Friday, 25 September 2020

Q. A nurse is caring for a client who required chest tube insertion for a pneumothorax. To assess for pneumothorax resolution, the nurse can anticipate that the client will require:

A. monitoring of arterial oxygen saturation (SaO2).

B. arterial blood gas (ABG) studies.

C. chest auscultation.

D. a chest X-ray.

Correct Answer: D

Reason: Chest X-ray confirms diagnosis by revealing air or fluid in the pleural space. SaO2 values may initially decrease with a pneumothorax but typically return to normal within 24 hours. ABG studies may show hypoxemia, possibly with respiratory acidosis and hypercapnia but these are not necessarily related to a pneumothorax. Chest auscultation will determine overall lung status, but it's difficult to determine if the chest has reexpanded sufficiently.

Thursday, 24 September 2020


Q.
When caring for a client after a closed renal biopsy, the nurse should?

A. Maintain the client on strict bed rest in a supine position for 6 hours.

B. Insert an indwelling catheter to monitor urine output.

C. Apply a sandbag to the biopsy site to prevent bleeding.

D. Administer I.V. opioid medications to promote comfort.

Correct Answer: A

Reason: After a renal biopsy, the client is maintained on strict bed rest in a supine position for at least 6 hours to prevent bleeding. If no bleeding occurs, the client typically resumes general activity after 24 hours. Urine output is monitored, but an indwelling catheter is not typically inserted. A pressure dressing is applied over the site, but a sandbag is not necessary. Opioids to control pain would not be anticipated; local discomfort at the biopsy site can be controlled with analgesics.

Monday, 21 September 2020

Q. A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?

A. Hypoactive bowel sounds

B. Severe lower back pain

C. Sensory deficits in one arm

D. Weakness and atrophy of the arm muscles

Correct Answer: B

Reason: The most common finding in a client with a herniated lumbar disk is severe lower back pain, which radiates to the buttocks, legs, and feet — usually unilaterally. A herniated disk also may cause sensory and motor loss (such as footdrop) in the area innervated by the compressed spinal nerve root. During later stages, it may cause weakness and atrophy of leg muscles. The condition doesn't affect bowel sounds or the arms.

 

Friday, 18 September 2020

Q. The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend?

A. Carcinoembryonic antigen (CEA) test after age 50

B. Proctosigmoidoscopy after age 30

C. Annual digital examination after age 40

D. Barium enema after age 20

Correct Answer: C

Reason: The American Cancer Society recommends an annual digital examination after age 40 for the purpose of detecting colorectal cancer. The CEA test is performed on clients who have already been treated for colorectal cancer. It helps monitor a client's response to treatment as well as detect metastasis or recurrence. Proctosigmoidoscopy is recommended every 3 to 5 years for people older than age 50. Barium enema isn't a screening test.

Thursday, 17 September 2020

Q. A client with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She is complaining of dyspnea with exertion and being very tired. Her vital signs are 98, 80, 20, BP 116/72. She has + 2 pedal edema and clear breath sounds. As the nurse plans this client's care, which of the following is her cardiac classification according to the New York Heart Association Cardiac Disease classification?

A. Class I.

B. Class II.

C. Class III.

D. Class IV.

Correct Answer: B

Reason: According to the New York Heart Association Cardiac Disease classification, this client would fit under Class II because she is symptomatic with increased activity (dyspnea with exertion). The New York Heart Association Cardiac Disease Classification identifies Class II clients as having cardiac disease and a slight limitation in physical activity. When physical activity occurs, the client may experience angina, difficulty breathing, palpations, and fatigue. All of the client's other symptoms are within normal limits.

Wednesday, 16 September 2020

Q. A client's gestational diabetes is poorly controlled throughout her pregnancy. She goes into labor at 38 weeks and gives birth. Which priority intervention should be included in the care plan for the neonate during his first 24 hours?

A. Administer insulin subcutaneously.
B. Administer a bolus of glucose I.V.
C. Provide frequent early feedings with formula.
D. Avoid oral feedings.

Correct Answer: C

Reason: The neonate of a mother with gestational diabetes may be slightly hyperglycemic immediately after birth because of the high glucose levels that cross the placenta from mother to fetus. During pregnancy, the fetal pancreas secretes increased levels of insulin in response to this increased glucose amount that crosses the placenta from the mother. However, during the first 24 hours of life, this combination of high insulin production in the neonate coupled with the loss of maternal glucose can cause severe hypoglycemia. Frequent, early feedings with formula can prevent hypoglycemia. Insulin shouldn't be administered because the neonate of a mother with gestational diabetes is at risk for hypoglycemia. A bolus of glucose given I.V. may cause rebound hypoglycemia. If glucose is given I.V., it should be administered as a continuous infusion. Oral feedings shouldn't be avoided because early, frequent feedings can help avoid hypoglycemia.

Tuesday, 15 September 2020

Q. After being treated with heparin therapy for thrombophlebitis, a multiparous client who delivered 4 days ago is to be discharged on oral warfarin (Coumadin). After teaching the client about the medication and possible effects, which of the following client statements indicates successful teaching?

A. "I can take two aspirin if I get uterine cramps."
B. "Protamine sulfate should be available if I need it."
C. "I should use a soft toothbrush to brush my teeth."
D. "I can drink an occasional glass of wine if I desire."

Correct Answer: C

Reason: Successful teaching is demonstrated when the client says, "I should use a soft toothbrush to brush my teeth." Heparin therapy can cause the gums to bleed, so a soft toothbrush should be used to minimize this adverse effect. Use of aspirin and other nonsteroidal anti-inflammatory medications should be avoided because of the increased risk for possible hemorrhage. Protamine sulfate is the antidote for heparin therapy. Vitamin K is the antidote for warfarin excess. Alcohol can inhibit the metabolism of oral anticoagulants and should be avoided.

Monday, 14 September 2020

Q. A nurse is assessing a woman in labor. Her cervix is dilated 8 cm. Her contractions are occurring every 2 minutes. She's irritable and in considerable pain. What type of breathing should the nurse instruct the woman to use during the peak of a contraction?

A. Deep breathing
B. Shallow chest breathing
C. Deep, cleansing breaths
D. Chest panting

Correct Answer: B

Reason: Shallow chest breathing is used during the peak of a contraction during the transitional phase of labor. Deep breathing can cause a woman to hyperventilate and feel light-headed, with numbness or tingling in her fingers or toes. A deep, cleansing breath taken at the beginning and end of each breathing exercise can help prevent hyperventilation. Chest panting may be used to prevent a woman from pushing before the cervix is fully dilated. 

Saturday, 12 September 2020

Question Of The Day, Substance Abuse, Eating Disorders, Impulse Control Disorders
Q. A client with a history of polysubstance abuse is admitted to the facility. He complains of nausea and vomiting 24 hours after admission. The nurse who assesses the client notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through withdrawal from which substance?

A. Alcohol
B. Cannabis
C. Cocaine
D. Opioids

Correct Answer: D

Reason: Piloerection, pupillary dilation, and lacrimation are specific to opioid withdrawal. A client with alcohol withdrawal would show elevated vital signs. There is no real withdrawal from cannabis. Symptoms of cocaine withdrawal include depression, anxiety, and agitation.

Friday, 11 September 2020

Question Of The Day, Psychotic Disorders
Q. The nurse should assess the client who is taking risperidone (Risperdal) 1 mg, orally twice a day for:

A. Insomnia.
B. Headache.
C. Anxiety.
D. Orthostatic hypotension.



Correct Answer: D

Reason: Significant orthostatic hypotension is associated with risperidone (Risperdal) therapy. The nurse should monitor the client's blood pressure sitting and standing and teach the client interventions to manage this adverse effect to prevent risk of injury. Although insomnia, headache, and anxiety are possible adverse effects of risperidone therapy, they are of less immediate concern than orthostatic hypotension.

Thursday, 10 September 2020

Q. Which statement about somatoform pain disorder is accurate?

A. The pain is intentionally fabricated by the client to receive attention.
B. The pain is real to the client, even though the pain may not have an organic etiology.
C. The pain is less than would be expected as a result of the underlying disorder the client identifies.
D. The pain is what would be expected as a result of the underlying disorder the client identifies.

Correct Answer: B

Reason: In a somatoform pain disorder, the client has pain even though a thorough diagnostic workup reveals no organic cause for it. The nurse must recognize that the pain is real to the client. By refusing to believe that the client is in pain, the nurse impedes the development of a therapeutic trust-based relationship. While somatoform pain offers the client secondary gains, such as attention or avoidance of an unpleasant activity, the pain isn't intentionally fabricated by the client. Even if a pathologic cause of the pain can be identified, the pain is usually in excess of what the pathologic cause would normally be expected to produce.

Wednesday, 9 September 2020

Q. A nurse notices that a client with obsessive-compulsive disorder washes his hands for long periods each day. How should the nurse respond to this compulsive behavior?

A. By setting aside times during which the client can focus on the behavior
B. By urging the client to reduce the frequency of the behavior as rapidly as possible
C. By calling attention to or trying to prevent the behavior
D. By discouraging the client from verbalizing his anxieties

Correct Answer: A

Reason: The nurse should set aside times during which the client is free to focus on his compulsive behavior or obsessive thoughts. The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. She shouldn't call attention to the behavior or try to prevent it. Trying to prevent the behavior may frighten and hurt the client. The nurse should encourage the client to verbalize his anxieties to help distract attention from his compulsive behavior. 

Tuesday, 8 September 2020

Question Of The Day, Foundations of Psychiatric Nursing
Q. A 28-year-old client with an Axis I diagnosis of major depression and an Axis II diagnosis of dependent personality disorder has been living at home with very supportive parents. The client is thinking about independent living on the recommendation of the treatment team. The client states to the nurse, "I don't know if I can make it in an apartment without my parents." The nurse should respond by saying to the client:

A. "You're a 28-year-old adult now, not a child who needs to be cared for."
B. "Your parents won't be around forever. After all, they are getting older."
C. "Your parents need a break, and you need a break from them."
D. "Your parents have been supportive and will continue to be even if you live apart."

Correct Answer: D

Reason: Some characteristics of a client with a dependent personality are an inability to make daily decisions without advice and reassurance and the preoccupation with fear of being alone to care for oneself. The client needs others to be responsible for important areas of his life. The nurse should respond, "Your parents have been supportive of you and will continue to be supportive even if you live apart," to gently challenge the client's fears and suggest that they may be unwarranted. Stating, "You're a 28-year-old adult now, not a child who needs to be cared for," or "Your parents need a break, and you need a break from them," is reprimanding and would diminish the client's self-worth. Stating, "Your parents won't be around forever; after all they are getting older," may be true, but it is an insensitive response that may increase the client's anxiety.

Monday, 7 September 2020

Question Of The Day: School-age Child
Q. An 8-year-old child is suspected of having meningitis. Signs of meningitis include:

A. Cullen's sign.
B. Koplik's spots.
C. Kernig's sign.
D. Chvostek's sign.

Correct Answer: C


Reason: Signs and symptoms of meningitis include Kernig's sign, stiff neck, headache, and fever. To test for Kernig's sign, the client is in the supine position with knees flexed; a leg is then flexed at the hip so that the thigh is brought to a position perpendicular to the trunk. An attempt is then made to extend the knee. If meningeal irritation is present, the knee can't be extended and attempts to extend the knee result in pain. Cullen's sign is the bluish discoloration of the periumbilical skin caused by intraperitoneal hemorrhage. Koplik's spots are reddened areas with grayish blue centers that are found on the buccal mucosa of a client with measles. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. A calcium deficit is suggested if the facial muscles twitch.

Friday, 4 September 2020

Question Of The Day, The Nursing Process
Q. A group of nurses has established a focus group and pilot study to examine the potential application of personal data assistants (PDAs) in bedside care. This study is a tangible application of:

A. Nursing informatics.
B. Electronic medical records.
C. Telemedicine.
D. Computerized documentation

Correct Answer: A

Reason: Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. A specific application of nursing informatics is the use of PDAs in the clinical setting. The devices are less likely to be used to perform documentation or to constitute client records. Telemedicine involves the remote provision of care.

Thursday, 3 September 2020

Q. Twenty-four hours after a bone marrow aspiration, the nurse evaluates which of the following as an appropriate client outcome?

A. The client maintains bed rest.
B. There is redness and swelling at the aspiration site.
C. The client requests morphine sulfate for pain.
D. There is no bleeding at the aspiration site.



Correct Answer: D

Reason: After a bone marrow aspiration, the puncture site should be checked every 10 to 15 minutes for bleeding. For a short period after the procedure, bed rest may be ordered. Signs of infection, such as redness and swelling, are not anticipated at the aspiration site. A mild analgesic may be ordered. If the client continues to need the morphine for longer than 24 hours, the nurse should suspect that internal bleeding or increased pressure at the puncture site may be the cause of the pain and should consult the physician.

Wednesday, 2 September 2020

Q. When giving an I.M. injection, the nurse should insert the needle into the muscle at an angle of:

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



Correct Answer: D

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

Tuesday, 1 September 2020

Q. A primiparous woman has recently delivered a term infant. Priority teaching for the patient includes information on:

A. Sudden infant death syndrome (SIDS)
B. Breastfeeding
C. Infant bathing
D. Infant sleep-wake cycles



Correct Answer: B

Reason: Breastfed infants should eat within the first hour of life and approximately every 2 to 3 hours. Successful breastfeeding will likely require sustained support, encouragement, and instruction from the nurse. Information on SIDS, infant bathing, and sleep-wake cycles are also important topics for the new parent, but they can be covered at any time prior to discharge.

Wednesday, 26 August 2020

Question Of The Day, Gastrointestinal Disorders
Q. A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

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



Correct Answer: C

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

Tuesday, 25 August 2020

Question Of The Day: Oncologic Disorders
Q. A client who is undergoing radiation therapy develops mucositis. Which of the following interventions should be included in the client's plan of care?

A. Increase mouth care to twice per shift.
B. Provide the client with hot tea to drink.
C. Promote regular flossing of teeth.
D. Use half-strength hydrogen peroxide on mouth ulcers.

Correct Answer: C

Reason: Mucositis is an inflammation of the oral mucosa caused by radiation therapy. It is important that the client with mucositis receive meticulous mouth care, including flossing, to prevent the development of an infection. Mouth care should be provided before and after each meal, at bedtime, and more frequently as needed. Extremes of temperature should be avoided in food and drink. Half-strength hydrogen peroxide is too harsh to use on irritated tissues.

Monday, 24 August 2020

Q. A client is recovering from an acute myocardial infarction (MI). During the first week of the client's recovery, the nurse should stay alert for which abnormal heart sound?

A. Opening snap
B. Graham Steell's murmur
C. Ejection click
D. Pericardial friction rub


Correct Answer: D

Reason: A pericardial friction rub, which sounds like squeaky leather, may occur during the first week following an MI. Resulting from inflammation of the pericardial sac, this abnormal heart sound arises as the roughened parietal and visceral layers of the pericardium rub against each other. Certain stenosed valves may cause a brief, high-pitched opening snap heard early in diastole. Graham Steell's murmur is a high-pitched, blowing murmur with a decrescendo pattern; heard during diastole, it indicates pulmonary insufficiency, such as from pulmonary hypertension or a congenital pulmonary valve defect. An ejection click, associated with mitral valve prolapse or a rigid, calcified aortic valve, causes a high-pitched sound during systole.

Saturday, 22 August 2020

Q. A nurse is preparing to perform a postpartum assessment on a client who gave birth 5 hours ago. Which precaution should the nurse plan to take for this procedure?

A. Washing the hands
B. Washing the hands and wearing latex gloves
C. Washing the hands and wearing latex gloves and a barrier gown
D. Washing the hands and wearing latex gloves, a barrier gown, and protective eyewear

Correct Answer: B

Reason: During a postpartum assessment, the nurse is likely to come into contact with the client's blood or body fluids, especially when examining the perineal region. Therefore, the nurse must wear latex gloves; hand washing alone would neither provide adequate protection nor comply with universal precautions. The nurse should wear a barrier gown and protective eyewear in addition to latex gloves only when anticipating splashing of blood or body fluids such as during childbirth. Splashing isn't likely to occur during a postpartum assessment.

Friday, 21 August 2020

Q. A client who has been in the latent phase of the first stage of labor is transitioning to the active phase. During the transition, the nurse expects to see which client behavior?

A. A desire for personal contact and touch
B. A full response to teaching
C. Fatigue, a desire for touch, and quietness
D. Withdrawal, irritability, and resistance to touch

Correct Answer: D

Reason: During the transition to the active phase of the first stage of labor, increased pain typically makes the client withdrawn, irritable, and resistant to touch. During the latent phase (the early part of the first stage of labor), when contractions aren't intensely painful, the client typically desires personal contact and touch and responds to teaching and interventions. Fatigue, a desire for touch, and quietness are common during the third and fourth stages of labor.

Thursday, 20 August 2020

Q. A client who's 7 weeks pregnant comes to the clinic for her first prenatal visit. She reports smoking 20 to 25 cigarettes per day. When planning the client's care, the nurse anticipates informing her that if she doesn't stop smoking, her fetus may be at risk for:

A. spina bifida.
B. tetralogy of Fallot.
C. low birth weight.
D. hydronephrosis.

Correct Answer: C

Reason: The risk of intrauterine growth retardation may increase with the number of cigarettes a pregnant woman smokes. Neural tube defects (such as spina bifida), cardiac abnormalities (such as tetralogy of Fallot), and renal disorders (such as hydronephrosis) are associated with multifactorial genetic inheritance, not maternal cigarette smoking.

Wednesday, 19 August 2020

Q. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?

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

Correct Answer: A

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

Tuesday, 18 August 2020

Q. At an outpatient visit 3 months after discharge from the hospital, a client says he has stopped his olanzapine (Zyprexa) even though it controls his symptoms of schizophrenia better than other medications. "I have gained 20 lb already. I can't stand any more." Which response by the nurse is most appropriate?

A. "I don't think you look fat, why do you think so?"
B. "I can help you with a diet and exercise plan to keep your weight down."
C. "You can be switched to another medicine."
D. "Your weight gain will level off if you stay on the medication 3 more months."

Correct Answer: B

Reason: Helping the client control his weight is the most appropriate approach. The nurse's contradiction of the client's complaint is inappropriate. Most atypical antipsychotics cause weight gain and are not a solution to the weight gain. There is little evidence that weight gain from taking olanzapine decreases with time.

Monday, 17 August 2020

Q. A client diagnosed with a cognitive disorder is showing signs of confusion, short-term memory loss, and a short attention span. Which of the following therapy groups would be best suited for this client?

A. Insight-oriented.
B. Medication management.
C. Problem solving.
D. Reality-orientation.
 
Correct Answer: D

Reason: Because the client has confusion, short-term memory loss, and a short attention span, a reality-orientation group is recommended to help the client maintain an optimal level of functioning, decrease isolation, and increase self-esteem. Focus is on the "here and now" and provides reality testing, structure, and social support. A client with a cognitive disorder is unlikely to benefit from an insight-oriented group, where the focus is on role relationships. Short-term memory loss and confusion interfere with the ability to learn about medication management. Short-term memory loss and confusion interfere with the ability to describe and solve problems.

Friday, 14 August 2020

Q. According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage?

A. Trust versus mistrust
B. Initiative versus guilt
C. Industry versus inferiority
D. Identity versus role confusion



Correct Answer: C

Reason: In middle childhood, the 6- to 12-year-old child is mastering the task of industry versus inferiority. The trust versus mistrust task is in infancy (birth to 1 year). In early childhood, the 1- to 3-year-old child is in the stage of initiative versus guilt. Identity versus role confusion occurs during adolescence.

Thursday, 13 August 2020

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

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

Correct Answer: D

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

Tuesday, 11 August 2020

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

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

Correct Answer: D

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

Monday, 10 August 2020

Question Of The Day, The Nursing Process
Q. Which of the following should be included in the plan of care for a client with a surgical wound that requires a wet-to-dry dressing?

A. Place a dry dressing in the wound.
B. Use Burrow's solution to wet the dressing.
C. Pack the wet dressing tightly into the wound.
D. Cover the wet packing with a dry sterile dressing.



Correct Answer: D

Reason: A wet-to-dry dressing should be able to dry out between dressing changes. Thus, the dressing should be moist, not dry, when applied. As the moist dressing dries, the wound will be debrided of necrotic tissue, exudate, and so forth. Normal saline is most commonly used to moisten the sponge; Burrow's solution will irritate the wound. The sponge should not be packed into the wound tightly because the circulation to the site could be impaired. The moist sponge should be placed so that all surfaces of the wound are in contact with the dressing. Then the sponge is covered and protected by a dry sterile dressing to prevent contamination from the external environment.

Saturday, 8 August 2020

Nursing Career, Nursing Responsibilities, Nursing Job, Nursing Degree

I feel the need to apologize for the state of our current profession. By saying that, I don’t mean anything negative towards nursing in general, it’s actually quite contrary. I have more pride than ever in our profession.

I worry, however, that your first year will bring so many different challenges and obstacles that I didn’t have to face as a new nurse. The past four months have taken a toll on nurses worldwide, and I fear that the enthusiasm and zest for this profession will be muddled under a veil of exhaustion and compassion fatigue. Just know that although we may not greet you with streamers and kazoos, behind our tired eyes and blistered faces we are ecstatic to welcome you into our family.

This year’s group of new nurses face an uphill learning curve that hasn’t been experienced before. These ever-changing scenarios will be frustrating to navigate, and I can’t imagine the added stress you will be under to learn the nuances of this job in the midst of a Pandemic. 

◉ It’s hard enough learning the skills, time management, and medications, but now hospitals have policies that change faster than a woman changes out of her Spanx after a long night out.

◉ Hospitals have shortened orientations and eliminated residency programs as a result of budget cuts and an increasing demand for full time nurses.

◉ Since the development of COVID + units, nurses often float between departments at a higher frequency than normal which may result in an inconsistent staff to learn beside.

Show Me Nursing Programs

I urge you to find your people. Regardless of your department or hospital, there are always people around you ready and willing to help. Although you sometimes have to look harder to find them than others, find the coworkers that you feel safe asking questions to, will laugh with you at your mistakes, and will take the additional 30 seconds to help you navigate your way. Sometimes these people will be your preceptors, and other times it might be your Respiratory Therapist. On tough days when nothing feels right, text or call a friend from nursing school and commiserate together on the challenges and difficulties of this season. Oftentimes, the most meaningful comfort you can receive is the affirmation of a friend who is in the same scenario that you are walking through. Nursing is far from an independent profession, it’s the “you hold this butt cheek, I’ll hold the other” teamwork and reliability that carries us through.

I write this to you, beloved new grad, to tell you that although you are entering this profession at an unprecedented time, I know that you will come out of this experience far stronger than you could ever imagine. You have already proven your resiliency by graduating in unconventional ways, fighting for a position regardless of the potential dangers, and continually showing up despite the uncertainty in healthcare today. When you feel like you have hit your breaking point, which is an incredibly normal and predictable emotion to feel in those first few months, just remember that you are stronger than your surroundings.

Source: nurse.org
Q. A woman is taking oral contraceptives. The nurse teaches the client to report which of the following danger signs?

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




Correct Answer: B

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

Friday, 7 August 2020

Question Of The Day, Basic Psychosocial Needs
Q. The health care provider at a prenatal clinic has ordered multivitamins for a woman who is 3 months' pregnant. The client calls the nurse to report that she has gone to the pharmacy to fill her prescription but is unable to buy it as it costs too much. The nurse should refer the client to:

A. The charge nurse.
B. The hospital finance office.
C. Her hospital social worker.
D. Her insurance company.

Correct Answer: C

Reason: The social worker is available to assist the client in finding services within the community to meet client needs. This individual is able to provide the names of pharmacies within the community that offer generic substitutes or others that utilize the client's insurance plan. The charge nurse of the unit would be able to refer the client to the social worker. The hospital finance office does not handle this type of situation and would refer the client back to the unit. The client's insurance company deals with payments for health care and would refer the client back to the local setting.

Thursday, 6 August 2020

Q. As a nurse helps a client ambulate, the client says, "I had trouble sleeping last night." Which action should the nurse take first?

A. Recommending warm milk or a warm shower at bedtime
B. Gathering more information about the client's sleep problem
C. Determining whether the client is worried about something
D. Finding out whether the client is taking medication that may impede sleep

Correct Answer: B

Reason: The nurse first should determine what the client means by "trouble sleeping." The nurse lacks sufficient information to recommend warm milk or a warm shower or to make inferences about the cause of the sleep problem, such as worries or medication use.

Wednesday, 5 August 2020

Question Of The Day: Genitourinary Disorders
Q. The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on these data, the nurse should?

A. Change the appliance bag.
B. Notify the physician.
C. Obtain a urine specimen for culture.
D. Encourage a high fluid intake.


Correct Answer: D

Reason: Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or to notify the physician. The mucus is not an indication of an infection, so a urine culture is not necessary.

Tuesday, 4 August 2020

Q. A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A. Nausea or vomiting
B. Abdominal pain or diarrhea
C. Hallucinations or tinnitus
D. Light-headedness or paresthesia



Correct Answer: D

Reason: The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

Saturday, 1 August 2020

Q. A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus?

A. Recent weight gain of 20 lb (9.1 kg)
B. Failure to monitor blood glucose levels
C. Skipping insulin doses during illness
D. Crying whenever diabetes is mentioned


Correct Answer: D

Reason: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

Thursday, 30 July 2020

Question Of The Day, Gastrointestinal Disorders
Q. A client with cholecystitis is taking Propantheline bromide (Pro-Banthine). The expected outcome of this drug is:

A. Increased bile production.
B. Decreased biliary spasm.
C. Absence of infection.
D. Relief from nausea.



Correct Answer: B

Reason: Propantheline bromide is an anticholinergic used to decrease biliary spasm. Decreasing biliary spasm helps to reduce pain in cholecystitis. Propantheline does not increase bile production or have an antiemetic effect, and it is not effective in treating infection.

Wednesday, 29 July 2020

Q. A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents?

A. Wear disposable gloves and protective clothing.
B. Break needles after the infusion is discontinued.
C. Disconnect I.V. tubing with gloved hands.
D. Throw I.V. tubing in the trash after the infusion is stopped.

Correct Answer: A

Reason: A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.

Tuesday, 28 July 2020

Q. In preparing the client and the family for a postoperative stay in the intensive care unit (ICU) after open heart surgery, the nurse should explain that:

A. The client will remain in the ICU for 5 days.
B. The client will sleep most of the time while in the ICU.
C. Noise and activity within the ICU are minimal.
D. The client will receive medication to relieve pain.


Correct Answer: D

Reason: Management of postoperative pain is a priority for the client after surgery, including valve replacement surgery, according to the Agency for Health Care Policy and Research. The client and family should be informed that pain will be assessed by the nurse and medications will be given to relieve the pain. The client will stay in the ICU as long as monitoring and intensive care are needed. Sensory deprivation and overload, high noise levels, and disrupted sleep and rest patterns are some environmental factors that affect recovery from valve replacement surgery.

Monday, 27 July 2020

Q.
A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The primary care provider has ordered I.V. fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4Meq/ L. The nurse should:

A. Notify the primary care provider.
B. Administer the ordered fluids.
C. Verify that the infant has urinated.
D. Have the potassium level redrawn.


Correct Answer: C

Reason: Normal serum potassium levels are 3.5-4.5 Meq/L. Elevated potassium levels can cause life threatening cardiac arrhythmias. The nurse must verify that the client has the ability to clear potassium through urination before administering the drug. Infants with pyloric stenosis frequently have low potassium levels due to vomiting. A level of 3.4Meq/l is not unexpected and should be corrected with the ordered fluids. The lab value does not need to be redrawn as the findings are consistent with the infant's condition.

Saturday, 25 July 2020

Question Of The Day, Intrapartum Period
Q. The nurse is caring for a multigravid client who speaks little English. As the nurse enters the client's room, the nurse observes the client squatting on the bed and the fetal head crowning. After calling for assistance and helping the client lie down, which of the following actions should the nurse do next?

A. Tell the client to push between contractions.
B. Provide gentle support to the fetal head.
C. Apply gentle upward traction on the neonate's anterior shoulder.
D. Massage the perineum to stretch the perineal tissues.

Correct Answer: B

Reason: During a precipitous delivery, after calling for assistance and helping the client lie down, the nurse should provide support to the fetal head to prevent it from coming out. It is not appropriate to tell the client to push between contractions because this may lead to lacerations. The shoulder should be delivered by applying downward traction until the anterior shoulder appears fully at the introitus, then upward pressure to lift out the other shoulder. Priority should be given to safe delivery of the infant over protecting the perineum by massage.

Friday, 24 July 2020

Question Of The Day, Antepartum Period
Q. Which medication is considered safe during pregnancy?

A. Aspirin
B. Magnesium hydroxide
C. Insulin
D. Oral antidiabetic agents




Correct Answer: C

Reason: Insulin is a required hormone for any client with diabetes mellitus, including the pregnant client. Aspirin, magnesium hydroxide, and oral antidiabetic agents aren't recommended for use during pregnancy because these agents may cause fetal harm. 

Thursday, 23 July 2020

Question Of The Day, Substance Abuse, Eating Disorders, Impulse Control Disorders
Q. A client with alcohol dependency is prescribed a B-complex vitamin. The client states, "Why do I need a vitamin? My appetite is just fine." Which of the following responses by the nurse is most appropriate?

A. "Your doctor wants you to take it for at least 4 months."
B. "You've been drinking alcohol and eating very little."
C. "The vitamin is a nutritional supplement important to your health."
D. "The amount of vitamins in the alcohol you drink is very low."

Correct Answer: C

Reason: Stating that the vitamin is a nutritional supplement important to the client's health is the best response. The client is nutritionally depleted, and the B-complex vitamins produce a calming effect on the irritated central nervous system and prevent anemia, peripheral neuropathy, and Wernicke's encephalopathy. Although the statements about drinking alcohol and eating very little and that there is a low amount of vitamins in the alcohol consumed may be true, they fail to address the client's concerns directly and fail to provide the necessary information, as does telling the client that the doctor wants the client to take the vitamin for 4 months.

Wednesday, 22 July 2020

Question Of The Day, Psychotic Disorders
Q. Which condition or characteristic is related to the cluster of symptoms associated with disorganized schizophrenia?

A. Odd beliefs
B. Flat affect
C. Waxy flexibility
D. Systematized delusions



Correct Answer: B

Reason: Flat affect (the lack of facial or behavioral manifestations of emotion) is related to disorganized schizophrenia. Other characteristics of disorganized schizophrenia include incoherence, loose associations, and disorganized behavior. Paranoid residual type schizophrenia is characterized by odd beliefs, unusual perceptions, and systematized delusions. Waxy flexibility, or maintaining the position the client is placed in, is seen in catatonic schizophrenia.

Tuesday, 21 July 2020

Question Of The Day, Mood, Adjustment, and Dementia Disorders
Q. A client with major depression sleeps 18 to 20 hours per day, shows no interest in activities he previously enjoyed and reports a 17-lb (7.7-kg) weight loss over the past month. Because this is the client's first hospitalization, the physician is most likely to order:

A. phenelzine (Nardil).
B. thiothixene (Navane).
C. nortriptyline (Pamelor).
D. trifluoperazine (Stelazine).

Correct Answer: C

Reason: Nortriptyline, a tricyclic antidepressant, is used in first-time drug therapy because it causes few anticholinergic and sedative adverse effects. Phenelzine isn't ordered initially because it may cause many adverse effects and necessitates dietary restrictions. Thiothixene and trifluoperazine are antipsychotic agents and, therefore, inappropriate for clients with uncomplicated depression.

Monday, 20 July 2020

Q. A client who recently developed paralysis of the arms is diagnosed with conversion disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the care plan for this client?

A. Exercising the client's arms regularly
B. Insisting that the client eat without assistance
C. Working with the client rather than with the family
D. Teaching the client how to use nonpharmacologic pain-control methods

Correct Answer: A

Reason: To maintain the integrity of the affected areas and prevent muscle wasting and contractures, the nurse should help the client perform regular passive range-of-motion exercises with his arms. The nurse shouldn't insist that the client use his arms to perform such functions as eating without assistance, because he can't consciously control his symptoms and move his arms; such insistence may anger the client and endanger the therapeutic relationship. The nurse should include family members in the client's care because they may be contributing to the client's stress or conflict and are essential to helping him regain function of his arms. The client isn't experiencing pain and, therefore, doesn't need education regarding pain management.

Friday, 17 July 2020

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

COVID-19, the novel coronavirus that has changed the face of America for the  last several months, has forever changed the healthcare landscape. While the general population is learning to navigate the “new normal” nurses, nursing students, and prospective students are facing the unknown. As restrictions across the country continue to ease and states enter the green phase, the pandemic is far from over.

One of the most notable changes to nursing during the pandemic is the relaxation of state regulations for licensure. At the start of the pandemic, state boards of nursing allowed for temporarily changing certain requirements that affected nurses practicing in their states, due to the impact of the coronavirus on their healthcare workforce. Every state, territory, and the District of Columbia declared a state of emergency, allowing nurses licensed in other states to be fast-tracked for practice.

Currently, states are tightening restrictions again but many are currently looking at the importance of the Enhanced Nursing Compact License. With thirty-two states, and two more set to join in July 2020, the eNLC  can help solve the predicament that many states had at the start of the pandemic. If all states were part of the eNLC prior to COVID-19, nurses could have easily mobilized to areas of highest need, specifically Seattle and New York City.

So let’s break it down to how it is affecting nurses, nursing students, and prospective students. Unfortunately, most would say that COVID-19 has hurt the field of nursing because it has changed many opportunities that were once available to nurses such as flexibility in per diem jobs, raises, vacation time, and overtime shifts. Many healthcare systems have been forced to re-evaluate their budget and this has dramatically affected nurses and future nurses.

Prospective Students


◉ More colleges and universities are offering online and distance learning programs.

◉ Nursing programs are limiting incoming classes due to clinical placement restrictions.

◉ Prospective students are unable to tour nursing classrooms and lab facilities to determine compatibility with their needs.

◉ Due to limitations on class size, nursing programs are becoming increasingly competitive. Applying to multiple programs is essential to earning your well-deserved spot.

Nursing Students


◉ Many nursing clinical rotations have been canceled or suspended while others have been moved to COVID-19 testing sites.

◉ There has been a mass movement to online and distance learning education versus in-person instruction.

◉ Senior nursing students did not all graduate due to the suspension of in-person clinicals.

◉ The NCLEX examination was delayed at the start of the pandemic and now there is a backlog of students needing to take the exam.

     ◉ There have been many changes made to the NCLEX examination,
     ◉ Exam Time: Shortened from 6 hours to 4 hours
     ◉ Questions: Decreased the number of questions to pass the exam from 75 questions to 60 questions
     ◉ Maximum number of questions: Decreased from 265 questions to 130 questions
     ◉ No pre-test questions
     ◉ Research section questions of NCLEX have been removed
     ◉ Students must wear gloves and a mask

◉ Some nursing students are concerned for job opportunities after graduation as most healthcare companies instituted a hiring freeze due to the pandemic.

◉ New nursing jobs are expected to emerge from the pandemic, especially those in telehealth and remote work-from-home settings.

Current Nurses


◉ Increase in telehealth and remote work-from-home positions.

◉ More flexibility to work in different healthcare settings.

◉ Learn ICU skills quickly and with limited orientation.

◉ Travel nursing became extremely competitive during the height of the crisis but now travel nurses are struggling to find contracts as many hospitals are seeing a downward trend in patients.

◉ Ability to expand nursing skill set.

◉ Ability to function more autonomously at the bedside.

◉ Connection with patients as most hospitals and nursing homes has visitor restrictions and patients were often alone, especially those suffering from COVID-19.

◉ Focus on community and public nursing care versus individualized nursing care.

◉ Hospitals have taken a thoughtful look at finances and cut overtime, per diem nurses and instituted hiring and wage freezes during the pandemic. They have also limited vacation time.

◉ The safety of nursing staff has been an ongoing issue. Due to the focus on PPE and lack thereof in most hospitals, nurses are concerned about another wave of the pandemic. Most have had to reuse PPE for countless shifts which have left many to question the effectiveness of it.

◉ Nurses continue to work with fewer resources due to staffing shortages and budget cuts.

◉ Increased retirement due to concerns of catching COVID-19 in the workplace.

◉ Increase in compassion fatigue and decrease in self-care.

COVID-19 highlighted the need for nurses throughout the United States. As the nursing profession continues to grow, the shortage also continues to grow. Now as nurses fight to earn back quality and safety standards in hospitals, healthcare systems will continue to have high expectations of their nursing staff. During the pandemic, healthcare administrators used the attitude that “a nurse is a nurse is a nurse” but that is not true. Each nurse has a special skill set, whether they work in the OR, ER, ICU, or medical-surgical floor. Nurses can not simply be replaced by another nurse but this is now the current expectation.

The effects of COVID-19 will long be seen throughout the nursing profession and despite everything that it has taken from nurses, nursing students, and prospective nurses - the “Year of the Nurse” will continue to show that nurses are resilient, dedicated, and compassionate.

Source: nurse.org
Q. Which of the following measures should the nurse include in the care plan for a child who is receiving high-dose methotrexate (amethopterin) therapy?

A. Keeping the child in a fasting state.
B. Obtaining a white blood cell (WBC) count.
C. Preparing for radiography of the spinal canal.
D. Collecting a specimen for urinalysis.



Correct Answer: B

Reason: Methotrexate is not highly toxic in low doses but may cause severe leukopenia at higher doses. It is customary and recommended for blood tests to be done before therapy to provide a baseline from which to study the effects of the drug on WBC count. Maintaining a fasting state, radiography of the spinal canal, and urinalysis are not necessary when this drug is administered.

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