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: Adolescent

Q. A 17-year-old client who has been taking an antidepressant for six weeks has returned to the clinic for a medication check. When the nurse talks with the client and her mother, the mother reports that she has to remind the client to take her antidepressant every day. The client says, "Yeah, I'm pretty bad about remembering to take my meds, but I never miss a dose because Mom always bugs me about taking it." Which of the following responses would be effective for the nurse to make to the client?

A. "It's a good thing your mom takes care of you by reminding you to take your meds."
B. "It seems there are some difficulties with being responsible for your medications that we need to address".
C. "You'll never be able to handle your medication administration at college next year if you're so dependent on her."
D. "I'm surprised your mother allows you to be so irresponsible."

Correct Answer: B

Explanation: The client and mother need to address the issue of responsibility for medication administration and only Option 2 opens that subject to discussion. Option 1 reinforces the mother's over-involvement in medication taking. Options 3 and 4 make negative comments about the client and mother that are unlikely to engage them in problem-solving about the matter.

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Question Of The Day: School-age Child

Q. Which of the following measures should the nurse include in the care plan for a child who is receiving high-dose methotrexate (amethopterin) therapy?

A. Keeping the child in a fasting state.
B. Obtaining a white blood cell (WBC) count.
C. Preparing for radiography of the spinal canal.
D. Collecting a specimen for urinalysis.



Correct Answer: B

Explanation: Methotrexate is not highly toxic in low doses but may cause severe leukopenia at higher doses. It is customary and recommended for blood tests to be done before therapy to provide a baseline from which to study the effects of the drug on WBC count. Maintaining a fasting state, radiography of the spinal canal, and urinalysis are not necessary when this drug is administered.

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Question Of The Day: Preschooler

Q. A 4-year-old boy presents to the emergency department. His father tearfully reports that he was in the driveway and had his son on his shoulders when the child began to fall. The father grabbed him by the leg, swinging him toward the grass to avoid landing on the pavement. As the father swung his son, the child hit his head on the driveway and twisted his right leg. After a complete examination, it is determined that the child has a skull fracture and a spiral fracture of the femur. Which of the following actions should the nurse take?

A. Restrict the father's visitation.
B. Notify the police immediately.
C. Refer the father for parenting classes.
D. Record the father's story in the chart.

Correct Answer: D

Explanation: The father's story is consistent with the injuries incurred by the child; therefore, the nurse should document the cause of injury. There is no need to restrict the father's visitation, because the injuries sustained by the child are consistent with the explanation given. The police need to be notified only if there is suspicion of child abuse. The injuries incurred by this child appear accidental. There is no need to refer the father for parenting classes. The father seems upset about the accident and will not likely repeat such reckless behavior. The nurse should educate the father, however, regarding child safety.

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Question Of The Day: Toddler

Q. A nurse should expect a 3-year-old child to be able to perform which action?

A. Ride a tricycle
B. Tie his shoelaces
C. Roller-skate
D. Jump rope





Correct Answer: A

Explanation: The nurse should expect the child to ride a tricycle because, at age 3, gross motor development and refinement in eye-hand coordination enable a child to perform such an action. The fine motor skills required to tie shoelaces and the gross motor skills required for roller-skating and jumping rope develop around age 5.

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Question Of The Day: Infant

Q. During assessment of a small infant admitted with a diagnosis of meningitis, the infant becomes less responsive to stimuli and exhibits bradycardia, slight hypertension, irregular respirations, and a temperature of 103.2° F (39.6° C). The infant's fontanel is more tense than at the last assessment. What should the nurse do first?

A. Ask another nurse to verify the findings.
B. Notify the primary care provider of the findings.
C. Raise the head of the bed.
D. Administer an antipyretic.

Correct Answer: C

Explanation: Signs such as a decrease in the level of consciousness, bradycardia, hypertension, irregular respirations, and a tense fontanel strongly suggest increased intracranial pressure. The first action should be to attempt to lower the pressure by raising the head of the bed, which should improve venous return and decrease the pressure. Asking another nurse to verify the findings is unnecessary because temperature, pulse, and respirations are fairly objective data and not subject to interpretation. Additionally, asking for verification would waste valuable time. After elevating the infant's head by raising the bed, the nurse can notify the primary care provider and administer the antipyretic.

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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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ICN Calls for Better Pay of World’s Nurses to Make Profession More Attractive

Nurses across the world have experienced a fall in their purchasing power in real terms over the past ten years, according to a report recently released by the International Centre on Nurse Migration (ICNM). This was the first time the International Council of Nurses (ICN) used salary data collected through its member associations to determine global trends over time.

The ICNM analyzed pay data from various countries for the years 2006-2016. This information is collected annually from member associations by the International Council of Nurses International and Asian Workforce Forums. The fall in nurses’ real-time purchasing power and even stagnation and decline in salaries over the past two years in some Asian countries has serious implications for retention and recruitment in the profession where there is already a concerning shortage globally.

The shortage of nurses is due not only to the aging of the nursing force, but nurses are also being driven to leaving the profession because of heavy workloads, low salaries, and poor working conditions. Despite this, it appears that governments are not using wages as a motivator to improve the attractiveness of the profession.

“With a predicted shortage of nine million nurses by 2030, and global health priorities such as Universal Health Coverage and NCDs it is vital for governments to invest in nursing and address issues to recruit and retain nurses, such as starting salaries and prospects of reasonable career and pay progression,” said Howard Catton, ICN Director of Nursing and Health Policy and author of the report.

“…INVESTMENT IN HEALTH SERVICES IS NECESSARY FOR ANY COUNTRY’S ECONOMIC PROSPERITY RATHER THAN BEING A DRAG ON ECONOMIC GROWTH.”

The recent UN Commission on Health Employment and Economic Growth stressed that investment in health services is necessary for any country’s economic prosperity rather than being a drag on economic growth. Governments are responsible for the safety and security of their citizens and a shortage of healthcare professionals has serious consequences for human health and mortality.

It appeared that investment in nursing stalled after the global recession in 2008 as governments focused on reducing debt. With the return of economic growth, there had been some improvement over the past two years in starting salary levels for nurses in a number of countries, but this was limited. In other countries, the pay levels are stagnant or even falling back. At the same time, it appeared that physicians had not been subjected to the same pay restraints.

While politicians make the decisions that affect nurse’s pay, potential recruits and nurses within the profession will make choices based on how their daily lives are affected by their present and future economic prospects. “Given the relative fall in nurses’ purchasing power over the last 10 years, there is an urgent need to give the world’s nurses a pay rise and better working conditions in order to address the attractiveness of the profession,” the report states in its conclusion.

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

Q. The nurse administers an intradermal injection to a client. Proper technique has been used if the injection site demonstrates which of the following?

A. Minimal leaking.
B. No swelling.
C. Tissue pallor.
D. Evidence of a bleb or wheal.



Correct Answer: D

Explanation: A properly administered intradermal injection shows evidence of a bleb or wheal at the injection site. There should be no leaking of medication from the bleb; it needs to be absorbed into the tissue. Lack of swelling at the injection site means that the injection was given too deeply. The presence of tissue pallor does not indicate that the injection was given correctly.

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Medication Error: Nurse Accused Of Reusing Syringes - Hundreds Tested For HI

As nurses, medication errors are an everyday threat on the job. We follow procedures like checking and rechecking, scanning wristbands, stating names aloud, and adhering to updated policies on our units. However, every time we encounter a medication, there is a potential for a deadly error. 

An oversite with best practices?

According to the Cherokee Phoenix, a nurse working at W.W. Hastings Hospital committed a very serious medication error that exposed 186 patients to a host of infectious diseases, including HIV and Hepatitis C. The nurse, who has not been named, used the same syringe and medication vial to inject multiple IV bags between patients. She drew out the medication from its vial using a syringe and injected the medication into the patient’s already-hooked up IV bag. She then repeated this process over and over on all of the patients. By injecting the syringe directly into the patient’s IV bag and then inserting it back into the same medication vial, she was potentially sharing countless pathogens that may have been present in the IV bag and tubing among all of the patients that received the medication after.

However serious her medication error was, a spokesperson for the Cherokee Nation Health Services noted that the possibility that it had caused a direct infection was low. “Patients were never directly in contact with any needle,” the spokesperson told the publication. “In all instances, medication was administered into an IV bag or tubing. The likelihood of bloodborne pathogens traveling up the lines into an IV bag or IV tubing to cause cross contamination from using the same syringe is extremely remote.”

Patient Outcomes

To date, 64 of the 186 patients involved in the incident have received blood testing, with no one showing any exposure. The Cherokee Phoenix reported that the facility called the medication error an “employment matter,” with no news on whether the nurse had received any corrective action or if the individual was still employed with the health facility.

A potentially life-altering error like this one begs the question of: how do mistakes like this happen? Unfortunately, it can be incredibly difficult to say. There could be anything from a nurse being overly pressed for time that day, inadequate policies in the facility, a lack of knowledge on how to administer that medication, to an employee who is not a good fit for the job. But no matter what the exact situation is, as nurses, there are a few things we can do to reduce medication error in our interactions with patients, such as:

Tips To Reduce Medication Errors

1. When in doubt, ask. Don’t assume you know the proper way to administer a medication, especially if it’s something new to you. I once heard a nursing professor tell us as students that it’s never the new nurses that ask questions that scared her; it was the ones who didn’t. Taking the time to double-check with an experienced nurse or reviewing your facility medication administration policy for that specific medication could mean the difference between life and death.

2. Never try to cut corners when it comes to meds. Medication administration is an area that, as a nurse, you are primarily responsible for. There are so many times I can think of when I was tempted to “speed things along” while giving medications: do I really need to check her armband again? Do I really need to clean that IV port again? I know I have the right med in my pocket…right? And despite my inherent tendency to be lazy, every time, I was glad to have taken the time to double check again. We have all heard the horror stories about medication errors and the majority of the time, they appear to be “simple” errors that could have easily been prevented if the nurse had taken extra time to be safe.

3. Keep each other accountable. Most of the time, we aren’t working as solo units as a nurse. We are surrounded by co-workers and other staff members and the truth is, we need each other. If you see someone making a potential mistake, don’t be afraid to speak up. Not only could that potentially save a life, but it creates a culture where your co-workers can return the favor to you.

4. Know that you are not above a medication error. The best way to prevent a medication error? Stay humble. No one is immune to making mistakes and while we may read stories such as this one and think, “That will never happen to me!”, the truth is, a medication error can happen to anyone. Staying humble and being aware of the ways that we put ourselves at risk for an error, such as being understaffed, taking on too much at once, and skipping corners here there, can help us prevent them from happening in the first place. 

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Question Of The Day: Basic Psychosocial Needs

Q. An Arab client with pneumonia has been admitted to the health care facility. What should the nurse avoid while conducting the interview of the client?

A. Giving a light handshake.
B. Maintaining eye contact.
C. Asking about the client's symptoms.
D. Asking about the client's medical history.



Correct Answer: B

Explanation: While interviewing an Arab client, the nurse should avoid maintaining eye contact. In Arab culture, maintaining eye contact is sexually suggestive; if the nurse does so during the interview, it may give the wrong message to the client. However, the nurse may give a light handshake or ask about the client's personal life and medical history during the interview.

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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: Genitourinary Disorders

Q. A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

A. nausea and vomiting.
B. dyspnea and cyanosis.
C. fatigue and weakness.
D. thrush and circumoral pallor.



Correct Answer: C

Explanation: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

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Question Of The Day: Respiratory Disorders

Q. A 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: 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: Endocrine and Metabolic Disorders

Q. A 75-year-old client is newly diagnosed with diabetes. The nurse is instructing him about blood glucose testing. After the session, the client states, "I can't be expected to remember all this stuff." The nurse should recognize this response as most likely related to which of the following?

A. Moderate to severe anxiety.
B. Disinterest in the illness.
C. Early-onset dementia.
D. Normal reaction to learning a new skill.

Correct Answer: A

Explanation: Anxiety, especially at higher levels, interferes with learning and memory retention. After the client's anxiety lessens, it will be easier for him to learn the steps of the blood glucose monitoring. Because the client's illness is a chronic, lifelong illness that severely changes his lifestyle, it is unlikely that he is uninterested in the illness or how to treat it. It is also unlikely that dementia would be the cause of the client's frustration and lack of memory. The client's response indicates anxiety. Client responses that would indicate lessening anxiety would be questions to the nurse or requests to repeat part of the instruction.

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Question Of The Day: Immune and Hematologic Disorders

Q. A client receiving a blood transfusion begins to have chills and headache within the first 15 minutes of the transfusion. The nurse should first:

A. Administer acetaminophen.
B. Take the client's blood pressure.
C. Discontinue the transfusion.
D. Check the infusion rate of the blood.



Correct Answer: C

Explanation: Chills and headache are signs of a febrile, nonhemolytic blood transfusion reaction and the nurse's first action should be to discontinue the transfusion as soon as possible and then notify the physician. Antipyretics and antihistamines may be ordered. The nurse would not administer acetaminophen without an order from the physician. The client's blood pressure should be taken after the transfusion is stopped. Checking the infusion rate of the blood is not a pertinent action; the infusion needs to be stopped regardless of the rate.

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10 Networking Tips for Nurses Who Hate Networking

Networking is an essential aspect of your nursing career. According to the Bureau of Labor Statistics, over 70% of jobs are found through professional networking. Whether the need to network is for mentorship or to land a dream job, it is crucial that one builds a secure network of professionals. Opportunities that arise from networking are priceless and limitless. Career advancement and placement are just two benefits. Being a confident networker is a necessity. 

Here is a list of 10 ways to build a long-lasting and robust network:

1. Social Media

Today is the age of social media. There is no better time to be a nurse. With access to resources and tools, at the click of a tab, social media is quickly becoming the number one resource for professional networking. It is one of the most effective ways to build alliances. Tens of millions of people use the internet, and social media is where you can find potential partners, mentors, and collaborations. Using hashtags on Twitter and Instagram is an easy and straightforward way to spot those who share the same interests as you. With the click of the follow tab, you’ll have access to them. Linkedin is a sure way to find quality contacts. When using Linkedin look for those who are high-level networkers. These are the people with at least 500 connections and have optimized profiles; meaning their profiles are entirely set up and complete. Send connection requests to those of influence in your industry (aka the movers and shakers). Linkedin also has a feature that will connect you with those who are open to mentorship and consulting. These are people who are willing and wanting to network. Utilize it!

2. Facebook groups 

Let’s face it. Facebook isn’t going anywhere. With the ever-changing algorithms, Facebook groups are still an effortless way to make connections. Facebook groups offer visibility with colleagues from all over the world. With groups such as Nurse CEOs for nurses interested in entrepreneurship and The Travel Nurse Network-the Gypsy Nurse, for those interested in travel, there is sure to be a group that fits your needs. Reading the descriptions of the group is the simplest way to determine if it’s a fit for you. Try joining no more than ten groups, if you are a novice networker, as to not become overwhelmed. The key to networking is building genuine relationships. Introduce yourself and your specialty; comment on posts; share relevant articles or resources to the group; most of all be active.

3. Become an Influencer

Like to write? Then, become a blogger. Like to teach? Fill your Instagram page with graphics of interesting facts. Create content that is compelling, informative, and intriguing. Influencers network with other influencers. One does NOT need to have a 10k+ following. All that is necessary is value. When others see you are offering valuable information and substance, your profile will become attractive, and before you can say, “network” you will be receiving invitations to seminars and conferences. Use your nursing knowledge. Even if you’re a novice nurse, share your journey with other novice nurses, nursing students, and aspiring nurses. Be consistent. Connect with and contact those whom you are beneficial to your network. Like, comment, and tag. Share ideas and information. Be noticeable.

4. Volunteer

Volunteering gives the chance to learn a new set of skills while providing the experience of working with diverse types of people. Find charities and organizations that align with your cause and goals. Volunteer to work events and fundraisers. You’ll get to connect with the community and learn more about the industry. Here, you have a free opportunity to rub elbows with those in your space. Use this opportunity to learn from the leaders of the organizations and to build meaningful relationships. 

5. Conferences

Conferences are an excellent way to meet like-minded individuals. They provide a way to be in the same room, with those who have similar interests. You will have access to successful nurses who have achieved the goals and aspirations you have set for yourself, and they are accessible. This may be a once in a lifetime opportunity to speak with some of the top leaders in your specialty or industry. Prepare yourself. Have networking cards readily available. Have a professional email address. Make certain your social media pages do not show you in a bad light. This could be your opportunity to meet a mentor, and he or she wants to know that they will not be wasting their valuable time.

6. Have a signature look

While attending events, conferences, and seminars make sure you are noted. Be certain there is something about you that is memorable. Wear a signature color, statement jewelry, or clothing. Stand out! Be sure to remain professional, yet confident. 

7. Ask for a connection

Utilize family, friends, and classmates. There might be someone, in their network whom you should connect with. Ask for a warm connection. Do not be afraid to ask. It’s a small world. There’s a chance you already know someone who can offer an intro.

8. Networking cards

What happens when you meet that Director of Nursing or Chief Nursing Officer of your dream unit? What will you have to present when he or she asks for your contact info? You want to make sure that others have an uncomplicated way to access to you. Networking cards are tangibles that you can use to create connections. They can be icebreakers or conversations starters. They focus on YOUR unique selling proposition. Include your specialty, certifications, degrees awarded, and a link to your full online resume. Be sure to include links to your Linkedin account, blog, and any other pertinent information. 

9. Be ahead of the curve

Once the initial connection is made, prepare for the next contact. Use your connection’s business card to jot down keywords, phrases, or distinctive characteristics to assist you in differentiating and remembering people. ALWAYS send a follow-up email. A few days to weeks after the initial contact, reach out and mention something that he or she said in the previous conversation.  Send links to articles that may peak their interest; showing you are a giver and resourceful: two traits that can get anyone through almost any door. 

10. Practice

As with anything, the more you network, the better and the more comfortable you’ll become. Join a local Toastmasters if you have difficulty with public speaking. Get comfortable with meeting and speaking with strangers. Find your strengths are and use those to your advantage. Work on your weaknesses. 

A nursing career has many career paths that one can explore. Becoming an adept networker is a skill that can open doors to new career paths, positions, and even specialties. Whether you want to climb the ladder or become a nurse entrepreneur learning to network is a useful skill. Often, the adage is true: it’s not what you know, it’s whom you know! Ensure that those whom you know can help get you to the next level.

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Question Of The Day: Integumentary Disorders

Q. Following a small-bowel resection, a client develops fever and anemia. The surface surrounding the surgical wound is warm to the touch and necrotizing fasciitis is suspected. Another manifestation that suggests necrotizing fasciitis is:

A. erythema.
B. leukocytosis.
C. pressurelike pain.
D. swelling.

Correct Answer: C

Explanation: Severe pressurelike pain out of proportion to visible signs distinguishes necrotizing fasciitis from cellulitis. Erythema, leukocytosis, and swelling are present in both cellulitis and necrotizing fasciitis.

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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: The Neonate

Q. A neonate has a large amount of secretions. After vigorously suctioning the neonate, the nurse should assess for what possible result?

A. Bradycardia.
B. Rapid eye movement.
C. Seizures.
D. Tachycardia.



Correct Answer: A

Explanation: As a result of vigorous suctioning the nurse must watch for bradycardia due to potential vagus nerve stimulation. Rapid eye movement is not associated with vagus nerve stimulation. Vagal stimulation will not cause seizures or tachycardia.

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Question Of The Day: Postpartum Period

Q. A primiparous client at 4 hours after a vaginal delivery and manual removal of the placenta voids for the first time. The nurse palpates the fundus, noting it to be 1 cm above the umbilicus, slightly firm, and deviated to the left side, and notes a moderate amount of lochia rubra. The nurse notifies the physician based on the interpretation that the assessment indicates which of the following?

A. Perineal lacerations.

B. Retained placental fragments.

C. Cervical lacerations.

D. Urine retention.

Correct Answer: B

Explanation: At 4 hours postpartum, the fundus should be midline and at the level of the umbilicus. Whenever the placenta is manually removed after delivery, there is a possibility that all of the placenta has not been removed. Sometimes small pieces of the placenta are retained, a common cause of late postpartum hemorrhage. The client is exhibiting signs and symptoms associated with retained placental fragments. The client will continue to bleed until the fragments are expelled. Perineal and cervical lacerations are characterized by bright red bleeding and a firmly contracted fundus at the level that is expected. Urine retention is characterized by a full bladder, which can be observed by a bulge or fullness just above the symphysis pubis. Also, the client's fundus would be deviated to one side and boggy to the touch.

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Question Of The Day: Intrapartum Period

Q. Which finding indicates placental detachment?

A. An abrupt lengthening of the cord
B. A decrease in the number of contractions
C. Relaxation of the uterus
D. Decreased vaginal bleeding





Correct Answer: A

Explanation: An abrupt lengthening of the cord, an increase (not a decrease) in the number of contractions, and an increase (not a decrease) in vaginal bleeding are all indications that the placenta has detached from the wall of the uterus. Relaxation of the uterus isn't an indication for detachment of the placenta.

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Question Of The Day: Antepartum Period

Q. The primary health care provider orders intravenous magnesium sulfate for a primigravid client at 38 weeks' gestation diagnosed with severe preeclampsia. Which of the following medications should the nurse have readily available at the client's bedside?

A. Diazepam (Valium).
B. Hydralazine (Apresoline).
C. Calcium gluconate.
D. Phenytoin (Dilantin).

Correct Answer: C

Explanation:  The client receiving magnesium sulfate intravenously is at risk for possible toxicity. The antidote for magnesium sulfate toxicity is calcium gluconate, which should be readily available at the client's bedside. Diazepam (Valium), used to treat anxiety, usually is not given to pregnant women. Hydralazine (Apresoline) would be used to treat hypertension, and phenytoin (Dilantin) would be used to treat seizures.

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

Q. After a dose-response test, the client with an overdose of barbiturates receives pentobarbital sodium (Nembutal) at a nonintoxicating maintenance level for 2 days and at decreasing dosages thereafter. This regimen is effective in the client does not develop:

A. Psychosis.
B. Seizures.
C. Hypotension.
D. Hypothermia.

Correct Answer: B

Explanation: Generalized seizures may occur on the second or third day of withdrawal from barbiturates. Without treatment, the seizures may be fatal. Psychosis is a possibility but is not fatal and will not be prevented by the pentobarbital sodium regimen. Orthostatic hypotension is possible but is unlikely to be fatal; it is also not treatable by the pentobarbital sodium regimen. Hyperthermia, rather than hypothermia, occurs during withdrawal.

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Question Of The Day: Psychotic Disorders

Q. A newly admitted client diagnosed with paranoid schizophrenia is pacing rapidly and wringing his hands. He states that another client is out to get him. Then he says, "Protect me, select me, reject me." The nurse should next:

A. Administer his oral PRN lorazepam (Ativan) and haloperidol (Haldol).
B. Place the client in temporary seclusion before he has a chance to hurt others.
C. Call the primary health care provider for a prescription for restraints.
D. Ask the other clients to leave the immediate area.

Correct Answer: A

Explanation: The client's anxiety as reflected in rapid pacing and clang associations is rising as a result of his paranoid delusions. Administering the Ativan and Haldol will help the anxiety and delusions. He is not threatening others at this point, so seclusion, restraints, and asking clients to leave the area is not necessary.

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Question Of The Day: Foundations of Psychiatric Nursing

Q. A client in an acute care setting tells the nurse, "I don't think I can face going home tomorrow." The nurse replies, "Do you want to talk more about it?" The nurse is using which technique?

A. Presenting reality
B. Making observations
C. Restating
D. Exploring


Correct Answer: D

Explanation: The nurse is using the technique of exploring because she's willing to delve further into the client's concern. She isn't presenting reality or making observations or simply restating. The nurse is encouraging the client to explore his feelings.

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