Saturday, 4 July 2020

Q. A 75-year-old client is newly diagnosed with diabetes. The nurse is instructing him about blood glucose testing. After the session, the client states, "I can't be expected to remember all this stuff." The nurse should recognize this response as most likely related to which of the following?

A. Moderate to severe anxiety.
B. Disinterest in the illness.
C. Early-onset dementia.
D. Normal reaction to learning a new skill.

Correct Answer: A

Reason: Anxiety, especially at higher levels, interferes with learning and memory retention. After the client's anxiety lessens, it will be easier for him to learn the steps of the blood glucose monitoring. Because the client's illness is a chronic, lifelong illness that severely changes his lifestyle, it is unlikely that he is uninterested in the illness or how to treat it. It is also unlikely that dementia would be the cause of the client's frustration and lack of memory. The client's response indicates anxiety. Client responses that would indicate lessening anxiety would be questions to the nurse or requests to repeat part of the instruction.

Friday, 3 July 2020

Q. A client receiving a blood transfusion begins to have chills and headache within the first 15 minutes of the transfusion. The nurse should first:

A. Administer acetaminophen.
B. Take the client's blood pressure.
C. Discontinue the transfusion.
D. Check the infusion rate of the blood.


Correct Answer: C

Reason: Chills and headache are signs of a febrile, nonhemolytic blood transfusion reaction and the nurse's first action should be to discontinue the transfusion as soon as possible and then notify the physician. Antipyretics and antihistamines may be ordered. The nurse would not administer acetaminophen without an order from the physician. The client's blood pressure should be taken after the transfusion is stopped. Checking the infusion rate of the blood is not a pertinent action; the infusion needs to be stopped regardless of the rate.

Thursday, 2 July 2020

Q. Following a small-bowel resection, a client develops fever and anemia. The surface surrounding the surgical wound is warm to the touch and necrotizing fasciitis is suspected. Another manifestation that suggests necrotizing fasciitis is:

A. erythema.
B. leukocytosis.
C. pressurelike pain.
D. swelling.

Correct Answer: C

Reason: Severe pressurelike pain out of proportion to visible signs distinguishes necrotizing fasciitis from cellulitis. Erythema, leukocytosis, and swelling are present in both cellulitis and necrotizing fasciitis.

Wednesday, 1 July 2020

Q. A client with esophageal cancer decides against placement of a jejunostomy tube. Which ethical principle is a nurse upholding by supporting the client's decision?

A. Autonomy
B. Fidelity
C. Nonmaleficence
D. Veracity


Correct Answer: A

Reason: Autonomy refers to an individual's right to make his own decisions. Fidelity is equated with faithfulness. Nonmaleficence is the duty to "do no harm." Veracity refers to telling the truth.

Tuesday, 30 June 2020

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

Reason: 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.

Monday, 29 June 2020

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

Reason: 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.

Saturday, 27 June 2020

Q. A primiparous client at 4 hours after a vaginal delivery and manual removal of the placenta voids for the first time. The nurse palpates the fundus, noting it to be 1 cm above the umbilicus, slightly firm, and deviated to the left side, and notes a moderate amount of lochia rubra. The nurse notifies the physician based on the interpretation that the assessment indicates which of the following?

A. Perineal lacerations.
B. Retained placental fragments.
C. Cervical lacerations.
D. Urine retention.

Correct Answer: B

Reason: At 4 hours postpartum, the fundus should be midline and at the level of the umbilicus. Whenever the placenta is manually removed after delivery, there is a possibility that all of the placenta has not been removed. Sometimes small pieces of the placenta are retained, a common cause of late postpartum hemorrhage. The client is exhibiting signs and symptoms associated with retained placental fragments. The client will continue to bleed until the fragments are expelled. Perineal and cervical lacerations are characterized by bright red bleeding and a firmly contracted fundus at the level that is expected. Urine retention is characterized by a full bladder, which can be observed by a bulge or fullness just above the symphysis pubis. Also, the client's fundus would be deviated to one side and boggy to the touch.

Friday, 26 June 2020

Q. Which finding indicates placental detachment?

A. An abrupt lengthening of the cord
B. A decrease in the number of contractions
C. Relaxation of the uterus
D. Decreased vaginal bleeding




Correct Answer: A

Reason: An abrupt lengthening of the cord, an increase (not a decrease) in the number of contractions, and an increase (not a decrease) in vaginal bleeding are all indications that the placenta has detached from the wall of the uterus. Relaxation of the uterus isn't an indication for detachment of the placenta. 

Thursday, 25 June 2020

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

Reason: 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.

Wednesday, 24 June 2020

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

Reason: 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.

Monday, 22 June 2020

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

Reason: 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.

Saturday, 20 June 2020

Question Of The Day, Foundations of Psychiatric Nursing
Q. A client in an acute care setting tells the nurse, "I don't think I can face going home tomorrow." The nurse replies, "Do you want to talk more about it?" The nurse is using which technique?

A. Presenting reality
B. Making observations
C. Restating
D. Exploring


Correct Answer: D

Reason: The nurse is using the technique of exploring because she's willing to delve further into the client's concern. She isn't presenting reality or making observations or simply restating. The nurse is encouraging the client to explore his feelings.

Friday, 19 June 2020

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

Reason: 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.

Thursday, 18 June 2020

Question Of The Day, School-age Child
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

Reason: 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.

Tuesday, 16 June 2020

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

Reason: 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.

Monday, 15 June 2020

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

Reason: 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.

Saturday, 13 June 2020

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

Reason: 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, 12 June 2020

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

Reason: 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.

Thursday, 11 June 2020

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

Reason: 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.

Wednesday, 10 June 2020

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

Reason: 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.

Tuesday, 9 June 2020

Question Of The Day, Genitourinary Disorders
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

Reason: 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.

Monday, 8 June 2020

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

Reason: 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.

Friday, 5 June 2020

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

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

Thursday, 4 June 2020

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

Reason: 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.

Wednesday, 3 June 2020

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

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



Correct Answer: D

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

Tuesday, 2 June 2020

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

Reason: 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.

Monday, 1 June 2020

Question Of The Day, Oncologic Disorders
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

Reason: 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.

Saturday, 30 May 2020

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

Reason: 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.

Friday, 29 May 2020

Question Of The Day, Postpartum Period
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

Reason: 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.

Thursday, 28 May 2020

Nurse Practitioners, Nursing Responsibilities, Nursing Job, Nursing Career

Nurse Practitioners have consistently been ranked as one of the top 5 best occupations in the United States, thanks to its high marks in categories such as work-life balance, low-stress levels, and salary.

And the streak for Nurse Practitioners (NPs) as a top 5 job has continued, ranking in at #5 out of all occupations in the U.S. News and World Report Best 100 Jobs Rankings for 2020. Nurse Practitioners also nabbed an impressive spot at #4 out of all healthcare jobs, and #5 in STEM jobs.

How Jobs Are Ranked 


In order to compile its jobs rankings, U.S. News and World Report reviewed the following categories of data for various industries and occupations, weighted in importance by their corresponding percentage:

◉ Median Salary
◉ Employment Rate
◉ 10-Year Growth Volume
◉ 10-Year Growth Percentage
◉ Job Prospects
◉ Stress Level
◉ Work-Life Balance

For nurse practitioners, upward mobility – or the ability to advance in terms of responsibility and salary – was categorized as average, the stress level was measured as below average, and flexibility ranked lower than average.

The lower-than-average flexibility is an interesting distinction and may be due to the hours that NPs typically keep in their positions. For instance, many NPs work in a hospital or office setting with set hours that don’t offer a lot of flexibility. However, NPs still report a high work-life balance and the lower-stress levels can help offset any limited flexibility.

NP Salary and Prospects


Why exactly do NPs rank so highly--and consistently--through the years? As the U.S. News and World Report highlights, NPs make a median salary of $107,030. The highest quarter of NPs made even more than that, at $125,440 per year, while even the lowest-paid NPs made over $90,760.

Combined with a low unemployment rate of only 1.2% and high projected growth, the stability and high salary of a NP position is a definite draw to make this a highly-ranked job. Some of the other high rankings for NPs include:

◉ Low-stress level. NPs have a below-average stress level ranking for on-the-job stress.
◉ Advancement opportunity. Opportunities for advancement and growth come in at average but are still available for NPs who wish to climb higher in their careers.

Out of all of the possible rankings, the role of NP received a 7.6 out of 10. And all in all, healthcare roles dominated the reports best jobs, with Physician Assistants taking the #3 spot in overall 100 Best Jobs, Physicians taking #7, and Registered Nurses coming in at #13.

Nurse Anesthetists and Nurse-Midwives


Certified Registered Nurse Anesthetists (CRNAs) and Certified Nurse Midwives (CNMs) are closely related to NPs in terms of education. Both roles require a Master’s in Nursing and are an Advanced Practice Registered Nursing (APRN) role.

And although they are similar to NPs in terms of education, there are wide variances in the salary earnings and job duties among NPs, CRNAs, and CNMs. For instance, CRNAs are generally the highest-paid APRNs in the United States – the median salary comes in at $167,950, with an unemployment rate that is literally non-existent (no danger of losing your job as a CRNA!).

CRNAs ranked in as #21 in all best jobs, #15 in healthcare jobs, and #11 in the category of best-paying jobs.

Meanwhile, nurse midwives ranked in at #23 in best healthcare jobs and #82 out of all 100 best jobs, with a mean salary of $103,770. They don’t have a lot of job flexibility, but the opportunity for growth is considered to be strong, and they rank as a below-average stress level on the job.

From these numbers, we can see that nurse practitioners generally earn slightly more than their CNM colleagues, but CRNAs hold a large advantage in terms of earning power. Having said that, Nurse Anesthetists’ training is more intensive, and they are required to complete significantly more clinical hours in order to achieve licensure to practice.

Primary Care: Enter the Nurse Practitioner


According to the American Academy of Family Physicians (AAFP), a “significant physician shortage” is projected to grip the U.S. by 2025. While the growth of the primary care physician workforce is earnestly called for by the AAFP, it is anecdotally difficult to recruit medical students into practicing primary care since medical specialties are so much more lucrative for new doctors who carry enormous educational debt and costly professional liability.

While some physician groups continue to push back regarding nurse practitioners’ increasing ability to practice autonomous primary care, there is growing evidence of the value of NPs in healthcare. For example, the American Association of Nurse Practitioners (AANP) states that research has proven that:

◉ NPs provide care that is safe, effective, patient-centered, timely, efficient, equitable, and evidenced-based.
◉ NP care is comparable to physician-provided care.
◉ Patients under the care of NPs have higher patient satisfaction, fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations and fewer unnecessary emergency room visits than patients under physician-directed care

The Future of Nurse Practitioners


Many people have encountered a Nurse Practitioner in the course of receiving healthcare. NPs abound in ambulatory surgical centers, physician group practices, community health centers, urgent care centers, and other clinical milieus. NPs are also found in various hospital-based roles--patients are increasingly likely to receive acute care from hospitalist nurse practitioners with specific training and qualifications.

With NPs ranking as the #5 job in the United States in 2020, more nurses will begin pursuing the achievable goal of a career as a nurse practitioner. And as more RNs go onto become NPs, everyone--insurance companies, hospitals, consumers, nurses, and patients alike– will be able to see the benefits. With high marks all around pursuing education and training as a Nurse Practitioner or other type of APRN is a solid career move for those interested in providing health care to a wide variety of patients across the lifespan.

As an NP, not only will you be able to work as a healthcare provider, but you will also be able to enjoy the benefits of a highly-ranked job, such as higher-than-average salary, positive work-life balance and low-stress levels.

From pregnant moms and newborns to the aged and the dying, nurse practitioners and advanced practice nurses provide necessary healthcare to those in need. And with NP’s autonomy of practice growing in both depth and breadth, opportunities are consistently expanding for the enterprising and savvy Nurse Practitioner.

Source: nurse.org
Question Of The Day, Intrapartum Period
Q. Which nursing action is required before a client in labor receives epidural anesthesia?

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




Correct Answer: A

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

Wednesday, 27 May 2020

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

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




Correct Answer: B

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

Tuesday, 26 May 2020

Question Of The Day, Substance Abuse, Eating Disorders, Impulse Control Disorders
Q. Which of the following is a priority during the first 24 hours of hospitalization for a comatose client with suspected drug overdose?

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



Correct Answer: C

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

Monday, 25 May 2020

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

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

Correct Answer: D

Reason: 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.

Sunday, 24 May 2020

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

Reason: 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.

Friday, 22 May 2020

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

Reason: 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.

Thursday, 21 May 2020

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

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

Wednesday, 20 May 2020

Question Of The Day: School-age Child
Q. A 10-year-old with glomerulonephritis reports a headache and blurred vision. The nurse should immediately:

A. Put the client to bed.
B. Obtain the child's blood pressure.
C. Notify the physician.
D. Administer acetaminophen (Tylenol).



Correct Answer: B

Reason: Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the physician before confirming the cause of the symptoms would not assist the physician in his treatment. Putting the client to bed may help treat an elevated blood pressure, but first the nurse must establish that high blood pressure is the cause of the symptoms. Administering Tylenol for high blood pressure is not recommended.

Tuesday, 19 May 2020

Q. After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease?

A. "We try to keep him happy at all costs; otherwise, he has an asthma attack."
B. "We keep our child away from other children to help cut down on infections."
C. "Although our child's disease is serious, we try not to let it be the focus of our family."
D. "I'm afraid that when my child gets older, he won't be able to care for himself like I do."

Correct Answer: C

Reason: Positive adjustment to a chronic condition requires placing the child's illness in its proper perspective. Children with asthma need to be treated as normally as possible within the scope of the limitations imposed by the illness. They also need to learn how to manage exacerbations and then resume as normal a life as possible. Trying to keep the child happy at all costs is inappropriate and can lead to the child's never learning how to accept responsibility for behavior and get along with others. Although minimizing the child's risk for exposure to infections is important, the child needs to be with his or her peers to ensure appropriate growth and development. Children with a chronic illness need to be involved in their care so that they can learn to manage it. Some parents tend to overprotect their child with a chronic illness. This overprotectiveness may cause a child to have an exaggerated feeling of importance or later, as an adolescent, to rebel against the overprotectiveness and the parents.

Monday, 18 May 2020

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

Reason: 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.

Sunday, 17 May 2020

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

Reason: 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.

Saturday, 16 May 2020

Question Of The Day, The Nursing Process
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

Reason: 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.

Friday, 15 May 2020

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

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

Thursday, 14 May 2020

COVID-19, Nursing Responsibilities, Nursing Career, Nursing Degree US

As colleges and universities across the nation have shuttered in-person education, training for future nursing professionals has shifted considerably. Some schools have elected to extend semesters, meaning students who were due to graduate this spring have been forced to wait another semester.

At Ohio University, however, the College of Health Sciences and Professions took a different approach: they have advanced their 153 senior nursing students to early graduation in an effort to help against the fight of COVID-19.

Why Early Graduation? 


Dr. Randy Leite, Dean of the Ohio University College of Health Sciences and Professions (CHSP), tells Nurse.org that as a university, they believe that one of the most valuable contributions they can provide is equipping the workforce with trained public health professionals, which is exactly what they have done.

“Right now, we are facing a public health crisis of unprecedented proportions–one in which days or weeks can make a critical difference in terms of response,” Dr. Leite explains. “Allowing our new graduates to enter the workforce early provides valuable, and vital, medical resources during this critical time.”

According to Dr. Leitie, although Southeast Ohio, where the university is located, has experienced relatively low cases of COVID-19, many of the graduating seniors plan on working in hospitals across Ohio, where higher numbers of COVID have been reported, so their presence is a vital resource.

How They Made It Happen


Dr. Deborah Henderson, Director of the School of Nursing within the College of Health Sciences and Professions, explains that the school worked with the Ohio Board of Nursing to determine if their graduates were ready to graduate early.

She notes that they were able to modify their clinical experiences, as well as utilize remote clinical learning and simulations in order to complete all the board requirements for their coursework. In addition to shifting educational requirements, the school also worked under the Ohio Board of Nursing’s guidance that allows for nursing graduates to apply for a temporary nursing license that will allow the seniors to actually begin practicing as licensed nurses before taking the NCLEX.

And although she adds that CHSP believes that a graduate’s strongest opportunity for successful licensure is shortly after graduation, many testing sites have been closed, so students simply have not had the option for testing as usual. The temporary nursing license helps fill that gap for now.

“We commend the Ohio Board of Nursing for establishing a temporary nursing license that will allow graduates to enter the workforce more quickly in order to supplement the ranks of nurses during a period in which our state and nation anticipate a surge in hospitalized patients,” says Dr. Henderson.

According to Dr. Henderson, when the graduates do take their NCLEX, they may encounter a slightly modified exam, with fewer questions and time to take the test. However, all candidates for licensure must still demonstrate the same knowledge, skills, attitudes and clinical reasoning that have always been required.

How The Early Grads Feel About The Decision


Caleb Moore, 22, from Cleveland, one of the members of the 2020 Ohio University’s graduating class of senior nursing students, says he believes that the school made the right decision in giving the students the opportunity to graduate early.

COVID-19, Nursing Responsibilities, Nursing Career, Nursing Degree US

“Nobody is being forced into the workforce due to graduating early, so if you feel like you want to take more time before heading to the bedside, by all means, take that time,” he points out. “The new nurses who want to enter the workforce will help to ease the staffing burden and make the healthcare system more resilient.”

Moore, who tells Nurse.org that he first became “hooked” on nursing as a career after watching a flight helicopter land while visiting a friend at a hospital, says he is grateful to the pivots that the school made to tailor their education in their last semester. Along with the move towards online education, he explains that they shifted their content to be more specific to COVID-related care, such as more emphasis on disease transmission, PPE use, ventilator function, and other critical care-focused areas.

Recognizing that the influx of new nurses entering the workforce in the wake of a global pandemic will forever influence how they carry out their nursing care, Moore says he believes he and his fellow COVID-prepared nurses will play a role in changing the future of the nursing profession.

“We will have a big part in shaping this landscape and influencing the policies that will guide our practice for the future, and I think it’s going to be interesting to see the changes that will happen because of this,” he says.

And with a position at the Cleveland Clinic Heart Failure ICU already lined up, Moore is ready to tackle the challenges ahead of him.

“I think the biggest thing that we all realized is that we needed to stay confident in the education that we had received and be strong advocates for ourselves and for our patients in order to keep our patients and ourselves safe,” he says. “This is definitely a challenging time, but it’s nothing that we can’t handle.”

Source: nurse.org
Q. A client is scheduled for an excretory urography at 10 a.m. An order directs the nurse to insert a saline lock I.V. device at 9:30 a.m.. The client requests a local anesthetic for the I.V. procedure and the physician orders lidocaine-prilocaine cream (EMLA cream). The nurse should apply the cream at:

A. 7:30 a.m.
B. 8:30 a.m.
C. 9 a.m.
D. 9:30 a.m.

Correct Answer: A

Reason: It takes up to 2 hours for lidocaine-prilocaine cream (EMLA cream) to anesthetize an insertion site. Therefore, if the insertion is scheduled for 9:30 a.m., EMLA cream should be applied at 7:30 a.m. The local anesthetic wouldn't be effective if the nurse administered it at the later times.

Wednesday, 13 May 2020

Question Of The Day, Basic Psychosocial Needs
Q. A worried mother confides in the nurse that she wants to change physicians because her infant is not getting better. The best response by the nurse is which of the following?

A. "This doctor has been on our staff for 20 years."
B. "I know you are worried, but the doctor has an excellent reputation."
C. "You always have an option to change. Tell me about your concerns."
D. "I take my own children to this doctor."

Correct Answer: C

Reason: Asking the mother to talk about her concerns acknowledges the mother's rights and encourages open discussion. The other responses negate the parent's concerns.

Tuesday, 12 May 2020

Question Of The Day, Basic Physical Care
Q. A nurse takes informed consent from a client scheduled for abdominal surgery. Which of the following is the most appropriate principle behind informed consent?

A. Protects the client's right to self-determination in health care decision making.
B. Helps the client refuse treatment that he or she does not wish to undergo.
C. Helps the client to make a living will regarding future health care required.
D. Provides the client with in-depth knowledge about the treatment options available.

Correct Answer: A

Reason: Informed consent protects the client's right to self-determination in health care decision making. Informed consent helps the client to refuse a treatment that the client does not wish to undergo and helps the client to gain in-depth knowledge about the treatment options available, but the most important function is to encourage shared decision making. Informed consent does not help the client to make a living will.

Monday, 11 May 2020

Q. A client who has a history of Crohn's disease is admitted to the hospital with fever, diarrhea, cramping, abdominal pain, and weight loss. The nurse should monitor the client for:

A. Hyperalbuminemia.
B. Thrombocytopenia.
C. Hypokalemia.
D. Hypercalcemia.



Correct Answer: C

Reason: Hypokalemia is the most expected laboratory finding owing to the diarrhea. Hypoalbuminemia can also occur in Crohn's disease; however, the client's potassium level is of greater importance at this time because a low potassium level can cause cardiac arrest. Anemia is an expected development, but thrombocytopenia is not. Calcium levels are not affected.

Sunday, 10 May 2020

Q. When developing a care plan for a client with a do-not-resuscitate (DNR) order, a nurse should:

A. withhold food and fluids.
B. discontinue pain medications.
C. ensure access to spiritual care providers upon the client's request.
D. always make the DNR client the last in prioritization of clients.


Correct Answer: C

Reason: Ensuring access to spiritual care, if requested by the client, is an appropriate nursing action. A nurse should continue to administer appropriate doses of pain medication as needed to promote the client's comfort. A health care provider may not withhold food and fluids unless the client has a living will that specifies this action. A DNR order does not mean that the client does not require nursing care.

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