Saturday, 19 January 2019

Q. Prochlorperazine (Compazine) is prescribed postoperatively. The nurse should evaluate the drug's therapeutic effect when the client expresses relief from which of the following?

A. Nausea.
B. Dizziness.
C. Abdominal spasms.
D. Abdominal distention.



Correct Answer: A


Explanation: Prochlorperazine is administered postoperatively to control nausea and vomiting. Prochlorperazine is also used in psychotherapy because of its effects on mood and behavior. It is not used to treat dizziness, abdominal spasms, or abdominal distention.

Friday, 18 January 2019

Q. A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client?

A. Wear sterile gloves.
B. Place incontinence pads in the regular trash container.
C. Wear personal protective equipment when handling blood, body fluids, and feces.
D. Provide a urinal or bedpan to decrease the likelihood of soiling linens.

Correct Answer: C

Explanation: Chemotherapy drugs are present in the waste and body fluids of clients for 48 hours after administration. The nurse should wear personal protective equipment when handling blood, body fluids, or feces. Gloves offer minimal protection against exposure. The nurse should wear a face shield, gown, and gloves when exposure to blood or body fluid is likely. Placing incontinence pads in the regular trash container and providing a urinal or bedpan don't protect the nurse caring for the client.

Thursday, 17 January 2019

Q. A client with chronic heart failure is receiving digoxin (Lanoxin), 0.25 mg by mouth daily, and furosemide (Lasix), 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity may also cause:

A. visual disturbances.
B. taste and smell alterations.
C. dry mouth and urine retention.
D. nocturia and sleep disturbances.

Correct Answer: A

Explanation: Digoxin toxicity may cause visual disturbances (such as, flickering flashes of light, colored or halo vision, photophobia, blurring, diplopia, and scotomata), central nervous system abnormalities (such as headache, fatigue, lethargy, depression, irritability and, if profound, seizures, delusions, hallucinations, and memory loss), and cardiovascular abnormalities (abnormal heart rate and arrhythmias). Digoxin toxicity doesn't cause taste and smell alterations. Dry mouth and urine retention typically occur with anticholinergic agents, not inotropic agents such as digoxin. Nocturia and sleep disturbances are adverse effects of furosemide — especially if the client takes the second daily dose in the evening, which may cause diuresis at night.


Wednesday, 16 January 2019

Question Of The Day, The Neonate
Q. During the first feeding, the nurse observes that the neonate becomes cyanotic after gagging on mucus. Which of the following should the nurse do first?

A. Start mouth-to-mouth resuscitation.
B. Contact the neonatal resuscitation team.
C. Raise the neonate's head and pat the back gently.
D. Clear the neonate's airway with suction or gravity.

Correct Answer: D

Explanation: If a neonate gags on mucus and becomes cyanotic during the first feeding, the airway is most likely closed. The nurse should clear the airway by gravity (by lowering the infant's head) or suction. Starting mouth-to-mouth resuscitation is not indicated unless the neonate remains cyanotic and lowering his head or suctioning doesn't clear his airway. Contacting the neonatal resuscitation team is not warranted unless the infant remains cyanotic even after measures to clear the airway. Raising the neonate's head and patting the back are not appropriate actions for removing mucus. Doing so allows the mucus to remain lodged causing further breathing difficulties.


Tuesday, 15 January 2019

Q. On the second postpartum day a gravida 6, para 5 complains of intermittent abdominal cramping. The nurse should assess for:

A. endometritis.
B. postpartum hemorrhage.
C. subinvolution.
D. afterpains.




Correct Answer: D

Explanation: In a multiparous client, decreased uterine muscle tone causes alternating relaxation and contraction during uterine involution, which leads to afterpains. The client's symptoms don't suggest endometritis, hemorrhage, or subinvolution.

Friday, 11 January 2019

Q. A client with chronic undifferentiated schizophrenia is admitted to the psychiatric unit of a local hospital. During the next several days, the client is seen laughing, yelling, and talking to himself. This behavior is characteristic of:

A. delusion.
B. looseness of association.
C. illusion.
D. hallucination.


Correct Answer: D

Explanation: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.




Thursday, 10 January 2019

There was an article that was released about nurses being overworked, overstressed, and underpaid. Nurses are working two or three jobs just to maintain their cost of living and pay down debt from nursing school and previous degrees. Others are frustrated with the time and the demands of the job and are leaving the profession all together to go into sales or other professions for the sake of quality of life. Some will even drive Uber on the weekends just to make extra money that doesn’t involve a bed or tele-alarms.


As a nurse of 5 years working from coast to coast, I have witnessed this first hand and very much felt it myself. Our job is crazy at times and if we aren’t careful, it can burn us out to a crisp. Although sometimes you need to make difficult decisions and leave a facility or even the career for the sake of bringing in higher cash flow, my heart feels for the nurses who are in that place right now. I hear you, I see you.

This piece is to share with all my fellow nurses, some good energy for the New Year. Life is crazy, our job is stressful and quite unglamorous at times, but it doesn’t always have to weigh heavy on your heart. For those of you who are feeling the burn of this job, here are a few tips on how to bring in that good energy into 2019…

1. Take a deep breath


Start right now. Take a deep breath, close your eyes, hold it, and then let it out. Remember this point when you’re in the “thick” of it. Yes, you may not have time to eat and you may not have time to pee (all habits we really need to let go of in 2019) but one thing you do have time to do is TAKE A DEEP BREATH. Link it to a task – every time you’re at the Pyxsis or the Omnicel, put your finger down on the reader, close your eyes and take a deep breath. Let this habit spread to all aspects of your day: when you’re opening that new bag of fluids, running to get the code cart, or sitting down to finally chart. And don’t do one of those sighs that lead to a defeated slouch. Sit up straight and make your Respiratory Therapist proud of that big deep breath. 

2. Get a hobby


Everyone needs something to do that they enjoy. If your next thought is, “well I don’t know what I like,” then think about something small that you’ve been curious about, even just mildly. Maybe it’s buying that one pretty ceramic pot you saw to put a plant in it  or learning how to work a camera. Perhaps it’s picking up a new recipe to try. Whatever has crossed your mental sphere and piqued your interest, do just that. 

3. Invest in yourself 


This means different things to different people. If you’re a spa and massage person, then by all means, book the appointment or if you’re a get outside and hike person, put those hiking boots on! The most important thing is to know what feeds you and what fuels you; whatever it is,  also do that.

4. Have a saving system that works for you


Seeing that money build up in your bank account is not only empowering and exciting but smart. This is what works for my husband and me: both our paychecks go straight into a checking account with no debit card linked to it. On payday every Friday (travel nursing weekly pay) we log into our account and physically transfer our spending money for the week into the checking account with a debit card. Depending on our location and our goals, we calculate how much spending money for the week we will use that will allow us to save what we want to. Living in New York City on two incomes with a savings goal of a solid down payment for a house in the next few years, we allow ourselves $800 a week. From this $800, we will buy groceries, subway fair, lots and lots of eating out, and whatever odds and ends happen throughout the week. Maybe it sounds like a lot, maybe it sounds like a little, but we have found for the two of us in the city, that this is the sweet spot. The rest of our pay goes into savings, minus what is needed for bills and rent, which is directly deducted from the first checking account with no card attached to it. This system makes it easy to log into our bank account and physically see exactly how much money we have left budgeted for the week.

5. Get out of town


Getting out of the drama and the usual work-home-work routine is a very healthy thing to do. You don’t have to go across the world to do this – although that is fun too. But taking a weekend to check out a local retreat, or even a short day trip somewhere close to window shop and eat a nice dinner can help you clear your head and get some distance from work.

6. Focus on the positive attributes that make you enjoy your job


You know they’re out there. You may really like joking with your patients, or you may enjoy the technical procedures. Whatever it is, enjoy it, dwell on that aspect of the job, and not the parts that drive you nuts. Let those parts roll off of you like butter on a hot biscuit. Remember, you are responsible for your own experience of life, and that includes work! Make it a good experience for yourself.

7. This is not forever 


Your situation today will not be your situation forever! Back when I started my nursing career, I fell into a strange depression that came from a place of starting a career I didn’t know if I really liked, working nights, and feeling really alone and incompetent to boot. Now looking back (that was only a handful of years ago) I realize that those first few years were just a small spec on the timeline of my life. I did my due diligence of gaining my experience before I left travel nursing and although I still get quite frustrated with the nature of the job, I know better than to feel like there is no end in sight. Life is whatever you want it to be, and at the very least, you have a career that can support you steadily throughout any economic environment, is versatile, and can set you up for anything else you want to do.

8. Don’t get yourself down – stop that negative self-talk 


I enjoy my job less when I feel that I’m not meeting my own expectations. When I miss something in the report or when another nurse gives me attitude about something I did or did not do, it tends to send me into a spiral of negative self-talk and I mentally beat myself up for it. Finally, I am learning to catch myself at the beginning of those spirals and stop myself in my tracks. I will repeat my mantra: “Good job, Mariam! You’re doing a great job.” It feels silly and even fake at first. But part of the magic of “fake it till you make it” lies in this very quality. What your mind says, you believe. So force yourself to say nice things and you’ll see it makes a difference. 

Yes, many nurses are out there working multiple jobs to make ends meet or would rather leave the profession to gain income in different ways than at the bedside. The point of this message is to really understand yourself; if you are stressed, worried, ready to crack – sit down for a minute and really ask yourself why. Why are you struggling and what would make things better? What is realistic for you and what steps could you take, right now?

If your heart is set on leaving nursing, that’s okay. If you just need to step away for a week or month or year, that’s okay too. If you enjoy the work but know you need to up your income, speak to your boss. Negotiate a pay raise or at least a higher OT rate. Find some financial resources that can help you manage your debt and pay structure, and get you to the place where you want to be. If you’re professionally frustrated and know you need to do something else, whether it’s to go back to school or open that coffee shop you’ve always wanted, do a quick Google search. What are the requirements? What are the start-up costs?
Question Of The Day, Mood, Adjustment, and Dementia Disorders
Q. A client was hospitalized for 1 week with major depression with suicidal ideation. He is taking venlafaxine (Effexor), 75 mg three times a day, and is planning to return to work. The nurse asks the client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it anymore and wouldn't do anything to hurt myself." The nurse should make which judgment about the client?

A. The client is decompensating and in need of being readmitted to the hospital.
B. The client needs an adjustment or increase in his dose of antidepressant.
C. The depression is improving and the suicidal ideation is lessening.
D. The presence of suicidal ideation warrants a telephone call to the client's primary care provider.

Correct Answer: C

Explanation: The client's statements about being in control of his behavior and his or her plans to return to work indicate an improvement in depression and that suicidal ideation, although present, is decreasing. Nothing in his comments or behavior indicate he is decompensating. There is no evidence to support an increase or adjustment in the dose of Effexor or a call to the primary care provider. Typically, the cognitive components of depression are the last symptoms eliminated. For the client to be experiencing some suicidal ideation in the second week of psychopharmacologic treatment is not unusual.

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