ATI - RN Predictor

We seniors have taken our last ATI test! This ATI exam does not affect our grades, like the tests did last year, but it does predict how we will do on the NCLEX exam.

The NCLEX exam is the test you take to get your RN license. It is a computer adaptive test, meaning that the next question given depends on how you answered the previous question. So if I get a question wrong, the next question will be easier (and probably concerning the same topic), and if I get a question right, the next question will be more difficult. There is a "passing bar", and as long as you stay above the passing bar you are considered to be "minimally competent in nursing", and you pass! Our teachers keep telling us, "You are all... minimally... competent." :)

To explain this bar, think of a ladder with a red rung smack dab in the middle. We all start at the minimally competent rung. If I get the first question right (a question that would be considered to test minimal competency), then I move up a rung into the passing zone! But the next question is harder now, and if I get it right, I move up another rung! The next question I get wrong because it's about a drug I've never heard of before, so I move down a rung, but I'm still above the red one, so I'm still passing. This keeps going; up and down and up and up (hopefully), and as long as I end up above the red rung when the test is over, I'm good.

Some NCLEX facts to scare us:

The NCLEX exam is written by nurse specialists who are experts in a cotent area of nursing.

All content is selected to allow the beginning practitioner to prove minimum competency on all areas of the test plan, and tests your judgment and discretion and ability to think critically and solve problems.

Minimum competency questions are most frequently asked at the application level, not the knowledge level.

Questions and answers are written in such a way that you will not be able to predict or recognize the correct answer.

The answer choices have been extensively tested, and the people who write the questions make the incorrect answer choices look attractive to the unwary test-taker.

So, I took the ATI exam consisting of 180 questions. I even used the Decision Tree for a few of the questions, and it helped! In order to pass the test for school, we needed to get a 70% or higher; this would put us in the high 90th percentile for passing the NCLEX exam the first time.

At the end of the test, my results showed that I got an 80%.
My predicted probability of passing NCLEX-RN on the first attempt: 98%!!!!!!

Mean Score - Nationally: 71%
Mean Score in the Program: 70.7%
My Percentile Rank - Nationally: 91
My Percentile Rank - Program: 91

The biggest thing I need to work on: Pharmacology.

The Interview

I had typed out the story of my interview last night, only to accidently delete it. I guess this really isn't a good excuse as to why it's taken me a whole week to update everyone about what happened! Sorry! And thank you all for your prayers :) Here is everything I can remember about what happened last Monday.

This interview was probably the weirdest and biggest thing I've ever done.

Weird because: It's a big-girl job. It's part of "the real world". It'll be what I do till I'm in my 60's.

Big because: It's a big-girl job. It's part of "the real world". It'll be what I do till I'm in my 60's.

So here's how my day went: I woke up and put on my best black pencil skirt, light blue striped collared short-sleeved shirt, and black heels. Boy did I look professional. I was so excited to be walking back into the doors of Johns Hopkins; it's always a great feeling, less so when it'll be job time and it's 6:00 am (actually still a great feeling, it's the alarm going off at home at 5 that is less than ideal).

It was also great to be back in the NICU and see everyone I've worked with. I enjoyed looking on the boards to see which babies were still there that I have cared for, too :) Such cuties!

The first thing I did was meet with a nurse manager and talk about my ethical issues with abortion and active euthanasia (where the actions taken by the medical team directly cause the death of the patient, rather than the removal of medical treatment and allowing the illness itself to cause the death of the patient [Passive euthanasia]). Active euthanasia, a form of physician assisted suicide, does not happen in the USA except for in one state, but I wanted to cover all ethical situations that I would be unwilling to participate in after learning about them in class this semester. After the nurse manager explained to me how my scheduling would work (work every-other weekend for the first year then every third after that, working half of the holidays, working 8 and/or 12 hour shifts), we headed over to a conference room where there were 3 other nurses waiting for us! I interviewed with all 4 of them, but it wasn't as frightening as I thought it would be because I knew them all and they were kind!

The interview started with me telling about how when I was in middle school, I saw a TIME magazine article about a neonate and the nurses in the NICU, and I told my mom that "this is what I want to do!". I explained how I love children and feel that it is an amazing experience to be able to care for the most helpless. I also told them how I came to work at Hopkins and how I love being a part of such a distinguished team.

The majority of the questions were based on previous clinical experiences or asking how I would handle certain clinical situations. I was able to tell of my missions trip to Guatemala, where I translated spanish and worked all day long (the question being if there were ever a time where I had to move-move-move all day). I wasn't asked to give my weaknesses, but I was asked if there were a time where I felt overwhelmed, and I told them that there has not been a time that I can remember where I was not able to do the work required of me (and I attributed that to the fact that I have had great fellow nursing students and instructors who were always willing to help me if I needed anything, and that in my down-time, I can be of help to others).

An interesting question that ended the interview was if I felt my CNE experience at Hopkins has helped me with my Leadership clinicals here in Lynchburg. I have felt that my CNE experience has been a great help and that I have been able to see both sides of patient care and learn how that care differs when I am practicing as a nurse. I also told them how I would tell myself, when first starting in the NICU here at school, that I needed to have a teachable spirit and be quiet and learn... that there was much I could learn from my preceptor who is an expert in her field and has much wisdom. They asked for examples of how things differed from Hopkins and I told them how there is about 5 patients in the unit here at school compared with the 45 at Hopkins! I was also able to remove an umbilical venous catheter (an IV line placed in a vein in the umbilical cord) from one of my patients (nurses do not perform this at Hopkins) and how I feel guilty eating my lunch with the other nurses in the unit (this isn't allowed at Hopkins!). They thought that was funny, which was a nice way to end the interview, in my opinion.

All-in-all I feel the interview went well; but I do feel like I repeated myself at times. It was weird after the interview feeling that there was nothing more I could do but wait for their decision. They still have 4 more people to interview (I was the first) and they won't know how many positions are available until they get their budget back for the unit. But it really is nice to know that it is in the Lord's hands and that His will for me will be done! So I'm not feeling anxious... there's simply no reason at all to "worry about tomorrow..." :) Plus I've got NCLEX to think about, and actually there is worrying involved with that. Baaah!

Before heading back to school, Matt and I had lunch at a fun Greek restaurant in Baltimore. I tried really, really hard to pay for it all, but Matt insisted. What a nice brother ;)

P.S. - I have some amazing pictures from Mom, Matt, Bryce, and Brandon's visit this past weekend, but I've lost the cord that transfers my pictures to my computer. So until I can get a new one, I'll have to just tell you - the pictures are worth waiting for.

The Decision Tree

I'm in the process of finishing out the last semester of my college life. There is no greater feeling.

One of my classes is a review course for the NCLEX RN test I'll be taking after I graduate. We are learning how to answer questions and get the right answer (easier said than done) even when we aren't sure what the question is asking, or when we feel that every answer option is right! After each class, we all feel stupid.

More on what the NCLEX test is like later. First I want to show you what it takes to answer one question.

The Decision Tree:

Here's the best example I could find in my book to go through the Tree with. Try to go through the steps yourself and see if you can get the right answer!

Question:

A child has just returned to the pediatric unit following ventriculoperitoneal shunt placement for hydrocephalus. Which intervention should a nurse perform first?

(A VP shunt is put into the head to drain CSF fluid that the baby's body can't drain by itself; Hydrocephalus is a big word for fluid (CSF) on the brain).

1. Assess intake and output.

2. Place the child on the side opposite the shunt.

3. Offer fluids because the child has a dry mouth.

4. Administer pain medication by mouth as ordered.

The Decision Tree:

1) Can the topic of the question be identified?

Yes - Proceed to step 2

No - Read answer choices for clues. Identify the topic question. Proceed to step 2.

Topic of the question would be... PRIORITY intervention for VP shunt. On to step 2!

2) Are the answers assessments or implementations, or both?

- A mix of both? Read the step/topic of the question to determine if it is asking you to assess further or implement. Select correct answer.

- Are all answers assessments or implementation? Proceed to step 3.

With this question, answers are both assessment and implementation. 1= assess. 2= implement. 3=implement. 4= implement.

I think we need to go to step 3.

3)Maslow's Heirarchy of Needs - Physical or Psychosocial needs?

Does Maslow fit?

No - Are all answers physical? Proceed to step 4. Are all answers psychosocial? Proceed to step 5.

Yes - Eliminate psychosocial answers (they will never precede physical needs! Pain is considered a psychosocial need). Do physical needs make sense? ABC's (priorties of patient needs; Airway, Breathing, Circulation).

We can eliminate some!

4) All answers physical?

No - step 5

Yes - ABC's

There is nothing about the patient's airway or breathing...

5) What is the outcome of the remaining answer?

Is it desired? Select correct answer.

Desired outcome is correct functioning of the shunt and being sure it drains the CSF.

Whew. That's quite a lot of work for one answer! Which did you pick?

The correct answer is....

2! Placing the child on the side opposite the shunt prevents pressure on the shunt valve. Intake and output will also need to be assessed, but that isn't the nurse's priority. The child is usually on nothing-by-mouth status until bowel sounds return/able to eat. Pain medications should be administered by an I.V. route initially postoperatively.

Very rarely does it seem that there is a clear-cut answer, even when using the tree. I hear that some have felt that all they did during the NCLEX test was make educated guesses. I am sure that these test taking strategies help, even if only to make educated guesses!

Things To Do:

1. Find a yellow outfit for Grace's birthday :) Yay!
2. Begin studying between 4500 and 5000 NCLEX review questions (for my nursing exam when I graduate).
3. Laundry
4. Get two clinical instructor recommendations, a transcript, and new outfit for...
5. ... my interview at Hopkins!!!!

I have an interview with the NICU on Monday, April 5th, so be praying for me as I mentally prepare for this; I'll be interviewing in front of a few people this time. Thankfully, I'll know them since I've worked with them over the summer and winter, but I'm still nervous! This is such a huge opportunity for me, one that I am so thankful for and excited to begin. I've really come to LOVE Baltimore more and more the longer that I've been away from it. I can't wait to get home and settle in and start this next chapter of my life at home, and at Hopkins if that's where the Lord leads me!

I just want a crab feast, to go to an O's game, to get some ice cream at the Prigel Family Creamery, sleep in my enormous fluffy cloud bed, and be around YOU all again. So... for now... I'll see you for Easter; but in 52 days, I'll see you whenever I want!

I Found It In The Kitchen

Gross.

I got home from spring break Wednesday night, in the dark, and had to walk into my house all alone. I walked into every room with a broom making tons of noise, even looked under my bed, but saw nothing. The last room I went into was the kitchen, and as I turned my head to look at the floor, I saw a little rat butt poking out from under the cabinets... my cabinets actually... and I sucked wind. I found it odd that the mouse was still in the middle of the kitchen after I had been making so much noise with the broom, so I walked to the other doorway of the kitchen and looked in from a safe distance. There it was, grossing me out. So, I called home, and Matt picked up. I think he loved that he picked up the phone and got to hear me in such a panicked state. Here's our conversation:

"The rat's in our house!"
"What?"
"Eeeeh, is Mom or Dad there?"
"Hahaa No."
"Ewww it's in our kitchen."
"Ok...Heehe haha!"
"It isn't funny I almost walked on top of it!"
"Yeah? And how does that make you feel?"
"uuuhhh, ewww! ok..."
"April, talk to me"
"I'm all sweaty and my armpits are itching, that's how it makes me feel."
"Ha haaa! Are you looking at it right now?"
"No I walked away. EEEh. Ok. You get to play this for everyone because I'm sure it's being recorded."
"It is. Ha."
"Alright, I'm gonna hang up now and call Dad."
"Alright, one second though, Dad's at work. Ummm another question, do you have a crush on anyone?"
"Do I have a crush on anyone.... haha, no."
"Hahaha."
"Eew I'm so creeped out Matt I have to go, I have to call Dad."
"Alright, what's Dad's gonna say?"
"I don't know, I'll call the landlord."
"Call up one of your dude friends and tell them to come over and get it."
"Alright, aaah. Ok bye."
"And then block the entryway so It doesn't get out of the kitchen."
"It's dead!"
"Oh it's dead?!"
"Matt, I think so, I'm not gonna go close to it, but it's not moving, EEEW!"
"Call one of your dude friends. Call the one that broke the Jeep window because he owes you, and me."
"Ok."
"Alright."
"Ok. Everyone's on spring break, but alright."
"Alright, bye."
"Bye."

There it was folks. And in case you couldn't tell who-said-what above, Matt's the one who kept saying "ha ha".

It'll Be Funny One Day, Right?

Update on the mouse situation: well, it's a rat.

My roommates and I have a rat living in our house, and my nightmare of stepping on the body of a vermin almost came true. We had set out a couple mouse traps to catch the little guy Lindsay saw in her room. After weeks of no success, we assumed he went back outside after all the snow melted. Some time last week, I was home alone, in my room with the door closed and heard a loud chewing noise coming from somewhere in the kitchen or dining room. I ventured out with as much bravery as I could gather while being home alone with a "mouse" but soon realized that the noises were coming from inside a wall. Eeeew! My roommates started hearing the noises throughout the day as well.

So, this past Thursday night, I was getting ready for the arrival of my mom, Aunt Becki, and cousin Katie for the weekend. While I was in my room I heard the wires behind my desk shift. I convinced myself that it was nothing and continued getting ready for my family to arrive, when I heard them shift again. As quickly as I could, I threw open my door and ran out into the hallway, screaming "The mouse is in my room!". My two roommates ran to my rescue, one of them kneeling down to look under my bed and the other walking around and making noise with a broom. I was standing at the doorway really grossed out. Then suddenly, we heard scurrying and a big, ugly, black RAT ran behind my desk and out the doorway.... towards my feet.

I screamed and jumped in the air as I saw this "not a mouse" hover under my feet for a split second in all the confusion, and all I could think to myself was, "I'm going to land on it and feel it under my feet! (read previous post)". Thankfully, I did not land on top of the rat, but ran instead back into my room and jumped into the middle of my papasan chair. Mom, Aunt Becki, Katie arrived soon after this mess.

We were all in the hallway and my roommate started opening a cereal box. I thought that the rustling of the cereal bag was the rustling of the rat, and when I gasped, Mom, Aunt Becki, and Katie thought that it was the rat coming out. I can't even begin to describe the scene. Mom and Katie screamed but both maintained a stellar composure when compared to what was going on next to them with Aunt Becki. She lost her head and started jumping up and down on top of Katie, screaming and spinning; she told us later that she twisted her ankles and momentarily lost her vision! Needless to say, no one wanted to sleep on the floor that night, so we all went to a hotel. Over the next couple of days I was discovering more and more rat poop in my room, under my bed, and in my closet.

The exterminator (I now feel that exterminators are very, very brave men) placed sticky traps and rat poison throughout the house. Hopefully, when I get home, the rat will be dead! Hooray!

Of Mice And Women

Yes, I have legs so pale they are almost transparent. But, this is what I look like every night while getting ready for bed, because we have a mouse in our house.

And yes, it knows we are afraid of it, and yes, it probably lives in our walls with an army of 500. And yes, I refuse to walk around the house without shoes on, because if I did, the mouse would know, and scurry across my feet (or, in my process of jumping and screaming, I would accidently land on top of it and feel it under my foot).

And I'm sure that the mouse can get into my room despite the fact that I have found a new use for my school books; blocking the crack under my door.

It turns out my fan sounds just like a chitter-chattering mouse.

And yes, when I heard there was a mouse in our house, I mentally went through Dr. Seuss' Cat in the Hat, Fox in a Box, Mouse in a House rhyme.

And yes, I am quite certain that this mouse knows how to climb into washing machines, cabinets, bath tubs, beds, and toilets. And for that reason, I take deep breaths before entering any room of the house, and I whistle under my bed each night to see if a little creature responds.