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Wednesday, October 5, 2011

Easy and Effective Test Taking Strategies for Board Exams RULE 3

  RECOGNIZE AND SPOT THE KEY WORDS in the stem or background information. Be alert that those keywords can sometimes be overlook at the stem of the question or may possibly placed at the choices.

a.    Specific determiners or Clang Association between the stem and the choices or options.  Clang association is the repetitious use of a word in the stem and choice. Repetitious words are specific determiners towards the right answer.
When the options of a test item consists words that are identical or similar to words in the stem, the attentive test taker distinguishes the stimulus as clues about the possible answer to the question. The stem word that clues you to a similar word in the option or that limits possible options is identified as a specific determiner.

Example 3:
To meet a client’s physical needs, the nurse will:
a.    Pull the curtains when providing care
b.    Answer call bell immediately
c.    Administer physical hygiene
d.    Obtain vital signs
Answer: C. The word physical is the key word in the stem. It appeared again in Choice C. Administer physical hygiene.

Example 4:  
            When providing perineal care in patients, nurses can most appropriately protect themselves from microorganisms by:
a.    Washing hands prior to giving care
b.    Wearing clean gloves during perineal care
c.    Discarding contaminated water in the toilet
d.    Encourage patients
Answer: B. The key word in the stem and choices is the word perineal.

Example 5:
The government agency responsible for administering the nursing practice act in each state is the:
a.    Board of Regents
b.    Board of Nursing
c.    Philippine Nurses’ Association
d.    American Hospital Association
Answer: B. Options b and c contain the closely related words nurse and nursing. The word nursing, used both in the stem and in option 2, is a clue to the correct answers.

b.    Key words such as: best, most, correct, most appropriate, does not need further intervention, needs further intervention, and needs attention, critical and others which qualify the answer.

c.    If the options in an item do not seem to make sense because more than one option is correct, reread the questions; you may have missed one of the key words in the stem. Also be on guard when you see one of the key words in an option; it may limit the context in which such an option would be correct.
Example 6:
The nurse would most likely assess all but which one of the following signs of dehydration in a preschooler?
a.    Tenting of the skin
b.    Sunken eyeballs
c.    Depressed fontanel
d.    Lack of tears
All choices above are correct about dehydration. The key word is pre-schooler. Choice C cannot be assessed in a preschooler. Answer is C.

Easy and Effective Test Taking Strategies for Board Exams Rule 2

 & Easy and Effective Test Taking Strategies for Board Exams RULE 2
                                                  
    CAREFUL READING IN EVERY QUESTION

CAUTIOUSLY READ THE OPTIONS AND BE AWARE TO SPECIF DETAILS. Focus on “What exactly is being asked?” A well formed multiple-choice question is purposely stated, given that only information required making the question or problem clear and detailed. Careful reading of details in the stem can offer important clues to the right option.

Scores on tests are sturdily affected by reading ability. In answering a test item, you must begin by cautiously reading the stem and then asking yourself the following questions:
«                      What is the question actually asking?
«                      What information appropriate to answering this question is incorporated in the stem?
«                      How would I ask this question in my own words?

Deal with the question as it is stated, with no reading anything into it or making guess about it. Answer the question in conditions of what is accurately being asked, not the one you would like to answer. For easy recall items the self-questioning procedure will typically be accomplished rapidly. For more compound items the self-questioning procedure may take longer, however it may help you in clarifying the item and choose the best answer.
            
Ask yourself the following questions:
                  “Is there an option that is similar to the one I thought of?”
                  “Is this option the best, most complete answer to the question?        “
For each option, answer “YES” or “NO” according to whether it fits or answers the question in the stem.

Example 1:
A male client is told that he will no longer be able to ingest alcohol if he wants to live. To effect a change in his behavior while he is in the hospital, the nurse should attempt to:
a.    Help the client set short-term dietary goals.
b.    Discuss his hopes and dreams for the future
c.    Discuss the pathophysiology of the liver with him.
d.    Withhold approval until the client agrees to stop drinking.

The specific clause “to effect a change in his behavior while he is in the hospital”… is crucial. Option a, the correct answer, may perhaps result in an obvious behavioral change while the client is hospitalized; for example, he might define ways attain short-term goals linking to diet and alcohol while in the hospitals.
Option b does not actually relate to his alcoholism. Option c may be part of educating the alcoholic, but you might not expect a behavioral change visible in the hospital to come out from this discussion. Option d rejects the client as well as his behavior instead of only his behavior.

            Example 2:
The nurse assessing a client in labor recognizes that the sign most diagnostic of effectiveness of labor is:
a.    Rupture of BOW
b.    Passage of mucus plug
c.    Cervical dilation
d.    Increasing intensity of pain
Answer: C. The key word is effectiveness of labor. Choice C answers the questions BEST.

 Easy and Effective Test Taking Strategies for Board Exams RULE 1

  & Easy and Effective Test Taking Strategies for Board Exams RULE 1:
     
      IDENTIFY THE STRUCTURE OF THE QUESTION.
     A typical board question is a multiple choice type that consists 
  of two major parts:
                                                ·       STEM
                                                ·       OPTIONS or CHOICES.

The STEM of the question contains:
a. The background statement – is a short situation that gives information that is essential or helpful in answering the question. Nevertheless, the background statement does not constantly give information needed in answering the question. It might be comprised to supply an outline for the stem or to flavor the test with attention and behavior. It perhaps includes determining how successfully you can arrange through the data and choose relevant information. In the above example, for example, offers a background question properly. In developing Easy and Effective Test Taking Strategies for Board Exams, you will learn how to distinguish necessary from supplementary information in the background statement and the stem.
Example:   
Mrs. Thomas arrived at the hospital in early labor.

b. The Question - signify what is being asked for or it’s purpose for asking. It can be embodied in the form of a question or an unfinished statement twisted by a subject and a verb (open-ended statement).
            Example:
          A.    purpose in question form:
            “Which of the following signs is the best indicator that labor is progressing?”
          B.    purpose in unfinished statement or open-ended statement:
            “The best indicator that labor is progressing is.:”

The OPTIONS – are likely the answers to the question or probable solutions to the problem. The right answer is called the keyed response and the other options are called distracters. The word, option, distracters, response, and answer are used interchangeably in the test. A question is frequently followed by four single option choices. In answering the test question you will choose the option that most excellent completes the question or answers the problem.


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>>Easy and Effective Test Taking Strategies for Board Exams Rule 2<<

Easy and Effective Test Taking Strategies for Board Exams

Easy and Effective Test Taking Strategies for Board Exams

Test questions in nursing are intended to evaluate your nursing knowledge. That's why "Easy and Effective Test Taking Strategies for Board Exams" provides you 16 tips to help you improve your test taking skills in answering every question.

The most crucial fundamentals for doing well in licensure examinations are:

  •                You must have a good understanding about the subject matters in every question
  •          And a high level of reading capacity
Easy and Effective Test Taking Strategies for Board Exams will increase the chances for a well-prepared examinee to pass the test with “flying colors”. Test taking strategies are not a substitute for good study habits. Good test taking skills show you towards the right answers through a detailed breakdown of the question and improve your general test performance.


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Thursday, September 29, 2011

TYPHOID FEVER

Other Terms:
ü  Enteric fever
ü  Typhus abdominalis

It is a general infection usually affects the Digestive system by the bacterium salmonella Typhi, causing a generalized weakness, ladderlike fever, red spots on chest and abdomen, sweating, chills, delirium and in serious cases inflammation of the spleen and bone.
Typhoid fever also characterized by ulceration of the Peyer’s Patches that leads to erosion of the intestinal wall resulting to internal hemorrhage as manifested by the enlargement of the spleen (Spleenomegaly).

Despite the fact that the disease commonly affects the gastrointestinal system, the following body systems might as well be affected:
1.      Muscular System
2.      Genito-urinary system
3.      Cardio-pulmonary system

Mode of Entry – Fecal-oral route through infected urine and feces.

Principal Vehicles
1.      Feces
2.      Foods
3.      Foamites
4.      Flies
5.      Fingers

Causative Agent
1.      Salmonella Typhi
2.      Typhoid Bacillus
3.      Salmonella Typhosa


Mode of Transmission
            Typhoid Fever may be transmitted via Fecal-oral route through infected feces and urine of the patient.
ü  Eating of contaminated foods like meat, eggs, shellfish and other meat and poultry products.
ü  Ingestion of uncooked or undercooked foods.
ü  Hands of infected persons.
ü  Flies and other flying insects.
ü  Consumption of contaminated water, milk and other dairy products.
ü  Through convalescent carriers that continue to harbor organisms in their tissues for variable lengths of time


Source of infection: Contaminated food and water

Signs and Symptoms
1. Prodromal – stage wherein the patient may have a flulike symptom.
·         Fever, headache
·         Anorexia, lethargy
·         Constipation or diarrhea, vomiting
·         Abdominal pain due to ulceration of the Peyer’s patches
·         Feeling of unwellness
2. Fastigal
·         Ladder like curve body temperature
·         Rose spots – Maculopapular rashes appear on chest or abdomen of patient usually appear on 7 – 12 days.
·         Spleenomegaly
·         Typhoid state – A condition in which there is brain involvement resulting to “Typhoid Psychosis”.
1.      The patient could have altered level of consciousness.
2.      Coma state wherein the patient appears to stare without seeing and a vigil look.
3.      Locomotive disturbance carphologia through picking up of linens
4.      Sultus tendium observed through involuntary twitching of tendons part of wrist of the patient.
3. Defervescence
·         Fever gradually subsides – fever mild & symptoms subsides

Diagnostic exam
    1. Hemoculture – confirmatory of typhoid (+) organism after 1 week
    2. Widal’s test/ blood serum agglutination (+) end of 2nd week
    3. Fecalysis – Done by swabbing the rectal area.
ü   Advise the patient not to eat meat especially red meat 1-2 days prior to the test cause it may give a false positive internal bleeding result.
    1.  Typhi Dot test- new method on diagnosing typhoid fever to detect IgH, IgG

Nursing Care
  • Supportive care
  • Proper positioning
  • Use of enteric precautions
  • TSB for high fever
  • Increase fluid intake
  • Administration of prescribed medications
  • Monitor for possible complications


Prevention
  • Handwashing
  • Decontamination of water sources milk pasteurization,
Immunization – vaccine of C.T. cholera typhoid, oral vivotif.

Complications
           
    1. Perforation of the intestine
    2. Intestinal hemorrhage
    3. Thrombophlebitis
    4. Urinary infection
    5. Meningitis

Ø  Note that typhoid fever may relapse.

Treatment
  • Chloramphenicol – 14 days
  •  Amoxicillin – (oral) in case the patient is resistant to Chloramphenicol
ü  Monitor CBC to detect Chloramphenicol toxicity SE of Chloramphenicol: Bone depression
·         If with resistance to both, use trimethoprim-sulfamethoxazole as an alternative drug.


SCHISTOSOMIASIS

Definition
            Schistosomiasis also called as Snail fever and or Bilharziasis. The disease was named after Theodor Bilharz, which is considered to be the first person to identify the parasite on 1851 in Egypt. The disease is common in tropical and subtropical country and it has relatively low mortality rate but a high morbidity cases.
Schistosomiasis is often related to the water resource development projects like irrigations or dams, where the snails (main host of the parasite) breed.
            The disease commonly affects farmer in which the nature of their job gives way in contacting directly with the parasite.
            The disease may also affect the following system:
1.      Urinary
2.      Central Nervous System
3.      Gastrointestinal system

Infectious Agents
1.      Schistosoma Japonicum  - a type that is endemic in the Philippines
2.      Schistosoma Mansoni      - it is found in Africa and the only specie found in Latin America. Oncomelania snail is the main host for this type.
3.      Schistosoma Haematobium –Specie that is most common in Africa and in Middle East. This type is contracted through a snail called Bulinus snail.
4.      Schistosoma Intercalatum
5.      Schistosoma Mekongi – This type of specie is found only in Laos and Cambodia.

The Infection Process and its Pathophysiology
ü  Schistosomiasis is contracted through direct contact of an open skin with water contaminated by a parasite.
ü  Upon contact with human, it burrows on skin, and matures into larval stage called (Schistosomula), then migrates into lung and liver where it matures to Adult worm.
ü  The adult worm then travels to different organ like bladder, rectum, intestines, portal venous system and spleen.

“The male and female parasites (s. Japonicum) lived in the blood vessels of the intestines and liver. The eggs of the parasite are laid in the terminal capillary vessels in the submucosa of the intestines and through ulceration reach the lumen of the intestines and pass out with the feces and upon contact with fresh water hatches into a larva (miracidium). The free-swimming larva seeks and penetrates soft part of the intermediate host – a tiny snail called Oncomelania quadrasi, multiples and within two months becomes the infective stage called the cercaria. This fork tailed larva emerges from the snail onto water and enters the skin of man and other warm blooded animals as cows, dogs, carabaos, cats, rats, horses and goats who come contact with infected water through the lymphatic and then the veins, it eventually goes to the heart, systemic circulation, and into the intrahepatic portal circulation where they mature, copulate and start laying eggs in about one month’s time.” (CHN 9th edition pg.222)

Eggs       miracidia (hatched)       snail        sporocyst and cercaria (inside the snail)       human skin (open skin)       schistosomulae       human veins       lungs and  liver (maturation to become adult worm)       travels to differen organs of the body       Schistosomiasis


Incubation Period - 4-6 weeks

Sign and Symptoms
  • Rash (Swimmers Itch) –Pathognomonic sign
  • Hematuria
  • Diarrhea                                             
  • Bloody stools                                       
  • Enlargement of abdomen
  • Spleenomegaly
  • Enlargement of the liver
  • Enlargement of the lymph node
  • Chills
  • Painful urination
  • Glomerulonephritis
  • Pulmonary hypertension
  • Ureteritis
  • Cystitis
  • Hematemesis
  • Eosinophilia
  • Abdominal pain
  • Cough
  • Fever
  • Weakness
  • Anemia
  • Inflamed liver


Diagnostic Exam:
1.      Serology
Ø  Tool used for epidemiological cases.
Ø  It detects antibody that is specific to S. Mansoni, S. Japonicum, and S. Haematobium adult worm microsomal antigen.
a.       Mansoni Adult worm Microsomal Antigen    (MAMS)
b.      Haematobium Adult worm Microsomal Antigen (HAMA)
c.       Japonicum Adult worm Microsomal Antigen (JAMA)
Ø  These three have been reported to be highly specific when used in the Falcon assay screening test (FAST), enzyme linked immune-assays.   (CD 5th edition Untalan pg.477)

2.      Stool Exam is used to determine the type of eggs in the stool.
3.      Urine exam is used in identifying the severity of the infection.
Ø  Below 100 eggs per gram – light infection
Ø  100-400 eggs per gram is a moderate infection
Ø  Above 400 eggs per gram is a severe infection
4.      Egg Viability Test is done to examine the effectiveness of the treatment
5.      Detecting circulating antigen to assess an active infection.
6.      Intradermal test
7.      Immunodiagnostic test

Assessment
ü  Inspect the frequency of evacuation of stools.
ü  Auscultate hyperactivity of the bowel sounds
ü  Palpate if there is enlargement of the spleen and to assess tenderness in the abdominal area.
ü  Intradermal test
ü  Direct fecal smears
ü  Kato Kats technique
ü  Concentration technique
ü  Circumoval precipitin test

Nursing Diagnosis
ü  Pain
ü  Potential infection
ü  Impaired skin integrity
ü  Altered nutrition
ü  Fluid volume deficit
ü  Knowledge deficit
ü  Self care deficit
ü  Activity intolerance

Method of Control
·         Educate people about the disease and how to prevent it.
·         Proper disposal of the excreta contaminated with parasite.
·         Improve water resources facilities.
·         Treat the snail breeding site.
·         Minimize if not prevented the exposure to contaminated water.
·         Provide water for drinking, boiling of water is recommended.
·         Treat the patient as soon as possible to prevent the progression of the disease.
·         Travelers should be informed if the place is endemic for Schistosomiasis.
·         There’s no need for the patient to be isolated.
·         Quarantine: None
·         Immunization of contacts: None
·         Concurrent disinfection: sanitary disposal of infected urine and stools.



Treatment
1.      Praziquantel (Biltricide) a drug given 30 mg/kg, orally, twice a day for the treatment of infection caused by the parasite Schistosoma. The main action of the drug is to detach the adult worm from the wall of the vein and die.
2.      Nitidazole is given once a day, orally, 25mg/kg/per day to a maximum of  1.5gm for ten days.
3.      Oxamniquine is the best treatment for the infection caused by S. Mansoni.
4.      N-diethyl-m-toluamide is a very potent topical drug for killing cercaria (cercaricidal). The action of this drug is to prevent the entry of the cercaria into the human skin as a result it prevents the person to acquire the disease.
5.      LIPODEET is best preventive measures to people who work on field. It is applied before working in the field because the drug can effectively last up to 60 minutes so that farmers can work safely.
6.      Trivalent Antimony
a.       Tartar emetic administered through vein only
b.      Stibophen (Fuadin) is given through intramuscular. This drug can effectively cure the disease if given in correct dosage and compliance to drug.
    
Prevention
  • Avoid washing cloths and bathing in streams
  • Proper and sanitary disposal of human feces
  • Destruction of snail host –control the multiplication of snails by using snail killing chemicals.
  • Improve irrigation and agriculture projects to reduce snail habitat

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