What is Nursing?

21st Century nursing is the glue that holds a patient’s health care journey together. Across the entire patient experience, and wherever there is someone in need of care, nurses work tirelessly to identify and protect the needs of the individual.

Beyond the time-honored reputation for compassion and dedication lies a highly specialized profession, which is constantly evolving to address the needs of society. From ensuring the most accurate diagnoses to the ongoing education of the public about critical health issues; nurses are indispensable in safeguarding public health.

Nursing can be described as both an art and a science; a heart and a mind. At its heart, lies a fundamental respect for human dignity and an intuition for a patient’s needs. This is supported by the mind, in the form of rigorous core learning. Due to the vast range of specialisms and complex skills in the nursing profession, each nurse will have specific strengths, passions, and expertise.

However, nursing has a unifying ethos:  In assessing a patient, nurses do not just consider test results. Through the critical thinking exemplified in the nursing process (see below), nurses use their judgment to integrate objective data with subjective experience of a patient’s biological, physical and behavioral needs. This ensures that every patient, from city hospital to community health center; state prison to summer camp, receives the best possible care regardless of who they are, or where they may be.

What exactly do nurses do?

In a field as varied as nursing, there is no typical answer. Responsibilities can range from making acute treatment decisions to providing inoculations in schools. The key unifying characteristic in every role is the skill and drive that it takes to be a nurse. Through long-term monitoring of patients’ behavior and knowledge-based expertise, nurses are best placed to take an all-encompassing view of a patient’s wellbeing.

What types of nurses are there?

All nurses complete a rigorous program of extensive education and study, and work directly with patients, families, and communities using the core values of the nursing process. In the United States today, nursing roles can be divided into three categories by the specific responsibilities they undertake.

Registered Nurses

Registered nurses (RN) form the backbone of health care provision in the United States. RNs provide critical health care to the public wherever it is needed.

Key Responsibilities

◈ Perform physical exams and health histories before making critical decisions

◈ Provide health promotion, counseling and education

◈ Administer medications and other personalized interventions

◈ Coordinate care, in collaboration with a wide array of health care professionals

Advanced Practice Registered Nurses

Advance Practice Registered Nurses (APRN) hold at least a Master’s degree, in addition to the initial nursing education and licensing required for all RNs. The responsibilities of an APRN include, but are not limited to, providing invaluable primary and preventative health care to the public. APRNs treat and diagnose illnesses, advise the public on health issues, manage chronic disease and engage in continuous education to remain at the very forefront of any technological, methodological, or other developments in the field.

APRNs Practice Specialist Roles

◈ Nurse Practitioners prescribe medication, diagnose and treat minor illnesses and injuries

◈ Certified Nurse-Midwives provide gynecological and low-risk obstetrical care

◈ Clinical Nurse Specialists handle a wide range of physical and mental health problems

◈ Certified Registered Nurse Anesthetists administer more than 65 percent of all anesthetics

Licensed Practical Nurses

Licensed Practical Nurses (LPN), also known as Licensed Vocational Nurses (LVNs), support the core health care team and work under the supervision of an RN, APRN or MD. By providing basic and routine care, they ensure the wellbeing of patients throughout the whole of the health care journey

Key Responsibilities

◈ Check vital signs and look for signs that health is deteriorating or improving

◈ Perform basic nursing functions such as changing bandages and wound dressings

◈ Ensure patients are comfortable, well-fed and hydrated

◈ May administer medications in some settings

What is the nursing process?

No matter what their field or specialty, all nurses utilize the same nursing process; a scientific method designed to deliver the very best in patient care, through five simple steps.

◈ Assessment – Nurses assess patients on an in-depth physiological, economic, social and lifestyle basis.

◈ Diagnosis – Through careful consideration of both physical symptoms and patient behavior, the nurse forms a diagnosis.

◈ Outcomes / Planning – The nurse uses their expertise to set realistic goals for the patient’s recovery. These objectives are then closely monitored.

◈ Implementation – By accurately implementing the care plan, nurses guarantee consistency of care for the patient whilst meticulously documenting their progress.

◈ Evaluation – By closely analyzing the effectiveness of the care plan and studying patient response, the nurse hones the plan to achieve the very best patient outcomes. 

Nurses are Key to the Health of the Nation

◈ There are over 4 million registered nurses in the United States today.

◈ That means that one in every 100 people is a registered nurse.

◈ Nurses are in every community – large and small – providing expert care from birth to the end of life.

◈ According to the January 2012 “United States Registered Nurse Workforce Report Card and Shortage Forecast” in the American Journal of Medical Quality, a shortage of registered nurses is projected to spread across the country between 2009 and 2030. In this state-by-state analysis, the authors forecast the RN shortage to be most intense in the South and the West

◈ Nurses' roles range from direct patient care and case management to establishing nursing practice standards, developing quality assurance procedures, and directing complex nursing care systems.

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Question Of The Day: Psychotic Disorders

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.

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

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.

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Question Of The Day: Foundations of Psychiatric Nursing

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.

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Question Of The Day: School-age Child

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.

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Question Of The Day: Infant

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.

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Question Of The Day: The Nursing Process

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.

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Question Of The Day: Genitourinary Disorders

Q. Which of the following laboratory findings is present in nephrotic syndrome?

A. Decreased total serum protein.
B. Hypercalcemia.
C. Hyperglycemia.
D. Decreased hematocrit.





Correct Answer: A

Explanation: A decreased total serum protein occurs as extensive amounts of protein are excreted from the body through the urine. Clients may develop hypocalcemia. Hyperglycemia is not a finding related to nephrotic syndrome. A decreased hematocrit is not a finding related to nephrotic syndrome.

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Question Of The Day: Respiratory Disorders

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.

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Question Of The Day: Neurosensory Disorders

Q. A nurse on a rehabilitation unit is caring for a client who sustained a head injury in a motor vehicle accident. She notes that the client has become restless and agitated during therapy; previous documentation described the client as cooperative during therapy sessions. The nurse's priority action should be to:

A. gather assessment data and notify the physician of the change in the client's status.
B. ask the physician to order an antipsychotic medication for the client.
C. consult with the social worker about the possibility of discharging the client from the facility.
D. tell the client that she'll punish him if he doesn't behave.

Correct Answer: A

Explanation: A client with a head injury who experiences a change in cognition requires further assessment and evaluation, and the nurse should notify the physician of the change in the client's status. The physician should rule out all possible medical causes of the change in mental status before ordering antipsychotic medications or considering discharging the client from the facility. A nurse shouldn't threaten a client with punishment; doing so is a violation of the client's rights.

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Question Of The Day: Endocrine and Metabolic Disorders

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.

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Question Of The Day: Gastrointestinal Disorders

Q. A client with gastroenteritis is admitted to an acute care facility and presents with severe dehydration and electrolyte imbalances. Diagnostic tests reveal the Norwalk virus as the cause of gastroenteritis. Based on this information, the nurse knows that:

A. the client requires an antiviral agent.
B. enteric precautions must be continued.
C. enteric precautions can be discontinued.
D. the client's infection may be caused by droplet transmission.

Correct Answer: B

Explanation: The nurse must continue enteric precautions for a client with gastroenteritis caused by the Norwalk virus because this virus is transmitted by the fecal-oral route. No safe and effective antiviral agent is available specifically for treating viral gastroenteritis. The Norwalk virus isn't transmitted by droplets.

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Question Of The Day: Cardiovascular Disorders

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.

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Question Of The Day: The Neonate

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.

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Question Of The Day: Postpartum Period

Q. A client is experiencing an early postpartum hemorrhage. Which item in the client's care plan requires revision?

A. Inserting an indwelling urinary catheter
B. Fundal massage
C. Administration of oxytocics
D. Pad count



Correct Answer: D

Explanation: By the time the client is hemorrhaging, a pad count is no longer appropriate. Inserting an indwelling urinary catheter eliminates the possibility that a full bladder may be contributing to the hemorrhage. Fundal massage is appropriate to ensure that the uterus is well contracted, and oxytocics may be ordered to promote sustained uterine contraction.

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Question Of The Day: Antepartum Period

Q. A nurse is using Doppler ultrasound to assess a pregnant woman. When should the nurse expect to hear fetal heart tones?

A. 7 weeks' gestation
B. 11 weeks' gestation
C. 17 weeks' gestation
D. 21 weeks' gestation



Correct Answer: B

Explanation: Using Doppler ultrasound, fetal heart tones may be heard as early as the 11th week of pregnancy. Using a stethoscope, fetal heart tones may be heard between 17 and 20 weeks' gestation.

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Question Of The Day: Psychotic Disorders

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.

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

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.

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Question Of The Day: Foundations of Psychiatric Nursing

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.

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Question Of The Day: Toddler

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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Question Of The Day: Infant

Q. The nurse is assessing the development of a 7-month-old. The child should be able to:

A. Play pat-a-cake.
B. Sit without support.
C. Say two words.
D. Wave bye-bye.





Correct Answer: B

Explanation: The majority of infants (90%) can sit without support by 7 months of age. Approximately 75% of infants at 10 months of age are able to play pat-a-cake. The ability to say two words occurs in 90% of children by age 16 months. A child typically can wave bye-bye at about 14 months of age.

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Question Of The Day: The Nursing Process

Q. A 57-year-old Hispanic woman with breast cancer who does not speak English is admitted for a lumpectomy. Her daughter, who speaks English, accompanies her. In order to obtain admission information from the client, what should the nurse do?

A. Ask the client's daughter to serve as an interpreter.
B. Ask one of the Hispanic nursing assistants to serve as an interpreter.
C. Use the limited Spanish she remembers from high school along with nonverbal communication.
D. Obtain a trained medical interpreter.

Correct Answer: D

Explanation: A trained medical interpreter is required to ensure safety, accuracy of history data, and client confidentiality. The medical interpreter knows the client's rights and is familiar with the client's culture. Using the family member as interpreter violates the patient's confidentiality. Using the nursing assistant or limited Spanish and nonverbal communication do not ensure accuracy of interpretation and back-translation into English.

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5 Things You Didn’t Know Nurses Do for You

Whether you’re in the hospital for an injury or are going into labor, nurses are one of the main people who will tend to your needs with your treatment. Most people assume that nurses simply handle bed pans or check blood pressure, but the professionals have a long list of duties to perform behind the scenes. As one of the most difficult roles to perform in the healthcare industry, there are a few things you didn’t know that nurses do for you. [no_toc]

1. We order supplies and maintain inventory levels.

RN’s often perform non-clinical duties that include ordering supplies to maintaining adequate inventory levels at their stations. Nurses are often the ones who are most aware of what is needed for the patients and must determine what products and tools need to be delivered in specific quantities.

2. We bathe patients when they are physically unable to do so.

When patients are too ill or injured to bathe themselves, this requires the nurses to perform the task to maintain proper hygiene for the individual. If personal hygiene is not maintained, it can lead to infections that develop. This can also include cutting the patients’ hair and helping them to get dressed each day.

3. We help patients that need assistance with their diets and eating food.

A loss of appetite is common for patients who are admitted for an illness or disease. Nurses will often be required to feed the individuals and convince them to take a few bites to maintain their health and nutrition.

4. We communicate with other associated health care professionals consistently for higher patient care quality.

According to the University of San Francisco School of Nursing, which offers an online masters of nursing program, clinical nurse leaders must communicate on a regular basis with other healthcare professionals to improve the quality of patient care. Without proper communication to social workers or nurse practitioners, patients can suffer both physically and mentally. Their care must also be planned well by the nurse to increase their chances of a good outcome.

5. We provide entertainment to patients that are bored to sustain enjoyable environment.

Although it may not be in their job description, nurses are often asked to provide entertainment to patients who may become bored in their rooms. This can include reading, turning the television channel, and playing board games to maintain the patients’ mental well-being.

Nurses are often required to remain flexible in their positions and wear many different hats to perform their job well and provide proper care to the patients. The most qualified nurses are often those who are willing to go to extreme lengths to care for patients and ensure that they can recover in a shorter timeframe.

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

Q. Total parenteral nutrition (TPN) is prescribed for a client who has recently had a significant small and large bowel resection and is currently not taking anything by mouth. The nurse should:

A. Administer TPN through a nasogastric or gastrostomy tube.
B. Handle TPN using strict aseptic technique.
C. Auscultate for bowel sounds prior to administering TPN.
D. Designate a peripheral intravenous (IV) site for TPN administration.

Correct Answer: B

Explanation: TPN is hypertonic, high-calorie, high-protein, intravenous (IV) fluid that should be provided to clients without functional gastrointestinal tract motility, to better meet their metabolic needs and to support optimal nutrition and healing. TPN is ordered once daily, based on the client's current electrolyte and fluid balance, and must be handled with strict aseptic technique (because of its high glucose content, it is a perfect medium for bacterial growth). Also, because of the high tonicity, TPN must be administered through a central venous access, not a peripheral IV line. There is no specific need to auscultate for bowel sounds to determine whether TPN can safely be administered.

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Question Of The Day: Basic Physical Care

Q. The nurse observes that the right eye of an unconscious client does not close completely. Which nursing intervention is most appropriate?

A. Have the client wear eyeglasses at all times.
B. Lightly tape the eyelid shut.
C. Instill artificial tears once every shift.
D. Clean the eyelid with a washcloth every shift.




Correct Answer: B

Explanation: When the blink reflex is absent or the eyes do not close completely, the cornea may become dry and irritated. Corneal abrasion can occur. Taping the eye closed will prevent injury. Having the client wear eyeglasses or cleaning the eyelid will not protect the cornea from dryness or irritation. Artificial tears instilled once per shift are not frequent enough for preventing dryness.

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Question Of The Day: Neurosensory Disorders

Q. A nurse, a licensed practical nurse (LPN), and a nursing assistant are caring for a group of clients. The nurse asks the nursing assistant to check the pulse oximetry level of a client who underwent laminectomy. The nursing assistant reports that the pulse oximetry reading is 89%. The client Kardex contains an order for oxygen application at 2 L/min should the pulse oximetry level fall below 92%. The nurse is currently assessing a postoperative client who just returned from the postanesthesia care unit. How should the nurse proceed?

A. Immediately go the client's room and assess vital signs, administer oxygen at 2 L/minute, and notify the physician.
B. Ask the nursing assistant to notify the physician of the low pulse oximetry level.
C. Ask the LPN to obtain vital signs and administer oxygen at 2 L/min to the client who underwent laminectomy.
D. Complete the assessment of the new client before attending to the client who underwent laminectomy.

Correct Answer: C

Explanation: Because it's important to get more information about the client with a decreased pulse oximetry level, the nurse should ask the LPN to obtain vital signs and administer oxygen as ordered. The nurse must attend to the newly admitted client without delaying treatment to the client who is already in her care. The nurse can effectively do this by delegating tasks to an appropriate health team member such as an LPN. The nurse doesn't need to immediately attend to the client with a decreased pulse oximetry level; she may wait until she completes the assessment of the newly admitted client. The physician doesn't need to be notified at this time because an order for oxygen administration is already on record.

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