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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Question Of The Day: Antepartum Period

Q. Which medication is considered safe during pregnancy?

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




Correct Answer: C

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

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

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

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

Correct Answer: C

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

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Question Of The Day: Psychotic Disorders

Q. Which condition or characteristic is related to the cluster of symptoms associated with disorganized schizophrenia?

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

Correct Answer: B

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

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

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

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

Correct Answer:  C

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

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Question Of The Day: Anxiety Disorders

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

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

Correct Answer: A

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

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Question Of The Day: Foundations of Psychiatric Nursing

Q. The nursing staff has finished restraining a client. In addition to determining whether anyone was injured, the staff is mandated to evaluate the incident to obtain which of the following ultimate outcomes?

A. Coordinate documentation of the incident.
B. Resolve negative feelings and attitudes.
C. Improve the use of restraint procedures.
D. Calm down before returning to the other clients.

Correct Answer: C
Explanation: Although coordinating documentation, resolving negative feelings, and calming down are goals of debriefing after a restraint, the ultimate outcome is to improve restraint procedures.

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Question Of The Day: Basic Physical Assessment

Q. The nurse is assessing a client's testes. Which of the following findings indicate the testes are normal?

A. Soft.
B. Egg-shaped.
C. Spongy.
D. Lumpy.



Correct Answer: B

Explanation: Normal testes feel smooth, egg-shaped, and firm to the touch, without lumps. The surface should feel smooth and rubbery. The testes should not be soft or spongy to the touch. Testicular malignancies are usually nontender, nonpainful hard lumps. Lumps, swelling, nodules, or signs of inflammation should be reported to the physician.

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Question Of The Day: Basic Physical Care

Q. A physician has ordered penicillin G potassium (Pfizerpen), I.V., for a client with a severe streptococcal infection. A nurse determines that the client may be allergic to penicillin. When considering best practice, what should the nurse's priority intervention be?

A. Holding the penicillin G potassium and charting that it was held because the client is allergic
B. Administering the penicillin G potassium and staying alert for any reaction
C. Holding the penicillin G potassium and notifying the physician that the client may have an allergy to penicillin
D. Administering the penicillin G potassium but notifying the pharmacist that the client might experience an allergic reaction

Correct Answer: C

Explanation: The nurse should hold the penicillin G potassium, even if the client isn't sure he's allergic to penicillin, and notify the physician so he may order a different antibiotic. Many clients can't act as their own advocates; they rely on nurses to protect their rights. An allergy to penicillin G potassium is suspected, but not comfirmed. Administering penicillin G potassium could cause a life-threatening reaction. Administering the medication, then watching for a reaction or notifying the pharmacist that a reaction might occur, isn't best practice. If a client is allergic to penicillin, a nurse should alert the pharmacist and label the client's chart appropriately.

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Question Of The Day: Respiratory Disorders

Q. client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician orders acetylcysteine (Mucomyst). Before administering the first dose, the nurse checks the client's history for asthma. Acetylcysteine must be used cautiously in a client with asthma because it:

A. is a respiratory depressant.
B. is a respiratory stimulant.
C. may induce bronchospasm.
D. inhibits the cough reflex.

Correct Answer: C

Explanation: Acetylcysteine must be used cautiously in a client with asthma because it may induce bronchospasm. The drug isn't a respiratory depressant or stimulant. It's a mucolytic agent that decreases the viscosity of respiratory secretions by altering the molecular composition of mucus. Acetylcysteine doesn't inhibit the cough reflex.

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Question Of The Day: Neurosensory Disorders

Q. A potential concern when caring for an older adult who has diminished hearing and vision is the client's:

A. Feelings of disorientation.
B. Cognitive impairment.
C. Sensory overload.
D. Social isolation.

Correct Answer: D

Explanation: Social isolation is a concern for an older adult who has diminished hearing and vision. Feeling disoriented may be related to cognitive problems rather than diminished hearing and vision. Diminished hearing and vision is related to the aging process and does not result in impairment of the older adult's thought processes. The client with impaired hearing and vision is unlikely to experience sensory overload.

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Question Of The Day: Musculoskeletal Disorders

Q. The nurse is evaluating the pin insertion site of a client's skeletal traction. Which of the following indicate a complication?

A. Presence of crusts around the pin insertion site.
B. Serous drainage on the dressing.
C. Pin moves slightly at insertion site.
D. Client does not feel pain at insertion site.

Correct Answer: C

Explanation: Skeletal pins should not be loose and able to move. Any pin loosening should be reported immediately. Slight serous drainage is normal and may crust around the insertion site or be present on the dressing. The pin insertion site should be cleaned with aseptic technique according to facility policy. Pin insertion sites are typically not painful; pain may be indicative of an infection and should be reported.

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Question Of The Day: Gastrointestinal Disorders

Q. A client with esophageal cancer decides against placement of a jejunostomy tube. Which ethical principle is a nurse upholding by supporting the client's decision?

A. Autonomy
B. Fidelity
C. Nonmaleficence
D. Veracity


Correct Answer: A

Explanation: Autonomy refers to an individual's right to make his own decisions. Fidelity is equated with faithfulness. Nonmaleficence is the duty to "do no harm." Veracity refers to telling the truth.

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Question Of The Day: Oncologic Disorders

Q. A 45-year-old single mother of three teenaged boys has metastatic breast cancer. Her parents live 750 miles away and have only been able to visit twice since her initial diagnosis 14 months ago. The progression of her disease has forced the client to consider high-dose chemotherapy. She is concerned about her children's welfare during the treatment. When assessing the client's present support systems, the nurse will be most concerned about the potential problems with:

A. Denial as a primary coping mechanism.
B. Support systems and coping strategies.
C. Decision-making abilities.
D. Transportation and money for the boys.

Correct Answer: B

Explanation: The client's resources for coping with the emotional and practical needs of herself and her family need to be assessed because usual coping strategies and support systems are often inadequate in especially stressful situations. The nurse may be concerned with the client's use of denial, decision-making abilities, and ability to pay for transportation; however, the client's support systems will be of more importance in this situation.

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Question Of The Day: Cardiovascular Disorders

Q. A nurse should monitor a client receiving lidocaine (Xylocaine) for toxicity. Which signs or symptoms in a client suggest lidocaine toxicity?

A. Nausea and vomiting
B. Pupillary changes
C. Confusion and restlessness
D. Hypertension


Correct Answer: C

Explanation: Confusion and restlessness are signs of lidocaine toxicity. Nausea and vomiting may occur with oral administration of mexiletine (Mexitil) or tocainide (Tonocard) — other class IB drugs. Pupillary changes and hypertension aren't signs of lidocaine toxicity, although visual changes and hypotension may occur as adverse reactions to class IB drugs.

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