Amarillo TX Test Site

Here is yet another student experience from my past files....


First let me say....do not be surprised how stressful and exhausting
this whole process will make you feel physically and mentally!! I
know you feel prepared academically but be ready to pull your stress relief coping mechanisms when you start on Saturday. Nothing....can prepare you for the stress.... and this has been said by everyone I know who has taken the test with every type of clinical background and every type of CPNE preparation. But, if you can control your stress and stay focused you will be okay!!!!

So of course :

Tip #1 Control your stress. Have a plan!!! Clam deep breathing .. A positive message to keep saying in your head.

Tip # 2 Eat well.
When the test begins on Friday you forget to eat. Make your self no matter how tired you get make yourself eat breakfast, lunch ( at
least a snack), and dinner.

Tip #3 Sleep:
The Walmart is down the street from the hospital a couple of
miles.....get some benadryl if you have to but make your self sleep
at least 8 hours on Friday and Saturday night.

Ok that was the basics... I am sure you already know but really make your self stick to those tips!!!!


Now on Friday everyone will meet in the lobby of the hospital. No
reason to arrive too early because the CE will arrive exactly on
schedule. I had the same CA both times and she was really nice. They will take you down to the basement and sit you at a table facing a wipe board. The lab stations are right behind you. The CA will try to make you feel pretty comfortable. After you chat about the rule and roles of the CA and CE's you will establish which group you will be in. You will do this by blindly picking cards. After the group has been established then you will have time to look at the lab for 15 minutes.

Tip #4 Go through every Lab until the time is up!!!!
Wound Care: Start with the wound care. You need to check out the
wound.Take off the dressing and see how it is packed. When I looked at the wound packing under the dressing ....I thought hhmmm looks a little messy. So I called the CA over and said " If you can answer this ok..If not I understand.. .Is this how you want this wound packed." Now keep in mind it was not terribly packed but not perfect and could be judged a failure. The CA said " I packed that a little messy" so she repacked it. She said " Look at the wound there is a color difference at the edge. Your packing must cover the red areas". And of course you know not to let it touch the skin. Also the wound has a jagged edge that is like a small triangle that you have to pack. One time someone forgot to label/date/ and time the tape on the dressing. Just do it first while you are preparing!!! !

REMEMBER: Kick the trash can away from each station so you do not accidentally throw away any needles or syringes without needles. They will remind you at this site because people were failing for this. Also of course wear your gloves.

The below is to include what you already know........

IM: Let see ...the most important if you can use the thigh do it. It
is the easiest site not to screw up. Just make sure you know how to
site it. It you use any other site make sure you now how to site it
correctly. The mannequin has bones. So it was a surprise when he hit it. My advice is to pick your site while practicing and actually do the injection. Palpate for the bones...you can feel them. Also if you look at the mannequins they have been stuck so many times you can see the site most chosen by the students before you....that is just a hint still feel for the bones!!!!! Be ready to pick the needle
size and gauge. Don't worry the calculations are very very easy.

SC: This was easy also. Just remember to mix your insulin right.
Clear to cloudy. The cloudy was barely cloudy so I did verbalize
with my ce that it was the cloudy vile.

IV Push: Make sure you wipe your ports with alcohol . Make sure you flush. Make sure you aspirate before you push. Make sure to flush after you push. While your pushing time it correctly. It does not hurt to say what your doing. Now the big thing on this station.
Amarillo has needles ports on the med vile's for the IV push. If
your not familiar with this it looks like a heplock on the end of
the vile or the blue port on a IV line. When you draw over draw the
medication. This way you can push out the air drawn from the port.
They don't care if you squirt the over draw out. Also turn your
needle up and down to check for any air bubbles hidden bubbles. And tap out any air bubbles before you push. They really look for air bubbles.

IV Piggy Back: You will have to spike your own piggy back bag. The bags are out on the table. The IV is set up with a Litter bag of
fluid and a piggy back in place. The line was already primed. Just
do not forget to lower the primary bag. As far as the drop thing
goes. Lower the clamp so the line is straight while you are
counting. Then let go of the clamp and tubing and count for one
full minute before allowing the CE to count with you. This is so if
the line begins running faster then you expected you can correct it
before the CE counts with you. You have enough time on this lab to get it right so do not rush yourself. When you do count with the CE say " I am going to begin counting on the 12 and say stop on the 12. Then count the first 5 out loud and nod or tap your wrist with your count. This is a good way if the CE accidentally losses her count..remember they are not perfect and are tired at the end of
their day.

Just stay focused during the lab. Block everyone else out. Try not
to talk when you finish one lab and your waiting for another in the
hall. Do not absorb the stress from your other peers..this is your
test. Talk your way step by step so you do not miss a step there is
nothing wrong with that. Do not let them see you sweat....they can
sense fear and if it is a tough CE they will work it against you!
And of course.....try your best not to repeat because this will
reduce 50% of your stress for the weekend having the lab behind
you!!!!!

Here are some questions I was asked by other people after my test
that may be helpful.....
1. Did you have to weigh your pedi patient:
I had the 18 month old for peds. I did not have to weigh her. I did
have to wieght the diaper. The scale is by the sink. The nursing
staff already has the scale preset for account for the weight of the
dry diaper. My Ce wanted me to weigh the dry diaper then weigh the wet diaper. Know how many cc per gram....I think I have that in my notes I sent you...can't remember it off the top of my head. Both times my pedi's were clinically easy. They are a little tougher
because they really are not thrilled by seeing you come in full
white scrubs. Just FYI...the clean toys are usually keep at the
station you will be charting. It doesn't hurt to bring stickers but
ask if you can use them to the nurse or CE. Also make sure they are age appropriate ...ie a 2 year old may choke on a sticker. My pedi had to ambulate so we walked down the hall to get a toy..she liked that.

2. What were your AOC's?

PT #1: 18 year old female craniotomy s/p head bleed with repair
of some artery with Rt side paralysis and oropharangeal dysphasia.
AOC: Neuro Assessment, Comfort Management, I&O's, Medication Management and all other overriding areas of care.


Pt # 2: 18 month old female Dx: Asthma Aoc: Respiratory assessment, Skin Assessment, Neuro Assessment, Comfort Management, I&O's, Ambulate x one with all other overriding areas of care

Pt #3: 60 year female Dx: abcess of the rt breast. AOC: Neuro
Assessment, Medication Management, Comfort Management, Respiratory Assessessment, all other overriding areas of care.

3. How were the CE's:
All the CE's I had were great the second time. They were much
better then the one's I had the first time. The people who had the
Shum CE said she was particular about her paper work. I did not care for Bonnie she was in my first CPNE. She did not want to talk to the
student or the patient in the CE. She made it very clear she was a
silent observer. She did not even answer the patient when she
directly asked her a question. That made me and the patient
uncomfortable ( thought that was emotional jeopardy.... guess not for her???!?!?). . Gloria Valdez is really nice. She has nice energy
and makes you feel very comfortable. I had two other Hispanic CEs( one for pedi and one for adult) that were really nice with nice
energy. I wish I could remember their names but just can't. And
shoot I had another nice instructor and can't remember her name.

But all in all the instructors were nice but they do expect you to
know all your critical elements and do them right. They are being
watched also ...this is their job. The best advice I can give is to
ignore the tester. Only prompt them to had over the stethoscope ...etc. When you do it this way it will seem you are in
control over the test. If you have to do cough and Deep breathing
with a toddler be prepared to make up a game for them to suck in and blow. But over all the peds are not bad.

4. How about charting:
I did not have any problems with charting either time. I just jotted
out my critical elements in each care area and charted on every
critical element. Plus if you forgot something you can always go
back and do it!!! Make sure you fill out the final evaluation
correctly. Review this in your guide if you have to. The part that
you have to write how the patient responds...do it like the care
jack, "the patient states I feel like I can breath much deeper
now" Make sure if the nurses station is too loud and distracting to
chart asked to be moved so you can concentrate.


5. What about Meds:
I had to hang a piggy back and pass po meds. No irrigation No wound management no peg tubes no tube feeds. No one had anything like that. Meds are done on the Pxysis system. Always of course check the name band....... you can never over check . And pop your med sheet out of the 3 ring binder and take it to your patients room.


6. what did you do in your planning phase
Of course I wrote down all my munomics but I wrote out what my plan was going to be when I got into the room. Plus when I did my care plan I wrote the page number for the CE so she could look it up quickly. I haven't heard of anyone having problems with the care plan.

7. During your breaks between PCS's
Definitely don't come back smelling like smoke. Keep your bag
available. We kept our stuff in the basement so I just sat down
their reviewing my critical elements to keep me focused on the next PCS.

8. The Room:The rooms are all private rooms

Just remember go in and do what you have to do as quick as
possible!! Then get out and chart!!!!!!! If your patent is in the
shower...... well have her brush her teeth....wash her face with a
warm cloth...change her linens and bang you have done your comfort management. sit her up in the chair, asses her pain.....her breath sounds and neuro assessment. You see just do it all as quick as possible. Don't do something and slowly transition into the other do it all at once.... Does that make any sense?? It just helps to
avoid interruptions.

Try not to feel to stressed ( I know yea right>!?!?!> !!?) Every
night I just studied my notes. I really had my mnunomics down.
During lab sims I just concentrated went slow and did it step by
step. Keep your stress under control!!All I can say is that it is very doable. You can do it!!!!!!!! Plus
Amarillo will really want to see the student pass this weekend!!!!!
I hoped this helped you,
Good Luck!!!


For more info, visit Tina's CPNE Workshop website at www.cheducation.com