Essay: Women empowerment

Quaid-e-Azam said in a speech in 1944, “No nation can rise to the height of glory unless your women are side by side with you; we are victims of evil customs. It is a crime against humanity that our women are shut up within the four walls of the houses as prisoners.”

Women empowerment refers broadly to the expansion of freedom of choice and action to shape one’s life. It implies control over resources and decisions. An empowered woman will be one who is self confident, who critically analyses her environment and who exercises control over decisions that affect her life. The idea of empowerment manifests itself at all levels of societal interaction. It is found in giving a voice to the weak and marginalized. It requires having an access to the needed tools and materials for the expansion of capacities. Women empowerment has five components: women sense of self worth; their right to have and determine choices; their right to have access to opportunities and resources; their right to have the power to control their own lives, both within and outside the home; and their ability to influence the direction of social change to create a more just social and economic order nationally and internationally.

National development must be balanced with the equal distribution of resources to both males and females as in Pakistan females are approximately 51 percent of the total population and without the active participation of females Pakistan cannot achieve the required level of growth rate. Since the creation of Pakistan in 1947 it inherited the menace of poverty and the burden of this poverty was put heavily on female population because of the reason that the majority of females are involved in agriculture work, performing tasks to maintain household , carrying water and collecting fuel wood but their work in productive activities is unrecognised and, therefore, the female participation represented in economic activities seems to be low.

o promote the gender equality and women empowerment; to highlight the importance of women representation and participation in decision making; and to motivate the women towards public and private sector employment, GRAP is organising awareness raising programmes like celebration of events, seminars, workshops and trainings at district and at provincial level that are being organised on regular basis through its three main units ie, Gender Mainstreaming Units(GMUs) at provincial level, Career Development Centers at University level and Gender Support Units(GSUs) at district level.

Moreover, for the promotion and protection of women rights, to restore the personal security and dignity of women and to give them protection at workplace, the Pakistan government has taken deliberate and conscious steps like reservation of 10 percent quota for females, on the political side, reservation of thirty three percent seats for women in all local bodies (more than 36000 women councilors), seventeen percent seats have been reserved for women in the constituent assembly, senate, provincial assembly and in national assembly, to tackle the issues of harassment and to eliminate the gender based violence.

No doubt Pakistan government has taken many measures to enhance the participation of women in economic sphere but instead of all this, there is dire need to upgrade the status of women in society and it is only possible through giving them protection legally and mentally. She should be given access and control over resources. An effective mechanism should be institutionalised to enable the women in decision making at all levels. Subject of gender studies should be introduced from secondary level in the course curriculum, provision of women friendly infrastructure and environment at workplace, research and documentation on the achievements of women and launching of awareness raising campaigns among citizens on gender and development.

Essay: Role of Nurse in improving hospitals’ quality and efficiency

The Health Care Industry is one of the most important industries if not the most important one. The Health Care industry consists of everything from the little pharmacy across the street, drugs processing plants all the way to the hospital where we immune our kids. The Health Care industry affects nearly every living person. Most people don’t realize how important this industry is and how it affects their everyday lives, not to mention how complicated it is. That is why it is so critical that products and services of this industry are at their highest quality and are free of harm to ensure that the consumer will not face any damaging consequences. Therefore, as any other industry, quality in the health care system has become the element in the world’s market competition and Total Quality Management (TQM) plays a big role in promising that result.

Nurses are directly involved in almost all aspects of hospital quality, including patient care, bedside and medication management, assistance with surgeries and other major operations, data collection/reporting, and more.

Furthermore, nurses are directly responsible for monitoring and assessing patients, and performing immediate interventions to reduce risk or prevent medical complications. Nurses also oversee other care providers, i.e. CNAs, LPNs, patient care technicians, caregivers, and more. An attending nurse even helps educate patients and family members regarding post hospital care, before discharge.

Demand for Hospital Quality Improvement:

The demand for quality improvement in hospitals is ever increasing due to federal government mandates, as well as local requirements, accreditation or regulatory boards, hospital organizations, medical societies, non-profit organizations (NGOs) and health insurance plans. Core qualities reported may vary in terms of target medical concern or hospital department, but in most cases, employee and patient feedback is included in the measurement.

Magnet Recognition:

Among numerous programs demanding or requesting hospital quality improvement, the most relevant for nurses is the Magnet Recognition. It was developed by the American Nurses Credentialing Center (ANCC) – a subsidiary of the American Nurses Association – in order to recognize hospitals which provide nursing excellence. 

The Magnet Recognition program is based on an appraisal consisting of 14 characteristics. Foundationally, Magnet looks for a strong presence of nurses in the organizational committee structure of hospitals – including executive functions – empowering nurses in all levels to have a voice in hospital processes. While Magnet was originally focused on recognizing hospitals with higher nurse retention, there are researchers which have proven that Magnet-awarded medical institutions boast of lower mortality rates and higher hospital quality care in general.

Challenges Involved

Some of the usual hindrances involved revolve around nurses. Problems include inadequate staffing or uneven distribution of schedules, demanding responsibility which covers all aspects of patient care, ineffective nurse training, inefficient administrative tasks, and traditional nursing education, which often clashes with advancing nursing techniques.

Staffing and Patient Care Quality

In relation to staffing and scheduling, research from the Institute of Medicine (IOM) pointed out the direct connection between hospital care quality and nurse staffing. 

Staffing is directly related to hospital budget considerations as well as the demand of the local labor market for nurses. Quality of care, on the other hand, is dependent on various factors, such as a nurse’s experience, skills, and education. Another important aspect is the human factor. Fatigue and stress can lead to a decline in patient care quality due to errors in medication, treatment, usage of medical devices, data reporting, and more.

In conclusion, Healthcare organizations are required to focus on total quality improvement and providing acceptable, quality health services to patients at affordable price within reasonable price, within in a reasonable time. We have learned by past experiences as Nightingale’s efforts to improve the quality of medical care. The Health Care Industry is one of the most important industries if not the most important one.

Essay: Effective ways to change image of nurse

Throughout time the world’s image on Nursing has evolved rapidly. Nurses work in an extremely stressful environment and must carry out their duties in a professional manner to ensure proper procedures are followed throughout their routines. They also have a considerable amount of responsibility that comes with their career. For those reasons nurses must present themselves in a professional and structured manner at all times. The Image of Nursing describes how people in and out of the profession see nurses. Nurses must protect and continuously improve their image by fully applying themselves to their profession every day.

Generally only people who have had extended contact with nurses, in the healthcare setting or as family and friends, really understand what nursing entails. We need to do much more to get the correct image of the nurse out there – that of an educated and highly skilled independent professional practitioner, male or female, who is self-assured and confident.

  1. Have pride in your profession

When asked in a social setting what your job is don’t answer with “Oh, um, I’m just a nurse” as though you are ashamed. Hold your head high and reply with confidence something like: “I’m a nurse working at St. John’s hospital in the pediatric unit”. If relevant, add that you are a specialist, e.g. in critical care. This may be a good opening for further conversation.

Never criticize patients, co-workers, your employer or the profession in front of patients or in social settings. The place to vent about your horrible day is either at home with your family or alone with your nursing colleagues or best friend.

  1. Maintain a professional image

Look and act like a professional person 24/7 – wherever you are you serve as a role model of who and what a nurse is.

Professional appearance starts with good grooming and workwear appropriate for a professional person. Keep to the dress code of the institution where you are working. Cartoon characters on uniforms might have a place – but only on a pediatric ward.

Introduce yourself to patients and explain to them who you are, why you are there and what are going to do. Explaining procedures and medications, and the reasons for them, not only reassures the patient but also shows that you are knowledgeable and confident in what you are doing.

  1. Get the nursing story in the media

A study conducted by Woodhall on nurses in the media during 1997 was published under the title “Health Care’s invisible partner”. It was found that nurses were referred to in fewer than 4% of over 2000 health articles in newspapers from across the United States. The researcher came to the conclusion that this largest group of health care providers was virtually invisible to the public.

The main career motivator for most nurses is service, rather than money or power and prestige. This is why nurses shy away from and are unaware of the need for media to promote the profession. For the public to understand the major and indispensable role of nurses in healthcare, they need to be shown who she is and what she does.

  1. Become a community leader

Given their education, background and exposure to community issues nurses can serve effectively on various platforms and become leaders in their communities. Participation by nurses at this level shows them as concerned and knowledgeable citizens and enhances the public image of nursing. Participating in community activities also contribute to your own professional development.

  1. Speak up for you and your patient’s rights

How many times have we been advocating for safe nurse-to-patient ratios? Numerous studies (here, here, and here) have found out that understaffing causes increased risk not only for patients but also for nurses. These studies support the minimum staffing levels, but hospital administrators are reluctant to adopt them, of course, to save money. Press would usually attribute the overburdened state of hospitals to a national nursing shortage, but most everywhere there has been a surplus of educated nurses for years.

  1. Make a difference

Contribute to the future of your profession – what you as a nurse do or say does make a difference. Be proud to be a nurse, always look and act professionally, help to inform the public about nurses and nursing an example within your community.

Conclusions

Promoting and sustaining positive nursing image is very crucial in nursing profession to keep nurses to be motivated to work and retain in the profession to be more professional and be a role model and mentor nurses everywhere you go to promote nursing image either in personal life or professional workplace. It is also very inspiring to correct public media’s misconception of nursing image by writing to them to keep inform and upgrade them regarding positive image in nursing to recruit more staff to join nursing and retain in nursing and to enhance job satisfaction, job performance. By actively involved in professional organization to talk to policy maker, writer to media or newspaper to keep them well-informed of nurses’ achievement and to get recognition from public.

Essay Health Insurance Pros And Cons

At present, the health care dilemma has become a bone of contention with the public as to whether or not this health coverage is to be supplied by the government. People often possess different perspectives and referred to pros and cons on both sides of the spectrum. While some believes a universal healthcare system will set a foundation for lower quality of service, increasing governmental finance deficit, and being burdened by high tax for tax-payer, others do not hold the same thought. A universal healthcare system brings enormous advantages rather than disadvantages, such as all-inclusive population coverage, convenient accessibility, low time cost, and affordable medical cost, all of which not only provide minimum insurance.

As the increasing of the patients, they still needed working capital to support their expenditure. The most sources of money were from found-raising and receiving the donation from tycoons or philanthropists. Fortunately, this model of operation for health institutions struck the balance between income and expense barely. However, the situation went worse and worse because of the increasing of tax from the government and raising of resource abuse from immoral patients. As a result, the health institutions were compelled not to provide shelter for the low-income people and underprivileged. In addition, they changed their mind on their operation and decided to charge their patients in order to restrain the immoral phenomenon. The notion of Health insurance also budded in this time. The accident insurance, another name with which we are more familiar is Disability insurance, was provided by the Franklin Health Assurance Company of Massachusetts. The purpose of the plan was to compensate the salary those who got hurt and couldn’t work in a rail or steamboat accident. However, patients still paid the healthcare fee when they went to the hospital.

During the Great Depression, hundreds of thousands of middle-class people lost their bread-and-butter. The tough circumstance brought a series of sequential problems, such as poor quality of life, public disorder, and especially unsatisfying demand of medical services. It is a stimulus for employer-sponsored organization to assist low-income family to cover their expenses at health institutions. It is a kind of health insurance. Simultaneously, government drafted out a plan to resolve social problems. President Franklin Delano Roosevelt prepared to pass the Social Security Act (SSA). Originally, he considered the concept of all-inclusive healthcare system in this provision.

Pros/Advantages of health insurance

Of course, the most obvious advantage is that health insurance can provide coverage for some of your healthcare expenses. Doctor’s visits, trips to the emergency room and specialist treatments may be paid for (either in part or in whole) by this type of insurance. With health insurance, large hospital bills associated with surgery or other major treatments may also be covered depending on your specific policy.

And a PPO health insurance plan may also allow you to choose your own doctor, although you may pay more if he or she is not included in the network maintained by your health insurance carrier.

Private coverage also usually comes with more choices than those offered by public plans such as Medicare. This could allow you to choose the options that you are most likely to need and omit those that you don’t. The experiences that come with private health insurance might include shorter wait times, greater individualized attention and more sophisticated facilities. Public facilities can be overcrowded at times and may provide a lower level of care in many cases.

Cons/Disadvantages of health insurance

As you might expect, the greatest disadvantage of private health insurance can be the cost. This is especially true if you are in poor health and do not have access to group coverage of any kind. Many individual policies can cost several hundred dollars a month, and family coverage can be even higher. And even the more comprehensive policies come with deductibles and copays that insureds must meet before their coverage kicks in.

Most health insurance policies don’t offer coverage for all types of diseases and conditions. Those who need care that falls into one of the gaps that are written into these policies are on their own when it comes to paying for certain medical services. Furthermore, the cost of healthcare has risen much faster than the general rate of inflation, and this trend shows no sign of slowing.

Sex education: These 4 facts about virginity will bust all myths

By: Aishwarya Chopra

There have been a lot of misconceived myths about virginity, which are accepted as the truth. It is time to bust these myths and know the real facts.

Untouched by the world of sexual experiences, there exists a unicorn land where virgin women tightly-hold onto their hymen as a mark of their character. Right? Wrong.

It’s time to shun the wrong perception that songs, movies and gossip sessions on ‘virginity-par-charcha‘ have fed us. Let’s talks virginity myths and facts in this chapter of sex education 101:

1. Your “cherry” can’t be popped! 
We all seem to have false ideas about what the hymen ( a.k.a cherry ) is. It is often assumed that the hymen is a thin membrane that goes over the vagina. After penetrative sex, this hymen is broken, which results in bleeding. Its ‘absence’ is seen to signify a lack of virginity.

All of this is FALSE! The hymen doesn’t completely cover the vagina. This thin elastic membrane sits either outside the vagina or just inside of it. So the first time you experience sexual intercourse, you aren’t popping anything but just stretching the membrane a little bit.

So, always remember ladies: the hymen isn’t a sign of your virginity. It is significantly elastic and can be penetrated without breaking–but fragile enough to be affected by intense physical activity too.

2. Stop believing in absurd virginity tests!
The hymen doesn’t disappear forever after your first sexual intercourse. In fact, it stays in the body forever. Yet, many cultures have ritualized displaying bloody sheets after a married couple gets intimate for the first time to show that the young woman was a virgin.

Yet, what really is the connection between losing one’s virginity and bleeding? According to medical professionals, many women do not experience tearing or bleeding of the hymen the first time they have sex. This myth has a negative impact on women soon to experience sex.

The fear of pain or the anticipation of bleeding makes it harder for the muscles around the opening of the vagina to be relaxed. The feelings attached to the probable pain of penetration spread through the myth are the real culprits rather than the experience itself.

3. A visit to the gynaecologist won’t affect your virginity
Going for your first gynaecologist exam often brings anxiety, yet there is also a misconception that surrounds it. Similar to tampons, gynaecological exams are there to ensure reproductive health.

Gentle inspection of the external genitals is recommended by the Ministry of Health and Family Welfare as a routine part of health care for kids and teens.

In a Pap smear test, an exam used to detect precancerous cells from the cervix, an instrument called a speculum is used to spread the walls of the stretchy hymen and vagina. However, the speculum‘s movement is wrongly considered to be an equivalent to sexual penetration–which often discourages women from taking the Pap test, leaving the potential diseases go unnoticed.

4. Your sexual partner can’t tell whether you’re a virgin or a not with certainty
If an experienced gynaecologist can’t tell if a woman has had intercourse by examining her hymen, then how on earth can your partner? On the other hand, to practice healthy sexual health it is essential to build relationships of trust with your partner. Being open with them about your sexual history can build deeper connections and keep you both healthy and happy.

Our ‘Lashman rekha’ of virginity is based on elastic scrunchies aka hymen that are built and evolve into different anatomic variations with different experiences. The intent in talking about virginity myths and facts is to shift the focus of the collective from just the status of the hymen to the entire knowledge of intimate health.

Reference:

https://www.healthshots.com/intimate-health/sexual-health/virginity-myths-and-facts/

 

English MCQs for Staff Nurse /Head Nurse/ Clinical/Nursing Instructor Jobs/ B.Sc/ Master of Nursing Nursing Entry Test

  1. While Pakistan has earned record revenue this year, __________ well behind in exports? it still lags
  2. Anna and Tania went shopping, but __________ couldn‘t find anything __________ liked? they, they
  3. Nuclear energy is __________ dangerous to be used widely? too
  4. I have money, I __________ it tomorrow? will purchase
  5. Cannon had __________ unique qualities _________ it was used widely in ancient times? such, that
  6. She succeeded by __________ hard? working
  7. Galilei made her children __________ chores on Sunday? do some
  8. I enjoy __________ tennis? playing
  9. Most of the guests arrived __________ buses? in
  10. The departmental store is open __________ eight to seven? from
  11. On leaving the shopping plaza, Kate was robbed __________ purse? of her
  12. If I had money, I __________ it now? would purchase
  13. The man __________ you met is an anchorperson? whom
  14. The woman __________ is standing by the table works in electronic media? who
  15. He is looking for accommodation __________ in flat or shared house? either
  16. You can go neither by train __________ by bus? nor
  17. Before designing a public park, the architect must __________ the public? consider
  18. When she was younger, she __________ five kilometers a day? walked
  19. The house is large __________ is quite old-fashioned? but
  20. We need to find __________ method to solve this problem? another
  21. The students in our school are __________ in other schools? smarter than those
  22. The number of web entrepreneurs __________ increasing every year? is
  23. Write down __________ your name and roll number? both
  24. Compressed Natural Gas (CNG) burns less efficiently than gasoline __________? burns
  25. Oxygen can be mixed with __________ gasses such as Hydrogen, Nitrogen and Chlorine? other
  26. The man __________ wallet was stolen called the police? whose
  27. The market is nearer to them than __________? us
  28. He takes his turn, and she takes __________? hers
  29. If I had had money, I __________ it yesterday? would have purchased
  30. Umma, accompanied by her brother, __________ at the party? was
  31. White ball __________ for the first time in the 1992 Cricket World Cup? was used
  32. The new information on dengue virus caused panic in the public and government
    __________? alike
  33. I cannot come to see you _________ tomorrow? until
  34. He has been living in Switzerland _________ two years? for
  35. She is standing __________ her boyfriend? by
  36. He paid the dining bill __________ a credit card? with
  37. He did not give up __________? hoping
  38. __________ the bad weather, the outdoor party was rescheduled? Because
  39. of__________ loosing the first match, our team has won the world cup? Despite
  40. Everyone at the party __________ amazed by his performance? was
  41. She __________ for the upcoming tennis tournament? is training
  42. I __________ Afghanistan next year? am going to
  43. There are some vacant rooms __________ in flats and shared houses? both
  44. The sun rises __________ the east? in
  45. Nitrogen gas is in abundance __________ the Earth? on
  46. I was watching a TV program, when he __________ in? walked
  47. We are planning __________ out to dinner tonight? to take our guests
  48. She took lessons __________ how to swim? to learn
  49. The class teacher __________ Anna move to another chair? let
  50. He devotes much of his time __________ for the future? to planning

 

  1. For good health, she __________ bed earlier? should go to
  2. If you have time, you __________ the nature museum? should visit
  3. It is our problem, not __________?  theirs
  4. The number of guests at the party __________ amazing? was
  5. __________ 600 and 800 B.C, Olympics were held in Athens, Greece? Between
  6. She __________ the driving test to get a license? has to pass
  7. As there were no buses, she __________ home last night? had to walk
  8. __________ these books belong to? Who do
  9. I cannot concentrate, here is too much __________? detraction
  10. It is expected that the assembly will _________ these treaties? ratify
  11. He came in Karachi __________ August 14, 2010? on
  12. Bilal is not receiving the call. He is __________ at work? still
  13. Bilal is getting __________ the car? out of
  14. Saad is travelling __________ the school? towards
  15. They went __________ the rain? despite
  16. I was surprised by the large __________ people who came? number of
  17. Synonym of Bonhomie_____________? Affability
  18. He was abstained_______ salted food by the doctor? From
  19. Well, this is very interesting but I am very_____ ?Busy
  20. You _____very clearSound
  21. I am just____ out my new mobileTrying
  22. Drugs addicts in Pakistan are___ in special centers set up by the Government? Consulted
  23. Can you help____ up the mess? clear
  24. The deadline was nearby, so Mrs. Jamal had her student _____their essays? completed
  25. Javed, two of______ brothers attend primary school? wishes to be a school
  26. teacher after his graduation from the University? whose
  27. She lived_____ juice for ten days to slim down for the fashion show? off
  28. My husband asked him if he’d ever been convicted_____ a crimes? of
  29. The department head insisted that he____ absolute authority to regulate office
    work? would be given
  30. She has been supporting her family______ her husband’s death? since
  31. There is something wonderful_____ him? about
  32. Could I have a____ of chocolate? bar
  33. Four independent______ testified to seeing him at the scene of the crime? witnesses
  34. May I give you______ advice? some
  35. There______ any message from my teacher since she moved to London? hasn’t been
  36. If everything goes according to_______ , work will be complete in December.? schedule
  37. Please_____ two color passport photographs to the application form? attach
  38. He shows great ability____ Mathematics? in
  39. The sparrows took no____ the bread? notice of
  40. The powers of the party are__ in several places in the Constitution? enumerated
  41. The teacher found many mistakes in my composition, when she went___ it? through
  42. The President’s speech was so_____ that many people were persuaded to
    accept the need for change? eloquent
  43. The fireman managed to put____ the fire? out
  44. A system is_____ if it is easy for citizens to access and understand? transparent
  45. Did the boys turn____ for football practice? up
  46. Health______ labels have adorned cigarette packages since 1966 in USA? warning
  47. Some animals have unique_____ that allow them to survive in extreme weather
    conditions? characteristic
  48. What was the main______ behind London bombings? motive
  49. There was an_____ response for the marathon? overwhelming
  50. I would really______ if you could help me out? appreciate

 

  1. A speed limit is the______ legal speed that you can travel on the road? maximum
  2. Ali must have the______ to stick to his diet, if he wants to lose weight? determination
  3. Although he had no_____ injuries, doctors found that he was suffering from
    internal bleeding? external
  4. _______weight gain or weight loss is not good for your body? Excessive
  5. Water is made up of two____ , namely oxygen and hydrogen? Elements
  6. and Mrs. Khan go for a______ walk just before dinner? brisk
  7. A Computer is hard to repair as there may be hundreds of different_____ ? components
  8. We shall go for a picnic if the weather______ good? is
  9. In the test, we will_______ your work and then give you detailed feedback? assess
  10. The smoke went_______ the chimney? up
  11. She has only_____ friends? a few
  12. He wore multiple bracelets on_____ hand? each
  13. I______ to the Islamabad with some friends last night? went
  14. Army_____ troubled places as curfew remained in force? patrolling
  15. _____you hear the President’s speech? Did
  16. How much longer_____ this book? will you be needing
  17. He decided to______ his degree examination in order to get a higher score? rewrite
  18. The news was____ good to be true? too
  19. The speaker did not properly space out his speech, but went on_____ one point
    only? stressing
  20. How did these things come______? about
  21. Macbeth’s desire_____ power brought about his downfall? for
  22. The worker used_____ to patch up the hole in the wall? cement
  23. The agenda for the meeting is____ the notice? enclosed with
  24. I am exhausted, let’s_____ a day? call it
  25. It’s difficult_________ reconcile such different points of view? to
  26. Many people reported_________ a noise in the night? to have heard
  27. The color of the walls in my room has faded_____? away
  28. The flight stewardess the passenger_____________? how to fasten the seat belt
  29. _______a single word he says? don’t believe
  30. She made her stepson her______ to her large fortune? heir
  31. The girl ran______ the field when she saw her father after long time? across
  32. The Paralympics is a competition for the______? disabled
  33. He has___________ his mind to Join Pak Army? made up
  34. The farmers___________ their farms, if they had known that a thunderstorm was
    approaching? would have left
  35. I promise________ to you in all circumstances? stand with
  36. The problem___________ a lot of thought? calls for
  37. Do you prefer_________ or traditional art forms? contemporary
  38. It is already 8 o’clock. Can you________ time to catch the bus? make it in
  39. _________she is clever, she often makes mistakes? Although
  40. It is certain that human beings_______ latent power of which they are only vaguely aware? possess
  41. _________your instruction, we have closed your bank account? In accordance with
  42. He tends to________ any suggestion I make in meetings? cooperate
  43. My younger sister constantly misbehaves and is always causing_________? mischief
  44. If you had followed the rules, you_______ disqualified? would not have been
  45. The_______ were arrested for illegally hunting the bears? poachers
  46. _______you leave now, you will be late? Unless
  47. The man________ down the road is my brother? hurrying
  48. John said he________ to play at home? would prefer
  49. The housewife________ the cakes burning, and ran to switch off the oven? smelt
  50. If we go to the park___________, you like to come too? would

 

  1. When will you hand ________your assignment? in
  2. I am very much_________ to meet you? delighted
  3. If I had helped him, he________ drowned? would not have
  4. He has many friends, but______ are good ones? few
  5. ______ the rain forests is very important, if we do not want the flora and fauna
    found there to become extinct? Preserving
  6. That was______ movie I have ever seen? the worst
  7. I assume________ with me? that everyone agrees
  8. There is quite tenuous evidence________ it? for
  9. The company let me_____ time off work? take
  10. ________you wake me up so early on a Sunday? could
  11. Do not stay in the grasslands after dark, as some animals become______ when
    they see humans? aggressive
  12. My father was angry______ my failure? At
  13. She remained a______ all her life? spinster
  14. My brother is devoted_________ religion? to
  15. The lion sprang______ the buffaloes? upon
  16. The song in the play cannot be deleted as it is_____ to the story? integral
  17. After_______ smoking, they let the cigarette fall on the wood floor? finishing
  18. There is something wonderful_____ him? about
  19. He_______ in Pakistan? lives
  20. The building is not safe and must be______ down? pulled
  21. He is blind_____ one eye? of
  22. I shall look_____ the matter? into
  23. I am very much_______ to meet you? delighted
  24. All of us are devoted____ one another? to
  25. The man_________ down the road is my brother? hurrying
  26. It is already 5 o’clock. Can you_________ time to catch the bus? make it in
  27. It is certain that human beings__ latent power of which they are only vaguely aware? possess
  28. If we go to the park__________ you like to come too? would
  29. Some people_______ to the officer against him about his misdeeds? complained
  30. The police forces have launched an operation to__ out the kidnapped person? trace
  31. If she is not interested, we will___________ the proposal? abandon
  32. There is something wonderful________ him? about
  33. The President’s speech was so______ that many people were persuaded to
    accept the need for change? eloquent
  34. A speed limit is the legal speed_____ that you can travel on the road? maximum
  35. In the test, we will_____ your work and then give you detailed feedback? assess
  36. The speaker did not properly space out his speech, but went on___ one point only? stressing
  37. Its difficult_______ reconcile such different points of view? to
  38. I promise to_________ you in all circumstances? stand with
  39. Asmah __________ a book yesterday? read
  40. It was raining yesterday, so we __________ out? did not go
  41. I __________ what was happening? couldn‘t understand
  42. If you work hard, you __________ good marks? will get
  43. If you __________ hard, you would not have failed in the exams? had worked
  44. If the camera was working, we __________ a movie? .could make
  45. Emma is getting __________ the car? out of
  46. Near the London eye, there is a bridge __________ the Thames River? .over
  47. Asmat is falling __________ the horse? off
  48. She is looking for a job in __________ electronic or print media? either
  49. They could save money if they bought __________ furniture? economical
  50. I ___an old friend in Empress Market this morning? came across

 

  1. Nothing must be allowed to_____ our search for the truth? interfered with
  2. Our plan_____ to succeed? bid fair
  3. Complete the following sentence: No sooner did the thief see the policeman____? then  he ran away
  4. What is Synonyms of word Nightmare? Incubus
  5. Pick the correct response from following sentence “In the beginning he worked
    honestly but later he turned_________ to be a cheat? Out
  6. As he was not prepared for making a speech he broke_______ in the middle? off
  7. Complete the following sentence: The doctor advised the patient________? not to neglect his health
  8. I dont agree with you; I think_________? it is rather a good film
  9. I enquired of him________? if he wanted to join the course
  10. He exclaimed with shock________? that it was a very tragic accident
  11. What is antonyms of word Restoration______? Depredation
  12. What is synonyms of word Pedigree_________? Lineage
  13. Because of oil crisis, the prices of commodities are looking_______? up
  14. Synonym of “Mano a Mano? Hand to hand
  15. I am astonished______ his behavior? With
  16. “Profligate” Antonym______? Thrifty
  17. “Reading” quickly and well requires practice. The “Reading” word is a/an _______? Gerund
  18. What does the word ‘CASCADE’ means? Waterfall
  19. Adnan is “very different about” passing the Civil Services Examination this year? Lacking self-confidence about
  20. It was he who put “a spoke in my wheel? thwarted in the execution of the plan
  21. Plough a lonely furrow means_____? do without the help of others
  22. He is “out and out” a reactionary? thoroughly
  23. Synonym of Shelve_______? postpone
  24. The decision did not appear to “hold out” bright prospects? offer
  25. Stew in ones own juice means________? Suffer for his own act
  26. Play to the gallery means_________? attempt to appeal to popular taste
  27. He is using “backstairs influence” to sort out his matter? Secret and unfair influence
  28. He was undecided. He “let the grass grow under his feet? loitered around
  29. This matter has been “hanging fire” for the last many days. It should be sorted out? going on slowly
  30. I ___an old friend in Empress Market this morning? came across
  31. Nothing must be allowed to_____ our search for the truth? interfered with
  32. Our plan_____ to succeed? bid fair
  33. Complete the following sentence: No sooner did the thief see the policeman____? then  he ran away
  34. What is Synonyms of word Nightmare? Incubus
  35. Pick the correct response from following sentence “In the beginning he worked
    honestly but later he turned_________ to be a cheat? Out
  36. As he was not prepared for making a speech he broke_______ in the middle? off
  37. Complete the following sentence: The doctor advised the patient________? not to neglect his health
  38. I dont agree with you; I think_________? it is rather a good film
  39. I enquired of him________? if he wanted to join the course
  40. He exclaimed with shock________? that it was a very tragic accident
  41. What is antonyms of word Restoration______? Depredation
  42. What is synonyms of word Pedigree_________? Lineage
  43. Because of oil crisis, the prices of commodities are looking_______? up
  44. Synonym of “Mano a Mano? Hand to hand
  45. I am astonished______ his behavior? With
  46. “Profligate” Antonym______? Thrifty
  47. “Reading” quickly and well requires practice. The “Reading” word is a/an _______? Gerund
  48. What does the word ‘CASCADE’ means? Waterfall
  49. Adnan is “very different about” passing the Civil Services Examination this year? Lacking self-confidence about
  50. It was he who put “a spoke in my wheel? thwarted in the execution of the plan
  51. Plough a lonely furrow means_____? do without the help of others
  52. He is “out and out” a reactionary? thoroughly
  53. Synonym of Shelve_______? postpone
  54. The decision did not appear to “hold out” bright prospects? offer
  55. Stew in ones own juice means________? Suffer for his own act
  56. Play to the gallery means_________? attempt to appeal to popular taste
  57. He is using “backstairs influence” to sort out his matter? Secret and unfair influence
  58. He was undecided. He “let the grass grow under his feet? loitered around
  59. This matter has been “hanging fire” for the last many days. It should be sorted out? going on slowly

Allergy & Asthma Network Statement on Pfizer/BioNTech Vaccine for COVID-19

Photo of close up doctor holding syringe and using cotton before make injection to patient in medical mask. Covid-19 or coronavirus vaccine

Note: This issue is evolving. We will update this post as news comes out. This post was updated on December 16, 2020.

What is the current guidance for Pfizer/BioNTech vaccine administration in the US for people with allergies?

The U.S. Centers for Disease Control and Prevention (CDC) has issued guidance for people with allergies and whether they should receive the Pfizer/BioNTech vaccine for COVID-19. This guidance was issued when the U.S. Food and Drug Administration (FDA) approved the vaccine Dec. 11 for emergency use in Americans ages 16 and over.

The guidance states the following:

People who should receive the Pfizer/BioNTech vaccine

  • Anyone with a history of food, insect venom, oral medications, environmental or latex allergies
  • Anyone who has a non-serious allergy to vaccines or other injected medications.
  • Anyone with a family history of anaphylaxis

Must undergo a 15-minute observation period after receiving the vaccine to ensure there’s no severe allergic reaction.

People who should take caution with the vaccine along with a 30-minute observation period after vaccination

  • Anyone with a history of anaphylaxis to another vaccine or an injected medication

Discuss risks of vaccine and whether to wait to receive the vaccine; must undergo a 30-minute observation period after receiving the vaccine to ensure there’s no severe allergic reaction.

People who should not receive the vaccine:

  • Anyone with a history of anaphylaxis to any component of the Pfizer/BioNTech vaccine.

What is the algorithm use to decide if people should receive the Pfizer/BioNTech COVID-19 vaccine?

Photo of pfizer biotech vaccine chart

What is known regarding the COVID-19 vaccine allergy warning from the United Kingdom?

The CDC guidance came after health officials in the United Kingdom issued a warning for the Pfizer/BioNTech vaccine. UK health officials warned that people with a significant history of allergic reactions to food, vaccines or medicines should not be given the vaccine. The warning came after two healthcare workers experienced anaphylaxis after receiving the vaccine. Both had a history of allergic reactions and used epinephrine to treat symptoms.

More research is needed to investigate the two reported cases of anaphylaxis, as well as the thousands of people who received the Pfizer/BioNTech vaccine in the UK and United States during clinical trials.

People with a history of severe allergic reactions to vaccines were not part of Pfizer/BioNTech clinical trials earlier this year, notes allergist Purvi Parikh, MD, national spokesperson for Allergy & Asthma Network. “People with other types of allergies participated in the clinical trials and likely tolerated the vaccine with no issue,” she says.

UK health officials state that people with food allergies or a single medication allergy and no history of anaphylaxis are not at significantly higher risk of experiencing an allergic reaction to the vaccine. In addition, if a person experiences anaphylaxis as a result of the vaccine, they should not receive a second dose, UK health officials say.

How common is anaphylaxis to a vaccine?

Anaphylactic reactions to vaccines are extremely rare. They can occur due to the presence of a particular ingredient or preservative, such as egg or gelatin, however, the amount is so tiny that it is unlikely to trigger a severe allergic reaction.

Does the Pfizer/BioNTech COVID-19 vaccine contain egg?

There is no link to the Pfizer/BioNTech vaccine and concerns of egg allergy and flu vaccine, as has been falsely reported by some media outlets.

Does the Pfizer/BioNTech COVID-19 vaccine contain any preservatives?

The Pfizer-BioNTech COVID-19 vaccine does not contain any preservatives that may trigger an allergic reaction.

Do the Pfizer/BioNTech COVID-19 vaccine stoppers contain any natural rubber latex?

The vial stoppers are not made with natural rubber latex, so the Pfizer/BioNTech COVID-19 vaccine is safe for people with latex allergy.

Does the Pfizer/BioNTech COVID-19 vaccine contain PEG?

Some reports suggest that polyethylene glycol (PEG), a compound that helps the vaccine access cells, may have played a role in the two cases of anaphylaxis. Allergic reactions to PEG are also considered rare. The American College of Allergy, Asthma & Immunology (ACAAI) recommends that people with a known history of severe allergic reactions to PEG should not receive the vaccine.

The two reported cases of anaphylaxis in the UK should not deter anyone from seeking out the COVID-19 vaccine.

COVID-19 vaccines from other pharmaceutical companies are coming soon. Similar allergy concerns may arise with these new vaccines. We urge people with a history of anaphylaxis to consult with a board-certified allergist if they are concerned about the COVID-19 vaccine. Always keep with you two epinephrine auto-injectors if you are at risk for anaphylaxis.

 

Gynecology and Obstetrics- BCQs/MCQs

1. Contains FSH to stimulate the ovaries to perform oogenesis or gametogenesis?
a. MOM               c. Syntocinon
b. Clomid            d. Methergine

2. This is given to contract uterus and remove retained secundines to prevent bleeding and infection?
a. Yutopar                                        c. Prednisone
b. Methylergonovine maleate     d. Tamoxifen

3. One of this medication counteracts oxytocin to stop preterm labor?
a. Pitocin            c. Methergin
b. Syntocinon     d. Terbutaline

4. Anti-estrogen helps suppress growth of breast tumor that is supported by estrogen?
a. Teslac             c. Nolvadex
b. Halostiten     d. Methergix

5. Helps relieve severe labor pain, best given at 6-7 cm cervical dilatation or at active phase of the 1st stage of labor?
a. Allopurinol    c. Dolfenal
b. Demerol       d. Indomethacin

6. Sim’s Hunher test is ordered after a normal semen analysis. Which two of the following results are normal?
I. 15-20 live motile sperm per hpf
II. Mucus stretches 8-10 cms per hpf
III. Less than 15 live motile sperm per hpf
IV. Mucus stretches 5-7 cms

  1. II and III
  2. I and II
  3. I and IV
  4. II and IV

7. What method of delivery is based on the theory of stimulus-response conditioning to reduce pain sensation during labor?
a. Lamaze        c. Leboyer
b. Bradley        d. Natural childbirth

8. Which of the following is not observed in Leboyer method?
a. Birth occurs in a well-lighted and quiet room
b. The cord is cut after the pulsation ceases
c. Neonate is placed immediately on the mother’s abdomen
d. Neonate is emerged in a tub of warm water

9. Jenny, a severe pre-eclamptic, has been on IV magnesium sulfate for 12 hours. Which of the following is not a sign overdose?
a. Absence of deep tendon reflexes
b. Respiration rate slower than 12 per minute
c. Urinary output less than 30 cc per hour
d. Decrease BP

10. Ritodrine hydrochloride has been infusing IV for several hours to stop Jane’s preterm labor. Since there are no contraindications for inhibiting labor and Jane is 30 weeks gestation, what other standard tocolytic therapy might the nurse use in place of ritodrine?
a. Indomethacin
b. Demerol and Vistaril IM
c. Magnesium sulfate
d. Morphine sulfate

11. Pat has a history of genital herpes during pregnancy. She is now term, in labor. Her cervical cultures for the last 2 months were negative. She delivers vaginally. The day after delivery, Pat has lesion on her labia majora. What medication can the nurse use to help alleviate the pain.
a. Acyclovir
b. T-stat (erythromycin lotion)
c. Hydrocortisone cream
d. Ampicillin

12. During labor a client who has been receiving epidural anesthesia has a sudden episode of severe nausea and her skin becomes pale and clammy. The nurse’s immediate reaction is to:
a. Notify the physician
b. Elevate the client’s legs
c. Check for vaginal bleeding
d. Monitor the FHR every 3 minutes

13. A client who was admitted inactive labor has only progressed from 2-3 cm in 8 hours. She is diagnosed having hypotonic dystocia and is given oxytocin (Pitocin) to augment her contractions. The most important aspect of nursing at this time is to:
a. Monitor the FHR
b. Check the perineum for bulging
c. Time and record length of contractions
d. Preparing for an emergency ceasarian delivery

14. A client in the midphase of labor becomes very uncomfortable and asks for medication. Meperidine (Demerol) 50 mg and Phenergan 50mg are ordered. These medications:
a. Act to produce anesthesia
b. Act as preliminary anesthetics
c. Induce sleep until the time of delivery
d. Increase the client’s pain threshold, resulting in relaxation

15. Overstretching of perineal supporting tissues as a result of childbirth can bring about a rectocele. The most common symptom is:
a. Crampy abdominal pain
b. A bearing down sensation
c. Urinary stress incontinence
d. Recurrent urinary tract infection

16. During pregnancy, the uterine musculature hypertrophies and is greatly stretched as the fetus grows. This stretching:
a. By itself inhibits uterine contraction until oxytocin stimulates the birth process
b. Is prevented from stimulating uterine contraction by high levels of estrogen during late pregnancy
c. Inhibits uterine contraction along with combined inhibitory effects of estrogen and progesterone
d. Would ordinarily stimulate contraction but is prevented by high levels of progesterone during pregnancy

17. The nurse would suspect an ectopic pregnancy if the client complained of:
a. An adherent painful ovarian mass
b. Sharp lower left abdominal pain radiating to the shoulder
c. Leukorrhea and dysuria a few days after the first missed period
d. Sharp lower left or right abdominal pain radiating to the shoulder

18. When obtaining the nursing history from a client with diagnosis of ruptured tubal pregnancy, the nurse should expect the client to indicate that her symptoms of pain in the lower abdomen and vaginal bleeding started:
a. About 6th week of pregnancy
b. At the beginning of the last trimester
c. Midway through the second trimester
d. Immediately after implantation

19. A client is on magnesium sulfate therapy for severe preeclampsia. The nurse must be alert for the first sign of an excessive blood magnesium level, which is:
a. Change in level of consciousness
b. Severe persistent headache
c. Epigastric pain
d. Disappearance of the knee-jerk reflex

20. A client with preeclampsia with two preschool children is prescribed bed rest at home. To help stimulate compliance plans for the client’s care should include:
a. A suggestion to find a housekeeper
b. An explanation as to why bed rest is necessary
c. A warning of the risks involved in non-compliance
d. A contract that 4 hours of nap time will neet the requirement

21. A post partum mother with diagnosis of thrombophlebitis has been placed on Coumadin therapy. The nurse knows the client understands teaching about Coumadin when she states:
a. “If I miss a dose, I will double the next dose.”
b. “I should eat plenty of green leafy vegetables.”
c. “If my arthritis flares up again, I’ll take only 2 aspirins every 6 hours.”
d. “I will use a soft toothbrush and stop flossing my teeth.”

22. Warfarin sodium (Coumadin) is ordered for a client along with the medications listed below. Which of the following medications should the nurse question before administering the drug?
a. Ascorbic acid (Vitamin C)      c. Cimetidine
b. Secobarbital (Seconal)          d. Psyllium

23. Which nursing care measure is not appropriate for client with thrombophlebitis?
a. Careful leg massages     c. Elevating the legs
b. Elastic stockings             d. Leg exercises

24. Which of the following the postpartum mother with diagnosis of thrombophlebitis should avoid?
a. Helping the client avoid straining at stool
b. Telling the client to avoid sudden movements
c. Assisting the client to dangle on the side of the bed 3 times a day
d. Teaching the client to avoid bumping the legs against other objects

25. A client with deep vein thrombosis is started on Heparin therapy. Which nursing action is not indicated during heparin administration?
a. Having vitamin K available if bleeding occurs
b. Observing for hematoma at IV puncture site
c. Suggesting that the client use a soft bristled toothbrush
d. Using an IV control device for drug administration

26. A client has thrombophlebitis. Heparin SC q 8hrs is prescribed. Nursing interventions related to the administration of heparin include:
a. Monitoring the client’s UO
b. Checking the client’s INR before administration
c. Checking the client for ecchymosis
d. Informing the client that NSAIDS may be taken for discomfort

27. The patient who has a deep vein thrombosis has been receiving heparin sodium. Which of these findings will evidence the desired effect of heparin therapy?
a. A reduction of pedal edema
b. A rapid capillary refill after squeezing the big toe
c. An increase in blood sedimentation rate
d. An elevation of the prothrombin time

28. Which statement by the client with thrombophlebitis indicates a need for further instructions?
a. I can cross my legs at the knee but not the ankle
b. I need to elevate the foot of the bed during sleep
c. I need to avoid prolonged sitting or standing
d. I should continue to wear elastic hose for at least 6-8 weeks

29. All of the following measures may be performed when a patient with diagnosis of previa is being admitted to the labor room except:
a. Auscultating the FHT with a fetoscope
b. Performing Leopold maneuvers
c. Determined cervical dilatation
d. Checking the vaginal discharge with nitrazine paper

30. Which of these comments, if made by the woman would indicate accurate knowledge of the non stress test?
a. “I know that I can’t eat anything after midnight on the day of the test.”
b. “I hope that they can find a vein for the test. Often my veins seem to disappear.”
c. “I hope that my baby is active when I come to the clinic for the test.”
d. “I’ll have to drink about 4 glasses of water within the hour before the test.”

31. Which sign helped confirm the diagnosisof severe PIH?
a. Proteinuria +3 on reagent strip
b. Elevated BP 155/98
c. Marked edema of lower extremities (+2)
d. Deep tendon hyperreflexia (+3)

32. During labor the woman is receiving magnesium sulfate IV. It is essential the nurse have which of the following drugs available to counteract the potential adverse effect?
a. Oxytocin (Pitocin)
b. Sodium bicarbonate
c. Phenytoin sodium (Dilantin)
d. Calcium gluconate

33. Which of the following position is best indicated in woman with diagnosis of PIH?
a. Semi-fowler’s, alternating sides
b. Left lateral position
c. Supine with head elevated on a small pillow
d. Right lateral Sim’s

34. A woman with diagnosis of PIH tells the nurse that she has severe headache and asks for medication to relieve it. The nurse should:
a. Notify the physician immediately
b. Explain that headaches are common in PIH
c. Offer some tea and toast
d. Administer prescribed prn pain medications

35. Twenty-fours after delivery the woman with history of PIH has BP of 150/100mmhg. The nurse should recognize that:
a. PIH can continue for 48 hours after delivery
b. This may be precursor of chronic hypertension
c. Kidney damage has probably occurred
d. There is no longer a danger of a convulsion

36. A woman who has PIH is receiving magnesium sulfate therapy. Which of the following manifestations would the nurse expect the woman to have if the magnesium sulfate is having the desired effect?
a. Reduction in patellar reflex response from +4 to +2
b. Decreased in urine output from 100ml/hr to 50 ml/hr
c. Increase in frequency of contractions from every 5 minutes to every 3 minutes
d. Increase in respiratory rate from 12/minute to 18/minute

37. A 26 year old woman is brought to the emergency room, complaining of severe left lower quadrant pain. She tells the nurse that she performed a home pregnancy test and believes that she is 8 weeks pregnant. On the admission the patient’s v/s are: pulse 90, BP 110/70, respirations 20. a half hour later her v/s are pulse 120, BP 85/50, respirations 26. The nurse interprets the change in the patient’s v/s to mean that:
a. The patient’s pain may have increased
b. The patient may be bleeding internally
c. The patient may be frightened
d. The patient may have an infection

38. A 23 year old woman comes to the clinic at 32 weeks gestation. A diagnosis of PIH is made. The nurse performs teaching. Which of the following statements made by the patient indicates to the nurse that further teaching is required?
a. “Lying in bed on my left side is likely to increase my urinary output.”
b. “If the bed rest works. I may lose a pound of two in the next few days.”
c. “I should be sure to maintain a diet that has a good amount of protein.”
d. “I will have to keep my room darkened and not watch much television.”

39. A 30 week pregnant attending the prenatal clinic has symptoms of PIH. Which of the following findings is indicative of this condition?
a. The woman has been getting short of breath when climbing the second flight of stairs in the family’s apartment
b. The woman has a craving for salty foods lately
c. The woman has a BP of 124/80mmhg, compared with 90/60mmhg a month ago
d. The woman has gained 3 lbs (1.4kgs) during the past month

40. At 33 weeks gestation, a woman who has been treated for PIH is admitted to the hospital because her condition has not improved. She is placed on bed rest and started on magnesium sulfate therapy. Which of the following assessment is essential for the nurse to make?
a. Obtaining the woman’s weight daily
b. Assessing the woman’s abdominal circumference daily
c. Observing the woman for jaundice
d. Checking the equality of the woman’s femoral pulse

41. A patient with history of abruptio placenta bleeds continuously after delivery. A diagnosis of Couvelaire uterus is mad. The nurse should:
a. Prepare the client for a uterine examination and insertion of vaginal packing.
b. Return the client to the DR for curettage
c. Add 10U of oxytocin (Pitocin) to the IV infusion
d. Ask the client to sign consent for a hysterectomy

42. While in the recovery room a patient with history of abruptio placenta begins to hemorrhage after delivery. Which is the most likely cause of hemorrhage?
a. Her uterus was not massaged adequately
b. She developed hypofibrinogenemia, a coagulation defect
c. Her rigid abdomen resulted in atony of the uterine muscles
d. Placental fragments remained in her uterus

43. A 34 yearl old G4P2 is admitted in active labor. She complains of severe pain that does not subside between contractions and her abdomen has become rigid. A diagnosis of abruption placenta is made. The priority nursing actions for the patient is/are to prepare for a blood transfusion and:
a. Observe for changes in her v/s and skin color
b. Obtain a clean catch urine specimen for culture and sensitivity
c. Prepare a solution of calcium gluconate for IV infusion
d. Maintain her in supine position

44. A woman who is hospitalized because of abruptio placenta would be carefully monitored for which of the following complications?
a. Toxic shock syndrome
b. Pulmonary embolism
c. Cerebrovascular accident
d. Disseminated intravascular coagulation

45. In which type of high risk pregnancy would abruptio placenta most likely occur?
a. Cardiac disease                    c. Drug addiction
b. Chronic hypertension         d. Hyperthyroidism

46. The fetal monitoring strip shows an FHR deceleration occurring midway during contraction; the FHR return to baseline midway between contractions. With this type of deceleration; the nurse’s first action should be to:
a. Place the woman in trendelenburg or knee-chest position
b. Call the physician
c. Position the woman in labor on the left side
d. Stop infusion of oxytocin

47. A woman in labor with complete cervical dilatation begins pushing during contractions, the FHR drops to approximately 90 BPM and then quickly returns to the baseline when she stops pushing. This sudden change is probably the result of:
a. Maternal position
b. Decreased utero-placental perfusion
c. Fetal distress
d. Umbilical cord compression

48. The fetal monitor strips shows an FHR deceleration occurring during the increment of a contraction, reaching its lowest point at the acme of the contraction, and returning to baseline during the decrement of the contraction. This type of deceleration indicates:
a. Fetal distress
b. Uteroplacental perfusion
c. Fetal vagal nerve stimulation
d. Umbilical cord compression

49. The fetal monitor strips shows an FHR deceleration occurring during the increment of contraction, reaching its lowest point at the acme of the contraction, and returning to baseline during the decrement of the contraction. This type of deceleration indicates:
a. Maternal hypoxia                c. Fetal movement
b. Fetal lung maturity             d. Fetal well-being

50. The electric monitor tracing shows the FHR is not smooth and straight between contractions. This indicates that:
a. The monitor cannot record the FHR accurately
b. The fetus is jumpy between contractions
c. The healthy FHR has beat to beat variability and should be not smooth
d. Application of internal monitor is necessary

51. Which of the following FHR patterns would indicate to the nurse that the fetus may be experiencing distress?
a. A baseline rate of 140-150 between contractions with moderate variability.
b. Consistent heart rate accelerations that coincide with the fetal movements
c. A heart rate that slows midway during contraction and returns to baseline 30 seconds after the contraction ends
d. Gradual slowing of the heart rate that begins with the onset of the contraction and return quickly to the baseline

52. An electronic fetal monitor is attached. The fetal monitoring strip shows an FHR deceleration occurring about 30 seconds after each contraction begins and the FHR return to baseline after the contraction is over. This type of deceleration is caused by:
a. Fetal head compression
b. Umbilical cord compression
c. Uteroplacental insufficiency
d. Cardiac anomalies

53. Which one would clue the nurse to suspect pregnancy in a woman with history of diabetes mellitus since she was 10 years old and hospitalization for DKA?
a. Nausea and vomiting             c. Listless and fatigue
b. Urinary frequency                  d. Breast sensitivity

54. A woman who is 20 weeks pregnant has history IDDM. The nurse understands that her insulin dosage has been increased to her prepregnant dose and will probably be further increased as her pregnancy progresses in order to:
a. Utilize the increase caloric intake of the second half of pregnancy
b. Limit the total pregnancy weight gain to 12.5 kg (27.5 lbs)
c. Meet the increasing glucose demands of the rapidly growing fetus
d. Counteract the effects of insulin antagonists produced by the placenta

55. When discussing diet with a newly diagnosed pregnant woman who is diabetic and taking insulin, the nurse should:
a. Emphasize the normalcy of pregnancy and the fact that her prescribed pregnancy diet will be suitable
b. Explain that pregnancy increases the need for protein and calcium but that will be the only needed diet adjustment
c. Confirm that dietary and insulin needs may vary throughout the pregnancy thus requiring close follow-up
d. Instruct her to self-regulate her diet and insulin based on daily urine tests for glucose

56. The woman is 6 weeks pregnant. She has history of IDDM. Her insulin dosage has been lowered at this time because:
a. Fetal insulin crosses the immature placent and enters maternal circulation
b. Increasing fetal demands deplete maternal blood glucose levels
c. Diabetic dietary needs decrease and less insulin is required
d. Maternal glucose levels decrease in direct proportion to increased maternal metabolism

57. Before amniocentesis, the amniotic sac should be located with the aid of:
a. Ultrasonography          c. Amniography
b. X-ray photography      d. Fetoscopy

58. Physical preparation for the amniocentesis includes:
a. No solid food between the previous midnight and the time of the procedure
b. Ingestion of 8 glasses of water 2 hours before the procedure
c. An enema on the morning of the procedure
d. Emptying the bladder just before the procedure

59. The woman is admitted with diagnosis of placenta previa. She is taken to the delivery room for a double set-up examination. Nursing responsibilities include preparing the woman for regional or inhalation anesthesia and:
a. vaginal or rectal examination
b. vaginal delivery or ceasarian section
c. ceasarian section
d. hysterectomy

60. Which ultrasound finding helped confirm the diagnosis of H-mole?
a. Multiple gestation of at least 4 fetuses
b. No discernible fetal skeleton or soft parts
c. Fetal anencephaly with hydrocephalus
d. Large fetal meningomyelocele

61. After removal of H-mole by D&C, which of the following finding would indicate that it would be safe to start another pregnancy?
a. Albumin/globulin ratio of 2:1
b. Negative HCG
c. Blood urea nitrogen of 18 mg/dl
d. Negative-C reactive protein

62. Fifteen minutes after the administration of epidural anesthesia the nurse observes decelerations of the FHR midway during contractions. The nurse should first:
a. Notify the physician
b. Administer O2
c. Record the findings q 5mins
d. Assess the maternal BP

63. In the patient’s chart, the nurse notes doctor’s order of Ergonovine maleate (Ergotrate) 0.4mg 4 x a day. The primary reason for the nurse to question the order of Ergonovine maleate to the post partum with history of RHD is that Ergotrate:
a. Can be administered either by oral or IM route
b. Is rarely ordered more than 2 days with a maximum of 1 week
c. Is usually prescribed in a dosage of 0.2 mg 4 x a day
d. Is usually contraindicated for cardiac clients

64. A teenager who is 4 months pregnant verbalizes that she has herpes genitalis. She asks if her baby will have the virus. The best response by the nurse should be:
a. If treatment is started during pregnancy, her baby will probably protected
b. That is one of the few vaginal diseases that does no affect the baby before, during or after delivery
c. If she has an active infection at term, a CS will probably protect her baby
d. Her baby will be protected by vaccine that will be administered immediately after delivery

65. A woman with diagnosis of PIH is placed on bed rest. An IV of LR has been started. The nurse has started an indwelling catheter to measure urine output because:
a. Incontinence may occur if preeclampsia progresses to eclampsia
b. Some urine may be lost when voiding on a bedpan
c. UO should be measured hourly to detect increasing oliguria
d. A 24hour urine collection is needed to measure total daily protein excretion

66. Which of the following side effect of ritodrine administration that would require physician’s notification?
a. Diuresis of 100ml/hr
b. Maternal tachycardia of over 120 bpm
c. Nausea followed by projectile vomiting
d. Fetal bradycardia of 110 bpm

67. Betamethasone (Celestone) a glucocorticoid is ordered to patient with premature labor because this medication:
a. Acts as mild tranquilizer during pregnancy and will enhance uterine relaxation
b. Promotes fetal lung maturity, which can prevent respiratory distress syndrome in a premature infant
c. Is an anti-inflammatory agent and will decrease the irritability of her uterine muscles
d. Elevates maternal blood glucose levels, which could lessen hypoglycemia in the premature infant

68. Which of the following responses would a nurse expect to find in a reactive non-stress test?
a. Acceleration of the fetal heart rate with fetal movement
b. Deceleration of the FHR without fetal movement
c. No change in the FHR with fetal movement
d. No change in FHR without fetal movement

69. Which of the following symptoms would be most significant when assessing a woman who has PIH?
a. Severe headache
b. Urine output of 200ml in the last 4 hours
c. Dependent edema
d. Patellar reflex of +2

70. A woman who is at 34 weeks pregnant is experiencing a sudden painless bright red vaginal bleeding. A nurse observes a colleague taking all of the following measures with the woman. Which one would the nurse question?
a. Palpating uterine firmness
b. Performing Leopold maneuvers
c. Preparing a vaginal exam
d. Preparing a non-stress test

71. Which of the following clients would the nurse prepare for an emergency CS?
a. A woman who has prolapsed cord
b. A woman with twin gestation
c. A woman who has meconium-stained amniotic fluid
d. A woman who has a non-reactive non-stress test

Mrs. Dantes, gravida 2 para 1 is admitted to the labor unit by ambulance and deliver is imminent. She keeps bearing down and after two contractions the baby’s head is crowning.

72. The nurse should:
a. Tell her to breathe through her mouth and pant during contractions
b. Tell her to breathe through her mouth the not to bear down
c. Transfer her immediately by stretcher to the delivery room
d. Tell her to pant while supporting the perineum with the hand to prevent tearing

73. With the nest contraction Mrs. Dantes delivers a large baby boy spontaneously. The nurse’s initial action should be:
a. Ascertain the condition of the fundus
b. Establish airway for the baby
c. Quickly tie and cut the umbilical cod
d. Move mother and baby to the delivery room.

74. The physician arrives and cares for the baby and delivers the placenta. Pitocin, an oxytocic drug, is administered IM. Since Mrs. Dantes has had a precipitous delivery, it is important to observe for:
a. Bleeding
b. Sudden chilling
c. Elevation of RR
d. Respiratory insufficiency in the baby

75. If involution is progressing normally, few hours after birth the nurse should expect the fundus to be located:
a. Three cm above the umbilicus
b. At the level of the umbilicus
c. 2 cm below the umbilicus
d. 2 cm above the symphysis pubis

Mrs. Roldan was admitted to the OB ward in active labor.

76. During contraction, the nurse observes a 15-beat per minute deceleration of the FHR. The most appropriate action would be to:
a. Prepare for immediate delivery because the fetus is in distress
b. Call the physician immediately and await the orders
c. Turn Mrs. Roldan on her left side to increase venous return
d. Record this normal fetal response to contractions in the chart.

77. The patient begins to experience contractions 2-3 minutes apart that last about 45 seconds. Between contractions, the nurse records a fetal heart rate of 100 bpm. The nurse should:
a. Closely monitor maternal vital signs
b. Chart the rate as a normal response to contractions
c. Notify the physician immediately
d. Continue to monitor the fetal heart rate

78. During delivery, episiotomy was performed. When caring for the patient during the post partum period, the nurse encourages sitz bath TID for 15 mins. Sitz baths primarily aid the healing process by:
a. Softening the incision site
b. Promoting vasodilation
c. Cleansing the perineal area
d. Tightening the perineal sphincter

79. When preparing Mrs. Roldan to care for her episiotomy after discharge, the nurse should include, as a priority, instructions to:
a. Continue the Sitz bath TID if it provides comfort
b. Discontinue the sitz bath once she is at home
c. continue perineal care after toileting until healing occurs
d. avoid stair climbing for at least a few days after discharge

Mrs. Walang, a 32 year old G3P2, spontaneously delivers a 4082g baby boy in route after a brief labor.

80. The nurse should be aware that the chief hazard to a child in precipitate delivery is:
a. Brachial palsy                     c. Dislocated hip
b. Intracranial hemorrhage d. Fractured clavicle

81. Perineal laceration is a common complication of precipitate delivery. In addition to regular perineal care, Mrs. Walang’s nursing care should include:
a. Encouraging early and frequent ambulation
b. Encouraging perineal exercises to strengthen the muscles
c. Telling the client to expect slower healing
d. Providing a high protein, high roughage diet

82. Baby Walang sustained a tear in the tentorial membrane which leads to intracranial bleeding. The nurse should expect the baby to display:
a. Extreme lethargy
b. Weak, timorous cry
c. Abnormal respirations
d. Generalized purpura

83. Nursing care of Baby Walang should include:
a. Stimulating frequently to monitor level of consciousness
b. Elevating his head higher than his hips
c. Checking reflexes every 15 minutes
d. Weighing him daily before feeding

84. The nurse who has been caring for the baby decides on a plan of care for the mother as well. The plan calls for:
a. Setting up a schedule for teaching the mother how to care for her baby.
b. Discussing the matter with her in a non-threatening way
c. Showing by example how to care for the infant and satisfy her own needs
d. Supplying emotional support to the mother and encouraging her dependence.

Mercedes, age 41, is admitted to the labor and delivery unit at 4:00 pm. While taking the history, the nurse notes the following: gravida 8, para 7, 41 weeks AOG, membranes ruptures at 10:00 am that day, contractions occur every 3 minutes; strong intensity with a duration of 60seconds.

85. What nursing action would take the highest priority at this time?
a. Get blood and urine samples
b. Do perineal prep and give enema
c. Attach monitor to the client
d. Determine extent of cervical dilation

86. Mercedes has just been given epidural anesthesia. What is the most important assessment at this time?
a. Maternal blood pressure
b. Fetal heart rate
c. Maternal level of consciousness
d. Fetal position

87. Mercedes had a normal spontaneous delivery. Why would she be considered at risk for development of postpartal hemorrhage?
a. Grand multiparity
b. Premature rupture of membranes
c. Post term delivery
d. Anesthesia

Sylvia Mariano has just delivered a 10-lb girl.

88. In assessing Sylvia immediately after delivery, which of the following would the nurse most likely to find?
a. Fundus located halfway between the symphysis pubis and umbilicus, lochia rubra
b. Fundus displaced to the right and 3 cm above the umbilicus, lochia serosa
c. Fundus located at the umbilicus, lochia rubra
d. Fundus located halfway between the symphysis pubis and the umbilicus, lochia serosa

89. Sylvia is having vaginal bleeding of bright red blood that is continuously trickling from the vagina. Her fundus is firm and in the midline. What is the most likely cause of this bleeding?
a. Lacerations
b. Subinvolution
c. Uterine atony
d. Retained placental fragment

90. Which of the following conditions predispose a client to postpartal hemorrhage?
a. Twin pregnancy
b. Breech presentation
c. Premature rupture of membranes
d. Ceasarian section

91. After 24 hours, Sylvia has a temperature of 38 degrees Celsius, has voided 2,000ml since delivery, and her skin is diaphoretic. Nursing actions should include which of the following?
a. Notify the physician of the findings
b. Notify the nursery to feed the baby in the nursery, as the mother has a fever
c. Explain to Sylvia that these symptoms are very normal for a woman who has just delivered
d. Suspect a postpartal infection and isolate the mother and the newborn

92. Sylvia’s sister warned her to suspect afterpains. The nurse’s teaching is based on the knowledge that the most likely candidate for afterpains is the:
a. Primipara who is bottle-feeding
b. Grand multipara who is breast feeding twin boys
c. Primipara who delivered prematurely and who is pumping her breasts
d. Adolescent primipara who is breastfeeding

93. Sylvia is using bottlefeeding for her baby and asks when she should expect her first menses. The appropriate response would be:
a. It usually takes at least 3 months before menstruation resumes after delivery
b. “As you aren’t breastfeeding, it should occur in 4-6 weeks.”
c. Two weeks is the average time for menses to return
d. “Ask your doctor. I’m sure that after doing a pelvic exam, she can tell you.”

Sheila, 32 weeks AOG, enters the emergency room complaining of premature labor.

94. Which of the following nursing actions is appropriate when caring for Sheila?
a. Prepare for an oxytocin challenge test to determine fetal status
b. Prepare for application of an internal monitor
c. Give frequent analgesia to relieve anxiety and promote comfort
d. Discuss the potential problems and preparations being made for the infant

95. Bed rest is prescribed for Sheila primarily because:
a. It will keep the pressure of the fetus off the cervix
b. May stop the labor by decreasing uterine irritability
c. Will promote and reduce anxiety
d. Will reduce fetal activity

96. A tocolytic agent is administered to suppress her labor. Which of the following nursing actions would be most appropriate in preventing side effects from this type of drug?
a. Side lying, anitembolic stockings, adequate hydration
b. Reduction in extraneous stimuli, frequent assessment of FHT
c. Use of side rails, frequent monitoring of uterine contractions
d. Frequent monitoring of BP and pulse

97. Which of the following drugs is considered a tocolytic agent?
a. Levallorphan            c. Phenobarbital
b. Terbutaline               d. Betamethasone

98. Attempts to stop labor were unsuccessful and a baby boy was born weighing 4lb 2 oz. Which of the following observations of the baby suggest a gestational age of less than 40 weeks?
a. Small amounts of lanugo and vernix, testes descended, palmar and plantar creases
b. Parchment-like skin, no lanugo, full areola in breast
c. Upper pinna of ear well curbed with instant recoil, small amounts of lanugo, pink in color
d. Dark red skin, testes undescended with few rugae, abundant lanugo

99. Which of the following is an important difference between a premature and a term infant?
a. Owing to size, a premature infant will have a more efficient metabolic rate for heat productions and maintenance
b. In proportion to size, the premature infant will have more lanugo, and more vernix than a full-term infant
c. GI motility is decreased in preterm infant. Stools may be infrequent resulting in abdominal distention
d. Heat production is low in premature infant because of the greater boy surface related to weight and lack of subcutaneous fat

Situation: Susan delivered her first child, a boy, 24 hours ago. She had a normal vaginal delivery with midline episiotomy and is breast feeding.

100. Instructions to Susan regarding care of the perineal area should include which of the following?
a. Separate the labia while cleansing
b. Cleanse the perineum with soap and water after elimination
c. Pour sterile water over the perineum after elimination
d. Perform perineal care only if an episiotomy is performed

Lumber Puncture

Indications

  1. Suspected CNS infection
  2. Suspected subarachnoid hemorrhage
  3. Therapeutic reduction of cerebrospinal fluid (CSF) pressure
  4. Sampling of CSF for any other reason

Contraindications

  1. Local skin infections over proposed puncture site (absolute contraindication)
  2. Raised intracranial pressure (ICP); exception is pseudotumor cerebri
  3. Suspected spinal cord mass or intracranial mass lesion (based on lateralizing neurological findings or papilledema)
  4. Uncontrolled bleeding diathesis
  5. Spinal column deformities (may require fluoroscopic assistance)
  6. Lack of patient cooperation

Materials

  1. Lumbar puncture tray (to include 20 or 22 gauge Quinke needle with stylet, prep solution, manometer, drapes, tubes, and local anesthetic)
  2. Universal precautions materials

Pre-procedure patient education

  1. Obtain informed consent
  2. Inform patient of possibility of complications (bleeding, persistent headache, infection) and their treatment
  3. Explain the major steps of the procedure, positioning, and postpocedure care

Procedure

  1. Assess indications for procedure and obtain informed consent as appropriate
  2. Provide necessary analgesia and/or sedation as required
  3. Position patient: lateral decubitus position with “fetal ball” curling up, or seated and leaning over a table top; both these positions will open up the interspinous spaces (see Figure 1)

LUMBAR%20PUNCTURE1_files/image001.jpg

 

Figure 1: Positioning patient for lumbar puncture

  1. Locate landmarks: between spinous processes at L4-5, L3-4, or L2-3 levels (see Figure 2). On obese patients, find the sacral promontory; the end of this structure marks the  L5-S1 interspace.  Use this reference to locate L4-5 for the entry point. You will aim the needle towards the navel.

Figure 2. Anatomy of lumbar spine

 

LUMBAR%20PUNCTURE1_files/image002.jpg

  1. Prep and drape the area after identifying landmarks. Use lidocaine 1% with or without epinephrine to anesthetize the skin and the deeper tissues under the insertion site
  2. Assemble needle and manometer. Attach the 3-way stopcock to manometer
  3. Insert Quinke needle bevel-up through the skin and advance through the deeper tissues. A slight pop or give is felt when the dura is punctured. Angle of insertion is on a slightly cephalad angle, between the vertebra (Figure 3). If you hit bone, partially withdraw the needle, reposition, and re-advance

LUMBAR%20PUNCTURE1_files/image003.jpg  

Figure 3

  1. When CSF flows, attach the 3-way stopcock and manometer. Measure ICP…this should be 20 cm or less. Note that the pressure reading is not reliable if the patient is in the sitting position
  2. If CSF does not flow, or you hit bone, withdraw needle partially, recheck landmarks, and re-advance
  3. Once the ICP has been recorded, remove the 3-way stopcock, and begin filling collection tubes 1-4 with 1-2 ml of CSF each

Tube 1: glucose, protein, protein electrophoresis

Tube 2: Gram’s stain, bacterial and viral cultures

Tube 3: cell count and differential

Tube 4: reserve tube for any special tests

  1. After tap, remove needle, and place a bandage over the puncture site. Instruct patient to remain lying down for 1-2 hours before getting up

NOTES:

  1. Insertion of the needle bevel-up minimizes dural trauma
  2. A traumatic “bloody tap” occurs when a spinal venous plexus is penetrated. Often the fluid will clear as succeeding tubes are filled. Spin down the first tube: if red blood cells have been in the spinal fluid for some time (for example, subarachnoid hemorrhage), xanthochromia will be present in the supernatant fluid. If the fluid is clear after it is spun down, the tap was only traumatic
  3. In some cases, conscious sedation is helpful in reducing patient anxiety and allowing maximal spinal flexion

COMPLICATIONS, PREVENTION, AND MANAGEMENT

Complication  Prevention  Management 
 Bleeding from puncture site post-tap  None

 

 Local pressure 
Bloody spinal fluid

 

 

None

 

Withdraw needle and perform tap at interspace either above or below
Infection

 

 

Do not perform tap through infected skin

Use sterile technique

Antibiotics

 

Post-tap persisting headache

 

Use pencil-tipped needle if possible; insert needle bevel-up  Post-procedure epidural blood patch by anesthesia consultant

Documentation in the medical record

Include in your note a brief history and physical examination of the patient, the reasons for performing the lumbar puncture, and consent. Note in particular a brief examination of the cranial nerves, presence or absence of papilledema, or any other lateralizing neurological finding. Also include a brief note of examination of the patient’s spine with attention to any obvious spinal deformity.

 Document position of patient during the procedure, opening pressure, and clarity/color of the CSF. Once results of the CSF analysis are available, they can be appended to your note.

 NORMAL CSF VALUES

Parameter Normal Values
Protein 15-45 mg/dl
Glucose 50-80 mg/dl
WBC < 5 mm3
RBC 0-5
Opening pressure 5-20 cm
Clarity, color Clear and colorless

 Items for evaluation of person learning this procedure

  1. Anatomy of lumbar spine
  2. Indications of procedure
  3. Contraindications for procedure
  4. Interaction between physician, staff, patient, and/or family
  5. Sterile technique, universal precautions
  6. Technical ability
  7. Appropriate documentation
  8. Understanding of potential complications and their correction

 

Application of Pharmacology in Nursing Practice

I. Evolution of Nursing Responsibilities Regarding Drugs

A. Five Rights of Drug Administration
– give the right drug to the right patient in the right dose by the right route at the right time
– proper delivery is only the beginning of responsibilities: Important events will take place after the “pill” is delivered, and these must be responded to.
– a broad base of pharmacology knowledge is needed so as to contribute fully to achieving the therapeutic objective
– should include a patient advocate position
PRE-TEST ? When applying pharmacology to patient care what is most important: assessment of the patient

II. Application of Pharmacology in Patient Care
– pharmacologic knowledge is applied in patient care and patient education
A. Pre-administration Assessment
1. Goals
a. collecting baseline data needed to evaluate therapeutic and adverse responses
b. identifying high-risk patients
c. assessing the patient’s capacity for self care
B. Collecting Baseline Data
– baseline data are needed to evaluate drug responses, both therapeutic and adverse

C. Identifying High Risk Patients
– predisposing factors are pathophysiology (especially liver and kidney function), genetic factors, drug allergies, pregnancy, old age, and extreme youth
– tools for identification are the patient history, physical examination and laboratory tests – need to know what to look for: factors that can increase the risk of severe reactions to the drug in question
PRE-TEST ? What predisposing factor can make a patient high risk when giving medications: pathophysiological conditions
D. Dosage and Administration
1. Read the medication order carefully. If the order is unclear, verify it with the prescribing physician.
2. Verify the identity of the patient by comparing the name on the wristband with the name on the drug order or administration record.
3. Read the medication label carefully. Verify the identity of the drug, the amount of drug (per tablet, volume of liquid, etc.) and its suitability for administration by the intended route.
4. Verify dosage calculations.
5. Implement any special handling the drug may require.
6. Don’t administer any drug if you don’t understand the reason for its use.

E. Evaluating and Promoting Therapeutic Effects
1. Evaluating Therapeutic Responses – evaluation is one of the most important aspects of drug therapy
– process that tells us whether or not our drug is doing anything useful
– need to know the rationale for treatment and the nature and time course of the intended response
2. Promoting Compliance – drugs an be of great value to patients, but only if they are taken correctly
3. Implementing Non-drug Measures – supportive measures directly, through patient education, or by coordinating the activities of other healthcare providers
F. Minimizing Adverse Effects – all drugs have the potential to produce undesired effects. In order to help reduce adverse effects, you must know the following about the drugs you’re working with:
– major adverse effects that the drug can produce
– time when these reactions are likely to occur
– early signs that an adverse reaction is developing
– interventions that can minimize discomfort and harm

G. Minimizing Adverse Interactions – when a patient is taking two or more drugs, those drugs may interact with one another to diminish therapeutic effects or intensify adverse effects. Ways to help reduce adverse interactions include:
– taking a thorough drug history
– advising the patient to avoid over the counter drugs that can interact with the prescribed
medication
– monitoring for adverse interactions known to occur between the drugs the patient is taking
– being alert for as-yet unknown interactions
H. Making PRN Decisions – PRN medication order is one in which the nurse has discretion regarding how much drug to give and when to give it.
– PRN is an abbreviation that stands for pro re nata (Latin for as needed or as the occasion arises)
– in order to implement a PRN order rationally, the reason for the drug use and the patient’s medication needs must be known
PRE-TEST ? What does PRN mean: as needed
I. Managing Toxicity – some adverse drug reactions are extremely dangerous; if toxicity is not diagnosed early and responded to quickly, irreversible injury or death can result.
– early signs of toxicity and the procedure for toxicity management must be known
III. Application of Pharmacology in Patient Education
As a patient educator, you must give the patient the following information:
– drug name and therapeutic category – dosage size
– dosing schedule – route and technique of administration
– duration of treatment – method of drug storage
– expected therapeutic response and when it should develop
– non-drug measures to enhance therapeutic responses
– symptoms of major adverse effects and measure to minimize discomfort and harm
– major adverse drug-drug and drug-food interactions
– whom to contact in the event of therapeutic failure, severe adverse reactions, or severe adverse interactions

A. Dosage and Administration
1. Drug Name – if the drug has been prescribed by trade name, the patient should be given its generic name too
– this information will reduce the risk of overdose that can result when a patient fails to realize that two prescriptions that bear different names actually contain the same medicine
2. Dosage Size and Schedule of Administration – patients need to be told how much drug to take and when to take it
3. Technique of Administration – patients must be taught how to administer their drugs
4. Duration of Drug Use – just as patient must know when to take their medicine, they must know when to stop
5. Drug Storage – certain medications are chemically unstable and hence deteriorate rapidly if stored improperly. Patients must be taught how to store their medications correctly. – all drugs should be stored where children cannot reach them

B. Promoting Therapeutic Effects – patients must know the nature and time course of expected beneficial effects
– non-drug measures can complement drug therapy; teaching patients about non-drug measures can greatly increase the chances of success

C. Minimizing Adverse Effects – knowledge of adverse drug effects will enable the patient to avoid some adverse effects and minimize others through early detection
D. Minimizing Adverse Interactions – patient education can help avoid hazardous drug-drug and drug-food interactions.

***IF IT’S NOT DOCUMENTED, IT’S NOT BEEN ADMINISTERED***

IV. Application of Nursing Process in Drug Therapy

A. Review of Nursing Process
1. Assessment – consists of collecting data about the patient
– methods of data collection are:

  • patient interview
  • medical and drug use histories
  • physical examination
  • observation of the patient
  • laboratory tests

    2. Analysis: Nursing Diagnosis – nurses analyze the database to determine the actual and potential health problems, which can be physiologic, psychologic or sociologic
    nursing diagnosis – states each problem as an actual or potential health problem that nurses
    are qualified and licensed to treat
    – consists of two statements that are usually separated by the phrase related to:
    a. statement of the patient’s actual or potential health problem
    b. statement of the problem’s probable cause or risk factors
    3. Planning – the nurse delineates specific interventions directed at solving or preventing the problems identified in analysis
    – in the care plan, the nurse must define goals, set priorities, and identify nursing interventions performed by other healthcare providers
    4. Implementation (Intervention) – begins with carrying out the interventions identified during planning
    collaborative interventions – require a physician’s order
    independent interventions – do not require a physician’s order
    – involves coordinating actions of other members of the healthcare team
    – is completed by observing and recording the outcomes of treatment
    5. Evaluation – performed to determine the degree to which treatment has succeeded
    – accomplished by analyzing the data collected during implementation
    – should identify those interventions: – that should be continued
    – those that should be discontinued
    – potential new interventions that should be implemented

    B. Applying the Nursing Process in Drug Therapy – overall objective in drug therapy is to produce maximum benefit with minimum harm
    – therapy must be individualized

    1. Pre-administration Assessment – establishes the baseline data needed to tailor drug therapy to the individual
    a. Basic Goals
    i. collection of baseline data needed to evaluate therapeutic responses
    – in order to know what baseline measurements to make, the reason for the drug use must be known
    ii. collection of baseline data needed to evaluate adverse effects
    – all drugs have the ability to produce undesired effects
    – knowing what data to collect comes directly from your knowledge of the drug under consideration
    iii. identification of high-risk patients
    – just which individual characteristics will predispose a patient to an adverse reaction depends on the drug under consideration
    – multiple factors that can increase the patient’s risk of adverse reactions to a particular drug include:
    – impaired liver and kidney function – age
    – body composition – pregnancy
    – diet – genetic heritage
    – other drugs being used
    – practically any pathophysiological conditions
    – distinguish between factors that put the patient at extremely high risk versus factors that put the patient at moderate or low risk

    contraindication – a pre-existing condition that precludes use of a particular drug under all but the most desperate circumstances

    precaution – a pre-existing condition that significantly increases the risk of an adverse reaction to a particular drug, but not to a degree that is life threatening
    iv. assessment of the patient’s capacity for self-care
    – for drug therapy to succeed, the outpatient must be willing and able to self-administer medication as prescribed
    – factors that can affect the capacity for self-care and probability of adhering to the prescribed regimen include:
    – reduced visual acuity – limited manual dexterity
    – limited intellectual ability – severe mental illness
    – inability to afford drugs
    – individual and/or cultural attitude toward drugs
    – conviction that the drug was simply not needed in the dosage prescribed
    – methods of data collection include:
    – interviewing the patient and family – observing the patient
    – physical examination – laboratory tests
    – patient’s medical history
    – patient’s drug history (including prescription drugs, over the counter drugs, herbal medications, non-medical drugs, such as alcohol, nicotine, caffeine, illicit drugs)
    – prior drug reactions should be noted

    b. Components of Drug History
    i. Allergies to medications (OTC and prescribed) or food

    ***If there are more than 2 medications, BE AWARE***
    ii. Habits
    – dietary
    – recreational drug usage (alcohol, tobacco, stimulants, illicit drugs) ask the patient “How much do you smoke? drink?”
    “What social drugs do you use?”
    iii. Socioeconomic Status
    – age – occupation
    – education level – insurance coverage

    iv. Life Style Beliefs
    – marital status – childbearing status
    – personal support system – utilization of health care system
    – typical pattern of daily activities
    v. Sensory Deficit / Capacity for self-care
    vi. Pre-existing conditions
    vii. Prescription and OTC Drugs:
    – reasons for use – knowledge of drugs
    – frequency of dosage – effectiveness or reaction
    – pattern and route of administration

2. Analysis and Nursing Diagnosis
a. Three objectives:
i. First, judge to appropriateness of the prescribed regimen
– the data collected during assessment must be analyzed to determine if the proposed treatment has a reasonable likelihood of being effective and safe
– judgment is made by considering:
– medical diagnosis – known actions of the prescribed drug
– patient’s prior responses to the drug
– presence of contraindications
– question the drug’s appropriateness:
– if the drug has no actions that are known to benefit individuals with the patient’s medical diagnosis
– if the patient failed to respond to the drug in the past
– if the patient has a serious adverse reaction to the drug in the past
– if the patient has a condition or is using a drug that contraindicates the prescribed drug
ii. Second, identify potential health problems that the drug might cause
– accomplished by synthesizing knowledge of the drug under consideration and the data collected during assessment

iii. Third, determine the patient’s capacity for self-care
– should indicate potential impediments to self-care (visual impairment, reduced manual dexterity, impaired cognitive function, insufficient understanding of the prescribed regimen)
– nursing diagnosis applicable to almost every patient is “deficient knowledge related to the drug regimen”
b. Planning – consists of defining goals, stabling priorities, identifying specific interventions, and establishing criteria for evaluating success

i. Defining Goals – the goal of drug therapy is to produce maximum benefit with minimum harm
– maximize therapeutic responses while preventing or minimizing adverse
reactions and interactions
ii. Setting Priorities – highest priority is given to life threatening conditions and reactions that cause severe, acute discomfort and to reactions that can result in long-term harm
iii. Identifying Intervention – heart of planning
i. Major Groups:
– drug administration = must consider dosage size and route of administration as well as less obvious factors, including timing of administration with respect to meals and with respect to administration of other drugs
– enhanced therapeutic effects = non-drug measures can help promote therapeutic effects and should be included in the planning
– interventions to minimize adverse effects and interactions distinguish between reactions that develop quickly and reactions that are delayed
– patient education = well planned patient education is central to success
– address the following: – technique of administration
– dosage size and timing
– duration of treatment
– method of drug storage
– measures to promote therapeutic effects
– measures to minimize adverse effects
iv. Establishing Criteria for Evaluation – the need for objective criteria by which to measure desired drug responses is obvious: without such criteria we could not determine if our drug was doing anything useful

3. Implementation
a. Four Major Components:
i. drug administration ii. patient education
iii. interventions to promote therapeutic effects
iv. interventions to minimize adverse effects

4. Evaluation – over the course of drug therapy, the patient must be evaluated for:
a. therapeutic responses
– how frequently evaluations are performed depends on the expected time course of therapeutic and adverse effects
– based on laboratory tests, observation of the patient, physical examination and patient interview
– to evaluate therapeutic responses, compare patient’s current status with baseline data
– to evaluate treatment, know the reason for drug use, criteria for success, and expected time course of responses
b. adverse drug reactions and interactions
– to make evaluates, know which adverse effects are likely to occur, how they are manifested, and their probable time course
c. compliance (adhere to prescribed regimen)
– include measurement of plasma drug levels, interviewing patient and counting pills
d. satisfaction with treatment
– satisfaction with drug therapy increases quality of life and promotes compliance
– factors that can cause dissatisfaction include unacceptable side effects, inconvenient dosing schedule, difficulty of administration, and high cost

C. Use of a Modified Nursing Process Format to Summarize Nursing Implications
1. Pre-administration Assessment – summarizes the information you should have before giving a drug
2. Implementation Administration – summarizes the routes of administration guidelines for dosage adjustment, and special considerations in administration
3. Implementation: Measures to Enhance Therapeutic Effects – addresses issues such as diet modification, measures to increase comfort and ways to promote adherence to the prescribed regimen

4. Ongoing Evaluation and Intervention – summarizes nursing implications that relate to drug responses, both therapeutic and undesired
a. Subsections:
i. summary of monitoring = summarizes the physiologic and psychologic parameters that must be monitored in order to evaluate therapeutic and adverse responses
ii. evaluating therapeutic effects = summarizes criteria and procedures for evaluating therapeutic responses
iii. minimizing adverse effects = summarizes the major adverse reactions that should be monitored for and presents interventions to minimize harm
iv. minimizing adverse interactions = summarizes the major drug interactions to be alert for and gives interventions to minimize them
v. managing toxicity – describes major symptoms of toxicity and treatment