Wednesday, 17 October 2018

Q. During rounds, a nurse finds that a client with hemiplegia has fallen from the bed because the nursing assistant failed to raise the side rails after giving a back massage. The nurse assists the client to the bed and assesses for injury. As per agency policies, the nurse fills out an incident report. Which of the following activities should the nurse perform after finishing the incident report?

A. Attach a copy to the client's records.
B. Highlight the mistake in the client's records.
C. Include the time and date of the incident.
D. Mention the name of the nursing assistant in the client records.

Correct Answer: C

Explanation: The nurse should include the date and time of the incident in the incident report, the events leading up to it, the client's response, and a full nursing assessment. To prevent legal issues, the nurse should not attach the copy of the incident report to the client's records. Also to prevent litigation, the mistake should not be highlighted in the client's records. As the client report is a legal document, it should not contain the name of the nursing assistant.


Tuesday, 16 October 2018

Question Of The Day, Medication and I.V. Administration
Q. The client is receiving an I.V. infusion of 5% dextrose in normal saline running at 125 ml/hour. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first:

A. Discontinue the infusion.
B. Apply a warm soak to the site.
C. Stop the flow of solution temporarily.
D. Irrigate the needle with normal saline.


Correct Answer: A

Explanation: Signs of infiltration include slowing of the infusion and swelling, pain, hardness, pallor, and coolness of the skin at the site. If these signs occur, the I.V. line should be discontinued and restarted at another infusion site. The new anatomic site, time, and type of cannula used should be documented. The nurse may apply a warm soak to the site, but only after the I.V. line is discontinued. Parenteral administration of fluids should not be stopped intermittently. Stopping the flow does not treat the problem, nor does it address the client's needs for fluid replacement. Infiltrated I.V. sites should not be irrigated; doing so will only cause more swelling and pain.

Saturday, 13 October 2018

Q. A client with a tracheostomy tube coughs and dislodges the tracheostomy tube. The nurse's first action should be to:

A. Call for emergency assistance.
B. Attempt reinsertion of tracheostomy tube.
C. Position the client in semi-Fowler's position with the neck hyperextended.
D. Insert the obturator into the stoma to reestablish the airway.



Correct Answer: B

Explanation: The nurse's first action should be to attempt to replace the tracheostomy tube immediately so that the client's airway is reestablished. Although the nurse may also call for assistance, there should be no delay before attempting reinsertion of the tube. The client is placed in a supine position with the neck hyperextended to facilitate reentry of the tube. The obturator is inserted into the replacement tracheostomy tube to guide insertion and is then removed to allow passage of air through the tube.

Thursday, 11 October 2018

Q. Which finding best indicates that a nursing assistant has an understanding of blood glucose meter use?

A. Verbalizing an understanding of blood glucose meter use
B. Documenting a normal blood glucose level
C. Providing documentation of previous certification
D. Demonstrating correct technique


Correct Answer: D

Explanation: The best way to validate blood glucose meter use is to allow the nursing assistant to demonstrate correct technique. Verbalizing understanding doesn't demonstrate that the nursing assistant knows proper technique. Documenting a normal blood glucose level and having previous certification don't demonstrate blood glucose meter use.

Tuesday, 9 October 2018

Leaders are change agents, and all nurses are leaders at some level – whether it entails persuading patients to take the steps needed to regain or maintain their health, being a mentor and role model to less experienced nurses, or working as a nurse manager. Everyone can benefit by developing their leadership skills, and it is essential for advancing your career in nursing.

Nursing Skill, Nursing Tutorial and Material, Nursing Career

The need for strong leadership in nursing is taking center stage in discussions around moving the profession forward and meeting the global goal of universal health coverage. “You know your patients, and you know their needs, and you have to be involved in health policy at every level,” emphasized Anette Kennedy, President of the ICN, in her end of year message for 2017.


A leader is someone who can effect change by inspiring and empowering others to work towards accomplishing individual or organizational goals. Good leaders have qualities such as positivity, flexibility, and strategic vision. They can solve problems as well as communicate and delegate effectively.

It is never too early to start developing your leadership skills. These skills can be learned and developed, contrary to the popular belief that leaders are born and not made.

1. Work on your strengths and weaknesses 


One of the characteristics of great leaders is a high level of self-awareness – they know in which areas they are strong and where their weaknesses lie, as well as what their most effective leadership style is.

Everyone has certain natural abilities as well as skills developed over their lifetimes. Everyone also has weaknesses. Self-examination will help you to identify the strengths that you can use to your advantage as well as the weaknesses you can consciously work on to improve.

Consider the people in your life who you feel are excellent leaders (managers are hierarchical heads, but they are not necessarily outstanding leaders). What qualities make these people leaders? Which of these qualities do you possess and what are the areas you could work on?

There are also many questionnaires and exercises on the web that can help you with self-analysis. For example, you can take a quiz to identify your current personal leadership style, which will also give you an indication of where you need to develop your abilities.

Active reflection is probably the most effective learning tool for skills development. Start a journal in which you reflect on incidents at work – write about situations that you managed well, and why, and also those where you could have acted differently. Think about what behavior would have been more effective.

2. Be positive and enthusiastic 


When you think about effective leaders, you don’t get a picture of grumpy, complaining and rude people. Inspirational leaders are passionate about their work, and if their plans don’t succeed at first they will try again – their positive attitude attracts people, and their passion becomes infectious.

Always aim to be the role model that you would follow. Be enthusiastic about your work with a “can do” attitude, even in difficult situations. Go the extra mile when needed – you are get noticed and earn respect when you do more than what is expected of you. Use initiative and attempt to solve problems before you hand them over to others, and even come up with suggestions of how things can be improved for everyone in your working situation.

3. Maintain your morals and values


People follow those in whom they sense a high level of integrity and authenticity – those you “walk the talk” and that they can believe in.

Live out your morals and values – do your work according to the highest possible professional standards, be honest in all things, deliver on the commitments and promises you make, and accept personal responsibility when you make a mistake. Avoid taking things personally or making assumptions without first determining the truth. 

4. Develop excellent communication skills 


Leadership goes hand-in-hand with being an outstanding communicator. You cannot achieve your goals of motivating, guiding, influencing and persuading others without communicating well and creating real personal connections.

Develop your skills in both spoken and written communication and never forget that communication flows in two directions. An important part of communication is listening – really listening to what the other person is saying, to show that you are interested in them and their opinion, and also picking up on their non-verbal cues. 

5. Continuously expand your knowledge


Extensive knowledge which can be mined to come up with ideas and solutions are the key to the vision, innovation and critical thinking of great leaders. They can identify opportunities or foresee problems and threats before they arise, and plan strategic action.

You not only need to keep up with the date with changes in your field of expertise but also to grow your knowledge on a wide variety of topics related to the world around you. Offer to help with tasks and projects that will help you to expand your skills. Use opportunities to attend continuing education workshops, seminars, and conferences. Have discussions and ask questions, from anyone and everyone, to get information and to learn about different perspectives. Read continuously and widely.

6. Join professional and community organizations 


Active membership in organizations – whether nursing organizations, student bodies or those dealing with community issues that you support – provide many opportunities for leadership development.

You can expand your knowledge and insight about issues affecting the profession or your community and learn how leaders approach advocacy, activism, and lobbying. Grab any opportunity to serve on committees as this will give you many different experiences in a leadership role.

Being active in organizations also provides you with the opportunity for networking – meeting and building relationships with a variety of different people with whom you can share your ideas and vision. These connections can offer valuable feedback and advice as well as provide you with motivation and support.
Q. When assessing a client for early septic shock, the nurse should assess the client for which of the following?

A. Cool, clammy skin.
B. Warm, flushed skin.
C. Increased blood pressure.
D. Hemorrhage.




Correct Answer: B

Explanation: Warm, flushed skin from a high cardiac output with vasodilation occurs in warm shock or the hyperdynamic phase (first phase) of septic shock. Other signs and symptoms of early septic shock include fever with restlessness and confusion; normal or decreased blood pressure with tachypnea and tachycardia; increased or normal urine output; and nausea and vomiting or diarrhea. Cool, clammy skin occurs in the hypodynamic or cold phase (later phase). Hemorrhage is not a factor in septic shock.

Monday, 8 October 2018

Q. Just after delivery, a nurse measures a neonate's axillary temperature at 94.1° F (34.5° C). What should the nurse do?

A. Rewarm the neonate gradually.
B. Rewarm the neonate rapidly.
C. Observe the neonate hourly.
D. Notify the physician when the neonate's temperature is normal.



Correct Answer: A

Explanation: A neonate with a temperature of 94.1° F is experiencing cold stress. To correct cold stress while avoiding hyperthermia and its complications, the nurse should rewarm the neonate gradually, observing closely and checking vital signs every 15 to 30 minutes. Rapid rewarming may cause hyperthermia. Hourly observation isn't frequent enough because cold stress increases oxygen, calorie, and fat expenditure, putting the neonate at risk for anabolic metabolism and possibly metabolic acidosis. A neonate with cold stress requires intervention; the nurse should notify the physician of the problem as soon as it's identified.

Friday, 5 October 2018

Q. A client with a tentative diagnosis of psychosis is admitted to the psychiatric unit. A physician orders the phenothiazine thioridazine 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:

A. deeper sleep than CNS depressants.
B. greater sedation than CNS depressants.
C. a calming effect from which the client is easily aroused.
D. more prolonged sedative effects, making the client more difficult to arouse.

Correct Answer: C

Explanation: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.

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