Tuesday 26 September 2017

Question Of The Day, Mood, Adjustment, and Dementia Disorders
Q. A nurse is evaluating a client's electrocardiogram (ECG). Which ECG change can result from amitriptyline (Elavil) therapy?

A. Presence of U waves
B. Depressed ST segment
C. Widening QT interval
D. Prolonged PR interval

Correct Answer: C

Explanation: Amitriptyline therapy may cause a conduction delay, demonstrated by a widening QT interval on the ECG. U waves, a depressed ST segment, and a prolonged PR interval aren't typically induced by amitriptyline therapy.

Monday 25 September 2017

Question Of The Day, Anxiety Disorders
Q. A client with obsessive-compulsive disorder may use reaction formation as a defense mechanism to cope with anxiety and stress. What typically occurs in reaction formation?

A. The client assumes an attitude that contradicts an impulse he harbors.
B. The client believes his thoughts can control other people and events.
C. The client persistently thinks and talks about a particular idea or subject.
D. The client uses a specific act to negate a previous act.

Correct Answer: A

Explanation: Reaction formation is a defense mechanism in which a person assumes an attitude that contradicts an impulse or a wish that he harbors. The belief that one's thoughts can control other people and events is called "magical thinking." Persistent thoughts and discussion of a particular idea or subject are called "rumination." Use of an act to negate a previous act is called "undoing."

Thursday 21 September 2017

Q. A dehydrated 3 year old has vomited three times in the last hour and continues to have frequent diarrhea. The child was admitted 2 days ago with gastroenteritis caused by rotavirus. The child weighs 22 kg, has a normal saline lock in the right hand, and has had 30 ml of urine output in the last 4 hours. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for:

A. Giving a dose of loperaminde (Immodium).
B. Starting a fluid bolus of normal saline.
C. Beginning an intravenous (IV) antibiotic.
D. Establishing a Foley catheter.

Correct Answer: B

Explanation: The child is dehydrated, cannot retain oral fluids, and continues to have diarrhea. A normal saline bolus should be given followed by maintenance IV fluids. Anti-diarrheal medications are not recommended for children and will prolong the illness. The child has gastroenteritis caused by a viral illness. IV antibiotics are not indicated for viral illnesses.

Wednesday 20 September 2017

Nursing Tutorial and Material, Infant
Q. Before placement of a ventriculoperitoneal shunt for hydrocephalus, an infant is irritable, lethargic, and difficult to feed. To maintain the infant's nutritional status, which of the following actions would be most appropriate?

A. Feeding the infant just before doing any procedures.
B. Giving the infant small, frequent feedings.
C. Feeding the infant in a horizontal position.
D. Scheduling the feedings for every 6 hours.

Correct Answer: B

Explanation: An infant with hydrocephalus is difficult to feed because of poor sucking, lethargy, and vomiting, which are associated with increased intracranial pressure. Small, frequent feedings given at times when the infant is relaxed and calm are tolerated best. Feeding an infant before any procedure is inappropriate because the stress of the procedure may lead to vomiting. Ideally, the infant should be held in a slightly vertical position when feeding to prevent backflow of formula into the eustachian tubes and subsequent development of ear infections. Most infants are fed on demand every 3 to 4 hours.

Monday 18 September 2017

Question Of The Day, The Nursing Process
Q. The nurse is assigning tasks to unlicensed assistive personnel (UAP) for a client with an abdominal hysterectomy on the first postoperative day. Which of the following can NOT be delegated to the UAP?

A. Taking vital signs.
B. Recording intake and output.
C. Giving perineal care.
D. Assessing the incision site.

Correct Answer: D

Explanation: The registered nurse is responsible for monitoring the surgical site for condition of the dressing, status of the incision, and signs and symptoms of complications. Unlicensed assistive personnel who have been trained to report abnormalities to the registered nurse supervising the care may take vital signs, record intake and output, and give perineal care.

Thursday 14 September 2017

Q. The nurse-manager of a home health facility includes which item in the capital budget?

A. Salaries and benefits for her staff
B. A $1,200 computer upgrade
C. Office supplies
D. Client-education materials costing $300

Correct Answer: B
Explanation: Capital budgets generally include items valued at more than $500. Salaries and benefits are part of the personnel budget. Office supplies and client education materials are part of the operating budget.

Tuesday 12 September 2017

Q. Which of the following alert the nurse to possible internal bleeding in a client who has undergone pulmonary lobectomy 2 days ago?

A. Increased blood pressure and decreased pulse and respiratory rates.
B. Sanguineous drainage from the chest tube at a rate of 50 ml/hour during the past 3 hours.
C. Restlessness and shortness of breath.
D. Urine output of 180 ml during the past 3 hours.

Correct Answer: C
Explanation: Restlessness indicates cerebral hypoxia due to decreased circulating volume. Shortness of breath occurs because blood collecting in the pleural space faster than suction can remove it prevents the lung from reexpanding. Increased blood pressure and decreased pulse and respiratory rates are classic late signs of increased intracranial pressure. Decreasing blood pressure and increasing pulse and respiratory rates occur with hypovolemic shock. Sanguineous drainage that changes to serosanguineous drainage at a rate less than 100 ml/hour is normal in the early postoperative period. Urine output of 180 ml over the past 3 hours indicates normal kidney perfusion.

Monday 11 September 2017

Question Of The Day, Neurosensory Disorders
Q. A client is receiving an I.V. infusion of mannitol (Osmitrol) after undergoing intracranial surgery to remove a brain tumor. To determine whether this drug is producing its therapeutic effect, the nurse should consider which finding most significant?

A. Decreased level of consciousness (LOC)
B. Elevated blood pressure
C. Increased urine output
D. Decreased heart rate

Correct Answer: C
Explanation: The therapeutic effect of mannitol is diuresis, which is confirmed by an increased urine output. A decreased LOC and elevated blood pressure may indicate lack of therapeutic effectiveness. A decreased heart rate doesn't indicate that mannitol is effective.

Saturday 9 September 2017

If you are preparing to graduate nursing school this semester or still have few semesters left, it’s always a great idea to start building your resume and add to it as you progress through your program.

Job-Seeker’s Journal: Preparing Your Resume in Nursing School
For the most effective nursing school resume, it’s best to start early.

As I embark on my final weeks of nursing school, here are some tips that I have learned while writing my resume. Remember, there are many ways to construct a resume, so it’s important to find a format that best showcases your unique achievements, skills, and experiences. Here are a few tips to help you get started:

Know what nursing recruiters look for in a resume  

Nursing recruiters are always looking for a stand-out candidate that will bring something to their nursing staff.  Before you even get an interview, nurse recruiters will evaluate you based on your resume alone, so it’s important to have a unique resume. Typically, they look for a resume that looks professional, highlights your achievements, includes your recent and relevant work history as it pertains to the position you are applying for, references, and recommendation letters from your professors and/or clinical instructors.

How to stand out from the nursing student crowd

When I first started to write my resume, I thought it was great and that it hit the major components of what should be in a resume. And then I looked at a few of my peers’ resumes and I realized they were all basically the same. Next, I found a new template to use and formatted my information accordingly. It’s important to avoid using bright colors and dizzy fonts—keep it simple and clean, so it’s easy for the nurse recruiter to read. I always have a hard time getting my resume to fit on one page, but I managed to include only the things that will help me to get the job as a nurse. Depending on who you ask, some people will say you absolutely need it on one page, and others may say that rule doesn’t stand so much today (just don’t exceed 2!).

What skills to include showcase yourself

Most importantly, make sure you have any information listed that will showcase your talents and potential as a nurse on the unit applying for. The first draft of my resume listed skills such as Microsoft Word, Excel, and PowerPoint—all great skills, but not those nursing recruiters are most interested in. I tweaked my resume to more strongly showcase my skills of working well in groups, teamwork, utilizing critical thinking, evidence based-knowledge, and incorporating QSEN (Quality and Safety Education for Nurses) into my nursing practice.

Again, one of the hardest parts of writing my resume was narrowing it down to about a page while still highlighting my skills and achievements. It’s important to look great on paper, but don’t forget the actual interview is where you will really want to shine.

Utilize your professors with letters of recommendation

With your stellar resume, nursing recruiters really want to see letters of recommendations.  I was told this in my nursing program as well, and I think it’s important to include 1-2 letters of recommendations with your resume. This is a way for nursing recruiters to hear about your work ethic and skills from someone who has worked closely with you and has seen you learn and grow.

It’s always a great idea to ask a professor that you developed a great rapport with or a clinical instructor. These are the people that have been with you day in and day out of your nursing program, and can really vouch for you as a student, person, and nurse.

Writing a resume can seem challenging, but think of it as your calling card. Many places ask you to apply by submitting your resume through the internet, and if they like what they see there, they will call you in for an interview. If you have a great resume, it helps to get your foot in the door for an interview, which will hopefully lead to a job as a registered nurse.

Friday 8 September 2017

Question Of The Day, Immune and Hematologic Disorders
Q. A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. Which is the nurse's best response?

A. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid."
B. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor."
C. "The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction."
D. "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."

Correct Answer: B
Explanation: Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of red blood cells in this condition.

Thursday 7 September 2017

Starting a new position as a nurse can be stressful and overwhelming–even for the more experienced nurse. Policies and procedures can vary wildly from one nursing unit to the next, and learning where all of the essential patient care resources and supplies are housed can prove to be quite a challenge.

Nursing Job, Nursing Career, Nurse
Orientation helps you get up close and personal with your new workplace environment.

To help you focus on the essentials during this often challenging time, here are five tips that will be sure to help you get the most out of your workplace orientation:

Seek out tasks and skills in your new workplace environment

It is very important that you get as much hands-on experience during your orientation time so that when you no longer have a preceptor, you will be able to independently perform the duties of your role. A great way to ensure that you get maximum exposure to skills and tasks is to other nurses on the unit as well as your preceptor. The more you do during your orientation, the better you will perform when you are on your own.

Ask questions that go beyond the call of duty

Seeking out clarification when you do not fully understand something is one of the most important things you can do when you have a preceptor to help guide you to the answers you seek. It is recommended that you ask questions that go beyond daily responsibilities and search for a deeper understanding of the big picture. For example, understanding the rationales behind why certain wound care supplies are used versus others that you may be more familiar with allows you to learn and grow your expertise. When in doubt, seek it out!

Establish a feedback schedule with your preceptor and manager

It is important for you to receive regular and structured feedback regarding your performance during your orientation. Generally, this is done with both your preceptor as well as your direct supervisor or nurse manager. Topics during these meetings usually include: anything you may have questions about, observations made regarding your performance level, as well as your strengths and areas in need of improvement. This is also a time that you may provide feedback to your preceptor and manager about their performance in regards to helping you meet your learning needs. If there is an issue where you feel that you are not getting what you need out of the orientation, this is the best time to discuss this so that a plan for improvement may be made immediately.

Find a method of staying organized that works for you

Organization is key to keeping everything in order during an overwhelming orientation. You will be provided with lots of new information in a short period of time, so it is important that you find a way to keep everything straight. Some examples for staying organized include: creating folders to keep important documents safe and readily available, using electronic calendars for scheduling, creating step-by-step guides to facilitate your learning–especially in regards to electronic documentation, and multi-step skills or tasks–and keeping all essential nursing equipment and tools (stethoscope, scissors, pens, markers, etc.) in a designated bag, or your facility provided locker. Staying organized will help you learn more efficiently and will help to reduce the stress of an overwhelming orientation.

Remain professional and positive on the job at all times

Though it is easy to get frustrated when you are overwhelmed or stressed during an orientation, you must remain positive and professional at all times. Your first few days in your new assignment are critical in making a good impression, so be sure to smile, introduce yourself and get to know the other nurses and doctors you’ll be working with. Forming strong working relationships early on will help you ease into your new role by establishing a good team that you can depend on when you need help.
Question Of The Day, Integumentary Disorders
Q. A nurse is performing a baseline assessment of a client's skin integrity. What is the priority assessment parameter?

A. Family history of pressure ulcers
B. Presence of pressure ulcers on the client
C. Potential areas of pressure ulcer development
D. Overall risk of developing pressure ulcers

Correct Answer: D Explanation: When assessing skin integrity, the overall risk potential of developing pressure ulcers takes priority. Overall risk encompasses existing pressure ulcers as well as potential areas for development of pressure ulcers. Family history isn't important when assessing skin integrity.

Wednesday 6 September 2017

To say registered nurses are busy is a bit of an understatement. But for those of us who are called to the nursing profession, each day is as reenergizing as it is tiring. While there’s really no such thing as a typical day in the eventful life of a registered nurse, here is one example.

A Day in the Life of a Registered Nurse: Samantha
For a registered nurse, a typical day is anything but.

Morning routine

5:15 am and my alarm clock goes off with a loud buzz. I roll over to turn it off and begin my day. Luckily, I laid out my clothes the night before, allowing me to sleep to the very last second possible (every little bit of sleep helps).

I pull on my compression socks, because at the age of 23, I am already concerned about the spider and varicose veins that are destined to come my way. Next my scrubs pants, followed by a quick trip to the bathroom to brush my teeth. Yes, I brush my teeth BEFORE putting on my scrub top. Otherwise, one drop of toothpaste and into the wash it must go.

Next stop—the kitchen to make my breakfast and my essential morning cup of coffee. Then, I take my hour drive into Manhattan, wait in line in the morning mayhem of the parking garage, and then walk my six blocks to the hospital.

Arriving on the scene

7:30am and I am ready to take report. I exchange the usual AM banter with the night nurses while assessing how the day might go. Once the report is finished, we walk around together to say hello to all the patients, letting them know this is just a hello and to make sure they are not in emergent need of anything. I bid the night RN sweet dreams as I’m wiping down the computer desk.

7:50am and I’m signed onto a computer, reviewing doctor’s notes, reviewing orders I need to execute, looking at AM blood work results, and checking to see if anyone requires 8am medications. I determine who is the most critical and should be seen first, and I’m off.

Making the rounds

If all goes well, I have patient assessments finished between 9 and 9:30am, allowing me some time to formally document in the computer before 10am meds are due. After administering medications, I take a few minutes to sit at the computer and see if orders have been updated. At this point in time, I find myself prioritizing new orders alongside the existing orders.

I begin by sending repeat AM labs for a patient whose labs hemolyzed. Naturally, they aren’t pleased at the thought of a second stick, but fortunately, they have plump veins. With a quick joke and a simple butterfly stick, I have my labs. Then, through the pneumatic tube system they go.

Next, I remove the foley catheter from my patient down the hall, sharing in his excitement to finally have the catheter removed. I inform him that post removal of a foley we like to see patients void minimally 200ml within eight hours. I ask him to measure his output, and mention that perhaps we will do a bladder scan later to confirm there is no residual volume in the bladder.

As I’m walking back to the desk, an Alaris pump beeps, alerting me that my patient needs a new bag of Normal Saline hung. This won’t be the last beeping Alaris pump of the day, but is a good opportunity to check in on a patient who has been requiring less attention throughout the morning.

At the computer, I document the foley removal as an event note and review the lab results from the specimen I sent confirming labs aren’t hemolyzed. I also take the opportunity to confirm my patient’s potassium is low and she will require repletion. Once that order is placed I will explain to the patient her plan of care and begin the medication infusion.

Before I break for lunch, I visit my patient with a newly placed pleurx catheter. I begin education on the catheter, step by step teaching the patient and his family member how they will drain the catheter at home. After 30 minutes of teaching and them demonstrating what I have taught, I inform them I will be back later for further review.

Afternoon releases

3pm and I return from lunch. My patient has finished her potassium repletion, and the doctors say she can be discharged. I quickly get her paperwork together and no sooner is she out the door, do I hear I’m getting an admission. I head down the hall before the new patient comes and bladder scan my patient whose foley was removed earlier. Wonderful! He reports he has voided 300ml and only 80ml remain in the bladder. He can go home home too!

I come back to the station to receive the report on my new patient. An older gentleman with EKG changes. He is monitored on telemetry and serial troponins will be done. I get him settled, placed on the EKG monitor, and perform an assessment.

Before documenting that assessment, I complete the discharge for my foley patient. I print his paperwork and explain the antibiotic he will be going home on. One last set of vitals, removal of his IV, a “safe home and all the best,” and he’s out of here.

Next, I stop in to see my pleurx catheter gentlemen who looks much calmer when discussing and demonstrating care of his pleurx catheter. My teaching was successful.

Final stretch

6:30pm and I get that new assessment in and complete follow up notes on my patients just in time to see the night nurses and give report to them. It’s a long day, but a successful one.

During these 12 hours, I was able to calm someone’s fears about their newly placed drain. I was also able to spend time getting to know patients and explain the steps of the day to them. Something that is often not done. Just because you know how the system works, you can’t take that for granted. The patient doesn’t always understand the system and why things take time.

Some of the most appreciative patients I have are thankful and calmer because I’ve taken the time to explain how things work to them. This keeps them from becoming frustrated because they now know things take time and they aren’t just forgotten. I leave with the feeling I did my best and I’m ready to come back tomorrow for another successful day.
Question Of The Day, Gastrointestinal Disorders
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.



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