Tuesday 31 December 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.

Sunday 29 December 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.

Saturday 28 December 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.

Friday 27 December 2019

Registered Nurse, Nursing Career, Nursing Degree, Nursing Skill, Nursing Responsibilities,

How RN Salaries Compare to Other Nursing Jobs

Before diving into the various RN specialties or which areas of the country offer the most lucrative opportunities for nurses, you might be interested to learn about the value of the RN license itself. In other words, how much will an RN make in comparison to a Licensed Practical Nurse (LPN) or a Licensed Vocational Nurse (LVN)? The short answer is that you can earn significantly more, plus you are positioned to keep advancing.

According to the Bureau of Labor Statistics, the median annual salary for registered nurses as of 2012 was $65,470. Remember, that means that half of the workers earned more (as high as $94,720) and half earned less, but that number should give you a good idea of how high you should expect your starting salary to be.

Now, compare that to LPN and LVN salaries, and you’ll see a notable difference. These lower level nurses (who work under the direction of RNs) earned a $41,540 median pay, says the BLS. It makes sense given the qualifications for and responsibilities of the two nursing jobs. The path to RN takes is more intensive.

On the other end of the spectrum, there are advanced nursing occupations like nurse anesthetists, nurse midwives, and nurse practitioners, all of which are sometimes referred to collectively as an advanced practice registered nurses (APRNs). Professionals working in one of these areas earned a median wage of $96,460 in 2012.

As you can see, there are different tiers of nursing jobs, and salaries increase along with the level of skill required.

Becoming a registered nurse takes a lot of commitment, and working in the job itself not only requires a specialized set of skills but a special kind of person. Choosing a career as an RN is not something that should be taken lightly, which is why it’s important to get a sense of nursing salaries.

Depending on your level of expertise and areas of specialization, the number of years experiences you gain, and the city and state in which you work, your RN salary can range quite a bit.

This comprehensive look at nursing salaries will help you see how you’ll be compensated depending on the direction you decide to take your nursing career. The good news is even those who are just entering the profession can expect a healthy starting RN salary. From there, the possibilities and income potential are only limited by your willingness to pursue advanced certifications and/or seek out a higher-paying employer.

Advanced Registered Nursing Specialties

The great thing about RN careers is that there are multiple career paths to choose from if you decide that you’d like to advance or specialize. As noted above, that usually comes along with a salary increase. To help you decide which career direction is most appealing to you, take a look at some of these 11 high paying specialties for RNs:

1. Family Nurse Practitioner - Advanced RNs who earn an average of $83,527 per year, according to PayScale. FNPs must earn a special certification in family practice, and usually a master’s degree. FNPs provide primary care in either a doctor’s office, clinic, hospital, or nursing home, and typically perform many of the same functions as a doctor (without the intense work hours). That includes patient assessments, prescribing medications and treatment, and more.

2. Certified Nurse Midwife - Becoming a Certified Nurse Midwife is a great choice for RNs who are interested in obstetrics, labor and delivery, and prenatal care. Midwives can expect to earn an average salary of $85,000, as per PayScale. They typically work in OB/Gyn offices, clinics, or hospital settings, but some choose to open private practices as well. A special certification is required to practice certified nurse-midwifery.

3. Neonatal Nurse - For those who love taking care of newborn babies, becoming a neonatal nurse is a good fit, and one that commands a strong salary, too. The average hourly wage for neonatal nurses as per Payscale is $29.76 per hour. Those who work in the neonatal intensive care unit have the potential to earn more.

4. Psychiatric Nurse Practitioner - Psychiatric Nurse Practitioners earns on average $89,634 per year, according to PayScale. This advanced position usually requires a master’s degree with a specialty in psychiatric nursing, and you’ll usually work under the supervision of a psychiatric physician to administer patient care.

5. Certified Registered Nurse Anesthetist (CRNA) - Of all the RN specialties, Certified Registered Nurse Anesthetists command the highest salaries, with an average of $133,000 per year, as reported by PayScale. This highly skilled profession involves prepping and administering anesthesia to patients. Additional education is required to achieve a license from the American Association of Nurse Anesthetists (AANA).

6. Pain Management Nurse - After earning a Nurse Practitioner certification for Pain Management Specialists, Pain Management Nurses have the advanced credentials to help manage patient pain post-surgery or during a health crisis. The average yearly salary for this specialized RN track is $90,288 per year.

7. Gerontological Nurse Practitioner - Once you become a Certified Gerontological Nurse Practitioner (CGNP), you can begin a career in working with elderly patients, and administering the specialized health care that they require. The BLS reports the median annual salary for this specialty to be $95,070 as of May 2013.

8. General Nurse Practitioner - While there are a number of additional credentials that one can pursue as an RN, a general nurse practitioner can work independent practice or as part of a healthcare team, according to the BLS. Per year, those with this designation can expect to earn $97,990, as of the May 2014 occupational employment statistics.

9. Clinical Nurse Specialist - Choosing the Clinical nurse specialist (CNS) route means you’ve chosen to work in a specialized unit or clinic. Because that requires additional training and advanced skills, the median salary as per PayScale is $80,984.

10. Nurse Educator - Some RNs decide to move out of the patient care realm to work directly with other nurses to help them achieve their continuing education credits, facilitate training programs, and help employees with remediation. Working in this area, you can earn an average yearly salary of $69,249, as reported by PayScale.

11. Nursing Administrator - Another behind-the-scenes position you can pursue as an RN is a nursing administrator. In this position, you’ll oversee the “business” of nursing, including budgets, HR functions, and more. Doing so can earn you an average salary of $80,351, as per PayScale.

Where are the Highest Paying RN Salaries?

As with any profession, where you work can have a major influence on your income potential. As such, certain cities offer significantly higher salaries for RNs than others. Keep in mind, though, that other economic factors should go into any decisions you have regarding relocation for a job, the cost of living being the biggest among them.

Still, it’s worth noting which metropolitan areas offer the best opportunities, especially if you live in the vicinity of any of them. The top-paying cities for RNs all happen to be in California, according to U.S. News and World Report . They are, in order: San Francisco, San Jose, Vallejo, Oakland, and Sacramento. Beyond the California area, other high-paying cities for RN salaries according to LPN.com are Boston, New York, Baltimore, Worcester (MA), Seattle, Portland, and Minneapolis-St. Paul.

Salary Variations by State or Region

As for states, we already know that California comes in as the most generous when it comes to RN salaries, with a median salary of $98,400. Next on the list in order is Hawaii ($88,230), Massachusetts ($85,770), Alaska ($85,740), and Oregon ($82,940), according to the BLS4.

As you can see, nursing salaries vary widely based on the level of specialization and where you choose to work. Becoming an RN is the first step toward a lucrative career in healthcare, thanks to a respectable starting salary. The appeal is not only financial in nature, however. It’s also a versatile career in which you can seek out different niche areas that you’re passionate about, whether it’s caring for babies or seniors, managing other nurses, or working closely with a physician.

Where you decide to take your RN career – and your salary – is in your hands.

Source: nurse.org
Question Of The Day, Medication and I.V. Administration
Q. When giving an I.M. injection, the nurse should insert the needle into the muscle at an angle of:

A. 15 degrees.
B. 30 degrees.
C. 45 degrees.
D. 90 degrees.

Correct Answer: D

Explanation: When giving an I.M. injection, the nurse inserts the needle into the muscle at a 90-degree angle, using a quick, dartlike motion. A 15-degree angle is appropriate when administering an intradermal injection. A 30-degree angle isn't used for any type of injection. The nurse may use a 45- or 90-degree angle when giving a subcutaneous injection.

Thursday 26 December 2019

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.

Wednesday 25 December 2019

Question Of The Day, Genitourinary Disorders
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.

Tuesday 24 December 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.

Monday 23 December 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.

Saturday 21 December 2019

Nursing Schools, Nursing Skill, Nursing Responsibilities, Nursing Career, Nursing Degree

Whether you’re in nursing school now or are preparing to enter the world of scrubs and stethoscopes, we have some news for you: nursing school is like nothing you can ever imagine.

From the bonds you will form with the other humans who know what it’s like to cram for a test designed to confuse you to the bitter regret of watching other majors do things like relax on the weekends instead of head to clinicals, nursing school is not your typical educational experience. But fortunately, we are here to spill the beans on all of the things that no one will actually tell you about nursing school.


It’s not exactly something that I imagine nursing schools like to advertise, but it’s kind of the hard truth: nursing school has one of the strictest attendance policies known to humankind. Take it from someone who was once involved in a car accident and happened to get married during nursing school — there are no such things as excused absences in nursing school.


By the time you graduate, you will have chuckled your way through some seriously dark stuff, so be prepared to maybe not be the one to crack jokes at the next party--and if you don’t heed our warning, at the very least, be prepared to get some seriously weird looks from non-medical people.


AS IF A DOCTOR WOULD EVER DO THAT, ARE YOU KIDDING ME??! Your eyes have been opened now and there’s no going back, sorry.


Cervical dilation, sputum consistency, and fecal impaction, oh my! The things that have become normal to discuss with your fellow students while you casually eat lunch may just cause other people to lose their lunch.


Leisurely meal times will become a thing of the past, as you soon learn to adopt the nurse’s habit of scarfing down food any chance they get for a real meal--because you just never know what’s going to happen, even when you’re technically on break. I mean, are you going to miss that chest tube insertion or code blue just because you’re on lunch?


That first time you nail the hard stick? Nurse Blake just gets us and it’s a beautiful thing. 


Practicing the perfect balance of -- blending in innocuously, being somewhat helpful to the “real” nurses doing, you know, their actual paid work, and asking the appropriate amount of questions so you can actually learn, but not be too annoying -- is a downright overlooked award-winning performance skill and no one can convince me otherwise.


Hmmm, maybe art history? I bet art history majors don’t have to wipe anyone’s butt! Ooo, or maybe economics? That sounds, um, economical.


Studying every free moment has become a way of life by now, so once you cross that graduation finish line, it will be hard to accept that your new normal does not include studying while your brush your teeth anymore.

Congrats! You are now someone who feels strangely guilty for having any sort of free time whatsoever, but I promise you, it will get easier. Also, night shift is most likely in your future, so free time will be replaced by sleep before you know it anyways.


All of those regular students attending boring classes that don’t talk about things like gastric emptying rate, tachycardia, and drug half-life, not cramming for tests after getting home exhausted from clinical work, making it through school without learning what it’s like to be responsible for saving lives, and somehow rocking a normal sleep schedule?
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.

Friday 20 December 2019

Q. A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

A. Straw-colored urine
B. Reduced hematocrit
C. Clay-colored stools
D. Elevated urobilinogen in the urine

Correct Answer: C

Explanation: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

Thursday 19 December 2019

Question Of The Day, Oncologic Disorders
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.

Wednesday 18 December 2019

Question Of The Day, Cardiovascular Disorders
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.

Tuesday 17 December 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.

Monday 16 December 2019

Question Of The Day, Intrapartum Period
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.

Saturday 14 December 2019

Question Of The Day, Antepartum Period
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.

Friday 13 December 2019

Nursing Classes, Nursing Responsibilities, Nursing Career, Nursing Degree, Nursing Skill

Most nurses understand the benefits of furthering their education. Higher salary, more opportunities, and a personal sense of accomplishment are at the top of many lists. But working a full-time job and going to school isn't an easy task. Many nurses consider online nursing degrees to help lighten such a heavy load. Before deciding to pursue your next nursing degree online, take a look at the pros and cons.


1. Convenience. Work schedules, family life, and other priorities may make it difficult to commit to a school's schedule. Many online programs offer the flexpath track, allowing you to work at your own pace. Often, with no set class schedules, extended deadlines, and no on-campus requirements, the flexibility of online nursing programs is attractive to busy nurses. 

2. More choices. Location may be a significant deciding factor when considering traditional nursing programs. Many choose not to further their education because of limited options in their area. But, with online programs, you can enroll in colleges and universities hundreds or thousands of miles from home. 

3. Save money. Online classes are often less expensive than on-site courses. Additional fees such as parking, technology, student center, and sometimes out-of-state tuition may be waived for online students. It may be possible to purchase books online or use digital editions, which can be less expensive than actual textbooks. Also, students will save money on gas, car maintenance, and let's not forget room and board.  


1. No interactions with your instructors and classmates. In a traditional classroom setting, it's not uncommon for students to gain great rapport with instructors. Some of the best friendships form in nursing school.  A physical classroom setting offers immediate feedback and clarification from professors, as well as tips and help from fellow nursing students. In online programs, you'll rely on emails, whiteboards, and forums. 

2. Difficulty staying on task. Since a lot of online programs offer the "at-your-own-pace" option, you may be tempted to postpone assignments and lessons. Exhaustion from a hard shift or family life makes it difficult to encourage yourself to complete tasks. If you're not motivated to complete assignments or lessons on time, it will be easy to fall behind and get off track. If you're a procrastinator, online classes may be a big hurdle to jump.

3. Lack of accreditation. Nursing students who attend non-accredited programs, whether an ADN or BSN program, will face challenges obtaining gainful employment. Firstly, they are ineligible to sit for the NCLEX and without the NCLEX exam they will not become a Registered Nurse. Accreditation is a process that ensures all schools and programs are held to and satisfy specific high-quality standards. Primarily, a form of quality control, certain criteria must be met, among those are qualified faculty, quality and competent course content, and program quality.

Online nursing school accreditation is important for several reasons:

◉ Ensures all nursing school graduates have the same level of education

◉ Only students attending accredited programs are eligible for federal financial aid

◉ If you decide to transfer, many schools won't accept credits from non-accredited programs

◉ Many employers won't hire graduates of non-accredited programs

Be sure to check the school’s and their nursing program's accreditation before committing to attend. All schools listed here are accredited. 

There are two main accrediting bodies for nursing programs. They are:

◉ The Accreditation Commission for Education in Nursing (ACEN)

◉ The Commission on Collegiate Nursing Education (CCNE)

Is an online nursing program right for me?

Enrolling in an online nursing degree program is a convenient way to further your education, advance your career, and learn new skills. Considering the pros and cons of any programs will help ensure a program meets your needs.
Question Of The Day, Substance Abuse, Eating Disorders, Impulse Control Disorders
Q. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?

A. Seizures
B. Shivering
C. Anxiety
D. Chest pain

Correct Answer: A

Explanation: Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain.

Wednesday 11 December 2019

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.

Tuesday 10 December 2019

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.

Monday 9 December 2019

Question Of The Day, Foundations of Psychiatric Nursing
Q. A nurse makes a home visit to a client who was discharged from a psychiatric hospital. The client is irritable and walks about her room slowly and morosely. After 10 minutes, the nurse prepares to leave, but the client plucks at the nurse's sleeve and quickly asks for help rearranging her belongings. She also anxiously makes inconsequential remarks to keep the nurse with her. In view of the fact that the client has previously made a suicidal gesture, which of the following interventions by the nurse should be a priority at this time?

A. Ask the client frankly if she has thoughts of or plans for committing suicide.
B. Avoid bringing up the subject of suicide to prevent giving the client ideas of self-harm.
C. Outline some alternative measures to suicide for the client to use during periods of sadness.
D. To draw out the client, mention others the nurse has known who have felt like the client and attempted suicide.

Correct Answer: A

Explanation: Investigating the presence of suicidal thoughts and plans by overtly asking the client if she is thinking of or planning to commit suicide is a priority nursing action in this situation. Direct questioning about thoughts or plans related to self-harm does not give a person the idea to harm herself. Self-harm is an individual decision. Avoiding the subject when a client appears suicidal is unwise; the safest procedure is to investigate. It would be premature in this situation to outline alternative measures to suicide. Describing other clients who have attempted suicide is too indirect to be helpful and minimizes the client's feelings.

Saturday 7 December 2019

Question Of The Day, Preschooler
Q. A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/minute. Which of the following actions should the nurse do first?

A. Obtain an order for sedation for the child.
B. Assess for an irregular heart rate and rhythm.
C. Explain to the child that it will only hurt for a short time.
D. Place the child in a knee-to-chest position.

Correct Answer: D

Explanation: The child is experiencing a tet or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from the lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of Fallot. As a result, the blood then entering the systemic circulation has a higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position in the crib, or the mother learns to put the infant over her shoulder while holding the child in a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need a sedative. Once the child is in the position, the nurse may assess for an irregular heart rate and rhythm. Explaining to the child that it will only hurt for a short time does nothing to alleviate the hypoxia.

Friday 6 December 2019

Question Of The Day, Toddler
Q. After teaching a group of parents about temper tantrums, the nurse knows the teaching has been effective when one of the parents states which of the following?

A. "I will ignore the temper tantrum."
B. "I should pick up the child during the tantrum."
C. "I'll talk to my daughter during the tantrum."
D. "I should put my child in time out."

Correct Answer: A

Explanation: Children who have temper tantrums should be ignored as long as they are safe. They should not receive either positive or negative reinforcement to avoid perpetuating the behavior. Temper tantrums are a toddler's way of achieving independence.

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

Why a Guide on Staffing is So Important

Nursing staffing is an issue that has been forefront lately; in the spring, New York nurses battled for months to establish the state’s first-ever minimum staffing guidelines and Illinois introduced a bill to mandate staffing ratios.  

As McMillan explains, staffing -- which she calls a “complex issue”-- is a long-standing and important focus for the ANA; in their 2019 membership survey, for example, 93% of the respondents identified staffing as an “important” issue, and 72% identified it as “extremely important.” Additionally, she adds that research demonstrates that appropriate nurse staffing leads to better patient outcomes, reduced costs, fewer adverse events, and fewer complications and readmissions.  

She also points out that staffing is a factor in nurse turnover, which costs an average hospital $300,000 for each percent point in RN turnover. If staffing policies don’t adequately meet the needs of nurses, they are more at risk for burnout and as a result, leaving their position, which costs the hospital money for training and recruitment and also leaves patients at higher risk. 

Although the ANA had identified a guide to nursing staffing in its original principles, McMillan notes that an update was necessary, as the original principles were first published in 1999 and updated in 2012. 

ANA’s 5 Principles For Nurse Staffing

The ANA has created free staffing resources including a free eBook, downloadable infographic and staffing webinar on their site. 

Nursing Career, Nursing Degree, Nursing Responsibilities, Nursing Degree US
Chart via ANA website

According to the ANA, the 5 Principles include, 

1. Health Care Consumer: Nurse staffing decisions are based on the number and needs of the patients, families, groups, communities, and populations served.

2. Interprofessional Teams: Optimal care is achieved through individual actions and collaboration with other health care team members. Nurses are full partners in the delivery of safe, quality health care.

3. Workplace Culture: Organizational leaders must create a workplace environment that values nurses as critical members of the health care team.

4. Practice Environment: All nursing care delivery systems must provide the necessary resources to meet each health care consumer's individual needs and the demands of the unit.

5. Evaluation: Organizations must have appropriate nurse staffing plans. All settings need well-developed staffing guidelines with measurable nurse-sensitive outcomes.

Why the ANA Supports Flexible Nursing Staffing

In the updated guidelines on staffing, the ANA supports a flexible approach to nurse staffing, identifying it as beneficial for both patients and nurses. 

“Nurse staffing is more than numbers, and one size does not fit all,” McMillan says. “A flexible approach is associated with improved patient outcomes, including reduced mortality rates, shorter stays, lower readmission rates, and reduced hospital-acquired conditions.”

The organization believes that a flexible approach to nurse staffing allows for “nurse-specific factors,” which can include things like a nurse’s level of experience, knowledge, education, and skillset, as well as patient-specific factors such as acuity and intensity. 

On a practical level, you can see how this might look like when you consider that a minimum staffing ratio might dictate that two nurses be staffed on the floor--but what if both of those nurses are brand-new grads, fresh off of orientation? Technically, the ratio might be met, but will it be the optimum situation for both those nurses and their patients? The ANA’s view is that more nurses who are appropriately matched to patient assignments equal better patient outcomes and improved quality of work-life that will ultimately result in lower rates of nurse burnout, turnover, fatigue, and fatigue-related errors.

According to McMillan, ANA’s staffing principles support all nurses, like the ones performing direct-care and therefore attuned to what patients actually need -- even as those needs can shift on an hourly level -- having a role in nurse staffing decisions. 

With nurses’ input, following the principles would lead to a healthcare organization with the following: 

◉ Nurse-driven staffing guidelines with measurable outcomes

◉ Nurses at all levels having a role in staffing decisions

◉ Staffing needs and assignments taking into account factors such as patient status and nurse competencies 

◉ Flexibility to reassess and adjust staffing during the course of a shift as patients are admitted and discharged

◉ Sufficient training time and resources for new grads and orientees 

◉ Nurse staffing would be referred to as more than numbers, known as “one size does not fit all” 

◉ A focus on flexibility and teamwork to effectively meet the ever-changing needs of patients 

◉ A workplace culture that values nurses as a vital part of the healthcare team

How All Nurses Can Be Involved

To help establish the staffing policies that ANA believes will benefit both patients and staff alike, ANA explains that the organization has been working hard to not only share the updated principles and encourage “a shift in paradigm,” but has also been working on a federal level as well. For example, ANA has been working with federal officials to push for the Centers for Medicare & Medicaid Services to provide Congress with information about how the agency assesses “adequate” staffing levels as part of its 2020 budget request. 

ANA is also working to maintain National Quality Forum endorsement for two nurse staffing measures: skill mix and nursing hours per patient day. McMillan notes that several states already require their hospitals to publicly report these measures, and ANA’s continued advocacy will encourage increased transparency, especially with respect to the Medicare program.

And while federal and state measures are vital for change, the ANA also encourages every nurse who wants to get involved in promoting and implementing flexible nursing staffing policies to take action on a personal level too. 

For instance, McMillan suggests that nurses could start by simply having a conversation with nurse managers and other leaders who are responsible for nurse staffing in your workplace as a first step.

Thursday 5 December 2019

Question Of The Day, Infant
Q. An infant is hospitalized for treatment of inorganic failure to thrive. Which nursing action is most appropriate for this child?

A. Encouraging the infant to hold a bottle
B. Keeping the infant on bed rest to conserve energy
C. Rotating caregivers to provide more stimulation
D. Maintaining a consistent, structured environment

Correct Answer: D

Explanation: The nurse caring for an infant with inorganic failure to thrive should strive to maintain a consistent, structured environment because it reinforces a caring feeding environment. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.

Tuesday 3 December 2019

Q. Crackles heard on lung auscultation indicate which of the following?

A. Cyanosis.
B. Bronchospasm.
C. Airway narrowing.
D. Fluid-filled alveoli.

Correct Answer: D

Explanation: Crackles are auscultated over fluid-filled alveoli. Crackles heard on lung auscultation do not have to be associated with cyanosis. Bronchospasm and airway narrowing generally are associated with wheezing sounds.

Monday 2 December 2019

Question Of The Day, Medication and I.V. Administration
Q. A woman is taking oral contraceptives. The nurse teaches the client to report which of the following danger signs?

A. Breakthrough bleeding.
B. Severe calf pain.
C. Mild headache.
D. Weight gain of 3 lb.

Correct Answer: B

Explanation: Women who take oral contraceptives are at increased risk for thromboembolic conditions. Severe calf pain needs to be investigated as a potential sign of deep vein thrombosis. Breakthrough bleeding, mild headache, or weight gain may be common benign side effects that accompany oral contraceptive use. Clients may be monitored for these side effects without a change in treatment.



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