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Saturday, December 30, 2006



I. Physiology of Breast milk production

As soon as delivery of the placenta is over there will be an abrupt decrease on both Estrogen and Progesterone -----> this will stimulate the APG to secrete PROLACTIN.

note: Be aware that sucking also stimulates Prolactin secretion as this will stimuate the nerves and impulse will travel from the nipple to the Hypothalamus

PROLACTIN will act on the acini cells (alveolar cells) of the breast to produce milk. This milk is called FOREMILK and is stored in the lactiferous sinus. FOREMILK is contiously being produced.

What happens next?

When the baby sucks on the breast of the mother OXYTOCIN is stimulated and oxytocin will act on 2 organs.

1. Breast (Let down reflex)
2. Uterus (promotes Involutions)

OXYTOCIN will cause the mammary galnds to contract and push the milk forward making it available for the baby.

What will stimulate the Let Down reflex?
1. Sucking of the baby
2. Sound of the baby's cry

note: After the Let Down Reflex a new milk will be formed and this is called HINDMILK and this contains more FATS that is needed for the growing newborn

1. Colostrum - 2-4 days present
-content: decrease fats, increase IgA, dec CHO, dec CHON, inc minerals, -inc fat soluble minerals
2. Transitional milk- 4 – 14 days
-content: inc lactose, inc water soluble vit., inc minerals

3. Mature milk- 14 & up
-content: inc fats (linoleic acid) – resp for devt of brain & integrity of skin
-inc CHO- lactose – easily digested, baby not constipated.- esp of sour milk smelling odor of stool.

-Lactose intolerance- deficiency of enzyme LACTASE that digest LACTOSE
-Decrease CHON- lactalbumin

Difference with cow's milk

Cows milk
–inc fats -Dec CHO
-Inc CHON – casing- has curd that’s hard to digest.
-Inc minerals–traumatic effect on kidneys of babies. Can trigger stone formation.
-Inc phosphorusnote:

Note Baby who are breastfed are least likely to develop tetany. It is seen that botlle fed infants have more difficulty in regulating calcium and phosporus. Because cow's milk have more fat contents, this fatty acids may bind with calcium in the GIT causing more decrease in calcium.

Note: Breast feeding can be iniated
if had Cesarian Section- after 4 hours

Advantages of Breast feeding
1. Economical
2. Always available
3. Breastfed babies have higher IQ than bottle fed babies.
4. It facilitates rapid involution
5. Decrease incidence of breast cancer.
6. Has antibodiesI(gA), lactoferrin, lyzozymes and interferon (inhibit and/or destroy pathogenic bacteria and viruses)
7. Has lactobacillius bifidus- interferes with attack of pathogenic bacteria in GIT
8. Has macrophages
Store milk- plastic storage container
Store milk – good for 6 months from freezer- put rm temp. don’t heat

1. Possibility of transfer HEP B, HIV, cytomegalo virus.
2. No iron
3. Father can’t feed & bond as well

Proper breast feeding technique

1. Be in a comfortable position
(Most appropriate is Upright sitiing for this position avoids tension)
2. Entire body of teh baby should be turned towards the mother's breast.
3. Initiate feeding by stimulating the Rooting reflex- by touching the side of lips/cheeks then baby will turn to stimulus. Disappear by 6 weeks- by 6 weeks baby can focus. Reflex will be gone-
Purpose rooting- to look for food.

Sucking Mechanism (breast)
a. Lips of the infant should clamp a C-shape
b. The tounge thrusts forward to grasp nipple and areola
c. The nipple is brought against the ahrd palate as the tounge pulls the areola into the mouth
d. the gums compresses the areola, squezing milk at the back of the throat

Sucking mechanism (bottle)
The large rubber nipple strikes the soft palate and interferes with the action of the tounge. The tounge moves forwards against the gum to control overflow of milk in the espphagous (same reason why dental malocllusion is prone to bottle fed babies, because they thrust their tounge FORWARD causing problem in the formation od the dental arch)

4. Burp or Bubble the babyduring and after feeding to allow escape of air (preventing colic). Sit infant on lap, flexed forward, then rub or pat the back (note: avoid jarring the infant)

Criteria of Effective Sucking
a.) Baby’s mouth is hiked up to areola
b.) Mom experiences after pain.
c.) Other nipple is also flowing with milk.

NOTE: Make sure that the mother feeds the baby at the same breast she last feed her baby. THis is to facilitated complete emptying of the breast and thereby promote complete filling of milk.

Contra Indications in Breast Feeding:
a. Maternal Conditions:
1. HIV, CMV, Hepa B
2. Recieving Coumadin, Lithium or Methotrexate
3. has breast cancer
4. has herpes lesion on breast

b.Newborn Condition - Inborn errors of metabolism usch asErythrobastosis Fetalis – Rh incompatibility, Hydrops Fetalis, Phenylketonuria, Galactosemia, Tay Sachs disease

Problems experienced in Breastfeeding :

3RD day changes in breast post partuma.1
1)Engorged breast- feeling of fullness & tension in breast. - sometimes accompanied by fever known as MILK FEVER.
Mgt:Warm compress- for breastfeeding momCold compress
– for bottle feeding & wear supportive bra.
When is involution of breast- 4 weeks

b.) Sore nipple – cracked with painful nipple
Mgt: 1.) exposure to air – remove bra & wear dress, if not, expose to 20 Watt bulbavoid wearing plastic liner bra-will create moisture, cotton only

c.) Mastitis- inflammation of breast : staphylococcus aureus
1. Improper breast emptying
2. Unhealthy sexual practices
- manually express inflamed breastfeed on unaffected breast- give antibiotics
– can still feed on unaffected breast

Type of stools with different milk products:

1. Transitional stool - - green loose & shiny, like diarrhea to the untrained eye
2. Breastfed stool
- golden yellow, soft, mushy with sour milk smell, frequently passed
- recur every feeding
3.. Bottlefed stool –
- pale yellow, formed hard with typical offensive odor, seldom passed, 2–3 x/day
- with food added -brown & odorous

Jeddah's note: Hope this helps. God bless us all

15 item ACLS Drill

1. To confirm proper placement of tracheal tube through 5-point auscultation, which of the following observations are appropriate? Check all that apply.

__ check breath sounds in the left and right lateral chest and lung bases
__ auscultate breath sounds in the left and right anterior sides of the chest
__ listen for gastric bubbling noises front the epigastrium
__ ensure equal and adequate chest expansion bilaterally

2. Which of the following is true about an oropharyngeal airway?

a. it eliminates the need to position the head of the unconscious patient
b. it eliminates the possibility of an upper airway obstruction
c. it is of no value once a tracheal tube is inserted
d. it may stimulate vomiting or laryngospasm if inserted in the semiconscious patient

3. Which of the following is an indication for tracheal intubation?

a. difficulty encountered by qualified rescuers in ventilating an apneic patient with a bag-mask device
b. a respiratory rate of less than 20 breaths per minute in a patient with severe chest pain
c. presence of premature ventricular contractions
d. to provide airway protection in a responsive patient with an adequate gag reflex

4. Which of the following is the most important step to restore oxygenation and ventilation for the unresponsive, breathless submersion (near drowning) victim?

a. attempt to drain water from breathing passages by performing the Heimlich maneuver
b. begin chest compressions
c. provide cervical spine stabilization because a diving accident may have occurred
d. open the airway and begin rescue breathing as soon as possible even in the water

5. You respond with 2 other rescuers to a 50 year old man who is unresponsive, pulseless, and not breathing. What tasks would you assign the other rescuers while you set up the AED?

a. one rescuer should call rescue assistance and the others rescuer should begin CPR
b. both rescuers should help set up the AED and provide CPR
c. one rescuer should open the airway and begin rescue breathing, and the second rescuer should begin chest compressions
d. recruit additional first responders to help

6. An AED hangs on the wall suddenly a code is called, you grab the AED and run to the room where the resuscitation is ongoing. A colleague has begun CPR and confirms that the patient is in pulseless arrest. As you begin to attach the AED, you see a transdermal medication patch on the victim’s upper right chest, precisely where you were going to place an AED electrode pad. What is your most appropriate action?

a. ignore the medication patch and place the electrode pad in the usual position
b. avoid the medication patch and place the second electrode pad on the victim’s back
c. remove the medication patch, wipe the area dry, and place the electrode pad in the correct position
d. place the electrode pad on the victim’s right abdomen

7. A patient who has Ventricular Fibrillation has failed to respond to 3 shocks. Paramedics started an IV and inserted a tracheal tube, confirming proper placement. Which of the following drugs should this patient receive first?

a. Amiodarone 300 mg IV push
b. Lidocaine 1 to 1.5 mg/kg IV push
c. Procainamide 30 mg/min up to a total dose of 17 mg/kg
d. Epinephrine 1 mg IV push

8. After giving epinephrine 1 mg IV and a fourth shock, a patient remains in VF. You want to continue to administer epinephrine at appropriate doses and intervals if the patient remains in VF. Which epinephrine dose is recommended under these conditions?

a. give the following epinephrine dose sequence, each 3 minutes apart: 1 mg, 3 mg, and 5 mg
b. give a single high dose of epinephrine: 0.1 to 0.2 mg/kg
c. give epinephrine 1 mg IV, then in 5 minutes start vasopressin 40 U IV every 3 to 5 minutes
d. give epinephrine 1 mg IV; repeat 1 mg every 3 to 5 minutes

9. Which of the following therapies is the most important intervention for VF/pulseless VT with the greatest effect on survival to hospital discharge?

a. Epinephrine
b. Defibrillation
c. Oxygen
d. Amiodarone

10. A 60 yr old man persists in VF arrest despite 3 stacked shocks at appropriate energy levels. Your code team, however, has been unable to start an IV or insert a tracheal tube. Therefore administration of IV or tracheal medications will be delayed. What is the most appropriate immediate next step?

a. deliver additional shocks in an attempt to defibrillate
b. deliver a precordial thump
c. perform a venous cut-down to gain IV access
d. administer intramuscular epinephrine 2 mg

11. A 75 year old homeless man is in cardiac arrest with pulseless VT at a rate of 220 bpm. After CPR, 3 shocks in rapid succession, 1mg IV epinephrine, plus 3 more shocks, the man continues to be in polymorphic pulseless VT. He appears wasted and malnourished. The paramedics recognize him as a chronic alcoholic known in the neighborhood. Because he remains in VT after 6 shocks, you are considering an antiarryhthymic. Which of the following agents would be most appropriate for this patient at this time?

a. Amiodarone
b. Procainamide
c. Magnesium
d. Diltiazem

12. You are called to assist in the attempted resuscitation of a patient who is demonstrating PEA. As you hurry to the patient’s room, you review the information you learned in the ACLS course about management of PEA. Which one of the following about PEA is true?

a. chest compressions should be administered only if the patient with PEA develops a ventricular rate of less than 50 bpm
b. successful treatment of PEA requires identification and treatment of reversible causes
c. atropine is the drug of choice for treatment of PEA, whether the ventricular rate is slow or fast
d. PEA is rarely caused by hypovolemia, so fluid administration is contraindicated and should not be attempted

13. For which of the following patients with PEA is sodium bicarbonate therapy (1 mEq/kg) most likely to be most effective?

a. the patient with hypercarbic acidosis and tension pneumothorax treated with decompression
b. the patient with a brief arrest interval
c. the patient with documented severe hyperkalemia
d. the patient with documented severe hypokalemia

14. Which of the following is the correct initial drug and dose for treatment of asystole?

a. epinephrine 2mg IV
b. atropine 0.5 mg IV
c. lidocaine 1mg/kg IV
d. epinephrine 1mg IV

15. You are considering transcutaneous pacing for a patient in asystole. Which of the following candidates would be most likely to respond to such a pacing attempt?

a. the patient in asystole who has failed to respond to 20 minutes of BLS and ACLS therapy
b. the patient in asystole following blunt trauma
c. the patient in asystole following a defibrillatory shock
d. the patient who has just arrived in the emergency department following transport and CPR in the field for persistent asystole after submersion

Source: American Heart Association ACLS Provider Manual


Wednesday, December 27, 2006

40 items Comprehensive NCLEX review answer key

1. Which individual is at greatest risk for developing hypertension?
A) 45 year-old African American attorney
B) 60 year-old Asian American shop owner
C) 40 year-old Caucasian nurse
D)55 year-old Hispanic teacher

The correct answer is A: 45 year-old African American attorney The incidence of hypertension is greater among African Americans than other groups in the US. The incidence among the Hispanic population is rising.

2. A child who ingested 15 maximum strength acetaminophen tablets 45 minutes ago is seen in the emergency department. Which of these orders should the nurse do first?
A) Gastric lavage PRN
B) Acetylcysteine (mucomyst) for age per pharmacy
C) Start an IV Dextrose 5% with 0.33% normal saline to keep vein open
D) Activated charcoal per pharmacy

The correct answer is A: Gastric lavage PRN Removing as much of the drug as possible is the first step in treatment for this drug overdose. This is best done by gastric lavage. The next drug to give would be activated charcoal, then mucomyst and lastly the IV fluids.

3. Which complication of cardiac catheterization should the nurse monitor for in the initial 24 hours after the procedure?
A) angina at rest
B) thrombus formation
C) dizziness
D) falling blood pressure

The correct answer is B: thrombus formation Thrombus formation in the coronary arteries is a potential problem in the initial 24 hours after a cardiac catheterization. A falling BP occurs along with hemorrhage of the insertion site which is associated with the first 12 hours after the procedure.

4. A client is admitted to the emergency room with renal calculi and is complaining of moderate to severe flank pain and nausea. The client’s temperature is 100.8 degrees Fahrenheit. The priority nursing goal for this client is
A) Maintain fluid and electrolyte balance
B) Control nausea
C) Manage pain
D) Prevent urinary tract infection

The correct answer is C: Manage pain The immediate goal of therapy is to alleviate the client’s pain.

5. What would the nurse expect to see while assessing the growth of children during their school age years?
A) Decreasing amounts of body fat and muscle mass
B) Little change in body appearance from year to year
C) Progressive height increase of 4 inches each year
D) Yearly weight gain of about 5.5 pounds per year

The correct answer is D: Yearly weight gain of about 5.5 pounds per year School age children gain about 5.5 pounds each year and increase about 2 inches in height.

6. At a community health fair the blood pressure of a 62 year-old client is 160/96. The client states “My blood pressure is usually much lower.” The nurse should tell the client to
A) go get a blood pressure check within the next 48 to 72 hours
B) check blood pressure again in 2 months
C) see the health care provider immediately
D) visit the health care provider within 1 week for a BP check

The correct answer is A: go get a blood pressure check within the next 48 to 72 hours The blood pressure reading is moderately high with the need to have it rechecked in a few days. The client states it is ‘usually much lower.’ Thus a concern exists for complications such as stroke. However immediate check by the provider of care is not warranted. Waiting 2 months or a week for follow-up is too long.

7. The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission?
A) A middle aged client with a history of being ventilator dependent for over 7 years and admitted with bacterial pneumonia five days ago
B) A young adult with diabetes mellitus Type 2 for over 10 years and admitted with antibiotic induced diarrhea 24 hours ago
C) An elderly client with a history of hypertension, hypercholesterolemia and lupus, and was admitted with Stevens-Johnson syndrome that morning
D) An adolescent with a positive HIV test and admitted for acute cellulitus of the lower leg 48 hours ago

The correct answer is A: A middle aged client with a history of being ventilator dependent for over 7 years and admitted with bacterial pneumonia five days ago The best candidate for discharge is one who has had a chronic condition and is most familiar with their care. This client in option A is most likely stable and could continue medication therapy at home.

8. A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:
A) Should be taken in the morning
B) May decrease the client's energy level
C) Must be stored in a dark container
D) Will decrease the client's heart rate

The correct answer is A: Should be taken in the morning Thyroid supplement should be taken in the morning to minimize the side effects of insomnia

9. A 3 year-old child comes to the pediatric clinic after the sudden onset of findings that include irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning forward, tongue protruding, drooling and suprasternal retractions. What should the nurse do first?
A) Prepare the child for x-ray of upper airways
B) Examine the child's throat
C) Collect a sputum specimen
D) Notify the healthcare provider of the child's status

The correct answer is D: Notify the health care provider of the child''s status These findings suggest a medical emergency and may be due to epiglottises. Any child with an acute onset of an inflammatory response in the mouth and throat should receive immediate attention in a facility equipped to perform intubation or a tracheostomy in the event of further or complete obstruction.

10. In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school age child for evaluation?
A) Polyphagia
B) Dehydration
C) Bed wetting
D) Weight loss

The correct answer is C: Bed wetting In children, fatigue and bed wetting are the chief complaints that prompt parents to take their child for evaluation. Bed wetting in a school age child is readily detected by the parents

11. A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection?
A) Trichomoniasis
B) Chlamydia
C) Staphylococcus
D) Streptococcus

The correct answer is B: Chlamydia Chlamydial infections are one of the most frequent causes of salpingitis or pelvic inflammatory disease.

12. An RN who usually works in a spinal rehabilitation unit is floated to the emergency department. Which of these clients should the charge nurse assign to this RN?
A) A middle-aged client who says "I took too many diet pills" and "my heart feels like it is racing out of my chest."
B) A young adult who says "I hear songs from heaven. I need money for beer. I quit drinking 2 days ago for my family. Why are my arms and legs jerking?"
C) An adolescent who has been on pain medications for terminal cancer with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 10
D) An elderly client who reports having taken a "large crack hit" 10 minutes prior to walking into the emergency room

The correct answer is c: An adolescent who has been on pain medications for terminal cancer with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 10 Nurses who are floated to other units should be assigned to a client who has minimal anticipated immediate complications of their problem. The client in option C exhibits opoid toxicity with the pinpoint pupils and has the least risk of complications to occur in the near future.

13. When teaching a client with coronary artery disease about nutrition, the nurse should emphasize
A) Eating 3 balanced meals a day
B) Adding complex carbohydrates
C) Avoiding very heavy meals
D) Limiting sodium to 7 gms per day

The correct answer is C: Avoiding very heavy meals Eating large, heavy meals can pull blood away from the heart for digestion and is dangerous for the client with coronary artery disease.

14. Which of these findings indicate that a pump to deliver a basal rate of 10 ml per hour plus PRN for pain break through for morphine drip is not working?
A) The client complains of discomfort at the IV insertion site
B) The client states "I just can't get relief from my pain."
C) The level of drug is 100 ml at 8 AM and is 80 ml at noon
D) The level of the drug is 100 ml at 8 AM and is 50 ml at noon

The correct answer is C: The level of drug is 100 ml at 8 AM and is 80 ml at noon The minimal dose of 10 ml per hour which would be 40 ml given in a 4 hour period. Only 60 ml should be left at noon. The pump is not functioning when more than expected medicine is left in the container.

15. The nurse is speaking at a community meeting about personal responsibility for health promotion. A participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse’s response? A) Electrical energy fields
B) Spinal column manipulation
C) Mind-body balance
D) Exercise of joints

The correct answer is B: Spinal column manipulation The theory underlying chiropractic is that interference with transmission of mental impulses between the brain and body organs produces diseases. Such interference is caused by misalignment of the vertebrae. Manipulation reduces the subluxation.

16. The nurse is performing a neurological assessment on a client post right CVA. Which finding, if observed by the nurse, would warrant immediate attention?
A) Decrease in level of consciousness
B) Loss of bladder control
C) Altered sensation to stimuli
D) Emotional lability

The correct answer is A: Decrease in level of consciousness A further decrease in the level of consciousness would be indicative of a further progression of the CVA.

17. A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is performing an assessment. Which later finding of this disease would the nurse not expect to see at this time?
A) Positive sweat test
B) Bulky greasy stools
C) Moist, productive cough
D) Meconium ileus

The correct answer is C: Moist, productive cough Option c is a later sign. Noisy respirations and a dry non-productive cough are commonly the first of the respiratory signs to appear in a newly diagnosed client with cystic fibrosis (CF). The other options are the earliest findings. CF is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva and digestive juices. Normally, these secretions are thin and slippery, but in CF, a defective gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts and passageways, especially in the pancreas and lungs. Respiratory failure is the most dangerous consequence of CF.

18. The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs 2 hours ago. The nurse should
A) Place a call to the client's health care provider for instructions
B) Send him to the emergency room for evaluation
C) Reassure the client's wife that the symptoms are transient
D) Instruct the client's wife to call the doctor if his symptoms become worse

The correct answer is B: Send him to the emergency room for evaluation This client requires immediate evaluation. A delay in treatment could result in further deterioration and harm. Home care nurses must prioritize interventions based on assessment findings that are in the client''s best interest.

19. Which of the following should the nurse implement to prepare a client for a KUB (Kidney, Ureter, Bladder) radiograph test?
A) Client must be NPO before the examination
B) Enema to be administered prior to the examination
C) Medicate client with Lasix 20 mg IV 30 minutes prior to the examination
D) No special orders are necessary for this examination

The correct answer is D: No special orders are necessary for this examination No special preparation is necessary for this examination.

20. The nurse is giving discharge teaching to a client 7 days post myocardial infarction. He asks the nurse why he must wait 6 weeks before having sexual intercourse. What is the best response by the nurse to this question?
A) "You need to regain your strength before attempting such exertion." B) "When you can climb 2 flights of stairs without problems, it is generally safe."
C) "Have a glass of wine to relax you, then you can try to have sex."
D) "If you can maintain an active walking program, you will have less risk."

The correct answer is B: "When you can climb 2 flights of stairs without problems, it is generally safe." There is a risk of cardiac rupture at the point of the myocardial infarction for about 6 weeks. Scar tissue should form about that time. Waiting until the client can tolerate climbing stairs is the usual advice given by health care providers.

21. A triage nurse has these 4 clients arrive in the emergency department within 15 minutes. Which client should the triage nurse send back to be seen first?
A) A 2 month old infant with a history of rolling off the bed and has buldging fontanels with crying
B) A teenager who got a singed beard while camping
C) An elderly client with complaints of frequent liquid brown colored stools
D) A middle aged client with intermittent pain behind the right scapula

The correct answer is B: A teenager who got singed a singed beard while camping This client is in the greatest danger with a potential of respiratory distress, Any client with singed facial hair has been exposed to heat or fire in close range that could have caused damage to the interior of the lung. Note that the interior lining of the lung has no nerve fibers so the client will not be aware of swelling.

22. While planning care for a toddler, the nurse teaches the parents about the expected developmental changes for this age. Which statement by the mother shows that she understands the child's developmental needs?
A) "I want to protect my child from any falls."
B) "I will set limits on exploring the house."
C) "I understand the need to use those new skills."
D) "I intend to keep control over our child."

The correct answer is C: "I understand the need to use those new skills." Erikson describes the stage of the toddler as being the time when there is normally an increase in autonomy. The child needs to use motor skills to explore the environment.

23. The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The most important action of the nurse is
A) Verify correct placement of the tube
B) Check that the feeding solution matches the dietary order
C) Aspirate abdominal contents to determine the amount of last feeding remaining in stomach
D) Ensure that feeding solution is at room temperature

The correct answer is A: Verify correct placement of the tube Proper placement of the tube prevents aspiration.

24. The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq KCL in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued? A) Narrowed QRS complex
B) Shortened "PR" interval
C) Tall peaked T waves
D) Prominent "U" waves

The correct answer is C: Tall peaked T waves A tall peaked T wave is a sign of hyperkalemia. The health care provider should be notified regarding discontinuing the medication.

25. A nurse prepares to care for a 4 year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body?
A) All striated muscles
B) The cerebellum
C) The kidneys
D) The leg bones

The correct answer is A: All striated muscles Rhabdomyosarcoma is the most common children''s soft tissue sarcoma. It originates in striated (skeletal) muscles and can be found anywhere in the body. The clue is in the middle of the word and is “myo” which typically means muscle.

26. The nurse anticipates that for a family who practices Chinese medicine the priority goal would be to
A) Achieve harmony
B) Maintain a balance of energy
C) Respect life
D) Restore yin and yang

The correct answer is D: Restore yin and yang For followers of Chinese medicine, health is maintained through balance between the forces of yin and yang.

27. During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per minute and the client complains of periodic dizzy spells. The nurse instructs the client to A) Increase fluids that are high in protein
B) Restrict fluids
C) Force fluids and reassess blood pressure
D) Limit fluids to non-caffeine beverages

The correct answer is C: Force fluids and reassess blood pressure Postural hypotension, a decrease in systolic blood pressure of more than 15 mm Hg and an increase in heart rate of more than 15 percent usually accompanied by dizziness indicates volume depletion, inadequate vasoconstrictor mechanisms, and autonomic insufficiency.

28. A client has a Swan-Ganz catheter in place. The nurse understands that this is intended to measure
A) Right heart function
B) Left heart function
C) Renal tubule function
D) Carotid artery function

The correct answer is B: Left heart function The Swan-Ganz catheter is placed in the pulmonary artery to obtain information about the left side of the heart. The pressure readings are inferred from pressure measurements obtained on the right side of the circulation. Right-sided heart function is assessed through the evaluation of the central venous pressures (CVP).

29. A nurse enters a client's room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is
A) Start a peripheral IV
B) Initiate closed-chest massage
C) Establish an airway
D) Obtain the crash cart

The correct answer is C: Establish an airway Establishing an airway is always the primary objective in a cardiopulmonary arrest.

30. A client is receiving digoxin (Lanoxin) 0.25 mg. Daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg. B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider?
A) Blood pressure 94/60
B) Heart rate 76
C) Urine output 50 ml/hour
D) Respiratory rate 16

The correct answer is A: Blood pressure 94/60 Both medications decrease the heart rate. Metoprolol affects blood pressure. Therefore, the heart rate and blood pressure must be within normal range (HR 60-100; systolic B/P over 100) in order to safely administer both medications.

31. While assessing a 1 month-old infant, which finding should the nurse report immediately?
A) Abdominal respirations
B) Irregular breathing rate
C) Inspiratory grunt
D) Increased heart rate with crying

The correct answer is C: Inspiratory grunt Inspiratory grunting is abnormal and may be a sign of respiratory distress in this infant.

32. The nurse practicing in a maternity setting recognizes that the post mature fetus is at risk due to
A) Excessive fetal weight
B) Low blood sugar levels
C) Depletion of subcutaneous fat
D) Progressive placental insufficiency

The correct answer is D: Progressive placental insufficiency The placenta functions less efficiently as pregnancy continues beyond 42 weeks. Immediate and long term effects may be related to hypoxia.

33. The nurse is caring for a client who had a total hip replacement 4 days ago. Which assessment requires the nurse’s immediate attention? A) I have bad muscle spasms in my lower leg of the affected extremity.
B) "I just can't 'catch my breath' over the past few minutes and I think I am in grave danger."
C) "I have to use the bedpan to pass my water at least every 1 to 2 hours." D) "It seems that the pain medication is not working as well today."

The correct answer is B: "I just can''t ''catch my breath'' over the past few minutes and I think I am in grave danger." The nurse would be concerned about all of these comments. However the most life threatening is option B. Clients who have had hip or knee surgery are at greatest risk for development of post operative pulmonary embolism. Sudden dyspnea and tachycardia are classic findings of pulmonary embolism. Muscle spasms do not require immediate attention. Option C may indicate a urinary tract infection. And option D requires further investigation and is not life threatening.

34. A client has been taking furosemide (Lasix) for the past week. The nurse recognizes which finding may indicate the client is experiencing a negative side effect from the medication?
A) Weight gain of 5 pounds
B) Edema of the ankles
C) Gastric irritability
D) Decreased appetite

The correct answer is D: Decreased appetite Lasix causes a loss of potassium if a supplement is not taken. Signs and symptoms of hypokalemia include anorexia, fatigue, nausea, decreased GI motility, muscle weakness, dysrhythmias.

35. A client who is pregnant comes to the clinic for a first visit. The nurse gathers data about her obstetric history, which includes 3 year-old twins at home and a miscarriage 10 years ago at 12 weeks gestation. How would the nurse accurately document this information?
A) Gravida 4 para 2
B) Gravida 2 para 1
C) Gravida 3 para 1
D) Gravida 3 para 2

The correct answer is C: Gravida 3 para 1 Gravida is the number of pregnancies and Parity is the number of pregnancies that reach viability (not the number of fetuses). Thus, for this woman, she is now pregnant, had 2 prior pregnancies, and 1 viable birth (twins).

36. The nurse is caring for a client with a venous stasis ulcer. Which nursing intervention would be most effective in promoting healing?
A) Apply dressing using sterile technique
B) Improve the client's nutrition status
C) Initiate limb compression therapy
D) Begin proteolytic debridement

The correct answer is B: Improve the client''s nutrition status The goal of clinical management in a client with venous stasis ulcers is to promote healing. This only can be accomplished with proper nutrition. The other answers are correct, but without proper nutrition, the other interventions would be of little help.

37. A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4 mg, and promethizine hydrochloride (Phenergan) 50 mg IM to a pre-operative client. Which action should the nurse take first?
A) Raise the side rails on the bed
B) Place the call bell within reach
C) Instruct the client to remain in bed
D) Have the client empty bladder

The correct answer is D: Have the client empty bladder The first step in the process is to have the client void prior to administering the pre-operative medication. The other actions follow this initial step in this sequence: 4 3 1 2

38. Which of these statements best describes the characteristic of an effective reward-feedback system?
A) Specific feedback is given as close to the event as possible
B) Staff are given feedback in equal amounts over time
C) Positive statements are to precede a negative statement
D) Performance goals should be higher than what is attainable

The correct answer is A: Specific feedback is given as close to the event as possible Feedback is most useful when given immediately. Positive behavior is strengthened through immediate feedback, and it is easier to modify problem behaviors if the standards are clearly understood.

39. A client with multiple sclerosis plans to begin an exercise program. In addition to discussing the benefits of regular exercise, the nurse should caution the client to avoid activities which
A) Increase the heart rate
B) Lead to dehydration
C) Are considered aerobic
D) May be competitive

The correct answer is B: Lead to dehydration The client must take in adequate fluids before and during exercise periods.

40. During the evaluation of the quality of home care for a client with Alzheimer's disease, the priority for the nurse is to reinforce which statement by a family member?
A) At least 2 full meals a day is eaten.
B) We go to a group discussion every week at our community center.
C) We have safety bars installed in the bathroom and have 24 hour alarms on the doors.
D) The medication is not a problem to have it taken 3 times a day.

The correct answer is C: We have safety bars installed in the bathroom and have 24 hour alarms on the doors. Ensuring safety of the client with increasing memory loss is a priority of home care. Note all options are correct statements. However, safety is most important to reinforce.

Monday, December 25, 2006

60 Item Medical Surgical Nursing : Musculoskeletal Examination Answers

60 Item Medical Surgical Nursing : Musculoskeletal Examination Answers

1. A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position?

a. Supine
b. Semi Fowler's
c. Orthopneic
d. Trendelenburg

2. A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make?

a. Observe the color of the fingers
b. Palpate the radial pulse under the cast
c. Check the cast for odor and drainage
d. Evaluate the response to analgesics

3. After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for:

a. An anaphylactic reaction to the dye
b. Inflammation from the extravasation of fluid during injection.
c. Fluid overload from the volume of the infusions
d. A normal reaction to the stress of the diagnostic procedure.

4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immedite notification of the physician?

a. Moderate pain, as reported by the client
b. Report, by client, the heat is being felt under the cast
c. Presence of slight edema of the toes of the casted foot
d. Onset of paralysis in the toes of the casted foot

5. Which of these nursing actions will best promote independence for the client in skeletal traction?

a. Instruct the client to call for an analgesic before pain becomes severe.
b. Provide an overhead trapeze for client use
c. Encourage leg exercise within the limits of traction
d. Provide skin care to prevent skin breakdown.

6. A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis.

a. The client reports pain in the affected leg
b. A large hematoma is visible in the affected extremity
c. The affected extremity is shortenend, adducted, and extremely rotated
d. The affected extremity is edematous.

7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan?

a. Order a trapeze to increase the client's ambulation
b. Maintain the client in a flat, supine position at all times.
c. Provide pin care at least every hour
d. Remove traction weights for 20 minutes every two hours.

8. To prevent foot drop in a client with Buck's traction, the nurse should:

a. Place pillows under the client's heels.
b. Tuck the sheets into the foot of the bed
c. Teach the client isometric exercises
d. Ensure proper body positioning.

9. Which nursing intervention is appropriate for a client with skeletal traction?

a. Pin care
b. Prone positioning
c. Intermittent weights
d. 5lb weight limit

10. In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position?

a. Supine c. Sim's
b. Prone d. Lithotomy

11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is:

a. It will be very painful for the client
b. The soft tissue around the site will be damaged
c. Displacement can occur with flexion
d. It will pull the hip out of alignment

12. When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a:

a. Trochanter roll by the knee
b. Sandbag to the lateral calf
c. Trochanter roll to the thigh
d. Footboard

13. A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to:

a. Leave the pillow as his stump is elevated
b. Remove the pillow and elevate the foot of the bed
c. Leave the pillow and elevate the foot of the bed
d. Check with the physician and clarify the orders

14. A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to:

a. Protect the skin with lotion
b. Keep the client pulled up in bed
c. Pad the top of the splint with washcloths
d. Provide a footplate in the bed

15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to:

a. Reduce fever
b. Reduce the inflammation of the joints
c. Assist the client's range of motion activities without pain
d. Prevent extension of the disease process

16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is:

a. Ability to ambulate sooner
b. Less change of phantom limb sensation
c. Dressing changes are not necessary
d. Better fit of the prosthesis

17. One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to:

a. Cough and deep breathe
b. Turn himself in bed
c. Perform biceps exercise
d. Wiggle his toes

18. The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to:

a. Get the client up in a chair after dangling at the bedside.
b. Use a walker for balance when getting the client out of bed
c. Have the client put minimal weight on the affected side when getting up
d. Practice getting the client out of bed by having her slightly flex her hips

19. A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to:

a. Anchor the traction
b. Prevent footdrop
c. Keep the client from sliding down in bed
d. Prevent pressure areas on the foot

20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the:

a. Client's position
b. Rope/pulley system
c. Amount of weight
d. Point of friction

21. When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by:

a. Elevating the foot of the bed
b. Elevating the head of the bed
c. Application of the pelvic girdle
d. Lowering the head of the bed

22. After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for:

a. Increase in the temperature
b. Change in color
c. Edema
d. Movement

23. A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for:

a. Urinary retention
b. Bladder distention
c. Weight gain
d. Bower evacuation

24. A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has

a. Headaches
b. Tarry stools
c. Blurred vision
d. Decreased appetite

25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to

a. Read a story and act out the part
b. Watch a puppet show
c. Watch television
d. Listen to the radio

26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses:

a. Limited motion of joints
b. Deformed joints of the hands
c. Early morning stiffness
d. Rheumatoid nodules

27. After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching?

a. History of Epstein-Barr virus infection
b. Female gender
c. Adults between the ages 60 to 75 years
d. Positive testing for human leukocyte antigen (HLA) DR4 allele

28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods?

a. Proper body alignment
b. Elevating the part
c. Prone lying positions
d. Positions of flexion

29. After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methothrexate (Rheumatrex 0), which of the following statements indicates the need for further teaching?

a. "I will take my vitamins while I am on this drug"
b. "I must not drink any alcohol while I'm taking this drug"
c. I should brush my teeth after every meal"
d. "I will continue taking my birth control pills"

30. When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess?

a. Anemia c. Weight loss
b. Osteoporosis d. Local joint pain

31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?

a. At bedtime c. Immediately after meal
b. On arising d. On an empty stomach

32. When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following?

a. Hepatotoxicity
b. Renal toxicity
c. Gastrointestinal bleeding
d. Nausea and vomiting

33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following?

a. A developing infection
b. Bleeding in the operative site
c. Joint dislocation
d. Glue seepage into soft tissue

34. Which of the following would the nurse assess in a client with an intracapsular hip fracture?

a. Internal rotation c. Shortening of the affected leg
b. Muscle flaccidity d. Absence of pain the fracture area

35. Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc?

a. Informing the client that the procedure is painless
b. Taking a thorough history of past surgeries
c. Checking for previous complaints of claustrophobia
d. Starting an intravenous line at keep-open rate

36. Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site?

a. Elevate the stump
b. Reinforcing the dressing
c. Calling the surgeon
d. Drawing a mark around the site

37. A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first?

a. Tell the client it is impossible to feel the pain
b. Show the client that the toes are not there
c. Explain to the client that the pain is real
d. Give the client the prescribed narcotic analgesic

38. The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches?

a. Abdominal exercises
b. Isometric shoulder exercises
c. Quadriceps setting exercises
d. Triceps stretching exercises

39. The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas?

a. Axillae
b. Elbows
c. Upper arms
d. Hands

40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following?

a. Hemorrhage
b. Infection
c. Deformity
d. Shock

41. The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect?

a. Killing of microorganisms
b. Reduction in itching
c. Relief of muscle spasms
d. Decrease in nervousness

42. A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following?

a. Expected common side effects
b. Hypersensitivity reactions
c. Possible habituating effects
d. Hemorrhage from GI irritation

43. When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first?

a. The area proximal to the fracture
b. The actual fracture site
c. The area distal to the fracture
d. The opposite extremity for baseline comparison

44. A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure?

a. Rales c. Generalized edema
b. Jaundice d. Dark, scanty urine

45. Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus?

a. Acute respiratory distress syndrome
b. Migraine like headaches
c. Numbness in the right leg
d. Muscle spasms in the right thigh

46. The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following?

a. Pulmonary emboli
b. Osteomyelitis
c. Fat emboli
d. Urinary tract infection

47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely?

a. Formation of scar tissue interfering with absorption
b. Development of pus leading to ischemia
c. Production of bacterial growth by avascular tissue
d. Antibiotics not being instilled directly into the bone

48. Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury?

a. Homan's sign c. Tenderness
b. Pain d. Leg girth

49. The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse are of highest priority?

a. Allergy to iodine or shellfish
b. Ability of the client to remain still during the procedure
c. Whether the client has any remaining questions about the procedure
d. Whether the client wishes to void before the procedure

50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client?

a. Divertional activity deficit
b. Powerlessness
c. Self care deficit
d. Impaired physical mobility

51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse includes which of the following items as part of the instructions?

a. The gallium will be injected intravenously 2 to 3 hours before the procedure
b. The procedure takes about 15 minutes to perform
c. The client must stand erect during the filming
d. The client should remain on bed rest for the remainder of the day after the scan

52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection?

a. Coolness and pallor of the extremity
b. Presence of a "hot spot" on the cast
c. Diminished distal pulse
d. Dependent edema

53. The client has Buck's extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device?

a. Massage the skin of the right leg with lotion every 8 hours
b. Give pin care once a shift
c. Inspect the skin on the right leg at least once every 8 hours
d. Release the weights on the right leg for range of motion exercises daily

54. The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the:

a. Left leg and right crutch then right leg and left crutch
b. Crutches and then both legs simultaneously
c. Crutches and the right leg then advance the left leg
d. Crutches and the left leg then advance the right leg

55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the:

a. Left hand and placing the cane in front of the left foot
b. Right hand and placing the cane in front of the right foot
c. Left hand and 6 inches lateral to the left foot
d. Right hand and 6 inches lateral to the left foot

56. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a:

a. Pillow to keep the right leg abducted during turning
b. Pillow to keep the right leg adducted during turning
c. Trochanter roll to prevent external rotation while turning
d. Trochanter roll to prevent abduction while turning

57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint:

a. Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting
b. Apply an Ace wrap around the dressing and put ice on the knee while sitting
c. Lift the client to the bedside change leaving the CPM machine in place
d. Obtain a walker to minimize weight bearing by the client on the affected leg

58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately:

a. Calls the physician
b. Rewrap the stump with an elastic compression bandage
c. Applies ice to the site
d. Applies a dry sterile dressing and elevates it on a pillow

59. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to:

a. Wear a clean nylon stump sock daily
b. Toughen the skin of the stump by rubbing it with alcohol
c. Prevent cracking of the skin of the stump by applying lotion daily
d. Using a mirror to inspect all areas of the stump each day

60. The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to note in the client?

a. Uric acid level of 8 mg/dl
b. Calcium level of 9 mg/dl
c. Phosphorus level of 3 mg/dl
d. Uric acid level of 5 mg/dl

Sunday, December 24, 2006

Pinoy BSN Forum NOW UP!

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Pinoy BSN Forum now up and running. It's purpose is to help students and serve as a place for free exchange of ideas and information. I sense the need for a filipino nursing forum. The current popular nursing forum for filipinos are foreign owned and is overly moderated, such place will prevent information to flourish.

PBSNFORUM.CO.NR Will maintain a minimum set of rules and moderations that will make the forum appropriate and enjoyable for everyone while still maintaining and respecting the freedom of expression. We must observe a balance between freedom and responsiblity. If this is achieved, The community will not only thrive but each and everyone will be a source of inspiration to power the community to make a difference and to help each other.

The mission of the forum is simply, to HELP : By providing means wherein free exchange of information and ideas come together towards the betterment of the profession.

Our vision is simply to be the leading and largest forum that will serve the needs of the filipino nursing community.

Big difference starts with little steps. I welcome everyone to the forum. As promised, We will do everything to entertain each and everyones question with the best of our knowledge.


The team is planning to make videos of nursing related skills that will be uploaded in the website. This will be for free, and we will do it for fun. Ofcourse, we are obsessed with the ideals and technicalities so the videos will be studied very carefully... detail by detail and will all be based on the books.

Lectures, return demonstration, researches, nursing documentaries.... They are all BIG STEPS for each and everyone of us. But we will work on it soon.

Goodluck to us and to you! Happy holidays!

EGO precor ut deus ut sulum steps Capio , is ero me. EGO sum hoping ut sulum sententia EGO planto in vita mos have suus voluntas. Deus mos planto mihi valde , EGO mos humilis meus ego quod is mos levo mihi in palma quod caput capitis of maiestas. Deus est me , Deus est in mihi , Is ero me pro totus infinitio. ops operor maiestas , ops planto a distinctus , vox of Bonus.

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