Download 5-11 Administering Medication via Z

Danylo Halytsky Lviv National Medical University
Faculty of medicine
Department of Propedeutics of Internal Medicine №1
Discipline: Nursing (Practice)
Methodological Guidelines for English-speaking Students of Medical Faculty
(3-d Year of Study)
“Main duties and professional actions of a nurse from Internal Medicine
Department” – Module №1
Lviv-2014
CONTENT
1. ETHICAL
AND
LEGAL
FRAMEWORK
OF
NURSING.
ORGANIZATION OF THE WORK AND RESPONSIBILITIES OF A
NURSE OF THERAPEUTIC DEPARTMENT…………………………....3
2. RESPONSIBILITIES
OF
A
NURSE
OF
A
ROOM
OF
MANIPULATIONS………………………………………………………...6
3. THE RESPONSIBILITIES OF A NURSE TO PROVIDE DIAGNOSTIC
PROCESS IN THERAPEUTIC DEPARTMENT…………………….……9
4. SPECIFICITY OF PROCEDURAL ROOM AND FUNCTIONS OF A
NURSE FOR ITS ACTIVITY……………………………………………..13
5. DIETS. ORGANIZATION OF CLINICAL NUTRITION OF PATIENTS
IN
THE
HOSPITAL.
CHARACTERISTICS
OF
THE
DIETS.
ARTIFICIAL NUTRITION……………………………………………….16
6. RESPONSIBILITIES OF THE NURSE IN THE INTENSIVE CARE
UNIT………………………………………………………………….……20
THE FINAL MODULE CONTROL……………………………...……….22
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Topic 1
ETHICAL AND LEGAL FRAMEWORK OF NURSING
ORGANIZATION OF THE WORK AND RESPONSIBILITIES OF A
NURSE OF THERAPEUTIC DEPARTMENT
Type of a lesson – theoretical consideration, practical (bedside).
I.
Please answer the following questions (List of questions).
1. Discuss the various health care settings through which health care services
are delivered.
2. Identify the members of the health care team and respective roles.
3. Explain factors influencing health care delivery.
4. Discuss nursing’s role in meeting the challenges within the health care
system.
5. Identify the levels of preventive care.
6. Identify major purposes of data collection.
7. Describe three types of assessment.
8. Differentiate subjective and objective data.
9. Identify examples of nursing and nonnursing models used in collecting and
organizing data.
10.Describe five methods involved in data collection.
11.Explain the stages of the assessment interview.
12.Outline the elements of the health history and their importance.
13.Describe the purposes of the physical assessment.
14.Discuss assessment techniques used in the physical examination.
15.Discuss the use of data clustering in organizing the information obtained
about the client.
16.Identify four types of assessment formats.
17.Explain the relationship between ethics and law.
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18.List the legal responsibilities of nurses in delivering client care.
19.Discuss actions that nurses can implement to avoid potential liability.
20.Explain the role of the nurse in the informed consent process.
21.Define the three types of advance directives.
22.Describe the legal and ethical considerations for nurses involved in client
care situations involving abortion, pronouncement of death, do not
resuscitate orders, euthanasia, care of the deceased, wills, organ donation,
autopsies, and refusal of treatment.
23.Discuss the ethical theories of teleology and deontology.
24.Describe the major ethical principles that affect health care.
25.Explain meaning the following expressions: Active euthanasia, passive
euthanasia, assisted suicide.
II.
Test Control of theoretical knowledge.
1. The nurse who is working in a rehabilitation facility is providing which level
of care?
a) Primary;
b) Secondary;
c) Tertiary;
d) Palliative.
2. Which of the following nursing actions will adversely affect customer
satisfaction of hospitalized clients?
a) Introducing self to client and family;
b) Assessing pain level;
c) Implementing a routine schedule for every client;
d) Documenting all care provided in a timely manner.
3. Function/role of Nurse (RN) all except:
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a) Provides care to individuals who are unable to care for themselves; with a
holistic approach, nurses assist clients to cope with illness or disability;
b) Provides medical services under the supervision of a physician;
c) Addresses the needs of the client (individual, family, community);
d) Emphasizes health promotion.
4. Basically, health care services can be categorized into three levels so Health
Promotion and Illness Prevention is:
a) Primary;
b) Secondary;
c) Tertiary;
d) Primary and secondary.
5. Negligence:
a) refers to a professional person’s wrongful conduct, improper discharge of
professional duties, or failure to meet the standards of acceptable care
that results in harm to another person;
b) is the failure of an individual to provide care that a reasonable person
would ordinarily use in a similar circumstance;
c) touching of another person without the person’s consent;
d) stated intent to touch a person in an offensive, insulting, or physically
intimidating manner.
Suggested Reading:
1. Fundamentals of Nursing: Standards and Practice Fourth Edition / Sue C.
DeLaune, Patricia K. Ladner – United States of America: Delmar, Cengage
Learning, 2011. – 1438 p.;
2. Delmar’s fundamental and advanced nursing skills / Gaylene Altman, Patricia
Buschel, and Valerie Coxon – Canada: Delmar, Thomson Learning, 2000. –
1436 p.
5
Topic 2
RESPONSIBILITIES OF A NURSE OF A ROOM OF MANIPULATIONS
Type of a lesson – theoretical consideration, practical (bedside).
I.
Please answer the following questions (List of questions).
1. Equipment Needed for Administering Oral, Sublingual, and Buccal
Medications (please note).
2. Please indicate client education that necessary for Administering Oral,
Sublingual, and Buccal Medications.
3. List all you have to assess for Administering Oral, Sublingual, and Buccal
Medications.
4. Equipment Needed for Administering an Intradermal Injection (please note).
5. Please indicate client education that necessary for Administering an
Intradermal Injection.
6. List all you have to assess for Administering an Intradermal Injection.
7. Equipment Needed for Administering Medication via Z-track Injection
(please note).
8. Please indicate client education that necessary for Administering Medication
via Z-track Injection.
9. List all you have to assess for Administering Medication via Z-track
Injection.
10.Equipment Needed for Administering Eye and Ear Medications (please
note).
11.Please indicate client education that necessary for Administering Eye and
Ear Medications.
12.List all you have to assess for Administering Eye and Ear Medications.
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II.
Please describe the following methods for patients care, that are
included in the duties of nurses (Рractical skills).
1. Administering Oral, Sublingual, and Buccal Medications your actions)
2. Administering Eye and Ear Medications
3. Administering Skin/Topical Medications
4. Administering Nasal Medications
5. Administering Rectal Medications
6. Administering Nebulized Medications
7. Administering an Intradermal Injection
8. Administering a Subcutaneous Injection
9. Administering an Intramuscular Injection
10.Administering Medication via Z-track Injection
III.
Test Control of theoretical knowledge.
1. The prescribing practitioner has order 2 teaspoonsful of Milk of Magnesia.
The nurse converts this dose to the metric system and administers:
a) 5 mL;
b) 10 mL;
c) 15 mL;
d) 30 mL.
2. What information should be obtained from the drug history?
a) Prescription drugs;
b) Allergies;
c) Herbal supplements;
d) Over-the-counter drugs;
e) Client’s sensory and cognitive status;
f) Lifestyles and beliefs.
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3. What is the appropriate method to administer medications through a
nasogastric tube?
a) Mix all medications together that are compatible, and flush with 20 to 30
mL warm water at the end.
b) Administer those medications that are compatible, and flush with 60 mL
warm water at the end.
c) Administer each medication individually, and flush with 100 mL warm
water at the end.
d) Administer each medication individually, flush with 15 to 30 mL warm
water between each medication, and flush with 30 to 60 mL at the end.
4. What is the usual dosage range for intradermal injections?
a) 0.01 to 0.1 mL;
b) 0.1 to 0.15 mL;
c) 1.15 to 0.2 mL;
d) 0.2 to 0.25 mL.
5. The correct way to administer eardrops to an adult client is to:
a) Pull the pinna straight back;
b) Pull the pinna down and back;
c) Pull the pinna upward and outward;
d) Pull the pinna straight down.
Suggested Reading:
1. Fundamentals of Nursing: Standards and Practice Fourth Edition / Sue C.
DeLaune, Patricia K. Ladner – United States of America: Delmar, Cengage
Learning, 2011. – 1438 p.;
2. Delmar’s fundamental and advanced nursing skills / Gaylene Altman, Patricia
Buschel, and Valerie Coxon – Canada: Delmar, Thomson Learning, 2000. –
1436 p.
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Topic 3
THE RESPONSIBILITIES OF A NURSE TO PROVIDE DIAGNOSTIC
PROCESS IN THERAPEUTIC DEPARTMENT
Type of a lesson – theoretical consideration, practical (bedside).
I.
Please answer the following questions (List of questions).
1. List all you have to assess for Administering Electrocardiogram.
2. Equipment Needed for Administering Electrocardiogram (please note).
3. Please indicate client education that necessary for Administering
Electrocardiogram.
4. Provide documentation necessary for Administering Electrocardiogram.
5. Please List nursing tips that need to know for Administering
Electrocardiogram.
6. List all you have to assess for Administering Magnetic Resonance Imaging
(MRI) (please note).
7. Equipment Needed for Magnetic Resonance Imaging (MRI) (please note).
8. Please indicate client education that necessary for Administering Magnetic
Resonance Imaging (MRI) (please note).
9. Provide documentation necessary for Administering Magnetic Resonance
Imaging (MRI) (please note).
10.Please List nursing tips that need to know for Administering Magnetic
Resonance Imaging (MRI) (please note).
11.List all you have to assess for Administering Computed Tomography (CT)
Scanning.
12.Equipment Needed for Administering Computed Tomography (CT)
Scanning (please note).
13.Please indicate client education that necessary for Computed Tomography
(CT) Scanning.
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14.Provide documentation necessary for Administering Computed Tomography
(CT) Scanning.
15.Please List nursing tips that need to know for Administering Computed
Tomography (CT) Scanning.
16.List all you have to assess for Administering Liver Biopsy
17.Equipment Needed for Administering Liver Biopsy (please note).
18.Please indicate client education that necessary for Administering Liver
Biopsy.
19.Provide documentation necessary for Liver Biopsy.
20.Please List nursing tips that need to know for Administering Liver Biopsy.
21.List all you have to assess for Administering Lumbar Puncture
22.Equipment Needed for Administering Lumbar Puncture (please note).
23.Please indicate client education that necessary for Administering Lumbar
Puncture.
24.Provide documentation necessary for Administering Lumbar Puncture.
25.Please List nursing tips that need to know for Lumbar Puncture.
II.
Please describe the following methods for patients care, that are
included in the duties of nurses (Рractical skills).
1. Measuring Intake and Output (your actions)
2. Collecting a Clean-Catch, Midstream Urine Specimen (your actions)
3. Performing a Skin Puncture (your actions)
4. Collecting Nose, Throat, and Sputum Specimens (your actions)
5. Administering Electrocardiogram (your actions)
6. Assisting with Magnetic Resonance Imaging (MRI) (your actions)
7. Assisting with Computed Tomography (CT) Scanning (your actions)
8. Assisting with a Liver Biopsy (your actions)
9. Assisting with a Thoracentesis (your actions)
10.Assisting with Abdominal Paracentesis (your actions)
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11.Assisting with a Bone Marrow Biopsy/Aspiration (your actions)
12.Assisting with a Lumbar Puncture (your actions)
13.Assisting with Amniocentesis (your actions)
14.Assisting with Bronchoscopy (your actions)
15.Assisting with a Gastrointestinal Endoscopy (your actions)
16.Assisting with a Proctosigmoidoscopy (your actions)
17.Assisting with Arteriography (your actions)
18.Positron-Emission Tomography Scanning (your actions)
III.
Test Control of theoretical knowledge.
1. Equipment needed for administering Electrocardiogram it is all listed, except:
a) Twelve-lead ECG machine with charged battery, cables and leads, graph
paper;
b) Disposable electrodes (12);
c) Magnetic Resonance Imaging scanner;
d) Electrode paste or gel;
e) Alcohol wipes.
2. Electrode V1 must be set in:
a) 4th intercostal space (ICS) at right sterna border.
b) 4th ICS at left sternal border.
c) 5th ICS at midclavicular line.
d) Left anterior axillary line at level of V4 horizontally.
e) Left midaxillary line at level of V4 horizontally.
3. Provide the necessary amount of time to perform ECG:
a) 10 minutes;
b) 30 – 90 minutes;
c) 5 – 15 minutes;
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d) 60 – 120 minutes;
e) 60 – 90 minutes.
4. Provide the necessary amount of time to perform Magnetic resonance imaging
(MRI):
a) 10 minutes;
b) 30 – 90 minutes;
c) 5 – 15 minutes;
d) 60 – 120 minutes;
e) 60 – 90 minutes.
5. All of the following are contraindications to Magnetic resonance imaging
(MRI)
a) weight over 300 pounds;
b) cardiac pacemaker, aneurysm clips;
c) metal objects in the body;
d) pregnancy;
e) massive ascites.
Suggested Reading:
1. Fundamentals of Nursing: Standards and Practice Fourth Edition / Sue C.
DeLaune, Patricia K. Ladner – United States of America: Delmar, Cengage
Learning, 2011. – 1438 p.;
2. Delmar’s fundamental and advanced nursing skills / Gaylene Altman, Patricia
Buschel, and Valerie Coxon – Canada: Delmar, Thomson Learning, 2000. –
1436 p.
12
Topic 4
SPECIFICITY OF PROCEDURAL ROOM AND FUNCTIONS OF A
NURSE FOR ITS ACTIVITY
Type of a lesson – theoretical consideration, practical (bedside).
I.
Please answer the following questions (List of questions).
1. Equipment Needed for Administering Oral, Sublingual, and Buccal
Medications (please note).
2. Please indicate client education that necessary for Administering Oral,
Sublingual, and Buccal Medications.
3. List all you have to assess for Administering Oral, Sublingual, and Buccal
Medications.
4. Equipment Needed for Administering an Intradermal Injection (please note).
5. Please indicate client education that necessary for Administering an
Intradermal Injection.
6. List all you have to assess for Administering an Intradermal Injection.
7. Equipment Needed for Administering Medication via Z-track Injection
(please note).
8. Please indicate client education that necessary for Administering Medication
via Z-track Injection.
9. List all you have to assess for Administering Medication via Z-track
Injection.
10.Equipment Needed for Administering Eye and Ear Medications (please
note).
11.Please indicate client education that necessary for Administering Eye and
Ear Medications.
12.List all you have to assess for Administering Eye and Ear Medications.
13
II.
Please describe the following methods for patients care, that are
included in the duties of nurses (Рractical skills).
5-1 Administering Oral, Sublingual, and Buccal Medications your actions)
5-2 Administering Eye and Ear Medications
5-3 Administering Skin/Topical Medications
5-4 Administering Nasal Medications
5-5 Administering Rectal Medications
5-7 Administering Nebulized Medications
5-8 Administering an Intradermal Injection
5-9 Administering a Subcutaneous Injection
5-10 Administering an Intramuscular Injection
5-11 Administering Medication via Z-track Injection
III.
Test Control of theoretical knowledge.
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Suggested Reading:
1. Fundamentals of Nursing: Standards and Practice Fourth Edition / Sue C.
DeLaune, Patricia K. Ladner – United States of America: Delmar, Cengage
Learning, 2011. – 1438 p.;
2. Delmar’s fundamental and advanced nursing skills / Gaylene Altman, Patricia
Buschel, and Valerie Coxon – Canada: Delmar, Thomson Learning, 2000. –
1436 p.
15
Topic 5
DIETS
ORGANIZATION OF CLINICAL NUTRITION OF PATIENTS IN THE
HOSPITAL
CHARACTERISTICS OF THE DIETS
ARTIFICIAL NUTRITION
Type of a lesson – theoretical consideration, practical (bedside).
I.
Please answer the following questions (List of questions).
1. Spell and define terms: intake and output, push fluids or force fluids, fluid
balance, edema, urinary incontinence, urinalysis.
2. Identify aging changes of the urinary system.
3. List some common diseases of the urinary system.
4. Identify signs and symptoms of the urinary system that the nurse must
observe and report.
5. Describe nurse related to the care of patients with urinary system diseases
and conditions.
6. Spell and define terms: cholecystitis, constipation, diarrhea, enema, fecal
impaction, hernia, peristalsis, stool, suppository, ulcer, urgency.
7. Describe aging changes of the gastrointestinal system.
8. Describe some common disorders of the gastrointestinal system.
9. Describe nurse actions related to the care of patients with disorders of the
gastrointestinal system.
10.List signs and symptoms the nurse should observe for and report.
11.Indicate the main types of enemas, their function and purpose.
12.Spell and define terms: dysphagia, enteral feeding, full liquid diet,
gastrostomy feeding, nasogastric (NG) feeding, nutrition, pureed diet, soft
diet, therapeutic diets.
13.Define normal nutrition.
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14.List the essential nutrients.
15.Name the six groups listed on the food pyramid.
16.Identify the basic facility diets and describe each.
17.State the purpose of calorie counts and food intake studies.
18.Describe general care for the patient with dysphagia and swallowing
problems.
19.List types of alternative nutrition.
II.
Please describe the following methods for patients care, that are
included in the duties of nurses assistant (Рractical skills).
1. Procedure 61 – Collecting a Routine Urine Specimen
2. Procedure 62 – Collecting a Clean-Catch Urine Specimen
3. Procedure 63 – Collecting a 24-Hour Urine Specimen
4. Procedure 73 – Testing Stool for Occult Blood
5. Procedure 74 – Giving a Soap-Solution Enema
6. Procedure 75 – Giving a Commercially Prepared Enema
7. Procedure 76 – Inserting a Rectal Suppository
8. Procedure 78 – Serving Meal Trays
9. Procedure 79 – Feeding the Dependent Patient
III.
Test Control of theoretical knowledge.
1. Occult blood is:
a) easily seen in the patient’s stools;
b) hidden blood that you cannot see;
c) always black, tarry, and pasty;
d) seen only when a person vomits.
2. Water is a/an:
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a) vitamin;
b) essential nutrient;
c) mineral;
d) discretionary calorie;
e) vegetable.
3. Fats, such as those that are found in fish, olive oil, and nuts:
a) cause narrowing of the arteries;
b) must be limited to once a week;
c) are in the dairy food group;
d) are healthful and recommended.
4. Hematuria is:
a) Pain or burning on urination;
b) Blood in the urine;
c) Decreased urine production;
d) Loss of control over urination.
5. An ulcer
a) (sore or tissue breakdown) can occur anywhere along the digestive
tract.
b) results when a structure such as the intestine pushes through a
weakened area in a normally restraining wall.
c) is an inflammation of small sacs protruding from the wall of the colon.
d) is the formation of stones in the gallbladder.
6. Gastrostomy feeding:
a) feedings that may be administered by a tube inserted surgically
through the abdominal skin and into the stomach;
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b) feedings that may be administered by a tube inserted through the nose
and into the stomach;
c) feedings that may be administered by a special catheter inserted into a
vein near the patient’s collar bone;
d) usual feedings through the mouth.
7. A clear liquid diet:
a) is a temporary diet, because it consists of water and carbohydrates for
energy but is inadequate for full nutrition;
b) this means that the consistency and texture are modified, making the
food easier to chew and swallow;
c) fats are limited and calories are balanced by increasing proteins and
carbohydrates;
d) some of the most difficult diets to follow.
8. Low-Fat Diet:
a) are ordered for patients with heart, blood vessel, liver, or gallbladder
disease;
b) is used for patients who have difficulty swallowing;
c) may be ordered for patients with chronic kidney and heart disease;
d) purpose of the diet is to replace fluids that may have been lost by
vomiting or diarrhea.
Suggested Reading:
1. Fundamentals of Nursing: Standards and Practice Fourth Edition / Sue C.
DeLaune, Patricia K. Ladner – United States of America: Delmar, Cengage
Learning, 2011. – 1438 p.;
2. Delmar’s fundamental and advanced nursing skills / Gaylene Altman, Patricia
Buschel, and Valerie Coxon – Canada: Delmar, Thomson Learning, 2000. –
1436 p.
19
Topic 6
RESPONSIBILITIES OF THE NURSE IN THE INTENSIVE CARE UNIT
THE FINAL MODULE CONTROL
Type of a lesson – theoretical consideration, practical (bedside).
I.
Please answer the following questions (List of questions).
1. Equipment Needed for Administering Cardiopulmonary Resuscitation
(CPR) (please note).
2. Please indicate client education that necessary for Performing the Heimlich
Maneuver.
3. Provide documentation necessary for Accidental Poisoning.
4. Please List nursing tips that need to know for Emergency Airway
Management.
5. Please indicate client education that necessary for Administering
Cardiopulmonary Resuscitation (CPR).
6. Provide documentation necessary for Performing the Heimlich Maneuver.
7. Please List nursing tips that need to know for Accidental Poisoning.
8. Equipment Needed for Emergency Airway Management (please note).
II.
Please describe the following methods for patients care, that are
included in the duties of nurses (Рractical skills).
1. Administering Cardiopulmonary Resuscitation (CPR)
2. Performing the Heimlich Maneuver
3. Responding to Accidental Poisoning.
III.
Test Control of theoretical knowledge.
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1. Defibrillation is a method of treatment that uses an electric shock to reverse
disorganized activity in the heart during cardiac arrest. In health care facilities,
the goal is to defibrillate:
a) within 1 minutes;
b) within 3 minutes;
c) within 15 minutes;
d) within 20 minutes.
2. You suspect that a patient is in shock because the:
a) blood pressure is elevated;
b) face is flushed;
c) skin is cold and clammy;
d) pulse is full and bounding.
3. Permanent damage to the brain occurs within:
a) 2 to 4 minutes;
b) 4 to 6 minutes;
c) 6 to 10 minutes;
d) 10 to 15 minutes.
4. During applying abdominal thrusts (Heimlich maneuver) place your fist, thumb
side in, against the victim’s abdomen:
a) on the navel below the tip of the xiphoid process;
b) at the level of the sixth rib, slightly above the navel;
c) at the level of the sixth rib, above the tip of the xiphoid process;
d) slightly above the navel and below the tip of the xiphoid process.
5. First aid is care given:
a) for nausea and vomiting;
b) only upon a physician’s order;
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c) if medical help is delayed;
d) for cough, cold, or sore throat.
Suggested Reading:
1. Fundamentals of Nursing: Standards and Practice Fourth Edition / Sue C.
DeLaune, Patricia K. Ladner – United States of America: Delmar, Cengage
Learning, 2011. – 1438 p.;
2. Delmar’s fundamental and advanced nursing skills / Gaylene Altman, Patricia
Buschel, and Valerie Coxon – Canada: Delmar, Thomson Learning, 2000. –
1436 p.
EVALUATION OF STUDENT KNOWLEDGE ON FINAL MODULE
The final module control includes two situational tasks, practical skills and
control test of theoretical knowledge that are added.
Maximum points that can be earned for the module is 100 points:
- control test of theoretical knowledge – 50 points;
- 2 situational tasks – each task is rated at 20 points;
- practical skill – 10 points.
Minimum points that can be earned for the module is 50 points:
Module consists of two parts:
- First part of the module involves writing control test of theoretical
knowledge. Maximum – 50 points, minimum – 25 points. *
- Second part of the module consists of two situational tasks (each task is
rated at 20 points) and practical skill (10 points). Maximum – 50 points,
minimum – 25 points.
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The final score of the module
Evaluation of a four-system
100……….85
"Excellent" – 5
84…….…70
"Good" – 4
69…….…50
"Satisfactory" – 3
49…….….0
"Unsatisfactory" – 2
* If student received less than 25 points on first part of the module this involves
re-writing of the first part (control test of theoretical knowledge). In this situation
student not permitted to the second part of the module and in convenient for
teacher and for student time again writes test control of theoretical knowledge. In
case of receiving 25 or more points for test control student is admitted to the
second part of the module.
Approved at the department meeting Propaedeutics of Internal Medicine №1
“
“ of ____________ 20___ year
Head of the chair ______________ Prof. MD Dutka R.J.
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