Q. Which scenario complies with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations?
A. Two nurses in the cafeteria are discussing a client's condition. B. The health care team is discussing a client's care during a formal care conference. C. A nurse checks the computer for the laboratory results of a neighbor who has been admitted to another floor. D. A nurse talks with her spouse about a client's condition.
Correct Answer: B
Explanation: To provide interdisciplinary continuity of care, nurses must share relevant information during client care conferences. Nurses discussing information in the cafeteria may be overheard; this indiscretion violates HIPAA regulations. Looking up laboratory results for a neighbor is a HIPAA violation, as is discussing a client's condition with one's spouse.
Q. After surgery for an ileal conduit, the nurse should closely assess the client for the occurrence of which of the following complications related to pelvic surgery?
A. Peritonitis. B. Thrombophlebitis. C. Ascites. D. Inguinal hernia.
Correct Answer: B
Explanation: After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in intra-abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal incision.
Q. A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis?
A. The client sees his physician for a check-up yearly. B. The client has never traveled outside of the country. C. The client had a liver transplant 2 years ago. D. The client works in a health care insurance office.
Correct Answer: C
Explanation: A history of immunocompromised status, such as that which occurs with liver transplantation, places the client at a higher risk for contracting tuberculosis. Other risk factors include inadequate health care, traveling to countries with high rates of tuberculosis (such as southeastern Asia, Africa, and Latin America), being a health care worker who performs procedures in which exposure to respiratory secretions is likely, and being institutionalized.
Q. A multigravid client in labor at 38 weeks' gestation has been diagnosed with Rh sensitization and probable fetal hydrops and anemia. When the nurse observes the fetal heart rate pattern on the monitor, which of the following patterns is most likely?
A. Early deceleration pattern. B. Sinusoidal pattern. C. Variable deceleration pattern. D. Late deceleration pattern.
Correct Answer: B
Explanation: The fetal heart rate of a multipara diagnosed with Rh sensitization and probable fetal hydrops and anemia will most likely demonstrate a sinusoidal pattern that resembles a sine wave. It has been hypothesized that this pattern reflects an absence of autonomic nervous control over the fetal heart rate resulting from severe hypoxia. This client will most likely require a cesarean delivery to improve the fetal outcome. Early decelerations are associated with head compression; variable decelerations are associated with cord compression; and late decelerations are associated with poor placental perfusion.
In the United Kingdom, a quarter of nursing students drop out of their courses, and it seems that similar or higher drop-out rates occur across the world. This is particularly worrying in the light of the growing global nursing shortages.
Data collected jointly by the Nursing Standard and the Health Foundation in the UK found that 25% of nursing students who started nursing degrees either left or suspended their studies. Despite attempts to reduce student drop-outs, the figure had remained nearly constant since the 25.8% in 2006.
25% OF NURSING STUDENTS WHO STARTED NURSING DEGREES EITHER LEFT OR SUSPENDED THEIR STUDIES
Retention of student nurses and drop-out rates are a significant issue across the globe. In many areas, the numbers of nurses qualifying are not enough to replace those that are leaving. While student attrition is the focus of numerous research studies, few provide comprehensive country-wide data like the study done in the UK. Other studies have revealed drop-out rates of as high as 50% in some baccalaureate programs and that most of these students leave within their first semester of study.
The Royal College of Nursing in the UK expressed the view that students were put off by bad experiences during clinical placements, financial difficulties and the academic pressure of nursing courses.
According to Anne Corrin, RCN head of professional learning and development, financial challenges often made it difficult for student nurses to continue with their course, also considering their travel expenses for clinical placements. The RCN is suggesting that more funding is needed to help students who are struggling financially.
Corrin also highlighted the fact that placement experiences can either provide positive or very negative experiences for students. “‘Good mentors can be key. A role model can inspire you if you are struggling on a course, as they keep people going, while a less interested mentor might cause a student to find it difficult to cope with that relationship,” she said.
Nigel Harrison, of the Council of Deans of Health (CoDoH), added that the responsibility of retention did not only lie with the universities, but also with the placement provider organizations. The CoDoH had developed a peer mentoring system. “A key message has been that student peer mentors are really effective in listening to each other and helping [struggling students] not feel so alone,” Harrison explained.
The University of Northampton brought down its attrition rate from 24% to 10% by obtaining funding to bring in additional staff to address student retention. “The academic rigor and first placement can be a shock for them although we try hard to prepare them,” said Donna Bray, subject lead for nursing at the University. “We bid to create a “super-supportive culture” for students and used the money to develop two nursing student support posts.” The support staff focuses on students who are vulnerable to leaving. The university also presents emotional resilience workshops to develop students’ personal and emotional skills.
Studies across the globe have identified similar causes of student nurse drop-out to those discussed above. Numerous projects that have successfully reduced attrition have also been reported on. Nursing schools, as well as student nurse organisations, could take a lesson from these success stories.
Q. The mother of a client with chronic undifferentiated schizophrenia calls the visiting nurse in the outpatient clinic to report that her daughter has not answered the phone in 10 days. "She was doing so well for months. I don't know what's wrong. I'm worried." Which of the following responses by the nurse is most appropriate?
A. "Maybe she's just mad at you. Did you have an argument?" B. "She may have stopped taking her medications. I'll check on her." C. "Don't worry about this. It happens sometimes." D. "Go over to her apartment and see what's going on."
Correct Answer: B
Explanation: Noncompliance with medications is common in the client with chronic undifferentiated schizophrenia. The nurse has the responsibility to assess this situation. Asking the mother if they've argued or if the client is mad at the mother or telling the mother to go over to the apartment and see what's going on places the blame and responsibility on the mother and therefore is inappropriate. Telling the mother not to worry ignores the seriousness of the client's symptoms.
Q. A 40-year-old executive who was unexpectedly laid off from work 2 days earlier complains of fatigue and an inability to cope. He admits drinking excessively over the previous 48 hours. This behavior is an example of:
A. alcoholism. B. a manic episode. C. situational crisis. D. depression.
Correct Answer: C
Explanation: A situational crisis results from a specific event in the life of a person who is overwhelmed by the situation and reacts emotionally. Fatigue, insomnia, and inability to make decisions are common signs and symptoms. The situational crisis may precipitate behavior that causes a crisis (alcohol or drug abuse). There isn't enough information to label this client an alcoholic. A manic episode is characterized by euphoria and labile affect. Symptoms of depression are usually present for 2 or more weeks.
Q. The family of an older adult wants their mother to have counseling for depression. During the initial nursing assessment, the client denies the need for counseling. Which of the following comments by the client supports the fact that the client may not need counseling?
A. "My doctor just put me on an antidepressant, and I'll be fine in a week or so." B. "My daughter sent me here. She's mad because I don't have the energy to take care of my grandkids." C. "Since I've gotten over the death of my husband, I've had more energy and been more active than before he died." D. "My son got worried because I made this silly comment about wanting to be with my husband in heaven."
Correct Answer: C
Explanation: Resolving grief and having increased energy and activity convey good mental health, indicating that counseling is not necessary at this time. Taking an antidepressant or having less energy and involvement with grandchildren reflects possible depression and the need for counseling. Wanting to be with her dead husband suggests possible suicidal ideation that warrants serious further assessment and counseling.
Q. Compared to the food requirements of preschoolers and adolescents, the food requirements of school-age children are not as great because these children have a lower:
A. Growth rate. B. Metabolic rate. C. Level of activity. D. Hormonal secretion rate.
Correct Answer: A
Explanation: Children ages 6 to 12 have a slower growth rate than do younger children and adolescents. As a result, their food requirements are comparatively less.
Q. A nurse is caring for a family whose infant has anencephaly. The most appropriate nursing intervention is to:
A. help the family prepare for the infant's imminent death. B. implement measures to facilitate the attachment process. C. provide emotional support so the family can adjust to the birth of an infant with health problems. D. prepare the family for the extensive surgical procedures the infant will require.
Correct Answer: A
Explanation: Anencephaly is incompatible with life. The nurse should support family members as they prepare for the infant's imminent death. Facilitating the attachment process, helping the family to adjust to the infant's problems, and preparing the family for extensive surgical procedures are inappropriate because the infant can't survive.
Q. During rounds, a nurse finds that a client with hemiplegia has fallen from the bed because the nursing assistant failed to raise the side rails after giving a back massage. The nurse assists the client to the bed and assesses for injury. As per agency policies, the nurse fills out an incident report. Which of the following activities should the nurse perform after finishing the incident report?
A. Attach a copy to the client's records. B. Highlight the mistake in the client's records. C. Include the time and date of the incident. D. Mention the name of the nursing assistant in the client records.
Correct Answer: C
Explanation: The nurse should include the date and time of the incident in the incident report, the events leading up to it, the client's response, and a full nursing assessment. To prevent legal issues, the nurse should not attach the copy of the incident report to the client's records. Also to prevent litigation, the mistake should not be highlighted in the client's records. As the client report is a legal document, it should not contain the name of the nursing assistant.
Q. The client is receiving an I.V. infusion of 5% dextrose in normal saline running at 125 ml/hour. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first:
A. Discontinue the infusion. B. Apply a warm soak to the site. C. Stop the flow of solution temporarily. D. Irrigate the needle with normal saline.
Correct Answer: A
Explanation: Signs of infiltration include slowing of the infusion and swelling, pain, hardness, pallor, and coolness of the skin at the site. If these signs occur, the I.V. line should be discontinued and restarted at another infusion site. The new anatomic site, time, and type of cannula used should be documented. The nurse may apply a warm soak to the site, but only after the I.V. line is discontinued. Parenteral administration of fluids should not be stopped intermittently. Stopping the flow does not treat the problem, nor does it address the client's needs for fluid replacement. Infiltrated I.V. sites should not be irrigated; doing so will only cause more swelling and pain.
Q. A client with a tracheostomy tube coughs and dislodges the tracheostomy tube. The nurse's first action should be to:
A. Call for emergency assistance. B. Attempt reinsertion of tracheostomy tube. C. Position the client in semi-Fowler's position with the neck hyperextended. D. Insert the obturator into the stoma to reestablish the airway.
Correct Answer: B
Explanation: The nurse's first action should be to attempt to replace the tracheostomy tube immediately so that the client's airway is reestablished. Although the nurse may also call for assistance, there should be no delay before attempting reinsertion of the tube. The client is placed in a supine position with the neck hyperextended to facilitate reentry of the tube. The obturator is inserted into the replacement tracheostomy tube to guide insertion and is then removed to allow passage of air through the tube.
Q. Which finding best indicates that a nursing assistant has an understanding of blood glucose meter use?
A. Verbalizing an understanding of blood glucose meter use B. Documenting a normal blood glucose level C. Providing documentation of previous certification D. Demonstrating correct technique
Correct Answer: D
Explanation: The best way to validate blood glucose meter use is to allow the nursing assistant to demonstrate correct technique. Verbalizing understanding doesn't demonstrate that the nursing assistant knows proper technique. Documenting a normal blood glucose level and having previous certification don't demonstrate blood glucose meter use.
Leaders are change agents, and all nurses are leaders at some level – whether it entails persuading patients to take the steps needed to regain or maintain their health, being a mentor and role model to less experienced nurses, or working as a nurse manager. Everyone can benefit by developing their leadership skills, and it is essential for advancing your career in nursing.
The need for strong leadership in nursing is taking center stage in discussions around moving the profession forward and meeting the global goal of universal health coverage. “You know your patients, and you know their needs, and you have to be involved in health policy at every level,” emphasized Anette Kennedy, President of the ICN, in her end of year message for 2017.
A leader is someone who can effect change by inspiring and empowering others to work towards accomplishing individual or organizational goals. Good leaders have qualities such as positivity, flexibility, and strategic vision. They can solve problems as well as communicate and delegate effectively.
It is never too early to start developing your leadership skills. These skills can be learned and developed, contrary to the popular belief that leaders are born and not made.
1. Work on your strengths and weaknesses
One of the characteristics of great leaders is a high level of self-awareness – they know in which areas they are strong and where their weaknesses lie, as well as what their most effective leadership style is.
Everyone has certain natural abilities as well as skills developed over their lifetimes. Everyone also has weaknesses. Self-examination will help you to identify the strengths that you can use to your advantage as well as the weaknesses you can consciously work on to improve.
Consider the people in your life who you feel are excellent leaders (managers are hierarchical heads, but they are not necessarily outstanding leaders). What qualities make these people leaders? Which of these qualities do you possess and what are the areas you could work on?
There are also many questionnaires and exercises on the web that can help you with self-analysis. For example, you can take a quiz to identify your current personal leadership style, which will also give you an indication of where you need to develop your abilities.
Active reflection is probably the most effective learning tool for skills development. Start a journal in which you reflect on incidents at work – write about situations that you managed well, and why, and also those where you could have acted differently. Think about what behavior would have been more effective.
2. Be positive and enthusiastic
When you think about effective leaders, you don’t get a picture of grumpy, complaining and rude people. Inspirational leaders are passionate about their work, and if their plans don’t succeed at first they will try again – their positive attitude attracts people, and their passion becomes infectious.
Always aim to be the role model that you would follow. Be enthusiastic about your work with a “can do” attitude, even in difficult situations. Go the extra mile when needed – you are get noticed and earn respect when you do more than what is expected of you. Use initiative and attempt to solve problems before you hand them over to others, and even come up with suggestions of how things can be improved for everyone in your working situation.
3. Maintain your morals and values
People follow those in whom they sense a high level of integrity and authenticity – those you “walk the talk” and that they can believe in.
Live out your morals and values – do your work according to the highest possible professional standards, be honest in all things, deliver on the commitments and promises you make, and accept personal responsibility when you make a mistake. Avoid taking things personally or making assumptions without first determining the truth.
4. Develop excellent communication skills
Leadership goes hand-in-hand with being an outstanding communicator. You cannot achieve your goals of motivating, guiding, influencing and persuading others without communicating well and creating real personal connections.
Develop your skills in both spoken and written communication and never forget that communication flows in two directions. An important part of communication is listening – really listening to what the other person is saying, to show that you are interested in them and their opinion, and also picking up on their non-verbal cues.
5. Continuously expand your knowledge
Extensive knowledge which can be mined to come up with ideas and solutions are the key to the vision, innovation and critical thinking of great leaders. They can identify opportunities or foresee problems and threats before they arise, and plan strategic action.
You not only need to keep up with the date with changes in your field of expertise but also to grow your knowledge on a wide variety of topics related to the world around you. Offer to help with tasks and projects that will help you to expand your skills. Use opportunities to attend continuing education workshops, seminars, and conferences. Have discussions and ask questions, from anyone and everyone, to get information and to learn about different perspectives. Read continuously and widely.
6. Join professional and community organizations
Active membership in organizations – whether nursing organizations, student bodies or those dealing with community issues that you support – provide many opportunities for leadership development.
You can expand your knowledge and insight about issues affecting the profession or your community and learn how leaders approach advocacy, activism, and lobbying. Grab any opportunity to serve on committees as this will give you many different experiences in a leadership role.
Being active in organizations also provides you with the opportunity for networking – meeting and building relationships with a variety of different people with whom you can share your ideas and vision. These connections can offer valuable feedback and advice as well as provide you with motivation and support.
Q. When assessing a client for early septic shock, the nurse should assess the client for which of the following?
A. Cool, clammy skin. B. Warm, flushed skin. C. Increased blood pressure. D. Hemorrhage.
Correct Answer: B
Explanation: Warm, flushed skin from a high cardiac output with vasodilation occurs in warm shock or the hyperdynamic phase (first phase) of septic shock. Other signs and symptoms of early septic shock include fever with restlessness and confusion; normal or decreased blood pressure with tachypnea and tachycardia; increased or normal urine output; and nausea and vomiting or diarrhea. Cool, clammy skin occurs in the hypodynamic or cold phase (later phase). Hemorrhage is not a factor in septic shock.
Q. Just after delivery, a nurse measures a neonate's axillary temperature at 94.1° F (34.5° C). What should the nurse do?
A. Rewarm the neonate gradually. B. Rewarm the neonate rapidly. C. Observe the neonate hourly. D. Notify the physician when the neonate's temperature is normal.
Correct Answer: A
Explanation: A neonate with a temperature of 94.1° F is experiencing cold stress. To correct cold stress while avoiding hyperthermia and its complications, the nurse should rewarm the neonate gradually, observing closely and checking vital signs every 15 to 30 minutes. Rapid rewarming may cause hyperthermia. Hourly observation isn't frequent enough because cold stress increases oxygen, calorie, and fat expenditure, putting the neonate at risk for anabolic metabolism and possibly metabolic acidosis. A neonate with cold stress requires intervention; the nurse should notify the physician of the problem as soon as it's identified.
Q. A client with a tentative diagnosis of psychosis is admitted to the psychiatric unit. A physician orders the phenothiazine thioridazine 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:
A. deeper sleep than CNS depressants. B. greater sedation than CNS depressants. C. a calming effect from which the client is easily aroused. D. more prolonged sedative effects, making the client more difficult to arouse.
Correct Answer: C
Explanation: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.
Q. Family members of a client with bipolar disorder tell a nurse that they are concerned that the client is becoming manic. The nurse knows that the manic phase is marked by:
A. flight of ideas and inflated self-esteem. B. increased sleep and greater distractibility. C. decreased self-esteem and increased physical restlessness. D. obsession with following rules and maintaining order.
Correct Answer: A
Explanation: The manic phase of bipolar disorder is characterized by recurrent episodes of a persistently euphoric and expansive or irritable mood. This phase is diagnosed if the client experiences four of the following signs and symptoms for at least 1 week: flight of ideas; inflated self-esteem; unusual talkativeness; increased social, occupational, or sexual activity; physical restlessness; a decreased need for sleep; increased distractibility; and excessive involvement in activities with a high potential for painful but unrecognized consequences. Obsession with following rules and maintaining order characterizes obsessive-compulsive disorder.
Q. A client is irritable and hostile. He becomes agitated and verbally lashes out when his personal needs are not immediately met by the staff. When the client's request for a pass is refused by the primary care provider, he utters a stream of profanities. Which of the following statements best describes the client's behavior?
A. The client's anger is not intended personally. B. The client's anger is a reliable sign of serious pathology. C. The client's anger is an intended attack on the primary care provider's skills D. The client's anger is a sign that his condition is improving.
Correct Answer: A
Explanation: Staff members sometimes are the recipients of a client's angry behavior because they are safe targets and are available for attack. The display of anger is rarely intended to be personal. Such behavior is not necessarily a sign of serious pathology but must be weighed in conjunction with other behaviors. An angry outburst is not an attack on a primary care provider's skills. While not necessarily pathologic, the client's behavior isn't a sign that his condition is improving.
Q. When performing a physical assessment on an 18-month-old child, which of the following would be best?
A. Have a parent hold the toddler. B. Assess the ears and mouth first. C. Carry out the assessment from head to toe. D. Assess motor function by having the child run and walk.
Correct Answer: A
Explanation: The best strategy for assessing a toddler is to have the parent hold the toddler. Doing so is comforting to the toddler. Assessment should begin with noninvasive assessments first while the child is quiet. Typically these include assessments of the cardiac and respiratory systems. The ears and throat are typically examined last. Using a head-to-toe approach is more appropriate for an older child. For a toddler, assessment should begin with noninvasive assessments first while the child is quiet. Having a toddler run and be active may make it difficult to settle the child down after the physical exertion.
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