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 patients health care needs
Evaluating the effectiveness of treatment based on patients 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 patients 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 staffs 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 patients response to
interventions

PROCEL

PROCEL TEMPORARY SERVICES, INC.
Documentation of the ability of patients 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
Disclosur e and Author i zati on to Obtai n I nvestigative Consumer Repor t

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

and/or

Insight Investigations, Inc. PO Box 891571 Temecula, CA 92589 (800)615-8111

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.

Disclosur e and Author i zati on to Obtai n I nvestigative Consumer Repor t

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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Nationally Validated Content
Copyright 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/Teach
Frequency: [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
General
Admission
Advance Directives
Collect Appropriate
Data
Discharge Teaching
Organ/Tissue
Donation
Patient and Family
Teaching
Suspected Abuse
EMTALA Procedures
Computerized Documentation
Computerized
Documentation
Cardiovascular
General
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 --
Permanent
Monitoring
Assessment/Patient Care Continued

1 2 3 4 1 2 3 4
12 Lead EKG
Interpretation
Arrhythmia Interpretation
Arterial Line
CVP Monitoring
Intra-Aortic Balloon
Pump
PA/Swan-Ganz
Labs
BNP (Brain Natriuretic
Peptide)
Cardiac Enzymes &
Isoenzymes
Coagulation Studies
Troponin
Pulmonary
General
Assess Lung Sounds
Identify/Manage Resp.
Complications
Oxygenation Status
Rate and Work of
Breathing
Patient 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: _
Date: _
Skills Checklist
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Page 2 of 6
Emergency Room
1 2 3 4 1 2 3 4
Pulse Oximetry
Lab
Interpretation of
ABGs
Neurology
General
Glasgow Coma Scale
Neurological
Assessment
Reflex/Motor
Deficits
Visual Communication
Deficits
Patient 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
Gastrointestinal
General

1 2 3 4 1 2 3 4
Assess Nutritional
Status
G.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/Genitourinary
General
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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Page 3 of 6
Emergency Room
1 2 3 4 1 2 3 4
Serum Electrolytes
Endocrine/Metabolic
Patient Experience
Adrenal Gland
Disorders
Diabetic Ketoacidosis
Drug Overdose
Insulin Shock
Pituitary Gland
Disorders
Diabetic Coma
Insulin Reaction
Thyroid Gland
Disorders
Labs
Blood Glucose
Thyroid Studies
Musculoskeletal
General
Pulse/Circulation
Checks
Patient Experience
Amputation
External Fixation
Multiple Trauma
Paraplegia
Skeletal/Skin
Traction
Cast Care
Fractures
Crutch Walking
Immunology/Hematology/Oncology
General
Blood Transfusions
Patient Experience
Acute Leukemia
Anaphylactic Shock
Cancer
HIV/AIDS

1 2 3 4 1 2 3 4
Sepsis
Sickle Cell Anemia
Treatment Side Effects
Chemo/Radiation
Labs
Hematology
Wounds/Integument
General
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 Health
General
Abruptio Placenta
DIC
Eclampsia
Hemorrhage
Precipitous Delivery
Preeclampsia
Premature Labor
Rape Kit
Spontaneous Abortion
Medications/Therapeutic Interventions
General
Adenocard
Name:, _
Date: _
Skills Checklist
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Emergency Room
Medications/Therapeutic Interventions Continued
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

1 2 3 4 1 2 3 4
Medications Administration
Administer IM and
SQ Meds
Administer Inhalation
Medications
Administer PO
Medications
Bladder Irrigation and
Instillation
Ear Irrigation
Eye Irrigation
Needleless Systems
IV Therapy
Adverse Reactions
Assess/Maintain IV
Site
CVP Lines/Measurement
of CVP
Infusion Pumps
Peripheral IV
Insertion
Syringe Pumps
Vascular Access Devices
Care/Maintenance
Administer IV
Medications
Mixing IV Solutions
Blood
Administer Blood/Blood
Products
Albumin
Nutritional Therapy
NGT Insertion
TPN and Hyperalimentation
Oxygen Administration
Ambu-Bag
Nasal Cannula
Name: _
Date: _
Skills Checklist
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Page 5 of 6
Emergency Room
1 2 3 4 1 2 3 4
Nebulizer Treatments
Non-Rebreather Mask
Portable Oxygen
Tracheostomy
Venti Mask
Ventilator (A/C, IMV,
PEEP)
Pain Management
Assess Pain
Level/Tolerance
Moderate Sedation
Ramsey Scale
Procedures/Equipment
Perform
Applying Brace/Splint
Cast
Cervical Collar
Chest Tube Drainage
Systems
Crisis Intervention
Doppler
Drains (JP-Hemovac-Penrose)
Dressing Changes
Establish/Protect
Airway
Foley, 3-Way
Foley, Female
Foley, Male
Hyper/Hypothermia
Blanket
Iced Saline Lavage
Isolation
Pinned Fractures
Restraints
Steristrips
Suctioning (Oral-Naso-Pharynx)
Suicide Precautions
Trach Care/Suctioning
Wound Care/Irrigations
Wrist Splint
Procedures/Equipment Continued
1 2 3 4 1 2 3 4
Specimen Collections
Arterial 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
Assist
Arterial Line
Insertion
Bedside Invasive
Procedures
Bronchoscopy
Cardioversion/Defibrillation
Central Line
Insertion
Chest Tube Insertion
Emergency Tracheostomy
ET Intubation and
Extubation
Halo Traction/Cervical
Tongs Placement
IV Cutdown
Lumbar Puncture
Nasal Packing
Open Chest Emergency
PA Catheter/Swan-Ganz
Insertion
Pericardiocentesis
Pericentesis
Staples Assist/Removal
Sutures Assist/Removal
Name: _
Date: _
Skills Checklist
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Page 6 of 6
Emergency Room
Procedures/Equipment Continued
1 2 3 4 1 2 3 4
Thoracentesis
Insert Temp-Pacemaker
Age Group Experience
Age Groups
0 - 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 Experience
Level I
Level II
Level III
Clinical Settings
Acute Care ER
Chest Pain ER
CHF Clinic
Flight Nursing
Pacemaker Clinic
Urgent Care Clinic
Ambulance/Transport
Signature
Date
"Gold Seal of Approval"

Application Form
TO APPLI CANTS: 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: (____) _______-____________

I n Case of Emer gency, Contact: Name: _____________________ Number: (____) _______-____________

E-Mail Addr ess: ____________________________________________________________________________

I NTERESTED I N: x PER DI EM x TRAVEL

2. Licensure/Credentials:

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

Education Pr epar ation:

Name/Address: Year Graduated: Degree(s) Obtained:
High School: ______________________ (Mo)_______(Yr)________ _____________________________
______________________ _______________________ _____________________________
College: ______________________ (Mo)_______(Yr)________ _____________________________
______________________ _______________________ _____________________________

3. Continuing Education for the last two (2) year s:

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

4. Work Experience: (Please provide last seven (7) years wor k history. Most recent or cur rent employer
fi rst)

1) Name and Addr ess of Employer : Employment Dates - Fr om: _____(mo) _______ (yr ) To: _____(mo) _______ (yr )

Employer: Main Phone #:

City, State:

Was this a Tr avel 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: ___________

Duties and Responsibilities:
__________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________



City, State:



this facility:


__________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________



City, State:



this facility:


__________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

4. Work Experience: (continued)



City, State:



this facility:


__________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________



City, State:



this facility:


__________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________



City, State:



this facility:


__________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

5. Work References:

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

6. I have a MI NI MUM OF ONE-YEAR experience in the following units and I am prepared to car e 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. Refer ral 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.

(Remi nder to appl i cants: We do Cr i mi nal Backgr ound Scr eeni ng on ALL appl i cants befor e hi r e)

Do you drive? x YES x NO

Do you have a car or other transportation for wor k? x YES x NO

What languages other than English do you speak/write and understand?

_________________________________________________________________________________________

Employment Agr eement

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 employees responsibility to determine whether a prescribed
drug may impair job performance.

V. DRUG TESTING
Employees 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 Companys 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 employees 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 employees 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 Companys 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 PROCELs current standards for dealing
with a serious national problem and is subject to change.

REFERENCE CHECK FORM
APPLI CANT I NFORMATI ON

Speci al t y : Cl assi f i cat i on:

Name:

Em pl oy ed:

From:

To:
REFERENCE I NFORMATI ON

Name:

Ti t l e:

Ph one:

Uni t :

Faci l i t y :

Ad dr ess:

Ci t y :

St at e:

Zi p:
EVALUATI ON
Per sonal Eval uat i on Excel l ent Good Fai r Poor
At t endance
Punct ualit y
Qualit y of Work
Perf ormance
Skill
At t it ude
I nit iat ive
Adapt abilit y
Appearance
Co-Operat ion
Wou l d y ou r eh i r e t hi s emp l oy ee? ________ Yes _________ No
Com men t s:
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.

__________________________________________________________________

__________________________________________________________________

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.

__________________________________________________

__________________________________________________
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 PRECAUTIONS
Standard precautions are based upon common sense. They apply to the care of all patients, since it's not always
possible to tell who is infectious. The very basics of standard precautions include hand hygiene. Hand hygiene is
the 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 HYGIENE
It may seem basic, simple, easy to do; yet inadequate hand hygiene is one of the most common reasons that
patients get infections.
CATERGORIES
These recommendations are designed to improve hand-hygiene practices of health care workers and to reduce
transmission 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 scientific
data, theoretical rationale, applicability, and economic impact. The CDC/HICPAC system for catergorizing
recommendations 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 experimental
clinical or epidemiologic studies and a strong theoretical rationale.
Catergory IC: Required for implementation, as mandated by federal or state regulation or standard
Catergory II: Suggested for implementation and supported by suggestive clinical or epidmiologic
studies or a theoretical rationale.
No recommendation: Unresolved issue. Practices for which insufficient evidence or no consensus
regarding efficacy exsist.
_____________________________________________________________
_____________________________________________________________
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, t he under si gned, her eby aut hor i ze Pr ocel Tempor ar y Ser vi ces Inc. t o
pr ovi de my per sonnel and medi cal i nf or mat i on t o Faci l i t i es cur r ent l y
Cont r act ed wi t h Pr ocel , f or t he pur pose of ver i f yi ng t hat I meet t he
r equi r ement s speci f i ed i n t he Agr eement For Tempor ar y St af f i ng of Nur si ng
Ser vi ces. The use of t he i nf or mat i on suppl i ed i s t o be r est r i ct ed t o t he
f or egoi ng st at ed ver i f i cat i on.

Rel ease or t r ansf er of t he speci f i ed i nf or mat i on t o any per son or ent i t y
not speci f i ed her ei n i s pr ohi bi t ed. An addi t i onal wr i t t en consent must be
obt ai ned f or a pr oposed new use of t he i nf or mat i on or f or i t s t r ansf er t o
anot her or ent i t y.

Unl ess ot her wi se st at ed or mandat ed by l aw, t hi s r el ease of i nf or mat i on
consent f or m wi l l not expi r e.

___________________________________________________
Fi r st Name Last Name

___________________________________________________
Si gnat ur e Dat e

NOTICE TO EMPLOYEE

You have a r i ght t o r ecei ve a copy of t hi s aut hor i zat i on.
Revised: 6/30/2010

HEPATI TI S B VACCI NATI ON DECLI NATI ON

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.

________________________________________________________________________

______________
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 Pr int)

_____________________________________________________________________
Signature Date
poration
heslthcsl"8 staffing BElrW:e
Index: Page Numbers:
1 Qualifications of Procel Temporary Services, Inc. and Mission Statement . 1
2 Cultural Diversity 2
3 Continuous Quality Improvement ..3
4 Patient Safety 2009 4-5
5 Joint Commission National Patient Safety Goals .... 6-8
6 Patient Rights 9-11
7 HIPAA Privacy Act and Confidentiality Management 12-13
8 Infection Control: Hand Hygiene and OSHA Regulations 14-18
Standard Precautions
a Hand Hygiene (CDC Guildelines)
b Exposure to blood products
c OSHA's Exposure Control plans
-Bloodbourne Pathogens
-Hepatitis B Virus
-Tuberculosis
9 Safety in the Environment of Care . 19-35
a General Safety
b Fire and Life Safety
c Hospital Emergency Preparedness
d Electrical and Medical Equipment Safety
e Patient Fall Prevention
f Utility System Safety
g Hazardous Materials and Material Safety Data Sheets (MSDS)
h Radiation Safety
i Safety and Violence in the Workplace
j Medications Safety
10 Body Mechanics 36-38
11 Restraints and Seclusion . 39-42
12 Age Specific Related Care 43-46
13 Pain Assessment and Management .. 47-48
14 Advance Directives, Capping and Organ Donation 49-50
15 Suspected Abuse 51-56
a Suspected Child Abuse and Neglect
b Suspected Abuse of Elders and Dependent Adults
c Domestic Violence
16 Abbreviations: Joint Commission Official "Do Not Use" List 57
1 Team Dynamics 58
2 Corporate Compliance and Reporting to the Joint Commission . 59-62
3 Terms of Employment and Job Descriptions 53
a. Job Description Registered Nurse 64-65
Orientation and Annual Educational Updates
RN'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 66
c. Job Description Licensed Vocational Nurse 67-68
d. Job Description Certified Nursing Assistant 69
e. Job Description Operating Room Technician 70
f. Job Description Instrument Technician 71
g. Job Description Respiratory Therapist 72-73
h. Job Description Case Manager 74-75
i. Job Description Medical Social Worker 76
4 Per Diem Policies and Procedures ..77
5 Floating Policy 78
6 Dress Code and Hand Hygiene Policy, etc. 79
7 Workers Compensation Benefits ..80
8 Harassment Prevention Policy ..81-83
9 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.
__________________________________________________
__________________________________________________ __________________
Procel Temporary Services, Inc.

CODE OF BUSI NESS ETHI CS

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 Procels 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 compliant@jcaho.org

I have reviewed the PROCEL Code of Ethics and I know how to contact Joint Commission.

_____________________________________________________________

______________________________________________________________
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 emotional
needs 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 their
lives. 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 dying
patient, physically, spiritually and emotionally.
That excellent culturally competent end of life care is the
physical, emotional and spiritual care we provide to our
patients in the last year of their lives, not the last days.
That pain and symptom management is every patient's
right along with education about their disease process.
That patients often require additional support in the last
years and months of life and to meet this need, our nurses
may 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 emotional
needs 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 their
lives. 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 dying
patient, physically, spiritually and emotionally.
That excellent culturally competent end of life care is the
physical, emotional and spiritual care we provide to our
patients in the last year of their lives, not the last days.
That pain and symptom management is every patient's
right along with education about their disease process.
That patients often require additional support in the last
years and months of life and to meet this need, our nurses
may 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 st
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 wil be respected
after death.
I have read the above Procel policy and procedure for meeting the needs of
dying patients and end of life care.
___________________________________ ________________________
JCAHO CERTI FI ED
2447 Paci fi c Coast Highway, Suite #207 Her mosa Beach, Califor ni a 90254 P: 310-372-0560 F: 877-707-5576
www.pr ocelnurses.com

HI PAA Awar eness Tr aining

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

____________________________________________________

____________________________________________________
Signature Date

Pr ocel Tempor ar y Ser vices, I nc.

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 and
neglect.
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 decide
what 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
Name:_____________________________________________ CIass:______
Date:___________________________
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 must
be 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 disciplines
involved 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 patient
will 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, may
have.
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 medication
during 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: _
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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 verbal
commands.
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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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 level
of 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 of
consciousness.
A. True
B. False
Date:
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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 laws 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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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 neighboring
clinic directing them to another neighboring hospital for sick infant with 103 fever. Family is directed into Triage, baby is examined and vital
signs taken. Temperature 103, baby lethargic, parents upset. The father asks if the hospital they are now in is the neighboring hospital. In
the above scenario the most appropriate response by the nurse is:
A. No, it isnt.
B. This is ABC Hospital and a Physician will see your baby shortly.
C. No, it isnt 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 for
discharge the family was referred back to the clinic they came from for follow up. The nurse tells the family, Bring your baby back to the
nearest 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 will
give you a medical screening exam and transfer you to XYZ Hospital. Patient replies, I would rather drive my own car over to XYZ
Hospital rather than wait here and get transferred. Nurse documents this on her triage note. Have we violated EMTALA rules? In the
above 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 dont provide that level of care and you will just be sent elsewhere anyway. The information provided gave
the patient the I dont want to wait and/or I shouldnt 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 inability
to 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 minute
but 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 childs admission
5. A patient is admitted to the Emergency Room with head and chest injuries received in an automobile accident. When evaluating the
patients response to the Emergency Room treatments, which assessments indicate that the patient can safely be transferred to a critical
care 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 nurse
should 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 complications
that most commonly affect the:
A. GI Tract
B. Genitourinary tract
C. Respiratory tract
D. Capillary vasculature
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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 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
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
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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 LIKELY
cause 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 an
acetaminophen 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 give
equal 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 the
dorsal surface of the second digit of his right hand. He has no other complaints. Based on this history, the most likely thing that may have
bitten him is:
A. Back widow spider
B. Blue scorpion
C. Brown recluse spider
D. Wolf spider
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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
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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, or
diarrhea but reports moderate spotting over the past 24 hours. Her last menstrual period was 2 months before the onset of symptoms. Her
vital signs include blood pressure of 124/84, P 90, and temperature 98.8 degrees. Based on these assessment findings, the emergency
nurse 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: _
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Test Name: Emergency Room Medication
1. The nurse knows that a patient on long term anticoagulant therapy must be carefully monitored for potential hemorrhage
complications 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 would
MOST 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 of
an 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 strip
changes 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 260/120
mm Hg. In addition to other drugs, the physician orders a Sodium Nitroprusside infusion. The nurse recognized that
this 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 should
anticipate that the patient would receive:
A. Epinephrine
B. Atropine Sulfate
C. Sodium Bicarbonate
D. Lidocaine Hydrochloride
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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) to
infuse 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 would
you 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 this
dose?
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 initial
dose is 0.1 mg/kg. The available 10 ml vial of Norcuron containes 1 mg/ml. How many milliliters shoud the patient
receive?
A. 0.07 ml
B. 7 mg
C. 0.7 ml
D. 15.4 ml
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15. An infusion of phenytoin (Dilantin) at a rate greater than 50 mg/min for an adult may result in which of these side
effects?
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 and
will be treated with ampicillin and phenazopyridine. The emergency nurse should instruct the patient that phenazopyridine
would:
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 this
dose?
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 aware
that Tylenol poisoning is treated first with:
A. Acetylcysteine
B. Deferoximine
C. Edetate calcium disodium
D. Activated charcoal
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22. The patient is admitted to the emergency room with shortness of breath, anxiety, and tachycardia. His ECG reveals atrial
fibrillation with a ventricular response rate of 130 beats per minute. The physician orders quinidine sulfate. While
he 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 physician
prescribes 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 side
effect 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 watch
for 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
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Test Name:
Date: _
Score:
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. Which
finding 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 effect
of 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 who
has 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 800
mg 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: _
Score:
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 immediately
report to the physician?
A. PVCs
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 many
ml'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.
Employees signature
(This form is not valid unless you sign it.) Date
8 Employers 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)
Procel Nurses | 2447 Pacific Coast Hwy Suit e 207 Hermosa Beach, CA 90254
95 4215452
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)
State City Zip Code Social Security #
A lawful permanent resident (Alien #) A
A 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 Name Preparer'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).
AND List B List C OR List A
Document 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 Title Signature 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.

_____________________________________________________________

_____________________________________________________________
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

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PROCEL TEMPORARY SERVICES, INC.

Procel Temporary Services Inc.

Assessment/Patient Care Continued

Assessment/Patient Care Continued

Assessment/Patient Care Continued

Medications/Therapeutic Interventions Continued

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

30. Your best defense in any legal issue is:

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

23. A late sign or symptom of hyponatremia is:

31. Name this rhythm:

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