Saturday, March 6, 2010


Subject: CPNE FAQs Topic: CPNE (FAQs)

Author: DARREN WALSH Date: July 31, 2009 8:49 AM

This is a post from Excelsior about the CPNE


PLEASE NOTE that the questions and answers are also available in a PDF format at the end of this message so you can print them out or save them to your computer.

1. What is included in the 20 minute check?

The 20 minute check occurs after implementation begins, and is preceded by the overriding area of care Asepsis (SG pages 117-119) Caring (SG pages 124-130. This pertains to fluids that are entering the body by intravenous method or enteral feeding and includes: Fluid Management critical element 3 a 1,2,3,4. Also, reference on SG pg. 113

2. Do I have to reidentify the patient each time I leave and enter the room?

No. Identifying the patient MUST occur two times during the PCS: 1. in the area of care Caring (SG p. 124, critical element 1 A,B,C,D, before beginning any required or selected areas of care, and 2. prior to entering the selected area of care medication (SG p. 285) critical element 4 a,b,c. You must also re-identify the patient if you have to hang a new IV bag.

3. Where can I put the paperwork during the PCS?

You could keep it in the pocket of your uniform top or pants. Additionally, the clinical examiner will be able to answer your question as to where to place it if this is not an option.

4. Must there be a barrier between my paperwork and any surface in the room?

No. The clinical examiner will be able to answer your question as to where to place the paperwork in the room.

5. When does Caring come in? Each time I leave and enter the room?

Caring is an overriding area of care (SG pages 124-130.) If you are referring to identifying yourself, the examiner, and the patient, this is done at the beginning of implementation, upon first entering the room. If you are asking about the other critical elements listed in caring, they are to be carried out throughout the PCS and will be evaluated by the clinical examiner. This includes therapeutic communication (element 2), verbal and physical expressions, as well as respect for the client (elements 3, 4 and 5).

6. When can I change a diagnosis to AT RISK and must I use the revised form to do it?

You are not required to make any change to your nursing care plan once the clinical examiner has reviewed it and accepted it in planning. However, should you choose to do so, you may do that at any time during the PCS, once you have determined that the patient’s condition warrants it. (SG pages 112 – 113) At that time, you must show the changes to your clinical examiner by writing them on the revised form, found behind your evaluation phase form in your kardex. Be sure to copy those areas you did not change to facilitate the examiners review of what was changed. The CE will then use the planning phase criteria to re-evaluate your plan.

7. If I have washed my hands, do I have to wash them again after identifying the patient before putting on my gloves to check the IV site?

No. You are expected to wash your hands in order to protect others, yourself and the environment from contamination. No contamination occurred (SG p. 119).

8. Do I have to wash my hands when I take my gloves off after checking the IV site and before touching the tubing?

Yes. The guidelines in the SG pages 120-122 use this as an example. Think about going from a dirty to clean area. The potential exists for contamination from the IV site.

9. For fluid management, how do I convert popsicles and ice chips to fluids?

In many hospitals, there is a conversion sheet that will be provided to you by the clinical examiner. The rule of thumb is one cup of ice chips (a cup that measures 240 ml) is equal to 120 ml. The popsicle wrapper may also provide you with the volume. When in doubt, ask the clinical examiner or staff nurse.

10. What type of fluid is included in intake and output?

Intake you are responsible to record includes: All fluids consumed during the PCS, including the fluids on the breakfast or lunch tray, or what has been taken in during the one hour you have been assigned to measure intake for hourly intake. The volume of the primary IV fluid infused during the PCS when the primary IV fluid has totally infused and the next ordered solution is hung, the IV orders are discontinued, or the patient is on hourly intake; the volume of a secondary IV when it has fully infused. When output is designated, you are to collect and measure all output. Output to measure may include urine, liquid stool, emesis, and chest tube drainage and/or wound or nasogastric secretions. (SG p. 161)

11. Must I keep track of everything that goes in?

Yes, if intake has been designated. (fluids) (SG p. 160)

12. When do I mark the bag so I know what I am responsible for as IV intake?

Page 157 in the study guide states that the student is to determine the amount that is in the bag at the beginning of implementation with the CE. When a new IV needs to be hung, the CE will indicate this in writing on the PCS assignment Kardex. (SG p. 158)

13. How will I know that the CE and I are on the same page for fluids in the bag if I have to change it?

(see above, same answer)

14. When assigned output for children, will I include stool?

Page 162 of the study guide states “Check with the assigned nurse to learn whether formed stool is weighed with the diaper.” On some hospital units the formed stool is removed prior to measuring the diaper weight.

15. When assigned output for children, what if the stool is liquid?

When measuring all output, page 161 of the study guide states: Output to measure may include urine, liquid stool, emesis, chest tube drainage, and/or wound or nasogastric secretions.

16. When do I declare pain level assessment?

If pain level assessment has been assigned under the area of care Vital Signs, you must assess and record this under Vital Signs, and declare it when you declare Vital Signs. (SG p. 176) If you are assigned pain level assessment under the area of care Pain Management, (SG p. 236) you do not have to declare pain level and will be recording it in the narrative notes under Pain Management.

17. What if I am not assigned pain management, will I still have to let the staff nurse know if the number has changed?

Yes. Study Guide pg 176 states: If pain is assessed as part of Vital Signs, and you are not assigned the area of care Pain Management, you are still responsible for intervening in the management of your patient’s pain by reporting the pain level to the staff nurse if indicated.

18. If my diagnoses have changed from planning, can I wait until evaluation to change it if I did the interventions I planned?

Yes. You may change your diagnoses any time during the PCS, including evaluation. (SG pages 112-113). Study guide pg 314 also states: If needed, you may write an entirely new nursing diagnosis and address this as a priority problem in evaluation. Any interventions that are written either in planning or revised during implementation or evaluation must be performed.

19. Do I need to reassess lungs after each intervention (during Respiratory Management), or only at the beginning and end?

The study guide, page 253 states: Immediately following completion of all assigned respiratory hygiene activities, reassess respiratory status with patient in the same position as during initial assessment.

20. Do I have to tell the examiner when I am performing skin turgor assessment or assessing peripheral pulses?

You do not have to verbalize what you are doing to the examiner, however, study guide pg 152 states: Since the assessment of hydration status may be done unobtrusively, be obvious in your actions when performing this assessment and verbalize your findings to alert the CE that you are completing the critical elements. The same is true for pulses.

21. When performing an abdominal assessment, do I have to interrupt the tube feeding?

The SG p. 181 states to turn off the suction machine while auscultating bowel sounds, however, there is nothing to indicate the need to interrupt the tube feeding.

22. If the patient has a nasogastric tube, can I put them flat to do the abdominal assessment?

Yes. If the patient is on suction, you must turn off the suction while auscultating bowel sounds, however, there is nothing in the study guide to support not putting them flat. (SG p. 181) If the patient has a tube feeding via a nasogastric tube, you cannot put them flat, but must keep the head of the bed elevated at least 30 degrees.

23. If the patient is on continuous suction, do I need to interrupt the suction to listen to bowel sounds?

Yes. (See above explanation)

24. If I forget to do a part of an area of care, can I go back into the room during evaluation and if so does the 20 minute check start again?

You may go back into the room if you recognize that you have forgotten something during evaluation. The “20 minute check” only related to fluids in the beginning of implementation. (SG p. 113) You can only be evaluated once on any critical element, therefore, there would be no reason for redoing this check

25. How many repetitions must I do when assigned ROM? The text reference says 3-5 and the study guide states 1.

Study Guide page 220 states: When ROM is designated, you will be expected to direct or assist the patient to perform at least one pair of the following movements: abduction and adduction; flexion and extension. All joints of the designated extremity (ies) are assessed.

26. Is it OK to put tabs in our care plan book and medication book and write what area the tabs are indicating? Can we do this before coming to the CPNE?


27. Is it acceptable to highlight our kardex in order to keep us focused during the PCS?

Yes. Some students create their organizational plan on the Kardex as well.

28 . If the clinical examiner indicates one area to assess under skin assessment, do we have to choose two more?

No. Study guide, p. 208 states: Assess a minimum of two vulnerable skin surfaces from the list. You must do two. (the study guide does not state that the Clinical examiner may assign one and you have to choose one more, nor does it state that if the examiner does not indicate any but assigns skin assessment, you will choose two).

29. When may I identify the patient at the lab stations that require identification?

The study guide states, in the simulation lab (pages 359, 361, 370, p. 379) you are to identify this “patient:” immediately before administering the medication.

Attachments: CPNE_FAQS_updated.pdf;

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CPNE FAQs DARREN WALSH July 31, 2009 8:49 AM

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