Article: Sleeping Less; What To Do About It

Generally, it has been assumed that the need for sleep does not decrease with age, but rather that other factors gradually come to interfere with our ability to sleep through the night.

Older individuals, for instance, are at greater risk not only for developing medical and psychiatric disorders but also for taking medications that can disrupt sleep. In spite of these influences, however, it may be that an actual biological deterioration of the sleep drive might also be playing a role.

A new study published in the journal Current Biology has been able to shed some light on this puzzle of sleep and aging. The researchers, who wanted to determine the maximal sleep capacity of both young and older persons, arranged for groups of younger adults (ages 18 to 32 years) and older adults (ages 60 to 76 years) to lie in bed for 12 hours during the night and for another 4 hours in the afternoon.

The subjects tended to sleep significantly longer at the beginning of the experiment, presumably because they were making up for a sleep debt accrued during their usual daily sleep routines. When the sleep patterns stabilized, however, the younger adults were capable of sleeping for much longer times — an average of 8.9 hours daily — than were the elderly people, who got only 7.4 hours daily. This 1.5-hour difference in maximal sleep capacity is impressive.

If your biological drive for sleep seems to have decreased, make sure that you are following the kinds of routines and behaviors that will give you the best chance of getting as much refreshing sleep as possible. Here are some examples of good sleep hygiene:

• Make sure that you're going to bed early enough to allow yourself to get an adequate night's sleep.
• As your bedtime approaches, develop a relaxing routine in the evening — don't keep busy until the moment before you expect to fall asleep.
• Avoid watching TV in bed.
• Sleep in a cool, relatively dark room.
• Consider going to sleep to the sound of white noise, either from a bedside fan or a machine that generates calming sounds.
• Increase your exercising, but don't do it so near to bedtime that it gets your adrenaline flowing and keeps you awake.
• Limit your daily intake of caffeinated beverages and avoid them completely after lunchtime.
• Avoid alcoholic beverages.

© 2007 Johns Hopkins University. All Rights Reserved. This article from Johns Hopkins University is provided as a service by Yahoo. All materials are produced independently by Johns Hopkins University, which is solely responsible for its content.

Drug Study: Types of Anesthesia

Anesthesia, or anaesthesia has traditionally meant the condition of having sensation (including the feeling of pain) blocked. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes, Sr. in 1846. Another definition is a “reversible lack of awareness”, whether this is a total lack of awareness (e.g. a general anaesthestic) or a lack of awareness of a part of a the body such as a spinal anaesthetic or another nerve block would cause. Anesthesia differs from analgesia in blocking all sensation, not only pain.

Classification:

A. General Anesthesia - is the loss of all sensation and consciousness. Protective reflexes such as cough and gag reflexes are lost. A general anesthetic acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur. General anesthetics are usually administered by intravenous infusion or by inhalation of gases through a mask or through an endotracheal tube inserted into the trachea.

Advantages:

• Because the client is unconscious rather then awake and anxious, respiration and cardiac function are readily regulated.
• The anesthesia can be adjusted to the length of the operation and the client’s age and physical status.

Disadvantage:

• It depresses the respiratory and circulatory systems.
• Some clients become more anxious about a general anesthetic that about the surgery itself. Often this is because they fear losing the capacity to control their own bodies.
  

B. Regional Anesthesia - is the temporary interruption of the transmission of nerve impulses to and from a specific area or region of the body. The client loss sensation in an area of the body but remains conscious. Several techniques are used:
1. Topical (surface) Anesthesia

• Is applied directly to the skin and mucous membranes, open skin surfaces, wounds, and burns. The most common used topical agents are lidocaine (Xylocaine) and benzocaine. Topical anesthetics are readily absorbed and act rapidly.

2. Local Anesthesia

• (Infiltration)is injected into a specific area and is used for minor surgical procedures such as suturing a small wound or performng a biopsy. Lidocaine or tetracaine 0.1% may be used.

3. Nerve Block

• Is a technique in which the anesthetic agent is injected into and around a nerve or small nerve group that supplies sensation to a small area of the body. Major blocks involve multiple nerves or a plexus (e.g. the brachial plexus anesthetizes the arm); minor blocks involve a single nerve (e.g. a facial nerve)

4. Intravenous block (Bier block)

• Is used most often for procedures involving the arm, wrist and hand. An occlusion tourniquet is applied to the extremity to prevent infiltration and absorption of the injected intravenous agent beyond the involved extremity.

5. Spinal anesthesia (Subarachnoid block)

• It requires a lumbar puncture through one of the interspaces between lumbar disc 2 (L2) and the sacrum (S1). An anesthetic agent is injected into the subarachnoid space surrounding the spinal cord. Categorized into Low Spinals (saddle or caudal blocks) are primarily used for surgeries involving the perineal or rectal areas. Mild Spinals (below the level of the umbilicus - T10) can be used for hernia repairs or appendectomies. High Spinals (reaching the nipple line - T4) can be used for surgeries such as cesarean sections.

6. Epidural (peridural) anesthesia

• Is an injection of an anesthetic agent into the epidural space, the area inside the spinal column but outside the dura mater.
  Conscious Sedation may be used alone or in conjuction with regional anesthesia for some diagnostic tests and surgical procedures. Conscious sedation refers to minimal depression of the level of consciousness in which the client retains the ability to maintain a patent airway and respond appropriately to commands.

Intravenous narcotics such as morphine or fentanyl (Sublimaze) and antianxiety agents such as diazepam (Valium) or midazolam (Versed) are commonly used to induce and maintain conscious sedation. Conscious sedation increases the client’s pain threshold and induces a degree of amnesia but allows for prompt reversal of its effects and a rapid return to normal activities of daily living. Procedures such as endoscopies, incision and drainage of abcesses, and even balloon angioplasty may be performed under conscious sedation.

Risk Factors for Complications During the Procedure:

• Current or past health problems
• Taking medications, supplements, or herbal remedies, blood thinners
• Allergies (eg, food allergies, medication allergies, latex allergies)
• Smoking
• Drinking alcohol
• Taking recreational drugs
• Personal or family history of adverse reactions to anesthesia

Possible Complications:

• Pain and tenderness around the injection site
• Bruising, infection, or bleeding of the injection site
• Hematoma (a mass of clotted blood that forms in a tissue, organ, or body space as a result of a broken blood vessel)
• Spinal headache (a severe headache that may occur after spinal or epidural anesthesia)
• Decrease in blood pressure
• Nerve damage
• Medication mistakenly injected into a vein; symptoms include dizziness, rapid heartbeat, and funny taste or numbness around the mouth
• Horner’s syndrome (change of pupil size on one side)
• Ptosis (drooping of the eyelid)
• Pneumothorax (air trapped between the lung and rib cage)

Call Your Doctor If Any of the Following Occurs:

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, or discharge from the injection site
• Tingling, numbness, or trouble moving around the affected area
• Headache
• Persistent coughing
• Chest pain
• Trouble breathing or shortness of breath
• Dizziness
• Heartbeat abnormalities
• Funny taste or numbness of the mouth
• Other worrisome symptoms
  

Resources:

• http://en.wikipedia.org/
• http://www.thompsonhealth.com/
• Fundamentals of Nursing - Barbara Kozier et al

Case Study: Amoebiasis/Amebiasis (Amoebic Dysentery)

Introduction:

Amoebiasis protozoal infection of human beings initially involves the colon, but may spread to soft tissues, most commonly to the liver or lungs, by contiguity or hematogenous or lymphatic dissemination.

Amoebiasis is the third leading parasitic cause of death worldwide, surpassed only by malaria and schistosomiasis. On a global basis, amoebiasis affects approximately 50 million persons each year, resulting in nearly 100,000 deaths.

Etiologic Agent:

1. Enatamoeba Histolytica

• Prevalent in unsanitary areas
• Common in warm climate
• Acquired by swallowing
• Cysts survives a few days outside of the body
• Cyst passes to the large intestine and hatch into trophozoites. It passes into the mesenteric veins, to the portal vein, to the liver, thereby forming amoebic liver abscess.

2. Entamoeba Histolytica has two developmental stages:

• Trophozoites/vegetative form : facultative parasites that may invade the tissues or may be found in the parasitized tissues and liquid colonic contents.
• Cyst : passed out with formed or semi-formed stools and are resistant to environmental conditions. This is considered as the infective stage in the cycle of E. histolytica

Source: Human Excreta
Incubation Period: The incubation period in severe infection is three days. In subacute and chronic form it lasts for several months. In average cases the incubation period varies from three to four weeks

Period of Communicability: The microorganism is communicable for the entire duration of the illness.

Modes of Transmission:

• The disease can be passed from one person to another through fecal-oral transmission.
• The disease can be transmitted through direct contact, through sexual contact by orogenital, oroanal, and proctogenital sexual activity.
• Through indirect contact, the disease can infect humans by ingestion of food especially uncooked leafy vegetables or foods contaminated with fecal materials containing E. histolytica cysts.

Food or drinks maybe contaminated by cyst through pollution of water supplies, exposure to flies, use of night soil for fertilizing vegetables, and through unhygienic practices of food handlers.

Clinical Manifestations:
1. Acute amoebic dysentery

• Slight attack of diarrhea, altered with periods of constipation and often accompanied by tenesmus.
• Diarrhea, watery and foul smelling stool often containing blood-streaked mucus
• Colic and gaseous distension of the lower abdomen
• Nausea, flatulence, abdomnal distension and tenderness in the right iliac region over the colon

2. Chronic amoebic dysentery

• Attack dysentery that lasts for several days, usually succeeded by constipation
• Tenesmus accompanied by the desire to defacate
• Anorexia, weight loss, and weakness
• Liver may be enlarged
• The stool at first is semifluid but soon becomes watery, bloody, and mucoid
• Vague abdominal distress, flatulence, constipation or irregularity of bowel
• Mild toxemia, constant fatigue and lassitude
• Abdomen loses its elasticity when picked up between fingers
• On sigmoidoscopy, scattered ulceration with yellowish and erythematous border
• The gangrenous type (fatal cases) is characterized by the appearance of large sloughs of intestinal tissues in the stool accompanied by hemorrhage.

3. Extraintestinal forms
Hepatic

• Pain at the upper right quadrant with tenderness of the liver
• Jaundice
• Intermittent fever
• Loss of weight or anorexia
• Abscess may break through the lungs, patient coughs anchovy-sauce sputum

Clinical Features:

• Onset is gradual
• Diarrhea increases and stool becomes bloody and mucoid
• In untreated cases:

Anatomy and Physiology:
Amebiasis is an intestinal illness that’s typically transmitted when someone eats or drinks something that’s contaminated with a microscopic parasite called Entamoeba histolytica (E. histolytica). The parasite is an amoeba, a single-celled organism. That’s how the illness got its name — amebiasis.

In many cases, the parasite lives in a person’s large intestine without causing any symptoms. But sometimes, it invades the lining of the large intestine, causing bloody diarrhea, stomach pains, cramping, nausea, loss of appetite, or fever. In rare cases, it can spread into other organs such as the liver, lungs, and brain.
I. Structure. The GI System consists of the oral structures, esophagus, stomach, small intestine, large intestine and associated structures.

• Oral Structures include the lips, teeth, gingivae and oral mucosa, tongue, hard palate, soft palate, pharynx and salivary glands.
• The esophagus is a muscular tube extending from the pharynx to the stomach.
• 1. Esophageal openings include:
• o a. The upper esophageal sphincter at the cricopharyngeal muscle.
• o b. The lower esophageal sphincter (LES), or cardiac sphincter, which normally remains closed and opens only to pass food into the stomach.
• The Stomach is a muscular pouch situated in the upper abdomen under the liver and diaphragm. The stomach consists of three anatomic areas: the fundus, body (i.e., corpus), and antrum (i.e., pylorus)
• Sphincters. The LES allows food to enter the stomach and prevents reflux into the esophagus. The pyloric sphincter regulates flow of stomach contents (chyme) into the duodenum.
• The small intestine, a coiled tube, extends from the pyloric sphincter to the ileocecal valve at the large intestine. Sections of the small intestine include the duodenum, jejunum and ileum
• The large intestine is a shorter, wider tube beginning at the ileocecal valve and ending at the anus. The large intestine consists of three sections:
• 1. The cecum is a blind pouch that extends from the ileocecal valve to the vermiform appendix.
• 2. The colon, which is the main portion of the large intestine, is divided into four anatomic sections: ascending, transverse, descending and sigmoid.
• 3. The rectum extends from the sigmoid colon to the anus.
• The ileocecal valve prevents the return of feces from the cecum into the small intestine and lies at the upper border of the cecum.
• The appendix, which collects lymphoid tissues, arises from the cecum.
• The GI tract is composed of five layers.
• 1. An inner mucosal layer lubricates and protects the inner surface of the alimentary canal.
• 2. A submucosal layer is responsible for secreting digestive enzymes.
• 3. A layer of circular smooth muscle fibers is responsible for movement of the GI tract.
• 4. A layer of longitudinal smooth muscle fibers also facilitates movement of the GI tract.
• 5. The peritoneum, an outer serosal layer, covers the entire abdomen and is composed of the parietal and visceral layers.

II. Function. The GI system performs two major body functions: digestion and elimination.

• Digestion of food and fluid, with absorption of nutrients into the bloodstream, occurs in the upper GI tract, stomach and small intestines.
• 1. Digestion begins in the mouth with chewing and the action of ptyalin, an enzyme contained in saliva that breaks down starch.
• 2. Swallowed food passes through the esophagus to the stomach, where digestion continues by several processes.
• o a. Secretion of gastric juice, containing hydrochloric acid and the enzymes pepsin and lipase ( and renin in infants)
• o b. Mixing and churning through peristaltic action
• 3. From the pylorus, the mixed stomach contents (i.e. chyme) pass into the duodenum through the pyloric valve.
• 4. In the small intestine, food digestion is completed, and most nutrient absorption occurs. Digestion results from the action of numerous pancreatic and intestinal enzymes (e.g., trypsin, lipase, amylase, lactase, maltase, sucrase( and bile.

• Elimination of waste products through defacation occurs in the large intestines and rectum. In the large intestine, the cecum and ascending colon absorb water and electrolytes from the now completely digested material. The rectum stores feces for elimination.

Pathophysiology

Laboratory Diagnosis:

• Stool exam (cyst, white and yellow pus with plenty of amoeba)
• Blood exam (Leukocytosis)
• Proctoscopy/Sigmoidoscoppy

Diagnosis of amoebiasis can be very difficult. One problem is that other parasites and cells can look very similar to E. histolytica when seen under a microscope. Therefore, sometimes people are told that they are infected with E. histolytica even though they are not. Entamoeba histolytica and another ameba, Entamoeba dispar, which is about 10 times more common, look the same when seen under a microscope. Unlike infection with E. histolytica, which sometimes makes people sick, infection with E. dispar does not make people sick and therefore does not need to be treated.

If you have been told that you are infected with E. histolytica but you are feeling fine, you might be infected with E. dispar instead. Unfortunately, most laboratories do not yet have the tests that can tell whether a person is infected with E. histolytica or with E. dispar. Until these tests become more widely available, it usually is best to assume that the parasite is E. histolytica.
A blood test is also available but is only recommended when your health care provider thinks that your infection may have spread beyond the intestine (gut) to some other organ of your body, such as the liver. However, this blood test may not be helpful in diagnosing your current illness because the test may still be positive if you had amoebiasis in the past, even if you are no longer infected now.

Complications:

1. Amebic colitis

• Fulminant or necrotizing colitis
• Toxic megacolon
• Ameboma
• Rectovaginal fistulas

2. Amebic liver abscess

• Intrathoracic or intraperitoneal rupture with or without secondary bacterial infection
• Direct extension to pleura or pericardium

3. Brain abscess

Treatment:

1. Metronidazole (Flagyl) 800mg TID X 5 days

2. Tetracyline 250 mg every 6 hours

3. Ampicillin, quinolones sulfadiazine

4. Streptomycin SO4, Chloramphenicol

5. Lost fluid and electrolytes should be replaced

Several antibiotics are available to treat amoebiasis. Treatment must be prescribed by a physician. You will be treated with only one antibiotic if your E. histolytica infection has not made you sick. You probably will be treated with two antibiotics (first one and then the other) if your infection has made you sick.

Nursing Management:

1. Observe isolation and enteric precaution

2. Provide health education and instruct patient to

• Boil water for drinking or use purified water
• Avoid washing food from open drum or pail
• Cover leftover food
• Wash hands after defacation and before eating
• Avoid ground vegetables (lettuce, carrots, and the like)

Methods of Prevention:

• Health education
• Sanitary disposal of feces
• Protect, chlorinate, and purify drinking water
• Observe scrupulous cleanliness in food preparation and food handling
• Detection and treatment of carriers
• Fly control (they can serve as vector)

Resources:

• 
  

http://www.emedicine.com/

http://en.wikipedia.org/

http://kidshealth.org/

http://cdc.gov/

Handbook of Common Communicable and infectious Disease by Dionesia Monjejar-Navales, RN, MAEd

Lippincott Review Series Medical Surgical Nursing 4th Ed

Case Study: Common Discomforts of Pregnancy

Pregnancy is a time of both physical and emotional changes. Aside from the obvious changes in your body shape and the size of your uterus, shifts in hormonal levels and metabolism can contribute to various physical and emotional discomforts.

Although the pregnancy discomforts mentioned below are common, they are not experienced by all pregnant women and may not be a part of your pregnancy. It is important to remember:

• You may need to try more than one remedy before you find one that works for you.
• Good nutrition is especially important for a comfortable and healthy pregnancy. Eating well can minimize discomforts and help your body cope with the stress of daily life.
• If you have a physical discomfort that is severe or does not go away, contact your health care provider.
• If you have a chronic health condition, such as diabetes or asthma, it is very important that you see your health care provider throughout your pregnancy.

DISCOMFORT
1. Ankle Edema

• Rest with your feet elevated.
• Avoid standing for long periods.
• Avoid restrictive garments on the lower half of your body.

2. Backache

• Apply local heat.
• Avoid long periods of standing.
• Stoop to pick up objects.
• Tylenol in usual adult dose may help.
• Wear low-heeled shoes.

3. Breast Tenderness

• Wear a supportive bra.
• Decrease the amount of caffeine and carbonated beverages ingested.

4. Constipation

• Increase fiber in your diet.
• Drink additional fluids.
• Have a regular time for bowel movements.

5. Difficulty Sleeping

• Drink a warm, caffeine-free drink before bed and practice relaxation techniques.

6. Fatigue

• Schedule a rest period daily.
• Have a regular bedtime routine.
• Use extra pillows for comfort.

7. Faintness

• Move slowly.
• Avoid crowds.
• Remain in a cool environment.
• Lie on your left side when at rest.

8. Headache

• Avoid eye strain.
• Visit your eye doctor.
• Rest with a cool cloth on your forehead.
• Take Tylenol in regular adult dose, as needed.
• Report frequent or persistent headaches to your primary care provider.

9. Heartburn

• Eat small, frequent meals each day.
• Avoid overeating, as well as spicy, fatty, and fried foods.

10. Hemorrhoids

• Avoid constipation and straining with a bowel movement.
• Take a sitz bath.
• Apply a witch hazel compress.

11. Leg cramps

• Avoid pointing your toes.
• Straighten your leg and dorsiflex your ankle.

12. Nausea

• Eat six small meals per day rather than three.
• Eat a piece of dry toast or some crackers before getting out of bed.
• Avoid foods or situations that worsen the nausea.
• If it persists, report this problem to your primary care provider.

13. Nasal stuffiness

• Use cool air vaporizer or humidifier
• Increase fluid intake
• Place moist towel on the sinuses
• Massage the sinuses.

14. Ptyalism

• Use mouthwash as needed
• Chew gum or suck on hard candy.

15. Round ligament pain

• Avoid twisting motions.
• Rise to standing position slowly and use your hands to support the abdomen.
• Bend forward to relieve discomfort.

16. Shortness of breath

• Use proper posture.
• Use pillows behind head and shoulders at night.

17. Urinary frequency

• Void as necessary, at least every 2 hours.
• Increase fluid intake.
• Avoid caffeine.
• Practice Kegel exercise.

18. Vaginal discharge

• Wear cotton underwear.
• Bathe daily.
• Avoid tight pantyhose.

19. Varicose veins

• Walk regularly.
• Rest with feet elevated.
• Avoid long periods of standing.
• Rest with feet elevated.
• Avoid long periods of standing.
• Do not cross your legs when sitting.
• Avoid knee-high stockings.
• Wear support hosiery.

Resources:

• California Pacific Medical Center
• Maternal and Child Health Nursing by Adele Pillitteri 3rd Ed

Case Study: Common Problems Among Elderly

Aging is a normal progressive process, beginning at conception and ending in death. Aging is not synonymous with diseases but diseases become more common as age progresses. Usually the diseases present with non-specific multiple symptoms that involve many organs. Increasing age in the elderly is associated with the higher morbidity and frequent use of health services. Their illness tends to be chronic with no simple cure. This makes them more dependent on the family, society and health services.

As the population ages, the nurse practitioner will be more involved in geriatric care. There are solutions that nurse practitioners can offer elderly patients to improve day-to-day functioning.

Problems

1. Confusion/Dementia

• Spend time with the Patient
• Use touch to convey concern
• Provide frequent reiteration of orienting data (e.g. time, place)
• Have clocks or calendars in the environment
• Explain all actions, procedures and routines to the patient
• Address the patient by his/her name
• Keep a routine activities

2. Constipation

• Increase Fluid Intake
• Daily Exercise
• Increase fiber intake (e.g. fruits and vegetables)
• Complications associated with constipation include hemorrhoids from straining, anal fissures, rectal prolapse, and fecal impaction. Untreated constipation in institutionalized patients can lead to cemented lesions in the colon, megacolon, bowel blockage and perforation, peritonitis, and sepsis.

3. Osteoporosis

• Have adequate calcium in diet:
• · Milk/dairy products
• · Fish
• · Beans
• · Orange Juice
• · Cereal or read that have added calcium
• · Take calcium supplements
• Get regular exercise
• Avoid alcohol, quit smoking. Alcohol and smoking reduce bone mass.
• Avoid large amounts of protein – rich or salty and caffeine foods. They can cause loss of calcium from the body.
• Make the home safe to avoid accidents.
• Practice good posture.
• Use good body mechanics when lifting objects (e.g. bend the knees instead of the back).
• Do back exercises to improve posture.
• Wear rubber-soled, low-heeled shoes that grip well.
• Don’t lift heavy objects.
• Avoid using a stool or bending over.
• Put items frequently used within easy reach.
• Use handrails when going up and down stairs.
• Hormonal Replacement Therapy (HRT) for menopausal women as prescribed.

4. Postural Hypotension (PH)

• Get out of bed slowly and in stages.
• Sleep with head of bed elevated several inches.
• Have a daily fluid intake of 2 to 3 liters.
• Avoid hot showers or baths, may cause venous dilatation thereby, venous pooling.
• Avoid straining at stool. This may cause fall of BP
• Avoid bending down and suddenly standing up again.
• Rest for 60 minutes after meals.
• Avoid hyperventilation. This lowers the BP.
• Exercise regimen must be recommended.
• Use thigh-length elastic stockings to reduce venous pooling.
• Avoid prolonged standing.
• Heed warning signs of PH (e.g., dizziness, faintness, visual disturbances)
• Pharmacotherapy: Fludrocortisone (a mineralocorticoid that promotes retention of water and sodium)

5. Hypertension

• Encourage stress reduction and relaxation.
• Encourage exercise such as swimming and walking.
• Encourage healthy diet (fresh fruits, rice, vegetable).
• No weightlifting.
• Quit smoking, no alcohol,
• Reduce intake of saturated fats.
• Reduce salt intake to 1 to 6 gm per day.
• Take prescribed medications at regular basis.

6. Elder abuse

There are many types of abuse used against the elderly. They include:

• Psychologic abuse such as instilling fear, threatening or making the elderly perform demeaning tasks
• Physical abuse such as hitting, slapping, or burning.
• Financial abuse such as taking their money or forcing them to sign over their assets.
• Neglect such as withholding food, medications or basic care.
• Infringement of personal rights such as restraining for long periods of time against their will or isolating them from normal social interactions.
• Sexual abuse
• The perpetrator of abuse is usually the spouse or the children of the victim. Caregivers who abuse their elderly family members are often middle-aged or older or have emotional problems such as alcoholism or substance abuse.

Source: http://www.medscape.com/

Medical-Surgical Nursing First Ed by Professor Josie Quiambao-Udan, RN, MAN

Initial Registration For New Nurses Who Passes Board Exam

Instructions

Initial registrants should come personally to the PRC Central Office or to the nearest Regional Office to file his/her application for registration and to affix his/her signature in the registry book.

All Registration Certificates and PRC ID shall be claimed by the licensee personally at the Central Office or the Regional Office where the application for the same has been filed. If there is an unavoidable need for a representative, he must present his/her identification paper with picture and a Special Power of Attorney.


Requirements

• Duly accomplished Oath Form or Panunumpa ng Propesyonal
• Current Community Tax Certificate (cedula)
• Two pcs. passport size pictures with name tag (for Oath Form and Certificate of Registration)
• One pc. 1”x1” picture in plain background with complete name tag (for Registry of Professionals)
• Two sets of metered documentary stamps (for Oath Form and Certificate of Registration)
• One (1) short brown envelope with name and profession

Prohibitied Acts Inside the Examination Room

1. Accepting or receiving anything, including food from any person while the examination is in progress.
2. Giving money, food, or any favor and other consideration to the Room Watchers and other examination personnel.
3. Loitering, talking, or discussing your answers inside the room or along the corridor while the examination is in progress.
4. Putting any of the following markings on your answer sheets: name, seat number, unnecessary words or phrases, strokes, dots or any other marks not called for in the test questions.

Penalties:

• placing of name in the space provided for the subject of the examination shall be, aside from the cancellation of the examination papers, suspension from taking the examination for one (1) year;
• multiple markings shall be cancellation of the examiness examination and suspension from taking the examination for two (2) years.

5. Taking out the examination room test questions used or pages thereof, copying, and/or divulging or making known the nature or content of any examination question or answer to any individual or entity.


6. Copying or referring to any solution, answer or work of another examinee or allowing anyone to copy or refer to your work, helping or asking help from any person or communication with anyone by means of words, signs, gestures, codes and other similar acts which enable you to exchange, impart or acquire relevant information.
7. Bringing inside the examination rooms the following: books, notes, review materials and other printed materials containing principles or excerpts thereof, coded data/information/ formula which are relevant to or connected with the examination subject, PROGRAMMABLE CALCULATORS, CELLULAR PHONES, beeper, portable personal computers or other similar gadgets/devices. The act shall be considered cheating and/or act of dishonesty and shall be a ground for the cancellation of your examinations (PRC Resolution No. 463 dated November 27, 1996)



Maintain discipline at all times, any misconduct or irregularity on your part or any violation of the examination rules and regulations and instructions will be sufficient cause for the cancellation of your examination papers and your debarment from taking any future licensure examination.
To clear the examinations rooms, do not bring bags of any kind. Keep allowed items and valuables inside your plastic envelope. PRC will not be answerable for lost items.

Handling of Examinee Identification Sheet or Answer Sheet

• Check if the Serial Number of Examinee Identification Sheet/Answer Sheets are the same for all the sheets. If there is any discrepancy, return the set to your Room Watchers for replacement. The Serial Number is NOT the examination number. It has nothing to do with your examination.
• Check if there are defects or unnecessary marks on your Examinee Identification Sheet/Answer Sheets.
• Check if the number of Answer Sheets corresponds to the number of examination subjects.
• Do not fold or mutilate, take extra care and keep clean your Examinee Identification Sheet/Answer Sheets.
• Before detaching an answer sheet, check if the brown envelope is yours and the set inside belongs to you.
  

How To Mark Your Examinee Identification Sheet/Answer Sheets

• Use standard No. 2 pencil only
• Do not use too much pressure
• Mark like this not like these
• Make the mark dark and straight
• Strictly no erasures allowed
  

How to Accomplish Examinee Identification Sheet

Brown Envelope
Print your name on the left top corner and your seat number on the right top corner.









Handling Of Test Question Sets

• Indicate your seat number at the right top corner of page 1
• Check if the number of pages of Test Question Set is complete and no misprint. If there is any problem, return the set to your Room Watchers for replacement.
• Mark A or B on the answer sheet to indicate the set of Test Question assigned to you.
• You can use your Test Question Set as your Scratch .
• Keep the Test Question Set stapled until the end of examination.

Allowable Calculators

Examinees shall be allowed to bring in and use ONLY any of the following calculators that were identified as non-programmable (PRC Memorandum Circular No. 2002-24 dated September 27, 2002.

Casio Standard Scientific Calculators

• Fx82TL
• Fx911W
• Fx570W
• Fx992
• Fx65
• Fx350TL
• Fx100W
• Fx991W
• Fx122S
• Fx500A
• Fx350TLG
• Fx115W
• Fx992S
• Fx901
• Fx95
• FX570MS
• Fx991MS
• Fx115MS
• Fx100Ms
• Fx95MS
  

Casio Standard Calculators (phased-out, still allowed to be used in the examinations)

• Fx260
• Fx509G
• Fx824
• Fx82
• Fx350HA
• Fx520G
• Fx992VB
• Fx82LB
• Fx350HB
• Fx531LH
• Fx991S
• Fx82SX
• Fx300SA
• Fx546D
• Fx991H
• Fx82Super
• Fx300W
• Fx570S
• Fx100D
• Fx401
• Fx570AD
• Fx100S
• Fx451M
• Fx580
• Fx115D
• Fx85S
• Fx506G
• Fx580D
• Fx115S
• Fx546L
• Fx506M
• Fx825X
• Fx75
• Fx509D
• Fx531GH
  

Sharp Calculators Non-Programmable

• EL-506V
• EL-510R
• EL-531G
• EL-520V
• EL-501V
• EL-506P
• EL-531VH
• EL-546L
• EL-520G
• EL-509V
• EL-509D

OtherBrands

• TL30XS
• AURORA 2512
• AURORA
  

Calculators whose brand and identifying mark do not appear in the list above provided shall be prohibited in the examinations.

General Instructions to Examinees

1. Report to the Test Center before 6:30 a.m. on the first day of examination to verify your room and seat numbers.
2. Late examinees will not be admitted.
3. Attend to your personal needs before the start of examination in every subject. No examinee will be allowed to go out of the examination room while the examination is in progress.
4. Always put your answer sheet on top of the armchair while taking the examination.
5. Stop answering the test questions at the end of the time alloted for the subject. Arrange your test papers as follows:

• Notice of Admission;
• Answer Sheet; and
• Test Questionnaire

6. Do not leave the room until

• your answer sheet and test question set are received by the room watchers,
• you have signed, indicated the time and set ( A or B ) on the Examinees Record of Attendance, and
• the lower portion of your Notice of Admission (Certification on the Receipt of Test Papers) is signed by the Room Watchers and returned to you.

How To Apply for The Local Nursing Board Exam

STEP 1. Secure Action Sheet from the PRC Customer Service Center (CSC) and accomplish the same.

STEP 2. Submit the Action Sheet for processing and evaluation at any of the Processing Windows together with the following:

• Original and photo/xerox copies of Transcript of Records with Special Order and Date of Graduation SCANNED PICTURES AND WITH REMARKS “FOR BOARD EXAMINATION PURPOSES ONLY” .View Res.2004-200 .(Graduates of government schools and institutions/programs accredited by recognized accredited agencies under the FAAP are exempted from SO [B]). Graduates of New Schools/degree Programs must submit School Recognition and/or Permit to operate.
• Original and photo/xerox copy of NSO-issued Birth Certificate (in NSO security paper; if NSO copy not very clear, bring copy from the Local Civil Registrar)
• Original and photo/xerox copies of Marriage Contract in NSO security paper (for married female only;if NSO copy not very clear, bring copy from local civil registrar).
• Four (4) passport size colored pictures in white background with complete name tag.
• Current Community Tax Certificate (Cedula)
• Other specific requirements as required by the Commission and/or Professional Regulatory Board.

NOTE: Secure the following from the processor upon approval of your application:

• Computerized Application form (CAF)
• Permanent Examination and Registration Record card (PERRC) (for first-timers)
• Notice of Admission (NOA)
  

STEP 3. Pay examination fee at any of the Cashier Windows. Get Official Receipt.

• Baccalaureate Degree - P 900.00
• Non-Baccalaureate Degree - P600.00
• Removal - P450.00
  

STEP 4. Pay for metered documentary stamps and mailing envelope with metered documentary stamps at the CSC.


STEP 5. Accomplish the CAF, PERRC, and NOA. Indicate the Official Receipt number, date, and amount on the CAF.


STEP 6. Proceed to any of the Issuance Windows (Window 9, 10, 11, 12) for final review of qualifications and documents and issuance of NOA, Applicant's Stub, Program of Examination,

Examinee's Guide and Self-Instruction Sheet.


STEP 7. Keep the Notice of Admission, Official Receipt, and the Applicant's Stub. Bring these with you on the first day of the examination. For further information, read the General Instructions at the back page of the Notice of Admission, Program of Examination, Examinee's guide and Self-Instruction Sheet.


STEP 8. Bring your NOA when you verify with the PRC your school and building assignment which will be posted at the PRC premises two (2) three(3) working days before the examination date.


NO APPLICATION SHALL BE ACCEPTED AFTER THE DEADLINE


Click here to download application flow chart.

Article: Updated List of Products Tested for Presence of Melamine

The health official released yesterday the latest results of the laboratory analysis being performed by BFAD on China-made milk. Melamine was "NOT DETECTED" in the following products:

1. Anchor Wam Froot Milk Drink (Mango Magic)
2. Anchor Wam Froot Milk Drink (Orange Chill)
3. Anchor Wam Froot Milk Drink (Strawberry Spin)
4. Arla Full Cream Milk (repacked)
5. Austria Milk Candies
6. Candyman White Rabbit Butter Toffee Candy
7. Cottage Milk Sweet Cream Butter Milk
8. Crisp Bean Chocolate
9. Crisp Chocolate Stone
10. Dairy America Milk Powder (repacked)
11. Dairy Kreem Skimmed Milk Powder
12. Dong Guan Bairong Coconut Biscuits
13. Farmland Milk Powder
14. Kiddie Soya Milk Egg Delight
15. La Crema (Puregold) Skimmed Milk Powder (original)
16. La Crema (Puregold) Skimmed Milk Powder (regular)
17. Magic Chew Grape Fruit Sharing
18. Milk Drink in Red Can
19. Oakland Skimmed Milk Power
20. Showa Tempura Batter Mix

Fundamentals of Nursing Practice Test III

1. Which element in the circular chain of infection can be eliminated by preserving skin integrity?

a. Host
b. Reservoir
c. Mode of transmission
d. Portal of entry

2. Which of the following will probably result in a break in sterile technique for respiratory isolation?

a. Opening the patient’s window to the outside environment
b. Turning on the patient’s room ventilator
c. Opening the door of the patient’s room leading into the hospital corridor
d. Failing to wear gloves when administering a bed bath

3. Which of the following patients is at greater risk for contracting an infection?

a. A patient with leukopenia
b. A patient receiving broad-spectrum antibiotics
c. A postoperative patient who has undergone orthopedic surgery
d. A newly diagnosed diabetic patient

4. Effective [1] hand washing requires the use of:

a. Soap or detergent to promote emulsification
b. Hot water to destroy bacteria
c. A disinfectant to increase surface tension
d. All of the above

5. After routine patient contact, [1] hand washing should last at least:

a. 30 seconds
b. 1 minute
c. 2 minute
d. 3 minutes

6. Which of the following procedures always requires surgical asepsis?

a. Vaginal instillation of conjugated estrogen
b. [2] Urinary catheterization
c. [3] Nasogastric tube insertion
d. [4] Colostomy irrigation

7. Sterile technique is used whenever:

a. Strict isolation is required
b. Terminal disinfection is performed
c. Invasive procedures are performed
d. Protective isolation is necessary

8. Which of the following constitutes a break in sterile technique while preparing a sterile field for a dressing change?

a. Using sterile forceps, rather than sterile gloves, to handle a sterile item
b. Touching the outside wrapper of sterilized material without sterile gloves
c. Placing a sterile object on the edge of the sterile field
d. Pouring out a small amount of solution (15 to 30 ml) before pouring the solution into a sterile container

9. A natural body defense that plays an active role in preventing infection is:

a. Yawning
b. Body hair
c. Hiccupping
d. Rapid eye movements

10. All of the following statement are true about [5] donning sterile gloves except:

a. The first glove should be picked up by grasping the inside of the cuff.
b. The second glove should be picked up by inserting the gloved fingers under the cuff outside the glove.
c. The gloves should be adjusted by sliding the gloved fingers under the sterile cuff and pulling the glove over the wrist
d. The inside of the glove is considered sterile

11. When removing a contaminated gown, the nurse should be careful that the first thing she touches is the:

a. Waist tie and neck tie at the back of the gown
b. Waist tie in front of the gown
c. Cuffs of the gown
d. Inside of the gown

12. Which of the following nursing interventions is considered the most effective form or universal precautions?

a. Cap all used needles before removing them from their syringes
b. Discard all used uncapped needles and syringes in an impenetrable protective container
c. Wear gloves when administering IM injections
d. Follow enteric precautions

13. All of the following measures are recommended to prevent pressure ulcers except:

a. Massaging the reddened are with lotion
b. Using a water or air mattress
c. Adhering to a schedule for positioning and turning
d. Providing meticulous skin care

14. Which of the following blood tests should be performed before a blood transfusion?

a. Prothrombin and coagulation time
b. Blood typing and cross-matching
c. Bleeding and clotting time
d. Complete blood count (CBC) and electrolyte levels.

15. The primary purpose of a platelet count is to evaluate the:

a. Potential for clot formation
b. Potential for bleeding
c. Presence of an antigen-antibody response
d. Presence of cardiac enzymes

16. Which of the following white blood cell (WBC) counts clearly indicates leukocytosis?

a. 4,500/mm³
b. 7,000/mm³
c. 10,000/mm³
d. 25,000/mm³

17. After 5 days of diuretic therapy with 20mg of [6] furosemide (Lasix) daily, a patient begins to exhibit fatigue, muscle cramping and muscle weakness. These symptoms probably indicate that the patient is experiencing:

a. Hypokalemia
b. Hyperkalemia
c. Anorexia
d. Dysphagia

18. Which of the following statements about chest X-ray is false?

a. No contradictions exist for this test
b. Before the procedure, the patient should remove all jewelry, metallic objects, and buttons above the waist
c. A signed consent is not required
d. Eating, drinking, and medications are allowed before this test

19. The most appropriate time for the nurse to obtain a sputum specimen for culture is:

a. Early in the morning
b. After the patient eats a light breakfast
c. After aerosol therapy
d. After chest physiotherapy

20. A patient with no known allergies is to receive penicillin every 6 hours. When administering the medication, the nurse observes a fine rash on the patient’s skin. The most appropriate nursing action would be to:

a. Withhold the moderation and notify the physician
b. Administer the medication and notify the physician
c. Administer the medication with an antihistamine
d. Apply corn starch soaks to the rash

21. All of the following nursing interventions are correct when using the Z-track method of drug [7] injection except:

a. Prepare the injection site with alcohol
b. Use a needle that’s a least 1” long
c. Aspirate for blood before injection
d. Rub the site vigorously after the injection to promote absorption

22. The correct method for determining the vastus lateralis site for I.M. injection is to:

a. Locate the upper aspect of the upper outer quadrant of the buttock about 5 to 8 cm below the iliac crest
b. Palpate the lower edge of the acromion process and the midpoint lateral aspect of the arm
c. Palpate a 1” circular area anterior to the umbilicus
d. Divide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh

23. The mid-deltoid injection site is seldom used for I.M. injections because it:

a. Can accommodate only 1 ml or less of medication
b. Bruises too easily
c. Can be used only when the patient is lying down
d. Does not readily parenteral medication

24. The appropriate needle size for insulin injection is:

a. 18G, 1 ½” long
b. 22G, 1” long
c. 22G, 1 ½” long
d. 25G, 5/8” long

25. The appropriate needle gauge for intradermal injection is:

a. 20G
b. 22G
c. 25G
d. 26G

26. Parenteral penicillin can be administered as an:

a. IM injection or an IV solution
b. IV or an intradermal injection
c. Intradermal or [8] subcutaneous injection
d. IM or a subcutaneous injection

27. The physician orders gr 10 of aspirin for a patient. The equivalent dose in milligrams is:

a. 0.6 mg
b. 10 mg
c. 60 mg
d. 600 mg

28. The physician orders an IV solution of dextrose 5% in water at 100ml/hour. What would the flow rate be if the drop factor is 15 gtt = 1 ml?

a. 5 gtt/minute
b. 13 gtt/minute
c. 25 gtt/minute
d. 50 gtt/minute

29. Which of the following is a sign or symptom of a hemolytic reaction to blood transfusion?

a. Hemoglobinuria
b. Chest pain
c. Urticaria
d. Distended neck veins

30. Which of the following conditions may require fluid restriction?

a. Fever
b. Chronic Obstructive Pulmonary Disease
c. Renal Failure
d. Dehydration

31. All of the following are common signs and symptoms of phlebitis except:

a. Pain or discomfort at the IV insertion site
b. Edema and warmth at the IV insertion site
c. A red streak exiting the IV insertion site
d. Frank bleeding at the insertion site

32. The best way of determining whether a patient has learned to instill ear medication properly is for the nurse to:

a. Ask the patient if he/she has used ear drops before
b. Have the patient repeat the nurse’s instructions using her own words
c. Demonstrate the procedure to the patient and encourage to ask questions
d. Ask the patient to demonstrate the procedure

33. Which of the following types of medications can be administered via gastrostomy tube?

a. Any oral medications
b. Capsules whole contents are dissolve in water
c. Enteric-coated tablets that are thoroughly dissolved in water
d. Most tablets designed for oral use, except for extended-duration compounds

34. A patient who develops hives after receiving an antibiotic is exhibiting drug:

a. Tolerance
b. Idiosyncrasy
c. Synergism
d. Allergy

35. A patient has returned to his room after femoral arteriography. All of the following are appropriate nursing interventions except:

a. Assess femoral, popliteal, and pedal pulses every 15 minutes for 2 hours
b. Check the pressure dressing for sanguineous drainage
c. Assess a vital signs every 15 minutes for 2 hours
d. Order a hemoglobin and hematocrit count 1 hour after the arteriography

36. The nurse explains to a patient that a cough:

a. Is a protective response to clear the respiratory tract of irritants
b. Is primarily a voluntary action
c. Is induced by the administration of an antitussive drug
d. Can be inhibited by “splinting” the abdomen

37. An infected patient has chills and begins shivering. The best nursing intervention is to:

a. Apply iced alcohol sponges
b. Provide increased cool liquids
c. Provide additional bedclothes
d. Provide increased ventilation

38. A clinical nurse specialist is a nurse who has:

a. Been certified by the National League for Nursing
b. Received credentials from the Philippine Nurses’ Association
c. Graduated from an associate degree program and is a registered professional nurse
d. Completed a master’s degree in the prescribed clinical area and is a registered professional nurse.

39. The purpose of increasing urine acidity through dietary means is to:

a. Decrease burning sensations
b. Change the urine’s color
c. Change the urine’s concentration
d. Inhibit the growth of microorganisms

40. Clay colored stools indicate:

a. Upper GI bleeding
b. Impending constipation
c. An effect of medication
d. Bile obstruction

41. In which step of the [9] nursing process would the nurse ask a patient if the medication she administered relieved his pain?

a. [10] Assessment
b. Analysis
c. [11] Planning
d. [12] Evaluation

42. All of the following are good sources of vitamin A except:

a. White potatoes
b. Carrots
c. Apricots
d. Egg yolks

43. Which of the following is a primary nursing intervention necessary for all patients with a Foley Catheter in place?

a. Maintain the drainage tubing and collection bag level with the patient’s bladder
b. Irrigate the patient with 1% Neosporin solution three times a daily
c. Clamp the catheter for 1 hour every 4 hours to maintain the bladder’s elasticity
d. Maintain the drainage tubing and collection bag below bladder level to facilitate drainage by gravity

44. The ELISA test is used to:

a. Screen blood donors for antibodies to human immunodeficiency virus (HIV)
b. Test blood to be used for transfusion for HIV antibodies
c. Aid in diagnosing a patient with AIDS
d. All of the above

45. The two blood vessels most commonly used for TPN infusion are the:

a. Subclavian and jugular veins
b. Brachial and subclavian veins
c. Femoral and subclavian veins
d. Brachial and femoral veins

46. Effective skin disinfection before a surgical procedure includes which of the following methods?

a. Shaving the site on the day before surgery
b. Applying a topical antiseptic to the skin on the evening before surgery
c. Having the patient take a tub bath on the morning of surgery
d. Having the patient shower with an antiseptic soap on the evening v=before and the morning of surgery

47. When transferring a patient from a bed to a chair, the nurse should use which muscles to avoid back injury?

a. Abdominal muscles
b. Back muscles
c. Leg muscles
d. Upper arm muscles

48. Thrombophlebitis typically develops in patients with which of the following conditions?

a. Increases partial thromboplastin time
b. Acute pulsus paradoxus
c. An impaired or traumatized blood vessel wall
d. Chronic Obstructive Pulmonary Disease (COPD)

49. In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:

a. Respiratory acidosis, ateclectasis, and hypostatic pneumonia
b. Appneustic breathing, atypical pneumonia and respiratory alkalosis
c. Cheyne-Strokes respirations and spontaneous pneumothorax
d. Kussmail’s respirations and hypoventilation

50. Immobility impairs bladder elimination, resulting in such disorders as

a. Increased urine acidity and relaxation of the perineal muscles, causing incontinence
b. Urine retention, bladder distention, and infection
c. Diuresis, natriuresis, and decreased urine specific gravity
d. Decreased calcium and phosphate levels in the urine

Fundamentals of Nursing Practice Test II

1. The most appropriate nursing order for a patient who develops dyspnea and shortness of breath would be…

a. Maintain the patient on strict bed rest at all times
b. Maintain the patient in an orthopneic position as needed
c. Administer oxygen by Venturi mask at 24%, as needed
d. Allow a 1 hour rest period between activities

2. The nurse observes that Mr. Adams begins to have increased difficulty breathing. She elevates the head of the bed to the high Fowler position, which decreases his respiratory distress. The nurse documents this breathing as:

a. Tachypnea
b. Eupnca
c. Orthopnea
d. Hyperventilation

3. The physician orders a platelet count to be performed on Mrs. Smith after breakfast. The nurse is responsible for:

a. Instructing the patient about this diagnostic test
b. Writing the order for this test
c. Giving the patient breakfast
d. All of the above

4. Mrs. Mitchell has been given a copy of her diet. The nurse discusses the foods allowed on a 500-mg low sodium diet. These include:

a. A ham and Swiss cheese sandwich on whole wheat bread
b. Mashed potatoes and broiled chicken
c. A tossed salad with oil and vinegar and olives
d. Chicken bouillon

5. The physician orders a maintenance dose of 5,000 units of subcutaneous heparin (an anticoagulant) daily. Nursing responsibilities for Mrs. Mitchell now include:

a. Reviewing daily activated partial thromboplastin time (APTT) and prothrombin time.
b. Reporting an APTT above 45 seconds to the physician
c. Assessing the patient for signs and symptoms of frank and occult bleeding
d. All of the above

6. The four main concepts common to nursing that appear in each of the current conceptual models are:

a. Person, nursing, environment, medicine
b. Person, health, nursing, support systems
c. Person, health, psychology, nursing
d. Person, environment, health, nursing

7. In Maslow’s hierarchy of physiologic needs, the human need of greatest priority is:

a. Love
b. Elimination
c. Nutrition
d. Oxygen

8. The family of an accident victim who has been declared brain-dead seems amenable to organ donation. What should the nurse do?

a. Discourage them from making a decision until their grief has eased
b. Listen to their concerns and answer their questions honestly
c. Encourage them to sign the consent form right away
d. Tell them the body will not be available for a wake or funeral

9. A new head nurse on a unit is distressed about the poor staffing on the 11 p.m. to 7 a.m. shift. What should she do?

a. Complain to her fellow nurses
b. Wait until she knows more about the unit
c. Discuss the problem with her supervisor
d. Inform the staff that they must volunteer to rotate

10. Which of the following principles of primary nursing has proven the most satisfying to the patient and nurse?

a. Continuity of patient care promotes efficient, cost-effective nursing care
b. Autonomy and authority for [1] planning are best delegated to a nurse who knows the patient well
c. Accountability is clearest when one nurse is responsible for the overall plan and its [2] implementation.
d. The holistic approach provides for a therapeutic relationship, continuity, and efficient nursing care.

11. If nurse administers an [3] injection to a patient who refuses that injection, she has committed:

a. Assault and battery
b. Negligence
c. Malpractice
d. None of the above

12. If patient asks the nurse her opinion about a particular physicians and the nurse replies that the physician is incompetent, the nurse could be held liable for:

a. Slander
b. Libel
c. Assault
d. Respondent superior

13. A registered nurse reaches to answer the telephone on a busy pediatric unit, momentarily turning away from a 3 month-old infant she has been weighing. The infant falls off the scale, suffering a skull fracture. The nurse could be charged with:

a. Defamation
b. Assault
c. Battery
d. Malpractice

14. Which of the following is an example of nursing malpractice?

a. The nurse administers penicillin to a patient with a documented history of allergy to the drug. The patient experiences an allergic reaction and has cerebral damage resulting from anoxia.
b. The nurse applies a hot water bottle or a heating pad to the abdomen of a patient with abdominal cramping.
c. The nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus.
d. The nurse administers the wrong medication to a patient and the patient vomits. This information is documented and reported to the physician and the nursing supervisor.

15. Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative pain following abdominal surgery?

a. Decreased blood pressure and heart rate and shallow respirations
b. Quiet crying
c. Immobility, diaphoresis, and avoidance of deep breathing or coughing
d. Changing position every 2 hours

16. A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea, and severe abdominal pain. Which of the following would immediately alert the nurse that the patient has bleeding from the GI tract?

a. Complete blood count
b. Guaiac test
c. Vital signs
d. Abdominal girth

17. The correct sequence for assessing the abdomen is:

a. Tympanic percussion, measurement of abdominal girth, and inspection
b. Assessment for distention, tenderness, and discoloration around the umbilicus.
c. Percussions, palpation, and auscultation
d. Auscultation, percussion, and palpation

18. High-pitched gurgles head over the right lower quadrant are:

a. A sign of increased bowel motility
b. A sign of decreased bowel motility
c. Normal bowel sounds
d. A sign of abdominal cramping

19. A patient about to undergo abdominal inspection is best placed in which of the following positions?

a. Prone
b. Trendelenburg
c. Supine
d. Side-lying

20. For a rectal examination, the patient can be directed to assume which of the following positions?

a. Genupecterol
b. Sims
c. Horizontal recumbent
d. All of the above

21. During a Romberg test, the nurse asks the patient to assume which position?

a. Sitting
b. Standing
c. Genupectoral
d. Trendelenburg

22. If a patient’s blood pressure is 150/96, his pulse pressure is:

a. 54
b. 96
c. 150
d. 246

23. A patient is kept off food and fluids for 10 hours before surgery. His oral temperature at 8 a.m. is 99.8 F (37.7 C) This temperature reading probably indicates:

a. Infection
b. Hypothermia
c. Anxiety
d. Dehydration

24. Which of the following parameters should be checked when assessing respirations?

a. Rate
b. Rhythm
c. Symmetry
d. All of the above

25. A 38-year old patient’s vital signs at 8 a.m. are axillary temperature 99.6 F (37.6 C); pulse rate, 88; respiratory rate, 30. Which findings should be reported?

a. Respiratory rate only
b. Temperature only
c. Pulse rate and temperature
d. Temperature and respiratory rate

26. All of the following can cause tachycardia except:

a. Fever
b. Exercise
c. Sympathetic nervous system stimulation
d. Parasympathetic nervous system stimulation

27. Palpating the midclavicular line is the correct technique for assessing

a. Baseline vital signs
b. Systolic blood pressure
c. Respiratory rate
d. Apical pulse

28. The absence of which pulse may not be a significant finding when a patient is admitted to the hospital?

a. Apical
b. Radial
c. Pedal
d. Femoral

29. Which of the following patients is at greatest risk for developing pressure ulcers?

a. An alert, chronic arthritic patient treated with steroids and aspirin
b. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home
c. An apathetic 63-year old COPD patient receiving nasal oxygen via cannula
d. A confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed.

30. The physician orders the administration of high-humidity oxygen by face mask and placement of the patient in a high Fowler’s position. After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. Which of the following nursing interventions has the greatest potential for improving this situation?

a. Encourage the patient to increase her fluid intake to 200 ml every 2 hours
b. Place a humidifier in the patient’s room.
c. Continue administering oxygen by high humidity face mask
d. Perform chest physiotheraphy on a regular schedule

31. The most common deficiency seen in alcoholics is:

a. Thiamine
b. Riboflavin
c. Pyridoxine
d. Pantothenic acid

32. Which of the following statement is incorrect about a patient with dysphagia?

a. The patient will find pureed or soft foods, such as custards, easier to swallow than water
b. Fowler’s or semi Fowler’s position reduces the risk of aspiration during swallowing
c. The patient should always feed himself
d. The nurse should perform oral hygiene before assisting with feeding.

33. To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures his hourly urine output. She should notify the physician if the urine output is:

a. Less than 30 ml/hour
b. 64 ml in 2 hours
c. 90 ml in 3 hours
d. 125 ml in 4 hours

34. Certain substances increase the amount of urine produced. These include:

a. Caffeine-containing drinks, such as coffee and cola.
b. Beets
c. Urinary analgesics
d. Kaolin with pectin (Kaopectate)

35. A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Which of the following nursing interventions would be appropriate?

a. Encourage the patient to walk in the hall alone
b. Discourage the patient from walking in the hall for a few more days
c. Accompany the patient for his walk.
d. Consuit a physical therapist before allowing the patient to ambulate

36. A patient has exacerbation of chronic obstructive pulmonary disease (COPD) manifested by shortness of breath; orthopnea: thick, tenacious secretions; and a dry hacking cough. An appropriate nursing diagnosis would be:

a. Ineffective airway clearance related to thick, tenacious secretions.
b. Ineffective airway clearance related to dry, hacking cough.
c. Ineffective individual coping to COPD.
d. Pain related to immobilization of affected leg.

37. Mrs. Lim begins to cry as the nurse discusses hair loss. The best response would be:

a. “Don’t worry. It’s only temporary”
b. “Why are you crying? I didn’t get to the bad news yet”
c. “Your hair is really pretty”
d. “I know this will be difficult for you, but your hair will grow back after the completion of chemotheraphy”

38. An additional Vitamin C is required during all of the following periods except:

a. Infancy
b. Young adulthood
c. Childhood
d. Pregnancy

39. A prescribed amount of oxygen s needed for a patient with COPD to prevent:

a. Cardiac arrest related to increased partial pressure of carbon dioxide in arterial blood (PaCO2)
b. Circulatory overload due to hypervolemia
c. Respiratory excitement
d. Inhibition of the respiratory hypoxic stimulus

40. After 1 week of hospitalization, Mr. Gray develops hypokalemia. Which of the following is the most significant symptom of his disorder?

a. Lethargy
b. Increased pulse rate and blood pressure
c. Muscle weakness
d. Muscle irritability

41. Which of the following nursing interventions promotes patient safety?

a. Asses the patient’s ability to ambulate and transfer from a bed to a chair
b. Demonstrate the signal system to the patient
c. Check to see that the patient is wearing his identification band
d. All of the above

42. Studies have shown that about 40% of patients fall out of bed despite the use of side rails; this has led to which of the following conclusions?

a. Side rails are ineffective
b. Side rails should not be used
c. Side rails are a deterrent that prevent a patient from falling out of bed.
d. Side rails are a reminder to a patient not to get out of bed

43. Examples of patients suffering from impaired awareness include all of the following except:

a. A semiconscious or over fatigued patient
b. A disoriented or confused patient
c. A patient who cannot care for himself at home
d. A patient demonstrating symptoms of drugs or alcohol withdrawal

44. The most common injury among elderly persons is:

a. Atheroscleotic changes in the blood vessels
b. Increased incidence of gallbladder disease
c. Urinary Tract Infection
d. Hip fracture

45. The most common psychogenic disorder among elderly person is:

a. Depression
b. Sleep disturbances (such as bizarre dreams)
c. Inability to concentrate
d. Decreased appetite

46. Which of the following vascular system changes results from aging?

a. Increased peripheral resistance of the blood vessels
b. Decreased blood flow
c. Increased work load of the left ventricle
d. All of the above

47. Which of the following is the most common cause of dementia among elderly persons?

a. Parkinson’s disease
b. Multiple sclerosis
c. Amyotrophic lateral sclerosis (Lou Gerhig’s disease)
d. Alzheimer’s disease

48. The nurse’s most important legal responsibility after a patient’s death in a hospital is:

a. Obtaining a consent of an autopsy
b. Notifying the coroner or medical examiner
c. Labeling the corpse appropriately
d. Ensuring that the attending physician issues the death certification

49. Before rigor mortis occurs, the nurse is responsible for:

a. Providing a complete bath and dressing change
b. Placing one pillow under the body’s head and shoulders
c. Removing the body’s clothing and wrapping the body in a shroud
d. Allowing the body to relax normally

50. When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to:

a. Protect the patient from injury
b. Insert an airway
c. Elevate the head of the bed
d. Withdraw all pain medications

Fundamentals of Nursing Practice Test I

1. Using the principles of standard precautions, the nurse would wear gloves in what nursing interventions?

a. Providing a back massage
b. Feeding a client
c. Providing hair care
d. Providing oral hygiene

2. The nurse is preparing to take vital sign in an alert client admitted to the hospital with dehydration secondary to vomiting and diarrhea. What is the best method used to assess the client’s temperature?

a. Oral
b. Axillary
c. Radial
d. Heat sensitive tape

3. A nurse obtained a client’s pulse and found the rate to be above normal. The nurse document this findings as:

a. Tachypnea
b. Hyper pyrexia
c. Arrythmia
d. Tachycardia

4. Which of the following actions should the nurse take to use a wide base support when assisting a client to get up in a chair?

a. Bend at the waist and place arms under the client’s arms and lift
b. Face the client, bend knees and place hands on client’s forearm and lift
c. Spread his or her feet apart
d. Tighten his or her pelvic muscles

5. A client had oral surgery following a motor vehicle accident. The nurse assessing the client finds the skin flushed and warm. Which of the following would be the best method to take the client’s body temperature?

a. Oral
b. Axillary
c. Arterial line
d. Rectal

6. A client who is unconscious needs frequent mouth care. When performing a mouth care, the best position of a client is:

a. Fowler’s position
b. Side lying
c. Supine
d. Trendelenburg

7. A client is hospitalized for the first time, which of the following actions ensure the safety of the client?

a. Keep unnecessary furniture out of the way
b. Keep the lights on at all time
c. Keep side rails up at all time
d. Keep all equipment out of view

8. A walk-in client enters into the clinic with a chief complaint of abdominal pain and diarrhea. The nurse takes the client’s vital sign hereafter. What phrase of nursing process is being implemented here by the nurse?

a. Assessment
b. Diagnosis
c. [1] Planning
d. [2] Implementation

9. It is best describe as a systematic, rational method of planning and providing nursing care for individual, families, group and community

a. Assessment
b. Nursing Process
c. Diagnosis
d. Implementation

10. Exchange of gases takes place in which of the following organ?

a. Kidney
b. Lungs
c. Liver
d. Heart

11. Chambers of the heart that receives oxygenated blood from the lungs is the?

a. Left atrium
b. Right atrium
c. Left ventricle
d. Right ventricle

12. A muscular enlarge pouch or sac that lies slightly to the left which is used for temporary storage of food…

a. Gallbladder
b. Urinary bladder
c. Stomach
d. Lungs

13. The ability of the body to defend itself against scientific invading agent such as baceria, toxin, viruses and foreign body

a. Hormones
b. Secretion
c. Immunity
d. Glands

14. Hormones secreted by Islets of Langerhans

a. Progesterone
b. Testosterone
c. Insulin
d. Hemoglobin

15. It is a transparent membrane that focuses the light that enters the eyes to the retina.

a. Lens
b. Sclera
c. Cornea
d. Pupils

16. Which of the following is included in Orem’s theory?

a. Maintenance of a sufficient intake of air
b. Self perception
c. Love and belonging
d. Physiologic needs

17. Which of the following cluster of data belong to Maslow’s hierarchy of needs

a. Love and belonging
b. Physiologic needs
c. Self actualization
d. All of the above

18. This is characterized by severe symptoms relatively of short duration.

a. Chronic Illness
b. Acute Illness
c. Pain
d. Syndrome

19. Which of the following is the nurse’s role in the health promotion

a. Health risk appraisal
b. Teach client to be effective health consumer
c. Worksite wellness
d. None of the above

20. It is describe as a collection of people who share some attributes of their lives.

a. Family
b. Illness
c. Community
d. Nursing

21. Five teaspoon is equivalent to how many milliliters (ml)?

a. 30 ml
b. 25 ml
c. 12 ml
d. 22 ml

22. 1800 ml is equal to how many liters?

a. 1.8
b. 18000
c. 180
d. 2800

23. Which of the following is the abbreviation of drops?

a. Gtt.
b. Gtts.
c. Dp.
d. Dr.

24. The abbreviation for micro drop is…

a. µgtt
b. gtt
c. mdr
d. mgts

25. Which of the following is the meaning of PRN?

a. When advice
b. Immediately
c. When necessary
d. Now

26. Which of the following is the appropriate meaning of CBR?

a. Cardiac Board Room
b. Complete Bathroom
c. Complete Bed Rest
d. Complete Board Room

27. 1 tsp is equals to how many drops?

a. 15
b. 60
c. 10
d. 30

28. 20 cc is equal to how many ml?

a. 2
b. 20
c. 2000
d. 20000

29. 1 cup is equals to how many ounces?

a. 8
b. 80
c. 800
d. 8000

30. The nurse must verify the client’s identity before administration of medication. Which of the following is the safest way to identify the client?

a. Ask the client his name
b. Check the client’s identification band
c. State the client’s name aloud and have the client repeat it
d. Check the room number

31. The nurse prepares to administer buccal medication. The medicine should be placed…

a. On the client’s skin
b. Between the client’s cheeks and gums
c. Under the client’s tongue
d. On the client’s conjuctiva

32. The nurse administers cleansing enema. The common position for this procedure is…

a. Sims left lateral
b. Dorsal Recumbent
c. Supine
d. Prone

33. A client complains of difficulty of swallowing, when the nurse try to administer capsule medication. Which of the following measures the nurse should do?

a. Dissolve the capsule in a glass of water
b. Break the capsule and give the content with an applesauce
c. Check the availability of a liquid preparation
d. Crash the capsule and place it under the tongue

34. Which of the following is the appropriate route of administration for insulin?

a. Intramuscular
b. Intradermal
c. Subcutaneous
d. Intravenous

35. The nurse is ordered to administer ampicillin capsule TIP p.o. The nurse shoud give the medication…

a. Three times a day orally
b. Three times a day after meals
c. Two time a day by mouth
d. Two times a day before meals

36. Back Care is best describe as:

a. Caring for the back by means of massage
b. Washing of the back
c. Application of cold compress at the back
d. Application of hot compress at the back

37. It refers to the preparation of the bed with a new set of linens

a. Bed bath
b. Bed making
c. Bed shampoo
d. Bed lining

38. Which of the following is the most important purpose of handwashing

a. To promote hand circulation
b. To prevent the transfer of microorganism
c. To avoid touching the client with a dirty hand
d. To provide comfort

39. What should be done in order to prevent contaminating of the environment in bed making?

a. Avoid funning soiled linens
b. Strip all linens at the same time
c. Finished both sides at the time
d. Embrace soiled linen

40. The most important purpose of cleansing bed bath is:

a. To cleanse, refresh and give comfort to the client who must remain in bed
b. To expose the necessary parts of the body
c. To develop skills in bed bath
d. To check the body temperature of the client in bed

41. Which of the following technique involves the sense of sight?

a. Inspection
b. Palpation
c. Percussion
d. Auscultation

42. The first techniques used examining the abdomen of a client is:

a. Palpation
b. Auscultation
c. Percussion
d. Inspection

43. A technique in physical examination that is use to assess the movement of air through the tracheobronchial tree:

a. Palpation
b. Auscultation
c. Inspection
d. Percussion

44. An instrument used for auscultation is:

a. Percussion-hammer
b. Audiometer
c. Stethoscope
d. Sphygmomanometer

45. Resonance is best describe as:

a. Sounds created by air filled lungs
b. Short, high pitch and thudding
c. Moderately loud with musical quality
d. Drum-like

46. The best position for examining the rectum is:

a. Prone
b. Sim’s
c. Knee-chest
d. Lithotomy

47. It refers to the manner of walking

a. Gait
b. Range of motion
c. Flexion and extension
d. Hopping

48. The nurse asked the client to read the Snellen chart. Which of the following is tested:

a. Optic
b. Olfactory
c. Oculomotor
d. Troclear

49. Another name for knee-chest position is:

a. Genu-dorsal
b. Genu-pectoral
c. Lithotomy
d. Sim’s

50. The nurse prepare IM [3] injection that is irritating to the subcutaneous tissue. Which of the following is the best action in order to prevent tracking of the medication

a. Use a small gauge needle
b. Apply ice on the injection site
c. Administer at a 45° angle
d. Use the Z-track technique

Article: How To Stay Happy Always

1. Throw out nonessential numbers. This includes age, weight, and height. Let the doctors worry about them.. That is why you pay them.

2. Keep only cheerful friends. The grouches pull you down. (Keep this in mind if you are one of those grouches!)

3. Keep learning: Learn more about the computer, crafts, gardening, whatever. Never let the brain get idle. 'An idle mind is the devil's workshop.' And the devil's name is Alzheimer's!

4. Enjoy the simple things

5. Laugh often, long and loud. Laugh until you gasp for breath. And if you have a friend who makes you laugh, spend lots and lots of time with him or her! 6. The tears happen: Endure, grieve, and move on. The only person who is with us our entire life, is ourself. LIVE while you are alive.

7. Surround yourself with what you love: Whether it's family, pets, keepsakes, music, plants, hobbies, whatever. Your home is your refuge.

8. Cherish your health: If it is good, preserve it. If it is unstable, improve it. If it is beyond what you can improve, get help.

9. Don't take guilt trips. Take a trip to the mall, even to a foreign country, but NOT to where the guilt is

10. Tell the people you love that you love them, at every opportunity.

Article: 22 More Products Banned in RP for Testing Positive in Melamine

Aside from the two products found positive for Melamine before, BFAD added these 22 products in its ban list in the Philippines because of presence of Melamine last October 8, 2008:

• Sanlu (Shijiazhuang Sanlu Group Inc.);
• Panda Baby (Shanghai Panda Dairy Co. Ltd.);
• Syrutra (Syrutra International Inc.);
• Gucheng (Shanxi Gucheng Dairy Co. Ltd.);
• Hero (Jiangxi Bright & Hero Dairy C);
• Huimin/HMDP (Baoji Huimin Milk Co. Ltd.);
• Mengniu (Mengniu Dairy);
• Kocci (Duojiaduo Dairy Industry Tianjin Co. Ltd.);
• Yaahili (Guangdong Yashili Group Co. Ltd.);
• Nanshan Beiyi (Hunan Peiyi Dairy Co.);
• Heilongjiang Qining Dairy Co.);
• Yashili (Shanxi Yashili Dairy Co.);
• Jinbishi (Shenzhen Jinbishi Milk Co. Ltd.);
• Scient (Guangzhou Shien Dairy Co.);
• Jinding (Guangzhou Jinding Dairy Co.);
• Yili (Inner Mongolia Yili Industrial Group Co.);
• Ausmeadow (Ausmeadow Nutriment Co. Ltd.);
• Suncare (Aikeding, Qingdao Suncare Nutritional Technology Co. Ltd.);
• Yubao (Xi'an Baiyue Dairy Co. Ltd.);
• Leilei (Yantai Leilei Dairy Products Co. Ltd.);
• Baoanli (Shanghai Bao'anli Dairy Co. Ltd.);
• Hikid (Fuding Chenguan Dairy Co. Ltd.)

Watch out for these products and should never be distributed or displayed in groceries nationwide...

Article: List of Milk and Milk Products Tested for Presence of Melamine

The following are the products tested by the Department of Health (DOH) and Bureau of Foods and Drugs (BFAD) due to the Melamine Scare brought by incidences in China where consuming products with Melamine caused many children and infants to have kidney stones and some even lead to DEATH. This products are being tested because of their milk content which is believed to be imported from China. If found positive, the products will be banned in the country for the safety and welfare of the public. it is important that Filipinos adhere to this list to avoid complications of such chemical.

The following is the list of products found by the DOH-BFAD to be NEGATIVE FOR MELAMINE. The list, officially referred to as DOH-BFAD Health Advisory No. 2008-009, Partial List of Milk and Milk products Tested for the Presence of Melamine [PDF file- Ed.], of products deemed melamine-free are as follows:

• Anchor Lite Milk
• Anlene High Calcium Low Fat Milk U.H.T. (recombined)
• Bear Brand Instant
• Chichok Milk Chocolate
• Farmland Skim Milk
• Jinwei Drink
• Jolly Cow Pure Fresh Milk
• Kiddie Soya Milk Egg Delight
• Lactogen 1 DHA Infant Formula
• M&M’s Milk Chocolate Candies
• M&M’s Peanut Chocolate Candies
• Milk Boy
• Nestogen 2 DHA Follow-up Formula
• Nestogen 3 DHA Follow-up Formula
• Nido 3+ Prebio with DHA
• Nido Full Cream Milk Powder
• Nido Junior
• No-Sugar Chocolate of Isomaltooligosaccharide (Cocoa Butter Substitute)
• Nutri Express Milk Drink
• PURA UHT Fresh Milk
• Snickers Fresh Roasted in Caramel & Soft Nougat in Thick Milk Chocolate
• Vitasoy Soya Bean Milk
• Wahaha Orange
• Wahaha Yellow
• Want-Want Milk Drink (Red Can)
• Windmill Skim Milk Powder
• Yinlu Milk Peanut
• Yogee Yoghurt Flavor Milk Drink

However, this products tested POSITIVE for MELAMINE:

• Greenfood Yili Fresh Milk (in Chinese character)
• Mengniu Drink (in Chinese character)
  

Article: 8 Easy, Instant Mood Busters

by Jessica Ashley, Shine staff

We all have our ups and downs, there are days that seems hell to us and there are ones which makes us smile. Living in a big city brings stress almost everyday and usually at every bend which means it is exhausting our energy and positive mood. In order to destress, some opt to go to Spa and other stress busters out there. Fascinatingly, putting your stress away does not really need to be expensive, you will even be surprise on how simple it is to relax and avoid stress. You can actually boost your mood quickly with these 8 easy tips:

1. Clear your space, clear your mind. It's amazing how a few piles of paperwork and a pile of empty containers can make a busy day feel even more gruesome. Set a cell phone alarm or timer for five minutes and use that time to de-clutter a manageable space around you. Focus your efforts on your desk or kitchen counter rather than a whole room or cubicle. Put everything that needs your attention today into a file folder and find a place everything else in drawers, baskets or the trash. Write down any thoughts or tasks that are causing you anxiety or have upcoming deadlines so you are left with reminders rather than worries. If you need to take three breaks a day to clean your space, so be it. As long as it helps you stay calm and feel organized and in control, it is worth the time. If you make a habit of taking one of these breaks before you leave the office or turn in for the night, think how much better your mood will be when you return in the morning.

2. Put on a little mood-lifting music. Whether pop music, nature sounds or jazz makes you smile or sing or dance in your chair, even a song or two will help you escape the blues. Bring a CD in your car, bag or desk to pop in or upload a special playlist full of songs that always make you feel better. If you don't have an MP3 player or disc at your fingertips, simply go to YouTube and search for videos tagged "peaceful" or "happy." You may end up with a crazy karaoke lady performance or a kitty cat rolling around to hip-hop, but the chances are good your mood will be boosted with those funny acts.

3. Make yourself laugh (or at least grin). Studies show that laughter not only has a powerful impact on your mood, it sends your body into an instant state of relaxation. In fact, the anticipation of laughter (as we wait for a punchline, for example) sends a wave of electricity over our cerebral cortex, causing a physiological and psychological connection to even the worst jokes. There's no need to force yourself to smile or do any of that weird belly-laugh yoga to get the good effects of humor. Make it easy on yourself by keeping an email file or folder of emails, cards, messages and cartoons you get that really do make you LOL (laugh out loud). Birthday card from your best friend or a sticky note of congratulations on a successful project are also nice reminders that people love and support you and are guaranteed to warm up your attitude. (Be sure to delete or throw items from this folder once in a while so your happy file doesn't cause unhappiness-inducing clutter.)

4. Focus on your favorite color. There's plenty of research that says painting your walls certain colors will help make you feel more serene or productive or sexy in that room. I love that strategy when I move into a new place or redecorate, but that investment's not always plausible and it's certainly not quick or easy. Thank goodness it's possible to get a quick fix with just a bit of those mood-lifting colors. The colors evoke such a sense of joy and serenity that it will make you feel glad each time you ntake a glance of it. If hot pink makes you feel happy or turquoise reminds you of the most amazing, relaxing vacation of your life, get a coffee mug or flowers or nail polish in that color as a focal point when you need a boost.

5. Mix up something good to eat or drink. Being hungry or hydrated can impact your concentration, energy level and ability to cope with stressers. No, that doesn't mean a bottle of beer or a bag full of candy bars will make you feel better. While alcohol or sugar may give you temporary comfort, you will probably feel worse once that wears off. Instead, choose a healthier snack or small meal that combines protein and carbohydrates. Bread with peanut butter, butter and honey, nuts and dried fruit, skim milk are all tasty and will fuel your body longer than a treat. Drinking a big glass of water (rather than coffee...sigh) will also help boost you up.

6. Stretch yourself. Get up from behind the monitor or television or steering wheel. Go for a ten-minute walk or just do three or four stretches. There's no need to do a full workout but do focus in on which muscles ache and gently stretch and massage those areas to increase circulation. Rubbing your hands, feet, neck and temples with a lightly-scented lotion or oil does wonders if you have to remain seated. I keep a small bottle of cologne in my desk and next to my laptop for quick, rejuvenating hand massages while I sit. It's amazing how diverting my attention just slightly from work keeps my stress away. If depression is an issue for you, regular exercise may be a way to help elevate your mood. For all of us, it's no shock that pounding out stress on a treadmill or releasing everyday anxiety on the yoga mat does wonders for how good we feel physically and emotionally over time.

7. Exhale the tension, then inhale something that smells sweet. Combine the one-two of breathing deeply as an exercise or in meditation or prayer with aromatherapy for a quick mood change. Set the stage for a few peaceful moments by spritzing a room spray or lighting a candle in a calming scent. If there is a tea or flower that evokes a sense of calm to you, keep some on hand for these occasions. Once that scent has circulated a bit, take a breathing break. Close your eyes or turn away from whatever it is that has brought your mood down and center on taking full breaths in and out. Add a time for reflection or prayer, or if you need guidance, listen to a meditation podcast.

8. Start over. If nothing else helps and it looks like your day is a complete dump, why not take a shower? If you can make the time, give yourself a half-hour (or more) to linger a little longer than usual in a warm shower. Not only will the change in your routine shake off some of the stress, studies show that heating up your core temperature can also warm up your mood. Then do some simple self-care rituals like applying your favorite moisturizer and putting on comfortable clothes you feel good wearing. Even if you have to return to work or your to-do list, at least you know you can hit the re-set button on your attitude first.