Question Of The Day: Gastrointestinal Disorders

Q. A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:

A. Absence of nausea and vomiting.
B. Passage of mucus from the rectum.
C. Passage of flatus and feces from the colostomy.
D. Absence of stomach drainage for 24 hours.


Correct Answer: C

Explanation: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery.

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Question Of The Day: Oncologic Disorders

Q. The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend?

A. Carcinoembryonic antigen (CEA) test after age 50
B. Proctosigmoidoscopy after age 30
C. Annual digital examination after age 40
D. Barium enema after age 20


Correct Answer:  C

Explanation: The American Cancer Society recommends an annual digital examination after age 40 for the purpose of detecting colorectal cancer. The CEA test is performed on clients who have already been treated for colorectal cancer. It helps monitor a client's response to treatment as well as detect metastasis or recurrence. Proctosigmoidoscopy is recommended every 3 to 5 years for people older than age 50. Barium enema isn't a screening test.

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Nursing Team Initiative Reduces Noise in ICU

The constant high levels of noise in intensive care units hurt patient recovery as it can cause to sleep deprivation, increased pain perception and even heightened delirium. At the end of a 6-month project implemented by nurses in a neurosurgical intensive care unit (NSCU), they concluded that “limiting conversations, eliminating environmental noise, and dimming the lights as a reminder to be quiet are three simple strategies that can be implemented to lessen noise” during planned daily quiet times.

Nurses working in the 16-bed neurosurgical ICU at North Shore University Hospital in Manhasset, New York, identified noise as a problem on their unit. They agreed to introduce quiet times for two hours twice a day – from 3 am to 5 am and 3 pm to 5 pm – with the goal of reducing noise levels during these times by 10 decibels within six months.

THE RESEARCH HAD SHOWN THAT PATIENTS DO SLEEP BETTER DURING QUIET TIMES AND THAT IT ALSO REDUCED THE STRESS LEVELS OF STAFF.

The research had shown that patients do sleep better during quiet times and that it also reduced the stress levels of staff. Studies had further demonstrated that most noise in ICU’s could be attributed to staff conversations. For sleeping environments, the World Health Organization recommends background noise of less than 30 dB, with single noise events not exceeding 45 dB.

At the start of the project, nurses collected baseline data for eight days by measuring noise levels at four locations in the unit every 30 minutes during the chosen times. This was followed by education sessions for all healthcare and support staff on the NSCU team. The measured data was shared to increase awareness of noise and discussions were held on the benefits of quiet times.

The noise reduction plan was introduced a week after the education was completed. Strategies included completing patient procedures and other activities before or after the designated hours, reducing conversations and speaking with lowered voices, as well as dimming lights as a visual cue that quiet time was in force. The team also made use of notices on doors and pamphlets, while unit staff monitored each other and reminded visitors to observe the quiet times.

As the project progressed, consultants and other members of the healthcare team adapted to the quiet time environment and some even changed the timing of their visits to the unit so that their rounds would be completed before the quiet time. Staff also identified that the monitor alarms were adding excessive noise. The unit had a smart-monitor upgrade and the alarm parameters and default settings of some patient monitoring devices were adjusted as well.

The noise measurements were repeated after six months. A peak noise reduction of 10-15 dB during the prescribed quiet times had been achieved and was statistically significant in two of the four locations. Because of the layout of the unit, with the patient’s rooms being near the centralized the nurses’ station, as well as the constant moving of patients in and out of the unit, it was impossible to achieve noise reduction to the level recommended for sleeping.

Particularly meaningful though was that, through their commitment, the team was able to maintain the quiet time and the noise reduction for six months after implementation of the project.

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Question Of The Day: Cardiovascular Disorders

Q. A client with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She is complaining of dyspnea with exertion and being very tired. Her vital signs are 98, 80, 20, BP 116/72. She has + 2 pedal edema and clear breath sounds. As the nurse plans this client's care, which of the following is her cardiac classification according to the New York Heart Association Cardiac Disease classification?

A. Class I.
B. Class II.
C. Class III.
D. Class IV.

Correct Answer: B

Explanation: According to the New York Heart Association Cardiac Disease classification, this client would fit under Class II because she is symptomatic with increased activity (dyspnea with exertion). The New York Heart Association Cardiac Disease Classification identifies Class II clients as having cardiac disease and a slight limitation in physical activity. When physical activity occurs, the client may experience angina, difficulty breathing, palpations, and fatigue. All of the client's other symptoms are within normal limits.

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Question Of The Day: The Neonate

Q. A client's gestational diabetes is poorly controlled throughout her pregnancy. She goes into labor at 38 weeks and gives birth. Which priority intervention should be included in the care plan for the neonate during his first 24 hours?

A. Administer insulin subcutaneously.
B. Administer a bolus of glucose I.V.
C. Provide frequent early feedings with formula.
D. Avoid oral feedings.

Correct Answer: C

Explanation: The neonate of a mother with gestational diabetes may be slightly hyperglycemic immediately after birth because of the high glucose levels that cross the placenta from mother to fetus. During pregnancy, the fetal pancreas secretes increased levels of insulin in response to this increased glucose amount that crosses the placenta from the mother. However, during the first 24 hours of life, this combination of high insulin production in the neonate coupled with the loss of maternal glucose can cause severe hypoglycemia. Frequent, early feedings with formula can prevent hypoglycemia. Insulin shouldn't be administered because the neonate of a mother with gestational diabetes is at risk for hypoglycemia. A bolus of glucose given I.V. may cause rebound hypoglycemia. If glucose is given I.V., it should be administered as a continuous infusion. Oral feedings shouldn't be avoided because early, frequent feedings can help avoid hypoglycemia.

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Question Of The Day: Postpartum Period

Q. After being treated with heparin therapy for thrombophlebitis, a multiparous client who delivered 4 days ago is to be discharged on oral warfarin (Coumadin). After teaching the client about the medication and possible effects, which of the following client statements indicates successful teaching?

A. "I can take two aspirin if I get uterine cramps."
B. "Protamine sulfate should be available if I need it."
C. "I should use a soft toothbrush to brush my teeth."
D. "I can drink an occasional glass of wine if I desire."

Correct Answer: C

Explanation: Successful teaching is demonstrated when the client says, "I should use a soft toothbrush to brush my teeth." Heparin therapy can cause the gums to bleed, so a soft toothbrush should be used to minimize this adverse effect. Use of aspirin and other nonsteroidal anti-inflammatory medications should be avoided because of the increased risk for possible hemorrhage. Protamine sulfate is the antidote for heparin therapy. Vitamin K is the antidote for warfarin excess. Alcohol can inhibit the metabolism of oral anticoagulants and should be avoided.

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Question Of The Day: Antepartum Period

Q. A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should first:

A. perform a pelvic examination.
B. assess the client's blood pressure.
C. assess the fetal heart rate.
D. order a stat hemoglobin and hematocrit.



Correct Answer: C

Explanation: The nurse should assess the fetal heart rate for distress or viability. She shouldn't attempt to perform a pelvic examination because of the possibility of placenta previa, which presents as bright red bleeding without abdominal pain. The nurse should assess the client's blood pressure after attempting to hear fetal heart tones. Ordering a hemoglobin and hematocrit is a physician intervention, not a nursing intervention.

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Question Of The Day: Psychotic Disorders

Q. The nurse should assess the client who is taking risperidone (Risperdal) 1 mg, orally twice a day for:

A. Insomnia.
B. Headache.
C. Anxiety.
D. Orthostatic hypotension.




Correct Answer: D

Explanation: Significant orthostatic hypotension is associated with risperidone (Risperdal) therapy. The nurse should monitor the client's blood pressure sitting and standing and teach the client interventions to manage this adverse effect to prevent risk of injury. Although insomnia, headache, and anxiety are possible adverse effects of risperidone therapy, they are of less immediate concern than orthostatic hypotension.

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

Q. Which statement about somatoform pain disorder is accurate?

A. The pain is intentionally fabricated by the client to receive attention.
B. The pain is real to the client, even though the pain may not have an organic etiology.
C. The pain is less than would be expected as a result of the underlying disorder the client identifies.
D. The pain is what would be expected as a result of the underlying disorder the client identifies.

Correct Answer: B

Explanation: In a somatoform pain disorder, the client has pain even though a thorough diagnostic workup reveals no organic cause for it. The nurse must recognize that the pain is real to the client. By refusing to believe that the client is in pain, the nurse impedes the development of a therapeutic trust-based relationship. While somatoform pain offers the client secondary gains, such as attention or avoidance of an unpleasant activity, the pain isn't intentionally fabricated by the client. Even if a pathologic cause of the pain can be identified, the pain is usually in excess of what the pathologic cause would normally be expected to produce.

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20 Key Steps For An Organized Start To Your ICU Shift

Early in my career as an ICU nurse, I was lucky enough to have a preceptor who helped me develop a solid morning routine I have carried ever since. Because my experience is primarily Cardiac ICU, this routine mirrors what I do in that area of practice, however, it can be tailored to meet the needs of any ICU patient.

While the following list may look like a lot, pending any instabilities or interruptions with the patient, it can be completed within 30-90 minutes (depending on experience level) for each patient after a few months of experience.

Of note, this routine is completed simultaneously with a thorough head to toe assessment. The steps for a head to toe assessment are not included in this post. The purpose of this is to incorporate parts of a morning routine that are often missed, but when completed, can make your day much smoother.

This is how I do it but, make sure to follow your hospital's protocol or previous training.

The following comprises the 20 integral steps that have worked for my personal routine as an ICU nurse.

1) Upon arrival to the unit and after receiving your assignment, breeze past both patient’s rooms and glance at the patients and monitors. Make sure nothing needs your immediate attention, and if the patients are restrained, make sure the restraints are tied properly.

2) Take bedside report – it is evidence-based practice to receive report at the bedside. Encourage your peers to partake in bedside report as well.

3) Do a quick check of orders, medications, and the morning chest X-ray. Also, trend pertinent labs. Looking at the trend of labs is very important. For instance, you can note if a hemoglobin is dropping or a white blood cell count is trending up. Whereas, if you just look at the morning set of labs, you will not know if your patient’s condition is worsening or improving.

4) Go into the room of the most critical patient first.

5) Check drip concentrations, confirm the weight programmed into the IV pump matches the patient. Confirm infusion rates, and patient name on IV bags.

6) Check monitor alarm parameters. Alarm parameters should be patient specific. For example, if your patient lives with a heart rate of 50, you will want to set the high alarm around 70 and low alarm around 45. But if your patient has a heart rate of 70, the parameters might be set 50-100.

7) Check the IV access on patient. Flush all peripheral IVs and central access with a normal saline flush to ensure proper functioning. I always make a note of the functionality of my access and think, “if my patient were to code, where could I push code drugs?”

8) Check for an accessible ambu bag in case of emergency, trach supplies and obturator if warranted, and ensure one suction apparatus is set up and functioning.

9) Check ET tube size, length, and vent settings, including peak pressure.

10) Check settings on any device and insertion sites: CRRT, IABP, LVAD, ECMO, PA cath etc. Level, zero, and flush all tranducers, note waveforms.

11) Note the feeding tube length and securement, check residuals and placement if applicable (tube dependent and per hospital policy.)

12) Note the date on central line dressing and all dressings. Change per hospital protocol.

13) Complete urinary catheter care and make sure there are no dependent loops or kinks in tubing.

14) Make sure all chest tubes, cords, IV tubing, drains are operating properly (either hooked to suction or not per order, canisters aren’t full, tubing isn’t under patient, etc.)

15) Note the patient’s skin, particularly the bottoms of heels and behind the ears. Prop heels on pillows, change draw sheet and chucks pad, note sacral region for breakdown, turn patient.

16) TALK to the patient and develop a plan for the day, also let them know what you are doing during your morning routine and why. The ICU strips so much control away from patients. By giving them the opportunity to develop a plan, you are providing better patient-centered care.

17) Make sure the patient’s call light is in place and the TV is on their chosen channel. You can also put on music for your vented patients.

18) Complete the CAM-ICU delirium scale or delirium scale per your hospital protocol. 

19) Throw away old supplies, Cavi wipe surfaces, move any chairs or tables out of the way that might be blocking a path to the patient or cluttering room.

20) Repeat with next patient. 

What is your morning routine for your specialty? As an ICU nurse would you add anything to the above list?

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Question Of The Day: Anxiety Disorders

Q. A nurse notices that a client with obsessive-compulsive disorder washes his hands for long periods each day. How should the nurse respond to this compulsive behavior?

A. By setting aside times during which the client can focus on the behavior
B. By urging the client to reduce the frequency of the behavior as rapidly as possible
C. By calling attention to or trying to prevent the behavior
D. By discouraging the client from verbalizing his anxieties

Correct Answer: A

Explanation: The nurse should set aside times during which the client is free to focus on his compulsive behavior or obsessive thoughts. The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. She shouldn't call attention to the behavior or try to prevent it. Trying to prevent the behavior may frighten and hurt the client. The nurse should encourage the client to verbalize his anxieties to help distract attention from his compulsive behavior.

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Question Of The Day: Foundations of Psychiatric Nursing

Q. A 28-year-old client with an Axis I diagnosis of major depression and an Axis II diagnosis of dependent personality disorder has been living at home with very supportive parents. The client is thinking about independent living on the recommendation of the treatment team. The client states to the nurse, "I don't know if I can make it in an apartment without my parents." The nurse should respond by saying to the client:

A. "You're a 28-year-old adult now, not a child who needs to be cared for."
B. "Your parents won't be around forever. After all, they are getting older."
C. "Your parents need a break, and you need a break from them."
D. "Your parents have been supportive and will continue to be even if you live apart."

Correct Answer: D

Explanation: Some characteristics of a client with a dependent personality are an inability to make daily decisions without advice and reassurance and the preoccupation with fear of being alone to care for oneself. The client needs others to be responsible for important areas of his life. The nurse should respond, "Your parents have been supportive of you and will continue to be supportive even if you live apart," to gently challenge the client's fears and suggest that they may be unwarranted. Stating, "You're a 28-year-old adult now, not a child who needs to be cared for," or "Your parents need a break, and you need a break from them," is reprimanding and would diminish the client's self-worth. Stating, "Your parents won't be around forever; after all they are getting older," may be true, but it is an insensitive response that may increase the client's anxiety.

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Question Of The Day: School-age Child

Q. An 8-year-old child is suspected of having meningitis. Signs of meningitis include:

A. Cullen's sign.
B. Koplik's spots.
C. Kernig's sign.
D. Chvostek's sign.





Correct Answer: C

Explanation: Signs and symptoms of meningitis include Kernig's sign, stiff neck, headache, and fever. To test for Kernig's sign, the client is in the supine position with knees flexed; a leg is then flexed at the hip so that the thigh is brought to a position perpendicular to the trunk. An attempt is then made to extend the knee. If meningeal irritation is present, the knee can't be extended and attempts to extend the knee result in pain. Cullen's sign is the bluish discoloration of the periumbilical skin caused by intraperitoneal hemorrhage. Koplik's spots are reddened areas with grayish blue centers that are found on the buccal mucosa of a client with measles. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. A calcium deficit is suggested if the facial muscles twitch.

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Question Of The Day: Toddler

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

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




Correct Answer: B

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

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Question Of The Day: Infant

Q. A parent confides to the nurse that their 8-month-old infant is anxious. Which of the following suggestions by the nurse is most appropriate to help the mother lessen her anxiety about her infant?

A. Limit holding the infant to feeding times.
B. Talk quietly to the infant while he is awake.
C. Play music in his room for most of the day and night.
D. Have a close friend keep the infant for a few days.

Correct Answer: B

Explanation: Infants are sensitive to stress in their caretakers. The best way to handle an anxious infant is to talk quietly to him, thereby soothing the infant. Limiting holding of the infant to feeding periods interferes with meeting the infant's needs for close contact, possibly compromising his ability to develop trust. Playing music in the room for most of the day and night will make it difficult for the infant to differentiate days from nights. Having a friend take the infant for several days will not necessarily take care of the problem because when the infant returns to the mother the same behaviors will recur unless the mother makes some changes.

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Question Of The Day: The Nursing Process

Q. A group of nurses has established a focus group and pilot study to examine the potential application of personal data assistants (PDAs) in bedside care. This study is a tangible application of:

A. Nursing informatics.
B. Electronic medical records.
C. Telemedicine.
D. Computerized documentation.


Correct Answer: A

Explanation: Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. A specific application of nursing informatics is the use of PDAs in the clinical setting. The devices are less likely to be used to perform documentation or to constitute client records. Telemedicine involves the remote provision of care.

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

Q. When giving an I.M. injection, the nurse should insert the needle into the muscle at an angle of:

A. 15 degrees.
B. 30 degrees.
C. 45 degrees.
D. 90 degrees.




Correct Answer: D

Explanation: When giving an I.M. injection, the nurse inserts the needle into the muscle at a 90-degree angle, using a quick, dartlike motion. A 15-degree angle is appropriate when administering an intradermal injection. A 30-degree angle isn't used for any type of injection. The nurse may use a 45- or 90-degree angle when giving a subcutaneous injection.

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Question Of The Day: Basic Physical Care

Q. A primiparous woman has recently delivered a term infant. Priority teaching for the patient includes information on:

A. Sudden infant death syndrome (SIDS)
B. Breastfeeding
C. Infant bathing
D. Infant sleep-wake cycles




Correct Answer: B

Explanation: Breastfed infants should eat within the first hour of life and approximately every 2 to 3 hours. Successful breastfeeding will likely require sustained support, encouragement, and instruction from the nurse. Information on SIDS, infant bathing, and sleep-wake cycles are also important topics for the new parent, but they can be covered at any time prior to discharge.

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Question Of The Day: Respiratory Disorders

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

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



Correct Answer: C

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

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Question Of The Day: Neurosensory Disorders

Q. Before cataract surgery, the nurse is to instill several types of eye drops. The surgeon writes orders for 5 gtts of antibiotic in OD, and 3 drops of topical steroid drops in OD. The nurse should:

A. Contact the surgeon to rewrite the order.
B. Administer the antibiotic in the left eye and the steroid in the right eye.
C. Administer both types of drops in the right eye.
D. Contact the pharmacist for clarification of the order.

Correct Answer: A

Explanation: The nurse should not administer drugs without a complete order. In this case the order does not contain information about dosage and uses abbreviations that can cause confusion.

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Question Of The Day: Musculoskeletal Disorders

Q. A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

A. administration of opioids for pain control.
B. administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.
C. administration of monthly intra-articular injections of corticosteroids.
D. vigorous physical therapy for the joints.

Correct Answer: B

Explanation: NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, which causes pain. Opioids aren't used for pain control in osteoarthritis. Intra-articular injection of corticosteroids is used cautiously for an immediate, short-term effect when a joint is acutely inflamed. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.

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Question Of The Day: Endocrine and Metabolic Disorders

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

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

Correct Answer: C

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

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Question Of The Day: Gastrointestinal Disorders

Q. A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

A. Straw-colored urine
B. Reduced hematocrit
C. Clay-colored stools
D. Elevated urobilinogen in the urine




Correct Answer: C

Explanation: s the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

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Question Of The Day: Oncologic Disorders

Q. A client who is undergoing radiation therapy develops mucositis. Which of the following interventions should be included in the client's plan of care?

A. Increase mouth care to twice per shift.
B. Provide the client with hot tea to drink.
C. Promote regular flossing of teeth.
D. Use half-strength hydrogen peroxide on mouth ulcers.

Correct Answer:  C

Explanation: Mucositis is an inflammation of the oral mucosa caused by radiation therapy. It is important that the client with mucositis receive meticulous mouth care, including flossing, to prevent the development of an infection. Mouth care should be provided before and after each meal, at bedtime, and more frequently as needed. Extremes of temperature should be avoided in food and drink. Half-strength hydrogen peroxide is too harsh to use on irritated tissues.

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Question Of The Day: The Neonate

Q. When performing an initial assessment of a post-term male neonate weighing 4,000 g (9 lb) who was admitted to the observation nursery after a vaginal delivery with low forceps, the nurse detects Ortolani's sign. Which of the following actions should the nurse do next?

A. Determine the length of the mother's labor.
B. Notify the primary health care provider immediately.
C. Keep the neonate under the radiant warmer for 2 hours.
D. Obtain a blood sample to check for hypoglycemia.

Correct Answer: B

Explanation: Ortolani's maneuver involves flexing the neonate's knees and hips at right angles and bringing the sides of the knees down to the surface of the examining table. A characteristic click or "clunk," felt or heard, represents a positive Ortolani's sign, suggesting a possible hip dislocation. The nurse should notify the primary health care provider promptly because treatment is needed, while maintaining the dislocated hip in a position of flexion and abduction. Determining the length of the mother's labor provides no useful information related to the nurse's finding. Keeping the infant under the radiant warmer is necessary only if the neonate's temperature is low or unstable. Checking for hypoglycemia is not indicated at this time, unless the neonate is exhibiting jitteriness.

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UK Removes Visa Cap Limiting the Number of Overseas Nurses and Doctors

The United Kingdom announced recently that it was excluding doctors and nurses from the Tier 2 visa cap which applies to skilled workers from outside the European Union. This was to help alleviate the severe staff shortages in the National Health Service (NHS). This response came in answer to an extensive campaign by NHS organizations and other groups.

The Tier 2 visa is used by employers to bring in skilled workers for specific jobs which appear on a list of occupations where there is a shortage. The visa cap was introduced in 2011 as part of the government’s attempt to control migration. A provision was made for a limit of 20,700 Tier 2 visas per year, split into monthly allocations. Since then about 40% of these visas had been allocated to health professionals every year.

Previously the cap was seldom reached, but the demand for overseas skilled labor has increased gradually and so far in 2018 the limit has been reached every month. Thousands of skilled health professionals recruited by the NHS have been unable to obtain working visas over the past months.

“I recognize the pressures faced by the NHS and other sectors in recent months. Doctors and nurses play a vital role in society and at this time we need more in the UK,”. “That is why I have reviewed our skilled worker visa route. This is about finding a solution to increased demand and to support our essential national services.” In February 2018 the NHS had 35,000 unfilled positions for nurses and almost 10,000 vacancies for doctors.

Jeremy Hunt, Health and Social Care Secretary, welcomed the move explaining that staff from overseas have been an important part of the NHS since it was started 70 years ago. “Today’s news sends a clear message to nurses and doctors from around the world that the NHS welcomes and values their skills and dedication,” he said.

However, many have criticized the government’s reliance on overseas staff and for not having made provision for training sufficient staff to meet the country’s needs. Also for the fact that they are recruiting staff from countries that probably have an even greater need. Hunt responded by indicating that steps have already been taken by increasing training places for doctors, nurses, and midwives by 25 % and giving NHS employees a well-deserved pay rise.

“In the period between now and when those training places convert into fully trained clinicians, the government should be flexible on visas. And that is why it is extremely welcome that today the prime minister has announced that doctors and nurses will be removed from the tier 2 visa caps,” Hunt said during the NHS Confederation’s annual conference.

Besides applying for a working visa, nurses who wish to work in the UK have to pass an exam to demonstrate their proficiency in English. The exam, for which two options are available, can usually be taken in their home country.

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Question Of The Day: Postpartum Period

Q. A nurse is preparing to perform a postpartum assessment on a client who gave birth 5 hours ago. Which precaution should the nurse plan to take for this procedure?

A. Washing the hands
B. Washing the hands and wearing latex gloves
C. Washing the hands and wearing latex gloves and a barrier gown
D. Washing the hands and wearing latex gloves, a barrier gown, and protective eyewear

Correct Answer: B

Explanation: During a postpartum assessment, the nurse is likely to come into contact with the client's blood or body fluids, especially when examining the perineal region. Therefore, the nurse must wear latex gloves; hand washing alone would neither provide adequate protection nor comply with universal precautions. The nurse should wear a barrier gown and protective eyewear in addition to latex gloves only when anticipating splashing of blood or body fluids such as during childbirth. Splashing isn't likely to occur during a postpartum assessment.

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Question Of The Day: Intrapartum Period

Q. A client who has been in the latent phase of the first stage of labor is transitioning to the active phase. During the transition, the nurse expects to see which client behavior?

A. A desire for personal contact and touch
B. A full response to teaching
C. Fatigue, a desire for touch, and quietness
D. Withdrawal, irritability, and resistance to touch

Correct Answer: D

Explanation: During the transition to the active phase of the first stage of labor, increased pain typically makes the client withdrawn, irritable, and resistant to touch. During the latent phase (the early part of the first stage of labor), when contractions aren't intensely painful, the client typically desires personal contact and touch and responds to teaching and interventions. Fatigue, a desire for touch, and quietness are common during the third and fourth stages of labor.

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Study: 12-Hour Nursing Shifts Lead to More Sick Days

Nurses were more likely to call in sick when scheduled to work a 12-hour shift, as well as significantly more likely to be absent due to illness after a series of long 12-hour shifts.

These findings of a recently published study are significant considering the trend towards introducing more 12-hour shifts in hospital units. Management perceives this as improving organizational efficiency by reducing overlapping of staff, especially in the light of current staff shortages. Many nurses also prefer 12-hour shifts as it gives them more full days off.

“Our research suggests that, while occasional 12-hour shift work may not have adverse consequences, working higher proportions may lead to higher sickness absence,” said Dr. Chiara Dall’Ora, lead author of the study. “Therefore, nurse managers should question the routine implementation of long shift patterns, especially if this is based on assumed cost savings.”

“OUR RESEARCH SUGGESTS THAT, WHILE OCCASIONAL 12-HOUR SHIFT WORK MAY NOT HAVE ADVERSE CONSEQUENCES, WORKING HIGHER PROPORTIONS MAY LEAD TO HIGHER SICKNESS ABSENCE,”

Researchers at the University of Southampton conducted the study across 32 units at an acute general hospital in the United Kingdom. It was the first research in which sickness absence was studied looking back over a period. Data was collected on shifts worked by registered nurses and healthcare assistants over a period of three years as well as their absence due to sickness.

The analysis included over 600,000 shifts worked by 1,944 staff members. Shifts lost due to illness were 6.3%, and 86% of the employees had at least one sickness episode in the 3-year period.

The study found that where the scheduled shift was to be 12 hours or longer, staff was 24% more likely to call in sick than if it was to be eight hours or less.

Sickness episodes were lowest where no long (12-hours or more) shifts had been worked over the past seven days, compared to the odds of sickness increasing by 27% where more than three-quarters of shifts over the past seven days had been long shifts. Occasional long shifts did not appear to be associated with increased absence. Furthermore, the effects of long shifts appeared to be the same whether nurses worked on day or night duty. Long sickness absences of more than seven days were also associated with nurses working 75% or more of their shifts for 12 hours or longer.

Absence due to sickness is costly for health services and has also been shown to lower patient satisfaction. Longer shifts also have been shown to have adverse effects of staff, including increased job dissatisfaction, burn-out, and eventual resignation – and this study now adds the consequence of an increased possibility of impaired health.

The researchers concluded that routine implementation of 12-hour shifts should be avoided. Besides having potential health implications for nurses and care workers, it does not appear to have the intended benefit of increasing organizational efficiency as higher sickness absences increase costs and lower productivity.

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Question Of The Day: Antepartum Period

Q. A client who's 7 weeks pregnant comes to the clinic for her first prenatal visit. She reports smoking 20 to 25 cigarettes per day. When planning the client's care, the nurse anticipates informing her that if she doesn't stop smoking, her fetus may be at risk for:

A. spina bifida.
B. tetralogy of Fallot.
C. low birth weight.
D. hydronephrosis.

Correct Answer: C

Explanation: The risk of intrauterine growth retardation may increase with the number of cigarettes a pregnant woman smokes. Neural tube defects (such as spina bifida), cardiac abnormalities (such as tetralogy of Fallot), and renal disorders (such as hydronephrosis) are associated with multifactorial genetic inheritance, not maternal cigarette smoking.

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