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    Scrubcheats by NURSING.com (nursing cheatsheets podcast) (NRSNG)

    Short. To the point. Episodes for nurses and nursing students about critical clinical tips and information.

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    Copyright: © TazKai NRSNG

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    Latest Episodes:
    BREAKING: Massive Updates to NCLEX due to COVID-19 (must listen) Mar 26, 2020
    Show notes

    NCSBN & PeasonVue just announced some significant changes to the NCLEX as a result of COVID-19. Here is what we are doing about it . . . MUST WATCH. Learn more about SIMCLEX at https://www.nursing.com Speaker 1: What’s up guys. I’m Jon Haws RN in founder of nursing.com and I’m here with Speaker 2: Marie Clark. Oh yeah, me. So I’ve already Clark and I am the question director here at nursing at time. Speaker 1: And today we wanted to come on and talk specifically. We’re kind of rushing together. You can tell we’re piecing everything together as we go. I’m actually in my closet here trying to hide the mess from you guys. Um, and Marie’s at her normal workstation cause she always works remote. But um, we, you know, with everything that’s kind of exploded over the last couple of weeks, there’s been a lot of concerns about, well I already had my end click scheduled or I was planning to take my eclipse here in the next little bit. And the first kind of piece of information we got from Pearson view is they’re closing all testing centers and then they came back a couple of days later, uh, through the NTSB end and made some updates to that. So specifically right now we want to talk about what those updates are. Uh, Maria’s been on top of this. And so I want to let her kind of talk about what those updates are and then we’ll talk about where they take place and kind of what you guys can do. So go ahead and read. Speaker 2: All right. So, um, first keep in mind that Pearson view NTSB and just like everybody is scrambling to figure out what we’re supposed to do and it’s pretty anxious, anxiety provoking. I’ll even say for me looking from a distance, um, but they’re making some solutions and I think their main point here is that they want to be able to test as many students as they can under the circumstances. So just like all of us are told to stay six feet away from each other and no more than 10 people gathering at a time. And a lot of areas, including my own here in Colorado, um, the Pearson view testing centers are implementing these same things and also trying to get the students through as quickly as possible to test. And so what that looks like is they are shortening the end clicks. So if ever there was a time where you maybe want to take the end clicks, it’s now, um, we’re talking instead of 75 questions minimum, you would only have 60 minimum and then up to 130 questions. Speaker 2: And so, um, that’s the first and the biggest change. The other one is instead of having six hours to take these questions, you have four. But I was thinking through that and I’m like, okay, well 265 questions max or 130 questions max, you’re actually getting more time per question, so this is a good thing for you. Um, so hopefully that kind of helps ease your anxiety a little bit. You have to go in and check your email because if your test was canceled, you will get an email about that. Um, so keep looking for that. And I will tell you that I was trying to get information yesterday from Pearson view, so I hop onto their chat and I was literally on chat for two hours and did not get any response at all. And then I emailed and I also didn’t hear back. So, um, that’s kind of frustrating. I’m sure you guys frustrated too, but we just have to do the best with what we can. Um, call, check your email. If you get an email from them, you can respond to that. But yeah, so that’s kind of what we’re dealing with John. Speaker 1: So I guess my, so my first question is then that you would have maybe already got an email from Pearson view when they made the first change of canceling. Is that correct? That’s correct. Are they saying, are they then coming back and saying, we’re going to re email you and say nevermind. Or do you know yet? Is it the reschedule thing or is it a, it’s back on find out or what, Speaker 2: you know, I am not sure because it changes so much every day, but I believe if your test was in a re was originally canceled, uh, it’s probably still canceled. But I guess I’m not really sure about that, John. Speaker 1: Yeah, I don’t, I, uh, I’m not sure either. I, I thought about the same thing you did too as far as like this is the time to take it. If you can get in because um, from what I read, usually those first 15 questions on any intellects exam or those kind of testing, trying up the new NGN stuff, et cetera, et cetera. Um, and they’ve ripped all that out entirely. So you won’t be seeing these crazy new weird question formats your right to your test immediately with the ability to get out and under sick well at 60 questions. Speaker 2: Yeah. Yeah. That’s, that’s I guess the silver lining here. Speaker 1: Yeah. Um, and then talk about locations. You had said something to me over chat yesterday about kind of what locations have been canceled and stuff. Can you explain some of that? Speaker 2: Yeah. So starting today, March 25th, is when they are opening test centers again for testing with those new changes. And so the information that you can find online is that they’re going to open 60 test centers today and they’re going to be in large metropolitan areas. And so my guess would be the largest. However, that’s why I was trying to get a hold of them as I was trying to figure out which testing centers were open, but that’s actually not public information. You have to have your authorization to test, sign in and sign up to take a test before you can see what test centers are open. Speaker 1: I want to face Palm really bad right now, but I’m not allowed to because of coven. Goodness. Um, so yeah, as you kind of did a little tricky thing there by getting online and saying what are the largest cities? And you are assuming those would be some of them, but I know for example, like in Texas there’s one in Dallas where I took it, right? Kind of North Dallas and then like Tyler, Texas about an hour away has one. My guess would be Tyler’s probably not going to be open because it’s a little town of 80,000 people, but probably some of these Dallas ones would be as, as your guests. Speaker 2: Yeah. So I basically just Googled like what are the top 10 metropolitan areas in North America? Because we’re also talking Canada. So New York city, LA, Chicago, and then your town of Dallas. Fort worth is number five and Houston is number six. Um, then we go to Toronto, Washington, DC, Philadelphia, Miami and Atlanta. So those are the top 10. And we just, I don’t know, I don’t know what to tell you about how to find out. Speaker 1: Right. So, so it seems like, so again, we don’t know this and so there’s a lot of what I’ll say here is probably speculation, but it sounds like, you know, on what it was at like the 19th or so of of March when here’s some, you sent out mass email saying it’s all canceled. Uh, then it was like the 20th or so they said, Hey, we might be opening more. It sounds like maybe you need like an authorization to test to get into one of those new centers. Possibly. Speaker 2: Yes. Speaker 1: Oh, they’re not new centers. One of those open centers. Speaker 2: One of the open centers. Yep. And again, your way of signing up through your program is when you go in is when you can find out where you can test. So hopefully we’re not talking a road trip of like 12 hours. Speaker 1: Right, right, right, right. Okay. Okay, cool. Um, cool. Not cool. Good. Good information. Good to get it out there. Um, and I think that this will help a lot of people. The next thing I want to talk about, Marie, is online with this or in line with this is the SIMCLEX maybe explain first of all what the SIMCLEX collects is, um, and then kind of our response there. Speaker 2: Totally. Um, so if you haven’t heard of this SIMCLEX then you are in for a treat. So the SIMCLEX is our computer adaptive tests and it mimics theM and CLECs with algorithms behind the scenes that would blow your mind. It blows my mind. I don’t even totally understand it. But if you are going to take the NCLEX Speaker 2: and you’re thinking about those changes that have been implemented are SIMCLEX actually has those same exact changes right now. They updated that as soon as we found out. And so instead of having 75 questions a minimum on our SIMCLEX, you would have 60 just like the new changes with the NCS VN. Um, so 60 to 130, and then, um, we also have that four hour time limit. Um, as far as difficulty is concerned, nothing is changing with the end clacks or our SIMCLEX. So that’s gonna stay exactly the same. And then the question formats are also exactly the same as they have been. Speaker 1: Can you see me? Can you, can you see my screen? Okay. So I wanted to log in here really quick and show people where they can get to the same clicks. It’s under the INCLAX prep Academy. Um, so if you go into nursing.com under the intellect prep Academy, you can see right here, they just pushed this update before Pearson. Do you even push their update? So we were even ahead of them. So that’s pretty cool. I think that Christian about 11:00 PM last night, um, central time. And you can see here, we’ve paid this massively ugly designed by engineering update here. So you can know that this is, this is different than what your previous and clicks would have been. But the reason we did this, uh, to talk to what Maria, um, is because this is what you’re going to experience when you go and take the NCLEX. Speaker 1: Um, and we want to stay as true to the inklings as possible. Um, delivery for you guys, 265 questions or a hundred questions or just a quiz would be worthless to you. We want you to simulate to the end clicks. So you can see here due to COBIT, we’ve updated it, minimum 60, maximum one 34 hour time limit. And we do put a link here for you guys, uh, to be able to go and, uh, read from the NTSB in their update. Um, and then we even, anyway, maybe I’ll just take one question here. So you guys what it looks like. Um, so we need to update right there. So then when you started this, so talk about this screen and why it’s so ugly. Speaker 2: All right. Yeah. So we’re all about the ugly today, but that is because we are mimicking exactly how it looks and feels when you take the real end clicks. So what you see here is very close to the real and clicks. Speaker 1: Yeah. And so as soon as I submit that question, so that first question it delivers to me is kind of random. But as soon as I submit that first question in the background, all these algorithms are driving what your next question is going to be. Uh, and so what a lot of, well, and I’ll, I’ll have you answer this Murray, but we get a lot of questions about people were posting their pass-fail graphs first in clicks and they’ll say it’s weird because I got more questions right this time, but I fell or I only got 30 questions right and I pass what’s going on? So can you talk to that a little bit? Speaker 2: Absolutely. Yeah. I follow some of those on Facebook too. I’m where people take a minimum amount but don’t pass and or get the same amount as someone else. One person pass and one person didn’t. So the way that the computer adaptive testing works is you are fed the next question based on how well you did on the question before. And so you could get 100 questions just like the next person, but your 100 questions were more difficult and this person’s 100 questions were really easy. So that could mean that you pass in a hundred, that person fails in a hundred and it’s so it’s, it might be confusing, but the way it works is it’s all based on the difficulty of the question. Speaker 1: Right. Um, Speaker 1: yeah. So it’s, it’s, it’s all designed to give you the most simulated experience possible of the inklings. So that when you, because one of my biggest fears, and Marie and I were just talking about this before we started, is I’ve been a nurse for, uh, what is it like seven years or something like that. Marie’s been a nurse for over 10 years. My biggest fear personally going into the NCLEX was [inaudible]. I don’t know what it actually looks like or feels like or how it acts. I hadn’t really taken computer data tests. Even in nursing school. They would give us a 75 tests or question test. Um, I took all these question banks. I took thousands and thousands of questions going into it. And so my wife Sandy, she would always say, you’re fine. It’s going to be fine. I was like, yeah, but I don’t know that. Mmm. And so that anxiety would build up. But the purpose of SIM is to give you that real experience so you shouldn’t take SIMCLEX until your final semester in nursing school. Um, and it’s most helpful for you in that month leading up to the ink clicks because you have all that knowledge in your brain and SIMCLEX is all about giving you that experience as you work through it. Anything else about that Marine? Speaker 2: I think one thing I just wanted to say was in our end PQ bank, I think we do such a good job@nursing.com about, um, helping students know when they’re at that point where they’re probably going to pass the NCLEX. Um, we have this 55% recommendation where if you’re going through our question bank and you’re getting 50 to 60%, right, then you have a really good chance of passing. So I think that’s really reassuring. Just to add on to that. Speaker 1: Yeah. Um, well this is a little sneak peek for people I guess. Uh, so I have the new, can you see my screen again? Speaker 2: Yup. Speaker 1: So I have the new NBQ. We were releasing a brand new, uh, NBQ that is a much more um, simple and more complex quiz builder platform than anything we’ve had before. Uh, it allows you to very quickly start questions based on uh, anything you want and you can see kind of as Maria was talking that uh, 55 or so percent we shoot for. You can quickly see on all your categories how you’re doing. So eating my categories that are red here, I really should be practicing on, so I can select all that. So let me go into just, let’s say here, but then I can make it much more complex and how I build a quiz by pulling in all these inklings categories, question types, a quiz mode, just test my incorrect. And if I’m a first or second semester student, I want to deal with question difficulty one or two, right as I’m third, fourth semester, I want to bring in all category difficulties are focused on three. Speaker 1: So you can see with within PQ or nursing practice questions, we let you be in the driver’s seat and pick what it is most important for you to study. When you get to SIMCLEX, we kind of take control of that because that’s what you’re going to experience as you get into, um, to take the in clicks. So [inaudible] I’ll take a question here. We can show what these are all, all about. [inaudible] and the internet is slow because it’s slow for everybody right now. Sorry. So the best part about these MPQ questions is what happens when you hit submit. And that’s what we kind of say, like in marketing, what we talk about is the learning begins on submit. Like you take the question, but your learning begins here. Marie, you want to talk about this screen and I’ll kind of scroll through as you talk. Speaker 2: Sure. Um, so this is, uh, when your view of a question and our MPQ bank. So, um, when you get a question either right or wrong, everything’s going to pop up for all of the answers so you can see the rationale for the correct answer here and then every incorrect answer as well. Um, and then as you go down, we also attached to all these questions are steady tools. So here’s a nursing process cheat sheet. We have references. Um, and you can see how you do compared to other nurses too. Speaker 1: So a lot of these, and I’ll talk to this again too, like part of the, some of the features here were built with some of our anxieties of I went to a small private nursing school. And so I honestly had no clue how I compared to someone who went to Baylor or to, you know, one of these Penn state is this fancy nursing school. Um, and so even though I was doing well in my coh…

    Full show notes at the publisher

    Answers to Your Fears About COVID-19 (and 3 ways we can help you today) Mar 16, 2020
    Show notes

    (click above to listen to the podcast episode)

    You’re probably feeling a bit scared right now . . .

    Maybe you’re nursing school just canceled clinicals or moved classes 100% online. Now, on top of everything that it is to be a nursing student, you are dealing with the fear brought on by COVID-19 (coronavirus).

    Last night, I asked: “How has COVID-19 impacted you as a nursing student?” . . . I got hundreds of responses.

    So I wanted to make a quick podcast to answer some of those concerns.

    View this post on Instagram

    NURSING Family, ⠀ Please let us know how you are being impacted by COVID-19. ⠀ ⠀ ✔️Are classes canceled?⠀ ✔️Are clinicals canceled?⠀ ✔️Has your NCLEX been canceled?⠀ ⠀ We are a #nursingfamily and we are all in this together. How can we help?

    A post shared by NURSING.com (@nursing.com_) on Mar 15, 2020 at 10:22am PDT

    Our Response to COVID-19

    We are implementing an aggressive response to COVID-19 for nursing students and nursing school impacted. You can see all of our efforts HERE (nursing.com/lp/covid).

    Some of our efforts include:

    • Reducing the price of our NURSING STUDENT & NCLEX Academies by 36% until May 15, 2020
    • Providing free student accounts to any nursing school experiencing closures until May 15, 2020
    • Develop a Nursing Clinical 360 course
    • Donating up to $10,000 to WHO COVID-19 Response Fund
    • Providing pizza 🍕 dinners to night shift nurses

    We Are All In This Together

    From the early days of NURSING.com (NRSNG), I used to say “We’re all in this together . . . “. That is true now more than ever.

    We need you. I hope this podcast episode helps reduce some of your fears or at least gives you some motivation to keep going.

    coronavirus nursing school

    Resources Mentioned In The Episode

    • Nursing Student Academy
    • NCLEX Prep Academy
    • Serenity Prayer
    • Pearson Vue Updates

    nursing covid response

    The post Answers to Your Fears About COVID-19 (and 3 ways we can help you today) appeared first on NURSING.com.


    Scrubcheats Special Jan 16, 2020
    Show notes

    For the next few days, we are running a special on the Scrubcheats. Just head over to Scrubcheats.com to grab a set.

    The post Scrubcheats Special appeared first on NURSING.com.


    Ep0035: Conclusion Aug 20, 2018
    Show notes

    The post Ep0035: Conclusion appeared first on NURSING.com.


    Ep0034: Invasive Lines Aug 16, 2018
    Show notes

    The post Ep0034: Invasive Lines appeared first on NURSING.com.


    Ep0032: APGAR Scoring Aug 09, 2018
    Show notes

    The APGAR score is a simple way to objectively determine how well a baby is doing immediately after birth.

    It is measured at 1 minute and 5 minute intervals. It helps to determine whether the baby needs resuscitation and might need the NICU. We look at their Appearance – looking for pink torso and extremities, a Pulse above 100, their Grimace or response to stimuli (we want them crying!), how Active they are and their Respiratory effort.

    Each of these things are scored on a scale of 0-2. A score of 8-10 is normal, 4-6 indicates depression in normal vital functions – these babies will likely need some help after birth, and a score of 0-3 requires aggressive resuscitation and likely a transfer to the NICU.

    Let’s look at an example. Let’s say a baby’s 1-minute APGAR was 9 because they weren’t crying vigorously. At 5 minutes, we check again and the baby is pink all over (that’s a 2), but her heart rate is in the 90s (that’s a 1), she’s still not crying vigorously, but she is responding to stimuli (that’s a 1), she isn’t very active, her movement is limited (that’s also a 1), and her breathing has become irregular (that’s also a 1).

    So the total score is a 6. We see the baby’s APGAR has dropped from a 9 to a 6, so we know something isn’t right. This baby is going to need more detailed attention and possible resuscitation.

    The post Ep0032: APGAR Scoring appeared first on NURSING.com.


    Ep0029: Immunization Schedule Jul 30, 2018
    Show notes

    QR Script:

    Pediatric immunizations are a controversial topic. It’s important that you know which immunizations are recommended at which stages of a child’s life. It is up to the parents and the pediatrician as to how closely they follow the recommended schedule.

    This recommended schedule is ever changing and is put out by the Centers for Disease Control and Prevention. This is the most up to date schedule as of November 2017.

    There is now a 5th recommended dose of the TDap, an extra 3 months in the range for the 3rd Polio vaccine, and a reminder that the HepA vaccine is a 2-dose series. To see the full recommended immunization schedule through age 18, go to www.cdc.gov/vaccines.

    The post Ep0029: Immunization Schedule appeared first on NURSING.com.


    Ep0028: Therapeutic Drug Levels Jul 26, 2018
    Show notes

    There are some medications that we give our patients that require close monitoring through testing the blood for levels of the drug.

    The goal is to make sure the drug is at therapeutic levels in the system so that it produces the optimum effect with minimal side effects. This also applies to some drugs that can cause toxicity at higher levels.

    For drugs like Vancomycin, we draw these drug levels with what we call a trough level. This means we draw the blood right before a dose is due.

    The provider or pharmacist will tell you which dose to draw a trough before. Others, like digoxin, lithium, and phenytoin, are drawn at specific intervals after the medication is started.

    These timings are based on the half-life of the drug, so it’s important that you draw the level at the time it is ordered. If you notice results that show a drug is non-therapeutic (below range) or supratherapeutic (above range), notify the provider immediately.

    The post Ep0028: Therapeutic Drug Levels appeared first on NURSING.com.


    Ep0027: IM Injection Sites Jul 23, 2018
    Show notes

    There are 4 sites we can use for Intramuscular or IM injections, though 3 of them are the most common. The dorsogluteal, is rarely used due to its risk of damaging the sciatic nerve.

    The other three sites are the vastus lateralis, found in the middle third of the lateral aspect of the thigh, the ventrogluteal, on the outside of the hip, and the deltoid muscle of the upper arm. Let’s look at these sites in detail.

    To locate the vastus lateralis, visually divide the thigh into thirds vertically and draw a line directly down the front. You will inject in the lateral aspect of the middle third section.

    To locate the ventrogluteal site, place the plam of your hand over the greater trochanter with your middle finger pointing toward the iliac crest and index finger toward the anterior superior iliac spine. Both of these sites can take up to 3mL of medication with a 1 to 1 ½ inch needle, depending on the size of your patient. The injection site for the deltoid muscle is 2-5cm (or about 3 fingers) below the lower edge of the acromion process.

    For this site, use 1mL of medication and a 1 inch needle. This site has the most variance based on the size of your patient. A very large patient could handle 2mL and a 1 ½ inch needle.

    However, a very small, frail patient, would require a ⅝ inch needle and no more than 1 mL. And remember, intramuscular injections should be administered at a 90 degree angle, with a gentle dart-like motion.

    The post Ep0027: IM Injection Sites appeared first on NURSING.com.


    Ep0026: Med Math Equations Jul 19, 2018
    Show notes

    Dosage calculation is something that every nursing student either loves or dreads! We all have to pass math exams every semester. It’s either easy points or makes you a nervous wreck! If you’re the second type, I hope this little explanation helps simplify it a bit for you. Because after all, we believe here at NRSNG that nursing school shouldn’t be that hard. There are four main types of questions we get. 1 is drip rate or drops per minute. 2 is total infusion time, 3 is dosage, and 4 is IV pump rate – always in mililiters per hour. Let’s talk through the basics of how to do each of these.

    Calculating drip rate, while not used very often anymore, is very important to know in case pumps fail or the power goes out. The information you need for this formula is the total volume to be infused, total time in minutes, and the drip factor. The drip factor can be found on the packaging for the tubing and will likely be given to you in the problem in nursing school. So let’s say you need to administer 200 mL over 2 hours or 120 minutes. The drip factor is 15 drops per mL. You multiply the total volume in mL by the drip factor (200 x 15) to get a total number of drops. Divide that by the time in minutes and you’ll be left with drops per minute. In this cast 200 x 15 / 120 = 25 drops per minute. Always round to the nearest whole drop. To titrate that on a roller clamp, you’d think that’s approximately 1 drop every 2 seconds, then time it for a whole minute for accuracy.

    To find total infusion time, you will divide the total volume to be infused by the rate. For example “How long would it take to infuse 400 mL at 75 mL per hour?”. 400 divided by 75 = 5.333 or 5 ⅓ hours, which is 5 hrs and 30 minutes. Or how about this. The nurse is infusing a bolus of normal saline. She starts the bolus at 2pm and will run 500 mL at 200 mL per hour. At what time will the bolus be completed? It’s not a trick question, just has an extra step. We’ll still divide total volume to be infused over the rate in mL per hour. So 500 / 200 = 2 ½. So just find out what time 2 ½ hours later is. In this case, 4:30pm.

    3rd, to determine a dose or volume to be administered, you need to know the desired dose, the available dose, and the quantity that dose is in – also known as the concentration. For example, the nurse needs to administer 20 mEq of Potassium Chloride. The available dose is 40 mEq of Potassium Chloride in 30 mL of liquid. So, desired dose is 20, divided by available dose which is 40, times the quantity which is 30. 20 / 40 x 30 = 15 mL of liquid.

    Finally, to find the rate to set on the pump, you need to find the total volume to be infused in a certain amount of time and divide volume by hours. This one may require extra steps to find the total volume or dose – which is the problem we just did! Once you’ve calculated the volume required, simply divide that over total time in hours to get mL per hour. Here’s an example: The nurse is to administer 1g of Vancomycin over 2 hours. The bag contains 2g of Vancomycin in 500mL. First – how much total volume is required? If you have 2g in 500mL, then 1g is in 250mL. So now we know that we need a total of 250 mL to infuse over a total time of 2 hours. 250 / 2 = 125 mL/hr.

    I hope this has helped to make med math a bit simpler. Make sure convert all units before starting these formulas, know your rounding rules and weight-based calculations for pediatric doses, and always double and triple check your answers if you aren’t sure.

    The post Ep0026: Med Math Equations appeared first on NURSING.com.


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