Tuesday, April 29, 2008

Making Headway?

My sister game me the OK to share our conversation we had over lunch today. To understand the context you should know that my sister and I have been nearly polar opposites in regards to pregnancy, childbirth and beastfeeding.

I had uncomplicated, straight forward pregnancies and I LOVED being pregnant. Her pregnancies brought on medical problems to overcome and the pregnancies became largely a chore to get through. My goal with my births was to have an unmedicated, empowering experience. She wanted a painless removal of the baby from her uterus. I breastfed well over a year. She chooses bottle-feeding.

We've come to peace with our differences and are able to respect each others view point and maintain a healthy relationship. I respect her as a mother and am constantly learning new things from her about my children and myself. And, she is able to understand how passionate I am about my feelings around birth and she respects that.

This is why today's conversation caught me off-guard and left me .....um...speechless....not for long, obviously, though. She told me today that after her last birth (2months ago) she felt like something was missing... Yes, a baby came out of her body (this cutie pie shown here, to be exact)....but wasn't there something more that was supposed to happen? She went on to say that if she ever had another baby she would actually consider an unmedicated childbirth experience in an attempt to experience that "something more" with her birth.

All I can say is WOW. It is awesome to see the first seeds of birth change and the possibility of a realization that birth is a sacred experience to be embraced rather than a physical/medical procedure to be endured...

She's still not budging on the breastfeeding issue, though. :)

Peace on earth begins at birth....One birth at a time...one woman at a time.

My sister has also agreed to provide a guest post on this subject which I will post here soon.

Monday, April 28, 2008

Last Few Days

I just attended my LAST CLASS!!! I have 2 clinical days this week and then finals next week. I will surely enjoy my time off when classes are over. I have a few things on my to-do list: fun things like plant pansies and start teaching myself how to knit, etc.

I had lunch with my sister and mom today and it kinda hit me that after finals next week, I will no longer have a reason to travel "down the mountain" everyday... I live in a little town on top of a mountain. My family lives in the valley (about 1 hour away - South). I've been traveling down for school and have been able to meet my sister and new niece for lunch, shopping, etc. before or after class. But, when it's over, next week... and I start working, next month (in a town about 1 hour away -North) I will see much less of my extended family. Take the good with the bad, I suppose.

Anyway, we had a good weekend. Lance tested again in Karate and did an awesome job! He is now a green belt with a stripe.

I went to a ladies banquet at my church with my mother, sister, daughter and baby niece.

I also did some cooking. Apple Crisp recipe is here if you want it. And, Caressa, there are samples in my fridge you can have, but they won't last long. :)

Friday, April 25, 2008

Closure

If you recall, I went on three different interviews for potential nursing jobs about 3 months ago.

After the interviews I had a clear favorite. It was clear to me what hospital I wanted to work at and in what department, maternity, of coarse. And, within a short amount of time (maybe two weeks) I received job offers from two of the three. I gladly accepted the offer from my 1st choice hospital. I was thrilled because I knew that even if I received better offers from the other hospitals, I would want to be at this particular hospital. The atmosphere is so warm and welcoming. The nurse manager is approachable. The facility modern and up to date with labor jacuzzi tubs, telemetry units, birth balls, etc.

Anyway, it has since bothered me that I never did hear back from the other, last hospital that I interviewed with. WHAT was that all about. Don't potential employers let the interviewee know either way? And, my perfectionistic personality was showing: "What was wrong with me that I wasn't offered a job at all three hospitals in stead of just two?"

Well, this past week, nearly 3 months later, I received a phone call and an offer of employment at the final hospital that I interviewed at. I told them, "Thanks, but no thanks" essentially as I already accepted a job that I am excited about.

But, it was good closure for me. I did have a little doubt: What would I REALLY do if I was offered a job at this other hospital - it is closer to my home and does pay slightly more than the hospital I chose. It is reassuring that I was able to honor my intuition and turn down the other offer, in spite of the entice.

And, as a note of encouragement to any future nurses out there: If you get the education, the jobs WILL come. Instructors and nurses all told me not to expect to get into maternity for at least a year after graduation. I had two offers to go directly into maternity. Believe in yourself. Build up your resume. Do volunteer work. Network. And, DO worry about your GPA. It will separate you from the masses in the end. It will all pay off.

Thursday, April 24, 2008

Inspired

Ok, so I was saying in my last post that I haven't been inspired lately to write about birth. Well, I found myself inspired this morning after I read this article at TIME.com entitled "Choosy Mothers Choose Cesareans." (Those who know me: Can you hear my silent scream as I read this?)

It highlights one mother's choice to choose a cesarean for her birth based on two things: her mother's story of a long labor followed by a cesarean and her own experience observing vaginal deliveries in her medical school rotation.

This is a perfect example of what I think are the most common reasons women in today's society are scared of natural childbirth: Sometimes Scared to Death, literally, because cesarean mothers are 3-5 times as likely to die from the major cesarean surgery and it's complications.

The issues brought out here by this article are these:
1- A negative birth culture perpetuated by misinformation
2- The misconception that what goes on at the hospital is "Normal" childbirth.

Let's start with no. 1.
The culture in America around women's issues, not just childbirth, is profoundly negative. It starts at menarche goes full force into childbirth and doesn't end before covering menopause with its dark, negative cloak.

Young girls are taught subtly or even outright that having their period is a shameful event that should be concealed and suffered through. I have the pleasure of currently raising a young daughter who is quickly approaching menarche. I've strived to instill in her a natural love for her blooming womanhood. But, I have to say it is an uphill battle. Evan in elementary school, her teacher told the classroom full of impressionable girls that she "hated" that time of the month and can only get through it with chocolate.

The young girls grow up ashamed of their natural womanly processes and this negativity continues to build. When they become pregnant women who should be encouraging her and strengthening their sister try to scare her and make her doubt her innate wisdom and ability to birth the child that grows within.

Fearful women tell expectant women horror stories, sometimes in an attempt to justify their own choices and the consequences of them. For example, I've heard this Myth more than once, "My water broke and I had to have a "DRY" birth. It was terrible." FACT: There is no such thing as a DRY birth! Your amniotic fluid constantly replenishes itself. While I do not doubt that the memories she has are terrible, she is misinformed and spreading her misinformation and negativity like poison ivy. Baby Showers become showers of nightmares - who endured the worst labor? Who wins the metal? Ha! It should be a time of hope and inspiration.

Previously, a woman would be surrounded by her mother, sisters, aunts and grandmother who would pamper her and prepare her to walk through the journey of childbirth and come out a strong mother. Because of the history of childbirth in our country the mothers and grandmothers of todays pregnant women do not have that strong courage to pass on because their own births were isolated, drugged events that left them without empowerment and alone.

It's no wonder then that these same women who are taught to fear childbirth also do not believe their cursed, broken bodies can provide nourishment for their babies. Breastfeeding, along with childbirth has been riddled with negativity, shame and doubt. Again, our mothers were taught that scientific formula was better for their babies than primitive, unscientific breastmilk. They believed it - science DISPROVED it, but the culture of fear and misinformation remains.

Now, no. 2:
The idea of a "normal" birth happening in a hospital - especially a large teaching hospital with medical residents perfecting their skills - is laughable. What this poor, scared woman saw in her medical training is a FAR, FAR cry from normal. One travels off of the path of normal once they take that first intervention. From there it is a domino effect.

It is certainly true that doctors truly believe that they are doing what is best, most of the time. I say most of the time because I have personally heard doctors while they made the decision to do a C-section verbalize the fear of a law suit as their motivating factor. But, most of the time doctors are just as scared as the laboring women. They have seen births go bad - birth riddled with interventions, I must say - but nonetheless births have gone bad.

My own sister-in-law is an OB/GYN and recently got married and pregnant for the first time. Well, at the bridal shower - BEFORE she was even pregnant - she told us that she has her c-section already planned out. "Why," I asked. Because she doesn't think that having a baby vaginally is a "good" way to have a baby. This is just sad.

The science has said it. The risks of cesareans are great to both mother and baby. But, people are too afraid.

The only way to change the tide in America is to start young. Infuse your young daughters with truth and power and the ability to embrace their womanhood, conquer difficult circumstances and come out empowered and ready to be a powerful parent to their children.

The article, "Choosy Mothers Choose Cesareans" ends by saying as birth EVOLVES, a woman will be able to choose a c-section over a vaginal birth with as much ease as she can choose bottle-feeding over breastfeeding.

May God help us and not let that be the case.

Wednesday, April 23, 2008

More NCLEX questions

Before I head out for clinical I thought I would post more NCLEX style questions with OB content... It may help keep this blog semi-midwifery focused as I haven't had many birth posts in a while... That is because I haven't been around birth in a while...I'm busy focusing on finishing nursing school, which has nothing to do with birth - directly. Anyway, when I start working on L&D, I'm sure I'll be more inspired to write about birth.

Here they are:

1) A pregnant client is taking folic acid. During prenatal teaching, which of the following foods would the nurse recommend as high in folic acid?
A. Egg yolks
B. Fruit
C. Bread
D. Milk

2) A 21 year old primigravida has an emergency cesarean delivery under general anesthesia. One postoperative intervention is to assist her to turn every 2 hours. Which of the following conditions is this intervention intended to prevent?
A. Pressure Ulcers
B. Muscular Stiffness
C. Respiratory complications
D. Venous stasis

3) During her first prenatal visit to the obstetrician's office, a client complains of increased vaginal drainage. Which of the following responses by the nurse is most appropriate?
A. "This is normal during pregnancy. Just be sure to wash daily with soap and water."
B. "This may indicate an infection, and the drainage will have to be cultured."
C. "This is normal during pregnancy, and you can douche daily to control it."
D. "This is an unusual occurrence, and you must be seen b the physician."

4) A pregnant client is receiving heparin. Which of the following should be a part of the nursing assessment on every shift in light of this drug?
A. Change in fetal activity and position
B. Increase in blood pressure and temperature
C. Any signs of pre-term labor and bleeding from an orifice
D. Homan's sign or periorbital edema


Questions from: American Nursing Review Questions & Answers for NCLEX-RN


Answers: 1) A, 2) C, 3) A, 4) C

Monday, April 21, 2008

Study Break

So, as promised, I am taking a study break to write about what a lovely spring weekend we had. It began Friday when I woke up early and instead of studying like I was planning on doing, I made a wonderful new recipe for lemon muffins (The recipe is over at Myra's Meals if you want to try it). No food says spring to me more than something made with fresh lemons!

All of us ate breakfast together composed of freshly baked muffins, fruit and coffee. Just a perfect start to the day.

I went to classes and review/study sessions all day. But, at the end of the day I came home and we moved our patio furniture up from the basement onto the deck again and had a nice dinner out on the deck. Friday was one of the first days around here it was in the 70's and we enjoyed being outside.

Saturday was just as nice. The weather was beautiful again. And, my youngest, Lance was honored by his teacher by being nominate to receive a "Student All-Star" award at our local minor league baseball game Saturday evening. So, we went as a family to the game and Lance got to go out onto the field and accept a pennant and say his name, etc. It was neat seeing him on the "big screen." He enjoyed it, and the game was very fun to go to.

There were fireworks afterwards, too, which the kids loved.

Very nice spring weekend.

Sunday, April 20, 2008

Intention

I want to get around to posting the lovely blog post in my head about what a wonderful spring weekend I've had....baking, going to a baseball game, eating on my deck again...but instead I am studying for an exam I have Tuesday. It is my last exam before finals. This exam covers these topics:
  • Peripheral Nervous System Disorders & Degenerative disorders including: Guillain-Barre Syndrome, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Multiple Sclerosis, Myasthenia Gravis, Muscular Dystrophy, Bell's Palsy & Peripheral Nerve Trauma
  • Head Trauma & Increased Intracranial Pressure including: Contusions, Hematomas & Herniations
  • Brain Tumors
  • Seizures
  • Strokes including: Transient Ischemic Attacks (TIAs),Ischemic Strokes (Thrombosis & Embolism as causes),Hemorrhagic Strokes, & Cerebral aneurysm
  • Metabolic Disorders including: Hyper & Hypo Pituitarism, Diabetes Insipidus & Syndrome of Inappropriate ADH Secretion, Hyper & Hypo Thyroidism (cretinism, Myxedema & Graves Disease), Hyper & Hypo Parathyroidism, Hyper & Hypo Adrenal Cortex Disorders
  • Finally, my favorite: Headaches!
Well, for the amount of time it just took me to type that all in, I should have just wrote the post I intended to.... Maybe tomorrow when I need a break from studying.

Thursday, April 17, 2008

Exit Exam

Today we took the HESI Exam. It is a comprehensive exam that predicts a student's performance on the NCLEX-RN . Basically, it is a "mock NCLEX." They tout 97.4% accuracy in predicting success or failure of the NCLEX.

Some schools use this an a true exit exam by making it a benchmark that must be met in order to graduate. Our school, however, does not. They encouraged us to study and do our best, though, as we receive feedback about our areas of weakness. We then can have a plan on how to focus our studies for the real deal - state boards, the NCLEX.

Well, we just had an exam Monday and have another one coming up on Tuesday - both DO count towards our grade...so needless to say there wasn't a whole lot of "HESI Studying" being done here.

I felt like taking it was a good experience. I really appreciated the feedback and being able to experience the feel of what the NCLEX may be like. It gave me confidence, too.

This brings me to a question. Isn't there some etiquette somewhere that says it is RUDE to ask someone what their score was? There were students after the exam sharing their scores with each other, which is fine...they were all willingly participating in it......which is fine, but I wanted no part of..... However, my one friend blatantly asked me what my score was. I really was offended that people could be so bold. If I wanted to share my grade, I would have.

I don't know why that bothered me so much. Yes, there is the straight out attempt at invasion of privacy, and putting someone on the spot...but it REALLY bothered me. I just said, with a laugh, I don't think I want to share that information. She was fine with it... end of story. But, what are my reasons for not sharing.

It is not the obvious: a bad grade. Actually, I got a very good grade... But, why wouldn't I want to share that with my classmates? I can share it here - in near anonymity. I shared it with my husband and children and no doubt will tell my sister. But not my classmates.

Am I afraid of looking the part of the nerdy, adult student? Isolating myself from the rest of the struggling students, lamenting together the unfairness of it all. Am I afraid of making them feel inadequate because the material was attainable for me? Or is it the "English" in me... wanting to adhere to proper etiquette?

Despite the drama afterwards, the test gave me confidence that I can make this last push through to the end successfully. Maybe I'll lighten up on myself a little bit these last few weeks. But probably not.

Monday, April 14, 2008

The New Report Card

My children brought home their report cards last week. All made the honor roll. All were outstanding. But my daughter had a defeated look on her face as she handed hers over. She had several high 90's and no grade lower than a 90. So, what was the issue?

Tucked inside her report card, very attainable to her, was her "BMI report" stating that she was "overweight."

That's outrageous on many levels.

To begin, there are many false positives and false negatives with BMI measurement. The BMI is the currently acceptable mode of determining if a child is growing normally. You can plug your height and weight into online BMI models easily. However, even though it is a widely acceptable method, it is only a rough estimate and is influenced by many other factors including muscle mass and a child's stage of puberty.

In females, girls experiencing puberty lay down fat pads and grow "out" before they grow "up." This stage of puberty is very common for the 6th grade girls who are carrying home their own "BMI report cards" labeling them as "overweight." The girls are also at a very vulnerable and impressionable stage that could easily influence them to create a negative self-body image.

Disturbed thought disorders such as anorexia occur most frequently in adolescents going through puberty and the rates of anorexia are only increasing. With this in mind, wouldn't one want to guard defensively any negative influence exerted on the young impressionable minds of prepubescent girls?

One has to question the overall goals of the school in doing this. Is it to bring awareness to parents about the obesity epidemic in our country. If this were the case, wouldn't it make sense that along with the "BMI Report Card" the parents would also receive recommendations such as following up with their family doctor or tips on providing adequate exercise and sound nutrition.

And, if the schools were so concerned about the obesity epidemic, to what extent are they willing to back up their deep concern by implementing healthy changes in the school environment? Does a 40 minute gym class once every 6 school days count as adequate exercise? Are school lunches consisting of cheeseburgers, fries and milk cutting it as sound nutrition?

I take personal responsibility for the health and well-being of my children. They are involved in activities, their TV time is limited, and we eat responsibly. If the school system has concerns about my children's health, let them voice it to me, personally or by mail at least. Do not put this outrageous claim inside my honor roll daughters report card, making her feel inadequate.

Saturday, April 12, 2008

Another year closer to _________(fill in the blank)

Ok, so it was my 30 something-ith birthday yesterday. In honor of that, I will share with you this super cool website I found a little bit ago. You may have already heard of it or visited... It is by Dr. Oz (Oprah's Dr.). Anyway, it is called "Real Age.com." It's pretty cool. You go to the site and take the "Real Age" test. You answer questions about your health, exercise pattern and family history, then it calculates your "Real Age." And, it gives you very do-able tips to improve your "age."

It was also my youngest son, Lance's, birthday yesterday as well. He was my little birthday present 8 years ago - the best present ever!!
Happy Bday to us.
:)

Friday, April 11, 2008

Oh my!

I just noticed the "ticker" at the bottom of my blog has moved from counting the months/weeks until graduation to days!!!!

29 DAYS until graduation!

Yeah!

The Answer

I asked in my previous post, "What would [a student nurse] do if they were assigned to a pt with [every tube and intervention ever invented in the ICU]?"

I think I have the answer.

The student would be intimidated by all of the equipment....spider web-like entanglements of various IV, TPN, and lipid tubing surrounding the bed. Her heart would jump every time the ventilator's high pressure alarm would sound, wondering if this was it - the end. And, she would be half afraid to even touch the patient for fear of disconnecting some tube and disturbing his "lifeline" finally pushing this poor soul over the edge: from death's doorstep propelling him into it.

Then, slowly, this same student nurse would timidly execute one order after another, successfully without any catastrophes ensuing. She would suction his trach successfully, though tense and shaking slightly. She would check the placement of his J-G-tube and hang his TPN, without incident. And, all the while she would look ever so curiously into this patient's eyes. Was there a clue hidden there?

As the initial intimidation and nervousness wore off and the student nurse grew accustomed to the occasional occluded tubing that needed un-kinked...and she became increasingly comfortable with the new, previously unfamiliar clinical tasks that were required of her....then, after all of that.... the student nurse would be able to look beyond the equipment and see the person.

The person; not the patient. The person who got dressed for church on Sunday, unsuspecting and without warning of what was to come ... The person who fell to the floor of his church clutching his chest, on the verge of death, in V-Tach. The person, now dependent on machinery for his very breath and helpless, in need of human connection and human touch.

The student nurse would speak softly to the man...at first he would continue to block out her voice along with the world....the world that was now so cruel and painful. But she would continue to babble on about this or that, knowing that while his body was failing him, his mind and cognition weren't. And, then, one of the things the student nurse said to him would touch him and he would opened his eyes and look the student nurse right in the eyes and give a weak, endearing smile. The smile, then, truly would warm the student nurse's frightened, timid heart.

She would then be able to move beyond hanging the proper IVs and interpreting the ekg rhythm strips correctly and she would be richly rewarded for it.

She truly connected to another human on this planet who was in need of a personal connection at that moment.

She then would leave, after 2 days of caring for this dear man, with both happiness and sadness in her heart for him. She will diligently look in the obituaries - not knowing what she is hoping for more: to not see his name or to see his handsome picture knowing he is finally at peace.

That is what a student nurse would do.

Tuesday, April 8, 2008

No Room for Error

What would one do if they were assigned to a patient in ICU that had all of the following things:

Post op from quadruple coronary artery bypass (that had a poor recovery)
Tracheostomy
On ventilator
On TPN
New subclavian hemodialysis cath for CVVH (continuous venovenous hemofiltration; like dialysis at the bedside)
New IJ CVP
New J-tube
Nasogastric tube to suction
Double chest tubes
Radial A-Line
New Ileostomy
Foley
Has a dopamine & insulin drip running
And, was receiving PRBCs

Only 2 more weeks in ICU... I hope it goes quickly....the stress would be too much to do on a daily basis, and I'm not sure how the ICU nurses cope. Last week in ICU there was a family that decided to turn off all supportive equipment. The patient died. And, we students then had the task of removing all tubes and doing the postmortem care, including putting him in the body bag. Very sobering environment. I surely commend those who do ICU nursing well as I'm not sure I could for any amount of time.

Friday, April 4, 2008

Back in the Day

When I had my first baby, there was no such thing as a "onesie." Am I dating myself? I remember attaching elastic suspender-like straps that wrapped around Alex's butt from the back to the front in order to keep the t-shirt from riding up. With my second baby, I thought the onesie was the best invention ever!!!

Well, after 8 years without a baby, it is amazing to see all of the new things that are available for my sister's new baby. My absolute favorite new baby gadget is this blanket/swaddling device.

Remember having to learn how to swaddle a baby? Position blanket like a diamond. Fold down top corner. Place baby on it. Fold over left side. Fold up bottom. Fold over right side, tucking tightly all the while. Mark and I would almost compete at who had the better swaddle.

Well, with this new thing, there's no going wrong... It has velcro and all to hold the swaddle tight. It is awesome.

And, my new niece, Berkeley looks adorable in it, and LOVES it... my sister says it puts her right to sleep.
It's like a little "Berkeley Burrito."

Wednesday, April 2, 2008

Post ER

I recently got home from spending my first night in the ER - as a nurse...not a patient....because we've no doubt all had the middle of the night visits to the ER.... But this time I was on the other side of the curtain, so to speak.

One of the things I wanted to know going into this experience was: "What in the world takes so long????" It seems that each time I've had the misfortune to have to visit an ER, it seemed like it took FOREVER!!

Well, let me tell you it is NOT because the nurses are at the station exchanging gossip. What I saw was nurses running their butts off from one patient to another. And, as soon as one of their bays would open up they would have to fill it with another patient who was waiting to be seen. One interesting thing I noticed: the nurses could go through a list of patients waiting to be seen and "pick" the one they wanted to take. Hmmm.

Anyway, the nurses were ever-so-glad to be blessed with an eager student willing to do "fun" clinical tasks for them. I got my fill of doing EKGs, that's for sure. And, I got to do something else that really, really boosted my confidence level: I inserted 2 successful IVs!!!

I had been feeling somewhat unsure of myself with this skill. Since the hospital I do clinicals at has an IV team that handles all of the IVs on the floors, I only had one chance so far to insert an IV line - and it was unsuccessful. I was especially nervous about my lack of experience because the hospital I signed on to work at after graduation has no such IV team and the nurses insert all of their own IVs.

Well, I feel a lot more confident in my ability to at least get proficient with practice - given the opportunity.

One IV I inserted was into the metacarpal, the other in the cephalic. I found it much easier inserting it into the metacarpal, though, because I was able to flex the hand/fingers downward and it was a semi-straight shot in with the needle from there.

Fun, fun, fun. I also got to go to the cardiac cath lab with a patient and watch a cath being done. Very cool. And, I assisted with a central line insertion into the right subclavian.

ER nurses rock.

NCLEX-RN

To be a registered nurse one must
1) Complete an accredited nursing program
2) Pass the NCLEX-RN

NCLEX-RN stands for "The National Council Licensure Examination for Registered Nurses. It is basically, "boards."

In preparation for the NCLEX, it is recommended that a student answer 5,000 practice NCLEX questions. I have 2 books dedicated to NCLEX questions and an online subscription as well that I've been using. Not sure how close I am to 5,000...but I'm on my way. I sent in my application for the test yesterday!

For fun, I'll post some NCLEX questions here from time to time..... And, since this blog is birth related, I'll make sure they are mostly OB/GYN questions.
Here are some to start.

1) A 19-year old primigravida is admitted to the labor and delivery unit in labor. She is 2 cm dilated and 50% effaced, and the fetal head is at 0 station. She is having moderately strong 40-second contractions every 5 minutes. She seems rather anxious and becomes very tense during each contraction. When the client asks for pain relief, what should the nurse do next?

a) Determine the source of her anxiety and institute interventions to help her relax.
b) Immediately check the physician's orders and give her the analgesic ordered.
c) Inform her that the baby's head is not down fa enough just yet, but that as soon as it is, medication will be given.
d) Tell her that her contractions are only moderately strong, and that she should wait until later to take medication.

2) A 17 year old primigavida with severe PIH has been receiving magnesium sulfate IV for 3 hours. The nurse assesses deep tendon reflexes (DTR), vital signs, and fetal heart tones every 15 minutes and urine output hourly. The latest assessment yields the following data: DTR, +1; blood pressure, 150/100mm Hg; pulse, 92 beats/minute; respirations, 10; urine output, 20ml/hour. The client appears flushed and complains of feeling warm. Which nursing action would be most appropriate in light of the current assessment data?

a) Take no action; continue monitoring per standards of care.
b) Discontinue the magnesium sulfate infusion.
c) Increase the infusion rate by 5 gtt/min.
d) Decrease the infusion rate by 5 gtt/min.

3) Which of the following indicates fetal distress?

a) FHR of 144 beats per minute.
b) Acceleration of FHR with contractions
c) Long-term variability
d) Fetal scalp pH of 7.14

4) A baby born at 34 weeks' gestation has a surfactant deficit. Which of the following conditions would the nurse most likely find in completing a newborn assessment?

a) Jaundice
b) Sternal retractions
c) Abdominal distention
d) Frothy, blood-tinged sputum

5) A client has a boggy uterus during Stage IV of her delivery. Four hours postpartum, the nurse is preparing to administer methylergonovine maleate (Methergine) 0.2mg PO as prescribed every 6 hours. The client's vital signs are: T 100.4, P 60, R 14, BP 140/90. Which is the most appropriate intervention?

a) Administer the drug STAT.
b) Administer the drug and call the physician.
c) Do not administer the drug.
d) Administer the drug and recheck vital signs.

6) A client who has suffered a closed head injury has been placed on a cooling blanket and given an antipyretic, as prescribed. In evaluating the client's response to these treatments, the nurse should anticipate that the therapeutic effects of these measures will do which of the following?

a) Prevent hypoxia secondary to diaphoresis.
b) Reduce brain metabolism and limit bain hypoxia.
c) Promote integrity of intracerebral neurons.
d) Promote equalization of osmotic factors.

For answers see below. If you would like rationale for any, let me know.

Answers: 1) a, 2) b, 3) d, 4) b, 5) c, 6) b
Questions from American Nursing Review Questions & Answers for NCLEX-RN, second edition.

Tuesday, April 1, 2008

Vaginal Births Banned

An April Fool's Joke that nearly had me going!!!
Sadly, it is not THAT unbelievable.
Peace