Thursday 31 January 2019

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

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

Correct Answer: D

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

Wednesday 30 January 2019

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

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

Correct Answer: B

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

Tuesday 29 January 2019

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

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

Correct Answer: C

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

Monday 28 January 2019

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

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

Correct Answer: C

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

Thursday 24 January 2019

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

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

Correct Answer: C

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

Wednesday 23 January 2019

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

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

Correct Answer: C

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

Tuesday 22 January 2019

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

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

Correct Answer: B

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

Monday 21 January 2019

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

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

Correct Answer: B

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

Saturday 19 January 2019

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

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

Correct Answer: A

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

Friday 18 January 2019

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

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

Correct Answer: C

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

Thursday 17 January 2019

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

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

Correct Answer: A

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

Wednesday 16 January 2019

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

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

Correct Answer: D

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

Tuesday 15 January 2019

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

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

Correct Answer: D

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

Friday 11 January 2019

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

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

Correct Answer: D

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

Thursday 10 January 2019

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

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

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

1. Take a deep breath

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

2. Get a hobby

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

3. Invest in yourself 

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

4. Have a saving system that works for you

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

5. Get out of town

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

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

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

7. This is not forever 

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

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

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

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

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

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

Correct Answer: C

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

Wednesday 9 January 2019

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

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

Correct Answer: D

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

Tuesday 8 January 2019

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

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

Correct Answer: D

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

Monday 7 January 2019

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

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

Correct Answer: C

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

Friday 4 January 2019

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

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

Correct Answer: C

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

Thursday 3 January 2019

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

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

Correct Answer: A

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

Wednesday 2 January 2019

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

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

Correct Answer: D

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

Tuesday 1 January 2019

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

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

Correct Answer: D

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



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