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.

Tuesday, 13 November 2018

Q. The nurse has administered aminophylline to a client with emphysema. The medication is effective when there is:

A. Relief from spasms of the diaphragm.
B. Relaxation of smooth muscles in the bronchioles.
C. Efficient pulmonary circulation.
D. Stimulation of the medullary respiratory center.


Correct Answer: B

Explanation: Aminophylline, a bronchodilator that relaxes smooth muscles in the bronchioles, is used in the treatment of emphysema to improve ventilation by dilating the bronchioles. Aminophylline does not have an effect on the diaphragm or the medullary respiratory center and does not promote pulmonary circulation.

Monday, 12 November 2018

Nurses administer hundreds of medications to their patients on a regular basis and are responsible for patient safety. Thus, medication administration becomes a major challenge, as nurses struggle to keep up with all the latest pharmaceutical advances and medications on the market.

Nursing Career, Nursing Certification, Nursing Responsibilities, Nursing Skill

According to the American Nurses Association (2017), medication errors are one of the leading causes of injury to hospital patients. In many cases, medication errors are preventable, and it requires skillful nursing judgement to identify errors and potential risks before they happen.

To help you avoid medication errors and keep your patients safe, you must master the five rights of medication administration:

RIGHT MEDICATION

The first thing you want to consider before administering a medication is your complete understanding of the medication. The indications, side effects, and expected outcomes must make sense to you before proceeding with giving the medication to a patient. Once you have a good understanding of the medication, you must then check the medication order against the medication that you obtained at least three times before giving it so you will be sure that you have the correct medication.

RIGHT PATIENT

It is important for you to check your patient’s identity against two identifiers. For patients who are alert and oriented, you should ask them for their name and date of birth, and then check that it matches the name on the order, or electronic medication administration record (eMAR). If your patient is unable to verbalize their name and date of birth, then you should identify them by using their ID wristband and checking it against the chart to confirm that you have the correct patient. Most facilities now use bedside medication verification, which utilizes barcode scanning to confirm or deny the correct patient has been selected.

RIGHT DOSE

Nursing Career, Nursing Certification, Nursing Responsibilities, Nursing Skill

By checking the ordered medication dose against the medication that you obtained at least three times, you will be sure that you have the correct dose. Some medications will come in concentrations that require wasting, splitting, or dividing the medication to end with the appropriate dose. If you are unsure of how to accomplish this task, please seek assistance from a coworker or a facility pharmacist.

RIGHT TIME

Most medications are ordered with specific times to be administered, and it is important that you can be able to identify a safe administration schedule. By checking the ordered time and frequency of the medication against the medication administration record, you will be able to determine if it is safe to give the next dose of medication. Overdosing patients with pain medication is one of the most common medication errors. For example, if your patient has IV pain medication as needed every four hours, you need to check the administration record prior to giving the medication to see if the last time the patient received the pain medication.

RIGHT ROUTE

There are many routes for administering drugs. Remember, oral meds are not to be given parenterally. Carefully read the orders before you give it to your patients. Routes for administering medications may include oral, parenteral, topical, enteral, inhalation, drops in the eyes or ears, or through injection. If you are uncertain of how a medication should be administered, or if the order is unclear, seek out additional clarification. Asking for clarification when in doubt is one of the SAFEST things a nurse can do for their patients.
Q. Which of the following is an early symptom of glaucoma?

A. Hazy vision.
B. Loss of central vision.
C. Blurred or "sooty" vision.
D. Impaired peripheral vision.





Correct Answer: D

Explanation: In glaucoma, peripheral vision is impaired long before central vision is impaired. Hazy, blurred, or distorted vision is consistent with a diagnosis of cataracts. Loss of central vision is consistent with senile macular degeneration but it occurs late in glaucoma. Blurred or "sooty" vision is consistent with a diagnosis of detached retina.

Saturday, 10 November 2018

Q. The nurse is caring for several mother-baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains?

A. G 4, P 1 client who is breastfeeding her infant.
B. G 3, P 3 client who is breastfeeding her infant.
C. G 2, P 2 cesarean client who is bottle-feeding her infant.
D. G 3, P 3 client who is bottle-feeding her infant.

Correct Answer: B

Explanation: The major reasons for afterbirth pains are breast-feeding, high parity, overdistended uterus during pregnancy, and a uterus filled with blood clots. Physiologically, afterbirth pains are caused by intermittent contraction and relaxation of the uterus. These contractions are stronger in multigravidas in order to maintain a contracted uterus. The release of oxytocin when breast-feeding also stimulates uterine contractions. There is no data to suggest any of these clients has had an overdistended uterus or currently has clots within the uterus. The G 3, P 3 client who is breast-feeding has the highest parity of the clients listed, which—in addition to breast-feeding—places her most at risk for afterbirth pains. The G 2, P 2 postcesarean client may have cramping but it should be less than the G 3, P 3 client. The G 3, P 3 client who is bottle-feeding would be at risk for afterbirth pains because she has delivered several children, but her choice to bottle-feed reduces her risk of pain.

Friday, 9 November 2018

Question Of The Day, Antepartum Period
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.

Tuesday, 6 November 2018

Q. A 7 year old with a history of tonic-clonic seizures has been actively seizing for 10 minutes. The child weighs 22 kg and currently has an intravenous (IV) line of D5 1/2 NS + 20 meq KCL/L running at 60 ml/hr. Vital signs are a temperature of 38 degrees C, heart rate of 120, respiratory rate of 28, and oxygen saturation of 92%. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for:

A. Rectal diazepam (Diastat).
B. IV lorazepam (Ativan).
C. Rectal acetaminophen (Tylenol).
D. IV fosphenytoin.

Correct Answer: B

Explanation: IV ativan is the benzodiazepine of choice for treating prolonged seizure activity. IV benzodiazepines potentiate the action of the gamma-aminobutyric acid (GABA) neurotransmitter, stopping seizure activity. If an IV line is not available, rectal Diastat is the benzodiazepine of choice. The child does have a low-grade fever; however, this is likely caused by the excessive motor activity. The primary goal for the child is to stop the seizure in order to reduce neurologic damage. Benzodiazepines are used for the initial treatment of prolonged seizures. Once the seizure has ended, a loading dose of fosphenytoin or phenobarbital is given.

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