NUR 195 week 1 – Exams, Leadership Styles, Meds, Lab Values & Delegation

Course & Grading Logistics

  • General tone
    • Instructor stresses that exams in this course are “harder” than in many other nursing courses.
    • Success comes from keeping up with readings, EAQs and simulations starting Week 1–2.
  • Grade-breakdown figures mentioned in the talk (exact syllabus may vary – verify!)
    • \text{Simulation / Debriefing Forms} \approx 40\% of total course grade.
    • \text{Exam 1} = 15\%
    • \text{Exam 2} = 25\%
    • A line was heard as “Exam 22 is 30 %” – generally interpreted as the Final Exam ≈ 30\%.
    • Together these numbers >100 %; instructor repeatedly said “double-check your syllabus” – expect a corrected grid in class.
  • Exam formats
    • Because course is only 1 credit-hour, unit exams contain 40\text{–}45 questions.
    • Final Exam → ≈ 70 questions with a 2-hour time limit.
  • EAQs (Elsevier Adaptive Quizzing)
    • Each course shell contains EAQ assignments; the NUR 190 bank has hundreds (500–800) of questions.
    • Recommendation: “Chip away now so it doesn’t pile up.”
  • Out-of-class assignments
    • Due BEFORE lecture begins on the posted date (ignore mis-printed end-dates in Canvas).
    • Simulation (debriefing) paperwork due Monday @ 23:59 following your lab week.
  • Debriefing forms
    • New rubric this semester – more straightforward; “Just follow the rubric line-by-line.”
    • Blank template will be uploaded; if not posted by next week instructor will bring hard copies.
    • Must be hand-written.
      • iPad/Surface handwriting that visually mimics script is fine.
      • Typing that auto-converts to print not accepted.
  • Printing
    • Print out all blank forms before lab; complete every section.
    • If a datum is not applicable write “N/A”—no blanks.
  • Course schedule highlights
    • Week 2 lab scenario: patient with CVA (stroke) or history of CVA.
    • Week 3: first unit exam (conflicting instructor memories—verify whose class).
    • Course outline in syllabus shows weekly readings and which patient type appears in simulation.

Leadership & Management Content

  • Historical foundation
    • Florence Nightingale—considered the first systems-oriented nurse leader; advocated hand-washing, uniforms, data-based practice.
  • Can an LPN be a leader?
    • Yes—both formal (charge‐type roles) and informal (role-model, resource) leadership exist.
  • Core leadership qualities offered by students/instructor
    • Professional appearance & punctuality.
    • Warm, approachable demeanor.
    • Clinical knowledge, self-confidence, and accountability.
  • Three primary styles to memorize for the exam (7–8 exist, but focus on these):
    1. Autocratic / Authoritarian
    • Leader makes rapid, unilateral decisions; ideal for emergencies.
    • Examples: managing an MI or ischemic stroke—many time-sensitive tasks in <3 hours (e.g., TPA administration).
    1. Laissez-faire
    • Apparent “hands-off / lazy” approach but actually shows high trust in experienced staff.
    • Example: leader lets experienced nurses self-assign patient load.
    1. Democratic / Participative
    • Leader seeks staff input, fosters shared decision-making.
    • Example: Self-scheduling committees, unit-based councils.
  • Combo styles: Real-world leaders may blend styles; exams will isolate each.

Medication Highlights

  • Metformin (Glucophage)
    • Must be held prior to any IV contrast (CT, MRI) and for 24\text{–}48\,\text{h} after if renal function uncertain.
    • Rationale: reduce risk of lactic acidosis because contrast + impaired filtration ⟶ accumulation.
  • Statins (e.g., Atorvastatin)
    • Can cause rhabdomyolysis → myoglobinuria → acute tubular necrosis.
    • Monitor for muscle pain, CK rise, dark urine.
  • “Nine beats” heard—likely instructor shorthand for beta-blockers (check context in reading).

Laboratory & Diagnostic Review

Core Normal Ranges (memorize)

  • \text{Glucose}=70\text{–}100\,\text{mg/dL} (fasting)
  • \text{Hemoglobin}=12\text{–}18\,\text{g/dL} (combined male/female ref; female lower end)
  • \text{Calcium}=8.5\text{–}10.5\,\text{mg/dL}
  • \text{BUN}=7\text{–}20\,\text{mg/dL}
  • \text{Creatinine}=0.6\text{–}1.3\,\text{mg/dL}
  • HCO_3^-=22\text{–}26\,\text{mEq/L} (some texts use 27 upper)

ABG Case Example (Pneumonia)

  • Given: pH=7.20 (acid), PaCO2 = 50\,\text{mmHg} (resp. acid), HCO3^- = 30\,\text{mEq/L} (renal base ↑)
  • Interpretation: Primary respiratory acidosis with partial metabolic compensation.

INR / Warfarin Case

  • A-fib patient on warfarin 2 mg daily; AM INR =4.5.
    • Goal therapeutic range 2.0\text{–}3.0.
    • INR >3 → blood is too thin; risk of bleeding.
  • Actions discussed
    • Hold today’s dose; notify provider for possible dose reduction.
    • Monitor for bleeding (gums, urine, stool, VS).
  • Mnemonic: “INR is a ratio—blood should take 2–3× longer than normal to clot.”

Delegation Principles (LPN ↔ UAP)

  • General rules repeated in lecture
    • No unstable patients to UAP.
    • No first assessments/first VS post-procedure.
    • UAP can only perform standardized, predictable, low-risk tasks once properly trained.
  • Example question walk-through
    1. Give PRN pain med to post-op patient → NO (assessment + med administration).
    2. First VS after cardiac cath → NO (new, unstable).
    3. Trach care immediately after oral surgery → NO (airway, sterile procedure).
    4. Instill OTC eye drops day 2 → YES (stable, OTC, routine).
  • Remember: LPN must ensure delegatee is competent and provide specific instructions & time frames (e.g., daily weights by 06{:}00).

Study / Time-Management Tips

  • Start EAQs immediately – target ≥20 questions/day to finish \sim 500 bank before mid-semester.
  • Review PowerPoint slides before coming to lecture so in-class time becomes clarification.
  • Fill every blank on forms; write “N/A” rather than leaving empty.
  • Keep an organized weekly planner: some students have 4-hour lab gaps or long commutes; adjust study blocks accordingly.

Ethical, Practical & Real-World Nuggets

  • “Best practice vs real life” was stressed repeatedly: exams test IDEAL practice even if staffing realities differ.
  • Instructor encourages asking for schedule changes if long on-campus gaps affect study / commute.
  • Professionalism: “Show up on time, not in ‘crazy’ attire.”
  • Always double-check the rubric—grading literally follows each line.

Quick-Reference Formulas & Numbers

  • Debriefing weight (sounded like) 40\% of grade.
  • Unit exams 40\text{–}45 Qs; Final \approx 70 Qs / 120\text{ min}.
  • INR therapeutic for A-fib 2.0\text{–}3.0.
  • IV contrast + Metformin → hold drug 24\text{–}48 h (prevent lactic acidosis).