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

Explanation: 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.

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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

Explanation: 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.

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Quesetion 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

Explanation: 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.

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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
Explanation: 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.

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Question Of Tha 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

Explanation: 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.

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Question OF The Day: Intrapartum Period

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

Explanation: 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.

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Question Of The Day: Antepartum Period

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

Explanation: 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.

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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

Explanation: 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.

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Question Of The Day: Mood, Adjustment, and Dementia Disorders

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

Explanation: 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.

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Advocacy Guide for Nurses: How To Be a Change Agent

All of us have some issues relating to the workplace, patient care, health and wellness within our communities or the healthcare system that we are passionate about and wish we could change for the better. We might believe that it is not within our ability or power to bring about change. However, through well planned and executed advocacy we CAN make a difference while still remaining within the boundaries of professional ethics and workplace policies.

Briefly, advocacy means to act on someone’s behalf. The World Health Organisation defines advocacy within the health care arena as “A combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular goal or programme.”

“…THROUGH WELL PLANNED AND EXECUTED ADVOCACY WE CAN MAKE A DIFFERENCE.”

Nurses are by far the largest group in health care. With their education and exposure to the needs of patients and the community, as well as being recognised as the most trusted and ethical profession, they should be a major force for social change.

Advocacy is also recognised as a core component of the nurse’s role. This is clearly stated in the ICN Code of Ethics for Nurses:

◉ The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular, those of vulnerable populations.
◉ The nurse advocates for equity and social justice in resource allocation, access to health care and other social and economic services.

Initial involvement in advocacy need not be a major project; it can be as small as motivating for a suitable breastfeeding room for staff or healthier food choices at the local school canteen. Participation in advocacy initiatives also leads to personal and professional development, including growth in leadership and communication skills, as well as empowerment for all concerned.

The advocacy process

1. Take the initiative

The first step in advocacy is to make the decision to act. This could be you alone or a group who all feel strongly about the problem. The particular issue must be defined and framed as one for which there is a potential solution, within the framework of available support and resources.

Using the above example of the breastfeeding room broad the felt problem might be that staff who want to feed their babies have to use the toilets. The issue is then framed by the need for a clean and comfortable place where staff can breastfeed, given that breastfeeding is the healthiest option for babies and should be encouraged.

2. Gather information

Once the issue has been framed in-depth, research must be done to collect evidence which will help to build a strong, credible case. This information gathering would include the most recent scientific research related to the issue; views expressed by international organisations; the number of people affected and their ideas about the problem and possible solutions.

Research must also include the political context–find out who the people in high places are that make the decisions about priorities, changes in policy and funding. What other influential leaders or organisations could be approached for support? What are others saying and doing about the issue? What coverage is being given to the media – both positive and negative? Who are the possible opponents and what are their points of view.

3. Strategic planning

Once as much information is possible has been collected the next step is to set a goal for the campaign. As for all goals, it should be specific, achievable, have a measurable outcome and a time frame. Smaller institutional or local campaigns might have a short period, whereas, for others, the goal might take years or even decades to achieve (for example, the action against global warming).

Once the goal has been decided on, a strategy can be planned on how to achieve it. This planning is the most important part in ensuring the success of the campaign.

Communication is at the centre of all advocacy – getting the message out there, gaining the support of stakeholders and the public and putting pressure on decision makers.

Stakeholders who will be affected by the action should be involved as soon as possible in the advocacy process, not only for their personal knowledge and experience of the issue but also to get their buy-in and support.

There should be a strong key message with a call to action which should preferably be supported by a visual such as a logo or a “face” on the issue. Specific information packages can then be developed to target different audiences such as the stakeholders and the public; the media; and decision makers. The who, what, why, when, where and how of putting the message out there must be planned in detail.

Where the campaign addresses a community issue, communication through the media will be essential. Win the media over as a partner in the campaign by building a relationship with journalists in the print media, radio and television. Identify a spokesperson for the campaign who will come over well in interviews. Stakeholders who can be talked about their personal experiences can add a compelling human interest angle. Internet-based and social media campaigns are cost-effective and can reach large audiences very quickly but should not be used on their own. Lobbying influential leaders and policy makers, meeting with them and presenting the facts and figures and possible solutions must also be included in the plan.

It is also a good idea to network and form alliances with organisations that have similar goals to provide for information sharing and mutual support. There is always power in numbers.

4. Implementation and evaluation

After careful planning, the campaign is ready to be implemented. This is also the time to be alert and watch the news as it unfolds. With fast action, the campaign message can become newsworthy when linked to relevant breaking news. For example, if the danger of childhood obesity makes the news after a government report is released, it can support the campaign for healthier foods in the school canteen.

There should be continuous evaluation and adjustment of the plan as needed as well as final evaluation at the conclusion of the advocacy campaign.This is essential for accountability, especially where donor funding was involved. How successful was the campaign? What were the strong points and what could have been done differently? Methods used for evaluation will depend on the goal of the campaign. It might be as simple as that the change has been implemented or might require surveys and relevant statistics.

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Question Of The Day: Anxiety Disorders

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

Explanation: 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.

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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

Explanation: 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.

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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

Explanation: 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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8 Ways Nurses Can Raise Their Level of Nursing Professionalism

Your level of professionalism as demonstrated by your behaviour and attitudes can be a deciding factor in whether you get that promotion or are passed over for someone else.

Nursing is a profession, but the individual nurse’s level of professionalism develops throughout her career. The professionalism of an individual can be seen on a sliding scale with the new recruit at the one end and the professional ideal on the other. Professional socialisation, through education and practice, begins when the student enters nursing school. The sliding scale also means that all nurses are not equally professionalised with very few, if any, reaching the ideal. The nurse develops professionally throughout her career as she increasingly adopts the professional culture, and demonstrates its norms and values in her daily attitudes, behaviours and practices – both at work and in the community.

What are the norms and values in nursing?

Any culture is made up of standards and values which are transmitted in various ways to socialise the child or the new colleague to a workplace or profession.

Core elements the professional behaviour and attitudes of the nurse are contained in nursing codes of ethics. To be able to apply these concepts in practice the statements should be analysed and discussed, and your practice continuously assessed against these guidelines.

How can I raise my level of professionalism?

By increasingly paying attention to the following eight elements relating to patient care, your development as well as your interaction with colleagues and within the community, you can raise your level of professionalism and your chances of career advancement.

1. Put caring first

Nursing came into being because of the need of human beings for care in times of need. Caring is the nurse’s unique function, and all other professional behaviours are in support this function. The majority of the provisions in the ethical code will be met if the nurse genuinely cares for each patient and accepts the patient as unique, respects his individual rights, and meets all his physical, psychological, social and spiritual needs. This includes respect for dignity irrespective of nationality, race, creed, colour, age, sex, politics or social status.

2. Be professionally responsible and accountable

Nursing is a profession in its right and nurses no longer seen as subservient to the medical practitioner. She is an independent practitioner with the freedom to make nursing care decisions for her patients. In the interests of her patients she should analyse and question, use initiative and take decisions. She can lose her licence is she does not act responsibly and accountably regarding what she has been trained to do. For example, if she executes physician’s orders or prescriptions which she should know from her training to be incorrect instead of questioning them, she is also held professionally liable in the event of problems.

3. Be an advocate for your patient

While advocacy is a relatively new term in nursing, the concept was entrenched in Virginia Henderson’s definition of nursing: “the nurse assists the individual, sick or well, in the performance of those activities… which they would perform unaided if they had the necessary strength will or knowledge”. An advocate acts on behalf of the client and in this role, it is the nurse’s duty to help her client to obtain the health care and other assistance they require when they don’t have the knowledge or ability to act for themselves. Here the client can be an individual patient, family or community. Advocacy must however also be conducted in a professional way and according to acceptable standards.

4. Maintain a good relationship with co-workers

Only the best communication and co-operation between members of the health care team will ensure quality care for the client. The nurse often coordinates this communication as she is the one who spends the most time with the client. Any problems or disagreements which arise between the patient and other members of the team, or between members of the team, should be resolved in a professional manner and never in front of the patient.

5. Maintain patient confidentiality

Every nurse knows this basic human rights principle which is stressed in training and contained in all codes of nursing and medical ethics, and often in professional legislation as well. However, breaches of confidentiality happen daily, often unknowingly in casual conversation. If you listen to conversations between nurses during tea you will often hear discussions which could constitute a breach of confidentiality. There are times when personal information needs to be shared with other members of the team caring for the patient, and the codes of ethics make provision for this.

6. Develop and maintain professional standards

Only nurses can determine professional standards for nurses and nursing care. It is nurses’ responsibility to continually evaluate their own practice against the set standards. Because of commitment to quality patient care the nurse should also strive to continually raise those standards.

7. Maintain professional competence

The best quality of care for the patient is only possible if the nurse accepts responsibility for increasing her professional knowledge and keeping up to date with new developments. She should have an enquiring mind and learn all the time and not limit learning to that required for CPD points for registration. With all the information available on the web, there is no excuse for not reading up on a topic where you have discovered a gap in your knowledge.

The nurse who assigns tasks to other nurses remains ultimately responsible for the care which is provided to clients. It follows then that she also needs to teach subordinates to ensure that they are competent to perform their tasks correctly and according to the accepted standards.

8. Participate in professional affairs

Every nurse should be concerned about and active in promoting the profession and addressing current issues in nursing and health care. Professional groups, including nursing associations or societies representing different nursing specialties, are more successful than individuals in bringing about change through the voice of numbers. Becoming active in professional groups and sharing your expertise can add considerably to your professional development and recognition.

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Question Of The Day: Toddler

Q. When assessing for pain in a toddler, which of the following methods should be the most appropriate?

A. Ask the child about the pain.
B. Observe the child for restlessness.
C. Use a numeric pain scale.
D. Assess for changes in vital signs.



Correct Answer: B

Explanation: Toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability, and crying. It is not particularly helpful to ask toddlers about pain. In most instances, they would be unable to understand or describe the nature and location of their pain because of their lack of verbal and cognitive skills. However, preschool and older children have the verbal and cognitive skills to be able to respond appropriately. Numeric pain scales are more appropriate for children who are of school age or older. Changes in vital signs do occur as a result of pain, but behavioral changes usually are noticed first.

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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

Explanation: 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.

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Question Of The Day: Basic Physical Assessment

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

Explanation: 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.

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Question Of The Day: Basic Physical Care

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

Explanation: 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.

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Question Of The Day: Respiratory Disorders

Q. A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says:

A. "I need to keep my inhaler at the bedside."
B. "I should eat a high-protein diet."
C. "I should become involved in a weight loss program."
D. "I should sleep on my side all night long."


Correct Answer: C

Explanation: Obesity and decreased pharyngeal muscle tone commonly contribute to sleep apnea; the client may need to become involved in a weight loss program. Using an inhaler won't alleviate sleep apnea, and the physician probably wouldn't order an inhaler unless the client had other respiratory complications. A high-protein diet and sleeping on the side aren't treatment factors associated with sleep apnea.

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How to Stay Positive When You Work in Hospice

When you meet a hospice nurse, you might look at her and say, “I could never do that kind of nursing; it’s so depressing.” If you already work in hospice, nurses and non-nurses alike might say similar things to you. But is it really that depressing? And is it possible to maintain your positivity when you work with people who are staring death in the face?

Hospice nurses work in patients’ homes and inpatient units. Each environment has its own pluses and minuses, but their goals -- symptom management and dignified death -- remain the same.

Nurses Know Death

Let’s face it: nurses know death pretty intimately. Maybe you experienced the death of a patient during nursing school, or you were recently involved in your first code.

While some nurses work in environments where death isn’t common (eg: school nursing, education, research, primary care), many of us work where patients routinely die.

We all grow old and die, and some of us die before making it that far. Hospice nurses know this process a little more intimately than many of their nurse colleagues. How about you?

Hospice, Death, and Nurses

The purpose of hospice is to support patients facing a terminal diagnosis and the potential for death. Some hospice patients actually get better and “graduate” from care, but most don’t have that option and remain in hospice until the end.

If a hospice patient has a painful condition like bone cancer, symptom management is crucial. As a patient nears death, they can experience confusion, delirium, agitation, and other symptoms that are difficult for family to witness.

Even if the nurse’s own emotions arise, the nurse has to remain thoroughly logical, while simultaneously communicating compassion and understanding towards the patient and their loved ones.

Watching a patient die is an honor, but it can also be scary. If you’ve never been present at a death, it’s an intense experience, to say the least. Hospice nurses learn to take this process in stride while providing awesome care for patients and families.

Staying Positive in the Face of Suffering

Whether your patients routinely die or not, you probably witness suffering as a nurse. Just realize that the suffering you see in hospice may actually be a lot less dramatic than what you see in the ER, ICU, or trauma. Most hospice deaths are actually very peaceful.

When you witness suffering as a hospice nurse, your job is to alleviate that suffering as best you can. When witnessing the dying process, your job is to make sure it’s as painless and peaceful as possible.

One of the challenges is alleviating others’ spiritual and emotional pain while dealing with your own feelings. Staying positive for your patients and their families is important in hospice, but you also have to stay positive for yourself.

10 Steps to Maintaining Positivity

Even if you work in hospice and are faced with death and suffering almost every day, here are 10 ways to stay positive as you provide amazing nursing care:

◉ Go to therapy or counseling to cultivate your own emotional health.
◉ Attend religious services or meet regularly with your favorite faith leader.
◉ Make time for friends.
◉ Take care of your physical health; you’ll be more positive more often when your body feels good.
◉ Talk with your hospice colleagues about how they stay positive and emotionally healthy.
◉ Volunteer with children, animals, or others that bring you joy.
◉ Surround yourself with positive, happy people.
◉ Use movies, books, movies, podcasts, and videos to fill your head with positive messages and uplifting stories. There’s nothing like a funny kitten or baby video to make you see the world through happy eyes.
◉ Focus on what’s good in your life through a gratitude practice; give thanks regularly for your blessings.
◉ Remind yourself that the excellent care you give to your patients and their families brings them great peace of mind. This is a reward of your work that can help you feel very good about yourself. 

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Question Of The Day: Endocrine and Metabolic Disorders

Q. When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is:

A. "The physician wants to be sure your shoes fit properly so you won't develop pressure sores."
B. "The circulation in your feet can help us determine how severe your diabetes is."
C. "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."
D. "It's easier to get foot infections if you have diabetes."

Correct Answer: C

Explanation: The nurse should make the client aware that diabetes affects sensation in the feet and that he might hurt his foot but not feel the wound. Although it's important that the client's shoes fit properly, this isn't the only reason the client's feet need to be checked. Telling the client that diabetes mellitus increases the risk of infection or stating that the circulation in the client's feet indicates the severity of his diabetes doesn't provide the client with complete information.

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Question Of The Day: Antepartum Period

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

Explanation: 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.

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Question Of The Day: Substance Abuse, Eating Disorders, Impulse Control Disorders

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
C. Shivering
C. Anxiety
D. Chest pain

Correct Answer: A

Explanation: 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.

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Question Of The Day: Anxiety Disorders

Q. Which of the following should the nurse teach a client with generalized anxiety disorder to help the client cope with anxiety?

A. Cognitive and behavioral strategies.
B. Issue avoidance and denial of problems.
C. Rest and sleep.
D. Withdrawal from role expectations and role relationships.


Correct Answer: A

Explanation: A client with generalized anxiety disorder needs to learn cognitive and behavioral strategies to cope with anxiety appropriately. In doing so, the client's anxiety decreases and becomes more manageable. The client may need assertiveness training, reframing, and relaxation exercises to adaptively deal with anxiety.

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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

Explanation: 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.

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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

Explanation: 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.

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4 Positive Uses of Social Media in Nursing

Communication through social media has become a way of life, especially for the younger generation, and will continue to increase. Although indiscriminate posting on social media by nurses hold a number of pitfalls, nurses should embrace this evolving technology in order to keep up with the changing needs and demands of contemporary society. The creative use of social media has limitless potential in nursing education, nursing management, and health care. It is still a vast, mostly unexplored territory.

1. Nursing Education

Nursing students are skilled in the use of social media and will welcome their use in education. Online groups can be used very effectively to create interactive and self-directed learning opportunities. The educator can, for example, post links to web-based articles and YouTube videos for the students to read and watch in preparation for the next classroom session. Instead of the information being presented to the students by the teacher, classroom sessions can be used for clarification, group discussions, and role plays.

Groups can be created by which the educator can connect with their students to share interesting content related to their studies and to inform them of special lectures, test timetables, and other events. An account such as Twitter can even connect the educator with students who are on clinical practice assignments so that she can answer questions, provide guidance and support. There could also be a planned communication session every week at a particular time.

Students themselves can form study support groups through which they can exchange questions and explanations as well as support each other in general. They could also share interesting content related to the topic they are studying.

2. Personal development and support

Nurses can join any of countless nursing groups and pages on Facebook and other social media. These are either for nurses in general or for nurses specializing in a particular field. They serve to share information on developments and issues in nursing and health care and to network with other nurses locally or worldwide. These groups also enhance morale within the nursing profession – just think of the warm feeling you get from a meme or quote about how wonderful nurses are.

One of the most popular nursing groups on Facebook is SMYS that aims to unify the voices of nurses and other healthcare professionals.

The instantaneous and wide sharing of content is one of the major advantages of social media for professional development. This characteristic can be used to start a journal club, either for a special interest group or within an organization. Links to journal articles are posted to the group and, once members have read the article, there can be a discussion in the group about the content of the article, its value for nursing practice and whether and how the research can be implemented in the clinical situation.

Within a specific workplace, nurses can also have a dedicated group where they can ask questions, express feelings, reflect and provide general support for each other.

3. Nursing management

Nurse managers should become familiar with social media, using it to improve communication, obtain staff participation in management decisions and enhance staff morale.

A group for nurses in the workplace can be created with regular postings of the following:

◉ Reminders about continuing education programs and other educational opportunities

◉ Requests for input for or information about policy changes. Allowing nurses to participate in decisions by making use of a voting app can be a great morale booster

◉ Introducing newly appointed nurses with a photo and brief resume

◉ A nurse’s “face for the day” with a positive comment about the nurse’s contribution to the organization

◉ Recognition of achievements by nurses in the organization, including obtaining new qualifications, awards or promotions

◉ Updates on feedback received from patients for positive encouragement or to point out areas needing attention

Imagine the positive influence the above communication will have on staff engagement and cohesion among nurses, as well as on staff recruitment and the branding of the health care institution.

Nursing managers can also use a social media application, dedicated and always attended to, to provide nurses with advice and feedback about problems in real time.

To make effective use of social media in the workplace, nurse managers should also actively engage their staff in developing policy and new methods in information sharing, collaboration on projects, education and patient care.

4. Patient Care

Worldwide there are numerous developments and projects in using social media to enhance health care for patients and communities.

They can be used effectively in communication with patients and patient monitoring. A chat line can be made available for newly discharged patients where they can safely and discreetly communicate with a member of the nursing staff to confirm discharge instructions, enquire about symptoms they are experiencing which might indicate a complication, or even post images of their wounds so that the nurse can monitor the healing process. The nurse can even monitor a patient’s wound dressing technique or method of administering medication via a video. Other uses include medication reminders and confirming upcoming appointments.

Patients can be referred to social media groups which offer support and information for individuals with specific long-term conditions. A group can even be created by a health care institution for patients with specific long-term conditions, or even for new mothers, where they can provide each other with support. A nurse with specialized knowledge could form part of the group to give professional advice, patient education and information about events and new developments in treatments.

A number of mobile-based online applications, which interact with social media, have been developed for monitoring and assessing patient information. One such application, for teenage diabetics, prompts users to enter blood glucose data. Trends are tracked and remotely monitored by health care professionals.

Social media have also proved to be a powerful tool in public advocacy campaigns. They can be used effectively by nurses and organizations to advocate for change in local, regional and national nursing and health issues.

Nurses might feel anxious about using social media in health care but the profession should evolve with developments in the society which they serve. As long as the core ethical principles of nursing are kept in mind, new technology should be embraced for its potential benefits in nursing and health care.

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Question Of The Day: Basic Physical Assessment

Q. Crackles heard on lung auscultation indicate which of the following?

A. Cyanosis.
B. Bronchospasm.
C. Airway narrowing.
D. Fluid-filled alveoli.




Correct Answer: D

Explanation: Crackles are auscultated over fluid-filled alveoli. Crackles heard on lung auscultation do not have to be associated with cyanosis. Bronchospasm and airway narrowing generally are associated with wheezing sounds.

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Question Of The Day: Basic Physical Care

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

Explanation: 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.

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Question Of The Day: Respiratory Disorders

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

Explanation: 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.

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Question Of The Day: Musculoskeletal Disorders

Q. After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

A. With the affected hip flexed acutely

B. With the leg on the affected side abducted

C. With the leg on the affected side adducted

D. With the affected hip rotated externally

Correct Answer: B

Explanation: The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

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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

Explanation: 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.

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Question Of The Day: Oncologic Disorders

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

Explanation: 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.

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Question Of The Day: Cardiovascular Disorders

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
Explanation: 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.

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Question Of The Day: Postpartum Period

Q. Twelve hours after a vaginal delivery with epidural anesthesia, the nurse palpates the fundus of a primiparous client and finds it to be firm, above the umbilicus, and deviated to the right. Which of the following would the nurse do next?

A. Document this as a normal finding in the client's record.
B. Contact the physician for an order for methylergonovine (Methergine).
C. Encourage the client to ambulate to the bathroom and void.
D. Gently massage the fundus to expel the clots.

Correct Answer: C

Explanation: At 12 hours postpartum, the fundus normally should be in the midline and at the level of the umbilicus. When the fundus is firm yet above the umbilicus, and deviated to the right rather than in the midline, the client's bladder is most likely distended. The client should be encouraged to ambulate to the bathroom and attempt to void, because a full bladder can prevent normal involution. A firm but deviated fundus above the level of the umbilicus is not a normal finding and if voiding does not return it to midline, it should be reported to the physician. Methylergonovine (Methergine) is used to treat uterine atony. This client's fundus is firm, not boggy or soft, which would suggest atony. Gentle massage is not necessary because there is no evidence of atony or clots.

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