Friday, 24 January 2020

Question Of The Day, School-age Child
Q. The nurse should instruct the family of a child with newly diagnosed hyperthyroidism to:

A. Keep their home warmer than usual.
B. Encourage plenty of outdoor activities.
C. Promote interactions with one friend instead of groups.
D. Limit bathing to prevent skin irritation.




Correct Answer: C

Reason: Children with hyperthyroidism experience emotional labiality that may strain interpersonal relationships. Focusing on one friend is easier than adapting to group dynamics until the child's condition improves. Because of their high metabolic rate, children with hyperthyroidism complain of being too warm. Bright sunshine may be irritating because of disease-related ophthalmopathy. Sweating is common and bathing should be encouraged.

Thursday, 23 January 2020

Question Of The Day, Toddler
Q. A child, age 3, is brought to the emergency department in respiratory distress caused by acute epiglottiditis. Which clinical manifestations should the nurse expect to assess?

A. Severe sore throat, drooling, and inspiratory stridor
B. Low-grade fever, stridor, and a barking cough
C. Pulmonary congestion, a productive cough, and a fever
D. Sore throat, a fever, and general malaise

Correct Answer: A

Reason: A child with acute epiglottiditis appears acutely ill and clinical manifestations may include drooling (because of difficulty swallowing), severe sore throat, hoarseness, a high temperature, and severe inspiratory stridor. A low-grade fever, stridor, and barking cough that worsens at night are suggestive of croup. Pulmonary congestion, productive cough, and fever along with nasal flaring, retractions, chest pain, dyspnea, decreased breath sounds, and crackles indicate pneumococcal pneumonia. A sore throat, fever, and general malaise point to viral pharyngitis.

Wednesday, 22 January 2020

Question Of The Day, Infant
Q. A 10-month-old child has cold symptoms. The mother asks how she can clear the infant's nose. Which of the following would be the nurse's best recommendation?

A. Use a cool air vaporizer with plain water.
B. Use saline nose drops and then a bulb syringe.
C. Blow into the child's mouth to clear the infant's nose.
D. Administer a nonprescription vasoconstrictive nose spray.

Correct Answer: B

Reason: Although a cool air vaporizer may be recommended to humidify the environment, using saline nose drops and then a bulb syringe before meals and at nap and bed times will allow the child to breathe more easily. Saline helps to loosen secretions and keep the mucous membranes moist. The bulb syringe then gently aids in removing the loosened secretions. Blowing into the child's mouth to clear the nose introduces more organisms to the child. A nonprescription vasoconstrictive nasal spray is not recommended for infants because if the spray is used for longer than 3 days a rebound effect with increased inflammation occurs.

Tuesday, 21 January 2020

Nursing Career, Nursing Certification, Nursing Degree, Nursing Responsibilities

In an impressive 18 year running streak, Americans have rated nurses as the #1 most ethical and honest profession, according to the most recent Gallup poll. 

The 2019 poll revealed that 85% of Americans rated nurses’ honesty and ethical standards as “high” or “very high,” coming in even higher than last year’s numbers. The honor is an impressive one, as the poll included other medical professionals, including physicians, dentists, and pharmacists. Nursing holds a high margin as the most honest and ethical, with the next most honest profession, engineering, ranking at 66%. 

Healthcare Dominates


Medical professionals, in general, are viewed as the most ethical and honest of all professions, as opposed to the professions Americans see as the least ethical and honest, such as Congress members (ranked by 9%) and car salespeople (9% ranked them as honest and ethical). 2019 marked a year of a lot of change in Americans’ perceptions of even professions that have historically widely been regarded as honest and ethical--clergy members, for instance, have continued to decline in the public’s view of who is the most ethical and honest--so the fact that nurses have continued to hold strong is a testament to the profession as a whole. 

As in the years past, the survey was conducted through telephone interviews that included both cellphone and landline respondents in a random sample of 1,025 adults in the U.S. 

2020 Named 'Year of the Nurse' 


Nursing’s news has been celebrated by The American Nurses Association (ANA) as the organization ushers in 2020 as the “Year of the Nurse,” designated by the World Health Organization (WHO) in honor of the 200th birth anniversary of Florence Nightingale. ANA is celebrating Year of the Nurse with special promotions, contests, and is encouraging nurses to share their own stories with the hashtag #YON2020 and #YearoftheNurse. 

“I am extremely proud that nurses everywhere have been bestowed this wonderful accolade by the people whose lives they touch every day. The fact that nurses have been consistently voted the most honest and ethical professionals is a testament to the public’s trust. We’ll work hard to keep their good faith throughout 2020 and beyond. I couldn’t think of a better way to enter into the “Year of the Nurse,” says ANA President Ernest Grant, Ph.D., RN, FAAN.

Grant added that the news from the Gallup poll not only is especially fitting in the Year of the Nurse but that the long-standing rank is an opportunity to shine a light on the noble profession of nursing. 

“This milestone celebration offers a platform to raise the visibility of nurses and increase the capacity of the nursing workforce,” he noted. “Nurses occupy many roles in our society and are on the front lines when it comes to immunizations, natural disaster preparedness, shaping health policy, and advocacy. For this reason, nurses are critical in improving the landscape of health and health care because an effective health care system is one that values all nurses.”

Thank you, Nurses! 


Here’s to 18 years in a row and the Year of the Nurse--which, in our opinion, should definitely be every year. Nurse.org applauds all of the nurses who continue to fight to change the lives of their patients and their families, the nursing students who are entering a profession that continues to advocate, and those who rated nurses as the most trusted and ethical profession again.

Source: nurse.org
Question Of The Day, The Nursing Process
Q. A nurse is documenting a variance that has occurred during the shift, and this report will be used for quality improvement to identify high-risk patterns and potentially initiate in-service programs. This is an example of which type of report?

A. Incident report.
B. Nurse's shift report.
C. Transfer report.
D. Telemedicine report.

Correct Answer: A

Reason: An incident report, also termed a variance report or occurrence report, is a tool healthcare agencies use to document anything out of the ordinary that results in or has the potential to result in harm to a client, employee, or visitor. These reports are used for quality improvement and not for disciplinary action. They are a means of identifying risks and high-risk patterns and initiating in-service programs to prevent future problems. A nurse's shift report is given by a primary nurse to the nurse replacing him or her or by the charge nurse to the nurse who assumes responsibility for continuing client care. A transfer report is a summary of a client's condition and care when transferring clients from one unit or institution to another. A telemedicine report can link healthcare professionals immediately and enable nurses to receive and give critical information about clients in a timely fashion.




Monday, 20 January 2020

Q. To prevent development of peripheral neuropathies associated with isoniazid administration, the nurse should teach the client to:

A. Avoid excessive sun exposure.
B. Follow a low-cholesterol diet.
C. Obtain extra rest.
D. Supplement the diet with pyridoxine (vitamin B6).




Correct Answer: D

Reason: Isoniazid competes for the available vitamin B6 in the body and leaves the client at risk for developing neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed to address this issue. Avoiding sun exposure is a preventive measure to lower the risk of skin cancer. Following a low-cholesterol diet lowers the individual's risk of developing atherosclerotic plaque. Rest is important in maintaining homeostasis but has no real impact on neuropathies.

Saturday, 18 January 2020

Question Of The Day, Genitourinary Disorders
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.


Friday, 17 January 2020

Question Of The Day, Respiratory Disorders
Q. The physician ordered I.V. naloxone (Narcan) to reverse the respiratory depression from morphine administration. After administration of the naloxone the nurse should:

A. Check respirations in 5 minutes because naloxone is immediately effective in relieving respiratory depression.
B. Check respirations in 30 minutes because the effects of morphine will have worn off by then.
C. Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone.
D. Monitor respirations each time the client receives morphine sulfate 10 mg I.M.

Correct Answer: C

Reason: The nurse should monitor the client's respirations closely for 4 to 6 hours because naloxone has a shorter duration of action than opioids. The client may need repeated doses of naloxone to prevent or treat a recurrence of the respiratory depression. Naloxone is usually effective in a few minutes; however, its effects last only 1 to 2 hours and ongoing monitoring of the client's respiratory rate will be necessary. The client's dosage of morphine will be decreased or a new drug will be ordered to prevent another instance of respiratory depression.

Thursday, 16 January 2020

Question Of The Day, Neurosensory Disorders
Q. The client with a hearing aid does not seem to be able to hear the nurse. The nurse should do which of the following?

A. Contact the client's audiologist.
B. Cleanse the hearing aid ear mold in normal saline.
C. Irrigate the ear canal.
D. Check the hearing aid's placement.



Correct Answer: D

Reason: Inadequate amplification can occur when a hearing aid is not placed properly. The certified audiologist is licensed to dispense hearing aids. The ear mold is the only part of the hearing aid that may be washed frequently; it should be washed daily with soap and water. Irrigation of the ear canal is done to remove impacted cerumen or a foreign body.

Wednesday, 15 January 2020

Question Of The Day, Musculoskeletal Disorders
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.

Tuesday, 14 January 2020

Question Of The Day, Infant
Q. A parent confides to the nurse that their 8-month-old infant is anxious. Which of the following suggestions by the nurse is most appropriate to help the mother lessen her anxiety about her infant?

A. Limit holding the infant to feeding times.
B. Talk quietly to the infant while he is awake.
C. Play music in his room for most of the day and night.
D. Have a close friend keep the infant for a few days.

Correct Answer: B

Reason: Infants are sensitive to stress in their caretakers. The best way to handle an anxious infant is to talk quietly to him, thereby soothing the infant. Limiting holding of the infant to feeding periods interferes with meeting the infant's needs for close contact, possibly compromising his ability to develop trust. Playing music in the room for most of the day and night will make it difficult for the infant to differentiate days from nights. Having a friend take the infant for several days will not necessarily take care of the problem because when the infant returns to the mother the same behaviors will recur unless the mother makes some changes. 

Monday, 13 January 2020

Q. A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:

A. Absence of nausea and vomiting.
B. Passage of mucus from the rectum.
C. Passage of flatus and feces from the colostomy.
D. Absence of stomach drainage for 24 hours.


Correct Answer: C

Reason: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery.

Saturday, 11 January 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.

Friday, 10 January 2020

Question Of The Day, The Neonate
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.

Thursday, 9 January 2020

Question Of The Day, Postpartum Period
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.


Tuesday, 7 January 2020

Q. A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should first:

A. perform a pelvic examination.
B. assess the client's blood pressure.
C. assess the fetal heart rate.
D. order a stat hemoglobin and hematocrit.



Correct Answer: C

Reason: The nurse should assess the fetal heart rate for distress or viability. She shouldn't attempt to perform a pelvic examination because of the possibility of placenta previa, which presents as bright red bleeding without abdominal pain. The nurse should assess the client's blood pressure after attempting to hear fetal heart tones. Ordering a hemoglobin and hematocrit is a physician intervention, not a nursing intervention.

Monday, 6 January 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.

Sunday, 5 January 2020

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, 2 January 2020

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.

Wednesday, 1 January 2020

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.

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