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Friday, August 31, 2007

Nursing Board Exam Practice Test 5

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Situation 1: An understanding of the usefulness of scientific finding is more and more essential for quality nursing practice.

1. You decided to do a review of literature. The most important reason for doing so
is to:


a. improve your library reading skills
b. get ideas on interpretation of findings
c. formulate a conceptual framework for the study
d. decide on a sampling method

2. The sampling method where each member of the study population has an equal chance to be selected as a subject is called :

a. purposive sampling
b. selective sampling
c. random sampling
d. convenient sampling

3. The study population where you will select your study subjects is referred to as the:

a. research subjects
b. study group
c. population
d. universe

4. Which part of the study relates to validity and reliability criteria?

a. Hypothesis
b. Methodology
c. Variables
d. Instrument

Situation 2: Mr. Tinio, a cardiovascular patient has been hospitalized for 4 months and his doctor has ordered for discharge. -

5. Mr. Tinio appears anxious about numerous aspects of his home care. The best response you would give is:

a. explore with him his fears and allow him to verbalize feelings
b. advice him to take all his medication regularly
c. explain why he has to have certain activity limitation
d. let him express his feelings to reduce his anxiety

6. An immediate need for Mr. Tinio is:

a. reduce anxiety
b. more independent in outlook
c. security and comfort
d. conserve energy

7. Cardiac rehabilitation programs in the acute stage aids the person in:

a. reaching an activity level required for self-care
b. preventing further complications
c. plan his activity of living
d. acceptance of his condition

8. Cardiac rehabilitation goals in long-term, restore individual to optimum health and:

a. prevent health complaints
b. slow down progress of disease
c. another myocardiac infarction attack
d. avoid exposure to infection

9. The greatest effect on his home recovery will be his:

a. expectation to go back to work
b. dietary needs to be well
c. family’s emotional support
d. understanding of the cause d: his illness

Situation 3: A survey of first year students in your school showed that about 40% do not eat breakfast before coming to school. •

10. The most appropriate research design for the study is:
a. Descriptive
b. Retrospective
c. ex post facto
d. quasi-experimental

11. If you decide to study the relationship of eating breakfast and performance in class, which would be the independent variable?
a. Student's characteristic
b. Meal patterns
c. Performance in class
d. Eating breakfast

12. The most appropriate statement of your hypothesis is:

a. There is a positive correlation between eating habits class performance
b. There is a relationship between eating breakfast and performance in class
c. Performance in class is more likely to be affected when eating breakfast
d. Performance in class is associated with eating breakfast

Situation 4: Mrs. Alcantara, a 56 years old cardiovascular patient has edema of the lower limits. You suspect some electrolyte imbalance.

13. These are signs of fluid volume excess Except:

a. weight gain
b. ollguria
c. neck vein distention
d. edema

14. Which is the main excretory organ for regulation of fluid electrolyte balance?

a. Kidneys
b. gastro intestinal tract
c. lungs
d. skin

15-Which is the best way to assess degree of edema?

a. skin indentation when pressed my finger
b. comparing present with previous weight
c. pinching a fold of skin
d. measuring intake and output

Situation 5: Mrs. B. Santos, 5 years married; postponed pregnancy to save money. She visits her physician because complaints of increasing pelvic pain, dysmenorrhea and dyspareunia from a series of diagnostic evaluations the physician ruled out in endometriosis.

16. Endometriosis is best described as:

a. a defect in the endometrial lining
b. a major cause of primary dysmenorrhea
c. a pathological condition due to abnormal proliferation of uterine lining
d. the growth of endometrial tissue outside the uterus

17. The criteria used to confirm a diagnosis of endometriosis is:

a. laparoscopy and biopsy results
b. laboratory findings
c. result of endometrial biopsy ,
d. family's health

18. The physician prescribes danazol (Danocrine, for Mrs. B. Santos). The nurse anticipates the needed health teaching when she tells her that while taking this drug, she can expect to experience all of the following except:

a. diminished menstrual flew
b. edema and increase in weight
c. menses stops
d. anovulation

19. In order to get the most accurate reading the nurse Informs Mrs. B. Santos to take her BBT:

a. within half and hour after rising
b. immediately before rising
c. before going to bed in the evening
d. at the same time every day immediately after awakening and before rising

Situation 6: Justice Yu is scheduled for cholecystectomy in the morning.

20. From the recovery room he was brought back to the ward with nasogastric tube, the rationale for his having NGT is to:

a. prevent abdominal distention
b. prevent nausea and vomiting
c. promote hydration .
d. promote drainage

21. Post operative order is NPO. You will tell him that feeding begin as soon as:

a. abdominal spasm
b. peristalsis returns
c. forty-eight hours is over
d. absence of bowel sound is appreciated

22. Which of these is not likely to happen as his post operative complication:

a. Pancreatitis
b. post operative jaundice
c. bile leakage
d. ventricular hypertrophy

23. The rationale of your supervising properly how he does the coughing exercise is to prevent him from developing:

a. Bronchlectasis
b. Bronchopneumonia
c. atelectasis
d. pneumonia

Situation 7: Mrs. Cayetano is brought to the emergency room complaining of chest pain, perspiring profusely and breathing rapidly. .

24. Upon admission, Mrs. Cayetano is screaming, saying " I'm dying. I can't breathe." The nurse therapeutically says;

a. "Why are you saying that?"
b. "You are not dying. Let me help you."
c. "You are very upset. Let me help you."
d. "We are here to help you."

25. Mrs. Cayetano is experiencing what level of anxiety:

a. moderate
b. mild
c. severe
d. panic

26. A minor tranquilizer to relieve Mrs. Cayetano's anxiety is ordered because this medication:

a. causes fewer undesirable side effects
b. does not impair intellectual activity
c. induces sleep easily
d. is excreted from the body more rapidly

27 An example of minor tranquilizer is:

a. Amitryptyline (Elavil)
b. Chlorpromazine (Thorazine)
c. Diazepam (Valium)
d. Imipramine Hcl (Trofranil)

28. Upon discharge to evaluate Mrs. Cayetano's progress, this important factor should be considered:

a. recognizes the need of describing situations proceeding her feeling of anxiety
b. can change her method of handling anxiety
c. understand the rationale for taking the prescribed medication
d. knows the reason for tier feelings of anxiety

Situation 8: Mercedes is admitted with acute depression. Assessment data revealed that she was terminated from her job as a secretary two (2) months ago.

29. In the initial nurse-client interaction. Mercedes says to the nurse "! am a worthless person I should be dead," The nurse appropriately responds by sayings

a. "Don’t says that, you are not a worthless person."
b. "We are trying to help you with your feelings."
c. "What make you feet worthless?" It: must be awful to feel that way"
d. "What you are feeling is part of your illness." It will lessen as you get better."

30. The therapeutic environment for a depressed client is one which

a. allows her to verbalize her feelings
b. pays particular attention to her physical needs
c. provide opportunity for interacting with others
d. allows freedom to select her own daily activities

31. The appropriate nursing diagnosis is:

a. sensory-perceptual a!teration
b. impaired adjustment
c altered thought process
d. self esteem disturbance

32. MAO inhibitor anti depressant drug was ordered. This is:

a. Diazapam (Vallium)
b. Imipramine HCL (Trofanil)
c: Phenelzine sulfate (Nardil)
d. Amitryptyline (Elavil)

33 Mercedes is being prepared for discharge. The nurse instructs tier husband to observe signs of depression. The following behaviors indicate recurrence of depression. Except:

a. Grandiosity
b. Insomnia
c. psychomotor retardation
d. feeling of hopelessness

Situation 9: during the past two years, Aling Maring , age 70, manifested progressive memory impairment and confusion.

34. Initial nursing diagnosis would be:

a. impaired adjustment
b. altered thought process
c. disturbance in self esteem
d. impaired social interaction

35.Aling Maring makes up stories about events she can not recall because it:

a. reduces feeling of isolation
b. maintains her self esteem
c. reduces her feelings of frustration
d. increases her feeling of security

36. She is observed to be repeating the same word oyer and over again. This symptom is known as:

a. Aphasia
b. Apraxia
c. perseveration
d. confabulation

Situation 10: A 29 year old assistant manager of a prestigious bank, Anna, has been suffering from peptic ulcer for one year.

37. In caring of patients with psychophysiology disorders, the nurse knows that:

a. Psycho physiologic disorders are not usually a medical emergency
b. The relief of physical symptoms will help resolve the psychological problems
c. There are no pathological findings that would cause the symptoms
d. Psychological stress can precipitate physical disorders

38. Because of limited coping skills in dealing with anxiety, the nurse identifies this nursing diagnosis:

a. impaired adjustment
b. social isolation
c. impaired social interaction
d. ineffective individual coping

39. On admission, the nurse priorities one of the following nursing intervention:

a. Help Anna socialize with other patients
b. Help Anna perform activities of daily living
c. Alleviate physical symptoms
d. Help Anna identify situations which increase anxiety

40. Primary gain In Illness refers to:

a. Feeling of indifference to the distressing symptom
b. Use of symptom to decrease anxiety
c. Interpersonal benefits the patient derives from illness
d. Increased ability to cope with anxiety in the future

Situation 11: A teacher, Flora, 52 years old, with severe depression was admitted to the hospital. Her past history regaled she had suicidal ideation and has expressed feelings of helplessness.

41. One of the following statements is true with regard to the care of a depressed patient like Flora:

a. ail depressed clients are potentially suicidal
b. most suicidal persons give no warning
c only rnentally ill persons commit suicide
d. the chance of suicide decreases as depression lessen

42. Patients with severe depression, uses this defense mechanism:

a. Projection
b. repression
c. Introjection
d. suppression

43. During the initial stage of hospitalization, the most appropriate nursing intervention in planning activities for Flora is:

a. allow her to cheese what she wants to do each day
b. provide daily schedule of activities for her to follow
c. observe for signs which will indicate her willingness to participate in any activity
d. schedule one's activity per day to give her time to rest

44. One morning Flora says to the nurse. "Go away and leave me alone. All I want is rest." The nurse response therapeutically when she replies:

a. "Since you say you are tired, I'll check you later."
b. "I am going to stay with you for a while."
c. "When would you like me to return."
d. "Why do you want me to leave."

45. Flora is being prepared for discharge. However, she says "I am afraid to go home, no one wants to live with me." One of the following would be the appropriate nursing intervention;

a. involve the family in planning for discharge of Flora
b. accept her appraisal of the situation and explore their alternatives
c. discourage her from thinking that no one wants to live with her
d. encourage her to discuss discharge plans her family

Situation 12: Millie R., ages 74, was recently admitted to a nursing home because of confusion, disorientation, and negativistic behavior. Her family states that Millie is in good health.

46. Millie asks you," Where am I?" The best response of the nurse to make is

a. "Don't worry, Millie. You're safe here."
b. "Where do you think you are?"
c. What did your family tell you?"
d. "You're at the community nursing home."

47. Which at the following would be an appropriate strategy in reorienting a confused client to where her room is?

a. Race pictures of her family on the bedside stand
b. Put her name in large letters on her forehead
c. Remind the client where her room is
d. Let the ether residents knew where the client's roan is

48. Which activity would you engage Millie in at the nursing home?

a. reminiscence group
b. sing-along
c. discussion group
d. exercise class

49. Millie has had difficulty sleeping since admission. Which of the following would be the best intervention?

a. Provide her with a glass of warm milk
b. Ask the physician for a mid sedative
c. Do net allow Millie to take naps during the day
d. Ask her family what they prefer

50.Millie R. has self-care deficit. She has difficulty herself. The best action for the nurse to take is to

a. have the client to wear hospital gowns
b. explain to the client why he should dress herself
c. give the client step-by-step instructions for dressing herself
d. allow enough time for the client to dress herself.

Situation 13: Ronald, 23 years old, was voluntarily admitted to the inpatient unit with a
diagnosis of paranoid schizophrenia.

51. AS the nurse approaches Ronald he says, "If you come any closer, I die." This is an example of:

a. Hallucination
b. Delusion
c. illusion
d. idea of reference

52. The best response for the nurse to make to this behavior is:
a. How can I hurt you?
b. I'm the nurse
c. Tell me more about this
d. That's a silly thing to say

53. Ronald is pacing the halls and is agitated. The nurse hears him saying, "I have to get away from those doctors! They are trying to commit me to the state hospital". The nurse's continued assessment should include

a. clarifying information with the doctor
b. observing Ronald for rising anxiety
c. renewing history of involuntarily commitment
d. checking dosage of prescribed medication

Situation 14: Mr. K, 24 years old, was admitted on a voluntary basis to psychiatric services, He had agreed to inpatient care as an alternative to a 30 day jail sentence fro reckless driving, driving under the influence of alcohol and over speeding. He has been under psychiatric care for three years, has a long history of petty crimes, and was able with help of his therapist, to convince the judge that a higher level of psychiatric care would be in everyone's best interest,

54. When a scheduled group therapy session in announcement, he refuses to go and the nurse has to resort inn pleading with him to attend. He uses ether client to his own needs and often pioneers causes that are disruptive to the milieu. The diagnostic title that best describes Mr. Ks behavior is

a. Antisocial personality disorder
b. Borderline personality disorder
c. Passive-aggressive personality disorder
d. Passive-dependent personality disorder

55. In planning care for Mr. K it is important for the nurse to recognize that all of the following are likely to occur except

a. staff and client agree when setting treatment goals
b. staff and client are consonant struggle for control of the milieu
c. staff and client feel threatened by one another
d. staff and client use the same defense mechanism when interacting

56. Key intervention for a client with an antisocial personality disorder include all of the following except:

a. assisting him to identity and clarify his feelings
b. changing staff assigned to Mr. K at his request
c. making expectations about his behavior dear as well as consequences for same.
d Setting firm limit with clear consequences

57. At the time of discharge the nurse understands that Mr. K is most likely to:

a. be committed to another facility for a longer length of stay
b. be committed to a virtuous and socially acceptable life-style
c. discontinue treatment with the outpatient therapist
d. revert to pre hospitalization behaviors

Situation 15: Tammy, 18 months old, has been admitted for second degree burns surroundings the genital area. Her mother told the nurse that Tammy grabbed the hot coffee cup and spilled it on herself.

58. The nurse is required by law to

a. testify in court on the injuries.
b. Reports suspected child abuse
c. Have the mother arrested
d. Refer the mother to counseling

59. Tammy’s mother is 17 years old, in which of the areas would the nurse provide health teaching?

a. Normal growth and development
b. Bonding techniques
c. How to childproof the apartment
d. Parenting skills

Situation 16:.Annie, a 4th year BSN student will have their duty in psychiatric hospital, She is reviewing her notes about: Nurses -Client relationship/Therapeutic Communication

60. Trust may develop in the nurse -client relationship when the nurse

a. avoid limit setting
b. encourage the client to use "testing" behaviors
c. tell the clients how he should behave
d. Uses consistency in approaching the client.

61. A client has just begun, to discuss important feelings when the time of the interview is up. The next day, when the nurse meets with the client the agreed-upon time, the initial intervention would be to say

a. "Good morning; how are you today?"
b. "Yesterday you were talking about some very important feelings. Let's continue."
c. "What would you like to talk about today?"
d. Nothing and wait for the client to introduce the topic.

62. A new staff is on orientation tour with the head nurse. A client approaches her and says, "I don't belong here. Please try to get me out." The staff nurse's response would be.

a. “What would you do if you were out of the hospital?"
b. "I am a new staff member, and I'm on a tour. I'll come back and talk with you."
c. "1 think you should talk with the head nurse about that."
d. "I can't do anything about that."

63. The nurse is in the day room with the group of the client who has been quietly watching TV suddenly jumps up screaming and runs out of the room. The nurse's priority intervention would be to

a. Turn off the TV and ask the group what they think about the client's behavior
b. Follow after the client to see what has happened.
c. ignore the incident because these outbreak are frequent,
d. Send another client out of the room to check on tile agitated client.

64. A nurse observes the client sitting alone in her room crying. As the nurse approaches her, the client states, "I'm feeling sad- S don't want to talk now." The nurse's best response would be

a. "lt will help you feel better if you talk about it."
b. "I’ll come back when you feel like talking."
c. "Ill stay with you a few minutes."
d. "Sometimes it helps to talk." •

Situation 16: Defense mechanisms are used by individuals, in order to cope with anxiety and stress in life. The following questions refer to anxiety and stress disorders/defense mechanisms.

65. A student failed her psychology final exam and spent the entire evening berating the teacher and the course. This behavior would be an example of which defense mechanisms?

a. reaction-formation
b. Compensation
c. Projection
d. Acting out

66. The most effective nursing intervention for a severely anxious client who is pacing vigorously would be to

a. instruct her to sit down and quit pacing
b. place her In bed to reduce stimuli and allow rest
c. allow tier to walk unit she becomes physically tired
d. give her PRN medication and walk with her at a gradual slewing pace

67. A client is experiencing high degree or anxiety. It is important to recognize if additional help is required because

a. if the client is out of control, another person will help to decrease his anxiety level.
b. Being alone with an anxious client is dangerous.
c. It will take another person to direct the client into activities to relieve anxiety.
d. Hospital protocol for handing anxious clients requires at least two people.

68. A client with a diagnosis of obsessive-compulsive disorder constantly does repetitive cleaning. The nurse knows that this behavior is probably most basically an attempt to:

a. decrease anxiety to tolerate level
b. focus attention on non threatening task
c. control others
d. decrease, the time available for interaction with people.

69. A client is suffering from post-traumatic stress disorder following a rape by an unknown assailant. One of the primary goals of nursing care for this client would be to;

a. Establish safe, supportive environment
b. Control aggressive behavior
c. Deal with the client's anxiety
d. Discuss client's nightmare and reactions.

70. A client's deafness has been diagnosed as convention disorder. Nursing intervention should be guided by which one of the following?

a. The client will probably express much anxiety about her deafness and require much reassurance.
b. The client will have little or no awareness of the psychogenic cause of her deafness.
c. Tile client's need for the symptom should be respected; thus, secondary gains should be allowed.
d. The defense mechanisms of suppression and rationalization are involved in creating symptom.

71. A female client has just received the diagnosis of hypochondriasis. This client continually focuses on gastrointestinal problems and constantly rings for a nurse to meet her every demand. The best nursing approach is to

a. ignore the demands because the nurse knows it is net necessary to respond.
b. Assign various staff members to work with the client so no staff member will become negative.
c. Anticipate the client's demands and spend them with her even though she does not demand it.
d. Provide for the client's basic needs, but do not respond her every demand, which reinforces secondary gains.

72. Person with personality disorders are known to be manipulators. Which principles is it important for the nurse to Know in planning the care of a person, with this diagnosis?

a. The nurse should allow manipulation so as to not raise the client's anxiety
b. The nurse should appeal to the client's sense of loyalty in adhering to the rules of the community.
c. When the client's manipulations are not successful, anxiety will increase.
d. The establishment of a nurse-client relationship will decrease the client's manipulations.

73. A mate client on the psychiatric unit becomes upset and breaks a chair when a visitor does not show up. The first nursing intervention should be to"

a. Say with the client during the stressful time.
b. Ask direct questions about the client's behavior
c. Set limits and restrict client's behavior
d. Ran with the client on hew he can better handle frustration.

74. The nurse has been interviewing the client who ha snot been able to discuss any feelings. This day, 5 minutes before the time is over, the client begins to talk about important feelings. The intervention is to

a. Go over the agreed-upon time, as the client is finally able to discuss important feelings.
b. Tell client that is time to end the session now, but another nurse will discuss his feelings with him.
c. Set an extra meeting time a little later to discuss these feelings.
d. Bid just as agreed, but tell the client these are very important feelings and he can continue tomorrow.

Situation 17: A 60-year old client complains of headaches, restlessness and insomnia. During an interview, the nurse Seams that the symptoms began 3 months ago after the client was forced into early retirement.

75. The nurse recognizes that the client is probably experiencing:

a. A social crisis
b. A situational crisis
c. An economic crisis
d. A development crisis

76. According to crisis theory, the minimal long term goal in crisis intervention is:

a. Relief of acute symptoms
b. Relief of panic-level anxiety .
c. Restoration of the origins functioning level
d. Reorganization and reordering of the personality

77. The most critical factor for tine nurse to determine during crisis intervention is the client's:

a. developmental history
b. available situational supports
c. underlying unconscious conflict
d. willingness to restructure the personality

78. When Interviewing in a crisis situation, the initial concern of the nurse is:

a. What was the precipitating factor?
b. How is the individual affecting others?
c. How will the client deal with successive crisis
d. Whether the individual can go back to daily activities

Situation 17: Ms. Zepetee is a client with a history of abuse of multiple drugs.

79. When planning care for her. The nurse should be aware that the most serious life-threatening symptoms during withdrawal usually result from:

a. heroin
b. methadone
c. barbiturates
d. amphetamines

80. With a tentative diagnosis of opiate addiction, the nurse should assess this recently hospitalize client for signs of opiate withdrawal. These signs would include:

a. lacrimation vomiting, drowsiness
b. nausea, dilated pupils, constipation
c. muscle aches, papillary constriction, yawning
d. rhino rhea, convulsions, abnormal temperature

81. The nurse aware that opiates are most commonly used because the individual.

a. desire to become independent
b. wants to fit In with the peer group
c. attempts to blur reality and reduce stress
d. enjoys the social interrelationship that occur

82. Ms. Zepetee is treated for multiple stab wounds to the abdomen. After surgical repair the nurse notes that the client's pain does not seem to be relieved by the prescribed IM mepericline hydrochloride. The nurse recognizes that the failure to achieve pain relief from indicates that she is probably experiencing the phenomenon of:

a. tolerance
b. habituation
c. physical addiction
d. psychologic

83. After a visit from several friends the nurse finds a client with a known history of opiate addiction in a deep sleep and unresponsive to attempts at arousal The nurse assesses the client's vital signs and would evaluate that an overdose of opiates had occurred if the findings showed a:

a. blood pressure of 70/40 mm Hg, pulse of 120- and respirations of 10
b. blood pressure of 120/80 mm Hg, a pulse of 84, and respirations of 20
c. blood pressure of 140/90 mmHg, a pulse of 76, and respirations of 28.
d. blood pressure of 180/100 mm Mg, a pulse of 72, and respirations of 18

84. At a staff meeting the question of a staff nurse returning to work after a dug rehabilitation program Is discussed. The nursing supervisor helps the staff to decide that the most therapeutic way to handle the nurse's return would be to:

a. Offer the nurse support In a. direct, straightforward manner
b. Avoid mentioning the problem unless the nurse brings up the topic
c. Assigns another staff member to keep the nurse under dose observation
d. Make certain the nurse is assigned to administer only non-narcotic medications.

85. Addicted clients commonly expect prejudice and hostility from psychiatric personnel. The nurse can best overcome their expectation by using:

a. acceptance and consistency In the approach
b. reassurance that nonjudgmental attitudes exists
c. self-disclosure to promote a therapeutic relationship
d. confrontation of these judgmental attitudes is'' the client

86. A client with a long history to alcohol abuse is placed on a diet in vitamin B1 (Thiamine). "The nurse would know that the diet is understood when the client states" I will select something for each meal from among:

a. Fish, aged cheese, and breads
b. Poultry, milk products, and eggs
c. Lean pork, organ meat, and nuts
d. "Leafy and green vegetables and citrus fruits." '

87. The nurse is aware that tile reason some alcoholics are unable to stop drinking even though they begin to attend AA meetings is that they:

a enjoy the feeling caused by drinking alcohol
b. physiologically require the substance in their body
c. are trying to drastically stop after a long-standing habit
d. often have a character direct that defeats their will power

Situation 18: ethical and legal responsibilities are part of your nursing practices

88. Which of the following statements is true?

a. ethics prescribed what are right and wrong conduct
b. ethics and morals are synonymous
c. morals as human conduct is also a legal rights
d. an unethical act is immoral

89. The Code for Nurse best describes:

a. rules that protect public interest and welfare
b. principles of conduct becoming a nurse
c. right ways of giving nursing care
d. society's norm in the practice of nursing

90. When you start the practice of professional nursing you assume "ipso facto" obligations to uphold the noble traditions of the professions. You are expected to:

a. earn a living
b. safeguard public health
c. abide by the law
d. fulfill your civic duties

91. The scope of nursing practice based on RA 7164 the following responsibilities. EXCEPT:

a. interpreting results of sensitivity test
b. initiating "code blue"
c. suturing laceration
d. care of women during pregnancy, labor and delivery

92. To develop independence of families in health, which of the following is the best approach?

a. family education for life
b. family empowerment
e. family health work
d. family health organization

Situation 19: You often do not finish your nursing work on the time for shift endorsement

93. This is an indicator of effective use of your time:

a. Keeping a time schedule
b. using a log book
c. checking Kardex cards
d. reading ward

94. What evidence will indicate your effective use of time?

a. doctor's bill have been issued
b. charting completed on time
c. all serious patients have been cared
d. patient's bills forwarded to billing office

95. You knew that in practice effective use of time is good management. Which of the following measures would be most helpful in keeping tract of work time?

a. keep a log for the day
b. plan your work activities
c. do a time analysis
d. request health in your work

96. Which of the following would you first do?

a. organize activities by priority
b. ask an attendant to help you
c. attend first to patients without watchers
d. none of the above

97. Research contributes to the acknowledge-based on professional nursing. Which of the following, statement in the improvement is TRUE?

a. research seeks the unknown
b. research resolve a problem
c. research studies the world of reality
d. research relies on observable evidence

98. When you participate in nursing research your main activity is to:

a. develop problem solving skills
b. explain a nursing phenomenon
c. solve a nursing problem
d. understand man as human being

99. This type of research that attempts to solve practical nursing problems.

a. clinical-problem research
b. basic research
c. applied research
d. quasi-experimental research

100. The most import art value of research to practicing nurse is:

a. it improve clinical competence
b. it develops analytical skills
c. it contribute to new knowledge
d. it demonstrate professionalism




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Wednesday, August 29, 2007

‘Call us Batch 2007,’ says successful nursing test retaker

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Northern Luzon Bureau
Last updated 05:13pm (Mla time) 08/27/2007


BAGUIO CITY, Philippines -- Nurses who passed the scandal-ridden 2006 licensure examinations wanted to call themselves members of Batch 2007, after successfully passing the licensure test for a second time.

"Refer to us as Batch 2007, please," said Cyndi Erfe, one of the three Baguio nurses who first exposed cheating in 2006.

Erfe was among the June 2006 board passers who gave up their licenses and retook the five sets of examinations in 2007.

She said retaking the whole test erased the stigma of last year's examinations, which prompted American nurses' associations to review the licenses of Filipino nurses seeking employment there.

She is testifying against two former board examiners and two nursing review centers for their alleged role in test leakages in 2006.

Maria Grace Lacanaria, nursing school dean of the Saint Louis University, said nurses of Batch 2006 who chose to keep their licenses still "have great professional futures."

Read More.. http://globalnation.inquirer.net/news/breakingnews/view_article.php?article_id=84969





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IELTS Resource Downloads

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ACE TGE IELTS

http://rapidshare.com/files/48612218/Ace_the_IELTS.pdf

--VIDEO TELL U WHICH MISTAKE U AVOID IN SPEAKING

http://rapidshare.com/files/48613850/dont_in_ielts.rar

--SUCCESSFUL WRITING PROFICENCY

http://rapidshare.com/files/48617178/Successful_ Writing_Proficiency.rar

http://rapidshare.com/files/48619232/Successful_Writing_Proficiency_-_Teacher_s_Book.rar

--OXFORD ESSENTIAL GUIDE FOR WRITING

http://rapidshare.com/files/48617760/The_Oxford_Essential_Guide_to_Writing.rar

--EXAMPLES WHICH TEL U WHAT IS RIGHT WAY OF SPEAKING MODULE(INCLUDES
VIDEO EXAMPLE)

--EXTRA SPEAKING MATERIAL INCLUDE TIPS,VARIOUS CUE CARDS

http://rapidshare.com/files/48622992/speakig_module_ extra_by_rupinder.rar

--101 HELPFUL HINT FOR IELTS

http://rapidshare.com/files/48647456/101_helpful_hint_for_ielts.rar

--EXAMPLE OF IELTS ESSAY(MORE THAN 90 ESSAY)

http://rapidshare.com/files/48647765/IELTSEssays.zip

--VARIOUS EXAMPLE OF GRAPH(MORE THAN 70 EXAMPLE)

http://rapidshare.com/files/48648181/graph.rar

--IELTS SPEAKING TOPIC

http://rapidshare.com/files/48648424/IELTS_Speaking_Topics.pdf

--VARIOUS INTERVIEW QUESTION FOR IELTS

OH.FINALLY I POST ALL MORE 85% OF IELTS MATERIAL AFTER THE HARD WORK
OF 5 DAYS.IT`S VERY DIFFIVULT TO UPLOAD ANY FILE ON SLOW
CONNECTION.remember that the file will remain 15-20 day.bcz validity
of my account will finished,so file will also delted with my account

http://rapidshare.com/files/48648519/interview_question_for_ielts.DOC

--SPEAK ENGLISH IN AMERICAN ACCENT

http://rapidshare.com/files/48648618/SpeakEnglishLAA_1.pdf

--WRITING BAND DESCRIPTION

http://rapidshare.com/files/48648726/Writing_Band_ Descriptors.pdf

--TIPS FOR CONCLUDING THE ESSAY

http://rapidshare.com/files/ 48648863/tips_for_ concluding_the_essay. pdf

--IDEAS INTO WORDS

http://rapidshare.com/files/48779073/Ideas_into_ Words_2_. pdf

--202 USEFUL EXERCISE FOR IELTS(GOOD BOOK)

http://rapidshare.com/files/49045022/202_useful_ exercises_for_ielts. rar

AUDIO
DISK1
http://rapidshare.com/files/49460948/part1_202_ audio_disk1.rar
http://rapidshare.com/files/49461174/part2_202_ audio_disk1.rar
http://rapidshare.com/files/49461432/part_3_202_ audio_disk_1.rar
http://rapidshare.com/files/49461661/part_4_202_ audio_disk1.rar
DISK2
http://rapidshare.com/files/49461802/202_ielts_part1_disk2.rar
http://rapidshare.com/files/49462060/202_ielts_part2_disk2.rar
http://rapidshare.com/files/49462380/202_ielts_part3_disk2.rar

--SOME ACADEMIC TESTS

http://rapidshare.com/files/49423591/The_Academic_Tests_2_.rar

--CAMBRIDGE IELTS PRACTICE1

http://rapidshare.com/files/49424643/IELTS1.pdf

AUDIO

http://rapidshare.com/files/49426095/ielts11.mp3
http://rapidshare.com/files/49427076/ielts12.mp3
http://rapidshare.com/files/49431433/ielts21.mp3
http://rapidshare.com/files/49432585/ielts22.mp3

--CAMBRIDGE IELTS PRACTICE2
BOOK
http://rapidshare.com/files/49432620/ielts2.pdf

AUDIO

http://rapidshare.com/files/49432984/01.mp3
http://rapidshare.com/files/49433361/02.mp3
http://rapidshare.com/files/49433700/03.mp3
http://rapidshare.com/files/49434044/04.mp3

--CAMBRIDGE IELTS PRACTICE3

http://rapidshare.com/files/49434233/Cambridge_ IELTS_3.pdf
AUDIO

http://rapidshare.com/files/49434481/practics1.mp3
http://rapidshare.com/files/49434735/practics2.mp3
http://rapidshare.com/files/49435024/practics3.mp3
http://rapidshare.com/files/49435257/practics4.mp3

--CAMBRIDGE IELTS PRACTICE4{BEST BOOK FOR IELTS PRACTICE}

http://rapidshare.com/files/49435276/Cambridge_IELTS4.01.pdf
http://rapidshare.com/files/49435451/Cambridge_IELTS4.02.pdf
http://rapidshare.com/files/49435494/Cambridge_IELTS4.03.pdf
http://rapidshare.com/files/49435776/Cambridge_IELTS4.04.pdf
http://rapidshare.com/files/49435798/cambridge_4_ans_key.pdf
AUDIO
TEST1
http://rapidshare.com/files/49436230/Test1.Section1.mp3
http://rapidshare.com/files/49436628/Test1.Section2.mp3
http://rapidshare.com/files/49436967/Test1.Section3.mp3
http://rapidshare.com/files/49437270/Test1.Section4.mp3
TEST2
http://rapidshare.com/files/49437684/Test2.Section1.mp3
http://rapidshare.com/files/49438000/Test2.Section2.mp3
http://rapidshare.com/files/49438287/Test2.Section3.mp3
http://rapidshare.com/files/49438755/Test2.Section4.mp3
TEST3
http://rapidshare.com/files/49439172/Test3.Section1.mp3
http://rapidshare.com/files/49439564/Test3.Section2.mp3
http://rapidshare.com/files/49439925/Test3.Section3.mp3
http://rapidshare.com/files/49440204/Test3.Section4.mp3

TEST4
http://rapidshare.com/files/49440565/Test4.Section1.mp3
http://rapidshare.com/files/49440797/Test4.Section2.mp3
http://rapidshare.com/files/49441132/Test4.Section3.mp3
http://rapidshare.com/files/49441406/Test4.Section4.mp3

--CAMBRIDGE IELTS PRACTICE 5{BEST BOOK FOR IELTS PRACTICE}

http://rapidshare.com/files/49441953/Cambridge_ IELTS_5_with_Answers.pdf
http://rapidshare.com/files/49442042/test_1section1.mp3
http://rapidshare.com/files/49442103/test1_section3.mp3
http://rapidshare.com/files/49442170/test1_section4.mp3
http://rapidshare.com/files/49442279/test2_section1.mp3

http://rapidshare.com/files/49442371/test2_section2.mp3
http://rapidshare.com/files/49442440/test2_section3.mp3
http://rapidshare.com/files/49442514/test2_section4.mp3

http://rapidshare.com/files/49442824/Cambridge_IELTS_5_with_Answers_Test3.rar

http://rapidshare.com/files/49443071/Cambridge_IELTS_5_with_Answers_Test4.rar

--IELTS PRACTICE TEST PLUS

http://rapidshare.com/files/49443457/IELTS_Practice_ Test_Plus.pdf
http://rapidshare.com/files/49443916/c1s1.mp3
http://rapidshare.com/files/49444373/c1s2.mp3
http://rapidshare.com/files/49444852/c2s1.mp3
http://rapidshare.com/files/49445568/c2s2.mp3

--IELTS TO SUCCESS BOOK

http://rapidshare.com/files/49446115/IeltsToSuccess. tif
http://rapidshare.com/files/49446534/IeltsToSuccess1.mp3
http://rapidshare.com/files/49446821/IeltsToSuccess2.mp3
http://rapidshare.com/files/49447000/IeltsToSuccess3.mp3

--INSIGHT INTO IELTS

http://rapidshare.com/files/49448553/Side_1.mp3
http://rapidshare.com/files/49449074/Side_2.mp3

--INSIGHT INTO IELTS EXTRA

http://rapidshare.com/files/49449831/insight_extra.pdf
http://rapidshare.com/files/49450274/art01.wma
http://rapidshare.com/files/49450830/art02.wma

--PASSPORT TO IELTS
http://rapidshare.com/files/49451057/Passport_ to_IELTS__IELT__by_ Diana_Hopkins__Nettle.djvu

TO OPEN THIS BOOK U NEED TO DOWNLOAD SOFTWARE AT FOLLOWING LINK
hssp://rapidshare.com/files/49451396/DJVUCNTL_61_EN.EXE
http://rapidshare.com/files/49452481/Passport_to_IELTS_Side_A.mp3
http://rapidshare.com/files/49453377/Passport_To_IELTS_Side_B.mp3

--PRACTICE NOW

http://rapidshare.com/files/49453609/PracticeNow.doc
http://rapidshare.com/files/49454059/PracticeNow1.mp3
http://rapidshare.com/files/49454438/PracticeNow2.mp3

--PREPARATION AND PRACTICE

http://rapidshare.com/files/49454480/PreparationAndPractice.doc
http://rapidshare.com/files/49454896/PreparationAndPractice1.side1.mp3
http://rapidshare.com/files/49455072/PreparationAndPractice1.side2.mp3
http://rapidshare.com/files/49455250/PreparationAndPractice2.side1.mp3
http://rapidshare.com/files/49455535/PreparationAndPractice2.side2.mp3

--PREPARE FOR IELTS

http://rapidshare.com/files/49455651/Prepare_For_IELTS.doc
http://rapidshare.com/files/49456103/PrepareForIelts1.mp3
http://rapidshare.com/files/49456306/PrepareForIelts2.mp3

--SPECIMEN MATERIAL
http://rapidshare.com/files/49456417/SpecimenMaterialsHandbook.tif
http://rapidshare.com/files/49456515/SpecimenMaterialsForAll.tif
http://rapidshare.com/files/49456703/SpecimenMaterials1.mp3
http://rapidshare.com/files/49456900/SpecimenMaterials2.mp3

--STRATEGIES FOR IELTS

http://rapidshare.com/files/49457333/StrategiesForStudy.tif
http://rapidshare.com/files/49458332/StrategiesForStudy1.mp3
http://rapidshare.com/files/49458805/StrategiesForStudy2.mp3

CAMBRIDGE ACTION PLAN FOR IELTS

http://rapidshare.com/files/49459420/Cambridge-Action.Plan.for.IELTS.rar
http://rapidshare.com/files/49459468/IELTS_Secrets.pdf

--101 HELPFUL HINT FOR IELTS(EXCELLENT BOOK FOR BEGINNER)

http://rapidshare.com/files/49459542/101_Helpful_Hints_for_IELTS
http://rapidshare.com/files/49459688/01-AudioTrack_01.mp3
http://rapidshare.com/files/49459818/02-AudioTrack_02.mp3
http://rapidshare.com/files/49459965/03-AudioTrack_03.mp3
http://rapidshare.com/files/49460130/04-AudioTrack_04.mp3
http://rapidshare.com/files/49460299/05-AudioTrack_05.mp3
http://rapidshare.com/files/49460424/06-AudioTrack_06.mp3
http://rapidshare.com/files/49460574/07-AudioTrack_07.mp3
http://rapidshare.com/files/49460737/08-AudioTrack_08.mp3

--CAMBRIDGE IELTS PRACTICE TEST

http://rapidshare.com/files/49463662/Cambridge_6.rar
http://rapidshare.com/files/49464291/Cambridge_Ielts_6_audio.rar

--ENGLISH HINDI DICTIONARY

http://rapidshare.com/files/49464420/EngHindiDict.exe



Article copyright NurseReview.org - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.




Easing the course of Guillan-Barre syndrome

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Easing the course of Guillan-Barre syndrome
Author/s: Treesa L. Worsham
Issue: March, 2000

Patients can rapidly develop a number of life-threatening problems,
including the inabiltly to swallow and breathe. Here you'll find
information about GBS and the nursing care necessary to see patients
safely through the crisis.

In the late '70s, Guillain-Barre syndrome (GBS) was little known,
tied in the public's mind to flu shots, and much feared. The panic
associated with it then is no more, but for those afflicted, the fear
is still very real. That's 'because GBS, which comes on seemingly out
of the blue, is an inflammatory disorder that affects the peripheral
nervous system, causing motor weakness and sensory abnormalities. It
strikes approximately one in 100,000 people each year without regard
to gender, age, or race. [1]

Scientists believe that GBS, also called acute idiopathic
polyneuritis, is an autoimmune disease. What initially causes it
isn't known; however frequent triggers include viral and bacterial
infections.

Since GBS can cause respiratory paralysis, it's considered a medical
emergency. In order to act quickly and care for GBS patients most
effectively, nurses need to know how the syndrome progresses, how
it's diagnosed and treated, and what problems these patients will
encounter during their hospital stay.

Signs and symptoms are key to diagnosis

The syndrome--which can develop over hours, days, or weeks--typically
begins with muscle weakness and abnormal sensations, such as tingling
or numbness, in the legs. (The box at right explains the
pathophysiology. ) These symptoms usually ascend symmetrically to the
upper body.

There are no tests specifically for GBS, so diagnosis is based mainly
on the history and physical exam. Patients typically arrive in the ED
complaining of symptoms of two weeks' duration. They may or may not
report a recent infection.

The physical exam will reveal motor, autonomic, and sensory deficits,
which are listed in the box on page 50. Not all of these signs may be
present on the initial exam, however.

To help confirm the diagnosis, a physician may perform a lumbar
puncture. Cerebrospinal fluid in patients with GBS commonly has
elevated protein levels (greater than 400 mg/[L). [2] The doctor may
also order a nerve conduction velocity study to test for slow impulse
transmission- -another finding in GBS. Electromyography, which records
muscle activity, is also helpful; in GBS, the results generally show
that single muscle cells are activated rather than groups of muscle
fibers.

Once GBS is suspected, hospitalization is a must. The patient's
condition can rapidly deteriorate into paralysis that affects the
respiratory muscles, necessitating intubation and mechanical
ventilation. Depending on the severity of the patient's symptoms (not
all will experience paralysis), he may be admitted to a medical or
neurology floor or to an ICU.

Nine out of 10 patients are at their weakest by the third week after
the onset of symptoms. [3] About 5% die. [4] The other 95% eventually
recover on their own, which normally takes at least a couple of
months. However, there are treatments that can help speed healing.

Treatment leads to faster recuperation
Plasmapheresis and intravenous immune globulin (IVIG) are two of the
more effective therapies for GBS. Plasmapheresis removes plasma from
the blood that may contain antibodies responsible for the attack.
Since it carries its own risks, though, it's generally reserved for
patients who develop major problems, such as the inability to walk.
How often plasmapheresis is done will vary depending on the patient's
condition; but in a typical case, several times over about five days
could be expected. The procedure is done only by a specially trained
nurse or technician.

Although plasmapheresis can decrease the amount of time a patient
must spend on a ventilator and bedridden in the hospital, [5] it has
its drawbacks. It must be started within two weeks of the onset of
symptoms to be effective, and has been associated, rarely, with an
increased rate of relapse. [6] Therefore, patients who've undergone
plasmapheresis should be followed closely after treatment.

An alternative to plasmapheresis is IVIG. Although the exact mode of
action is unknown, it may help GBS patients by binding good
antibodies to the receptor sites on nerve cells and preventing the
bad antibodies from attaching there.

IVIG, such as Gamimune N, is administered as an infusion over several
hours--usually once a day for three to five days. It must be given in
the earlier stages of the syndrome. IVIG can be administered by the
patient's bedside nurse so it's more readily available than
plasmapheresis.

IVIG is more expensive, though. As with plasmapheresis, patients need
to be watched closely after it's administered to them.

Supportive measures keep the patient alive
Other treatment focuses on keeping the patient's body functioning as
he recovers. Even with plasmapheresis or IVIG, the patient may need
mechanical ventilation. It should be initiated when he can no longer
breathe effectively on his own -- usually once pulmonary function
tests show that his vital capacity has dropped to 10 or 12 ml/kg.

If long-term ventilatory support is needed (more than a couple of
weeks), a tracheotomy is usually done; it's generally better
tolerated than endotracheal intubation.

If the patient can't swallow or he's on a ventilator, he'll need to
be fed through a nasointestinal or gastrostomy tube. High-protein,
high-calorie enteral formulas, such as TwoCal HN, are preferred. They
deliver the calories needed to maintain basal metabolic rate and
prevent muscle wasting.

Although total parenteral nutrition is an option, enteral feeding is
preferred if the patient has a functioning gut. That's because if the
GI tract is not used, the junction between intestinal cells widens,
allowing gut bacteria to translocate and possibly cause sepsis.

A watchful eye will help spot complications
Frequent assessment is especially important in GBS; because of the
progressive nature of this disease, a change in cardiovascular,
neurological, or respiratory status can be life-threatening.


Vigilant assessment will also help detect other problems that can
develop, such as urinary tract infection. UTIs are common in GBS
patients, who may develop bladder atony and require an indwelling
(Foley) catheter to prevent urinary retention.

Gastrointestinal dysfunction can also occur. If it does, it's likely
to cause severe constipation. This problem may be alleviated
naturally with fiber or chemically with laxatives or suppositories.

Patients with CI dysfunction are also at risk for paralytic ileus. If
you suspect this--you note abdominal distention or an absence of
bowel sounds, for example--you' ll temporarily stop the feeding and
alert the physician. You may also need to perform gastric
decompression.

Of course, any patient who's on a ventilator is at risk for
nosocomial pneumonia. Meticulous pulmonary hygiene--which includes
prn suctioning and chest PT to facilitate the removal of secretions--
will help prevent it.

Keeping the patient comfortable
Pain management and comfort measures are also vital. Although your
patient may have extensive paralysis, he isn't numb. On the contrary,
because GBS causes an alteration in nerve function, the patient may
develop paresthesia, deep muscle aches, and muscle stiffness.

To help relieve some of the discomfort, reposition your patient
frequently. That may mean every 30 -- 45 minutes. (This will also
help prevent nosocomial pneumonia.)

You should gently perform range-of-motion exercises approximately
three to six times a day and keep your patient's body in alignment.
Ask the occupational therapist to provide padded foot-boards or bunny
boots to prevent footdrop and supportive wrist splints to prevent
hyperflexion.

Physical therapy should be initiated early in the course of the
disease and continued throughout recovery to prevent contractures.
You can increase your patient's tolerance to the therapy by
administering an analgesic before each session. Make sure he receives
medication to help reduce neuropathic pain, such as gabapentin
(Neurontin) or a tricyclic antidepressant like amitriptyline
(Elavil). Patients with severe pain may need narcotics.

In order to guard against pressure ulcers, use an air mattress.
Padded heel and elbow protectors may help prevent abrasions from
friction.

Communication, education, and support

Keep in mind that your patient is physically, not mentally, impaired.
His hearing is intact and he's probably very anxious about what is
happening to him. Help decrease his fear by talking to him.
Acknowledge him when you enter the room, and explain what you're
doing as you perform his care.

In addition, devise a way for him to communicate. For example, if he
can blink his eyes, teach him to do so in response to Yes/No
questions--once for Yes, twice for No--or in response to large-print
picture cards. These may be available in your speech therapy
department. Or you can obtain them from the Guillain-Barre Syndrome
Foundation International (see the box below for contact information) .

Keep in mind that mechanically ventilated patients may fear that the
ventilator will become disconnected or malfunction. Be sure to
explain the built-in safeguards that will prevent that from happening.

Don't forget the family members, who are probably stressed and
anxious as well. Offer them counseling services from your pastoral
care or social work departments. Also encourage them to openly
discuss their concerns with you and join a support group.

You can help them gain a sense of control by encouraging them to
participate in their loved one's care. They can learn to perform
passive range-of-motion exercises and perhaps provide bolus feedings
through the gastrostomy tube. As the patient recovers, encourage him,
too, to take an active role in his care.

Patients are generally discharged from the hospital once they are
medically stable. They'll need physical and, possibly, occupational
therapy to regain their lost motor function. Whether rehab is done at
an inpatient center or on an outpatient basis, make sure patients
understand it can be a lengthy process that can take up to two years.

Explain that the extent of residual weakness from GBS varies.
Generally speaking, only 20% of patients still have weakness at one
year and only 5% have severe permanent disability. [5] Only about 3%
of patients will ever experience a relapse of symptoms after the
initial episode. [3]

GBS often leads to an extensive and trying hospital stay. Providing
patients and their families with education, support, and the best
nursing care possible will help them cope with the stress and chaos
this disorder brings into their lives.

TREESA L. WORSHAM is an acute care nurse practitioner at the Stern
Cardiovascular Center in Memphis.

REFERENCES

(1.) Diseases of the peripheral nerves. (1997). In R. D. Adams, M.
Victor, & A. H. Ropper (Eds.), Principles of neurology (pp. 1302 -
1369). New York: McGraw-Hill.

(2.) Bacher, I., Braunwald. E., et al. (Eds.). (1994). Harrison's
principles of internal medicine (13th ed.). New York: McGraw-Hill.

(3.) National Institutes of Health. "Guillain-Barre Syndrome."
http://www.ninds. nih.gov/patients /Disorder/ guillain/ guillain. htm (11
Nov. 1999).

(4.) Peripheral nerve disorders. (1997). In The Merck manual of
medical information (Home edition) (pp. 330 - 344). Whitehouse
Station, NJ: Merck & Co. Inc.

(5.) Pascuzzi, R. M., & Fleck. J. D. (1997). Acute peripheral
neuropathy in adults: Guillain-Barre syndrome and related disorders.
Neurol. Clin., 15(3), 529.

(6.) Parry, G. J. (1993). Guillain-Barre syndrome. New York: Thieme
Medical Publishers. Inc.

How GBS weakens the body
The peripheral nervous system is composed of 31 pairs of spinal
nerves, 12 pairs of cranial nerves, and various plexuses and ganglia.
Each nerve cell, or neuron, is composed of several parts, including
the axon. Responsible for transmitting nerve impulses, axons are
wrapped in segments of insulation called the myelin sheath, which is
composed of Schwann cells.

In GBS, antibodies attack the Schwann cells, causing the sheath to
break down--a process called demyelination- -and the uninsulated
portion of the nerve to become inflamed. Nerve conduction is,
interrupted, causing the classic signs of muscle weakness, tingling,
and numbness, which begin in the legs or feet and work their way
upward.

It's possible that the signals to and from the legs are most
vulnerable to interruption because they have to travel the longest
distance. Perhaps that's why symptoms appear there first, and
progress upward.

The demyelination is self-limiting. Once it stops, the Schwann cells
rebuild the lost insulation. Remyelination, and therefore recovery,
occurs in reverse; it starts at the top of the body and proceeds
downward.

Clinical signs of GBS

Motor

Upper and lower limb weakness

Complete or partial absence of reflexes

Decreased pulmonary function

Autonomic

Cardiac dysrhythmias

Increased or decreased heart rate

Increased or decreased blood pressure

Paroxysmal hypertension

Bladder atony

Gastroparesis

Sensory

Impaired response to light touch and pin prick

Decreased proprioception

KEYWORDS

* Guillain-Barre syndrome

* autoimmune disease

* peripheral nervous system

* paralysis

* respiratory failure

* lumbar puncture

* nerve condution velocity study

* electromyography

* plasmapheresis

* intravenous immune globulin (IVIG)

* mechanical ventilation

* enternal nutrition



Article copyright NurseReview.org - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.




Preventing Clogged Feeding Tubes

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Going with the flow. (preventing clogged feeding tubes)
Author/s: Karen Brennan Krupp
Issue: April, 1998

Find out what problems to anticipate-- and how a few simple steps can
head them off.

A clogged enteral feeding tube that can't be cleared must be replaced
an unwelcome prospect for you and your patient. At the very least,
he'll miss getting some of the fluid and nutrition he needs. At
worst, if he's homebound or a nursing home resident, he'll need to
travel to an appropriate facility for tube reinsertion and X-ray
confirmation of placement. The expression An ounce of prevention is
worth a pound of cure could have been coined by a nurse managing
feeding tubes.

In this article, we'll describe two simple ways you can keep feeding
tubes patent: pump-assisted infusion of enteral formulas and frequent
tube flushing. But first, let's review factors that can increase the
risk of a clogged feeding tube.

Problems in the pipeline

Feeding tubes can become clogged for one of these reasons:

* calorically dense formulas. When a dense formula is delivered in a
slow, uneven infusion (as by gravity drip), formula coagulation and
tube occlusion are more likely.

* small-bore feeding tubes. Small-bore tubes are more flexible and
less irritating to patients and can be left in place longer than
larger ones. But their smaller lumens make them more likely to clog.

* gravity drip. An imprecise roller clamp adjustment may increase or
decrease the amount of formula delivered by as much as 50%. When
formula flows slowly, residue clings to the wall of the tube,
creating a buildup that eventually clogs the tube.

A slow or stopped flow of formula also causes gastric pH to decrease
because there's less nutritional liquid to dilute the stomach acid.
This excess acid may then flow into the tube, causing the formula to
clump.

* medications. Bulk-forming agents such as psyllium (Metamucil),
antacids, and medications that haven't been properly crushed or
reconstituted can also clog a tube. The combination of crushed
medications and a small-bore feeding tube is a common cause of slowed
or blocked formula flow. Whenever possible, administer the liquid
formulation of a medication rather than creating a mixture from
crushed tablets.

* gastric residuals. When you check gastric residuals through a
feeding tube, gastric acid mixes with the formula in the tube and
causes formula coagulation, which can lead to tube clogging. This
problem is more common when small-bore feeding tubes are used to
aspirate gastric residuals.

An ounce of prevention

Now let's look at the two steps you can take to prevent feeding tubes
from clogging.

A pump-assisted infusion is especially helpful for administering a
calorically dense formula. The slight degree of pump-generated
pressure means the formula is delivered in a continuous, even
infusion, avoiding the problems associated with an uneven
administration rate.

Regular tube flushing with water is, the simplest way to prevent tube
clogging--and the most often neglected. The most common practice is
to instill 50 to 100 ml of water every 4 hours; before, after, and
between multiple doses of medications; and when stopping and starting
a feeding. If you flush the tube consistently, you can clear even
viscous enteral formulas from the tube lumen. Also flush before and
after you check gastric residuals.

Continued from page 1

Cranberry juice, carbonated beverages, meat tenderizers, enzymatic
solutions ... over the years, nurses have tried all sorts of remedies
for clogged enteral tubes. But researchers who've studied various
preventive irrigants have learned something surprising: Nothing beats
plain water. In fact, acidic colas and cranberry juice can actually
cause an obstruction by promoting formula coagulation.

The bottom line? Flushing the tube regularly with water remains the
most effective and practical way to prevent enteral, feeding tube
clogs.

Making it automatic

A heavy nursing workload and lack of written policies and procedures
for tube flushing can lead to inconsistency in tube flushing. So some
enteral pumps also have an automatic flush feature, which delivers a
preprogrammed amount of fluid, typically water, every hour. This
simulates the flushing action of a syringe and helps minimize residue
buildup.

Automatic flushing doesn't just save nursing time--it's also more
effective. Two studies found clogging in 75% of gastrostomy tubes in
the manually flushed group, compared with only 5% in the
automatically flushed group. The results were even more dramatic for
nasogastric tubes: 91% in the manually flushed group clogged; none
clogged in the automatic flush group.

Smooth sailing

By knowing which, factors predispose an enteral tube to clogging and
taking a few preventive measures, you can keep your patient
comfortable- -and save yourself some time.

SELECTED REFERENCES

Brennan, K., et al.: "The Effect of Automatic Flushing on Gastrostomy
Tube Clogging Rates" (abstract), FASEB Journal. 7:A377,1993.

Krupp, K, et al.: "The Effect of Automatic Flushing on Nasogastric
Tube Clogging Rates" (abstract), Journal of the American College of
Nutrition. 12:598, 1993.

Powell, K., et al.: "Aspirating Gastric Residuals Causes Occlusion of
Small-Bore Feeding Tubes," Journal of Parenteral and Enteral
Nutrition. 17(3):243-246, May/June 1993.

Silk, D.: "Enteral Nutrition: Current Clinical Practice: Part III,"
Nutrition 9(1):1-9, January/February 1993.

KAREN BRENNAN KRUPP, RN, BSN Research Nurse Hill Top Research, Inc.
Pharmaceutical Clinical Trials Division Former Clinical Research
Associate

BETSY HEMMER, RN, CETN Former Enterostornal Therapy Nurse Consultant

Ross Products Division Abbott Laboratories

COPYRIGHT 1998 Springhouse Corporation

COPYRIGHT 2000 Gale Group


Article copyright NurseReview.org - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.




Tuesday, August 28, 2007

Caring for the Patient on a Ventilator

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The nurse must be able to do the following:

1. Identify the indications for mechanical ventilation.
2. List the steps in preparing a patient for intubation.
3. Determine the FIO2, tidal volume, rate and mode of ventilation on a given
ventilator.
4. Describe the various modes of ventilation and their implications.
5. Describe at least two complications associated with patient’s response to mechanical ventilation and their signs and symptoms.
6. Describe the causes and nursing measures taken when trouble-shooting ventilator alarms.
7. Describe preventative measures aimed at preventing selected other complications related to endotracheal intubation.
8. Give rationale for selected nursing interventions in the plan of care for the ventilated patient.
9. Complete the care of the ventilated patient checklist.
10. Complete the suctioning checklist.

1. To review indications for and basic modes of mechanical ventilation, possible complications that can occur, and nursing observations and procedures to detect and/or prevent such complications.
2. To provide a systematic nursing assessment procedure to ensure early detection of complications associated with mechanical ventilation.

Indication for Intubation
1. Acute respiratory failure evidenced by the lungs inability to maintain arterial oxygenation or eliminate carbon dioxide leading to tissue hypoxia in spite of low-flow or high-flow oxygen delivery devices. (Impaired gas exchange, airway obstruction or ventilation-perfusion abnormalities).
2. In a patient with previously normal ABGs, the ABG results will be as follows:
PaO2 > 50 mm Hg with pH < 7.25
PaO2 < 50 mm Hg on 60% FIO2 : restlessness, dyspnea, confusion, anxiety, tachypnea, tachycardia, and diaphoresis
PaCO2 > 50 mm Hg : hypertension, irritability, somnolence (late), cyanosis (late), and LOC (late)
3. Neuromuscular or neurogenic loss of respiratory regulation. (Impaired ventilation)
4. Usual reasons for intubation: Airway maintenance, Secretion control, Oxygenation and Ventilation.

Types of intubation: Orotracheal, Nasotracheal, Tracheostomy
Preparing for Intubation
1. Recognize the need for intubation.
2. Notify physician and respiratory therapist. Ensure consent obtained if not emergency.
3. Gather all necessary equipment:
a. Suction canister with regulator and connecting tubing
b. Sterile 14 Fr. suction catheter or closed in-line suction catheter
c. Sterile gloves
d. Normal saline
e. Yankuer suction-tip catheter and nasogastric tube
f. Intubation equipment: Manual resuscitator bag (MRB), Laryngoscope and blade, Wire guide, Water soluble lubricant, Cetacaine spray
g. Endotracheal attachment device (E-tad) or tape
h. Get order for initial ventilator settings
i. Sedation prn
j. Soft wrist restraints prn
k. Call for chest x-ray to confirm position of endotracheal tube
l. Provide emotional support as needed/ ensure family notified of change in condition.

Intubation

Types of Ventilators
Ventilator Settings
Modes of Mechanical Ventilation
Complications of Mechanical Ventilation
1. Associated with patient’s response to mechanical ventilation:

A. Decreased Cardiac Output
1. Cause - venous return to the right atrium impeded by the dramatically increased intrathoracic pressures during inspiration from positive pressure ventilation. Also reduced sympatho-adrenal stimulation leading to a decrease in peripheral vascular resistance and reduced blood pressure.
2. Symptoms – increased heart rate, decreased blood pressure and perfusion to vital organs, decreased CVP, and cool clammy skin.
3. Treatment – aimed at increasing preload (e.g. fluid administration) and decreasing the airway pressures exerted during mechanical ventilation by decreasing inspiratory flow rates and TV, or using other methods to decrease airway pressures (e.g. different modes of ventilation).

B. Barotrauma
1. Cause – damage to pulmonary system due to alveolar rupture from excessive airway pressures and/or overdistention of alveoli.
2. Symptoms – may result in pneumothorax, pneumomediastinum, pneumoperitoneum, or subcutaneous emphysema.
3. Treatment - aimed at reducing TV, cautious use of PEEP, and avoidance of high airway pressures resulting in development of auto-PEEP in high risk patients (patients with obstructive lung diseases (asthma, bronchospasm), unevenly distributed lung diseases (lobar pneumonia), or hyperinflated lungs (emphysema).

C. Nosocomial Pneumonia
1. Cause – invasive device in critically ill patients becomes colonized with pathological bacteria within 24 hours in almost all patients. 20-60% of these, develop nosocomial pneumonia.
2. Treatment – aimed at prevention by the following:
Avoid cross-contamination by frequent handwashing
Decrease risk of aspiration (cuff occlusion of trachea, positioning, use of small-bore NG tubes)
Suction only when clinically indicated, using sterile technique
Maintain closed system setup on ventilator circuitry and avoid pooling of condensation in the tubing
Ensure adequate nutrition
Avoid neutralization of gastric contents with antacids and H2 blockers

D. Positive Water Balance
1. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) – due to vagal stretch receptors in right atrium sensing a decrease in venous return and see it as hypovolemia, leading to a release of ADH from the posterior pituitary gland and retention of sodium and water. Treatment is aimed at decreasing fluid intake.
2. Decrease of normal insensible water loss due to closed ventilator circuit preventing water loss from lungs. This fluid overload evidenced by decreased urine specific gravity, dilutional hyponatremia, increased heart rate and BP.

E. Decreased Renal Perfusion – can be treated with low dose dopamine therapy.

F. Increased Intracranial Pressure (ICP) – reduce PEEP

G. Hepatic congestion – reduce PEEP

H. Worsening of intracardiac shunts –reduce PEEP

2. Associated with ventilator malfunction:
A. Alarms turned off or nonfunctional – may lead to apnea and respiratory arrest
Troubleshooting Ventilator Alarms
Low exhaled volume: Cuff leak, Tubing disconnect, Patient disconnected
Evaluate cuff; reinflate prn; if ruptured, tube will need to be replaced. Evaluate connections; tighten or replace as needed; check ETT placement, Reconnect to ventilator
High pressure: Secretions in airway, Patient biting tubing, Tube kinked, Cuff herniation, Increased airway resistance/decreased lung compliance (caused by bronchospasm, right mainstem bronchus intubation, pneumothorax, pneumonia), Patient coughing and/or fighting the ventilator; anxiety; fear; pain.
Suction patient, Insert bite block, Reposition patient’s head/neck; check all tubing lengths, Deflate and reinflate cuff, Auscultate breath sounds, Evaluate compliance and tube position; stabilize tube, Explain all procedures to patient in calm, reassuring manner, Sedate/medicate as necessar
Low oxygen pressure: Oxygen malfunction
Disconnect patient from ventilator; manually bag with ambu; call R.T

3. Other complications related to endotracheal intubation.
A. Sinusitis and nasal injury – obstruction of paranasal sinus drainage; pressure necrosis of nares
1. Prevention: avoid nasal intubations; cushion nares from tube and tape/ties.
2. Treatment: remove all tubes from nasal passages; administer antibiotics.
B. Tracheoesophageal fistula – pressure necrosis of posterior tracheal wall resulting from overinflated cuff and rigid nasogastric tube
1. Prevention: inflate cuff with minimal amount of air necessary; monitor cuff pressures q. 8 h.
2. Treatment: position cuff of tube distal to fistula; place gastrostomy tube for enteral feedings; place esophageal tube for secretion clearance proximal to fistula.
C. Mucosal lesions – pressure at tube and mucosal interface
1. Prevention: Inflate cuff with minimal amount of air necessary; monitor cuff pressure q. 8 h.; use appropriate size tube.
2. Treatment: may resolve spontaneously; perform surgical interventions.
D. Laryngeal or tracheal stenosis – injury to area from end of tube or cuff, resulting in scar tissue formation and narrowing of airway
1. Prevention: inflate cuff with minimal amount of air necessary; monitor cuff pressure q. 8.h.; suction area above cuff frequently.
2. Treatment: perform tracheostomy; place laryngeal stint; perform surgical repair.
E. Cricoid abcess – mucosal injury with bacterial invasion
1. Prevention: inflate cuff with minimal amount of air necessary; monitor cuff pressure q. 8 h.; suction area above cuff frequently.
2. Treatment: perform incision and drainage of area; administer antibiotics.
4. Other common potential problems related to mechanical ventilation:
Aspiration, GI bleeding, Inappropriate ventilation (respiratory acidosis or alkalosis, Thick secretions, Patient discomfort due to pulling or jarring of ETT or tracheostomy, High PaO2, Low PaO2, Anxiety and fear, Dysrhythmias or vagal reactions during or after suctioning, Incorrect PEEP setting, Inability to tolerate ventilator mode.

PLAN OF CARE FOR THE VENTILATED PATIENT
Patient Goals:
Patient will have effective breathing pattern.
Patient will have adequate gas exchange.
Patient’s nutritional status will be maintained to meet body needs.
Patient will not develop a pulmonary infection.
Patient will not develop problems related to immobility.
Patient and/or family will indicate understanding of the purpose for mechanical ventilation.

Nursing Diagnosis
Nursing Interventions
Rationale
Ineffective breathing pattern r/t ____________________________.
Observe changes in respiratory rate and depth; observe for SOB and use of accessory muscles.
An increase in the work of breathing will add to fatigue; may indicate patient fighting ventilator.
.
Observe for tube misplacement- note and post cm. Marking at lip/teeth/nares after x-ray confirmation and q. 2 h.
Indicates correct position to provide adequate ventilation.
.
Prevent accidental extubation by taping tube securely, checking q.2h.; restraining/sedating as needed.
Avoid trauma from accidental extubation, prevent inadequate ventilation and potential respiratory arrest.
.
Inspect thorax for symmetry of movement.
Determines adequacy of breathing pattern; asymmetry may indicate hemothorax or pneumothorax.
.
Measure tidal volume and vital capacity.
Indicates volume of air moving in and out of lungs.
.
Asses for pain
Pain may prevent patient from coughing and deep breathing.
.
Monitor chest x-rays
Shows extent and location of fluid or infiltrates in lungs.
.
Maintain ventilator settings as ordered.
Ventilator provides adequate ventilator pattern for the patient.
.
Elevate head of bed 60-90 degrees.
This position moves the abdominal contents away from the diaphragm, which facilitates its contraction.

Impaired gas exchange r/t alveolar-capillary membrane changes
Monitor ABG’s.
Determines acid-base balance and need for oxygen.
.
Assess LOC, listlessness, and irritability.
These signs may indicate hypoxia.
.
Observe skin color and capillary refill.
Determine adequacy of blood flow needed to carry oxygen to tissues.
.
Monitor CBC.
Indicates the oxygen carrying capacity available.
.
Administer oxygen as ordered.
Decreases work of breathing and supplies supplemental oxygen.
.
Observe for tube obstruction; suction prn; ensure adequate humidification.
May result in inadequate ventilation or mucous plug.
.
Reposition patient q. 1-2 h.
Repositioning helps all lobes of the lung to be adequately perfused and ventilated.
Potential altered nutritional status: less than body requirements r/t NPO status
Monitor lymphocytes and albumin.
Indicates adequate visceral protein.
.
Provide nutrition as ordered, e.g. TPN, lipids or enteral feedings.
Calories, minerals, vitamins, and protein are needed for energy and tissue repair.
.
Obtain nutrition consult.
Provides guidance and continued surveillance.
Potential for pulmonary infection r/t compromised tissue integrity.
Secure airway and support ventialtor tubing.
Prevent mucosal damage.
.
Provide good oral care q. 4 h.; suction when need indicated using sterile technique; handwashing with antimicrobial for 30 seconds before and after patient contact; do not empty condensation in tubing back into cascade.
Measures aimed at prevention of nosocomial infections.
.
Use disposable saline irrigation units to rinse in-line suction; ensure ventilator tubing changed q. 7 days, in-line suction changed q. 24 h.; ambu bags changes between patients and whenever become soiled.
IAW Infection Control Policy and Respiratory Therapy Standards of Care for CCNS.
Potential for complications r/t immobility.
Assess for psychosocial alterations.
Dependency on ventilator with increased anxiety when weaning; decreased ability to communicate; social isolation/alteration in family dynamics.
.
Assess for GI problems. Preventative measures include relieving anxiety, antacids or H2 receptor antagonist therapy, adequate sleep cycles, adequate communication system.
Most serious is stress ulcer. May develop constipation.
.
Observe skin integrity for pressure ulcers; preventative measures include turning patient at least q. 2 h.; keep HOB < 30 degrees with a 30 degree side-lying position; use pressure relief mattress or turning bed if indicated; follow prevention of pressure ulcers plan of care; maintain nutritional needs.
Patient is at high risk for developing pressure ulcers due to immobility and decreased tissue perfusion.
.
Maintain muscle strength with active/active-assistive/passive ROM and prevent contractures with use of span-aids or splints.
Patient is at risk for developing contractures due to immobility, use of paralytics and ventilator related deficiencies.
Knowledge deficit r/t intubation and mechanical ventilation
Explain purpose/mode/and all treatments; encourage patient to relax and breath with the ventilator; explain alarms; teach importance of deep breathing; provide alternate method of communication; keep call bell within reach; keep informed of results of studies/progress; demonstrate confidence.
Reduce anxiety, gain cooperation and participation in plan of care.


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Monday, August 27, 2007

Choosing the Correct Answer!

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Decide What the Question is Dealing With:
*Which part of the Nursing Process: Assessment; Analysis; Planning; Implementation or Evaluation?

*Next, Decide the Order of Priority

First you must decide what part of the nursing process the question is connected with:

ANALYSIS--is the process of identifying potential and actual health problems. Most identify pertinent assessment information and assimilate it into the nursing diagnosis. Prioritize the needs that have been identified during analysis.

Some common words that are associated with ANALYSIS questions:
*diagnose; contrast; compare; analyze; order; prioritize; define; classify; catagorize; synthesize; sort; arrange;

ASSESSMENT--consists of a collection of data. Baseline information for pre and post procedures is included. Also included the recognition of pertinent signs and symptoms of health problems both present and potential. Verification of data and confirmation of findings are also included. Assess a situation before doing an intervention.

Some common words that are associated with ASSESSMENT questions:
observe; gather; collect; differentiate; assess; recognize; detect; distinguish; identify; display; indicate; describe;

PLANNING--Involves formulating goals and outcomes. It also involves various members of the health care team and the patient's family. All outcome criteria must be able to be evaluated with a specific time frame. Be sure to establish priorities and modify according to question.

Some common words that are associated with PLANNING questions:
rearrange; reconstruct; determine; outcomes; formulate; include; expected; designate; plan; generate; short/long term goal; develop;

IMPLEMENTATION--Addresses the actual/direct care of a patient. Direct care entails pre, intra and postoperative management, preforming procedures, treatments, activities of daily living. Also includes the coordination of care and referral on discharge. It involves documentation and therapeutic response to intervention and patient teaching for health promotion and helping the patient maintain proper health.

Some common words that are associated with IMPLEMENTATION questions:
*document; explain; give; inform; administer; implement; encourage; advise; provide; perform;

EVALUATION--Determines if the interventions were effective. Were goals met? Was the care delivered properly? Are modification plans needed. Addresses the effectiveness of patient teaching and understands and determines in proper care was offered. Evaluation can involve documentation, reporting issues, evaluates care given and determine the appropriateness of delegating to others. Most significantly, it finds out the response of the patient to care and the extent to which the goals we met.

Some common words that are associated with EVALUATION questions:
monitor; expand; evaluate; synthesize; determine; consider; question; repeat; outcomes; demonstrate; reestablish;

After determining what part of the nursing process the question is concerned with, next focus your attention on determining the category of priority:
Safe and effective care environment is always first. Patient safety is related to the proper preparation and delivery of nursing techniques and procedures as part of the nursing practice. It relates to every aspect of the delivery of care.

Physiologic integrity is the ability to provide competent care Information that may be described as traditionally medical- surgical and pediatric nursing falls into this category. Specific questions in this area can be related to many direct-care aspects of nursing practice. The importance of this area is highlighted because it is one in which planning, implementation and evaluation of care needs can easily be identified and tested. Physiologic integrity is always a slight lower priority than safety unless it involves airway, breathing and circulation. "ABC's" always comes first!

Psychosocial integrity tests the knowledge about a patients response to a disease or disorder. An understanding of stress, anxiety and ways to cope are essential. This is a lower priority the physiological integrity.

Health maintenance deals with health promotion, health teaching, disease prevention and assessment of risk factors for health problems. Normal growth and development is a major theme in this category. This however, is a low priority.

In Summary, when choosing the right answer for you NCLEX exam question 1) ask yourself, "what part of the nursing process is this question dealing with: analysis, assessment, planning, implantation or evaluation? and 2) Remember to prioritize your choices: safety always being first, 2)physiological integrity, 3)psychosocial integrity and health maintenance always has the lowest priority when choosing an answer.

Other tidbits:
avoid choices with the answers "all" "always" "never" or "none". Nothing is ever a definite in Science.
look for answers that are different. If three answers say the same thing but in different words, choose the answer that is different.
when given choices that are pharmacologically based or non pharmacologically based, choose the non pharmacological intervention. It is more often then not, the correct answer.


SOURCE: http://caring4you.net/answer.html



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Quick Guide in applying for NCLEX

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#1 Determine which state you want to apply
If you applied in New Mexico for example, it does not mean that you have to work there, once you pass the exam, you can always apply for reciprocity. Another factor that you need to consider when choosing the state to apply for nclex is their requirements, for example, some states some state requires that you be a cgfns passer and so on..

#2 Visit chosen state's websites
Reason here is you want to checkout their requirements when applying. Each state has different requirements and procedures that you need to follow. Read carefully as to avoid mistakes. You also might want to email them requesting for a finger printing card.

#3 Request from your school your Transcript, Special Order, etc..
Try to contact your school registrar, they will guide you on what to request from the school for your nclex application.

#4 Submit application forms and payments
Proccessing time from states varies. Some state takes 5-7 months to process your application form. Before submitting your application, please double check everything is in order. Missing a requirement can delay your application significantly. It is also advisable that you do periodic follow-ups by email just to check the status of your application.

#5 As soon as you are eligible to take the exam, register with Pearson Vue
NCLEX Examinations are administered by Pearson Vue. To schedule an exam date, your must register with them, an Authorization to Test(ATT) will be issued to the applicant. The ATT will contain your schedule date to take the nclex exam.

Good Luck!



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NLE June 2007 Topnotchers

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1 DARLYN LUBANG CHUTUAPE
OUR LADY OF FATIMA UNIVERSITYVALENZUELA 88.00

2 ROMEO CARANDANG PANGILINAN
DE OCAMPO MEMORIAL COLLEGES 87.80

3 PIERRE CREED GARIN FLORENDO
MOUNTAIN VIEW COLLEGE 87.20

MONA LISA UY PUA
CHINESE GENERAL HOSPITAL COLLEGE OF NURSING & LIBERAL ARTS
87.20

4 JAYSON LIBAO CO
UNIVERSITY OF SANTO TOMAS 87.00

JEMIE SERRANO KOON
UNIVERSITY OF SANTO TOMAS 87.00

5 IVY JOY TUGAS CASIS
DE LOS SANTOS COLLEGE (DELOS SANTOS SCHOOL OF NURSING) 86.80

JUNDELL ANDRADE CASTARDO
UNIVERSITY OF CEBU 86.80

MICHELLE ANCHO CORPUS
SAINT DOMINIC SAVIO COLLEGE 86.80

MEL ANTONETTE MENDOZA LUCERO
BATAAN POLYTECHNIC STATE COLLEGEBALANGA 86.80

MARK RODELIO MACARAEG MARCOS
UNIVERSITY OF SANTO TOMAS 86.80
MA. PRISCILLE TUBIANOSA OGENA BICOL UNIVERSITY-TABACO 86.80

SHALYMAR SANTIAGO ZABALA
UNIVERSITY OF LUZON (LUZON COLL.) 86.80

6 NICOLE JAN ARROJADO CABRERA
UNIVERSITY OF SANTO TOMAS 86.60

CECILIA ARCEO DACANAY
BAGUIO CENTRAL UNIVERSITY 86.60

JULIE ANNE PAULE PINEDA
OUR LADY OF FATIMA UNIVERSITYVALENZUELA 86.60

AYNNE TUMOLVA TAGUBA
SOUTHEAST ASIAN COLLEGE (UDMC) 86.60

YASMIN MICHELLE DE RAMOS UMALI
UNIVERSITY OF SANTO TOMAS 86.60

7 IMELDA TERESITA PASIA CELESTINO
PHILIPPINE COLLEGE OF HEALTH & SCIENCES 86.40

PATRIUSS DIONISIO CRUZ
FAR EASTERN UNIVERSITY-MANILA 86.40

HILARIOUS EVANGELISTA DE JESUS
UNIVERSITY OF SANTO TOMAS 86.40

LEAH TUPINO QUIJANCE
SAINT DOMINIC SAVIO COLLEGE 86.40

CLAUDINE MARIE LLAVE RENIEDO
UNIVERSITY OF SANTO TOMAS 86.40

DANIELLE RITZ ESCOPETE SHALA
UNIVERSITY OF SANTO TOMAS 86.40

HAIDEE ALEJANDRO WASAN
UNIVERSITY OF SANTO TOMAS 86.40

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ABELLA WEST NEGROS COLLEGE 86.20

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UNIVERSITY OF SAINT LA SALLE 86.20

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APRIL CANDY UY YAP KONG
CEBU NORMAL UNIVERSITY (CEBU STATE COLLEGE) 86.20

JAIMIE RIZZA SANTOS MISLANG
UNIVERSITY OF SANTO TOMAS 86.20

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CHINESE GENERAL HOSPITAL COLLEGE OF NURSING & LIBERAL ARTS 86.20

SANTONIN DUARTE YU
UNIVERSITY OF CEBU IN LAPULAPU & MANDAUE 86.20

9 MAE AILEEN VALDEZ AGUSTIN
UNIVERSITY OF SANTO TOMAS 86.00

ARIAN JOY OLIVA ANDONG
CENTRO ESCOLAR UNIVERSITY-MANILA 86.00

TRACY JOANNA ANARCON BIAZON
MANILA DOCTORS COLLEGE 86.00

FLORENCIA CAMPOS CAMPOS
ARRIESGADO COLLEGE FOUNDATION, INC. 86.00

MICHAEL LOUISE ALPUERTO CERVANTES
CEBU CITY MEDICAL CENTER (CEBU CITY GENERAL HOSPITAL) 86.00

DIVINA ZUERTE PASETES DIOMAMPO
PINES CITY COLLEGE (PCEC) 86.00

MARK DAVID DE GUZMAN FRANCISCO
OUR LADY OF FATIMA UNIVERSITYVALENZUELA 86.00

MA. ASUNCION QUITO HIPOLITO
PERPETUAL HELP COLLEGE OF MANILA 86.00

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VELEZ COLLEGE 86.00

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DR. YANGA'S FRANCISCO BALAGTAS COLLEGE 86.00

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MANUEL S. ENVERGA UNIV. FOUNDATION LUCENA CITY 86.00

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CENTRAL PHILIPPINE UNIVERSITY 86.00

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FAR EASTERN UNIVERSITY-MANILA 86.00

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VELEZ COLLEGE 86.00

MARIA REGINA MERZA TIRU
UNIVERSITY OF SANTO TOMAS 86.00

JEWEY ANN REGNER TORREFRANCA
SOUTHWESTERN UNIVERSITY 86.00

MARIA CHRISTABELLE MENDOZA VINARAO
MANILA CENTRAL UNIVERSITY-CALOOCAN CITY
86.00

MAUREEN MANALANG ZABALA
OUR LADY OF FATIMA UNIVERSITYVALENZUELA 86.00

10 KINO XANDRO GONZALES ANUDDIN
ATENEO DE ZAMBOANGA 85.80

FRANCO ASUNCION BAIÑGAN
ARELLANO UNIVERSITY-MANILA 85.80

MARIE JOY GUNDRAN BORDEOS
MANILA DOCTORS COLLEGE 85.80

GILBERT CALZADA ENDRIGA
VELEZ COLLEGE 85.80

ROANNE MANZON MENDOZA
FAR EASTERN UNIVERSITY-MANILA 85.80

CYRUS MAN GONZAGA PAALISBO
SOUTHWESTERN UNIVERSITY 85.80

MARY ANNE REAL REYNES
RIVERSIDE COLLEGE 85.80

CRYSTAL GAYLE GUINTO SARMIENTO
DEE HWA LIONG COLLEGE FOUNDATION 85.80

CHERYL ROQUE VILLANUEVA
MANILA DOCTORS COLLEGE 85.80


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