For the answer key for Chapter 8, Type 2 does have a genetic and ethnic component, not just lifestyle.

For drop and drag, would use naloxone, rather then the name brand Narcan. For Next Gen, #1, I wasn't sure why metoprolol IVP was an appropriate key.

Would include EMLA cream in this section. It is considered to be a standard of care for non-emergent invasive pediatric treatments (such as IV restarts, labs). It is also used prior to insertion of Huber needles for implanted ports. https://www.webmd.com/drugs/2/drug-2358-8170/emla-topical/lidocaine-prilocaine-cream-topical/details Also consider gabapentin and pregabalin as other pain med modalities.

Would include hydromorphone (Dilaudid). This medication is still available, and is different from morphine for side effects, in that it can cause euphoria, and is thus a risk for abuse. Fentanyl is used for intraoperative procedures and end-stage cancer pain, so maybe this can be added as well.

There has been multi-modal treatment for pain using non-opioids, such as acetaminophen and ibuprofen. There are now OTC versions of this synergistic combination. It might help students to be aware that these options exist. https://www.mayoclinic.org/drugs-supplements/ibuprofen-and-acetaminophen-oral-route/description/drg-20526898#:~:text=Ibuprofen%20is%20a%20nonsteroidal%20anti,taken%20for%20a%20long%20time.

For assessment, I'd include PAINAD and FLACC scales for those who cannot verbalize pain. PAINAD: https://dementiapathways.ie/_filecache/04a/ddd/98-painad.pdf The WHO ladder now has a fourth step: Invasive or Minimally Invasive treatments. Please see the illustration in this URL: https://www.statpearls.com/ArticleLibrary/viewarticle/31358

FLACC: https://pubmed.ncbi.nlm.nih.gov/9220806/

For NGN Endocrine Assignment 1, I wasn't sure about the key(s). Both Type 1 and Type 2 were accepted as answers. There would need to be other diagnostic work-up to differentiate difinitively.

For 9.7 Learning Activities. There is a genetic component to Type 2 diabetes, so the activity should be rewritten to reflect not just lifestyle.

Levothyroxine can also be give IV for patients who are NPO.

Would add that the ADA notes that fasting glucose for those with diabetes is 80-130 mg/dL For those who do not have diabetes, it is under 100 mg/dL. https://diabetes.org/diabetes/a1c/diagnosis

Under Implementation, suggest that Addisonian Crisis can occur without tapering a treatment course of corticosteroids, as this is a potentially life-threatening condition: https://www.ncbi.nlm.nih.gov/books/NBK441933/#:~:text=An%20Addisonian%20crisis%2C%20or%20adrenal,mineralocorticoid)%20and%20requires%20immediate%20treatment.

For section 1, the last item regarding Levetiracetam doesn't have a true/false option.

Would include for newer antipsychotics the risk for hyperglycemia, hyperlipidemia and weight gain. Both older and newer antipsychotics may pose a risk of agranulocytosis.

For critical thinking 7.5, the nurse should anticipate another route of administration (IV) for ondansetron, as the patient is still experiencing vomiting.

For renal medications, consider proamatine, which is administered to ESRD patients receiving dialysis. There isn't a dedicated section for renal meds, which are not that large in number.

For the NGN Bow Time Items #1 (MI), the reference range for blood pressure doesn't match the one for Bow Tie Item #2.

For the question, "Which of the following in not a potential cause of hypovolemia?": 1. There is a typo in the stem (Is instead of in). 2. One of the answers is blank. 3. Is this a Select all that Apply item, as there are five potential answers? For the stem, "The release of catecholamine..." is missing a comma, making it difficult to read.

For alteplase, a CT of the head should be completed, as brain tumor, and hemorrhagic stroke are contraindications.

For furosemide, would suggest adding "daily" to "Monitor weight". This is used for fluid balance for both inpatients and home care patients, and is one of the cornerstones of heart failure management.

May wish to include a reference for GFR to further explain, such as this: https://www.kidney.org/atoz/content/gfr

Due to the large amount of A&P in this section, should Cardiovascular and Renal be split into two separate chapters? It was more in depth than other sections of the text.

Good use of an unfolding case study, and supports diversity.

In the patient teaching & education section, I'd suggest adding a sentence about tapering dose slowly for PO or IV administration to avoid Addisonian Crisis.

Here is a video on how to use a Spiriva inhaler. I've had many students think the capsule is taken separately from the device via PO route. It might be a good opportunity to use the clip in this subchapter. https://www.youtube.com/watch?v=4Tj85Ujs5F0

Cough syrups that contain decongestants—including pseudoephedrine, ephedrine, phenylephrine, naphazoline, and oxymetazoline—should be avoided if you have high blood pressure, as they can further elevate blood pressure.

Good use of Next Gen items to help with knowledge acquisition and critical thinking. All inks are functional.

With a focus on patient education, for the Planning section, consider a statement such as: "Patient will be able to verbalize understanding of action of drug and side effects to report to the healthcare provider." This supports questions on HCAHPS.

Would include that rifampin can discolor contact lenses, so they should not be worn during treatment.

Critical thinking activity supports safe care and is an excellent illustration for nursing students.

Good critical thinking activity for this page.

This might be covered elsewhere, but checking a patient's labs for renal or hepatic clearance prior to administration would be an important safety consideration. Also, trough levels for certain drugs, like Vancomycin, should be mentioned.

It might be helpful to have a final paragraph on MDRS organisms and how they have and will continue to impact on health outcomes. https://www.mskcc.org/cancer-care/patient-education/multidrug-resistant-organisms-mdros

Another good example of a Next Gen NCLEX type question.

In many nursing programs, the "three checks" are taught: 1. Check LIP order against MAR. 2. Check med against MAR when pulling from dispensing cabinet. 3. Check med order against packaging. https://www.oregon.gov/dhs/PROVIDERS-PARTNERS/LICENSING/SafeMedDocs/six-rights-three-checks.pdf

The ISMP Do Not Crush list is no longer downloadable without purchase. Please see the hyperlink in section 2.5 for this information.

Hyperlink for DEA reporting doesn't function.

Disposal of controlled substances is being investigated as it can contaminate ground water. An example of an alternative is RX Destroyer, which denatures controlled substances via charcoal additive. https://www.rxdestroyer.com/

Inclusion of the clinical judgment model is important, as this is the basis for the Next Gen case study questions.

The hyperlink and bowtie question is functional, and a great addition to the other critical thinking questions, flash cards and quizzes.

For adverse drug effects, some are reportable to a hospital's pharmacy so that these events can be tracked as a patient safety concern. Many nurses are not aware if and what process exists to report ADRs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578206/

Suggest to incorporate an example of how different ethnic groups may respond to medications, such as anti-hypertensives, and the importance of having a diverse representation for drug trials, including different genders and ethnicities.

Typo "freee" should be free.

Would include as part of community assessment: Crime statistics Environmental factors, such as incidence of air pollution, lead poisoning incidence

Would include Non-Violent Crisis Intervention training as a resource to help healthcare workers attend to patients at risk for escalation of behaviors. Identification of patients who have a history of violence is also a step some hospitals have taken to prevent future episodes of violence. Would also include debriefing with patient after an episode of restraints to help the patient understand why they were used. Would suggest including this link from American Nurses Association regarding workplace violence: https://www.nursingworld.org/practice-policy/advocacy/state/workplace-violence2/

Under Elder Abuse, would emphasize that nurses should use their facility's policy and procedure, as well as the identified chain of command for reporting, rather than directly reporting to APS.

Would emphasize that DTs are a medical emergency, and require immediate response. Also include seizures and hallucinations as signs of DTs.

For substance use, would include the risk for accidental ingestion by children, especially for beverages or gummies which they might have access to.

Would mention Good Samaritan laws in states vary as to reporting an overdose with regard to bystander present.

Substance use disorder doesn't directly cause HIV/AIDS and unintended pregnancies; the disinhibition contributes to those. Sexually transmitted infections should be included with HIV/AIDs for the same rationale.

Under Schedule 1, marinol is an approved medication which is cannabis, based, and is used for end-stage cancer patients for nausea.

For the SATA question on caring for a patient experiencing an acute psychotic episode, it wouldn't be appropriate to ask a question such as "Do you believe that what you hear is real?" as this can be confrontational to the client. Would not include this as a correct answer.

At the top of the grid it notes that asterisked items require notification of a provider immediately, which related to suicidal ideation. Would also note worsening condition as a need to contact the provider in the other areas. Instead of medical workout, should be work-up. For safety, when assessing the client with hallucinations, the nurse should ask the client, "What are the voices telling you?" This relates to safety of the patient with regard to suicidality or violence towards others on the unit.

Drag and Drop on Cluster B, item #1: "since age ?" add in the correct age.

Need closing parenthesis under the Ideas of reference. Could also just leave out the opening parenthesis, remove "i.e.".

It's recommended that family members also receive counseling, as they bear witness to the distress the patient is experiencing.

For the illustration under Panic Disorder, would suggest a different photo. This may lead students to think of these patients being aggressive.

Perhaps a different illustration could be substituted as this is more commonly associated with theater.

Under labs, would also include B vitamin panel, as low levels can mimic cognitive impairment and/or depression.

The grid should have SNRIs as part of the antidepressants (pagination revision).

Broken hyperlink for the podcast on personal perspectives on depression.

All hyperlinks worked correctly.

Under Second-Gen Antipsychotics, would suggest adding hyperglycemia and risk for Type 2 Diabetes as a specific side effect.

Typographical error in question #3 (Chia): t should be that.

With regard to seclusion, it should not be used for "convenience" as it has the potential to be in violation of the patient's rights. It is used to keep a patient off the psychiatric unit if they are displaying aggressive or violent behaviors that don't respond to redirection.

In the restraint picture the patient has sneaker with shoelaces in place. The shoelaces might constitute a hazard for this patient or others on a unit, so would have been removed.

Would provide a title & brief instructions for the environmental hazards pictures. It's not clear that the reader has to click on the check marks to see the directions. Rather than "Can you see the changes in the environment?" I'd have the reader list the changes to support learning. In the check-marked area for scrubs, the patient would have to give their shoes to staff (flight risk), and socks (ligature risk if tied together).

Under Risk for Suicide, Selected Defining Characteristics, consider adding prior suicide attempt or family history of suicide attempt/completion, as this is considered an important contributory factor(s).

Under Lab and Diagnostic Testing, I'd suggest adding B vitamin and thyroid panels, as these are commonly ordered to rule out physiological causes of impairment.

Would suggest changing "nurse may" to "nurse should" [also use general survey techniques...]. Non-verbal cues are very important parts of assessment, especially for clients with mental health alterations.

All hyperlinks are functional.

The second two videos (angry client and client with schizophrenia) aren't available, and have a note that they've been removed.

Under the Exploring category in the table, the contents need to move over one cell to display correctly.

All videos played correctly; hyperlinks functional.

I have used the NCSBN Guide for both new graduate nurses as well as nurses working on a behavioral health unit, with positive feedback.

Under the ANA resources, it might be helpful to include the Scope and Standards for psychiatric nursing: https://www.nursingworld.org/nurses-books/psychiatric-mental-health-nursing-scope-and-stand/ All hyperlinks functional.

Very good resources in the APA hyperlink.

These extra activities are very useful and can help solidify knowledge acquisition.

Consider adding adequate sleep, physical activity, and good nutrition. Some hospitals have replaced vending machine choices to include healthy options such as an apple. Napping on shift is becoming a possible solution. Changing to more flexible shift options, such as 8 or 10 hours shifts, helps staff who need child care or have improved work-life balance.

Would suggest listing some of the strategies some healthcare facilities have instituted to help decrease stress and retain nurses, such as: "Watson rooms" - these are dedicated space(s) in which a staff member can go to decompress. They include a recliner, soft lighting and ability to play soft music. Rounding to check on how a unit is doing, and intervening for the easier "wins" such as locating missing equipment.

Consider including self-paced continuing education offerings as part of life-long learning. Some states, such as New Jersey, have a requirement of 30 continuing education hours for re-licensure every 2 years.

Examples of business casual attire could be provided, as many students do not have a clear idea of what this entails. For questions for the interviewer, consider changing "Do you have a nurse residency program," to an open-ended question such as "What does the nurse residency program consist of?"

In some states, such as NJ and Maine, fingerprinting is required to obtain a nursing license, and is an additional fee from the license application.

The link for NGN Sample questions provides an error message. For Tips for testing, the candidate must arrive at least 30 minutes prior, or testing may be denied. When registering for their Pearson Vue test center, the name must exactly match the photo ID they will present on the day of testing. All of the links are helpful for students, who have many questions about the NCLEX process.

For the question regarding which is not a tenet of QSEN advocacy, there is no "show solution" available, and all of the answers are incorrect.

The link for oxygen tx for COPD patients is from 2010, so would either delete or substitute a more current reference.

Suggest a link which would identify different legislative districts, so that the reader could identify who their representatives in Washington are.

Excellent resources. Might want to add a question about how a nursing admission database may identify social determinants of health and suggest needs for advocacy for patients. Suggest to also include a link to ANCC's Pathway to Excellence, which is used in smaller healthcare facilities, such as community hospitals and long term care facilities: https://www.nursingworld.org/organizational-programs/pathway/overview/

Suggest to include a link for which states are compact states, as this may not be familiar to nursing students, and can directly impact where they may choose to practice upon licensure: https://nurse.org/articles/enhanced-compact-multi-state-license-eNLC/

Excellent resources for readers, especially the EBP exemplars form Johns Hopkins. One (Lippincott Advisor) of the other links for resources require a subscription.

The nursing process model is sometimes being replaced in some schools of nursing with the NCSBN newer model.

The CMS Core Measures link directs the reader to the TJC page. Is this the link that should be substituted: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures

A variety of learning activities will help to utilize the information presented in this chapter.

Client referral article is from 2007. While the information is still relevant, could a newer reference be located?

Conflict Resolution questionnaire has a broken link/error message. One of the other quizzes look as though one must purchase it, until the graphic is shown further down free of charge.

Good resources which may not be otherwise known to nursing students or nurses, such as Team STEPPS. The debrief after a code or critical incident will help prepare a newer member to the team to see this process as a means to improve future interventions. The CUS and DESC mnemonics are useful to help nurses express concerns in a professional manner.

From 7.1 to 7.5, very helpful tools such as ISBAR download. All hyperlinks functional.

For Case B, I'd suggest to include "What resources could you access as the nurse?" These could include Bioethics Committees, chain of command, LIP, and pastoral care.

All hyperlinks functional. For the final paragraphs on Covid-19, this may be a good opportunity to include a question to ponder, such as, "What would you as a nurse, do if you did not have adequate infection control protection to do your patient care? What resources could/would you access?" Since the chapter is about Leadership, I'd like students to think about using the chain of command, and initiating meetings or work groups to identify how to address gaps in practice. This would underpin advocacy for nurses themselves.

Excellent resources and functional hyperlinks. The references for moral distress are particularly important in these times. For the Nursing Process Model, NCSBN is moving away from the framework noted. I teach both frameworks currently, as a bridge to critical thinking/clinical judgment.

Comprehensive discussion on basic but important topics. All hyperlinks are functional, and useful. Consider adding a hyperlink to a national organ donation organization such as: https://unos.org/about/national-organ-transplant-system/#:~:text=About%20UNOS,oversight%20by%20the%20federal%20government. Some states require organ donation continuing education for licensure, while others do not; this information can help to provide uniform information to all nurses/nursing students.

Suggest a hyperlink with bedside reporting as a possible learning activity. Here is one approx. five minute example from You Tube: https://www.youtube.com/watch?v=RHpbuljThoc

Good choices of the landmark court cases for Nancy Cruzan and Terry Shaivo to contextualize why advance directives came to be and why they continue to be important for patients of all ages to direct their care if they are no longer able to.

For the sample case regarding the student nurse and discontinuation of the IV antibiotic, I would also include a reference to the liability of the clinical instructor for oversight of this clinical skill. In the sample case of the RN in the ICU, Ondansetron should be lower case, rather than initial capitalization, as it's a generic medication.

For the sample case, I'd suggest a bit more information. For instance, this might result in the revocation of the LPN's license, and require participation in a RAMP program. What did the LPN do with the stolen medications, and were they controlled substances? This would provide further context for a deeper analysis of legal implications. For the sample case about the RN accessing unauthorized health records, this could be grounds for immediate termination in some healthcare facilities. This might be important to include in this case.

All of the activities operated appropriately and worked to reinforce the concepts. Would suggest some "solutions" to the sample scenario for readers working on this independently; this is a good discussion for class, lab or clinical, which also has underpinnings of legal responsibilities.

Excellent presentation on theories of change. This will help nursing students and staff nurses recognize the importance of utilizing change theory to improve workflow and patient outcomes.

These activities were very helpful to improve knowledge and application. I've found nursing students and nurses to have knowledge gaps around these terms and concepts. Knowing them will help them to see their role in an organization more clearly.

This is an important topic. Linkage and referral to the dietician during this hospitalization as well as consideration of a referral to home care follow up are strategies that could be effective to prevent continued re-hospitalizations for HF patients. Would suggest that this be included with the spotlight application.

This application could be used in clinical or class. An answer key with rationales would be helpful for the student completing this exercise on their own.

Important information, with a variety of means to examine the components of appropriate delegation. No changes.

Tables on scope of practice for various team members is helpful and concise. Suggest a sentence to direct each reader to the state Board of Nursing for the location(s) in which they practice, as just the Wisconsin site is suggested.

Realistic scenarios which helps to practice the use of critical thinking and clinical judgement. The check answer feature with rationales would be very helpful for a nursing student.

The sample task management, or "Organizational Tools" are helpful for a novice or seasoned nurse. Some organizations have a "worksheet" that is printable from the EHR. The use of an organizational tool is an important component of clinical care.

Here is a link about the incidence of errors involving nursing care which might be helpful in demonstrating scope of the problem: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208929/

The acuity chart and CURE mnemonic could be used as a small group activity for nursing students in class or clinical. This is concise and will engender critical thinking in the novice nurse/nursing student.

Would suggest "pulled into many competing directions" rather than a million, which could be interpreted as hyperbole.

Provides a useful framework for the reader to anticipate subsequent chapters, and to also review areas that may be needed.

An excellent resource for those students who have an interest in end of life care is a film by Carolyn Jones, "Defining Hope." Segments can be viewed by the ANA website, and this also include PDF discussion guides to accompany each vignette: https://www.nursingworld.org/foundation/programs/defining-hope/ POLST could be included in the glossary, as students should be aware of what this document represents: https://polst.org/form-patients/ Since many states have their own legal form, I've included the national website as a resource.

This might be found in the Skills Checklist book, but would suggest a pictograph of passive ROM exercises, as students would benefit from reinforcement of this important element of the standard of care. During Covid-19 ICUs put renewed emphasis on passive and active ROM to prevent deconditioning. https://medical-dictionary.thefreedictionary.com/passive+exercise Reducing functional decline is also a topic that I'd suggest be included: https://hign.org/consultgeri/try-this-series/reducing-functional-decline-older-adults-during-hospitalization

Under GU, would also include risk for renal calculi

For comfort, would suggest a holistic approach including nonpharmacological measures, such as repositioning, ambulation, distraction, creating a calm environment. I'd also like to see other factors that can negatively impact on comfort, such as nausea or dyspnea. I teach this to Fundamentals students, as they will sometimes encounter symptoms other than pain which can be an issue for patients.

Some EHRs have a trigger for a dietary consult, including wounds. Information on obtaining a nutrition consultation for fundamentals students would be important to create linkage to both the interdisciplinary team and also helping to support positive patient outcomes. Worsening or hospital-acquired pressure injuries are a never event, and this is something they also should be aware of: https://www.rn.com/clinical-insights/pressure-injury/ From AHRQ: https://psnet.ahrq.gov/primer/never-events

Would also include apnea in glossary. May want to include CPAP and BIPAP, as these are interventions used across many healthcare settings.

Would include bradypnea and apnea in signs and symptoms.

For sensory impairment, may wish to include daily inspection of feet both by the RN and also the client in the home setting, esp. for those with diabetic or other neuropathies.

For delirium, it would be helpful to note that this is considered a potential medical emergency, so requires immediate reporting and intervention. The longer delirium persists without resolution, the more likely a patient may be permanently impaired, sometimes requiring nursing home placement. https://hign.org/consultgeri/resources/symptoms/abrupt-change-mental-status

Under the section for depression, the definition is that the symptoms persist beyond 14 days, which would be helpful in providing objective data for assessment of clients. https://hign.org/consultgeri/try-this-series/geriatric-depression-scale-gds

Erickson's Stages of Development is on the current NCLEX blueprint, so would suggest that these be listed.

Workplace violence could be included here, as this is a focus for ANA: https://www.nursingworld.org/practice-policy/advocacy/state/workplace-violence2/ OSHA also has resources for this topic: https://www.osha.gov/workplace-violence It's important to prepare students for the realities of the workplace, as many are shocked at the aggression from patients and families.

Would suggest that soft limb restraints be included as one of the types of restraints, as these are the more commonly used restraint in acute care. Would also suggest specific alternatives to restraints, as these are nursing students who may not have the knowledge as yet. Examples include moving closer to the nurses' station, sitting in chair in hallway, and if needed, a sitter or companion (title is specific to a facility).

In the first section under preventing falls and high risk medications, I'd include diuretics, hypnotics, bendodiazepines and antiepileptics, as these are correlated with a higher risk for falls. By listing three as shown, it might imply that these are the only medications that may pose a fall risk for patients. While there is more detail further on, it would be important to emphasize this from the beginning.

I appreciate that the culture of safety was extended to behavioral expectations of nursing students, as this should be emphasized early in the program as well as throughout in preparation for their professional role.

Would suggest considering inclusion of TJC's National Patient Safety Goals, since this is also part of safety initiatives. A link to the NPSGs could be included, as follows: https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2021/simplified-2021-hap-npsg-goals-final-11420.pdf I include this content when I teach the Safety chapter in Fundamentals.

Would suggest including the Plan of Care, as The Joint Commission requires that this be documented upon each shift. It helps nursing students to realize that plan of care and nursing process doesn't end with nursing school, and that this is utilized in acute care to work as a team towards discharge.

Very well done presentation on non- and therapeutic communication, as well as social media considerations.

Would suggest including AACN under specialty nursing organizations, as they have a number of resources that are helpful to nursing students and practicing nurses: https://www.google.com/search?q=american+association+of+critical+care+nurses&source=hp&ei=E0GRYLujH4aztQb39pzgBg&iflsig=AINFCbYAAAAAYJFPI1pVz9rtZ4cLTrmhDTBD-C2KsN9Q&oq=american+association+of+critical&gs_lcp=Cgdnd3Mtd2l6EAEYADICCAAyAggAMgIIADICCAA6CAgAELEDEIMBOgUIABCxAzoICC4QxwEQowI6CwguELEDEMcBEKMCOg4ILhCxAxDHARCjAhCTAjoICC4QsQMQgwE6CAguELEDEJMCOgUIABDJA1DNCFjgO2DMSGgBcAB4AIABuwGIAdobkgEFMTYuMTeYAQCgAQGqAQdnd3Mtd2l6&sclient=gws-wiz

Inclusion of social media guidelines is important. You might also want to include professional boundaries guidelines from NCSBN: https://www.ncsbn.org/professional-boundaries.htm

Under the Master's Degree in Nursing section, would suggest an edit to note: "requires an additional two or more years of schooling." Some specialties require more clinical hours than others, which may extend the time to complete the degree requirements beyond two years of full-time study.

Under Nurse Specialties, would suggest including Emergency Room nurses. This specialty serves all age groups, performs life-saving stabilization, and also serves as a safety net for clients who do not access primary care. ED RNs also have specialized knowledge, such as trauma and triage, so their specialty is different from critical care.

In many areas of the United States, Physician Assistants are also part of the healthcare team, so would suggest including this provider category, even if they are not mentioned in the Wisconsin Nurse Practice Act.