
Botulism and smallpox

Show answer

Answer: 1

Rationale:
Both anthrax and botulism can be aerosolized, inhaled, and disseminated by airborne release. There are no isolation requirements for botulism, because it usually is transmitted by ingestion of contaminated food; however, botulism can be made into an aerosol and inhaled (manmade). Anthrax requires standard isolation precautions. After the client with anthrax gets sick, there is no person-to-person transmission. Plague and smallpox are spread person to person.

Practice Question Sourced From: Zerwekh: Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition

NCLEX Exam Practice Question of the Week - 10/16/19

After assessment and diagnostic evaluation, it has been determined that the client has a diagnosis of Lyme disease, stage II. The nurse assesses the client for which manifestation that is most indicative of this stage?

Lethargy
Headache
Erythematous rash
Cardiac dysrhythmias

Show answer

Answer: 4

Rationale:
Stage II of Lyme disease develops within 1 to 3 months in most untreated individuals. The most serious problems in this stage include cardiac dysrhythmias, dyspnea, dizziness, and neurological disorders such as Bell's palsy and paralysis. These problems are not usually permanent. Flulike symptoms (headache and lethargy), muscle pain and stiffness, and a rash appear in stage I.

Tip:
The typical ring-shaped rash of Lyme disease does not occur in all clients. Additionally, if a rash does occur, it can occur anywhere on the body, not only at the site of the tick bite.

Strategy:
Note the strategic word, most. Focus on the subject, Lyme disease. Recalling that a rash and flulike symptoms occur in stage I will assist you in eliminating options 1, 2, and 3 and direct you to the correct option.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7th Edition

How to Find Balance in Nursing School

Written by Leann Indolos

You’re 3 weeks into another semester of nursing school and you realize that you can’t remember the last time you watched a movie or called your parents. You can’t remember the last time you took time to do something fun, but you can definitely remember how many nights in the last week you didn’t get enough sleep and how many hours you’ve spent studying for your upcoming exam. It’s true that nursing school is a challenging and fast-paced program that requires intense dedication, but that doesn’t mean it should completely consume your life.

People often believe “nursing students have no life”, but I’m here to tell you that statement is so far from the truth! In fact, I have found more life since I started nursing school. After a few months of trial and error, I found a way to juggle working 12 hours a week, spending quality time with my family and friends, exercising 4-5 times a week, and volunteering, while still succeeding in my classes. I believe a rich and full student life is possible for every nursing student with just a few helpful tips:

Plan ahead. Plan ahead. Plan ahead. You can fit a lot into your schedule, if you plan for it and manage your time well! For example, if there’s something fun you want to do on a Saturday, like go to a college football game or go out to see a movie, plan ahead by making sure you get your school work/studying done by Friday night. That way, you are completely free to enjoy your day off without worrying about homework, and then you’re ready to refocus and work hard the next day. When you have free time, enjoy it! But when it’s time to hit the books, you have to be diligent and focused in order to make use of your time.
Work smart not hard. Try your best to be as productive as you can with your time. When you’re learning a new topic in class, go ahead and start preparing for the exam! Start your exam study guide in class and ask your professor all the questions you have so that you don’t need to teach yourself or re-learn the topic when the test comes around. This will save you time studying!
Multitask! What I mean by this is that you can sometimes incorporate 2 aspects of your life in a single task. For example, studying with friends is a great way to get work done and spend time with your friends at the same time! You can listen to the audiobook version of your textbooks while driving in the car on the way to. Or, you can go on a walk with your family to get in your exercise and spend quality time with your family too.

It’s important to focus on nursing school and take breaks from it too. Finding balance is an excellent form of “self-care” and will help you to have a happy, healthy, and full life which will ultimately help you in becoming an amazing future nurse.

F is For Friends Who Keep Us Together

Written by Taylor Scruggs

Nursing school is extremely stressful. No one can argue with that or say otherwise. However, knowing how to handle the stresses of nursing school is vital to your own mental health. After all, you can’t take care of other people if you’re not functioning at your best. For me, my friends are my everything. I don’t think I would have made it this far in my program without them. When I entered the nursing program at Tuskegee University, I knew a few other students but wasn’t particularly close to any one person. However, now I can proudly say that I will be graduating in May of 2020 alongside 5 of my best friends.

With nursing, I need to study a little bit each day in order to feel like I’m not drowning in school work or falling behind. However, I don’t always have the internal strength or motivation to study – sometimes I just want to be lazy. To overcome this feeling, my friends and I will gather in our study group and ensure that each of us are reviewing and understanding the information we’ve learned in class throughout the week.

On nights before tests, I’m known for pulling all-nighters. I know this method isn’t necessarily recommended by professors, but it works for me. It helps my friends and I to have the information fresh on our minds right before walking into a test. I’m a night owl, so late night studying is easy for me and I can always stay awake. My friends, however, don’t always possess the same energy that I do when it comes to pulling all-nighters. We will buy each other coffee and energy drinks (even though as nursing students, we know that they aren’t the best for us) in order to get through the rough hours of the night. When we can’t be together before an exam because of late night work schedules or health issues, we’ll improvise and use Facetime to quiz each other.

In order to be a successful nursing student and enjoy some of the best years of your life, it’s important to maintain a healthy balance of work and play. To do this, some of my classmates and I get together at least once a week for dinner (typically on Sunday nights). A couple of us buy the food while the others cook it, and we spend quality time together outside of the nursing building. This is honestly my favorite day of the week - something that I always look forward to over a long week of studying.

My friends and I also attend our school’s football games together. It helps to go to these events with other nursing students because we can set goals for each other to make sure we don’t lose an entire day. We tell ourselves that we can be at the game until a certain time, but we can only go to the game if we get through specific chapters or sections of notes the night before. Holding each other accountable ensures that we end up being successful – together.

If someone doesn’t receive the grade they hoped for, there’s always plenty of shoulders to cry on. We let each other know “it’s just one test” and that “we’ll work harder for the next one”. This has been one of the hardest things for my friend group to get through as we tend to lean on the side of perfectionism. Knowing this, we remind each other that we’re never going to be perfect and that trying to be perfect will only lead to disappointment. We can only do our best. Having people in your nursing school journey who continue to push you is an important part of getting through those hard times.

All in all, I absolutely love my nursing friends. They are the rocks that hold me down when I feel like I can’t do it anymore. When we graduate, many of us hope to move to Hawaii and begin our nursing journey together – and I can’t imagine it any other way.

NCLEX Exam Practice Question of the Week - 10/9/19

The nurse has a prescription to discontinue a client's nasogastric tube. The nurse prepares the client and asks the client to take a deep breath and perform which action next?

Bear down.
Exhale rapidly.
Hold the breath.
Breathe normally.

Show answer

Answer: 3

Rationale:
On tube removal the client is instructed to take and hold a deep breath. The client takes a deep breath because the airway will be temporarily obstructed during tube removal. Holding the breath helps prevent aspiration. Bearing down and exhaling rapidly could inhibit tube removal by increasing intrathoracic pressure. Breathing normally could result in aspiration of gastric secretions during inhalation.

Tip for the Nursing Student:
A nasogastric tube is a tube that is inserted through the nose into the stomach. The tube can be attached to suction to relieve gastric distention by removing gas, gastric secretions, or food. The tube also can be used to instill medication, liquid food, or fluids or to obtain a gastric specimen for laboratory analysis. In any physical condition in which the client is able to digest food but cannot eat it orally, the tube may be inserted and left in place for tube feedings until the ability to eat normally returns. You will learn about nasogastric tubes and the nursing care involved in your fundamentals of nursing course or in your medical-surgical course when you study gastrointestinal disorders.

Test-taking Strategy:
Note the strategic word next. Visualize this procedure. Eliminate options 1 and 2 because they are comparable or alike. From the remaining options, remember that holding the breath will prevent aspiration. The correct option also relates to the ABCs—airway, breathing, and circulation.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e

NCLEX Exam Practice Question of the Week - 10/2/19

The nurse notes that a hospitalized client is receiving sotalol. The nurse should monitor the client for which side effect related to the medication?

Dry mouth
Diaphoresis
Bradycardia
Difficulty swallowing

Show answer

Answer: 3

Rationale:
Sotalol is a β-adrenergic blocking agent. Side effects include bradycardia, palpitations, difficulty breathing, irregular heartbeat, signs of heart failure, and cold hands and feet. Gastrointestinal disturbances, anxiety and nervousness, and unusual tiredness and weakness also can occur. The other options are not side effects.

Tip for the Nursing Student:
Sotalol is a cardiac medication that is used to treat irregular heartbeats in conditions, such as atrial fibrillation, atrial flutter, or ventricular irregularities. Therefore, its therapeutic effect is that it produces antidysrhythmic (anti-irregular) activity. You will learn about sotalol in your pharmacology course or in your medical-surgical nursing course when you study cardiovascular disorders.

Test-taking Strategy:
Focus on the subject, a side effect. Remember that medication names ending with -lol (e.g., sotalol) are β-blockers, which are commonly used for cardiac disorders. The only option that is directly cardiac-related is the correct option.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e (Question 217, Strategies 201-701)

NCLEX Exam Practice Question of the Week - 9/25/19

Which intervention should the nurse includein the plan of care for a client admitted to the hospital with ulcerative colitis?

Administer stool softeners.
Place the client on fluid restriction.
Provide a low-residue diet.
Add a milk product to each meal.

Show answer

NCLEX Exam Practice Question of the Week - 9/18/19

The clinic nurse is performing a medication assessment on a client being seen in the clinic for the first time. The nurse notes that the client takes terbutaline and should ask the client about a history of which disorder that is treated with this medication?

Asthma
Heart failure
Hypothyroidism
Ulcerative colitis

Show answer

Answer: 1

Rationale:
Terbutaline is an oral β-adrenergic agonist bronchodilator that is used to treat asthma. It is not used to treat heart failure, hypothyroidism, or ulcerative colitis.

Tip for the Nursing Student:
Asthma is a respiratory disorder characterized by episodes of difficulty breathing, wheezing, coughing, and mucoid bronchial secretions. The episodes may be precipitated by exposure to allergens, infection, vigorous exercise, or stress. Constriction of the bronchi results in the symptoms. Medication is one component of treatment for the disorder. You will learn about asthma and bronchodilators in your pharmacology course and in your medical-surgical nursing course when you study respiratory disorders.

Test-taking Strategy:
Focus on the name of the medication and on the subject, indications for the medication terbutaline. Recalling that most bronchodilator medication names end with the letters -line will direct you to option 1.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e (Questions 234, Strategies 702-1200)

Self Care for Nursing Students

Written by Hannah Shay

Nursing students are over-achievers. It is in our blood. We beat ourselves up whenever we forget an assignment, don’t study as much as we told ourselves we would, or fail a skills check-off. Being so tough on yourself can take a toll on your mental health. We must remember that it is ok to make mistakes and it is ok to not be perfect.

Self-care is more than just face masks and excuses for binge watching Netflix. Self-care is taking the time to give yourself what you deserve mentally, physically and spiritually in order to make sure you are the best version of yourself. Throughout the last semesters of nursing school, I have learned a thing or two on dealing with stress and anxiety.

Everything happens for you, not to you. It is OK to make a mistake. In some cases, your professors and preceptors WANT you to fail, because these certain mistakes and failures happen so we can learn how to provide the best care possible for our patients to be able to thrive.
Show up for yourself the same way you would for a patient. If you make a mile-long to-do list and only finish half of it, you might feel upset or disappointed in yourself. This disappointment leads to a depletion in your self-confidence. Confidence is a reoccurring concern for nursing students when it comes to skills and clinicals. When you “show up” for your commitments, such as extracurriculars, clubs, and clinicals, you arrive prepared and professional. When you “show up” for your patients you ensure that all of their needs are met to the utmost satisfaction. Make sure you are giving yourself the same time and love that you do everything else in your chaotic life.
Put your leisure time into your schedule after important things has been completed. For example, set aside time for an activity that helps you to de-stress. This might look like scheduling time to listen to a motivating podcast, taking a nap (personal favorite), reading a book, etc. The trick is to schedule this “me-time” after you have finished all the tasks you told yourself you would do. But also make sure not to jam pack your day with a to-do list! There are only so many hours in the day.
Always stay humble and kind. There will be days that you sit in your car after a 13-hour shift absolutely discouraged, drained, and defeated. During these times it is important to reflect. Remember where you came from. If you are a nursing student, remember the anxiety you felt when you gave your first set of vital signs. Look at where you are now. If you are a patient care technician or nurse, remember your worst shift. Reflect on all that you have learned from that day. Nursing is an intense profession. There is constant learning and growth to be done. When you are struggling, remember the reason why you chose nursing as your career path, and always be kind to yourself for choosing this profession.

NCLEX Exam Practice Question of the Week - 9/11/19

The nurse instructs a laboring client to use accelerated blow breathing. The client begins to complain of tingling fingers and dizziness. Which action should the nurse take next?

Administer oxygen by facemask.
Notify the health care provider of the client's symptoms.
Have the client breathe into her cupped hands.
Check the client's blood pressure and fetal heart rate.

Show answer

Making the Most of Your Clinical Rotations as a Nursing Student

Written by Alexis Alexandre, “Nurse Lexi”

My nursing school schedule consisted of lecture, labs, simulations, and clinical rotations. Although simulations place students into “real-life” scenarios to enhance learning, I feel the best experience is gained through clinicals. By the time I graduated from nursing school, I logged more than 500 clinical hours. I had clinicals in a wide variety of specialties, such as geriatrics, pediatrics, maternity, critical care, and adult acute care. Clinical rotations are a huge part of the nursing school experience, allowing you to put your nursing school knowledge into practice. The more hands-on experience you gain as a student, the more comfortable you will be with performing nursing skills.

While clinicals are a great tool, they can also be very overwhelming and a source of anxiety if you don’t know how to make the most of your time. I’ve looked back on my clinical experiences and gathered some tips that will help all nursing students excel during those 8- to 12-hour clinical shifts.

Take the more difficult patient

If your clinical instructor lets you choose which patient you want to assist during the day, choose the patient that has a more complex medical history. You will end up having a more interesting shift. I would usually choose patients who needed bedside procedures, such as a thoracentesis or a cardioversion, so that I could observe and learn about how the nurse prepares and assists with those procedures. Also, taking these complex patients will allow you to be exposed to a variety of medications that you may not have seen in practice before.

Say yes!

If a nurse or CNA needs assistance with caring for their patient, be the student who is always willing to lend a hand. Being helpful will allow you to see more types of patients and get more experience with patient care. Also, if you would like to work at that specific facility upon completion of nursing school, it will work in your favor to be as resourceful as possible.

Seek out opportunities

There will always be a lot going on in the unit, and sometimes there may be procedures that your clinical instructor didn’t know were being performed. If your nurse has a patient that is going down for a diagnostic procedure, ask your clinical instructor if you can go with them to observe! As a student, you must advocate for yourself to ensure you are getting the most out of your clinical experience. In my last semester, I asked to observe central lines and nasogastric tubes being inserted. I also offered to insert Foley catheters and change central line dressings in the presence of my clinical instructor.

Take advantage of the hours that you’re spending at your clinical rotations. This is the time to ask questions, learn, and even make mistakes. The nurses you’re shadowing know that you are a student and don’t know everything, and that’s perfectly okay! Be a sponge, be helpful, and be proactive!

NCLEX Exam Practice Question of the Week - 9/4/19

The nurse is assisting in monitoring a client who just received a dose of nitroglycerin sublingually. The nurse should monitor for which intended effect of the medication?

Headache
Hypotension
Relief of chest pain
Flushing of the skin

Show answer

Answer: 3

Rationale:
Nitroglycerin is an antihypertensive, antianginal, and coronary vasodilator. Its therapeutic or intended effect is to dilate coronary arteries, decrease oxygen consumption, and relieve chest pain. Headache, hypotension, and flushing of the skin can occur, but these are not intended effects of the medication.

Tip for the Nursing Student:
Nitroglycerin is an important medication to learn because it is the first medication administered when the client experiences chest pain from a cardiac disorder, such as angina (chest pain caused by lack of oxygen in the heart muscle) or if myocardial infarction (heart attack) is suspected. You will learn about nitroglycerin in your pharmacology course or in your medical-surgical nursing course when you study cardiovascular disorders.

Test-taking Strategy:
If you are unfamiliar with the medication identified in the question (nitroglycerin), noting that its name contains nitr- provides the clue that it is a nitrate. Focus on the subject, an intended effect. Recalling that an intended effect is a desirable effect and the effect that you would expect to occur and that nitrates vasodilate will direct you to the correct option.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e (Questions 218, Strategies 702-1200)

Top 5 NCLEX Prep Books

Nursing Students’ Favorite Resources to Study for the NCLEX-RN Exam

Saunders Comprehensive Review for the NCLEX-RN® Examination, 7th Edition
by Linda Anne Silvestri, PhD, RN

If you’re looking to cover everything the NCLEX-RN Exam could possibly ask you, look no further! Between the book and its companion online Evolve resources, Saunders Comprehensive Review offers 5,200 NCLEX-style questions in every major content category (and quality in-depth rationales for each answer). Utilizing the online aspect of this text also means customizable exams or study sessions that are tailored toward individualized remediation and retention.

Another pro - this book has extra emphasis on question areas of high prevalence on the NCLEX exam, such as delegation, prioritization, and triage/disaster management. Saunders Comprehensive Review condenses the massive amount of information covered on the NCLEX into easily consumable pieces of high-value material. This way, you can spend more time studying what you’re sure to see on the test.

We also love the organization of this book and how its efficient overviews can shorten your study time. Key concepts, tips and test-taking strategies are emphasized throughout the text to draw your eye, and alternate item format questions are highlighted with a special icon. Priority Nursing Action boxes list actions for clinical emergent situations requiring immediate action, including a detailed rationale and textbook reference. Pyramid Alert boxes spotlight important nursing procedures and shortcuts for remembering key information. Page references for each question guide users toward an Elsevier nursing textbook for further study and self-remediation. If you’re searching to review a specific topic, the easy-to-use index lets you quickly locate questions for a given topic or body system.

This book makes studying a piece of cake! And to top it off – this NCLEX review comes with 75-question pre- and post-tests that cover all content areas in the book in the same percentages that they are covered on the NCLEX-RN test plan.

“I loved this book! It helped me pass my exams for school and the NCLEX. I didn’t really feel like I needed any other study guides for the NCLEX, because between the book and the Evolve site, there were tons of questions.” - Melissa Wilson, RN

If you’re interested in purchasing Saunders Comprehensive Review for the NCLEX-RN® Examination, 7th Edition, visit Elsevier’s Evolve website to see why it’s our best seller in the NCLEX prep category!

Saunders 2020-2021 Strategies for Test Success, 6th Edition
by Linda Anne Silvestri, PhD, RN and Angela Silvestri, MSN, RN

With this invaluable guide to strategic test taking, you can master critical thinking, problem solving and time management skills as they relate to NCLEX-style questions. Think back to when you were applying for college and studying for the ACT or SAT; You may remember hearing: “it’s all about knowing how to take the test.” The same is partly true for the NCLEX. Although you won’t pass the exam with strategy alone, it’s extremely helpful to lean on NCLEX specific test-taking tips when coming across questions that seem confusing. This book will most definitely help you learn how to look at a question, understand exactly what it’s asking, prioritize the answer options and use process of elimination to your advantage.

There are 1,200 review questions included in this book and its online counterpart – including alternate item formats. The rationale for these questions is beyond thorough, including proven tips and real-world hints to confidently evaluate and identify the correct answer in an any question type. Priority concepts for each question help you link your concept-based classes and NCLEX prep. Another cool feature is self-check button that you can use when you’re practicing questions. This lets you see if how you arrived at your answer is the best strategic approach for that question.

This book is just as useful for your first day of nursing school as it is on graduation day. Why? One of the most unique parts of this NCLEX review book is a chapter dedicated to Reducing Test Anxiety and Developing Study Skills. For higher level strategy, prioritization, pharmacology, triage/disaster management, and delegation chapters prove extremely helpful as well. This emphasis on comprehensive test preparation helps you develop, refine, and apply the reasoning skills you need to succeed throughout nursing school and on the NCLEX examination.

“My favorite thing about this book are all of the sample questions and the nursing tips included with rationales. I’m looking forward to reading the entire book and learning new tips for nailing the NCLEX!” – Brianda, Nursing Student

Visual learners will also like Saunders Strategies for Test Success – featuring colors, bold designs and fun cartoons. Get your copy today and become a pro-test taker!

Saunders Q & A Review for the NCLEX-RN® Examination, 7th Edition
by Linda Anne Silvestri, PhD, RN and Angela Silvestri, MSN, RN

Learning to adapt to different types of NCLEX-style questions is one of the hardest aspects of studying for the exam. But don’t fret, this book has you covered! As the title implies with “Q & A,” the variety of question types that this book offers can’t be beat. It includes all alternate item format questions: multiple response, prioritization, fill-in-the-blank, illustrations, charts and exhibits, video and audio questions, decision making and critical thinking skills. The questions are even organized to match the Client Needs and Integrated Processes found in the most recent NCLEX-RN test plan. After using this book and Evolve site to practice there will be no surprises; you’ll know exactly what to expect when you sit for the NCLEX.

One of the greatest differentiating factors for this text is the unmatched depth of rationale provided for each of the 6,000+ questions (for the correct and incorrect answer options). Questions come with a detailed test-taking strategy and clues for finding the correct answer. There is also a Priority Nursing Tip included with each question, highlighting need-to-know patient care information.

Like the Comprehensive Review, Saunders Q & A Review for the NCLEX-RN also has 75-question pre- and post-tests that mirror the official test plan. Unique to the Q & A book, however, are introductory chapters for each content-specific section of questions. Brief but extremely useful, these chapters have academic and nonacademic preparation guidance for the licensure exam, advice from a recent nursing graduate, and transitional issues for the foreign-educated nurse.

“I am currently using this book in my final semester of nursing school. It helps me to get in the habit of answering NCLEX style questions – and makes me feel confident that I’ll know what to expect when I sit for the test in a few weeks.” -Aya, Elsevier Student Ambassador

Visit Elsevier’s Evolve website to see if the Saunders Q & A Review for the NCLEX-RN® Examination, 7th Edition, is your perfect study tool.

Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition
by JoAnn Zerwekh, EdD, RN

Calling all visual learners! This NCLEX prep book turns content into context with colorful illustrations and mnemonic cartoons for almost every key concept. We’ve found that illustrations can make studying a bit more exciting by framing information in a way that you likely haven’t seen before in your classes.

This may be the best NCLEX study guide for you if pharmacology is a trouble area that needs attention. Illustrated pharmacology tables make key drug information easy to find, with high-alert medications noted by a special icon. There are also separate chapters on pharmacology and nursing management to help you dive deep into these areas as a part of your NCLEX preparation. For the topics you feel more confident about, you can simply review the appendix for that chapter and get a quick reference of related medications and nursing procedures.

Zerwekh’s Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition, takes an integrated systems approach that incorporates pediatric, adult, and older adult lifespan consideration in each body system chapter. If you’re a student who likes clear distinction between the differing medical symptoms and treatments for these demographics, this is a huge bonus. Special icons distinguish pediatric and adult disorders and identify content on Self-Care and Home Care throughout the text.

Not to be missed - keep your eyes out for Test Alert boxes throughout the text that highlight key concepts frequently found on the NCLEX exam. There are also 2,500 NCLEX review questions to choose from between this printed book and its Evolve companion website. Definitely a great choice when it comes to preparing for your big test!

“This colorful book kept my interest throughout my time studying. The images helped me a lot since I’m more of a visual learner and really stuck in my head while I was taking the NCLEX. I felt very prepared for my licensure exam after using Zerwekh’s Illustrated Study Guide!” – Greer, RN

Purchase your copy of Zerwekh’s Illustrated Study Guide for the NCLEX-RN Exam on Evolve for a visual learning experience.

HESI Comprehensive Review for the NCLEX-RN Examination, 5th Edition
by HESI

You may be familiar with the HESI entrance and exit exams from your school’s nursing program. These tests are designed to challenge you the same way the NCLEX will and give a very accurate prediction for how you will perform on the nursing licensure exam. Rest assured, preparing well for the HESI will shorten your study time when it comes to sitting for the NCLEX. Whether you’re looking to prepare for your HESI or the NCLEX, this is a great overall comprehensive review. And for those taking both – it’s the perfect one-stop-shop.

If you’re someone who likes to break your studies down by specialty – this book is a great choice. Written in an easy-to-read outline format, the HESI Comprehensive Review breaks down chapters by clinical areas. This format stays consistent throughout the text, making it easy to move between topics as you’re studying. For additional support, keep an eye out for HESI Hint Boxes with important clinical information and concepts tested on the NCLEX and HESI. You’ll also find pharmacology tables that highlight the most important drug therapy content based on the latest evidence-based practices.

As far as preparing for NCLEX-style questions, this text offers 700 practice questions on the companion Evolve website. A strength of these questions is the new alternate item format – complete with fill-in-the-blank and prioritizing questions. With the option to study in quiz or exam mode, you can truly retain what you’re learning and take notice of areas that need extra attention. Rationales are also provided for any incorrect answers or areas of weakness to strengthen your understanding.

“At first, I was really nervous to take the HESI. But, after I took the entrance exam it was helpful to see the areas I needed to improve on and study more. Using this book and the HESI exam to study really did make the NCLEX feel like a breeze. I passed two weeks ago and am now a nurse in the NICU.” -Kate, RN

Shop now to pass the HESI and the NCLEX-RN with flying colors!

NCLEX Exam Practice Question of the Week - 8/28/19

Which condition should the nurse anticipate as a potential problem in a female client with a neurogenic bladder?

Stress incontinence
Infection
Painless gross hematuria
Peritonitis

Show answer

Answer: B

Rationale:
Infection is the major complication resulting from stasis of urine and subsequent catheterization. Option A is the involuntary loss of urine through an intact urethra as a result of a sudden increase in intraabdominal pressure. Option C is the most common symptom of bladder cancer. Option D is the most common and serious complication of peritoneal dialysis.

Practice Question Sourced From: HESI Comprehensive Review for the NCLEX-RN Examination, 6e (Chapter: Medical Surgery)

NCLEX Exam Practice Question of the Week - 8/21/19

The nurse is caring for a 5-year-old client 3 hours after a tonsillectomy. Which drink should the nurse offer the child to encourage fluid intake?

Milk
Orange juice
Cherry Gatorade®
Diluted apple juice

Show answer

Answer: 4

Rationale:
After a tonsillectomy, cool water, crushed ice, flavored ice pops, or diluted fruit juice may be given. Milk, ice cream, and pudding are usually not offered because milk products coat the mouth and throat and may cause the child to clear the throat, which can initiate bleeding. Citrus juice may cause discomfort and is usually poorly tolerated. Fluids with a red or brown color are avoided to distinguish fresh or old blood in emesis from the ingested liquid.

Tip for the Nursing Student:
Tonsillectomy is the surgical removal of the palatine tonsils. The area is very vascular, and bleeding is a potential postoperative complication. You will learn about tonsillectomy in your pediatrics course.

Test-taking Strategy:
Focus on the subject, the postoperative tonsillectomy client. Remember that after a tonsillectomy, it is important to encourage fluids that will not cause coating of the throat and pain or be mistaken for bleeding if the child vomits. Therefore, the only correct option is diluted apple juice.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e (Question 536, Strategies 201-701)

Experiencing Loss as a Nursing Student

Written by Alyssa (Aya) Camille Vinzons.

It’s already 4:00 pm and you can’t believe how fast the time passed today at your favorite clinical placement. Only three more hours left of the shift. Another nurse on the same unit comes by to share that her patient hasn’t been doing well and had a difficult time with her surgery this morning. You take a walk to the patient’s room to assess her together. You feel your heart stop briefly, but you don’t understand why. That balloon-like belly looks so familiar, but you cannot recall from where. The patient’s nurse pulls up her chart so you can read through her medical history and ask questions. As soon as your eyes meet her name on the screen, it all comes rushing back — you had specifically requested to observe her surgery in the operating room when you were rotating in the PACU last week.

You remember how small she was, and how flaccid her limbs were as the anesthesia team transferred her from the isolette to the operating table. The procedure itself went by as quickly as watching an episode of Friends, but you remember how meticulous the team was in ensuring she was stable and safe to bring back upstairs. You don’t stay too long because you must prepare the next round of medications for your own patient assignment, but it’s only a matter of minutes until you see a flash of red in your peripheral vision (the crash cart). Flashes continue to cross your vision as nurses sprint back to the room to draw meds and set the metronome app to 100 bpm for compressions.

Compressions, pulse check, compressions, pushing meds, pulse check, compressions, pushing meds and blood for a rapid blood transfusion, pulse check. The cycle goes on and on. You know that they are only going to do this for so long, but the question is how long? Consumed by so many thoughts, you try to process everything going on in real time. Suddenly, the current moment hits and you realize everything has just…stopped. Hands are no longer on the patient, people aren’t frantically moving, and the rhythm strip has shifted to a steady flat line. Asystole. The patient has been pronounced dead.

As students, we thankfully do not experience these situations often. We’re assisting nurses with their patients on a unit for roughly 7-12 hours, one day a week, for 12 weeks’ time. Duties typically consist of learning to think critically about patient conditions and practicing hands-on nursing skills. Seldom are we prepared for the emotional and mental challenges that come with losing a patient.

Remember, it’s okay to cry and it’s important to feel. You might try to tell yourself to be strong, to hold back the tears by focusing on how you didn’t truly know that patient. However, it’s important to avoid this mindset. You can remain strong while also allowing yourself to embrace natural human emotions. No matter how brief your time may be caring for a patient, you do get to know them in some respect — and sometimes their family and friends, too. Allow yourself to mourn a lost life, but stay composed to console the family, provide psychosocial support, and deliver post-mortem care. Demonstrating respect to the patient and family is your priority.

Establishing emotional connections with patients is one of the greatest parts of nursing, but in times like these it’s also one of the hardest parts. If you need to cry after your shift or take a minute alone to collect yourself, that’s okay. Take the time you need, then leave your sadness at the door so you’re not constantly carrying around this emotional weight.

How can we keep such emotional burdens from negatively affecting our daily lives? The answer: the same way we separate work from home, or how we cope with life in general. For some, that might mean going to a mentor, friend, or significant other to share their feelings. Sometimes we need to express ourselves to someone with an understanding ear to come to terms with what has happened. For others, maybe they just need a night of self-care activities, such as a journaling, taking a warm bath, getting a massage, listening to music, reading a book, or watching a favorite TV show.

If we dwell on such emotions, it can become difficult to continue caring for others. We must take care of ourselves before we can take care of other people. We chose to pursue nursing as a career for a reason. We need to remember that reason, but also remember that there are many paths we can take in nursing. Some people may find that a situation like this has a severely negative impact on their psychological wellbeing — and that’s okay, too. If that’s you, be sure to carefully consider this when determining where you will fit best in nursing.

One of the beauties of nursing is that there are so many opportunities out there for us depending on our interests — working with children, working with the older adult population, oncology nursing or rehabilitative nursing, home care nursing, education, management, and so on. It might take experiencing a certain kind of situation to help some of us realize where we do or don’t wish to work. But wherever each of us ends up, we need to make sure we’re doing something we love, something we’re passionate about. That’s where we’ll excel and have the drive to become the best nurses we can be and provide the best possible care.

NCLEX Exam Practice Question of the Week - 8/14/19

The emergency department nurse assesses a new client and finds constricted pupils, drowsiness, impaired memory, and slurred speech. Which vital sign would be most concerning to the nurse?

B/P 108/64 mmHg
Temperature 99⁰F/37.2⁰C
Respirations 10 breaths per minute
Pulse 64 beats per minute

Show answer

Answer: C

Rationale:
The client is demonstrating signs of opioid intoxication. Depression of the respiratory center is most concerning for this client. Blood pressure and pulse can also run low with opioid intoxication. The temperature is mildly elevated.

Practice Question Sourced From: HESI Comprehensive Review for the NCLEX-RN Examination, 6e (Psych_HESI6e)

NCLEX Exam Practice Question of the Week - 8/7/19

A client with severe hyponatremia is being treated with intravenous hypertonic saline (3%). The nurse determines that the treatment is effective when the laboratory results reveal which sodium level?

120 mEq/L (120 mmol/L)
130 mEq/L (130 mmol/L)
140 mEq/L (140 mmol/L)
150 mEq/L (150 mmol/L)

Show answer

Answer: 3

Rationale:
Hyponatremia is defined as a serum sodium level of less than 135 mEq/L (135 mmol/L). The normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). Options 1 and 2 identify hyponatremia. Option 4 indicates hypernatremia.

Tip for the Nursing Student:
Hyponatremia is a low serum sodium level in the body, and hypernatremia is a high serum sodium level in the body. The normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). Blood work can be drawn on a client to determine the serum sodium level as well as other fluid and electrolyte values. After determining the value of serum electrolytes, the proper interventions can be implemented if necessary. You will learn about fluid and electrolyte imbalances and hypernatremia and hyponatremia in your fundamentals of nursing course.

Test-taking Strategy:
Focus on the subject, interpretation of a sodium level and note the strategic word effective. This indicates that you need to select the option that identifies a normal sodium level. Recalling that the normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L) will direct you to option 3.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e (Question 297, Strategies 702-1200)

NCLEX Exam Practice Question of the Week - 7/31/19

A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse?

A. Dizziness when first getting up
An unpleasant metallic taste in the mouth
Parkinson-like symptoms
Inability to see well at night

Show answer

Answer: C

Rationale:
Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson disease. Reglan has been associated with hypertension, not option A. Option B is often associated with metronidazole, not metoclopramide HCl. Option D, and other vision problems, have not been associated with metoclopramide HCl.

Practice Question Sourced From: HESI Comprehensive Review for the NCLEX-RN Examination, 6e (Chapter: Pharmaceuticals)

NCLEX Exam Practice Question of the Week - 7/24/19

A client taking valproic acid for the management of seizure disorder reports to the laboratory for follow-up blood tests. The nurse should check the results of which laboratory test to monitor for medication toxicity?

Glucose
Electrolytes
Sedimentation rate
Liver function studies

Show answer

Answer: 4

Rationale:
Valproic acid is an anticonvulsant that can cause fatal hepatotoxicity. The nurse checks the results of liver function studies to monitor for toxicity. Options 1, 2, and 3 are not associated with monitoring for medication toxicity.

Tip for the Nursing Student:
A seizure is a sudden and violent involuntary series of contractions of a group of muscles that results from hyperexcitation of neurons in the brain. If a person has a seizure disorder, medication is prescribed to produce an anticonvulsant effect and control the disorder. Valproic acid is one of the many anticonvulsant medications available. An important point to remember about this medication is that it can affect liver function. You will learn about valproic acid in your pharmacology course or in your medical-surgical nursing course when you study neurological disorders.

Test-taking Strategy:
Focus on the subject, toxicity. Recall that toxicity occurs when the medication level in the body exceeds the therapeutic level either from overdosing or medication accumulation. Think about the organs involved in the absorption and elimination of medications. Although some medications are ototoxic (ear) or neurotoxic (neurological system), the body organs most often affected are the liver (hepatotoxic) and the kidneys (nephrotoxic). Keeping these guidelines in mind, look for the option that relates to one of these body systems. This will direct you to the correct option.

Practice Question Sourced From: Silvestri: Saunders 2020-2021 Strategies for Test Success, 6e (Question 213, Strategies 201-701)

NCLEX Exam Practice Question of the Week - 7/17/19

The nurse is examining a male child experiencing an exacerbation of juvenile rheumatoid arthritis (JRA) and notes that mobility is greatly reduced. What is the most likely cause of the child's impaired mobility?

Pathologic fractures
Poor alignment of joints
Dyspnea on exertion
Joint inflammation

Show answer

Answer: D

Rationale:
Joint inflammation and pain are the typical manifestations of an exacerbation of JRA. Options A, B, and C are not specifically related to JRA.

Practice Question Sourced From: HESI Comprehensive Review for the NCLEX-RN Examination, 6e (Chapter: Pediatrics)

NCLEX Exam Practice Question of the Week - 7/10/19

A young adult comes to the clinic complaining of dizziness, weakness, and palpitations. What will be important for the nurse to evaluate initially when obtaining the health history?

Activity and exercise patterns
Nutritional patterns
Family health status
Coping and stress tolerance

Show answer

Answer: 2

Rationale:
Iron deficiency anemia is characterized by fatigue, dizziness, weakness, increased pulse, palpitations, and increased sensitivity to cold. The adult female often becomes anemic for a variety of reasons, such as poor nutrition and heavy menses.

Practice Question Sourced From: Zerwekh: Illustrated Study Guide for the NCLEX-RN Exam, 9th (Hematology: Care of Adult and Pediatric Clients, Ch. 15, pg. 300, Question 5)

NCLEX Exam Practice Question of the Week - 7/10/19

Which client is at highest risk for retinal detachment?

A 4-year-old with amblyopia
A 17-year-old who plays physical contact sports
A 33-year-old with severe ptosis and diplopia
A 72-year-old with nystagmus and Bell palsy

Show answer

Answer: 2

Rationale:
Participating in physical contact sports puts this person at the highest risk for retinal detachment because trauma is a leading cause. The other pathologies (amblyopia, ptosis, diplopia, nystagmus, and Bell’s palsy) will affect eye function but have minimal likelihood of causing retinal detachment.

Practice Question Sourced From: Zerwekh: Illustrated Study Guide for the NCLEX-RN Exam, 9th Edition (Sensory: Care of Adult and Pediatric Clients, Ch. 12, pg. 250, Question 10)

NCLEX Exam Practice Question of the Week - 5/1/19

Oxygen by nasal cannula at 4 L/minute is prescribed for a hospitalized client. The nurse should perform which actions in the care of the client? Select all that apply.

Humidify the oxygen.
Apply water-soluble lubricant to the nares.
Instruct the client to breathe through the nose only.
Instruct the client and family about the purpose of the oxygen.
Increase the oxygen flow if the client complains of dryness in the nares

Show answer

Answer: 1,2,4

Rationale:
The nasal cannula provides for lower concentrations of oxygen and can even be used with mouth breathers because movement of air through the oropharynx pulls oxygen from the nasopharynx. The nurse should humidify the oxygen and apply water-soluble lubricant to the nares to prevent and treat dryness. The nurse should also instruct the client and family regarding the purpose of the oxygen. It is not necessary to instruct a client to breathe only through the nose. It is unnecessary and potentially harmful to increase the oxygen flow; this action requires a primary health care provider’s prescription. Additionally, increasing the flow of oxygen will contribute further to dryness of the nares.

Practice Question Sourced From: Silvestri: Saunders 2018-2019 Strategies for Test Success, 5th Edition (Fundamentals of Care Questions, Ch. 13, pg. 126, Question 9)

NCLEX Exam Practice Question of the Week - 4/24/19

A nurse identifies that a client’s hemoglobin level is decreasing and is concerned about tissue hypoxia. An increase in what diagnostic test result indicates an acceleration in oxygen dissociation from hemoglobin?

pH
Po2
Pco2
HCO3

Show answer

Answer: 3

Rationale:
3 - The lower the Po2 and the higher the Pco2, the more rapidly oxygen dissociates from the oxyhemoglobin molecule.

1 - The pH will decrease with an increase in CO2 pressure.
2 - An increase in Po2 will not increase oxygen dissociation from hemoglobin.
4 - Oxygen dissociation will decrease with an increase in HCO3.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Pharmacology (Respiratory Drugs, Ch. 15, pg. 309, Question 3)

NCLEX Exam Practice Question of the Week - 4/17/19

An infant who has had diarrhea for 3 days is admitted in a lethargic state and is breathing rapidly. The parent states that the baby has been ingesting formula, although not as much as usual, and cannot understand the sudden change. What explanation should the nurse give the parent?

Cellular metabolism is unstable in young children.
The proportion of water in the body is less than in adults.
Renal function is immature in children until they reach school age.
The extracellular fluid requirement per unit of body weight is greater than in adults.

Show answer

Answer: 4

Rationale:
4 - The extracellular body fluid represents 45% at birth, 25% at 2 years of age, and 20% at maturity. Another measurement is fluid’s percentage of total body weight, which is 80% at birth, 63% at 3 years, and approximately 60% at 12 years.

1 - Cellular metabolism in children is stable, but its rate is higher than that in adults.
2 - The proportion of total body water in children (up to 2 years) is greater than it is in adults.
3 - Renal function is immature through the second year of life, not until school age, which makes it more difficult to maintain fluid balance.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Pediatrics (Growth, Development, and Physical Assessment, Ch. 2, pg. 18, Question 2)

NCLEX Exam Practice Question of the Week - 4/10/19

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply.

Hypoglycemia may be experienced before dinnertime.
The insulin dose should be decreased if illness occurs.
The insulin should be administered at room temperature.
The insulin vial needs to be shaken vigorously to break up the precipitates.
The NPH insulin should be drawn into the syringe first, then the regular insulin.

Show answer

Answer: 1,3

Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 30 to 60 minutes, it peaks in 1 to 5 hours, and its duration is 6 to 10 hours. Hypoglycemic reactions most likely occur during peak time. Insulin should be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials should never be shaken vigorously. Regular insulin is always drawn up before NPH.

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Adult - Endocrine, Ch. 51, pg. 664, Question 575)

NCLEX Exam Practice Question of the Week - 4/3/19

A 42-year-old client has an amniocentesis during the 16th week of gestation because of concern about Down syndrome. What additional information about the fetus will examination of the amniotic fluid reveal at this time?

Lung maturity
Type 1 diabetes
Cardiac anomaly
Neural tube defect

Show answer

Answer: 4

Rationale:
4 - Alpha-fetoprotein in amniotic fluid is elevated in the presence of a neural tube defect.

1 - Lung maturity cannot be determined until after 35 weeks’ gestation.
2 - Diabetes cannot be detected via an amniocentesis.
3 - Cardiac disorders cannot be detected via an amniocentesis.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Maternity (Assessment of High-Risk Pregnancy, Ch. 5, pg. 59, Question 5)

NCLEX Exam Practice Question of the Week - 3/27/19

A client who has been told she needs a hysterectomy for cervical cancer is upset about being unable to have a third child. What is the next nursing action?

Evaluate her willingness to pursue adoption
Encourage her to focus on her own recovery
Emphasize that she does have two children already
Ensure that other treatment options for her will be explored

Show answer

Answer: 4

Rationale:
Although a hysterectomy may be performed, conservative management may include cervical conization and laser treatment that do not preclude future pregnancies; clients have a right to be informed by their health care provider of all treatment options.
1 - Evaluating her willingness to pursue adoption currently is not the issue for the client.
2 - Encouraging her to focus on her own recovery negates the client’s feelings.
3 - Emphasizing that she has two children already negates the client’s feelings.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Mental Health (Legal and Ethical Issues, Ch. 4, pg. 54, Question 9)

NCLEX Exam Practice Question of the Week - 3/20/19

The nurse prepares to insert a nasogastric tube in a client with hyperemesis who is awake and alert. Which intervention(s) is(are) correct? (Select all that apply.)

Place the client in a high Fowler position.
Help the client assume a left side-lying position.
Measure the tube from the tip of the nose to the umbilicus.
Instruct the client to swallow after the tube has passed the pharynx.
Assist the client in extending the neck back so the tube may enter the larynx.

Show answer

Answer: A,D

Rationale:
(A and D) are the correct steps to follow during nasogastric intubation. Only the unconscious or obtunded client should be placed in a left side-lying position (B). The tube should be measured from the tip of the nose to behind the ear and then from behind the ear to the xiphoid process (C). The neck should only be extended back prior to the tube passing the pharynx and then the client should be instructed to position the neck forward (E).

Practice Question Sourced From: HESI Comprehensive Review for the NCLEX-RN Examination, 5e (Evolve Resources - Fundamentals)

NCLEX Exam Practice Question of the Week - 3/13/19

The primary health care provider has prescribed a cleansing enema for an adult client. The nurse provides directions to a nursing student who is trained to administer enemas and should tell the student that the maximum volume of fluid that can be administered is which volume?

100 mL
300 mL
500 mL
1000 mL

Show answer

Answer: 4

Rationale:
Cleansing enemas promote complete evacuation of feces from the colon. They act by stimulating peristalsis through the infusion of a large volume of solution or through local irritation of the colon’s mucosa. For an adult client, 750 to 1000 mL is used. Therefore, the maximum volume of solution for an adult is 1000 mL.

Practice Question Sourced From: Silvestri: Saunders 2018-2019 Strategies for Test Success, 5th Edition (Leadership/Management Questions, Ch. 20, pg. 224, Question 186)

NCLEX Exam Practice Question of the Week - 3/6/19

The nurse is conducting a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings should the nurse expect to note? Select all that apply.

Pathological fracture
Urinalysis positive for nitrites
Hemoglobin level of 15.5 g/dL (155 mmol/L)
Calcium level of 8.6 mg/dL (2.15 mmol/L)
Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L)

Show answer

Answer: 1,2,5

Rationale:
Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. The client with malignant melanoma may experience pathologic fractures, hypercalcemia, anemia, recurrent infections, and renal failure. A serum calcium level of 8.6 mg/dL (2.15 mmol/L) and a hemoglobin level of 15.5 g/dL (155 mmol/L) are normal values. Therefore, the correct answers are pathological fractures, positive urinalysis for nitrites, and a serum creatinine level of 2.0 mg/dL (176.6 mcmol/L).

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Adult - Oncological, Ch. 48, pg. 607, Question 516)

NCLEX Exam Practice Question of the Week - 2/27/19

What is the most important observation a nurse makes with an adolescent diagnosed with an adjustment disorder?

Depressive symptoms
Manic symptoms
Risk for suicide
Anger and aggression

Show answer

Answer: 3

Rationale:
3 - Risk for suicide is the most important observation in clients with an adjustment disorder.
1 - Depressive symptoms, though common, are not the most important observation in clients with an adjustment disorder.
2 - Manic symptoms are not the most important observation in clients with an adjustment disorder.
4 - Anger and aggression, though important, are not the most important observation in clients with an adjustment disorder.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Mental Health (Trauma-Related and Stress-Related Disorders, Ch. 19, pg. 373, Question 8)

NCLEX Exam Practice Question of the Week - 2/20/19

A 5-week-old infant is admitted to the hospital with a tentative diagnosis of a congenital heart defect. The infant tires easily and has difficulty breathing and feeding. In what position should the nurse place this infant?

Supine with the knees flexed
Orthopneic with pillows for support
Side-lying with the upper body elevated
Prone with the head supported by pillows

Show answer

Answer: 3

Rationale:
With the head and chest elevated, gravity promotes respiratory excursion; alternating side-lying positions allows for pulmonary drainage and expansion. Placing the infant in an infant seat helps to maintain these positions.
1 - The supine position with the knees flexed causes the abdominal viscera to put pressure on the diaphragm, thereby impeding lung expansion.
2 - It is difficult to maintain a 5-week-old infant in orthopneic position with pillows for support; in addition, this position will not promote rest.
4 - The prone position with the head supported by pillows will make it difficult for the lungs to expand, causing difficulty in breathing. The prone position is contraindicated for all infants because of its relationship to sudden infant death syndrome (SIDS).

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Pediatrics (Care of the Child with Cardiac Problems, Ch. 13, pg. 220, Question 24)

NCLEX Exam Practice Question of the Week - 2/13/19

The client has been prescribed oxcarbazepine. Which nursing assessments are of particular importance to a client prescribed iminostilbene therapy for a seizure disorder? Select all that apply.

Eye
Skin
Hearing
Hematologic
Gastrointestinal

Show answer

Answer: 1,2,4

Rationale:
Iminostilbene therapy increases the client’s risk for the development of eye related problems like diplopia, blurred vision, photosensitivity, and the exacerbation of glaucoma. Iminostilbene therapy also raises the risk for rashes and urticaria making a skin assessment a priority. Finally, the client is at risk for thrombocytopenia, leukopenia, leukocytosis, eosinophilia, agranulocytosis, and anemia.
3 - Iminostilbene therapy is not known to pose a significant risk to hearing.
5 - Although vomiting (GI related) may occur, generally all clients have a gastrointestinal assessment.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Pharmacology (Antiepileptic Drugs, Ch. 4, pg. 67, Question 17)

NCLEX Exam Practice Question of the Week - 2/6/19

The nurse is developing an educational session on client advocacy for the nursing staff. The nurse should include which interventions as examples of the nurse acting as a client advocate? Select all that apply.

Obtaining an informed consent for a surgical procedure
Providing information necessary for a client to make informed decisions
Providing assistance in asserting the client’s human and legal rights if the need arises
Including the client’s religious or cultural beliefs when assisting the client in making an informed decision
Defending the client’s rights by speaking out against policies or actions that might endanger the client’s well-being

Show answer

Answer: 2,3,4,5

Rationale:
In the role of client advocate, the nurse protects the client’s human and legal rights and provides assistance in asserting those rights if the need arises. The nurse advocates for the client by providing information needed so that the client can make an informed decision. The nurse needs to consider the client’s religion and culture when functioning as an advocate and when providing care. The nurse would include the client’s religious or cultural beliefs in discussions about treatment plans so that an informed decision can be made. The nurse also defends clients’ rights in a general way by speaking out against policies or actions that might endanger the client’s well-being or conflict with his or her rights. Informed consent is part of the primary health care provider–client relationship; in most situations, obtaining the client’s informed consent does not fall within the nursing duty. Even though the nurse assumes the responsibility for witnessing the client’s signature on the consent form, the nurse does not legally assume the duty of obtaining informed consent.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7e (Safe amd Effective Care Environment, Test 2, Question 401, Page 189)

NCLEX Exam Practice Question of the Week - 1/30/19

Nurses who care for the terminally ill apply the theories of Kübler-Ross in planning care. According to Kübler-Ross, individuals who experience a terminal illness go through a grieving process. Place the stages of this process in the order identified by Kübler-Ross.

Anger
Denial
Bargaining
Depression
Acceptance

Show answer

Answer: 2,1,3,4,5

Rationale:
2 - The initial response is shock, disbelief, and denial, and the client seeks additional opinions to negate the diagnosis.
1 - When negating the diagnosis is unsuccessful, the client becomes angry and negative.
3 - Bargaining for wellness follows in an attempt to prolong life.
4 - As the reality of the situation becomes more apparent, depression sets in and the client may become withdrawn.
5 - Acceptance is the final stage of grieving; this stage may never be achieved.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Maternity (Perinatal Loss, Bereavement, and Grief, Ch. 20, pg. 329, Question 4)

Preparing for the Exit Exam

Written by Rashana Mahamane.

When it’s time to take the exit exam, many of us begin to feel overwhelmed. No matter which exit exam you’re taking, it’s a lot of material to cover and somehow remember for the exam. But, don’t stress!

A good study plan and study materials are all you need. The best thing you can do is identify your weak areas, meaning the information you remember the least. It’s also important to know your strong areas. How do you accomplish this? Take a practice exam. If you have the NCLEX Saunders book for RN or LPN/LVN, then you’re in luck because the online portion of the book comes with a pre- and post-test for the NCLEX. After taking the pre-test, you get results that pinpoint the subjects in which you’re strong and weak. The analysis of the exam is pretty detailed and creates a personalized, 6-week study guide that puts the different subjects in the order of your weaknesses (what you should concentrate on first, next, etc.). If you follow this schedule, a lot of the stress that comes with preparing for the exam will hopefully subside.

If you don’t have the book, that’s okay. Take an online practice test and review the material you got right and wrong. Pay attention to the areas where you missed the most questions. For example, maybe maternity, pediatrics, or cardiology. Based on the number of questions you missed, arrange the content in priority order from the subject where you missed the most questions to the subject where you missed the fewest questions. This organization will allow you to strengthen your weak areas and increase your chances of passing the test on the next try.

In addition to the pre- and post-tests, there are many practice questions available online. Those questions allow you to quiz yourself on the information as you study, enabling you to see how well you grasp the material. Once again, if you don’t have the book with access to the online practice questions, you can use any nursing quizzing program you may have purchased during your nursing program.

If you follow these tips on preparing for the exam, I have faith that you can ace it. Remember to challenge yourself, but don’t compare yourself to others. Wishing you all the success in the world!

NCLEX Exam Practice Question of the Week - 1/23/19

The nurse is planning the client assignments for the day. Which client should the nurse assign to the unlicensed assistive personnel (UAP)?

A client on strict bed rest
A client scheduled for discharge to home
A client scheduled for a cardiac catheterization
A postoperative client who had an emergency appendectomy

Show answer

Answer: 1

Rationale:
The nurse is legally responsible for client assignments and must assign tasks based on the guidelines of nurse practice acts and the job descriptions of the employing agency. A client scheduled for discharge to home, a client scheduled for a cardiac catheterization, or a postoperative client who had an emergency appendectomy has both physiological and psychosocial needs that require care by a licensed nurse. The UAP has been trained to care for a client on bed rest. The nurse provides instruction to the UAP, but the tasks required are within the role descriptions of a UAP.

Practice Question Sourced From: Silvestri: Saunders 2018-2019 Strategies for Test Success, 5th Edition (Delegating/Prioritizing Questions, Ch. 19, pg. 213, Question 168)

NCLEX Exam Practice Question of the Week - 1/16/19

A client is brought to the emergency department with partial-thickness burns to his face, neck, arms, and chest after trying to put out a car fire. The nurse should implement which nursing actions for this client? (Select all that apply)

Restrict fluids.
Assess for airway patency.
Administer oxygen as prescribed.
Place a cooling blanket on the client.
Elevate extremities if no fractures are present.
Prepare to give oral pain medication as prescribed.

Show answer

Answer: 2,3,5

Rationale:
The primary goal for a burn injury is to maintain a patent airway, administer intravenous (IV) fluids to prevent hypovolemic shock, and preserve vital organ functioning. Therefore, the priority actions are to assess for airway patency and maintain a patent airway. The nurse then prepares to administer oxygen. Oxygen is necessary to perfuse vital tissues and organs. An IV line should be obtained and fluid resuscitation started. The extremities are elevated to assist in preventing shock and decrease fluid moving to the extremities, especially in the burn-injured upper extremities. The client is kept warm since the loss of skin integrity causes heat loss. The client is placed on NPO (nothing by mouth) status because of the altered gastrointestinal function that occurs as a result of a burn injury.

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Adult - Integumentary, Ch. 46, pg. 563, Question 486)

Staying Stress-Free in Nursing School

Written by Joy Clark.

Now this may seem like a laughing matter for some, but I think it's something that can be (at least in part) attained.

My last blog piece was on living a balanced life, managing time wisely and making time for the things you enjoy. Those things may assist me in being stress free but there is more that goes into living stress free.

I actually wrote a research paper last year on the effects of stress in nursing school. Qualitatively, we assessed the positive and negative behaviors that developed due to stress. Surprisingly, exercise and healthy eating seemed to remain unchanged. However, a troubling change in sleep patterns emerged. The most distressing example of this, came from a student who reported that each night before an exam they would wake up every fifteen minutes to check the clock, despite setting six alarms.

The results of the study, aside from the change in sleep patterns, were fairly positive. We concluded that everyone found a way to manage their stress somehow but that no two-people managed it the same. I acknowledge that some level of stress is good. It enables us to push through for those all-nighters or make important, quick decisions. Yet living with constant stress is unhealthy, and leaves us feeling drained.

Let me briefly describe my own struggles with stress and share a few tips that I have found to be life-saving.

I’ll begin by stating I have never failed to turn an assignment in on time…yet. However, this past September I was more disorganized than I had ever been. Due dates loomed over my head and I felt unprepared for every one of them. I was not prioritizing my education and I felt like I was finishing my senior year strictly out of obligation. I was continuously fatigued. Finally, after complaining about the mountains of work I had and consistent stress, a good friend reminded me who I was.

I am an organizer. She encouraged me to make my lists and fill my calendars. Previously, I assumed I had so little time that I couldn't take time to plan. However, taking ten minutes to spend with my syllabi and daily planner so I could organize my assignments brought immediate peace.

I like to say that my house depicts my mind; when it is in a disarray, so am I. Yet, when it is clean and tidy I feel calm and organized. I lie to myself constantly saying that I don't have time to put my clothes away. Inevitably, it doesn't take long for piles of laundry to collect on my floor. Somehow, it only takes five minutes to actually put them away and I always feel so relieved when I’m finished.

There are many more things that can reduce your stress. Planning a girl’s night out, a night in, date night, studying ahead of time, getting assignments/group projects done ahead of time, even positive thinking can make a major difference in our week, and the list goes on and on. Every person is unique. If being an uptight planner doesn't work for you, that is ok! While nothing is going to take away pre-exam jitters, organization is what has made a big difference for me. I advise you to explore different techniques and find what works for you.

Wishing you a happy, less stressful, New Year!

NCLEX Exam Practice Question of the Week - 1/9/19

The nurse is assessing a client suspected of having a rib fracture. Which typical signs/symptoms should the nurse observe for?

Pain on expiration, deep rapid respirations
Pain on inspiration, deep rapid respirations
Pain on expiration, shallow guarded respirations
Pain on inspiration, shallow guarded respirations

Show answer

Answer: 4

Rationale:
The client with fractured ribs typically has pain over the fracture site with inspiration and to palpation. Respirations are shallow, and guarding of the area is often noted. Bruising may or may not be present. Therefore, the remaining options are incorrect.

Practice Question Sourced From: Silvestri: Saunders Q&A Review for the NCLEX-RN Examination, 7e (Comprehensive Test, Test 6, Question 1328 Page 588)

NCLEX Exam Practice Question of the Week - 1/2/19

A patient who was recently diagnosed with conversion disorder is experiencing a sudden loss of vision after witnessing a violent fight between her husband and adult-age son. What is the priority therapeutic approach to use with this patient?

Reassure her that her blindness is temporary and will resolve with time
Gently point out that she seems to be able to see well enough to function independently
Encourage expression of feelings and link emotional trauma to the blindness
Teach ways to cope with blindness, such as methodically arranging personal items

Show answer

Answer: 4

Rationale:
Patients with conversion disorders are experiencing symptoms, even though there is no identifiable organic cause; therefore, the patient should be assisted in learning ways to cope and live with the disability. Encouraging the expression of feelings is okay, but it is premature to expect the patient to link the fight to her blindness. It is likely that the sudden onset of blindness will quickly resolved. The patient may physically be able to see, but presenting facts would not be helpful at this time.

Practice Question Sourced From: LaCharity: Prioritization, Delegation, and Assignment, 4e (Chapter 22, Question 4, Page 196)

NCLEX Exam Practice Question of the Week - 12/26/18

Which sign/symptom indicates that a client being treated with haloperidol may be experiencing an adverse effect of this medication?

Nausea
Hypotension
Blurred vision
Excessive drooling

Show answer

Answer: 4

Rationale:
Adverse effects of antipsychotic medications such as haloperidol include marked drowsiness and lethargy; extrapyramidal symptoms, including parkinsonism effects (drooling); dystonias; akathisia; and tardive dyskinesia. The correct option is a parkinsonism effect of this medication, excessive drooling. Nausea, hypotension, and blurred vision are occasional side effects of the medication.

Practice Question Sourced From: Selvestri: Saunders Q&A Review for the NCLEX-RN Examination, 7e (Comprehensive Test, Test 6, Question 1265 Page 566)

NCLEX Exam Practice Question of the Week - 12/19/18

A client's medical record states a history of intermittent claudication. In collecting data about this symptom, the nurse should ask the client about which symptom?

Chest pain that is dull and feels like heartburn
Leg pain that is sharp and occurs with exercise
Chest pain that is sudden and occurs with exertion
Leg pain that is achy and gets worse as the day progresses

Show answer

Answer: 2

Rationale:
Intermittent claudication is a symptom characterized by a sudden onset of leg pain that occurs with exercise and is relieved by rest. It is the classic symptom of peripheral arterial insufficiency. Chest pain can occur for a variety of reasons, including indigestion or angina pectoris. Venous insufficiency is characterized by an achy type of leg pain that intensifies as the day progresses.

Practice Question Sourced From: Silvestri: Saunders Q&A Review for the NCLEX-RN Examination, 7e (Comprehensive Test, Test 6, Question 1315 Page 584)

NCLEX Exam Practice Question of the Week - 12/12/18

A patient diagnosed with hypertension has received the first dose of lisinopril. Which interventions will the RN delegate to the unlicensed assistive personnel (UAP)? Select all that apply.

Restrict the patient to bed rest for at least 12 hours
Recheck the patient's vital signs every 4 to 8 hours
Ensure that the patient's call light is within easy reach
Keep the patient's bed in a supine position with all side rails up
Remind the patient to rise slowly from the bed and sit before standing
Assist the patient to get out of bed and use the bathroom
Assess the patient for signs of dizziness

Show answer

Answer: 2, 3, 5, 6

Rationale:
After the first dose of most antihypertensive drugs, dizziness is a common side effect. The patient should call for help when getting out of bed, and the call light should be within easy reach. The patient should rise slowly, sitting on the side of the bed before standing, and then can be assisted to the bathroom. The UAP's scope of practice includes these actions. Patients are not restricted to bed rest or kept in a supine (flat) position, and side rails are not all kept up for safety of the patient. Assessment is not within the scope of practice for a UAP. However, the RN could instruct the UAP to ask the patient about dizziness before and during ambulation and then report any dizziness immediately to the RN.

Practice Question Sourced From: LaCharity: Prioritization, Delegation, and Assignment, 4e (Chapter 20, Question 11, Page 179)

NCLEX Exam Practice Question of the Week - 12/5/18

The nurse caring for a child diagnosed with rubeola (measles) notes that the primary health care provider has documented the presence of Koplik's spots. On the basis of this documentation, which observation is expected?

Pinpoint petechiae noted on both legs
Whitish vesicles located across the chest
Petechiae spots that are reddish and pinpoint on the soft palate
Small, blue-white spots with a red base found on the buccal mucosa

Show answer

Answer: 4

Rationale:
In rubeola (measles), Koplik's spots appear approximately 2 days before the appearance of the rash. These are small, blue-white spots with a red base that are found on the buccal mucosa. The spots last approximately 3 days, after which time they slough off. Based on this information, the remaining options are all incorrect.

Practice Question Sourced From: Silvestri: Saunders Q&A Review for the NCLEX-RN Examination, 7e (Chapter 6, Test 5, Question 1089 Page 498)

NCLEX Exam Practice Question of the Week - 11/28/18

After a radical prostatectomy, a client is ready to be discharged. Which nursing action included in the discharge plan should be assigned to an experienced LPN/LVN?

Reinforcing the client's need to check his temperature daily
Teaching the client how to care for his retention catheter
Documenting a discharge assessment in the client's chart
Instructing the client about the prescribed narcotic analgesic

Show answer

Answer: 1

Rationale:
Reinforcement of previous teaching is an expected role of the LPN/LVN. Planning and implementing client initial teaching and documentation of a client's discharge assessment should be performed by experienced RN staff members.

Practice Question Sourced From: LaCharity: Prioritization, Delegation, and Assignment, 4e (Chapter 17, Question 11, Page 147)

NCLEX Exam Practice Question of the Week - 11/21/18

The nurse has provided home care instructions to a client with prostate cancer who has been hospitalized for a transurethral resection of the prostate (TURP). Which statement by the client indicates the need for further teaching?

“Prune juice needs to be included in my diet.”
“I need to avoid strenuous activity for 4 to 6 weeks.”
“My intake of water needs to be at least 6 to 8 glasses daily.”
“I can't lift or push objects that weigh more than 30 pounds.”

Show answer

Answer: 4

Rationale:
The client needs to be advised to avoid strenuous activity for 4 to 6 weeks and avoid lifting items that weigh more than 20 pounds. Straining during defecation is avoided to prevent bleeding. Prune juice is a satisfactory bowel stimulant. The client needs to consume a daily intake of at least 6 to 8 glasses of nonalcoholic fluids to minimize clot formation.

Practice Question Sourced From: Silvestri: Saunders Q&A Review for the NCLEX-RN Examination, 7e (Chapter 6, Test 5, Question 1066, Page 489)

Embracing the Work/Life/School Balance

Written by Meagan MacDonald.

Balancing a family, nursing school, and trying to have some sort of social life is not easy. Nursing school on its own requires so much time and dedication, plus having a family to take care of sometimes makes me wonder how I can get everything done.

When I feel completely overwhelmed I’ve found it’s best to leave the house, and either go to school or the public library. This separation between school and home makes assignments easier to complete since there’s less distractions. To be honest, most of my studying at home is done after everyone is asleep. For example, I have a 12-hour clinical, I get home, cook dinner, get the baby fed and ready for bed, then do some homework and get to bed at some point. Talk about a busy day? What is important for you to realize is that it’s all manageable.

After a long day in clinical, it’s nice to come home, take a breath, and hang out with my boys. This time stands as a reminder as to why I work so hard and do what I do. My husband works until 6 at night and leaves for work around 5:30 in the morning, so we both have very long days. After everyone is settled, and I finally do get to sit down to study, the house is quiet, and it’s time for me to accomplish what I need to for school.

My recommendation to anyone beginning nursing school would be to find that time slot, whether its early in the morning or after everyone goes to bed, to give yourself time to get your school work done and prepare for what you need. Also, don’t forget to give yourself some “me” time. Whether it’s watching your favorite tv show or getting your nails done, find time to do things that you enjoy and make time to relax.

I know balancing nursing school with the day-to-day sounds tough (and believe me it is), but it is totally possible and completely worth it.

NCLEX Exam Practice Question of the Week - 11/14/18

The nurse is caring for a patient who has just undergone hypophysectomy for hyperpituitarism. Which postoperative finding requires immediate intervention?

Presence of glucose in the nasal drainage
Presence of nasal packing in the nares
Urine output of 40 to 50 mL/hr
Patient reports of thirst

Show answer

Answer: 1

Rationale:
The presence of glucose in nasal drainage indicates that the fluid is cerebrospinal fluid (CSF) and suggests a CSF leak. Packing is normally inserted in the nares after the surgical incision is closed. Urine output of 40 to 50 mL/hr is adequate, and patients may experience thirst postoperatively. When patients are thirsty, nursing staff should encourage fluid intake.

Practice Question Sourced From: LaCharity: Prioritization, Delegation, and Assignment, 4e (Chapter 14, Question 13, Page 125)

NCLEX Exam Practice Question of the Week - 11/7/18

The nurse is conducting a cultural and spiritual assessment on a newly admitted client. Which factors specifically related to culture and spirituality should the nurse address? Select all that apply.

Nutrition
Communication
Insurance coverage
High-risk behaviors
Health care practices
Family roles and organization

Show answer

Answer: 1, 2, 4, 5, 6

Rationale:
When performing a cultural and spiritual assessment, the nurse should focus on the following factors: nutrition, communication, high-risk behaviors, health care practices, family roles and organizations, workforce issues, biocultural ecology, overview (e.g., heritage), pregnancy and childbirth practices, death rituals, spirituality preferences, and health care practitioners. Asking the client about insurance coverage is not specifically related to culture or spiritual practices.

Practice Question Sourced From: Silvestri: Saunders Q&A Review for the NCLEX-RN Examination, 7e (Chapter 6, Test 5, Question 1052, Page 483)

NCLEX Exam Practice Question of the Week - 10/31/18

The charge nurse observes an LPN/LVN assigned to provide all of these interventions for a patient with Paget disease. Which action requires that the charge nurse intervene?

Administering 600 mg of ibuprofen to the patient
Encouraging the patient to perform exercises recommended by a physical therapist
Applying ice and gentle massage to the patient's lower extremities
Reminding the patient to drink milk and eat cottage cheese

Show answer

Answer: 3

Rationale:
Applying heat, not ice, is the appropriate measure to help reduce the patient's pain. Ibuprofen is useful to manage mild to moderate pain. Exercise prescribed by a physical therapist would be nonimpact in nature and provide strengthening for the patient. A diet rich in calcium promotes bone health.

Practice Question Sourced From: LaCharity: Prioritization, Delegation, and Assignment, 4e (Chapter 11, Question 6, Page 99)

NCLEX Exam Practice Question of the Week - 10/24/18

A client diagnosed with angina pectoris appears to be very anxious and states, “So, I had a heart attack, right?” Which response should the nurse make to the client?

“No. That is not why you are hospitalized.”
“No, but there could be some minimal damage to your heart.”
“No, not this time and we will do our best to prevent a future heart attack.”
“No, but it's necessary to monitor you and control or eliminate your pain.”

Show answer

Answer: 4

Rationale:
Angina pectoris occurs as a result of an inadequate blood supply to the myocardium causing pain; managing the condition will help address the client's pain. The nurse will want to correct the client's misconception regarding a heart attack while addressing the client's concerns. Option 1 does not address the client's concerns. Option 2 is not correct because angina involves interrupted blood supply but does not result in cardiac tissue damage. Neither the nurse nor the primary health care provider can guarantee that a heart attack will not occur as option 3 seems to indicate.

Practice Question Sourced From: Saunders Q&A Review for the NCLEX-RN Examination, 7e (Chapter 6, Test 5, Question 1039, Page 476)

Life Hacks: Nursing Student Edition

Written by Ari Anderson.

There is no question that life as a nursing student is nothing short of busy; somedays there is barely enough time in the day to eat and sleep! We can probably all agree that if we could stretch our day more than 24 hours or freeze time for a bit to accomplish all our tasks with ease, we absolutely would. Since this is not a possibility.... yet, here are some ‘nursing student life-hacks’ that I have picked up along the way that have really helped me with time management during my schooling.

Buy A Planner- A planner can help you to write out everything that needs to be done for the day, so you can decide how and when to tackle each task.
Print Out A ‘Semester Calendar’- Visualizing what you are responsible for completing throughout the semester such as exams, projects, papers, practical, and anything else is helpful when trying to plan your schedule. It can make coming up with work and social calendars easier when you know what can’t be changed or moved around, to prevent scheduling conflicts from occurring.
Pack Your Bag the Night Before- Before you go to bed for the night, make sure your school bag, gym bag, work bag, or any other bags you may need are packed and ready to go, so you don’t spend time searching for things in the morning when you have limited time. It also lowers the chance that you will forget something...like your Stethoscope!
Meal Prep All Your Meals for The Week- It really cuts down on the time it takes to cook or prepare a few meals a day when you prepare all your meals at one time and store them in the fridge. You can just ‘grab-and-go’ during the week, instead of spending time doing one meal at a time, three times a day. For our Supermoms (and Superdads) out there who are cooking for more than one/ two, casserole dishes or a rotisserie chicken is a great option that can feed your whole family for a few days.
Ask for Help- Don’t be afraid to ask a spouse, older children, family members, or roommates to pitch in a little more when you’re extra busy during the school year, before an exam, or whenever you feel overwhelmed! Family members are there to support you and help you out when they can; communicate with them so you have some relief from chores, cooking, or other responsibilities when you need it.
Study Efficiently- Don’t try to pull an all-nighter before the exam or just start studying the material a day or two before the exam. Try to set daily, uninterrupted study time aside for a few hours a day, starting after the respective lecture. Turning the phone off for a couple hours a day and dedicating yourself to your lecture material before you’re pressed for time is so much more effective that spending an entire day cramming before the exam.
Don’t Over-Commit- Sometimes, you have to just say no. Unfortunately, that leisurely event or get together with friends might need to wait for when your schedule has opened up or during time off from school.
Work Smart- Have your school schedule on hand when planning your work schedule. If possible, try to decrease your work schedule during the school year, especially during exams. If this is not an option, try not to schedule a shift before an exam, on the same day as a mandatory nursing event, or practical assessment. Collaborate with people on your unit or at your job so you can switch if necessary.
Study While You Work Out- If you are doing cardio, such as walking on the treadmill or using an elliptical, this is a great time to drag your notes along with you and review while getting exercise!
Follow a Routine- Following a similar daily routine helps to condition yourself to getting certain tasks done at a certain time because you will become used to it. Knowing that you have certain responsibilities to complete by a certain time each day can help you to stay on task.
Take Time for Mindfulness- A few minutes a day to sit aside and meditate, relax, and de-stress can really help you stay focused and not get overwhelmed. I personally like to meditate for 30 minutes at the end of my day to make sure I am tending to my mental/spiritual needs as well.

Each student has certain things they do to help them achieve their necessary tasks daily. Some things work and some don’t for certain types of people and their way of accomplishing them. What are some things you’ve learned in nursing school that help you? Share them with us!

NCLEX Exam Practice Question of the Week - 10/17/18

A patient in a long-term care facility who has anemia reports chronic fatigue and dizziness with minimal activity. Which nursing activity will the nurse delegate to the unlicensed assistive personnel (UAP)?

Evaluating the patient's response to normal activities of daily living
Obtaining the patient's blood pressure and pulse with position changes
Determining which self-care activities the patient can do independently
Assisting the patient in choosing a diet that will improve strength

Show answer

Answer: 2

Rationale:
UAP education covers routine nursing skills such as assessment of vital signs. Evaluation, baseline assessment of patient abilities, and nutrition planning are activities appropriate to RN practice.

Practice Question Sourced From: LaCharity: Prioritization, Delegation, and Assignment, 4e (Chapter 8, Question 20, Page 77)

NCLEX Exam Practice Question of the Week - 10/10/18

On assessment of a newborn being admitted to the nursery, the nurse palpates the anterior fontanel and notes that it feels soft. The nurse determines that this finding indicates which condition?

Dehydration
A normal finding
Increased intracranial pressure
Decreased intracranial pressure

Show answer

5 Ways to Keep from Procrastinating

Written by Alannah Davis.

Nursing school can be very overwhelming at times, and sometimes you would rather go shopping or watch a movie instead of studying for an exam. When this happens later that night or the next day you are frantically trying to get everything you need to do finished in order to feel semi-prepared for your exam or to turn your homework in on time. Generally, everyone is guilty of this, including myself. This creates copious amounts of unnecessary stress, and in my case, a lack of sleep when I already don’t get enough. I have finally learned my lesson about procrastinating after countless nights of barely sleeping. Below I have included 5 steps to help you keep from procrastinating:

GET A PLANNER! My planner is my life-saver. It is my best friend and is one of my most prized possessions. I write everything down in my planner so I never forget about a test or an assignment. My planner is color coated to help me keep up with what lecture I went over in class, what I have for homework, and anything I have to do outside of school.
Review the material you learn in class that night before you go to bed. This may sound silly, but I find this very helpful. I usually review my notes or the PowerPoint presentation that I had in lecture that day before I go to bed. This helps me learn the material and saves me a bunch of time when I go back to study for the test.
Create a routine. This helps me a ton because once I finally get in the habit of doing something it doesn’t seem as difficult. I try to balance my homework and social life, so I have a routine of finishing all of my nursing homework assignments on Sunday night. This way the rest of my week is clear for studying or doing clinical paperwork. For example, I know that on Tuesdays I do all my work for my non-nursing classes and on Thursdays and Fridays I complete all of my clinical paperwork. This keeps me from feeling overwhelmed if I have an extra assignment, or if I have other obligations for the week outside of school.
Study for the test AT LEAST two nights before. Before nursing school, I had always been able to study the night before a test and do perfectly fine but nursing school tests can be difficult. The more time you have to study, the better. I like to give myself two nights to read over the PowerPoints and my notes, and then I study a lot the day and night before the test. This method is how I retain the most information.
Have time to relax. Relaxing is important to keep yourself from feeling stressed and from shutting down mentally. It is important to give yourself a break. That way when you are doing your work or studying, you give it your full attention. I give myself a little time each night to relax. It could be going out to eat with my friends, taking a bubble bath, or even watching my favorite show on Netflix.

NCLEX Exam Practice Question of the Week - 10/3/18

The healthcare provider has written these orders for a client with a diagnosis of pulmonary edema. The client's morning assessment reveals bounding peripheral pulses, weight gain of 2 lb, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time?

Weigh the client every morning
Maintain accurate intake and output records
Restrict fluids to 1500 mL/day
Administer furosemide 40 mg IV push

Show answer

Answer: 4

Rationale:
Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchanges. Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other orders are important but not urgent.

Practice Question Sourced From: LaCharity: Prioritization, Delegation, and Assignment, 4e (Chapter 4, Question 6, Page 39)

NCLEX Exam Practice Question of the Week - 9/26/18

The nurse is teaching a client with a right-leg fracture who has a prescription for partial weight-bearing status how to ambulate with crutches. The nurse determines that the client demonstrates compliance with this restriction to prevent complications of the fracture if the client follows which direction?

Allows the right foot to only touch the floor
Does not bear any weight on the right leg/foot
Puts 30% to 50% of the weight on the right leg/foot
Puts 60% to 80% of the weight on the right leg/foot

Show answer

Answer: 3

Rationale:
The client who has partial weight-bearing status is allowed to place 30% to 50% of the body weight on the affected limb. Touchdown weight-bearing allows the client to let the limb touch the floor but not to bear weight. Non–weight-bearing status does not allow the client to let the limb touch the floor. There is no classification for 60% to 80% weight-bearing status. Full weight-bearing status involves placing full weight on the limb.

Practice Question Sourced From: Silvestri: Saunders Q&A Review for the NCLEX-RN Examination, 7e (Chapter 5, Test 3, Question 604, Page 281)

Making Yourself Marketable to Future Employers

Written by Kate Dookie.

As nursing students, we are constantly busy. We have virtual calendars, paper agendas, and to-do lists to keep track of our slightly chaotic lives. Towards the end of nursing school, we have the privilege of adding “study for the NCLEX” and “land my dream job” to the ever-growing list of tasks. After years of studying, we will begin to pursue careers as nurses. So, as soon-to-be-grads, how can we make ourselves marketable to potential employers?

First, begin to network while still in school. There are many professional organizations that will allow students to attend, such as the American Association of Critical Care Nurses or the Society of Pediatric Nurses. Many of these meetings offer education regarding their specific specialty, so you can add to your education as you network.

Second, evaluate your previous work experience. Even if you have not worked in healthcare, many job skills will ease your transition into nursing. Have you served in a restaurant? You’ve mastered time management. Have you worked in customer service? You have good people skills and can connect with guests (and patients). Have you worked in retail? Your organizational skills are sought after. These job skills are important to broadcast when you begin to write your resume.

Next, assess your clinical experience. Did you have a unit you loved learning on? Did you connect with a nurse or a nurse manager on that unit? When you are learning in a hospital setting, introduce yourself to the nurse manager and ask what they look for in new hires. Ask your preceptor questions and learn as much as you can about the unit’s procedures. When units hire a new graduate nurse, they want to make sure you are teachable.

Above everything else, don’t give up! Decide on your dream job, develop your resume, collect a few letters of recommendation, and remember that you have put in years of hard work and studying to land this job!

NCLEX Exam Practice Question of the Week - 9/19/18

A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported?

Hot, flushed feeling
Sudden chills and fever
Chest pain that occurs suddenly
Dyspnea when deep breaths are taken

Show answer

Answer: 3

Rationale:
The most common initial symptom in pulmonary embolism is chest pain that is sudden in onset. The next most commonly reported symptom is dyspnea, which is accompanied by an increased respiratory rate. Other typical symptoms of pulmonary embolism include apprehension and restlessness, tachycardia, cough, and cyanosis.

Test-Taking Strategy: Note the strategic word, most. Because pulmonary embolism does not result from an infectious process or an allergic reaction, eliminate options 1 and 2 first. To select between the correct option and option 4, look at them closely. Option 4 states dyspnea when deep breaths are taken. Although dyspnea commonly occurs with pulmonary embolism, dyspnea is not associated only with deep breathing. Therefore, eliminate option 4.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Respiratory System, Ch. 54, pg. 731, Question 639)

NCLEX Exam Practice Question of the Week - 9/12/18

The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse should assess which item based on priority?

Anxiety level of the client and family
Presence of a MedicAlert card for the client to carry
Knowledge of restrictions on postdischarge physical activity
Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver

Show answer

Answer: 4

Rationale:
The nurse who is caring for the client after insertion of an automatic internal cardioverter-defibrillator needs to assess device settings, similar to after insertion of a permanent pacemaker. Specifically, the nurse needs to know whether the device is activated, the heart rate cutoff above which it will fire, and the number of shocks it is programmed to deliver. The remaining options are also nursing interventions but are not the priority.

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition (Cardiovascular System, Ch. 56, pg. 791, Question 683)

Why Should You Get Involved?

Written by Justina Dreschler.

Getting involved in something takes time, effort and often times a financial commitment. Nursing school is a huge commitment in and of itself, so it’s easy to ask this question when it comes to leadership opportunities during nursing school.

Why should you get involved? Well, I can tell you from personal experience that it is worth the time, effort and energy! During my first semester of nursing school I was actively involved in my SNA chapter at my university. Before I knew it, I was approached by the previous President of the club and she encouraged me to run for a position and currently I am the President. I was not too sure about it at first because I was involved in other things and nursing school is already a big commitment. However, I am so glad that I chose to run because now I look back on all the opportunities that have come up because of my willingness to take a risk.

Some of the amazing benefits of being involved may include connections with local hospitals, professors, other staff at your university’s nursing school knowing who you are and willing to write recommendations, and the opportunity to attend conventions. In my time of being in a leadership position, I have been able to grow in my personal and professional skills as I interact with several different people to help coordinate events. I also have grown in public speaking as I have lead several meetings of up to 100 students, and spoke at different events in which hospital representatives attended. I have made a name for myself in the College of Nursing at my university and most professors know who I am and can see my work ethic by the amount of effort I put into the club. I have attended several conventions both on the state and national level and have been a delegate at both. I’ve been a part of national level change we make as the National Student Nurses’ Association when we vote on resolutions and join movements that are influential to give our patients the best quality of care we can.

Overall, I completely recommend getting involved because this blog post only scratches the surface of what I have gained from my time leading the SNA chapter at my university. I feel more qualified to take on the world of applying to several different hospitals as I have all this valuable experience under my belt. It may take some time and effort but it will pay off in the end!

NCLEX Exam Practice Question of the Week - 9/5/18

The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg appears fractured. Which intervention should the nurse take?

Try to reduce the fracture manually.
Assist the victim to get up and walk to the sidewalk.
Leave the victim for a few moments to call an ambulance.
Stay with the victim and encourage him or her to remain still.

Show answer

Answer: 4

Rationale:
With a suspected fracture, the victim is not moved unless it is dangerous to remain in that spot. The nurse should remain with the victim and have someone else call for emergency help. A fracture is not reduced at the scene. Before the victim is moved, the site of fracture is immobilized to prevent further injury.

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition (Musculoskeletal System, Ch. 64, pg. 952, Question 802)

NCLEX Exam Practice Question of the Week - 8/29/18

The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse plans care for the client, determining that this type of crisis could be caused by which event?

Witnessing a murder
The death of a loved one
A fire that destroyed the client's home
A recent rape episode experienced by the client

Show answer

Answer: 2

Rationale:
A situational crisis arises from external rather than internal sources. External situations that could precipitate a crisis include loss or change of a job, the death of a loved one, abortion, change in financial status, divorce, addition of new family members, pregnancy, and severe illness. Options 1, 3, and 4 identify adventitious crises. An adventitious crisis refers to a crisis of disaster, is not a part of everyday life, and is unplanned and accidental. Adventitious crises may result from a natural disaster (e.g., floods, fires, tornadoes, earthquakes), a national disaster (e.g., war, riots, airplane crashes), or a crime of violence (e.g., rape, assault, murder in the workplace or school, bombings, or spousal or child abuse).

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition (Crisis Theory and Intervention, Ch. 71, pg. 1038, Question 894)

NCLEX Exam Practice Question of the Week - 8/22/18

An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse prepare for the client?

Face tent
Venturi mask
Aerosol mask
Tracheostomy collar

Show answer

Answer: 2

Rationale:
The Venturi mask delivers the most accurate oxygen concentration. It is the best oxygen delivery system for the client with chronic airflow limitation such as chronic obstructive pulmonary disease, because it delivers a precise oxygen concentration. The face tent, aerosol mask, and tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.

Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition (Respiratory System, Ch. 54, pg. 731, Question 644)

NCLEX Exam Practice Question of the Week - 8/15/18

A client who just gave birth has three young children at home. She comments to the nursery nurse that she must prop the baby during feedings when she returns home because she has too much to do, and anyway holding babies during feedings spoils them. What is the nurse's best response?

“You seem concerned about time. Let's talk about it.”
“That's up to you because you have to do what works for you.”
“Holding the baby when feeding is important for development.”
“It is not safe to prop a bottle. The baby could aspirate the fluid.”

Show answer

Answer: 1

Rationale:
The nurse should suggest talking about the client's concern regarding the time. This opens up an area of communication to determine what really is troubling the mother about feeding her baby.

The nurse is aware that propping the baby during feedings is not the bet method when using a bottle to feed an infant; the problem of time should be explored with the mother.
Holding can be accomplished at times other than feeding periods; talking about the importance to development does not explore the client's feelings.
““It is not safe to prop a bottle.”” The baby could aspirate the fluid"" is true, but the mother should not be challenged so directly; a more gentle explanation should be offered.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Maternity (Nursing Care of the Family During the Postpartum Period, Ch. 14, pg. 227, Question 18)

NCLEX Exam Practice Question of the Week - 8/8/18

A client has refused to eat more than a few spoonfuls of breakfast. The health care provider has prescribed that tube feedings be initiated if the client fails to eat at least half of a meal because the client has lost a significant amount of weight during the previous 2 months. The nurse enters the room, looks at the tray, and states, “If you don't eat any more than that, I'm going to have to put a tube down your throat and get a feeding in that way.” The client begins crying and tries to eat more. Based on the nurse's actions, the nurse may be accused of which violation?

Assault
Battery
Slander
Invasion of privacy

Show answer

Answer: 1

Rationale:
Assault occurs when a person puts another person in fear of harmful or offensive contact and the victim fears and believes that harm will result as a result of the threat. In this situation, the nurse could be accused of the tort of assault. Battery is the intentional touching of another's body without the person's consent. Slander is verbal communication that is false and harms the reputation of another. Invasion of privacy is committed when the nurse intrudes into the client's personal affairs or violates confidentiality.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Comprehensive Test, pg. 1060, Question 961)

NCLEX Exam Practice Question of the Week - 8/1/18

A female victim of a sexual assault is being seen in the crisis center. The client states that she still feels “as though the rape just happened yesterday,” even though it has been a few months since the incident. Which is the most appropriate nursing response?

“You need to try to be realistic. The rape did not just occur.”
“It will take some time to get over these feelings about your rape.”
“Tell me more about the incident that causes you to feel like the rape just occurred.”
“What do you think that you can do to alleviate some of your fears about being raped again?”

Show answer

Answer: 3

Rationale:
The correct option allows the client to express her ideas and feelings more fully and portrays a nonhurried, nonjudgmental, supportive attitude on the part of the nurse. Clients need to be reassured that their feelings are normal and that they may express their concerns freely in a safe, caring environment. Option 1 immediately blocks communication. Option 2 places the client's feelings on hold. Option 4 places the problem solving totally on the client.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Crisis Theory and Intervention, Ch. 71, pg. 1039, Question 905)

NCLEX Exam Practice Question of the Week - 7/25/18

A nurse is evaluating a parent's understanding of his child's peritoneal dialysis. Which information in the parent's response indicates an understanding of the purpose of the procedure?

Reestablishes kidney function
Cleans the peritoneal membrane
Provides fluid for intracellular spaces
Removes toxins in addition to other metabolic wastes

Show answer

Answer: 4

Rationale:
Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialyzing solution.

Peritoneal dialysis acts as a substitute for kidney functions; it does not reestablish kidney function.
The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity.
Fluid in the abdominal cavity does not enter the intracellular compartment.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Pediatrics (Care of the Child with Genitourinary and Reproductive Problems, Ch. 15, pg. 289, Question 18)

NCLEX Exam Practice Question of the Week - 7/18/18

The nurse has given the client instructions about crutch safety. Which statement indicates that the client understands the instructions? Select all that apply.

“I should not use someone else's crutches.”
“I need to remove any scatter rugs at home.”
“I can use crutch tips even when they are wet.”
“I need to have spare crutches and tips available.”
“When I'm using the crutches, my arms need to be completely straight.”

Show answer

Answer: 1, 2, 4

Rationale:
The client should use only crutches measured for the client. When assessing for home safety, the nurse ensures that the client knows to remove any scatter rugs and does not walk on highly waxed floors. The tips should be inspected for wear, and spare crutches and tips should be available if needed. Crutch tips should remain dry. If crutch tips get wet, the client should dry them with a cloth or paper towel. When walking with crutches, both elbows need to be flexed not more than 30 degrees when the palms are on the handle.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Musculoskeletal System, Ch. 64, pg. 953, Question 810)

NCLEX Exam Practice Question of the Week - 7/11/18

A client with Guillain-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which strategy should the nurse incorporate in the plan of care to help the client cope with this illness?

Giving client full control over care decisions and restricting visitors
Providing positive feedback and encouraging active range of motion
Providing information, giving positive feedback, and encouraging relaxation
Providing intravenously administered sedatives, reducing distractions, and limiting visitors.

Show answer

Answer: 3

Rationale:
The client with Guillain-Barr e syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate information about the client's condition, giving expert care and positive feedback to the client, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion for the client as well.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Neurological System, Ch. 62, pg. 918, Question 783)

NCLEX Exam Practice Question of the Week - 7/4/18

An adult client was burned in an explosion. The burn initially affected the client's entire face (anterior half of the head) and the upper half of the anterior torso, and there were circumferential burns to the lower half of both arms. The client's cloths caught on fire, and the client ran, causing subsequent burn injuries to the posterior surface of the head and the upper half of the posterior torso. Using the rule of nines, what would be the extent of the burn injury?

Show answer

Answer: 3

Rationale:
According to the rule of nines, with the initial burn, the anterior half of the head equals 4.5%, the upper half of the anterior torso equals 9%, and the lower half of both arms equals 9%. The subsequent burn included the posterior half of head, equaling 4.5%, and the upper half of the posterior torso, equaling 9%. This totals 36%.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Integumentary System: Chapter 46, Question 483, Page 566)

NCLEX Exam Practice Question of the Week - 6/27/18

Anger
Denial
Bargaining
Depression
Acceptance

Show answer

Answer: 2, 1, 3, 4, 5

Rationale:

The initial response is shock, disbelief, and denial, and the client seeks additional opinions to negate the diagnosis.
When negating the diagnosis is unsuccessful, the client becomes angry and negative.
Bargaining for wellness follows in an attempt to prolong life.
As the reality of the situation becomes more apparent, depression sets in and the client may become withdrawn.
Acceptance is the final stage of grieving; this stage may never be achieved.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Maternity (Perinatal Loss, Bereavement, and Grief, Ch. 20, pg. 329, Question 4)

How To Land A New Grad Nursing Job

Written by Ari Anderson.

“Begin with the end in mind” as said by Steven Covey, is one of my favorite quotes. In nursing school, we often get so wrapped up in focusing on the present and just “getting through” it all, that we tend to forget to also start preparing for the next step—getting a nursing job! Although the job outlook for nursing is positive, with the field expected to grow about 15% from 2016-2026 (Bureau of Labor Statistics, 2018), this doesn't necessarily make things any easier for ‘new grad' nurses. Applying for new grad nurse positions is a competitive process and should be approached with strategy and extra care. There are many aspects of the application process that the student nurse should try their best to excel in and positively set themselves apart from the other applicants. Here is some advice directly from a nursing supervisor, an experienced charge nurse, and an experienced staff nurse who have all participated in the hiring of new grad nurses

The Application

The application is the first thing seen by the hiring managers before they even consider bringing you in to interview you for a position. Having a strong resume that sets you apart from the average applicant will help you better your chances of making it further in the application process. Here is some advice on how to construct your resume and a few things that hiring managers look for that makes your resume stand out.

A new grad resume should be about one page; most new grads have little to no experience, so a lengthy resume is unnecessary and most likely won't be read because there is just not enough time. The resume should be professional and formatted correctly; most schools have a resource center where someone can read over the resume and help them edit it for free!
Relevant Experience- new grad nurses who have worked as techs/ student nurses before have a better chance of getting hired because they have experience in the field that will benefit their transition. Make sure you try to get a tech or student nurse job as soon as possible while in nursing school.
GPA- although GPA isn't the only factor, it is important when it comes to certain units and hospitals.
School and Level of education- Some hiring managers look for certain schools because they know them well and have had success with those students in the past. Furthering your education is exponentially important; especially at a Magnet Status hospital BSNs are strongly preferred. You should continue to gather certifications and increase your education throughout your career.
Leadership and Membership- Memberships to organizations (such as student nurse association and/or student memberships to specialty related fields) really stand out to hiring managers because it shows your dedication and involvement in the nursing field.
Apply as soon as possible! Don't wait until the last minute to apply to posted jobs; be proactive.
Apply to the place you work at first- internal applicants are often preferred because they know you and the lateral transfer process is easier.

The Interviewing Process

First impressions are extremely important and can make or break how the rest of the interview progresses. Here are a few things you should keep in mind before and during an interview, to make your interview the best it can be.

When you show up, show up early; if you are on time, you are already late.
Dress appropriately-Business casual (from head-to-toe) is the way to go at the initial interview; leave the low-cut shirts, tight pants, flip-flops, jeans, acrylic nails, colorful hair, and exercise attire (ie: Yoga Pants) at home that day. Wear something modest, appropriate, and professional.
Shake the manager's hand and make eye contact; these are professional behaviors that are looked for during an interview.
Do your homework- Know about the hospital or facility you are applying to work at; it is great when you are knowledgeable about the place, it shows your level of interest.
Be prepared- Bring any supplemental material, licenses, or anything else you may need or be asked for during the interview.
Silence isn't always a bad thing! If the manager asks you a question, take some time to really think about a strong answer, if you need a minute say so, don't just answer just to answer.
Be confident but have humility when appropriate. We all have room to grow; acknowledge that and grow build on it.
Be flexible! As a nurse (especially the new nurse) you will absolutely have to work weekends and holidays, and most likely even night shifts. Know that this won't necessarily be permanent, but you will need to work where you are needed; a manager will be more likely to hire you if there are less “demands” to your schedule.
Ask questions! The interview isn't just for you; it's also you are interviewing the place in a way. The only way to know the answer to if you would be a good fit for a place is if you find out all the information you can.

The Final Steps

After it is all said and done, then comes the worst part: the waiting game! Although in a perfect world, it would be amazing to be offered the job ‘on the spot', often times the hiring manager would prefer to meet and interview all of their options and then compare everyone so they can pick the new grad nurse(s) that they feel is the best fit. After an interview, it is always a good practice to send a follow up “Thank you” email. About a day after the interview, follow up with the hiring manager and thank them for their time and express how much you enjoyed the opportunity to speak with them. Finally, if there is a follow up call asking for further information, respond politely and promptly. These are all things that will positively affect the outcome.

Hopefully following these tips will help you get the nursing job of your dreams! Good luck to those in the application process and those who are approaching it. I want to give a special thanks to Barbara McGuinness, RN, MS, the Nursing Supervisor on the Heart and Vascular Unit at AAMC, Laura Kistler, RN, BSN, B-C, Charge Nurse on the Heart and Vascular Unit, and Diana Cole RN, BSN, an experienced staff nurse on the Heart and Vascular Unit for their help and feedback with this post.

NCLEX Exam Practice Question of the Week - 6/20/18

What treatment should the nurse suggest to an adolescent with type 1 diabetes if an insulin reaction is experienced while at a basketball game?

“Call your parents immediately.”
“Buy a soda and hamburger to eat.”
“Administer insulin as soon as possible.”
“Leave the arena and rest until the symptoms subside.”

Show answer

Answer: 2

Rationale:
The adolescent needs immediate and easily absorbable glucose, such as soda, and long-lasting complex carbohydrates and protein, which are supplied by the bun and hamburger.

Calling the parents can be done after some glucose has been ingested; otherwise, the adolescent's hypoglycemia can become severe.
Extra insulin will further aggravate the problem.
Leaving is unsafe; appropriate intervention is necessary.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Pediatrics (Family-Centered Care of the School-Age and Adolescent Child, Ch. 11, pg. 183, Question 21) Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Pediatrics (Family-Centered Care of the School-Age and Adolescent Child, Ch. 11, pg. 183, Question 21)

Finding Balance

Written by Joy Clark.

We have all heard that nursing students have no lives, seen the t-shirts that state "I can't I'm in nursing school", or heard people say "I'll sleep when school is over". However, I want to give you hope that this chaotic lifestyle isn't always the reality. I was not willing to simply stop living when I started nursing school.

I have always lead a pretty jam packed life. From working part time in high school, participating in sports, and taking AP classes. Then into college with 18 units, joining clubs and playing on intramural sports teams. My life has been full, but never overwhelming. Neither was my transition from my exhaustive prerequisites into nursing school. Time management has always been an area of my life I had to stay on top of.

Nursing school did change a few things. I no longer looked at assignments and did them in the order they were due. Instead, I learned to work as far ahead as possible. If I found myself with a free afternoon I would write a paper even if it was not due for another month. The syllabus usually does a great job outlining assignments and utilizing it to get as many projects done ahead of time really relieves a lot of stress. I also learned I needed more than just one day to study for an exam. On days I had extra time in the morning I would review PowerPoints from that week to keep the information fresh.

The most important part of balance is making sure you allow time for things you enjoy so you don't get burned out. Saturday's were my day off. I would sleep in, play ultimate frisbee, go out for lunch, volunteer at my church and then go out in the evening. I made sure that I saw friends outside my nursing world by getting lunch/dinner with them throughout the week. I strategized my study habits to ensured that if there was an event I wanted to go to, even one that was the night before an exam, I had studied sufficiently ahead of time.

Now you might be thinking this girl must never have slept. I usually managed 6 hours of sleep a night.

I pray that this gives you hope and relieves some of your fears if you are an incoming nursing student. Plan out your days, use your time wisely, and schedule in fun things! Spend an hour at lunch with a friend. Take a nap when you need one. Say yes to going to the movies on Friday. Just ensure that you are aware of your time spent and that you are focused when you are studying. Bring balance into your life.

“Wherever you are be all there” Jim Elliot

NCLEX Exam Practice Question of the Week - 6/13/18

The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instruction?

“A balance of rest and exercise is important.”
“I can apply lotion or powder to the incision if it is itchy.”
“Activities in which my child could fall need to be avoided for 2 to 4 weeks.”
“Large crowds of people need to be avoided for at least 2 weeks after surgery.”

Show answer

Answer: 2

Rationale:
The mother should be instructed that lotions and powders should not be applied to the incision site after cardiac surgery. Lotions and powders can irritate the surrounding skin, which could lead to skin breakdown and subsequent infection of the incision site. Options 1, 3, and 4 are accurate instructions regarding home care after cardiac surgery.

Practice Question Sourced From: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Cardiovascular Disorders, Ch. 40, pg. 488, Question 418)

It's Okay to Have Bad Days

Written by Kate Dookie.

Nursing school is one of the most intense and stressful programs for students. Many hear how time-consuming and difficult it may be, but you never understand it until you have jumped off the diving board, head first, into your nursing school curriculum. Nurses have their own language, including nursing diagnosis, medical terminology, and the many abbreviations for all the above. It is important to remember, that it is difficult just to begin nursing school. If you are in your first semester, give yourself a pat on the back; you made it through all the prerequisites and entrance exams.

As you continue through your program, you will experience many accomplishments, a little anxiety, and possibly, a few bad days. It's important to remember that we all have bad days. There is not a single person going through nursing school right now that will not have a bad day. Bad days are okay. You might have a bad day because you didn't score as well on a test as you would have liked. Or, you did not pass your checkoff or dreaded simulation on your first try. Maybe, you had a tough patient during clinicals and it pulled at your heartstrings. No matter the reason, you have bad days because you care about your education and most of all, your future career. You care because you know how important your education is, because you desire to be the best nurse you can to provide exceptional care to your patients. So, when you have that awful day, tears are streaming down your face, and you consider giving up, just know that you are right where you are supposed to be.

On these bad days, give yourself a break. Find a way to relieve some of your stress, like going to the gym, taking a yoga class, cooking some comfort food, spending time with your family or friends, or escaping into a good (non-nursing) book. Have a friend that you call to vent to or go out to dinner with a group of your friends, they are there to celebrate the good times and support you during the rough days. Take the night off and remember the next day will be a new day, full of opportunity.

When you awake the next day (hopefully refreshed) take a minute to evaluate the previous day. What made it so bad? Did you not do well on that dreaded nursing school test? (Don't worry, those Select All That Apply Questions make us all cringe.) Evaluate how you studied and change what didn't work. This is trial and error. For me, using Elsevier Adaptive Quizzing helped ensure I really knew the information. After I mastered the concepts, I began my practice questions to prepare for the test.

If you didn't pass your checkoff/simulation, know you are not alone! Many don't pass the first time, and that's okay. The reason you have simulations are to prepare you for “real life” when you have graduated, and you have that beautiful license number that makes you a Registered Nurse. These can be difficult because they want to make sure you are prepared to assess and care for your patients in the field. If you didn't pass the first time, go practice! Remember that you are still learning, and you are preparing yourself to be a safe, exceptional nurse.

When you have a bad day because a patient really tugged at your heartstrings, know that this is because you truly care. Compassion and caring is something they cannot teach you in nursing school but are qualities that will make you a great nurse. Find a stress relief outlet like we discussed before and continue to use this as you graduate and become a nurse.

Bad days are okay! With the bad days, you will have many good days. Keep your eye on your long-term goals and know that you are one day further than you were yesterday. Keep pushing forward and be proud of your accomplishments, there are more to come!

How to Survive the First Year of Nursing School

Written by Alannah Davis.

Nursing school is a roller coaster of emotions, and to be completely honest the first year feels like you are going on the scary upside-down ride at the carnival for the very first time. You feel terrified during orientation and oh boy the first day of clinicals might be one of the hardest things you have ever done, but if you just keep pushing through you will realize that it is filled with experiences that will make it all worth it.

Nursing school coursework and clinicals are hard don't get me wrong but learning the tricks to keep yourself calm and focused are some of the most important parts.

Step One: Do NOT Procrastinate!!!!
This was the toughest thing that I had to learn. I was used to being able to complete a homework assignment or a project the night before it was due and not even bat an eye. Saving 100 practice questions for OB that were due the same day of the test was not the smartest move of my nursing school career, and my grade on the first exam definitely could vouch for me. If you know that you have an assignment due in a week and have a little extra time, make sure to do it then and skip the shopping trip.

Step Two: Actually Study.
I was never a good studier before this past year, but when my grades were not all A's like I was used to I decided I needed to change my study habits. I practiced studying the same day as I learned the material in class and not the night before the test. I am still guilty of not studying as much as I should until the last minute, but I have gotten a lot better. This takes a lot of practice and dedication, but in the end your grades will improve.

Step Three: Don't Be Afraid to Ask for Help.
This is something that is very important that you must learn in order to succeed throughout nursing school. You have to realize that your professors are there to help you and not hurt you, as well as your peers in the classes above you. If you don't understand something or are even confused on assignment it is always better to ask someone who can point you in the right direction. Ultimately one day you will be in charge of saving someone's life so now is the time to get clarification on whether something is correct or not.

Step Four: Get Sleep and Take Care of Yourself.
This is the most important step that I have given to survive nursing school. Sleep is an amazing thing and you really don't retain anymore information after 2:00 a.m. On test day make sure you get plenty of sleep. Also make sure that you are taking care of yourself mentally and physically. You can't drink coffee and energy drinks or eat chicken nuggets for every single meal, even though I personally wish I could. You also need to have some fun. I like to go shopping, running, or mostly come home and visit my puppy.

If you just take a deep breath and realize that nursing school isn't impossible your life will be so much easier your first year! I hope this article helps.

NCLEX Exam Practice Question of the Week - 6/6/18

What is the most common complication for which a nurse must monitor preterm infants?

Hemorrhage
Brain damage
Respiratory distress
Aspiration of mucus

Show answer

Answer: 3

Rationale:
Immaturity of the respiratory tract in preterm infants is evidenced by a lack of functional alveoli, smaller lumina with increased possibility of collapse of the respiratory passages, weakness of respiratory musculature, and insufficient calcification of the bony thorax, leading to respiratory distress.

Hemorrhage is not a common occurrence at the time of birth unless trauma has occurred.
Brain damage is not a primary concern unless severe hypoxia occurred during labor; it is difficult to diagnose at this time.
Aspiration of mucus may be a problem, but generally the air passageway is suctioned as needed.

Practice Question Sourced From: Elsevier: Nursing Key Topics Review: Maternity (Newborn Complications, Ch. 19, Pg. 286, Question 3)

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