Wednesday 31 January 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.

Tuesday 30 January 2018

Everything Nurses Need to Know About ACLS, BLS & PALS Certifications

It's a fact that aspiring nurses have to complete a nursing program and take licensing exams, but what about certifications? While requirements for RN positions vary by employer, there are some certifications you may have to get, or that may be worth pursuing to be more competitive.

Nursing ACLS, Nursing BLS, Nursing PALS

Take a look at three popular – and sometimes required – certifications for nurses:

BLS (Basic Life Support) Certification

BLS certification is usually a requirement for anyone entering the medical profession, and even those working with the public or with children. It covers the basics of CPR, as well as other lifesaving procedures.

The course is not extensive, but students will learn how to use an AED (automatic external defibrillator), as well as how to help a choking victim.

BLS certification must be renewed every two years.

ACLS (Advanced Cardiac Life Support) Certification

ACLS certification is not always a requirement for nursing positions, but it is a good one to consider (and might be required) if you plan to work in emergency and critical care units.

ACLS courses go beyond what the BLS certification covers, although some of the content is similar, such as how to use an AED. Unlike the BLS, however, ACLS certification courses are almost always exclusively made up of healthcare workers, and a strong medical knowledge is needed. In addition to nurses, you might find paramedics, physicians, and dentists taking the course.

Typically, students in an ACLS course will already be BLS certified. Additional coursework will cover everything from intubation to IV medications to resuscitation procedures and airway management. It can take about two days to complete the class, and students must pass a written and practical exam in order to pass.

Once students earn the ACLS certification, it is good for two years, at which time, they will have to take a renewal course.

ACLS is a strong credential to add to your resume if you're becoming a nurse, especially if you want to work in a fast-paced hospital team.

PALS (Pediatric Advanced Life Support) Certification

As the name suggests, PALS is similar to ACLS, but it is focused on pediatric care. Emergency care can be very different if you're dealing with an infant or small child, which is why this certification focuses on how to administer the various emergency treatments to young patients.

The class covers the same types of topics as ACLS (i.e. airway management, CPR for young patients, etc.). The exam also featured both a written and hands-on practical component.

Those who pass the PALS certification will have to renew it every two years to keep it active.

Depending on your aspirations, a PALS certification can help you stand out if you're seeking positions that involve working with pediatric patients, or even in the general emergency room.

Should you get certified?

Getting your BLS certification is a no-brainer and must be done. As for ACLS and PALS, it will depend on what type of nursing career you plan to pursue, but more certifications can't hurt.

For starters, having additional knowledge on your side is always a good thing since you never know when a patient much have a sudden reaction to medication, or an emergency can happen in front of you at any time.

As far as your resume, adding certifications can make you a more competitive job seeker. It might be the tie-breaking item that sets you apart from another candidate with a similar background, for example.

If you do decide to get certified, the ACLS will have more application than the PALS (unless you're heading into a pediatric nursing career).

No matter which certifications you decide to pursue, consider the time and expense a smart investment into your career. Not only will they make you a stronger, more knowledgeable nursing professional, but it could help you save a life.
Question Of The Day, Postpartum Period
Q. A client is experiencing an early postpartum hemorrhage. Which item in the client's care plan requires revision?

A. Inserting an indwelling urinary catheter
B. Fundal massage
C. Administration of oxytocics
D. Pad count

Correct Answer: D

Explanation: By the time the client is hemorrhaging, a pad count is no longer appropriate. Inserting an indwelling urinary catheter eliminates the possibility that a full bladder may be contributing to the hemorrhage. Fundal massage is appropriate to ensure that the uterus is well contracted, and oxytocics may be ordered to promote sustained uterine contraction.

Monday 29 January 2018

Q. A nurse is using Doppler ultrasound to assess a pregnant woman. When should the nurse expect to hear fetal heart tones?

A. 7 weeks' gestation
B. 11 weeks' gestation
C. 17 weeks' gestation
D. 21 weeks' gestation

Correct Answer: B

Explanation: C

Sunday 28 January 2018

Question Of The Day, Mood, Adjustment, and Dementia Disorders
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.

Friday 26 January 2018

Question Of The Day, Foundations of Psychiatric Nursing
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.

Thursday 25 January 2018

Question Of The Day, Toddler
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.

Tuesday 23 January 2018

What is a hyperbaric nurse?

The Undersea and Hyperbaric Medical Society (UHMS) describes hyperbaric oxygen therapy (HBO2) as “an intervention in which an individual breathes near 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure.” 

Hyperbaric Nurse, Nurse Skill, Nursing Students

“In certain circumstances, hyperbaric oxygen therapy represents the primary treatment modality while in others it is an adjunct to surgical or pharmacologic interventions,” Gwilliam says.

Research is very important in hyperbaric medicine, and many centers are studying the effects of 100% oxygen under pressure on various diagnoses, including traumatic brain injuries. 

What is a hyperbaric treatment, and who can it help?

Treatment can be carried out in either a mono- or multi-place chamber. The former accommodates a single patient. The entire chamber is pressurized with near 100% oxygen, and the patient breathes the ambient chamber oxygen directly, Gwilliam explains.

The latter holds two or more people (patients, observers, and/or support personnel); the chamber is pressurized with compressed air while the patients breathe near 100% oxygen via masks, head hoods, or endotracheal tubes. 

There is science to prove that the 14 indications recommended by the UHMS (and covered by Medicare and most insurances) are effective and can help heal patients, she says. Those include: air or gas embolism; carbon monoxide poisoning; gas gangrene; crush injury; decompression sickness; arterial insufficiencies and problem wounds; severe anemia; intracranial abscess; necrotizing soft tissue infections; refractory osteomyelitis; delayed radiation injury; compromised grafts and flaps; acute thermal burn injury; and idiopathic sudden sensorineural hearing loss.

Why did you want to be a nurse in the first place?

“I enrolled in nursing school with a goal of becoming a nurse midwife.  As happens sometimes in life, my nursing career went in a very different direction,” she says. 

Besides hyperbaric nursing, she has spent time on a pediatric office, on the hospital medical and oncology floor, and home care.

What are the day-to-day duties of a hyperbaric nurse?

They include some or all of the following: case managing patients, patient advocate, documentation, insurance authorization, and operating the chambers or working with HBO techs that operate the chamber.

There are always lots of “regular” nursing duties that need to be done: patient assessment and education, wound care, pain management, medication administration including oral meds as well as IV’s, Gwilliam adds. 

Some HBO nurses are ICU trained and provide the same care as in the ICU hospital unit, with a twist that the nurse must now meet the needs of the very sick patient through the chamber (for mono-place chambers) or inside a chamber under the same pressure just as the patient is receiving (in multi-place chamber programs). 

Some programs around the country are on call 24/7 for emergency cases including for carbon monoxide poisoning and failing plastic surgery grafts or flaps.

How did you get involved in the Baromedical Nurses Association?

As a hyperbaric nurse, Gwilliam attended a UHMS national annual scientific meeting. During the conference, the nurses in attendance had the annual general meeting of the BNA (Baromedical Nurses Association), which she attended. 

She volunteered to help on the membership committee and then became chairman. This led to other opportunities to volunteer, and she became vice president,  and now serves as its president.

The website has CEU’s free to members as well as other information about HBO nursing, certification and lots of other information including nursing plan of care for HBO patients.

What does it take to become a hyperbaric nurse?

Hyperbaric nursing is a very specialized field, Gwilliam says.  As you start working in the field, most nurses take a 40-hour basic course to learn about how pressure affects the body as well how it enhances healing in the 14 diagnoses mentioned above.  After this training, you learn from others on the job or through education, either online or through books. This is where the BNA can assist nurses to improve their skills and treat patients safely.

The next step is certification through the National Board of Diving and Hyperbaric Medicine Technology (NBDHMT). After that training course, you apprentice for 480 hours under the direction of the hyperbaric physician or other certified RN’s. You are then eligible to sit for the certification examination. There are three different levels of certification. 

Talk about one of the best days you had as a hyperbaric nurse

One of her best days involves the miraculous healing of a patient with CRAO (Central Retinal Arterial Occlusion).

“We received a call from an ophthalmologist who referred a patient to us that had spontaneously lost the vision in one eye. He was a surgeon and could not continue to work without vision in both eyes,” Gwilliam explains.

They administered O2 to him outside the chamber, without any success. He then received a treatment in the multi-place chamber. After he had been compressed the equivalent of being under water about 45 feet on 100% oxygen for about 10 minutes, he started seeing shadows. Before the first treatment was over, he was seeing shapes and color. Throughout the next several days and eight hyperbaric treatments, he received 95% of his vision back.  

What is the salary range of a hyperbaric nurse?

The salary range for an HBO nurse is usually higher than floor nursing and as in any nursing job, increases with the amount of experience in the field, she says.

What is the job outlook for these type of nurses?

“There are always RN positions open in the HBO field, and we are always trying to recruit interested nurses willing to be trained,” Gwilliam states. “HBO nurses are found in almost all states as well as around the world, especially in many in areas with scuba diving, such as Cozumel.”
Question Of The Day, Infant
Q. The nurse is assessing the development of a 7-month-old. The child should be able to:

A. Play pat-a-cake.
B. Sit without support.
C. Say two words.
D. Wave bye-bye.

Correct Answer: B

Explanation: The majority of infants (90%) can sit without support by 7 months of age. Approximately 75% of infants at 10 months of age are able to play pat-a-cake. The ability to say two words occurs in 90% of children by age 16 months. A child typically can wave bye-bye at about 14 months of age.

Monday 22 January 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 19 January 2018

Question Of The Day, Genitourinary Disorders
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.
Travel Nursing, Nursing Job, Nursing Career

For many nurses and their families, the biggest deterrent to taking the leap and going on that first travel nurse assignment is - what is my partner going to do?!

If you are a nurse and your wife, husband, or significant other is not in the medical field, this may seem like a big hurdle, but it doesn't have to be. With a little planning, patience, and teamwork, it is possible to position yourselves to take the leap together!

Continue reading to find out ways others have managed to navigate their own situations.  

1. Be the travel support person.

In some cases, income from one travel nurse is enough to cover expenses and lifestyle requirements for the family during months of travel. This allows spouses and partners to be able to quit their jobs - at least temporarily - and jump aboard the move to a new city.

If your spouse is going sans-job to the next travel assignment, a very valuable position to take is to be the travel support person. 

Taking the leap to a new city can be daunting: where do we live? Is it close to work? Will it be furnished? Will they allow pets? Do we have to set up our utilities? Where will we park the car?

Having your partner take command of the logistics of moving while you focus on the details of transitioning to the new job is a great way to make for a pleasant assignment. If your partner ops to not work during the assignment, they can also help by driving you to work and setting up life at home.

It takes the edge off of being in an unfamiliar place and allows you to take the housing stipend, giving you more freedom and potentially more cash flow. 

2. Take an On-Demand Job

On-demand jobs like Uber, Postmates, and Wag are a great way for non-medical partners to earn cash and stay busy while on a travel assignment, and it is easy to transfer to different locations if you decide to take more assignments. Check out this link for a list of similar positions, from personal assistants to tech support. 

3. Check Out the Local Scene

Wherever you go, there are always places to work that are fairly easy to leave once the contract is over: serving, bartending, giving lessons, barista, trainer, etc. Not only do you bring in extra cash, but there are opportunities to learn about the local community and events from peers and customers. 

4. Distance Makes the Heart Grow Fonder

In my time traveling, I have met plenty of travel nurses whose partner stayed in their hometown to work, making visits periodically during the assignment. That much time apart may not sound appealing to some, but for others, it’s a way to become familiar with the whole travel nurse process, eventually traveling together in a way that is best for both people. 

5. Travel Nurse Couple

If travel nursing appeals to your spouse, remind them that nursing school is only two years! A great 5-year goal could be to eventually do travel nursing together. For travel nurse couples, the trick is finding two positions that are reasonably close to each other with close start dates. And remember, for many agencies, even significant others count as referrals, and therefore referral bonuses! 

Wednesday 17 January 2018

Question Of The Day, Neurosensory Disorders
Q. A nurse, a licensed practical nurse (LPN), and a nursing assistant are caring for a group of clients. The nurse asks the nursing assistant to check the pulse oximetry level of a client who underwent laminectomy. The nursing assistant reports that the pulse oximetry reading is 89%. The client Kardex contains an order for oxygen application at 2 L/min should the pulse oximetry level fall below 92%. The nurse is currently assessing a postoperative client who just returned from the postanesthesia care unit. How should the nurse proceed?

A. Immediately go the client's room and assess vital signs, administer oxygen at 2 L/minute, and notify the physician.
B. Ask the nursing assistant to notify the physician of the low pulse oximetry level.
C. Ask the LPN to obtain vital signs and administer oxygen at 2 L/min to the client who underwent laminectomy.
D. Complete the assessment of the new client before attending to the client who underwent laminectomy.

Correct Answer: C
Explanation: Because it's important to get more information about the client with a decreased pulse oximetry level, the nurse should ask the LPN to obtain vital signs and administer oxygen as ordered. The nurse must attend to the newly admitted client without delaying treatment to the client who is already in her care. The nurse can effectively do this by delegating tasks to an appropriate health team member such as an LPN. The nurse doesn't need to immediately attend to the client with a decreased pulse oximetry level; she may wait until she completes the assessment of the newly admitted client. The physician doesn't need to be notified at this time because an order for oxygen administration is already on record.

Tuesday 16 January 2018

Question Of The Day, Musculoskeletal Disorders
Q. A nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test, the nurse should place the client in which position?

A. Head of the bed elevated 45 degrees
B. Prone
C. Supine with feet raised
D. Supine with the head lower than the trunk

Correct Answer: A

Explanation: After a myelogram, positioning depends on the dye injected. When a water-soluble dye such as metrizamide is injected, the head of the bed is elevated to a 45-degree angle to slow the upward dispersion of the dye. The prone and supine positions are contraindicated when a water-soluble contrast dye is used. The client should be positioned supine with the head lower than the trunk after an air-contrast study.

Monday 15 January 2018

Resigning from a job is a natural consequence of having a long, successful working career. However, it is not always easy and can feel very awkward. It’s important to take comfort in the fact that going through a resignation has a massive impact on personal and professional growth.

5 Key Steps To Quitting Your Nursing Job

Here is our best strategy for quitting your nursing job with grace.

1) Deciding to Quit 

There may come a time in your nursing career that you choose to leave a job. There are two phases that comprise resignation: the decision to quit and the action of doing it.

The decision in itself should take a generous amount of time and careful deliberation. Leaving a job can seriously impact you in many aspects - professionally, emotionally, financially – and it’s important to consider the consequences.

To start, evaluate your reasons for wanting to quit. It may stem from frustrations or dissatisfaction within your work environment. If that’s the case, you may ask yourself if you have given management a fair chance to make positive changes with honest feedback and suggestions. Don’t make a hasty decision after one bad shift.

Perhaps your decision to resign derives from external factors in your life like family dynamics, the need to relocate, or financial burden. Others choose to resign from the internal motivation for change, such as career growth, studying for an advanced degree, or accepting a new professional opportunity.

Whatever the reason, be sure to thoroughly consider the advantages and disadvantages of resigning.

2) Giving Notice

With all things considered, if quitting your job is still the best option, then be prepared to take care with the process that follows.

Be calculated in your next steps. Before you actually resign, be sure to tie up all loose ends for your next opportunity. Finalize a start date for your next job, negotiate pay and benefits, confirm a schedule, and get everything documented in writing. If there will be a gap between jobs, budget your savings accordingly and set specific goals for yourself.

Consider the notice you will need to give your current employer. Out of respect for your manager and coworkers, always try to give as much notice as possible. Most legal minimums are 2 weeks, but some hospitals may specify more notice time.

Your employer will need time to find a replacement for you, and in the meantime, it’s possible your unit will operate below ideal staffing. This could result in heavier workload or changes in scheduling for other nurses whom you worked alongside. To find a replacement, your manager will need time for the hiring and interview process, as well as time to train the new employee.

If you do not give adequate notice, you will not be able to use your employer as a reference in the future. Even worse, leaving without notice could put other nurses or patients in jeopardy.

The best approach is to give ample notice (ideally 4 weeks). This will help you to keep a positive rapport with your employer and show respect for your coworkers.

3) How to Tell Your Manager

When you have chosen a date to tell your manager about your decision to resign, you should schedule a time to meet face-to-face. It is important to set up a meeting beforehand, so you and your manager have a dedicated time and space for uninterrupted conversation. It is okay to send an email or write a letter, but there should always be face-to-face follow-up.

Plan what you will say during the meeting ahead of time. You should be clear, concise, and honest about your decision to resign. Be truthful about your reasons for leaving, never lie to your employer. Let them know if it was a difficult decision, and express your sincere gratitude for your most positive experiences.

If you are leaving for reasons of dissatisfaction, be professional and constructive when expressing criticism. It’s possible to lose your train of thought or become clouded from emotion during that meeting, so it is okay to jot down a few key points on a notebook to use as a reference if needed.

The most important thing is to not burn any bridges. Always show respect and professionalism when you leave a place of employment. Express heartfelt and honest appreciation for experiences you cherish and relationships which helped you grow. Circumstances in life change and better opportunities arise – most managers will understand and be supportive!

4) Submitting Formal Resignation

After your conversation with your manager, you will also need to write a formal letter of resignation for Human Resources. The letter or email should be succinct and accurate.

An example:

“Dear [Manager],

I would like to inform you that I am resigning from my position as [Professional Title] in [Healthcare Organization], effective [Date].


[Your Signature]

[Your Typed Name]”

Include your contact information somewhere in the letter. Sign all copies by hand and keep at least one copy for your own reference. Don’t include reasons for leaving or any elaboration in this letter – those are points of discussion for your in-person meeting. The letter for HR is simply a legal documentation of notice for your place of employment.

5) Leaving Gracefully

It is essential to fulfill your commitment as an employee during your last weeks at work. You have a responsibility to your coworkers and patients to take pride and care in your work while you are still present.  Do not call in on your last day and leave your team without support. Show you care, be professional, and focus your energy on the tasks at hand.

Exit interviews are commonly conducted by HR as an opportunity for finalizing pay/benefits, returning identification badges, and collecting honest feedback as a former employee. Although the comments are processed anonymously, only share honest and constructive criticism which can be used for positive changes – nothing malicious or petty.

You may choose to collect manager and colleague information for references in the future. It will always help your career to maintain professional connections after you leave. Thank the people who gave you support, reflect on the experiences which helped you grow, and savor the last moments in your role. 
Question Of The Day, Endocrine and Metabolic Disorders
Q. A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

A. Administer half of the client's typical morning insulin dose as ordered.
B. Administer an oral antidiabetic agent as ordered.
C. Administer an I.V. insulin infusion as ordered.
D. Administer the client's normal daily dose of insulin as ordered.

Correct Answer: A

Explanation: If the nurse administers the client's normal daily dose of insulin while he's on nothing-by-mouth status before surgery, he'll experience hypoglycemia. Therefore, the nurse should administer half the daily insulin dose as ordered. Oral antidiabetic agents aren't effective for type 1 diabetes. I.V. insulin infusions aren't necessary to manage blood glucose levels in clients undergoing routine surgery.

Friday 12 January 2018

Question Of The Day, Cardiovascular Disorders
Q. Before discharge, which instruction should a nurse give to a client receiving digoxin (Lanoxin)?

A. "Take an extra dose of digoxin if you miss one dose."
B. "Call the physician if your heart rate is above 90 beats/minute."
C. "Call the physician if your pulse drops below 80 beats/minute."
D. "Take digoxin with meals."

Correct Answer: B

Explanation: The nurse should instruct the client to notify the physician if his heart rate is greater than 90 beats/minute because cardiac arrhythmias may occur with digoxin toxicity. To prevent toxicity, the nurse should instruct the client never to take an extra dose of digoxin if he misses a dose. The nurse should show the client how to take his pulse and tell him to call the physician if his pulse rate drops below 60 beats/minute — not 80 beats/minute, which is a normal pulse rate and doesn't warrant action. The client shouldn't take digoxin with meals; doing so slows the absorption rate.

Thursday 11 January 2018

Question Of The Day, The Neonate
Q. The neonate of a client with type 1 diabetes is at high risk for hypoglycemia. An initial sign the nurse should recognize as indicating hypoglycemia in a neonate is:

A. peripheral acrocyanosis.
B. bradycardia.
C. lethargy.
D. jaundice.

Correct Answer: C

Explanation: Lethargy in the neonate may be seen with hypoglycemia because of a lack of glucose in the nerve cells. Peripheral acrocyanosis is normal in the neonate because of immature capillary function. Tachycardia — not bradycardia — is seen with hypoglycemia. Jaundice isn't a sign of hypoglycemia.

Tuesday 9 January 2018

Question Of The Day, Intrapartum Period
Q. A client with Rh isoimmunization gives birth to a neonate with an enlarged heart and severe, generalized edema. The neonate is immediately transferred to the neonatal intensive care unit. Which nursing diagnosis is most appropriate for the client?

A. Ineffective denial related to a socially unacceptable infection
B. Impaired parenting related to the neonate's transfer to the intensive care unit
C. Deficient fluid volume related to severe edema
D. Fear related to removal and loss of the neonate by statute

Correct Answer: B

Explanation: Because the neonate is severely ill and needs to be placed in the neonatal intensive care unit, the client may have a nursing diagnosis of Impaired parenting related to the neonate's transfer to the neonatal intensive care unit. (Another pertinent nursing diagnosis may be Compromised family coping related to lack of opportunity for bonding.) Rh isoimmunization isn't a socially unacceptable infection. This condition causes an excess fluid volume (not deficient) related to cardiac problems. Rh isoimmunization doesn't lead to loss of the neonate by statute.
Nursing Care, Nursing Tutorials and Materials, Nursing Education

If you aspire to become a nurse, you'll want to familiarize yourself with what Nursing Care Plans (NCPs) are all about. Nursing care plans provide a means of communication among nurses, their patients, and other healthcare providers to achieve healthcare outcomes.

In essence, quality patient care that is consistent stems from a detailed NCP. What's more is a nursing care plan provides documentation of the care that was administered, something that is required by health insurance companies, and for patient health records.

A Closer Look at NCPs 

In most nursing workplaces, patient care is a team effort. Whether it’s one nurse taking over another’s shift, or a collaboration between different healthcare professionals, having a consistent care plan is what will ensure that everyone is on the same page.

A nursing care plan contains all of the relevant information about a patient’s diagnoses, the goals of treatment, the specific nursing orders (including what observations are needed and what actions must be performed), and a plan for evaluation. Over the course of the patient’s stay, the plan is updated with any changes and new information as it presents itself.

Creating a care plan

Depending on the workplace, nursing care plans can vary. In most cases, however, you can expect that they will include the same pertinent information: the diagnoses, the anticipated outcome, nursing orders, and evaluation.


According to the North American Nursing Diagnosis Organization-International (NANDA-I), nursing diagnoses compile a list of health problems or conditions that the patient is facing. This information is used to determine the appropriate care that the patient will receive.

In order to make a diagnosis, a thorough patient assessment must take place. According to the American Nurses Association, that assessment should include physiological, psychological, sociocultural, spiritual, and economic data, as well as other lifestyle factors.

In addition to just listing the diagnoses, a good care plan will also define them so there is no confusion moving forward. So for example, pneumonia is an excess fluid in the lungs.


After a nurse performs a patient assessment and the diagnosis is made, the next step is to map out goals for the patient for both the short- and long-term. For instance, if a patient is diagnosed with acute pain from hypertension, the desired outcome might be that the patient begins a new prescription and the pain becomes is controlled.

Nursing Orders/Interventions

This is the part of the nursing care plan where all the action is. Based on the diagnosis and the desired outcome, here, nurses will have a checklist of how to care for the patient. It might include things like checking vital signs every few hours, assess patient by asking pain scale questions, provide medication, etc. Expect to include a lot of specifics here, including times, dosages, etc.

This part of the nursing care plan will be adjusted accordingly as the patient’s condition improves or changes in any way. All care is carefully documented in the patient’s health record and will be used to determine if the patient can be discharged.


Throughout the patient’s stay, their status will be monitored and evaluated so that the plan can be updated as necessary.  As progress is made toward the patient goal, the evaluation is used to determine if the nursing orders need to change, or are complete.

Putting NCPs into Practice

Learning how to create a nursing care plan is something you will learn a lot about in nursing school, and then later, on the job as a Registered Nurse. The good news is that you are not on your own.

There are many online resources that provide templates, sample care plans, and even video tutorials to help you learn the ropes of NCPs. There’s even an app from NANDA that gives you access to over 300 common care plans.

You can also search for NCPs by your specific nursing specialization, for example, such as if you work in medical-surgical or pediatrics. Even Pinterest has a collection of nursing care plans to peruse.

Learning how to write up a nursing care plans is a vital part of your responsibilities as an RN. The key is to be detailed and accurate and to use the resources that are available to help you.

Monday 8 January 2018

Q. A client has an episiotomy to widen her birth canal. Birth extends the incision into the anal sphincter. This complication is called:

A. a first-degree laceration.
B. a second-degree laceration.
C. a third-degree laceration.
D. a fourth-degree laceration.

Correct Answer: C

Explanation: Birth may extend an episiotomy incision to the anal sphincter (a third-degree laceration) or the anal canal (a fourth-degree laceration). A first-degree laceration involves the fourchette, perineal skin, and vaginal mucous membranes. A second-degree laceration extends to the fasciae and muscle of the perineal body.

Friday 5 January 2018

Question Of The Day, Foundations of Psychiatric Nursing
Q. A nurse is instructing a client with bipolar disorder on proper use of lithium carbonate (Eskalith), the drug's adverse effects, and symptoms of lithium toxicity. Which client statement indicates that additional teaching is required?

A. "I can still eat my favorite salty foods."
B. "When my moods fluctuate, I'll increase my dose of lithium."
C. "A good blood level of the drug means the drug concentration has stabilized."
D. "Eating too much watermelon will affect my lithium level."

Correct Answer: B

Explanation: A client who states that he'll increase his dose of lithium if his mood fluctuates requires additional teaching because increasing the dose of lithium without evaluating the client's laboratory values can cause serious health problems, such as lithium toxicity, overdose, and renal failure. Clients taking lithium don't need to limit their sodium intake. A low-sodium diet causes lithium retention. A therapeutic lithium blood level indicates that the drug concentration has stabilized. The client demonstrates effective teaching by stating his lithium levels will be affected by foods that have a diuretic effect, such as watermelon, cantaloupe, grapefruit juice, and cranberry juice.

Wednesday 3 January 2018

Q. A child, age 3, is brought to the emergency department in respiratory distress caused by acute epiglottiditis. Which clinical manifestations should the nurse expect to assess?

A. Severe sore throat, drooling, and inspiratory stridor
B. Low-grade fever, stridor, and a barking cough
C. Pulmonary congestion, a productive cough, and a fever
D. Sore throat, a fever, and general malaise

Correct Answer: A

Explanation: A child with acute epiglottiditis appears acutely ill and clinical manifestations may include drooling (because of difficulty swallowing), severe sore throat, hoarseness, a high temperature, and severe inspiratory stridor. A low-grade fever, stridor, and barking cough that worsens at night are suggestive of croup. Pulmonary congestion, productive cough, and fever along with nasal flaring, retractions, chest pain, dyspnea, decreased breath sounds, and crackles indicate pneumococcal pneumonia. A sore throat, fever, and general malaise point to viral pharyngitis.

Tuesday 2 January 2018

Health Insurance Portability and Accountability Act (HIPAA)

Imagine what it would be like if there were no HIPAA violations. Everyone would be respectful, and trustworthy. Employees would be honest. Patients wouldn’t withhold important information from medical staff due to mistrust. Unfortunately, this is not the case. HIPAA violations are very common, and the laws are violated every day. Here are a few common Health Insurance Portability and Accountability Act (HIPAA) violations, and tips to help avoid them.

1. Gossiping

So, gossiping in itself isn’t a HIPAA violation. However, chatting loudly about a patient and their situation in front of the nurses’ station where everyone can hear, is a violation. Gossiping about patients outside of the work environment to friends or family is also a violation.

Health Insurance Portability and Accountability Act (HIPAA)

I get it. We, nurses, see a lot of crazy, weird, disgusting, appalling things. It’s understandable that you want to share it with your friends. Don’t. Even if you don’t include a name, a patient may be identified by their medical situation. So, just don’t.

2. Being Nosy

Health Insurance Portability and Accountability Act (HIPAA)

People are naturally curious. As employees, we have access to patient information, even information we don’t necessarily need to know to do our jobs. Naturally, when a patient is famous or is well-known on the news, we want to know all the inside information. Once the patient’s record or chart is accessed unlawfully, it’s a HIPAA violation. As curious as you may be, resist the urge to be nosy. This violation could cost you a hefty fine, your job and even jail time.

3. Disclosure of Information to the Wrong Party

Health Insurance Portability and Accountability Act (HIPAA)

This seems to be a very common occurrence. Many times, a “family member” or “friend” of a patient will request information about a patient’s status. Some employees take the person at their word and provide them with personal patient information. Without the patient’s permission to give out information, this is a HIPAA violation. This seems to happen more during phone calls. Anyone can call and request information, but you need to be able to verify their identity. Many facilities have a protocol in place where designated persons have a password to give healthcare personnel in order to obtain information about a patient. Ask about your company’s policy.

4. Leaving Patient Information Out in the Open

Health Insurance Portability and Accountability Act (HIPAA)

I see this all the time. A nurse or physician gets distracted, or called to an emergent situation and leaves their station with the patient chart still open. When information is left out, anyone can walk by and look at, or even take the information. It’s very important to always close down the patient chart, or put away any paperwork containing PPI.

With some effort, we can all prevent PPI from getting in the wrong hands. The steps to protect patient information are simple. Keep your mouth shut, mind your own business, hide your paperwork, be cautious about releasing information. Remember, patient’s overall well-being is your responsibility and privacy and confidentiality are parts of your care.
Q. A 10-month-old child has cold symptoms. The mother asks how she can clear the infant's nose. Which of the following would be the nurse's best recommendation?

A. Use a cool air vaporizer with plain water.
B. Use saline nose drops and then a bulb syringe.
C. Blow into the child's mouth to clear the infant's nose.
D. Administer a nonprescription vasoconstrictive nose spray.

Correct Answer: B

Explanation: Although a cool air vaporizer may be recommended to humidify the environment, using saline nose drops and then a bulb syringe before meals and at nap and bed times will allow the child to breathe more easily. Saline helps to loosen secretions and keep the mucous membranes moist. The bulb syringe then gently aids in removing the loosened secretions. Blowing into the child's mouth to clear the nose introduces more organisms to the child. A nonprescription vasoconstrictive nasal spray is not recommended for infants because if the spray is used for longer than 3 days a rebound effect with increased inflammation occurs.

Monday 1 January 2018

Q. A nurse is documenting a variance that has occurred during the shift, and this report will be used for quality improvement to identify high-risk patterns and potentially initiate in-service programs. This is an example of which type of report?

A. Incident report.
B. Nurse's shift report.
C. Transfer report.
D. Telemedicine report.

Correct Answer: A

Explanation: An incident report, also termed a variance report or occurrence report, is a tool healthcare agencies use to document anything out of the ordinary that results in or has the potential to result in harm to a client, employee, or visitor. These reports are used for quality improvement and not for disciplinary action. They are a means of identifying risks and high-risk patterns and initiating in-service programs to prevent future problems. A nurse's shift report is given by a primary nurse to the nurse replacing him or her or by the charge nurse to the nurse who assumes responsibility for continuing client care. A transfer report is a summary of a client's condition and care when transferring clients from one unit or institution to another. A telemedicine report can link healthcare professionals immediately and enable nurses to receive and give critical information about clients in a timely fashion.



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