Wednesday, 17 January 2018

Question Of The Day, Neurosensory Disorders
Q. A nurse, a licensed practical nurse (LPN), and a nursing assistant are caring for a group of clients. The nurse asks the nursing assistant to check the pulse oximetry level of a client who underwent laminectomy. The nursing assistant reports that the pulse oximetry reading is 89%. The client Kardex contains an order for oxygen application at 2 L/min should the pulse oximetry level fall below 92%. The nurse is currently assessing a postoperative client who just returned from the postanesthesia care unit. How should the nurse proceed?

A. Immediately go the client's room and assess vital signs, administer oxygen at 2 L/minute, and notify the physician.
B. Ask the nursing assistant to notify the physician of the low pulse oximetry level.
C. Ask the LPN to obtain vital signs and administer oxygen at 2 L/min to the client who underwent laminectomy.
D. Complete the assessment of the new client before attending to the client who underwent laminectomy.

Correct Answer: C
Explanation: Because it's important to get more information about the client with a decreased pulse oximetry level, the nurse should ask the LPN to obtain vital signs and administer oxygen as ordered. The nurse must attend to the newly admitted client without delaying treatment to the client who is already in her care. The nurse can effectively do this by delegating tasks to an appropriate health team member such as an LPN. The nurse doesn't need to immediately attend to the client with a decreased pulse oximetry level; she may wait until she completes the assessment of the newly admitted client. The physician doesn't need to be notified at this time because an order for oxygen administration is already on record.

Tuesday, 16 January 2018

Question Of The Day, Musculoskeletal Disorders
Q. A nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test, the nurse should place the client in which position?

A. Head of the bed elevated 45 degrees
B. Prone
C. Supine with feet raised
D. Supine with the head lower than the trunk

Correct Answer: A

Explanation: After a myelogram, positioning depends on the dye injected. When a water-soluble dye such as metrizamide is injected, the head of the bed is elevated to a 45-degree angle to slow the upward dispersion of the dye. The prone and supine positions are contraindicated when a water-soluble contrast dye is used. The client should be positioned supine with the head lower than the trunk after an air-contrast study.

Monday, 15 January 2018

Resigning from a job is a natural consequence of having a long, successful working career. However, it is not always easy and can feel very awkward. It’s important to take comfort in the fact that going through a resignation has a massive impact on personal and professional growth.

5 Key Steps To Quitting Your Nursing Job

Here is our best strategy for quitting your nursing job with grace.

1) Deciding to Quit 

There may come a time in your nursing career that you choose to leave a job. There are two phases that comprise resignation: the decision to quit and the action of doing it.

The decision in itself should take a generous amount of time and careful deliberation. Leaving a job can seriously impact you in many aspects - professionally, emotionally, financially – and it’s important to consider the consequences.

To start, evaluate your reasons for wanting to quit. It may stem from frustrations or dissatisfaction within your work environment. If that’s the case, you may ask yourself if you have given management a fair chance to make positive changes with honest feedback and suggestions. Don’t make a hasty decision after one bad shift.

Perhaps your decision to resign derives from external factors in your life like family dynamics, the need to relocate, or financial burden. Others choose to resign from the internal motivation for change, such as career growth, studying for an advanced degree, or accepting a new professional opportunity.

Whatever the reason, be sure to thoroughly consider the advantages and disadvantages of resigning.

2) Giving Notice

With all things considered, if quitting your job is still the best option, then be prepared to take care with the process that follows.

Be calculated in your next steps. Before you actually resign, be sure to tie up all loose ends for your next opportunity. Finalize a start date for your next job, negotiate pay and benefits, confirm a schedule, and get everything documented in writing. If there will be a gap between jobs, budget your savings accordingly and set specific goals for yourself.

Consider the notice you will need to give your current employer. Out of respect for your manager and coworkers, always try to give as much notice as possible. Most legal minimums are 2 weeks, but some hospitals may specify more notice time.

Your employer will need time to find a replacement for you, and in the meantime, it’s possible your unit will operate below ideal staffing. This could result in heavier workload or changes in scheduling for other nurses whom you worked alongside. To find a replacement, your manager will need time for the hiring and interview process, as well as time to train the new employee.

If you do not give adequate notice, you will not be able to use your employer as a reference in the future. Even worse, leaving without notice could put other nurses or patients in jeopardy.

The best approach is to give ample notice (ideally 4 weeks). This will help you to keep a positive rapport with your employer and show respect for your coworkers.

3) How to Tell Your Manager

When you have chosen a date to tell your manager about your decision to resign, you should schedule a time to meet face-to-face. It is important to set up a meeting beforehand, so you and your manager have a dedicated time and space for uninterrupted conversation. It is okay to send an email or write a letter, but there should always be face-to-face follow-up.

Plan what you will say during the meeting ahead of time. You should be clear, concise, and honest about your decision to resign. Be truthful about your reasons for leaving, never lie to your employer. Let them know if it was a difficult decision, and express your sincere gratitude for your most positive experiences.

If you are leaving for reasons of dissatisfaction, be professional and constructive when expressing criticism. It’s possible to lose your train of thought or become clouded from emotion during that meeting, so it is okay to jot down a few key points on a notebook to use as a reference if needed.

The most important thing is to not burn any bridges. Always show respect and professionalism when you leave a place of employment. Express heartfelt and honest appreciation for experiences you cherish and relationships which helped you grow. Circumstances in life change and better opportunities arise – most managers will understand and be supportive!

4) Submitting Formal Resignation

After your conversation with your manager, you will also need to write a formal letter of resignation for Human Resources. The letter or email should be succinct and accurate.

An example:

“Dear [Manager],

I would like to inform you that I am resigning from my position as [Professional Title] in [Healthcare Organization], effective [Date].


[Your Signature]

[Your Typed Name]”

Include your contact information somewhere in the letter. Sign all copies by hand and keep at least one copy for your own reference. Don’t include reasons for leaving or any elaboration in this letter – those are points of discussion for your in-person meeting. The letter for HR is simply a legal documentation of notice for your place of employment.

5) Leaving Gracefully

It is essential to fulfill your commitment as an employee during your last weeks at work. You have a responsibility to your coworkers and patients to take pride and care in your work while you are still present.  Do not call in on your last day and leave your team without support. Show you care, be professional, and focus your energy on the tasks at hand.

Exit interviews are commonly conducted by HR as an opportunity for finalizing pay/benefits, returning identification badges, and collecting honest feedback as a former employee. Although the comments are processed anonymously, only share honest and constructive criticism which can be used for positive changes – nothing malicious or petty.

You may choose to collect manager and colleague information for references in the future. It will always help your career to maintain professional connections after you leave. Thank the people who gave you support, reflect on the experiences which helped you grow, and savor the last moments in your role. 
Question Of The Day, Endocrine and Metabolic Disorders
Q. A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

A. Administer half of the client's typical morning insulin dose as ordered.
B. Administer an oral antidiabetic agent as ordered.
C. Administer an I.V. insulin infusion as ordered.
D. Administer the client's normal daily dose of insulin as ordered.

Correct Answer: A

Explanation: If the nurse administers the client's normal daily dose of insulin while he's on nothing-by-mouth status before surgery, he'll experience hypoglycemia. Therefore, the nurse should administer half the daily insulin dose as ordered. Oral antidiabetic agents aren't effective for type 1 diabetes. I.V. insulin infusions aren't necessary to manage blood glucose levels in clients undergoing routine surgery.

Friday, 12 January 2018

Question Of The Day, Cardiovascular Disorders
Q. Before discharge, which instruction should a nurse give to a client receiving digoxin (Lanoxin)?

A. "Take an extra dose of digoxin if you miss one dose."
B. "Call the physician if your heart rate is above 90 beats/minute."
C. "Call the physician if your pulse drops below 80 beats/minute."
D. "Take digoxin with meals."

Correct Answer: B

Explanation: The nurse should instruct the client to notify the physician if his heart rate is greater than 90 beats/minute because cardiac arrhythmias may occur with digoxin toxicity. To prevent toxicity, the nurse should instruct the client never to take an extra dose of digoxin if he misses a dose. The nurse should show the client how to take his pulse and tell him to call the physician if his pulse rate drops below 60 beats/minute — not 80 beats/minute, which is a normal pulse rate and doesn't warrant action. The client shouldn't take digoxin with meals; doing so slows the absorption rate.

Thursday, 11 January 2018

Question Of The Day, The Neonate
Q. The neonate of a client with type 1 diabetes is at high risk for hypoglycemia. An initial sign the nurse should recognize as indicating hypoglycemia in a neonate is:

A. peripheral acrocyanosis.
B. bradycardia.
C. lethargy.
D. jaundice.

Correct Answer: C

Explanation: Lethargy in the neonate may be seen with hypoglycemia because of a lack of glucose in the nerve cells. Peripheral acrocyanosis is normal in the neonate because of immature capillary function. Tachycardia — not bradycardia — is seen with hypoglycemia. Jaundice isn't a sign of hypoglycemia.

Tuesday, 9 January 2018

Question Of The Day, Intrapartum Period
Q. A client with Rh isoimmunization gives birth to a neonate with an enlarged heart and severe, generalized edema. The neonate is immediately transferred to the neonatal intensive care unit. Which nursing diagnosis is most appropriate for the client?

A. Ineffective denial related to a socially unacceptable infection
B. Impaired parenting related to the neonate's transfer to the intensive care unit
C. Deficient fluid volume related to severe edema
D. Fear related to removal and loss of the neonate by statute

Correct Answer: B

Explanation: Because the neonate is severely ill and needs to be placed in the neonatal intensive care unit, the client may have a nursing diagnosis of Impaired parenting related to the neonate's transfer to the neonatal intensive care unit. (Another pertinent nursing diagnosis may be Compromised family coping related to lack of opportunity for bonding.) Rh isoimmunization isn't a socially unacceptable infection. This condition causes an excess fluid volume (not deficient) related to cardiac problems. Rh isoimmunization doesn't lead to loss of the neonate by statute.
Nursing Care, Nursing Tutorials and Materials, Nursing Education

If you aspire to become a nurse, you'll want to familiarize yourself with what Nursing Care Plans (NCPs) are all about. Nursing care plans provide a means of communication among nurses, their patients, and other healthcare providers to achieve healthcare outcomes.

In essence, quality patient care that is consistent stems from a detailed NCP. What's more is a nursing care plan provides documentation of the care that was administered, something that is required by health insurance companies, and for patient health records.

A Closer Look at NCPs 

In most nursing workplaces, patient care is a team effort. Whether it’s one nurse taking over another’s shift, or a collaboration between different healthcare professionals, having a consistent care plan is what will ensure that everyone is on the same page.

A nursing care plan contains all of the relevant information about a patient’s diagnoses, the goals of treatment, the specific nursing orders (including what observations are needed and what actions must be performed), and a plan for evaluation. Over the course of the patient’s stay, the plan is updated with any changes and new information as it presents itself.

Creating a care plan

Depending on the workplace, nursing care plans can vary. In most cases, however, you can expect that they will include the same pertinent information: the diagnoses, the anticipated outcome, nursing orders, and evaluation.


According to the North American Nursing Diagnosis Organization-International (NANDA-I), nursing diagnoses compile a list of health problems or conditions that the patient is facing. This information is used to determine the appropriate care that the patient will receive.

In order to make a diagnosis, a thorough patient assessment must take place. According to the American Nurses Association, that assessment should include physiological, psychological, sociocultural, spiritual, and economic data, as well as other lifestyle factors.

In addition to just listing the diagnoses, a good care plan will also define them so there is no confusion moving forward. So for example, pneumonia is an excess fluid in the lungs.


After a nurse performs a patient assessment and the diagnosis is made, the next step is to map out goals for the patient for both the short- and long-term. For instance, if a patient is diagnosed with acute pain from hypertension, the desired outcome might be that the patient begins a new prescription and the pain becomes is controlled.

Nursing Orders/Interventions

This is the part of the nursing care plan where all the action is. Based on the diagnosis and the desired outcome, here, nurses will have a checklist of how to care for the patient. It might include things like checking vital signs every few hours, assess patient by asking pain scale questions, provide medication, etc. Expect to include a lot of specifics here, including times, dosages, etc.

This part of the nursing care plan will be adjusted accordingly as the patient’s condition improves or changes in any way. All care is carefully documented in the patient’s health record and will be used to determine if the patient can be discharged.


Throughout the patient’s stay, their status will be monitored and evaluated so that the plan can be updated as necessary.  As progress is made toward the patient goal, the evaluation is used to determine if the nursing orders need to change, or are complete.

Putting NCPs into Practice

Learning how to create a nursing care plan is something you will learn a lot about in nursing school, and then later, on the job as a Registered Nurse. The good news is that you are not on your own.

There are many online resources that provide templates, sample care plans, and even video tutorials to help you learn the ropes of NCPs. There’s even an app from NANDA that gives you access to over 300 common care plans.

You can also search for NCPs by your specific nursing specialization, for example, such as if you work in medical-surgical or pediatrics. Even Pinterest has a collection of nursing care plans to peruse.

Learning how to write up a nursing care plans is a vital part of your responsibilities as an RN. The key is to be detailed and accurate and to use the resources that are available to help you.




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