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Media Contact: Dawn M. Kappel
Director, Marketing and Communications
312.525.3667 direct
312.279.1034 fax
dkappel@ncsbn.org
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FOR IMMEDIATE RELEASE
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CHICAGO – The National Council of State Boards of Nursing, Inc. (NCSBN) voted on Dec. 10, 2009, to raise the passing standard for the NCLEX-RN Examination (the National Council Licensure Examination for Registered Nurses). The new passing standard is -0.16 logits on the NCLEX-RN logistic scale, 0.05 logits higher than the previous standard of -0.21. The new passing standard will take effect on April 1, 2010, in conjunction with the 2010 NCLEX-RN Test Plan.
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After consideration of all available information, the NCSBN Board of Directors determined that safe and effective entry-level RN practice requires a greater level of knowledge, skills, and abilities than was required in 2007, when NCSBN implemented the current standard. The passing standard was increased in response to changes in U.S. health care delivery and nursing practice that have resulted in the greater acuity of clients seen by entry-level RNs.
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The Board of Directors used multiple sources of information to guide its evaluation and discussion regarding the change in passing standard. As part of this process, NCSBN convened an expert panel of nine nurses to perform a criterion-referenced standard setting procedure. The panel’s findings supported the creation of a higher passing standard. NCSBN also considered the results of national surveys of nursing professionals including nursing educators, directors of nursing in acute care settings and administrators of long-term care facilities.
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In accordance with a motion adopted by the 1989 NCSBN Delegate Assembly, the NCSBN Board of Directors evaluates the passing standard for the NCLEX-RN examination every three years to protect the public by ensuring minimal competence for entry-level RNs. NCSBN coordinates the passing standard analysis with the three-year cycle of test plan evaluation.  This three-year cycle was developed to keep the test plan and passing standard current. A PDF of the 2010 NCLEX-RN Test Plan is available free of charge from the NCSBN Web site https://www.ncsbn.org/2010_NCLEX_RN_TestPlan.pdf.
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The National Council of State Boards of Nursing (NCSBN) is a not-for-profit organization whose members include the boards of nursing in the 50 states, the District of Columbia and four U.S. territories — American Samoa, Guam, Northern Mariana Islands and the Virgin Islands. There are also four associate members.

Mission: The National Council of State Boards of Nursing (NCSBN), composed of Member Boards, provides leadership to advance regulatory excellence for public protection.
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Media inquiries may be directed to the contact listed above. Technical inquiries about the NCLEX examination may be directed to the NCLEX information line at 1.866.293.9600 or nclexinfo@ncsbn.org.
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The definition of a logit may be found on NCSBN’s Web site at https://www.ncsbn.org/02_18_05_brief.pdf.

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Research has revealed a great deal of valuable medical, scientific, and public health information about the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The ways in which HIV can be transmitted have been clearly identified. Unfortunately, false information or statements that are not supported by scientific findings continue to be shared widely through the Internet or popular press.

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How HIV Is Transmitted

HIV is spread by sexual contact with an infected person, by sharing needles and/or syringes (primarily for drug injection) with someone who is infected, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth or through breastfeeding after birth.

In the health care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker’s open cut or a mucous membrane (for example, the eyes or inside of the nose). There has been only one instance of patients being infected by a health care worker in the United States; this involved HIV transmission from one infected dentist to six patients. Investigations have been completed involving more than 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and no other cases of this type of transmission have been identified in the United States.

Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. If HIV were being transmitted through other routes (such as through air, water, or insects), the pattern of reported AIDS cases would be much different from what has been observed. For example, if mosquitoes could transmit HIV infection, many more young children and preadolescents would have been diagnosed with AIDS.

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC. No additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence.

The following paragraphs specifically address some of the common misperceptions about HIV transmission.

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HIV in the Environment

Scientists and medical authorities agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva, and tears. (See page 3, Saliva, Tears, and Sweat.) To obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these unnatural concentrations of HIV can be kept alive for days or even weeks under precisely controlled and limited laboratory conditions, CDC studies have shown that drying of even these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within several hours. Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV-infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed—essentially zero. Incorrect interpretation of conclusions drawn from laboratory studies has unnecessarily alarmed some people.

Results from laboratory studies should not be used to assess specific personal risk of infection because (1) the amount of virus studied is not found in human specimens or elsewhere in nature; and (2) no one has been identified as infected with HIV due to contact with an environmental surface. Additionally, HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions, therefore, it does not spread or maintain infectiousness outside its host.

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Households

Although HIV has been transmitted between family members in a household setting, this type of transmission is very rare. These transmissions are believed to have resulted from contact between skin or mucous membranes and infected blood. To prevent even such rare occurrences, precautions, as described in previously published guidelines, should be taken in all settings “including the home” to prevent exposures to the blood of persons who are HIV infected, at risk for HIV infection, or whose infection and risk status are unknown. For example,

• Gloves should be worn during contact with blood or other body fluids that could possibly contain visible blood, such as urine, feces, or vomit.
• Cuts, sores, or breaks on both the caregiver’s and patient’s exposed skin should be covered with bandages.
• Hands and other parts of the body should be washed immediately after contact with blood or other body fluids, and surfaces soiled with blood should be disinfected appropriately.
• Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, should be avoided.
• Needles and other sharp instruments should be used only when medically necessary and handled according to recommendations for health-care settings. (Do not put caps back on needles by hand or remove needles from syringes. Dispose of needles in puncture-proof containers out of the reach of children and visitors.)

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Businesses and Other Settings

There is no known risk of HIV transmission to co-workers, clients, or consumers from contact in industries such as food-service establishments (see information on survival of HIV in the environment). Food-service workers known to be infected with HIV need not be restricted from work unless they have other infections or illnesses (such as diarrhea or hepatitis A) for which any food-service worker, regardless of HIV infection status, should be restricted. CDC recommends that all food-service workers follow recommended standards and practices of good personal hygiene and food sanitation.

In 1985, CDC issued routine precautions that all personal-service workers (such as hairdressers, barbers, cosmetologists, and massage therapists) should follow, even though there is no evidence of transmission from a personal-service worker to a client or vice versa. Instruments that are intended to penetrate the skin (such as tattooing and acupuncture needles, ear piercing devices) should be used once and disposed of or thoroughly cleaned and sterilized. Instruments not intended to penetrate the skin but which may become contaminated with blood (for example, razors) should be used for only one client and disposed of or thoroughly cleaned and disinfected after each use. Personal-service workers can use the same cleaning procedures that are recommended for health care institutions.

CDC knows of no instances of HIV transmission through tattooing or body piercing, although hepatitis B virus has been transmitted during some of these practices. One case of HIV transmission from acupuncture has been documented. Body piercing (other than ear piercing) is relatively new in the United States, and the medical complications for body piercing appear to be greater than for tattoos. Healing of piercings generally will take weeks, and sometimes even months, and the pierced tissue could conceivably be abraded (torn or cut) or inflamed even after healing. Therefore, a theoretical HIV transmission risk does exist if the unhealed or abraded tissues come into contact with an infected person’s blood or other infectious body fluid. Additionally, HIV could be transmitted if instruments contaminated with blood are not sterilized or disinfected between clients.

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Kissing

Casual contact through closed-mouth or “social” kissing is not a risk for transmission of HIV. Because of the potential for contact with blood during “French” or open-mouth kissing, CDC recommends against engaging in this activity with a person known to be infected. However, the risk of acquiring HIV during open-mouth kissing is believed to be very low. CDC has investigated only one case of HIV infection that may be attributed to contact with blood during open-mouth kissing.

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Biting

In 1997, CDC published findings from a state health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other reports in the medical literature in which HIV appeared to have been transmitted by a bite. Severe trauma with extensive tissue tearing and damage and presence of blood were reported in each of these instances. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that did not result in HIV infection.

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Saliva, Tears, and Sweat

HIV has been found in saliva and tears in very low quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

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Insects

From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting and bloodsucking insects. However, studies conducted by researchers at CDC and elsewhere have shown no evidence of HIV transmission through insects—even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects.

The results of experiments and observations of insect biting behavior indicate that when an insect bites a person, it does not inject its own or a previously bitten person’s or animal’s blood into the next person bitten. Rather, it injects saliva, which acts as a lubricant or anticoagulant so the insect can feed efficiently. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. HIV is not found in insect feces.

There is also no reason to fear that a biting or bloodsucking insect, such as a mosquito, could transmit HIV from one person to another through HIV-infected blood left on its mouth parts. Two factors serve to explain why this is so–first, infected people do not have constant, high levels of HIV in their bloodstreams and, second, insect mouth parts do not retain large amounts of blood on their surfaces. Further, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Rather, they fly to a resting place to digest this blood meal.

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Effectiveness of Condoms

Condoms are classified as medical devices and are regulated by the Food and Drug Administration (FDA). Condom manufacturers in the United States test each latex condom for defects, including holes, before it is packaged. The proper and consistent use of latex or polyurethane (a type of plastic) condoms when engaging in sexual intercourse—vaginal, anal, or oral—can greatly reduce a person’s risk of acquiring or transmitting sexually transmitted diseases, including HIV infection.

There are many different types and brands of condoms available—however, only latex or polyurethane condoms provide a highly effective mechanical barrier to HIV. In laboratories, viruses occasionally have been shown to pass through natural membrane (“skin” or lambskin) condoms, which may contain natural pores and are therefore not recommended for disease prevention (they are documented to be effective for contraception). Women may wish to consider using the female condom when a male condom cannot be used.

For condoms to provide maximum protection, they must be usedconsistently (every time) and correctly. Several studies of correct and consistent condom use clearly show that latex condom breakage rates in this country are less than 2 percent. Even when condoms do break, one study showed that more than half of such breaks occurred prior to ejaculation.

When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the time among couples using them as their only method of contraception. Similarly, numerous studies among sexually active people have demonstrated that a properly used latex condom provides a high degree of protection against a variety of sexually transmitted diseases, including HIV infection.

For more detailed information about condoms, see the CDC publication “Male Latex Condoms and Sexually Transmitted Diseases.“

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CDC’s Response

CDC is committed to providing the scientific community and the public with accurate and objective information about HIV infection and AIDS. It is vital that clear information on HIV infection and AIDS be readily available to help prevent further transmission of the virus and to allay fears and prejudices caused by misinformation.

Source: http://www.cdc.gov/hiv/resources/factsheets/transmission.htm

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TEMPERATURE
■ Afebrile: Oral: 97.5–99.5F and rectal: 0.5–1.0F↑ than oral route
■ Hyperthermia: 99.5F; hypothermia: 97.5F

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PULSE
■ Normal: 60–100bpm
■ Tachycardia: 100bpm; bradycardia: 60bpm
■ Thready:Weak, feeble; bounding: forceful, full
■ Dysrhythmia: Irregular pattern
■ Pulse deficit: Difference between radial and apical rate

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RESPIRATIONS
■ Eupnea, normal: 12–20bpm
■ Tachypnea: 20bpm; bradypnea: 12bpm
■ Apnea: Absence of breathing
■ Hyperventilation: ↑Rate and depth
■ Kussmaul: Deep and rapid, associated with metabolic acidosis
■ Cheyne-Stokes: Rhythmic waxing and waning from very deep to very shallow and temporary apnea
■ Orthopnea: Upright position to breathe
■ Dyspnea: Difficulty breathing

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BLOOD PRESSURE
■ Normal: SBP 120 and DBP 80
■ Prehypertension: SBP 120–139 or DBP 80–89
■ Stage 1 hypertension: SBP 140–159 or DBP 90–99
■ Stage 2 hypertension: SBP ≥160 or DBP ≥100
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Key Terms:
BPM: Breaths per minute / Beats per minute
DBP: Diastolic Blood Pressure
SBP: Systolic Blood Pressure

■ Peak expiratory flow rate, the maximum flow of air forcefully exhaled in 1min, decreases

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Etiology and Pathophysiology
■ Autoimmune response → demyelination of CNS neurons and formation of sclerotic plaques → ↓impulse conduction
■ Remissions and exacerbations with downward plateaus
■ S&S vary depending on nerves involved

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Risk Factors
■ Caucasian race 20-40yr old
■ Female gender

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Signs and Symptoms
■ Charcot’s triad (intention tremor, nystagmus, scanning speech)
■ Visual disturbances (diplopia, visual field deficits)
■ Fatigue, paresthesias of face and/or extremities, incoordination, slurred speech, spasticity
■ Bladder dysfunction

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Treatment
■ Disease modifying therapy (interferon beta-1a and -1b, glatiramer acetate)
■ Meds: Corticosteroids, antispasmodics (baclofen)
■ Palliative care

Nursing Care
■ Monitor S&S, balance activity/rest, provide cool environment, ↓fat diet
■ Safe mobility: Wide base of support, assistive devices
■ ↓Pressure ulcers: Change position q1-2hr, skin care, pull sheet to ↓shearing, pressure relieving devices
■ Improve elimination pattern: Respond to urge, follow bowel and bladder toileting schedule, ↑fiber and fluids, ascorbic acid to acidify urine if ordered
■ Emotional support: ↑Ventilation of feelings, refer to National Multiple Sclerosis Society

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CAUTION: EARLY SIGNS OF CANCER

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C – hange in bowel or bladder habits

A – sore throat that doesn’t heal

U – nusual bleeding or discharge

T – hickening or lump

I – ndigestion; dysphagia

O – bvious change in a wart or mole

N – agging cough ot hoarseness

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We hope that this information would be disseminated so we can all decrease the mortality rate for Cancer. Let’s all fight against Cancer.

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■ Education can prevent illness, promote or restore health, ↓complications, ↑independence and coping, ↑individual and family growth. Incorporate throughout health care delivery.
■ Environment should be conducive to learning: Private, quiet, well lit, comfortable, and lack distractions (close door/curtain, shut off TV).
■ Teaching process should follow format of Nursing Process.
■ Both short- and long-term goals should be set to ↑motivation and allow for evaluation. Goals must be pt centered, specific, measurable, realistic, and have a time frame.
■ A variety of teaching strategies that use different senses should be used (written materials, videos, discussion, demonstration).
■ Teaching can be formal/informal, individualized, or within a group
■ Information should move from the simple to complex, from known to unknown, be appropriate for pt’s cognitive and developmental level.
■ Shorter more frequent sessions most effective (15–30min)
■ Learning is ↑with repetition, consistency, practice.
■ Evaluation and documentation are essential elements of teaching.

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C – heck why the medication is given and know the classification of the drug. In other words, you should know the purpose why the medication is given.

H – ow will you know the medication was effective? What are you assessment parameters in monitoring the effects of the drug?

E – xactly what time should the medcation be given? Some drugs are best taken with meals, some are after meals while some are on an empty stomach. Some medications may also be taken without regard to meals.

C – lient teaching tips? What do you have for them? You should let them know what to expect so they can report unexpected side effects. Don’t forget to give instructions related to the therapeutic and side effects of the drug.

K – eys to giving it safely! Don’t forget the 10 rights of drug administration. You should always be able to identify interventions to counteract the side/adverse effects of the drug.

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So always don’t forget to C.H.E.C.K. the medication, aright? Good luck!