JOHN AND HIS APPLE TREE.(BEDTIME STORY)

John is a 9years old boy.

Who lived in the farm with his adopted parents.

He was adopted at the age of 4 years old.

John watched them farm.

So one day John planted apple seeds.

He did not scattered his seeds.

Some seeds did not fall by the roadside.

None of his seeds fell by the rock.

But he dig the ground very well with the help of his father.

He poured some good soil before planting.

Because he wanted his seeds to yield apple trees.

Every day John will stand by his plant.

And sing a song.

As he watched  his plant.

My plant, my plant please grow and grow.

Can you please grow.

Grow so that I can harvest the fruits.

Grow because I am hungry.

Grow because I need to eat.

Grow because I need to sell the fruits.

I have no other means of survival.

Grow because I am suffering.

Grow because I am am orphan.

I have given you seven reasons why you should grow.

So now that you know the reasons, can you begin to yield fruits.

John watched   fruit tree all the time except when he is sleeping.

Or when he is at school.

He watered his plant in the morning and at night.

John never gave up.

He became happy as the tree grew and bear delicious apple fruits.

He persisted, sang and watered his plant.

Yes he sang and watered his plant.

THE END.

IS LOYALTY A COMMITMENT ?.

Loyalty means to have a strong feelings of support.It is to be committed,patriotic,dedicated,devoted and having strong bond.

It is a very important component of business.

Loyal employees will keep the business going under sunshine or rainfall.Loyal customers will take the business to the future.What did we learn from Naomi and Ruth story.Ruth and Naomi had close relationship and they both live in Moab when they both lost their husband.Naomi planned to return to Israel but encouraged Ruth to remain in Moab.

But Ruth showed her commitment to Naomi and said,” RUTH 1:16-17 Do not urge me to leave you or to turn back from you.Where you go I go,and where you stay I will stay.Your people will also be my people,and your God my God.Where you die I will die and will be buried.” Naomi had a strong relationship with Ruth ,and she became committed and highly devoted.

Take care of your employees and they will take care of your business.It is a simple as that

Richard Brandon.Loyal employees are assets not liabilities. But some people take comfort in their acquisition of power ,and having placed themselves in most high positions,they become obsessed with power and wealth,forget their loyal employees in an attempt to enrich themselves.They become defiant,stubborn,difficult,controlling,disregard and disrespect.

Some of these people end up unhappy ,lonely and miserable because they have acquired so many enemies but very few friends.They will then begin to realize that power is not permanent rather temporary.And will leave the power possessor miserable and sad at the end.

Our God is our God ,he is a faithful God.So be patient when the time comes he will deliver.Be loyal and faithful in all your endeavor. Roman 10: 17 said that faith comes by hearing the words of God.You have faith in what you understand.Therefore we should pray for the Holy Spirit to direct us and lead us to the understanding of the Lord.

I watch ELLEN SHOW every day,and you can see that Ellen employees are very committed,dedicated and faithful and her fans show allegiance,bond and inseparable .And Ellen in return shows serious commitment to her staff and customers.

NURSES QUESTIONS

A patient is developing wernicke-korsaff syndrome ,what will be the

signs that the patient will exhibit?

(A) Memory loss and disorientation.

(B)Wernicke -korsaff syndrome is due to Vitamin B deficiency and usually is exhibited in patients with poor diet intake and long standing alcoholism.

(C ) Confabulation,disorientation and memory loss are some of the signs.

(D ) All of the above.

2. A Rape victim came to the emergency room for treatment.

What will be very necessary for the nurse to carry out for her own and the victim legal protection .

(A) Record the victim’s account of the assault accurately in the victim’s own word.

(B) Assess the victim to make sure that she is honest.

(C) What is the victim’s origin.

(D) She asked for it.

3. Patient with pernicious anemia received intramuscular vitamin B12.

The patient asked the nurse when will she stop taking the injection.

What will be the right response from the nurse?

(A) The injection will be necessary for the rest of your life.

(B) For two more weeks.

( C) For three months.

(D) For two more months.

4. Jennifer 29years old female delivered a full term baby boy,about 6hours after delivery ,the nurse assisted patient with ambulation.What was the primary reason why the nurse encouraged patient to walk.

(A) The nurse is terrible and controlling.

(B) She does not want the patient to go to sleep.

(C ) The primary purpose of walking is to prevent thrombophlebitis.

(D)To avoid bedpan.

5. A newly diagnosed cancer patient is to start chemotherapy.

The nurse should know that the early side effect of chemotherapy is.

(A) Weakness and irritation

(B )Poor appetite and sleep.

(C) Anger and frustration.

(D) Mouth ulcerations.

6. Patient wanted to know if he will be bald as a result of the chemotherapy.

The nurse should.

(A) Assess patient understanding of alopecia.

(B) Explain the side effect of chemotherapy.

(C ) Encourage patient not focus on that yet.

(D )No you will be just fine.

ANSWERS 1.D,2 A,3.A,4.C,5.D,6.A

NURSING QUESTIONS(comfort and mobility)

(1) A 69 years old  female  is living with her handicapped daughter.She develop pain and swelling on her left leg,she was brought in by ambulance to the emergency room.   

  The emergency room doctor diagnosed her with thrombophebitis which is inflammation of blood vessels.She is placed on bedrest 5-7 days, and admitted to Medical /Surgical floor.What will be the most important thing  the nurse must have available for this patient.   

(a)Air mattress and heel protector.To prevent dislodgement of clot,and prevent skin breakdown.     

  (b)Warm packs,bedrest with elevated foot of the bed (6inches)heparin, Coumadin, venous thrombectomy.

(c)Good skin care for bedrest,stool,softeners, deep breathing exercise and elastic wrap from the toe up. 

(d) All of the above.                                 

  (2) The nurse received a patient from another floor with a diagnosis of Osteoporosis.

What is the major factors that predispose her to develop osteoporosis? 

(a) Decrease in her estrogen levels.                

  (b)Her mom is black and her dad is Indian.   

(c) Smoking for 30years.                           

(d) Late marriage.             

 (3)  A 63years old female diagnosed  with Osteoporosis is ready for discharge, the nurse performed teaching.The patient told the nurse that the doctor recommended that patient should walk 30minutes three times a week.And the patient wants to know how will that help her?    

(a)Walking is beneficial for patients with Osteoporosis because it will promote  weight bearing on the long bones,preventing calcium from leaving the bones.                         (b)Exercise might  not help but make it worst.                        

  (C) That has nothing to do with why I  came  to the hospital.                   

     (d)Lack of sleep.                                                                            

(4)When  do we remove  foot pump  or SCD?         

  (a)Whenever the patient complain and ask for its removal.                               

   (b) It should not be removed.                                 

(c)It should be as needed(prn).                               

  (d)During the patient’s initial skin assessment.         

(5)A 54years old man with a history of rheumatoid arthritis is being prepared for discharge from the Community hospital.What will be the most important teaching objectives for this patient?                     

  (a) Rheumatoid arthritis can be a debilitating disease so be careful.              

  (b)It is important to maintain mobility. And this can be achieved by exercise and independent ADL.         

(c) I don’t think anyone can help you.You just have to do it.                   

     (d)None of the above.

ANSWERS 1 D ,2A,3A,4D,5 B.

STORY TIME. (Unpreparedness )

Once upon a time, there live a man who has no plans or goals,but he has confidence.So when his age mates started to get married,then it hit him that he also need to get married.Where are all my beautiful girlfriends.

It is time to get married, so he called the first girlfriend and she replied.Sorry I am married with children.He called the second girlfriend and she said the same thing.Then he called the least of his girlfriends and she replied sorry I am engaged.

Mr Confidence looked up and he looked


down.He has no solution. It seemed like he is beginning to loose his confidence.He said to himself I know what I am doing.I am Mr Confidence. But he quickly and quietly ran to his brothers, friends and sisters but they could not help him.So one day his nephew decided to help him out.

She brought a  very dangerous woman with multiple colors and he fell in love with the snake (woman)immediately.

It was love at first sight or infatuation or a little bit of both.

So he planned for their wedding, organised and arranged everything but on the wedding day the wicked woman refused to show up.So the wedding was cancelled.Yes,I mean cancelled.

She didn’t show up because she does not want people to see her.

She (snake ) moved in and they live together. As time goes on the snake (wife)started to show her true color and he began to complain.

I did not know this side of you my  dear  wife.The Snake replied,I am the same is just that you did not look or pay attention.So he kept quiet.Two months later the Snake transferred all the money from their joint account to her account.He complained and the Snake replied, you are beginning to upset me.This is me, I did not change.Why did you transfer our money into your account without my consent?.The Snake replied look before you leap .We have been together for ten years if you want separation let us go for it.

Mr Confidence started crying, I should have planned, I should have built my house on a solid ground.

Where is Cecilia?

Where is Jennie?.

These women were there for me,when I needed support.Mommy, daddy, I am sorry I didn’t listen to you.

How can I make up for the lost love?How can I make up for the lost time.

I thought that my good look and confidence will me a good promising wife.Who is this woman?.Now I realized that I needed to be prepared to be able to embrace opportunities.

Oprah Winfrey said this a lot.But I never realized that she is also talking to me.I thought that her message is for college students, losers, or people that lack confidence.

Where did I go wrong?

I have made a  very bad decision.

How can I take it back?My agony is beyond words.

A house built without Foundation will Fall.

I now realized also that she cannot and will not bear children because  she has passed the child bearing age.

Anyway we will adopt.

NURSING QUESTIONS(MEDICAL/SURGICAL)

(1) A 40 years old man is admitted to the hospital. Admission orders include heparin 2000unit/hr in 5% Dextrose water.
Since patient is on heparin therapy.Which of the medications listed below did the Nurse need to have available?

(a)Protamine Sulfate.

(b) Warfarin.

(C) Nitroglycerin.

(d) Narcan.

(2)66 years old woman is brought into the Emergency room complaining of pressure in her chest.Her BP 150/96,pulse 89,Respiration 20.The admitting nurse gave nitroglycerin 0.4 mg sublingual as ordered by the doctor.For the nurse to evaluate the effect of this medication, the nurse should expect which of the following changes in patient vital sign.

(a)The heart rate will definitely change with respiration.

(b)BP and heart rate will decrease.

(c )BP 102/60,pulse 94,Respiration 20.That is reduced peripheral resistance,

will lead to decrease BP and pulse will increase while respiration will not change .

(d) Only blood pressure will decrease after getting nitroglycerin three times.

(3)The early signs of left CHF could be.

(a)Dyspnea, crackles and orthopnea.

(b) Insomnia.

(c)Pitting edema, weight gain,and distended neck vein.

(d)Confusion and increased CVP line.

(4) Who do you call when there is a problem with your patient(s)?

(a) You should call the supervisor.

(b) Call the primary or the doctor that is on call.

(c) Call the case manager and social worker ,because they are managers of cases.

(d) Tell charge nurse to call the doctor.

(5)Functions of chest tube drainage include.

(a)Prevention of escape of air from pleural space.

(b)Removal of air from pleural space.

(c) Encourage negative alveolar pressure.

( d) Equalization of air cavity pressure.

(6)Patient was admitted under the trauma team after a motorcycle accident, and he develop small pneumothorax to the right chest.He was placed on three-Chamber water seal drainage system at 20cm suction.

The nurse observed that there is a continuous bubbling in the water seal chamber during inspiration and expiration.

(a) The nurse suspected that there is a leak and notify MD.

(b)Nothing, after all the vital signs are stable.

(c)It was like that in the previous shift and they did nothing.

(d)Patient is  in stable condition.

(7)A 73 years old female sustains a fracture of her left femur in a car accident.

To  treat the fracture ,the orthopedic  doctor performs an open reduction internal fixation.Which of these statement if made by the nurse shows a clear understanding of

the advantages of performing of ORIF.

(a) The nurse educate the  patient and family on early mobilization with this procedure.

Your doctor ordered physical Therapist to help you regain strength and motion on the affected leg.Exercise is important for you to be able to use your leg again.I will medicate you for pain  before PT and as needed.

(b) With this kind of surgery you just need to rest.

(c) Your doctor do not  want you to move but just take your pain medications.

(d) None of the above.

(8) A sixty years old male”s family pushed the call light ,and the nurse went in to respond

to the call light,and the patient complained of shortness of breath  and crushing chest pain.

The doctor notified and ABG was ordered.What result will indicate respiratory acidosis?

(a) PH 7.5,Pao2 90,paco2 60

(b) PH 7.29,Pao2 75,paco2 46.

(c) PH 7.45,Pao2 80,paco245.

(d)PH 7.35,Pao2 76,paco2  56.

(9) Partial Thickness wound can be classified as

(a) Stage IV.

(b) Stage 111.

(c) Stage 11 loss of dermis,shallow open ulcer without slough.

(d)  Wound covered with eschar and some slough.

(10) The nurse received an eighty three years old female from emergency

room with the diagnosis of dizziness.She is very skinny,appeared malnourished,and weight  lost of  5lbs in the last three months.02 @ 3L NC,with a saturation of 93%,alert and oriented x3,stable,breath sound clear ,bowel sound normal.
But there is no doctor orders.The nurse will:

(a) Call the doctor and obtain admitting  orders and make the patient comfortable.

(b) Be patient the doctor will eventually put in the orders.

(c) Notify the doctor,charge nurse ,supervisor and patient family.

(d) A and C.

ANSWERS 1. A Protamine sulfate is an antidote for heparin.It helps to reverse the effect of heparin.

2. C

3. A.

4.B

5.B

6.A

7.A

8 B. Respiratory  acidosis  Because the lung is compromised  and is not getting rid of carbon dioxide so it stays in the blood and the  lung.

9.C

10.D

WHO ARE YOU?(ROMAN 2:5)

You are adamant.

Adamantine.

Hard-nosed.

Hardened.

Yes hardened.

Hardheaded.

Immovable.

Cannot be moved.

Inflexible.

Not flexible.

It is my way.

Or no way.

Implacable.

Self-willed.

Mulish.

In Hebrew you meant “turned away”.Deuteronomy 9:13,Esv.

You are the opposite of humility.

So who are you?.

You are a determination not to change behaviour.

You are against open mind.

“Do nothing from rivalry but in humility count others more significant than yourself “.Philippians 2:3.

“He who is often reproved yet stiffens his/her neck will suddenly be broken beyond recognition”.

You are more resistant to advice or counseling.

In some cases you are good but in most cases you are disaster.

Volcanic mountain that will erupt one day.

Psalm 32:9 “Do not be like the horse or the mule,which has no understanding and must be controlled by bit and bridle”.

Yes I know you,your name is STUBBORN.

But if it comes to following God’s commands

“we should not be stubborn”.

“We must not turn away and stiffen the neck”.

Exodus 7:13-14 talks about Pharaoh stubbornness and the negative impact on his family and the community.

“Stubborness and defiance of God and His ordained authority is a serious offense, one that can spread to family and the community”.

Have you ever thought about why some people are homeless?

Stubborness is the Waiting Room for homelessness.

Because you have everything within your disposal but you refused to listen to advice.

He/she that knows everything will often use basket to fetch water.

“You stiff neck people your hearts and ears are still uncircumcised”.Mark 3:1-6.

NURSING QUESTIONS (Wounds )

(1) Signs of chronic wounds are:

(a) Non healing wound >4 weeks old,lack of viable tissues, no vigorous healthy granular tissue. With dusty wound tissue and magins.

(b)Non viable tissues >4days old.

(c)Dusty wound tissues and margins >4months old.

(d) None of the above.

(2) Factors that can affect wound healing:

(a) Smoking.

(b) Diabetes and PVD

(c)CHF,ESRD,and Hepatic failure.

(d) All of the above.

(3) Infection of wound can lead to:

(a)Excessive pain and worsening of wound bed despite treatment.

(b) Discomfort and pain.

(b) None wound healing.

(c) High blood sugar.

(d)Hepatic Failure.

(4) Dry necrotic wound on the feet should not be debride without consultation of wound specialist.(doctor or specialized wound Therapist.)

(a) True.

(b) False.

(5)Full thickness wound without exposed bony areas, tendon,or slough should be classify as:

(a) Stage 11.

(b) Unstageable.

(c ) Stage 1V.

(d)Stage 111.

ANSWERS 1.A,2.D,3.A,4 A,5.D.

NURSING QUESTIONS (Health Promotion )

(1) The RN assessed her patient and found out that she has clammy skin,cool,and diaphoretic,low blood pressure of 101/58,pulse 115.The first immediate reaction of the nurse is:

(a) Check blood sugar and give dextrose and later give complex carbohydrates.If <60.

(b)Complain about your Charge Nurse and check blood sugar.

(C) Wait for the resource nurse or charge nurse to give dextrose.

(d) Do nothing after all it is normal for the patient.

(2) Normal potassium level is:

(a) 5.5mEq/L to 6.5mEq/L

(b)2.9mEq/L to 3.5mEq/L

(c) 3.5mEq/L to 5.0mEq/L.

(d) A &C.

(3) Flait chest can be caused by.

(a) Osteo Scoliosis.

(b) Multiple rib fractures.

(c)Small pneumothorax.

(d)Difficulty breathing.

(4)For patient with hyperkalemia,the doctor will order:

(a) Phosphate.

(b)Insulin, dextrose(glucose), and kayexalate.

(c)Nacl.

(d)Bicarbonate.

(5) Hypotonic solution is given for :

(a)Normal Blood pressure.

(b)Restoration of fluid volume in the intracellular space.

(c) To support the adequate perfusion of a healthy kidney.

ANSWERS 1.A,2.C,3.B,4.B,5.B

*NB* There are other new medication to treat Hyperkalemia. Follow doctors order.