Monday, 15 July 2019

Question Of The Day, Psychotic Disorders
Q. A client with bipolar disorder, manic phase, just sat down to watch television in the lounge. As the nurse approaches the lounge area, the client states, "The sun is shining. Where is my son? I love Lucy. Let's play ball." The client is displaying:

A. Concreteness.
B. Flight of ideas.
C. Depersonalization.
D. Use of neologisms.

Correct Answer: B

Explanation: The client is demonstrating flight of ideas, or the rapid, unconnected, and often illogical progression from one topic to another. Concreteness involves interpreting another person's words literally. Depersonalization refers to feelings of strangeness concerning the environment or the self. A neologism is a word made up by a client.

Saturday, 13 July 2019

Question Of The Day, School-age Child
Q. A 7 year old with a history of tonic-clonic seizures has been actively seizing for 10 minutes. The child weighs 22 kg and currently has an intravenous (IV) line of D5 1/2 NS + 20 meq KCL/L running at 60 ml/hr. Vital signs are a temperature of 38 degrees C, heart rate of 120, respiratory rate of 28, and oxygen saturation of 92%. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for:

A. Rectal diazepam (Diastat).
B. IV lorazepam (Ativan).
C. Rectal acetaminophen (Tylenol).
D. IV fosphenytoin.

Correct Answer: B

Explanation: IV ativan is the benzodiazepine of choice for treating prolonged seizure activity. IV benzodiazepines potentiate the action of the gamma-aminobutyric acid (GABA) neurotransmitter, stopping seizure activity. If an IV line is not available, rectal Diastat is the benzodiazepine of choice. The child does have a low-grade fever; however, this is likely caused by the excessive motor activity. The primary goal for the child is to stop the seizure in order to reduce neurologic damage. Benzodiazepines are used for the initial treatment of prolonged seizures. Once the seizure has ended, a loading dose of fosphenytoin or phenobarbital is given.

Thursday, 11 July 2019

Question Of The Day, Infant
Q. A 10-month-old child with recurrent otitis media is brought to the clinic for evaluation. To help determine the cause of the child's condition, the nurse should ask the parents:

A. "Does water ever get into the baby's ears during shampooing?"
B. "Do you give the baby a bottle to take to bed?"
C. "Have you noticed a lot of wax in the baby's ears?"
D. "Can the baby combine two words when speaking?"

Correct Answer: B

Explanation: In a young child, the eustachian tube is relatively short, wide, and horizontal, promoting drainage of secretions from the nasopharynx into the middle ear. Therefore, asking if the child takes a bottle to bed is appropriate because drinking while lying down may cause fluids to pool in the pharyngeal cavity, increasing the risk of otitis media. Asking if the parent noticed earwax, or cerumen, in the external ear canal is incorrect because wax doesn't promote the development of otitis media. During shampooing, water may become trapped in the external ear canal by large amounts of cerumen, possibly causing otitis external (external ear inflammation) as opposed to internal ear inflammation. Asking if the infant can combine two words is incorrect because a 10-month-old child isn't expected to do so.

Wednesday, 10 July 2019

Q. A client complains of severe abdominal pain. To elicit as much information as possible about the pain, the nurse should ask:

A . "Do you have the pain all the time?"
B. "Can you describe the pain?"
C. "Where does it hurt the most?"
D. "Is the pain stabbing like a knife?"

Correct Answer: B

Explanation: Asking an open-ended question such as "Can you describe the pain?" encourages the client to describe any and all aspects of the pain in his own words. The other options are likely to elicit less information because they're more specific and would limit the client's response.

Tuesday, 9 July 2019

Question Of The Day, Medication and I.V. Administration
Q. A 56-year-old client is receiving chemotherapy that has the potential to cause pulmonary toxicity. Which of the following symptoms indicates a toxic response to the chemotherapy?

A. Decrease in appetite.
B. Drowsiness.
C. Spasms of the diaphragm.
D. Cough and shortness of breath.

Correct Answer: D

Explanation: Cough and shortness of breath are significant symptoms because they may indicate decreasing pulmonary function secondary to drug toxicity. Decrease in appetite, difficulty in thinking clearly, and spasms of the diaphragm may occur as a result of chemotherapy; however, they are not indicative of pulmonary toxicity.

Monday, 8 July 2019

Question Of The Day, Basic Physical Care
Q. Which scenario complies with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations?

A. Two nurses in the cafeteria are discussing a client's condition.
B. The health care team is discussing a client's care during a formal care conference.
C. A nurse checks the computer for the laboratory results of a neighbor who has been admitted to another floor.
D. A nurse talks with her spouse about a client's condition.

Correct Answer: B

Explanation: To provide interdisciplinary continuity of care, nurses must share relevant information during client care conferences. Nurses discussing information in the cafeteria may be overheard; this indiscretion violates HIPAA regulations. Looking up laboratory results for a neighbor is a HIPAA violation, as is discussing a client's condition with one's spouse.

Saturday, 6 July 2019

Q. A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis?

A. The client sees his physician for a check-up yearly.
B. The client has never traveled outside of the country.
C. The client had a liver transplant 2 years ago.
D. The client works in a health care insurance office.

Correct Answer: C

Explanation: A history of immunocompromised status, such as that which occurs with liver transplantation, places the client at a higher risk for contracting tuberculosis. Other risk factors include inadequate health care, traveling to countries with high rates of tuberculosis (such as southeastern Asia, Africa, and Latin America), being a health care worker who performs procedures in which exposure to respiratory secretions is likely, and being institutionalized.

Friday, 5 July 2019

Q. When obtaining the vital signs of a client with multiple traumatic injuries, a nurse detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings may reflect which complication?

A. Shock
B. Encephalitis
C. Increased intracranial pressure (ICP)
D. Status epilepticus

Correct Answer: C

Explanation: When ICP increases, Cushing's triad may develop, which involves decreased heart and respiratory rates and increased systolic blood pressure. Shock typically causes tachycardia, tachypnea, and hypotension. In encephalitis, the temperature rises and the heart and respiratory rates may increase from the effects of fever on the metabolic rate. (If the client doesn't maintain adequate hydration, hypotension may occur.) Status epilepticus causes unceasing seizures, not changes in vital signs.




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