good luck on test 2 first years!!!!

Volume 2, Issue 2
November 30, 2009
College of San Mateo
VITAL SIGNS
Nursing Newsletter
GOOD LUCK ON TEST 2
FIRST YEARS!!!!
Inside this issue:
1
Message from the
Editor
1-2
Tips for a Successful
Maternity Rotation
2-3
Pointers on Getting
Through N222
3
Diagram of the heart
5-6
Dear Flo
6-8
NCLEX Review
Questions
9
Upcoming Events
10-12 Pictures!
13
Nurstoons
13
References
13
Corrections
OK, First years. Your first semester of nursing school is over in 15 days.
Yes, you read that correctly...15 DAYS!!! I hope that all of you have
something fun planned for the winter break.
You deserve it!
Unfortunately, before you know it, your 1 month of winter break will be
over with a blink of an eye and you'll be back at school. Some of you
will be in Maternity and the others will be in Pediatrics. For many of
you, these are new and unfamiliar topics. Lucky for you, we have
included some tips for you in this issue. So read on!
Second years...1 more semester. That's all I have to say. I don't
know about the rest of you, but I plan on sleeping in...A LOT! And if I
feel motivated enough, I just might sign up for the 3-week online course,
offered by NCBSN. Any of you signing up for that?
I hope you all have a fabulous winter break with friends and
family. I wish you all the best of luck on the finals!
--Wendy Chin, Editor in Chief
Tips for a Successful Maternity Rotation
By: Ruth Palmeri
First things first: there is NO preclinical paperwork in this rotation.
Maternity patients are unpredictable–laboring patients come in and out at
all hours of the day and it would be impractical to prepare the night
before. Now that you have this free time the night before clinical, use it
to study ;).
Go to open skills lab with a partner and get comfortable with
starting IVs. Practice handling the catheter and your equipment with one
free hand. Maternity patients will have big, hydrated veins. Some nurses
say they are the “easiest” to stick. Take advantage of this! Ask the nurse
(and obtain patient permission) if you can start the IV if it has not been
done already.
VITAL SIGNS
Volume 2, Issue 2
Continued from page 1–Tips for a Successful Maternity Rotation
In this rotation, it is my opinion that you will
have more chances to do Foley catheter insertions.
Brush up on your Foley skills so you are prepared
when the opportunity comes up! As an added bonus,
the patient has usually been given an epidural. What
does this mean? The procedure will be more
comfortable for the patient and you will have less
stress. Make sure to tell your nurse when your shift
starts so that you are able to perform a Foley insertion.
And always remember to obtain patient permission.
This tip is for students who don’t have babies at
home. Do you have friends with babies? Be a good
friend and offer to babysit! If you aren’t around babies
very much, it can seem intimidating to handle them and
change their diaper. Get used to handling babies. Bring
your stethoscope and use your babysitting time to
practice your neonatal assessment skills (which will be
graded by your instructor during your clinical time). By
the time clinical starts, you won’t be worried about
dropping your patient.
Does that neonatal heart rate seem to be going too
fast for you to count? Try tapping your finger with the
heart rate to keep track of the beats.
Remember, you will be caring for TWO patients
this time–mother and baby. This also applies in the
labor and delivery setting. Whenever you go into the
room, assess both of them to ensure everything is going
smoothly.
Last but not least, always thank your patient if they
allow your observe the birth of their child. A surprising
number of patients are gracious enough to allow a
stranger to witness a very intimate experience. On the
other hand, don’t take it personally if they say they
would prefer not to have a student during the birth.
Oh, one more thing. When your syllabus comes
out–get it as soon as you can and look through it.
There is a list of medications that you need to make
medication cards for. Do it during the break!
Page 2
Practice those IVs!!! (Left to right: Tanya Isaeff, Adna
Yeung, Bryan Lo)
Pointers on Getting Through N222
By: Lisette Varela
The pediatric rotation with Beth Smith is a
tough rotation. What makes it tough is all the
diseases and congenital malformations that you
need to know and to have an understanding of.
The congenital malformations of the heart
will spin your head around, but you need to gain
control and be confident that you will master it.
Know the anatomy of the heart and also which
way the blood flows. For those going into your
pediatric rotation, First, spend some of the
winter break looking over the anatomy of the
body–especially the heart. It will help to make
more sense when Beth lectures on it.
Another difficult part to this rotation is
the vaccinations–when each vaccination is
administered and for what reason. I made index
cards and left them in my purse, and when I was
waiting for whatever reason, I’d pop them out
and review those vaccinations. Trust me, they
will haunt you for the whole 8 weeks.
VITAL SIGNS
Volume 2, Issue 2
Continued from page 2–Pointers on Getting Through N222
And last but not least, the first test is the
easiest–so master it! Know the differences in child
development, and importantly, childhood milestones.
Do not think for one second that the material learned
for the first test is easy, because it isn’t. It’s a lot of
memorization so start studying early for ALL 3 tests.
Good Luck!!
Working hard at clinical (Lisette Varela)
Page 3
Also, just as a reminder...for N222's preclinical,
you will need to bring in a child under 6 years old to do
a physical assessment on. So, if you don't have kids–
start asking around to borrow one. Classmates with
more than one kid are always good to ask.
VITAL SIGNS
Volume 2, Issue 2
Finally...
By: Katrina Pangilinan
Holiday Getaway...
By: Michelle Nerona
It is finally that time of year that we all have been
waiting for - Winter Break! As I venture out to the
Philippines right after finals, I am interested in what
other students are doing. Emmelene FernandezCaroro, a second year student, decided to share
with me what she was partaking in this year's
festivities.
Isn’t it sad how we dream our lives away when we
are at school? It is sad for me, but I always feel this
way, especially when I am not with my family.
So Emmelene, what're your plans for our long
awaited Winter Break?
Emmelene: Not sure yet. We have nothing planned.
Money has been issue.
That’s why come December 15th, we are off
to Disneyland. Disneyland will give my family and
I the morale we need, especially after being apart so
many times this semester. It will also be the first
time my younger daughters get to go, so that is
even more exciting. Seeing their faces with such
happiness melts my heart.
I understand. I bet money is an issue for a lot of
us! Haha. Do you have any exciting plans for
New Years?
Emmelene: For New Years? Hmm... My husband
and I would like to go Vegas!
What's in Vegas? I've heard it gets crazy!
Emmelene: Haha, yeah, I heard. But we would like
to spend some time with our friends that we've lost
touch with during the school year.
That sounds nice.
Emmelene: Exactly. It's time to start relaxing, free
such a busy semester.
With all the extra time we have. Do you have
any plans on studying and trying to keep your
nursing brain ready for our last semester?
Emmelene: Of course! I plan on studying NCLEX
questions this time. That would help me a lot!
Emmelene, we hope you have an awesome Winter
Break! Thanks for sharing!
Page 4
January offers more vacation fun for my
husband and I. We are going to Maui, Hawaii! We
have visited in 2008 and we cannot get enough of
it. The rest of our break is spent on R & R. Being
in the program demands lots of our time and a little
R & R goes a long way. Happy vacationing
everyone and I will see you next semester!
VITAL SIGNS
Dear Flo
By: Wendy Chin and Jill Wylie
Dear Flo,
Why do students have to wear
white uniforms? –Anonymous
White uniforms were initially
introduced because they were
thought to be professional and
hygienic.
These uniforms were not created for
practicality, because we all know how often these
uniforms become covered with bodily fluids!
There is currently an ongoing debate about
whether white uniforms should be used in the
hospital setting. Some nurses like the white
uniforms because they believe it restores
professionalism to the job. They don't understand
how patients will be able to take them seriously
with a big Tweety Bird or Elmo on their uniform.
These images can be distracting to the fact that
nurses are responsible for saving lives.
The benefit of the white nursing uniform is
that patients are better able to tell the staff apart.
Patients are better able to distinguish between the
licensed RNs and student RNs if we continue to
wear white uniforms.
Although white uniforms may be seen as
stifling our sense of individuality, they help us to
maintain our sense of professionalism, which is
something that we all strive for in our careers.
Volume 2, Issue 2
Dear Flo,
If a nursing student was to get caught drinking and
driving, what would happen to their status as a
student at CSM? And when applying for their
license? –Anonymous
The first place we looked to for answers was the
Nursing Student handbook (it is our "Bible" after
all). We found that CSM follows the guidelines for
the "Impaired Nursing Student" from the BRN. We
couldn't find this section, but we did come across
the section for the "Impaired RN."
In summary, if a RN received 1 DUI, it is
the RN's responsibility to decide if that 1 DUI is
indeed a drug problem or an isolated event. From
there, the RN is to seek help from the BRN's
Diversion Program. But this does not answer our
question for the nursing student...is it the same
process?
We weren't entirely sure of where to start
researching, so we turned to Jane McAteer,
Director of the CSM Nursing Program, for help. It
turns out that getting a DUI is a very serious
offense. Jane stated that if this DUI was received
during the program, she would be required to report
this to the clinical site (at which the student is
attending) to see if any problems had occurred. The
student's clinical instructor would also be the one to
document any drug-related behaviors.
This
situation may also be referred to Student Services
and/or to the Vice President of Instruction.
What's worse is that this DUI offense will
show up during the Live Scan that is required for
taking the NCLEX. The BRN would then consider
each offense on a case-by-case basis.
So please, we are urging all of you out there
to be careful...especially during the holidays.
We've all worked too hard to have it all thrown
away due to a mistake.
Page 5
VITAL SIGNS
Continued from page 5–Dear Flo
Dear Flo,
What is the care plan constructor that I've been
hearing so much about? –Anonymous
The care plan constructor is a tool that some of the
students use as a guide for their care plans. It is
similar to the Cox's Clinical Applications of
Nursing Diagnosis textbook that we already
have...except for the fact that it's online. Some
instructors might even let you copy and paste
straight from the website (check with your
instructor first!). But always remember, as with all
nursing diagnosis books, pick interventions that are
specific for your patient.
The following steps will guide
you through setting up the care plan
constructor:
1. First, you must register at
https://evolve.elsevier.com/
2. Go to search and type in "nursing diagnosis."
3. Click "Register" under the nursing diagnosis
textbook of your choice. We personally like
"Ackley's Nursing Diagnosis Handbook, 8th
edition."
4. Click register again (on the new page).
5. Click "Yes, I accept this agreement" and click
"Submit."
6. Now your care plan constructor is ready for you
to use. Go back to the homepage by clicking "My
Home."
7. Under "My Content," expand the "Resources"
tab and find your nursing diagnosis book. Click on
that book.
8. Click on "Course Documents"
9. Click on "Resources"
Volume 2, Issue 2
NCLEX Review Questions
By: Amber Rhodes and Joanna Udasco
NCLEX Questions for the First years
1.) Frequent pain assessment includes assessing the
intensity of pain. The nurse can best assess the
intensity of a client’s pain by:
A. asking about what precipitates the pain.
B. questioning the client about the location of
pain.
C. offering the client a pain scale to measure his
pain.
D. using open-ended questions to find out about
the sensation.
2.) An older adult client has had a cerebrovascular
accident and is prescribed a metered dose inhaler.
Which nursing consideration is a priority when
teaching the client how to take the medication?
A. Dosage and amount of medication
B. Schedule of administration
C. Coordination and cognition of the client
D. The purpose and goal of the medication
regimen
3.) Identify the correct equipment needed for each
of the following types of injections
___ Intradermal
___ Subcutaneous
___ Intramuscular
___ Intravenous
A. 16-to 24-gauge catheters appropriate for most
adults, smaller-gauge catheters appropriate for
infants and children.
B. A tuberculin syringe with a fine-gauge needle
(26 to 27).
C. A short, fine-gauge needle (3/8 to 5/8-inch, 25to 27-gauge).
D. Needle size 18 to 27 (1 to 1 1/2 –inch, 22- to
25-gauge).
10. Click on "Care Plan Constructor"
11. Click on the nursing diagnosis of your choice.
12. Have fun!
Page 6
4.) A client with chronic low back pain who was
receiving an opioid ATC for the past year decided
to abruptly stop the medication for fear of
VITAL SIGNS
Continued from page 6–NCLEX Review Questions
addiction. He is now experiencing shaking chills,
abdominal cramps, and joint pain. The nurse
recognizes that this client is experiencing symptoms
of:
A. Addiction
B. Tolerance
C. Pseudoaddiction
D. Physical dependence
5.) A client is being discharged home on an ATC
opioid for chronic back pain. Because of this order,
which class of medication does the nurse request an
order for?
A. Stool softener
B. Stimulant laxative
C. H2 receptor blocker
D. Proton pump inhibitor
6.) If a client who is receiving IV fluids develops
tenderness, warmth, erythema, and pain at the site,
the nurse suspects:
A. Sepsis
B. Phlebitis
C. Infiltration
D. Fluid overload
7) The client has an order for 2 tablespoons of Milk
of Magnesia. The nurse converts this dose to the
metric system and gives the client:
A.. 2 mL
B. 5 mL
C. 16 mL
D. 30 mL
8.) The preferred vein for venipuncture for
phlebotomy is:
A. The antecubital vein, which is less painful
B. The basilic vein, which is straight
C. The cephalic vein, which is in the hand and
well anchored
D The median cubital vein, which is larger, well
anchored, and closer to the surface
Answers: 1) C; 2) C; 3) B, C, D, A; 4) D; 5) B; 6)
B; 7) D; 8) D
Page 7
Volume 2, Issue 2
NCLEX Questions for the Second years
1.) A 68-year-old male has been receiving monthly
doses of chemotherapy for treatment of stage III
colon cancer. He comes to the clinic for his fourth
monthly dose. Which laboratory result should be
reported to the oncologist before the next dose of
chemotherapy is administered? Select all that
apply.
1. Hemoglobin of 14.5 g/dl.
2. Platelet count of 40,000/mm3
3. Blood urea nitrogen (BUN) level of 12 mg/dl.
4. White blood cell count of 2,300/mm3
5. Temperature of 101.2 F (38.4 C)
6. Urine specific gravity of 1.020
2.) The client asks the nurse whether he will need
surgery to correct his hiatal hernia. Which reply by
the nurse would be most accurate?
1. “Surgery is usually required, although medical
treatment is attempted first.”
2. “Hiatal hernia symptoms can usually be
successfully managed with diet modifications,
medications, and lifestyle changes.”
3. “Surgery is not performed for this type of
hernia.”
4. “A minor surgical procedure to reduce the size
of the diaphragmatic opening will probably be
planned.”
3.) On the day of surgery, a diabetic client who
takes insulin on a sliding scale is ordered to have
nothing by mouth and all medications withheld.
Her 6 a.m. glucose level is 300 mg/dl. What is the
correct initial nursing action regarding the client’s
high blood glucose level?
1. Withhold all medications as ordered.
2. Administer the insulin dose dictated by the
sliding scale.
3. Call the physician for specific orders based on
the glucose level.
4. Notify the surgery department.
4.) The nurse is assessing the home environment of
an elderly client who is using crutches during the
VITAL SIGNS
Continued from page 7–NCLEX Review Questions
postoperative recovery phase after hip pinning.
Which of the following would pose the greatest
hazard to the client as risk for falling at home?
1. A 4-year-old cocker spaniel.
2. Scatter rugs.
3. Snack tables.
4. Rocking chairs.
5.) On the fourth day after surgery, a client has a
post-operative wound infection. Which of the
following should the nurse expect to assess? Select
all that apply.
1. Total white blood count (WBC) 10,000/mm3.
2. Redness and swelling beyond the incision line.
3. Temperature or 102 F.
4. 89% segmented neutrophils.
5. Incisional pain greater than on day 2.
Answers:
1.) 2, 4, 5. Chemotherapy causes bone marrow
suppression and risk of infection. A platelet count
of 40,000/mm3 and a white blood cell count of
2,300/mm3. A temperature of 101.2 F is high and
could indicate an infection. Further assessment and
examination should be performed to rule out
infection. The BUN, hemoglobin, and specific
gravity values are normal.
2.) 2. Most clients can be treated successfully with
a combination of diet restrictions, medications,
weight control, and lifestyle modifications. Surgery
to correct a hiatal hernia, which commonly
produces complications, is performed only when
medical therapy fails to control the symptoms.
3. 3. The nurse should notify the physician directly
for specific orders based on the client’s glucose
level. The nurse cannot ignore the elevated glucose
level. The surgical experience is stressful and the
client needs specific insulin coverage during the
perioperative period.
The nurse should not
administer the insulin without checking with the
surgeon because there are specific orders to
withhold all medications. It is not necessary to
notify the surgery department unless the physician
Page 8
Volume 2, Issue 2
cancels the surgery.
4.) 2. Although pets and furniture, such as snack
tables and rocking chairs, may pose a problem,
scatter rugs are the single greatest hazard in the
home, especially for elderly people who are unsure
and unsteady with walking. Falls have been found
to account for almost half the accidental deaths that
occur in the home. The risk of falls is further
compounded by the client’s need for crutches.
5.) 2, 3, 4. WBC count should be above normal
(4,500 to 11,000/mm3) with an acute infection or
inflammatory response such as a postoperative
wound infection. Redness and swelling beyond
th4e incision line is expected with a wound
infection. An elevated temperature such as 102F on
the third to fourth postoperative day indicates an
infection process rather than an inflammatory
process. An elevation in the segmented neutrophils
demonstrates that the most mature WBCs have
responded to the invading bacteria at the incision
site, which is an expected response. Typically,
postoperative pain begins to less by the 4th day.
VITAL SIGNS
Volume 2, Issue 2
Upcoming Events
Cookie Lee Jewelry Sale
Thursday, December 3rd
Student Lounge: 19-104
3:30pm-7:00pm
Sponsored by the Nursing Student Association
Hottest trends in fine fashion jewelry from eclectic
to trendy, and natural to glamorous
Entire line is priced from just $14-48 so you
don’t have to spend much to look trendy
Caminar Wrap
Giving Back to the Universe, Time to Share our Blessings!
This is to remind all of you about the Caminar Wrap, the day of the Final!! We highly encourage you
to bring any small items/travel size items (toiletries) to donate please put them in the X-mas boxes located
in the skills lab. We have two more weeks left, so keep donating, you still have time.
All Nursing Students are invited to this event, so please come help us wrap all the presents! The more
people to help, the merrier! There will be food and time for all of us to mingle, and get together. This
event will be held in Skills Lab, on December 14, 2009, 4pm. Head there right after you're done with
your finals.
SEE YOU THERE!!!
Page 9
VITAL SIGNS
Volume 2, Issue 2
Pictures, pictures, pictures!
Hanging out...
Page 10
VITAL SIGNS
Volume 2, Issue 2
Skills Lab...
Page 11
VITAL SIGNS
Volume 2, Issue 2
Clinical...
We are currently working on posting
pictures on the internet. Check it out at
http://picasaweb.google.com/nsa.csm
If there are some pictures you'd like to
share, please copy them onto a CD and
give that CD to one of the NSA
officers.
Page 12
VITAL SIGNS
Volume 2, Issue 2
References:
Pointers on Getting Through N222:
 http://en.wikipedia.org/wiki/File:Diagram_of_the_human_heart_%28cropped%29.svg
Dear Flo:
 http://www.nursingadvocacy.org/news/2005nov/14_ch_trib.html.
 http://collegeofsanmateo.edu/nursing/StudentHandbookSY09-10.pdf
 http://www.rn.ca.gov/diversion/div-faqs.shtml
 https://evolve.elsevier.com/
NCLEX Review Questions:
 ATI Review Module: Fundamentals for Nursing. Version 6.1.
 Potter and Perry. 7th ed. (2009). Fundamentals of Nursing. St. Louis, Mo: Mosby.
 Billings, D. M. (2008). Lippincott's Q & A review for NCLEX-RN (9th ed.). Philadelphia: Lippincott Williams &
Wilkins.
Nurstoons: Please visit www.nurstoon.com for more nursing cartoons.
Corrections from Newsletter, Volume 2, Issue 1
--Relay for Life took place on Jul 18-19, 2009 (not July 18-19, 1009)
--NCLEX Questions for First years should be numbered 1, 2, 3, 4, 5, 6 (not 3, 4, 5, 6, 1, 2)
Page 13