10. Accept the fact that you can never know everything.

Therefore, once you

see an unfamiliar question that was never been taught, use your test taking
strategies. [ From principle of contradiction up to magic words. Please refer to
Dervid Jungco's lecture ]

9. If you are in Test I, II, III, and IV and you are being asked to prioritize, Use
the principle of prioritization. [ Refer to Dervid Jungco's lecture ]

8. The use of your nursing process is heralded by the word: "The Nurse Would or
The nurse's initial action" Remember to Assess first before intervening. If the
situation and the question already assessed the patient, then proceed with the
next step.

7. Encircle your modifiers. Some people make mistakes because of failure to

see the word, "EXCEPT" or "NOT" or "INAPPROPRIATE"

6. Use your questionnaires as your scratch. You can write anything on that
paper. If you will skip a number, place an asterisk or encircle the number.

5. DO NOT USE BLUNT PENCIL. Always use a sharp one and shade lightly. A
sharpened pencil will give a very dark shade even if you will shade it lightly.
Use the sides of the pencil not the tip. Use MONGOL NUMBER 2 ONLY. Some
brands especially those made in china pencils are substandard. The machine
will check the lead. If you are INCONSISTENT with your shading like an altering
dark and light shades, you will FAIL the boards because of technicalities.

NEVER USE SAME PENCIL THAT YOU USED IN ANNOTATING YOUR QUESTIONNAIRE
AND ANSWERING THE ANSWER SHEET. Use separate pencils for the questionnaire
and answer sheet.

4. In your NP I, Remember to master these topics : The levels of prevention, 3

way bottle system, Chest physiotherapy and Postural drainage,Nursing process,
Managerial process, Managerial leadership style, Patterns of Nursing care,
Knowing your Independent and Dependent variable, The exact arrangement of
the research process as well as research design [qualitative and quantitative] ,
Sampling methods both the probability and non probability, RA 9173, The PRC
and the BON Power and responsibilities as stipulated in RA 9173, The nurse's
code of ethics, Nursing ethical principles like your benificence, non
maleficence, prudence, justice, etc. Delegation and prioritization [Staff nurse
will report to headnurse and then supervisor] Therapeutic communication,
always answer "You seem afraid or upset"The complications of Immobility like
your atelectasis, pneumonia and deep vein thrombosis and also your crimes
related to nursing and the circumstances of the crimes, Blood transfusion and
IV Fluids and your IV Therapy, which are isotonic, hypo and hypertonic, The
complications associated with IV therapy like Phlebitis and Infiltration.

For optimum studying, read MERGE diagnostic, comprehensive preboard

examination and critical examination for NP1.

3. In your NP II, Remember the following : Stages of labor, The causes of

bleeding during pregnancy in the first, second and third trimester, Anesthesia
during labor and interventions when the client is in PACU, IMCI Pneumonia,
Diarrhea, Malaria and Measles especially the breathing cut off according to age
[ Eg. 60 for under 2 months ], Acute/Chronic cutoff [Acute diarrhea and ear
infection under 14 days] The interventions for CHILD A, B and C, The world
health organization programs, Breastfeeding and Attachment, Heat loss of
neonates, Characteristic of toddlers in communicating [ Negativistic, Give
option, Asking too many questions] .Leukemia and other hematologic diseases
of the child, Newborn screening and the different diagnostic examinations for
the female client and neonate especially your Amniocentesis, Sonogram and
Leopold's maneuver. Study Pregnancy induce hypertension.

For optimum studying, Refer to the NP2 material that will be given last day of
your final coaching [ For MERGE students only ]

2. In your III and IV, Master the following topics : Burns, Classification of Burns
and Nursing Diagnosis for Burns, Drug use in burns [Silver Sulfadiazine],
Electrolyte changes in burn [Hyperkalemia, Hyponatermia]. The WHO Pain
ladder scale, Pain medications especially Demerol and Morphine, Pancreatitis,
Cholecystitis, Hepatitis, Diabetes Milletus, Hyperkalemia, Hypokalemia, Hypo
and Hypercalcemia ECG Changes in your fluid and electrolye imbalances as well
as in your Myocardial Infarction, Pharmacologic and Non pharmacologic pain
medications, HIV/AIDS Psychosocial managements, Pneumonia, Tuberculosis
and Leprosy especially knowing which are the late and early signs of leprosy.
Study Blood transfusion, Breast cancer and Colon cancer and the management
and care of client's with colostomy. Study perioperative nursing and the
complications following anesthesia, PACU Monitoring, Activities in the operating
room, The aseptic technique, the functions of a srub and circulating nurse.
Diabetes Milletus type 1, Insulin administration and monitoring for
hypoglycemia, S/S of hypoglycemia, Hyperthyroidism and Hypothyroidism, PTU,
Lugol's,Tapazole/Methimazole, Acute and chronic renal failure, Dialysis, AGN,
Rheumathoid and Ostearthritis, Bell's Palsy and Trigeminal neuralgia, Leukemia
and Hematologic disorders especially Anemia. Blood transfusion reaction and
the nursing actions during blood transfusion reaction. Anticancer drugs
especially Oncovin, Prednisone, Adriamycin and Cytoxan. Study radiation and
chemotherapy and their usual side effects [Skin burn, redness, do not wet
radiation mark]. Mammography, BSE, TSE, DRE, Prostate and Colon cancer,
Changes that occurs during elderly, Bladder, Colon and Cervical cancer
Diagnostic examination/CEA,Proctosigmoidoscopy,Biopsy,Pap smear.

For optimum studying, Refer to NP3 AND NP4 of MERGE preboard, diagnostic
and comprehensive exam. Study the FINAL COACHING material given during Mr,
Dervid Jungco's lecture. [ The 250 item bullets ]
1. In your Test V study the following : Anxiety and anxiety disorders, The level
of anxiety and your anxiolytics, Schizophrenia : Paranoid type and Catatonic
type and your nursing interventions for these clients as well as your priority
nursing diagnosis. Depression and your antidepressants, Mania, Personality
disorders especially your Antisocial, Borderline and Paranoid. The defense
mechanism use for different types of disorders and the priority NURSING
DIAGNOSIS for each psychiatric disorders, Antipsychotic drugs its side effects
and nursing intervention for each side effects. Electroconvulsive therapy,
Thought process disturbance manifestation such as Clang Association, Pressured
speech, Thought blocking, Word salad, perseveration etc. etc. Alteration in
perception and thought like hallucination and delusion. Types of delusions eg.
religious and persecutory. Activities and diet as well as nursing diagnosis for a
client with Mania, Depressed and Alzhemiers/Dementia patient, Eating
disorders and the treatments of choice [Cognitive Behavior therapy for
Anorexia, Psychotheapy for the PDs, Cognitive for depression ] Always answer
"STAY WITH THE CLIENT" especially if the question is about anxiety disorders
and panic attacks. Always choose an option that will encourage verbalization of
feelings, never answer an option with the word WHY.

Study your counter transference and your transference, Glaucoma, Cataract

and crutch/cane walking. The principles of body mechanics, cranial nerve
functioning and how to assess them as well as their disturbances especially
Bells and Trigemnal Neuralgia. Meniere's disease, Delirum, Dementia,
CVA/Stroke pathophysiology and Factors.

For optimum studying, Read NPV of MERGE Preboard, comprehensive and

diagnostic examination. Also study the 250 item bullets given by Mr. Dervid
Jungco.

ADDENDUM
For OPERATING ROOM NURSING in NP3, answer them with breeze using your OR
questions seen in diagnostic, comprehensive and preboard examination in NP3.
For non merge students, study the following:1. Functions and roles of the
Circulating nurse, scrub nurse, anesthesiologist and surgeon.2. Counting
process of instruments, needles, and equipments.3. Sterilization, Disinfection
[High level to low level] and decontamination.4. AORN guidelines in
sterilization5. Restricted, semi restricted and unrestricted areas and their
appropriate attire6. PERSONAL PROTECTIVE EQUIPMENTS7. Critical, Non critical
and Semi critical instruments. [ Critical is sterilized, Non critical is
decontaminated and Semi critical is disinfected ]8. Event related sterility9.
ANESTHESIA : Types and side effects. Routes of Spinal and epidural anesthesia.
Caring for clients in the PACU.10. The functions of different hospital
departments: Blood bank, Dietary, Chaplaincy, Social service, pathology and
crematory.

You are all set!

What Michelle Means to Us
We've never had a First Lady quite like Michelle Obama. How she'll change the world's image of African-American
women—and the way we see ourselves.

Allison Samuels
NEWSWEEK
From the magazine issue dated Dec 1, 2008
At a recent Sunday brunch after church, my "sista friends" and I sat on the patio of a Los Angeles restaurant gabbing
about the election of Barack Obama. Sure, we were caught up in the history of the moment. Most of us never thought
we'd see an African-American president. But as a group of six black women in our 30s and 40s, we were equally
excited by who is coming along with Obama to the White House—his wife, Michelle, and their two young daughters.
We all praised—OK, maybe even envied—Michelle's double Ivy League pedigree, her style, her cool but friendly
demeanor. And yet we're all aware of how much we have riding on her. At 44, Michelle Obama will be the youngest
First Lady since Jacqueline Kennedy. And many are expecting her to usher in a similarly glamorous era in Washington.
("Bamelot," as some are already calling it.) But Michelle's influence could go far beyond the superficial. When her
husband raises his hand to take the oath of office, Michelle will become the world's most visible African-American
woman. The new First Lady will have the chance to knock down ugly stereotypes about black women and educate the
world about American black culture more generally. But perhaps more important—even apart from what her husband
can do—Michelle has the power to change the way African-Americans see ourselves, our lives and our possibilities.

It's an amazing opportunity—and a huge responsibility. "I think she's always going to be classy, because she knows
she's not just representing herself,'' said my friend Gertrude Justin, 40, a nurse from Houston. "She knows she's fighting
stereotypes of black people that have been around for decades and that her every move will be watched. I'm sure she's
been just as insulted by the lack of true depictions of African-American women as any other black woman.'' Michelle
will be a daily reminder that we're not all hotheaded, foaming-at-the-mouth drug addicts, always ready with a quick
one-liner and a roll of the eyes.

Like many African-American women I know, Michelle has had a lot of practice at the delicate tap dance of getting
along in the mainstream white world. During all those years in boardrooms and a topnotch law firm—not to mention
the exclusive clubs of Princeton and Harvard Law School—she's had to learn to blend in. Now she'll have to go even
further in convincing two very different constituencies—African-Americans and everyone else—that they can trust her
as their First Lady. And she'll have to do it all while remaining true to her authentic self.

Michelle has already shown she understands how universal her appeal must be. Early on in the primaries, after she was
labeled too forward and too loud, Michelle demonstrated self-restraint and discipline by dialing back. She stopped
making harmless jokes about Obama's morning breath and other breaches of hygiene. Her remark about being "proud
of my country" for the first time was another rare misstep. But she quickly learned to play the adoring and
uncontroversial wife, talking up her husband on shows like "The View."

She showed she could calibrate her remarks for predominantly black audiences too, opening up a bit more about what
Obama's election would mean for them—and what it would also mean for her, referring to herself as "the little black
girl from the South Side of Chicago." Yet when The New Yorker caricatured the Obamas in July doing a "terrorist fist
bump" in the Oval Office, the image stung. It was Michelle who came across as the domineering one—the angry black
woman. She toned it down and took to wearing pearls and reassuring J.Crew cardigans.

Will that softer side win out now that she's headed to the East Wing? When I met Michelle earlier this year for an
interview in Atlanta, I was taken by her warmth and eagerness to chat about everything—fashion designers she'd like to
wear, her girls' taste in clothes, even dogs. (On a follow-up phone call, she greeted me with "Hey, girlfriend," like she
was a long-lost sorority sister.) There was no pretense—no second-guessing her next word or move the way she seemed
to do after the campaign became a mudfest.

I personally hope that she will let more of that true, colorful personality seep through. There are some good hints she
might. Her daring election-night red-speckled dress, designed by Narciso Rodriguez, was hardly a cautious choice. It
wasn't altogether flattering, but it showed that Michelle is searching for her own style. Other clues come from her
winning, if still demure, performance during the recent "60 Minutes" interview. Looking chic and relaxed—and
genuinely affectionate with her husband—she poked fun at the president-elect's professed affinity for doing the dishes
and told him she wouldn't accompany him on a walk on a cold Chicago day.

That easy warmth between the Obamas as a couple was another thing that my girlfriends and I fixated on at our brunch.
Nearly 50 percent of all African-American women are single. And, "The Cosby Show" aside, there are still woefully
few public examples of solid, stable black marriages. What can this handsome first couple do for the future of the black
family, we wondered? "I want my son to see first-hand what two people can do when they work together and respect
each other,'' said Janese Sinclair, an executive assistant and 34-year-old single mother of a 12-year-old son. "His father
and I divorced when he was 2—so he never had the chance to see the way a relationship works. Many of his friends
have single moms too, so the Obamas are going to teach us that love and happiness is not just for others but us too. It's
easy to forget when you look at TV or movies."

Making her young daughters, Malia and Sasha, her top priority is heartfelt, but it could also help Michelle broaden her
appeal. Taking lessons from the Carters and the Clintons—Amy was 9 and Chelsea was 12 when their fathers took
office—Michelle is creating a protective cordon around the girls. What parent can't relate to wanting to shield young
children from the glare of the national spotlight?

But Michelle's declaration that she plans to be the "Mom in Chief" has already ignited a minor flare-up in the ongoing
white mommy wars between stay-at-home mothers and working women. (Don't all moms put their kids first, even if
they're working? Is such an accomplished woman going to be content with Mom in Chief?) Still, most African-
American women I know are thrilled she's in a position to make that choice. The average African-American family
can't survive without two incomes—the poverty level among black families hovers above 30 percent, according to 2006
U.S. Census figures. And for single moms, that can mean working two jobs, leaving precious little time with the
children. Michelle has already survived the working-mom juggling act, getting her law degree and working in
government and administration before leaving during Obama's campaign.

I'm hoping the whole Mom in Chief role will leave plenty of room for Michelle to tackle significant, meaty issues even
if she's not clamoring for a West Wing office. That's a tricky balancing act for any First Lady—think Hillary Clinton
and health-care reform. Most follow the path of Laura Bush in choosing non controversial interests like literacy. So far,
Michelle has listed popular causes—military families and the struggles of working parents—that are hard to find fault
with. But she'll have another dimension to worry about: if she focuses on the black community—helping urban schools,
say—will her interests be viewed as too parochial? And while every First Lady—and plenty of professional women—
walk the line between being confident and seeming like a bitch, African-American women are especially wary that
being called "strong" is just another word for "angry."

Appearance could be another minefield for Michelle. First Ladies are always scrutinized—how else did Hillary end up
in those black pant-suits? Though Michelle has shown a penchant for sleek hair and form-fitting dresses, her style is
still evolving and wide-ranging. She's gone from $148 off-the-rack outfits to Dolce & Gabbana. When she showed up
for her first tour of the White House wearing a striking red dress, she indicated she's willing to be daring. But will she
retreat if critics slam her for bad hair days or talk too intimately about her shape?

She has one advantage over many of her predecessors—she's got the lean, tall build of an athlete. That could have
serious implications far beyond the style pages. A self-proclaimed fitness junkie who works out every morning,
Michelle could actually encourage women of color to take better care of themselves. African-American women face
alarmingly high rates of high blood pressure and obesity. And like everyone else, we have plenty of excuses for being
sedentary, including the always-present fear of messing up our carefully done hair. "I look at her and think, I have two
kids and she has two kids,'' said my friend Tamara Rhodes, a 37-year-old public-safety officer in Long Beach, Calif. "If
she can find time in the day to do her thing to look good—why can't I? She looks good and in a way that I can see
myself looking—not a size zero—but really healthy.''

As my brunch friends and I continued talking about Michelle, our conversation wandered into one area we seldom
discuss, even among our families and closest confidantes. Michelle is not only African-American, but brown. Real
brown. In an era when beauty is often defined on television, in magazines and in movies as fair or white skin, long
straight hair and keen features, Michelle looks nothing like the supermodels who rule the catwalks or the porcelain-
faced actresses who hawk must-have cosmetics. Yet now she's going to grace the March cover of Vogue magazine—the
ultimate affirmation of beauty.

Who and what is beautiful has long been a source of pain, anger and frustration in the African-American community. In
too many cases, beauty for black women (and even black men) has meant fair skin, "good hair" and dainty facial
features. Over the years, African-American icons like Lena Horne, Dorothy Dandridge, Halle Berry and Beyoncé—
while beautiful and talented—haven't exactly represented the diversity of complexions and features of most black
women in this country.

That limited scope has had a profound effect on the self-esteem of many African-American women, including me.
"When I see Michelle Obama on the cover of magazines and on TV shows, I think, Wow, look at her and her brown
skin,'' said Charisse Hollands, a 30-year-old mail carrier from Inglewood, Calif., with flawless ebony skin. "And I don't
mean any disrespect to my sisters who aren't dark brown, but gee, it's nice to see a brown girl get some attention and be
called beautiful by the world. That just doesn't happen a lot, and our little girls need to see that—my little girl needs to
see it.''
In Africa, skin-lightening creams are all the rage even though the chemical they contain, hydroquinone, has been shown
to cause harm in high doses. Visit any beauty-supply shop in an American inner city and you'll find an entire aisle
dedicated to less-potent forms of these products. "It's a truth that's long been with us,'' says comic and television host
Whoopi Goldberg, who came to fame with a one-woman stage show featuring her longing for straight blond hair and
blue eyes. "In society and in the black community, the lighter you are and the more European your features, the more
you are desired. Now many of us want to deny that's true or say it's changed, but it hasn't. The darker you are makes
you less than ideal. Plain and simple. And that messes with your mind something awful."

If you're an actress, it can also keep you from appearing in a hip-hop video or getting the juiciest movie role. But it
affects regular girls and women too. On a recent episode of the nationally syndicated "Tom Joyner Morning Show," the
host asked listeners if the president-elect's choice of a wife and her look had in any way influenced their vote. The
answer was a resounding yes, followed by comments like "She's a regular sister,'' and "I love the fact that she looks like
the woman next door or like my cousin or niece.''

Michelle has accomplished so much even before moving into the White House. Imagine what she can do if she decides
to tackle substantive problems—perhaps even just a single one she's mused about, like helping the local Washington,
D.C., community. Now that's the kind of influence that could reach far beyond my friends at the brunch table.

URL: http://www.newsweek.com/id/170383
 HYPERNATREMIA Hyperkalemia
"You Are Fried" Signs & Symptoms Increased
Serum K+
F - Fever (low), flushed skin MURDER
R - Restless (irritable)
I - Increased fluid retention & M - Muscle weakness
increased BP U - Urine, oliguria, anuria
E - Edema (peripheral and pitting) R- Respiratory distress
HYPERKALEMIA Causes of
Increased Serum K+
“Machine"
M - Medications - ACE inhibitors,
NSAIDS
A - Acidosis - Metabolic and respiratory
C - Cellular destruction - Burns,
traumatic injury

D - Decreased urinary output, dry D - Decreased cardiac H – Hypoaldosteronism/

mouth contractility hemolysis
E - ECG changes I - Intake - Excessive
Can also use this one: R - Reflexes, hyperreflexia, N - Nephrons, renal failure
SALT or areflexia (flaccid) E - Excretion - Impaired
S = Skin flushed
A = Agitation
L = Low-grade fever
T = Thirst
HYPOCALCEMIA Sx’s minor bleeding: . "HOOK" for serum sickness:
“CATS” BEEP each letter stands for a key sign
or symptom of serum sickness.
C - Convulsions B: Bleeding gums
A- Arrhythmias E: Ecchymoses (bruises) F: Fever
T - Tetany E: Epistaxis (nosebleed) A: Arthralgias
S - Spasms and stridor P: Petechiae (tiny purplish R: Rash
spots) M: Malaise

Cancer Assessment ABG's: Respiratory depression

CAUTION inducing drugs
ROME "STOP breathing":
C: Change in bowel/ bladder Sedatives and hypnotics
habits Respiratory Opposite Trimethoprim
A: A sore that doesn’t heal Metabolic Equal Opiates
U: Unusual bleeding or discharge Polymyxins
T: Thickening or lump
I: Indigestion or difficulty
swallowing
O: Obvious changes in a wart or
mole
N: Nagging cough or hoarseness.
 COPD: Croup: symptoms Neonatal resuscitation:
blue bloater vs. pink puffer diseases 3 S's: successive steps
"Do What Pediatricians Say To, Or
emPhysema has letter P (and not Stridor Be Inviting Costly Malpractice"
B) so Pink Puffer. Subglottic swelling
chronic Bronchitis has letter B Seal-bark cough Drying
(and not P) so Blue Bloater. Warming
Positioning
Suctioning
Tactile stimulation
Oxygen
Bagging
Intubate endotracheally
Chest compressions
Medications

Asthma acute attack: Pneumonia: risk factors Asthma: management of acute

5 life threatening signs SHOCK: INSPIRATION: severe
Immunosuppression “O-SHIT”
Silent chest Neoplasia
Hypotension Secretion retention O- oxygen (high dose: >60%)
One third of best/predicted PFR Pulmonary oedema S- salbutamol (5mg via oxygen-driven
Cyanosis Impaired alveolar nebuliser)

Konfusion macrophages H- Hydrocortisone (or prednisolone)

RTI (prior) I - Ipratropium bromide (if life
threatening)
Antibiotics & cytotoxics T- theophylline (or preferably
Tracheal instrumentation aminophylline-if life threatening
IV dug abuse
Other (general debility,
immobility)
Neurologic impairment of
cough reflex, (eg NMJ
disorders)
RDS -Respiratory distress syndrome in Lung cancer: main sites for distant Pneumothorax: sx
infants: major risk factors PCD metastases BLAB: P-THORAX:
(Primary Ciliary Dyskinesia, a Bone
cause of Respiratory distress Liver Pleuretic pain
syndrome): Adrenals Trachea deviation
Prematurity Brain Hyperresonance
Cesarean section Onset sudden
Diabetic mother Reduced breath sounds (&
dypsnea)
Absent fremitus
X-ray shows collapse
Bronchi: which one is more Beta-1 vs Beta-2 receptor Wheezing: causes ASTHMA:
vertical location Asthma
"Inhale a bite, goes down the "You have 1 heart and 2 Small airways disease
right" lungs": Tracheal obstruction
Inhaled objects more likely to Beta-1 are therefore primarily Heart failure
lodge in right bronchus, since it is on heart. Mastocytosis or carcinoid
the one that is more vertical. Beta-2 primarily on lungs. Anaphylaxis or allergy

Shortness of breath: short Respiratory co anaesthesia: Dyspnea: differential

differential AAAA PPPP: patients at risk COUPLES: 3A's: Three Airways: Airway
obstruction, Anaphylaxis, Asthma
Airway obstruction COPD 3P's: Three Pulmonary's:
Angina Obese Pneumothorax, PE, Pulmonary edema
Anxiety Upper abdominal surgery 3C's: Three Cardiacs: Cardiogenic
Asthma Prolonged bed rest pulmonary edema, Cardiac ischemia,
Pneumonia Long surgery Cardiac tamponade
3M's: Three Metabolics: (DOC) DKA,
Pneumothorax Elderly Organophosphates, Carbon monoxide
Pulmonary Edema Smokers poisoning
Pulmonary Embolus
TB: antibiotics used Ascultation: crackles (rales) treat viral respiratory
drugs to
STRIPE: "PEBbles": infections "You'd get a respiratory
infection if you shoot an ARO (arrow)
STreptomycin Pneumonia laced with viruses into the lungs":
Rifampicin Edema of lung ARO:
Isoniazid Bronchiti Amantadine
Pyrizinamide Rimantadine
Ethambutol Oseltamivir

Pulmonary edema: tx Kubler-Ross dying process:

MAD DOG stages
"Death Always Brings Great
Morphine Acceptance":
Aminophylline
Digitalis Denial
Diuretics Anger
Oxygen Bargaining
GGases in blood (ABG's) Grieving
Acceptance

http://d.scribd.com/docs/14j5j21qrfudwy4r7tud.pdf