You are adamant.




Yes hardened.



Cannot be moved.


Not flexible.

It is my way.

Or no way.




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.


(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.



(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.


God so love the world,that he gave his only begotten son that whoever believe him will live

and not perish.This is telling us to do the right thing.

Doing the right is easier than doing the wrong thing.

When you are doing the right thing your response will be smooth and direct.

But when you are doing the wrong thing you cannot give a quick response, for example you might repeat yourself then choke a little bit in your own saliva before answering.

Remember the story of Eve in the bible as soon as she did the wrong thing,

they starting hiding away from God.

And he said unto the woman ,yea hath God said.

Ye shall not eat of every tree of the garden.

And the woman said unto the Serpent, we may eat of the fruits

of the trees of the garden. But of the fruit of the tree which is in

the Midst of the Garden, God hath said, ye shall not eat of it,neither

shall you touch it lest you die.

And the the Serpent said unto the woman, you shall not surely die.

For God know that in the day that you eat the fruit, then your eyes shall be as god,knowing good and evil.That is knowing right and wrong.And when the woman saw that the tree was good for food, and that it was pleasant to the eyes and a tree to be desired to make one wise,and she took the fruit ate it and gave some to her husband. Their eyes were opened and they knew that they were naked.They went and hide.(The beginning of deception and lies)And they heard the voice of the Lord walking in the garden. Adam and Evil hide themselves from the presence of God.They have done wrong and could not face the truth.GENESIS 3:1-6.

As a young child you go to pre-school then to elementary school finish, go to middle school, then go to high school finish, go to college.If you do not want to go to College then let your parents know. If you are not going to College then you Must get a job or learn a trade because an idle mind is a devil workshop.This is doing the right thing.

Life is not complicated at all only if you make it to be complicated then it becomes complicated, there are bumps on the roads, there are no straight lines.All these minor obstacles is to motivate,energize ,encourage and force us to focus on the right path.We must not deviate to the wrong path since it leads to pain and suffering.

That is lying over simple thing is not necessary.

For example 08am should be morning but you said that it is evening,

even though that you are looking at your watch. Acts 17:28-29

“For in him we live and move and have our being”.

When you do good you are leaving behind a positive legacy,but when you do wrong it will continue to hunt you and you have left Nothing behind but shame.Anything that is worth doing is worth doing well.Do not suffocate the people you love,your co-workers and friends by not doing the right thing.

For example 1+1=2,2+2 =4, 4+4 =8 ,but 4×4 =16,17×6 =102,5×5=25,30 x7 =210.

There is no confusion.


Three men with pre-existing conditions died and went to heaven.

On the gate to heaven, angel Gabriel asked the First man what is your pre-existing condition? He replied I have asthma and COPD ,sometimes it is difficult to get some air.

But I feel better when I saw you.God replied pre-existing condition is not accepted here.

We have no room to babysit anyone.Go back on earth and get rid of your pre-existing conditions. Before you will be accepted.

The second man came forward and angel Gabriel asked him about his pre-existing condition.

He replied ,the only pre-existing condition that I have is that, I know that God is the controller of all pre-existing conditions.And I have no other God before him.

God replied you have answered well.So go into my kingdom,relax and enjoy since you have no pre-existing conditions. I created pre-existing conditions and do not want to hear about it.Because you are all qualified before God.”Hear thou ,my son and be wise and guide thy heart in the way” Proverb chapter 23:19

The third man came and angel Gabriel asked about his pre-existing condition.

He replied what pre-existing conditions do you want to know? Are you not the cause of my predicaments?.God replied since you are ungrateful and disrespectful ,I will send you to Hell where there will be weeping and grinding of your teeth.So he left for hell.

This is my humor.Thanks.

NURSING QUESTIONS.(Blood Transfusion).

(1) The nurse admitted a patient with a low blood level H/H 7.3/24.4.

The doctor ordered to transfuse PRBC of one unit.Five to ten minutes into the transfusion,

patient started itching all over,complain of chill and hives.

The first immediate reaction of the nurse(RN) will be :

(a) Tell the patient that this is normal ,and will stop at the end of the transfusion.

(b)Call the charge nurse to assist.

(c)Complain about unfair assignment.

(d)Stop the transfusion immediately and notify the doctor.

(2) The nurse admitted a patient with low H/H 8.1/26.2.

The patient told the nurse that she takes ferous sulfate medication

in empty stomach.What will be the nurse advice?

(a) To take with meal to avoid upset stomach.

(b) Take with orange juice for better absorption.

(c) Monitor for constipation.

(d) All of the above.

(3) The doctor ordered for a 75 years old man to receive two units of PRBC

(Packed red blood cells).The nurse received a PRBC from the Blood

Bank labelled AB+.The patient’s blood type is 0+.

What will be the nurse first reaction.

(a) Return the blood to the blood bank immediately because type 0 can only

receive type 0 blood components but can be a donor for all other blood types.

(b) Patient with AB+ can receive ABO.

(c) I have verified name,ID#,blood type for patient,unit type,

donor type and expiration name.

(d) Let me talk to the Charge nurse and resource nurse first

to see if universal donor is the same as universal recipient.

(4) One unit of packed red blood cell is ordered for patient in room 4300

who is anemic.After the transfusion is started ,which of the following

actions taken by the nurse is most appropriate.

(a) Nurse to stay with patient during the first few minutes of the transfusion

to monitor and recognize early transfusion reaction.

(b) Blood Transfusion should be given  18gauge needle or 20gauge

needle and normal saline solution.
Check vital sign before starting to establish a baseline.

(c) Start transfusion slowly .Signs of reaction are usually seen in the first 50ml-100ml.

(d) All of the above.

(5) A 56 years old woman is to receive two units of packed red blood cells.

At the beginning of second unit patient develops a transfusion reaction.

The nurse called the doctor ,and the doctor ordered benadryl.

The nurse recognizes that the side effect of benadryl is :

(a) Dry mouth. Antihistamine use to relieve allergy activity ,side effect

is drowsiness ,nausea,tiredness and fatigue.

(b) Sleepiness and irritable.

(c) Angry and dry mouth

(d)It is contraindicated to take benadryl while receiving blood.

ANSWERS (1)D,(2)D(3)A (4)D(5)A


(1) The Nurse immediate action for patient admitted with Alzheimer/dementia disease will be:

(a) Assess level of orientation

(b) Put the bed alarm on and ask God why.

(c)Put patient in the sitter room and restraint her.

(d)Complain about your  assignment.

(2) A 68 years old woman had CVA ,and her left temporal lobe is affected.

She is admitted to the hospital.

What should the nurse expect when performing physical assessment of the patient.

(a) The left hemisphere which controls speech ,math skills and analytical thinking is affected.

(b) Nothing is affected except the inability to move the left leg.

(c)The patient cries all the time but cannot talk.

(d)She is a lovely,pleasant patient.

(3)A 64years old man was admitted into the hospital due to nonstop lower back pain.

The nurse placed patient in 30degree position with his hips and knees

moderately flexed. The rationale for this position is ;

(a) Relieve tension at the lumbar-sacral region.Knee flexed relieves pressure on sciatic nerve or disk.

(b) The most important thing is to medicate the patient first.

(c)30 degree position is not recommended at all.

(d) Patient is already old why all the pain.

(4) A 48years old man with rheumathoid arthritis wanted to know why he should perform range of motion(ROM) excercises .The nurse response should be based on the

understanding of the benefits of ROM:

(a) It is a good excercise for the body.

(b) To prevent contractures and deformities .Improve and maintain ROM.

(C) No need for ROM when you are not in the mood.

(d) Range of motion is contraindicated.

(5) A 12 years old boy is discharged from outpatient surgery clinic after a

arthroscopy of his left knee.Non weight bearing on his left leg for two weeks.

He has to use crutches.The nurse teaches the boy how to use crutches.

The nurse should educate the boy that to go downstairs ,he should

(a) Advance the affected leg and both crutches together.And to go upstairs

the unaffected leg first,then both crutches,then affected leg.

(b) It does not matter as long as you are using the crutches.

(c)Use the crutches only o\when necessary.

(d) Why crutches if you can use the wheelchair.

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


Why do we undergo surgeries or procedures?

So many people undergo surgery or procedure without asking questions.

Surgery is the use of instrument to create incisions so that injuries or disorders in

the body is treated.It is usually done under general anesthesia.

Some people ask questions before the procedure or surgery.


But some people don’t ask questions.They just trust their surgeons.

You should be aware of not only the Name of the Procedure or Surgery

but Why do you need it.

Ask questions and make sure that you are answered correctly.

Do not be shy or ashamed to ask for clarifications.

Your surgeon should  explain to you what he/she intend to do before you sign

the consent form.After the doctor and the Anesthesiologist talked to you then

you can sign the consent form.

The anesthesiologist is the doctor that will put you to sleep.

Don’t you think that you need to know?

The informed consent means that you got the information and that you totally agreed.

PERSISTENT/SCD/LOVENOX by Philomena N Okeke.(My little poem)

I like to stick to

what I believe in.

I persisted on my speech.

I must persist

To persist you must know

He said NO.

But I persisted .

Where is NO?

I t does not fit.

I have no time to waste.

Push ,push on.

In Nursing School you persist.

No is not an answer.

It pushes you back.

Revisit NO and make it YES.

Persistent is the answer.

To persist is to press on.

Give to Cesar what is his.

I got what is mine.

Presumption does not mean right.

Nurse persisted on the need for

ambulation based on doctor’s order.

Walking decreases hospitalization.

The Nurse was right.

There should be no presumption

that patient does not want to ambulate.

Ambulation is good for me.

Ambulation is good for you.

If immobile.

Where is SCD?

Where is lovenox?

Is it contraindicated?

Why is patient not ambulating?

Per doctor’s order (Ambulate patient TID)

Who wants DVT/PE?


Does patient need pain medication before ambulation?

Nurse medicated patient for pain.

Patient felt better and ambulated.

Does patient need assistive device to ambulate?

Nurse ,thanks I feel better.

Nurse persisted everyone won.

Efforts were planned and coordinated .

There is no fear when you persist.

It is good to persist.

Determination is to persist.

To persist is to insist and press on.

Push,push on.

I pursue.

He perseveres.

I endured and ride on.

I strive.

Jesus persist that he

should wash his eyes in the pool.

He washed and received his sight.

NURSES BURNOUT by Philomena N Okeke,Author.

Burnout can be defined as depletion of your physical and emotional energy

for over a long period of time due to unrelieved pressure from your job.

So many nurses have been burned out in the past.Some of them changed jobs,relocated,

got married,develop health issues, but so many are still hanging in,doing it differently

with smile on their faces,coffee in the hands,friendly environment and doing what they love.

The ball is your hand.Nursing is a very beautiful ,fantastic,lovely but challenging profession.

You make the best of it.I love it and so will you.

I have been burnt out in the past without realizing it until someone pointed it out.

Over fourteen years ago ,it all started when I told one of the doctors that I worked with, that I saw him ,the managers and everyone working in our unit in my dream .And that we were preparing for JCAHO(Joint Commission on Accreditation of Health Care Organization) visit.(JCAHO came to our hospital that year and we scored 93%,I was one of the coordinators in my unit)He replied,” if you saw us in your dream then you are definitely burnt out.So please evaluate the jobs that you have and see which one is giving you stress the most.If it is this job or any other job .Whatever it is, you must leave it immediately.”I did not like the doctor’s suggestion.I thought that he hated me. Two days later my manager called me into her office to tell me that my Primary doctor called and said that I needed emergency surgery.And that I must go for the surgery immediately.I told my manager “NO” the doctor just wanted to make extra cash.I do not want to go.I do not need any surgery.She replied,”YOU MUST GO BECAUSE IF ANYTHING HAPPEN TO YOU ,WE WILL NOT BE LIABLE”. So I left very uncertain of what will be my faith.I had my surgery done.It was the removal of cyst .I returned to work immediately.I love working .Working was my only language that I speak.One year later I decided to move on and left that hospital but never stopped working.But drastically reduced my hours,learned to speak up ,make friends and then learn to educate and delegate.Also learn to listen to my body.


(1)Unrelieved pressure from work.You work in a hostile and unconducive environment.You are constantly harassed ,rather than encourage and support you.Or Charge nurses give you the worst assignment and bully you all the the time. The other nurses do not like you because you are inexperience or not one of “them” or from the Registry.You come to work tortured,ridicule and relegated to the background.That is working in a stressful,dangerous environment

(2) Lack of support : You are single or divorced and has no support,friends or families to help you.

(3) Difficult Co-workers: You have difficult co-workers that are not supportive.

Their main agenda is to see you fail.They are not happy if you sit down to review

your work or chart. And their popular language is that “she does not belong here”

(4)Having a lower degree: BSN rather than associate degree is much better.

You have more respect. And the doctors want to communicate with a BSN

than associate degree.There is a proverb that says,”If you want to eat a toad get

the juicy one”.

Nursing profession have so many specialty ,bedside Nursing is one of them.

(5) Bedside :Bedside Nursing can be emotionally draining.You see so many trauma on a daily basis.You watch people of your age ,your dad age ,your son’s age your brother age die of various diseases from gunshot wound to cancer, car accident. Nurses experience death,and complication lost of limb can be so emotional and can affect the ability to continue.

(6) New Nurse: Lack of knowledge and inexperience can make it difficult for new nurses.

There is the unrealistically high aspirations in Nursing Program that teaches “the perfect patient situations”,which most often does not exist.It is surprising to the new nurses when the those situations in nursing  schools does not apply in the real world.They start to feel incompetent and lack of resources at the beginning of their career.

Rome was not built in a day so new nurses should learn to ask questions rather than development attitude.What attitude do you want to show when you are inexperience?.And the experience nurses should learn to support their own.The doctors knows when we have new nurses and they (doctors) react to their inexperience. Who is that nurse that called me? She does not know anything.Doctor :she is new ,please be gentle ,we want them to stay I replied.Do not chase them away please.

(7) Lack of Respect among the healthcare Team.Respect is reciprocal.Please give me some.

(8) Under staffing: Sometimes there is not enough staffing ,so we have to manage the limited

staff that we have.With long hours of work,and maintaining a high quality standard of care.

(9) Delegation: Most Nurses do not know how to delegate or they believe that it will not be delivered the way they want it.In an attempt to do it all without seeking help could contribute to burnt-out.

(10) Lack of Emotional intelligent: It is very important to know how to deal with people.It is always good to understand people that you work with before dealing with them.Because we have the individual differences.If you do not know how to fit in,it can be very deterimental, frustrating and can contribute to burn out.


(1) Emotionally exhausted.This is much more than tiredness after working eight

hours and you want to go home and rest.This is complete fatigue.

Asking you to do one more problem will upset you or too much to ask.

(2)Depersonalization: This is a situation where the nurse has no feelings for the patients

that he/she is taking care of.All the patients are the same in her/his eyes.

There is no individualized plan of care.He/she became a slective listener.

The nurse does not have feelings for the patients that he/she is taking care of.

(3)Decreased in Personal Accomplishment:In this situation a competent nurse becomes

the nurse that barely provide minimal patient care.

Patients are dissatisfied with Nurse care.This is a situation where

there is unhappy outcome.The nurse in this stage feels other nurses

are better so my effort will not yield any difference or a better positive outcome.

Nurses experience death,and complication lost of

limb can be so emotional and can affect their ability to continue.


(1)ACKNOWLEDGEMENT: Identify when you feel burnout.

Provide an equitable assignment.Work should be assigned

effectively.Please do not overload the highly competent nurses.

(2)SELF CARE: Take time to care for yourself.Exercise,meditate.Take your

PTO ,have time for you.You earned the PTO is yours,use it but do not abuse it.

(3)STRONG TEAM :Find time to develop strong ,and compassionate

co-workers who are supportive. I can tell you that they do not need to

speak the same language with you,but they are great team players.

(4)RESILENCE : Develop a coping mechanism in other to alleviate burnout.

Preserve Nursing morale,and avoid role confusion.Salary most often is not the number one factor but if the physical enviroment is not conducive.The salary becomes a serious issue.Is the environment clean,safe?What is the organizational climate? Is the establishment friendly?Is it difficult to interact or communicate with other nurses.

(5)EDUCATION: Educate yourself,subscribe to Nurses Journal.Stay current in Nursing practice.

The ANA Ethical Code for Nurses is that Nurses must maintain competency in Nursing profession.

(6) SAFE TIME: Delegation could be the fundamental key to successful management of your time.

Delegate correctly to the right professional.Understand the roles of the Nurse,Case manager,the CNA,Manger,PT so that your needs will be met.

(7)Realistically look at your environment Do you have any control?But you can control yourself,your mood,and your behavor.Do not be too apologetic.Prevent defensive mechanism.Acknowlege your limitations.