Question Of The Day: Basic Physical Care

Q. As a nurse helps a client ambulate, the client says, "I had trouble sleeping last night." Which action should the nurse take first?

A. Recommending warm milk or a warm shower at bedtime
B. Gathering more information about the client's sleep problem
C. Determining whether the client is worried about something
D. Finding out whether the client is taking medication that may impede sleep

Correct Answer: B

Explanation: The nurse first should determine what the client means by "trouble sleeping." The nurse lacks sufficient information to recommend warm milk or a warm shower or to make inferences about the cause of the sleep problem, such as worries or medication use.

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Question Of The Day: Genitourinary Disorders

Q. The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on these data, the nurse should?

A. Change the appliance bag.
B. Notify the physician.
C. Obtain a urine specimen for culture.
D. Encourage a high fluid intake.



Correct Answer: D

Explanation: Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or to notify the physician. The mucus is not an indication of an infection, so a urine culture is not necessary.

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Question Of The Day: Respiratory Disorders

Q. A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A. Nausea or vomiting
B. Abdominal pain or diarrhea
C. Hallucinations or tinnitus
D. Light-headedness or paresthesia


Correct Answer: D

Explanation: The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

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Question Of The Day: Neurosensory Disorders

Q. A nurse is monitoring a client for adverse reactions to atropine (Atropine Care) eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction?

A. Tachycardia
B. Increased salivation
C. Hypotension
D. Apnea


Correct Answer: A

Explanation: Systemic absorption of atropine can cause tachycardia, palpitations, flushing, dry skin, ataxia, and confusion. To minimize systemic absorption, the client should apply digital pressure over the punctum at the inner canthus for 2 to 3 minutes after instilling the drops. The drug also may cause dry mouth. It isn't known to cause hypotension or apnea.

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10 Emergency ‘MacGyver’ Hacks for Nurses

You’re at a party, a family gathering, or next to the sports field – and someone develops a health issue. All eyes turn to you because, after all, you’re the nurse or nurse-to-be. Does this scenario sound familiar to you? 

There’s just one problem–you don’t have any of the hospital equipment and supplies and there might not even be a first aid kit.

This is when you need to keep your wits about you, recall the basic principles you’ve learned, and come up with some creative problem-solving. Having one of the following emergency hacks up your sleeve might also be just the solution you’re looking for.

Dr. Amy Faith Ho, an emergency physician in a trauma center, introduced the first five hacks which she refers to as emergency “MacGyver” tips. The best thing about these tips is that they can be used effectively by anyone, anywhere–and will probably save a trip to the ER. 

1. Black tea bags as a vasoconstrictor

Black tea contains tannic acid which is a vasoconstrictor. Image: Pixabay

As Dr. Amy Ho describes, there is seldom a place where tea bags aren’t available. Any brand will do as long as it’s regular black tea which contains tannic acid. Tannic acid is a proven vasoconstrictor.

Wet the tea bag and apply it topically with slight pressure to nearly stop any mucous membrane bleeding. This tip works particularly well when bleeding restarts after a tooth extraction, or you can use it for bleeding cuts inside the mouth and also with bleeding hemorrhoids.

2. Remove a ring with a string

Stuck ring? Get a string! Image: YouTube

Someone has injured his finger and it’s starting to swell. You realize that you need to remove his ring immediately but it just can’t pass the knuckle or the swollen part. This tip won’t need any ring cutters or call in the fire department.

Grab some dental floss or any thin string. Slip the end of the string under the ring and then wrap the other side of the string around the finger as tightly as possible. Wrap from the edge of the ring and have someone carefully unwind it all the way down the finger. 

3. Rubbing alcohol for nausea

You can use ordinary rubbing alcohol to aid someone nauseous from whatever cause. Studies have shown that it’s just as effective as any of the common medications used to treat nausea. You’re likely to find a bottle of this inexpensive substance hiding in most bathroom cabinets.

To treat nausea, pour some into a small container and have the person inhale it with a deep breath through the nose, and out through the mouth. Repeat three times every 15 minutes. Research found that rubbing alcohol reduces nausea by more than 50%, beating antiemetics like ondansetron, metoclopramide, and promethazine. You can use this trick in the hospital or community clinic setting as well. 

4. Milk for (capsaicin) burns

Pepper spray accidentally let off while fooling around? Or maybe someone thoughtlessly rubbed his eyes after chopping up chili peppers? Rinsing with water doesn’t help from this burn. No problem. Capsaicin is fat-soluble and anything fatty will easily and quickly relieve the burn.

Grab a bottle of whole fat milk and pour it over, even in the eyes. You can also use mayonnaise on a skin burn. According to Dr. Ho, you can actually see the fatty globules coming out with the milk.

5. Hot sauce when vomiting after smoking pot

When someone is vomiting excessively, ask them if they experience it regularly and whether hot showers help. In this case, the vomiting is most likely caused by cannabis use. Grab the hot sauce and pour it onto their stomach. Studies have shown that there is a receptor that responds to both hot water and capsaicin, and that capsaicin cream works very well to provide relief for this condition.

However, the likelihood of capsaicin cream being available is very small–but hot sauces also contain this ingredient and can be found in most kitchens. You do need a fairly mild to moderate hot sauce to avoid burns. Hot sauces are graded in Scoville units and you’re looking at a sauce with 4,000 to 12,000 Scoville units only. The person will obviously feel some burning sensation from the treatment. When the sauce has done its work, you can rinse the skin with some milk to neutralize the capsaicin. 

6. Superglue for lacerations

Add superglue in your first-aid kit! Image: criticalchoicesfirstaid.ca

Dr. Troy Madsen, an emergency room physician, explains that the glue used in the ER these days instead of stitches is the same as superglue. The formulation is just slightly different so that it doesn’t sting.

You can treat a simple laceration with an ordinary superglue, as long as it’s a clean wound with no serious indications for potential infection. Also, make sure that there’s no damage to tendons. Wash the wound well and bond the sides together with superglue. The glue will fall off on its own after a while. It’s quick and simple and can save a visit to the ER. 

7. Cardboard box and t-shirt for splints

When you have a fractured bone, every single bump hurts like crazy until a cast is placed–so the trip to the ER without a splint can be very painful.Dr. Troy Madsen again has some good advice when there’s no first-aid box or emergency services available. You can find a cardboard box lying around almost anywhere and you can use this to make an effective splint. In fact, the newer splints used in emergency care are a specialized type of cardboard.  

Cut a few layers of cardboard to the right size and place lengths on either side of the limb to immobilize the fracture. Wrap something around to keep it in place–even a t-shirt will do the thing. 

8. Dig into the cooler to treat sprains

Strains and sprains happen most often during outdoor activities–across the sports field or while running around on a family picnic. You know that Rest, Ice, Compression and Elevation or R.I.C.E. is the treatment. 

When outdoors, someone is bound to have a cooler–and you can find the “ice” right away. There might be some actual ice that you can put into a plastic bag and place on the injury. Otherwise, just use the ice pack or even that ice-cold can of cold drink or beer that you have. If you’re at home, a pack of frozen veggies makes a great cold pack because it molds neatly around the injured area. Always remember to put a barrier like a towel or even an item of clothing between the cold pack and the skin. Don’t apply the cold pack for more than 20 minutes every two to three hours. 

9. Sterile dressings for open wounds

It’s been drilled into you that dressings on open wounds must be sterile to prevent infection. But what do you do when there aren’t any sterile dressings available? Look for the cleanest option that’s available–and it’s usually not clothing. At least one woman is likely to have a sanitary pad or even a tampon in their bag. These wrapped items are near sterile and make for great pressure dressings.

Unopened plastic grocery bags are sterile inside, because of the heat during the manufacturing process. So, if there’s a general dealer shop nearby you can grab a bag, tear it open and place them inside of it over the wound. Then you can wrap it with whatever is available. Hopefully, you’ll never need it, but this hack is also a good one to remember in the event of mass injuries in a shopping center when there is just not enough dressing material available to treat everyone.

10. Ice pack for migraine headache

Cold therapy has been used effectively for a long time to treat migraine and other severe headaches although scientists are still not quite sure why it works. What they do know is that migraine is caused by dilation of cerebral blood vessels due to physiological processes that are still unclear. 

A study found that applying ice packs with a neck wrap at the front of the neck where the carotid arteries are close to the skin significantly reduced migraine headaches. The cold therapy likely helps to constrict the blood vessels. The cooling could possibly also reduce inflammation. Another theory is that the cold sensation overrides the neurotransmission of pain. Apply the ice pack no longer than about 20 minutes at a time, or shorter if the person complains that it’s getting too cold. 

Other emergency hacks?

Do you have any other emergency care hacks, using commonly available materials, that can be used outside of the hospital setting? Maybe something you came up with on the spur of the moment and that worked well? Please share your tips in the comments section below.

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Question Of The Day: Postpartum Period

Q. Twelve hours after a vaginal delivery with epidural anesthesia, the nurse palpates the fundus of a primiparous client and finds it to be firm, above the umbilicus, and deviated to the right. Which of the following would the nurse do next?

A. Document this as a normal finding in the client's record.
B. Contact the physician for an order for methylergonovine (Methergine).
C. Encourage the client to ambulate to the bathroom and void.
D. Gently massage the fundus to expel the clots.

Correct Answer: C

Explanation: At 12 hours postpartum, the fundus normally should be in the midline and at the level of the umbilicus. When the fundus is firm yet above the umbilicus, and deviated to the right rather than in the midline, the client's bladder is most likely distended. The client should be encouraged to ambulate to the bathroom and attempt to void, because a full bladder can prevent normal involution. A firm but deviated fundus above the level of the umbilicus is not a normal finding and if voiding does not return it to midline, it should be reported to the physician. Methylergonovine (Methergine) is used to treat uterine atony. This client's fundus is firm, not boggy or soft, which would suggest atony. Gentle massage is not necessary because there is no evidence of atony or clots.

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Question Of The Day: Endocrine and Metabolic Disorders

Q. A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus?

A. Recent weight gain of 20 lb (9.1 kg)
B. Failure to monitor blood glucose levels
C. Skipping insulin doses during illness
D. Crying whenever diabetes is mentioned



Correct Answer: D

Explanation: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

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Question Of The Day: Intrapartum Period

Q. The nurse is caring for a multigravid client who speaks little English. As the nurse enters the client's room, the nurse observes the client squatting on the bed and the fetal head crowning. After calling for assistance and helping the client lie down, which of the following actions should the nurse do next?

A. Tell the client to push between contractions.
B. Provide gentle support to the fetal head.
C. Apply gentle upward traction on the neonate's anterior shoulder.
D. Massage the perineum to stretch the perineal tissues.

Correct Answer: B

Explanation: During a precipitous delivery, after calling for assistance and helping the client lie down, the nurse should provide support to the fetal head to prevent it from coming out. It is not appropriate to tell the client to push between contractions because this may lead to lacerations. The shoulder should be delivered by applying downward traction until the anterior shoulder appears fully at the introitus, then upward pressure to lift out the other shoulder. Priority should be given to safe delivery of the infant over protecting the perineum by massage.

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Question Of The Day: Gastrointestinal Disorders

Q. A client with cholecystitis is taking Propantheline bromide (Pro-Banthine). The expected outcome of this drug is:

A. Increased bile production.
B. Decreased biliary spasm.
C. Absence of infection.
D. Relief from nausea.




Correct Answer: B

Explanation: Propantheline bromide is an anticholinergic used to decrease biliary spasm. Decreasing biliary spasm helps to reduce pain in cholecystitis. Propantheline does not increase bile production or have an antiemetic effect, and it is not effective in treating infection.

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Question Of The Day: Oncologic Disorders

Q. A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents?

A. Wear disposable gloves and protective clothing.
B. Break needles after the infusion is discontinued.
C. Disconnect I.V. tubing with gloved hands.
D. Throw I.V. tubing in the trash after the infusion is stopped.

Correct Answer: A

Explanation: A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.

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Question Of The Day: Cardiovascular Disorders

Q. In preparing the client and the family for a postoperative stay in the intensive care unit (ICU) after open heart surgery, the nurse should explain that:

A. The client will remain in the ICU for 5 days.
B. The client will sleep most of the time while in the ICU.
C. Noise and activity within the ICU are minimal.
D. The client will receive medication to relieve pain.

Correct Answer: D

Explanation: Management of postoperative pain is a priority for the client after surgery, including valve replacement surgery, according to the Agency for Health Care Policy and Research. The client and family should be informed that pain will be assessed by the nurse and medications will be given to relieve the pain. The client will stay in the ICU as long as monitoring and intensive care are needed. Sensory deprivation and overload, high noise levels, and disrupted sleep and rest patterns are some environmental factors that affect recovery from valve replacement surgery.

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Question Of The Day: The Neonate

Q. A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The primary care provider has ordered I.V. fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4Meq/ L. The nurse should:

A. Notify the primary care provider.
B. Administer the ordered fluids.
C. Verify that the infant has urinated.
D. Have the potassium level redrawn.

Correct Answer: C

Explanation: Normal serum potassium levels are 3.5-4.5 Meq/L. Elevated potassium levels can cause life threatening cardiac arrhythmias. The nurse must verify that the client has the ability to clear potassium through urination before administering the drug. Infants with pyloric stenosis frequently have low potassium levels due to vomiting. A level of 3.4Meq/l is not unexpected and should be corrected with the ordered fluids. The lab value does not need to be redrawn as the findings are consistent with the infant's condition.

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

Q. A client with major depression sleeps 18 to 20 hours per day, shows no interest in activities he previously enjoyed and reports a 17-lb (7.7-kg) weight loss over the past month. Because this is the client's first hospitalization, the physician is most likely to order:

A. phenelzine (Nardil).
B. thiothixene (Navane).
C. nortriptyline (Pamelor).
D. trifluoperazine (Stelazine).

Correct Answer: C

Explanation: Nortriptyline, a tricyclic antidepressant, is used in first-time drug therapy because it causes few anticholinergic and sedative adverse effects. Phenelzine isn't ordered initially because it may cause many adverse effects and necessitates dietary restrictions. Thiothixene and trifluoperazine are antipsychotic agents and, therefore, inappropriate for clients with uncomplicated depression.

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Question Of The Day: Anxiety Disorders

Q. A client who recently developed paralysis of the arms is diagnosed with conversion disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the care plan for this client?

A. Exercising the client's arms regularly
B. Insisting that the client eat without assistance
C. Working with the client rather than with the family
D. Teaching the client how to use nonpharmacologic pain-control methods

Correct Answer: A

Explanation: To maintain the integrity of the affected areas and prevent muscle wasting and contractures, the nurse should help the client perform regular passive range-of-motion exercises with his arms. The nurse shouldn't insist that the client use his arms to perform such functions as eating without assistance, because he can't consciously control his symptoms and move his arms; such insistence may anger the client and endanger the therapeutic relationship. The nurse should include family members in the client's care because they may be contributing to the client's stress or conflict and are essential to helping him regain function of his arms. The client isn't experiencing pain and, therefore, doesn't need education regarding pain management.

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10 Tips for Online Nursing Class Success

Attending nursing classes online can have a lot of benefits, like accommodating your current work schedule (hellllooooo night shift), allowing you to attend class in your pajamas, and fit in family life.

But all that flexibility can also make online classes challenging. Without an in-person class to attend combined with the distractions of home life, it can be difficult to stay on-task and motivated. For many people, however, the good outweighs the bad, so if online nursing school is in your future, here are some tips for success.

1. Stay Ahead of Schedule

Julie Widzinski, a mom of three active boys and a current Family Nurse Practitioner student, advises anyone taking classes online to stay ahead of their classwork. She points out that most online class formats allow you to see the entire course schedule ahead of time, which can help you plan school work around your life and even work in advance.

“I try to get ahead as best as I can, so if something comes up with the kids, etc., I don’t have to be stuck doing work,” Widzinski explains. “, when the deadline is Wednesday, I usually try posting on Monday.”

2. Do NOT Clean Before You Do Your Homework

I know exactly what you’re thinking — you’re home, you have some time set aside to do your homework, but you’re just going to switch the laundry real quick. Oh, and maybe get dinner started in the crockpot so it can cook while you work. Well, next thing you know you’re making a grocery list and ordering groceries because you noticed you were out of something in the pantry and an hour has gone by and you’re still not working.

Housework of any kind has a way of sucking you in (it’s the “If You Give a Mouse a Cookie” scenario, except for adults), so if you have work that’s due or you’ve committed a time slot to study, you need to just sit your butt down, ignore the housework completely, and make sure you do your homework first. The dishes will be there when you’re done, but you might lose that precious time to work or burn up all of your energy if you try to clean first.

3. Leave Your Home

That being said, if you absolutely cannot avoid getting distracted at home, you may find you work better out of your house or apartment, so head to a local coffee shop, restaurant during a slow time (like late afternoon), or the library. (I’ve even been known to do my online work in a parking lot where the WiFi will still work #noshame). Getting some fresh scenery can also help you stay energized in a new way that staying home can’t.

4. Utilize Time-Blocking

If you’re not familiar with time-blocking, it’s a time-management strategy designed to help you be more productive with your time. Essentially, instead of switching from one task to another, you “block” off time for each specific task so your brain can be completely focused on one thing at a time. So, instead of studying, then looking something up, then trying to answer your online discussion board, you block off a certain amount of time for each task: 30 minutes to study, 30 minutes to research, and 10 to answer your discussion questions, for instance.

You can even use a time-blocking app, such as Toggl, to help you stay on task if you’re using the computer to work; the app will block other distractions, such as texts or calls, or even web browsing if you need that limited so you can stay completely focused.

5. Don’t Work with Any Other Screens On

Sure, it may be tempting to plop down on the couch with a little bit of your favorite show on in the background as you work, but trust me, you will be much more effective and efficient if you study or complete your assignments with no other distractions.

Research shows that you might be just fine — or even more on-task with some background noise, like chatter from your family or the background of a coffee house — but when it comes to other screens or visual distractions, our brains just can’t handle both tasks at once. Just say no to screens while studying.

6. Invest in Noise-Cancelling Headphones

In an ideal world, sure, you may only complete your work or studying in a tranquil environment with a fresh cup of coffee and the birds chirping in the background. But in the real world, especially if you have a family, you’ll be cramming for a test while your kids wrestle in the living room or your partner wanders in and out of the bedroom looking for that one item right in front of their face that they just “can’t find.”

So, for the days that you can’t get away from them or just can’t answer another question about what’s for dinner, put on your noise-canceling headphones and (literally) block them all out. You can pick up a pair for around $60 on Amazon and you should 100% ask your accountant if you can write those off as a job-related expense.

7. Get an Accountability Partner

If staying on task and motivated is a challenge for you, try linking up with an accountability partner from your class. Ask one of your classmates if you can be accountability partners and set a system of checking in with each other; you’ll be less likely to blow off studying if you know your partner is expecting a text from you. Even better, find an IRL partner so you have to stay committed.

If you don’t know anyone in “real life” from your nursing class or don’t feel comfortable asking them, find an accountability partner online — there are many different online nursing student support groups.

Alternatively, you could find an accountability partner who is working toward a different goal. For instance, you check in when it’s time to study and they have to check in when it’s time for them to hit the gym. That way, you both win!

8. Ask for Help

Don’t fall into the trap of thinking that just because you’re taking an online class that you’re on your own—your professor is still available to help you if you’re struggling. In fact, his or her “office hours” might be even more accessible than an in-person professor, so don’t be afraid to schedule time to chat, video conference, or speak on the phone if there are concepts you need additional assistance with.

9. Keep a Back-up Copy of Your Work

When I was attending a graduate school program, I can’t tell you how many times I typed a long, thought-out discussion into the online class board only to have the thing completely disappear in some kind of glitch. With a newborn and a toddler at home at the time, I had precious little time to work, so I quickly learned to type out my answers in a Word or Google doc first, save it, then transfer the work to the online submission forms—that way, there was no risk of losing it.

10. Know Thyself

It sounds simple, but it’s a strategy that can serve you well when taking classes online because ultimately, you’re in charge of your own success. If you know that you have more energy in the morning, schedule your most intense work during that time. Conversely, if you’re a night owl, make that your most productive time. Save less intense work, such as outlining or writing out your schedule, for your energy “downtimes.”

If you have a family, don’t let yourself feel guilty for using your high-energy times to work, even if it’s when the kids are clamoring for you, or your partner wants to spend time with you. School is a short time in your life and it’s important to understand what works best for you—and stick to that schedule so ultimately you can all benefit. 

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Question Of The Day: Foundations of Psychiatric Nursing

Q. The nursing staff has finished restraining a client. In addition to determining whether anyone was injured, the staff is mandated to evaluate the incident to obtain which of the following ultimate outcomes?

A. Coordinate documentation of the incident.
B. Resolve negative feelings and attitudes.
C. Improve the use of restraint procedures.
D. Calm down before returning to the other clients.

Correct Answer: C

Explanation: Although coordinating documentation, resolving negative feelings, and calming down are goals of debriefing after a restraint, the ultimate outcome is to improve restraint procedures.

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Question Of The Day: Preschooler

Q. A 4-year-old boy presents to the emergency department. His father tearfully reports that he was in the driveway and had his son on his shoulders when the child began to fall. The father grabbed him by the leg, swinging him toward the grass to avoid landing on the pavement. As the father swung his son, the child hit his head on the driveway and twisted his right leg. After a complete examination, it is determined that the child has a skull fracture and a spiral fracture of the femur. Which of the following actions should the nurse take?

A. Restrict the father's visitation.
B. Notify the police immediately.
C. Refer the father for parenting classes.
D. Record the father's story in the chart.

Correct Answer: D

Explanation: The father's story is consistent with the injuries incurred by the child; therefore, the nurse should document the cause of injury. There is no need to restrict the father's visitation, because the injuries sustained by the child are consistent with the explanation given. The police need to be notified only if there is suspicion of child abuse. The injuries incurred by this child appear accidental. There is no need to refer the father for parenting classes. The father seems upset about the accident and will not likely repeat such reckless behavior. The nurse should educate the father, however, regarding child safety.

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Question Of The Day: Toddler

Q. A nurse should expect a 3-year-old child to be able to perform which action?

A. Ride a tricycle
B. Tie his shoelaces
C. Roller-skate
D. Jump rope





Correct Answer: A

Explanation: The nurse should expect the child to ride a tricycle because, at age 3, gross motor development and refinement in eye-hand coordination enable a child to perform such an action. The fine motor skills required to tie shoelaces and the gross motor skills required for roller-skating and jumping rope develop around age 5.

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Question Of The Day: Infant

Q. During assessment of a small infant admitted with a diagnosis of meningitis, the infant becomes less responsive to stimuli and exhibits bradycardia, slight hypertension, irregular respirations, and a temperature of 103.2° F (39.6° C). The infant's fontanel is more tense than at the last assessment. What should the nurse do first?

A. Ask another nurse to verify the findings.
B. Notify the primary care provider of the findings.
C. Raise the head of the bed.
D. Administer an antipyretic.

Correct Answer: C

Explanation: Signs such as a decrease in the level of consciousness, bradycardia, hypertension, irregular respirations, and a tense fontanel strongly suggest increased intracranial pressure. The first action should be to attempt to lower the pressure by raising the head of the bed, which should improve venous return and decrease the pressure. Asking another nurse to verify the findings is unnecessary because temperature, pulse, and respirations are fairly objective data and not subject to interpretation. Additionally, asking for verification would waste valuable time. After elevating the infant's head by raising the bed, the nurse can notify the primary care provider and administer the antipyretic.

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Question Of The Day: The Nursing Process

Q. An 18-year-old high school senior wishes to obtain birth control through her parents' insurance but does not want the information disclosed. The nurse tells the client that under the Health Information Portability and Accountability Act (HIPAA) parents:

A. Have the right to review a minor's medical records until high school graduation.
B. Have the right to review a minor's medical record if they are responsible for the payment.
C. May not view the medical record, but may learn of the visit through the insurance bill.
D. May not view the minor's medical record or the insurance bill.

Correct Answer: C

Explanation: Under HIPAA, 18-year-olds have the right to medical privacy and their medical records may not be disclosed to their parents without their permission. However, the adolescent must be made aware of the fact that information is sent to third party payers for the purpose of reimbursement. Those payers send the primary insurer, in this case the parent, a statement of benefits. HIPAA protects the right to medical privacy of all 18-year-olds regardless of their educational status. Even if parents are responsible for payment, they may not view the patient's chart without the consent of the adolescent.

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

Q. The nurse administers an intradermal injection to a client. Proper technique has been used if the injection site demonstrates which of the following?

A. Minimal leaking.
B. No swelling.
C. Tissue pallor.
D. Evidence of a bleb or wheal.



Correct Answer: D

Explanation: A properly administered intradermal injection shows evidence of a bleb or wheal at the injection site. There should be no leaking of medication from the bleb; it needs to be absorbed into the tissue. Lack of swelling at the injection site means that the injection was given too deeply. The presence of tissue pallor does not indicate that the injection was given correctly.

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Question Of The Day: Basic Physical Care

Q. A physician has ordered penicillin G potassium (Pfizerpen), I.V., for a client with a severe streptococcal infection. A nurse determines that the client may be allergic to penicillin. When considering best practice, what should the nurse's priority intervention be?

A. Holding the penicillin G potassium and charting that it was held because the client is allergic
B. Administering the penicillin G potassium and staying alert for any reaction
C. Holding the penicillin G potassium and notifying the physician that the client may have an allergy to penicillin
D. Administering the penicillin G potassium but notifying the pharmacist that the client might experience an allergic reaction

Correct Answer: C

Explanation: The nurse should hold the penicillin G potassium, even if the client isn't sure he's allergic to penicillin, and notify the physician so he may order a different antibiotic. Many clients can't act as their own advocates; they rely on nurses to protect their rights. An allergy to penicillin G potassium is suspected, but not comfirmed. Administering penicillin G potassium could cause a life-threatening reaction. Administering the medication, then watching for a reaction or notifying the pharmacist that a reaction might occur, isn't best practice. If a client is allergic to penicillin, a nurse should alert the pharmacist and label the client's chart appropriately.

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Question Of The Day: Genitourinary Disorders

A. client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

A. nausea and vomiting.
B. dyspnea and cyanosis.
C. fatigue and weakness.
D. thrush and circumoral pallor.



Correct Answer: C

Explanation: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

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