Saturday 30 May 2020

Question Of The Day, The Neonate
Q. During the first feeding, the nurse observes that the neonate becomes cyanotic after gagging on mucus. Which of the following should the nurse do first?

A. Start mouth-to-mouth resuscitation.
B. Contact the neonatal resuscitation team.
C. Raise the neonate's head and pat the back gently.
D. Clear the neonate's airway with suction or gravity.

Correct Answer: D

Reason: If a neonate gags on mucus and becomes cyanotic during the first feeding, the airway is most likely closed. The nurse should clear the airway by gravity (by lowering the infant's head) or suction. Starting mouth-to-mouth resuscitation is not indicated unless the neonate remains cyanotic and lowering his head or suctioning doesn't clear his airway. Contacting the neonatal resuscitation team is not warranted unless the infant remains cyanotic even after measures to clear the airway. Raising the neonate's head and patting the back are not appropriate actions for removing mucus. Doing so allows the mucus to remain lodged causing further breathing difficulties.

Friday 29 May 2020

Question Of The Day, Postpartum Period
Q. On the second postpartum day a gravida 6, para 5 complains of intermittent abdominal cramping. The nurse should assess for:

A. endometritis.
B. postpartum hemorrhage.
C. subinvolution.
D. afterpains.

Correct Answer: D

Reason: In a multiparous client, decreased uterine muscle tone causes alternating relaxation and contraction during uterine involution, which leads to afterpains. The client's symptoms don't suggest endometritis, hemorrhage, or subinvolution.

Thursday 28 May 2020

Nurse Practitioners, Nursing Responsibilities, Nursing Job, Nursing Career

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

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

How Jobs Are Ranked 

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

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

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

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

NP Salary and Prospects

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

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

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

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

Nurse Anesthetists and Nurse-Midwives

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

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

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

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

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

Primary Care: Enter the Nurse Practitioner

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

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

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

The Future of Nurse Practitioners

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

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

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

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

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

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

Correct Answer: A

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

Wednesday 27 May 2020

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

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

Correct Answer: B

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

Tuesday 26 May 2020

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

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

Correct Answer: C

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

Monday 25 May 2020

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

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

Correct Answer: D

Reason: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.

Sunday 24 May 2020

Q. A client was hospitalized for 1 week with major depression with suicidal ideation. He is taking venlafaxine (Effexor), 75 mg three times a day, and is planning to return to work. The nurse asks the client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it anymore and wouldn't do anything to hurt myself." The nurse should make which judgment about the client?

A. The client is decompensating and in need of being readmitted to the hospital.
B. The client needs an adjustment or increase in his dose of antidepressant.
C. The depression is improving and the suicidal ideation is lessening.
D. The presence of suicidal ideation warrants a telephone call to the client's primary care provider.

Correct Answer: C

Reason: The client's statements about being in control of his behavior and his or her plans to return to work indicate an improvement in depression and that suicidal ideation, although present, is decreasing. Nothing in his comments or behavior indicate he is decompensating. There is no evidence to support an increase or adjustment in the dose of Effexor or a call to the primary care provider. Typically, the cognitive components of depression are the last symptoms eliminated. For the client to be experiencing some suicidal ideation in the second week of psychopharmacologic treatment is not unusual.

Friday 22 May 2020

Q. Based on a client's history of violence toward others and her inability to cope with anger, which of the following should the nurse use as the most important indicator of goal achievement before discharge?

A. Acknowledgment of her angry feelings.
B. Ability to describe situations that provoke angry feelings.
C. Development of a list of how she has handled her anger in the past.
D. Verbalization of her feelings in an appropriate manner.

Correct Answer: D

Reason: Verbalizing feelings, especially feelings of anger, in an appropriate manner is an adaptive method of coping that reduces the chance that the client will act out these feelings toward others. The client's ability to verbalize her feelings indicates a change in behavior, a crucial indicator of goal achievement. Although acknowledging feelings of anger and describing situations that precipitate angry feelings are important in helping the client reach her goal, they are not appropriate indicators that she has changed her behavior. Asking the client to list how she has handled anger in the past is helpful if the nurse discusses coping methods with the client. However, based on this client's history, this would not be helpful because the nurse and client are already aware of the client's aggression toward others.

Thursday 21 May 2020

Q. A nurse is performing a psychosocial assessment on a 14-year-old adolescent. Which emotional response is typical during early adolescence?

A. Frequent anger
B. Cooperativeness
C. Moodiness
D. Combativeness

Correct Answer: C

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

Wednesday 20 May 2020

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

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

Correct Answer: B

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

Tuesday 19 May 2020

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

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

Correct Answer: C

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

Monday 18 May 2020

Q. A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse anticipates that the physician will order which laboratory test?

A. Total iron-binding capacity
B. Hemoglobin (Hb)
C. Total protein
D. Sweat test

Correct Answer: C

Reason: The nurse anticipates the physician will order a total protein test because negative nitrogen balance may result from inadequate protein intake. Measuring total iron-binding capacity and Hb levels would help detect iron deficiency anemia, not a negative nitrogen balance. The sweat test helps diagnose cystic fibrosis, not a negative nitrogen balance.

Sunday 17 May 2020

Q. Which of the following should the nurse use to determine achievement of the expected outcome for an infant with severe diarrhea and a nursing diagnosis of Deficient fluid volume related to passage of profuse amounts of watery diarrhea?

A. Moist mucous membranes.
B. Passage of a soft, formed stool.
C. Absence of diarrhea for a 4-hour period.
D. Ability to tolerate intravenous fluids well.

Correct Answer: A

Reason: The outcome of moist mucous membranes indicates adequate hydration and fluid balance, showing that the problem of fluid volume deficit has been corrected. Although a normal bowel movement, ability to tolerate intravenous fluids, and an increasing time interval between bowel movements are all positive signs, they do not specifically address the problem of deficient fluid volume.

Saturday 16 May 2020

Question Of The Day, The Nursing Process
Q. A nurse is caring for a client with a diagnosis of Impaired gas exchange. Based upon this nursing diagnosis, which outcome is most appropriate?

A. The client maintains a reduced cough effort to lessen fatigue.
B. The client restricts fluid intake to prevent overhydration.
C. The client reduces daily activities to a minimum.
D. The client has normal breath sounds in all lung fields.

Correct Answer: D

Reason: If the interventions are effective, the client's breath sounds should return to normal. The client should be able to cough effectively and should be encouraged to increase activity, as tolerated. Fluids should help thin secretions, so fluid intake should be encouraged.

Friday 15 May 2020

Q. When assessing an elderly client, the nurse expects to find various aging-related physiologic changes. These changes include:

A. increased coronary artery blood flow.
B. decreased posterior thoracic curve.
C. decreased peripheral resistance.
D. delayed gastric emptying.

Correct Answer: D

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

Thursday 14 May 2020

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

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

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

Why Early Graduation? 

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

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

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

How They Made It Happen

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

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

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

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

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

How The Early Grads Feel About The Decision

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

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

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

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

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

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

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

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

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

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

Correct Answer: A

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

Wednesday 13 May 2020

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

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

Correct Answer: C

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

Tuesday 12 May 2020

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

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

Correct Answer: A

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

Monday 11 May 2020

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

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

Correct Answer: C

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

Sunday 10 May 2020

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

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

Correct Answer: C

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

Friday 8 May 2020

Q. The nurse is caring for a client with asthma. The nurse should conduct a focused assessment to detect which of the following?

A. Increased forced expiratory volume.
B. Normal breath sounds.
C. Inspiratory and expiratory wheezing.
D. Morning headaches.

Correct Answer: C

Reason: The hallmark signs of asthma are chest tightness, audible wheezing, and coughing. Inspiratory and expiratory wheezing is the result of bronchoconstriction. Even between exacerbations, there may be some soft wheezing, so a finding of normal breath sounds would be expected in the absence of asthma. The expected finding is decreased forced expiratory volume [forced expiratory flow (FEF) is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration] due to bronchial constriction. Morning headaches are found with more advanced cases of COPD and signal nocturnal hypercapnia or hypoxemia.

Thursday 7 May 2020

Q. A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching?

A. "I'll increase my intake of protein during exacerbations."
B. "I should increase my intake of fresh fruits and vegetables during remissions."
C. "I'll snack on nuts, olives, and popcorn during flare-ups."
D. "I'll incorporate foods rich in omega-3 fatty acids into my diet."

Correct Answer: B

Reason: A client with diverticulitis needs to modify fiber intake to effectively manage the disease. During episodes of diverticulitis, he should follow a low-fiber diet to help minimize bulk in the stools. A client with diverticulosis should follow a high-fiber diet. Clients with diverticular disease don't need to modify their intake of protein and omega-3 fatty acids.

Wednesday 6 May 2020

Q. The nurse is serving on the hospital ethics committee which is considering the ethics of a proposal for the nursing staff to search the room of a client diagnosed with substance abuse while he is off the unit and without his knowledge. Which of the following should be considered concerning the relationship of ethical and legal standards of behavior?

A. Ethical standards are generally higher than those required by law.
B. Ethical standards are equal to those required by law.
C. Ethical standards bear no relationship to legal standards for behavior.
D. Ethical standards are irrelevant when the health of a client is at risk.

Correct Answer: A

Reason: Some behavior that is legally allowed might not be considered ethically appropriate. Legal and ethical standards are often linked, such as in the commandment "Thou shalt not kill." Ethical standards are never irrelevant, though a client's safety or the safety of others may pose an ethical dilemma for health care personnel. Searching a client's room when they are not there is a violation of their privacy. Room searches can be done with a primary health care provider's order and generally are done with the client present.

Tuesday 5 May 2020

Q. Which of the following interventions would be most appropriate for the nurse to recommend to a client to decrease discomfort from hemorrhoids?

A. Decrease fiber in the diet.
B. Take laxatives to promote bowel movements.
C. Use warm sitz baths.
D. Decrease physical activity.

Correct Answer: C

Reason: Use of warm sitz baths can help relieve the rectal discomfort of hemorrhoids. Fiber in the diet should be increased to promote regular bowel movements. Laxatives are irritating and should be avoided. Decreasing physical activity will not decrease discomfort.

Monday 4 May 2020

Question Of The Day, Antepartum Period
Q. The nurse has discussed sexuality issues during the prenatal period with a primigravida who is at 32 weeks' gestation. She has had one episode of preterm labor. The nurse determines that the client understands the instructions when she says:

A. "I can resume sexual intercourse when the bleeding stops."
B. "I should not get sexually aroused or have any nipple stimulation."
C. "I can resume sexual intercourse in 1 to 2 weeks."
D. "I should not have sexual intercourse until my next prenatal visit."

Correct Answer: B

Reason: This client has already had one episode of preterm labor at 32 weeks' gestation. Sexual intercourse, arousal, and nipple stimulation may result in the release of oxytocin which can contribute to continued preterm labor and early delivery. The client should be advised to refrain from these activities until closer to term, which is 6 to 8 weeks later. Telling the client that intercourse is acceptable after the bleeding stops is incorrect and may lead to early delivery of a preterm neonate. The client should not have intercourse for at least 6 weeks because of the danger of inducing labor. There is no indication when the client's next prenatal visit is scheduled.

Sunday 3 May 2020

Q. During the health history interview, which of the following strategies is the most effective for the nurse to use to help clients take an active role in their health care?

A. Ask clients to complete a questionnaire.
B. Provide clients with written instructions.
C. Ask clients for their description of events and for their views concerning past medical care.
D. Ask clients if they have any questions.

Correct Answer: C

Reason: One of the best strategies to help clients feel in control is to ask them their view of situations, and to respond to what they say. This technique acknowledges that clients' opinions have value and relevance to the interview. It also promotes an active role for clients in the process. Use of a questionnaire or written instructions is a means of obtaining information but promotes a passive client role. Asking whether clients have questions encourages participation, but alone it does not acknowledge their views.

Friday 1 May 2020

Q. A client in the triage area who is at 19 weeks' gestation states that she has not felt her baby move in the past week and no fetal heart tones are found. While evaluating this client, the nurse identifies her as being at the highest risk for developing which problem?

A. Abruptio placentae.
B. Placenta previa.
C. Disseminated intravascular coagulation.
D. Threatened abortion.

Correct Answer: C

Reason: A fetus that has died and is retained in utero places the mother at risk for disseminated intravascular coagulation (DIC) because the clotting factors within the maternal system are consumed when the nonviable fetus is retained. The longer the fetus is retained in utero, the greater the risk of DIC. This client has no risk factors, history, or signs and symptoms that put her at risk for either abruptio placentae or placenta previa, such as sharp pain and "woody," firm consistency of the abdomen (abruption) or painless bright red vaginal bleeding (previa). There is no evidence that she is threatening to abort as she has no complaints of cramping or vaginal bleeding.



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