Wednesday, 1 April 2020

Q. A client diagnosed with pain disorder is talking with the nurse about fishing when he suddenly reverts to talking about the pain in his arm. Which of the following should the nurse do next?

A. Allow the client to talk about his pain.
B. Ask the client if he needs more pain medication.
C. Get up and leave the client.
D. Redirect the interaction back to fishing.

Correct Answer: D

Reason: The nurse should redirect the interaction back to fishing or another focus whenever the client begins to ruminate about physical symptoms or impairment. Doing so helps the client talk about topics that are more therapeutic and beneficial to recovery. Allowing the client to talk about his pain or asking if he needs additional pain medication is not therapeutic because it reinforces the client's need for the symptom. Getting up and leaving the client is not appropriate unless the nurse has set limits previously by saying, "I will get up and leave if you continue to talk about your pain."

Tuesday, 31 March 2020

Q. After staying several hours with her 9-year-old daughter who is admitted to the hospital with an asthma attack, the mother leaves to attend to her other children. The child exhibits continued signs and symptoms of respiratory distress. Which of the following findings should lead the nurse to believe the child is experiencing anxiety?

A. Not able to get comfortable.
B. Frequent requests for someone to stay in the room.
C. Inability to remember her exact address.
D. Verbalization of a feeling of tightness in her chest.

Correct Answer: B

Reason: A 9-year-old child should be able to tolerate being alone. Frequently asking for someone to be in the room indicates a degree of psychological distress that, at this age, suggests anxiety. The inability to get comfortable is more characteristic of a child in pain. Inability to answer questions correctly may reflect a state of anoxia or a lack of knowledge. Tightness in the chest occurs as a result of bronchial spasms.

Monday, 30 March 2020

Q. A client is scheduled for surgery under general anesthesia. The night before surgery, the client tells the nurse, "I can't wait to have breakfast tomorrow." Based on this statement, which nursing diagnosis should be the nurse's priority?

A. Deficient knowledge related to food restrictions associated with anesthesia
B. Fear related to surgery
C. Risk for impaired skin integrity related to upcoming surgery
D. Ineffective coping related to the stress of surgery

Correct Answer: A

Reason: The client's statement reveals a Deficient knowledge related to food restrictions associated with general anesthesia. Fear related to surgery, Risk for impaired skin integrity related to upcoming surgery, and Ineffective coping related to the stress of surgery may be applicable nursing diagnoses but they aren't related to the client's statement.

Saturday, 28 March 2020

Nursing Responsibilities, Nursing Job, Nursing Career, Nursing Degree, Nursing Professionals, Nursing Skill

As our previous way of life has shuttered to an unexpected stop and everyone is hunkering down at home in an attempt to stop the spread of COVID-19 (well, aside from the spring breakers whose beach beers were obviously more important), now is a great opportunity to consider if a career in nursing might be right for you.

If you have ever thought about a career in healthcare, or have felt a call to action in the time of seeing so many suffer, here are a few reasons why now might be the time for you to pursue a future in nursing.

1. You Can Make a True Difference in the World

Have you been stuck at home, wishing you could be one of the heroes in this fight to save lives? Have you wished that your efforts to help people extended farther than just your own couch? Now is your time to make an impact not only in the lives of others, but in the entire world by becoming a nurse.

2. The Nursing Shortage is Increasing by the Minute

There was already a predicted shortage of nurses, but this pandemic will only increase that need. Some nurses, as The New York Times reported, have already been quitting on-the-spot under the pressure of dire conditions in hard-hit infected areas.

The American Association of Colleges of Nursing has predicted that there will be a need for 203,700 new RNs each year through 2026, and those numbers will be much higher in the aftermath of this pandemic.

3. There Will be Increased Pay Opportunities

Especially if you can enter the nursing field rather quickly, such as if you are near graduating from nursing school, have an RN license but haven’t been working lately, or can take an accelerated nursing program, (if you have a Bachelor’s degree in another field, for instance, you can get a nursing degree as quickly as one year), there will be increased opportunity for higher wages. Many high-need areas are offering sign-on bonuses, for instance, along with OT opportunities.

And if you have the ability to do so, staffing nursing agencies are at an all-time high, offering crisis pay, along with sign-on bonuses, quarantine pay, and more stipends for emergency areas. Some staffing nurse agencies allow you to start work as a travel RN right away, and some may even waive minimum requirements for crisis areas if you have recently graduated and don’t have a lot of experience yet.

4. You Will Always Have Stable Income as a Nurse

No one quite knows what the aftermath of COVID-19 will be on the economy, but if there’s one job that’s completely recession-proof, it’s nursing. I graduated from nursing school myself in 2008--remember that little time of the worst recession in America since the Great Depression?--and started a nursing job right out of school.

Nursing, and really any position in healthcare, will always be in high demand, and entering a program now can ensure that you will be ready to hit the ground running when the need for nurses is at its peak.

5. More Government Aid for Healthcare Training 

Many COVID-19 bills and incentive programs are in the process of being drafted and finalized, so while the exact details aren’t fully known yet, you can expect an increase in the number of government-aided training programs to help train new healthcare workers. For example, as many people have been laid off or lost their jobs as a result of COVID-19 closures, the federal government will be rolling programs to train them in growing industries--with healthcare as a priority.

These programs will include everything from nursing to entry-level certificate programs like CNA and allied health professions. As a result, there will be plenty of opportunities to get involved in healthcare, even if financial constraints have been an issue for you in the past.

6. Waived Requirements for Nursing School Admission

Some schools are waiving certain requirements for entrance into nursing programs for upcoming start times, meaning that there may be increased access for nursing programs across the country. For instance, Concordia University in Texas is waiving Test of Essential Academic Skills requirements for nursing school students who will be applying for summer and fall program start times.

With many standardized testing centers that provide exams such as the ACT and SAT shut down, colleges and universities are having to quickly scramble to assess entry requirements--which could mean more opportunities to be admitted into a nursing program near you.

7. The Future of Nursing Could Include More Telehealth Nursing opportunities

Hopefully, the aftermath of COVID-19 is that the healthcare system in the U.S. gets a major overhaul, starting with ensuring we have the supplies we need to protect and equip our healthcare professionals. But some health experts are also predicting that this pandemic could also be a catalyst for increased telehealth services in the future -- including funding the technology to make it possible, training healthcare staff on how to use it, and increasing consumer confidence and ability to use it.

If you are interested in healthcare but are also intrigued by the idea of patient care from a telehealth perspective, this would be an excellent time to get in on the ground level. Most telehealth positions will need nurses with experience in direct patient care as well, so it would be a good idea to make sure you are in the process of starting now, while the field is still relatively new.

Take the First Steps in Your Nursing Journey

Anytime is a good time to join the incredible people that make up the nursing workforce, but now, in a world that will forever be changed by COVID-19, it’s become clear, more than ever, how important nurses are to the future.

Wherever you are in your career, we have a guide to help you get started in nursing.

Question Of The Day, Basic Physical Care
Q. A client with burns on his groin has developed blisters. As the client is bathing, a few blisters break. The best action for the nurse to take is to:

A. remove the raised skin because the blister has already broken.
B. wash the area with soap and water to disinfect it.
C. apply a weakened alcohol solution to clean the area.
D. clean the area with normal saline solution and cover it with a protective dressing.

Correct Answer: D

Reason: The nurse should clean the area with a mild solution such as normal saline, and then cover it with a protective dressing. Soap and water and alcohol are too harsh. The body's first line of defense broke when the blisters opened; removing the skin exposes a larger area to the risk of infection.

Thursday, 26 March 2020

Question Of The Day, Neurosensory Disorders
Q. Which of the following is an early symptom of glaucoma?

A. Hazy vision.
B. Loss of central vision.
C. Blurred or "sooty" vision.
D. Impaired peripheral vision.

Correct Answer: D

Reason: In glaucoma, peripheral vision is impaired long before central vision is impaired. Hazy, blurred, or distorted vision is consistent with a diagnosis of cataracts. Loss of central vision is consistent with senile macular degeneration but it occurs late in glaucoma. Blurred or "sooty" vision is consistent with a diagnosis of detached retina.
COVID-19, Nursing Responsibilities, Nursing Job, Nursing Career, Nursing Degree US, Nursing Exam US

During a time that may feel out-of-control for many nurses, it’s important to take control of our mental health and try our best to focus on self-care when away from work. You owe it to yourself to intentionally control how you spend time away from work and where you place your thoughts in-between shifts.

After returning home from work, most nurses must quarantine themselves, giving them few outlets to deal with the heavy mental load required of them in the workplace.

"I'm scared.  For myself, husband, family, my coworkers. I just take it day by day. I can't do anything else but that. My husband is great, he's funny, makes me laugh. But I know in the coming weeks it will be crazier and I'm scared,” said Lein, a registered nurse in Los Angeles. 

It is definitely not a reassuring time for nurses. And, many of us might feel as if a tsunami of COVID-19 patients could overwhelm us at any moment. Here are eight ways to manage feelings of anxiety and overwhelm as we tackle the COVID-19 pandemic.   

1. Take a break from COVID-19 by not watching the news or social media

Consider taking a mental break from COVID-19 information overload. Even during non-pandemic times, evidence shows the news and social media outlets can make people sadder and more anxious, than if they didn't watch it at all. Consider finding one or two expert sources for your medical news, instead of mass consuming from several sources, which may or may not be accurate.    

2. Video chat with friends and family

While much of the world is hunkering down at home, many nurses are forced to deal with fear and anxiety surrounding COVID-19 alone. This leaves our frontline workers vulnerable to depression and anxiety with few outlets for social communication.

"I feel very isolated and alone being a travel nurse hundreds of miles away from family and friends." - Brittney, RN, Chicago, Il. 

Here are some way to video chat, 

Zoom can help with that. Try setting up a lunch or dinner date with friends a few times a week to stay socially connected with the outside world.

Facebook messenger has video chatting capabilities.

Facetime on the iPhone is also a great way to video chat.

Studies show that face-to-face contact is more effective at preventing depression and anxiety than using email or even talking on the phone. As many nurses are unable to meet others in person, connecting through Zoom is another option.

3. Get outdoors 

While many public areas are temporarily closed to the public, most hiking areas are not. It is possible to hike while keeping within the CDC guidelines of keeping at least 6 feet between yourself and others. If you can, bring someone you already live with along. 

A recent study analyzed the impact of a physical activity program on anxiety, depression, occupational stress and burnout syndrome of nursing professions. It found that after the intervention, participants reported improved perceptions of bodily pain and feeling of fatigue at work.  

Even though it might feel more natural to want to hide out at home and hibernate, getting entirely out of your element and being in nature may help nurses shake off some work pressure. 

4. Watch funny movies

Laughing is no joke when it comes to relieving anxiety and stress. In fact, laughing has many therapeutic benefits for those under extreme duress, including reducing depression, calming the nervous system, and producing oxytocin (aka the feel-good hormone).  

If you feel anxiety creeping up, stop it in its tracks by watching something so funny that you can't help but laugh.  

5. Try free online yoga & meditation

One study on yoga's effect among intensive care unit nurses analyzed the impact of yoga on ICU coping strategies over an 8-week period. The results showed that the nurses who participated in the yoga study had a major reduction in their perceived mental pressure, as well as improved mental focus.  

Since we can't physically go to a class, try these ideas from home: 

◉ YouTube - there are lots of free YouTube videos with Yoga classes and guided meditation.
◉ Calm - is a great, free meditation app with sessions lasting 3-5 minutes. It is available on the App Store or Google Play. 
◉ Insight Timer - the awesome thing about this app is that it offers customization based on the type of meditation you need - love/kindness, stress or mindfulness, for example. It is available on the App Store or Google Play. 

6. Eat nutritious, immune-boosting foods

Nurses are great instructors on how to eat a healthy diet, but sometimes taking our own advice during times of extreme stress can be challenging.  But what is right for patient-care, also goes for hard-working nurses, many of which are already suffering from severe burnout and exhaustion. 

Stress and immune function are interrelated.  Eating the right foods can help boost immunity, especially for nurses nerve-wracked about COVID-19.

Some of the best immune-boosting foods include, 

◉ Citrus fruits like, oranges, grapefruit, and lemons. 
◉ Leafy green vegetables like, broccoli, spinach, and kale.  
◉ Garlic
◉ Ginger
◉ Tumeric 
◉ Yogurt
◉ Zinc

7. Talk to a therapist or other healthcare staff who can understand you struggle

Often family and friends who do not work on the frontlines of healthcare, though they mean well, have a hard time empathizing with a nurse's experience in the workplace.  Talk with someone who understands the stresses that come with being a nurse.  It can help you put a voice to your fear and may help you be more open to exploring helpful ways to manage it. 

Can’t make it to a therapist’s office? That’s OK, many therapists offer video and phone sessions. There are also many mobile apps available that focus on therapy and mental health to work with your schedule. 

Here are a few online therapy apps that have great reviews, 

◉ Betterhelp
◉ Talkspace
◉ Breakthrough

8. Practice gratitude

A little gratitude can go a long way for our mental health. Try starting every day simply saying 3 things that you are grateful for. It can be as simple as feeling grateful for your warm bed, food in the pantry and a roof over your head. The more you practice gratitude, the more you’ll find things to be grateful for, even in challenging times. 

Here's an exercise you can do right now,

1. Take a deep breath in through your nose and out through your mouth.
2. Ask yourself, "what am I grateful for today?"
3. Say 3 things that you're grateful for - say it out loud. 
4. Smile

9. Ask for what you need

As nurses, we often try to be the superheroes - packing on the weight of the world. Yes, we are nurses but, we are also spouses, parents, bread-winners, and we play so many other roles in society. Here’s a warm reminder that it’s OK to ask for help. Our friends and family certainly mean well when they say, “let me know if you need anything.” Which, of course, we don’t. 

Here’s a tip, make a list of things that your loved one can help you with - and, ask for help. Here’s a list of things your friends and family can help with,

◉ Drop off pre-packaged meals
◉ Donate masks and PPE
◉ Stop by the store while you’re at work to pick up things you need
◉ Babysit your children
◉ Send words of encouragement and support 

10. Remind yourself, and others, that we will get through this

"I've seen so much negativity.  Even from myself," says Marcus Figueroa, RN from San Diego. "I want to think about the positives. I want to have a beer at the beach this summer, hopefully, without fear of getting close to people. In the meantime, have dance parties in the front room, drink that wine, paint, and play. And let's hope the experts get this under control soon."

Self-care for nurses is more important than ever.  Especially for nurses during the COVID-19 pandemic who have no choice but to focus on what is happening today, at this moment.


Wednesday, 25 March 2020

Question Of The Day, Gastrointestinal Disorders
Q. A client with a bleeding ulcer is vomiting bright red blood. The nurse should assess the client for which of the following indicators of early shock?

A. Tachycardia.
B. Dry, flushed skin.
C. Increased urine output.
D. Loss of consciousness.

Correct Answer: A

Reason: In early shock, the body attempts to meet its perfusion needs through tachycardia, vasoconstriction, and fluid conservation. The skin becomes cool and clammy. Urine output in early shock may be normal or slightly decreased. The client may experience increased restlessness and anxiety from hypoxia, but loss of consciousness is a late sign of shock.

Tuesday, 24 March 2020

Question Of The Day, The Neonate
Q. Nurses teach infant care and safety classes to assist parents in appropriately preparing to take their neonates home. Which statement about automobile restraints for infants is correct?

A. An infant should ride in a front-facing car seat until he weighs 20 lb (9.1 kg) and is 1 year old.
B. An infant should ride in a rear-facing car seat until he weighs 25 lb (11.3 kg) or is 1 year old.
C. An infant should ride in a front-facing car seat until he weighs 30 lb (13.6 kg) or is 2 years old.
D. An infant should ride in a rear-facing car seat until he weighs 20 lb and is 1 year old.

Correct Answer: D

Reason: Until the infant weighs 20 lb and is 1 year old, he should ride in a rear-facing car seat.

Monday, 23 March 2020

Question Of The Day, Postpartum Period
Q. The nurse is caring for several mother-baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains?

A. G 4, P 1 client who is breastfeeding her infant.
B. G 3, P 3 client who is breastfeeding her infant.
C. G 2, P 2 cesarean client who is bottle-feeding her infant.
D. G 3, P 3 client who is bottle-feeding her infant.

Correct Answer: B

Reason: The major reasons for afterbirth pains are breast-feeding, high parity, overdistended uterus during pregnancy, and a uterus filled with blood clots. Physiologically, afterbirth pains are caused by intermittent contraction and relaxation of the uterus. These contractions are stronger in multigravidas in order to maintain a contracted uterus. The release of oxytocin when breast-feeding also stimulates uterine contractions. There is no data to suggest any of these clients has had an overdistended uterus or currently has clots within the uterus. The G 3, P 3 client who is breast-feeding has the highest parity of the clients listed, which—in addition to breast-feeding—places her most at risk for afterbirth pains. The G 2, P 2 postcesarean client may have cramping but it should be less than the G 3, P 3 client. The G 3, P 3 client who is bottle-feeding would be at risk for afterbirth pains because she has delivered several children, but her choice to bottle-feed reduces her risk of pain.

Saturday, 21 March 2020

Question Of The Day, Psychotic Disorders
Q. A client with bipolar disorder, manic phase, just sat down to watch television in the lounge. As the nurse approaches the lounge area, the client states, "The sun is shining. Where is my son? I love Lucy. Let's play ball." The client is displaying:

A. Concreteness.
B. Flight of ideas.
C. Depersonalization.
D. Use of neologisms.

Correct Answer: B

Reason: The client is demonstrating flight of ideas, or the rapid, unconnected, and often illogical progression from one topic to another. Concreteness involves interpreting another person's words literally. Depersonalization refers to feelings of strangeness concerning the environment or the self. A neologism is a word made up by a client.

Friday, 20 March 2020

Q. A nurse is monitoring a client receiving tranylcypromine sulfate (Parnate). Which serious adverse reaction can occur with high dosages of this monoamine oxidase (MAO) inhibitor?

A. Hypotensive episodes
B. Hypertensive crisis
C. Muscle flaccidity
D. Hypoglycemia

Correct Answer: B

Reason: The most serious adverse reaction associated with high doses of MAO inhibitors is hypertensive crisis, which can lead to death. Although not a crisis, orthostatic hypotension is also common and may lead to syncope with high doses. Muscle spasticity (not flaccidity) is associated with MAO inhibitor therapy. Hypoglycemia isn't an adverse reaction of MAO inhibitors.

Thursday, 19 March 2020

Q. A client was talking with her husband by telephone, and then she began swearing at him. The nurse interrupts the call and offers to talk with the client. She says, "I can't talk about that bastard right now. I just need to destroy something." Which of the following should the nurse do next?

A. Tell her to write her feelings in her journal.
B. Urge her to talk with the nurse now.
C. Ask her to calm down or she will be restrained.
D. Offer her a phone book to "destroy" while staying with her.

Correct Answer: D

Reason: At this level of aggression, the client needs an appropriate physical outlet for the anger. She is beyond writing in a journal. Urging the client to talk to the nurse now or making threats, such as telling her that she will be restrained, is inappropriate and could lead to an escalation of her anger.

Wednesday, 18 March 2020

Question Of The Day, School-age Child
Q. A 7 year old with a history of tonic-clonic seizures has been actively seizing for 10 minutes. The child weighs 22 kg and currently has an intravenous (IV) line of D5 1/2 NS + 20 meq KCL/L running at 60 ml/hr. Vital signs are a temperature of 38 degrees C, heart rate of 120, respiratory rate of 28, and oxygen saturation of 92%. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for:

A. Rectal diazepam (Diastat).
B. IV lorazepam (Ativan).
C. Rectal acetaminophen (Tylenol).
D. IV fosphenytoin.

Correct Answer: B

Reason: IV ativan is the benzodiazepine of choice for treating prolonged seizure activity. IV benzodiazepines potentiate the action of the gamma-aminobutyric acid (GABA) neurotransmitter, stopping seizure activity. If an IV line is not available, rectal Diastat is the benzodiazepine of choice. The child does have a low-grade fever; however, this is likely caused by the excessive motor activity. The primary goal for the child is to stop the seizure in order to reduce neurologic damage. Benzodiazepines are used for the initial treatment of prolonged seizures. Once the seizure has ended, a loading dose of fosphenytoin or phenobarbital is given.

Tuesday, 17 March 2020

Question Of The Day, Infant
Q. A 10-month-old child with recurrent otitis media is brought to the clinic for evaluation. To help determine the cause of the child's condition, the nurse should ask the parents:

A. "Does water ever get into the baby's ears during shampooing?"
B. "Do you give the baby a bottle to take to bed?"
C. "Have you noticed a lot of wax in the baby's ears?"
D. "Can the baby combine two words when speaking?"

Correct Answer: B

Reason: In a young child, the eustachian tube is relatively short, wide, and horizontal, promoting drainage of secretions from the nasopharynx into the middle ear. Therefore, asking if the child takes a bottle to bed is appropriate because drinking while lying down may cause fluids to pool in the pharyngeal cavity, increasing the risk of otitis media. Asking if the parent noticed earwax, or cerumen, in the external ear canal is incorrect because wax doesn't promote the development of otitis media. During shampooing, water may become trapped in the external ear canal by large amounts of cerumen, possibly causing otitis external (external ear inflammation) as opposed to internal ear inflammation. Asking if the infant can combine two words is incorrect because a 10-month-old child isn't expected to do so.

Monday, 16 March 2020

Q. A client complains of severe abdominal pain. To elicit as much information as possible about the pain, the nurse should ask:

A. "Do you have the pain all the time?"
B. "Can you describe the pain?"
C. "Where does it hurt the most?"
D. "Is the pain stabbing like a knife?"

Correct Answer: B

Reason: Asking an open-ended question such as "Can you describe the pain?" encourages the client to describe any and all aspects of the pain in his own words. The other options are likely to elicit less information because they're more specific and would limit the client's response.

Saturday, 14 March 2020

Q. Which scenario complies with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations?

A. Two nurses in the cafeteria are discussing a client's condition.
B. The health care team is discussing a client's care during a formal care conference.
C. A nurse checks the computer for the laboratory results of a neighbor who has been admitted to another floor.
D. A nurse talks with her spouse about a client's condition.

Correct Answer: B

Reason: To provide interdisciplinary continuity of care, nurses must share relevant information during client care conferences. Nurses discussing information in the cafeteria may be overheard; this indiscretion violates HIPAA regulations. Looking up laboratory results for a neighbor is a HIPAA violation, as is discussing a client's condition with one's spouse.

Friday, 13 March 2020

Q. After surgery for an ileal conduit, the nurse should closely assess the client for the occurrence of which of the following complications related to pelvic surgery?

A. Peritonitis.
B. Thrombophlebitis.
C. Ascites.
D. Inguinal hernia.

Correct Answer: B

Reason: After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in intra-abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal incision.

Thursday, 12 March 2020

Q. A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis?

A. The client sees his physician for a check-up yearly.
B. The client has never traveled outside of the country.
C. The client had a liver transplant 2 years ago.
D. The client works in a health care insurance office.

Correct Answer: C

Reason: A history of immunocompromised status, such as that which occurs with liver transplantation, places the client at a higher risk for contracting tuberculosis. Other risk factors include inadequate health care, traveling to countries with high rates of tuberculosis (such as southeastern Asia, Africa, and Latin America), being a health care worker who performs procedures in which exposure to respiratory secretions is likely, and being institutionalized.

Wednesday, 11 March 2020

Question Of The Day, Neurosensory Disorders
Q. When obtaining the vital signs of a client with multiple traumatic injuries, a nurse detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings may reflect which complication?

A. Shock
B. Encephalitis
C. Increased intracranial pressure (ICP)
D. Status epilepticus

Correct Answer: C

Reason: When ICP increases, Cushing's triad may develop, which involves decreased heart and respiratory rates and increased systolic blood pressure. Shock typically causes tachycardia, tachypnea, and hypotension. In encephalitis, the temperature rises and the heart and respiratory rates may increase from the effects of fever on the metabolic rate. (If the client doesn't maintain adequate hydration, hypotension may occur.) Status epilepticus causes unceasing seizures, not changes in vital signs.

Monday, 9 March 2020

Q. A client with inflammatory bowel disease is receiving total parenteral nutrition (TPN). The basic component of the client's TPN solution is most likely to be:

A. An isotonic dextrose solution.
B. A hypertonic dextrose solution.
C. A hypotonic dextrose solution.
D. A colloidal dextrose solution.

Correct Answer: B

Reason: The TPN solution is usually a hypertonic dextrose solution. The greater the concentration of dextrose in solution, the greater the tonicity. Hypertonic dextrose solutions are used to meet the body's calorie demands in a volume of fluid that will not overload the cardiovascular system. An isotonic dextrose solution (e.g., 5% dextrose in water) or a hypotonic dextrose solution will not provide enough calories to meet metabolic needs. Colloids are plasma expanders and blood products and are not used in TPN.

Sunday, 8 March 2020

Question Of The Day, The Neonate
Q. While assessing a male neonate whose mother desires him to be circumcised, the nurse observes that the neonate's urinary meatus appears to be located on the ventral surface of the penis. The primary health care provider is notified because the nurse suspects which of the following?

A. Phimosis.
B. Hydrocele.
C. Epispadias.
D. Hypospadias.

Correct Answer: D

Reason: The condition in which the urinary meatus is located on the ventral surface of the penis, termed hypospadias, occurs in 1 of every 500 male infants. Circumcision is delayed until the condition is corrected surgically, usually between 6 and 12 months of age. Phimosis is an inability to retract the prepuce at an age when it should be retractable or by age 3 years. Phimosis may necessitate circumcision or surgical intervention. Hydrocele is a painless swelling of the scrotum that is common in neonates. It is not a contraindication for circumcision. Epispadias occurs when the urinary meatus is located on the dorsal surface of the penis. It is extremely rare and is commonly associated with bladder extrophy.

Saturday, 7 March 2020

Question Of The Day, Postpartum Period
Q. While assessing the fundus of a multiparous client on the first postpartum day, the nurse performs handwashing and dons clean gloves. Which of the following should the nurse do next?

A. Place the nondominant hand above the symphysis pubis and the dominant hand at the umbilicus.
B. Ask the client to assume a side-lying position with the knees flexed.
C. Perform massage vigorously at the level of the umbilicus if the fundus feels boggy.
D. Place the client on a bedpan in case the uterine palpation stimulates the client to void.

Correct Answer: A

Reason: The nurse should place the nondominant hand above the symphysis pubis and the dominant hand at the umbilicus to palpate the fundus. This prevents uterine inversion and trauma, which can be very painful to the client. The nurse should ask the client to assume a supine, not side-lying, position with the knees flexed. The fundus can be palpated in this position and the perineal pads can be evaluated for lochia amounts. The fundus should be massaged gently if the fundus feels boggy. Vigorous massaging may fatigue the uterus and cause it to become firm and then boggy again. The nurse should ask the client to void before fundal evaluation. A full bladder can cause discomfort to the client, the uterus to be deviated to one side, and postpartum hemorrhage.

Friday, 6 March 2020

Question Of The Day, Antepartum Period
Q. A multigravid client in labor at 38 weeks' gestation has been diagnosed with Rh sensitization and probable fetal hydrops and anemia. When the nurse observes the fetal heart rate pattern on the monitor, which of the following patterns is most likely?

A. Early deceleration pattern.
B. Sinusoidal pattern.
C. Variable deceleration pattern.
D. Late deceleration pattern.

Correct Answer: B

Reason: The fetal heart rate of a multipara diagnosed with Rh sensitization and probable fetal hydrops and anemia will most likely demonstrate a sinusoidal pattern that resembles a sine wave. It has been hypothesized that this pattern reflects an absence of autonomic nervous control over the fetal heart rate resulting from severe hypoxia. This client will most likely require a cesarean delivery to improve the fetal outcome. Early decelerations are associated with head compression; variable decelerations are associated with cord compression; and late decelerations are associated with poor placental perfusion.

Thursday, 5 March 2020

Question Of The Day, Psychotic Disorders
Q. The mother of a client with chronic undifferentiated schizophrenia calls the visiting nurse in the outpatient clinic to report that her daughter has not answered the phone in 10 days. "She was doing so well for months. I don't know what's wrong. I'm worried." Which of the following responses by the nurse is most appropriate?

A. "Maybe she's just mad at you. Did you have an argument?"
B. "She may have stopped taking her medications. I'll check on her."
C. "Don't worry about this. It happens sometimes."
D. "Go over to her apartment and see what's going on."

Correct Answer: B

Reason: Noncompliance with medications is common in the client with chronic undifferentiated schizophrenia. The nurse has the responsibility to assess this situation. Asking the mother if they've argued or if the client is mad at the mother or telling the mother to go over to the apartment and see what's going on places the blame and responsibility on the mother and therefore is inappropriate. Telling the mother not to worry ignores the seriousness of the client's symptoms.

Wednesday, 4 March 2020

Question Of The Day: Mood, Adjustment, and Dementia Disorders
Q. A 40-year-old executive who was unexpectedly laid off from work 2 days earlier complains of fatigue and an inability to cope. He admits drinking excessively over the previous 48 hours. This behavior is an example of:

A. alcoholism.
B. a manic episode.
C. situational crisis.
D. depression

Correct Answer: C

Reason: A situational crisis results from a specific event in the life of a person who is overwhelmed by the situation and reacts emotionally. Fatigue, insomnia, and inability to make decisions are common signs and symptoms. The situational crisis may precipitate behavior that causes a crisis (alcohol or drug abuse). There isn't enough information to label this client an alcoholic. A manic episode is characterized by euphoria and labile affect. Symptoms of depression are usually present for 2 or more weeks.
Nursing Degree, Nursing Degree US, Nursing Responsibilities, Nursing Career, Nursing Job

If you’re considering what subject to major in, it is also important to consider what NOT to major in. Forbes recently released its list of the 10 worst college majors to pursue; from philosophy to anthropology to religious studies, the majors that made the list had to yield the lowest pay with the most challenging job market. Guess what major wasn’t listed --- nursing! 

Going to school to obtain a degree is an investment, and when we put that much money and time into something, we want something to come of it. The return on investment for a nursing degree is likely second to none. What other job has the security and stability to outlast any economic turn or bubble burst as much as nursing has? What other career has employers knocking at your door months before you even graduate? Read on to find out why nursing has proven to be a solid career choice and one with a high ROI.

1. There are many ways to get a nursing degree

Whether it is through a trade school, an associate’s degree, or a bachelor’s degree at a 4-year university, there are multiple ways to become a nurse. If you already have a degree, there are many fast-track programs that can get you graduating with your nursing degree in less than a year. Whatever your situation is, there is a way to become a nurse that is unique to you, and that is also efficient and effective. 

2. There are always a plethora of jobs!

Struggling to find a job after graduation is not a common challenge for nurses. From hospitals to clinics to schools, nurses are notorious for being in high demand. The healthcare needs of our population are only growing and this is reflected in the number of jobs available for nurses. According to research on nursing supply and demand by Georgetown University, there will be a job surplus of 200,000 positions that will go unfilled. This shortage continues to make nursing more and more valuable. 

3. There is so much variety

From bedside nursing to outpatient clinics to case management to legal nursing, this profession is one of the most versatile careers you could embark on. Besides the expected places to find nurses, there are also unique positions that a nursing license can get you -- yacht nurse, Disney nurse, and even cannabis nurse, just to name a few. With a nursing degree, you should never underestimate where you can put your skills to work. You also have the potential to begin your own business. The skillset that is cultivated in a job like nursing, along with exposure to endless possibilities, creates inspiration for many future entrepreneurs.

4. Let's talk money, honey...

Salaries for nurses vary by state, however, the reported median annual wage for nurses is around $71,000. This does not reflect the potential for an increase in income with PRN and per diem positions, or travel nurse pay packages, which can be quite lucrative. You can also increase your earning power by advancing your practice -- nurse practitioners and certified nurse anesthetists reported median annual salaries around $107,000 and $175,000, respectively. Where there is a nursing degree, there is the ability to build a nice nest egg. 

5. It feels good to do something purposeful

No, nursing isn't always easy, and sometimes there are moments that are less than fabulous. But what makes this profession unique is the difference you make in people's lives. It's tangible, powerful, and important. And witnessing that impact first hand is rewarding in ways that only this sort of profession can be. Caring for a vulnerable population takes a certain heart, and can be an endless source of meaning and purpose.


Tuesday, 3 March 2020

Question Of The Day, Foundations of Psychiatric Nursing
Q. The family of an older adult wants their mother to have counseling for depression. During the initial nursing assessment, the client denies the need for counseling. Which of the following comments by the client supports the fact that the client may not need counseling?

A. "My doctor just put me on an antidepressant, and I'll be fine in a week or so."
B. "My daughter sent me here. She's mad because I don't have the energy to take care of my grandkids."
C. "Since I've gotten over the death of my husband, I've had more energy and been more active than before he died."
D. "My son got worried because I made this silly comment about wanting to be with my husband in heaven."

Correct Answer: C

Reason: Resolving grief and having increased energy and activity convey good mental health, indicating that counseling is not necessary at this time. Taking an antidepressant or having less energy and involvement with grandchildren reflects possible depression and the need for counseling. Wanting to be with her dead husband suggests possible suicidal ideation that warrants serious further assessment and counseling.

Monday, 2 March 2020

Question Of The Day, School-age Child
Q. Compared to the food requirements of preschoolers and adolescents, the food requirements of school-age children are not as great because these children have a lower:

A. Growth rate.
B. Metabolic rate.
C. Level of activity.
D. Hormonal secretion rate.

Correct Answer: A

Reason: Children ages 6 to 12 have a slower growth rate than do younger children and adolescents. As a result, their food requirements are comparatively less.

Sunday, 1 March 2020

Question Of The Day, Endocrine and Metabolic Disorders
Q. Which finding best indicates that a nursing assistant has an understanding of blood glucose meter use?

A. Verbalizing an understanding of blood glucose meter use
B. Documenting a normal blood glucose level
C. Providing documentation of previous certification
D. Demonstrating correct technique

Correct Answer: D

Reason: The best way to validate blood glucose meter use is to allow the nursing assistant to demonstrate correct technique. Verbalizing understanding doesn't demonstrate that the nursing assistant knows proper technique. Documenting a normal blood glucose level and having previous certification don't demonstrate blood glucose meter use.

Saturday, 29 February 2020

Question Of The Day, The Nursing Process
Q. During rounds, a nurse finds that a client with hemiplegia has fallen from the bed because the nursing assistant failed to raise the side rails after giving a back massage. The nurse assists the client to the bed and assesses for injury. As per agency policies, the nurse fills out an incident report. Which of the following activities should the nurse perform after finishing the incident report?

A. Attach a copy to the client's records.
B. Highlight the mistake in the client's records.
C. Include the time and date of the incident.
D. Mention the name of the nursing assistant in the client records.

Correct Answer: C

Reason: The nurse should include the date and time of the incident in the incident report, the events leading up to it, the client's response, and a full nursing assessment. To prevent legal issues, the nurse should not attach the copy of the incident report to the client's records. Also to prevent litigation, the mistake should not be highlighted in the client's records. As the client report is a legal document, it should not contain the name of the nursing assistant.

Friday, 28 February 2020

Question Of The Day, Medication and I.V. Administration
Q. The client is receiving an I.V. infusion of 5% dextrose in normal saline running at 125 ml/hour. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first:

A. Discontinue the infusion.
B. Apply a warm soak to the site.
C. Stop the flow of solution temporarily.
D. Irrigate the needle with normal saline.

Correct Answer: A

Reason: Signs of infiltration include slowing of the infusion and swelling, pain, hardness, pallor, and coolness of the skin at the site. If these signs occur, the I.V. line should be discontinued and restarted at another infusion site. The new anatomic site, time, and type of cannula used should be documented. The nurse may apply a warm soak to the site, but only after the I.V. line is discontinued. Parenteral administration of fluids should not be stopped intermittently. Stopping the flow does not treat the problem, nor does it address the client's needs for fluid replacement. Infiltrated I.V. sites should not be irrigated; doing so will only cause more swelling and pain.

Thursday, 27 February 2020

Question Of The Day, Basic Physical Care
Q. Communicating with parents and children about health care has become increasingly significant because:

A. Consumers of health care cannot keep up with rapid advances in science.
B. The influence of the media and specialization have increased the complexity of managing health.
C. Nurse educators have recognized the value of communication.
D. Clients are more demanding that their rights be respected.

Correct Answer: B

Reason: Today's health care network includes many specialized areas, such as respiratory therapy, medicine, laboratory, social services, and technical monitoring, to name a few. Due to expanded media coverage of health care issues, parents are more aware of health care issues but cannot understand all the ramifications of possible health care decisions. Because of this expanded media coverage, health care consumers are more aware of advances in the science of health care. Nurses have always recognized the value of communication and that all nurses are teachers. Clients are more aware of their rights through media exposure and information disseminated by health care facilities. However, respect for the client's rights should be the nurse's concern as well and communicating with parents and children should not be impacted by a client's knowledge or demand for those rights.

Wednesday, 26 February 2020

Question Of The Day, Genitourinary Disorders
Q. Which of the following laboratory findings is present in nephrotic syndrome?

A. Decreased total serum protein.
B. Hypercalcemia.
C. Hyperglycemia.
D. Decreased hematocrit.

Correct Answer: A

Reason: A decreased total serum protein occurs as extensive amounts of protein are excreted from the body through the urine. Clients may develop hypocalcemia. Hyperglycemia is not a finding related to nephrotic syndrome. A decreased hematocrit is not a finding related to nephrotic syndrome.

Tuesday, 25 February 2020

Q. A client with a tracheostomy tube coughs and dislodges the tracheostomy tube. The nurse's first action should be to:

A. Call for emergency assistance.
B. Attempt reinsertion of tracheostomy tube.
C. Position the client in semi-Fowler's position with the neck hyperextended.
D. Insert the obturator into the stoma to reestablish the airway.

Correct Answer: B

Reason: The nurse's first action should be to attempt to replace the tracheostomy tube immediately so that the client's airway is reestablished. Although the nurse may also call for assistance, there should be no delay before attempting reinsertion of the tube. The client is placed in a supine position with the neck hyperextended to facilitate reentry of the tube. The obturator is inserted into the replacement tracheostomy tube to guide insertion and is then removed to allow passage of air through the tube.

Monday, 24 February 2020

Q. A nurse on a rehabilitation unit is caring for a client who sustained a head injury in a motor vehicle accident. She notes that the client has become restless and agitated during therapy; previous documentation described the client as cooperative during therapy sessions. The nurse's priority action should be to:

A. gather assessment data and notify the physician of the change in the client's status.
B. ask the physician to order an antipsychotic medication for the client.
C. consult with the social worker about the possibility of discharging the client from the facility.
D. tell the client that she'll punish him if he doesn't behave.

Correct Answer: A

Reason: A client with a head injury who experiences a change in cognition requires further assessment and evaluation, and the nurse should notify the physician of the change in the client's status. The physician should rule out all possible medical causes of the change in mental status before ordering antipsychotic medications or considering discharging the client from the facility. A nurse shouldn't threaten a client with punishment; doing so is a violation of the client's rights.

Thursday, 20 February 2020

Question Of The Day, The Neonate
Q. Just after delivery, a nurse measures a neonate's axillary temperature at 94.1° F (34.5° C). What should the nurse do?

A. Rewarm the neonate gradually.
B. Rewarm the neonate rapidly.
C. Observe the neonate hourly.
D. Notify the physician when the neonate's temperature is normal.

Correct Answer: A

Reason: A neonate with a temperature of 94.1° F is experiencing cold stress. To correct cold stress while avoiding hyperthermia and its complications, the nurse should rewarm the neonate gradually, observing closely and checking vital signs every 15 to 30 minutes. Rapid rewarming may cause hyperthermia. Hourly observation isn't frequent enough because cold stress increases oxygen, calorie, and fat expenditure, putting the neonate at risk for anabolic metabolism and possibly metabolic acidosis. A neonate with cold stress requires intervention; the nurse should notify the physician of the problem as soon as it's identified.

Wednesday, 19 February 2020

Q. A client is experiencing an early postpartum hemorrhage. Which item in the client's care plan requires revision?

A. Inserting an indwelling urinary catheter
B. Fundal massage
C. Administration of oxytocics
D. Pad count

Correct Answer: D

Reason: By the time the client is hemorrhaging, a pad count is no longer appropriate. Inserting an indwelling urinary catheter eliminates the possibility that a full bladder may be contributing to the hemorrhage. Fundal massage is appropriate to ensure that the uterus is well contracted, and oxytocics may be ordered to promote sustained uterine contraction.

Tuesday, 18 February 2020

Question Of The Day, Antepartum Period
Q. A nurse is using Doppler ultrasound to assess a pregnant woman. When should the nurse expect to hear fetal heart tones?

A. 7 weeks' gestation
B. 11 weeks' gestation
C. 17 weeks' gestation
D. 21 weeks' gestation

Correct Answer: B

Reason: Using Doppler ultrasound, fetal heart tones may be heard as early as the 11th week of pregnancy. Using a stethoscope, fetal heart tones may be heard between 17 and 20 weeks' gestation.

Monday, 17 February 2020

Question Of The Day, Psychotic Disorders
Q. A client with a tentative diagnosis of psychosis is admitted to the psychiatric unit. A physician orders the phenothiazine thioridazine 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:

A. deeper sleep than CNS depressants.
B. greater sedation than CNS depressants.
C. a calming effect from which the client is easily aroused.
D. more prolonged sedative effects, making the client more difficult to arouse.

Correct Answer: C

Reason: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.

Saturday, 15 February 2020

Question Of The Day, Foundations of Psychiatric Nursing
Q. A client is irritable and hostile. He becomes agitated and verbally lashes out when his personal needs are not immediately met by the staff. When the client's request for a pass is refused by the primary care provider, he utters a stream of profanities. Which of the following statements best describes the client's behavior?

A. The client's anger is not intended personally.
B. The client's anger is a reliable sign of serious pathology.
C. The client's anger is an intended attack on the primary care provider's skills
D. The client's anger is a sign that his condition is improving.

Correct Answer: A

Reason: Staff members sometimes are the recipients of a client's angry behavior because they are safe targets and are available for attack. The display of anger is rarely intended to be personal. Such behavior is not necessarily a sign of serious pathology but must be weighed in conjunction with other behaviors. An angry outburst is not an attack on a primary care provider's skills. While not necessarily pathologic, the client's behavior isn't a sign that his condition is improving.

Friday, 14 February 2020

Question Of The Day, School-age Child
Q. On initial assessment of a 7-year-old child with rheumatic fever, which of the following would require contacting the primary care provider immediately?

A. Heart rate of 150 beats/minute.
B. Swollen and painful knee joints.
C. Twitching in the extremities.
D. Red rash on the trunk.

Correct Answer: A

Reason: A heart rate of 150 beats/minute is very high for a 7-year-old child and may indicate carditis. For this age group, the normal heart rate while awake is 70 to 110 beats/minute. Swollen and painful joints such as the knee are characteristic findings in the child with rheumatic fever and do not require immediate physician notification. Twitching in the extremities, known as chorea, is a characteristic finding in a child with rheumatic fever and does not require immediate physician notification. A red rash on the trunk typically indicates rheumatic fever and does not require immediate physician notification.

Thursday, 13 February 2020

Q. When performing a physical assessment on an 18-month-old child, which of the following would be best?

A. Have a parent hold the toddler.
B. Assess the ears and mouth first.
C. Carry out the assessment from head to toe.
D. Assess motor function by having the child run and walk.

Correct Answer: A

Reason: The best strategy for assessing a toddler is to have the parent hold the toddler. Doing so is comforting to the toddler. Assessment should begin with noninvasive assessments first while the child is quiet. Typically these include assessments of the cardiac and respiratory systems. The ears and throat are typically examined last. Using a head-to-toe approach is more appropriate for an older child. For a toddler, assessment should begin with noninvasive assessments first while the child is quiet. Having a toddler run and be active may make it difficult to settle the child down after the physical exertion. 

Tuesday, 11 February 2020

Question Of The Day, The Nursing Process
Q. A 57-year-old Hispanic woman with breast cancer who does not speak English is admitted for a lumpectomy. Her daughter, who speaks English, accompanies her. In order to obtain admission information from the client, what should the nurse do?

A. Ask the client's daughter to serve as an interpreter.
B. Ask one of the Hispanic nursing assistants to serve as an interpreter.
C. Use the limited Spanish she remembers from high school along with nonverbal communication.
D. Obtain a trained medical interpreter.

Correct Answer: D

Reason: A trained medical interpreter is required to ensure safety, accuracy of history data, and client confidentiality. The medical interpreter knows the client's rights and is familiar with the client's culture. Using the family member as interpreter violates the patient's confidentiality. Using the nursing assistant or limited Spanish and nonverbal communication do not ensure accuracy of interpretation and back-translation into English.

Monday, 10 February 2020

Question Of The Day, Medication and I.V. Administration
Q. Total parenteral nutrition (TPN) is prescribed for a client who has recently had a significant small and large bowel resection and is currently not taking anything by mouth. The nurse should:

A. Administer TPN through a nasogastric or gastrostomy tube.
B. Handle TPN using strict aseptic technique.
C. Auscultate for bowel sounds prior to administering TPN.
D. Designate a peripheral intravenous (IV) site for TPN administration.

Correct Answer: B

Reason: TPN is hypertonic, high-calorie, high-protein, intravenous (IV) fluid that should be provided to clients without functional gastrointestinal tract motility, to better meet their metabolic needs and to support optimal nutrition and healing. TPN is ordered once daily, based on the client's current electrolyte and fluid balance, and must be handled with strict aseptic technique (because of its high glucose content, it is a perfect medium for bacterial growth). Also, because of the high tonicity, TPN must be administered through a central venous access, not a peripheral IV line. There is no specific need to auscultate for bowel sounds to determine whether TPN can safely be administered. 



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