Thursday, 14 November 2019

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

Wednesday, 13 November 2019

Question Of The Day, Anxiety Disorders
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.
Attending nursing classes online can have a lot of benefits, like accommodating your current work schedule (hellllooooo night shift), allowing you to attend class in your pajamas, and fit in family life.

Nursing Responsibilities, Nursing Career, Nursing Degree, Nursing Certification,

But all that flexibility can also make online classes challenging. Without an in-person class to attend combined with the distractions of home life, it can be difficult to stay on-task and motivated. For many people, however, the good outweighs the bad, so if online nursing school is in your future, here are some tips for success.

1. Stay Ahead of Schedule

Julie Widzinski, a mom of three active boys and a current Family Nurse Practitioner student, advises anyone taking classes online to stay ahead of their classwork. She points out that most online class formats allow you to see the entire course schedule ahead of time, which can help you plan school work around your life and even work in advance.

“I try to get ahead as best as I can, so if something comes up with the kids, etc., I don’t have to be stuck doing work,” Widzinski explains. “, when the deadline is Wednesday, I usually try posting on Monday.”

2. Do NOT Clean Before You Do Your Homework

I know exactly what you’re thinking — you’re home, you have some time set aside to do your homework, but you’re just going to switch the laundry real quick. Oh, and maybe get dinner started in the crockpot so it can cook while you work. Well, next thing you know you’re making a grocery list and ordering groceries because you noticed you were out of something in the pantry and an hour has gone by and you’re still not working.

Housework of any kind has a way of sucking you in (it’s the “If You Give a Mouse a Cookie” scenario, except for adults), so if you have work that’s due or you’ve committed a time slot to study, you need to just sit your butt down, ignore the housework completely, and make sure you do your homework first. The dishes will be there when you’re done, but you might lose that precious time to work or burn up all of your energy if you try to clean first.

3. Leave Your Home

That being said, if you absolutely cannot avoid getting distracted at home, you may find you work better out of your house or apartment, so head to a local coffee shop, restaurant during a slow time (like late afternoon), or the library. (I’ve even been known to do my online work in a parking lot where the WiFi will still work #noshame). Getting some fresh scenery can also help you stay energized in a new way that staying home can’t.

4. Utilize Time-Blocking

If you’re not familiar with time-blocking, it’s a time-management strategy designed to help you be more productive with your time. Essentially, instead of switching from one task to another, you “block” off time for each specific task so your brain can be completely focused on one thing at a time. So, instead of studying, then looking something up, then trying to answer your online discussion board, you block off a certain amount of time for each task: 30 minutes to study, 30 minutes to research, and 10 to answer your discussion questions, for instance.

You can even use a time-blocking app, such as Toggl, to help you stay on task if you’re using the computer to work; the app will block other distractions, such as texts or calls, or even web browsing if you need that limited so you can stay completely focused.

5. Don’t Work with Any Other Screens On

Sure, it may be tempting to plop down on the couch with a little bit of your favorite show on in the background as you work, but trust me, you will be much more effective and efficient if you study or complete your assignments with no other distractions.

Research shows that you might be just fine — or even more on-task with some background noise, like chatter from your family or the background of a coffee house — but when it comes to other screens or visual distractions, our brains just can’t handle both tasks at once. Just say no to screens while studying.

6. Invest in Noise-Cancelling Headphones

In an ideal world, sure, you may only complete your work or studying in a tranquil environment with a fresh cup of coffee and the birds chirping in the background. But in the real world, especially if you have a family, you’ll be cramming for a test while your kids wrestle in the living room or your partner wanders in and out of the bedroom looking for that one item right in front of their face that they just “can’t find.”

So, for the days that you can’t get away from them or just can’t answer another question about what’s for dinner, put on your noise-canceling headphones and (literally) block them all out. You can pick up a pair for around $60 on Amazon and you should 100% ask your accountant if you can write those off as a job-related expense.

7. Get an Accountability Partner

If staying on task and motivated is a challenge for you, try linking up with an accountability partner from your class. Ask one of your classmates if you can be accountability partners and set a system of checking in with each other; you’ll be less likely to blow off studying if you know your partner is expecting a text from you. Even better, find an IRL partner so you have to stay committed.

If you don’t know anyone in “real life” from your nursing class or don’t feel comfortable asking them, find an accountability partner online — there are many different online nursing student support groups.

Alternatively, you could find an accountability partner who is working toward a different goal. For instance, you check in when it’s time to study and they have to check in when it’s time for them to hit the gym. That way, you both win!

8. Ask for Help

Don’t fall into the trap of thinking that just because you’re taking an online class that you’re on your own—your professor is still available to help you if you’re struggling. In fact, his or her “office hours” might be even more accessible than an in-person professor, so don’t be afraid to schedule time to chat, video conference, or speak on the phone if there are concepts you need additional assistance with.

9. Keep a Back-up Copy of Your Work

When I was attending a graduate school program, I can’t tell you how many times I typed a long, thought-out discussion into the online class board only to have the thing completely disappear in some kind of glitch. With a newborn and a toddler at home at the time, I had precious little time to work, so I quickly learned to type out my answers in a Word or Google doc first, save it, then transfer the work to the online submission forms—that way, there was no risk of losing it.

10. Know Thyself

It sounds simple, but it’s a strategy that can serve you well when taking classes online because ultimately, you’re in charge of your own success. If you know that you have more energy in the morning, schedule your most intense work during that time. Conversely, if you’re a night owl, make that your most productive time. Save less intense work, such as outlining or writing out your schedule, for your energy “downtimes.”

If you have a family, don’t let yourself feel guilty for using your high-energy times to work, even if it’s when the kids are clamoring for you, or your partner wants to spend time with you. School is a short time in your life and it’s important to understand what works best for you—and stick to that schedule so ultimately you can all benefit. 

Tuesday, 12 November 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.

Saturday, 9 November 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, 8 November 2019

Q. A nurse should expect a 3-year-old child to be able to perform which action?

A. Ride a tricycle
B. Tie his shoelaces
C. Roller-skate
D. Jump rope

Correct Answer: A

Explanation: The nurse should expect the child to ride a tricycle because, at age 3, gross motor development and refinement in eye-hand coordination enable a child to perform such an action. The fine motor skills required to tie shoelaces and the gross motor skills required for roller-skating and jumping rope develop around age 5.

Thursday, 7 November 2019

Question Of The Day, Infant
Q. During assessment of a small infant admitted with a diagnosis of meningitis, the infant becomes less responsive to stimuli and exhibits bradycardia, slight hypertension, irregular respirations, and a temperature of 103.2° F (39.6° C). The infant's fontanel is more tense than at the last assessment. What should the nurse do first?

A. Ask another nurse to verify the findings.
B. Notify the primary care provider of the findings.
C. Raise the head of the bed.
D. Administer an antipyretic.

Correct Answer: C

Explanation: Signs such as a decrease in the level of consciousness, bradycardia, hypertension, irregular respirations, and a tense fontanel strongly suggest increased intracranial pressure. The first action should be to attempt to lower the pressure by raising the head of the bed, which should improve venous return and decrease the pressure. Asking another nurse to verify the findings is unnecessary because temperature, pulse, and respirations are fairly objective data and not subject to interpretation. Additionally, asking for verification would waste valuable time. After elevating the infant's head by raising the bed, the nurse can notify the primary care provider and administer the antipyretic.

Wednesday, 6 November 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.

Monday, 4 November 2019

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

Saturday, 2 November 2019

Q. A physician has ordered penicillin G potassium (Pfizerpen), I.V., for a client with a severe streptococcal infection. A nurse determines that the client may be allergic to penicillin. When considering best practice, what should the nurse's priority intervention be?

A. Holding the penicillin G potassium and charting that it was held because the client is allergic
B. Administering the penicillin G potassium and staying alert for any reaction
C. Holding the penicillin G potassium and notifying the physician that the client may have an allergy to penicillin
D. Administering the penicillin G potassium but notifying the pharmacist that the client might experience an allergic reaction

Correct Answer: C

Explanation: The nurse should hold the penicillin G potassium, even if the client isn't sure he's allergic to penicillin, and notify the physician so he may order a different antibiotic. Many clients can't act as their own advocates; they rely on nurses to protect their rights. An allergy to penicillin G potassium is suspected, but not comfirmed. Administering penicillin G potassium could cause a life-threatening reaction. Administering the medication, then watching for a reaction or notifying the pharmacist that a reaction might occur, isn't best practice. If a client is allergic to penicillin, a nurse should alert the pharmacist and label the client's chart appropriately.

Friday, 1 November 2019

A. client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

A. nausea and vomiting.
B. dyspnea and cyanosis.
C. fatigue and weakness.
D. thrush and circumoral pallor.

Correct Answer: C

Explanation: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

Thursday, 31 October 2019

Q. A client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician orders acetylcysteine (Mucomyst). Before administering the first dose, the nurse checks the client's history for asthma. Acetylcysteine must be used cautiously in a client with asthma because it:

A. is a respiratory depressant.
B. is a respiratory stimulant.
C. may induce bronchospasm.
D. inhibits the cough reflex.

Correct Answer: C

Explanation: Acetylcysteine must be used cautiously in a client with asthma because it may induce bronchospasm. The drug isn't a respiratory depressant or stimulant. It's a mucolytic agent that decreases the viscosity of respiratory secretions by altering the molecular composition of mucus. Acetylcysteine doesn't inhibit the cough reflex. 

Wednesday, 30 October 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, 24 October 2019

Q. A 45-year-old single mother of three teenaged boys has metastatic breast cancer. Her parents live 750 miles away and have only been able to visit twice since her initial diagnosis 14 months ago. The progression of her disease has forced the client to consider high-dose chemotherapy. She is concerned about her children's welfare during the treatment. When assessing the client's present support systems, the nurse will be most concerned about the potential problems with:

A. Denial as a primary coping mechanism.
B. Support systems and coping strategies.
C. Decision-making abilities.
D. Transportation and money for the boys.

Correct Answer: B

Explanation: The client's resources for coping with the emotional and practical needs of herself and her family need to be assessed because usual coping strategies and support systems are often inadequate in especially stressful situations. The nurse may be concerned with the client's use of denial, decision-making abilities, and ability to pay for transportation; however, the client's support systems will be of more importance in this situation.

Wednesday, 23 October 2019

Question Of The Day, Cardiovascular Disorders
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.

Tuesday, 22 October 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. Tachycardia.

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.

Sunday, 20 October 2019

Nursing Degree, Nursing Responsibilities, Nursing Skill

“Just recognizing that somebody is having a bad day is a suicide prevention technique” explained Judy Davidson, a nurse researcher involved in a three-pronged suicide prevention program at the University of California San Diego (UCSD).

A recent report released in the UK showed that 300 nurses died by suicides during the last seven years. Similar data for the US are not available and researchers concluded that nurse suicide in that country was “shrouded in silence, avoidance, and denial”.

Nurses at high risk of suicide

Nurses work exhausting hours, often short-staffed, at duties that are complex and with an ever-present possibility of errors. There is also the emotional toll of tensions between co-workers, bullying, and violence from patients.

Furthermore, nurses experience emotional stress from deaths and trauma almost on a daily basis. They’re expected to just carry on with their work, without the debriefing offered to those in other occupations such as police and firefighters.

These circumstances put nursing staff at a high-risk burn-out, caregiver fatigue, and depression – all of which could trigger the worst case scenario of suicide.

Let’s take a look at the suicide prevention strategies used at UCSD which consists of three interlinked programs: Code Lavender, a Caregiver Support Team, and the Healer Education Assessment and Referral (HEAR) program. 

Code Lavender

Nursing Degree, Nursing Responsibilities, Nursing Skill
Code Lavender kit contents. Image via:

Code Lavender involves simply reaching out to a coworker, acknowledging that one is aware that they’re going through a rough patch – either personally or after a particularly bad workplace experience. Code Lavender doesnt prevent burnout or stress but is rather akin to psychological first aid.

One is often at a loss for words of support when you want to reach out to a stressed-out colleague. Code Lavender consists of a packet with a comforting message, a bar of chocolate, lavender essential oil, and a referral card for employee assistance. There’s also a starfish sticker that the nurse can put on their uniform to show that they’re feeling fragile.   

A coworker gives this token a colleague to show that they’ve noticed and care – and to possibly nudge them to seek professional help if they need it. Even this small act of kindness can help to prevent suicide.

After the pilot project with Code Lavender, Davidson and her colleagues found that there was an improvement in self-reports of feeling cared for. All those who had received the Code Lavender intervention reported that they had found it helpful and 84% recommended its wider use. 

Caregiver Support Team

The introduction of the Caregiver Support Team initiative was an extension of the Code Lavender project. While team members don’t give professional counseling, it’s described as providing emotional first-aid in the workplace.

A survey was conducted to identify persons whom staff felt they would turn to for emotional support at times of stress. These nominees were invited to become peer supporters. They had eight hours of training by a psychologist, which included how to recognize the signs of burnout, depression, and risks for suicide. They were then encouraged to actively identify and reach out to staff in crisis.

At the end of the pilot project, 40% of the respondents had received intervention by a member of the Caregiver Support Team and all reported that it had been helpful and that they would recommend it to others.

At least one suicide had definitely been prevented after a peer supporter had reached out and was able to set a process in motion which concluded in a professional intervention. Staff had also started to proactively contact peer supporters for emotional debriefings. 

HEAR program

The Healer Education Assessment and Referral Program (HEAR) had been running for seven years for medical practitioners at UCSD when a number of nurse suicides prompted its extension to nursing staff in 2016. The aim of this program is to get those who need it into mental health treatment.

The program has two components. Firstly, educational presentations are provided to create greater awareness about depression, burnout, and suicide among healthcare staff, and to emphasize that it’s okay to seek treatment for mental health issues. 

The second part is a digital survey tool which is sent at least once a year to all healthcare staff.  The questionnaire is used to identify at-risk individuals and to help them connect to mental health services. Respondents can choose to remain anonymous until they themselves choose to connect to the counselor for a referral.

The counselors also arrange appointments to avoid the possibility of delayed treatment or that the person gives up when they can’t get an appointment with a therapist after a number of unsuccessful few phone calls. 

A culture of caring and action

According to Davidson, the success of these programs is that they are pro-active. It reaches out to people as opposed to employee assistance programs that wait for staff to contact them.

Who developed a similar peer support program in Missouri, explained that the peer-initiated intervention eventually changed staff attitude towards work stresses. “What we’ve seen now in 10 years,” she said, “Is that we now have this culture of supportive presence for staff.”

Saturday, 19 October 2019

Question Of The Day, Antepartum Period
Q. The primary health care provider orders intravenous magnesium sulfate for a primigravid client at 38 weeks' gestation diagnosed with severe preeclampsia. Which of the following medications should the nurse have readily available at the client's bedside?

A. Diazepam (Valium).
B. Hydralazine (Apresoline).
C. Calcium gluconate.
D. Phenytoin (Dilantin).

Correct Answer: C

Explanation: The client receiving magnesium sulfate intravenously is at risk for possible toxicity. The antidote for magnesium sulfate toxicity is calcium gluconate, which should be readily available at the client's bedside. Diazepam (Valium), used to treat anxiety, usually is not given to pregnant women. Hydralazine (Apresoline) would be used to treat hypertension, and phenytoin (Dilantin) would be used to treat seizures.

Friday, 18 October 2019

Q. After a dose-response test, the client with an overdose of barbiturates receives pentobarbital sodium (Nembutal) at a nonintoxicating maintenance level for 2 days and at decreasing dosages thereafter. This regimen is effective in the client does not develop:

A. Psychosis.
B. Seizures.
C. Hypotension.
D. Hypothermia.

Correct Answer: B

Explanation: Generalized seizures may occur on the second or third day of withdrawal from barbiturates. Without treatment, the seizures may be fatal. Psychosis is a possibility but is not fatal and will not be prevented by the pentobarbital sodium regimen. Orthostatic hypotension is possible but is unlikely to be fatal; it is also not treatable by the pentobarbital sodium regimen. Hyperthermia, rather than hypothermia, occurs during withdrawal.

Thursday, 17 October 2019

Question Of The Day, Psychotic Disorders
Q. A newly admitted client diagnosed with paranoid schizophrenia is pacing rapidly and wringing his hands. He states that another client is out to get him. Then he says, "Protect me, select me, reject me." The nurse should next:

A. Administer his oral PRN lorazepam (Ativan) and haloperidol (Haldol).
B. Place the client in temporary seclusion before he has a chance to hurt others.
C. Call the primary health care provider for a prescription for restraints.
D. Ask the other clients to leave the immediate area.

Correct Answer: A

Explanation: The client's anxiety as reflected in rapid pacing and clang associations is rising as a result of his paranoid delusions. Administering the Ativan and Haldol will help the anxiety and delusions. He is not threatening others at this point, so seclusion, restraints, and asking clients to leave the area is not necessary.

Wednesday, 16 October 2019

Q. A nurse is evaluating a client's electrocardiogram (ECG). Which ECG change can result from amitriptyline (Elavil) therapy?

A. Presence of U waves
B. Depressed ST segment
C. Widening QT interval
D. Prolonged PR interval

Correct Answer: C

Explanation: Amitriptyline therapy may cause a conduction delay, demonstrated by a widening QT interval on the ECG. U waves, a depressed ST segment, and a prolonged PR interval aren't typically induced by amitriptyline therapy.

Tuesday, 15 October 2019

Nursing Responsibilities, Nursing Advocacy, Nursing Career, Nursing Degree, Nursing Degree US

That very first year (or two) of nursing can be some of the most challenging and emotionally taxing years of your nursing career. You are thrust into an environment that is largely foreign — because come on, we all know nursing school is not capable of truly preparing you for the real world!

Right off the bat, you are expected to hold the lives of others in your hands. This is no small undertaking, and it's easy to beat ourselves up for not being the perfect new graduate specimen.

I had a difficult time as a new graduate, especially as my expectations of myself met the realities of the job. This made for very deflated and exhausting days. Looking back, I am so proud of myself for sticking it out and pushing through those tough years. Here’s what I learned during the process and what I try to tell every new graduate who is going through the same thing.  

Treat Yourself With Grace

Being a new graduate is like learning to ride a bicycle. A bicycle with thirteen wheels, a drum set, and a crossword puzzle you must do all at the same time. Be patient with yourself and your mistakes. Treat yourself as a friend, and don't put yourself down when you're not as proficient as someone with 10 years of experience. 

Getting Off Orientation Is Not A Race

If you are hired with other new graduates, it is common to look at them and feel like you are competing in the race of who can be the best new grad nurse. Who can take care of more patients with higher acuities quicker? Who will be let off orientation the earliest? Unfortunately, your work culture can perpetuate this, especially if managers start making comments that make you feel like you're behind. 

Learn to decrease your sensitivity to this scenario. If others get off orientation sooner, fine. If others seem to be having more advanced patients, so be it. YOU must focus on YOUR journey and fill in the gaps YOU need. It's not about winning a race. We all have different speeds and strengths, and, trust me, in time they will shine. 

This Doesn't Have To Be Your Forever Job

When I began my job as an ICU nurse, I signed a three-year contract that made me feel like I would be tied to the facility forever. I knew I really wanted to go travel nursing, but I wasn’t sure what that looked like. Some days are more difficult than others, but know that the way your life looks now — especially if you're having a hard time — doesn't mean it's going to look this way forever. Things are ever-changing. People come and go. Managers come and go. 

If you already know you will be leaving the unit you're on, that day is going to come sooner than you think. Do your best to focus on each day as it comes, and to put your best foot forward as you step across the threshold into your unit. 

Do Something That Makes You Feel Powerful

When I graduated from nursing school and began preceptorship in the Level I Trauma ICU of my hometown, I remember feeling so inadequate and so, so new. I needed something to counterbalance these feelings. So amidst the stress of precepting, I began teaching piano lessons. I had played piano for 10+ years, and teaching elementary school kids was something I enjoyed. 

Teaching piano was also an excellent metaphor for what I was going through. I remember playing Für Elise for my little 7-year-old student when her eyes widened and her jaw dropped. She couldn't believe that such beautiful and harmonious melodies could come out of "Mary Had a Little Lamb." "How can I do that?!" she asked. "All it takes is practice and time!" Hmmm…you don’t say?? 

Pick something you enjoy and that you're good at, whether it's skating, basketball, painting, or gardening. But pick it up again and let it remind you that you are capable of getting good at things. 

Get Yourself Some Self-Care Days

Self-care culture seems to be at an all-time high right now. Treat yourself, take yourself out, get massages, buy yourself some nice outfits. Get those feel-good endorphins pumping. 

You Are Currently Building Empathy

One day, you will be teaching someone who feels exactly like you do now. Do not let bitter situations make you jaded. Don't let someone else's pain continue through you and onto someone else. Remember how you feel in this moment and give to others what you may be needing right now. 

Get Out Of Town 

Yes, maybe it'll take some time for you accrue PTO, but it doesn't need to be a month-long escape. About three months into your new job, take a long weekend and fly somewhere. Get a mental and physical break from your routine and do some activity that puts you in a different headspace. Then when you get back, start planning the next one in a few months. These little benchmarks will help you get through tough times!
Q. A client with obsessive-compulsive disorder may use reaction formation as a defense mechanism to cope with anxiety and stress. What typically occurs in reaction formation?

A. The client assumes an attitude that contradicts an impulse he harbors.
B. The client believes his thoughts can control other people and events.
C. The client persistently thinks and talks about a particular idea or subject.
D. The client uses a specific act to negate a previous act.

Correct Answer: A

Explanation: Reaction formation is a defense mechanism in which a person assumes an attitude that contradicts an impulse or a wish that he harbors. The belief that one's thoughts can control other people and events is called "magical thinking." Persistent thoughts and discussion of a particular idea or subject are called "rumination." Use of an act to negate a previous act is called "undoing."

Monday, 14 October 2019

Question Of The Day, Adolescent
Q. A nurse is about to conduct a sexual history for a 16-year-old female who is accompanied by her mother. What is an appropriate question for the nurse to ask this client or her mother?

A. "What do you think about having your mother leave the room now?"
B. "Mother, do you think your daughter is sexually active?"
C. "Mother, I am going to ask you to wait a few minutes in the waiting room now so I can complete the health history with your daughter."
D. "The two of you seem like you share everything. I am going to ask questions about sexual history now."

Correct Answer: C

Explanation: Confidentiality and privacy are critical developmental needs for the adolescent. These needs are important to enable the nurse to establish a relationship of trust with the adolescent. A sexual history should be conducted with a teen without parents. Therefore, the nurse should not ask the mother to provide information or put the daughter in a position of having to make a decision about her mother remaining in the room. Inform the adolescent that this information is confidential, and will not be shared with the parent. Inform the adolescent that issues of abuse or life-threatening issues are required by law to be disclosed to the authorities, and all other information is private.

Saturday, 12 October 2019

Q. A parent asks the nurse about head lice (pediculosis capitis) infestation during a visit to the clinic. Which of the following symptoms should the nurse tell the parent is most common in a child infected with head lice?

A. Itching of the scalp.
B. Scaling of the scalp.
C. Serous weeping on the scalp surface.
D. Pinpoint hemorrhagic spots on the scalp surface.

Correct Answer: A

Explanation:  The most common characteristic of head lice infestation (pediculosis capitis) is severe itching. The head is the most common site of lice infestation. If the child scratches, scaling may occur. Itching also occurs when lice infest other parts of the body. Scratch marks are almost always found when lice are present. Weeping on the scalp surface may be an indication of an infection or other dermatologic condition. Hemorrhagic spots are not a symptom of head lice, but may be caused by scratch marks.

Friday, 11 October 2019

Q. A dehydrated 3 year old has vomited three times in the last hour and continues to have frequent diarrhea. The child was admitted 2 days ago with gastroenteritis caused by rotavirus. The child weighs 22 kg, has a normal saline lock in the right hand, and has had 30 ml of urine output in the last 4 hours. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for:

A. Giving a dose of loperaminde (Immodium).
B. Starting a fluid bolus of normal saline.
C. Beginning an intravenous (IV) antibiotic.
D. Establishing a Foley catheter.

Correct Answer: B

Explanation: The child is dehydrated, cannot retain oral fluids, and continues to have diarrhea. A normal saline bolus should be given followed by maintenance IV fluids. Anti-diarrheal medications are not recommended for children and will prolong the illness. The child has gastroenteritis caused by a viral illness. IV antibiotics are not indicated for viral illnesses.

Thursday, 10 October 2019

Question Of The Day, Toddler
Q. After teaching the parents of an 18-month-old who was treated for a foreign body obstruction about the three cardinal signs indicative of choking, the nurse determines that the teaching has been successful when the parents state that a child is choking when he or she cannot speak, turns blue, and does which of the following?

A. Vomits.
B. Gasps.
C. Gags.
D. Collapses.

Correct Answer: D

Explanation: The three cardinal signs indicating that a child is truly choking and requires immediate life-saving interventions include inability to speak, blue color (cyanosis), and collapse. Vomiting does not occur while a child is unable to breathe. Once the object is dislodged, however, vomiting may occur. Gasping, a sudden intake of air, indicates that the child is still able to inhale. When a child is choking, air is not being exchanged, so gagging will not occur.

Wednesday, 9 October 2019

Q. Before placement of a ventriculoperitoneal shunt for hydrocephalus, an infant is irritable, lethargic, and difficult to feed. To maintain the infant's nutritional status, which of the following actions would be most appropriate?

A. Feeding the infant just before doing any procedures.
B. Giving the infant small, frequent feedings.
C. Feeding the infant in a horizontal position.
D. Scheduling the feedings for every 6 hours.

Correct Answer: B

Explanation: An infant with hydrocephalus is difficult to feed because of poor sucking, lethargy, and vomiting, which are associated with increased intracranial pressure. Small, frequent feedings given at times when the infant is relaxed and calm are tolerated best. Feeding an infant before any procedure is inappropriate because the stress of the procedure may lead to vomiting. Ideally, the infant should be held in a slightly vertical position when feeding to prevent backflow of formula into the eustachian tubes and subsequent development of ear infections. Most infants are fed on demand every 3 to 4 hours.

Tuesday, 8 October 2019

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.

Monday, 7 October 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.

Friday, 4 October 2019

Q. The nurse-manager of a home health facility includes which item in the capital budget?

A. Salaries and benefits for her staff
B. A $1,200 computer upgrade
C. Office supplies
D. Client-education materials costing $300

Correct Answer: B

Explanation: Capital budgets generally include items valued at more than $500. Salaries and benefits are part of the personnel budget. Office supplies and client education materials are part of the operating budget.

Thursday, 3 October 2019

Q. Of the following findings in the client's history, which would be the least likely to have predisposed the client to renal calculi?

A. Having had several urinary tract infections in the past 2 years.
B. Having taken large doses of vitamin C over the past several years.
C. Drinking less than the recommended amount of milk.
D. Having been on prolonged bed rest after an accident the previous year.

Correct Answer: C

Explanation: A high, rather than low, milk intake predisposes to renal calculi formation, owing to the calcium in milk. Recurrent urinary tract infections are implicated in stone formation as certain bacteria promote stone formation. High daily doses of vitamins C are a risk factor because they can increase the citric acid level. Prolonged immobility is a risk factor for renal calculi because it causes calcium to be released into the bloodstream.

Wednesday, 2 October 2019

Question Of The Day, Respiratory Disorders
Q. Which of the following alert the nurse to possible internal bleeding in a client who has undergone pulmonary lobectomy 2 days ago?

A. Increased blood pressure and decreased pulse and respiratory rates.
B. Sanguineous drainage from the chest tube at a rate of 50 ml/hour during the past 3 hours.
C. Restlessness and shortness of breath.
D. Urine output of 180 ml during the past 3 hours.

Correct Answer: C

Explanation: Restlessness indicates cerebral hypoxia due to decreased circulating volume. Shortness of breath occurs because blood collecting in the pleural space faster than suction can remove it prevents the lung from reexpanding. Increased blood pressure and decreased pulse and respiratory rates are classic late signs of increased intracranial pressure. Decreasing blood pressure and increasing pulse and respiratory rates occur with hypovolemic shock. Sanguineous drainage that changes to serosanguineous drainage at a rate less than 100 ml/hour is normal in the early postoperative period. Urine output of 180 ml over the past 3 hours indicates normal kidney perfusion.

Tuesday, 1 October 2019

Question Of The Day, Neurosensory Disorders
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.

Monday, 30 September 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.

Friday, 27 September 2019

Q. A nurse is performing a baseline assessment of a client's skin integrity. What is the priority assessment parameter?

A. Family history of pressure ulcers
B. Presence of pressure ulcers on the client
C. Potential areas of pressure ulcer development
D. Overall risk of developing pressure ulcers

Correct Answer: D

Explanation: When assessing skin integrity, the overall risk potential of developing pressure ulcers takes priority. Overall risk encompasses existing pressure ulcers as well as potential areas for development of pressure ulcers. Family history isn't important when assessing skin integrity.

Thursday, 26 September 2019

Question Of The Day, Gastrointestinal Disorders
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.

Wednesday, 25 September 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.

Tuesday, 24 September 2019

Question Of The Day, Cardiovascular Disorders
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.

Monday, 23 September 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.
Nursing, Nursing Career, Nursing Certification, Nursing Skill, Nursing Course

This video by the Wall Street Journal deals with why prescription medicines in the US cost so much more than in other parts of the world—even in neighboring countries like Canada and Mexico.

The reason appears to have everything to do with rebates and negotiations for money making along a very long supply chain. Even with the explanation in this clip, one is left somewhat mystified because the role players are tight-lipped about the details of the process which they view as a protected information.

Complex system of drug pricing

In usual trade, the manufacturer sets the price they charge the retailer. The retailer then determines the amount the customer will pay. There might be some bulk discounts along the way, but in essence, all customers will pay the same price at the counter of a particular retailer.

With medicines, it’s not as simple. The drug manufacturer sets its list price for their new product. This is then open to rebates which are negotiated with the pharmaceutical company by pharmacy benefit managers (PBM’s). The PBM’s negotiate rebates on behalf of health insurance companies, government agencies, and employers so that these prescription drugs cost them less. The PBM also takes a cut of the rebate.

Watch the video to understand how drug prices work.

Benefits and costs of drug rebates

The benefit of rebates for the pharmaceutical company is that the bigger the rebates on a particular product, the higher up it moves in the formulary of preferred medicines covered by the health insurers. The higher up in the formulary a drug is, the bigger the portion of the cost covered by the insurance company and the less the patient’s co-payment is. Obviously, this increases sales.

Pharmaceutical companies say that the rebate system is a big reason why they keep raising the price of drugs—they have to protect their profits. In turn, the PBM’s claim that they help to ensure the lowest possible cost to the end-user. In the end, the patient probably pays what the list price would have been and those that don’t have insurance pay the entire inflated price.

WHO calls for transparency in drug pricing

Many who commented on the WSJ video liken the current secretive system of drug pricing in the US to corruption—although it’s perfectly legal.

At the 72nd meeting of the World Health Assembly, a resolution was adopted that public sharing of information on health products should be increased. There should be greater transparency in what determines the pricing of pharmaceuticals, from the lab to the patient, to improve the affordability of health care.

Saturday, 21 September 2019

Q. Which nursing action is required before a client in labor receives epidural anesthesia?

A. Give a fluid bolus of 500 ml.
B. Check for maternal pupil dilation.
C. Assess maternal reflexes.
D. Assess maternal gait.

Correct Answer: A

Explanation: One of the major adverse effects of epidural administration is hypotension. Therefore, a 500-ml fluid bolus is usually administered to prevent hypotension in the client who wishes to receive an epidural for pain relief. Assessing maternal reflexes, pupil response, and gait isn't necessary.

Friday, 20 September 2019

Question Of The Day, Antepartum Period
Q. A nurse is assessing the legs of a client who's 36 weeks pregnant. Which finding should the nurse expect?

A. Absent pedal pulses
B. Bilateral dependent edema
C. Sluggish capillary refill
D. Unilateral calf enlargement

Correct Answer: B

Explanation: As the uterus grows heavier during pregnancy, femoral venous pressure rises, leading to bilateral dependent edema. Factors interfering with venous return, such as sitting or standing for long periods, contribute to edema. Absence of pedal pulses and sluggish capillary refill signal inadequate circulation to the legs — an unexpected finding during pregnancy. Unilateral calf enlargement, also an abnormal finding, may indicate thrombosis.

Thursday, 19 September 2019

Q. Which of the following is a priority during the first 24 hours of hospitalization for a comatose client with suspected drug overdose?

A. Educate regarding drug abuse.
B. Minimize pain.
C. Maintain intact skin.
D. Increase caloric intake.

Correct Answer: C

Explanation: Maintaining intact skin is a priority for the unconscious client. Unconscious clients need to be turned every hour to prevent complications of immobility, which include pressure ulcers and stasis pneumonia. The unconscious client cannot be educated at this time. Pain is not a concern. During the first 24 hours, the unconscious client will mostly likely be on nothing-by-mouth status.

Wednesday, 18 September 2019

Question Of The Day, Psychotic Disorders
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.

Deciding if you should go back to school for a higher nursing degree – whether it’s a masters in nursing science or nurse practitioner – is a personal decision that includes so many different factors including, 

◈ Your financial picture
◈ Your family situation
◈ How much experience you have or feel you need

You probably won’t be able to find the answers to all your questions in an article. But from a professional standpoint, there are certain factors that are good to meditate on in order to make a decision that fits you best.  


This can be tricky because the long hours and heavy work of the bedside can push people to change their working environment and practicing ability. It's not a bad reason to go back to school, but it shouldn't be the only reason. Be aware of how you're feeling and if you're simply trying to escape (if that's the case, try travel nursing, it's an excellent outlet!) 


Instead of being pushed by frustration, try to be led by curiosity when it comes to choosing the next turn in your career. Maybe you feel curious about research and adding to the body of nursing theories. Maybe you feel curious about how to manage anesthesia. Wherever your curiosity lies, begin there.


Getting second-hand experience from a practitioner who is working in a position that you are interested in (and even if you’re not interested in it!) is a good place to start. You can get a little taste of what the lifestyle and day to day operations are like prior to making the full commitment. It’s also an excellent way to get candid feedback on the intricacies of the work.


I’ve definitely felt this pressure as many of my peers are in the works of getting their advanced degrees. But again, going back to school is as much a personal decision as it is a professional one, and a healthy source of motivation doesn’t always come from comparison.


If you are still unsure if you want to dive into school again, give your current degree one more opportunity to show you what you can do besides the bedside. Try at least one job (two is better) that’s completely different from what you’re doing now.

If you’re at the bedside, try home health. Or case management. Or product sales. (or travel nursing!!) Even if you just do it PRN, giving yourself a bit more exposure to the entire field will help you make a well-rounded decision.




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