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.



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