Monday, 20 May 2019

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

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

Correct Answer: B

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

Saturday, 18 May 2019

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

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

Correct Answer: A

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

Friday, 17 May 2019

Q. A 10-month-old child has cold symptoms. The mother asks how she can clear the infant's nose. Which of the following would be the nurse's best recommendation?

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

Correct Answer: B

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

Thursday, 16 May 2019

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

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

Correct Answer: A

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

Wednesday, 15 May 2019

Question Of The Day, Medication and I.V. Administration
Q. To prevent development of peripheral neuropathies associated with isoniazid administration, the nurse should teach the client to:

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

Correct Answer: D

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

Tuesday, 14 May 2019

Question Of The Day, Basic Physical Care
Q. A nurse is caring for a client who required chest tube insertion for a pneumothorax. To assess for pneumothorax resolution, the nurse can anticipate that the client will require:

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


Correct Answer: D

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


Monday, 13 May 2019

Question Of The Day, Genitourinary Disorders
Q. When caring for a client after a closed renal biopsy, the nurse should?

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

Correct Answer: A

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




Sunday, 12 May 2019

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

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

Correct Answer: C

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

Saturday, 11 May 2019

Q. The client with a hearing aid does not seem to be able to hear the nurse. The nurse should do which of the following?

A. Contact the client's audiologist.
B. Cleanse the hearing aid ear mold in normal saline.
C. Irrigate the ear canal.
D. Check the hearing aid's placement.



Correct Answer: D

Explanation: Inadequate amplification can occur when a hearing aid is not placed properly. The certified audiologist is licensed to dispense hearing aids. The ear mold is the only part of the hearing aid that may be washed frequently; it should be washed daily with soap and water. Irrigation of the ear canal is done to remove impacted cerumen or a foreign body.

Friday, 10 May 2019

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

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



Correct Answer: B

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


Thursday, 9 May 2019

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

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


Correct Answer:  A

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

Wednesday, 8 May 2019

Q. A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:

A. Absence of nausea and vomiting.
B. Passage of mucus from the rectum.
C. Passage of flatus and feces from the colostomy.
D. Absence of stomach drainage for 24 hours.


Correct Answer: C

Explanation: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery.


Tuesday, 7 May 2019

Question Of The Day, Oncologic Disorders
Q. The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend?

A. Carcinoembryonic antigen (CEA) test after age 50
B. Proctosigmoidoscopy after age 30
C. Annual digital examination after age 40
D. Barium enema after age 20


Correct Answer: C

Explanation: The American Cancer Society recommends an annual digital examination after age 40 for the purpose of detecting colorectal cancer. The CEA test is performed on clients who have already been treated for colorectal cancer. It helps monitor a client's response to treatment as well as detect metastasis or recurrence. Proctosigmoidoscopy is recommended every 3 to 5 years for people older than age 50. Barium enema isn't a screening test.

Monday, 6 May 2019

Question Of The Day, Cardiovascular Disorders
Q. A client with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She is complaining of dyspnea with exertion and being very tired. Her vital signs are 98, 80, 20, BP 116/72. She has + 2 pedal edema and clear breath sounds. As the nurse plans this client's care, which of the following is her cardiac classification according to the New York Heart Association Cardiac Disease classification?

A. Class I.
B. Class II.
C. Class III.
D. Class IV.

Correct Answer: B

Explanation: According to the New York Heart Association Cardiac Disease classification, this client would fit under Class II because she is symptomatic with increased activity (dyspnea with exertion). The New York Heart Association Cardiac Disease Classification identifies Class II clients as having cardiac disease and a slight limitation in physical activity. When physical activity occurs, the client may experience angina, difficulty breathing, palpations, and fatigue. All of the client's other symptoms are within normal limits.


Saturday, 4 May 2019

Q. After being treated with heparin therapy for thrombophlebitis, a multiparous client who delivered 4 days ago is to be discharged on oral warfarin (Coumadin). After teaching the client about the medication and possible effects, which of the following client statements indicates successful teaching?

A. "I can take two aspirin if I get uterine cramps."
B."Protamine sulfate should be available if I need it."
C. "I should use a soft toothbrush to brush my teeth."
D. "I can drink an occasional glass of wine if I desire."

Correct Answer: C

Explanation: Successful teaching is demonstrated when the client says, "I should use a soft toothbrush to brush my teeth." Heparin therapy can cause the gums to bleed, so a soft toothbrush should be used to minimize this adverse effect. Use of aspirin and other nonsteroidal anti-inflammatory medications should be avoided because of the increased risk for possible hemorrhage. Protamine sulfate is the antidote for heparin therapy. Vitamin K is the antidote for warfarin excess. Alcohol can inhibit the metabolism of oral anticoagulants and should be avoided.

Friday, 3 May 2019

Q. A nurse is assessing a woman in labor. Her cervix is dilated 8 cm. Her contractions are occurring every 2 minutes. She's irritable and in considerable pain. What type of breathing should the nurse instruct the woman to use during the peak of a contraction?

A. Deep breathing
B. Shallow chest breathing
C. Deep, cleansing breaths
D. Chest panting


Correct Answer: B

Explanation: Shallow chest breathing is used during the peak of a contraction during the transitional phase of labor. Deep breathing can cause a woman to hyperventilate and feel light-headed, with numbness or tingling in her fingers or toes. A deep, cleansing breath taken at the beginning and end of each breathing exercise can help prevent hyperventilation. Chest panting may be used to prevent a woman from pushing before the cervix is fully dilated.

Thursday, 2 May 2019

Q. A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should first:

A. perform a pelvic examination.
B. assess the client's blood pressure.
C. assess the fetal heart rate.
D. order a stat hemoglobin and hematocrit.



Correct Answer: C

Explanation: The nurse should assess the fetal heart rate for distress or viability. She shouldn't attempt to perform a pelvic examination because of the possibility of placenta previa, which presents as bright red bleeding without abdominal pain. The nurse should assess the client's blood pressure after attempting to hear fetal heart tones. Ordering a hemoglobin and hematocrit is a physician intervention, not a nursing intervention.



Wednesday, 1 May 2019

A comprehensive study has confirmed that across the world, the environment in which nurses’ work influences the quality of nursing care, nurses’ job outcomes and patient well-being. These findings should convince health administrators to give more attention to working environments, according to the researchers.

Nursing Responsibilities, Nursing Career, Nursing Job,

“Our results support the unique status of the nurse work environment as a foundation for both patient and provider well-being that warrants the resources and attention of health care administrators,” said Eileen Lake, the lead investigator. Lake is the Associate Director of the Center for Health Outcomes and Policy Research of the University of Pennsylvania School of Nursing.

Nurses’ work environment compared to outcomes


The research was an extensive meta-analysis of previous studies where measurements of nursing work environments were statistically compared to four outcomes. The first was nurse job outcomes in terms of burnout, job dissatisfaction and intention to leave. The second was nurses’ reports on the quality and safety of patient care and conditions in the unit.

Patient outcomes were analyzed based on 30-day inpatient mortality and adverse events. The final result included in the analysis was patient satisfaction, measured on patients’ ratings of the hospital.

The findings showed that in better working environments nurses were 28%-32% less likely to experience job dissatisfaction, burnout and intention to leave. The chances of poor quality and safety ratings were reduced by 23%-51%.

At the same time, the odds that patients were satisfied increased by 16% and the possibility of inpatient deaths and adverse events was reduced by 8% – nearly 1 in 10.

Rigorous study design


The value and strength of the above conclusions lie in the fact that they are a summary of extensive previous research, using a quantitative meta-analysis. Out of a possible 308 studies, 17 qualified for inclusion and they spanned 16 years. The studies represented research undertaken in 22 different countries across the world – in the US, UK, Canada, Europe, and Asia. Data from more than 2,600 hospitals, 165,000 nurses and 1.3 million patients were subjected to rigorous statistical analysis.

Only studies using the Practice Environment Scale of Nursing Work Index (PES-NWI) as a measurement were included in the research. This the most accepted tool for assessing nursing work environments. It covers quality care, nurse manager ability, adequacy of staffing and resources, and the relationships between colleagues. The tool is supported globally by quality, health professional and accreditation organizations.

Nurses’ work environments need attention


The researchers believed that the study provides conclusive evidence that nurses’ work environment is related to a wide range of outcomes both for the service provider and the patient. The findings are relevant not only for policymakers and health care administrators but also for nurses, patients, and their families.
Q. A client with a history of polysubstance abuse is admitted to the facility. He complains of nausea and vomiting 24 hours after admission. The nurse who assesses the client notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through withdrawal from which substance?

A. Alcohol
B. Cannabis
C. Cocaine
D. Opioids

Correct Answer: D

Explanation: Piloerection, pupillary dilation, and lacrimation are specific to opioid withdrawal. A client with alcohol withdrawal would show elevated vital signs. There is no real withdrawal from cannabis. Symptoms of cocaine withdrawal include depression, anxiety, and agitation.

Tuesday, 30 April 2019

Q. The nurse should assess the client who is taking risperidone (Risperdal) 1 mg, orally twice a day for:

A. Insomnia.
B. Headache.
C. Anxiety.
D. Orthostatic hypotension.




Correct Answer: D

Explanation: Significant orthostatic hypotension is associated with risperidone (Risperdal) therapy. The nurse should monitor the client's blood pressure sitting and standing and teach the client interventions to manage this adverse effect to prevent risk of injury. Although insomnia, headache, and anxiety are possible adverse effects of risperidone therapy, they are of less immediate concern than orthostatic hypotension.

Monday, 29 April 2019

Question Of The Day, Mood, Adjustment, and Dementia Disorders
Q. Which statement about somatoform pain disorder is accurate?

A. The pain is intentionally fabricated by the client to receive attention.
B. The pain is real to the client, even though the pain may not have an organic etiology.
C. The pain is less than would be expected as a result of the underlying disorder the client identifies.
D. The pain is what would be expected as a result of the underlying disorder the client identifies.

Correct Answer: B

Explanation: In a somatoform pain disorder, the client has pain even though a thorough diagnostic workup reveals no organic cause for it. The nurse must recognize that the pain is real to the client. By refusing to believe that the client is in pain, the nurse impedes the development of a therapeutic trust-based relationship. While somatoform pain offers the client secondary gains, such as attention or avoidance of an unpleasant activity, the pain isn't intentionally fabricated by the client. Even if a pathologic cause of the pain can be identified, the pain is usually in excess of what the pathologic cause would normally be expected to produce.

Friday, 26 April 2019

Q. An 8-year-old child is suspected of having meningitis. Signs of meningitis include:

A. Cullen's sign.
B. Koplik's spots.
C. Kernig's sign.
D. Chvostek's sign.





Correct Answer: C

Explanation: Signs and symptoms of meningitis include Kernig's sign, stiff neck, headache, and fever. To test for Kernig's sign, the client is in the supine position with knees flexed; a leg is then flexed at the hip so that the thigh is brought to a position perpendicular to the trunk. An attempt is then made to extend the knee. If meningeal irritation is present, the knee can't be extended and attempts to extend the knee result in pain. Cullen's sign is the bluish discoloration of the periumbilical skin caused by intraperitoneal hemorrhage. Koplik's spots are reddened areas with grayish blue centers that are found on the buccal mucosa of a client with measles. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. A calcium deficit is suggested if the facial muscles twitch.

Thursday, 25 April 2019

Question Of The Day, Toddler
Q. When assessing for pain in a toddler, which of the following methods should be the most appropriate?

A. Ask the child about the pain.
B. Observe the child for restlessness.
C. Use a numeric pain scale.
D. Assess for changes in vital signs.




Correct Answer: B

Explanation: Toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability, and crying. It is not particularly helpful to ask toddlers about pain. In most instances, they would be unable to understand or describe the nature and location of their pain because of their lack of verbal and cognitive skills. However, preschool and older children have the verbal and cognitive skills to be able to respond appropriately. Numeric pain scales are more appropriate for children who are of school age or older. Changes in vital signs do occur as a result of pain, but behavioral changes usually are noticed first.

Wednesday, 24 April 2019

Q. A parent confides to the nurse that their 8-month-old infant is anxious. Which of the following suggestions by the nurse is most appropriate to help the mother lessen her anxiety about her infant?

A. Limit holding the infant to feeding times.
B. Talk quietly to the infant while he is awake.
C. Play music in his room for most of the day and night.
D. Have a close friend keep the infant for a few days.

Correct Answer: B

Explanation: Infants are sensitive to stress in their caretakers. The best way to handle an anxious infant is to talk quietly to him, thereby soothing the infant. Limiting holding of the infant to feeding periods interferes with meeting the infant's needs for close contact, possibly compromising his ability to develop trust. Playing music in the room for most of the day and night will make it difficult for the infant to differentiate days from nights. Having a friend take the infant for several days will not necessarily take care of the problem because when the infant returns to the mother the same behaviors will recur unless the mother makes some changes.


Tuesday, 23 April 2019

Question Of The Day, The Nursing Process
Q. A group of nurses has established a focus group and pilot study to examine the potential application of personal data assistants (PDAs) in bedside care. This study is a tangible application of:

A. Nursing informatics.
B. Electronic medical records.
C. Telemedicine.
D. Computerized documentation.

Correct Answer: A

Explanation: Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. A specific application of nursing informatics is the use of PDAs in the clinical setting. The devices are less likely to be used to perform documentation or to constitute client records. Telemedicine involves the remote provision of care.


Monday, 22 April 2019

Q. Twenty-four hours after a bone marrow aspiration, the nurse evaluates which of the following as an appropriate client outcome?

A. The client maintains bed rest.
B. There is redness and swelling at the aspiration site.
C. The client requests morphine sulfate for pain.
D. There is no bleeding at the aspiration site.



Correct Answer: D

Explanation: After a bone marrow aspiration, the puncture site should be checked every 10 to 15 minutes for bleeding. For a short period after the procedure, bed rest may be ordered. Signs of infection, such as redness and swelling, are not anticipated at the aspiration site. A mild analgesic may be ordered. If the client continues to need the morphine for longer than 24 hours, the nurse should suspect that internal bleeding or increased pressure at the puncture site may be the cause of the pain and should consult the physician.


Saturday, 20 April 2019

Question Of The Day, Basic Physical Care
Q. A primiparous woman has recently delivered a term infant. Priority teaching for the patient includes information on:

A. Sudden infant death syndrome (SIDS)
B. Breastfeeding
C. Infant bathing
D. Infant sleep-wake cycles




Correct Answer: B

Explanation: Breastfed infants should eat within the first hour of life and approximately every 2 to 3 hours. Successful breastfeeding will likely require sustained support, encouragement, and instruction from the nurse. Information on SIDS, infant bathing, and sleep-wake cycles are also important topics for the new parent, but they can be covered at any time prior to discharge.


Friday, 19 April 2019

Nurse Career, Nursing Exam US, Nursing Responsibilities,

Healthcare market research and consulting company PRC recently announced the results of its National Nursing Engagement Report. The report was based on survey findings from over 2,000 healthcare partners and revealed key data about nurses in the workforce today, as well as what the future will hold for nurses and how hospital administrators can help support nurses going forward.

The Buzz on Nurse Burnout


One of the main focuses of the study was to examine how many nurses in the workplace today report feeling burned out. According to the report, 15.6% of all nurses reported feelings of burnout, with the percentage rising to 41% of “unengaged” nurses. What’s really interesting as well, is that 50% of nurses who reported feeling burned out also reported that they had no plans to leave their organization—pointing to the importance of supporting and meeting nurses where they are at in the workforce.

The report explained that unengaged nurses are nurses who,

◈ May not be part of a team with their colleagues,
◈ Have diminished morale,
◈ Feel emotionally checked out from their work, which also ultimately affects their patient care.

Factors such as autonomy, nurse-to-nurse teamwork and collaboration, staffing and resources, interpersonal relationships, and leadership access and responsiveness were all factors in nursing engagement.

ER nurses also seemed to be at a higher risk for burnout, with 20% of ER nurses reporting feeling unengaged.

“Burnout is an important topic in healthcare today,” the report’s authors, Cynthia King, Ph.D., MA, Director Client Organizational Development, PRC and Leigh Ann Bradley, Ph.D., MSN, MA, BS-CHE, RN, Executive Coach & National Speaker, PRC Excellence Accelerator, explain.

“We are asking nurses to do more with fewer resources. At the same time, nurses must be compassionate caregivers, technical experts, clinicians, and experts.”

Supporting Nurses = Better Patient Care


King and Bradley tell Nurse.org that one of the most exciting findings of the data was the fact that there is a statistical significance between nurse engagement and patients having better experiences. “To us, this highlights the sacred nature of the patient/nurse relationship,” they note. 

You mean when nurses feel more supported at work, they are better able to do their job and care for patients? What a revolutionary idea!

Fortunately, however, 85% of nurses did report feeling engaged or fully engaged, so continuing to support nurses, while also exploring ways to support those who are finding engagement to be lacking, is imperative.

“We believe it is important for healthcare leaders to support and grow an engaged workforce,” they add. “At the same time, leaders need to determine ways to restore joy and purpose to nurses whose engagement has diminished.”

And as the report details, the demand for nurses will increase by 15% by 2026, so it’s more important than ever that nurses feel supported and engaged in the field. King and Bradley also explain that the report revealed that in order to improve engagement, hospital administrators need to primarily focus on three things:

Involve nursing leaders and professionals as active participants in decision making impacting the organization and patient care. It is important that nurses know their opinions are valued by leadership.

Create environments in nursing units where there are respect, teamwork, and collaboration between nurses and other healthcare professionals.

Make leadership accessible to nurses and be responsive to their needs. Having trusting relationships between nursing and the senior leadership of an organization is critical.

The Needs of Millennial Nurses


Despite the reputation that millennials get about working, King and Bradley tell Nurse.org that their research found that all generations—millennials included—are “deeply committed” to the nursing profession. Despite the fact that millennials have a slightly lower percentage of engagement, they also share the same goals and dedication as all other generations studied.

Thus, the report only reveals how important it is for nurse leaders to invest time in building relationships and exploring ways to support millennial nurses. Millennial nurses, as part of a different generation of nurses, may have their own unique needs than past or even future generations, but the paper authors point out that uncovering those expectations and needs will only help improve nurse engagement, retention, and patient care.

Overall, the report provides an important landscape for defining what factors are necessary to help nurses feel engaged in the workplace, what may lead nurses to experience burnout, and how to move forward to ensure that the needs of nurses in all generations are identified and valued.

“Too often nurses are so focused on caring for others, [so] we need to create a safe place to care for nurses,” King and Bradley summarize. “We want to create climates where employees can speak up for help if they are experiencing signs and symptoms of burnout.”
Q. A nurse is caring for a client diagnosed with ovarian cancer. Diagnostic testing reveals that the cancer has spread outside the pelvis. The client has previously undergone a right oophorectomy and received chemotherapy. The client now wants palliative care instead of aggressive therapy. The nurse determines that the care plan's priority nursing diagnosis should be:

A. Acute pain
B. Impaired home maintenance
C. Noncompliance
D. Ineffective breast-feeding

Correct Answer: A

Explanation: Palliative care for the client with advanced cancer includes pain management, emotional support, and comfort measures. The client is in the hospital, so home maintenance doesn't apply at this time. The client has chosen palliative care, so she isn't noncompliant. The client isn't breast-feeding, so the diagnosis of Ineffective breast-feeding doesn't apply.

Thursday, 18 April 2019

Question Of The Day, Respiratory Disorders
Q. A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says:

A. "I need to keep my inhaler at the bedside."
B. "I should eat a high-protein diet."
C. "I should become involved in a weight loss program."
D. "I should sleep on my side all night long."



Correct Answer: C

Explanation: Obesity and decreased pharyngeal muscle tone commonly contribute to sleep apnea; the client may need to become involved in a weight loss program. Using an inhaler won't alleviate sleep apnea, and the physician probably wouldn't order an inhaler unless the client had other respiratory complications. A high-protein diet and sleeping on the side aren't treatment factors associated with sleep apnea.

Wednesday, 17 April 2019

Question Of The Day, Neurosensory Disorders
Q. Before cataract surgery, the nurse is to instill several types of eye drops. The surgeon writes orders for 5 gtts of antibiotic in OD, and 3 drops of topical steroid drops in OD. The nurse should:

A. Contact the surgeon to rewrite the order.
B. Administer the antibiotic in the left eye and the steroid in the right eye.
C. Administer both types of drops in the right eye.
D. Contact the pharmacist for clarification of the order.

Correct Answer: A

Explanation: The nurse should not administer drugs without a complete order. In this case the order does not contain information about dosage and uses abbreviations that can cause confusion.

Tuesday, 16 April 2019

Q. A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

A. administration of opioids for pain control.
B. administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.
C. administration of monthly intra-articular injections of corticosteroids.
D. vigorous physical therapy for the joints.

Correct Answer: B

Explanation: NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, which causes pain. Opioids aren't used for pain control in osteoarthritis. Intra-articular injection of corticosteroids is used cautiously for an immediate, short-term effect when a joint is acutely inflamed. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.

Monday, 15 April 2019

Question Of The Day, Endocrine and Metabolic Disorders
Q. When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is:

A. "The physician wants to be sure your shoes fit properly so you won't develop pressure sores."
B. "The circulation in your feet can help us determine how severe your diabetes is."
C. "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."
D. "It's easier to get foot infections if you have diabetes."

Correct Answer: C

Explanation: The nurse should make the client aware that diabetes affects sensation in the feet and that he might hurt his foot but not feel the wound. Although it's important that the client's shoes fit properly, this isn't the only reason the client's feet need to be checked. Telling the client that diabetes mellitus increases the risk of infection or stating that the circulation in the client's feet indicates the severity of his diabetes doesn't provide the client with complete information.

Saturday, 13 April 2019

Q. A client who is undergoing radiation therapy develops mucositis. Which of the following interventions should be included in the client's plan of care?

A. Increase mouth care to twice per shift.
B. Provide the client with hot tea to drink.
C. Promote regular flossing of teeth.
D. Use half-strength hydrogen peroxide on mouth ulcers.


Correct Answer: C

Explanation: Mucositis is an inflammation of the oral mucosa caused by radiation therapy. It is important that the client with mucositis receive meticulous mouth care, including flossing, to prevent the development of an infection. Mouth care should be provided before and after each meal, at bedtime, and more frequently as needed. Extremes of temperature should be avoided in food and drink. Half-strength hydrogen peroxide is too harsh to use on irritated tissues.

Friday, 12 April 2019

Q. A client is recovering from an acute myocardial infarction (MI). During the first week of the client's recovery, the nurse should stay alert for which abnormal heart sound?

A. Opening snap
B. Graham Steell's murmur
C. Ejection click
D. Pericardial friction rub



Correct Answer: D

Explanation: A pericardial friction rub, which sounds like squeaky leather, may occur during the first week following an MI. Resulting from inflammation of the pericardial sac, this abnormal heart sound arises as the roughened parietal and visceral layers of the pericardium rub against each other. Certain stenosed valves may cause a brief, high-pitched opening snap heard early in diastole. Graham Steell's murmur is a high-pitched, blowing murmur with a decrescendo pattern; heard during diastole, it indicates pulmonary insufficiency, such as from pulmonary hypertension or a congenital pulmonary valve defect. An ejection click, associated with mitral valve prolapse or a rigid, calcified aortic valve, causes a high-pitched sound during systole.

Thursday, 11 April 2019

Q. When performing an initial assessment of a post-term male neonate weighing 4,000 g (9 lb) who was admitted to the observation nursery after a vaginal delivery with low forceps, the nurse detects Ortolani's sign. Which of the following actions should the nurse do next?

A. Determine the length of the mother's labor.
B. Notify the primary health care provider immediately.
C. Keep the neonate under the radiant warmer for 2 hours.
D. Obtain a blood sample to check for hypoglycemia.

Correct Answer: B

Explanation: Ortolani's maneuver involves flexing the neonate's knees and hips at right angles and bringing the sides of the knees down to the surface of the examining table. A characteristic click or "clunk," felt or heard, represents a positive Ortolani's sign, suggesting a possible hip dislocation. The nurse should notify the primary health care provider promptly because treatment is needed, while maintaining the dislocated hip in a position of flexion and abduction. Determining the length of the mother's labor provides no useful information related to the nurse's finding. Keeping the infant under the radiant warmer is necessary only if the neonate's temperature is low or unstable. Checking for hypoglycemia is not indicated at this time, unless the neonate is exhibiting jitteriness.

Wednesday, 10 April 2019

Question Of The Day, Postpartum Period
Q. A nurse is preparing to perform a postpartum assessment on a client who gave birth 5 hours ago. Which precaution should the nurse plan to take for this procedure?

A. Washing the hands
B. Washing the hands and wearing latex gloves
C. Washing the hands and wearing latex gloves and a barrier gown
D. Washing the hands and wearing latex gloves, a barrier gown, and protective eyewear

Correct Answer: B

Explanation: During a postpartum assessment, the nurse is likely to come into contact with the client's blood or body fluids, especially when examining the perineal region. Therefore, the nurse must wear latex gloves; hand washing alone would neither provide adequate protection nor comply with universal precautions. The nurse should wear a barrier gown and protective eyewear in addition to latex gloves only when anticipating splashing of blood or body fluids such as during childbirth. Splashing isn't likely to occur during a postpartum assessment.


Tuesday, 9 April 2019

Q. A client who has been in the latent phase of the first stage of labor is transitioning to the active phase. During the transition, the nurse expects to see which client behavior?

A. A desire for personal contact and touch
B. A full response to teaching
C. Fatigue, a desire for touch, and quietness
D. Withdrawal, irritability, and resistance to touch

Correct Answer: D

Explanation: During the transition to the active phase of the first stage of labor, increased pain typically makes the client withdrawn, irritable, and resistant to touch. During the latent phase (the early part of the first stage of labor), when contractions aren't intensely painful, the client typically desires personal contact and touch and responds to teaching and interventions. Fatigue, a desire for touch, and quietness are common during the third and fourth stages of labor.

Monday, 8 April 2019

Q. A client who's 7 weeks pregnant comes to the clinic for her first prenatal visit. She reports smoking 20 to 25 cigarettes per day. When planning the client's care, the nurse anticipates informing her that if she doesn't stop smoking, her fetus may be at risk for:

A. spina bifida.
B. tetralogy of Fallot.
C. low birth weight.
D. hydronephrosis.

Correct Answer: C

Explanation: The risk of intrauterine growth retardation may increase with the number of cigarettes a pregnant woman smokes. Neural tube defects (such as spina bifida), cardiac abnormalities (such as tetralogy of Fallot), and renal disorders (such as hydronephrosis) are associated with multifactorial genetic inheritance, not maternal cigarette smoking.

Saturday, 6 April 2019

Q. At an outpatient visit 3 months after discharge from the hospital, a client says he has stopped his olanzapine (Zyprexa) even though it controls his symptoms of schizophrenia better than other medications. "I have gained 20 lb already. I can't stand any more." Which response by the nurse is most appropriate?

A. "I don't think you look fat, why do you think so?"
B. "I can help you with a diet and exercise plan to keep your weight down."
C. "You can be switched to another medicine."
D. "Your weight gain will level off if you stay on the medication 3 more months."

Correct Answer: B

Explanation: Helping the client control his weight is the most appropriate approach. The nurse's contradiction of the client's complaint is inappropriate. Most atypical antipsychotics cause weight gain and are not a solution to the weight gain. There is little evidence that weight gain from taking olanzapine decreases with time.


Friday, 5 April 2019

During my senior year of nursing school, life suddenly got a little busy for me. And by a “little busy” I mean I found out I was pregnant, I started planning a wedding with a deadline of three months, and I was still working night shift as a nurse tech.

Nursing Schools, Nursing Responsibilities, Nursing Career, Nursing Job, Nursing Professionals

Honestly, I don’t know how I survived that time in my life, although I do hazily recall a lot of puking and a lot of ice cream consumed. One thing that I remember clearly, however, is that I didn’t have the energy or time to focus on studying as I had during my early days of nursing school. Heck, I barely could make it through class without having to run out and throw up in the nearest trash can, so you had better believe I didn’t have time to take pages and pages of notes. If you’re anything like me and looking for a little help studying (probably minus the pregnancy part), I’ve rounded up some of the best study and nursing school survival tips that won’t leave your hand cramping from taking notes.

1. Take a break when you need a break


If you’re feeling like you need a break from studying, don’t fall trap to the thinking that you need to power through and keep cramming. You might think more = better, but studies have shown that taking a break can actually make you more productive.

2. Know your own learning style


Many students may make it to the college-level without even knowing what their unique learning style is. Some people learn best by reading, some by writing out notes, others by listening, and still others by seeing or doing. The important thing is that you realize that no way is the “right” way, but there is a right way that will work for you, so experiment to find out what works best for you.

3. Reward yourself


A year out of school, 26-year-old labor and delivery nurse Danielle Smith’s biggest tip is to set rewards for studying. For example, she suggests that if you want to watch the new episode of “This is Us”, you should tell yourself you must first finish your flash cards for a chapter or complete at least 25 practice questions, etc.

“Other rewards could be a date/night out, or even a treat like your favorite candy bar, but not unless you accomplish something for school first,” Smith says. “This worked wonders for me!”

4. Avoid cramming


My biggest tip is to make sure you give yourself enough time to study all the content before your test!” advises second-year nursing student Kaylee Fenslau, 20. “Cramming is never good. I normally like to start studying a week before my class and I always do a little bit every day no matter what. I also use a planner, so I know exactly when my assignments and tests are due! Another tip I have is to do a lot of practice questions. That’s helped me immensely in knowing how to answer NCLEX questions—always make time for yourself so you don’t overload yourself with the stress of the assignments and studying!”

5. Schedule that study time


Second-year nursing student Kelly Carson, 25, says that time management and prioritizing are everything. And the real key? Scheduling out a time to study—don’t just leave it until you feel like it.

“The assignments are never ending so make sure you have a place whether it’s on the computer or an old fashion planner to write down your assignments for the entire semester,” she notes. “Also, getting a head start at the beginning of the semester has helped me to not get behind on readings and assignments!”

6. Diffuse oils to help increase concentration


If you need a little pick-me-up before studying, try some essential oils. Lavender, rosemary, and peppermint oils have all been studied and have been shown to increase concentration and retention. Try diffusing the oils or dabbing a little on your wrists before sitting down to a study sesh.

7. Try the 45-15 study strategy


If you’re having trouble focusing on your study sessions, try mixing things up with the 45-15 study strategy. The strategy is simple: set a timer for 45 minutes, then take a break for the next 15. The key is really, really focusing during those 45 minutes (no social media, folks!) and then really, really taking a break. Get up, get moving, talk a walk, and then get back to it. The strategy is a good way to prep and take advantage of the natural ebb and flow of concentration in your brain.

8. Don’t study solo


RN Ashley Cloutier, 31, knows that just like nurses out in the field depend on their coworkers to survive, so too do nursing students. “You develop an odd little family with your peers because you are together more than anyone else,” she explains. “Find a few people who you mesh well with, this is what got me through nursing school. Support each other, encourage, and hold each other accountable.

We used each other to study, quiz, vent, give a different perspective and discuss how nursing school was affecting our families, therefore us as well. People who have never experienced nursing school cannot relate to what you're going through. The stress, demands, assignments, working for free, being away from your family, and when you are home, doing nothing but read or study. These guys will know exactly how you feel because they are going through it, too. Nursing school is one of the hardest things I've accomplished. I couldn't have done it without my nursing crew.”

9. Create a study ritual


Pay attention to how you feel when you sit down to study—are you dreading it before you even begin? Groaning internally? Exhausted just thinking about it? It may be time to reevaluate your study environment. There is no reason to make study time something you absolutely hate; instead, try to set up little rituals for yourself before and while you study to make it more enjoyable. Try setting up a special corner, lighting a candle or even stashing your favorite snacks nearby for a little treat. And on the flip side, if you’re a creature of habit while studying, you could also try mixing up your environment. Get out of your house or apartment and visit a new coffee shop or deli to get some new sights and sounds while you study.

10. Prep before class


Chances are, your typical study style might look something like this: go to class, take notes, review the material, study, take test, right? Well, Shelby B., a second-year nursing student who runs the account @coffeeandcareplans has a different strategy that I think is genius.
Q. A client diagnosed with a cognitive disorder is showing signs of confusion, short-term memory loss, and a short attention span. Which of the following therapy groups would be best suited for this client?

A. Insight-oriented.
B. Medication management.
C. Problem solving.
D. Reality-orientation.

Correct Answer: D

Explanation: Because the client has confusion, short-term memory loss, and a short attention span, a reality-orientation group is recommended to help the client maintain an optimal level of functioning, decrease isolation, and increase self-esteem. Focus is on the "here and now" and provides reality testing, structure, and social support. A client with a cognitive disorder is unlikely to benefit from an insight-oriented group, where the focus is on role relationships. Short-term memory loss and confusion interfere with the ability to learn about medication management. Short-term memory loss and confusion interfere with the ability to describe and solve problems.

Thursday, 4 April 2019

Question Of The Day, Anxiety Disorders
Q. Which of the following should the nurse teach a client with generalized anxiety disorder to help the client cope with anxiety?

A. Cognitive and behavioral strategies.
B. Issue avoidance and denial of problems.
C. Rest and sleep.
D. Withdrawal from role expectations and role relationships.



Correct Answer: A

Explanation: A client with generalized anxiety disorder needs to learn cognitive and behavioral strategies to cope with anxiety appropriately. In doing so, the client's anxiety decreases and becomes more manageable. The client may need assertiveness training, reframing, and relaxation exercises to adaptively deal with anxiety.

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