FAQ:
0________________________________________________
Q: What are the EBOOKS?
A: There are two EBOOKS, One that goes with each video:
1) AOC EBOOK for the AOC (areas of care) video
2) Lab Sim EBOOK for the LS (lab sims) video
Upon ordering the VIDEO(s) you will receive the username and password
for each EBOOK via E-mail.
(NOTE: If you order both videos you will receive 2 separate E-mails for
each EBOOK - one Email will have the username and password for the
AOC EBOOK and another Email will have the username and password for
the LAB SIM EBOOK. Please check your JUNK/SPAM folder if they do not
arrive in your INBOX within 15 minutes. :NOTE)
Each Ebook contains all of the ancillary documents that you will need to be
successful for the CPNE. Since I created the video in 2008 there have
been changes to the CPNE. As such, I have reflected those changes in the
EBOOKS so you can be sure that you are getting the most up to date
information to prepare you to pass the CPNE. To be truly successful with
my program you MUST use the EBOOKS.
You may download and evaluate the EBOOKS for free by going to the
HOME page of this website. Downloads are at the top in RED (full version
of the EBOOKS available upon purchase of the AOC and/or LAB SIM video)
1________________________________________________
Q: What are the requirements for the DOUBLE YOUR MONEY BACK
GUARANTEE ?
A: Starting 12/5/2009 - If my videos and EBOOK do not get you through this
test then simply return the videos and your "notice of failure" sheet given to you by
the CA and I will REFUND DOUBLE THE MONEY THAT YOU PAID FOR THE VIDEOS! Since
April 2008 I have only had ONE person ask for a refund (through no fault of the videos)
If the videos/EBOOK are directly responsible for your failure then you are eligible.
Now you really have nothing to lose with this system.
2________________________________________________
Q: Why should I order from you? Can't I just go to one of those workshops and learn
from them?
A: You CAN go to a workshop and learn a lot of good information. However, do you
want to spend hundreds of dollars on the workshop, not including airfare, hotel, food,
and time off of work and family? With this video it will show you EXACTLY how to
prepare for the CPNE so you PASS! Look at me, I am in a sales job and have zero
patient contact, but yet I passed with no repeats.
3________________________________________________
Q: What is the difference between the Area of Care Video and the Lab Sim video?
A: The CPNE is divided into 2 sections. The lab sims, and the PCS (patient care
situations). In each PCS you will have to do AOC's (areas of care). The areas of care
are divided into 3 categories with their own critical elements:
AOC Critical Elements
1) Overriding areas of care - Asepsis, Caring, Emotional Jeopardy, Mobility, Physical
Jeopardy
2) Required areas of care - Fluid management, vital signs
3) Selected areas of care - abdominal assessment, neurological assessment,
peripheral vascular assessment, respiratory
assessment, skin assessment, comfort management,
musculoskeletal management, oxygen management,
pain management, respiratory management,
wound management, drainage and specimen collection,
irrigation, medications and patient teaching
When I talk about the AOC video and documents I am talking about teaching the 3
categories of AOC's, their critical elements, and the documents that support this
section (nursing care plans, grid, sample charting, mnemonics, and mnemonic
pictures).
When I am talking about the lab sim section that consists of 4 stations - IV
medications station (IV piggyback), IM/SQ Injection station, IV push station, and
Wound station and all the documents that support this section
4________________________________________________
Q: Why is the cost so low? I see simple notes being sold online for more, so what
gives?
A: I paid $7800.00 to an outside agency for help with the nursing concepts test. Then I
paid another $1500.00 for all the testing centers. And THEN I paid for my first CPNE
and I FAILED! (grand total for my first CPNE was $2789.00). I felt that the only thing
that people wanted from me was money and I was sick of, "higher learning
establishments". The reason the cost is so low is because I know how expensive this
process can be and I understand where you are coming from. If there was a website
out there that was like this one I would not have hesitated to buy an actual VIDEO of
someone doing the areas of care so I could go into the CPNE with CONFIDENCE.
Instead I had to buy someone's notes on EBAY for $100.00 that turned out to be
worthless.
5________________________________________________
Q: You keep talking about these mnemonics with pictures that will help the
information stick. What does that mean?
A: I consider myself a reasonably smart person, but I have a horrible memory. I
learned a long time ago that people think in pictures. This is why apple computers are
so successful. They have a bunch of little icons that represent a lot of different
information. Mnemonics are great, but unless you practice them over and over you will
forget, and sometimes nerves take over and you still forget! That is why I use pictures
with my mnemonics. For example, the area of care, Skin assessment, has the
mnemonic TIME to check Color of skin. T=temp, I=integrity, M=moisture, E=edema,
Color=color. The picture is a persons arm from the elbow down and it is covered with
hives. On the wrist is a watch and it is causing you an unbearable itch. If you think of
this picture, the mnemonic "comes alive". These pictures and mnemonics are available
to you when you sign up. To see what I am talking about check out the "EXAMPLES" tab
6________________________________________________
Q: In your video you made reference to obtaining the Nursing care plans,
mnemonics and sample charting. i looked everywhere for these items
after I got your DVD and I have not been able to find them, so where are
they?
A: When I made the DVD I was led to believe through my web server that
I could offer these items on my website for my customers. I have since
learned that it is not possible to offer these items that way. So with every
purchase you will receive an Email with a USERNAME and PASSWORD for
the EBOOKS (one set for the AOC EBOOK and one set for the LAB SIM
EBOOK if that is what you ordered).
The password and username open up the EBOOK that contains all of the
documentation you will need. To download the ebook go to the front page
of www.robscpne.com. There will be 2 EBOOKS -
1) AOC EBOOK
2) LAB SIM EBOOK
Download the EBOOK that refers to the video that you purchased (AOC,
LAB SIM or both) and when you try to open up the first chapter it will ask
you for the username and password. Enter both and register the EBOOK.
REMEMBER>>>You can only Register the Ebook on ONE computer.
Meaning you cant view it on any other computer after you register it on
the original computer. If you want to study the material at work or school,
simply print off the Ebook and take it with you
7________________________________________________
Q: I am REALLY nervous about this test. How do I overcome this fear I have?
A: There is no sure fire way to beat all the jitters, but here is what I recommend:
- As you get closer to your test date start increasing the amount of times you perform
your critical elements on your dummy. do it to the point that you become sick of doing
them. At the point when you do the critical elements, and you can do them with ZERO
mistakes AND they are second nature where you don't even have to see the picture of
the mnemonic, then you will be ready.
I felt when i went to take the test the second time that I wasn't just there to pass, but
to go into the pts room and see how fast and accurate I could do the critical elements
on the patient. It allowed me to stop thinking of "what if i fail" and changed my
mindset to " lets see how fast i can blow through this test". With that mindset it took
the pressure off enough to be successful. Good luck.
______________________________________________________________________
GENERAL QUESTIONS -
8________________________________________________
Q: What does "offloading" mean
A: Offload means to reduce pressure to the skins surface. for example, when you put
a pts legs on a pillow while in bed and their heels are suspended above the surface of
the bed you are "floating the heels" and thus "offloading" the pressure from the heels.
The same can be said as you roll the pt. off their coccyx and put them on their left or
right side. You have just "offloaded" the pressure from the pts coccyx and thus they
will not get a bed sore. As you can see in these examples "offloading" is just a term to
describe how you reduce pressure.
9________________________________________________
Q: What schedule to you suggest to study for this test? How much do I have to study ?
A: I suggest taking 2 months out and slowly building in the amount of time you
practice. For example:
weeks 1-2 do 1 PCS per day (with all the critical elements) and ALL the lab sims
weeks 3-4 do 2 PCS per day (with all the critical elements) and ALL the lab sims
weeks 5-7 do 3 PCS per day (with all the critical elements) and ALL the lab sims TWICE
week 8 do 1 PCS every other day (with all the critical elements) and ALL the lab sims
You will notice that on the last week you do LESS. This is because you should have done
the lab sims and the critical ellments that they will be SECOND NATURE. Too much
studying at this point would not be beneficial. Also, the first weeks it will take you a
long time to do all the critcial elements on the PCS and the lab sims. As you become
more proficient you will notice that the time it takes you to do EVERYTHING drastically
reduces. For example, it would take me no more than 15 minutes to do the
PCS critical elements on my dummy and no more than 15 minutes to do
the 4 lab sim stations !
10____________________________________________________
Q: Where do I put my paper down to record my VS, assessments. Did you
use a clipboard ?
A: I never put down my clipboard because I never used one ! Here is the
thing, before the Implementation phase the CE will tell you where you can
set down your papers to do any charting. Some may tell you the pts table
is acceptable, others may say the counter at the front of the room.
What I did was simply roll up my papers and put them into my back or side
pants pocket. When I needed to write something down that was important
- i.e., vital signs, ABNORMAL assessment findings (not NORMAL
assessment findings because I could easily remember those) or things the
pt said - I would take my paper out and jot the notes down (remember to
take off your gloves before you chart anything).
If you use your other hand to create a solid surface to write down quick
things you wont need to go all the way to the counter to jot things down. If
it is the pts table then you can use your hand or the table but I just found it
easier to whip out the paper, write it down, then roll it up and stick it in
my back pocket
11_______________________________________________
Q: Will the examiners write down if I have to take an apical pulse/BP
before administering meds ?
A: They should but not all the time. Be careful and if you think you have to
check the apical pulse and it is not written down (Digoxin) then check the
apical pulse ! Same thing applies for BP meds
12_______________________________________________
Q: If your pt has a BM while wearing depends undergarments are you
responsible for changing them ?
A: Check to see if the pt has an assigned CNA, or let the primary nurse
know at least. NEVER let a problem go without follow up. It may not be
YOUR responsibility to perform a function but you MUST let someone know
13_______________________________________________
Q: The plunger on my syringe felt like it was welded in place. What can I
do to make these lab stations go easier in regards to working with the
syringes ?
A: Move the plunger back and forth 3 or 4 times before drawing up
medication. It makes everything that much easier
14_______________________________________________
Q: The gloves were horrible or did not fit me when I went to do the lab
sim portion of the CPNE. How can I rectify this the next time I go ?
A: Bring your own gloves with you. Just be aware that at some sites they
may not allow you to use your own supplies. I would bring them just in
case they do. When you have gloves that fit you can actually pack a
wound correctly !
15_______________________________________________
Q: Do you need to re-do 20 minute checks each time you re-enter the pt's
room ?
A: No 20 minute checks are to be done ONE TIME at the start of each PCS
16_______________________________________________
Q: I purchased the program prior to 9/1/09 and I would like to ONLY
purchase the EBOOKS, how do I do that?
A: To begin with EBOOKS will not be sold separately if the original videos
were not ordered (AOC video and/or LAB SIMS video). If the video was
purchased previously and you want to purchase the EBOOKS:
1) Go to the ORDER tab and purchase the insurance option
2) At the checkout screen choose "EBOOK only" (this way you will not be
charged Shipping and handling).
-Once completed the codes will be sent to you on how to access the full
version of the EBooks via Email.
17_______________________________________________
Q: I paid for the download of the videos/EBOOKS and my computer
crashed/failed, OR I lost the videos. How can I download the
videos/EBOOKS again ?
A: robscpne.com is not responsible for backing up data. If you
downloaded the video/EBOOK (which is not offered anymore due to
piracy) and the video/EBOOK is no longer accessible to you for whatever
reason then you will need to pay for the insurance option ($5.95) and you
will have to pay to have the videos shipped to you ($7.95 S&H).
18_______________________________________________
Q: In regards to the pt IV - if we aspirate and we do not have blood
return but our IV site looks good and it flushes without difficulty, do we
have to tell the CE or just continue
A: I asked this myself during my pre-CPNE phone interview and here is
what the faculty told me. If the IV has no blood return but site looks OK,
you can continue to flush. During the flush if the area above the IV
insertion site becomes swollen or pt. complains of pain you must stop and
inform primary nurse, if not continue to flush total amount of required
flush medication. You would still document in your notes that there was no
blood return and notify primary nurse (i.e., if there is anything ABNORMAL
report it to the primary nurse to be safe)
19_______________________________________________
Q: what are some of the most common nursing diagnosis to "tag" on my
Nursing diagnosis book?
A: I would pay close attention and "tag" (highlight) these diagnosis in
your book:
Activity Intolerance
Ineffective Airway clearance
Risk for aspiration
Bowel Incontinence
Readiness for enhanced Comfort
Constipation
Diarrhea
Impaired gas exchange
Risk for Injury
Deficient Knowledge (specify)
Readiness for enhanced knowledge
Impaired physical mobility
Nausea
Acute pain
Chronic pain
Disturbed Sensory perception (works great for diabetics)
Impaired skin integrity
20_______________________________________________
Q: What is the MAXIMUM amount that I can inject into the Vastus
Lateralis muscle for the IM injection?
A: Depending on where you get your information this answer varies.
HOWEVER, Excelsior College uses the book: Kee, J.R., et. al. (2009).
Pharmacology: A Nursing Process Approach (6th Ed.)
*** Don't take my word for it: You can find which book Excelsior is
using for medication administration by looking at the Excelsior CPNE
guidebook, pg. 16 ***
On pg. 40-41 this book states:
Intramuscular Injections: Needle size 20-23 gauge, 18 gauge for blood
Needle length 1.5 inches.
Technique: Same as sub q except flatten the skin area using the thumb
and index finger and inject between them. Insert the needle at a 90
degree angle into the muscle.
Vastus Lateralis:
Volume of drug administered is 0.5 ml or less for infants. (Max=1ml)
1ml for pediatrics.
1-1.5 ml for adults, (max=2ml)
21_______________________________________________
Q: How do I assess an infant, toddler and non communicating adult's
neurological status (LOC). I know that the critical elements are to assess
the tactile, auditory, and visual....but what do I do?
A:
Visual stimuli - How did the pt. respond to a familiar toy ? To their parents
faces ?
Tactile stimuli - "tactile = touch". How did the infant respond when you
touched
his/her_______?
Auditory stimuli - (baby's name is Jacob) " Hello Jacob, you're a good
boy/baby!" How did the infant/toddler respond to his name or any
auditory stimuli -(i.e., sounds in the room - did he respond in some way ?)
Pg. 185 of the Excelsior guidebook (at the bottom of the page) has an
example of acceptable charting of this
22___________________________________________
Q: What feedback have you heard about the testing site at NY, WI, TX? Is
it a good place to test ?
A: I don't have feedback on any one site and I'll tell you why:
I can hear that one week a certain site is great ! Then the very next week
I hear that it is horrible. Their are 2 reasons for this:
1) There were different groups of examiners from one week to the
next. Remember, just like when you go to a restaurant - sometimes
the food is made by the top chef at the restaurant and the food is
excellent so you say the restaurant is excellent and recommend it to
a friend. That friend goes the next week and gets a different chef
and the food is horrible, so the friend states that the place is
horrible...It is the same way with testing sites.
2) The student was not prepared and because of his/her lack of
preparation states that the site was "unreasonably hard". Let's be
honest, sometimes this DOES happen. Does it happen ALL the time
where the student was unprepared and the examiners were
supportive, understanding people? Hardly, but it does happen.
My recommendation is forget the good site/ bad site and
instead focus on being CONFIDENT ! If you can show these
examiners that you can perform these simple assessments and tasks then
they will have no problem passing you and letting you practice as an RN in
the outside world.
When I was going through LVN school in the U.S. Army an instructor told
the class that his son was in Iraq and the only way he would pass us is if
he felt that we could take care of his son if he was injured and we were
taking care of him while he was in the hospital.
Guess what? The students with the highest confidence almost always
passed because they showed him that they KNEW what they were doing.
In my opinion EVERYONE knew what they were doing but the ones that
could show that competence with CONFIDENCE passed. The same criteria
has probably been told to these examiners - "pass the ones that are
competent and ones that YOU would let take care of people on the outside
as an RN"
23___________________________________________
Q: I just got back from one of the test sites and I failed ! This test is
IMPOSSIBLE ! How do I get through this?
A: First let me say I am sorry that this happened to you. It happened to
me too as well as happening to thousands of other students. Here is the
deal - This test can be passed by just doing these critical elements over
and over again until they become second nature.
Let's look at it like this - If the critical elements take up 80-90% of the
test and you do them 100% accurately when you practice at home then
you should already be 80-90% to the finish line. Now then, when some
unknown pops up - like the pt is vomiting, or the patient left the room to
get an X-ray you will only have to deal with these outliers that happen 10-
20% of the time.
The ones who get flustered with this test are the ones who cannot do the
critical elements effortlessly. Then, not only do they have to worry about
these 10-20% outliers, they also have the added pressure of thinking to
themselves, "I hope I don't mess up this respiratory assessment" (or
whatever area they were assigned that they cannot do 100% accurately).
That is really the secret. Eliminate the problems that you can, (critical
elements, lab sims, nursing care plan interventions) so when you are
faced with unknowns (outlier problems) you are not adding any undo
pressure. The EBOOKS and video cover how to do all of these processes.
Don't worry - many people have failed and come back to pass and you will
too !
24___________________________________________
Q: Do I have to wear gloves AFTER assessing the IV site and BEFORE I
assess the IV tubing ?
A: This question was asked to Sharon A. Aronovitch, Ph.D., APRN, BC,
CWOCN (sometimes referred to as Dr. A). She states:
"You must take gloves off AFTER assessing the IV site, then check the IV
tubing for air after gelling. Rationale: asepsis, moisture vapor can escape
and be transfered to the tubing, which is a clean, non-gloved area/field to be
working."
So there it is, the tubing is considered a non-gloves, clean area....
25___________________________________________
Q: When I am packing the wound in the lab sim station can I use more
than ONE piece of gauze ?
A: For a simple question this has a complex answer. Here is what I know -
Sharon A. Aronovitch, Ph.D., APRN, BC, CWOCN (Dr. A)says:
"Only ONE gauze is to be packed in the wound during the lab wound station.
Rationale: violates the critical element of overpacking the wound. The lab
wound can only fit ONE gauze that is to be fully unfolded and fluffed."
However, after posting this statement in a newsletter I have gotten these
responses:
"I have thankfully passed the cpne, I would like to mention a few thing. in
racine - they did not have 12 ply gauze. [they had 8 ply] The 8 ply really
needed two pieces of gauze and i did pass. Looking at it from this standpoint
I can totally understand why you would need 2 pieces of gauze and it would
not be considered "overpacking the wound."
Also I received this very important E-mail:
“ I was just reviewing their [Excelsior college’s] guidebook "Nursing Clinical
Skills: A Thinking Approach. Feb 2009 edition. On page 14 in this guidebook
it states:
"PREFERRED that you use only ONE sponge to pack. If you are careful to
open it adequately in the beginning, this skill can be performed using only
one sponge."
On my first CPNE, I did pass the wound station and did use two gauze
sponges...”
As you can read here, the guidebook PREFERS you use one, and the wound
CAN be packed with only one sponge. It does not state that you MUST use
one piece of gauze (especially if it is only 8 ply like noted above)
I encourage EVERYONE to ask about this question either on their weekly
phone conversations with Excelsior faculty OR the night you do your Lab
Sim stations (you are allowed to ask the examiners anything you want
before you perform the lab sims after they have demonstrated all
stations).
25___________________________________________
Q: I don't fully understand how we go about charting our critical elements
during our PCS's. I see the sample kardexes and I understand that that is
where I see what I need to do, but where do I chart that I have completed
what I needed to do (like the 20 min checks where I would document the
tube feeding or IV mls/hr).
A: The 20 minute checks include:
A) introducing yourself
B) Identifying pt with 2 of 3 pieces of info (MR #, DOB, NAME)
C) Explain the purpose of the interaction
D) using touch with a child or an adult who is non-communicating if
culturally appropriate
** A-D we do not need to chart in within 20 minutes **
E) Verify rate of flow of IV solution ( 75 ml/hr)
F) Adjust rate of flow of IV solution (if it is at 70 ml/hr then bump setting
up to 75 ml/hr)
G) Verifies TYPE of IV solution being administered
** You would record E-G on your PCS RECORDING FORM. To see an
example of the PCS RECORDING FORM go to pg. 422 of your CPNE
GUIDEBOOK. This info would be recorded under "PARENTERAL FLUIDS"
H) Verify rate of flow of enteral feeding ( 75 ml/hr)
I) Adjust rate of flow of enteral feeding (if it is at 70 then bump setting up
to 75)
J) Verifies TYPE of enteral feeding being administered
** You would record H-J on your PCS RECORDING FORM. To see an
example of the PCS RECORDING FORM go to pg. 422 of your CPNE
GUIDEBOOK. This info would be recorded under "ENTERAL FEEDING"
- For your critical elements you would document all those under the
NARRATIVE NOTES. You can find an example of the NARRATIVE NOTES on
pg. 423-426 of your CPNE guidebook
26___________________________________________
Q: when assigned Pt teaching are you also assigned what to teach? Also
where do I get the information to teach and for how long am I expected to
teach
A: With Pt. Teaching the examiner will write down what she wants you to
teach. I remember for my teaching I was assigned incentive spirometer. If
I did not know how to use an incentive spirometer or its' purpose, I would
have grabbed a respiratory therapist on the floor and asked OR I could
have taken a look at one of the fundamentals of nursing books that are
available to you at the nurses station and looked it up. As far as how long
there is no time limit, just make sure that you:
1) Ask the patient if it is a good time to teach him/her about _______
2) Ask the patient what he/she knows about the subject - i.e, is there
something the patient does not know that needs to be taught ?
3) After you have taught the patient make sure they understand what
you told them by asking, "Mr. smith, what can you tell me about
what we just talked about ?
27___________________________________________
Q: I am having trouble printing out the content of the EBOOK. What can I
do if this happens?
A: Try these steps to print out the EBOOK successfully:
1) Obtain the most recent updates to the AOC and LAB SIM EBOOKS by
DELETING your copy on your computer (I said DELETE your copy DO NOT
UN-REGISTER IT !) and Re-download a copy from the front page at:
www.robscpne.com
2) Open your EBOOK and click on Chapter 1 (or whatever page you want
to start printing)
3) Once there click on "FILE" in the UPPER LEFT CORNER
4) Scroll down to "PRINT PAGE" and print each chapter individually
instead of printing the entire book
5) If the above does not work, repeat steps 1-3 and now click on "PRINT
SETUP"
6) At the LOWER RIGHT HAND CORNER it will say "ORIENTATION".
Please choose the option of "LANDSCAPE" and click on the OK button
7) Now click on "FILE" again and click on "PRINT PAGE" - make sure you
have your printer selected and click on the PRINT button
28___________________________________________
Q: IF I was to use the "readiness for enhanced comfort" as my PRIMARY
DIAGNOSIS what would I use for the R/T and AEB ?
A: We all know that in the PLANNING phase of writing your 2 nursing
care plans that you DO NOT NEED R/T or AEB. Only the nursing diagnosis
(ex, readiness for enhanced comfort)
When you get to the IMPLEMENTATION phase you will need to CHOOSE A
PRIMARY DIAGNOSIS and use the R/T and AEB. The chances of using
"readiness for enhanced comfort" as your PRIMARY diagnosis is low.
However if you do please read one student's experience with this problem
listed below and what he did to overcome:
Nursing Diagnosis #1 Readiness for enhanced comfort
Outcome: can't remember exactly something like pt will verbalize an increased
level of comfortduring my PCS.
Intervention #1; Assess level of comfort
Intervention #2: ?? perform comfort measures ?? not sure
Mosbys book does not have a related to category for the nursing diagnosis
readiness for enhanced comfort. just defining characteristics that states that the
patient expresses that they would like a greater level of comfort.
In questioning the patient I got her to say that she "didn't want to feel worse"
and that she just wanted to go home were she would be more comfortable.
perfect... I had the statements that I wanted for my documentation.
Here is the problem: In filling out my evaluation paperwork I became confused as
to what to put in the related to box. I knew that the patients statements would
be what I wrote in the AEB box, but was struggling with what to put in the
related to box. remember their are no related to's for this nursing diagnosis in
Mosbys book. So I left the related to box blank...bad idea...
The Ce ended up walking me down so that she could talk with the CA. spent
about 5 gut wrenching minutes in the room and then called me in. They sat me
down and asked why I had not wrote anything in the related to box. I explained
to them that I believed the patients statements were my AEB and that Mosbys
book had thrown me by not having a related to category to choose from. They
asked me what was making the patient uncomfortable and I responded by telling
them that the Patient had Bilateral arm pain that has been chronic and right groin
tightness were the cardiac cath incision was. They both nodded at each other and
said that they knew what I was trying to do, and that I had documented what I
had just said in other places in the evaluation form. The CA said just write that in
the related to box and you will pass, but to not leave anything blank again. She
said that since the book did not have a related to category for readiness for
enhance comfort and that I had documented what I should have written in the
R/T box in the rest of the evaluation form that she would pass me.
I had never thought that I would be using that Diagnosis as a primary diagnosis
and never practiced using it. So I was caught off-guard and thankfully was able to
recover and pass.
Just like you said... argue your point and document. That is what saved me.
29___________________________________________
Q: Where can I write down my mnemonics when I am in the planning
phase before I go into see the pt?
A: You can write your mnemonics down in numerous places like a scrap
piece of paper which you could ask for, or just do what I did and write
your mnemonics on the back of your PCS recording form. You are going to
be writing everything down that you do on the FRONT of this paper so why
not write your mnemonics down on the BACK of the paper. To see an
example of the PCS recording form please look at pg. 422-426 of your
CPNE guidebook
30___________________________________________
Q: What is the difference between Rhythm and Pattern in your
mnemonics for respiratory assessment? They seem similar
A: the difference between rhythm and pattern is
Rhythm is regular, irregular
Pattern is labored or unlabored, etc.
31___________________________________________
Q: Why do you recommend practicing the LAB SIM stations and ALL
critical elements EVERY DAY ? Isn't that excessive ?
A: Here is the long answer:
I know we get tired of doing the same thing over and over again but there
really is a great reason for so much repetition. It is called "muscle
memory"
When we practice over and over again until we can do a certain action "in
our sleep" then we have successfully transferred the action from our short
term memory into our long term memory and finally into a part of our
brain that functions automatically (i.e. muscle memory). A great example
are musicians. In the book, " Outliers " by Malcolm Gladwell, it took a look
at what separates the music teachers of the world from the virtuosos (the
ones who could go on to become famous performers/world-class talent).
Psychologists did a study at the Berlin Academy of Music. They looked at
the violinists and found a very simple correlation - the more they
practiced, the better they were. They became better because they could
perform their musical numbers almost effortlessly. They checked it with
the pianists and found the same thing - everybody had some talent and
started playing around age five. But when students were around age 8,
real differences started to emerge. The students who would end up the
BEST in their class began to practice MORE than anyone else...until by the
age of 20 they were practicing ....over 30 hours per week. These students
would later go on to become "the great ones" and the others were
destined to be music teachers.
The incredible thing was there were NO "naturals" or people who were at
the top WITHOUT this commitment. NOBODY in the top third had practiced
LESS THAN 30 hours per week. Also interesting to note was that there
were NO students who practiced for 30 hours or more per week and were
not considered elite. There was a magical number in this study: 10,000
hours of diligent, intentional, informed practice. That's it - practice more
than most people would and you will be successful.
You can see this type of dedication to practice and then having that action
transferred to muscle memory. Take a look at rifle marksmen, golfers,
basketball players, etc., The more they practiced the better they were
because their action(s) became automatic.
Now then...I don't expect you to practice 30 hours a week or a total of
10,000 hours. I DO expect you to practice EVERY SINGLE DAY with your
mock dummy set-up AND do ALL 4 lab sim stations. No exceptions ! For a
look at a reasonable timeline of practice, please see Q #9 in this section.
Short answer: Just do it so you can pass
32___________________________________________
Q: The mnemonics and videos are great but I want to make SURE I can
pass this test. Do you have any tips to stay mentally sharp/focused ?
A: I realize that with every tool that is given to you it means nothing if the
mind breaks down at critical moments !
Listen, even the best in the world have mental lapses as we can see at the
recent winter olympics. How can WE stay focused when taking the CPNE ?
You need to get into a "zone".
"The zone" as most athletes and sports psychologists put it is a state
where the person does everything right through various factors. The 9
commonalities that ALL people feel who are in this state are:
- Loss of fear (no fear of failure)
- No thinking of performance (muscle memory - automatic action)
- Total immersion in activity
- Narrow focus of attention
- Effortless performance
- feeling of being in complete control
- time/space distortion (time slows down)
- universe perceived to be integrated - everything feels connected
- unique, temporary involuntary experience
Wouldn't it be nice to get there when you are taking the CPNE ? I believe
there are things you can do to get you closer to being in this state of mind.
Here are some things I did and thought about when taking the test
1) accept you can fail and move forward
Do you think a neurosurgeon goes into surgery constantly thinking " I
could kill this patient if I do the wrong thing?" Or a boxer who is about to
enter the ring thinking " This guy is going to knock me out !" You know
what would probably happen ? The patient has a much higher chance of
dying and the boxer will probably get knocked out or lose the fight by way
of decision.
2) Get your mind into the right state by finding a rhythm
A student once told me that to help her pass she would tap her pen on
the palm of her hand 5 times hard before she would practice her MOCK
LAB SIM stations and MOCK AOC stations. When she went to the CPNE she
would do the same thing - tap her pen on the palm of her hand 5 times
before the LAB SIM stations and then tap the pen on the palm of her hand
5 times before each PCS. I didn't understand the reason until I saw a
basketball player by the name of Jason Kidd shooting a free throw....
He blows a kiss to his wife before every free throw.
I have to assume this is good for his marriage but most importantly his
free throw percentage is in the high 80 percentile range (not bad when
you have thousands of people shouting at you...)
When you have a ritual it calms you down and puts you into the right
frame of mind....hopefully closer to "the zone"
3) In between patients play some loud music on your music player -
It is good to hit the reset button when you are in between patients
(between patients 2 and 3 I had an hour wait !) It does us no good to just
sit there thinking about what could happen. Give your mind a break !
I played this same song over and over again (yes, only one song!).
Repetition helps me to relax and zone out for a little bit. The song I played
was Chiquilla by The Cumbia All Stars. It's a catchy upbeat song and the
beat of the music stayed with me. It's a song entirely in spanish so go
figure.
AND THE MOST IMPORTANT ASPECT.......
4) Change the way you are motivated by this test
Someone once told me that, "it is better to be pulled TOWARD the
prospect of success than PUSHED by the idea of failure". When we are
PUSHED by the idea of failure we will do those things that are necessary
to simple not fail. When we are being PUSHED by this prospect things feel
tight and they don't "flow" as easily.
On the flip side If you can see the finish line up ahead and you are close to
it all the anxiety and apprehension that you may have had will have faded
away. VISUALIZE the goal of passing all 4 LAB SIM stations and all PCS's
- let the test happen; you have practiced enough to allow your muscle
memory to take over. Trust in yourself and your abilities so that you can
be PULLED toward success.
0________________________________________________
Q: What are the EBOOKS?
A: There are two EBOOKS, One that goes with each video:
1) AOC EBOOK for the AOC (areas of care) video
2) Lab Sim EBOOK for the LS (lab sims) video
Upon ordering the VIDEO(s) you will receive the username and password
for each EBOOK via E-mail.
(NOTE: If you order both videos you will receive 2 separate E-mails for
each EBOOK - one Email will have the username and password for the
AOC EBOOK and another Email will have the username and password for
the LAB SIM EBOOK. Please check your JUNK/SPAM folder if they do not
arrive in your INBOX within 15 minutes. :NOTE)
Each Ebook contains all of the ancillary documents that you will need to be
successful for the CPNE. Since I created the video in 2008 there have
been changes to the CPNE. As such, I have reflected those changes in the
EBOOKS so you can be sure that you are getting the most up to date
information to prepare you to pass the CPNE. To be truly successful with
my program you MUST use the EBOOKS.
You may download and evaluate the EBOOKS for free by going to the
HOME page of this website. Downloads are at the top in RED (full version
of the EBOOKS available upon purchase of the AOC and/or LAB SIM video)
1________________________________________________
Q: What are the requirements for the DOUBLE YOUR MONEY BACK
GUARANTEE ?
A: Starting 12/5/2009 - If my videos and EBOOK do not get you through this
test then simply return the videos and your "notice of failure" sheet given to you by
the CA and I will REFUND DOUBLE THE MONEY THAT YOU PAID FOR THE VIDEOS! Since
April 2008 I have only had ONE person ask for a refund (through no fault of the videos)
If the videos/EBOOK are directly responsible for your failure then you are eligible.
Now you really have nothing to lose with this system.
2________________________________________________
Q: Why should I order from you? Can't I just go to one of those workshops and learn
from them?
A: You CAN go to a workshop and learn a lot of good information. However, do you
want to spend hundreds of dollars on the workshop, not including airfare, hotel, food,
and time off of work and family? With this video it will show you EXACTLY how to
prepare for the CPNE so you PASS! Look at me, I am in a sales job and have zero
patient contact, but yet I passed with no repeats.
3________________________________________________
Q: What is the difference between the Area of Care Video and the Lab Sim video?
A: The CPNE is divided into 2 sections. The lab sims, and the PCS (patient care
situations). In each PCS you will have to do AOC's (areas of care). The areas of care
are divided into 3 categories with their own critical elements:
AOC Critical Elements
1) Overriding areas of care - Asepsis, Caring, Emotional Jeopardy, Mobility, Physical
Jeopardy
2) Required areas of care - Fluid management, vital signs
3) Selected areas of care - abdominal assessment, neurological assessment,
peripheral vascular assessment, respiratory
assessment, skin assessment, comfort management,
musculoskeletal management, oxygen management,
pain management, respiratory management,
wound management, drainage and specimen collection,
irrigation, medications and patient teaching
When I talk about the AOC video and documents I am talking about teaching the 3
categories of AOC's, their critical elements, and the documents that support this
section (nursing care plans, grid, sample charting, mnemonics, and mnemonic
pictures).
When I am talking about the lab sim section that consists of 4 stations - IV
medications station (IV piggyback), IM/SQ Injection station, IV push station, and
Wound station and all the documents that support this section
4________________________________________________
Q: Why is the cost so low? I see simple notes being sold online for more, so what
gives?
A: I paid $7800.00 to an outside agency for help with the nursing concepts test. Then I
paid another $1500.00 for all the testing centers. And THEN I paid for my first CPNE
and I FAILED! (grand total for my first CPNE was $2789.00). I felt that the only thing
that people wanted from me was money and I was sick of, "higher learning
establishments". The reason the cost is so low is because I know how expensive this
process can be and I understand where you are coming from. If there was a website
out there that was like this one I would not have hesitated to buy an actual VIDEO of
someone doing the areas of care so I could go into the CPNE with CONFIDENCE.
Instead I had to buy someone's notes on EBAY for $100.00 that turned out to be
worthless.
5________________________________________________
Q: You keep talking about these mnemonics with pictures that will help the
information stick. What does that mean?
A: I consider myself a reasonably smart person, but I have a horrible memory. I
learned a long time ago that people think in pictures. This is why apple computers are
so successful. They have a bunch of little icons that represent a lot of different
information. Mnemonics are great, but unless you practice them over and over you will
forget, and sometimes nerves take over and you still forget! That is why I use pictures
with my mnemonics. For example, the area of care, Skin assessment, has the
mnemonic TIME to check Color of skin. T=temp, I=integrity, M=moisture, E=edema,
Color=color. The picture is a persons arm from the elbow down and it is covered with
hives. On the wrist is a watch and it is causing you an unbearable itch. If you think of
this picture, the mnemonic "comes alive". These pictures and mnemonics are available
to you when you sign up. To see what I am talking about check out the "EXAMPLES" tab
6________________________________________________
Q: In your video you made reference to obtaining the Nursing care plans,
mnemonics and sample charting. i looked everywhere for these items
after I got your DVD and I have not been able to find them, so where are
they?
A: When I made the DVD I was led to believe through my web server that
I could offer these items on my website for my customers. I have since
learned that it is not possible to offer these items that way. So with every
purchase you will receive an Email with a USERNAME and PASSWORD for
the EBOOKS (one set for the AOC EBOOK and one set for the LAB SIM
EBOOK if that is what you ordered).
The password and username open up the EBOOK that contains all of the
documentation you will need. To download the ebook go to the front page
of www.robscpne.com. There will be 2 EBOOKS -
1) AOC EBOOK
2) LAB SIM EBOOK
Download the EBOOK that refers to the video that you purchased (AOC,
LAB SIM or both) and when you try to open up the first chapter it will ask
you for the username and password. Enter both and register the EBOOK.
REMEMBER>>>You can only Register the Ebook on ONE computer.
Meaning you cant view it on any other computer after you register it on
the original computer. If you want to study the material at work or school,
simply print off the Ebook and take it with you
7________________________________________________
Q: I am REALLY nervous about this test. How do I overcome this fear I have?
A: There is no sure fire way to beat all the jitters, but here is what I recommend:
- As you get closer to your test date start increasing the amount of times you perform
your critical elements on your dummy. do it to the point that you become sick of doing
them. At the point when you do the critical elements, and you can do them with ZERO
mistakes AND they are second nature where you don't even have to see the picture of
the mnemonic, then you will be ready.
I felt when i went to take the test the second time that I wasn't just there to pass, but
to go into the pts room and see how fast and accurate I could do the critical elements
on the patient. It allowed me to stop thinking of "what if i fail" and changed my
mindset to " lets see how fast i can blow through this test". With that mindset it took
the pressure off enough to be successful. Good luck.
______________________________________________________________________
GENERAL QUESTIONS -
8________________________________________________
Q: What does "offloading" mean
A: Offload means to reduce pressure to the skins surface. for example, when you put
a pts legs on a pillow while in bed and their heels are suspended above the surface of
the bed you are "floating the heels" and thus "offloading" the pressure from the heels.
The same can be said as you roll the pt. off their coccyx and put them on their left or
right side. You have just "offloaded" the pressure from the pts coccyx and thus they
will not get a bed sore. As you can see in these examples "offloading" is just a term to
describe how you reduce pressure.
9________________________________________________
Q: What schedule to you suggest to study for this test? How much do I have to study ?
A: I suggest taking 2 months out and slowly building in the amount of time you
practice. For example:
weeks 1-2 do 1 PCS per day (with all the critical elements) and ALL the lab sims
weeks 3-4 do 2 PCS per day (with all the critical elements) and ALL the lab sims
weeks 5-7 do 3 PCS per day (with all the critical elements) and ALL the lab sims TWICE
week 8 do 1 PCS every other day (with all the critical elements) and ALL the lab sims
You will notice that on the last week you do LESS. This is because you should have done
the lab sims and the critical ellments that they will be SECOND NATURE. Too much
studying at this point would not be beneficial. Also, the first weeks it will take you a
long time to do all the critcial elements on the PCS and the lab sims. As you become
more proficient you will notice that the time it takes you to do EVERYTHING drastically
reduces. For example, it would take me no more than 15 minutes to do the
PCS critical elements on my dummy and no more than 15 minutes to do
the 4 lab sim stations !
10____________________________________________________
Q: Where do I put my paper down to record my VS, assessments. Did you
use a clipboard ?
A: I never put down my clipboard because I never used one ! Here is the
thing, before the Implementation phase the CE will tell you where you can
set down your papers to do any charting. Some may tell you the pts table
is acceptable, others may say the counter at the front of the room.
What I did was simply roll up my papers and put them into my back or side
pants pocket. When I needed to write something down that was important
- i.e., vital signs, ABNORMAL assessment findings (not NORMAL
assessment findings because I could easily remember those) or things the
pt said - I would take my paper out and jot the notes down (remember to
take off your gloves before you chart anything).
If you use your other hand to create a solid surface to write down quick
things you wont need to go all the way to the counter to jot things down. If
it is the pts table then you can use your hand or the table but I just found it
easier to whip out the paper, write it down, then roll it up and stick it in
my back pocket
11_______________________________________________
Q: Will the examiners write down if I have to take an apical pulse/BP
before administering meds ?
A: They should but not all the time. Be careful and if you think you have to
check the apical pulse and it is not written down (Digoxin) then check the
apical pulse ! Same thing applies for BP meds
12_______________________________________________
Q: If your pt has a BM while wearing depends undergarments are you
responsible for changing them ?
A: Check to see if the pt has an assigned CNA, or let the primary nurse
know at least. NEVER let a problem go without follow up. It may not be
YOUR responsibility to perform a function but you MUST let someone know
13_______________________________________________
Q: The plunger on my syringe felt like it was welded in place. What can I
do to make these lab stations go easier in regards to working with the
syringes ?
A: Move the plunger back and forth 3 or 4 times before drawing up
medication. It makes everything that much easier
14_______________________________________________
Q: The gloves were horrible or did not fit me when I went to do the lab
sim portion of the CPNE. How can I rectify this the next time I go ?
A: Bring your own gloves with you. Just be aware that at some sites they
may not allow you to use your own supplies. I would bring them just in
case they do. When you have gloves that fit you can actually pack a
wound correctly !
15_______________________________________________
Q: Do you need to re-do 20 minute checks each time you re-enter the pt's
room ?
A: No 20 minute checks are to be done ONE TIME at the start of each PCS
16_______________________________________________
Q: I purchased the program prior to 9/1/09 and I would like to ONLY
purchase the EBOOKS, how do I do that?
A: To begin with EBOOKS will not be sold separately if the original videos
were not ordered (AOC video and/or LAB SIMS video). If the video was
purchased previously and you want to purchase the EBOOKS:
1) Go to the ORDER tab and purchase the insurance option
2) At the checkout screen choose "EBOOK only" (this way you will not be
charged Shipping and handling).
-Once completed the codes will be sent to you on how to access the full
version of the EBooks via Email.
17_______________________________________________
Q: I paid for the download of the videos/EBOOKS and my computer
crashed/failed, OR I lost the videos. How can I download the
videos/EBOOKS again ?
A: robscpne.com is not responsible for backing up data. If you
downloaded the video/EBOOK (which is not offered anymore due to
piracy) and the video/EBOOK is no longer accessible to you for whatever
reason then you will need to pay for the insurance option ($5.95) and you
will have to pay to have the videos shipped to you ($7.95 S&H).
18_______________________________________________
Q: In regards to the pt IV - if we aspirate and we do not have blood
return but our IV site looks good and it flushes without difficulty, do we
have to tell the CE or just continue
A: I asked this myself during my pre-CPNE phone interview and here is
what the faculty told me. If the IV has no blood return but site looks OK,
you can continue to flush. During the flush if the area above the IV
insertion site becomes swollen or pt. complains of pain you must stop and
inform primary nurse, if not continue to flush total amount of required
flush medication. You would still document in your notes that there was no
blood return and notify primary nurse (i.e., if there is anything ABNORMAL
report it to the primary nurse to be safe)
19_______________________________________________
Q: what are some of the most common nursing diagnosis to "tag" on my
Nursing diagnosis book?
A: I would pay close attention and "tag" (highlight) these diagnosis in
your book:
Activity Intolerance
Ineffective Airway clearance
Risk for aspiration
Bowel Incontinence
Readiness for enhanced Comfort
Constipation
Diarrhea
Impaired gas exchange
Risk for Injury
Deficient Knowledge (specify)
Readiness for enhanced knowledge
Impaired physical mobility
Nausea
Acute pain
Chronic pain
Disturbed Sensory perception (works great for diabetics)
Impaired skin integrity
20_______________________________________________
Q: What is the MAXIMUM amount that I can inject into the Vastus
Lateralis muscle for the IM injection?
A: Depending on where you get your information this answer varies.
HOWEVER, Excelsior College uses the book: Kee, J.R., et. al. (2009).
Pharmacology: A Nursing Process Approach (6th Ed.)
*** Don't take my word for it: You can find which book Excelsior is
using for medication administration by looking at the Excelsior CPNE
guidebook, pg. 16 ***
On pg. 40-41 this book states:
Intramuscular Injections: Needle size 20-23 gauge, 18 gauge for blood
Needle length 1.5 inches.
Technique: Same as sub q except flatten the skin area using the thumb
and index finger and inject between them. Insert the needle at a 90
degree angle into the muscle.
Vastus Lateralis:
Volume of drug administered is 0.5 ml or less for infants. (Max=1ml)
1ml for pediatrics.
1-1.5 ml for adults, (max=2ml)
21_______________________________________________
Q: How do I assess an infant, toddler and non communicating adult's
neurological status (LOC). I know that the critical elements are to assess
the tactile, auditory, and visual....but what do I do?
A:
Visual stimuli - How did the pt. respond to a familiar toy ? To their parents
faces ?
Tactile stimuli - "tactile = touch". How did the infant respond when you
touched
his/her_______?
Auditory stimuli - (baby's name is Jacob) " Hello Jacob, you're a good
boy/baby!" How did the infant/toddler respond to his name or any
auditory stimuli -(i.e., sounds in the room - did he respond in some way ?)
Pg. 185 of the Excelsior guidebook (at the bottom of the page) has an
example of acceptable charting of this
22___________________________________________
Q: What feedback have you heard about the testing site at NY, WI, TX? Is
it a good place to test ?
A: I don't have feedback on any one site and I'll tell you why:
I can hear that one week a certain site is great ! Then the very next week
I hear that it is horrible. Their are 2 reasons for this:
1) There were different groups of examiners from one week to the
next. Remember, just like when you go to a restaurant - sometimes
the food is made by the top chef at the restaurant and the food is
excellent so you say the restaurant is excellent and recommend it to
a friend. That friend goes the next week and gets a different chef
and the food is horrible, so the friend states that the place is
horrible...It is the same way with testing sites.
2) The student was not prepared and because of his/her lack of
preparation states that the site was "unreasonably hard". Let's be
honest, sometimes this DOES happen. Does it happen ALL the time
where the student was unprepared and the examiners were
supportive, understanding people? Hardly, but it does happen.
My recommendation is forget the good site/ bad site and
instead focus on being CONFIDENT ! If you can show these
examiners that you can perform these simple assessments and tasks then
they will have no problem passing you and letting you practice as an RN in
the outside world.
When I was going through LVN school in the U.S. Army an instructor told
the class that his son was in Iraq and the only way he would pass us is if
he felt that we could take care of his son if he was injured and we were
taking care of him while he was in the hospital.
Guess what? The students with the highest confidence almost always
passed because they showed him that they KNEW what they were doing.
In my opinion EVERYONE knew what they were doing but the ones that
could show that competence with CONFIDENCE passed. The same criteria
has probably been told to these examiners - "pass the ones that are
competent and ones that YOU would let take care of people on the outside
as an RN"
23___________________________________________
Q: I just got back from one of the test sites and I failed ! This test is
IMPOSSIBLE ! How do I get through this?
A: First let me say I am sorry that this happened to you. It happened to
me too as well as happening to thousands of other students. Here is the
deal - This test can be passed by just doing these critical elements over
and over again until they become second nature.
Let's look at it like this - If the critical elements take up 80-90% of the
test and you do them 100% accurately when you practice at home then
you should already be 80-90% to the finish line. Now then, when some
unknown pops up - like the pt is vomiting, or the patient left the room to
get an X-ray you will only have to deal with these outliers that happen 10-
20% of the time.
The ones who get flustered with this test are the ones who cannot do the
critical elements effortlessly. Then, not only do they have to worry about
these 10-20% outliers, they also have the added pressure of thinking to
themselves, "I hope I don't mess up this respiratory assessment" (or
whatever area they were assigned that they cannot do 100% accurately).
That is really the secret. Eliminate the problems that you can, (critical
elements, lab sims, nursing care plan interventions) so when you are
faced with unknowns (outlier problems) you are not adding any undo
pressure. The EBOOKS and video cover how to do all of these processes.
Don't worry - many people have failed and come back to pass and you will
too !
24___________________________________________
Q: Do I have to wear gloves AFTER assessing the IV site and BEFORE I
assess the IV tubing ?
A: This question was asked to Sharon A. Aronovitch, Ph.D., APRN, BC,
CWOCN (sometimes referred to as Dr. A). She states:
"You must take gloves off AFTER assessing the IV site, then check the IV
tubing for air after gelling. Rationale: asepsis, moisture vapor can escape
and be transfered to the tubing, which is a clean, non-gloved area/field to be
working."
So there it is, the tubing is considered a non-gloves, clean area....
25___________________________________________
Q: When I am packing the wound in the lab sim station can I use more
than ONE piece of gauze ?
A: For a simple question this has a complex answer. Here is what I know -
Sharon A. Aronovitch, Ph.D., APRN, BC, CWOCN (Dr. A)says:
"Only ONE gauze is to be packed in the wound during the lab wound station.
Rationale: violates the critical element of overpacking the wound. The lab
wound can only fit ONE gauze that is to be fully unfolded and fluffed."
However, after posting this statement in a newsletter I have gotten these
responses:
"I have thankfully passed the cpne, I would like to mention a few thing. in
racine - they did not have 12 ply gauze. [they had 8 ply] The 8 ply really
needed two pieces of gauze and i did pass. Looking at it from this standpoint
I can totally understand why you would need 2 pieces of gauze and it would
not be considered "overpacking the wound."
Also I received this very important E-mail:
“ I was just reviewing their [Excelsior college’s] guidebook "Nursing Clinical
Skills: A Thinking Approach. Feb 2009 edition. On page 14 in this guidebook
it states:
"PREFERRED that you use only ONE sponge to pack. If you are careful to
open it adequately in the beginning, this skill can be performed using only
one sponge."
On my first CPNE, I did pass the wound station and did use two gauze
sponges...”
As you can read here, the guidebook PREFERS you use one, and the wound
CAN be packed with only one sponge. It does not state that you MUST use
one piece of gauze (especially if it is only 8 ply like noted above)
I encourage EVERYONE to ask about this question either on their weekly
phone conversations with Excelsior faculty OR the night you do your Lab
Sim stations (you are allowed to ask the examiners anything you want
before you perform the lab sims after they have demonstrated all
stations).
25___________________________________________
Q: I don't fully understand how we go about charting our critical elements
during our PCS's. I see the sample kardexes and I understand that that is
where I see what I need to do, but where do I chart that I have completed
what I needed to do (like the 20 min checks where I would document the
tube feeding or IV mls/hr).
A: The 20 minute checks include:
A) introducing yourself
B) Identifying pt with 2 of 3 pieces of info (MR #, DOB, NAME)
C) Explain the purpose of the interaction
D) using touch with a child or an adult who is non-communicating if
culturally appropriate
** A-D we do not need to chart in within 20 minutes **
E) Verify rate of flow of IV solution ( 75 ml/hr)
F) Adjust rate of flow of IV solution (if it is at 70 ml/hr then bump setting
up to 75 ml/hr)
G) Verifies TYPE of IV solution being administered
** You would record E-G on your PCS RECORDING FORM. To see an
example of the PCS RECORDING FORM go to pg. 422 of your CPNE
GUIDEBOOK. This info would be recorded under "PARENTERAL FLUIDS"
H) Verify rate of flow of enteral feeding ( 75 ml/hr)
I) Adjust rate of flow of enteral feeding (if it is at 70 then bump setting up
to 75)
J) Verifies TYPE of enteral feeding being administered
** You would record H-J on your PCS RECORDING FORM. To see an
example of the PCS RECORDING FORM go to pg. 422 of your CPNE
GUIDEBOOK. This info would be recorded under "ENTERAL FEEDING"
- For your critical elements you would document all those under the
NARRATIVE NOTES. You can find an example of the NARRATIVE NOTES on
pg. 423-426 of your CPNE guidebook
26___________________________________________
Q: when assigned Pt teaching are you also assigned what to teach? Also
where do I get the information to teach and for how long am I expected to
teach
A: With Pt. Teaching the examiner will write down what she wants you to
teach. I remember for my teaching I was assigned incentive spirometer. If
I did not know how to use an incentive spirometer or its' purpose, I would
have grabbed a respiratory therapist on the floor and asked OR I could
have taken a look at one of the fundamentals of nursing books that are
available to you at the nurses station and looked it up. As far as how long
there is no time limit, just make sure that you:
1) Ask the patient if it is a good time to teach him/her about _______
2) Ask the patient what he/she knows about the subject - i.e, is there
something the patient does not know that needs to be taught ?
3) After you have taught the patient make sure they understand what
you told them by asking, "Mr. smith, what can you tell me about
what we just talked about ?
27___________________________________________
Q: I am having trouble printing out the content of the EBOOK. What can I
do if this happens?
A: Try these steps to print out the EBOOK successfully:
1) Obtain the most recent updates to the AOC and LAB SIM EBOOKS by
DELETING your copy on your computer (I said DELETE your copy DO NOT
UN-REGISTER IT !) and Re-download a copy from the front page at:
www.robscpne.com
2) Open your EBOOK and click on Chapter 1 (or whatever page you want
to start printing)
3) Once there click on "FILE" in the UPPER LEFT CORNER
4) Scroll down to "PRINT PAGE" and print each chapter individually
instead of printing the entire book
5) If the above does not work, repeat steps 1-3 and now click on "PRINT
SETUP"
6) At the LOWER RIGHT HAND CORNER it will say "ORIENTATION".
Please choose the option of "LANDSCAPE" and click on the OK button
7) Now click on "FILE" again and click on "PRINT PAGE" - make sure you
have your printer selected and click on the PRINT button
28___________________________________________
Q: IF I was to use the "readiness for enhanced comfort" as my PRIMARY
DIAGNOSIS what would I use for the R/T and AEB ?
A: We all know that in the PLANNING phase of writing your 2 nursing
care plans that you DO NOT NEED R/T or AEB. Only the nursing diagnosis
(ex, readiness for enhanced comfort)
When you get to the IMPLEMENTATION phase you will need to CHOOSE A
PRIMARY DIAGNOSIS and use the R/T and AEB. The chances of using
"readiness for enhanced comfort" as your PRIMARY diagnosis is low.
However if you do please read one student's experience with this problem
listed below and what he did to overcome:
Nursing Diagnosis #1 Readiness for enhanced comfort
Outcome: can't remember exactly something like pt will verbalize an increased
level of comfortduring my PCS.
Intervention #1; Assess level of comfort
Intervention #2: ?? perform comfort measures ?? not sure
Mosbys book does not have a related to category for the nursing diagnosis
readiness for enhanced comfort. just defining characteristics that states that the
patient expresses that they would like a greater level of comfort.
In questioning the patient I got her to say that she "didn't want to feel worse"
and that she just wanted to go home were she would be more comfortable.
perfect... I had the statements that I wanted for my documentation.
Here is the problem: In filling out my evaluation paperwork I became confused as
to what to put in the related to box. I knew that the patients statements would
be what I wrote in the AEB box, but was struggling with what to put in the
related to box. remember their are no related to's for this nursing diagnosis in
Mosbys book. So I left the related to box blank...bad idea...
The Ce ended up walking me down so that she could talk with the CA. spent
about 5 gut wrenching minutes in the room and then called me in. They sat me
down and asked why I had not wrote anything in the related to box. I explained
to them that I believed the patients statements were my AEB and that Mosbys
book had thrown me by not having a related to category to choose from. They
asked me what was making the patient uncomfortable and I responded by telling
them that the Patient had Bilateral arm pain that has been chronic and right groin
tightness were the cardiac cath incision was. They both nodded at each other and
said that they knew what I was trying to do, and that I had documented what I
had just said in other places in the evaluation form. The CA said just write that in
the related to box and you will pass, but to not leave anything blank again. She
said that since the book did not have a related to category for readiness for
enhance comfort and that I had documented what I should have written in the
R/T box in the rest of the evaluation form that she would pass me.
I had never thought that I would be using that Diagnosis as a primary diagnosis
and never practiced using it. So I was caught off-guard and thankfully was able to
recover and pass.
Just like you said... argue your point and document. That is what saved me.
29___________________________________________
Q: Where can I write down my mnemonics when I am in the planning
phase before I go into see the pt?
A: You can write your mnemonics down in numerous places like a scrap
piece of paper which you could ask for, or just do what I did and write
your mnemonics on the back of your PCS recording form. You are going to
be writing everything down that you do on the FRONT of this paper so why
not write your mnemonics down on the BACK of the paper. To see an
example of the PCS recording form please look at pg. 422-426 of your
CPNE guidebook
30___________________________________________
Q: What is the difference between Rhythm and Pattern in your
mnemonics for respiratory assessment? They seem similar
A: the difference between rhythm and pattern is
Rhythm is regular, irregular
Pattern is labored or unlabored, etc.
31___________________________________________
Q: Why do you recommend practicing the LAB SIM stations and ALL
critical elements EVERY DAY ? Isn't that excessive ?
A: Here is the long answer:
I know we get tired of doing the same thing over and over again but there
really is a great reason for so much repetition. It is called "muscle
memory"
When we practice over and over again until we can do a certain action "in
our sleep" then we have successfully transferred the action from our short
term memory into our long term memory and finally into a part of our
brain that functions automatically (i.e. muscle memory). A great example
are musicians. In the book, " Outliers " by Malcolm Gladwell, it took a look
at what separates the music teachers of the world from the virtuosos (the
ones who could go on to become famous performers/world-class talent).
Psychologists did a study at the Berlin Academy of Music. They looked at
the violinists and found a very simple correlation - the more they
practiced, the better they were. They became better because they could
perform their musical numbers almost effortlessly. They checked it with
the pianists and found the same thing - everybody had some talent and
started playing around age five. But when students were around age 8,
real differences started to emerge. The students who would end up the
BEST in their class began to practice MORE than anyone else...until by the
age of 20 they were practicing ....over 30 hours per week. These students
would later go on to become "the great ones" and the others were
destined to be music teachers.
The incredible thing was there were NO "naturals" or people who were at
the top WITHOUT this commitment. NOBODY in the top third had practiced
LESS THAN 30 hours per week. Also interesting to note was that there
were NO students who practiced for 30 hours or more per week and were
not considered elite. There was a magical number in this study: 10,000
hours of diligent, intentional, informed practice. That's it - practice more
than most people would and you will be successful.
You can see this type of dedication to practice and then having that action
transferred to muscle memory. Take a look at rifle marksmen, golfers,
basketball players, etc., The more they practiced the better they were
because their action(s) became automatic.
Now then...I don't expect you to practice 30 hours a week or a total of
10,000 hours. I DO expect you to practice EVERY SINGLE DAY with your
mock dummy set-up AND do ALL 4 lab sim stations. No exceptions ! For a
look at a reasonable timeline of practice, please see Q #9 in this section.
Short answer: Just do it so you can pass
32___________________________________________
Q: The mnemonics and videos are great but I want to make SURE I can
pass this test. Do you have any tips to stay mentally sharp/focused ?
A: I realize that with every tool that is given to you it means nothing if the
mind breaks down at critical moments !
Listen, even the best in the world have mental lapses as we can see at the
recent winter olympics. How can WE stay focused when taking the CPNE ?
You need to get into a "zone".
"The zone" as most athletes and sports psychologists put it is a state
where the person does everything right through various factors. The 9
commonalities that ALL people feel who are in this state are:
- Loss of fear (no fear of failure)
- No thinking of performance (muscle memory - automatic action)
- Total immersion in activity
- Narrow focus of attention
- Effortless performance
- feeling of being in complete control
- time/space distortion (time slows down)
- universe perceived to be integrated - everything feels connected
- unique, temporary involuntary experience
Wouldn't it be nice to get there when you are taking the CPNE ? I believe
there are things you can do to get you closer to being in this state of mind.
Here are some things I did and thought about when taking the test
1) accept you can fail and move forward
Do you think a neurosurgeon goes into surgery constantly thinking " I
could kill this patient if I do the wrong thing?" Or a boxer who is about to
enter the ring thinking " This guy is going to knock me out !" You know
what would probably happen ? The patient has a much higher chance of
dying and the boxer will probably get knocked out or lose the fight by way
of decision.
2) Get your mind into the right state by finding a rhythm
A student once told me that to help her pass she would tap her pen on
the palm of her hand 5 times hard before she would practice her MOCK
LAB SIM stations and MOCK AOC stations. When she went to the CPNE she
would do the same thing - tap her pen on the palm of her hand 5 times
before the LAB SIM stations and then tap the pen on the palm of her hand
5 times before each PCS. I didn't understand the reason until I saw a
basketball player by the name of Jason Kidd shooting a free throw....
He blows a kiss to his wife before every free throw.
I have to assume this is good for his marriage but most importantly his
free throw percentage is in the high 80 percentile range (not bad when
you have thousands of people shouting at you...)
When you have a ritual it calms you down and puts you into the right
frame of mind....hopefully closer to "the zone"
3) In between patients play some loud music on your music player -
It is good to hit the reset button when you are in between patients
(between patients 2 and 3 I had an hour wait !) It does us no good to just
sit there thinking about what could happen. Give your mind a break !
I played this same song over and over again (yes, only one song!).
Repetition helps me to relax and zone out for a little bit. The song I played
was Chiquilla by The Cumbia All Stars. It's a catchy upbeat song and the
beat of the music stayed with me. It's a song entirely in spanish so go
figure.
AND THE MOST IMPORTANT ASPECT.......
4) Change the way you are motivated by this test
Someone once told me that, "it is better to be pulled TOWARD the
prospect of success than PUSHED by the idea of failure". When we are
PUSHED by the idea of failure we will do those things that are necessary
to simple not fail. When we are being PUSHED by this prospect things feel
tight and they don't "flow" as easily.
On the flip side If you can see the finish line up ahead and you are close to
it all the anxiety and apprehension that you may have had will have faded
away. VISUALIZE the goal of passing all 4 LAB SIM stations and all PCS's
- let the test happen; you have practiced enough to allow your muscle
memory to take over. Trust in yourself and your abilities so that you can
be PULLED toward success.
FAQ (Frequently Asked Questions)
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