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.

Sunday 23 September 2018

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.

Saturday 22 September 2018

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 21 September 2018

What is a career network (or a professional networking) and how do nurses go about networking to land that ideal job or advance your career in other ways?

You’ve heard it said “It’s not what you know but who you know” if you want to advance in life. Unfortunately, there is a lot of truth in this. Surveys show that 70% – 85% of candidates are appointed through some form of networking, and up to 70% of jobs are never advertised to the public in media or on job boards.

What is professional networking?

Nurse A and Nurse B have both applied for the same position that will be a promotion in the organization where they both work. They have the same qualifications and experience. They are both admired for the quality of their work, respected by their colleagues, and liked by their patients.

◈ Nurse A gets on with her work. She talks to her co-workers about the work to be done, but seldom chats to and laughs with them on a more informal basis. They know very little about her as a person or of her home life, she avoids social events at work and doesn’t belong to or participate in professional organizations.

◈ Nurse B often asks co-workers how they are, how things are going at home and gives support when she notices they are down. In chatting, she also shares some of her problems, dreams, and ambitions. Everyone knows Nurse B because she joins in when there is an event at work, has been asked to serve on committees, and is an active member of her local nursing association.

Who do you think is the most likely to get the promotion?

The goal of professional networking is to build real connections with others. Some even say it’s not so much who you know but who knows you. People who know what you are like as a person, what your interests, abilities, and strengths are. Who would bring you to mind if they hear about a job opening and let you know, or who would be prepared to put their reputation on the line to recommend you?

The bigger your network, the more potential opportunities could come your way. But networking involves more than just collecting contacts – as in sharing names, a business card and a few words. You have to build and maintain a connection, and this involves creating rapport as well as mutual trust and respect. This needs some work from your side by giving the other person something of value as well as linking up from time-to-time.

As a student or a newly qualified nurse, you already have a social network of family, friends, and members of groups you belong to such as your church or sports groups. You have the beginnings of a career network in fellow nursing students and colleagues. Don’t neglect this network as they can provide valuable connections now and in the future. Keep your professional and career network active.

Nursing Career, Nursing Certification, Nursing Job, Nursing Profession, Nursing Responsibilities

Keep your professional and career network active.

Professional networking is not only about potentially getting job referrals. It is also about:

◈ Building your career through gaining knowledge, including internal organizational knowledge;
◈ Staying up to date with the latest developments and trends in your workplace and the profession;
◈ Having a support system you can turn to for professional advice when you have to manage new or stressful situations in your career; and
◈ Gaining the respect and recognition that will give you a voice within your organization through which you can have a positive influence on systems and procedures.

You might feel that intentional networking is artificial, but it isn’t really if you see it as creating friendships where there is a give-and-take relationship that is work-related rather than social or recreational. As with friends, you build connections with people that you hit it off with and with whom you share common interests.

So who can you include in your professional network? Here are some suggestions:

◈ Nursing colleagues, supervisors and managers at work;
◈ Nurses who share your specialty interests;
◈ Other health care professionals including doctors and paramedical staff;
◈ Your old classmates;
◈ Your teachers and professors – past and present; and
◈ Experts in areas that you are interested in who you meet at nursing or healthcare meetings and conferences

Professional Networking Tips

1. To build a career network, you first need to meet people, and then you need to get to know them. Go out of your way to strike up conversations wherever you are. This may be difficult if you are shy but when you call others by name, ask questions and listen to what they have to say, they will immediately be attracted to you because they feel that you are interested in them.

2. Put yourself in places where you can meet people. Accept invitations. Attend events that are organized at your place of work or by nursing or other healthcare organizations. Plan to attend a few nursing conferences every year.

3. If you’re given the opportunity to serve on committees at work or in other organizations, don’t hesitate to get involved and stay involved. Not only will you get to know the other members very well, but you’ll also learn new skills and get a chance to showcase your abilities.

4. Join professional organizations and engage and interact with other members. Be prepared to give some of your time and expertise to advance the interests of the organization. This will get you noticed by other professionals who might help you to improve your career in the future.

5. Work on building a deeper relationship with the people you meet. Where appropriate, you can send an “it was great to have met you” or a thank you e-mail to follow up. Or you can connect on social media. Make sure to keep any promises you made during a meeting like passing on a message to a mutual friend or sending a web link that the other person was interested in.

6. Once you have a good career network going avoid losing contact when “life happens.” Keep in touch regularly even if it’s just sharing something on social media that you know the other person will be interested in or a quick phone call. Try to give more than you get. You never know when the day might come when someone passes on information about that ideal opportunity, or you need support in a work crisis.

Expertise and networks work hand-in-hand 

You’ve put a lot of work and time into building your knowledge and skills through qualifications and experience. How much effort have you put into building your nursing career network? As busy as you are, take 10 minutes here and 10 minutes there to connect with someone face-to-face or on social media and commit to attending a few professional meetings and conferences every year.
Question Of The Day, Gastrointestinal Disorders
Q. The comatose victim of the car accident is to have a gastric lavage. Which of the following positions would be most appropriate for the client during this procedure?

A. Lateral.
B. Supine.
C. Trendelenburg's.
D. Lithotomy.

Correct Answer: A

Explanation: An unconscious client is best positioned in a lateral or semiprone position because these positions allow the jaw and tongue to fall forward, facilitate drainage of secretions, and prevent aspiration. Positioning the client supine carries a major risk of airway obstruction from the tongue, vomitus, or nasopharyngeal secretions. Trendelenburg's position, with the head lower than the heart, decreases effective lung volume and increases the risk of cerebral edema. The lithotomy position has no purpose in this situation.

Thursday 20 September 2018

Q. A young man with early-stage testicular cancer is scheduled for a unilateral orchiectomy. The client confides to the nurse that he is concerned about what effects the surgery will have on his sexual performance. Which of the following responses by the nurse provides accurate information about sexual performance after an orchiectomy?

A. "Most impotence resolves in a couple of months."
B. "You could have early ejaculation with this type of surgery."
C. "We will refer you to a sex therapist because you will probably notice erectile dysfunction."
D. "Because your surgery does not involve other organs or tissues, you'll likely not notice much change in your sexual performance."

Correct Answer: D

Explanation: Although there may not be a big change in sexual function with a unilateral orchiectomy, the loss of a gonad and testosterone may result in decreased libido and sterility. Sperm banking may be an option worth exploring if the number and motility of the sperm are adequate. Remember, the population most affected by testicular cancer is generally young men ages 15 to 34, and in this crucial stage of life, sexual anxieties may be a large concern.

Wednesday 19 September 2018

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.

Tuesday 18 September 2018

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.

Monday 17 September 2018

Q. The nurse is assessing a client at her postpartum checkup 6 weeks after a vaginal delivery. The mother is bottle feeding her baby. Which client finding indicates a problem at this time?

A. Firm fundus at the symphysis.
B. White, thick vaginal discharge.
C. Striae that are silver in color.
D. Soft breasts without milk.

Correct Answer: A

Explanation: By 4 to 6 weeks postpartum, the fundus should be deep in the pelvis and the size of a nonpregnant uterus. Subinvolution, caused by infection or retained placental fragments, is a problem associated with a uterus that is larger than expected at this time. Normal expectations include a white, thick vaginal discharge, striae that are beginning to fade to silver, and breasts that are soft without evidence of milk production (in a bottle-feeding mother).

Sunday 16 September 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 14 September 2018

Q. A client has refused to take a shower since being admitted 4 days earlier. He tells a nurse, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate?

A. Dismantling the showerhead and showing the client that there is nothing in it
B. Explaining that other clients are complaining about the client's body odor
C. Asking a security officer to assist in giving the client a shower
D. Accepting these fears and allowing the client to take a sponge bath

Correct Answer: D

Explanation: By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Because these fears are real to the client, providing a demonstration of reality by dismantling the shower head wouldn't be effective at this time. Explaining that other clients are complaining about his body odor or asking a security officer to assist in giving the client a shower would violate the client's rights by shaming or embarrassing him.

Thursday 13 September 2018

Question Of The Day, Mood, Adjustment, and Dementia Disorders
Q. The major goal of therapy in crisis intervention is to:

A. withdraw from the stress.
B. resolve the immediate problem.
C. decrease anxiety.
D. provide documentation of events.

Correct Answer: B

Explanation: During a period of crisis, the major goal is to resolve the immediate problem, with hopes of getting the individual to the level of functioning that existed before the crisis or to a higher level of functioning. Withdrawing from stress doesn't address the immediate problem and isn't therapeutic. The client's anxiety will decrease after the immediate problem is resolved. Providing support and safety are necessary interventions while working toward accomplishing the goal. Documentation is necessary for maintaining accurate records of treatment; it isn't a major goal.

Wednesday 12 September 2018

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.

Tuesday 11 September 2018

Q. The nurse should instruct the family of a child with newly diagnosed hyperthyroidism to:

A.  Keep their home warmer than usual.
B. Encourage plenty of outdoor activities.
C. Promote interactions with one friend instead of groups.
D. Limit bathing to prevent skin irritation.

Correct Answer: C

Explanation: Children with hyperthyroidism experience emotional labiality that may strain interpersonal relationships. Focusing on one friend is easier than adapting to group dynamics until the child's condition improves. Because of their high metabolic rate, children with hyperthyroidism complain of being too warm. Bright sunshine may be irritating because of disease-related ophthalmopathy. Sweating is common and bathing should be encouraged.

Monday 10 September 2018

Question Of The Day, Toddler
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.

Friday 7 September 2018

Q. To prevent development of peripheral neuropathies associated with isoniazid administration, the nurse should teach the client to:

A. Avoid excessive sun exposure.
B. Follow a low-cholesterol diet.
C. Obtain extra rest.
D. Supplement the diet with pyridoxine (vitamin B6).

Correct Answer: D

Explanation: Isoniazid competes for the available vitamin B6 in the body and leaves the client at risk for developing neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed to address this issue. Avoiding sun exposure is a preventive measure to lower the risk of skin cancer. Following a low-cholesterol diet lowers the individual's risk of developing atherosclerotic plaque. Rest is important in maintaining homeostasis but has no real impact on neuropathies.

Thursday 6 September 2018

Q. A nurse is caring for a client who required chest tube insertion for a pneumothorax. To assess for pneumothorax resolution, the nurse can anticipate that the client will require:

A. monitoring of arterial oxygen saturation (SaO2).
B. arterial blood gas (ABG) studies.
C. chest auscultation.
D. a chest X-ray.

Correct Answer: D

Explanation: Chest X-ray confirms diagnosis by revealing air or fluid in the pleural space. SaO2 values may initially decrease with a pneumothorax but typically return to normal within 24 hours. ABG studies may show hypoxemia, possibly with respiratory acidosis and hypercapnia but these are not necessarily related to a pneumothorax. Chest auscultation will determine overall lung status, but it's difficult to determine if the chest has reexpanded sufficiently.

Wednesday 5 September 2018

Improved patient outcomes are dependent on safe nurse staffing levels as well as not substituting registered nurses with lower qualified categories of nurses and support staff. This was stressed in the International Council of Nurses’ position statement on Evidence-based safe nurse staffing which was released on August 6. “Evidence shows nurses save lives, reduce costs and improve patient outcomes.”

Nursing Responsibilities, Nursing Career, Staff Nurse

The position statement is based on evidence provided by research into nurse staffing from across the world. Safe nurse staffing is critical for patient safety as well as for quality care in all the settings where nurses work. Besides enough staff, the right mix of education, skill, and experience are also necessary to meet patient needs.

“There is clear evidence of the importance of safe nurse staffing in relation to patient safety in all healthcare sectors. Inadequate or insufficient nurse staffing levels increase the risk of care being compromised, adverse events for patients, inferior clinical outcomes, in-patient deaths in hospitals and poorer patient experience of care,” said Howard Catton, Director of Nursing and Health Policy at ICN. “ICN recognizes that safe staffing is a key priority and major issue of concern for many of our members and the nurses they represent.”


Evidence has shown that, besides improved patient outcomes, safe nurse staffing also leads to better nurse outcomes – including reduced workloads and enhanced job satisfaction and staff retention. The stress associated with excessive workloads has a significant impact on costs when it leads to burnout, decreased job satisfaction and increased staff turnover.

In some countries, registered nurses are being replaced by lower qualified nurses and healthcare support workers to address the shortage of nurses as well as to reduce costs.  The position paper strongly cautions against this practice. Evidence has clearly shown patient outcomes are better and mortality rates lower in hospitals that have higher proportions of baccalaureate prepared RN’s.

In contrast, replacing RN’s with other categories of health care workers is associated with poorer patient outcomes, higher hospital mortality rates as well as more adverse events such as medication errors and falls – therefore not being cost-effective in the long run.

The position paper recommends that safe staffing should be based on evidence-based planning regarding patient needs in real time. This requires quality tools to measure patient and staffing data as well as allowing for professional judgment by both the direct care providers and nursing management to determine the safe number and ratio of staff to patients. Nursing management should be in control of nurse staffing levels and be able to make adjustments as needed to ensure the patient safety.

The ICN also called on individual nurses to report unsafe nurse staffing. They should also participate in developing evidence-based tools, systems, policies and processes for safe staffing.
Q. When caring for a client after a closed renal biopsy, the nurse should?

A. Maintain the client on strict bed rest in a supine position for 6 hours.
B. Insert an indwelling catheter to monitor urine output.
C. Apply a sandbag to the biopsy site to prevent bleeding.
D. Administer I.V. opioid medications to promote comfort.

Correct Answer: A

Explanation: After a renal biopsy, the client is maintained on strict bed rest in a supine position for at least 6 hours to prevent bleeding. If no bleeding occurs, the client typically resumes general activity after 24 hours. Urine output is monitored, but an indwelling catheter is not typically inserted. A pressure dressing is applied over the site, but a sandbag is not necessary. Opioids to control pain would not be anticipated; local discomfort at the biopsy site can be controlled with analgesics.

Tuesday 4 September 2018

Q. The physician ordered I.V. naloxone (Narcan) to reverse the respiratory depression from morphine administration. After administration of the naloxone the nurse should:

A. Check respirations in 5 minutes because naloxone is immediately effective in relieving respiratory depression.
B. Check respirations in 30 minutes because the effects of morphine will have worn off by then.
C. Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone.
D. Monitor respirations each time the client receives morphine sulfate 10 mg I.M.

Correct Answer: C

Explanation: The nurse should monitor the client's respirations closely for 4 to 6 hours because naloxone has a shorter duration of action than opioids. The client may need repeated doses of naloxone to prevent or treat a recurrence of the respiratory depression. Naloxone is usually effective in a few minutes; however, its effects last only 1 to 2 hours and ongoing monitoring of the client's respiratory rate will be necessary. The client's dosage of morphine will be decreased or a new drug will be ordered to prevent another instance of respiratory depression.

Monday 3 September 2018

Q. A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?

A. Hypoactive bowel sounds
B. Severe lower back pain
C. Sensory deficits in one arm
D. Weakness and atrophy of the arm muscles

Correct Answer: B

Explanation: The most common finding in a client with a herniated lumbar disk is severe lower back pain, which radiates to the buttocks, legs, and feet — usually unilaterally. A herniated disk also may cause sensory and motor loss (such as footdrop) in the area innervated by the compressed spinal nerve root. During later stages, it may cause weakness and atrophy of leg muscles. The condition doesn't affect bowel sounds or the arms.

Saturday 1 September 2018

Q. The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can:

A. Perform the procedure safely and correctly.
B. Critique the nurse's performance of the procedure.
C. Explain all steps of the procedure correctly.
D. Correctly answer a posttest about the procedure.

Correct Answer: A

Explanation: The nurse should judge that learning has occurred from evidence of a change in the client's behavior. A client who performs a procedure safely and correctly demonstrates that he has acquired a skill. Evaluation of this skill acquisition requires performance of that skill by the client with observation by the nurse. The client must also demonstrate cognitive understanding, as shown by the ability to critique the nurse's performance. Explaining the steps demonstrates acquisition of knowledge at the cognitive level only. A posttest does not indicate the degree to which the client has learned a psychomotor skill.



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