Friday, January 9, 2009

NCLEX Test Taking Tips

Hope this helps all of you. I got this from another site http://pinoynurseszone.blogspot.com/2007/09/nclex-test-taking-tips.html. If any of you that have already taken the NCLEX have any tips, or if you agree/disagree with anything here, please comment!


NCLEX TEST TAKING TIPS

Over the course of my studying I have ran across a lot of helpful hints that have helped me study. I thought I would post them in hopes that it would help out others......These are bits and pieces that I use whenever I get a question I have no clue how to answer while I study. They have really helped me out tons and I hope they can help out others as well. There are also some self talk things in here too......

*Everyone thinks they have failed the NCLEX but more people pass than fail. It's OK to cry and feel horrible after taking the test, every single person who walks out the NCLEX feels this way. Know this right now before you take the test so that you don't freak out during the test or shortly thereafter.

*You have no idea how many questions you got right. It may feel like you missed them all - chances are, you didn't. People who get 75 questions have a 50/50 chance of pass/fail just like people who get 265 questions. The amount of questions has NO BEARING on whether or not you'll pass/fail the test.

*The NCLEX is hard, it's harder than your review books, your NS tests. It's harder than anything you could've ever imagined. If you use common sense and ABC's when answering your questions you will get more right than wrong. Do not freak out, do not panic and do not run screaming out of the building. This test is hard for every single person who takes it. It isn't just you.

*You have to know and understand your basics in order to answer these questions. If you don't know how the heart works, it will be difficult to answer questions relating to the heart.

*You don't have to memorize every single drug out there - there are 60,000+ drugs. Break down the drug name and look for something that jumps out at you. If it's a cardiac drug - look for the cardiac answer. 2 cardiac answers...look for the one that doesn't harm, kill or delay treatment to your patient.

*Trust your instinct. Do not sit there and try and talk yourself out of an answer because you don't know why you know it. If it feels right to you - it more than likely is right and pick the answer. Your mind stores a huge amount of information and it's burried deep down in there somewhere and it comes out when you least expect it.

*You are going to get things on the NCLEX over material you have NEVER seen or studied before and that's OK......just stop, breath and use common sense here.

*The test isn't trying to make you fail...it's testing your ability to think and rationalize and safely care for your patient. It doesn't know that you stink in one particular area or another, it's a computer. It doesn't know just by looking at you that you didn't study your drugs and therefore it's going to ask you 14 questions on drugs. It's a computer. It also isn't trying to allow you to redeem yourself 10 questions later by asking you a similar question. It's a computer.....it's a random selection of questions. Treat each question like you've never seen it before.

*Remember, there are test questions that do not count.

*Pain has never killed anyone....yes they think they are dying....but more often than not, pain is not the answer on the NCLEX usually if you look, there is something much worst going on somewhere else.

*Always pick the least invasive answer. If you have to choose between a trach and an ET tube, pick the ET tube.

*NCLEX people don't like when you tie people up....so trying looking for a more therapeutic approach.

*If you can do something 1st without drugs...that is more often a better choice for NCLEX than drugging up the patient.

*This is not the real world - repeat that over and over and over when you take the test. Do not rely on the information you have seen or done in the real world. This is a "perfect world" test.

*The test adjusts the difficulty based on how you answer the questions. The first question will be a medium level question. It doesn't matter if the question says....a Potassium level of 100.5 is lethal...you are going to freak out and suddenly not know the answer because all 4 answers are going to look good. Pull yourself together.

*If you get a multiple answer question, answer it the best you can and don't freak out if you get 10 of them.....remember there are questions that do not count and these might be it. You never know.

*People always think they got more questions on one certain topic than they really did. When you leave the test - if you are weak in say....ortho...you will be positive you had 25 questions on ortho alone, when in fact, you probably had 1 or maybe 2.

*Cover up the counter at the bottom of the screen. It's never wise to know how many questions you took. People pass/fail regardless of the of questions. There is no magical number that means you have passed and no magical number means you have failed.

*You aren't supposed to know all the answers. The NCLEX people know this. What they do want to know is that you are safe in your practice and you won't do things that will kill, harm or mame the patient.

*Get that idea of percentages out of your head right now. This is the NCLEX and not NS and you are not trying to make 100%, you are trying to get more right than wrong. Take all the practice tests you want - forget the % at the end - just make sure you got more right than wrong with a couple to spare.

*If you have never heard of it, no one else has either. Don't pick that answer.

*You are a nurse, not a doctor or a surgeon, so don't pick the answer that makes you do things that are outside your practice. You can call the dr. and ask for pains meds, but you can't order them. You also can't trach a person or crack a chest open or insert a chest tube.

*The NCLEX people know you are a brand new nurse with 2 weeks of experience. Keep that in mind when taking the test. Don't pick answers that are outside your level of knowledge.

*You aren't there to make the doctor happy, you are there to keep your patient alive. If the answer says to question an order....DO NOT think...I can't call and question the doctor...he might yell at me. Who cares...this is the NCLEX...you are there to keep your patient alive.

*In every single NCLEX question you get, there is a problem. Figure out first what exactly the problem is.

*Do not pick answers that delay treatment. If your patient is unstable, don't pick the answer that says to reassess in 15 mins. because your patient might just be dead in 15 mins. Look for another answer that doesn't delay treatment and calling the dr. just might be the ONLY thing you can do.

*NCLEX is the perfect world. You only have the patient in front of you on the computer screen. Forget that 2 questions ago you had 14 patients, RIGHT NOW you have just 1 patient. If the answer says to stay there for the entire shift because you patient is unstable....that is OK for NCLEX because THAT IS YOUR ONLY PATIENT.

*Because the NCLEX is the perfect world, you have RT, OT and every other "T" available to you and your beck and call 24/7. But remember, don't pick the answer that dumps your patient off either.

*When you get the priority questions...you are looking for the "killer" answer.

*Always think....is this answer going to 1 kill or harm my patient or 2 delay treatment. If it does....look for another answer.

*If you have to, put yourself in the patients shoes. If it's asking how to position after a procedure...picture how this person will look laying in each of the answers. If you get it narrowed down to 2, pick the one that won't harm or kill your patient (or mess up the suture lines).

*Always pick the answer that allows your patient to speak. The patient has 100% right to their healthcare. Do not pick the answers that make the family speak or answers that make the family happy. You are only talking about your patient here.

*Eliminate answers that have "always, never, etc..." because in the nursing profession - nothing is that certain. They will be tempting to pick too because they look so good....but nursing IS NOT certain and those words make it certain.

*If there is anything that you can do that will not harm, kill or delay treatment to your patient, pick that answer before you call the doctor.

*Don't pick answers that will cause long term consequences to your patient.

*Like patients can be placed in the same room. Think about cross contamination issues when thinking about room assignments.

*Stable, chronic, etc...patients can be released to go home when you get the question about which patients can be released to free up an empty room on your floor.

*Stable patients can be cared for by an LPN. Something may sound really, really bad but chronic disease are usually stable...that's why they are chronic and not acute.

*For RN's, do not delegate unstable patients to anyone. Again, this is the perfect world and you only have the patient on your screen RIGHT THEN to care for.

*You can't use a medical dx in a nursing dx. NCLEX people are testing your ability to be a nurse, not a doctor.

*When you see assessment or eval in the stem of the question....start thinking S/S.

*When giving report to the oncomming shift, you are reporting things that are "new" or "different" or "possible" to them. Don't pick the answer that reports the obvious to the oncomming shift.

*Try to narrow it down to 2 answers and then pick the answer that is the most threatening to the patient.

*If you have no idea how to answer the question - look for the answer that will kill the patient. Sodium, Mag and Potassium can all cause problems when they are out of whack....but Potassium will cause heart issues and if your heart isn't beating...nothing else matters.

*It's all about ABC's for the test. If you patient doesn't have an airway - he doesn't have anything else for that matter.

*Pick the answer that address the problem in the question (because every question...there is a problem). If it's talking about the heart...no matter how good it sounds...the leg is not an issue.

*Tell yourself over and over during the test, you can pass it and you will pass it. Self talk goes a long way during a test like this.

*Take a break, even if you think you don't need one...you do.

*Use your dry erase board for other things that just calculations. Draw pictures....eliminate answers on it....it's there for you to use for whatever you need it to be used for.

*You can't think the same way you think in NS or even at work. This test is going to give you questions, scenerios, etc.. .over things you have never seen or heard of. All the NCLEX people want to know is that you can safely care for your patient. Pick the answer that does that.

Saturday, January 3, 2009

Common Drugs for RN’s - Last Semester

In preparation for my last semester I've been getting a jump start on studying. I know my (school) clinical for my 5 weeks. I'm so excited about it! It's at my fave hospital close to home and I work 12 hour Saturdays! How cool is that? Friday lectures and Saturday clinicals. I don't know my preceptor schedule yet. I'm assigned to Telemetry, which I did at another hospital in my first semester. I totally enjoyed it and look forward to doing it again.

But I need some ideas on medications. Especially from Telemetry nurses. What are the most common drugs that you need to know? I know I also need to brush up on lab values. I also need to know what information helped you guys the most making it through your last semester.

I found this on nurses.com and it gives the 10 most common meds for each specialty. Maybe it'll help some of you prepare for your clinicals! Especially with regards to emergency care and perhaps psychiatric, naloxone should probably be added to the list, don't you think?

Critical Care (also good for Telemetry):
amiodarone hydrochloride
diltiazem hydrochloride
dopamine hydrochloride
epinephrine hydrochloride
furosemide
insulin
lorazepam
morphine sulfate
nitroglycerin
propofol

Emergency Care:
acetaminophen
aspirin
diltiazem hydrochloride
diphtheria and tetanus toxoids
famotidine
ibuprofen
ketorolac
levofloxacin
metoclopramide
nitroglycerin

Home Care:
acetaminophen
acetaminophen/oxycodone
acetaminophen/propoxyphene napsylate
digoxin
diltiazem hydrochloride
docusate sodium
furosemide
metformin hydrochloride
potassium chloride
warfarin

Long-Term Care Nursing:
carbidopa/levodopa
digoxin
docusate sodium
donepezil hydrochloride
enalapril maleate
furosemide
metoprolol tartrate
mirtazapine
pantoprazole sodium
potassium chloride

Med-Surg Nursing:
acetaminophen
diltiazem hydrochloride
enalapril maleate
furosemide
heparin sodium
insulin
levofloxacin
metoprolol tartrate
morphine sulfate
potassium chloride

Obstetric Nursing:
acetaminophen/codeine
acetaminophen/oxycodone
dinoprostone
ibuprofen
magnesium sulfate
nalbuphine hydrochloride
oxytocin
penicillin
promethazine hydrochloride
terbutaline sulfate

Pediatric Nursing:
albuterol
amoxicillin/clavulanate potassium
amoxicillin trihydrate
cetirizine hydrochloride
co-trimoxazole
fluticasone propionate
gentamicin sulfate
hydrocortisone (topical)
methylphenidate hydrochloride
montelukast sodium

PACU:
bupivacaine hydrochloride
fentanyl citrate
hydromorphone hydrochloride
lidocaine hydrochloride
lorazepam
meperidine hydrochloride
metoclopramide hydrochloride
midazolam hydrochloride
morphine sulfate
ondansetron hydrochloride

Psychiatric Nursing:
carbamazepine
clonazepam
divalproex sodium
escitalopram oxalate
lithium carbonate
olanzapine
paroxetine hydrochloride
risperidone
sertraline hydrochloride
venlafaxine hydrochloride

Sunday, November 16, 2008

How to Apply to Nursing School

Someone sent me an email today and I swear it was like reading an email I wrote in the past. This girl and I are remarkably similar! All of her fears and concerns mirror mine 100%. She wants to go to nursing school and is just scared and intimidated. Yeah it is scary and intimidating, but at the same time empowering. So I thought, if she has the same emotions that I used to, how many others are holding out on applying for nursing school because they're scared? So I decided to put part of my response to her into a blog. I hope it helps at least one person some day!!!

Your heart is exactly where mine is! I've wanted to be a midwife since I was 12. I only started college when I was 26. So I really put it off for a million reasons in the past. It was just never a good time. And I know EXACTLY what you mean by not having the self-confidence. You know, after these years of college and doing good and people saying they're proud of me... I STILL doubt myself. But at the same time I've been able to show myself and others around me that I'm not the loser that I always saw myself as being. Yeah I spent years saying "One day I will be a nurse" and that's how people saw me. Someone who "wishes" they could be a nurse, but would never go for it. Or at least that's how I felt they saw me.

I don't know, I just got fed up one day. I decided to take the dive and apply for admission to a local college. Even after that it took me almost a year to actually carry through with it. College seemed so intimidating and I never seemed to have the answers I really needed. So girl I hope you found the person who will give you that little push to just do it. It's scary, but you can do it. Nursing is not something to take lightly, but remember that people with the drive and the true desire to make it do. And I believe you are EXACTLY like I was.

Like I said, it IS scary and intimidating and you will always doubt yourself along the way. You will think the end is SO far away and there's just too many opportunities to fall off track. Stay focused! You can email me ANY time and I will talk you through it.

One thing they will not do in nursing school is let you go into a clinical situation unprepared. There is alot of class and lab time that you master before you even go out into the hospitals. Even while you're in the hospitals you have classmates and instructors that will help you. Heck, I hung IV antibiotics and programmed the machines for the first time this week and my instructor was there every step of the way. You have to think, you're working under their license and they won't let you screw up THAT badly. You won't be perfect, that's to be expected. But they want to see that you catch your mistakes and explain what you will do different next time. And then you do it!

I also know just what you mean when you say that you have no desire to do things like bathe the elderly and things like that. Yeah that was me LOL And that's what I seemed to always get. Old people. But I was shocked that it was nothing like I thought it would be. It's not that bad. You just do it. It's like when you become a mother, you aren't perfect, but you're able to go by instinct and take care of them. And they actually respect you for trying your best with them.

As far as websites go, I really recommend allnurses. com. And me! I can try to fill you in the best I can with what to expect every step of the way.

So the first thing you need to do is make up a plan. Remember, you're in control and you can wait until you're comfortable before moving on to the next step.

Keep a notebook that you write everything college related in. Write down the local colleges that offer nursing and their website. If you talk to someone, write down their name and what they say. It'll help you, trust me.

Next, pick your college and apply. They will often times want your high school transcript and they will tell you how to get it (or how they will get it). You will also need your shot record. But if you're like me I had no access to it. You can get a blood test to see what you're immune to and just get shots for the things you're not immune to.

The next thing you need to do is take a placement test. This will just show if you need some "refresher courses" in math and English. I'm horrible in math and had to take a refresher course.

You will have to go to FAFSA. ed. gov and fill out the application for financial aid. Everyone does it whether they need financial aid or not. Schools use this as a way to determine what you qualify for to pay for college. Go to the FAFSA site I gave you. It is free, but there are tons of sites that try to be the real thing that charge you money. Don't fall for that. You will need last years tax return 1040 to fill it out.

You will get a letter from the financial aid department telling you what you qualify for. Hopefully you will qualify for the Pell Grant. School is paid for, books are paid for, and you generally get some good money back to pay for college expenses. Look online for scholarships as well. They have all kinds of scholarships. I'm sure they even have scholarships for people with your name LOL

If you're self disciplined, I recommend online classes. It's a great transition to the whole college thing and you work at your own pace. But take it seriously and keep up with your classes and assignments. I had like a 1.5 GPA in high school cause I didn't take it seriously and I went through online classes for a year with a 4.0. If you know you have to be in class hearing things in order to learn it, take classes on campus. Don't worry about not fitting in. There are people from 18-60+ in college from all backgrounds.

After that, just hang in there! Take it one step at a time. Colleges can be a pain in the butt to try working with because noone seems to know what they're talking about. That's where the notebook comes in handy. You know who helps you and who is dumb as heck. You will know who to ask for in the future LOL

Well, like I said, please feel free to write me any time. Keep me updated every step of the way. You CAN do this!!!!!!

Ok people. If you've been there and want to add something, please do! If you are thinking about applying, please take my advice and go for it. Good luck!!!

Wednesday, November 5, 2008

Peds Clinicals - Stopping in my Nursing Education to Look Around

Wow, I can't believe that my last semester in years is almost finally here. As many of you know, even after I delete blog postings here on myspace I save them in Yahoo. I still go back and read some of my first blogs sometimes. I don't want to speak too soon cause anything can still keep me from graduating in May. But standing at my front door, I see the welcome friend of graduation walking my way.

I never thought that I would get so attached to the friends I have made in school. I'm the type that will be friends with anyone. That's a far cry from high school where I hated so many of the immature brats I graduated with. It's better with college. There's more at stake than just mommy and daddys money. It's our personal investments and lives on the lines. And of course I'm scared to death what a new presidency will bring.

Like anything I've met good people and bad people, good instructors and bad instructors. When I graduate I plan to thank big time all of my instructors, but I want to do something for my two most favorite instructors. One I've known for several months and another I just met this semester. The one I just met this semester, I see so much of what I want to be in her. I feel she would make a great role model and someone I can look up to. She reassured me when I felt out of place in her own mellow and genteel ways. The other one brought lots of fun and entertainment along the way and would never let me feel out of place. She's only a Fundamentals and Med-Surg instructor, so I don't see her anymore, but she still made nursing school somewhat dealable LOL (No I don't think it's a word)

For all of you current nursing students and nursing students to be, please keep in touch with me. As many of you already know, I'm always here to help anyone who has nursing school questions, or anything else. And to all of you who have seen me through nursing school, thank you for your unique contributions, no matter how insignificant it may seem. Especially my family and closest friends (Esp McKenzie, Melody, and Shabrina). But there's so many. I'll be sure to give you a personal shout out at a later time in a more formal way.

I'm calling it a night now in preparation for another day at CHOA. Have a great week everyone!

Tuesday, October 21, 2008

L & D: So this is what I’ve wanted to do my whole life

Today was emotionally and physically exhausting. I kept plenty busy in L & D today. Before I knew it, it was time for post-conference. I didn't even catch lunch. In only 6 hours I got to be there (and help out in many ways!) on two deliveries.

One baby, I was just a foot away when she entered the world and I watched as she let out just the most adorable cry. It was very special. Way better than what you see on "A Baby Story" and all those other shows. When I looked up and the daddy and the grandmother their faces were priceless. Yes, I about lost a tear, but it was all good.

The other one I watched being delivered and I watched as she never opened her eyes and never took a breath. Her mother never heard her cry. This is something I'll get used to, I know, but it's just so sad. Fortunately, my clinical instructor said that it's great when people can feel for their patients so much. So my prayers are with them tonight. I've been where they are now and I feel their pain all too well.

Wednesday, September 24, 2008

Childbirth Workshop - Mother/Baby Assignment

Childbirth Workshop
September 24, 2008


The Childbirth Education Workshop definitely proved to be incredibly valuable to my education, and hopefully my lifelong career working as a nurse in labor and delivery. It will definitely prove invaluable when it comes time to assist a woman and support her during such a special time in her and her family’s life.

Although I have two children, I didn’t get any preparation through a childbirth class. Constant preterm labor with my first son kept me from attending every childbirth class I hoped to attend. When labor finally occurred at term, it was nothing but extreme pain and “counting the centimeters” until I qualified for an epidural. I was completely unprepared. After complications and reaching only 5 centimeters in two days an emergency cesarean section was performed. My second son was born at 35 weeks by cesarean section as well after a horrible experience with preeclampsia.

I described my personal experiences because although absolutely nothing went "according to plan" I still view the whole maternity experience in a very positive way. Why? Because there was always that one special nurse each time who had a real passion for her work and was full of wonderful information. Today in the workshop I also acquired some fantastic knowledge and hopefully someday I can make another woman’s experience positive no matter how non-traditional it becomes.

I was introduced to how the process of labor and delivery occur and how the nurse assists the mother, and entire family, to make it the best experience possible. I was especially interested in how the workshop focused on the mother's inner strength and how the nurse can educate and support her so that she can walk away with a positive experience. Pain can be managed and controlled, but the mother must first overcome fear of the unknown with knowledge. That's the first step.

Learning a history of the various childbirth practices was also fun to learn. It’s so interesting to see how far we have come, even in the last 10 years! Supplementing with the videos was also very informative. It showed the best methods of supporting the laboring mother, helping her not feel so alone in the experience, and showing ways to also teach the support person what they can do to help so they feel like they are a part of the process. Giving us the opportunity to experience a brief, yet effective demonstration of relaxation showed us how it felt for us. We, now, have more ideas of ways to assist the laboring mother.

Before today, I felt that I didn’t have great hands-on knowledge about helping a laboring woman. Now, because of the workshop, I feel like I have insight on what occurs during the “traditional” delivery of a baby. I’m ready, more than ever, to go out and help mothers and their families, in the same positive ways that nurses always helped me and it’s so exciting!

Wednesday, August 27, 2008

Week 1: Psych Clinical

Ok well it goes like this. I have to be up at 4:00 am for clinical. I have a 3 year old who had a cold the other day so I gave him a pediatric dose of pediatric cold medicine. You know on the label where it says "May cause marked drowsiness" and then later on it says "May cause excitability"? Which one do you think Colin is the night before my first clinical? You guessed it. I got to sleep around 1 or 2 am. I woke up so tired every cell in my body was aching and screaming.

Well I made it to the hospital an hour away. Mind you I don't know what to expect. Still a little shaky from my brother's suicide.

During group therapy I find my patient. Fortunately the social worker has each of the patients introduce themselves and where they are from. She is very well-groomed. Her clothes are clean and she looks to be very "normal".

As soon as group therapy is over I go over to my patient and introduce myself. She was full of smiles and very friendly to me. Right away she told me stories of her childhood that were rather remarkable. I was instantly interested in this woman. I love the elderly anyways and feel they have so much to teach us if we just listen, but she was so knowledgeable about so much. Art therapy was about to begin and she didn't care to join in. I was unable to convince her to stay, but told her if she didn't mind I would like to talk to her some more later on.

I attended art therapy with the 5 other girls in my clinical group. The patients were coloring leaves for the approaching fall season. We were invited to join in but we just stood there and watched. Finally, being like I am, I jumped in front of my classmates and instructor and said "Come on! Let's go color!" LOL Wouldn't you know but my classmates jumped at the opportunity? HAHA... they just needed someone to take the lead. Yeah, leave it up to me.

So we all colored the blank leaves that was on the sheets of paper. Everyone was doing such a great job of making real colorful leaves. And then I got ahold of every hot pink, electric blue, shocking green, and vibrant yellow crayon I could find and colored the most manic leaf you could ever imagine LOL! Ho-ly heck. I think they considered hospitalizing ME instead! But it was so fun.

Later on I went in to visit my patient as promised. We share so many of the same interests and she is beyond intelligent! But then again, being smart doesn't make you immune to depression. My impression of her is that she has spent her lifetime experiencing so much and has this treasure chest of knowledge to share, but no one to share it with.

I really hope that she is able to find out what will help her feel better. But if she's there next week I will be on cloud nine. I feel I was "led" to her for a reason. Both for my benefit and hers. Just like my first patient ever my first semester of nursing in Cardiac Telemetry touched me spiritually, this psych patient left a lasting impression on me. There's something very special about certain patients. You care about all of them, but there's a few that just really get you.