Friday, 22 March 2019

Q. A nurse is monitoring a client for adverse reactions to atropine (Atropine Care) eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction?

A. Tachycardia
B. Increased salivation
C. Hypotension
D. Apnea


Correct Answer: A

Explanation: Systemic absorption of atropine can cause tachycardia, palpitations, flushing, dry skin, ataxia, and confusion. To minimize systemic absorption, the client should apply digital pressure over the punctum at the inner canthus for 2 to 3 minutes after instilling the drops. The drug also may cause dry mouth. It isn't known to cause hypotension or apnea.

Wednesday, 20 March 2019

Q. A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus?

A. Recent weight gain of 20 lb (9.1 kg)
B. Failure to monitor blood glucose levels
C. Skipping insulin doses during illness
D. Crying whenever diabetes is mentioned



Correct Answer: D

Explanation: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

Tuesday, 19 March 2019

Q. A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

A. "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear."
B. "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."
C. "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year."
D. "I will receive parenteral vitamin B12 therapy for the rest of my life."

Correct Answer: D

Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.




Saturday, 16 March 2019

Q. In preparing the client and the family for a postoperative stay in the intensive care unit (ICU) after open heart surgery, the nurse should explain that:

A. The client will remain in the ICU for 5 days.
B. The client will sleep most of the time while in the ICU.
C. Noise and activity within the ICU are minimal.
D. The client will receive medication to relieve pain.

Correct Answer: D

Explanation: Management of postoperative pain is a priority for the client after surgery, including valve replacement surgery, according to the Agency for Health Care Policy and Research. The client and family should be informed that pain will be assessed by the nurse and medications will be given to relieve the pain. The client will stay in the ICU as long as monitoring and intensive care are needed. Sensory deprivation and overload, high noise levels, and disrupted sleep and rest patterns are some environmental factors that affect recovery from valve replacement surgery.


Friday, 15 March 2019

Q. A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The primary care provider has ordered I.V. fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4Meq/ L. The nurse should:

A. Notify the primary care provider.
B. Administer the ordered fluids.
C. Verify that the infant has urinated.
D. Have the potassium level redrawn.

Correct Answer: C

Explanation: Normal serum potassium levels are 3.5-4.5 Meq/L. Elevated potassium levels can cause life threatening cardiac arrhythmias. The nurse must verify that the client has the ability to clear potassium through urination before administering the drug. Infants with pyloric stenosis frequently have low potassium levels due to vomiting. A level of 3.4Meq/l is not unexpected and should be corrected with the ordered fluids. The lab value does not need to be redrawn as the findings are consistent with the infant's condition.


Thursday, 14 March 2019

Q. Twelve hours after a vaginal delivery with epidural anesthesia, the nurse palpates the fundus of a primiparous client and finds it to be firm, above the umbilicus, and deviated to the right. Which of the following would the nurse do next?

A. Document this as a normal finding in the client's record.
B. Contact the physician for an order for methylergonovine (Methergine).
C. Encourage the client to ambulate to the bathroom and void.
D. Gently massage the fundus to expel the clots.

Correct Answer: C

Explanation: At 12 hours postpartum, the fundus normally should be in the midline and at the level of the umbilicus. When the fundus is firm yet above the umbilicus, and deviated to the right rather than in the midline, the client's bladder is most likely distended. The client should be encouraged to ambulate to the bathroom and attempt to void, because a full bladder can prevent normal involution. A firm but deviated fundus above the level of the umbilicus is not a normal finding and if voiding does not return it to midline, it should be reported to the physician. Methylergonovine (Methergine) is used to treat uterine atony. This client's fundus is firm, not boggy or soft, which would suggest atony. Gentle massage is not necessary because there is no evidence of atony or clots.

Wednesday, 13 March 2019

Question Of The Day, Intrapartum Period
Q. The nurse is caring for a multigravid client who speaks little English. As the nurse enters the client's room, the nurse observes the client squatting on the bed and the fetal head crowning. After calling for assistance and helping the client lie down, which of the following actions should the nurse do next?

A. Tell the client to push between contractions.
B. Provide gentle support to the fetal head.
C. Apply gentle upward traction on the neonate's anterior shoulder.
D. Massage the perineum to stretch the perineal tissues.

Correct Answer: B

Explanation: During a precipitous delivery, after calling for assistance and helping the client lie down, the nurse should provide support to the fetal head to prevent it from coming out. It is not appropriate to tell the client to push between contractions because this may lead to lacerations. The shoulder should be delivered by applying downward traction until the anterior shoulder appears fully at the introitus, then upward pressure to lift out the other shoulder. Priority should be given to safe delivery of the infant over protecting the perineum by massage.


Tuesday, 12 March 2019

Q. Which medication is considered safe during pregnancy?

A. Aspirin
B. Magnesium hydroxide
C. Insulin
D. Oral antidiabetic agents





Correct Answer: C

Explanation: Insulin is a required hormone for any client with diabetes mellitus, including the pregnant client. Aspirin, magnesium hydroxide, and oral antidiabetic agents aren't recommended for use during pregnancy because these agents may cause fetal harm.

Monday, 11 March 2019

Q. A client with alcohol dependency is prescribed a B-complex vitamin. The client states, "Why do I need a vitamin? My appetite is just fine." Which of the following responses by the nurse is most appropriate?

A. "Your doctor wants you to take it for at least 4 months."
B. "You've been drinking alcohol and eating very little."
C. "The vitamin is a nutritional supplement important to your health."
D. "The amount of vitamins in the alcohol you drink is very low."

Correct Answer: C

Explanation: Stating that the vitamin is a nutritional supplement important to the client's health is the best response. The client is nutritionally depleted, and the B-complex vitamins produce a calming effect on the irritated central nervous system and prevent anemia, peripheral neuropathy, and Wernicke's encephalopathy. Although the statements about drinking alcohol and eating very little and that there is a low amount of vitamins in the alcohol consumed may be true, they fail to address the client's concerns directly and fail to provide the necessary information, as does telling the client that the doctor wants the client to take the vitamin for 4 months.


Saturday, 9 March 2019

Q. A client with major depression sleeps 18 to 20 hours per day, shows no interest in activities he previously enjoyed and reports a 17-lb (7.7-kg) weight loss over the past month. Because this is the client's first hospitalization, the physician is most likely to order:

A. phenelzine (Nardil).
B. thiothixene (Navane).
C. nortriptyline (Pamelor).
D. trifluoperazine (Stelazine).

Correct Answer: C

Explanation: Nortriptyline, a tricyclic antidepressant, is used in first-time drug therapy because it causes few anticholinergic and sedative adverse effects. Phenelzine isn't ordered initially because it may cause many adverse effects and necessitates dietary restrictions. Thiothixene and trifluoperazine are antipsychotic agents and, therefore, inappropriate for clients with uncomplicated depression.

Friday, 8 March 2019

Q. A client who recently developed paralysis of the arms is diagnosed with conversion disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the care plan for this client?

A. Exercising the client's arms regularly
B. Insisting that the client eat without assistance
C. Working with the client rather than with the family
D. Teaching the client how to use nonpharmacologic pain-control methods

Correct Answer: A

Explanation: To maintain the integrity of the affected areas and prevent muscle wasting and contractures, the nurse should help the client perform regular passive range-of-motion exercises with his arms. The nurse shouldn't insist that the client use his arms to perform such functions as eating without assistance, because he can't consciously control his symptoms and move his arms; such insistence may anger the client and endanger the therapeutic relationship. The nurse should include family members in the client's care because they may be contributing to the client's stress or conflict and are essential to helping him regain function of his arms. The client isn't experiencing pain and, therefore, doesn't need education regarding pain management.

Thursday, 7 March 2019

Q. The nursing staff has finished restraining a client. In addition to determining whether anyone was injured, the staff is mandated to evaluate the incident to obtain which of the following ultimate outcomes?

A. Coordinate documentation of the incident.
B. Resolve negative feelings and attitudes.
C. Improve the use of restraint procedures.
D. Calm down before returning to the other clients.

Correct Answer: C

Explanation: Although coordinating documentation, resolving negative feelings, and calming down are goals of debriefing after a restraint, the ultimate outcome is to improve restraint procedures.

Wednesday, 6 March 2019

Q. A 17-year-old client who has been taking an antidepressant for six weeks has returned to the clinic for a medication check. When the nurse talks with the client and her mother, the mother reports that she has to remind the client to take her antidepressant every day. The client says, "Yeah, I'm pretty bad about remembering to take my meds, but I never miss a dose because Mom always bugs me about taking it." Which of the following responses would be effective for the nurse to make to the client?

A. "It's a good thing your mom takes care of you by reminding you to take your meds."
B. "It seems there are some difficulties with being responsible for your medications that we need to address".
C. "You'll never be able to handle your medication administration at college next year if you're so dependent on her."
D. "I'm surprised your mother allows you to be so irresponsible."

Correct Answer: B

Explanation: The client and mother need to address the issue of responsibility for medication administration and only Option 2 opens that subject to discussion. Option 1 reinforces the mother's over-involvement in medication taking. Options 3 and 4 make negative comments about the client and mother that are unlikely to engage them in problem-solving about the matter. 

Tuesday, 5 March 2019

Q. Which of the following measures should the nurse include in the care plan for a child who is receiving high-dose methotrexate (amethopterin) therapy?

A. Keeping the child in a fasting state.
B. Obtaining a white blood cell (WBC) count.
C. Preparing for radiography of the spinal canal.
D. Collecting a specimen for urinalysis.



Correct Answer: B

Explanation: Methotrexate is not highly toxic in low doses but may cause severe leukopenia at higher doses. It is customary and recommended for blood tests to be done before therapy to provide a baseline from which to study the effects of the drug on WBC count. Maintaining a fasting state, radiography of the spinal canal, and urinalysis are not necessary when this drug is administered.


Monday, 4 March 2019

Question Of The Day, Preschooler
Q. A 4-year-old boy presents to the emergency department. His father tearfully reports that he was in the driveway and had his son on his shoulders when the child began to fall. The father grabbed him by the leg, swinging him toward the grass to avoid landing on the pavement. As the father swung his son, the child hit his head on the driveway and twisted his right leg. After a complete examination, it is determined that the child has a skull fracture and a spiral fracture of the femur. Which of the following actions should the nurse take?

A. Restrict the father's visitation.
B. Notify the police immediately.
C. Refer the father for parenting classes.
D. Record the father's story in the chart.

Correct Answer: D

Explanation: The father's story is consistent with the injuries incurred by the child; therefore, the nurse should document the cause of injury. There is no need to restrict the father's visitation, because the injuries sustained by the child are consistent with the explanation given. The police need to be notified only if there is suspicion of child abuse. The injuries incurred by this child appear accidental. There is no need to refer the father for parenting classes. The father seems upset about the accident and will not likely repeat such reckless behavior. The nurse should educate the father, however, regarding child safety.

Friday, 1 March 2019

Q. An 18-year-old high school senior wishes to obtain birth control through her parents' insurance but does not want the information disclosed. The nurse tells the client that under the Health Information Portability and Accountability Act (HIPAA) parents:

A. Have the right to review a minor's medical records until high school graduation.
B. Have the right to review a minor's medical record if they are responsible for the payment.
C. May not view the medical record, but may learn of the visit through the insurance bill.
D. May not view the minor's medical record or the insurance bill.

Correct Answer: C

Explanation: Under HIPAA, 18-year-olds have the right to medical privacy and their medical records may not be disclosed to their parents without their permission. However, the adolescent must be made aware of the fact that information is sent to third party payers for the purpose of reimbursement. Those payers send the primary insurer, in this case the parent, a statement of benefits. HIPAA protects the right to medical privacy of all 18-year-olds regardless of their educational status. Even if parents are responsible for payment, they may not view the patient's chart without the consent of the adolescent.

Thursday, 28 February 2019

Q. A neonate has a large amount of secretions. After vigorously suctioning the neonate, the nurse should assess for what possible result?

A. Bradycardia.
B. Rapid eye movement.
C. Seizures.
D. Tachycard




Correct Answer: A

Explanation: As a result of vigorous suctioning the nurse must watch for bradycardia due to potential vagus nerve stimulation. Rapid eye movement is not associated with vagus nerve stimulation. Vagal stimulation will not cause seizures or tachycardia.


Wednesday, 27 February 2019

Q. The nurse administers an intradermal injection to a client. Proper technique has been used if the injection site demonstrates which of the following?

A. Minimal leaking.
B. No swelling.
C. Tissue pallor.
D. Evidence of a bleb or wheal.



Correct Answer: D

Explanation: A properly administered intradermal injection shows evidence of a bleb or wheal at the injection site. There should be no leaking of medication from the bleb; it needs to be absorbed into the tissue. Lack of swelling at the injection site means that the injection was given too deeply. The presence of tissue pallor does not indicate that the injection was given correctly.

Friday, 22 February 2019

Q. A potential concern when caring for an older adult who has diminished hearing and vision is the client's:

A. Feelings of disorientation.
B. Cognitive impairment.
C. Sensory overload.
D. Social isolation.




Correct Answer: D

Explanation: Social isolation is a concern for an older adult who has diminished hearing and vision. Feeling disoriented may be related to cognitive problems rather than diminished hearing and vision. Diminished hearing and vision is related to the aging process and does not result in impairment of the older adult's thought processes. The client with impaired hearing and vision is unlikely to experience sensory overload.


Thursday, 21 February 2019

Q. The nurse is evaluating the pin insertion site of a client's skeletal traction. Which of the following indicate a complication?

A. Presence of crusts around the pin insertion site.
B. Serous drainage on the dressing.
C. Pin moves slightly at insertion site.
D. Client does not feel pain at insertion site.



Correct Answer: C

Explanation: Skeletal pins should not be loose and able to move. Any pin loosening should be reported immediately. Slight serous drainage is normal and may crust around the insertion site or be present on the dressing. The pin insertion site should be cleaned with aseptic technique according to facility policy. Pin insertion sites are typically not painful; pain may be indicative of an infection and should be reported.

Wednesday, 20 February 2019

Q. A 75-year-old client is newly diagnosed with diabetes. The nurse is instructing him about blood glucose testing. After the session, the client states, "I can't be expected to remember all this stuff." The nurse should recognize this response as most likely related to which of the following?

A. Moderate to severe anxiety.
B. Disinterest in the illness.
C. Early-onset dementia.
D. Normal reaction to learning a new skill.

Correct Answer: A

Explanation: Anxiety, especially at higher levels, interferes with learning and memory retention. After the client's anxiety lessens, it will be easier for him to learn the steps of the blood glucose monitoring. Because the client's illness is a chronic, lifelong illness that severely changes his lifestyle, it is unlikely that he is uninterested in the illness or how to treat it. It is also unlikely that dementia would be the cause of the client's frustration and lack of memory. The client's response indicates anxiety. Client responses that would indicate lessening anxiety would be questions to the nurse or requests to repeat part of the instruction.


Tuesday, 19 February 2019

Q. A client receiving a blood transfusion begins to have chills and headache within the first 15 minutes of the transfusion. The nurse should first:

A. Administer acetaminophen.
B. Take the client's blood pressure.
C. Discontinue the transfusion.
D. Check the infusion rate of the blood.



Correct Answer: C

Explanation: Chills and headache are signs of a febrile, nonhemolytic blood transfusion reaction and the nurse's first action should be to discontinue the transfusion as soon as possible and then notify the physician. Antipyretics and antihistamines may be ordered. The nurse would not administer acetaminophen without an order from the physician. The client's blood pressure should be taken after the transfusion is stopped. Checking the infusion rate of the blood is not a pertinent action; the infusion needs to be stopped regardless of the rate.


Monday, 18 February 2019

Q. Following a small-bowel resection, a client develops fever and anemia. The surface surrounding the surgical wound is warm to the touch and necrotizing fasciitis is suspected. Another manifestation that suggests necrotizing fasciitis is:

A. erythema.
B. leukocytosis.
C. pressurelike pain.
D. swelling.

Correct Answer: C

Explanation: Severe pressurelike pain out of proportion to visible signs distinguishes necrotizing fasciitis from cellulitis. Erythema, leukocytosis, and swelling are present in both cellulitis and necrotizing fasciitis.

Saturday, 16 February 2019

Q. A nurse should monitor a client receiving lidocaine (Xylocaine) for toxicity. Which signs or symptoms in a client suggest lidocaine toxicity?

A. Nausea and vomiting
B. Pupillary changes
C. Confusion and restlessness
D. Hypertension



Correct Answer: C

Explanation: Confusion and restlessness are signs of lidocaine toxicity. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard) — other class IB drugs. Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.

Thursday, 31 January 2019

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

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


Correct Answer: D

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


Wednesday, 30 January 2019

Q. A nurse is assessing a client's pulse. Which pulse feature should the nurse document?

A. Timing in the cycle
B. Amplitude
C. Pitch
D. Intensity





Correct Answer: B

Explanation: The nurse should document the rate, rhythm, and amplitude, such as weak or bounding, of a client's pulse. Pitch, timing, and intensity aren't associated with pulse assessment.

Tuesday, 29 January 2019

Q. A health care provider orders 0.5 mg of protamine sulfate for a client who is showing signs of bleeding after receiving a 100-unit dose of heparin. The nurse should expect the effects of the protamine sulfate to be noted in which of the following time frames?

A. 5 minutes.
B. 10 minutes.
C. 20 minutes.
D. 30 minutes.

Correct Answer: C

Explanation: A dose of 0.5 mg of protamine sulfate reverses a 100-unit dose of heparin within 20 minutes. The nurse should administer protamine sulfate by I.V. push slowly to avoid adverse effects, such as hypotension, dyspnea, bradycardia, and anaphylaxis.


Monday, 28 January 2019

Q. Before preparing a client for surgery, the nurse assists in developing a teaching plan. What is the primary purpose of preoperative teaching?

A. To determine whether the client is psychologically ready for surgery
B. To express concerns to the client about the surgery
C. To reduce the risk of postoperative complications
D. To explain the risks associated with the surgery and obtain informed consent

Correct Answer: C

Explanation: Preoperative teaching helps reduce the risk of postoperative complications by telling the client what to expect and providing a chance for him to practice, before surgery, any required postoperative activities, such as breathing and leg exercises. The physician — not the nurse — is responsible for determining the client's psychological readiness for surgery. It's inappropriate for the nurse to express personal concerns about surgery to a client. The physician should describe alternative treatments and explain the risks to the client when obtaining informed consent.

Thursday, 24 January 2019

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

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

Correct Answer: C

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

Wednesday, 23 January 2019

Q. A client has been diagnosed with degenerative joint disease (osteoarthritis) of the left hip. Which of the following factors in the client's history would most likely increase the
joint symptoms of osteoarthritis?

A. A long history of smoking.
B. Excessive alcohol use.
C. Obesity.
D. Emotional stress.


Correct Answer: C

Explanation: Osteoarthritis most commonly results from "wear and tear"---excessive and prolonged mechanical stress on the joints. Increased weight increases stress on weight-bearing joints. Therefore, an obese client with osteoarthritis should be encouraged to lose weight. Smoking does not cause osteoarthritis. Excessive alcohol use does not cause osteoarthritis. Emotional stress does not cause osteoarthritis.

Tuesday, 22 January 2019

Q. A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every:

A. 10 g of carbohydrates.
B. 15 g of carbohydrates.
C. 20 g of carbohydrates.
D. 25 g of carbohydrates.



Correct Answer: B

Explanation: The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates.


Monday, 21 January 2019

Q. A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. Which is the nurse's best response?

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

Correct Answer: B

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

Saturday, 19 January 2019

Q. Prochlorperazine (Compazine) is prescribed postoperatively. The nurse should evaluate the drug's therapeutic effect when the client expresses relief from which of the following?

A. Nausea.
B. Dizziness.
C. Abdominal spasms.
D. Abdominal distention.



Correct Answer: A


Explanation: Prochlorperazine is administered postoperatively to control nausea and vomiting. Prochlorperazine is also used in psychotherapy because of its effects on mood and behavior. It is not used to treat dizziness, abdominal spasms, or abdominal distention.

Friday, 18 January 2019

Q. A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client?

A. Wear sterile gloves.
B. Place incontinence pads in the regular trash container.
C. Wear personal protective equipment when handling blood, body fluids, and feces.
D. Provide a urinal or bedpan to decrease the likelihood of soiling linens.

Correct Answer: C

Explanation: Chemotherapy drugs are present in the waste and body fluids of clients for 48 hours after administration. The nurse should wear personal protective equipment when handling blood, body fluids, or feces. Gloves offer minimal protection against exposure. The nurse should wear a face shield, gown, and gloves when exposure to blood or body fluid is likely. Placing incontinence pads in the regular trash container and providing a urinal or bedpan don't protect the nurse caring for the client.

Thursday, 17 January 2019

Q. A client with chronic heart failure is receiving digoxin (Lanoxin), 0.25 mg by mouth daily, and furosemide (Lasix), 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity may also cause:

A. visual disturbances.
B. taste and smell alterations.
C. dry mouth and urine retention.
D. nocturia and sleep disturbances.

Correct Answer: A

Explanation: Digoxin toxicity may cause visual disturbances (such as, flickering flashes of light, colored or halo vision, photophobia, blurring, diplopia, and scotomata), central nervous system abnormalities (such as headache, fatigue, lethargy, depression, irritability and, if profound, seizures, delusions, hallucinations, and memory loss), and cardiovascular abnormalities (abnormal heart rate and arrhythmias). Digoxin toxicity doesn't cause taste and smell alterations. Dry mouth and urine retention typically occur with anticholinergic agents, not inotropic agents such as digoxin. Nocturia and sleep disturbances are adverse effects of furosemide — especially if the client takes the second daily dose in the evening, which may cause diuresis at night.


Wednesday, 16 January 2019

Question Of The Day, The Neonate
Q. During the first feeding, the nurse observes that the neonate becomes cyanotic after gagging on mucus. Which of the following should the nurse do first?

A. Start mouth-to-mouth resuscitation.
B. Contact the neonatal resuscitation team.
C. Raise the neonate's head and pat the back gently.
D. Clear the neonate's airway with suction or gravity.

Correct Answer: D

Explanation: If a neonate gags on mucus and becomes cyanotic during the first feeding, the airway is most likely closed. The nurse should clear the airway by gravity (by lowering the infant's head) or suction. Starting mouth-to-mouth resuscitation is not indicated unless the neonate remains cyanotic and lowering his head or suctioning doesn't clear his airway. Contacting the neonatal resuscitation team is not warranted unless the infant remains cyanotic even after measures to clear the airway. Raising the neonate's head and patting the back are not appropriate actions for removing mucus. Doing so allows the mucus to remain lodged causing further breathing difficulties.


Tuesday, 15 January 2019

Q. On the second postpartum day a gravida 6, para 5 complains of intermittent abdominal cramping. The nurse should assess for:

A. endometritis.
B. postpartum hemorrhage.
C. subinvolution.
D. afterpains.




Correct Answer: D

Explanation: In a multiparous client, decreased uterine muscle tone causes alternating relaxation and contraction during uterine involution, which leads to afterpains. The client's symptoms don't suggest endometritis, hemorrhage, or subinvolution.

Friday, 11 January 2019

Q. A client with chronic undifferentiated schizophrenia is admitted to the psychiatric unit of a local hospital. During the next several days, the client is seen laughing, yelling, and talking to himself. This behavior is characteristic of:

A. delusion.
B. looseness of association.
C. illusion.
D. hallucination.


Correct Answer: D

Explanation: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.




Thursday, 10 January 2019

There was an article that was released about nurses being overworked, overstressed, and underpaid. Nurses are working two or three jobs just to maintain their cost of living and pay down debt from nursing school and previous degrees. Others are frustrated with the time and the demands of the job and are leaving the profession all together to go into sales or other professions for the sake of quality of life. Some will even drive Uber on the weekends just to make extra money that doesn’t involve a bed or tele-alarms.


As a nurse of 5 years working from coast to coast, I have witnessed this first hand and very much felt it myself. Our job is crazy at times and if we aren’t careful, it can burn us out to a crisp. Although sometimes you need to make difficult decisions and leave a facility or even the career for the sake of bringing in higher cash flow, my heart feels for the nurses who are in that place right now. I hear you, I see you.

This piece is to share with all my fellow nurses, some good energy for the New Year. Life is crazy, our job is stressful and quite unglamorous at times, but it doesn’t always have to weigh heavy on your heart. For those of you who are feeling the burn of this job, here are a few tips on how to bring in that good energy into 2019…

1. Take a deep breath


Start right now. Take a deep breath, close your eyes, hold it, and then let it out. Remember this point when you’re in the “thick” of it. Yes, you may not have time to eat and you may not have time to pee (all habits we really need to let go of in 2019) but one thing you do have time to do is TAKE A DEEP BREATH. Link it to a task – every time you’re at the Pyxsis or the Omnicel, put your finger down on the reader, close your eyes and take a deep breath. Let this habit spread to all aspects of your day: when you’re opening that new bag of fluids, running to get the code cart, or sitting down to finally chart. And don’t do one of those sighs that lead to a defeated slouch. Sit up straight and make your Respiratory Therapist proud of that big deep breath. 

2. Get a hobby


Everyone needs something to do that they enjoy. If your next thought is, “well I don’t know what I like,” then think about something small that you’ve been curious about, even just mildly. Maybe it’s buying that one pretty ceramic pot you saw to put a plant in it  or learning how to work a camera. Perhaps it’s picking up a new recipe to try. Whatever has crossed your mental sphere and piqued your interest, do just that. 

3. Invest in yourself 


This means different things to different people. If you’re a spa and massage person, then by all means, book the appointment or if you’re a get outside and hike person, put those hiking boots on! The most important thing is to know what feeds you and what fuels you; whatever it is,  also do that.

4. Have a saving system that works for you


Seeing that money build up in your bank account is not only empowering and exciting but smart. This is what works for my husband and me: both our paychecks go straight into a checking account with no debit card linked to it. On payday every Friday (travel nursing weekly pay) we log into our account and physically transfer our spending money for the week into the checking account with a debit card. Depending on our location and our goals, we calculate how much spending money for the week we will use that will allow us to save what we want to. Living in New York City on two incomes with a savings goal of a solid down payment for a house in the next few years, we allow ourselves $800 a week. From this $800, we will buy groceries, subway fair, lots and lots of eating out, and whatever odds and ends happen throughout the week. Maybe it sounds like a lot, maybe it sounds like a little, but we have found for the two of us in the city, that this is the sweet spot. The rest of our pay goes into savings, minus what is needed for bills and rent, which is directly deducted from the first checking account with no card attached to it. This system makes it easy to log into our bank account and physically see exactly how much money we have left budgeted for the week.

5. Get out of town


Getting out of the drama and the usual work-home-work routine is a very healthy thing to do. You don’t have to go across the world to do this – although that is fun too. But taking a weekend to check out a local retreat, or even a short day trip somewhere close to window shop and eat a nice dinner can help you clear your head and get some distance from work.

6. Focus on the positive attributes that make you enjoy your job


You know they’re out there. You may really like joking with your patients, or you may enjoy the technical procedures. Whatever it is, enjoy it, dwell on that aspect of the job, and not the parts that drive you nuts. Let those parts roll off of you like butter on a hot biscuit. Remember, you are responsible for your own experience of life, and that includes work! Make it a good experience for yourself.

7. This is not forever 


Your situation today will not be your situation forever! Back when I started my nursing career, I fell into a strange depression that came from a place of starting a career I didn’t know if I really liked, working nights, and feeling really alone and incompetent to boot. Now looking back (that was only a handful of years ago) I realize that those first few years were just a small spec on the timeline of my life. I did my due diligence of gaining my experience before I left travel nursing and although I still get quite frustrated with the nature of the job, I know better than to feel like there is no end in sight. Life is whatever you want it to be, and at the very least, you have a career that can support you steadily throughout any economic environment, is versatile, and can set you up for anything else you want to do.

8. Don’t get yourself down – stop that negative self-talk 


I enjoy my job less when I feel that I’m not meeting my own expectations. When I miss something in the report or when another nurse gives me attitude about something I did or did not do, it tends to send me into a spiral of negative self-talk and I mentally beat myself up for it. Finally, I am learning to catch myself at the beginning of those spirals and stop myself in my tracks. I will repeat my mantra: “Good job, Mariam! You’re doing a great job.” It feels silly and even fake at first. But part of the magic of “fake it till you make it” lies in this very quality. What your mind says, you believe. So force yourself to say nice things and you’ll see it makes a difference. 

Yes, many nurses are out there working multiple jobs to make ends meet or would rather leave the profession to gain income in different ways than at the bedside. The point of this message is to really understand yourself; if you are stressed, worried, ready to crack – sit down for a minute and really ask yourself why. Why are you struggling and what would make things better? What is realistic for you and what steps could you take, right now?

If your heart is set on leaving nursing, that’s okay. If you just need to step away for a week or month or year, that’s okay too. If you enjoy the work but know you need to up your income, speak to your boss. Negotiate a pay raise or at least a higher OT rate. Find some financial resources that can help you manage your debt and pay structure, and get you to the place where you want to be. If you’re professionally frustrated and know you need to do something else, whether it’s to go back to school or open that coffee shop you’ve always wanted, do a quick Google search. What are the requirements? What are the start-up costs?
Question Of The Day, Mood, Adjustment, and Dementia Disorders
Q. A client was hospitalized for 1 week with major depression with suicidal ideation. He is taking venlafaxine (Effexor), 75 mg three times a day, and is planning to return to work. The nurse asks the client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it anymore and wouldn't do anything to hurt myself." The nurse should make which judgment about the client?

A. The client is decompensating and in need of being readmitted to the hospital.
B. The client needs an adjustment or increase in his dose of antidepressant.
C. The depression is improving and the suicidal ideation is lessening.
D. The presence of suicidal ideation warrants a telephone call to the client's primary care provider.

Correct Answer: C

Explanation: The client's statements about being in control of his behavior and his or her plans to return to work indicate an improvement in depression and that suicidal ideation, although present, is decreasing. Nothing in his comments or behavior indicate he is decompensating. There is no evidence to support an increase or adjustment in the dose of Effexor or a call to the primary care provider. Typically, the cognitive components of depression are the last symptoms eliminated. For the client to be experiencing some suicidal ideation in the second week of psychopharmacologic treatment is not unusual.

Wednesday, 9 January 2019

Q. A 16-year-old academically gifted boy is about to graduate from high school early, because he has completed all courses needed to earn a diploma. Within the last 3 months, he has experienced panic attacks that have forced him to leave classes early and occasionally miss a day of school. He is concerned that these attacks may hinder his ability to pursue a college degree. What would be the best response by the school nurse who has been helping him deal with his panic attacks?

A. "It is natural to be worried about going into a new environment. I am sure with your abilities you will do well once you get settled."
B. "You are putting too much pressure on yourself. You just need to relax more and things will be alright."
C. "It might be best for you to postpone going to college. You need to get these panic attacks controlled first."
D. "It sounds like you have a real concern about transitioning to college. I can refer you to a health care provider for assessment and treatment."

Correct Answer: D

Explanation: The client's concerns are real and serious enough to warrant assessment by a physician rather than being dismissed as trivial. Though he is very intelligent, his intelligence cannot overcome his anxiety. In fact, his anxiety is likely to interfere with his ability to perform in college if no assessment and treatment are received. Just postponing college is likely to increase rather than lower the client's anxiety, because it does not address the panic he is experiencing.

Tuesday, 8 January 2019

Q. Based on a client's history of violence toward others and her inability to cope with anger, which of the following should the nurse use as the most important indicator of goal achievement before discharge?

A. Acknowledgment of her angry feelings.
B. Ability to describe situations that provoke angry feelings.
C. Development of a list of how she has handled her anger in the past.
D. Verbalization of her feelings in an appropriate manner.

Correct Answer: D

Explanation: Verbalizing feelings, especially feelings of anger, in an appropriate manner is an adaptive method of coping that reduces the chance that the client will act out these feelings toward others. The client's ability to verbalize her feelings indicates a change in behavior, a crucial indicator of goal achievement. Although acknowledging feelings of anger and describing situations that precipitate angry feelings are important in helping the client reach her goal, they are not appropriate indicators that she has changed her behavior. Asking the client to list how she has handled anger in the past is helpful if the nurse discusses coping methods with the client. However, based on this client's history, this would not be helpful because the nurse and client are already aware of the client's aggression toward others.


Monday, 7 January 2019

Q. A nurse is performing a psychosocial assessment on a 14-year-old adolescent. Which emotional response is typical during early adolescence?

A. Frequent anger
B. Cooperativeness
C. Moodiness
D. Combativeness



Correct Answer: C

Explanation: Moodiness may occur often during early adolescence. Frequent anger and combativeness are more typical of middle adolescence. Cooperativeness typically occurs during late adolescence.

Friday, 4 January 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.

Thursday, 3 January 2019

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.

Wednesday, 2 January 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.

Tuesday, 1 January 2019

Q. When assessing an elderly client, the nurse expects to find various aging-related physiologic changes. These changes include:

A. increased coronary artery blood flow.
B. decreased posterior thoracic curve.
C. decreased peripheral resistance.
D. delayed gastric emptying.




Correct Answer: D

Explanation: Aging-related physiologic changes include delayed gastric emptying, decreased coronary artery blood flow, an increased posterior thoracic curve, and increased peripheral resistance.

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