Question Of The Day: Basic Psychosocial Needs

Q. A worried mother confides in the nurse that she wants to change physicians because her infant is not getting better. The best response by the nurse is which of the following?

A. "This doctor has been on our staff for 20 years."
B. "I know you are worried, but the doctor has an excellent reputation."
C. "You always have an option to change. Tell me about your concerns."
D. "I take my own children to this doctor."

Correct Answer: C

Explanation: Asking the mother to talk about her concerns acknowledges the mother's rights and encourages open discussion. The other responses negate the parent's concerns.

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Question Of The Day: Gastrointestinal Disorders

Q. A client who has a history of Crohn's disease is admitted to the hospital with fever, diarrhea, cramping, abdominal pain, and weight loss. The nurse should monitor the client for:

A. Hyperalbuminemia.
B. Thrombocytopenia.
C. Hypokalemia.
D. Hypercalcemia.



Correct Answer: C

Explanation: Hypokalemia is the most expected laboratory finding owing to the diarrhea. Hypoalbuminemia can also occur in Crohn's disease; however, the client's potassium level is of greater importance at this time because a low potassium level can cause cardiac arrest. Anemia is an expected development, but thrombocytopenia is not. Calcium levels are not affected.

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Question Of The Day: The Nursing Process

Q. When developing a care plan for a client with a do-not-resuscitate (DNR) order, a nurse should:

A. withhold food and fluids.
B. discontinue pain medications.
C. ensure access to spiritual care providers upon the client's request.
D. always make the DNR client the last in prioritization of clients.



Correct Answer: C

Explanation: Ensuring access to spiritual care, if requested by the client, is an appropriate nursing action. A nurse should continue to administer appropriate doses of pain medication as needed to promote the client's comfort. A health care provider may not withhold food and fluids unless the client has a living will that specifies this action. A DNR order does not mean that the client does not require nursing care.

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Question Of The Day: Gastrointestinal Disorders

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

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




Correct Answer: C

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

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Question Of The Day: Gastrointestinal Disorders

Q. A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching?

A. "I'll increase my intake of protein during exacerbations."
B. "I should increase my intake of fresh fruits and vegetables during remissions."
C. "I'll snack on nuts, olives, and popcorn during flare-ups."
D. "I'll incorporate foods rich in omega-3 fatty acids into my diet."

Correct Answer: B

Explanation: A client with diverticulitis needs to modify fiber intake to effectively manage the disease. During episodes of diverticulitis, he should follow a low-fiber diet to help minimize bulk in the stools. A client with diverticulosis should follow a high-fiber diet. Clients with diverticular disease don't need to modify their intake of protein and omega-3 fatty acids.

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Question Of The Day: Gastrointestinal Disorders

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

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


Correct Answer: A

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

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Question Of The Day: Gastrointestinal Disorders

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

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

Correct Answer: A

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

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Question Of The Day: Antepartum Period

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

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


Correct Answer: D

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

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

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

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

Correct Answer: C

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

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Question Of The Day: The Nursing Process

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

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





Correct Answer: C

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

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Question Of The Day: Gastrointestinal Disorders

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

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

Correct Answer: B

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

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Question Of The Day: Neurosensory Disorders

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

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



Correct Answer: B

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

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Nurses Win Mega Millions Lottery Ticket And Donate The Money

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

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

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

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

Selfless acts of kindness

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

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

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

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

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

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

Praises for compassion

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

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

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

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Question Of The Day: Basic Physical Care

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

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

Correct Answer: C

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

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Question Of The Day: Respiratory Disorders

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

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



Correct Answer: A

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

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Question Of The Day: Neurosensory Disorders

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

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



Correct Answer: D

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

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