Thursday, 15 February 2018

Question Of The Day, Antepartum Period
Q. A multigravid client in labor at 38 weeks' gestation has been diagnosed with Rh sensitization and probable fetal hydrops and anemia. When the nurse observes the fetal heart rate pattern on the monitor, which of the following patterns is most likely?

A. Early deceleration pattern.
B. Sinusoidal pattern.
C. Variable deceleration pattern.
D. Late deceleration pattern.

Correct Answer: B

Explanation: The fetal heart rate of a multipara diagnosed with Rh sensitization and probable fetal hydrops and anemia will most likely demonstrate a sinusoidal pattern that resembles a sine wave. It has been hypothesized that this pattern reflects an absence of autonomic nervous control over the fetal heart rate resulting from severe hypoxia. This client will most likely require a cesarean delivery to improve the fetal outcome. Early decelerations are associated with head compression; variable decelerations are associated with cord compression; and late decelerations are associated with poor placental perfusion.

Wednesday, 14 February 2018

Question Of The Day, Psychotic Disorders
Q. The mother of a client with chronic undifferentiated schizophrenia calls the visiting nurse in the outpatient clinic to report that her daughter has not answered the phone in 10 days. "She was doing so well for months. I don't know what's wrong. I'm worried." Which of the following responses by the nurse is most appropriate?

A. "Maybe she's just mad at you. Did you have an argument?"
B. "She may have stopped taking her medications. I'll check on her."
C. "Don't worry about this. It happens sometimes."
D. "Go over to her apartment and see what's going on."

Correct Answer: B

Explanation: Noncompliance with medications is common in the client with chronic undifferentiated schizophrenia. The nurse has the responsibility to assess this situation. Asking the mother if they've argued or if the client is mad at the mother or telling the mother to go over to the apartment and see what's going on places the blame and responsibility on the mother and therefore is inappropriate. Telling the mother not to worry ignores the seriousness of the client's symptoms.


Tuesday, 13 February 2018

Q. A 40-year-old executive who was unexpectedly laid off from work 2 days earlier complains of fatigue and an inability to cope. He admits drinking excessively over the previous 48 hours. This behavior is an example of:

A. alcoholism.
B. a manic episode.
C. situational crisis.
D. depression.

Correct Answer: C

Explanation: A situational crisis results from a specific event in the life of a person who is overwhelmed by the situation and reacts emotionally. Fatigue, insomnia, and inability to make decisions are common signs and symptoms. The situational crisis may precipitate behavior that causes a crisis (alcohol or drug abuse). There isn't enough information to label this client an alcoholic. A manic episode is characterized by euphoria and labile affect. Symptoms of depression are usually present for 2 or more weeks.

Monday, 12 February 2018

Question Of The Day, Foundations of Psychiatric Nursing
Q. The family of an older adult wants their mother to have counseling for depression. During the initial nursing assessment, the client denies the need for counseling. Which of the following comments by the client supports the fact that the client may not need counseling?

A. "My doctor just put me on an antidepressant, and I'll be fine in a week or so."
B. "My daughter sent me here. She's mad because I don't have the energy to take care of my grandkids."
C. "Since I've gotten over the death of my husband, I've had more energy and been more active than before he died."
D. "My son got worried because I made this silly comment about wanting to be with my husband in heaven."

Correct Answer: C

Explanation: Resolving grief and having increased energy and activity convey good mental health, indicating that counseling is not necessary at this time. Taking an antidepressant or having less energy and involvement with grandchildren reflects possible depression and the need for counseling. Wanting to be with her dead husband suggests possible suicidal ideation that warrants serious further assessment and counseling.

Saturday, 10 February 2018

Question Of The Day, Infant
Q. A nurse is caring for a family whose infant has anencephaly. The most appropriate nursing intervention is to:

A. help the family prepare for the infant's imminent death.
B. implement measures to facilitate the attachment process.
C. provide emotional support so the family can adjust to the birth of an infant with health problems.
D. prepare the family for the extensive surgical procedures the infant will require.

Correct Answer: A

Explanation: Anencephaly is incompatible with life. The nurse should support family members as they prepare for the infant's imminent death. Facilitating the attachment process, helping the family to adjust to the infant's problems, and preparing the family for extensive surgical procedures are inappropriate because the infant can't survive.

Friday, 9 February 2018

Question Of The Day, The Nursing Process
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.

Thursday, 8 February 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.

While there is a well-known shortage of registered nurses, current U.S. Immigration laws can make it difficult for foreign-educated nurses to obtain jobs. It is important for those interested in pursuing this avenue to obtain the proper visas and paperwork from the U.S. Citizenship and Immigration Services department. 

8-Steps To Work In The U.S. As A Nurse


There are eight key steps foreign-educated nurses will need to take in order to obtain a position as an RN in a U.S. hospital. 

1. Meet the educational requirements
2. Take and pass an English language proficiency test, if mandated.
3. Obtain credential evaluation  
4. Pass your National Council Licensing Examination-Registered Nurse (NCLEX – RN)
5. Find a nursing recruiting agency or US-based employer
6. Apply and obtain an RN immigrant visa/green card
7. RN visa interview and medical examination
8. Accept an RN position

Education 


First and foremost, international educated nurses must meet basic education requirements. These include: 

◈ Graduation from an accredited Registered Nursing program
◈ Licensing as a Registered Nurse (RN)
◈ Experience practicing as an RN for at least two years

Licensed practical nurses, licensed vocational nurses, and patient care assistants are not eligible to transfer their licenses to the United States.

While the aforementioned are required, most states also require foreign-educated nurses to complete a Foreign Educated Nurses (FEN) refresher course. The course consists of 120 hours in the classroom and 120 hours of clinical practice under the supervision of a licensed Registered Nurse.

English Language Proficiency Tests


After meeting the initial education requirements, some foreign educated nurses must take and pass the Test of English as a Foreign Language (TOEFL), the Test of English for International Communication (TOEIC) or the International English Language Testing System (IELTS). This will vary depending on the country of origin and results are sent directly to the state nursing board. 

Nurses who went to nursing school in the United Kingdom, Australia, New Zealand, Canada (except Quebec), or Ireland are exempt as are those whose spoken language in nursing school was English and/or the nursing school textbooks were written in English.

Pass The NCLEX Examination


After ensuring you meet the education and language requirements it’s time to apply for the NCLEX in the state of intended employment. Registration with Pearson Vue is required and costs $200 plus additional foreign fees.

According to the webpage, NCLEX examinations are currently administered in Australia, Canada, England, Germany, Hong Kong, India, Japan, Mexico, Philippines, Puerto Rico, and Taiwan. 

Credentials Evaluation And Reports


The Commission on Graduates of Foreign Nursing Schools (CGFNS) is a company that is employed by State Boards of Nursing to ensure that applicants meet the basic requirements and are fit to take the NCLEX.

Established in 1977 after a thorough investigation of the immigration of foreign-born and educated registered nurses, the U.S. Department of State and Labor developed the Commission with a dual purpose: to ensure safe patient care to Americans and to help prevent the exploitation of graduates from foreign nursing schools who are employed in the United States to practice.

This company specifically will go through all nursing school transcripts and education history from your home country. While this company is the most popular and most well known - it is expensive and each state requires different levels of credentialing. 

There are three main credentialing reports: 

1. Credentials Evaluation Service Professional Report
2. CGFNS Certification Program
3. Visa Credentials Assessment

Credentials Evaluation Service Professional Report


This report is less involved and cheaper than the Certificate Program or VisaScreen. It provides the basic information for the State Board of Nursing and only a handful of states accept this. 

Below are the requirements you’ll need to mee:

◈ English Requirement
◈ Secondary School Documents
◈ Licensure Documents from your Home Country
◈ Nursing Education Documents from your Home Country
◈ $350 Fee

CGFNS Certification Program


This evaluation is the same as above but requires the applicant to take the CGFNS Qualifying Exam.

Here are some specifics:

◈ Everything in a Credentials Evaluation Service Professional Report
◈ CGFNS Qualifying Exam 
◈ $445 Fee

The CGFNS Qualifying Exam helps states determine if foreign-educated nurses are well suited to care for patients in America. According to the CGFNS web page, individuals must possess a wide variety of nursing knowledge.

Applicants are required to have a minimum number of classroom and clinical hours in required fields such as pediatric nursing, psychiatric nursing, neonatal nursing, and adult medical/surgical nursing. 

The examination is held three times a year at over 40 testing centers across the globe. Individuals may travel to other countries, if needed, in order to take the exam. 

VisaScreen: Visa Credentials Assessment


The same requirements as the CGFNS Certification Program but will qualify the individual for a Work Visa after successful completion of the NCLEX. 

You’ll also need to pay a $540 fee.

Other credentialing services could potentially be cheaper and still accepted by the State Boards of Nursing. It is important to check with the State Board before using a different credential service. Alternatives to CGFNS include:

◈ International Education Research Foundation 
◈ Educational Records Evaluation Service

Obtain Employment Visa “Work Visa”


The next step is to obtain an employment visa. There are several options for these nurses but nurses must have sponsorship from a staffing agency. It is easier for foreign nurses to work with an independent staffing recruiter and agency then directly with a hospital.

Agencies are well versed in helping nurses work in the U.S. and have systems in place in order to ensure all information and paperwork is completed accurately. 

Mexican And Canadian Nurses - TN Visa


Mexican and Canadian nurses may work in the United States with a special TN visa if the individual has an offer of employment, a license to practice in their home country, and pass the NCLEX and state licensure requirements. 

H-1B Temporary Work Visa


Nurses who hold a four-year degree and fulfill a specialized nursing role may qualify for an H-1B temporary work visa and then apply for a green card once stateside. These specialized roles include critical care nurses, emergency room nurses, and/or cardiology nurses.

It is important to note that there a very limited number of H-1C visas available to nurses who want to work in very specific hospitals in underserved communities. 

Permanent Work Visa


The majority of foreign-trained nurses will need to obtain a permanent work visa, otherwise known as a green card. This application needs to be completed prior to travel to the United States and the visa must be obtained before immigrating legally. 

Nurses NOT Eligible To Work In The United States


Unfortunately, not all foreign-educated nurses are eligible to work in the United States. These include but are not limited to:

◈ Nurses with less than two years experience
◈ Nurses lacking a four-year nursing degree
◈ Individuals who have committed a crime
◈ Nurses who lack sponsorship from a reputable nursing agency

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