Nursing Exam Notes

Attendance and Punctuality

  • Arrive on time for class and exams.

  • Quizzes and exams start exactly on time.

  • For exams, aim to be present 15 minutes early to settle in.

Entering the Profession

  • Convocation marks entry into a profession, signifying permission to practice.

  • Be prepared to change the profession from within.

  • Embrace the role of a change agent.

  • Historically, there were constraints like required white uniforms.

Diversity in Nursing

  • The program graduates many minority nurses.

  • Nationally, approximately 80% of nurses are white.

  • There is a push to change the face of the profession.

  • The Northeast is more multicultural and diverse.

  • Trinitas aims to provide opportunities for the local community.

  • Many students are the first in their families to attend college, bringing determination and a desire for change.

Expectations of a Professional Nurse

  • Passing the NCLEX means holding the same license and expectations as any other RN.

Safe Practice

  • Safe practice involves critical thinking and using the nursing process.

  • The nursing process includes assessment, identifying problems, planning, implementing interventions, and evaluating outcomes.

  • Focus is placed on evaluation and prioritization.

  • Reliance on the nursing process is emphasized in the practice act.

Competency

  • Competency doesn't mean knowing everything upon graduation.

  • Orientation periods and ongoing learning are necessary.

  • Nurses start as novices and progress to competency.

  • When unsure, ask for help, consult policies, and avoid "winging it."

  • Institutional policy is always the first reference in cases of negligence or malpractice.

  • A prudent nurse adheres to standards and doesn't improvise.

Ethical Practice

  • Ethical practice includes treating patients well and upholding professional standards.

  • Advocacy and treating all people equally are foundational.

  • The ANA code of ethics also addresses competency and managing unsafe environments.

  • While working, the personal self transitions to the professional nurse role.

  • The unspoken standards of practice and code of ethics guide nurses.

  • Nurses often voice concerns about safety and ethical challenges when standards of care are compromised.

Code of Ethics

  • The code of ethics distinguishes nursing from other professions.

  • It dictates how nurses should act when facing ethical dilemmas.

  • Nurses hold each other accountable for ethical conduct.

  • Speaking up against unethical behavior is expected, even concerning small issues like phone use at the nurses' station.

Plan for Success

  • Be proactive about responsibilities and utilize available resources.

  • Faculty offers an open-door policy for questions and assistance.

  • Students should take initiative and not expect to be mothered.

  • Entitlement and the notion of "it's not fair" should be avoided.

  • Proactive engagement, guided by faculty, is crucial.

Clinical Expectations

  • Clinical aims to help students reach the required skill level.

  • Psychomotor skills like suctioning will be guided by instructors.

  • Sterile gloving is expected.

  • Resources like syllabi, guidelines, and preclinical PowerPoints should be used.

  • Pretests assess understanding; aiming for 90% is necessary.

  • Clinical diagnosis documents contain essential information.

  • Care plans must be thorough and not "winged it."

Resources

  • Canvas shell provides helpful resources that may seem overwhelming.

  • Lab, tutoring, and steps sessions offer additional support.

  • Clinical judgment model is the basis of NCLEX.

  • Clinical judgment involves recognizing cues, analyzing, prioritizing, generating solutions, taking action, and evaluating.

  • Exams include alternative format questions (SATA, matching, charts).

  • 25% of questions can be next-gen by exam three.

Syllabus and Guidelines

  • Reviewing the syllabus and guidelines is essential.

  • If running late to clinical, text the group for on-site notification and email the course coordinators.

  • Clinical absences are for emergencies only.

  • Consistent attendance is needed to ensure readiness, safety, effectiveness, and competency.

Class Preparation

  • Read the textbook; don't come to class unprepared.

  • Be on time for simulation exercises, which will be rescheduled in case of emergencies.

  • L and M is a requirement, contributing 6% of the course grade; aim for grades above 90.

Exam Requirements

  • Bring a Trinidad school ID to exams and keep it on your lapel.

  • Students' grades below 75 will be reviewed; a specific process will be followed.

  • Address any issues early with scientific interventions.

  • Do not email if you get a bad grade; there is a process to follow.

  • Exam grades are typically posted within a week.

  • Item analysis is conducted to decide if multiple answers were allowable.

Expectations of Instructors

  • Instructors should help students learn, focusing on important content.

  • Test questions should not be trivial or overly challenging.

  • Treat students well and with respect, expecting the same in return.

Recording Policy

  • Recording is permitted but requires notifying instructors by putting names on the board daily.

  • The lecture is the instructor's intellectual property and cannot be posted inappropriately.

  • No video recording or pictures are allowed.

  • Clickers are requiered for clicker questions.

Mindset

  • Realize where you stand.

  • Being high up and clinical judgements do not come optional.

  • Do the needed work.

  • Acknowledge our help.

Readings focus

  • I did say, don't panic.

Cardiac System Concepts

  • Automaticity: Ability of cardiac cells to initiate an impulse, leading to arrhythmias.

  • EKG Complex: The QRS represents ventricular depolarization.

Clinical Scenarios

  • Radial Arterial Line: Prioritize assessing for circulatory compromise (color, temperature, cap refill).

  • Infection Control: Important to wash hands, keep nails short, avoid rings and bracelets, and keep jackets clean to prevent hospital-acquired infections.

Pharmacology

  • Use generic drug names in class and on tests.

  • Always use brand names as well.

Drug Classes

  • Enalapril: ACE inhibitor, vasodilator.

  • Furosemide: Loop diuretic, used in heart failure, pulls sodium and water.

  • Digoxin: Cardiac glycoside, inotropic (increases contraction force), chronotropic (affects heart rate).

  • Ditalizine: Calcium channel blocker, vasodilates smooth muscle, slows heart rate by affecting AV node.

  • Amlodipine: Calcium channel blocker.

  • Metoprolol: Beta blocker.

  • Dopamine: Vasopressor, beta and alpha stimulator.

  • Atropine: Sympathomimetic, mimics the sympathetic nervous system to increase heart rate.

Drug Actions

  • Vasodilators: Calcium channel blockers and ACE inhibitors.

  • Chronotropic Drug: Digoxin slows heart rate; metoprolol and calcium channel blockers have similar effects.

  • Preload Reduction: Furosemide and morphine.

Detail Reduction

  • Details are the enemy and are what separate relevancy from everything else

Key Drugs

  • Aspirin: Platelet aggregation inhibitor, prevents clot formation.

  • Nitroglycerin: Nitrate, dilates coronary vessels, reduces venous return (preload), potential side effect: hypotension.

  • Morphine: Opioid, reduces preload, potential side effects: constipation, respiratory depression.

  • Metoprolol: Beta blocker, decreases myocardial oxygen consumption, lowers heart rate; monitor for bradycardia.

  • Enalapril: ACE inhibitor, dilates arterial system, drops afterload, monitor blood pressure; can cause cough or angioedema.

  • Heparin: Prevents clotting by prolonging clotting time (PTT).

  • Enoxaparin: Low molecular weight heparin.

  • Warfarin: Anticoagulant, monitored by PTINR; antidote: vitamin K.

  • Clopidogrel: Antiplatelet agent, inhibits platelet aggregation, used with stents.

Pharmacology Notes

  • Creatinine is the best indicator of kidney function at the moment it is being tested.

Medication Administration

  • Always look at the action of a drug and ask, do I know what this is doing and does it align with the desired outcome.

  • Follow a consistent process: identify the drug, its action, and potential contraindications.

  • Pull drugs from the box to avoid mistakes.

Code Handoff Example

  • The professor provides here an example handdoff using SBAR

Case Study: Chest Pain

Assessment of Chest Pain

  • Location: Where is the pain located?

  • Quality: What does the pain feel like?

  • Intensity. Rate the pain.

  • Timing. When did the pain begin?

Interventions

  • Put the person in the bed an off their feed.

  • Use oxygen.

  • Nitroglycerin Administration: 1 every 3 to 5 minutes if SBP is ok - greater than 90 SBP.
    *Did the initial dose take pain down. Is that worth continuing?
    *The goal is zero after multiple doses.

  • Aspirin, MONA.

  • Nitroglycerin Infusion: Titrate based on blood pressure every 3 to 5 minutes.

Calculations Notes

  • Med math will be on every test: be comfortable at calculating
    *Mic per minute
    *Mic per kg per minute
    *Universal calculation for critical care drugs.

ER or ICU First Job

  • Don't Go to the the speciality areas. Need the fundamentals.

STEMI

  • Protocol is going to dictate which ones follow.
    *Emergency Reperfusion.
    *PCI Percutaneous Intervention cat scan then stent. Check occlusion.
    *Fibrolytic Medication.
    *Emergency Open heart.

Notes

  • Trinitas does STEMIS with PCI

  • Outside Trinitas that could do thrombolytics then transfer to open heart.

  • Decisions are not time based. STEMI criteria at baseline.
    *D2B, Door to Ball90 Minutes.
    *Really good is fifty eighth.
    *D2N-Door to needle Thirty Minutes.

Post Percutaneous Interventional Interventions

What should the nurse focus on?

*Bleeding.
*Circulation."

Priority Action With Potential Bleeding

  • Assess vital signs for internal bleeding.

Other important concepts

  • Prevent Nephropathy - hydration.

  • Maintain good alignment, keep leg straight from Femoral Artery Procedure.
    Vital Signs per protocol. Usual is Q15 Minutes x Four, Q 30 Minutes x 2, and Q 1 hour.

Post Cath Complications.

Two steps

  • Recognize Cues.

  • Follow that up. If Not then what is going on.

Notes On Patient Follow Up

  • Follow ups should involve all relevant steps.

  • Palpable Swelling - Bleeding, Retroperitoneal Bleeding.
    Back Pain - Bleeding, and Kidney.

  • The main things you should measure the output with any procedures. Ie Cath

Analysis With Vitals

  • If you want the best look at The Pulse the Blood Pressure, and The Respiratory Rate
    What med you can give.
    Checklist to do those vitals every routine.

What patient cannot get
Use vitals to do the outcome. What they're supposed to do? Then you understand where you stand up

*Remember what you are trying
If it's a hold but you know it's supposed to be getting you get it anyway

Fundamentals Psych

  • So Mental is tied to The Biological as both is is a illness or any other disorders.
    Can become oppressed. With this is why it can be just as just in medicine. The brain is just affected.
    Takes long time to start. To be able to handle

Notes on Mental Disorders

*Mental does affects relationship. With mental to help with coping skills
The health wellness
A social spiritual vocational
Enviroment.
*Stress is the same change there’s no stress for everything