Wednesday, 21 November 2018

Q. When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which of the following points?

A. Halfway between the client's symphysis pubis and umbilicus.
B. At about the level of the client's umbilicus.
C. Between the client's umbilicus and xiphoid process.
D. Near the client's xiphoid process and compressing the diaphragm.

Correct Answer: B

Explanation: Measurement of the client's fundal height is a gross estimate of fetal gestational age. At 20 weeks' gestation, the fundal height should be at about the level of the client's umbilicus. The fundus typically is over the symphysis pubis at 12 weeks. A fundal height measurement between these two areas would suggest a fetus with a gestational age between 12 and 20 weeks. The fundal height increases approximately 1 cm/week after 20 weeks' gestation. The fundus typically reaches the xiphoid process at approximately 36 weeks' gestation. A fundal height between the umbilicus and the xiphoid process would suggest a fetus with a gestational age between 20 and 36 weeks. The fundus then commonly returns to about 4 cm below the xiphoid owing to lightening at 40 weeks. Additionally, pressure on the diaphragm occurs late in pregnancy. Therefore, a fundal height measurement near the xiphoid process with diaphragmatic compression suggests a fetus near the gestational age of 36 weeks or older.

Tuesday, 20 November 2018

A few weeks ago, I took my oldest daughter in for a flu shot. I signed the paperwork, looked over the informational pamphlet, and reassured her when the medical assistant brought the imposing-looking syringe into the room.

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And then, I cringed when she proceeded to shut the door behind her, pull open a band-aid and stick it to her bare hand, then jab my daughter with the shot, all without wearing any gloves. I thought back to my time as a nurse at the hospital—had I ever administered a vaccine without wearing gloves? Was it required? Was I overreacting in thinking she should wear gloves?

I honestly couldn’t think of a time when I hadn’t worn gloves to give a vaccine, so I piped up and said something to the assistant, not-very-kindly suggested that she should be sure to wear gloves next time. But when I got home and did some research, I sheepishly realized that I was the one who had been wrong, not her. Turns out, gloves aren’t required to give vaccinations and I was actually a big ol’ jerk to the poor young woman.

Oops.

According to the Centers for Disease Control (CDC) and Administration’s Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP), wearing gloves is not required for healthcare workers who are administering vaccinations. The official guidelines state: “Occupational Safety and Health Administration (OSHA) regulations do not require gloves to be worn when administering vaccinations unless persons administering vaccinations have open lesions on their hands or are likely to come into contact with a patient’s body fluids.”

The rules on vaccines + gloves


So, if gloves aren’t required, what is required? Well, basic handwashing and clean hygiene, essentially. As the guidelines state: “Persons administering vaccinations should follow appropriate precautions to minimize risk for disease exposure and spread. Hands should be cleaned with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing vaccines for administration and between each patient contact.”

Kasey Baylis, 26, a public health nurse for Oakland County in Michigan who works with the Vaccine for Children program as a partner provider and immunization nurse educator, tells Nurse.org that she has given “hundreds of shots” in her lifetime as a nurse.

With a job that literally entails making sure vaccines are stored, handled, and administered correctly, Baylis is a woman who knows about vaccine safety. She explains that the way she was trained and the way she continues to train others on vaccine administration is that the administrator should properly wash his/her hands and use aseptic technique when administering the vaccine (i.e. using alcohol to clean the injection site, not contaminating the site after cleaned and not contaminating the needle), but that gloves are not required unless the nurse or healthcare worker has any open lesions or is likely to come in contact with the person's bodily fluids.

Gloves aren’t really that clean anyways


Baylis also points out that if a vaccine is administered correctly, there should be little, if any, bodily fluid exposure and that contrary to popular belief, the gloves sitting in an open box in a doctor’s office or health clinic really aren’t all that much more sanitary than a clean pair of hands. In fact, the gloves may even contain more germs than clean hands. “Gloves are not required and generally do not provide any additional benefit to the patient,” she adds.

If gloves are worn, the administrator is still required to wash his or her hands between injections and patients, to remove any germs that may have transferred from the gloves to their hands. And many times, the only benefit to wearing gloves during vaccine administration is for protection for the administrator, not the patient.

Should you ask for gloves if you want them? 


That being said, if you are just plain uncomfortable with the idea of a healthcare worker giving you or your family a vaccine without wearing gloves, Baylis encourages the idea of speaking up and asking them to don a pair of gloves before an injection, simply because in her mind, if that means one more person is vaccinated against a preventable disease, then it’s worth it.

“When it comes to vaccines and all of the negative propaganda out there, I feel that gloves should not be another barrier to being immunized,” she says. “Adhering to the ACIP recommended schedule is your best protection against vaccine-preventable diseases that still exist today, so ultimately, if that means wearing gloves for a patient than I would gladly do it!” 
Question Of The Day, Psychotic Disorders
Q. The client is taking risperidone (Risperdal) to treat the positive and negative symptoms of schizophrenia. Improvement of which of the following negative symptoms indicate the drug is effective?

A. Abnormal thought form.
B. Hallucinations and delusions.
C. Bizarre behavior.
D. Asocial behavior and anergia.


Correct Answer: D

Explanation: Asocial behavior, anergia, alogia, and affective flattening are some of the negative symptoms of schizophrenia that may improve with risperidone therapy. Abnormal thought form is a positive symptom of schizophrenia. Hallucinations and delusions are positive symptoms of schizophrenia. Bizarre behavior is a positive symptom of schizophrenia.

Monday, 19 November 2018

Q. The wife of a 67-year-old client who has been taking imipramine (Tofranil) for 3 days asks the nurse why her husband isn't better. The nurse should tell the wife:

A. "It takes 2 to 4 weeks before the full therapeutic effects are experienced."
B. "Your husband may need an increase in dosage."
C. "A different antidepressant may be necessary."
D. "It can take 6 weeks to see if the medication will help your husband."

Correct Answer: A

Explanation: Imipramine, a tricyclic antidepressant, typically requires 2 to 4 weeks of therapy before the full therapeutic effects are experienced. Because the client has been taking the drug for only 3 days, it is too soon to determine if the current dosage of imipramine is effective. It is also too soon to consider taking another antidepressant.

Saturday, 17 November 2018

Q. After staying several hours with her 9-year-old daughter who is admitted to the hospital with an asthma attack, the mother leaves to attend to her other children. The child exhibits continued signs and symptoms of respiratory distress. Which of the following findings should lead the nurse to believe the child is experiencing anxiety?

A. Not able to get comfortable.
B. Frequent requests for someone to stay in the room.
C. Inability to remember her exact address.
D. Verbalization of a feeling of tightness in her chest.

Correct Answer: B

Explanation: A 9-year-old child should be able to tolerate being alone. Frequently asking for someone to be in the room indicates a degree of psychological distress that, at this age, suggests anxiety. The inability to get comfortable is more characteristic of a child in pain. Inability to answer questions correctly may reflect a state of anoxia or a lack of knowledge. Tightness in the chest occurs as a result of bronchial spasms.

Friday, 16 November 2018

Question Of The Day, Medication and I.V. Administration
Q. A nurse is helping a physician insert a subclavian central line. After the physician has gained access to the subclavian vein, he connects a 10-ml syringe to the catheter and withdraws a sample of blood. He then disconnects the syringe from the port. Suddenly, the client becomes confused, disoriented, and pale. The nurse suspects an air embolus. She should:

A. place the client in a supine position and prepare to perform cardiopulmonary resuscitation.
B. place the client in high-Fowler's position and administer supplemental oxygen.
C. turn the client on his left side and place the bed in Trendelenburg's position.
D. position the client in the shock position with his legs elevated.

Correct Answer: C

Explanation: A nurse who suspects an air embolism should place the client on his left side and in Trendelenburg's position. Doing so allows the air to collect in the right atrium rather than enter the pulmonary system. The supine position, high-Fowler's position, and the shock position are therapeutic for other situations but not for air embolism.

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.

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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

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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.

Monday, 5 November 2018

Q. A client was talking with her husband by telephone, and then she began swearing at him. The nurse interrupts the call and offers to talk with the client. She says, "I can't talk about that bastard right now. I just need to destroy something." Which of the following should the nurse do next?

A. Tell her to write her feelings in her journal.
B. Urge her to talk with the nurse now.
C. Ask her to calm down or she will be restrained.
D. Offer her a phone book to "destroy" while staying with her.

Correct Answer: D

Explanation: At this level of aggression, the client needs an appropriate physical outlet for the anger. She is beyond writing in a journal. Urging the client to talk to the nurse now or making threats, such as telling her that she will be restrained, is inappropriate and could lead to an escalation of her anger.

Friday, 2 November 2018

Q. A client complains of severe abdominal pain. To elicit as much information as possible about the pain, the nurse should ask:

A. "Do you have the pain all the time?"
B. "Can you describe the pain?"
C. "Where does it hurt the most?"
D. "Is the pain stabbing like a knife?"




Correct Answer: B

Explanation: Asking an open-ended question such as "Can you describe the pain?" encourages the client to describe any and all aspects of the pain in his own words. The other options are likely to elicit less information because they're more specific and would limit the client's response.


Thursday, 1 November 2018

Q. A 56-year-old client is receiving chemotherapy that has the potential to cause pulmonary toxicity. Which of the following symptoms indicates a toxic response to the chemotherapy?

A. Decrease in appetite.
B. Drowsiness.
C. Spasms of the diaphragm.
D. Cough and shortness of breath.


Correct Answer: D

Explanation: Cough and shortness of breath are significant symptoms because they may indicate decreasing pulmonary function secondary to drug toxicity. Decrease in appetite, difficulty in thinking clearly, and spasms of the diaphragm may occur as a result of chemotherapy; however, they are not indicative of pulmonary toxicity.


Wednesday, 31 October 2018

Q. Which scenario complies with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations?

A. Two nurses in the cafeteria are discussing a client's condition.
B. The health care team is discussing a client's care during a formal care conference.
C. A nurse checks the computer for the laboratory results of a neighbor who has been admitted to another floor.
D. A nurse talks with her spouse about a client's condition.

Correct Answer: B

Explanation: To provide interdisciplinary continuity of care, nurses must share relevant information during client care conferences. Nurses discussing information in the cafeteria may be overheard; this indiscretion violates HIPAA regulations. Looking up laboratory results for a neighbor is a HIPAA violation, as is discussing a client's condition with one's spouse.

Tuesday, 30 October 2018

Q. After surgery for an ileal conduit, the nurse should closely assess the client for the occurrence of which of the following complications related to pelvic surgery?

A. Peritonitis.
B. Thrombophlebitis.
C. Ascites.
D. Inguinal hernia.



Correct Answer: B

Explanation: After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in intra-abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal incision.

Monday, 29 October 2018

Q. A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis?

A. The client sees his physician for a check-up yearly.
B. The client has never traveled outside of the country.
C. The client had a liver transplant 2 years ago.
D. The client works in a health care insurance office.

Correct Answer: C

Explanation: A history of immunocompromised status, such as that which occurs with liver transplantation, places the client at a higher risk for contracting tuberculosis. Other risk factors include inadequate health care, traveling to countries with high rates of tuberculosis (such as southeastern Asia, Africa, and Latin America), being a health care worker who performs procedures in which exposure to respiratory secretions is likely, and being institutionalized.

Tuesday, 23 October 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.

Monday, 22 October 2018

In the United Kingdom, a quarter of nursing students drop out of their courses, and it seems that similar or higher drop-out rates occur across the world. This is particularly worrying in the light of the growing global nursing shortages.

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Data collected jointly by the Nursing Standard and the Health Foundation in the UK found that 25% of nursing students who started nursing degrees either left or suspended their studies. Despite attempts to reduce student drop-outs, the figure had remained nearly constant since the 25.8% in 2006.

25% OF NURSING STUDENTS WHO STARTED NURSING DEGREES EITHER LEFT OR SUSPENDED THEIR STUDIES

Retention of student nurses and drop-out rates are a significant issue across the globe. In many areas, the numbers of nurses qualifying are not enough to replace those that are leaving. While student attrition is the focus of numerous research studies, few provide comprehensive country-wide data like the study done in the UK. Other studies have revealed drop-out rates of as high as 50% in some baccalaureate programs and that most of these students leave within their first semester of study.

The Royal College of Nursing in the UK expressed the view that students were put off by bad experiences during clinical placements, financial difficulties and the academic pressure of nursing courses.

According to Anne Corrin, RCN head of professional learning and development, financial challenges often made it difficult for student nurses to continue with their course, also considering their travel expenses for clinical placements. The RCN is suggesting that more funding is needed to help students who are struggling financially.

Corrin also highlighted the fact that placement experiences can either provide positive or very negative experiences for students. “‘Good mentors can be key. A role model can inspire you if you are struggling on a course, as they keep people going, while a less interested mentor might cause a student to find it difficult to cope with that relationship,” she said.

Nigel Harrison, of the Council of Deans of Health (CoDoH), added that the responsibility of retention did not only lie with the universities, but also with the placement provider organizations. The CoDoH had developed a peer mentoring system. “A key message has been that student peer mentors are really effective in listening to each other and helping [struggling students] not feel so alone,” Harrison explained.

The University of Northampton brought down its attrition rate from 24% to 10% by obtaining funding to bring in additional staff to address student retention. “The academic rigor and first placement can be a shock for them although we try hard to prepare them,” said Donna Bray, subject lead for nursing at the University. “We bid to create a “super-supportive culture” for students and used the money to develop two nursing student support posts.” The support staff focuses on students who are vulnerable to leaving. The university also presents emotional resilience workshops to develop students’ personal and emotional skills.

Studies across the globe have identified similar causes of student nurse drop-out to those discussed above. Numerous projects that have successfully reduced attrition have also been reported on. Nursing schools, as well as student nurse organisations, could take a lesson from these success stories.
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.

Sunday, 21 October 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.

Saturday, 20 October 2018

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.

Friday, 19 October 2018

Q. Compared to the food requirements of preschoolers and adolescents, the food requirements of school-age children are not as great because these children have a lower:

A. Growth rate.
B. Metabolic rate.
C. Level of activity.
D. Hormonal secretion rate.



Correct Answer: A

Explanation: Children ages 6 to 12 have a slower growth rate than do younger children and adolescents. As a result, their food requirements are comparatively less.

Thursday, 18 October 2018

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.

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.

Thursday, 4 October 2018

Q. Family members of a client with bipolar disorder tell a nurse that they are concerned that the client is becoming manic. The nurse knows that the manic phase is marked by:

A. flight of ideas and inflated self-esteem.
B. increased sleep and greater distractibility.
C. decreased self-esteem and increased physical restlessness.
D. obsession with following rules and maintaining order.

Correct Answer: A

Explanation: The manic phase of bipolar disorder is characterized by recurrent episodes of a persistently euphoric and expansive or irritable mood. This phase is diagnosed if the client experiences four of the following signs and symptoms for at least 1 week: flight of ideas; inflated self-esteem; unusual talkativeness; increased social, occupational, or sexual activity; physical restlessness; a decreased need for sleep; increased distractibility; and excessive involvement in activities with a high potential for painful but unrecognized consequences. Obsession with following rules and maintaining order characterizes obsessive-compulsive disorder.

Wednesday, 3 October 2018

Q. A client is irritable and hostile. He becomes agitated and verbally lashes out when his personal needs are not immediately met by the staff. When the client's request for a pass is refused by the primary care provider, he utters a stream of profanities. Which of the following statements best describes the client's behavior?

A. The client's anger is not intended personally.
B. The client's anger is a reliable sign of serious pathology.
C. The client's anger is an intended attack on the primary care provider's skills
D. The client's anger is a sign that his condition is improving.

Correct Answer: A

Explanation: Staff members sometimes are the recipients of a client's angry behavior because they are safe targets and are available for attack. The display of anger is rarely intended to be personal. Such behavior is not necessarily a sign of serious pathology but must be weighed in conjunction with other behaviors. An angry outburst is not an attack on a primary care provider's skills. While not necessarily pathologic, the client's behavior isn't a sign that his condition is improving.


Monday, 1 October 2018

Q. When performing a physical assessment on an 18-month-old child, which of the following would be best?

A. Have a parent hold the toddler.
B. Assess the ears and mouth first.
C. Carry out the assessment from head to toe.
D. Assess motor function by having the child run and walk.



Correct Answer: A

Explanation: The best strategy for assessing a toddler is to have the parent hold the toddler. Doing so is comforting to the toddler. Assessment should begin with noninvasive assessments first while the child is quiet. Typically these include assessments of the cardiac and respiratory systems. The ears and throat are typically examined last. Using a head-to-toe approach is more appropriate for an older child. For a toddler, assessment should begin with noninvasive assessments first while the child is quiet. Having a toddler run and be active may make it difficult to settle the child down after the physical exertion.


Saturday, 29 September 2018

Question Of The Day, The Nursing Process
Q. A 57-year-old Hispanic woman with breast cancer who does not speak English is admitted for a lumpectomy. Her daughter, who speaks English, accompanies her. In order to obtain admission information from the client, what should the nurse do?

A. Ask the client's daughter to serve as an interpreter.
B. Ask one of the Hispanic nursing assistants to serve as an interpreter.
C. Use the limited Spanish she remembers from high school along with nonverbal communication.
D. Obtain a trained medical interpreter.

Correct Answer: D

Explanation: A trained medical interpreter is required to ensure safety, accuracy of history data, and client confidentiality. The medical interpreter knows the client's rights and is familiar with the client's culture. Using the family member as interpreter violates the patient's confidentiality. Using the nursing assistant or limited Spanish and nonverbal communication do not ensure accuracy of interpretation and back-translation into English.

Friday, 28 September 2018

Q. Total parenteral nutrition (TPN) is prescribed for a client who has recently had a significant small and large bowel resection and is currently not taking anything by mouth. The nurse should:

A. Administer TPN through a nasogastric or gastrostomy tube.
B. Handle TPN using strict aseptic technique.
C. Auscultate for bowel sounds prior to administering TPN.
D. Designate a peripheral intravenous (IV) site for TPN administration.

Correct Answer: B

Explanation: TPN is hypertonic, high-calorie, high-protein, intravenous (IV) fluid that should be provided to clients without functional gastrointestinal tract motility, to better meet their metabolic needs and to support optimal nutrition and healing. TPN is ordered once daily, based on the client's current electrolyte and fluid balance, and must be handled with strict aseptic technique (because of its high glucose content, it is a perfect medium for bacterial growth). Also, because of the high tonicity, TPN must be administered through a central venous access, not a peripheral IV line. There is no specific need to auscultate for bowel sounds to determine whether TPN can safely be administered.

Thursday, 27 September 2018

Q. The nurse observes that the right eye of an unconscious client does not close completely. Which nursing intervention is most appropriate?

A. Have the client wear eyeglasses at all times.
B. Lightly tape the eyelid shut.
C. Instill artificial tears once every shift.
D. Clean the eyelid with a washcloth every shift.



Correct Answer: B

Explanation: When the blink reflex is absent or the eyes do not close completely, the cornea may become dry and irritated. Corneal abrasion can occur. Taping the eye closed will prevent injury. Having the client wear eyeglasses or cleaning the eyelid will not protect the cornea from dryness or irritation. Artificial tears instilled once per shift are not frequent enough for preventing dryness.

Wednesday, 26 September 2018

Q. A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department?

A. Bacterial vaginitis
B. Gonorrhea
C. Genital herpes
D. Human papillomavirus (HPV)

Correct Answer: B

Explanation: Gonorrhea must be reported to the public health department. Bacterial vaginitis, genital herpes, and HPV aren't reportable diseases.

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