Confessions of a 30-something RN grad

So, I am in the seat, feeling comfortable, calm (even though I have went through enough security to enter Fort Knox).  I read through the instructions as to not miss anything.  “You have 6 hours….”  Sounds good, all is well…..

First question, okay, 50/50…..A or C….. hmmm…A…. “next”…..2^nd question…..what?  What are they asking?  These are all right, and there are no indicators in the question showing priority.  Can I ask them “is this patient stable?”  “how old are they?”  “should I assume they are anxious?”….Can I phone a friend?

Okay, quit assuming, take the question at face value……uh……well, if I were getting this done, this is what I would want to know…….B……..

Right about question 8 I hear the girl next to me groan.  Then about 10 questions later she does a big sigh, then a few later she says, “Oh God.”   Seriously?  Shut-up…..I am freaking out, too.  The least you can do is give me some silence, right?  Maybe I should’ve said yes to those earplugs.

Where’s the delegation?  Where is the alternate question with apical pulse location?  Where are the labs?  Where is the question on crutches?

Why do I get the feeling they are asking me about the same thing over and over?  Maybe they are thinking (I have now humanized the NCLEX monster as “they”) if I give her the question 5 or 6 more times, maybe she’ll get it right…..then…….

Black screen…..wait!  They are thinking….we gave her every shot possible, but she blew it.  75 questions, and I knew the answer to a whopping…..TWO (with certainty).

I do the outgoing survey, looking for the question that says, do you think these questions blow?  “Strongly agree”

I again get fingerprinted (I am thinking, if you think I actually paid this pathetic looking, short-haired blonde girl in sweatpants to take the test for me, then she did a piss poor job…..I want my money back).  I courteously smile and get my stuff.  Then I realize, it’s time to hit the potty.  My stomach is gurgling, and I can actually see my heartbeat in my abdomen.  It is pounding.  I get into my car, deciding who won’t think I am crazy if I call in this state of mind.  Okay, my hubby, of course, he always makes me feel better.  “Oh, that stinks.” Is his response to my description.  “When can you take it again?”  I’m thinking “I DON’T KNOW, I DIDN’T PLAN ON FAILING!”  You’re not helping, click……then, my mom.  Mom’s always make you feel better, right?  “Oh sweetie, it’s not the end of the world, you can just take it over.”  Again, not what I wanted to hear.

At this point I am hoping that Ashton pops out from behind the car next to me with his trendy hair and crooked smile and says, “You’ve been Punk’d!”  so that I can slap him in the face or kick him in the balls or something equally degrading.

Where are all of my girlfriends who are RNs?  Voicemail, Voicemail, Voicemail.

I am sitting in a random parking lot in Roseville thinking, “Maybe I’ll just tell everyone that I had to reschedule, then take the exam again before anybody finds out that I’ve failed.”  How vain is that?!

Ugh!!!  My stomach is hurting again.  I get a few calls/texts and I can’t bear to tell the whole ugly story again.

I get home (I can’t even remember driving really….it feels like I got home in 5 minutes).  I sit on my couch for about 45 minutes…..no TV, no kids, no talking, maybe even no blinking.  I didn’t take the NCLEX serious enough.  I should’ve done a different review.  I should’ve done more questions.  I should’ve taken it later or maybe earlier or maybe I should’ve just NOT studied. 

Of course, nothing on BRN the next day, the day after that, I wake up at 0500 and check…nope…I am even looking on allnurses.com to see what the odds are of failing at 75 questions.  Meanwhile, I am talking to people now.  I am trying to convince myself that I am okay with whatever happens (of course, I am MORE okay with passing!).  I contemplate setting my alarm for 0200 Saturday morning (I’ve heard the BRN updates their website at 0200 for the previous day).  I decide that if it isn’t there, it will ruin the rest of my night’s sleep, so I pass on the alarm idea.

Saturday morning, I get up at 0300 bc Mason is crying.  I pick him up and carry him to my computer…….I click on my bookmark (yes, I have bookmarked it)…..type “eagal”…….can you believe it?  There is another Trina Eagal in San Joaquin county….well, that is annoying, even SHE passed the NCLEX….wait….oh, okay, I think I can actually hear the word relief as I exhale.  Now, I can drop the weight on my chest and the pit from my stomach.  Phew.

Moral of the story, sometimes the signs and symptoms (diarrhea, abdominal pain, bounding pulse, anxiety, feelings of impending doom) don’t match the diagnosis (Effective testing output r/t using my noggin aeb name showing up on BRN site)

What’s next?

You mean, now I have to find a job?  My stomach hurts again.

NCLEX prep

For those who are starting to think about NCLEX prep, check out:
NCLEX 3500 (Lippincott, Williams & Wilkins)
Study tips for NCLEX Exam
Exam information
NCSBN info (including test plans, statistics, psychometrics)

Also:
NCLEX 4000 is available in the computer lab

Trina found a podcast called "F.A. Davis NCLEX-RN audio prep: Test-taking tips and tactics to help you pass." It's free on iTunes and you can subscribe to it.

Other links:
Board of Registered Nursing (BRN)
California Nursing Practice Act
California Nurses Association (CNA)

NCLEX/Critical thinking questions - Community based settings for Pt care

1. Which of the following programs illustrates a focus on health in our society?
a. Research on the treatment of AIDS
b. Incarceration of drug addicts
c. Antismoking ads on TV
d. Aggressive therapy for cancer

2. Mrs. Rogers is in acute respiratory distress from pneumonia but refuses to stay for treatment. It is the nurse's responsibility to do which of the following?
a. Restrain the pt until a social worker can talk to her about the possible results of her actions.
b. Call for a psychological consultation to see if she is mentally stable.
c. Notify the physician; discuss the outcomes of the pt's decision and have her sign a release form
d. Call the pt's family and have them discharge her

3. Which of the following actions must be performed by the nurse upon discharging a pt from a healthcare agency?
a. coordinating future care for the pt
b. writing a discharge order for the pt
c. Writing any orders for future home visits that may be necessary for the pt
d. Sending the pt's records to the attending physician.

4. When pts are transferred within or among health care settings, which of the following is most important in ensuring the continuity of care?
a. Notification of all departments of room change
b. Careful moving of all personal items
c. Asking family members to take home the pt's jewelry, money or other valuables
d. Accurate and complete communication

5. Which of the following statements concerning the characteristics of a home care nurse is accurate?
a. Clinical skills are less important in a home care setting than in a hospital setting
b. The nurse should not make independent decisions about pt care
c. The increased autonomy of the nurse reduces the nurse's legal risks.
d. Physical assessment, nursing diagnosis, and infection control are all part of the nurse's role

6. Which of the following statements concerning the unique role of the home care nurse is accurate?
a. Home care is provided to the pt in a setting that is controlled by the nurse
b. The nurse should not feel that she is only a "guest" in the pt's home
c. the nurse must adapt to the pt's environemt instead of the pt adapting to a strange environment.
d. Home care nurses do not need the pt's permission to adjust furniture or pt belongings to provide a safe environment.

7. Which of the following activities would be performed by a home care nurse in the pre-entry phase of the home visit?
a. The nurse gathers supplies that may be needed for the pt
b. The nurse develops rapport c the pt and family
c. The nurse determines desired outcomes, makes assessments and plans and implements care
d. The nurse provides teaching to promote independence in self-care.

Critical thinking:
Identify care priorities for the pts listed below who are being transferred to a home healthcare setting. Include physical, psychological, socioeconomic, environmental, spiritual and cultural assessments for each pt. Think about nursing's role in making necessary resources available to the pt and family.

a. 76yo male, advanced cancer being sent home c a catheter and pca pump. lives alone, son lives 45 min away and has promised to check on him once/day. members of his church have offered to visit him and bring him a meal once/day.

b. 32yo male, advanced AIDS being sent home to spend his remaining days c parents. His life partner died of AIDS the previous year and he is angry about this situation. his parents do not accept his condition and lifestyle but offer to take care of his healthcare needs.

c. young, single mother lives c her boyfreind is released from the hospital c an infant who has Down syndrome. Both the mother and her boyfriend work and two incomes are needed to maintain the household. The mother has expressed concerns about being able to give her infant the proper treatment and attention.

Urinary/Fecal Elimination and Nutrition, Oh my!

This link will take you to questions about nutrition, urinary elimination, fecal elimination and also questions on electrolytes.

After clicking the link, choose the option "Quiz bank" to the left, then "Unit 8".

Acid-base imbalance Questions

Sue has done such a great job posting questions, that I'm not sure if you even need any more, but I did find a great site that helped me distinguish between primary and compensatory systems. The rationales are very helpful as well.

Acid-Base Imbalance Questions

Good luck.

Oxygenation quiz

The following ten questions come from the book “Test Success” (Nugent/Vitale). See if you can answer them, then check for the answer key and rationales in the comments section of this post.

1. To prevent aspiration while administering physical hygiene to a patient receiving a nasogastric feeding tube, the nurse should:
a.) Lower the height of the bag
b.) Seek additional assistance
c.) Slow the rate of flow
d.) Shut off the feeding

2. A patient walking in the hall complains of sudden chest pain. The initial intervention by the nurse should be to:
a.) Take the patient's vital signs
b.) Perform a detailed pain assessment
c.) Walk the patient back to bed slowly
d.) Get a chair so the patient can sit and rest

3. When oxygen therapy via nasal cannula is ordered for a patient, the first action by the nurse is to:
a.) Post an “oxygen in use” sign on the door to the room
b.) Adjust the oxygen level before applying the cannula
c.) Explain the rules of fire safety and oxygen use
d.) Lubricate the nares with water-soluble jelly

4. To prevent aspiration after meals by a patient who has difficulty swallowing, the nurse should first:
a.) Position the patient in the low-Fowler's position
b.) Provide a pitcher of water at the bedside
c.) Encourage mouth care when necessary
d.) Inspect the mouth for pocketed food

5. What should the nurse do first when a patient chokes on food and is unable to speak?:
a.) Initiate the abdominal thrust maneuver
b.) Clap between the scapulae several times
c.) Instruct the patient to swallow forcefully
d.) Wait to see if the patient can cough up the obstruction

6. A patient with a history of chronic respiratory disease begins to have difficulty breathing. The adaptations that are the most serious would be:
a.) Orthostatic hypotension when rising and the need to sit in the orthopneic position.
b.) The need to sit in the orthopneic position and wheezing sounds on inspiration.
c.) Wheezing sounds on inspiration and mucus tinged with frank red streaks.
d.) Mucus tinged with frank red streaks and chest pain.

7. The adequacy of tissue oxygenation is most accurately measured by:
a.) Hematocrit values
b.) Hemoglobin levels
c.) Arterial blood gases
d.) Pulmonary function tests

8. The nurse assesses that the patient understands diaphragmatic breathing when the patient says, “I should:
a.) Feel my abdomen flatten on inspiration.”
b.) Raise my shoulders and chest when I breathe.”
c.) Hold my breath for 3 seconds at the height of inspiration.”
d.) Use my hands to put pressure against my abdomen when I inhale.”

9. When do wheezing breath sounds occur?
a.) When fluid is in the lung
b.) When sitting in the orthopneic position
c.) When air moves through a narrowed airway
d.) When the pleural sack rubs against the lung surface

10. Which is most effective for maintaining a patent airway?
a.) Active coughing
b.) Incentive spirometry
c.) Nebulizer treatments
d.) Abdominal breathing

Gearing up for exam #2

1. Which of the following is the primary purpose of surfactant?
a. to propel sheets of mucus toward the upper airway
b. to warm inspired air
c. to produce watery mucus
d. to reduce surface tension of the fluid lining the alveoli

2. a pt who has difficulty breathing, increased respiratory and HR and pale skin with regions of cyanosis may be suffering from...
a. hyperventilation
b. hypoxia
c. perfusion
d. atelectasis

3. when inspecting a pt's chest to assess respiratory status, the nurse should be aware of which of the following normal findings?
a. the contour of the intercostal spaces should be rounded
b. the skin at the thorax should be cool and moist
c. the anteroposterior diameter should be greater than the transverse diameter
d. the chest should be slightly convex with no sternal depression

4. which of the following normal breath sounds should be heard over the rtrachea?
a. vesicular
b. bronchovesicluar
c. bronchial
d. tympanic

5. mr. paks has COPD. his nurse has taught him pursed-lip breathing, which helps him in which of the following ways?
a. increase CO2, which stimulates breathing
b. teaches him to porlong inspiration and shorten expiration
c. helps liquefy his scretions
d. decreases the amount of air trapping and resistance

6. when caring for a pt with a tracheotomy, the nurse should be aware of which of the following?
a. the wound around the tube and inner cannula should be cleaned at least every 24 hrs
b. the pt has no impairment of speaking function
c. a newly inserted tracheostomy tube requires no immediate attention
d. suctioning of the tracheostomy tube must be done using sterile technique

7. which of the following statements regarding nursing diagnoses is accurate?
a. nursing diagnoses remain the same for as long as the disease is present
b. nursing diagnoses are written to identify disease
c. nursing diagnoses are written to describe pt problems that nurses can treat
d. nursing diagnoses focus on identifying healthy responses to health and illness

8. which of the following would be an appropriate nursing diagnosis for a toddler who has been treated on 2 different occasions for lacerations and contusions due to the parents' negligence in providing a safe environment?
a. high risk for injury related to abusive parents
b. high risk for injury related to impaired home managment
c. child abuse related to unsafe home environment
d. high risk for injury related to unsafe home environment
e. high risk for parents to be hung by their toenails by the nurse (just seeing if you are paying attention)

9. which of the following actions would be performed during the planning step of the nursing process?
a. interpreting and analyzing pt data
b. establishing the database
c. identifying factors contributing to pt's success or failure
d. selecting nursing measures

10. which of the following is a correctly written goal for a pt who is scheduled to amb following hip surgery?
a. over the next 24 hr period, the pt will walk the length of the hallway assisted by the nurse
b. the nurse will help the pt amb the length of the hallway once a day
c. offer to help the pt walk the length of the hallway each day
d. pt will become mobile within a 24 hr period

11. mr. conner is a 48-yr-old pt with a new colostomy. which of the following pt goals is written correctly?
a. explain to mr. conner the proper care of the stoma by 3/29/08
b. mr conner will know how to care for his stoma by 3/29/08
c. mr conner will demonstrate proper care of stoma by 3/29/08
d. mr conner will be able to care for stoma and cope with psychological loss by 3/29/08

12. which nursing action is considered an independent (nurse initiated) action?
a. executing physician orders for a catheter
b. meeting with other healthcare professionals to discuss a pt
c. helping to allay a pt's fears about surgery
d. administering meds to a pt

13. your pt, who is presented with high bp, is put on a low salt diet and instructed to quit smoking. you find him in the cafeteria eating a cheeseburger and french fries. he tells you there is not way he can quit smoking what is your first objective when implementing care for this pt?
a. explain to the pt the effects of a high salt diet and smoking on bp
b. identify why the pt is not following the therapy
c. collaborate with other healthcare professionals about the pt's treatment
d. change the nursing care plan

14. which is the most important act of evaluation performed by the nurse?
a. evaluating the pt's goal/outcome achievement
b. " the plan of care
c. " the competence of nurse practitioners
d. " the types of healthcare services available to the pt

15. which should the nurse do when pt data indicate that the stated goals have not been achieved?
a. collect more data for the database
b. review each preceding step of the nursing process
c. implement a standardized plan of care
d. change the nursing orders

N-CLEX style questions for Exam #1

Here are some examples of NCLEX questions pertaining to what we are learning.

1. When a nurse provides the info and support that patients and their families need to make the decision that is right for them, he/she is practicing which of the following principles of bioethics?
A. Autonomy
B. Nonmaleficence
C. Justice
D. Fidelity

2. A nurse who comments to her coworkers at lunch that her patient with a sexually transmitted disease has been sexually active in the community may be guilty of which of the following torts?
A. Slander
B. Libel
C. Fraud
D. Assault

3. Which of the following accurately describes the behavior of the middle adult?
A. Believes in establishment of self but fears being pulled back into the family
B. Usually substitutes new roles for old roles and perhaps continues formal roles in a new context.
C. Looks inward, accepts life span as having definite boundaries, and has special interest in spouse, friends and community.
D. Looks forward but also looks back and begins to reflect on his/her life.

4. As defined by Erikson, in what stage of human development is the older adult?
A. Intimacy vs isolation
B. Identity vs role diffusion
C. Ego-integriy vs despair
D. Generativity vs stagnation

5. Which of the following is a developmental task of the middle adult?
A. Selecting a life partner
B. Establishing and guiding the next generation
C. Establishing a social network
D. Forming a peronsal philosophical and ethical structure.

6. A 36-year-old woman who underwent a hysterectomy 4 days ago says to the nurse, "I wonder if I'll still feel like a woman." Which response would most likely encourage the patient to expand on this and express her concerns in more specific terms?
A. "When did you begin to wonder about this?"
B. "Do you want more children?"
C. "Feel like a woman...?"
D. Remaining silent

7. Which of the following statements about the communication process is accurate?
A. Communication is a reciprocal process in which both the sender and receiver of messages take turns participating.
B. One-to-one communication occurs when 3 or more people are involved in the communication process.
C. Nursing instructors and students seldom experience the communication process in large groups.
D. Communicating people receive and send messages through verbal and nonverbal means, which occur simultaneously.

8. Which of the following conditions would be a normal finding when palpating the skin of a patient?
A. The skin is cool and dry
B. When picked up in a fold, the skin fold slowly returns to normal.
C. The skin is taut and moist to the touch
D. The texture of the skin varies from smooth and soft to rough and dry.

9. Which of the following is a type of unintentional tort?
A. Invasion of privacy
B. Malpractice
C. Assault and battery
D. Defamation

10. What is a good way to communicate with a very young child?
A. Role playing
B. Explaining procedures
C. Showing him pictures
D. Showing him a movie

11.Which behavior provides encouragement during communication without indicating agreement or disagreement?
A. Clapping
B. Sighing
C. Looking away
D. Nodding

12. What is the main source of info and communication among nurses, doctors, and other caregivers?
A. Computer
B. Medical record
C. Telephone
D. Word of mouth

13. Silence is a communication technique used during an interview to:
A. Show respect
B. Change the topic
C. Encourage the patient to continue talking
D. Clarify info

14. The highest temperature reading would be expected to occur during what time of day?
A. 4-5am
B. 8-9am
C. 4-8pm
D. 9-11pm

Answers are in comment section