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

Explanation: 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.

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Question Of The Day: Gastrointestinal Disorders

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

Explanation: 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.

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Question Of The Day: The Nursing Process

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

Explanation: 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.

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Question Of The Day: Gastrointestinal Disorders

Q. Which of the following laboratory findings are expected when a client has diverticulitis?

A. Elevated red blood cell count.
B. Decreased platelet count.
C. Elevated white blood cell count.
D. Elevated serum blood urea nitrogen concentration.




Correct Answer: C

Explanation: Because of the inflammatory nature of diverticulitis, the nurse would anticipate an elevated white blood cell count. The remaining laboratory findings are not associated with diverticulitis. Elevated red blood cell counts occur in clients with polycythemia vera or fluid volume deficit. Decreased platelet counts can occur as a result of aplastic anemias or malignant blood disorders, as an adverse effect of some drugs, and as a result of some heritable conditions. Elevated serum blood urea nitrogen concentration is usually associated with renal conditions.

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Question Of The Day: Gastrointestinal Disorders

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

Explanation: 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.

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Question Of The Day: Gastrointestinal Disorders

Q. Which of the following client statements indicates that the client with hepatitis B
understands discharge teaching?

A. "I will not drink alcohol for at least 1 year."
B. "I must avoid sexual intercourse."
C. "I should be able to resume normal activity in a week or two.
D. "Because hepatitis B is a chronic disease, I know I will always be jaundiced."


Correct Answer: A

Explanation: It is important that the client understand that alcohol should be avoided for at least 1 year after an episode of hepatitis. Sexual intercourse does not need to be avoided, but the client should be instructed to use condoms until the hepatitis B surface antigen measurement is negative. The client will need to restrict activity until liver function test results are normal; this will not occur within 1 to 2 weeks. Jaundice will subside as the client recovers; it is not a permanent condition.

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Question Of The Day: Gastrointestinal Disorders

Q. A nurse preceptor is working with a student nurse who is administering medications. Which statement by the student indicates an understanding of the action of an antacid?

A. "The action occurs in the stomach by increasing the pH of the stomach contents and decreasing pepsin activity."
B. "The action occurs in the small intestine, where the drug coats the lining and prevents further ulceration."
C. "The action occurs in the esophagus by increasing peristalsis and improving movement of food into the stomach."
D. "The action occurs in the large intestine by increasing electrolyte absorption into the system that decreases pepsin absorption."

Correct Answer: A

Explanation: The action of an antacid occurs in the stomach. The anions of an antacid combine with the acidic hydrogen cations secreted by the stomach to form water, thereby increasing the pH of the stomach contents. Increasing the pH and decreasing the pepsin activity provide symptomatic relief from peptic ulcer disease. Antacids don't work in the large or small intestine or in the esophagus.

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Question Of The Day: Antepartum Period

Q. A nurse is providing care for a pregnant client in her second trimester. Glucose tolerance test results show a blood glucose level of 160 mg/dl. The nurse should anticipate that the client will need to:

A. start using insulin.
B. start taking an oral antidiabetic drug.
C. monitor her urine for glucose.
D. be taught about diet.


Correct Answer: D

Explanation: The client will need to watch her overall diet intake to control her blood glucose level. The client's blood glucose level should be controlled initially by diet and exercise, rather than insulin. Oral antidiabetic drugs aren't used in pregnant clients. Urine glucose levels aren't an accurate indication of blood glucose levels.

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

Q. The nurse meets with the client and his wife to discuss depression and the client's medication. Which of the following comments by the wife would indicate that the nurse's teaching about disease process and medications has been effective?

A. "His depression is almost cured."
B. "He's intelligent and won't need to depend on a pill much longer."
C. "It's important for him to take his medication so that the depression will not return or get worse."
D. "It's important to watch for physical dependency on Zoloft."

Correct Answer: C

Explanation: Improved balance of neurotransmitters is achieved with medication. Clients with endogenous depression must take antidepressants to prevent a return or worsening of depressive symptoms. Depression is a chronic disease characterized by periods of remission; however, it is not cured. Depression is not dependent on the client's intelligence to will the illness away. Zoloft is not physically addictive.

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Question Of The Day: The Nursing Process

Q. A nurse is developing a nursing diagnosis for a client. Which information should she include?

A. Actions to achieve goals
B. Expected outcomes
C. Factors influencing the client's problem
D. Nursing history





Correct Answer: C

Explanation: A nursing diagnosis is a written statement describing a client's actual or potential health problem. It includes a specified diagnostic label, factors that influence the client's problem, and any signs or symptoms that help define the diagnostic label. Actions to achieve goals are nursing interventions. Expected outcomes are measurable behavioral goals that the nurse develops during the evaluation step of the nursing process. The nurse obtains a nursing history during the assessment step of the nursing process.

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Question Of The Day: Gastrointestinal Disorders

Q. Before an incisional cholecystectomy is performed, the nurse instructs the client in the correct use of an incentive spirometer. Why is incentive spirometry essential after surgery in the upper abdominal area?

A. The client will be maintained on bed rest for several days.
B. Ambulation is restricted by the presence of drainage tubes.
C. The operative incision is near the diaphragm.
D. The presence of a nasogastric tube inhibits deep breathing.

Correct Answer: B

Explanation: For clients with increased intracranial pressure (ICP), the head of the bed should be elevated to 30 degrees to promote venous outflow. Trendelenburg's position is contraindicated because it can raise ICP. Flat or neutral positioning is indicated when elevating the head of the bed would increase the risk of neck injury or airway obstruction. A side-lying position isn't specifically a therapeutic treatment for increased ICP.

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Question Of The Day: Neurosensory Disorders

Q. When planning care for a client with a head injury, which position should the nurse include in the care plan to enhance client outcomes?

A. Trendelenburg's
B. 30-degree head elevation
C. Flat
D. Side-lying



Correct Answer: B

Explanation: For clients with increased intracranial pressure (ICP), the head of the bed should be elevated to 30 degrees to promote venous outflow. Trendelenburg's position is contraindicated because it can raise ICP. Flat or neutral positioning is indicated when elevating the head of the bed would increase the risk of neck injury or airway obstruction. A side-lying position isn't specifically a therapeutic treatment for increased ICP.

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Nurses Win Mega Millions Lottery Ticket And Donate The Money

A group of NICU nurses from Missouri has once again proven that nurses are the most amazing creatures on the planet by donating the money they received after their combo Mega Millions ticket turned out to be a winner.

And even more heartwarming? They donated the money to two co-workers, one who just lost her son and one whose husband was recently diagnosed with cancer.

Earlier this month, the entire country was captivated with the premise of winning the largest-ever lottery jackpot, set at 1.6 billion dollars, and co-workers around the nation joined in on “office pools” to enter. The NICU nurses at Mercy Children’s Hospital in Missouri were no exception, with 126 nurses pooling their money together to enter the Mega Millions. And not only did they end up scoring one of five $10,000 winning tickets in their state, but their winning ticket was only one number away from winning the entire jackpot.

“We never thought in a million years we would win anything at all and then we came one number away from winning $1.6 billion,” NICU nurse Stephanie Brinkman, who organized the lottery pool, told KMOV4 news station.

Selfless acts of kindness

Despite being so close to the big jackpot, after taxes, the grand total of the winning ticket came to $7,200. Split between all 126 nurses, each nurse would only receive $56. So, instead of each of them pocketing enough to buy a few pizzas for their family, they once again decided to pool their resources together—this time, to make a difference for two people who really needed it. The nurses decided to keep the lottery winnings together and donate it all instead of keeping any small amount of money for themselves.

While their winnings may not have been a billion dollars, it was still enough to make a big difference and Brinkman was able to present a check to two of their co-workers, fellow nurse Gretchen Post and hospital neonatologist Casey Orellana.

The neonatologist’s husband, Phil, was recently diagnosed with sarcoma cancer, which has spread to his lungs, a news article described, and with him requiring care, along with the couple’s two young children, Orellana has been forced to drop her work hours by half. She told the news outlet that on the day the nurses gave her the check, she had been worrying about how she was going to pay for medication for her husband and that the gesture “touched her heart.”

The rest of the money went to Post, who lost her 17-year-old son, Jack, the youngest of her three children, to suicide on October 23rd. Jack died the night of the Mega Millions drawing and Post told her co-workers that the money will be used to pay for his funeral. “Jack always had a smile on his face. He did not lead anyone on that this would happen,” his grieving mother described.

Mercy Hospital is obviously very proud of its NICU nurses, who demonstrated the selfless giving and kind-hearted compassion that drives so much of the work they do each and every day and sent out a Tweet praising the staff:

“When it comes to incredible #nurses, we hit the jackpot!” the hospital wrote.

Praises for compassion

Those who read the story on Twitter couldn’t help but agree with the hospital, praising the nurses for not only the work they do daily in caring for the tiniest of patients but in showing the world the spirit of the season at the end of a very long year. Comments poured in in response to the tweet, saying:

◈ “What wonderful folks you are! Thank you for reminding me that there is still good in this world. My thoughts & prayers to Gretchen Post on the loss of her son, Jack. And to Casey & Phil Orellana, praying for your full & speedy recovery. God Bless! XOXO”
◈ “Wow! Grateful hearts, compassion for others. Nurses you are our role models. Thank you for this beautiful story at Christmas time too!”
◈ “You gals are AWESOME!!! I mean seriously, you dedicate your life to helping your fellow human beings and then you go one step further. There is so much good out there, I wish we heard more of it.”

We would have to say we agree and may we all be inspired by their act of giving this holiday season, billion-dollar lottery winners or not. 

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Question Of The Day: Basic Physical Care

Q. A man of Chinese descent is admitted to the hospital with multiple injuries after a motor vehicle accident. His pain is not under control. The client states, "If I could be with my people, I could receive acupuncture for this pain." The nurse should understand that acupuncture in the Asian culture is based on the theory that it:

A. Purges evil spirits.
B. Promotes tranquility.
C. Restores the balance of energy.
D. Blocks nerve pathways to the brain.

Correct Answer: C

Explanation: Acupuncture, like acumassage and acupressure, is performed in certain Asian cultures to restore the energy balance within the body. Pressure, massage, and fine needles are applied to energy pathways to help restore the body's balance. Acupuncture is not based on a belief in purging evil spirits. Although pain relief through acupuncture can promote tranquility, acupuncture is performed to restore energy balance. In the Western world, many researchers think that the gate-control theory of pain may explain the success of acupuncture, acumassage, and acupressure.

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Question Of The Day: Respiratory Disorders

Q. A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation?

A. Endotracheal suctioning
B. Encouragement of coughing
C. Use of a cooling blanket
D. Incentive spirometry



Correct Answer: A

Explanation: Endotracheal suctioning removes secretions as well as gases from the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and using an incentive spirometer improve oxygenation and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldn't be affected.

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Question Of The Day: Neurosensory Disorders

Q. A nurse is caring for a client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should the nurse perform?

A. Sit with the client for a few minutes.
B. Administer an analgesic.
C. Inform the nurse manager.
D. Call the physician immediately.



Correct Answer: D

Explanation: The nurse should notify the physician immediately because the headache may be an indication that the aneurysm is leaking. Sitting with the client is appropriate but only after the physician has been notified of the change in the client's condition. The physician will decide whether or not administration of an analgesic is indicated. Informing the nurse manager isn't necessary.

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Question Of The Day: Antepartum Period

Q. An anxious young adult is brought to the interviewing room of a crisis shelter, sobbing and saying that she thinks she is pregnant but does not know what to do. Which of the following nursing interventions is most appropriate at this time?

A. Ask the client about the type of things that she had thought of doing.
B. Give the client some ideas about what to expect to happen next.
C. Recommend a pregnancy test after acknowledging the client's distress.
D. Question the client about her feelings and possible parental reactions.

Correct Answer: C

Explanation: Before any interventions can occur, knowing whether the client is pregnant is crucial in formulating a plan of care. Asking the client about what things she had thought about doing, giving the client some ideas about what to expect next, and questioning the client about her feelings and possible parental reactions would be appropriate after it is determined that the client is pregnant.

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

Q. A client who took an overdose of Tylenol in a suicide attempt is transferred overnight to the psychiatric inpatient unit from the intensive care unit. The night shift nurse called the primary health care provider on call to obtain initial prescriptions. The primary health care provider prescribes the typical routine medications for clients on this unit: Milk of Magnesia, Maalox and Tylenol as needed. Prior to implementing the prescriptions, the nurse should?

A. Ask the primary health care provider about holding all the client's PM prescriptions.
B. Question the primary health care provider about the Tylenol prescription.
C. Request a prescription for a medication to relieve agitation.
D. Suggest the primary health care provider write a prescription for intravenous fluids.

Correct Answer: B

Explanation: The nurse should question the Tylenol order because the client overdosed on Tylenol, and that analgesic would be contraindicated as putting further stress on the liver. There is no need to hold the PM Milk of Magnesia or Maalox. There is no indication that the client is agitated or needs medication for agitation. There is little likelihood that the client needs an IV after being transferred out of an intensive care unit, as the client will be able to take oral fluids.

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Question Of The Day: School-age Child

Q. A 10-year-old child diagnosed with acute glomerulonephritis is admitted to the pediatric unit. The nurse should ensure that which action is a part of the child's care?

A. Taking vital signs every 4 hours and obtaining daily weight
B. Obtaining a blood sample for electrolyte analysis every morning
C. Checking every urine specimen for protein and specific gravity
D. Ensuring that the child has accurate intake and output and eats a high-protein diet

Correct Answer: A

Explanation: Because major complications — such as hypertensive encephalopathy, acute renal failure, and cardiac decompensation — can occur, monitoring vital signs (including blood pressure) is an important measure for a child with acute glomerulonephritis. Obtaining daily weight and monitoring intake and output also provide evidence of the child's fluid balance status. Sodium and water restrictions may be ordered depending on the severity of the edema and the extent of impaired renal function. Typically, protein intake remains normal for the child's age and is only increased if the child is losing large amounts of protein in the urine. Checking urine specimens for protein and specific gravity and daily monitoring of serum electrolyte levels may be done, but their frequency is determined by the child's status. These actions are less important nursing measures in this situation.

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Question Of The Day: The Nursing Process

Q. A client has the following arterial blood gas values: pH, 7.30; PaO2, 89 mm Hg; PaCO2, 50 mm Hg; and HCO3–, 26 mEq/L. Based on these values, the nurse should suspect which condition?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

Correct Answer: A

Explanation: This client has a below-normal (acidic) blood pH value and an above-normal partial pressure of arterial carbon dioxide (PaCO2) value, indicating respiratory acidosis. In respiratory alkalosis, the pH value is above normal and the PaCO2 value is below normal. In metabolic acidosis, the pH and bicarbonate (HCO3–) values are below normal. In metabolic alkalosis, the pH and HCO3– values are above normal.

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Question Of The Day: Basic Physical Care

Q. The nurse walks into a client's room to administer the 9:00 a.m. medications and notices that the client is in an awkward position in bed. What is the nurse's first action?

A. Ask the client his name.
B. Check the client's name band.
C. Straighten the client's pillow behind his back.
D. Give the client his medications.



Correct Answer: C

Explanation: The nurse should first help the client into a position of comfort even though the primary purpose for entering the room was to administer medication. After attending to the client's basic care needs, the nurse can proceed with the proper identification of the client, such as asking the client his name and checking his armband, so that the medication can be administered.

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Question Of The Day: Neurosensory Disorders

Q. A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should:

A. provide instructions on eye patching.
B. assess the client's visual acuity.
C. demonstrate eyedrop instillation.
D. teach about intraocular lens cleaning.




Correct Answer: C

Explanation: Eyedrop instillation is a critical component of self-care for a client with glaucoma. After demonstrating eyedrop instillation to the client and family, the nurse should verify their ability to perform this measure properly. An eye patch isn't necessary unless the client has undergone surgery. Visual acuity assessment isn't necessary before discharge. Intraocular lenses aren't implanted in clients with glaucoma.

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Question Of The Day: Psychotic Disorders

Q. A client with bipolar disorder, manic phase, just sat down to watch television in the lounge. As the nurse approaches the lounge area, the client states, "The sun is shining. Where is my son? I love Lucy. Let's play ball." The client is displaying:

A. Concreteness.
B. Flight of ideas.
C. Depersonalization.
D. Use of neologisms.

Correct Answer: B

Explanation: The client is demonstrating flight of ideas, or the rapid, unconnected, and often illogical progression from one topic to another. Concreteness involves interpreting another person's words literally. Depersonalization refers to feelings of strangeness concerning the environment or the self. A neologism is a word made up by a client.

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Study Finds That Post-Birth Massage Could Decrease Opioid Usage For Moms

A new study by the Journal of Obstetrical, Gynecological and Neonatal Nurses has released an important finding that could change the way that women are treated for pain after C-sections in the hospital. The study, which examined 165 mothers in the Northeastern United States who had undergone unplanned C-sections, found that using massage as a post-op pain management strategy can be effective.

Massages in the hospital? Yes, please!

How it worked

The study was performed at teaching hospitals in the Northeast and aimed to specifically examine how post-operative massage might impact a woman’s pain after a C-section. To complete the study, women in the hospitals were divided into three different groups: 1) One group of women all received 20-minute massages 2) One group got normal post-birth care and 3) One group was treated to 20 minutes of individualized attention (I’m assuming this meant something like a health professional talking to them, perhaps a distraction technique or someone to just listen to their concerns?)

Each patient in the program completed a questionnaire before their intervention and again one hour later to gather data about their overall pain, stress, and level of relaxation. The study authors also gathered the exact pain rating and medication administration times from the patients’ medical charts to correlate with the data.

Across the board, the study found that the group who received the post-birth massages reported decrease stress levels, decreased pain levels, and decreased opioid usage for mothers who had experienced received C-sections. Not only did the mothers report the decreased levels of stress and pain, but their medical charts supported the findings, with nurses’ charts showing that the mothers were able to control their pain more effectively with less medication.

Why it’s important 

Studies have found that many women are being prescribed too many opioids after receiving C-sections in the hospital and with the opioid crisis in America still a serious concern, it is an important healthcare initiative to provide effective pain management with lower risks of opioid dependency. There are, so far, no direct studies proving any correlation between the number of opioids prescribed to mothers specifically following a C-section and a later risk for dependency, but it is worrisome that women may be unnecessarily exposed to any risk at all. 

There has been a recent push to look for more effective strategies for pain management for women undergoing C-sections, such as medication-free interventions like massage, to patient-controlled pain pumps that may decrease the total amount of opioids delivered post-operatively.

What comes next

Odds are, it will take some time before doctors and midwives are routinely prescribing massages for patients fresh from the OR, but as a nurse, you could help encourage your patient and her partner, if applicable, to incorporate massage into her pain management strategy after birth. As her nurse, it is your job to help give her the best care possible and empower her to take her health into her own hands, or in this case, perhaps a willing partner’s hands.

Three options you may try:

1. Share the study findings with your patient. She may be surprised to see massage being so effective, especially for C-section pain.

2. Encourage her partner, if applicable, to perform a safe massage on the mother. Instruct him or her to avoid any medically-affected areas, such as the stomach area and epidural site, of course.

3. Offer to rub your patient’s feet. Many patient’s feet are swollen and uncomfortable after months of pregnancy and lots of fluid through surgery and IVs, so she will probably appreciate a nice foot rub. It’s a small gesture you can do to make a difference.

As the healthcare community works together to help curb the opioid crisis, new and alternative ways of pain management will become more important than ever. And if a completely free, safe, and healthy intervention like a 20-minute massage can help a woman be comfortable after going through a C-section, we should all be encouraging it. My only request would be that doctors also consider a recommendation for a prescription for maternal massages for say, the next 18 years because my kids have definitely continued to cause me a heck of a lot of pain.

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Question Of The Day: Antepartum Period

Q. When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which of the following points?

A. Halfway between the client's symphysis pubis and umbilicus.
B. At about the level of the client's umbilicus.
C. Between the client's umbilicus and xiphoid process.
D. Near the client's xiphoid process and compressing the diaphragm.

Correct Answer: B

Explanation: Measurement of the client's fundal height is a gross estimate of fetal gestational age. At 20 weeks' gestation, the fundal height should be at about the level of the client's umbilicus. The fundus typically is over the symphysis pubis at 12 weeks. A fundal height measurement between these two areas would suggest a fetus with a gestational age between 12 and 20 weeks. The fundal height increases approximately 1 cm/week after 20 weeks' gestation. The fundus typically reaches the xiphoid process at approximately 36 weeks' gestation. A fundal height between the umbilicus and the xiphoid process would suggest a fetus with a gestational age between 20 and 36 weeks. The fundus then commonly returns to about 4 cm below the xiphoid owing to lightening at 40 weeks. Additionally, pressure on the diaphragm occurs late in pregnancy. Therefore, a fundal height measurement near the xiphoid process with diaphragmatic compression suggests a fetus near the gestational age of 36 weeks or older.

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Why The CDC is “Okay” With No Gloves To Administer Vaccines

A few weeks ago, I took my oldest daughter in for a flu shot. I signed the paperwork, looked over the informational pamphlet, and reassured her when the medical assistant brought the imposing-looking syringe into the room.

And then, I cringed when she proceeded to shut the door behind her, pull open a band-aid and stick it to her bare hand, then jab my daughter with the shot, all without wearing any gloves. I thought back to my time as a nurse at the hospital—had I ever administered a vaccine without wearing gloves? Was it required? Was I overreacting in thinking she should wear gloves?

I honestly couldn’t think of a time when I hadn’t worn gloves to give a vaccine, so I piped up and said something to the assistant, not-very-kindly suggested that she should be sure to wear gloves next time. But when I got home and did some research, I sheepishly realized that I was the one who had been wrong, not her. Turns out, gloves aren’t required to give vaccinations and I was actually a big ol’ jerk to the poor young woman.

Oops.

According to the Centers for Disease Control (CDC) and Administration’s Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP), wearing gloves is not required for healthcare workers who are administering vaccinations. The official guidelines state: “Occupational Safety and Health Administration (OSHA) regulations do not require gloves to be worn when administering vaccinations unless persons administering vaccinations have open lesions on their hands or are likely to come into contact with a patient’s body fluids.”

The rules on vaccines + gloves

So, if gloves aren’t required, what is required? Well, basic handwashing and clean hygiene, essentially. As the guidelines state: “Persons administering vaccinations should follow appropriate precautions to minimize risk for disease exposure and spread. Hands should be cleaned with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing vaccines for administration and between each patient contact.”

Kasey Baylis, 26, a public health nurse for Oakland County in Michigan who works with the Vaccine for Children program as a partner provider and immunization nurse educator, tells Nurse.org that she has given “hundreds of shots” in her lifetime as a nurse.

With a job that literally entails making sure vaccines are stored, handled, and administered correctly, Baylis is a woman who knows about vaccine safety. She explains that the way she was trained and the way she continues to train others on vaccine administration is that the administrator should properly wash his/her hands and use aseptic technique when administering the vaccine (i.e. using alcohol to clean the injection site, not contaminating the site after cleaned and not contaminating the needle), but that gloves are not required unless the nurse or healthcare worker has any open lesions or is likely to come in contact with the person's bodily fluids.

Gloves aren’t really that clean anyways

Baylis also points out that if a vaccine is administered correctly, there should be little, if any, bodily fluid exposure and that contrary to popular belief, the gloves sitting in an open box in a doctor’s office or health clinic really aren’t all that much more sanitary than a clean pair of hands. In fact, the gloves may even contain more germs than clean hands. “Gloves are not required and generally do not provide any additional benefit to the patient,” she adds.

If gloves are worn, the administrator is still required to wash his or her hands between injections and patients, to remove any germs that may have transferred from the gloves to their hands. And many times, the only benefit to wearing gloves during vaccine administration is for protection for the administrator, not the patient.

Should you ask for gloves if you want them? 

That being said, if you are just plain uncomfortable with the idea of a healthcare worker giving you or your family a vaccine without wearing gloves, Baylis encourages the idea of speaking up and asking them to don a pair of gloves before an injection, simply because in her mind, if that means one more person is vaccinated against a preventable disease, then it’s worth it.

“When it comes to vaccines and all of the negative propaganda out there, I feel that gloves should not be another barrier to being immunized,” she says. “Adhering to the ACIP recommended schedule is your best protection against vaccine-preventable diseases that still exist today, so ultimately, if that means wearing gloves for a patient than I would gladly do it!” 

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Question Of The Day: Psychotic Disorders

Q. The client is taking risperidone (Risperdal) to treat the positive and negative symptoms of schizophrenia. Improvement of which of the following negative symptoms indicate the drug is effective?

A. Abnormal thought form.
B. Hallucinations and delusions.
C. Bizarre behavior.
D. Asocial behavior and anergia.


Correct Answer: D

Explanation: Asocial behavior, anergia, alogia, and affective flattening are some of the negative symptoms of schizophrenia that may improve with risperidone therapy. Abnormal thought form is a positive symptom of schizophrenia. Hallucinations and delusions are positive symptoms of schizophrenia. Bizarre behavior is a positive symptom of schizophrenia.

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

Q. The wife of a 67-year-old client who has been taking imipramine (Tofranil) for 3 days asks the nurse why her husband isn't better. The nurse should tell the wife:

A. "It takes 2 to 4 weeks before the full therapeutic effects are experienced."
B. "Your husband may need an increase in dosage."
C. "A different antidepressant may be necessary."
D. "It can take 6 weeks to see if the medication will help your husband."

Correct Answer: A

Explanation: Imipramine, a tricyclic antidepressant, typically requires 2 to 4 weeks of therapy before the full therapeutic effects are experienced. Because the client has been taking the drug for only 3 days, it is too soon to determine if the current dosage of imipramine is effective. It is also too soon to consider taking another antidepressant.

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Question Of The Day: School-age Child

Q. After staying several hours with her 9-year-old daughter who is admitted to the hospital with an asthma attack, the mother leaves to attend to her other children. The child exhibits continued signs and symptoms of respiratory distress. Which of the following findings should lead the nurse to believe the child is experiencing anxiety?

A. Not able to get comfortable.
B. Frequent requests for someone to stay in the room.
C. Inability to remember her exact address.
D. Verbalization of a feeling of tightness in her chest.

Correct Answer: B

Explanation: A 9-year-old child should be able to tolerate being alone. Frequently asking for someone to be in the room indicates a degree of psychological distress that, at this age, suggests anxiety. The inability to get comfortable is more characteristic of a child in pain. Inability to answer questions correctly may reflect a state of anoxia or a lack of knowledge. Tightness in the chest occurs as a result of bronchial spasms.

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Question Of The Day: Medication and I.V. Administration

Q. A nurse is helping a physician insert a subclavian central line. After the physician has gained access to the subclavian vein, he connects a 10-ml syringe to the catheter and withdraws a sample of blood. He then disconnects the syringe from the port. Suddenly, the client becomes confused, disoriented, and pale. The nurse suspects an air embolus. She should:

A. place the client in a supine position and prepare to perform cardiopulmonary resuscitation.
B. place the client in high-Fowler's position and administer supplemental oxygen.
C. turn the client on his left side and place the bed in Trendelenburg's position.
D. position the client in the shock position with his legs elevated.

Correct Answer: C

Explanation: A nurse who suspects an air embolism should place the client on his left side and in Trendelenburg's position. Doing so allows the air to collect in the right atrium rather than enter the pulmonary system. The supine position, high-Fowler's position, and the shock position are therapeutic for other situations but not for air embolism.

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Question Of The Day: Basic Physical Care

Q. A client with burns on his groin has developed blisters. As the client is bathing, a few blisters break. The best action for the nurse to take is to:

A. remove the raised skin because the blister has already broken.
B. wash the area with soap and water to disinfect it.
C. apply a weakened alcohol solution to clean the area.
D. clean the area with normal saline solution and cover it with a protective dressing.

Correct Answer: D

Explanation: The nurse should clean the area with a mild solution such as normal saline, and then cover it with a protective dressing. Soap and water and alcohol are too harsh. The body's first line of defense broke when the blisters opened; removing the skin exposes a larger area to the risk of infection.

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Question Of The Day: Antepartum Period

Q. A pregnant client in her third trimester is started on chlorpromazine (Thorazine) 25 mg four times daily. Which of the following instructions is most important for the nurse to include in the client's teaching plan?

A. "Don't drive because there's a possibility of seizures occurring."

B. "Avoid going out in the sun without a sunscreen with a sun protection factor of 25."

C. "Stop the medication immediately if constipation occurs."

D. "Tell your doctor if you experience an increase in blood pressure."

Correct Answer: B

Explanation: Chlorpromazine is a low-potency antipsychotic that is likely to cause sun-sensitive skin. Therefore the client needs instructions about using sunscreen with a sun protection factor of 25 or higher. Typically, chlorpromazine is not associated with an increased risk of seizures. Although constipation is a common adverse effect of this drug, it can be managed with diet, fluids, and exercise. The drug does not need to be discontinued. Chlorpromazine is associated with postural hypotension, not hypertension. Additionally, if postural hypotension occurs, safety measures, such as changing positions slowly and dangling the feet before arising, not stopping the drug, are instituted.

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Question Of The Day: Respiratory Disorders

Q. The nurse has administered aminophylline to a client with emphysema. The medication is effective when there is:

A. Relief from spasms of the diaphragm.
B. Relaxation of smooth muscles in the bronchioles.
C. Efficient pulmonary circulation.
D. Stimulation of the medullary respiratory center.


Correct Answer: B

Explanation: Aminophylline, a bronchodilator that relaxes smooth muscles in the bronchioles, is used in the treatment of emphysema to improve ventilation by dilating the bronchioles. Aminophylline does not have an effect on the diaphragm or the medullary respiratory center and does not promote pulmonary circulation.

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5 Ways to Avoid Medication Errors

Nurses administer hundreds of medications to their patients on a regular basis and are responsible for patient safety. Thus, medication administration becomes a major challenge, as nurses struggle to keep up with all the latest pharmaceutical advances and medications on the market.

According to the American Nurses Association (2017), medication errors are one of the leading causes of injury to hospital patients. In many cases, medication errors are preventable, and it requires skillful nursing judgement to identify errors and potential risks before they happen.

To help you avoid medication errors and keep your patients safe, you must master the five rights of medication administration:

RIGHT MEDICATION

The first thing you want to consider before administering a medication is your complete understanding of the medication. The indications, side effects, and expected outcomes must make sense to you before proceeding with giving the medication to a patient. Once you have a good understanding of the medication, you must then check the medication order against the medication that you obtained at least three times before giving it so you will be sure that you have the correct medication.

RIGHT PATIENT

It is important for you to check your patient’s identity against two identifiers. For patients who are alert and oriented, you should ask them for their name and date of birth, and then check that it matches the name on the order, or electronic medication administration record (eMAR). If your patient is unable to verbalize their name and date of birth, then you should identify them by using their ID wristband and checking it against the chart to confirm that you have the correct patient. Most facilities now use bedside medication verification, which utilizes barcode scanning to confirm or deny the correct patient has been selected.

RIGHT DOSE

By checking the ordered medication dose against the medication that you obtained at least three times, you will be sure that you have the correct dose. Some medications will come in concentrations that require wasting, splitting, or dividing the medication to end with the appropriate dose. If you are unsure of how to accomplish this task, please seek assistance from a coworker or a facility pharmacist.

RIGHT TIME

Most medications are ordered with specific times to be administered, and it is important that you can be able to identify a safe administration schedule. By checking the ordered time and frequency of the medication against the medication administration record, you will be able to determine if it is safe to give the next dose of medication. Overdosing patients with pain medication is one of the most common medication errors. For example, if your patient has IV pain medication as needed every four hours, you need to check the administration record prior to giving the medication to see if the last time the patient received the pain medication.

RIGHT ROUTE

There are many routes for administering drugs. Remember, oral meds are not to be given parenterally. Carefully read the orders before you give it to your patients. Routes for administering medications may include oral, parenteral, topical, enteral, inhalation, drops in the eyes or ears, or through injection. If you are uncertain of how a medication should be administered, or if the order is unclear, seek out additional clarification. Asking for clarification when in doubt is one of the SAFEST things a nurse can do for their patients.

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Question Of The Day: Neurosensory Disorders

Q. Which of the following is an early symptom of glaucoma?

A. Hazy vision.
B. Loss of central vision.
C. Blurred or "sooty" vision.
D. Impaired peripheral vision.





Correct Answer: D

Explanation: In glaucoma, peripheral vision is impaired long before central vision is impaired. Hazy, blurred, or distorted vision is consistent with a diagnosis of cataracts. Loss of central vision is consistent with senile macular degeneration but it occurs late in glaucoma. Blurred or "sooty" vision is consistent with a diagnosis of detached retina.

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Question Of The Day: Postpartum Period

Q. The nurse is caring for several mother-baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains?

A. G 4, P 1 client who is breastfeeding her infant.
B. G 3, P 3 client who is breastfeeding her infant.
C. G 2, P 2 cesarean client who is bottle-feeding her infant.
D. G 3, P 3 client who is bottle-feeding her infant.

Correct Answer: B

Explanation: The major reasons for afterbirth pains are breast-feeding, high parity, overdistended uterus during pregnancy, and a uterus filled with blood clots. Physiologically, afterbirth pains are caused by intermittent contraction and relaxation of the uterus. These contractions are stronger in multigravidas in order to maintain a contracted uterus. The release of oxytocin when breast-feeding also stimulates uterine contractions. There is no data to suggest any of these clients has had an overdistended uterus or currently has clots within the uterus. The G 3, P 3 client who is breast-feeding has the highest parity of the clients listed, which—in addition to breast-feeding—places her most at risk for afterbirth pains. The G 2, P 2 postcesarean client may have cramping but it should be less than the G 3, P 3 client. The G 3, P 3 client who is bottle-feeding would be at risk for afterbirth pains because she has delivered several children, but her choice to bottle-feed reduces her risk of pain.

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Question Of The Day: Antepartum Period

Q. A pregnant client in her third trimester is started on chlorpromazine (Thorazine) 25 mg four times daily. Which of the following instructions is most important for the nurse to include in the client's teaching plan?

A. "Don't drive because there's a possibility of seizures occurring."
B. "Avoid going out in the sun without a sunscreen with a sun protection factor of 25."
C. "Stop the medication immediately if constipation occurs."
D. "Tell your doctor if you experience an increase in blood pressure."

Correct Answer: B

Explanation: Chlorpromazine is a low-potency antipsychotic that is likely to cause sun-sensitive skin. Therefore the client needs instructions about using sunscreen with a sun protection factor of 25 or higher. Typically, chlorpromazine is not associated with an increased risk of seizures. Although constipation is a common adverse effect of this drug, it can be managed with diet, fluids, and exercise. The drug does not need to be discontinued. Chlorpromazine is associated with postural hypotension, not hypertension. Additionally, if postural hypotension occurs, safety measures, such as changing positions slowly and dangling the feet before arising, not stopping the drug, are instituted.

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Question Of The Day: School-age Child

Q. A 7 year old with a history of tonic-clonic seizures has been actively seizing for 10 minutes. The child weighs 22 kg and currently has an intravenous (IV) line of D5 1/2 NS + 20 meq KCL/L running at 60 ml/hr. Vital signs are a temperature of 38 degrees C, heart rate of 120, respiratory rate of 28, and oxygen saturation of 92%. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for:

A. Rectal diazepam (Diastat).
B. IV lorazepam (Ativan).
C. Rectal acetaminophen (Tylenol).
D. IV fosphenytoin.

Correct Answer: B

Explanation: IV ativan is the benzodiazepine of choice for treating prolonged seizure activity. IV benzodiazepines potentiate the action of the gamma-aminobutyric acid (GABA) neurotransmitter, stopping seizure activity. If an IV line is not available, rectal Diastat is the benzodiazepine of choice. The child does have a low-grade fever; however, this is likely caused by the excessive motor activity. The primary goal for the child is to stop the seizure in order to reduce neurologic damage. Benzodiazepines are used for the initial treatment of prolonged seizures. Once the seizure has ended, a loading dose of fosphenytoin or phenobarbital is given.

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Question Of The Day: Foundations of Psychiatric Nursing

Q. A client was talking with her husband by telephone, and then she began swearing at him. The nurse interrupts the call and offers to talk with the client. She says, "I can't talk about that bastard right now. I just need to destroy something." Which of the following should the nurse do next?

A. Tell her to write her feelings in her journal.
B. Urge her to talk with the nurse now.
C. Ask her to calm down or she will be restrained.
D. Offer her a phone book to "destroy" while staying with her.

Correct Answer: D

Explanation: At this level of aggression, the client needs an appropriate physical outlet for the anger. She is beyond writing in a journal. Urging the client to talk to the nurse now or making threats, such as telling her that she will be restrained, is inappropriate and could lead to an escalation of her anger.

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Question Of The Day: The Nursing Process

Q. A client complains of severe abdominal pain. To elicit as much information as possible about the pain, the nurse should ask:

A. "Do you have the pain all the time?"
B. "Can you describe the pain?"
C. "Where does it hurt the most?"
D. "Is the pain stabbing like a knife?"




Correct Answer: B

Explanation: Asking an open-ended question such as "Can you describe the pain?" encourages the client to describe any and all aspects of the pain in his own words. The other options are likely to elicit less information because they're more specific and would limit the client's response.

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