Friday, 13 September 2019

Q. A 10-year-old with glomerulonephritis reports a headache and blurred vision. The nurse should immediately:

A. Put the client to bed.
B. Obtain the child's blood pressure.
C. Notify the physician.
D. Administer acetaminophen (Tylenol).

Correct Answer: B

Explanation: Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the physician before confirming the cause of the symptoms would not assist the physician in his treatment. Putting the client to bed may help treat an elevated blood pressure, but first the nurse must establish that high blood pressure is the cause of the symptoms. Administering Tylenol for high blood pressure is not recommended.

Thursday, 12 September 2019

Question Of The Day, Preschooler
Q. After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease?

A. "We try to keep him happy at all costs; otherwise, he has an asthma attack."
B. "We keep our child away from other children to help cut down on infections."
C. "Although our child's disease is serious, we try not to let it be the focus of our family."
D. "I'm afraid that when my child gets older, he won't be able to care for himself like I do."

Correct Answer: C

Explanation: Positive adjustment to a chronic condition requires placing the child's illness in its proper perspective. Children with asthma need to be treated as normally as possible within the scope of the limitations imposed by the illness. They also need to learn how to manage exacerbations and then resume as normal a life as possible. Trying to keep the child happy at all costs is inappropriate and can lead to the child's never learning how to accept responsibility for behavior and get along with others. Although minimizing the child's risk for exposure to infections is important, the child needs to be with his or her peers to ensure appropriate growth and development. Children with a chronic illness need to be involved in their care so that they can learn to manage it. Some parents tend to overprotect their child with a chronic illness. This overprotectiveness may cause a child to have an exaggerated feeling of importance or later, as an adolescent, to rebel against the overprotectiveness and the parents.

Wednesday, 11 September 2019

Q. A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse anticipates that the physician will order which laboratory test?

A. Total iron-binding capacity
B. Hemoglobin (Hb)
C. Total protein
D. Sweat test

Correct Answer: C

Explanation: The nurse anticipates the physician will order a total protein test because negative nitrogen balance may result from inadequate protein intake. Measuring total iron-binding capacity and Hb levels would help detect iron deficiency anemia, not a negative nitrogen balance. The sweat test helps diagnose cystic fibrosis, not a negative nitrogen balance.

Tuesday, 10 September 2019

Question Of The Day, Infant
Q. Which of the following should the nurse use to determine achievement of the expected outcome for an infant with severe diarrhea and a nursing diagnosis of Deficient fluid volume related to passage of profuse amounts of watery diarrhea?

A. Moist mucous membranes.
B. Passage of a soft, formed stool.
C. Absence of diarrhea for a 4-hour period.
D. Ability to tolerate intravenous fluids well.

Correct Answer: A

Explanation: The outcome of moist mucous membranes indicates adequate hydration and fluid balance, showing that the problem of fluid volume deficit has been corrected. Although a normal bowel movement, ability to tolerate intravenous fluids, and an increasing time interval between bowel movements are all positive signs, they do not specifically address the problem of deficient fluid volume.

Monday, 9 September 2019

Q. A nurse is caring for a client with a diagnosis of Impaired gas exchange. Based upon this nursing diagnosis, which outcome is most appropriate?

A. The client maintains a reduced cough effort to lessen fatigue.
B. The client restricts fluid intake to prevent overhydration.
C. The client reduces daily activities to a minimum.
D. The client has normal breath sounds in all lung fields.

Correct Answer: D

Explanation: If the interventions are effective, the client's breath sounds should return to normal. The client should be able to cough effectively and should be encouraged to increase activity, as tolerated. Fluids should help thin secretions, so fluid intake should be encouraged.

Wednesday, 4 September 2019

Q. A client who has a history of Crohn's disease is admitted to the hospital with fever, diarrhea, cramping, abdominal pain, and weight loss. The nurse should monitor the client for:

A. Hyperalbuminemia.
B. Thrombocytopenia.
C. Hypokalemia.
D. Hypercalcemia.

Correct Answer: C

Explanation: Hypokalemia is the most expected laboratory finding owing to the diarrhea. Hypoalbuminemia can also occur in Crohn's disease; however, the client's potassium level is of greater importance at this time because a low potassium level can cause cardiac arrest. Anemia is an expected development, but thrombocytopenia is not. Calcium levels are not affected.

Tuesday, 3 September 2019

Q. When developing a care plan for a client with a do-not-resuscitate (DNR) order, a nurse should:

A. withhold food and fluids.
B. discontinue pain medications.
C. ensure access to spiritual care providers upon the client's request.
D. always make the DNR client the last in prioritization of clients.

Correct Answer: C

Explanation: Ensuring access to spiritual care, if requested by the client, is an appropriate nursing action. A nurse should continue to administer appropriate doses of pain medication as needed to promote the client's comfort. A health care provider may not withhold food and fluids unless the client has a living will that specifies this action. A DNR order does not mean that the client does not require nursing care.

Monday, 2 September 2019

Q. Which of the following laboratory findings are expected when a client has diverticulitis?

A. Elevated red blood cell count.
B. Decreased platelet count.
C. Elevated white blood cell count.
D. Elevated serum blood urea nitrogen concentration.

Correct Answer: C

Explanation: Because of the inflammatory nature of diverticulitis, the nurse would anticipate an elevated white blood cell count. The remaining laboratory findings are not associated with diverticulitis. Elevated red blood cell counts occur in clients with polycythemia vera or fluid volume deficit. Decreased platelet counts can occur as a result of aplastic anemias or malignant blood disorders, as an adverse effect of some drugs, and as a result of some heritable conditions. Elevated serum blood urea nitrogen concentration is usually associated with renal conditions.

Sunday, 1 September 2019

Q. The nurse is caring for a client with asthma. The nurse should conduct a focused assessment to detect which of the following?

A. Increased forced expiratory volume.
B. Normal breath sounds.
C. Inspiratory and expiratory wheezing.
D. Morning headaches.

Correct Answer: C

Explanation: The hallmark signs of asthma are chest tightness, audible wheezing, and coughing. Inspiratory and expiratory wheezing is the result of bronchoconstriction. Even between exacerbations, there may be some soft wheezing, so a finding of normal breath sounds would be expected in the absence of asthma. The expected finding is decreased forced expiratory volume [forced expiratory flow (FEF) is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration] due to bronchial constriction. Morning headaches are found with more advanced cases of COPD and signal nocturnal hypercapnia or hypoxemia.

Friday, 30 August 2019

Q. The nurse is serving on the hospital ethics committee which is considering the ethics of a proposal for the nursing staff to search the room of a client diagnosed with substance abuse while he is off the unit and without his knowledge. Which of the following should be considered concerning the relationship of ethical and legal standards of behavior?

A. Ethical standards are generally higher than those required by law.
B. Ethical standards are equal to those required by law.
C. Ethical standards bear no relationship to legal standards for behavior.
D. Ethical standards are irrelevant when the health of a client is at risk.

Correct Answer: A

Explanation: Some behavior that is legally allowed might not be considered ethically appropriate. Legal and ethical standards are often linked, such as in the commandment "Thou shalt not kill." Ethical standards are never irrelevant, though a client's safety or the safety of others may pose an ethical dilemma for health care personnel. Searching a client's room when they are not there is a violation of their privacy. Room searches can be done with a primary health care provider's order and generally are done with the client present.

Thursday, 29 August 2019

Question Of The Day, Gastrointestinal Disorders
Q. Which of the following interventions would be most appropriate for the nurse to recommend to a client to decrease discomfort from hemorrhoids?

A. Decrease fiber in the diet.
B. Take laxatives to promote bowel movements.
C. Use warm sitz baths.
D. Decrease physical activity.

Correct Answer: C

Explanation: Use of warm sitz baths can help relieve the rectal discomfort of hemorrhoids. Fiber in the diet should be increased to promote regular bowel movements. Laxatives are irritating and should be avoided. Decreasing physical activity will not decrease discomfort.

Wednesday, 28 August 2019

Q. The nurse has discussed sexuality issues during the prenatal period with a primigravida who is at 32 weeks' gestation. She has had one episode of preterm labor. The nurse determines that the client understands the instructions when she says:

A. "I can resume sexual intercourse when the bleeding stops."
B. "I should not get sexually aroused or have any nipple stimulation."
C. "I can resume sexual intercourse in 1 to 2 weeks."
D. "I should not have sexual intercourse until my next prenatal visit."

Correct Answer: B

Explanation: This client has already had one episode of preterm labor at 32 weeks' gestation. Sexual intercourse, arousal, and nipple stimulation may result in the release of oxytocin which can contribute to continued preterm labor and early delivery. The client should be advised to refrain from these activities until closer to term, which is 6 to 8 weeks later. Telling the client that intercourse is acceptable after the bleeding stops is incorrect and may lead to early delivery of a preterm neonate. The client should not have intercourse for at least 6 weeks because of the danger of inducing labor. There is no indication when the client's next prenatal visit is scheduled. 

Tuesday, 27 August 2019

Q. During the health history interview, which of the following strategies is the most effective for the nurse to use to help clients take an active role in their health care?

A. Ask clients to complete a questionnaire.
B. Provide clients with written instructions.
C. Ask clients for their description of events and for their views concerning past medical care.
D. Ask clients if they have any questions.

Correct Answer: C

Explanation: One of the best strategies to help clients feel in control is to ask them their view of situations, and to respond to what they say. This technique acknowledges that clients' opinions have value and relevance to the interview. It also promotes an active role for clients in the process. Use of a questionnaire or written instructions is a means of obtaining information but promotes a passive client role. Asking whether clients have questions encourages participation, but alone it does not acknowledge their views.

Friday, 23 August 2019

Question Of The Day, Neurosensory Disorders
Q. Which of the following statements would provide the best guide for activity during the rehabilitation period for a client who has been treated for retinal detachment?

A. Activity is resumed gradually, and the client can resume her usual activities in 5 to 6 weeks.
B. Activity level is determined by the client's tolerance; she can be as active as she wishes.
C. Activity level will be restricted for several months, so she should plan on being sedentary.
D. Activity level can return to normal and may include regular aerobic exercises.

Correct Answer: A

Explanation: The scarring of the retinal tear needs time to heal completely. Therefore, resumption of activity should be gradual; the client may resume her usual activities in 5 to 6 weeks. Successful healing should allow the client to return to her previous level of functioning.

Tuesday, 20 August 2019

Q. The nurse meets with the client and his wife to discuss depression and the client's medication. Which of the following comments by the wife would indicate that the nurse's teaching about disease process and medications has been effective?

A. "His depression is almost cured."
B. "He's intelligent and won't need to depend on a pill much longer."
C. "It's important for him to take his medication so that the depression will not return or get worse."
D. "It's important to watch for physical dependency on Zoloft."

Correct Answer: C

Explanation: Improved balance of neurotransmitters is achieved with medication. Clients with endogenous depression must take antidepressants to prevent a return or worsening of depressive symptoms. Depression is a chronic disease characterized by periods of remission; however, it is not cured. Depression is not dependent on the client's intelligence to will the illness away. Zoloft is not physically addictive.

Monday, 19 August 2019

Q. A nurse is developing a nursing diagnosis for a client. Which information should she include?

A. Actions to achieve goals
B. Expected outcomes
C. Factors influencing the client's problem
D. Nursing history

Correct Answer: C

Explanation: A nursing diagnosis is a written statement describing a client's actual or potential health problem. It includes a specified diagnostic label, factors that influence the client's problem, and any signs or symptoms that help define the diagnostic label. Actions to achieve goals are nursing interventions. Expected outcomes are measurable behavioral goals that the nurse develops during the evaluation step of the nursing process. The nurse obtains a nursing history during the assessment step of the nursing process.

Saturday, 17 August 2019

Question Of The Day, Neurosensory Disorders
Q. When planning care for a client with a head injury, which position should the nurse include in the care plan to enhance client outcomes?

A. Trendelenburg's
B. 30-degree head elevation
C. Flat
D. Side-lying

Correct Answer: B

Explanation: For clients with increased intracranial pressure (ICP), the head of the bed should be elevated to 30 degrees to promote venous outflow. Trendelenburg's position is contraindicated because it can raise ICP. Flat or neutral positioning is indicated when elevating the head of the bed would increase the risk of neck injury or airway obstruction. A side-lying position isn't specifically a therapeutic treatment for increased ICP.

Friday, 16 August 2019

Question Of The Day, Gastrointestinal Disorders
Q. Before an incisional cholecystectomy is performed, the nurse instructs the client in the correct use of an incentive spirometer. Why is incentive spirometry essential after surgery in the upper abdominal area?

A. The client will be maintained on bed rest for several days.
B. Ambulation is restricted by the presence of drainage tubes.
C. The operative incision is near the diaphragm.
D. The presence of a nasogastric tube inhibits deep breathing.

Correct Answer: C

Explanation: The incisions made for upper abdominal surgeries, such as cholecystectomies, are near the diaphragm and make deep breathing painful. Incentive spirometry, which encourages deep breathing, is essential to prevent atelectasis after surgery. The client is not maintained on bed rest for several days. The client is encouraged to ambulate by the first postoperative day, even with drainage tubes in place. Nasogastric tubes do not inhibit deep breathing and coughing.

Wednesday, 14 August 2019

Question Of The Day, Mood, Adjustment, and Dementia Disorders
Q. A nurse is facilitating mandated group therapy for clients who have sexually abused children. Children who are victims of sexual abuse are typically:

A. from any segment of the population.
B. of low socioeconomic background.
C. strangers to the abuser.
D. willing to engage in sexual acts with adults.

Correct Answer: A

Explanation: Victims of childhood sexual abuse come from all segments of the population and from all socioeconomic backgrounds. Most victims know their abuser. Children rarely willingly engage in sexual acts with adults because they don't have full decision-making capacities.

Tuesday, 13 August 2019

Q. A nurse has received change-of-shift-report and is briefly reviewing the documentation about a client in the client's medical record. A recent entry reads, "Client was upset throughout the morning." How could the charting entry be best improved?

A. The entry should include clearer descriptions of the client's mood and behavior.
B. The entry should avoid mentioning cognitive or psychosocial issues.
C. The entry should list the specific reasons that the client was upset.
D. The entry should specify the subsequent interventions that were performed.

Correct Answer: A

Explanation: Entries in the medical record should be precise, descriptive, and objective. An adjective such as "upset" is unclear and open to many interpretations. As such, the nurse should elaborate on this description so a reader has a clearer understanding of the client's state of mind. Stating the apparent reasons that the client was "upset" does not resolve the ambiguity of this descriptor. Cognitive and psychosocial issues are valid components of the medical record. Responses and interventions should normally follow assessment data but the data themselves must first be recorded accurately.

Monday, 12 August 2019

Q. A man of Chinese descent is admitted to the hospital with multiple injuries after a motor vehicle accident. His pain is not under control. The client states, "If I could be with my people, I could receive acupuncture for this pain." The nurse should understand that acupuncture in the Asian culture is based on the theory that it:

A. Purges evil spirits.
B. Promotes tranquility.
C. Restores the balance of energy.
D. Blocks nerve pathways to the brain.

Correct Answer: C

Explanation: Acupuncture, like acumassage and acupressure, is performed in certain Asian cultures to restore the energy balance within the body. Pressure, massage, and fine needles are applied to energy pathways to help restore the body's balance. Acupuncture is not based on a belief in purging evil spirits. Although pain relief through acupuncture can promote tranquility, acupuncture is performed to restore energy balance. In the Western world, many researchers think that the gate-control theory of pain may explain the success of acupuncture, acumassage, and acupressure.

Saturday, 10 August 2019

Question Of The Day, Neurosensory Disorders
Q. A nurse is caring for a client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should the nurse perform?

A. Sit with the client for a few minutes.
B. Administer an analgesic.
C. Inform the nurse manager.
D. Call the physician immediately.

Correct Answer: D

Explanation: The nurse should notify the physician immediately because the headache may be an indication that the aneurysm is leaking. Sitting with the client is appropriate but only after the physician has been notified of the change in the client's condition. The physician will decide whether or not administration of an analgesic is indicated. Informing the nurse manager isn't necessary. 

Friday, 9 August 2019

Question Of The Day, Gastrointestinal Disorders
Q. A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet?

A. Lean beef.
B. Air-popped popcorn.
C. Hot chocolate.
D. Raw vegetables.

Correct Answer: C

Explanation: With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol. A diet high in protein and low in fat is recommended for clients with GERD. Lean beef, popcorn, and raw vegetables would be acceptable.

Thursday, 8 August 2019

Q. A woman who has recently immigrated from Africa who delivered a term neonate a short time ago requests that a "special bracelet" be placed on the baby's wrist. The nurse should:

A. Tell the mother that the bracelet is not recommended for cleanliness reasons.
B. Apply the bracelet on the neonate's wrist as the mother requests.
C. Place the bracelet on the neonate, limiting its use to when the neonate is with the mother.
D. Recommend that the mother wait until she is discharged to apply the bracelet.

Correct Answer: B

Explanation: The nurse should abide by the mother's request and place the bracelet on the neonate. In some cultures, amulets and other special objects are viewed as good luck symbols. By allowing the bracelet, the nurse demonstrates culturally sensitive care, promoting trust. The neonate can wear the bracelet while with the mother or in the nursery. The bracelet can be used while the neonate is being bathed, or if necessary and acceptable to the client removed and replaced afterward.

Wednesday, 7 August 2019

Question Of The Day, Antepartum Period
Q. An anxious young adult is brought to the interviewing room of a crisis shelter, sobbing and saying that she thinks she is pregnant but does not know what to do. Which of the following nursing interventions is most appropriate at this time?

A. Ask the client about the type of things that she had thought of doing.
B. Give the client some ideas about what to expect to happen next.
C. Recommend a pregnancy test after acknowledging the client's distress.
D. Question the client about her feelings and possible parental reactions.

Correct Answer: C

Explanation: Before any interventions can occur, knowing whether the client is pregnant is crucial in formulating a plan of care. Asking the client about what things she had thought about doing, giving the client some ideas about what to expect next, and questioning the client about her feelings and possible parental reactions would be appropriate after it is determined that the client is pregnant.

Friday, 2 August 2019

Q. A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol?

A. Irregular heartbeat.
B. Constipation.
C. Pedal edema.
D. Decreased pulse rate.

Correct Answer: A

Explanation: Irregular heartbeats should be reported promptly to the care provider. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.

Thursday, 1 August 2019

Q. A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should:

A. provide instructions on eye patching.
B. assess the client's visual acuity.
C. demonstrate eyedrop instillation.
D. teach about intraocular lens cleaning.

Correct Answer: C

Explanation: Eyedrop instillation is a critical component of self-care for a client with glaucoma. After demonstrating eyedrop instillation to the client and family, the nurse should verify their ability to perform this measure properly. An eye patch isn't necessary unless the client has undergone surgery. Visual acuity assessment isn't necessary before discharge. Intraocular lenses aren't implanted in clients with glaucoma.

Wednesday, 31 July 2019

Q. A client with an incomplete small-bowel obstruction is to be treated with a Cantor tube. Which of the following measures would most likely be included in the client's care once the Cantor tube has passed into the duodenum?

A. Maintain bed rest with bathroom privileges.
B. Advance the tube 2 to 4 inches at specified times.
C. Avoid frequent mouth care.
D. Provide ice chips for the client to suck.

Correct Answer: B

Explanation: Once the intestinal tube has passed into the duodenum, it is usually advanced as ordered 2 to 4 inches every 30 to 60 minutes. This, along with gravity and peristalsis, enables passage of the tube forward. The client is encouraged to walk, which also facilitates tube progression. A client with an intestinal tube needs frequent mouth care to stimulate saliva secretion, to maintain a healthy oral cavity, and to promote comfort regardless of where the tube is placed in the intestine. Ice chips are contraindicated because hypotonic fluid will draw extra fluid into an already distended bowel.

Tuesday, 30 July 2019

Question Of The Day, The Neonate
Q. A primigravid client gives birth to a full-term girl. When teaching the client and her partner how to change their neonate's diaper, the nurse should instruct them to:

A. fold a cloth diaper so that a double thickness covers the front.
B. clean and dry the neonate's perineal area from front to back.
C. place a disposable diaper over a cloth diaper to provide extra protection.
D. position the neonate so that urine will fall to the back of the diaper.

Correct Answer: B

Explanation: When changing a female neonate's diaper, the caregiver should clean the perineal area from front to back to prevent infection and then dry the area thoroughly to minimize skin breakdown. For a male, the caregiver should clean and dry under and around the scrotum. Because of anatomic factors, a female's diaper should have the double thickness toward the back. The diaper, not the neonate, should be positioned properly. Placing a disposable diaper over a cloth diaper isn't necessary. The direction of urine flow can't be ensured.

Monday, 29 July 2019

Question Of The Day, Antepartum Period
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.

Saturday, 27 July 2019

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.

Friday, 26 July 2019

Q. A client diagnosed with pain disorder is talking with the nurse about fishing when he suddenly reverts to talking about the pain in his arm. Which of the following should the nurse do next?

A. Allow the client to talk about his pain.
B. Ask the client if he needs more pain medication.
C. Get up and leave the client.
D. Redirect the interaction back to fishing.

Correct Answer: D

Explanation: The nurse should redirect the interaction back to fishing or another focus whenever the client begins to ruminate about physical symptoms or impairment. Doing so helps the client talk about topics that are more therapeutic and beneficial to recovery. Allowing the client to talk about his pain or asking if he needs additional pain medication is not therapeutic because it reinforces the client's need for the symptom. Getting up and leaving the client is not appropriate unless the nurse has set limits previously by saying, "I will get up and leave if you continue to talk about your pain."

Thursday, 25 July 2019

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.

Wednesday, 24 July 2019

Question Of The Day, The Nursing Process
Q. A client is scheduled for surgery under general anesthesia. The night before surgery, the client tells the nurse, "I can't wait to have breakfast tomorrow." Based on this statement, which nursing diagnosis should be the nurse's priority?

A. Deficient knowledge related to food restrictions associated with anesthesia
B. Fear related to surgery
C. Risk for impaired skin integrity related to upcoming surgery
D. Ineffective coping related to the stress of surgery

Correct Answer: A

Explanation: The client's statement reveals a Deficient knowledge related to food restrictions associated with general anesthesia. Fear related to surgery, Risk for impaired skin integrity related to upcoming surgery, and Ineffective coping related to the stress of surgery may be applicable nursing diagnoses but they aren't related to the client's statement.

Tuesday, 23 July 2019

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. 

Monday, 22 July 2019

Question Of The Day, Basic Physical Care
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.

Saturday, 20 July 2019

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.

Friday, 19 July 2019

Question Of The Day, Gastrointestinal Disorders
Q. A client with a bleeding ulcer is vomiting bright red blood. The nurse should assess the client for which of the following indicators of early shock?

A. Tachycardia.
B. Dry, flushed skin.
C. Increased urine output.
D. Loss of consciousness.

Correct Answer: A

Explanation: In early shock, the body attempts to meet its perfusion needs through tachycardia, vasoconstriction, and fluid conservation. The skin becomes cool and clammy. Urine output in early shock may be normal or slightly decreased. The client may experience increased restlessness and anxiety from hypoxia, but loss of consciousness is a late sign of shock.

Thursday, 18 July 2019

Question Of The Day, The Neonate
Q. Nurses teach infant care and safety classes to assist parents in appropriately preparing to take their neonates home. Which statement about automobile restraints for infants is correct?

A. An infant should ride in a front-facing car seat until he weighs 20 lb (9.1 kg) and is 1 year old.
B. An infant should ride in a rear-facing car seat until he weighs 25 lb (11.3 kg) or is 1 year old.
C. An infant should ride in a front-facing car seat until he weighs 30 lb (13.6 kg) or is 2 years old.
D. An infant should ride in a rear-facing car seat until he weighs 20 lb and is 1 year old.

Correct Answer: D

Explanation: Until the infant weighs 20 lb and is 1 year old, he should ride in a rear-facing car seat.

Wednesday, 17 July 2019

Question Of The Day, Postpartum Period
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.
Nursing Degree, Nursing Responsibilities, Nursing Professionals, Nursing Roles, Nursing Schools

The staff and administrators of the hospital in Jonquière, Quebec, were in disbelief when it was discovered that a woman who had been working as a nurse and caring for hospital patients was a fraud.

Working as a ‘Nurse’

Following 20 years of experience in the job, the woman was immediately fired from her position in the said hospital by the health authority in the Saguenay-Lac-Saint-Jean region of eastern Quebec.

The health authority revealed that the woman managed to get hired and retain her position by presenting someone else’s nursing license number with an identical name as hers.

It was during her enrollment in a training course when an official remarked that the age placed on her license number did not meet up with her actual age.

Her tactic readily made headlines and she was quickly suspended pending an investigation, which led to her expulsion.

Prior to her dismissal, the woman had served in various departments of the hospital, including the operating room.

No Evidence of ‘Nursing Degree’

The health authorities teamed up with the investigators and found out that there is no evidence the woman had a nursing degree.

“Over the years, the documents asked of her were provided — falsified documents,” said spokeswoman Joelle Savard. She mentioned that the gap in its records system has been settled to ensure two people cannot use the same license number.

The spokeswoman was in disbelief how someone with no formal training had remained in the position for so long without anyone noticing her secret. She thought that the woman had been with mostly good medical staff and incorporated the basic and required skills for the job.

Big Surprise

The news arrived as a great hysteria, according to a union representative, Julie Bouchard.

“A few weeks, or a few months, that has happened before. But for such a long time, in our minds it was impossible,” she said.

President of Quebec’s Order of Nurses, Luc Mathieu, stated such matters involving frauds are rare but can cause great distress.

“It’s very serious, because that person could have committed acts that could have had serious consequences for patients,” he stated.

Tuesday, 16 July 2019

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.

Monday, 15 July 2019

Question Of The Day, Psychotic Disorders
Q. A client with bipolar disorder, manic phase, just sat down to watch television in the lounge. As the nurse approaches the lounge area, the client states, "The sun is shining. Where is my son? I love Lucy. Let's play ball." The client is displaying:

A. Concreteness.
B. Flight of ideas.
C. Depersonalization.
D. Use of neologisms.

Correct Answer: B

Explanation: The client is demonstrating flight of ideas, or the rapid, unconnected, and often illogical progression from one topic to another. Concreteness involves interpreting another person's words literally. Depersonalization refers to feelings of strangeness concerning the environment or the self. A neologism is a word made up by a client.

Saturday, 13 July 2019

Question Of The Day, School-age Child
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.

Thursday, 11 July 2019

Question Of The Day, Infant
Q. A 10-month-old child with recurrent otitis media is brought to the clinic for evaluation. To help determine the cause of the child's condition, the nurse should ask the parents:

A. "Does water ever get into the baby's ears during shampooing?"
B. "Do you give the baby a bottle to take to bed?"
C. "Have you noticed a lot of wax in the baby's ears?"
D. "Can the baby combine two words when speaking?"

Correct Answer: B

Explanation: In a young child, the eustachian tube is relatively short, wide, and horizontal, promoting drainage of secretions from the nasopharynx into the middle ear. Therefore, asking if the child takes a bottle to bed is appropriate because drinking while lying down may cause fluids to pool in the pharyngeal cavity, increasing the risk of otitis media. Asking if the parent noticed earwax, or cerumen, in the external ear canal is incorrect because wax doesn't promote the development of otitis media. During shampooing, water may become trapped in the external ear canal by large amounts of cerumen, possibly causing otitis external (external ear inflammation) as opposed to internal ear inflammation. Asking if the infant can combine two words is incorrect because a 10-month-old child isn't expected to do so.

Wednesday, 10 July 2019

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.

Tuesday, 9 July 2019

Question Of The Day, Medication and I.V. Administration
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.

Monday, 8 July 2019

Question Of The Day, Basic Physical Care
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.

Saturday, 6 July 2019

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.

Friday, 5 July 2019

Q. When obtaining the vital signs of a client with multiple traumatic injuries, a nurse detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings may reflect which complication?

A. Shock
B. Encephalitis
C. Increased intracranial pressure (ICP)
D. Status epilepticus

Correct Answer: C

Explanation: When ICP increases, Cushing's triad may develop, which involves decreased heart and respiratory rates and increased systolic blood pressure. Shock typically causes tachycardia, tachypnea, and hypotension. In encephalitis, the temperature rises and the heart and respiratory rates may increase from the effects of fever on the metabolic rate. (If the client doesn't maintain adequate hydration, hypotension may occur.) Status epilepticus causes unceasing seizures, not changes in vital signs.




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