Question Of The Day: Musculoskeletal Disorders

Q. A client has been diagnosed with degenerative joint disease (osteoarthritis) of the left hip. Which of the following factors in the client's history would most likely increase the joint symptoms of osteoarthritis?

A. A long history of smoking.
B. Excessive alcohol use.
C. Obesity.
D. Emotional stress.

Correct Answer: C

Explanation: Osteoarthritis most commonly results from "wear and tear"---excessive and prolonged mechanical stress on the joints. Increased weight increases stress on weight-bearing joints. Therefore, an obese client with osteoarthritis should be encouraged to lose weight. Smoking does not cause osteoarthritis. Excessive alcohol use does not cause osteoarthritis. Emotional stress does not cause osteoarthritis.

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Question Of The Day: Integumentary Disorders

Q. A nurse is performing a baseline assessment of a client's skin integrity. What is the priority assessment parameter?

A. Family history of pressure ulcers

B. Presence of pressure ulcers on the client

C. Potential areas of pressure ulcer development

D. Overall risk of developing pressure ulcers

 

Correct Answer: D

Explanation: When assessing skin integrity, the overall risk potential of developing pressure ulcers takes priority. Overall risk encompasses existing pressure ulcers as well as potential areas for development of pressure ulcers. Family history isn't important when assessing skin integrity.

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Question Of The Day: Gastrointestinal Disorders

Q. Prochlorperazine (Compazine) is prescribed postoperatively. The nurse should evaluate the drug's therapeutic effect when the client expresses relief from which of the following?

A. Nausea.
B. Dizziness.
C. Abdominal spasms.
D. Abdominal distention.



Correct Answer: A

Explanation: Prochlorperazine is administered postoperatively to control nausea and vomiting. Prochlorperazine is also used in psychotherapy because of its effects on mood and behavior. It is not used to treat dizziness, abdominal spasms, or abdominal distention.

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Question Of The Day: Oncologic Disorders

Q. A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client?

A. Wear sterile gloves.
B. Place incontinence pads in the regular trash container.
C. Wear personal protective equipment when handling blood, body fluids, and feces.
D. Provide a urinal or bedpan to decrease the likelihood of soiling linens.

Correct Answer: C

Explanation: Chemotherapy drugs are present in the waste and body fluids of clients for 48 hours after administration. The nurse should wear personal protective equipment when handling blood, body fluids, or feces. Gloves offer minimal protection against exposure. The nurse should wear a face shield, gown, and gloves when exposure to blood or body fluid is likely. Placing incontinence pads in the regular trash container and providing a urinal or bedpan don't protect the nurse caring for the client.

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Question Of The Day: Cardiovascular Disorders

Q. A client with chronic heart failure is receiving digoxin (Lanoxin), 0.25 mg by mouth daily, and furosemide (Lasix), 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity may also cause:

A. visual disturbances.
B. taste and smell alterations.
C. dry mouth and urine retention.
D. nocturia and sleep disturbances.

Correct Answer: A

Explanation: Digoxin toxicity may cause visual disturbances (such as, flickering flashes of light, colored or halo vision, photophobia, blurring, diplopia, and scotomata), central nervous system abnormalities (such as headache, fatigue, lethargy, depression, irritability and, if profound, seizures, delusions, hallucinations, and memory loss), and cardiovascular abnormalities (abnormal heart rate and arrhythmias). Digoxin toxicity doesn't cause taste and smell alterations. Dry mouth and urine retention typically occur with anticholinergic agents, not inotropic agents such as digoxin. Nocturia and sleep disturbances are adverse effects of furosemide — especially if the client takes the second daily dose in the evening, which may cause diuresis at night.

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Question Of The Day: The Neonate

Q. During the first feeding, the nurse observes that the neonate becomes cyanotic after gagging on mucus. Which of the following should the nurse do first?

A. Start mouth-to-mouth resuscitation.
B. Contact the neonatal resuscitation team.
C. Raise the neonate's head and pat the back gently.
D. Clear the neonate's airway with suction or gravity.

Correct Answer: D

Explanation: If a neonate gags on mucus and becomes cyanotic during the first feeding, the airway is most likely closed. The nurse should clear the airway by gravity (by lowering the infant's head) or suction. Starting mouth-to-mouth resuscitation is not indicated unless the neonate remains cyanotic and lowering his head or suctioning doesn't clear his airway. Contacting the neonatal resuscitation team is not warranted unless the infant remains cyanotic even after measures to clear the airway. Raising the neonate's head and patting the back are not appropriate actions for removing mucus. Doing so allows the mucus to remain lodged causing further breathing difficulties.

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Why Are Meds so Expensive in the US?

This video by the Wall Street Journal deals with why prescription medicines in the US cost so much more than in other parts of the world—even in neighboring countries like Canada and Mexico.

The reason appears to have everything to do with rebates and negotiations for money making along a very long supply chain. Even with the explanation in this clip, one is left somewhat mystified because the role players are tight-lipped about the details of the process which they view as a protected information.

Complex system of drug pricing

In usual trade, the manufacturer sets the price they charge the retailer. The retailer then determines the amount the customer will pay. There might be some bulk discounts along the way, but in essence, all customers will pay the same price at the counter of a particular retailer.

With medicines, it’s not as simple. The drug manufacturer sets its list price for their new product. This is then open to rebates which are negotiated with the pharmaceutical company by pharmacy benefit managers (PBM’s). The PBM’s negotiate rebates on behalf of health insurance companies, government agencies, and employers so that these prescription drugs cost them less. The PBM also takes a cut of the rebate.

Watch the video to understand how drug prices work.

Benefits and costs of drug rebates

The benefit of rebates for the pharmaceutical company is that the bigger the rebates on a particular product, the higher up it moves in the formulary of preferred medicines covered by the health insurers. The higher up in the formulary a drug is, the bigger the portion of the cost covered by the insurance company and the less the patient’s co-payment is. Obviously, this increases sales.

Pharmaceutical companies say that the rebate system is a big reason why they keep raising the price of drugs—they have to protect their profits. In turn, the PBM’s claim that they help to ensure the lowest possible cost to the end-user. In the end, the patient probably pays what the list price would have been and those that don’t have insurance pay the entire inflated price.

WHO calls for transparency in drug pricing

Many who commented on the WSJ video liken the current secretive system of drug pricing in the US to corruption—although it’s perfectly legal.

At the 72nd meeting of the World Health Assembly, a resolution was adopted that public sharing of information on health products should be increased. There should be greater transparency in what determines the pricing of pharmaceuticals, from the lab to the patient, to improve the affordability of health care.

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Question Of The Day: Intrapartum Period

Q. Which nursing action is required before a client in labor receives epidural anesthesia?

A. Give a fluid bolus of 500 ml.
B. Check for maternal pupil dilation.
C. Assess maternal reflexes.
D. Assess maternal gait.





Correct Answer: A

Explanation: One of the major adverse effects of epidural administration is hypotension. Therefore, a 500-ml fluid bolus is usually administered to prevent hypotension in the client who wishes to receive an epidural for pain relief. Assessing maternal reflexes, pupil response, and gait isn't necessary.

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Question Of The Day: Antepartum Period

Q. A nurse is assessing the legs of a client who's 36 weeks pregnant. Which finding should the nurse expect?

A. Absent pedal pulses
B. Bilateral dependent edema
C. Sluggish capillary refill
D. Unilateral calf enlargement




Correct Answer: B

Explanation: As the uterus grows heavier during pregnancy, femoral venous pressure rises, leading to bilateral dependent edema. Factors interfering with venous return, such as sitting or standing for long periods, contribute to edema. Absence of pedal pulses and sluggish capillary refill signal inadequate circulation to the legs — an unexpected finding during pregnancy. Unilateral calf enlargement, also an abnormal finding, may indicate thrombosis.

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

Q. Which of the following is a priority during the first 24 hours of hospitalization for a comatose client with suspected drug overdose?

A. Educate regarding drug abuse.
B. Minimize pain.
C. Maintain intact skin.
D. Increase caloric intake.




Correct Answer: C

Explanation: Maintaining intact skin is a priority for the unconscious client. Unconscious clients need to be turned every hour to prevent complications of immobility, which include pressure ulcers and stasis pneumonia. The unconscious client cannot be educated at this time. Pain is not a concern. During the first 24 hours, the unconscious client will mostly likely be on nothing-by-mouth status.

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Question Of The Day: Psychotic Disorders

Q. A client with chronic undifferentiated schizophrenia is admitted to the psychiatric unit of a local hospital. During the next several days, the client is seen laughing, yelling, and talking to himself. This behavior is characteristic of:

A. delusion.
B. looseness of association.
C. illusion.
D. hallucination.

Correct Answer: D

Explanation: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.

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5 Things to Consider Before Going Back to Nursing School

Deciding if you should go back to school for a higher nursing degree – whether it’s a masters in nursing science or nurse practitioner – is a personal decision that includes so many different factors including, 

◈ Your financial picture

◈ Your family situation

◈ How much experience you have or feel you need

You probably won’t be able to find the answers to all your questions in an article. But from a professional standpoint, there are certain factors that are good to meditate on in order to make a decision that fits you best.  

1. DON'T LET PURE FRUSTRATION OF YOUR CURRENT JOB BE YOUR ONLY REASON FOR GOING BACK TO SCHOOL 

This can be tricky because the long hours and heavy work of the bedside can push people to change their working environment and practicing ability. It's not a bad reason to go back to school, but it shouldn't be the only reason. Be aware of how you're feeling and if you're simply trying to escape (if that's the case, try travel nursing, it's an excellent outlet!) 

2. WHAT ARE YOU CURIOUS ABOUT?

Instead of being pushed by frustration, try to be led by curiosity when it comes to choosing the next turn in your career. Maybe you feel curious about research and adding to the body of nursing theories. Maybe you feel curious about how to manage anesthesia. Wherever your curiosity lies, begin there.

3. DO SOME JOB SHADOWING 

Getting second-hand experience from a practitioner who is working in a position that you are interested in (and even if you’re not interested in it!) is a good place to start. You can get a little taste of what the lifestyle and day to day operations are like prior to making the full commitment. It’s also an excellent way to get candid feedback on the intricacies of the work.

4. “BECAUSE EVERYONE ELSE IS DOING IT” DOESN’T ALWAYS LEAD TO JOB SATISFACTION 

I’ve definitely felt this pressure as many of my peers are in the works of getting their advanced degrees. But again, going back to school is as much a personal decision as it is a professional one, and a healthy source of motivation doesn’t always come from comparison.

5. TRY ONE JOB CHANGE BEFORE MAKING THE JUMP

If you are still unsure if you want to dive into school again, give your current degree one more opportunity to show you what you can do besides the bedside. Try at least one job (two is better) that’s completely different from what you’re doing now.

If you’re at the bedside, try home health. Or case management. Or product sales. (or travel nursing!!) Even if you just do it PRN, giving yourself a bit more exposure to the entire field will help you make a well-rounded decision.

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

Q. A client was hospitalized for 1 week with major depression with suicidal ideation. He is taking venlafaxine (Effexor), 75 mg three times a day, and is planning to return to work. The nurse asks the client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it anymore and wouldn't do anything to hurt myself." The nurse should make which judgment about the client?

A. The client is decompensating and in need of being readmitted to the hospital.
B. The client needs an adjustment or increase in his dose of antidepressant.
C. The depression is improving and the suicidal ideation is lessening.
D. The presence of suicidal ideation warrants a telephone call to the client's primary care provider.

Correct Answer: C

Explanation: The client's statements about being in control of his behavior and his or her plans to return to work indicate an improvement in depression and that suicidal ideation, although present, is decreasing. Nothing in his comments or behavior indicate he is decompensating. There is no evidence to support an increase or adjustment in the dose of Effexor or a call to the primary care provider. Typically, the cognitive components of depression are the last symptoms eliminated. For the client to be experiencing some suicidal ideation in the second week of psychopharmacologic treatment is not unusual.

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Question Of The Day: Anxiety Disorders

Q. A 16-year-old academically gifted boy is about to graduate from high school early, because he has completed all courses needed to earn a diploma. Within the last 3 months, he has experienced panic attacks that have forced him to leave classes early and occasionally miss a day of school. He is concerned that these attacks may hinder his ability to pursue a college degree. What would be the best response by the school nurse who has been helping him deal with his panic attacks?

A. "It is natural to be worried about going into a new environment. I am sure with your abilities you will do well once you get settled."

B. "You are putting too much pressure on yourself. You just need to relax more and things will be alright."

C. "It might be best for you to postpone going to college. You need to get these panic attacks controlled first."

D. "It sounds like you have a real concern about transitioning to college. I can refer you to a health care provider for assessment and treatment."

Correct Answer: D

Explanation: The client's concerns are real and serious enough to warrant assessment by a physician rather than being dismissed as trivial. Though he is very intelligent, his intelligence cannot overcome his anxiety. In fact, his anxiety is likely to interfere with his ability to perform in college if no assessment and treatment are received. Just postponing college is likely to increase rather than lower the client's anxiety, because it does not address the panic he is experiencing.

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Question Of The Day: School-age Child

Q. A 10-year-old with glomerulonephritis reports a headache and blurred vision. The nurse should immediately:

A. Put the client to bed.
B. Obtain the child's blood pressure.
C. Notify the physician.
D. Administer acetaminophen (Tylenol).



Correct Answer: B

Explanation: Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the physician before confirming the cause of the symptoms would not assist the physician in his treatment. Putting the client to bed may help treat an elevated blood pressure, but first the nurse must establish that high blood pressure is the cause of the symptoms. Administering Tylenol for high blood pressure is not recommended.

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Question Of The Day: Preschooler

Q. After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease?

A. "We try to keep him happy at all costs; otherwise, he has an asthma attack."
B. "We keep our child away from other children to help cut down on infections."
C. "Although our child's disease is serious, we try not to let it be the focus of our family."
D. "I'm afraid that when my child gets older, he won't be able to care for himself like I do."

Correct Answer: C

Explanation: Positive adjustment to a chronic condition requires placing the child's illness in its proper perspective. Children with asthma need to be treated as normally as possible within the scope of the limitations imposed by the illness. They also need to learn how to manage exacerbations and then resume as normal a life as possible. Trying to keep the child happy at all costs is inappropriate and can lead to the child's never learning how to accept responsibility for behavior and get along with others. Although minimizing the child's risk for exposure to infections is important, the child needs to be with his or her peers to ensure appropriate growth and development. Children with a chronic illness need to be involved in their care so that they can learn to manage it. Some parents tend to overprotect their child with a chronic illness. This overprotectiveness may cause a child to have an exaggerated feeling of importance or later, as an adolescent, to rebel against the overprotectiveness and the parents.

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Question Of The Day: Toddler

Q. A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse anticipates that the physician will order which laboratory test?

A. Total iron-binding capacity
B. Hemoglobin (Hb)
C. Total protein
D. Sweat test

Correct Answer: C

Explanation: The nurse anticipates the physician will order a total protein test because negative nitrogen balance may result from inadequate protein intake. Measuring total iron-binding capacity and Hb levels would help detect iron deficiency anemia, not a negative nitrogen balance. The sweat test helps diagnose cystic fibrosis, not a negative nitrogen balance.

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Question Of The Day: Infant

Q. Which of the following should the nurse use to determine achievement of the expected outcome for an infant with severe diarrhea and a nursing diagnosis of Deficient fluid volume related to passage of profuse amounts of watery diarrhea?

A. Moist mucous membranes.
B. Passage of a soft, formed stool.
C. Absence of diarrhea for a 4-hour period.
D. Ability to tolerate intravenous fluids well.

Correct Answer: A

Explanation: The outcome of moist mucous membranes indicates adequate hydration and fluid balance, showing that the problem of fluid volume deficit has been corrected. Although a normal bowel movement, ability to tolerate intravenous fluids, and an increasing time interval between bowel movements are all positive signs, they do not specifically address the problem of deficient fluid volume.

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Question Of The Day: The Nursing Process

Q. A nurse is caring for a client with a diagnosis of Impaired gas exchange. Based upon this nursing diagnosis, which outcome is most appropriate?

A. The client maintains a reduced cough effort to lessen fatigue.
B. The client restricts fluid intake to prevent overhydration.
C. The client reduces daily activities to a minimum.
D. The client has normal breath sounds in all lung fields.

Correct Answer: D

Explanation: If the interventions are effective, the client's breath sounds should return to normal. The client should be able to cough effectively and should be encouraged to increase activity, as tolerated. Fluids should help thin secretions, so fluid intake should be encouraged.

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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: The Nursing Process

Q. The nurse is caring for a client with asthma. The nurse should conduct a focused assessment to detect which of the following?

A. Increased forced expiratory volume.
B. Normal breath sounds.
C. Inspiratory and expiratory wheezing.
D. Morning headaches.



Correct Answer: C

Explanation: The hallmark signs of asthma are chest tightness, audible wheezing, and coughing. Inspiratory and expiratory wheezing is the result of bronchoconstriction. Even between exacerbations, there may be some soft wheezing, so a finding of normal breath sounds would be expected in the absence of asthma. The expected finding is decreased forced expiratory volume [forced expiratory flow (FEF) is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration] due to bronchial constriction. Morning headaches are found with more advanced cases of COPD and signal nocturnal hypercapnia or hypoxemia.

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