rn -er application packet

PROCEL TEMPORARY SERVICES, INC.

Procel Temporary Services Inc. JOB DESCRIPTION: REGISTERED NURSE EFFECTIVE DATE: SUPERSEDES:

August 1, 2006 May 10, 2005 APPROVED BY: Marylin Stephens, RN, MSN, MBA, Chief Executive Officer _______________________________________ ___________________________ **EMPLOYEE SIGNATURE DATE RESPONSIBLE TO:

The Registered Nurse is responsible to the Charge Nurse of their specific unit. QUALIFICATION: Educational – High School Graduate Current California State License Current BCLS (Additional credentials may be required by specialty) Experience – One-Year Experience Required - Two- Year Experience For Specialty Units RESPONSIBILITIES:

Diagnosis and treatment of human responses to actual or potential health problems based on interpretation of assessment data

Formulation of a care plan or treatment regimen in collaboration with other disciplines and the patient to assure safety, comfort, hygiene, protection, prevention and restoration of health

Planning and providing nursing care, explanation of treatments to the patients and education of the patient and family regarding how to care for the patient’s health care needs

Evaluating the effectiveness of treatment based on patient’s response/outcome and modification of the plan as needed in collaboration with the patient and the health team

Acting as a patient advocate by initiating actions in accordance with the patient’s wishes and by providing the patient with sufficient information to make informed decisions

Planning, delegating and supervising tasks performed by non-licensed staff within the limits of the law and staff’s job responsibilities

Administration of medications and therapeutic agents as ordered by a duly licensed practitioner authorized to do so under the provision of section 1316.5 of the Health and Safety Code

Performance of skin tests, immunization techniques and withdrawal of blood from peripheral veins or specific venous access devices

Following approved standardized procedures of each Facility Documentation of initial assessments, reassessments, interventions and patient’s response to

interventions © PROCEL

PROCEL TEMPORARY SERVICES, INC.

Documentation of the ability of patient’s and/or family to manage continuing care needs after discharge

Evaluation of care by utilizing continuous performance improvement monitoring activities and patient outcomes

Utilization of standards of patient care and standards of practice to provide patient care. Utilizations of resources such as the Code for Nurses, the patient Bill of Rights and other

hospital established structures to guide ethical decision making. Provide care to patients and their significant others taking into consideration their cultural,

religious, and social preferences as well as age specific care needs and incorporating these needs in the development and implementation of their plan of care. SPECIALTIES: Certain units require special training, skills and proven competency in addition to the usual skills of the Registered Nurse. These areas include, but are not limited to, the following: Intensive Care, Coronary Care Neonatal Intensive Care Unit (NICU) Telemetry/DOU Rehabilitation Emergency Department Post Partum Operating Room Psychology PACU/Recovery Room Medical Surgical Mental Health Pediatric Intensive Care Unit (PICU) Obstetrics Pediatrics © PROCEL

Disclosure and Authorization to Obtain Investigative Consumer Report In connection with my application for employment or promotion or other job change, I understand that Procel Temporary Services, Inc. (the Company) may obtain an INVESTIGATIVE CONSUMER REPORT that will include information as to my character, general reputation, personal characteristics and mode of living. This report may reveal information about work habits, including oral assessments of my job performance, experiences and abilities, along with reasons for termination of past employment. Such a report may be requested by the Company or on behalf of the Company. Further, I understand and agree that the Company may request information from various federal, state, and other agencies, including public and private sources which maintain records concerning my past activities relating to my driving record, credit history, criminal record, civil matters, previous employment, educational background and professional licensing, if any. Report may be ordered from: Interstate Data/Megacriminal.com 113 Latigo Lane #401 Canyon City, CO 81212 (800)332-7999 Consumer Reporting Agency Name Address City, State, Zip Telephone

and/or

KROLL Background Check 600 Third Ave New York, NY 10016 (888)209-9526 Consumer Reporting Agency Name Address City, State, Zip Telephone

and/or

Insight Investigations, Inc. PO Box 891571 Temecula, CA 92589 (800)615-8111 Consumer Reporting Agency Name Address City, State, Zip Telephone You have the right, upon written request made within a reasonable period of time (not to exceed 30 days) after receipt of this notice to receive a written disclosure of the nature and scope of any investigation. If a consumer investigative report is obtained and an adverse decision is made affecting your employment, the Company will provide to you, before making the adverse decision, a copy of the investigative consumer report and a description in writing of your rights under the Fair Credit Reporting Act.

You have a right to obtain a copy of any investigative consumer report obtained by Procel Temporary Services, Inc. by checking the box provided. The report will be provided to you within three business days after the report is provided to Procel Temporary Services, Inc.

I request to receive a free copy of this report by checking this box. x

Under section 1786.22 of the California Civil Code, you may view the file maintained on your by the consumer reporting agency named above during normal business hours. You may also obtain a copy of this file upon submitting proper identification and paying the costs of duplication services, by appearing at the Consumer Reporting Agency identified above in person or by mail. You may also receive a summary of the file by telephone. The agency is required to have personnel available to explain your file to you and the agency must explain to you any coded information appearing in your file. If you appear in person, a person of your choice may accompany you, provided that this person furnishes proper identification.

Disclosure and Authorization to Obtain Investigative Consumer Report I acknowledge that a fax or copy of this Disclosure and Authorization bearing my signature shall be valid as the original. This release is valid for all federal, state, county and local agencies and authorities. I acknowledge that I have received a copy of the Summary of Rights pursuant to the Fair Credit Reporting Act (FRCA).

Name Address City State Zip ( ) - Home Telephone Social Security Number Date of Birth Driver’s License #

State of Issue Applicant Signature

Name: _

Date: _ Skills Checklist

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DDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDDDDDD DDDD

DDDD DDDD

Nationally Validated ContentCopyright © 2010 Clearview Staffing Software Inc.

Page 1 of 6

Emergency Room

Using the scale(s) below, please complete the following skill self assessment based upon your experience within the last 2 years.

Proficiency: [1] None [2] Intermittent [3] Experienced [4] Supervise/TeachFrequency: [1] Never/Observed Only [2] Less than 6 times/year [3] Twice a Month [4] Daily - Weekly

Assessment/Patient Care Proficiency Frequency 1 2 3 4 1 2 3 4

GeneralAdmission

Advance Directives

Collect Appropriate

DataDischarge Teaching

Organ/Tissue

DonationPatient and Family

TeachingSuspected Abuse

EMTALA Procedures

Computerized DocumentationComputerized

DocumentationCardiovascularGeneral Abnormal Heart

Sounds/Murmurs Auscultation (Rate,

Rhythm)Patient Experience Abdominal Aortic

Aneurysm Acute Angina

Acute C.H.F.

Acute MI

Cardiac Arrest/CPR

Cardiac Tamponade

Cardiomyopathy

Defibrillation/Cardioversion

Hypertension

Myocardial Contusion

Pacemaker --

External Pacemaker --

PermanentMonitoring

Assessment/Patient Care Continued Proficiency Frequency 1 2 3 4 1 2 3 4

12 Lead EKG

InterpretationArrhythmia Interpretation

Arterial Line

CVP Monitoring

Intra-Aortic Balloon

PumpPA/Swan-Ganz

Labs BNP (Brain Natriuretic

Peptide) Cardiac Enzymes &

Isoenzymes Coagulation Studies

Troponin

PulmonaryGeneral Assess Lung Sounds

Identify/Manage Resp.

Complications Oxygenation Status

Rate and Work of

BreathingPatient Experience Acute Pneumonia

ARDS

Aspiration

Chest Trauma

Chest Tube

COPD

Hemopneumothorax

Inhalation Injuries

Near Drowning

Pulmonary Edema

Pulmonary Emboli

Status Asthmaticus

Tension Pneumothorax

Tracheostomy

Tuberculosis

Monitoring Apnea

Name: _


DDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDD

DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD


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Emergency Room




Pulse Oximetry

Lab Interpretation of

ABGsNeurologyGeneral Glasgow Coma Scale

Neurological

Assessment Reflex/Motor

Deficits Visual Communication

DeficitsPatient Experience Acute Head Injury

Alzheimer's Disease

Basal Skull Fracture

Cerebral Hemorrhage/Aneurysm

Closed Head Injury

CNS Infection

Coma

CVA

DTs

Increased ICP

Intracranial

Hemorrhage Meningitis

Neuromuscular

Disease Seizure Disorder

Spinal Cord Injury

Halo Traction/Cervical

Tongs Neurogenic Shock

TIAs

Monitoring ICP Monitoring

GastrointestinalGeneral


Assess Nutritional

StatusG.I. Assessment

Patient Experience Abdominal Trauma

Abdominal Wounds

and Surgeries Acute GI Bleed

Bowel Obstruction

Esophageal Bleed

Hepatitis

Ileostomy

Liver Failure

Pancreatitis

Paralytic Ileus

Poison Ingestion

Labs LFTs (Liver Function

Test) Serum Ammonia

Serum Amylase

Renal/GenitourinaryGeneral Assess Fluid Status

Patient Experience Acute Renal Failure

End Stage Renal

Disease Peritoneal Dialysis

Renal Rejection

Syndrome Renal Transplant

Suprapubic Cath

Urinary Tract

Infection Fistula/Shunt

Monitoring Fluid Balance

Measurement of I & O

Labs BUN & Creatinine

Name: _


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DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD

DDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD IDDDD DDDDDDDD DDDD DDDD DDDDI


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Emergency Room




Serum Electrolytes

Endocrine/MetabolicPatient Experience Adrenal Gland

Disorders Diabetic Ketoacidosis

Drug Overdose

Insulin Shock

Pituitary Gland

Disorders Diabetic Coma

Insulin Reaction

Thyroid Gland

DisordersLabs Blood Glucose

Thyroid Studies

MusculoskeletalGeneral Pulse/Circulation

ChecksPatient Experience Amputation

External Fixation

Multiple Trauma

Paraplegia

Skeletal/Skin

Traction Cast Care

Fractures

Crutch Walking

Immunology/Hematology/OncologyGeneral Blood Transfusions

Patient Experience Acute Leukemia

Anaphylactic Shock

Cancer

HIV/AIDS


Sepsis

Sickle Cell Anemia

Treatment Side Effects

Chemo/RadiationLabs Hematology

Wounds/IntegumentGeneral S/S Infection

Skin Assessment

Patient Experience Burns

Hazardous Material

Exposure Pressure Sores

Shingles

Staged Decubitus

Ulcers Stasis Ulcers

Surgical Wounds

Surgical Wounds

w/Drains Traumatic Wounds

Monitoring Skin Breakdown

Women's HealthGeneral Abruptio Placenta

DIC

Eclampsia

Hemorrhage

Precipitous Delivery

Preeclampsia

Premature Labor

Rape Kit

Spontaneous Abortion

Medications/Therapeutic InterventionsGeneralAdenocard

Name:, _


DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDDDDDD DDDD


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Emergency Room



Medications/Therapeutic Interventions Continued Proficiency Frequency 1 2 3 4 1 2 3 4

Adrenalin

Antiemetics

Antispasmodic

Atropine

Bicarbonate

Bretylium (Bretylol)

Bumex

Cardizem (Diltazem)

Charcoal

Decadron

Dilantin

Dobutamine

Dopamine

Epinephrine

Esmolol

Heparin

Insulin

Ipecac

Isuprel

Lanoxin

Lasix

Lidocaine

Mannitol

Nipride (Nitroprusside)

Nitroglycerin

Nitroprusside

Paralytics

Phenobarbital

Pitressin

Pronestyl (Procainamide)

Retavase

Solu-Medrol

Steroids

Streptokinase

Tenectaplase

(TNKase)Terbutaline

TPA/Thrombolytics

Verapamil

Versed

Theophylline


Medications AdministrationAdminister IM and

SQ MedsAdminister Inhalation

MedicationsAdminister PO

MedicationsBladder Irrigation and

InstillationEar Irrigation

Eye Irrigation

Needleless Systems

IV TherapyAdverse Reactions

Assess/Maintain IV

SiteCVP Lines/Measurement

of CVPInfusion Pumps

Peripheral IV

InsertionSyringe Pumps

Vascular Access Devices

Care/MaintenanceAdminister IV

MedicationsMixing IV Solutions

BloodAdminister Blood/Blood

ProductsAlbumin

Nutritional TherapyNGT Insertion

TPN and Hyperalimentation

Oxygen AdministrationAmbu-Bag

Nasal Cannula

Name: _


DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDD IDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDDDDDD DDDD DDDD DDDD


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Emergency Room




Nebulizer Treatments

Non-Rebreather Mask

Portable Oxygen

Tracheostomy

Venti Mask

Ventilator (A/C, IMV,

PEEP)Pain ManagementAssess Pain

Level/ToleranceModerate Sedation

Ramsey Scale

Procedures/EquipmentPerformApplying Brace/Splint

Cast

Cervical Collar

Chest Tube Drainage

SystemsCrisis Intervention

Doppler

Drains (JP-Hemovac-Penrose)

Dressing Changes

Establish/Protect

AirwayFoley, 3-Way

Foley, Female

Foley, Male

Hyper/Hypothermia

BlanketIced Saline Lavage

Isolation

Pinned Fractures

Restraints

Steristrips

Suctioning (Oral-Naso-Pharynx)

Suicide Precautions

Trach Care/Suctioning

Wound Care/Irrigations

Wrist Splint

Procedures/Equipment Continued Proficiency Frequency 1 2 3 4 1 2 3 4

Specimen CollectionsArterial Line Draw

Assist with Rape Exam

Butterfly Stick

Central Line Draw

Clean Catch Urine

Cultures-Blood

Dipstick Urine

Finger Stick

Stool

Sputum

Sterile Urine

Throat Swabs

Venipuncture

AssistArterial Line

InsertionBedside Invasive

ProceduresBronchoscopy

Cardioversion/Defibrillation

Central Line

InsertionChest Tube Insertion

Emergency Tracheostomy

ET Intubation and

ExtubationHalo Traction/Cervical

Tongs PlacementIV Cutdown

Lumbar Puncture

Nasal Packing

Open Chest Emergency

PA Catheter/Swan-Ganz

InsertionPericardiocentesis

Pericentesis

Staples Assist/Removal

Sutures Assist/Removal

Name: _


DODD DODDDODD DODDI

DODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODDDODD DODD

DateNationally Validated Content

Copyright © 2010 Clearview Staffing Software Inc.Page 6 of 6

Emergency Room



Procedures/Equipment Continued Proficiency Frequency 1 2 3 4 1 2 3 4

Thoracentesis

Insert Temp-Pacemaker

Age Group ExperienceAge Groups0 - 30 Days

30 Days - 1 Year

1 - 3 Years

3 - 5 Years

5 - 12 Years

12 - 18 Years

18 - 39 Years

39 - 64 Years

64+ Years

Trauma Level ExperienceLevel I

Level II

Level III

Clinical SettingsAcute Care ER

Chest Pain ER

CHF Clinic

Flight Nursing

Pacemaker Clinic

Urgent Care Clinic

Ambulance/Transport

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"Gold Seal of Approval"

Application Form TO APPLICANTS: We deeply appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in a position that is best suited for you. 1. PERSONAL: Name: _________________________________________________________________________________________ (Last) (First) (Middle)

Address: (Current) _______________________________________________________________________________ (Number) (Street) (Apt/Unit/Suite #)

________________________________________________________________________________________ (City) (State) (Zip/Postal Code) Permanent Address: _________________________________________________________________________________ (If different from above) (Number/Street/Apt) (City/State) (Zip) Telephone Number(s): Home/Day: (____) _______-____________ Cell/Pager: (____) _______-____________ In Case of Emergency, Contact: Name: _____________________ Number: (____) _______-____________ E-Mail Address: ____________________________________________________________________________ INTERESTED IN: x PER DIEM x TRAVEL 2. Licensure/Credentials:

State: License Number: Expiration Date: State License: _____________________ # _____________________ (Mo) _________ (Yr) __________ _____________________ # _____________________ (Mo) _________ (Yr) __________ Foreign: _____________________ # _____________________ Date Obtained: ________________ Education Preparation:

Name/Address: Year Graduated: Degree(s) Obtained: High School: ______________________ (Mo)_______(Yr)________ _____________________________ ______________________ _______________________ _____________________________ College: ______________________ (Mo)_______(Yr)________ _____________________________ ______________________ _______________________ _____________________________ 3. Continuing Education for the last two (2) years:

Completion Date Provider Number Course Name Contact Hours _____________________ _________________________ _________________________________ __________ _____________________ _________________________ _________________________________ __________ _____________________ _________________________ _________________________________ __________ _____________________ _________________________ _________________________________ __________ _____________________ _________________________ _________________________________ __________ _____________________ _________________________ _________________________________ __________ _____________________ _________________________ _________________________________ __________ _____________________ _________________________ _________________________________ __________

4. Work Experience: (Please provide last seven (7) years work history. Most recent or current employer first) 1) Name and Address of Employer: Employment Dates - From: _____(mo) _______ (yr) To: _____(mo) _______ (yr)

Employer: Main Phone #:

City, State:

Was this a Travel Assignment? x No x Yes Facility Name:

Job Title: Indicate Specific Unit(s):

If you have experience in more than one unit, please indicate how many months/years you have worked in each unit at this facility:

Unit: __________ Years of Experience: ___________ Unit: __________ Years of Experience: ___________ Unit: __________ Years of Experience: ___________ Unit: __________ Years of Experience: ___________

Duties and Responsibilities: __________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

2) Name and Address of Employer: Employment Dates - From: _____(mo) _______ (yr) To: _____(mo) _______ (yr)


City, State:






____________________________________________________________________________________________________________

____________________________________________________________________________________________________________



City, State:






____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

4. Work Experience: (continued) 4) Name and Address of Employer: Employment Dates - From: _____(mo) _______ (yr) To: _____(mo) _______ (yr)


City, State:






____________________________________________________________________________________________________________

____________________________________________________________________________________________________________



City, State:






____________________________________________________________________________________________________________

____________________________________________________________________________________________________________



City, State:






____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

5. Work References:

Manager/Charge Nurse Name Facility Position Contact Number 1. _________________________________ ___________________ ___________________ ______________________

2. _________________________________ ___________________ ___________________ ______________________

3. _________________________________ ___________________ ___________________ ______________________

4. _________________________________ ___________________ ___________________ ______________________

6. I have a MINIMUM OF ONE-YEAR experience in the following units and I am prepared to care for patients in these specialties: x General Medical/Surgical x PICU x Hospice Care x NICU x Telemetry x Labor & Delivery x Stepdown x PEDS C/V x Intensive Care/ICU x PEDS General x PACU x PEDS Oncology x Operating Room x Nursery II x Emergency Room x Nursery N/B x Outpatient Clinic x Couplet Care

x Cath Lab/Cardiology x Surgery Center x Pre-Op Holding x Psychiatric General x Post-Op Care x Chemical Dependency

x GI-LAB x Adolescent Psychiatric 7. Referral Source: x Walk In x Nurseweek x Nurse Magazines x Healthcare Traveler Journal x Monster.com x Internet/Web x Career Builder x Hospital Referral x Nurse Referral Name: First ______________ Last ______________ Phone Number: _____________________ and/or Email: __________________________ x Other: __________________________________________________________ 8. Have you ever been convicted of any crime? x YES x NO If so, WHEN? Date: _____________________ Place: __________________________________________________

An Affirmative Response is not an automatic bar from employment.

(Reminder to applicants: We do Criminal Background Screening on ALL applicants before hire) Do you drive? x YES x NO Do you have a car or other transportation for work? x YES x NO What languages other than English do you speak/write and understand?

_________________________________________________________________________________________

Employment Agreement I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I hereby certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any documentation used to secure employment shall be ground for rejection of this application, or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I hereby authorize Procel Temporary Services, Inc. (Procel) to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment. I further authorize my former employers to disclose Procel all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Procel my former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising, or that may arise, our of, or in any way related to, such investigation or disclosure. I understand that nothing contained in the application or conveyed during any interview that may be granted is intended to create an employment contact between Procel and myself. In addition, I understand and agree that if I am employed, my employment is At Will and is for no definite or determinable period and may be terminated at any time, with or without prior notice, and for any reason or no reason, at the option of either myself or Procel and that promises or representations contrary to the forgoing or given at any time in the future are not binding. I understand it is the Policy of Procel to comply with the Drug-Free Workplace Act of 1988, and to refer all qualified candidates, without regard to race, color, national origin, sex, age, physical handicap or medical condition in accordance with the Federal and State Equal Opportunity Laws. I further understand that Procel complies with all applicable Accreditation of Healthcare Organizations (Joint Commission) and with regulations related to HIPAA Security Compliance. Applicant Name (PLEASE PRINT) Date Applicant Signature

Revised: 03/11/11

DRUG AND ALCOHOL POLICY I. STATEMENT OF PURPOSE OF POLICY PROCEL TEMPORARY SERVICES, INC. recognizes the legal and moral responsibility to provide a safe and productive work environment for all employees. Statistics show that drug and alcohol use in the workplace results in accidents, injuries, lower productivity, lost profits, increased health care costs, and legal difficulties for employees and employers. Clearly the use, possession or sale of illegal drugs and alcohol in the workplace poses serious risks to the health, safety and well being of our employees. For these reasons, we have adopted this policy that all employees must repot to work completely free fro the presence of illegal drugs and the effects of alcohol. II. ILLEGAL DRUG USE AND DISTRIBUTION All employees are prohibited from manufacturing, cultivating, distributing, dispensing, possessing or using illegal or other mind-altering or intoxicating substances while on Company premises (including parking areas and other Company grounds), or while otherwise performing duties away, from the Company premises. Employees shall not report to work with illegal substances in their systems. III. ALCOHOL AND USE IMPAIRMENT All employees are prohibited from using alcohol on Company property on while on Company related business, without the prior approval of the CEO. Furthermore, all employees are prohibited fro having alcohol in their systems while at work or on duty. In the selected circumstances when alcohol use has been permitted, alcohol abuse, unruly or un-business like behavior will not be tolerated and may result in discipline, up to and including termination. IV. PRESCRIPTION DRUGS The use of prescription drugs, as part of a prescribed medical treatment by a licensed physician is not prohibited. An employee is required to inform his or her supervisor if the legal use of a prescription drug will in any way affect the ability to safely perform his or her assigned job. It is in the employee’s responsibility to determine whether a prescribed drug may impair job performance. V. DRUG TESTING Employee’s who test positive, admit to drug and alcohol use or distribution, and who are not terminated, will not be returned to work until they have been evaluated by the Company’s coordinating physician (MRO) in conjunction with the management to determine if they can safely return to work. Results and record of drug tests are confidential and handled on a need-to-know basis. Laboratory reports test results shall appear in an employee’s personnel folder in a secured location (envelope). The release of drug test results is strictly forbidden without the specific consent of the applicant or employee authorizing release of his or her information. Prior to administering any drug test, a written release of the results of that test will be obtained from the employee or applicant being testes.

APPLICANTS FOR EMPLOYMENT All applicants will be informed that as a part of an offer of employment, the applicant will be required to undergo a drug test. Applicants who decline to undergo the drug test will not be considered for employment. Applicants who test positive will be reviewed by the Medical Review Officer and depending on that report a decision to hire will be made.

REHABILITATION MONITORING An employee who tests positive in a confirmed drug test, or who has successfully completed a drug or alcohol drug rehabilitation program as a condition of continued employment to sign an agreement which will include periodic random testing for a specific period of time following his or her reentry.

VI. POSITIVE TEST RESULTS Any employee, who tests positive in a confirmed drug test, will be reviewed by the MRO and depending upon that report will be subject to discipline up to and including termination. Employees who are not immediately terminated for testing positive or for some other violation of the policy may at the sole discrete of the Company, be suspended without pay pending a review of an MRO (medical review officer) or other responsible corporate officer.

VII. NOTIFICATION OF IMPAIRMENT It shall be the responsibility of each employee who observe or has knowledge of another employee in a condition which impairs the employee’s ability to perform their job duties, or who presents a hazard to the safety of others, or is otherwise in violation of this policy, to promptly report that fact to their immediate supervisor. VIII. EMPLOYEE ASSISTANCE The Company expects employees who suspect they have an alcohol or drug problem to seek treatment. The Company will help employees who abuse alcohol or drugs by providing a referral to an appropriate professional organization. However, it is the responsibility of the employee to seek and accept assistance before drug and alcohol problems lead to disciplinary action, including termination. Failure to enter, remain or successfully complete a prescribed treatment program may result in termination of employment. Strict confidentiality of records and information will be maintained. Nothing in this section shall be constructed to prohibit the Company from imposing discipline for violations of other work rules or misconduct committed by an employee who voluntarily enters an Employee Assistance Program. IX. SEARCHES, INSPECTIONS AND TESTING Where the Company has reasonable suspicion that an employee has violated the drug and alcohol policy, management retains the right to inspect all personal and company property, which is or may be a part of the policy violation. The right to inspect will include but not limited to vehicles (both personal – while on company property – and company owned), desks, purses and briefcases. Employees will be expected to cooperate in the conduct of such inspections as a condition of continued employment. Where the employee is not present or refuses to remove a personal lock, the Company may do so for him or her and compensate the employee for the lock. Many facilities require a drug screen 30 days prior to starting a travel assignment. Should a facility have reason to believe that a Nurse/Tech has a substance abuse problem, the Nurse/Tech will be asked to take a drug screen. Refusal will result in termination. X. DISCIPLINARY ACTIONS Violations of this policy will result in disciplinary action. Disciplinary action may include suspension and/or immediate termination of employment. Employment may be terminated even for a first time violation. XI. INVOLVEMENT OF LAW ENFORCEMENT AGENCIES The use, sale, purchase, transfer or possession of an illegal drug is usually a violation of law. The Company may refer such illegal drug activities to law enforcement agencies. XII. ACKNOWLEDGEMENT OF UNDERSTANDING I acknowledge receipt of the Company’s Drug and Alcohol Abuse Policy. I understand that it is my responsibility to read and comprehend its on contents and should I have any questions, I will contact my supervisor. Nothing in this policy alters my status as an “at will” employee. I have the right to terminate my employment with or without cause at any time and I understand that the Company has a similar right. __________________________________________________________________ First Name Last Name ___________________________________________________________________ Employee Signature Date This policy should not be considered as a contractual in nature. It represents PROCEL’s current standards for dealing with a serious national problem and is subject to change.

REFERENCE CHECK FORM

APPLICANT INFORMATION

Specialty: Classification:

Name:

Employed:

From:

To:

REFERENCE INFORMATION

Name:

Title:

Phone:

Unit:

Facility:

Address:

City:

State:

Zip:

EVALUATION

Personal Evaluation Excellent Good Fair Poor

Attendance

Punctuality

Quality of Work

Performance

Skill

Attitude

Initiative

Adaptability

Appearance

Co-Operation

Would you rehire this employee? ________ Yes _________ No

Comments:

JCAHO CERTIFIED 2447 Pacific Coast Highway Suite #207 Hermosa Beach, CA 90254

Phone: 310-372-0560 Fax: 310-372-6067 www.procelnurses.com

PROCEL TUBERCULOSIS SCREENING QUESTIONNAIRE

Please answer YES or NO to the following: 1. Have you ever been diagnosed with Tuberculosis (TB)? YES NO 2. Have you ever had a positive or reactive TB test? YES NO 3. Have you had a TB immunization in the past 6 months? YES NO 4. Are you taking corticosteriods or immunosuppressive meds? YES NO 5. Have you ever had a BCG vaccination? (If yes, year: ______) YES NO 6. Have you ever taken any medication for TB? YES NO 7. In the past 12 months, have you had any of the following: YES NO Persistent Cough YES NO Night Sweats YES NO Excessive Fatigue YES NO Persistent skin rashes, sores or abscesses YES NO Diarrhea lasting more than 48 hours with blood/mucous in stool If you have a positive PPD, a baseline chest x-ray is required every 4 years. Date of last chest x-ray: ______________________ Results: _________________________

PPD POSITIVE DATE: ____________________ INDURATION: __________________ I understand that all employees must have an annual Tuberculosis Screening. I hereby give my consent for the appropriate tests to be done as indicated. __________________________________________________________________ First Name Last Name __________________________________________________________________ Employee Signature Date

LATEX ALLERGY QUESTIONNAIRE

I DO have a latex allergy

I DO NOT have a latex allergy

I DO have a SENSITIVITY TO POWDER and require powder free gloves

My signature below indicates that the above information is correct and I give permission for this information to be shared with PROCEL for the purpose of staffing placement with contracting facilities. __________________________________________________ First Name Last Name __________________________________________________ Signature Date

There are two basic sets of Infection Control procedures:* Standard Precautions - which are to be followed with every patient, every time* Isolation Precautions - followed only for patients with certain diseases or organisms. Patients in Isolation have a sign on or near the door telling you what is required before entering the room.

STANDARD PRECAUTIONSStandard precautions are based upon common sense. They apply to the care of all patients, since it's not alwayspossible to tell who is infectious. The very basics of standard precautions include hand hygiene. Hand hygiene isthe use of soap and water or alcohol gel.

* Wash hands before/after patient care to prevent carrying organisms from one patient to another. This means that you hands must be in contact with soap and water for a full 15 seconds. Find a clock with a second hand now and note how long 15 seconds is… its longer than you think! See below.* Use of alcohol gel on non-visibly soiled hands is now recommended as a substitute for hand washing Its effective and good for hands.* Alcohol gel does not kill C difficile spores which cause AB associated diarrhea. Always use gloves when carrying patients with diarrhea & use soap & water (not alcohol rub) after removing gloves.* Artificial Nails are not allowed in ANY Health Care Facility. Any material applied or added to the natural nails to augment or enhance (strenghten and lenghten) the wearer's own fingernails, including wraps, acrylics, extenders, overlays, gels, tips, and any item that is glued or pierced through the nail. (AORN, 2002 Standards, Recommended Practices, and Guidelines).* Natural nails: nails without artificial covering other than fresh nail polish.* Fresh Nail Polish: nail polish that is not obviously chipped or worn for more than four days (AORN, 2002 Standards, Recommended Practices, and Guidelines).

I. HAND HYGIENEIt may seem basic, simple, easy to do; yet inadequate hand hygiene is one of the most common reasons that patients get infections.

CATERGORIESThese recommendations are designed to improve hand-hygiene practices of health care workers and to reducetransmission of pathogenic microorganisms to patients and personnel in health-care settings.

As in previous CDC/HICPAC guidelines, each recommendation is categorized on the basis of exisisting scientificdata, theoretical rationale, applicability, and economic impact. The CDC/HICPAC system for catergorizingrecommendations is as follows: Catergory IA: Strongly recommended for implementation and strongly supported by well-designed

experimental, clinical or epidemiologic studies.Catergory IB: Strongly recommended for implementation and supported by certain experimentalclinical or epidemiologic studies and a strong theoretical rationale.Catergory IC: Required for implementation, as mandated by federal or state regulation or standardCatergory II: Suggested for implementation and supported by suggestive clinical or epidmiologicstudies or a theoretical rationale.No recommendation: Unresolved issue. Practices for which insufficient evidence or no consensusregarding efficacy exsist.

_____________________________________________________________First Name Last Name

_____________________________________________________________Signature Date

Hand Hygiene

Hand Hygiene is the single most important infection control activity in a Hospital.

Hand Hygiene Recommendations from CDC

AUTHORIZATION OF RELEASE OF PERSONNEL AND MEDICAL INFORMATION

I, the undersigned, hereby authorize Procel Temporary Services Inc. to provide my personnel and medical information to Facilities currently Contracted with Procel, for the purpose of verifying that I meet the requirements specified in the Agreement For Temporary Staffing of Nursing Services. The use of the information supplied is to be restricted to the foregoing stated verification. Release or transfer of the specified information to any person or entity not specified herein is prohibited. An additional written consent must be obtained for a proposed new use of the information or for its transfer to another or entity. Unless otherwise stated or mandated by law, this release of information consent form will not expire. ___________________________________________________ First Name Last Name ___________________________________________________ Signature Date

NOTICE TO EMPLOYEE

You have a right to receive a copy of this authorization.

Revised: 6/30/2010

HEPATITIS B VACCINATION DECLINATION I understand that due to my occupational exposure to blood and/or other potentially infectious materials, I may be at risk of acquiring Hepatitis B (HBV) infection. I have been given the opportunity to be vaccinated with the Hepatitis B vaccine. However, I decline the Hepatitis B vaccine at this time. I understand that by declining the vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If, in the future, I continue to have occupational exposure to blood and or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine, I can receive the vaccination series at no charge to me. __________________________________________ Name __________________________________________ Signature Date

INFLUENZA VACCINE DECLINATION

Written declination is required by new California Law (SB 739) beginning 2007. I ACKNOWLEDGE THAT I AM AWARE OF THE FOLLOWING FACTS:

• Influenza is a serious respiratory disease that kills, on average, 36,000 Americans every year.

• Influenza virus may be shed for up to 48 hours before symptoms begin, allowing transmission to others.

• Up to 30% of people with influenza have no symptoms, allowing transmission to others.

• Flu virus changes often, making annual vaccination necessary. Immunity following vaccination is strongest for two (2) to six (6) months. In California, influenza usually arrives around New Year through February or March.

• I understand that flu vaccine cannot transmit influenza. It does not, however, prevent all disease. I have declined to receive the influenza vaccine for the 2008-2009 season. I acknowledge that influenza vaccination is recommended by the CDC for all healthcare workers to prevent infection from and transmission of influenza and its complications, including death, to patients, my coworkers, my family and my community.

Please check one of the boxes below:

□ KNOWING THESE FACTS, I CHOOSE TO DECLINE VACCINATION AT THIS TIME. I may change my mind and accept vaccination later, if vaccine is available. I have read and fully understand the information on this declination form.

□ I HAVE HAD THE VACCINATION. If you have had the vaccination please provide proof of the vaccination. ________________________________________________________________________ First Name Last Name ______________ Signature Date

Revised: 12/07/10

Tdap Declination:

I have read and have had an opportunity to review the latest CDC educational material (Vaccine Information Sheet Tdap) and ask questions regarding: 1) Tetanus, Diphtheria and Pertussis and their risks to healthcare personnel, and 2) the potential risk and benefits of the Tetanus, Diphtheria and Pertussis (Tdap) vaccine. I have elected NOT to receive the Tdap vaccine at this time. I understand that I may elect to receive the Tdap vaccine at a later time. I understand I may be at risk of acquiring Pertussis due to my occupational exposure to aerosol transmissible diseases. I have been given the opportunity to be vaccinated against this disease or pathogen at my OWN expense but, I decline the Tdap vaccination at this time. I understand that by declining the Tdap vaccine, I will continue to be at risk of acquiring a serious disease. If in the future I want to be vaccinated, I can still receive the Tdap vaccination at my OWN expense. _____________________________________________________________________ Name (Please Print) _____________________________________________________________________ Signature Date

porationheslthcsl"8 staffing BElrW:e

Index: Page Numbers:1 Qualifications of Procel Temporary Services, Inc. and Mission Statement …………. 12 Cultural Diversity ……………………………………………………………………23 Continuous Quality Improvement …………..…………………………………………… 34 Patient Safety 2009 ……………………………………………………………………4-55 Joint Commission National Patient Safety Goals ……..……………………………….. 6-86 Patient Rights ……………………………………………………………………9-117 HIPAA Privacy Act and Confidentiality Management ………………………… 12-138 Infection Control: Hand Hygiene and OSHA Regulations ………………………… 14-18

Standard Precautionsa Hand Hygiene (CDC Guildelines)b Exposure to blood productsc OSHA's Exposure Control plans

-Bloodbourne Pathogens -Hepatitis B Virus -Tuberculosis

9 Safety in the Environment of Care ………………………………………………………. 19-35a General Safetyb Fire and Life Safetyc Hospital Emergency Preparednessd Electrical and Medical Equipment Safetye Patient Fall Preventionf Utility System Safetyg Hazardous Materials and Material Safety Data Sheets (MSDS)h Radiation Safetyi Safety and Violence in the Workplacej Medications Safety

10 Body Mechanics ……………………………………………………………………36-3811 Restraints and Seclusion …………………………………………………………………. 39-4212 Age Specific Related Care …………………………………………………………………43-4613 Pain Assessment and Management ………………………………………………….. 47-4814 Advance Directives, Capping and Organ Donation …………………………………… 49-5015 Suspected Abuse ……………………………………………………………………51-56

a Suspected Child Abuse and Neglectb Suspected Abuse of Elders and Dependent Adultsc Domestic Violence

16 Abbreviations: Joint Commission Official "Do Not Use" List ………………………… 57

1 Team Dynamics ……………………………………………………………………582 Corporate Compliance and Reporting to the Joint Commission ………………………. 59-623 Terms of Employment and Job Descriptions ……………………………………… 53

a. Job Description Registered Nurse ……………………………………… 64-65

Orientation and Annual Educational UpdatesRN's, LVN's, RT's, TECH's, Social Workers and CNA's

Employee Handbook

Our orientation manual can be viewed by CD or on our website at www.procelnurses.com. From the website go to Employee Forms and select the Orientation Manual document.

Procel Temporary Services, Inc.

Orientation Index Continued:

b. Job Description Registered Nurse/Operating Room ………………………… 66c. Job Description Licensed Vocational Nurse ……………………………………… 67-68d. Job Description Certified Nursing Assistant ……………………………………… 69e. Job Description Operating Room Technician ……………………………………… 70f. Job Description Instrument Technician ……………………………………… 71g. Job Description Respiratory Therapist ……………………………………… 72-73h. Job Description Case Manager …………………………………………………… 74-75i. Job Description Medical Social Worker ……………………………………… 76

4 Per Diem Policies and Procedures ………..……………………………………………775 Floating Policy ……………………………………………………………………786 Dress Code and Hand Hygiene Policy, etc. ……………………………………… 797 Workers Compensation Benefits ………..……………………………………………808 Harassment Prevention Policy ………..……………………………………………81-839 Personnel Counseling Policy ………..……………………………………………84

10 Community Emergency Prevention ………..……………………………………………85

I have thoroughly and completely read and understand the Orientation and/or Annual Education provided.I have been given the opportunity to seek clarification on any information that I may have had questions.I understand a copy of this acknowledgement will be placed in my file.

__________________________________________________First Name Last Name

__________________________________________________ __________________Employee Signature Date

Procel Temporary Services, Inc.

CODE OF BUSINESS ETHICS

PROCEL Daily Mission: Is to earn our customers business for life by exceeding their expectations and delighting them with our service. •PROCEL believes in providing prompt and courteous service to all Nurses, Technicians and Client Facilities. •PROCEL supports and encourages partnerships with Client Facilities and Nurses through teamwork and collaboration. •PROCEL values honesty, confidentiality and mutual respect. •PROCEL facilitates clear and continuous communication with Staff Nurses, Technicians and Facility Staff. •PROCEL participates in comprehensive Quality Improvement Program that addresses Operations, Practice, and Safe Patient Care. •PROCEL recognizes and supports the Patient Bill of Rights. •PROCEL believes in an environment that promotes practice and productivity, encourages excellence and provides for growth. •PROCEL contributes to the success of our Clients and Nurses through active Partnership and through commitment to the success of our Organization. •PROCEL is dedicated to providing Facilities with Nurses and Technicians who demonstrate compassionate and safe patient centered care. •PROCEL believes patients are individuals who have needs arising from conditions, feels and situations, which they are currently unable to deal with independently. •PROCEL provides PROfessionals who exCEL in their clinical practice and who make a difference in how care is delivered to patients in all Clinical settings. •PROCEL Corporal Employees have the responsibilities to insure through a clinical screening process, that all Nurses and Technicians have met Procel’s hiring standards. •PROCEL strives to achieve the highest standard of clinical practice and an excellent reputation amongst Healthcare Facilities. •PROCEL is dedicated to full compliance with Regulations Agencies; JCAHO, EEOC, OSHA, State and Federal. Joint Commission standards relate to quality and safety of care issues. Anyone believing that he or she has pertinent and valid information about such matters related to patient quality and patient safety issues may provide input to the Joint Commission by submitting a complaint to the Office of Quality Monitoring at:

Division of Accreditation Operations Office of Quality Monitoring Joint Commission on Accreditation of Healthcare Organizations One Renaissance Boulevard Oakbrook Terrace, IL 60181

Faxed to (630) 792-5636 or E-mailed to [email protected] I have reviewed the PROCEL Code of Ethics and I know how to contact Joint Commission. _____________________________________________________________ First Name Last Name ______________________________________________________________ Employee Signature Date

PROCEDURE:

Date:

Approved by:

NEEDS OF DYING PATIENTS AND End of Life Care

111912009 Supersede: 101112009

~~iiJ Date:~

Needs of Dying Patients and End of Life Care

Learning Objectives:

After reading this section on Needs of Dying Patients and End of Life Care,the learner will be able to:

1. Discuss the need to meet physical, spiritual and emotionalneeds of the dying patient.

2. State resources available to help meet the needs of the dyingpatient.

PROCEL Nurses is committed to caring for patients all the days of theirlives. Part of the care includes end of life care.

We believe:1.

2.

3.

4.

That it is our responsibility to meet the needs of the dyingpatient, physically, spiritually and emotionally.That excellent culturally competent end of life care is thephysical, emotional and spiritual care we provide to ourpatients in the last year of their lives, not the last days.That pain and symptom management is every patient'sright along with education about their disease process.That patients often require additional support in the lastyears and months of life and to meet this need, our nursesmay participate in Palliative Care and Hospice.

PROCEDUR:

Date:

Approved by:

NEEDS OF DYING PATIENTS AND End of Life Care

11/9/2009 Supersede: 10/1/2009

~~¿i Date:~Needs of Dying Patients and End of Life Care

Learning Objectives:

After reading this section on Needs of Dying Patients and End of Life Care,the learner wil be able to:

1. Discuss the need to meet physical, spiritual and emotionalneeds of the dying patient.

2. State resources available to help meet the needs of the dying

patient.

PROCEL Nurses is committed to caring for patients all the days of theirlives. Part of the care includes end of life care.

We believe:1.

2.

3.

4.

That it is our responsibility to meet the needs of the dyingpatient, physically, spiritually and emotionally.That excellent culturally competent end of life care is thephysical, emotional and spiritual care we provide to ourpatients in the last year of their lives, not the last days.That pain and symptom management is every patient'sright along with education about their disease process.That patients often require additional support in the lastyears and months of life and to meet this need, our nursesmay participate in Palliative Care and Hospice.

Our Nurses are encouraged to read Kubler-Ross E. On death and dying:What the dying have to teach doctors, nurses, clergy and their families: 1st

ed. New York: Simon and Schuster, 1997

The Needs of the Dying

1. The need to be treated as a living human being.2. The need to maintain a sense of hopefulness, however changing

its focus may be.3. The need to be cared for by those who can maintain a sense of

hopefulness, however changing this may be.4. The need to express feelings and emotions about death in one's

own way.5. The need to participate in decisions concerning one's care.6. the need to be cared for by compassionate, sensitive,

knowledgeable people.7. the need for continuing medical care, even though the goals

may change from "cure" to "comfort" goals.8. The need to have all questions answered honestly and fully.9. The need to seek spirituality.10. The need to be free of physical pain.11. The need to express feelings and emotions about pain in one's

own way.12. The need of children to participate in death.13. The need to understand the process of death.14. The need to die in peace and dignity.15. The need not to die alone.16. The need to know that the sanctity of the body will be respected

after death.

Our Nurses are encouraged to read Kubler-Ross E. On death and dying:What the dying have to teach doctors, nurses, clergy and their families: 1 sted. New York: Simon and Schuster, 1997

The Needs of the Dying

1. The need to be treated as a living human being.

2. The need to maintain a sense of hopefulness, however changing

its focus may be.3. The need to be cared for by those who can maintain a sense of

hopefulness, however changing this may be.4. The need to express feelings and emotions about death in one's

own way.5. The need to participate in decisions concerning one's care.6. the need to be cared for by compassionate, sensitive,

knowledgeable people.7. the need for continuing medical care, even though the goals

may change from "cure" to "comfort" goals.8. The need to have all questions answered honestly and fully.

9. The need to seek spirituality.

10. The need to be free of physical pain.11. The need to express feelings and emotions about pain in one's

own way.12. The need of children to participate in death.13. The need to understand the process of death.14. The need to die in peace and dignity.15. The need not to die alone.16. The need to know that the sanctity of the body wil be respected

after death.

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JCAHO CERTIFIED 2447 Pacific Coast Highway, Suite #207 Hermosa Beach, California 90254 P: 310-372-0560 F: 877-707-5576

www.procelnurses.com

HIPAA Awareness Training

I certify that I have received HIPAA Awareness Training. I understand it represents mandatory policies of the organization and agree to abide by it.

____________________________________________________ First Name Last Name ____________________________________________________ Signature Date Procel Temporary Services, Inc.

www.procelnurses.com

p

Nationally Validated Content - Copyright © 2010 Clearview Staffing Software Inc. Page 1 of 6

Score: Test Name: Comprehensive Core Competency - Nursing

1. The cycles of domestic violence includes incident, tension building, making-up, and calm.

A. True B. False

2. Seniors who are abusive to their caregivers can increase the caregiver's stress levels and has been known to contribute to abuse andneglect.

A. True B. False

3. Some other names for Advance Directives are: Out of Hospital DNR, Medical Power of Attorney, Living Will.

A. True B. False

4. It is a federal law that adults over 18 years of age have the right to make their own healthcare decisions, including the right to decidewhat medical care or treatment to accept, reject or discontinue.

A. True B. False

5. When explaining a procedure to a preschooler it is okay to use technical medical terms.

A. True B. False

6. For adults you should encourage as much self care as possible.

A. True B. False

7. The following are guidelines for transferring patients from a dialysis chair to a wheelchair, EXCEPT:

A. Lock the wheels B. The patient should hold your waist C. Face the patient and spread your legs to increase support base D. Lower the patient into the wheelchair by slowly flexing your knees

8. All of the following natural curves are present in a normal spine, EXCEPT:

A. Cervical B. Lumbar C. Thoracic D. Abdominal

9. A care plan should include discharge planning instructions.

A. True B. False

10. Completing a comprehensive assessment is the first step in the care planning process.

A. True B. False

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11. Even if you are able to resolve a complaint, the supervisor should be notified of the issues.

A. True B. False

12. Verbal or written complaints concerning abuse or neglect are considered a grievance.

A. True B. False

13. It is okay for companies to give the hospital free products that the hospital charges the patients for.

A. True B. False

14. You should always consider your patient's and their family's beliefs when giving your patient a bed bath.

A. True B. False

15. It is important to understand how a patient interacts with their family when taking care of them.

A. True B. False

16. Medical Equipment must be inspected every five years.

A. True B. False

17. All healthcare facilities use the same name for emergency and disaster codes.

A. True B. False

18. You can find information on proper chemical storage in the Material Safety Data Sheets (MSDS).

A. True B. False

19. The practicing of Autonomy is difficult for us when our patients choose alternatives that are in conflict with our own value system.

A. True B. False

20. The underlying core value of the Americans with Disabilities Act is based on the principle of:

A. Veracity B. Justice C. Respect for others D. Autonomy


21. Which of the following is a contributing factor to a fall?

A. Bed Rails B. Restraints C. Brakes D. All of the above

22. Side effects of some medications can increase a patient's risk for a fall.

A. True B. False

23. Accessible Protected Health Information (PHI) is limited to only information needed for performance of services.

A. True B. False

24. It is acceptable to disclose to any third party, the identity of any physicians that have treated or are treating a patient.

A. True B. False

25. If a patient has C. Diff, the best source to wash your hands with is:

A. Alcohol based soap B. Soap and warm water

26. A patient is admitted with a positive stool culture for Salmonella. Which of the following types of transmission based precautions mustbe followed?

A. Contact precautions B. Airborne precautions C. Droplet precautions D. None of the above

27. Why are healthcare workers at higher risk for developing latex allergy?

A. Higher exposure to latex due to glove usage B. Women are more prone to develop latex allergy and mostly women work in healthcare C. They use more soap than others because of frequent hand washing

28. If a patient tells you they have a latex allergy, you should:

A. Call the doctor to discharge them immediately B. Not wear gloves when caring for them C. Put them on latex precautions

29. Standards of Care are established by:

A. State Boards of Clinical Disciplines B. Professional Organizations C. Policies and Procedures D. All of the Above


30. Your best defense in any legal issue is:

A. Strong documentation B. A good memory C. Being certified in your field

31. Your facility's Exposure Control Plan is designed to protect all employees.

A. True B. False

32. Moderate pain corresponds to which number on the numerical pain scale?

A. 10 B. 5 C. 8 D. 2

33. The assessment of pain is an interdisciplinary process including physicians, nurses, physical therapists, and other clinical disciplinesinvolved with the patient's care.

A. True B. False

34. Respect for the patient's psychological, spiritual, and cultural values in the healthcare setting is important since it affects how the patientwill respond to their care.

A. True B. False

35. Patients have the right and responsibility to report perceived risk of their care and/or safety issues or concerns they, as patients, mayhave.

A. True B. False

36. Accredited institutions are required to conduct a patient safety survey of the staff annually.

A. True B. False

37. Medication errors and adverse drug reactions are included in the scope of the patient safety plan.

A. True B. False

38. Hospitals are required to perform how many FMEA(s) a year?

A. One B. Two C. Five D. Ten

39. Quality Improvement focuses on collecting data.

A. True B. False


40. Restraints can cause the patient's level of anxiety and confusion to increase.

A. True B. False

41. Monitoring of restrained patients consists of documenting behavior, addressing basic needs, and attempting or addressing alternatives.How often is this required?

A. Every hour B. Every 2 hours C. Every 4 hours D. Once a shift

42. Risk Management is important to healthcare facilities in order to:

A. Reduce costs B. Improve care C. Protect employees D. All of the above

43. Incident reports should NOT be placed in the patient's medical record.

A. True B. False

44. Aggressive behavior may occur between:

A. Families and staff B. Patients and families C. Staff and patients D. All of the above

45. Zero tolerance is a policy outlining what is and is not acceptable behavior in the workplace.

A. True B. False

46. One sign that a nurse may be impaired is when patients complain that pain medication is not effective or deny receiving medicationduring that nurse's shift.

A. True B. False

47. There are three major categories of impairment - alcoholism, drug addiction, and mental health disorders.

A. True B. False

48. You do not have to be the one being harassed to be a victim of sexual harassment.

A. True B. False


49. If you feel you are being sexually harassed, you should first:

A. Tell the harasser that their conduct is unwelcomed B. Tell your supervisor C. Just quit and find another job

50. Medicare/Medicaid providers are required to conduct employee training on Compliance.

A. True B. False

Date: _


Score: Test Name: Moderate Sedation

1. The primary goal of moderate sedation is to eliminate patient pain/discomfort during planned procedures.

A. True B. False

2. When managing a patient receiving moderate sedation, the nurse should monitor all of the following EXCEPT:

A. Vital signs B. Blood gases C. Level of consciousness D. Skin condition

3. Which of the following statements about midazolam (Versed) is true?

A. Is a potent respiratory depressant B. Excessive doses may lead to agitation and involuntary movement C. May be reversed with flumazenil (Romazicon) D. All the above are true

4. Vital Signs during a procedure should be recorded, how often?

A. every 5 minutes B. every 10 minutes C. every 15 minutes D. None of the above

5. Moderate sedation/analgesia is a drug-induced depression of consciousness during which patients respond purposefully to verbalcommands.

A. True B. False

6. Patients receiving moderate sedation do not need vascular access during the procedure.

A. True B. False

7. The nurse monitoring a patient should be able to demonstrate acquired knowledge of:

A. Pharmacology of drugs used for moderate sedation/analgesia B. Cardiac arrhythmia interpretation C. Principles of oxygen delivery D. All of the above

8. Patients may be discharged by the post-procedural caregiver when:

A. Respirations are greater than 12 B. All discharge criteria are met C. Thirty minutes have elapsed post-procedure D. The patient is pain free

9. An informed consent must be signed prior to the administration of sedation.

A. True B. False

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Score:Moderate Sedation


10. In the post-procedure phase, the patient will have q 15 minute vital signs until an Aldrete score of at least 9 and/or a pre-sedation levelof consciousness/activity has been achieved.

A. True B. False

11. Patients may not be discharged for a minimum of 1 hour following the procedure unless specifically ordered by the physician.

A. True B. False

12. Intravenous drugs should be given in small, incremental doses that are titrated to the desired end points.

A. True B. False

13. For patients receiving IV push sedation, a physician does not need to be present during the administration of the medication.

A. True B. False

14. The response of patients to commands during procedures performed with moderate sedation serves as a guide to their level ofconsciousness.

A. True B. False

Date:

No electronic signature on record. Page 1 of 2

Score: Test Name: EMTALA

1. What do the letters EMTALA stand for?

A. Emergency Medical Treatment And Labor (meaning pregnant women who are in labor) Act B. Emergency Medical Transitional Labor (meaning pregnant women who are in labor) Act

2. The goal of the EMTALA law is to:

A. Protect the financial health of the hospital B. Protect the public from fraud C. Prevent discrimination in health care D. Ensure free health care for all

3. With regards to the EMTALA law and your work, which of the following statements reflects the law’s impact on your?

A. I may be in a position to deal with patients who come to the hospital for urgent care and I want to make sure that everything I say to the patient is compliant with EMTALA rules. B. I want to provide safe and compassionate care to all who come to the hospital regardless of their ability to pay. C. If I break EMTALA rules, even without the intention to break the rules, the hospital might suffer grave consequences. D. All of the above.

4. There are many different types of patients who may be covered by the EMTALA rules. Which of the following are appropriate?

A. Anyone who presents to the ED with a complaint. B. Anyone who brings up an urgent condition even if that person is not present in the ED but in another area of the hospital and/or visiting a friend/family. C. Anyone in active labor. D. All of the above.

5. EMTALA laws mandate what we must provide for patients who are covered by EMTALA rules. Select the answer that does NOT apply.

A. Health insurance at no cost to the patient B. A free transfer to another facility C. A medical screening exam by a qualified medical provider D. Any treatment required to stabilize the patient

6. When is it safe to ask about insurance for any patient who comes to the ED?

A. Never. B. When the patient first comes to admissions, so we can be sure to follow all the rules. C. After the medical screening exam has been completed. D. Only if the patient is admitted as an inpatient at the hospital.

7. Can we transfer a patient covered by EMTALA rules?

A. Yes, if we have permission from the receiving hospital and the qualified medical provider at the hospital provides a written certification that the benefits of transfer outweigh the risks of staying at the hospital. B. Yes, especially if the patient has Medi-Cal insurance since the hospital is not a Medi-Cal provider. C. No, we can never transfer a patient who is covered by EMTALA rules.

8. What happens if we do not abide by the EMTALA rules?

A. Nothing B. Not much C. Fines, loss of the ability to care for Medicare patients.

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Test Name: EMTALA

Date: _

No electronic signature on record. Page 2 of 2

9. Emergency Department Scenario A young couple arrives to the ED carrying a newborn infant, handing the RN a form from a neighboringclinic directing them to another neighboring hospital for sick infant with 103 fever. Family is directed into Triage, baby is examined and vitalsigns taken. Temperature 103, baby lethargic, parents upset. The father asks if the hospital they are now in is the neighboring hospital. Inthe above scenario the most appropriate response by the nurse is:

A. No, it isn’t. B. This is ABC Hospital and a Physician will see your baby shortly. C. No, it isn’t and we do not admit children. D. This is ABC Hospital and we do not admit children.

10. In the above scenario, the physician sees baby, medication given and hydration given with improvement. When the baby is ready fordischarge the family was referred back to the clinic they came from for follow up. The nurse tells the family, “Bring your baby back to thenearest Emergency Room if symptoms reoccur”. Did the nurses stay within limits of EMTALA rules and regulations?

A. Yes B. No

11. Emergency Department Scenario A 23 year old women presents to the Emergency Department at 0500 asking, “Is this XYZ Hospital?Do you have rape kits?” The triage RN states, “No. This is ABC Hospital and we do not have rape kits here. However our physician willgive you a medical screening exam and transfer you to XYZ Hospital.” Patient replies, “I would rather drive my own car over to XYZHospital rather than wait here and get transferred.” Nurse documents this on her triage note. Have we violated EMTALA rules? In theabove scenario, were the EMTALA rules violated?

A. Yes. The initial information provided to the patient was not focused on the necessary initial medical screening (MSE) but on the “We don’t provide that level of care and you will just be sent elsewhere anyway”. The information provided gave the patient the “I don’t want to wait and/or I shouldn’t wait option”, thus violating the EMTALA law. B. No. The patient was provided factual answers to her questions and offered a medical screening exam and was informed regarding her eventual transfer. She decided to leave before the MSE.

Date: _


Score: Test Name: Emergency Room

1. An elderly patient is brought to the Emergency Room after falling at home. The patient complains of severe pain in the hip and an inabilityto walk. To assess for a hip fracture, the nurse would:

A. Observe for bruising over the affected hip B. Observe for shortening of the affected leg C. Move the affected leg to see whether it causes pain D. Move the affected leg to feel and hear crepitus

2. A patient is admitted to the Emergency Room with multiple injuries including a crushed chest, abdominal trauma, probable head injury,and multiple fractures. In order of priority, the initial emergency care interventions for this patient are to:

A. Conduct a thorough physical assessment, assess vital signs, and cover open wounds B. Assess vital signs, control accessible bleeding, and determine the presence of critical injuries C. Start an IV, get blood for typing and cross matching, and obtain a history D. Assess vital signs, obtain a history, and arrange for emergency x-ray films

3. After an accident in which there is a question of back injury, the individual involved:

A. Can be transported in sitting position B. May be transported best when placed in a side-lying position C. Should be protected from flexion and hyperextension of the spine D. May be transported in any position because position in not important

4. A child who was found face down in a water ditch is brought to the Emergency Room. The child, who has a pulse of 50 beats per minutebut no spontaneous respirations, is intubated and bagged with 100% oxygen. The most important nursing measure at this time is to:

A. Start an IV to provide fluid and electrolytes B. Assist the physician in delivering intracardiac medications C. Suction the endotracheal tube, mouth, and nasal passages D. Call the pediatric ICU to inform them of the child’s admission

5. A patient is admitted to the Emergency Room with head and chest injuries received in an automobile accident. When evaluating thepatient’s response to the Emergency Room treatments, which assessments indicate that the patient can safely be transferred to a criticalcare unit?

A. Alert but restless, stable vital signs, and cyanosis B. Stable vital signs, apprehension, and complaints of pain C. Drowsy but easily aroused, improving tissue perfusion, and fluctuating vital signs D. Elevated temperature, slowing pulse and respirations, and pain in the injured extremity

6. During the initial assessment of a 70-year-old male who is being re-admitted with hematemesis and bright-red rectal bleeding, the nurseshould be particularly alert for:

A. Facial flushing B. Petechiae C. Pruritus D. Hypertension

7. The nurse knows that a patient on long term anticoagulant therapy must be carefully monitored for potential hemorrhage complicationsthat most commonly affect the:

A. GI Tract B. Genitourinary tract C. Respiratory tract D. Capillary vasculature

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Test Name:

Date: _

Score:Emergency Room Competency Exam


8. Which sign is typically the first indication of increased ICP?

A. Elevated systolic blood pressure B. Elevated body temperature C. Altered respiratory pattern D. Altered level of consciousness

9. Which condition commonly mimics the signs and symptoms of alcohol intoxication?

A. Diabetic reactions B. Head injury C. Drug overdose D. All of the above

10. Which symptom of cocaine abuse would the nurse expect to detect during a patient assessment?

A. Lethargy and obtundation B. Constricted pupils C. Hypothermia and tiredness D. Euphoria and restlessness

11. The major objective during the emergent phase of a burn is to:

A. Relieve pain B. Prevent infection C. Replace blood loss D. Restore fluid volume

12. Which treatment would the nurse expect a physician to order for a suspected cocaine overdose patient?

A. Oxygen B. Naloxone C. Physostigmine D. Activated charcoal

13. The goals of triage include all of the following EXCEPT:

A. Control of patient flow through the emergency department. B. Assignment of patients to appropriate care areas within the emergency department C. Performing and documenting secondary survey on all patients who come to triage D. Determination of the urgency of the patient's condition.

14. A patient is receiving intravenous potassium chloride for the treatment of hypokalemia. Which of these rhythm strip changes should thenurse expect to observe if the patient develops hyperkalemia?

A. Shortened PR interval B. Peaked T waves C. Prominent U wave D. Elevated ST segment

15. A clinical sign that would indicate a child is suffering severe dehydration is:

A. The presence of excessive drooling B. The absence of tears C. A slightly increased respiratory rate D. A slowed heart rate

Name: ------------------------------------Test Name:

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16. A patient complains of a sudden headache one minute after a drug is administered. Which of the following drugs would MOST LIKELYcause this symptom?

A. Lidocaine B. Quinidine C. Nitrates D. Digoxin

17. Which of the following assessment parameters may be used by the emergency department nurse to evaluate the toxicity of anacetaminophen poisoning?

A. Liver Function Test B. Serial arterial blood gases C. Coagulation studies D. Electrolytes

18. Methods that the emergency room nurse may use to reinforce discharge instructions include:

A. Give only oral instructions when discharging a patient from the ER B. Tell the patient to call their physician or nurse practitioner if there is anything they do not understand about their care in the emergency room C. Involve the patient's family or significant others (with patient consent) with the discharge instructions that are being given to the patient D. If the patient does not speak English, encourage him/her to contact a translator when he/she returns home to explain the instructions to him

19. When establishing and maintaining adequate airway, breathing, and circulation for trauma victims, the emergency nurse should giveequal priority to:

A. Assessing the patient's neurological status B. Identifying all injuries C. Maintaining cervical spine precautions D. Assessing vital signs

20. Your patient is on a ventilator. The low volume alarm sounds. This may be due to:

A. Pulmonary edema B. Decreased secretions C. A disconnected tube D. Biting the tube

21. Which of these medications in a patient's history would be associated with hematemesis?

A. Hydromorphone hydrochloride (Dilaudid) B. Acetaminophen (Tylenol) C. Meperidine hydrochloride (Demerol) D. Ketorolac tromethamine (Toradol)

22. A 15-year-old boy who was stacking wood 2 days ago presents to the emergency department complaining of a painful ulceration on thedorsal surface of the second digit of his right hand. He has no other complaints. Based on this history, the most likely thing that may havebitten him is:

A. Back widow spider B. Blue scorpion C. Brown recluse spider D. Wolf spider

Name: _Test Name:

Oate: _Score:

Emergency Room Competency Exam


23. A late sign or symptom of hyponatremia is:

A. Hypertension B. Hyperactivity C. Seizure activity D. Neck vein distention

24. One of the best ways to prevent misinterpretation of patient care situations is to:

A. Clearly and concisely document what happened B. Call the supervisor to witness any unusual events C. Ask the physician to add information to their dictation D. Complete an exception report as a routine part of the chart

25. An injury where skin is peeled away from an extremity is:

A. Contusion B. Laceration C. Abscess D. Avulsion

26. When using active external re-warming devices, caution must be exercised to prevent:

A. Additional vasoconstriction in the affected extremities from the application of heat B. Decrease in patient's core body temperature from the application of heat C. Injury to the patient's skin from heat application because of the initial peripheral vasoconstriction D. The development of hypertension from heat application

27. When a child presents to the ER and abuse or neglect is suspected, the emergency nurse must:

A. Notify the parents about her concern B. Report to the appropriate authorities C. Obtain the appropriate consent for further treatment D. Consult with an attorney to protect herself from a lawsuit

28. The nurse's most immediate concern for a patient sustaining a LeFort fracture should be:

A. Tooth loss B. Airway management C. Tooth malocclusion D. Uncontrolled epistaxis and resultant hypovolemia

29. The purpose of charcoal in the care of the poisoned patient is to:

A. Absorb toxins from the gastrointestinal tract B. Induce vomiting and remove all the remaining toxins C. Prevent cardiac dysrhythmia that may result from absorbed toxins D. Decrease the possibility of bleeding from the absorbed toxins

30. What specific physical signs may indicate respiratory distress in the adult asthmatic patient?

A. Paroxysmal coughing B. Sternocleidomastoid retractions C. Audible wheezing D. Nausea and vomiting

Name: -------------------------------Test Name:

Date: _



31. Name this rhythm:

A. 1st degree heart block B. Normal sinus rhythm C. 3rd degree heart block D. Bradycardia

32. A 24-year-old woman complains of crampy pain in the right lower quadrant for the past several hours. She denies nausea, vomiting, ordiarrhea but reports moderate spotting over the past 24 hours. Her last menstrual period was 2 months before the onset of symptoms. Hervital signs include blood pressure of 124/84, P 90, and temperature 98.8 degrees. Based on these assessment findings, the emergencynurse should suspect:

A. Dysmenorrhea B. Endometriosis C. Ectopic pregnancy D. Ruptured ovarian cyst

33. What is the principal cause of a radial head dislocation in children?

A. A pull on a pronated forearm B. A fall onto an outstretched forearm C. A blow to pronated forearm D. A crush injury to a supinated forearm

34. Respiratory syncytial virus (RSV) is NOT transmitted by:

A. Large droplet aerosols B. Sneezing C. Visitors D. Hand washing

Date: _


Score: Test Name: Emergency Room Medication

1. The nurse knows that a patient on long term anticoagulant therapy must be carefully monitored for potential hemorrhagecomplications that most commonly affect the:

A. GI Tract B. Genitourinary tract C. Respiratory tract D. Capillary vasculature

2. A patient complains of a sudden headache one minute after a drug is administered. Which of the following drugs wouldMOST LIKELY cause this symptom?

A. Lidocaine B. Quinidine C. Nitrates D. Digoxin

3. Which of the following assessment parameters may be used by the emergency department nurse to evaluate the toxicity ofan acetaminophen poisoning?

A. Liver Function Test B. Serial arterial blood gases C. Coagulation studies D. Electrolytes

4. Which of these medications in a patient's history would be associated with hematemesis?

A. Hydromorphone hydrochloride (Dilaudid) B. Acetaminophen (Tylenol) C. Meperidine hydrochloride (Demerol) D. Ketorolac tromethamine (Toradol)

5. A patient is receiving intravenous potassium chloride for the treatment of hypokalemia. Which of these rhythm stripchanges should the nurse expect to observe if the patient develops hyperkalemia?

A. Shortened PR interval B. Peaked T waves C. Prominent U wave D. Elevated ST segment

6. A patient with a history of hypertension comes to the Emergency Room with double vision and a blood pressure of 260/120mm Hg. In addition to other drugs, the physician orders a Sodium Nitroprusside infusion. The nurse recognized thatthis drug decreases blood pressure by:

A. Increasing cardiac output B. Decreasing the heart rate C. Increasing peripheral resistance D. Relaxing venous and arterial muscles

7. A patient brought to the Emergency Room develops premature ventricular Beats (PVBs) after arrival. The nurse shouldanticipate that the patient would receive:

A. Epinephrine B. Atropine Sulfate C. Sodium Bicarbonate D. Lidocaine Hydrochloride

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Score:Emergency Room Medication


8. The physician orders a heparin infusion. He orders 25,000 units of heparin in 500 ml of dextrose 5% in water (D5W) toinfuse at the rate of 1,000 units/hr. The flow rate in milliliters per hours is:

A. 12 mls per hour B. 24 mls per hour C. 20 mls per hour D. 6 mls per hour

9. The order reads: Bumex 5 mg IV. Bumex is available in 0.25 mg/ml vials. How many ml's would you give?

A. 12.5 mls B. 2 mls C. 125 mls D. 20 mls

10. The order reads: Haldol 1 mg IV. Haldol is available in a 5mg/ml ampule. How many ml's would you give?

A. 0.1 ml B. 0.2 ml C. 1 ml D. 2 ml

11. The order reads: Tylenol elixir 350 mg via NGT. Tylenol elixir is available in 80 mg/5ml bottles. How many ml's wouldyou give?

A. 2.18 mls B. 21 mls C. 218 mls D. 21.8 mls

12. The drug of choice for a pregnant patient who has seizures associated with pregnancy-induced hypertension is:

A. Phenytoin sodium (Dilantin) B. Magnesium sulfate C. Diazepam (Valium) D. Valproic acid (Depakene)

13. The order reads: Synthroid 0.75mgIV. Synthroid is available in 500mcg/ml vial. How many ml's would you give for thisdose?

A. 15ml B. 1.5 ml C. 0.15ml D. 150 ml

14. A 154lb patient has been sedated and is now being paralyzed with vecuronium bromide (Norcuron). The recommended initialdose is 0.1 mg/kg. The available 10 ml vial of Norcuron containes 1 mg/ml. How many milliliters shoud the patientreceive?

A. 0.07 ml B. 7 mg C. 0.7 ml D. 15.4 ml

Name: -------------------------------Test Name:

Date: _



15. An infusion of phenytoin (Dilantin) at a rate greater than 50 mg/min for an adult may result in which of these sideeffects?

A. Tachypnea B. Bradycardia C. Hypertension D. Tachycardia

16. The order reads: Vancomycin 15 mg/kg over 1 hour x1. The patient weighs 60 kg. How many mg will be given?

A. 1000 mg B. 90 mg C. 900 mg D. 600 mg

17. A female patient diagnosed with a urinary tract infection (UTI) is being discharged from the emergency department andwill be treated with ampicillin and phenazopyridine. The emergency nurse should instruct the patient that phenazopyridinewould:

A. Decrease her needs for drinking additional fluids B. Turns her urine orange C. Treat her fever and chills D. Take several days to be effective

18. One indicator of myocardial reperfusion during thrombolytic therapy is:

A. Relief of chest pain B. Q waves less than 0.04 seconds in width C. Prothrombin time greater than 25 seconds D. Absence of ventricular dysrhythmias

19. The order reads: Digoxin 0.25 mg IV Digoxin is available in a 0.5mg/2ml ampoule. How many ml's would you give for thisdose?

A. 1ml B. 0.5 ml C. 2 ml D. 1 mg

20. Which drug is the treatment of choice to prevent seizure from traumatic head injury?

A. Diazepam B. Dexamethasone (Decadron) C. Phenytoin D. Phenobarbital

21. A child is admitted to the emergency room following ingestion of a bottle of Children's Tylenol. The nurse is awarethat Tylenol poisoning is treated first with:

A. Acetylcysteine B. Deferoximine C. Edetate calcium disodium D. Activated charcoal

Name: -------------------------------Test Name:

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22. The patient is admitted to the emergency room with shortness of breath, anxiety, and tachycardia. His ECG reveals atrialfibrillation with a ventricular response rate of 130 beats per minute. The physician orders quinidine sulfate. Whilehe is receiving quinidine, the nurse should monitor his ECG for:

A. Peaked P wave B. Elevated ST segment C. Inverted T wave D. Prolonged QT interval

23. The patient is admitted from the emergency room with multiple injuries sustained from an auto accident. His physicianprescribes a histamine blocker. The nurse is aware that the reason for this order is:

A. To treat general discomfort B. To correct electrolyte imbalances C. To prevent stress ulcers D. To treat nausea

24. After the administration of epinephrine to a child with asthma, the nurse would carefully monitor for the common sideeffect of:

A. Flushing B. Dyspnea C. Tachycardia D. Hypotension

25. When administering an intravenous titrated drip of Lidocaine HCL to a patient, an adverse effect to immediately watchfor is:

A. Tremors B. Anorexia C. Tachycardia D. Hypertension

26. Which of the following is appropriate for acute M.I. treatment?

A. Morphine B. Oxygen C. Nitroglycerin D. All of the above

27. For a patient in P.E.A. (Pulseless electrical activity), which medication would be given first?

A. Dopamine B. Lidocaine C. Amiodarone D. Epinephrine

28. What is the MOST important nursing goal for a patient in septic shock?

A. To promote adequate tissue perfusion and support oxygenation, ventilation, and hemodynamic stability B. To maintain accurate intake and output records and to optimize support C. To prevent skin and soft tissue breakdown D. To promote comfort and provide psychosocial support to the patient and family

Name: _

Test Name:

Date: _



29. When administering medications via the endotracheal tube, the dose should be increased at:

A. 1 to 1.5 times the normal dose B. 2 to 2.5 times the normal dose C. 3 to 3.5 times the normal dose D. 4 to 4.5 times the normal dose

30. All of the following medications may be helpful in the treatment of acute pulmonary edema EXCEPT:

A. Morphine B. Nitroglycerin C. Furosemide D. Epinephrine

31. The physician has ordered an infusion of Osmitrol (mannitol) for a patient with increased intracranial pressure. Whichfinding indicates the direct effectiveness of the drug?

A. Increased pulse rate B. Increased urinary output C. Decreased diastolic blood pressure D. Increased pupil size

32. The physician has ordered Activase (alteplase) for a patient admitted with a myocardial infarction. The desired effectof Activase is:

A. Prevention of congestive heart failure B. Stabilization of the clot C. Stabilization of the Vessel Tunica Intima D. Lysis of the clot

33. Which of the following is a true statement in relation to the positive effects of Morphine Sulfate in a patient whohas experienced a myocardial infarction?

A. Morphine relieves the anxiety a patient feels secondary to a catecholamine release, decreases myocardial workload by increasing venous capacitance and reducing systemic vascular resistance B. Morphine relieves anxiety and decreases workload of the heart through a diuretic effect C. Morphine relieves anxiety and decreases myocardial workload by vasodilating the pulmonary arterial tree D. Morphine relieves the anxiety a patient feels secondary to a decrease in catecholamine release, decreases myocardial workload by decreasing venous capacitance and increasing systemic vascular resistance

34. Which of the following drugs is now considered the standard therapy for unstable angina and after treatment of a MI?

A. Ticlopidine (Ticlid) B. Abciximab (ReoPro) C. Eptifibatide (Integrilin) D. Aspirin

35. A patient weighing 40 kilograms is to receive Dopamine at 7 micrograms/kg/min. The dosage available is Dopamine 800mg to be mixed in 250 ml of Normal Saline. What is the infusion rate?

A. 5.25 ml/hr B. 10 ml/hr C. 5 ml/hr D. 10.5 ml/hr

Name: -------------------------------Test Name:

Date: _



36. A patient is admitted to the hospital with pneumonia and congestive heart failure and requires mechanical ventilation.Which of the following medications would you anticipate the patient receiving?

A. Tetracycline B. Sodium Bicarbonate C. Pepcid D. Mannitol

37. A patient is receiving tenecteplase (TNKase) 3 hours after an acute MI. Which of the following should you immediatelyreport to the physician?

A. PVC’s B. Bleeding gums C. Oozing at the insertion site D. Change in mental status

38. Your patient is on a Dopamine drip for hypotension. However, the more you increase the Dopamine, the lower the BP drops.You should consider:

A. Continuing to increase the drip because the patient may need more alpha effect B. Doing nothing and see if the patient stabilizes C. Administering additional fluids D. Giving another more potent drug such as Neosynephrine

39. A child has been diagnosed as having acute acetaminophen (Tylenol) poisoning. Which of these antidotes, if administered,would bind with the toxic metabolites released from the medication?

A. Acetylcysteine (Mucomyst) B. Ibuprofen (Advil) C. Magnesium citrate D. Syrup of ipecac

40. The order reads: Heparin 1700 units/hr. Premixed Heparin drips are available with Heparin 25,000 units/500ml. how manyml's per hour would you administer?

A. 580 mls B. 3.4 mls C. 58 mls D. 34 mls

Form W-4 (2012)Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.

Exemption from withholding. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2012 expires February 18, 2013. See Pub. 505, Tax Withholding and Estimated Tax.

Note. If another person can claim you as a dependent on his or her tax return, you cannot claim exemption from withholding if your income exceeds $950 and includes more than $300 of unearned income (for example, interest and dividends).

Basic instructions. If you are not exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations.

Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.

Head of household. Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information.

Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances.

income, see Pub. 505 to find out if you should adjust your withholding on Form W-4 or W-4P.

Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details.

Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.

Check your withholding. After your Form W-4 takes effect, use Pub. 505 to see how the amount you are having withheld compares to your projected total tax for 2012. See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married).

Future developments. The IRS has created a page on IRS.gov for information about Form W-4, at www.irs.gov/w4. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted on that page.

Personal Allowances Worksheet (Keep for your records.)

A Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . A

B Enter “1” if:

• You are single and have only one job; or

• You are married, have only one job, and your spouse does not work; or . . .

•

B

C Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or more

than one job. (Entering “-0-” may help you avoid having too little tax withheld.) . . . . . . . . . . . . . . C

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . D

E Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . . E

F Enter “1” if you have at least $1,900 of child or dependent care expenses for which you plan to claim a credit . . . F

(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)

G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.

• If your total income will be less than $61,000 ($90,000 if married), enter “2” for each eligible child; then less “1” if you have three to

seven eligible children or less “2” if you have eight or more eligible children.

G

H H

For accuracy, complete all worksheets that apply.

• If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments Worksheet on page 2.

• If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed $40,000 ($10,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld.

• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

Separate here and give Form W-4 to your employer. Keep the top part for your records.

Form

Department of the Treasury Internal Revenue Service

Employee's Withholding Allowance Certificate Whether you are entitled to claim a certain number of allowances or exemption from withholding is

subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.

OMB No. 1545-0074

1 Your first name and middle initial Last name

Home address (number and street or rural route)

City or town, state, and ZIP code

2 Your social security number

3 Single Married Married, but withhold at higher Single rate.

4 If your last name differs from that shown on your social security card,

check here. You must call 1-800-772-1213 for a replacement card.

5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5

6 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . . 6 $

7 I claim exemption from withholding for 2012, and I certify that I meet both of the following conditions for exemption.

• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and

• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.

If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . 7

Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.

Employee’s signature (This form is not valid unless you sign it.) Date

8 Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10220Q Form W-4 (2012)

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www.irs.gov/w4

Department of Homeland Security U.S. Citizenship and Immigration Services

Form I-9, Employment Eligibility Verification

OMB No. 1615-0047; Expires 06/30/08

Please read instructions carefully before completing this form. The instructions must be available during completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Verification. To be completed and signed by employee at the time employment begins.Print Name: Last First Middle Initial Maiden Name

Address (Street Name and Number) Apt. # Date of Birth (month/day/year)

StateCity Zip Code Social Security #

A lawful permanent resident (Alien #) AA citizen or national of the United States I am aware that federal law provides for

imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

An alien authorized to work until

(Alien # or Admission #)Employee's Signature Date (month/day/year)

Preparer and/or Translator Certification. (To be completed and signed if Section 1 is prepared by a person other than the employee.) I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.

Address (Street Name and Number, City, State, Zip Code)

Print NamePreparer's/Translator's Signature

Date (month/day/year)

Section 2. Employer Review and Verification. To be completed and signed by employer. Examine one document from List A OR examine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number and expiration date, if any, of the document(s).

ANDList B List CORList ADocument title:

Issuing authority:

Document #:

Expiration Date (if any):Document #:

Expiration Date (if any):

and that to the best of my knowledge the employee is eligible to work in the United States. (State(month/day/year)employment agencies may omit the date the employee began employment.)

CERTIFICATION - I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that the above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on

Print Name TitleSignature of Employer or Authorized Representative

Date (month/day/year)Business or Organization Name and Address (Street Name and Number, City, State, Zip Code)

B. Date of Rehire (month/day/year) (if applicable)A. New Name (if applicable)

C. If employee's previous grant of work authorization has expired, provide the information below for the document that establishes current employment eligibility.

Document #: Expiration Date (if any):Document Title:

Section 3. Updating and Reverification. To be completed and signed by employer.

l attest, under penalty of perjury, that to the best of my knowledge, this employee is eligible to work in the United States, and if the employee presented document(s), the document(s) l have examined appear to be genuine and to relate to the individual.

Date (month/day/year)Signature of Employer or Authorized Representative

Form I-9 (Rev. 06/05/07) N

I attest, under penalty of perjury, that I am (check one of the following):

Meal Break Agreement I understand that I am entitled to one meal period per eight (8) hour shift that I work. I would prefer to waive my meal break when I work less than six (6) hours per day. I will continue to take my rest breaks. When I work over six (6) hours in one day, I agree to take my thirty-minute meal period. When I work a twelve (12) hour shift, I agree to take a thirty-minute meal period and will waive a second thirty-minute meal period. This will be in effect my first day of employment with PROCEL. I understand that I may revoke this at any time. _____________________________________________________________ First Name Last Name _____________________________________________________________ Signature Date

Authorization Agreement for Automatic Direct Deposit

Company Name: Procel Temporary Services Inc. Company ID#: ______________ I hereby authorize the COMPANY, to make payments of any amount owing to me by initiating credit entries to my account indicated in the bank names below, hereinafter called BANK, and I authorize and respect BANK to accept any credit entries initiated by COMPANY to such account without responsibility for the correctness thereof. I also authorize and request COMPANY to effect repayments to COMPANY for any amounts owed it because of prior erroneous credit initiated to my account if prior to initiation of the correcting entry, the COMPANY has notified me of the correction and the reason therefore: and, the correcting entry is transmitted in such time as to be delivered or make available to BANK before midnight of the tenth day next following for the erroneous entry. It is understood that either party may terminate this agreement at any time by written notification to COMPANY or BANK. Any such notifications to COMPANY shall be effected only with respect to entries initiated by COMPANY after receipt of such notification and reasonable opportunity to act on it. Any such notification to BANK shall be effective only with respect to entries credited into my account by BANK after receipt of such notifications and reasonable time to act on it. I recognize, acknowledge, and accept that this service is being provided for my convenience. As such, I agree to hold the COMPANY, PROCEL, each participating bank and NACHA harmless from any claim incident to the operating of this plan, arising from any act or omission by the COMPANY and/or PROCEL and their employees, including without limitation any claim based on an alleged loss as a result of non-credit of any deposit, and any claim which ay be made by any depositor as a result the rejection of any of his debits because of insufficient funds arising from failure to credit deposits to my account.

IMPORTANT!!! ATTACH VOIDED CHECK FOR CHECKING ACCOUNT

OR ATTACH DEPOSIT SLIP FOR SAVINGS ACCOUNT

Name of Institution: ______________________________________________________ Employee Name: _________________________________________________________ Account #: __________________________ Routing #: __________________________ Account Type: Checking Savings Cancel Direct Deposit Direct Deposit will be tested the first week. This is called a “Pre-Note”. The purpose is to ensure your correct account. If test is successful the direct deposit will be activated the following week. Thereafter, PROCEL will process direct deposit every payday (Thursday). Friday is usually the day our employees receive their direct deposit pay. PROCEL cannot guarantee that your bank will post the direct deposit in your account on Fridays. Therefore, please ask your bank representative when you can expect your money to be deposited into your account. I understand that is it my responsibility to notify PROCEL of any changes related to my direct deposit: Bank, Account #, Closing, etc. I also understand that if I fail to notify PROCEL of these changes I may not receive my direct deposit pay. Name: __________________________________________________________________ Signature: ______________________________________ Date: ___________________

Revised 10/2008 LB

rn -er application packet

Documents

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