Wednesday, 21 November 2018

Q. When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which of the following points?

A. Halfway between the client's symphysis pubis and umbilicus.
B. At about the level of the client's umbilicus.
C. Between the client's umbilicus and xiphoid process.
D. Near the client's xiphoid process and compressing the diaphragm.

Correct Answer: B

Explanation: Measurement of the client's fundal height is a gross estimate of fetal gestational age. At 20 weeks' gestation, the fundal height should be at about the level of the client's umbilicus. The fundus typically is over the symphysis pubis at 12 weeks. A fundal height measurement between these two areas would suggest a fetus with a gestational age between 12 and 20 weeks. The fundal height increases approximately 1 cm/week after 20 weeks' gestation. The fundus typically reaches the xiphoid process at approximately 36 weeks' gestation. A fundal height between the umbilicus and the xiphoid process would suggest a fetus with a gestational age between 20 and 36 weeks. The fundus then commonly returns to about 4 cm below the xiphoid owing to lightening at 40 weeks. Additionally, pressure on the diaphragm occurs late in pregnancy. Therefore, a fundal height measurement near the xiphoid process with diaphragmatic compression suggests a fetus near the gestational age of 36 weeks or older.

Tuesday, 20 November 2018

A few weeks ago, I took my oldest daughter in for a flu shot. I signed the paperwork, looked over the informational pamphlet, and reassured her when the medical assistant brought the imposing-looking syringe into the room.

Nursing Responsibilities, Nursing Job, Nursing Career, Nursing Professionals

And then, I cringed when she proceeded to shut the door behind her, pull open a band-aid and stick it to her bare hand, then jab my daughter with the shot, all without wearing any gloves. I thought back to my time as a nurse at the hospital—had I ever administered a vaccine without wearing gloves? Was it required? Was I overreacting in thinking she should wear gloves?

I honestly couldn’t think of a time when I hadn’t worn gloves to give a vaccine, so I piped up and said something to the assistant, not-very-kindly suggested that she should be sure to wear gloves next time. But when I got home and did some research, I sheepishly realized that I was the one who had been wrong, not her. Turns out, gloves aren’t required to give vaccinations and I was actually a big ol’ jerk to the poor young woman.

Oops.

According to the Centers for Disease Control (CDC) and Administration’s Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP), wearing gloves is not required for healthcare workers who are administering vaccinations. The official guidelines state: “Occupational Safety and Health Administration (OSHA) regulations do not require gloves to be worn when administering vaccinations unless persons administering vaccinations have open lesions on their hands or are likely to come into contact with a patient’s body fluids.”

The rules on vaccines + gloves


So, if gloves aren’t required, what is required? Well, basic handwashing and clean hygiene, essentially. As the guidelines state: “Persons administering vaccinations should follow appropriate precautions to minimize risk for disease exposure and spread. Hands should be cleaned with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing vaccines for administration and between each patient contact.”

Kasey Baylis, 26, a public health nurse for Oakland County in Michigan who works with the Vaccine for Children program as a partner provider and immunization nurse educator, tells Nurse.org that she has given “hundreds of shots” in her lifetime as a nurse.

With a job that literally entails making sure vaccines are stored, handled, and administered correctly, Baylis is a woman who knows about vaccine safety. She explains that the way she was trained and the way she continues to train others on vaccine administration is that the administrator should properly wash his/her hands and use aseptic technique when administering the vaccine (i.e. using alcohol to clean the injection site, not contaminating the site after cleaned and not contaminating the needle), but that gloves are not required unless the nurse or healthcare worker has any open lesions or is likely to come in contact with the person's bodily fluids.

Gloves aren’t really that clean anyways


Baylis also points out that if a vaccine is administered correctly, there should be little, if any, bodily fluid exposure and that contrary to popular belief, the gloves sitting in an open box in a doctor’s office or health clinic really aren’t all that much more sanitary than a clean pair of hands. In fact, the gloves may even contain more germs than clean hands. “Gloves are not required and generally do not provide any additional benefit to the patient,” she adds.

If gloves are worn, the administrator is still required to wash his or her hands between injections and patients, to remove any germs that may have transferred from the gloves to their hands. And many times, the only benefit to wearing gloves during vaccine administration is for protection for the administrator, not the patient.

Should you ask for gloves if you want them? 


That being said, if you are just plain uncomfortable with the idea of a healthcare worker giving you or your family a vaccine without wearing gloves, Baylis encourages the idea of speaking up and asking them to don a pair of gloves before an injection, simply because in her mind, if that means one more person is vaccinated against a preventable disease, then it’s worth it.

“When it comes to vaccines and all of the negative propaganda out there, I feel that gloves should not be another barrier to being immunized,” she says. “Adhering to the ACIP recommended schedule is your best protection against vaccine-preventable diseases that still exist today, so ultimately, if that means wearing gloves for a patient than I would gladly do it!” 
Question Of The Day, Psychotic Disorders
Q. The client is taking risperidone (Risperdal) to treat the positive and negative symptoms of schizophrenia. Improvement of which of the following negative symptoms indicate the drug is effective?

A. Abnormal thought form.
B. Hallucinations and delusions.
C. Bizarre behavior.
D. Asocial behavior and anergia.


Correct Answer: D

Explanation: Asocial behavior, anergia, alogia, and affective flattening are some of the negative symptoms of schizophrenia that may improve with risperidone therapy. Abnormal thought form is a positive symptom of schizophrenia. Hallucinations and delusions are positive symptoms of schizophrenia. Bizarre behavior is a positive symptom of schizophrenia.

Monday, 19 November 2018

Q. The wife of a 67-year-old client who has been taking imipramine (Tofranil) for 3 days asks the nurse why her husband isn't better. The nurse should tell the wife:

A. "It takes 2 to 4 weeks before the full therapeutic effects are experienced."
B. "Your husband may need an increase in dosage."
C. "A different antidepressant may be necessary."
D. "It can take 6 weeks to see if the medication will help your husband."

Correct Answer: A

Explanation: Imipramine, a tricyclic antidepressant, typically requires 2 to 4 weeks of therapy before the full therapeutic effects are experienced. Because the client has been taking the drug for only 3 days, it is too soon to determine if the current dosage of imipramine is effective. It is also too soon to consider taking another antidepressant.

Saturday, 17 November 2018

Q. After staying several hours with her 9-year-old daughter who is admitted to the hospital with an asthma attack, the mother leaves to attend to her other children. The child exhibits continued signs and symptoms of respiratory distress. Which of the following findings should lead the nurse to believe the child is experiencing anxiety?

A. Not able to get comfortable.
B. Frequent requests for someone to stay in the room.
C. Inability to remember her exact address.
D. Verbalization of a feeling of tightness in her chest.

Correct Answer: B

Explanation: A 9-year-old child should be able to tolerate being alone. Frequently asking for someone to be in the room indicates a degree of psychological distress that, at this age, suggests anxiety. The inability to get comfortable is more characteristic of a child in pain. Inability to answer questions correctly may reflect a state of anoxia or a lack of knowledge. Tightness in the chest occurs as a result of bronchial spasms.

Friday, 16 November 2018

Question Of The Day, Medication and I.V. Administration
Q. A nurse is helping a physician insert a subclavian central line. After the physician has gained access to the subclavian vein, he connects a 10-ml syringe to the catheter and withdraws a sample of blood. He then disconnects the syringe from the port. Suddenly, the client becomes confused, disoriented, and pale. The nurse suspects an air embolus. She should:

A. place the client in a supine position and prepare to perform cardiopulmonary resuscitation.
B. place the client in high-Fowler's position and administer supplemental oxygen.
C. turn the client on his left side and place the bed in Trendelenburg's position.
D. position the client in the shock position with his legs elevated.

Correct Answer: C

Explanation: A nurse who suspects an air embolism should place the client on his left side and in Trendelenburg's position. Doing so allows the air to collect in the right atrium rather than enter the pulmonary system. The supine position, high-Fowler's position, and the shock position are therapeutic for other situations but not for air embolism.

Thursday, 15 November 2018

Q. A client with burns on his groin has developed blisters. As the client is bathing, a few blisters break. The best action for the nurse to take is to:

A. remove the raised skin because the blister has already broken.
B. wash the area with soap and water to disinfect it.
C. apply a weakened alcohol solution to clean the area.
D. clean the area with normal saline solution and cover it with a protective dressing.

Correct Answer: D

Explanation: The nurse should clean the area with a mild solution such as normal saline, and then cover it with a protective dressing. Soap and water and alcohol are too harsh. The body's first line of defense broke when the blisters opened; removing the skin exposes a larger area to the risk of infection.

Wednesday, 14 November 2018

Q. A pregnant client in her third trimester is started on chlorpromazine (Thorazine) 25 mg four times daily. Which of the following instructions is most important for the nurse to include in the client's teaching plan?

A. "Don't drive because there's a possibility of seizures occurring."
B. "Avoid going out in the sun without a sunscreen with a sun protection factor of 25."
C. "Stop the medication immediately if constipation occurs."
D. "Tell your doctor if you experience an increase in blood pressure."

Correct Answer: B

Explanation: Chlorpromazine is a low-potency antipsychotic that is likely to cause sun-sensitive skin. Therefore the client needs instructions about using sunscreen with a sun protection factor of 25 or higher. Typically, chlorpromazine is not associated with an increased risk of seizures. Although constipation is a common adverse effect of this drug, it can be managed with diet, fluids, and exercise. The drug does not need to be discontinued. Chlorpromazine is associated with postural hypotension, not hypertension. Additionally, if postural hypotension occurs, safety measures, such as changing positions slowly and dangling the feet before arising, not stopping the drug, are instituted.

Facebook

Google+

Twitter

Popular Posts

Blog Archive

Total Pageviews