CPNE Sept 12-14, 2014 Meriter Hospital Madison WI BRACE YOURSELF, ITS LONG AND RAMBLES

This was my second attempt at CPNE. I tested two years prior at Lubbock. That was an expensive
practice run. It had haunted me for two years. I let my nerves take over and ruin my weekend. Best
thing I learned from that weekend, take meds and do not let other students distract you.
For my second attempt, I finally scrapped together the money with the help of my employer and
reapplied June 29, 2014. I waited a month before I started calling for cancellation dates. I originally only
selected Lubbock, but added the Madison sites just in case I could get a date sooner. I called three times
a week for a month. Then my grandfather passed, and there was a week of preparing for the funeral.
The day of visitation, I received a call offering a cancellation date. I declined initially, and then four
minutes later called back and accepted. I would be going to Meriter the following week.
I drove to Madison from Fort Worth, Texas. It would be cheaper than flying and Id feel better having a
vehicle while out of state. I left on Wednesday and it was an ordeal of a drive. I finally arrived at the
hotel at 5pm on Thursday. Im still glad that I drove.
On Friday, I left the hotel two hours early to drive to the hospital just to be safe. I finally went into the
lobby at 3pm and just did some last minute review and let my nerves calm. I was purposefully anti-
social the entire weekend. The CA came down, we waited for one more student, and I became the girl
who drove from Texas for the rest of the weekend. We walked across the street for labs. After the
standard paperwork and speech, we were free to check out the stations. Try on the gloves, sterile and
non sterile. Check needles, syringes, and vials. I kept to myself and messed with every station. I
remember at one point someone asked me if it was my first time to test. I lied and said yes and kept on
trying gloves and such. I felt bad about it, but I was there for me.
Labs, I had IM/SQ first, insulin regular and NPH. Passed. I next moved to IV piggy back. Dear God, I hate
38 gtt/min. I spent too much time with the drops. Fail. Luckily, I was very calm, thanks to plenty of
meds. I had a very nonchalant attitude about it. Moved on to wound. Completed in 9 minutes. The CE
turned the wound around and boom, 4x4 barely peeking from underneath the abd pad like it was
flipping me off. Fail. Again, I just said ok and sat down. Even after two fails, I had no nerves. Lastly, IV
push. Went through the motions, passed. Now, to head to the floor for PCS 1.
The CE was wonderful, they all were. Like I said before, I was the girl who drove from Texas all
weekend. Made for nice small talk instead of awkward silence. PCS 1 female s/p abdominal sx , being
discharged soon. She had sx in May and had a student then, so she knew the routine and was willing to
help me pass. Mobility (standby assist), fluid mgt (IV running, NPO except ice chips), vs manual bp, abd
assessment (binder), meds w/ lovenox, resp mgt (DB&C). Care plans- ineffective airway clearance r/t
retained secretions aeb abn breath sounds, assess breath sounds, goal- clear breath sounds, int 1-
DB&C, int 2- position upright. Care plan 2- impaired physical mobility, assess gait while ambulating,
goal- will ambulate around nurses station once during pcs, int 1- provide stand by assist, int 2-
completely forgot. Went into room, said hello at the door and told patient I would wash my hands first.
ID patient, told her I would be looking at my paperwork and doing a lot of talking out loud, introduced
self and CE. Grabbed gloves, assessed site, verified fluid and rate. 20 min check done. VS next to get
them out of the way, told patient I would check bp once more before I was done. Next was abd
assessment, did not know about binder until I raised the gown. After that, went ahead and completed
Resp Mgt. So far so good. Onto meds, left room to look for meds. At Meriter, there is a patient station
in the hall with a lock box for meds. Our meds were not there, so off we went to look for them. Found
meds, did checks with mar in med room, grabbed cup of water for meds. Stopped at ledge by nurses
station just to pause, breath, and look at grid. Measured beginning water. Into room, clean space given
by CE, she held meds while I washed my hands. ID patient with mar, gave pills, set water aside. Lovenox
given in midabdomen. I had asked nurse in report where they were giving it, since I default to love
handles. Sharps dropped. Next, and last thing was getting patient up and walking in the hall. I walked
with IV pumped while patient walked and occasionally used hand rail. Done, back to bed, anything else?
Onto evaluation. Used ineffective airway clearance, rationale of must continue interventions of
complications of pneumonia and prolong hospital stay. CE took me down the hall to a waiting room
because it had the best view of the city. Looked at the lake and remained calm. She came back about
10 minutes later and I passed. I asked a few questions about the lake and city and down we went back
to CA. Studied mnemonics while waiting for next pcs. Again, I was anti-social so I could focus. Took
more meds.
PCS 2 pleasant older gentleman who was hard of hearing. I dont remember why he was admitted. I
have a higher pitched voice and had to mentally remind myself to try to lower my voice while talking.
His doctor had taken him off glyburide and thats all he could talk about. Mobility (walker, ambulate in
room), fluid mgt (I&O only), vs, skin (scapula, heels), neuro , resp assessment, comfort mgt. Care plan 1-
impaired physical mobility r/t I forgot aeb I forgot. Assess gait during ambulation, goal- ambulate once
in room during pcs, int1- encourage use of walker, int 2- provide stand by assist. Care plan 2- impaired
comfort, ask patient what is making them uncomfortable, goal- verbalize comfort after interventions, int
1- tv as distraction, int 2- reposition, int 3- face wash. Into room, wash hands, ID patient, then he begins
with the doctor taking him off his med and its not like its Actos and how he doesnt want to test his
blood. He was really pleasant, and his going on just made me and the CE smile. Told him what I would
be doing, started with vital signs. Checked how much water in his jug. Did neuro first, after checking
dorsiflexion, immediately checked heels for skin assessment. Next moved to resp assessment, he didnt
want to sit up in bed, he rolled to his side, used pillow for positioning, listened to breath sounds then
checked scapula for second skin area. Repositioned him, attempted every comfort measure I had listed,
then moved onto every comfort measure possible. Nope, not interested. Ok, write on grid and move
on. Asked about getting up to chair, counts as ambulate in room. He wanted to wait until his lunch
came. CE asked him if he ordered it. Nope, we get the menu, finalize what he wants, I call down his
order. We leave room to wait for tray, I chart everything I can. Tray comes in 10 mins, thank goodness.
Go back into room, get him ready to get up to chair. Transfer with walker and stand by assist. Position
tray and open everything for him. Cut up meat, wants to know where mashed potatoes are, uh you
didnt order any. Talks more about glyburide. He wants towel for bib, finally get TV turned on. I chart
some more while waiting for him to finish, count his I&O, thank him and go off to chart. I used impaired
physical mobility, ambulated once in room, encouraged walker, provided stand by assist. I charted for
comfort mgt everything I offered, what he refused, what he eventually accepted (tv), and improvised
with the towel as bib and he wanted two pillows upright in chair behind him. Done, turned in and
waited. 15 minutes later, passed and downstairs we go. Every time I had to wait, I always looked out
the window, Madison is pretty, and it was always calming to get lost in it.
Back across street for labs, I stayed away from others, I do feel bad after the fact for being anti-social. I
did the wound first. I took off my watch and had set my pen down on top of my bag. It fell in the trash,
I shrugged it off and went to start the lab. I set everything up, took off dressing, went for tape and to
date it first. Ah, a pen, crap. CE just sets hers on the table and slides it to me. She had seen mine fall
into trash. Wrote on tape quickly and gave it back. Completed lab, turned the wound around like four
times checking the dressing. Completed, passed. Back to hall to wait. Went over steps in my head and
out loud over and over again until I went back in. IV piggyback, same calculation, 38 gtt/min. I nailed it,
CE had counted when I was counting, completed station, pass. Exhale, relief. CA says no peds at either
hospital, so substitutes the next day. I brought the big pediatric book for nothing. Head back to hotel,
change, drive out of Madison because I want to see dairy cows in the dairy land. Have yet to see any.
Get dinner, shower, try and sleep.
Last day, can see light at end of tunnel. This is where I get fuzzy on the details. PCS 3 was a sweet older
lady, CHF, pedal edema, abn lung sounds, afib. She was a peds substitute. She liked asking questions
about me and where I was from, I gently answered them without getting too personal. She was so
sweet and really wanted to do whatever I needed to do so I could pass. Mobility(transfer to chair), fluid
mgt, vs with apical and O2 sat, abd assessment, pnva, resp assessment, meds(coreg and lasix). Care plan
1- impaired physical mobility, int 1- stand by assist, int2-encourage walker. Care plan 2- impaired gas
exchange r/t chf aeb abn breath sounds, goal- clear breath sounds, int 1- position upright, int 2- give
lasix. It was a stretch, but I was thinking priority. Report from nurse, had been holding meds d/t bp.
Found vs machine, into room, wash hands, ID patient. Attempt vital signs. Bp cuff too big for her arm,
gave low reading, completed other vs and out to find a smaller cuff. Back into room, machine wont
read bp, try twice. Out to find another machine, finally found another one, still bp not taking. CE didnt
bring manual, continue to look for machine. Found another and finally got a bp 88/49. Out to find
nurse and give report. Hold meds. Assignment revised, no meds to give. Back into room, do pnva first,
move onto resp assessment next, and abd assessment last. Completed all assessments. Out to hall,
breathe, chart a little, revise care plan. Changed to ineffective airway clearance, changed int 2 from give
lasix to ??? Revision approved, back into room for transferring. Everything went smoothly. Back to
chart, time added. Charted all areas first, then onto eval care plan. Chose ineffective airway clearance
r/t chf aeb abn breath sounds, assess breath sounds bilaterally, goal- clear breath sounds after
interventions, int 1- position patient upright, int 2- ? Turned in paperwork right on time, down hall to
waiting room. This time I sat watching the hallway. I was looking for the CA to pass by, I kept thinking
about what I had done or might have done wrong. Then I would try and focus and prepare for another
pcs. Finally, the CE came, said we had to go downstairs to verify. I sat and watched two other testers
out front take their pictures with their pass papers. I mentally prepared for another pcs. I was finally
called in and the CA immediately says you passed. My eyes well up with tears and she goes to hand
me the pass paper. I say wait I have something for you, she said something about not necessary, and I
pulled out my fail letter from Lubbock two years before and hand it to her. I had held onto it and
brought it with me as a reminder of where I have been and I was trading it for a pass letter. She tore it
up for me and then went over the pass letter. I was in complete shock. I got my bag, put up my letter,
thanked everyone, and booked it to the parking garage. Called the husband, changed clothes in parking
lot, and got out of town. I made my phone calls and texts. Im still in shock a week later. I cant believe
I only have Nclex left.
I left Madison and headed for Chicago, since my husband and his family is from there and Ive never
been. Thats another story in its self. I drove until about 2:30am and finally stopped for a hotel in
Missouri. The next day I drove back to Texas, getting home at 6pm.
Tips:
1. Do whatever it takes to stay calm, if its meds, take them. I took a lot, but I was determined to
not go through that a third time. I took enough to take the edge off and numb any adrenaline
rush. Thats the only way I got through and was able to think.
2. I remember by memorizing and writing. I had memorized everything two years ago, so I really
only refreshed and changed a few things this time. I even kept the same mnemonics.
3. At Meriter, they really want you to pass. You can feel it. I didnt feel it when I was at Lubbock,
but that could totally be because of the nerves.
4. I tried to make everything as simple as possible. I did take Sheri Taylors online workshop, I only
did 6 of the email care plans, but I watched every care plan video and practiced along with it.
5. Since I drove, I gave myself two days of driving, just to get there without having to worry.
6. There was a ton of construction in Madison, apparently getting the roads ready for winter. And
no service roads like in Texas. My first night and morning there, it took me two hours to get
anywhere, so I ended up two hours early for Friday afternoon.
7. If you have to be anti-social, do it. Do not get wrapped up in others conversations, last minute
studying, or if they failed. I can still remember the stories of the other students in Lubbock.
8. I had two years before I retested. Since then the school changed the policy that you have to
retest within a year. Take all the time you need. I definitely am thankful for the two years. I
just went on with life, but my first test always haunted me. Now, the memories of Meriter are
overtaking the ones from Lubbock. Theres a lot I dont remember now, except the name of
that one CE.
9. Its ok to have that one CE, the one you will always have a sour taste for, but own your mistakes.
I was a wreck in Lubbock. I was prepared for everything but the stress. I had a horrible
experience with one CE in particular. I will always remember it.
10. Im really a bad example on how to pass. Just use my story on insight into what it is like. Do as I
say, not as I do. I am able to memorize easily, whether written or verbal. I still had mnemonics
from the 18
th
edition that still worked. I still remember a lot from my previous studying, so I
slacked a lot. I honestly didnt practice the labs until the morning of, and just wrote the steps
that afternoon to remember. Every time I tried to study, it was hard because I already knew it.
This is where practice care plans helped a lot. It was something I had never seen before, so I
was bored by it.
Everyone is different. So is every site. Im glad I took the chance on Madison.