"A 98.8% passing rate...?"

While promoting and publishing my own CEN review course and CEN Review Manual, I have been keeping abreast of what others are doing out there.

One "competitior" company is Med-Ed. On their website they boldy proclaim a "98.8%" passing rate.
While they do not specific which exam that refers to, they do print it on their flyer for their CEN classes.

I found this passing rate pretty high and had some questions as to how they calculated it so on 9/12 I called them. I called their office in Charlotte and spoke with the lady who answered the phone. She was nice and pleasant. I introduced myself and stated that I was wondering about their quoted passing rate. I asked her how they knew who did and did not pass the exam. (I do not have her permission to use her name publicly, so I will honor that).

She politely told me that they know the pass rate based on the number of people who have requested a refund based on not passing their exam.

Okay, I can buy that, I guess. But, what if someone doesn't even take the exam? I asked her this, and she said, "well, why wouldn't they take it?".

So I clarified by saying to her that she was telling me that they calculate their pass rate based on how many attendees request a refund for not passing; she said "Yes"....

Seems to me this isn't very scientific at all.
Just because someone doesn't pass the exam, does NOT mean they will contact Med-Ed for a refund.

I can think of several scenarios where someone would NOT be contacting them for a refund....

1) If the attendee is taking the class merely for CEU (continuing education) purposes and they are already certified as a CEN - they have NO NEED to take the exam! (I've had a few of these people in my own classes)

2) If the attendee does not take their exam within the 60 day window, then they do not qualify for a refund; there is the potential for many delays in this 60 day time frame. It takes at LEAST 3-4 weeks to get the "permission to test" letter from the BCEN, then you still have to make an appointment to take the exam. Some exam centers have very limited openings.

3) Another person who would not qualify for a refund is an attendee who has had their registration paid for by the hosting institution in a "flat fee" pricing structure.

There are other permutations of similar scenarios here but I believe the point is clear, there is ABSOLUTELY no sure way to know who has not passed their CEN exam.

The opposite is true however, you can find out who HAS passed their exam by checking the BCEN website and looking at the names of those who have passed their CEN. However, that still would not account for those who have NOT taken it yet.

I'll be doing my own research and study from an upcoming Med-Ed CEN review class and seeing just who is and who isn't passing their exam and running my own numbers.

In the meantime, feel free to check out MY CEN revivew book which is 10% off through the end of September!

10% OFF Thru September 30, 2009

Use code "LULUBOOK" at checkout.

(Click on the Book to Preview or Purchase!)

CEN Review Questions 5/19/09

Sorry for the delay folks!

Here's some more CEN Exam Review Questions for practice/review...

Here's some sample CEN like review questions. Try to answer them and write out a rationale. Try to justify why the answer you choose is correct and why the others are wrong.....

The link to the answers is at the Bottom of this page...

Category: Psychiatric/Mental Health
(1) When caring for a delusional patient, the ED RN knows that it is important to:

A) Allow the patient to freely verbalize his thoughts.
B) Provide distraction activities for this patient.
C) Acknowledge the thought disorder and orient the patient to reality.
D) Place the patient on a suicide precautions.

Category: Cardiac

(2) Which of the following is an INAPPROPRIATE route to give epinephrine by:

A) Intravenous
B) Endotracheal
C) Intraosseous
D) Epidural

Category: OB/GYN

(3) At what point during pregnancy is the fetus at most risk of injury due to trauma?

A) In the first week of pregnancy
B) In the second trimester
C) In the third trimester
D) In the first trimester

Category: Professional/Legal

(4) Which of the following sources of evidence is the BEST to establish the standard of care in a legal case?

A) The defendant's testimony
B) Nurse Practice Act
C) The plaintiff's attorney
D) An expert witness

Category: Professional/Legal

(5) A prior ED patient is suing after having complications from an IV access while in the ED previously. During that visit the pt became agitated and ripped the IV out. This went unnoticed for 3 hours as the primary RN did not do any assessment or documentation of the IV site. Based on this information, which principle of negligence is being described.?

A) Duty
B) Breach of duty
C) Causation
D) Damages

GOOD LUCK!

CLICK HERE TO CHECK YOUR ANSWERS

CCC Class Wake Med - Day 1 Report

What a day!
Just finished day 1 of a 2 day CFRN/FP-C course here in Raleigh NC at Wake Med. This was a 2-day certification review course produced by Critical Care Concepts and Rick Patterson. I was assisting Rick in teaching for his company during this class.

Their conference facility was THE BOMB. Rick even compared it to some conference hall. He said "man this is like JEMS" the EMS today national conference. Wake Med (WM) has this AWESOME conference center across from the main hospital. It's got several multi-size rooms with sweet A/V setups in each. Nice central lobby, reception areas and a juice/soda/coffe bar (self serve)....it's freakin sweet! Just being in such a nice place, made us feel like some special guest speakers and such!

Class went pretty well on day 1. We ran long and didn't cover as much as we wanted. We hit most of the big topics, but probably ran a little long winded for most of the audience.

After course introductions and "settng the stage". We kicked it off with me doing the cardio lecture. This cardio lecture is always a tiring one. The one we do for Rick's classes is a bit longer (about 80-90 minutes) than the stand alone one I do for my "CEN-only" classes. I think it's a good starting point however, and it DOES lend itself to some minor alterations depending on class prior expeience and knowledge level. Today's version we cut a bit short due to time and we dropped off the 15 or so, ACLS review slides. Instead of slides we closed out the ACLS with a 20 minute "core" ACLS review and Rick went impromptu as he finished the cardiovascular by hitting on the main ACLS bullet points. And, as always, reminded the students that if they hadn't attended an ACLS provider class within the last 6-8 months, that it's probably a good idea to hit that before taking the cert exams (CEN, CFRN, FP-C).

Then we jumped over to the flight portion of the class. Rick jumped right in and ran through the flight principles and concepts (gas laws, stressors of flight etc)..and as always, while I was sitting back watching/listening - I once again was quite engaged when Rick "does his thing"! Shortly later, we went to aircrew safety, survival and regulation to complete most of the dedicated flight content. And once again, Rick gets right into his "zone" and runs through this, lecturing effectively while inserting his anecdotes and war-stories as appropriate. Pretty cool this time working through the survival/shelter part using the big graphics on the LARGE screen; cool to see the "big picture".

Due to time concerns we carried the neuro lecture on into and through lunch this time. I was giving this one and probably where we started to see the early signs of the diverse audience starting to loose their learning thread. You start to see it when we start talking about some more "general" neuro stuff like Multiple Sclerosis or Lyme disease -- the people there for flight certifications are probably starting to think like "why do I need to know this"... So it's always a challenge to try to deliver it and at least make some relevancy to the entire audience. Interesting, at the beginning of the neuro lecture we review the cranial nerves (Nursing 101 right?)....well when I threw up the "Old Olympus Towering Tops" slide, I got so many blank stares...? Kind of made me stop and think. However as this was not a "teaching class" but rather a "review class" - I just referenced it and pointed out that some people may want to spend some time reviewing this on their own before sitting for their exams. So I knocked out the neuro lecture and then we took a break for fresh air and a leg stretch.

We proceeded to head across the parking lot to the helipad. We all posed around the Wake Med hel0; a beautiful machine -- the EC 135 with their appealing crimson and white paint scheme. It really is an appealing piece of equipment - I hope the class photos came out okay!

Afterwards we headed back in for another lecture. This time it was back to Rick for his ABG lecture. Now since I've known Rick, and since the first time I've seen him do this lecture; I am continually amazed and blown away how he does this. The first 15 min or so arethe groundwork for the topic; looking at some basic ABG concepts, pulmonary function/gas laws etc. Once that's done, the "show" begins. Rick starts to run through these ABG "problems" on the board. He starts off like a kindergarten teacher, holding the student's hand through the first few examples, prompting them along the way. Then he backs off a bit and starts letting the class work through the problems more independently.

Towards the end, the students are engaged and interacting. There were a few people however that just "didn't get it" completly and a few who were aking the time honored "calculus question: but what will I do with this in the real world?"... We had to try to explain to them that it's not so much that you'll be doing calculations like this bedside or stretcher side, rather it was a learning curve to start to drive home the relationships between the components and the principles there which lent themselves to overally pt management.

There wasn't a person who told us they had looked at the whole ABG/respiratory function like we just did here - I'm sure there were SEVERAL seasoned people who left that room feeling like they actually LEARNED something!

That pretty much wound it up for the day, it was close to 5pm and people were tired.

We'll be back hitting it early Sunday morning...bright and early at 0800!
Gonna have to step it up and get in our "zone" to keep this puppy on track.

Full day tomorrow, topics include...
1)Airway/respiratory/vents
2)Toxicology
3)Burns
4)Thoracic/abdominal trauma
5)OB/Neonatal
6)Peds
7)General medical

Gonna sign off for now, it's late and I gotta review some notes!
http://www.bemetweb.com
"...KMG-365, Clear..."

CEN Practice Questions 2-25-09

(ANSWERS POSTED 3/12/09 - Scroll to bottom of this article for link)
Here's some sample CEN like review questions. Try to answer them and write out a rationale. Try to justify why the answer you choose is correct and why the others are wrong.....

Category: Special Populations
(1) You are discharging your 79 year old female pt who sustained a large skin tear. Which of the following is the best answer regarding patient education for this client?

A) Use pre-printed instruction sheets.
B) Prepare handwritten instruction sheets.
C) Instruct the patient to call their private physician if they
have any questions.
D) Conduct a one-on-one discussion with the patient.

Category: Gastro-intestinal Emergencies
(2) A 36-year-old male is in severe distress due to upper gastrointestinal bleeding. He has been vomiting bright red blood at home for 4 hours. Which of the following interventions is the highest priority?

A) Apply 100% non-rebreather oxygen mask.
B) Initiates IV access and starts a Normal Saline bolus.
C) Inserts nasogastric (NG) tube.
D) Draws blood for a type and cross.

Category: Respiratory Emergencies
(3) The SPO2 of an ED patient suddently drops to 88%. Of the following, what should the RN do first?

A) Put the pulse ox sensor on another finger.
B) Check to see if the auto-blood pressure cuff is inflated.
C) Assess for changes in the patient's mental status.
D) Obtain an arterial blood gas.

Category: Environmental Emergencies
(4) Your patient sustained a near-drowning incident. Which of the following plays the most significant role in their condition?

A) Hypothermia
B) Pneumonia
C) Dysrhythmia
D) Hypoxemia

Category: Professional-Legal Topics
(5) Which of the following legal principles applies to the RN working in the Emergency Department?

A) Duty of care
B) Breach of duty
C) Proximate causation
D) Injury

GOOD LUCK!

CLICK HERE TO CHECK YOUR ANSWERS

CEN Practice Questions 2-12-09

(ANSWERS POSTED 2/15/09 - Scroll to bottom of this article for link)
Here's some sample CEN like review questions. Try to answer them and write out a rationale. Try to justify why the answer you choose is correct and why the others are wrong.....

The link to the answers with rationales will be posted here in 1-2 days.....


Category: Professional-Legal
(1) Local EMS brings you, into your trauma bay, a 17-year-old female, who was involved in a pedestrian versus motor vehicle crash. A CT of the head shows that she has an epidural bleed and the neurosurgeon is summoned for emergent, life saving surgery. However, the neurosurgeon refuses to come in for this pt. Which of the following best explains the possible liability for the neurosurgeon in this case?

A) Federal laws that require all patients who present to an emergency department receive stabilizing treatment and state laws concerning professional negligence.
B) Case law requiring a specialist on call to respond and federal law requiring all patients who present to an emergency department receive stabilizing treatment.
C) State laws relevant to professional negligence and case law requiring a specialist on call to respond.
D) There are state laws covering professional negligence and case law requiring a specialist on call to respond.

Category: Special Populations
(2) An elderly trauma patient "might" be considered for early, invasive hemodynamic monitoring because the geriatric population has:

A) Decreased peripheral vascular resistance and cardiac workload.
B) Increased pulmonary compensatory mechanisms.
C) Increased physiological reserves
D) Decreased cardiac output

Category: OB/GYN
(3)A patient with an ovarian cyst may present with signs/symptoms similar to which of the following?:

A) Pyelonephritis
B) Pelvic inflammatory disease (PID)
C) Intrauterine pregnancy
D) Ectopic Pregnancy

Category: General Medical
(4) What is the treatment for acute sinusitis?

A) Over-the-counter nasal decongestant sprays for 1 week
B) Hypertonic saline nose drops
C) Use of a humidifier
D) Application of ice or cool compresses to the sinus area

Category: Cardiovascular
(5) The MD has ordered a heparin drip to be started at 1000 units/hour. Your pt weighs 220 lbs. You have on hand a heparin IV bag with 20,000 units of heparin in 500 cc of D5W. How fast (ml/hour) would you run the drip at?

A)20 ml/hour
B)25 ml/ hour
C)40 ml/hour
D)100 ml/hour

GOOD LUCK!
CLICK HERE TO CHECK YOUR ANSWERS

-KMG-365, Clear

The Economy and Specialty (CEN) Certification...?

So I was sitting down tonight watching President Obama's first press conference (8:00 pm EST ????)....Anyways, as he was explaining his take on the pulse of our current economy and how he has seen "first hand" the effects of it on places like Elkhart IN that saw it's jobless rate nearly triple in the last 3 months, and how people are out of work and loosing jobs; I was considering what relevance this state of affairs has to achieving specialty board certification for nurses.

Mr. Obama was explaining his take on principles of economy that decreased consumer credit causes people to spend less, companies to produce less and companies to have to reduce their costs on such things as payrolls and numbers of employees. He went on to talk some about the hardships faced by "Main st" while on the unemployment dole and I got to thinking about nurses...Specifically my brethren Emergency Nurses.

Through many online and in person conversations, one of the recurring themes as to why more ER nurses don't pursue specialty certification (CEN) is their "lack of interest or motivation". Some people I've talked to have even said the extraordinary lengths their employers will go through to support and encourage certifications. At some facilities, the nurses actually risk NOTHING at all due to employer compensations - and they (the nurses) still aren't motivated to pursue certification.

Although we hear about a nursing shortage (and I'm not here to tell you there isn't one) we know that in hospitals, the payroll is THE SINGLE LARGEST line item and it is a direct reflection of the current numbers on the employee payroll. So if a company is going to start "downsizing" to control it's costs, don't you think the choice of who stays and who goes will factor in things like credentials or qualifications.

Like myself, ALL RN's came on board with only a generic entry-level license (AKA right to practice) in a general setting. No RN comes out of nursing school with a competency or credential to practice ER nursing. It is through the on-the-job-training, experience, mentoring and good 'ole 'elbow grease' that many RNs working in an ER setting claim the title "Emergency Nurse".

Until those same nurses acquire a professionally recognized and verifiable credential as the CEN (Certified Emergency Nurse), they technically remain just a generalist in nature.

Now, don't get me wrong, there are THOUSANDS of RNs working in our nation's ERs who probably have the experience and knowledge commensurate with that of the CEN credential, however, they have not been recognized in that manner...yet.

Once the ER RN decides to prepare for and sit for the CEN exam, and then PASS it - then they can truly call themselves an "Emergency Nurse".

In today's health care arena we are already seeing a shift in our Emergency Medicine Doctors in that more and more hospitals and practice groups are mandating Board Certification in Emergency Medicine. The days are slipping by where once a Family Practice trained MD could take a job in an ER and practice as an "Emergency Physician". The credentialing, accrediting and regulatory groups are more and more looking to set the bar "higher" for the attainment of an elevated, verified skill, knowledge and practice level. And like the RN's -this does NOT mean that there aren't some FP's out there that are not EM boarded, practicing at an equivalent high level as their boarded peers; on the contrary, there are assuredly MANY who are.

But as we see this push and shift from non EM boarded MD's to EM boarded one's, undoubtedly natural progression will dictate at some point that it is desirable for the RNs as well as it denotes a verified specialty locus of practice.

So as we see our nation's economy stumbling, the workforce dwindling and health care crumbling, it becomes more concerning for the Emergency RN who wants to secure their place in teh workforce to attain certification in their speciality.

Some call it pride,
Others call it professionalism,
Others still call it accountability,
I say it is more and more likely that someday not too far off, it will be mandatory....

LINKS for more information:
-The BCEN (who adminsters the CEN)
-The Emergency Nurses Association (ENA)
-CEN exam preparation continuing education

CEN Practice Questions 2-5-09

Here's some sample CEN like review questions. Try to answer them and write out a rationale. Try to justify why the answer you choose is correct and why the others are wrong.....

Answers with rationales will be posted here in 1-2 days.....

Category: Professional-Legal
(1) A 49-year-old woman with a subarachnoid hemorrhage is identified as a potential organ donor. The patient’s family consists of her husband, from whom she is separated, elderly parents, her 18-year-old son, and 44-year-old sister. Who is the legal next of kin that can give permission?

A) Her son
B) Her sister
C) Her parents
D) Her husband

Category: Neuro
(2) The normal range for intracranial pressure (ICP) in an adult is:

A) 0 to 15 mm hg
B) 5 to 30 mm Hg
C) 30 to 45 mm Hg
D) 45 to 60 mm Hg


Category: Pediatrics
(3) A 3-year-old presents with N/V/D for 36 hours. The assesment shows: pale skin, sunken eyes, and is tachycardic. The child is unresponsive to pain. The priority intervention for this patient is to administer:

A) Intravenous fluids (IVF) immediately
B) Oral replacement fluids in small sips
C) Prochlorperazine (Chlorpazine®) 12.5 mg IM
D) Ciprofloxacin (Cipro®) 500 mg PO

Category: Respiratory
(4) An obese 33-year-old female presents with sudden onset of left-sided chest pain and shortness of breath. She is diaphoretic, pale, and in acute respiratory distress. There is no history of trauma, fever, nausea or vomiting. Medical Hx is unremarkable. Current Meds: Birth Control Pills. VS: BP = 100/60, HR = 118, RR = 36.

ABG's are done which show:
pH 7.27,
PaCO2 53,
PaO2 61 and
HC03 26.

These results suggest which of the following?

A) Uncompensated respiratory acidosis
B) Compensated metabolic acidosis
C) Uncompensated metabolic acidosis
D) Compensated respiratory acidosis

Category: Wounds
(5) An 78-year-old is being discharged after having a laceration of his left leg sutured. Which of the following methods of patient education is most appropriate for this patient?

A) Use preprinted instruction sheets.
B) Prepare handwritten instruction sheets.
C) Instruct the patient to call his physician if he has any questions.
D) Conduct a one-on-one discussion with the patient.

GOOD LUCK!

CLICK HERE TO CHECK YOUR ANSWERS